The local food environment and diet: a systematic review

The Association between Residence in a Food Desert Census Tract and Adherence to Dietary Patterns in the REGARDS Cohort

Increased interest in determining areas in need of improved food access led the U.S Department of Agriculture (USDA) to define food desert census tracts; however, no nationwide studies have compared dietary patterns in food desert tracts to other tracts. Our objective was to examine dietary patterns in residents of food desert and non-food desert census tracts. We performed a cross-sectional analysis of 19,179 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled January 2003-October 2007. We used participants' geocoded address with USDA Food Desert Locator to identify food deserts and multivariable-adjusted odds ratios (ORs) to calculate adherence to Southern, Plant-based, and Mediterranean dietary patterns. Odds of adherence to the Southern dietary pattern were higher among white high school graduates (OR=1.41; 95% CI: 1.20-1.67), white college graduates (OR=1.91; 95% CI: 1.55-2.35) and black college graduates (OR=1.38; 95% CI: 1.14-1.68) who reside in a food desert versus non-food desert. Odds of adherence to the Plant-based dietary pattern were 15% lower among non-southeastern residents (OR=0.85; 95% CI: 0.72-0.99), who reside in food desert versus non-food desert. No statistically significant differences were observed for the Mediterranean dietary pattern. Residents living in food deserts had lower adherence to healthy dietary pattern than residents not living in food deserts; the association may vary by race, education, and region.

The dietary impact of introducing new retailers of fruits and vegetables into a community: results from a systematic review

OBJECTIVE

To investigate the potential dietary impact of the opening of new retailers of healthy foods.

DESIGN

Systematic review of the peer-reviewed research literature.

SETTING

References published before November 2015 were retrieved from MEDLINE, EMBASE and Web of Science databases using keyword searches.

SUBJECTS

The outcome of the review was change in fruit and vegetable consumption among adults.

RESULTS

Of 3514 references retrieved, ninety-two articles were reviewed in full text, and twenty-three articles representing fifteen studies were included. Studies used post-test only (n 4), repeated cross-sectional (n 4) and repeated measures designs (n 7) to evaluate the dietary impact of supermarket (n 7), farmers' market (n 4), produce stand (n 2) or mobile market (n 2) openings. Evidence of increased fruit and vegetable consumption was most consistent among adults who began shopping at the new retailer. Three of four repeated measures studies found modest, albeit not always statistically significant, increases in fruit and vegetable consumption (range 0·23-0·54 servings/d) at 6-12 months after baseline. Dietary change among residents of the broader community where the new retailer opened was less consistent.

CONCLUSIONS

The methodological quality of studies, including research designs, sampling methods, follow-up intervals and outcome measures, ranged widely. Future research should align methodologically with previous work to facilitate meta-analytic synthesis of results. Opening a new retailer may result in modest short-term increases in fruit and vegetable consumption among adults who choose to shop there, but the potential longer-term dietary impact on customers and its impact on the broader community remain unclear.

The influence of meal and food markets in fruit and vegetable consumption among adults in the city of São Paulo

INTRODUCTION

Despite the increased consumption of fruits and vegetables in the Brazilian population, a great proportion of people do not meet the recommendations. Purchasing sites associated with fruit and vegetable consumption has not been widely explored.

OBJECTIVE

To explore the association between fruit and vegetable purchasing and consumption sites and the consumption of these foods among adults living in the city of São Paulo, Brazil.

METHODS

Cross-sectional study with 2 thousand individuals living in the city of São Paulo, aged between 20 and 59 years, participants of the "Obesogenic Environment Study in São Paulo". The outcome was fruit and vegetable consumption measured by weekly consumption. Exposure variables included purchasing sites (supermarkets, open-air food markets, fruit and vegetable specialized markets, and corner stores) and consumption sites (full service restaurants and fast food restaurants).

RESULTS

The sample comprises women (52.3%) aged between 25 and 34 years (30.2%), with at least 8 years of schooling (42.8%) receiving 2 to 5 minimum wages (34.6%). Demographic and socioeconomic variables showed association with regular consumption of fruits and vegetables (p < 0.05). The regular consumption of meals in full service restaurant was associated with vegetables consumption. The regular consumption of meals in fast-food restaurants was not associated with vegetables consumption. Food purchasing sites were not associated with fruit or vegetable consumption.

CONCLUSION

The choice of restaurant type was associated with vegetable consumption. In the studied population, food purchasing sites were not associated with fruit or vegetable consumption.

A spatial analysis of dietary patterns in a large representative population in the north of The Netherlands - the Lifelines cohort study

BACKGROUND

Diet is an important modifiable risk factor for chronic diseases. In the search for effective strategies to improve dietary patterns in order to promote healthy ageing, new approaches considering contextual factors in public health medicine are warranted. The aim of this study is to examine the spatial clustering of dietary patterns in a large representative sample of adults.

METHODS

Dietary patterns were defined on the basis of a 111 item Food Frequency Questionnaire among n = 117,570 adults using principal components analysis. We quantified the spatial clustering of dietary pattern scores at the neighborhood level using the Global Moran's I spatial statistic, taking into consideration individual demographic and (neighborhood) socioeconomic indicators.

RESULTS

Four dietary patterns explaining 27% of the variance in dietary data were extracted in this population and named the "bread and cookies" pattern, the "snack" pattern, the "meat and alcohol" pattern and the "vegetable, fruit and fish" pattern. Significant spatial clustering of high (hot spot) and low (cold spot) dietary pattern scores was found for all four dietary patterns irrespective of age and gender differences. Educational attainment and neighborhood income explained the global clustering to some extent, although clustering at smaller regional scales persisted.

CONCLUSION

The significant region-specific hot and cold spots of the four dietary patterns illustrate the existence of regional "food cultures" and underscore the need for interventions targeted at the sub-national level in order to tackle unhealthy dietary behavior and to stimulate people to make healthy dietary choices.

Eating at Food Outlets and "On the Go" Is Associated with Less Healthy Food Choices in Adults: Cross-Sectional Data from the UK National Diet and Nutrition Survey Rolling Programme (2008-2014)

Eating location has been linked with variations in diet quality including the consumption of low-nutrient energy-dense food, which is a recognised risk factor for obesity. Cross-sectional data from 4736 adults aged 19 years and over from Years 1–6 of the UK National Diet and Nutrition Survey (NDNS) Rolling Programme (RP) (2008–2014) were used to explore food consumption patterns by eating location. Eating location was categorized as home, work, leisure places, food outlets and “on the go”. Foods were classified into two groups: core (included in the principal food groups and considered important/acceptable within a healthy diet) and non-core (all other foods). Out of 97,748 eating occasions reported, the most common was home (67–90% of eating occasions). Leisure places, food outlets and “on the go” combined contributed more energy from non-core (30%) than from core food (18%). Analyses of modulating factors revealed that sex, income, frequency of eating out and frequency of drinking were significant factors affecting consumption patterns (p < 0.01). Our study provides evidence that eating patterns, behaviours and resulting diet quality vary by location. Public health interventions should focus on availability and access to healthy foods, promotion of healthy food choices and behaviours across multiple locations, environments and contexts for food consumption.

Understanding bias in relationships between the food environment and diet quality: the Coronary Artery Risk Development in Young Adults (CARDIA) study

BACKGROUND

The relationship between food environment exposures and diet behaviours is unclear, possibly because the majority of studies ignore potential residual confounding.

