|
||||||||||||||||
|
||||||||||||||||
The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy. 6
|
||||||||||||||||
 |
 |
Page 153 |
 |
 |
 |
|
| ||||||||||||||||||||||||||||||||
|
|
|||||||||||||||||||||||||||||||
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 153
Strategies to Reduce Sodium Intake in the United States
6
The Food Environment: Key to Formulating Strategies for Change in Sodium Intake
As often pointed out, the United States has one of the most diverse and plentiful food supplies in the world. On balance, food is relatively inexpensive and readily available. However, the food supply is also characterized by high levels of sodium. Very little of the sodium in foods is naturally occurring; most of it is added by the food industry in the form of sodium chloride, but other sodium-containing compounds make a contribution. Further, as described in Chapter 5, the amount of salt added to foods at the table and during cooking currently contributes only minor amounts to the overall diet of Americans.
An important consideration for this report is not only that the food supply contains high levels of sodium, but also that increasing amounts of the food consumed by Americans are formulated by entities outside the home (see Chapter 5). These range from single items typically regarded as processed foods, such as canned soups and baked goods, to entire meals and sometimes entire diets. This is mirrored in the steady growth of the processed food industry, the high consumer demand for convenience and ready-to-serve products, and changes in the types of stores selling foods (Martinez, 2007).
The food environment framework reflects an interaction of multiple components: manufacturers, retailers, restaurant/foodservice operations, consumers, regulation/policy, and communication/advertising (Glanz et al., 2005). This chapter outlines the nature of the first four components. It begins with an overview of U.S. food manufacturing and retailing industries, then continues with an overview of restaurant/foodservice operations. Large-scale government programs that provide foods to individuals and
OCR for page 154
Strategies to Reduce Sodium Intake in the United States
households are also discussed. The chapter concludes with a discussion of consumer interactions with the food environment, looking specifically at how the food environment influences consumer choice and at current understanding of consumer behavior change models.
MANUFACTURING AND RETAILING OF PROCESSED FOODS WITHIN THE FOOD ENVIRONMENT
Since the late 1800s, the U.S. food environment has experienced tremendous growth and changes in the food manufacturing and retailing sectors, which continue to evolve (Beckley et al., 2007). Today, the majority of food undergoes some type of processing before reaching consumers. Some processing is so extensive that little or no preparation of the food is needed before consumption. As discussed in Chapter 5, processed foods are major contributors to sodium intake, making the food manufacturing and retailing sectors of key interest to the committee. This section provides an overview of food manufacturing and retailing in the United States, information on how food products are developed, and examples of efforts taken by the food industry to reduce sodium intake and the levels of sodium in the foods it produces.
Characteristics of the Processed Food Industry
Processed food represents one of the largest sectors of the U.S. manufacturing industry, accounting for 10 percent of manufacturing shipments and valued at $538 billion in 2006. The U.S. Department of Commerce defines food manufacturing as an industry that “transforms livestock and agricultural products into products for intermediate or final consumption.”1 Although the definition of processing may include minimal manipulation, such as cutting meat or slicing fresh produce, the term “processed foods” is most closely associated with more complex products, such as baked goods, canned soups, and frozen meals. Restaurant foods and food served by commercial foodservice operations are considered in the following sections.
Table 6-1 shows the wholesale value of shipments for various food categories. To produce these goods, the food manufacturing industry employed 1,476,300 people as of September 2009.2 There are approximately 31,000 food and beverage processing plants in the United States; however, most of the output of the processed food industry is derived from a relatively
1
Available online: http://www.trade.gov/td/ocg/report08_processedfoods.pdf (accessed July 20, 2009).
2
Available online: http://www.bls.gov/iag/tgs/iag311.htm#workforce (accessed October 12, 2009).
OCR for page 155
Strategies to Reduce Sodium Intake in the United States
TABLE 6-1 Value of Shipments by the U.S. Food Manufacturing Industry in 2006
Type of Shipment
Value (billions of U.S. dollars)
Meat
145
Dairy
69
Other food
71
Grain and oilseed milling
52
Fruit, vegetable, and specialty food
54
Bakeries and tortilla
49
Sugar and confectionery
28
Seafood
10
SOURCE: U.S. Department of Commerce Processed Food Outlook, 2008. Available online: http://www.trade.gov/td/ocg/report08_processedfoods.pdf (accessed July 20, 2009).
small number of large manufacturing plants. Large plants (100 or more employees) comprised only 12 percent of all processing plants in 2005, yet produced 77 percent of products by value. Small plants (1–19 employees) comprised 69 percent of all plants in 2005, while producing only 4 percent of products by value.3 Further, the size of the domestic manufacturing system does not provide a complete picture because substantial amounts of the food sold for consumption in the United States are processed overseas. In 2007, more than $60 billion in consumer-ready processed foods were imported, an increase from approximately $30 billion in 1998. Canada, the European Union, Mexico, and China were the top four exporters of these products (Brooks et al., 2009). In addition, many ingredients for foods processed in the United States are imported.4
Table 6-2 lists the top 20 food processors in the United States and Canada on the basis of food sales in 2008. The top food manufacturers in the United States are multinationals that create and sell a variety of products under numerous national brand names. National brands are typically those that are well known and advertised, and most have strong customer loyalty.5 In addition to large multinationals, thousands of small- and medium-sized companies make products that are sold nationally or regionally. For example, it is estimated that the average supermarket stocks products from more than 16,000 food processing companies (Harris et al., 2002), many of which produce far fewer products than large multinationals. Both large
3
Available online: http://ers.usda.gov/Briefing/FoodMarketingSystem/processing.htm (accessed August 1, 2009).
4
Available online: http://www.foodprocessing.com/articles/2008/037.html (accessed November 11, 2009).
5
Available online: http://www.fmi.org/glossary/index.cfm (accessed October 12, 2009).
OCR for page 156
Strategies to Reduce Sodium Intake in the United States
TABLE 6-2 Top Food Processors in the United States and Canada
Company Name
2008 Food Sales (millions of U.S. dollars)
Nestlé
26,477
Tyson Foods Inc.
26,325
PepsiCo Inc.
25,346
Kraft Foods Inc.
23,956
Anheuser-Busch InBev
15,571
Dean Foods Co.
12,455
General Mills Inc.
