All change. Has COVID-19 transformed the way we need to plan for a healthier and more equitable food environment?

The food environment has taken on much of the impact of the COVID-19 pandemic. Evidence shows people's relationship and access to the food environment is a determinant of their health and wellbeing, and in relation to prevalence of chronic and non-communicable diseases. The spatial planning system forms part of a whole systems action in shaping the environment in a way that maximises population health gain. While these practices have had varying degrees of success, the sudden introduction and spread of COVID-19, and the responses to it, has forced us to re-examine the utility of current planning practice, particularly the impact on inequalities. In this commentary we aim to explore the post-pandemic role of spatial planning as a mechanism for improving public health by highlight a whole system perspective on the food environment, referring to experiences in Wales as a case study, and concluding with observation on future consumer trends around access to food.

Availability and advertising of sugar sweetened beverages in South African public primary schools following a voluntary pledge by a major beverage company: a mixed methods study

Background: Towards the end of the 2017 school year, a prominent beverage company in South Africa pledged to remove their sugar-sweetened beverages (SSBs) and advertisements from primary schools in order to contribute to the realization of a healthy school environment.Objectives: To assess the availability and advertising of the company's beverages in public primary schools in Gauteng province following their voluntary pledge to remove the products, and to explore perceptions of school staff regarding SSB availability in schools and processes related to the implementation of the pledge.Methods: In 2019, we conducted a representative survey of public sector primary (elementary) schools in Gauteng province, South Africa. A random sample of schools was drawn, with schools stratified by whether or not they charge fees. This was a proxy for the socioeconomic status of the locale and student body. At each school, the availability of beverages and presence of advertising or not was assessed by an observational audit tool and differences across fee status assessed by Pearson χ 2 test. Semi-structured interviews were conducted with a purposive sample of school officials. Data from the interviews were coded and thematic analysis conducted.Results: Two years following a voluntary pledge, the company's carbonated SSBs were available for sale in 54% (CI: 45-63%) of schools with tuck shops and advertised in 31% (CI: 25-39%). Qualitative interviews revealed a complex landscape of actors within schools, which, combined with indifference or resistance to the pledge, may have contributed to the continued availability of SSBs.Conclusions: Though we were unable to examine SSB availability before and after the pledge, our findings provide some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove SSBs and advertisements from schools. Mandatory regulations coupled with in-depth engagement with schools may be an avenue to pursue in the future.

Impacts of a New Supermarket on Dietary Behavior and the Local Foodscape in Kisumu, Kenya: Protocol for a Mixed Methods, Natural Experimental Study

Background

Access to healthy food is considered a key determinant of dietary behavior, and there is mixed evidence that living near a supermarket is associated with a healthier diet. In Africa, supermarkets may contribute to the nutrition transition by offering both healthy and unhealthy foods and by replacing traditional food sellers. In Kisumu, Kenya, a planned hypermarket (ie, a supermarket combined with a department store) will form the basis for a natural experimental evaluation.

Objective

The aim of this study is to explore the impacts of a new hypermarket on food shopping practices, dietary behaviors, physical activity patterns, and body composition among local residents and to identify concurrent changes in the local foodscape. We also aim to explore how impacts and associations vary by socioeconomic status.

Methods

We employ a mixed methods, longitudinal study design. Two study areas were defined: the hypermarket intervention area (ie, Kisumu) and a comparison area with no hypermarket (ie, Homabay). The study is comprised of 4 pieces of primary data collection: a quantitative household survey with local residents, a qualitative study consisting of focus group discussions with local residents and semistructured interviews with government and private sector stakeholders, an audit of the local foodscape using on-the-ground data collection, and an intercept survey of shoppers in the hypermarket. Assessments will be undertaken at baseline and approximately 1 year after the hypermarket opens.

Results

Baseline assessments were conducted from March 2019 to June 2019. From a total sampling frame of 400 households, we recruited 376 of these households, giving an overall response rate of 94.0%. The household survey was completed by 516 individuals within these households. Across the two study areas, 8 focus groups and 44 stakeholder interviews were conducted, and 1920 food outlets were geocoded.

