Neighborhood disparities in access to healthy foods and their effects on environmental justice

Adult food choices in association with the local retail food environment and food access in resource-poor communities: a scoping review

BACKGROUND

There is a growing body of research on local retail food environments globally in both urban and rural settings. Despite this, little research has been conducted on adult food choices, local retail environments, and healthy food access in resource-poor communities. The purpose of this study is therefore to provide an overview of the evidence on adult food choices (measured as dietary intake) in association with the local retail food environment and food access in resource-poor communities (defined as low-income communities and/or households).

METHODS

We searched nine databases for studies published from July 2005 to March 2022 and identified 2426 records in the primary and updated search. Observational studies, empirical and theoretical studies, focused on adults ≤ 65 years, published in English peer-reviewed journals, examining local retail food environments and food access, were included. Two independent reviewers screened identified articles using the selection criteria and data extraction form. Study characteristics and findings were summarized for all studies and relevant themes summarized for qualitative and mixed methods studies.

RESULTS

A total of 47 studies were included in this review. Most studies were cross sectional (93.6%) and conducted in the United States of America (70%). Nineteen (40.4%) studies assessed the association between food choice outcomes and local retail food environment exposures, and evidence on these associations are inconclusive. Associations of certain food choice outcomes with healthy food retail environments were positive for healthy foods (in 11 studies) and unhealthy foods (in 3 studies). Associations of certain food choice outcomes with unhealthy retail food environment exposures were positive for unhealthy foods in 1 study and negative for healthy foods in 3 studies. In 9 studies, some of the food choice outcomes were not associated with retail food environment exposures. A healthy food store type and lower food prices were found to be major facilitators for healthy food access in resource-poor communities, while cost and transportation were the main barriers.

CONCLUSIONS

More research is needed on the local retail food environment in communities in low- and middle-income countries to develop better interventions to improve food choices and access to healthy foods in resource-poor communities.

Influence of Neighborhood Socioeconomic Status on Adverse Outcomes in Pregnancy

PURPOSE

To evaluate whether ZIP-code level neighborhood socioeconomic status (SES) is associated with adverse pregnancy outcomes.

METHODS

A retrospective study of 2009-2014 Oregon Health and Science University (OHSU) births with maternal ZIP codes in one of 89 Portland metropolitan area ZIP codes. Deliveries with ZIP codes outside of the Portland metro area were excluded. Deliveries were stratified by SES based on ZIP code median household income: low (below 10th percentile), medium (11th-89th percentile), and high (above 90th percentile). Univariate analysis and multivariable logistic regression with medium SES as the reference group evaluated perinatal outcomes and strength of association between SES and adverse events.

RESULTS

This study included 8118 deliveries with 1654 (20%) classified as low SES, 5856 (72%) medium SES, and 608 (8%) high SES. The low SES group was more likely to be younger, have a higher maternal BMI, have increased tobacco use, identify as Hispanic or Black, and less likely to have private insurance. Low SES was associated with a significantly increased risk of preeclampsia (RR 1.23 95% CI 1.01-1.49), but this was no longer significant after adjusting for confounders (aRR 1.23 95% CI .971-1.55). High SES was negatively associated with gestational diabetes mellitus (GDM), even after adjusting for confounders (aRR 0.710, 95% CI 0.507-0.995).

CONCLUSION

In the Portland metropolitan area, high SES was associated with a lower risk of GDM. Low SES was associated with a higher risk of preeclampsia before accounting for covariates. ZIP code-based risk assessment may be a useful indicator in detecting healthcare disparities.

Implications of the COVID-19 Pandemic for the Well-Being of Emerging Adult Populations: A Synthesis of Findings From the COVID-19 Eating and Activity Over Time (C-EAT) Study

Research addressing the impact of the COVID-19 pandemic on psychosocial well-being and health behavior is accumulating; however, implications for emerging adult populations are underexplored. This manuscript synthesizes findings from a mixed-methods study of well-being, eating and activity behaviors, and food insecurity among a diverse, longitudinal cohort of emerging adults. The review includes findings from 11 original studies that involved collecting online surveys from 720 emerging adults and in-depth, virtual interviews with 33 respondents who were food insecure. Findings indicated the pandemic had widespread impacts on well-being. Population groups at greatest risk for poor outcomes included women; those who identified as Black, Indigenous, or a Person of Color; persons in households of low socioeconomic status; parents of young children; and persons who previously experienced mental health challenges or weight stigma. Further research will be needed to evaluate efforts to improve the well-being of emerging adults in the aftermath of the pandemic.

Beyond Neighborhood Disadvantage: Local Resources, Green Space, Pollution, and Crime as Residential Community Correlates of Cardiovascular Risk and Brain Morphology in Midlife Adults

OBJECTIVE

Residing in communities characterized by socioeconomic disadvantage confers risk of cardiometabolic diseases. Residing in disadvantaged communities may also confer the risk of neurodegenerative brain changes via cardiometabolic pathways. This study tested whether features of communities-apart from conventional socioeconomic characteristics-relate not only to cardiometabolic risk but also to relative tissue reductions in the cerebral cortex and hippocampus.

METHODS

Participants were 699 adults aged 30 to 54 years (340 women; 22.5% non-White) whose addresses were geocoded to compute community indicators of socioeconomic disadvantage, as well as air and toxic chemical pollutant exposures, homicide rates, concentration of employment opportunities, land use (green space), and availability of supermarkets and local resources. Participants also underwent assessments of cortical and hippocampal volumes and cardiometabolic risk factors (adiposity, blood pressure, fasting glucose, and lipids).

RESULTS

Multilevel structural equation modeling demonstrated that cardiometabolic risk was associated with community disadvantage ( β = 0.10, 95% confidence interval [CI] = 0.01 to 0.18), as well as chemical pollution ( β = 0.11, 95% CI = 0.02 to 0.19), homicide rates ( β = 0.10, 95% CI = 0.01 to 0.18), employment opportunities ( β = -0.16, 95% CI = -0.27 to -0.04), and green space ( β = -0.12, 95% CI = -0.20 to -0.04). Moreover, cardiometabolic risk indirectly mediated the associations of several of these community features and brain tissue volumes. Some associations were nonlinear, and none were explained by participants' individual-level socioeconomic characteristics.

CONCLUSIONS

Features of communities other than conventional indicators of socioeconomic disadvantage may represent nonredundant correlates of cardiometabolic risk and brain tissue morphology in midlife.

A Pilot Study Exploring Practices that Support the Longevity of Community Gardens Supported by Religious Organizations

Current food production methods in the United States (US) contribute to environmental degradation as well as food insecurity. Food production by means of community gardens has the potential to reduce the deleterious effects of current production methods. However, many community gardens face challenges that hinder their longevity, thereby reducing the likelihood of the support they might provide for environmentally sustainable food production and decreased food insecurity for community members. Researchers conducted a literature review regarding best practices for community gardens, and used ethnographic research methods to inform a culturo-behavioral systems analysis using the Total Performance System and matrix (systems interdependency) analysis to better understand the cultural practices of two established community gardens in the southwest region of the US. The results of the analyses are presented in terms of recommendations to support each community garden's sustainability. Recommendations regarding future research include environmental manipulations to identify functional relations and potential outcome measures for improving the longevity of community gardens.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42822-023-00124-7.

Association of Food Deserts and Food Swamps With Obesity-Related Cancer Mortality in the US

Importance

Obesity-related cancers account for 40% of all cancers in the US. Healthy food consumption is a modifiable factor shown to reduce obesity-related cancer mortality, but residing in areas with less access to grocery stores (food deserts) or higher access to fast food (food swamps) reduces healthy food access and has been understudied.

Objective

To analyze the association of food deserts and food swamps with obesity-related cancer mortality in the US.

Design, Setting, and Participants

This cross-sectional ecologic study used US Department of Agriculture Food Environment Atlas data from 2012, 2014, 2015, 2017, and 2020 and Centers for Disease Control and Prevention mortality data from 2010 to 2020. A total of 3038 US counties or county equivalents with complete information on food environment scores and obesity-related cancer mortality data were included. An age-adjusted, generalized, mixed-effects regression model was performed for the association of food desert and food swamp scores with obesity-related cancer mortality rates. Data were analyzed from September 9, 2022, to September 30, 2022.

