NEMS-R Projects and Applications
The New Ulm Minnesota Project
The Minneapolis Heart Institute Foundation has been doing a variety of NEMS related work in New Ulm, Minnesota over the last few years. Click here to see their poster of their convenience store program. They also have been doing an ambitious restaurant program. Late 2013, they completed a follow-up NEMS-R assessment and wrote a paper. Click here to read their paper.
The LiveWell EatWell Restaurant Challenge in Lawrence, KS (April 2013)
LiveWell Lawrence began the LiveWell EatWell Restaurant Challenge in late 2010. To date, 17 restaurants have accepted the challenge to offer healthy options for restaurant patrons. The program is managed and sustained by a WIC nutritionist at the Lawrence-Douglas County Health Department. The initiative rewards participating restaurants by promoting them and featuring their menu offerings in short stories posted on WellCommons, an award-winning community-journalism website that empowers local consumers and community health advocates reporting on and communicating about health and well-being issues that impact residents of Douglas County, Kansas.
To understand the relationship of food environments to eating and weight patterns, researchers need to examine accessibility of restaurants, but also factors that are believed to contribute to food choices in restaurants, including availability of more healthful foods, factors that facilitate or hinder healthful eating, pricing, and signage or promotion of healthful and unhealthful foods. As the program was originally designed, restaurants qualify for recognition by LiveWell required meeting several criteria including but not limited to the following: offering fresh, frozen or canned fruit; entrées prepared with lower-fat method (baked, steamed, poached, broiled or barbecued); offering smaller servings of entrées; offering lower fat or sugar free dessert options on menu; and providing a substitute for fried side dishes (e.g., side salad, vegetables, pasta salad or fresh fruit). This original program design is being modified as a result of an evaluation activity supported by the 2012-2013 CDRR grant. That activity resulted in the assessment of 56 Douglas County restaurants, including 17 that are currently participating in the LiveWell EatWell Restaurant Challenge. The assessment was completed using the nationally recognized Nutrition Environment Measures Survey for Restaurants (NEMS-R), which was recommended by the Dr. Anthony Randles, KDHE Physical Activity and Nutrition Program Manager. The NEMS-R assessment activity targeted current and prospective participants in the LiveWell EatWell Restaurant Challenge. As part of the 2012-2013 CDRR NEMS-R activity, a NEMS-R assessment report will be produced and provided to the 56 Douglas County restaurants evaluated in 2012. The analysis will summarize restaurant practices that facilitate or create barriers to healthful dining. The report will also identify opportunities for improvement in healthy dining.
Among EatWell restaurants, scores on the NEMS-R assessment ranged from a high of 17 to a low of 3 (excluding points allowable for kids’ menus, which not all participating restaurants had). Higher NEMS-R scores are associated with health promoting restaurant environments. 24% (4 of 17) of EatWell restaurants scored 10 or higher: Jason’s Deli (17), Carlos O’Kelly’s (15), Applebee’s (13) and Bambino’s (10).
NEMS smart phone app related to NEMS-R scores developed for Cerro Gordo County in Iowa! (Nov. 2013)
The Cerro Gordo County Department of Public Health, located in north central Iowa, has been using the NEMS assessment tools for many years now. They have recently used the NEMS-R tool to assess every restaurant in the county in an effort to encourage restaurant managers to enhance their restaurant environment through healthy strategies. They have put together a book explaining the NEMS-R tool, the restaurant’s respective NEMS-R score, and highlighted a few strategies the restaurants could implement to improve their score and consequently provide a healthier eating environment for residents. Click here to see the NEMS-R Strategy Guide for Improvement that they would like to distribute to the restaurant managers.
To complement the NEMS-R Scores, they have released a Smart Phone App that utilizes NEMS-R scores in the county for public use when deciding where to dine throughout Cerro Gordo County. As restaurants improve, their scores will be updated. The public health department received funding through the Iowa Department of Public Health Community Transformation Grant. Click here to view Powerpoint presentation.
To see the Android version, click here.
To see the Apple version, click here.
Chenango Health Network NEMS Assessment (Nov. 2011)
The Chenango Health Network who is the lead organization of a local health planning group conducted NEMS assessments of restaurants in their area in Chenango County in rural New York in late 2010. If you’d like to read about their results, click here.
After reviewing the results, the group members developed The Restaurant project which is an ecological approach to healthy eating, uses evidence-based chronic disease prevention strategies, builds on community strengths and resources and, uses a logic model which enables partners to assess and evaluate progress. If you’d like to see their logic model, click here.
