Nutrition environment measures survey in stores (NEMS-S) - Development and evaluation

Background: Eating, or nutrition, environments are believed to contribute to obesity and chronic diseases. There is a need for valid, reliable measures of nutrition environments. This article reports on the development and evaluation of measures of nutrition environments in retail food stores. Methods: The Nutrition Environment Measures Study developed observational measures of the nutrition environment within retail food stores (NEMS-S) to assess availability of healthy options, price, and quality. After pretesting, measures were completed by independent raters to evaluate inter-rater reliability and across two occasions to assess test-retest reliability in grocery and convenience stores in four neighborhoods differing on income and community design in the Atlanta metropolitan area. Data were collected and analyzed in 2004 and 2005. Results: Ten food categories (e.g., fruits) or indicator food items (e.g., ground beef) were evaluated in 85 stores. Inter-rater reliability and test-retest reliability of availability were high: inter-rater reliability kappas were 0.84 to 1.00, and test-retest reliabilities were .73 to 1.00. Inter-rater reliability for quality across fresh produce was moderate (kappas, 0.44 to 1.00). Healthier options were higher priced for hot dogs, lean ground beef, and baked chips. More healthful options were available in grocery than convenience stores and in stores in higher income neighborhoods. Conclusions: The NEMS-S tool was found to have a high degree of inter-rater and test-retest reliability, and to reveal significant differences across store types and neighborhoods of high and low socioeconomic status. These observational measures of nutrition environments can be applied in multilevel studies of community nutrition, and can inform new approaches to conducting and evaluating nutrition interventions.