The local food environment and diet: a systematic review

A scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence

INTRODUCTION

Despite the accumulating Canadian evidence regarding the relations between urban form and health behaviours, less is known about the associations between urban form and health conditions. Our study aim was to undertake a scoping review to synthesize evidence from quantitative studies that have investigated the relationship between built environment and chronic health conditions, self-reported health and quality of life, and injuries in the Canadian adult population.

METHODS

From January to March 2017, we searched 13 databases to identify peer-reviewed quantitative studies from all years that estimated associations between the objectively-measured built environment and health conditions in Canadian adults. Studies under-taken within urban settings only were included. Relevant studies were catalogued and synthesized in relation to their reported study and sample design, and health outcome and built environment features.

RESULTS

Fifty-five articles met the inclusion criteria, 52 of which were published after 2008. Most single province studies were undertaken in Ontario (n = 22), Quebec (n = 12), and Alberta (n = 7). Associations between the built environment features and 11 broad health outcomes emerged from the review, including injury (n = 19), weight status (n = 19), cardiovascular disease (n = 5), depression/anxiety (n = 5), diabetes (n = 5), mortality (n = 4), self-rated health (n = 2), chronic conditions (n = 2), metabolic condi-tions (n = 2), quality of life (n = 1), and cancer (n = 1). Consistent evidence for associations between aggregate built environment indicators (e.g., walkability) and diabetes and weight and between connectivity and route features (e.g., transportation route, trails, pathways, sidewalks, street pattern, intersections, route characteristics) and injury were found. Evidence for greenspace, parks and recreation features impacting multiple health outcomes was also found.

CONCLUSION

Within the Canadian context, the built environment is associated with a range of chronic health conditions and injury in adults, but the evidence to date has limitations. More research on the built environment and health incorporating rigorous study designs are needed to provide stronger causal evidence to inform policy and practice.

Supermarket access and childhood bodyweight: Evidence from store openings and closings

Retail food environment is increasingly considered in relation to obesity. This study investigates the impacts of access to supermarkets, the primary source of healthy foods in the United States, on the bodyweight of children. Empirical analysis uses individual-level panel data covering health screenings of public schoolchildren from Arkansas with annual georeferenced business lists, and utilizes the variations of supermarket openings and closings. There is little overall impact in either case. However, supermarket openings are found to reduce the BMI z-scores of low-income children by 0.090 to 0.096 standard deviations. Such impact remains in a variety of robustness exercises. Therefore, improvement in healthy food access could at least help reduce childhood obesity rates among certain population groups.

A food hub to address healthy food access gaps: Residents' preferences

Interventions aimed at improving access to healthy food in low-income communities should consider the preferences of residents. Household food shoppers in two urban, low-income communities were asked about their preferences for vendors at, and qualities of, a potential nearby food hub. Universally, participants preferred availability of whole foods, primarily fruits and vegetables. They also favored cleanliness, quality, and affordability. The demographics and preferences of potential customers raise central issues that would need to be integrated into the development of a food hub, namely affordability (likely through subsidization), attention to accommodation and cultural accessibility, and programming that builds community.

Disability and food access and insecurity: A scoping review of the literature

A scoping review was conducted, using a social ecological model approach, of 106 articles examining the effect of disability on food access and (in)security. Results of the review show a consistently increased risk of food insecurity among people with disabilities with a higher risk for mental health disabilities, and among disabled younger adults. Mediators of this relationship were underexplored. Disability was mainly conceptualized as a problematic category preventing food access while ignoring disabling social and environmental barriers. A social model of disability can inform future research by acknowledging the role of socio-environmental influences on the production and experience(s) of disability.

Socioecological Path Analytic Model of Diet Quality among Residents in Two Urban Food Deserts

BACKGROUND

Diet is critical to chronic disease prevention, yet there are persistent disparities in diet quality among Americans. The socioecological model suggests multiple factors, operating at multiple levels, influence diet quality.

OBJECTIVE

The goal was to model direct and indirect relationships among healthy eating identity, perceived control of healthy eating, social support for healthy eating, food retail choice block scores, perceptions of healthy food availability, and food shopping behaviors and diet quality measured using Healthy Eating Index-2010 scores (HEI-2010) for residents living in two urban communities defined as food deserts.

DESIGN

A cross-sectional design was used including data collected via self-reported surveys, 24-dietary recalls, and through objective observations of food retail environments.

PARTICIPANTS/SETTING

Data collection occurred in 2015-2016 in two low-income communities in Cleveland (n=243) and Columbus (n=244), OH.

MAIN OUTCOME MEASURE

HEI-2010 scores were calculated based on the average of three 24-hour dietary recalls using the Nutrition Data System for Research.

ANALYSIS

Separate path models, controlled for income, were run for each community. Analysis was guided by a conceptual model with 15 hypothesized direct and indirect effects on HEI-2010 scores. Associations were considered statistically significant at P<0.05 and P<0.10 because of modest sample sizes in each community.

RESULTS

Across both models, significant direct effects on HEI-2010 scores included healthy eating identity (β=.295, Cleveland; β=.297, Columbus, P<0.05) and distance traveled to primary food store (β=.111, Cleveland, P<0.10; β=.175, Columbus, P<0.05). Perceptions of healthy food availability had a significant, inverse effect in the Columbus model (β=-.125, P<0.05). The models explained greater variance in HEI-2010 scores for the Columbus community compared with Cleveland (R²=.282 and R²=.152, respectively).

CONCLUSIONS

Findings highlight the need for tailored dietary intervention approaches even within demographically comparable communities. Interventions aimed at improving diet quality among residents living in food deserts may need to focus on enhancing healthy eating identity using culturally relevant approaches while at the same time addressing the need for transportation supports to access healthy food retailers located farther away.

Built Environment and Health Behaviors: Deconstructing the Black Box of Interactions-A Review of Reviews

A review of reviews following a scoping review study design was conducted in order to deconstruct the black box of interactions between the built environment and human behaviors pertaining to physical activity and/or diet. In the qualitative analysis 107 records were included, 45 of which were also coded. Most review papers confirmed the influence of the built environment on the behaviors of interest with some noting that a same built environment feature could have different behavioral outcomes. The conceptual model developed sheds light on these mixed results and brings out the role of several personal and behavioral factors in the shift from the measured to the perceived built environment. This shift was found to shape individuals' behaviors critically and to have the power of redefining the strength of every interaction. Apart from its theoretical relevance, this model has high practical relevance especially for the design and implementation of interventions with a behavioral component. Intervention researchers can use the model developed to identify and label the built environment and individual factors that can be measured objectively or perceived as facilitators, concurrent options and barriers, in order to develop comprehensive and multi-component intervention strategies.

