Neighbourhood fruit and vegetable availability and consumption: the role of small food stores in an urban environment

Urban environment exposures, energy balance-related behaviors and their combination in preschoolers from three European countries

BACKGROUND

Urban environments are characterized by many factors that may influence children's energy balance-related behaviors (EBRBs), but there is limited research on the impact of prospective exposure to multiple urban factors in preschoolers. We evaluated prospective associations between various urban exposures and EBRBs in preschoolers across Europe, with EBRBs considered both individually and combined into lifestyle patterns.

METHODS

We used data from 4,073 preschoolers (aged 3-4 years) participating in three European cohorts from the EU Child Cohort Network: BiB (United Kingdom), EDEN (France), and INMA (Spain). Eighteen built and food environment, green spaces, road traffic and ambient air pollution exposures were characterized at residential addresses. Various EBRBs were considered as the outcomes including screen time, sleep duration and diet (fruit, vegetables, discretionary sweet foods, sweet beverages) individually and combined into unhealthy lifestyle patterns, using principal components analysis. Associations between urban exposures and outcomes were estimated using a single-exposure analysis and the deletion-substitution-addition algorithm was used to construct multi-exposure models.

RESULTS

In multi-exposure models, greater walkability and smaller distance to the nearest road were associated with higher scores on the unhealthy lifestyle patterns. Likewise, greater walkability was associated with higher screen time and more frequent discretionary sweet food consumption. A smaller distance to the nearest road was also associated with lower sleep duration and more frequent sweet beverages consumption. On the other hand, higher levels of street connectivity showed an inverse association with the unhealthy lifestyle patterns. In the same vein, greater street connectivity was associated with decreased screen time.

CONCLUSION

This comprehensive examination of multiple urban exposures indicates that residing in walkable environments and in close proximity to roads in densely-populated areas may not be advantageous for children EBRBs, while residing in neighborhoods with higher street connectivity appears to supposedly be beneficial.

Promoting healthful food purchases through in-store interventions: Empirical evidence from rural food deserts

Effective ways to promote healthful food intake in rural areas are understudied. The paper evaluated whether a two-component, in-store intervention designed to encourage healthy food purchases was associated with improved healthfulness scores of food items purchased by shoppers in rural food deserts. One component introduced a point-of-sales label that assigned a single numerical score to each food item facilitating direct comparisons of the product's nutrition with those of other products shelved around it. The other component was a one-day nutrition education workshop promoted within the store. Interventions took place in 2015 at two stores in rural counties in the U.S. Midwest. Four stores in similar communities were selected as the control group. We applied a difference-in-difference model to estimate changes in the healthfulness of food items purchased attributable to the intervention among shoppers at the treatment stores (n = 486) and control stores (n = 10,759) using store transaction data. Healthfulness of food items was measured in terms of food scores published by the Environmental Working Group on a 1-10 scale. Both components had minimal impacts on the scores, although 0.2 and 0.1 points increases in the score per item and score per dollar were statistically significant at the 1% level respectively. A year after the intervention, these small effects of the intervention further diminished compared to the immediately after implementation. Results suggest the average effects of intervention across the study communities had limited practical significance but benefited some rural residents who were exposed to the intervention.

New insights into grocery store visits among east Los Angeles residents using mobility data

In this study, we employed spatially aggregated population mobility data, generated from mobile phone locations in 2021, to investigate patterns of grocery store visits among residents east and northeast of Downtown Los Angeles, in which 60% of the census tracts had previously been designated as "food deserts". Further, we examined whether the store visits varied with neighborhood sociodemographics and grocery store accessibility. We found that residents averaged 0.4 trips to grocery stores per week, with only 13% of these visits within home census tracts, and 40% within home and neighboring census tracts. The mean distance from home to grocery stores was 2.2 miles. We found that people visited grocery stores more frequently when they lived in neighborhoods with higher percentages of Hispanics/Latinos, renters and foreign-born residents, and a greater number of grocery stores. This research highlights the utility of mobility data in elucidating grocery store use, and factors that may facilitate or be a barrier to store access. The results point to limitations of using geographically constrained metrics of food access like food deserts.

Assessing the association between food environment and dietary inflammation by community type: a cross-sectional REGARDS study

BACKGROUND

Communities in the United States (US) exist on a continuum of urbanicity, which may inform how individuals interact with their food environment, and thus modify the relationship between food access and dietary behaviors.

OBJECTIVE

This cross-sectional study aims to examine the modifying effect of community type in the association between the relative availability of food outlets and dietary inflammation across the US.

METHODS

Using baseline data from the REasons for Geographic and Racial Differences in Stroke study (2003-2007), we calculated participants' dietary inflammation score (DIS). Higher DIS indicates greater pro-inflammatory exposure. We defined our exposures as the relative availability of supermarkets and fast-food restaurants (percentage of food outlet type out of all food stores or restaurants, respectively) using street-network buffers around the population-weighted centroid of each participant's census tract. We used 1-, 2-, 6-, and 10-mile (~ 2-, 3-, 10-, and 16 km) buffer sizes for higher density urban, lower density urban, suburban/small town, and rural community types, respectively. Using generalized estimating equations, we estimated the association between relative food outlet availability and DIS, controlling for individual and neighborhood socio-demographics and total food outlets. The percentage of supermarkets and fast-food restaurants were modeled together.

RESULTS

Participants (n = 20,322) were distributed across all community types: higher density urban (16.7%), lower density urban (39.8%), suburban/small town (19.3%), and rural (24.2%). Across all community types, mean DIS was - 0.004 (SD = 2.5; min = - 14.2, max = 9.9). DIS was associated with relative availability of fast-food restaurants, but not supermarkets. Association between fast-food restaurants and DIS varied by community type (P for interaction = 0.02). Increases in the relative availability of fast-food restaurants were associated with higher DIS in suburban/small towns and lower density urban areas (p-values < 0.01); no significant associations were present in higher density urban or rural areas.

CONCLUSIONS

The relative availability of fast-food restaurants was associated with higher DIS among participants residing in suburban/small town and lower density urban community types, suggesting that these communities might benefit most from interventions and policies that either promote restaurant diversity or expand healthier food options.

The association between the food environment and adherence to healthy diet quality: the Maastricht Study

OBJECTIVE

The purpose of this study is to determine if healthier neighbourhood food environments are associated with healthier diet quality.

DESIGN

This was a cross-sectional study using linear regression models to analyse data from the Maastricht Study. Diet quality was assessed using data collected with a FFQ to calculate the Dutch Healthy Diet (DHD). A buffer zone encompassing a 1000 m radius was created around each participant home address. The Food Environment Healthiness Index (FEHI) was calculated using a Kernel density analysis within the buffers of available food outlets. The association between the FEHI and the DHD score was analysed and adjusted for socio-economic variables.

SETTING

The region of Maastricht including the surrounding food retailers in the Netherlands.

PARTICIPANTS

7367 subjects aged 40-75 years in the south of the Netherlands.

RESULTS

No relationship was identified between either the FEHI (B = 0·62; 95 % CI = -2·54, 3·78) or individual food outlets, such as fast food (B = -0·07; 95 % CI = -0·20, 0·07) and diet quality. Similar null findings using the FEHI were identified at the 500 m (B = 0·95; 95 % CI = -0·85, 2·75) and 1500 m (B = 1·57; 95 % CI = -3·30, 6·44) buffer. There was also no association between the food environment and individual items of the DHD including fruits, vegetables and sugar-sweetened beverages.

CONCLUSION

The food environment in the Maastricht area appeared marginally unhealthy, but the differences in the food environment were not related to the quality of food that participants reported as intake.

