Development of the Menu Assessment Scoring Tool (MAST) to Assess the Nutritional Quality of Food Service Menus

Preventing the rise in obesity is a global public health priority. Neighbourhood environments can help or undermine people's efforts to manage their weight, depending on availability of nutritious and nutrient-poor 'discretionary' foods. The proportion of household food budgets spent on eating outside the home is increasing. To inform nutrition policy at a local level, an objective assessment of the nutritional quality of foods and beverages on food service menus that is context-specific is needed. This study describes the development and piloting of the Menu Assessment Scoring Tool (MAST), used to assess the nutritional quality of food service menus in Australia. The MAST is a desk-based tool designed to objectively assess availability of nutrient-poor and absence of nutritious food and beverages on food service menus. A risk assessment approach was applied, using the best available evidence in an iterative way. MAST scores for 30 food service outlets in one Local Government Authority in Perth, Western Australia highlight opportunities for improvements. MAST is the first tool of its kind in Australia to assess the nutritional quality of food service menus. It was practical and feasible to use by public health nutritionists/dietitians and can be adapted to suit other settings or countries.

Can Ordering Groceries Online Support Diet Quality in Adults Who Live in Low Food Access and Low-Income Environments?

During the COVID-19 pandemic, U.S. food assistance programs allowed the use of program benefits to order groceries online. We examined relationships between the food environment, food assistance, online grocery ordering, and diet quality among adults from one low-income, low food access community in Northeastern Connecticut during the pandemic. Via online survey, adults (n = 276) reported their perceived home and store food environments, food assistance participation, whether they ordered groceries online, and consumption frequency and liking of foods/beverages to calculate diet quality indices. Those who ordered groceries online (44.6%) were more likely to participate in food assistance programs and report greater diet quality. Perceived healthiness of store and home food environments was variable, with the ease of obtaining and selecting unhealthy foods in the neighborhood significantly greater than healthy foods. Healthier perceived home food environments were associated with significantly higher diet qualities, especially among individuals who participated in multiple food assistance programs. Ordering groceries online interacted with multiple measures of the food environment to influence diet quality. Generally, the poorest diet quality was observed among individuals who perceived their store and home food environments as least healthy and who did not order groceries online. Thus, ordering groceries online may support higher diet quality among adults who can use their food assistance for purchasing groceries online and who live in low-income, low-access food environments.

Food and Physical Activity Environment in the US-Affiliated Pacific Region: The Children's Healthy Living Program

OBJECTIVE

To describe the quality of food and physical activity (PA) environments by World Bank Income level in jurisdictions from the Children's Healthy Living Program.

DESIGN

Baseline cross-sectional community data were analyzed from 11 jurisdictions categorized by World Bank Income levels to describe exposure to different food and PA outlets. The Children's Healthy Living Program was a multilevel, multijurisdictional prevalence study and community intervention trial that reduced child obesity in the US-Affiliated Pacific region.

SETTING

US-Affiliated Pacific region.

PARTICIPANTS

Food (n = 426) and PA (n = 552) Outlets.

MAIN OUTCOME MEASURES

Physical activity and food scores that reflect the quality of the outlets that support being physically active and healthy eating options, respectively.

ANALYSIS

Descriptive statistics are presented as means ± SD or percentages.

RESULTS

High-income-income level jurisdictions had higher food and PA scores than middle-income level jurisdictions.

CONCLUSIONS AND IMPLICATIONS

The US-Affiliated Pacific region has limited quality food and PA outlets in underserved communities at risk for obesity. The findings in this paper can be used to develop tools and design interventions to improve the food and PA environment to increase a healthier, active lifestyle.

A mixed-methods evaluation of a health-promoting café located in a small health service in rural Victoria, Australia

INTRODUCTION

Residents of rural areas internationally typically experience chronic disease risk profiles worse than city dwellers. Poor diet, a key driver of chronic disease, has been associated with unhealthy food environments, and rural areas often experience limited access to healthy, fresh and affordable food.

OBJECTIVE

This study aimed to evaluate the first three years of a health promoting social enterprise café established in a small rural health service.

DESIGN

A mixed-methods evaluation study. Quantitative sales data, surveys and key informant interviews that included both quantitative and qualitative responses.

