Identifying food deserts and swamps based on relative healthy food access: a spatio-temporal Bayesian approach

WEIRD and non-consensual food deserts and swamps: A scoping review of operational definitions

The aim of the present study was to critically analyze operational definitions of food deserts and food swamps included in empirical studies published in peer-reviewed journals. A scoping review was conducted following the recommendations of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. A search of the scientific literature was performed on August 2023 to identify empirical studies including operational definitions of food deserts and/or food swamps in three databases: Scopus, PubMed, and Scielo. A total of 932 scientific articles were identified in the three databases, from which 157 articles, published between 2002 and 2023, were included in the review. The included studies were mainly conducted in WEIRD (Western, Educated, Industrilaized, Rich and Democractic) countries. They presented a total of 107 operational definitions of food deserts and 30 operational definitions of food swamps. Large heterogeneity in the operational definitions of food deserts and food swamps was found. Published studies differed in all the elements of the operational definitions analyzed in the present work. Results stress the need for standardization and the development of more objective and multivariate continuous measures of physical food accessibility that reflect the complexity of modern food environments globally. A series of recommendations to advance food environment research are derived.

Social inequities in food deserts and food swamps in a northeastern Brazilian capital

This study identified food deserts and swamps, investigating their associations with socioeconomic and demographic conditions. This ecological study was conducted using data from urban census tracts in the city of Recife, which were considered the unit of analysis. Information on food retail was obtained from government sources in 2019. Census tracts below the 25th percentile in the density of healthy food retail (i.e., those that predominantly sell natural or minimally processed foods, mixed businesses, and super- and hypermarkets) were classified as food deserts. Census tracts above the 25th percentile in the density of unhealthy food retail (i.e., those selling primarily ultra-processed foods) were considered food swamps. The socioeconomic and demographic conditions of the census tracts were evaluated using variables from the 2010 census (per capita income, average income, race, literacy of the head of household, and the availability of essential services) and the Health Vulnerability Index. Census tracts considered food deserts (28.5%) were more vulnerable, characterized by lower income and access to essential services, more illiterate residents and more minorities (Black/Indigenous/mixed race). Food swamps (73.47%) were more prevalent in less vulnerable neighbourhoods characterized by higher percentages of literate residents and Whites, greater purchasing power, and better basic sanitation. The characteristics of Recife's food deserts and swamps demonstrate social inequalities in the food environment. Public facilities could play a vital role in promoting healthy eating within food deserts. Additionally, future implementation of taxes on ultra-processed foods and the provision of tax subsidies to natural or minimally processed food sellers might contribute to fostering healthier dietary choices.

Effect of mobile food environments on fast food visits

Poor diets are a leading cause of morbidity and mortality. Exposure to low-quality food environments saturated with fast food outlets is hypothesized to negatively impact diet. However, food environment research has predominantly focused on static food environments around home neighborhoods and generated mixed findings. In this work, we leverage population-scale mobility data in the U.S. to examine 62M people's visits to food outlets and evaluate how food choice is influenced by the food environments people are exposed to as they move through their daily routines. We find that a 10% increase in exposure to fast food outlets in mobile environments increases individuals' odds of visitation by 20%. Using our results, we simulate multiple policy strategies for intervening on food environments to reduce fast-food outlet visits. This analysis suggests that optimal interventions are informed by spatial, temporal, and behavioral features and could have 2x to 4x larger effect than traditional interventions focused on home food environments.

Prevalence of Adolescents Meeting Criteria for Metabolic and Bariatric Surgery

BACKGROUND AND OBJECTIVES

The American Academy of Pediatrics endorses metabolic and bariatric surgery (MBS) as a safe and effective treatment of severe obesity in children with class 3 obesity or with class 2 obesity and qualifying comorbidities. The study objective was to determine eligibility and characteristics of adolescents who qualify for MBS based on American Academy of Pediatrics guidelines.

METHODS

This retrospective cohort study analyzed electronic health record data of 603 051 adolescents aged 13 to 17 years between January 1, 2018, and December 31, 2021. Centers for Disease Control and Prevention criteria were used to define obesity classes 2 and 3. Multivariable logistic regression was used to evaluate the factors associated with meeting MBS eligibility criteria.

RESULTS

Of the 603 041 adolescents evaluated, 22.2% had obesity (12.9% class 1, 5.4% class 2, and 3.9% class 3). The most frequently diagnosed comorbid conditions were gastroesophageal reflux disease (3.2%), hypertension (0.5%), and nonalcoholic fatty liver disease (0.5%). Among adolescents with class 2 obesity, 9.1% had 1 or more comorbidities qualifying for MBS, and 4.4% of all adolescents met the eligibility criteria for MBS. In multivariable modeling, males, Black and Hispanic adolescents, and those living in more deprived neighborhoods were more likely to meet MBS eligibility criteria.

CONCLUSIONS

Overall, 1 in 23 adolescents met the eligibility criteria for MBS. Demographic and social determinants were associated with a higher risk for meeting these criteria. The study suggests that the health care system may face challenges in accommodating the demand for MBS among eligible adolescents.

