The influence of the WIC food package changes on the retail food environment in New Orleans

OBJECTIVE

To examine the effect of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package changes on availability of healthy foods in small stores.

DESIGN

Pre-post comparison group design with repeat in-store observations.

SETTING

New Orleans.

PARTICIPANTS

Small stores (n = 102; 77% of total) were visited in 2009. Of these, 91% were observed again in 2010, including both WIC (n = 27) and non-WIC (n = 66) stores.

INTERVENTION

The 2009 WIC food package changes to include healthier foods.

MAIN OUTCOME MEASURES

Change in store availability of fruits, vegetables, lower-fat milks, whole wheat bread, and brown rice. Change in number of varieties and shelf length of fruits and vegetables.

ANALYSIS

Difference-in-differences analysis using logit models for change in availability and regression models for change in number of varieties or shelf length.

RESULTS

The WIC stores were more likely to improve availability of lower-fat milks than non-WIC stores (adjusted odds ratio, 5.0, 95% confidence interval, 1.2-21.0). An even greater relative improvement was seen with whole grains. The WIC stores showed a relative increase in number of varieties of fresh fruits (0.9 ± 0.3; P < .01) and shelf length of vegetables (1.2 ± 0.4 meters; P < .01).

CONCLUSIONS AND IMPLICATIONS

Results suggest that WIC changes improved the availability of healthy foods in small stores in New Orleans. Similar changes throughout the country could have a significant impact on neighborhood food environments.

A systematic review of the influence of the retail food environment around schools on obesity-related outcomes

The high prevalence of childhood obesity has led to questions about the influence of 'obesogenic' environments on children's health. Public health interventions targeting the retail food environment around schools have been proposed, but it is unclear if they are evidence based. This systematic review investigates associations between food outlets near schools and children's food purchases, consumption and body weight. We conducted a keyword search in 10 databases. Inclusion criteria required papers to be peer reviewed, to measure retailing around schools and to measure obesity-related outcomes among schoolchildren. Thirty papers were included. This review found very little evidence for an effect of the retail food environment surrounding schools on food purchases and consumption, but some evidence of an effect on body weight. Given the general lack of evidence for association with the mediating variables of food purchases and consumption, and the observational nature of the included studies, it is possible that the effect on body weight is a result of residual confounding. Most of the included studies did not consider individual children's journeys through the food environment, suggesting that predominant exposure measures may not account for what individual children actually experience. These findings suggest that future interventions targeting the food environment around schools need careful evaluation.

Development and evaluation of a food environment survey in three urban environments of Kunming, China

BACKGROUND

Given the rapid pace of urbanization and Westernization and the increasing prevalence of obesity, there is a need for research to better understand the influence of the built environment on overweight and obesity in world's developing regions. Culturally-specific food environment survey instruments are important tools for studying changing food availability and pricing. Here, we present findings from an effort to develop and evaluate food environment survey instruments for use in a rapidly developing city in southwest China.

METHODS

We developed two survey instruments (for stores and restaurants), each designed to be completed within 10 minutes. Two pairs of researchers surveyed a pre-selected 1-km stretch of street in each of three socio-demographically different neighborhoods to assess inter-rater reliability. Construct validity was assessed by comparing the food environments of the neighborhoods to cross-sectional height and weight data obtained on 575 adolescents in the corresponding regions of the city.

RESULTS

273 food establishments (163 restaurants and 110 stores) were surveyed. Sit-down, take-out, and fast food restaurants accounted for 40%, 21% and 19% of all restaurants surveyed. Tobacco and alcohol shops, convenience stores and supermarkets accounted for 25%, 12% and 11%, respectively, of all stores surveyed. We found a high percentage of agreement between teams (>75%) for all categorical variables with moderate kappa scores (0.4-0.6), and no statistically significant differences between teams for any of the continuous variables. More developed inner city neighborhoods had a higher number of fast food restaurants and convenience stores than surrounding neighborhoods. Adolescents who lived in the more developed inner neighborhoods also had a higher percentage of overweight, indicating well-founded construct validity. Depending on the cutoff used, 19% to 36% of male and 10% to 22% of female 16-year old adolescents were found to be overweight.

