A multilevel analysis of socioeconomic (small area) differences in household food purchasing behaviour

Integrating human activity into food environments can better predict cardiometabolic diseases in the United States

The prevalence of cardiometabolic diseases in the United States is presumably linked to an obesogenic retail food environment that promotes unhealthy dietary habits. Past studies, however, have reported inconsistent findings about the relationship between the two. One underexplored area is how humans interact with food environments and how to integrate human activity into scalable measures. In this paper, we develop the retail food activity index (RFAI) at the census tract level by utilizing Global Positioning System tracking data covering over 94 million aggregated visit records to approximately 359,000 food retailers across the United States over two years. Here we show that the RFAI has significant associations with the prevalence of multiple cardiometabolic diseases. Our study indicates that the RFAI is a promising index with the potential for guiding the development of policies and health interventions aimed at curtailing the burden of cardiometabolic diseases, especially in communities characterized by obesogenic dietary behaviors.

Healthier Food Purchase and Its Determinants in an Urban Resettlement Colony of Delhi

Dietary risk, one of the major risk factors for the increasing burden of non-communicable diseases, is influenced by household food choices and purchases. A community-based cross-sectional study was conducted in 250 randomly selected households of an urban resettlement colony in Delhi to estimate the proportion of households purchasing different healthier food options during the last purchasing occasion and to identify its key determinants. Purchase of healthier options in staple items like wheat flour with fiber (100%), plant-based oils (97.9%), unpolished pulses (96.2%), and toned milk (94.5%) was high. Affordability and health considerations in food purchases were identified as key determinants.

Socioeconomic inequalities in food purchasing practices and expenditure patterns: Results from a cross-sectional household survey in western Kenya

Introduction

Socioeconomic inequalities contribute to poor health. Inequitable access to diverse and healthy foods can be a risk factor for non-communicable diseases, especially in individuals of low socioeconomic status. We examined the extent of socioeconomic inequalities in food purchasing practices, expenditure, and consumption in a resource-poor setting in Kenya.

Methods

We conducted a secondary analysis of baseline cross-sectional data from a natural experimental study with a sample size of 512 individuals from 376 households in western Kenya. Data were collected on household food sources, expenditure and food consumption. Household socioeconomic status (SES) was assessed using the multiple correspondence analysis (MCA) model. Concentration indices (Ci) and multivariable linear regression models were used to establish socioeconomic inequalities.

Results

About half (47.9%) of individuals achieved a minimum level of dietary diversity with the majority coming from wealthier households. The two most consumed food groups were grains and roots (97.5%, n = 499) and dark green leafy vegetables (73.8%, n = 378), but these did not vary by SES. The consumption of dark green leafy vegetables was similar across wealth quantiles (Ci = 0.014, p = 0.314). Overall, the wealthier households spent significantly more money on food purchases with a median of USD 50 (IQR = 60) in a month compared to the poorest who spent a median of USD 40 (IQR = 40). Of all the sources of food, the highest amount was spent at open-air markets median of USD 20 (IQR = 30) and the expenditure did not vary significantly by SES (Ci = 0.4, p = 0.684). The higher the socioeconomic status the higher the total amount spent on food purchases. In multivariable regression analysis, household SES was a significant determinant of food expenditure [Adjusted coefficient = 6.09 (95%confidence interval CI = 2.19, 9.99)].

Conclusion

Wealthier households spent more money on food compared to the poorest households, especially on buying food at supermarkets. Individuals from the poorest households were dominant in eating grains and roots and less likely to consume a variety of food groups, including pulses, dairy, eggs and fruits, and vegetables. Individuals from the poorest households were also less likely to achieve adequate dietary diversity. Deliberate policies on diet and nutrition are required to address socioeconomic inequalities in food purchasing practices.

Dietary Patterns in Association with Sleep Duration in Iranian Adults: Results from YaHS-TAMYZ and Shahadieh Cohort Studies

Background

Little observational studies have been conducted on the association between diet and sleep. We conducted a cross-sectional study to evaluate the associations of dietary patterns with sleep duration in an Iranian population.

Methods

This study was conducted on the baseline data of two population-based Iranian cohorts: the YaHS-TAMYS and Shahedieh studies. Dietary intakes were assessed in 10451 Yazdi people aged 20-75 years. Dietary habits were derived from answers to a food frequency questionnaire, and a factor analysis using principal component analysis (PCA) was used to identify dietary patterns. The reported sleep duration was categorized as short (<6 h), normal (6-8 h) or long (>8 h). Multivariable logistic regression was used to determine the relationship between dietary patterns and the odds of short and long sleep duration.

Results

Four major dietary patterns were identified: "healthy," "western," "traditional," and "high-carbohydrate, high-fat." In the Shahedieh study, participants in the top quartile of the western dietary pattern had greater odds of short (<6 h) and long (>8 h) sleep duration (OR = 1.49; 95% CI: 1.17, 1.90; P trend <0.001 and OR = 1.46; 95% CI: 1.12, 1.90; P trend = 0.014, respectively) than those in the bottom quartile. Also, participants in the highest quartile of the high-carbohydrate, high-fat pattern had higher odds of long sleep duration compared with those in the lowest quartile (OR = 1.36; 95% CI: 1.05, 1.75; P trend = 0.005). Pooling the two studies revealed that the western dietary pattern was significantly associated with short sleep duration (OR = 1.31; 95% CI: 1.08, 1.59).

Conclusions

The western dietary pattern might inversely be associated with sleep duration. Future prospective studies are recommended to confirm these results.

A Spatial Analysis of Access to Physical Activity Infrastructure and Healthy Food in Regional Tasmania

Prevalence of physical inactivity and obesity continues to increase in regional areas such as North-West (NW) Tasmania and show no signs of abating. It is possible that limited access to physical activity infrastructure (PAI) and healthier food options are exacerbating the low levels of habitual physical activity and obesity prevalence in these communities. Despite a burgeoning research base, concomitant exploration of both physical activity and food environments in rural and regional areas remain scarce. This research evaluated access (i.e., coverage, variety, density, and proximity) to physical activity resources and food outlets in relation to socioeconomic status (SES) in three NW Tasmanian communities. In all three study areas, the PAI and food outlets were largely concentrated in the main urban areas with most recreational tracks and natural amenities located along the coastline or river areas. Circular Head had the lowest total number of PAI (n = 43) but a greater proportion (30%) of free-to-access outdoor amenities. There was marked variation in accessibility to infrastructure across different areas of disadvantage within and between sites. For a considerable proportion of the population, free-to-access natural amenities/green spaces and recreational tracks (73 and 57%, respectively) were beyond 800 m from their households. In relation to food accessibility, only a small proportion of the food outlets across the region sells predominantly healthy (i.e., Tier 1) foods (~6, 13, and 10% in Burnie, Circular Head and Devonport, respectively). Similarly, only a small proportion of the residents are within a reasonable walking distance (i.e., 5–10 min walk) from outlets. In contrast, a much larger proportion of residents lived close to food outlets selling predominantly energy-dense, highly processed food (i.e., Tier 2 outlets). Circular Head had at least twice as many Tier 1 food stores per capita than Devonport and Burnie (0.23 vs. 0.10 and 0.06; respectively) despite recording the highest average distance (4.35 and 5.66 km to Tier 2/Tier 1 stores) to a food outlet. As such, it is possible that both food and physical activity environment layouts in each site are contributing to the obesogenic nature of each community.

