Food and Beverage Options at Highway Rest Areas in North Carolina: A Mixed-Methods Audit and Geospatial Approach

Abstract

IntroductionEach year, millions of people purchase food at highway rest areas. Rest areas are potential sites for health promotion because they are operated by the public sector; they are frequently visited by professional truck drivers, who have a disproportionate burden of chronic disease; and they are easily accessible. To our knowledge, no research has systematically examined the healthfulness of food offerings at rest areas. The objective of this study was to determine the accessibility and healthfulness of food and beverages offered at highway rest areas in North Carolina using a mixed-methods audit and geospatial approach.MethodsWe conducted a cross-sectional audit of all rest areas offering foods and beverages in North Carolina (N = 30) in summer 2018. We used the Nutrition Environment Measures Survey–Vending (NEMS–V) to record the 1) type, price, and size of all foods and beverages and 2) healthfulness of items offered (based on NEMS–V categorization). Two researchers independently double coded NEMS–V data. We used geospatial analysis to examine proximity of rest areas to food stores. We analyzed data by using univariate and bivariate analysis.ResultsThe mean number of vending machines per site was 8.0 (range, 2–12, standard deviation, 2.8). The healthfulness of offerings varied across sites. Most food items (88.1%; 2,922 of 3,315) and beverage items (63.7%; 1,567 of 2,459) were classified as least healthful. Cold beverage machines had a greater percentage of healthful items (38.2%; 778 of 2,036) than snack machines (11.4%; 374 of 3,270) (P < .001), mainly because of water and diet soda in beverage machines.ConclusionPolicy changes are needed to increase the number and presentation of healthful food options at highway rest areas. Policy changes could provide travelers with more healthful options conveniently located along their travel route.

A systematic review of trucking food, physical activity, and tobacco environments and tractor-trailer drivers’ related patterns and practices in the United States and Canada, 1993–2021

“…Thirty-eight original research articles published between the years 1993 and 2021 were identified ( Apostolopoulos et al, 2013 , Crizzle et al, 2020 , Apostolopoulos et al, 2012 , Angeles et al, 2014 , Apostolopoulos et al, 2016 , Apostolopoulos et al, 2011 , Bachmann et al, 2018 , Birdsey et al, 2015 , Van Hemel and Rogers, 1998 , Heaton and Griffin, 2015 , Hege et al, 2019 , Holmes and Power, 1996 , Korelitz et al, 1993 , Layne et al, 2009 , Lemke et al, 2016 , Lincoln et al, 2018 , McDonough et al, 2014 , McGuirt et al, 2019 , Mullins et al, 2013 , Olson et al, 2009 , Olson et al, 2016 , Olson et al, 2016 , Passey et al, 2014 , Ronna et al, 2016 , Sieber et al, 2014 , Staško and Neale, 2007 , Thiese et al, 2015 , Turner and Reed, 2011 , Versteeg et al, 2018 , Wenger, 2008 , Whitfield Jacobson et al, 2007 , Gay Anderson and Riley, 2008 , Crizzle et al, 2020 , Johnson et al, 2021 , Shattell et al, 2012 , Shattell et al, 2012 , Solomon et al, 2004 , Williams et al, 2017 ). The 2009 PRISMA diagram is shown in Fig.…”