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Exploring the Retail Food Environment Surrounding Two Secondary Schools with Predominantly Pacific Populations in Tonga and New Zealand to Enable the Development of Mapping Methods Appropriate for Testing in a Classroom

Rates of noncommunicable diseases (NCDs) are disproportionately high among people of Pacific ethnicity. Nutrition-related environmental exposures including food access and quality contribute to the matrix of factors impacting risk. Preventative interventions in adolescence and the opportunity to integrate health promotion into school-based learning are often overlooked. This study tested the potential of a low-cost method to map the retail food environment in a 1 km radius of two secondary schools in low socioeconomic communities with predominantly Pacific populations, in Tonga and New Zealand (NZ). Mapping utilized Google Earth, Google Maps, government maps, and observations. A rubric was developed to categorize food quality. Outlets within a 1 km radius of each school, (Tonga, n = 150; NZ, n = 52) stocked predominantly unhealthy foods. The NZ data compared favorably to previous studies, indicating the method was valid. The Tongan data is novel and indicates that alternative strategies can be used when access to GIS-type tools is limited. The method produced visual data that has the potential to be analyzed using strategies appropriate for secondary schools. The method should now be tested in classrooms to assess its potential to support school-age students to engage in mapping and critiquing the retail food environment.

The Changing Landscape of Food Deserts and Swamps over More than a Decade in Flanders, Belgium

Food deserts and swamps have previously been mostly studied in Anglo-Saxon countries such as the USA and Great Britain. This research is one of the first studies to map food deserts and swamps in a mainland European, densely populated but heavily fragmented region such as Flanders. The evolution of food deserts and swamps between 2008 and 2020 was assessed. Special focus was given to areas where high numbers of elderly, young people and/or families with low income live. Food deserts were calculated based on supermarket access within 1000 m and bus stop availability, while food swamps were calculated using the Modified Food Environment Retail Index. The main cause behind the formation of food deserts in Flanders is its rapidly aging population. Food deserts with a higher number of older people increased from 2.5% to 3.1% of the residential area between 2008 and 2020, housing 2.2% and 2.8% of the population, respectively. Although the area that could become a food desert in the future due to these sociospatial and demographic evolutions is large, food deserts are currently a relatively small problem in Flanders in comparison to the widespread existence of food swamps. Unhealthy retailers outnumbered healthy retailers in 74% of residential areas in 2020, housing 88.2% of the population. These food swamps create an environment where unhealthy food choices predominate. Residential areas with a higher number of elderly people, young people and families with low incomes had healthier food environments than Flanders as a whole, because these areas are mostly found in dense urban centers where the ratio of healthy food retailers to all retailers is higher. This research showed that food deserts and swamps could be a growing problem in European regions with a high population density that experience the high pressures of competing land uses.

Food swamps in Campinas, Brazil

The characteristics of the food environment can interfere with physical access to healthy foods and accentuate health inequalities. The presence of food swamps, i.e., the greater availability of ultra-processed food and commercial establishments compared to those that sell healthier options, are associated with the consumption of unhealthy foods. This study identified the spatial distribution of these establishments in Campinas, São Paulo. Fast-food restaurants, open-air organic/agroecological food markets and supermarkets were geocoded. Regional administrations (RAs) with greater social vulnerability according to the 2010 Census and with a greater availability of fast-food restaurants in relation to open-air food markets and supermarkets were considered food swamps. The less vulnerable neighborhoods had a higher concentration of all types of commercial food establishments compared to the most vulnerable regions. In Campinas, of eighteen RAs, five were considered food swamps. The findings reinforce the need for actions to improve exposure to healthy foods in more vulnerable neighborhoods.

Premiums for Residing in Unfavorable Food Environments: Are People Rational?

The most extensive research areas in the food environment literature include identifying vulnerable dietary environments and studying how these environments affect eating behaviors and health. So far, research on people’s willingness to pay (WTP) for residing in different types of food environments is limited. Therefore, this study aims to estimate WTP for different types of food environments by using spatial hedonic pricing models. The empirical application applies to the Canadian city of Edmonton. The results show that people are willing to pay a premium to live in neighborhoods with poor access to supermarkets and grocery stores (food-desert type) and neighborhoods with excessive access to fast-food restaurants and convenience stores (food-swamp type). Why do rational people prefer to live in disadvantaged food environments? The seemingly counter-intuitive result has its rationality. The premium paid to live in food-desert type environment may reflect people’s dislike of noise, traffic jams, and potential safety issues brought by supermarkets and grocery stores. The WTP for living in food-swamp type environment may reflect people’s preference for convenience and time-saving brought by fast-food consumption in modern urban society. Additionally, the inability of low-income families to afford healthy food may be a deeper reason for choosing to live in neighborhoods with excess access to fast food. To improve the eating environment and encourage healthy lifestyles, the government can encourage healthier fast-food restaurants, provide grocery shopping vouchers, and promote community garden projects.

Investigation of Whether People Are Willing to Pay a Premium for Living in Food Swamps: A Study of Edmonton, Canada

Extensive studies have examined how unfavorable food environments, especially food swamps (neighborhoods with oversaturated unhealthy food sources), influence people’s dietary behaviors and health. Although excess fast-food consumption may have an adverse effect on health, it also benefits consumers due to its convenience, time saving, and affordability. Therefore, people’s preference for an unhealthy food environment is not necessarily negative. Understanding how people value or disvalue unhealthy food environments is a prerequisite for developing effective policies to promote good diet habits and improve public health. Thus, this study adopts spatial hedonic pricing models to estimate people’s willingness to pay to live in food swamps. The results show that people are willing to pay a premium to live in food swamps when taking low income and low healthy-to-unhealthy food ratios into consideration. On average, a household is willing to pay a premium of C$12,309 to reside in a food swamp neighborhood. Potential reasons for the positive willingness to pay among low-income communities and households with relatively limited access to healthy food may include the unaffordability of healthy diets, preference for better tastes, and time saved in fast-food consumption. These findings can help policymakers evaluate the effectiveness of relevant policies and develop targeted strategies to improve the local food environment.