Access to fruit and vegetable markets and childhood obesity: A systematic review

The lack of access to fruit/vegetable markets (FVMs) is thought to be a risk factor for childhood obesity by discouraging healthy dietary behaviours while encouraging access to venues that offer more unhealthy food (and thus the compensatory intake of those options). However, findings remain mixed, and there has not been a review of the association between FVM access and childhood obesity. A comprehensive and systematic understanding of this epidemiologic relationship is important to the design and implementation of relevant public health policies. In this study, a literature search was conducted in the Cochrane Library, PubMed, and Web of Science for articles published before 1 January 2019 that focused on the association between neighbourhood FVM access and weight-related behaviours and outcomes among children and adolescents. Eight cross-sectional studies, two longitudinal studies, and one ecological study conducted in five countries were identified. The median sample size was 2142 ± 1371. Weight-related behaviours and outcomes were used as the outcome variable in two and eight studies, respectively, with one study using both weight-related behaviours and outcomes as outcome variables. We still found a negative association between access to FVMs in children's residential and school neighbourhoods and weight-related behaviours and an inconclusive association between FVM access and overweight or obesity. This conclusion should be regarded as provisional because of a limited amount of relevant evidence and may not be a strong guide for policymaking. Nonetheless, it points to an important research gap that needs to be filled if successful public health interventions are to be undertaken.

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

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

Dietary inequity? A systematic scoping review of dietary intake in low socio-economic groups compared with high socio-economic groups in Australia

OBJECTIVE

Low socio-economic groups (SEG) in Australia suffer poorer diet-related health than the rest of the population. Therefore, it is expected that low SEG are less likely to consume diets conforming to Australian Dietary Guidelines (ADG) than higher SEG. However, dietary intake of low SEG in Australia has not been synthesised methodically. This systematic scoping review aims to explore detailed dietary intake of low SEG in Australia in comparison to higher SEG.

DESIGN

A systematic search of peer-reviewed literature and websites, since 1999. Data were extracted, synthesised and analysed in relation to study populations, dietary assessment methods, food groups studied, socio-economic measures and dietary intake.

SETTING

Australia.

PARTICIPANTS

Persons of any age and gender, differentiated by a socio-economic measure.

RESULTS

Results from thirty-three included studies confirmed that overall dietary nutritional value/quality tended to be lower in low SEG than higher SEG in Australia. However, findings were inconsistent across studies for all food groups or all socio-economic measures. Large variations were found between study metrics, definitions, dietary assessment methods, granularity of results and conclusions. Quantitative intakes of all ADG food groups by SEG were not reported in most studies and, where reported, were not comparable.

CONCLUSION

The review showed detailed dietary data are lacking to inform policy and practice and help develop targeted interventions to improve diet-related health of Australian low SEG. There is urgent need for regular, granular assessment of population dietary data to enable comparison of intake between SEG in the context of national food-based dietary guidelines in Australia.

Associations between area socioeconomic status, individual mental health, physical activity, diet and change in cardiometabolic risk amongst a cohort of Australian adults: A longitudinal path analysis

Presumed pathways from environments to cardiometabolic risk largely implicate health behaviour although mental health may play a role. Few studies assess relationships between these factors. This study estimated associations between area socioeconomic status (SES), mental health, diet, physical activity, and 10-year change in glycosylated haemoglobin (HbA_1c), comparing two proposed path structures: 1) mental health and behaviour functioning as parallel mediators between area SES and HbA_1c; and 2) a sequential structure where mental health influences behaviour and consequently HbA_1c. Three waves (10 years) of population-based biomedical cohort data were spatially linked to census data based on participant residential address. Area SES was expressed at baseline using an established index (SEIFA-IEO). Individual behavioural and mental health information (Wave 2) included diet (fruit and vegetable servings per day), physical activity (meets/does not meet recommendations), and the mental health component score of the 36-item Short Form Health Survey. HbA_1c was measured at each wave. Latent variable growth models with a structural equation modelling approach estimated associations within both parallel and sequential path structures. Models were adjusted for age, sex, employment status, marital status, education, and smoking. The sequential path model best fit the data. HbA_1c worsened over time. Greater area SES was statistically significantly associated with greater fruit intake, meeting physical activity recommendations, and had a protective effect against increasing HbA_1c directly and indirectly through physical activity behaviour. Positive mental health was statistically significantly associated with greater fruit and vegetable intakes and was indirectly protective against increasing HbA_1c through physical activity. Greater SES was protective against increasing HbA_1c. This relationship was partially mediated by physical activity but not diet. A protective effect of mental health was exerted through physical activity. Public health interventions should ensure individuals residing in low SES areas, and those with poorer mental health are supported in meeting physical activity recommendations.

Mother–child dietary behaviours and their observed associations with socio-demographic factors: findings from the Healthy Beginnings Trial

Few studies have investigated the effect of maternal factors on child eating practices. Our study aimed to explore mother–child dietary behaviours and their associations with socio-demographic factors. A cross-sectional analysis was conducted using data from control participants (n 243) in the Healthy Beginnings Trial, which involved first-time mothers and their 2-year-old children. Mother–child dietary behaviours were assessed using short dietary questions (short FFQ) and their associations with socio-demographic factors were examined using binary logistic regression. The dietary intake of 2-year-old children was characterised by low vegetable consumption and high discretionary food intake. In multivariate analysis, lower-income mothers (<Australian $40 000 per annum) reported their child was more likely to consume less fruit (<1 serve/d) (adjusted OR (AOR): 5·83; 95 % CI 1·49, 22·80) and ate hot chips more frequently (≥2 times/week) (AOR: 4·80; 95 % CI 1·28, 18·04), compared with higher-income mothers (≥Australian $40 000 per annum). Younger mothers (<25 years) reported their child consumed more sugary drinks and soft drink (>0·5 cups/d) AOR 2·93 (95 % CI 1·03, 8·35), compared with older mothers (≥25 years). Non-Australian-born mothers reported their child consumed more fruit juice (>0·5 cups/d) AOR 2·04 (95 % CI 1·02, 4·05), sweet snacks AOR 1·96 (95 % CI 1·02, 3·76) and fast food (≥2 times/week) AOR 3·67 (95 % CI 1·29, 10·43) compared with Australian-born mothers. Significant positive correlations between maternal and child dietary intake were observed for all dietary variables except milk, with the largest association for fast foods (Pearson’s r 0·52, P<0·001). This study shows that maternal factors are associated with child dietary behaviours. Targeting young mothers (<25 years) of potential disadvantage, before commencement of early feeding practices, has the potential to improve children’s diets.

