The local food environment and diet: a systematic review

Community Priorities for Healthy Eating in Older Adults

Community planners such as policymakers and health care and nutrition service providers can create an "age-friendly" environment to support healthy eating in older residents by addressing the highest priorities that enable older adults to improve their dietary intake through different food-related community settings. To identify and prioritize these factors that facilitate behavioral change (enablers) and behavioral settings important for older adult nutrition based on the social ecological model, nutrition and aging professionals (n = 30) from two rural (West Virginia, Iowa) and two urban (Massachusetts, New York) city/county regions (communities) participated in an online or live focus group discussion and completed an analytic hierarchy process survey online. Overall, the most important perceived enablers were accessibility and cost, followed by transportation and social support, but their relative importance varied by community. Participants from all communities considered congregate meal sites and food banks among the most important behavioral settings. Participants from most communities considered food stores to be important and also highlighted other settings unique to the area, such as senior housing, neighborhood, and farmers' markets. By targeting interventions to address the most notable enablers and behavioral settings specific to their community, planning groups can enhance their older residents' ability to achieve optimal nutritional health.

Using Agent-Based Models to Develop Public Policy about Food Behaviours: Future Directions and Recommendations

Most adults are overweight or obese in many western countries. Several population-level interventions on the physical, economical, political, or sociocultural environment have thus attempted to achieve a healthier weight. These interventions have involved different weight-related behaviours, such as food behaviours. Agent-based models (ABMs) have the potential to help policymakers evaluate food behaviour interventions from a systems perspective. However, fully realizing this potential involves a complex procedure starting with obtaining and analyzing data to populate the model and eventually identifying more efficient cross-sectoral policies. Current procedures for ABMs of food behaviours are mostly rooted in one technique, often ignore the food environment beyond home and work, and underutilize rich datasets. In this paper, we address some of these limitations to better support policymakers through two contributions. First, via a scoping review, we highlight readily available datasets and techniques to deal with these limitations independently. Second, we propose a three steps' process to tackle all limitations together and discuss its use to develop future models for food behaviours. We acknowledge that this integrated process is a leap forward in ABMs. However, this long-term objective is well-worth addressing as it can generate robust findings to effectively inform the design of food behaviour interventions.

Comparison of the Availability and Cost of Foods Compatible With a Renal Diet Versus an Unrestricted Diet Using the Nutrition Environment Measures Survey

OBJECTIVE

Hemodialysis patients' ability to access food that is both compatible with a renal diet and affordable is affected by the local food environment. Comparisons of the availability and cost of food items suitable for the renal diet versus a typical unrestricted diet were completed using the standard Nutrition Environment Measures Survey and a renal diet-modified Nutrition Environment Measures Survey.

DESIGN

Cross-sectional study.

SETTING

Twelve grocery stores in Northeast Ohio.

MAIN OUTCOME MEASURE

Availability and cost of food items in 12 categories.

RESULTS

The mean total number of food items available differed significantly (P ≤ .001) between the unrestricted diet (38.9 ± 4.5) and renal diet (32.2 ± 4.7). The mean total cost per serving did not differ significantly (P = 0.48) between the unrestricted diet ($5.67 ± 2.50) and renal diet ($5.76 ± 2.74).

CONCLUSION

The availability of renal diet food items is significantly less than that of unrestricted diet food items, but there is no difference in the cost of items that are available in grocery stores. Further work is needed to determine how to improve the food environment for patients with chronic diseases.

Where do people purchase food? A novel approach to investigating food purchasing locations

Background

Studies exploring associations between food environments and food purchasing behaviours have been limited by the absence of data on where food purchases occur. Determining where food purchases occur relative to home and how these locations differ by individual, neighbourhood and trip characteristics is an important step to better understanding the association between food environments and food behaviours.

Methods

Conducted in Melbourne, Australia, this study recruited participants within sixteen neighbourhoods that were selected based on their socioeconomic characteristics and proximity to supermarkets. The survey material contained a short questionnaire on individual and household characteristics and a food purchasing diary. Participants were asked to record details related to all food purchases made over a 2-week period including food store address. Fifty-six participants recorded a total of 952 food purchases of which 893 were considered valid for analysis. Households and food purchase locations were geocoded and the network distance between these calculated. Linear mixed models were used to determine associations between individual, neighbourhood, and trip characteristics and distance to each food purchase location from home. Additional analysis was conducted limiting the outcome to: (a) purchase made when home was the prior origin (n. 484); and (b) purchases made within supermarkets (n. 317).

Results

Food purchases occurred a median distance of 3.6 km (IQR 1.8, 7.2) from participants’ homes. This distance was similar when home was reported as the origin (median 3.4 km; IQR 1.6, 6.4) whilst it was shorter for purchases made within supermarkets (median 2.8 km; IQR 1.6, 5.6). For all purchases, the reported food purchase location was further from home amongst the youngest age group (compared to the oldest age group), when workplace was the origin of the food purchase trip (compared to home), and on weekends (compared to weekdays). Differences were also observed by neighbourhood characteristics.

Conclusions

This study has demonstrated that many food purchases occur outside what is traditionally considered the residential neighbourhood food environment. To better understand the role of food environments on food purchasing behaviours, further work is needed to develop more appropriate food environment exposure measures.

Electronic supplementary material

The online version of this article (doi:10.1186/s12942-017-0082-z) contains supplementary material, which is available to authorized users.

