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Mackenbach JD, Pinho MGM, Stuber JM, van der Roest J, Lakerveld J, Beulens JWJ. The effects of nudging and pricing strategies on the availability and purchases of ultra-processed foods: A secondary analysis of the Supreme Nudge trial. Appetite 2024; 201:107599. [PMID: 38992569 DOI: 10.1016/j.appet.2024.107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/13/2024]
Abstract
Regular consumption of ultra-processed foods (UPF) is a risk factor for morbidity and mortality. UPF are widely available in supermarkets. Nudging and pricing strategies are promising strategies to promote healthier supermarket purchases and may reduce UPF purchases. We investigated whether supermarket nudging and pricing strategies targeting healthy foods, but not specifically discouraging UPF, would change UPF availability, price, promotion and placement (UPF-APPP) in supermarkets and customer UPF purchases. We used data from the Supreme Nudge parallel cluster-randomized controlled trial, testing the effect of a combined nudging and pricing intervention promoting healthy products. The Dutch Consumer Food Environment Score (D-CFES) was used to audit 12 participating supermarkets in terms of UPF-APPP. We used customer loyalty card data of the first twelve intervention weeks from 321 participants to calculate the proportion of UPF purchases. Descriptive statistics were used to assess differences in D-CFES between supermarkets. Mixed model analyses were used to assess the association between the D-CFES and UPF purchases and the effect of the intervention on UPF purchases. No difference in the D-CFES between intervention and control supermarkets were found. No statistically significant association between the D-CFES and UPF purchases (β = -0.00, 95%CI: -0.02, 0.01) and no significant effect of the intervention on UPF purchases (β = 0.02, 95%CI: -0.07, 0.12) was observed. Given the significant proportion of unhealthy and UPF products in Dutch supermarkets, nudging and pricing strategies aimed at promoting healthy food purchases are not sufficient for reducing UPF-APPP nor purchases, and nationwide regulation may be needed.Trial registration number: Dutch Trial Register ID NL7064, May 30, 2018, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7302.
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Affiliation(s)
- J D Mackenbach
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands; Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands.
| | - M G M Pinho
- Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands; Copernicus Institute of Sustainable Development, Utrecht University, Princetonlaan 8a, 3584 CB, Utrecht, Netherlands
| | - J M Stuber
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands; Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands
| | - J van der Roest
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands
| | - J Lakerveld
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands; Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands; Institute for Risk Assessment Sciences, Utrecht University, Netherlands
| | - J W J Beulens
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health, Amsterdam, Netherlands; Upstream Team, Amsterdam UMC, De Boelelaan 1117, Amsterdam, Netherlands
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Karnik H, Hanawa Peterson H. Promoting healthful food purchases through in-store interventions: Empirical evidence from rural food deserts. Appetite 2024; 197:107305. [PMID: 38521414 DOI: 10.1016/j.appet.2024.107305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
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.
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Affiliation(s)
- Harshada Karnik
- Center for Public Health Systems, University of Minnesota-School of Public Health, USA; Department of Applied Economics, University of Minnesota, USA.
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Caruso OT, McEachern LW, Minaker LM, Gilliland JA. The Influence of the School Neighborhood Food Retail Environment on Unhealthy Food Purchasing Behaviors Among Adolescents: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:145-161. [PMID: 38284954 DOI: 10.1016/j.jneb.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Adolescents are often exposed to food retailers selling unhealthy food items during their lunch breaks and school commutes. This systematic review examines the influence of school neighborhood food retail environments on adolescent food purchasing. METHODS A systematic search of 6 databases. Observational studies published from January 2012 to December 2022 that measured food availability, accessibility, or exposure, measured food purchasing, and focused on adolescents (aged 10-19 years) were eligible for inclusion. RESULTS Twelve studies with 97 findings were included. Thirty-one findings indicated that a school neighborhood with a high density of unhealthy food retail, a school with unhealthy food retail nearby, or exposure to unhealthy food retail on the journey to/from school was associated with higher prevalence and frequency of unhealthy food purchases. DISCUSSION Adolescents' food purchasing behaviors may be meaningfully affected by their school neighborhood food retail environment; however, the included studies have many methodological shortcomings. IMPLICATIONS FOR RESEARCH AND PRACTICE Results identify the need for new studies that measure food purchasing, use comprehensive definitions of food retail environments, and adopt more rigorous methods to approximate exposure to food retail. More robust evidence would strengthen the rationale for policy or program interventions and potentially indicate specific targets for intervention.
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Affiliation(s)
- Olivia T Caruso
- Department of Geography and Environment, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada
| | - Louise W McEachern
- Department of Geography and Environment, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | - Jason A Gilliland
- Department of Geography and Environment, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Department of Pediatrics, Western University, London, Ontario, Canada; School of Health Studies, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
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Hill CM, Chi DL, Mancl LA, Jones-Smith JC, Chan N, Saelens BE, McKinney CM. Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state. PLoS One 2023; 18:e0290287. [PMID: 37699013 PMCID: PMC10497152 DOI: 10.1371/journal.pone.0290287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
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.
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Affiliation(s)
- Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Lloyd A. Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Jessica C. Jones-Smith
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Nadine Chan
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Public Health-Seattle & King County, Assessment, Policy, Development and Evaluation Division, Seattle, WA, United States of America
| | - Brian E. Saelens
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - Christy M. McKinney
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
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Pemjean I, Mediano F, Ferrer P, Garmendia ML, Corvalán C. Food access, domestic environments, and dietary quality of low-middle income Chilean children during the COVID-19 pandemic. Front Public Health 2023; 11:1164357. [PMID: 37408742 PMCID: PMC10319070 DOI: 10.3389/fpubh.2023.1164357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Food access is associated with dietary quality; however, people living in similar physical environments can have different food access profiles. Domestic environments may also influence how food access relates to dietary quality. We studied food access profiles of 999 low-middle income Chilean families with children during the COVID-19 lockdown and how these profiles relate to dietary quality; secondarily, we also explore the role of the domestic environment in this relationship. Materials and methods Participants of two longitudinal studies conducted in the southeast of Santiago, Chile, answered online surveys at the beginning and end of the COVID-19 pandemic lockdown. Food access profiles were developed by a latent class analysis considering food outlets and government food transfers. Children's dietary quality was estimated by self-reported compliance with the Chilean Dietary Guidelines of Americans (DGA) and daily ultra-processed food (UPF) consumption. Logistic and linear regressions were used to assess the association between food access profiles and dietary quality. Domestic environment data (i.e., the sex of the person who buys food and cooks, meal frequency, cooking skills, etc.) were incorporated in the models to assess their influence on the relationship between food access and dietary quality. Results We have categorized three food access profiles: Classic (70.2%), Multiple (17.9%), and Supermarket-Restaurant (11.9%). Households led by women are concentrated in the Multiple profile, while families from higher income or education levels are focused on the Supermarket-Restaurant profile. On average, children presented poor dietary quality, with a high daily UPF consumption (median = 4.4; IQR: 3) and low compliance with national DGA recommendations (median = 1.2; IQR: 2). Except for the fish recommendation (OR = 1.77, 95% CI:1.00-3.12; p: 0.048 for the Supermarket-Restaurant profile), the food access profiles were poorly associated with children's dietary quality. However, further analyses showed that domestic environment variables related to routine and time use influenced the association between food access profiles and dietary quality. Conclusion In a sample of low-middle income Chilean families, we identified three different food access profiles that presented a socioeconomic gradient; however, these profiles did not significantly explain children's dietary quality. Studies diving deeper into household dynamics might give us some clues on intra-household behaviors and roles that could be influencing how food access relates to dietary quality.
