The local food environment and diet: a systematic review

Food Insecurity, Food Deserts, and Waist-to-Height Ratio: Variation by Sex and Race/Ethnicity

The purpose of this study is to investigate the association between two food-related hardships-food insecurity and living in a food desert-on waist-to-height ratio (WHtR). Data on participants from waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed. The association between food-related hardships and waist-to-height ratio were examined using logistic regression. Models were stratified by sex and race/ethnicity to examine potential moderating effects. Study results suggest food insecurity has a positive association with WHtR among female respondents (OR = 1.360, p = .017). Living in a food desert has a positive association with WHtR among both females (OR = 1.247, p = .026) and males (OR = 1.245, p = .024). In models stratified by race/ethnicity living in a food desert is positively associated with WHtR among White respondents (OR = 1.279, p = .003). Given the link between food-related hardships and obesity, targeted interventions that alleviate food insecurity and inadequate access to healthy food retailers could be effective in reducing obesity.

Invited Commentary: Learning From Our Past to Build on Our Future- Lessons Learned From MRFIT and JUMBO

We propose that Blackburn (Am J Epidemiol. 2020;189(6):491-498) ignores several important issues that need to be considered in the context of a historical reflection of the National Heart Institute's landmark study, the Multiple Risk Factor Intervention Trial (MRFIT), and the alternative proposal, the "JUMBO" trial, submitted to the National Heart Institute by an experienced team of extramural investigators but never funded. A key focus of this commentary is to offer an alternative perspective on both studies using our current understanding of the impact of social and structural determinants of health; evidence that policy, systems, and environmental interventions are needed to support behavior change at the individual level; and the significance of examining research from a racial/socioeconomic equity lens. While we strongly agree with Blackburn's conclusion urging the National Institutes of Health to invest in prevention research at a level consistent with its social and economic impact, we encourage the author to move beyond simply underscoring the methodological limitations and failure of the findings of MRFIT compared with the potential of the proposed JUMBO trial to consider the contribution of MRFIT to our current understanding of chronic disease prevention and treatment.

Identifying and assessing factors affecting farmers' markets Electronic Benefit Transfer sales in Hawai'i

OBJECTIVE

Electronic Benefit Transfer (EBT) placement at farmers' markets can reduce access disparities for low-income consumers. However, resources needed to operate EBT programs may challenge markets' business models. A conceptual model of factors impacting EBT program success was developed from literature, and an exploratory study conducted to assess the impact of model variables on market EBT sales.

DESIGN

Annual EBT sales data were obtained for all Hawai'i farmers' markets with EBT programs (n 22). Key informant interviews (n 19), along with records review, were performed to gather data on model variables. Exploratory analysis was conducted to estimate the impact of individual model variables on EBT sales.

SETTING

Farmers' markets accepting EBT in the state of Hawai'i.

PARTICIPANTS

Market managers and EBT program partners (n 19).

RESULTS

Markets engaging in community partnerships $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ 852} \right)$, consumer education $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ {\rm{598}}} \right)$, social media promotion $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ {\rm{732}}} \right)$ or EBT incentives $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ {\rm{5}}0{\rm{9}}} \right)$ averaged higher sales than markets not reporting these practices. Sales increased by $3 for every ten additional SNAP-participating households and decreased by $35 for each competing EBT-accepting supermarket, grocery or farmers' market within the market's access area. Sales increased by $137/vendor for each additional hour/week the market was open.

CONCLUSION

Factors suggested by the model, particularly community engagement and partnership, marketing methods, consumer base and competition for EBT sales in the market area substantively affected EBT sales. Assessing these factors may identify markets with the greatest chance of EBT success and suggest ways to strengthen struggling EBT programs.

Socioeconomic Disparities in the Community Food Environment of a Medium-Sized City of Brazil

Objective: The purpose of this ecological study was to characterize the community food environment according to the socioeconomic condition of census tracts (CTs) in the urban area of a medium-sized city of southeastern Brazil in 2016.Method: Food establishments were identified on the streets covered by raters and information about type was collected through objective assessment. Geocoding was carried out from address observed by raters. Food establishments were categorized into establishments with predominant sale of natural or minimally processed foods, mixed establishments, and establishments with predominant sale of ultra-processed foods. The distribution of the number of establishments, by category, was evaluated according to tertiles of per capita income of the CT. The kernel estimation was used to analyze the density of establishments by category. The spatial pattern of the categories of establishments was investigated using the univariate Ripley's K-function.Results: A total of 656 establishments were evaluated. In all, 11.1% had predominant sale of natural or minimally processed foods, 44.5% were mixed, and 44.4% had predominant sale of ultra-processed foods. The average of establishments with predominant sale of natural or minimally processed foods, of ultra-processed foods, and all categories increased according to the income of the CT. There was a clustering of all categories of establishments in high-income CTs downtown. However, peripheral and low-income CTs were composed of a higher number of mixed establishments or those with predominant sale of ultra-processed foods than establishments with predominant sale of natural or minimally processed foods.Conclusions: On average, the number of all categories of establishments increased according to the per capita income of the CT and were clustered in central and higher-income regions of the city. These findings may have practical implications for the development of public policies to increase the availability of healthy foods and to reduce the sale of unhealthy foods.

Foodscape: A scoping review and a research agenda for food security-related studies

Since 1995, the term 'foodscape', a contraction of food and landscape, has been used in various research addressing social and spatial disparities in public health and food systems. This article presents a scoping review of the literature examining how this term is employed and framed. We searched publications using the term foodscape in the Web of Science Core Collection, MEDLINE, and Scopus databases. Analyzing 140 publications, we highlight four approaches to the foodscape: (i) Spatial approaches use statistics and spatial analysis to characterize the diversity of urban foodscapes and their impacts on diet and health, at city or neighborhood scales. (ii) Social and cultural approaches at the same scales show that foodscapes are socially shaped and highlight structural inequalities by combining qualitative case studies and quantitative surveys of food procurement practices. (iii) Behavioral approaches generally focus on indoor micro-scales, showing how consumer perceptions of foodscapes explain and determine food behaviors and food education. (iv) Systemic approaches contest the global corporate food regime and promote local, ethical, and sustainable food networks. Thus, although spatial analysis was the first approach to foodscapes, sociocultural, behavioral and systemic approaches are becoming more common. In the spatial approach, the term 'foodscape' is synonymous with 'food environment'. In the three other approaches, 'foodscape' and 'food environment' are not synonymous. Scholars consider that the foodscape is not an environment external to individuals but a landscape including, perceived, and socially shaped by individuals and policies. They share a systemic way of thinking, considering culture and experience of food as key to improving our understanding of how food systems affect people. Foodscape studies principally address three issues: public health, social justice, and sustainability. The review concludes with a research agenda, arguing that people-based and place-based approaches need to be combined to tackle the complexity of the food-people-territory nexus.

Association between time-weighted activity space-based exposures to fast food outlets and fast food consumption among young adults in urban Canada

BACKGROUND

Despite increased attention on retail food environments and fast food consumption, results from previous studies have been inconsistent. Variation in measurement of exposure to retail food environments and the context of the built environment are possible reasons for inconsistencies. The purpose of the current study is to examine the association between exposure to fast food environment and fast food consumption among young adults, and to explore possible associations between built environment and fast food consumption.

METHODS

We employed an observational, cross-sectional study design. Cross-sectional surveys were conducted in 2016 and 2017. In a sample of 591 young adults aged 16-30 years in five Canadian cities, we constructed and computed individual-level time-weighted number and ratio of fast food outlets in activity spaces derived from GPS trajectory data. Negative binomial regression models estimated the associations between exposure measures and frequency of fast food consumption (number of times consuming fast food meals in a seven-day period), controlling for built environment characterization and individual-level characteristics.

RESULTS

Significant positive associations were found between time-weighted number of fast food outlets and count of fast food meals consumed per week in models using a radius of 500 m (IRR = 1.078, 95% CI: 0.999, 1.163), 1 km (IRR = 1.135, 95% CI: 1.024, 1.259), or 1.5 km (IRR = 1.138, 95% CI: 1.004, 1.289) around GPS tracks, when generating activity spaces. However, time-weighted ratio of fast food outlets was only significantly associated with count of fast food meals consumed when a radius of 500 m is used (IRR = 1.478, 95% CI: 1.032, 2.123). The time-weighted Active Living Environment Index with Transit measure was significantly negatively related to count of fast food meals consumed across all models.

