U.S. county "food swamp" severity and hospitalization rates among adults with diabetes: A nonlinear relationship

WEIRD and non-consensual food deserts and swamps: A scoping review of operational definitions

The aim of the present study was to critically analyze operational definitions of food deserts and food swamps included in empirical studies published in peer-reviewed journals. A scoping review was conducted following the recommendations of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. A search of the scientific literature was performed on August 2023 to identify empirical studies including operational definitions of food deserts and/or food swamps in three databases: Scopus, PubMed, and Scielo. A total of 932 scientific articles were identified in the three databases, from which 157 articles, published between 2002 and 2023, were included in the review. The included studies were mainly conducted in WEIRD (Western, Educated, Industrilaized, Rich and Democractic) countries. They presented a total of 107 operational definitions of food deserts and 30 operational definitions of food swamps. Large heterogeneity in the operational definitions of food deserts and food swamps was found. Published studies differed in all the elements of the operational definitions analyzed in the present work. Results stress the need for standardization and the development of more objective and multivariate continuous measures of physical food accessibility that reflect the complexity of modern food environments globally. A series of recommendations to advance food environment research are derived.

Social inequities in food deserts and food swamps in a northeastern Brazilian capital

This study identified food deserts and swamps, investigating their associations with socioeconomic and demographic conditions. This ecological study was conducted using data from urban census tracts in the city of Recife, which were considered the unit of analysis. Information on food retail was obtained from government sources in 2019. Census tracts below the 25th percentile in the density of healthy food retail (i.e., those that predominantly sell natural or minimally processed foods, mixed businesses, and super- and hypermarkets) were classified as food deserts. Census tracts above the 25th percentile in the density of unhealthy food retail (i.e., those selling primarily ultra-processed foods) were considered food swamps. The socioeconomic and demographic conditions of the census tracts were evaluated using variables from the 2010 census (per capita income, average income, race, literacy of the head of household, and the availability of essential services) and the Health Vulnerability Index. Census tracts considered food deserts (28.5%) were more vulnerable, characterized by lower income and access to essential services, more illiterate residents and more minorities (Black/Indigenous/mixed race). Food swamps (73.47%) were more prevalent in less vulnerable neighbourhoods characterized by higher percentages of literate residents and Whites, greater purchasing power, and better basic sanitation. The characteristics of Recife's food deserts and swamps demonstrate social inequalities in the food environment. Public facilities could play a vital role in promoting healthy eating within food deserts. Additionally, future implementation of taxes on ultra-processed foods and the provision of tax subsidies to natural or minimally processed food sellers might contribute to fostering healthier dietary choices.

Food deserts exposure, density of fast-food restaurants, and park access: Exploring the association of food and recreation environments with obesity and diabetes using global and local regression models

To prevent obesity and diabetes environmental interventions such as eliminating food deserts, restricting proliferation of food swamps, and improving park access are essential. In the United States, however, studies that examine the food and park access relationship with obesity and diabetes using both global and local regression are lacking. To guide county, state, and federal policy in combating obesity and diabetes, there is a need for cross-scale analyses to identify that relationship at national and local levels. This study applied spatial regression and geographically weighted regression to the 3,108 counties in the contiguous United States. Global regression show food deserts exposure and density of fast-food restaurants have non-significant association with obesity and diabetes while park access has a significant inverse association with both diseases. Geographically weighted regression that takes into account spatial heterogeneity shows that, among southern states that show high prevalence of obesity and diabetes, Alabama and Mississippi stand out as having opportunity to improve park access. Results suggest food deserts exposure are positively associated with obesity and diabetes in counties close to Alabama, Georgia, and Tennessee while density of fast-food restaurants show positive association with two diseases in counties of western New York and northwestern Pennsylvania. These findings will help policymakers and public health agencies in determining which geographic areas need to be prioritized when implementing public interventions such as promoting healthy food access, limiting unhealthy food options, and increasing park access.