Healthy home food environments of pregnant Black women are shaped by food outlet access and participation in nutrition assistance programs

OBJECTIVES

Improving access to healthy food in Black communities is imperative to combat intergenerational health disparities. Pregnant Black women represent an especially vulnerable population to multiple (and overlapping) sources of socioeconomic and political disenfranchisement and thus for whom maternal nutrition is crucial. This study aimed to (1) define household food environment types, (2) determine whether the distribution of community food outlets is associated with these household food environment types, and (3) determine whether the community-household food environment relationship differs by maternal education or participation in nutrition assistance programs.

METHODS

Cross-sectional data for pregnant Black women in North Carolina (n = 429) come from the Mothers & Others study, an obesity-prevention randomized control trial, with linked spatial data on all community food outlets (n = 6312) in the study area in 2015. Factor analysis was used to define household food environment types. These factor scores were regressed on access metrics to community food outlets. Adjusted linear regressions tested interaction by maternal education and nutrition assistance programs.

RESULTS

Four household food environment types were defined: Factor 1 (fresh fruits and vegetables (F/V), low snack), Factor 2 (canned F/V, sweet drinks), Factor 3 (dried/frozen F/V, candy), and Factor 4 (low F/V, soda). Having more convenience stores within 0.25 miles was associated with higher Factor 4 scores. No food outlets were associated with higher Factor 1 scores overall. However, SNAP or WIC participating households saw higher Factor 1 scores with increased access to supermarkets, convenience stores, and dollar stores.

CONCLUSIONS

Nutrition assistance programs play an important role as buffers against unhealthy community food environments which influence household food environments and maternal nutrition.

Exploration of the food environment in different socioeconomic areas in Hong Kong and Singapore: a cross-sectional case study

This study explored the local food environment of Hong Kong and Singapore using a qualitative case study approach to inform future upstream public health nutrition policies. Food outlets that provide food to be eaten in the home were mapped in selected areas of high and low socioeconomic status (SES) of Hong Kong and Singapore. Food outlet density relative to land area was determined. In both countries, lower SES areas surveyed were shown to have higher food outlet density while higher SES areas had fewer but larger food outlets. In Hong Kong, both SES areas reported similar proportions of healthy and unhealthy food outlets.This study highlights the accessibility of food outlet types through their geographical location and density. Future research assessing the differences in eating culture between these two countries should be considered alongside this study's findings, to investigate strategies influencing the food environment in order to promote healthier eating habits.

Beyond the Plate: Uncovering Inequalities in Fruit and Vegetable Intake across Indonesian Districts

BACKGROUND

Non-communicable diseases (NCDs) are responsible for the deaths of 41 million individuals every year, with 77% of them occurring in low- and middle-income countries. Among the main NCD risk factors, inadequate intake of fruits and vegetables (FV) was one of the leading causes of death in 2019. Our study aims to identify disparities in inadequate FV intake among adults in 514 districts. We utilized the latest Indonesian Basic Health Survey 2018 to conduct geospatial and quantitative analyses. We used the World Health Organization's definition of inadequate FV intake, which refers to consuming less than five servings of fruit and vegetables daily. We analyzed inadequate FV intake among adults over the age of 18 years, as well as by gender and age group (including young adults 18-24 years, adults 25-59 years, and older adults 60+ years). Our study showed an alarmingly high prevalence of inadequate FV intake among adults, with 96.3% in 2018. The prevalence of inadequate FV intake drastically varied across 514 districts, ranging from 70.1% to 100%. Notable geographic and socioeconomic disparities were observed across the districts studied. Rural districts exhibited a higher prevalence of inadequate FV intake, translating to poorer diets, particularly among females and older adults, when compared to their urban counterparts. Interestingly, districts within more developed regions had poorer FV diets than those in less developed regions. Although districts with lower incomes generally had poorer FV diets, the association was not significant in multivariate analysis. However, districts with lower levels of education demonstrated poorer FV diets, especially among females, adults, and older adults. Despite its limitations, our study provides crucial insights for health policies in Indonesia and other LMICs.

Measuring food insecurity: An introduction to tools for human biologists and ecologists

OBJECTIVE

Food insecurity is a significant and growing concern undermining the wellbeing of 30% of the global population. Food in/security is a complex construct consisting of four dimensions: availability, access, utilization, and stability, making it challenging to measure. We provide a toolkit human biologists/ecologists can use to advance research on this topic.

METHODS

We review the strengths and limitations of common tools used to measure food access and utilization, the two dimensions most proximate to people's lived experience, and emphasize tools that provide data needed to best link food security with human biological outcomes. We also discuss methods that provide contextual data human biologists/ecologists will find useful for study design, ensuring instrument validity, and improving data quality.

RESULTS

Food access is principally measured using experience-based instruments that emphasize economic access. Social access, such as food sharing, is under-studied and we recommend using social network analysis to explore this dimension. In terms of utilization, emphasis has been on food choice measured as dietary diversity. Food preparation and intrahousehold distribution, also part of the utilization dimension, are less studied and standardized instruments for measuring both are lacking. The embodiment of food insecurity has focused on child growth, although a growing literature addresses adult mental wellbeing and chronic and infectious disease risk.

CONCLUSIONS

We see the potential to expand outcomes to include reproductive and immune function, physical activity, and the gut microbiome. Human biologists/ecologists are well-positioned to advance understanding of the human health impacts of food insecurity and provide data to support intervention efforts.

Multilevel correlates of abdominal obesity in adolescents and youth living with HIV in peri-urban Cape Town, South Africa

BACKGROUND

Chronic non-communicable disease comorbidities are a major problem faced by people living with HIV (PLHIV). Obesity is an important factor contributing to such comorbidities and PLHIV face an elevated risk of obesity. However, there is data paucity on the intersection of obesity and HIV in adolescents and youth living with HIV (AYLHIV) in sub-Saharan Africa. We therefore aimed to investigate the prevalence of abdominal obesity and associated multilevel factors in AYLHIV in peri-urban Cape Town, South Africa.

METHODS

We conducted a cross-sectional study enrolling AYLHIV aged 15-24 years attending primary healthcare facilities in peri-urban Cape Town in 2019. All measures, except for physical examination measures, were obtained via self-report using a self-administered electronic form. Our outcome of interest was abdominal obesity (waist-to-height ratio ≥ 0.5). We collected individual-level data and data on community, built and food environment factors. Data was summarized using descriptive statistics, stratified by obesity status. Multilevel logistic regression was conducted to investigate factors associated with abdominal obesity, adjusted for sex and age.

FINDINGS

A total of 87 participants were interviewed, 76% were female and the median age was 20.7 (IQR 18.9-23.0) years. More than two fifths had abdominal obesity (41%; 95% CI: 31.0-51.7%), compared to published rates for young people in the general population (13.7-22.1%). In multilevel models, skipping breakfast (aOR = 5.42; 95% CI: 1.32-22.25) was associated with higher odds of abdominal obesity, while daily wholegrain consumption (aOR = 0.20; 95% CI: 0.05-0.71) and weekly physical activity (aOR = 0.24; 95% CI: 0.06-0.92) were associated with lower odds of abdominal obesity. Higher anticipated stigma was associated with reduced odds of obesity (aOR = 0.58; 95% CI: 0.33-1.00). Land-use mix diversity (aOR = 0.52; 95% CI: 0.27-0.97), access to recreational places (aOR = 0.37; 95% CI: 0.18-0.74), higher perceived pedestrian and traffic safety (aOR = 0.20; 95% CI: 0.05-0.80) and having a non-fast-food restaurant within walking distance (aOR = 0.30; 95% CI: 0.10-0.93) were associated with reduced odds of abdominal obesity. The main limitations of the study were low statistical power and possible reporting bias from self-report measures.

