Food and Beverage Availability in Small Food Stores Located in Healthy Food Financing Initiative Eligible Communities

Association of Food Desert Residency and Preterm Birth in the United States

INTRODUCTION

Food deserts are a major public health concern. Inadequate access to healthy food has been associated with poor nutrition and the development of dietary related chronic conditions.

OBJECTIVE

To determine the association between geographic access to nutritious food and preterm birth and whether gestational hypertension mediates this relationship.

METHODS

Food access data was retrieved from the U.S. Department of Agriculture Food Access Research Atlas (2019) and used to quantify the percentage of Census tracts within each county that were food deserts: low-income tracts with limited access to grocery stores, supermarkets, or other sources of healthy, nutritious foods. These data were merged with US birth records from 2018 to 2019 by using the maternal county of residence (n = 7,533,319). We fit crude and adjusted logistic regression models with generalized estimating equations to determine the association between living in a food desert and the odds of preterm birth. We conducted a secondary within-group analysis by stratifying the fully adjusted model by race for non-Hispanic White and non-Hispanic Black birthing people.

RESULTS

In the fully adjusted model, we found a dose-response relationship. As the prevalence of tract-level food deserts within counties increased, so did the likelihood of preterm birth (mid-range: odds ratio (OR) = 1.04, 95% confidence interval (C.I.) 1.01-1.07; high: OR = 1.07, 95% C.I. 1.03-1.11). Similar results were seen in the White-Black stratified models. However, a disparity remained as Black birthing people had the highest odds for preterm birth. Lastly, gestational hypertension appears to mediate the relationship between nutritious food access and preterm birth (natural indirect effect (NIE) = 1.01, 95% CI = 1.00, 1.01).

CONCLUSION

It is salient, particularly for Black birthing people who experience high rates of adverse birth outcomes, that the role of food desert residency be explored within maternal and child health disparities.

Linking Historical Discriminatory Housing Patterns to the Contemporary Alcohol Environment

Research on alcohol outlet density consistently shows greater disparities in exposure in disinvested communities. Likewise, structural racism via discriminatory housing practices has created many of the issues that beset contemporary disinvested neighborhoods. Little work, however, has examined the relationship between housing practices and alcohol outlet disparities. The central premise of our work is that these discriminatory and inequitable practices create distinctions in the alcohol environment, and that such disparities have implications for work on alcohol policy. Here we link alcohol outlet density with a spatial database examining redlining, blockbusting, and gentrification in Baltimore, Maryland, and Flint, Michigan (two cities with common experiences of urban disinvestment over the last 50 years). Standard measures are used to account for the impacts of neighborhood racial, socioeconomic, and housing composition in a multilevel model. Our findings highlight that gentrification and redlining are strongly associated with alcohol outlet density, while blockbusting is not. Gentrification and redlining also frequently co-occur in inner-urban areas, while the more suburban phenomenon of blockbusting rarely overlaps with either. These findings further contextualize nascent work on structural racism in housing that illustrates important disparities along the lines of these distinct practices. Future work should consider how legacy impacts of discriminatory housing patterns impact our communities today.

Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association

Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.

Community-Level Factors Associated With Geographic Access to Food Retailers Offering Nutrition Incentives in Chicago, Illinois

INTRODUCTION

Nutrition incentive programs provide low-income populations with a monetary resource to make healthy foods affordable and accessible. This study aimed to use geospatial analysis to evaluate availability of the Link Match nutrition incentive program in Chicago, Illinois, to determine whether underresourced communities have access.

METHODS

We obtained 2018 spatial data on census tract-level sociodemographic characteristics in Chicago. Fifty-seven retailers (eg, farmers markets, food cooperatives) offered Link Match across the city's 801 census tracts. We examined ordinary least squares and spatial lag regression models to identify census tract-level variables associated with distance (in miles) from the nearest Link Match retailer. Variables of interest included percentage of non-Hispanic Black residents, percentage of Hispanic residents, median household income, violent crime rate, per capita grocery store availability, and walkability.

RESULTS

Most Link Match retailers were located on Chicago's South and West sides. Ordinary least squares regression models indicated that low-income census tracts were on average closer to a Link Match retailer than higher-income tracts were (P < .001). Tracts in the highest quartile of violent crime were also significantly closer to a Link Match retailer than tracts in the lowest quartile (P < .001). After accounting for spatial dependency of census tracts, only violent crime rate was significantly associated with distance to nearest Link Match retailer.

CONCLUSION

Link Match retailers in Chicago appear to be in underresourced communities. However, these areas have high violent crime rates, which may negatively influence program use. Additional research is needed on how social and environmental factors influence availability and use of nutrition incentive programs.