12,100
Smithfield Foods Inc.
10,726
Kellogg Co.
8,457
Coca-Cola Co.
8,205
ConAgra Foods Inc.
8,031
Pilgrim’s Pride Corp.
8,025
JBS USA
8,000
Dole Food Co. Inc.
7,620
Mars Inc.
7,000
Sara Lee Corp.
6,828
Hormel Foods Corp.
6,755
Unilever North America
6,647
Saputo Inc.
5,793
Dr Pepper Snapple Group
5,710
SOURCE: Food Processing, 2009.
and small manufacturers produce private label products for retailers and products for the restaurant/foodservice sector in addition to well-known brand name products.
Private label products are those sold under retailer brands.6 On average, private label goods account for 16 percent of supermarket sales (Leader and Cuthill, 2008), but the dominance of such products varies greatly by food category. Although still less prevalent than brand name products, private label products are an important component of the processed food supply, especially given their current rate of growth, which is higher than that of national brand name products (Martinez, 2007).
Overall, the U.S. food manufacturing sector can be characterized as having a multitude of players of varied sizes. The sector ranges from large multinationals selling brand name and private label products in a range of food categories to small processing plants with only a few employees to produce a single regional brand or product. As discussed later, this land-
6
Available online: http://www.plmainternational.com/en/private_label_en3.htm (accessed July 31, 2009).
OCR for page 157
Strategies to Reduce Sodium Intake in the United States
scape creates both challenges and opportunities for reducing the sodium content of the U.S. food supply.
Characteristics of the Food Retailing Industry
Food retailers are increasingly important in the food environment, not only because of their longstanding role as key distributors for and promoters of processed foods, but also because their increasing concentration and data-gathering technologies have given them the ability to influence the types of products developed by manufacturers. Over the past decade, the food retail sector has seen dramatic changes driven by the growth of non-traditional food retailers such as big box supercenters (Martinez, 2007) and changes in technology that have revolutionized sales tracking (Leader and Cuthill, 2008). Supercenters (e.g., Wal-Mart, Super Target) and warehouse clubs (e.g., Costco, BJ’s) increased their shares of food-at-home expenditures from 4 percent in 1994 to 17 percent in 2005 at the expense of traditional food retailers (Martinez, 2007). Wal-Mart alone increased its number of supercenters from 672 U.S. stores in 1995 to 2,349 in 2005 (Martinez, 2007). Table 6-3 shows the share of food-at-home expenditures in 2005 by outlet type, and a list of the top 10 food retailers in the United States and Canada and their 2008 sales is provided in Table 6-4.7
Supermarkets commonly carry 30,000 to 40,000 stock keeping units (or distinguishable products) (Leader and Cuthill, 2008) but space remains limited, even in the largest of retailers. Convenience stores, drugstores, and dollar stores are also important parts of the food retailing industry. These retailers have more limited offerings than supermarkets, but have expanded their food offerings in recent years (Martinez, 2007).
Because of their purchasing power, large retailers gained the ability to influence the types of products produced by food manufacturers by determining which products will reach the limited space on retail shelves (Martinez, 2007). The introduction of checkout scanners and automated inventory control has given retailers powerful tools for determining which items sell best and, in turn, helped retailers determine which products they are willing to sell. With thousands of food products introduced to the market each year, products must compete for limited space on retail shelves, and manufacturers must develop products that will generate high profits for retailers in order to stay in the marketplace (Leader and Cuthill, 2008). To convince retailers that a new product should be carried, manufacturers often give them detailed sales pitches, including information on expected
7
Available online: http://supermarketnews.com/profiles/top75/2009-top-75/ (accessed July 31, 2009).
OCR for page 158
Strategies to Reduce Sodium Intake in the United States
TABLE 6-3 Share of Food-at-Home Expenditures by Type of Outlet, 2005
Type of Outlet
Percentage
Traditional Grocery Retailers
Supermarkets
58.2
Convenience stores
2.9
Other grocery stores
3.6
Specialty food stores
2.7
Nontraditional Grocery Retailers
Supercenters (e.g., Wal-Mart, Super Target, Super Kmart, Meijer, Fred Meyer) and warehouse clubs (e.g., Costco, Sam’s Club, BJ’s)
17.1
Mass merchandisers (e.g., traditional Wal-Mart, Target, and Kmart stores)
1.8
Other stores (e.g., Walgreens, Dollar General)
8.7
Home-delivered and mail order
4.0
SOURCE: Martinez, 2007.
TABLE 6-4 Top 10 Retailers in the United States and Canada
Company Name
2008 Sales (billions of U.S. dollars)
Wal-Mart Stores
258.5
Kroger Co.
77.2
Costco Wholesale Corp.
72.5
Supervalu
45.0
Safeway
44.8
Loblaw Cos.
31.5
Publix Super Markets
24.0
Ahold USA
21.8
Delhaize America
19.2
C&S Wholesale Grocers
19.0
NOTE: Sales volume includes revenues from both food and non-food merchandise in North America.
SOURCE: Supermarket News, 2009. Available online: http://supermarketnews.com/profiles/top75/2009-top-75/ (accessed July 31, 2009).
sales, marketing plans, and consumer research on the product category (FTC, 2003).
Retailers also often control what products are sold and where they are placed on retail shelves by creating slotting fees. Slotting fees are one-time payments made by food processors to retailers in exchange for placement of new products on store shelves (FTC, 2003). Some manufacturers are charged as much as $40,000 per store to stock a new food item (Desiraju, 2001).
OCR for page 159
Strategies to Reduce Sodium Intake in the United States
Some retailers have also created programs to pressure manufacturers into making changes in the product characteristics of the items they sell. A recent example is Wal-Mart’s work to encourage suppliers to improve the sustainability of product packaging.8 Although not from the United States, another example is the requirement that ASDA supermarkets (which are owned by Wal-Mart) in the United Kingdom placed on their private label manufacturers to meet certain standards for fat, saturated fat, sugar, and salt in their products and to remove artificial colors and flavors (Hattersley, 2009).
Because a relatively small number of retailers are responsible for a large volume of processed foods sales, they can be the gatekeeper to new product success. If manufacturers are unable to convince major retailers that a new or reformulated product will appeal to consumers or if the company cannot safely take the risk of paying high slotting fees, its product has little chance of succeeding in the marketplace. These factors have become a major consideration in the development and reformulation of processed foods.
