The local food environment and diet: a systematic review

A Randomized Trial to Encourage Healthy Eating Through Workplace Delivery of Fresh Food

PURPOSE

This study aimed to increase the consumption of home-cooked meals among employees at a large urban worksite through a fully subsidized Community Supported Agriculture (CSA) program.

DESIGN

Randomized trial.

SETTING

Worksite in a large northeast city.

PARTICIPANTS

Employees were recruited through flyers, e-mail listservs, and outreach from departmental administrators (n = 60).

INTERVENTION

Intervention participants received 8 biweekly fresh food deliveries through a CSA program. They also received cooking education and support. Control participants received usual employee benefits.

MEASURES

Consumption of meals prepared at home was the primary end point. Increased consumption of fresh fruits and vegetables was the secondary end point, and food insecurity was an exploratory end point.

ANALYSIS

Poisson regression was used to assess mean differences in weekly consumption of home-cooked meals. To assess differences in fruit and vegetable consumption and food insecurity, binary logistic regression was used to estimate odds ratios.

RESULTS

Compared to the control group, intervention participants consumed 29% more home-cooked meals per week (P < .01). Fruit and vegetable consumption also increased among intervention participants. The odds of at least twice-daily fruit consumption were 3.8 times higher among intervention participants than among controls, and the odds of at least twice-daily vegetable consumption were 6.2 times higher among intervention participants than among controls. Compared to control participants, intervention participants experienced a statistically significant 89% reduction in the odds of reporting food insecurity at follow-up, when controlling for baseline food insecurity. Participants reported perceived intervention benefits, including the opportunity to experiment with new, healthful foods without financial risk, as well as the social value of sharing recipes, food, and related conversation with colleagues.

CONCLUSION

The study demonstrated the feasibility and potential positive effects of a subsidized workplace CSA program, augmented with cooking education and support.

Social Support, but Not Perceived Food Environment, Is Associated with Diet Quality in French-Speaking Canadians from the PREDISE Study

The objectives were to assess whether social support for healthy eating and perceived food environment are associated with diet quality, and to investigate if sociodemographic characteristics moderate these associations. A probability sample of French-speaking adults from the Province of Québec, Canada, was recruited in the context of the PREDISE study. Participants reported their perceptions of supportive and non-supportive actions related to healthy eating from close others at home and outside of home (n = 952), and of the accessibility to healthy foods (n = 1035). The Canadian Healthy Eating Index (C-HEI) was calculated based on three Web-based 24 h food recalls. Multiple linear regression models showed that supportive (B = 1.50 (95% CI 0.46, 2.54)) and non-supportive (B = -3.06 (95% CI -4.94, -1.18)) actions related to healthy eating from close others at home were positively and negatively associated with C-HEI, respectively, whereas actions from close others outside of home were not. The negative association between non-supportive actions occurring at home and C-HEI was stronger among participants with lower (vs. higher) levels of education (p interaction = 0.03). Perceived accessibility to healthy foods was not associated with C-HEI (p > 0.05). These results suggest that the social environment may have a stronger influence on healthy eating than the perceived physical environment. This adds support for healthy eating promotion programs involving entire families, especially for more socioeconomically disadvantaged individuals, whose efforts to eat healthily may be more easily thwarted by non-supportive households.

The Local Food Environment and Food Security: The Health Behavior Role of Social Capital

Food politics and economic forces may determine the macro conditions for food supply, but the local environment has the most substantial impact on population health. Food security is determined not only by the basic availability of food, but also by social, economic, and cultural factors influencing dietary behaviors. This paper investigates the role of social institutions, specifically social capital, in affecting food security by proposing a theoretical linkage between social capital and health behavior, and an illustrative case is provided. Social capital, defined as the value of the bonding, bridging, and linking relationships between people, is well demonstrated to be related to health. Many mechanisms link social capital to health, including shared access to food and nutritional behaviors. Further, social capital influences health through social status and race. This paper further investigates the links between minority status, food security, social capital, and health. The analysis draws on empirical work in North Carolina with community gardens, faith communities, the local food environment, and other social capital-related variables. By investigating the nature of local food security, particularly for minority populations, this analysis allows for better integration of local conditions with global food politics.

Correlates of English local government use of the planning system to regulate hot food takeaway outlets: a cross-sectional analysis

Background

Greater neighbourhood takeaway food outlet access has been associated with increased takeaway food consumption and higher body weight. National planning guidelines in England suggest that urban planning could promote healthier food environments through takeaway food outlet regulation, for example by restricting the proliferation of outlets near schools. It is unknown how geographically widespread this approach is, or local characteristics associated with its use. We aimed to address these knowledge gaps.

Methods

We used data from a complete review of planning policy documents adopted by local government areas in England (n = 325), which contained policies for the purpose of takeaway food outlet regulation. This review classified local government area planning policies as having a health (diet or obesity) or non-health focus. We explored geographical clustering of similar planning policies using spatial statistics. We used multinomial logistic regression models to investigate whether the odds of planning policy adoption varied according to local characteristics, for example the proportion of children with excess weight or the current number of takeaway food outlets.

Results

We observed clusters of local government areas with similar adopted planning policies in the North East, North West, and Greater London regions of England. In unadjusted logistic regression models, compared to local government areas with the lowest, those with highest proportion of 10–11 year olds with excess weight (OR: 25.31; 95% CI: 6.74, 94.96), and takeaway food outlet number (OR: 54.00; 95% CI: 6.17, 472.41), were more likely to have a health-focused planning policy, than none. In models adjusted for deprivation, relationships for excess weight metrics were attenuated. Compared to local government areas with the lowest, those with the highest takeaway food outlet number remained more likely to have a health-focused planning policy, than none (OR: 16.98; 95% CI: 1.44, 199.04). When local government areas were under Labour political control, predominantly urban, and when they had more geographically proximal and statistically similar areas in the same planning policy status category, they were also more likely to have health-focused planning policies.

Conclusions

Planning policies for the purpose of takeaway food outlet regulation with a health focus were more likely in areas with greater numbers of takeaway food outlets and higher proportions of children with excess weight. Other characteristics including Labour political control, greater deprivation and urbanisation, were associated with planning policy adoption, as were the actions of similar and nearby local government areas. Further research should engage with local policymakers to explore the drivers underpinning use of this approach.