Geographic remoteness and socioeconomic disadvantage reduce the supportiveness of food and physical activity environments in Australia

OBJECTIVE

An analysis of food and physical activity environments in relation to socioeconomic disadvantage was conducted in 25 communities across Queensland, Australia.

METHODS

Physical activity and food environments were assessed in 25 Queensland communities using The Systematic Pedestrian and Cycling Environmental Scan (SPACES) and the Nutrition Environment Measurement Survey (NEMS). Spearman's correlation tested the association between physical activity and food environments and degree of remoteness and socioeconomic disadvantage of each region.

RESULTS

A significant negative association was observed between the supermarket food environment and degree of remoteness and socioeconomic disadvantage. All regions have a moderately supportive environment for physical activity. Food availability and price varied in supermarkets with more remote communities having less supportive food environments.

CONCLUSIONS

Areas with a high degree of remoteness and socioeconomic disadvantage were more likely to experience disadvantages in the physical activity, supermarket, and restaurant food environments than metropolitan areas and socioeconomically disadvantaged areas.

IMPLICATIONS FOR PUBLIC HEALTH

Socioeconomic disadvantage and remoteness were associated with reduced supportiveness of the built environment hindering the ability of consumers to make healthy food and physical activity choices. Improving the food and physical activity environments in these areas may assist in reducing the health inequalities experienced by these communities.

Beyond food swamps and food deserts: exploring urban Australian food retail environment typologies

OBJECTIVE

'Food deserts' and 'food swamps' are food retail environment typologies associated with unhealthy diet and obesity. The current study aimed to identify more complex food retail environment typologies and examine temporal trends.

DESIGN

Measures of food retail environment accessibility and relative healthy food availability were defined for small areas (SA2s) of Melbourne, Australia, from a census of food outlets operating in 2008, 2012, 2014 and 2016. SA2s were classified into typologies using a two-stage approach: (1) SA2s were sorted into twenty clusters according to accessibility and availability and (2) clusters were grouped using evidence-based thresholds.

SETTING

The current study was set in Melbourne, the capital city of the state of Victoria, Australia.

SUBJECTS

Food retail environments in 301 small areas (Statistical Area 2) located in Melbourne in 2008, 2012, 2014 and 2016.

RESULTS

Six typologies were identified based on access (low, moderate and high) and healthy food availability including one where zero food outlets were present. Over the study period, SA2s experienced an overall increase in accessibility and healthiness. Distribution of typologies varied by geographic location and area-level socio-economic position.

CONCLUSION

Multiple typologies with contrasting access and healthiness measures exist within Melbourne and these continue to change over time, and the majority of SA2s were dominated by the presence of unhealthy relative to healthy outlets, with SA2s experiencing growth and disadvantage having the lowest access and to a greater proportion of unhealthy outlets.

Food swamps in Campinas, Brazil

Abstract The characteristics of the food environment can interfere with physical access to healthy foods and accentuate health inequalities. The presence of food swamps, i.e., the greater availability of ultra-processed food and commercial establishments compared to those that sell healthier options, are associated with the consumption of unhealthy foods. This study identified the spatial distribution of these establishments in Campinas, São Paulo. Fast-food restaurants, open-air organic/agroecological food markets and supermarkets were geocoded. Regional administrations (RAs) with greater social vulnerability according to the 2010 Census and with a greater availability of fast-food restaurants in relation to open-air food markets and supermarkets were considered food swamps. The less vulnerable neighborhoods had a higher concentration of all types of commercial food establishments compared to the most vulnerable regions. In Campinas, of eighteen RAs, five were considered food swamps. The findings reinforce the need for actions to improve exposure to healthy foods in more vulnerable neighborhoods.

Study on Spatial Structure Characteristics of the Tourism and Leisure Industry

By taking Beijing as the case site, using open-source Point of Interest data, and employing spatial visualization techniques, this study explores the spatial structural characteristics of the Beijing tourism and leisure industry and its sub-sectors. It has been found that (1) the nearest neighbor indexes of the tourism and leisure industry and its sub-sectors are all less than 1, indicating that the tourism and leisure industry and its sub-sectors in Beijing exhibit a spatial clustering distribution. Scenic spots have the largest R-value of 0.52 and, thus, the lowest degree of clustering. The minimum R-value of 0.15 is found in catering, marking the highest degree of clustering in the industry; (2) the main directional trend of the tourism and leisure industry and its sub-sectors in Beijing is the “northeast-southwest” direction, the south-north directional dispersion is dominant, and scenic spots demonstrate a more noticeable trend of spatial dispersion; (3) within the area from Sanlitun Street in the north to Panjiayuan Street in the south, and from Chaoyangmen Street in the west to Liulitun Street in the east, is situated the largest portion of cluster centers with the highest degree of clustering in Beijing’s tourism and leisure industry. The contiguous high-density cluster center of catering starts from Sanlitun Street in the north to Jinsong Street in the south, and from Chaoyangmen Street in the west to Liulitun Street in the east. The cluster of shopping and entertainment shows a checkerboard pattern in the CZCF and NUDZ. The high-value cluster of accommodation occurs primarily around Sanlitun, Panjiayuan, and Qianmen; (4) the distribution of three grades of hot spot areas and non-significant areas of tourism and leisure, catering, accommodation, and shopping and entertainment in Beijing demonstrates a circular pattern that centers around the CZCF and expands outward in sequence. High-value hot spot streets for this area are dominated by Beixinqiao Street, Hepingli Street, Sanlitun Street, Heping Street, and Tuanjiehu Street; and the high-value cold spot streets of the area are chiefly in Fuzizhuang Township, Wangping Town, Miaofeng Mountain Town, and Tanzhesi Town.

