The local food environment and diet: a systematic review

Landscape analysis of environmental data sources for linkage with SEER cancer patients database

One of the challenges associated with understanding environmental impacts on cancer risk and outcomes is estimating potential exposures of individuals diagnosed with cancer to adverse environmental conditions over the life course. Historically, this has been partly due to the lack of reliable measures of cancer patients' potential environmental exposures before a cancer diagnosis. The emerging sources of cancer-related spatiotemporal environmental data and residential history information, coupled with novel technologies for data extraction and linkage, present an opportunity to integrate these data into the existing cancer surveillance data infrastructure, thereby facilitating more comprehensive assessment of cancer risk and outcomes. In this paper, we performed a landscape analysis of the available environmental data sources that could be linked to historical residential address information of cancer patients' records collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The objective is to enable researchers to use these data to assess potential exposures at the time of cancer initiation through the time of diagnosis and even after diagnosis. The paper addresses the challenges associated with data collection and completeness at various spatial and temporal scales, as well as opportunities and directions for future research.

Associations between the neighbourhood food environment and food and drink purchasing in England during lockdown: A repeated cross-sectional analysis

INTRODUCTION

Evidence for the effect of neighbourhood food environment (NFE) exposures on diet in the UK is mixed, potentially due to exposure misclassification. This study used the first national COVID-19 lockdown in England as an opportunity to isolate the independent effects of the NFE exposure on food and drink purchasing, and assessed whether these varied by region.

METHODS

Transaction-level purchasing data for food and drink items for at-home (1,221 households) and out-of-home consumption (171 individuals) were available from the GB Kantar Fast Moving Consumer Goods Panel for London and the North of England. The study period included 23rd March to 10th May 2020 ('lockdown'), and the same period in 2019 for comparison. NFE exposures included food outlet density and proximity, and NFE composition within a 1 km network buffer around the home. Associations were estimated for both years separately, adjusted for individual and household characteristics, population density and area deprivation. Interaction terms between region and exposures were explored.

RESULTS

There were no consistent patterns of association between NFE exposures and food and drink purchasing in either time period. In 2019, there was some evidence for a 1.4% decrease in energy purchased from ultra-processed foods for each additional 500 m in the distance to the nearest OOH outlet (IR 0.986, 95% CI 0.977 to 0.995, p = 0.020). In 2020, there was some evidence for a 1.8% reduction in total take-home energy for each additional chain supermarket per km2 in the neighbourhood (IR 0.982, 95% CI 0.969, 0.995, p = 0.045). Region-specific effects were observed in 2019 only.

DISCUSSION

Findings suggest that the differences in exposure to the NFE may not explain differences in the patterns or healthiness of grocery purchasing. Observed pre-pandemic region-specific effects allude to the importance of geographical context when designing research and policy. Future research may assess associations for those who relied on their NFE during lockdown.

Measuring access to food banks and food pantries: A scoping review of spatial analysis approaches

Food banks and food pantries are crucial in supporting access to food and addressing food insecurity for millions of people. This scoping review identified eighteen articles that applied spatial analysis approaches to measure access to food banks and food pantries. The review summarizes the methods and primary findings of these studies, and examines how these address different dimensions of food access. Findings suggest that the majority of studies measured the accessibility and availability dimensions of food access, and two addressed accommodation. Through a discussion of these studies' methods and broader literature on food environments, we highlight opportunities to integrate advanced geospatial and mixed methods to support an empirically grounded and broader understanding of food bank and pantry access in future research. This will yield a more holistic picture of food environments and provide practical implications for site selection, resource allocation, and food assistance operations.

Environmental Sustainability of Food Environments: Development and Application of a Framework in 4 cities in South Asia

Background

Food environments, where people directly engage with broader food systems, may be an important contributor to the environmental sustainability of food systems.

Objectives

The primary objectives of this study were to establish a new food environment framework that considers environmental indicators and to assess data availability and gaps using data previously collected as part of a food systems survey in 4 South Asian cities.

Methods

The framework was developed by conducting a structured literature review of previous food environment frameworks and in-depth interviews with content experts (n = 6). The framework and indicators were then mapped to data collected by consumer and vendor surveys using the Urban Food Systems Assessment Tool (UFSAT) in Ahmedabad (India), Pune (India), Kathmandu (Nepal), and Pokhara (Nepal).

Results

We have expanded the sustainability domain within food environments to include consumer travel to food vendors, the presence of food delivery services, policies related to sustainability, vendor food waste, vendor plastic use, vendor utility usage, vendor recycling and waste management practices, and food packaging. Mapping the framework to existing data from 4 cities in South Asia, we found variations in food environment sustainability indicators, particularly regarding consumer transportation to food vendors, the presence of delivery services, and food waste.

Conclusions

Although the majority of food environment research focuses on the availability and affordability of healthy foods, there is an urgent need to understand better how aspects of food environments contribute to environmental goals. When mapping the framework to existing food systems data, we found gaps in data on environmental sustainability in food environments and variation in indicators across settings.

Practicing Interoceptive Sensitivity as a Couple: A Mixed-Methods Acceptance Analysis of a Dyadic vs. Single Pilot Randomized Controlled Trial

Training interoceptive sensitivity (IS) might be a first step in effectively promoting intuitive eating (IE). A dyadic interoception-based pilot randomized controlled trial was conducted to increase IE among couples aged 50+. The training consisted of three exercises, a Body Scan (BS), a hunger exercise (HU), and a satiety (SA) exercise. This study explored how spouses accepted the (dyadic vs. single) training. In a mixed-methods convergence design, the findings of a survey (n = 68 couples) and focus groups (n = 4) were synthesized. Moderate general acceptance (e.g., regarding feasibility and low burden) and a hierarchical gradient in favor of the BS (e.g., pleasantness and improved sleep quality) emerged. Barriers concerned a perceived lack of the exercises' usefulness and a limited understanding of the training purpose. A wish for regular feedback and exchange with the study stuff and other participants was expressed. Spousal training involvement was experienced as being rather beneficial. Previously harmonized dietary practices and daily routines appeared as constructive pre-conditions for the joint training. This study highlights the potential and implications of training couples in IS. Future interventions should involve a regular exchange and closer guidance by study staff to promote a better understanding of the processes and goals of IS and IE.

'Acceleration' of the food delivery marketplace: Perspectives of local authority professionals in the North-East of England on temporary COVID regulations

In January 2021, we assessed the implications of temporary regulations in the United Kingdom allowing pubs and restaurants to operate on a takeaway basis without instigating a change of use. Local authorities (LAs) across the North-East of England were unaware of any data regarding the take-up of these regulations, partially due to ongoing capacity issues; participants also raised health concerns around takeaway use increasing significantly. One year on, we repeated the study aiming to understand the impact of these regulations on the policy and practice of key professional groups. Specifically, we wanted to understand if LAs were still struggling with staff capacity to address the regulations, whether professionals still had public health trepidations, and if any unexpected changes had occurred across the local food environment because of the pandemic. We conversed with 16 public health professionals, planners and environmental health officers across seven LAs throughout the North-East of England via focus groups and interviews. Data collated were analysed via an inductive and semantic, reflexive-thematic approach. Through analysis of the data, three themes were generated and are discussed throughout: popular online delivery services as a mediator to increased takeaway usage; potential long-term health implications and challenges; continued uncertainty regarding the temporary regulations. This paper highlights important changes to local food environments, which public health professionals should be aware of, so they are better equipped to tackle health inequalities across urban and sub-urban areas.

