The Nutrient Content of U.S. Household Food Purchases by Store Type

Promoting Healthier Purchases: Ultraprocessed Food Taxes and Minimally Processed Foods Subsidies for the Low Income

INTRODUCTION

Fiscal policies can shift relative food prices to encourage the purchase and consumption of minimally processed foods while discouraging the purchase and consumption of unhealthy ultraprocessed foods, high in calories and nutrients of concern (sodium, sugar, and saturated fats), especially for low-income households.

METHODS

The 2017-2018 packaged food purchase data among U.S. households were used to derive household income- and composition-specific demand elasticities across 22 food and beverage categories. Policy simulations, conducted in 2022-2023, assessed the impact of national taxes on unhealthy ultraprocessed food and beverage purchases, both separately and alongside subsidies for minimally processed foods and beverages targeted to low-income households. Resultant nutritional implications are reported on the basis of changes in purchased calories and nutrients of concern. In addition, financial implications for both households and the federal government are projected.

RESULTS

A sugar-based tax on sugar-sweetened beverages would lower both volume and calories purchased with the largest impact on low-income households without children. Meanwhile, targeted subsidies would increase fruit, vegetable, and healthier drink purchases without substantially increasing calories. Under tax simulations, low-income households would make larger reductions in their absolute volume and calorie purchases of taxed foods and beverages than their higher-income counterparts, suggesting that these policies, if implemented, could help narrow nutritional disparities.

CONCLUSIONS

Levying national taxes on unhealthy ultraprocessed foods/beverages and offering targeted subsidies for minimally processed foods/beverages could promote healthier food choices among low-income households. Such policies have the potential to benefit low-income households financially and at a relatively low cost for the federal government annually.

Heterogeneity in grocery shopping patterns among low-income minority women in public housing

BACKGROUND

Public housing residents, who tend to be predominantly female and racial/ethnic minorities, are at a particularly high risk for chronic health conditions. Prior studies have suggested that a lack of access to healthy and affordable food may be an important barrier in public housing communities, but evidence is mixed on the association between the neighborhood food environment and dietary quality, suggesting the need to examine food access patterns in low-income, minority communities more deeply. The purpose of this study was to examine the variability in grocery shopping patterns, and the factors that predict them, among low-income minority women in public housing.

METHODS

Interviewer-administered surveys and body composition measurements were collected in the Watts Neighborhood Health Study, an ongoing longitudinal cohort study of low-income urban public housing residents located in South Los Angeles. Descriptive analyses were conducted to understand the variation in grocery shopping patterns among women. Logistic and ordered logistic regression models were estimated to examine the association between resident characteristics and grocery shopping patterns.

RESULTS

There was considerable variability in grocery shopping patterns, including the types of grocery stores accessed, distance travelled, frequency of shopping, and reasons behind grocery store choice. Grocery shopping patterns were associated with several participant characteristics, including race/ethnicity, working status, access to a car, income, and education. Hispanic participants were less likely to shop at a supermarket, travel further distances to shop, shop more frequently, and were more likely to prioritize price in their choice of primary grocery store than non-Hispanic Black women participants.

CONCLUSIONS

There was considerable variability in grocery shopping patterns, even within this low-income, minority community despite access to the same neighborhood food environment. Convenience and quality, in addition to price, were priorities for choice of primary grocery store, and differences by race/ethnicity suggest that initiatives to improve the neighborhood food environment should consider quality of food, cultural factors, and availability of foods desired by the surrounding community, in addition to price and proximity of grocery stores.

Associations Among Select State Policies and the Nutritional Quality of Household Packaged Food Purchases in the United States from 2008 Through 2017

BACKGROUND

Policy interventions are important public health tools because they can reach large numbers of people. State context has been associated with health outcomes, yet few studies have examined the extent to which state-level policies are associated with dietary quality.

OBJECTIVES

The objective of this study was to evaluate whether state policies are associated with the nutritional quality of household packaged food purchases.

DESIGN

This observational study used data from Nielsen Homescan, an open-cohort household panel where participants track purchases, and a combination of state-level food and social safety net policy variables from 2008 through 2017.

PARTICIPANTS AND SETTING

This study included 615,634 household-year observations in the United States from 2008 through 2017. Household-year observations were excluded in the case that a household did not make a minimum number of purchases and in the case that they had incorrect geographic information. The final analytic sample was 611,719 household-years.

MAIN OUTCOME MEASURES

Study outcomes included a set of nutrition-related measures of public health interest, including nutrients of concern (eg, sugar, saturated fat, and sodium) and calories from specific food groups (eg, fruits, nonstarchy vegetables, processed meats, mixed dishes, sugar-sweetened beverages, and desserts and snacks).

STATISTICAL ANALYSIS

This study used multilevel generalized linear models with state fixed effects on three samples: all households, only households with low income, and only households with low educational attainment.

RESULTS

Few significant associations were found between healthy food retail policies and the nutritional quality of purchases, and mixed associations were found between social safety net policies and lower or higher quality packaged food purchases.

CONCLUSIONS

Little evidence was found that state policy context in 2008 through 2017 was associated with the quality of packaged food purchases. However, variation in state policies is increasing over time, warranting future research into the relationship between these policies, the quality of packaged food purchases, and the rest of the diet.

Associação entre padrões alimentares com fatores socioeconômicos e ambiente alimentar em uma cidade do Sul do Brasil

Resumo Objetivou-se estudar a associação entre padrão alimentar, fatores demográficos, socioeconômicos e o ambiente alimentar em uma população de adultos e idosos de uma cidade do Sul do Brasil. Estudo transversal com pessoas de ambos os sexos e idade entre 20 e 70 anos. Os padrões alimentares foram identificados por meio da análise de componentes principais. A regressão de Poisson foi utilizada para estimar as razões de prevalência brutas e ajustadas e os intervalos de 95% de confiança (IC 95%). Quatro padrões alimentares foram identificados: saudável, tradicional, carboidratos e açúcares refinados e fast food. Encontraram-se associações positivas entre: sexo feminino e maior renda com o padrão alimentar saudável; cor da pele preta ou parda e domicílios com seis ou mais moradores com padrões alimentares tradicional e carboidratos e açúcares refinados; maior escolaridade com o padrão fast food. Realizar as principais refeições em casa associou-se ao padrão tradicional, e almoço ou jantar fora do domicílio com os padrões carboidratos e açúcares refinados e fast food. Posição socioeconômica mais baixa leva ao maior consumo do padrão alimentar tradicional e/ou rico em carboidratos e açúcares, e uma posição socioeconômica mais elevada parece permitir uma escolha entre padrão saudável ou fast food.

More Frequent Food Shopping May Promote Fruit and Vegetable Intake: A Systematic Review

BACKGROUND

Food shopping frequency may be an important modifiable factor related to increasing fruit and vegetable (FV) intake. Because of mixed findings of individual studies of shopping frequency, a systematic review is needed to examine findings across studies and store types.

OBJECTIVE

To conduct a systematic review of articles examining the relationship between frequency of food shopping and FV intake including examination of participation in federal nutrition assistance programs on FV intake, if reported.

METHODS

A search, guided by the Preferred Reported Items for Systematic Reviews and Metanalyses, using terms related to FV consumption and food shopping across 4 online databases, was conducted. Studies conducted in the US and published through October, 2020, included adults, and had a cross-sectional, longitudinal, cohort, or randomized study design were eligible for inclusion.

RESULTS

Twenty-four articles were included. The majority of studies found at least 1 positive finding between the frequency of food shopping and FV intake, indicating that as the frequency of food shopping increased, FV intake increased. In studies with 100% participation in government/federal nutrition assistance programs, participation was associated with FV intake. Studies that included participation as a subset found participation not associated with FV intake.