Exposures

Food swamp score was calculated as the ratio of fast-food and convenience stores to grocery stores and farmers markets. Higher food swamp and food desert scores (20.0 to ≥58.0) indicated counties with fewer healthy food resources.

Main Outcomes and Measures

Obesity-related cancer (based on the International Agency for Research on Cancer evidence between obesity and 13 types of cancer) mortality rates were categorized as high (≥71.8 per 100 000 population) vs low (<71.8 per 100 000 population) per county.

Results

A total of 3038 counties or county equivalents with high obesity-related cancer mortality rates had a higher percentage of non-Hispanic Black residents (3.26% [IQR, 0.47%-26.35%] vs 1.77% [IQR, 0.43%-8.48%]), higher percentage of persons older than 65 years (15.71% [IQR, 13.73%-18.00%] vs 15.40% [IQR, 12.82%-18.09%]), higher poverty rates (19.00% [IQR, 14.20%-23.70%] vs 14.40% [IQR, 11.00%-18.50%]), higher adult obesity rates (33.00% [IQR, 32.00%-35.00%] vs 32.10% [IQR, 29.30%-33.20%]), and higher adult diabetes rates (12.50% [IQR, 11.00%-14.20%] vs 10.70% [IQR, 9.30%-12.40%]) compared with counties or county equivalents with low obesity-related cancer mortality. There was a 77% increased odds of having high obesity-related cancer mortality rates among US counties or county equivalents with high food swamp scores (adjusted odds ratio, 1.77; 95% CI, 1.43-2.19). A positive dose-response relationship among 3 levels of food desert and food swamp scores and obesity-related cancer mortality was also observed.

Conclusions and Relevance

The findings of this cross-sectional ecologic study suggest that policy makers, funding agencies, and community stakeholders should implement sustainable approaches to combating obesity and cancer and establishing access to healthier food, such as creating more walkable neighborhoods and community gardens.

Behavioral Patterns of Sugary Drink Consumption among African American Adolescents: A Pilot and Feasibility Study Using Ecological Momentary Assessment

BACKGROUND

Sugary drinks (SDs) are the predominant contributors to added sugar intake among adolescents, with the highest intakes reported among African American adolescents. The objective of this pilot study was to examine the feasibility of using mobile phone-based ecological momentary assessment (EMA) to investigate, in real time, behavioral patterns of SD consumption among African American adolescents from low-income households.

METHODS

Adolescents (n = 39, ages 12-17) attended a virtual meeting with a trained research assistant, which involved completion of surveys and training on responding to EMA prompts using a mobile phone application. On the seven subsequent days, adolescents were instructed to respond to researcher-initiated prompts three times daily, which queried their SD intake, location, social context, activities, stress, and mood. They were also asked to complete an analogous self-initiated survey each time they consumed SDs.

RESULTS

SD consumption was reported on 219 of 582 (38%) researcher-initiated surveys and on 135 self-initiated SD consumption surveys, for a total of 354 instances of SD intake over the 7-day assessment period. The majority (69%) of the surveys were completed while at home. SD consumption was reported on 37%, 35%, and 41% of researcher-initiated surveys completed at their home, at the home of a friend or family member, or while in transit, respectively.

CONCLUSIONS

These preliminary data indicate that mobile phone-based EMA is feasible for investigating SD intake behaviors among African American youth from low-income households and support the promise of EMA for investigating SD consumption in this population in larger samples of youth.

Association Between County-Level Food Retail and Socioeconomic Environment and Nutritional Quality of Household Food Purchases, 2015

BACKGROUND

About 40 million Americans do not have easy access to affordable nutritious foods. Healthier foods are less likely to be available to those living in rural and/or lower-income communities.

OBJECTIVE

The objective of this study was to analyze the association between nutritional quality of household food purchases and county-level food retail environment; county-level demographic, health, and socioeconomic indicators; and household composition, demographic characteristics, and socioeconomic characteristics.

DESIGN

This study is a secondary analysis of the 2015 Information Resources Inc Consumer Network panel; Purchase-to-Plate Crosswalk, which links US Department of Agriculture nutrition databases to Information Resources Inc scanner data; County Health Rankings; and the Food Environment Atlas data.

PARTICIPANTS AND SETTINGS

A total of 63,285 households, representative of the contiguous US population, consistently provided food purchase scanner data from retail stores throughout 2015.

MAIN OUTCOME MEASURES

Nutritional quality of retail food purchases was assessed using the Healthy Eating Index 2015 (HEI-2015).

STATISTICAL ANALYSIS

Multivariate linear regression analysis was used to simultaneously test the relationship between the main outcome and household-level demographic and socioeconomic characteristics as well as the county-level demographic, health, socioeconomic, and retail food environment.

RESULTS

Household heads who had higher education and households with higher incomes purchased food of better nutritional quality (ie, higher HEI-2015 scores). Also, the association between retail food purchase HEI-2015 scores and the food environment was weak. Higher density of convenience stores was associated with lower retail food purchase nutritional quality for higher-income households and households living in urban counties, whereas low-income households in counties with higher specialty (including ethnic) store density purchased higher nutritional quality food. Both in the full sample and when stratified by household income or county rural vs urban status, no association was found between grocery store, supercenters, fast-food outlets, and full-service restaurant densities and retail food purchase HEI-2015 scores. HEI-2015 scores were negatively correlated with the county average number of mental health days for higher income and urban households.

CONCLUSIONS

The study findings suggest that availability of healthier food alone may not improve healthfulness of retail food purchases. Future studies examining the influence of demand-side factors/interventions, such as habits, cultural preferences, nutrition education, and cost/affordability, on household purchasing patterns could provide complementary evidence to inform effective intervention strategies.

Can lifestyle factors explain racial and ethnic inequalities in all-cause mortality among US adults?

Background: Racial and ethnic inequalities in all-cause mortality exist, and individual-level lifestyle factors have been proposed to contribute to these inequalities. In this study, we evaluate the extent to which the association between race and ethnicity and all-cause mortality can be explained by differences in the exposure and vulnerability to harmful effects of different lifestyle factors. Methods: The 1997-2014 cross-sectional, annual US National Health Interview Survey (NHIS) linked to the 2015 National Death Index was used. NHIS reported on race and ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx), lifestyle factors (alcohol use, smoking, body mass index, physical inactivity), and covariates (sex, age, education, marital status, survey year). Causal mediation using an additive hazard and marginal structural approach was used. Results: 465,073 adults (18-85 years) were followed 8.9 years (SD:5.3); 49,804 deaths were observed. Relative to White adults, Black adults experienced 21.7 (men; 95%CI: 19.9, 23.5) and 11.5 (women; 95%CI: 10.1, 12.9) additional deaths per 10,000 person-years whereas Hispanic/Latinx women experienced 9.3 (95%CI: 8.1, 10.5) fewer deaths per 10,000 person-years; no statistically significant differences were identified between White and Hispanic/Latinx men. Notably, these differences in mortality were partially explained by both differential exposure and differential vulnerability to these lifestyle factors among Black women, while different effects of individual lifestyle factors canceled each other out among Black men and Hispanic/Latinx women. Conclusions: Lifestyle factors provide some explanation for racial and ethnic inequalities in all-cause mortality. Greater attention to structural, life course, healthcare, and other factors is needed to understand determinants of inequalities in mortality and advance health equity.

Experiences of Parents Earning Low Wages in Raleigh, North Carolina: Compounding Effects of Caretaker Responsibility, Piecemeal Resources, and Lack of Economic Opportunities

We conducted interviews with parents earning low wages to understand their experiences related to financial responsibilities and use of government and informal resources in Raleigh, North Carolina. Inadequate economic opportunities and assistance programs, and high costs of living, compounded into cycles of playing catch up on expenses. Assistance programs aimed at alleviating hardships related to poverty were described as piecemeal. We found that social and economic systems failed to support parents earning low wages. Our findings suggest that ordinances that assure a livable minimum wage paired with expansions of safety net programs could better meet the needs these parents.

Associations of the Neighborhood Built Environment with Gestational Weight Gain

OBJECTIVE

This study aimed to determine whether specific factors of the built environment related to physical activity and diet are associated with inadequate and excessive gestational weight gain (GWG).

