Disparities in the food environments of New York City public schools

Structural racism and geographic access to food retailers in the United States: A scoping review

This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. In 2022, relevant scientific literature was reviewed using Covidence software. Independent reviewers examined 13,069 citations; 163 citations advanced to the full-text review stage and 70 were selected for inclusion. Twenty-one studies (30%) linked one or more indicator of structural racism to food retailer access while 49 (70%) solely examined differences in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Many U.S.-based studies have evaluated food retailer access by neighborhood racial/ethnic composition. Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.

Neighborhood walkability and sex steroid hormone levels in women

BACKGROUND

Neighborhood walkability (NW) has been linked to increased physical activity, which in turn is associated with lower concentrations of sex hormones and higher concentration of SHBG in women. However, no study has directly examined the association of NW with female sex hormone levels.

OBJECTIVE

We conducted a cross-sectional study to evaluate the association between NW and circulating levels of sex hormones and SHBG in pre- and post-menopausal women.

METHODS

We included 797 premenopausal and 618 postmenopausal women from the New York University Women's Health Study (NYUWHS) who were healthy controls in previous nested case-control studies in which sex hormones (androstenedione, testosterone, DHEAS, estradiol and estrone) and SHBG had been measured in serum at enrollment. Baseline residential addresses were geo-coded and the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) was calculated. Generalized Estimating Equations were used to assess the association between BEH-NWI and sex hormone and SHBG concentrations adjusting for individual- and neighborhood-level factors.

RESULTS

In premenopausal women, a one standard deviation (SD) increment in BEH-NWI was associated with a 3.5% (95% CI 0.9%-6.1%) lower DHEAS concentration. In postmenopausal women, a one SD increment in BEH-NWI was related to an 8.5% (95% CI 5.4%-11.5%) lower level of DHEAS, a 3.7% (95% CI 0.5%-6.8%) lower level of testosterone, a 1.8% (95% CI 0.5%-3.0%) lower level of estrone, and a 4.2% (95% CI 2.7%-5.7%) higher level of SHBG. However, the associations with respect to DHEAS and estrone became apparent only after adjusting for neighborhood-level variables. Sensitivity analyses using fixed effects meta-analysis and inverse probability weighting accounting for potential selection bias yielded similar results.

CONCLUSION

Our findings suggest that NW is associated with lower concentrations of androgens and estrone, and increased SHBG, in postmenopausal women, and lower levels of DHEAS in premenopausal women.

Food Environment around Schools: A Systematic Scope Review

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

Characterizing food environments near schools in California: A latent class approach simultaneously using multiple food outlet types and two spatial scales

It is challenging to evaluate associations between the food environment near schools with either prevalence of childhood obesity or with socioeconomic characteristics of schools. This is because the food environment has many dimensions, including its spatial distribution. We used latent class analysis to classify public schools in urban, suburban, and rural areas in California into food environment classes based on the availability and spatial distribution of multiple types of unhealthy food outlets nearby. All urban schools had at least one unhealthy food outlet nearby, compared to seventy-two percent of schools in rural areas did. Food environment classes varied in the quantity of available food outlets, the relative mix of food outlet types, and the outlets' spatial distribution near schools. Regardless of urbanicity, schools in low-income neighborhoods had greater exposure to unhealthy food outlets. The direction of associations between food environment classes and school size, type, and race/ethnic composition depends on the level of urbanicity of the school locations. Urban schools attended primarily by African American and Asian children are more likely to have greater exposures to unhealthy food outlets. In urban and rural but not suburban areas, schools attended primarily by Latino students had more outlets offering unhealthy foods or beverages nearby. In suburban areas, differences in the spatial distribution of food outlets indicates that food outlets are more likely to cluster near K-12 schools and high schools compared to elementary schools. Intervention design and future research need to consider that the associations between food environment exposures and school characteristics differ by urbanicity.

Availability of food stores around Brazilian schools

The aim of this study was to analyze the availability of food stores in the territory of schools. Ecological study conducted in Viçosa, Minas Gerais, Brazil, with all schools (N=42) and food stores (N=656). Data were collected through the objective evaluation of the environment, and the stores were categorized into healthy, unhealthy, mixed and supermarkets. Bivariate Ripley´s K function assessed the existence of clustering of categories of stores in the territory of schools. All the schools had at least one food store in their territory. Unhealthy stores were the most common and closest to the schools. There were more stores around private schools, offering high school education, located in the central region and in the highest per capita income tercile. The bivariate Ripley´s K function showed evidence of clustering of stores at all analyzed distances (400 to 1.5 km) with up to 3 times more establishments than would be expected if they were randomly distributed. Therefore, schoolchildren were likely exposed to unhealthy food environments, regardless of neighborhood income and location, which may contribute to inadequate food choices.

Parental divorce and nicotine addiction in Lebanese adolescents: the mediating role of child abuse and bullying victimization

BACKGROUND

Lebanon ranks first amongst Middle-Eastern countries in terms of cigarette and waterpipe smoking. Understanding the mediating factors for nicotine addiction in adolescents who have experienced parental divorce is vital to take effective measures that will help in lowering its prevalence in our community. The objective of this study was to investigate the association between the increasingly concerning parental divorce and nicotine addiction in Lebanese adolescents while taking into consideration the plausible mediating effect of abuse and bullying victimization.

METHODS

This was a cross-sectional survey-based study that was conducted between January and May 2019. A total of 1810 adolescents aged between 14 and 17 years was enrolled from 16 Lebanese schools. Linear regressions taking the cigarette and waterpipe dependence scores as dependent variables were conducted respectively, using the SPSS software. PROCESS v3.4 model 4 was used for mediation analysis.

RESULTS

A total of 11.9% of the enrolled participants had divorced parents. Higher cigarette and waterpipe dependence were found in adolescents whose parents were divorced compared to those living together. More child psychological abuse, having divorced parents vs living together, and more child physical abuse were significantly associated with higher cigarette dependence. More child psychological and physical, and having divorced parents vs living together were significantly associated with more waterpipe dependence. In addition, all forms of abuse (except neglect) and bullying victimization had a partially mediating effect in the associations between parental divorce and nicotine dependence (cigarette and waterpipe) in adolescents.

CONCLUSION

This study results may serve as a first step towards enrolling separated parents and their children in special prevention programs to help them create a protective and supportive environment.

Developing a Culturally Responsive Lifestyle Intervention for Overweight/Obese U.S. Mexicans

INTRODUCTION

Hispanics are the largest minority group in the United States, constituting 18 % of the population. Mexicans are the largest Hispanic subgroup and are at disproportionate risk for overweight/obesity. Lifestyle interventions targeting dietary change and physical activity have resulted in significant weight loss in several large randomized clinical trials in the general population, but few studies have tailored interventions to Mexican Americans. We conducted a community needs assessment from 2018 to 2020 in accordance with Domenech-Rodriguez and Wieling's Cultural Adaptation Process (CAP) model to inform the development of SANOS (SAlud y Nutrición para todOS) (Health and Nutrition for All), a culturally-tailored, community-based diet and lifestyle education and counseling program that addresses overweight/obesity among U.S. Mexicans.

