Disparities in food access: does aggregate availability of key foods from other stores offset the relative lack of supermarkets in African-American neighborhoods?

Understanding forms of childhood adversities and associations with adult health outcomes: A regression tree analysis

BACKGROUND

Empirical studies have demonstrated associations between ten original adverse childhood experiences (ACEs) and multiple health outcomes. Identifying expanded ACEs can capture the burden of other childhood adversities that may have important health implications.

OBJECTIVE

We sought to identify childhood adversities that warrant consideration as expanded ACEs. We hypothesized that experiencing expanded and original ACEs would be associated with poorer adult health outcomes compared to experiencing original ACEs alone.

PARTICIPANTS

The 11,545 respondents of the National Longitudinal Surveys (NLS) and Child and Young Adult Survey were 48.9 % female, 22.7 % Black, 15.8 % Hispanic, 36.1 % White, 1.7 % Asian/Native Hawaiian/Pacific Islander/Native American/Native Alaskan, and 7.5 % Other.

METHODS

This study used regression trees and generalized linear models to identify if/which expanded ACEs interacted with original ACEs in association with six health outcomes.

RESULTS

Four expanded ACEs-basic needs instability, lack of parental love and affection, community stressors, and mother's experience with physical abuse during childhood -significantly interacted with general health, depressive symptom severity, anxiety symptom severity, and violent crime victimization in adulthood (all p-values <0.005). Basic needs instability and/or lack of parental love and affection emerged as correlates across multiple outcomes. Experiencing lack of parental love and affection and original ACEs was associated with greater anxiety symptoms (p = 0.022).

CONCLUSIONS

This is the first study to use supervised machine learning to investigate interaction effects among original ACEs and expanded ACEs. Two expanded ACEs emerged as predictors for three adult health outcomes and warrant further consideration in ACEs assessments.

Using Mobile Phone Data to Assess Socio-Economic Disparities in Unhealthy Food Reliance during the COVID-19 Pandemic

Background: Although COVID-19 has disproportionately affected socio-economically vulnerable populations, research on its impact on socio-economic disparities in unhealthy food reliance remains scarce. Methods: This study uses mobile phone data to evaluate the impact of COVID-19 on socio-economic disparities in reliance on convenience stores and fast food. Reliance is defined in terms of the proportion of visits to convenience stores out of the total visits to both convenience and grocery stores, and the proportion of visits to fast food restaurants out of the total visits to both fast food and full-service restaurants. Visits to each type of food outlet at the county level were traced and aggregated using mobile phone data before being analyzed with socio-economic demographics and COVID-19 incidence data. Results: Our findings suggest that a new COVID-19 case per 1,000 population decreased a county's odds of relying on convenience stores by 3.41% and increased its odds of fast food reliance by 0.72%. As a county's COVID-19 incidence rate rises by an additional case per 1,000 population, the odds of relying on convenience stores increased by 0.01%, 0.02%, and 0.06% for each additional percentage of Hispanics, college-educated residents, and every additional year in median age, respectively. For fast food reliance, as a county's COVID-19 incidence rate increases by one case per 1,000 population, the odds decreased by 0.003% for every additional percentage of Hispanics but increased by 0.02% for every additional year in the county's median age. Conclusion: These results complement existing literature to promote equitable food environments.

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.

Supporting wellness at pantries (SWAP) nutrition stoplight system aids rural food pantry clients living with chronic disease in selecting nutritious options

OBJECTIVES

Chronic disease accounts for 70% of U.S. deaths, with suboptimal nutrition an important, preventable risk factor. Food insecurity is a contributor to poor nutrition. Food pantries are a regular source of groceries for the food insecure and an ideal place for nutrition literacy programs. Supporting Wellness at Pantries (SWAP) is a stoplight nutrition ranking system based on 2015-2020 Dietary Guidelines, but has only been implemented in urban areas. Rural communities experience higher rates of poor health and food insecurity.

METHODS

This study implements SWAP at a food pantry in a rural community with high rates of food insecurity and chronic disease. Food was sorted into "green," "yellow," and "red" items on color-coded shelves, with green foods the most accessible, and signage explaining the sorting was displayed. Surveys measured whether clients found SWAP helpful in choosing nutritious foods, particularly for households with chronic diseases.

RESULTS

Clients reported that it was significantly (p <.0001) easier to choose items low in salt, sugar, and fat. The benefits of SWAP extended outside the pantry by increasing confidence in choosing nutritious foods while grocery shopping.

DISCUSSION

SWAP can be an effective tool for improving nutrition literacy among food insecure rural residents with chronic illnesses.