CONCLUSIONS

Our study demonstrated associations of time-weighted activity space-based exposure to fast food outlets and fast food consumption frequency in a sample of young adults in urban Canada, and provides evidence of the association between context of built environment and fast food consumption, furthering discussion on the utility of individual-level, activity space-based data and methods in food environment research. These results imply that both food retail composition and activity spaces in urban areas are important factors to consider when studying diets.

Neighbourhood fast food exposure and consumption: the mediating role of neighbourhood social norms

Background

The association between the residential fast food environment and diet has gained growing attention. However, why the food environment affects food consumption is under-examined. This study aimed to investigate neighbourhood social norms with respect to fast food consumption as a potential mediating pathway between residential fast food outlet exposure and residents’ fast food consumption.

Methods

A correlational study was conducted in which a nationwide sample of 1038 respondents living across The Netherlands completed a survey. Respondents reported their fast food consumption (amount/week) as well as perceived descriptive and injunctive norms regarding fast food consumption in their neighbourhood. Fast food outlet exposure was measured by the average count of fast food outlets within a 400 m walking distance buffer around the zip-codes of the respondents, using a retail outlet database. Regression models were used to assess associations between residential fast food outlet exposure, fast food consumption, and social norm perceptions, and a bootstrapping procedure was used to test the indirect -mediation- effect. Separate analyses were performed for descriptive norms and injunctive norms.

Results

There was no overall or direct association between residential fast food outlet exposure and residents’ fast food consumption. However, fast food outlet exposure was positively associated with neighbourhood social norms (descriptive and injunctive) regarding fast food consumption, which in turn were positively associated with the odds of consuming fast food. Moreover, results of the bootstrapped analysis provided evidence of indirect effects of fast food outlet exposure on fast food consumption, via descriptive norms and injunctive norms.

Conclusions

In neighbourhoods with more fast food outlets, residents were more likely to perceive fast food consumption in the neighbourhood as more common and appropriate. In turn, stronger neighbourhood social norms were associated with higher fast food consumption. Acknowledging the correlational design, this study is the first that implies that neighbourhood social norms may be a mediating pathway in the relation between the residential fast food environment and fast food consumption. Future research may examine the role of neighbourhood social norms in other contexts and explore how the changing food environment may shift our consumption norms.

The influence of the local food environment on diet following residential relocation: longitudinal results from RESIDential Environments (RESIDE)

OBJECTIVE

To examine the associations of changes in the local food environment, individual behaviours and perceptions with changes in dietary intake, following relocation from an established neighbourhood to a new residential development.

DESIGN

Spatial food environment exposure measures were generated relative to each participant's home address using the locations of food outlets at baseline (before moving house) and follow-up (1-2 years after relocation). Self-reported data on socio-demographics, self-selection, usual dietary intake, individual behaviours and perceptions of the local food environment were sourced from the RESIDential Environments (RESIDE) Project. Changes in spatial exposure measures, individual behaviours and perceptions with changes in dietary outcomes were examined using mixed linear models.

SETTING

Perth, Western Australia, 2003-2007.

PARTICIPANTS

Adults (n 1200) from the RESIDE Project.

RESULTS

Moving to a new residential development with more convenience stores and café restaurants around the home was significantly associated with an increase in unhealthy food intake (β = 0·049, 95 % CI 0·010, 0·089; β = 0·020, 95 % CI 0·007, 0·033) and was partially mediated by individual behaviours and perceptions. A greater percentage of healthy food outlets around the home following relocation was significantly associated with an increase in healthy food (β = 0·003, 95 % CI 0·001, 0·005) and fruit/vegetable intake (β = 0·002, 95 % CI 0·001, 0·004).

CONCLUSIONS

Policy and planning may influence dietary intakes by restricting the number of convenience stores and other unhealthy food outlets and increasing the relative percentage of healthy food outlets.

Beyond the Chair: Public Health and Governmental Measures to Tackle Sugar

Limiting free sugars to <5% of energy intake is a World Health Organization evidence-based recommendation to protect oral health throughout the life course. Achieving this requires a concerted approach with upstream interventions, including legislation underpinning community interventions and health promotion. Global production and trade are the main drivers of sugars consumption, which can be addressed only through prioritization of health impacts in agricultural and trade agreements, including pricing and subsidies. Increasing evidence demonstrates the benefit, including dental benefits, of taxes on sugar-sweetened beverages, a major source of sugars—with taxes based on sugars content being favored due to the dual impact in incentivizing consumers to buy less and encouraging producers to use less through product reformulation. A benefit of product reformulation is that the potential impact on sugars intake occurs independent of consumer behavior change, making the benefits more equitable across social groups. Evidence from meta-analysis indicates that sugars reformulation and portion size reduction could lower energy intake by more than 10% and 16%, respectively. Sophisticated and targeted digital marketing of products high in sugars is another key driver of sugars intake. With the exception of children’s television broadcasting, marketing of products high in sugars is largely unregulated, and increased awareness of modern marketing strategies and more stringent regulation are urgently needed. To ensure a commercial level playing field, mandatory approaches are required. Midstream actions include creating healthier food environments in neighborhoods, community settings (schools, sports centers, hospitals), and workplaces. Only through coalition among authorities responsible for planning and health will “obesogenic and cariogenic” environments be replaced with those that make healthy choices the easiest choice. It is recognized that providing nutrition health education alone is insufficient to achieve necessary sugars reduction; however, education has a key role to play in changing social norms and creating drive for change.

Do Where The Elderly Live Matter? Factors Associated with Diet Quality among Korean Elderly Population Living in Urban Versus Rural Areas

This study aimed to examine whether there is an area difference on diet quality among the Korean elderly population. The effect of personal factors on diet quality is also estimated and compared between rural and urban areas. A cross-sectional data from the 2013-2015 Korea National Health and Nutrition Examination Survey (KNHANES) was used for this study. The participants were older adults aged ≥ 65 years (n = 3207) who participated in the KNHANES. Urban and rural areas classified the region and the Korean Healthy Eating Index (KHEI) assessed the diet quality. Personal factors that were related to diet quality included socio-demographic factors, health behaviors, and health conditions. This study found that the diet quality was different between urban and rural areas in the Korean elderly population, showing a higher mean of KHEI scores in urban areas than rural areas (67.3 for urban seniors, 63.6 for rural seniors, p < 0.001), and the regional difference was still significant, even after adjusting for the personal factors (p < 0.001). Different sets of personal factors were found to be significant that explain the diet quality of participants between areas, such as economic resources, walking exercise, and perceived oral health status in urban areas, and age and food insecurity in rural areas. In conclusions, this study found that there was a regional disparity in diet quality and some personal factors affecting diet quality were dependent on areas, which implied that regional environment with diverse contexts could influence diet quality. These findings emphasize the need to provide targeted intervention programs that take into account both the characteristics of individuals and local food environments in order to improve the overall diet quality in older adults.

Cognitive Distraction at Mealtime Decreases Amount Consumed in Healthy Young Adults: A Randomized Crossover Exploratory Study

BACKGROUND

Environmental distractions have been shown to affect eating patterns.

OBJECTIVE

The purpose of this study was to determine the effects of a cognitive distraction on amount, preference, and memory of food consumed and perceptions of fullness, hunger, and enjoyment of food in a healthy young-adult population.

METHODS

A randomized controlled crossover study of 119 healthy adults (20.2 ± 1.4 y; 57% women; 48% white) assigned participants to begin under either the distracted (DIS, n = 55) or control (CON, n = 64) conditions. DIS participants consumed a meal of quiche while completing a Rapid Visual Information Processing (RVIP) for 15 min. CON participants ate without any task assignment. After a 30-min rest period, participants were offered a snack and given 5 min to eat ad libitum. Participants completed a survey assessing fullness, hunger, and enjoyment of the meal using 100 mm visual analogue scales. One week later, participants completed the opposite condition. Data were analyzed using ANOVA.

RESULTS

Those in DIS consumed 13 g less of the meal (P < 0.001), even when comparing by initial condition (P < 0.001) and adjusting for sex (P < 0.001). A carryover effect of initial condition was found (P < 0.001), such that participants first assigned to DIS condition consumed less (95.2 ± 61.7 g) when distracted compared to all other condition combinations (127-133 g). Those in DIS had decreased accuracy for both memory of quiche received (absolute difference, 1.1 ± 1.6 compared with 0.7 ± 1.2 for CON, P < 0.001) and memory of quiche consumed (0.8 ± 1.1 for DIS compared with 0.7 ± 1.2 for CON, P = 0.007).