METHODS

We used 20 years (1985-1986, 1992-1993 2005-2006) of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study across four US cities (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; Oakland, California) and instrumental variables (IV) regression to obtain causal estimates of longitudinal associations between the percentage of neighbourhood food outlets (per total food outlets within 1 km network distance of respondent residence) and an a priori diet quality score, with higher scores indicating higher diet quality. To assess the presence and magnitude of bias related to residual confounding, we compared results from causal models (IV regression) to non-causal models, including ordinary least squares regression, which does not account for residual confounding at all and fixed-effects regression, which only controls for time-invariant unmeasured characteristics.

RESULTS

The mean diet quality score across follow-up was 63.4 (SD=12.7). A 10% increase in fast food restaurants (relative to full-service restaurants) was associated with a lower diet quality score over time using IV regression (β=-1.01, 95% CI -1.99 to -0.04); estimates were attenuated using non-causal models. The percentage of neighbourhood convenience and grocery stores (relative to supermarkets) was not associated with diet quality in any model, but estimates from non-causal models were similarly attenuated compared with causal models.

CONCLUSION

Ignoring residual confounding may generate biased estimated effects of neighbourhood food outlets on diet outcomes and may have contributed to weak findings in the food environment literature.

Best practices for using natural experiments to evaluate retail food and beverage policies and interventions

Policy and programmatic change in the food retail setting, including excise taxes on beverages with added-caloric sweeteners, new supermarkets in food deserts, and voluntary corporate pledges, often require the use of natural experimental evaluation for impact evaluation when randomized controlled trials are not possible. Although natural experimental studies in the food retail setting provide important opportunities to test how nonrandomized interventions affect behavioral and health outcomes, researchers face several key challenges to maintaining strong internal and external validity when conducting these studies. Broadly, these challenges include 1) study design and analysis; 2) selection of participants, selection of measures, and obtainment of data; and 3) real-world considerations. This article addresses these challenges and different approaches to meeting them. Case studies are used to illustrate these approaches and to highlight advantages and disadvantages of each approach. If the trade-offs required to address these challenges are carefully considered, thoughtful natural experimental evaluations can minimize bias and provide critical information about the impacts of food retail interventions to a variety of stakeholders, including the affected population, policymakers, and food retailers.

Are food and drink retailers within NHS venues adhering to NICE Quality standard 94 guidance on childhood obesity? A cross-sectional study of two large secondary care NHS hospitals in England

OBJECTIVE

To assess whether the food and drink retail outlets in two major National Health Service (NHS) district general hospitals in England adhere to quality statements 1-3 of the UK National Institute for Health and Care Excellence (NICE) quality standard 94.

DESIGN

Cross-sectional, descriptive study to assess the food and drink options available in vending machines, restaurants, cafes and shops in two secondary care hospitals.

MAIN OUTCOME MEASURES

Adherence to quality statement 1 whereby the food and drink items available in the vending machines were classified as either healthy or less healthy using the Nutrient Profiling Model (NPM). Compliance with quality statements 2 and 3 was assessed through the measurement of how clearly the shops, cafes and restaurants displayed nutrition information on menus, and the availability and prominent display of healthy food and drink options in retail outlets, respectively.

RESULTS

Adherence to quality statement 1 was poor. Of the 18 vending machines assessed, only 7 (39%) served both a healthy food and a healthy drink option. Neither hospital was compliant with quality statement 2 wherein nutritional information was not available on menus of food providers in either hospital. There was inconsistent compliance with quality standard 3 whereby healthy food and drink options were prominently displayed in the two main hospital restaurants, but all shops and cafes prioritised the display of unhealthy items.

CONCLUSIONS

Neither hospital was consistently compliant with quality statements 1-3 of the NICE quality standard 94. Improving the availability of healthy foods and drinks while reducing the display and accessibility to less healthy options in NHS venues may improve family awareness of healthy alternatives. Making it easier for parents to direct their children to healthier choices is an ostensibly central component of our healthcare system.

Food Melt in Consumer Food Environments in Low-income Urban Neighborhoods

OBJECTIVES

We systematically evaluated changes in availability, price, and quality of perishable food items from the beginning to the end of the month in lowincome, urban neighborhoods.

METHODS

The sample included grocery stores or supermarkets in Cleveland, Ohio, within neighborhoods with >30% of population receiving food assistance. We collected data for 2 sequential months during the first and fourth weeks of each month. Two coders evaluated stores, collecting measures of availability, price, and quality for 50 items. We examined difference in number and proportion of items available at the beginning of the month (BOM) to items remaining available at the end of the month (EOM), as well as quality and price of those items.

RESULTS

Across 48 stores, availability at EOM was lower than BOM; as store size increased, reduction in availability (ie, food melt) was significantly (p < .01) less pronounced. Overall, items became less expensive at the EOM whereas quality remained consistent; we noted no statistically significant differences by store type for price or quality.

CONCLUSIONS

Food melt differentially affects individuals in neighborhoods without grocery stores. Findings reveal composition of food environments is dynamic rather than static, influencing food-purchasing choices among lowincome consumers.

Interplay of Socioeconomic Status and Supermarket Distance Is Associated with Excess Obesity Risk: A UK Cross-Sectional Study

U.S. policy initiatives have sought to improve health through attracting neighborhood supermarket investment. Little evidence exists to suggest that these policies will be effective, in particular where there are socioeconomic barriers to healthy eating. We measured the independent associations and combined interplay of supermarket access and socioeconomic status with obesity. Using data on 9702 UK adults, we employed adjusted regression analyses to estimate measured BMI (kg/m²), overweight (25 ≥ BMI < 30) and obesity (≥30), across participants’ highest educational attainment (three groups) and tertiles of street network distance (km) from home location to nearest supermarket. Jointly-classified models estimated combined associations of education and supermarket distance, and relative excess risk due to interaction (RERI). Participants farthest away from their nearest supermarket had higher odds of obesity (OR 1.33, 95% CI: 1.11, 1.58), relative to those living closest. Lower education was also associated with higher odds of obesity. Those least-educated and living farthest away had 3.39 (2.46–4.65) times the odds of being obese, compared to those highest-educated and living closest, with an excess obesity risk (RERI = 0.09); results were similar for overweight. Our results suggest that public health can be improved through planning better access to supermarkets, in combination with interventions to address socioeconomic barriers.

Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United States Department of Agriculture-Mathematica) and the Nutrition Environment Measurement Survey for Stores, Restaurants, and Corner Stores. Results: Of 432 adolescents, 55% were normal weight, 24% were overweight, and 21% were obese. There was a direct association between unhealthy food purchasing patterns (shopping frequently at gas stations, fast food, and dollar stores) and consuming more added sugars, when compared to those with a healthy shopping pattern (shopping less frequently at gas stations, fast food, and dollar stores) [Odds Ratio = 2.41 (95% CI (confidence interval) 0.99, 3.82)]. Those who reported always having fruits and vegetables in the home consumed more servings of fruits and vegetables [OR = 0.31 cups (95% CI 0.22, 0.44)] compared to those who reported never having fruits and vegetables in the home. Adolescents attending a school with a low healthy food availability score consumed fewer servings of fruits and vegetables [−0.001 (95% CI −0.001, 0.0001)] compared to those attending a school with a high healthy food availability score. Conclusions: There are direct associations between food purchasing patterns, the home and school food environments, and dietary intake among rural adolescents. These cross-sectional results informed the development of the “Go Big and Bring it Home” program, a text messaging intervention to improve adolescents’ fruit, vegetable, and healthy beverage intake.

