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In the context of the ongoing process of high-quality development in the new era, which is focused on improving total factor productivity, it is of great importance to explore the spatial and temporal variations of total factor productivity growth and its driving factors in China's county regions' grain cultivation industry. This paper employs a three-stage DEA-Malmquist productivity method, the Gini coefficient method, and a panel fixed-effects model to analyze data from Chinese counties between 2009 and 2019. The analysis indicates that the growth of county food total factor productivity (FTFP) exhibits a fluctuating upward trend during the examination period, with an average annual growth rate of 2.43%. This is primarily driven by technological progress, yet the core driving role of technological efficiency is not effectively played. The average annual growth rate of county FTFP varies across different regions. The highest average annual growth rate of county FTFP in the eastern region and the primary grain-producing area is 2.75 and 3.04%, respectively. The lowest growth rates were observed in the western region and the main grain marketing area, at 1.44 and 1.23%, respectively. Secondly, the Gini coefficient of county FTFP continues to demonstrate a persistent upward trend during the examination period, with an average annual growth rate of 14.729%. The primary factor contributing to the observed variation in total factor productivity growth of the food sector at the regional level is the existence of disparate technological progress. Thirdly, there is a notable positive correlation between county financial deepening and financial self-sufficiency rates and county FTFP growth, with impact coefficients of 0.0503 and 0.0924, respectively. Conversely, county population density, degree of economic development, farmers' income level, and industrial structure exert a significant negative influence on county FTFP growth and technological progress. [ABSTRACT FROM AUTHOR]

Food delivery applications have grown rapidly in recent years, fueled by increasing consumer demand for convenience and prepared foods. Previous studies on what factors encourage consumers to use delivery platforms rely largely on survey data, likely due to the lack of availability of restaurant or industry level data. Utilizing web-scraping techniques to collect restaurant level data from one of the biggest delivery applications in South Korea, Yogiyo, this study conducts an analysis on spatial market structure of the restaurant business. Through restaurant level data, market expansion, changes in the number of restaurants to order from, and changes in prices across regions with delivery application are considered. Analysis suggests that the average number of orderable restaurants increased from a nearby 2.3 restaurants to distant 13.5 restaurants with customers willingly paying for delivery fees according to distance via the delivery application. As the restaurant delivery market becomes spatially more competitive with an additional 13.5 restaurants, it is found that aggregate prices totaled with food prices and delivery fees from two restaurants in different locations converge to serve the customers between the two restaurants. In addition, the increased degree of competition due to increased number of restaurants leads the aggregate prices to decrease by between 5.13 and 7.56%, depending on regional characteristics. [ABSTRACT FROM AUTHOR]

Copyright of Economics & Environment / Ekonomia i Środowisko is the property of Fundacja Ekonomistow Srodowiska i Zasobow Naturalnych and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of the study is to gather studies related to neural correlates that are used in agriculture and food economics. We classified and codified those studies to describe all of the contributions and to present the future prospects of neuroeconomics in the field of agriculture and food economics. A systematic literature review was carried out for this study to consolidate all of the relevant studies in one place. With the use of IEEE Xplore, Wiley Online Library, Taylor & Francis, Elsevier, Scopus and Sage, 190 records were identified and after a full text examination, 18 articles were selected for final review. Three major thematic areas viz: focus, method and field of study were identified and sub-classified into further classifications. In this systematic review, there were substantial evidence of the use of neuro tools such as the Eye Tracker (ET) and the electroencephalogram (EEG) in the field of agriculture and food economics. However, their application is still rare, creating significant opportunities for further research development in this direction.

Summary: Food plays a vital role in human sustenance and well-being, and the fluctuations in its price exert a significant impact on the attainment of the Sustainable Development Goals (SDGs) from social, economic, and environmental perspectives. This paper conducts an analysis utilizing data from 163 countries, revealing that an upsurge in global food commodity prices entails trade-offs with 13 SDGs, while exhibiting synergies with a few others. By considering specific food products, various types of countries, and the supply and demand shocks, further analysis confirms predominantly negative associations between spikes in food prices and the SDGs. Our findings highlight the urgent imperative to mitigate abrupt increases in food prices, such as those witnessed during the 2022 food crisis, to ensure the comprehensive fulfillment of the 2030 agenda for SDGs.

Copyright of Annals of the Polish Association of Agricultural & Agribusiness Economists is the property of Polish Association of Agricultural & Agribusiness Economists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Plant-based diets are often promoted as healthier and more sustainable and thus as a mechanism to achieve the targets proposed to mitigate climate change and noncommunicable diseases. However, plant-based diets can be perceived as more expensive than the common omnivorous diets, when considering the expensive novel meat substitutes and also the higher costs of fruits and vegetables, whose consumption is perceived to increase. Therefore, the present study assesses the question: Do plant-based consumers spend more on food compared to omnivorous consumers? Based on primary data (n = 1040) collected through an online survey, representative of the Portuguese population, through logistic regressions, it was possible to conclude that plant-based consumers, particularly vegan, are associated with lower food expenditures compared to omnivorous consumers. In fact, plant-based consumers are shown to spend less than all other consumers assessed. Food policies aligning healthiness and sustainability with affordability can deliver a major boost for the promotion of plant-based diets and help achieve the mitigation targets proposed.

