Food deserts in Leon County, FL: disparate distribution of Supplemental Nutrition Assistance Program-accepting stores by neighborhood characteristics

African Americans' perceptions of nutrition interventions: a scoping review

Nutrition education and policy, systems and environmental (PSE) change interventions may be able to address food insecurity and obesity, conditions which are disproportionately experienced by African Americans. Work that seeks to address these disparities and advance social justice should uplift and learn from participant voices, particularly from marginalised groups. This scoping review aimed to summarise the available literature describing African Americans' perceptions of and experiences participating in nutrition interventions. We conducted an electronic literature search with the assistance of a research librarian which encompassed six databases (MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX and ProQuest Dissertations & Theses) and identified thirty-five sources meeting our inclusion criteria. The majority of studies assessing African Americans' satisfaction with interventions examined educational interventions alone, and about half of the included studies assessed satisfaction through quantitative methods alone. The only studies which found participants to be dissatisfied with interventions used qualitative methods and examined interventions providing education alone. Future work should evaluate African Americans' experience with nutrition-focused PSE changes, interventions which may be better able to address racial disparities in obesity and food insecurity. Nutrition educators working with African Americans should also consider evaluating future interventions using qualitative inquiry, to obtain an in-depth understanding of participant experiences with interventions.

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

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

Supplemental Nutrition Assistance Program as a health intervention

PURPOSE OF REVIEW

In 2020, obesity prevalence among US children reached 19.7%, impacting about 14.7 million children and adolescents. Food insecurity among children is also a public health concern but has largely decreased or remained stable over the past decade, reaching 6.2% of US households with children in 2021. Given food insecurity and obesity's interconnected nature and their negative consequences on children's health, it is of interest to assess the Supplemental Nutrition Assistance Program's (SNAP's) impact on childhood food security, dietary quality, disease risk, and health outcomes.

RECENT FINDINGS

Evidence suggests that SNAP participants, including children, struggle to meet key dietary guidelines and perform poorly on key health indicators when compared with income-eligible and higher income nonparticipants. Children participating in SNAP were more likely to have elevated disease risk and consume more sugar-sweetened beverages (SSBs), more high-fat dairy, and more processed meats than income-eligible nonparticipants. However, research suggests that federal food assistance programs with more stringent nutrition standards - the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the National School Lunch Program (NSLP) and School Breakfast Program (SBP) - improve dietary quality, increase birth weight and gestation periods, and reduce childhood obesity, infant mortality and healthcare costs.

SUMMARY

After reviewing the evidence on SNAP's impacts on food insecurity, dietary quality, and health as well as research on the health impacts of other more successful federal food assistance programs, we provide three policy recommendations to strengthen SNAP's effectiveness as a health intervention for children and families.

Fruit and Vegetable Incentive Programs for Supplemental Nutrition Assistance Program (SNAP) Participants: A Scoping Review of Program Structure

The low intake of fruits/vegetables (FV) by Supplemental Nutrition Assistance Program (SNAP) participants is a persistent public health challenge. Fruit and vegetable incentive programs use inducements to encourage FV purchases. The purpose of this scoping review is to identify structural factors in FV incentive programs that may impact program effectiveness, including (i.) differences in recruitment/eligibility, (ii.) incentive delivery and timing, (iii.) incentive value, (iv.) eligible foods, and (v.) retail venue. Additionally, the FV incentive program impact on FV purchase and/or consumption is summarized. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, a search of four bibliographic databases resulted in the identification of 45 publications for consideration; 19 of which met the pre-determined inclusion criteria for full-length publications employing a quasi-experimental design and focused on verified, current SNAP participants. The data capturing study objective, study design, sample size, incentive program structure characteristics (participant eligibility and recruitment, delivery and timing of incentive, foods eligible for incentive redemption, type of retail venue), and study outcomes related to FV purchases/consumption were entered in a standardized chart. Eleven of the 19 studies had enrollment processes to receive the incentive, and most studies (17/19) provided the incentive in the form of a token, coupon, or voucher. The value of the incentives varied, but was usually offered as a match. Incentives were typically redeemable only for FV, although three studies required an FV purchase to trigger the delivery of an incentive for any SNAP-eligible food. Finally, most studies (16/19) were conducted at farmers’ markets. Eighteen of the 19 studies reported a positive impact on participant purchase and/or consumption of FV. Overall, this scoping review provides insights intended to inform the design, implementation, and evaluation of future FV incentive programs targeting SNAP participants; and demonstrates the potential effectiveness of FV incentive programs for increasing FV purchase and consumption among vulnerable populations.

