Additional file 2: Summary of identified studies assessing the extent of the government implementation of food environment policies and actions for preventing obesity and diet-related NCDs Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool WHO (2011) Global To assess the current global National NCDs and risk factors The existence of Qualitative method: The WHO global Medium [4] status of level such as tobacco, implementation of review of data from self- questionnaire tool on NCDs including current (detail on harmful use of policy of WHO administered survey assessment of state of progress countries setting not alcohol, breastfeeding, Member States to questionnaires national capacity for are making to address these given) physical activity and NCDs and risk factors NCD prevention and diseases in terms of unhealthy diets against control policies and plans, (no specific details on recommendations of [Yes vs No per infrastructure, surveillance food environments the Global Strategy for item/indicator and and population-wide and given) the Prevention and comparison to individual interventions Control of NCDs baseline] Swinburn et al. Global To assess government National Food composition, The existence and Mixed methods: The INFORMAS High (2013) [5] policies and actions for and food labelling, food level of cross-sectional study Healthy Food creating healthy subnational prices, food provision, implementation of using document review, Environment Policy food environments level, food promotion, food food environment expert consultations and Index various retail, food policies self-administered [0-5 per indicator settings production, and food questionnaires with non- where 0=less than trade and investment government stakeholders 20% implemented compared to international best practice, and 5=80- 100% implementation] WHO (2013) Global To assess progress of National Nutrition-related - The existence and Quantitative method: The WHO Global High [8] implementation of existing and sub- NCDs and malnutrition level of cross-sectional survey Nutrition Policy national policies and national (including food implementation of using self-administered Review questionnaire institutional environments levels, labelling, food nutrition policies and questionnaires with tool related to nutrition various promotion, food programmes government officials of [Yes vs No per settings composition, food - Implementation the WHO Member States indicator and provision and food coverage comparison to prices) baseline] Ardzejewska et Australia To investigate the barriers State level, Food provision The existence of Quantitative method: The Audit Form Low al. (2013) [33] and facilitators to, and the school implementation of the cross-sectional survey [number of actions extent of the setting New South Wales using questionnaires with implemented across implementation of, the ‘Healthy School schools different schools]

1 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool New South Wales Canteen Strategy’ (Australia) ‘Healthy School Canteen Strategy’ Hawkes et al. Global To describe the global National Food marketing to The existence of Qualitative methods: Interview template on Medium (2011) [34] regulatory environment level children government policies cross-sectional study policies and around food marketing to (detail on and actions on food using document review regulations on food children in 2009 and to setting not marketing to children and in-depth interviews marketing to children identify changes in this given) with government and [proportion of environment since 2006 non-government countries with actions stakeholders on food marketing (%)] Holthe et al. Norway To examine how schools National Food provision The level of Mixed methods: Interview guide and Low (2011) [35] implemented the national level, implementation of cross-sectional study observation form guidelines for healthy school Norwegian national using document review, [narrative report] school meals and the extent setting guidelines for healthy self-administered to which the degree of school meals questionnaires, focus (tool not specified for implementation was group interviews with questionnaire) related to the teachers and students, [Yes, Partial, No per organizational capacity of and school observations element] schools Rodriguez- 53 WHO To assess current salty National Food composition and The existence and Qualitative method: The EU framework Medium Fernandez et European reduction policies in level food labelling level of cross-sectional study and eight essential al. (2014) [36] Member countries of the WHO (details on implementation of salt using document review steps proposed by States European Region against settings not reduction policy and electronic WHO the backdrop of varying given) including communication with the [3 levels per indicator levels of human infrastructure WHO Nutrition where level 1=fully development adjusted for supports (i.e. industry Counterparts in the implemented, income, education and involvement and European Member States level2=‘partially health (longevity) monitoring and implemented/planned inequalities evaluation , and level3=non- mechanism) existent] Seo (2009) [37] USA To investigate the impact of Federal Food provision The existence of Quantitative method: Adaptive CDC School Low (Indiana) the law in terms level, implementation of cohort study using self- Health Policies and of school food policies and school school food policies administered Programs Study 2000 food preparation practices setting and food preparation questionnaires with Questionnaire using a prospective design practices school principals or food [Yes vs No per item service directors in 2006 and comparison to