We Don't Have a Lot of Healthy Options: Food Environment Perceptions of First-Year, Minority College Students Attending a Food Desert Campus

First-year college students are at particular risk of dietary maladaptation during their transition to adulthood. A college environment that facilitates consistent access to nutritious food is critical to ensuring dietary adequacy among students. The objective of the study was to examine perceptions of the campus food environment and its influence on the eating choices of first-year students attending a minority-serving university located in a food desert. Focus group interviews with twenty-one first-year students were conducted from November 2016 to January 2017. Students participated in 1 of 5 focus groups. Most interviewees identified as being of Hispanic/Latino or Asian/Pacific Islander origin. A grounded theory approach was applied for inductive identification of relevant concepts and deductive interpretation of patterns and relationships among themes. Themes related to the perceived food environment included adequacy (i.e., variety and quality), acceptability (i.e., familiarity and preferences), affordability, and accessibility (i.e., convenience and accommodation). Subjective norms and processes of decisional balance and agency were themes characterizing interpersonal and personal factors affecting students' eating choices. The perceived environment appeared to closely interact with subjective norms to inform internal processes of decision-making and agency around the eating choices of first-year students attending a minority-serving university campus located in a food desert.

The Academic, Behavioral, and Health Influence of Summer Child Nutrition Programs: A Narrative Review and Proposed Research and Policy Agenda

Since 1975, the US Department of Agriculture has sponsored the Summer Food Service Program as a nationwide strategy for providing nutritious meals to children and youth (aged 18 years or younger) in low-income communities during the summer months. Many programs are sponsored by community organizations as well as school districts that may offer the program through the Summer Food Service Program or a seamless waiver, allowing them to extend school meals programs into the summer. These summer nutrition programs are designed to decrease food insecurity and improve health outcomes among at-risk populations. However, the characteristics of these programs, including the types of participants reached, and the programs' influence on outcomes such as academics, behavior, and physical and mental health, have not been summarized. The aims of this narrative review are to present existing knowledge about the characteristics of summer nutrition programs and their influence on students, to identify knowledge gaps, and to identify future research needs. An extensive search identified eight peer-reviewed articles and 10 reports, briefs, or other documents reporting research on the Summer Food Service Program. A variety of additional literature was reviewed to provide relevant information about summer nutrition programs. The review revealed a dearth of research regarding current Summer Food Service Program implementation. Summer nutrition programs alleviated food insecurity among at-risk populations; however, little research was found about the influence of summer programs on students' dietary intake or weight outcomes. More rigorous and mixed-methods studies examining the characteristics and influence of summer nutrition programs are needed.

A Time-Based Objective Measure of Exposure to the Food Environment

Exposure to food environments has mainly been limited to counting food outlets near participants’ homes. This study considers food environment exposures in time and space using global positioning systems (GPS) records and fast food restaurants (FFRs) as the environment of interest. Data came from 412 participants (median participant age of 45) in the Seattle Obesity Study II who completed a survey, wore GPS receivers, and filled out travel logs for seven days. FFR locations were obtained from Public Health Seattle King County and geocoded. Exposure was conceptualized as contact between stressors (FFRs) and receptors (participants’ mobility records from GPS data) using four proximities: 21 m, 100 m, 500 m, and ½ mile. Measures included count of proximal FFRs, time duration in proximity to ≥1 FFR, and time duration in proximity to FFRs weighted by FFR counts. Self-reported exposures (FFR visits) were excluded from these measures. Logistic regressions tested associations between one or more reported FFR visits and the three exposure measures at the four proximities. Time spent in proximity to an FFR was associated with significantly higher odds of FFR visits at all proximities. Weighted duration also showed positive associations with FFR visits at 21-m and 100-m proximities. FFR counts were not associated with FFR visits. Duration of exposure helps measure the relationship between the food environment, mobility patterns, and health behaviors. The stronger associations between exposure and outcome found at closer proximities (<100 m) need further research.

The Moving to Health (M2H) approach to natural experiment research: A paradigm shift for studies on built environment and health

Improving the built environment (BE) is viewed as one strategy to improve community diets and health. The present goal is to review the literature on the effects of BE on health, highlight its limitations, and explore the growing use of natural experiments in BE research, such as the advent of new supermarkets, revitalized parks, or new transportation systems. Based on recent studies on movers, a paradigm shift in built-environment health research may be imminent. Following the classic Moving to Opportunity study in the US, the present Moving to Health (M2H) strategy takes advantage of the fact that changing residential location can entail overnight changes in multiple BE variables. The necessary conditions for applying the M2H strategy to Geographic Information Systems (GIS) databases and to large longitudinal cohorts are outlined below. Also outlined are significant limitations of this approach, including the use of electronic medical records in lieu of survey data. The key research question is whether documented changes in BE exposure can be linked to changes in health outcomes in a causal manner. The use of geo-localized clinical information from regional health care systems should permit new insights into the social and environmental determinants of health.

Assessing Support for Advantaged and Disadvantaged Groups: A Comparison of Urban Food Environments

Individuals from lower-socio-economic status (SES) communities have increased risk of developing obesity in developed countries such as Australia. Given the influence of the environment on dietary behaviour, this paper seeks to examine food environments in areas of differing social advantage. An established measurement tool (the NEMS-Nutrition Environment Measurement Survey), that captures aspects of support for healthy eating within restaurants (NEMS-R) and grocery/convenience stores (NEMS-S), was applied to both a high-SES and a low-SES suburb within Brisbane, Australia. The study found a significantly more supportive restaurant food environment in the high-SES suburb, with greater access to and availability of healthful foods, as well as facilitators for, reduced barriers to, and substantially more nutrition information for healthful eating. A higher number of outlets were found in the high-SES suburb, and later opening times were also observed. Overall, the results from stores (NEMS-S) suggest poor support for healthful eating across both suburbs. This study highlights how food environments in low-SES regions continue to be less supportive of healthful eating. Public health strategies must move beyond individual-focused strategies to ensure that our most disadvantaged, low-SES communities have an equal opportunity to access healthful foods.

Census Tract Food Tweets and Chronic Disease Outcomes in the U.S., 2015⁻2018

There is a growing recognition of social media data as being useful for understanding local area patterns. In this study, we sought to utilize geotagged tweets—specifically, the frequency and type of food mentions—to understand the neighborhood food environment and the social modeling of food behavior. Additionally, we examined associations between aggregated food-related tweet characteristics and prevalent chronic health outcomes at the census tract level. We used a Twitter streaming application programming interface (API) to continuously collect ~1% random sample of public tweets in the United States. A total of 4,785,104 geotagged food tweets from 71,844 census tracts were collected from April 2015 to May 2018. We obtained census tract chronic disease outcomes from the CDC 500 Cities Project. We investigated associations between Twitter-derived food variables and chronic outcomes (obesity, diabetes and high blood pressure) using the median regression. Census tracts with higher average calories per tweet, less frequent healthy food mentions, and a higher percentage of food tweets about fast food had higher obesity and hypertension prevalence. Twitter-derived food variables were not predictive of diabetes prevalence. Food-related tweets can be leveraged to help characterize the neighborhood social and food environment, which in turn are linked with community levels of obesity and hypertension.

Spatial Association of Food Sales in Supermarkets with the Mean BMI of Young Men: An Ecological Study

Supermarket food sales data might serve as a simple indicator of population-level dietary habits that influence the prevalence of excess weight in local environments. To test this possibility, we investigated how variation in store-level food sales composition across Switzerland is associated with the mean Body Mass Index (BMI) of young men (Swiss Army conscripts) living near the stores. We obtained data on annual food sales (2011) for 553 stores from the largest supermarket chain in Switzerland, identified foods commonly regarded as “healthy” or “unhealthy” based on nutrient content, and determined their contribution to each store’s total sales (Swiss francs). We found that the sales percentages of both “healthy” and “unhealthy” food types varied by 2- to 3-fold among stores. Their balance ranged from −15.3% to 18.0% of total sales; it was positively associated with area-based socioeconomic position (r = 0.63) and negatively associated with the mean BMI of young men in the area (r = −0.42). Thus, even though we compared supermarkets from a single chain, different shopping behaviors of customers caused stores in privileged areas to sell relatively more healthy food. Knowledge about such patterns could help in designing in-store interventions for healthier nutrition and monitoring their effects over time.