IMPLICATIONS FOR FUTURE RESEARCH AND PRACTICE

The frequency of shopping may be modifiable to increase FV intake. Experimental research is needed to test the directionality and causality of the relationship. Federal nutrition assistance programs may be a logical place to test the relationship through the adjustment of fund disbursements.

Resources in women's social networks for food shopping are more strongly associated with better dietary quality than people: A cross-sectional study

When healthy people are part of an individual's social network, those individuals will have better dietary quality. Little, however, is known about whether social networks for food shopping, including both people and resources (e.g. recipes, weight loss programmes and food advertisements) are associated with dietary quality. The aim of this study was to explore the relationship between social networks for food shopping and dietary quality, and whether this differs for people and resources, among women aged 18-45 years. A total of 129 participants completed a cross-sectional questionnaire including an ego-centric Social Network Exposure tool and short Food Frequency Questionnaire. Associations between dietary quality and type of network member, perceived healthiness and support for healthy shopping choices were explored using linear regression models. Analyses revealed that participants who nominated people in their food shopping social network that eat healthily or support healthy food shopping had better dietary quality (β = 0.16 SD per 1-point change on a 4-point scale, 95%CI -0.06, 0.39; β = 0.20, 95%CI -0.07, 0.46, respectively). Resources in participants' food shopping social networks which promote healthy eating or support healthy shopping were associated with better dietary quality. These associations remained robust after adjustment for confounding variables identified using a directed acyclic graph (β = 0.31 SD per 1-point change on a 4-point scale, 95%CI 0.03, 0.58; β = 0.44, 95%CI 0.09, 0.79 respectively). The results were strengthened when the outcome was multiplied by frequency of contact (β = 0.33, 95%CI 0.05, 0.61; β = 0.47, 95%CI 0.11, 0.83 respectively). This study suggests that resources which promote healthy eating and healthy food shopping have a stronger association with dietary quality than social support from people. Further research is required in a larger sample, including multiple time-points, to confirm these findings.

Healthy food retail availability and cardiovascular mortality in the United States: a cohort study

OBJECTIVES

We investigated the association of healthy food retail presence and cardiovascular mortality, controlling for sociodemographic characteristics. This association could inform efforts to preserve or increase local supermarkets or produce market availability.

DESIGN

Cohort study, combining Mortality Disparities in American Communities (individual-level data from 2008 American Community Survey linked to National Death Index records from 2008 to 2015) and retail establishment data.

SETTING

Across the continental US area-based sociodemographic and retail characteristics were linked to residential location by ZIP code tabulation area (ZCTA). Sensitivity analyses used census tracts instead, restricted to urbanicity or county-based strata, or accounted for non-independence using frailty models.

PARTICIPANTS

2 753 000 individuals age 25+ living in households with full kitchen facilities, excluding group quarters.

PRIMARY AND SECONDARY OUTCOME MEASURES

Cardiovascular mortality (primary) and all-cause mortality (secondary).

RESULTS

82% had healthy food retail (supermarket, produce market) within their ZCTA. Density of such retail was correlated with density of unhealthy food sources (eg, fast food, convenience store). Healthy food retail presence was not associated with reduced cardiovascular (HR: 1.03; 95% CI 1.00 to 1.07) or all-cause mortality (HR: 1.05; 95% CI 1.04 to 1.06) in fully adjusted models (with adjustment for gender, age, marital status, nativity, Black race, Hispanic ethnicity, educational attainment, income, median household income, population density, walkable destination density). The null finding for cardiovascular mortality was consistent across adjustment strategies including minimally adjusted models (individual demographics only), sensitivity analyses related to setting, and across gender or household type strata. However, unhealthy food retail presence was associated with elevated all-cause mortality (HR: 1.15; 95% CI 1.11 to 1.20).

CONCLUSIONS

In this study using food establishment locations within administrative areas across the USA, the hypothesised association of healthy food retail availability with reduced cardiovascular mortality was not supported; an association of unhealthy food retail presence with higher mortality was not specific to cardiovascular causes.

Geographic patterns and socioeconomic differences in the nutritional quality of household packaged food purchases in the United States

BACKGROUND

It is unclear whether dietary quality varies by geography in the US.

PURPOSE

Assess patterns in packaged food purchases (PFPs).

METHODS

We characterized variation in PFP quality from 2008 to 2018 by 1) examining geographic clustering and 2) using regression analysis to control for household characteristics.

RESULTS

Lower quality purchases clustered in the Southeast and Appalachia, whereas higher quality purchases clustered in the West and Northeast. Spatial patterns were similar for low socioeconomic households but not high socioeconomic households. Geographic differences in quality remained after controlling for demographic composition.

CONCLUSION

This analysis should inform research into systemic drivers of PFP quality.

Healthiness of foods and non-alcoholic beverages according to store type: A population-based study of household food and drink purchases in New Zealand

Background

Obesity and diet-related noncommunicable diseases (NCDs) account for the largest proportion of disease burden worldwide, and an unhealthy food environment is a key driver. Food retailers play an important role in food environments through the availability and purchases of healthy food products at various stores.

Objectives

To assess whether the healthiness of food and non-alcoholic drink product purchases vary according to retail store type.

Methods

We undertook a cross-sectional analysis of Nielsen New Zealand Homescan® panel data, which is a nationally representative sample of 2500 households in terms of certain key household demographic and socioeconomic characteristics. Panel members were asked to record all food and beverage products that were purchased and brought back to the home between October 2018 and October 2019. Household food and non-alcoholic drink purchases were linked with two food composition databases (Nutritrack, a New Zealand packaged food composition database, and the FOODfiles New Zealand Food Composition Database) to extract data on the nutrient profile of products purchased. We developed a store classification tool, and classified stores as supermarkets, grocery stores, convenience stores, fruit and vegetable stores, meat and fish stores, or bakeries. We estimated the Health Star Rating (HSR) for all products and defined a product with HSR ≥ 3.5 as ‘healthy’. We computed estimated mean HSR and conducted multivariate regression analyses.

Results

In total, 3,940,458 product purchases were included in the analyses, consisting of 20,491 unique products purchased at different stores over the one-year period by 1800 panellist households. Supermarket products made up the majority of household food and drink purchases (3,545,141 of 3,940,458; 90%). Overall, the estimated mean HSR was 3.5 stars. In comparison to the reference group of supermarkets, the odds ratio for healthy products purchased at fruit and vegetable stores was 4.62, at grocery stores it was 2.36, and at meat and fish stores it was 1.99. In contrast, the odds ratios from convenience stores and bakeries were 0.58 and 0.03. Except for convenience stores, these differences were statistically significant (p < 0.05).

Discussion

We found significant differences in household purchases of healthy food and beverages according to food retail store type, with healthier food much more likely to be purchased from fruit and vegetable stores, meat and fish stores and grocery stores, and much less likely to be purchased from bakeries and convenience stores as compared with supermarkets.

Conclusion

Policies to improve healthy food retailing should consider all retail store types and focus particularly on increasing the availability of healthy food options at convenience stores and bakeries. Given that supermarkets are the source of most household food purchases (both healthy and unhealthy), strategies are also warranted to increase the relative availability and purchases of healthy foods from supermarkets.

Heterogeneities in Consumer Diet Quality and Health Outcomes of Consumers by Store Choice and Income

Obesity and other diet-related health conditions have received much attention in the public health literature over the past two decades. This study investigates the relationship between household food budget shares at different food outlets with diet quality and weight-related health outcomes in the United States. Our analysis used event-level food purchase data from the national household food acquisition and purchases survey (FoodAPS). We find that, after controlling for observables, food purchase location is significantly associated with diet quality and body mass index (BMI). Our findings indicate that larger food budget shares at convenience stores and restaurants are linked with poor diet quality based on the healthy eating index-2015 (HEI-2015) scores and higher BMI. We further explored potential heterogeneity on outcomes of interest across income groups. Results suggest heterogeneous effects may exist across income groups: low-income households, who spent a larger share of their food budget at convenience stores and fast-food restaurants are related to poor diet quality and more likely to be obese. Our findings will help improve understanding of the causes of diet-related health problems and may illuminate potential avenues of intervention to address obesity.

