Assessing the dietary environment: examples from school-based nutrition interventions.
OBJECTIVE
The objectives of this paper are to (1) introduce the concept of upstream and downstream public health approaches and discuss diet assessment issues in that context, and (2) provide examples of diet assessment methods and challenges in assessing environmental factors influencing eating patterns.


METHODS
Dietary assessment of environmental factors is discussed as they relate to nutrition interventions for school-aged children, although the issues transcend population characteristics. Examples of assessment challenges in measuring 'dietary environments' are drawn from the Child and Adolescent Trial for Cardiovascular Health (CATCH), Teens Eating for Energy and Nutrition at School (TEENS) and Trying Alternative Cafeteria Options in Schools (TACOS) studies.


CONCLUSIONS
The healthfulness of our 'dietary environments' (which may include food availability, social norms around food choice and the effect of pricing, policy and promotion on food choice) may be more important in determining what people consume than their individual decision-making about food choice. There is a dearth of published information to inform us on how to assess these 'dietary environments'.
Lytle
Leslie A
LA
University of Minnesota, Division of Epidemiology, 1300 South 2nd Street, Suite 300, Minneapolis 55454, USA. lytle@epi.umn.edu
Fulkerson
Jayne A
JA
D000293:Adolescent; D002648:Child; D004032:Diet; D004034:Diet Surveys; D004045:Dietary Services / Q000706:statistics & numerical data*; D006801:Humans; D011634:Public Health; D012574:Schools