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

Food deserts are a major public health concern. This study aimed to assess food and beverage availability in four underserved communities eligible to receive funding from the Healthy Food Financing Initiative (HFFI). Data analyzed are part of a quasi-experimental study evaluating the impact of the HFFI on the retail food environment in selected Illinois communities. In 2015, 127 small grocery and limited service stores located in the four selected communities were audited. All communities had a large percentage of low-income and African-American residents. Differences in food and beverage item availability (e.g., produce, milk, bread, snack foods) were examined by store type and community location. Food stores had, on average, 1.8 fresh fruit and 2.9 fresh vegetable options. About 12% of stores sold low-fat milk while 86% sold whole milk. Only 12% of stores offered 100% whole wheat bread compared to 84% of stores offering white bread. Almost all (97%) stores offered soda and/or fruit juice. In summary, we found limited availability of healthier food and beverage items in the communities identified for HFFI support. Follow up findings will address how the introduction of new HFFI-supported supermarkets will affect food and beverage availability in these communities over time.

Accessibility of fast food outlets is associated with fast food intake. A study in the Capital Region of Denmark

Literature suggests that people living in areas with a wealth of unhealthy fast food options may show higher levels of fast food intake. Multilevel logistic regression analyses were applied to examine the association between GIS-located fast food outlets (FFOs) and self-reported fast food intake among adults (+ 16 years) in the Capital Region of Denmark (N = 48,305). Accessibility of FFOs was measured both as proximity (distance to nearest FFO) and density (number of FFOs within a 1km network buffer around home). Odds of fast food intake ≥ 1/week increased significantly with increasing FFO density and decreased significantly with increasing distance to the nearest FFO for distances ≤ 4km. For long distances (>4km), odds increased with increasing distance, although this applied only for car owners. Results suggest that Danish health promotion strategies need to consider the contribution of the built environment to unhealthy eating.

Photographic Methods for Measuring Packaged Food and Beverage Products in Supermarkets

Background: The global obesity pandemic and rates of nutrition-related noncommunicable diseases (NCDs) have increased worldwide, especially in the Latin American and Caribbean region. In an attempt to control this obesity epidemic, the Chilean government has established a comprehensive set of regulatory actions, including beverage taxation, warning labels on foods, and marketing restrictions to children. To improve the effectiveness of actions to prevent obesity, a better understanding of the food environment is needed. Objective: We developed and standardized photographic methods to assess and monitor packaged food and beverage products in supermarkets. Methods: A standardized protocol and food categorization system was used to guide photo collection and data management of photos taken between February and April 2015 in 11 supermarkets, consisting of 5 different supermarket chains, from high- (n = 6) and lower-middle (n = 5)-income neighborhoods in Santiago, Chile. Photos (n = ∼50,000) from nearly 10,000 unique food products from high- and lower-middle-income neighborhoods were used for this study. Results: We developed standardized methods to use photographs to assess and monitor the food environment. A food categorization scheme is essential to guiding the data collection process. Substantial time and human resources are required to assess packaged food and beverage products in supermarkets. Because the number of photos per food product is variable, the organization of the photographs according to the food categorization system, before data entry, is imperative for easy access during data entry and analysis. We identified the information necessary for a photographic registry, which, with the food categorization system, is critical to create unique identifiers that are linked to each food product and its photos. Conclusions: To adequately monitor food environments, standardized methods for food photo collection and management are essential. The information collected on food package photos to monitor food environments is important for guiding and evaluating actions in the context of the ongoing obesity and NCD epidemics.

Discrete Choice Model of Food Store Trips Using National Household Food Acquisition and Purchase Survey (FoodAPS)

Where households across income levels shop for food is of central concern within a growing body of research focused on where people live relative to where they shop, what they purchase and eat, and how those choices influence the risk of obesity and chronic disease. We analyzed data from the National Household Food Acquisition and Purchase Survey (FoodAPS) using a conditional logit model to determine where participants shop for food to be prepared and eaten at home and how individual and household characteristics of food shoppers interact with store characteristics and distance from home in determining store choice. Store size, whether or not it was a full-service supermarket, and the driving distance from home to the store constituted the three significant main effects on store choice. Overall, participants were more likely to choose larger stores, conventional supermarkets rather than super-centers and other types of stores, and stores closer to home. Interaction effects show that participants receiving Supplemental Nutrition Assistance Program (SNAP) were even more likely to choose larger stores. Hispanic participants were more likely than non-Hispanics to choose full-service supermarkets while White participants were more likely to travel further than non-Whites. This study demonstrates the value of explicitly spatial discrete choice models and provides evidence of national trends consistent with previous smaller, local studies.

Investigating the importance of the local food environment for fruit and vegetable intake in older men and women in 20 UK towns: a cross-sectional analysis of two national cohorts using novel methods

BACKGROUND

Local neighbourhood environments can influence dietary behavior. There is limited evidence focused on older people who are likely to have greater dependence on local areas and may suffer functional limitations that amplify any neighbourhood impact.

METHODS

Using multi-level ordinal regression analysis we investigated the association between multiple dimensions of neighbourhood food environments (captured by fine-detail, foot-based environmental audits and secondary data) and self-reported frequency of fruit and vegetable intake. The study was a cross-sectional analysis nested within two nationally representative cohorts in the UK: the British Regional Heart Study and the British Women's Heart and Health Study. Main exposures of interest were density of food retail outlets selling fruits and vegetables, the density of fast food outlets and a novel measure of diversity of the food retail environment.

RESULTS

A total of 1124 men and 883 women, aged 69 - 92 years, living in 20 British towns were included in the analysis. There was strong evidence of an association between area income deprivation and fruit and vegetable consumption, with study members in the most deprived areas estimated to have 27% (95% CI: 7, 42) lower odds of being in a higher fruit and vegetable consumption category relative to those in the least deprived areas. We found no consistent evidence for an association between fruit and vegetable consumption and a range of other food environment domains, including density of shops selling fruits and vegetables, density of premises selling fast food, the area food retail diversity, area walkability, transport accessibility, or the local food marketing environment. For example, individuals living in areas with greatest fruit and vegetable outlet density had 2% (95% CI: -22, 21) lower odds of being in a higher fruit and vegetable consumption category relative to those in areas with no shops.

CONCLUSIONS

Although small effect sizes in environment-diet relationships cannot be discounted, this study suggests that older people are less influenced by physical characteristics of neighbourhood food environments than is suggested in the literature. The association between area income deprivation and diet may be capturing an important social aspect of neighbourhoods that influence food intake in older adults and warrants further research.

An introduction to the healthy corner store intervention model in Canada

SETTING

The majority of Canadians' food acquisition occurs in retail stores. Retail science has become increasingly sophisticated in demonstrating how consumer environments influence population-level diet quality and health status. The retail food environment literature is new but growing rapidly in Canada, and there is a relative paucity of evidence from intervention research implemented in Canada.

INTERVENTION

The healthy corner store model is a comprehensive complex population health intervention in small retail stores, intended to transform an existing business model to a health-promoting one through intersectoral collaboration. Healthy corner store interventions typically involve conversions of existing stores with the participation of health, community, and business sector partners, addressing business fundamentals, merchandising, and consumer demand.

OUTCOMES

This article introduces pioneering experiences with the healthy corner store intervention in Canada. First, we offer a brief overview of the state of evidence within and outside Canada. Second, we discuss three urban and one rural healthy corner store initiatives, led through partnerships among community food security organizations, public health units, academics, and business partners, in Manitoba, Ontario, and Newfoundland and Labrador. Third, we synthesize the promising practices from these local examples, including aspects of both intervention science (e.g., refinements in measuring the food environment) and community-based practice (e.g., dealing with unhealthy food items and economic impact for the retailer).

