Obesity and economic environments

This review summarizes current understanding of economic factors during the obesity epidemic and dispels some widely held, but incorrect, beliefs. Rising obesity rates coincided with increases in leisure time (rather than increased work hours), increased fruit and vegetable availability (rather than a decline in healthier foods), and increased exercise uptake. As a share of disposable income, Americans now have the cheapest food available in history, which fueled the obesity epidemic. Weight gain was surprisingly similar across sociodemographic groups or geographic areas, rather than specific to some groups (at every point in time; however, there are clear disparities). It suggests that if one wants to understand the role of the environment in the obesity epidemic, one needs to understand changes over time affecting all groups, not differences between subgroups at a given time. Although economic and technological changes in the environment drove the obesity epidemic, the evidence for effective economic policies to prevent obesity remains limited. Taxes on foods with low nutritional value could nudge behavior toward healthier diets, as could subsidies/discounts for healthier foods. However, even a large price change for healthy foods could close only part of the gap between dietary guidelines and actual food consumption. Political support has been lacking for even moderate price interventions in the United States and this may continue until the role of environmental factors is accepted more widely. As opinion leaders, clinicians play an important role in shaping the understanding of the causes of obesity.

Do we produce enough fruits and vegetables to meet global health need?

BACKGROUND

Low fruit and vegetable (FV) intake is a leading risk factor for chronic disease globally, but much of the world's population does not consume the recommended servings of FV daily. It remains unknown whether global supply of FV is sufficient to meet current and growing population needs. We sought to determine whether supply of FV is sufficient to meet current and growing population needs, globally and in individual countries.

METHODS AND FINDINGS

We used global data on agricultural production and population size to compare supply of FV in 2009 with population need, globally and in individual countries. We found that the global supply of FV falls, on average, 22% short of population need according to nutrition recommendations (supply:need ratio: 0.78 [Range: 0.05-2.01]). This ratio varies widely by country income level, with a median supply:need ratio of 0.42 and 1.02 in low-income and high-income countries, respectively. A sensitivity analysis accounting for need-side food wastage showed similar insufficiency, to a slightly greater extent (global supply:need ratio: 0.66, varying from 0.37 [low-income countries] to 0.77 [high-income countries]). Using agricultural production and population projections, we also estimated supply and need for FV for 2025 and 2050. Assuming medium fertility and projected growth in agricultural production, the global supply:need ratio for FV increases slightly to 0.81 by 2025 and to 0.88 by 2050, with similar patterns seen across country income levels. In a sensitivity analysis assuming no change from current levels of FV production, the global supply:need ratio for FV decreases to 0.66 by 2025 and to 0.57 by 2050.

CONCLUSION

The global nutrition and agricultural communities need to find innovative ways to increase FV production and consumption to meet population health needs, particularly in low-income countries.

Quantitative analysis of neonicotinoid insecticide residues in foods: implication for dietary exposures

This study quantitatively measured neonicotinoids in various foods that are common to human consumption. All fruit and vegetable samples (except nectarine and tomato) and 90% of honey samples were detected positive for at least one neonicotinoid; 72% of fruits, 45% of vegetables, and 50% of honey samples contained at least two different neonicotinoids in one sample, with imidacloprid having the highest detection rate among all samples. All pollen samples from New Zealand contained multiple neonicotinoids, and five of seven pollens from Massachusetts detected positive for imidacloprid. These results show the prevalence of low-level neonicotinoid residues in fruits, vegetables, and honey that are readily available in the market for human consumption and in the environment where honeybees forage. In light of new reports of toxicological effects in mammals, the results strengthen the importance of assessing dietary neonicotinoid intakes and the potential human health effects.

Comparing farmers' market revenue trends before and after the implementation of a monetary incentive for recipients of food assistance

INTRODUCTION

We examined the influence of an intervention to increase fruit and vegetable purchases at farmers' markets for recipients of food assistance, Shop N Save (SNS), on revenue trends at a farmers' market located at a federally qualified health center (FQHC) in rural South Carolina. We compared revenue trends for 20 weeks before the intervention (2011) and 20 weeks after (2012).

METHODS

SNS provided one $5 monetary incentive per week to customers spending $5 or more in food assistance at the farmers' market. SNS was available to any farmers' market customer using Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and/or Senior or WIC Farmers' Market Nutrition Program (FMNP) vouchers. Sales receipts were recorded for each transaction at the farmers' market to document payment type and the cost of the purchase. All SNS participants completed a one-time enrollment survey.

RESULTS

A total of 336 customers self-enrolled in SNS from June through October 2012. Most SNS participants were female, African American, and patients at the FQHC. In total, the use of all forms of food assistance (SNAP, WIC, and FMNP) at the farmers' market increased significantly after the intervention (from 10% before, to 25% after, P = .003). Senior FMNP vouchers and SNAP usage increased the most.

CONCLUSION

Interventions that provide incentives to recipients of food assistance programs at farmers' markets are a viable strategy for increasing food assistance usage and revenue.

Food expenditure patterns in the Canadian Arctic show cause for concern for obesity and chronic disease

BACKGROUND

Little is understood about the economic factors that have influenced the nutrition transition from traditional to store-bought foods that are typically high in fat and sugar amongst people living in the Canadian Arctic. This study aims to determine the pattern of household food expenditure in the Canadian Arctic.

METHOD

Local food prices were collected over 12 months in six communities in Nunavut and the Northwest Territories. Dietary intake data were collected from 441 adults using a validated quantitative food frequency questionnaire. Money spent on six food groups was calculated along with the cost of energy and selected nutrients per person.

RESULTS

Participants spent approximately 10% of total food expenditure on each of the food groups of fruit/vegetables, grains and potatoes, and dairy, 17% on traditional meats (e.g. caribou, goose, char, and seal liver), and 20% on non-traditional meats (e.g. beef, pork, chicken, fish, and processed meats). Non-nutrient-dense foods (NNDF) accounted for 34% of food expenditure. Younger participants (<30 years) spent more on NNDF and less on traditional meats compared with the older age groups. Participants with higher levels of formal education spent more on fruit and vegetables and less on traditional meats, when compared with participants with lower levels of formal education.

CONCLUSIONS

Participants spent most household income on NNDF, a possible consequence of generation discrepancy between younger and older participants. The tendency toward NNDF, particularly among youth, should be addressed with an assessment of predictive factors and the development of targeted approaches to population-based interventions.

Obtaining fruit and vegetables for the lowest prices: pricing survey of different outlets and geographical analysis of competition effects

Aims

Inadequate fruit and vegetable (F&V) consumption is an important dietary risk factor for disease internationally. High F&V prices can be a barrier to dietary intake and so to improve understanding of this topic we surveyed prices and potential competition between F&V outlet types.