Understanding Pathways Between Agriculture, Food Systems, and Nutrition: An Evidence and Gap Map of Research Tools, Metrics, and Methods in the Last 10 Years

New tools, metrics, and methods in agriculture, food systems, and nutrition (A&N) research proliferated in the decade following the 2007-2008 food price crisis. We map these developments across themes derived from conceptual A&N pathways and expert consultations. We created an interactive Evidence and Gap Map (EGM) from a systematic search of published and gray literature since 2008, following Campbell Collaboration guidelines. We retrieved over 30,000 reports from published literature databases, and individually searched 20 online repositories. We systematically screened 24,359 reports by title and/or abstract, 1577 by full report, and included 904 eligible reports. The EGM consists of rows of thematic domains and columns of types of tools, metrics, and methods, as well as extensive coding applied as filters. Each cell of the map represents research surrounding a type of tool, metric, or method within a given theme. Reports in each cell are grouped by stage of development, which expand to a corresponding bibliography. Users can filter EGM reports by various characteristics. The 4 most populated domains were: diets, nutrition, and health; primary food production; water, sanitation, and hygiene; and environment and sustainability. The 4 most common types of metrics, methods, and tools were: diet metrics; footprint analysis (especially water); technology applications; and network or Bayesian analysis. Gaps represent areas of few or no reports of innovation between 2008 and 2018. There were gaps in reports and innovations related to: power or conflicts of interest; food environments; markets; private sector engagement; food loss and waste; conflict; study design and system-level tools, metrics, and methods. The EGM is a comprehensive tool to navigate advances in measurement in A&N research: to highlight trends and gaps, conduct further synthesis and development, and prioritize the agenda for future work. This narrative synthesis accompanies the EGM, which can be found at https://www.anh-academy.org/evidence-and-gap-map.

Social inequalities in the surrounding areas of food deserts and food swamps in a Brazilian metropolis

Background

Food deserts are neighborhoods with little or no access to healthy food, whereas food swamps are neighborhoods where unhealthy food options prevail over healthy ones. The main aims of the current study are to feature and compare the neighborhoods of food deserts and food swamps based on social inequality.

Methods

Ecological study carried out in Belo Horizonte City, Minas Gerais State, Brazil. Information about commercial food establishments derived from two different databases. It was measured by secondary governmental databases, which were virtually conferred in the present study. Census tracts were considered as analysis units and classified as food deserts and food swamps, based on the Brazilian methodology. Take into consideration the density of establishments classified as selling fresh or minimally-processed food, mixed establishments, and establishments selling ultra-processed food. The Brazilian methodology evaluates food deserts by the density of healthy establishments (establishments classified as mostly selling fresh or minimally-processed food and mixed establishments) per 10 thousand inhabitants. And the metric to evaluate food swamps considers the density of unhealthy establishments (establishments mostly selling ultra-processed food) per 10 thousand inhabitants. Information about social inequalities comprised aspects such as income, population count, number of households, number of literate individuals, race, water and energy supply, and garbage collection. The Health Vulnerability Index (HVI) was used as a synthetic social vulnerability indicator.

Results

Neighborhoods of food deserts presented worse essential service availability, lower income per capita, and smaller mean number of literate individuals. Census tracts classified as food swamps presented better socio-demographic conditions than those areas food deserts. Neighborhoods simultaneously classified as food deserts and food swamps presented lower income per capita and were more often observed in census sectors presenting medium and high HVI.

Conclusion

The food environment in Belo Horizonte was featured by the strong presence of food deserts and food swamps. However, the potential influence of these areas on food intake has changed depending on social inequalities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01501-7.

Predicting access to healthful food retailers with machine learning

Many U.S. households lack access to healthful food and rely on inexpensive, processed food with low nutritional value. Surveying access to healthful food is costly and finding the factors that affect access remains convoluted owing to the multidimensional nature of socioeconomic variables. We utilize machine learning with census tract data to predict the modified Retail Food Environment Index (mRFEI), which refers to the percentage of healthful food retailers in a tract and agnostically extract the features of no access-corresponding to a "food desert" and low access-corresponding to a "food swamp." Our model detects food deserts and food swamps with a prediction accuracy of 72% out of the sample. We find that food deserts and food swamps are intrinsically different and require separate policy attention. Food deserts are lightly populated rural tracts with low ethnic diversity, whereas swamps are predominantly small, densely populated, urban tracts, with more non-white residents who lack vehicle access. Overall access to healthful food retailers is mainly explained by population density, presence of black population, property value, and income. We also show that our model can be used to obtain sensible predictions of access to healthful food retailers for any U.S. census tract.

Exploring Dietary Behavior Differences among Children by Race/Ethnicity and Socioeconomic Status

BACKGROUND

In Spartanburg County, SC, nearly 33.7% of children are overweight or obese. The purpose of this study was to investigate differences in eating behavior of youth by race/ethnicity and socioeconomic status.

METHODS

Students (N = 997) in 4th to 5th grades completed the School Nutrition and Physical Activity Survey. School databases categorized students as either White or racial/ethnic minority and free/reduced or full paid lunch status. Dietary behaviors included 13 composite measures: unhealthy proteins, healthy proteins, dairy, refined grains, whole grains, vegetables, fruit, fried snacks, sugar-sweetened beverages, sweets, and consumption of a breakfast, evening, and/or restaurant meal. Logistic regression, controlling for sex, was used to analyze differences in consumption for each nutrition variable.