Sociocultural Influences on Dietary Practices and Physical Activity Behaviors of Rural Adolescents-A Qualitative Exploration

In the aftermath of nutrition transition and ever-increasing sedentarism, adolescents globally are exposed to negative health consequences. Diverse sociocultural influences play a critical role in their adoption of unhealthy dietary practices and suboptimal physical activity behaviors. Context-specific understandings of how these sociocultural influences shape adolescents’ dietary and physical activity patterns in a rural, resource-limited setting remained elusive. Aiming to address the gap, this qualitative study explored adolescents’ and mothers’ perception of broader sociocultural aspects that sculpt the food choices, eating habits and physical activity behaviors of adolescents in Matlab, Bangladesh. Six digitally-recorded focus group discussions were transcribed verbatim, translated into English and analyzed thematically. Marked taste-driven dietary preference of adolescents and its prioritization within family by the mothers, popularity of street foods, better understanding of the importance of food hygiene and safety contrasting with narrow perception of balance and diversity in diet, peer influence along with deficient school and community food environment, internalization and rigidity of gender norms were found to be exerting major influence. The findings highlighted key targets for community-based nutrition interventions and endorsed thorough consideration of socio-cultural factors in formulating strategies to promote healthful eating and physical activity behaviors among the adolescents.

A Systematic Review of the Effect of Retail Food Environment Interventions on Diet and Health with a Focus on the Enabling Role of Public Policies

PURPOSE OF REVIEW

Update the state of evidence on the effectiveness of retail food environment interventions in influencing diet and explore the underlying role of public policy, through a systematic review of population-level interventions to promote health in the retail food environment, including community and consumer environments. Diet-related outcomes included purchasing, dietary intakes, diet quality, and health including weight. We coded studies for enabling public policy levers underpinning the intervention, using two widely used conceptual frameworks.

RECENT FINDINGS

Of 86 articles (1974-2018), the majority (58 articles, 67%) showed at least one positive effect on diet. Thirteen articles (15%) discussed natural experiments, 27 articles (31%) used a design involving comparison groups including 23 articles (27%) specifically describing randomized controlled trials, and 46 (53%) were quasi-experimental (cross-sectional) evaluations. Across the "4Ps" of marketing (product, promotion, placement, and price), promotion comprised the greatest proportion of intervention strategies, especially in earlier literature (pre-2008). Few studies combined geographic access interventions with 4P strategies, and few used robust dietary intake assessments. Behavior change communication remains an intervention mainstay, but recent work has also incorporated environmental and social planning, and fiscal strategies. More recent interventions were multi-component. The retail food environment intervention literature continues to grow and has become more robust overall, with clearer evidence of the effect of interventions on diet-related outcomes, including consumer purchasing, dietary intakes, and health. There is still much scope for development in the field. Attention to enabling public policy could help to strengthen intervention implementation and evaluation in the retail food environment.

Identifying social norms in physical aspects of food environments: A photo study

It is widely accepted that physical food environments can contribute to unhealthy eating, but less is known about how physical cues in these environments actually stimulate eating. Our study starts from the assumption that social norms are embedded in physical cues and aims to make an inventory of physical cues that communicate what is socially accepted as normal and/or appropriate to eat in a Dutch outside-the-home food context. In Study 1, we conducted a qualitative study in which photographs taken in self-service food environments were analyzed using strategies from photo documentation and semiology. Grounded theory was applied to identify a wide variety of specific physical cues that were ultimately grouped into 18 higher level categories of physical cues (e.g. consumption traces, product availability). Most cue categories were associated with either descriptive or injunctive social norms, but some were associated with both types. In Study 2, we aimed to quantitatively cross-validate the social norm interpretations among laypeople (N = 173) by focusing on two selected photographs. More than half of the physical cues that participants identified in these photographs as being influential had been identified in Study 1 as cues bearing a normative message. The results further indicated that other people's behavior is easier to recognize in physical food environments than signals about what ought to be done. Given the great variety of identified physical cues associated with social norms, we posit that social norms are widely embedded in food environments and might guide eating behavior. Further research should study the effects of these cues on behavior and test whether the underlying process can be attributed to social norm interpretations.

Residents' perceptions of their local food environment in socioeconomically diverse neighborhoods: A photovoice study

The influence of unhealthy food environments on residents' eating behaviors has been previously documented. Yet, socioeconomic differences across areas are less studied. Participatory studies provide relevant knowledge to better inform future nutrition interventions. We conducted a participatory Photovoice project in which residents interpreted the influence of the local food environment on eating behaviors across three neighborhoods of contrasting area-level socioeconomic status (SES) in Bilbao, Spain. From April to July 2017, a total of 23 residents participated in the three Photovoice groups. Each group critically discussed their photographs (N = 110) in groups of 6-9 participants along six group sessions. Through a consensus-building process, participants identified 27 emerging categories choosing finally 39 related photographs, which followed six conceptual main themes characterizing their local food environment: 1) unhealthy eating behaviors, 2) cultural diversity, 3) retail transformation, 4) social relationships, 5) precariousness, and 6) healthy eating. Although high food quality and fresh products may portray a general healthy food environment in all three neighborhoods, participants discussed why some residents still adopt unhealthy eating behaviors characterized by an excessive consumption of alcohol (high-SES area), sugar loaded foods (high- and middle-SES) and fast food (middle and low-SES). This photovoice participatory methodology helps highlighting important similarities and differences regarding food environment perceptions in the whole socioeconomic spectrum of any given city. This type of participatory approach helps guiding local policies and interventions promoting healthier local food environments.

Systematic review: a systems innovation perspective on barriers and facilitators for the implementation of healthy food-store interventions

BACKGROUND

Due to their central position in the modern food system, food stores present a unique opportunity to promote healthy dietary behaviour. However, there is a lack of insight into the factors that impede or enhance the implementation of nutritional interventions in food stores. We applied a systems innovation and implementation science framework to the identification of such barriers and facilitators.

METHODS

We conducted a systematic literature review. A search string was developed to identify qualitative and quantitative articles on environmental nutritional interventions in the food store. Four databases were systematically searched for studies published between 2000 and 2018. Eligible publications described study designs or original studies, focused on stimulating healthier dietary behaviour through environmental changes in retail settings and contained information on the perceptions or experiences of retailers or interventionists regarding the implementation process of the intervention. Context-descriptive data was extracted and a quality assessment was performed.

RESULTS

We included 41 articles, of which the majority was conducted in the USA and involved single stores or a mix of single and multi-store organisations. We categorized barriers and facilitators into 18 themes, under five domains. In the 'outer setting' domain, most factors related to consumers' preferences and demands, and the challenge of establishing a supply of healthy products. In the 'inner setting' domain, these related to conflicting values regarding health promotion and commercial viability, store lay-out, (insufficient) knowledge and work capacity, and routines regarding waste avoidance and product stocking. In the 'actors' domain, no major themes were found. For the 'intervention 'domain', most related to intervention-context fit, money and resource provision, material quality, and the trade-offs between commercial costs and risks versus commercial and health benefits. For the 'process' domain, most factors related to continuous engagement and strong relationships.