Conclusions

This study aims to further the understanding of the relationship between food retail and dietary behaviors in Kenya. Baseline assessments for the study have been completed.

International Registered Report Identifier (IRRID)

DERR1-10.2196/17814

Understanding the healthfulness of outlets providing lunch and dinner meals: a census of a rural food retail environment in Victoria, Australia

OBJECTIVE

To undertake a census of the healthfulness of food venues providing lunch or dinner meals in a rural Australian setting and compare healthfulness by remoteness, using two measurement tools.

METHODS

A census of the rural local government area food venues was undertaken using two validated tools: the Healthfulness Rating Classification System (HRCS) and the Nutrition Environment Measures Survey (NEMS-R). Data were collected covering an area of 3,438 square kilometres in Victoria, Australia, with a population of >21,000. Healthfulness by remoteness was described and variability between tools was explored.

RESULTS

Data were collected from all 95 eligible food venues. Both tools classified the food venues as relatively unhealthy. The mean HRCS score was -2.9 (unhealthy) and the mean NEMS-R score was 10.8 (SD 7.0; possible range -27 to 64). There were no significant differences in healthiness of venues by remoteness (as measured by the Modified Monash Model), although the outer-rural region had lower scores.

CONCLUSIONS

This census of a rural food retail environment showed low access to healthy menu options along with minimal provision of nutrition information and promotion of healthy food in food venues. This environment has the potential to affect the dietary intake of more than 21,000 rural-dwelling Australians and action to improve rural food environments is desperately needed. Implications for public health: If unhealthful rural food environments are not addressed, inequalities in the diet-related disease burden for rural Australians will continue to persist. This study shows that interventions are needed for independent venues that could be targeted by researchers, local health promotion officers, community nutritionists or community education programs.

The Healthiness of Food and Beverages on Price Promotion at Promotional Displays: A Cross-Sectional Audit of Australian Supermarkets

Supermarket environments can strongly influence purchasing decisions. Price promotions are recognised as a particularly persuasive tactic, but the healthiness of price promotions in prominent in-store locations is understudied. This study compared the prevalence and magnitude of price promotions on healthy and unhealthy food and beverages (foods) displayed at prominent in-store locations within Australian supermarkets, including analyses by supermarket group and area-level socio-economic position. A cross-sectional in-store audit of price promotions on foods at key display areas was undertaken in 104 randomly selected stores from major Australian supermarket groups (Woolworths, Coles, Aldi and independents) in Victoria, Australia. Of the display space dedicated to foods with price promotions, three of the four supermarket groups had a greater proportion of display space devoted to unhealthy (compared to healthy) foods at each promotional location measured (end of aisles: 66%; island bins: 53%; checkouts: 88%). Aldi offered very few price promotions. Few measures varied by area-level socio-economic position. This study demonstrated that price promotions at prominent in-store locations in Australian supermarkets favoured unhealthy foods. Marketing of this nature is likely to encourage the purchase of unhealthy foods, highlighting the need for retailers and policy-makers to consider addressing in-store pricing and placement strategies to encourage healthier food environments.

Overabundance of unhealthy food advertising targeted to children on Guatemalan television

To assess, for the first time, the extent (by hour channel) and nature (e.g. persuasive marketing techniques (PMT) and health-related claims) of unhealthy food advertisements (ads) targeted at children (3–11 years) on the six most-watched television (TV) channels in Guatemala. We recorded 864 h of video on the six most popular channels featuring children’s programmes. We classified food and beverage ads as permitted or non-permitted for marketing to children, according to the 2015 World Health Organisation (WHO) nutrient profile. Furthermore, we also analysed PMT (i.e. premium offers, promotional characters, brand benefit claims) and health-related claims. Most food ads (85%) were non-permitted to be marketed to children. Non-permitted food ads were six times more likely, either on weekdays or weekends, for all programme and channel categories compared with permitted food ads. There was no difference in the frequency of non-permitted food ads between peak and non-peak hours, weekend and weekdays or children and non-children programmes. PMT and health-related claims were present in all food ads (5.3 ± 1.9 techniques/claims per ad). There is a need to regulate food ads on TV channels featuring children’s programmes in Guatemala as a result of a high frequency of non-permitted food ads and extensive use of PMT together with health-related claims.