2 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool and 2007 baseline]

Silberfarb. USA To assess multicity Local level, Food provision and The existence of Quantitative method: A policy checklist Low (2014) [38] (Minnesota) implementation of various food promotion implementation of cross-sectional survey [Yes vs No per healthful food access policy, settings policies including using self-administered indicator] systems, and infrastructure questionnaires with environmental changes supports (i.e. multiple city officials monitoring mechanism) Vandevijvere New To describes the design and National Food composition, The existence and Mixed methods: The INFORMAS High et al. (2014) Zealand methods of comprehensive and food labelling, food level of cross-sectional study Healthy Food [39] national survey on the subnational prices, food provision, implementation of using document review, Environment Policy healthiness of food level, food promotion, food policies expert consultations and Index environments and the various retail, food self-administered [0-5 per indicator public and private sector settings production, and food questionnaires with non- where 0=less than policies influencing them trade and investment government stakeholders 20% implemented compared to international best practice, and 5=80- 100% implementation] Vandevijvere New To pilot test the INFORMAS National Food composition, The existence and Mixed methods: Food-EPI tool High et al. (2015) Zealand Healthy Food Environment and food labelling, food level of cross-sectional study [0-5 per indicator [40] Policy Index subnational prices, food provision, implementation of using document review, where 0=less than (Food-EPI), and level, food promotion, food policies expert consultations and 20% implemented revise the tool and process various retail, food self-administered compared to settings production, and food questionnaires with non- international best trade and investment government stakeholders practice, and 5=80- 100% implementation] Olstad et al. Canada To assess how current National, Food and nutrition The level of Mixed methods: The Report Card on Medium (2014) [41] environments and policies provincial/l education, and breast- implementation of cross-sectional study Healthy Food in Canada support or create ocal and milk feeding food environment and using document review, Environments and barriers to improving organizatio (including food nutrition policies and expert consultations and Nutrition for Children children's dietary n levels, composition, food actions targeting self-administered in Canada behaviours and body various labelling, food children questionnaires with [Grade A to F where

3 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool weights settings provision, food researchers, members of A=being implemented promotion and food the Active Healthy Kids so as to affect a large retails) Canada Research Work majority of children Group, and policymakers and youth, and and practitioners F=being implemented so as to affect very few children and youth] WHO/Europe Norway To evaluate the Norwegian National Food and nutrition, The existence of Qualitative methods: Thematic matrix for Medium (2013) [42] Action Plan on Nutrition and local physical activity and implementation of the cross-sectional study guiding the interviews 2007–2011 levels, education Norwegian Action Plan using document review [narrative report] various (including food on Nutrition 2007- and in-depth interviews settings composition, food 2011 with policy makers and provision, food retail, government and non- food labelling, food government stakeholders prices and food promotion) Mâsse et al. Canada To explore the factors Provincial Food and nutrition, The level of Qualitative method: Interview guide with Low (2013) [43] which impeded or level, physical activity and implementation of cross-sectional study broad open-ended facilitated the school education publicly mandated using semi-structured questions with probes implementation of publicly setting (including food physical activity and interviews with school [narrative report] mandated school-based provision) food and beverage principals and key physical activity and sales guidelines teachers/school nutrition guidelines in the informants province of British Columbia (BC), Canada Martin et al. Australia To develop a benchmarking State level, Food and nutrition, The existence of Quantitative method: The Obesity Action Medium (2013) [44] tool for government action various physical activity and implementation of cross-sectional survey checklist on obesity prevention, settings education policies and actions on using self-administered [0-10 per indicator implement it across (including food obesity prevention questionnaires with key where 0=non-existent Australian jurisdictions and marketing, food price non-government action and 10=fully to publicly award the best and affordability, food informants from each implemented] and worst performers retail and food state or territory provision) Barnidge et al. USA To (1) identify types of Federal Food and nutrition, The existence of Qualitative method: Interview protocol Low (2013) [45] environmental and policy level, physical activity and implementation of cross-sectional study [number of actions interventions being community education environmental or using in-depth interviews implemented across