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Affiliation(s)
- Isabel Pemjean
- Doctoral Program in Public Health, School of Public Health, University of Chile, Santiago, Chile
| | - Fernanda Mediano
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, United States
| | - Pedro Ferrer
- Center for Research in Food Environments and Prevention of Nutrition-Related Diseases (CIAPEC), Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - María Luisa Garmendia
- Center for Research in Food Environments and Prevention of Nutrition-Related Diseases (CIAPEC), Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Camila Corvalán
- Center for Research in Food Environments and Prevention of Nutrition-Related Diseases (CIAPEC), Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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Nguyen V, Ferdinand KC. Primordial prevention: Reducing consumption of sugar-sweetened beverages in racial/ethnic populations. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100278. [PMID: 38511089 PMCID: PMC10946006 DOI: 10.1016/j.ahjo.2023.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/19/2023] [Accepted: 02/19/2023] [Indexed: 03/22/2024]
Abstract
Beyond pharmacotherapy in adulthood, primordial prevention in United States (U.S.) children and adolescents is needed to avoid the upcoming tsunami of cardiometabolic and cardiovascular disease (CVD). Healthcare disparities were unmasked by the disparate morbidity and mortality of COVID-19 in racial/ethnic populations, especially in persons with obesity, diabetes, and CVD. One potential successful strategic improvement of childhood cardiovascular health is to reduce sugar consumption in early life as CVD is the number one cause of death in patients with Type 2 diabetes (T2D). Furthermore, cardiologists treat more patients with T2D than endocrinologists. This commentary challenges cardiovascular specialists and other clinicians to address the increasing burden of cardiometabolic and CVD in adults, especially in racial/ethnic populations, by supporting primordial prevention in childhood.
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Affiliation(s)
- Vi Nguyen
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Keith C. Ferdinand
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States of America
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Local Measures to Curb Dollar Store Growth: A Policy Scan. Nutrients 2022; 14:nu14153092. [PMID: 35956269 PMCID: PMC9370551 DOI: 10.3390/nu14153092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022] Open
Abstract
In recent years, advocates have expressed concern about the exponential growth of dollar stores in low-income communities, given their limited stock of healthy foods, and several municipalities in the U.S. have passed novel policies to curb the proliferation of these stores. The purpose of this scan is to create a legal database to inform future healthy retail policies and programs. Legal mapping methods were used to identify local policies aimed at moderating dollar store proliferation. A search yielded 25 policies that met the inclusion criteria, all enacted between 2018 and 2020. Recent policies aiming to slow local dollar store growth were mostly passed in low-income communities of color. All identified policies were passed in either the Midwest or South. The majority of municipalities that passed the policies had populations where more than half of residents identified as non-Hispanic Black or Hispanic and where the poverty rate was greater than the national average. Twelve (48%) municipalities imposed temporary moratoria halting new dollar stores from opening, and ten (40%) banned new construction within a specified distance of an existing dollar store. Key themes identified from analysis of policies’ purpose statements included increasing healthy food availability, diversifying local businesses, and improving community safety. These findings may be useful to leaders in other communities seeking to potentially moderate the impact of dollar stores on community health, as well as researchers and policy makers seeking to evaluate the efficacy of existing policies.
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Food Desert Status of Family Child Care Homes: Relationship to Young Children's Food Quality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116393. [PMID: 35681977 PMCID: PMC9180288 DOI: 10.3390/ijerph19116393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
Abstract
Family child care homes (FCCHs) are a favored child care choice for parents of young children in the U.S. Most FCCH providers purchase and prepare foods for the children in their care. Although FCCH providers can receive monetary support from the Child and Adult Care Food Program (CACFP), a federal subsidy program, to purchase nutritious foods, little is known about FCCH providers' access to nutritious foods, especially among FCCH providers serving children from communities that have been historically disinvested and predominantly Black. This study aims to describe the food desert status of FCCHs in Baltimore City, Maryland, and examine the relationship between food desert status and the quality of foods and beverages purchased and provided to children. A proportionate stratified random sample of 91 FCCH providers by CACFP participation status consented. Geographic information system mapping (GIS) was used to determine the food desert status of each participating FCCH. Participants reported on their access to food and beverages through telephone-based surveys. Nearly three-quarters (66/91) of FCCHs were located in a food desert. FCCH providers working and living in a food desert had lower mean sum scores M (SD) for the quality of beverages provided than FCCH providers outside a food desert (2.53 ± 0.81 vs. 2.92 ± 0.70, p = 0.036, respectively). Although the significant difference in scores for beverages provided is small, FCCH providers working in food deserts may need support in providing healthy beverages to the children in their care. More research is needed to understand food purchases among FCCH providers working in neighborhoods situated in food deserts.
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Children's Community Nutrition Environment, Food and Drink Purchases and Consumption on Journeys between Home and School: A Wearable Camera Study. Nutrients 2022; 14:nu14101995. [PMID: 35631135 PMCID: PMC9146069 DOI: 10.3390/nu14101995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 02/05/2023] Open
Abstract
Children's community nutrition environments are an important contributor to childhood obesity rates worldwide. This study aimed to measure the type of food outlets on children's journeys to or from school, children's food purchasing and consumption, and to determine differences by ethnicity and socioeconomic status. In this New Zealand study, we analysed photographic images of the journey to or from school from a sample of 147 children aged 11-13 years who wore an Autographer camera which recorded images every 7 s. A total of 444 journeys to or from school were included in the analysis. Camera images captured food outlets in 48% of journeys that had a component of active travel and 20% of journeys by vehicle. Children who used active travel modes had greater odds of exposure to unhealthy food outlets than children who used motorised modes; odds ratio 4.2 (95% CI 1.2-14.4). There were 82 instances of food purchases recorded, 84.1% of which were for discretionary foods. Of the 73 food and drink consumption occasions, 94.5% were for discretionary food or drink. Children on their journeys to or from school are frequently exposed to unhealthy food outlets. Policy interventions are recommended to limit the availability of unhealthy food outlets on school routes.
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Siegel SD, Brooks M, Bourke J, Curriero FC. Reducing Exposure to Tobacco Retailers with Residential Zoning Policy: Insights from a Geospatial Analysis of Wilmington, Delaware. CITIES & HEALTH 2022; 6:752-764. [PMID: 36570619 PMCID: PMC9783014 DOI: 10.1080/23748834.2021.1935141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cigarette use remains the leading preventable cause of premature mortality in the US, with declines in smoking rates slowing in recent years. One promising target for improved tobacco control is the expanded regulation of tobacco retailers. Evaluations of such policy attempts have largely produced mixed results to date. The objective of this study was to the assess the potential of using a novel, residentially-focused zoning approach to produce a more targeted and equitable reduction in tobacco retailers in high-risk urban settings. We focused on Wilmington, Delaware, a city characterized by high poverty rates, a majority Black population, a disparate number of tobacco retailers, and an elevated smoking prevalence. Through the use of geospatial analyses, we observed disproportionately higher counts of convenience store tobacco retailers in medium- and high-density residential zones in Wilmington relative to the surrounding county. By linking electronic health record (EHR) data from a local health care system and US Census Bureau data, we further found that approximately 80% of Wilmington smokers and 60% of Wilmington youth lived in these residential zones. These findings highlight the potential to more equitably reduce tobacco retailer exposure through a residentially-focused zoning approach. Tobacco control policy and research implications are considered.
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Affiliation(s)
- Scott D. Siegel
- Institute for Research on Equity and Community Health, Christiana Care Health System,Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System,Address for correspondence: Dr. Scott D. Siegel, Christiana Care Health System,
| | - Madeline Brooks
- Institute for Research on Equity and Community Health, Christiana Care Health System
| | | | - Frank C. Curriero
- Johns Hopkins Spatial Science for Public Health Center, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Quinn EL, Ortiz K, Titzer L, Houston-Shimizu B, Jones-Smith J. Healthy Food Environments in Food Pantries: Lessons Learned from a Sodium Reduction Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13206. [PMID: 34948815 PMCID: PMC8701667 DOI: 10.3390/ijerph182413206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022]
Abstract
In the United States, food pantries increasingly serve as regular food sources for low income households experiencing high rates of chronic disease, including hypertension. Sodium consumption is a modifiable risk factor for hypertension, so pantry customers would benefit from access to low-sodium foods. Pantry customers often experience difficulty acquiring healthy foods, however; little is known about pantry foods' sodium content specifically. This study assesses the sodium content of pantry foods and lessons learned from an adaptable intervention to support pantries in adopting policies and environmental changes to make healthy, lower-sodium foods appealing and accessible. We conducted sodium assessments of food at 13 food pantries, tracked implementation of intervention strategies, and interviewed 10 pantry directors. More than half of food items in 11 categories met sodium standards for foods to be chosen "often". Pantry directors reported valuing the intervention approach and implemented six of nine behavioral economics strategies, especially those targeting the visibility and convenience of foods, along with layout changes and expanded customer choice. One pantry adopted an agency-specific nutrition policy and 12 adopted a coalition-level policy. Results can inform intervention efforts to make available healthy options appealing and easy to select while also improving the customer experience in food pantries.