CONCLUSIONS

The prevalence of overweight Chinese adolescents, and the food environments they are exposed to, deserve immediate attention. To our knowledge, these are the first food environment surveys developed specifically to assess changing food availability, accessibility, and pricing in China. These instruments may be useful in future systematic longitudinal assessments of the changing food environment and its health impact in China.

Construct validation of 4 food-environment assessment methods: adapting a multitrait-multimethod matrix approach for environmental measures

Few studies have assessed the construct validity of measures of neighborhood food environment, which remains a major challenge in accurately assessing food access. In this study, we adapted a psychometric tool to examine the construct validity of 4 such measures for 3 constructs. We used 4 food-environment measures to collect objective data from 422 Ontario, Canada, food stores in 2010. Residents' perceptions of their neighborhood food environment were collected from 2,397 households between 2009 and 2010. Objective and perceptual data were aggregated within buffer zones around respondents' homes (at 250 m, 500 m, 1,000 m, and 1,500 m). We constructed multitrait-multimethod matrices for each scale to examine construct validity for the constructs of food availability, food quality, and food affordability. Convergent validity between objective measures decreased with increasing geographic scale. Convergent validity between objective and subjective measures increased with increasing geographic scale. High discriminant validity coefficients existed between food availability and food quality, indicating that these two constructs may not be distinct in this setting. We conclude that the construct validity of food environment measures varies over geographic scales, which has implications for research, policy, and practice.

Food environment and socioeconomic status influence obesity rates in Seattle and in Paris

OBJECTIVE

To compare the associations between food environment at the individual level, socioeconomic status (SES) and obesity rates in two cities: Seattle and Paris.

METHODS

Analyses of the SOS (Seattle Obesity Study) were based on a representative sample of 1340 adults in metropolitan Seattle and King County. The RECORD (Residential Environment and Coronary Heart Disease) cohort analyses were based on 7131 adults in central Paris and suburbs. Data on sociodemographics, health and weight were obtained from a telephone survey (SOS) and from in-person interviews (RECORD). Both studies collected data on and geocoded home addresses and food shopping locations. Both studies calculated GIS (Geographic Information System) network distances between home and the supermarket that study respondents listed as their primary food source. Supermarkets were further stratified into three categories by price. Modified Poisson regression models were used to test the associations among food environment variables, SES and obesity.

RESULTS

Physical distance to supermarkets was unrelated to obesity risk. By contrast, lower education and incomes, lower surrounding property values and shopping at lower-cost stores were consistently associated with higher obesity risk.

CONCLUSION

Lower SES was linked to higher obesity risk in both Paris and Seattle, despite differences in urban form, the food environments and in the respective systems of health care. Cross-country comparisons can provide new insights into the social determinants of weight and health.

Where are the food deserts? An evaluation of policy-relevant measures of community food access in South Carolina

Several recent United States (US) policies target spatial access to healthier food retailers. We evaluated two measures of community food access developed by two different agencies, using a 2009 food environment validation study in South Carolina as a reference. While the US Department of Agriculture Economic Research Service's (USDA ERS) measure designated 22.5% of census tracts as food deserts, the Centers for Disease Control and Prevention's (CDC) measure designated 29.0% as non-healthier retail tracts; 71% of tracts were designated consistently between USDA ERS and CDC. Our findings suggest a need for greater harmonization of these measures of community food access.

Variation in low food access areas due to data source inaccuracies

Several spatial measures of community food access identifying so called "food deserts" have been developed based on geospatial information and commercially-available, secondary data listings of food retail outlets. It is not known how data inaccuracies influence the designation of Census tracts as areas of low access. This study replicated the U.S. Department of Agriculture Economic Research Service (USDA ERS) food desert measure and the Centers for Disease Control and Prevention (CDC) non-healthier food retail tract measure in two secondary data sources (InfoUSA and Dun & Bradstreet) and reference data from an eight-county field census covering169 Census tracts in South Carolina. For the USDA ERS food deserts measure accuracy statistics for secondary data sources were 94% concordance, 50-65% sensitivity, and 60-64% positive predictive value (PPV). Based on the CDC non-healthier food retail tracts both secondary data demonstrated 88-91% concordance, 80-86% sensitivity and 78-82% PPV. While inaccuracies in secondary data sources used to identify low food access areas may be acceptable for large-scale surveillance, verification with field work is advisable for local community efforts aimed at identifying and improving food access.

