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Lytle LA, Sokol RL. Measures of the food environment: A systematic review of the field, 2007-2015. Health Place 2017; 44:18-34. [PMID: 28135633 DOI: 10.1016/j.healthplace.2016.12.007] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/21/2016] [Accepted: 12/02/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Many studies have examined the relationship between the food environment and health-related outcomes, but fewer consider the integrity of measures used to assess the food environment. The present review builds on and makes comparisons with a previous review examining food environment measures and expands the previous review to include a more in depth examination of reliability and validity of measures and study designs employed. METHODS We conducted a systematic review of studies measuring the food environment published between 2007 and 2015. We identified these articles through: PubMed, Embase, Web of Science, PsycINFO, and Global Health databases; tables of contents of relevant journals; and the National Cancer Institute's Measures of the Food Environment website. This search yielded 11,928 citations. We retained and abstracted data from 432 studies. RESULTS The most common methodology used to study the food environment was geographic analysis (65% of articles) and the domination of this methodology has persisted since the last review. Only 25.9% of studies in this review reported the reliability of measures and 28.2% reported validity, but this was an improvement as compared to the earlier review. Very few of the studies reported construct validity. Studies reporting measures of the school or worksite environment have decreased since the previous review. Only 13.9% of the studies used a longitudinal design. CONCLUSIONS To strengthen research examining the relationship between the food environment and population health, there is a need for robust and psychometrically-sound measures and more sophisticated study designs.
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Affiliation(s)
- Leslie A Lytle
- Department of Health Behavior, Campus Box 7440, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, United States.
| | - Rebeccah L Sokol
- Department of Health Behavior, Campus Box 7440, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, United States
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Understanding barriers to fruit and vegetable intake in the Australian Longitudinal Study of Indigenous Children: a mixed-methods approach. Public Health Nutr 2016; 20:832-847. [PMID: 27894381 PMCID: PMC5426329 DOI: 10.1017/s1368980016003013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective To identify barriers to fruit and vegetable intake for Indigenous Australian children
and quantify factors related to these barriers, to help understand why children do not
meet recommendations for fruit and vegetable intake. Design We examined factors related to carer-reported barriers using multilevel Poisson models
(robust variance); a key informant focus group guided our interpretation of
findings. Setting Eleven diverse sites across Australia. Subjects Australian Indigenous children and their carers (N 1230) participating
in the Longitudinal Study of Indigenous Children. Results Almost half (45 %; n 555/1230) of carers reported barriers to their
children’s fruit and vegetable intake. Dislike of fruit and vegetables was the most
common barrier, reported by 32·9 % of carers; however, we identified few factors
associated with dislike. Carers were more than ten times less likely to report barriers
to accessing fruit and vegetables if they lived large cities v. very
remote areas. Within urban and inner regional areas, child and carer well-being,
financial security, suitable housing and community cohesion promoted access to fruit and
vegetables. Conclusions In this national Indigenous Australian sample, almost half of carers faced barriers to
providing their children with a healthy diet. Both remote/outer regional carers and
disadvantaged urban/inner regional carers faced problems accessing fruit and vegetables
for their children. Where vegetables were accessible, children’s dislike was a
substantial barrier. Nutrition promotion must address the broader family, community,
environmental and cultural contexts that impact nutrition, and should draw on the
strengths of Indigenous families and communities.
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53
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Moayyed H, Kelly B, Feng X, Flood V. Evaluation of a 'healthiness' rating system for food outlet types in Australian residential communities. Nutr Diet 2016; 74:29-35. [PMID: 28731554 DOI: 10.1111/1747-0080.12286] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 03/09/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
Abstract
AIM To obtain expert consensus to develop and evaluate a rating system on the relative healthiness of Australian suburbs' food outlet types. METHODS Twenty-four food outlet types and 10 local suburbs were identified from previous mapping studies and based on a scan of suburbs across one large Australian geographical region. Initial food outlet 'scores' for relative healthiness were proposed based on available literature, classified into five categories, from 'most' to 'least' healthy. In round 1 of a modified Delphi survey, participants, Australian public health and nutrition experts, were given each outlet type's definition and the proposed scores and invited to modify the scores based on their perceived 'healthiness'. In round 2, participants were able to revise or adjust their scores. RESULTS Median scores for food outlet types from both rounds highly correlated with the originally proposed scores (two-tailed Pearson's correlation coefficient 0.97 and 0.96, respectively, P = 0.01), and scores from round 1 highly correlated with those from round 2 (Pearson's coefficient 0.998, P = 0.01). Round 2 scores were used to calculate suburbs' overall food environment score, healthiness score, unhealthiness score and a ratio of unhealthiness to healthiness scores. There was strong positive correlation between suburbs' ratio of unhealthiness to healthiness scores and a previously recognised scoring ratio, Retail Food Environment Index (Spearman's rho 0.847, P < 0.01). CONCLUSIONS The study generated experts' consensus about relative healthiness of food outlet types found in Australian neighbourhoods. Proposed scores can be used to assess and compare healthiness of community food environments and to explore their associations with area characteristics, population's diet and health outcomes.
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Affiliation(s)
- Hamid Moayyed
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bridget Kelly
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Xiaoqi Feng
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia.,Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Flood
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,St Vincent's Hospital Research Committee, Sydney, New South Wales, Australia
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54
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Kim S, Macaskill P, Baur LA, Hodson EM, Daylight J, Williams R, Kearns R, Vukasin N, Lyle DM, Craig JC. The differential effect of socio-economic status, birth weight and gender on body mass index in Australian Aboriginal Children. Int J Obes (Lond) 2016; 40:1089-95. [PMID: 27121249 DOI: 10.1038/ijo.2016.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 04/04/2016] [Accepted: 04/18/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adult Aboriginal Australians have 1.5-fold higher risk of obesity, but the trajectory of body mass index (BMI) through childhood and adolescence and the contribution of socio-economic factors remain unclear. Our objective was to determine the changes in BMI in Australian Aboriginal children relative to non-Aboriginal children as they move through adolescence into young adulthood, and to identify risk factors for higher BMI. METHODS A prospective cohort study of Aboriginal and non-Aboriginal school children commenced in 2002 across 15 different screening areas across urban, regional and remote New South Wales, Australia. Socio-economic status was recorded at study enrolment and participants' BMI was measured every 2 years. We fitted a series of mixed linear regression models adjusting for age, birth weight and socio-economic status for boys and girls. RESULTS In all, 3418 (1949 Aboriginal) participants were screened over a total of 11 387 participant years of follow-up. The prevalence of obesity was higher among Aboriginal children from mean age 11 years at baseline (11.6 vs 7.6%) to 16 years at 8 years follow-up (18.6 vs 12.3%). The mean BMI increased with age and was significantly higher among Aboriginal girls compared with non-Aboriginal girls (P<0.01). Girls born of low birth weight had a lower BMI than girls born of normal birth weight (P<0.001). Socio-economic status and low birth weight had a differential effect on BMI for Aboriginal boys compared with non-Aboriginal boys (P for interaction=0.01). Aboriginal boys of highest socio-economic status, unlike those of lower socio-economic status, had a higher BMI compared with non-Aboriginal boys. Non-Aboriginal boys of low birth weight were heavier than Aboriginal boys. CONCLUSIONS Socio-economic status and birth weight have differential effects on BMI among Aboriginal boys, and Aboriginal girls had a higher mean BMI than non-Aboriginal girls through childhood and adolescence. Intervention programs need to recognise the differential risk for obesity for Aboriginal and non-Aboriginal boys and girls to maximise their impact.
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Affiliation(s)
- S Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - P Macaskill
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - L A Baur
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - E M Hodson
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - J Daylight
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - R Williams
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - R Kearns
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - N Vukasin
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - D M Lyle
- Department of Rural Health, University of Sydney, Camperdown, New South Wales, Australia
| | - J C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
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Lee AJ, Kane S, Ramsey R, Good E, Dick M. Testing the price and affordability of healthy and current (unhealthy) diets and the potential impacts of policy change in Australia. BMC Public Health 2016; 16:315. [PMID: 27067642 PMCID: PMC4828857 DOI: 10.1186/s12889-016-2996-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Price and affordability of foods are important determinants of health. Targeted food pricing policies may help improve population diets. However, methods producing comparable data to inform relevant policy decisions are lacking in Australia and globally. The objective was to develop and pilot standardised methods to assess the price, relative price and affordability of healthy (recommended) and current (unhealthy) diets and test impacts of a potential policy change. METHODS Methods followed the optimal approach proposed by INFORMAS using recent Australian dietary intake data and guidelines. Draft healthy and current (unhealthy) diet baskets were developed for five household structures. Food prices were collected in stores in a high and low SES location in Brisbane, Australia. Diet prices were calculated and compared with household incomes, and with potential changes to the Australian Taxation System. Wilcoxen-signed rank tests were used to compare differences in price. RESULTS The draft tools and protocols were deemed acceptable at household level, but methods could be refined. All households spend more on current (unhealthy) diets than required to purchase healthy (recommended) diets, with the majority (53-64 %) of the food budget being spent on 'discretionary' choices, including take-away foods and alcohol. A healthy diet presently costs between 20-31 % of disposable income of low income households, but would become unaffordable for these families under proposed changes to expand the GST to apply to all foods in Australia. CONCLUSIONS Results confirmed that diet pricing methods providing meaningful, comparable data to inform potential fiscal and health policy actions can be developed, but draft tools should be refined. Results suggest that healthy diets can be more affordable than current (unhealthy) diets in Australia, but other factors may be as important as price in determining food choices.