STUDY DESIGN

This analysis is based on data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be, a prospective cohort of nulliparous women who were followed from the beginning of their pregnancies through delivery. At each study visit, home addresses were recorded and geocoded. Locations were linked to several built-environment characteristics such as the census tract National Walkability Score (the 2010 Walkability Index) and the number of gyms, parks, and grocery stores within a 3-km radius of residential address. The primary outcome of GWG (calculated as the difference between prepregnancy weight and weight at delivery) was categorized as inadequate, appropriate, or excessive based on weight gained per week of gestation. Multinomial regression (generalized logit) models evaluated the relationship between each factor in the built environment and excessive or inadequate GWG.

RESULTS

Of the 8,182 women in the analytic sample, 5,819 (71.1%) had excessive GWG, 1,426 (17.4%) had appropriate GWG, and 937 (11.5%) had inadequate GWG. For the majority of variables examined, built environments more conducive to physical activity and healthful food availability were associated with a lower odds of excessive or inadequate GWG category. For example, a higher number of gyms or parks within 3 km of a participant's residential address was associated with lower odds of having excessive (gyms: adjusted odds ratio [aOR] = 0.93 [0.89-0.96], parks: 0.94 [0.90-0.98]) or inadequate GWG (gyms: 0.91 [0.86-0.96]; parks: 0.91 [0.86-0.97]). Similarly, a higher number of grocery stores was associated with lower odds of having excessive GWG (0.94 [0.91-0.97]).

CONCLUSION

Among a diverse population of nulliparous women, multiple aspects of the built environment are associated with excessive and inadequate GWG.

KEY POINTS

· There are little data on the association between the built environment and pregnancy outcomes.. · Multiple aspects of the built environment are associated with excessive and inadequate GWG.. · These results suggest the role that neighborhood investment may play in improving pregnancy outcomes..

Cross-sectional and prospective associations between household socioeconomic resources, appetite traits, and body size among Samoan infants

In high-income countries, household socioeconomic resources (as measured by education, occupation, income, and/or household assets) and childhood obesity risk tend to be negatively associated. This association may arise in part because children from households with fewer resources are exposed to obesogenic environments that shape appetite trait development. In contrast, many low- and middle-income countries (LMICs) exhibit a positive association between socioeconomic resources and child body size. There is less evidence from LMIC settings about when during development this association emerges and whether appetite traits play a mediatory role. To explore these questions, we examined cross-sectional and longitudinal associations between socioeconomic resources, appetite traits, and body size among infants in Samoa, an LMIC in Oceania. Data were from the Foafoaga O le Ola prospective birth cohort of 160 mother-infant dyads. Appetite traits were characterized using the Baby and Child Eating Behavior Questionnaires and household socioeconomic resources were quantified using an asset-based measure. While infant body size and household socioeconomic resources were positively associated in both cross-sectional and prospective analyses, we found no evidence that appetite traits mediate this relationship. These results suggest that other aspects of the food environment, such as food security and feeding style, may explain the positive association between socioeconomic resources and body size observed in many LMICs.

Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study

OBJECTIVE

To assess inequities in mortality by race and sex for eight common surgical procedures (elective and non-elective) across specialties in the United States.

DESIGN

Retrospective cohort study.

SETTING

US, 2016-18.

PARTICIPANTS

1 868 036 Black and White Medicare beneficiaries aged 65-99 years undergoing one of eight common surgeries: repair of abdominal aortic aneurysm, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection.

MAIN OUTCOME MEASURE

The main outcome measure was 30 day mortality, defined as death during hospital admission or within 30 days of the surgical procedure.

RESULTS

Postoperative mortality overall was higher in Black men (1698 deaths, adjusted mortality rate 3.05%, 95% confidence interval 2.85% to 3.24%) compared with White men (21 833 deaths, 2.69%, 2.65% to 2.73%), White women (21 847 deaths, 2.38%, 2.35% to 2.41%), and Black women (1631 deaths, 2.18%, 2.04% to 2.31%), after adjusting for potential confounders. A similar pattern was found for elective surgeries, with Black men showing a higher adjusted mortality (393 deaths, 1.30%, 1.14% to 1.46%) compared with White men (5650 deaths, 0.85%, 0.83% to 0.88%), White women (4615 deaths, 0.82%, 0.80% to 0.84%), and Black women (359 deaths, 0.79%, 0.70% to 0.88%). This 0.45 percentage point difference implies that mortality after elective procedures was 50% higher in Black men compared with White men. For non-elective surgeries, however, mortality did not differ between Black men and White men (1305 deaths, 6.69%, 6.26% to 7.11%; and 16 183 deaths, 7.03%, 6.92% to 7.14%, respectively), although mortality was lower for White women and Black women (17 232 deaths, 6.12%, 6.02% to 6.21%; and 1272 deaths, 5.29%, 4.93% to 5.64%, respectively). These differences in mortality appeared within seven days after surgery and persisted for up to 60 days after surgery.

CONCLUSIONS

Postoperative mortality overall was higher among Black men compared with White men, White women, and Black women. These findings highlight the need to understand better the unique challenges Black men who require surgery face.

COVID-19 Spotlights Connections between Disease and Multiple Lifestyle Factors

The SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2), and the disease it causes (COVID-19), have had a profound impact on global human society and threaten to continue to have such an impact with newly emerging variants. Because of the widespread effects of SARS-CoV-2, understanding how lifestyle choices impact the severity of disease is imperative. This review summarizes evidence for an involvement of chronic, non-resolving inflammation, gut microbiome disruption (dysbiosis with loss of beneficial microorganisms), and impaired viral defenses, all of which are associated with an imbalanced lifestyle, in severe disease manifestations and post-acute sequelae of SARS-CoV-2 (PASC). Humans' physiological propensity for uncontrolled inflammation and severe COVID-19 are briefly contrasted with bats' low propensity for inflammation and their resistance to viral disease. This insight is used to identify positive lifestyle factors with the potential to act in synergy for restoring balance to the immune response and gut microbiome, and thereby protect individuals against severe COVID-19 and PASC. It is proposed that clinicians should consider recommending lifestyle factors, such as stress management, balanced nutrition and physical activity, as preventative measures against severe viral disease and PASC.

Socioeconomic and Demographic Factors Associated with the Influence of the Food Traffic Light Labeling on the Decision of the Adult Population of Ecuador to Purchase Processed Foods, 2018

To determine the socioeconomic and demographic factors associated with the influence of the nutritional traffic light (NTL) on the decision to purchase processed foods using information from the National Health and Nutrition Survey (ENSANUT) 2018 of Ecuador, a cross-sectional and analytical study based on a secondary analysis of the information from the ENSANUT 2018 was performed. We collected data from 25,932 participants 18 years of age or older who knew or had seen the NTL, and for whom complete information on the variables of interest for the study was available. The "Influence of the NTL on the purchase decision of processed foods" was the outcome variable of the study. Generalized linear models of the Poisson family, with log link, were used to assess the association between socioeconomic factors and outcome, using crude (PR) and adjusted (aPR) prevalence ratios, with 95% confidence intervals (CI) and a p-value < 0.05. Participants who understood the NTL (aPR: 2.49; 95% CI: 2.19-2.83), with a higher educational level (aPR: 1.33; 95% CI: 1.09-1.61), women (aPR 1.06; 95% CI: 1.01-1.10), and who had a partner (aPR 1.09; 95% CI: 1.04-1.14) were more likely to be influenced by the NTL when deciding to purchase processed foods, compared to people who did not understand the NTL, who had no educational level or who only attended a literacy center, were men, and those without a partner. The inhabitants of the coastal region (aPR: 0.92; 95% CI: 0.88-0.97), the Amazon (aPR 0.93; 95% CI: 0.88-0.98), and the insular region (aPR 0.76; 95% CI: 0.68-0.84) had few probabilities of being influenced by the NTL in the decision to purchase processed foods, in comparison with the residents of the highlands. Similarly, compared to non-poor people, poor people had a lower probability of being influenced by the NTL (aPR 0.89; 95% CI: 0.82-0.97). Factors associated with the influence of NTL on the decision to purchase processed foods were identified. It is recommended to reformulate and focus awareness strategies for using the NTL to purchase processed foods by taking into account the associated factors.

Food and Physical Activity Environment in the US-Affiliated Pacific Region: The Children's Healthy Living Program

OBJECTIVE

To describe the quality of food and physical activity (PA) environments by World Bank Income level in jurisdictions from the Children's Healthy Living Program.