The demand for food has been increasing throughout the years, with notable preferences for animal-based foods. Considering the impact of the excessive animal-based consumption on the environment and public health, international organisations and the scientific literature have advised for a large-scale transition towards healthier and more sustainable food consumptions, i.e., a systematic decrease in animal-based consumption followed by an increase in plant-based consumption. However, to effectively promote healthier and more sustainable food choices such as plant-based ones, it is crucial to understand what motivates consumers' food choices. Based on primary data (N = 1040), representative of the Portuguese population, it was possible to assess the potential motivators behind food choices, allowing to provide guidelines for policy decision. The impact of different socioeconomic characteristics, food consumption orientations, and food-related behaviours on food choices was estimated. In general, most of the drivers of plant-based meals were also motivators for reducing animal-based meals. The main findings demonstrate that the more environmentally conscious and informed the consumer, the more likely they are to choose more plant-based and less animal-based meals on a weekly basis; not only informed consumers, but consumers who actively look for information before buying choose more plant-based meals. Thus, not only information, but, more importantly, education regarding food characteristics and its impact on society should be the focus of policymakers. Understanding the drivers and barriers of food choices is vital for informing future food policy to promote healthier and more sustainable choices rich in plant-based foods, both for Portugal as well as for other European countries, particularly the southern ones with similar culture and where the Mediterranean diet is highly promoted. [ABSTRACT FROM AUTHOR]

Objective: This study examined the relationship between reformulation and food price in Canadian packaged foods and beverages between 2017 and 2020., Design: Matched foods and beverages in the University of Toronto Food Label Information and Price 2017 and 2020 databases were analysed ( n 5774). Price change by food category and by retailer were compared using Wilcoxon signed-rank tests. The proportion of products with changes in calories and nutrient levels were determined, and mixed-effects models were used to examine the relationship between reformulation and price changes. The Food Standards Australia New Zealand (FSANZ) nutrient profiling model was applied to calculate nutritional quality scores, and mixed-effects models were used to assess if changes in nutritional quality score were associated with price changes., Setting: Large grocery retailers by market share in Canada., Participants: Foods and beverages available in 2017 and 2020., Results: Food price changes differed by retailer and by food category (e.g. increased in Bakery, Snacks, etc; decreased in Beverages, Miscellaneous, etc.). Nutrient reformulation was minimal and bidirectional with the highest proportion of products changing in sodium (17·8 %; 8·4 % increased and 9·4 % decreased). The relationship between nutrient reformulation and price change was insignificant for all nutrients overall and was not consistent across food categories. Average FSANZ score did not change (7·5 in both years). For Legumes and Combination dishes, improvements in nutritional quality were associated with a price decrease and increase, respectively., Conclusions: Stronger policies are required to incentivise reformulation in Canada. Results do not provide evidence of reformulation impacting food prices.

Objective: This study examined changes food and drink purchasing during the first 3 months of the COVID-19 pandemic in England, and if changes varied by population subgroups., Design: We investigated changes in take-home food and drink purchasing and frequency of out-of-home (OOH) purchasing using an interrupted time series analysis design. The start of pandemic restrictions (the intervention) was defined as 16 March 2020, when first announced in the UK., Setting: London and the North of England., Participants: 1245 households reporting take-home and 226 individuals reporting OOH purchases between January 2019 and mid-June 2020 from the GB Kantar Fast Moving Consumer Goods Panel., Results: The marginal mean estimate of total take-home energy purchased was 17·4 % (95 % CI 14·9, 19·9) higher during the pandemic restriction period compared with the counterfactual. Increases of 35·2 % (95 % CI 23·4, 47·0) in take-home volume of alcoholic beverages and 1·2 % (95 % CI 0·1, 2·4) in foods and drinks high in fat, salt and sugar were observed. Reductions in purchased energy from fruit and vegetables (-7·3 %, 95 % CI -10·9, -3·6), ultra-processed foods (-4·0 %, 95 % CI -5·2, -2·8) and in OOH purchasing frequency (-44·0 %, 95 % CI -58·3, -29·6) were observed. Changes in chocolate and confectionery, soft drink and savoury snack purchases levelled off over time. Changes in all studied outcomes varied by sociodemographic characteristics and usual purchasing., Conclusions: Pandemic restrictions were associated with positive and negative changes in food and drink purchasing, which differed by individual characteristics. Future research should ascertain if changes persist and translate into changes in health.

Background: Different food price sources and dietary assessment tools may impact the estimation of diet costs and hamper our understanding of the relationship between diet costs and dietary intakes., Objectives: We aimed to investigate the effect of 3 diet cost derivation methods, with increasing numbers of food prices and geographic specificity, holding consistent the dietary assessment tool, on the estimation of diet costs overall and by food group., Methods: We matched 24-h dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) to food price data from 3 Canadian Consumer Price Index (CPI) food price lists; national short list, national long list, and provincial long list. We compared the daily ($/day) and energy-adjusted ($/2000 kcal) diet costs overall and by food groups for the overall population (4+), children (4-18), and adults (19+)., Results: The proportion of dietary intakes (grams) that were covered by CPI prices significantly increased from the national short list to the national long list but did not significantly differ from the national long list to the provincial long list. The national short list resulted in the highest daily and energy-adjusted diet costs overall. No difference in diet costs was noted between the national and provincial long lists. Diet costs for 4 food groups-additions, sweets, fruits, and vegetables, which were poorly covered by the national short list-significantly differed using the national and provincial long lists. All 3 diet cost methods were significantly correlated with energy intakes; however, a strong/very strong correlation was detected for children, and a weak/moderate correlation for adults., Conclusions: The choice of food price data may introduce bias in the diet cost estimate, as well as limiting our understanding of how individuals allocate their diet costs. Refinement of diet cost estimation methodology and measures can strengthen future studies of how consumers allocate their purchases to their diets., Competing Interests: Conflict of interest The authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the locations of food and beverage acquisition in Brazil, according to the level of food processing and household location (urban/rural)., Methods: Data from 49,489 households from the Household Budget Survey 2017-2018 were used. Information regarding food and beverages was collected through a collective acquisition booklet over 7 consecutive days. Locations were classified into 10 groups on the basis of similarities in sales structure and mode of food offering, and food and beverages were categorized according to the NOVA classification. The frequency of households acquiring food in each location was estimated, as well as the acquisition frequency according to processing level, considering significance through non-overlapping 95% confidence intervals., Results: Half of the households (51.9%) acquired food in supermarkets, contributing to both the acquisition of fresh and minimally processed foods (92.2% in urban; 90.2% in rural) and ultra-processed foods (78.6% in urban; 74.1% in rural). For the urban area, the Supermarket (55.0%), Bakery (46.5%) and Small markets (43.1%) are among the places with the highest frequency of food acquisition, while for rural areas, it is found that Small Markets (53%), Supermarkets (32.3%) and Home production (31.0%) presented the highest frequencies., Conclusion: The acquisition of food and beverages for household consumption in Brazil differs according to household location (urban/rural), indicating the importance of the community food environment in the consumption patterns of ultra-processed foods.