Kernel Density Estimation as a Measure of Environmental Exposure Related to Insulin Resistance in Breast Cancer Survivors

Background: Environmental factors may influence breast cancer; however, most studies have measured environmental exposure in neighborhoods around home residences (static exposure). We hypothesize that tracking environmental exposures over time and space (dynamic exposure) is key to assessing total exposure. This study compares breast cancer survivors' exposure to walkable and recreation-promoting environments using dynamic Global Positioning System (GPS) and static home-based measures of exposure in relation to insulin resistance.Methods: GPS data from 249 breast cancer survivors living in San Diego County were collected for one week along with fasting blood draw. Exposure to recreation spaces and walkability was measured for each woman's home address within an 800 m buffer (static), and using a kernel density weight of GPS tracks (dynamic). Participants' exposure estimates were related to insulin resistance (using the homeostatic model assessment of insulin resistance, HOMA-IR) controlled by age and body mass index (BMI) in linear regression models.Results: The dynamic measurement method resulted in greater variability in built environment exposure values than did the static method. Regression results showed no association between HOMA-IR and home-based, static measures of walkability and recreation area exposure. GPS-based dynamic measures of both walkability and recreation area were significantly associated with lower HOMA-IR (P < 0.05).Conclusions: Dynamic exposure measurements may provide important evidence for community- and individual-level interventions that can address cancer risk inequities arising from environments wherein breast cancer survivors live and engage.Impact: This is the first study to compare associations of dynamic versus static built environment exposure measures with insulin outcomes in breast cancer survivors. Cancer Epidemiol Biomarkers Prev; 26(7); 1078-84. ©2017 AACR.

Local food environment and fruit and vegetable consumption: An ecological study

Ecological studies are essential for understanding the environment-diet relationship. The purpose of this study was to describe environmental conditions and their relationship with fruit and vegetable (FV) consumption among Brazilian public health service users in the city of Belo Horizonte. We evaluated food stores contained within 1600 m buffer zones at 18 Health Academy Programme sites, from 2013 to 2014. Variables at the community (density, proximity and type) and the consumer (sectional location of FV; availability, quality, variety, price and advertising of FV and ultra-processed foods) nutrition environment were measured by direct observation, while aggregate data from users (income and FV consumption) were obtained by interview. Data were analysed using the Kernel intensity estimator, average nearest neighbour value and Local Moran's Index for local spatial autocorrelation. We interviewed 3414 users and analysed 336 food stores. Major geographical variations in the FV consumption were identified. Average consumption was higher (site 2A: 410.5 ± 185.7 g vs. site 4B: 311.2 ± 159.9 g) in neighbourhoods with higher income and concentration of food stores, and better index of access to healthy foods. Sites with poor FV consumption had the most stores with poor access to healthy foods (index in the first tertile, ≤ 10). In conclusion, negative characteristics of the food environment, as seen in the present study, may contribute to low FV consumption, suggesting the need for the development and consolidation of public policies aimed at creating healthy environments through built environment interventions that increase access to and consumption of healthy foods like FV.

The association between health-related quality of life/dietary satisfaction and perceived food environment among Japanese individuals with spinal cord injury

STUDY DESIGN

Cross-sectional.

OBJECTIVES

To examine the association between health-related quality of life (HRQOL)/dietary satisfaction and perceived food environment in community-dwelling individuals with spinal cord injury (SCI).

SETTING

Members of the Spinal Injuries Japan organization.

METHODS

Subjects were 2007 Japanese individuals with SCI. A questionnaire conducted in 2015 included items addressing sociodemographic characteristics, HRQOL, dietary satisfaction and eight perceived food environment items. Responses from 506 individuals were analyzed (valid response rate=25%). Dependent variables were the physical and mental summary scores of the HRQOL and dietary satisfaction. The independent variable was the perceived food environment. We used a univariate analysis (in Model 1) and a multivariate analysis (in Models 2 and 3) as part of a binominal logistic regression analysis. In Model 3, we divided and analyzed the perceived food environment variable into 'access to food' and 'access to information'.

RESULTS

Both physical and mental summary scores were related to 'dietary information acquisition in the community'. Dietary satisfaction was related to 'balanced meals in the household', 'food and health information available from family' and 'right health and dietary information acquisition from the media'.

CONCLUSION

HRQOL and dietary satisfaction were differentially associated with perceived food environment factors in community-dwelling individuals with SCI. HRQOL was positively related to dietary information of perceived food environment in the community. Dietary satisfaction was positively related to perceived food environment in the household.

Biobehavioral Factors That Shape Nutrition in Low-Income Populations: A Narrative Review

Although evidence exists for an association between income level and diet quality, a causal relationship has not been established. A number of studies found that the price of nutritious food and the time cost to prepare foods are economically driven reasons for this relationship. However, in addition to economic constraints, low-income individuals and families face a number of additional challenges linked with food choice, eating behaviors, and diet-related chronic conditions that contribute to diet quality and health. Low-income individuals have a higher burden of employment-, food-, and housing-related insecurity that threaten the livelihood of their household. Poverty and exposure to these insecurities are hypothesized to activate biobehavioral and psychological mechanisms-endocrine, immune, and neurologic systems-that influence food choice and consumption. Examples of biobehavioral and psychological factors that influence diet are stress, poor sleep, and diminished cognitive capacity. High levels of stress, poor sleep, and cognitive overload compound the challenges of economic constraints, creating a mentality of scarcity that leads to poor diet quality.

Assessment of Healthy Food Availability in Washington State-Questioning the Food Desert Paradigm

OBJECTIVE

To assess the geographic distribution of healthy food retailers in Washington State and estimate the number of Washington State residents with restricted availability of healthy food.

METHODS

Street network service areas were drawn around Special Supplemental Nutrition Program for Women, Infant, and Children retailers for multiple drive times and walking distances in urban and rural Washington State. Population characteristics inside and outside each service area were examined.

RESULTS

Nearly all Washington State residents in urban areas lived within a 10-minute drive of a Special Supplemental Nutrition Program for Women, Infant, and Children retailer. Among rural residents, 4.6% were in census blocks outside a 20-minute drive, but the populations were dispersed. Differential access related to income was attributable to a lack of transportation.

CONCLUSIONS AND IMPLICATIONS

Disparities in nutrition described in the published literature may not be due to the geographic distribution of healthy food retailers. Programs for improving nutrition should consider broader interventions to increase access to healthy food.

Measures of the food environment: A systematic review of the field, 2007-2015

BACKGROUND

Many studies have examined the relationship between the food environment and health-related outcomes, but fewer consider the integrity of measures used to assess the food environment. The present review builds on and makes comparisons with a previous review examining food environment measures and expands the previous review to include a more in depth examination of reliability and validity of measures and study designs employed.

