Measuring local food environments: an overview of available methods and measures

GIS-Based Assessments of Neighborhood Food Environments and Chronic Conditions: An Overview of Methodologies

The industrial revolution and urbanization fundamentally restructured populations' living circumstances, often with poor impacts on health. As an example, unhealthy food establishments may concentrate in some neighborhoods and, mediated by social and commercial drivers, increase local health risks. To understand the connections between neighborhood food environments and public health, researchers often use geographic information systems (GIS) and spatial statistics to analyze place-based evidence, but such tools require careful application and interpretation. In this article, we summarize the factors shaping neighborhood health in relation to local food environments and outline the use of GIS methodologies to assess associations between the two. We provide an overview of available data sources, analytical approaches, and their strengths and weaknesses. We postulate next steps in GIS integration with forecasting, prediction, and simulation measures to frame implications for local health policies.

Designing and Evaluating a Hierarchical Framework for Matching Food Outlets across Multi-sourced Geospatial Datasets: a Case Study of San Diego County

Research on retail food environment (RFE) relies on data availability and accuracy. However, the discrepancies in RFE datasets may lead to imprecision when measuring association with health outcomes. In this research, we present a two-tier hierarchical point of interest (POI) matching framework to compare and triangulate food outlets across multiple geospatial data sources. Two matching parameters were used including the geodesic distance between businesses and the similarity of business names according to Levenshtein distance (LD) and Double Metaphone (DM). Sensitivity analysis was conducted to determine thresholds of matching parameters. Our Tier 1 matching used more restricted parameters to generate high confidence-matched POIs, whereas in Tier 2 we opted for relaxed matching parameters and applied a weighted multi-attribute model on the previously unmatched records. Our case study in San Diego County, California used government, commercial, and crowdsourced data and returned 20.2% matched records from Tier 1 and 18.6% matched from Tier 2. Our manual validation shows a 100% matching rate for Tier 1 and up to 30.6% for Tier 2. Matched and unmatched records from Tier 1 were further analyzed for spatial patterns and categorical differences. Our hierarchical POI matching framework generated highly confident food POIs by conflating datasets and identified some food POIs that are unique to specific data sources. Triangulating RFE data can reduce uncertain and invalid POI listings when representing food environment using multiple data sources. Studies investigating associations between food environment and health outcomes may benefit from improved quality of RFE.

Food in my life: How Australian adolescents perceive and experience their foodscape

Food choice has long been recognized as an interaction between psychological, social, cultural, economic, and biological forces through life course events and experiences. Adolescence is a particularly sensitive life stage during which personal and external environments influence food decisions and attitudes that can have long-term implications. Young people represent future households, yet little is understood about their perspectives on, and experiences of, their foodscape. To address this, a photovoice study with thirty-two students was undertaken at three state high schools with differing foodscapes in South East Queensland (Australia). Adolescent perspectives on foodscapes highlighted the food in front of them (either common or favourite foods), food routines, their emotional relationship with food, and the important role that family has in shaping their relationship with food (in particular mothers). Adolescents demonstrated an astute awareness of healthy/good and unhealthy/bad foods in relation to ingredients, ways of eating and different types of foods. Yet they expressed noticeable confusion on this matter, referring to some foods as "healthy-ish", or describing a "balanced" diet as consuming something healthy followed by something unhealthy. We found that adolescents are inundated by discretionary foods on a daily basis, however, are not particularly cognisant of them. These findings have direct implications for preventative health messages targeting adolescents.

Using Crowdsourced Food Image Data for Assessing Restaurant Nutrition Environment: A Validation Study

Crowdsourced online food images, when combined with food image recognition technologies, have the potential to offer a cost-effective and scalable solution for the assessment of the restaurant nutrition environment. While previous research has explored this approach and validated the accuracy of food image recognition technologies, much remains unknown about the validity of crowdsourced food images as the primary data source for large-scale assessments. In this paper, we collect data from multiple sources and comprehensively examine the validity of using crowdsourced food images for assessing the restaurant nutrition environment in the Greater Hartford region. Our results indicate that while crowdsourced food images are useful in terms of the initial assessment of restaurant nutrition quality and the identification of popular food items, they are subject to selection bias on multiple levels and do not fully represent the restaurant nutrition quality or customers' dietary behaviors. If employed, the food image data must be supplemented with alternative data sources, such as field surveys, store audits, and commercial data, to offer a more representative assessment of the restaurant nutrition environment.

What counts? Adding nuance to retail food environment measurement tools in a Canadian context

OBJECTIVE

Limitations of traditional geospatial measures, like the modified Retail Food Environment Index (mRFEI), are well documented. In response, we aimed to: (1) extend existing food environment measures by inductively developing subcategories to increase the granularity of healthy v. less healthy food retailers; (2) establish replicable coding processes and procedures; and (3) demonstrate how a food retailer codebook and database can be used in healthy public policy advocacy.

DESIGN

We expanded the mRFEI measure such that 'healthy' food retailers included grocery stores, supermarkets, hypermarkets, wholesalers, bulk food stores, produce outlets, butchers, delis, fish and seafood shops, juice/smoothie bars, and fresh and healthy quick-service retailers; and 'less healthy' food retailers included fast-food restaurants, convenience stores, coffee shops, dollar stores, pharmacies, bubble tea restaurants, candy stores, frozen dessert restaurants, bakeries, and food trucks. Based on 2021 government food premise licences, we used geographic information systems software to evaluate spatial accessibility of healthy and less healthy food retailers across census tracts and in proximity to schools, calculating differences between the traditional v. expanded mRFEI.

SETTING

Calgary and Edmonton, Canada.

PARTICIPANTS

N/A.

RESULTS

Of the 10 828 food retailers geocoded, 26 % were included using traditional mRFEI measures, while 53 % were included using our expanded categorisation. Changes in mean mRFEI across census tracts were minimal, but the healthfulness of food environments surrounding schools significantly decreased.

CONCLUSIONS

Overall, we show how our mRFEI adaptation, and transparent reporting on its use, can promote more nuanced and comprehensive food environment assessments to better support local research, policy and practice innovations.

