Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED)

Abstract

The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED tool to observe and rate food outlets in 21 census tracts and 43 food stores across the city of Madrid, Spain. We evaluated inter-rater and intra-rater reliabilities, construct validity, and the tool’s ability to discriminate between store types and between stores by area-level Socio-Economic Status (SES). Overall, the mean NEMS-S-MED score was 20.7 (SD = 9.8), which ranged from 7 to 43. Most food items displayed substantial or almost perfect inter-rater and intra-rater agreements; the percentage agreement across availability items was almost perfect and kappa statistics were also very high (median κ = 1.00 for inter-rater; κ = 0.92 for intra-rater). Furthermore, the NEMS-S-MED tool was able to discriminate between store types and census tracts of different SES. The adapted NEMS-S-MED instrument is a reliable and valid audit tool to assess the consumer food environment in Mediterranean urban contexts. Well-constructed measurement tools, such as the NEMS-S-MED, may facilitate the development of effective policy interventions to increase healthy food access and affordability.

Adaption and reliability of the Nutrition Environment Measures for stores (NEMS-S) instrument for use in urban areas of Chile

“…However, Group 3 of processed foods presented moderate concordance in mature cheese and nuts (0.42-0.43). A similar situation was observed in other instruments where product packaging, diversity of nutritional labels and healthy descriptors are illegible, making it difficult to understand these foods [15,17,36].…”

Prevalence of Overweight and Obesity in Children of Immigrant Origin in Spain: A Cross-Sectional Study

“…In the case of families of immigrant origin, culture is a key factor in the preparation and consumption of different dishes and foods, which can also be affected by the process of acculturation. The choice of food type may also be determined by the availability and affordability of food in the family's immediate food environment [33,34]. Additionally, in different studies [22][23][24][25], socioeconomic status has been associated with the development of excess weight, with a higher prevalence of obesity being found in those with lower incomes, demonstrating data similar to those of the present study.…”

“…Similarly, the present study shows that, for the same social class, overweight/obesity tends to be higher in children of immigrant origin. This could also be linked to the problem of the access and availability of healthy foods, as they are often more expensive [33].…”

Residents’ Insights on Their Local Food Environment and Dietary Behaviors: A Cross-City Comparison Using Photovoice in Spain

“…Previous quantitative studies have also shown that access to unhealthy food is higher in low-SES areas as compared to medium-SES and high- SES areas [ 41 , 42 ]. In the city of Madrid, previous studies have also found a higher density of retailers selling unhealthy foods and sugar-sweetened beverages within most socioeconomically disadvantaged areas [ 43 , 44 ]. Moreover, other studies have linked this increased access to a higher consumption of unhealthy food [ 45 , 46 ].…”