Where do U.S. households purchase healthy foods? An analysis of food-at-home purchases across different types of retailers in a nationally representative dataset

Household Food Sourcing Patterns and Their Associations With Food Insecurity in Appalachian Ohio

BACKGROUND

Households experiencing food insecurity may use dynamic strategies to meet food needs. Yet, the relationship between household food sourcing behaviors and food security, particularly in rural settings, is understudied.

OBJECTIVE

To identify food sourcing patterns and their associations with food insecurity among households in rural Appalachian Ohio during the COVID-19 pandemic.

DESIGN

Survey data were collected from a cohort of households in Athens County, OH, in July 2020, October 2020, January 2021, and April 2021.

PARTICIPANTS/SETTING

The sample included 663 households with household food sourcing and food security information for ≥1 survey wave.

MAIN OUTCOME MEASURES

Household food sourcing patterns. Households reported the frequency with which they obtained food from various retailers and charitable sources, classified as supercenters, supermarkets, convenience stores, farmers markets, or charitable sources.

STATISTICAL ANALYSES

Principal component analysis was used to identify food sourcing patterns. Linear mixed models were used to assess changes in food sourcing behaviors over the study period and to determine whether food sourcing behaviors differed according to food security status.

RESULTS

Two patterns were identified: Convenience Stores and Charitable Food and Supermarkets and Farmers Markets, not Supercenters. Relative to July 2020, alignment of households' food sourcing behaviors with the Supermarkets and Farmers Markets, not Supercenters pattern was higher in October 2020 (β .07, 95% CI .02 to .12) and alignment with the Convenience Stores and Charitable Food pattern was lower in April 2021 (β -.06, 95% CI -.11 to -.02). Compared with food-secure households, food sourcing behaviors of food-insecure households were more closely aligned with the Convenience Stores and Charitable Food pattern (β .07, 95% CI .00 to .13); no statistically significant difference in scores was observed for the Supermarkets and Farmers Markets, not Supercenters pattern (β -.07, 95% CI -.15 to .02).

CONCLUSIONS

These findings support efforts to increase access to healthy, affordable options at venues where food-insecure households may be likely to obtain food, such as convenience stores and charitable sources.

Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state

INTRODUCTION

There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children.

MATERIALS AND METHODS

Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects.

RESULTS

Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33).

CONCLUSIONS

Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.

Evaluating the impact of marketing interventions on sugar-free and sugar-sweetened soft drink sales and sugar purchases in a fast-food restaurant setting

BACKGROUND

Beverages high in added sugar, such as sugar-sweetened soft drinks, continue to be associated with various health issues. This study examines the effects of a manufacturer-initiated multicomponent intervention on the sales of sugar-free (SFD) and sugar-sweetened (SSD) soft drinks and the amount of sugar people purchase from soft drinks in a fast-food restaurant setting.

METHODS

A database of monthly sales data of soft drinks from January 2016 to December 2018 was obtained from three treatment and three control fast-food restaurants. A multicomponent intervention consisting of free coupons, point-of-purchase displays, a menu board, and two sugar-free replacements for sugar-sweetened soft drinks was introduced in August 2018 for five months in Western Sydney, Australia. A retrospective interrupted time series analysis was used to model the data and examine the effects of the interventions on SFD and SSD sales and their consequential impact on sugar purchases from soft drinks. The analyses were carried out for volume sales in litres and sugar in grams per millilitre of soft drinks sales. A comparison of these measures within the treatment site (pre- and post-intervention) and between sites (treatment and control) was conducted.

RESULTS

The interventions had a statistically significant impact on SFDs but not SSDs. On average, SFD sales in the treatment site were 56.75% higher than in the control site. Although SSD sales were lower in the treatment site, the difference with the control site was not statistically significant. The net reduction of 6.34% in the amount of sugar purchased from soft drinks between sites during the experimental period was attributed to the interventions.