CONCLUSIONS

This review provides a comprehensive overview of barriers and facilitators to be taken into account when implementing nutritional interventions in food stores. Furthermore, we propose a novel perspective on implementation as the alignment of intervention and retail interests, and a corresponding approach to intervention design which may help avoid barriers, and leverage facilitators.

TRIAL REGISTRATION

PROSPERO; CRD42018095317.

Government data v. ground observation for food-environment assessment: businesses missed and misreported by city and state inspection records

OBJECTIVE

To assess the accuracy of government inspection records, relative to ground observation, for identifying businesses offering foods/drinks.

DESIGN

Agreement between city and state inspection records v. ground observations at two levels: businesses and street segments. Agreement could be 'strict' (by business name, e.g. 'Rizzo's') or 'lenient' (by business type, e.g. 'pizzeria'); using sensitivity and positive predictive value (PPV) for businesses and using sensitivity, PPV, specificity and negative predictive value (NPV) for street segments.

SETTING

The Bronx and the Upper East Side (UES), New York City, USA.

PARTICIPANTS

All food/drink-offering businesses on sampled street segments (n 154 in the Bronx, n 51 in the UES).

RESULTS

By 'strict' criteria, sensitivity and PPV of government records for food/drink-offering businesses were 0·37 and 0·57 in the Bronx; 0·58 and 0·60 in the UES. 'Lenient' values were 0·40 and 0·62 in the Bronx; 0·60 and 0·62 in the UES. Sensitivity, PPV, specificity and NPV of government records for street segments having food/drink-offering businesses were 0·66, 0·73, 0·84 and 0·79 in the Bronx; 0·79, 0·92, 0·67, and 0·40 in the UES. In both areas, agreement varied by business category: restaurants; 'food stores'; and government-recognized other storefront businesses ('gov. OSB', i.e. dollar stores, gas stations, pharmacies). Additional business categories - 'other OSB' (barbers, laundromats, newsstands, etc.) and street vendors - were absent from government records; together, they represented 28·4 % of all food/drink-offering businesses in the Bronx, 22·2 % in the UES ('other OSB' and street vendors were sources of both healthful and less-healthful foods/drinks in both areas).

CONCLUSIONS

Government records frequently miss or misrepresent businesses offering foods/drinks, suggesting caveats for food-environment assessments using such records.

Development of a Teen-Informed Coding Tool to Measure the Power of Food Advertisements

The food-related information environment, comprised of food and beverage advertising within one’s surroundings, is a growing concern for adolescent health given that food marketing disproportionately targets adolescents. Despite strong public interest concerning the effects of food marketing on child health, there is limited evidence focused on outdoor food advertising in relation to teenage diets, food purchasing, and perceptions. Further, limited research has considered both the exposure to and influence of such advertisements. This study used a novel multi-method approach to identify and quantify the features of outdoor food and beverage advertisements that are most effective at drawing teenagers into retail food establishments. An environmental audit of outdoor advertisements and consultations with youth were used to: (1) identify teen-directed food marketing techniques; (2) validate and weigh the power of individual advertising elements; and, (3) develop a teen-informed coding tool to measure the power of food-related advertisements. Results indicate that marketing power is a function of the presence and size of teen-directed advertisement features, and the relative nature of each feature is an important consideration. This study offers a quantitative measurement tool for food environment research and urges policymakers to consider teen-directed marketing when creating healthy communities.

Does the neighborhood food environment contribute to ethnic inequalities in fast-food intake? findings from the ORiEL study

The neighborhood food environment may contribute to ethnic inequalities in diet. Using data from 1389 participants in the Olympic Regeneration in East London (UK) study we assessed whether ethnic inequalities in neighborhood availability of fast-food restaurants mediated and/or modified ethnic inequalities in fast-food intake in 13–15 year-old adolescents. We compared the proportion of high fast-food consumers across “White UK”, “Black”, and “South Asian” ethnic categories. We used Poisson regression with robust standard errors to assess direct and indirect effects (mediation analysis) and risk ratios of high fast-food intake by ethnic category and fast-food restaurant availability level (effect measure modification analysis). There were ethnic inequalities in high fast-food intake, with risk ratios in adolescents of Black and South Asian background of 1.53 (95% CI: 1.25, 1.87) and 1.71 (95% CI: 1.41, 2.07) respectively compared to White UK participants. We found no evidence of a mediating effect by fast-food restaurant availability, but found some evidence of effect measure modification: ethnic inequalities in fast-food intake were largest in neighborhoods lacking fast-food restaurants, and narrowed as availability increased. Future research should explore why ethnic minorities are more likely to be high fast-food consumers than the majority ethnic group, especially when fast-food restaurant availability is lowest.

Prevalence of metabolic syndrome and its associated risk factors in an African-Caribbean population with severe mental illness

This cross-sectional study aims to determine the prevalence of metabolic syndrome (MetS) in patients with severe mental illness (SMI) on a Caribbean island, Curaçao, using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Among 350 patients (240 men and 110 women) with a mean age of 51.9 years (S.D.=13.5) MetS prevalence was 37.4%, significantly higher in female patients (63.6%) compared to male patients (25.4%). Increased waist circumference was present in 51.1%, low HDL in 50.6%, hypertension in 49.4%, hyperglycemia in 28.6% and 25.7% had hypertriglyceridemia. Except for hypertriglyceridemia, all criteria were more prevalent in female patients. Binary logistic regression analysis indicated that female gender, outpatient treatment setting and the absence of substance use disorder were all significant predictors for MetS. Compared to data from the general population obtained by the 2013 National Health Survey Curaçao, this study showed significantly higher prevalence of diabetes and hypertension in patients with SMI. Moreover, female patients had the highest prevalence of diabetes (28.2%), obesity (50.0%) and increased waist circumference (88.2%). This study demonstrates that African-Caribbean patients with SMI are at high-risk for MetS, especially female patients. Our data suggest to focus on modifiable lifestyle risk factors, as promoting physical activity and healthy dietary habits.

The food environment in Latin America: a systematic review with a focus on environments relevant to obesity and related chronic diseases

OBJECTIVE

Food environments may be contributing to the rapid increase in obesity occurring in most Latin American (LA) countries. The present study reviews literature from LA that (i) describes the food environment and policies targeting the food environment (FEP); and (ii) analytic studies that investigate associations between the FEP and dietary behaviours, overweight/obesity and obesity related chronic diseases. We focus on six dimensions of the FEP: food retail, provision, labelling, marketing, price and composition.