4 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool implemented in rural setting (including food policy interventions to with public health different communities to promote provision and food promote physical professionals from non- communities] physical activity or healthy production) activity and/or healthy profit or local eating, (2) identify barriers eating in rural governments to the implementation communities of environmental or policy interventions, and (3) identify strategies rural communities have employed to overcome these barriers Anderson et al. USA To assess the extent to State level, Food and nutrition, The existence of Quantitative method: The Implementation Medium (2013) [46] (New which MP-recommended municipalit physical activity and implementation of cross-sectional survey and Measurement Hampshire) policies and assets already y setting breast-milk feeding policies and using online self- Guide of exist in New Hampshire (including food infrastructure administered Recommended municipalities promotion, food retail, supports questionnaires with Community Strategies food provision and municipal representatives and Measurements to food prices) Prevent Obesity in the United States [Yes vs No per item] Schwartz et al. USA To assess the strength and Federal Food and nutrition, The level of Quantitative method: The 96 items Wellness Medium (2012) [47] (Connecticu comprehensiveness of 1 level, physical activity and implementation of cross-sectional survey School Assessment t) state’s written district school education district School using self-administered Tool (WellSAT-96) policies using a coding tool, setting (including food Wellness policies questionnaires with [0, 1, 2 per item where and tested whether these provision) school principals 0=policy being not in traits predicted school-level place or don’t know implementation and and 2=policy being practices fully in place] Phillips et al. USA To assess implementation State level, Food and nutrition, The existence and Quantitative method: Scoring policy index Low (2012) [48] (Arkansas) of school policies related to school and physical activity level of cross-sectional survey system tool nutrition and physical setting (including food implementation of using self-administered [0, partial, 1 per activity provision and food nutrition and physical questionnaires with indicator where 0=the promotion) activity policies in school principals and policy did not exist or Arkansas public district superintendents did not meet schools from 2004 recommendations and through 2009 1=the policy existed and met

5 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool recommendations]

Budd et al. USA To characterize the school Federal Food and nutrition, The existence of Quantitative method: The School Wellness Low (2012) [49] wellness policy level, physical activity and implementation of the cross-sectional survey Policies environment nationally and school education School Wellness using self-administered Implementation identify factors influencing setting (including food policies questionnaires with high Questionnaire tool the quality and provision) school representatives [Yes, No, Not sure per effectiveness of policy indicator where implementation Yes=the school took action to implement the policies, and No=the school did not take action to implement the policies] Beam et al. USA To evaluate interim Federal Food and nutrition, The existence of Quantitative method: The Healthy Schools Low (2012) [50] progress in schools level, physical activity and implementation of the cross-sectional survey Program tool receiving hands-on school education Healthy Schools using self-administered [Yes vs No per training from the Healthy setting (including food Program questionnaires with indicator and Schools Program, the provision) school representatives comparison to nation’s largest school- (e.g. school baseline] based program aimed at directors/principals preventing childhood teachers and food service obesity managers) Pitt Barnes et USA To describe the content of Federal Food and nutrition, The existence of Qualitative methods: Interview questions Low al. (2011) [51] local wellness policies of 6 level, physical activity and implementation of cross-sectional study based on information US school districts and school education Local School Wellness using document review, from document steps taken toward their setting (including food policies school visits and in-depth review implementation and provision) interviews with key [narrative report] evaluation stakeholders (including food service directors and physical education staff, principals, teachers, parents, and community partners)