CONCLUSIONS

The interventions significantly increased SFD sales and reduced sugar purchases in the short run. Aside from free coupons, the findings support the recommendation for fast food restaurants to nudge customers towards choosing SFDs through point-of-purchase displays and the replacement of popular SSDs with their SFD counterparts.

Regional Variation in Hormonal and Metabolic Parameters of White and Black Women With PCOS in the United States

CONTEXT

Ongoing research is needed to determine geo-epidemiologic differences of polycystic ovary syndrome (PCOS).

OBJECTIVE

Determine hormonal and metabolic parameters of women with PCOS in 2 environments.

METHODS

Prospective cohort study.

SETTING

Tertiary-care based specialty clinics in Alabama and California.

PATIENTS OR OTHER PARTICIPANTS

A total of 1610 women with PCOS by National Institutes of Health Criteria from 1987 to 2010.

INTERVENTIONS

Interview, physical examination, laboratory studies.

MAIN OUTCOMES MEASURES

Demographic data, menstrual cycle history, and hormonal and metabolic parameters were collected. Hirsutism was defined as modified Ferriman-Gallwey scores ≥4. Androgen values greater than laboratory reference ranges or >95th percentile of all values were considered elevated (hyperandrogenemia). Metabolic parameters included body mass index (BMI), waist-hip-ratio (WHR), glucose tolerance test, and homeostatic model assessment for insulin resistance (HOMA-IR) scores.

RESULTS

Alabama women with PCOS were younger with a higher BMI. After adjustment for age and BMI, Alabama women with PCOS were more likely hirsute (adjusted odds ratio [aOR], 1.8; 95% CI, 1.4-2.4; P < 0.001), with elevated HOMA-IR scores (adjusted beta coefficient 3.6; 95% CI, 1.61-5.5; P < 0.001). California women with PCOS were more likely to have hyperandrogenemia (free testosterone aOR, 0.14; 95% CI, 0.11-0.18; P < 0.001; total testosterone aOR, 0.41; 95% CI, 0.33-0.51). Results were similar when stratified by White race. In Black women with PCOS, BMI and WHR did not differ between locations, yet differences in androgen profiles and metabolic dysfunction remained.

CONCLUSION

Alabama women with PCOS, regardless of Black or White race, were more likely hirsute with metabolic dysfunction, whereas California women with PCOS were more likely to demonstrate hyperandrogenemia, highlighting potential environmental impacts on PCOS.

Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples

OBJECTIVE

We examined whether relative availability of fast-food restaurants and supermarkets mediates the association between worse neighborhood socioeconomic conditions and risk of developing type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS

As part of the Diabetes Location, Environmental Attributes, and Disparities Network, three academic institutions used harmonized environmental data sources and analytic methods in three distinct study samples: 1) the Veterans Administration Diabetes Risk (VADR) cohort, a national administrative cohort of 4.1 million diabetes-free veterans developed using electronic health records (EHRs); 2) Reasons for Geographic and Racial Differences in Stroke (REGARDS), a longitudinal, epidemiologic cohort with Stroke Belt region oversampling (N = 11,208); and 3) Geisinger/Johns Hopkins University (G/JHU), an EHR-based, nested case-control study of 15,888 patients with new-onset T2D and of matched control participants in Pennsylvania. A census tract-level measure of neighborhood socioeconomic environment (NSEE) was developed as a community type-specific z-score sum. Baseline food-environment mediators included percentages of 1) fast-food restaurants and 2) food retail establishments that are supermarkets. Natural direct and indirect mediating effects were modeled; results were stratified across four community types: higher-density urban, lower-density urban, suburban/small town, and rural.

RESULTS

Across studies, worse NSEE was associated with higher T2D risk. In VADR, relative availability of fast-food restaurants and supermarkets was positively and negatively associated with T2D, respectively, whereas associations in REGARDS and G/JHU geographies were mixed. Mediation results suggested that little to none of the NSEE-diabetes associations were mediated through food-environment pathways.