Cell-cultured meat has received favorable press and is being touted as a replacement for the entire livestock industry. The objective of the study was to determine what it will cost to produce cell-cultured meat in a large-scale ($60 million) production facility that produces 540,000 kg of product annually. Many of the funders behind this industry hope to reduce the environmental and land impacts of our current agricultural system. Although the initial goal is to use stem cells that must be replenished directly from animals, many firms want to develop cell lines that allow them to be independent of animals in the future. The technologies used to produce cell-cultured meat are continuously being improved, so there is still much uncertainty on what the final product will cost. Previous research has focused primarily on the cost of the cell-culture medium—a liquid or gel designed to support the growth of cells—rather than other potentially important costs. We estimate startup, production, employment, and transportation costs in addition to available cell-culture medium costs and expected output per batch to create a full-detailed enterprise budget. Cost estimates are calculated using (1) cell-cultured bioprocess information from published literature; (2) bioreactor and cold storage infrastructure information from engineers; and (3) prices and quantities of other relevant costs obtained from public and private sources. Results suggest that the cell-cultured meat industry has a long way to go before it can operate and make an acceptable return on investment. Assuming that technology will be developed to reduce the cost of the medium including growth hormone substitutes and buying ingredients in bulk, 1 kg of cell-cultured meat is estimated to cost $63/kg to produce in a large-scale facility. The three major costs of production are the cell-culture medium, bioreactors, and labor. These costs make up over 80% of the overall cost of production.

Plant-based diets are often promoted as healthier and more sustainable and thus as a mechanism to achieve the targets proposed to mitigate climate change and noncommunicable diseases. However, plant-based diets can be perceived as more expensive than the common omnivorous diets, when considering the expensive novel meat substitutes and also the higher costs of fruits and vegetables, whose consumption is perceived to increase. Therefore, the present study assesses the question: Do plant-based consumers spend more on food compared to omnivorous consumers? Based on primary data (n = 1040) collected through an online survey, representative of the Portuguese population, through logistic regressions, it was possible to conclude that plant-based consumers, particularly vegan, are associated with lower food expenditures compared to omnivorous consumers. In fact, plant-based consumers are shown to spend less than all other consumers assessed. Food policies aligning healthiness and sustainability with affordability can deliver a major boost for the promotion of plant-based diets and help achieve the mitigation targets proposed. [ABSTRACT FROM AUTHOR]

ABSTRACT OBJECTIVE To evaluate the trend of household food acquisition according to the NOVA classification in Brazil between 1987–1988 and 2017–2018. METHODS We used household food acquisition data from five editions of the Pesquisas de Orçamentos Familiares (Household Budget Surveys), conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), in the years 1987–1988, 1995–1996, 2002–2003, 2008–2009, and 2017–2018. All reported foods were categorized according to the NOVA classification. The household availability of food groups and subgroups was expressed through their share (%) in total calories, for all Brazilian families, by household situation (urban or rural), for each of the five geographic regions of the country, by fifths of the household income per capita distribution (2002–2003, 2008–2009 and 2017–2018 surveys), and for the 11 main urban regions of the country (1987–1988, 1995–1996, 2002–2003, 2008–2009 and 2017–2018 surveys). Linear regression models were used to assess the trend of increasing or decreasing food purchases. RESULTS The diet of the Brazilian population is still composed predominantly of foods in natura or minimally processed and processed culinary ingredients. However, our findings point to trends of increasing share of ultra-processed foods in the diet. This increase of 0.4 percentage points per year between 2002 and 2009 slowed down to 0.2 percentage points between 2008 and 2018. The consumption of ultra-processed food was higher among households with higher income, in the South and Southeast regions, in urban areas, and in metropolitan regions. CONCLUSION Our results indicate an increase in the share of ultra-processed foods in the diet of Brazilians. This is a worrisome scenario, since the consumption of such foods is associated with the development of diseases and the loss of nutritional quality of the diet.

Rural households in East Africa rely on local markets, but the influence of market food diversity and household food purchase diversity on diets has not been well-characterized. We quantify the associations among market food diversity, household food purchase diversity and dietary diversity of mothers, fathers and children in rural Tanzania. This study uses baseline data from a randomized controlled trial, Engaging Fathers for Effective Child Nutrition and Development in Tanzania. We used the 10 food groups for women's dietary diversity to assess the seasonal availability of nutritious foods in 79 markets. Using data from 957 rural households in two districts in Mara, Tanzania, we measured household food purchase diversity over the previous month and dietary diversity among children (6-23 months), mothers and fathers. Overall, 63% of markets sold all 10 food groups throughout the year, indicating high-market food diversity and minimal seasonality. However, only 33% of women and 35% of children met dietary diversity recommendations. Households that reported higher purchasing power (0.14, p < 0.001), lived within 30 min of a market (0.36, p = 0.001) and had access to a highly diverse market (0.37, p = 0.01) purchased a higher diversity of foods. In turn, food purchase diversity was positively associated with the dietary diversity of mothers (p < 0.001) and children 9-23 months (p < 0.001) but not fathers (p = 0.56). Interventions must account for food availability and access in local markets, and promoting diverse food purchases may be an effective strategy to improve women's and children's diets in rural areas., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: Poor-quality diets are a major risk factor for noncommunicable diseases. Few studies in Mexico have tested whether higher expenditures are needed to purchase high-quality food., Objective: The objective of the study was to assess how dietary quality of food purchases was associated with household food at home expenditures., Design: This study was a secondary analysis of cross-sectional data from the National Household Income and Expenditure Survey (EncuestaNacional de Ingresos y Gastos de los Hogares [ENIGH] 2018)., Participants/setting: The study included 74 469 households with information on food and beverage purchases in Mexico in 2018., Main Outcome Measures: Quarterly household food at home expenditures by adult equivalent (AE) for all food groups that were scored with the Global Dietary Quality Score (GDQS) for food purchases expressed in dollars/quarterly/AE., Statistical Analyses Performed: Adjusted generalized linear models were used to evaluate the association between GDQS for food purchases (expressed in tertiles: low, mid, and high) and quarterly food expenditures. The analyses were performed at the national level by place of residence and income quintile., Results: At the national level, the difference in food expenditures between the high- and the low-GDQS groups was +$13.85/AE. By place of residence, the difference between the high- and the low-GDQS groups was +$17.31/AE in urban and +$5.12/AE in rural areas. For income quintile 1 (lowest), there was a statistical difference of -$4.79/AE and +$43.25 for quintile 5 (highest)., Conclusions: Quality of food purchases can be associated with higher or lower expenditures depending on the specific food purchased. High GDQS is associated with lower expenditures among the lowest-income households as they purchase less expensive options compared with high-income households., (Copyright © 2025 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