CONCLUSIONS

Our findings demonstrate a high prevalence of abdominal obesity and highlight multilevel correlates of obesity in AYLHIV in South Africa. An intersectoral approach to obesity prevention, intervening at multiple levels is necessary to intervene at this critical life stage.

Association between healthy food environment and metabolic syndrome, waist circumference, and systolic blood pressure in older adults in Southern Brazil

The aim of this study was to investigate the association between healthy food outlet proximity, metabolic syndrome (MS), and two of its components, waist circumference (WC) and systolic blood pressure (SBP), in older adults (63-107 years old, median age 73 years) living in Florianópolis, South Brazil in 2013-2014. This is a cross-sectional analysis of the second wave of the EpiFloripa Aging Cohort Study. Individual-level data on MS, WC, SBP, and socio-demographic and health-related characteristics were collected from face to face interviews. The healthy food environment was assessed via the number and types of establishments present. The residences of older adult participants were georeferenced using Geographical Information System (GIS) software. The number of each type of food establishment in a 500 m buffer around the each residence was determined. Multivariate linear regression was used to test association between food outlet proximity and continuous outcomes (SBP and WC), and multiple logistic regression was used to examine the relations between the predictor variables and the dichotomous outcome of MS (yes/no). The study revealed that greater frequency of supermarkets and restaurants in the neighborhood was associated with a lower likelihood of having MS. WC was lower in individuals living in places with greater availability of greengrocers' shops and restaurants. The results demonstrated that the number of establishments in a neighborhood is associated with cardiometabolic outcomes, and the likelihood of MS and increased WC is lower for older adults who live in neighborhoods with more access to establishments that sell foundational components of a healthy diet.

Sustaining Agriculture and Nutrition Interventions: Continued Engagement of Village Model Farmers in Nepal

BACKGROUND

In homestead food production (HFP) programs, village model farmers (VMFs), after training, implement agriculture and nutrition activities to improve household knowledge and practices. Little evidence exists on what enables VMFs to remain actively engaged and for impacts to be sustained.

OBJECTIVE

To examine variables explaining active engagement of VMFs, at least 4 years post-training, in an HFP program in Nepal.

METHODS

We used cross-sectional data, collected from 2018 to 2019, among 4750 VMFs of Suaahara, a multisectoral nutrition program. We assessed whether respondents registered their HFP group with the local government, conducted regular group meetings, discussed vegetable growing and chicken rearing practices with group members, or engaged in saving and credit activities in their HFP group. Outcome variable was a count of these 4 activities in which the VMF engaged. Socioeconomic, demographic, and programmatic explanatory variables were identified a priori and by bivariate analysis and were adjusted in ordinal regression models accounting for clusters.

RESULTS

On average, VMFs engaged in 1.4 activities. Having attended primary or secondary school (adjusted odds ratios [AOR] = 1.39), being a female community health volunteer (AOR = 1.27), being from an advantaged caste/ethnic group (AOR = 1.34), receiving additional trainings (AOR = 1.56) and inputs (AOR = 1.31) were associated with more active engagement of VMFs.

CONCLUSION

Village model farmers receiving more training and inputs were more likely to remain actively engaged. Female community health workers, people from higher caste/ethnic groups, and those with primary or secondary education were more likely to remain active VMFs and could be targeted for this role in HFP programs leading to sustained impact.

Exploring the associations between neighbourhood food environment, household food insecurity and child weight-related outcomes in socio-economically and racially/ethnically diverse families

OBJECTIVE

To examine associations among neighbourhood food environments (NFE), household food insecurity (HFI) and child's weight-related outcomes in a racially/ethnically diverse sample of US-born and immigrant/refugee families.

DESIGN

This cross-sectional, observational study involving individual and geographic-level data used multilevel models to estimate associations between neighbourhood food environment and child outcomes. Interactions between HFI and NFE were employed to determine whether HFI moderated the association between NFE and child outcomes and whether the associations differed for US-born v. immigrant/refugee groups.

SETTING

The sample resided in 367 census tracts in the Minneapolis/St. Paul, MN metropolitan area, and the data were collected in 2016-2019.

PARTICIPANTS

The sample was from the Family Matters study of families (n 1296) with children from six racial/ethnic and immigrant/refugee groups (African American, Latino, Hmong, Native American, Somali/Ethiopian and White).

RESULTS

Living in a neighbourhood with low perceived access to affordable fresh fruits and vegetables was found to be associated with lower food security (P < 0·01), poorer child diet quality (P < 0·01) and reduced availability of a variety of fruits (P < 0·01), vegetables (P < 0·05) and whole grains in the home (P < 0·01). Moreover, residing in a food desert was found to be associated with a higher child BMI percentile if the child's household was food insecure (P < 0·05). No differences in associations were found for immigrant/refugee groups.

CONCLUSIONS

Poor NFE were associated with worse weight-related outcomes for children; the association with weight was more pronounced among children with HFI. Interventions aiming to improve child weight-related outcomes should consider both NFE and HFI.

Validity of a Market Basket Assessment Tool for Use in Supplemental Nutrition Assistance Program Education Healthy Retail Initiatives

OBJECTIVE

To assess the validity of the Market Basket Analysis Tool (MBAT) for food environment quality within various retail environments compared to the Nutrition Environment Measures Survey in Stores (NEMS-S).

METHODS

In-store assessments using the MBAT and the NEMS-S on the same day in a given store were conducted in grocery stores, corner stores, pharmacies, and dollar stores in a metropolis, and urban and rural counties across 4 states: Louisiana, Mississippi, North Carolina, and Virginia. Descriptive statistics, correlations, and ANOVAs were used to assess store location, store type differences, and MBAT and NEMS-S scores.

RESULTS

Market Basket Analysis Tool and NEMS-S data were collected from 114 stores. Market Basket Analysis Tool and NEMS-S total and all individual component scores were significantly correlated (r = 0.84, P ≤ 0.0001; r range, 0.51-0.88; P ≤ 0.0001).

CONCLUSIONS AND IMPLICATIONS

The MBAT offers a methodology to measure the food retail environment focusing on the availability of healthful food items with a reduced training time and streamlined data collection compared with the NEMS-S. Future work can assess the completion time of the MBAT compared with the NEMS-S and the ability of the MBAT to detect changes in food environment quality post healthy food retail interventions.

The 5 A's Approach for Contextual Assessment of Food Environment

OBJECTIVE

To develop a context-specific methodology to assess the 5 A's of food environment: availability, accessibility, affordability, acceptability, and accommodation.

DESIGN

Cross-sectional mixed-methods study. Availability of foods was assessed by on-site observation and interviewing vendors. To assess accessibility, buffer zones around food stores were created using geographic information systems. Affordability was controlled by selecting participants from the middle-income group. Accommodation and acceptability were assessed by interviewing vendors and caregivers.

SETTING

Villages of Ghatkesar subdistrict (n = 4), Telangana, South India.

PARTICIPANTS

Caregivers of children aged 6-10 years (n = 160) and food vendors (n = 68).

ANALYSIS

The quality of the 5 A's was graded on the basis of concurrence between actual and perceived measures.

RESULTS

The actual and perceived 5 A's for semiperishable foods matched, and hence the food environment was graded as good across the villages. However, for perishable foods, the food environment was graded as poor with respect to accommodation and acceptability in all villages; and with respect to availability and affordability in at least 2 villages as the actual and perceived measures did not match.

CONCLUSIONS AND IMPLICATIONS

This study demonstrated the use of context-specific methods to assess the 5 key dimensions of the food environment, which can be attempted in other contexts with suitable modifications.