Redlining, racism and food access in US urban cores

In the 1930s, the Home Owners' Loan Corporation (HOLC) graded the mortgage security of urban US neighborhoods. In doing so, the HOLC engaged in the practice, imbued with racism and xenophobia, of "redlining" neighborhoods deemed "hazardous" for lenders. Redlining has caused persistent social, political and economic problems for communities of color. Linkages between redlining and contemporary food access remain unexamined, even though food access is essential to well-being. To investigate this, we used a census tract-level measure of low-income and low grocery store food access from the US Department of Agriculture Food Access Research Atlas, redlining data from Mapping Inequality Project, and demographic data from the American Community Survey. We employed generalized estimating equations with robust covariance estimates to analyze data pertaining to 10,459 census tracts in 202 US cities. Tracts that the HOLC graded as "C" ("decline in desirability") and "D" ("hazardous") had reduced contemporary food access compared to those graded "A" ("best"). Increases in contemporary census tract proportions of Black, Hispanic, or other racial/ethnic minority residents, as well as disabled residents, were associated with reduced food access. Increases in contemporary proportions of residents age 75 years and older or those without a car were associated with better food access. Tracts that underwent housing redevelopment since being graded had better food access, while those undergoing gentrification had reduced food access. Results suggest that issues of redlining, housing discrimination, racism, ableism, displacement, and food inaccessibility are deeply intertwined.

[Food environment in São Leopoldo, Rio Grande do Sul, Brazil: the association with neighborhood sociodemographic variables]

The scope of this study is to describe the food environment of a medium-sized municipality in southern Brazil and compare the availability of different types of food outlets in neighborhood socioeconomic and demographic environments. An ecological study was carried out in 45 buffers of 400m in São Leopoldo county, RS. The buffer was calculated from the center point of the residences of women participating in a larger research project. All streets were surveyed to identify food stores and record their geographical coordinates, as well as apply the NEMS questionnaire on the availability, price and quality of 108 items. The commercial outlets were classified as supermarkets, grocery stores, fruit stores and convenience stores. Supermarkets and grocery stores were present in higher quantity in lower income buffers and grocery stores were more prevalent in those with higher population tertiles. Another result was a direct relationship between NEMS and tertile income scores for supermarkets, grocery stores and fruit stores, and an indirect relationship for the same stores and population tertile. The availability of healthy food was higher in areas with higher income and lower numbers of inhabitants, indicating the need for better distribution of food stores and availability of varieties of food in the municipality.

Racial Differences in Perceived Food Swamp and Food Desert Exposure and Disparities in Self-Reported Dietary Habits

Both food swamps and food deserts have been associated with racial, ethnic, and socioeconomic disparities in obesity rates. Little is known about how the distribution of food deserts and food swamps relate to disparities in self-reported dietary habits, and health status, particularly for historically marginalized groups. In a national U.S. sample of 4305 online survey participants (age 18+), multinomial logistic regression analyses were used to assess by race and ethnicity the likelihood of living in a food swamp or food desert area. Predicted probabilities of self-reported dietary habits, health status, and weight status were calculated using the fitted values from ordinal or multinomial logistic regression models adjusted for relevant covariates. Results showed that non-Hispanic, Black participants (N = 954) were most likely to report living in a food swamp. In the full and White subsamples (N = 2912), the perception of residing in a food swamp/desert was associated with less-healthful self-reported dietary habits overall. For non-Hispanic Blacks, regression results also showed that residents of perceived food swamp areas (OR = 0.66, p < 0.01, 95% CI (0.51, 0.86)) had a lower diet quality than those not living in a food swamp/food desert area. Black communities in particular may be at risk for environment-linked diet-related health inequities. These findings suggest that an individual's perceptions of food swamp and food desert exposure may be related to diet habits among adults.

Neighborhood Poverty and Physical Health at Midlife: The Role of Life-Course Exposure

Studies of the effect of neighborhood poverty on health are dominated by research designs that measure neighborhood poverty at a single point in time, ignoring the potential influence of exposure to neighborhood poverty over the life course. Applying latent class analysis to restricted residential history data from the National Longitudinal Survey of Youth, 1979 Cohort, we identify four trajectories of life-course exposure to high-poverty neighborhoods between adolescence and midlife and then examine how these groups differ in their physical health conditions (SF-12 score) and self-rated health at around age 40. Linear and logistic regression analyses show that life-course exposure to high-poverty neighborhoods is a stronger predictor of midlife physical health than are point-in-time measures of neighborhood poverty observed during either adolescence or midlife. Our findings suggest that a life-course approach can enhance our understanding of how neighborhood poverty affects physical health.

Associations between Subjective and Objective Measures of the Community Food Environment and Executive Function in Early Childhood

The present study utilized a cross-sectional design to assess whether two indicators of the community food environment, parent perceptions of the community food environment (i.e., as assessed by parent reports of access to, availability, and affordability of foods) and limited food access (via census data), were related to executive function in preschool children. Children were recruited during the 2014–2015 academic year from Head Start and community-based preschools (N = 102) and children’s executive function ability was tested using the Head–Toes–Knees–Shoulders task. Multiple linear regression analysis was used, as well as adjusted standard errors to account for clustering at the classroom level. Parent reports of their food environment were significantly related to children’s executive function, such that children living in higher quality community food environments had better executive function. In contrast, limited food access using census data was not significantly related to executive function. The results suggest that parent reports of the community food environment in early childhood may contribute to young children’s cognitive outcomes more so than being in a limited food access area, as these data may not represent individual behaviors or capture the variability of the accessibility and affordability of healthy foods. Policy makers should consider correlations between the food environment and early executive functioning when developing new community health/wellness legislation.