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Affiliation(s)
- Amanda J Lee
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Sarah Kane
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rebecca Ramsey
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Elizabeth Good
- Preventive Health Branch, Prevention Division, Department of Health, Brisbane, QLD, Australia
| | - Mathew Dick
- Preventive Health Branch, Prevention Division, Department of Health, Brisbane, QLD, Australia
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Zhang M, Debarchana G. Spatial Supermarket Redlining and Neighborhood Vulnerability: A Case Study of Hartford, Connecticut. TRANSACTIONS IN GIS : TG 2016; 20:79-100. [PMID: 27034615 PMCID: PMC4810442 DOI: 10.1111/tgis.12142] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The disinclination of chain supermarkets to locate or pull out existing stores from impoverished neighborhoods is termed as "supermarket redlining". This paper attempts to map and understand the spatial effects of potential supermarket redlining on food vulnerability in urban disadvantaged neighborhoods of Hartford, Connecticut. Using a combination of statistical and spatial analysis functions, we first, built a Supermarket Redlining Index (SuRI) from five indicators such as sales volume, employee count, accepts food coupons from federally assisted programs, and size and population density of the service area to rank supermarkets in the order of their importance. Second, to understand the effect of redlining, a Supermarket Redlining Impact Model (SuRIM) was built with eleven indicators describing both the socioeconomic and food access vulnerabilities. The interaction of these vulnerabilities would identify the final outcome: neighborhoods where the impact of supermarket redlining would be critical. Results mapped critical areas in the inner-city of Hartford where if a nearby supermarket closes or relocates to a suburb with limited mitigation efforts to gill the grocery gap, a large number of minority, poor, and disadvantaged residents will experience difficulties to access healthy food leading to food insecurity or perhaps a food desert. We also suggest mitigation efforts to reduce the impact of large supermarket closures.
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Affiliation(s)
| | - Ghosh Debarchana
- Department of Geography, University of Connecticut, 215 Glenbrook Road, CLAS 422, U-4148, ,
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57
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Duran AC, Lock K, Latorre MDRDO, Jaime PC. Evaluating the use of in-store measures in retail food stores and restaurants in Brazil. Rev Saude Publica 2015; 49:S0034-89102015000100261. [PMID: 26538101 PMCID: PMC4617430 DOI: 10.1590/s0034-8910.2015049005420] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 01/15/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess inter-rater reliability, test-retest reliability, and construct validity of retail food store, open-air food market, and restaurant observation tools adapted to the Brazilian urban context. METHODS This study is part of a cross-sectional observation survey conducted in 13 districts across the city of Sao Paulo, Brazil in 2010-2011. Food store and restaurant observational tools were developed based on previously available tools, and then tested it. They included measures on the availability, variety, quality, pricing, and promotion of fruits and vegetables and ultra-processed foods. We used Kappa statistics and intra-class correlation coefficients to assess inter-rater and test-retest reliabilities in samples of 142 restaurants, 97 retail food stores (including open-air food markets), and of 62 restaurants and 45 retail food stores (including open-air food markets), respectively. Construct validity as the tool’s abilities to discriminate based on store types and different income contexts were assessed in the entire sample: 305 retail food stores, 8 fruits and vegetable markets, and 472 restaurants. RESULTS Inter-rater and test-retest reliability were generally high, with most Kappa values greater than 0.70 (range 0.49-1.00). Both tools discriminated between store types and neighborhoods with different median income. Fruits and vegetables were more likely to be found in middle to higher-income neighborhoods, while soda, fruit-flavored drink mixes, cookies, and chips were cheaper and more likely to be found in lower-income neighborhoods. CONCLUSIONS The measures were reliable and able to reveal significant differences across store types and different contexts. Although some items may require revision, results suggest that the tools may be used to reliably measure the food stores and restaurant food environment in urban settings of middle-income countries. Such studies can help .inform health promotion interventions and policies in these contexts.
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Affiliation(s)
- Ana Clara Duran
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Karen Lock
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | | | - Patricia Constante Jaime
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
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58
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Lê Q, Nguyen HB, Terry DR, Dieters S, Auckland S, Long G. Quantifying and visualizing access to healthy food in a rural area of Australia: A spatial analysis. Food Secur 2015. [DOI: 10.1007/s12571-015-0491-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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59
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Bridle-Fitzpatrick S. Food deserts or food swamps?: A mixed-methods study of local food environments in a Mexican city. Soc Sci Med 2015; 142:202-13. [PMID: 26318209 DOI: 10.1016/j.socscimed.2015.08.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 07/19/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
Differential access to healthy foods has been hypothesized to contribute to disparities in eating behaviors and health outcomes. While food deserts have been researched extensively in developed Anglophone countries, evidence from low- and middle-income countries is still scarce. In Mexico, prevalence of obesity is among the highest worldwide. As obesity has increased nationally and become a widespread public health issue, it is becoming concentrated in the low-income population. This mixed-methods study uses a multidimensional approach to analyze food environments in a low-, middle-, and high-income community in a Mexican city. The study advances understanding of the role that food environments may play in shaping eating patterns by analyzing the density and proximity of food outlet types as well as the variety, quantity, quality, pricing, and promotion of different foods. These measures are combined with in-depth qualitative research with families in the communities, including photo elicitation, to assess perceptions of food access. The central aims of the research were to evaluate physical and economic access and exposure to healthy and unhealthy foods in communities of differing socioeconomic status as well as participants' subjective perceptions of such access and exposure. The findings suggest a need to reach beyond a narrow focus on food store types and the distance from residence to grocery stores when analyzing food access. Results show that excessive access and exposure to unhealthy foods and drinks, or "food swamps," may be a greater concern than food deserts for obesity-prevention policy in Mexico.
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Affiliation(s)
- Susan Bridle-Fitzpatrick
- Korbel School of International Studies, University of Denver, 2201 S. Gaylord St., Denver, CO 80210, USA.
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60
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Lamb KE, Thornton LE, Cerin E, Ball K. Statistical Approaches Used to Assess the Equity of Access to Food Outlets: A Systematic Review. AIMS Public Health 2015; 2:358-401. [PMID: 29546115 PMCID: PMC5690240 DOI: 10.3934/publichealth.2015.3.358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/19/2015] [Indexed: 11/21/2022] Open
Abstract
Background Inequalities in eating behaviours are often linked to the types of food retailers accessible in neighbourhood environments. Numerous studies have aimed to identify if access to healthy and unhealthy food retailers is socioeconomically patterned across neighbourhoods, and thus a potential risk factor for dietary inequalities. Existing reviews have examined differences between methodologies, particularly focussing on neighbourhood and food outlet access measure definitions. However, no review has informatively discussed the suitability of the statistical methodologies employed; a key issue determining the validity of study findings. Our aim was to examine the suitability of statistical approaches adopted in these analyses. Methods Searches were conducted for articles published from 2000–2014. Eligible studies included objective measures of the neighbourhood food environment and neighbourhood-level socio-economic status, with a statistical analysis of the association between food outlet access and socio-economic status. Results Fifty-four papers were included. Outlet accessibility was typically defined as the distance to the nearest outlet from the neighbourhood centroid, or as the number of food outlets within a neighbourhood (or buffer). To assess if these measures were linked to neighbourhood disadvantage, common statistical methods included ANOVA, correlation, and Poisson or negative binomial regression. Although all studies involved spatial data, few considered spatial analysis techniques or spatial autocorrelation. Conclusions With advances in GIS software, sophisticated measures of neighbourhood outlet accessibility can be considered. However, approaches to statistical analysis often appear less sophisticated. Care should be taken to consider assumptions underlying the analysis and the possibility of spatially correlated residuals which could affect the results.
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Affiliation(s)
- Karen E Lamb
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Lukar E Thornton
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Ester Cerin
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kylie Ball
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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The role of the local retail food environment in fruit, vegetable and sugar-sweetened beverage consumption in Brazil. Public Health Nutr 2015; 19:1093-102. [DOI: 10.1017/s1368980015001524] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo examine the relationship between the local retail food environment and consumption of fruits and vegetables (FV) and sugar-sweetened beverages (SSB) in São Paulo, Brazil, as well as the moderation effects of income in the studied relationships.DesignCross-sectional study design that drew upon neighbourhood- and individual-level data. For each participant, community (density and proximity) and community food environment (availability, variety, quality and price) measures of FV and SSB were assessed in retail food stores and specialized fresh produce markets within 1·6 km of their homes. Poisson generalized estimating equations (GEE) were used to model the associations of food consumption with food environment measures, adjusted by individual-level characteristics.SettingSão Paulo, Brazil.SubjectsAdults (n 1842) residing in the same census tracts (n 52) in São Paulo, Brazil as those where the neighbourhood-level measures were taken.ResultsFV availability in neighbourhoods was associated with regular FV consumption (≥5 times/week; prevalence ratio=1·41; 95 % CI 1·19, 1·67). Regular FV consumption prevalence was significantly lower among lower-income individuals living in neighbourhoods with fewer supermarkets and fresh produce markets (P-interaction <0·05). A greater variety of SSB was associated with a 15 % increase in regular SSB consumption (≥5 times/week) prevalence, after adjustment for confounding variables.ConclusionsOur findings suggest that the local retail food environment is associated with FV and SSB consumption in a Brazilian urban sample.