Comparison of Objective and Perceived Access to Food Stores Associated with Intake Frequencies of Vegetables/Fruits and Meat/Fish among Community-Dwelling Older Japanese

This cross-sectional study aimed to compare access to the nearest food stores with perceived access associated with intake frequencies of vegetables/fruits and meat/fish among older Japanese people. We used intake frequencies of vegetables/fruits and meat/fish from a self-administered questionnaire in the Japan Gerontological Evaluation Study among 83,384 adults aged over 65 years. We defined distance over 1 km as poor objective access in community level. We performed multilevel regression analysis to investigate the association of objective and perceived access with intake frequencies of vegetables/fruits and meat/fish, respectively. Participants who lived in poor objective access had a significantly higher intake frequency of vegetables/fruits than those who lived in good access. In contrast, residents with poor perceived access consumed lower frequent intake of vegetables/fruits (beta coefficient (standard error) 0.086 (0.021) for objective access; -0.093 (0.009) for perceived access). There was no significant association between objective access and intake frequency of meat/fish, but poor perceived access showed a significant association with lower intake frequency of meat/fish. There was inconsistency between objective and perceived measurement of access to food stores associated with dietary habits among older Japanese adults. Food access needs to be comprehensively assessed, while considering characteristics of measurements.

Neighborhood Food Environment and Dementia Incidence: the Japan Gerontological Evaluation Study Cohort Survey

INTRODUCTION

Interventions targeting built environmental factors may encourage older people to engage in favorable behaviors and decrease dementia risk, but epidemiologic evidence is limited. This study investigated the association between neighborhood food environment and dementia incidence.

METHODS

A 3-year follow-up (2010-2013) was conducted among participants in the Japan Gerontological Evaluation Study, a population-based cohort study of older adults aged ≥65 years. Dementia incidence for 49,511 participants was assessed through the public long-term care insurance system. Availability of food stores (defined as the number of food stores selling fruits and vegetables within 500 meters or 1 kilometer of residence) was assessed for each participant using objective (GIS-based) and subjective (participant-reported) measurements. Data were analyzed from 2017 to 2018.

RESULTS

A total of 3,162 cases of dementia occurred during the follow-up. Compared with the highest quartile for objective availability of food stores, the hazard ratio adjusting for age and sex was 1.60 (95% CI=1.43, 1.78) for the second-lowest quartile. Compared with the highest subjective availability of food stores, the hazard ratio was 1.74 (95% CI=1.49, 2.04) for the lowest category. After successive adjustment for sociodemographic characteristics, health status, and other geographic neighborhood factors (availability of restaurants, convenience stores, and community centers), the hazard ratio remained statistically significant.

CONCLUSIONS

Lower food store availability was associated with increased dementia incidence. Given that food shopping is a routine activity and a main motive for going out among older adults, increasing the availability of food stores may contribute to dementia prevention.

Appraisal of short and long versions of the Nutrition Environment Measures Survey (NEMS-S and NEMS-R) in Australia

OBJECTIVE

Research has begun to take a more ecological view of eating behaviour, examining multiple levels of influence: personal, social and environmental. The food environment is a major influence on eating behaviour, attracting the attention of researchers who have measured it in a number of ways. The present paper examines the short-form version, in comparison to the long-form version, of the Nutrition Environment Measures Survey (NEMS) - an observational food outlet audit tool.

DESIGN

Both the short-form and long-form were examined to qualitatively appraise the dimensions of the food environment assessed by each measure. Data from 135 food outlets in Australia were then used to compare results obtained using the short-form with the results from the long-form method, to consider the utility of the short-form measure.

SETTING

The retail food environment in Australia.ParticipantsOne hundred and thirty-five food outlets in Australia.

RESULTS

Results indicate that the short-form predominantly assessed availability of healthful foods (one aspect of the food environment). Several critical dimensions of the food environment known to influence eating behaviour were not assessed. For this data set, the short-form produced scores inconsistent with the longer version of the measure, delivering inflated estimates for stores and deflated estimates for restaurants.

CONCLUSIONS

Scores between the long-form and short-form versions were not comparable in this Australian study. Further development of food environment measures is recommended and must balance instrument brevity with the need to accurately capture important aspects of the food environment known to influence eating behaviour.

Individual Mobility and Uncertain Geographic Context: Real-time Versus Neighborhood Approximated Exposure to Retail Tobacco Outlets Across the US

There is growing interest in the way exposure to neighborhood risk and protective factors affects the health of residents. Although multiple approaches have been reported, empirical methods for contrasting the spatial uncertainty of exposure estimates are not well established. The objective of this paper was to contrast real-time versus neighborhood approximated exposure to the landscape of tobacco outlets across the contiguous US. A nationwide density surface of tobacco retail outlet locations was generated using kernel density estimation (KDE). This surface was linked to participants' (N p  = 363) inferred residential location, as well as to their real-time geographic locations, recorded every 10 min over 180 days. Real-time exposure was estimated as the hourly product of radius of gyration and average tobacco outlet density (N hour = 304, 164 h). Ordinal logit modeling was used to assess the distribution of real-time exposure estimates as a function of each participant's residential exposure. Overall, 61.3% of real-time, hourly exposures were of relatively low intensity, and after controlling for temporal and seasonal variation, 72.8% of the variance among these low-level exposures was accounted for by residence in one of the two lowest residential exposure quintiles. Most moderate to high intensity exposures (38.7% of all real-time, hourly exposures) were no more likely to have been contributed by subjects from any single residential exposure cluster than another. Altogether, 55.2% of the variance in real-time exposures was not explained by participants' residential exposure cluster. Calculating hourly exposure estimates made it possible to directly contrast real-time observations with static residential exposure estimates. Results document the substantial degree that real-time exposures can be misclassified by residential approximations, especially in residential areas characterized by moderate to high retail density levels.

Access to healthy food retailers among formerly incarcerated individuals

OBJECTIVE

To assess access to healthy food retailers among formerly incarcerated individuals.

DESIGN

Using linked data from the National Longitudinal Study of Adolescent to Adult Health and the Modified Retail Food Environment Index, the present study applies multivariate logistic regression to assess the association between incarceration and (i) living in a food desert and (ii) having low access to healthy food retailers. To account for unobserved heterogeneity, additional analyses are performed comparing formerly incarcerated individuals with persons arrested or convicted for a crime but not previously incarcerated.

SETTING

Sample of respondents living in urban census tracts in the USA.

SUBJECTS

Adults (n 10390) aged 24-34 years.

RESULTS

In adjusted logistic regression models, prior incarceration was not significantly associated with living in a food desert (OR=1·097; 95% CI 0·896, 1·343). Prior incarceration significantly increased the likelihood of living in a census tract with low access to healthy food retailers (OR=1·265; 95% CI 1·069, 1·498). This significant association remained when comparing formerly incarcerated individuals with those who had been arrested or convicted of a crime, but not previously incarcerated (OR=1·246; 95% CI 1·032, 1·503).