RESULTS

Minority youth were less likely to consume healthy proteins (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.55-0.92) and more likely to eat at a restaurant (OR = 1.32, 95% CI = 1.02-1.70) compared to white youth. Lower socioeconomic status youth were less likely to eat an evening meal compared to higher socioeconomic status youth (OR = 0.59, 95% CI = 0.39-0.89).

CONCLUSIONS

Differences in dietary behaviors may result from food accessibility and insecurity in minority and/or low-income neighborhoods. Future research should explore policy strategies that can help ensure all youth maintain healthy eating habits and weight status.

Google-truthing to assess hot spots of food retail change: A repeat cross-sectional Street View of food environments in the Bronx, New York

Google Street View (GSV) images can be used to "ground-truth" current and historical food retail data from approximately 2007 - when GSV was launched in a few US cities - to the present, facilitating analyses of food environments over time. A review of GSV images of all food retailers listed in a government database of licensed establishments in the Bronx, New York enabled records to be verified, businesses classified, and retail change quantified. The data revealed several trends likely to affect food access and health: increasing overall numbers of food retailers; the growth of dollar stores; and numerous openings, closings, and ownership changes across all food retail segments. Hot spot analysis identified statistically significant clusters of new dollar stores and bodegas, purveyors of less healthy processed foods, in lower-income neighborhoods in the South Bronx that face elevated rates of diet-related diseases. This article demonstrates the benefits and limitations of using GSV to conduct "virtual" food environment research.

Food Retail Environments in Greater Melbourne 2008-2016: Longitudinal Analysis of Intra-City Variation in Density and Healthiness of Food Outlets

Obesity prevalence is inequitably distributed across geographic areas. Food environments may contribute to health disparities, yet little is known about how food environments are evolving over time and how this may influence dietary intake and weight. This study aimed to analyse intra-city variation in density and healthiness of food outlets between 2008 and 2016 in Melbourne, Australia. Food outlet data were classified by location, type and healthiness. Local government areas (LGAs) were classified into four groups representing distance from the central business district. Residential population estimates for each LGA were used to calculate the density of food outlets per 10,000 residents. Linear mixed models were fitted to estimate the mean density and ratio of ‘healthy’ to ‘unhealthy’ food outlets and food outlet ‘types’ by LGA group over time. The number of food outlets increased at a faster rate than the residential population, driven by an increasing density of both ‘unhealthy’ and ‘healthy’ outlets. Across all years, ratios of ‘unhealthy’ to ‘healthy’ outlets were highest in LGAs located in designated Growth Areas. Melbourne’s metropolitan food environment is saturated by ‘unhealthy’ and ‘less healthy’ food outlets, relative to ‘healthy’ ones. Melbourne’s urban growth areas had the least healthy food environments.

U.S. county "food swamp" severity and hospitalization rates among adults with diabetes: A nonlinear relationship

The relationship between food environments and diabetes morbidity is vastly understudied, despite the well-recognized linkage between dietary quality and diabetes complications. Further, literature demonstrates that attributes of places can have nonlinear relationships with health outcomes. This study examines the extent to which "food swamps" are associated with greater rates of hospitalizations for complications among adults with diabetes over time as well as the linearity of this relationship. We conduct a longitudinal county-level analysis of 832 counties across 16 U.S. states in 2010, 2012, and 2014 using data from the USDA Food Environment Atlas and the AHRQ Health Care Cost and Utilization Project State Inpatient Databases. Food swamp severity is measured as the percentage of food outlets in a county that sell primarily unhealthy foods. Hierarchical linear mixed models with county random intercepts are estimated, controlling for area-level covariates and state and year fixed effects. Curvilinear relationships are explored by additively incorporating quadratic terms. We find that, over the study period, mean food swamp severity remained relatively stable. Mean hospitalization rates decreased from 296.72 to 262.82 hospitalizations per 1000 diabetic adults (p < 0.001). In adjusted models, greater food swamp severity was associated with higher hospitalization rates in a curvilinear manner (severity: β = 2.181, p = 0.02; severity2: β = -0.017, p = 0.04), plateauing at approximately 64% unhealthy outlets, a saturation point observed in 17% of observations. Policies that limit saturation of the environment with unhealthy outlets may help in the prevention of diabetic complications, but more saturated counties will likely require more extensive intervention.

Housing and Healthy Child Development: Known and Potential Impacts of Interventions

Housing is often described as an important determinant of health, but less commonly of child health. Despite acknowledgment of the importance of housing to health, however, there are relatively few studies of the effects of housing interventions on health, and again even fewer on child health. This article argues that a broad focus on healthy child development-as opposed to just physical health-coupled with a conceptual framework outlining specific attributes of housing with the potential to influence child health, should be adopted to guide a comprehensive approach to public health policy for healthy child development. Most housing interventions address direct pathways linking in-home hazard exposures to child health outcomes, with promising but mixed results. But few housing interventions address the broader aspects of healthy child development. This review addresses potential housing interventions that could impact the broader determinants of healthy child development and accompanying methodological challenges.

Intakes of energy, macronutrients and micronutrients of a population in severe food insecurity risk in Brazil

OBJECTIVE

To analyse usual intakes of energy, macronutrients and micronutrients, and their percentage of inadequacy, in a Brazilian population at severe food insecurity (SFI) risk, determined from a predictive model using two national databases.