CONCLUSIONS

When distracted, healthy young adults consumed significantly less food and their memory of the meal was dampened. These findings underscore the potential importance of cognitive distraction in affecting food intake. This trial was registered at clinicaltrials.gov as NCT04078607.

Facilitating barriers: Contextual factors and self-management of type 2 diabetes in urban settings

Urban environments create unique challenges for the management of type 2 diabetes (T2D). City living is associated with unhealthy occupational, nutritional, and physical activity patterns. However, it has also been linked to behaviours that promote health, such as walking and cycling for transportation. Our research is situated at the intersection of these contradictory findings. We ask: What aspects of urban living impact the ability of those living with diabetes to reach optimal health? What contextual and structural factors influence how barriers are experienced in the everyday lives of those living with T2D? We conducted semi-structured interviews with 29 individuals living in Toronto and Vancouver. Interviews were recorded, transcribed, and systematically coded for themes and sub-themes. In addition to affirming readily acknowledged barriers to diabetes management, such as accessing healthy, culturally appropriate food and the cost of management, our findings suggest that the unpredictable nature of urban living creates barriers to routinizing self-management practices. As large, cosmopolitan centres with an abundance of activities on offer, cities pulls people away from home, making adherence to self-management recommendations more difficult. Moreover, our findings challenge commonly held assumptions about the mutually exclusive and static nature of barriers and facilitators. Public transit, a readily acknowledged facilitator of healthy living, can be experienced as a barrier to diabetes management. Participants report intentional non-adherence to their medication regimens for fear of hypoglycemia in subway or traffic delays. While the stimulating nature of cities promotes walkability, it produces barriers as well: participants partake in more restaurant eating than they would if they lived in a rural area and were home to cook their own meals. Understanding how barriers are experienced by people living with diabetes will help mitigate some of the unintended consequences associated with various contextual factors. We recommend that healthcare professionals acknowledge and support people with T2D in routinizing self-management and developing contingency plans for the unpredictability and complexity that urban living entails. We suggest further research be carried out to develop contextually-tailored municipal policies and interventions that will support self-management and improve outcomes for individuals living with T2D in urban settings.

Residential mobility and chronic disease among World Trade Center Health Registry enrollees, 2004-2016

Residential mobility is hypothesized to impact health through changes to the built environment and disruptions in social networks, and may vary by neighborhood deprivation exposure. However, there are few longitudinal investigations of residential mobility in relation to health outcomes. This study examined enrollees from the World Trade Center Health Registry, a longitudinal cohort of first responders and community members in lower Manhattan on September 11, 2001. Enrollees who completed ≥2 health surveys between 2004 and 2016 and did not have diabetes (N = 44,089) or hypertension (N = 35,065) at baseline (i.e., 2004) were included. Using geocoded annual home addresses, residential mobility was examined using two indicators: moving frequency and displacement. Moving frequency was defined as the number of times someone was recorded as living in a different neighborhood; displacement as any moving to a more disadvantaged neighborhood. We fit adjusted Cox proportional hazards models with time-dependent exposures (moving frequency and displacement) and covariates to evaluate associations with incident diabetes and hypertension. From 2004 to 2016, the majority of enrollees never moved (54.5%); 6.5% moved ≥3 times. Those who moved ≥3 times had a similar hazard of diabetes (hazard ratio (HR) = 0.78; 95% Confidence Interval (CI): 0.40, 1.53) and hypertension (HR = 0.99; 95% CI: 0.68, 1.43) compared with those who never moved. Similarly, displacement was not associated with diabetes or hypertension. Residential mobility was not associated with diabetes or hypertension among a cohort of primarily urban-dwelling adults.

Twenty-five years of Health & Place: Citation classics, internationalism and interdisciplinarity

To mark 25 years of Health & Place Health & Place, we identify and appraise some key contributions to the journal over this period. We use citation data to identify 'classics' from the journal's back catalogue. We also examine trends in the international reach and disciplinary homes of our authors. We show that there has been a near 7-fold increase in the number of published papers between the early and most recent years of the journal and that the journal's citation levels are amongst the top 2% of social science journals. Amongst the most cited papers, some clear themes are evident such as physical activity, diet/food, obesity and topics relating to greenspace. The profile of the journal's authors is becoming more internationally diverse, represents a broader range of disciplines, and increasingly demonstrating cross/interdisciplinary ways of working. Although Anglophone countries have led the way, there is an increasing number of contributions from elsewhere including emerging economies such as China. We conclude with some comments on likely future directions for the journal including enduring concerns such as greenspace, obesity, diet and unhealthy commodities (alcohol, tobacco, ultra-processed food) as well as more recent directions including planetary health, longitudinal and lifecourse analyses, and the opportunities (and challenges) of big data and machine learning. Whatever the thematic concerns of the papers over next 25 years, we will continue to welcome outstanding research that is concerned with the importance place makes to health.

A cross-sectional comparison of meal delivery options in three international cities

BACKGROUND/OBJECTIVES

The recent upsurge in online food delivery options has reshaped the food market. The aim of this study was to examine between-city differences and within-city socioeconomic differences in the number of online meal delivery options, meal types, and meal prices.

SUBJECTS/METHODS

A cross-sectional study was conducted in three international cities within high-income countries. Across 10 sampled addresses in Chicago (USA), Amsterdam (The Netherlands), and Melbourne (Australia), meal delivery options provided by a major international meal delivery company were sampled. Bonferroni adjusted Chi²-tests were conducted to assess between-city differences as well as within-city socioeconomic differences in price levels.

RESULTS

Across the 10 sampled addresses in each city, there were n = 1668 delivery options in Chicago, n = 1496 in Amsterdam and n = 1159 in Melbourne. In total, 10,220 keywords (representing 148 different meal types) were recorded across all 4323 delivery options. In all three cities, burgers, pizza and Italian were in the top 10 of most advertised meals. Compared with Amsterdam, healthy and meat-free meals were less commonly advertised in Chicago and Melbourne. In Chicago, the number of delivery options for addresses in the most disadvantaged and least disadvantaged neighborhoods were similar. In Amsterdam and Melbourne, a greater number of options was available for the addresses in the least disadvantaged neighborhoods.

CONCLUSIONS

This study highlights the vast number of meal delivery options individuals can source when at home via a meal delivery service, noting the number differs across and within cities. In each city, most food types available for delivery were not considered healthy.

Food Security in Artisanal Mining Communities: An Exploration of Rural Markets in Northern Guinea

The number of people engaged in artisanal and small-scale mining (ASM) has grown rapidly in the past twenty years, but they continue to be an understudied population experiencing high rates of malnutrition, poverty, and food insecurity. This paper explores how characteristics of markets that serve ASM populations facilitate and pose challenges to acquiring a nutritious and sustainable diet. The study sites included eight markets across four mining districts in the Kankan Region in the Republic of Guinea. Market descriptions to capture the structure of village markets, as well as twenty in-depth structured interviews with food vendors at mining site markets were conducted. We identified three forms of market organization based on location and distance from mining sites. Markets located close to mining sites offered fewer fruit and vegetable options, as well as a higher ratio of prepared food options as compared with markets located close to village centers. Vendors were highly responsive to customer needs. Food accessibility and utilization, rather than availability, are critical for food security in non-agricultural rural areas such as mining sites. Future market-based nutrition interventions need to consider the diverse market settings serving ASM communities and leverage the high vendor responsiveness to customer needs.

Differences in Nutrient Intake and Diet Quality Between Non-Hispanic Black and Non-Hispanic White Men in the United States

OBJECTIVES

Non-Hispanic black (NHB) men have higher rates of chronic disease than men in other racial/ethnic groups. Poor diet quality is one risk factor for chronic disease, but research on the diet quality and nutrient intake of NHB men is sparse. The objective of this study was to describe and compare the diet quality and nutrient intake of NHB and non-Hispanic white (NHW) men in the United States.

METHODS

We analyzed cross-sectional data on 5050 men (31.3% NHB, 68.7% NHW) who participated in the National Health and Nutrition Examination Survey (NHANES) during 2007-2012. To assess diet quality, we calculated Healthy Eating Index (HEI)-2010 scores from each participant's 24-hour recall data. We used logistic regression models to determine if NHB men had lower odds of meeting dietary recommendations for nutrient intake than NHW men. We used linear regression models to identify significant differences in HEI-2010 scores between NHB and NHW men.