Validation of an adapted version of the nutrition environment measurement tool for stores (NEMS-S) in an urban area of Brazil

OBJECTIVE

To validate an adapted instrument that assesses the nutritional environment of food stores in Brazilian urban areas.

METHODS

The instrument measured aspects of food environment such as availability, prices, and quality. The Harvard Healthy Eating Pyramid and the degree of processing were used to define healthy foods. The sample included 44 food stores in 3 census tracts in the city of Santos. Inter-rater reliability and stability coefficient were obtained with measurements performed by different individuals at different times. Internal consistency and construct validity were assessed by Cronbach α and the known-groups comparison method, respectively.

RESULTS

Inter-rater reliability was high. The mean intra-class correlation coefficient was 0.98 and the mean kappa was 0.77. Cronbach α values ranged from .68 to .93.

CONCLUSIONS AND IMPLICATIONS

The instrument can be useful in the development of interventions to promote healthy eating through actions focused on healthy food availability in Brazilian communities.

Determinants of diet quality in pregnancy: sociodemographic, pregnancy-specific, and food environment influences

OBJECTIVE

To advance the knowledge of determinants of diet quality in pregnancy by focusing on both personal characteristics and the food environment.

DESIGN

Cross-sectional study in which participants from the Prenatal Health Project were linked to a geographic dataset by home address. Access to fast food, convenience stores, and grocery stores was measured using a geographic information system (ArcGIS9.3).

SETTING

Pregnant women (n = 2,282) were recruited between 2002 and 2005 in London, Ontario, Canada.

MAIN OUTCOME MEASURE

Dietary quality was measured using a validated food frequency questionnaire and the Canadian Diet Quality Index for Pregnancy.

ANALYSIS

Univariate and multivariate linear regressions were calculated with the predictor variables on the Canadian Diet Quality Index for Pregnancy.

RESULTS

Pregnant women who were born in Canada, common-law, nulliparous, less physically active, smokers, more anxious, or lacking family support had lower diet quality on average. Presence of fast-food restaurants, convenience stores, and grocery stores within 500 m of participants' homes was not associated with diet quality after controlling for personal variables.

CONCLUSIONS AND IMPLICATIONS

The food environment does not seem to have a large influence on diet quality in pregnancy. Further research is needed to determine other potential reasons for low diet quality among pregnant women.

Food availability en route to school and anthropometric change in urban children

This study examined food availability along children's paths to and from elementary school, and associations with change in body mass index (BMI) and waist circumference over 1 year. Secondary data from 319 children aged 8-13 years from the "Multiple Opportunities to Reach Excellence" Project was used. Child anthropometry and demographic variables were obtained at baseline (2007) and 1 year follow-up. Food outlet locations (n = 1,410) were obtained from the Baltimore City Health Department and validated by ground-truthing. Secondary data on healthy food availability within select food stores in Baltimore City in 2007 were obtained via a validated food environment assessment measure, the Nutrition Environments Measures Study. Multilevel models were used to examine associations between availability of healthy food and number of various food outlets along paths to school and child anthropometric change over 1 year. Controlling for individual-, neighborhood-, and school-level characteristics, results indicated that higher healthy food availability within a 100 m buffer of paths to school was associated with 0.15 kg/m(2) lower BMI gain (p = 0.015) and 0.47 cm smaller waist circumference gain (p = 0.037) over 1 year. Although prior research has illuminated the importance of healthy food choices within school and home environments, the current study suggests that exposure to the food environment along paths to school should be further explored in relation to child health outcomes.

Area-based variations in obesity are more than a function of the food and physical activity environment : area-based variations in obesity

This study examines the area-based variations in obesity from a community-based epidemiologic survey of Boston, MA, USA, using a geographic information system and multilevel modeling techniques. A combination of quantitative and qualitative methods was used to assess whether a function of the food and the physical activity (PA) environment can explain the body weight of residents. First, a series of multilevel analyses was conducted after accounting for the well-established individual determinants and capturing a wide range of environmental attributes to represent a more realistic portrayal of urban typology. Second, the results of multilevel analysis were framed into the theoretical model of area-based variations in obesity to qualitatively summarize the association of contextual factors with the body weight of residents. Based on the overall correlation, the area-based variations defined by a function of the food and PA environment seem to be insufficient in explaining the body weight of residents. By testing the cross-level interactions of gender and race/ethnicity with contextual factors, the results suggest that the concept of area-based variations in obesity will have to consider how residents behave differently within a given environment. More research is needed to better understand the contextual determinants of obesity so as to put forth population-wide interventions.