Methods

Over a three week early autumn period in 2013, prices were collected bi-weekly for 18 commonly purchased F&Vs from farmers' markets (FM) selling local produce (n = 3), other F&V markets (OFVM) (n = 5), supermarkets that neighbored markets (n = 8), and more distant supermarkets (n = 8), (in urban Wellington and Christchurch areas of New Zealand). Prices from an online supermarket were also collected.

Results

A total of 3120 prices were collected. Most F&Vs (13/18) were significantly cheaper at OFVMs than supermarkets. Over half of the F&Vs (10/18) were significantly cheaper at nearby compared to distant supermarkets, providing evidence of a moderate ‘halo effect’ in price reductions in supermarkets that neighbored markets. Weekend (vs midweek) prices were also significantly cheaper at nearby (vs distant) supermarkets, supporting evidence for a ‘halo effect’.

Ideal weekly ‘food basket’ prices for a two adult, two child family were: OFVMs (NZ$76), online supermarket ($113), nearby supermarkets ($124), distant supermarkets ($127), and FMs ($138). This represents a savings of $49 per week (US$26) by using OFVMs relative to (non-online) supermarkets. Similarly, a shift from non-online supermarkets to the online supermarket would generate a $13 saving.

Conclusions

In these locations general markets appear to be providing some substantially lower prices for fruit and vegetables than supermarkets. They also appear to be depressing prices in neighboring supermarkets. These results, when supplemented by other needed research, may help inform the case for interventions to improve access to fruit and vegetables, particularly for low-income populations.

Impact of the revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package policy on fruit and vegetable prices

Obesity is generally inversely related to income among women in the United States. Less access to healthy foods is one way lower income can influence dietary behaviors and body weight. Federal food assistance programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), are an important source of healthy food for low-income populations. In 2009, as part of a nationwide policy revision, WIC added a fruit and vegetable (F/V) voucher to WIC food packages. This quasi-experimental study determined whether F/V prices at stores authorized to accept WIC (ie, WIC vendors) decreased after the policy revision in seven Illinois counties. It also examined cross-sectional F/V price variations by store type and neighborhood characteristics. Two pre-policy observations were conducted in 2008 and 2009; one post-policy observation was conducted in 2010. Small pre- to post-policy reductions in some F/V prices were found, particularly for canned fruit and frozen vegetables at small stores. Compared with chain supermarkets, mass merchandise stores had lower prices for fresh F/V and frozen F/V and small stores and non-chain supermarkets had higher canned and frozen F/V prices, but lower fresh F/V prices. Limited price differences were found across neighborhoods, although canned vegetables were more expensive in neighborhoods with higher concentrations of either Hispanics or blacks and fresh F/V prices were lower in neighborhoods with more Hispanics. Results suggest the WIC policy revision contributed to modest reductions in F/V prices. WIC participants' purchasing power can differ depending on the type and neighborhood of the WIC vendor used.

Evaluation of the microbiological quality of conventional and organic leafy greens at the time of purchase from retail markets in Alexandria, Egypt

This is a pioneer study in Egypt that provides some assessment of the microbiological quality of conventional and organic leafy green vegetables that constitute an essential component of the Egyptians' daily diet. A total of 380 samples of unpackaged whole conventional and 84 packaged whole organic leafy greens were collected from retail markets in Alexandria, and analyzed for total aerobic mesophilic count (AMC) and total E. coli count (ECC) using the standard spread plate method. Mean AMC values for organic samples were statistically less (p < 0.05) than those of the corresponding conventional samples. Conventional radish and organic parsley samples had the highest AMC of 7.17 and 7.68 log CFU/g respectively, while conventional green cabbage and organic basil had the lowest AMC of 3.63 and 3.23 log CFU/g respectively. The presence of E. coli in 100% of the studied leafy greens was indicative of potential fecal contamination, in view of open and unhygienic environmental and unsanitary handling conditions, as leafy green items are available for sale by street-vendors. Unsatisfactory AMC and ECC levels encountered in the studied samples, warrant future investigations to determine the potential prevalence of foodborne pathogens, and to identify sources of dominating microorganisms, which could make a contribution to the field of food safety

Examining the Influence of price and accessibility on willingness to shop at farmers' markets among low-income eastern North Carolina women

OBJECTIVE

To examine the influence of farmers' market pricing and accessibility on willingness to shop at farmers' markets, among low-income women.

DESIGN

Qualitative interviews using scenarios with quantitative assessment of willingness to shop at farmers' markets given certain pricing and accessibility scenarios.

SETTING

Eastern North Carolina.

PARTICIPANTS

A total of 37 low-income women of childbearing age (18-44 years) receiving family planning services at the health department.

PHENOMENON OF INTEREST

Willingness to shop at a farmers' market.

ANALYSIS

Fisher's exact test was used to examine associations between willingness to shop at farmers' markets by urban/rural residence, race, and employment status. Direct quotations relevant to participants' use of farmers' markets were extracted based on a positive deviance framework.

RESULTS

Participants were increasingly willing to shop at the farmers' market when price savings increased and when the market was incrementally closer to their residence. Willingness was highest when there was at least a 20% price savings. Participants seemed to be influenced more by a visual representation of a greater quantity of produce received with the price savings rather than a quantitative representation of the money saved by the reduced price.

CONCLUSIONS AND IMPLICATIONS

Future farmers' market interventions should take into account these consumer level preferences.

Supermarket discounts of low-energy density foods: effects on purchasing, food intake, and body weight

OBJECTIVE

To assess the effects of a 50% discount on low-energy density (ED) fruits and vegetables (F&V), bottled water, and diet sodas on shoppers' purchasing, food intake, and body weight.

DESIGN AND METHODS

A randomized, controlled trial was conducted at two Manhattan supermarkets, in which a 4-week baseline period (no discounts) preceded an 8-week intervention period (50% discount), and a 4-week follow-up period (no discounts). Twenty-four hour dietary recall, as well as body weight and body composition measures were obtained every 4 weeks. Participants (n = 47, 33f; 14m) were overweight and obese (BMI ≥ 25) shoppers.

RESULTS

Purchasing of F&V during intervention was greater in the discount group than in the control group (P < 0.0001). Purchasing of these items by the discount group relative to the control group during follow-up was reduced from intervention (P = 0.002), but still remained higher than during baseline (P = 0.01), indicating a partially sustained effect. Intake of F&V increased from baseline to intervention in the discount group relative to the control group (P = 0.037) and was sustained during follow-up. Body weight change did not differ significantly between groups, although post hoc analysis indicated a change within the discount group (-1.1 kg, P = 0.006) but not within the control group.

CONCLUSIONS

Discounts of low-ED F&V led to increased purchasing and intake of those foods.

Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments

OBJECTIVE

To systematically review evidence from field interventions on the effectiveness of monetary subsidies in promoting healthier food purchases and consumption.