The economics of nature's healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

Green spaces play a crucial role in promoting sustainable and healthy lives. Recent evidence shows that green space also may reduce the need for healthcare, prescription medications, and associated costs. This systematic review provides the first comprehensive assessment of the available literature examining green space exposure and its associations with healthcare prescriptions and expenditures. We applied Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search MEDLINE, Scopus, and Web of Science for observational studies published in English through May 6, 2023. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 26 studies that met the inclusion criteria and were included in our review. Among these, 20 studies (77 % of the total) showed beneficial associations of green space exposure with healthcare prescriptions or expenditures. However, most studies had risks of bias, and the overall strength of evidence for both outcomes was limited. Based on our findings and related bodies of literature, we present a conceptual framework to explain the possible associations and complex mechanisms underlying green space and healthcare outcomes. The framework differs from existing green space and health models by including upstream factors related to healthcare access (i.e., rurality and socioeconomic status), which may flip the direction of associations. Additional research with lower risks of bias is necessary to validate this framework and better understand the potential for green space to reduce healthcare prescriptions and expenditures.

Unraveling the Role of Objective Food Environment in Chinese Elderly's Diet-Related Diseases Epidemic: Considering Both Healthy Food Accessibility and Diversity

The essential role of the objective food environment in achieving healthy aging has been widely recognized worldwide. However, the existing empirical evidence is mostly based on Western cases, and how the objective food environment associates with health outcomes among Chinese elderly remains poorly understood. By merging nationally representative micro survey data with Baidu-based spatial data on the location of food outlets, this study develops accessibility and diversity indicators to explore the relationship between food environment and diet-related diseases among Chinese elderly and investigates how healthy lifestyles moderate this relationship. The results show that improvement in healthy food accessibility and diversity decreases both the probability and the number of diet-related diseases that the elderly suffer. Having more healthy lifestyle factors is associated with a lower risk of suffering from diet-related diseases and strengthens the negative effect of healthy food environment on suffered diet-related diseases. Heterogeneity effect analysis suggests that the relationship between objective food environment and diet-related diseases differs by city scale and income level. The findings of this study shed light on designing tailor-made policies for non-Western countries to promote healthy aging.

Food swamps in Campinas, Brazil

The characteristics of the food environment can interfere with physical access to healthy foods and accentuate health inequalities. The presence of food swamps, i.e., the greater availability of ultra-processed food and commercial establishments compared to those that sell healthier options, are associated with the consumption of unhealthy foods. This study identified the spatial distribution of these establishments in Campinas, São Paulo. Fast-food restaurants, open-air organic/agroecological food markets and supermarkets were geocoded. Regional administrations (RAs) with greater social vulnerability according to the 2010 Census and with a greater availability of fast-food restaurants in relation to open-air food markets and supermarkets were considered food swamps. The less vulnerable neighborhoods had a higher concentration of all types of commercial food establishments compared to the most vulnerable regions. In Campinas, of eighteen RAs, five were considered food swamps. The findings reinforce the need for actions to improve exposure to healthy foods in more vulnerable neighborhoods.

Understanding the information culture for self-management support of people living with diabetes in Ghana

Purpose

The purpose of this study is to explore the information culture of people living with Diabetes Mellitus (DM) and how that impacts their self-management practices in Ghana. The study focuses on the information experiences and information cultural patterns and creates awareness of the need for people to be aware of effective information management for sustainable self-management support.

Design/methodology/approach

An interpretive qualitative approach was used. A total of 12 interviewees involving 10 diabetes patients and 2 health professionals provided data for the study. Allowing the participants to freely talk about their attitude and behaviour, defining their experiences around information for their self-management was the best approach to achieve an in-depth understanding this study seeks.

Findings

The specific elements defining the information of people living with DM in Ghana can be identified. People living with the condition are willing to share information about their condition not only with those within their diabetic community but also with anyone interested. They prefer to use information from sources they find reliable and trust, and they have good information-related competencies that are consistent with diabetic patients in other countries’ contexts to help them identify, access, use and share relevant information. Only a few of the interviewees have difficulty in evaluating the accuracy and currency of some of the information. But they receive a lot of support from experienced people from their community. People also prefer to have information about the condition in their ethnic language. It is important for people living with the condition in Ghana to get involved in the diabetic groups, clubs and community, as members appear to receive the most benefit and support from the community to self-manage the condition alone.

Research limitations/implications

The study is limited by the number of participants and the distances between the researchers and the research context. Also, even though two groups of participants were interviewed (diabetic patients and health professionals), the analysis did not separate the responses of the different groups of study participants. This paper provides a useful insight and understanding of the culture of people living with diabetes in Ghana in terms of how they access, use and share the information they need to support their self-management. It will create awareness of the importance of being mindful of information culture patterns in people in other groups in Ghana and beyond. The research processes and procedures described in the paper can be replicated by other researchers in other contexts.