DESIGN

Cross-sectional study. Our study used a statistical model to predict SFI using the 2009 National Sample Household Survey, where the Brazilian Food Insecurity Scale measured SFI.

SETTING

Brazil.

PARTICIPANTS

The model was applied in a probabilistic sample of 34 003 Brazilians aged 10 years or older that participated in a national dietary survey during 2008-2009. The application of the model generated the probability of each individual being in SFI. The probability of SFI was grouped into quartiles (first quartile with the lowest SFI risk, fourth quartile with highest probability of SFI risk).

RESULTS

The intakes of macro- and micronutrients were associated with SFI. The amount of energy and nutrients in the diet tended to be lower among individuals in the fourth quartile, with highest probability of SFI. The average intake of all studied minerals (Ca, Fe, Na, Mg) was less in individuals in the fourth quartile. Only Na presented a higher percentage of inadequacy in the first quartile, the one with a lower chance of SFI.

CONCLUSIONS

The food intake of the Brazilian population at higher SFI risk is characterized by energy reduction, reduced consumption of macronutrients and high prevalence of inadequate micronutrient intakes, as well as a lower mean intakes, when compared with the first quartile with the lowest SFI risk.

Relative Density of Away from Home Food Establishments and Food Spend for 24,047 Households in England: A Cross-Sectional Study

Eating away from home is a risk factor for poor diet quality and obesity. With an ever-increasing proportion of household food spend directed toward eating out, the proliferation of these food establishments may contribute to their use, a potential precursor to less healthy food choices and low overall diet quality. However few studies are conducted at the national level and across a range of away from home food sources. The purpose of this study was to examine the association between the density of away from home food establishments (e.g., restaurants, fast food outlets and cafés) and household spend on away from home food within a nationally representative sample for England, UK. A cross-sectional analysis of data from Wave 1 of the UK Household Longitudinal Survey (n = 24,047 adults aged ≥19y) was conducted. Exposure was characterised as the density of away from home food establishments to all other food sources within 1 mile of the home, divided into quintiles (Q1 as lowest exposure and Q5 as highest exposure). The primary outcome included households with a high away from home equivalised monthly food spend (≥25% of total food spend). Logistic regression was used to estimate associations between away from home food establishment exposure and high away from home food spend. Away from home food establishment density was significantly associated with a greater odds of high monthly food spend (Q3: OR = 1.18, 95% CI = 1.07, 1.30; Q4: OR = 1.30, 95% CI = 1.18, 1.43; and Q5: OR = 1.52, 95% CI = 1.37, 1.68) with attenuation after controlling for known socioeconomic confounders (Q4: OR = 1.13, 95% CI = 1.02, 1.25; and Q5: OR = 1.16, 95% CI = 1.04, 1.30) compared to those least exposed (Q1). Those most exposed to away from home food establishments had a 16% greater odds of allocating more than 25% of household food spend on away from home food sources. This study provides one of the first analyses at the national level to examine the role of the local food environment in relation to household food spend, a potential precursor to diet quality and health.

Food deserts in Winnipeg, Canada: a novel method for measuring a complex and contested construct

INTRODUCTION

"Food deserts" have emerged over the past 20 years as spaces of concern for communities, public health authorities and researchers because of their potential negative impact on dietary quality and subsequent health outcomes. Food deserts are residential geographic spaces, typically in urban settings, where low-income residents have limited or no access to retail food establishments with sufficient variety at affordable cost. Research on food deserts presents methodological challenges including retail food store identification and classification, identification of low-income populations, and transportation and proximity metrics. Furthermore, the complex methods often used in food desert research can be difficult to reproduce and communicate to key stakeholders. To address these challenges, this study sought to demonstrate the feasibility of implementing a simple and reproducible method of identifying food deserts using data easily available in the Canadian context.

METHODS

This study was conducted in Winnipeg, Canada in 2014. Food retail establishments were identified from Yellow Pages and verified by public health dietitians. We calculated two scenarios of food deserts based on location of the lowest-income quintile population: (a) living ≥ 500 m from a national chain grocery store, or (b) living ≥ 500 m from a national chain grocery store or a full-service grocery store.

RESULTS

The number of low-income residents living in a food desert ranged from 64 574 to 104 335, depending on the scenario used.

CONCLUSION

This study shows that food deserts affect a significant proportion of the Winnipeg population, and while concentrated in the urban core, exist in suburban neighbourhoods also. The methods utilized represent an accessible and transparent, reproducible process for identifying food deserts. These methods can be used for costeffective, periodic surveillance and meaningful engagement with communities, retailers and policy makers.

Access to healthy food retailers among formerly incarcerated individuals

Objective

To assess access to healthy food retailers among formerly incarcerated individuals.

Design

Using linked data from the National Longitudinal Study of Adolescent to Adult Health and the Modified Retail Food Environment Index, the present study applies multivariate logistic regression to assess the association between incarceration and (i) living in a food desert and (ii) having low access to healthy food retailers. To account for unobserved heterogeneity, additional analyses are performed comparing formerly incarcerated individuals with persons arrested or convicted for a crime but not previously incarcerated.

Setting

Sample of respondents living in urban census tracts in the USA.

Subjects

Adults (n10390) aged 24–34 years.

Results

In adjusted logistic regression models, prior incarceration was not significantly associated with living in a food desert (OR=1·097; 95% CI 0·896, 1·343). Prior incarceration significantly increased the likelihood of living in a census tract with low access to healthy food retailers (OR=1·265; 95% CI 1·069, 1·498). This significant association remained when comparing formerly incarcerated individuals with those who had been arrested or convicted of a crime, but not previously incarcerated (OR=1·246; 95% CI 1·032, 1·503).