Availability of public outlets and regular consumption of fruits and vegetables among adolescents in public schools

Objective:

To assess the association between the presence of public outlets selling fruits and vegetables and the regular intake of these foods by adolescents from public schools in the city of Curitiba, Paraná, Brazil.

Methods:

Data collection was carried out by a questionnaire answered by the adolescents. Regular intake was defined as eating fruits and vegetables five or more times a week. Environmental data were obtained by assessing the availability and prices of fruits and vegetables traded in public outlets within a 1.6-km radius from 30 randomly selected public schools.

Results:

A total of 1,232 students from 30 public schools participated in the study. 43.4% of the adolescents reported a regular intake of fruits; 67.0% of them reported a regular intake of vegetables. In the schools, fruit intake ranged from 26.8 to 68.0%, and the vegetables intake ranged from 54.8 to 82.2%. A total of 22 schools had fruit and vegetables being traded in their surroundings. Regular intake of vegetables was positively correlated with their variety (r=0.82; p=0.007). The Moran’s local index indicated low fruit intake in a high-supply region; in other three regions with low supply, there was a high intake of fruits; and there was a high consumption of vegetables in a high-supply region.

Conclusions:

There are differences in the supply of fruits and vegetables of public outlets in the school’s surroundings as well as in the distribution of regular intake among regions. The density of public outlets and the variety were both associated with greater intake of fruits and vegetables among adolescents of public school.

Examining Geographic Food Access, Food Insecurity, and Urbanicity among Diverse, Low-Income Participants in Austin, Texas

The purpose of this study was to explore the association between geographic food access and food insecurity and the potential role of race/ethnicity, income, and urbanicity among a low-income, diverse sample in Central Texas. Utilizing a cross-sectional study design, secondary data analysis of an existing cohort was used to examine the association between food insecurity; geographic food access; and sociodemographic factors of race/ethnicity, income, urbanicity, and additional covariates using binomial logistic regression models. The existing cohort was recruited from lower-income communities in Travis County, Texas. The sample (N = 393) was predominantly Hispanic, lived in urban areas, and nearly 40% were food insecure. Geographic food access was not found to be significantly associated with food insecurity. However, rural residents had greater odds of being food insecure than urban residents. Also, participants who earned USD 45,000-64,999 and over USD 65,000 had lower odds of being food insecure than participants who earned under USD 25,000. These findings add to the inconsistent literature about the association between geographic food access and food insecurity and contribute to urbanicity and income disparities in food-insecurity literature. Future work should consider urbanicity, income, and utilize community-specific data to gain greater understanding of the association between geographic food access and food insecurity.

Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data

BACKGROUND

The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people's diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the role they may play in the context of low- and middle-income countries (LMICs). We examined the associations of food environments on T2DM among adults and its heterogeneity by income and sex.

METHODS AND FINDINGS

We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018 and 2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300 m from study participant's home, and proximity was defined as having at least 1 outlet within 100 m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socioeconomic status (SES), health status, healthcare utilization, and physical activities. Data were analyzed in ArcMap 10.3 and STATA 15.1. A higher share of fast-food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p < 0.05). Having at least 1 FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p < 0.01). A 1% increase in the share of FFR near an individual's home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AMEs): 0.08; CI: 0.02, 0.14; p < 0.05). Having at least 1 FFR near home was associated with 16% (odds ratio [OR]: 1.16; CI: 1.01, 1.33; p < 0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p < 0.05) increases in the odds of higher blood glucose levels and diagnosed diabetes, respectively. The positive association between FFR density and blood glucose level was stronger among women than men, but the association between FFR proximity and blood glucose level was stronger among men as well as among those with higher incomes. One of the study's key limitations is that we measured exposure to food environments around residency geolocation; however, participants may source their meals elsewhere.

CONCLUSIONS

Our results suggest that the exposure to fast-food outlets may have a detrimental impact on the risk of T2DM, especially among females and higher-income earners. Policies should target changes in the food environments to promote better diets and prevent T2DM.

Disponibilidade de equipamentos públicos de comércio no entorno de escolas públicas e consumo regular de frutas e hortaliças em adolescentes

RESUMO Objetivo: Avaliar a associação entre presença de equipamentos públicos de comércio de frutas e hortaliças com seu consumo regular por adolescentes de escolas públicas de Curitiba, Paraná. Métodos: Informações dos adolescentes foram coletadas por meio de questionário. Considerou-se como regular o consumo de frutas e hortaliças cinco ou mais vezes na semana. Foram incluídos dados do ambiente obtidos por auditagem de equipamentos públicos de venda de frutas e hortaliças no raio de 1,6 km do entorno de 30 escolas estaduais aleatoriamente sorteadas, no qual foram avaliados a disponibilidade e os preços desses alimentos. Resultados: Participaram do estudo 1.232 alunos de 30 escolas estaduais. O consumo regular de frutas foi referido por 43,4% e de hortaliças por 67,0% dos adolescentes. Nas escolas, o consumo de frutas variou entre 26,8 e 68,0% e o de hortaliças entre 54,8 e 82,2%; 22 escolas contavam com oferta de frutas e hortaliças no entorno. O consumo regular de hortaliças esteve correlacionado positivamente com a sua variedade (r=0,82; p=0,007). O índice de Moran local indicou baixo consumo de frutas em uma regional de alta oferta e, em outras três, alto consumo de frutas e hortaliças para baixa oferta e alto consumo de hortaliças em uma regional de alta oferta. Conclusões: Existem diferenças na oferta de frutas e hortaliças dos equipamentos públicos no entorno escolar e na distribuição do consumo regular entre as regionais. Características relacionadas à densidade de equipamentos de comércio e à variedade estiveram associadas ao maior consumo de frutas e hortaliças entre os adolescentes de escolas públicas.

Transformation in culinary behaviour during the COVID-19 pandemic: In-depth interviews with food gatekeepers in urban India

COVID-19 and its associated regulatory measures including lockdowns, curfews, and physical distancing norms have significantly affected individual's dietary and culinary behaviours. Although there is ample empirical evidence available on dietary changes within the Indian context, very limited evidence exists about the factors influencing these dietary modifications and changes in culinary behaviours during COVID-19 lockdown. Therefore, the aim of this qualitative study was to explore the views of Indian household food gatekeepers towards meal planning, food purchasing, and meal preparation during the pandemic and its associated lockdowns. A convenience sample of 34 female gatekeepers from the Mumbai metropolis participated in online interviews. Interviews were conducted in English and Hindi (then translated in English), audio-recorded and transcribed verbatim. Underpinned by Template Analysis technique, transcribed data were analysed manually and using the NVivo software program. The interview structure guided the development of themes. The emerging themes included were: Increased household cooking; Involvement of children and male members in food-related activities; Experimentation in the kitchen; Adoption of meal planning skills; Increase in online food shopping; Bulk buying; Shortage of food items; Reduced consumption of outside home food; Increased variety of home-cooked meals; Increase in snacking and overall food intake; Determinants of food choices; and Family meals-a new norm. In the light of these findings, developing family-focussed, web-based nutrition programs to enhance gatekeepers' and their families' food literacy including declarative and procedural nutritional knowledge would be beneficial. The importance of organisational culinary behaviours such as planning meals in advance, shopping with a food list should be promoted to prevent hoarding and subsequently reduce strain on the food supply system. With a surge in domestic cooking, low cost nutritious recipes with the use of local and seasonal produce should be emphasized promoting healthy eating among the gatekeepers and their family members. The inclusion of food studies in the school curriculum will facilitate the development of culinary skills among children and youth. Also, there is a need for further research and surveillance to strengthen understanding of sustainability of healthy culinary behaviours practiced during the pandemic.