RESULTS

After adjusting for sociodemographic measures, NHB and NHW men had similar diet quality (P = .59). Compared with NHW men, NHB men had lower odds of meeting recommendations for dietary fiber and cholesterol intake and higher odds of meeting recommendations for saturated fat and sodium intake.

CONCLUSION

Differences between NHB and NHW men in the intake of certain nutrients may be related to chronic disease disparities. Future research should consider racial/ethnic differences in dietary intake among men and the impact these differences have on men's health.

The impact of a randomized dietary and physical activity intervention on chronic inflammation among obese African-American women

Lifestyle interventions may reduce inflammation and lower breast cancer (BrCa) risk. This randomized trial assessed the impact of the Sistas Inspiring Sistas Through Activity and Support (SISTAS) study on plasma C-reactive protein (CRP), interleukin-6 (IL-6) and Dietary Inflammatory Index (DII). This unblinded, dietary and physical activity trial was implemented in 337 obese (body mass index [BMI] ≥30 kg/m²) African American (AA) women recruited between 2011 and 2015 in South Carolina through a community-based participatory approach with measurements at baseline, 3 months, and 12 months. Participants were randomized into either intervention (n = 176) or wait-list control group (n = 161). Linear mixed-effect models were used for analyses of CRP and IL-6. Baseline CRP was significantly higher in those with greater obesity, body fat percentage, and waist circumference (all p <.01). No difference was observed between groups for CRP or IL-6 at 3 or 12 months; however, improvements in diet were observed in the intervention group compared to the control group (p = .02) at 3 months but were not sustained at 12 months. Although the intervention was not successful at reducing levels of CRP or IL-6, a significant decrease was observed in DII score for the intervention group, indicating short-term positive dietary change.

Methods for accounting for neighbourhood self-selection in physical activity and dietary behaviour research: a systematic review

BACKGROUND

Self-selection into residential neighbourhoods is a widely acknowledged, but under-studied problem in research investigating neighbourhood influences on physical activity and diet. Failure to handle neighbourhood self-selection can lead to biased estimates of the association between the neighbourhood environment and behaviour. This means that effects could be over- or under-estimated, both of which have implications for public health policies related to neighbourhood (re)design. Therefore, it is important that methods to deal with neighbourhood self-selection are identified and reviewed. The aim of this review was to assess how neighbourhood self-selection is conceived and accounted for in the literature.

METHODS

Articles from a systematic search undertaken in 2017 were included if they examined associations between neighbourhood environment exposures and adult physical activity or dietary behaviour. Exposures could include any objective measurement of the built (e.g., supermarkets), natural (e.g., parks) or social (e.g., crime) environment. Articles had to explicitly state that a given method was used to account for neighbourhood self-selection. The systematic review was registered with the PROSPERO International Prospective Register of Systematic Reviews (number CRD42018083593) and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

Of 31 eligible articles, almost all considered physical activity (30/31); few examined diet (2/31). Methods used to address neighbourhood self-selection varied. Most studies (23/31) accounted for items relating to participants' neighbourhood preferences or reasons for moving to the neighbourhood using multi-variable adjustment in regression models (20/23) or propensity scores (3/23). Of 11 longitudinal studies, three controlled for neighbourhood self-selection as an unmeasured confounder using fixed effects regression.

CONCLUSIONS

Most studies accounted for neighbourhood self-selection by adjusting for measured attributes of neighbourhood preference. However, commonly the impact of adjustment could not be assessed. Future studies using adjustment should provide estimates of associations with and without adjustment for self-selection; consider temporality in the measurement of self-selection variables relative to the timing of the environmental exposure and outcome behaviours; and consider the theoretical plausibility of presumed pathways in cross-sectional research where causal direction is impossible to establish.

Healthful and less-healthful foods and drinks from storefront and non-storefront businesses: implications for 'food deserts', 'food swamps' and food-source disparities

OBJECTIVE

Conceptualisations of 'food deserts' (areas lacking healthful food/drink) and 'food swamps' (areas overwhelm by less-healthful fare) may be both inaccurate and incomplete. Our objective was to more accurately and completely characterise food/drink availability in urban areas.

DESIGN

Cross-sectional assessment of select healthful and less-healthful food/drink offerings from storefront businesses (stores, restaurants) and non-storefront businesses (street vendors).

SETTING

Two areas of New York City: the Bronx (higher-poverty, mostly minority) and the Upper East Side (UES; wealthier, predominantly white).

PARTICIPANTS

All businesses on 63 street segments in the Bronx (n 662) and on 46 street segments in the UES (n 330).

RESULTS

Greater percentages of businesses offered any, any healthful, and only less-healthful food/drink in the Bronx (42·0 %, 37·5 %, 4·4 %, respectively) than in the UES (30 %, 27·9 %, 2·1 %, respectively). Differences were driven mostly by businesses (e.g. newsstands, gyms, laundromats) not primarily focused on selling food/drink - 'other storefront businesses' (OSBs). OSBs accounted for 36·0 % of all food/drink-offering businesses in the Bronx (more numerous than restaurants or so-called 'food stores') and 18·2 % in the UES (more numerous than 'food stores'). Differences also related to street vendors in both the Bronx and the UES. If street vendors and OSBs were not captured, the missed percentages of street segments offering food/drink would be 14·5 % in the Bronx and 21·9 % in the UES.

CONCLUSIONS

Of businesses offering food/drink in communities, OSBs and street vendors can represent substantial percentages. Focusing on only 'food stores' and restaurants may miss or mischaracterise 'food deserts', 'food swamps', and food/drink-source disparities between communities.

Relationship between different levels of the Mexican food environment and dietary intake: a qualitative systematic review

Objective:

To investigate the possible associations between the food environment and dietary intake in the Mexican population.

Design:

Four databases (PubMed, PsychInfo, Web of Science and SCIelo) were used to retrieve relevant articles using an open timeframe. Articles were reviewed if they contained a systematic measure (i.e. food checklist) of the food environment (e.g. food availability) and dietary intake.

Setting:

Urban and rural communities in Mexico.

Participants:

Population-based studies of Mexican communities.

Results:

Twenty studies that assessed at least one food environment level, and at least one dietary outcome, were reviewed. Findings from these studies showed that changes in the Mexican food environment seem to be associated with higher availability of energy-dense foods. Energy-dense foods can be linked to a high consumption in household, environment and community food environments. When both nutrient-dense and energy-dense foods were present, individuals were more likely to consume foods with added sugars, fats and salt options than nutrient-dense items.

Conclusions:

The various levels of the food environment (i.e. household, school, community) exposed participants to energy-dense foods. Although nutrient-dense foods were present in all three levels, individuals were more likely to consume energy-dense food items. Not all three levels of the food environment are well represented in the urban and rural settings. Most studies on the community food environment were done in rural areas, whereas most studies on the school food environment were done in urban settings. Additional rigorously designed studies are needed to document the relationship between the food environment and dietary intake in the Mexican population.

"The coupons and stuff just made it possible": economic constraints and patient experiences of a produce prescription program

Although produce prescription (PRx) programs have been shown to improve fruit and vegetable (FV) consumption, few studies have examined how economic constraints influence participant experience. We conducted a qualitative study of patient experience of a 3-month PRx program for hypertension (PRxHTN) including 3 safety-net clinics and 20 farmers' markets (FMs). We interviewed 23 PRxHTN participants using semistructured guides to understand their program experiences. Interviews were audio-taped, transcribed, and analyzed to identify a priori and emergent themes. PRxHTN participants completing qualitative interviews were mostly middle-aged (mean: 62 years) African American (100%) women (78%). Economic hardship as a barrier to maximum program participation and sustainability was a main theme identified, with three subthemes: (i) transportation issues shaped shopping and eating patterns and limited participant ability to access FMs to utilize PRxHTN vouchers; (ii) limited and unstable income shaped participant shopping and eating behavior before, during, and after PRxHTN; and (iii) participants emphasized individual-level influences like personal or perceived motivations for program participation, despite significant structural constraints, such as economic hardship, shaping their program engagement. Future PRx programs should bolster economic and institutional supports beyond FM vouchers such as transportation assistance, partnering with local food banks and expansion to local grocery stores offering year-round FV access to support sustained behavior change. Additionally, structural competency tools for providers may be warranted to reorient focus on structural influences on program engagement and away from potentially stigmatizing individual-level explanations for program success. These efforts have potential to enhance the translation of PRx programs to the needs of economically vulnerable patients who struggle to manage chronic illness and access basic nutrition.