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Affiliation(s)
- Emilee L. Quinn
- Department of Health Systems and Population Health, University of Washington, Seattle, WA 98195, USA;
| | - Kate Ortiz
- Chronic Disease & Injury Prevention Division, Public Health Seattle and King County, Seattle, WA 98104, USA;
| | | | | | - Jessica Jones-Smith
- Department of Health Systems and Population Health, University of Washington, Seattle, WA 98195, USA;
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
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Boys KA, Haynes-Maslow L, McGuirt JT, Ammerman AS, Van Fleet EE, Johnson NS, Kelley CJ, Donadio VE, Fleischhacker SE, Truesdale KP, Bell RA, Jilcott Pitts SB. Perceived barriers and facilitators to participating in the North Carolina Healthy Food Small Retailer Program: a mixed-methods examination considering investment effectiveness. Public Health Nutr 2021; 24:6555-6565. [PMID: 34509178 PMCID: PMC11148602 DOI: 10.1017/s1368980021003955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The North Carolina Legislature appropriated funds in 2016-2019 for the Healthy Food Small Retailer Program (HFSRP), providing small retailers located in food deserts with equipment to stock nutrient-dense foods and beverages. The study aimed to: (1) examine factors facilitating and constraining implementation of, and participation in, the HFSRP from the perspective of storeowners and (2) measure and evaluate the impact and effectiveness of investment in the HFSRP. DESIGN The current analysis uses both qualitative and quantitative assessments of storeowner perceptions and store outcomes, as well as two innovative measures of policy investment effectiveness. Qualitative semi-structured interviews and descriptive quantitative approaches, including monthly financial reports and activity forms, and end-of-programme evaluations were collected from participating HFSRP storeowners. SETTING Eight corner stores in North Carolina that participated in the two cohorts (2016-2018; 2017-2019) of the HFSRP. PARTICIPANTS Owners of corner stores participating in the HFSRP. RESULTS All storeowners reported that the HFSRP benefitted their stores. In addition, the HFSRP had a positive impact on sales across each category of healthy food products. Storeowners reported that benefits would be enhanced with adjustments to programme administration and support. Specific suggestions included additional information regarding which healthy foods and beverages to stock; inventory management; handling of perishable produce; product display; modified reporting requirements and a more efficient process of delivering and maintaining equipment. CONCLUSIONS All storeowners reported several benefits of the HFSRP and would recommend that other storeowners participate. The barriers and challenges they reported inform potential approaches to ensuring success and sustainability of the HFSRP and similar initiatives underway in other jurisdictions.
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Affiliation(s)
- Kathryn A Boys
- Department of Agricultural & Resource Economics, North Carolina State University, 4306 Nelson Hall, Campus Box 8109, Raleigh, NC27695-8109, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural & Human Sciences, North Carolina State University, Raleigh, NC, USA
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin E Van Fleet
- Department of Agricultural & Resource Economics, North Carolina State University, 4306 Nelson Hall, Campus Box 8109, Raleigh, NC27695-8109, USA
| | - Nevin S Johnson
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Casey J Kelley
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Victoria E Donadio
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | | | - Kimberly P Truesdale
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Fultz AK, Sundermeir SM, Katz S, Robson SM. More Frequent Food Shopping May Promote Fruit and Vegetable Intake: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:957-965. [PMID: 34452830 DOI: 10.1016/j.jneb.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Food shopping frequency may be an important modifiable factor related to increasing fruit and vegetable (FV) intake. Because of mixed findings of individual studies of shopping frequency, a systematic review is needed to examine findings across studies and store types. OBJECTIVE To conduct a systematic review of articles examining the relationship between frequency of food shopping and FV intake including examination of participation in federal nutrition assistance programs on FV intake, if reported. METHODS A search, guided by the Preferred Reported Items for Systematic Reviews and Metanalyses, using terms related to FV consumption and food shopping across 4 online databases, was conducted. Studies conducted in the US and published through October, 2020, included adults, and had a cross-sectional, longitudinal, cohort, or randomized study design were eligible for inclusion. RESULTS Twenty-four articles were included. The majority of studies found at least 1 positive finding between the frequency of food shopping and FV intake, indicating that as the frequency of food shopping increased, FV intake increased. In studies with 100% participation in government/federal nutrition assistance programs, participation was associated with FV intake. Studies that included participation as a subset found participation not associated with FV intake. IMPLICATIONS FOR FUTURE RESEARCH AND PRACTICE The frequency of shopping may be modifiable to increase FV intake. Experimental research is needed to test the directionality and causality of the relationship. Federal nutrition assistance programs may be a logical place to test the relationship through the adjustment of fund disbursements.
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Affiliation(s)
- Amanda K Fultz
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE; Center for Health Behavior Research, University of Pennsylvania, Philadelphia, PA.
| | - Samantha M Sundermeir
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE; Department of International Health, Johns Hopkins University, Baltimore, MD
| | - Sarah Katz
- Health Science Librarian, University of Delaware Library, Museums and Press, Newark, DE
| | - Shannon M Robson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE
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14
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Caspi CE, Davey C, Barsness CB, Wolfson J, Peterson H, Pratt RJ. Applying the Healthy Eating Index-2015 in a Sample of Choice-Based Minnesota Food Pantries to Test Associations Between Food Pantry Inventory, Client Food Selection, and Client Diet. J Acad Nutr Diet 2021; 121:2242-2250. [PMID: 34103273 PMCID: PMC8530893 DOI: 10.1016/j.jand.2021.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/15/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Food pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food. OBJECTIVE This study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores. DESIGN This cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections ("client carts"), and single 24-hour client dietary recalls. PARTICIPANTS/SETTING The analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit. MAIN OUTCOME MEASURES A Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall. STATISTICAL ANALYSIS Descriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates. RESULTS Food pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P = .005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P = .002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant. CONCLUSIONS In choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality.
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Affiliation(s)
- Caitlin E Caspi
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford; Department of Allied Health Sciences, University of Connecticut, Storrs; Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.
| | - Cynthia Davey
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis
| | - Christina Bliss Barsness
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Hikaru Peterson
- Department of Applied Economics, University of Minnesota, St Paul
| | - Rebekah J Pratt
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
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15
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Haynes-Maslow L, Jilcott Pitts SB, Boys KA, McGuirt JT, Fleischhacker S, Ammerman AS, Johnson N, Kelley C, Donadio VE, Bell RA, Laska MN. Qualitative perspectives of the North Carolina healthy food small retailer program among customers in participating stores located in food deserts. BMC Public Health 2021; 21:1459. [PMID: 34315470 PMCID: PMC8317385 DOI: 10.1186/s12889-021-11509-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/10/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The North Carolina Healthy Food Small Retailer Program (NC HFSRP) was established through a policy passed by the state legislature to provide funding for small food retailers located in food deserts with the goal of increasing access to and sales of healthy foods and beverages among local residents. The purpose of this study was to qualitatively examine perceptions of the NC HFSRP among store customers. METHODS Qualitative interviews were conducted with 29 customers from five NC HFSRP stores in food deserts across eastern NC. Interview questions were related to shoppers' food and beverage purchases at NC HFSRP stores, whether they had noticed any in-store efforts to promote healthier foods and beverages, their suggestions for promoting healthier foods and beverages, their familiarity with and support of the NC HFSRP, and how their shopping and consumption habits had changed since implementation of the NC HFSRP. A codebook was developed based on deductive (from the interview guide questions) and inductive (emerged from the data) codes and operational definitions. Verbatim transcripts were double-coded and a thematic analysis was conducted based on code frequency, and depth of participant responses for each code. RESULTS Although very few participants were aware of the NC HFSRP legislation, they recognized changes within the store. Customers noted that the provision of healthier foods and beverages in the store had encouraged them to make healthier purchase and consumption choices. When a description of the NC HFSRP was provided to them, all participants were supportive of the state-funded program. Participants discussed program benefits including improving food access in low-income and/or rural areas and making healthy choices easier for youth and for those most at risk of diet-related chronic diseases. CONCLUSIONS Findings can inform future healthy corner store initiatives in terms of framing a rationale for funding or policies by focusing on increased food access among vulnerable populations.