IMPLICATIONS

This article will synthesize practical experiences with healthy corner stores in Canada. It offers a baseline assessment of promising aspects of this intervention for health and health equity, and identifies opportunities to strengthen both science and practice in this area of retail food environment work.

Supermarket access, transport mode and BMI: the potential for urban design and planning policy across socio-economic areas

OBJECTIVE

To investigate dietary intake, BMI and supermarket access at varying geographic scales and transport modes across areas of socio-economic disadvantage, and to evaluate the implementation of an urban planning policy that provides guidance on spatial access to supermarkets.

DESIGN

Cross-sectional study used generalised estimating equations to investigate associations between supermarket density and proximity, vegetable and fruit intake and BMI at five geographic scales representing distances people travel to purchase food by varying transport modes. A stratified analysis by area-level disadvantage was conducted to detect optimal distances to supermarkets across socio-economic areas. Spatial distribution of supermarket and transport access was analysed using a geographic information system.

SETTING

Melbourne, Australia.

SUBJECTS

Adults (n 3128) from twelve local government areas (LGA) across Melbourne.

RESULTS

Supermarket access was protective of BMI for participants in high disadvantaged areas within 800 m (P=0·040) and 1000 m (P=0·032) road network buffers around the household but not for participants in less disadvantaged areas. In urban growth area LGA, only 26 % of dwellings were within 1 km of a supermarket, far less than 80-90 % of dwellings suggested in the local urban planning policy. Low public transport access compounded disadvantage.

CONCLUSIONS

Rapid urbanisation is a global health challenge linked to increases in dietary risk factors and BMI. Our findings highlight the importance of identifying the most appropriate geographic scale to inform urban planning policy for optimal health outcomes across socio-economic strata. Urban planning policy implementation in disadvantaged areas within cities has potential for reducing health inequities.

Does exposure to the food environment differ by socioeconomic position? Comparing area-based and person-centred metrics in the Fenland Study, UK

Background

Retail food environments (foodscapes) are a recognised determinant of eating behaviours and may contribute to inequalities in diet. However, findings from studies measuring socioeconomic inequality in the foodscape have been mixed, which may be due to methodological differences. The aim of this cross-sectional study was to compare exposure to the foodscape by socioeconomic position using different measures, to test whether the presence, direction or amplitude of differences was sensitive to the choice of foodscape metric or socioeconomic indicator.

Methods

A sample of 10,429 adults aged 30–64 years with valid home address data were obtained from the Fenland Study, UK. Of this sample, 7270 participants also had valid work location data. The sample was linked to data on food outlets obtained from local government records. Foodscape metrics included count, density and proximity of takeaway outlets and supermarkets, and the percentage of takeaway outlets relative to all food outlets. Exposure metrics were area-based (lower super output areas), and person-centred (proximity to nearest; Euclidean and Network buffers at 800 m, 1 km, and 1 mile). Person-centred buffers were constructed using home and work locations. Socioeconomic status was measured at the area-level (2010 Index of Multiple Deprivation) and the individual-level (highest educational attainment; equivalised household income). Participants were classified into socioeconomic groups and average exposures estimated. Results were analysed using the statistical and percent differences between the highest and lowest socioeconomic groups.

Results

In area-based measures, the most deprived areas contained higher takeaway outlet densities (p < 0.001). However, in person-centred metrics lower socioeconomic status was associated with lower exposure to takeaway outlets and supermarkets (all home-based exposures p < 0.001) and socioeconomic differences were greatest at the smallest buffer sizes. Socioeconomic differences in exposure was similar for home and combined home and work measures. Measuring takeaway exposure as a percentage of all outlets reversed the socioeconomic differences; the lowest socioeconomic groups had a higher percentage of takeaway outlets compared to the middle and highest groups (p < 0.001).

Conclusions

We compared approaches to measuring socioeconomic variation in the foodscape and found that the association was sensitive to the metric used. In particular, the direction of association varied between area- and person-centred measures and between absolute and relative outlet measures. Studies need to consider the most appropriate measure for the research question, and may need to consider multiple measures as a single measure may be context dependent.

The mismatch between observational measures and residents' perspectives on the retail food environment: a mixed-methods approach in the Heart Healthy Hoods study

OBJECTIVE

To gain a deeper understanding of the retail food environment by investigating similarities and differences between objective measures and residents' perspectives.

DESIGN

The study incorporated Geographic Information System (GIS)-based measures, in-store surveys and the results from a larger photovoice project. We combined these data using a convergent parallel mixed-methods approach.

SETTING

We conducted this study in a low-income neighbourhood in Madrid (Spain) in 2016.

SUBJECTS

We assessed healthy food availability, accessibility and affordability using GIS-based measures and in-store audits. We also analysed the photographs and discussions from twelve participants who engaged in a photovoice project on their food environment.

RESULTS

Quantitative results depicted a widely served and highly accessible retail food environment, in which supermarkets scored highest in terms of healthy food availability (36·5 out of 39) and 98·9 % of residents could access a healthy food store within a walking travel distance of less than 15 min. Qualitative results showed that participants preferred small local businesses over supermarkets, and revealed built environment obstacles for elderly residents. They also highlighted how the socio-economic context constrained residents' food choices.

CONCLUSIONS

People's experienced retail food environment is different from the one quantitatively analysed. Results show the potential of using a mixed-methods approach to enrich food environment research and enhance public health interventions.

Perception of food consumed at home and dietary intake: A nationwide study from Brazil

Perception of food consumed is a key factor in acknowledging the need for behavioral change to improve diet quality. We analyzed family dietary intake according to the head of household's perception of satisfaction with food consumed by the family. Households (n = 13,351) that participated in the Brazilian Household Budget Survey and the National Dietary Survey were classified as satisfied or dissatisfied with the food consumed in the home. We compared the family dietary intake of the two groups considering their socio-demographic characteristics. Satisfied families (n = 4429) reported statistically higher intake (in grams/1000 kcal) of vegetables (47.3 vs 33.7), fruits (46.9 vs 21.4), sugar-sweetened beverages (118 vs 71.7), milk and dairy (57.9 vs 34.6), and ultra-processed products (18.6 vs 9.8); and lower intake of rice (86.2 vs 112), beans (91.7 vs 136), and meat (76.5 vs 84.0) when compared to dissatisfied families (n = 1717). Among satisfied families, in the youngest group we found lower consumption of fruits and higher intake of sugar-sweetened beverages and ultra-processed products when compared to the oldest group. Also among satisfied families, those in the highest per capita income group presented higher intake of fruits and lower intake of beans than those in the lowest income group. Satisfied families in the highest income group also consumed more fruits and less beans than dissatisfied families in the same income group. Socio-demographic characteristics may influence perception of satisfaction with food consumed and potentially influence the success of public health efforts to offer nutrition guidance for families satisfied with diets that may or may not be comprised of healthy food and beverages.