Gastronomic Heritage of Făgăraș Land: A Worthwhile Sustainable Resource

The present study highlights the value of gastronomy and culinary practices in Făgăraș County as a dimension of the Intangible Cultural Heritage that can contribute to the sustainable development of the area. The field research carried out within an interdisciplinary project of the Transilvania University of Brașov pointed out the importance of the different “ciorbe” (sour soups) in the local gastronomy of Făgăraș County. Our groundwork found some traditional local soups and soup recipes. Starting from these results, the study stresses the opportunity to exploit this heritage resource through social entrepreneurship. To uphold this perspective, our study highlights that soups and sour soups are prepared with local ingredients, that women in the area are experienced and have the willingness to cook together. The tourist specificity of the area favors the creation of a local network between entrepreneurs from all over the country. The main contribution of the study derives from the fact that it presents arguments that show the generosity of gastronomy and culinary practices as a heritage resource, illustrating that a popular culinary product can grow and become a local brand.

Sustainable food systems and nutrition in the 21st century: a report from the 22nd annual Harvard Nutrition Obesity Symposium

Food systems are at the center of a brewing storm consisting of a rapidly changing climate, rising hunger and malnutrition, and significant social inequities. At the same time, there are vast opportunities to ensure that food systems produce healthy and safe food in equitable ways that promote environmental sustainability, especially if the world can come together at the UN Food Systems Summit in late 2021 and make strong and binding commitments toward food system transformation. The NIH-funded Nutrition Obesity Research Center at Harvard and the Harvard Medical School Division of Nutrition held their 22nd annual Harvard Nutrition Obesity Symposium entitled "Global Food Systems and Sustainable Nutrition in the 21st Century" in June 2021. This article presents a synthesis of this symposium and highlights the importance of food systems to addressing the burden of malnutrition and noncommunicable diseases, climate change, and the related economic and social inequities. Transformation of food systems is possible, and the nutrition and health communities have a significant role to play in this transformative process.

Food environment of the economic capital of the Northeast: social and territorial disparities in the availability of food stores

ABSTRACT Objective Characterize the community food environment through the different types of food outlets in the city of Fortaleza and associate their distribution according to sociodemographic indicators. Methods This is an ecological study carried out in the city of Fortaleza in which data from the Health Surveillance Service were used with the location of all licensed food stores in the city in the years 2018 and 2019. Georeferenced maps were set up to illustrate the spatial distribution of the establishments. Correlation analyses were performed to verify the association between food outlets and socioeconomic data. Values of p≤0.005 were considered significant. Results We identified a greater concentration of food stores in the neighborhoods with better socioeconomic levels. Snack bars (n=2051; 27.7%) and restaurants (n=1945; 26.3%), were in greater quantity and exhibited a positive correlation with the Human Development Index and average income. Supermarkets and hypermarkets (n=288; 3.9%) and street markets (n=81; 1.1%) were in a smaller number and had the worst spatial distribution. Conclusion We observed socioeconomic inequalities in the distribution of different types of food outlets. The little diversity and the limited number of establishments in peripheral neighborhoods, besides the centralization of outlets that sell food that is harmful to health, constitute obstacles for the population to make healthy food choices.

Examining changes to food and beverage availability and marketing in a low-income community after the opening of a new supermarket

OBJECTIVE

In 2016, a Whole Foods Market© opened in the Englewood community of Chicago, IL - a predominately low-income African American community. This study aimed to examine changes to food and beverage availability and marketing in Englewood's existing food stores after the opening of this supermarket.

DESIGN

Quasi-experimental study.

SETTING

Two low-income African American communities in Chicago, IL.

PARTICIPANTS

Fieldworkers audited all small grocery and limited service stores (e.g. convenience stores, liquor stores and dollar/discount stores) located within one-square mile of the new supermarket and a one-square mile area of a demographically comparable community that also lacked a supermarket. Stores were audited before (2016) and after (2017 and 2018) the supermarket opened.

RESULTS

Of the 78 stores audited at baseline, 71·8 % were limited service stores and 85·9 % accepted Supplemental Nutrition Assistance Program (SNAP) benefits. Overall, the availability of healthy food and beverage options in nearby small stores was low at baseline and both follow-up periods. Difference-in-difference regression models revealed a significant increase in: (1) the percentage of stores in the intervention community (i.e. Englewood) offering regular cheese and promoting salty snacks at check-out from 2016 to 2017; and (2) the percentage of stores in the comparison community with interior store promotions for other sweetened beverages from 2016 to 2018.

CONCLUSIONS

Minimal changes in food and beverage availability and marketing occurred 1 and 2 years after the opening of a new supermarket. However, the wide range of staple food items offered by the supermarket expanded healthy food retail in Chicago's Englewood community.

A rapid review of stocking and marketing practices used to sell sugar-sweetened beverages in U.S. food stores

Sugar-sweetened beverages (SSBs) are a primary source of added sugars in the American diet. Habitual SSB consumption is associated with obesity and noncommunicable disease and is one factor contributing to U.S. health disparities. Public health responses to address marketing-mix and choice-architecture (MMCA) strategies used to sell SSB products may be required. Thus, our goal was to identify original research about stocking and marketing practices used to sell SSB in U.S. food stores. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the World Health Organization (WHO) protocol for rapid reviewing. We searched six databases and Google Scholar using key terms focused on store type and SSB products. We characterized results using an MMCA framework with categories place, profile, portion, pricing, promotion, priming or prompting, and proximity. Our search resulted in the identification of 29 articles. Most results focused on profile (e.g., SSB availability) (n = 13), pricing (e.g., SSB prices or discounts) (n = 13), or promotion (e.g., SSB advertisements) (n = 13) strategies. We found some evidence of targeted MMCA practices toward at-risk consumers and differences by store format, such as increased SSB prominence among supermarkets. The potential for systematic variations in MMCA strategies used to sell SSB requires more research. We discuss implications for public health, health equity, and environmental sustainability.