This article summarizes the substantial contribution of federal women agricultural economists in producing unique research reliant on restricted federal data; the female economist‐led expansion of Economic Research Service (ERS) and other research programs into new, contemporary areas beyond production agriculture; the development of data on contemporary issues; and the widely distributed explosion of new work in those new areas enabled by access to ERS data and resources to researchers outside the agency. Important facilitation by ascendant female leadership in ERS and other government agencies is emphasized. Related Content: Contributions of women at the intersection of agricultural economics and environmental and natural resource economics Related Content: How women in agricultural economics expanded the profession's role in food safety and nutrition Related Content: How women saved agricultural economics [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the trend of household food acquisition according to the NOVA classification in Brazil between 1987-1988 and 2017-2018. METHODS: We used household food acquisition data from five editions of the Pesquisas de Orçamentos Familiares (Household Budget Surveys), conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), in the years 1987-1988, 1995-1996, 2002-2003, 2008-2009, and 2017-2018. All reported foods were categorized according to the NOVA classification. The household availability of food groups and subgroups was expressed through their share (%) in total calories, for all Brazilian families, by household situation (urban or rural), for each of the five geographic regions of the country, by fifths of the household income per capita distribution (2002-2003, 2008-2009 and 2017-2018 surveys), and for the 11 main urban regions of the country (1987-1988, 1995-1996, 2002-2003, 2008-2009 and 2017-2018 surveys). Linear regression models were used to assess the trend of increasing or decreasing food purchases. RESULTS: The diet of the Brazilian population is still composed predominantly of foods in natura or minimally processed and processed culinary ingredients. However, our findings point to trends of increasing share of ultra-processed foods in the diet. This increase of 0.4 percentage points per year between 2002 and 2009 slowed down to 0.2 percentage points between 2008 and 2018. The consumption of ultra-processed food was higher among households with higher income, in the South and Southeast regions, in urban areas, and in metropolitan regions. CONCLUSION: Our results indicate an increase in the share of ultra-processed foods in the diet of Brazilians. This is a worrisome scenario, since the consumption of such foods is associated with the development of diseases and the loss of nutritional quality of the diet. [ABSTRACT FROM AUTHOR]

Copyright of Food Science & Technology & Economy is the property of Grain Science & Technology & Economy Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Indigenous communities in the North American Arctic are characterized by mixed economies that feature hunting, fishing, gathering, and trapping activities-and associated sharing practices-alongside the formal wage economy. The region is also undergoing rapid social, economic, and climate changes, including, in Canada, carbon taxation, which is impacting the cost of fuel used in local food harvesting. Because of the importance of local foods to nutrition, health, and well-being in Arctic Indigenous communities, there is an urgent need to better understand the sensitivity of Arctic food systems to social, economic, and climate changes and to develop plans for mitigating potential adverse effects. Here, we develop a Bayesian model to calculate the substitution value and carbon emissions of market replacements for local food harvests in the Inuvialuit Settlement Region, Canada. Our estimates suggest that under plausible scenarios, replacing locally harvested foods with imported market substitutes would cost over 3.1 million Canadian dollars per year and emit over 1,000 tons of CO 2 -equivalent emissions per year, regardless of the shipping scenario. In contrast, we estimate that gasoline inputs to harvesting cost approximately $295,000 and result in 315 to 497 tons of emissions. These results indicate that climate change policies that fail to account for local food production may undermine emissions targets and adversely impact food security and health in Arctic Indigenous communities, who already experience a high cost of living and high rates of food insecurity., Competing Interests: Competing interests statement:This article was developed from an impact report completed by E.R. under contract for the Inuvialuit Regional Corporation.