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McGill R, Anwar E, Orton L, Bromley H, Lloyd-Williams F, O'Flaherty M, Taylor-Robinson D, Guzman-Castillo M, Gillespie D, Moreira P, Allen K, Hyseni L, Calder N, Petticrew M, White M, Whitehead M, Capewell S. Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health 2015; 15:457. [PMID: 25934496 PMCID: PMC4423493 DOI: 10.1186/s12889-015-1781-7] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 04/22/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Interventions to promote healthy eating make a potentially powerful contribution to the primary prevention of non communicable diseases. It is not known whether healthy eating interventions are equally effective among all sections of the population, nor whether they narrow or widen the health gap between rich and poor. We undertook a systematic review of interventions to promote healthy eating to identify whether impacts differ by socioeconomic position (SEP). METHODS We searched five bibliographic databases using a pre-piloted search strategy. Retrieved articles were screened independently by two reviewers. Healthier diets were defined as the reduced intake of salt, sugar, trans-fats, saturated fat, total fat, or total calories, or increased consumption of fruit, vegetables and wholegrain. Studies were only included if quantitative results were presented by a measure of SEP. Extracted data were categorised with a modified version of the "4Ps" marketing mix, expanded to 6 "Ps": "Price, Place, Product, Prescriptive, Promotion, and Person". RESULTS Our search identified 31,887 articles. Following screening, 36 studies were included: 18 "Price" interventions, 6 "Place" interventions, 1 "Product" intervention, zero "Prescriptive" interventions, 4 "Promotion" interventions, and 18 "Person" interventions. "Price" interventions were most effective in groups with lower SEP, and may therefore appear likely to reduce inequalities. All interventions that combined taxes and subsidies consistently decreased inequalities. Conversely, interventions categorised as "Person" had a greater impact with increasing SEP, and may therefore appear likely to reduce inequalities. All four dietary counselling interventions appear likely to widen inequalities. We did not find any "Prescriptive" interventions and only one "Product" intervention that presented differential results and had no impact by SEP. More "Place" interventions were identified and none of these interventions were judged as likely to widen inequalities. CONCLUSIONS Interventions categorised by a "6 Ps" framework show differential effects on healthy eating outcomes by SEP. "Upstream" interventions categorised as "Price" appeared to decrease inequalities, and "downstream" "Person" interventions, especially dietary counselling seemed to increase inequalities. However the vast majority of studies identified did not explore differential effects by SEP. Interventions aimed at improving population health should be routinely evaluated for differential socioeconomic impact.
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Affiliation(s)
- Rory McGill
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Lois Orton
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Helen Bromley
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | | | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | | | | | - Duncan Gillespie
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Patricia Moreira
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Kirk Allen
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Nicola Calder
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Mark Petticrew
- Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, Liverpool, UK.
| | - Martin White
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK.
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
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63
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Maguire ER, Burgoine T, Monsivais P. Area deprivation and the food environment over time: A repeated cross-sectional study on takeaway outlet density and supermarket presence in Norfolk, UK, 1990-2008. Health Place 2015; 33:142-7. [PMID: 25841285 PMCID: PMC4415115 DOI: 10.1016/j.healthplace.2015.02.012] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/26/2015] [Indexed: 11/28/2022]
Abstract
Socioeconomic disparities in the food environment are known to exist but with little understanding of change over time. This study investigated the density of takeaway food outlets and presence of supermarkets in Norfolk, UK between 1990 and 2008. Data on food retail outlet locations were collected from telephone directories and aggregated within electoral wards. Supermarket presence was not associated with area deprivation over time. Takeaway food outlet density increased overall, and was significantly higher in more deprived areas at all time points; furthermore, socioeconomic disparities in takeaway food outlet density increased across the study period. These findings add to existing evidence and help assess the need for environmental interventions to reduce disparities in the prevalence of unhealthy food outlets.
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Affiliation(s)
- Eva R Maguire
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Box 285, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - Thomas Burgoine
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Box 285, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - Pablo Monsivais
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Box 285, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
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Markow K, Booth S, Savio S, Coveney J. Improving access to community-based food systems: Comparing perspectives of low socioeconomic individuals and food system representatives. Nutr Diet 2014. [DOI: 10.1111/1747-0080.12153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kylie Markow
- Nutrition and Dietetics; Flinders University; Adelaide South Australia Australia
| | - Sue Booth
- Public Health; Flinders University; Adelaide South Australia Australia
| | - Stephanie Savio
- Public Health; Flinders University; Adelaide South Australia Australia
| | - John Coveney
- Public Health; Flinders University; Adelaide South Australia Australia
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Abbott G, Backholer K, Peeters A, Thornton L, Crawford D, Ball K. Explaining educational disparities in adiposity: the role of neighborhood environments. Obesity (Silver Spring) 2014; 22:2413-9. [PMID: 25111375 DOI: 10.1002/oby.20853] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/23/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the extent to which characteristics of the neighborhood built environment explain the association between adiposity and educational qualifications in Australian women. METHODS A community sample of 1,819 women (aged 18-66) from the Melbourne SESAW study provided information regarding their body mass index (BMI) and level of education. Objective measures of participants' residential neighborhood built environments were obtained using a Geographic Information System. RESULTS Compared with women with a high school degree or above, women who did not complete high school had higher average BMI, which was partially explained by lower density of sports facilities and living less proximally to the coastline and to supermarkets. In a multiple mediator model, which explained 16.6% of the educational disparity in BMI, the number of sports facilities and presence of the coastline within 2 km of participants' homes were significant mediators of the observed socioeconomic disparity in BMI. CONCLUSIONS The residential neighborhood environment may help to explain socioeconomic patterning of overweight and obesity in Australian women. These results provide further support for considering the built environment in obesity prevention initiatives, suggesting a potential role in decreasing social inequalities in obesity.
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Affiliation(s)
- Gavin Abbott
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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66
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Is the gene-environment interaction paradigm relevant to genome-wide studies? The case of education and body mass index. Demography 2014; 51:119-39. [PMID: 24281739 DOI: 10.1007/s13524-013-0259-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study uses data from the Framingham Heart Study to examine the relevance of the gene-environment interaction paradigm for genome-wide association studies (GWAS). We use completed college education as our environmental measure and estimate the interactive effect of genotype and education on body mass index (BMI) using 260,402 single-nucleotide polymorphisms (SNPs). Our results highlight the sensitivity of parameter estimates obtained from GWAS models and the difficulty of framing genome-wide results using the existing gene-environment interaction typology. We argue that SNP-environment interactions across the human genome are not likely to provide consistent evidence regarding genetic influences on health that differ by environment. Nevertheless, genome-wide data contain rich information about individual respondents, and we demonstrate the utility of this type of data. We highlight the fact that GWAS is just one use of genome-wide data, and we encourage demographers to develop methods that incorporate this vast amount of information from respondents into their analyses.
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Black C, Ntani G, Inskip H, Cooper C, Cummins S, Moon G, Baird J. Measuring the healthfulness of food retail stores: variations by store type and neighbourhood deprivation. Int J Behav Nutr Phys Act 2014; 11:69. [PMID: 24884529 PMCID: PMC4132210 DOI: 10.1186/1479-5868-11-69] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 05/13/2014] [Indexed: 11/24/2022] Open
Abstract
Background The consumer nutrition environment has been conceptualised as in-store environmental factors that influence food shopping habits. More healthful in-store environments could be characterised as those which promote healthful food choices such as selling good quality healthy foods or placing them in prominent locations to prompt purchasing. Research measuring the full-range of in-store environmental factors concurrently is limited. Purpose To develop a summary score of ‘healthfulness’ composed of nine in-store factors that influence food shopping behaviour, and to assess this score by store type and neighbourhood deprivation. Methods A cross-sectional survey of 601 retail food stores, including supermarkets, grocery stores and convenience stores, was completed in Hampshire, United Kingdom between July 2010 and June 2011. The survey measured nine variables (variety, price, quality, promotions, shelf placement, store placement, nutrition information, healthier alternatives and single fruit sale) to assess the healthfulness of retail food stores on seven healthy and five less healthy foods that are markers of diet quality. Four steps were completed to create nine individual variable scores and another three to create an overall score of healthfulness for each store. Results Analysis of variance showed strong evidence of a difference in overall healthfulness by store type (p < 0.001). Large and premium supermarkets offered the most healthful shopping environments for consumers. Discount supermarkets, ‘world’, convenience and petrol stores offered less healthful environments to consumers however there was variation across the healthfulness spectrum. No relationship between overall healthfulness and neighbourhood deprivation was observed (p = 0.1). Conclusions A new composite measure of nine variables that can influence food choices was developed to provide an overall assessment of the healthfulness of retail food stores. This composite score could be useful in future research to measure the relationship between main food store and quality of diet, and to evaluate the effects of multi-component food environment interventions.
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Affiliation(s)
- Christina Black
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton SO16 6YD, United Kingdom.