FINDINGS

Three years of sales data were included; 111customer surveys and five key informant interviews were conducted. Food and beverages on displayed and sold consistently met or exceeded the healthy criteria set by policy. Stakeholders supported the traffic light system, the social enterprise model and rated the likelihood of sustainability of the café as high.

DISCUSSION

Customers used the 'traffic light' system to inform food choices, placed value on the warmth of the staff and on the welcoming environment created through the social enterprise model. Resources remain tight although all stakeholders are committed to the sustainability of the YarriYak café.

CONCLUSION

The study shows the acceptability, feasibility and sustainability of a health promoting social enterprise café in a rural area.

[Relationship between the dietary behavior targets of Health Japan 21 (second term) and perceived food environment and health literacy]

Objective　The interim evaluation of Health Japan 21(second term), a national health promotion plan, suggested that improvements in the food environment did not lead to improvements in individual dietary habits. The present study aimed to evaluate the relationship between the dietary behavior targets of Health Japan 21 (second term) and perceived food environment and health literacy.Method　We conducted an online cross-sectional survey in March 2019 among adults aged 20-64 years. From the 9,667 registered monitors of the research firm, we collected 2,851 responses (29.5% response rate). The perceived food environment (how people perceive the local food environment) was estimated using the following six questions, namely, availability: easy access to nutritionally balanced meals, accessibility: no inconvenience in daily shopping, affordability: access to nutritionally balanced meals at reasonable prices, accommodation: easy access to food services within business hours, acceptability: satisfaction with the quality of food ingredients, and another form of acceptability: adequate food safety. Health literacy was evaluated using five questions related to information gathering, information selection, information transfer, information judgment, and self-determination. Last, we asked the respondents about two dietary behaviors, namely, the frequency of a balanced diet (defined as comprising the staple food, a main dish, and a side dish) and the quantity of vegetable intake, along with sociodemographic information. The analysis included 2,111 respondents, excluding those whose socioeconomic status was unknown. Multiple logistic regression analyses were performed to determine the relationship between perceived food environment and health literacy on dietary behaviors, while adjusting for sociodemographic factors.Result　A balanced diet was associated with the following perceptions of the food environment: "access to nutritionally balanced meals at reasonable prices" (adjusted odds ratio [95% confidence interval] = 1.37 [1.02, 1.82]; women), and "adequate food safety" (1.54 [1.19, 1.98]; men), and health literacy: "information gathering" (0.84 [0.73,0.97]; men) and "self-determination" (1.28 [1.10,1.50], 1.37 [1.14,1.63]; men, women). The quantity of vegetable intake was associated with the following perceptions of the food environment: "easy access to nutritionally balanced meals" (1.54 [1.15,2.06]; men), and "no inconvenience in daily shopping" (1.55 [1.12,2.15]; women), and health literacy: "information transfer" (1.30 [1.10,1.54]; men), and "self-determination" (1.67 [1.38,2.02]; women)).Conclusion　To achieve a balanced diet and increased vegetable intake in a population, it is necessary to promote both the acquisition of a higher level of "self-determination" (rather than "information gathering") in health literacy and the creation of a heathy food environment.

The Association between the School Environment and Adolescent Alcohol Drinking Behavior in Six Cities in China

Drinking alcohol during adolescence has short-term and long-term effects on physical and mental health. At this stage, teenagers are greatly influenced by their schoolmates and friends. We conducted a multicenter cross-sectional study to investigate the association between school environment factors and adolescents’ drinking behavior in China. Using multistage stratified cluster sampling, the study investigated 27,762 middle school students from six cities in China. The logistic regression model was used to explore the association between the school environment and adolescent alcohol drinking behaviors after adjusting for confounders, including gender, age, city, location, and smoking status. Compared with students with none of their close friends drinking, students with more than half of their close friends drinking were more likely to drink in a year (OR = 20.148, 95% CI: 17.722−22.905, p < 0.001) and in a month (OR = 13.433, 95% CI: 11.779−15.319, p < 0.001). In addition, classmates’ drinking behaviors, friends’ persuasion, and attending parties were risk factors for adolescents’ drinking behavior, while the propaganda and regulations of banning drinking in school were protective factors. The school environment, especially friends drinking, is associated with students’ drinking behavior. It is necessary to mobilize the strength of schools and peers to strengthen the prevention and control of adolescent drinking.