School food environments contribute to children's nutritional intake and overall health. As such, the World Health Organization and other public health organizations encourage policies that restrict children's access and exposure to foods and beverages that do not build health in and around schools. This global scoping review explores the presence and characteristics of policies that restrict competitive food sales and marketing for unhealthy foods across 193 countries using evidence from policy databases, gray literature, peer-reviewed literature, and primary policy documents. Policies were included if they were nationally mandated and regulated marketing and/or competitive foods in the school environments. Worldwide, only 28% of countries were found to have any national-level policy restricting food marketing or competitive food sales in schools: 16% of countries restrict marketing, 25% restrict competitive foods, and 12% restrict both. Over half of policies were found in high-income countries. No low-income countries had either policy type. Eight marketing policies (27%) and 14 competitive foods policies (29%) lacked explicit guidelines for either policy monitoring or enforcement. Future research is needed to assess the prevalence of policies aimed at improving other key aspects of the school food environment, such as dietary quality of school meals or food procurement, as well as assess the implementation and efficacy of existing policies., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Evidence for the effect of neighbourhood food environment (NFE) exposures on diet in the UK is mixed, potentially due to exposure misclassification. This study used the first national COVID-19 lockdown in England as an opportunity to isolate the independent effects of the NFE exposure on food and drink purchasing, and assessed whether these varied by region., Methods: Transaction-level purchasing data for food and drink items for at-home (1,221 households) and out-of-home consumption (171 individuals) were available from the GB Kantar Fast Moving Consumer Goods Panel for London and the North of England. The study period included 23rd March to 10th May 2020 ('lockdown'), and the same period in 2019 for comparison. NFE exposures included food outlet density and proximity, and NFE composition within a 1 km network buffer around the home. Associations were estimated for both years separately, adjusted for individual and household characteristics, population density and area deprivation. Interaction terms between region and exposures were explored., Results: There were no consistent patterns of association between NFE exposures and food and drink purchasing in either time period. In 2019, there was some evidence for a 1.4% decrease in energy purchased from ultra-processed foods for each additional 500 m in the distance to the nearest OOH outlet (IR 0.986, 95% CI 0.977 to 0.995, p = 0.020). In 2020, there was some evidence for a 1.8% reduction in total take-home energy for each additional chain supermarket per km2 in the neighbourhood (IR 0.982, 95% CI 0.969, 0.995, p = 0.045). Region-specific effects were observed in 2019 only., Discussion: Findings suggest that the differences in exposure to the NFE may not explain differences in the patterns or healthiness of grocery purchasing. Observed pre-pandemic region-specific effects allude to the importance of geographical context when designing research and policy. Future research may assess associations for those who relied on their NFE during lockdown., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kalbus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Globalization, income growth and changing cultural trends are believed to prompt consumers in low-income countries to adopt the more affluent diet of high-income countries. This study investigates the convergence of food expenditure patterns worldwide, focusing on total food expenditure, raw food categories and ultra-processed foods and beverages across more than 90 countries over the past decades. Contrary to prior belief, we find that food expenditure patterns of lower-income countries do not universally align with those of higher-income nations. This trend is evident across most raw food categories and ultra-processed foods and beverages, as the income level of a country continues to play a crucial role in determining its food expenditure patterns. Importantly, expenditure patterns offer estimates rather than a precise idea of dietary intake, reflecting consumer choices shaped by economic constraints rather than exact dietary consumption., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Given the impact of food consumption on climate change and the scarcity of natural resources, along with its effect on public health, a new dietary transition away from environmentally burdensome and unhealthy foods is needed. To promote such a transition in the dietary habits of consumers, it is crucial to understand what motivates their consumption habits. Therefore, this study seeks to assess potential drivers of a new dietary transition. Drivers such as income, prices, education, human development, and environmental awareness were assessed for 25 countries around the world over the last two decades. The panel-corrected standard errors estimator was computed to control for data specificities. Results revealed that prices, education and environmental awareness promote the new dietary transition, while income, human development, and globalization may act as barriers. Moreover, evidence of an Environmental Kuznets Curve was found. To meet sustainability targets, strategies that can help developing countries “tunnel” through this curve are recommended. Education and information campaigns, along with price mechanism strategies could be effective ways to promote the new dietary transition. Food policymakers need to understand what drives this transition, so they can design effective and efficient strategies that promote economic growth while guaranteeing sustainable development.

The study examines the relationship between the corporate social responsibility (CSR) investments of a food firm, an activist's incentive to target the firm to uncover and deter fraudulent behavior, and the firm's incentive to commit food fraud. Specifically, we develop a game theoretic model to analyze the strategic interaction between a food firm that decides whether to provide a credence food attribute and whether to misrepresent the quality of its product, and an activist who decides whether to monitor the firm and launch a campaign to uncover and remove false/misleading quality claims. We further examine the effect of CSR and the activist's presence on the level of quality the firm provides. We derive the conditions under which an activist will find it optimal to monitor the firm to uncover fraudulent quality claims and the firm will find it optimal to misrepresent its product quality. Analytical results show that the greater the firm's CSR investments, the less likely it is that the activist will find it optimal to monitor the firm, and the more likely it is that the firm will find it optimal to misrepresent its product quality. Results also show that the firm is more likely to misrepresent its product quality when its effectiveness in contesting the activist's campaign is relatively high, and more likely to actually provide a high-quality product when the cost of the credence attribute is relatively low., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Deka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Retailers have been using promotion as a differentiation strategy that influences consumers' expenditures and their shopping basket budgetary allocation. This study assessed the effect of retail promotions on total shopping basket expenditure and determined whether promotions provoke a reallocation of the shopping budget. The analysis was performed on a chain of supermarkets in Catalonia, Spain using a consumer scanner data set from Kantar Worldpanel for 2017. The methodological approach had two steps: prediction of the effect of promotion on household expenditures using an expenditure regression model and estimation of the promotion own- and cross-effect using the censored Exact Affine Stone Index. Promotion had a positive own-effect and mostly a negative asymmetric cross-effect, implying a small but significant budget reallocation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mehaba et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: This study aimed to assess the reliability and validity of an online approach to monitoring food affordability in Ontario using the updated Ontario Nutritious Food Basket (ONFB). Methods: The ONFB was priced online in 12 large multi-chain grocery stores to test intra-/inter-rater reliability using percent agreement and intra-class correlations (ICCs). Then, the ONFB was priced in-store and online in 28 stores to estimate food price differences using paired t-tests and Pearson's correlation for all (n =1708) and matched items (same product/brand and purchase unit) (n = 1134). Results: Intra-/inter-rater agreement was high (95.4%/81.6%; ICC = 0.972, F = 69.9, p  < 0.001). On average, in-store prices were less than $0.02 lower than online prices. There were no significant differences between mean in-store and online prices for all items (t = 0.504 p  = 0.614). The mean price was almost perfectly correlated between in-store and online (fully matched: R = 0.993 p  < 0.001; all items: R = 0.967 p  < 0.001). Online monthly ONFB estimates for a family of four were strongly correlated (R = 0.937 p  < 0.001) with estimates calculated using in-store data. Conclusions: Online pricing is a reliable and valid approach to food costing in Ontario that contributes to modernizing the monitoring of food affordability in Canada and abroad.