Creating urban green infrastructure where it is needed - A spatial ecosystem service-based decision analysis of green roofs in Barcelona

As cities face increasing pressure from densification trends, green roofs represent a valuable source of ecosystem services for residents of compact metropolises where available green space is scarce. However, to date little research has been conducted regarding the holistic benefits of green roofs at a citywide scale, with local policymakers lacking practical guidance to inform expansion of green roofs coverage. The study addresses this issue by developing a spatial multi-criteria screening tool applied in Barcelona, Spain to determine: 1) where green roofs should be prioritized in Barcelona based on expert elicited demand for a wide range of ecosystem services and 2) what type of design of potential green roofs would optimize the ecosystem service provision. As inputs to the model, fifteen spatial indicators were selected as proxies for ecosystem service deficits and demands (thermal regulation, runoff control, habitat and pollination, food production, recreation, and social cohesion) along with five decision alternatives for green roof design (extensive, semi-intensive, intensive, naturalized, and allotment). These indicators and alternatives were analyzed probabilistically and spatially, then weighted according to feedback from local experts. Results of the assessment indicate that there is high demand across Barcelona for the ecosystem services that green roofs potentially might provide, particularly in dense residential neighborhoods and the industrial south. Experts identified habitat, pollination and thermal regulation as the most needed ES with runoff control and food production as the least demanded. Naturalized roofs generated the highest potential ecosystem service provision levels for 87.5% of rooftop area, apart from smaller areas of central Barcelona where intensive rooftops were identified as the preferable green roof design. Overall, the spatial model developed in this study offers a flexible screening based on spatial multi-criteria decision analysis that can be easily adjusted to guide municipal policy in other cities considering the effectiveness of green infrastructure as source of ecosystem services.

Introducing the Facility List Coder: A New Dataset/Method to Evaluate Community Food Environments

Community food environments have been shown to be important determinants to explain dietary patterns. This data descriptor describes a typical dataset obtained after applying the Facility List Coder (FLC), a new tool to asses community food environments that was validated and presented. The FLC was developed in Python 3.7 combining GIS analysis with standard data techniques. It offers a low-cost, scalable, efficient, and user-friendly way to indirectly identify community nutritional environments in any context. The FLC uses the most open access information to identify the facilities (e.g., convenience food store, bar, bakery, etc.) present around a location of interest (e.g., school, hospital, or university). As a result, researchers will have a comprehensive list of facilities around any location of interest allowing the assessment of key research questions on the influence of the community food environment on different health outcomes (e.g., obesity, physical inactivity, or diet quality). The FLC can be used either as a main source of information or to complement traditional methods such as store census and official commercial lists, among others.

Associations of Unhealthy Food Environment With the Development of Coronary Artery Calcification: The CARDIA Study

Background

While prior studies have linked the neighborhood environment and development of subclinical atherosclerosis, it is unknown whether living in neighborhoods with greater availability of “unhealthy” food outlets (fast‐food chain restaurants and convenience stores) is associated with risk of developing coronary artery calcification (CAC).

Methods and Results

We included 2706 CARDIA study (Coronary Artery Risk Development in Young Adults) participants who underwent CAC measurement during follow‐up years 15 (2000–2001), 20 (2005–2006), and 25 (2010–2011). Neighborhood features examined included percentage of all food outlets that were convenience stores and fast‐food chain restaurants within a 3‐km Euclidean buffer distance from each participant's residence. Econometric fixed effects models, which by design control for all time‐invariant covariates, were used to model the longitudinal association between simultaneous within‐person change in percentage food outlet and change in CAC. At baseline (year 15), 9.7% of participants had prevalent CAC. During 10 years of follow‐up, 21.1% of participants developed CAC. Each 1‐SD increase in percentage of convenience stores was associated with a 1.34 higher odds of developing CAC (95% CI: 1.04, 1.72) after adjusting for individual‐ and neighborhood‐level covariates; however, there was no significant association between increased percentage of fast‐food chain restaurants and developing CAC (odds ratio=1.15; 95% CI: 0.96, 1.38). There were no significant associations between increases in either food outlet percentage and progression of CAC.

Conclusions

Our findings suggest that increases in the relative availability of convenience stores in participants' neighborhoods is related to the development of CAC over time.

Measurement Methods Used to Assess the School Food Environment: A Systematic Review

Children consume approximately half of their total daily amount of energy at school. Foods consumed are often energy-dense, nutrient-poor. The school food environment represents an effective setting to influence children’s food choices when dietary habits are established and continue to track into adulthood. The aim of this review was to: (1) group methods used for assessing the school food environment according to four food environment dimensions: Physical, economic, socio-cultural and policy and (2) assess the quality of the methods according to four criteria: Comprehensiveness, relevance, generalizability and feasibility. Three databases were searched, and studies were used to assess food and beverages provided at school canteens, tuck shops or cafeterias were included. The review identified 38 global studies (including 49 methods of measuring the food environment). The physical environment was the primary focus for 47% of articles, aspects of policy environment was assessed by 37% articles and a small number of studies assessed the economic (8%) and socio cultural (8%) environment. Three methods were rated ‘high’ quality and seven methods received ‘medium’ quality ratings. The review revealed there are no standardized methods used to measure the school food environment. Robust methods to monitor the school food environment across a range of diverse country contexts is required to provide an understanding of obesogenic school environments.

Food Environment Research in Low- and Middle-Income Countries: A Systematic Scoping Review

Food environment research is increasingly gaining prominence in low- and middle-income countries (LMICs). However, in the absence of a systematic review of the literature, little is known about the emerging body of evidence from these settings. This systematic scoping review aims to address this gap. A systematic search of 6 databases was conducted in December 2017 and retrieved 920 records. In total, 70 peer-reviewed articles met the eligibility criteria and were included. Collectively, articles spanned 22 LMICs, including upper-middle-income countries (n = 49, 70%) and lower-middle-income countries (n = 18, 26%). No articles included low-income countries. Articles featured quantitative (n = 45, 64%), qualitative (n = 17, 24%), and mixed-method designs (n = 11, 8%). Studies analyzed the food environment at national, community, school, and household scales. Twenty-three articles (55%) assessed associations between food environment exposures and outcomes of interest, including diets (n = 14), nutrition status (n = 13), and health (n = 1). Food availability was associated with dietary outcomes at the community and school scales across multiple LMICs, although associations varied by vendor type. Evidence regarding associations between the food environment and nutrition and health outcomes was inconclusive. The paucity of evidence from high-quality studies is a severe limitation, highlighting the critical need for improved study designs and standardized methods and metrics. Future food environment research must address low-income and lower-middle-income countries, and include the full spectrum of dietary, nutrition, and health outcomes. Improving the quality of food environment research will be critical to the design of feasible, appropriate, and effective interventions to improve public health nutrition in LMICs.

Neighborhood food environment and consumption of fruit and leafy vegetables: Pro-Saude Study, Brazil

OBJECTIVE

To explore the relationship between availability of different types of retail food stores and consumption of fruit and leafy vegetables.

STUDY DESIGN

This study is a cross-sectional study.

METHODS

Data were derived from 2032 adults living in the city of Rio de Janeiro, Brazil, participating in the longitudinal Pro-Saude Study. Exposure to street markets, fruit and vegetable stores, groceries and markets, unhealthy food outlets, restaurants, and supermarkets within 1600 m buffers was obtained by georeferencing residential addresses. Consumption of fruit and leafy vegetables was assessed via two single questions, categorized as 'yes' (≥4 days/week) and 'no' (<3 days/week). Multiple logistic regression models were used to assess relationships of interest adjusted for surrounding average monthly income, sex, age, education, and family income per capita.

RESULTS

Except for supermarkets, the presence of a greater number of retail food stores - irrespective of the type - was associated with higher odds of consumption of fruit and leafy vegetables than with areas with a lower number (e.g. odds ratio = 1.47; 95% confidence interval = 1.13-1.91).

CONCLUSIONS

The greater availability of several types of retail food stores close to participants' residences was associated with higher consumption of fruit and leafy vegetables in Rio de Janeiro.