METHODS

Five Spanish-language focus groups were conducted until thematic saturation with 31 overweight/obese Mexicans in New York City about their knowledge, priorities, and preferences regarding diet, exercise, and evidence-based strategies for behavioral change. A grounded theory approach was used to analyze the data.

RESULTS

Five themes were identified: (1) A strong desire for tangible information related to diet and health, (2) Family as a primary motivator for behavior change, (3) Desire for group-based motivation and accountability to sustain intervention participation, (4) Belief in short-term goal setting to prevent loss of motivation, and (5) Time and workplace-related barriers to intervention adoption.

CONCLUSIONS

Ecological factors such as the effect of acculturation on diet, family members' role in behavior change, and socioenvironmental barriers to healthy dietary practices and physical activity should be considered when adapting evidence-based treatments for Mexican Americans.

Food Environment in and around Primary School Children's Schools and Neighborhoods in Two Urban Settings in Kenya

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low-, medium- and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 km of the schools and the school children's neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels and inform public health interventions aimed at promoting healthy food environments in Kenya.

Relationship between retail food outlets near public schools and adolescent obesity in New York City

Using objectively-measured height and weight data from academic years 2009-2013 (n = 1,114,010 student-year observations), we estimated the association between the food outlet in closest proximity to schools and the likelihood of obesity among New York City public high school students. Obesity risk was higher for students with a corner store as the nearest option to schools, regardless of whether other food outlet types were located within a quarter mile or a half mile of schools (i.e., benchmarks for zoning policies). Policymakers may want to consider introducing healthier food options near schools, in conjunction with programs to support changes within corner stores.

Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches

The Healthy, Hunger-Free Kids Act (HHFKA), a public law in the United States passed in 2010, sought to improve the healthfulness of the school food environment by requiring updated nutrition standards for school meals and competitive foods. Studies conducted since the passage of the HHFKA indicate improvements in the food environment overall, but few studies have examined whether these improvements varied by the socioeconomic and racial/ethnic composition of students in schools. To better understand the extent of disparities in the school food environment after HHFKA, this paper examined differences in the healthfulness of school food environments and the nutritional quality of school lunches by the school poverty level and racial/ethnic composition of students using data from the School Nutrition and Meal Cost Study. Results from chi-square analyses showed lower proportions of high poverty, majority black, and majority Hispanic schools had access to competitive foods, while higher proportions of these schools had a school wellness policy in addition to a district wellness policy. The overall nutritional quality of school lunches, as measured by total Healthy Eating Index (HEI)-2010 scores, did not vary significantly across school types, although some HEI component scores did. From these findings, we concluded that there were disparities in the school food environment based on the socioeconomic and racial/ethnic composition of students in schools, but no significant disparities in the overall nutritional quality of school lunches were found.

Food environment surrounding public and private schools: an opportunity or challenge for healthy eating?

The study analyzed and compared the types of food sold in the surroundings of 30 private and 26 public elementary schools in the city of Niterói, Rio de Janeiro. Data were collected by audit using a checklist instrument to characterize establishments (formal or informal) and identify the types of food and beverages sold, which were classified by processing level (fresh, processed, and ultraprocessed). Mann-Whitney statistical tests were used to verify the difference in the type of trade outlets d the categories of food sold between schools. The Kruskal-Wallis test was used to verify the difference in the amount of food traded between the categories. The amount of ultraprocessed food in the surroundings of public and private schools was statistically higher (p=0.0001) than the other categories. Some culinary preparations had a high rate of energy contribution from ultraprocessed foods (above 15%). There was no statistically significant difference (p = 0.478) in the categories of food sold between public and private schools. The sale of ultraprocessed products predominates around public and private schools, favoring the exposure of children to an environment that encourages the consumption of these products.

Healthful and less-healthful foods and drinks from storefront and non-storefront businesses: implications for 'food deserts', 'food swamps' and food-source disparities

OBJECTIVE

Conceptualisations of 'food deserts' (areas lacking healthful food/drink) and 'food swamps' (areas overwhelm by less-healthful fare) may be both inaccurate and incomplete. Our objective was to more accurately and completely characterise food/drink availability in urban areas.

DESIGN

Cross-sectional assessment of select healthful and less-healthful food/drink offerings from storefront businesses (stores, restaurants) and non-storefront businesses (street vendors).

SETTING

Two areas of New York City: the Bronx (higher-poverty, mostly minority) and the Upper East Side (UES; wealthier, predominantly white).

PARTICIPANTS

All businesses on 63 street segments in the Bronx (n 662) and on 46 street segments in the UES (n 330).

RESULTS

Greater percentages of businesses offered any, any healthful, and only less-healthful food/drink in the Bronx (42·0 %, 37·5 %, 4·4 %, respectively) than in the UES (30 %, 27·9 %, 2·1 %, respectively). Differences were driven mostly by businesses (e.g. newsstands, gyms, laundromats) not primarily focused on selling food/drink - 'other storefront businesses' (OSBs). OSBs accounted for 36·0 % of all food/drink-offering businesses in the Bronx (more numerous than restaurants or so-called 'food stores') and 18·2 % in the UES (more numerous than 'food stores'). Differences also related to street vendors in both the Bronx and the UES. If street vendors and OSBs were not captured, the missed percentages of street segments offering food/drink would be 14·5 % in the Bronx and 21·9 % in the UES.

CONCLUSIONS

Of businesses offering food/drink in communities, OSBs and street vendors can represent substantial percentages. Focusing on only 'food stores' and restaurants may miss or mischaracterise 'food deserts', 'food swamps', and food/drink-source disparities between communities.

Open Campus Policies: How Built, Food, Social, and Organizational Environments Matter for Oregon's Public High School Students' Health

Open campus policies that grant access to the off-campus food environment may influence U.S. high school students’ exposure to unhealthy foods, yet predictors of these policies are unknown. Policy holding and built (walkability), food (access to grocery stores), social (school-to-neighborhood demographic similarity), and organizational (policy holding of neighboring schools) environment data were collected for 200 Oregon public high schools. These existing data were derived from the Oregon School Board Association, WalkScore.com, the 2010 Decennial Census, the 2010–2014 American Community Survey, the Supplemental Nutrition Assistance Program, TDLinex, Nielson directories, the U.S. Department of Education, the National Center for Education Statistics, and the Common Core of Data. Most (67%) of Oregon public high schools have open campus policies. Logistic regression analyses modeled open campus policy holding as a function of built, food, social, and organizational environment influences. With health and policy implications, the results indicate that the schools’ walkability, food access, and extent of neighboring open campus policy-schools are significantly associated with open campus policy holding in Oregon.

Food democracy, health disparities and the New York City trans fat policy

OBJECTIVE

To investigate food democracy and health disparities in the New York City (NYC) trans fat policy process.

DESIGN

Texts from semi-structured interviews, public testimony and comments on the policy were analysed using categorization and thematic coding. A priori content analysis for themes of food democracy was followed by open, axial and selective coding for sub-themes on health disparities. Data and method triangulation and respondent validation were used to establish data dependability, trustworthiness and representativeness.