Socio-economic and racial/ethnic disparities in the nutritional quality of packaged food purchases in the USA, 2008-2018

OBJECTIVE

To determine whether disparities exist in the nutritional quality of packaged foods and beverage purchases by household income, education and race/ethnicity and if they changed over time.

DESIGN

We used Nielsen Homescan, a nationally representative household panel, from 2008 to 2018 (n = 672 821 household-year observations). Multivariate, multilevel regressions were used to model the association between sociodemographic groups and a set of nutritional outcomes of public health interest, including nutrients of concern (sugar, saturated fat and Na) and calories from specific food groups (fruits, non-starchy vegetables, processed meats, sugar-sweetened beverages and junk foods).

SETTING

Household panel survey.

PARTICIPANTS

Approximately 60 000 households each year from the USA.

RESULTS

Disparities were found by income and education for most outcomes and widened for purchases of fruits, vegetables and the percentage of calories from sugar between 2008 and 2018. The magnitude of disparities was largest by education. Disparities between Black and White households include the consumption of processed meats and the percentage of calories from sugar, while no disparities were found between White and Hispanic households. Disparities have been largely persistent, as any significant changes over time have been substantively small.

CONCLUSIONS

Policies to improve the healthfulness of packaged foods must be expanded beyond SSB taxes, and future research should focus on what mediates the relationship between education and diet so as not to exacerbate disparities.

Beyond the supermarket: analyzing household shopping trip patterns that include food at home and away from home retailers

BACKGROUND

Modifying a household's food environment by targeting a single retailer type, like supermarkets, has a limited impact on dietary outcomes. This may be because the food environment has a limited impact on shopping behaviors, or because households are not as reliant on supermarkets as we assume. However, our understanding of how households shop for food, especially when considering the use of both food at home (FAH) retailers, such as supermarkets, and away from home retailers (FAFH), such as restaurants, is limited. Thus, understanding how households shop for food is a necessary first step when developing programs to modify food purchasing behavior.

METHODS

K-means cluster analysis was used to identify weekly food shopping trip patterns based on the percentage of trips to FAH and FAFH retailers in the 2013 Food Acquisition and Purchase Survey (FoodAPS) dataset (n = 4665 households). Multinomial logistic regression was used to examine the relationship between shopping trip patterns, household and food environment characteristics.

RESULTS

Three patterns emerged: primarily supermarket, primarily supercenter, or mix (i.e. no dominant retailer type, but high FAFH use). Households with incomes below 185% of the federal poverty line were evenly divided between patterns that rely primarily on FAH retailers, and the mix pattern. While nearly 70% of households with incomes above 185% of the federal poverty line are in the mix cluster. Supermarket and superstore availability significantly influenced the likelihood of belonging to those clusters respectively, while having a child, higher income, and attitudes towards healthy meal preparation time or taste significantly influenced the likelihood of belonging to the mix cluster.

CONCLUSION

Although lower-income households are more likely to rely primarily on FAH retailers, household's, regardless of income, that primarily utilize FAH retailers show a strong preference for either superstores or supermarkets suggesting a need for interventions to reach both retailer types. However, altering the food environment alone may not be sufficient to discourage use of FAFH retailers as households relying on FAFH retailers are significantly influenced by meal preparation time and healthy food taste.

Urban vs. Rural Socioeconomic Differences in the Nutritional Quality of Household Packaged Food Purchases by Store Type

The U.S. food system is rapidly changing, including the growth of mass merchandisers and dollar stores, which may impact the quality of packaged food purchases (PFPs). Furthermore, diet-related disparities exist by socioeconomic status (SES) and rural residence. We use data from the 2010–2018 Nielsen Homescan Panel to describe the nutritional profiles of PFPs by store type and to assess whether these vary by household urbanicity and SES. Store types include grocery stores, mass merchandisers, club stores, online shopping, dollar stores, and convenience/drug stores. Food and beverage groups contributing the most calories at each store type are estimated using survey-weighted means, while the associations of urbanicity and SES with nutritional quality are estimated using multivariate regression. We find that households that are customers at particular store types purchase the same quality of food regardless of urbanicity or SES. However, we find differences in the quality of foods between store types and that the quantity of calories purchased at each store type varies according to household urbanicity and SES. Rural shoppers tend to shop more at mass merchandisers and dollar stores with less healthful PFPs. We discuss implications for the types of store interventions most relevant for improving the quality of PFPs.

Consumer Reactions to E. Coli and Antibiotic Residue Recalls: Utility Maximization vs. Regret Minimization

Food safety remains a major issue to many consumers. Previous studies examining the economic impact of food safety recalls have focused on Class I recalls. Antibiotic residue in meat products, a Class II recall, has increased in consumer importance yet little is known about how much research and development expenditure should be allocated to reduce antibiotic residue pre- and post-harvest. This study compares demand elasticities and the decrease in willingness to pay in response to either an E. coli (Class I) or antibiotic residue (Class II) recall. We compare and contrast two competing behavioral frameworks, Random Utility and Regret Minimizing. Modeling behavior using the random regret framework is found to be more powerful for assessing consumer responses. In addition, we explore if different groups of consumers exist that either maximize utility or minimize regret. Consumer devaluations of E. coli (Class I) are 40-65% larger than antibiotic residue (Class II). Approximately 60% of consumers are identified as regret minimizers and 40% were identified as utility maximizers. While industry response and government policy recommendations differed conditional on modeling framework, the regret minimizing framework required smaller price discounts than regret minimizing to maintain the same level of market share.

Examining Shopping Patterns, Use of Food-Related Resources, and Proposed Solutions to Improve Healthy Food Access Among Food Insecure and Food Secure Eastern North Carolina Residents

In the Southern United States (U.S.), food insecurity rates are higher in rural (20.8%) versus urban communities (15%). Food insecurity can exacerbate diet-related disease. Thus, the purpose of this study was to examine differences in the use of food-related community resources and potential solutions proposed among food insecure versus food secure residents. A community survey (n = 370) was conducted in rural eastern North Carolina, with questions pertaining to food security status and food-related resources. The IBM SPSS Statistics software and SAS software were used to examine differences in food-related resources, and qualitative data analysis was used to examine differences in solutions offered between food insecure and food secure participants. Of the 370 respondents, forty-eight-point-six percent were classified as food insecure. Food insecure participants were more likely to report shopping for groceries at a convenience/discount store, less likely to use their own vehicle for transportation, and less likely to purchase food from local producers. Food insecure participants were more likely to suggest solutions related to reducing the cost of healthy food, while food secure participants were more likely to suggest educational or convenience-related interventions.

Evaluating the effect of individually-targeted food incentives on grocery purchases: The smart cart study protocol for a randomized controlled cross-over trial

BACKGROUND/AIMS

Health stakeholders are interested in the promise of healthy food incentives to improve dietary quality. The Smart Cart Study tested whether targeting healthful food incentives based on customer preferences and purchase history was effective for improving grocery purchase quality.

DESIGN

Randomized controlled crossover design of 224 adults who shopped at an independent supermarket for ≥50% of their groceries, participated in the store's loyalty program, and completed validated diet and sociodemographic/behavioral questionnaires. Participants were randomized using 1:1 blocked randomization; all participants received a 5% discount on their purchases with their loyalty card. For the first 13-weeks, the intervention group received individually-targeted weekly coupons (valued up to $10) with brief nutrition education to improve grocery purchase quality. The study team developed healthy food coupons, and the study algorithm allocated targeted coupons to participants' loyalty cards using purchase history, dietary preferences/allergies, and baseline diet quality. Control participants received weekly untargeted nutrition education and occasional generic coupons. Following a 2-4 week washout period, the two groups crossed over. The primary study outcomes were purchases of targeted products and grocery purchase quality measured using the validated Grocery Purchase Quality Index-2016; the study was powered to detect a minimum 3% difference in purchase quality.