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What role do local grocery stores play in urban food environments? A case study of Hartford-Connecticut. PLoS One 2014; 9:e94033. [PMID: 24718579 PMCID: PMC3981752 DOI: 10.1371/journal.pone.0094033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/10/2014] [Indexed: 11/26/2022] Open
Abstract
Introduction Research on urban food environments emphasizes limited access to healthy food, with fewer large supermarkets and higher food prices. Many residents of Hartford, Connecticut, which is often considered a food desert, buy most of their food from small and medium-sized grocery stores. We examined the food environment in greater Hartford, comparing stores in Hartford to those in the surrounding suburbs, and by store size (small, medium, and large). Methods We surveyed all small (over 1,000 ft2), medium, and large-sized supermarkets within a 2-mile radius of Hartford (36 total stores). We measured the distance to stores, availability, price and quality of a market basket of 25 items, and rated each store on internal and external appearance. Geographic Information System (GIS) was used for mapping distance to the stores and variation of food availability, quality, and appearance. Results Contrary to common literature, no significant differences were found in food availability and price between Hartford and suburban stores. However, produce quality, internal, and external store appearance were significantly lower in Hartford compared to suburban stores (all p<0.05). Medium-sized stores had significantly lower prices than small or large supermarkets (p<0.05). Large stores had better scores for internal (p<0.05), external, and produce quality (p<0.01). Most Hartford residents live within 0.5 to 1 mile distance to a grocery store. Discussion Classifying urban areas with few large supermarkets as ‘food deserts’ may overlook the availability of healthy foods and low prices that exist within small and medium-sized groceries common in inner cities. Improving produce quality and store appearance can potentially impact the food purchasing decisions of low-income residents in Hartford.
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Zarnowiecki D, Ball K, Parletta N, Dollman J. Describing socioeconomic gradients in children's diets - does the socioeconomic indicator used matter? Int J Behav Nutr Phys Act 2014; 11:44. [PMID: 24674231 PMCID: PMC3986827 DOI: 10.1186/1479-5868-11-44] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 03/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children of low socioeconomic position (SEP) generally have poorer diets than children of high SEP. However there is no consensus on which SEP variable is most indicative of SEP differences in children's diets. This study investigated associations between diet and various SEP indicators among children aged 9-13 years. METHOD Families (n=625) were recruited from 27 Adelaide primary schools in 2010. Children completed semi-quantitative food frequency questionnaires providing intake scores for fruit, vegetables, non-core foods, sweetened drinks, and healthy and unhealthy eating behaviours. Parents reported demographic information by telephone interview. Differences in dietary intake scores were compared across parental education, income, occupation, employment status and home postcode. RESULTS Across most SEP indicators, lower SEP was associated with poorer dietary outcomes, including higher intake of non-core foods and sweetened drinks, and more unhealthy behaviours; and lower intake of fruit and vegetables, and fewer healthy behaviours. The number and type of significant SEP-diet associations differed across SEP indicators and dietary outcomes. Mother's education appeared most frequently as a predictor of children's dietary intake, and postcode was the least frequent predictor of children's dietary intake. CONCLUSION Socioeconomic gradients in children's dietary intake varied according to the SEP indicator used, suggesting indicator-specific pathways of influence on children's dietary intake. Researchers should consider multiple indicators when defining SEP in relation to children's eating.
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Affiliation(s)
- Dorota Zarnowiecki
- School of Population Health, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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70
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Lucan SC, Hillier A, Schechter CB, Glanz K. Objective and self-reported factors associated with food-environment perceptions and fruit-and-vegetable consumption: a multilevel analysis. Prev Chronic Dis 2014; 11:E47. [PMID: 24674635 PMCID: PMC3970773 DOI: 10.5888/pcd11.130324] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Few studies have assessed how people’s perceptions of their neighborhood environment compare with objective measures or how self-reported and objective neighborhood measures relate to consumption of fruits and vegetables. Methods A telephone survey of 4,399 residents of Philadelphia, Pennsylvania, provided data on individuals, their households, their neighborhoods (self-defined), their food-environment perceptions, and their fruit-and-vegetable consumption. Other data on neighborhoods (census tracts) or “extended neighborhoods” (census tracts plus 1-quarter–mile buffers) came from the US Census Bureau, the Philadelphia Police Department, the Southeastern Pennsylvania Transportation Authority, and the federal Supplemental Nutrition Assistance Program. Mixed-effects multilevel logistic regression models examined associations between food-environment perceptions, fruit-and-vegetable consumption, and individual, household, and neighborhood characteristics. Results Perceptions of neighborhood food environments (supermarket accessibility, produce availability, and grocery quality) were strongly associated with each other but not consistently or significantly associated with objective neighborhood measures or self-reported fruit-and-vegetable consumption. We found racial and educational disparities in fruit-and-vegetable consumption, even after adjusting for food-environment perceptions and individual, household, and neighborhood characteristics. Having a supermarket in the extended neighborhood was associated with better perceived supermarket access (adjusted odds ratio for having a conventional supermarket, 2.04 [95% CI, 1.68–2.46]; adjusted odds ratio for having a limited-assortment supermarket, 1.28 [95% CI, 1.02–1.59]) but not increased fruit-and-vegetable consumption. Models showed some counterintuitive associations with neighborhood crime and public transportation. Conclusion We found limited association between objective and self-reported neighborhood measures. Sociodemographic differences in individual fruit-and-vegetable consumption were evident regardless of neighborhood environment. Adding supermarkets to urban neighborhoods might improve residents’ perceptions of supermarket accessibility but might not increase their fruit-and-vegetable consumption.
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Affiliation(s)
- Sean C Lucan
- Department of Family and Social Medicine, Albert Einstein College of Medicine
- Montefiore Medical Center, 1300 Morris Park Ave, Block Building, Room 410, Bronx, NY 10461. E-mail:
| | - Amy Hillier
- School of Design, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Cetateanu A, Jones A. Understanding the relationship between food environments, deprivation and childhood overweight and obesity: evidence from a cross sectional England-wide study. Health Place 2014; 27:68-76. [PMID: 24561918 PMCID: PMC4018665 DOI: 10.1016/j.healthplace.2014.01.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 01/13/2014] [Accepted: 01/19/2014] [Indexed: 11/26/2022]
Abstract
Using a large cross sectional English sample, we quantified the association between weight status in children aged 4-5 and 10-11 year, characteristics of the food environment, and area deprivation. We observed a positive association between the density of unhealthy food outlets in a neighbourhood and the prevalence of overweight and obesity in children. An association in the opposite direction was observed for other types of food outlets, although after adjustment this was only statistically significant for older children. The prevalence of fast food and other unhealthy food outlets explained only a small proportion of the observed associations between weight status and socioeconomic deprivation. Children׳s weight status may be influenced by their local environment, particularly older children, but associations between obesity and deprivation do not appear strongly due to local food environment characteristics.
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Affiliation(s)
- Andreea Cetateanu
- School of Environmental Sciences, University of East Anglia, Norwich, Norfolk, NR4 7 TJ, UK; Centre for Diet and Physical Activity Research, Box 296, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7 TJ, UK; Centre for Diet and Physical Activity Research, Box 296, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
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Casey R, Oppert JM, Weber C, Charreire H, Salze P, Badariotti D, Banos A, Fischler C, Hernandez CG, Chaix B, Simon C. Determinants of childhood obesity: What can we learn from built environment studies? Food Qual Prefer 2014. [DOI: 10.1016/j.foodqual.2011.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Black C, Moon G, Baird J. Dietary inequalities: what is the evidence for the effect of the neighbourhood food environment? Health Place 2013; 27:229-42. [PMID: 24200470 DOI: 10.1016/j.healthplace.2013.09.015] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/21/2013] [Accepted: 09/29/2013] [Indexed: 01/01/2023]
Abstract
This review summarises the evidence for inequalities in community and consumer nutrition environments from ten previous review articles, and also assesses the evidence for the effect of the community and consumer nutrition environments on dietary intake. There is evidence for inequalities in food access in the US but trends are less apparent in other developed countries. There is a trend for greater access and availability to healthy and less healthy foods relating to better and poorer dietary outcomes respectively. Trends for price show that higher prices of healthy foods are associated with better dietary outcomes. More nuanced measures of the food environment, including multidimensional and individualised approaches, would enhance the state of the evidence and help inform future interventions.
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Affiliation(s)
- Christina Black
- Medical Research Council Lifecourse Epidemiology Unit (University of Southampton), Southampton General Hospital Tremona Road, Southampton SO16 6YD, England, UK.
| | - Graham Moon
- Geography and Environment University of Southampton, University Road, Southampton SO17 1BJ, England, UK.
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit (University of Southampton), Southampton General Hospital Tremona Road, Southampton SO16 6YD, England, UK.
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Burns C, Cook K, Mavoa H. Role of expendable income and price in food choice by low income families. Appetite 2013; 71:209-17. [PMID: 24008182 DOI: 10.1016/j.appet.2013.08.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 08/20/2013] [Accepted: 08/24/2013] [Indexed: 01/01/2023]
Abstract
The public health literature suggests that the cheapness of energy-dense foods is driving the obesity epidemic. We examined food purchases in low-income families and its relationship to the price of food and availability of funds. In-depth interviews were conducted with 22 parents with children less than 15 years of age whose major source of income was a government pension. A photo taxonomy, where participants sorted 50 photos of commonly purchased foods, was used to explore food choice. The most common food groupings used by the participants were: basic, emergency, treat and comfort. The process of food purchase was described by participants as weighing up the attributes of a food in relation to price and money available. Shoppers nominated the basic unit of measurement as quantity per unit price and the heuristic for food choice when shopping as determining "value for money" in a process of triage relating to food purchase decisions. Participants stated satiation of hunger to be the most common "value" relative to price. Given that the foods nominated as filling tended to be carbohydrate-rich staples, we suggest that public health initiatives need to acknowledge this triage process and shape interventions to promote nutrition over satiation.