SETTING

NYC.

PARTICIPANTS

Interviews from a purposive, snowballed sample of thirty-three participants included restaurateurs, scientists, health and consumer advocates, consumers and policy makers. Additionally, 261 pages of transcript from public testimony of fifty-three participants and a purposive sample of public comments on the policy from a pool of 2157 were analysed.

RESULTS

Principles of food democracy involving inclusive citizenship, access to information, collaborative participation and focus on collective good were well represented in the data. Additionally, sub-themes linked to health disparities included: government responsibility for fairer access to healthier foods; recognition that people made choices based on circumstances; concern for vulnerable groups; and outrage with a food industry viewed as unconcerned for public health.

CONCLUSIONS

Principles of food democracy present in the successful process of adoption of the 2006 NYC trans fat policy addressed nutrition-related health. Food democracy is a contemporary food system and policy approach with potential for public health benefits in reducing nutrition-related health disparities.

Residents' perceptions of their local food environment in socioeconomically diverse neighborhoods: A photovoice study

The influence of unhealthy food environments on residents' eating behaviors has been previously documented. Yet, socioeconomic differences across areas are less studied. Participatory studies provide relevant knowledge to better inform future nutrition interventions. We conducted a participatory Photovoice project in which residents interpreted the influence of the local food environment on eating behaviors across three neighborhoods of contrasting area-level socioeconomic status (SES) in Bilbao, Spain. From April to July 2017, a total of 23 residents participated in the three Photovoice groups. Each group critically discussed their photographs (N = 110) in groups of 6-9 participants along six group sessions. Through a consensus-building process, participants identified 27 emerging categories choosing finally 39 related photographs, which followed six conceptual main themes characterizing their local food environment: 1) unhealthy eating behaviors, 2) cultural diversity, 3) retail transformation, 4) social relationships, 5) precariousness, and 6) healthy eating. Although high food quality and fresh products may portray a general healthy food environment in all three neighborhoods, participants discussed why some residents still adopt unhealthy eating behaviors characterized by an excessive consumption of alcohol (high-SES area), sugar loaded foods (high- and middle-SES) and fast food (middle and low-SES). This photovoice participatory methodology helps highlighting important similarities and differences regarding food environment perceptions in the whole socioeconomic spectrum of any given city. This type of participatory approach helps guiding local policies and interventions promoting healthier local food environments.

Cross-Country Comparison of School Neighborhood Food Environments in Houston, Texas and Guadalajara, Mexico

Studies in the U.S. and Mexico have observed the clustering of food resources around schools, which may promote the use of these resources. Our study characterized and compared school neighborhood food environments in Guadalajara, Jalisco, and Houston, Texas, and examined socioeconomic disparities in food resource availability across school neighborhoods. We used the Goods and Services Inventory to document the frequency and type of resources within each school neighborhood. School neighborhoods in Guadalajara had significantly more food resources than those in Houston. We found that convenience stores and table service restaurants were the most prevalent food resources in school neighborhoods in both cities. Guadalajara school neighborhoods had a higher prevalence of supermarkets and grocery stores than Houston. Low-income school neighborhoods in Guadalajara with poorly educated residents had significantly more food carts than high-income neighborhoods with more educated residents. In Houston, we found significantly more fast food restaurants and convenience stores in school neighborhoods with more educated residents than school neighborhoods with less educated residents. The influence of food resources within school neighborhoods on the dietary habits of schoolchildren should be further explored in both the U.S. and Mexico. The characterization of school neighborhood food environments can inform policymakers, city planners, and school officials who seek to implement policies to create healthier food environments.

Changes in Fast Food Outlet Availability Near Schools: Unequal Patterns by Income, Race/Ethnicity, and Urbanicity

INTRODUCTION

Previous research has observed income or racial/ethnic inequalities in fast food restaurant availability near schools. The purpose of this study was to investigate changes in fast food restaurant availability near schools between 2000 and 2010 by school neighborhood income, race/ethnicity, and urbanicity.

METHODS

Using data from 7,466 California public schools, negative binomial regression models estimated the relative ratios to evaluate the income gradient in fast food restaurant availability, examine differences in the income gradient in fast food restaurant availability between 2000 and 2010, and investigate if fast food restaurant availability changed in 2010 versus 2000, stratified by race/ethnicity and urbanicity. The analyses were conducted in 2018 and early 2019.

RESULTS

In urban areas, there was a negative school neighborhood income gradient in fast food restaurant availability in both 2000 and 2010, and across all race/ethnic groups, except majority African American schools. The income gradient in fast food restaurant availability was steeper in 2010 relative to 2000 among Latino majority urban schools. Fast food restaurant availability increased in 2010 relative to 2000 among majority African American, majority Latino, and majority Asian schools in the least affluent neighborhoods. Among majority white schools in similar neighborhoods the availability of fast food restaurants did not change but declined in the most affluent school neighborhoods. In nonurban areas, the income patterns in fast food restaurant availability were less clear, and fast food restaurant availability increased among majority white and Latino schools within the middle neighborhood income tertile.

CONCLUSIONS

These findings suggest the need for future interventions to target schools in low-income urban neighborhoods. Additionally, reducing child health disparities and improving health for all children requires monitoring changes in the food environment near schools.

Socioeconomic Inequalities in the Retail Food Environment around Schools in a Southern European Context

Across Europe, excess body weight rates are particularly high among children and adolescents living in Southern European contexts. In Spain, current food policies appeal to voluntary self-regulation of the food industry and parents’ responsibility. However, there is no research (within Spain) assessing the food environment surrounding schools. We examined the association between neighborhood-level socioeconomic status (NSES) and the spatial access to an unhealthy food environment around schools using both counts and distance measures, across the city of Madrid. We conducted a cross-sectional study citywide (n = 2443 census tracts). In 2017, we identified all schools (n = 1321) and all food retailers offering unhealthy food and beverages surrounding them (n = 6530) using publicly available data. We examined both the counts of retailers (within 400 m) and the distance (in meters) from the schools to the closest retailer. We used multilevel regressions to model the association of neighborhood-level socioeconomic status (NSES) with both measures, adjusting both models for population density. Almost all schools (95%) were surrounded by unhealthy retailers within 400 m (median = 17 retailers; interquartile range = 8–34). After adjusting for population density, NSES remained inversely associated with unhealthy food availability. Schools located in low-NSES areas (two lowest quintiles) showed, on average, 29% (IRR (Incidence Rate Ratio) = 1.29; 95% CI (Confidence Interval) = 1.12, 1.50) and 62% (IRR = 1.62; 95% CI = 1.35, 1.95) more counts of unhealthy retailers compared with schools in middle-NSES areas (ref.). Schools in high-NSES areas were farther from unhealthy food sources than those schools located in middle-NSES areas (β = 0.35; 95% CI = 0.14, 0.47). Regulating the school food environment (within and beyond school boundaries) may be a promising direction to prevent and reduce childhood obesity.