DESIGN

Keyword and reference searches were conducted in five electronic databases: Cochrane Library, EconLit, MEDLINE, PsycINFO and Web of Science. Studies were included based on the following criteria: (i) intervention: field experiments; (ii) population: adolescents 12–17 years old or adults 18 years and older; (iii) design: randomized controlled trials, cohort studies or pre–post studies; (iv) subsidy: price discounts or vouchers for healthier foods; (v) outcome: food purchases or consumption; (vi) period: 1990–2012; and (vii) language: English. Twenty-four articles on twenty distinct experiments were included with study quality assessed using predefined methodological criteria.

SETTING

Interventions were conducted in seven countries: the USA (n 14), Canada (n 1), France (n 1), Germany (n 1), Netherlands (n 1), South Africa (n 1) and the UK (n 1). Subsidies applied to different types of foods such as fruits, vegetables and low-fat snacks sold in supermarkets, cafeterias, vending machines, farmers’ markets or restaurants.

SUBJECTS

Interventions enrolled various population subgroups such as school/ university students, metropolitan transit workers and low-income women.

RESULTS

All but one study found subsidies on healthier foods to significantly increase the purchase and consumption of promoted products. Study limitations include small and convenience samples, short intervention and follow-up duration, and lack of cost-effectiveness and overall diet assessment.

CONCLUSIONS

Subsidizing healthier foods tends to be effective in modifying dietary behaviour. Future studies should examine its long-term effectiveness and cost-effectiveness at the population level and its impact on overall diet intake.

A farmers' market at a federally qualified health center improves fruit and vegetable intake among low-income diabetics

OBJECTIVE

A 22-week federally qualified health center (FQHC)-based farmers' market (FM) and personal financial incentive intervention designed to improve access to and consumption of fruits and vegetables (FVs) among low-income diabetics in rural South Carolina was evaluated.

METHODS

A mixed methods, one-group, repeated-measures design was used. Data were collected in 2011 before (May/June), during (August), and after (November) the intervention with 41 diabetes patients from the FQHC. FV consumption was assessed using a validated National Cancer Institute FV screener modified to include FV sold at the FM. Sales receipts were recorded for all FM transactions. A mixed-model, repeated measures analysis of variance was used to assess intervention effects on FV consumption. Predictors of changes in FV consumption were examined using logistic regression.

RESULTS

A marginally significant (p=0.07) average increase of 1.6 servings of total FV consumption per day occurred. The odds of achieving significant improvements in FV consumption increased for diabetics using financial incentives for payment at the FM (OR: 38.8, 95% CI: 3.4-449.6) and for those frequenting the FM more often (OR: 2.1, 95% CI: 1.1-4.0).

CONCLUSIONS

Results reveal a dose-response relationship between the intervention and FV improvements and emphasize the importance of addressing economic barriers to food access.

Fresh fruit and vegetable purchases in an urban supermarket by low-income households

OBJECTIVE

To investigate the predictors of fresh fruit and vegetable purchases in a low-income population and identify subgroups in which interventions to increase such purchases might prove useful.

METHODS

Retrospective analysis of 209 shopping transactions from 30 households. Individual and household characteristics obtained from primary shopper. Data collected covered April 1-June 30, 2010. Primary outcome was number of servings of fresh produce purchased per week. Bivariate and multivariable analyses were conducted.

RESULTS

Controlling for household size, the average number of servings of fresh produce per week was higher in families with more children (P = .008) and in families with a wider age range of children (P = .04).

CONCLUSIONS AND IMPLICATIONS

Households with more children purchased more fresh produce. Purchase data combined with shopper household characteristics helped to distinguish relatively high from low purchasers of fresh produce among low-income families.

Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes

Taxes and subsidies are increasingly being considered as potential policy instruments to incentivize consumers to improve their food and beverage consumption patterns and related health outcomes. This study provided a systematic review of recent U.S. studies on the price elasticity of demand for sugar-sweetened beverages (SSBs), fast food, and fruits and vegetables, as well as the direct associations of prices/taxes with body weight outcomes. Based on the recent literature, the price elasticity of demand for SSBs, fast food, fruits and vegetables was estimated to be -1.21, -0.52, -0.49 and -0.48, respectively. The studies that linked soda taxes to weight outcomes showed minimal impacts on weight; however, they were based on existing state-level sales taxes that were relatively low. Higher fast-food prices were associated with lower weight outcomes particularly among adolescents, suggesting that raising prices would potentially impact weight outcomes. Lower fruit and vegetable prices were generally found to be associated with lower body weight outcomes among both low-income children and adults, suggesting that subsidies that would reduce the cost of fruits and vegetables for lower-socioeconomic populations may be effective in reducing obesity. Pricing instruments should continue to be considered and evaluated as potential policy instruments to address public health risks.

Household income disparities in fruit and vegetable consumption by state and territory: results of the 2009 Behavioral Risk Factor Surveillance System

Few studies take into account the influence of family size on household resources when assessing income disparities in fruit and vegetable (F/V) consumption. Poverty income ratio (PIR) is a measure that utilizes both reported income and household size. We sought to examine state-specific disparities in meeting Healthy People 2010 objectives for F/V consumption by percent PIR. This analysis included 353,005 adults in 54 states and territories reporting data to the 2009 Behavioral Risk Factor Surveillance System in the United States. Percent PIR was calculated using the midpoint of self-reported income range and family size. The prevalences consuming at least two fruits and at least three vegetables per day were examined by percent PIR (<130% [greatest poverty], 130% to <200%, 200% to <400%, and ≥ 400% [least poverty]). The percent of adults consuming vegetables at least three times daily was significantly lower (21.3%) among those living at greatest poverty (<130% PIR) compared with 30.7% among those with least poverty (≥ 400% PIR). Daily consumption of vegetables at least three times was significantly lower among those with greatest poverty in a majority of states and territories surveyed (43 of 54). The overall percent of adults consuming fruits at least 2 times daily was also lower among those living at greatest vs least poverty, but the difference was smaller (32.0% vs 34.2%), with 14 states reporting a difference that was significantly lower among those with greatest poverty. Our study revealed that in 2009 a significantly lower proportion of US adults living at greatest poverty consumed fruits at least two times daily or vegetables at least three times daily compared with those with the least poverty, with greater disparity in vegetable intake. Policy and environmental strategies for increased affordability, access, availability, and point-of-decision information are approaches that may help disparate households purchase and consume F/V.

Fruit and vegetable purchasing patterns and preferences in South Delhi

This study examines associations between consumer characteristics, beliefs, and preferences and fruit and vegetable (FV) purchasing and intake in South Delhi, India. Home interviews were conducted with 245 households, using a structured questionnaire to assess FV consumption and purchasing frequency, spending, place of purchase, mode of travel, knowledge and attitudes toward organics, and beliefs about barriers to FV consumption. In-depth interviews with 62 experts and key informants validated survey findings that street vendors and markets are currently the dominant source of FV in South Delhi and that affordability, not accessibility, is the main barrier to increasing FV intake.