Food environment, income and obesity: a multilevel analysis of a reality of women in Southern Brazil

The objective of this study was to explore relationships between the neighborhood food environment and obesity in urban women living in São Leopoldo, Rio Grande do Sul State, Brazil. A cross-sectional survey was carried out. This study was conducted with 1,096 women. Structured interviews were conducted using a standard pre-tested questionnaire. Obesity was defined as body mass index (BMI) ≥ 30kg/m2. Circular buffers of 400m in radius were created based on the centroid of the women's houses who participated, in the 45 census tracts inhabited by them. Neighborhood food establishments were identified through systematic survey of all streets in the study areas and geographical coordinates of shops were collected. Establishments were evaluated using the NEMS tool. The prevalence of obesity was 33% among the women participants. After adjusting for individual variables, supermarkets and healthy food establishments were positively associated with obesity, PR = 1.05 (95%CI: 1.01-1.10), PR = 1.02 (95%CI: 1.00-1.04), respectively, while mean buffer income was negatively associated, PR = 0.64 (95%CI: 0.49-0.83). Neighborhood food environment factors were associated with obesity even after controlled for individual variables, as socioeconomic variables, behavioral and food purchase.

Influence of the Local Food Environment on Hispanics' Perceptions of Healthy Food Access in New York City

INTRODUCTION

Studies have characterized food environments and documented its impact on access and consumption of healthy foods as well as diet-related health conditions. This study aims to characterize the local food environment in New York City's Washington Heights and Inwood community and to examine its influence on Hispanics' perceptions of healthy food access.

METHODS

Person-level local food environments were created by spatially modeling food retailers selling fresh fruits and vegetables or low-fat products within a participant's 400- and 800-m residential radius buffers. Data were analyzed using multivariate binary logistic regression.

RESULTS

Fruit/vegetable markets significantly increased participants' odds of perceiving the availability of a large selection as well as the high quality of fresh fruits and vegetables in their neighborhood. Medium-/large-size supermarkets/groceries within 400-m radius significantly increased participants' odds of perceiving the high quality of fresh fruits and vegetables in their neighborhood, whereas meat markets significantly lowered the odds. Fruit/vegetable markets and medium-/large-size supermarkets/groceries significantly increased participants' odds of perceiving the availability of a large selection of low-fat products in their neighborhood.

CONCLUSION

Study findings advance our understanding of the relationships between local food environment and perceived healthy food access among urban Hispanics.

Influence of Highly Accessible Urban Food Environment on Weight Management: A Qualitative Study in Seoul

We explored the characteristics of the food environment and its influence on weight management in Seoul, Korea. Photo elicitation interviews were conducted with 73 participants who took three photographs per topic related to their food environment and discussed these photographs in groups. Through thematic analysis, we identified four themes concerning participants’ perceptions of the food environment and weight management: (1) “convenience comes first,” (2) “tempting food environment,” (3) “alcohol and anju,” and (4) “burden of individual effort to manage weight.” A systematic change toward an environment supportive of healthy eating and weight management is recommended.

Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children's Diets

Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children’s diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children (n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children’s diets. We observed a negligible impact of the neighborhood food environment on children’s diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity.

Personal characteristics, cooking at home and shopping frequency influence consumption

This study examines how the consumption of fruits and vegetables is affected by home cooking habits and shopping patterns, including distance to patronized stores and frequency of shopping, in two low-income predominantly African American urban neighborhoods in New Orleans, Louisiana.

In-person interviews were conducted in 2013 with 901 adult residents who identified themselves as the primary household shopper. Respondents were asked where and how often they shopped and answered a food frequency questionnaire. Addresses were geocoded and distances to the stores where respondents shopped were calculated. Multivariable logistic regression was used to examine the relationship between food consumption and personal factors, neighborhood factors and shopping habits.

Consumption of daily servings of fresh produce increased by 3% for each additional trip to a grocery store, by 76% for shopping at a farmer's market, and by 38% for preparing food at home. Each additional trip to a convenience store increased the frequency of consumption of chips, candy and pastries by 3%. The distance from residence to the type of store patronized was not associated with consumption of produce or chips, candy or pastries.

Shopping at full-service grocery stores, farmer's markets and cooking at home were positively associated with the consumption of fresh produce while shopping at convenience stores was associated with increased consumption of chips, candy and pastries. These findings are useful for designing programmatic interventions to increase fresh fruit and vegetable consumption among residents in low-income urban communities.

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Shopping frequency and store type influence consumption of food.

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Distance to patronized store was not associated with consumption.

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Food prepared at home is associated with increased consumption of produce.

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.

Dietary and economic effects of eliminating shortfall in fruit intake on nutrient intakes and diet cost

Background

Children in the United States do not consume the recommended amounts of fruit. The economic and dietary consequences of meeting the shortfall in fruit consumption have not been evaluated.

Methods

Analyses were based on a nationally representative sample of 4–18 year-old children (n = 2,647) from the 2009–2010 National Health and Nutrition Examination Survey (NHANES). The shortfall in total fruit consumption for each child was estimated based on the USDA MyPlate recommendations. The potential impact of filling the shortfall in total fruit consumption was projected with whole fruit alone (WF model) or a combination of 100 % fruit juice and whole fruit (FJ + WF model). Juice consumption was capped using American Academy of Pediatrics (AAP) standards. The USDA national food prices database was used to estimate the cost of meeting the dietary recommendations for fruit. Selected nutrient and mineral intakes, as well as daily diet cost were estimated after eliminating the shortfall in fruit consumption.