A Cross-Sectional Evaluation of the Food Environment at an Australian University Campus

University food environments have a strong influence on the dietary choices of students and staff. The aim of this study was to assess the food environment at a large university in Sydney, Australia. Data were collected between March and July 2022 from 27 fixed food outlets and 24 vending machines. The healthiness of the food environment was evaluated using the Healthy Food and Drink in NSW Health Facilities for Staff and Visitors Framework (‘Framework’), which assesses food environment parameters including the availability, placement, and promotion of ‘Everyday’ (healthy) and ‘Occasional’ (less healthy) products. Each parameter was evaluated overall and across each food outlet type. Across all outlets, Everyday foods and drinks made up 43.9% of all products. Only two outlets met the Framework’s product availability benchmark of ≥75% Everyday foods and drinks. A total of 43 outlets (84.3%) sold sugary drinks as part of their product range. Occasional products made up 68.4%, 53.3%, and 59.9% of all items for sale at checkout areas, countertops, and eye-level shelves, respectively. Finally, 79.7% of meal deals included Occasional products. Our findings highlight the need to improve the availability, placement, and promotion of foods and drinks sold at a major university campus in Sydney, Australia.

Do products from healthier vending machines on a university campus sell?

ObjectiveThis is a cross-sectional study that compares the sales of "healthy" and "unhealthy" vending machines following the introduction of healthier vending machines on a university campus. Method: Healthy ("green" and "amber" category), competitively priced snacks and beverages in vending machines (n = 4) called Grab Goodness were placed alongside standard vending machines (n = 11). The monthly sales data from all vending machines were captured electronically for 20 months. Results: Assortment of snacks and beverages offered by standard vending machines were of low nutritional quality, with only 16% of all products categorized as "green." The new Grab Goodness machines accounted for 28% of all vending machine purchases over 20 months, and 50% of all products purchased through these machines were "green" category items. Conclusions: The purchases of healthier snack options demonstrate encouraging patterns that support more nutritious and healthy alternatives in vending machines.

Association between neighborhood food environment and dietary diversity score among older people in Beijing, China: A cross-sectional study

Objective

To examine the association between the neighborhood food environment and dietary diversity score (DDS) among elderly people in China.

Methods

Participants were recruited from 12 communities in Beijing, China, in 2019, using a multi-stage stratified random sampling method. Participants (n = 1,764, 730 men) in this study were elderly people aged 65 to 80. A questionnaire survey was used to investigate the intake of various foods in the past 3 days, and their dietary diversity score (DDS) was calculated. Baidu Map Application Programming Interface was used to measure the neighborhood food environments, including the density of and proximity to different food outlets. Adjusted multiple linear regression was performed to estimate the association between the neighborhood food environment and DDS.

Results

A total of 1,800 questionnaires were distributed, and 1,775 questionnaires were returned. The questionnaire response rate was 98.6%. Among them, the number of valid questionnaires was 1,764, and the valid rate was 99.4%. The mean age of the participants was 69.7 ± 4.3, and the average DDS was 7.2 ± 1.4. Among the three types of stores, convenience stores had the best access, followed by greengrocers, and finally supermarkets. Sit-down restaurants had the nearest walking distance, Chinese fast-food restaurants had the largest number, and western fast-food restaurants were the most difficult to access. Better access to supermarkets tended to be associated with higher DDS score within all the buffer zones (250 m buffer zone: β = 0.495, P < 0.001; 500 m buffer zone: β = 0.341, P < 0.001; 800 m buffer zone: β = 0.163, P < 0.001; 1,000 m buffer zone: β = 0.243, P < 0.001). However, greengrocers were negatively associated with DDS score within all the buffer zones (250 m buffer zone: β = −0.475, P < 0.001; 500 m buffer zone: β = −0.161, P < 0.001; 800 m buffer zone: β = −0.090, P < 0.001; 1000 m buffer zone: β = −0.112, P < 0.001). As for convenience stores, we only found significant results within the 250 m buffer zone (β = 0.075, P = 0.002). Among the three types of restaurants, the results were inconsistent within different buffer zones. Sit-down restaurants were negatively associated with DDS score within 250 m buffer zone (β = −0.257, P < 0.001), and positively associated with DDS score within 1,000 m buffer zone (β = 0.018, P < 0.001). Living in areas with more Chinese fast-food restaurants tended to have higher DDS within 250 m buffer zone (β = 0.357, P < 0.001); however, there was a opposite result within 1,000 m buffer zone (β = −0.044, P < 0.001). Better access to western fast-food restaurants tended to be associated with lower DDS score within 500 m buffer zone (β = −0.235, P < 0.001) and higher DDS score within 1,000 m buffer zone (β = 0.189, P < 0.001). There was a negative correlation between the nearest distance to the supermarket and the DDS score (β = −0.002, P < 0.001), and the nearest distance to the greengrocer was directly positively correlated with the DDS score (β = 0.004, P < 0.001).

Conclusion

This study suggests that supermarkets may increase the DDS score among older adults in Beijing, while greengrocers may reduce the DDS score. However, the current results are not strong enough to draw specific conclusions. Policymakers need to rely on more evidence to make specific policy recommendations.

Retail food environment in a Brazilian metropolis over the course of a decade: evidence of restricted availability of healthy foods

OBJECTIVE

To evaluate changes in the retail food environment profile in a Brazilian metropolis over a 10-year period.

DESIGN

An ecological study was conducted in the city of Belo Horizonte, Minas Gerais, Brazil. The addresses of formal food establishments were geocoded and classified according to their sold-food profile. Density changes were analysed according to neighbourhood, population size, income level and geospatial distribution.

SETTING

Totally, 468 neighbourhoods in the city of Belo Horizonte, Minas Gerais, Brazil.

PARTICIPANTS

Totally, 83 752 formal food establishments registered for operation in any one or more of those years: 2008, 2011, 2015 and 2018.

RESULTS

There was an increase in unhealthy establishments (154 %), followed by mixed (51 %) and healthy establishments (32 %), during the period evaluated, in addition to an increase in density according to income categories. There was a higher proportion of unhealthy establishments in relation to healthy establishments, indicating worsening of the community food environment over time.

CONCLUSIONS

Over the course of 10 years, changes in the neighbourhood's food environment were unfavourable for adequate access to healthy foods in lower-income neighbourhoods. The findings reinforce the need for interventions aimed at increasing the availability of businesses that offer healthy food in the city.

Retail food outlets and metabolic syndrome: a systematic review of longitudinal studies

CONTEXT

The community food environment covers the type, quantity, density, location, and access to retail food outlets, and its influence on eating behavior, obesity, and metabolic syndrome has been investigated.

OBJECTIVE

To evaluate the evidence on longitudinal associations between objectively measured retail food outlets and metabolic syndrome components in children, adolescents, and adults.

DATA EXTRACTION

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality and risk of bias were assessed with the Newcastle-Ottawa Scale.

DATA SOURCES

The Scopus, Embase, Web of Science, Scielo, PubMed, MEDLINE, and Lilacs databases were searched without any restriction on publication dates.