Shopping list development and use of advertisements' pre-store food-buying practices within different socio-economic status areas in South Africa

PURPOSE

The purpose of this paper is to determine whether there is a difference in the development of shopping lists and use of advertisements as pre-store food-buying practices in terms of planned shopping by South African consumers who dwell in different socio-economic status (SES) areas. The paper also considers the influence of shopper and socio-demographic characteristics on pre-store food-buying practices in a developing country.

DESIGN/METHODOLOGY/APPROACH

A self-administered questionnaire was used to survey 1 200 consumers in retail stores in low, middle and high SES areas in South Africa. A generalised linear model was employed for the statistical analysis of pre-store food-buying practices within the SES area groups in a developing country.

FINDINGS

South African consumers that reside in high SES area displayed the largest of shopping list development, while consumers who dwell in low SES areas showed the highest incidence of advertisement usage. Several shopper and socio-demographic characteristics were also found to have an influence on pre-store food-buying practices in different SES areas in South Africa.

RESEARCH LIMITATIONS/IMPLICATIONS

A qualitative approach would offer a deeper understanding of consumers' pre-store food shopping predispositions as opposed to the quantitative approach, which was adopted for this study. A longitudinal design would also provide a more extensive representation of pre-store food shopping practices over a longer time frame than cross-sectional research. The survey was conducted on Saturdays, whereas consumers who shop during the week may have different shopping and socio-demographic characteristics.

PRACTICAL IMPLICATIONS

Astute food brands, marketers and grocery stores could use the findings of this study to assist with their marketing efforts that they direct at consumers in different SES areas in South Africa and other developing countries.

SOCIAL IMPLICATIONS

The findings of this study may assist consumers in developing countries, especially those who reside in low SES areas, with food-buying strategies to reduce food costs, make wiser purchase decisions and reduce shopping.

ORIGINALITY/VALUE

No study (to the best of the researchers' knowledge) has considered shopping list development and use of advertisements' pre-store food-buying practices in different SES areas in a developing country. Furthermore, there is a dearth of research analysing shopper and socio-demographic characteristics in relation to pre-store food-buying practices among different SES areas in developing and developed countries.

The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area

The multifactorial causes of obesity require multilevel and multicomponent solutions, but such combined strategies have not been tested to improve the community food environment. We evaluated the impact of a multilevel (operating at different levels of the food environment) multicomponent (interventions occurring at the same level) community intervention. The B’more Healthy Communities for Kids (BHCK) intervention worked at the wholesaler (n = 3), corner store (n = 50), carryout (n = 30), recreation center (n = 28), household (n = 365) levels to improve availability, purchasing, and consumption of healthier foods and beverages (low-sugar, low-fat) in low-income food desert predominantly African American zones in the city of Baltimore (MD, USA), ultimately intending to lead to decreased weight gain in children (not reported in this manuscript). For this paper, we focus on more proximal impacts on the food environment, and measure change in stocking, sales and purchase of promoted foods at the different levels of the food system in 14 intervention neighborhoods, as compared to 14 comparison neighborhoods. Sales of promoted products increased in wholesalers. Stocking of these products improved in corner stores, but not in carryouts, and we did not find any change in total sales. Children more exposed to the intervention increased their frequency of purchase of promoted products, although improvement was not seen for adult caregivers. A multilevel food environment intervention in a low-income urban setting improved aspects of the food system, leading to increased healthy food purchasing behavior in children.

Exploring family home food environments: Household resources needed to utilise weekly deliveries of free fruits and vegetables

AIM

An adapted ethnographic approach was used to explore household factors that influence family fruit and vegetable consumption when access and cost barriers are removed. 'Structural' barriers, such as food affordability and accessibility, are likely to influence fruit and vegetable consumption in disadvantaged households, but households may require additional resources (human and social) to increase consumption.

METHODS

Five low-income and five high-income households with children (N = 39 individuals) were observed in their home environment for three months. Including both advantaged and disadvantaged families allowed exploration of socioeconomic factors influencing these households. Each household received a free box of fresh fruit and vegetables each week for 10-12 weeks, delivered to their home, and were home-visited twice a week by a researcher (40+ hours per household). An inductive analysis of rich observational and discussion data revealed themes describing factors influencing household fruit and vegetable consumption.

RESULTS

Household food cultures were dynamic and influenced by available resources. Even when free produce was delivered to homes, these households required human resource (personal drivers influenced by early life exposure and household dynamics) and external social networks to make use of them. When household finances and/or labour were limited, there was greater dependence on external organisations for tangible support.

CONCLUSIONS

Even when structural barriers were removed, disadvantaged families needed a range of resources across the life course to improve eating behaviours, including sufficient, motivated and skilled labour and harmonious family relationships. Strategies targeting these households must consider structural, social, cultural and intra-familial influences on food choice.

Can socioeconomic factors explain geographic variation in overweight in Norway?

We explore if the geographic variation in excess body-mass in Norway can be explained by socioeconomic status, as this has consequences for public policy. The analysis was based on individual height and weight for 198,311 Norwegian youth in 2011, 2012 and 2013, stemming from a compulsory screening for military service, which covers the whole population aged seventeen. These data were merged with municipality-level socioeconomic status (SES) variables and we estimated both ecological models and two-level models with a random term at the municipality level. Overweight was negatively associated with income, education and occupation at municipality level. Furthermore, the municipality-level variance in overweight was reduced by 57% in females and 40% in males, when SES factors were taken into account. This suggests that successful interventions aimed at reducing socioeconomic variation in overweight will also contribute to reducing the geographic variation in overweight, especially in females.

The Nutrient Content of U.S. Household Food Purchases by Store Type

INTRODUCTION

Little is known about where households shop for packaged foods, what foods and beverages they purchase, and the nutrient content of these purchases. This study describes volume trends and nutrient content (nutrient profiles, food and beverage groups) of household packaged foods purchases (PFPs) by store type.

