An examination of the roles played by early adolescent children in interactions with their local food environment

Using coupons to encourage healthier child snack purchases in corner stores: results from the CHOMPS study

Objectives

To examine youths' (ages 6-15 years) autonomous snack purchases in corner stores and pilot use of coupons to encourage more healthful snack purchases.

Methods

This pilot study involved four corner stores proximal to K-8 schools in Massachusetts. Kids-only coupons of varying discounts were provided in store and paired with simple visual and verbal economic and health messages. Observational data about youths' autonomous snack purchases was recorded pre- and post-intervention. Outcomes of interest were snack item, price, and nutrient content. Comparisons of purchase characteristics and nutritional content across intervention conditions were made using Chi-squared and t-tests.

Results

Across all stores, 2,973 purchase observations were recorded totaling approximately $6,000. Researchers estimated that about 55% of shoppers were 10-12 years old. Modest coupon usage (2.2% of purchases) was noted. However, candy purchases decreased, and the percentage of purchase events that included at least one healthier food item more than doubled, regardless of coupon use. Improvements in the nutritional content of snacks were also observed.

Conclusion

Kids-only coupons have the potential to assist with shifting autonomous snack purchase behavior in outside of school settings.

Longitudinal association between density of retail food stores and body mass index in Mexican school children and adolescents

BACKGROUND

Obesity is rapidly increasing in Mexican children and adolescents, while food environments are rapidly changing. We evaluated the association between changes in retail food stores and change in body mass index (BMI) in Mexican children and adolescents.

METHODS

Data on 7507 participants aged 5-19 years old came from the Mexican Family Life Survey 2002-2012. Density of food stores at the municipal-level (number of food stores/area in km²) came from the Economic Censuses of 1999, 2004 and 2009. We categorized food stores as small food retail (small neighborhood stores, tiendas de abarrotes in Mexico), specialty foods, fruit/vegetables, convenience foods, and supermarkets. Associations between change in food stores and change in BMI were estimated using five longitudinal linear fixed-effects regression models (one per type of food store) adjusted for age, parental education, municipal-level socioeconomic deprivation and population density. Density of each food store type was operationalized as quartiles. Analyses were stratified by urbanization.

RESULTS

There was an inverse dose-response association between increases in fruit/vegetable store density and BMI (β = -0.455 kg/m², β = -0.733 kg/m², and β = -0.838 kg/m² in the second, third, and fourth quartile). In non-urban areas, children living in municipalities with the highest density of small food retail stores experienced a reduction in BMI (β = -0.840 kg/m²). In urban areas, there was an inverse association between specialty food stores with BMI (β = -0.789 kg/m² in third quartile, and β = -1.204 kg/m² in fourth quartile). We observed dynamic associations with age; results suggested stronger associations in adolescents.

CONCLUSIONS

The availability of fruit/vegetable stores may influence a reduction in children and adolescents BMI. These results indicate that policy approaches could be tailored by type of food store - with some consideration for level of urbanization and children's age.

Children's Community Nutrition Environment, Food and Drink Purchases and Consumption on Journeys between Home and School: A Wearable Camera Study

Children's community nutrition environments are an important contributor to childhood obesity rates worldwide. This study aimed to measure the type of food outlets on children's journeys to or from school, children's food purchasing and consumption, and to determine differences by ethnicity and socioeconomic status. In this New Zealand study, we analysed photographic images of the journey to or from school from a sample of 147 children aged 11-13 years who wore an Autographer camera which recorded images every 7 s. A total of 444 journeys to or from school were included in the analysis. Camera images captured food outlets in 48% of journeys that had a component of active travel and 20% of journeys by vehicle. Children who used active travel modes had greater odds of exposure to unhealthy food outlets than children who used motorised modes; odds ratio 4.2 (95% CI 1.2-14.4). There were 82 instances of food purchases recorded, 84.1% of which were for discretionary foods. Of the 73 food and drink consumption occasions, 94.5% were for discretionary food or drink. Children on their journeys to or from school are frequently exposed to unhealthy food outlets. Policy interventions are recommended to limit the availability of unhealthy food outlets on school routes.