Promoting healthy food consumption: a review of state-level policies to improve access to fruits and vegetables

Research indicates poor nutrition is a leading determinant of the development of chronic disease, and increasing fruit and vegetable consumption is one method for decreasing obesity. Many policies have focused on increasing the demand for fruits and vegetables through price reductions and coupons. However, without ensuring a stable supply, increased demand can continue to raise prices, crowding out individuals who may otherwise have purchased fruits and vegetables and ultimately leading to continued disparities in access. This paper presents a review of selected state-level policy options recently proposed or implemented in states across the United States, and provides an evidence-based lens through which food access policy can be shaped in the Midwest. This review and potential framework uses Wisconsin to illustrate the feasibility of different state-level decisions and their potential impact on particular populations. Future supply-side policies to consider include expanding Electronic Benefit Transfer to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC),program and farmers markets, incentivizing the purchase of locally grown produce, assisting local specialty farmers directly, and/or establishing a state-level food policy council. This review reveals that a food policy council would create a more sustainable policy analysis process to better ensure future policy adoption is truly comprehensive, encompassing the production, distribution and purchase of locally grown fruits and vegetables.

The Change4Life convenience store programme to increase retail access to fresh fruit and vegetables: a mixed methods process evaluation

BACKGROUND

Consumption of fruit and vegetables is important for health, but is often lower than recommended and tends to be socio-economically patterned with lower consumption in more deprived groups. In 2008, the English Department of Health introduced the Change4Life convenience store programme. This aimed to increase retail access to fresh fruit and vegetables in deprived, urban areas by providing existing convenience stores with a range of support and branded point-of-sale materials and equipment.

METHODS

We undertook a mixed-methods study of the Change4Life convenience store programme in the North East of England around two years after initial implementation. Store mapping (n = 87; 100% stores) and systematic in-store observations (n = 74; 85% stores) provided information on intervention fidelity; the variety, purchase price and quality of fresh fruit and vegetables on sale; and purchase price compared to a major supermarket. Ten qualitative interviews with a purposive sample of retailers and other professionals explored experiences of the intervention and provided further insight on quantitative results.

RESULTS

Intervention stores were primarily located in socio-economically disadvantaged areas. Fidelity, in terms of presence of branded materials and equipment, was low and much was not being used as intended. Fresh fruit and vegetables on sale were of high quality and had a purchase price around 10% more than comparable products at a major supermarket. Interviewees were supportive of the health improvement aim of the intervention. Retailers were appreciative of part-funding for chill cabinets and free point-of-sale materials. The intervention suffered from: poor initial and on-going communication between the intervention delivery team and retailers; poor availability of replacement point-of-sale materials; and failure to cement intended links with health workers and community organisations.

CONCLUSIONS

Overall, intervention fidelity was low and the intervention is unlikely to have had a substantial or long-term effect on customers' consumption of fruit and vegetables.

Pesticide residues in imported, organic, and "suspect" fruits and vegetables

Consumers are frequently urged to avoid imported foods as well as specific fruits and vegetables due to health concerns from pesticide residues and are often encouraged to choose organic fruits and vegetables rather than conventional forms. Studies have demonstrated that while organic fruits and vegetables have lower levels of pesticide residues than do conventional fruits and vegetables, pesticide residues are still frequently detected on organic fruits and vegetables; typical dietary consumer exposure to pesticide residues from conventional fruits and vegetables does not appear to be of health significance. Similarly, research does not demonstrate that imported fruits and vegetables pose greater risks from pesticide residues than do domestic fruits and vegetables or that specific fruits and vegetables singled out as being the most highly contaminated by pesticides should be avoided in their conventional forms.

Use of vendedores (mobile food vendors), pulgas (flea markets), and vecinos o amigos (neighbors or friends) as alternative sources of food for purchase among Mexican-origin households in Texas border colonias

There is a paucity of studies acknowledging the existence of alternative food sources, and factors associated with food purchasing from three common alternative sources: vendedores (mobile food vendors), pulgas (flea markets), and vecinos/amigos (neighbors/friends). This analysis aims to examine the use of alternative food sources by Mexican-origin women from Texas-border colonias and determine factors associated with their use. The design was cross-sectional. Promotora-researchers (promotoras de salud trained in research methods) recruited 610 Mexican-origin women from 44 colonias and conducted in-person surveys. Surveys included participant characteristics and measures of food environment use and household food security. Statistical analyses included separate logistic regressions, modeled for food purchase from mobile food vendors, pulgas, or neighbors/friends. Child food insecurity was associated with purchasing food from mobile food vendors, while household food security was associated with using pulgas or neighbors/friends. School nutrition program participants were more likely to live in households that depend on alternative food sources. Efforts to increase healthful food consumption such as fruits and vegetables should acknowledge all potential food sources (traditional, convenience, nontraditional, and alternative), especially those preferred by colonia residents. Current findings support the conceptual broadening of the retail food environment, and the importance of linking use with spatial access (proximity) to more accurately depict access to food sources.

South Korea's entry to the global food economy: shifts in consumption of food between 1998 and 2009

Korea has undergone a major opening of its food markets and economy in the past decade. Little is understood about the impact of these shifts on the diet of Koreans. This analysis studies the shifts in consumption of foods between 1998 and 2009 to provide a thorough understanding of the transition and insights into directions in the next decades in Korea. Data are from the Korea National Health and Nutrition Examination Survey (KNHANES). The sample used was a nationally representative sample of individuals age ≥2 in 1998 and 2009 (n=10,267 and 9,264, respectively). The data was corrected for seasonality, and the original raw food data was regrouped into 53 food groups. SAS was used to adjust for design effects and weight. Despite a decade of efforts to increase whole grains intake, and fruit and vegetable intake, the mean intake of whole grains increased only a small amount (16 kcal/person/day); however, the proportion consuming any whole grains doubled from 24% to 46.3%. Rice declined significantly, and several important less healthful food trends emerged: total alcohol intake increased from 39 kcal/person/day to 82 kcal/person/day. Also, energy from sugar-sweetened beverages increased among teens and energy from tea and coffee increased among adults. Remarkably, compared to other Asian countries and a general worldwide trend, vegetable intake remained relative high in South Korea during this last decade while fat energy increased modestly from relative low levels. Dynamic causes of these trends and the government's response are discussed.