CONCLUSIONS

The Smart Cart Study tested a novel application of automated individually-targeted marketing using customer purchase history, dietary quality, and preferences to identify and deliver targeted incentives to improve grocery purchase quality. Future research could scale this program through collaboration between multiple stakeholders, including supermarkets, workplace wellness initiatives and insurance companies.

Prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on shopper purchasing behaviour: A systematic review of the literature

Policies to restrict unhealthy food and beverage price promotions have been recommended, as part of a broader strategy to reduce obesity, but little evidence underpins such recommendations. We aimed to synthesize the literature on the prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on purchasing behaviour. Eight scientific databases (covering health, business, and marketing) and grey literature were systematically searched using search terms related to "food and beverage price promotions" up until July 2019. Articles were included if they examined prevalence of, and/or consumer response to, food and non-alcoholic beverage price promotions, from a nutritional perspective. Of the 16 included studies, eight examined the prevalence of price promotions and eight examined the potential influence of price promotions on purchasing behaviour. Seven of the "prevalence" studies found that price promotions were more common for unhealthy foods and beverages. Seven "influence" studies found a greater proportion of price-promoted purchases were for unhealthy compared with healthy products. Policies that reduce the prevalence and/or influence of price promotions on unhealthy foods and beverages may shift consumer purchasing away from unhealthy foods and beverages. Empirical studies are required to better understand how consumers and industry may respond to such policies.

Improvements in the nutritional quality of US young adults based on food sources and socioeconomic status between 1989-1991 and 2011-2014

BACKGROUND

Fast food and other away from home food sources are linked with poorer diet quality and adverse health outcomes. The diet quality of young adults, major consumers of fast food, is understudied in terms of long-term shifts based on food sources for key subpopulation disparities.

METHODS

The study included young adults ages 18-39 (n = 8012) from the Continuing Survey of Food Intakes by Individuals 1989-1991 (n = 4217) and the National Health and Nutrition Examination Survey 2011-2012 and 2013-2014 (n = 3795). We stratified individuals based on their combination of food sources, race/ethnicity, and socioeconomic status. Using 24-h dietary recall data, we measured diet quality with the Healthy Eating Index-2015 (HEI-2015). Differences in diet quality were determined using 95% confidence intervals.

RESULTS

Overall, diet quality increased across all food sources between the 1989-1991 and 2011-2014 surveys. The restaurant category overtook the at home category as the healthiest food source, while the fast food category remained the unhealthiest on days it was consumed. Vegetable intake decreased, while added sugar intake increased across all sources. Non-Hispanic whites and non-Hispanic blacks experienced similar increases in HEI-2015 scores across all food sources except restaurants, while Mexican American diet quality remained unchanged. Although all income levels experienced an increase in diet quality, the disparity between low- and high-income groups increased considerably.

CONCLUSIONS

US young adults consume healthier foods from all food sources, however, fast food consumers have significantly lower quality in the remainder of their diets. Additionally, Mexican Americans and low-income individuals emerge as high-risk groups for poor diet quality.

Delay discounting and household food purchasing decisions: The SHoPPER study

OBJECTIVE

Delay discounting is a neurocognitive trait that has been linked to poor nutritional health and obesity, but its role in specific dietary choices is unclear. This study tested whether individual differences in delay discounting are related to the healthfulness of household food purchases and reliance on nonstore food sources such as restaurants.

METHOD

The food purchases of 202 primary household food shoppers were objectively documented for 14 days through a food receipt collection and analysis protocol. The nutrient content of household food purchases was derived for each participant, and the overall diet quality (Healthy Eating Index-2015) and energy density (kcal/g) of foods and beverages were calculated. The proportion of energy from nonstore food sources was also derived. Delay discounting was assessed with a choice task featuring hypothetical monetary rewards.

RESULTS

Data were available for 12,624 foods and beverages purchased across 2,340 shopping episodes. Approximately 13% of energy was purchased from restaurants and other nonstore food sources. Steeper discounting rates were associated with lower overall Healthy Eating Index-2015 scores and a higher energy density (kcal/g) of purchased foods. Associations were attenuated but remained statistically significant when accounting for body mass index and sociodemographic variables. Discounting rates were unrelated to reliance on nonstore food sources or the energy density of purchased beverages.

CONCLUSIONS

Delay discounting is related to the healthfulness of food purchases among primary household shoppers. As food purchasing is a key antecedent of dietary intake, delay discounting may be a viable target in dietary and weight management interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Purchasing patterns in low-income neighbourhoods: implications for studying sugar-sweetened beverage taxes

OBJECTIVE

The present study aimed to determine the store types from which people in low-income neighbourhoods purchase most sugar-sweetened beverages (SSB) and to identify associations between purchasing location and demographic characteristics.

DESIGN

Street-intercept surveys of passers-by near high foot-traffic intersections in 2016. Participants completed a beverage frequency questionnaire and identified the type of store (e.g. corner store, chain grocery) from which they purchased most SSB.

SETTING

Eight low-income neighbourhoods in four Bay Area cities, California, USA.ParticipantsSample of 1132 individuals who reported consuming SSB, aged 18-88 years, who identified as African-American (41 %), Latino (29 %), White (17 %) and Asian (6 %).

RESULTS

Based on surveys in low-income neighbourhoods, corner stores were the primary source from which most SSB were purchased (28 %), followed by discount stores (18 %) and chain groceries (16 %). In fully adjusted models, those with lower education were more likely to purchase from corner stores or discount groceries than all other store types. Compared with White participants, African-Americans purchased more frequently from corner stores, discount groceries and chain groceries while Latinos purchased more frequently from discount groceries.

CONCLUSIONS

The wide range of store types from which SSB were purchased and demographic differences in purchasing patterns suggest that broader methodological approaches are needed to adequately capture the impact of SSB taxes and other interventions aimed at reducing SSB consumption, particularly in low-income neighbourhoods.

Variation in the food environment of small and non-traditional stores across racial segregation and corporate status

OBJECTIVE

We examined differences in consumer-level characteristics and structural resources and capabilities of small and non-traditional food retailers (i.e. corner stores, gas-marts, pharmacies, dollar stores) by racial segregation of store neighbourhood and corporate status (corporate/franchise- v. independently owned).

DESIGN

Observational store assessments and manager surveys were used to examine availability-, affordability- and marketing-related characteristics experienced by consumers as well as store resources (e.g. access to distributors) and perceived capabilities for healthful changes (e.g. reduce pricing on healthy foods). Cross-sectional regression analyses of store and manager data based on neighbourhood segregation and store corporate status were conducted.

SETTING

Small and non-traditional food stores in Minneapolis and St. Paul, MN, USA.ParticipantsOne hundred and thirty-nine stores; seventy-eight managers.

RESULTS

Several consumer- and structural-level differences occurred by corporate status, independent of residential segregation. Compared with independently owned stores, corporate/franchise-owned stores were more likely to: not offer fresh produce; when offered, receive produce via direct delivery and charge higher prices; promote unhealthier consumer purchases; and have managers that perceived greater difficulty in making healthful changes (P≤0·05). Only two significant differences were identified by residential racial segregation. Stores in predominantly people of colour communities (&lt;30 % non-Hispanic White) had less availability of fresh fruit and less promotion of unhealthy impulse buys relative to stores in predominantly White communities (P≤0·05).