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Affiliation(s)
- Lindsey Haynes-Maslow
- Department of Agricultural & Human Sciences, NC State University, 512 Brickhaven Drive, Room 240c, Raleigh, NC, 27695, USA.
| | - Stephanie B Jilcott Pitts
- Department of Public Health, East Carolina University, 115 Heart Drive, Room #2239, Greenville, NC, 27834, USA
| | - Kathryn A Boys
- Department of Agricultural and Resource Economics, North Carolina State University, 4306 Nelson Hall, Raleigh, NC, 27695-8109, USA
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina Greensboro, 319 Colllege Avenue, 318 Stone Building, Greensboro, NC, 27412, USA
| | | | - Alice S Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, CB# 7426, 1700 MLK Jr. Blvd, Room 239, Chapel Hill, NC, 27599-7426, USA
| | - Nevin Johnson
- Department of Public Health, East Carolina University, 115 Heart Drive, Room #2239, Greenville, NC, 27834, USA
| | - Casey Kelley
- University of North Carolina at Chapel Hill, School of Medicine, Division of Geriatric Medicine, Center for Aging and Health, 5003 Old Clinic CB#7550, Chapel Hill, NC, 27599, USA
| | - Victoria E Donadio
- Department of Public Health, East Carolina University, 115 Heart Drive, Room #2239, Greenville, NC, 27834, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Melissa N Laska
- Epidemiology & Community Health, University of Minnesota, 1300 South 2nd Street, WBOB Suite 300, Minneapolis, MN, 55454-1015, USA
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Shand C, Crozier S, Vassilev I, Penn-Newman D, Dhuria P, Cooper C, Rogers A, Baird J, Vogel C. Resources in women's social networks for food shopping are more strongly associated with better dietary quality than people: A cross-sectional study. Soc Sci Med 2021; 284:114228. [PMID: 34325327 DOI: 10.1016/j.socscimed.2021.114228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 02/05/2023]
Abstract
When healthy people are part of an individual's social network, those individuals will have better dietary quality. Little, however, is known about whether social networks for food shopping, including both people and resources (e.g. recipes, weight loss programmes and food advertisements) are associated with dietary quality. The aim of this study was to explore the relationship between social networks for food shopping and dietary quality, and whether this differs for people and resources, among women aged 18-45 years. A total of 129 participants completed a cross-sectional questionnaire including an ego-centric Social Network Exposure tool and short Food Frequency Questionnaire. Associations between dietary quality and type of network member, perceived healthiness and support for healthy shopping choices were explored using linear regression models. Analyses revealed that participants who nominated people in their food shopping social network that eat healthily or support healthy food shopping had better dietary quality (β = 0.16 SD per 1-point change on a 4-point scale, 95%CI -0.06, 0.39; β = 0.20, 95%CI -0.07, 0.46, respectively). Resources in participants' food shopping social networks which promote healthy eating or support healthy shopping were associated with better dietary quality. These associations remained robust after adjustment for confounding variables identified using a directed acyclic graph (β = 0.31 SD per 1-point change on a 4-point scale, 95%CI 0.03, 0.58; β = 0.44, 95%CI 0.09, 0.79 respectively). The results were strengthened when the outcome was multiplied by frequency of contact (β = 0.33, 95%CI 0.05, 0.61; β = 0.47, 95%CI 0.11, 0.83 respectively). This study suggests that resources which promote healthy eating and healthy food shopping have a stronger association with dietary quality than social support from people. Further research is required in a larger sample, including multiple time-points, to confirm these findings.
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Affiliation(s)
- Calum Shand
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton, SO16 7NP, UK
| | - Ivaylo Vassilev
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Daniel Penn-Newman
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; National Institute for Health Research Southampton Biomedical Research, Centre, University of Southampton and University Hospital Southampton, NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Anne Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; National Institute for Health Research Southampton Biomedical Research, Centre, University of Southampton and University Hospital Southampton, NHS Foundation Trust, Southampton, SO16 6YD, UK; NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton, SO16 7NP, UK
| | - Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; National Institute for Health Research Southampton Biomedical Research, Centre, University of Southampton and University Hospital Southampton, NHS Foundation Trust, Southampton, SO16 6YD, UK; NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton, SO16 7NP, UK.
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Bleich SN, Lawman HG, LeVasseur MT, Yan J, Mitra N, Lowery CM, Peterhans A, Hua S, Gibson LA, Roberto CA. The Association Of A Sweetened Beverage Tax With Changes In Beverage Prices And Purchases At Independent Stores. Health Aff (Millwood) 2021; 39:1130-1139. [PMID: 32634353 DOI: 10.1377/hlthaff.2019.01058] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In January 2017 Philadelphia, Pennsylvania, implemented an excise tax of 1.5 cents per ounce on beverages sweetened with sugar or artificial sweeteners. Small independent stores are an important yet understudied setting. They are visited frequently in urban and low-income areas, and sugary beverages are among the most commonly purchased items in them. We compared changes in beverage prices and purchases before and twelve months after tax implementation at small independent stores in Philadelphia and an untaxed control city, Baltimore, Maryland. Our sample included 134 stores with price data and 4,584 customer purchases. Compared with Baltimore, Philadelphia experienced significantly greater increases in the price of taxed beverages (1.81 cents per ounce, or 120.4 percent of the tax) and significantly larger declines in the volume of taxed beverages sold (5.76 ounces, or 38.9 percent) after tax implementation. Beverage excise taxes may be an effective policy tool for decreasing the purchase of sweetened drinks in small independent stores, particularly among populations at higher risk for sugar-sweetened beverage consumption.
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Affiliation(s)
- Sara N Bleich
- Sara N. Bleich is a professor of public health policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Hannah G Lawman
- Hannah G. Lawman is director of research and evaluation in the Division of Chronic Disease Prevention, Get Healthy Philly, Philadelphia Department of Public Health, in Philadelphia, Pennsylvania
| | - Michael T LeVasseur
- Michael T. LeVasseur is an adjunct professor of biostatistics at Drexel University, in Philadelphia
| | - Jiali Yan
- Jiali Yan is a data analyst in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Nandita Mitra
- Nandita Mitra is a professor in the Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania
| | - Caitlin M Lowery
- Caitlin M. Lowery is a project manager in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Ana Peterhans
- Ana Peterhans is a project manager in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Sophia Hua
- Sophia Hua is a project manager in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Laura A Gibson
- Laura A. Gibson is a research assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Christina A Roberto
- Christina A. Roberto is an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
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18
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Sachdev PK, Freeland-Graves J, Babaei M, Sanjeevi N, Zamora AB, Wright GJ. Associations Between Diet Quality and Dental Caries in Low-Income Women. J Acad Nutr Diet 2021; 121:2251-2259. [PMID: 33992584 DOI: 10.1016/j.jand.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/14/2021] [Accepted: 04/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Healthy Eating Index 2015 (HEI-2015) is a diet quality measure of conformity of diet to the 2015-2020 Dietary Guidelines for Americans. This tool is being used increasingly to assess relationships between diet quality and health outcomes. OBJECTIVE The objective of this research was to investigate the relationships between diet quality as measured by HEI-2015 total and component scores and Decayed, Missing, Filled Teeth Index (DMFT) scores in low-income women. DESIGN In this cross-sectional study, low-income women were administered questionnaires and dental examinations on 1 occasion. The questionnaires included demographics, food frequency, and oral health questionnaires, and the US Adult Food Security Survey Module. PARTICIPANTS/SETTINGS Participants in this study were part of a larger research project-Impact of Diet and Nutrition on Dental Caries in Low-Income Women. For the larger research project, a total of 255 women aged 18 to 50 years with annual income <250% of the Federal Poverty Line were recruited from low-income housing units in Central Texas from June 1, 2018 to December 30, 2018. Of the 255 women, 28 underwent dental screenings but did not complete the questionnaires. Seven women were excluded because energy intakes exceeded 4,000 kcal/d. The final sample for the current analysis was 220 women who had completed their dental examinations and provided complete data. MAIN OUTCOME MEASURES The exposure was diet quality and the main outcome measure was DMFT score. STATISTICAL ANALYSIS Dental caries scores were calculated by addition of decayed, missing, and filled teeth. Descriptive statistics were conducted on the variables of age, race and ethnicity, education, annual household income, food security status, and frequency of brushing and flossing. Linear regression analysis was used to discern relationships between diet quality-as assessed by HEI-2015 total and component scores-and dental caries experience, adjusting for the covariates. RESULTS Caries in permanent teeth was present in 95.6% of participants. HEI-2015 total scores were inversely associated with dental caries. An increase of 1 point in total HEI-2015 score was accompanied by a decrease in DMFT score by 0.569 (P = .001). In addition, component scores for total vegetables (P = .001), greens and beans (P = .002), dairy (P = .004), refined grains (P = .001), and added sugars (P = .001) were inversely related to DMFT scores. CONCLUSIONS This research suggests that diet quality, as measured by the HEI-2015, is inversely associated with DMFT scores in low-income women. Future research is needed to investigate the influence of diet and nutrition on the integrity of oral health.
