title: Using the Hospital Nutrition Environment Scan to Evaluate Health Initiative in Hospital Cafeterias.
abstract: BACKGROUND
  Health-promoting environments advance health and prevent chronic disease. Hospitals have been charged to promote health and wellness to patients, communities, and 5.3 million adults employed in United States health care environments.
  
  
  METHODS
  In this cross-sectional observational study, the Hospital Nutrition Environment Scan (HNES) was used to measure the nutrition environment of hospital cafeterias and evaluate the influence of the LiVe Well Plate health initiative. Twenty-one hospitals in the Intermountain West region were surveyed between October 2013 and May 2014. Six hospitals participated in the LiVe Well Plate health initiative and were compared with 15 hospitals not participating. The LiVe Well Plate health initiative identified and promoted a healthy meal defined as <600 kcal, <700 mg sodium, and <30% fat. Signage with nutrition information and health initiative branding were also posted at point of purchase. Hospital cafeterias were scored on four subcategories: facilitators and barriers, grab-and-go items, menu offerings, and selection options at point of purchase.
  
  
  RESULTS
  Overall, hospitals scored 35.3±13.7 (range=7 to 63) points of 86 total possible points. Cafeterias in health initiative hospitals had significantly higher mean nutrition composite scores compared with non-health initiative hospitals (49.2 vs 29.7; P<0.001).
  
  
  CONCLUSIONS
  Promoting healthy entrées with nutrition information and branding has a positive influence on the nutrition environment of hospital cafeterias. Additional research is needed to quantify and strategize ways to improve nutrition environments within hospital cafeterias and assess the influence on healthy lifestyle behaviors.
authors.forename: Jennifer Willahan
authors.initials: JW
authors.lastname: Derrick
authors.forename: Sarah Gunnell
authors.initials: SG
authors.lastname: Bellini
authors.forename: Julie
authors.initials: J
authors.lastname: Spelman
mesh_terms: D003430:Cross-Sectional Studies; D004777:Environment; D005521:Food Service, Hospital; D015438:Health Behavior; D006293:Health Promotion; D008019:Life Style; D062407:Meals; D018673:Nutrition Policy; D009752:Nutritional Status; D012982:Sodium, Dietary / Q000008:administration & dosage / Q000032:analysis; D014481:United States
chemical_list: D012982:Sodium, Dietary
keywords: Consumer nutrition environment; Food environment; Health promotion; Hospitals; Nutrition