A Spatial Analysis of the Food Environment and Overweight and Obesity Among Rhode Island Youth

BACKGROUND

This study examined how proximity to food sources differed at the block group and town level, stratified by socioeconomic risk, and how the average distance to a food source was associated with child overweight and obesity rates in Rhode Island.

METHODS

Eight correlated variables from the 2014-2018 American Community Survey were used to measure high and low socioeconomic risk at the block group and town level. Linear regression models were used to assess the association between mean driving distance to food sources and prevalence of child overweight and obesity.

RESULTS

All food sources were closer to residences in the high-risk group than the low-risk group at the block group and town level. Convenience stores, sit-down restaurants, and snack and beverage stores showed the largest associations with prevalence of overweight and obesity.

CONCLUSION

Efforts to better understand the food environment are needed to address overweight and obesity among youth.

The Retail Food Sector and Indigenous Peoples in High-Income Countries: A Systematic Scoping Review

Indigenous Peoples in high-income countries experience higher burdens of food insecurity, obesity, and diet-related health conditions compared to national averages. The objective of this systematic scoping review is to synthesize information from the published literature on the methods/approaches, findings, and scope for research and interventions on the retail food sector servicing Indigenous Peoples in high-income countries. A structured literature search in two major international databases yielded 139 relevant peer-reviewed articles from nine countries. Most research was conducted in Oceania and North America, and in rural and remote regions. Several convergent issues were identified across global regions including limited grocery store availability/access, heightened exposure to unhealthy food environments, inadequate market food supplies (i.e., high prices, limited availability, and poor quality), and common underlying structural factors including socio-economic inequality and colonialism. A list of actions that can modify the nature and structure of retailing systems to enhance the availability, accessibility, and quality of healthful foods is identified. While continuing to (re)align research with community priorities, international collaboration may foster enhanced opportunities to strengthen the evidence base for policy and practice and contribute to the amelioration of diet quality and health at the population level.

Can Healthy Checkout Counters Improve Food Purchases? Two Real-Life Experiments in Dutch Supermarkets

Most snacks displayed at supermarket checkouts do not contribute to a healthy diet. We investigated the effects of introducing healthier snack alternatives at checkouts in supermarkets on purchasing behavior. In Study 1, we investigated the effect of completely substituting less healthy with healthier snacks (one supermarket). In Study 2, we investigated the effect of placing and discounting healthier snacks while the less healthy snacks remain in place (two supermarkets). In both studies, the number of purchased snacks (per 1000 customers) was used as the outcome variable. Results for Study 1 showed that the absolute number of purchased checkout snacks was 2.4 times lower (95% confidence interval (CI): 1.9-2.7) when healthier snacks instead of less healthy snacks were placed at the supermarket checkouts. Results for Study 2 showed that when additional healthier snacks were placed near the checkouts, the absolute number of healthier purchased snacks increased by a factor of 2.1 (95% CI: 1.3-3.3). When additional healthier snacks were placed near the checkouts and discounted, the absolute number of healthier purchased snacks increased by a factor of 2.7 (95% CI: 2.0-3.6), although this was not statistically significant higher than placement only (ratio: 1.1, 95% CI: 0.7-1.9). Purchases of less healthy snacks did not decline, and even slightly increased, during the intervention period (ratio: 1.3, 95% CI: 1.1-1.5). If supermarkets want to promote healthier snack purchases, additional healthier products can be positioned near the checkouts. However, this does not discourages the purchase of less healthy snacks. Therefore, to discourage unhealthy snack purchases at supermarket checkouts, a total substitution of less healthy snacks with healthier alternatives is most effective.