DESIGN

Baseline cross-sectional community data were analyzed from 11 jurisdictions categorized by World Bank Income levels to describe exposure to different food and PA outlets. The Children's Healthy Living Program was a multilevel, multijurisdictional prevalence study and community intervention trial that reduced child obesity in the US-Affiliated Pacific region.

SETTING

US-Affiliated Pacific region.

PARTICIPANTS

Food (n = 426) and PA (n = 552) Outlets.

MAIN OUTCOME MEASURES

Physical activity and food scores that reflect the quality of the outlets that support being physically active and healthy eating options, respectively.

ANALYSIS

Descriptive statistics are presented as means ± SD or percentages.

RESULTS

High-income-income level jurisdictions had higher food and PA scores than middle-income level jurisdictions.

CONCLUSIONS AND IMPLICATIONS

The US-Affiliated Pacific region has limited quality food and PA outlets in underserved communities at risk for obesity. The findings in this paper can be used to develop tools and design interventions to improve the food and PA environment to increase a healthier, active lifestyle.

Association of Perceived Neighborhood Health With Hypertension Self-care

Importance

Hypertension self-management is recommended for optimal blood pressure (BP) control, but self-identified residential contextual factors that hinder hypertension self-care are understudied.

Objective

To quantify perceived neighborhood health and hypertension self-care and assess interactions with the area deprivation index (ADI) and healthy food availability at home.

Design, Setting, and Participants

A cross-sectional study was conducted in Baltimore, Maryland, including primary care adults enrolled in the Achieving Blood Pressure Control Together trial between September 1, 2013, and June 30, 2014. Participants were Black and had at least 2 BP readings greater than or equal to 140/90 mm Hg in the 6 months before enrollment. Analyses were conducted from August 5, 2021, to January 28, 2022.

Exposures

Participants' perceived neighborhood health, defined as the mean standardized score across 4 subdomains of aesthetic quality, walkability, safety, and violence, with a higher score signifying better neighborhood health.

Main Outcomes and Measures

Hypertension self-care behavior and self-efficacy. Multivariable generalized linear models were fit regressing each outcome on perceived neighborhood health (higher scores on each domain signify better perceived neighborhood health), adjusted for confounders, and interaction terms between neighborhood health and potential modifiers (ADI [higher percentiles correspond to more deprivation] and healthy food availability [higher scores indicate greater availability]) of the primary association were included.

Results

Among 159 participants (median [IQR] age, 57 [49-64] years; mean [SD] age, 57 (11) years; 117 women [74%]), median (IQR) hypertension self-care behavior was 50 (45-56) and self-efficacy was 64 (57-72). Better perceived neighborhood health was associated with greater hypertension self-care behavior (β, 2.48; 95% CI, 0.63-4.33) and self-efficacy (β, 4.42; 95% CI, 2.25-6.59); these associations persisted for all neighborhood health subdomains except aesthetic quality. There were no statistically significant interactions between perceived neighborhood health or its subdomains with ADI on self-care behavior (P = .74 for interaction) or self-efficacy (P = .85 for interaction). However, better perceived neighborhood aesthetic quality had associations with greater self-care behavior specifically at higher healthy food availability at home scores: β at -1 SD, -0.29; 95% CI, -2.89 to 2.30 vs β at 1 SD, 2.97; 95% CI, 0.46-5.47; P = .09 for interaction). Likewise, associations of perceived worse neighborhood violence with lower self-care behavior were attenuated at higher healthy food availability at home scores (β for -1 SD, 3.69; 95% CI, 1.31-6.08 vs β for 1 SD, 0.01; 95% CI, -2.53 to 2.54; P = .04 for interaction).

Conclusions and Relevance

In this cross-sectional study, better perceived neighborhood health was associated with greater hypertension self-care among Black individuals with hypertension, particularly among those with greater in-home food availability. Thus, optimizing hypertension self-management may require multifaceted interventions targeting both the patients' perceived contextual neighborhood barriers to self-care and availability of healthy food resources in the home.

Do neighbourhood traffic-related air pollution and socio-economic status moderate the associations of the neighbourhood physical environment with cognitive function? Findings from the AusDiab study

Characteristics of the neighbourhood environment, including the built and natural environment, area-level socio-economic status (SES) and air pollution, have been linked to cognitive health. However, most studies have focused on single neighbourhood characteristics and have not considered the extent to which the effects of environmental factors may interact. We examined the associations of measures of the neighbourhood built and natural environment, area-level SES and traffic-related air pollution (TRAP) with two cognitive function domains (memory and processing speed), and the extent to which area-level SES and TRAP moderated the associations. We used cross-sectional data from the AusDiab3 study, an Australian cohort study of adults (mean age: 61 years) in 2011-12 (N = 4141) for which geocoded residential addresses were available. Spatial data were used to create composite indices of built environment complexity (population density, intersection density, non-commercial land use mix, commercial land use) and natural environment (parkland and blue spaces). Area-level SES was obtained from national census indices and TRAP was based on estimates of annual average levels of nitrogen dioxide (NO2). Confounder-adjusted generalised additive mixed models were used to estimate the independent associations of the environmental measures with cognitive function and the moderating effects of area-level SES and TRAP. The positive associations between built environment complexity and memory were stronger in those living in areas with higher SES and lower NO2 concentrations. A positive association between the natural environment and memory was found only in those living in areas with lower NO2 concentrations and average or below-average SES. Built environment complexity and the natural environment were positively related to processing speed. Complex urban environments and access to nature may benefit cognitive health in ageing populations. For higher-order cognitive abilities, such as memory, these positive effects may be stronger in areas with lower levels of TRAP.

Adapting a cooking, food budgeting and nutrition intervention for a rural community of American Indians with type 2 diabetes in the North-Central United States

American Indian (AI) communities experience persistent diabetes-related disparities, yet few nutrition interventions are designed for AI with type 2 diabetes or address socio-contextual barriers to healthy eating. We describe our process of adapting the evidence-based Cooking Matters® program for use by AI adults with type 2 diabetes in a rural and resource-limited setting in the North-Central United States. We conducted three focus groups with AI adults with diabetes to (i) identify Cooking Matters® adaptations and (ii) gather feedback on appropriateness of the adapted intervention using Barrera and Castro's cultural adaptation framework. Transcripts were coded using an inductive, constant comparison approach. Queries of codes were reviewed to identify themes. Contextual considerations included limited access to grocery stores and transportation barriers, reliance on government food assistance and the intergenerational burden of diabetes. Adaptations to content and delivery included incorporating traditional and locally available foods; appealing to children or others in multigenerational households and prioritizing visual over written content. Our use of Barrera and Castro's framework adds rigor and structure to the cultural adaptation process and increases the likelihood of future intervention success. Other researchers may benefit from using this framework to guide the adaptation of evidence-based interventions in AI communities.

Dietary interventions, the gut microbiome, and aggressive behavior: Review of research evidence and potential next steps

Research in biosocial criminology and other related disciplines has established links between nutrition and aggressive behavior. In addition to observational studies, randomized trials of nutritional supplements like vitamins, omega-3 fatty acids, and folic acid provide evidence of the dietary impact on aggression. However, the exact mechanism of the diet-aggression link is not well understood. The current article proposes that the gut microbiome plays an important role in the process, with the microbiota-gut-brain axis serving as such a mediating mechanism between diet and behavior. Based on animal and human studies, this review synthesizes a wide array of research across several academic fields: from the effects of dietary interventions on aggression, to the results of microbiota transplantation on socioemotional and behavioral outcomes, to the connections between early adversity, stress, microbiome, and aggression. Possibilities for integrating the microbiotic perspective with the more traditional, sociologically oriented theories in criminology are discussed, using social disorganization and self-control theories as examples. To extend the existing lines of research further, the article considers harnessing the experimental potential of noninvasive and low-cost dietary interventions to help establish the causal impact of the gut microbiome on aggressive behavior, while adhering to the high ethical standards and modern research requirements. Implications of this research for criminal justice policy and practice are essential: not only can it help determine whether the improved gut microbiome functioning moderates aggressive and violent behavior but also provide ways to prevent and reduce such behavior, alone or in combination with other crime prevention programs.