Results

Among all children, vitamin C (+22.8 mg [95 % CI 21.4, 24.1] in the WF model and +48.1 mg [95 % CI 45.2, 51.1] in the FJ + WF model) and potassium intakes (+203 mg [95 % CI 190, 215] in WF and +263 mg [95 % CI 248, 280] in FJ + WF) were increased in both models. The FJ + WF model resulted in a marginal increase in dietary fiber (e.g., a relative change less than 10 %), while the WF model resulted in a meaningful increase in dietary fiber (e.g., a relative change greater than 10 %; +2.2 g [95 % CI 2.1, 2.3]). Conversely, the WF model resulted in only a marginal increase in calcium, while the FJ + WF model resulted in a meaningful increase in calcium (+85 mg [95 % CI 79, 89]). Calories were increased in all models (+4.5 % [95 % CI 4.1, 4.9 %] for FJ + WF and +3.5 % [95 % CI 3.2, 3.7 %] for WF). Meeting the fruit shortfall with whole fruit alone increased estimated diet costs by 9.9 % (+$0.44/d [95 % CI 0.42, 0.47]), while the fruit juice/whole fruit combination increased diet costs by 5.2 % (+$0.23/d [95 % CI 0.22, 0.25]).

Conclusions

Meeting fruit consumption guidelines without a substantial increase in diet costs may be a challenge. Combining whole fruit with 100 % fruit juice capped at AAP standards may be one approach to meeting fruit recommendations within cost constraints. Identifying approaches to increasing whole fruit consumption in as cost-neutral a fashion as possible should be a priority.

Challenges to Healthy Eating Practices: A Qualitative Study of Non-Hispanic Black Men Living With Diabetes

PURPOSE

The purpose of this study was to explore current dietary practices and perceived barriers to healthy eating in non-Hispanic black men with type 2 diabetes.

METHODS

Four 90-minute focus groups held in September and October 2011 were led by a trained moderator with a written guide to facilitate discussion on dietary practices and barriers to healthy eating. Participants were recruited from the diabetes database at a public safety-net health system in Jefferson County, Alabama. Two-independent reviewers performed content analysis to identify major themes using a combined deductive and inductive approach.

RESULTS

There were 34 male participants aged 18 years and older. Mean years living with diabetes was 9.6 ± 5.9. Sixty-two percent of participants perceived themselves to be in fair or poor health. Participants' self-reported eating practices did not always relate to hunger. Internal cues to eat included habit and response to emotions, and external cues to eat included media messaging, medication regimens, and work schedules. Men identified multiple barriers to healthy eating including hard-to-break habits, limited resources and availability of food at home and in neighborhood grocery stores, and perceived poor communication with health care professionals.

CONCLUSION

Non-Hispanic black men acknowledged the importance of healthy eating as part of diabetes self-management but reported various internal and external challenges that present barriers to healthy eating. Tailored strategies to overcome barriers to healthy eating among non-Hispanic black men should be developed and tested for their impact on diabetes self-management.

Decomposing Racial Disparities in Obesity Prevalence: Variations in Retail Food Environment

INTRODUCTION

Racial disparities in obesity exist at the individual and community levels. Retail food environment has been hypothesized to be associated with racial disparities in obesity prevalence. This study aimed to quantify how much food environment measures explain racial disparities in obesity at the county level.

METHODS

Data from 2009 to 2010 on 3,135 U.S. counties were extracted from the U.S. Department of Agriculture Food Environment Atlas and the Behavioral Risk Factor Surveillance System and analyzed in 2013. Oaxaca-Blinder decomposition was used to quantify the portion of the gap in adult obesity prevalence observed between counties with a high and low proportion of African-American residents is explained by food environment measures (e.g., proximity to grocery stores, per capita fast-food restaurants). Counties were considered to have a high African-American population if the percentage of African-American residents was >13.1%, which represents the 2010 U.S. Census national estimate of percentage African-American citizens.

RESULTS

There were 665 counties (21%) classified as a high African-American county. The total gap in mean adult obesity prevalence between high and low African-American counties was found to be 3.35 percentage points (32.98% vs 29.63%). Retail food environment measures explained 13.81% of the gap in mean age-adjusted adult obesity prevalence.

CONCLUSIONS

Retail food environment explains a proportion of the gap in adult obesity prevalence observed between counties with a high proportion of African-American residents and counties with a low proportion of African-American residents.

The Built Food Environment and Dietary Intake among African-American Adults

OBJECTIVES

The built food environment surrounding people's homes may influence their dietary intake. This exploratory study examined how the density of different sources of food in the residential environment was associated with dietary consumption among 77 African-American adults in Houston, Texas.

METHODS

The number of fast-food-type restaurants, large grocery stores, and convenience-type stores within 2- and 5-mile residential buffers were divided by the respective areas to obtain food environment density variables. Intake of fruit and vegetables [FV], fiber [FI], and percent energy from fat [PEF] was assessed using National Health Interview Survey items. Covariate-adjusted regressions were used to assess relations of interest.