Unreliable and Difficult-to-Access Food for Those in Need: A Qualitative and Quantitative Study of Urban Food Pantries

For individuals who are food insecure, food pantries can be a vital resource to improve access to adequate food. Access to adequate food may be conceptualized within five dimensions: availability (item variety), accessibility (e.g., hours of operation), accommodation (e.g., cultural sensitivity), affordability (costs, monetary or otherwise), and acceptability (e.g., as related to quality). This study examined the five dimensions of access in a convenience sample of 50 food pantries in the Bronx, NY. The design was cross-sectional. Qualitative data included researcher observations and field notes from unstructured interviews with pantry workers. Quantitative data included frequencies for aspects of food access, organized by the five access dimensions. Inductive analysis of quantitative and qualitative data revealed three main inter-related findings: (1) Pantries were not reliably open: only 50% of pantries were open during hours listed in an online directory (several had had prolonged or indefinite closures); (2) Even when pantries were open, all five access dimensions showed deficiencies (e.g., limited inventory, few hours, pre-selected handouts without consideration of preferences, opportunity costs, and inferior-quality items); (3) Open pantries frequently had insufficient food supply to meet client demand. To deal with mismatch between supply and demand, pantries developed rules for food provision. Rules could break down in cases of pantries receiving food deliveries, leading to workarounds, and in cases of compelling client need, leading to exceptions. Adherence to rules, versus implementation of workarounds and/or exceptions, was worker- and situation-dependent and, thus, unpredictable. Overall, pantry food provision was unreliable. Future research should explore clients' perception of pantry access considering multiple access dimensions. Future research should also investigate drivers of mismatched supply and demand to create more predictable, reliable, and adequate food provision.

Knowledge Visualizations to Inform Decision Making for Improving Food Accessibility and Reducing Obesity Rates in the United States

The aim of this article is to promote the use of knowledge visualization frameworks in the creation and transfer of complex public health knowledge. The accessibility to healthy food items is an example of complex public health knowledge. The United States Department of Agriculture Food Access Research Atlas (FARA) dataset contains 147 variables for 72,864 census tracts and includes 16 food accessibility variables with binary values (0 or 1). Using four-digit and 16-digit binary patterns, we have developed data analytical procedures to group the 72,684 U.S. census tracts into eight and forty groups respectively. This value-added FARA dataset facilitated the design and production of interactive knowledge visualizations that have a collective purpose of knowledge transfer and specific functions including new insights on food accessibility and obesity rates in the United States. The knowledge visualizations of the binary patterns could serve as an integrated explanation and prediction system to help answer why and what-if questions on food accessibility, nutritional inequality and nutrition therapy for diabetic care at varying geographic units. In conclusion, the approach of knowledge visualizations could inform coordinated multi-level decision making for improving food accessibility and reducing chronic diseases in locations defined by patterns of food access measures.

U.S. county "food swamp" severity and hospitalization rates among adults with diabetes: A nonlinear relationship

The relationship between food environments and diabetes morbidity is vastly understudied, despite the well-recognized linkage between dietary quality and diabetes complications. Further, literature demonstrates that attributes of places can have nonlinear relationships with health outcomes. This study examines the extent to which "food swamps" are associated with greater rates of hospitalizations for complications among adults with diabetes over time as well as the linearity of this relationship. We conduct a longitudinal county-level analysis of 832 counties across 16 U.S. states in 2010, 2012, and 2014 using data from the USDA Food Environment Atlas and the AHRQ Health Care Cost and Utilization Project State Inpatient Databases. Food swamp severity is measured as the percentage of food outlets in a county that sell primarily unhealthy foods. Hierarchical linear mixed models with county random intercepts are estimated, controlling for area-level covariates and state and year fixed effects. Curvilinear relationships are explored by additively incorporating quadratic terms. We find that, over the study period, mean food swamp severity remained relatively stable. Mean hospitalization rates decreased from 296.72 to 262.82 hospitalizations per 1000 diabetic adults (p < 0.001). In adjusted models, greater food swamp severity was associated with higher hospitalization rates in a curvilinear manner (severity: β = 2.181, p = 0.02; severity2: β = -0.017, p = 0.04), plateauing at approximately 64% unhealthy outlets, a saturation point observed in 17% of observations. Policies that limit saturation of the environment with unhealthy outlets may help in the prevention of diabetic complications, but more saturated counties will likely require more extensive intervention.

Snapshots of Urban and Rural Food Environments: EPOCH-Based Mapping in a High-, Middle-, and Low-Income Country from a Non-Communicable Disease Perspective

A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high income), with one matched pair of urban-rural sites per country. Fifty formal and informal food retail outlets were assessed, and descriptive and comparative statistical analyses were performed. We found that formal food retail outlets in these countries had both positive and negative traits, as they were the main source of basic food items but also made unhealthy food items readily available. The Ugandan setting had predominantly informal outlets, while the Swedish setting had primarily formal outlets and South Africa had both, which fits broadly into the traditional (Uganda), mixed (South Africa) and modern (Sweden) conceptualized food systems. The promotion of unhealthy food products was high in all settings. Uganda had the highest in-community advertising, followed by South Africa and Sweden with the lowest, perhaps related to differences in regulation and implementation. The findings speak to the need to address contextual differences in NCD-related health interventions by incorporating strategies that address the food environment, and for a critical look at regulations that tackle key environment-related factors of food on a larger scale.

A systematic review of the Australian food retail environment: Characteristics, variation by geographic area, socioeconomic position and associations with diet and obesity

There is strong support across multiple sectors for the implementation of policies to create healthier food environments as part of comprehensive strategies to address obesity and improve population diets. The existing evidence base describing food retail environments and their relationship with health outcomes is limited in several respects. This systematic review examines the current evidence regarding food retail environments in Australia, including associations with diet and people with obesity, and socioeconomic and geographic disparities. Three databases were searched and independently screened. Studies were included if they were undertaken in Australia and objectively measured the food retail environment. Sixty papers were included. The broad range of methodological approaches used across studies limited the ability to synthesize the evidence and draw conclusions. Results indicated that there is some evidence that disparities exist in food retail environments across measures of socioeconomic position and geographic area in parts of Australia. Overall, there were inconsistent findings regarding the association between the healthiness of food retail environments and diet or people with obesity. Findings support previous calls for standardized tools and measures for monitoring the healthiness of food retail environments. This is imperative to inform evidence-based policy and evaluation in this critical component of recommended obesity prevention strategies.

A Smartphone App Combining Global Positioning System Data and Ecological Momentary Assessment to Track Individual Food Environment Exposure, Food Purchases, and Food Consumption: Protocol for the Observational FoodTrack Study

Background

Our understanding of how food choices are affected by exposure to the food environment is limited, and there are important gaps in the literature. Recently developed smartphone-based technologies, including global positioning systems and ecological momentary assessment, enable these gaps to be filled.

Objective

We present the FoodTrack study design and methods, as well as participants’ compliance with the study protocol and their experiences with the app. We propose future analyses of the data to examine individual food environmental exposure taking into account the accessible food environment and individual time constraints; to assess people’s food choices in relation to food environmental exposure; and to examine the moderating role of individual and contextual determinants of food purchases and consumption.

Methods

We conducted a 7-day observational study among adults (25-45 years of age) living in urban areas in the Netherlands. Participants completed a baseline questionnaire, used an app (incorporating global positioning system tracking and ecological momentary assessment) for 7 days, and then completed a closing survey. The app automatically collected global positioning system tracking data, and participants uploaded information on all food purchases over the 7-day period into the app. Participants also answered questions on contextual or individual purchase-related determinants directly after each purchase. During the final 3 days of the study, the participants also uploaded data on fruit, vegetable, and snack consumption and answered similar ecological momentary assessment questions after each intake.

Results

In total, 140 participants completed the study. More than half of the participants said they liked the app (81/140, 57.9%) and found it easy to use (75/140, 53.6%). Of the 140 participants, 126 (90.0%) said that they had collected data on all or almost all purchases and intakes during the 7-day period. Most found the additional ecological momentary assessment questions “easy to answer” (113/140, 80.7%) with “no effort” (99/140, 70.7%). Of 106 participants who explored their trips in the app, 20 (18.8%) had trouble with their smartphone’s global positioning system tracking function. Therefore, we will not be able to include all participants in some of the proposed analyses, as we lack these data. We are analyzing data from the first study aim and we expect to publish the results in the spring of 2020.