Fruit and Vegetable Shopping Behavior and Intake among Low-Income Minority Households with Elementary-Aged Children

Low-income children and families do not meet the recommendations for fruit and vegetable (FV) intake. This study aimed to assess the association between FV shopping behavior and child FV intake through a cross-sectional study design analyzing self-reported surveys (n = 6074) from adult-child dyads of Hispanic/Latino and African American participants enrolled in the Brighter Bites co-op program. Through quantitative mixed effects linear regression models, accounting for school-level clustering and adjusting for covariates, child FV intake was positively associated with shopping for FV at large chain grocery stores (p < 0.001), natural/organic supermarkets (p < 0.001), warehouse club stores (p = 0.002), discount superstores (p < 0.001), small local stores/corner stores (p = 0.038), convenience stores (p = 0.022), ethnic markets (p = 0.002), farmers’ markets/co-op/school farm stands (p < 0.001), and gardens (p = 0.009) among Hispanic/Latinos participants. Among African American participants, there was significant positive association between child FV intake and shopping for FV at natural/organic supermarkets (p < 0.001), discount superstores (p = 0.005), and convenience stores (p = 0.031). The relationship between location and frequency of shopping for FV and child FV intake varied between races. Further research is needed to better understand the influence of cultural and physical environmental factors. Nutrition education programs are vital to encouraging families to make healthier food choices and purchases to improve child FV consumption.

Association between Neighbourhood Deprivation Trajectories and Self-Perceived Health: Analysis of a Linked Survey and Health Administrative Data

Life course exposure to neighbourhood deprivation may have a previously unstudied relationship with health disparities. This study examined the association between neighbourhood deprivation trajectories (NDTs) and poor reported self-perceived health (SPH) among Quebec's adult population. Data of 45,990 adults with complete residential address histories from the Care-Trajectories-Enriched Data cohort, which links Canadian Community Health Survey respondents to health administrative data, were used. Accordingly, participants were categorised into nine NDTs (T1 (Privileged Stable)-T9 (Deprived Stable)). Using multivariate logistic regression, the association between trajectory groups and poor SPH was estimated. Of the participants, 10.3% (95% confidence interval [CI]: 9.9-10.8) had poor SPH status. This proportion varied considerably across NDTs: From 6.4% (95% CI: 5.7-7.2) for Privileged Stable (most advantaged) to 16.4% (95% CI: 15.0-17.8) for Deprived Stable (most disadvantaged) trajectories. After adjustment, the likelihood of reporting poor SPH was significantly higher among participants assigned to a Deprived Upward (odds ratio [OR]: 1.77; 95% CI: 1.48-2.12), Average Downward (OR: 1.75; CI: 1.08-2.84) or Deprived trajectory (OR: 1.81; CI: 1.45-2.86), compared to the Privileged trajectory. Long-term exposure to neighbourhood deprivation may be a risk factor for poor SPH. Thus, NDT measures should be considered when selecting a target population for public-health-related interventions.

Assessment of Doubly Disadvantaged Neighborhoods by Healthy Living Environment Exposure

Good access to greenspace and healthy food has commonly been found to be positively associated with health outcomes, despite some studies finding no significant relationship between them. Examining inequalities in accessing greenspace and healthy food among different disadvantaged neighborhoods can help reveal the disadvantaged races/ethnicities in cities with a high level of residential segregation (i.e., population of the same race/ethnicity concentrated in the same neighborhoods). However, existing studies have mostly focused on measuring the inequalities in accessing either greenspace or healthy food alone, which can lead to the inaccurate depiction of disadvantaged neighborhoods in healthy living environments. Therefore, this paper aims at improving the assessment of doubly disadvantaged neighborhoods by considering accessibility to both greenspace and healthy food in the City of Chicago. Our results show that black-majority neighborhoods are the most doubly disadvantaged in terms of exposure to healthy living environments. This study can help guide policymakers to divert more resources towards the improvement of the urban environment for the most doubly disadvantaged neighborhoods.

Associations of Cumulative and Point-in-Time Neighborhood Poverty and Walkability with Body Mass from Age 30 to 39

Few studies examining the effects of neighborhood exposures have accounted for longitudinal residential history. This study examined associations of body mass index (BMI, kg/m2) with neighborhood-level walkability and poverty, both assessed concurrently and cumulatively in the years leading up to BMI assessment. Participants (N = 808) were from a cohort study of individuals originally recruited from public schools in Seattle, Washington, in fifth grade in 1985. Height and weight for BMI were obtained at four assessments at ages: 30 (in 2005), 33, 35, and 39. Participants also completed residential timelines listing each address where they lived from ages 28 to 39, creating a continuous record of addresses and moves. Neighborhood-level walkability and poverty were based on census block groups of each address. Generalized estimating equation models estimated associations of standardized neighborhood variables, both at point-in-time concurrently with assessment of BMI and cumulatively up to the time of BMI assessment. Mean BMI across observations was 28.8 (SD = 7.1). After adjusting for covariates, cumulative walkability was associated with lower BMI (b =  - 0.28; 95% CI: - 0.55, - 0.02), and cumulative neighborhood poverty was associated with higher BMI (b = 0.35; 95% CI: 0.09, 0.60). When examining point-in-time concurrent walkability and poverty with BMI, adjusted associations were close to the null and non-significant. This study provides evidence for a significant role of cumulative exposure to neighborhood built and socioeconomic environments predicting BMI. It underscores the relative strength and importance of cumulative assessments to capture neighborhood exposure not captured through point-in-time assessments.

The Weight of Place: Built Environment Correlates of Obesity and Diabetes

In recent decades, the prevalence of obesity and diabetes has risen substantially in North America and worldwide. To address these dual epidemics, researchers and policymakers alike have been searching for effective means to promote healthy lifestyles at a population level. As a consequence, there has been a proliferation of research examining how the "built" environment in which we live influences physical activity levels, by promoting active forms of transportation, such as walking and cycling, over passive ones, such as car use. Shifting the transportation choices of local residents may mean that more members of the population can participate in physical activity during their daily routine without structured exercise programs. Increasingly, this line of research has considered the downstream metabolic consequences of the environment in which we live, raising the possibility that "healthier" community designs could help mitigate the rise in obesity and diabetes prevalence. This review discusses the evidence examining the relationship between the built environment, physical activity, and obesity-related diseases. We also consider how other environmental factors may interact with the built environment to influence metabolic health, highlighting challenges in understanding causal relationships in this area of research.

Systematic realist synthesis of health-related and lifestyle interventions designed to decrease overweight, obesity and unemployment in adults

Background

Obesity and unemployment are complex social and health issues with underlying causes that are interconnected. While a clear link has been established, there is lack of evidence on the underlying causal pathways and how health-related interventions could reduce obesity and unemployment using a holistic approach.

Objectives

The aim of this realist synthesis was to identify the common strategies used by health-related interventions to reduce obesity, overweight and unemployment and to determine for whom and under what circumstances these interventions were successful or unsuccessful and why.

Methods

A realist synthesis approach was used. Systematic literature searches were conducted in Cochrane library, Medline, SocIndex, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PsychInfo. The evidence from included studies were synthesised into Context-Mechanism-Outcome configurations (CMOcs) to better understand when and how programmes work, for which participants and to refine the final programme theory.

Results

A total of 83 articles met the inclusion criteria. 8 CMOcs elucidating the contexts of the health-related interventions, underlying mechanisms and outcomes were identified. Interventions that were tailored to the target population using multiple strategies, addressing different aspects of individual and external environments led to positive outcomes for reemployment and reduction of obesity.

Conclusion

This realist synthesis presents a broad array of contexts, mechanisms underlying the success of health-related interventions to reduce obesity and unemployment. It provides novel insights and key factors that influence the success of such interventions and highlights a need for participatory and holistic approaches to maximise the effectiveness of programmes designed to reduce obesity and unemployment.

Trial registration

PROSPERO 2020 CRD42020219897.