RESULTS

Greater density of fast-food-type restaurants within 2 miles was associated with greater FV, FI, and PEF (ps ≤ .012); and for FV and FI within 5 miles (ps ≤ .004). Density of large grocery stores was unrelated to intake. Greater density of convenience-type stores within 2 miles was negatively associated with FV and FI (ps ≤ .03); results became marginal at 5 miles for FV (p = .10) but not FI (p = .03).

CONCLUSION

Maximizing healthy offerings in venue-rich metropolitan areas might provide direction for policies to reduce obesity.

Multiple pathways from the neighborhood food environment to increased body mass index through dietary behaviors: A structural equation-based analysis in the CARDIA study

OBJECTIVES

To examine longitudinal pathways from multiple types of neighborhood restaurants and food stores to BMI, through dietary behaviors.

METHODS

We used data from participants (n=5114) in the United States-based Coronary Artery Risk Development in Young Adults study and a structural equation model to estimate longitudinal (1985-86 to 2005-06) pathways simultaneously from neighborhood fast food restaurants, sit-down restaurants, supermarkets, and convenience stores to BMI through dietary behaviors, controlling for socioeconomic status (SES) and physical activity.

RESULTS

Higher numbers of neighborhood fast food restaurants and lower numbers of sit-down restaurants were associated with higher consumption of an obesogenic fast food-type diet. The pathways from food stores to BMI through diet were inconsistent in magnitude and statistical significance.

CONCLUSIONS

Efforts to decrease the numbers of neighborhood fast food restaurants and to increase the numbers of sit-down restaurant options could influence diet behaviors. Availability of neighborhood fast food and sit-down restaurants may play comparatively stronger roles than food stores in shaping dietary behaviors and BMI.

Disparities in the Availability of Farmers Markets in the United States

Farmers markets (FM) have been proposed by researchers, policymakers, and health agencies as a potential community-level strategy to prevent obesity and reduce disparities in healthy food access in the U.S. Information about disparities in farmers market availability is scarce. This research aimed to examine county-level associations between farmers market (FM) availability and demographic, socioeconomic, health, and environmental measures in an effort to determine if disparities in availability exist in the U.S. An ecological study of 3,135 U.S. counties was conducted in 2013 using 2009-2010 data extracted from the United States Department of Agriculture Food Environment Atlas. Logistic regression and Poisson regression models were used to determine associations between county-level FM availability and measures such as percentage of non-Hispanic black residents, median household income, and number of grocery stores per 100,000 residents (i.e., per capita). Regression models were stratified by metro county status and all analyses were adjusted for state-level clustering. There were 1,774 (56.6%) counties with at least one FM available. Median household income was associated with increased odds of having at least one FM available among non-metro counties, but not metro counties. Percentage of non-Hispanic black residents and residents living in poverty were negatively associated with per capita FMs among metro and non-metro counties. Per capita fast food restaurants was negatively associated with per capita FMs among metro counties. Disparities in FM availability exist in the U.S. More research on the behavioral and health implications of farmers market availability should be conducted.

10 Years Later: Changes in Food Access Disparities in New Orleans since Hurricane Katrina

Inadequate access to healthy food is a problem in many urban neighborhoods, particularly for racial-ethnic minorities and low-income groups who are more likely to reside in food deserts. Although substantial research throughout the country has documented the existence of these disparities, few studies have focused on how this access changes over time or is affected by environmental shocks. This study examined citywide supermarket access in New Orleans as well as racial-ethnic disparities in this access, prior to Hurricane Katrina and at three times afterwards. On-the-ground verification of supermarket locations was conducted in 2004-2005, 2007, 2009, and 2014 and was mapped with secondary demographic data. Census tracts were defined as predominantly African-American neighborhoods if 80 % or more of the population identified as such. HLM Poisson regression analyses were conducted in 2014 to identify the difference in likelihood of finding supermarkets in a neighborhood by race-ethnicity and across all years of interest. Racial-ethnic disparities existed before the storm and worsened after it (IRR = 0.35; 95 % CI = 0.21, 0.60). Improvements in disparities to pre-storm levels were not seen until 2009, 4 years after the storm. By 2014, supermarket access, on average, was not significantly different in African-American neighborhoods than in others (IRR = 0.90; 95 % CI = 0.65, 1.26). The slow recovery of New Orleans' retail food infrastructure after Hurricane Katrina highlights the need for an increased focus on long-term planning to address disparities, especially those that may be exaggerated by shocks.

Fresh produce consumption and the association between frequency of food shopping, car access, and distance to supermarkets

BACKGROUND

Fresh fruit and vegetables are important components of a healthy diet. Distance to a supermarket has been associated with the ability to access fresh produce.

METHODS

A randomly sampled telephone survey was conducted with the main shopper for 3000 households in New Orleans, Louisiana in 2011. Individuals were asked where and how often they shopped for groceries, frequency of consumption of a variety of foods, and whether they had access to a car. Bivariate models assessed the relationship between four outcomes: car access, distance to the store patronized by the respondent, number of monthly shopping trips, and daily servings of produce. Structural equation modeling (SEM) was used to distinguish direct and indirect effects.

RESULTS

In bivariate models, car access was positively associated with number of shopping trips and produce consumption while distance was inversely associated with shopping trips. In SEM models, produce consumption was not associated with car access or distance, but to the number of monthly shopping trips.

CONCLUSION

The frequency of shopping is associated with car access but a further distance deters it. Access to stores closer to the shopper may promote more frequent shopping and consumption of produce.

