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Kalbus AI, Cornelsen L, Ballatore A, Cummins S. Associations between the neighbourhood food environment and food and drink purchasing in England during lockdown: A repeated cross-sectional analysis. PLoS One 2024; 19:e0305295. [PMID: 39018304 PMCID: PMC11253942 DOI: 10.1371/journal.pone.0305295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/27/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Evidence for the effect of neighbourhood food environment (NFE) exposures on diet in the UK is mixed, potentially due to exposure misclassification. This study used the first national COVID-19 lockdown in England as an opportunity to isolate the independent effects of the NFE exposure on food and drink purchasing, and assessed whether these varied by region. METHODS Transaction-level purchasing data for food and drink items for at-home (1,221 households) and out-of-home consumption (171 individuals) were available from the GB Kantar Fast Moving Consumer Goods Panel for London and the North of England. The study period included 23rd March to 10th May 2020 ('lockdown'), and the same period in 2019 for comparison. NFE exposures included food outlet density and proximity, and NFE composition within a 1 km network buffer around the home. Associations were estimated for both years separately, adjusted for individual and household characteristics, population density and area deprivation. Interaction terms between region and exposures were explored. RESULTS There were no consistent patterns of association between NFE exposures and food and drink purchasing in either time period. In 2019, there was some evidence for a 1.4% decrease in energy purchased from ultra-processed foods for each additional 500 m in the distance to the nearest OOH outlet (IR 0.986, 95% CI 0.977 to 0.995, p = 0.020). In 2020, there was some evidence for a 1.8% reduction in total take-home energy for each additional chain supermarket per km2 in the neighbourhood (IR 0.982, 95% CI 0.969, 0.995, p = 0.045). Region-specific effects were observed in 2019 only. DISCUSSION Findings suggest that the differences in exposure to the NFE may not explain differences in the patterns or healthiness of grocery purchasing. Observed pre-pandemic region-specific effects allude to the importance of geographical context when designing research and policy. Future research may assess associations for those who relied on their NFE during lockdown.
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Affiliation(s)
- Alexandra Irene Kalbus
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrea Ballatore
- Department of Digital Humanities, King’s College London, London, United Kingdom
| | - Steven Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Xue Q, Li X, Ma H, Wang X, Heianza Y, Qi L. Ready-to-Eat Food Environments and Risk of Incident Heart Failure: A Prospective Cohort Study. Circ Heart Fail 2024; 17:e010830. [PMID: 38410999 PMCID: PMC10950530 DOI: 10.1161/circheartfailure.123.010830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/04/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Food environments have been linked to cardiovascular diseases; however, few studies have assessed the relationship between food environments and the risk of heart failure (HF). We aimed to evaluate the association between ready-to-eat food environments and incident HF at an individual level in a large prospective cohort. METHODS Exposure to ready-to-eat food environments, comprising pubs or bars, restaurants or cafeterias, and fast-food outlets, were individually measured as both proximity and density metrics. We also developed a composite ready-to-eat food environment density score by summing the densities of 3 types of food environments. Cox proportional analyses were applied to assess the associations of each single type and the composite food environments with HF risk. RESULTS Closer proximity to and greater density of ready-to-eat food environments, particularly for pubs and bars and fast-food outlets (P<0.05 for both proximity and density metric) were associated with an elevated risk of incident HF. Compared with those with no exposure to composite ready-to-eat food environments, participants in the highest density score category had a 16% (8%-25%; P<0.0001) higher risk of HF. In addition, we found significant interactions of food environments with education, urbanicity, and density of physical activity facilities on HF risk (all Pinteraction<0.05); the ready-to-eat food environments-associated risk of HF was stronger among participants who were poorly educated, living in urban areas, and without physical activity facilities. CONCLUSIONS Exposure to ready-to-eat food environments is associated with a higher risk of incident HF, suggesting the potential importance of minimizing unfavorable food environments in the prevention of HF.
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Affiliation(s)
- Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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Coppell KJ, Keall M, Mandic S. Dietary Pattern Indicators among Healthy and Unhealthy Weight Adolescents Residing in Different Contexts across the Otago Region, New Zealand. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1445. [PMID: 37761405 PMCID: PMC10528431 DOI: 10.3390/children10091445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Reported obesity rates for adolescents in different urban and rural areas are inconsistent. We examined indicators of healthy and unhealthy dietary patterns among 1863 adolescents aged 13-18 years with a healthy or excess body weight attending 23 secondary schools in four different settlement types across the Otago region, New Zealand. An online survey included demographics and dietary behaviours. Height and weight were measured, and body mass index was calculated. New Zealand defined urban and rural settlement types were used. Home addresses determined a small area-level index of deprivation. Data were analysed using Chi-square tests and ANOVA. A logistic model was fitted to estimate adjusted odds ratios of excess weight. The proportion of adolescents with a healthy weight differed (p < 0.001) between the most (64.9%) and least (76.4%) deprived neighbourhood areas. There was only indicative evidence of differences between settlement types (p = 0.087). Sugar-sweetened beverage and fast-food consumption was more frequent in the most deprived areas (p < 0.001), and in urban versus rural settlements (p < 0.001). The most important associations with excess weight were area-level deprivation and ethnicity, but not settlement type. Prioritising socioeconomic factors irrespective of settlement type is necessary when developing interventions to improve dietary patterns and body weight status among adolescents.
