Promoting access to fresh fruits and vegetables through a local market intervention at a subway station

Implementing a Rural Natural Experiment: A Protocol for Evaluating the Impacts of Food Coops on Food Consumption, Resident's Health and Community Vitality

Background: Local food environments are recognized by experts as a determinant of healthy eating. Food cooperatives (coop) can promote the accessibility to healthier foods and thus improve the health of the population, particularly in remote rural communities. Objective: To measure the effects of implementing a food coop in a disadvantaged community with poor access to food. We have two main research questions: (1). Does the establishment of a food coop in rural areas described as food deserts have an impact on accessibility, frequency of use, food consumption, food quality, and ultimately the health of individuals? (2). Does the establishment of a food coop in rural areas described as food deserts have an impact on food security and community vitality? Design: A natural experiment with a mixed pre/post method will be used. The sample is composed of households that came from geographically isolated communities (population: 215 to 885 inhabitants) which qualified as food deserts and located in rural areas of Quebec (Canada). All communities plan to open a food coop (in the years 2022–2023), and as their opening will be staggered over time, participants from communities with a new food coop (intervention) will be compared to communities awaiting the opening of their food coop (control). Data collection was carried out at three time points: (1) before; (2) 1 to 5 months after; and (3) 13 to 17 months after the opening of the coop. Questionnaires were used to measure sociodemographic variables, dietary intake, residents’ health, and community vitality. Semi-structured interviews were conducted with community stakeholders. Results: Few natural experiments have been conducted regarding the impact of implementing food coops. Gathering concrete data on the effectiveness and processes surrounding these interventions through natural experiments will help to quantify their impact and guide knowledge users and policymakers to make more informed decisions.

Dietary Patterns among Older People and the Associations with Social Environment and Individual Factors in Taiwan: A Multilevel Analysis

Individual factors relating to dietary behaviors are widely explored. However, the effects of social environment on dietary patterns for the older people are less explored. The purpose of this study was to identify dietary patterns among older people in Taiwan and to examine the relationship of dietary patterns with social environment and individual factors. The current study used the 2013–2016 Nutrition and Health Survey in Taiwan. The sample was representative at the national and city levels. Only those who were aged 55 years old and above were included for analysis (n = 2922); the mean age of the participants was 68.62 (SD = 8.76). The city-level data, including population characteristics, food availability, and age-friendly city indicators, were obtained from the open data and survey report of government. Three dietary patterns were identified: high protein-vegetable (41.6%), high sweets and low protein-vegetables (37.9%), and high viscera and fats (20.5%). The results of multilevel multinomial logistic regressions showed that marital status, economic status, education, drinking alcohol, dietary belief, living a the city with more food availability, and bus accessibility were related to dietary patterns. Dietary patterns are related to the individual-level factors and social environment. Healthy dietary beliefs and age-friendly environments are beneficial to promoting healthy dietary patterns.

Nutritional Content of Street Food and Takeaway Food Purchased in Urban Bosnia and Herzegovina

Street food (SF) and takeaway food (TAF) are important sources of out-of-home meals in urban Bosnia and Herzegovina, where diet-related non-communicable diseases are growing rapidly. This study aimed to characterise SF and TAF purchased in urban areas of Bosnia and Herzegovina, regarding customers' characteristics and the nutritional composition of the foods and beverages. A cross-sectional study was conducted in Sarajevo and Banja Luka in 2017. SF (n = 194) and TAF vending sites (n = 154) were selected through random and systematic sampling. Data on the food items purchased and customers' characteristics were collected by direct observation. Nutritional composition was estimated using data from chemical analyses of the foods most commonly available. Two-thirds of the customers observed (n = 755) were aged ≥35 years, half were women and 27.7% were overweight/obese. A total of 929 food items were purchased. The most commonly bought SFs were confectionery (30.5%), water (27.9%) and soft drinks/juices (22.2%). TAF customers purchased mostly savoury pastries (39.8%), breads (27.1%) and main dishes (21.4%). Almost half of customers purchased industrial food (i.e., pre-packaged foods and beverages produced by the food industry). The purchases presented median contents of 18.7 g of fat (39.6% saturated, 32.3% monounsaturated, 22.1% polyunsaturated, 1.5% trans), 838 mg of sodium and 285 mg of potassium. Saturated-fat contribution was higher in SF purchases (60.4% vs. 30.2%, p < 0.001), whereas TAF purchases presented higher trans-fat proportion (1.8% vs. 0.6%, p < 0.001), sodium (1241 vs. 89 mg, p < 0.001) and sodium-potassium ratio (6.1 vs. 0.6, p < 0.001). Generally, SF and TAF bought in Sarajevo and Banja Luka were rich in saturated and trans fatty-acids and sodium, and poor in potassium. Nutrition policies promoting use of healthier fats and salt reduction in SF and TAF may contribute to the prevention of diet-related diseases in these settings.

Fruit and Vegetable Purchases in Farmer's Market Stands: Analysing Survey and Sales Data

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.