Product Development Process
In 2005, 18,722 new food and beverage products were introduced by food manufacturers (Martinez, 2007). The breakdown of these products by type is provided in Table 6-5.
To create new products, the largest processed food manufacturers have
TABLE 6-5 New Product Introductions in 2005
Type of Product
Percentage of Total
Candy, gum, snacks
27.7
Beverages
25.1
Condiments
10.2
Dairy
7.2
Baking ingredients
6.0
Processed meat
5.0
Meals and entrées
4.7
Bakery foods
4.1
Fruit and vegetables
3.4
Pasta and rice
2.2
Soups
1.6
Cereals
1.4
Desserts
0.8
SOURCE: Martinez, 2007.
8
Available online: http://walmartstores.com/Sustainability/9125.aspx (accessed October 12, 2009).
OCR for page 160
Strategies to Reduce Sodium Intake in the United States
FIGURE 6-1 Business groups involved with product development.
SOURCE: Adapted from Beck, 2002. In Organizing human resources: By project? By discipline? As a matrix? Copyright © 2002 Iowa State Press. Reproduced with permission of John Wiley & Sons, Inc.
large groups of employees with a range of skills. As shown in Figure 6-1, these groups include employees with operations, customer, technical, and administrative expertise, including market researchers, food scientists, nutritionists, engineers, chemists, and microbiologists. Research and development teams within these companies are involved in both developing new products and reformulating existing products. Multinational manufacturers may conduct some of their research and development activities at international research centers (Nestle, 2007).
In smaller companies, research and development staff may be limited (Beck, 2002). For these manufacturers, a single scientist may be responsible for multiple functions.
All sizes of food manufacturers are relying more on ingredient suppliers, external contract developers, and consultants to be part of the product development process (Beckley et al., 2007; Thomas, 2007). These groups are useful in providing expertise that may otherwise be lacking in the company or conducting research at a lower cost than the company could do in-house (Beckley et al., 2007; Fuller, 2005). Consultants may be from private companies or from universities that see consulting as a useful way to apply their research and to generate revenues (Fuller, 2005). State Coop-
OCR for page 161
Strategies to Reduce Sodium Intake in the United States
erative Extension Services also provide expertise, particularly to small food processors and entrepreneurs.9
The reasons companies undergo the costly and time-consuming process of new product development include the following (Fuller, 2005):10
New or reformulated products are needed for manufacturers to maintain and expand their business as products end their life cycle and suffer from reduced sales;
New market demands arise (e.g., more demand for healthful products);
New technologies may make possible the creation of new products that were not feasible in the past;
Changes in government regulations and policies may make it necessary to reformulate existing products or create incentives for new product development and reformulation (e.g., to meet requirements for health or content claims); and
New or reformulated products are needed to respond to new or improved competitive products.
Steps to Develop New Products and Reformulate Existing Products
The product development process generally involves a series of steps that are depicted in Figure 6-2, although the ordering of initial steps may vary from project to project.
Valdovinos (2009) more simply categorized this process into four steps: (1) idea generation; (2) concept development; (3) plan and design; and (4) launch and produce. A more detailed description of these steps is provided below.
Idea generation Ideas for new products come from a variety of internal and external sources. Examples of these sources are provided in Box 6-1. Large companies have marketing teams devoted to searching consumer data and gathering information on the existing food market. This work is intended to produce insights into how to fill consumer needs and, in the process, generate successful products (Straus, 2009). Marketing, business, and research and development personnel work to brainstorm ideas and determine which ideas are promising (Straus, 2009; Thomas, 2007; Topp, 2007).
Several considerations are needed in screening ideas. Questions asked
9
Available online: http://www.uga.edu/nchfp/business/starting_business.html#ceslinks and http://www.ces.ncsu.edu/index.php?page=foodsafetyprocessing (accessed October 15, 2009).
10
Personal communication, J. Ruff, Kraft Foods (retired), October 2009.
OCR for page 162
Strategies to Reduce Sodium Intake in the United States
FIGURE 6-2 Phases of new product development.
SOURCE: Fuller, 2005. Reproduced with permission of Taylor and Francis Group LLC from “New food product development: From concept to marketplace,” 2nd edition; permission conveyed through Copyright Clearance Center, Inc.
OCR for page 163
Strategies to Reduce Sodium Intake in the United States
BOX 6-1
Sources of Product Ideas
Internal Sources
Business and marketing teams
Research and development teams
Sales personnel
Packaging teams
Regulatory affairs departments
External Sources
Competitors
Suppliers
Consumers
Retailers
SOURCES: Straus, 2009; Topp, 2007.
include the following (Heyhoe, 2002; Moskowitz et al., 2009; Straus, 2009):
How closely does the new product idea fit with the corporation’s strength in the market (i.e., does the company have closely related products that are successful)?
How technically feasible is the project?
How well can the product idea be protected from competition (i.e., can patents or commercial secrets ensure that competitors will be unable to easily copy the product)?
What capital expenditures will be needed?
What is the expected life of the product (1 year, 3–5 years, etc.)?
What is the spinoff potential of the product for line extensions and related products?
How well do consumers rate the product compared to products with known success?
Another consideration that has emerged with greater importance in recent years is determining what will influence a retailer to stock the product. Retailers are the first customers and their acceptance is needed (Topp, 2007) because their willingness to stock a new product will be a major factor in its success (van Boekel, 2009).
With the above questions in mind, business teams can estimate the costs of production and the potential profit the product might generate and then
OCR for page 202
Strategies to Reduce Sodium Intake in the United States
rather than expert opinion or judgment. The available literature suggests that risk in the context of consumer products is difficult to communicate and comprehend, for both consumers and experts. There are many ways to conceptualize risk, and while many are considered appropriate and defensible, it is established that they can lead to very different behavioral outcomes (Stewart and Martin, 1994).
Available research in this area has tended to focus on surveys designed to measure attention to a warning, perceived credibility of the messages, or awareness of warning information (Kimmerling, 1985; Lehto and Miller, 1986). Such measures, although useful, are incomplete because exposure and attention do not ensure that the warnings are perceived as credible, nor do they provide insight about whether and under what circumstances consumers will alter their attitudes, decision making, or behavior in response to warnings (Stewart and Martin, 1994).