Comparison of two indices of availability of fruits/vegetable and fast food outlets

Studies of food environment often examine single dimensions of areas that may not account for complexity of exposure to all food sources. With respect to the deprivation amplification hypothesis, particular needs are to assess whether relative or absolute measures of the food environment are related to characteristics of social environment. The objective of this study was to compare absolute availability (AA) of fast food outlets (FFO) and stores selling fresh fruits and vegetables (FVS) with the relative availability (RA) of the same food sources in relation to area-level poverty and ethnic diversity in 248 selected census tracts (CT) in Montreal, Canada. AA of FFO and FVS were expressed as areal densities of food sources within CTs. RA indices were calculated as the proportion of FVSs relative to total food stores and the proportion of FFOs relative to all restaurants within CTs, respectively. Whereas the AA of FFO was positively associated with area-level poverty and ethnic diversity, the RA of FFO was inversely associated with area-level poverty and not associated with ethnic diversity. Both measures of FVS were positively associated with area-level poverty and ethnic diversity. These findings do not support a model of deprivation amplification. Furthermore, results of FFO suggest that the alternate measure of RA can complement information based on AA indicators of the food environment, with potential utility in predicting eating practices.

Corner Store Inventories, Purchases, and Strategies for Intervention: A Review of the Literature

INTRODUCTION

An increasingly popular strategy to improving the food retail environment and promoting healthy eating in low-income and minority communities is the corner store conversion. This approach involves partnering with small 'corner' food stores to expand access to high-quality fruits, vegetables, and other healthy foods.

METHODS

We conducted a structured review of the literature to assess inventories and sales in corner stores, as well as to identify intervention strategies employed by corner store conversions.

RESULTS

Our review returned eight descriptive studies that discussed corner store inventories and sales, as well as ten intervention studies discussing six unique corner store conversion interventions in the United States, the Marshall Islands, and Canada. Common intervention strategies included: 1) partnering with an existing store, 2) stocking healthy foods, and 3) social marketing and nutrition education. We summarize each strategy and review the effectiveness of overall corner store conversions at changing peoples' food purchasing, preparation, and consumption behaviors.

CONCLUSIONS

Consumption of fresh, healthy, affordable foods could be improved by supporting existing retailers to expand their selection of healthy foods and promoting healthy eating at the neighborhood level. Additional corner store conversions should be conducted to determine the effectiveness and importance of specific intervention strategies.

Addressing the policy cacophony does not require more evidence: an argument for reframing obesity as caloric overconsumption

BACKGROUND

Numerous policies have been proposed to address the public health problem of obesity, resulting in a policy cacophony. The noise of so many policy options renders it difficult for policymakers to determine which policies warrant implementation. This has resulted in calls for more and better evidence to support obesity policy. However, it is not clear that evidence is the solution. This paper argues that to address the policy cacophony it is necessary to rethink the problem of obesity, and more specifically, how the problem of obesity is framed. This paper argues that the frame "obesity" be replaced by the frame "caloric overconsumption", concluding that the frame caloric overconsumption can overcome the obesity policy cacophony.

DISCUSSION

Frames are important because they influence public policy. Understood as packages that define issues, frames influence how best to approach a problem. Consequently, debates over public policy are considered battles over framing, with small shifts in how an issue is framed resulting in significant changes to the policy environment. This paper presents a rationale for reframing the problem of obesity as caloric overconsumption. The frame "obesity" contributes to the policy cacophony by including policies aimed at both energy output and energy input. However, research increasingly demonstrates that energy input is the primary cause of obesity, and that increases in energy input are largely attributable to the food environment. By focusing on policies that aim to prevent increases in energy input, the frame caloric overconsumption will reduce the noise of the obesity policy cacophony. While the proposed frame will face some challenges, particularly industry opposition, policies aimed at preventing caloric overconsumption have a clearer focus, and can be more politically palatable if caloric overconsumption is seen as an involuntary risk resulting from the food environment.