Contribution of take-out food consumption to socioeconomic differences in fruit and vegetable intake: a mediation analysis

Lower fruit and vegetable (F/V) intake among socioeconomically disadvantaged groups has been well documented, and may be a consequence of a higher consumption of take-out foods. This study examined whether, and to what extent, take-out food consumption mediated (explained) the association between socioeconomic position and F/V intake. A cross-sectional postal survey was conducted among 1,500 randomly selected adults aged 25 to 64 years in Brisbane, Australia, during 2009 (response rate 63.7%, N=903). A food frequency questionnaire assessed usual daily servings of F/V (0 to 6), overall take-out consumption (times per week), and the consumption of 22 specific take-out items (never to once per day or more). These specific take-out items were grouped into "less healthy" and "healthy" choices and indexes were created for each type of choice (0 to 100). Socioeconomic position was ascertained by education. The analyses were performed using linear regression, and a bootstrap resampling approach estimated the statistical significance of the mediated effects. Mean daily servings of F/V were 1.89±1.05 and 2.47±1.12, respectively. The least educated group members were more likely to consume fewer servings of fruit (β= -.39, P<0.001) and vegetables (β= -.43, P<0.001) compared with members of the highest educated group. The consumption of "less healthy" take-out food partly explained (mediated) education differences in F/V intake; however, no mediating effects were observed for overall and "healthy" take-out consumption. Regular consumption of "less healthy" take-out items may contribute to socioeconomic differences in F/V intake, possibly by displacing these foods.

An assessment of the barriers to accessing food among food-insecure people in Cobourg, Ontario

INTRODUCTION

Low-income people are most vulnerable to food insecurity; many turn to community and/or charitable food programs to receive free or low-cost food. This needs assessment aims to collect information on the barriers to accessing food programs, the opportunities for improving food access, the barriers to eating fresh vegetables and fruit, and the opportunities to increasing their consumption among food-insecure people in Cobourg, Ontario.

METHODS

We interviewed food program clients using structured individual interviews consisting of mostly opened-ended questions.

RESULTS

Food program clients identified barriers to using food programs as lack of transportation and the food programs having insufficient quantities of food or inconvenient operating hours. They also stated a lack of available vegetables and fruit at home, and income as barriers to eating more vegetables and fruit, but suggested a local fresh fruit and vegetable bulk-buying program called "Good Food Box" and community gardens as opportunities to help increase their vegetable and fruit intake.

DISCUSSION

Many of the barriers and opportunities identified can be addressed by working with community partners to help low-income individuals become more food secure.

Can low-income Americans afford to satisfy MyPyramid fruit and vegetable guidelines?

OBJECTIVE

To estimate the costs of satisfying MyPyramid fruit and vegetable guidelines, with a focus on whether low-income households can bear these costs.

DESIGN

Descriptive analysis of the 2008 National Consumer Panel with information on the food purchases of 64,440 households across the contiguous United States was used to analyze the cost of fruits and vegetables. Costs per MyPyramid cup-equivalents were calculated by accounting for cooking yields and the portion of a food item's retail weight that is inedible.

VARIABLES MEASURED

Costs per cup-equivalent for less expensive fruits and vegetables by MyPyramid subgroup including whole and cut fruit, fruit juice, dark green vegetables, orange vegetables, starchy vegetables, other vegetables, and legumes.

RESULTS

In 2008, a variety of fruits and vegetables was available for an average cost of $0.40 to $0.50 per cup-equivalent. MyPyramid fruit and vegetable recommendations could be satisfied at this cost level.

CONCLUSIONS AND IMPLICATIONS

Low-income Americans facing national average food prices can satisfy MyPyramid fruit and vegetable guidelines with a budget equal to the Thrifty Food Plan allocation to fruits and vegetables. However, many low-income households spend too much money on food that is low in fruit and vegetable content. Some money should be reallocated to fruits and vegetables.

Five-a-day, a price to pay: an evaluation of the UK program impact accounting for market forces

We provide an ex-post assessment of the UK 5-a-day information campaign, where the positive effects of information are disentangled from potentially conflicting price dynamics. Using 4 years of data from the Expenditure and Food Survey between 2002 and 2006, we estimate that the 5-a-day program has lifted fruit and vegetable consumption by 0.3 portions, on average. We also provide quantitative evidence of a differentiated impact by income group, ranging from 0.2 to 0.7 portions. All impacts are larger than those observed by simply comparing pre-policy and post-policy intakes.

Youth proxy efficacy for fruit and vegetable availability varies by gender and socio-economic status

OBJECTIVE

The current study examined proxy efficacy, which was defined as youth's confidence to influence their parents to provide fruits and vegetables. The overall objective was to examine change in middle-school youth's proxy efficacy over time, and to determine if changes were moderated by gender and socio-economic status.

DESIGN

Longitudinal cohort nested within schools.

SETTING

Eight middle schools located in urban, suburban and rural areas of a mid-western US state.

SUBJECTS

Seven hundred and twelve youth followed across their 6th, 7th and 8th grade years. The sample was 51.8 % female, 30.5 % low socio-economic status and 89.5 % Caucasian, non-Hispanic.

RESULTS

Males and lower socio-economic status youth were significantly lower in proxy efficacy at each assessment year compared with females and high socio-economic youth, respectively.

CONCLUSIONS

Proxy efficacy to influence parents to provide fruits and vegetables may be an important construct to target in future interventions.

Cost of eating: whole foods versus convenience foods in a low-income model

BACKGROUND AND OBJECTIVES

Financial limitations in low-income populations, those at highest risk for poor health outcomes, may preclude adherence to recommended dietary guidelines. We examine the financial burden of shopping for foods to meet national dietary recommendations in a supermarket compared to eating primarily in a fast-food restaurant.

METHODS

Using a single-parent, low-income model, we obtained whole food costs (healthy) from local supermarkets and from fast-food outlets (convenient). Using cost per calorie as a metric for comparison, we used estimated single-parent, low-income living expenses to determine the relative costs of meeting national dietary guidelines.

RESULTS

Average food costs for healthy and convenience diets accounted for 18% and 37% of income, respectively. Dairy products and vegetables accounted for the largest cost percentages of diet costs (36% and 28%, respectively). The cost per calorie of a convenience diet was 24% higher than the healthy diet. Both models resulted in net financial loss over the course of a year for a single-parent, low-income family.

CONCLUSIONS

Food costs represent a significant proportion of annual income. Diets based heavily on foods from convenient sources are less healthy and more expensive than a well-planned menu from budget foods available from large supermarket chains.

Farm-to-school programs: perspectives of school food service professionals

OBJECTIVE

This qualitative study used a case study approach to explore the potential of farm-to-school programs to simultaneously improve children's diets and provide farmers with viable market opportunities.

DESIGN

Semistructured interviews were the primary data collection strategy.

SETTING

Seven farm-to-school programs in the Upper Midwest and Northeast regions of the United States.

PARTICIPANTS

Seven school food service professionals, 7 farmers, and 4 food distributors recruited from 7 farm-to-school programs.

PHENOMENON OF INTEREST

Interviews probed why farmers, school food service professionals, and food distributors participate in farm-to-school programs and how they characterize the opportunities and challenges to local school food procurement.