CONCLUSIONS

Worse neighborhood socioeconomic conditions were associated with higher T2D risk, yet associations are likely not mediated through food-environment pathways.

Changes in the Retail Food Environment in Mexican Cities and Their Association with Blood Pressure Outcomes

Shifting food environments in Latin America have potentially contributed to an increase in the consumption of ultra-processed foods and sugar-sweetened beverages, along with decreases in healthy foods, such as fruits and vegetables. Yet, little is known about the impact that such changes in the food environment have on blood pressure in low- and middle-income countries, including Mexico. We utilized individual-level systolic and diastolic blood pressure (SBP and DBP) measures from the 2016 Mexican Health and Nutrition Survey (ENSANUT, n = 2798 adults). Using an inventory of food stores based on the economic census for 2010 and 2016, we calculated the change in the density of fruit and vegetable stores, convenience stores, and supermarkets. Multilevel regression was used to estimate the association between the 2010–2016 food environment neighborhood-level changes with individual-level blood pressure measured in 2016. Declines in neighborhood-level density of fruit and vegetable stores were associated with higher individual SBP (2.67 mmHg, 95% CI: 0.1, 5.2) in unadjusted models, and marginally associated after controlling for individual-level and area-level covariates. Increases in the density of supermarkets were associated with higher blood pressure outcomes among adults with undiagnosed hypertension. Structural interventions targeting the retail food environment could potentially contribute to better nutrition-related health outcomes in Latin American cities.

Food Acquisition Practices, Body Mass Index, and Dietary Outcomes by Level of Rurality

PURPOSE

Rural residents are more likely to be obese than urban residents. Research on how people navigate their local food environments through food acquisition behaviors, such as food shopping and restaurant use, in different types of communities may help to create a deeper understanding of the multilevel determinants of obesity.

METHODS

Data are from a national sample of US adults ages 18-75. Respondents were recruited from an online survey panel in 2015 and asked about food shopping, restaurant use, diet and weight (N = 3,883). Comparisons were made by level of rurality as assessed by Rural-Urban Continuum Codes (RUCC) and self-reported rurality of the area around their home.

FINDINGS

Food acquisition behaviors varied minimally by RUCC-defined level of rurality, with the exceptions of type and distance to primary food store. Rural residents drove further and were more likely to shop at small grocery stores and supercenters than were residents of semiurban or urban counties. In contrast, all of the food acquisition behaviors varied by self-reported rurality of residential areas. Respondents living in rural areas shopped for groceries less frequently, drove further, more commonly shopped at small grocery stores and supercenters, and used restaurants less frequently. In multivariable analyses, rural, small town, and suburban areas were each significantly associated with BMI and fruit and vegetable intake, but not percent energy from fat.

CONCLUSION

Findings show that self-reported rurality of residential area is associated with food acquisition behaviors and may partly explain rural-urban differences in obesity and diet quality.

Philadelphia's Excise Tax on Sugar-Sweetened and Artificially Sweetened Beverages and Supplemental Nutrition Assistance Program Benefit Redemption

Objectives. To assess the effect of a 2017 excise tax on sugar and artificially sweetened beverages in Philadelphia, Pennsylvania, on the shopping patterns of low-income populations using Supplemental Nutrition Assistance Program (SNAP) data. Methods. I used a synthetic controls approach to estimate the effect of the tax on Philadelphia and neighboring Pennsylvania counties (Bucks, Delaware, and Montgomery) as measured by total SNAP sales ("SNAP redemption") and SNAP redemption per SNAP participant. I assembled biannual data (2005-2019) from all US counties for SNAP redemption and relevant predictors. I performed placebo tests to estimate statistically significant effects and conducted robustness checks. Results. Detectable increases in SNAP spending occurred in all 3 Philadelphia neighboring counties. Per-participant SNAP spending increased in 2 of the neighboring counties and decreased in Philadelphia. These effects were robust across multiple specifications and placebo tests. Conclusions. The tax contributed to increased SNAP shopping in Philadelphia's neighboring counties across both outcome measures, and decreased spending in Philadelphia (at least by 1 measure). This raises questions about retailer behavior, the effectiveness of the tax's public health aim of reducing sugar-sweetened beverage consumption, and policy aims of investing in low-income communities. (Am J Public Health. 2021;111(11):1986-1996. https://doi.org/10.2105/AJPH.2021.306464).