A Geospatial Analysis of Access to Ethnic Food Retailers in Two Michigan Cities: Investigating the Importance of Outlet Type within Active Travel Neighborhoods

To date, the research that examines food accessibility has tended to ignore ethnic food outlets. This void leaves us with a limited understanding of how such food stores may, or may not, impact food security. The study discussed herein addressed this by conducting a geospatial assessment of ethnic food outlet accessibility in two U.S. cities: Flint and Grand Rapids, Michigan. We used Geographic Information Systems (GIS) tools to create a revealed accessibility index for each food outlet, and used the index to determine access within active travel service areas. We utilized an ordinary least squares regression (OLS), and two local models: spatial autoregression (SAR) and geographically weighted regression (GWR) to enhance our understanding of global and localized relationships between outlet accessibility and type (while controlling for known covariates). The results show that the local models outperformed (R² max = 0.938) the OLS model. The study found that there was reduced access to ethnic restaurants in all service areas of Grand Rapids. However, in Flint, we observed this association in the bicycling areas only. Also notable were the influences that demographic characteristics had on access in each city. Ultimately, the findings tell us that nuanced planning and policy approaches are needed in order to promote greater access to ethnic food outlets and reduce overall food insecurity.

Effect of Change in the Supplemental Nutrition Assistance Program Guidelines on Vendor Participation and Availability of Fresh Produce

Introduction

In January 2018, new vendor eligibility standards for the Supplemental Nutrition Assistance Program (SNAP) were fully implemented to increase availability of healthy staple and perishable foods. We examined changes in SNAP vendor participation and availability of fresh fruits and vegetables (FFV) both short-term (2015 vs 2018) and long term (2003 vs 2018) in an urban, low-income community.

Methods

We conducted food store assessments from late June through early September of 2003, 2009, 2012, 2015, and 2018 in Albany, New York. SNAP status was assessed by using the US Department of Agriculture’s list of SNAP-authorized stores and in-store verification.

Results

Numbers of SNAP vendors were 77 in 2003, 92 in 2009, 103 in 2012, 115 in 2015, and 109 in 2018. We observed a marginally significant (P = .049) short-term (2015, 85.9% vs 2018, 73.9%) decline in SNAP participation among convenience stores but no significant short-term changes in FFV availability among either SNAP or non-SNAP vendors. In long-term (2003 through 2018) trends, we found significant (P < .01) increases in SNAP participation among farmers markets and nonprofit organizations. The proportion of SNAP vendors stocking only 1 type of FFV also significantly increased, which was likely related to a consumer trend of favoring bananas as a grab-and-go snack.

Conclusion

Despite the decline of SNAP participation among convenience stores, which primarily came from increased program withdrawals, the new SNAP rule did not substantially alter FFV availability after 6 to 8 months of its full implementation. Long term, policy efforts increased SNAP participation among farmers markets.

Accessibility Landscapes of Supplemental Nutrition Assistance Program-Authorized Stores

BACKGROUND

The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program in the United States. Participants receive electronic benefits that are redeemable at a variety of food stores. Previous research notes that low-income neighborhoods often lack supermarkets with high-quality, affordable food.

OBJECTIVE

The first aim of this study was to explore the number and spatial distribution of SNAP stores by type and to assess how SNAP benefit redemption is linked to store type in North Carolina in 2015. The second aim was to compare the demographics of populations living in areas with a high concentration of SNAP participants vs areas with a lower concentration of SNAP participants. The third aim was to test for disparities in the availability of and access to SNAP-authorized stores in areas with high vs low concentration of SNAP participants stratified by rural/urban status.