SUMMARY

The paper concludes that policymakers will be able to make better sense of the obesity policy cacophony if the problem of obesity is reframed as caloric overconsumption. By focusing on a specific cause of obesity, energy input, the frame caloric overconsumption allows policymakers to focus on the most promising obesity prevention policies.

Associations between residential food environment and dietary patterns in urban-dwelling older adults: results from the VoisiNuAge study

OBJECTIVE

To examine associations between the availability of residential-area food sources and dietary patterns among seniors.

DESIGN

Cross-sectional analyses. Individual-level data from the NuAge study on nutrition and healthy ageing were merged with geographic information system data on food store availability and area-level social composition. Two dietary patterns reflecting lower- and higher-quality diets (respectively designated 'western' and 'prudent') were identified from FFQ data. Two food source relative availability measures were calculated for a 500 m road-network buffer around participants' homes: (i) proportion of fast-food outlets (%FFO) relative to all restaurants and (ii) proportion of stores potentially selling healthful foods (%HFS, healthful food stores) relative to all food stores. Associations between dietary patterns and food source exposure were tested in linear regression models accounting for individual (health and sociodemographic) and area-level (socio-economic and ethnicity) covariates.

SETTING

Montréal metropolitan area, Canada.

SUBJECTS

Urban-dwelling older adults (n 751), aged 68 to 84 years.

RESULTS

%FFO was inversely associated with prudent diet (β = -0·105; P < 0·05) and this association remained statistically significant in models accounting for %HFS. %HFS was inversely associated with lower western diet scores (β = -0·124; P < 0·01). This latter association no longer reached significance once models were adjusted for area-level covariates.

CONCLUSIONS

In Montréal, the food environment is related to the diet of older adults but these links are more complex than straightforward. The absence of significant relationships between healthful food stores and prudent diets, and between fast-food outlets and western diets, deserves further investigation.

Associations between children's diets and features of their residential and school neighbourhood food environments

OBJECTIVES

Among studies of the built environment, few examine neighbourhood food environments in relation to children's diets. We examined the associations of residential and school neighbourhood access to different types of food establishments with children's diets.

METHODS

Data from QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), an ongoing study on the natural history of obesity in 630 Quebec youth aged 8-10 years with a parental history of obesity, were analyzed (n=512). Three 24-hour diet recalls were used to assess dietary intake of vegetables and fruit, and sugar-sweetened beverages. Questionnaires were used to determine the frequency of eating/snacking out and consumption of delivered/take-out foods. We characterized residential and school neighbourhood food environments by means of a Geographic Information System. Variables included distance to the nearest supermarket, fast-food restaurant and convenience store, and densities of each food establishment type computed for 1 km network buffers around each child's residence and school. Retail Food Environment indices were also computed. Multivariable logistic regressions (residential access) and generalized estimating equations (school access) were used for analysis.

RESULTS

Residential and school neighbourhood access to supermarkets was not associated with children's diets. Residing in neighbourhoods with lower access to fast-food restaurants and convenience stores was associated with a lower likelihood of eating and snacking out. Children attending schools in neighbourhoods with a higher number of unhealthful relative to healthful food establishments scored most poorly on dietary outcomes.

CONCLUSIONS

Further investigations are needed to inform policies aimed at shaping neighbourhood-level food purchasing opportunities, particularly for access to fast-food restaurants and convenience stores.

Associations between children's diets and features of their residential and school neighbourhood food environments

OBJECTIVES

Among studies of the built environment, few examine neighbourhood food environments in relation to children's diets. We examined the associations of residential and school neighbourhood access to different types of food establishments with children's diets.

METHODS

Data from QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), an ongoing study on the natural history of obesity in 630 Quebec youth aged 8-10 years with a parental history of obesity, were analyzed (n=512). Three 24-hour diet recalls were used to assess dietary intake of vegetables and fruit, and sugar-sweetened beverages. Questionnaires were used to determine the frequency of eating/snacking out and consumption of delivered/take-out foods. We characterized residential and school neighbourhood food environments by means of a Geographic Information System. Variables included distance to the nearest supermarket, fast-food restaurant and convenience store, and densities of each food establishment type computed for 1 km network buffers around each child's residence and school. Retail Food Environment indices were also computed. Multivariable logistic regressions (residential access) and generalized estimating equations (school access) were used for analysis.