Fresh street: the development and feasibility of a place-based, subsidy for fresh fruit and vegetables

Background

Many UK communities experience food insecurity, and consume diets high in energy-dense, nutrient poor, processed foods and low in fruit and vegetables (FV). We explored a novel area-based approach to promote FV consumption and healthy eating in one such community.

Methods

We developed a weekly subsidy scheme for fresh FV with key local stakeholders in an area of socioeconomic deprivation in Northern England. The scheme (Fresh Street) offered five £1 vouchers to every household, regardless of income or household type. Vouchers were redeemable with local suppliers of fresh FV (not supermarkets). The feasibility of the scheme was assessed in four streets using rapid ethnographic assessment and voucher redemption information.

Results

Local councillors and public health teams were supportive of the scheme. Most eligible households joined the scheme (n = 80/97, 83%), and 89.3% (17 849/19 982) of vouchers issued were redeemed. Householders reported that the scheme made them think about what they were eating, and prompted them to buy and eat more FV.

Conclusions

This feasibility study reported high levels of acceptance for a place-based, household-level weekly FV subsidy scheme. Further research is required to evaluate the effectiveness of this approach to creating healthy diets, eating behaviours and food systems.

KIMEHS-Proposal of an Index for Qualitative Evaluation of Children's Menus-A Pilot Study

Considering the importance of the food environments for health promotion, and the lack of simple, easy to use, low-cost measures of the quality of meals, the authors developed a qualitative menu index (KIMEHS—Kids’ Menu Healthy Score), tailored to children’s menu evaluation. Development of the tool was based on the Mediterranean food pattern. It includes 18 components, divided into seven main groups that reflect key aspects of menu quality, including protein source, side dishes, vegetables, dessert and beverages, and also allergens and nutritional information. The index was analysed for content and construct validity, as well as inter-rater reliability, and was applied to a sample of menus from restaurants in shopping centres in the Lisbon region. Possible index point ranges from −17 to 17, with a higher score indicating greater compliance with the recommendations. A value of 5.5 is obtained if all KIMEHS items are available, considering healthy and non-healthy options. The inter-rater reliability was assessed and values above 0.80 were obtained for Alpha Cronbach, as well as agreement % rate >75%. Agreement percentage is above 75% for all the components. Evaluated restaurants scored from −14 to 7, with an average KIMEHS of −6.15. Only four restaurants scored positive values, ranging from 0.25 to 7. KIMEHS was considered to be an adequate index to evaluate children’s menus, from the menu information displayed on restaurant websites and/or on restaurant displays or table menus. It is a simple, low-cost tool that may be used as a reference for health professionals as an objective measure to evaluate the food environment. Stakeholders could also be involved in their own assessment to help educate consumers about healthy food choices, strengthening the efforts to promote an adequate food pattern and health, contributing to the fight against obesity.

Developing a National Research Agenda to Support Healthy Food Retail

The food retail environment is an important driver of dietary choices. This article presents a national agenda for research in food retail, with the goal of identifying policies and corporate practices that effectively promote healthy food and beverage purchases and decrease unhealthy purchases. The research agenda was developed through a multi-step process that included (1) convening a scientific advisory committee; (2) commissioned research; (3) in-person expert convening; (4) thematic analysis of meeting notes and refining research questions; (5) follow-up survey of convening participants; and (6) refining the final research agenda. Public health researchers, advocates, food and beverage retailers, and funders participated in the agenda setting process. A total of 37 research questions grouped into ten priority areas emerged. Five priority areas focus on understanding the current food retail environment and consumer behavior and five focus on assessing implementation and effectiveness of interventions and policies to attain healthier retail. Priority topics include how frequency, duration, and impact of retailer promotion practices differ by community characteristics and how to leverage federal nutrition assistance programs to support healthy eating. To improve feasibility, researchers should explore partnerships with retailers and advocacy groups, identify novel data sources, and use a variety of study designs. This agenda can serve as a guide for researchers, food retailers, funders, government agencies, and advocacy organizations.