Essential Business Visits and Social Vulnerability during New York City's Initial COVID-19 Outbreak

New York City (NYC) was deeply impacted by COVID-19 in spring 2020, with thousands of new cases daily. However, the pandemic's effects were not evenly distributed across the city, and the specific contributors have not yet been systematically considered. To help investigate that topic, this study analyzed the interaction of people with neighborhood businesses and other points of interest (POIs) in parts of three NYC neighborhoods in the spring of 2020 during the peak of the first COVID-19 wave through anonymized cellphone data and direct the observation of 1313 individuals leaving healthcare facilities. This study considered social vulnerability index (SVI) levels, population density, and POI visit behaviors from both cellphone data and firsthand observations of behavior around select NYC health facilities in different boroughs as various proxies. By considering equivalent businesses or groups of businesses by neighborhood, POI visits better aligned with COVID-19 infection levels than SVI. If tracking POI visit levels proves a reliable direct or relative proxy for disease transmission when checked against larger datasets, this method could be critical in both predictions of future outbreaks and the setting of customer density limits.

Differential Associations Between Changes in Food Environment and Changes in BMI Among Adults Living in Urban, Low-Income Communities

BACKGROUND

Food environments can contribute to excess weight gain among adults, but the evidence is mixed.

OBJECTIVES

This longitudinal study investigated the associations between changes in the food environment and changes in BMI in adults and whether changes in the food environment differentially impact various subgroups.

METHODS

At 2 time points, BMI was calculated using self-reported height and weight data from 517 adults (mean age, 41 years) living in 4 New Jersey cities. The counts of different types of food outlets within 0.4, 0.8, and 1.6 km of respondents' residences were collected at baseline and tracked until follow-up. A binary measure of social standing (social-advantage group, n = 219; social-disadvantage group, n = 298) was created through a latent class analysis using social, economic, and demographic variables. Multivariable linear regression modeled the associations between changes in BMI with measures of the food environment; additionally, interaction terms between the measures of food environment and social standing were examined.

RESULTS

Overall, over 18 months, an increase in the number of small grocery stores within 0.4 km of a respondent's residence was associated with a decrease in BMI (β = -1.0; 95% CI: -1.9, -0.1; P = 0.024), while an increase in the number of fast-food restaurants within 1.6 km was associated with an increase in BMI (β = 0.1; 95% CI: 0.01, 0.2; P = 0.027). These overall findings, however, masked some group-specific associations. Interaction analyses suggested that associations between changes in the food environment and changes in BMI varied by social standing. For instance, the association between changes in fast-food restaurants and changes in BMI was only observed in the social-disadvantage group (β = 0.1; 95% CI: 0.02, 0.2; P = 0.021).

CONCLUSIONS

In a sample of adults living in New Jersey, changes in the food environment had differential effects on individuals' BMIs, based on their social standing.

Who Likes Unhealthy Food with a Strong Flavour? Influence of Sex, Age, Body Mass Index, Smoking and Olfactory Efficiency on Junk Food Preferences

Background. Unhealthy food is an important element in the development of diseases of civilisation. The aim of this study was to determine how sex, age, body mass index, smoking and olfactory efficiency influence the consumption of such foods. Methods. A total of 283 people living in the Silesian Voivodeship in Poland took part in the study. They were aged 18−82. An interview and olfactory tests were conducted together with assessments of food preferences from 25 types of food products. The extent to which sex, age, body mass index, tobacco addiction and sense of smell influence unhealthy food consumption was assessed. Results. Using the VARIMAX factor analysis, a coherent group of ‘unhealthy food with a strong flavour’ products was selected: crisps, salty snacks, fast food, sugary carbonated drinks and sour products. Unhealthy food was liked more by people who were younger (B = −0.04; PU = −0.05, −0.03; t = −7.43, eta2 = 0.17; p < 0.001) and who had a higher BMI (B = 0.03; PU ≤ 0.01, 0.06; t = 1.92, eta2 = 0.01; p = 0.056). The efficiency of the sense of smell does not play a significant role in the preference for the ‘unhealthy food’ group as a whole. The analysis of each type of unhealthy food separately showed that young people liked crisps, salty snacks, fast food and sugary carbonated drinks more, men liked fast food and sugary carbonated drinks more than women, and people with a good sense of smell liked sour products. Conclusion. According to the food preferences stated, dietary education should be targeted at young people, especially young men, to prevent the development of overweight and obesity.

Nutrition Risk is Associated With Falls Risk in an Observational Study of Community-Dwelling, Rural, Older Adults

OBJECTIVES

Poor nutritional status is a risk factor for falls and impedes recovery from falls in older adults. The primary objective of this study was to investigate the relationship between nutrition status and fall risk over time in a cohort of older adults.

METHODS

Using an observational analytic study design, we collected demographic, fall risk, nutrition risk, food insecurity, and incident falls data from community-dwelling older Vermonters.

RESULTS

Data from 708 participants (70.3 years ± 6.6; 82% female) indicate a significant association between fall risk and nutrition risk (p < 0.001), fall risk and food insecurity (p < 0.001), and food insecurity and nutrition risk (p < 0.001). After adjusting for potential confounders, elevated nutrition risk was significantly associated with an incident fall over the next 6 months (p < 0.05).

CONCLUSION

Given the evidence for an association between nutrition status and falls, additional research, in a more diverse population, is needed to understand the nuances of these relationships.

Obesity in Adolescents: Understanding the Combined Role of Food Security and Emotional and Behavioral Disorders

PURPOSE

To examine the associations and interactions between levels of food security and emotional and behavioral disorders with obesity in adolescents.

METHODS

Multiple logistic regression modeling was used to analyze the association of adolescent obesity with levels of food security and emotional and behavior disorders in children aged 12-17 years using data from National Health Interview Survey 2016-2018 combined years. Presence of emotional and behavioral disorders within food security categories was added to logistic regression modeling to examine interactions.

RESULTS

When added individually to multiple logistic regression models, marginal and low food security, Attention Deficit Hyperactivity Disorder (ADHD) and anxiety were associated with increased odds of obesity, but very low food security and depression were not. Within the group of adolescents with very low food security, those with anxiety, depression, or ADHD had a nearly two to three-fold increase in odds of obesity compared to adolescents with very low food security and no emotional and behavioral disorders. A similar increase in the odds of obesity with the presence of anxiety, depression, or ADHD was not seen in the adolescents with high food security.

DISCUSSION

This study finds a significant interaction between food security level and emotional and behavioral disorders. The distinction that very low food security in adolescents is only associated with obesity when either anxiety, depression or ADHD are present, but not independently, is an important contribution to understanding complex interactions contributing to obesity.

Current and Future Food Insufficiency During Covid-19: Examining Disparities by Race/Ethnicity and Recent Work Loss

The Covid-19 pandemic, which began in early 2020, has eroded the previous decade's reductions in food insecurity. Pandemic-related food insufficiency has been concentrated among Black and Hispanic households and those who have experienced a recent work loss. Households with children are particularly vulnerable. Using the first twenty-one weeks of the US Census Bureau's Household Pulse Survey data from April 2020 through December of 2020, we examine the association between recent work losses and food insufficiency and document the extent to which the impact varies by race/ethnicity. Work loss is predictive of current and future food insufficiency, with the association most acutely experienced by Blacks and Hispanics and households with children. There is evidence of racial/ethnic disparities in current and future food insufficiency. The results provide insight into how the pandemic has widened racial/ethnic gaps in the experience of food insufficiency despite recent policy interventions.

Association of Food Insecurity and Food Addiction Symptoms: A Secondary Analysis of Two Samples of Low-Income Female Adults

BACKGROUND

Household food insecurity persists in the United States and has important implications for health and well-being. Food insecurity in female-identified caregivers is particularly concerning, given its association with their mental health and adverse health outcomes for their children. Food insecurity is associated with disordered eating but, to our knowledge, no prior studies have examined an association between food insecurity and food addiction.

OBJECTIVE

Our aim was to examine whether food insecurity is associated with higher food addiction symptom endorsement in low-income female adults.

DESIGN

Secondary analysis of baseline data from a quasi-experimental study of a mindfulness-based intervention on gestational weight gain among low-income pregnant individuals and an observational study of low-income families.

PARTICIPANTS/SETTING

Participants in study 1 (n = 208) were English-speaking, low-income pregnant individuals with overweight or obesity, recruited in California from 2011 to 2013. Participants in study 2 (n = 181) were English-speaking, low-income female caregivers for children aged 8 through 10 years, recruited in Michigan from 2018 to 2019. Both studies recruited participants from community health clinics, social service agencies, and online advertisements.