Spatial influence on qualitative food consumption in Colombia

Spatial location is a factor that may facilitate the consumption of processed foods due to the ease of access, especially in highly urbanized, high density populations. This study presents the differences in food consumption in populations with different densities and urban and rural characteristics, and income above and below ten dollars a day. A sample of 2,130 subjects was used from 9 populations that included the Capital of Colombia, outlying medium-sized municipalities, metropolitan-area municipalities and small villages. The results confirm that processed and ultra-processed foods are consumed more in cities and urban areas than in smaller and rural populations, and that there are differences in consumption generated by income.

Availability, variety and distribution of healthy and unhealthy foods and beverages sold at street food stands in Mexico City

OBJECTIVE

To examine differences in the availability, variety and distribution of foods and beverages sold at street food stands (SFS) across neighbourhood income levels in Mexico City.

DESIGN

Cross-sectional.

SETTING

Twenty neighbourhoods representing low-, middle- and high-income levels in Mexico City.

PARTICIPANTS

Direct observations of SFS (n 391).

RESULTS

The availability of healthy foods such as fruits/vegetables was high in middle- and high-income neighbourhoods, whereas the availability of unhealthy foods such as processed snacks was higher in low-income neighbourhoods. However, statistically significant differences in food availability across neighbourhoods were only observed for dairy and processed snack items (P < 0·05). Similarly, differences in variety were only observed for cereal and processed snacks (P < 0·05). No statistically significant differences were seen for variety of fruits/vegetable across neighbourhood income levels (P > 0·05). No statistically significant differences across neighbourhood income levels were observed for beverage availability and variety (P > 0·05). Although street foods and beverages were often distributed near homes, public transportation centres and worksites, no differences were observed across neighbourhood income levels (P > 0·05).

CONCLUSIONS

Findings suggest that SFS can be a source of both unhealthy foods and healthy foods for communities across neighbourhoods in Mexico City. Additional studies are needed to assess the relationship between street food and beverage availability, and consumption.

Using Ecological Diversity Analyses to Characterize the Availability of Healthy Food and Socio-Economic Food Deserts

"Food deserts" are usually defined as geographic areas without local access to fresh, healthy food. We used community ecology statistics in supermarkets to quantify the availability of healthy food and to potentially identify food deserts as areas without a diverse selection of food, rather than a binary as to whether fresh food is present or not. We test whether produce diversity is correlated with neighborhood income or demographics. Abundance and diversity of fresh produce was quantified in supermarkets in Broward County, Florida, USA. Neighborhood income level and racial/ethnic makeup were retrieved from the U.S. Census and American Community Survey. Although diversity varied, there were no communities that had consistently less available fresh food, although the percent of a neighborhood identifying as "white" was positively correlated with produce diversity. There may be fewer choices in neighborhoods with a higher proportion of minorities, but there were no consistent patterns of produce diversity in Broward County. This method demonstrates an easy, inexpensive way to characterize food deserts beyond simple distance, and results in precise enough information to identify gaps in the availability of healthy foods.

Behavioural change box? Applying the COM-B model to understand behavioural triggers that support consumption of fruits and vegetable among subscribers of a fruit and vegetable box scheme

OBJECTIVE

To understand the key mechanisms that support healthy dietary habits promoted by fruit and vegetable (F&V) box schemes, testing relevant behaviour change triggers identified under the COM-B model in an evaluation research study of a Portuguese F&V box scheme (PROVE).

DESIGN

Correlation study with a post-test-only non-equivalent group design based on survey data. The mechanisms underpinning the differences between subscribers and non-subscribers are operationalised as mediation effects. Data availability, theoretical relevance and empirical validation supported the selection and testing of four potential mediators for the effects of subscribing to the box scheme on F&V consumption. These estimations derive from the coefficients of a structural equation model combined with the product coefficient approach and Sobel test.

SETTING

The study is part of a wider evaluation study on the impact of the PROVE box scheme on sustainability, health and equity.

PARTICIPANTS

A sample of PROVE box subscribers (n 294) was compared with a matched subsample of non-subscribers (n 571) in a nationally representative survey.

RESULTS

Subscribing to the PROVE box correlates with an increased probability of eating at least five portions of F&V, irrespective of differences in age, education and perceived economic difficulties. Diet quality perceptions, and more robustly, the strength of meal habits and household availability were identified as relevant mediators.

CONCLUSIONS

The subscription to an F&V box scheme is connected with proximal context that enables the consumption of F&V by ensuring more readily available F&V and better situational conditions associated with healthier meal habits.

Exploring factors affecting individual GPS-based activity space and how researcher-defined food environments represent activity space, exposure and use of food outlets

Background

Obesity remains one of the most challenging public health issues of our modern time. Despite the face validity of claims for influence, studies on the causes of obesity have reported the influence of the food environment to be inconsistent. This inconsistency has been attributed to the variability of measures used by researchers to represent the food environments—Researcher-Defined Food Environments (RDFE) like circular, street-network buffers, and others. This study (i.) determined an individual’s Activity Space (AS) (ii.) explored the accuracy of the RDFE in representing the AS, (iii.) investigated the accuracy of the RDFE in representing actual exposure, and (iv.) explored whether exposure to food outlet reflects the use of food outlets.

Methods

Data were collected between June and December 2018. A total of 65 participants collected Global Positioning System (GPS) data, kept receipt of all their food purchases, completed a questionnaire about their personal information and had their weight and height measured. A buffer was created around the GPS points and merged to form an AS (GPS-based AS).

Results

Statistical and geospatial analyses found that the AS size of participants working away from home was positively related to the Euclidean distance from home to workplace; the orientation (shape) of AS was also influenced by the direction of workplace from home and individual characteristics were not predictive of the size of AS. Consistent with some previous studies, all types and sizes of RDFE variably misrepresented individual exposure in the food environments. Importantly, the accuracy of the RDFE was significantly improved by including both the home and workplace domains. The study also found no correlation between exposure and use of food outlets.

Conclusions

Home and workplace are key activity nodes in modelling AS or food environments and the relationship between exposure and use is more complex than is currently suggested in both empirical and policy literature.

The association of dimensions of fruit and vegetable access in the retail food environment with consumption; a systematic review

The consumption of fruit and vegetables (F&V) is important for human health to protect against non-communicable disease and micronutrient deficiency. Increasing consumption of F&V may also benefit planetary health if these foods are substituted for foods with higher environmental footprints such as red meat or dairy. The retail food environment (RFE) is an influential junction between the food system and individual diets as it drives access to F&V through external (physical access) and personal (availability, affordability, acceptability) domains. We performed a systematic search of six literature databases (January 2021) for studies assessing access to F&V in the RFE and its association with F&V consumption in adults in high- and upper-middle income countries. 36 studies were identified and categorised by dimensions of food access – accessibility, affordability, acceptability, availability and accommodation. More than half of the studies (n = 20) were based in the USA. F&V accessibility was the most commonly reported dimension (n = 29); no study reported on accommodation. 6 studies were rated to be high quality. A positive association of increased availability of F&V options in the RFE with intake was identified in 9 of 15 studies. Associations in both acceptability and accessibility dimensions were inconsistent. No association was observed between F&V affordability and consumption although available data were limited. Many challenges exist to building a robust evidence base within food environment research including conceptual, definitional and methodological heterogeneity and measurement standardisation. Future food policies should consider multi-dimensional interventions to promote access to F&V in the RFE across all domains.

•

First systematic review of dimensions of access in the retail food environment (RFE) and fruit and vegetable (F&V) intake.

•

This review suggests potential importance of having access to available healthy options in the RFE for F&V intake.