Putting It All Together: Embedding Health Behavior for Sodium Intake Reduction Within the Broader Food Environment
In the case of sodium, removal of the environmental constraints to health behavior change is a critical first step. As stated above, with their growing reliance on processed and prepared foods, consumers have diminishing control over the amount of salt they consume.
The need for a population-wide reduction strategy rests on the massive scope of the high blood pressure epidemic, documented in prior chapters, and the limited success of individual-based sodium reduction interventions. Such interventions have been notoriously difficult to implement, especially in the setting of the current food supply, which is replete with “hidden” salt. In clinical trials, intensive interventions that focused only on salt reduction were able to shift mean intake to approximately 100 mmol/d (2,300 mg/d) (see left panel of Figure 6-5). When efforts to reduce sodium intake were combined with weight loss or part of a comprehensive lifestyle intervention program, sodium reduction was more modest (see right panel of Figure 6-5), likely because of the complexity of making multiple lifestyle changes and potential trade-offs when there are multiple goals (Appel, 2008).
Thus, it is unlikely that the average consumer will be able to successfully reduce sodium intake without changes to other components of the food environment. Changes at the policy level diminish the need for individual action to reduce sodium in the diet, which is of particular importance because, as documented in Chapter 2, the benefits of sodium reduction can accrue regardless of age or risk level. This approach to reducing risk at the source of exposure has been a long-standing cornerstone of public health practice (Winslow, 1984). In the case of sodium reduction, changes in the food supply could be aimed at reducing risk at the source of possible expo-
OCR for page 203
Strategies to Reduce Sodium Intake in the United States
FIGURE 6-5 Mean pre- and post-levels of urinary sodium excretion in three trials (Trials of Hypertension Prevention Phase 1 and 2 [TOHP1 and TOHP2] and Trials of Nonpharmacologic Interventions in the Elderly [TONE]) that tested interventions focused only on salt reduction (left panel) and two trials (TOHP2 and PREMIER) that combined sodium reduction with other lifestyle interventions (right panel).
NOTE: d = day; mmol = millimole.
SOURCE: Appel, 2008. Copyright © 2008 Journal of Clinical Hypertension. Reproduced with permission from John Wiley & Sons, Inc.
sure. Policy changes to increase the content of nutrients such as folic acid and niacin have been highly effective in improving the nutritional status of the U.S. population with respect to these nutrients (Park et al., 2000; Pfeiffer et al., 2007). Monitoring and surveillance activities were critical to documenting folate’s effectiveness and potential safety concerns (Lucock and Yates, 2009). However, sodium presents some unique challenges that were not encountered in these earlier policy issues, making effective monitoring and surveillance systems even more critical for implementing sodium reduction strategies. For example, sodium has taste and functional effects in foods, whereas earlier fortification policies were flavorless and had poten-
OCR for page 204
Strategies to Reduce Sodium Intake in the United States
tially less serious functional effects. Nevertheless, there is limited evidence that sodium intake reductions achieved by changes in the food supply can create meaningful changes in health status. Two decades ago, a small but significant study illustrated the potential impact on blood pressure of passive reductions of sodium in available foods. The Exeter-Andover study, conducted by Ellison and colleagues (1989), was designed to examine the extent to which reductions in the sodium content of dining hall foods would result in blood pressure reductions among students in the intervention versus control schools. Students were not instructed to change their dietary patterns or to avoid salty foods, and salt shakers were left on the tables. Sodium intake was reduced by 15–20 percent through modifications in food purchasing and preparation, and resulted in significant reductions in systolic and diastolic blood pressure over the academic year. These findings further illustrate the potential value of passive changes in the food supply, in line with changes in the macro-level environment.
Policy changes have been highly effective in influencing the intake of other nutrients. For example, food fortification was likely an important tool in eliminating pellagra in the United States (Park et al., 2000). These findings further illustrate the potential value of passive changes in the food supply, in line with changes in the macro-level environment.
By emphasizing changes in the food supply, individual consumer efforts to reduce salt intake are embedded in these broader changes. Consumers’ roles in reducing salt intake will change in response to the new environment. With a broader range of food choices, consumers’ control over the level of sodium in their diets is likely to increase. Additional changes of other factors in the behavior change process are supplemental.
REFERENCES
Ajzen, I., and M. Fishbein. 1980. Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice Hall.
Appel, L. J. 2008. At the tipping point: Accomplishing population-wide sodium reduction in the United States. Journal of Clinical Hypertension 10(1):7-11.
Balentine, D. 2009. Salt reduction: Making the healthy choice the tasty choice. Presented at the Institute of Medicine Committee on Strategies to Reduce Sodium Intake’s Public Information-Gathering Workshop, March 30, Washington, DC.
Ball, P., D. Woodward, T. Beard, A. Shoobridge, and M. Ferrier. 2002. Calcium diglutamate improves taste characteristics of lower-salt soup. European Journal of Clinical Nutrition 56(6):519-523.
Bandura, A. 1994. Social cognitive theory and exercise of control over HIV infection. In Preventing AIDS: Theories and methods of behavioral interventions, edited by R. J. DiClemente and J. L. Peterson. New York: Plenum Press.
Bassett, M. T., T. Dumanovsky, C. Huang, L. D. Silver, C. Young, C. Nonas, T. D. Matte, S. Chideya, and T. R. Frieden. 2008. Purchasing behavior and calorie information at fast-food chains in New York City, 2007. American Journal of Public Health 98(8): 1457-1459.
OCR for page 205
Strategies to Reduce Sodium Intake in the United States
Beck, C. 2002. Organizing human resources: By project? By discipline? As a matrix? In Food product development: Based on experience, edited by C. Side. Ames: Iowa State Press. Pp. 31-49.
Becker, G. S. 1965. A theory of the allocation of time. The Economic Journal 75(299): 493-517.
Beckley, J. H., M. M. Foley, E. J. Topp, J. C. Huang, and W. Prinyawiwatkul (eds). 2007. Accelerating new food product design and development. Ames, IA: Blackwell Publishing and the Institute of Food Technologists.
Berry, D. 2009. Our inevitable sodium swap out. Culinology, May 26.
Berta, D. 2006. Retreat examines realistic ways to provide healthful menu items. Nation’s Restaurant News 40(8):12.