DESIGN

Systematic literature review. Three databases (Web of Science, SciELO, LILACS) were searched, from 1 January 1999 up to July 2017. Two authors independently selected the studies. A narrative synthesis was used to summarize, integrate and interpret findings.

SETTING

Studies conducted in LA countries.

PARTICIPANTS

The search yielded 2695 articles of which eighty-four met inclusion criteria.

RESULTS

Most studies were descriptive and came from Brazil (61 %), followed by Mexico (18 %) and Guatemala (6 %). Studies were focused primarily on retail/provision (n 27), marketing (n 16) and labelling (n 15). Consistent associations between availability of fruit and vegetable markets and higher consumption of fruits and vegetables were found in cross-sectional studies. Health claims in food packaging were prevalent and mostly misleading. There was widespread use of marketing strategies for unhealthy foods aimed at children. Food prices were lower for processed relative to fresh foods. Some studies documented high sodium in industrially processed foods.

CONCLUSIONS

Gaps in knowledge remain regarding policy evaluations, longitudinal food retail studies, impacts of food price on diet and effects of digital marketing on diet/health.

Food Purchasing Behaviors of a Remote and Rural Adult Solomon Islander Population

The aim of this study was to investigate the food purchasing behaviors of an adult Solomon Islander population within a transitioning food system in Auki, Malaita. Food purchasing behavior measures included; venue type and transportation for purchasing food, previous day expenditure on food purchases, number of weekly shopping experiences for store foods (generally long-life shelf and frozen items) and fresh foods (such as fruits and vegetables and fresh fish) and the importance of factors (i.e., price) on purchasing decisions. One hundred and thirty-three adults (aged 18 to 74 years; female: 63%, males: 37%) completed an interviewer administered questionnaire during December 2018. Food items were primarily sourced from Auki markets (n = 70) and stores (n = 40). Food purchasing differed between fresh and semi-perishable foods (store food). Participants reported similar shopping experiences for store food and fresh food (M = 3.87 and M = 3.25 times a week, respectively) and spending between $1 and $200 (M = $56.12) Solomon Island dollars on food in the previous day. The most reported purchased item was white rice (n = 117, 88%), with taste, freshness and family preference the most important factors reported as influencing food purchasing choices. While our findings are from a small sample in Auki, further research could build upon this work by investigating food purchasing behaviors at other times of the year, and more widely in the Solomon Islands and greater Pacific region.

Association between Food Store Availability and the Incidence of Functional Disability among Community-Dwelling Older Adults: Results from the Japanese Gerontological Evaluation Cohort Study

This study sought to clarify the association between food store availability and the incidence of disability in older adults. This study utilized a population-based cohort study of independent Japanese adults aged ≥65 years, which was a 6 year follow-up of participants in the Japan Gerontological Evaluation Study. A total of 31,273 respondents were extracted. Food store availability was evaluated based on the existence of food stores within 500/1000 m of the home. We utilized participant-reported subjective measurement as well as geographic information system-based objective measurement for the evaluation. The incidence of disability was determined using municipal data on eligibility for long-term care insurance benefits. There were 7643 (24.4%) community-dwelling participants with low subjective food store availability and 5673 (18.1%) with low objective food store availability. During the follow-up period of 6 years, the cumulative incidence of disability was 20.9%, with a significant association between low subjective food store availability and increased disability. Participants who reported low subjective food store availability had a significantly higher likelihood of developing disability (hazard ratio = 1.18, 95% confidence interval: 1.11-1.25) than those who reported high subjective food store availability after adjusting for age, sex, sociodemographic status, environmental status, walking and going out, dietary food intake, body mass index, and comorbidities. Low subjective food store availability was associated with early onset of disability. Accessibility of food stores might contribute to maintaining a disability-free life.

How and why does discretionary food consumption change when we promote fruit and vegetables? Results from the ShopSmart randomised controlled trial

OBJECTIVE

The present study aimed to identify whether discretionary food consumption declined in an intervention focused primarily on promoting fruit and vegetable consumption. We also aimed to identify potential mediators explaining intervention effects on discretionary food consumption.

DESIGN

Secondary analysis of data from the ShopSmart study, a randomised controlled trial involving a 6-month intervention promoting fruit and vegetable consumption. Linear regression models examined intervention effects on discretionary food consumption at intervention completion (T2). A half-longitudinal mediator analyses was performed to examine the potential mediating effect of personal and environmental factors on the association between the intervention effects and discretionary food consumption. Indirect (mediated) effects were tested by the product of coefficients method with bootstrapped se using Andrew Hayes' PROCESS macro for SPSS.

SETTING

Women were recruited via the Coles FlyBuys loyalty card database in socio-economically disadvantaged suburbs of Melbourne, Australia.

PARTICIPANTS

Analyses included 225 women (116 intervention and 109 control).

RESULTS

Compared with controls, intervention participants consumed fewer discretionary foods at T2, after adjusting for key confounders (B = -0·194, 95 % CI -0·378, -0·010 servings/d; P = 0·039). While some mediators were associated with the outcome (taste, outcome expectancies, self-efficacy, time constraints), there was no evidence that they mediated intervention effects.

CONCLUSIONS

The study demonstrated that a behavioural intervention promoting fruit and vegetable consumption among socio-economically disadvantaged participants was effective in reducing discretionary food intake. Although specific mediators were not identified, researchers should continue searching for mechanisms by which interventions have an effect to guide future programme design.

The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: a systematic review

A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.

Neighbourhood retail food outlet access, diet and body mass index in Canada: a systematic review

INTRODUCTION

There is growing interest in the role of food environments in suboptimal diet and overweight and obesity. This review assesses the evidence for the link between the retail food environment, diet quality and body mass index (BMI) in the Canadian population.

METHODS

We conducted a systematic keyword search in two bibliometric databases. We tabulated proportions of conclusive associations for each outcome and exposure of interest. Absolute and relative measures of exposure to the food environment were compared and theoretical framing of the associations noted. We assessed two key methodological issues identified a priori-measurement of BMI, and validation of the underlying retail food environment data.

RESULTS

Seventeen studies were included in the review. There was little evidence of a food environment-diet quality relationship and modest evidence of a food environment-BMI relationship. Relative measures of the food environment were more often associated with an outcome in the expected direction than absolute measures, but many results were inconclusive. Most studies adopted ecological theoretical frameworks but methodologies were similar regardless of stated theoretical approaches. Self-reported BMI was common and there was no "gold standard" database of food outlets nor a consensus on best ways to validate the data.

