The local food environment and diet: a systematic review

Physical and online food outlet availability and its influence on out-of-home dietary behaviours in Great Britain: A repeated cross-sectional study

Background

As online food delivery service (OFDS) platforms gain popularity, understanding their impact on diet alongside physical food outlets is important for addressing suboptimal dietary quality. This study examined the independent and combined associations between physical and online food outlet availability and out-of-home dietary behaviours in 2019 and 2022. We also explored whether associations between physical outlet availability and dietary behaviours are modified by online food outlet availability.

Methods

In this repeated cross-sectional analysis, we used British data from the adult International Food Policy Study (IFPS) in 2019 (n = 2912) and 2022 (n = 3544). Postcodes were used to assess neighbourhood food outlet availability using Ordnance Survey data and to determine OFDS availability on three platforms through web scraping. Associations were examined between neighbourhood outlet and OFDS availability with self-reported frequency of physical food outlet use, online food outlet use, and consuming meals prepared out-of-home.

Results

In 2019 and 2022, both neighbourhood and OFDS availability were positively associated with all outcome measures. In 2019, after mutual adjustment, both availability measures remained associated with online food outlet use and consuming meals prepared out-of-home. However, in 2022, only OFDS availability was associated with these outcomes. For example, a one standard deviation increase in OFDS availability was associated with a 9% (95%CI 3%-14%) increase in frequency of consuming meals prepared out-of-home after adjusting for neighbourhood outlet availability. OFDS availability also modified associations between neighbourhood outlets and both online food outlet use and out-of-home meal consumption. As OFDS availability increased, the link between neighbourhood outlets and out-of-home meal consumption weakened.

Conclusion

Neighbourhood outlet availability may influence out-of-home dietary behaviours, but its impact appears to weaken when OFDS availability is considered. Public health strategies should address the growing influence of OFDS platforms to improve dietary quality.

Association of food environment with diet quality and Body Mass Index (BMI) of school-going adolescents in Nepal

BACKGROUND

Adolescents are being more vulnerable to non-communicable diseases (NCDs). A healthy food environment is crucial in maintaining a healthy diet and achieving better health outcomes. This study aimed to determine how certain features of home food environment affect diet quality and Body Mass Index (BMI) of school-going adolescents.

METHODS

We conducted a cross-sectional analytical study among 678 school-going adolescents aged 15-19 years in Budanilkantha municipality of Kathmandu, Nepal. We assessed home availability of food items in the past day, walking time needed to reach nearest shops from home, parental modeling, and parenting style. Furthermore, we assessed diet quality using a Diet Quality Questionnaire as Global Dietary Recommendations (GDR) Score and measured height and weight of participants to calculate BMI. We used multiple regression models to analyze data, all statistical analyses were performed using STATA-14.

RESULTS

Of 678 participants, 51.92% were males, and mean age was 15.56 years. Those who had to walk > 20 minutes to reach nearest vegetable shop had an average 1.44 point lower GDR Score (95% CI: -2.08, -0.19) than those with vegetable shops at their home. Those who had processed meat at home in the past day had 1.61 points lower GDR Score (95% CI: -1.95, -1.28), those with fruits and vegetables had 0.74 points lower GDR Score (95% CI: 0.48, 1.00) as compared to those who didn't have. Participants who had starchy staple available had a BMI score lower by 5.59 kg/m2 on average (95% CI: - 10.78, - 0.40), and when two participants whose parental modeling scores differed by a unit were compared, the one with a higher score had on an average 0.19 kg/m2 greater BMI (95% CI: 0.01, 0.37).

CONCLUSION

This study highlights impact of home food environment on diet quality and BMI among adolescents in urban Nepal. Availability of healthy foods positively affects diet quality, while unhealthy items negatively influences it. Future research should explore wider food environmental factors and intervention strategies to improve adolescents' diet quality.

