Validation of the FRESH Austin food frequency questionnaire using multiple 24-h dietary recalls

The dynamics in food selection stemming from price awareness and perceived income adequacy: a cross-sectional study using 1-year loyalty card data

BACKGROUND

Higher cost of healthy foods may explain unhealthy dietary patterns in lower-income households. Unfortunately, combining food selection and nutrient intake data to price and expenditure is challenging. Food retailer's customer loyalty card data, linked to nutrient composition database, is a novel method for simultaneous exploration of food purchases, price, and nutrition.

OBJECTIVES

We studied the associations between perceived income adequacy (PIA) as a grouping variable with price (per kilogram or megajoule) and the volume of purchases (percentage of expenditure or energy) simultaneously as outcome variables for 17 most purchased food groups.

METHODS

We used 1-year (2018) loyalty card data from the largest grocery chain in Finland. Participants were 28,783 loyalty cardholders who made ≥41% of food purchases from the retailer and answered an online questionnaire at the midpoint of data collection. The 5-level PIA described the perceived financial situation in the household. Energy and nutrient content of foods purchased were from the Finnish Food Composition Database Fineli. We calculated the Nutrient Rich Food Index per 100 g food using 11 nutrients. Trends in prices and expenditures between PIA levels were analyzed using 2-sided Jonckheere-Terpstra tests, with false discovery rate control (Benjamini-Hochberg method) and confounder adjustments (inverse probability weighting).

RESULTS

Lower PIA participants selected cheaper foods per kilogram and megajoule within most food groups. They also favored unhealthy food groups cheap in energy [<1 € (USD 1.18)/MJ]. Despite lower purchase price, the expenditure (%) among lower PIA was higher on alcohol, snacks, sugar-sweetened beverages, and sweets and chocolates.

CONCLUSIONS

Participants with lower PIA showed stronger price awareness. It is crucial to consider the pricing of competing alternative food groups, when steering toward environmentally sustainable and healthier food purchases. Package labeling might also direct the selection of healthier choices among the less expensive items within a food group.

Association between Fresh Fruit and Vegetable Consumption and Purchasing Behaviors, Food Insecurity Status and Geographic Food Access among a Lower-Income, Racially/Ethnically Diverse Cohort in Central Texas

The aims of this study were to determine if fresh fruit and vegetable consumption and purchasing behaviors were associated with geographic food access and/or food insecurity status, and to explore the role of sociodemographic characteristics among participants of a lower-income, racially/ethnically diverse cohort. This study used a cross-sectional design and baseline survey data from the FRESH-Austin study (N = 393). Associations between fresh produce consumption/purchasing and food insecurity status and geographic access to food were assessed utilizing univariate, bivariate, and multivariate linear regression methods and potential interactions were examined. The sample 40% reported being food insecure and the majority identified as Hispanic. Geographic food access was directly associated with fresh produce consumption (β = 0.46, p = 0.02); however, the directionality of the relationship between food insecurity and fresh produce consumption varied due to a significant interaction with race/ethnicity. Only utilizing food assistance was associated with purchasing fewer fresh produce (β= -1.83, p = 0.03). Findings suggest that communities experience food insecurity and limited healthy food access in different ways, and in some situations, are associated with fresh produce consumption and purchasing behaviors. Future research adopting an intersectionality-sensitive approach to better understand how to best support communities at risk is needed.

A Multi-Pronged Evaluation of a Healthy Food Access Initiative in Central Texas: Study Design, Methods, and Baseline Findings of the FRESH-Austin Evaluation Study

Food insecurity and limited healthy food access are complex public health issues and warrant multi-level evaluations. The purpose of this paper was to present the overall study design and baseline results of the multi-pronged evaluation of a healthy food access (i.e., Fresh for Less (FFL)) initiative in Central Texas. The 2018-2021 FRESH-Austin study was a natural experiment that utilized a cluster random sampling strategy to recruit three groups of participants (total n = 400): (1) customers at FFL assets, (2) residents that lived within 1.5 miles of an FFL asset, and (3) residents from a comparison community. Evaluation measures included annual cohort surveys, accelerometers and GPS devices, store-level audits, and built environment assessments. Data are being used to inform and validate an agent-based model (ABM) to predict food shopping and consumption behaviors. Sociodemographic factors and food shopping and consumption behaviors were similar across the three groups; however, customers recruited at FFL assets were lower income and had a higher prevalence of food insecurity. The baseline findings demonstrate the need for multi-level food access interventions, such as FFL, in low-income communities. In the future, ABM can be used as a cost-effective way to determine potential impacts of future large-scale food environment programs and policies.