Disparities in food access around homes and schools for New York City children

Demographic and income disparities may impact food accessibility. Research has not yet well documented the precise location of healthy and unhealthy food resources around children's homes and schools. The objective of this study was to examine the food environment around homes and schools for all public school children, stratified by race/ethnicity and poverty status. This cross-sectional study linked data on the exact home and school addresses of a population-based sample of public school children in New York City from 2013 to all corner stores, supermarkets, fast-food restaurants, and wait-service restaurants. Two measures were created around these addresses for all children: 1) distance to the nearest outlet, and 2) count of outlets within 0.25 miles. The total analytic sample included 789,520 K-12 graders. The average age was 11.78 years (SD ± 4.0 years). Black, Hispanic, and Asian students live and attend schools closer to nearly all food outlet types than White students, regardless of poverty status. Among not low-income students, Black, Hispanic, and Asian students were closer from home and school to corner stores and supermarkets, and had more supermarkets around school than White students. The context in which children live matters, and more nuanced data is important for development of appropriate solutions for childhood obesity. Future research should examine disparities in the food environment in other geographies and by other demographic characteristics, and then link these differences to health outcomes like body mass index. These findings can be used to better understand disparities in food access and to help design policies intended to promote healthy eating among children.

A Meta-analysis of the Literature on the Association of the Social and Built Environment With Obesity: Identifying Factors in Need of More In-Depth Research

Objective:

This study aims to identify groups of the social and built environment factors that have been studied substantially along with factors that need further attention, to guide the research, designing, and planning of the social and built environment for reducing obesity prevalence.

Data Source:

A systematic search of literature was undertaken from PubMed, Google Scholar, and Web of Knowledge.

Study Inclusion and Exclusion Criteria:

Keyword combination of “built environment,” “social environment,” and “obesity” were used to expand the search scope. Exclusion criteria included (1) any article with less than 50 citations from 2005 to 2010, and those with less than 25 citations from 2011 to 2015. In this way we included the most prominent peer-reviewed studies published in recent years while excluding less influential publications; (2) any article published in a language other than English; (3) literature review articles; (4) any article studying health outcomes not obesity related. We included research on eating behaviors since the studies contributed profoundly to food environment research.

Data Synthesis:

A meta-analysis of 153 empirical studies, selected from 2005 to 2015 based on a series of criteria, was conducted using factor analysis. The exploratory factor analysis was undertaken to group the prevalence and use of the social and built environment factors associated with obesity.

Results:

The findings suggested that the research community has gained a substantial understanding of the D variables of the built environment, including density, diversity, design, distance to transit, and destination access. Factors concerning different age groups, minority populations, groups with low socioeconomic status, food environment, and street-level urban design features have been less examined.

Conclusions:

The findings are important to guide future research directions, giving more attention to the factors in need of more in-depth research.

From the Lunch Table, to the Family Table: A Grounded Theory Approach to Understanding Urban Adolescents' Experiences of Food Culture Mismatch between School and Home Environments

Based on a participatory action research project in New York City from 2012 to 2014, our study compares the experience of black and Latino adolescents between their school and home food environments. Following a photovoice approach, adolescents participated in a "food justice" curriculum, photographed foodscapes, and conducted photo-elicited interviews. Using a grounded theory approach, we found that adolescents had mismatched experiences between school and home food environments under two conditions: sensory-emotional and sociopolitical. Mismatch suggested psychological and behavioral consequences, including skipping or wasting school lunch entrées and consuming energy-dense, nutrient-poor snack foods. We named this middle-range substantive theory food culture mismatch.

School-Level Body Mass Index Shapes Children's Weight Trajectories

BACKGROUND

Embedded within children's weight trajectories are complex environmental contexts that influence obesity risk. As such, the normative environment of body mass index (BMI) within schools may influence children's weight trajectories as they age from kindergarten to fifth grade.

METHODS

I use 5 waves of the ECLS-K-Kindergarten Class 1998-1999 data and a series of multilevel growth models to examine whether attending schools with higher overall BMI influences children's weight status over time.

RESULTS

Results show that, net of child, family, and school sociodemographic characteristics, children who attend schools with higher rates of obesity have increased weight compared to children who attend schools with lower rates of obesity, and this effect increases annually.

CONCLUSIONS

Findings indicate that the overall weight status of schools influence child obesity, and further speak to the importance of school-based intervention programs.

Influence of the Local Food Environment on Hispanics' Perceptions of Healthy Food Access in New York City

INTRODUCTION

Studies have characterized food environments and documented its impact on access and consumption of healthy foods as well as diet-related health conditions. This study aims to characterize the local food environment in New York City's Washington Heights and Inwood community and to examine its influence on Hispanics' perceptions of healthy food access.

METHODS

Person-level local food environments were created by spatially modeling food retailers selling fresh fruits and vegetables or low-fat products within a participant's 400- and 800-m residential radius buffers. Data were analyzed using multivariate binary logistic regression.

RESULTS

Fruit/vegetable markets significantly increased participants' odds of perceiving the availability of a large selection as well as the high quality of fresh fruits and vegetables in their neighborhood. Medium-/large-size supermarkets/groceries within 400-m radius significantly increased participants' odds of perceiving the high quality of fresh fruits and vegetables in their neighborhood, whereas meat markets significantly lowered the odds. Fruit/vegetable markets and medium-/large-size supermarkets/groceries significantly increased participants' odds of perceiving the availability of a large selection of low-fat products in their neighborhood.

CONCLUSION

Study findings advance our understanding of the relationships between local food environment and perceived healthy food access among urban Hispanics.

Sources of Foods That Are Ready-to-Consume ('Grazing Environments') Versus Requiring Additional Preparation ('Grocery Environments'): Implications for Food-Environment Research and Community Health

Local businesses that offer foods may create different 'grazing environments' (characterized by sources of ready-to-consume foods) and 'grocery environments' (characterized by source of foods for later preparation). Such environments may be relevant to different populations at different times and may vary by neighborhood. In neighborhoods within two demographically distinct areas of the Bronx, NY [Area A (higher-poverty, greater minority representation, lesser vehicle ownership) vs. Area B], researchers assessed all storefront businesses for food offerings. Food offerings could be ready-to-consume or require additional preparation. 'Healthful' offerings included fruits and vegetables, whole grains, and nuts; 'less-healthful' offerings included 'refined sweets' and 'salty/fatty fare.' 'Food businesses' (those primarily focused on selling food) were distinguished from 'other businesses' (not focused primarily on food selling). Area A had a higher percentage of street segments on which foods were available (28.6% vs. 6.9% in Area B; difference 21.7% points [95% CI 17.0, 26.5]) and a higher percentage of businesses offering foods (46.9% vs. 41.7% in Area B; difference 5.2% points [95% CI - 2.0, 12.4]). 'Less-healthful' items predominated in both 'grazing environments' and overall environments ('grazing' plus 'grocery environments'; the environments researchers typically measure) in both Areas A and B. 'Other businesses' represented about 2/3 of all businesses and accounted for nearly 1/3 of all the businesses offering food in both geographic areas. The lower-income area with greater minority representation and less private transportation had more businesses offering foods on more streets. There was near-perfect overlap between 'grazing environments' and overall environments in both geographic areas. Future research should consider the extent of 'grazing' and 'grocery environments,' and when each might be most relevant to populations of interest.