Diet Quality and Food Prices Modify Associations between Genetic Susceptibility to Obesity and Adiposity Outcomes

The role of the retail food environment in obesity risk is unclear, which may be due in part to the lack of consideration of individual differences in the responsivity to food cues. This cross-sectional investigation geo-temporally linked the CARTaGENE biobank (including genetic, dietary, lifestyle, and anthropometric data) with in-store retail food environment data to examine interactions between a polygenic risk score (PRS) for obesity and (1) diet quality (n = 6807) and (2) in-store retail food measures (n = 3718). The outcomes included adiposity-related measures and diet quality assessed using the 2010 Canadian-adapted Healthy Eating Index. A vegetable:soft drink ratio was constructed for each retail measure to assess the relative healthfulness of exposures. Generalized linear models adjusted for individual and neighborhood socio-demographic factors were used to evaluate main and interactive effects. Diet quality significantly modified the association between polygenic risk of obesity and body mass index, waist circumference, and body fat percent. A significant interaction was also observed between PRS and frequency of price discount of vegetables in relation to soft drinks on waist circumference. These results replicate previous reports of diet moderating polygenic risk of obesity and suggest that prices of low vs. high-energy density foods are an intervention target to address population obesity rates.

Is the Perceived Fruit Accessibility Related to Fruit Intakes and Prevalence of Overweight in Disadvantaged Youth: A Cross-Sectional Study

Background: Few investigations have studied the relationship between home and school food environments, fruit intakes, and prevalence of overweight in children and adolescents from disadvantaged backgrounds. This study aimed to determine whether food environments for fruit intake at household and school levels affect fruit intakes and risk of overweight among children and adolescents with low household income. Methods: Students (n = 3148) in Seoul, Korea completed questionnaires pertaining to select aspects of their food environments, frequency of fruit intakes, and weight status. Chi-square tests and logistic regressions evaluated associations between the aforementioned variables. Results: Participants consumed fruit an average of 0.77 times per day, though its frequency increased when fruit accessibility was perceived positively. The percentage of overweight participants was 23.5% for boys and 22.8% for girls. Generally, fruit intake frequency was linked to a lower prevalence of overweight. Regular provision of fruit in school lunches was associated with a reduced risk of overweight among elementary school girls (odds ratio (OR): 0.52, 95% confidence interval (CI): 0.30–0.92), and having someone at home to prepare fruit was associated with a reduced risk of overweight in elementary school boys (OR: 0.64, 95% CI: 0.43–0.94) and girls (OR: 0.63, 95% CI: 0.43–0.93). Conclusions: The frequency of fruit intake was low among disadvantaged youth. Increasing access to fruit in their food environments appears to enhance consumption and lower the risk of overweight, especially for elementary school girls.

Cultural Adaptation and Evaluation of the Perceived Nutrition Environment Measures Survey to the Mediterranean Spanish Context (NEMS-P-MED)

Individuals’ perceptions of their food environments are a mediator between exposure to the environment and people’s interaction with it. The Nutrition Environment Measures Surveys (NEMS) are valid and reliable measures to assess food environments. In Spain, there is no adapted instrument to measure the perceived obesogenic environment. This article aims to adapt and evaluate the Perceived Nutrition Environment Measures Survey for a Spanish context (NEMS-P-MED). The Spanish version has 32 questions to measure the perception about availability, accessibility and marketing of 3 types of environment: home, shops and restaurants. We assess feasibility, construct validity and internal consistency reliability through a sample of 95 individuals. The internal consistency was acceptable for most items (Cronbach’s alpha coefficients range from 0.6 to 0.9), similar to that of the original scale. The NEMS-P-MED has been shown to be valid and, on certain items reliable, and was useful to assess the population’s perceptions of the food environment in the home, restaurants and food stores in a Spanish context. Adapting standardized measurement tools to specific contexts to assess the perceived and observed characteristics of food environments may facilitate the development of effective policy interventions to reduce excess weight.