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Affiliation(s)
- Cate Burns
- Population Health Strategic Research Centre, Deakin University, Australia.
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75
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Duran AC, Diez Roux AV, Latorre MDRDO, Jaime PC. Neighborhood socioeconomic characteristics and differences in the availability of healthy food stores and restaurants in Sao Paulo, Brazil. Health Place 2013; 23:39-47. [PMID: 23747923 PMCID: PMC3758426 DOI: 10.1016/j.healthplace.2013.05.001] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 04/18/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
Abstract
Differential access to healthy foods has been hypothesized to contribute to health disparities, but evidence from low and middle-income countries is still scarce. This study examines whether the access of healthy foods varies across store types and neighborhoods of different socioeconomic statuses (SES) in a large Brazilian city. A cross-sectional study was conducted in 2010-2011 across 52 census tracts. Healthy food access was measured by a comprehensive in-store data collection, summarized into two indexes developed for retail food stores (HFSI) and restaurants (HMRI). Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood SES with healthy food access. Fast food restaurants were more likely to be located in low SES neighborhoods whereas supermarkets and full service restaurants were more likely to be found in higher SES neighborhoods. Multilevel analyses showed that both store type and neighborhood SES were independently associated with in-store food measures. We found differences in the availability of healthy food stores and restaurants in Sao Paulo city favoring middle and high SES neighborhoods.
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Affiliation(s)
- Ana Clara Duran
- Public Health Nutrition Graduate Program, School of Public Health, University of Sao Paulo, Av Dr Arnaldo 715, Cerqueira Cesar Sao Paulo, Sao Paulo 01246-904, Brazil.
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Williams LK, Andrianopoulos N, Cleland V, Crawford D, Ball K. Associations between Education and Personal Income with Body Mass Index among Australian Women Residing in Disadvantaged Neighborhoods. Am J Health Promot 2013; 28:59-65. [DOI: 10.4278/ajhp.120316-quan-143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. The aims of the current study were to (1) determine the association between personal income and body mass index (BMI) and between individual education and BMI, and (2) examine the association between education and BMI across strata of personal income among women. Design. The design of the study was a quantitative analysis of data from self-report questionnaires. Setting. The study setting was socioeconomically disadvantaged neighborhoods in Victoria, Australia. Subjects. The study included 4065 nonpregnant women (ages 18–45 years) living in socioeconomically disadvantaged areas. Measures. The study used a self report questionnaire measuring sociodemographic characteristics known to be associated with BMI. Analysis. Multiple linear regressions with imputation were used to assess the association between education level, personal income, and BMI, while controlling for covariates. Results. Mean (SD) observed BMI was 26.0 (6.1) kg/m2. Compared with women with low education, women with medium (b = −0.81; 95% confidence interval, −1.30 to −0.27; p = .004) and high (b = −1.71; 95% confidence interval, −2.34 to −1.09; p < .001) education had statistically significantly lower BMI values. No differences in BMI were observed between income categories. Stratified analyses suggested that the education-BMI association may be stronger in low-income than higher-income women. Conclusion. Our data show that among women living in socioeconomically disadvantaged areas, high education level rather than personal income may be protective against overweight/obesity. High personal income, however, may buffer the effects of low education on BMI. Obesity prevention efforts should target women with amplified disadvantage.
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Sadler RC, Gilliland JA, Arku G. A food retail-based intervention on food security and consumption. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:3325-46. [PMID: 23921626 PMCID: PMC3774441 DOI: 10.3390/ijerph10083325] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/18/2013] [Accepted: 07/27/2013] [Indexed: 01/22/2023]
Abstract
The effect of the built environment on diet (and ensuing health outcomes) is less understood than the effect of diet on obesity. Natural experiments are increasingly advocated in place of cross-sectional studies unable to suggest causality. The central research question of this paper, therefore, asks whether a neighborhood-level food retail intervention will affect dietary habits or food security. The intervention did not have a significant impact on fruit and vegetable consumption, and the intervention population actually purchased prepared meals more frequently. More problematic, only 8% of respondents overall regularly consumed enough fruits and vegetables, and 34% were food insecure. Further complicating this public health issue, the new grocery store closed after 17 months of operation. Results indicate that geographic access to food is only one element of malnutrition, and that multi-pronged dietary interventions may be more effective. The economic failure of the store also suggests the importance of non-retail interventions to combat malnutrition.
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Affiliation(s)
- Richard C Sadler
- Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON N6A 5C2, Canada.
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Burgoine T, Alvanides S, Lake AA. Creating 'obesogenic realities'; do our methodological choices make a difference when measuring the food environment? Int J Health Geogr 2013; 12:33. [PMID: 23816238 PMCID: PMC3723649 DOI: 10.1186/1476-072x-12-33] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of Geographical Information Systems (GIS) to objectively measure 'obesogenic' food environment (foodscape) exposure has become common-place. This increase in usage has coincided with the development of a methodologically heterogeneous evidence-base, with subsequent perceived difficulties for inter-study comparability. However, when used together in previous work, different types of food environment metric have often demonstrated some degree of covariance. Differences and similarities between density and proximity metrics, and within methodologically different conceptions of density and proximity metrics need to be better understood. METHODS Frequently used measures of food access were calculated for North East England, UK. Using food outlet data from local councils, densities of food outlets per 1000 population and per km² were calculated for small administrative areas. Densities (counts) were also calculated based on population-weighted centroids of administrative areas buffered at 400/800/1000 m street network and Euclidean distances. Proximity (street network and Euclidean distances) from these centroids to the nearest food outlet were also calculated. Metrics were compared using Spearman's rank correlations. RESULTS Measures of foodscape density and proximity were highly correlated. Densities per km² and per 1000 population were highly correlated (r(s) = 0.831). Euclidean and street network based measures of proximity (r(s) = 0.865) and density (r(s) = 0.667-0.764, depending on neighbourhood size) were also highly correlated. Density metrics based on administrative areas and buffered centroids of administrative areas were less strongly correlated (r(s) = 0.299-0.658). CONCLUSIONS Density and proximity metrics were largely comparable, with some exceptions. Whilst results suggested a substantial degree of comparability across existing studies, future comparability could be ensured by moving towards a more standardised set of environmental metrics, where appropriate, lessening the potential pitfalls of methodological variation between studies. The researchers' role in creating their own obesogenic 'reality' should be better understood and acknowledged.
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Affiliation(s)
- Thomas Burgoine
- UKCRC Centre for Diet and Activity Research (CEDAR), Box 296, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Seraphim Alvanides
- Geography and the Built Environment, Ellison Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Amelia A Lake
- Centre for Public Policy and Health, School of Medicine, Pharmacy and Health, Wolfson Research Institute, Queen’s Campus, Thornaby, Durham University, Stockton-on-Tees, TS17 6BH, UK
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Thornton LE, Cameron AJ, McNaughton SA, Waterlander WE, Sodergren M, Svastisalee C, Blanchard L, Liese AD, Battersby S, Carter MA, Sheeshka J, Kirkpatrick SI, Sherman S, Cowburn G, Foster C, Crawford DA. Does the availability of snack foods in supermarkets vary internationally? Int J Behav Nutr Phys Act 2013; 10:56. [PMID: 23672409 PMCID: PMC3660266 DOI: 10.1186/1479-5868-10-56] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 05/06/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cross-country differences in dietary behaviours and obesity rates have been previously reported. Consumption of energy-dense snack foods and soft drinks are implicated as contributing to weight gain, however little is known about how the availability of these items within supermarkets varies internationally. This study assessed variations in the display of snack foods and soft drinks within a sample of supermarkets across eight countries. METHODS Within-store audits were used to evaluate and compare the availability of potato chips (crisps), chocolate, confectionery and soft drinks. Displays measured included shelf length and the proportion of checkouts and end-of-aisle displays containing these products. Audits were conducted in a convenience sample of 170 supermarkets across eight developed nations (Australia, Canada, Denmark, Netherlands, New Zealand, Sweden, United Kingdom (UK), and United States of America (US)). RESULTS The mean total aisle length of snack foods (adjusted for store size) was greatest in supermarkets from the UK (56.4 m) and lowest in New Zealand (21.7 m). When assessed by individual item, the greatest aisle length devoted to chips, chocolate and confectionery was found in UK supermarkets while the greatest aisle length dedicated to soft drinks was in Australian supermarkets. Only stores from the Netherlands (41%) had less than 70% of checkouts featuring displays of snack foods or soft drinks. CONCLUSION Whilst between-country variations were observed, overall results indicate high levels of snack food and soft drinks displays within supermarkets across the eight countries. Exposure to snack foods is largely unavoidable within supermarkets, increasing the likelihood of purchases and particularly those made impulsively.
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Affiliation(s)
- Lukar E Thornton
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Melbourne 3125, Australia.