A Mixed-Methods Comparison of Classroom Context During Food, Health & Choices, a Childhood Obesity Prevention Intervention

BACKGROUND

Schools are frequent settings for childhood obesity prevention; however, intervention results are mixed. Classroom context may hold important clues to improving these interventions.

METHODS

We used mixed methods to examine classroom context during a curriculum intervention taught by trained instructors in fifth grade classrooms. We identified classrooms with high and low buy-in using cluster analysis and compared intervention delivery and reception, student energy balance-related behavior, and student perceptions about supports and barriers to energy balance.

RESULTS

Delivery and reception did not differ between the groups. Between-group differences in unhealthy behaviors were smaller at posttest, due to improvement in low buy-in classes. Although student perceptions of supports and barriers to energy balance were similar across groups, students in high buy-in classes indicated food preferences as a support while students in low buy-in classes indicated food preferences as a barrier. Neighborhood environment emerged as a universal barrier.

CONCLUSIONS

Trained instructors may improve intervention delivery and reception regardless of classroom context. Social norms could explain high levels of unhealthy behavior in low buy-in classes at baseline; improvement at posttest suggests that the curriculum may have motivated change. All children need more strategies and supportive policies to overcome a challenging food environment.

Effect of personal activity trackers on weight loss in families enrolled in a comprehensive behavioral family-lifestyle intervention program in the Federally Qualified Health Center setting: a randomized controlled trial

BACKGROUND

Childhood obesity continues to be a substantial problem despite major public health efforts, and disproportionately impacts children from low-income families. Digital health tools and consumer technology offer promising opportunities for interventions, but few studies have evaluated how they might be incorporated into existing interventions or used to create new types of interventions. It remains unclear which approaches would be most beneficial for underserved pediatric populations.

PURPOSE

To describe the design and rationale of a single-center randomized, controlled trial evaluating the effects of personal activity tracker (PAT) use by parents on weight-status improvement in both parents and overweight children enrolled in BodyWorks (BW), a comprehensive behavioral family-lifestyle intervention program (CBFLI), in a primary-care clinic serving a predominantly low-income Latino population.

METHODS

This study is being conducted in the AltaMed general pediatrics clinic at Children's Hospital Los Angeles. Eligible participants are families (child and adult caregiver) in which the child is between 7-18 years of age, has a BMI ≥85th percentile for age and sex, and has been referred to BW by their AltaMed pediatrician. BW consists of one weekly, two-hour session for 7 weeks. In a given cycle, the program is offered on two separate nights: Monday (Spanish) and Wednesday (English). Families self sort into one of two groups based on language preference. To ensure balanced allocation of language preference groups and prevent in-group cross contamination, block randomization is used to assign whole groups to either the intervention or control arms of the study. The control arm consists of usual care, while the intervention arm adds assigning a Fitbit PAT to the parents and training them in its proper use. Study personnel are blinded to group assignment during the analysis phase. Study outcomes include attendance rate, program completion rate, and changes in weight-status improvement, defined as change in weight and BMI for adults and change in BMI z-score for children. We hypothesize that the intervention arm will have better weight-related outcomes than the control arm. Study completion is anticipated in 2017, after the enrollment of approximately 150 families.

CONCLUSIONS

The study aim is to evaluate the effects of PATs on weight-related outcomes in overweight children and parents participating in a CBFLI. The results will be important for determining whether wearable devices are an effective addition to weight loss interventions for overweight and obese children.

Differences in the Association of Physical Activity and Children's Overweight and Obesity Status Among the Major Racial and Ethnic Groups of U.S. Children

OBJECTIVE

To examine the relationship of exercise with overweight and obesity among an ethnically diverse sample of U.S. children.

METHOD

Data from the 2011-2012 National Survey of Children's Health were analyzed to examine the relationship of daily exercise with children's weight status. Propensity score covariate adjustment and multivariate logistic regression with survey weights were used to control for child, home, and community characteristics.

RESULTS

Approximately 22% of all children ages 10 to 17 years engaged in daily exercise for at least 20 minutes. In the adjusted model for the entire sample, daily exercise was associated with children having a lower likelihood of being overweight or obese (odds ratio = 0.79; 95% confidence interval = 0.68-0.91). In a stratified analysis of the major racial and ethnic groups, however, while White children who exercised daily were found to have a lower odds of being overweight or obese (odds ratio = 0.70; 95% confidence interval = 0.60-0.82), this relationship was not found for most minority children.

CONCLUSIONS

Racial and ethnic minority children were not found to have the same weight status relationship with exercising daily. These findings suggest that some population-average exercise recommendations may not be as applicable to minority children.

Measures of the food environment: A systematic review of the field, 2007-2015

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.

Sociodemographic Disparities in Proximity of Schools to Tobacco Outlets and Fast-Food Restaurants

OBJECTIVES

To examine the association of school sociodemographic characteristics with tobacco outlet and fast-food restaurant availability near schools in a national study.

METHODS

Business lists and data from the National Center for Education Statistics were used to calculate the numbers of tobacco outlets and fast-food restaurants within 800 meters of public schools in 97 US counties.

RESULTS

More than 50% of schools with a majority of Hispanic students had both a fast-food restaurant and tobacco outlet nearby, compared with 21% of schools with a majority of White students. In adjusted models, each 10% increase in the number of low-income and Hispanic students enrolled in a school led to a 3% to 5% increase in the odds of the school having both a fast-food restaurant and a tobacco outlet nearby.

CONCLUSIONS

Low-income and Hispanic students are disproportionately exposed to both tobacco outlets and fast-food restaurants near their schools. Easy access to tobacco products and fast food may influence youth smoking initiation and contribute to poor dietary intake.

Perceived Barriers and Facilitators of Farm-to-Consumer Retail Outlet Use Among Participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Alabama

This research aimed to identify perceived barriers and facilitators of farm-to-consumer (FTC) retail outlet (eg, farmers' markets, farm/roadside stands) usage among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants residing in Birmingham, Alabama. Additionally, associations between barriers and facilitators reported and daily fruit and vegetable (F&V) intake were examined. A sample of 312 lower income women (mean age = 27.6; 67.0% non-Hispanic black; 45.3% obese) who participate in the Birmingham WIC program were surveyed between October 2014 and January 2015. Fischer's exact test was used to assess associations between barriers (eg, outlet location, price, transportation), facilitators (eg, produce quality, produce variety), and high F&V intake (ie, consuming ≥ 5 servings per day). Approximately 81 (26.1%) participants reported using an FTC outlet to purchase produce in 2014. Lack of awareness (39.3%), outlet location (32.8%), and lack of interest (28.4%) were the barriers most often reported. Produce quality (69.1%), produce variety (49.4%), and price (39.5%) were the facilitators most often reported. Barriers and facilitators mentioned were not associated with high F&V intake. Lack of awareness and lack of interest are key barriers to FTC outlet usage among Birmingham WIC recipients. Interventions aiming to promote use of FTC outlets should consider the perceived barriers and facilitators to usage.