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Affiliation(s)
- Prageet K Sachdev
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX
| | - Jeanne Freeland-Graves
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX.
| | - Mahsa Babaei
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX
| | - Namrata Sanjeevi
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX
| | - Annemarie B Zamora
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX
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19
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Dhakal CK, Khadka S. Heterogeneities in Consumer Diet Quality and Health Outcomes of Consumers by Store Choice and Income. Nutrients 2021; 13:1046. [PMID: 33804858 PMCID: PMC8063805 DOI: 10.3390/nu13041046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Chandra K. Dhakal
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA 30602, USA;
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20
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Lenk KM, Winkler MR, Caspi CE, Laska MN. Food shopping, home food availability, and food insecurity among customers in small food stores: an exploratory study. Transl Behav Med 2020; 10:1358-1366. [PMID: 33421081 DOI: 10.1093/tbm/ibaa005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Customers who frequently shop in small food stores (e.g., convenience stores) may face numerous challenges to procuring healthful food for their household, and these may vary by food security status. The purpose of this study is to examine associations between food security and food shopping-related behaviors among frequent shoppers at small stores. Our sample included participants from customer intercept interviews at small food stores in an urban area. A follow-up in-home visit with a subset of customers who reported frequently shopping in these stores (≥1/week; n = 78) included a survey and researcher-administered home food inventory. Food security status was identified via the U.S. Household Food Security Survey Six-Item Short Form. Outcomes included shopping frequency and money spent by store type (e.g., small vs. large), home-to-store distance, and observed home availability of fruits, vegetables, and obesogenic foods. We estimated associations between food security status and each outcome, adjusting for demographic and poverty-related confounders. Participants were 56% female and 65% people of color; 45% received Supplemental Nutrition Assistance Program benefits and 54% experienced food insecurity in the past year. Unadjusted models indicated several significant associations: compared to those who were food secure, food-insecure participants shopped for food/beverages at small stores more times per month, spent more on food/beverages at dollar stores, and had less home availability of fruit and obesogenic foods. Associations remained significant (p = .04) between food insecurity and shopping frequency in adjusted models. Interventions requiring or incentivizing small food stores to stock healthful products could be important for improving access to nutritious food for food-insecure persons.
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Affiliation(s)
- Kathleen M Lenk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Megan R Winkler
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Caitlin E Caspi
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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21
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Leschewski AM, Davis DE. The Nutritional Quality of Food Purchases at SNAP-Authorized and Unauthorized Non-Traditional Retailers. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2020.1787289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Andrea M. Leschewski
- Ness School of Management and Economics, South Dakota State University, Brookings, South Dakota, USA
| | - David E. Davis
- Ness School of Management and Economics, South Dakota State University, Brookings, South Dakota, USA
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22
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Understanding the Intersection of Race/Ethnicity, Socioeconomic Status, and Geographic Location: A Scoping Review of U.S. Consumer Food Purchasing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207677. [PMID: 33096828 PMCID: PMC7593902 DOI: 10.3390/ijerph17207677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/11/2023]
Abstract
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.
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Kids in a Candy Store: An Objective Analysis of Children's Interactions with Food in Convenience Stores. Nutrients 2020; 12:nu12072143. [PMID: 32708485 PMCID: PMC7400802 DOI: 10.3390/nu12072143] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 01/18/2023] Open
Abstract
Increasing rates of childhood obesity worldwide has focused attention on the obesogenic food environment. This paper reports an analysis of children's interactions with food in convenience stores. Kids'Cam was a cross-sectional study conducted from July 2014 to June 2015 in New Zealand in which 168 randomly selected children aged 11-14 years old wore a wearable camera for a 4-day period. In this ancillary study, images from children who visited a convenience store were manually coded for food and drink availability. Twenty-two percent of children (n = 37) visited convenience stores on 62 occasions during the 4-day data collection period. Noncore items dominated the food and drinks available to children at a rate of 8.3 to 1 (means were 300 noncore and 36 core, respectively). The food and drinks marketed in-store were overwhelmingly noncore and promoted using accessible placement, price offers, product packaging, and signage. Most of the 70 items purchased by children were noncore foods or drinks (94.6%), and all of the purchased food or drink subsequently consumed was noncore. This research highlights convenience stores as a key source of unhealthy food and drink for children, and policies are needed to reduce the role of convenience stores in the obesogenic food environment.
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Dono J, Ettridge K, Wakefield M, Pettigrew S, Coveney J, Roder D, Durkin S, Wittert G, Martin J, Miller C. Nothing beats taste or convenience: a national survey of where and why people buy sugary drinks in Australia. Aust N Z J Public Health 2020; 44:291-294. [DOI: 10.1111/1753-6405.13000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Joanne Dono
- Health Policy CentreSouth Australian Health and Medical Research Institute
- School of PsychologyThe University of Adelaide South Australia
| | - Kerry Ettridge
- Health Policy CentreSouth Australian Health and Medical Research Institute
- School of PsychologyThe University of Adelaide South Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in CancerCancer Council Victoria
- School of Psychological SciencesThe University of Melbourne Victoria
| | - Simone Pettigrew
- Food PolicyThe George Institute for Global Health New South Wales
| | - John Coveney
- College of Nursing and Health SciencesFlinders University South Australia
| | - David Roder
- Cancer Epidemiology and Population HealthUniversity of South Australia
| | - Sarah Durkin
- Centre for Behavioural Research in CancerCancer Council Victoria
- School of Psychological SciencesThe University of Melbourne Victoria
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health SciencesUniversity of Adelaide South Australia
- Centre for Nutrition and GI DiseasesSouth Australian Health and Medical Research Institute
| | - Jane Martin
- Obesity Policy Coalition and Alcohol and Obesity PolicyCancer Council Victoria
| | - Caroline Miller
- Health Policy CentreSouth Australian Health and Medical Research Institute
- School of Public HealthThe University of Adelaide South Australia
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Neighborhood Food Outlet Access and Dietary Intake among Adults with Chronic Kidney Disease: Results from the Chronic Renal Insufficiency Cohort Study. J Acad Nutr Diet 2020; 120:1151-1162.e3. [PMID: 32146126 DOI: 10.1016/j.jand.2019.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/16/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Healthy diet is essential in the management of chronic kidney disease (CKD) and preventing related comorbidities. Food outlet access has been studied in the general population; however, the influence of the local food environment on dietary intake among people with CKD has not been evaluated. OBJECTIVES This study examined the associations of food outlet density and type of outlets with dietary intake in a multicenter cohort of racially and ethnically diverse patients with CKD. METHODS The Chronic Renal Insufficiency Cohort Study is a multicenter prospective study of patients with CKD that used a validated food frequency questionnaire to capture dietary intake at the baseline visit. This is a cross-sectional analysis of 2,484 participants recruited in 2003-2006 from seven Chronic Renal Insufficiency Cohort Study centers. Food outlet data were used to construct a count of the number of fast-food restaurants, convenience stores, and grocery stores per 10,000 population for each geocoded census block group. Multivariable linear and logistic regression models were used to evaluate the associations between measures of food outlet availability and dietary factors. RESULTS The proportion of participants living in zero-, low-, and high-food outlet density areas differed by gender, race or ethnicity, and income level. Among male subjects, living in areas with zero or the highest number of outlets was associated with having the highest caloric intakes in multivariable models. Male subjects living in areas with zero outlets consumed the highest levels of sodium and phosphorous. Female subjects living in areas with zero outlets had the lowest average intake of calories, sodium, and phosphorous. Among low-income female subjects, close proximity to more outlets was associated with higher calorie consumption. Among all participants, access to fast-food restaurants was not associated with an unhealthy diet score, and access to grocery stores was not associated with a healthy diet score. CONCLUSIONS Average caloric and nutrient intakes differed by outlet availability; however, there were no strong associations with type of food outlet. This should be considered when developing food-focused public health policies.