The foodscapes of children and adolescents attending schools in Lima, Peru

Foodscapes are the sum of all places where food and eating are actualized, as well as the institutional arrangements, discourses, cultural practices, trends and meanings that shape the relationship between individuals and food. However, limited research is available on how the different elements of foodscapes (physical, social, institutional) interact to influence children's and adolescents' eating behaviors. The aim of this study was to identify and characterize the factors influencing Peruvian children's and adolescents' practices around food, focusing on the systemic and complex nature of eating. We conducted non-participant observations inside and around two schools-one public and one private-located in Lima, Peru, for an entire school-week, and interviewed 44 parents/caregivers of children and adolescents, ages 6-16. Qualitative content analysis was developed, as its iterative and reflective nature allowed for evolving understandings of the data. Results showed that individual attributes (SES, age and gender) interact with individual agency, the physical environment, parental and peer influence, to determine differentiated food-related outcomes of children and adolescents. Moreover, the state-wide law aiming to protect children's and adolescents' health and nutrition seemed to partially influence the eating practices of parents and children at school and at home. This study is unique in its kind, as existent research has mainly focused on the effects of foodscapes on children and adolescents in Western countries, while research in the Global South, such as Peru, remains mostly underdeveloped. Moreover, this study, unlike previous ones, intends to systematically understand how foodscapes shape children's and adolescents' eating practices.

Association between convenience stores near schools and obesity among school-aged children in Beijing, China

Background

Food environments have rapidly changed over the past years in China and children have more access to unhealthy food in convenience stores near schools. Since the studies on the association between convenience stores near schools and obesity had inconsistent results and no similar study in China, we conducted a study on the association in Beijing of China, which will provide scientific evidence for the intervention of childhood obesity.

Methods

The study included 2201 students at grade 4 of 37 primary schools in Dongcheng or Miyun district of Beijing. The food environment data was acquired from AMAP, the free web-based geospatial service provider. The numbers of convenience stores were captured within the 800-m network buffer near schools using Geographic Information System. The weight and height of each student were measured by trained health professionals. Students’ dietary and physical behaviors and other information associated with obesity were collected with questionnaires for students and their parents. The generalized linear mixed model (GLMM) was used to analyze the data.

Results

The average age of the students was 10.2 years (Standard Deviation (SD) = 0.33). The prevalence of obesity in students was 14.9%. The median number of convenience stores within the 800-m network buffer near schools was 24 in two districts. The number of convenience stores near each school varied from 5 to 67 (median: 25) in Dongcheng district and from 1 to 57 (median: 22) in Miyun district. After adjusting for the confounding factors at the family and individual levels, the association between convenience stores and childhood obesity was statistically significant. Additional ten convenience stores near schools were associated with an increased risk of obesity (Odds Ratio (OR) = 1.13, 95% confidence interval (CI): 1.03,1.24, P = 0.011). Compared with less than 24 convenience stores near schools, the students with more than or equal to 24 convenience stores near schools had an increased risk of obesity (OR = 1.49, 95% CI: 1.09, 2.03, P = 0.013).

Conclusion

The students with more convenience stores near their schools had an increased risk of obesity. The findings provided evidence for developing public health policy to restrict the number of convenience stores near schools to prevent and control childhood obesity.

Is the local food environment associated with excess body weight in adolescents in São Paulo, Brazil?

The obesogenic environment stimulates an inadequate diet by hampering healthy choices. This cross-sectional study evaluated the association between the local food environment and the prevalence of overweight and obesity in a representative sample population of adolescents living in the city of São Paulo, Brazil, using multilevel logistic regression models. Among the adolescents, 29.6% were overweight/obese. There were no significant differences between food environment and adolescents’ weight status. However, the presence of fast food restaurants near their home increased the chances of being overweight or obese (OR = 2.53; 95%CI: 1.02-6.27). Results suggest the need to intensify food and nutrition policies, development of culinary skills, and the reduction in prices of healthy foods to facilitate access to these foods, so that adolescents have options in locations to socialize with friends and family.