Heterogeneities in Consumer Diet Quality and Health Outcomes of Consumers by Store Choice and Income

Obesity and other diet-related health conditions have received much attention in the public health literature over the past two decades. This study investigates the relationship between household food budget shares at different food outlets with diet quality and weight-related health outcomes in the United States. Our analysis used event-level food purchase data from the national household food acquisition and purchases survey (FoodAPS). We find that, after controlling for observables, food purchase location is significantly associated with diet quality and body mass index (BMI). Our findings indicate that larger food budget shares at convenience stores and restaurants are linked with poor diet quality based on the healthy eating index-2015 (HEI-2015) scores and higher BMI. We further explored potential heterogeneity on outcomes of interest across income groups. Results suggest heterogeneous effects may exist across income groups: low-income households, who spent a larger share of their food budget at convenience stores and fast-food restaurants are related to poor diet quality and more likely to be obese. Our findings will help improve understanding of the causes of diet-related health problems and may illuminate potential avenues of intervention to address obesity.

Socio-economic and racial/ethnic disparities in the nutritional quality of packaged food purchases in the USA, 2008-2018

OBJECTIVE

To determine whether disparities exist in the nutritional quality of packaged foods and beverage purchases by household income, education and race/ethnicity and if they changed over time.

DESIGN

We used Nielsen Homescan, a nationally representative household panel, from 2008 to 2018 (n = 672 821 household-year observations). Multivariate, multilevel regressions were used to model the association between sociodemographic groups and a set of nutritional outcomes of public health interest, including nutrients of concern (sugar, saturated fat and Na) and calories from specific food groups (fruits, non-starchy vegetables, processed meats, sugar-sweetened beverages and junk foods).

SETTING

Household panel survey.

PARTICIPANTS

Approximately 60 000 households each year from the USA.

RESULTS

Disparities were found by income and education for most outcomes and widened for purchases of fruits, vegetables and the percentage of calories from sugar between 2008 and 2018. The magnitude of disparities was largest by education. Disparities between Black and White households include the consumption of processed meats and the percentage of calories from sugar, while no disparities were found between White and Hispanic households. Disparities have been largely persistent, as any significant changes over time have been substantively small.

CONCLUSIONS

Policies to improve the healthfulness of packaged foods must be expanded beyond SSB taxes, and future research should focus on what mediates the relationship between education and diet so as not to exacerbate disparities.

Understanding the Intersection of Race/Ethnicity, Socioeconomic Status, and Geographic Location: A Scoping Review of U.S. Consumer Food Purchasing

Disparities in diet quality persist in the U.S. Examining consumer food purchasing can provide unique insight into the nutritional inequities documented by race/ethnicity, socioeconomic status (SES), and geographic location (i.e., urban vs. rural). There remains limited understanding of how these three factors intersect to influence consumer food purchasing. This study aimed to summarize peer-reviewed scientific studies that provided an intersectional perspective on U.S. consumer food purchasing. Thirty-four studies were examined that presented objectively measured data on purchasing outcomes of interest (e.g., fruits, vegetables, salty snacks, sugar-sweetened beverages, Healthy Eating Index, etc.). All studies were of acceptable or high quality. Only six studies (17.6%) assessed consumer food purchases at the intersection of race/ethnicity, SES, or geographic location. Other studies evaluated racial/ethnic or SES differences in food purchasing or described the food and/or beverage purchases of a targeted population (example: low-income non-Hispanic Black households). No study assessed geographic differences in food or beverage purchases or examined purchases at the intersection of all three factors. Overall, this scoping review highlights the scarcity of literature on the role of intersectionality in consumer food and beverage purchasing and provides recommendations for future studies to grow this important area of research.