Conclusions

Participants perceived the FoodTrack app as a user-friendly tool. The app is particularly useful for observational studies that aim to gain insight into daily food environment exposure and food choices. Further analyses of the FoodTrack study data will provide novel insights into individual food environmental exposure, evidence on the individual food environment-diet interaction, and insights into the underlying individual and contextual mechanisms of food purchases and consumption.

International Registered Report Identifier (IRRID)

DERR1-10.2196/15283

Comparing food desert residents with non-food desert residents on grocery shopping behaviours, diet and BMI: results from a propensity score analysis

OBJECTIVE

To determine whether residence in a US Department of Agriculture-designated food desert is associated with perceived access to healthy foods, grocery shopping behaviours, diet and BMI among a national sample of primary food shoppers.

DESIGN

Data for the present study came from a self-administered cross-sectional survey administered in 2015. Residential addresses of respondents were geocoded to determine whether their census tract of residence was a designated food desert or not. Inverse probability of treatment-weighted regression was used to assess whether residence in a food desert was associated with dependent variables of interest.

SETTING

USA.

PARTICIPANTS

Of 4942 adult survey respondents, residential addresses of 75·0 % (n 3705) primary food shoppers were included in the analysis.

RESULTS

Residence in a food desert (11·1 %, n 411) was not significantly associated with perceived access to healthy foods, most grocery shopping behaviours or dietary behaviour, but was significantly associated with primarily shopping at a superstore or supercentre v. a large grocery store (OR = 1·32; 95 % CI 1·02, 1·71; P = 0·03) and higher BMI (b = 1·14; 95 % CI 0·36, 1·93; P = 0·004).

CONCLUSIONS

Results suggest that food desert residents shop at different food stores and have higher BMI than non-food desert residents.

A free-produce stand on campus: impact on fruit and vegetable intake in Dutch university students

OBJECTIVE

To investigate the effects of providing free fruit and snack vegetables at a university on students' fruit intake, snack vegetable intake and total vegetable intake.

DESIGN

Free fruit and raw snack vegetables (e.g. bite-sized tomatoes) were provided in a stand in the form of a miniature wooden house located in the central hall of the university's main building, which students regularly pass through on their way to lectures and the cafeteria. Three interventions tested with a pre-test/post-test design were performed. In these three interventions, small changes to the appearance of the stand were made, such as placing potted plants around it. Demographic characteristics and fruit and vegetable intakes were assessed with questionnaires.

SETTING

A Dutch university of applied science.

PARTICIPANTS

Intervention 1 included 124 students; Intervention 2 included ninety-two students; Intervention 3 included 237 students.

RESULTS

Longitudinal linear regression analyses showed that post-test snack vegetable intake was consistently higher compared with pre-test. In the three interventions, post-test snack vegetable intakes were between 11 and 14 g/d higher than at the pre-test, which is comparable to three bite-sized tomatoes. No differences in fruit intake or total vegetable intake were found. Subgroup analyses showed that, in all three interventions, students with the lowest pre-test fruit intake and total vegetable intake reported the largest increase in fruit intake and snack vegetable intake after the interventions.

CONCLUSIONS

Providing free fruit and vegetables to students at their university might be beneficial for those with low habitual intakes.

Association of change in the neighborhood obesogenic environment with colorectal cancer risk: The Multiethnic Cohort Study

Background

Neighborhood environment has been associated with health behaviors. Despite the evidence of the influence of neighborhood social and physical factors on cancer risk, no research has evaluated whether changes in the neighborhood obesogenic environment, either by physical moves to different neighborhoods or experiencing neighborhood redevelopment or neglect, affect cancer risk.

Methods

The association of change in neighborhood environment attributes (socioeconomic status, population density, restaurant and retail food environments, numbers of recreational facilities and businesses, commute patterns, traffic density, and street connectivity) with colorectal cancer (CRC) risk was examined among 95,472 Los Angeles, CA, Multiethnic Cohort participants, including 2295 invasive CRC cases diagnosed between 1993 and 2010 using Cox proportional hazards regression, adjusting for age, race/ethnicity, other risk factors including BMI and physical activity, and baseline levels of neighborhood attributes. Stratified analyses were conducted by racial/ethnic group and moving status.

Results

40% of participants moved (changed physical residence) during follow-up. Across all races/ethnicities, upward change in population density was statistically significantly associated with higher CRC risk among male and female non-movers (HR: 1.35 and 1.41, respectively). The same association was also observed separately among female African American and Japanese American non-movers, male Latino non-movers, female African American and male White movers. Downward change in population density was significantly related to higher CRC risk among female non-movers (HR: 1.33). Downward change in traffic density was associated with lower CRC risk among male non-movers but with higher CRC risk among female movers (HR: 0.66 and 1.43, respectively). Downward changes in street connectivity or the number of recreational facilities were associated with higher CRC risk (HR: 1.34 and 1.54, respectively). Upward change in the number of recreational facilities was associated with lower CRC risk among female non-movers (HR: 0.70). Changes in the other neighborhood attributes did not exhibit significant associations with CRC risk within more than one racial/ethnic group.

Conclusion

Changes over time in neighborhood attributes have an effect on the risk of colorectal cancer, which is separate from the baseline levels of the same attributes and individual-level risk factors, and differs between sexes, movers and non-movers and across racial/ethnic groups.

•

A person's neighborhood environment can change due to physical moves or neighborhood redevelopment.

•

Association of change in neighborhood environment with colorectal cancer risk was examined.

•

The California part of the Multiethnic Cohort was used for the analysis.

•

Upward change in population density was associated with higher colorectal cancer risk among non-movers.

[Research on Healthy Neighborhood Evaluation System Based on the Combined Perspectives of Urban Planning and Public Health]

Neighborhoods are places where people spend the most time in their lives. Neighborhoods have a decisive impact on the residents' health. With several important tasks, including the transformation of old neighborhoods, the maintenance of existing neighborhoods, and the construction of new neighborhoods in the future, a scientific and reasonable evaluation standard is urgently needed to guide the development of healthy neighborhoods. To build the evaluation system, this paper first clarifies the principles for selecting evaluation indicators, which include: 1) the indicators are selected from a humanistic perspective; 2) the pathways between neighborhoods environment and health outcomes are deeply considered; 3) the indicators are selected from multiple scales. Secondly, based on the combined perspectives of urban planning and public health, it identifies the indicators that affect the residents' health in neighborhoods and searches the literature through the quality assessment to provide evidence to support the accuracy and effectiveness of the indicators. Finally, it proposes prospect to the evaluation, including 1) it is urgent to improve and utilize the healthy neighborhoods based on the Chinese condition; 2) advanced technologies need to be widely applied in neighborhoods in the future; 3) the transitions in cities should be considered in the future development of neighborhoods. It hopes that relevant researchers and government leaders to realize the importance and urgency of healthy neighborhoods to build more healthy neighborhoods in China.

Impact of Changes in the Food, Built, and Socioeconomic Environment on BMI in US Counties, BRFSS 2003-2012

OBJECTIVE

Researchers have linked geographic disparities in obesity to community-level characteristics, yet many prior observational studies have ignored temporality and potential for bias.

METHODS

Repeated cross-sectional data were used from the Behavioral Risk Factor Surveillance System (BRFSS) (2003-2012) to examine the influence of county-level characteristics (active commuting, unemployment, percentage of limited-service restaurants and convenience stores) on BMI. Each exposure was calculated using mean values over the 5-year period prior to BMI measurement; values were standardized; and then variables were decomposed into (1) county means from 2003 to 2012 and (2) county-mean-centered values for each year. Cross-sectional (between-county) and longitudinal (within-county) associations were estimated using a random-effects within-between model, adjusting for individual characteristics, survey method, and year, with nested random intercepts for county-years within counties within states.

RESULTS

A negative between-county association for active commuting (β = -0.19; 95% CI: -0.23 to -0.16) and positive associations for unemployment (β = 0.17; 95% CI: 0.14 to 0.19) and limited-service restaurants (β = 0.13; 95% CI: 0.11 to 0.14) were observed. An SD increase in active commuting within counties was associated with a 0.51-kg/m² (95% CI: -0.72 to -0.31) decrease in BMI over time.

CONCLUSIONS

These results suggest that community-level characteristics play an important role in shaping geographic disparities in BMI between and within communities over time.