RESULTS

Residential and school neighbourhood access to supermarkets was not associated with children's diets. Residing in neighbourhoods with lower access to fast-food restaurants and convenience stores was associated with a lower likelihood of eating and snacking out. Children attending schools in neighbourhoods with a higher number of unhealthful relative to healthful food establishments scored most poorly on dietary outcomes.

CONCLUSIONS

Further investigations are needed to inform policies aimed at shaping neighbourhood-level food purchasing opportunities, particularly for access to fast-food restaurants and convenience stores.

Inter-rater reliability of the food environment audit for diverse neighborhoods (FEAD-N)

Studies have shown that neighborhood food environments are important influences on dietary intake and may contribute to health disparities. While instruments with high reliability have been developed to assess food availability, price, and quality, few measures to assess items associated with the physical and social features of food stores have been developed. Yet, recent qualitative studies have documented aspects associated with such features of urban food stores that are barriers to food acquisition. We assessed the reliability of measures to assess multiple components of the food environment-including physical and social store features--in three geographically distinct and diverse communities in Detroit, Michigan, using the Food Environment Audit for Diverse Neighborhoods (FEAD-N). Using the FEAD-N, four trained observers conducted observations of 167 food stores over a 10-week period between October and December 2008. To assess inter-rater reliability, two trained observers independently visited, on the same day, a random subset of 44 food stores. Kappa statistics and percent agreement were used to evaluate inter-rater reliability. Overall, the instrument had mostly high inter-rater reliability with more than 75% of items with kappa scores between 0.80 and 1.00, indicating almost perfect reliability. More than half of the physical store features and 47% of the social store features had almost perfect reliability and about 37% and 47%, respectively, had substantial reliability. Measuring factors associated with the physical and social environment of food stores with mostly high reliability is feasible. Systematic documentation of the physical and social features of food stores using objective measures may promote a more comprehensive understanding of how neighborhood food environments influence health.

The Hub Population Health System: distributed ad hoc queries and alerts

The Hub Population Health System enables the creation and distribution of queries for aggregate count information, clinical decision support alerts at the point-of-care for patients who meet specified conditions, and secure messages sent directly to provider electronic health record (EHR) inboxes. Using a metronidazole medication recall, the New York City Department of Health was able to determine the number of affected patients and message providers, and distribute an alert to participating practices. As of September 2011, the system is live in 400 practices and within a year will have over 532 practices with 2500 providers, representing over 2.5 million New Yorkers. The Hub can help public health experts to evaluate population health and quality improvement activities throughout the ambulatory care network. Multiple EHR vendors are building these features in partnership with the department's regional extension center in anticipation of new meaningful use requirements.

Characteristics of prepared food sources in low-income neighborhoods of Baltimore City

The food environment is associated with obesity risk and diet-related chronic diseases. Despite extensive research conducted on retail food stores, little is known about prepared food sources(PFSs). We conducted an observational assessment of all PFSs(N = 92) in low-income neighborhoods in Baltimore. The most common PFSs were carry-outs, which had the lowest availability of healthy food choices. Only a small proportion of these carry-outs offered healthy sides, whole wheat bread, or entrée salads (21.4%, 7.1%, and 33.9%, respectively). These findings suggest that carry-out-specific interventions are necessary to increase healthy food availability in low-income urban neighborhoods.

Neighbourhood immigrant acculturation and diet among Hispanic female residents of New York City

OBJECTIVE

To identify predominant dietary patterns among Hispanic women and to determine whether adherence to dietary patterns is predicted by neighbourhood-level factors: linguistic isolation, poverty rate and the retail food environment.

DESIGN

Cross-sectional analyses of predictors of adherence to dietary patterns identified from principal component analysis of data collected using the Study of Women's Health Across the Nation FFQ. Census data were used to measure poverty rates and the percentage of Spanish-speaking families in the neighbourhood in which no person aged ≥14 years spoke English very well (linguistic isolation) and the retail food environment was measured using business listings data.

SETTING

New York City.

SUBJECTS

A total of 345 Hispanic women.