DATA ANALYSIS

Of the 18 longitudinal studies included, significant associations were reported in 9 between retail food outlets and metabolic syndrome components in adults (6 positive associations, 2 negative, and 1 both positive and negative), and in 3 studies of children and adolescents (2 negative associations and 1 both positive and negative). Six studies with adults found no association.

CONCLUSION

Limited evidence was found for longitudinal associations between retail food outlets and metabolic syndrome components. In future studies, researchers should consider the use of standardized retail food outlet measurements and accurate analysis to better understand the influence of the community food environment on metabolic syndrome.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no: CRD42020177137.

Large-scale diet tracking data reveal disparate associations between food environment and diet

An unhealthy diet is a major risk factor for chronic diseases including cardiovascular disease, type 2 diabetes, and cancer1-4. Limited access to healthy food options may contribute to unhealthy diets5,6. Studying diets is challenging, typically restricted to small sample sizes, single locations, and non-uniform design across studies, and has led to mixed results on the impact of the food environment7-23. Here we leverage smartphones to track diet health, operationalized through the self-reported consumption of fresh fruits and vegetables, fast food and soda, as well as body-mass index status in a country-wide observational study of 1,164,926 U.S. participants (MyFitnessPal app users) and 2.3 billion food entries to study the independent contributions of fast food and grocery store access, income and education to diet health outcomes. This study constitutes the largest nationwide study examining the relationship between the food environment and diet to date. We find that higher access to grocery stores, lower access to fast food, higher income and college education are independently associated with higher consumption of fresh fruits and vegetables, lower consumption of fast food and soda, and lower likelihood of being affected by overweight and obesity. However, these associations vary significantly across zip codes with predominantly Black, Hispanic or white populations. For instance, high grocery store access has a significantly larger association with higher fruit and vegetable consumption in zip codes with predominantly Hispanic populations (7.4% difference) and Black populations (10.2% difference) in contrast to zip codes with predominantly white populations (1.7% difference). Policy targeted at improving food access, income and education may increase healthy eating, but intervention allocation may need to be optimized for specific subpopulations and locations.

Spatial influence on qualitative food consumption in Colombia

Spatial location is a factor that may facilitate the consumption of processed foods due to the ease of access, especially in highly urbanized, high density populations. This study presents the differences in food consumption in populations with different densities and urban and rural characteristics, and income above and below ten dollars a day. A sample of 2,130 subjects was used from 9 populations that included the Capital of Colombia, outlying medium-sized municipalities, metropolitan-area municipalities and small villages. The results confirm that processed and ultra-processed foods are consumed more in cities and urban areas than in smaller and rural populations, and that there are differences in consumption generated by income.

Recommendations for Assessment of Environmental Exposures in Longitudinal Life Course Studies Such as the National Children's Study

An important step toward understanding the relationship between the environment and child health and development is the comprehensive cataloging of external environmental factors that may modify health and development over the life course. Our understanding of the environmental influences on health is growing increasingly complex. Significant key questions exist as to what genes, environment, and life stage mean to defining normal variations and altered developmental trajectories throughout the life course and also across generations. With the rapid advances in genetic technology came large-scale genomic studies to search for the genetic etiology of complex diseases. While genome-wide association studies (GWAS) have revealed genetic factors and networks that advance our understanding to some extent, it is increasingly recognized that disease causation is largely non-genetic and reflects interactions between an individual's genetic susceptibility and his or her environment. Thus, the full promise of the human genome project to prevent or treat disease and promote good health arguably depends on a commitment to understanding the interactions between our environment and our genetic makeup and requires a design with prospective environmental data collection that considers critical windows of susceptibility that likely correspond to the expression of specific genes and gene pathways. Unlike the genome, which is static, relevant exposures as well as our response to exposures, change over time. This has fostered the complementary concept of the exposome ideally defined as the measure of all exposures of an individual over a lifetime and how those exposures relate to health. The exposome framework considers multiple external exposures (e.g., chemical, social) and behaviors that may modify exposures (e.g., diet), as well as consequences of environmental exposures indexed via biomarkers of physiological response or measures of behavioral response throughout the lifespan. The exposome concept can be applied in prospective developmental studies such as the National Children's Study (NCS) with the practical understanding that even a partial characterization will bring major advances to health. Lessons learned from the NCS provide an important opportunity to inform future studies that can leverage these evolving paradigms in elucidating the role of environment on health across the life course.

Street Food Stand Availability, Density, and Distribution Across Income Levels in Mexico City

Street food stands (SFS) are an understudied element of the food environment. Previous SFS studies have not used a rigorous approach to document the availability, density, and distribution of SFS across neighborhood income levels and points of access in Mexico City. A random sample (n = 761) of street segments representing 20 low-, middle-, and high-income neighborhoods were assessed using geographic information system (GIS) and ground-truthing methods. All three income levels contained SFS. However, SFS availability and density were higher in middle-income neighborhoods. The distribution of SFS showed that SFS were most often found near homes, transportation centers, and worksites. SFS availability near schools may have been limited by local school policies. Additional studies are needed to further document relationships between SFS availability, density, and distribution, and current structures and processes.

'It's Hard to Make Good Choices and It Costs More': Adolescents' Perception of the External School Food Environment

Research on the impact of school and community food environments on adolescent food choice is heavily reliant on objective rather than subjective measures of food outlets around schools and homes. Gaining the perspective of adolescents and how they perceive and use food environments is needed. The aim of this study was to explore adolescent’s perception and use of the food environment surrounding their schools. Purposive sampling was used to recruit schools. Mapping exercises and discussion groups were facilitated with 95 adolescents from six schools. Thematic analysis showed that adolescents are not loyal to particular shops but are attracted to outlets with price discounts, those with ‘deli’ counters and sweets. Cost, convenience and choice are key factors influencing preference for food outlets and foods. Quality, variety and health were important factors for adolescents but these features, especially affordable healthy food, were hard to find. Social factors such as spending time with friends is also an important feature of food environments that deserves further attention. Adolescents’ perceptions of their food environment provide insights into features that can be manipulated to enable healthy choices.

Defining and Developing Measures of Checklist for Measuring Food Store Environment: A Systematic Review

Background:

Food store measurement is important for planners and policy makers to improve unhealthy stores towards healthy stores. This review aimed to outline the concepts and measures development of checklists that assess food store environment in urban communities.

Methods:

The search was carried out in PubMed, Embase, Web of Science and Scopus as well as reference lists of included studies for obtaining published articles between 1990 up to the date of search (30 June 2017). Eligibility criteria attempted to capture peer-reviewed articles aimed at development and validation of checklists for assessing food stores.