Longitudinal changes in the retail food environment in Mexico and their association with diabetes

The retail food environment is a potential population-level determinant of diet and nutrition-related chronic diseases, yet little is known about its composition and association with diabetes in low- and middle-income countries. Our objectives were: (1) to describe changes in the composition of the retail food environment in Mexican neighborhoods from 2010 to 2016 and (2) to examine the association between these changes and diabetes cases diagnosed over the same period. Individual level data came from the 2016 Mexican Health and Nutrition Survey (N = 2808 adults). Neighborhood level retail food environment data for 2010 and 2016 came from the National Directory of Economic Units of Mexico. Multilevel logistic regression was used to examine the adjusted association between changes in the neighborhood density per km² of fruit and vegetable stores, chain convenience stores and supermarkets with diabetes. Small store formats still predominate in Mexico's food environment, however there is evidence of fast increase in chain convenience stores and supermarkets. Adults living in neighborhoods that saw a decline in fruit and vegetable store density and a simultaneous increase in chain convenience store density experienced higher odds of diabetes, compared to adults who lived in neighborhoods where fruit and vegetable and convenience stores did not change (OR 3.90, 95% CI 1.61, 9.48). Considering the complex interplay between store types, understanding the mechanisms and confirming the causal implications of these findings could inform policies that improve the quality of food environments in cities.

•

We examined changes in the retail food environment in Mexican cities.

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We also examined whether those changes were associated with new diabetes cases.

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Small food stores still predominate but evidence of fast increase in chain convenience stores and supermarkets.

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Odds of diabetes were highest when fruit and vegetable stores declined and chain convenience stores increased.

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Changes in the density of supermarkets were not associated with diabetes.

Comparison of food and beverage products' availability, variety, price and quality in German and US supermarkets

Objective:

To assess availability, variety, price and quality of different food products in a convenience sample of supermarkets in Germany and the USA.

Design:

Cross-sectional study using an adapted version of the Bridging the Gap Food Store Observation Form.

Setting:

Information on availability, quality, price and variety of selected food products in eight German and seven US supermarkets (discount and full service) was obtained and compared by country.

Results:

A general tendency for lower prices of fruits and vegetables in Germany was observed, while produce quality and variety did not seem to differ between countries, with the exception of the variety of some vegetables such as tomatoes. Chips and cereals did not differ significantly in variety nor price. In both countries, high energy-dense foods were lower in energy costs than lower energy-dense foods.

Conclusions:

The influence of food prices and availability on consumption should be further explored, including the impact of country differences.

Urban-regional patterns of food purchasing behaviour: a cross-sectional analysis of the 2015-2016 Australian Household Expenditure Survey

BACKGROUND/OBJECTIVES

In many high-income countries people living in regional (rural) areas have higher rates of chronic disease compared to people living in urban areas. Food purchasing behaviour provides a potential pathway linking residential location with dietary intake and health outcomes. This study examined the relationship between geographic location and food expenditure on a range of foods.

SUBJECTS/METHODS

Data from the 2015-2016 Australian Household Expenditure Survey (number of households = 9827) were used to examine weekly household food expenditure and proportion of total food expenditure on 14 categories of food items. Foods were classified using the Australian Guide to Healthy Eating. Two-part models and zero-one inflated beta regression models were used to assess the association between geographic area and food expenditure.

RESULTS

Average proportion of total food expenditure on fruit was estimated to be more for households located in major cities compared to households located in inner and outer regional areas. Households located in inner and outer regional areas allocated less to fresh fruit, fish and meals out compared to households in major cities. Households located in inner regional areas allocated a greater proportion of their food budget to sweet cakes, biscuits, puddings, desserts, chocolate and ice-cream compared to households in major cities and outer regional areas.