Decomposing Racial Disparities in Obesity Prevalence: Variations in Retail Food Environment

INTRODUCTION

Racial disparities in obesity exist at the individual and community levels. Retail food environment has been hypothesized to be associated with racial disparities in obesity prevalence. This study aimed to quantify how much food environment measures explain racial disparities in obesity at the county level.

METHODS

Data from 2009 to 2010 on 3,135 U.S. counties were extracted from the U.S. Department of Agriculture Food Environment Atlas and the Behavioral Risk Factor Surveillance System and analyzed in 2013. Oaxaca-Blinder decomposition was used to quantify the portion of the gap in adult obesity prevalence observed between counties with a high and low proportion of African-American residents is explained by food environment measures (e.g., proximity to grocery stores, per capita fast-food restaurants). Counties were considered to have a high African-American population if the percentage of African-American residents was >13.1%, which represents the 2010 U.S. Census national estimate of percentage African-American citizens.

RESULTS

There were 665 counties (21%) classified as a high African-American county. The total gap in mean adult obesity prevalence between high and low African-American counties was found to be 3.35 percentage points (32.98% vs 29.63%). Retail food environment measures explained 13.81% of the gap in mean age-adjusted adult obesity prevalence.

CONCLUSIONS

Retail food environment explains a proportion of the gap in adult obesity prevalence observed between counties with a high proportion of African-American residents and counties with a low proportion of African-American residents.

Disparities in the Availability of Farmers Markets in the United States

Farmers markets (FM) have been proposed by researchers, policymakers, and health agencies as a potential community-level strategy to prevent obesity and reduce disparities in healthy food access in the U.S. Information about disparities in farmers market availability is scarce. This research aimed to examine county-level associations between farmers market (FM) availability and demographic, socioeconomic, health, and environmental measures in an effort to determine if disparities in availability exist in the U.S. An ecological study of 3,135 U.S. counties was conducted in 2013 using 2009-2010 data extracted from the United States Department of Agriculture Food Environment Atlas. Logistic regression and Poisson regression models were used to determine associations between county-level FM availability and measures such as percentage of non-Hispanic black residents, median household income, and number of grocery stores per 100,000 residents (i.e., per capita). Regression models were stratified by metro county status and all analyses were adjusted for state-level clustering. There were 1,774 (56.6%) counties with at least one FM available. Median household income was associated with increased odds of having at least one FM available among non-metro counties, but not metro counties. Percentage of non-Hispanic black residents and residents living in poverty were negatively associated with per capita FMs among metro and non-metro counties. Per capita fast food restaurants was negatively associated with per capita FMs among metro counties. Disparities in FM availability exist in the U.S. More research on the behavioral and health implications of farmers market availability should be conducted.

Defining Neighbourhoods as a Measure of Exposure to the Food Environment

Neighbourhoods are frequently used as a measure for individuals' exposure to the food environment. However, the definitions of neighbourhoods fluctuate and have not been applied consistently in previous studies. Neighbourhoods defined from a single fixed location fail to capture people's complete exposure in multiple locations, but measuring behaviour using traditional methods can be challenging. This study compares the traditional methods of measuring exposure to the food environment to methods that use data from GPS tracking. For each of the 187 participants, 11 different neighbourhoods were created in which the exposure to supermarkets and fast food outlets were measured. ANOVA, Tukey's Honestly Significant Difference (HSD) test and t-tests were performed to compare the neighbourhoods. Significant differences were found between area sizes and the exposure to supermarkets and fast food outlets for different neighbourhood types. Second, significant differences in exposure to food outlets were found between the urban and rural neighbourhoods. Neighbourhoods are clearly a diffused and blurred concept that varies in meaning depending on each person's perception and the conducted study. Complexity and heterogeneity of human mobility no longer appear to correspond to the use of residential neighbourhoods but rather emphasise the need for methods, concepts and measures of individual activity and exposure.

Associations between Food Outlets around Schools and BMI among Primary Students in England: A Cross-Classified Multi-Level Analysis

INTRODUCTION

Researchers and policy-makers are interested in the influence that food retailing around schools may have on child obesity risk. Most previous research comes from North America, uses data aggregated at the school-level and focuses on associations between fast food outlets and school obesity rates. This study examines associations between food retailing and BMI among a large sample of primary school students in Berkshire, England. By controlling for individual, school and home characteristics and stratifying results across the primary school years, we aimed to identify if the food environment around schools had an effect on BMI, independent of socio-economic variables.

METHODS

We measured the densities of fast food outlets and food stores found within schoolchildren's home and school environments using Geographic Information Systems (GIS) and data from local councils. We linked these data to measures from the 2010/11 National Child Measurement Programme and used a cross-classified multi-level approach to examine associations between food retailing and BMI z-scores. Analyses were stratified among Reception (aged 4-5) and Year 6 (aged 10-11) students to measure associations across the primary school years.

RESULTS

Our multilevel model had three levels to account for individual (n = 16,956), home neighbourhood (n = 664) and school (n = 268) factors. After controlling for confounders, there were no significant associations between retailing near schools and student BMI, but significant positive associations between fast food outlets in home neighbourhood and BMI z-scores. Year 6 students living in areas with the highest density of fast food outlets had an average BMI z-score that was 0.12 (95% CI: 0.04, 0.20) higher than those living in areas with none.

DISCUSSION

We found little evidence to suggest that food retailing around schools influences student BMI. There is some evidence to suggest that fast food outlet densities in a child's home neighbourhood may have an effect on BMI, particularly among girls, but more research is needed to inform effective policies targeting the effects of the retail environment on child obesity.

Fast-food intake and perceived and objective measures of the local fast-food environment in adolescents

Objective

We examined associations between fast-food intake and perceived and objective fast-food outlet exposure.

Design

Information from the Health Behaviours in School-aged Children Study was linked to fast-food outlets in seventy-five school neighbourhoods. We used multivariate multilevel logistic regression analyses to examine associations between at least weekly fast-food intake and perceived and objective fast-food outlet measures.

Subjects

Data represent 4642 adolescents (aged 11–15 years) in Denmark.

Results

Boys reporting two or more fast-food outlets had 34 % higher odds consuming fast food at least weekly. We detected higher odds of at least weekly fast-food intake among 15-year-old 9th graders (ORall=1·74; 95 % CI 1·40, 2·18; ORboys=2·20; 95 % CI 1·66, 2·91; ORgirls=1·41; 95 % CI 1·03, 1·92), Danish speakers (ORall=2·32; 95 % CI 1·68, 3·19; ORboys=2·58; 95 % CI 1·69, 3·93; ORgirls=2·37; 95 % CI 1·46, 3·84) and those travelling 15 min or less to school (ORall=1·21; 95 % CI 1·00, 1·46; ORgirls=1·44; 95 % CI 1·08, 1·93) compared with 11-year-old 5th graders, non-Danish speakers and those with longer travel times. Boys from middle- (OR=1·28; 95 % CI 1·00, 1·65) and girls from low-income families (OR=1·46; 95 % CI 1·05, 2·04) had higher odds of at least weekly fast-food intake compared with those from high-income backgrounds. Girls attending schools with canteens (OR=1·47; 95 % CI 1·00, 2·15) had higher odds of at least weekly fast-food intake than girls at schools without canteens.