ANALYSIS

Data were analyzed using thematic coding and data displays.

RESULTS

School food service professionals described 3 motivators for buying locally grown food for their cafeterias: (1) "The students like it," (2) "The price is right," and (3) "We're helping our local farmer." Students' preference for locally grown food was related to food quality, influence of school staff, and relationships with farmers. Buying food directly from farmers and wholesalers was associated with lower prices and flexible specifications, and the "local feel."

CONCLUSIONS AND IMPLICATIONS

Understanding school food service professionals' motivations for buying locally grown food is critical to the sustainability of farm-to-school programs.

Short-term temporal stability in observed retail food characteristics

OBJECTIVE

Use of direct observation to characterize neighborhood retail food environments is increasing, but to date most studies have relied on a single observation. If food availability, prices, and quality vary over short time periods, repeated measures may be needed to portray these food characteristics. This study evaluated short-term (2-week), within-season temporal stability in retail food availability, prices, and quality.

DESIGN

In-person observations of retail food stores at 2 time points, 2 weeks apart.

SETTING

Southwest Chicago, IL.

SAMPLE

157 food stores.

MAIN OUTCOME MEASURES

Availability and prices of food items selected from the following food groups: fruit, vegetables, grains, meats and beans, and dairy, as well as fresh produce quality.

ANALYSIS

Temporal stability was tested for availability using a McNemar test and for price and quality using a Wilcoxon signed-rank test.

RESULTS

Measures of food availability and prices as well as fresh produce quality at stores were generally stable at the 2 time points.

CONCLUSIONS AND IMPLICATIONS

This study suggests that a single observation may be sufficient to accurately characterize within-season food availability, food prices, and fresh produce quality.

Adopting a plant-based diet minimally increased food costs in WHEL Study

OBJECTIVE

To assess the cost of adopting a plant-based diet.

METHODS

Breast cancer survivors randomized to dietary intervention (n=1109) or comparison (n=1145) group; baseline and 12-month data on diet and grocery costs.

RESULTS

At baseline, both groups reported similar food costs and dietary intake. At 12 months, only the intervention group changed their diet (vegetable-fruit: 6.3 to 8.9 serv/d.; fiber: 21.6 to 29.8 g/d; fat: 28.2 to 22.3% of E). The intervention change was associated with a significant increase of $1.22/ person/week (multivariate model, P=0.027).

CONCLUSIONS

A major change to a plant-based diet was associated with a minimal increase in grocery costs.

Economic access to fruits and vegetables in the greater Quebec City: do disparities exist?

OBJECTIVES

To examine the cost of fruits and vegetables (FV) with respect to different food store types, urbanization level and material deprivation for various urban areas of greater Quebec City.

METHODS

A sample of 85 food stores was selected. They represented five store types (small, conventional, and large grocery stores; greengrocers; convenience stores) in four geographic areas reflecting three different socio-economic levels. We identified three FV baskets (grocery, fresh FV, convenience) by drawing on data on household food spending and consumption, and food supply in the five store types. Four investigators were trained to conduct a survey of prices for the week of September 17-23, 2007. Analysis of variance and t tests were conducted to examine variations in food baskets with regard to the variables defined in this study. A chi-square test was used to measure the frequency distribution of stores throughout the greater Quebec City.

RESULTS

Only food store type had a significant influence on FV cost: cost was much lower in large grocery stores and greengrocers. Convenience stores, where prices are higher, outnumbered all others in deprived urban areas, supporting the contention that there are inequities in economic access.

DISCUSSION

Economic access to FV may differ by area in the greater Quebec City, putting rural inhabitants and less privileged urban dwellers at the greatest disadvantage; this may, in turn, contribute to health disparities. The results point to the need to improve our understanding of the way components of the food environment at the regional level affect social inequality.

Multilevel correlates of satisfaction with neighborhood availability of fresh fruits and vegetables

BACKGROUND

Little is known about influences on perceptions of neighborhood food environments, despite their relevance for food-shopping behaviors and food choices.

PURPOSE

This study examined relationships between multilevel factors (neighborhood structure, independently observed neighborhood food environment, and individual socioeconomic position) and satisfaction with neighborhood availability of fruits and vegetables.

METHODS

The multilevel regression analysis drew on data from a community survey of urban adults, in-person audit and mapping of food stores, and the 2000 Census.

RESULTS

Satisfaction with neighborhood availability of fruits and vegetables was lower in neighborhoods that were farther from a supermarket and that had proportionately more African-American residents. Neighborhood poverty and independently observed neighborhood fruit and vegetable characteristics (variety, prices, and quality) were not associated with satisfaction. Individual education modified relationships between neighborhood availability of smaller food stores (small grocery stores, convenience stores, and liquor stores) and satisfaction.

CONCLUSIONS

Individual-level and neighborhood-level factors affect perceptions of neighborhood food environments.

Food prices and fruit and vegetable consumption among young American adults

Multivariate negative binomial count models were estimated to examine associations between young adults' fruit and vegetable (FV) consumption and the prices of FV, other food at home grocery items, and fast food and the availability of restaurants and food stores. This study used the 2002 wave of data collected from US young adults aged 18-23 years in the 1997 National Longitudinal Survey of Youth merged by geocode identifiers with food prices and restaurant and food store availability. The results showed that higher levels of FV consumption were associated with lower FV prices (price elasticity of -0.32) and that this own-price effect was robust to the inclusion of other food prices and food outlet availability. Lower income and lower educated young adults and those with lower educated mothers and middle-income parents were found to be most price sensitive. No statistically significant cross-price effects on FV consumption were found with other grocery food (meat, dairy and bread) prices or fast food prices. Fiscal policy instruments such as FV subsidies may help to increase FV intake, particularly among young adults of lower socioeconomic status.

The relationship between low income and household food expenditure patterns in Canada

Objectives:

To compare food expenditure patterns between low-income households and higher- income households in the Canadian population, and to examine the relationship between food expenditure patterns and the presence or absence of housing payments among low-income households.

Design:

Secondary data analysis of the 1996 Family Food Expenditure Survey conducted by Statistics Canada.

Setting:

Sociodemographic data and 1-week food expenditure data for 9793 households were analysed.

Subjects:

Data were collected from a nationally representative sample drawn through stratified multistage sampling. Low-income households were identified using Statistics Canada's Low Income Measures.

Results:

Total food expenditures, expenditures at stores and expenditures in restaurants were lower among low-income households compared with other households. Despite allocating a slightly greater proportion of their food dollars to milk products, low-income households purchased significantly fewer servings of these foods. They also purchased fewer servings of fruits and vegetables than did higher-income households. The effect of low income on milk product purchases persisted when the sample was stratified by education and expenditure patterns were examined in relation to income within strata. Among low-income households, the purchase of milk products and meat and alternatives was significantly lower for households that had to pay rents or mortgages than for those without housing payments.