They launched The Restaurant Project which involves seven locally owned restaurants in different parts of this rural county. They have been working with the restaurants–adding and promoting healthy food choices and have started to promote these restaurants locally. These restaurants also have a strong community connection. The next step is to begin a broad community education campaign about eating out and ordering choices. They have been partnering with worksites/employers who have wellness activities underway. Other restaurants would like to participate but due to funding and staffing, they will have to wait.
If you’d like to learn more about this project, you can contact Tina Utley Edwards, Executive Director of the Chenango Health Network at email@example.com
NEMS-S Projects and Applications
Example of Using NEMS as a Teaching Tool
John Hopkins Political Science Professor Adam Sheingate decided to use the NEMS-S tool with a summer class. Click here if you would like to read more about his class project.
Using NEMS-S to Study Food Access in Baton Rouge, LA.
Dr. Stephanie Broyles at the Pennington Biomedical Research Center in Baton Rouge, LA, received a grant from the American Heart Association to study children’s neighborhood food environments. Four data collectors used the NEMS-S program for tablets and visited over 550 food stores and produce markets in the parishes surrounding Baton Rouge. The data are being linked to other study data to investigate the impact of local food environments on a variety of health outcomes and behavior changes. The data have also been used to inform local food access policy within the East Baton Rouge Food Access Policy Commission’s findings and recommendations.
Presentation of NEMS-S Adaptation for Mexican Americans
Dr. Donna M. Winham presented the adaptation of the NEMS-S tool for the Mexican American population at the Experimental Biology Conference in April 2013 that she and Dr. Seline Szkupinski Quiroga collaborated on while at Arizona State University. The tool itself has not been publicly released but you can click here to view the slides on the adaptation. Dr. Winham is the owner and principal consultant at Howell Research Associates, LLC www.howellresearch.org and can be contacted at firstname.lastname@example.org.
Seattle, WA (2010)
Graduate student Sara Coulter wrote her thesis on her NEMS-S data collected in a low-income racially diverse neighborhood in Seattle, WA. To read the abstract of her results, please click here. To read the entire thesis, click here.
Leon County, Florida (2010)
Angela Leone, a graduate student at UGA analyzed the NEMS data collected in Leon County, Florida. To read the abstract of her results, please click here. You can also see her publication of the results on the publications webpage.
Combinations of NEMS Tools Used
Farmer’s Market Audit Tool
Dr. Carmen Byker Shanks of Montana State and others have developed an audit tool for Farmer’s Markets modified from NEMS. Their recent publication of the tool (Shanks, C. B., Pitts, S. J., & Gustafson, A. (2015). Development and Validation of a Farmers’ Market Audit Tool in Rural and Urban Communities. Health promotion practice, 1524839915597899) is now available.
Please click on the links below for the tool and instructions.
CDC and NPS Tools and Protocol for Evaluating National Parks
CDC and the National Park Service modified NEMS tools to evaluate the nutrition environments in the national parks. To see each setting’s tool and protocol, click on each link below:
- Restaurant tool and protocol
- Store tool and protocol
- Snack shop tool and protocol
- Vending tool and protocol
- Public water tool and protocol
NEMS Project in Rural Arizona Town
The Arizona Area Health Education Center (AHEC) is funding a project using both the NEMS-S and NEMS-R in a rural Arizona town as part of a comprehensive assessment of the community nutrition environment. The assessment combines data collected from surveys of members of a local coalition, community meetings, community surveys, secondary data, and the NEMS tools. The goal is to establish baseline measures and identify policy or environmental-level interventions that could potentially improve the local community nutrition environment. The assessment, including the NEMS project, is the preliminary research of a Mel and Enid Zuckerman College of Public Health, University of Arizona, doctoral student, Elizabeth Kizer, for a planned community based participatory research dissertation project. Six local residents are participating in the NEMS project by volunteering their time to be trained as NEMS raters and perform surveys in every licensed store and restaurant in town (a total of 35 surveys). A community action board will review the assessment, the NEMS data collected, and develop strategies to achieve policy or environmental-level change, which will guide this researcher and the local coalition, to improve the local food environment.
Hospital Food/Beverage and Physical Activity Environment Scans
Researchers at the Centers for Disease Control and Prevention have adapted a version of NEMS-R, NEMS-S and NEMS-V to assess the nutrition environment in hospitals.