HealthyPlan.City: A Web Tool to Support Urban Environmental Equity and Public Health in Canadian Communities

Urban environmental factors such as air quality, heat islands, and access to greenspaces and community amenities impact public health. Some vulnerable populations such as low-income groups, children, older adults, new immigrants, and visible minorities live in areas with fewer beneficial conditions, and therefore, face greater health risks. Planning and advocating for equitable healthy urban environments requires systematic analysis of reliable spatial data to identify where vulnerable populations intersect with positive or negative urban/environmental characteristics. To facilitate this effort in Canada, we developed HealthyPlan.City ( https://healthyplan.city/ ), a freely available web mapping platform for users to visualize the spatial patterns of built environment indicators, vulnerable populations, and environmental inequity within over 125 Canadian cities. This tool helps users identify areas within Canadian cities where relatively higher proportions of vulnerable populations experience lower than average levels of beneficial environmental conditions, which we refer to as Equity priority areas. Using nationally standardized environmental data from satellite imagery and other large geospatial databases and demographic data from the Canadian Census, HealthyPlan.City provides a block-by-block snapshot of environmental inequities in Canadian cities. The tool aims to support urban planners, public health professionals, policy makers, and community organizers to identify neighborhoods where targeted investments and improvements to the local environment would simultaneously help communities address environmental inequities, promote public health, and adapt to climate change. In this paper, we report on the key considerations that informed our approach to developing this tool and describe the current web-based application.

Associations between the objective and perceived food environment and eating behavior in relation to socioeconomic status among adults in peri-urban settings: results from the CIVISANO study in Flanders, Belgium

Obesity, a significant public health concern, disproportionately affects people with lower socioeconomic status (SES). Food environments have been identified as part of the causal chain of this disparity. This study investigated variations in the food environment across groups with different SES profiles residing in peri-urban municipal settings. In addition, it examined the association of the perceived and objective food environments with eating behaviour and assessed if these associations were moderated by SES. Utilizing GIS and survey data (n = 497, aged 25-65), results showed differences in the objective and perceived food environments based on SES. Respondents with higher SES perceived their food environments as better but resided farther from all food outlets compared to respondents with lower SES. However, there was no difference in outlet density or mRFEI between SES groups. SES moderated associations between the objective and perceived food environments and most eating behavior outcomes except fast food consumption frequency. For fruits and vegetables, SES moderated the association between neighborhood availability and consumption frequency (β0.23,CI0.03;0.49). Stratified analysis revealed a positive association for both lower (β0.15, CI0.03;0.27) and higher (β0.37, CI 0.12;0.63) SES groups. For snack foods, SES moderated the association between healthy outlet density and consumption frequency (β-0.60, CI-0.94; -0.23), showing statistical significance only for respondents with higher SES (β0.36,CI 0.18;0.55). Similarly, for sugar-sweetened beverages, a statistically significant interaction was observed between unhealthy outlet density in the 1000m buffer and consumption frequency (β 0.06, CI 0.02; 0.11). However, this association was only statistically significant for respondents with higher SES (β-0.02,CI -0.05;-0.0002). These results emphasize the significance of SES as a crucial element in comprehending the connection between the food environment and eating behaviour. Indicating the need for policymakers to take SES into account when implementing food environment interventions, particularly when focusing on the neighborhood food environment without considering residents' SES and their perceptions.

Spatial pattern analysis of the impact of community food environments on foetal macrosomia, preterm births and low birth weight

Community food environments (CFEs) have a strong impact on child health and nutrition and this impact is currently negative in many areas. In the Republic of Argentina, there is a lack of research evaluating CFEs regionally and comprehensively by tools based on geographic information systems (GIS). This study aimed to characterize the spatial patterns of CFEs, through variables associated with its three dimensions (political, individual and environmental), and their association with the spatial distribution in urban localities in Argentina. CFEs were assessed in 657 localities with ≥5,000 inhabitants. Data on births and CFEs were obtained from nationally available open-source data and through remote sensing. The spatial distribution and presence of clusters were assessed using hotspot analysis, purely spatial analysis (SaTScan), Moran's Index, semivariograms and spatially restrained multivariate clustering. Clusters of low risk for LBW, macrosomia, and preterm births were observed in the central-east part of the country, while high-risk clusters identified in the North, Centre and South. In the central-eastern region, low-risk clusters were found coinciding with hotspots of public policy coverage, high night-time light, social security coverage and complete secondary education of the household head in areas with low risk for negative outcomes of the birth variables studied, with the opposite with regard to households with unsatisfied basic needs and predominant land use classes in peri-urban areas of crops and herbaceous cover. These results show that the exploration of spatial patterns of CFEs is a necessary preliminary step before developing explanatory models and generating novel findings valuable for decision-making.

GIS-Based Assessments of Neighborhood Food Environments and Chronic Conditions: An Overview of Methodologies

The industrial revolution and urbanization fundamentally restructured populations' living circumstances, often with poor impacts on health. As an example, unhealthy food establishments may concentrate in some neighborhoods and, mediated by social and commercial drivers, increase local health risks. To understand the connections between neighborhood food environments and public health, researchers often use geographic information systems (GIS) and spatial statistics to analyze place-based evidence, but such tools require careful application and interpretation. In this article, we summarize the factors shaping neighborhood health in relation to local food environments and outline the use of GIS methodologies to assess associations between the two. We provide an overview of available data sources, analytical approaches, and their strengths and weaknesses. We postulate next steps in GIS integration with forecasting, prediction, and simulation measures to frame implications for local health policies.

New insights into grocery store visits among east Los Angeles residents using mobility data

In this study, we employed spatially aggregated population mobility data, generated from mobile phone locations in 2021, to investigate patterns of grocery store visits among residents east and northeast of Downtown Los Angeles, in which 60% of the census tracts had previously been designated as "food deserts". Further, we examined whether the store visits varied with neighborhood sociodemographics and grocery store accessibility. We found that residents averaged 0.4 trips to grocery stores per week, with only 13% of these visits within home census tracts, and 40% within home and neighboring census tracts. The mean distance from home to grocery stores was 2.2 miles. We found that people visited grocery stores more frequently when they lived in neighborhoods with higher percentages of Hispanics/Latinos, renters and foreign-born residents, and a greater number of grocery stores. This research highlights the utility of mobility data in elucidating grocery store use, and factors that may facilitate or be a barrier to store access. The results point to limitations of using geographically constrained metrics of food access like food deserts.

Local retail food environment exposure and diet quality in rural and urban adults: A longitudinal analysis of the ORISCAV-LUX cohort study

Despite growing interest in understanding how food environments shape dietary behaviors, European longitudinal evidence is scarce. We aimed to investigate the associations of 9-year average and change in exposure to local retail food environments with the diet quality of residents in Luxembourg. We used data from 566 adults enrolled in both waves of the nationwide ORISCAV-LUX study (2007-2017). Dietary quality was assessed by the Diet Quality Index-International (DQI-I). Exposure to "healthy" and "less healthy" food outlets was assessed by both absolute and relative GIS-based measurements. The results showed a 56.3% increase in less healthy food outlets over the period. In adjusted linear mixed models, high (vs. low) 9-year average exposure to less healthy food outlets was associated with lower DQI-I, when examining spatial access (β = -1.25, 95% CI: -2.29, -0.22) and proportions (β = -1.24, 95% CI: -2.15, -0.33). Stratified analyses showed these associations to be significant only among urban residents. There was no association between change in exposure to less healthy food outlets and DQI-I. Increased exposure to healthy outlets in rural areas, using absolute measurements, was associated with worsened DQI-I. Neighborhood socioeconomic status did not moderate the above associations. Findings suggest that the proliferation of less healthy food outlets may have contributed to the deterioration of the diet quality of urban residents, and support the use of relative measurements to fully capture the healthiness of food environments.

Prenatal Risks to Healthy Food Access and High Birthweight Outcomes

OBJECTIVE

Infants with high birthweight have increased risk for adverse outcomes at birth and across childhood. Prenatal risks to healthy food access may increase odds of high birthweight. We tested whether having a poor neighborhood food environment and/or food insecurity had associations with high birthweight.

METHODS

We analyzed cross-sectional baseline data in Greenlight Plus, an obesity prevention trial across six US cities (n = 787), which included newborns with a gestational age greater than 34 weeks and a birthweight greater than 2500 g. We assessed neighborhood food environment using the Place-Based Survey and food insecurity using the US Household Food Security Module. We performed logistic regression analyses to assess the individual and additive effects of risk factors on high birthweight. We adjusted for potential confounders: infant sex, race, ethnicity, gestational age, birthing parent age, education, income, and study site.