CONCLUSIONS

Formerly incarcerated individuals are more likely to live in areas with low access to healthy food retailers compared with their non-incarcerated counterparts. Because lower access healthy food retailers may be associated with worse health and dietary behaviour, disparities in local food retail environments may exacerbate health inequalities among formerly incarcerated individuals.

Spatial Technologies in Obesity Research: Current Applications and Future Promise

Geographic Information Systems (GIS), Global Positioning Systems (GPS), and remote sensing (RS) are revolutionizing obesity-related research. The primary applications of GIS have included visualizing obesity outcomes and risk factors, constructing obesogenic environmental indicators, and detecting geographical patterns of obesity prevalence and obesogenic environmental features. GPS was mainly used to delineate individual activity space and combined with other devices to measure obesogenic behaviors. RS has been understated for its role as important sources of data about natural and built environments. These spatial technologies, collectively called the 3S technologies, will be useful in measuring more facets of obesogenic environments and individual environmental exposure at finer levels and studying obesity etiology and interventions.

Obesity among black women in food deserts: An "omnibus" test of differential risk

The “omnibus” hypothesis, as forwarded by Ford and Dzewaltowski (2008), asserts that poor-quality food environments differentially affect low- and high-socioeconomic status (SES) populations. Accordingly, we examine, in a large sample of non-Hispanic (NH) black women, whether low access to healthy food corresponds with increased risk of obesity among residents of low- and high-poverty neighborhoods. In addition, we analyze whether any discovered association between low-food access and obesity appears stronger in neighborhoods with a high proportion of black residents. We retrieved body mass index (BMI) data for 97,366 NH black women residing in 6258 neighborhoods from the California Department of Public Health birth files for years 2007-2010. We linked BMI data with census tract-level data on neighborhood food access from the 2010 Food Access Research Atlas and neighborhood poverty and black composition from the 2006-2010 American Community Survey 5-year estimates. We applied generalized estimating equation methods that permit analysis of clustered data within neighborhoods. Methods also controlled for individual-level characteristics which might confound the relation between food access and obesity, including health insurance status, age, education, and parity. Results indicate that low-food access does not impact risk of obesity among NH black women residing in low-poverty neighborhoods. However, low-food access varies positively with risk of obesity in high-poverty neighborhoods. Moreover, the association between low-food access and obesity appears stronger in high-poverty, high-black composition neighborhoods, relative to high-poverty, low-black composition neighborhoods. Our findings support the omnibus hypothesis and indicate a potential interaction between factors in the local food and social environments on an individual’s risk of obesity.

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No relation between food access and obesity in low-poverty neighborhoods.

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In high-poverty neighborhoods, obesity risk rises above expected levels in “food deserts”.

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Greatest obesity risk in food deserts located in high-poverty, high-black neighborhoods.

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Suggests interplay of social and food environments in influencing obesity risk.

Identifying gaps in the food security safety net: the characteristics and availability of summer nutrition programmes in California, USA

Objective

The US Department of Agriculture’s Summer Food Service Program and Seamless Summer Option (summer nutrition programmes (SNP)) aim to relieve food insecurity for children and teens during summer months. More needs to be known about when and where SNP are available, and how availability varies by community characteristics, particularly in rural areas where food insecurity and reduced food access are more prevalent.

Design

The present study examined the geographic availability of SNP and summer meal uptake rates in 2016, using state-wide administrative claims data.

Setting

Public schools and SNP in California, USA.

Participants

Schools (n8842) and SNP (n4685).

Results

Urban counties were more likely than rural counties to have higher summer uptake rates, calculated as the percentage of summer meals served relative to eligible students utilizing school meal programmes during the academic school year, but uptake overall was low at 18·2 % of target populations. Geographic availability analyses showed that 63·9 % of public urban schools had an SNP available within 1·6 km (1 mile), but availability was significantly higher within the proximity of larger, higher-poverty high schools with diverse or majority non-White students, and those with higher school-year breakfast participation rates. Availability of an SNP within 16 km (10 miles) of rural schools averaged 68·1 % but was significantly higher around larger schools, higher-poverty schools and those with diverse or majority non-White students.

Conclusions

While many communities have SNP available, much more work is needed to increase the availability of these programmes to reduce summer food insecurity for children, particularly in rural communities.

Protocol for a cross sectional study of cancer risk, environmental exposures and lifestyle behaviors in a diverse community sample: the Community of Mine study

Background

Physical inactivity and unhealthy diet are modifiable behaviors that lead to several cancers. Biologically, these behaviors are linked to cancer through obesity-related insulin resistance, inflammation, and oxidative stress. Individual strategies to change physical activity and diet are often short lived with limited effects. Interventions are expected to be more successful when guided by multi-level frameworks that include environmental components for supporting lifestyle changes. Understanding the role of environment in the pathways between behavior and cancer can help identify what environmental conditions are needed for individual behavioral change approaches to be successful, and better recognize how environments may be fueling underlying racial and ethnic cancer disparities.

Methods

This cross-sectional study was designed to select participants (n = 602 adults, 40% Hispanic, in San Diego County) from a range of neighborhoods ensuring environmental variability in walkability and food access. Biomarkers measuring cancer risk were measured with fasting blood draw including insulin resistance (fasting plasma insulin and glucose levels), systemic inflammation (levels of CRP), and oxidative stress measured from urine samples. Objective physical activity, sedentary behavior, and sleep were measured by participants wearing a GT3X+ ActiGraph on the hip and wrist. Objective measures of locations were obtained through participants wearing a Qstarz Global Positioning System (GPS) device on the waist. Dietary measures were based on a 24-h food recall collected on two days (weekday and weekend). Environmental exposure will be calculated using static measures around the home and work, and dynamic measures of mobility derived from GPS traces. Associations of environment with physical activity, obesity, diet, and biomarkers will be measured using generalized estimating equation models.

Discussion

Our study is the largest study of objectively measured physical activity, dietary behaviors, environmental context/exposure, and cancer-related biomarkers in a Hispanic population. It is the first to perform high quality measures of physical activity, sedentary behavior, sleep, diet and locations in which these behaviors occur in relation to cancer-associated biomarkers including insulin resistance, inflammation, impaired lipid metabolism, and oxidative stress. Results will add to the evidence-base of how behaviors and the built environment interact to influence biomarkers that increase cancer risk.

Trial registration

ClinicalTrials.gov NCT02094170, 03/21/2014.

Social Norms Influencing the Local Food Environment as Perceived by Residents and Food Traders: The Heart Healthy Hoods Project

Exploring subjective elements of the food environment remains key to understand why and how residents purchase food. Our aim was to explore and describe the social norms relating to the local food environment and food purchasing behaviors, as perceived by residents and food traders in Madrid, Spain. This qualitative study took place in a middle socioeconomic status neighborhood of Madrid between January 2015 and May 2016. We conducted 35 semi-structured interviews. We used stratified purposive sampling to recruit residents, neighborhood workers (N = 20) and food traders (N = 15) representing different levels of involvement with food purchasing behaviors. We analyzed these data using an interpretative phenomenological analysis approach. Participants highlighted social aspects of the food environment in relation to food purchasing behaviors. First, interpersonal and relational food environment elements were emphasized, including trust and tradition. Participants also identified generational demographic trends in relation to changes in the way residents purchased food: the new pace of life and the lack of time to buy fresh food and to cook at home. All these elements were influenced by the economic crisis. Food environment interventions aiming to improve food purchasing behaviors and residents' diets should consider intermediate social aspects of the food environment like trust and tradition and the fast pace of life of younger generations.