Results:

From 3,862 records, 24 studies were included in this review. Findings showed constructs included in the instruments were availability (n=22); price (n=22); quality of fresh foods (n=13); promotion (n=6); product placement (n=6); advertisement (n=5); shelf space (n=3); display (n=3); store features or characteristics (n=2); marketing (n=2); accessibility; nutrition information; visibility; food variety; signage. There are differences on the conceptual definition of each constructs across the checklists. Only half of studies pursued fully systematic steps for the measures development.

Conclusion:

Consensus for definition of constructs of food store measurement is necessary. Besides, the development of the measures of checklists needs to be done by high-quality methods.

Where we eat is who we are: a survey of food-related travel patterns to Singapore's hawker centers, food courts and coffee shops

Background

The development of empirically-grounded policies to change the obesogenic nature of urban environment has been impeded by limited, inconclusive evidence of the link between food environments, dietary behaviors, and health-related outcomes, in part due to inconsistent methods of classifying and analyzing food environments. This study explores how individual and built environment characteristics may be associated with how far and long people travel to food venues,that can serve as a starting point for further policy-oriented research to develop a more nuanced, context-specific delineations of ‘food environments’ in an urban Asian context.

Methods

Five hundred twenty nine diners in eight different neighborhoods in Singapore were surveyed about how far and long they travelled to their meal venues, and by what mode. We then examined how respondents’ food-related travel differed by socioeconomic characteristics, as well as objectively-measured built environment characteristics at travel origin and destination, using linear regression models.

Results

Low-income individuals expended more time traveling to meal destinations than high-income individuals, largely because they utilized slower modes like walking rather than driving. Those travelling from areas with high food outlet density travelled shorter distances and times than those from food-sparse areas, while those seeking meals away from their home and work anchor points had lower thresholds for travel. Respondents also travelled longer distances to food-dense locations, compared to food-sparse locations.

Conclusion

Those seeking to improve food environments of poor individuals should consider studying an intervention radius pegged to typical walking distances, or ways to improve their transport options as a starting point. Policy-focused research on food environments should also be sensitive to locational characteristics, such as food outlet densities and land use.

Association between Neighborhood Food Environment and Body Mass Index among Older Adults in Beijing, China: A Cross-Sectional Study

OBJECTIVE

To investigate the association between the neighborhood food environment and body mass index (BMI) among Chinese older adults.

METHODS

A multi-stage stratified random sampling method was used to recruit participants from 12 communities in Beijing, China, in 2019. Participants (n = 1764, 1034 women) in this study were older adults aged 65 to 80. We collected the participants' basic information, measured their height and weight, and calculated their BMI. Neighborhood food environments were measured by the density of and proximity to different food outlets using the Baidu Map Application Programming Interface. Adjusted multiple linear regression was performed to estimate the association between the food environment and BMI.

RESULTS

Participants had a mean age of 69.7 ± 4.32 years old and an average BMI of 26.3 ± 3.50 kg/m². Among the three types of stores, convenience stores had the easiest access, followed by greengrocers and supermarkets. Sit-down restaurants had the best access among different restaurants, followed by Chinese fast-food restaurants, and western fast-food restaurants had the worst access. Easier access to greengrocers (β = 0.281, p < 0.001) and sit-down restaurants (β = 0.304, p < 0.001) was associated with higher BMI in the 250 m buffer zone. More supermarkets were associated with higher BMI in the 500 m buffer zone (β = 0.593, p < 0.001). Access to convenience stores was positively associated with BMI in the 800 m buffer zone (β = 0.057, p < 0.001). Better access to Chinese fast-food restaurants was associated with higher BMI (β = 0.071, p = 0.001), and better access to western fast- food restaurants was associated with lower BMI (β = -0.400, p < 0.001) in the 1000 m buffer zone. There was a negative association between the nearest distance to greengrocers and BMI (β = -0.004, p < 0.001).

CONCLUSION

Although we found some significant associations between the neighborhood food environment and obesity, the current results are not strong enough to draw specific conclusions. Policymakers will need to rely on more evidence to derive concrete policy recommendations.

Development and pilot of a tool to measure the healthiness of the in-store food environment

Objective:

To rigorously develop a tool which enables rapid yet comprehensive appraisal of the consumer food retail environment and provision of real-time feedback to store managers and owners, based on the ‘4Ps’ principles of marketing.

Design:

Multi-stage iterative approach including (1) Systematic literature review; (2) Stakeholder consultation; (3) Assessment of existing tools against identified needs; (4) Tool development; (5) Pilot testing and (6) Transition of tool to mobile application (the Store Scout app).

Setting:

Northern Territory, Australia.

Participants:

Nine remote Aboriginal community food stores; public health nutritionists, retailers, store board directors, Aboriginal community members, government representatives.

Results:

Forty-seven existing tools and thirty-four stakeholder interviews informed the development of the current instrument, which comprised: (1) seven product categories (Fruit & Vegetables, Drinks, Snack Foods, Meals & Convenience Foods, Meat & Seafood, Dairy & Eggs, Breads & Cereals) across the ‘4Ps’ (Product, Placement, Price, Promotion); (2) Store manager questions about context and perceived importance of key principles about the store environment and (3) a scoring and feedback component. The tool was considered feasible and acceptable by all testers.

Conclusions:

The developed tool addresses an unmet need to measure the consumer food retail environment across all 4Ps whilst also incorporating manager perspectives and immediate feedback. Our objectives of developing a comprehensive, feasible and acceptable instrument were achieved during pilot testing. The tool will support implementation of best practice within stores to encourage healthy food choices and has potential for broad application in retail settings locally and internationally, as well as for research purposes.

Kids in a Candy Store: An Objective Analysis of Children's Interactions with Food in Convenience Stores

Increasing rates of childhood obesity worldwide has focused attention on the obesogenic food environment. This paper reports an analysis of children's interactions with food in convenience stores. Kids'Cam was a cross-sectional study conducted from July 2014 to June 2015 in New Zealand in which 168 randomly selected children aged 11-14 years old wore a wearable camera for a 4-day period. In this ancillary study, images from children who visited a convenience store were manually coded for food and drink availability. Twenty-two percent of children (n = 37) visited convenience stores on 62 occasions during the 4-day data collection period. Noncore items dominated the food and drinks available to children at a rate of 8.3 to 1 (means were 300 noncore and 36 core, respectively). The food and drinks marketed in-store were overwhelmingly noncore and promoted using accessible placement, price offers, product packaging, and signage. Most of the 70 items purchased by children were noncore foods or drinks (94.6%), and all of the purchased food or drink subsequently consumed was noncore. This research highlights convenience stores as a key source of unhealthy food and drink for children, and policies are needed to reduce the role of convenience stores in the obesogenic food environment.