Bisogni, C. A., M. Connors, C. M. Devine, and J. Sobal. 2002. Who we are and how we eat: A qualitative study of identities in food choice. Journal of Nutrition Education and Behavior 34(3):128-139.
Booth, S. L., J. F. Sallis, C. Ritenbaugh, J. O. Hill, L. L. Birch, L. D. Frank, K. Glanz, D. A. Himmelgreen, M. Mudd, B. M. Popkin, K. A. Rickard, S. St. Jeor, and N. P. Hays. 2001. Environmental and societal factors affect food choice and physical activity: Rationale, influences, and leverage points. Nutrition Reviews 59(3):S21-S39.
Briefel, R. R., and C. L. Johnson. 2004. Secular trends in dietary intake in the United States. Annual Review of Nutrition 24:401-431.
Brooks, N., A. Regmi, and A. Jerardo. 2009. U.S. food import patterns, 1998–2007. FAU-125. Washington, DC: Economic Research Service.
Burger, J., W. L. Stephens Jr., C. S. Boring, M. Kuklinski, J. W. Gibbons, and M. Gochfeld. 1999. Factors in exposure assessment: Ethnic and socioeconomic differences in fishing and consumption of fish caught along the Savannah River. Risk Analysis 19(3):427-438.
Capps, O., J. R. Tedford, and J. Havlice. 1985. Household demand for convenience and non-convenience foods. American Journal of Agricultural Economics 67(4):862-869.
Cauvain, S. P. 2003. Bread making: Improving quality. Boca Raton, FL: CRC Press.
Christian, T., and I. Rashad. 2009. Trends in U.S. food prices, 1950–2007. Economics and Human Biology 7(1):113-120.
Cobe, P. 2008. Getting a new product in the door. Foodservice Buyer, December 2008.
Connor, J. M., and W. A. Schiek. 1997. Food processing: An industrial powerhouse in transition. 2nd ed. New York: John Wiley & Sons.
Cox, S. A., and R. Delaney. 2009. Evolution of sensory evaluation: How product research is being integrated into the product design process. In An integrated approach to new food product development, edited by H. Moskowitz, I. S. Saguy and T. Straus. Boca Raton, FL: Taylor and Francis Group. Pp. 277-289.
CSPI (Center for Science in the Public Interest). 2005. Salt: The forgotten killer. Washington, DC: Center for Science in the Public Interest.
CSPI. 2007. School foods report card: A state-by-state evaluation of policies for foods and beverages sold through vending machines, school stores, a la carte, and other venues outside of school meals. Washington, DC: Center for Science in the Public Interest.
CSPI. 2008. Salt assault: Brand-name comparisons of processed foods. 2nd ed. Washington, DC: Center for Science in the Public Interest.
de la Huerga, V., and E. Topp. 2007. A supplier perspective: Superior services and product help change happen. In Accelerating new food product design and development, edited by J. H. Beckley, M. M. Foley, E. J. Topp, J. C. Huang, and W. Prinyawiwatkul. Ames, IA: Blackwell Publishing and the Institute of Food Technologists. Pp. 55-72.
Defense Logistics Agency. 2009. Defense Supply Center Philadelphia. http//www.dscp.dla.mil/ (accessed November 18, 2009).
OCR for page 206
Strategies to Reduce Sodium Intake in the United States
Departments of the Army, Navy, and Air Force Headquarters. 2001. Nutrition standards and education. Army Regulation 40-25, BUMEDINST 10110.6, AFI 44-141. Washington, DC: Departments of the Army, Navy, and Air Force.
Desiraju, R. 2001. New product introductions, slotting allowances, and retailer discretion. Journal of Retailing 77:335-358.
Devine, C. M. 2005. A life course perspective: Understanding food choices in time, social location, and history. Journal of Nutrition Education and Behavior 37(3):121-128.
Dornenburg, A., and K. Page. 2008. The flavor bible: The essential guide to culinary creativity, based on the wisdom of America’s most imaginative chefs. 1st ed. New York: Little, Brown and Company. P. 2.
Drewnowski, A. 1997. Taste preferences and food intake. Annual Review of Nutrition 17: 237-253.
Ellison, R. C., A. L. Capper, W. P. Stephenson, R. J. Goldberg, D. W. Hosmer Jr., K. F. Humphrey, J. K. Ockene, W. J. Gamble, J. C. Witschi, and F. J. Stare. 1989. Effects on blood pressure of a decrease in sodium use in institutional food preparation: The Exeter-Andover project. Journal of Clinical Epidemiology 42(3):201-208.
ERS (Economic Research Service). 1998. Food procurement by USDA’s farm service agency. Agricultural Economic Report No. 766. Washington, DC: Economic Research Service.
ERS. 2010. The food assistance landscape: FY 2009 annual report. Economic Information Bulletin No. 6-7. Washington, DC: Economic Research Service.
Fern, E. 2009. Identifying strategies to reduce sodium intake in the U.S. population. Presented at the Institute of Medicine Committee on Strategies to Reduce Sodium Intake’s Public Information-Gathering Workshop, March 30, Washington, DC.
Fishbein, M. 2000. The role of theory in HIV prevention. AIDS Care 12:273-278.
Fishbein, M., S. E. Middlestadt, and P. J. Hitchcock. 1991. Using information to change sexually transmitted disease-related behaviors: An analysis based on the theory of reasoned action. In Research issues in human behavior and sexually transmitted diseases in the AIDS era, edited by J. N. Wasserheit, S. O. Aral, and K. K. Holmes. Washington, DC: American Society for Microbiology. Pp. 243-257.
FNS (Food and Nutrition Service). 2009. Nutrition Assistance Programs. http://www.fns.usda.gov/fns (accessed November 18, 2009).
Food Marketing Institute. 2005. Shopping for health 2004: Making sense of nutrition news and health claims. Washington, DC and Emmaus, PA: Food Marketing Institute and Prevention magazine.
Food Processing. 2009. Top 100 report for 2009. Food Processing August:28-29.
Fox, M. K., W. Hamilton, and B. H. Lin. 2004. Effects of food assistance and nutrition programs on nutrition and health: Volume 4, executive summary of the literature review.
Food Assistance and Nutrition Research Report No. 19-4. Washington, DC: Economic Research Service.