Neighborhood and Individual Sociodemographic Characteristics Associated with Disparities in Adult Obesity and Perceptions of the Home Food Environment

Purpose: Multiple studies have demonstrated significant disparities in the relationship between individual sociodemographic characteristics and risk of overweight or obesity. However, little information is available for assessing the complex associations among being overweight or obese with neighborhood and individual sociodemographic factors and the measured and perceived community food environment. Methods: Using 2014 national evaluation data from 20 communities (analyzed 2015-2016) that participated in the U.S. Centers for Disease Control and Prevention Community Transformation Grants Program, we used multilevel multivariable models to assess associations among factors at the individual, census tract, and county levels with being overweight or obese and with the perceived home food environment. Results: Individual level factors (age, sex, race/ethnicity, household income, and education) were significantly associated with the likelihood of being overweight or obese in every model tested. Census tract level poverty and education were significantly associated with the likelihood of being overweight or obese in univariate but not multivariable analyses. Perceived community food environment was a significant predictor of the perceived home food environment; the objective measure of county-level grocery store access was not. Neither perceived nor objective community food environment measures were significantly associated with overweight/obesity in multivariable analyses. Conclusion: Individual-level sociodemographic characteristics are more strongly associated with obesity-related outcomes than are area-level measures. Future interventions designed to address health equity issues in obesity among underserved populations may benefit from focusing on nutrition education tailored to individuals, to encourage purchase and consumption of healthy food. Improving healthy food availability in underserved communities may also be critical for nutrition education to have a meaningful impact.

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association

Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.

Greater access to healthy food outlets in the home and school environment is associated with better dietary quality in young children

OBJECTIVE

To explore associations between dietary quality and access to different types of food outlets around both home and school in primary school-aged children.

DESIGN

Cross-sectional observational study.

SETTING

Hampshire, UK.

SUBJECTS

Children (n 1173) in the Southampton Women's Survey underwent dietary assessment at age 6 years by FFQ and a standardised diet quality score was calculated. An activity space around each child's home and school was created using ArcGIS. Cross-sectional observational food outlet data were overlaid to derive four food environment measures: counts of supermarkets, healthy specialty stores (e.g. greengrocers), fast-food outlets and total number of outlets, and a relative measure representing healthy outlets (supermarkets and specialty stores) as a proportion of total retail and fast-food outlets.

RESULTS

In univariate multilevel linear regression analyses, better diet score was associated with exposure to greater number of healthy specialty stores (β=0·025 sd/store: 95 % CI 0·007, 0·044) and greater exposure to healthy outlets relative to all outlets in children's activity spaces (β=0·068 sd/10 % increase in healthy outlets as a proportion of total outlets, 95 % CI 0·018, 0·117). After adjustment for mothers' educational qualification and level of home neighbourhood deprivation, the relationship between diet and healthy specialty stores remained robust (P=0·002) while the relationship with the relative measure weakened (P=0·095). Greater exposure to supermarkets and fast-food outlets was associated with better diet only in the adjusted models (P=0·017 and P=0·014, respectively).

CONCLUSIONS

The results strengthen the argument for local authorities to increase the number of healthy food outlets to which young children are exposed.

The relationship between dietary quality and the local food environment differs according to level of educational attainment: A cross-sectional study

There is evidence that food outlet access differs according to level of neighbourhood deprivation but little is known about how individual circumstances affect associations between food outlet access and diet. This study explored the relationship between dietary quality and a measure of overall food environment, representing the balance between healthy and unhealthy food outlet access in individualised activity spaces. Furthermore, this study is the first to assess effect modification of level of educational attainment on this relationship. A total of 839 mothers with young children from Hampshire, United Kingdom (UK) completed a cross-sectional survey including a 20-item food frequency questionnaire to measure diet and questions about demographic characteristics and frequently visited locations including home, children’s centre, general practitioner, work, main food shop and physical activity location. Dietary information was used to calculate a standardised dietary quality score for each mother. Individualised activity spaces were produced by creating a 1000m buffer around frequently visited locations using ArcGIS. Cross-sectional observational food outlet data were overlaid onto activity spaces to derive an overall food environment score for each mother. These scores represented the balance between healthy and unhealthy food outlets using weightings to characterise the proportion of healthy or unhealthy foods sold in each outlet type. Food outlet access was dominated by the presence of unhealthy food outlets; only 1% of mothers were exposed to a healthy overall food environment in their daily activities. Level of educational attainment moderated the relationship between overall food environment and diet (mid vs low, p = 0.06; high vs low, p = 0.04). Adjusted stratified linear regression analyses showed poorer food environments were associated with better dietary quality among mothers with degrees (β = -0.02; 95%CI: -0.03, -0.001) and a tendency toward poorer dietary quality among mothers with low educational attainment, however this relationship was not statistically significant (β = 0.01; 95%CI: -0.01, 0.02). This study showed that unhealthy food outlets, like takeaways and convenience stores, dominated mothers’ food outlet access, and provides some empirical evidence to support the concept that individual characteristics, particularly educational attainment, are protective against exposure to unhealthy food environments. Improvements to the imbalance of healthy and unhealthy food outlets through planning restrictions could be important to reduce dietary inequalities.

Assessing the validity of commercial and municipal food environment data sets in Vancouver, Canada

OBJECTIVE

The present study assessed systematic bias and the effects of data set error on the validity of food environment measures in two municipal and two commercial secondary data sets.

DESIGN

Sensitivity, positive predictive value (PPV) and concordance were calculated by comparing two municipal and two commercial secondary data sets with ground-truthed data collected within 800 m buffers surrounding twenty-six schools. Logistic regression examined associations of sensitivity and PPV with commercial density and neighbourhood socio-economic deprivation. Kendall's τ estimated correlations between density and proximity of food outlets near schools constructed with secondary data sets v. ground-truthed data.

SETTING

Vancouver, Canada.

SUBJECTS

Food retailers located within 800 m of twenty-six schools RESULTS: All data sets scored relatively poorly across validity measures, although, overall, municipal data sets had higher levels of validity than did commercial data sets. Food outlets were more likely to be missing from municipal health inspections lists and commercial data sets in neighbourhoods with higher commercial density. Still, both proximity and density measures constructed from all secondary data sets were highly correlated (Kendall's τ>0·70) with measures constructed from ground-truthed data.

CONCLUSIONS

Despite relatively low levels of validity in all secondary data sets examined, food environment measures constructed from secondary data sets remained highly correlated with ground-truthed data. Findings suggest that secondary data sets can be used to measure the food environment, although estimates should be treated with caution in areas with high commercial density.

Pricing of Staple Foods at Supermarkets versus Small Food Stores

Prices affect food purchase decisions, particularly in lower-income communities, where access to a range of food retailers (including supermarkets) is limited. The aim of this study was to examine differences in staple food pricing between small urban food stores and the closest supermarkets, as well as whether pricing differentials varied based on proximity between small stores and larger retailers. In 2014, prices were measured for 15 staple foods during store visits in 140 smaller stores (corner stores, gas-marts, dollar stores, and pharmacies) in Minneapolis/St. Paul, MN and their closest supermarket. Mixed models controlling for store type were used to estimate the average price differential between: (a) smaller stores and supermarkets; (b) isolated smaller stores (>1 mile to closest supermarket) and non-isolated smaller stores; and (c) isolated smaller stores inside versus outside USDA-identified food deserts. On average, all items except white bread were 10-54% more expensive in smaller stores than in supermarkets (p < 0.001). Prices were generally not significantly different in isolated stores compared with non-isolated stores for most items. Among isolated stores, there were no price differences inside versus outside food deserts. We conclude that smaller food stores have higher prices for most staple foods compared to their closest supermarket, regardless of proximity. More research is needed to examine staple food prices in different retail spaces.