•

The absence of an association of F&V affordability with consumption is likely due to limited and mixed data availability.

•

F&V accessibility and acceptability require development as dimensions of access for clearer links to be made.

•

The retail food environment is complex but likely predictor of F&V consumption.

Food Environments and Hepatocellular Carcinoma Incidence

Research into the potential impact of the food environment on liver cancer incidence has been limited, though there is evidence showing that specific foods and nutrients may be potential risk or preventive factors. Data on hepatocellular carcinoma (HCC) cases were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registries. The county-level food environment was assessed using the Modified Retail Food Environment Index (mRFEI), a continuous score that measures the number of healthy and less healthy food retailers within counties. Poisson regression with robust variance estimation was used to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between mRFEI scores and HCC risk, adjusting for individual- and county-level factors. The county-level food environment was not associated with HCC risk after adjustment for individual-level age at diagnosis, sex, race/ethnicity, year, and SEER registry and county-level measures for health conditions, lifestyle factors, and socioeconomic status (adjusted IRR: 0.99, 95% CI: 0.96, 1.01). The county-level food environment, measured using mRFEI scores, was not associated with HCC risk.

Perceived Neighborhood-Level Drivers of Food Insecurity Among Aging Women in the United States: A Qualitative Study

BACKGROUND

Aging populations in the United States exhibit high rates of food insecurity and chronic illness. Few studies have explored the neighborhood-level drivers of food insecurity among such populations, and how they intersect with experiences of aging.

OBJECTIVE

The aim of this study was to explore how aging women experience food insecurity in the United States, and the neighborhood-level factors that influence these experiences.

DESIGN

Semistructured qualitative interviews were conducted to elicit participants' perceptions of how their neighborhood influenced their experiences with food security and aging.

PARTICIPANTS/SETTING

Thirty-eight food-insecure women aged 50 years and older were purposively sampled from the Northern California, Georgia, and North Carolina sites of the Women's Interagency Human Immunodeficiency Virus Study. Interviews were conducted between November 2017 and July 2018 at the three Women's Interagency Human Immunodeficiency Virus Study sites.

STATISTICAL ANALYSIS

Three researchers thematically analyzed the data using an inductive-deductive approach.

RESULTS

Participants described neighborhood-level drivers of food insecurity that centered around three themes: accessibility of food from traditional food stores, the role of food aid institutions, and the intersection of aging with the food environment. Participants explained that food insecurity was related to limited access to food stores largely due to long distances and poor public transportation in Georgia and North Carolina, and high food prices in Northern California. Most participants described being dependent on food aid programs, but found this difficult due to poor quality food and long wait times. Aging-related issues emerged as a cross-cutting theme, with fatigue, poor strength, and chronic illness amplifying barriers to accessing food.

CONCLUSIONS

Findings from this study reveal the structural barriers that aging women face in accessing healthy food within their neighborhoods, and how experiences with aging and chronic illnesses exacerbate these barriers. Although future programs should address common neighborhood-level barriers such as the accessibility and affordability of healthy foods, they should also be tailored to aging women and the local context.

A systematic review of the influences of food store product placement on dietary-related outcomes

Context

Product placement strategies have been used to influence customers’ food purchases in food stores for some time; however, assessment of the evidence that these techniques can limit unhealthy, and promote healthy, food choices has not been completed.

Objective

This systematic review aimed to determine how product placement strategies, availability, and positioning, in physical retail food stores located in high-income countries, influence dietary-related behaviors.

Data Sources

From a search of 9 databases, 38 articles, 17 observational studies, and 22 intervention studies met the study inclusion criteria.

Data Extraction

Two reviewers independently extracted data relating to study design, study population, exposures, outcomes, and key results. Each study was also assessed for risk of bias in relation to the research question.

Data Analysis

Meta-analysis was not possible owing to heterogeneous study designs and outcomes. As recommended by Cochrane, results were synthesized in effect direction plots using a vote-counting technique which recorded the direction of effect and significance level according to the expected relationship for health improvement.

Conclusions

The majority of studies showed that greater availability and more prominent positioning of healthy foods, or reduced availability and less prominent positioning of unhealthy foods, related to better dietary-related behaviors. A large number of results, however, were nonsignificant, which likely reflects the methodological difficulties inherent in this research field. Adequately powered intervention studies that test both the independent and additive effects of availability and positioning strategies are needed.

Systematic Review Registration

PROSPERO registration no. 42016048826

Food havens not swamps: a strength-based approach to sustainable food environments

The current paper provides a critical review of food environments' literature, with a focus on the metaphoric typology that has been developed over recent decades. This has tended to focus understandably on harmful food environments using well-known metaphors: that of food deserts, food swamps and food mirages. The purpose of the review was to consider the current typology in relation to what constitutes healthy food environments, and the implications for population groups in low socioeconomic environments who are often disadvantaged by current food systems and unhealthy food environments. The paper posits a new term, alongside the notion of the food oasis, that of food havens. Oasis indicates a small place of plenty in a setting of scarcity. Haven extends the boundaries of plenty in society by positing places and settings of refuge and safety, even sanctuary from which health and well-being can be attained and supported. We argue for focusing on creating such sustainable food environments so as to proliferate and promote examples of what needs to be done urgently in the fight to transform global food environments for the health of people particularly those that are vulnerable and the planet. Elements of the food haven as proposed in this paper have been drawn from indigenous perspectives-these include Māori and Pacific worldviews. Future research should consider what food environments might look like in different contexts and how we might move away from food swamps and deserts to food oases and havens; and utilize these positive motifs to go further in creating whole sustainable food environments encompassing all of society.

Perceived environmental supports for fruit and vegetable consumption among older adults in the US

BACKGROUND

The physical and social environments surrounding food, whether perceived or observed, can influence consumers' food choices by changing food access, and affordability, or by changing settings where food-related behaviors occur.

AIM

To describe older adults' perceived food environment, identify the most important sites and factors that enable healthy eating, and explore older adults' recommendations for communities to facilitate fruit and vegetable consumption.

METHODS

Participants aged 60 and older from metropolitan areas in Massachusetts, Iowa, and Illinois completed a researcher-administered survey to rate the perceived environment including accessibility, availability, and affordability of fruits and vegetables, and perceived importance of factors and establishments related to fruit and vegetable consumption. Participants also suggested changes for establishments to facilitate fruit and vegetable consumption.

RESULTS

The majority of the 142 participants perceived their food environment for fruits and vegetables as not difficult to access (85.2%) with good or excellent availability (90.1%). Education, marital status, and race were associated with some aspects of the perceived food environment. Perceived accessibility and supermarkets were rated as the most important factor and establishment, respectively, to facilitate fruit and vegetable consumption across all study sites. Participants proposed recommendations to address the availability, quality, accessibility and affordability of fruits and vegetables.

CONCLUSION

Interventions promoting accessible, affordable, quality fruits and vegetables may improve older adult consumers' perceptions of their food environment. Communities may also use undervalued resources such as mobile markets more strategically to provide additional support for healthy eating in older adults.

Contributions of Food Environments to Dietary Quality and Cardiovascular Disease Risk

PURPOSE OF REVIEW

To evaluate the multidimensional influence of food environments on food choice, dietary quality, and diet-related health and identify critical gaps necessary to develop effective population interventions that influence food choice.

RECENT FINDINGS

Multicomponent interventions that interact with multiple layers of the food environment show limited but consistent effects on dietary behaviors and may have wider and substantive population-level reach with greater incorporation of validated, holistic measurement tools. Opportunities to use smartphone technology to measure multiple components of the food environment will facilitate future interventions, particularly as food environments expand into online settings and interact with consumers in novel ways to shape food choice. While studies suggest that all dimensions of the food environment influence diet and health outcomes, robust and consistent measurements of food environments that integrate objective and subjective components are essential for developing stronger evidence needed to shift public policies.