SnackTrack-An App-Based Tool to Assess the Influence of Digital and Physical Environments on Snack Choice

As food choices are usually processed subconsciously, both situational and food environment cues influence choice. This study developed and tested a mobile app to investigate the association between physical and digital environments on snack choices. SnackTrack was designed and used to collect data on the snack choices of 188 users in real-life settings during an 8-week feasibility trial. The app asks users to take a photo of the food they are planning to consume and to provide additional information regarding the physical environment and context in which this food was eaten. The app also displayed various user interface designs (i.e., different background images) to investigate the potential effects of images on snack choice. Preliminary results suggest that the time of snack obtainment did not have a significant effect on the healthfulness of the snacks chosen. Conversely, it was found that unhealthy background images appeared to encourage healthier snack choices. In conclusion, despite consumers having the knowledge to make healthy choices, environmental cues can alter food choices. SnackTrack, a novel tool to investigate the influence of physical and digital environments on consumers' food choices, provides possibilities for exploring what encourages (un)healthy eating behaviours.

Retail Food Environment around Schools in Barcelona by Neighborhood Socioeconomic Status: Implications for Local Food Policy

Childhood obesity is a relevant public health problem. The school food environment has been identified as an important factor for promoting healthy eating behaviors. This study assessed the availability of and proximity to unhealthy food stores around schools (n = 22) in the city of Barcelona and its association with neighborhood socioeconomic status (NSES). We conducted this cross-sectional study between 2019 and 2020. First, we identified all food retailers (n = 153) within a 400-m buffer around each school and identified those selling unhealthy food products. Then, we used Poison regression models to measure the association between NSES and the healthy food availability index (HFAI), adjusting for population density and distance. A total of 95% of the food establishments studied were classified as unhealthy (n = 146). In all, 90% of schools that had, at least, two unhealthy retailers in their proximity. There were significant differences in the mean distance to unhealthy establishments according to neighborhood SES and population density (p < 0.05). We found a positive association between schools located in higher SES neighborhoods and a higher availability and affordability of healthy food products (IIR = 1.67, 95% CI = 1.45−1.91 p = 0.000). We found strong social inequalities in the supply of healthy foods in Barcelona. Local food policy interventions addressing retail food environment around schools should consider socioeconomic inequalities.

[Changes in the neighborhood food environment and walking time among older adults: A longitudinal Japan Gerontological Evaluation Study (JAGES) between 2016 and 2019]

Objective　Maintaining or increasing walking provides several health benefits to older adults. However, the mid-term evaluation of Health Japan 21 [second term] showed that older adults' daily steps did not meet the goal. Therefore, this study emphasized primordial prevention, which is different from previous preventive approaches and focuses on the relationship between the built environment and physical activities, including daily steps. This study investigated the relationship between changes in the number of food stores and walking time.Methods　This longitudinal study utilized the self-administered mail survey data between 2016 and 2019 from the Japan Gerontological Evaluation Study (JAGES). Older adults aged ≥65 years and residing in 27 independent municipalities were recruited. The dependent variable was a change in the walking time at two-time points (increase or not). Our explanatory variable was the change in the number of food stores at two-time points, reported on a 5-point scale, including no store (reference), increased stores, store available, decreased stores, and I don't know. Equivalently, it was defined as the self-reported change in the number of food stores (stores that sell meats, fish, fruits, and vegetables) within the walking distance of participants' homes (within ～1 km) from 2016 to 2019. The covariates included demographic factors, health behavior factors, environmental factors, and health factors in 2016. We used Poisson regression analysis (5% significance level) to calculate the cumulative incidence rate ratio (CIRR) and 95% confidence interval (CI) for an increase in walking time compared to no increase in walking time. The multivariate normal imputation method supplemented missing data of the dependent variable, explanatory variable, and covariates. Additionally, respondents' answer of "other" for the covariates was supplemented.Results　Three years later, 13,400 (20.4%) respondents had increased their walking time. Older adults who reported increased number of stores (5,311, 8.1%) had more walking time than those who reported no stores (6,577, 10.0%) (CIRR=1.12; 95% CI: 1.03-1.21).Conclusion　Participants who reported an increase in the number of fresh food stores within the walking distance had 12% more walking time three years later. A built environment might be used to measure primordial prevention that increases the amount of walking in daily life. Our results may provide evidence for policymakers and stakeholders to consider healthy urban planning.