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Food stress in Adelaide: the relationship between low income and the affordability of healthy food. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2013; 2013:968078. [PMID: 23431321 PMCID: PMC3569900 DOI: 10.1155/2013/968078] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 12/06/2012] [Accepted: 12/13/2012] [Indexed: 11/17/2022]
Abstract
Healthy food is becoming increasingly expensive, and families on low incomes face a difficult financial struggle to afford healthy food. When food costs are considered, families on low incomes often face circumstances of poverty. Housing, utilities, health care, and transport are somewhat fixed in cost; however food is more flexible in cost and therefore is often compromised with less healthy, cheaper food, presenting an opportunity for families on low incomes to cut costs. Using a “Healthy Food Basket” methodology, this study costed a week's supply of healthy food for a range of family types. It found that low-income families would have to spend approximately 30% of household income on eating healthily, whereas high-income households needed to spend about 10%. The differential is explained by the cost of the food basket relative to household income (i.e., affordability). It is argued that families that spend more than 30% of household income on food could be experiencing “food stress.” Moreover the high cost of healthy foods leaves low-income households vulnerable to diet-related health problems because they often have to rely on cheaper foods which are high in fat, sugar, and salt.
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81
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Abstract
Objective: In this study, an instrument was created to measure the healthy and unhealthy characteristics of food environments and investigate associations between the whole of the food environment and fast food consumption. Design and subjects: In consultation with other academic researchers in this field, food stores were categorised to either healthy or unhealthy and weighted (between +10 and −10) by their likely contribution to healthy/unhealthy eating practices. A healthy and unhealthy food environment score (FES) was created using these weightings. Using a cross-sectional study design, multilevel multinomial regression was used to estimate the effects of the whole food environment on the fast food purchasing habits of 2547 individuals. Results: Respondents in areas with the highest tertile of the healthy FES had a lower likelihood of purchasing fast food both infrequently and frequently compared with respondents who never purchased, however only infrequent purchasing remained significant when simultaneously modelled with the unhealthy FES (odds ratio (OR) 0.52; 95% confidence interval (CI) 0.32–0.83). Although a lower likelihood of frequent fast food purchasing was also associated with living in the highest tertile of the unhealthy FES, no association remained once the healthy FES was included in the models. In our binary models, respondents living in areas with a higher unhealthy FES than healthy FES were more likely to purchase fast food infrequently (OR 1.35; 95% CI 1.00–1.82) however no association was found for frequent purchasing. Conclusion: Our study provides some evidence to suggest that healthier food environments may discourage fast food purchasing.
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82
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Mitchell JA. Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum. JOURNAL OF TEACHING IN SOCIAL WORK 2012; 32:471-486. [PMID: 31289423 PMCID: PMC6615890 DOI: 10.1080/08841233.2012.725458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training vary widely. The additional training provided at places of employment and through continuing education after the master's degree is often inadequate for competently addressing the issues clinicians face in practice.
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83
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Black C, Ntani G, Kenny R, Tinati T, Jarman M, Lawrence W, Barker M, Inskip H, Cooper C, Moon G, Baird J. Variety and quality of healthy foods differ according to neighbourhood deprivation. Health Place 2012; 18:1292-9. [PMID: 23085202 DOI: 10.1016/j.healthplace.2012.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 08/29/2012] [Accepted: 09/07/2012] [Indexed: 11/18/2022]
Abstract
This study addresses a gap in the food environment literature by investigating spatial differences in the inter relationship of price, variety and quality of food in southern England. We conducted a survey of all grocery stores (n=195) in the city of Southampton, UK, and ranked neighbourhoods according to national quintiles of deprivation. We found no difference in availability or cheapest price across neighbourhoods. However, the poorest neighbourhoods had less variety of healthy products and poorer quality fruit and vegetables than more affluent neighbourhoods. Dietary inequalities may be exacerbated by differences in the variety and quality of healthy foods sold locally; these factors may influence whether or not consumers purchase healthy foods.
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Affiliation(s)
- Christina Black
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, England, UK.
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84
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Gustafson A, Hankins S, Jilcott S. Measures of the consumer food store environment: a systematic review of the evidence 2000-2011. J Community Health 2012; 37:897-911. [PMID: 22160660 PMCID: PMC3386483 DOI: 10.1007/s10900-011-9524-x] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Description of the consumer food environment has proliferated in publication. However, there has been a lack of systematic reviews focusing on how the consumer food environment is associated with the following: (1) neighborhood characteristics; (2) food prices; (3) dietary patterns; and (4) weight status. We conducted a systematic review of primary, quantitative, observational studies, published in English that conducted an audit of the consumer food environment. The literature search included electronic, hand searches, and peer-reviewed from 2000 to 2011. Fifty six papers met the inclusion criteria. Six studies reported stores in low income neighborhoods or high minority neighborhoods had less availability of healthy food. While, four studies found there was no difference in availability between neighborhoods. The results were also inconsistent for differences in food prices, dietary patterns, and weight status. This systematic review uncovered several key findings. (1) Systematic measurement of determining availability of food within stores and store types is needed; (2) Context is relevant for understanding the complexities of the consumer food environment; (3) Interventions and longitudinal studies addressing purchasing habits, diet, and obesity outcomes are needed; and (4) Influences of price and marketing that may be linked with why people purchase certain items.
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Affiliation(s)
- Alison Gustafson
- Department of Nutrition and Food Science, University of Kentucky, Lexington, KY 40506, USA.
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85
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Positive effect of a targeted intervention to improve access and availability of fruit and vegetables in an area of deprivation. Health Place 2012; 18:1074-8. [PMID: 22705164 DOI: 10.1016/j.healthplace.2012.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/30/2012] [Accepted: 05/07/2012] [Indexed: 11/24/2022]
Abstract
Increasing fruit and vegetable intake has the potential to prevent chronic disease risk but substantial inequalities in intake exist between advantaged and disadvantaged communities. Access and availability of fruit and vegetables have been shown to be important determinants of intake. The current study aimed to evaluate the effectiveness of a Mobile Food Store intervention to improve access to fruit and vegetables by making cost-price produce available to targeted communities. Postcode mapping identified communities with low fruit and vegetable intake and high chronic disease risk. The Mobile Food Store travelled to these communities each week. Evaluation of self-reported fruit and vegetable intake was collected by validated questionnaire for 255 users (62% response rate). Store use resulted in a significant increase in intake (1.2 portions per day, 95%CI 0.83-1.48; p<0.001) which was greater than all but one previous intervention in the UK. The targeted model of improving access to fruit and vegetables was effective in increasing intake; however future controlled trials are required to objectively examine potential effects on fruit and vegetable intake and health outcomes.
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86
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Variation in supermarket exposure to energy-dense snack foods by socio-economic position. Public Health Nutr 2012; 16:1178-85. [PMID: 22613746 DOI: 10.1017/s1368980012002649] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study aimed to examine the availability of energy-dense,nutrient-poor snack foods (and fruits and vegetables) in supermarkets located insocio-economically advantaged and disadvantaged neighbourhoods. DESIGN Cross-sectional supermarket audit. SETTING Melbourne, Australia. Measures included product shelf space and number of varieties for soft drinks, crisps, chocolate, confectionery and fruits and vegetables, as well as store size. SUBJECTS Thirty-five supermarkets (response 83 %) from neighbourhoods in the lowest and highest quintile of socio-economic disadvantage. RESULTS Shelf space allocated to soft drinks (23?6m v. 17?7m, P50?006), crisps (16?5m v. 13?0m, P50?016), chocolate (12?2m v. 10?1m, P50?022) and confectionery (6?7m v. 5?1m, P50?003) was greater in stores from socioeconomically disadvantaged neighbourhoods. After adjustment for store size (stores in disadvantaged areas being larger), shelf space for confectionery (6?3m v. 5?6m, P50?024) and combined shelf space for all energy-dense foods and drinks (55?0m v. 48?9m, P50?017) remained greater in stores from socio-economically disadvantaged neighbourhoods. The ratio of shelf space allocated to fruits and vegetables to that for energy-dense snack foods also varied by socio-economic disadvantage after adjustment for store size (most disadvantaged v. least disadvantaged: 1?7 v. 2?1, P50?025). Varieties of fruits and vegetables and chocolate bars were more numerous in less disadvantaged areas (P,0?05). CONCLUSIONS Exposure to energy-dense snack foods and soft drinks in supermarketswas greater in socio-economically disadvantaged neighbourhoods. Thismay impact purchasing, consumption and cultural norms related to eatingbehaviours and may therefore work against elimination of the known socioeconomicgradient in obesity levels. Reform of supermarket stocking practicesmay represent an effective means of obesity prevention.
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Abstract
Until recently, little attention has been paid to geocoding positional accuracy and its impacts on accessibility measures; estimates of disease rates; findings of disease clustering; spatial prediction and modeling of health outcomes; and estimates of individual exposures based on geographic proximity to pollutant and pathogen sources. It is now clear that positional errors can result in flawed findings and poor public health decisions. Yet the current state-of-practice is to ignore geocoding positional uncertainty, primarily because of a lack of theory, methods and tools for quantifying, modeling, and adjusting for geocoding positional errors in health analysis. This paper proposes a research agenda to address this need. It summarizes the basics of the geocoding process, its assumptions, and empirical evidence describing the magnitude of geocoding positional error. An overview of the impacts of positional error in health analysis, including accessibility, disease clustering, exposure reconstruction, and spatial weights estimation is presented. The proposed research agenda addresses five key needs: (1) a lack of standardized, open-access geocoding resources for use in health research; (2) a lack of geocoding validation datasets that will allow the evaluation of alternative geocoding engines and procedures; (3) a lack of spatially explicit geocoding positional error models; (4) a lack of resources for assessing the sensitivity of spatial analysis results to geocoding positional error; (5) a lack of demonstration studies that illustrate the sensitivity of health policy decisions to geocoding positional error.
