Background Most Americans consume more sodium than is recommended, the vast majority of which comes from commercially packaged and restaurant foods. In 2010 the Institute of Medicine recommended that manufacturers reduce the amount of sodium in their products. Objective The aim was to assess the sodium content in commercially packaged food products sold in U.S. grocery stores in 2009. Design With the use of sales and nutrition data from commercial sources, we created a database with nearly 8000 packaged food products sold in major U.S. grocery stores in 2009. We estimated the sales-weighted mean and distribution of sodium content (mg/serving, mg/100 g, and mg/kcal) of foods within food groups that contribute the most dietary sodium to the U.S. diet. We estimated the proportion of products within each category that exceed 1) the Food and Drug Administration’s (FDA’s) limits for sodium in foods that use a “healthy” label claim and 2) 1150 mg/serving or 50% of the maximum daily intake recommended in the 2010 Dietary Guidelines for Americans. Results Products in the meat mixed dishes category had the highest mean and median sodium contents per serving (966 and 970 mg, respectively). Products in the salad dressing and vegetable oils category had the highest mean and median concentrations per 100 g (1072 and 1067 mg, respectively). Sodium density was highest in the soup category (18.4 mg/kcal). More than half of the products sold in 11 of the 20 food categories analyzed exceeded the FDA limits for products with a “healthy” label claim. In 4 categories, >10% of the products sold exceeded 1150 mg/serving. Conclusions The sodium content in packaged foods sold in major U.S. grocery stores varied widely and a large proportion of top-selling products exceeded limits, indicating the potential for reduction. Ongoing monitoring is necessary to evaluate the progress in sodium reduction.

Vignettes representing mentally ill people were presented to about 2000 randomly selected residents in Bromsgrove, served by a mental hospital, and Malvern, served by a community-based psychiatric service. They were asked about the likely cause of the condition, what action they would take, and what agencies were most likely to help. In Malvern, residents seemed more enterprising in involving various agencies and more tolerant. It is possible to derive simple 'action scores' as an indicator of such tolerance. Although there were significant demographic differences between subgroups, overall identification of vignette subjects as mentally ill was surprisingly low, and so was knowledge both of community psychiatric nurses as an agency, and of the location of dispersed treatment facilities in both areas.

The average adult in the United States of America consumes well above the recommended daily limit of sodium. Average sodium intake is about 3 463 mg/day, as compared to the 2010 dietary guidelines for Americans recommendation of < 2 300 mg/day. A further reduction to 1 500 mg/day is advised for people 51 years or older; African Americans; and people with high blood pressure, diabetes, or chronic kidney disease. In the United States of America, the problem of excess sodium intake is related to the food supply. Most sodium consumed comes from packaged, processed, and restaurant foods and therefore is in the product at the time of purchase. This paper describes sodium reduction policies and programs in the United States at the federal, state, and local levels; efforts to monitor the health impact of sodium reduction; ways to assess consumer knowledge, attitudes, and behavior; and how these activities depend on and inform global efforts to reduce sodium intake. Reducing excess sodium intake is a public health opportunity that can save lives and health care dollars in the United States and globally. Future efforts, including sharing successes achieved and barriers identified in the United States and globally, may quicken and enhance progress.

Restaurant foods can be a substantial source of sodium in the American diet. According to the Institute of Medicine, the significant contribution made by restaurants and food service menu items to Americans’ sodium intake warrants targeted attention. Public health practitioners are uniquely poised to support sodium-reduction efforts in restaurants and help drive demand for lower-sodium products through communication and collaboration with restaurant and food service professionals and through incentives for restaurants. This article discusses the role of the public health practitioner in restaurant sodium reduction and highlights select strategies that have been taken by state and local jurisdictions to support this effort.

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