The Socio-Ecological Context of the Nutrition Transition in Indonesia: A Qualitative Investigation of Perspectives from Multi-Disciplinary Stakeholders

Background: Indonesia is undergoing a rapid nutrition transition—a shift in food consumption related to globalization, modernization, urbanization, and economic development—with potentially adverse impacts on diets, health, and the environment. This study sought to understand the perspectives of a multi-disciplinary group of experts on the effects of the nutrition transition on dietary behaviors, cardiovascular disease (CVD) risk factors, and the food environment in Indonesia. Methods: In-depth interviews were conducted online with 27 Indonesian experts, who are either healthcare providers, nutrition researchers, or environmental researchers. Interview question guides were developed based on a socio-ecological framework. We analyzed the data using deductive and inductive approaches. Results: Experts described a disconnect between awareness about and adherence to healthy diets among Indonesians. They highlighted a marked generational divide in food preferences between the younger population (<40y) and older population (40y+), due to the nutrition transition. Experts perceived that the nutrition transition has also resulted in more eating out, which promotes obesity, through the unhealthy menu offerings from restaurants. Experts also implied that traditional diets are no better than modern diets, due to unhealthy cooking practices, especially frying; suggesting that the combination of higher consumption of fast foods and unhealthy cooking practices may have worsened CVD risk factors in the population. Conclusion: Multi-disciplinary experts indicated that the nutrition transition has negatively impacted diets, health, and food environment in Indonesia. Our findings offer potential hypotheses that can be tested using quantitative approaches, to inform policy and the design of programs to reduce the adverse impacts of the nutrition transition in Indonesia.

Association between healthy food environment and metabolic syndrome, waist circumference, and systolic blood pressure in older adults in Southern Brazil

The aim of this study was to investigate the association between healthy food outlet proximity, metabolic syndrome (MS), and two of its components, waist circumference (WC) and systolic blood pressure (SBP), in older adults (63-107 years old, median age 73 years) living in Florianópolis, South Brazil in 2013-2014. This is a cross-sectional analysis of the second wave of the EpiFloripa Aging Cohort Study. Individual-level data on MS, WC, SBP, and socio-demographic and health-related characteristics were collected from face to face interviews. The healthy food environment was assessed via the number and types of establishments present. The residences of older adult participants were georeferenced using Geographical Information System (GIS) software. The number of each type of food establishment in a 500 m buffer around the each residence was determined. Multivariate linear regression was used to test association between food outlet proximity and continuous outcomes (SBP and WC), and multiple logistic regression was used to examine the relations between the predictor variables and the dichotomous outcome of MS (yes/no). The study revealed that greater frequency of supermarkets and restaurants in the neighborhood was associated with a lower likelihood of having MS. WC was lower in individuals living in places with greater availability of greengrocers' shops and restaurants. The results demonstrated that the number of establishments in a neighborhood is associated with cardiometabolic outcomes, and the likelihood of MS and increased WC is lower for older adults who live in neighborhoods with more access to establishments that sell foundational components of a healthy diet.

What Is Associated with Changes in Food Security among Low-Income Residents of a Former Food Desert?

Lack of geographic access to foods has been postulated as a cause for food insecurity, which has been linked to poor nutrition, obesity, and chronic disease. Building on an established cohort of randomly selected households from a low-income, predominantly Black neighborhood, we examined household food security, distance to where study participants reported doing their major food shopping, and prices at stores where they shopped. Data from the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health study for years 2011, 2014 and 2018 was limited to residents of the neighborhood that began as a food desert (i.e., low access to healthy foods), but acquired a full-service supermarket in 2013. We calculated descriptive statistics and compared study participants in the former food desert neighborhood whose food security improved to those whose food security did not improve across survey waves. We estimated cross sectional linear regressions using all waves of data to assess food security level among study participants. Distance to major food shopping store was positively associated with food security (p < 0.05) while food-store prices were not significantly associated with food security. Findings suggest that for predominantly low-income residents, food secure individuals traveled further for their major food shopping.

