Measurement of Nutrition Environments in Grocery Stores, Convenience Stores, and Restaurants in the Lower Mississippi Delta

Dietary contributions of food outlets by urbanization level in the US population aged 2 years and older-NHANES 2013-2018

BACKGROUND

Differences in food access, availability, affordability, and dietary intake are influenced by the food environment, which includes outlets where foods are obtained. These differences between food outlets within rural and urban food environments in the United States are not well understood.

OBJECTIVES

The aim of this analysis is to describe the contribution of foods and beverages from 6 outlets-grocery stores, convenience stores, full-service restaurants, quick-service restaurants, schools, and other outlets-to the total energy intake and Healthy Eating Index (HEI)-2015 scores in the United States population, by urbanization level (nonmetropolitan statistical areas [MSAs], small-to-medium MSAs, and large MSAs).

METHODS

Data from the National Health and Nutrition Examination Survey 2013-2018 were used. Dietary intake from one 24-h dietary recall was analyzed by the outlet where a food or beverage was obtained and by urbanization. Linear regression, adjusted for sex, age, race and Hispanic origin, and family income, was used to predict the contribution of each food outlet to the total energy intake and HEI-2015 total and component scores by urbanization level.

RESULTS

During 2013-2018, foods and beverages from grocery stores and quick-service and full-service restaurants contributed to 62.1%, 15.1%, and 8.5% of the energy intake, respectively. The percentage of energy intake from full- and quick-service restaurants increased with increasing urbanization level. HEI-2015 total scores increased with the increasing urbanization level overall (48.1 non-MSAs, 49.2 small-to-medium MSAs, and 51.3 large MSAs) for grocery stores (46.7 non-MSAs, 48.0 small-to-medium MSAs, and 50.6 large MSAs) and for quick-service restaurants (35.8 non-MSAs, 36.3 small-to-medium MSAs, and 37.5 large MSAs).

CONCLUSIONS

Grocery stores and restaurants were the largest contributors of energy intake in urban and rural areas. Diet quality improved with increasing urbanization overall and for grocery stores and quick-service restaurants.

Nutrition and Health Programming and Outreach in Grocery Retail Settings: A Community Coalition in Action

Grocery stores can provide a conducive environment for interventions targeting healthy eating and access to health services, particularly in low-income communities. A wide array of organizations deliver nutrition and related programs in community settings, but rarely in a coordinated fashion. Collaboration of local health promotion organizations with grocery stores could increase consumers' access to and selection of healthy foods and related services. This evaluation of the In-Store Programming and Outreach Coalition (IPOC) uses thematic analysis of first-person accounts from coalition members. To our knowledge, this is the first study of such a coalition. We present perspectives from six stakeholders about the IPOC strengths, challenges, and recommendations for strengthening the delivery of in-store interventions. Themes identified include partnership, increased client reach and cross-referrals, conflicting work schedules, leadership, and recommendations to identify coalition leaders and expand services to other grocery stores. We conclude that grocery stores can offer a suitable setting for programming and community outreach through coalitions.

Food Away from Home Frequency, Diet Quality, and Health: Cross-Sectional Analysis of NHANES Data 2011-2018

The consumption of meals prepared away from home (FAFH) in the U.S. has been commonly linked to overall poorer diet quality; however, less is known about the relationship with health parameters. The aim of this cross-sectional study was to assess the diet quality and health parameters of adults who reported the frequency of obtaining or eating FAFH using a combination of four 2-year cycles of National Health and Nutrition Examination Survey (NHANES, 2011−2018) data. Data from 14,999 adults aged 20 to 65 years were used to examine the associations between diet and health outcomes and the weekly frequency of FAFH. Multivariable regression models were used to compare Healthy Eating Index-2015 (HEI-2015) scores by FAFH frequency, adjusting for sociodemographic variables. Adults with more frequent FAFH meals were more likely to be younger, male, lower-income, and unmarried. Total HEI-2015 scores and component scores for greens and beans, total and whole fruits, whole grains, saturated fats, and added sugars were significantly lower in those consuming >2 FAFH meals/week vs. ≤2 FAFH meals/week. BMI and waist circumference tended to be higher for women having more frequent FAFH meals. More frequent FAFH meals among adults were associated with poorer diet quality and weight outcomes, building on results from earlier studies.