RESULTS

Thirty-four percent of birthing parents reported poor neighborhood food environment and/or food insecurity. Compared to those without food insecurity, food insecure families had greater odds of delivering an infant with high birthweight (adjusted odds ratios [aOR] 1.96, 95% confidence intervals [CI]: 1.01, 3.82) after adjusting for poor neighborhood food environment, which was not associated with high birthweight (aOR 1.35, 95% CI: 0.78, 2.34). Each additional risk to healthy food access was associated with a 56% (95% CI: 4%-132%) increase in high birthweight odds.

CONCLUSIONS

Prenatal risks to healthy food access may increase high infant birthweight odds. Future studies designed to measure neighborhood factors should examine infant birthweight outcomes in the context of prenatal social determinants of health.

Spatial Barriers to Transforming toward a Healthy Food System in the Noreste of Mexico

In the past five decades, global food systems have undergone a notable transition, moving from predominantly rural settings to increasingly urban and industrialized environments, largely driven by processes of globalization and supply chain integration. However, this evolution has not adequately addressed equitable access to nutritious diets and food environments, resulting in adverse health outcomes. This study delves into the spatial and non-spatial barriers that impede the adoption of healthy diets in the Noreste of Mexico, particularly focusing on the challenges associated with accessing and cultivating plant-based foods. Through an examination of suitable areas for urban agriculture and an exploration of the socio-cultural factors influencing the adoption of plant-based diets, the research focuses on interventions aimed at promoting healthier and more sustainable eating practices in Monterrey. The findings of the study reveal significant disparities in food access across the Monterrey metropolitan area, with central urban zones exhibiting superior access to fresh foods compared to suburban and peripheral regions. This inequality disproportionately affects marginalized areas characterized by higher poverty rates, exacerbating issues of food insecurity. Nevertheless, traditional dietary practices could offer promising avenues for creating culturally significant and healthier dietary transitions, even amidst the ongoing process of urbanization.

Food environment and obesity: a systematic review and meta-analysis

Background

Obesity is influenced by a complex, multifaceted system of determinants, including the food environment. Governments need evidence to act on improving the food environment. The aim of this study was to review the evidence from spatial environmental analyses and to conduct the first series of meta-analyses to assess the impact of the retail food environment on obesity.

Methods

We performed a systematic review and random-effects meta-analyses, focusing on geographical-statistical methods to assess the associations between food outlet availability and obesity. We searched OvidSP-Medline, Scielo, Scopus and Google Scholar databases up to January 2022. The search terms included spatial analysis, obesity and the retail food environment. Effect sizes were pooled by random-effects meta-analyses separately according to food outlet type and geographical and statistical measures.

Findings

Of the 4118 retrieved papers, we included 103 studies. Density (n=52, 50%) and linear and logistic regressions (n=68, 66%) were the main measures used to assess the association of the food environment with obesity. Multilevel or autocorrelation analyses were used in 35 (34%) studies. Fast-food outlet proximity was positively and significantly associated with obesity (OR: 1.15, 95% CI: 1.02 to 1.30, p=0.02). Fresh fruit and vegetable outlet density and supermarket proximity were inversely associated with obesity (OR: 0.93, 95% CI: 0.90 to 0.96, p<0.001; OR: 0.90, 95% CI: 0.82 to 0.98, p=0.02). No significant associations were found for restaurants, convenience stores or any of the body mass index measures.

Conclusions

Food outlets which sell mostly unhealthy and ultra-processed foods were associated with higher levels of obesity, while fruit and vegetable availability and supermarket accessibility, which enable healthier food access, were related to lower levels of obesity. The regulation of food outlets through zoning laws may not be enough to tackle the burden of obesity. Regulations that focus on increasing the availability of healthy food within stores and ensure overall healthy food environments require further attention.

PROSPERO registration number

CRD42018111652.

Agreement between a web collaborative dataset and an administrative dataset to assess the retail food environment in Mexico

BACKGROUND

Latin American countries are often limited in the availability of food outlet data. There is a need to use online search engines that allow the identification of food outlets and assess their agreement with field observations. We aimed to assess the agreement in the density of food outlets provided by a web collaborative data (Google) against the density obtained from an administrative registry. We also determined whether the agreement differed by type of food outlet and by area-level socioeconomic deprivation.

METHODS

In this cross-sectional study, we analyzed 1,693 census tracts from the municipalities of Hermosillo, Leon, Oaxaca de Juarez, and Tlalpan. The Google service was used to develop a tool for the automatic acquisition of food outlet data. To assess agreement, we compared food outlet densities obtained with Google against those registered in the National Statistical Directory of Economic Units (DENUE). Continuous densities were assessed using Bland-Altman plots and concordance correlation coefficient (CCC), while agreement across tertiles of density was estimated using weighted kappa.

RESULTS

The CCC indicated a strong correlation between Google and DENUE in the overall sample (0.75); by food outlet, most of the correlations were from negligible (0.08) to moderate (0.58). The CCC showed a weaker correlation as deprivation increased. Weighted kappa indicated substantial agreement between Google and DENUE across all census tracts (0.64). By type of food outlet, the weighted kappa showed substantial agreement for restaurants (0.69) and specialty food stores (0.68); the agreement was moderate for convenience stores/small food retail stores (0.49) and fair for candy/ice cream stores (0.30). Weighted kappa indicated substantial agreement in low-deprivation areas (0.63); in very high-deprivation areas, the agreement was moderate (0.42).

CONCLUSIONS

Google could be useful in assessing fixed food outlet densities as a categorical indicator, especially for some establishments, like specialty food stores and restaurants. The data could also be informative of the availability of fixed food outlets, particularly in less deprived areas.

Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity

Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.

Availability and properties of commercially produced food products offered in European public universities: A North-South comparison

To date, there are no studies that have compared university food environments (FEs) with different sociocultural contexts. Therefore, we analyzed differences in the availability and properties of commercially produced foods, in a northern and a southern European university (located in Norway and Spain, respectively). A cross-sectional observational study was conducted at OsloMet-Oslo Metropolitan University and at the University of the Basque Country UPV/EHU. The nutritional quality of food products was estimated through the following nutrient profiling models (NPMs): those proposed by the Spanish Agency for Consumer Affairs, Food Safety and Nutrition (AECOSAN), the UK nutrient profiling model (UK NPM), the Norwegian Food and Drink Industry Professional Practices Committee (Matbransjens Fagligle Utvalg [MFU]), and a combination of them. In addition, food items were classified using the NOVA system. A total of 251 and 1051 products were identified at OsloMet and the UPV/EHU, respectively. The percentage categorized as low nutritional quality (LNQ) was higher at the UPV/EHU (almost 54.5% of the total products) compared with at OsloMet (almost 40%) (p < 0.001). Most of the products were categorized as ultra-processed, and there were no differences in the percentage of ultra-processed foods between the two universities (OsloMet 86.1%, UPV/EHU 83.3%, p > 0.05). A higher proportion of LNQ products was found at the UPV/EHU than at OsloMet, probably due to the government policies and actions for creating healthy FEs. Consequently, there is a need to develop interventions to improve the FE at the UPV/EHU, adapted to its sociocultural context. PRACTICAL APPLICATION: This study reveals north-south differences in terms of the availability of low nutritional quality food products. In particular, a higher proportion of this type of product was found at the University of the Basque Country UPV/EHU than at OsloMet-Oslo Metropolitan University. Our exploratory hypothesis is that this phenomenon is a consequence of the Nordic government policies that have great potential to create healthy FEs.