Perceptions of dietary sugar consumption among public housing residents using a modified qualitative photovoice methodology

BACKGROUND

Consumption of dietary sugar (e.g. sugar-sweetened beverages and high sugar foods) is a predominant contributor to chronic health conditions, particularly in communities of low socio-economic position. Our objective was to explore social contextual influences on dietary sugar consumption among public housing residents in Boston, MA.

METHODS

This study employed the use of photovoice, a qualitative technique involving participant photography and narratives. Due to the COVID-19 pandemic, we conducted photovoice methods using Zoom. Adult residents of two public housing developments were invited to participate in pairs of online group sessions. The first session provided training on photovoice methodology and a discussion of example photographs and written narratives. Over the ensuing two weeks, participants took or identified stock photos as visual examples of personally-experienced barriers and facilitators of avoiding sugary foods and beverages. During the second session, study staff facilitated development of verbal narratives via group discussion. A total of 18 sessions were audio recorded, transcribed, and double-coded for themes.

RESULTS

Participants (n = 49) were predominantly women and identified as either Hispanic (61.2%) or non-Hispanic Black (30.6%). Approximately half of participants (51.1%) reported consuming sugar-sweetened beverages at least once per day. Qualitative analysis revealed participant-identified influences on dietary sugar consumption across multiple domains of influence, including individual preferences, beliefs, or circumstance, the social environment, the physical environment, and the macro environment.

CONCLUSIONS

The multiple social contextual influences on dietary sugar consumption identified in this study, particularly centrality of the home, cultural influences, individual-level sabotaging factors, may be useful for development of culturally tailored health promotion messaging and intervention through multiple channels.

Changes in the healthfulness of food and beverage purchases from 2006 to 2022 by outlet type in Mexico

BACKGROUND

To better inform retail food environment policies in the global south, it is necessary to further understand the healthfulness of food and beverages purchased by type of food outlet over time.

METHODS

Using repeated cross-sectional data from the National Income and Expenditure Survey (ENIGH) in Mexico (2006 to 2022), we estimate the percentage of food and beverage purchases by processing level for each food outlet for the overall population and stratify by education (proxy of socioeconomic status) and urbanicity levels.

RESULTS

In 2006, the food outlets with the largest proportions of ultra-processed foods purchases were chain convenience stores (49%), small neighborhood stores (37%), and supermarkets (35%). In contrast, the outlets with the highest proportions of minimally processed food purchases were street markets (83%), public markets (81%), and specialty stores (75%). Over time, households increased the proportion of expenditure in minimally processed foods in supermarkets and slightly in small neighborhood stores (49 to 54% and 46 to 47%, respectively). Conversely, the proportion of expenditures in minimally processed foods decreased from 70 to 62% in street vendors. Households without formal education and residing in rural areas increased their minimally processed food purchases in specialty stores, but decreased in street vendors, acquaintances, and public markets. Households with higher education and residing in more urbanized areas increased their purchases of minimally processed foods in supermarkets and small neighborhood stores and decreased in street vendors. These households also increased their purchases in ultra-processed foods in chain convenience stores.

CONCLUSIONS

There is a wide range of food outlets in Mexico, each with varying levels of healthfulness. While purchases in supermarkets have become healthier, particularly among higher socioeconomic households and in larger cities, small neighborhood stores have also shown improvements, especially in lower-income households and smaller cities. Since no outlet exclusively sells healthy or unhealthy foods, policies should focus on where people make the majority of their purchases and address healthfulness variations based on education level education and urbanization.

Food purchasing places classification system based on the Dietary Guidelines for the Brazilian Population: Locais-Nova

OBJECTIVE

To propose a new classification system for food purchasing places (Locais-Nova) based on the Dietary Guidelines for the Brazilian Population.

METHODS

We used 2017-2018 Brazilian Household Budgets Survey data on household food purchasing. Foods were categorized, according to the Nova classification, into unprocessed or minimally processed food, processed culinary ingredients, processed foods and ultra-processed foods. We estimated the average share of each Nova classification group in the total of grams acquired in Brazil. This estimate was compared with the average share of each Nova classification group in each of the 16 purchasing places assessed. Places were classified as "purchasing sources" for a specific Nova classification group whenever that group's share a given place was equal to or greater than the national average.