They collaborated with hospitals across the country to conduct validity testing of these tools. The objectives of their project were to adapt a food & beverage retail environment assessment tool for hospitals and to disseminate these tools such that hospitals can increase knowledge about and monitor healthy hospital environments. To read the published article in Preventing Chronic Disease, click here.
If you are interested in learning more about the tool for your own use, please contact Dr. Brook Belay at email@example.com.
NEMS Tool for Assessing the Nutrition Environment on College Campuses
Fifteen post-secondary institutions assessed their near and on-campus eating environment using NEMS-S and NEMS-R tools modified by Dr. Tanya Horacek from Syracuse University. In the study, Dr. Horacek concluded that a college campus provides an eating environment with an array of dining and shopping venues, most of which are not consistent with dietary recommendations for good health and obesity prevention. The findings of this study provide evidence in support of campus initiatives to evaluate and improve the quality of their own and surrounding eating environments.
The modifications made to NEMS-R to assess Campus Dining venues included the addition of a detailed evaluation of salad bars, vegetarian options, non-dairy milk alternatives, and cereals. NEMS-S was expanded to evaluate canned and frozen fruits and vegetables (F/V), other ground lean meats, vegetarian (meat alternative) products, and the cereal (by fiber criteria).
Please go to the publications page, to view Dr. Horacek’s published articles on the project.
NEMS-Related Video from NEMS User
Sarah Moen, a student in Wisconsin who worked on a NEMS project over the summer of 2011, created a video of her NEMS experience. To see her video, click here.
NEMS YouTube Video
Jenny Chen, a senior at the University of Pennsylvania, created a YouTube video about NEMS for her Urban Planning fieldwork class. (11/18/2019 – The video is now private https://www.youtube.com/watch?v=Oe3KS8ZGdfU)
Article in Huffington Post
Daniel J. Shultz, a public health nutritionist, wrote an article recently in the Huffington Post mentioning NEMS titled “A New Year’s Resolution That Benefits Everyone: Upgrading How We Evaluate and Shape Our Food Environment.”
NEMS Project in Guatemala
Towards the development of a Nutrition Environment Measures Survey in Stores (NEMS-S) tool to measure the Guatemalan food environment
With greater availability of ultra-processed foods and the transition away from subsistence agriculture, Guatemala is undergoing a nutrition transition. Whereby, with a greater availability of energy-dense, inexpensive foods high in fats and sugars, there is a greater consumption of these foods; this has often been associated with obesity. Amongst Guatemalan women aged 15-49 y, overweight and obesity have increased from rates of 34% to 59% between 1995-2008 (Kanter et al. 2013). To be able to conduct studies to assess associations between individual level diet, health, and socio-demographic data and food environment measures between urban and rural areas, respectively, in Guatemala, valid and reliable food environment measures are necessary.
To develop an appropriate NEMS-S tool for Guatemala, it was important to first pilot test the original NEMS-S in Guatemala in its verbatim, original form. This work is a collaboration between the Institute of Nutrition of Central America and Panama, specifically the INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), and CeSSIAM, Center for Studies on Sensory Impairment, Aging, and Metabolism, both located in Guatemala City, Guatemala. Two certified NEMS-S raters pilot tested the original NEMS-S on two separate occasions in four different supermarkets in Zone 3 of Quetzaltenango (Xela), Guatemala, the second largest city in Guatemala. We found that the original NEMS-S had both high inter-rater and test-test reliability. However, measurement validity varied by food item. Based on a subjective analysis regarding how easy raters could fill out the original NEMS-S, it performed very good for fruits and vegetables; good for juice, bread, chips, and cereal; but poor for lean meat, milk, frozen dinners, hot dogs, diet soda, and baked goods. Based on these results and Guatemalan dietary survey data, we have begun a process to design a modified NEMS-S tool for Guatemala; and are in the process of testing this tool. Ultimately, we plan to conduct studies that assess the relationship between individual level data and food environment measures between urban and rural areas of Guatemala with survey instruments of equal reliability, but adapted to the food-offering realities of the Western Highlands.
Using NEMS-S in a Latino Neighborhood in Milwaukee, WI (about 45 minutes) (2012)
Stephanie Calloway and Tatiana Maida of CORE/El Centro in Milwaukee, WI trained some promotoras to collect NEMS-S data. Learn about their project and results in this webinar. If you would like to contact them to learn more, email Stephanie at firstname.lastname@example.org.