6 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool Gaines et al. USA To evaluate wellness Federal Food and nutrition, The existence of Quantitative method: The policy content Low (2011) [52] (Alabama) policies created by Alabama level, physical activity and implementation of cross-sectional survey checklist public school districts and school education Alabama public school using self-administered [proportion of districts progress made in the setting (including food district Wellness questionnaires with public implemented (%)] implementation of Alabama provision and food policies against school districts State Department of promotion) federal requirements, Education (ALSDE) school and of districts’ food and nutrition implementation of mandates Alabama State Department of Education mandates Haire-Joshu et USA To develop the Missouri State level, Healthy eating and The existence of Qualitative methods: Open-ended questions Low al. (2010) [53] (Missouri) Obesity, Nutrition, and various physical activity implementation of cross-sectional study [proportion of policies Activity Policy Database, a setting including food obesity-related using document review implemented by geographically environments policies and interviews with setting (%)] representative baseline of (no specific details on government and non- Missouri’s existing obesity- food environments government informants related local policies on given) healthy eating and physical activity Belansky et al. USA To describe changes Federal Food and nutrition, The existence of Mixed methods: The 96 items Wellness Medium (2010) [54] (Colorado) in evidence-based practices level, physical activity and implementation of cross-sectional study School Assessment related to healthy food school education Local School Wellness using in-depth interviews Tool (WellSAT-96) consumption before and setting (including food policies with foodservice [0, 1, 2 per item where after Local Wellness Policies provision) managers and self- 0=policy being not in (LWPs) implementation; administered place or don’t know, contents of districts’ LWPs questionnaires with and 2=policy being related to nutrition, school principals, fully in place] including foodservice managers and comprehensiveness and teachers (detail not given for strength of LWP wording; interview) and school foodservice managers’ impressions about the impact of the LWP on school cafeteria practices

7 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool Longley et al. USA To examine the process and Federal Food and nutrition, The existence of Mixed methods: Open-ended questions Low (2009) [55] outcome of wellness policy level, physical activity and implementation of cross-sectional study for interviews development in school school education district Wellness using telephone [narrative report] districts setting (including food School policies before interviews and self- provision) and after the federal administered (tool not specified for mandate questionnaires with questionnaire) school foodservice [proportion of policies directors in place (%)] Leowski et al. 11 countries To assess the status of National NCDs and risk factors The existence of Quantitative method: Adapted WHO global Medium (2009) [56] in South national capacity for level including policies and implementation of cross-sectional survey questionnaire tool on East Asia prevention and control of (detail on programs national legislation, using self-administered assessment of the (SEA) region non-communicable setting not recommended by the policies, strategies, questionnaires with the national capacity for diseases (NCDs) in the specified) WHO Global Strategy and programmes on Ministries of Health NCD prevention and Member States of the on Diet, Physical NCD prevention and of the countries of the control in 2001 South-East Asia (SEA) Activity and Health control including the SEA Region [comparison to Region of the World Health (including food WHO Global Strategy baseline] Organization (WHO) promotion, food on Diet, Physical labelling, food prices Activity and Health and food composition) Yeatman Australia To determine the current Local Food and nutrition The level of Quantitative method: Tool developed based Low (2008) [57] level of activity of governmen and education implementation of cross-sectional survey on the framework of Australian local t level, (including food retail activity of local using self-administered Lester’s 1994 governments in twenty- rural and and food provision) governments between questionnaires with local overview of the nine food and nutrition urban 1995 and 2007 governments Australian food and action areas and whether settings nutrition system the level of activity had [Yes vs No per changed between 1995 and item/indicator] 2007 Probart et al. USA To assess local wellness Federal Food and nutrition, The existence of Quantitative method: The Local Wellness Low (2008) [58] (Pennsylvan policies established by level, physical activity and implementation of cross-sectional survey Policy Checklist ia) Pennsylvania public school school education Local School Wellness using self-administered [Yes vs No per districts, compare these setting (including food Policies questionnaires with item/indicator] policies to local wellness provision) school district policy mandate representatives requirements, and provide information about local wellness policy

8 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool development and implementation