Access and quality of parks and associations with obesity: A cross-sectional study

Public health is increasingly engaging with multi-faceted obesity prevention efforts. Although parks represent key community assets for broader public health, they may not be distributed equitably and associations with obesity are equivocal. We investigated park access and quality relative to deprivation and obesity with individual-level data from the Yorkshire Health Study. Compared to the least deprived areas, the moderately and most deprived areas had a greater park access and park quality in terms of features and amenities. However, parks in the moderately and most deprived areas also had the most safety concerns and incivilities. Although deprivation was associated with obesity, contrary to current policy guidance, both park access and quality appear less important for understanding variations in obesity within this study. Although sub-group analyses by deprivation tertile revealed that low quality park amenities in highly and moderately deprived areas may be important for understanding obesity prevalence, all other associations were non-significant.

Investigating the Spatial Dimension of Food Access

The purpose of this article is to investigate the sensitivity of food access models to a dataset’s spatial distribution and the empirical definition of food access, which contributes to understanding the mixed findings of previous studies. Data was collected in the Dan River Region in the United States using a telephone survey for individual-level variables (n = 784) and a store audit for the location of food retailers and grocery store quality. Spatial scanning statistics assessed the spatial distribution of obesity and detected a cluster of grocery stores overlapping with a cluster of obesity centered on a grocery store suggesting that living closer to a grocery store increased the likelihood of obesity. Logistic regression further examined this relationship while controlling for demographic and other food environment variables. Similar to the cluster analysis results, increased distance to a grocery store significantly decreased the likelihood of obesity in the urban subsample (average marginal effects, AME = −0.09, p-value = 0.02). However, controlling for grocery store quality nullified these results (AME = −0.12, p-value = 0.354). Our findings suggest that measuring grocery store accessibility as the distance to the nearest grocery store captures variability in the spatial distribution of the health outcome of interest that may not reflect a causal relationship between the food environment and health.

Obesity Pathogenesis: An Endocrine Society Scientific Statement

Obesity is among the most common and costly chronic disorders worldwide. Estimates suggest that in the United States obesity affects one-third of adults, accounts for up to one-third of total mortality, is concentrated among lower income groups, and increasingly affects children as well as adults. A lack of effective options for long-term weight reduction magnifies the enormity of this problem; individuals who successfully complete behavioral and dietary weight-loss programs eventually regain most of the lost weight. We included evidence from basic science, clinical, and epidemiological literature to assess current knowledge regarding mechanisms underlying excess body-fat accumulation, the biological defense of excess fat mass, and the tendency for lost weight to be regained. A major area of emphasis is the science of energy homeostasis, the biological process that maintains weight stability by actively matching energy intake to energy expenditure over time. Growing evidence suggests that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight. We need to elucidate the mechanisms underlying this "upward setting" or "resetting" of the defended level of body-fat mass, whether inherited or acquired. The ongoing study of how genetic, developmental, and environmental forces affect the energy homeostasis system will help us better understand these mechanisms and are therefore a major focus of this statement. The scientific goal is to elucidate obesity pathogenesis so as to better inform treatment, public policy, advocacy, and awareness of obesity in ways that ultimately diminish its public health and economic consequences.

Is food store type associated with the consumption of ultra-processed food and drink products in Brazil?

Objective

To analyse the association between food store type and the consumption of ultra-processed products in Brazil.

Design

Data from the 2008–2009 Household Budget Survey involving a probabilistic sample of 55 970 Brazilian households. Food stores were grouped into nine categories. Foods and drinks were grouped according to characteristics of food processing. The contribution of each food store type to the total energy acquired from each food processing group, and according to quintiles of consumption of ultra-processed products, was estimated. Exploratory factor analysis was conducted to identify a pattern of food store usage. Linear regression models were performed to estimate the relationship between the purchase pattern and the consumption of ultra-processed products.

Results

In line with their larger market share, supermarkets accounted for 59 % of total energy and participated most in acquisition for three food groups, with emphasis on ultra-processed products (60·4 % of energy). The participation of supermarkets in total purchase tended to increase in populations with higher consumption of ultra-processed products, while the participation of small markets and small producers tended to decrease. The purchase pattern characterized by use of traditional retail (street fairs and vendors, small markets, small farmers, butcheries) was associated with a smaller consumption of ultra-processed products.

Conclusions

Food policies and interventions aiming to reduce the consumption of ultra-processed products should consider the influence of supermarkets on the consumption of these products. A purchase pattern based on traditional retail constitutes an important tool for promoting healthy eating in Brazil.

Barriers to and facilitators of ultra-processed food consumption: perceptions of Brazilian adults

OBJECTIVE

To explore how individuals perceive the availability of ultra-processed foods in their neighbourhoods and the barriers to and facilitators of consumption of such foods.

DESIGN

A qualitative design was chosen. In-depth, face-to-face semi-structured interviews were conducted and a content analysis was performed.

SETTING

São Paulo, Brazil.

SUBJECTS

A purposeful sample of adults (n 48), stratified by sex and age group (20-39 years and 40-59 years).

RESULTS

All participants perceived their neighbourhoods as favourable regarding the availability of ultra-processed foods. Three barriers were identified: health concerns, not appreciating the taste of these foods and not being used to eating them. Five facilitators, however, were identified: appreciating the taste of these foods, their children's preference, convenience, addiction and cost.

CONCLUSIONS

Participants perceived their neighbourhoods as favourable to the consumption of ultra-processed foods and reported more facilitators than barriers to their consumption. Reported barriers point to the need to include measures promoting a healthy food system and traditional eating practices. The facilitators reinforce the idea that these foods are habit-forming and that regulatory measures to offset the exposure to ultra-processed foods are necessary.

The moderating role of food cue sensitivity in the behavioral response of children to their neighborhood food environment: a cross-sectional study

Background

Neighborhood food cues have been inconsistently related to residents’ health, possibly due to variations in residents’ sensitivity to such cues. This study sought to investigate the degree to which children’s predisposition to eat upon exposure to food environment and food cues (external eating), could explain differences in strength of associations between their food consumption and the type of food outlets and marketing strategies present in their neighborhood.

Methods

Data were obtained from 616 6–12 y.o. children recruited into a population-based cross-sectional study in which food consumption was measured through a 24-h food recall and responsiveness to food cues measured using the external eating scale. The proportion of food retailers within 3 km of residence considered as “healthful” was calculated using a Geographical Information System. Neighborhood exposure to food marketing strategies (displays, discount frequency, variety, and price) for vegetables and soft drinks were derived from a geocoded digital marketing database. Adjusted mixed models with spatial covariance tested interaction effects of food environment indicators and external eating on food consumption.

Results

In children with higher external eating scores, healthful food consumption was more positively related to vegetable displays, and more negatively to the display and variety of soft drinks. No interactions were observed for unhealthful food consumption and no main effects of food environment indicators were found on food consumption.

Conclusions

Children differ in their responsiveness to marketing-related visual food cues on the basis of their external eating phenotype. Strategies aiming to increase the promotion of healthful relative to unhealthful food products in stores may be particularly beneficial for children identified as being more responsive to food cues.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0540-9) contains supplementary material, which is available to authorized users.

Influence of environmental factors on food intake among nursing home residents: a survey combined with a video approach

Background

In addition to the well-known physiological factors, dietary behavior that affects health seems to be influenced by a wide variety of environmental factors. The aim of this study was to assess, by means of an original video approach, the influence of the environment on food intake in nursing homes.