Conclusions:

Our findings indicate that, among Canadian households, access to milk products and fruits and vegetables may be constrained in the context of low incomes. This study highlights the need for greater attention to the affordability of nutritious foods for low-income groups.

Disparities in the availability of fruits and vegetables between racially segregated urban neighbourhoods

OBJECTIVE

Public health professionals continue to see the benefits of fruit and vegetable consumption on population health. While studies that evaluate the availability of produce are sparse in the medical literature, disparities in availability may explain the disproportional intake of produce for some people. Therefore, the purpose of this study was to evaluate the availability and variety of produce located in two racially and economically diverse urban neighbourhoods.

DESIGN

A cross-sectional study was conducted in which 50% of the supermarkets, small grocery stores, delicatessens, and fruit and vegetable markets located in specific neighbourhoods were randomly sampled and surveyed between September 2004 and July 2005. Food stores were evaluated for the availability of 20 types of fresh fruits and 19 types of fresh vegetables, as well as their varieties and whether they were canned, frozen or previously prepared. 2000 US Census information was used to determine characteristics of the geo-coded census tracts where the food stores were located.

SETTING

Brooklyn, New York.

RESULTS

A supermarket was located in approximately every third census tract in predominantly white areas (prevalence = 0.33) and every fourth census tract in racially mixed areas (prevalence = 0.27). There were no supermarkets located in the predominantly black areas. With the exception of bananas, potatoes, okra and yucca, a lower proportion of predominantly black area stores carried fresh produce, while supermarkets carried the largest variety of produce types. Canned and frozen fruits and vegetables were found in the majority of stores, whereas prepared and organic produce was limited to predominantly white area stores.

CONCLUSIONS

These data demonstrate that the availability and variety of fresh produce is associated with neighbourhood racial composition and may be a factor contributing to differences in intake among residents.

Trends of socioeconomic differences in daily vegetable consumption, 1979-2002

BACKGROUND

Studies from different time periods have shown that consumption of vegetables is more common in higher socioeconomic groups and among women. However, there are only few studies of changes of socioeconomic differences in vegetable consumption over time. Our aim was to determine whether socioeconomic differences, measured by educational level and household income, in daily vegetable consumption have increased, decreased or been stable over the last two decades among Finnish men and women.

METHODS

Data on daily consumption of fresh vegetables were derived from repeated annual cross-sectional surveys performed among representative samples of Finnish working aged (15-64 years) population. Data from the years 1979-2002 were linked with data on education and household income from Statistics Finland. Those under 25 years and all students were excluded, giving a total of 69 383 respondents. The main analyses were conducted with logistic regression.

RESULTS

Daily consumption of fresh vegetables became overall more prevalent during the study period. Daily consumption of fresh vegetables was more common among those with higher education and higher income during the whole study period. Both educational level and household income differences in daily vegetable consumption slightly narrowed since 1979 among men and women.

CONCLUSIONS

Women with high socioeconomic position have been initial trend setters, but the prevalence of daily consumers of vegetables in these groups has not increased since the early 1990s. The prevalence of daily consumption of fresh vegetables has increased more in lower educational and income groups during the 1980s and 1990s along with narrowing socioeconomic differences.

Energy-dense diets are associated with lower diet costs: a community study of French adults

Objective:

High consumption of energy-dense foods has been linked to high energy intakes and excess weight gain. This study tested the hypothesis that high energy density of the total diet is associated with lower diet costs.

Design:

Dietary intakes of 837 French adults, aged 18–76 years, were assessed using a dietary history method. Dietary energy density (MJ kg−1) was calculated by dividing total energy by the edible weight of foods consumed. Daily diet cost (€day−1) was estimated using mean national food prices for 57 food items. The relationship between dietary energy density and diet cost at each level of energy intake was examined in a regression model, adjusted for gender and age.

Results:

The more energy-dense refined grains, sweets and fats provided energy at a lower cost than did lean meats, vegetables and fruit. Within each quintile of energy intake, diets of lower energy density (MJ kg−1) were associated with higher diet costs (€day−1).

Conclusion:

In this observational study, energy-dense diets cost less whereas energy-dilute diets cost more, adjusting for energy intakes. The finding that energy-dilute diets are associated with higher diet costs has implications for dietary guidelines and current strategies for dietary change.

Food spending behaviors and perceptions are associated with fruit and vegetable intake among parents and their preadolescent children

OBJECTIVE

Examine the role of food spending behaviors and perceptions on fruit and vegetable intake among preadolescent children and their parents.

DESIGN

Cross-sectional study.

SETTING

Metropolitan city.

PARTICIPANTS

Five hundred fifty-five parent/child dyads participating in the PARADE study. More than 50% of participants were African American and nearly 40% of households were low income.

VARIABLES MEASURED

Body mass index calculated from child anthropometric data and parents' self-reported height and weight. Adult and child fruit and vegetable intake, annual household income, and food purchase behavior and perceptions obtained from parent questionnaire.

ANALYSIS

Analysis of variance used to identify differences in means at P<.05 level.

RESULTS

No statistically significant differences in fruit and vegetable intake by income status were observed. Children in households spending the least per week on groceries consumed fewer daily fruits and vegetables. Perceptions of cost of fruits and vegetables were also found to be significantly associated with fruit and vegetable intake among children and parents.

CONCLUSIONS AND IMPLICATIONS

Public health efforts to raise awareness of the relatively low cost of fruits and vegetables should be continued. These efforts may be complemented with policy strategies that make fruits and vegetables more viable options for low-income households.

Does living in a disadvantaged area entail limited opportunities to purchase fresh fruit and vegetables in terms of price, availability, and variety? Findings from the Brisbane Food Study

Understanding the role environmental factors may play in the dietary behaviours of socioeconomic groups is relevant for efforts to reduce health inequalities. In contrast with international research, earlier findings from the Brisbane Food Study (BFS), Australia, found no relationship between area socioeconomic characteristics and dietary behaviours or location of food shops. This paper examines whether the price and availability of fruits and vegetables are socioeconomically patterned using data from the BFS. Fifty census collection districts were randomly sampled and all local (i.e. within 2.5 km) supermarkets, greengrocers and convenience stores were observed. Little or no differences in price and availability were found on the basis of area socioeconomic characteristics.

The impact of cost on the availability of fruits and vegetables in the homes of schoolchildren in Birmingham, Alabama

OBJECTIVES

Fruit and vegetable cost is a presumed barrier to intake. We sought to determine whether fruit and vegetable cost and consumers' race and income would predict availability of fruits and vegetables in homes of schoolchildren in the Birmingham, Ala, area.