CONCLUSIONS

Corporate status appears to be a relevant determinant of the consumer-level food environment of small and non-traditional stores. Policies and interventions aimed at making these settings healthier may need to consider multiple social determinants to enable successful implementation.

Development of a Quality Score for the Home Food Environment Using the Home-IDEA2 and the Healthy Eating Index-2010

The home food environment (HFE) is an important factor in the development of food preferences and habits in young children, and the availability of foods within the home reflects dietary intake in both adults and children. Therefore, it is important to consider the holistic quality of the HFE. The purpose of this study was to apply the Healthy Eating Index (HEI; a measure of diet quality in conformance to the Dietary Guidelines for Americans) algorithm to the Home-IDEA2, a valid and reliable food inventory checklist, to develop a Home-IDEA2 HEI Score. After an initial score was developed, it was psychometrically tested for content, criterion, and construct validity. Content validity testing resulted in 104 foods being retained. Internal criterion testing demonstrated that 42 foods (40%) changed component scores by >5%; however, no single food changed a total Home-IDEA2 HEI score by >5%. Testing of hypothetical HFEs resulted in a range of scores in the expected directions, establishing sensitivity to varied HFEs. This study resulted in a validated methodology to assess the overall quality of the HFE, thus contributing a novel approach for examining home food environments. Future research can test interventions modifying the HFE quality to improve individual dietary intake.

Gender Comparison of the Diet Quality and Sources of Food Purchases Made by Urban Primary Household Food Purchasers

OBJECTIVE

To compare food purchasing behaviors and diet quality of foods purchased between men and women who were the primary food purchaser for their households.

METHODS

Food purchasing was measured via itemized receipts. The dietary composition of purchased foods was derived using the Nutrition Data System for Research and quality was assessed using the Healthy Eating Index-2010.

RESULTS

Men comprised 17.2% of the household primary food purchasers in the sample (n = 204). There were no differences by gender in the number of items purchased or the number of receipts. Men made fewer purchases at stores (74.0%) than did women (81.4%; P < .001). There were no gender differences in the quality of foods purchased overall or by source of purchase.

CONCLUSIONS AND IMPLICATIONS

In primary purchasers, purchasing behaviors varied by gender but not purchases did not. Food purchasing interventions should include both genders for greatest impact.

The use of commercial food purchase data for public health nutrition research: A systematic review

BACKGROUND

Traditional methods of dietary assessment have their limitations and commercial sources of food sales and purchase data are increasingly suggested as an additional source to measuring diet at the population level. However, the potential uses of food sales data are less well understood. The aim of this review is to establish how sales data on food and soft drink products from third-party companies have been used in public health nutrition research.

METHODS

A search of five electronic databases was conducted in February-March 2018 for studies published in peer-reviewed journals that had used food sales or purchase data from a commercial company to analyse trends and patterns in food purchases or in the nutritional composition of foods. Study quality was evaluated using the National Institutes of Health (NIH) Quality Assessment Tool for Cohort and Cross-Sectional Studies.

RESULTS

Of 2919 papers identified in the search, 68 were included. The selected studies used sales or purchase data from four companies: Euromonitor, GfK, Kantar and Nielsen. Sales and purchase data have been used to evaluate interventions, including the impact of the saturated fat tax in Denmark, the soft drink and junk food taxes in Mexico and supplemental nutrition programmes in the USA. They have also been used to identify trends in the nutrient composition of foods over time and patterns in food purchasing, including socio-demographic variations in purchasing.

CONCLUSION

Food sales and purchase data are a valuable tool for public health nutrition researchers and their use has increased markedly in the last four years, despite the cost of access, the lack of transparency on data-collection methods and restrictions on publication. The availability of product and brand-level sales data means they are particularly useful for assessing how changes by individual food companies can impact on diet and public health.

Perceptions of a healthier neighborhood food environment linked to greater fruit and vegetable purchases at small and non-traditional food stores

The aim of this study was to examine associations between perceived neighborhood food environments and food purchasing at small and non-traditional food stores. Intercept interviews of 661 customers were conducted in 105 small and non-traditional food stores. We captured (1) customer perceptions of the neighborhood food environment, (2) associations between customer perceptions and store-level characteristics, and (3) customers' perceptions and shopping behaviors. Findings suggest that customers with more favorable perceptions of the neighborhood food environment were more likely to purchase fruits and vegetables, despite no significant association between perceptions of the neighborhood and objectively measured store characteristics.

Mexican Households' Purchases of Foods and Beverages Vary by Store-Type, Taxation Status, and SES

Where people shop for food is often linked to the healthiness of food purchases. In Mexico, no research has examined the connection between where people shop, what they buy, and their socioeconomic status (SES). Mexico’s sugary beverage and junk food taxes have made households decrease purchases of taxed products. However, whether households have changed where they shop is unknown. To address this gap, we use a repeated cross-sectional analysis of household packaged food and beverage purchases from the Nielsen Mexico Consumer Panel Survey from 2012 to 2015 (n > 5500 households). We examine changes in the volume of the purchase of taxed and untaxed products from different store-types (i.e., convenience stores, supermarkets, traditional retailers, wholesalers, home water-delivery, and others) by SES using multivariate linear regression models. Results show that high-SES households purchased more foods and beverages at all store-types except for low-SES who purchased the most foods and taxed beverages at traditional retailers. Purchases of taxed foods and beverages from traditional retailers significantly decreased for low-SES and middle-SES households and from supermarkets for middle-SES and high-SES households. Purchases of untaxed beverages from wholesalers significantly increased for middle-SES households and from convenience stores for high-SES households. Our findings suggest that consumers choose different stores to purchase beverages than to purchase foods and that taxes may have differentially affected each store-type.

Nutritional Profile of Purchases by Store Type: Disparities by Income and Food Program Participation

INTRODUCTION

Policymakers have focused on the food retail environment for improving the dietary quality for Supplemental Nutrition Assistance Program (SNAP) participants. Yet little is known about where SNAP households make food and beverage purchases or how purchases may vary by store type, SNAP participation, and income level. The objective of this study was to examine the association between SNAP-income status (participant, income-eligible non-participant, higher-income non-participant) and healthfulness of household purchases across store types.

METHODS

Data included household packaged food purchases (N=76,458 unique households) from 2010 to 2014, analyzed in 2017 with multivariable adjusted models to examine the nutritional profile of purchases by store type (grocery, convenience, big box, and other stores) for SNAP participating households, income-eligible non-participants, and higher-income non-participants. Outcomes included volume and nutrients (kilocalories, total sugar, saturated fat, and sodium) and calories from food groups.

RESULTS

All households purchased the greatest volume of foods and beverages from grocery stores, followed by big-box and other stores, with relatively little purchased from convenience stores. The largest differences between SNAP participants and non-participants were observed at grocery stores and big-box stores, where SNAP households purchased more calories from starchy vegetables, processed meat, desserts, sweeteners and toppings, total junk food, sugar-sweetened beverages, and milk, than income-eligible and higher-income SNAP non-participants. SNAP purchases also had considerably higher sodium density. Across store types, the nutritional profile of income-eligible non-participants' purchases was similar to higher-income households' purchases.

CONCLUSIONS

More research is needed to identify strategies to improve the nutritional profile of purchases among SNAP households.

Food sources among young people in five major Canadian cities

OBJECTIVE

To examine food sources among young people in five major Canadian cities.

METHODS

As part of the 2016 Canada Food Study, respondents aged 16-30 were recruited from five Canadian cities (Toronto, Montreal, Halifax, Edmonton, and Vancouver) using in-person intercept sampling and completed an online survey (n = 2840 retained for analysis). Descriptive statistics were used to summarize food preparation and purchase locations. A linear regression model was fitted to examine correlates of the proportion of meals that were ready-to-eat or prepared outside the home.