METHODS

Cross-sectional analysis of U.S. households' PFPs (Nielsen Homescan) from 2000 to 2012 (N=652,023 household-year observations) with survey weights used for national representativeness. Household PFP trends (% volume), household purchases of key food and beverage groups based on caloric contribution, and mean caloric and nutrient densities (sugars, saturated fat, and sodium) of household PFPs were analyzed by store type. Data were collected from 2000 to 2012. Analyses were conducted in 2014-2015.

RESULTS

The proportion of total volume of household PFPs significantly increased from 2000 to 2012 for mass merchandisers (13.1% to 23.9%), convenience stores (3.6% to 5.9%), and warehouse clubs (6.2% to 9.8%), and significantly decreased for grocery chains (58.5% to 46.3%) and non-chain grocers (10.3% to 5.2%). Top common sources of calories (%) from household PFPs by food/beverage group included: savory snacks, grain-based desserts, and regular soft drinks. The energy, total sugar, sodium, and saturated fat densities of household PFPs from mass merchandisers, warehouse clubs, and convenience stores were higher compared with grocery stores.

CONCLUSIONS

PFPs from stores with poorer nutrient density (more energy, total sugar, sodium, and saturated fat-dense), such as warehouse clubs, mass merchandisers, and convenience stores are growing, representing a potential U.S. public health concern.

Influences underlying family food choices in mothers from an economically disadvantaged community

PURPOSE

The purpose of this qualitative study was to explore the perceptions and attitudes that underlie food choices, and, the impact of a school-based healthy eating intervention in mothers from an economically-disadvantaged community. The aim of the intervention was to educate children to act as 'health messengers' to their families.

METHOD

Sixteen semi-structured phone interviews were conducted with mothers with four receiving a second interview. Interviews were conducted following their child's participation in a six-week after school healthy cooking intervention.

RESULTS

Thematic content analysis revealed four main themes: Cost and budget influence on food choices, diversity in household rules controlling food, role of socialisation on diet, and improved cooking skills and confidence to make homemade meals. The interview findings demonstrated the positive influence of the after-school cooking intervention on children and their families in cooking skills, promoting healthier cooking methods and increasing confidence to prepare homemade meals.

CONCLUSIONS

The findings demonstrated the wider economic and social influences on food choices and eating practices. Socialisation into, and strong cultural norms around, eating habits were significant influences on family diet and on parental decisions underpinning food choices and attitudes towards the control of food within the family. The intervention was perceived to be successful in terms of improving nutritional knowledge, cooking skills and increasing confidence to make healthy and tasty homemade meals. The study demonstrates the importance of parental involvement in school-based interventions if improvements in healthy eating are to be evidenced at the family level and maintained.

Neighbourhood socioeconomic disadvantage and fruit and vegetable consumption: a seven countries comparison

BACKGROUND

Low fruit and vegetable consumption is a risk factor for poor health. Studies have shown consumption varies across neighbourhoods, with lower intakes in disadvantaged neighbourhoods. However, findings are inconsistent, suggesting that socio-spatial inequities in diet could be context-specific, highlighting a need for international comparisons across contexts. This study examined variations in fruit and vegetable consumption among adults from neighbourhoods of varying socioeconomic status (SES) across seven countries (Australia, Canada, Netherlands, New Zealand, Portugal, Scotland, US).

METHODS

Data from seven existing studies, identified through literature searches and knowledge of co-authors, which collected measures of both neighbourhood-level SES and fruit and vegetable consumption were used. Logistic regression was used to examine associations between neighbourhood-level SES and binary fruit and vegetable consumption separately, adjusting for neighbourhood clustering and age, gender and education. As much as possible, variables were treated in a consistent manner in the analysis for each study to allow the identification of patterns of association within study and to examine differences in the associations across studies.

RESULTS

Adjusted analyses showed evidence of an association between neighbourhood-level SES and fruit consumption in Canada, New Zealand and Scotland, with increased odds of greater fruit intake in higher SES neighbourhoods. In Australia, Canada, New Zealand and Portugal, those residing in higher SES neighbourhoods had increased odds of greater vegetable intake. The other studies showed no evidence of a difference by neighbourhood-level SES.

CONCLUSIONS

Acknowledging discrepancies across studies in terms of sampling, measures, and definitions of neighbourhoods, this opportunistic study, which treated data in a consistent manner, suggests that associations between diet and neighbourhood-level socioeconomic status vary across countries. Neighbourhood socioeconomic disadvantage may differentially impact on access to resources in which produce is available in different countries. Neighbourhood environments have the potential to influence behaviour and further research is required to examine the context in which these associations arise.

Trends in socio-economic inequalities in the Scottish diet: 2001-2009

OBJECTIVE

To explore the association between diet and socio-economic position for 2007-2009 and investigate trends in socio-economic inequalities in the Scottish diet between 2001 and 2009.

DESIGN

UK food purchase data (collected annually from 2001 to 2009) were used to estimate household-level consumption data. Population mean food consumption, nutrient intakes and energy density were estimated by quintiles of an area-based index of multiple deprivation. Food and nutrient intakes estimated were those targeted for change in Scotland and others indicative of diet quality. The slope and relative indices of inequality were used to assess trends in inequalities in consumption over time.

SETTING

Scotland.

SUBJECTS

Scottish households (n 5020).

RESULTS

Daily consumption of fruit and vegetables (200 g, 348 g), brown/wholemeal bread (17 g, 26·5 g), breakfast cereals (16 g, 27 g) and oil-rich (21 g, 40 g) and white fish (77 g, 112 g) were lowest, and that of total bread highest (105 g, 91·5 g) in the most deprived compared with the least deprived households, respectively, for the period 2007-2009. With regard to nutrients, there was no association between deprivation and the percentage of food energy from total fat and saturated fat; however, non-milk extrinsic sugar intakes (15·5%, 14·3%) and energy density (741 kJ/100 g, 701 kJ/100 g) were significantly higher in the most deprived households. The slope and relative indices of inequality showed that inequalities in intakes between 2001 and 2009 have changed very little.

CONCLUSIONS

There was no evidence to suggest that the difference in targeted food and nutrient intakes between the least and most deprived has decreased compared with previous years.

Associations between neighbourhood environmental characteristics and obesity and related behaviours among adult New Zealanders

Background

The prevalence of adult obesity is escalating in most wealthy and middle income countries. Due to the magnitude of this issue, research and interventions at the individual-level abound. However, the limited success and high costs of such interventions has led to a growing recognition of the potential role of environmental factors in reducing obesity and promoting physical activity and healthy diets.