Switching between similar food and beverage products may reduce greenhouse gas emissions (GHGe). Here, using consumer data linked to 23,550 product-specific GHGe values, we estimated annual GHGe attributable to product purchases consumed at home in Australia and calculated reductions from specific switches. Potential changes to mean Health Star Rating, mean energy density and the proportion of ultraprocessed foods purchased were assessed. Approximately 31 million tonnes of GHGe were attributable to products consumed at home in 2019, the three highest contributors of GHGe being 'meat and meat products' (49%), 'dairy' (17%) and 'non-alcoholic beverages' (16%). Switching higher-emission products for 'very similar' lower-emission products could reduce total emissions by 26%. Switches to 'less similar' lower-emission products could lead to a 71% reduction. Switches had little impact on the average Health Star Rating, energy density of purchases and proportion of ultraprocessed foods purchased. Directing manufacturing and marketing towards lower-environmental-impact products and signposting such options to consumers are key., (© 2024. The Author(s).)

The present study aims to analyze the trends in food price in Brazil with emphasis on the period of the Covid-19 pandemic (from March 2020 to March 2022). Data from the Brazilian Household Budget Survey and the National System of Consumer Price Indexes were used as input to create a novel data set containing monthly prices (R$/Kg) for the foods and beverages most consumed in the country between January 2018 and March 2022. All food items were divided according to the Nova food classification system. We estimated the mean price of each food group for each year of study and the entire period. The monthly price of each group was plotted to analyze changes from January 2018 to March 2022. Fractional polynomial models were used to synthesize price changes up to 2025. Results of the present study showed that in Brazil unprocessed or minimally processed foods and processed culinary ingredients were more affordable than processed and ultra-processed foods. However, trend analyses suggested the reversal of the pricing pattern. The anticipated changes in the prices of minimally processed food relative to ultra-processed food, initially forecasted for Brazil, seem to reflect the impact of the Covid-19 pandemic on the global economy. These results are concerning as the increase in the price of healthy foods aggravates food and nutrition insecurity in Brazil. Additionally, this trend encourages the replacement of traditional meals for the consumption of unhealthy foods, increasing a health risk to the population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Andrade et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Malnutrition poses a substantial challenge in Somalia, impacting approximately 1.8 million children. This critical issue is exacerbated by a multifaceted interplay of factors. Consequently, this study seeks to examine the long-term and short-term effects of armed conflicts, food price inflation, and climate variability on global acute malnutrition in Somalia., Methods: The study utilized secondary data spanning from January 2015 to December 2022, sourced from relevant databases. Two distinct analytical approaches were employed to comprehensively investigate the dynamics of global acute malnutrition in Somalia. Firstly, dynamic autoregressive distributed lag (ARDL) simulations were applied, allowing for a nuanced understanding of the short and long-term effects of armed conflicts, food price inflation, and climate variability on malnutrition. Additionally, the study employed kernel-based regularized least squares, a sophisticated statistical technique, to further enhance the robustness of the findings. The analysis was conducted using STATA version 17., Results: In the short run, armed conflicts and food price inflation exhibit positive associations with global acute malnutrition, particularly in conflict-prone areas and during inflationary periods. Moreover, climatic variables, specifically temperature and rainfall, demonstrate positive associations. It is important to note that temperature lacks a statistically significant relationship with global acute malnutrition in the short run. In the long run, armed conflicts and food price inflation maintain persistent impacts on global acute malnutrition, as confirmed by the dynamic ARDL simulations model. Furthermore, both temperature and rainfall continue to show positive associations with global acute malnutrition, but it is worth noting that temperature still exhibits a non-significant relationship. The results from kernel-based regularized least squares were consistent, further enhancing the robustness of the findings., Conclusions: Increased armed conflicts, food price inflation, temperature, and rainfall were associated with increased global acute malnutrition. Strategies such as stabilizing conflict-prone regions, diplomatic interventions, and peace-building initiatives are crucial, along with measures to control food price inflation. Implementing climate adaptation strategies is vital to counter temperature changes and fluctuating rainfall patterns, emphasizing the need for resilience-building. Policymakers and humanitarian organizations can leverage these insights to design targeted interventions, focusing on conflict resolution, food security, and climate resilience to enhance Somalia's overall nutritional well-being., (© 2024. The Author(s).)

Background: The WHO highlight alcohol, tobacco, unhealthy food, and sugar-sweetened beverage (SSB) taxes as one of the most effective policies for preventing and reducing the burden of non-communicable diseases. This umbrella review aimed to identify and summarise evidence from systematic reviews that report the relationship between price and demand or price and disease/death for alcohol, tobacco, unhealthy food, and SSBs. Given the recent recognition as gambling as a public health problem, we also included gambling., Methods: The protocol for this umbrella review was pre-registered (PROSPERO CRD42023447429). Seven electronic databases were searched between 2000-2023. Eligible systematic reviews were those published in any country, including adults or children, and which quantitatively examined the relationship between alcohol, tobacco, gambling, unhealthy food, or SSB price/tax and demand (sales/consumption) or disease/death. Two researchers undertook screening, eligibility, data extraction, and risk of bias assessment using the ROBIS tool., Results: We identified 50 reviews from 5,185 records, of which 31 reported on unhealthy food or SSBs, nine reported on tobacco, nine on alcohol, and one on multiple outcomes (alcohol, tobacco, unhealthy food, and SSBs). We did not identify any reviews on gambling. Higher prices were consistently associated with lower demand, notwithstanding variation in the size of effect across commodities or populations. Reductions in demand were large enough to be considered meaningful for policy., Conclusions: Increases in the price of alcohol, tobacco, unhealthy food, and SSBs are consistently associated with decreases in demand. Moreover, increasing taxes can be expected to increase tax revenue. There may be potential in joining up approaches to taxation across the harm-causing commodities., (© 2024. The Author(s).)