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88
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Comparing the availability, price, variety and quality of fruits and vegetables across retail outlets and by area-level socio-economic position. Public Health Nutr 2012; 16:171-8. [PMID: 22433912 DOI: 10.1017/s1368980012000766] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore whether area-level socio-economic position or the form of retail stream (conventional v. farmers' market) is associated with differences in the price, availability, variety and quality of a range of fresh fruit and vegetables. DESIGN A multi-site cross-sectional pilot study of farmers' markets, supermarkets and independent fruit and vegetable retailers. Each was surveyed to assess the price, availability, variety and quality of fifteen fruit and eighteen vegetable items. SETTING Retail outlets were located in south-east Queensland. SUBJECTS Fifteen retail outlets were surveyed (five of each retail stream). RESULTS Average basket prices were not significantly different across the socio-economic spectrum, but prices in low socio-economic areas were cheapest. Availability, variety and quality did not differ significantly across levels of socio-economic position; however, the areas with the most socio-economic disadvantage scored poorest for quality and variety. Supermarkets had significantly better fruit and vegetable availability than farmers' markets, although price, variety and quality scores were not different across retail streams. Results demonstrate a trend to fruit and vegetable prices being more expensive at farmers' markets, with the price of the fruit basket being significantly greater at the organic farmers' market compared with the non-organic farmers' markets. CONCLUSIONS Neither area-level socio-economic position nor the form of retail stream was significantly associated with differences in the availability, price, variety and quality of fruit and vegetables, except for availability which was higher in supermarkets than farmers' markets. Further research is needed to determine what role farmers' markets can play in affecting fruit and vegetable intake.
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89
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Thornton LE, Cameron AJ, McNaughton SA, Worsley A, Crawford DA. The availability of snack food displays that may trigger impulse purchases in Melbourne supermarkets. BMC Public Health 2012; 12:194. [PMID: 22420759 PMCID: PMC3386861 DOI: 10.1186/1471-2458-12-194] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/15/2012] [Indexed: 12/04/2022] Open
Abstract
Background Supermarkets play a major role in influencing the food purchasing behaviours of most households. Snack food exposures within these stores may contribute to higher levels of consumption and ultimately to increasing levels of obesity, particularly within socioeconomically disadvantaged neighbourhoods. We aimed to examine the availability of snack food displays at checkouts, end-of-aisle displays and island displays in major supermarket chains in the least and most socioeconomically disadvantaged neighbourhoods of Melbourne. Methods Within-store audits of 35 Melbourne supermarkets. Supermarkets were sampled from the least and most socioeconomically disadvantaged suburbs within 30 km of the Melbourne CBD. We measured the availability of crisps, chocolate, confectionery, and soft drinks (diet and regular) at the checkouts, in end-of-aisle displays, and in island bin displays. Results Snack food displays were most prominent at checkouts with only five stores not having snack foods at 100% of their checkouts. Snack foods were also present at a number of end-of-aisle displays (at both the front (median 38%) and back (median 33%) of store), and in island bin displays (median number of island displays: 7; median total circumference of island displays: 19.4 metres). Chocolate items were the most common snack food item on display. There was no difference in the availability of these snack food displays by neighbourhood disadvantage. Conclusions As a result of the high availability of snack food displays, exposure to snack foods is almost unavoidable in Melbourne supermarkets, regardless of levels of neighbourhood socioeconomic disadvantage. Results of this study could promote awareness of the prominence of unhealthy food items in chain-brand supermarkets outlets.
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Affiliation(s)
- Lukar E Thornton
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Vic 3125, Australia.
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90
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Perceived quality and availability of fruit and vegetables are associated with perceptions of fruit and vegetable affordability among socio-economically disadvantaged women. Public Health Nutr 2012; 15:1262-7. [DOI: 10.1017/s1368980011003417] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectivePerceptions that fruit and vegetables are expensive have been found to be associated with lower consumption of fruit and vegetables among disadvantaged women; however, the determinants of these perceptions are relatively unknown. The purpose of the current paper is to examine whether perceived availability and quality of fruit and vegetables, and social support for healthy eating, are associated with perceptions of fruit and vegetable affordability among women residing in disadvantaged neighbourhoods.DesignCross-sectional self-report survey.SettingThe study was conducted in Melbourne, Australia.SubjectsAn Australian sample of 4131 women, aged 18–45 years, residing in neighbourhoods ranked in the lowest Victorian tertile of relative disadvantage by the Australian Bureau of Statistics, an index that considers aspects of disadvantage such as residents’ income, education, motor vehicle access and employment.ResultsResults showed that irrespective of education, income and other key covariates, women who perceived poor availability and quality of fruit and vegetables in their local neighbourhood were more likely to perceive fruit and vegetables as expensive.ConclusionsOur results suggest that perceptions of fruit and vegetable affordability are not driven exclusively by lack of financial or knowledge-related resources, but also by women's psychological response and interpretation of their local nutrition environment.
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91
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Kelly B, Flood VM, Yeatman H. Measuring local food environments: an overview of available methods and measures. Health Place 2011; 17:1284-93. [PMID: 21908229 DOI: 10.1016/j.healthplace.2011.08.014] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 08/15/2011] [Accepted: 08/24/2011] [Indexed: 11/18/2022]
Abstract
Reliable and valid measures of local food environments are needed to more fully understand the relationship between these environments and health and identify potential intervention points to improve access to, and the availability of, healthy foods. These measures also inform policy making, including the zoning of food outlets and food labelling/information requirements. A literature review was undertaken using health, behavioural and social sciences, nutrition and public health databases and grey literature, to determine available information on the measurement of local food environments. Included articles were those measuring aspects of food environments published from 2000 to 2010. A range of tools and methods are available to measure different components of food environments. Those focusing on community nutrition environments record the number, type and location of food outlets. The tools that focus on the consumer nutrition environment incorporate other factors, such as available food and beverage products, their price and quality, and any promotions or information to prompt consumers to make purchasing decisions. A summary and critique of these measures are provided.
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Affiliation(s)
- Bridget Kelly
- School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, NSW 2522, Australia.
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92
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Is the objective food environment associated with perceptions of the food environment? Public Health Nutr 2011; 15:291-8. [PMID: 21835079 DOI: 10.1017/s1368980011001947] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study examined whether objective measures of the food environment are associated with perceptions of the food environment and whether this relationship varies by socio-economic disadvantage. DESIGN The study is a cross-sectional analysis of self-report surveys and objective environment data. Women reported their perceptions on the nutrition environment. Participants' homes and food stores were geocoded to measure the objective community nutrition environment. Data on the average price and variety of fruit and vegetables were used to measure the objective consumer nutrition environment. SETTING The study was conducted in Melbourne, Australia, in 2003-2004. SUBJECTS Data presented are from a sample of 1393 women aged 18-65 years. RESULTS Overall the match between the perceived and objective environment was poor, underscoring the limitations in using perceptions of the environment as a proxy for the objective environment. Socio-economic disadvantage had limited impact on the relationship between perceived and objective nutrition environment. CONCLUSIONS Further research is needed to understand the determinants of perceptions of the nutrition environment to enhance our understanding of the role of perceptions in nutrition choices and drivers of socio-economic inequalities in nutrition.
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93
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Thornton LE, Cameron AJ, Crawford DA, McNaughton SA, Ball K. Is greater variety of chocolates and confectionery in supermarkets associated with more consumption? Aust N Z J Public Health 2011; 35:292-3. [PMID: 21627731 DOI: 10.1111/j.1753-6405.2011.00706.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Holthe A, Larsen T, Samdal O. Understanding barriers to implementing the Norwegian national guidelines for healthy school meals: a case study involving three secondary schools. MATERNAL & CHILD NUTRITION 2011; 7:315-27. [PMID: 21689274 PMCID: PMC6860841 DOI: 10.1111/j.1740-8709.2009.00239.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The main goal of the present study was to investigate the barriers to implementing the Norwegian national guidelines for healthy school meals as perceived by principals, project leaders, teachers and students. This study employed a multiple-case design using an explorative approach. Data were collected at three secondary schools in Norway participating in the intervention project Physical activity and healthy school meals. Individual interviews were conducted with school principals and project leaders, and focus group interviews were conducted separately with teachers and students. Four categories of barriers were identified: (1) lack of adaptation of the guidelines to the target group; (2) lack of resources and funding; (3) conflicting values and goals; and (4) access to unhealthy food outside school. The research identified differences in perceived barriers between the staff responsible for implementation and the students as the target group of the measures. All staff groups perceived barriers relating to both resources, and conflicting values and goals. The teachers were more concerned about issues of relevance for adaptation to the target groups than were the principals and project leaders. The students were concerned mostly with issues directly affecting their experience with items offered in the canteen.