CONCLUSION

There was limited evidence of a relationship between the food environment and diet quality, but stronger evidence of a relationship between the food environment and BMI for Canadians. Studies with broad geographic scope that adopt innovative methods to measure diet and health outcomes and use relative measures of the food environment derived in geographic information systems are warranted. Consensus on a gold standard food environment database and approaches to its validation would also advance the field.

Adoption and Reach of a statewide policy, systems, and environment intervention to increase access to fresh fruits and vegetables in West Virginia

Local public health professionals’ consistency, connections, and presence at meetings were critical to making changes in schools, farmers markets, and retail food stores to improve access to fruits and vegetables in rural, low-income food deserts.

Validity and Reliability of the Facility List Coder, a New Tool to Evaluate Community Food Environments

A community food environment plays an essential role in explaining the healthy lifestyle patterns of its community members. However, there is a lack of compelling quantitative approaches to evaluate these environments. This study introduces and validates a new tool named the facility list coder (FLC), whose purpose is to assess food environments based on data sources and classification algorithms. Using the case of Mataró (Spain), we randomly selected 301 grids areas (100 m²), in which we conducted street audits in order to physically identify all the facilities by name, address, and type. Then, audit-identified facilities were matched with those automatically-identified and were classified using the FLC to determine its quality. Our results suggest that automatically-identified and audit-identified food environments have a high level of agreement. The intra-class correlation coefficient (ICC) estimates and their respective 95% confidence intervals for the overall sample yield the result “excellent” (ICC ≥ 0.9) for the level of reliability of the FLC.

Assessing the Retail Food Environment in Madrid: An Evaluation of Administrative Data against Ground Truthing

Previous studies have suggested that European settings face unique food environment issues; however, retail food environments (RFE) outside Anglo-Saxon contexts remain understudied. We assessed the completeness and accuracy of an administrative dataset against ground truthing, using the example of Madrid (Spain). Further, we tested whether its completeness differed by its area-level socioeconomic status (SES) and population density. First, we collected data on the RFE through the ground truthing of 42 census tracts. Second, we retrieved data on the RFE from an administrative dataset covering the entire city (n = 2412 census tracts), and matched outlets using location matching and location/name matching. Third, we validated the administrative dataset against the gold standard of ground truthing. Using location matching, the administrative dataset had a high sensitivity (0.95; [95% CI = 0.89, 0.98]) and positive predictive values (PPV) (0.79; [95% CI = 0.70, 0.85]), while these values were substantially lower using location/name matching (0.55 and 0.45, respectively). Accuracy was slightly higher using location/name matching (k = 0.71 vs 0.62). We found some evidence for systematic differences in PPV by area-level SES using location matching, and in both sensitivity and PPV by population density using location/name matching. Administrative datasets may offer a reliable and cost-effective source to measure retail food access; however, their accuracy needs to be evaluated before using them for research purposes.

A Systematic Review on Socioeconomic Differences in the Association between the Food Environment and Dietary Behaviors

Little is known about socioeconomic differences in the association between the food environment and dietary behavior. We systematically reviewed four databases for original studies conducted in adolescents and adults. Food environments were defined as all objective and perceived aspects of the physical and economic food environment outside the home. The 43 included studies were diverse in the measures used to define the food environment, socioeconomic position (SEP) and dietary behavior, as well as in their results. Based on studies investigating the economic (n = 6) and school food environment (n = 4), somewhat consistent evidence suggests that low SEP individuals are more responsive to changes in food prices and benefit more from healthy options in the school food environment. Evidence for different effects of availability of foods and objectively measured access, proximity and quality of food stores on dietary behavior across SEP groups was inconsistent. In conclusion, there was no clear evidence for socioeconomic differences in the association between food environments and dietary behavior, although a limited number of studies focusing on economic and school food environments generally observed stronger associations in low SEP populations. (Prospero registration: CRD42017073587)

Diet Quality Affects the Association between Census-Based Neighborhood Deprivation and All-Cause Mortality in Japanese Men and Women: The Japan Public Health Center-Based Prospective Study

Background: Individuals residing in more deprived areas with a lower diet quality might have a higher mortality risk. We aimed to examine the association between deprivation within an area and all-cause mortality risk according to diet quality. Methods: We conducted a population-based prospective study on 27,994 men and 33,273 women aged 45–75 years. Neighborhood deprivation was assessed using the Japanese areal deprivation index (ADI). Dietary intakes were assessed using a validated 147-item food frequency questionnaire. Results: Individuals residing in the most deprived area had the lowest dietary scores. During the 16.7-year follow-up, compared to individuals with a high quality diet residing in the least deprived area, individuals with a low quality diet had a higher risk of mortality according to increment of ADI (p trend = 0.03); the multivariate-adjusted hazard ratio (95% confidence interval) was 1.09 (0.999–1.19), 1.17 (1.08–1.27), and 1.19 (1.08–1.32) in those residing in the lowest through the highest third of ADI, respectively. However, individuals with a high quality diet had no significant association between ADI and mortality. Conclusion: A well-balanced diet may prevent early death associated with neighborhood socioeconomic status among those residing in highly deprived areas.

Social Integration may Moderate the Relationship between Neighborhood Vacancy and Mental Health Outcomes: Initial Evidence from Flint, Michigan

Long-term residence in neighborhoods is thought to promote the development and maintenance of supportive relationships and trust. These strong social ties may, however, be limited in communities in post-industrial cities characterized by high levels of vacant properties. This study aimed to examine the relationship between neighborhood vacancy and mental health with adjustment for length of residence and possible moderation by social (dis)integration in a sample of Flint, MI, residents. We found that short-term (but not long-term) increases in neighborhood vacancy were associated with poorer mental health, after adjustment for individual covariates. When considering neighborhood vacancy, length of residence and individual covariates, however, the only significant association detected was between higher social disintegration and lower wellbeing. This effect was direct and not mediated by other factors. In this way, it appears that the social conditions of neighborhoods may be important, particularly in places that have experienced declines in the built environment. In addition, we identified evidence that social integration moderates the relationship between neighborhood vacancy and mental health outcomes. The level of neighborhood vacancies had a weaker relationship to wellbeing among those with higher levels of social ties. But none of the independent variables in our study were able to predict social integration, highlighting some potential areas for future research. From these findings, we posit that establishing strong social connections can buffer residents against negative mental health outcomes, and health promotion efforts could usefully assist in maintaining social ties among neighbors.