METHODS

We conducted a systematic review of studies measuring the food environment published between 2007 and 2015. We identified these articles through: PubMed, Embase, Web of Science, PsycINFO, and Global Health databases; tables of contents of relevant journals; and the National Cancer Institute's Measures of the Food Environment website. This search yielded 11,928 citations. We retained and abstracted data from 432 studies.

RESULTS

The most common methodology used to study the food environment was geographic analysis (65% of articles) and the domination of this methodology has persisted since the last review. Only 25.9% of studies in this review reported the reliability of measures and 28.2% reported validity, but this was an improvement as compared to the earlier review. Very few of the studies reported construct validity. Studies reporting measures of the school or worksite environment have decreased since the previous review. Only 13.9% of the studies used a longitudinal design.

CONCLUSIONS

To strengthen research examining the relationship between the food environment and population health, there is a need for robust and psychometrically-sound measures and more sophisticated study designs.

Baltimore City Stores Increased The Availability Of Healthy Food After WIC Policy Change

As part of a 2009 revision to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program, the Department of Agriculture required WIC-authorized stores to stock additional varieties of healthy food. The long-term effects of this policy on access to healthy food are unknown. Using surveys conducted in 118 Baltimore City, Maryland, food stores in 2006 and 2012, we examined associations of the change in healthy food availability with store type, neighborhood demographics, and the 2009 WIC policy change. Overall, healthy food availability improved significantly between 2006 and 2012, with the greatest increases in corner stores and in census tracts with more than 60 percent black residents. On an 11-point scale measuring availability of fruit (3 points), vegetables (4 points), bread (2 points), and milk (2 points), the WIC policy change was associated with a 0.72-point increase in WIC-relevant healthy food availability, while joining WIC was associated with a 0.99-point increase. Stores that carry a limited variety of food items may be more receptive to stocking healthier food than previously thought, particularly within neighborhoods with a majority of black residents. Policies targeting healthy food availability have the potential to increase availability and decrease health disparities.

Diet And Perceptions Change With Supermarket Introduction In A Food Desert, But Not Because Of Supermarket Use

Placing full-service supermarkets in food deserts--areas with limited access to healthy food--has been promoted as a way to reduce inequalities in access to healthy food, improve diet, and reduce the risk of obesity. However, previous studies provide scant evidence of such impacts. We surveyed households in two Pittsburgh, Pennsylvania, neighborhoods in 2011 and 2014, one of which received a new supermarket in 2013. Comparing trends in the two neighborhoods, we obtained evidence of multiple positive impacts from new supermarket placement. In the new supermarket neighborhood we found net positive changes in overall dietary quality; average daily intakes of kilocalories and added sugars; and percentage of kilocalories from solid fats, added sugars, and alcohol. However, the only positive outcome in the recipient neighborhood specifically associated with regular use of the new supermarket was improved perceived access to healthy food. We did not observe differential improvement between the neighborhoods in fruit and vegetable intake, whole grain consumption, or body mass index. Incentivizing supermarkets to locate in food deserts is appropriate. However, efforts should proceed with caution, until the mechanisms by which the stores affect diet and their ability to influence weight status are better understood.

Between exposure, access and use: Reconsidering foodscape influences on dietary behaviours

Good accessibility to both healthy and unhealthy food outlets is a greater reality than food deserts. Yet, there is a lack of conceptual insights on the contextual factors that push individuals to opt for healthy or unhealthy food outlets when both options are accessible. Our comprehension of foodscape influences on dietary behaviours would benefit from a better understanding of the decision-making process for food outlet choices. In this paper, we build on the fundamental position that outlet choices are conditioned by how much outlets' attributes accommodate individuals' constraints and preferences. We further argue that food outlets continuously experienced within individuals' daily-path help people re-evaluate food acquisition possibilities, push them to form intentions, and shape their preferences for the choices they will subsequently make. Doing so, we suggest differentiating access, defined as the potential for the foodscape to be used at the time when individuals decide to do so, from exposure, which acts as a constant catalyst for knowledge, intention, preferences and routine tendency. We conclude with implications for future research, and discuss consequences for public policy.

A possible dose-response association between distance to farmers' markets and roadside produce stands, frequency of shopping, fruit and vegetable consumption, and body mass index among customers in the Southern United States

BACKGROUND

The association between farmers' market characteristics and consumer shopping habits remains unclear. Our objective was to examine associations among distance to farmers' markets, amenities within farmers' markets, frequency of farmers' market shopping, fruit and vegetable consumption, and body mass index (BMI). We hypothesized that the relationship between frequency of farmers' market shopping and BMI would be mediated by fruit and vegetable consumption.

METHODS

In 15 farmers' markets in northeastern North Carolina, July-September 2015, we conducted a cross-sectional survey among 263 farmers' market customers (199 provided complete address data) and conducted farmers' market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent variables included farmers' market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for age, race, sex, and education, were used to examine associations between distance to farmers' markets, amenities within farmers' markets, frequency of farmers' market shopping, fruit and vegetable consumption, and BMI.

RESULTS

Those who reported shopping at farmers' markets a few times per year or less reported consuming 4.4 (standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers' market amenities, and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of the relationship between frequency of shopping and BMI by fruit and vegetable consumption.

CONCLUSIONS

More work should be done to understand factors within farmers' markets that encourage fruit and vegetable purchases.

Obesogenic environments: current evidence of the built and food environments

Aims:

Obesity is one of the most significant global health and social problems, with rates rising dramatically over the past few decades. While the basic drivers of obesity are obvious (more energy consumed than expended), the causes are multifactorial and complex. A decade ago, it was suggested that exploring the ways in which the built environment influenced physical activity and dietary behaviours might provide fertile ground for investigation. This article overviews current evidence and, in particular, emergent themes that are of significance for the United Kingdom.

Methods:

This article is based on literature extracted from keyword searching of electronic databases. A timeframe of 2006–2016 was used.

Results:

In the past decade, the research base has grown significantly; while frustratingly some results are still inconclusive or contradictory, it might be argued enough evidence exists to act upon. Themes such as the importance of the journey to school for young people and the multiple environments in which people spend their time are examples of where real progress has been made in the evidence base.