RESULTS

In total, 80% of meals were prepared at home and 20% were prepared outside the home. More than 25% of meals prepared at home were ready-to-eat/box food. Of all meals consumed, 42% were either ready-to-eat/box food prepared at home or prepared outside the home. Food for meals prepared at home was purchased predominantly at grocery stores/supercentres while meals prepared outside the home were purchased predominantly at fast food/quick service/coffee shop outlets. Respondents who were younger, identified as Aboriginal, had obesity, had no children, lived in residence at school, university, or college, and reported poorer cooking skills reported more meals that were ready-to-eat or prepared outside the home.

CONCLUSIONS

The current findings indicate that a substantial proportion of meals consumed by young people consist of meals either prepared outside the home or ready-to-eat/box food prepared at home. Dietary recommendations should highlight basic patterns of food preparation and eating, such as limiting ultra-processed food and food prepared outside the home.

Development of a food composition database to monitor changes in packaged foods and beverages

In order to monitor nutritional changes in the US food supply and assess potential impact on individual dietary intake, an approach was developed to enhance existing standard food composition tables with time-varying product- and brand-specific information for barcoded packaged foods. A "Crosswalk" was formed between barcoded products and USDA foodcodes in a time-specific manner, such that sales-weighted average nutritional profiles were generated for each foodcode based on corresponding products (275,000 to 350,000 per 2-year cycle). This Crosswalk-enhanced food composition table was applied to dietary intake data from the National Health and Nutrition Examination Survey (cycles 2007-2008, 2009-2010, and 2011-2012). Total energy density of foods consumed by Americans from stores/vending was stable over time and differed by <5 kcal/100g using the Crosswalk-enhanced vs standard database. However, changes in the energy density of food groups were found utilizing the Crosswalk that were not detected using the standard database. Likewise, significant declines in energy intake from beverages among children (288±7.3 to 258±6.8 kcal/d) were found using the Crosswalk-enhanced database but were non-significant using the standard database. The Crosswalk approach can potentially augment national nutrition surveys by utilizing commercial food purchase and nutrient databases to capture changes in the nutrient content of packaged foods.

Understanding bias in relationships between the food environment and diet quality: the Coronary Artery Risk Development in Young Adults (CARDIA) study

BACKGROUND

The relationship between food environment exposures and diet behaviours is unclear, possibly because the majority of studies ignore potential residual confounding.

METHODS

We used 20 years (1985-1986, 1992-1993 2005-2006) of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study across four US cities (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; Oakland, California) and instrumental variables (IV) regression to obtain causal estimates of longitudinal associations between the percentage of neighbourhood food outlets (per total food outlets within 1 km network distance of respondent residence) and an a priori diet quality score, with higher scores indicating higher diet quality. To assess the presence and magnitude of bias related to residual confounding, we compared results from causal models (IV regression) to non-causal models, including ordinary least squares regression, which does not account for residual confounding at all and fixed-effects regression, which only controls for time-invariant unmeasured characteristics.

RESULTS

The mean diet quality score across follow-up was 63.4 (SD=12.7). A 10% increase in fast food restaurants (relative to full-service restaurants) was associated with a lower diet quality score over time using IV regression (β=-1.01, 95% CI -1.99 to -0.04); estimates were attenuated using non-causal models. The percentage of neighbourhood convenience and grocery stores (relative to supermarkets) was not associated with diet quality in any model, but estimates from non-causal models were similarly attenuated compared with causal models.

CONCLUSION

Ignoring residual confounding may generate biased estimated effects of neighbourhood food outlets on diet outcomes and may have contributed to weak findings in the food environment literature.

Discrete Choice Model of Food Store Trips Using National Household Food Acquisition and Purchase Survey (FoodAPS)

Where households across income levels shop for food is of central concern within a growing body of research focused on where people live relative to where they shop, what they purchase and eat, and how those choices influence the risk of obesity and chronic disease. We analyzed data from the National Household Food Acquisition and Purchase Survey (FoodAPS) using a conditional logit model to determine where participants shop for food to be prepared and eaten at home and how individual and household characteristics of food shoppers interact with store characteristics and distance from home in determining store choice. Store size, whether or not it was a full-service supermarket, and the driving distance from home to the store constituted the three significant main effects on store choice. Overall, participants were more likely to choose larger stores, conventional supermarkets rather than super-centers and other types of stores, and stores closer to home. Interaction effects show that participants receiving Supplemental Nutrition Assistance Program (SNAP) were even more likely to choose larger stores. Hispanic participants were more likely than non-Hispanics to choose full-service supermarkets while White participants were more likely to travel further than non-Whites. This study demonstrates the value of explicitly spatial discrete choice models and provides evidence of national trends consistent with previous smaller, local studies.

Food Shopping and Acquisition Behaviors in Relation to BMI among Residents of Low-Income Communities in South Carolina

Low-income areas in which residents have poor access to healthy foods have been referred to as "food deserts." It is thought that improving food access may help curb the obesity epidemic. Little is known about where residents of food deserts shop and if shopping habits are associated with body mass index (BMI). We evaluated the association of food shopping and acquisition (e.g., obtaining food from church, food pantries, etc.) with BMI among 459 residents of low-income communities from two South Carolina counties, 81% of whom lived in United States Department of Agriculture-designated food deserts. Participants were interviewed about food shopping and acquisition and perceptions of their food environment, and weight and height were measured. Distances to food retail outlets were determined. Multivariable linear regression analysis was employed. Our study sample comprising largely African-American women had an average BMI of 32.5 kg/m². The vast majority of study participants shopped at supermarkets (61%) or supercenters/warehouse clubs (27%). Shopping at a supercenter or warehouse club as one's primary store was significantly associated with a 2.6 kg/m² higher BMI compared to shopping at a supermarket, independent of demographics, socioeconomics, physical activity, and all other food shopping/acquisition behaviors. Persons who reported shopping at a small grocery store or a convenience or dollar store as their tertiary store had a 2.6 kg/m² lower BMI. Respondents who perceived lack of access to adequate food shopping in their neighborhoods as a problem had higher BMI. Living in a food desert census tract was not significantly associated with BMI. Other shopping attributes, including distance to utilized and nearest grocery stores, were not independently associated with BMI. These findings call into question the idea that poor spatial access to grocery stores is a key underlying factor affecting the obesity epidemic. Future research should consider assessing foods purchased and dietary intake within a comprehensive study of food shopping behaviors and health outcomes among persons living in food deserts.

Is food store type associated with the consumption of ultra-processed food and drink products in Brazil?

Objective

To analyse the association between food store type and the consumption of ultra-processed products in Brazil.

Design

Data from the 2008–2009 Household Budget Survey involving a probabilistic sample of 55 970 Brazilian households. Food stores were grouped into nine categories. Foods and drinks were grouped according to characteristics of food processing. The contribution of each food store type to the total energy acquired from each food processing group, and according to quintiles of consumption of ultra-processed products, was estimated. Exploratory factor analysis was conducted to identify a pattern of food store usage. Linear regression models were performed to estimate the relationship between the purchase pattern and the consumption of ultra-processed products.

Results

In line with their larger market share, supermarkets accounted for 59 % of total energy and participated most in acquisition for three food groups, with emphasis on ultra-processed products (60·4 % of energy). The participation of supermarkets in total purchase tended to increase in populations with higher consumption of ultra-processed products, while the participation of small markets and small producers tended to decrease. The purchase pattern characterized by use of traditional retail (street fairs and vendors, small markets, small farmers, butcheries) was associated with a smaller consumption of ultra-processed products.

Conclusions

Food policies and interventions aiming to reduce the consumption of ultra-processed products should consider the influence of supermarkets on the consumption of these products. A purchase pattern based on traditional retail constitutes an important tool for promoting healthy eating in Brazil.

Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores

Background

Purchases at small/non-traditional food stores tend to have poor nutritional quality, and have been associated with poor health outcomes, including increased obesity risk The purpose of this study was to examine whether customers who shop at small/non-traditional food stores with more health promoting features make healthier purchases.

Methods

In a cross-sectional design, data collectors assessed store features in a sample of 99 small and non-traditional food stores not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Minneapolis/St. Paul, MN in 2014. Customer intercept interviews (n = 594) collected purchase data from a bag check and demographics from a survey. Store measures included fruit/vegetable and whole grain availability, an overall Healthy Food Supply Score (HFSS), healthy food advertisements and in-store placement, and shelf space of key items. Customer nutritional measures were analyzed using Nutrient Databases System for Research (NDSR), and included the purchase of ≥1 serving of fruits/vegetables; ≥1 serving of whole grains; and overall Healthy Eating Index-2010 (HEI-2010) score for foods/beverages purchased. Associations between store and customer measures were estimated in multilevel linear and logistic regression models, controlling for customer characteristics and store type.

Results

Few customers purchased fruits and vegetables (8%) or whole grains (8%). In fully adjusted models, purchase HEI-2010 scores were associated with fruit/vegetable shelf space (p = 0.002) and the ratio of shelf space devoted to healthy vs. less healthy items (p = 0.0002). Offering ≥14 varieties of fruit/vegetables was associated with produce purchases (OR 3.9, 95% CI 1.2–12.3), as was having produce visible from the store entrance (OR 2.3 95% CI 1.0 to 5.8), but whole grain availability measures were not associated with whole grain purchases.

Conclusions

Strategies addressing both customer demand and the availability of healthy food may be necessary to improve customer purchases.

Trial registration

ClinialTrials.gov: NCT02774330. Registered May 4, 2016 (retrospectively registered).

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0531-x) contains supplementary material, which is available to authorized users.

Wistar-Kyoto Female Rats Are More Susceptible to Develop Sugar Binging: A Comparison with Wistar Rats

The hedonic component of the feeding behavior involves the mesolimbic reward system and resembles addictions. Nowadays, the excessive consumption of sucrose is considered addictive. The Wistar-Kyoto (WKY) rat strain is prone to develop anxiety and addiction-like behavior; nevertheless, a lack of information regarding their vulnerability to develop sugar binging-like behavior (SBLB) and how it affects the reward system persist. Therefore, the first aim of the present study was to compare the different predisposition of two rat strains, Wistar (W) and WKY to develop the SBLB in female and male rats. Also, we studied if the SBLB-inducing protocol produces changes in anxiety-like behavior using the plus-maze test (PMT) and, analyzed serotonin (5-HT) and noradrenaline (NA) concentrations in brain areas related to anxiety and ingestive behavior (brain stem, hypothalamus, nucleus accumbens, and amygdala). Finally, we evaluated whether fluoxetine, a drug that has been effective in reducing the binge-eating frequency, body weight, and severity of binge eating disorder, could also block this behavior. Briefly, WKY and W female rats were exposed to 30% sucrose solution (2 h, 3 days/week for 4 weeks), and fed up ad libitum. PMT was performed between the last two test periods. Immediately after the last test where sucrose access was available, rats were decapitated and brain areas extracted for high-performance liquid chromatography analysis. The results showed that both W and WKY female and male rats developed the SBLB. WKY rats consumed more calories and ingested a bigger amount of sucrose solution than their W counterpart. This behavior was reversed by using fluoxetine, rats exposed to the SBLB-inducing protocol presented a rebound effect during the washout period. On female rats, the SBLB-inducing protocol induced changes in NA concentrations on WKY, but not on W rats. No changes were found in 5-HT levels. Finally, animals that developed SBLB showed increased anxiety-like behavior in the PMT. In conclusion, WKY female rats can be considered as a more susceptible rat strain to develop SBLB.

An Innovative Method for Monitoring Food Quality and the Healthfulness of Consumers' Grocery Purchases

This study presents a method laying the groundwork for systematically monitoring food quality and the healthfulness of consumers' point-of-sale grocery purchases. The method automates the process of identifying United States Department of Agriculture (USDA) Food Patterns Equivalent Database (FPED) components of grocery food items. The input to the process is the compact abbreviated descriptions of food items that are similar to those appearing on the point-of-sale sales receipts of most food retailers. The FPED components of grocery food items are identified using Natural Language Processing techniques combined with a collection of food concept maps and relationships that are manually built using the USDA Food and Nutrient Database for Dietary Studies, the USDA National Nutrient Database for Standard Reference, the What We Eat In America food categories, and the hierarchical organization of food items used by many grocery stores. We have established the construct validity of the method using data from the National Health and Nutrition Examination Survey, but further evaluation of validity and reliability will require a large-scale reference standard with known grocery food quality measures. Here we evaluate the method's utility in identifying the FPED components of grocery food items available in a large sample of retail grocery sales data (~190 million transaction records).

Association of a Community Campaign for Better Beverage Choices With Beverage Purchases From Supermarkets

IMPORTANCE

Data are needed to evaluate community interventions to reduce consumption of sugary drinks. Supermarket sales data can be used for this purpose.

OBJECTIVE

To compare beverage sales in Howard County, Maryland (HC), with sales in comparison stores in a contiguous state before and during a 3-year campaign to reduce consumption of sugary beverages.

DESIGN, SETTING, AND PARTIPICANTS

This observational experiment with a control group included 15 HC supermarkets and 17 comparison supermarkets. Weekly beverage sales data at baseline (January 1 to December 31, 2012) and from campaign years 1 to 3 (January 1, 2013, through December 31, 2015) were analyzed. A difference-in-differences (DID) regression compared the volume sales per product per week in the HC and comparison stores, controlling for mean product price, competitor's product price, product size, weekly local temperature, and manufacturer.

EXPOSURES

The campaign message was to reduce consumption of all sugary drinks. Television advertising, digital marketing, direct mail, outdoor advertising, social media, and earned media during the 3-year period created 17 million impressions. Community partners successfully advocated for public policies to encourage healthy beverage consumption in schools, child care, health care, and government settings.

MAIN OUTCOMES AND MEASURES

Sales were tracked of sugary drinks highlighted in the campaign, including regular soda, sports drinks, and fruit drinks. Sales of diet soda and 100% juice were also tracked. Sales data are expressed as mean fluid ounces sold per product, per store, per week.

RESULTS

Regular soda sales in the 15 HC supermarkets decreased (-19.7%) from 2012 through 2015, whereas sales remained stable (0.8%) in the 17 comparison supermarkets (DID adjusted mean, -369 fl oz; 95% CI, -469 to -269 fl oz; P < .01). Fruit drink sales decreased (-15.3%) in HC stores and remained stable (-0.6%) in comparison stores (DID adjusted mean, -342 fl oz; 95% CI, -466 to -220 fl oz; P < .001). Sales of 100% juice decreased more in HC (-15.0%) than comparison (-2.1%) stores (DID mean, -576 fl oz; 95% CI, -776 to -375 fl oz; P < .001). Sales of sports drinks (-86.3 fl oz; 95% CI, -343.6 to 170.9 fl oz) and diet soda (-17.8 in HC stores vs -11.3 in comparison stores; DID adjusted mean, -78.9 fl oz; 95% CI, -182.1 to 24.4 fl oz) decreased in both communities, but the decreases were not significantly different between groups.

CONCLUSIONS AND RELEVANCE

A locally designed, multicomponent campaign to reduce consumption of sugary drinks was associated with an accelerated decrease in sales of regular soda, fruit drinks, and 100% juice. This policy-focused campaign provides a road map for other communities to reduce consumption of sugary drinks.

To what extent do food purchases reflect shoppers' diet quality and nutrient intake?