Methods

This study utilised individual-level data from the 2006/7 New Zealand Health Survey on obesity, physical activity, diet and socio-economic variables linked to geographic information from other sources on potentially aetiologically-relevant environmental factors, based on the respondent’s residential address. We fitted logistic regression models for eight binary measures of weight or weight-related behaviours: 1) overweight; 2) obesity; 3) overweight + obesity; 4) active at least 30 minutes a day for 5+ days per week; 5) active <30 minutes per week; 6) walk 150 minutes + per week; 7) walk <30 minutes per week; and 8) consumption of 5+ fruits and vegetables per day. We included a range of independent environmental characteristics of interest in separate models.

Results

We found that increased neighbourhood deprivation and decreased access to neighbourhood greenspace were both significantly associated with increased odds of overweight and/or obesity. The results for weight-related behaviours indicate that meeting the recommended level of physical activity per week was associated with urban/rural status, with higher activity in the more rural areas and a surprising tendency for less activity among those living in areas with higher levels of active travel to work. Increased access to greenspace was associated with high levels of walking, while decreased access to greenspace was associated with low levels of walking. There was also a significant trend for low levels of walking to be positively associated with neighbourhood deprivation. Results for adequate fruit and vegetable consumption show a significant urban/rural gradient, with more people meeting recommended levels in the more rural compared to more urban areas.

Conclusion

Similar to findings from other international studies, these results highlight greenspace as an amenable environmental factor associated with obesity/overweight and also indicate the potential benefit of targeted health promotion in both urban and deprived areas in New Zealand.

Objective and self-reported factors associated with food-environment perceptions and fruit-and-vegetable consumption: a multilevel analysis

Introduction

Few studies have assessed how people’s perceptions of their neighborhood environment compare with objective measures or how self-reported and objective neighborhood measures relate to consumption of fruits and vegetables.

Methods

A telephone survey of 4,399 residents of Philadelphia, Pennsylvania, provided data on individuals, their households, their neighborhoods (self-defined), their food-environment perceptions, and their fruit-and-vegetable consumption. Other data on neighborhoods (census tracts) or “extended neighborhoods” (census tracts plus 1-quarter–mile buffers) came from the US Census Bureau, the Philadelphia Police Department, the Southeastern Pennsylvania Transportation Authority, and the federal Supplemental Nutrition Assistance Program. Mixed-effects multilevel logistic regression models examined associations between food-environment perceptions, fruit-and-vegetable consumption, and individual, household, and neighborhood characteristics.

Results

Perceptions of neighborhood food environments (supermarket accessibility, produce availability, and grocery quality) were strongly associated with each other but not consistently or significantly associated with objective neighborhood measures or self-reported fruit-and-vegetable consumption. We found racial and educational disparities in fruit-and-vegetable consumption, even after adjusting for food-environment perceptions and individual, household, and neighborhood characteristics. Having a supermarket in the extended neighborhood was associated with better perceived supermarket access (adjusted odds ratio for having a conventional supermarket, 2.04 [95% CI, 1.68–2.46]; adjusted odds ratio for having a limited-assortment supermarket, 1.28 [95% CI, 1.02–1.59]) but not increased fruit-and-vegetable consumption. Models showed some counterintuitive associations with neighborhood crime and public transportation.

Conclusion

We found limited association between objective and self-reported neighborhood measures. Sociodemographic differences in individual fruit-and-vegetable consumption were evident regardless of neighborhood environment. Adding supermarkets to urban neighborhoods might improve residents’ perceptions of supermarket accessibility but might not increase their fruit-and-vegetable consumption.

Factors influencing food choice in an Australian Aboriginal community

We explored with Aboriginal adults living in a remote Australian community the social context of food choice and factors perceived to shape food choice. An ethnographic approach of prolonged community engagement over 3 years was augmented by interviews. Our findings revealed that knowledge, health, and resources supporting food choice were considered "out of balance," and this imbalance was seen to manifest in a Western-imposed diet lacking variety and overrelying on familiar staples. Participants felt ill-equipped to emulate the traditional pattern of knowledge transfer through passing food-related wisdom to younger generations. The traditional food system was considered key to providing the framework for learning about the contemporary food environment. Practitioners seeking to improve diet and health outcomes for this population should attend to past and present contexts of food in nutrition education, support the educative role of caregivers, address the high cost of food, and support access to traditional foods.

Sociodemographic factors associated with healthy eating and food security in socio-economically disadvantaged groups in the UK and Victoria, Australia

OBJECTIVE

To investigate the associations between sociodemographic factors and both diet indicators and food security among socio-economically disadvantaged populations in two different (national) contextual settings.

DESIGN

Logistic regression was used to determine cross-sectional associations between nationality, marital status, presence of children in the household, education, employment status and household income (four low income categories) with daily fruit and vegetable consumption, low-fat milk consumption and food security.

SETTING

Socio-economically disadvantaged neighbourhoods in the UK and Australia.

SUBJECTS

Two samples of low-income women from disadvantaged neighbourhoods: (i) in the UK, the 2003-05 Low Income Diet and Nutrition Survey (LIDNS; n 643); and (ii) in Australia, the 2007-08 Resilience for Eating and Activity Despite Inequality (READI; n 1340).

RESULTS

The influence of nationality, marital status and children in the household on the dietary outcomes varied between the two nations. Obtaining greater education qualifications was the most telling factor associated with healthier dietary behaviours. Being employed was positively associated with low-fat milk consumption in both nations and with fruit consumption in the UK, while income was not associated with dietary behaviours in either nation. In Australia, the likelihood of being food secure was higher among those who were born outside Australia, married, employed or had a greater income, while higher income was the only significant factor in the UK.

CONCLUSIONS

The identification of factors that differently influence dietary behaviours and food security in socio-economically disadvantaged populations in the UK and Australia suggests continued efforts need to be made to ensure that interventions and policy responses are informed by the best available local evidence.

Role of expendable income and price in food choice by low income families

The public health literature suggests that the cheapness of energy-dense foods is driving the obesity epidemic. We examined food purchases in low-income families and its relationship to the price of food and availability of funds. In-depth interviews were conducted with 22 parents with children less than 15 years of age whose major source of income was a government pension. A photo taxonomy, where participants sorted 50 photos of commonly purchased foods, was used to explore food choice. The most common food groupings used by the participants were: basic, emergency, treat and comfort. The process of food purchase was described by participants as weighing up the attributes of a food in relation to price and money available. Shoppers nominated the basic unit of measurement as quantity per unit price and the heuristic for food choice when shopping as determining "value for money" in a process of triage relating to food purchase decisions. Participants stated satiation of hunger to be the most common "value" relative to price. Given that the foods nominated as filling tended to be carbohydrate-rich staples, we suggest that public health initiatives need to acknowledge this triage process and shape interventions to promote nutrition over satiation.