Associations between dietary habits, socio-demographics and gut microbial composition in adolescents

The relationship between dietary habits and microbiota composition during adolescence has not been well examined. This is a crucial knowledge gap to fill considering that diet-microbiota interactions influence neurodevelopment, immune system maturation and metabolic regulation. This study examined the associations between diet and the gut microbiota in a school-based sample of 136 adolescents (Mage = 12·1 years; age range 11-13 years; 48 % female; 47 % Black, 38 % non-Hispanic White, 15 % Hispanic or other minorities) from urban, suburban and rural areas in the Southeast USA. Adolescents completed the Rapid Eating Assessment for Participants and provided stool samples for 16S ribosomal RNA gene sequencing. Parents reported their child and family socio-demographic characteristics. The associations between diet and socio-demographics with gut microbiota diversity and abundance were analysed using multivariable regression models. Child race and ethnicity, sex, socio-economic status and geographic locale contributed to variation within microbiota composition (β-diversity). Greater consumption of processed meat was associated with a lower microbial α-diversity after adjusting for socio-demographic variables. Multi-adjusted models showed that frequent consumption of nutrient-poor, energy-dense foods (e.g. sugar-sweetened beverages, fried foods, sweets) was negatively associated with abundances of genera in the family Lachnospiraceae (Anaerostipes, Fusicatenibacter and Roseburia), which are thought to play a beneficial role in host health through their production of short-chain fatty acids (SCFAs). These results provide new insights into the complex relationships among socio-demographic factors, diet and gut microbiota during adolescence. Adolescence may represent a critical window of opportunity to promote healthy eating practices that shape a homoeostatic gut microbiota with life-long benefits.

The Relationship of Hedonic Hunger, Macronutrient Balance, Nutrition Knowledge, and Body Image and Weight Control with Dietary Intake in Student Athletes and Exercisers

Dietary intake is known to impact athletic performance. The factors that influence dietary intake have been investigated widely, but their collective effect has not been examined. The primary aim of this cross-sectional study was to assess the relationship between dietary intake and nutrition knowledge, body image, weight control, macronutrient balance, and hedonic hunger. Forty-two student athletes or active individuals were recruited through contact with sporting organisations and course coordinators, advertising via twitter, and flyers posted within university buildings. Nutrition knowledge, body image, weight control, macronutrient balance, and hedonic hunger were measured using the Abridged Nutrition for Sport Knowledge Questionnaire, Body Image Disturbance Questionnaire and Contour Drawing Rating Scale, a Weight Fluctuation Measure, Australian Eating Score, and Power of Food Scale, respectively. Hierarchical regression analysis, correlation testing, and mean difference testing were applied. Carbohydrate intake, body image disturbance scores, weight fluctuation, and hedonic hunger for food tasted had a significant relationship (R2 = 64.6%, Adj R2 = 0.608%, p < 0.001) with dietary energy intake. Student athletes' dietary intakes are influenced by multiple potentially modifiable factors. Future studies should use larger sample sizes, with interventions focusing on individual modifiable factors to determine how dietary intake can be most significantly impacted.

The Influence of the School Neighborhood Food Retail Environment on Unhealthy Food Purchasing Behaviors Among Adolescents: A Systematic Review

INTRODUCTION

Adolescents are often exposed to food retailers selling unhealthy food items during their lunch breaks and school commutes. This systematic review examines the influence of school neighborhood food retail environments on adolescent food purchasing.

METHODS

A systematic search of 6 databases. Observational studies published from January 2012 to December 2022 that measured food availability, accessibility, or exposure, measured food purchasing, and focused on adolescents (aged 10-19 years) were eligible for inclusion.

RESULTS

Twelve studies with 97 findings were included. Thirty-one findings indicated that a school neighborhood with a high density of unhealthy food retail, a school with unhealthy food retail nearby, or exposure to unhealthy food retail on the journey to/from school was associated with higher prevalence and frequency of unhealthy food purchases.

DISCUSSION

Adolescents' food purchasing behaviors may be meaningfully affected by their school neighborhood food retail environment; however, the included studies have many methodological shortcomings.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Results identify the need for new studies that measure food purchasing, use comprehensive definitions of food retail environments, and adopt more rigorous methods to approximate exposure to food retail. More robust evidence would strengthen the rationale for policy or program interventions and potentially indicate specific targets for intervention.

A natural experiment: The opening of a supermarket in a public housing community and impacts on children's dietary patterns

Objective

The aim of the present study is to utilize a natural experiment and examine changes in dietary patterns of predominantly low-income, racial and ethnic minority children who live in a public housing community following the opening of a new supermarket.

Methods

Data comes from the Watts Neighborhood Health Study (WNHS), an ongoing study in South Los Angeles, United States, that follows residents of Jordan Downs, a public housing community undergoing redevelopment. Surveys were administered to children aged 9-17 years (n = 297), as well as an adult in the household. The second baseline data collection was conducted June-December 2019, and follow-up was conducted June 2020-April 2021, shortly after the introduction of the new supermarket in January 2020. ANCOVA linear regression models were estimated to examine the association between children's proximity to the new supermarket with dietary outcomes at follow-up. Interactions with barriers to food access were also explored.

Results

Living close to the new supermarket was not significantly associated with dietary outcomes at follow-up. However, for children who lived in households with no vehicle access, living close to the new supermarket was associated with increased fruit and vegetable consumption, compared to children in the comparison group.

Conclusion

Proximity to the new supermarket was not associated with improved dietary outcomes among children unless they had transportation barriers. This adds to the growing body of literature that suggests that the effects of neighborhood food environments may be modified by individuals' mobility, and that comprehensive interventions are needed.

Understanding the Food Environment and Its Impact on Diet and Health in Asia: A Scoping Review

Food environment (FE), an interface where people interact with a broader food system, is critical to health. Understanding the Asian FE may help to tackle the "triple burden of malnutrition" through informed research and policy. This review identifies FE domains assessed in the Asian context and collates the tools/measures used in these evaluations. We further synthesized the reported associations of FE with diet and health outcomes and identified knowledge gaps. Forty-two articles were reviewed (East Asia, n = 25, 60%; South Asia, n = 8, 19%; and Southeast Asia, n = 9, 21%). The results showed that FE was frequently examined in children, adolescents, or adults, but data were scarce in older adults. Food availability (n = 30) and accessibility (n = 19) were popularly studied domains. Furthermore, FE was measured using geographic information systems (n = 18), market (n = 7), or stakeholder (n = 21) surveys. Twenty-eight (67%) articles assessed associations of FE exposures with diet (n = 12) and health (n = 21). Increased food availability and accessibility were associated with poorer dietary and health outcomes despite nonexisting validity and reliability reporting in 62% of articles. Limited high-quality studies emphasize the need for harmonized definitions, better study designs, and validated FE measures/tools in Asia. Improving the quality of FE research is critical to designing effective interventions to improve public health nutrition in Asia.

Centering context when characterizing food environments: the potential of participatory mapping to inform food environment research

Food environments are a critical place within the food system to implement interventions aimed at enabling sustainable diets. In this perspective article, we argue for the need for food environment research to more comprehensively examine the different types of food environments that people access within their communities to ensure that interventions and programs are better aligned with people's lived experiences. We highlight the potential ways in which participatory mapping (PM) can be leveraged to better design food environment research by: (1) identifying the different food environment types that are accessed within a given community; (2) providing insight into the timing for data collection; (3) informing the prioritization of where to conduct food environment assessments; and (4) highlighting the dynamism of food environments over time (e.g., across a given day or across seasons). We provide a case study example of the application of PM and the lessons learned from it in Cambodia. By conceptualizing food environments in a more comprehensive way, from the perspective of the people living within a given community, we will be able to measure food environments in a way that more closely aligns with people's lived experiences.

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Food environment of bus terminals in the Rio de Janeiro metropolitan region

PURPOSE

To describe and analyze the healthiness of formal and informal food establishments in bus terminals of the metropolitan region of the state of Rio de Janeiro.

METHOD

An audit was conducted in 156 formal and 127 informal food establishments located in 14 bus terminals of the five most populous cities of the metropolitan region of Rio de Janeiro. Proportions of types of establishments and means (95%CI) of food availability indicators in formal and informal settings were calculated. For the formal setting, prices, proportions of accepted payment methods, days and hours of operation, and food categories with displayed advertising were described.