Investigating foods and beverages sold and advertised in deprived urban neighbourhoods in Ghana and Kenya: a cross-sectional study

OBJECTIVES

The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods.

DESIGN

Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability.

SETTING

Three deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya).

MAIN OUTCOME MEASURE

Types of foods and beverages sold and/or advertised.

RESULTS

Jamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets.

CONCLUSION

Our study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.

Google-truthing to assess hot spots of food retail change: A repeat cross-sectional Street View of food environments in the Bronx, New York

Google Street View (GSV) images can be used to "ground-truth" current and historical food retail data from approximately 2007 - when GSV was launched in a few US cities - to the present, facilitating analyses of food environments over time. A review of GSV images of all food retailers listed in a government database of licensed establishments in the Bronx, New York enabled records to be verified, businesses classified, and retail change quantified. The data revealed several trends likely to affect food access and health: increasing overall numbers of food retailers; the growth of dollar stores; and numerous openings, closings, and ownership changes across all food retail segments. Hot spot analysis identified statistically significant clusters of new dollar stores and bodegas, purveyors of less healthy processed foods, in lower-income neighborhoods in the South Bronx that face elevated rates of diet-related diseases. This article demonstrates the benefits and limitations of using GSV to conduct "virtual" food environment research.

Food Environment Typology: Advancing an Expanded Definition, Framework, and Methodological Approach for Improved Characterization of Wild, Cultivated, and Built Food Environments toward Sustainable Diets

The food environment is a critical place in the food system to implement interventions to support sustainable diets and address the global syndemic of obesity, undernutrition, and climate change, because it contains the total scope of options within which consumers make decisions about which foods to acquire and consume. In this paper, we build on existing definitions of the food environment, and provide an expanded definition that includes the parameter of sustainability properties of foods and beverages, in order to integrate linkages between food environments and sustainable diets. We further provide a graphical representation of the food environment using a socio-ecological framework. Next, we provide a typology with descriptions of the different types of food environments that consumers have access to in low-, middle-, and high-income countries including wild, cultivated, and built food environments. We characterize the availability, affordability, convenience, promotion and quality (previously termed desirability), and sustainability properties of food and beverages for each food environment type. Lastly, we identify a methodological approach with potential objective and subjective tools and metrics for measuring the different properties of various types of food environments. The definition, framework, typology, and methodological toolbox presented here are intended to facilitate scholars and practitioners to identify entry points in the food environment for implementing and evaluating interventions that support sustainable diets for enhancing human and planetary health.

Relationship between different levels of the Mexican food environment and dietary intake: a qualitative systematic review

Objective:

To investigate the possible associations between the food environment and dietary intake in the Mexican population.

Design:

Four databases (PubMed, PsychInfo, Web of Science and SCIelo) were used to retrieve relevant articles using an open timeframe. Articles were reviewed if they contained a systematic measure (i.e. food checklist) of the food environment (e.g. food availability) and dietary intake.

Setting:

Urban and rural communities in Mexico.

Participants:

Population-based studies of Mexican communities.

Results:

Twenty studies that assessed at least one food environment level, and at least one dietary outcome, were reviewed. Findings from these studies showed that changes in the Mexican food environment seem to be associated with higher availability of energy-dense foods. Energy-dense foods can be linked to a high consumption in household, environment and community food environments. When both nutrient-dense and energy-dense foods were present, individuals were more likely to consume foods with added sugars, fats and salt options than nutrient-dense items.

Conclusions:

The various levels of the food environment (i.e. household, school, community) exposed participants to energy-dense foods. Although nutrient-dense foods were present in all three levels, individuals were more likely to consume energy-dense food items. Not all three levels of the food environment are well represented in the urban and rural settings. Most studies on the community food environment were done in rural areas, whereas most studies on the school food environment were done in urban settings. Additional rigorously designed studies are needed to document the relationship between the food environment and dietary intake in the Mexican population.

Measurement Methods Used to Assess the School Food Environment: A Systematic Review

Children consume approximately half of their total daily amount of energy at school. Foods consumed are often energy-dense, nutrient-poor. The school food environment represents an effective setting to influence children’s food choices when dietary habits are established and continue to track into adulthood. The aim of this review was to: (1) group methods used for assessing the school food environment according to four food environment dimensions: Physical, economic, socio-cultural and policy and (2) assess the quality of the methods according to four criteria: Comprehensiveness, relevance, generalizability and feasibility. Three databases were searched, and studies were used to assess food and beverages provided at school canteens, tuck shops or cafeterias were included. The review identified 38 global studies (including 49 methods of measuring the food environment). The physical environment was the primary focus for 47% of articles, aspects of policy environment was assessed by 37% articles and a small number of studies assessed the economic (8%) and socio cultural (8%) environment. Three methods were rated ‘high’ quality and seven methods received ‘medium’ quality ratings. The review revealed there are no standardized methods used to measure the school food environment. Robust methods to monitor the school food environment across a range of diverse country contexts is required to provide an understanding of obesogenic school environments.

Snapshots of Urban and Rural Food Environments: EPOCH-Based Mapping in a High-, Middle-, and Low-Income Country from a Non-Communicable Disease Perspective

A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high income), with one matched pair of urban-rural sites per country. Fifty formal and informal food retail outlets were assessed, and descriptive and comparative statistical analyses were performed. We found that formal food retail outlets in these countries had both positive and negative traits, as they were the main source of basic food items but also made unhealthy food items readily available. The Ugandan setting had predominantly informal outlets, while the Swedish setting had primarily formal outlets and South Africa had both, which fits broadly into the traditional (Uganda), mixed (South Africa) and modern (Sweden) conceptualized food systems. The promotion of unhealthy food products was high in all settings. Uganda had the highest in-community advertising, followed by South Africa and Sweden with the lowest, perhaps related to differences in regulation and implementation. The findings speak to the need to address contextual differences in NCD-related health interventions by incorporating strategies that address the food environment, and for a critical look at regulations that tackle key environment-related factors of food on a larger scale.