Socioeconomic gradient in consumption of whole fruit and 100% fruit juice among US children and adults

BACKGROUND

The consumption of fruit is generally associated with better health, but also higher socioeconomic status (SES). Most previous studies evaluating consumption of fruits have not separated 100% fruit juice and whole fruit, which may conceal interesting patterns in consumption.

OBJECTIVE

To estimate demographic and socioeconomic correlates of whole fruit versus 100% juice consumption among children and adults in the United States.

DESIGN

Secondary analyses of two cycles of the nationally representative National Health and Nutrition Examination Survey (NHANES) from 2007-2010, by gender, age group, race/ethnicity and SES among 16,628 children and adults.

RESULTS

Total fruit consumption (population average of 1.06 cup equivalents/d) fell far short of national goals. Overall, whole fruit provided about 65% of total fruit, while 100% juice provided the remainder. Whereas 100% juice consumption was highest among children and declined sharply with age, whole fruit consumption was highest among older adults. Total fruit and whole fruit consumption was generally higher among those with higher incomes or more education. By contrast, the highest 100% juice consumption was found among children, racial/ethnic minorities and lower-income groups.

CONCLUSIONS

Consumption patterns for whole fruit versus 100% fruit juice showed different gradients by race/ethnicity, education, and income. The advice to replace 100% juice with whole fruit may pose a challenge for the economically disadvantaged and some minority groups, whose fruit consumption falls short of national goals.

The influence of the WIC food package changes on the retail food environment in New Orleans

OBJECTIVE

To examine the effect of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package changes on availability of healthy foods in small stores.

DESIGN

Pre-post comparison group design with repeat in-store observations.

SETTING

New Orleans.

PARTICIPANTS

Small stores (n = 102; 77% of total) were visited in 2009. Of these, 91% were observed again in 2010, including both WIC (n = 27) and non-WIC (n = 66) stores.

INTERVENTION

The 2009 WIC food package changes to include healthier foods.

MAIN OUTCOME MEASURES

Change in store availability of fruits, vegetables, lower-fat milks, whole wheat bread, and brown rice. Change in number of varieties and shelf length of fruits and vegetables.

ANALYSIS

Difference-in-differences analysis using logit models for change in availability and regression models for change in number of varieties or shelf length.

RESULTS

The WIC stores were more likely to improve availability of lower-fat milks than non-WIC stores (adjusted odds ratio, 5.0, 95% confidence interval, 1.2-21.0). An even greater relative improvement was seen with whole grains. The WIC stores showed a relative increase in number of varieties of fresh fruits (0.9 ± 0.3; P < .01) and shelf length of vegetables (1.2 ± 0.4 meters; P < .01).

CONCLUSIONS AND IMPLICATIONS

Results suggest that WIC changes improved the availability of healthy foods in small stores in New Orleans. Similar changes throughout the country could have a significant impact on neighborhood food environments.

Feasibility of increasing access to healthy foods in neighborhood corner stores

The feasibility of working with neighborhood corner stores to increase the availability of fresh fruit and vegetables in low-income neighborhoods in New Orleans was assessed. Household interviews and 24-hour dietary recalls (n = 97), corner store customer intercept interviews (n = 60) and interviews with corner store operators (owners/managers) (n = 12) were conducted in three neighborhoods without supermarkets. Regional produce wholesalers were contacted by phone. Results indicated that the majority of neighborhood residents use supermarkets or super stores as their primary food source. Those who did shop at corner stores typically purchased prepared foods and/or beverages making up nearly one third of their daily energy intake. Most individuals would be likely to purchase fresh fruit and vegetables from the corner stores if these foods were offered. Store operators identified cost, infrastructure and lack of customer demand as major barriers to stocking more fresh produce. Produce wholesalers did not see much business opportunity in supplying fresh produce to neighborhood corner stores on a small scale. Increasing availability of fresh fruit and vegetables in corner stores may be more feasible with the addition of systems changes that provide incentives and make it easier for neighborhood corner stores to stock and sell fresh produce.

Trends of fruit and vegetable availability in neighbourhoods in Albany, NY, USA, 2003–2012

Objective

To investigate a 9-year trend of fresh fruit and vegetable availability and factors associated with the net availability change in two contrasting neighbourhoods.

Design

Longitudinal design. Data were collected in 2003, 2009 and 2012 through in-store observations. Fresh fruit and vegetable availability was presented by weight-adjusted counts of stores having designated varieties per 10 000 population.

Setting

A low-income minority neighbourhood and an adjacent middle-income racially mixed neighbourhood in Albany, NY, USA. These neighbourhoods became sites of fresh produce interventions after baseline data were collected.

Subjects

A total of 111, 128 and 146 eligible food stores in respective years.

Results

Fresh fruit availability (two or more varieties) increased in both neighbourhoods. Inventory expansion of existing stores and the convenience store intervention contributed to the significant increase (P for trend=0·04) of fresh fruit availability in the minority neighbourhood. Although not statistically significant (P>0·05), the availability of two or more dark-coloured fresh vegetables also increased in the mixed neighbourhood, but declined slightly in the minority neighbourhood. The secular (non-intervention) fresh vegetable availability rate ratio by neighbourhood reached 3·0 in 2012 (P<0·01). The net decline of fresh vegetable availability in the minority neighbourhood was primarily attributed to inventory reduction of existing stores.