A Cross-Sectional Analysis of Food Perceptions, Food Preferences, Diet Quality, and Health in a Food Desert Campus

The sensory properties of foods guide food choices and intake, importantly determining nutritional and health status. In communities that have inconsistent access to nutritious foods, such as food deserts, food taste perceptions and preferences have yet to be explored. The purpose of this study was to examine how taster status (supertaster vs. non-taster) and food security status (high or marginal vs. low or very low) influences food taste intensities, food preferences and perceptions, and diet quality in a cohort of students from a food desert campus in the Central Valley of California. Moreover, the complex relationship of socioeconomic status, race/ethnicity, and sex on cardiometabolic and cognitive health warrants further examination. Two hundred fifty participants (aged 18-24 years) living in a food desert campus were recruited in 2018 for this cross-sectional study where participants underwent taste tests on selected fruits, vegetables, and nuts, and clinical tests (anthropometrics, blood glucose, blood pressure, and endothelial function), cognitive function tests (memory and attention), diet quality assessment (Healthy Eating Index (HEI)), and food preference and perception assessments. Food taste intensities were influenced by sex with bitter and umami taste intensities of several foods being perceived more intensely by males. Moreover, food liking was largely influenced by ethnicity with Hispanics having higher liking ratings for several foods compared with non-Hispanics. Both, Hispanics and females, had higher total fruit HEI scores and lower attention scores than non-Hispanics and males, respectively. Females also had lower blood pressure, reactive hyperemia index, and fasting blood glucose. Food-insecure individuals rated cost and convenience as more important factors for overall food consumption and had lower attention scores than those with higher food-security status. Future research should consider the complex interactions of factors such as taste and flavor perception, sex, ethnicity, prior exposure to foods, and other environmental factors when studying food preferences and health in young adults.

Health of the Food Environment Is Associated With Heart Failure Mortality in the United States

BACKGROUND

Food environment factors contribute to cardiovascular disease, but their effect on population-level heart failure (HF) mortality is unclear.

METHODS

We utilized the National Vital Statistics System and USDA Food Environment Atlas to collect HF mortality rates (MR) and 2 county food environment indices: (1) food insecurity percentage (FI%) and (2) food environment index (FEI), a scaled index (0-10, 10 best) incorporating FI% and access to healthy food. We used linear regression to estimate the association between food environment and HF MR Results: Mean county FI% and FEI were 13% and 7.8 in 2956 included counties. Counties with FI% above the national median had significantly higher HF MR (30.7 versus 26.7 per 100 000; P<0.001) compared with FI% below the national median. Counties with HF MR above the national median had higher FI%, lower FEI, lower density of grocery stores, poorer access to stores among older adults, and lower Supplemental Nutrition Assistance Program participation rate (P<0.001 for all). Lower county FI% (β=-1.3% per 1% decrease) and higher county FEI (β=-3.6% per 1-unit increase in FEI) were significantly associated with lower HF MR after adjustment for county demographic, socioeconomic, and health factors. This association was stronger for HF MR compared with non-HF cardiovascular disease MR and all-cause MR The relationship between food environment and HF MR was stronger in counties with the highest income inequity and poverty rate.

CONCLUSIONS

Healthier food environment is significantly associated with lower HF mortality at the county level. This reinforces the role of food security on cardiovascular outcomes.

Food Environment around Schools: A Systematic Scope Review

The present systematic scope review intended to compile state-of-the-art information about the food environment around schools, exploring the main methods used to describe the food environment around schools as well as the possible effects that this environment can promote on the health of children and adolescents. The preferred reporting items for systematic reviews and meta-analyses-extension for scoping reviews (PRISMA-ScR) checklist and guidelines were followed to ensure a robust and repeatable methodological process. A systematic search was performed in the following electronic databases: MEDLINE, Embase, Science Direct, Web of Science, LILACS, and Scopus, as well as in related articles, a manual search of reference lists and gray literature. Forty-six studies were selected. There was no standardization regarding distances from food establishments to schools, methods of analysis, and software used. The food environment around the schools was characterized by the wide availability of food establishments, especially fast food, convenience stores, supermarkets, and grocery stores known for offering a wide variety of unhealthy foods. Regarding the correlations with the health of children and adolescents, the evidence points to possible interferences of the food environment known as obesogenic, but it cannot be related only to the school environment since most of the acquisition and consumption of food usually happens around family homes. Conducting standardized and comprehensive studies evaluating food choices in the school environment and their interrelationships is very important to ensure children's food and nutrition security and minimize negative health outcomes in the medium and long term.