Within-Day Variability in Negative Affect Moderates Cue Responsiveness in High-Calorie Snacking

Background

Many discretionary foods (“snacks”) contribute both to individual health risks and to global issues, in particular through high carbon footprints and water scarcity. Snacking is influenced by the presence of snacking cues such as food availability, observing others eating, and negative affect. However, less is known about the mechanisms underlying the effects of negative affect. This study examines whether the individual odds of consuming high-calorie snacks as a consequence to being exposed to known snacking cues were moderated by experiencing (i) higher or lower total negative affect per day or (ii) higher or lower negative affect variability per day.

Methods

Secondary analysis of an ecological momentary assessment study of 60 participants over 14 days with food logs and randomly timed assessments of known snacking cues. High total daily negative affect levels (daily within-participant means) and negative affect variability (daily within-participant SDs) were examined as moderators to predict high-calorie snacking in three-level hierarchical random effects logistic regressions.

Results

Consistent with previous studies, the odds of snacking increased when food was available (OR = 5.05, 95% CI 3.32, 7.66), when others were eating (OR = 5.11, 95% CI = 3.73, 6.99), and when participants experienced more negative affect (OR = 1.02, 95% CI = 1.01, 1.03). Associations for food availability (OR = 0.92, 95% CI 0.86, 0.99) and others eating (OR = 0.95, 95% CI 0.91, 0.99) were significantly moderated by negative affect variability such that associations between cues and high-calorie snacking were weaker on days with higher negative affect variability, but not negative affect levels.

Conclusion

The relationship between cues to high-calorie snacking and snacking behavior varies with variability in negative affect, suggesting a complex relationship between affect and high-calorie snacking. Clearer conceptualizations on the relation between affect and eating are needed.

Developing an index to estimate the association between the food environment and CVD mortality rates

The food environment has been shown to influence dietary patterns, which ultimately affects nutrition-related diseases such as diabetes, obesity, and cardiovascular disease (CVD). Measures of food accessibility and socioeconomics were combined to develop the Food Environment Index (FEI), characterizing all U.S. counties between 2008 and 2016. Multi-level regression models showed that this index is significantly negatively associated with CVD death rates across the two time periods studied (2008-2010 and 2013-2016). The FEI may be a useful proxy for identifying differences in the food environment to inform future interventions.

Association between Neighborhood Food Access, Household Income, and Purchase of Snacks and Beverages in the United States

Considerable research on the risk factors of obesity and chronic diseases has focused on relationships between where people live, where they shop, and the types of food they purchase. Rarely have investigators used a national sample and explicitly addressed the amount of energy-dense and nutrient-poor foods purchased in different types of neighborhood food stores. Even more rarely have studies accounted for the characteristics of the broader built environment in which food stores are located and which affect the convenience of using neighborhood food stores. We used a large population-based cohort of predominantly white U.S. households from the Nielsen Homescan Consumer Panel 2010 dataset to examine whether there were positive cross-sectional associations between availability of neighborhood convenience stores and supermarkets and self-reported household annual expenditures for snacks and beverages. We examined this relationship separately for poor and non-poor households as defined by the 2010 U.S. federal poverty threshold. We used mixed error-component regression models to examine associations between availability of neighborhood food stores and the expenditures on snacks and beverages, controlling for regional destination accessibility, availability and diversity of neighborhood destinations, and neighborhood street connectivity. In multivariate analyses, we observed that poor households in neighborhoods with few convenience stores purchased more snacks than poor households in neighborhoods with many convenience stores (b = -0.008, p < 0.05). Non-poor households in neighborhoods with many convenience stores and fewer supermarkets purchased more snacks than non-poor households in neighborhoods with few convenience stores and many supermarkets (b = 0.002, p < 0.05 for convenience stores; b = -0.027, p < 0.05 for supermarkets). Increase in number of convenience stores decreased the purchase of snacks by poor households, but increased in non-poor households. On other hand, increase in number of supermarkets discouraged purchase of snacks by non-poor households but had no effect on the purchasing behavior of the poor-households.Therefore, evaluation of access to energy-dense and nutrient-poor foods should include a consideration of geographic proximity. Local governments should consider strategies to expand the availability and access to nutrient-rich food and beverage products in convenience stores for consumers.

Associations of the consumer food environment with eating behaviours and BMI

OBJECTIVE

To examine cross-sectional associations of four aspects of the consumer food environment - price, availability, marketing and product placement - with BMI and fruit and vegetable intake.

DESIGN

This cross-sectional study measured the consumer food environment using grocery store audits and surveys. Outcomes were measured through surveys and physical exams. Multivariable linear regression models were run; models were all adjusted for age, neighbourhood, education, race/ethnicity and financial burden.

SETTING

Non-proportional quota sample of four socio-economically and racial/ethnically diverse neighbourhoods in Chicago, IL.

PARTICIPANTS

Women (n 228) aged 18-44 years.

RESULTS

Participants who reported seeing healthy food marketing had a higher vegetable intake (β = 0·24, 95 % CI 0·06, 0·42). There was some suggestive evidence that participants who shopped at stores that were more expensive (β = -0·90, 95 % CI -1·94, 0·14) had lower BMI, but this association was not statistically significant. Multivariable regression models did not indicate any significant association between any measure of the consumer food environment and fruit intake.

CONCLUSIONS

Our findings add to the growing interest in the role of the consumer food environment in health behaviours. Further research is needed to better understand the role of price and marketing characteristics on eating behaviours and BMI.

Participation in a Fruit and Vegetable Prescription Program for Pediatric Patients is Positively Associated with Farmers' Market Shopping

Objectives: The primary objective was to investigate the association between participation in a farmers’ market fruit and vegetable prescription program (FVPP) for pediatric patients and farmers’ market shopping. Methods: This survey-based cross-sectional study assessed data from a convenience sample of 157 caregivers at an urban pediatric clinic co-located with a farmers’ market. Prescription redemption was restricted to the farmers’ market. Data were examined using chi-square analysis and independent samples t-tests. Results: Approximately 65% of respondents participated in the FVPP. Those who received one or more prescriptions were significantly more likely to shop at the farmers’ market during the previous month when compared to those who never received a prescription (p = 0.005). Conclusions: This is the first study to demonstrate that participation in a FVPP for pediatric patients is positively associated with farmers’ market shopping.

Mineral Intake Status of Community-Dwelling Elderly from Urban and Rural Areas of South Korea: A Cross-Sectional Study Based on Korean National Health and Nutrition Examination Survey, 2013~2016

We aimed to evaluate the intake of minerals (calcium, phosphorous, sodium, and potassium) in the urban and rural elderly and explore the adequacy of intake and food sources for each mineral using nationwide big data. The study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2013 and 2016. We analyzed 5292 elderly individuals that were aged 65 years and older (2271 men, 3021 women). Daily calcium, phosphorous, sodium, and potassium intake, and they were analyzed using the 24-h dietary recall method. Additionally, the adequacy of intake and food sources for each mineral was analyzed. Blood triglyceride level was significantly higher in rural elderly than in urban elderly. The intake of calcium and potassium per 1000 kcal of energy intake was significantly lower in the rural elderly, and the proportion of participants with calcium intake below the Estimated Average Requirement was significantly higher in the rural elderly than in the urban elderly. The intake of calcium, phosphorous, and potassium in the rural elderly was lower than that in the urban elderly. These results can be used as basic data when making social and environmental policies for the health of the elderly and when providing targeted dietary education for the management of chronic diseases for the elderly.