Conclusions

Longitudinal observations revealed narrowed neighbourhood disparities of fresh fruit availability and widened gaps of fresh vegetable availability. Inventory shifts of existing stores impacted the net availability change more profoundly than store opening or closing in the minority neighbourhood. Findings support increasing the programme capacity of the convenience store intervention to address the fresh vegetable disparity.

The changing food outlet distributions and local contextual factors in the United States

Background

Little is known about the dynamics of the food outlet distributions associated with local contextual factors in the U.S. This study examines the changes in food stores/services at the 5-digit Zip Code Tabulated Area (ZCTA5) level in the U.S., and assesses contextual factors associated with the changes.

Methods

Data from 27,878 ZCTA5s in the contiguous United States without an extreme change in the number of 6 types of food stores/services (supermarkets, small-size grocery stores, convenience stores, fresh/specialty food markets, carry-out restaurants, and full-service restaurants) were used. ZCTA5s’ contextual factors were from the 2000 Census. Numbers of food stores/services were derived from the Census Business Pattern databases. Linear regression models assessed contextual factors’ influences (racial/ethnic compositions, poverty rate, urbanization level, and foreign-born population%) on 1-year changes in food stores/services during 2000–2001, adjusted for population size, total business change, and census regions.

Results

Small-size grocery stores and fresh/specialty food markets increased more and convenience stores decreased more in Hispanic-predominant than other areas. Among supermarket-free places, new supermarkets were less likely to be introduced into black-predominant than white-predominant areas (odds ratio (OR) = 0.52, 95% CI = 0.30-0.92). However, among areas without the following type of store at baseline, supermarket (OR = 0.48 (0.33-0.70)), small-size grocery stores (OR = 1.32 (1.08-1.62)), and fresh/specialty food markets (OR = 0.70 (0.53-0.92)) were less likely to be introduced into areas of low foreign-born population than into areas of high foreign-born population. Higher poverty rate was associated with a greater decrease in supermarket, a less decrease in small-size grocery stores, and a less increase in carry-out restaurants (all p for trends <0.001). Urban areas experienced more increases in full-service and carry-out restaurants than suburban areas.

Conclusions

Local area characteristics affect 1-year changes in food environment in the U.S. Hispanic population was associated with more food stores/services capable of supplying fresh food items. Black-predominant and poverty-afflicted areas had a greater decrease in supermarkets. Full-service and carry-out restaurants increased more in urban than suburban areas. Foreign-born population density was associated with introduction of grocery stores and fresh/specialty food markets into the areas.

The intersection of neighborhood racial segregation, poverty, and urbanicity and its impact on food store availability in the United States

BACKGROUND

Food store availability may determine the quality of food consumed by residents. Neighborhood racial residential segregation, poverty, and urbanicity independently affect food store availability, but the interactions among them have not been studied.

PURPOSE

To examine availability of supermarkets, grocery stores, and convenience stores in US census tracts according to neighborhood racial/ethnic composition, poverty, and urbanicity.

METHODS

Data from 2000 US Census and 2001 InfoUSA food store data were combined and multivariate negative binomial regression models employed.

RESULTS

As neighborhood poverty increased, supermarket availability decreased and grocery and convenience stores increased, regardless of race/ethnicity. At equal levels of poverty, Black census tracts had the fewest supermarkets, White tracts had the most, and integrated tracts were intermediate. Hispanic census tracts had the most grocery stores at all levels of poverty. In rural census tracts, neither racial composition nor level of poverty predicted supermarket availability.

CONCLUSIONS

Neighborhood racial composition and neighborhood poverty are independently associated with food store availability. Poor predominantly Black neighborhoods face a double jeopardy with the most limited access to quality food and should be prioritized for interventions. These associations are not seen in rural areas which suggest that interventions should not be universal but developed locally.

Neighborhood socioeconomic characteristics and differences in the availability of healthy food stores and restaurants in Sao Paulo, Brazil

Differential access to healthy foods has been hypothesized to contribute to health disparities, but evidence from low and middle-income countries is still scarce. This study examines whether the access of healthy foods varies across store types and neighborhoods of different socioeconomic statuses (SES) in a large Brazilian city. A cross-sectional study was conducted in 2010-2011 across 52 census tracts. Healthy food access was measured by a comprehensive in-store data collection, summarized into two indexes developed for retail food stores (HFSI) and restaurants (HMRI). Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood SES with healthy food access. Fast food restaurants were more likely to be located in low SES neighborhoods whereas supermarkets and full service restaurants were more likely to be found in higher SES neighborhoods. Multilevel analyses showed that both store type and neighborhood SES were independently associated with in-store food measures. We found differences in the availability of healthy food stores and restaurants in Sao Paulo city favoring middle and high SES neighborhoods.