Socioeconomic status and gender affects utilization of Medical Nutrition Therapy

AIMS

To identify socioeconomic status and gender inequalities in long and short-term Medical Nutrition Therapy among Israeli adult patients with diabetes.

METHODS

An analysis of data was performed on 90,900 patients over the age of 18 who were registered as patients with diabetes mellitus in Maccabi Healthcare Service Register which is the second largest health maintenance organization in Israel. Socioeconomic Rank for each patient was determined from the Israel Central Bureau of Statistics by geographical area of residence. Medical Nutrition Therapy was defined by the number of visits with registered dietitians. Short-term therapy was defined as one visit and long term therapy as two or more visits during the previous two years. Newly diagnosed patients were compared with veteran patients.

RESULTS

Only 25.8% of the patients with diabetes received nutrition therapy during the previous two years. Newly diagnosed patients received therapy more frequently than veterans. We found that long term therapy was positively dependent on socioeconomic rank. Women under the age of seventy five had a higher chance of receiving therapy compared to men.

CONCLUSIONS

A nationwide nutritional counseling service is available and accessible to all patients with diabetes. However, the patients with higher socioeconomic rank have a higher rate of persistence with long-term nutritional therapy.

Community food environment, home food environment, and fruit and vegetable intake of children and adolescents

OBJECTIVES

To determine (1) reliability of new food environment measures; (2) association between home food environment and fruit and vegetable (FV) intake; and (3) association between community and home food environment.

METHODS

In 2005, a cross-sectional survey was conducted with readministration to assess test-retest reliability. Adolescents, parents of adolescents, and parents of children (n = 458) were surveyed in San Diego, Boston, and Cincinnati.

RESULTS

Most subscales had acceptable reliability. Fruit and vegetable intake was positively associated with availability of healthful food (r = 0.15-0.27), FV (r = 0.22-0.34), and ratio of more-healthful/less-healthful food in the home (r = 0.23-0.31) and was negatively associated with less-healthful food in the home (r = -0.17 to -0.18). Home food environment was associated with household income but not with community food environment.

CONCLUSIONS AND IMPLICATIONS

A more healthful home food environment was related to youth FV intake. Higher income households had more healthful food in the home. The potential influence of neighborhood food outlets warrants further study.

Neighborhood disparities in access to healthy foods and their effects on environmental justice

Environmental justice is concerned with an equitable distribution of environmental burdens. These burdens comprise immediate health hazards as well as subtle inequities, such as limited access to healthy foods. We reviewed the literature on neighborhood disparities in access to fast-food outlets and convenience stores. Low-income neighborhoods offered greater access to food sources that promote unhealthy eating. The distribution of fast-food outlets and convenience stores differed by the racial/ethnic characteristics of the neighborhood. Further research is needed to address the limitations of current studies, identify effective policy actions to achieve environmental justice, and evaluate intervention strategies to promote lifelong healthy eating habits, optimum health, and vibrant communities.

Perceptions of the food environment are associated with fast-food (not fruit-and-vegetable) consumption: findings from multi-level models

OBJECTIVES

Diets low in fruits and vegetables and/or high in fast foods are associated with obesity and chronic diseases. Such diets may relate to different aspects of neighborhood food environments. We sought to evaluate if people's perceptions of their neighborhood food environment are associated with reported fruit-and-vegetable and fast-food consumption.

METHODS

Cross-sectional analysis of a community health survey from Philadelphia, PA and four surrounding suburban counties (n = 10,450 individuals). We used mixed-effects multi-level Poisson models, nesting individuals within neighborhoods-i.e. census tracts (n = 991).

RESULTS

Negative perceptions of the food environment (perceived difficulty finding fruits and vegetables, having to travel outside of one's neighborhood to get to a supermarket, and perceived poor grocery quality) were each directly associated with fast-food consumption (incident rate ratios [IRRs] 1.31, 1.06, 1.20; p < 0.001, 0.04, < 0.001 respectively), but not significantly associated with fruit-and-vegetable consumption.

CONCLUSIONS

Perceived difficulty finding or accessing produce and high-quality groceries may support the eating of more fast food. Neighborhoods where food-environment perceptions are worst might benefit from interventions to improve availability, accessibility, and quality of healthy foods, towards shifting consumption away from fast foods.

Fruit and vegetable consumption among older adults by tooth loss and socio-economic status

BACKGROUND

The aim of this study was to examine consumption of fruit and vegetables in relation to tooth loss and income.

METHODS

Data were collected in 2004-06, using a three-stage, stratified clustered sample, involving a computer-assisted telephone interview (CATI), oral examination and mailed questionnaire followed by a food frequency questionnaire.

RESULTS

A total of 14 123 adults responded to the CATI (49% response) of whom 5505 (44% of those interviewed) agreed to undergo an oral epidemiological examination. In the nutrition sub-study, a total of n = 1218 persons were approached in New South Wales and Queensland, with n = 1129 responding (92.7% response rate). Among respondents aged 55 years or more 34.5% had <21 teeth. Adjusting for income the prevalence of infrequent consumption ('never or less than once a month') was associated with [PR = prevalence ratio (95% CI)] fewer teeth for the fruits, 'peach, nectarine, plum, apricot' PR = 1.91 (1.12, 3.25) and 'grapes or berries' PR = 1.69 (1.03, 2.76), and for the vegetables 'stir-fried or mixed' PR = 2.34 (1.14, 4.78), 'sweetcorn' PR = 1.45 (1.001, 2.10), 'mushrooms' PR = 1.62 (1.05, 2.50), 'lettuce' PR = 3.99 (1.31, 12.17) and 'soy beans' PR = 1.11 (1.01, 1.21).

CONCLUSIONS

An inadequate dentition was associated with lower consumption of a range of fruits and vegetables indicating that dentition-related impairment of chewing ability could have adverse consequences on nutritional intake among Australian adults.

A healthy diet consistent with Australian health recommendations is too expensive for welfare-dependent families

OBJECTIVE

Examine the cost of healthy food habits for welfare-dependent families in Australia.

METHOD

A seven-day meal plan was developed, based on Australian public health recommendations, for two typical welfare-dependent families: a couple-family (two adults, two children) and a one-parent family (one adult, two children). The cost of the meal plan was calculated using market brand and generic brand grocery items, and total cost compared to income.

RESULTS

In Australia, the cost of healthy food habits uses about 40% of the disposable income of welfare-dependent families. Families earning an average income would spend only 20% of their disposable income to buy the same healthy food. Substituting generic brands for market brands reduced the weekly food cost by about 13%. This is one of few economic models to include generic brands.

CONCLUSION

Compared with average-income Australian families, healthy food habits are a fiscal challenge to welfare-dependent families.