A Model Depicting the Retail Food Environment and Customer Interactions: Components, Outcomes, and Future Directions

The retail food environment (RFE) has important implications for dietary intake and health, and dramatic changes in RFEs have been observed over the past few decades and years. Prior conceptual models of the RFE and its relationships with health and behavior have played an important role in guiding research; yet, the convergence of RFE changes and scientific advances in the field suggest the time is ripe to revisit this conceptualization. In this paper, we propose the Retail Food Environment and Customer Interaction Model to convey the evolving variety of factors and relationships that convene to influence food choice at the point of purchase. The model details specific components of the RFE, including business approaches, actors, sources, and the customer retail experience; describes individual, interpersonal, and household characteristics that affect customer purchasing; highlights the macro-level contexts (e.g., communities and nations) in which the RFE and customers behave; and addresses the wide-ranging outcomes produced by RFEs and customers, including: population health, food security, food justice, environmental sustainability, and business sustainability. We believe the proposed conceptualization helps to (1) provide broad implications for future research and (2) further highlight the need for transdisciplinary collaborations to ultimately improve a range of critical population outcomes.

Sugar-sweetened beverage prices: Variations by beverage, food store, and neighborhood characteristics, 2017

Sugar-sweetened beverage (SSB) consumption is associated with obesity, type 2 diabetes, and cardiovascular disease. A number of U.S. jurisdictions have levied volume-based specific SSB taxes. This study estimated baseline mean SSB prices across categories and sizes as this will help to determine the percentage increase in price resulting from the imposition of specific taxes. Data on food store SSB prices were collected in 2017 in Cook County, IL, St. Louis City/County, MO, Oakland, CA, and Sacramento, CA (N = 11,767 product-level observations from 581 stores). Data were weighted to represent volume sold by category and size. Mean prices per ounce were computed across categories and sizes. Linear regression models, clustered on store, were run to estimate associations between price per ounce and product characteristics, neighborhood (linked by census tract) characteristics, store type, and site. Weighted summary statistics show that the mean price of SSBs was 4.8 cents/oz. Soda was least expensive (3.4 cents/oz), followed by sports drinks (4.8 cents/oz), juice drinks (5.2 cents/oz), ready-to-drink tea/coffee (7.8 cents/oz), and energy drinks (19.9 cents/oz). Prices were higher for individual-sized (9.6 cents/oz) compared to family-sized drinks (>1 L/multi-pack; 3.5 cents/oz). Regression results revealed that prices were lower in stores in majority non-Hispanic black tracts and varied by beverage characteristics and store type but not tract-level socioeconomic status. Given substantial variation in prices by SSB category, a penny-per-ounce SSB tax, if fully passed through, would increase soda prices by 29% versus 5% for energy drinks, highlighting the potential importance of different specific tax rates across beverage categories.

Variation in the food environment of small and non-traditional stores across racial segregation and corporate status

OBJECTIVE

We examined differences in consumer-level characteristics and structural resources and capabilities of small and non-traditional food retailers (i.e. corner stores, gas-marts, pharmacies, dollar stores) by racial segregation of store neighbourhood and corporate status (corporate/franchise- v. independently owned).

DESIGN

Observational store assessments and manager surveys were used to examine availability-, affordability- and marketing-related characteristics experienced by consumers as well as store resources (e.g. access to distributors) and perceived capabilities for healthful changes (e.g. reduce pricing on healthy foods). Cross-sectional regression analyses of store and manager data based on neighbourhood segregation and store corporate status were conducted.

SETTING

Small and non-traditional food stores in Minneapolis and St. Paul, MN, USA.ParticipantsOne hundred and thirty-nine stores; seventy-eight managers.

RESULTS

Several consumer- and structural-level differences occurred by corporate status, independent of residential segregation. Compared with independently owned stores, corporate/franchise-owned stores were more likely to: not offer fresh produce; when offered, receive produce via direct delivery and charge higher prices; promote unhealthier consumer purchases; and have managers that perceived greater difficulty in making healthful changes (P≤0·05). Only two significant differences were identified by residential racial segregation. Stores in predominantly people of colour communities (&lt;30 % non-Hispanic White) had less availability of fresh fruit and less promotion of unhealthy impulse buys relative to stores in predominantly White communities (P≤0·05).

CONCLUSIONS

Corporate status appears to be a relevant determinant of the consumer-level food environment of small and non-traditional stores. Policies and interventions aimed at making these settings healthier may need to consider multiple social determinants to enable successful implementation.