DESIGN

US Department of Agriculture and US Census data were used to explore the spatial distribution of SNAP stores at the census block group level utilizing a Geographic Information System.

PARTICIPANTS

The 9,556 North Carolina SNAP stores in 2015 categorized into full-variety and limited-variety stores.

OUTCOME MEASURES

Proximity to limited-variety SNAP food stores and full-variety SNAP food stores within access range (1 mile in urban areas and 10 miles in rural areas).

STATISTICAL ANALYSES

Wilcoxon rank sum and χ² tests are used to compare the distance to and concentration of SNAP stores by rurality and SNAP participant concentration at census block group scale.

RESULTS

Among the SNAP stores in North Carolina, 83% are limited-variety stores and 17% are full-variety stores. There are disparities in the demographics of individuals living in census block groups with a high proportion of SNAP participants compared to census block groups with a lower proportion of SNAP participants. More households in higher SNAP participant census block groups were non-white, did not have a car, and had children compared to census block groups with lower SNAP participation. Residents in high SNAP participant census block groups typically had access to 0 full-variety stores and 4 limited-variety stores in urban areas and 3 full-variety stores and 17 limited-variety stores in rural areas.

CONCLUSIONS

SNAP participant access to a variety of stores should be considered when approving food stores for SNAP authorization. More research is essential to disentangle the relationship between access to SNAP store type and SNAP food choice and to estimate geographical disparities.

Foods and Beverages Available at SNAP-Authorized Drugstores in Sections of North Carolina

OBJECTIVE

To assess healthy food availability in Supplemental Nutrition Assistance Program-authorized drugstores by store chain and neighborhood income level in 3 regions of North Carolina.

DESIGN

Cross-sectional, descriptive study.

SETTING

Twenty-five counties in North Carolina.

PARTICIPANTS

A total of 108 drugstores (36 CVS Health, 36 Rite Aid, and 36 Walgreens).

MAIN OUTCOME MEASURE(S)

Fifty foods and beverages offered at drugstores, categorized as healthier and less healthy.

ANALYSIS

Kruskal-Wallis tests were used to test differences in the availability of foods and beverages by chain and neighborhood income.

RESULTS

Of the 50 foods/beverages observed, 11 were available at all drugstores. Three of the 36 (8%) healthier items were available at all stores (100% fruit juice, water, and high-fiber cereal) whereas 8 of the 14 less healthy items (57%) were available at all stores (chips, sports drinks, energy drinks, regular soda, diet soda, sugar-sweetened beverages, beer, and wine). Only 3% of drugstores offered fresh vegetables and 4% offered fresh fruits. Less than 20% offered frozen chicken or beef. For 36 healthier foods, 11 differed by chain (28%); for less healthy foods 2 of 14 differed by chain (7%). Foods and beverages offered did not vary by neighborhood income.

CONCLUSIONS AND IMPLICATIONS

Although drugstores offer some healthier items, few offer fresh produce. As the drugstore industry changes, it is important for the nutrition community to study the impact of these changes on food purchasing behavior and ultimately health.

Shopping pattern and food purchase differences among Supplemental Nutrition Assistance Program (SNAP) households and Non-supplemental Nutrition Assistance Program households in the United States

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SNAP households are influenced by proximity to stores in predicting store choice.

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Store choice among SNAP households predicted beverage purchases.

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SNAP households are more likely to purchase sugar-sweetened beverages at supercenters and convenience stores.

The unhealthy food environment does not modify the association between obesity and participation in the Supplemental Nutrition Assistance Program (SNAP) in Los Angeles County

BACKGROUND

Participation in the Supplemental Nutrition Assistance Program (SNAP) has been linked to an increased risk of obesity, but not much is known about the mechanisms behind this association. The objective of this study was to determine if the neighborhood density of unhealthy food outlets modifies the association between obesity and participation in SNAP.