MAIN OUTCOME MEASURES

The primary outcome measure was food addiction symptoms, assessed by the Yale Food Addiction Scale.

STATISTICAL ANALYSIS

Multivariate Poisson regression was used to examine the association between household food insecurity and food addiction symptoms in each sample, adjusted for sociodemographic characteristics.

RESULTS

In study 1, pregnant individuals in food-insecure households reported 21% higher food addiction symptoms than pregnant individuals in food-secure households (incidence rate ratio 1.21; 95% CI 1.00 to 1.47; P = .047). In study 2, caregivers in food-insecure households had 56% higher food addiction symptoms than caregivers in food-secure households (incidence rate ratio 1.56; 95% CI 1.01 to 2.40; P = .045).

CONCLUSIONS

These findings provide preliminary support for a relationship between household food insecurity and food addiction. Future research should examine potential mechanisms and whether interventions to reduce food insecurity lower risk of food addiction.

Neighborhood conditions and birth outcomes: Understanding the role of perceived and extrinsic measures of neighborhood quality

Living in a disadvantaged neighborhood has been associated with adverse birth outcomes. Most prior studies have conceptualized neighborhoods using census boundaries and few have examined the role of neighborhood perceptions, which may better capture the neighborhood environment. In the present study, we examined associations between extrinsic and perceived neighborhood quality measures and adverse birth outcomes.

Methods

Participants resided in the San Francisco Bay Area of California and were enrolled in Chemicals in Our Bodies, a prospective birth cohort (N = 817). The Index of Concentration at the Extremes (ICE) for income, Area Deprivation Index (ADI), and the Urban Displacement Project's measure of gentrification were included as census block group-level extrinsic neighborhood quality measures. Poor perceived neighborhood quality was assessed using an interview questionnaire. Linear regression models were utilized to examine associations between extrinsic and perceived neighborhood quality measures, and gestational age and birthweight for gestational age z-scores. Covariates in adjusted models were chosen via a directed acyclic graph (DAG) and included maternal age, education, and marital status.

Results

In adjusted models, having poor perceived neighborhood quality was associated with higher birthweight z-scores, relative to those who did not perceive their neighborhood as poor quality (β = 0.21, 95% confidence intervals = 0.01, 0.42). Relative to the least disadvantaged tertile, the upper tertile of the ADI was associated with a modest reduction in gestational age (β = -0.35, 95% confidence intervals = -0.67, -0.02).

Conclusions

In the Chemicals in Our Bodies study population, extrinsic and perceived neighborhood quality measures were inconsistently associated with adverse birth outcomes.

Food insecurity, food environments, and disparities in diet quality and obesity in a nationally representative sample of community-dwelling older Americans

Food insecurity, reflecting a household's low ability to purchase healthy food, is a public health concern that is associated with poor diet and obesity. Poor food environments, characterized as a neighborhood with low access to healthy, affordable food, may amplify the negative impact of food insecurity on diet and obesity. This study aims to investigate whether food insecurity and food environments are jointly associated with an increased risk of poor diet quality and obesity. We used data from a nationally representative sample of community-dwelling older adults in the Health and Retirement Study Health Care and Nutrition Survey and the National Neighborhood Data Archive to investigate the role of household and neighborhood characteristics on diet and obesity. Weighted regression models were estimated to examine the relationship between food insecurity and food environments as well as their interaction with diet quality and obesity. Food insecure respondents had lower Healthy Eating Index scores and were more likely to be obese than food secure respondents. Living in a poor food environment was associated with lower Healthy Eating Index scores, but not with obesity. We did not find any interaction between food insecurity and food environment in determining either healthy eating or obesity. Reducing food insecurity and increasing access to healthy food environments may encourage healthier eating among older adults, while alleviating food-related hardship may also reduce their obesity risk.

Association Between Family/Neighborhood Cancer Risk Factors and Adolescent Dietary Behaviors: A Parent-Adolescent Dyadic Analysis

Objective. This cross-sectional study examined associations between adolescent dietary behaviors and family/home environments with parent-adolescent dyadic analysis. Methods. Secondary data were analyzed for adolescents and their parents who participated in the 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Relationships between adolescent and parent intake of convenience/fast-food, fruits/vegetables, and sugar, as well as family/community and mealtime environments, were examined using Pearson's correlations, 2-sample t tests, analysis of variance, and general linear model analyses. Results. Among this nationwide parent-adolescent dyad sample (N = 1890), a moderate relationship between parent and adolescent consumption of convenience/fast-foods (r = 0.426) and fruits/vegetables (r = 0.416) was found. Adolescent convenience/fast-foods intake differed by sex, neighborhood socioeconomic status, meals eaten with family, and meals eaten in front of the TV (P < .001 for all) as well as race/ethnicity (P = .004). Adolescent fruit/vegetable intake differed by home location (P = .029), school location (P = .032), meals eaten together with family, meals eaten in front of the TV, and body mass index category (P < .001 for all). Generalized linear models revealed multiple predictors of adolescent dietary behaviors. Conclusion. Findings suggest dynamic relationships between adolescent and parent dietary cancer risk factors and adolescent fruit/vegetable consumption disparities by multiple environmental factors. Interventions targeting adolescent-parent dyads may help reduce cancer risk associated with diet.

Supporting wellness at pantries (SWAP) nutrition stoplight system aids rural food pantry clients living with chronic disease in selecting nutritious options

OBJECTIVES

Chronic disease accounts for 70% of U.S. deaths, with suboptimal nutrition an important, preventable risk factor. Food insecurity is a contributor to poor nutrition. Food pantries are a regular source of groceries for the food insecure and an ideal place for nutrition literacy programs. Supporting Wellness at Pantries (SWAP) is a stoplight nutrition ranking system based on 2015-2020 Dietary Guidelines, but has only been implemented in urban areas. Rural communities experience higher rates of poor health and food insecurity.

METHODS

This study implements SWAP at a food pantry in a rural community with high rates of food insecurity and chronic disease. Food was sorted into "green," "yellow," and "red" items on color-coded shelves, with green foods the most accessible, and signage explaining the sorting was displayed. Surveys measured whether clients found SWAP helpful in choosing nutritious foods, particularly for households with chronic diseases.

RESULTS

Clients reported that it was significantly (p <.0001) easier to choose items low in salt, sugar, and fat. The benefits of SWAP extended outside the pantry by increasing confidence in choosing nutritious foods while grocery shopping.

DISCUSSION

SWAP can be an effective tool for improving nutrition literacy among food insecure rural residents with chronic illnesses.

Enhancing the Retail Food Environment Index (RFEI) with Neighborhood Commuting Patterns: A Hybrid Human-Environment Measure

The Retail Food Environment Index (RFEI) and its variants have been widely used in public health to measure people's accessibility to healthy food. These indices are purely environmental as they only concern the geographic distribution of food retailers, but fail to include human factors, such as demographics, socio-economy, and mobility, which also shape the food environment. The exclusion of human factors limits the explanatory power of RFEIs in identifying neighborhoods of the greatest concern. In this study, we first proposed a hybrid approach to integrate human and environmental factors into the RFEI. We then demonstrated this approach by incorporating neighborhood commuting patterns into a traditional RFEI: we devised a multi-origin RFEI (MO_RFEI) that allows people to access food from both homes and workplaces, and further an enhanced RFEI (eRFEI) that allows people to access food with different transportation modes. We compared the traditional and proposed RFEIs in a case study of Florida, USA, and found that the eRFEI identified fewer and more clustered underserved populations, allowing policymakers to intervene more effectively. The eRFEI depicts more realistic human shopping behaviors and better represents the food environment. Our study enriches the literature by offering a new and generic approach for assimilating a neighborhood context into food environment measures.

Income and Health Perceptions in an Economically Disadvantaged Community: A Qualitative Case Study from Central Florida

The link between income and adverse health outcomes continues to be problematic among racially and economically segregated urban communities. Although the consequences of living in areas of concentrated disadvantage have been delineated, there is a dearth of knowledge on how citizens from such areas perceive the effects of neighborhood characteristics on their individual and community health. This qualitative study explored how minority residents ( N = 23) viewed the intersectionality of income and health within their urban neighborhoods of economic distress. Focus groups were conducted using semi-structured interviews to better understand health concerns, needs, and barriers for individuals and their community. The main finding highlighted how residents desired to be healthy, but economic barriers prevented them from maintaining a healthy lifestyle and diet. While residing in a concentrated disadvantaged community, lack of income and power contributed to stress and fear that forced residents to prioritize survival over their wellbeing. Implications for improving individual and community health include operating within a systems framework to affect collective efficacy and empowerment among residents of low-income neighborhoods.