The Chenango Health Network’s the Restaurant Project (about 25 mins) (2012)
The Chenango Health Network based in Norwich, NY conducted NEMS-R assessments almost two years ago. Based on the results, they along with their collaborators designed The Restaurant Project, an intervention with some of the restaurants. Chris McAvoy, the program coordinator would like to share more details about their project and their successes in this webinar on March 2, 2012.
If you’d like to view the webinar, click here.
The Children’s Menu Assessment (CMA) Tool and how it is being used to track policy change in California (2012)
On January 31, 2012, Becca Krukowski, PhD, University of Arkansas for Medical Sciences and Jennifer Otten, PhD, RD, Stanford Prevention Research Center presented on the use and scoring of the Children’s Menu Assessment tool and how the tool is being used to track the impacts of toy giveaway legislation in California.
Background: The Children’s Menu Assessment tool was adapted from the NEMS-R, to focus attention on restaurant children’s menus. This tutorial will provide training on the use of the tool, how to score it and an example of how it is being used in the field to track the impacts of California’s toy giveaway legislation – legislation prohibiting restaurants from distributing toy giveaways with meals, foods, and beverages not meeting minimal nutrition criteria. The tool and the instructions are attached and can also be found here)
NEMS-V: What is it and how it is changing Iowa and beyond!” (2012)
On January 26, 2012, Carol Voss of the Iowa Department of Public Health and Susan Klein of Iowans Fit for Life presented on Iowa’s experiences in using the NEMS vending machine assessment tool and its website development and how their project is leading to policy and environmental change in Iowa. If you’d like to contact Carol and Susan with questions, their emails are email@example.com and firstname.lastname@example.org.
- If you’d like to view the webinar, click here.
- If you’d like to go to the NEMS-V website, click here.
Omaha’s use of NEMS-S for their WIC Project (March 12, 2010)
During the March 12, 2010* State Nutrition Environment Workgroup webinar, Mary Baluff, MS, RD, LMNT, Chief of the Community and Health Nutrition Services from the Douglas County Health Department in Omaha, NE, presented on a community specific tool that was developed by the DCHD to better understand the adequacy of the retail food network and its capacity system to meet the demands of the new WIC food packages. *A combined report was compiled in 2015.
- To view the webinar, please click here.
- To view the original Omaha Nutrition Environment Measurement System, please click here.
- A more detailed description of Omaha’s work can be found here.
- A 2018 report can be found here.
Assessing Kid’s Menus in Restaurants in Thurston County, Washington (April 16, 2010)
Making a Better Choice for Kids: What Restaurants Have to Offer
Washington State University Extension partnered with Thurston County Public Health and Social Services to investigate the availability of healthier children’s menu options at restaurants. An adapted Nutrition Environment Measures Survey (NEMS) was used to assess availability of healthier entrees, sides, and beverages listed on children’s menus. All but nineteen potentially eligible restaurants in Thurston County, Washington were visited. After pre-testing and revising, surveys were completed by trained surveyors. A total of 129 quick service and 161 sit down restaurants were visited between April-May 2008. A children’s menu was present at 187 or 64% of all restaurants. Menu text, meal names, and food items were sometimes ambiguous or difficult to read. Zena Edwards, WSU Thurston County Extension Food Safety & Nutrition faculty will share lessons learned for conducting this type of assessment and plans for use of the data.
- To view the webinar, please click here.
- To read a brief summary of their findings, click here.
- To view their sit-down assessment tool, click here.
- To view their quick service assessment tool, click here.
NCI’s Measures of the Food Environment
Web-based Compilation (June 4, 2010)
Jill Reedy and Sharon Kirkpatrick will provide an overview of NCI’s Measures of the Food Environment web-based compilation, which includes citations for peer-reviewed research encompassing the measurement of food environments, as well as many of the instruments used in the research. The compilation currently includes articles (and associated instruments) published since 1990 related to food environments in stores, restaurants, schools, and worksites, and is being expanded to include measures of the home food environment.
- The webinar was recorded in two parts. To view the part one of the webinar, please click here. To view part two of the webinar, please click here.
- To view just the slides without the audio, click here.
- Jill and Sharon would appreciate any comments or feedback. Their emails are email@example.com and firstname.lastname@example.org
Adaptations and Modifications
The NEMS Tools are observational measures to assess the community and consumer nutrition environments in food outlets, specifically stores, corner stores and restaurants. The measures focus on availability of healthful choices, prices and quality.