CONCLUSIONS

The geographic patterns in food purchasing suggest those in regional areas may be at risk of diets less aligned with healthy guidelines. Given the findings of this study suggesting geographic differences in food purchasing, further research is warranted to enhance contextual understanding of food purchasing behaviours in regional areas.

Fruit and Vegetable Purchasing Patterns and Supplemental Nutrition Assistance Program Participation: Findings From a Nationally Representative Survey

BACKGROUND

Previous studies suggest that Supplemental Nutrition Assistance Program (SNAP) participants purchase less produce than nonparticipants. Whether this is due to buying smaller amounts or to being less likely to buy any produce is unclear. Purchase patterns may also differ over the monthly distribution cycle.

OBJECTIVE

To examine differences in the likelihood and amounts of fruits and vegetables purchased between SNAP household compared with nonparticipant households and to determine differences in produce purchases among SNAP households at different time points in the monthly distribution cycle.

DESIGN

Cross-sectional.

PARTICIPANTS/SETTING

Data from 4708 households in the National Household Food Acquisition and Purchase Survey (April 2012 to January 2013). Participants recorded all foods acquired over 7 days.

MAIN OUTCOME MEASURES

Fruits and vegetables acquired over a 7-day period.

STATISTICAL ANALYSES PERFORMED

Weighted logistic and linear regression models adjusting for household and primary respondent characteristics were used to compare odds of purchasing fruits and vegetables and amounts purchased across 3 categories: SNAP participants, SNAP-eligible nonparticipants, and ineligible nonparticipants. SNAP participants were further subdivided according to weeks since last receiving benefits.

RESULTS

In adjusted analyses, SNAP participants and nonparticipants were similarly likely to purchase fruits and vegetables. However, SNAP households within a week of receiving benefits were more likely than SNAP households later in the benefit cycle to buy fruit overall, especially frozen or canned fruit, and vegetables overall, including fresh, frozen or canned, starchy, and nonstarchy vegetables (fruit odds ratio [OR] 1.68, 95% confidence interval [CI] 1.12, 2.53; vegetable OR 1.63, 95% CI 1.04, 2.55 vs households in middle of cycle). In contrast, those in the last week of the benefit cycle were less likely to purchase fruit, especially fresh fruit, and vegetables, especially fresh and nonstarchy vegetables (fruit OR 0.58, 95% CI 0.35, 0.94; vegetable OR 0.58, 95% CI 0.42, 0.79 vs. households in middle of cycle), and when they bought vegetables, they bought significantly less.

CONCLUSION

Considering all SNAP households together at different points in their distribution cycle masks substantial declines in purchasing fruits and vegetables over the monthly cycle.

The effect of time use and food cost on dietary quality

OBJECTIVE

To develop a questionnaire to measure food nutrition, food expenditures and time spent in food-related activities; and to assess the association between diet quality, time spent in food-related activities and food expenditures using data from a pilot study.

DESIGN

Cross-sectional study. Multiple linear regression models were used to analyse participants' survey response behaviours and the relationship between food nutritional quality and time and money expenditures.

SETTING

Online survey using Qualtrics software in a public university located in West Texas, USA.

PARTICIPANTS

Faculty and staff aged 18 years and older from a public university located in West Texas, USA.

RESULTS

Combining questions from three survey instruments that collect data on food nutrition, food expenditures and time spent in food-related activities resulted in a thirty-page survey instrument. The median completion time of the survey instrument was about 30 min. Preliminary results suggest that time and money expenditures are associated with food quality but that their role is small relative to sociodemographic characteristics such as race and gender.

CONCLUSIONS

Time and money expenditures are associated with food quality but their role is small relative to sociodemographic characteristics such as race and gender.

