Comparative Performance of NEMS-S Surveys in Latino Food Stores in the Greater Boston Area

Introduction

Food patterns and consumption practices are intrinsic components of population groups across the world. Those dietary practices are influenced by the physical environment, particularly those products identified as edibles, but also by the cultural practices that define people. Extensive research indicates that food patterns play substantial roles in the causation and prevention of chronic, non-communicable diseases (1) and that the food environment, including access to food outlets and the presence of healthy choices, is associated with eating behaviors (2, 3). It has been shown that shopping preferences are linked to obesity and that the lack of healthy food options in grocery stores leads to weight-gain (4). Successful policies should also be part of a larger plan to change social norms (5). In response to this challenge, the Nutrition Environment Measures Survey for Stores (NEMS-S) was developed in the first decade of the millennium as a well-defined measurement tool to examine the availability of healthy food options in grocery and convenience stores in the United States (6). We refer to this original instrument as US-NEMS-S

Cultural factors play a significant role in determining shopping preferences, as food-related behavior is modified by culture (7, 8). Ethnic identity is positively correlated with consumption of culturally-significant foods and negatively correlated with the consumption of ‘convenience’ or prepackaged foods (9). Stores targeted to specific ethnic groups, including Latinos, serve as important sites for the preservation of their homeland culture (10), including their food preferences.

Despite the significance of culture in shaping food preferences, current research lacks a culturally-specific analysis of what drives food preferences, specifically for the growing Latino population, particularly recent arrivals of Central Americans (Guatemalans, Hondurans and Salvadorians) in the northeast region of the United States . The present study aimed to contribute with information to help to fill this gap in knowledge by assessing the applicability of the NEMS-S survey modified for use in Guatemala (11) as compared to the original US-NEMS-S, which wa, both in its original version designed for the US population, and as modified for use in Guatemala (11). The site identified for this study was Somerville, a small city located north of Boston, state of Massachusetts.

The Guatemala NEMS-S (GUA-NEMS-S) survey contained items more familiar in a Latino diet, including selected fruits and vegetables, canned beans and boxed fluid milk. Researchers believed that the conduct of the GUA-NEMS-S would result in a more thorough analysis of the availability of healthy and unhealthy foods in stores in Latino communities in the US because the items on the survey would match those being sold in these culturally specific stores.

The primary objective of this study was to test the GUA-NEMS-S to examine the food environment in a convenient, small sample of Latino stores, located in East Somerville, in which there is a rapidly growing Latino population, primarily of Central American origin. Secondarily, researchers also utilized the NEMSS surveys to assess the availability of healthy food options in the three Latino stores. The corresponding hypotheses were: 1) The foods found in the three Latino stores will apply more closely to the GUA-NEMSS than the original survey created for US stores (US-NEMS-S); and 2) There will be a general lack of healthy food options in these small stores indicated by the results of the NEMS-S surveys.

Material and methods

1. ENUMERATION
2. UTILIZATION OF NEMS-S
3. INTER-RATER CONCORDANCE
4. ANALYSIS OF FOOD ITEM AVAILABILITY

Results

1. STORE LAYOUT
2. INTER-RATER CONCORDANCE ON THE ITEMS OF THE US-NEMS-S VERSION

• INTER-STORE COMPARISON OF COMMON ITEMS BETWEEN SURVEYS

As there was 100% inter-rater concordance between raters for the 29 common items, there was a redundant certainty of the status of these items across store sites. This allowed the analysis of all of the items (none were in dispute) for inter- store analysis. Table 2 (non-produce items) and Table 3 (produce items) present the pooled results found in each store regarding the availability of items included in both, the US-NEMSS and the GUA-NEMS-S.

1. INTER-STORE COMPARISON OF HEALTHY OPTIONS OF THE US-NEMS-S ACROSS THE COMBINED SURVEYS
2. RELATIVE AVAILABILITY OF THE ADDITIONAL GUATEMALAN ITEMS AMONG THE THREE FOOD STORES

Discussion

1. INTER-RATER CONCORDANCE
2. HEALTHY FOOD AVAILABILITY ACROSS STORES
3. PERFORMANCE OF THE GUATEMALAN ADAPTATION OF THE NEMS-S
4. COMPARISON WITH NEMS-S APPLICATIONS OUTSIDE OF THE DOMINANT U.S. CULTURE
5. STRENGTHS AND LIMITATIONS OF THE STUDY

Conclusions

The results of this study highlight the importance of attending to the cultural characteristics of the diverse population groups that are more inclined to do their food shopping in small, ethnic stores such as those frequented by Latinos.

In the middle of the current epidemic of obesity and non-communicable diseases associated with eating patterns, it is needed to encourage and support owners of Latino stores to offer more ethnic specific healthy options of the traditional Latino food products.

Additionally, in the future, a second generation of culturally-sensitive NESM-S, that substitutes foods of a more tropical and Central American origin in the listing, rather than simply adding them on, will need to be developed and tested in a similar context and paradigm as the one that gave the cultural framework to this study.

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