Diet Quality and Neighborhood Environment in the Atlantic Partnership for Tomorrow's Health Project

An understanding of relationships between different constructs of the neighbourhood environment and diet quality is needed to inform public health interventions. This study investigated associations between material deprivation, social deprivation and population density with diet quality in a cohort of 19,973 Canadian adults aged 35 to 69 years within the Atlantic PATH cohort study. Diet quality, a metric of how well diet conforms to recommendations was determined from a 24-item food frequency questionnaire. Neighbourhood environment data were derived from dissemination area level Census data. Two deprivation indices were evaluated: material and social deprivation, which reflect access to goods and amenities and social relationships. Multi-level models were used to estimate relationships (mean differences and 95% CI) between neighbourhood environment and diet quality, adjusting for covariates. Mean diet quality was lower in the most socially deprived neighbourhoods compared to the least socially deprived: −0.56, 95% CI (−0.88, −0.25). Relationships between diet quality and population density differed between urban and rural areas (p-interaction < 0.0001). In rural areas, diet quality was higher in intermediate-density neighbourhoods: 0.54, 95% CI (0.05, 1.03). In urban areas, diet quality was lower in intermediate-density and the most-dense neighbourhoods: −0.84, 95% CI (−1.28, −0.40) and −0.72, 95% CI (−1.20, −0.25). Our findings suggest socially deprived and high-density neighbourhoods are associated with lower diet quality and possible urban-rural differences in neighbourhood environment-diet quality relationships. Additional studies are needed to determine the temporal nature of relationships and whether differences in diet quality are meaningful.

Association between Neighborhood Food Environment and Body Mass Index among Older Adults in Beijing, China: A Cross-Sectional Study

OBJECTIVE

To investigate the association between the neighborhood food environment and body mass index (BMI) among Chinese older adults.

METHODS

A multi-stage stratified random sampling method was used to recruit participants from 12 communities in Beijing, China, in 2019. Participants (n = 1764, 1034 women) in this study were older adults aged 65 to 80. We collected the participants' basic information, measured their height and weight, and calculated their BMI. Neighborhood food environments were measured by the density of and proximity to different food outlets using the Baidu Map Application Programming Interface. Adjusted multiple linear regression was performed to estimate the association between the food environment and BMI.

RESULTS

Participants had a mean age of 69.7 ± 4.32 years old and an average BMI of 26.3 ± 3.50 kg/m². Among the three types of stores, convenience stores had the easiest access, followed by greengrocers and supermarkets. Sit-down restaurants had the best access among different restaurants, followed by Chinese fast-food restaurants, and western fast-food restaurants had the worst access. Easier access to greengrocers (β = 0.281, p < 0.001) and sit-down restaurants (β = 0.304, p < 0.001) was associated with higher BMI in the 250 m buffer zone. More supermarkets were associated with higher BMI in the 500 m buffer zone (β = 0.593, p < 0.001). Access to convenience stores was positively associated with BMI in the 800 m buffer zone (β = 0.057, p < 0.001). Better access to Chinese fast-food restaurants was associated with higher BMI (β = 0.071, p = 0.001), and better access to western fast- food restaurants was associated with lower BMI (β = -0.400, p < 0.001) in the 1000 m buffer zone. There was a negative association between the nearest distance to greengrocers and BMI (β = -0.004, p < 0.001).

CONCLUSION

Although we found some significant associations between the neighborhood food environment and obesity, the current results are not strong enough to draw specific conclusions. Policymakers will need to rely on more evidence to derive concrete policy recommendations.