METHODS

Data comes from the first wave of the Los Angeles Family and Neighborhood Survey; included are a subsample of adults (18+ years) who were SNAP participants or eligible non-participants (N = 1,176). We carried out multilevel analyses with obesity (BMI ≥ 30 Kg/m2), SNAP participation, and the neighborhood density of unhealthy food outlets as dependent, independent and modifying variables, respectively, controlling for age, gender, race/ethnicity, marital status, working status, mental health, and neighborhood poverty.

RESULTS

SNAP participants had double the odds of obesity compared to eligible non-participants (OR = 2.02; 95%CI = 1.44-2.83). However, the neighborhood density of unhealthy food outlets did not modify this association.

CONCLUSIONS

SNAP participation was associated with higher odds of obesity in our primarily Hispanic sample in Los Angeles County, with no effect modification found for the unhealthy portion of the food environment. More research is needed with additional food environment measures to confirm our null findings. Additional research is needed to elucidate the mechanisms linking SNAP participation and obesity as they remain unclear.

Statistical Approaches Used to Assess the Equity of Access to Food Outlets: A Systematic Review

Background

Inequalities in eating behaviours are often linked to the types of food retailers accessible in neighbourhood environments. Numerous studies have aimed to identify if access to healthy and unhealthy food retailers is socioeconomically patterned across neighbourhoods, and thus a potential risk factor for dietary inequalities. Existing reviews have examined differences between methodologies, particularly focussing on neighbourhood and food outlet access measure definitions. However, no review has informatively discussed the suitability of the statistical methodologies employed; a key issue determining the validity of study findings. Our aim was to examine the suitability of statistical approaches adopted in these analyses.

Methods

Searches were conducted for articles published from 2000–2014. Eligible studies included objective measures of the neighbourhood food environment and neighbourhood-level socio-economic status, with a statistical analysis of the association between food outlet access and socio-economic status.

Results

Fifty-four papers were included. Outlet accessibility was typically defined as the distance to the nearest outlet from the neighbourhood centroid, or as the number of food outlets within a neighbourhood (or buffer). To assess if these measures were linked to neighbourhood disadvantage, common statistical methods included ANOVA, correlation, and Poisson or negative binomial regression. Although all studies involved spatial data, few considered spatial analysis techniques or spatial autocorrelation.

Conclusions

With advances in GIS software, sophisticated measures of neighbourhood outlet accessibility can be considered. However, approaches to statistical analysis often appear less sophisticated. Care should be taken to consider assumptions underlying the analysis and the possibility of spatially correlated residuals which could affect the results.

Food store owners' and managers' perspectives on the food environment: an exploratory mixed-methods study

BACKGROUND

Neighborhood characteristics such as poverty and racial composition are associated with inequalities in access to food stores and in the risk of obesity, but the pathways between food environments and health are not well understood. This article extends research on consumer food environments by examining the perspectives of food-store owners and managers.

METHODS

We conducted semistructured, open-ended interviews with managers and owners of 20 food stores in low-income, predominantly African American neighborhoods in Tallahassee, Florida (USA). The interviews were designed to elicit store managers' and owners' views about healthy foods, the local food environment, and the challenges and opportunities they face in creating access to healthy foods. We elicited perceptions of what constitutes "healthy foods" using two free-list questions. The study was designed and implemented in accord with principles of community-based participatory research.

RESULTS

Store owners' and managers' conceptions of "healthy foods" overlapped with public health messages, but (a) agreement about which foods are healthy was not widespread and (b) some retailers perceived processed foods such as snack bars and sugar-sweetened juice drinks as healthy. In semistructured interviews, store owners and managers linked the consumer food environment to factors across multiple levels of analysis, including: business practices such as the priority of making sales and the delocalization of decision-making, macroeconomic factors such as poverty and the cost of healthier foods, individual and family-level factors related to parenting and time constraints, and community-level factors such as crime and decline of social cohesion.

CONCLUSIONS

Our results link food stores to multilevel, ecological models of the food environment. Efforts to reshape the consumer food environment require attention to factors across multiple levels of analysis, including local conceptions of "healthy foods", the business priority of making sales, and policies and practices that favor the delocalization of decision making and constrain access to healthful foods.