[Spatial distribution of public outlets for fruit and vegetable sales in Curitiba in the state of Paraná, Brazil]

Greater availability of fruit and vegetables (FV) may enhance the consumption of these food products. This study sought to investigate demographic and household income inequalities in the spatial distribution of FV in the city of Curitiba, State of Paraná. A total of 106 FV outlets were listed in the 10 administrative regions on the City Hall Supply Department website. Data on population and household income of the administrative regions were obtained from the 2010 Demographic Census. The food sale outlets were identified, and subsequently analyzed for the correlation between the regions by the Moran index. A total of 407 food stands were evaluated in 103 public facilities that commercialized FV. A concentration of street food markets in the central areas of the city, with a global Moran index of 0.99, was observed. In the regions, only one did not have an outlet (Tatuquara). There was a higher concentration of outlets in the higher-income regions (9.82/10,000 inhabitants) compared to those with the lower income regions (2.60/10,000 inhabitants) (p <0.001). Inequities were observed in the supply and in the quality of FV available in public facilities in lower-income regions, which should be considered by administrators when planning distribution in these locations.

Contributions of Multiple Built Environment Features to 10-Year Change in Body Mass Index and Waist Circumference in a South Australian Middle-Aged Cohort

Residential areas may shape health, yet few studies are longitudinal or concurrently test relationships between multiple residential features and health. This longitudinal study concurrently assessed the contributions of multiple environmental features to 10-year change in clinically measured body mass index (BMI) and waist circumference (WC). Longitudinal data for adults (18+ years of age, n = 2253) from the north-west of Adelaide, Australia were linked to built environment measures representing the physical activity and food environment (expressed for residence-based 1600 m road-network buffers) and area education. Associations were concurrently estimated using latent growth models. In models including all environmental exposure measures, area education was associated with change in BMI and WC (protective effects). Dwelling density was associated with worsening BMI and WC but also highly correlated with area education and moderately correlated with count of fast food outlets. Public open space (POS) area was associated with worsening WC. Intersection density, land use mix, greenness, and a retail food environment index were not associated with change in BMI or WC. This study found greater dwelling density and POS area exacerbated increases in BMI and WC. Greater area education was protective against worsening body size. Interventions should consider dwelling density and POS, and target areas with low SES.

Evaluation of Store Environment Changes of an In-Store Intervention to Promote Fruits and Vegetables in Latino/Hispanic-Focused Food Stores

Implementing interventions that manipulate food store environments are one potential strategy for improving dietary behaviors. The present study evaluated intervention effects, from the El Valor de Nuestra Salud (The Value of Our Health) study, on in-store environmental changes within Latino/Hispanic-focused food stores (tiendas). Sixteen tiendas were randomly assigned to either: a six-month structural and social food store intervention or a wait-list control condition. Store-level environmental measures of product availability, placement, and promotion were assessed monthly from baseline through six-months post-baseline using store audits. Linear mixed effects models tested for condition-by-time interactions in store-level environmental measures. Results demonstrated that the intervention was successful at increasing the total number of fruit and vegetable (FV) promotions (p < 0.001) and the number of FV promotions outside the produce department (p < 0.001) among tiendas in the intervention versus control condition. No changes in product availability or placement were observed. Results suggests changing the marketing mix element of promotions within small stores is measurable and feasible in an in-store intervention. Difficulties in capturing changes in product availability and placement may be due to intervention implementation methods chosen by tiendas. It is important to build upon the lessons learned from these types of interventions to disseminate evidence-based in-store interventions.

Social Support, but Not Perceived Food Environment, Is Associated with Diet Quality in French-Speaking Canadians from the PREDISE Study

The objectives were to assess whether social support for healthy eating and perceived food environment are associated with diet quality, and to investigate if sociodemographic characteristics moderate these associations. A probability sample of French-speaking adults from the Province of Québec, Canada, was recruited in the context of the PREDISE study. Participants reported their perceptions of supportive and non-supportive actions related to healthy eating from close others at home and outside of home (n = 952), and of the accessibility to healthy foods (n = 1035). The Canadian Healthy Eating Index (C-HEI) was calculated based on three Web-based 24 h food recalls. Multiple linear regression models showed that supportive (B = 1.50 (95% CI 0.46, 2.54)) and non-supportive (B = -3.06 (95% CI -4.94, -1.18)) actions related to healthy eating from close others at home were positively and negatively associated with C-HEI, respectively, whereas actions from close others outside of home were not. The negative association between non-supportive actions occurring at home and C-HEI was stronger among participants with lower (vs. higher) levels of education (p interaction = 0.03). Perceived accessibility to healthy foods was not associated with C-HEI (p > 0.05). These results suggest that the social environment may have a stronger influence on healthy eating than the perceived physical environment. This adds support for healthy eating promotion programs involving entire families, especially for more socioeconomically disadvantaged individuals, whose efforts to eat healthily may be more easily thwarted by non-supportive households.

Association between Food Store Availability and the Incidence of Functional Disability among Community-Dwelling Older Adults: Results from the Japanese Gerontological Evaluation Cohort Study

This study sought to clarify the association between food store availability and the incidence of disability in older adults. This study utilized a population-based cohort study of independent Japanese adults aged ≥65 years, which was a 6 year follow-up of participants in the Japan Gerontological Evaluation Study. A total of 31,273 respondents were extracted. Food store availability was evaluated based on the existence of food stores within 500/1000 m of the home. We utilized participant-reported subjective measurement as well as geographic information system-based objective measurement for the evaluation. The incidence of disability was determined using municipal data on eligibility for long-term care insurance benefits. There were 7643 (24.4%) community-dwelling participants with low subjective food store availability and 5673 (18.1%) with low objective food store availability. During the follow-up period of 6 years, the cumulative incidence of disability was 20.9%, with a significant association between low subjective food store availability and increased disability. Participants who reported low subjective food store availability had a significantly higher likelihood of developing disability (hazard ratio = 1.18, 95% confidence interval: 1.11-1.25) than those who reported high subjective food store availability after adjusting for age, sex, sociodemographic status, environmental status, walking and going out, dietary food intake, body mass index, and comorbidities. Low subjective food store availability was associated with early onset of disability. Accessibility of food stores might contribute to maintaining a disability-free life.

Does access to healthy food vary according to socioeconomic status and to food store type? an ecologic study

BACKGROUND

The food environment can influence opportunities and barriers to food access. This study aimed to investigate whether access to healthy foods varies according to store types and the socioeconomic status of the users of the public health promotion program in Brazil, known as the Health Academy Program.

METHODS

A total of 18 Health Academy Program centers were selected via simple conglomerate sampling. Health Academy Program users living up to 1 km from the food stores were evaluated (n = 2831). Their socioeconomic status was investigated via face-to-face interviews. The food stores were audited through direct observation. Variables included the community nutrition environment (type and location) and consumer nutrition environment (healthy food store index, involving variables such as availability, variety, and advertising of healthy and unhealthy products). Multiple linear regression analysis was performed to examine the association between access to healthy foods, socioeconomic status, and food store type.

RESULTS

A total of 336 stores were investigated. The majority were specialty fruit and vegetable markets/stores or open-air food markets. Access to healthy food was only associated with the food store type. An increase of 1% in the availability of specialized fruits and vegetable markets or open-air food markets and supermarket raised healthy food store index values by 0.12 and 0.07, respectively.

CONCLUSIONS

Public food supply policies aimed at improving the diet quality of the population and reducing inequality in access should prioritize the implementation of stores of better quality, such as specialty fruit and vegetable markets and open-air food markets.