Conclusion:

Progress towards real change in policy and practice may seem slow; however, the opportunities afforded for health and planning professionals to work together provide a step towards the whole systems approaches to tackle obesity that are desperately needed.

Is the calorie concept a real solution to the obesity epidemic?

BACKGROUND

The obesity epidemic has been growing steadily across the whole world, and so far not a single country has been able to reverse it. The cause of obesity is stated by the World Health Organization as an energy imbalance between calories consumed and calories expended. However, growing evidence suggests that the calorie imbalance concept may not be sufficient to manage and reverse the obesity epidemic.

OBJECTIVE

To discuss the use of the calorie imbalance concept and its elements as a tool for weight management as well as its possible negative consequences and implications for public health, with the aim to point toward the need of an updated concept for causes of obesity. This update should guide public health interventions more efficiently to limit obesity by preventing weight gain or promoting weight loss.

METHODS

This is a literature reviews based on a semi-structured approach to determine the material to be examined.

RESULTS

After revisiting general facts about fat generation and accumulation, we propose an updated concept for the causes of obesity including diet composition and hormonal regulation of fat metabolism.

CONCLUSIONS

We discuss how this updated concept could benefit the overall efficiency of strategies against obesity, and hypothesize how potential resistance to adopting this new view could be lowered.

Do GIS-derived measures of fast food retailers convey perceived fast food opportunities? Implications for food environment assessment

PURPOSE

Geographic information systems (GISs) have been used to define fast food availability, with higher availability perhaps promoting poorer quality diets. Alternative measures involve perceptions; however, few studies have examined associations between GIS-derived and perceived measures of the food environment.

METHODS

Telephone surveys of 705 participants within an eight-county region in South Carolina were analyzed using logistic regression to examine relationships between geographic presence of and distance to various types of food retailers and perceived fast food availability.

RESULTS

The mean distance to the nearest fast food restaurant was 6.1 miles, with 16% of participants having a fast food restaurant within 1 mile of home. The geographic presence of and distance to all food retailer types were significantly associated with perceived availability of fast food in unadjusted models. After adjustment, only the presence of a fast food restaurant or pharmacy was significantly associated with greater odds of higher perceived availability of fast food. Greater odds of lower perceived availability of fast food were observed with the presence of a dollar store and increasing distance to the nearest supermarket or pharmacy.

CONCLUSIONS

Measures of fast food availability, whether objective or perceived, may not be interchangeable. Researchers should carefully decide on the appropriate measurement tool-GIS-derived or perceived-in food environment studies.

City planning and population health: a global challenge

Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.

The Local Food Environment and Fruit and Vegetable Intake: A Geographically Weighted Regression Approach in the ORiEL Study

Studies that explore associations between the local food environment and diet routinely use global regression models, which assume that relationships are invariant across space, yet such stationarity assumptions have been little tested. We used global and geographically weighted regression models to explore associations between the residential food environment and fruit and vegetable intake. Analyses were performed in 4 boroughs of London, United Kingdom, using data collected between April 2012 and July 2012 from 969 adults in the Olympic Regeneration in East London Study. Exposures were assessed both as absolute densities of healthy and unhealthy outlets, taken separately, and as a relative measure (proportion of total outlets classified as healthy). Overall, local models performed better than global models (lower Akaike information criterion). Locally estimated coefficients varied across space, regardless of the type of exposure measure, although changes of sign were observed only when absolute measures were used. Despite findings from global models showing significant associations between the relative measure and fruit and vegetable intake (β = 0.022; P < 0.01) only, geographically weighted regression models using absolute measures outperformed models using relative measures. This study suggests that greater attention should be given to nonstationary relationships between the food environment and diet. It further challenges the idea that a single measure of exposure, whether relative or absolute, can reflect the many ways the food environment may shape health behaviors.

Exploring associations between perceived home and work neighborhood environments, diet behaviors, and obesity: Results from a survey of employed adults in Missouri

Dietary behaviors are associated with obesity, and may be influenced by the environment. The objective of the current work was to investigate whether perceptions of built environment factors related to eating in the residential neighborhood will have different, independent associations with BMI and dietary behaviors than perceived built environment factors in the worksite neighborhood. In 2012-2013, a cross-sectional telephone-survey of Missouri adults (n = 2015) assessed perceptions of home and workplace built environment factors related to eating, dietary behaviors, and height and weight. Logistic regression models explored associations between perceived neighborhood built environment variables, diet, and obesity. The only variable associated with any of the outcomes explored in the fully adjusted models was the home neighborhood composite scale. None of the work environment variables were significantly associated with any of the health/behavior outcomes after adjustment. Few associations were found after adjustment for personal and job-related characteristics, and none were identified with the workplace neighborhood environment. While few home environment associations were found after adjustment, and none were identified with the perceived workplace neighborhood environment, the current study adds to the limited literature looking at associations between the perceived neighborhood around the workplace neighborhood and the perceived neighborhood around the home and dietary behaviors and obesity in adults. Future studies are needed to determine whether relationships between these environments and behavior exist, and if so, if they are causal and warrant intervention attempts.

How can GPS technology help us better understand exposure to the food environment? A systematic review

Purpose

Global Positioning Systems (GPS) are increasingly being used to objectively assess movement patterns of people related to health behaviours. However research detailing their application to the food environment is scarce. This systematic review examines the application of GPS in studies of exposure to food environments and their potential influences on health.

Methods

Based on an initial scoping exercise, published articles to be included in the systematic review were identified from four electronic databases and reference lists and were appraised and analysed, the final cut-off date for inclusion being January 2015. Included studies used GPS to identify location of individuals in relation to food outlets and link that to health or diet outcomes. They were appraised against a set of quality criteria.

Results

Six studies met the inclusion criteria, which were appraised to be of moderate quality. Newer studies had a higher quality score. Associations between observed mobility patterns in the food environment and diet related outcomes were equivocal. Findings agreed that traditional food exposure measures overestimate the importance of the home food environment.

Conclusions

The use of GPS to measure exposure to the food environment is still in its infancy yet holds much potential. There are considerable variations and challenges in developing and standardising the methods used to assess exposure.