IMPLICATIONS

These results provide a benchmark for economic and social policy analysis, and the influence disposable income has on prioritising healthy food habits.

Finding food: Issues and challenges in using Geographic Information Systems to measure food access

A significant amount of travel is undertaken to find food. This paper examines challenges in measuring access to food using Geographic Information Systems (GIS), important in studies of both travel and eating behavior. It compares different sources of data available including fieldwork, land use and parcel data, licensing information, commercial listings, taxation data, and online street-level photographs. It proposes methods to classify different kinds of food sales places in a way that says something about their potential for delivering healthy food options. In assessing the relationship between food access and travel behavior, analysts must clearly conceptualize key variables, document measurement processes, and be clear about the strengths and weaknesses of data.

Assessing the relevance of neighbourhood characteristics to the household food security of low-income Toronto families

OBJECTIVE

Although the sociodemographic characteristics of food-insecure households have been well documented, there has been little examination of neighbourhood characteristics in relation to this problem. In the present study we examined the association between household food security and neighbourhood features including geographic food access and perceived neighbourhood social capital.

DESIGN

Cross-sectional survey and mapping of discount supermarkets and community food programmes.

SETTING

Twelve high-poverty neighbourhoods in Toronto, Ontario, Canada.

SUBJECTS

Respondents from 484 low-income families who had children and who lived in rental accommodations.

RESULTS

Food insecurity was pervasive, affecting two-thirds of families with about a quarter categorized as severely food insecure, indicative of food deprivation. Food insecurity was associated with household factors including income and income source. However, food security did not appear to be mitigated by proximity to food retail or community food programmes, and high rates of food insecurity were observed in neighbourhoods with good geographic food access. While low perceived neighbourhood social capital was associated with higher odds of food insecurity, this effect did not persist once we accounted for household sociodemographic factors.

CONCLUSIONS

Our findings raise questions about the extent to which neighbourhood-level interventions to improve factors such as food access or social cohesion can mitigate problems of food insecurity that are rooted in resource constraints. In contrast, the results reinforce the importance of household-level characteristics and highlight the need for interventions to address the financial constraints that underlie problems of food insecurity.

A social marketing approach to improving the nutrition of low-income women and children: an initial focus group study

Objective

To identify approaches for interventions to improve the nutrition of low-income women and children.

Design

Seven focus groups were conducted with low-income women caring for young children in their households. They discussed shopping, eating at home, eating out and healthy eating. The discussions were recorded and subjected to qualitative thematic analysis.

Setting

A semi-rural community in Oregon, USA.

Subjects

There were seventy-four women (74 % White), most of whom were 18–29 years old.

Results

Four broad themes were identified, i.e. cost-consciousness, convenience, social influences and health issues.

Conclusions

The target population would benefit from improved understanding of what constitutes a balanced diet, with a greater emphasis on a more central role for fruit and vegetables. To persuade this population to change their eating habits, it will be necessary to convince them that healthful food can be low-cost, convenient and palatable for children. Comparing findings from the present study with a similar one in the UK suggests that the US women faced many of the same barriers to healthy eating but displayed less helplessness.

Disparities in fruit and vegetable supply: a potential health concern in the greater Québec City area

Objective

The present study explores the spatial distribution and in-store availability of fresh fruits and vegetables from a socio-environmental perspective in terms of the type of food store, level of deprivation and the setting (urban/rural) where the food outlets are located.

Design

Seven types of fresh fruit and vegetable stores (FVS) were identified then visited in six districts (urban setting) and seven communities (rural setting). The quantity and diversity of fresh fruits and vegetables (F&V) were also assessed.

Setting

Québec City, Canada.

Results

The FVS spatial distribution showed differences between the two settings, with accessibility to supermarkets being more limited in rural settings. The quantity and diversity of fresh F&V in-store availability were associated with the type of FVS, but not with setting or its level of deprivation. Greengrocers and supermarkets offered a greater quantity and diversity of fresh F&V than the other FVS.

Conclusions

The results suggest that inequalities in physical access to fresh F&V across the region could have an impact on public health planning considering that supermarkets, which are one of the excellent sources of F&V, are less prevalent in rural settings.

Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review

It has long been known that cardiovascular disease (CVD) rates vary considerably among populations, across space and through time. It is now apparent that most of the attributable risk for myocardial infarction 'within' populations from across the world can be ascribed to the varying levels of a limited number of risk factors among individuals in a population. Individual risk factors (e.g. blood pressure) can be modified with resulting health gains. Yet, the persistence of large international variations in cardiovascular risk factors and resulting CVD incidence and mortality indicates that there are additional factors that apply to 'populations' that are important to understand as part of a comprehensive approach to CVD control. This article reviews the evidence on why certain populations are more at risk than others.

Variations in fresh fruit and vegetable quality by store type, urban–rural setting and neighbourhood deprivation in Scotland

Objective

Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural–urban location and neighbourhood deprivation in a selection of communities across Scotland.

Design

Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban–rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban–rural classification.

Setting

Scotland.

Results

Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items.

Conclusions

The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.

A multilevel study of area socio-economic status and food purchasing behaviour

OBJECTIVE

The present study examined the association between area socio-economic status (SES) and food purchasing behaviour.

DESIGN

Data were collected by mail survey (64.2 % response rate). Area SES was indicated by the proportion of households in each area earning less than $AUS 400 per week, and individual-level socio-economic position was measured using education, occupation and household income. Food purchasing was measured on the basis of compliance with dietary guideline recommendations (for grocery foods) and variety of fruit and vegetable purchase. Multilevel regression analysis examined the association between area SES and food purchase after adjustment for individual-level demographic (age, sex, household composition) and socio-economic factors.

SETTING

Melbourne city, Australia, 2003.

SUBJECTS

Residents of 2564 households located in fifty small areas.

RESULTS

Residents of low-SES areas were significantly less likely than their counterparts in advantaged areas to purchase grocery foods that were high in fibre and low in fat, salt and sugar; and they purchased a smaller variety of fruits. There was no evidence of an association between area SES and vegetable variety.

CONCLUSIONS

In Melbourne, area SES was associated with some food purchasing behaviours independent of individual-level factors, suggesting that areas in this city may be differentiated on the basis of food availability, accessibility and affordability, making the purchase of some types of foods more difficult in disadvantaged areas.