Conclusions

The present study demonstrates that perceived food outlets may impact fast-food intake in boys while proximity impacts intake in girls. Public health planning could target food environments that emphasize a better understanding of how adolescents use local resources.

Mobile food vendors in urban neighborhoods-implications for diet and diet-related health by weather and season

This study describes mobile food vendors (street vendors) in Bronx, NY, considering neighborhood-level correlations with demographic, diet, and diet-related health measures from City data. Vendors offering exclusively "less-healthy" foods (e.g., chips, processed meats, sweets) outnumbered vendors offering exclusively "healthier" foods (e.g., produce, whole grains, nuts). Wet days and winter months reduced all vending on streets, but exclusively "less-healthy" vending most. In summer, exclusively "less-healthy" vending per capita inversely correlated with neighborhood-mean fruit-and-vegetable consumption and directly correlated with neighborhood-mean BMI and prevalences of hypertension and hypercholesterolemia (Spearman correlations 0.90-1.00, p values 0.037 to <0.001). In winter, "less-healthy" vending per capita directly correlated with proportions of Hispanic residents and those living in poverty (Spearman correlations 0.90, p values 0.037). Mobile food vending may contribute negatively to urban food-environment healthfulness overall, but exacerbation of demographic, diet, and diet-related health disparities may vary by weather, season, and neighborhood characteristics.

Examination of how neighborhood definition influences measurements of youths' access to tobacco retailers: a methodological note on spatial misclassification

Measurements of neighborhood exposures likely vary depending on the definition of "neighborhood" selected. This study examined the extent to which neighborhood definition influences findings regarding spatial accessibility to tobacco retailers among youth. We defined spatial accessibility to tobacco retailers (i.e., tobacco retail density, closest tobacco retailer, and average distance to the closest 5 tobacco retailers) on the basis of circular and network buffers of 400 m and 800 m, census block groups, and census tracts by using residential addresses from the 2008 Boston Youth Survey Geospatial Dataset (n = 1,292). Friedman tests (to compare overall differences in neighborhood definitions) were applied. There were differences in measurements of youths' access to tobacco retailers according to the selected neighborhood definitions, and these were marked for the 2 spatial proximity measures (both P < 0.01 for all differences). For example, the median average distance to the closest 5 tobacco retailers was 381.50 m when using specific home addresses, 414.00 m when using census block groups, and 482.50 m when using census tracts, illustrating how neighborhood definition influences the measurement of spatial accessibility to tobacco retailers. These analyses suggest that, whenever possible, egocentric neighborhood definitions should be used. The use of larger administrative neighborhood definitions can bias exposure estimates for proximity measures.

Understanding the relationship between food environments, deprivation and childhood overweight and obesity: evidence from a cross sectional England-wide study

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.

Comparing nutrition environments in bodegas and fast-food restaurants

Many small grocery stores or "bodegas" sell prepared or ready-to-eat items, filling a niche in the food environment similar to fast-food restaurants. However, little comparative information is available about the nutrition environments of bodegas and fast-food outlets. This study compared the nutrition environments of bodegas and national chain fast-food restaurants using a common audit instrument, the Nutrition Environment Measures Study in Restaurants (NEMS-R) protocol. The analytic sample included 109 bodegas and 107 fast-food restaurants located in New York City neighborhoods in the upper third and lower third of the census tract poverty rate distribution. Inter-rater reliability was evaluated in 102 food outlets, including 31 from the analytic sample and 71 from a supplementary convenience sample. The analysis compared scores on individual NEMS-R items, a total summary score, and subscores indicating healthy food availability, nutrition information, promotions of healthy or unhealthy eating, and price incentives for healthy eating, using t tests and χ(2) statistics to evaluate differences by outlet type and neighborhood poverty. Fast-food restaurants were more likely to provide nutrition information, and bodegas scored higher on healthy food availability, promotions, and pricing. Bodegas and fast-food restaurants had similar NEMS-R total scores (bodegas 13.09, fast food 14.31; P=0.22). NEMS-R total scores were higher (indicating healthier environments) in low- than high-poverty neighborhoods among both bodegas (14.79 vs 11.54; P=0.01) and fast-food restaurants (16.27 vs 11.60; P<0.01). Results imply different policy measures to improve nutrition environments in the two types of food outlets.

Neighbourhood food environments and body mass index among New York City adults

BACKGROUND

Studies evaluating the impact of the neighbourhood food environment on obesity have summarised the density or proximity of individual food outlets. Though informative, there is a need to consider the role of the entire food environment; however, few measures of whole system attributes have been developed. New variables measuring the food environment were derived and used to study the association with body mass index (BMI).

METHODS

Individual data on BMI and sociodemographic characteristics were collected from 48 482 respondents of the 2002-2006 community health survey in New York City and linked to residential zip code-level characteristics. The food environment of each zip code was described in terms of the diversity of outlets (number of types of outlets present in a zip code), the density of outlets (outlets/km(2)) and the proportion of outlets classified as BMI-unhealthy (eg, fast food, bodegas).

RESULTS

Results of the cross-sectional, multilevel analyses revealed an inverse association between BMI and food outlet density (-0.32 BMI units across the IQR, 95% CI -0.45 to -0.20), a positive association between BMI and the proportion of BMI-unhealthy food outlets (0.26 BMI units per IQR, 95% CI 0.09 to 0.43) and no association with outlet diversity. The association between BMI and the proportion of BMI-unhealthy food outlets was stronger in lower (<median for % poverty) poverty zip codes than in high-poverty zip codes.

CONCLUSIONS

These results support a more nuanced assessment of the impact of the food environment and its association with obesity.

Healthy eating design guidelines for school architecture

We developed a new tool, Healthy Eating Design Guidelines for School Architecture, to provide practitioners in architecture and public health with a practical set of spatially organized and theory-based strategies for making school environments more conducive to learning about and practicing healthy eating by optimizing physical resources and learning spaces. The design guidelines, developed through multidisciplinary collaboration, cover 10 domains of the school food environment (eg, cafeteria, kitchen, garden) and 5 core healthy eating design principles. A school redesign project in Dillwyn, Virginia, used the tool to improve the schools’ ability to adopt a healthy nutrition curriculum and promote healthy eating. The new tool, now in a pilot version, is expected to evolve as its components are tested and evaluated through public health and design research.

Does the local food environment around schools affect diet? Longitudinal associations in adolescents attending secondary schools in East London

Background

The local retail food environment around schools may act as a potential risk factor for adolescent diet. However, international research utilising cross-sectional designs to investigate associations between retail food outlet proximity to schools and diet provides equivocal support for an effect. In this study we employ longitudinal perspectives in order to answer the following two questions. First, how has the local retail food environment around secondary schools changed over time and second, is this change associated with change in diet of students at these schools?