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Since 2011 just 6 studies have been published employing GPS to quantify exposure to food environments.

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The studies were generally only of moderate quality.

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There were significant variations and challenges in the methods and techniques used.

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GIS neighbourhoods may not well represent food environment exposures based on GPS data.

Optimising measurement of health-related characteristics of the built environment: Comparing data collected by foot-based street audits, virtual street audits and routine secondary data sources

The role of the neighbourhood environment in influencing health behaviours continues to be an important topic in public health research and policy. Foot-based street audits, virtual street audits and secondary data sources are widespread data collection methods used to objectively measure the built environment in environment-health association studies. We compared these three methods using data collected in a nationally representative epidemiological study in 17 British towns to inform future development of research tools. There was good agreement between foot-based and virtual audit tools. Foot based audits were superior for fine detail features. Secondary data sources measured very different aspects of the local environment that could be used to derive a range of environmental measures if validated properly. Future built environment research should design studies a priori using multiple approaches and varied data sources in order to best capture features that operate on different health behaviours at varying spatial scales.

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This study compares multiple data collection methods for measuring built environment features.

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Virtual street audits are reliable for more objective built environment measures.

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Street-based audits are superior for collecting fine detail environmental features.

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Routine secondary data sources need less resources but must be properly validated.

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Appropriate methods for health studies vary depending on the research question and resources.

Retail Food Store Access in Rural Appalachia: A Mixed Methods Study

OBJECTIVE

To describe how characteristics of food retail stores (potential access) and other factors influence self-reported food shopping behavior (realized food access) among low-income, rural Central Appalachian women.

DESIGN AND SAMPLE

Cross-sectional descriptive. Potential access was assessed through store mapping and in-store food audits. Factors influencing consumers' realized access were assessed through in-depth interviews. Results were merged using a convergent parallel mixed methods approach. Food stores (n = 50) and adult women (n = 9) in a rural Central Appalachian county.

RESULTS

Potential and realized food access were described across five dimensions: availability, accessibility, affordability, acceptability, and accommodation. Supermarkets had better availability of healthful foods, followed by grocery stores, dollar stores, and convenience stores. On average, participants lived within 10 miles of 3.9 supermarkets or grocery stores, and traveled 7.5 miles for major food shopping. Participants generally shopped at the closest store that met their expectations for food availability, price, service, and atmosphere. Participants' perceptions of stores diverged from each other and from in-store audit findings.

CONCLUSIONS

Findings from this study can help public health nurses engage with communities to make affordable, healthy foods more accessible. Recommendations are made for educating low-income consumers and partnering with food stores.

Obesity, diet quality, physical activity, and the built environment: the need for behavioral pathways

BACKGROUND

The built environment (BE) is said to influence local obesity rates. Few studies have explored causal pathways between home-neighborhood BE variables and health outcomes such as obesity. Such pathways are likely to involve both physical activity and diet.

METHODS

The Seattle Obesity Study (SOS II) was a longitudinal cohort of 440 adult residents of King Co, WA. Home addresses were geocoded. Home-neighborhood BE measures were framed as counts and densities of food sources and physical activity locations. Tax parcel property values were obtained from County tax assessor. Healthy Eating Index (HEI 2010) scores were constructed using data from food frequency questionnaires. Physical activity (PA) was obtained by self-report. Weights and heights were measured at baseline and following 12 months' exposure. Multivariable regressions examined the associations among BE measures at baseline, health behaviors (HEI-2010 and physical activity) at baseline, and health outcome both cross-sectionally and longitudinally.

RESULTS

None of the conventional neighborhood BE metrics were associated either with diet quality, or with meeting PA guidelines. Only higher property values did predict better diets and more physical activity. Better diets and more physical activity were associated with lower obesity prevalence at baseline and 12 mo, but did not predict weight change.

CONCLUSION

Any links between the BE and health outcomes critically depend on establishing appropriate behavioral pathways. In this study, home-centric BE measures, were not related to physical activity or to diet. Further studies will need to consider a broader range of BE attributes that may be related to diets and health.

Urban Latino Families' Food Built Environment and Young Children's Produce Consumption

This study explored the association between objective and subjective ratings of the food environment and child produce consumption for Latino preschoolers at-risk for obesity. Parental surveys (N = 115) assessed perceptions of food availability, affordability, and acceptability. Comparable factors were objectively rated by a trained observer, using the Nutrition Environment Measures Survey for Stores (NEMS-S), in commonly frequented grocery stores cited by participants. There were no significant correlations between objective and subjective measures of food availability, affordability, and acceptability. Greater household income was associated with higher participant perceptions of food acceptability (r = .33, p = .003) and affordability (r = .22, p = .04). Participant-perceived affordability of food was correlated with more frequent child fruit and vegetable consumption (r = .21, p = .03). These findings support that parental subjective ratings of the food environment affects their child's eating behaviors more than objective ratings.

Perceived community environmental influences on eating behaviors: A Photovoice analysis

People's perceptions of local food environments influence their abilities to eat healthily. PhotoVoice participants from four communities in Alberta, Canada took pictures of barriers and opportunities for healthy eating and shared their stories in one-on-one semi-structured interviews. Using a socioecological framework, emergent themes were organized by type and size of environment. Findings show that, while availability and access to food outlets influence healthy eating practices, these factors may be eclipsed by other non-physical environmental considerations, such as food regulations and socio-cultural preferences. This study identifies a set of meta-themes that summarize and illustrate the interrelationships between environmental attributes, people's perceptions, and eating behaviors: a) availability and accessibility are interrelated and only part of the healthy eating equation; b) local food is synonymous with healthy eating; c) local food places for healthy eating help define community identity; d) communal dining (commensality) does not necessarily mean healthy eating; e) rewarding an achievement or celebrating special occasions with highly processed foods is socially accepted; f) food costs seemed to be driving forces in food decisions; g) macro-environmental influences are latent in food decisions. Recognizing the interrelationship among multiple environmental factors may help efforts to design effective community-based interventions and address knowledge gaps on how sociocultural, economic, and political environments intersect with physical worlds.