An Indicator Measuring the Influence of the Online Public Food Environment: An Analytical Framework and Case Study

The online public food environment (OPFE) has had a considerable impact on people's lifestyles over the past decade; however, research on its exposure is sparse. The results of the existing research on the impact of the food environment on human health are inconsistent. In response to the lack of food elements in the definition of the food environment and the lack of a clear method to assess the health attributes and the impact degree of the food environment, we proposed a new analytical framework based on the latest disease burden research, combining the characteristics of China's current food environment, from the perspective of environmental science. We redefined the food environment and proposed that food and its physical space are two core elements of the food environment. Accordingly, we extracted four domains of characteristics to describe the basic components of the food environment. Using the sales records, we designed an approach by referring to the standard process of environmental health indicators, including the health attributes and the impact degree of the food environment, to measure the OPFE of takeaway food outlets. Further, we conducted a case study and extracted three domains of characteristics for more than 18,000 effective takeaway meals from 812 takeaway food outlets located in 10 administrative subdivisions in the Haidian District and Xicheng District of Beijing Municipality. The results showed that more than 60% of single meals sold by takeaway food outlets were considered as healthy, and only 15% of takeaway food outlets sold healthy meals exclusively. Additionally, there were significant differences in health effects among different types of food environments, and high-risk areas of different types of food environments can be spatially identified. Compared with the counting method in the availability of food environment, the proposed new approach can depict food environment characteristics not only in the macro-scale like the counting method but also in the meal-scale. The indicators could be useful for large-scale and long-term monitoring of food environmental changes due to their simple calculation and design depending on the food delivery platform.

What is the availability, affordability, and quality of foods and beverages aligned with dietary guidance in Louisiana Supplemental Nutrition Assistance Program (SNAP) authorized stores?

Healthy food retail strategies are delivered by Cooperative Extension Services in Louisiana to improve public health among communities with lower income. To guide Cooperative Extension Services Programming, the aim of this study was to assess healthy food access among SNAP-authorized stores. This included comparing the availability, affordability, and quality of healthy foods sold in these stores by geography, ownership, and store type. Seventy-five Louisiana SNAP-authorized stores were selected for measurement. Between October 2019 and March 2020 (prior to the COVID-19 national emergency declaration), trained researchers used the Nutrition Environment Measures Survey in Stores (NEMS-S) to assess the availability, affordability, and quality of healthy versus less healthy foods and beverages in 42 SNAP-authorized stores, including: grocery (n = 12, 29%), convenience (n = 17, 41%), drug (n = 1, 2%), dollar (n = 11, 26%), and butcher/meat (n = 1, 2%). Multivariate analysis of variance (a priori, p < 0.05) determined if differences in total NEMS-S scores or subscores existed by geography (urban versus rural), ownership (corporate/chain versus independent), or store type. No urban/rural differences were identified. Corporate/chain SNAP-authorized stores scored higher on average than independent SNAP-authorized stores for the total NEMS-S score (17.2 versus 8.1; p = 0.009) and availability subscore (13.1 versus 6.1; p = 0.02). SNAP-authorized grocery stores scored higher than all other store types (total NEMS-S score 27.6), followed by SNAP-authorized dollar stores (total NEMS-S score 10.7), and SNAP-authorized convenience stores (total NEMS-S score 5) (p < 0.001). Louisiana Cooperative Extension Services should explore ways to scale healthy food retail strategies statewide with a specific emphasis on independent and smaller SNAP-authorized retailers.

A Mixed Methods Case Study of Food Shopping in a Community with High Infant Mortality

In the U.S., preterm birth disproportionately impacts certain racial/ethnic groups, with Black women experiencing preterm birth at a rate 50% higher than other groups. Among the numerous factors that likely contribute to these increased rates are neighborhood characteristics, such as food environment. In this mixed-methods case study, we evaluated how pregnant women living in a predominately minority, lower income community with high preterm birth rates navigate and perceive their food environment. Qualitative interviews were performed to assess perceptions of food environment (n = 7) along with geographic and observational assessments of their food environment. Participants traveled an average of 2.10 miles (SD = 1.16) and shopped at an average of 3 stores. They emphasized the importance of pricing and convenience when considering where to shop and asserted that they sought out healthier foods they thought would enhance their pregnancy health. Observational assessments of stores' nutrition environment showed that stores with lower nutritional scores were in neighborhoods with greater poverty and a higher percent Black population. Future policies and programmatic efforts should focus on improving nutrition during pregnancy for women living in communities with high rates of poor birth outcomes. Availability, affordability, and accessibility are key aspects of the food environment to consider when attempting to achieve birth equity.