Methods

The perception of the environment during meals in nursing homes was evaluated by residents and by two groups of volunteers who either work in the field of geriatrics, or who do not work in the field of geriatrics. First, a random sample of residents answered a self-administered questionnaire related to different indicators (ie, noise, space, comfort, light, odors, perceived satisfaction of meals, taste of meals, presentation of meals, service and setting). Second, two separate panels, one including the people who work in the field of geriatrics (ie, experts) and one including the people who have no particular interest in geriatrics (ie, nonexperts), were asked to answer a questionnaire on their perception of the environment after having watched a video of the lunch in each nursing home. Then, the food intake of the residents was measured by a precise food-weighing method.

Results

A total of 88 residents from nine different nursing homes, 18 experts and 45 nonexperts answered the questionnaires. This study highlighted that, on the one hand, after adjustment on confounding variables, the perception of the quantity of food served by the residents is the only single factor associated with food consumption (P=0.003). On the other hand, experts and nonexperts did not perceive any environmental factor that seems to be significantly associated with residents’ food intake.

Conclusion

Our results highlighted that, in a nursing home setting, environmental factors have limited influence on the food intake of the residents, with the exception of their own perception of the quantity served. The relevance of this factor deserves further investigation.

Does where you shop or who you are predict what you eat?: The role of stores and individual characteristics in dietary intake

Interventions to address diet, a modifiable risk factor for diabetes, cancer, and cardiovascular disease, have increasingly emphasized the influence of the physical environment on diet, while more traditional approaches have focused on individual characteristics. We examined environmental and individual influences on diet to understand the role of both. Household interviews were conducted in 2011 with 1372 individuals randomly selected from two low-income, predominantly African American neighborhoods in Pittsburgh, PA. Participants reported their sociodemographic characteristics, food shopping behavior, and dietary intake. Both food shopping frequency at different types of food stores and sociodemographic characteristics showed significant associations with diet in adjusted regression models. More frequent shopping at convenience and neighborhood stores and being younger, male, without a college degree, and receiving SNAP benefits were associated with greater intake of sugar-sweetened beverages (SSBs), added sugars, and discretionary fats. Being older, male, and having a college degree were associated with greater intake of fruits and vegetables. However, while food shopping behavior and sociodemographic characteristics accounted for similar amounts of nonoverlapping variance in fruit and vegetable intake, food shopping behavior accounted for much less variance, and little unique variance, in SSBs, added sugars, and discretionary fats in models with sociodemographic characteristics. The current study reinforces the need for policies and interventions at both the environmental and individual levels to improve diet in food desert residents. Individual interventions to address food choices associated with certain sociodemographic characteristics might be particularly important for curbing intake of SSBs, added sugars, and discretionary fats.

Association between distance to nearest supermarket and provision of fruits and vegetables in English nurseries

With 796,500 places available for children in England, pre-school nurseries could serve as an important setting for population-wide dietary intervention. It is critical to understand the determinants of healthy food provision in this setting, which may include access to food stores. This study examined the association between objective, GIS-derived supermarket proximity and fruit and vegetable serving frequency, using data from 623 English nurseries. Overall, 116 (18%) nurseries served fruits and vegetables infrequently (<2-3 times/week), but provision differed by supermarket proximity. In adjusted multivariable regression models, nurseries farthest from their nearest supermarket (Q5, 1.7-19.8km) had 2.38 (95% CI 1.01-5.63) greater odds of infrequent provision. Our results suggest that supermarket access may be important for nurseries in meeting fruit and vegetable provision guidelines. We advance a growing body of international literature, for the first time linking the food practices of institutions to their neighbourhood food retail context.

Changes in the food environment over time: examining 40 years of data in the Framingham Heart Study

Background

Research has explored associations between diet, body weight, and the food environment; however, few studies have examined historical trends in food environments.

Methods

In the Framingham Heart Study Offspring (N = 3321) and Omni (N = 447) cohorts, we created food environment metrics in four Massachusetts towns utilizing geocoded residential, workplace, and food establishment addresses from 1971 to 2008. We created multilevel models adjusted for age, sex, education, and census tract poverty to examine trends in home, workplace, and commuting food environments.

Results

Proximity to and density of supermarkets, fast-food, full service restaurants, convenience stores, and bakeries increased over time for residential, workplace, and commuting environments; exposure to grocery stores decreased. The greatest increase in access was for supermarkets, with residential distance to the closest supermarket 1406 m closer (95% CI 1303 m, 1508 m) by 2005–2008 than in 1971–1975. Although poorer census tracts had higher access to fast-food restaurants consistently across follow-up, this disparity dissipated over time, due to larger increases in proximity to fast-food in wealthier neighborhoods.

Conclusions

Access to most food establishment types increased over time, with similar trends across home, workplace, and commuter environments.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0537-4) contains supplementary material, which is available to authorized users.

Association of food access and neighbor relationships with diet and underweight among community-dwelling older Japanese

BACKGROUND

Food access is important for maintaining dietary variety, which predicts underweight. The aim of this study was to examine the association of food access and neighbor relationships with eating and underweight.

METHODS

We analyzed cross-sectional data from 102,869 Japanese individuals aged 65 years or older. The perceived availability of food was assessed using the presence or absence of food stores within 1 km of the home. Level of relationships with neighbors was also assessed. The odds ratios (ORs) and 95% confidence intervals (CIs) for infrequent food intake and underweight were determined using logistic regression analysis.

RESULTS

The proportion of men and women having low access to food was 25-30%. Having low food access (OR 1.18; 95% CI, 1.12-1.25 for men and OR 1.26; 95% CI, 1.19-1.33 for women) and a low level of relationship with neighbors (OR 1.38; 95% CI, 1.31-1.45 for men and OR 1.57; 95% CI, 1.48-1.67 for women) was associated with infrequent intake of fruits and vegetables in both sexes. Association between low food access and infrequent intake of fruits and vegetables was higher among men with low levels of neighbor relationship (OR 1.34; 95% CI, 1.23-1.46) than among men with high levels of relationship (OR 1.10; 95% CI, 1.03-1.18).

CONCLUSIONS

Low perceived availability of food is a risk factor for low dietary variety among older people. Furthermore, high levels of relationship with neighbors may relieve the harmful effect of low food access.

Exploring the influence of local food environments on food behaviours: a systematic review of qualitative literature

Objective

Systematic reviews investigating associations between objective measures of the food environment and dietary behaviours or health outcomes have not established a consistent evidence base. The present paper aims to synthesise qualitative evidence regarding the influence of local food environments on food and purchasing behaviours.

Design

A systematic review in the form of a qualitative thematic synthesis.

Setting

Urban localities.

Subjects

Adults.

Results

Four analytic themes were identified from the review including community and consumer nutrition environments, other environmental factors and individual coping strategies for shopping and purchasing decisions. Availability, accessibility and affordability were consistently identified as key determinants of store choice and purchasing behaviours that often result in less healthy food choices within community nutrition environments. Food availability, quality and food store characteristics within consumer nutrition environments also greatly influenced in-store purchases. Individuals used a range of coping strategies in both the community and consumer nutrition environments to make optimal purchasing decisions, often within the context of financial constraints.

Conclusions

Findings from the current review add depth and scope to quantitative literature and can guide ongoing theory, interventions and policy development in food environment research. There is a need to investigate contextual influences within food environments as well as individual and household socio-economic characteristics that contribute to the differing use of and views towards local food environments. Greater emphasis on how individual and environmental factors interact in the food environment field will be key to developing stronger understanding of how environments can support and promote healthier food choices.

Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores

Background

Purchases at small/non-traditional food stores tend to have poor nutritional quality, and have been associated with poor health outcomes, including increased obesity risk The purpose of this study was to examine whether customers who shop at small/non-traditional food stores with more health promoting features make healthier purchases.