Conclusions

Formerly incarcerated individuals are more likely to live in areas with low access to healthy food retailers compared with their non-incarcerated counterparts. Because lower access healthy food retailers may be associated with worse health and dietary behaviour, disparities in local food retail environments may exacerbate health inequalities among formerly incarcerated individuals.

Examining associations between school food environment characteristics and sugar-sweetened beverage consumption among Canadian secondary-school students in the COMPASS study

Objective

To examine associations between Canadian adolescents’ sugar-sweetened beverage (SSB) consumption and several school food environment characteristics, and to investigate differences in these characteristics between schools in provinces with voluntary (Alberta) v. mandatory (Ontario) provincial school nutrition policies.

Design

We used a questionnaire to assess the number of weekdays participants consumed three SSB categories (soft drinks, sweetened coffees/teas, energy drinks) and various sociodemographic and behavioural characteristics. We examined the in-school water fountain accessibility, vending machines’ contents and presence of various food outlets within schools’ 1 km buffer. We developed hierarchical Poisson regression models to identify associations between student- and school-level characteristics and students’ SSB outcomes.

Setting

Alberta and Ontario, Canada.

Subjects

Adolescents (n 41 829) from eighty-nine secondary schools.

Results

Compared with their Ontarian counterparts, Albertan participants had a significantly higher rate of SSB intake across all drink categories and SSB availability was significantly greater in Albertan schools’ vending machines. Availability of sweetened coffees/teas in school vending machines and access to restaurants within the school’s 1 km buffer were associated with increased SSB intake in three of the final models. Overall, the school food environment-level characteristics examined had a modest to negligible impact on student days of SSB intake.

Conclusions

We identified that the school food environment characteristics examined here had little impact on adolescents’ days of SSB consumption. While schools should adopt or maintain a comprehensive policy approach to discourage students’ SSB intake, population-level interventions focusing on other contexts (e.g. home and community) are needed to complement existing school-based interventions.

Diving into the consumer nutrition environment: A Bayesian spatial factor analysis of neighborhood restaurant environment

Neighborhood restaurant environment (NRE) plays a vital role in shaping residents' eating behaviors. While NRE 'healthfulness' is a multi-facet concept, most studies evaluate it based only on restaurant type, thus largely ignoring variations of in-restaurant features. In the few studies that do account for such features, healthfulness scores are simply averaged over accessible restaurants, thereby concealing any uncertainty that attributed to neighborhoods' size or spatial correlation. To address these limitations, this paper presents a Bayesian Spatial Factor Analysis for assessing NRE healthfulness in the city of Kitchener, Canada. Several in-restaurant characteristics are included. By treating NRE healthfulness as a spatially correlated latent variable, the adopted modeling approach can: (i) identify specific indicators most relevant to NRE healthfulness, (ii) provide healthfulness estimates for neighborhoods without accessible restaurants, and (iii) readily quantify uncertainties in the healthfulness index. Implications of the analysis for intervention program development and community food planning are discussed.

Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States

This paper investigates the effect of food environments, characterized as food swamps, on adult obesity rates. Food swamps have been described as areas with a high-density of establishments selling high-calorie fast food and junk food, relative to healthier food options. This study examines multiple ways of categorizing food environments as food swamps and food deserts, including alternate versions of the Retail Food Environment Index. We merged food outlet, sociodemographic and obesity data from the United States Department of Agriculture (USDA) Food Environment Atlas, the American Community Survey, and a commercial street reference dataset. We employed an instrumental variables (IV) strategy to correct for the endogeneity of food environments (i.e., that individuals self-select into neighborhoods and may consider food availability in their decision). Our results suggest that the presence of a food swamp is a stronger predictor of obesity rates than the absence of full-service grocery stores. We found, even after controlling for food desert effects, food swamps have a positive, statistically significant effect on adult obesity rates. All three food swamp measures indicated the same positive association, but reflected different magnitudes of the food swamp effect on rates of adult obesity (p values ranged from 0.00 to 0.16). Our adjustment for reverse causality, using an IV approach, revealed a stronger effect of food swamps than would have been obtained by naïve ordinary least squares (OLS) estimates. The food swamp effect was stronger in counties with greater income inequality (p < 0.05) and where residents are less mobile (p < 0.01). Based on these findings, local government policies such as zoning laws simultaneously restricting access to unhealthy food outlets and incentivizing healthy food retailers to locate in underserved neighborhoods warrant consideration as strategies to increase health equity.

Gardening in the desert: a spatial optimization approach to locating gardens in rapidly expanding urban environments

BACKGROUND

Food access is a global issue, and for this reason, a wealth of studies are dedicated to understanding the location of food deserts and the benefits of urban gardens. However, few studies have linked these two strands of research together to analyze whether urban gardening activity may be a step forward in addressing issues of access for food desert residents.

METHODS

The Phoenix, Arizona metropolitan area is used as a case to demonstrate the utility of spatial optimization models for siting urban gardens near food deserts and on vacant land. The locations of urban gardens are derived from a list obtained from the Maricopa County Cooperative Extension office at the University of Arizona which were geo located and aggregated to Census tracts. Census tracts were then assigned to one of three categories: tracts that contain a garden, tracts that are immediately adjacent to a tract with a garden, and all other non-garden/non-adjacent census tracts. Analysis of variance is first used to ascertain whether there are statistical differences in the demographic, socio-economic, and land use profiles of these three categories of tracts. A maximal covering spatial optimization model is then used to identify potential locations for future gardening activities. A constraint of these models is that gardens be located on vacant land, which is a growing problem in rapidly urbanizing environments worldwide.