Associations between eating behaviors, diet quality and body mass index among adolescents

OBJECTIVE

Some eating behaviors are associated with negative nutrition-related outcomes in adults, but research is lacking in adolescent samples. The current study examined whether dietary restraint moderates the relationship between disinhibition and weight outcomes and overall diet quality in a community sample of 16-year old adolescents.

METHODS

Participants were recruited from a longitudinal study examining self-regulation and cardiometabolic risk. Data for this cross-sectional study were collected from questionnaires and laboratory visits when participants were approximately 16 years old (n = 178). Disinhibition and restraint were assessed using two subscales of the Three-Factor Eating Questionnaire. Diet quality was determined using Healthy Eating Index-2010 (HEI-2010) scores that were calculated using dietary data from 24-h dietary recalls. Two separate hierarchical linear regression analyses tested whether restraint moderated the associations of disinhibition with BMI-for-age percentile and HEI-2010 scores.

RESULTS

After adjusting for covariates, restraint moderated the association between disinhibition and HEI-2010 scores (β = -0.21, p = 0.03). There was a main effect for disinhibition on BMI-for-age percentiles (β = 0.58, p = 0.02), but this relationship was not moderated by the level of restraint.

CONCLUSIONS

The relationship between disinhibition and overall diet quality differed among adolescents according to level of dietary restraint. Although disinhibition independently predicted weight status, the level of restraint had no influence on this association. Future studies should examine restraint in relation to energy intake and weight concerns to better understand how it influences weight and dietary outcomes in this population.

Caregiver perceptions of the neighborhood food environment and their relationship with the home food environment and childhood obesity in Northeast China

OBJECTIVE

To examine the relationships between caregiver perceptions of their neighborhood food environment and home food environment and between caregiver perceptions of neighborhood food environment and childhood obesity.

DESIGN

Cross-sectional.

SETTING

A total of twenty-six primary schools in northeast China.

PARTICIPANTS

Anthropometric measurements and questionnaire surveys were carried out on 3670 children (aged 9-12 years) and their caregivers.

RESULTS

Children of caregivers who perceived high local healthy food availability were more likely to always have fruits, vegetables, 100% juice, and low-fat milk or skim milk in their homes. Children of caregivers who perceived fast-food shopping to be easy were more likely to eat out for fast food. Children of caregivers who perceived high general access to food shopping were less likely to always have fruits, vegetables, and sugar-free breakfast in their home, and were more likely to eat out for fast food.

CONCLUSIONS

Future public health programs and interventions should take into consideration the role caregivers play in connecting neighborhood food environments with the home food environment.

Obesity and the Built Environment: A Reappraisal

The built environment (BE) has been viewed as an important determinant of health. Numerous studies have linked BE exposure, captured using a variety of methods, to diet quality and to area prevalence of obesity, diabetes, and cardiovascular disease. First-generation studies defined the neighborhood BE as the area around the home. Second-generation studies turned from home-centric to person-centric BE measures, capturing an individual's movements in space and time. Those studies made effective uses of global positioning system tracking devices and mobile phones, sometimes coupled with accelerometers and remote sensors. Activity space metrics explored travel paths, modes, and destinations to assess BE exposure that was both person and context specific. However, as measures of the contextual exposome have become ever more fine-grained and increasingly complex, connections to long-term chronic diseases with complex etiologies, such as obesity, are in danger of being lost. Furthermore, few studies on obesity and the BE have included intermediate energy balance behaviors, such as diet and physical activity, or explored the potential roles of social interactions or psychosocial pathways. Emerging survey-based applications that identify habitual destinations and associated travel patterns may become the third generation of tools to capture health-relevant BE exposures in the long term.

University food environment: characterization and changes from 2011 to 2016 in a Brazilian public university

ABSTRACT Objective To describe the food environment of a public university located in the city of Rio de Janeiro, Brazil, and to review the changes that occurred between the years 2011 and 2016. Methods Time trend study (through repeated cross-sectional studies) of the sale of food, culinary preparations and beverages in the University Campus establishments in 2011, 2012 and 2016. Variables regarding the description of the establishments and the offer, price and advertising of food, beverages and culinary preparations were assessed through a checklist. Comparisons between establishments in each year and the analysis of such comparison changes during the period were performed by assessing the difference between absolute and relative values observed in each year. Results Increased number of establishments available, good convenience and financial accessibility were observed. There was a relative disadvantage in the availability of fresh or minimally processed foods and culinary preparations; a predominance of advertising of ultra-processed foods; and lack of nutritional information of culinary preparations. The predominance of establishments selling snacks and candies increased over the years. Conclusion In the period studied, the university food environment did not favor healthy food choices.

Study on the Impact of the Objective Characteristics and Subjective Perception of the Built Environment on Residents’ Physical Activities in Fuzhou, China

Many researchers have confirmed a correlation between the built environment and physical activity. However, most studies are based on the objective characteristics of the built environment, and seldom involve the residents’ subjective perception. The purpose of this study is to explore the relationship between the subjective and objective characteristics of the built environment and physical activity at the community scale. Data consists of that collected from a social survey, Points of Interest (POI), the road network, and land use in Fuzhou, China. The duration of moderate-to-vigorous physical activity (MVPA) within a week is used to represent the general physical activity of residents. Security perception is introduced as an intermediary variable. SPSS software is used for factor analysis and Amos software for statistical analysis. Structural equations are set up to analyse the relationship between these variables. The final results show that: (1) The objective characteristics of the built environment have no direct impact on the development of leisure MVPA, but it can indirectly affect leisure MVPA through residents’ subjective perception of the built environment; (2) The subjective perception of residents has a significant impact on the duration of MVPA, the subjective perception of humanized space has a direct impact on the duration of MVPA, and destination accessibility and urban environment maintenance has an indirect impact through community public security perception; and (3) The individuals’ attributes such as gender and self-evaluated socioeconomic status have negative effects on the duration of leisure MVPA, and an individual’s love of sports has a positive effect on MVPA.

Australian Consumer Perceptions of Regionally Grown Fruits and Vegetables: Importance, Enablers, and Barriers

Fresh fruits and vegetables are a cornerstone of a balanced diet; their consumption has health, environmental, ethical, and economic implications. This pilot study aimed to: (i) measure fruit and vegetable consumption; (ii) understand consumer perceptions of the perceived importance of regionally grown fresh fruit and vegetables (RGFFV); and (iii) identify the barriers and enablers of access and consumption of RGFFV. The study took place in Tasmania (TAS) and South Western Australia (SWA). A 54-item survey included questions relating to purchasing and consumption patterns; barriers and enablers related to access and consumption of RGFFV; and sociodemographic information. Survey data were analyzed using Chi-square test and binary logistic regression. A total of n = 120 TAS and n = 123 SWA adult respondents participated. SWA respondents had higher intakes of fruit (p < 0.001) and vegetables (p < 0.001). Almost all respondents (97%) rated purchasing of RGFFV as important. Top enablers included produce freshness (97%), and to financially support local farmers (94%) and the local community (91%). Barriers included limited seasonal availability of the produce (26%), the belief that RGFFV were expensive (12%) and food budgetary constraints (10%). Recommendations include broader marketing and labelling of seasonal RGFFV; increasing ‘buy local’ campaigns; consumer information about how RGFFV benefits producers and communities; and pricing produce according to quality.

Gut Peptide Agonism in the Treatment of Obesity and Diabetes

Obesity is a global healthcare challenge that gives rise to devastating diseases such as the metabolic syndrome, type-2 diabetes (T2D), and a variety of cardiovascular diseases. The escalating prevalence of obesity has led to an increased interest in pharmacological options to counteract excess weight gain. Gastrointestinal hormones such as glucagon, amylin, and glucagon-like peptide-1 (GLP-1) are well recognized for influencing food intake and satiety, but the therapeutic potential of these native peptides is overall limited by a short half-life and an often dose-dependent appearance of unwanted effects. Recent clinical success of chemically optimized GLP-1 mimetics with improved pharmacokinetics and sustained action has propelled pharmacological interest in using bioengineered gut hormones to treat obesity and diabetes. In this article, we summarize the basic biology and signaling mechanisms of selected gut peptides and discuss how they regulate systemic energy and glucose metabolism. Subsequently, we focus on the design and evaluation of unimolecular drugs that combine the beneficial effects of selected gut hormones into a single entity to optimize the beneficial impact on systems metabolism. © 2020 American Physiological Society. Compr Physiol 10:99-124, 2020.