Originality/value

Although there have been a lot of studies about diabetes and people living with the condition in Ghana, to the best of the authors’ knowledge, this is the first study looking at how people define their need for information, how they identify the source of the information and how they access and use the information, including their general behavioural patterns that influence these information experiences.

Assessing physical access to healthy food across United Kingdom: A systematic review of measures and findings

Background

Existing research suggests that physical access to food can affect diet quality and thus obesity rates. When defining retail food environment (RFE) quantitatively, there is a little agreement on how to measure "lack of healthy food" and what parameters to use, resulting in a heterogeneity of study designs and outcome measures. In turn, this leads to a conflicting evidence base being one of the many barriers to using evidence in policy-making.

Aims

This systematic review aimed to identify and describe methods used to assess food accessibility in the United Kingdom (UK) to overcome heterogeneity by providing a classification of measures.

Materials & Methods

The literature search included electronic and manual searches of peer-reviewed literature and was restricted to studies published in English between January 2010 and March 2021. A total of 9365 articles were assessed for eligibility, of which 44 articles were included in the review. All included studies were analysed with regards to their main characteristics (e.g., associations between variables of interest, setting, sample, design, etc.) and definition of RFE and its metrics. When defining these metrics, the present review distinguishes between a point of origin (centroid, address) from which distance was calculated, summary statistic of accessibility (proximity, buffer, Kernel), and definition of distance (Euclidean, network distance). Trends, gaps and limitations are identified and recommendations made for food accessibility research in UK.

Results

Multiple theoretical and methodological constructs are currently used, mostly quantifying distance by means of Euclidean and ring-buffer distance, using both proximity- and density-based approaches, and ranging from absolute to relative measures. The association between RFE and diet and health in rural areas, as well as a spatiotemporal domain of food access, remains largely unaccounted.

Discussion

Evidence suggests that the duration of exposure may bear a greater importance than the level of exposure and that density-based measures may better capture RFE when compared with proximity-based measures, however, using more complex measures not necessarily produce better results. To move the field forward, studies have called for a greater focus on causality, individual access and the use of various measures, neighbourhood definitions and potential confounders to capture different aspects and dimensions of the RFE, which requires using univariate measures of accessibility and considering the overall context in terms of varying types of neighbourhoods.

Conclusion

In order to render ongoing heterogeneity in measuring RFE, researchers should prioritise measures that may provide a more accurate and realistic account of people's lives and follow an intuitive approach based on convergence of results until consensus could be reached on using some useful standards.

Data Science Trends Relevant to Nursing Practice: A Rapid Review of the 2020 Literature

BACKGROUND

The term "data science" encompasses several methods, many of which are considered cutting edge and are being used to influence care processes across the world. Nursing is an applied science and a key discipline in health care systems in both clinical and administrative areas, making the profession increasingly influenced by the latest advances in data science. The greater informatics community should be aware of current trends regarding the intersection of nursing and data science, as developments in nursing practice have cross-professional implications.

OBJECTIVES

This study aimed to summarize the latest (calendar year 2020) research and applications of nursing-relevant patient outcomes and clinical processes in the data science literature.

METHODS

We conducted a rapid review of the literature to identify relevant research published during the year 2020. We explored the following 16 topics: (1) artificial intelligence/machine learning credibility and acceptance, (2) burnout, (3) complex care (outpatient), (4) emergency department visits, (5) falls, (6) health care-acquired infections, (7) health care utilization and costs, (8) hospitalization, (9) in-hospital mortality, (10) length of stay, (11) pain, (12) patient safety, (13) pressure injuries, (14) readmissions, (15) staffing, and (16) unit culture.

RESULTS

Of 16,589 articles, 244 were included in the review. All topics were represented by literature published in 2020, ranging from 1 article to 59 articles. Numerous contemporary data science methods were represented in the literature including the use of machine learning, neural networks, and natural language processing.

CONCLUSION

This review provides an overview of the data science trends that were relevant to nursing practice in 2020. Examinations of such literature are important to monitor the status of data science's influence in nursing practice.