Food environment, income and obesity: a multilevel analysis of a reality of women in Southern Brazil

The objective of this study was to explore relationships between the neighborhood food environment and obesity in urban women living in São Leopoldo, Rio Grande do Sul State, Brazil. A cross-sectional survey was carried out. This study was conducted with 1,096 women. Structured interviews were conducted using a standard pre-tested questionnaire. Obesity was defined as body mass index (BMI) ≥ 30kg/m2. Circular buffers of 400m in radius were created based on the centroid of the women's houses who participated, in the 45 census tracts inhabited by them. Neighborhood food establishments were identified through systematic survey of all streets in the study areas and geographical coordinates of shops were collected. Establishments were evaluated using the NEMS tool. The prevalence of obesity was 33% among the women participants. After adjusting for individual variables, supermarkets and healthy food establishments were positively associated with obesity, PR = 1.05 (95%CI: 1.01-1.10), PR = 1.02 (95%CI: 1.00-1.04), respectively, while mean buffer income was negatively associated, PR = 0.64 (95%CI: 0.49-0.83). Neighborhood food environment factors were associated with obesity even after controlled for individual variables, as socioeconomic variables, behavioral and food purchase.

Caractériser l'environnement alimentaire d'une municipalité régionale de comté pour identifier les zones prioritaires d'intervention en matière de sécurité alimentaire

OBJECTIVES

Food security intervention is particularly complex in rural areas. The local stakeholders of the regional county municipality (RCM) of Portneuf wished to analyze the regional food supply in order to reduce food insecurity. The objective of this study was to characterize the RCM's food environment and to identify potential food deserts and priority intervention areas.

METHOD

We measured the quality of the food supply in the RCM's food stores, using four indicators: freshness, diversity, economic accessibility and relative availability. We mapped the distance between residences and the nearest food store with a favourable result for all four indices to locate potential food deserts. We then presented the mapping of the food environment to a group of local stakeholders and compared it to their own perception.

RESULTS

This study reveals three sectors that meet the criteria of a food desert in the RCM. Local actors did not perceive these sectors as food deserts, but thought they were at risk of becoming such in the future. We complemented the measures by taking into account the structuring impact of certain infrastructures as well as the temporal and seasonal accessibility of food stores in rural areas. Only one priority intervention area was suggested.

CONCLUSION

Presenting geographical analyses to local stakeholders improved the characterization of the studied food environment. The use of a mixed methodology has enabled the particularities of the rural environment to be better accounted for and has facilitated intersectoral mobilization around food insecurity at the regional level.

Gender differences in the association between modifiable risk factors and financial hardship among middle-aged and older adults

Objective

To identify associations between modifiable risk factors (cigarette smoking, alcohol consumption, and obesity) and financial hardship (difficulty paying bills, food insecurity and medication need) among middle-aged and older Americans in a nationally representative sample.

Methods

This was a cross-sectional study of 8212 persons age 50 years and older who completed the core 2010 Health and Retirement Study survey and the psychosocial questionnaire. We ran separate multinomial logistic regressions to assess the association of three modifiable risk factors and three different financial hardship indicators.

Results

Adjusting for all covariates, compared to men of normal weight, men who were obese had a 1.4 greater odds of difficulty paying their bills (95% CI: 1.08–1.76); former smokers had a 1.8 greater odds of being food insecure (95% CI: 1.05–2.95); current smokers were twice as likely to be food insecure (95% CI: 1.21–3.73); Compared to women who never smoked, current smokers had a 1.5 greater odds of having difficulty paying their bills (95% CI: 1.11–2.02); current smokers had a 1.8 greater odds of being food insecure (95% CI: 1.13–2.91); and women who were obese had a 1.5 greater odds of reducing medication due to cost (95% CI: 1.11, 2.02).

Conclusion

Our findings contribute to the literature on health behaviors and financial hardship by highlighting the cyclical nature between different indicators of socioeconomic status, modifiable risk factors, and poor health outcomes among middle-aged and older adults. Furthermore, findings highlight how modifiable risk factors may culminate in financial hardship in later life.

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This study contributes to the literature by describing the connection between health and individual and family finances.

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More than 60% of women in our sample had difficulty paying bills

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Close to 70% of women were food insecure, and 70% reduced medication use due to cost

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Modifiable risk behaviors – often socioeconomically patterned, may culminate in financial hardship in later life.

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This study highlights the importance of ongoing efforts to improve income equity between the genders.

Walkability, Overweight, and Obesity in Adults: A Systematic Review of Observational Studies

We conducted a systematic review to describe and summarize possible associations between the walkability index, overweight, and obesity. Systematic searches using seven electronic databases and reference lists were conducted to identify papers published until December 2017. Observational studies, describing associations using regression-based statistical methods, published in English and Portuguese, reporting markers of overweight and obesity, and involving adults (≥18 years) were included. Of the 2469 references initially retrieved, ten were used for the descriptive synthesis. Seven studies showed significant inverse associations between walkability and overweight and obesity, however, all were cross-sectional studies. High risk of bias scores were observed in "selection bias" and "withdrawals and dropouts". All studies were published in high-income countries with sample sizes ranging among 75 to 649,513 participants. Weight and height as measures for determining BMI tended to be self-reported. Indicators of walkability, such as land-use mix, street connectivity and residential density were used as components of the indices. Based on this review, more studies should be conducted in low, middle, and middle-high income countries, using longitudinal designs that control neighborhood self-selection; other indicators of the neighborhood environment, such as food access, physical activity facilities, sidewalks, and safety and crime prevention should be considered.

Objective and perceived food environment and household economic resources related to food insecurity in older adults living alone in rural areas

Background

Limited attention has been paid to an association between food environment and household economic resources related to food expenditure in food-insecure seniors. The aim of the study was to investigate the relationship between factors of economic resource, food environment, and food insecurity in single seniors residing in rural areas of South Korea.

Methods

A cross-sectional study was conducted in 170 single senior households aged 65 years or over residing in rural areas. Face-to-face interviews were performed to collect data on demographic characteristics, household economic resources/expenditure, food environmental factors, and food insecurity.

Results

Among economic resources, generally limited food expenditures due to housing fees and heating costs during the winter were positively related to food insecurity. Among food environmental factors, food accessibility at community level such as food stores located far from home and inconvenient bus routes was related to food insecurity. The most explainable economic and food environment factors related to food insecurity by stepwise logistic regression analysis were the percentage of total expenditure on housing fee (OR = 1.021, 95% CI: 1.008–1.034), foods purchasing at super supermarket (OR = 0.398, 95% CI: 0.166–0.951), having difficulties in food purchasing due to food stores being located far from home (OR = 14.487, 95% CI: 5.139–40.842) and inconvenient bus routes (OR = 0.083, 95% CI: 0.015–0.460).