RESULTS

The healthiness of food establishments in bus terminals was low (less than 36%). On average, ultra-processed food subgroups were 250% more available for purchase than fresh or minimally processed food. Purchasing food at these places was convenient because several forms of payment were available, and the opening hours of the establishments followed the peaks of movement. In addition, 73.3% of the advertising referred to ultra-processed drinks, and the cost-benefit of buying ultra-processed food was better than fresh or minimally processed food.

CONCLUSION

The food environment of bus terminals in the metropolitan region of Rio de Janeiro promotes unhealthy eating. Regulatory public policies should focus on initiatives to limit the wide availability and advertising of ultra-processed food in spaces of great circulation of people.

Global positioning system-based food environment exposures, diet-related, and cardiometabolic health outcomes: a systematic review and research agenda

BACKGROUND

Geographic access to food may affect dietary choices and health outcomes, but the strength and direction of associations may depend on the operationalization of exposure measures. We aimed to systematically review the literature on up-to-date evidence on the association between food environment exposures based on Global Positioning System (GPS) and diet-related and cardiometabolic health outcomes.

METHODS

The databases PubMed, Embase.com, APA PsycInfo (via Ebsco), Cinahl (via Ebsco), the Web of Science Core Collection, Scopus, and the International Bibliography of the Social Sciences (via ProQuest) were searched from inception to October 31, 2022. We included studies that measured the activity space through GPS tracking data to identify exposure to food outlets and assessed associations with either diet-related or cardiometabolic health outcomes. Quality assessment was evaluated using the criteria from a modified version of the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. We additionally used four items from a quality assessment tool to specifically assess the quality of GPS measurements.

RESULTS

Of 2949 studies retrieved, 14 studies fulfilled our inclusion criteria. They were heterogeneous and represent inconsistent evidence. Yet, three studies found associations between food outlets and food purchases, for example, more exposure to junk food outlets was associated with higher odds of junk food purchases. Two studies found associations between greater exposure to fast food outlets and higher fast food consumption and out of three studies that investigated food environment in relation to metabolic outcomes, two studies found that higher exposure to an unhealthy food environment was associated with higher odds of being overweight.

CONCLUSIONS

The current and limited evidence base does not provide strong evidence for consistent associations of GPS-based exposures of the food environment with diet-related and cardiometabolic health outcomes.

Designing and Evaluating a Hierarchical Framework for Matching Food Outlets across Multi-sourced Geospatial Datasets: a Case Study of San Diego County

Research on retail food environment (RFE) relies on data availability and accuracy. However, the discrepancies in RFE datasets may lead to imprecision when measuring association with health outcomes. In this research, we present a two-tier hierarchical point of interest (POI) matching framework to compare and triangulate food outlets across multiple geospatial data sources. Two matching parameters were used including the geodesic distance between businesses and the similarity of business names according to Levenshtein distance (LD) and Double Metaphone (DM). Sensitivity analysis was conducted to determine thresholds of matching parameters. Our Tier 1 matching used more restricted parameters to generate high confidence-matched POIs, whereas in Tier 2 we opted for relaxed matching parameters and applied a weighted multi-attribute model on the previously unmatched records. Our case study in San Diego County, California used government, commercial, and crowdsourced data and returned 20.2% matched records from Tier 1 and 18.6% matched from Tier 2. Our manual validation shows a 100% matching rate for Tier 1 and up to 30.6% for Tier 2. Matched and unmatched records from Tier 1 were further analyzed for spatial patterns and categorical differences. Our hierarchical POI matching framework generated highly confident food POIs by conflating datasets and identified some food POIs that are unique to specific data sources. Triangulating RFE data can reduce uncertain and invalid POI listings when representing food environment using multiple data sources. Studies investigating associations between food environment and health outcomes may benefit from improved quality of RFE.

An Increase in Food Insecurity Correlated with an Increase in Plasma Triglycerides among Latinx Children

BACKGROUND

Food insecurity and metabolic diseases both disproportionately affect Hispanic children. Cross-sectional studies have linked food insecurity with adverse cardiometabolic markers, including elevated plasma triglycerides and glucose concentrations. However, the association between changes in food insecurity and changes in cardiometabolic markers in children remains to be explored. Furthermore, few studies have assessed the impact of school-based nutrition interventions on household food insecurity.

OBJECTIVE

The objectives of this study are to assess the effect of the TX Sprouts intervention on household food insecurity and to examine the association between changes in household food insecurity and changes in cardiometabolic markers over 1 academic year.

METHODS

This secondary analysis used data from TX Sprouts, a cluster-randomized school-based gardening, cooking, and nutrition trial. The study enrolled 3rd-5th-grade students from 16 schools that served primarily (>50%) Hispanic families with low income in Austin, TX. Participants (n = 619) provided household food insecurity data and fasting lipid panels at both baseline and postintervention, ∼9 mo following.

RESULTS

There was no intervention effect on household food insecurity. Independent of the intervention, a 1-point increase in food insecurity, indicative of becoming more food insecure, was associated with a 2.61 mg/dL increase in triglycerides (P = 0.001; 95% CI: 1.04, 4.19) at follow-up. Children who were food insecure at baseline and became food secure at follow-up had a mean 5.05 mg/dL decrease in triglycerides compared with a 7.50 mg/dL increase in triglycerides in children who remained food insecure throughout (95% CI: -23.40, -1.71, P = 0.023). There were no other associations between changes in food insecurity and cardiometabolic markers.

CONCLUSION

Although the intervention did not improve food insecurity, reductions in food insecurity over 9 mo were associated with improved cardiometabolic markers in high-risk children, emphasizing the need for interventions targeting food insecurity. The study is registered at clinicaltrials.gov under NCT02668744 (https://classic.

CLINICALTRIALS

gov/ct2/show/NCT02668744).

Social inequities in neighborhood health amenities over time in the Wasatch Front Region of Utah: Historical inequities, population selection, or differential investment?

Socially disadvantaged groups generally are more likely to reside in areas with less desirable conditions. We examined longitudinal relationships between neighborhood resident characteristics and amenities from 1990 to 2010 in an urban area of Utah, U.S. Four temporal patterns of social inequities are described using mixed-effects models: historical inequities; differential selection into amenity-rich tracts; differential investment in amenities; and simultaneous twenty-year change. Results indicate historical differences by neighborhood socioeconomic status, with lower status tracts having fewer green/natural amenities and higher air pollution in 1990 but also greater walkability and more food stores. Differences in amenities by neighborhood socioeconomic status widened over time as aggregate socioeconomic status disproportionately increased in tracts with more green/natural amenities, less air pollution, and lower walkability in 1990, consistent with differential selection. Tract percentage non-Hispanic White did not predict historical differences, but tracts that were less walkable and had fewer healthy food stores in 1990 experienced larger subsequent increases in racial/ethnic diversity. Tracts with higher relative to lower percentage non-Hispanic White in 1990 had larger decreases in air pollution but declining green/natural amenities. This study shows how social inequities in neighborhood amenities change over time, providing evidence of historical socioeconomic differences increasing from differential resident selection.

A repeated cross-sectional analysis of the Icelandic baby food market surveyed in 2016, 2019 and 2021

World Health Organisation (WHO) has stated that countries need to know their local commercial baby food (CBF) market. Data from other countries suggest rapid changes in CBF options, highlighting the need for repeated analysis. In that context, this repeated cross-sectional study analysed the options and nutrient quality of different CBF types available in Iceland in years 2016, 2019 and 2021. Data was gathered on formulas, porridge flours, foods in jars and pouches, finger-foods, other CBF. They were classified into 26 subgroups based on ingredients and taste (sweet/savoury). Minimum consumer age as suggested by the manufacturers and nutritional content were registered. In each data-collection, 250-275 products were available. Over a third of products (37%-44%) were in pouches. Availability of products intended for 4-11-month-old infants decreased, driven largely by a 65% decrease in availability of food in jars (sweet/savoury) between 2016 and 2021. Availability of products intended from 12+ months or without age-labels increased, driven largely by quadrupling of finger-foods (predominantly sweet) between 2016 and 2021. The overall percentage of products classified as sweet increased from 65% (2016) to 73% (2019) and 77% (2021). Some finger-foods had high sugar content (up to 72 g/100 g), partly from fruit concentrate or sugar/syrup. Like other countries, the Icelandic CBF market has moved towards less availability of food intended in the first year and more availability of sweet finger-foods for an expanded consumer age. As sugar is added to some CBF, stronger regulations on promotion of foods for young consumers and updated recommendations for parents/caregivers may be needed.