Methods

In a cross-sectional design, data collectors assessed store features in a sample of 99 small and non-traditional food stores not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Minneapolis/St. Paul, MN in 2014. Customer intercept interviews (n = 594) collected purchase data from a bag check and demographics from a survey. Store measures included fruit/vegetable and whole grain availability, an overall Healthy Food Supply Score (HFSS), healthy food advertisements and in-store placement, and shelf space of key items. Customer nutritional measures were analyzed using Nutrient Databases System for Research (NDSR), and included the purchase of ≥1 serving of fruits/vegetables; ≥1 serving of whole grains; and overall Healthy Eating Index-2010 (HEI-2010) score for foods/beverages purchased. Associations between store and customer measures were estimated in multilevel linear and logistic regression models, controlling for customer characteristics and store type.

Results

Few customers purchased fruits and vegetables (8%) or whole grains (8%). In fully adjusted models, purchase HEI-2010 scores were associated with fruit/vegetable shelf space (p = 0.002) and the ratio of shelf space devoted to healthy vs. less healthy items (p = 0.0002). Offering ≥14 varieties of fruit/vegetables was associated with produce purchases (OR 3.9, 95% CI 1.2–12.3), as was having produce visible from the store entrance (OR 2.3 95% CI 1.0 to 5.8), but whole grain availability measures were not associated with whole grain purchases.

Conclusions

Strategies addressing both customer demand and the availability of healthy food may be necessary to improve customer purchases.

Trial registration

ClinialTrials.gov: NCT02774330. Registered May 4, 2016 (retrospectively registered).

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0531-x) contains supplementary material, which is available to authorized users.

Change in diet in the period from adolescence to early adulthood: a systematic scoping review of longitudinal studies

BACKGROUND

Late adolescence to early adulthood is a period of lifestyle change and personal development which may influence dietary behaviour. Understanding dietary trajectories across this age range may help in targeting interventions appropriately. This scoping review aimed to assess how longitudinal change in diet is conceptualised and measured between the ages of 13 to 30.

METHODS

We searched Medline, SCOPUS, Embase, PsycInfo (EBSCO), ASSIA, Sportdiscus, and Web of Science Core Collection (January 2016) using search terms combining diet outcomes, longitudinal methods and indicators of adolescent or young adult age. Titles and abstracts were screened and data extracted following published guidelines for scoping reviews. Data were analysed to summarize key data on each study and map availability of longitudinal data on macronutrients and food groups by age of study participants.

RESULTS

We identified 98 papers reporting on 40 studies. Longitudinal dietary data were available on intake of energy, key macronutrients and several food groups, but this data had significant gaps and limitations. Most studies provided only two or three waves of data within the age range of interest and few studies reported data collected beyond the early twenties. A range of dietary assessment methods were used, with greater use of less comprehensive dietary assessment methods among studies reporting food group intakes.

CONCLUSION

Despite limited availability of longitudinal data to aid understanding of dietary trajectories across this age range, this scoping review identified areas with scope for further evidence synthesis. We identified a paucity of longitudinal data continuing into the mid and late twenties, variability in (quality of) dietary assessment methods, and a large variety of macronutrients and food groups studied. Advances in dietary assessment methodologies as well as increased use of social media may facilitate new data collection to further understanding of changing diet across this life stage.

The effect of poverty-influenced, food-related consumer behaviors on obesity: An analysis of the NHANES flexible consumer behavioral module

Despite extensive research investigating obesity, the problem continues to increase, particularly in poor, minority, and under-resourced communities. However, the literature continues to demonstrate many obesity-predicating variables are outside of personal volitional control, such as food-related consumer behaviors, which are strongly influenced by income and environment. This cross-sectional study (n = 5,109) employed secondary data analysis to quantitatively examine the effect of food-related consumer variables on obesity while controlling for covariates. Participants answered questions regarding money spent on food, time preparing meals, number of meals eaten at home and away from home, and types of food products consumed (frozen/fast foods, sodas, salty snacks, etc.) In this study, 48.9% of respondents were either overweight or obese. No significant differences were noted between the contextual variables examined and BMI scores. However, given the sample's limitations illuminated in the study, further research regarding the relationship between obesity and poverty-influenced, food-related consumer behaviors is warranted.

Recruiting Community Partners for Veggie Van: Strategies and Lessons Learned From a Mobile Market Intervention in North Carolina, 2012-2015

BACKGROUND

Food access interventions are promising strategies for improving dietary intake, which is associated with better health. However, studies examining the relationship between food access and intake are limited to observational designs, indicating a need for more rigorous approaches. The Veggie Van (VV) program was a cluster-randomized intervention designed to address the gap between food access and intake. In this article, we aim to describe the approaches involved in recruiting community partners to participate in VV.

COMMUNITY CONTEXT

The VV mobile market aimed to improve access to fresh fruits and vegetables by providing subsidized, high-quality, local produce in low-resource communities in North Carolina. This study describes the strategies and considerations involved in recruiting community partners and individual participants for participation in the VV program and evaluation.

METHODS

To recruit partners, we used various strategies, including a site screener to identify potential partners, interest forms to gauge future VV use and prioritize enrollment of a high-need population, marketing materials to promote VV, site liaisons to coordinate community outreach, and a memorandum of understanding between all invested parties.

OUTCOME

A total of 53 community organizations and 725 participants were approached for recruitment. Ultimately, 12 sites and 201 participants were enrolled. Enrollment took 38 months, but our approaches helped successfully recruit a low-income, low-access population. The process took longer than anticipated, and funding constraints prevented certain strategies from being implemented.

INTERPRETATION

Recruiting community partners and members for participation in a multi-level, community-based intervention was challenging. Strategies and lessons learned can inform future studies.

Associations between the local food environment and the severity of food insecurity among new families using community food security interventions in Montreal

OBJECTIVES

To examine the association between the local food environment and the severity of food insecurity among new families using community food security interventions in Montreal.

METHODS

In this cross-sectional study, we analyzed baseline data from 785 adults aged 18-65 years enrolled in the evaluation of the effects of organizations delivering community food security interventions in Montreal. The dependent variable was household food insecurity, while the independent variable was the local food environment, assessed through: location of the most frequently used grocery store, distance between the participant's residence and the community organization used, mode of transportation, walking time to the most frequently used grocery store, satisfaction with the acceptability and affordability of food available at the most frequently used grocery store, and self-reported difficulties in accessing food. We used polytomous logistic regression to estimate the association between household food insecurity and the local food environment. In all the models, we coded food security status in three categories: food security, moderate food insecurity and severe food insecurity. The last group was used as a reference group.

RESULTS

Our data suggest that compared to households with severe food insecurity, those with moderate food insecurity (OR = 0.43, 95% CI: 0.28-0.62) and those with food security (OR = 0.13, 95% CI: 0.06-0.26) were less likely to report difficulties in accessing food due to food affordability. Food-secure households also had lower odds of reporting difficulties in accessing food due to transportation constraints (OR = 0.18, 95% CI: 0.06-0.55) compared with severe food-insecure households. Living a distance of between 1 and 2 km from the organization used was significantly correlated with moderate food insecurity (OR = 1.80, 95% CI: 1.12-2.88).

CONCLUSION

The local food environment is associated with severity of household food insecurity among new families using community food security interventions in Montreal. Future studies should study the relationship between the local food environment and food insecurity across all dimensions of food access.