Action for USA To provide a snapshot of Federal Food and nutrition, The level of Qualitative methods: Open-ended questions N/A Healthy Kids the state of school wellness level, physical activity and implementation of cross-sectional study [narrative report and (2008) [59] after more than five years school education School Wellness using in-depth interviews proportion of of work by Action for setting (including food policies after more with authorities on health respondents reporting Healthy Kids, and others, at provision and food than five years of and education, and school implementation (%)] the national, state, and composition) work by Action for observations grassroots levels Healthy Kids, and others Molaison et al. USA To identify attitudes of Federal Food and nutrition, The existence of Mixed methods: Open-ended questions Low (2007) [60] (Pennsylvan school nutrition directors, level, physical activity and implementation of cross-sectional study for focus group ia, Idaho, principals, teachers, and school education Local School Wellness using focus group [narrative report and Arkansas, parents regarding a Local setting (including food policies interviews and self- frequency of Mississippi) Wellness Policies (LWP) and provision) administered survey comments on specific barriers related to questionnaires with emerging issues] implementation of a LWP principals, teachers, parents, school nutrition (tool not specified for directors, and community questionnaire) professionals [proportion of respondents reporting implementation (%)] Yee et al. USA To assess the progress of National Nutrition and physical The existence of Qualitative method: The 2004 state semi- Low (2006) [61] the first 20 states funded by level activity including food implementation of the cross-sectional study annual reports for 21 the Nutrition and Physical (detail on environments nutrition and physical using document review funded states Activity Program to Prevent setting not (no specific details on activity program to [proportion of states Obesity and Other Chronic specified) food environments prevent obesity and reporting Diseases given) NCDs implementation (%)] Lang et al. Scotland To examine the progress National Food and nutrition, The existence and Mixed methods: (tool not specified for N/A (2006) [62] that has been made and local breastfeeding and level of cross-sectional study questionnaire) in the implementation of levels, health education implementation of the using document review, [narrative report] the Scottish Diet Action various (including food Scottish Diet Action expert reviews, self- Plan since 1996 – what has settings provision, food retail, Plan since 1996 administered List of key questions been achieved and what food composition, questionnaires with for discussion remains to be done food promotion, food government and non- [narrative report] labelling, food prices government stakeholders,

9 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool and food production) and discussion among key stakeholders

Lower et al. Australia To assess the State level, NCDs and risk factor The existence and Mixed methods: Tool developed based Low (2004) [63] (rural implementation of the local prevention, including level of cross-sectional study on Australian core Western Australian core functions of setting promoting and implementation of the using self-administered functions of public Australia) public health in rural supporting healthy Australian public questionnaires and semi- health as defined by Western Australia lifestyle and healthy health core functions structured interviews with the National Public environments public health practitioners Health Partnership (no specific details on [score 0-2 per item food environments where 0=action is given) either rare or not undertaken at all, and 2=action was frequently part of current practice] Institute of USA To measure progress in Federal, Food and nutrition, The existence of Guideline developed by Proposed 83 N/A Medicine obesity prevention, state, and physical activity and implementation of the Institute of Medicine indicators in five goal (2013) [64] including new metrics community education policies and programs committee areas for each goal area and levels, (including food towards proposed strategy and various provision, food retail, indicators notes whether data for settings food labelling and tracking change are food promotion) available at the community and national levels WHO (2008) Global To measure the National Diet and physical The existence of Framework Process, output and N/A [65] implementation of the and sub- activity implementation of outcome indicators WHO Global Strategy on national (including food policies and actions Diet, Physical Activity and levels, labelling, food retail, recommended in the Health (DPAS) at country various food prices, food WHO Global Strategy level and proposes a settings promotion, food on Diet, Physical framework and indicators provision and food Activity and Health for this purpose composition) Tagtow et al. USA (Iowa) To measure the National Food system The level of Quantitative method: Iowa Food System N/A (2011) [66] health of Iowa’s food level (including food implementation of cross-sectional survey Report Card system through a report (detail on marketing, food retail actions in Iowa’s food using self-administered [data comparison over card leading to setting not and food production) system questionnaires with key 10 years]

10 Author Study Objective of the study Policy Policy areas Aspects measured by Design and methods Tools Overall country levels and the study [scales used] quality of settings method/tool recommendations for given) stakeholders research, programs and policies to ensure a food system that supports healthier Iowans, communities, economies, and the environment Fox et al. 10 countries To assess national political National Food and nutrition The political Quantitative method: The Political Medium (2014) [67] from Asia commitment and level policy including food commitment to cross-sectional survey Commitment and and Latin opportunities to advance (details on security implement the policy using self-administered Opportunity America food and nutrition policy settings not (no specific details on questionnaires with Measurement-Rapid regions reform, completed by given) food environments government and non- Assessment Tool knowledgeable given) government stakeholders [Yes vs No per representatives from 10 indicator] countries

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