Methods

The locations of retail food outlets and schools in 2001 and 2005 were geo-coded in three London boroughs. Network analysis in a Geographic Information System (GIS) ascertained the number, minimum and median distances to food outlets within 400 m and 800 m of the school location. Outcome measures were ‘healthy’ and ‘unhealthy’ diet scores derived from adolescent self-reported data in the Research with East London Adolescents: Community Health Survey (RELACHS). Adjusted associations between distance from school to food retail outlets, counts of outlets near schools and diet scores were assessed using longitudinal (2001–2005 n=757) approaches.

Results

Between 2001 and 2005 the number of takeaways and grocers/convenience stores within 400 m of schools increased, with many more grocers reported within 800 m of schools in 2005 (p< 0.001). Longitudinal analyses showed a decrease of the mean healthy (−1.12, se 0.12) and unhealthy (−0.48, se 0.16) diet scores. There were significant positive relationships between the distances travelled to grocers and healthy diet scores though effects were very small (0.003, 95%CI 0.001 – 0.006). Significant negative relationships between proximity to takeaways and unhealthy diet scores also resulted in small parameter estimates.

Conclusions

The results provide some evidence that the local food environment around secondary schools may influence adolescent diet, though effects were small. Further research on adolescents’ food purchasing habits with larger samples in varied geographic regions is required to identify robust relationships between proximity and diet, as small numbers, because of confounding, may dilute effect food environment effects. Data on individual foods purchased in all shop formats may clarify the frequent, overly simple classification of grocers as ‘healthy’.

Individual- and school-level sociodemographic predictors of obesity among New York City public school children

To identify student- and school-level sociodemographic characteristics associated with overweight and obesity, the authors conducted cross-sectional analyses of data from 624,204 public school children (kindergarten through 12th grade) who took part in the 2007-2008 New York City Fitnessgram Program. The overall prevalence of obesity was 20.3%, and the prevalence of overweight was 17.6%. In multivariate models, the odds of being obese as compared with normal weight were higher for boys versus girls (odds ratio (OR) = 1.39, 95% confidence interval (CI): 1.36, 1.42), for black (OR = 1.11, 95% CI: 1.07, 1.15) and Hispanic (OR = 1.48, 95% CI: 1.43, 1.53) children as compared with white children, for children receiving reduced-price (OR = 1.17, 95% CI: 1.13, 1.21) or free (OR = 1.12, 95% CI: 1.09, 1.15) school lunches as compared with those paying full price, and for US-born students (OR = 1.54, 95% CI: 1.50, 1.58) as compared with foreign-born students. After adjustment for individual-level factors, obesity was associated with the percentage of students who were US-born (across interquartile range (75th percentile vs. 25th), OR = 1.10, 95% CI: 1.07, 1.14) and the percentage of students who received free or reduced-price lunches (across interquartile range, OR = 1.13, 95% CI: 1.10, 1.18). The authors conclude that individual sociodemographic characteristics and school-level sociodemographic composition are associated with obesity among New York City public school students.

Improving retrospective characterization of the food environment for a large region in the United States during a historic time period

Access to healthy foods has received increasing attention due to growing prevalence of obesity and diet-related health conditions yet there are major obstacles in characterizing the local food environment. This study developed a method to retrospectively characterize supermarkets for a single historic year, 2005, in 19 counties in 6 states in the USA using a supermarket chain-name list and two business databases. Data preparation, merging, overlaps, added-value amongst various approaches and differences by census tract area-level socio-demographic characteristics are described. Agreement between two food store databases was modest: 63%. Only 55% of the final list of supermarkets were identified by a single business database and selection criteria that included industry classification codes and sales revenue ≥$2 million. The added-value of using a supermarket chain-name list and second business database was identification of an additional 14% and 30% of supermarkets, respectively. These methods are particularly useful to retrospectively characterize access to supermarkets during a historic period and when field observations are not feasible and business databases are used.

Neighbourhood food and physical activity environments in England, UK: does ethnic density matter?

Background

In England, obesity is more common in some ethnic minority groups than in Whites. This study examines the relationship between ethnic concentration and access to fast food outlets, supermarkets and physical activity facilities.

Methods

Data on ethnic concentration, fast food outlets, supermarkets and physical activity facilities were obtained at the lower super output area (LSOA) (population average of 1500). Poisson multilevel modelling was used to examine the association between own ethnic concentration and facilities, adjusted for area deprivation, urbanicity, population size and clustering of LSOAs within local authority areas.

Results

There was a higher proportion of ethnic minorities residing in areas classified as most deprived. Fast food outlets and supermarkets were more common and outdoor physical activity facilities were less common in most than least deprived areas. A gradient was not observed for the relationship between indoor physical activity facilities and area deprivation quintiles. In contrast to White British, increasing ethnic minority concentration was associated with increasing rates of fast food outlets. Rate ratios comparing rates of fast food outlets in high with those in low level of ethnic concentration ranged between 1.28, 95% confidence interval 1.06-1.55 (Bangladeshi) and 2.62, 1.46-4.70 (Chinese). Similar to White British, however, increasing ethnic minority concentration was associated with increasing rate of supermarkets and indoor physical activity facilities. Outdoor physical activity facilities were less likely to be in high than low ethnic concentration areas for some minority groups.

Conclusions

Overall, ethnic minority concentration was associated with a mixture of both advantages and disadvantages in the provision of food outlets and physical activity facilities. These issues might contribute to ethnic differences in food choices and engagement in physical activity.

Do obesity-promoting food environments cluster around socially disadvantaged schools in Glasgow, Scotland?

Increase in the consumption of food and drinks outside the home by adolescents and young people and associations with rising levels of obesity is a significant concern worldwide and it has been suggested that the food environment around schools may be a contributory factor. As few studies have explored this issue in a UK setting, we examined whether different types of food outlets are clustered around public secondary schools in Glasgow, and whether this pattern differed by social disadvantage. We found evidence of clustering of food outlets around schools but a more complex picture in relation to deprivation was observed. Across all schools there were numerous opportunities for pupils to purchase energy dense foods locally and the implications for policy are discussed.

Availability of limited service food outlets surrounding schools in British Columbia

OBJECTIVE

The purpose of this study was to provide a descriptive profile of the availability of limited service food outlets surrounding public schools in British Columbia, Canada.

METHODS

Data from the 2010 Canadian Business Data Files were used to identify limited service food outlets including fast food outlets, beverage and snack food stores, delis and convenience stores. The number of food outlets within 800 metres of 1,392 public schools and the distance from schools to the nearest food outlets were assessed. Multivariate regression models examined the associations between food outlet availability and school-level characteristics.

RESULTS

In 2010, over half of the public schools in BC (54%) were located within a 10-12 minute walk from at least one limited service food outlet. The median closest distance to a food outlet was just over 1 km (1016 m). Schools comprised of students living in densely populated urban neighbourhoods and neighbourhoods characterized by lower socio-economic status were more likely to have access to limited service food outlets within walking distance. After adjusting for school-level median family income and population density, larger schools had higher odds of exposure to food vendors compared to schools with fewer students.

CONCLUSION

The availability of and proximity to limited service food outlets vary widely across schools in British Columbia and school-level characteristics are significantly associated with food outlet availability. Additional research is needed to understand how food environment exposures inside and surrounding schools impact students' attitudes, food choices and dietary quality.