RESULTS

The spatial analysis of garden locations reveals that they are centrally located in tracts with good food access. Thus, the current distribution of gardens does not provide an alternative food source to occupants of food deserts. The maximal covering spatial optimization model reveals that gardens could be sited in alternative locations to better serve food desert residents. In fact, 53 gardens may be located to cover 96.4% of all food deserts. This is an improvement over the current distribution of gardens where 68 active garden sites provide coverage to a scant 8.4% of food desert residents.

CONCLUSION

People in rapidly urbanizing environments around the globe suffer from poor food access. Rapid rates of urbanization also present an unused vacant land problem in cities around the globe. This paper highlights how spatial optimization models can be used to improve healthy food access for food desert residents, which is a critical first step in ameliorating the health problems associated with lack of healthy food access including heart disease and obesity.

How Latina mothers navigate a 'food swamp' to feed their children: a photovoice approach

OBJECTIVE

To understand how mothers who recently migrated from Central America to the USA feed their children in a neighbourhood saturated with unhealthful food choices ('food swamp') and to formulate a mother-driven plan of action to facilitate their acquisition of foods. Design/Setting/Subjects We purposively sampled mothers with children (<10 years old) who were recent immigrants/refugees from Central America and lived in a 'food swamp' neighbourhood. We used the photovoice approach to elicit textual data from thirty in-depth interviews, a participatory workshop, and visual data from photographs. Analyses were guided by the Social Ecological Framework and Social Cognitive Theory to identify barriers, facilitators and strategies that support parents in feeding their children.

RESULTS

Mothers valued foods that they considered to be 'traditional' and 'healthful'. They navigated their food retail environment looking for these foods (of good quality and well-priced). Food values were reinforced by pre-migration food customs and culture, health professionals' advice and, in some cases, by the desire to avoid conflict with their children. The neighbourhood food environment could directly influence children's food preferences and often created conflict between what the child wanted to eat and the foods that mothers valued. Mothers in this 'food swamp' wanted to be engaged in addressing the selection of foods offered in schools and in neighbourhood food venues to reflect their own food values.

CONCLUSIONS

These mothers' feeding choices were influenced directly by their food values, and indirectly by the neighbourhood and school food environments via their children's preferences.

Do marginalized neighbourhoods have less healthy retail food environments? An analysis using Bayesian spatial latent factor and hurdle models

Background

Findings of whether marginalized neighbourhoods have less healthy retail food environments (RFE) are mixed across countries, in part because inconsistent approaches have been used to characterize RFE ‘healthfulness’ and marginalization, and researchers have used non-spatial statistical methods to respond to this ultimately spatial issue.

Methods

This study uses in-store features to categorize healthy and less healthy food outlets. Bayesian spatial hierarchical models are applied to explore the association between marginalization dimensions and RFE healthfulness (i.e., relative healthy food access that modelled via a probability distribution) at various geographical scales. Marginalization dimensions are derived from a spatial latent factor model. Zero-inflation occurring at the walkable-distance scale is accounted for with a spatial hurdle model.

Results

Neighbourhoods with higher residential instability, material deprivation, and population density are more likely to have access to healthy food outlets within a walkable distance from a binary ‘have’ or ‘not have’ access perspective. At the walkable distance scale however, materially deprived neighbourhoods are found to have less healthy RFE (lower relative healthy food access).

Conclusion

Food intervention programs should be developed for striking the balance between healthy and less healthy food access in the study region as well as improving opportunities for residents to buy and consume foods consistent with dietary recommendations.

Health research needs more comprehensive accessibility measures: integrating time and transport modes from open data

Background

In this paper, we demonstrate why and how both temporality and multimodality should be integrated in health related studies that include accessibility perspective, in this case healthy food accessibility. We provide evidence regarding the importance of using multimodal spatio-temporal accessibility measures when conducting research in urban contexts and propose a methodological approach for integrating different travel modes and temporality to spatial accessibility analyses. We use the Helsinki metropolitan area (Finland) as our case study region to demonstrate the effects of temporality and modality on the results.

Methods

Spatial analyses were carried out on 250 m statistical grid squares. We measured travel times between the home location of inhabitants and open grocery stores providing healthy food at 5 p.m., 10 p.m., and 1 a.m. using public transportation and private cars. We applied the so-called door-to-door approach for the travel time measurements to obtain more realistic and comparable results between travel modes. The analyses are based on open access data and publicly available open-source tools, thus similar analyses can be conducted in urban regions worldwide.

Results

Our results show that both time and mode of transport have a prominent impact on the outcome of the analyses; thus, understanding the realities of accessibility in a city may be very different according to the setting of the analysis used. In terms of travel time, there is clear variation in the results at different times of the day. In terms of travel mode, our results show that when analyzed in a comparable manner, public transport can be an even faster mode than a private car to access healthy food, especially in central areas of the city where the service network is dense and public transportation system is effective.

Conclusions

This study demonstrates that time and transport modes are essential components when modeling health-related accessibility in urban environments. Neglecting them from spatial analyses may lead to overly simplified or even erroneous images of the realities of accessibility. Hence, there is a risk that health related planning and decisions based on simplistic accessibility measures might cause unwanted outcomes in terms of inequality among different groups of people.