Impact of Dining Hall Structural Changes on Food Choices: A Pre-Post Observational Study

Change that benefits individuals and organisations while delivering health outcomes and benefits society requires a research focus that extends ‘beyond the individual’ to environment shapers. A pre-post observational study assessed two food provision structural changes to understand the role food service environments had on food selections. Diners were observed prior to (lunch n = 1294; dinner n = 787) and following (lunch n = 1230; dinner n = 843) structural changes in a buffet-style dining room—including provision of a healthy convenient meal alternative for lunch (healthy lunch bag), and a pleasurable dinner (make-your-own pizza). Food choices shifted with 19% of diners opting for a healthy lunch bag and 29% of diners selecting a pizza dinner, moving away from the existing buffet. Examination of selections by those continuing to select from the concurrent buffet selections established that the availability of healthy alternatives in the buffet partially explained food choices, moderating any observed changes in food selections. The food service sector is a promising avenue through which dietary behaviours can be improved. Further studies, particularly those that measure selections over the longer term, and that include measures of satisfaction and profit, are needed.

Obesity and the Built Environment: A Reappraisal

The built environment (BE) has been viewed as an important determinant of health. Numerous studies have linked BE exposure, captured using a variety of methods, to diet quality and to area prevalence of obesity, diabetes, and cardiovascular disease. First-generation studies defined the neighborhood BE as the area around the home. Second-generation studies turned from home-centric to person-centric BE measures, capturing an individual's movements in space and time. Those studies made effective uses of global positioning system tracking devices and mobile phones, sometimes coupled with accelerometers and remote sensors. Activity space metrics explored travel paths, modes, and destinations to assess BE exposure that was both person and context specific. However, as measures of the contextual exposome have become ever more fine-grained and increasingly complex, connections to long-term chronic diseases with complex etiologies, such as obesity, are in danger of being lost. Furthermore, few studies on obesity and the BE have included intermediate energy balance behaviors, such as diet and physical activity, or explored the potential roles of social interactions or psychosocial pathways. Emerging survey-based applications that identify habitual destinations and associated travel patterns may become the third generation of tools to capture health-relevant BE exposures in the long term.

Development of a Teen-Informed Coding Tool to Measure the Power of Food Advertisements

The food-related information environment, comprised of food and beverage advertising within one’s surroundings, is a growing concern for adolescent health given that food marketing disproportionately targets adolescents. Despite strong public interest concerning the effects of food marketing on child health, there is limited evidence focused on outdoor food advertising in relation to teenage diets, food purchasing, and perceptions. Further, limited research has considered both the exposure to and influence of such advertisements. This study used a novel multi-method approach to identify and quantify the features of outdoor food and beverage advertisements that are most effective at drawing teenagers into retail food establishments. An environmental audit of outdoor advertisements and consultations with youth were used to: (1) identify teen-directed food marketing techniques; (2) validate and weigh the power of individual advertising elements; and, (3) develop a teen-informed coding tool to measure the power of food-related advertisements. Results indicate that marketing power is a function of the presence and size of teen-directed advertisement features, and the relative nature of each feature is an important consideration. This study offers a quantitative measurement tool for food environment research and urges policymakers to consider teen-directed marketing when creating healthy communities.

Investigating business outcomes of healthy food retail strategies: A systematic scoping review

Large changes to food retail settings are required to improve population diet. However, limited research has comprehensively considered the business implications of healthy food retail strategies for food retailers. We performed a systematic scoping review to identify types of business outcomes that have been reported in healthy food retail strategy evaluations. Peer-reviewed and grey literature were searched. We identified qualitative or quantitative real-world food or beverage retail strategies designed to improve the healthiness of the consumer nutrition environment (eg, changes to the "marketing mix" of product, price, promotion, and/or placement). Eligible studies reported store- or chain-level outcomes for measures of commercial viability, retailer perspectives, customer perspectives, and/or community outcomes. 11 682 titles and abstracts were screened with 107 studies included for review from 15 countries. Overall item sales, revenue, store patronage, and customer level of satisfaction with strategy were the most frequently examined outcomes. There was a large heterogeneity in outcome measures reported and in favourability for retailers of outcomes across studies. We recommend more consistent reporting of business outcomes and increased development and use of validated and reliable measurement tools. This may help generate more robust research evidence to aid retailers and policymakers to select feasible and sustainable healthy food retail strategies to benefit population health within and across countries.

Measuring Rural Food Environments for Local Action in Australia: A Systematic Critical Synthesis Review

Poor diet is a significant contributor to obesity and chronic disease. With all being more prevalent in rural than urban Australia, modifying the food environment is a potential intervention point to improve the health of rural populations. This review examined the applicability of measurement tools used in rural food environment research for rural Australia. Six electronic databases were searched for peer-reviewed literature, published in English between 2006 and 2018, including at least one objective measure of the Community or Consumer Food Environment in a rural or mixed rural/urban context. One-hundred and seventy-seven papers were returned after removal of duplicates, with a final review of 25. Most studies were cross-sectional, with one intervention study of quasi-experimental design. Nine studies employed a conceptual model; there was considerable variability in tools used; and few described psychometric testing. The most common attribute measured was price, followed by available healthy options. The findings of this review do not offer a suite of ‘gold standard’ measurement tools known to be reliable, valid and sensitive to change to assess the community or consumer food environments in rural Australian towns. However, recommendations are proposed to progress this important area of research within a rural context.

Exploring University Food Environment and On-Campus Food Purchasing Behaviors, Preferences, and Opinions

OBJECTIVE

Cross-sectional observation of a university food environment and a survey of food purchasing preferences, behaviors, and opinions of students and staff to formulate strategies for interventions.

DESIGN

A modified food environment-quality index was used to assess food outlets. A cross-sectional survey with closed (n = 42) and open-ended (n = 2) questions assessing students and staff purchasing, choice determinants, and opinions about the food environment.

SETTING

Six campuses of 1 large urban university.

PARTICIPANTS

Food outlets (eg, convenience stores, restaurant and café, takeout, vending machines) (n = 57). University students and staff (n = 1,954).

ANALYSIS

The researchers calculated descriptive statistics and Pearson chi-square tests to compare the percentages of healthy and/or unhealthy products in high- vs low-scoring outlets. Kruskal-Wallis H test was used to determine differences in healthiness between outlet types. Pearson chi-square tests were used to examine the influence of gender, and student and staff differences in survey responses.

RESULTS

Median food environment-quality index was 79 out of 199 (interquartile range = 7). Six food outlets were categorized as healthy and 2 as unhealthy; the rest were intermediate. Overall, healthy items were less available, accessible, and promoted and cost more than unhealthy items. The majority of respondents in the survey (79%) purchased food and beverages on campus; males consuming them more frequently than did females (P = .001) and students consumed them more frequently than did staff (P = .001). Value for money, healthfulness, and taste determined the choice. Respondents suggested increasing value for money and healthy options.