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Affiliation(s)
- Kirsten J. Coppell
- Department of Medicine, University of Otago Wellington, Wellington South 6242, New Zealand
- Nelson Marlborough Institute of Technology, Nelson 7010, New Zealand
| | - Michael Keall
- Department of Public Health, University of Otago Wellington, Wellington South 6242, New Zealand;
| | - Sandra Mandic
- School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 0627, New Zealand
- Centre for Sustainability, University of Otago, Dunedin 9054, New Zealand
- AGILE Research Ltd., Wellington 6012, New Zealand
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Kalbus A, Ballatore A, Cornelsen L, Greener R, Cummins S. Associations between area deprivation and changes in the digital food environment during the COVID-19 pandemic: Longitudinal analysis of three online food delivery platforms. Health Place 2023; 80:102976. [PMID: 36758447 PMCID: PMC9899780 DOI: 10.1016/j.healthplace.2023.102976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/09/2023]
Abstract
Online food delivery services facilitate access to unhealthy foods and have proliferated during the COVID-19 pandemic. This study explores associations between neighbourhood deprivation and exposure to online food delivery services and changes in exposure by deprivation during the first year of the pandemic. Data on food outlets delivering to 661 postcode districts in London and the North of England in 2020 and 2021 were collected from three online delivery platforms. The association between area deprivation and overall exposure to online food delivery services was moderated by region, with evidence of a positive relationship between count of outlets and deprivation in the North of England, and a negative relationship in London. There was no association between area deprivation and growth of online food delivery services. Associations between neighbourhood deprivation and exposure to the digital food environment vary geographically. Consequently, policies aimed at the digital food environment need to be tailored to the local context.
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Affiliation(s)
- Alexandra Kalbus
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, United Kingdom.
| | - Andrea Ballatore
- Department of Digital Humanities, King's College London, Strand, London, WC2R 2LS, United Kingdom
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, United Kingdom
| | - Robert Greener
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, United Kingdom
| | - Steven Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, United Kingdom
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Kalbus A, Cornelsen L, Ballatore A, Cummins S. Associations between the food environment and food and drink purchasing using large-scale commercial purchasing data: a cross-sectional study. BMC Public Health 2023; 23:72. [PMID: 36627591 PMCID: PMC9831883 DOI: 10.1186/s12889-022-14537-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/03/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evidence for an association between the local food environment, diet and diet-related disease is mixed, particularly in the UK. One reason may be the use of more distal outcomes such as weight status and cardiovascular disease, rather than more proximal outcomes such as food purchasing. This study explores associations between food environment exposures and food and drink purchasing for at-home and out-of-home (OOH) consumption. METHODS We used item-level food and drink purchase data for London and the North of England, UK, drawn from the 2019 Kantar Fast Moving Consumer Goods panel to assess associations between food environment exposures and household-level take-home grocery (n=2,118) and individual-level out-of-home (n=447) food and drink purchasing. Density, proximity and relative composition measures were created for both supermarkets and OOH outlets (restaurants and takeaways) using a 1 km network buffer around the population-weighted centroid of households' home postcode districts. Associations between food environment exposure measures and frequency of take-home food and drink purchasing, total take-home calories, calories from fruits and vegetables, high fat, salt and sugar products, and ultra-processed foods (UPF), volume of take-home alcoholic beverages, and frequency of OOH purchasing were modelled using negative binomial regression adjusted for area deprivation, population density, and individual and household socio-economic characteristics. RESULTS There was some evidence for an inverse association between distance to OOH food outlets and calories purchased from ultra-processed foods (UPF), with a 500 m increase in distance to the nearest OOH outlet associated with a 1.1% reduction in calories from UPF (IR=0.989, 95%CI 0.982-0.997, p=0.040). There was some evidence for region-specific effects relating to purchased volumes of alcohol. However, there was no evidence for an overall association between food environment exposures and take-home and OOH food and drink purchasing. CONCLUSIONS Despite some evidence for exposure to OOH outlets and UPF purchases, this study finds limited evidence for the impact of the food environment on household food and drink purchasing. Nonetheless, region-specific effects regarding alcohol purchasing indicate the importance of geographical context for research and policy.