Participation in the Supplemental Nutrition Assistance Program and Dietary Behaviors: Role of Community Food Environment

BACKGROUND

The United States Department of Agriculture's Supplemental Nutrition Assistance Program (SNAP) is the country's largest nutrition assistance program for low-income populations. Although SNAP has been shown to reduce food insecurity, research findings on the diet quality of program participants are inconsistent.

OBJECTIVE

This study evaluated whether the community food environment is a potential moderator of the association between SNAP participation and eating behaviors.

DESIGN

This cross-sectional study used participant data from a telephone survey of 2,211 households in four cities in New Jersey. Data were collected from two cross-sectional panels from 2009 to 2010 and 2014. Food outlet data were purchased from commercial sources and classified as supermarkets, small grocery stores, convenience stores, or limited service restaurants.

PARTICIPANTS/SETTING

Analysis is limited to 983 respondents (588 SNAP participants) with household incomes below 130% of the federal poverty level.

MAIN OUTCOME MEASURES

Eating behaviors were assessed as frequency of consumption of fruit, vegetables, salad, and sugar-sweetened beverages.

STATISTICAL ANALYSES PERFORMED

Interaction and stratified analyses using gamma regression determined the differences in the association between SNAP participation and eating behaviors by the presence or absence of food outlets adjusted for covariates.

RESULTS

SNAP participation was associated with a higher frequency of consuming sugar-sweetened beverages (P<0.05) when respondents lived within ¼ to ½ mile of a small grocery store, supermarket, and limited service restaurant. SNAP participants who did not live close to a convenience store reported a lower frequency of sugar-sweetened beverage consumption (P=0.01), and those living more than ½ mile away from a supermarket reported a lower frequency of fruit consumption (P=0.03).

CONCLUSIONS

The findings from this study suggest that the community food environment may play a role in moderating the association between SNAP participation and eating behaviors. Although SNAP participation is associated with some unhealthy behaviors, this association may only hold true when respondents live in certain food environments.

Obesogenic Environment Case Study from a Food and Nutrition Security Perspective: Hermosillo City

Obesity and certain nutritional deficiencies are global health problems that emerge in systems of interdependent individual biological and historical factors and social environmental determinants of health. Nutrition security is a framework that assumes stable access to sufficient innocuous and nutritious food (i.e., food security), health care, and sanitation, and information that in conjunction allows self-care-oriented behavior for health protection. To understand the social environment of nutrition insecurity, the object of study was the food distribution and consumption system of a marginalized community in Hermosillo, Mexico. We assessed the distribution of food establishments by social marginalization level in basic geo-statistical areas and the nutrition security status of women in underserved neighborhoods. We found that in Hermosillo >90% of food establishments included for analysis (grocery stores, supermarkets, convenience stores, and beer deposits) were distributed outside of areas with high levels of social marginalization. The nutrition security assessment suggests that low intakes of fruit and vegetables and high intakes of fat and sugar may be associated with food accessibility and acceptability factors in individual decision-making processes. Future research should take into account the variability of food system environments and address the particular needs of communities in terms of food and nutrition security.

Examination of how food environment and psychological factors interact in their relationship with dietary behaviours: test of a cross-sectional model

BACKGROUND

To improve population diet environmental strategies have been hailed the panacea because they require little agency or investment of personal resources; this contrasts with conventional strategies that rely on individuals to engage high levels of agency and make deliberate choices. There is an immediate need to improve understanding of the synergy between the psychological and environmental determinants of diet in order to optimise allocation of precious public health resources. This study examined the synergistic and relative association between a number of food environment and psychological factors and the dietary behaviours of a population sample of women with young children.

METHODS

Women in Hampshire were recruited from children's centres and asked about their demographic characteristics, psychological resources, dietary behaviours (food frequency questionnaire) and perceptions of healthy food access and affordability. Three local food environment factors were objectively assessed: i) spatial access to food outlets using activity spaces; ii) healthfulness of the supermarket where women did their main food shop, (based on nine in-store factors including price, placement and promotion on seven healthy and five less healthy foods); iii) nutrition environment of children's centres visited frequently by the women, assessed via staff-administered questionnaire. A theoretical model linking environmental factors to dietary behaviours, both directly and indirectly through three factors representing individual agency (psychological resources, perceived food affordability, perceived food accessibility), was tested using Structural Equation Modelling.

RESULTS

Complete data were available for 753 women. The environment of women's main supermarket was indirectly related to their dietary behaviours through psychological resources and perceived food affordability. Shopping at supermarkets classified as having a healthier in-store environment was associated with having greater psychological resources associated with healthy eating (standardised regression weight β = 0.14SD, p = 0.03) and fewer food affordability concerns (β = - 0.14SD, p = 0.01), which in turn related to healthier dietary behaviours (β = 0.55SD, < 0.001 and β = - 0.15, p = 0.01 respectively). The three food environment factors were not directly associated with dietary behaviour (p > 0.3). The overall model fit was good (CFI = 0.91, RMSEA = 0.05 [0.05, 0.06]).

CONCLUSIONS

This pathway analysis identified three focal points for intervention and suggests that high-agency interventions targeting individual psychological resources when combined with low-agency supermarket environment interventions may confer greater benefits on dietary behaviours than either intervention alone.

Urban food environments in Africa: implications for policy and research

Africa is currently experiencing rapid urbanisation impacting on people's food environments and dietary habits. Such changes are associated with higher prevalence of obesity coexisting with undernutrition. The present paper provides an overview of the healthiness of African urban food environments. We discuss the ways that food environments can be characterised and summarise the methods that can be used to investigate and intervene in the food environment. Data for Africa over a 50-year period (1961–2013) suggest an increasing availability of energy, animal products, fruit and vegetables, vegetable oils, sugar and sweeteners but a decrease in animal fats. There is a lack of evidence about how social, physical and macro-environments drive dietary habits in urban Africa, as most research has focused on the individual level. Examining how food consumption is embedded in everyday life, by investigating social environments is crucial to developing effective interventions. The informal food sector plays an important role in the retail food environment. Macro-level food price changes are an important factor influencing nutritional quality of African diets. The rapid expansion of food/beverages advertising in Africa threatens traditional food habits. Liberalisation of food trade is already impacting on the nutritional quality of food available. Improving African food environments represents a pressing public health concern and has the potential to prevent all forms of malnutrition. Hence, by conducting research into the role of urban social, physical and macro-environments, emerging interventions and policies are likely to positively impact on nutritional status, thereby enhancing social and economic development.

Adults with diabetes residing in "food swamps" have higher hospitalization rates

Objective

To examine the relationship between food swamps and hospitalization rates among adults with diabetes.