Supplemental Nutrition Assistance Program Data: Why Disclosure Is Needed

The Supplemental Nutrition Assistance Program (SNAP) provides funding to low-income households to purchase food at participating stores. The goals of the program include reducing hunger, improving nutrition, and strengthening the US food system. These are interrelated, as food access and choice depend on availability.SNAP generates data that could be useful for program evaluation and evidence-based policymaking to reach public health goals. However, the US Department of Agriculture (USDA) does not collect or disclose all SNAP-related data. In particular, the USDA does not systematically collect food expenditure data, and although it does collect transaction (sales) and redemption data (the amount retailers are reimbursed through SNAP), it does not release these data at the store level.In 2018, Congress quietly changed the law to prohibit the USDA from disclosing store-level transaction and redemption data, and in 2019, the US Supreme Court blocked disclosure of these data. These federal proceedings can inform the outcome of additional efforts to disclose SNAP-related data, as well as future research and policy evaluation to support improved public health outcomes for SNAP beneficiaries.

A Systematic Review on Socioeconomic Differences in the Association between the Food Environment and Dietary Behaviors

Little is known about socioeconomic differences in the association between the food environment and dietary behavior. We systematically reviewed four databases for original studies conducted in adolescents and adults. Food environments were defined as all objective and perceived aspects of the physical and economic food environment outside the home. The 43 included studies were diverse in the measures used to define the food environment, socioeconomic position (SEP) and dietary behavior, as well as in their results. Based on studies investigating the economic (n = 6) and school food environment (n = 4), somewhat consistent evidence suggests that low SEP individuals are more responsive to changes in food prices and benefit more from healthy options in the school food environment. Evidence for different effects of availability of foods and objectively measured access, proximity and quality of food stores on dietary behavior across SEP groups was inconsistent. In conclusion, there was no clear evidence for socioeconomic differences in the association between food environments and dietary behavior, although a limited number of studies focusing on economic and school food environments generally observed stronger associations in low SEP populations. (Prospero registration: CRD42017073587)

Availability of neighbourhood supermarkets and convenience stores, broader built environment context, and the purchase of fruits and vegetables in US households

OBJECTIVE

To determine whether neighbourhood supermarket and convenience store availability and broader built environment context are associated with food purchasing behaviour in a national population.

DESIGN

We used observational data to perform a cross-sectional study of food purchases for US households in 2010. We used three-level mixed-effect regression models to determine whether the associations between the number of neighbourhood supermarkets and convenience stores and the self-reported annual household expenditures for fruits and vegetables were affected by regional destination accessibility, neighbourhood destination diversity, availability of neighbourhood destinations and neighbourhood street connectivity.

SETTING

Metropolitan statistical areas (n 378) in the USA.

PARTICIPANTS

Households (n 22 448).

RESULTS

When we controlled for broader built environment context, there was no significant association between availability of neighbourhood supermarkets and expenditures on fruits and vegetables; instead, we observed an inverse association between the number of convenience stores and expenditures for fruits (P = 0·001). The broader built environment context was associated with food purchase, although the magnitude was small: (i) higher regional destination accessibility was associated with higher expenditures for fruits (P < 0·001); (ii) higher neighbourhood destination diversity was associated with lower expenditures for vegetables (P = 0·002); and (iii) higher neighbourhood street connectivity was associated with higher expenditures for fruits (P < 0·001).

CONCLUSIONS

The broader built environment factors contributed to understanding how people use neighbourhood food stores. However, there was only a small relationship between the broader environment context and fruit and vegetable expenditures. Policy interventions that focus exclusively on increasing the availability of neighbourhood supermarkets likely will not promote fruit and vegetable consumption.

Delay discounting and household food purchasing decisions: The SHoPPER study

OBJECTIVE

Delay discounting is a neurocognitive trait that has been linked to poor nutritional health and obesity, but its role in specific dietary choices is unclear. This study tested whether individual differences in delay discounting are related to the healthfulness of household food purchases and reliance on nonstore food sources such as restaurants.

METHOD

The food purchases of 202 primary household food shoppers were objectively documented for 14 days through a food receipt collection and analysis protocol. The nutrient content of household food purchases was derived for each participant, and the overall diet quality (Healthy Eating Index-2015) and energy density (kcal/g) of foods and beverages were calculated. The proportion of energy from nonstore food sources was also derived. Delay discounting was assessed with a choice task featuring hypothetical monetary rewards.