Development and Testing of the Toronto Nutrition Environment Measures Survey-Store (ToNEMS-S)

OBJECTIVE

To describe the adaptation and inter-rater reliability assessment of the Toronto Nutrition Environment Measures Survey-Store.

METHODS

A total of 55 food stores (2 bakeries, 2 dollar stores, 19 gas/convenience stores, 18 grocery stores, 4 pharmacies, 8 specialty stores, and 2 superstores) were assessed in 2014. Cohen's kappa and intra-class correlation coefficients (ICC) were assessed for inter-rater reliability for product availability, price, quality, ethno-cultural accessibility scores, and overall store scores.

RESULTS

Inter-rater reliability was high for availability (average kappa = 0.91), price (average ICC = 0.964), ethno-cultural accessibility score (ICC = 0.981), and overall store scores (ICC = 0.991).

CONCLUSIONS AND IMPLICATIONS

Measures in the Toronto Nutrition Environment Measures Survey-Store demonstrated excellent inter-rater agreement. Limited access to fruits and vegetables and ethno-cultural foods are related to diet-related chronic diseases, particularly among immigrants. Findings of the study may be useful in guiding public health programming.

The Role of Assimilating to the US Culture and the Relationship Between Neighborhood Ethnic Composition and Dietary Intake Among Hispanic Youth

BACKGROUND

Dietary fiber and sugar intake have been shown to affect metabolic health in overweight Hispanic youth. Evidence on the influence of culture on fiber and sugar intake in Hispanic youth is limited.

METHODS

The associations among score for levels of assimilation, neighborhood ethnic characteristics, and daily total and added dietary sugar and dietary fiber intake were assessed using regression analyses.

RESULTS

One hundred twenty-four Hispanic youth (age = 13.6 ± 3.0, 106 female) were included. The proportion of Hispanic population in the neighborhood was positively associated with fiber intake (standardized β = 0.205, p < 0.01) and inversely associated with added (standardized β = -0.234, p < 0.01) and total sugar intake (standardized β = -0.229, p < 0.01). Youth's self-identified levels of assimilation inversely moderated (standardized β = -0.465, p = 0.036) the association between %HP and dietary fiber intake.

CONCLUSIONS

Hispanic youth residing in areas of that are predominantly populated with Hispanics may be protected from conforming to unhealthy dietary behaviors. This protective effect is weaker among Hispanic youth with higher level of assimilation.

Dietary quality in children and the role of the local food environment

Diet is a modifiable contributor to many chronic diseases including childhood obesity. The local food environment may influence children's diet but this area of research is understudied. This study explores if distance to and the number of supermarkets and convenience stores in the local area around households are associated with dietary quality in nine year olds whilst controlling for household level socio-economic factors. This is a secondary analysis of Wave 1 (2007/2008) of the Growing Up in Ireland (GUI) Child Cohort Study, a sample of 8568 nine year olds from the Republic of Ireland. Dietary intake was assessed using a short, 20-item parent reported food frequency questionnaire and was used to create a dietary quality score (DQS) whereby a higher score indicated a higher diet quality. Socio-economic status was measured using household class, household income, and maternal education. Food availability was measured as road network distance to and the number of supermarkets and convenience stores around households. Separate fixed effects regression models assessed the association between local area food availability and dietary quality, stratified by sex. The DQS ranged from −5 to 25 (mean 9.4, SD 4.2). Mean DQS was higher in those who lived furthest (distance in quintiles) from their nearest supermarket (p<0.001), and in those who lived furthest from their nearest convenience store (p<0.001). After controlling for socio-economic characteristics of the household, there was insufficient evidence to suggest that distance to the nearest supermarket or convenience store was associated with dietary quality in girls or boys. The number of supermarkets or convenience stores within 1000 m of the household was not associated with dietary quality. Food availability had a limited effect on dietary quality in this study. Issues associated with conceptualising and measuring the food environment may explain the findings of the current study.

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This sample represents a large nationally representative sample of nine year old children.

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Distance to the nearest food outlet from the home had a limited impact on dietary quality.

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Having a food outlet within 1000 m of the home had a limited impact dietary quality.

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Household socio-economic indicators were important predictors of dietary quality.

Food swamps and food deserts in Baltimore City, MD, USA: associations with dietary behaviours among urban adolescent girls

OBJECTIVE

To determine whether living in a food swamp (≥4 corner stores within 0·40 km (0·25 miles) of home) or a food desert (generally, no supermarket or access to healthy foods) is associated with consumption of snacks/desserts or fruits/vegetables, and if neighbourhood-level socio-economic status (SES) confounds relationships.

DESIGN

Cross-sectional. Assessments included diet (Youth/Adolescent FFQ, skewed dietary variables normalized) and measured height/weight (BMI-for-age percentiles/Z-scores calculated). A geographic information system geocoded home addresses and mapped food deserts/food swamps. Associations examined using multiple linear regression (MLR) models adjusting for age and BMI-for-age Z-score.

SETTING

Baltimore City, MD, USA.

SUBJECTS

Early adolescent girls (6th/7th grade, n 634; mean age 12·1 years; 90·7 % African American; 52·4 % overweight/obese), recruited from twenty-two urban, low-income schools.

RESULTS

Girls' consumption of fruit, vegetables and snacks/desserts: 1·2, 1·7 and 3·4 servings/d, respectively. Girls' food environment: 10·4 % food desert only, 19·1 % food swamp only, 16·1 % both food desert/swamp and 54·4 % neither food desert/swamp. Average median neighbourhood-level household income: $US 35 298. In MLR models, girls living in both food deserts/swamps consumed additional servings of snacks/desserts v. girls living in neither (β=0·13, P=0·029; 3·8 v. 3·2 servings/d). Specifically, girls living in food swamps consumed more snacks/desserts than girls who did not (β=0·16, P=0·003; 3·7 v. 3·1 servings/d), with no confounding effect of neighbourhood-level SES. No associations were identified with food deserts or consumption of fruits/vegetables.

CONCLUSIONS

Early adolescent girls living in food swamps consumed more snacks/desserts than girls not living in food swamps. Dietary interventions should consider the built environment/food access when addressing adolescent dietary behaviours.

