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Adaptation and Validation of the Chinese Version of the Nutrition Environment Measurement Tool for Stores

Institute of Health Sciences, China Medical University, Shenyang 110122, China
Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2179, USA
Author to whom correspondence should be addressed.
Yang Liu and Shenzhi Song contributed equally to the paper.
Int. J. Environ. Res. Public Health 2019, 16(5), 782;
Received: 16 November 2018 / Revised: 17 January 2019 / Accepted: 27 February 2019 / Published: 4 March 2019
(This article belongs to the Special Issue Built Environments, Food Environments, and Public Health)
PDF [283 KB, uploaded 4 March 2019]


Changes in lifestyle and food environment have created a heavy burden of obesity and chronic disease in China. However, measurements of the food environment have been rarely reported in China or other countries with similar food cultures; this measurement shortage is partially due to the lack of valid and reliable measurement tools. The aim of the present study was to adapt and validate a Chinese version of the Nutritional Environment Measurement Survey for Stores (C-NEMS-S). Categories and items of the NEMS-S were culturally adapted to fit the Chinese population and included grains, dry beans, starchy tubers, vegetables, fruits, seafood, meat and poultry, dietary oils, milk, bread, instant noodles, and beverages. A scoring sheet for each food category was created to measure availability, quality, and pricing. Then, the C-NEMS-S was validated in 10 large-sized supermarkets and 10 convenience stores in Shenyang, China. Two trained raters performed their evaluations separately at the same store. The intra-class correlation coefficient (ICC) of the availability composite score was 0.98. All food measures had a moderate or good ICC (0.41 to 1.00). The kappa for each food measure ranged from 0.52 to 1.00. C-NEMS-S was able to show the difference in healthy food availability between large-sized supermarkets and convenience stores, as well as the price differences between healthier options and regular options. Large-sized supermarkets had a significantly higher total score (p < 0.001) and healthier option availability for all food measures (all items were statistically significant (p < 0.05), except sugar-free beverages). Healthier options cost more than regular options for grains, milk, bread, and instant noodles (from 4% to 153%). The adapted C-NEMS-S can be used to measure the consumer food environment in stores in China. View Full-Text
Keywords: food environment; China; Nutritional Environment Measurement Survey-Stores (NEMS-S) food environment; China; Nutritional Environment Measurement Survey-Stores (NEMS-S)
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Liu, Y.; Song, S.; Gittelsohn, J.; Jiang, N.; Hu, J.; Ma, Y.; Wen, D. Adaptation and Validation of the Chinese Version of the Nutrition Environment Measurement Tool for Stores. Int. J. Environ. Res. Public Health 2019, 16, 782.

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