Conclusion

Inadequate community food environment as well as limited household food resources were an important risk factor for food insecurity in Korean single rural seniors. Findings of this study could help us better understand how characteristics of household food resources and community food environment can serve as barriers or facilitators of food security among single older adults residing in rural areas.

Food store environment examination - FoodSee: a new method to study the food store environment using wearable cameras

INTRODUCTION

Food environments shape food behaviours and are implicated in rising rates of obesity worldwide. Measurement of people's interactions with food stores is important to advance understanding of the associations between the food environment and in-store behaviour. This paper describes a new method, Food Store Environment Examination (FoodSee) to measure people's interaction with the food store environment in a feasibility study focused on convenience stores and children.

METHODS

One hundred and sixty-eight randomly selected children (aged 11-13 years) recruited from 16 randomly selected schools in Wellington, New Zealand, used wearable cameras for 4 days that recorded images every 7 s. The study was conducted from July 2014 to June 2015. All images of convenience stores and service stations, and a sample of images from supermarkets, were evaluated to determine the feasibility of assessing food availability and marketing. The outcomes of interest assessed were: food product availability, placement, packaging, branding, price promotion, purchases and consumption.

RESULTS

Thirty-seven children (22%) visited a convenience store or service station at least once during the study period. In total, there were 65 visits to 34 different stores. Seven hundred and nineteen images revealed the in-store environment. Of those, 86.1% were usable and able to be analysed for the outcomes of interest.

CONCLUSIONS

The FoodSee methodology provides a promising new method to study people's interaction with the in-store food environment. The evidence generated will be valuable in understanding and improving the food store environment within which people shop, and will contribute to efforts to address obesity globally.

Comparing Different Residential Neighborhood Definitions and the Association Between Density of Restaurants and Home Cooking Among Dutch Adults

The definition of neighborhoods as areas of exposure to the food environment is a challenge in food environment research. We aimed to test the association of density of restaurants with home cooking using four different definitions of residential neighborhoods. We also tested effect modification by age, length of residency, education, and income. This innovative cross-sectional study was conducted in the Netherlands (N = 1245 adults). We calculated geographic information system-based measures of restaurant density using residential administrative neighborhood boundaries, 800 m and 1600 m buffers around the home and respondents' self-defined boundaries (drawn by the respondents on a map of their residential area). We used adjusted Poisson regression to test associations of restaurant density (tertiles) and the outcome "weekly consumption of home-cooked meals" (six to seven as compared to five days per week (day/week) or fewer). Most respondents reported eating home-cooked meals for at least 6 day/week (74.2%). Regardless of the neighborhood definition used, no association between food environment and home cooking was observed. No effect modification was found. Although exposure in terms of density of restaurants was different according to the four different neighborhood definitions, we found no evidence that the area under study influences the association between density of restaurants and home cooking among Dutch adults.

Activity space metrics not associated with sociodemographic variables, diet or health outcomes in the Seattle Obesity Study II

BACKGROUND

Activity spaces (AS), captured using GPS tracking devices, are measures of dynamic exposure to the built environment (BE).

METHODS

Seven days of Global Positioning Systems (GPS) tracking data were obtained for 433 adult participants in the Seattle Obesity Study (SOS II). Heights and weights were measured. Dietary intakes from a food frequency questionnaire were used to calculate Healthy Eating Index (HEI 2010) scores. Linear regression analyses examined associations between AS measures: daily route length, convex hull, and radius of gyration, and diet quality and health outcomes, adjusting for covariates.

RESULTS

AS measures did not vary by age, gender, race/ethnicity, or socioeconomic status. AS measures were not associated with diet quality or with self-reported obesity or diabetes. One AS measure, route length (in miles), was associated with being employed, living in the suburbs, and with distance and time commuting to work.

CONCLUSION

Spatial mobility studies based on GPS tracking of environmental exposure need to demonstrate a link to relevant health outcomes.

Measuring Rural Food Environments for Local Action in Australia: A Systematic Critical Synthesis Review

Poor diet is a significant contributor to obesity and chronic disease. With all being more prevalent in rural than urban Australia, modifying the food environment is a potential intervention point to improve the health of rural populations. This review examined the applicability of measurement tools used in rural food environment research for rural Australia. Six electronic databases were searched for peer-reviewed literature, published in English between 2006 and 2018, including at least one objective measure of the Community or Consumer Food Environment in a rural or mixed rural/urban context. One-hundred and seventy-seven papers were returned after removal of duplicates, with a final review of 25. Most studies were cross-sectional, with one intervention study of quasi-experimental design. Nine studies employed a conceptual model; there was considerable variability in tools used; and few described psychometric testing. The most common attribute measured was price, followed by available healthy options. The findings of this review do not offer a suite of ‘gold standard’ measurement tools known to be reliable, valid and sensitive to change to assess the community or consumer food environments in rural Australian towns. However, recommendations are proposed to progress this important area of research within a rural context.

Association between access to health-promoting facilities and participation in cardiovascular disease (CVD) risk screening among populations with low socioeconomic status (SES) in Singapore

BACKGROUND

Low socioeconomic status (SES) is a barrier for cardiovascular disease (CVD) risk screening and a determinant of poor CVD outcomes. This study examined the associations between access to health-promoting facilities and participation in a CVD risk screening program among populations with low SES residing in public rental flats in Singapore.

METHODS

Data from Health Mapping Exercises conducted from 2013 to 2015 were obtained, and screening participation rates of 66 blocks were calculated. Negative binomial regression was used to test for associations between distances to four nearest facilities (i.e., subsidized private clinics, healthy eateries, public polyclinics, and parks) and block participation rate in CVD screening. We also investigated potential heterogeneity in the association across regions with an interaction term between distance to each facility and region.

RESULTS

The analysis consisted of 2069 participants. The associations were only evident in the North/North-East region for subsidized private clinic and park. Specifically, increasing distance to the nearest subsidized private clinic and park was significantly associated with lower [incidence rate ratio (IRR) = 0.88, 95% confidence interval (CI): 0.80-0.98] and higher (IRR = 1.93, 95%CI: 1.15-3.25) screening participation rates respectively.

CONCLUSIONS

Our findings could potentially inform the planning of future door-to-door screenings in urban settings for optimal prioritization of resources. To increase participation rates in low SES populations, accessibility to subsidized private clinics and parks in a high population density region should be considered.