Data Sources

Blue Cross Blue Shield Association Community Health Management Hub^® 2014, AHRQ Health Care Cost and Utilization Project state inpatient databases 2014, and HHS Area Health Resources File 2010‐2014.

Study Design

Cross‐sectional analysis of 784 counties across 15 states. Food swamps were measured using a ratio of fast food outlets to grocers. Multivariate linear regression estimated the association of food swamp severity and hospitalization rates. Population‐weighted models were controlled for comorbidities; Medicaid; emergency room utilization; percentage of population that is female, Black, Hispanic, and over age 65; and state fixed effects. Analyses were stratified by rural‐urban category.

Principal Findings

Adults with diabetes residing in more severe food swamps had higher hospitalization rates. In adjusted analyses, a one unit higher food swamp score was significantly associated with 49.79 (95 percent confidence interval (CI) = 19.28, 80.29) additional all‐cause hospitalizations and 19.12 (95 percent CI = 11.09, 27.15) additional ambulatory care‐sensitive hospitalizations per 1000 adults with diabetes. The food swamp/all‐cause hospitalization rate relationship was stronger in rural counties than urban counties.

Conclusions

Food swamps are significantly associated with higher hospitalization rates among adults with diabetes. Improving the local food environment may help reduce this disparity.

The Association between Self-Reported Difficulty of Food Access and Nutrient Intake among Middle-Aged and Older Residents in a Rural Area of Japan

We investigated the association of self-reported difficulty of food access, accounting for the perception of food-store accessibility, with nutrient intake among 474 inhabitants (145 men and 329 women) aged ≥40 y in a rural area of Japan. Information on self-reported difficulty of food access and dietary intake was obtained via a self-administrated questionnaire. Analysis of covariance was performed to evaluate the adjusted associations between difficulty of food access and percentages of total energy (i.e., protein, fat, and carbohydrates). Among men, the adjusted means of percent energy from fat in the "difficulty of food access" group (19.2% energy) were significantly lower (by 2.4%) and the percent energy from carbohydrates for this group (57.3% energy) was significantly higher (by 3.3%) than for the "non-difficulty" group. In conclusion, this study found nutritional balance among residents experiencing difficulty of food access results in lower fat and higher carbohydrate intake than for those with non-difficulty of food access among middle-aged and older Japanese men in a rural area.

A Meta-analysis of the Literature on the Association of the Social and Built Environment With Obesity: Identifying Factors in Need of More In-Depth Research

Objective:

This study aims to identify groups of the social and built environment factors that have been studied substantially along with factors that need further attention, to guide the research, designing, and planning of the social and built environment for reducing obesity prevalence.

Data Source:

A systematic search of literature was undertaken from PubMed, Google Scholar, and Web of Knowledge.

Study Inclusion and Exclusion Criteria:

Keyword combination of “built environment,” “social environment,” and “obesity” were used to expand the search scope. Exclusion criteria included (1) any article with less than 50 citations from 2005 to 2010, and those with less than 25 citations from 2011 to 2015. In this way we included the most prominent peer-reviewed studies published in recent years while excluding less influential publications; (2) any article published in a language other than English; (3) literature review articles; (4) any article studying health outcomes not obesity related. We included research on eating behaviors since the studies contributed profoundly to food environment research.

Data Synthesis:

A meta-analysis of 153 empirical studies, selected from 2005 to 2015 based on a series of criteria, was conducted using factor analysis. The exploratory factor analysis was undertaken to group the prevalence and use of the social and built environment factors associated with obesity.

Results:

The findings suggested that the research community has gained a substantial understanding of the D variables of the built environment, including density, diversity, design, distance to transit, and destination access. Factors concerning different age groups, minority populations, groups with low socioeconomic status, food environment, and street-level urban design features have been less examined.

Conclusions:

The findings are important to guide future research directions, giving more attention to the factors in need of more in-depth research.

From the Lunch Table, to the Family Table: A Grounded Theory Approach to Understanding Urban Adolescents' Experiences of Food Culture Mismatch between School and Home Environments

Based on a participatory action research project in New York City from 2012 to 2014, our study compares the experience of black and Latino adolescents between their school and home food environments. Following a photovoice approach, adolescents participated in a "food justice" curriculum, photographed foodscapes, and conducted photo-elicited interviews. Using a grounded theory approach, we found that adolescents had mismatched experiences between school and home food environments under two conditions: sensory-emotional and sociopolitical. Mismatch suggested psychological and behavioral consequences, including skipping or wasting school lunch entrées and consuming energy-dense, nutrient-poor snack foods. We named this middle-range substantive theory food culture mismatch.

Association between Spatial Access to Food Outlets, Frequency of Grocery Shopping, and Objectively-Assessed and Self-Reported Fruit and Vegetable Consumption

Because supermarkets are a critical part of the community food environment, the purpose of this paper is to examine the association between accessibility to the supermarket where participants were surveyed, frequency of shopping at the supermarket, and self-reported and objectively-assessed fruit and vegetable consumption. Accessibility was assessed using Geographic Information Systems (GIS) measured distance and multiple versions of the modified Retail Food Environment Index (mRFEI), including a localized road network buffer version. Frequency of shopping was assessed using self-report. The National Cancer Institute Fruit and Vegetable screener was used to calculate daily servings of fruits and vegetables. Skin carotenoids were assessed using the "Veggie Meter™" which utilizes reflection spectroscopy to non-invasively assess skin carotenoids as an objective measure of fruit and vegetable consumption. Bivariate and multivariable statistics were used to examine the associations in RStudio. There was a positive association between skin carotenoids and the Special Supplemental Nutrition Program for Women Infants and Children (WIC) and mRFEI scores, suggesting that WIC participation and a healthier food environment were associated with objectively-assessed fruit and vegetable consumption (skin carotenoids). Future research should examine these associations using longitudinal study designs and larger sample sizes.

Soda, salad, and socioeconomic status: Findings from the Seattle Obesity Study (SOS)

Background

Documenting geographic disparities in dietary behaviors can help inform public health interventions at the local level.

Objective

To study and visualize socioeconomic gradient in soda and salad consumption using a geo-localized measure of socioeconomic status in contrast to more traditional measures.

Methods

Geo-localized dietary intake data came from the Seattle Obesity Study I, a population-based sample of King County adults (n=1099). Socio-demographic data and soda and salad consumption frequencies (times/week) were obtained by 20-min telephone survey. Food frequency questionnaire (FFQ) data were used to construct Healthy Eating Index (HEI) scores. Individual residential property values obtained from the King County tax assessor. Multivariable linear regressions examined socioeconomic gradient in the frequency of soda and salad consumption by residential property values, the primary independent variable, in comparison to annual household incomes and educational attainment, with adjustment for age, gender, and race/ethnicity. Geographic disparities in soda and salad consumption by property value metric were illustrated at the census block level using modeled predicted marginal means.

Results

Among all three socioeconomic indicators (income, education and residential property values), residential property values captured strongest gradient in soda and salad consumption. Higher quintiles of residential property values were associated with lower soda and higher salad consumption. Respondents living in the highest quintile of property values −1.04 fewer sodas per week (95% CI= −1.87, −0.21) and 0.89 more salads per week (95% CI= 0.36, 1.42), adjusting for sociodemographic covariates. Residential property values illustrated geographic disparities in soda and salad consumption at the census-block level.