Frazao, E., and J. E. Allshouse. 1996. Size and growth of the nutritionally-improved food market. Agricultural Information Bulletin No. 723. Washington, DC: Economic Research Service.
FTC (Federal Trade Commission). 2003. Slotting allowances in the retail grocery industry: Selected case studies in five product categories. FTC Staff Study.
Fuller, G. W. 2005. New food product development: From concept to marketplace. 2nd ed. Boca Raton, FL: CRC Press.
Galef, B. G., Jr. 1996. Food selection: Problems in understanding how we choose foods to eat. Neuroscience and Biobehavioral Reviews 20(1):67-73.
GAO (Government Accountability Office). 2000. Food and commodities: Federal purchases and major regulations that potentially affect prices paid. GAO/RCED-00-173R. Washington, DC: Government Accountability Office, Resources, Community, and Economic Development Division.
OCR for page 207
Strategies to Reduce Sodium Intake in the United States
GAO. 2008. Food Stamp Program options for delivering financial incentives to participants for purchasing targeted foods: Report to the Chairman, Committee on Agriculture, Nutrition, and Forestry, U.S. Senate. GAO-08-415. Washington, DC: Government Accountability Office.
Glanz, K., K. Resnicow, J. Seymour, K. Hoy, H. Stewart, M. Lyons, and J. Goldberg. 2007. How major restaurant chains plan their menus: The role of profit, demand, and health. American Journal of Preventive Medicine 32(5):383-388.
Glanz, K., B. K. Rimer, and K. Viswanath, (eds). 2008. Health behavior and health education: Theory, research, and practice. 4th ed. San Francisco, CA: Jossey-Bass.
Glanz, K., J. F. Sallis, B. E. Saelens, and L. D. Frank. 2005. Healthy nutrition environments: Concepts and measures. American Journal of Health Promotion 19(5):330-333.
Gordon, A., and M. K. Fox. 2007. School Nutrition Dietary Assessment Survey-III: Summary of findings. Washington, DC: USDA Food and Nutrition Service.
Grasso, V. B. 2008. Department of Defense food procurement: Background and status. CRS Report No. RS22190. Washington, DC: Congressional Research Service, Library of Congress.
Hanson, G. D., G. P. Rauniyar, and R. O. Herrmann. 1994. Using consumer profiles to increase the U.S. market for seafood: Implications for aquaculture. Aquaculture 127(4): 303-316.
Harris, J. M., P. R. Kaufman, S. W. Martinez, and C. Price. 2002. The U.S. food marketing system, 2002: Competition, coordination, and technological innovations into the 21st century. Agricultural Economic Report No. 811. Washington, DC: Economic Research Service.
Hattersley, V. 2009. A U.K. retailer perspective. Presented at the Institute of Medicine Committee on Strategies to Reduce Sodium Intake’s Public Information-Gathering Workshop, March 30, Washington, DC.
Hayden, K. 2004. Science and flavor at the crossroads. Flavor & the Menu, Fall 2004.
Heidolph, B. B. 2008. Is sodium reduction the next target in the “better-for-you” formulation trend? Cereal Foods World 53(1):21-27.
Heyhoe, T. 2002. Effective communication. In Food product development: Based on experience, edited by C. Side. Ames: Iowa State Press. Pp. 3-12.
HHS (U.S. Department of Health and Human Services). 1987. Review of research on the effects of health warning labels: A report to the United States Congress. Rockville, MD: U.S. Department of Health and Human Services.
Honkanen, P., S. O. Olsen, and B. Verplanken. 2005. Intention to consume seafood—The importance of habit. Appetite 45(2):161-168.
Hornik, R., and K. D. Woolf. 1999. Using cross-sectional surveys to plan message strategies. Social Marketing Quarterly 5(2):34-41.
Huang, K. S., and B. H. Lin. 2000. Estimation of food demand and nutrient elasticities from household survey data. Technical Research Bulletin 1887. Washington, DC: Economic Research Service.
IFIC (International Food and Information Council). 2008. 2008 Food and Health Survey: Consumer attitudes toward food, nutrition & health. Washington, DC: International Food Information Council.
IFIC. 2009. 2009 Food and Health Survey: Consumer attitudes toward food, nutrition & health. Washington, DC: International Food Information Council.
IOM (Institute of Medicine). 2002. Speaking of health: Assessing health communication strategies for diverse populations. Washington, DC: The National Academies Press.
IOM. 2007. Seafood choices: Balancing benefits and risks, edited by M. C. Nesheim and A. L. Yaktine. Washington, DC: The National Academies Press.
OCR for page 208
Strategies to Reduce Sodium Intake in the United States
IOM. 2009. School meals: Building blocks for healthy children, edited by V. A. Stallings, C. W. Suitor, and C. L. Taylor. Washington, DC: The National Academies Press.
Kahkonen, P., and H. Tuorila. 1998. Effect of reduced-fat information on expected and actual hedonic and sensory ratings of sausage. Appetite 30(1):13-23.
Kahkonen, P., P. Hakanpaa, and H. Tuorila. 1999. The effect of information related to fat content and taste on consumer responses to a reduced-fat frankfurter and a reduced-fat chocolate bar. Journal of Sensory Studies 14(1):35-46.
Khoo, C. 2009. Campbell’s salt reduction journey. Presented at the Institute of Medicine Committee on Strategies to Reduce Sodium Intake’s Public Information-Gathering Workshop, March 30, 2009, Washington, DC.
Kimmerling, G. F. 1985. Warning: Workers at risk, train effectively. Training and Development Journal 39(4):50-55.
Kinsey, J. 1983. Working wives and the marginal propensity to consume food away from home. American Journal of Agricultural Economics 65(1):10-19.
Kramer, F. 2002. Initial and progressive cost estimates. In Food product development: Based on experience, edited by C. Side. Ames: Iowa State Press. Pp. 179-188.
Lancaster, K. J. 1966. A new approach to consumer theory. Journal of Political Economy 74(2):132-157.
Lattin, G. W. 2009. The lodging and food service industry. 7th ed. Lansing, MI: American Hotel & Lodging Educational Institute.
Leader, N. G., and I. D. H. Cuthill. 2008. Impact of new product development of store brands on branded manufacturers in the U.S. grocery industry. Oswego, NY: State University of New York at Oswego, School of Business Marketing Department.