CONCLUSIONS AND IMPLICATIONS

Interventions that improve food availability, accessibility, prices, and promotions through policies are warranted and would be well-received among both university students and staff.

Issues in Measuring the Healthiness of Food Environments and Interpreting Relationships with Diet, Obesity and Related Health Outcomes

PURPOSE OF REVIEW

There is a broad consensus that policies to create healthier food environments are needed to address obesity. However, previous reviews of the relationships between the healthiness of food environments and diet/obesity-related outcomes have typically reported either mixed associations or none at all. This paper aimed to synthesise measurement and interpretation issues in this field, based on findings from previous reviews.

RECENT FINDINGS

Key issues, drawn from 14 previous reviews in the last decade, included: (1) the use of measures of the food environments that are too narrow in scope; (2) inadequate measures of the way in which people are exposed to, and interact with, food environments; and (3) large heterogeneity in tools and methods used. To evaluate the impact of food environments on diet and health, composite measures of the healthiness of food environments, informed by actual usage patterns, need to be developed and consistently applied.

Describing Food and Beverage Restaurants: Creating A Reliable Coding Tool

Objective

To develop an informed, reliable data collection tool to code restaurants found within the youth food environment.

Methods

Registered Dietitians were surveyed and academic literature review was reviewed to determine health centric food environment features. Features were incorporated into an electronic data collection tool. Inter-rater reliability was tested across coders of varying nutrition training on all restaurants located within a half-mile of three high schools.

Results

Sixteen restaurant food environment codes were generated. Data collection had a mean inter-rater reliability of 90.7% agreement (range=81.3-100%), suggesting that regardless of nutrition training, the restaurant food environment can be reliability coded.

Conclusions

Academic and public health professionals can use this tool to collect reliable, informed local restaurant food environment data.

Development and Validation of a Simple Convenience Store SHELF Audit

Background This paper describes the development, reliability, and convergent validity of a practical tool—the Convenience Store Supportive Healthy Environment for Life-Promoting Food (SHELF) Audit. Methods Audit items included: a variety of fresh, processed, and frozen fruits and vegetables; low-fat dairy products; healthy staples and frozen meals; healthy food incentive programs; items sold in check-out areas; portion/cup sizes; and pricing. Each audit item was scored using a five-point semantic-differential scale (1 = provides little or no support for healthful foods to 5 = provides high support for healthful foods). Convergent validity was examined by comparing the SHELF audit to Ghirardelli et al. and Laska et al. store audits. Statistical analysis included: Factor analysis, ANOVA, and Spearman correlations. Results SHELF included three factors: a Fruits/Vegetables scale (eight items, α = 0.79; total potential points = 34); a Healthy Foods scale (four items, α = 0.72; total potential points = 16); and a Supports scale (four items, α = 0.685; total potential points = 16). Only 6% of the 124 convenience stores assessed scored in the most healthful range (46–66). The assessed drug stores (n = 15) scored higher than convenience stores (n = 81) on the Healthy Foods and Supports scales but not the Fruits/Vegetables scale. The SHELF sub-scores were highly correlated with other audit tools indicating convergent validity. Conclusion The SHELF convenience store audit is a valid, reliable tool for assessing the degree to which convenience stores support healthfulness regarding Fruits/Vegetables, Healthy Foods, and Supports for choosing healthy.

Food environments and dietary intakes among adults: does the type of spatial exposure measurement matter? A systematic review

BACKGROUND

The relationships between food environments and dietary intake have been assessed via a range of methodologically diverse measures of spatial exposure to food outlets, resulting in a largely inconclusive body of evidence, limiting informed policy intervention.

OBJECTIVE

This systematic review aims to evaluate the influence of methodological choice on study outcomes by examining the within-study effect of availability (e.g., counts) versus accessibility (e.g., proximity) spatial exposure measures on associations with diet.

METHODS

(PROSPERO registration: CRD42018085250). PubMed, Web of Science, Scopus and ScienceDirect databases were searched for empirical studies from 1980 to 2017, in the English language, involving adults and reporting on the statistical association between a dietary outcome and spatial exposure measures of both availability and accessibility. Studies were appraised using an eight-point quality criteria with a narrative synthesis of results.

RESULTS

A total of 205 associations and 44 relationships (i.e., multiple measures of spatial exposure relating to a particular food outlet type and dietary outcome) were extracted from 14 eligible articles. Comparative measures were dominated by counts (availability) and proximity (accessibility). Few studies compared more complex measures and all counts were derived from place-based measures of exposure. Sixteen of the 44 relationships had a significant effect involving an availability measure whilst only 8 had a significant effect from an accessibility measure. The largest effect sizes in relationships were mostly for availability measures. After stratification by scale, availability measure had the greatest effect size in 139 of the 176 pairwise comparisons. Of the 33% (68/205) of associations that reached significance, 53/68 (78%) were from availability measures. There was no relationship between study quality and reported study outcomes.

CONCLUSIONS

The limited evidence suggests that availability measures may produce significant and greater effect sizes than accessibility measures. However, both availability and accessibility measures may be important concepts of spatial exposure depending on the food outlet type and dietary outcome examined. More studies reporting on multi-method effects are required to differentiate findings by the type of spatial exposure assessment and build an evidence base regarding the appropriateness and robustness of measures under different circumstances.

Healthiness of Food and Beverages for Sale at Two Public Hospitals in New South Wales, Australia

(1) Background: Our aim was to conduct objective, baseline food environment audits of two major western Sydney public hospitals and compare them to recently revised state nutritional guidelines. (2) Methods: A cross-sectional assessment was conducted (June-July2017) across 14 fixed food outlets and 70 vending machines in two hospitals using an audit tool designed to assess the guideline's key food environment parameters of availability, placement, and promotion of 'Everyday' (healthy) and 'Occasional' (less healthy) products. (3) Results: Availability: Overall, Everyday products made up 51% and 44% of all products available at the two hospitals. Only 1/14(7%) fixed outlets and 16/70(23%) vending machines met the guideline's availability benchmarks of ≥75% Everyday food and beverages. Proportion of Everyday products differed among different types of food outlets (café, cafeteria, convenience stores). Placement: On average, food outlets did not meet recommendations of limiting Occasional products in prominent positions, with checkout areas and countertops displaying over 60% Occasional items. Promotion: Over two-thirds of meal deals at both hospitals included Occasional products. (4) Conclusion: Baseline audit results show that substantial improvements in availability, placement, and promotion can be made at these public hospitals to meet the nutrition guidelines. Audits of other NSW hospitals using the developed tool are needed to investigate similarities and differences in food environment between sites. These findings highlight the need for ongoing tracking to inform whether the revised guidelines are leading to improved food environments in health facilities.