“…Most sources were classified as quantitative descriptive research, including baseline data included from intervention research (n = 27; 71%) ( Apostolopoulos et al, 2013 , Apostolopoulos et al, 2012 , Lincoln et al, 2018 , Ronna et al, 2016 , Sieber et al, 2014 , Thiese et al, 2015 , Turner and Reed, 2011 , Whitfield Jacobson et al, 2007 , Crizzle et al, 2020 , Shattell et al, 2012 , Solomon et al, 2004 , Angeles et al, 2014 , Apostolopoulos et al, 2016 , Apostolopoulos et al, 2011 , Bachmann et al, 2018 , Birdsey et al, 2015 , Van Hemel and Rogers, 1998 , Heaton and Griffin, 2015 , Hege et al, 2019 , Holmes and Power, 1996 , Korelitz et al, 1993 , Layne et al, 2009 , McGuirt et al, 2019 , Mullins et al, 2013 , Olson et al, 2009 , Olson et al, 2016 , Olson et al, 2016 ). Data from at least 16,600 truckers and 282 unique trucking settings in the U.S. (n = 32 studies; 84%) ( Apostolopoulos et al, 2013 , Apostolopoulos et al, 2012 , Apostolopoulos et al, 2016 , Apostolopoulos et al, 2011 , Bachmann et al, 2018 , Birdsey et al, 2015 , Van Hemel and Rogers, 1998 , Heaton and Griffin, 2015 , Hege et al, 2019 , Holmes and Power, 1996 , Korelitz et al, 1993 , Layne et al, 2009 , Lemke et al, 2016 , Lincoln et al, 2018 , McGuirt et al, 2019 , Mullins et al, 2013 , Olson et al, 2009 , Olson et al, 2016 , Olson et al, 2016 , Passey et al, 2014 , Ronna et al, 2016 , Sieber et al, 2014 , Staško and Neale, 2007 , Thiese et al, 2015 , Turner and Reed, 2011 , …”

“…Truckers were away from home overnight each week, and able to read, write, and speak English 2,945 long-haul truck drivers Layne, 2009 To determine if health conditions and health care access differ between male and female long-haul truck drivers London, Beaverdam, and Jeffersonville, Ohio, USA Researchers visited truck sites 5 or more times to recruit 25 males and 25 females. Flyers were used to engage truckers to participate and direct eligible participants to the nearby recreational vehicle and were posted on the fuel islands All truckers were licensed long-haul truck drivers, away from home overnight each week, and were able to read, write, and speak English 50 long-haul truck drivers Lemke, 2016 To investigate truckers' difficulties of engaging in favorable health behaviors Texas, USA Participants were identified via contact with a key informant who served as a gatekeeper, social media websites (Facebook), and snowball sampling Currently employed long-haul truck drivers 12 long-haul truck drivers Lincoln, 2018 To collect data on the built environment of trucking settings and the contribution to the emotional and physical wellbeing of drivers Minnesota, Ohio, Louisiana, Arkansas, and California, USA A national list of truck stops located near high-volume traffic highways was used to select stops that had a restaurant, at least 5 paved parking spaces, proximity to facilities, and the ability to combine multiple truck stop visits into single travel events Truck stops and nearby venues 16 truck stops, including 2 full-service restaurants, 3 fast-food restaurants, and 2 grocery stores McDonough, 2014 To design and administer a health and wellness survey that describes lifestyle issues affecting health and disease risk factors among truck drivers and perceived by their managers in the truck driving occupation Hamilton, Ontario, Canada The transport company occupational health and safety representatives invited focus group participants Company drivers 16 truck drivers McGuirt, 2019 To determine the availability, accessibility, and healthfulness of foods and beverages along highway rest areas North Carolina, USA Researchers used the North Carolina Department of Transportation website to identify all rest areas in North Carolina and selected locations offering food or beverages for sale Only toll-free highway rest areas were examined (24 rural, 6 urban) 241 vending machines Mullins, 2013 To validate the Health Promoting Lifestyle Profile II with Hispanic male truck drivers and assess differences based on occupa...…”

“…Four of 38 studies (11%) examined trucking food or PA environments ( Table 2 ) ( Apostolopoulos et al, 2012 , Apostolopoulos et al, 2011 , Lincoln et al, 2018 , McGuirt et al, 2019 ). No studies assessed tobacco environments.…”

“…None offered exercise facilities. McGuirt, 2019 X The Nutrition Environment Measures Survey–Vending (NEMS–V) measures type, price, and size of foods and beverages and the healthfulness of items offered in vending machines. The scoring criteria used a medal for vending machines based on healthy properties: bronze, at least 30% of food or 55% of beverage items were yellow or green; silver, at least 40% of food or 65% of beverage items were yellow or green; or gold, at least 50% of food or 75% of beverage items were yellow or green.…”