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Caspi CE, Winkler MR, Lenk KM, Harnack LJ, Erickson DJ, Laska MN. Store and neighborhood differences in retailer compliance with a local staple foods ordinance. BMC Public Health 2020; 20:172. [PMID: 32019508 PMCID: PMC7001202 DOI: 10.1186/s12889-020-8174-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/07/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Policies to improve healthy food retail have been recognized as a potential means of reducing diet-related health disparities. The revised 2014 Minneapolis Staple Foods Ordinance instituted minimum stocking standards for healthy, staple foods. The objective of this study was to examine retailer compliance with the policy, and whether compliance varied by neighborhood and store characteristics. METHODS In this natural experiment, audits were conducted annually pre- and post-ordinance (2014-2017) in 155 small/nontraditional stores in Minneapolis, MN and a comparison city (St. Paul, MN). Compliance measures for 10 product categories included: (1) met requirements for ≥8 categories; (2) 10-point scale (one point for each requirement met); and (3) carried any item in each category. Store characteristics included store size and ownership status. Neighborhood characteristics included census-tract socioeconomic status and low-income/low-access status. Analyses were conducted in 2018. RESULTS All compliance measures increased in both Minneapolis and St. Paul from pre- to post-policy; Minneapolis increases were greater only for carrying any item in each category (p < 0.01). In Minneapolis, corporate (vs. independent) stores were generally more compliant. No differences were found by neighborhood characteristics. CONCLUSIONS Overall trends suggest broad movement among Minneapolis stores towards providing a minimum level of staple foods. Increases were greater in corporate stores. Trends do not suggest neighborhood-level disparities in compliance. STUDY REGISTRATION ClinicalTrials.gov NCT02774330, retrospectively registered May 17, 2016.
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Affiliation(s)
- Caitlin E Caspi
- Department of Family Medicine and Community Health, Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN, USA.
| | - Megan R Winkler
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, USA
| | - Kathleen M Lenk
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, USA
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, USA
| | - Darin J Erickson
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, USA
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Rebouillat P, Bonin S, Kestens Y, Chaput S, Drouin L, Mercille G. Fruit and Vegetable Purchases in Farmer's Market Stands: Analysing Survey and Sales Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E88. [PMID: 31877682 PMCID: PMC6981572 DOI: 10.3390/ijerph17010088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/06/2019] [Accepted: 12/15/2019] [Indexed: 11/16/2022]
Abstract
Farmers' market implementation holds promise for increasing access to healthy foods. Although rarely measured, purchase data constitute an intermediate outcome between food environment and actual consumption. In a study conducted with two seasonal Fruits and Vegetables (FV) stands in a disadvantaged area of Montréal (Canada), we analysed how accessibility, perception, and mobility-related factors were associated with FV purchase. This analysis uses a novel measure of FV purchasing practices based on sales data obtained from a mobile application. A 2016 survey collected information on markets' physical access, perceived access to FV in the neighbourhood, usual FV consumption and purchases. Multivariate models were used to analyse three purchasing practice indicators: number of FV portions, FV variety and expenditures. Average shoppers purchased 12 FV portions of three distinct varieties and spent 5$. Shoppers stopping at the market on their usual travel route spent less (p = 0.11), bought fewer portions (p = 0.03) and a lesser FV variety (p < 0.01). FV stands may complement FV dietary intake. Individuals for whom the market is on their usual travel route might make more frequent visits and, therefore, smaller purchases. The novel data collection method allowed analysis of multiple purchase variables, is precise and easy to apply at unconventional points of sales and could be transposed elsewhere.
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Affiliation(s)
- Pauline Rebouillat
- Institut de Santé Publique d’Épidémiologie et de Développement (ISPED), Université de Bordeaux, 33000 Bordeaux, France
- Centre de recherche du Centre hospitalier de l’Université de Montréal, 850 St-Denis, Montréal, QC H2X 0A9, Canada
| | - Sarah Bonin
- Département de médecine sociale et préventive, École de Santé Publique de l’Université de Montréal, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Yan Kestens
- Centre de recherche du Centre hospitalier de l’Université de Montréal, 850 St-Denis, Montréal, QC H2X 0A9, Canada
- Département de médecine sociale et préventive, École de Santé Publique de l’Université de Montréal, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Sarah Chaput
- Centre de recherche du Centre hospitalier de l’Université de Montréal, 850 St-Denis, Montréal, QC H2X 0A9, Canada
- Département de médecine sociale et préventive, École de Santé Publique de l’Université de Montréal, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Louis Drouin
- Direction régionale de santé publique, Centre intégré universitaire de santé et services sociaux du Centre-Sud-de-l’Ile-de-Montréal, Montréal, QC H2L 1M3, Canada
| | - Geneviève Mercille
- Département de nutrition, Université de Montréal, 2450 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada
- Centre de recherche en santé publique, 1301 Sherbrooke Est, Montréal, QC H2L 1M3, Canada
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Evaluation of Store Environment Changes of an In-Store Intervention to Promote Fruits and Vegetables in Latino/Hispanic-Focused Food Stores. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010065. [PMID: 31861788 PMCID: PMC6981808 DOI: 10.3390/ijerph17010065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
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.
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Availability of neighbourhood supermarkets and convenience stores, broader built environment context, and the purchase of fruits and vegetables in US households. Public Health Nutr 2019; 22:2436-2447. [PMID: 31130150 DOI: 10.1017/s1368980019000910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Variation in the food environment of small and non-traditional stores across racial segregation and corporate status. Public Health Nutr 2019; 22:1624-1634. [PMID: 30846012 DOI: 10.1017/s1368980019000132] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We examined differences in consumer-level characteristics and structural resources and capabilities of small and non-traditional food retailers (i.e. corner stores, gas-marts, pharmacies, dollar stores) by racial segregation of store neighbourhood and corporate status (corporate/franchise- v. independently owned). DESIGN Observational store assessments and manager surveys were used to examine availability-, affordability- and marketing-related characteristics experienced by consumers as well as store resources (e.g. access to distributors) and perceived capabilities for healthful changes (e.g. reduce pricing on healthy foods). Cross-sectional regression analyses of store and manager data based on neighbourhood segregation and store corporate status were conducted. SETTING Small and non-traditional food stores in Minneapolis and St. Paul, MN, USA.ParticipantsOne hundred and thirty-nine stores; seventy-eight managers. RESULTS Several consumer- and structural-level differences occurred by corporate status, independent of residential segregation. Compared with independently owned stores, corporate/franchise-owned stores were more likely to: not offer fresh produce; when offered, receive produce via direct delivery and charge higher prices; promote unhealthier consumer purchases; and have managers that perceived greater difficulty in making healthful changes (P≤0·05). Only two significant differences were identified by residential racial segregation. Stores in predominantly people of colour communities (<30 % non-Hispanic White) had less availability of fresh fruit and less promotion of unhealthy impulse buys relative to stores in predominantly White communities (P≤0·05). CONCLUSIONS Corporate status appears to be a relevant determinant of the consumer-level food environment of small and non-traditional stores. Policies and interventions aimed at making these settings healthier may need to consider multiple social determinants to enable successful implementation.
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Jilcott Pitts SB, Wu Q, Truesdale KP, Haynes-Maslow L, McGuirt JT, Ammerman A, Bell R, Laska MN. One-Year Follow-Up Examination of the Impact of the North Carolina Healthy Food Small Retailer Program on Healthy Food Availability, Purchases, and Consumption. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2681. [PMID: 30487427 PMCID: PMC6313329 DOI: 10.3390/ijerph15122681] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/17/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
We examined the short-term impact of the North Carolina Healthy Food Small Retailer Program (HFSRP), a legislatively appropriated bill providing funding up to $25,000 to small food retailers for equipment to stock and promote healthier foods, on store-level availability and purchase of healthy foods and beverages, as well as customer dietary patterns, one year post-policy implementation. We evaluated healthy food availability using a validated audit tool, purchases using customer bag-checks, and diet using self-reported questionnaires and skin carotenoid levels, assessed via Veggie Meter™, a non-invasive tool to objectively measure fruit and vegetable consumption. Difference-in-difference analyses were used to examine changes in HFSRP stores versus control stores after 1 year. There were statistically significant improvements in healthy food supply scores (availability), with the Healthy Food Supply HFS score being -0.44 points lower in control stores and 3.13 points higher in HFSRP stores pre/post HFSRP (p = 0.04). However, there were no statistically significant changes in purchases or self-reported consumption or skin carotenoids among customers in HFSRP versus control stores. Additional time or other supports for retailers (e.g., marketing and promotional materials) may be needed for HFSRP implementation to influence purchase and consumption.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC 27834, USA.
| | - Kimberly P Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC 27695, USA.