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Affiliation(s)
- Alexandra Kalbus
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura Cornelsen
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrea Ballatore
- grid.13097.3c0000 0001 2322 6764Department of Digital Humanities, King’s College London, London, UK
| | - Steven Cummins
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Bonnet C, Détang-Dessendre C, Orozco V, Rouvière E. Spatial spillovers, living environment and obesity in France: Evidence from a spatial econometric framework. Soc Sci Med 2022; 305:114999. [PMID: 35594761 DOI: 10.1016/j.socscimed.2022.114999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/19/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
In 2019, obesity affected 17% of French adults. In this article, we use a unique data set that combines individual-level health and consumption data with living environment data (food, sports and health amenities). We develop a spatial econometric framework to address French health disparities in obesity prevalence across space. We find that regulations on fast food restaurant locations could be a policy instrument to counter the prevalence of obesity. We also establish the existence of spatial spillovers of sports and medical amenities on obesity. This new evidence points to the need to consider a wider context than just the immediate local environment in the fight against the obesity pandemic.
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Affiliation(s)
- Céline Bonnet
- Toulouse School of Economics, INRAE, Université Toulouse Capitole, 1, Esplanade de L'Université, 31080, Toulouse, France.
| | - Cécile Détang-Dessendre
- CESAER, Agrosup Dijon, INRAE, Université Bourgogne-Franche-Comté, 26, Bd Docteur Petitjean, BP 87999, 21079, Dijon Cedex, France.
| | - Valérie Orozco
- Toulouse School of Economics, INRAE, Université Toulouse Capitole, 1, Esplanade de L'Université, 31080, Toulouse, France.
| | - Elodie Rouvière
- SADAPT, AgroParisTech, INRAE, Université Paris Saclay, 16, Rue Claude Bernard, 75231, Paris Cedex 05, France.
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Wali B, Frank LD, Young DR, Meenan RT, Saelens BE, Dickerson JF, Fortmann SP. Causal evaluation of the health effects of light rail line: A Natural Experiment. JOURNAL OF TRANSPORT & HEALTH 2022; 24:101292. [PMID: 35096526 PMCID: PMC8797061 DOI: 10.1016/j.jth.2021.101292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE No research to date has causally linked built environment data with health care costs derived from clinically assessed health outcomes within the framework of longitudinal intervention design. This study examined the impact of light rail transit (LRT) line intervention on health care costs after controlling for mode-specific objectively assessed moderateto-vigorous physical activity (MVPA), participant-level neighborhood environmental measures, demographics, attitudinal predispositions, and residential choices. DATA AND METHODS Based on a natural experiment related to a new LRT line in Portland - 282 individuals divided into treatment and control groups were prospectively followed during the pre- and post-intervention periods. For each individual, we harness high-resolution data on Electronic Medical Record (EMR) based health care costs, mode-specific MVPA, survey-based travel behavior, attitudinal/perception information, and objectively assessed built environment measures. Simulation-assisted longitudinal grouped random parameter models are developed to gain more accurate insights into the effects of LRT line intervention. RESULTS Regarding the "average effect" of the LRT line intervention, no statistically significant reductions in health care costs were observed for the treated individuals over time. However, substantial heterogeneity was observed not only in the magnitude of effects but its direction as well after controlling for the within- and between-individual variations. For a subgroup of treated individuals, the LRT line opening decreased health care costs over time relative to the control group. Further comparative analysis based on the findings of heterogeneity-based models revealed that the effect of LRT intervention for the treated individuals differed by individual characteristics, attitudes/perceptions, and neighborhood level environmental features. CONCLUSIONS The study revealed the presence of significant effect modifiers and distinct subgroup structures in the data related to the effects of LRT line intervention on health care costs. Severe implications of ignoring unobserved heterogeneity are highlighted. Limitations and potential avenues for future research are discussed.
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Affiliation(s)
- Behram Wali
- Urban Design 4 Health, Inc., 24 Jackie Circle East, Rochester, NY 14612
| | - Lawrence D Frank
- Urban Design 4 Health, Inc., 24 Jackie Circle East, Rochester, NY 14612
| | - Deborah R Young
- Division of Behavioral Research, Department of Research & Evaluation Southern California, Kaiser Permanente Research, Pasadena, CA 91101, USA
| | - Richard T Meenan
- Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland, USA
| | - Brian E Saelens
- Seattle Children's Research Institute & The University of Washington, Seattle, WA, USA
| | - John F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland, USA
| | - Stephen P Fortmann
- Science Programs, Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland, USA
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