Conclusion

Geo-localized disparities in food consumption patterns by neighborhood can inform current discourse on the socioeconomic determinants of health, while providing a useful tool for targeted interventions at the local level.

•

Soda (inverse) and salad (positive) consumption show gradients with socioeconomic status (SES).

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Place-based measures of SES and property values, allow for high resolution mapping of diet measures.

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Provides new tools for spatial, nutritional epidemiology analyses.

Relative Density of Away from Home Food Establishments and Food Spend for 24,047 Households in England: A Cross-Sectional Study

Eating away from home is a risk factor for poor diet quality and obesity. With an ever-increasing proportion of household food spend directed toward eating out, the proliferation of these food establishments may contribute to their use, a potential precursor to less healthy food choices and low overall diet quality. However few studies are conducted at the national level and across a range of away from home food sources. The purpose of this study was to examine the association between the density of away from home food establishments (e.g., restaurants, fast food outlets and cafés) and household spend on away from home food within a nationally representative sample for England, UK. A cross-sectional analysis of data from Wave 1 of the UK Household Longitudinal Survey (n = 24,047 adults aged ≥19y) was conducted. Exposure was characterised as the density of away from home food establishments to all other food sources within 1 mile of the home, divided into quintiles (Q1 as lowest exposure and Q5 as highest exposure). The primary outcome included households with a high away from home equivalised monthly food spend (≥25% of total food spend). Logistic regression was used to estimate associations between away from home food establishment exposure and high away from home food spend. Away from home food establishment density was significantly associated with a greater odds of high monthly food spend (Q3: OR = 1.18, 95% CI = 1.07, 1.30; Q4: OR = 1.30, 95% CI = 1.18, 1.43; and Q5: OR = 1.52, 95% CI = 1.37, 1.68) with attenuation after controlling for known socioeconomic confounders (Q4: OR = 1.13, 95% CI = 1.02, 1.25; and Q5: OR = 1.16, 95% CI = 1.04, 1.30) compared to those least exposed (Q1). Those most exposed to away from home food establishments had a 16% greater odds of allocating more than 25% of household food spend on away from home food sources. This study provides one of the first analyses at the national level to examine the role of the local food environment in relation to household food spend, a potential precursor to diet quality and health.

Exploring absolute and relative measures of exposure to food environments in relation to dietary patterns among European adults

Objective

To explore the associations of absolute and relative measures of exposure to food retailers with dietary patterns, using simpler and more complex measures.

Design

Cross-sectional survey.

Setting

Urban regions in Belgium, France, Hungary, the Netherlands and the UK.

Participants

European adults (n 4942). Supermarkets and local food shops were classified as ‘food retailers providing healthier options’; fast-food/takeaway restaurants, cafés/bars and convenience/liquor stores as ‘food retailers providing less healthy options’. Simpler exposure measures used were density of healthy and density of less healthy food retailers. More complex exposure measures used were: spatial access (combination of density and proximity) to healthy and less healthy food retailers; density of healthier food retailers relative to all food retailers; and a ratio of spatial access scores to healthier and less healthy food retailers. Outcome measures were a healthy or less healthy dietary pattern derived from a principal component analysis (based on consumption of fruits, vegetables, fish, fast foods, sweets and sweetened beverages).

Results

Only the highest density of less healthy food retailers was significantly associated with the less healthy dietary pattern (β = −129·6; 95 % CI −224·3, −34·8). None of the other absolute density measures nor any of the relative measures of exposures were associated with dietary patterns.

Conclusions

More complex measures of exposure to food retailers did not produce stronger associations with dietary patterns. We had some indication that absolute and relative measures of exposure assess different aspects of the food environment. However, given the lack of significant findings, this needs to be further explored.

Perceptions of a healthier neighborhood food environment linked to greater fruit and vegetable purchases at small and non-traditional food stores

The aim of this study was to examine associations between perceived neighborhood food environments and food purchasing at small and non-traditional food stores. Intercept interviews of 661 customers were conducted in 105 small and non-traditional food stores. We captured (1) customer perceptions of the neighborhood food environment, (2) associations between customer perceptions and store-level characteristics, and (3) customers' perceptions and shopping behaviors. Findings suggest that customers with more favorable perceptions of the neighborhood food environment were more likely to purchase fruits and vegetables, despite no significant association between perceptions of the neighborhood and objectively measured store characteristics.

Home Matters: Adolescents Drink More Sugar-Sweetened Beverages When Available at Home

OBJECTIVES

To examine the association between sugar-sweetened beverage availability at home and sugar-sweetened beverage consumption, and to evaluate whether this association was consistent across school and school neighborhood sugar-sweetened beverage availability.

STUDY DESIGN

Secondary data analyses were performed from the 2014 cross-sectional, Internet-based Family Life, Activity, Sun, Health, and Eating (FLASHE) study of 1494 adolescents (age 12-17 years). Ordinal logistic regression analyses were conducted to examine the association between sugar-sweetened beverage availability in the home and adolescents' frequency of sugar-sweetened beverage consumption (nondaily, <1; daily, 1-<2; daily, ≥2), adjusting for adolescent age, sex, race, and body mass index and parent marital status and housing insecurity. Stratified ordinal logistic regression analyses were used to examine the associations by school and school neighborhood sugar-sweetened beverage availability.

RESULTS

One-third (32.6%) of adolescents were nondaily consumers of sugar-sweetened beverages, 33.9% consumed 1-<2 sugar-sweetened beverages daily, and 33.5% consumed ≥2 sugar-sweetened beverages daily. Almost one-half (44.4%) reported that sugar-sweetened beverages were often or always available in the home. Frequency of sugar-sweetened beverage availability at home was associated with greater sugar-sweetened beverage consumption (OR, 2.88; 95% CI, 2.86-2.89 for rarely/sometimes available at home; OR. 5.62; 95% CI, 5.60-5.64 for often/always available at home). Similar associations were found regardless of the availability of sugar-sweetened beverages in the adolescent's school or school neighborhood.

CONCLUSIONS

Sugar-sweetened beverage availability in the home was associated with adolescent sugar-sweetened beverage consumption, regardless of sugar-sweetened beverage availability in other settings, and may be a key target for obesity prevention efforts.

Status report - Geographic retail food environment measures for use in public health

The Association of Public Health Epidemiologists in Ontario (APHEO) Core Indicators Work Group standardizes definitions and calculation methods for over 120 public health indicators to enhance accurate and standardized community health status reporting across public health units in Ontario. The Built Environment Subgroup is a multi-disciplinary group made up of planners, researchers, policy analysts, registered dietitians, geographic information systems (GIS) analysts and epidemiologists. The Subgroup selected and operationalized a suite of objective, standardized indicators intended to help public health units and regional health authorities assess their community retail food environments. The Subgroup proposed three indicators that use readily available data sources and GIS tools to characterize geographic access to various types of retail food outlets within neighbourhoods in urban settings. This article provides a status report on the development of these food environment indicators.