Associations between the neighbourhood food environment, neighbourhood socioeconomic status, and diet quality: An observational study

Background

The neighbourhood environment may play an important role in diet quality. Most previous research has examined the associations between neighbourhood food environment and diet quality, and neighbourhood socioeconomic status and diet quality separately. This study investigated the independent and joint effects of neighbourhood food environment and neighbourhood socioeconomic status in relation to diet quality in Canadian adults.

Methods

We undertook a cross-sectional study with n = 446 adults in Calgary, Alberta (Canada). Individual-level data on diet and socio-demographic and health-related characteristics were captured from two self-report internet-based questionnaires, the Canadian Diet History Questionnaire II (C-DHQ II) and the Past Year Physical Activity Questionnaire (PAQ). Neighbourhood environment data were derived from dissemination area level Canadian Census data, and Geographical Information Systems (GIS) databases. Neighbourhood was defined as a 400 m network-based ‘walkshed’ around each participant’s household. Using GIS we objectively-assessed the density, diversity, and presence of specific food destination types within the participant’s walkshed. A seven variable socioeconomic deprivation index was derived from Canadian Census variables and estimated for each walkshed. The Canadian adapted Healthy Eating Index (C-HEI), used to assess diet quality was estimated from food intakes reported on C-DHQ II. Multivariable linear regression was used to test for associations between walkshed food environment variables, walkshed socioeconomic status, and diet quality (C-HEI), adjusting for individual level socio-demographic and health-related covariates. Interaction effects between walkshed socioeconomic status and walkshed food environment variables on diet quality (C-HEI) were also tested.

Results

After adjustment for covariates, food destination density was positively associated with the C-HEI (β 0.06, 95 % CI 0.01-0.12, p = 0.04) though the magnitude of the association was small. Walkshed socioeconomic status was not significantly associated with the C-HEI. We found no statistically significant interactions between walkshed food environment variables and socioeconomic status in relation to the C-HEI. Self-reported physical and mental health, time spent in neighbourhood, and dog ownership were also significantly (p < .05) associated with diet quality.

Conclusions

Our findings suggest that larger density of local food destinations may is associated with better diet quality in adults.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3631-7) contains supplementary material, which is available to authorized users.

Do marginalized neighbourhoods have less healthy retail food environments? An analysis using Bayesian spatial latent factor and hurdle models

Background

Findings of whether marginalized neighbourhoods have less healthy retail food environments (RFE) are mixed across countries, in part because inconsistent approaches have been used to characterize RFE ‘healthfulness’ and marginalization, and researchers have used non-spatial statistical methods to respond to this ultimately spatial issue.

Methods

This study uses in-store features to categorize healthy and less healthy food outlets. Bayesian spatial hierarchical models are applied to explore the association between marginalization dimensions and RFE healthfulness (i.e., relative healthy food access that modelled via a probability distribution) at various geographical scales. Marginalization dimensions are derived from a spatial latent factor model. Zero-inflation occurring at the walkable-distance scale is accounted for with a spatial hurdle model.

Results

Neighbourhoods with higher residential instability, material deprivation, and population density are more likely to have access to healthy food outlets within a walkable distance from a binary ‘have’ or ‘not have’ access perspective. At the walkable distance scale however, materially deprived neighbourhoods are found to have less healthy RFE (lower relative healthy food access).

Conclusion

Food intervention programs should be developed for striking the balance between healthy and less healthy food access in the study region as well as improving opportunities for residents to buy and consume foods consistent with dietary recommendations.

Using Photovoice and Asset Mapping to Inform a Community-Based Diabetes Intervention, Boston, Massachusetts, 2015

Introduction

Diabetes self-management takes place within a complex social and environmental context.  This study’s objective was to examine the perceived and actual presence of community assets that may aid in diabetes control.

Methods

We conducted one 6-hour photovoice session with 11 adults with poorly controlled diabetes in Boston, Massachusetts.  Participants were recruited from census tracts with high numbers of people with poorly controlled diabetes (diabetes “hot spots”).  We coded the discussions and identified relevant themes.  We further explored themes related to the built environment through community asset mapping.  Through walking surveys, we evaluated 5 diabetes hot spots related to physical activity resources, walking environment, and availability of food choices in restaurants and food stores.

Results

Community themes from the photovoice session were access to healthy food, restaurants, and prepared foods; food assistance programs; exercise facilities; and church.  Asset mapping identified 114 community assets including 22 food stores, 22 restaurants, and 5 exercise facilities.  Each diabetes hot spot contained at least 1 food store with 5 to 9 varieties of fruits and vegetables.  Only 1 of the exercise facilities had signage regarding hours or services.  Memberships ranged from free to $9.95 per month.  Overall, these findings were inconsistent with participants’ reports in the photovoice group.

Conclusion

We identified a mismatch between perceptions of community assets and built environment and the objective reality of that environment. Incorporating photovoice and community asset mapping into a community-based diabetes intervention may bring awareness to underused neighborhood resources that can help people control their diabetes.

Association between perceived neighbourhood characteristics, physical activity and diet quality: results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND

The study explores associations between perceived neighbourhood characteristics, physical activity and diet quality, which in Latin America and Brazil have been scarcely studied and with inconsistent results.

METHODS

We conducted a cross-sectional analysis of 14,749 individuals who participated in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil) baseline. The study included current and retired civil servants, aged between 35 and 74 years, from universities and research institutes in six Brazilian states. The International Physical Activity Questionnaire (IPAQ) long form was used to characterize physical activity during leisure time and commuting; additional questions assessed how often fruit and vegetables were consumed, as a proxy for diet quality. Neighbourhood characteristics were evaluated by the "Walking Environment" and "Availability of Healthy Foods" scales originally used in the Multi-Ethnic Study of Atherosclerosis (MESA). Associations were examined using multinomial logistic regression.