Lehto, M. R., and J. M. Miller. 1986. Warnings: Vol. I: Fundamentals, design, and evaluation methodologies. 1st ed. Ann Arbor, MI: Fuller Technical Publications.
Liese, A. D., K. E. Weis, D. Pluto, E. Smith, and A. Lawson. 2007. Food store types, availability, and cost of foods in a rural environment. Journal of the American Dietetic Association 107(11):1916-1923.
Lin, B. H., and J. F. Guthrie. 2007. How do low-income households respond to food prices? Economic Information Bulletin No. 29-5. Washington, DC: USDA Economic Research Service.
Lin, B.-H., J. Guthrie, and E. Frazão. 1999. Nutrient contribution of food away from home. In America’s eating habits: Changes and consequences, edited by E. Frazão. Agriculture Information Bulletin No. 750. Washington, DC: U.S. Department of Agriculture, Economic Research Service, Food and Rural Economics Division. Pp. 213-242.
Lucock, M., and Z. Yates. 2009. Folic acid fortification: A double-edged sword. Current Opinion in Clinical Nutrition and Metabolic Care 12(6):555-564.
Lutz, S. M., D. M. Smallwood, and J. R. Blaylock. 1995. Limited financial resources constrain food choices. FoodReview 18:13-17.
Maes, N. 2008. Child’s palate. Plate 67-72.
Martinez, S. 2007. The U.S. food marketing system: Recent developments, 1997–2006. Economic Research Report No. 42. Washington, DC: Economic Research Service.
Mayer, R. N., K. R. Smith, and D. L. Scammon. 1991. Evaluating the impact of alcohol warning labels. Advances in Consumer Research 18:706-714.
McCracken, V., and J. A. Brandt. 1987. Household consumption of food away from home: Total expenditure and by type of food facility. American Journal of Agricultural Economics 69(2):274-284.
McLeroy, K. R., D. Bibeau, A. Steckler, and K. Glanz. 1988. An ecological perspective on health promotion programs. Health Education Quarterly 15(4):351-377.
OCR for page 209
Strategies to Reduce Sodium Intake in the United States
Monahan, J. L. 1995. Thinking positively: Using positive affect when designing health messages. In Designing health messages: Approaches from communication theory and public health practice, edited by E. Maibach and R. L. Parrott. Thousand Oaks, CA: Sage. Pp. 81-98.
Morris, L. A., M. B. Mazis, and E. Gordon. 1977. A survey of the effects of oral contraceptive patient information. Journal of the American Medical Association 238:2504-2508.
Moskowitz, H., M. Reisner, and A. Maier. 2009. Creating food concepts to guide product development and marketing. In An integrated approach to new food product development, edited by H. Moskowitz, I. S. Saguy and T. Straus. Boca Raton: Taylor and Francis Group, LLC. Pp. 175-216.
Nachay, K. 2008. Staying smart about salt. Food Technology 62(3):26-35.
National Restaurant Association. 2008. 2009 Restaurant industry forecast. Washington, DC: National Restaurant Association.
Nestlé Ltd. 2007. Innovating the future: Research and development for nutrition, health and wellness. Vevey, Switzerland: Nestec Ltd.
Nestle, M., R. Wing, L. Birch, L. DiSogra, A. Drewnowski, S. Middleton, M. Sigman-Grant, J. Sobal, M. Winston, and C. Economos. 1998. Behavioral and social influences on food choice. Nutrition Reviews 56(5 (Part II)):S50-S74.
New York City Department of Health and Mental Hygiene. 2008. Mayor Bloomberg and Shaquille O’Neal announce new food standards for City agencies. (Press release.)
Nielsen, S. J., and B. M. Popkin. 2003. Patterns and trends in food portion sizes, 1977–1998. Journal of the American Medical Association 289(4):450-453.
Paeratakul, S., D. P. Ferdinand, C. M. Champagne, D. H. Ryan, and G. A. Bray. 2003. Fast-food consumption among US adults and children: Dietary and nutrient intake profile. Journal of the American Dietetic Association 103(10):1332-1338.
Park, Y. K., C. T. Sempos, C. N. Barton, J. E. Vanderveen, and E. A. Yetley. 2000. Effectiveness of food fortification in the United States: The case of Pellagra. American Journal of Public Health 90(5):727-738.
Petraitis, J., B. R. Flay, and T. Q. Miller. 1995. Reviewing theories of adolescent substance use: Organizing pieces in the puzzle. Psychological Bulletin 117:67-86.
Pfeiffer, C. M., C. L. Johnson, R. B. Jain, E. A. Yetley, M. F. Picciano, J. I. Rader, K. D. Fisher, J. Mulinare, and J. D. Osterloh. 2007. Trends in blood folate and vitamin B-12 concentrations in the United States, 1988–2004. American Journal of Clinical Nutrition 86(3):718-727.
Pollak, R. A., and M. L. Wachter. 1975. The relevance of the household production function and its implications for the allocation of time. Journal of Political Economy 83(2): 255-278.
Private eyes. 2007. Progressive Grocer, December 2007.
Raine, K. D. 2005. Determinants of healthy eating in Canada: An overview and synthesis. Canadian Journal of Public Health 96(Supplement 3).
Ram, C. 2008. Shaking things up: Low-sodium dishes offer flavor without sacrifice. Plate 59-64.
Ram, C. 2009. Whole grains, whole flavors. Plate 49-54.
Redman, B. J. 1980. The impact of women’s time allocation on expenditure for meals away from home and prepared foods. American Journal of Agricultural Economics 234-237.
Reichler, G., and S. Dalton. 1998. Chefs’ attitudes toward healthful food preparation are more positive than their food science knowledge and practices. Journal of the American Dietetic Association 98(2):165-169.
Rolls, B. J. 2003. The supersizing of America: Portion size and the obesity epidemic. Nutrition Today 38(2):42-53.
OCR for page 210
Strategies to Reduce Sodium Intake in the United States
Rosenstock, I. M., V. J. Stretcher, and M. H. Becker. 1994. The health belief model and HIV risk behavior change. In Preventing AIDS: Theories and methods of behavioral interventions, edited by R. J. DiClemente and J. L. Peterson. New York: Plenum Press. Pp. 5-24.