Food environment does not predict self-reported SSB consumption in New York City: A cross sectional study

The purpose of this research was to examine whether the local food environment, specifically the distance to the nearest sugar sweetened beverage (SSB) vendor, a measure of SSB availability and accessibility, was correlated with the likelihood of self-reported SSB consumption among a sample of fast food consumers. As part of a broader SSB behavior study in 2013–2014, respondents were surveyed outside of major chain fast food restaurants in New York City (NYC). Respondents were asked for the intersection closest to their home and how frequently they consume SSBs. Comprehensive, administrative food outlet databases were used to geo-locate the SSB vendor closest to the respondents’ home intersections. We then used a logistic regression model to estimate the association between the distance to the nearest SSB vendor (overall and by type) and the likelihood of daily SSB consumption. Our results show that proximity to the nearest SSB vendor was not statistically significantly associated with the likelihood of daily SSB consumption, regardless of type of vendor. Our results are robust to alternative model specifications, including replacing the linear minimum distance measure with count of the total number of SSB vendors or presence of a SSB vendor within a buffer around respondents’ home intersections. We conclude that there is not a strong relationship between proximity to nearest SSB vendor, or proximity to a specific type of SSB vendor, and frequency of self-reported SSB consumption among fast food consumers in NYC. This suggests that policymakers focus on alternative strategies to curtail SSB consumption, such as improving the within-store food environment or taxing SSBs.

Multilevel Structural Equation Modeling of Students' Dietary Intentions/Behaviors, BMI, and the Healthfulness of Convenience Stores

Background: When dietary behaviors are habitual, intentions are low, and environmental cues, such as the consumer food environment, might guide behavior. How might intentions to eat healthily and ultimately actual dietary behaviors, be influenced by the consumer food environment (including the availability and affordability of healthy foods) in convenience stores? This study will determine pathways between the healthfulness of convenience stores and college students’ dietary intentions/behaviors, and body mass index (BMI). Methods: Through multilevel structural equation modeling, a comparison was made of students’ healthful meal intentions (HMI); intake (fruits/vegetables, %kcal/fat, sugar-sweetened beverages (SSBs) and whole-grains); and measured BMI; as well as the healthfulness of convenience stores (fruits/vegetables availability/quality, healthy food availability/affordability). Data was collected on 1401 students and 41 convenience stores across 13 US college campuses. Results: Controlling for gender, HMI was negatively associated with SSBs (β = −0.859) and %kcal/fat (β = −1.057) and positively with whole-grains (β = 0.186) and fruits/vegetables intake (β = 0.267); %Kcal/fat was positively (β = 0.098) and fruits/vegetables intake (β = −0.055) negatively associated with BMI. Campus level, fruits/vegetables availability were positively associated to HMI (β = 0.214, β = 0.129) and directly/negatively to BMI (β = −2.657, β = −1.124). Conclusions: HMI modifies dietary behaviors, with energy from fat and fruit/vegetable intake the most predictive of weight. Availability of fruit/vegetables in convenience stores make it easier for young adults to eat well.

Neighborhood food environment and mortality among older Japanese adults: results from the JAGES cohort study

BACKGROUND

Previous research has linked lower availability of food stores selling fruits and vegetables to unhealthy diet. However, the longitudinal association between the availability of healthy food stores and mortality is unknown. This study examined the association between neighborhood availability of food stores and mortality by driving status among older adults.

METHODS

This study drew upon a three-year follow up of participants in the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese adults aged 65 years or older. Mortality from 2010 to 2013 was analyzed for 49,511 respondents. Neighborhood availability of food stores was defined as the number of food stores selling fruits and vegetables within a 500-m or 1-km radius of a person's residence. Both subjective (participant-reported) and objective (geographic information system-based) measurements were used to assess this variable. Cox regression models were used to estimate hazard ratios (HR) for mortality.

RESULTS

A total of 2049 deaths occurred during the follow up. Lower subjective availability of food stores was significantly associated with increased mortality. Compared with participants reporting the highest availability, the age- and sex-adjusted HR for those reporting the lowest availability was 1.28 (95% CI: 1.04-1.58; p = 0.02). The association remained significant after adjustment for sociodemographic (education, income, cohabitation, marital status, and employment status) and environmental (driving status, use of public transportation, and study site) status (HR = 1.24, 95% CI: 1.01-1.53, p = 0.04). This association was stronger among non-car users, among whom the HR for those reporting the lowest availability of food stores was 1.61 (95% CI: 1.08-2.41, p = 0.02). In contrast, no significant association was seen between objective availability and mortality.

CONCLUSIONS

Lower availability of healthy food stores measured subjectively, but not objectively, was associated with mortality, especially among non-car users. Considering the decline in mobility with age, living in a neighborhood with many options for procuring fruits and vegetables within walking distance may be important for healthy aging.

Environmental and Individual Predictors of Healthy Dietary Behaviors in a Sample of Middle Aged Hispanic and Caucasian Women

The objective of this effort is to gather data to tailor interventions appropriately. Greater understanding of the correlates of socioeconomic status and obesogenic dietary behaviors was the focus of this manuscript. Using multistage sampling, women with varied education levels completed a baseline assessment in a longitudinal study of women aged 30 to 50 years. This study was conducted in low-SES areas of South King County, Washington State. This study included 530 Caucasian and 510 Hispanic women. Fruit and vegetable consumption was positively associated and soft drink consumption inversely associated with the level of education in Caucasian women. In contrast, percentage calories from fat was positively associated with the level of education in Hispanic women. In Hispanic women, level of education interacted significantly with food security in relation to percentage calories from fat, and with eating norms in relation to soft drink consumption. Neighborhood presence of ethnic food stores was associated with outcomes for Hispanic women, but for Caucasians, presence of fast food restaurants was important. Education was consistently associated with two of the three obesogenic dietary behaviors studied among Caucasian women. Education played a moderating role in the associations of food security and eating norms, independent of area level food availability, in two of three obesogenic dietary behaviors studied. However, these patterns differed for Hispanic women, indicating the need for more research into important variables to support change in Hispanic women. Women of differing ethnic groups did not respond similarly to environmental conditions and policy-relevant surroundings. These data have meaning for considering urban policy that impacts obesity levels in the population.

Spatial Disparity in Food Environment and Household Economic Resources Related to Food Insecurity in Rural Korean Households with Older Adults

Different contextual factors of a household and a community, such as access to resources and transportation, may influence the level of food insecurity. The objective of this study was to identify how food environmental factors and economic resources were related to food insecurity in Korean older adults residing in different contexts of rural areas. Face-to-face interviews with 248 older adults residing in land (n = 149) and mountain (n = 99) rural areas were performed. In both areas, risk of food insecurity was increased for households with limited community food accessibility measured by having difficulties in food purchasing due to food stores far from home. There were discrepancies in factors related to increased risks of food insecurity between households in land and mountain areas. The experience of reducing food expenditure resulting from burden of heating costs during the winter in households in a mountain area whereas the percent proportion of housing fee and household cook’s physical disability in households residing in the land area were found to be factors associated with increased risks of food insecurity. For households residing in mountain areas, the risk of food insecurity was decreased when economic resources measured by average monthly income for the last one year was increased and there was farming or home gardening activity. Such spatial disparity might affect household food insecurity in rural areas. In addition, food environmental factors and economic resources may affect household food insecurity differently according to the diverse contexts of rural areas. Better understanding of spatial challenges in food insecurity faced by seniors in a large rural area would help prepare programs or policy change to strengthen and improve their food environments.