RESULTS

Perceiving a more walkable neighbourhood was positively associated with engaging in leisure time physical activity and doing so for longer weekly. Compared with those who saw their neighbourhood as less walkable, those who perceived it as more walkable had 1.69 (95 % CI 1.57-1.83) and 1.39 (1.28-1.52) greater odds of engaging in leisure time physical activity for more than 150 min/week or up to 150 min/week (vs. none), respectively. Perceiving a more walkable neighbourhood was also positively associated with transport-related physical activity. The same pattern was observed for diet: compared with participants who perceived healthy foods as less available in their neighbourhood, those who saw them as more available had odds 1.48 greater (1.31-1.66) of eating fruits, and 1.47 greater (1.30-1.66) of eating vegetables, more than once per day.

CONCLUSIONS

Perceived walkability and neighbourhood availability of healthy food were independently associated with the practice of physical activity and diet quality, respectively, underlining the importance of neighbourhood-level public policies to changing and maintaining health-related habits.

Education and the Relationship Between Supermarket Environment and Diet

INTRODUCTION

Supermarkets are a major source of food for many families. Knowledge of how educational attainment affects the relationship between in-store environments of supermarkets and diet is needed. This study examined the relationship between maternal dietary quality and overall in-store supermarket environment, and assessed the effect modification of educational attainment.

METHODS

Dietary quality z-scores were calculated for 829 mothers with young children using cross-sectional data collected in 2010-2011 from a 20-item food frequency questionnaire. Information about nine in-store factors (variety, price, quality, promotion, shelf placement, store placement, nutrition information, healthier alternatives, and single fruit sale) on 12 foods known to discriminate between better and poorer dietary quality were collected to create a standardized "healthfulness" z-score for each supermarket where mothers shopped.

RESULTS

Multilevel unadjusted linear regression analysis completed in 2014-2015 showed that shopping at more-healthful supermarkets was associated with better dietary quality (β=0.39 SD/SD, p=0.01, 95% CI=0.10, 0.68). However, the relationship differed according to educational attainment (interaction, p=0.006). Among mothers who left school at age 16 years, those who shopped at less healthful supermarkets had poorer dietary quality (β=0.31 SD/SD, 95% CI=0.07, 0.55). Among mothers with degrees, those who shopped at less healthful supermarkets had better dietary quality (β=-0.59 SD/SD, 95% CI=-1.19, 0.00).

CONCLUSIONS

Mothers with low educational attainment show greater susceptibility to less healthful in-store environments than mothers with higher educational attainment who may be protected by greater psychological and financial resources. Policy initiatives to improve supermarket environments may be necessary to address dietary inequalities.

Lifestyle behaviors and ethnic identity among diverse women at high risk for type 2 diabetes

BACKGROUND

Diet and physical activity lifestyle behaviors are modifiable risk factors for type 2 diabetes and are shaped by culture, potentially influencing diabetes health disparities.

OBJECTIVES

We examined whether ethnic identity-the strength of attachment to one's ethnic group, and a long-standing focus of psychological research-could help account for variations in lifestyle behaviors within a diverse population at high risk for chronic disease.

METHODS

Using data from the Gestational Diabetes' Effects on Moms trial, this US-based cross-sectional study included 1463 pregnant women (74% from minority ethnic/racial groups; 46% born outside the US) with gestational diabetes (GDM), a common pregnancy complication conferring high risk for type 2 diabetes after delivery. Mixed linear regression models examined whether ethnic identity is associated with lifestyle behaviors after adjusting for demographic, clinical, and acculturative characteristics (e.g., nativity and length of residence in the US).

RESULTS

In the overall sample, a one-unit increase in ethnic identity score was significantly associated with 3% greater fiber intake, 4% greater fruit/vegetable intake, 11% greater total activity, and 11% greater walking (p values < 0.01). Within ethnic/racial groups, a one-unit increase in ethnic identity score was significantly associated with 17% greater fiber intake among Filipina women; 5% lower total caloric intake among non-Hispanic White women; and 40% greater total activity, 35% greater walking, and 8% greater total caloric intake among Latina women (p values ≤ 0.03).

CONCLUSION

Results from this large study suggest that ethnic group attachment is associated with some lifestyle behaviors, independent of acculturation indicators, among young women with GDM who are at high risk for type 2 diabetes. Stronger ethnic identity may promote certain choices known to be associated with reduced risk of type 2 diabetes. Prospective research is needed to clarify the temporal nature of associations between ethnic identity and modifiable diabetes risk factors.

But Where Can We Buy an Ounce of Prevention? Sprawl, Access, and Fresh Fruit and Vegetable Consumption

Fresh fruit and vegetable consumption (FFV) is integral to a healthy diet and increased longevity, yet 25.8 million Americans live in areas of restricted access, with under-resourced communities particularly vulnerable. To consider how immediate environment influences FFV, this study uses the Behavioral Risk Factor Surveillance System (BRFSS) survey (N = 122,265) to examine the influence of sprawl on FFV consumption. Findings indicate that higher sprawl relates to lower FFV consumption, and this relationship persists net of demographic covariates. Implications offer that social work's person-in-environment approach can increase FFV access in under-resourced communities.

Beyond Access: Characteristics of the Food Environment and Risk of Diabetes

Characteristics of the built environment, including access to unhealthy food outlets, are hypothesized to contribute to type 2 diabetes mellitus (T2D). Swedish nationwide registry data on 4,718,583 adults aged 35-80 years living in 9,353 neighborhoods, each with at least 1 food outlet, were geocoded and linked to commercial registers (e.g., restaurants and grocery stores). Multilevel logistic regression was used to examine the prospective relationship between characteristics of the food environment and T2D from 2005 to 2010. Relative access to health-harming food outlets was associated with greater likelihood of both prevalent and incident T2D in a curvilinear manner, with the highest risk being observed for environments in which one-third of outlets were health-harming. Relative to individuals whose food environment did not change, those who moved into areas with more health-harming food outlets had higher odds of developing T2D (odds ratio = 3.67, 95% confidence interval: 2.14, 6.30). Among those who did not move, living in an area that gained relative access to health-harming food outlets was also associated with higher odds of T2D (odds ratio = 1.72, 95% confidence interval: 1.27, 2.33). These results suggest that local food environment, including changes that result in greater access to unhealthy food outlets, is associated with T2D.