Objective: To evaluate differences in the percentage of expenditure on food groups in Mexican households according to the gender of the household head and the size of the locality., Design: Analysis of secondary data from the National Household Income and Expenditure Survey (ENIGH) 2018. We estimated the percentage of expenditure on fifteen food groups according to the gender of the head of household and locality size and evaluated the differences using a two-part model approach., Setting: Mexico, 2018., Participants: A nationally representative sample of 74 647 Mexican households., Results: Female-headed households allocated a lower share of expenditure to the purchase of sweetened beverages and alcoholic beverages and higher percentages to milk and dairy, fruits and water . In comparison with metropolitan households, households in rural and urban localities spent more on cereals and tubers , sugar and honey , oil and fat and less on food away from home., Conclusions: Households allocate different percentages of expenditure to diverse food groups according to the gender of the head of the household and the size of the locality where they are located. Future research should focus on understanding the economic and social disparities related to differences in food expenditure, including the gender perspective.

Importance: Point-of-sale food messaging can encourage healthier purchases, but no studies have directly compared multiple interventions in the field., Objective: To examine which of 4 food and beverage messages would increase healthier vending machine purchases., Design, Setting, and Participants: This randomized trial assessed 13 months (February 1, 2019, to February 29, 2020) of vending sales data from 267 machines and 1065 customer purchase assessments from vending machines on government property in Philadelphia, Pennsylvania. Data analysis was performed from March 5, 2020, to November 8, 2022., Interventions: Study interventions were 4 food and beverage messaging systems: (1) beverage tax posters encouraging healthy choices because of the Philadelphia tax on sweetened drinks; (2) green labels for healthy products; (3) traffic light labels: green (healthy), yellow (moderately healthy), or red (unhealthy); or (4) physical activity equivalent labels (minutes of activity to metabolize product calories)., Main Outcomes and Measures: Sales data were analyzed separately for beverages and snacks. The main outcomes analyzed at the transaction level were calories sold and the health status (using traffic light criteria) of each item sold. Additional outcomes were analyzed at the monthly machine level: total units sold, calories sold, and units of each health status sold. The customer purchase assessment outcome was calories purchased per vending trip., Results: Monthly sales data came from 150 beverage and 117 snack vending machines, whereas 1065 customers (558 [52%] male) contributed purchase assessment data. Traffic light labels led to a 30% decrease in the mean monthly number of unhealthy beverages sold (mean ratio [MR], 0.70; 95% CI, 0.55-0.88) compared with beverage tax posters. Physical activity labels led to a 34% (MR, 0.66; 95% CI, 0.51-0.87) reduction in the number of unhealthy beverages sold at the machine level and 35% (MR, 0.65; 95% CI, 0.50-0.86) reduction in mean calories sold. Traffic light labels also led to a 30-calorie reduction (b = -30.46; 95% CI, -49.36 to -11.56) per customer trip in the customer purchase analyses compared to physical activity labels. There were very few significant differences for snack machines., Conclusions and Relevance: In this 13-month randomized trial of 267 vending machines, the traffic light and physical activity labels encouraged healthier beverage purchases, but no change in snack sales, compared with a beverage tax poster. Corporations and governments should consider such labeling approaches to promote healthier beverage choices., Trial Registration: ClinicalTrials.gov Identifier: NCT06260176.

The role of culture in connection with the development of food and bioeconomy issues has gained growing importance in recent years. In this editorial we provide background information on the three key topics addressed by the papers published in this special issue: cultural ecosystem services, cultural issues in the organisation of food chains, culture and food characteristics. In a way, the common denominator of these papers is the link between culture, food and territory, taken from different angles. More research and methodological advances are needed for a better consideration of culture in economic research accounting for the current needs of more systemic and holistic vision of the topic.

V této studii popisujeme aplikaci analýzy citlivosti při stanovení vlivu růstu mezd na ziskovost produktů průmyslové pekárny podnikající v České republice. Analýza citlivosti zisku je provedena pro 3 nejprodávanější výrobky průmyslové pekárny, kterými jsou bochník chleba, rohlík a houska s využitím nákladových kalkulací výrobků a také informací o prodejích výrobků a nákupních cenách vstupů do výrobního procesu v období 2009 – 2017. Výsledky studie ukazují, že u všech zkoumaných výrobků nepředstavuje růst mezd nejvýznamnější faktor z hlediska vlivu na ziskovost. Nejvýznamnějšími faktory u všech zkoumaných výrobků jsou jejich prodejní ceny a také nákupní ceny mouky. Dále bylo prokázáno, že růst mezd neohrožuje žádný ze zkoumaných výrobků z pohledu jejich rentability.

With the growing population and increasing purchasing power, the sustainability of the food sector is questioned as environmental externalities derive from consumption, mainly the emission of greenhouse gases, which contribute to climate change. Academic literature has suggested strategies to efficiently manage food consumption, but one of the main implications is to reduce meat consumption. Such a reduction would mitigate climate change and other environmental externalities as well as reduce health-related problems. However, the livestock sector is also a relevant economic sector for the subsistence of any economy. Therefore, this reduction could threaten economic growth. Following a sample of 14 European high-income countries over more than four decades, the impact of food consumption on economic growth is assessed. Results suggest that both meat and plant-based consumption contribute positively to economic growth. Consequently, a reduction in meat consumption could have a negative impact on the economy. However, strategies to both reduce meat consumption and promote economic growth are discussed in line with the results, with plant-based foods as an efficient option to solve the dilemma. Furthermore, specific strategies for both the supply and the demand side, education on food production and consumption are recommended, particularly in primary schools. Children could learn about healthy and sustainable dietary habits that would not hamper economic growth, as these should be the seeds of future consumption habits. [ABSTRACT FROM AUTHOR]

The role of culture in connection with the development of food and bioeconomy issues has gained growing importance in recent years. In this editorial we provide background information on the three key topics addressed by the papers published in this special issue: cultural ecosystem services, cultural issues in the organisation of food chains, culture and food characteristics. In a way, the common denominator of these papers is the link between culture, food and territory, taken from different angles. More research and methodological advances are needed for a better consideration of culture in economic research accounting for the current needs of more systemic and holistic vision of the topic. [ABSTRACT FROM AUTHOR]

Background: Environmental factors can impact the ability of food retail businesses to implement best practice health-enabling food retail., Methods: We co-designed a short-item survey on factors influencing food retail health-enabling practice in a remote Australian setting. Publicly available submissions to an Australian Parliamentary Inquiry into food pricing and food security in remote Indigenous communities were coded using an existing remote community food systems assessment tool and thematically analysed. Themes informed survey questions that were then prioritised, refined and pre-tested with expert stakeholder input., Results: One-hundred and eleven submissions were coded, and 100 themes identified. Supply chain related data produced the most themes (n = 25). The resulting 26-item survey comprised questions to assess the perceived impact of environmental factors on a store's health-enabling practice (n = 20) and frequency of occurrence (n = 6)., Conclusions: The application of this evidence-informed, co-designed survey will provide a first-time cross-sectional analysis and the potential for ongoing longitudinal data and advocacy on how environmental factors affect the operations of remote stores., (© 2024. The Author(s).)