Highlighting of Urinary Sodium and Potassium among Indonesian Schoolchildren Aged 9-12 Years: The Contribution of School Food

Background

Sodium (Na) and potassium (K), the essential nutrients, have vital role in promoting cellular growth including growth and development of children. Excessive Na intake and inadequate K consumption, which consequently increases the risk of cardiovascular disease, have been reported. Spot electrolyte urine was highly correlated and validated with gold standard to estimate electrolyte dietary intake. This study aimed at predicting sodium and potassium intake using morning spot urine among Indonesian schoolchildren.

Methods

A cross-sectional study was carried out in 155 healthy elementary students aged 9–12 years. Spot urine samples were collected and analyzed for Na, K, and creatinine. Predicted 24 h Na and K excretions were compared to the Indonesian recommendation dietary allowances. The Na and K contribution from school food was reported by observing directly and the dietary recall method.

Results

A total of 80 boys and 75 girls recruited as samples in this study demonstrated that their estimated urinary Na and K were 105.42 ± 66.05 mmol/day and 16.39 ± 12.57 mmol/day, respectively. Na intake was on average higher than recommended; meanwhile, almost all subjects showed very low compliance of K intake recommendation. Furthermore, food intake at school contributed to those conditions. Na and K content of school food contributed 33% and 29% of the daily intake of each nutrient and contributed 125% and 25% higher than the Na and K school standard, respectively.

Conclusions

Indonesian schoolchildren aged 9–12 years are categorized by excessive Na intake and very deficient K intake. The present study highlights the need for policies in the environmental school setting to reduce Na intake and K intake.

Sources of Foods That Are Ready-to-Consume ('Grazing Environments') Versus Requiring Additional Preparation ('Grocery Environments'): Implications for Food-Environment Research and Community Health

Local businesses that offer foods may create different 'grazing environments' (characterized by sources of ready-to-consume foods) and 'grocery environments' (characterized by source of foods for later preparation). Such environments may be relevant to different populations at different times and may vary by neighborhood. In neighborhoods within two demographically distinct areas of the Bronx, NY [Area A (higher-poverty, greater minority representation, lesser vehicle ownership) vs. Area B], researchers assessed all storefront businesses for food offerings. Food offerings could be ready-to-consume or require additional preparation. 'Healthful' offerings included fruits and vegetables, whole grains, and nuts; 'less-healthful' offerings included 'refined sweets' and 'salty/fatty fare.' 'Food businesses' (those primarily focused on selling food) were distinguished from 'other businesses' (not focused primarily on food selling). Area A had a higher percentage of street segments on which foods were available (28.6% vs. 6.9% in Area B; difference 21.7% points [95% CI 17.0, 26.5]) and a higher percentage of businesses offering foods (46.9% vs. 41.7% in Area B; difference 5.2% points [95% CI - 2.0, 12.4]). 'Less-healthful' items predominated in both 'grazing environments' and overall environments ('grazing' plus 'grocery environments'; the environments researchers typically measure) in both Areas A and B. 'Other businesses' represented about 2/3 of all businesses and accounted for nearly 1/3 of all the businesses offering food in both geographic areas. The lower-income area with greater minority representation and less private transportation had more businesses offering foods on more streets. There was near-perfect overlap between 'grazing environments' and overall environments in both geographic areas. Future research should consider the extent of 'grazing' and 'grocery environments,' and when each might be most relevant to populations of interest.

Access to Street Markets and Consumption of Fruits and Vegetables by Adolescents Living in São Paulo, Brazil

Food environment and income act as determinants of diet, and consequently, of the consumption of fruits and vegetables. The objective of this study is to investigate the association between fruit and vegetable consumption, income, and street market density in adolescents living in São Paulo, Brazil. Data from 521 adolescents (12 to 19 years) participating in the 2015 Health Survey of São Paulo were used. Buffers (500, 1000, and 1500 m) were drawn around the households and the street markets were counted in each zone. Multilevel logistic regression models were used to evaluate the association between fruit and vegetable consumption, income, and street market density. The main results showed that the presence of a street market in the zone closest to the households (500 m) was associated with higher consumption of fruits and vegetables (OR: 1.73; CI 95% 1.01-3.00). Higher family income was associated with a higher consumption of fruits and vegetables for models of 500 m buffer (OR: 2.56; CI 95% 1.47-4.45), 1000 m (OR: 2.30; CI 95% 1.33-3.96), and 1500 m (OR: 2.32; CI 95% 1.35-4.00). These results support the implementation of public policies that jointly consider income and the availability of street markets or healthy food environments.