RESULTS

Data were available for 12,624 foods and beverages purchased across 2,340 shopping episodes. Approximately 13% of energy was purchased from restaurants and other nonstore food sources. Steeper discounting rates were associated with lower overall Healthy Eating Index-2015 scores and a higher energy density (kcal/g) of purchased foods. Associations were attenuated but remained statistically significant when accounting for body mass index and sociodemographic variables. Discounting rates were unrelated to reliance on nonstore food sources or the energy density of purchased beverages.

CONCLUSIONS

Delay discounting is related to the healthfulness of food purchases among primary household shoppers. As food purchasing is a key antecedent of dietary intake, delay discounting may be a viable target in dietary and weight management interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Spatial Association of Food Sales in Supermarkets with the Mean BMI of Young Men: An Ecological Study

Supermarket food sales data might serve as a simple indicator of population-level dietary habits that influence the prevalence of excess weight in local environments. To test this possibility, we investigated how variation in store-level food sales composition across Switzerland is associated with the mean Body Mass Index (BMI) of young men (Swiss Army conscripts) living near the stores. We obtained data on annual food sales (2011) for 553 stores from the largest supermarket chain in Switzerland, identified foods commonly regarded as “healthy” or “unhealthy” based on nutrient content, and determined their contribution to each store’s total sales (Swiss francs). We found that the sales percentages of both “healthy” and “unhealthy” food types varied by 2- to 3-fold among stores. Their balance ranged from −15.3% to 18.0% of total sales; it was positively associated with area-based socioeconomic position (r = 0.63) and negatively associated with the mean BMI of young men in the area (r = −0.42). Thus, even though we compared supermarkets from a single chain, different shopping behaviors of customers caused stores in privileged areas to sell relatively more healthy food. Knowledge about such patterns could help in designing in-store interventions for healthier nutrition and monitoring their effects over time.

Participation in the Supplemental Nutrition Assistance Program and Dietary Behaviors: Role of Community Food Environment

BACKGROUND

The United States Department of Agriculture's Supplemental Nutrition Assistance Program (SNAP) is the country's largest nutrition assistance program for low-income populations. Although SNAP has been shown to reduce food insecurity, research findings on the diet quality of program participants are inconsistent.

OBJECTIVE

This study evaluated whether the community food environment is a potential moderator of the association between SNAP participation and eating behaviors.

DESIGN

This cross-sectional study used participant data from a telephone survey of 2,211 households in four cities in New Jersey. Data were collected from two cross-sectional panels from 2009 to 2010 and 2014. Food outlet data were purchased from commercial sources and classified as supermarkets, small grocery stores, convenience stores, or limited service restaurants.

PARTICIPANTS/SETTING

Analysis is limited to 983 respondents (588 SNAP participants) with household incomes below 130% of the federal poverty level.

MAIN OUTCOME MEASURES

Eating behaviors were assessed as frequency of consumption of fruit, vegetables, salad, and sugar-sweetened beverages.

STATISTICAL ANALYSES PERFORMED

Interaction and stratified analyses using gamma regression determined the differences in the association between SNAP participation and eating behaviors by the presence or absence of food outlets adjusted for covariates.

RESULTS

SNAP participation was associated with a higher frequency of consuming sugar-sweetened beverages (P<0.05) when respondents lived within ¼ to ½ mile of a small grocery store, supermarket, and limited service restaurant. SNAP participants who did not live close to a convenience store reported a lower frequency of sugar-sweetened beverage consumption (P=0.01), and those living more than ½ mile away from a supermarket reported a lower frequency of fruit consumption (P=0.03).

CONCLUSIONS

The findings from this study suggest that the community food environment may play a role in moderating the association between SNAP participation and eating behaviors. Although SNAP participation is associated with some unhealthy behaviors, this association may only hold true when respondents live in certain food environments.