Community Income, Healthy Food Access, and Repeat Surgery for Kidney Stones

OBJECTIVE

To determine if limited food access census tracts and food swamp census tracts are associated with increased risk for repeat kidney stone surgery. And to elucidate the relationship between community-level food retail environment relative to community-level income on repeat stone surgery over time.

METHODS

Data were abstracted from the University of California, San Francisco Information Commons. Adult patients were included if they underwent at least one urologic stone procedure. Census tracts from available geographical data were mapped using Food Access Research Atlas data from the United States Department of Agriculture Economic Research Service. Kaplan-Meier curves were employed to illustrate time to a second surgical procedure over 5 years, and log-rank tests were used to test for statistically significant differences. A multivariate Cox regression model was used to generate hazard ratios for undergoing second surgery by group.

RESULTS

A total of 1496 patients were included in this analysis. Repeat stone surgery occurred in 324 patients. Kaplan-Meier curves demonstrated a statistically significant difference in curves depicting patients living in low income census tracts (LICTs) vs those not living in LICTs (P <.001). On Cox regression models, patients in LICTs had significantly higher risk of undergoing repeat surgery (P = .011). Patients from limited food access census tracts and food swamp census tracts did not have a significantly higher adjusted risk of undergoing second surgery (P = .11 and P = .88, respectively).

CONCLUSION

Income more so than food access associates with increased risk of repeat kidney stone surgery. Further research is needed to explore the interaction between low socioeconomic status and kidney stone outcomes.

Food swamps in Campinas, Brazil

Abstract The characteristics of the food environment can interfere with physical access to healthy foods and accentuate health inequalities. The presence of food swamps, i.e., the greater availability of ultra-processed food and commercial establishments compared to those that sell healthier options, are associated with the consumption of unhealthy foods. This study identified the spatial distribution of these establishments in Campinas, São Paulo. Fast-food restaurants, open-air organic/agroecological food markets and supermarkets were geocoded. Regional administrations (RAs) with greater social vulnerability according to the 2010 Census and with a greater availability of fast-food restaurants in relation to open-air food markets and supermarkets were considered food swamps. The less vulnerable neighborhoods had a higher concentration of all types of commercial food establishments compared to the most vulnerable regions. In Campinas, of eighteen RAs, five were considered food swamps. The findings reinforce the need for actions to improve exposure to healthy foods in more vulnerable neighborhoods.

An Exploratory Approach to Deriving Nutrition Information of Restaurant Food from Crowdsourced Food Images: Case of Hartford

Deep learning models can recognize the food item in an image and derive their nutrition information, including calories, macronutrients (carbohydrates, fats, and proteins), and micronutrients (vitamins and minerals). This technology has yet to be implemented for the nutrition assessment of restaurant food. In this paper, we crowdsource 15,908 food images of 470 restaurants in the Greater Hartford region on Tripadvisor and Google Place. These food images are loaded into a proprietary deep learning model (Calorie Mama) for nutrition assessment. We employ manual coding to validate the model accuracy based on the Food and Nutrient Database for Dietary Studies. The derived nutrition information is visualized at both the restaurant level and the census tract level. The deep learning model achieves 75.1% accuracy when compared with manual coding. It has more accurate labels for ethnic foods but cannot identify portion sizes, certain food items (e.g., specialty burgers and salads), and multiple food items in an image. The restaurant nutrition (RN) index is further proposed based on the derived nutrition information. By identifying the nutrition information of restaurant food through crowdsourced food images and a deep learning model, the study provides a pilot approach for large-scale nutrition assessment of the community food environment.

Place Effects and Chronic Disease Rates in a Rural State: Evidence from a Triangulation of Methods

High rates of chronic diseases and increasing nutritional polarization between different income groups in the United States are issues of concern to policymakers and public health officials. Spatial differences in access to food are mainly blamed as the cause for these nutritional inequalities. This study first detected hot and cold spots of food providers in West Virginia and then used those places in a quasi-experimental method (entropy balancing) to study the effects of those places on diabetes and obesity rates. We found that although hot spots have lower rates of chronic diseases than non-hot spots and cold spots have higher rates of chronic diseases than non-cold spots-the situation is complicated. With the findings of income induced chronic disease rates in urban areas, where most hot spots are located, there is evidence of another case for "food swamps." However, in cold spots which are located mainly in rural areas, higher rates of chronic diseases are attributed to a combination of access to food providers along with lacking the means (i.e., income for low-income households) to form healthier habits.