Effect of implementation of a University Restaurant on the diet of students in a Brazilian public university

Abstract Dietary practices of college students were compared before and after implementation of the University Restaurant (UR) and examined according to frequency of UR use. A natural experiment was conducted with students (n = 1131) of a Brazilian public university using a validated self-completed and identified questionnaire that inquired information on practices of substituting lunch and/or dinner with a snack (≥ 5 days/week) and on regular consumption of foods that were markers of a healthy or unhealthy diet. At the second time point, UR use by students was also assessed based on their attendance to it. Changes in food practices were examined by determining differences in proportions between the two assessments. The analysis of the association between UR use and each dietary practice was carried out using multiple logistic regression models. An association was observed between greater UR use and higher frequency of regular consumption of beans, vegetables, raw vegetables, cooked vegetables and fruit and lower frequency of regular consumption of French fries and/or fried snacks. The UR proved to be an environment that facilitated the adoption of healthy dietary practices and promoted improvement in the diets of the students who were more assiduous to the restaurant.

Issues in Measuring the Healthiness of Food Environments and Interpreting Relationships with Diet, Obesity and Related Health Outcomes

PURPOSE OF REVIEW

There is a broad consensus that policies to create healthier food environments are needed to address obesity. However, previous reviews of the relationships between the healthiness of food environments and diet/obesity-related outcomes have typically reported either mixed associations or none at all. This paper aimed to synthesise measurement and interpretation issues in this field, based on findings from previous reviews.

RECENT FINDINGS

Key issues, drawn from 14 previous reviews in the last decade, included: (1) the use of measures of the food environments that are too narrow in scope; (2) inadequate measures of the way in which people are exposed to, and interact with, food environments; and (3) large heterogeneity in tools and methods used. To evaluate the impact of food environments on diet and health, composite measures of the healthiness of food environments, informed by actual usage patterns, need to be developed and consistently applied.

The evolution of local food environments within established neighbourhoods and new developments in Perth, Western Australia

Temporal changes in the location of food outlets can result in disparities in the availability and access of food across geographic areas, contributing to health inequalities. This study used mixed linear models to investigate how the location of food outlets around the home evolved over time with respect to area-level socio-economic status (SES) and urban design within established neighbourhoods and new residential developments. Food outlet data (supermarket/greengrocers, convenience stores, café restaurants and takeaway/fast food) were sourced from commercial database listings (SENSIS Pty. Ltd.) in 2004, 2006, 2007, and 2011. Using 2468 addresses from the RESIDential Environments Project (RESIDE), in Perth, Western Australia (WA), a count of each food outlet type and percentage of healthy food outlets within a 1.6 km road network buffer around the home, along with the road network distance to nearest food outlet were generated relative to each address at each time point. Proximity to and count of all food outlets increased over time in both new developments and established neighbourhoods. However, unhealthy food outlets were always in greater numbers and proximity to the home. The percentage of healthy food outlets was significantly greater in established neighbourhoods compared to new developments at all four time points. There were significantly more food outlets, and within closer proximity to the home, in established neighbourhoods compared to new developments at each time point. In established neighbourhoods, there were more convenience stores, takeaway/fast food and café restaurants, a lower percentage of healthy food outlets, and closer proximity to convenience stores in lower compared to high SES areas. In new developments there were significantly less supermarket/greengrocers, a lower percentage of healthy food outlets and greater proximity to takeaway/fast food and café restaurants in low compared to high SES areas. New developments designed according to the WA government's "Liveable Neighbourhoods Community Design Guidelines" policy had significantly more of all food outlets compared to other new developments. As such, people living in new developments, and low SES areas of Perth, may be disadvantaged with poorer access to healthy food outlets and greater exposure to unhealthy food outlets. Future urban planning and policy should focus on providing incentives that support the early development of supermarkets and healthy food outlets within new developments and low SES areas of Perth.

Entrepreneurialism and health-promoting retail food environments in Canadian city-regions

The retail sector is a dynamic and challenging component of contemporary food systems with an important influence on population health and nutrition. Global consensus is clear that policy and environmental changes in retail food environments are essential to promote healthier diets and reduce the burden of obesity and non-communicable diseases. In this article, we explore entrepreneurialism as a form of social change-making within retail food environments, focusing on small food businesses. Small businesses face structural barriers within food systems. However, conceptual work in multiple disciplines and evidence from promising health interventions tested in small stores suggest that these retail places may have a dual role in health promotion: settings to strengthen regional economies and social networks, and consumer environments to support healthier diets. We will discuss empirical examples of health-promoting entrepreneurialism based on two sets of in-depth interviews we conducted with public health intervention actors in Toronto, Canada, and food entrepreneurs and city-region policy actors in St. John's, Canada. We will explore the practices of entrepreneurialism in the retail food environment and examine the implications for population health interventions. We contend that entrepreneurialism is important to understand on its own and also as a dimension of population health intervention context. A growing social scientific literature offers a multifaceted lens through which we might consider entrepreneurialism not only as a set of personal characteristics but also as a practice in networked and intersectoral cooperation for public and population health.

Methods of measuring associations between the Retail Food Environment and weight status: Importance of classifications and metrics

Despite considerable research, evidence supporting associations between the 'Retail Food Environment' (RFE) and obesity remains mixed. Differences in the methods used to measure the RFE may explain this heterogeneity. Using data on a large (n = 10,111) sample of adults from the Yorkshire Health Study (UK), we modelled cross-sectional associations between the RFE and weight status using (i) multiple definitions of 'Fast Food', 'Convenience' and 'Supermarkets' and (ii) multiple RFE metrics, identified in a prior systematic review to be common in the literature. Both the choice of outlet definition and the choice of RFE metric substantively impacted observed associations with weight status. Findings differed in relation to statistical significance, effect sizes, and directions of association. This study provides novel evidence that the diversity of RFE measurement methods is contributing to heterogeneous study findings and conflicting policy messages. Greater attention is needed when selecting and communicating RFE measures in research.

A systematic review employing the GeoFERN framework to examine methods, reporting quality and associations between the retail food environment and obesity

This systematic review quantifies methods used to measure the 'retail food environment' (RFE), appraises the quality of methodological reporting, and examines associations with obesity, accounting for differences in methods. Only spatial measures of the RFE, such as food outlet proximity were included. Across the 113 included studies, methods for measuring the RFE were extremely diverse, yet reporting of methods was poor (average reporting quality score: 58.6%). Null associations dominated across all measurement methods, comprising 76.0% of 1937 associations in total. Outcomes varied across measurement methods (e.g. narrow definitions of 'supermarket': 20.7% negative associations vs 1.7% positive; broad definitions of 'supermarket': 9.0% negative associations vs 10.4% positive). Researchers should report methods more clearly, and should articulate findings in the context of the measurement methods employed.