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC 27412, USA.
| | - Alice Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Ronny Bell
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
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Barnes TL, Lenk K, Caspi CE, Erickson DJ, Laska MN. Perceptions of a healthier neighborhood food environment linked to greater fruit and vegetable purchases at small and non-traditional food stores. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018; 14:741-761. [PMID: 31798762 DOI: 10.1080/19320248.2018.1549518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to examine associations between perceived neighborhood food environments and food purchasing at small and non-traditional food stores. Intercept interviews of 661 customers were conducted in 105 small and non-traditional food stores. We captured (1) customer perceptions of the neighborhood food environment, (2) associations between customer perceptions and store-level characteristics, and (3) customers' perceptions and shopping behaviors. Findings suggest that customers with more favorable perceptions of the neighborhood food environment were more likely to purchase fruits and vegetables, despite no significant association between perceptions of the neighborhood and objectively measured store characteristics.
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Affiliation(s)
- Timothy L Barnes
- Children's Minnesota Research Institute, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Ave. S, Minneapolis, MN 55404.,University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN 55454
| | - Kathleen Lenk
- University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN 55454
| | - Caitlin E Caspi
- University of Minnesota, Department of Family Medicine and Community Health, Program in Health Disparities Research, 717 Delaware St. SE, Minneapolis, MN 55414
| | - Darin J Erickson
- University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN 55454
| | - Melissa N Laska
- University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN 55454
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Chrisinger BW, Kallan MJ, Whiteman ED, Hillier A. 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. Prev Med 2018; 112:15-22. [PMID: 29555187 PMCID: PMC5970989 DOI: 10.1016/j.ypmed.2018.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/16/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Abstract
Food shopping decisions are pathways between food environment, diet and health outcomes, including chronic diseases such as diabetes and obesity. The choices of where to shop and what to buy are interrelated, though a better understanding of this dynamic is needed. The U.S. Department of Agriculture's nationally representative Food Acquisitions and Purchase Survey food-at-home dataset was joined with other databases of retailer characteristics and Healthy Eating Index-2010 (HEI) of purchases. We used linear regression models with general estimating equations to assess relationships between trip, store, and shopper characteristics with trip HEI scores. We examined HEI component scores for conventional supermarkets and discount/limited assortment retailers with descriptive statistics. Overall, 4962 shoppers made 11,472 shopping trips over one-week periods, 2012-2013. Trips to conventional supermarkets were the most common (53.6%), followed by supercenters (18.6%). Compared to conventional supermarkets, purchases at natural/gourmet stores had significantly higher HEI scores (β = 6.48, 95% CI = [4.45, 8.51], while those from "other" retailers (including corner and convenience stores) were significantly lower (-3.89, [-5.87, -1.92]). Older participants (versus younger) and women (versus men) made significantly healthier purchases (1.19, [0.29, 2.10]). Shoppers with less than some college education made significantly less-healthy purchases, versus shoppers with more education, as did households participating in SNAP, versus those with incomes above 185% of the Federal Poverty Level. Individual, trip, and store characteristics influenced the healthfulness of foods purchased. Interventions to encourage healthy purchasing should reflect these dynamics in terms of how, where, and for whom they are implemented.
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Affiliation(s)
| | - Michael J Kallan
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, USA
| | - Eliza D Whiteman
- Department of City & Regional Planning, School of Design, University of Pennsylvania, USA
| | - Amy Hillier
- Department of City & Regional Planning, School of Design, University of Pennsylvania, USA; School of Social Policy and Practice, University of Pennsylvania, USA
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Gorski Findling MT, Wolfson JA, Rimm EB, Bleich SN. Differences in the Neighborhood Retail Food Environment and Obesity Among US Children and Adolescents by SNAP Participation. Obesity (Silver Spring) 2018; 26:1063-1071. [PMID: 29797558 PMCID: PMC5975976 DOI: 10.1002/oby.22184] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The goal of this study was to understand the association between children's neighborhood food access and overweight/obesity in a national sample of US households, and whether this association differs by Supplemental Nutrition Assistance Program (SNAP) participation or household purchases. METHODS Data were obtained from the National Household Food Acquisition and Purchase Survey (2012-2013; n = 3,748 children aged 2 to 18 years). Logistic regression was used to examine associations between neighborhood retail food access (≤1 mile from home), food purchases (including sugary beverages), and overweight/obesity, stratified by SNAP status (1,720 participants, 453 eligible nonparticipants, 1,575 SNAP ineligible). Store types included supermarkets/grocery, combination grocery/other (independent drug, dollar, and general stores), convenience, fast food, and non-fast food restaurants. RESULTS Odds of childhood overweight/obesity (OR [95% CI]) were higher with greater access to combination grocery/other stores overall (1.10 [1.03-1.17]) and for children in SNAP (1.14 [1.05-1.24]). Eligible non-SNAP children had higher odds of overweight/obesity with greater access to convenience stores (1.11 [1.04-1.18]). The average child lived in a household with 6.3% of total spending at food outlets on sugary beverages (SNAP: 8.3%, eligible non-SNAP: 7.7%, SNAP ineligible: 5.5%). CONCLUSIONS Greater neighborhood access to combination grocery/other stores is associated with higher obesity prevalence for children overall and those in SNAP.
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Affiliation(s)
| | - Julia A. Wolfson
- Departments of Health Management and Policy and Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Eric B. Rimm
- Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts and Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Abstract
OBJECTIVE Hunger relief agencies have a limited capacity to monitor the nutritional quality of their food. Validated measures of food environments, such as the Healthy Eating Index-2010 (HEI-2010), are challenging to use due to their time intensity and requirement for precise nutrient information. A previous study used out-of-sample predictions to demonstrate that an alternative measure correlated well with the HEI-2010. The present study revised the Food Assortment Scoring Tool (FAST) to facilitate implementation and tested the tool's performance in a real-world food pantry setting. DESIGN We developed a FAST measure with thirteen scored categories and thirty-one sub-categories. FAST scores were generated by sorting and weighing foods in categories, multiplying each category's weight share by a healthfulness parameter and summing the categories (range 0-100). FAST was implemented by recording all food products moved over five days. Researchers collected FAST and HEI-2010 scores for food availability and foods selected by clients, to calculate correlations. SETTING Five food pantries in greater Minneapolis/St. Paul, Minnesota, USA. SUBJECTS Food carts of sixty food pantry clients. RESULTS The thirteen-category FAST correlated well with the HEI-2010 in prediction models (r = 0·68). FAST scores averaged 61·5 for food products moved, 63·8 for availability and 62·5 for client carts. As implemented in the real world, FAST demonstrated good correlation with the HEI-2010 (r = 0·66). CONCLUSIONS The FAST is a flexible, valid tool to monitor the nutritional quality of food in pantries. Future studies are needed to test its use in monitoring improvements in food pantry nutritional quality over time.