Advancing Population Health Through Open Environmental Data Platforms

Data stand as the foundation for studying, evaluating, and addressing the multifaceted challenges within environmental health research. This chapter highlights the contributions of the Canadian Urban Environmental Health Research Consortium (CANUE) in generating and democratizing access to environmental exposure data across Canada. Through a consortium-driven approach, CANUE standardizes a variety of datasets - including air quality, greenness, neighborhood characteristics, and weather and climatic factors - into a centralized, analysis-ready, postal code-indexed database. CANUE's mandate extends beyond data integration, encompassing the design and development of environmental health-related web applications, facilitating the linkage of data to a wide range of health databases and sociodemographic data, and providing educational training and events such as webinars, summits, and workshops. The operational and technical aspects of CANUE are explored in this chapter, detailing its human resources, data sources, computational infrastructure, and data management practices. These efforts collectively enhance research capabilities and public awareness, fostering strategic collaboration and generating actionable insights that promote physical and mental health and well-being.

Improving Client Experience and Charitable Food Reach and Access at Food Pantries: A Qualitative Study

Food pantries are promising community partners in health promotion. This study explored client perspectives in food pantries to inform new approaches to improve client experience, reach, and access. We interviewed 52 adult clients who visited participating food pantries two or more times over 12 months in Cook County, Illinois in English, Spanish, or Cantonese. We analyzed transcripts using the Health Equity Implementation Framework. Participants were 69% female, 48% Black, 29% Asian, and 15% Hispanic/Latino. Participants identified availability of healthy and high-quality foods, client choice models, client-personnel interactions, multilingual services, and wait times as influential to pantry reach and access. Participants felt that client feedback opportunities and client-led community outreach could successfully engage community members who avoided food pantries due to stigma. Creating opportunities for client-centered feedback may improve client experience, reach, and access of food pantries, reduce stigma, and optimize a novel setting for community-based health promotion in diverse populations.

Socio-Spatial Segregation of Unhealthy Food Environments across Public Schools in Santiago, Chile

Santiago, Chile is a very segregated city, with higher childhood obesity rates observed in vulnerable areas. We compared the counts and proximity of unhealthy food outlets (UFOs) around a 400 m buffer of 443 public schools (municipal and subsidized) located in socioeconomically diverse neighborhoods in 14 municipalities of Santiago. This was a cross-sectional study in which the socioeconomic status (SES) of the population living inside the buffer was classified as middle-high, middle, and low. We used the Kruskal-Wallis test for comparisons of density and proximity between type of school, SES, and population density. We used a negative binomial model (unadjusted and adjusted by population density) to determine the expected change in counts of UFOs by SES, which was compared to the reference (middle-high). Low SES neighborhoods had significantly more counts of UFOs, and these were located much closer to schools. Low and middle SES neighborhoods had an 88% and 48% higher relative risk of having UFOs compared to middle-high SES areas; (IRR = 1.88; 95% CI 1.59-2.23) and (IRR = 1.48; 95% CI 1.20-1.82), respectively. A socio-spatial segregation of UFOs associated with childhood obesity across public schools was observed in Santiago.

Food desert residence has limited impact on veteran fecal microbiome composition: a U.S. Veteran Microbiome Project study

IMPORTANCE

Social and economic inequities can have a profound impact on human health. The inequities could result in alterations to the gut microbiome, an important factor that may have profound abilities to alter health outcomes. Moreover, the strong correlations between social and economic inequities have been long understood. However, to date, limited research regarding the microbiome and mental health within the context of socioeconomic inequities exists. One particular inequity that may influence both mental health and the gut microbiome is living in a food desert. Persons living in food deserts may lack access to sufficient and/or nutritious food and often experience other inequities, such as increased exposure to air pollution and poor access to healthcare. Together, these factors may confer a unique risk for microbial perturbation. Indeed, external factors beyond a food desert might compound over time to have a lasting effect on an individual's gut microbiome. Therefore, adoption of a life-course approach is expected to increase the ecological validity of research related to social inequities, the gut microbiome, and physical and mental health.

Validity and reliability of the Perceived Nutrition Environment Measures Survey (NEMS-P) for use in Brazil

OBJECTIVE

The aim of this study is to evaluate the validity and reliability of the Perceived Nutrition Environment Measures Survey (NEMS-P) translated and adapted for use in Brazil.

DESIGN

Validation of the NEMS-P questionnaire. The questionnaires were applied to assess validity and reliability, based on exploratory factor analysis, Cronbach's α coefficient and intra-class correlation, with a significance level of 95 %.

SETTING

Brazil.

PARTICIPANTS

Adults over 20 years of age diagnosed with hypertension were included in the internal validity and reliability test (n 176) and intra-rater reliability (subsample n 35).

RESULTS

Factor analysis obtained satisfactory results. Internal consistency was acceptable for most items, with Cronbach's α ranging from 0·6 to 0·9. The intra-rater reliability of the subsample was also valid, with intra-class correlation coefficient values ranging from 0·5 to 0·9.

CONCLUSION

This work reveals the usefulness of the instrument to assess the perceived food environment in the Brazilian context, being able to measure what is proposed according to its theoretical model, and reproduces the values when applied to a sample different from its original validation. However, refinement of some questions is suggested. Finally, it demonstrates the possibility of using the entire instrument or each section independently, according to the food environments to be investigated.

Store-specific grocery shopping patterns and their association with objective and perceived retail food environments

OBJECTIVE

To explore store-specific grocery shopping patterns and assess associations with the objective and perceived retail food environment (RFE).

DESIGN

This cross-sectional study used principal component analysis and hierarchical cluster analysis to identify grocery shopping patterns and logistic regression models to assess their associations with the RFE, while adjusting for household characteristics.

SETTING

The Montpellier Metropolitan Area, France.

PARTICIPANTS

To be eligible for inclusion, participants had to be 18 years of age or older and reside in the Montpellier Metropolitan Area. Analyses were carried out on 415 households.

RESULTS

Households of cluster 'Supermarket' (49 % of households) primarily shopped at supermarkets and were less likely to live near a convenience store. Households of cluster 'Diversified' (18 %) shopped mostly at organic stores, at markets, at specialised stores, and from producers and were more likely to have a market in their activity space. Households of cluster 'Discount' (12 %) primarily shopped at discounters and were less likely to perceive a producer in their activity space. Households of cluster 'Convenience' (12 %) mostly shopped online or in convenience stores. Finally, households of cluster 'Specialized' (9 %) had high expenditures in greengrocers and in other specialised food stores and were more likely to live near a specialised food store.

CONCLUSIONS

This study highlighted the importance of considering both perceived and objective RFE indicators, as well as assessments around the home and in activity space. Understanding how people buy food and interact with their RFE is crucial for policymakers seeking to improve urban food policies.

The interaction between the community food environment and cooking skills in association with diet-related outcomes in Dutch adults

OBJECTIVE

We examined whether associations between the food environment, frequency of home cooking, diet quality and BMI were modified by the level of cooking skills.

DESIGN

Cross-sectional study using linear and modified Poisson regression models adjusted for age, sex, energy intake, education, income, household size and urbanisation. The frequency of home cooking was categorised into <6 and 6-7 d. Diet quality was based on a validated Dutch healthy diet index (0-150 points). Count of restaurants and food stores were determined by their count in a 1000m buffer around home and work. Cooking skills (score 1-5) were assessed using a validated questionnaire and added as interaction term.

SETTING

The Netherlands.