Life-course socioeconomic environment and health risk behaviours. A multilevel small-area analysis of young-old persons in an urban neighbourhood in Lausanne, Switzerland

With a life expectancy at the age of 65 of around 20 years, damaging health risk behaviours of young-old adults have become a target for preventive actions. Such risk factors necessitate an accurate understanding of the present and past socioeconomic conditions associated with health risk behaviours. The aim of our study is to assess the impact of certain life events as well as economic and environmental factors on health risk behaviours. We included 1309 participants of the Lausanne Cohort Lc65+ aged 65-70 years and employed logistic regression analyses, with individuals nested within areas. The results illustrate the influences of socioeconomic factors from childhood to young-old age. Life experiences in adulthood and economic resources in young-old age are both associated with unfavourable health behaviours. Neighbourhood is a modest determinant as well, particularly regarding alcohol consumption. Therefore, prevention against health risk behaviours should focus on population subgroups defined on the basis of their socioeconomic and living contexts.

Obesogenic environments--aspects on measurement and indicators

BACKGROUND

The focus in understanding the causes of and preventing obesity has broadened from the individual level to include the obesogenic environment. Proving a causal relationship between environmental factors and eating patterns poses a great challenge because randomised controlled trials are seldom possible or feasible to conduct. Interactions between the environment and individuals are beginning to be explored in multilevel studies and qualitative and sociological research.

AIM

The aim is to give an overview of the wider environmental determinants of diet such as the national food supply, food availability and accessibility in different settings as well as the economic food environment and in relation to socio-economic status.

RESULTS

The indicators suggested are based on the amount of data available in the scientific literature and the potential for intervention. They can be used to monitor societal interventions or evaluate 'natural' changes in the food environment. The indicators are of relevance to the Second WHO European Action Plan for Food and Nutrition Policy 2007-2012.

CONCLUSION

The relatively weak empirical evidence does not imply the absence of causal relationships between environmental factors and diet. Potentially relevant factors have not been evaluated due to the complexity of the task and to lack of political will to change the food environment in a more healthy direction by use of legislation or economic instruments. Future intervention research, targeting the wider environmental determinants of diet, will give us better evidence to propose societal actions to counteract obesity and to strike the right balance between individual and societal action.

Disparities in obesity prevalence due to variation in the retail food environment: three testable hypotheses

Although the overall population in the United States has experienced a dramatic increase in obesity in the past 25 years, ethnic/racial minorities, and socioeconomically disadvantaged populations have a greater prevalence of obesity, as compared to white, and/or economically advantaged populations. Disparities in obesity are unlikely to be predominantly due to individual psychosocial or biological differences, and they may reflect differences in the built or social environment. The retail food environment is a critical aspect of the built environment that can contribute to observed disparities. This paper reviews the literature on retail food environments in the United States and proposes interrelated hypotheses that geographic, racial, ethnic, and socioeconomic disparities in obesity within the United States are the result of disparities in the retail food environment. The findings of this literature review suggest that poor-quality retail food environments in disadvantaged areas, in conjunction with limited individual economic resources, contribute to increased risk of obesity within racial and ethnic minorities and socioeconomically disadvantaged populations.

Mapping the evolution of 'food deserts' in a Canadian city: supermarket accessibility in London, Ontario, 1961-2005

Background

A growing body of research suggests that the suburbanization of food retailers in North America and the United Kingdom in recent decades has contributed to the emergence of urban 'food deserts', or disadvantaged areas of cities with relatively poor access to healthy and affordable food. This paper explores the evolution of food deserts in a mid-sized Canadian city (London, Ontario) by using a geographic information system (GIS) to map the precise locations of supermarkets in 1961 and 2005; multiple techniques of network analysis were used to assess changing levels of supermarket access in relation to neighbourhood location, socioeconomic characteristics, and access to public transit.

Results

The findings indicate that residents of inner-city neighbourhoods of low socioeconomic status have the poorest access to supermarkets. Furthermore, spatial inequalities in access to supermarkets have increased over time, particularly in the inner-city neighbourhoods of Central and East London, where distinct urban food deserts now exist.

Conclusion

Contrary to recent findings in larger Canadian cities, we conclude that urban food deserts exist in London, Ontario. Policies aimed at improving public health must also recognize the spatial, as well as socioeconomic, inequities with respect to access to healthy and affordable food. Additional research is necessary to better understand how supermarket access influences dietary behaviours and related health outcomes.

Tracking of dietary intake patterns is associated with baseline characteristics of urban low-income African-American adolescents

Young peoples' dietary habits may persist over time. However, few studies have examined the dynamic patterns in urban low-income African-American adolescents' intakes. This study examined these dynamic patterns and their predictors and explored the association between the patterns and BMI over time. Dietary data were collected from 181 low-income African-American adolescents using a 152-item FFQ at baseline and 1-y follow-up. High intakes and high BMI were defined as the top quartile and high-fat intake as >35% of energy from fat. Multinomial logistic regression models were fit to study the association between study variables. Correlation coefficients (0.4 < r < 0.6; P < 0.05) between participants' intakes at baseline and at 1-y follow-up suggested tracking, particularly intakes of energy, fat, fiber, calcium, vegetables and fruits, fried food, and snack food. However, the tracking of percentage of energy from fat and sugar-sweetened beverages was weak (0.2 < or = r < 0.3; P < 0.01). Proportion of agreement (>30%) and k-values (>0.2) also indicated tracking. Adjustment for tracking of energy changed little the observed tracking for other micronutrients and food groups. Factor analysis showed moderate tracking in a Western diet pattern (r = 0.47; P < 0.001) but was weaker in 2 healthier diet patterns (r = 0.31-0.36; P < 0.001). Age, gender, physical activity, and BMI predicted dietary changes (P < 0.05). Adolescents who tracked high intakes of energy, fiber, fried food, and snacks were less likely to track high BMI. Decreased energy and snack intakes were negatively related to tracking of high BMI. Overall, urban low-income African-American adolescents tracked their dietary patterns over time. The tracking was affected by baseline characteristics.

Awareness and perceived necessity of dietary guidelines among urban Koreans by gender

We examined an urban population's awareness of dietary guidelines to determine whether they perceived them to be necessary, and identified the factors affecting this awareness and perceived necessity. Data were collected via physical examinations and face-to-face interviews. Health indicators were collected from health examinations, and information on individual characteristics, including awareness, perceived necessity, and dietary status were obtained from the interviews. The subjects' sociodemographic, health and dietary status were examined as potential factors influencing awareness and perceived necessity. Descriptive statistics, contingency tables, and logistic regression modeling were used in the analysis. Low awareness of the dietary guidelines was displayed by the elderly and poorly educated individuals, and those without a spouse. Most people who were not aware of the dietary guidelines thought the guidelines unnecessary. Males with hypertension and lower hemoglobin levels, and females with less education had low awareness. Elderly females with lower bone density had less perceived necessity. Males and females with poor dietary status reported low perceived necessity.