RESULTS

Two major dietary patterns were identified: a healthy dietary pattern loading high for vegetables, legumes, potatoes, fish and other seafood, which explained 17 % of the variance in the FFQ data and an energy-dense dietary pattern loading high for red meat, poultry, pizza, french fries and high-energy drinks, which explained 9 % of the variance in the FFQ data. Adherence to the healthy dietary pattern was positively associated with neighbourhood linguistic isolation and negatively associated with neighbourhood poverty. Presence of more fast-food restaurants per square kilometre in the neighbourhood was significantly associated with lower adherence to the healthy diet. Adherence to the energy-dense dietary pattern was inversely, but not significantly, associated with neighbourhood linguistic isolation.

CONCLUSIONS

These results are consistent with the hypothesis that living in immigrant enclaves is associated with healthy dietary patterns among Hispanics.

Can a food justice movement improve nutrition and health? A case study of the emerging food movement in New York City

In response to increasing obesity, diabetes, and food-related contributions to climate change, many individuals and organizations are mobilizing to advocate for healthier and more just local and national food policies and systems. In this report, we describe and analyze the food movement in New York City, examine tensions within it, and consider its potential role in improving health and nutrition. We conclude by suggesting that public health professionals can amplify the health effects of such movements by creating opportunities for dialog with movement participants, providing resources such as policy-relevant scientific evidence, documenting problems and evaluating policies, and offering technical, political, and organizational development expertise.

"You have to hunt for the fruits, the vegetables": environmental barriers and adaptive strategies to acquire food in a low-income African American neighborhood

This qualitative study sought to understand food acquisition behaviors and environmental factors that influence those behaviors among women in a low-income African American community with limited food resources. We drew on in-depth interviews with 30 women ages 21 to 45 years recruited from a community health center in Chicago, Illinois. Data were analyzed using qualitative content analysis. Emergent themes revealed that women identified multiple environmental barriers--material, economic, and social-interactional--to acquiring food in an acceptable setting. In response, they engaged in several adaptive strategies to manage or alter these challenges, including optimizing, settling, being proactive, and advocating. These findings indicate that efforts to improve neighborhood food environments should address not only food availability and prices but also the physical and social environments of stores.

The association between obesity and urban food environments

Several studies have examined associations between the food retail environment and obesity, though virtually no work has been done in the urban South, where obesity rates are among the highest in the country. This study assessed associations between access to food retail outlets and obesity in New Orleans. Data on individual characteristics and body weight were collected by telephone interviews from a random sample of adults (N = 3,925) living in New Orleans in 2004-2005. The neighborhood of each individual was geo-mapped by creating a 2-km buffer around the center point of the census tract in which they lived. Food retailer counts were created by summing the total number of each food store type and fast food establishment within this 2-km neighborhood. Hierarchical linear models assessed associations between access to food retailers and obesity status. After adjusting for individual characteristics, each additional supermarket in a respondent's neighborhood was associated with a reduced odds for obesity (OR 0.93, 95% CI 0.88-0.99). Fast food restaurant (OR 1.01, 95% CI 1.00-1.02) and convenience store (OR 1.01, 95% CI 1.00-1.02) access were each predictive of greater obesity odds. An individual's access to food stores and fast food restaurants may play a part in determining weight status. Future studies with longitudinal and experimental designs are needed to test whether modifications in the food environment may assist in the prevention of obesity.

Publically funded recreation facilities: obesogenic environments for children and families?

Increasing healthy food options in public venues, including recreational facilities, is a health priority. The purpose of this study was to describe the public recreation food environment in British Columbia, Canada using a sequential explanatory mixed methods design. Facility audits assessed policy, programs, vending, concessions, fundraising, staff meetings and events. Focus groups addressed context and issues related to action. Eighty-eighty percent of facilities had no policy governing food sold or provided for children/youth programs. Sixty-eight percent of vending snacks were chocolate bars and chips while 57% of beverages were sugar sweetened. User group fundraisers held at the recreation facilities also sold ‘unhealthy’ foods. Forty-two percent of recreation facilities reported providing user-pay programs that educated the public about healthy eating. Contracts, economics, lack of resources and knowledge and motivation of staff and patrons were barriers to change. Recreation food environments were obesogenic but stakeholders were interested in change. Technical support, resources and education are needed.