Factors That "Nudge People towards the Healthier" Snacks-A Qualitative Study with Student, Faculty, and Staff Leaders and Decision Makers

(1) College campuses pose numerous public health challenges for students, faculty and staff. The healthfulness of the snacks available on campuses is lacking, and there is a desire for change among the students and staff. The objective of this study is to understand the perspectives of the students, staff, and decision makers regarding the college campus food environment and the perceived facilitators and barriers to improving it. (2) In-depth interviews were conducted (n = 15) with decision makers in food, policy development, wellness, and nutrition at a large Hispanic-Serving University in South Florida. (3) The key stakeholders shared that educational campaigns, student buy-in, raising awareness around obesity and chronic disease, and the university's position within the community would all help to facilitate improvements to the snack food environment. However, the participants noted that the complex nature of what is considered to be healthy and what divergent consumers want are significant barriers to improving the snack food environment along with concerns over lost revenue and the corporate structure. (4) These results inform potential focal points for multi-level interventions and inform policy discussions focused on improving the snack food environment at minority-serving universities. Taking strategic actions to improve the snack food environment may aid the students and staff of the university to enhance their diet quality.

Assessment of Nutritional Quality of Products Sold in University Vending Machines According to the Front-of-Pack (FoP) Guide

The aim of this research was to assess the nutritional composition of 654 foods and beverages from vending machines on a University Campus. The guide called “Creating a front of pack nutrition label for pre-packed products sold through retail outlets” from the Department of Health (UK) was used to assess the nutritional composition and to compare values from food and beverage categories. A high proportion of food items had high−moderate content of nutrients related to chronic disease (93, 88, 74 and 49% had high−moderate content of fat, saturated fat, salt and sugar, respectively). On the other hand, a few beverages had high−moderate content of these nutrients, except for sugar (2% high to moderate in fat, 2% in saturated fat, 0% in salt and 39% in sugar). The most frequent food categories were chocolates and bars (10.6%) and breadsticks (8.4%), whereas the most available beverages were water (27.7%) and soft drinks (23.4%). There were no statistically significant differences in the proportion of categories between the health science and humanities faculties, except for energy drinks (p < 0.05) and soft drinks (p < 0.05). Vending machines contribute to an obesogenic environment and do not support healthy snacking. Recommendations in this article should be considered to develop official guidelines to ensure the wider availability of healthy dietary choices in vending machines in university settings.

The community food environment and its association with diet, health or weight status in Australia: A systematic review with recommendations for future research

ISSUE ADDRESSED

This study systematically reviewed Australian literature to determine if an association exists between geospatial exposure to food outlets and diet, health or weight status. Recommendations for future research are provided.

METHODS

A systematic literature search was conducted in December 2021 using CINAHL Plus, PubMed and Web of Science databases. Data were extracted, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using an eight-item checklist. A descriptive synthesis of study characteristics and findings was carried out, stratified via study outcomes.

RESULTS

Of the 36 included articles, the majority were from Victoria (n = 19), involving adult participants (n = 30) and cross-sectional in design (n = 27). Overall, associations were mainly null (nonsignificant) for diet (80%), weight status (75%) and health outcomes (90%). Significant findings were mixed with no positive trend with study quality.

CONCLUSIONS

Six recommendations are suggested to address current knowledge gaps and limitations in the Australian evidence base: (1) Conduct research on different populations; (2) Employ robust study designs that can test the impact of change over time; (3) Improve the accuracy of food outlet data sources; (4) Improve food outlet geospatial exposure measures; (5) Improve measurement of outcome variables; and (6) Incorporate theoretical models into study design and data analysis. SO WHAT?: Improving the quality and consistency of research will be critical to informing locally relevant policy. Despite the present limitations in the evidence base, it is reasonable to assume that decisions to purchase and consume food are driven by availability and access. Thus, policy and planning aimed at improving the overall "healthiness" of the community food environment by increasing access to healthy food outlets is warranted to ensure that healthy options are easier choice for all.