METHODS

Data on availability of 27 fruit and vegetable items were obtained from homes of 1355 children (32% African American) in the Birmingham area. Fruit and vegetable costs were obtained from the US Department of Agriculture. We used discrete choice analysis with the dependent variable represented as presence or absence of the fruit or vegetable item. Explanatory variables included fruit and vegetable price per serving; child's gender, race, and age; and parent's body mass index and income.

RESULTS

Higher cost was inversely related to fruit and vegetable availability. Higher income, African American race, and female gender were positively related to availability. Cost per serving was stratified into 3 categories-low, medium, and high. Relative to low-cost items, only high-cost items decreased the odds of availability significantly.

CONCLUSIONS

Fruit and vegetable cost does impact availability and has the greatest impact for high-cost items. Although cost was inversely related to availability, African Americans reported higher fruit and vegetable availability than Whites. Additional studies are needed to determine whether food items of lower nutritive value and comparable cost impact availability.

The association of television and video viewing with fast food intake by preschool-age children

OBJECTIVE

To examine the extent to which television (TV) and video viewing is associated with consumption of fast food by preschool-age children.

RESEARCH METHODS AND PROCEDURES

In a cross-sectional study of 240 parents of children ages 2.0 to 5.9 years, parents reported the number of hours their child watched TV/videos on an average weekday and weekend day in the past month; a daily, weighted average of TV/video viewing was then calculated. The main outcome was parents' report of their children's fast food intake, using the question, "How many times a week does your child eat at fast food restaurants such as McDonald's, Burger King, or Kentucky Fried Chicken?" dichotomized to (never/<1 vs. > or =1 time/wk). The association of TV/video viewing with fast food intake was evaluated by multiple logistic regression before and after adjusting for several potential confounders.

RESULTS

Twenty-two percent of parents reported that their child ate at fast food restaurants at least once per week. After adjusting for parents' age, race/ethnicity, and household income as well as child's age and sex, for each 1-hour increase of TV/video watched per day, the odds ratio (OR) for consuming fast food > or =1 time per week was 1.60 (95% confidence interval, 1.03 to 2.49). After further adjustment for socio-environmental factors that might serve as proxies for the availability of healthy food options, such as parental time constraints and the availability and high cost of fresh fruits and vegetables in their neighborhoods, the OR for consuming fast food > or =1 time per week was minimally attenuated (OR, 1.55; 95% confidence interval, 1.04 to 2.31).

DISCUSSION

TV/video viewing was correlated with fast food consumption among preschool children in this study. Our findings raise the possibility that greater exposure to TV and videos may influence preschool children's consumption of unhealthful foods.

Relationship of mother and child food purchases as a function of price: a pilot study

To our knowledge, there are no data on parental influences on child purchasing behavior of healthy or unhealthy foods. Mothers and children in ten families were given 5.00 US dollars to purchase portions of preferred fruits/vegetables and high energy-dense snack foods for each of ten trials of price manipulations. For five of the trials the price of the fruit/vegetable increased in price from 0.50 US dollars to 2.50 US dollars (in 0.50 US dollar increments), while the price of the energy-dense snack food remained constant at 1.00 US dollar. For the remaining five trials, the commodity that previously rose in price remained constant at 1.00 US dollars and the other commodity varied from 0.50 US dollars to 2.50 US dollars. Same-price elasticity was shown for both the child and parent purchases, and parent purchases were significantly related to child purchases of both healthy (regression estimate = 0.46, p < 0.001) and unhealthy (regression estimate = 0.12, p = 0.036) foods. Children's purchases of unhealthy snack food items were positively related to family socioeconomic status, and negatively related to child age. These results indicate that parental food choice and purchasing behaviors may play a role in the development of children's purchasing of both healthy and unhealthy foods.

Fruit and vegetable access differs by community racial composition and socioeconomic position in Detroit, Michigan

OBJECTIVE

To compare the availability, selection, quality, and price of fresh fruit and vegetables at food stores in four Detroit-area communities: 1) predominately African-American, low socioeconomic position (SEP); 2) racially heterogeneous, low SEP; 3) predominately African-American, middle SEP; and 4) racially heterogeneous, middle SEP.

DESIGN

Cross-sectional observational survey, conducted fall 2002.

SETTING

Detroit, Michigan

SAMPLE

Overall, 304 food stores located in the four communities were evaluated: chain grocery, large independent grocery, "mom-and-pop" grocery, specialty (meat, fruit and vegetable markets), convenience without gasoline, and liquor stores.

MAIN OUTCOME MEASURES

Availability was indicated by whether a store carried fresh fruit or vegetables, selection was based on a count of 80 fruit and vegetables, quality was evaluated according to USDA guidelines for a subset of 20 fruit and vegetables, and price was assessed for 20 fruit and vegetables by using the lowest-cost method.

RESULTS

Mean quality of fresh produce was significantly lower in the predominately African-American, low-SEP community than in the racially heterogeneous, middle-SEP community. Differences in the types of stores present only partially explained this quality differential. The predominately African-American, low-SEP community had more than four times more liquor stores and fewer grocery stores per 100,000 residents than the racially heterogeneous, middle-SEP community. Mean overall selection and price of fresh produce at stores did not differ among communities.

CONCLUSIONS

Increasing access to high-quality fresh produce in low-income communities of color is a critical first step toward improving health through better dietary practices in this population.

A Nutrient Density Standard for Vegetables and Fruits: Nutrients per Calorie and Nutrients per Unit Cost

OBJECTIVES

The Dietary Guidelines for Americans 2005 recommended that consumers give priority to nutrient-dense foods, those that contain substantial amounts of key nutrients in relation to the dietary energy they provide. This study developed a scoring system to estimate the nutritional adequacy of vegetables and fruits, on a per weight, per calorie, and per unit cost basis.

DATA

We used a French national food composition database for 637 foods, including 129 vegetables and fruits. Mean national retail prices were obtained for each food.

METHODS

The nutrient adequacy score was defined as the mean of percent daily values for 16 nutrients, based on 100 g of food. The nutrient density score and the nutrient-to-price ratio were the mean of percent daily values for 16 nutrients, expressed per 100 kcal and per 1 euro of food, respectively. Relationships between energy density of vegetables and fruits, nutrient adequacy score, nutrient density score, and nutrient-to-price ratio were tested using linear regression.

RESULTS

Energy density and nutrient density score were negatively correlated, confirming the widely accepted notion that energy-dense foods tend to be nutrient-poor. As expected, fruits and vegetables had the highest nutrient density score because they were nutrient-rich in relation to their low energy content. They also had a relatively high nutrient-to-price ratio, showing that they provided nutrients at a reasonable cost when compared with other foods.

CONCLUSIONS

Foods ranked differently when nutritional adequacy was calculated per weight (nutrient adequacy score), per calorie (nutrient density score), or per unit cost (nutrient-to-price ratio). The present results showed that although fruits and vegetables are an expensive source of dietary energy, they provide key nutrients at a reasonable cost.