Dietary Exposure to United States Food and Drug Administration-Approved Synthetic Food Colors in Children, Pregnant Women, and Women of Childbearing Age Living in the United States

The Food and Drug Administration (FDA) regulates artificial food colors (AFCs) in the United States. Exposure to AFCs has raised concerns about adverse behavioral effects in children. We quantified AFC exposure in women of childbearing age, pregnant women, and children and compared them to FDA and World Health Organization acceptable daily intakes (ADIs). We estimated the “typical” and “high” single-day and two-day average dietary exposure to each AFC (mg/kg/day) based on laboratory measurements and food consumption data from the 2015−2016 National Health and Nutrition Examination Survey (NHANES). We also examined whether AFC intake differed by income, education, and ethnicity. Exposure tended to be higher in children and the highest AFC exposure was found for Red No. 40. Children’s mean and 95th percentile FD&C Red No. 3 estimated intakes exceeded the ADIs in some instances. Juice drinks, soft drinks, icings, and ice cream cones were major foods contributing to children’s (<16 years old) AFC exposure. AFC intake was higher in participants with lower incomes and education and of African American ethnicity. The findings indicate widespread AFC exposure including in very young children. Research is needed on the sociodemographic determinants of exposure and AFC toxicokinetics to better describe the absorption and organ-specific exposure.

Socioeconomic deprivation and changes in the retail food environment of Mexico from 2010 to 2020

We aimed to analyze the change in the retail food environment of Mexican municipalities from 2010 to 2020, and to assess if these trends were modified by socioeconomic deprivation. We used data from the National Statistical Directory of Economic Units. Changes in the food store count were estimated using fixed-effects Poisson regression models, including coefficients for time, socioeconomic deprivation, and their interaction. We found a rapid growth in convenience stores, seed-grain stores, and supermarkets while small food retail stores declined. Urban areas had a higher count of all types of food stores; however, the steepest increases in food stores were observed in non-urban areas. The increase in convenience stores, supermarkets, specialty food stores, fruit-vegetable stores, and seed-grain stores was greater in the most deprived areas, compared to the least deprived areas. There has been a substantial expansion and rapid change in Mexico's food environment, mainly driven by increases in convenience stores and supermarkets in more deprived and less urbanized areas.

Area Characteristics and Consumer Nutrition Environments in Restaurants: an Examination of Hispanic Caribbean Restaurants in New York City

Hispanics in the USA, particularly those of Caribbean descent, experience high levels of diet-related diseases and dietary risk factors. Restaurants are an increasingly important yet understudied source of food and may present opportunities to positively influence urban food environments. We sought to explore food environments further, by examining the association between neighborhood characteristics and restaurant consumer nutrition environments within New York City's Hispanic Caribbean (HC) restaurant environments. We applied an adapted version of the Nutrition Environment Measurements Survey for Restaurants (NEMS-R) to evaluate a random sample of HC restaurants (n=89). NEMS-HCR scores (continuous and categorized as low, medium, and high based on data distribution) were examined against area sociodemographic characteristics using bivariate and logistic regression analysis. HC restaurants located in Hispanic geographic enclaves had a higher proportion of fried menu items (p<0.01) but presented fewer environmental barriers to healthy eating, compared with those in areas with lower Hispanic concentrations. No significant differences in NEMS-R scores were found by other neighborhood characteristics. Size was the only significant factor predicting high NEMS-HCR scores, where small restaurants were less likely to have scores in the high category (NEMS-HCR score>6), compared with their medium (aOR: 6.6, 95% CI: 1.8-24.6) and large counterparts (aOR: 5.6, 95% CI: 1.5-21.4). This research is the first to examine the association between restaurant location and consumer nutrition environments, providing information to contribute to future interventions and policies seeking to improve urban food environments in communities disproportionately affected by diet-related conditions, as in the case of HC communities in New York City.

Local Measures to Curb Dollar Store Growth: A Policy Scan

In recent years, advocates have expressed concern about the exponential growth of dollar stores in low-income communities, given their limited stock of healthy foods, and several municipalities in the U.S. have passed novel policies to curb the proliferation of these stores. The purpose of this scan is to create a legal database to inform future healthy retail policies and programs. Legal mapping methods were used to identify local policies aimed at moderating dollar store proliferation. A search yielded 25 policies that met the inclusion criteria, all enacted between 2018 and 2020. Recent policies aiming to slow local dollar store growth were mostly passed in low-income communities of color. All identified policies were passed in either the Midwest or South. The majority of municipalities that passed the policies had populations where more than half of residents identified as non-Hispanic Black or Hispanic and where the poverty rate was greater than the national average. Twelve (48%) municipalities imposed temporary moratoria halting new dollar stores from opening, and ten (40%) banned new construction within a specified distance of an existing dollar store. Key themes identified from analysis of policies’ purpose statements included increasing healthy food availability, diversifying local businesses, and improving community safety. These findings may be useful to leaders in other communities seeking to potentially moderate the impact of dollar stores on community health, as well as researchers and policy makers seeking to evaluate the efficacy of existing policies.

The Baltimore Urban Food Distribution (BUD) App: Study Protocol to Assess the Feasibility of a Food Systems Intervention

Low-income urban communities in the United States commonly lack ready access to healthy foods. This is due in part to a food distribution system that favors the provision of high-fat, high-sugar, high-sodium processed foods to small retail food stores, and impedes their healthier alternatives, such as fresh produce. The Baltimore Urban food Distribution (BUD) study is a multilevel, multicomponent systems intervention that aims to improve healthy food access in low-income neighborhoods of Baltimore, Maryland. The primary intervention is the BUD application (app), which uses the power of collective purchasing and delivery to affordably move foods from local producers and wholesalers to the city's many corner stores. We will implement the BUD app in a sample of 38 corner stores, randomized to intervention and comparison. Extensive evaluation will be conducted at each level of the intervention to assess overall feasibility and effectiveness via mixed methods, including app usage data, and process and impact measures on suppliers, corner stores, and consumers. BUD represents one of the first attempts to implement an intervention that engages multiple levels of a local food system. We anticipate that the app will provide a financially viable alternative for Baltimore corner stores to increase their stocking and sales of healthier foods, subsequently increasing healthy food access and improving diet-related health outcomes for under-resourced consumers. The design of the intervention and the evaluation plan of the BUD project are documented here, including future steps for scale-up. Trial registration #: NCT05010018.

Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors

PURPOSE

Unfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group.

METHODS

Adiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models.

RESULTS

Adiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss.

CONCLUSION

Both individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.

The longitudinal associations between proximity to local grocery shops and functional ability in the very old living with and without multimorbidity: Results from the Newcastle 85+ study

BACKGROUNDS

The very old, people aged ≥85, is a fast-growing age group with high risk of disability and dependence. To identify environmental factors that support maintenance of functional ability, the aim of this study is to investigate the longitudinal associations between proximity to local grocery shops and the ability to shop for groceries in the very old and to examine the potential variation between those living with and without multimorbidity.

METHODS

This study was based on the Newcastle 85+ study, a population-based cohort of people aged 85 in North-East England. The numbers of grocery shops were identified within a 500 m road distance to participants' residence. Multilevel Poisson regression modelling was used to investigate whether proximity to local grocery shops was associated with the ability to do grocery shopping over five years in those with and without multimorbidity adjusting for sociodemographic factors and area deprivation.

RESULTS

The very old who lived in more deprived areas were more likely to have a grocery shop within 500 m than those in less deprived areas. Proximity to local grocery shops was not associated with the ability to do grocery shopping in the participants who had none or one chronic condition (IRR: 1.00; 95% CI: 0.89, 1.12) but moderated loss of the ability in those living with multimorbidity (IRR: 0.82; 95% CI: 0.70, 0.96).

CONCLUSIONS

For the very old living with multimorbidity, proximity to local grocery shops may support their functional ability. Future research should investigate how to support older people with poor health to access local grocery shops.