PARTICIPANTS

1461 adults aged 18-65 years.

RESULTS

Count of restaurants and food stores were not associated with the frequency of home cooking. A 10-unit higher count of food stores was associated with a higher diet quality (β: 0·58 (95 % CI (0·04, 1·12)), and a 10-unit higher count of restaurants was associated with a lower BMI kg/m2 (β: -0·02 (95 % CI (-0·04, -0·004)). Better cooking skills were associated with a higher likelihood of cooking 6-7 d compared with <6 d (risk ratio: 1·24 (95 % CI (1·16, 1·31)) and a higher diet quality (β: 4·45 (95 % CI (3·27, 5·63)) but not with BMI. We observed no interaction between the food environment and cooking skills (P-for-interaction > 0·1).

CONCLUSIONS

Exposure to food stores was associated with a higher diet quality and exposure to restaurants with a lower BMI. Better cooking skills were associated with a higher frequency of home cooking and better diet quality but did not modify associations with the food environment. Future studies should explore different approaches to understand how individuals interact with their food environment.

Exploring the role of nature-based typologies and stewardship schemes in enhancing urban green spaces: Citizen perceptions of landscape design scenarios and ecosystem services

This research investigates the UK citizens' perceptions of the ecosystem services (ES) created using a range of Nature-Based Solutions (NBS) in urban green spaces (UGS). The longevity of the ES derived from UGS is dependent on the effective on-going maintenance of urban landscapes, therefore this paper also gathers data on direct UGS participation specifically through the lens of civic stewardship to assess the impact of such schemes upon ES. NBS typologies were created and used, in the mixed methods study, to gauge perceptions of and preferences for alternative urban landscape design. The UGS survey collected data from 345 respondents on ES and the NBS typologies. Twelve semi-structured interviews provide qualitative data on NBS typology preferences, perceptions, and understanding of ES as well as motivations behind civic engagement in UGS in the UK. Stewardship programmes were found to increase community resilience by providing additional ES. The results showed a preference for integrating complex, multifunctional UGS into the fabric of urban centres to ensure accessibility and to maximise engagement. More complex NBS typologies were perceived to provide additional ES when compared with traditional monoculture mown grass and shrub amenity planting. Mixed native planting and Tiny Forest NBS typologies were perceived as providing more provisioning, cultural, regulating, and supporting ES. Considering both UK citizens' perceptions of the ES gained from alternative NBS and stewardship schemes in UGS represents a holistic approach that can improve the design and management of NBS in cities. This study is the first to explore both concepts in the UK and suggests a holistic UGS approach to address urban challenges, including those related to Climate Change.

Impact of food insecurity and food environment on the diet quality of older African Americans during the COVID-19 pandemic

Introduction

A high quality diet is vital in promoting wellbeing and ensuring good health, particularly for those living with chronic conditions. Older African Americans, already burdened with a higher prevalence of chronic conditions, also face a higher risk for suboptimal diets. The COVID-19 pandemic had lasting effects on access to healthy food for all Americans, but some demographic groups were disproportionately affected. Older African Americans, who already experienced reduced access to healthy food pre-pandemic, were particularly afflicted, but the full extent of the pandemic's impact on their food insecurity and food environment remains unclear.

Methods

To address this gap, we conducted a study among 102 older African Americans in South Los Angeles between October 2021 and July 2022 during the COVID-19 pandemic. Participants completed surveys on dietary intake, food insecurity, and neighborhood food environment. We measured dietary quality using the healthy eating index (HEI)-2015. The analysis included descriptive, bivariate chi-square, t-tests, analysis of variance, and multiple linear and logistic regression.

Results

While overall dietary quality was suboptimal, most participants met the guidelines for fruit and vegetable consumption. Food insecurity was associated with lower overall diet quality and lower total fruit and whole fruit intake. However, there was no association between food environment and diet quality.

Discussion

In light of our findings, further intervention is critical to improving diet quality, especially among older African Americans living with chronic conditions in the post-pandemic era.

Associations between the neighbourhood food environment and cardiovascular disease: a systematic review

AIMS

To systematically review the current evidence on the association between the neighbourhood food environment and cardiovascular disease (CVD) in adults.

METHODS AND RESULTS

We searched the literature databases CINAHL, MEDLINE, and EMBASE for studies published between 1 January 2000 and 1 May 2022. Studies focusing on the indoor home, workplace, or school food environment were excluded. Two independent reviewers screened all records. Included studies were assessed for risk of bias using the shortened QUIPS tool, and relevant data were extracted. We summarized the findings using a narrative synthesis approach. We included 15 studies after screening 5915 original records. Most studies were published in the last 4 years and were predominantly conducted in North American or European countries. These studies focused on fast-food restaurant density in the residential neighbourhood. A higher fast-food restaurant density was most consistently associated with a higher prevalence and incidence of CVD and CVD mortality, but effect sizes were small. Evidence of an association between fast-food restaurant density and myocardial infarction, or stroke was inconsistent. The other aspects of the food environment were density of food service restaurants, unhealthy food outlets, and food access score. However, there was scant evidence for these aspects.

CONCLUSION

We found evidence for associations between the neighbourhood food environment and CVD, suggesting that a higher fast-food restaurant density is associated with CVD and CVD mortality. Effect sizes were small but important, given the fact that a large population is exposed. Research is needed to assess the effects of other aspects of the food environment.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022317407.

Food retail environments, extreme weather, and their overlap: Exploratory analysis and recommendations for U.S. food policy

Extreme weather events are increasing in frequency and severity due to climate change, yet many of their impacts on human populations are not well understood. We examine the relationship between prior extreme weather events and food environment characteristics. To do so, we conduct a U.S. county-level analysis that assesses the association between extreme weather events and two common food retail environment dimensions. Overall, we find a relationship between higher levels of historic extreme weather exposure and lower food availability and accessibility. In addition, we find heterogeneity in association across the distribution of the number of extreme weather events and event type. Specifically, we find that more localized extreme weather events are more associated with a reduction of access and availability than broad geographic events. Our findings suggest that as extreme weather events amplify in intensity and increase in frequency, new approaches for mitigating less acute and longer-term impacts are needed to address how extreme weather may interact with and reinforce existing disparities in food environment factors. Furthermore, our research argues that integrated approaches to improving vulnerable food retail environments will become an important component of extreme weather planning and should be a consideration in both disaster- and food-related policy.

Design of an innovative digital application to facilitate access to healthy foods in low-income urban settings

Background

Under-resourced urban minority communities in the United States are characterized by food environments with low access to healthy foods, high food insecurity, and high rates of diet-related chronic disease. In Baltimore, Maryland, low access to healthy food largely results from a distribution gap between small food sources (retailers) and their suppliers. Digital interventions have the potential to address this gap, while keeping costs low.

Methods

In this paper, we describe the technical (I) front-end design and (II) back-end development process of the Baltimore Urban food Distribution (BUD) application (app). We identify and detail four main phases of the process: (I) information architecture; (II) low and high-fidelity wireframes; (III) prototype; and (IV) back-end components, while considering formative research and a pre-pilot test of a preliminary version of the BUD app.

Results

Our lessons learned provide valuable insight into developing a stable app with a user-friendly experience and interface, and accessible cloud computing services for advanced technical features.

Conclusions

Next steps will involve a pilot trial of the app in Baltimore, and eventually, other urban and rural settings nationwide. Once iterative feedback is incorporated into the app, all code will be made publicly available via an open source repository to encourage adaptation for desired communities.

Trial Registration

ClinicalTrials.gov NCT05010018.

Improvements in dietary intake, behaviors, and psychosocial measures in a community-randomized cardiovascular disease risk reduction intervention: Strong Hearts, Healthy Communities 2.0

BACKGROUND

Cardiovascular disease (CVD) prevalence has disproportionately risen among midlife and older female adults of rural communities, partly due to poor diet and diet-related behaviors and psychosocial factors that impede healthy eating.