NEMS-P adaptation in Alicante (Spain)
We decided to adapt the NEMS-P survey to develop a tool that characterizes the perceived food environment in the Alicante área of Spain. First, we had two bilingual translators translate the original NEMS-P tool. Then with a committee of experts, a cultural adaptation was made and the most appropriate questions were selected. The initial adaptation of the questionnaire was created.
We are in the process of conducting the pilot study with the newly designed NEMS-P tool, following the same methodology as in the development of the original tool. We are going to pilot it in two neighborhoods that are classified as high and low socioeconomic status. We will analyze the data and assess the adaptation.
The emerging research project is titled: “Obesogenic Environment: Barriers to maintaining a healthy weight” funded by the Vice-Rectorate for Research, Development and Innovation at the University of Alicante (GRE14-20). Alba Martínez-García (PhD student), Dr. Eva Mª Trescastro, Dr. Eugenia Galiana, Dr. Pamela Pereyra, Manuela Ibarra, RN, Dr. Cristóbal Llorens, Dr. Carmen Ballesta, Dr. Josep Xavier Esplugues are collaborating on the research at the University of Alicante.
Evaluation of ANCHOR Program using NEMS
In 2014, we, as evaluators at Texas A&M University, began work to evaluate a multifaceted program implemented by a large national non-profit at a variety of locations across the United States. Over the three-year span of the project, the main focus was to implement policy, systems, and/or environmental (PSE) changes focusing on nutrition, physical activity, and tobacco exposure. One of the main nutrition goals of this program was increasing access to healthy foods in a variety of settings. We chose NEMS as a key tool to be used in this evaluation because it was highly flexible and could be adapted to fit our needs, based on the chosen implementation settings, as this varied by community. We ultimately used the store tool in addition to variations of the tools to assess vending machines, cafeterias, and concessions. Local project staff collected baseline data for a variety of locations, and follow-up data if a PSE change was implemented. This allowed us to see whether or not the PSE change actually resulted in improvements to the food environment. In addition to the valuable information this provided us as evaluators, the local project managers appreciated quantifiable information and were able to use the information to start conversations with community organizations regarding potential improvements to the food environment.
Master’s Student Assesses Food Environment at Maastricht University, The Netherlands
Eva Vobis, a master’s student at Maastricht University in The Netherlands, did a systematic assessment of the food environment on her campus for her thesis. She adapted the NEMS tools for her project and named them UNEMS for University Nutrition Environment Measures Survey which encompasses four different tools (the cafeteria, the snack shop, the food vending machine and the beverage vending machine). To learn more details of her project, please read her thesis.
NEMS-V Poster Presentation at APHA 2013
Dr. Kimberly Narain used NEMS-V to analyze beverages sold in city parks and the impact of nutrition policy in Carson, CA. She presented her findings at APHA 2013.
NEMS Accessibility Modification
Angela Drent (email@example.com) of the Sioux Land District Health Department of Iowa developed an 8 question modification to the NEMS-R tool to measure Accessibility for people with disabilities. Based on the results, one can offer recommendations to restaurants, some which can be implemented with little or no cost to the restaurant. The modification was adapted from the Community Health Inclusion Index On-site assessment tool.
Professor uses NEMS each year for Urban Health class
Professor Michelle Congo, of both St, Francis College and Long Island University, uses NEMS each year for an Urban Health class and a Nutrition class, combining some of the online training with fieldwork and a write-up of the experience.
Honor’s Class of University of New Mexico’s BSN Nursing Program Choose NEMS
A group of nursing students in the Honor’s Class of University of New Mexico’s BSN nursing program chose to use NEMS to experience and participate in each step of the research process with their instructor, Dr. P.J. Wood. The group selected the concept of analyzing food environments surrounding high schools, wondering if having an open campus for lunch might expose students to a food environment which could either encourage or discourage healthy food choices. They used the NEMS tools to measure the food environments surrounding some Albuquerque open campus high schools.
We would like to share with others all of the exciting news and activities that relates to NEMS, whether it is a project update, a publication, grant funding, customizations, etc. Please send us an email at firstname.lastname@example.org
NEMS is funded with support from the National Institutes of Health, the United States Agricultural Department, the Robert Wood Johnson Foundation, the Georgia Cancer Coalition and the Center for Health Behavior Research at the University of Pennsylvania.