The Social Stratification of Availability, Affordability, and Consumption of Food in Families with Preschoolers in Addis Ababa; The EAT Addis Study in Ethiopia

The aim of this study was to understand the quality of diet being consumed among families in Addis Ababa, and to what extent social stratification and perceptions of availability and affordability affect healthy food consumption. Data were collected from 5467 households in a face-to-face interview with mothers/caretakers and analyzed using mixed effect logistic regression models. All family food groups, except fish were perceived to be available by more than 90% of the participants. The food groups cereals/nuts/seeds, other vegetables, and legumes were considered highly affordable (80%) and were the most consumed (>75%). Households with the least educated mothers and those in the lowest wealth quintile had the lowest perception of affordability and also consumption. Consumption of foods rich in micronutrients and animal sources were significantly higher among households with higher perceived affordability, the highest wealth quintile, and with mothers who had better education. Households in Addis Ababa were generally seen to have a monotonous diet, despite the high perceived availability of different food groups within the food environment. There is a considerable difference in consumption of nutrient-rich foods across social strata, hence the cities food policies need to account for social differences in order to improve the nutritional status of the community.

Junk Food on Demand: A Cross-Sectional Analysis of the Nutritional Quality of Popular Online Food Delivery Outlets in Australia and New Zealand

The demand for convenience and the increasing role of digital technology in everyday life has fueled the use of online food delivery services (OFD’s), of which young people are the largest users globally. OFD’s are disrupting traditional food environments, yet research evaluating the public health implications of such services is lacking. We evaluated the characteristics and nutritional quality of popular food outlets on a market-leading platform (UberEATS^®) in a cross-sectional observational study conducted in two international cities: Sydney (Australia) and Auckland (New Zealand). A systematic search using publicly available population-level data was used to identify geographical areas with above-average concentrations (>30%) of young people (15–34-years). A standardized data extraction protocol was used to identify the ten most popular food outlets within each area. The nutritional quality of food outlets was assessed using the Food Environment Score (FES) (range: −10 ‘unhealthiest’ to 10 ‘healthiest’). Additionally, the most popular menu items from each food outlet were classified as discretionary or core foods/beverages according to the Australian Dietary Guidelines. The majority of popular food outlets were classified as ‘unhealthy’ (FES range −10 to −5; 73.5%, 789/1074) and were predominately takeaway franchise stores (59.6%, 470/789, e.g., McDonald’s^®). 85.9% of all popular menu items were discretionary (n = 4958/5769). This study highlights the pervasion and accessibility of discretionary foods on OFD’s. This study demonstrated that the most popular food outlets on the market-leading online food delivery service are unhealthy and popular menu items are mostly discretionary foods; facilitating the purchase of foods of poor nutritional quality. Consideration of OFD’s in public health nutrition strategies and policies in critical.

Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED)

The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED tool to observe and rate food outlets in 21 census tracts and 43 food stores across the city of Madrid, Spain. We evaluated inter-rater and intra-rater reliabilities, construct validity, and the tool's ability to discriminate between store types and between stores by area-level Socio-Economic Status (SES). Overall, the mean NEMS-S-MED score was 20.7 (SD = 9.8), which ranged from 7 to 43. Most food items displayed substantial or almost perfect inter-rater and intra-rater agreements; the percentage agreement across availability items was almost perfect and kappa statistics were also very high (median κ = 1.00 for inter-rater; κ = 0.92 for intra-rater). Furthermore, the NEMS-S-MED tool was able to discriminate between store types and census tracts of different SES. The adapted NEMS-S-MED instrument is a reliable and valid audit tool to assess the consumer food environment in Mediterranean urban contexts. Well-constructed measurement tools, such as the NEMS-S-MED, may facilitate the development of effective policy interventions to increase healthy food access and affordability.

Do Changes in the Local Food Environment Within New Residential Developments Influence the Diets of Residents? Longitudinal Results from RESIDE

Background: There is limited longitudinal evidence supporting a link between food outlet locations and dietary outcomes to inform policy and urban planning. This study examined how longitudinal changes in the local food environment within new residential developments influenced changes in adult dietary intake. Methods: Adult participant data (n = 3223 person-observations) were sourced from the RESIDential Environments (RESIDE) project across three time points between 2004 to 2012 in Perth, Western Australia. Fixed effects regression estimated the relationship between change in spatial exposure to the local food environment, individual behaviours and perceptions of the local food environment with dietary outcome variables (healthy diet score, unhealthy diet score, diet quality score and fruit/vegetable intake). Results: An increase over time in the percentage of healthy food outlets around the home was significantly (p ≤ 0.05) associated with an increase in healthy diet scores and an increase in the distance from home to the nearest café restaurant was significantly (p ≤ 0.05) associated with an increase in diet quality scores. Conclusions: Modifying the local food environment by increasing the relative proportion of healthy food outlets around the home may support healthier dietary intake.