Saguy, I. S., and M. Peleg. 2009. Accelerated and parallel storage in shelf life studies. In An integrated approach to new food product development, edited by H. Moskowitz, I. S. Saguy, and T. Straus. Boca Raton, FL: Taylor and Francis Group, LLC. Pp. 429-455.
Scarpa, J. 2009. Healthy R&D perspectives. Culinology, September 3.
Shepherd, R. 2005. Influences on food choice and dietary behavior. Forum of Nutrition 57:36-43.
Shi, H., and D. W. Price. 1998. Impacts of sociodemographic variables on the implicit values of breakfast cereal characteristics. Journal of Agricultural and Resource Economics 23(1):126-139.
Stewart, D. W., and I. M. Martin. 1994. Intended and unintended consequences of warning messages: A review and synthesis of empirical research. Journal of Public Policy & Marketing 13(1):1-19.
Story, M., K. M. Kaphingst, R. Robinson-O’Brien, and K. Glanz. 2008. Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health 29:253-272.
Straus, T. 2009. The new product success equation: Building success into the new product development process (a.k.a. an objective-based product development process). In An integrated approach to new food product development, edited by H. Moskowitz, I. S. Saguy, and T. Straus. Boca Raton, FL: Taylor and Francis Group, LLC. Pp. 3-24.
Supermarket News. 2009. SN’s top 75 retailers for 2009. http://supermarketnews.com/profiles/top75/2009/top-75/ (accessed July 31, 2009).
Thomas, M. 2007. Improving the success rate of new food product introductions: The role of the research chef. In Developing new food products for a changing marketplace. 2nd ed., edited by A. L. Brody and J. B. Lord. Boca Raton, FL: CRC Press. Pp. 345-364.
Tippett, K. S., C. W. Enns, and A. Moshfegh. 1999. Food consumption surveys in the U.S. Department of Agriculture. Nutrition Today 34:33-46.
Topp, E. 2007. Building superior R&D organizations. In Accelerating new food product design and development, edited by J. H. Beckley, M. M. Foley, E. J. Topp, J. C. Huang, and W. Prinyawiwatkul. Ames, IA: Blackwell Publishing and the Institute of Food Technologists. Pp. 41-53.
Tuorila, H., A. V. Cardello, and L. L. Lesher. 1994. Antecedents and consequences of expectations related to fat-free and regular-fat foods. Appetite 23(3):247-263.
U.S. Department of Commerce. 2008. Processed food outlook. http://www.trade.gov/td/ocg/report08_processedfoods.pdf (accessed July 20, 2009).
USDA (U.S. Department of Agriculture). 1995. Improving USDA commodities: Tri-agency commodity specification review report. Washington, DC: U.S. Department of Agriculture.
USDA/Food and Consumer Service. 1995. National School Lunch Program and School Breakfast Program: School Meals Initiative for healthy children, final rule. Federal Register 60(113):31188.
USDA/FNS (Food and Nutrition Service). 2007. Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Revisions in the WIC food packages; interim rule. Federal Register 72(234):68966-69032.
Valdovinos, M. 2009. Chef formulation and integration: Ensuring that great food and food science work together. In An integrated approach to new food product development, edited by H. Moskowitz, I. S. Saguy, and T. Straus. Boca Raton, FL: Taylor and Francis Group, LLC. Pp. 303-316.
OCR for page 211
Strategies to Reduce Sodium Intake in the United States
van Boekel, M. A. J. S. 2009. Innovation as science. In An integrated approach to new food product development, edited by H. Moskowitz, I. S. Saguy, and T. Straus. Boca Raton, FL: Taylor and Francis Group, LLC. Pp. 37-52.
Walker, J. R. 2009. Introduction to hospitality. Upper Saddle River, NJ: Pearson Education, Inc.
Walker, J. R., and D. E. Lundberg. 2005. The restaurant: From concept to operation. 4th ed. Hoboken, NJ: John Wiley & Sons.
Ward, M. B., J. P. Shimshack, J. M. Perloff, and J. M. Harris. 2002. Effects of the private-label invasion in food industries. American Journal of Agricultural Economics 84(4): 961-973.
Watzke, H. J., and J. B. German. 2009. Personalizing foods. In An integrated approach to new food product development, edited by H. Moskowitz, I. S. Saguy, and T. Straus. Boca Raton, FL: Taylor and Francis Group, LLC. Pp. 133-173.
Webster, J. 2009. Reformulating food products for health: Context and key issues for moving forward in Europe. http://ec.europa.eu/health/nutrition_physical_activity/docs/ev20090714_wp_en.pdf (accessed February 3, 2010).
Weinstein, H. 2002. Contract packaging or in-house manufacturing? In Food product development: Based on experience, edited by C. Side. Ames: Iowa State Press. Pp. 171-177.
Weisberg, K. 2006. CIA, Harvard link on flavor. Foodservice Director 19(2):8.
Wetter, A. C., et al. 2001. How and why do individuals make food and physical activity choices? Nutrition Reviews 59(3, Part II):S11-S20.
Wiemer, K. 2009. Comment letter submitted to IOM Sodium Committee by General Mills, Inc.
Willows, N. D. 2005. Determinants of healthy eating in Aboriginal peoples in Canada: The current state of knowledge and research gaps. Canadian Journal of Public Health 96(Supplement 3):S32-S36.
Winslow, C. E. A. 1984 (Reprint of 1923 publication). The evolution and significance of the modern public health campaign. New Haven, CT: Yale University Press.
Wolf, C. W. 2009. Trend monitoring: Sorting fad from long-lasting profit-building trends. In An integrated approach to new food product development, edited by H. Moskowitz, I. S. Saguy, and T. Straus. Boca Raton, FL: Taylor and Francis Group, LLC. Pp. 79-95.
Wollmeringer, M. S. Guidelines for salt and fat reductions in the armed forces recipe service. Natick, MA: Natick, Soldier Center, U.S. Army Soldier and Biological Chemical Command.
Wrick, K. 2009. Tastefully reducing sodium. Prepared Foods 178(9):67-75.
Zoumas-Morse, C., C. L. Rock, E. J. Sobo, and M. L. Neuhouser. 2001. Children’s patterns of macronutrient intake and associations with restaurant and home eating. Journal of the American Dietetic Association 101(8):923-925.
OCR for page 212
Strategies to Reduce Sodium Intake in the United States
This page intentionally left blank.