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Affiliation(s)
- Asle Holthe
- Faculty of Education, Bergen University College, 5096 Bergen, Norway.
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95
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Jaime PC, Duran AC, Sarti FM, Lock K. Investigating environmental determinants of diet, physical activity, and overweight among adults in Sao Paulo, Brazil. J Urban Health 2011; 88:567-81. [PMID: 21327549 PMCID: PMC3126927 DOI: 10.1007/s11524-010-9537-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is worldwide recognition that the burden of noncommunicable diseases (NCDs) and obesity-related health problems is rapidly increasing in low- and middle-income countries. Environmental determinants of obesity are likely to differ between countries, particularly in those undergoing rapid socioeconomic and nutrition transitions such as Brazil. This study aims to describe some built environment and local food environment variables and to explore their association with the overweight rate and diet and physical activity area-level aggregated indicators of adults living in the city of Sao Paulo, the largest city in Brazil. This formative study includes an ecological analysis of environmental factors associated with overweight across 31 submunicipalities of the city of Sao Paulo using statistical and spatial analyses. Average prevalence of overweight was 41.69% (95% confidence interval 38.74, 44.64), ranging from 27.14% to 60.75% across the submunicipalities. There was a wide geographical variation of both individual diet and physical activity, and indicators of food and built environments, favoring wealthier areas. After controlling for area socioeconomic status, there was a positive correlation between regular fruits and vegetables (FV) intake and density of FV specialized food markets (r = 0.497; p < 0.001), but no relationship between fast-food restaurant density and overweight prevalence was found. A negative association between overweight prevalence and density of parks and public sport facilities was seen (r = -0.527; p < 0.05). Understanding the relationship between local neighborhood environments and increasing rates of poor diet, physical activity, and obesity is essential in countries undergoing rapid economic and urban development, such as Brazil, in order to provide insights for policies to reduce increasing rates of NCDs and food access and health inequalities.
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Affiliation(s)
| | - Ana Clara Duran
- Public Health Nutrition Program, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Flávia Mori Sarti
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Brazil
| | - Karen Lock
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, University of London, London, UK
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96
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Van Meter E, Lawson AB, Colabianchi N, Nichols M, Hibbert J, Porter D, Liese AD. Spatial accessibility and availability measures and statistical properties in the food environment. Spat Spatiotemporal Epidemiol 2011; 2:35-47. [PMID: 21499528 PMCID: PMC3076953 DOI: 10.1016/j.sste.2010.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Spatial accessibility is of increasing interest in the health sciences. This paper addresses the statistical use of spatial accessibility and availability indices. These measures are evaluated via an extensive simulation based on cluster models for local food outlet density. We derived Monte Carlo critical values for several statistical tests based on the indices. In particular we are interested in the ability to make inferential comparisons between different study areas where indices of accessibility and availability are to be calculated. We derive tests of mean difference as well as tests for differences in Moran's I for spatial correlation for each of the accessibility and availability indices. We also apply these new statistical tests to a data example based on two counties in South Carolina for various accessibility and availability measures calculated for food outlets, stores, and restaurants.
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Affiliation(s)
- E Van Meter
- Division of Biostatistics and Epidemiology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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97
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Dunn RA, Sharkey JR, Lotade-Manje J, Bouhlal Y, Nayga RM. Socio-economic status, racial composition and the affordability of fresh fruits and vegetables in neighborhoods of a large rural region in Texas. Nutr J 2011; 10:6. [PMID: 21244688 PMCID: PMC3033798 DOI: 10.1186/1475-2891-10-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 01/18/2011] [Indexed: 01/22/2023] Open
Abstract
Background Little is known about how affordability of healthy food varies with community characteristics in rural settings. We examined how the cost of fresh fruit and vegetables varies with the economic and demographic characteristics in six rural counties of Texas. Methods Ground-truthed data from the Brazos Valley Food Environment Project were used to identify all food stores in the rural region and the availability and lowest price of fresh whole fruit and vegetables in the food stores. Socioeconomic characteristics were extracted from the 2000 U.S. Census Summary Files 3 at the level of the census block group. We used an imputation strategy to calculate two types of price indices for both fresh fruit and fresh vegetables: a high variety and a basic index; and evaluated the relationship between neighborhood economic and demographic characteristics and affordability of fresh produce, using linear regression models. Results The mean cost of meeting the USDA recommendation of fruit consumption from a high variety basket of fruit types in our sample of stores was just over $27.50 per week. Relying on the three most common fruits lowered the weekly expense to under $17.25 per week, a reduction of 37.6%. The effect of moving from a high variety to a low variety basket was much less when considering vegetable consumption: a 4.3% decline from $29.23 to $27.97 per week. Univariate regression analysis revealed that the cost of fresh produce is not associated with the racial/ethnic composition of the local community. However, multivariate regression showed that holding median income constant, stores in neighborhoods with higher percentages of Black residents paid more for fresh fruits and vegetables. The proportion of Hispanic residents was not associated with cost in either the univariate or multivariate analysis. Conclusion This study extends prior work by examining the affordability of fresh fruit and vegetables from food stores in a large rural area; and how access to an affordable supply of fresh fruit and vegetables differs by neighborhood inequalities. The approach and findings of this study are relevant and have important research and policy implications for understanding access and availability of affordable, healthy foods.
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Affiliation(s)
- Richard A Dunn
- Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
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98
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Sparks AL, Bania N, Leete L. Comparative approaches to measuring food access in urban areas: the case of Portland, Oregon. URBAN STUDIES (EDINBURGH, SCOTLAND) 2011; 48:1715-1737. [PMID: 21954485 DOI: 10.1177/0042098010375994] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
GIS methods are used to construct measures of food access for neighbourhoods in the Portland, Oregon, US metropolitan area and the sensitivity of such measures to methodological variation is examined. The level of aggregation of data inputs is varied and the effect of using both Euclidean and street network distances is tested. It is found that, regardless of the level of geographical disaggregation, distance-based measures generate approximately the same conclusions about the distribution of food access in the area. It is also found that, while the relationship between street network and Euclidean distances varies with population density, measures computed with either construct generate the same relative patterns of food access. These findings suggest that results from food access studies employing disparate methodologies can often be compared.
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Affiliation(s)
- Andrea L Sparks
- US Department of Housing and Urban Development, Washington, DC
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99
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Who is eating where? Findings from the SocioEconomic Status and Activity in Women (SESAW) study. Public Health Nutr 2010; 14:523-31. [PMID: 21144099 DOI: 10.1017/s1368980010003022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Foods prepared outside of the home have been linked to less-than-ideal nutrient profiles for health. We examine whether the locations where meals are prepared and consumed are associated with socio-economic predictors among women. DESIGN A cross-sectional study using self-reported data. We examined multiple locations where meals are prepared and consumed: (i) at home; (ii) fast food eaten at home; (iii) fast food eaten at the restaurant; (iv) total fast food; (v) non-fast-food restaurant meals eaten at home; (vi) non-fast-food restaurant meals eaten at the restaurant; and (vii) all non-fast-food restaurant meals. Multilevel logistic regression was used to determine whether frequent consumption of meals from these sources varied by level of education, occupation, household income and area-level disadvantage. SETTING Metropolitan Melbourne, Australia. SUBJECTS A total of 1328 women from forty-five neighbourhoods randomly sampled for the SocioEconomic Status and Activity in Women study. RESULTS Those with higher educational qualifications or who were not in the workforce (compared with those in professional employment) were more likely to report frequent consumption of meals prepared and consumed at home. High individual- and area-level socio-economic characteristics were associated with a lower likelihood of frequent consumption of fast food and a higher likelihood of frequent consumption of meals from non-fast-food sources. The strength and significance of relationships varied by place of consumption. CONCLUSIONS The source of meal preparation and consumption varied by socio-economic predictors. This has implications for policy makers who need to continue to campaign to make healthy alternatives available in out-of-home food sources.
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Monsivais P, Aggarwal A, Drewnowski A. Are socio-economic disparities in diet quality explained by diet cost? J Epidemiol Community Health 2010; 66:530-5. [PMID: 21148819 DOI: 10.1136/jech.2010.122333] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Socio-economic disparities in nutrition are well documented. This study tested the hypothesis that socio-economic differences in nutrient intakes can be accounted for, in part, by diet cost. METHODS A representative sample of 1295 adults in King County (WA) was surveyed in 2008-2009, and usual dietary intakes were assessed based on a food-frequency questionnaire. The monetary value of individual diets was estimated using local retail supermarket prices for 384 foods. Nutrients of concern as identified by the 2005 Dietary Guidelines Advisory Committee were fibre, vitamins A, C and E, calcium, magnesium and potassium. A nutrient density score based on all seven nutrients was another dependent measure. General linear models and linear regressions were used to examine associations among education and income, nutrient density measure and diet cost. Analyses were conducted in 2009-2010. RESULTS Controlling for energy and other covariates, higher-cost diets were significantly higher in all seven nutrients and in overall nutrient density. Higher education and income were positively and significantly associated with the nutrient density measure, but these effects were greatly attenuated with the inclusion of the cost variable in the model. CONCLUSIONS Socio-economic differences in nutrient intake can be substantially explained by the monetary cost of the diet. The higher cost of more nutritious diets may contribute to socio-economic disparities in health and should be taken into account in the formulation of nutrition and public health policy.
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