Contribution of Home and School Environment in Children's Food Choice and Overweight/Obesity Prevalence in African Context: Evidence for Creating Enabling Healthful Food Environment

This review aimed primarily to investigate the current trends of overweight and obesity in school children in the African context, secondly to explore the contribution of home and school environments on the children’s food choices and lastly suggesting measures for creating a healthier food environment. Despite the increase in overweight and obesity among school children, empirical evidence on their determinants in the African context is scarce, thus calls for consideration of home and school environments. A literature search was conducted between October and December 2018 using Medline (PubMed), Directory of Open Access Journals, Google Scholar, manual search and “grey” literature. This review included articles published between the 1st January 2008 and 30th June 2018. Out of 343 articles, 49 were included for the full text reading after meeting the inclusion criteria. Five reports from grey literature were also included. Results show that the prevalence of overweight and obesity among school children in Africa is increasing and ranges from <5% to >40% in the 10-year period in which the review was taken. High socio-economic status, urban residence and female gender predicted higher prevalence of overweight/obesity. Few reviewed articles on the contribution of home and school environments on children’s food choices showed a shred of evidence, thus calls for further research to address this gap. This review found an increasing prevalence of overweight and obesity in school children in Africa. Therefore, further investigation of home and school environment is imperative to curb the increase in the magnitude of overweight and obesity.

Place Effects and Chronic Disease Rates in a Rural State: Evidence from a Triangulation of Methods

High rates of chronic diseases and increasing nutritional polarization between different income groups in the United States are issues of concern to policymakers and public health officials. Spatial differences in access to food are mainly blamed as the cause for these nutritional inequalities. This study first detected hot and cold spots of food providers in West Virginia and then used those places in a quasi-experimental method (entropy balancing) to study the effects of those places on diabetes and obesity rates. We found that although hot spots have lower rates of chronic diseases than non-hot spots and cold spots have higher rates of chronic diseases than non-cold spots-the situation is complicated. With the findings of income induced chronic disease rates in urban areas, where most hot spots are located, there is evidence of another case for "food swamps." However, in cold spots which are located mainly in rural areas, higher rates of chronic diseases are attributed to a combination of access to food providers along with lacking the means (i.e., income for low-income households) to form healthier habits.

Wild Food Plants and Trends in Their Use: From Knowledge and Perceptions to Drivers of Change in West Sumatra, Indonesia

Wild food plants (WFPs) are often highly nutritious but under-consumed at the same time. This study aimed to document the diversity of WFPs, and assess perceptions, attitudes, and drivers of change in their consumption among Minangkabau and Mandailing women farmers in West Sumatra. We applied a mixed-method approach consisting of interviews with 200 women and focus group discussions with 68 participants. The study documented 106 WFPs (85 species), and Minangkabau were found to steward richer traditional knowledge than Mandailing. Although both communities perceived WFPs positively, consumption has declined over the last generation. The main reasons perceived by respondents were due to the decreased availability of WFPs and changes in lifestyle. The contemporary barriers to consuming WFPs were low availability, time constraints, and a limited knowledge of their nutritional value. The key motivations for their use were that they are free and “unpolluted” natural foods. The main drivers of change were socio-economic factors and changes in agriculture and markets. However, the persistence of a strong culture appears to slow dietary changes. The communities, government and NGOs should work together to optimize the use of this food biodiversity in a sustainable way. This integrated approach could improve nutrition while conserving biological and cultural diversity.