OBJECTIVES

This study aimed to evaluate the impact of Strong Hearts Healthy Communities 2.0 (SHHC-2.0) on secondary diet-related outcomes between intervention and control participants that align with the dietary goal and behavioral aims of the SHHC-2.0, a CVD risk reduction program.

METHODS

A community-randomized controlled trial was conducted in rural, medically underserved communities. Participants were female adults ≥40 y who were classified as obese or both overweight and sedentary. Communities were randomized to SHHC-2.0 intervention (n = 5 communities; n = 87 participants) or control (with delayed intervention) (n = 6 communities; n = 95 participants). SHHC-2.0 consisted of 24 wk of twice-weekly experiential nutrition education and group-based physical activity classes led by local health educators. Changes between baseline and end point (24 wk) in dietary intake (24-h recalls), dietary behaviors (e.g., Rapid Eating Assessment for Participants-Short Version [REAP-S] scores) and diet-related psychosocial measures (e.g., Three Factor Eating questionnaire) between groups were analyzed using linear mixed-effects multilevel models.

RESULTS

At 24 wk, participants from the 5 intervention communities, compared with controls, consumed fewer calories (mean difference [MD]= -211 kcal, 95% CI: -412, -110, P = 0.039), improved overall dietary patterns measured by REAP-S scores (MD: 3.9; 95% CI: 2.26, 5.6; P < 0.001), and improved psychosocial measures (healthy eating attitudes, uncontrolled eating, cognitive restraint, and emotional eating).

CONCLUSIONS

SHHC-2.0 has strong potential to improve diet patterns and diet-related psychosocial wellbeing consistent with improved cardiovascular health. This trial was registered at www.

CLINICALTRIALS

gov as NCT03059472.

Tools and resources used to support implementation of workplace healthy food and drink policies: A scoping review of grey literature

AIMS

This study aimed to identify and evaluate tools and resources used to support the implementation of workplace healthy food and drink policies, primarily in Australia and New Zealand.

METHODS

A scoping grey literature review included searches of government agencies and non-governmental organisations' websites in six English-speaking countries, public health nutrition intervention databases and Google search engine queries. Paper-based and digital tools were included if they were written in English, referred to within a policy or on a policy's website, and primarily targeting supply-side stakeholders. Tools were evaluated on two domains: 'Features' (summarised descriptively) and 'Usability and Quality' (with inter-rater reliability scores calculated using an intraclass correlation coefficient).

RESULTS

Twenty paper-based tools were identified relating to Australian (n = 14) and New Zealand (n = 6) policies, and a further six digital tools were identified from Australia (n = 3) and Canada (n = 3). Target audiences included workplace managers, food providers and suppliers. The paper-based tools focused on general implementation guidance. In contrast, digital tools tended to support specific elements of policy implementation. 'Usability and Quality' scores ranged from 2.9 to 4.5 (out of 5.0) for paper-based tools, and 3.9 to 4.2 for digital tools, with a moderate agreement between reviewer scores (intraclass correlation coefficient 0.523, p = 0.010).

CONCLUSIONS

A range of tools have been developed to support the implementation of workplace healthy food and drink policies. Understanding the strengths and limitations of current tools will assist in developing improved aids to support policy implementation.

Socioeconomic distribution of food outlet availability through online food delivery services in seven European countries: A cross-sectional study

This area-level cross-sectional study examined online food outlet availability through the most popular online food delivery service platforms (OFDS) across seven European countries, and explored how this online food outlet availability was socioeconomically distributed. Data collection of online food outlet availability was automated in England, Italy, Luxembourg, the Netherlands, Portugal, Spain and Switzerland. We used a geographic information system to join online food outlet availability to socio-demographic information. Median number of food outlets delivering through OFDS was highest in England and lowest in Italy, Portugal and Spain. We also found that high-income areas have the greatest online food outlet availability in most countries. In England, areas with a middle income had the least online food outlets available and no income data was available for Switzerland. Further work is needed to understand drivers of disparities in online food outlet availability, as well as possible implications for public health.

Regulatory mechanisms to create healthier environments: planning appeals and hot food takeaways in England

AIMS

To explore existing regulatory mechanisms to restrict hot food takeaway (HFT) outlets through further understanding processes at local and national levels.

METHODS

The Planning Appeals Portal was utilised to identify recent HFT appeal cases across England between December 2016 and March 2020. Eight case study sites were identified using a purposive sampling technique and interviews carried out with 12 professionals involved in planning and health to explore perceptions of and including factors that may impact on the HFT appeal process. Additionally, documents applicable to each case were analysed and a survey completed by seven Local Authority (LA) health professionals. To confirm findings, interpretation meetings were conducted with participants and a wider group of planning and public health professionals, including a representative from the Planning Inspectorate.

RESULTS

Eight case study sites were identified, and 12 interviews conducted. Participants perceived that LAs would be better able to work on HFT appeal cases if professionals had a good understanding of the planning process/the application of local planning policy and supplementary planning documents; adequate time and capacity to deal with appeals cases; access to accurate, robust, and up to date information; support and commitment from elected members and senior management; good lines of communication with local groups/communities interested in the appeal; information and resources that are accessible and easy to interpret across professional groups.

CONCLUSIONS

Communication across professional groups appeared to be a key factor in successfully defending decisions. Understanding the impact of takeaway outlets on health and communities in the long term was also important. To create a more robust appeals case and facilitate responsiveness, professionals involved in an appeal should know where to locate current records and statistical data. The enthusiasm of staff and support from senior management/elected officials will play a significant role in driving these agendas forward.

Development and Validation of a Perceived Community Food Accessibility Measurement Questionnaire for Korean Older Adults

As the community food environment is known to be an important factor in healthy food choices, it needs to be measured, to increase awareness and improve healthy eating. The objective of this study was to develop a perceived community food accessibility measurement (P-CFAM) questionnaire applicable to older adults in Korea and evaluate its reliability and validity. The questionnaire was developed based on community food environment factors that were found to affect food choices in previous studies. We evaluated the internal consistency reliability, construct validity, and criterion-related validity. The subjects were 188 older adults for validity. The Cronbach's alpha value for the reliability measure was 0.9. The confirmatory factor analysis to evaluate the construct validity of the questionnaire showed values close to those of the optimal model (GFI = 0.983, AGFI = 0.948, RMR = 0.004, NFI = 0.987, CFI = 0.996). Regarding the criterion-related validity, the P-CFAM questionnaire results were significantly related to objective measurement indicators such as the number of grocery stores, the travel time to a grocery store, and the intake of vegetables and fruit. In conclusion, the developed P-CFAM questionnaire was shown to be reliable and valid, and useful for assessing older adults' perceptions of community food accessibility in Korea.

Concepts, Characterizations, and Cautions: A Public Health Guide and Glossary for Planning Food Environment Measurement

Background

There is no singular approach to measuring the food environment suitable for all studies. Understanding terminology, methodology, and common issues is crucial to choosing the best approach.

Objective

This review is designed to support a shared understanding so diverse multi-institutional teams engaged in food environment measurement can justify their measurement choices and have informed discussions about reasons for measurement strategies to vary across projects.

Methods

This guide defines key terms and provides annotated resources identified as a useful starting point for exploring the food environment literature. The writing team was an academic-practice collaboration, reflecting on the experience of a multi-institutional team focused on retail environments across the US relevant to cardiovascular disease.

Results

Terms and annotated resources are divided into three sections: food environment constructs, classification and measures, and errors and strategies to reduce error. Two examples of methods and challenges encountered while measuring the food environment in the context of a US health department are provided. Researchers and practice professionals are directed to the Food Environment Electronic Database Directory (https://www.foodenvironmentdirectory.com/) for comparing available data resources for food environment measurement, focused on the US; this resource incorporates updates informed by user input and literature reviews.

Discussion

Measuring the food environment is complex and risks oversimplification. This guide serves as a starting point but only partially captures some aspects of neighborhood food environment measurement.

Conclusions

No single food environment measure or data source meets all research and practice objectives. This shared starting point can facilitate theoretically grounded food environment measurement.