Frequency of consumption at fast-food restaurants is associated with dietary intake in overweight and obese women recruited from financially disadvantaged neighborhoods

Fast-food restaurants are more prevalent in lower-income and predominately African American neighborhoods, where consumption of fast food is also higher. In general populations, fast-food consumption is related to less healthy dietary intake. This cross-sectional study examined the hypotheses that greater fast-food consumption is associated with less healthy dietary intake and poorer diet quality in overweight and obese women (n = 196, 25-51 years, 87% African American) recruited from financially disadvantaged Census tracts. Dietary intake and diet quality (Alternate Healthy Eating Index) were assessed via three 24-hour dietary recalls. Linear regression models tested the association between fast-food consumption and each outcome (model 1). Model 2 added sociodemographics and physical activity. Model 3 added total caloric intake. Fast-food consumption was significantly associated with total caloric intake; total intake of meat, grains, sweetened beverages, dairy, fiber, cholesterol, sodium, and added sugar; and percent of calories from total fat, saturated fat, and trans-fatty acids. Statistically significant associations remained in model 2, but most were not significant in model 3. Fast-food consumption was not associated with diet quality (Alternate Healthy Eating Index) in any model. In this at-risk sample, fast-food consumption was associated with more negative dietary practices. Significant associations generally disappeared when controlling for total caloric intake, suggesting that women who eat more fast food have higher total caloric intakes as a result of increased consumption of unhealthy rather than healthy foods.

Feasibility and acceptability of Internet grocery service in an urban food desert, Chicago, 2011-2012

We explored the feasibility and acceptability of an Internet grocery service (IGS) as an approach to improving food access in urban neighborhoods. In our pilot study, caregivers residing in a documented Chicago food desert (N = 34, 79% ethnic minority) received a voucher to use a commercial IGS to purchase groceries for their household. Caregivers most frequently purchased fruits, vegetables, meats, and caloric beverages, and endorsed 4 factors as potentially important determinants of future IGS use. IGS programs could have a role in improving urban food access if they have competitive prices, provide rapid delivery, and incorporate strategies to discourage purchasing of discretionary caloric beverages.

What "price" means when buying food: insights from a multisite qualitative study with Black Americans

OBJECTIVES

We explored the role of price in the food purchasing patterns of Black adults and youths.

METHODS

We analyzed qualitative data from interviews and focus groups with socioeconomically diverse, primarily female, Black adults or parents (n = 75) and youths (n = 42) in 4 US cities. Interview protocols were locality specific, but all were designed to elicit broad discussion of food marketing variables. We performed a conventional qualitative content analysis by coding and analyzing data from each site to identify common salient themes.

RESULTS

Price emerged as a primary influence on food purchases across all sites. Other value considerations (e.g., convenience, food quality, healthfulness of product, and family preferences) were discussed, providing a more complex picture of how participants considered the price of a product.

CONCLUSIONS

Food pricing strategies that encourage consumption of healthful foods may have high relevance for Black persons across income or education levels. Accounting for how price intersects with other value considerations may improve the effectiveness of these strategies.

Understanding policy enactment: the New Orleans Fresh Food Retailer Initiative

BACKGROUND

Healthy-food financing initiatives have been endorsed as a way to improve food access, but relatively little research exists on understanding the formulation of such policies.

PURPOSE

This paper investigates the development of the New Orleans Fresh Food Retailer Initiative (FFRI) to highlight factors that enabled and impeded its enactment.

METHODS

In 2010 and 2011, semistructured interviews were conducted with 22 key informants with firsthand experience of this case, including representatives from the private sector, nonprofit organizations, and government. A participant-observer approach was used to synthesize these observations with archived written materials and the authors' own observations.

RESULTS

Historical disparities in food access in New Orleans were exacerbated by Hurricane Katrina, which also generated neighborhood activism and a pressing need to rebuild the city. A Food Policy Advisory Committee (FPAC) was formed from diverse groups. This paper describes the evolution of FPAC, its deliberations and report to the City Council, and actions to promote a financing initiative, as well as delays encountered in the process.

CONCLUSIONS

Enactment of the FFRI was facilitated by a window of opportunity that opened in the storm's aftermath, broad-based stakeholder buy-in, the existence of political champions, and policy-relevant information that was simple and convincing. Impediments to success included the constant turnover of city staff, a skeptical state bureaucracy, and the many competing priorities in New Orleans. This study highlights the importance of having a clear policy objective to address a well-defined and illustrated problem, key advocates in diverse organizations, and broad-based support for its implementation.

Balancing nurturance, cost and time: complementary feeding in Accra, Ghana

This paper presents a picture of the general patterns of complementary feeding behaviours in urban Ghana. A focused ethnographic study protocol for assessing complementary feeding developed for the Global Alliance for Improved Nutrition was used to collect data from caregivers of children 6-24 months of age. We examined the multiple factors that influence the selection of foods for infants and young children in this urban setting, and found that economic factors, health beliefs and other nurturing-related values, access to food and issues of convenience all play important roles. We conclude that the interactions of nurturance, cost and time are vectors that affect feeding decisions.

The effects of Hurricane Katrina on food access disparities in New Orleans

Disparities in neighborhood food access are well documented, but little research exists on how shocks influence such disparities. We examined neighborhood food access in New Orleans at 3 time points: before Hurricane Katrina (2004-2005), in 2007, and in 2009. We combined existing directories with on-the-ground verification and geographic information system mapping to assess supermarket counts in the entire city. Existing disparities for African American neighborhoods worsened after the storm. Although improvements have been made, by 2009 disparities were no better than prestorm levels.