Mobile produce market influences access to fruits and vegetables in an urban environment

Objective

To assess the influence of a mobile produce market (MPM) on fruit and vegetable access.

Design

Novel application of a structured assessment (five dimensions of access framework) to examine fruit and vegetable access through self-administered surveys on shopping behaviours, and perceptions and experiences of shopping at the MPM.

Setting

Low-income neighbourhoods with limited access to fruits and vegetables.

Subjects

Older (≥60 years) and younger (18–59·9 years) shoppers.

Results

Participants were more likely to be women and non-White, one-third lived alone and nearly half were older adults. Compared with younger, older participants had different shopping behaviours: tended to purchase food for one person (P < 0·001), be long-term shoppers (P=0·002) and use electronic benefit transfer (EBT) cards (P=0·012). Older adults were more likely to like the market location (P=0·03), while younger adults were more likely to want changes in location (P=0·04), more activities (P=0·04), taste sampling (P=0·05) and nutritional counselling (P=0·01). The MPM captured all dimensions of access: availability, indicated by satisfaction with the produce variety for nearly one-third of all participants; accessibility, indicated by participants travelling <1 mile (<1·6 km; 72·2 %) and appreciation of location (72·7 %); affordability, indicated by satisfaction with price (47·6 %); acceptability, indicated by appreciation of produce quality (46·2 %); and accommodation, indicated by satisfaction with safety of location (30·1 %) and high EBT use among older adults (41·8 %).

Conclusions

MPM may influence fruit and vegetable access in low-income urban neighbourhoods by facilitating the five dimensions of access and may especially benefit older adults and individuals living alone.

Food environments of young people: linking individual behaviour to environmental context

Background

We aimed to identify and characterize the food environments from which young people obtain food and to explore associations between the type of food environment and food intakes.

Methods

Young people (n = 86, mean age 17 years; combined data of two sequential pilot studies (collected in 2008-09) and a study conducted in 2011-12) recorded in 4-day self-complete food diaries what food they consumed and where food was sourced. Nutrient, fruit and vegetable intake was calculated according to the source of food, categorized using a food environment classification tool.

Results

Over 4 days, respondents sourced food from an average of 4.3 different food environments. Home food was used daily and was more favourable in terms of nutrient profile than out-of-home food. Food sourced from specialist outlets, convenience stores and retail bakers had the highest energy density. Food from retail bakers and 'takeaway and fast food' outlets were the richest sources of fat while vending machines and convenience stores had the highest percentage of energy from sugar.

Conclusions

This work provides details of 'where' young people obtain food and the nutritional consequences of choosing those food environments. While home food was a significant contributor to total dietary intake, food was obtained from a broad range of environments; particularly takeaway, fast food and education establishments.

Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States

This paper investigates the effect of food environments, characterized as food swamps, on adult obesity rates. Food swamps have been described as areas with a high-density of establishments selling high-calorie fast food and junk food, relative to healthier food options. This study examines multiple ways of categorizing food environments as food swamps and food deserts, including alternate versions of the Retail Food Environment Index. We merged food outlet, sociodemographic and obesity data from the United States Department of Agriculture (USDA) Food Environment Atlas, the American Community Survey, and a commercial street reference dataset. We employed an instrumental variables (IV) strategy to correct for the endogeneity of food environments (i.e., that individuals self-select into neighborhoods and may consider food availability in their decision). Our results suggest that the presence of a food swamp is a stronger predictor of obesity rates than the absence of full-service grocery stores. We found, even after controlling for food desert effects, food swamps have a positive, statistically significant effect on adult obesity rates. All three food swamp measures indicated the same positive association, but reflected different magnitudes of the food swamp effect on rates of adult obesity (p values ranged from 0.00 to 0.16). Our adjustment for reverse causality, using an IV approach, revealed a stronger effect of food swamps than would have been obtained by naïve ordinary least squares (OLS) estimates. The food swamp effect was stronger in counties with greater income inequality (p < 0.05) and where residents are less mobile (p < 0.01). Based on these findings, local government policies such as zoning laws simultaneously restricting access to unhealthy food outlets and incentivizing healthy food retailers to locate in underserved neighborhoods warrant consideration as strategies to increase health equity.

Is Living near Healthier Food Stores Associated with Better Food Intake in Regional Australia?

High prevalence of obesity and non-communicable diseases is a global public health problem, in which the quality of food environments is thought to play an important role. Current scientific evidence is not consistent regarding the impact of food environments on diet. The relationship between local food environments and diet quality was assessed across 10 Australian suburbs, using Australian-based indices devised to measure the two parameters. Data of dietary habits from the participants was gathered using a short questionnaire. The suburbs' Food Environment Score (higher being healthier) was associated with higher consumption of fruit (χ² (40, 230) = 58.8, p = 0.04), and vegetables (χ² (40, 230) = 81.3, p = 0.03). The Food Environment Score identified a significant positive correlation with four of the diet scores: individual total diet score (r_s = 0.30, p < 0.01), fruit and vegetable score (r_s = 0.43, p < 0.01), sugary drink score (r_s = 0.13, p < 0.05), and discretionary food score (r_s = 0.15, p < 0.05). Moreover, the suburbs' RFEI (Retail Food Environment Index, higher being unhealthier) showed a significant association with higher consumption of salty snacks (χ² (24, 230) = 43.9, p = 0.04). Food environments dominated by food outlets considered as 'healthier' were associated with healthier population food intakes, as indicated by a higher consumption of fruit, vegetables, and water, as well as a lower consumption of junk food, salty snacks, and sugary drinks. This association suggests that healthier diet quality is associated with healthier food environments in regional Australia.

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.

Geographic and socioeconomic distribution of food vendors: a case study of a municipality in the Southern Brazil

Abstract: The objective of this study was to identify the food vendor distribution profile of the city of Florianópolis, Santa Catarina State, Brazil, and investigate its association with the socioeconomic and demographic characteristics of different municipal regions. This descriptive, cross-sectional study obtained the location of food vendors from secondary data from different institutional sources. The density of different types of food vendors per 1,000 inhabitants in each municipal weighted area was calculated. The Kruskal-Wallis test compared the mean density of food vendors and the weighted income areas. The lowest-income regions had the lowest density of butchers, snack bars, supermarkets, bakeries/pastry shops, natural product stores, juice bars, and convenience stores. The identification of these areas may encourage the creation of public policies that facilitate healthy food startups and/or maintenance of healthy food vendors, especially in the lowest-income regions.