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Jilcott Pitts SB, Wu Q, Truesdale KP, Laska MN, Grinchak T, McGuirt JT, Haynes-Maslow L, Bell RA, Ammerman AS. Baseline Assessment of a Healthy Corner Store Initiative: Associations between Food Store Environments, Shopping Patterns, Customer Purchases, and Dietary Intake in Eastern North Carolina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1189. [PMID: 28991156 PMCID: PMC5664690 DOI: 10.3390/ijerph14101189] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Abstract
In 2016, the North Carolina (NC) Legislature allocated $250,000 to the NC Department of Agriculture, to identify and equip small food retailers to stock healthier foods and beverages in eastern NC food deserts (the NC Healthy Food Small Retailer Program, HFSRP). The purpose of this study was to examine associations between food store environments, shopping patterns, customer purchases, and dietary consumption among corner store customers. We surveyed 479 customers in 16 corner stores regarding demographics, food purchased, shopping patterns, and self-reported fruit, vegetable, and soda consumption. We objectively assessed fruit and vegetable consumption using a non-invasive reflection spectroscopy device to measure skin carotenoids. We examined associations between variables of interest, using Pearson's correlation coefficients and adjusted linear regression analyses. A majority (66%) of participants were African American, with a mean age of 43 years, and a mean body mass index (BMI) of 30.0 kg/m². There were no significant associations between the healthfulness of food store offerings, customer purchases, or dietary consumption. Participants who said they had purchased fruits and vegetables at the store previously reported higher produce intake (5.70 (4.29) vs. 4.60 (3.28) servings per day, p = 0.021) versus those who had not previously purchased fresh produce. The NC Legislature has allocated another $250,000 to the HFSRP for the 2018 fiscal year. Thus, evaluation results will be important to inform future healthy corner store policies and initiatives.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health, East Carolina University, Greenville, NC 27834, USA.
| | - Kimberly P Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Taras Grinchak
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC 27413, USA.
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC 27695, USA.
| | - Ronny A Bell
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Alice S Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
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Hillier A, Smith TE, Whiteman ED, Chrisinger BW. Discrete Choice Model of Food Store Trips Using National Household Food Acquisition and Purchase Survey (FoodAPS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101133. [PMID: 28953221 PMCID: PMC5664634 DOI: 10.3390/ijerph14101133] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/08/2017] [Accepted: 09/21/2017] [Indexed: 12/29/2022]
Abstract
Where households across income levels shop for food is of central concern within a growing body of research focused on where people live relative to where they shop, what they purchase and eat, and how those choices influence the risk of obesity and chronic disease. We analyzed data from the National Household Food Acquisition and Purchase Survey (FoodAPS) using a conditional logit model to determine where participants shop for food to be prepared and eaten at home and how individual and household characteristics of food shoppers interact with store characteristics and distance from home in determining store choice. Store size, whether or not it was a full-service supermarket, and the driving distance from home to the store constituted the three significant main effects on store choice. Overall, participants were more likely to choose larger stores, conventional supermarkets rather than super-centers and other types of stores, and stores closer to home. Interaction effects show that participants receiving Supplemental Nutrition Assistance Program (SNAP) were even more likely to choose larger stores. Hispanic participants were more likely than non-Hispanics to choose full-service supermarkets while White participants were more likely to travel further than non-Whites. This study demonstrates the value of explicitly spatial discrete choice models and provides evidence of national trends consistent with previous smaller, local studies.
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Affiliation(s)
- Amy Hillier
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Tony E Smith
- Department of Electrical and Systems Engineering, School of Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Eliza D Whiteman
- Department of City and Regional Planning, School of Design, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Benjamin W Chrisinger
- Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA 94305, USA.
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Caspi CE, Lenk K, Pelletier JE, Barnes TL, Harnack L, Erickson DJ, Laska MN. Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores. Int J Behav Nutr Phys Act 2017; 14:76. [PMID: 28583131 PMCID: PMC5460502 DOI: 10.1186/s12966-017-0531-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/26/2017] [Indexed: 12/19/2022] Open
Abstract
Background Purchases at small/non-traditional food stores tend to have poor nutritional quality, and have been associated with poor health outcomes, including increased obesity risk The purpose of this study was to examine whether customers who shop at small/non-traditional food stores with more health promoting features make healthier purchases. Methods In a cross-sectional design, data collectors assessed store features in a sample of 99 small and non-traditional food stores not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Minneapolis/St. Paul, MN in 2014. Customer intercept interviews (n = 594) collected purchase data from a bag check and demographics from a survey. Store measures included fruit/vegetable and whole grain availability, an overall Healthy Food Supply Score (HFSS), healthy food advertisements and in-store placement, and shelf space of key items. Customer nutritional measures were analyzed using Nutrient Databases System for Research (NDSR), and included the purchase of ≥1 serving of fruits/vegetables; ≥1 serving of whole grains; and overall Healthy Eating Index-2010 (HEI-2010) score for foods/beverages purchased. Associations between store and customer measures were estimated in multilevel linear and logistic regression models, controlling for customer characteristics and store type. Results Few customers purchased fruits and vegetables (8%) or whole grains (8%). In fully adjusted models, purchase HEI-2010 scores were associated with fruit/vegetable shelf space (p = 0.002) and the ratio of shelf space devoted to healthy vs. less healthy items (p = 0.0002). Offering ≥14 varieties of fruit/vegetables was associated with produce purchases (OR 3.9, 95% CI 1.2–12.3), as was having produce visible from the store entrance (OR 2.3 95% CI 1.0 to 5.8), but whole grain availability measures were not associated with whole grain purchases. Conclusions Strategies addressing both customer demand and the availability of healthy food may be necessary to improve customer purchases. Trial registration ClinialTrials.gov: NCT02774330. Registered May 4, 2016 (retrospectively registered). Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0531-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caitlin E Caspi
- Department of Family Medicine and Community Health, Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN, 55414, USA.
| | - Kathleen Lenk
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, 55454, USA
| | - Jennifer E Pelletier
- Statewide Health Improvement Program, Minnesota Department of Health, Saint Paul, MN, 55164, USA
| | - Timothy L Barnes
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, 55454, USA
| | - Lisa Harnack
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, 55454, USA
| | - Darin J Erickson
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, 55454, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, 55454, USA
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39
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Appelhans BM, French SA, Tangney CC, Powell LM, Wang Y. To what extent do food purchases reflect shoppers' diet quality and nutrient intake? Int J Behav Nutr Phys Act 2017; 14:46. [PMID: 28399887 PMCID: PMC5387266 DOI: 10.1186/s12966-017-0502-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/03/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Food purchasing is considered a key mediator between the food environment and eating behavior, and food purchasing patterns are increasingly measured in epidemiologic and intervention studies. However, the extent to which food purchases actually reflect individuals' dietary intake has not been rigorously tested. This study examined cross-sectional agreement between estimates of diet quality and nutrient densities derived from objectively documented household food purchases and those derived from interviewer-administered 24-h diet recalls. A secondary aim was to identify moderator variables associated with attenuated agreement between purchases and dietary intake. METHODS Primary household food shoppers (N = 196) collected and annotated receipts for all household food and beverage purchases (16,356 total) over 14 days. Research staff visited participants' homes four times to photograph the packaging and nutrition labels of each purchased item. Three or four multiple-pass 24-h diet recalls were performed within the same 14-d period. Nutrient densities and Healthy Eating Index-2010 (HEI-2010) scores were calculated from both food purchase and diet recall data. RESULTS HEI-2010 scores derived from food purchases (median = 60.9, interquartile range 49.1-71.7) showed moderate agreement (ρc = .57, p < .0001) and minimal bias (-2.0) with HEI-2010 scores from 24-h recalls (median = 60.1, interquartile range 50.8-73.9). The degree of observed bias was unrelated to the number of food/beverage purchases reported or participant characteristics such as social desirability, household income, household size, and body mass. Concordance for individual nutrient densities from food purchases and 24-h diet recalls varied widely from ρc = .10 to .61, with the strongest associations observed for fiber (ρc = .61), whole fruit (ρc = .48), and vegetables (ρc = .39). CONCLUSIONS Objectively documented household food purchases yield an unbiased and reasonably accurate estimate of overall diet quality as measured through 24-h diet recalls, but are generally less useful for characterizing dietary intake of specific nutrients. Thus, some degree of caution is warranted when interpreting food purchase data as a reflection of diet in epidemiological and clinical research. Future work should examine agreement between food purchases and nutritional biomarkers. TRIAL REGISTRATION ClinicalTrials.gov, NCT02073643 . Retrospectively registered.
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Affiliation(s)
- Bradley M. Appelhans
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL 60612 USA
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd. Suite 400, Chicago, IL 60612 USA
| | - Simone A. French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454 USA
| | - Christy C. Tangney
- Department of Clinical Nutrition, Rush University Medical Center, 1700 W. Van Buren St., Suite 425, Chicago, IL 60612 USA
| | - Lisa M. Powell
- Health Policy and Administration, School of Public Health, University of Illinois at Chicago, MC 923, 1603 W Taylor St., Chicago, IL 60612 USA
| | - Yamin Wang
- Department of Internal Medicine, Rush University Medical Center, 1645 W. Jackson, Suite 675, Chicago, IL 60612 USA
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