Community-Based Efforts Aim to Improve the Food Environment within a Highly Obese Rural Appalachian County

Rural communities in Appalachia are displaying increased obesity prevalence, yet traditional interventions have not provided a broad enough impact to improve dietary consumption patterns. Therefore, expanding efforts that address the food environment and incorporate behavioral nudges through community-developed marketing strategies may be a viable mechanism to improve food and beverage choices within this unique population. This study installed shelf-wobblers across n = 5 gas stations in one rural Appalachian county in Kentucky. Smart Snacks were identified from store inventory lists utilizing the CDC Food Service Guideline for Federal Facilities calculator and were categorized into high-protein snacks, low-fat carbohydrate snacks, meal replacement snacks, and no-calorie beverages. NEMS-CS audits were conducted, and monthly sales data was collected at baseline and for six months thereafter for each store location. A difference-in-difference model was used, adjusting for total sales or total mean sales for each Smart Snack model to assess the percentage change within and between stores. Overall, percent change in mean sales and total sales across all stores resulted in a percentage increase of sales of Smart Snack items following wobbler installment. This study provides unique insight into how a community-driven approach to marketing can influence the sale of healthier food and beverage items.

Three datasets for nutrition environment measures of food outlets located in the Lower Mississippi Delta region of the United States

This data note provides details of a research database containing 266 food outlets located in five rural towns in the Lower Mississippi Delta region of Mississippi, whose nutrition environments were measured from 2016 to 2018.  The food outlet types include grocery stores, convenience stores, full-service restaurants, and fast food restaurants.  The purpose of this publication is to describe the three datasets for external researchers who may be interested in making use of them.  The datasets are available from the USDA National Agricultural Library’s Ag Data Commons under a CC0 1.0 Universal License: https://doi.org/10.15482/USDA.ADC/1503704.

Rural SNAP Participants and Food Insecurity: How Can Communities Leverage Resources to Meet the Growing Food Insecurity Status of Rural and Low-Income Residents?

The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n = 152), most reported an annual household income less than USD 20,000 (n = 90, 60.4%), 29.1% reported food insecurity, and 39.5% reported receiving SNAP benefits within the last month. The overall mean FV intake was 3.46 daily servings (95% CI: 3.06–3.91) among all participants. SNAP participation was associated with food insecurity (p = 0.007) and those participating in SNAP were two times more likely to report being food insecure (OR = 2.707, 95% CI: 1.317, 5.563), relative to non-participants. These findings further depict the need for intervention, as the burden of food insecurity persists. Tailoring health-promoting initiatives to consider rurality and SNAP participation is vital for sustainable success among these populations.

Food Environment in the Lower Mississippi Delta: Food Deserts, Food Swamps and Hot Spots

The objectives for this study were to examine the location and density of measured food outlets in five rural towns in the Lower Mississippi Delta, determine the spatial location of Delta Healthy Sprouts (DHS) participants' homes in the food environment, and examine relationships between the spatial location of participants' homes and their diet quality. Using a food desert/food swamp framework, food outlet geographic locations were analyzed in relation to one another, the distance between DHS participants' residence and closest food outlets by class were computed, and associations among residents' diet quality, hot spot status, and census tract classification were explored. Of 266 food outlets identified, 11 (4%), 86 (32%), 50 (19%), and 119 (45%) were classified as grocery stores (GS), convenience stores (CS), full-service restaurants (FS), or fast food restaurants (FF), respectively. A third of participants lived in CS hot spots, while 22% lived in FF hot spots. DHS participants lived closer in miles to CS (0.4) and FF (0.5) as compared to GS (1.6) and FS (1.1) outlets. Participants bought most groceries at national chain grocery stores rather than their closest grocery store. The food environments of the five towns and associated neighborhoods in which DHS participants resided were not supportive of healthful eating, containing both food deserts and food swamps, often in overlapping patterns.