Regional Difference in the Effect of Food Accessibility and Affordability on Vegetable and Fruit Acquisition and Healthy Eating Behaviors for Older Adults

The food environment has been determined to affect a range of healthy eating and health indicators, but the study on the regional difference of food environment effects on these outcomes is limited. This study aimed to examine whether food environment factors influence vegetable and fruit acquisition and healthy eating behaviors in urban and rural areas using a nationwide dataset. The study participants were community-dwelling older adults aged 65 years and older (n = 830) who participated in the 2019 Consumer Behavior Survey for Food provided by the Korea Rural Economic Institute. Food environment factors were assessed using questionnaires measuring perceived food accessibility and affordability. The negative perceptions of food environment were related to lower vegetable and fruit acquisitions and poor healthy eating behaviors. The higher risks of low vegetable and fruit acquisitions in older rural adults were related to a negative perception of food accessibility only (odds ratio [OR]: 2.34, 95% confidence interval [CI]: 1.27-4.32 for vegetable; OR: 1.96, 95% CI: 1.02-3.75 for fruit). For older urban adults, negative perceptions of both food accessibility and food affordability were related to the increased risk of low vegetable acquisition (OR: 2.03, 95% CI: 1.07-3.83 for food accessibility; OR: 2.52, 95% CI: 1.26-5.04 for food affordability). In terms of healthy eating behaviors, for those who perceived that either food accessibility or affordability was poor, older urban adults were less likely to have various and healthy food eating behaviors when they had a negative perception of affordability (OR: 0.47, 95% CI: 0.25-0.90 for variety; OR: 0.23, 95% CI: 0.11-0.46 for eating healthy foods); however, older rural adults were less likely to have the behaviors when they had a negative perception of accessibility (OR: 0.49, 95% CI: 0.21-0.97 for variety; OR: 0.28, 95% CI: 0.13-0.63 for eating healthy foods). In conclusion, the negative perceptions of food accessibility and affordability were related to low vegetable acquisition and poor healthy eating behaviors. The effects of food accessibility and affordability on vegetable and fruit acquisitions and healthy eating behaviors were different between urban and rural areas.

Our Voice NOLA: Leveraging a Community Engaged Citizen Science Method to Contextualize the New Orleans Food Environment

OBJECTIVE

We employed the Our Voice citizen scientist method using a mobile application (app) to identify and contextualize neighborhood-level features influencing food access and wellbeing in New Orleans, Louisiana.

DESIGN

A three-phase, multi-method study comprised of: (1) a researcher-assisted tag-a-long neighborhood walk (referred to as a 'journey') with the Discovery Tool (DT) app to document neighborhood-level features via geo-coded photos and audio-recorded narratives; (2) a post-journey interview to enable citizen scientists to share their lived experiences; and (3) a community meeting with citizen scientists and local stakeholders.

SETTING

Various neighborhoods in New Orleans, Louisiana, USA.

PARTICIPANTS

Citizen Scientists (i.e., residents) aged 18 years and older.

MAIN OUTCOME MEASURE(S)

Features that influence food access and health behaviors.

ANALYSIS

Descriptive statistics and a thematic content analysis were conducted to assess survey and app data.

RESULTS

Citizen scientists (N = 14) captured 178 photos and 184 audio narratives. Eight major themes were identified: safety; walkability; aesthetics; amenities; food; health services; neighborhood changes; and infrastructure/city planning. The post-journey interview provided insights around the abovementioned themes. The community meeting demonstrated the willingness of citizen scientists and stakeholders to convene and discuss issues and relevant solutions.

CONCLUSIONS AND IMPLICATIONS

Findings demonstrate the ability of technology and citizen science to help better understand the complexities of New Orleans' past, present and distinct culture-and implications for food access and wellbeing in the context of trauma in an urban ecosystem.

Understanding maternal food choice for preschool children across urban-rural settings in Vietnam

Improving diet quality of preschool children is challenging in countries undergoing food environment and nutrition transition. However, few studies have sought to understand how mothers in these countries decide what and how to feed their children. This study aims to explore maternal experiences, perspectives and beliefs when making food choice decisions for preschool children in urban, peri-urban and rural areas in northern Vietnam. Two focus group discussions and 24 in-depth interviews were carried out and analysed using thematic analysis. The results showed that mothers across the urban-rural spectrum shared the intention to feed children safe, nutritious food for better health and weight gain while satisfying child food preferences to improve appetite and eating enjoyment. These food choice intentions were embedded within family food traditions, whereby mothers emphasised nutritious food and adopted strict feeding styles during lunch and dinner but were flexible and accommodating of child preferences during breakfast and side meals. These intentions were also embedded within the physical food environment, which provided a mix of healthy and unhealthy food through informal food retailers. Despite these intentions, mothers faced financial constraints and difficulties in managing children's refusal to chew, changes in eating mood and strong eating temperament. These findings support policies to limit the presence of unhealthy food in informal food retail and encourage meal-specific feeding strategies to help children enjoy nutritious food, transition from soft to textured food and become more cooperative during mealtime.