Food plays a vital role in human sustenance and well-being, and the fluctuations in its price exert a significant impact on the attainment of the Sustainable Development Goals (SDGs) from social, economic, and environmental perspectives. This paper conducts an analysis utilizing data from 163 countries, revealing that an upsurge in global food commodity prices entails trade-offs with 13 SDGs, while exhibiting synergies with a few others. By considering specific food products, various types of countries, and the supply and demand shocks, further analysis confirms predominantly negative associations between spikes in food prices and the SDGs. Our findings highlight the urgent imperative to mitigate abrupt increases in food prices, such as those witnessed during the 2022 food crisis, to ensure the comprehensive fulfillment of the 2030 agenda for SDGs., Competing Interests: The authors declare no competing interests., (© 2024 The Author(s).)

Context: Corporate engagement with food and beverage companies who produce food associated with health harms is a divisive topic in the global nutrition community, with high-profile cases of conflict of interest increasingly coming under scrutiny. There is a need for an agreed method to support health organizations in deciding whether and how to engage with large food and beverage manufacturers., Aim: The aim of this study was to develop a method to quantify the proportion of sales from food and beverage companies that are derived from unhealthy foods to support organizations in determining which companies might be considered high-risk for engagement., Methods: The 2015 WHO Euro nutrient profile model was applied to 35,550 products from 1294 brands manufactured by the top 20 global food and beverage companies from seven countries (Australia, Brazil, China, India, South Africa, UK and USA). For the purpose of this study, products that met the WHO Euro criteria were classified as "healthier" and those that failed were classified as "unhealthy". Products were grouped by brand and weighted by the brand's value sales for 2020. The primary outcome was the proportion of each company's sales that were classified as unhealthy and healthier by company and category., Results: Overall, 89% of the top 20 companies' brand sales were classified as unhealthy. For every USD$10 spent on the top 20 companies' brands, only $1.10 was spent on products considered healthier. All companies saw the majority of their sales come from unhealthy foods, including soft drinks, confectionery and snacks. None of Red Bull or Ferrero's sales were classified as healthier and less than 5% of total sales were healthier for Mondelēz, Mars, and PepsiCo. Some companies had higher proportions of sales deriving from healthier products, including Grupo Bimbo (48%), Danone (34%) and Conagra (32%), although the majority of their sales were still derived from unhealthy foods., Discussion: The results presented in this study highlight the reliance the leading food and beverage companies have on sales of unhealthy products that are contributing to diet-related disease globally. The method and steps we have laid out here could be used by organizations in the global health community to identify companies that have conflicts of interest when it comes to engaging with governments, international organizations and public health bodies on issues of policy and regulation., (© 2023. The Author(s).)

Objective: This study explored the relationship between health orientation (i.e. individual motivation to engage in healthy attitudes, beliefs and behaviours) and consumers' use of nutritional information on food labels. Specifically, this study analysed the relationship between a number of direct investments in health (namely those behaviours that can contribute directly to maintain a good health status) and use of nutritional information on food labels. Study design: Data for the analysis were collected through face-to-face interviews with a sample of 540 Italian consumers in charge of their grocery shopping. Forty grocery stores, including supermarkets and hypermarkets, were selected using a systematic sampling technique. Methods: Data were analysed using three equations and accounting for endogeneity issues. Results: This study found that those consumer groups with low health orientation (specifically smokers, those who do not exercise regularly, and those with an unhealthy body weight) show little interest in nutritional labels. Conclusion: Nutritional labels as a tool to promote healthier food choices have a limited effect on those consumers in greatest need of pursuing healthier lifestyle habits. Alternative policy intervention should be undertaken to reach these consumer groups. [ABSTRACT FROM AUTHOR]

Context: The Healthy Diné Nation Act (HDNA) of 2014 included a 2% tax on foods of little-to-no-nutritious value ("junk foods") on the Navajo Nation. The law was the first ever in the United States and any Indigenous nation worldwide with a population at a high risk for common nutrition-related conditions. To date, research on community support for food tax legislation among Indigenous nations is entirely lacking., Objective: To assess the extent of support for the HDNA and factors associated with support including sociodemographic variables, knowledge of the HDNA, nutrition intake, and pricing preferences., Design: Cross-sectional survey., Setting: The Navajo Nation., Participants: A total of 234 Navajo Nation community members across 21 communities., Outcome Measures: The percentage of participants who were supportive of the HDNA., Results: Participants were 97% Navajo, on average middle-aged, 67% reported an income below $25 000 annually, and 69.7% were female. Half of the respondents said they "support" (37.4%) or "strongly support" (13.0%) the tax, while another 35% of people said they were neutral or somewhat supportive; 15% did not support the tax. Participants with higher income ( P = .025) and education ( P = .026) and understanding of the legislation ( P < .001 for "very well" vs "not at all") had increased odds of greater support, as did people who believed that the HDNA would make Navajo people healthier (vs not, P < .001). Age, gender, language, and reported nutrition intake (healthy or unhealthy) were not associated with HDNA support, but participants willing to pay 5% or 12%-15% higher prices for fast food and soda had increased odds of greater support ( P values range from .023 to <.001)., Conclusions: The majority of Navajo community members surveyed were moderately supportive of the Navajo Nation tax on unhealthy foods. Higher income and education and understanding of the law were associated with greater support, but nutrition intake was not., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.)