BACKGROUND

Food purchasing is considered a key mediator between the food environment and eating behavior, and food purchasing patterns are increasingly measured in epidemiologic and intervention studies. However, the extent to which food purchases actually reflect individuals' dietary intake has not been rigorously tested. This study examined cross-sectional agreement between estimates of diet quality and nutrient densities derived from objectively documented household food purchases and those derived from interviewer-administered 24-h diet recalls. A secondary aim was to identify moderator variables associated with attenuated agreement between purchases and dietary intake.

METHODS

Primary household food shoppers (N = 196) collected and annotated receipts for all household food and beverage purchases (16,356 total) over 14 days. Research staff visited participants' homes four times to photograph the packaging and nutrition labels of each purchased item. Three or four multiple-pass 24-h diet recalls were performed within the same 14-d period. Nutrient densities and Healthy Eating Index-2010 (HEI-2010) scores were calculated from both food purchase and diet recall data.

RESULTS

HEI-2010 scores derived from food purchases (median = 60.9, interquartile range 49.1-71.7) showed moderate agreement (ρc = .57, p < .0001) and minimal bias (-2.0) with HEI-2010 scores from 24-h recalls (median = 60.1, interquartile range 50.8-73.9). The degree of observed bias was unrelated to the number of food/beverage purchases reported or participant characteristics such as social desirability, household income, household size, and body mass. Concordance for individual nutrient densities from food purchases and 24-h diet recalls varied widely from ρc = .10 to .61, with the strongest associations observed for fiber (ρc = .61), whole fruit (ρc = .48), and vegetables (ρc = .39).

CONCLUSIONS

Objectively documented household food purchases yield an unbiased and reasonably accurate estimate of overall diet quality as measured through 24-h diet recalls, but are generally less useful for characterizing dietary intake of specific nutrients. Thus, some degree of caution is warranted when interpreting food purchase data as a reflection of diet in epidemiological and clinical research. Future work should examine agreement between food purchases and nutritional biomarkers.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02073643 . Retrospectively registered.

Food and beverage purchases in corner stores, gas-marts, pharmacies and dollar stores

OBJECTIVE

Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type.

DESIGN

Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store.

SETTING

Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA.

SUBJECTS

Customers (n 661) from 105 food retailers.

RESULTS

Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of $US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4.

CONCLUSIONS

Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.

Where people shop is not associated with the nutrient quality of packaged foods for any racial-ethnic group in the United States

BACKGROUND

In the literature, it has been suggested that there are race-ethnic disparities in what Americans eat. In addition, some studies have shown that residents of African American and low-income neighborhoods have less access to grocery stores and supermarkets, which tend to stock healthier foods. However, it is unclear whether differences in food shopping patterns contribute to the poorer nutrient profile of food purchases made by racial-ethnic minorities.

OBJECTIVES

We examined whether the mix of food stores where people shop (i.e., food-shopping patterns) was associated with the nutrient profile of packaged food purchases (PFPs) and the types of foods and beverages purchased, and we determined whether these associations differ across racial-ethnic groups.

DESIGN

We used PFPs by US households (Nielsen National Consumer Panel) from 2007 to 2012 and implemented a cluster analysis to categorize households according to their food-shopping patterns. Longitudinal random-effects linear regression models were used to examine the association between food shopping patterns and the nutrient qualities and types of packaged foods and beverages purchased by race-ethnicity in US households.

RESULTS

Shopping primarily at grocery chains was not associated with a better nutrient profile of household PFPs or the food and beverages that households purchased than was shopping primarily at mass merchandisers (value-oriented stores that sell merchandise lines in multiple departments) or at a combination of large and small stores. These results were consistent across racial-ethnic groups. Regardless of where households shopped, non-Hispanic African American households purchased foods with higher energy, total sugar, and sodium densities than did non-Hispanic white and Hispanic households.

CONCLUSION

Policy initiatives that focus on increasing physical access to stores or helping stores sell healthier products to encourage healthier purchases may be ineffective because other factors may be more important determinants of food and beverage purchases than where people shop or what is available in the store.

Food Costs Are Higher in Counties With Poor Health Rankings

BACKGROUND

Poor dietary habits are associated with higher rates of cardiovascular disease. However, the cost of foods associated with lower risk of cardiovascular disease can be a significant barrier to healthy eating.

OBJECTIVE

The aim of this study is to determine whether food prices per serving differed across Kentucky counties based on health ranking and overall nutritional quality.

METHODS

Fifteen counties were randomly selected based on County Health Ranking. Overall Nutritional Quality Index and cost of 75 foods were assessed in all 15 counties in the same week. A generalized estimating equations model and post hoc analyses were used to assess differences in food cost by nutritional quality and health ranking.

RESULTS

Food prices were significantly less in the most healthy counties compared with the least healthy (Z = 3.8; P < .001; $0.08 per serving). Prices were also significantly higher in least healthy counties (tertile 3) compared with moderately healthy counties (tertile 2) (Z = 2.3; P = .024; $0.05 per serving).

CONCLUSIONS

Disproportionately higher food costs are associated with poor health outcomes in Kentucky counties. Community-based interventions can potentially improve access to affordable healthy foods. Current supplemental nutritional policies do not address disparate food costs. Health professionals should advocate for policy changes that are reflective of these food cost disparities.

Walmart and Other Food Retail Chains: Trends and Disparities in the Nutritional Profile of Packaged Food Purchases

INTRODUCTION

Proliferation of food retail chains has created an environment in which a few food retailers account for the majority of U.S. packaged food purchases (PFPs). Despite the major potential for these food retail chains (FRCs) to impact what U.S. consumers buy and eat, little is known about the nutritional profile of PFPs from these retailers, particularly PFPs from Walmart, the largest U.S. grocer.

METHODS

A data set of household PFPs from Nielsen Homescan was linked to data from the Nutrition Facts Panel (N=164,315), analyzed in 2014. Fixed effects models and inverse probability weights accounting for selectivity of shopping at a retailer were used to examine shifts in nutrient densities and key food groups purchased at Walmart and other FRCs from 2000 to 2013, and whether these changes differed for low-income or racial/ethnic-minority households.

RESULTS

There were substantial declines in energy (-73 kcal/100 g); total sugar (-8 g/100 g); and sodium density (-33 mg/100 g) of Walmart PFPs, coupled with decreases in percentage volume purchased from sweets (-11%); grain-based desserts (-2%); and savory snacks (-3%) and increases in fruits (+3%) and vegetables (+1%). PFPs from other FRCs had a more favorable nutritional profile than Walmart PFPs in 2000, but demonstrated smaller shifts over time. Disparities in the nutritional profile of Walmart PFPs by race/ethnicity but not by income level shrank over time.

CONCLUSIONS

The nutritional profile of Walmart purchases has improved over time and in 2013 was similar to PFPs from other FRCs.

US Household Food Shopping Patterns: Dynamic Shifts Since 2000 And Socioeconomic Predictors

Under the assumption that differential food access might underlie nutritional disparities, programs and policies have focused on the need to build supermarkets in underserved areas, in an effort to improve dietary quality. However, there is limited evidence about which types of stores are used by households of different income levels and differing races/ethnicities. We used cross-sectional cluster analysis to derive shopping patterns from US households' volume food purchases by store from 2000 to 2012. Multinomial logistic regression identified household socioeconomic characteristics that were associated with shopping patterns in 2012. We found three food shopping patterns or clusters: households that primarily shopped at grocery stores, households that primarily shopped at mass merchandisers, and a combination cluster in which households split their purchases among multiple store types. In 2012 we found no income or race/ethnicity differences for the cluster of households that primarily shopped at grocery stores. However, low-income non-Hispanic blacks (versus non-Hispanic whites) had a significantly lower probability of belonging to the mass merchandise cluster. These varied shopping patterns must be considered in future policy initiatives. Furthermore, it is important to continue studying the complex rationales for people's food shopping patterns.