Prevalence of food addiction among Iranian children and adolescents: Associations with sociodemographic and anthropometric indices

Background: Food addiction has been defined as consuming palatable foods leading to addictive-like behaviors. Little studies have assayed food addiction in children and adolescents. Thus, we aimed at identifying the prevalence of food addiction and the relationship between food addiction, sociodemographic and anthropometric indicators among children and adolescents in southwestern Iran. Methods: This cross-sectional study was conducted on 222 elementary school students aged 7 to 13 years in Ahvaz, Iran, using a random sampling method. Sociodemographic and anthropometric indicators were obtained. The 25-item child version of the Yale Food Addiction Scale (YFAS-C) was applied to provide food addiction diagnosis and symptoms. A nonparametric analysis was used for data analysis. Results: The prevalence of food addiction was 17.3%. Also, the most common symptoms associated with food addiction were (1) inability to cut down, (2) withdrawal, and (3) tolerance. The students with food addiction diagnosis were older than the undiagnosed (p=0.04). The males and students older than 8 years showed a higher food addiction score than females and students under 8 years (p<0.05). In females, significant positive correlations were found between anthropometric indicators, including body mass index and body mass index z-score, with food addiction score (p<0.01). Conclusion: Food addiction diagnosis was more prevalent in males and students over 8 years. Females with higher YFAS-C scores had elevated body mass index z-scores, suggesting that food addiction may be a remarkable problem in childhood and early adolescence and may also be related to a risk of overweight/obesity in Iranian students.

Greater access to healthy food outlets in the home and school environment is associated with better dietary quality in young children

OBJECTIVE

To explore associations between dietary quality and access to different types of food outlets around both home and school in primary school-aged children.

DESIGN

Cross-sectional observational study.

SETTING

Hampshire, UK.

SUBJECTS

Children (n 1173) in the Southampton Women's Survey underwent dietary assessment at age 6 years by FFQ and a standardised diet quality score was calculated. An activity space around each child's home and school was created using ArcGIS. Cross-sectional observational food outlet data were overlaid to derive four food environment measures: counts of supermarkets, healthy specialty stores (e.g. greengrocers), fast-food outlets and total number of outlets, and a relative measure representing healthy outlets (supermarkets and specialty stores) as a proportion of total retail and fast-food outlets.

RESULTS

In univariate multilevel linear regression analyses, better diet score was associated with exposure to greater number of healthy specialty stores (β=0·025 sd/store: 95 % CI 0·007, 0·044) and greater exposure to healthy outlets relative to all outlets in children's activity spaces (β=0·068 sd/10 % increase in healthy outlets as a proportion of total outlets, 95 % CI 0·018, 0·117). After adjustment for mothers' educational qualification and level of home neighbourhood deprivation, the relationship between diet and healthy specialty stores remained robust (P=0·002) while the relationship with the relative measure weakened (P=0·095). Greater exposure to supermarkets and fast-food outlets was associated with better diet only in the adjusted models (P=0·017 and P=0·014, respectively).

CONCLUSIONS

The results strengthen the argument for local authorities to increase the number of healthy food outlets to which young children are exposed.

Charting Availability of Processed and Unprocessed Foods in School Neighbourhood Nutrition Environments in an Urban Australian Setting

School Neighbourhood Nutrition Environments (SNNEs) can facilitate or impede healthy eating. This study describes the SNNEs surrounding 6 Good Start Program (GSP) schools in 5 suburbs in Logan, Queensland. Relative density of healthy and unhealthy food outlets was calculated for SNNEs surrounding GSP (6) and non-GSP (10) schools within the 5 suburbs. Relative accessibility of minimally processed and highly processed food and drink in SNNEs of the 6 GSP schools was determined using shelf measurements of snack foods. Unhealthy outlets greatly outnumber healthy outlets (mean relative density 15.6%, median 19.1%). The majority of outlets stock predominantly highly processed food and drink. Study areas are dominated by unhealthy food outlets and highly processed food.