Neighborhood Food Environment and Children's BMI: A New Framework with Structural Equation Modeling

The relationship between neighborhood food environment and childhood obesity is complex and not yet well defined by current research in China, especially when considering the integrated effects with other relative factors. The main purpose of this article is to introduce a framework of children's weight status, based on their neighborhood food environment, and to identify the impact of food environment on the children's BMI and potential pathways. The participants of this cross-sectional study were students aged 8-16.5 years old and their parents. Two conceptual frameworks were tested using the structural equation modeling method, and two models were extracted. Model B added the neighborhood food environment based on model A. By comparing the two models, the neighborhood environment was potentially correlated with the children's BMI directly and may have a positive impact on unhealthy-food eating behaviors, which were positively associated with the children's BMI. The results suggest that the focus should be placed on the integrated effects of the potential risk factors of childhood obesity, based on considering the neighborhood food environment, which may relate to children's unhealthy-food eating behaviors and weight status.

"Some are healthy and others not": Characterization of vended food products by Accra-based food retailers

Background and objectives

Increasing the availability of healthy foods within food retail outlets can improve consumers' food environments. Such actions or inactions by food retailers may affect people's food purchasing and consumption behavior. This study explored Accra-based food retailers' perceptions and appreciation of "healthiness of food" as a concept. It also documented measures that food retailers adopt to encourage healthy food choices.

Methods

In-person semi-structured interviews were conducted with owners and managers of Accra-based supermarkets (n = 7) and corner stores (n = 13) in March 2021. The interviews were recorded, transcribed, coded, and analyzed thematically.

Results

The retailers' understanding of healthy food, or lack thereof, is exemplified by such expressions as "health, absence of disease, longevity, balanced diet, diversity, sanitation, and certification." A handful of retailers described what they sell as "products that meet consumer needs," "harmless," or "generally good." Very few retailers described the food they sell as "junk," high in sugar, fat, and salt, or energy-dense but nutrient poor foods, or as food that could pose some health risk to consumers. However, some retailers indicated that they advise their customers against the overconsumption of some foods.

Conclusion

Overall, Accra-based retailers have a fair understanding of what constitutes healthy food - exhibiting limited knowledge of the connection between very salty, very sugary, and very fatty foods and health outcomes. Retailers in Accra require interventions that improve their food, health, and nutrition literacy. Improving retailers' food and nutrition literacy may improve the availability of healthier options in food retail outlets in Accra.

Differential Associations Between Changes in Food Environment and Changes in BMI Among Adults Living in Urban, Low-Income Communities

BACKGROUND

Food environments can contribute to excess weight gain among adults, but the evidence is mixed.

OBJECTIVES

This longitudinal study investigated the associations between changes in the food environment and changes in BMI in adults and whether changes in the food environment differentially impact various subgroups.

METHODS

At 2 time points, BMI was calculated using self-reported height and weight data from 517 adults (mean age, 41 years) living in 4 New Jersey cities. The counts of different types of food outlets within 0.4, 0.8, and 1.6 km of respondents' residences were collected at baseline and tracked until follow-up. A binary measure of social standing (social-advantage group, n = 219; social-disadvantage group, n = 298) was created through a latent class analysis using social, economic, and demographic variables. Multivariable linear regression modeled the associations between changes in BMI with measures of the food environment; additionally, interaction terms between the measures of food environment and social standing were examined.

RESULTS

Overall, over 18 months, an increase in the number of small grocery stores within 0.4 km of a respondent's residence was associated with a decrease in BMI (β = -1.0; 95% CI: -1.9, -0.1; P = 0.024), while an increase in the number of fast-food restaurants within 1.6 km was associated with an increase in BMI (β = 0.1; 95% CI: 0.01, 0.2; P = 0.027). These overall findings, however, masked some group-specific associations. Interaction analyses suggested that associations between changes in the food environment and changes in BMI varied by social standing. For instance, the association between changes in fast-food restaurants and changes in BMI was only observed in the social-disadvantage group (β = 0.1; 95% CI: 0.02, 0.2; P = 0.021).

CONCLUSIONS

In a sample of adults living in New Jersey, changes in the food environment had differential effects on individuals' BMIs, based on their social standing.