RESULTS

Locais-Nova identified three categories of purchasing places: sources of unprocessed or minimally processed food and processed culinary ingredients, sources of processed foods and sources of ultra-processed foods. Fruits, vegetables, and farm products and butcher shops stood out as the main sources of unprocessed or minimally processed food; minimarkets and grocery stores were the main sources of ultra-processed foods; and bakeries and confectionaries, stood out as sources of processed and ultra-processed foods. Supermarkets were classified as sources of unprocessed or minimally processed food and ultra-processed foods.

CONCLUSION

This study presented an innovative classification of food purchasing places. This reflected the recommendations of the Dietary Guidelines for the Brazilian Population and made it possible to understand food purchasing patterns in different types of purchasing places.

A Human-Centred Co-Design Framework for Developing a Web-Based Platform to Engage With Rural Australian Communities: Addressing the Complex Issue of Healthy Food Access

OBJECTIVE

This report presents the co-design framework for developing, prototyping, testing and implementing a Web-based Platform (WBP) that will use participatory approaches to engage rural communities.The WBP will be used to understand the unique factors influencing access to healthy and unhealthy foods and to generate potential solutions for promoting healthier diets.

METHODS

A human-centred design (HSD) approach will be used to ideate, prototype, test and implement the WBP.

DESIGN

Participatory Action Research.

SETTING

Two rural local government areas in Australia.

PARTICIPANTS

Participants will include key stakeholders from each local government's relevant public health organisations, in addition to community members.

MAIN OUTCOME MEASURES

Reach (number, cohort representation and geographic spread) of active participants in the co-design process, community members that used the WBP tool and adoption (completion of WBP activities).

RESULTS

A usable platform for communities to generate local solutions to drive change for diverse populations within rural communities in Australia.

DISCUSSION

Significant advances and innovative approaches are needed to address the challenges of accessing healthy food in rural areas.

CONCLUSIONS

The resulting WBP has the potential to work at scale for communities in Australia and internationally in designing effective place-based solutions.

Understanding Barriers and Strategies to Accessing Healthy Food in Urban Agriculture for Community Residents in Predominantly Black Communities

BACKGROUND

Some residents in predominantly Black communities face significant challenges in accessing healthy food. However, urban agriculture is a growing sector that aims to increase overall food production, access to affordable and nutritious produce, and potentially improve community food security.

PURPOSE

This study aimed to provide insight into barriers and strategies that urban agriculture growers and advocates identified for accessing urban agriculture markets in their communities.

RESEARCH DESIGN AND STUDY SAMPLE

We interviewed and conducted focus groups with 17 urban growers and local food advocates that work in predominantly Black communities in Chicago.

DATA COLLECTION AND/OR ANALYSIS

Understanding the complexities of access to healthy food can be challenging; therefore, we used the concept of access - accessibility, availability, affordability, accommodation, and acceptability - to better understand these barriers.

RESULTS

Key barriers were the lack of accessibility to traditional food retailers, high availability of processed foods, and cultural acceptability of urban-produced foods.

CONCLUSION

Building urban agriculture networks to support growers, connect with consumers, and emphasize political engagement can help to diversify and grow urban agriculture.

Effect of fast-food environments on children's eating behaviour: A random effect within between analysis within the Generation R Study

BACKGROUND

Focussing on appetitive traits associated with obesity, this study aimed to estimate the association between the fast-food environment and satiety responsiveness, enjoyment of food and food responsiveness.

METHODS

We used data from the Generation R Study. We included 2008 children with repeated measurements at the age of 4-10 years old. Three eating behaviour subscales from the Child Eating Behaviour Questionnaire (CEBQ) were used as outcomes. Geographical Information System data were used to map individual-level exposure to fast-food outlets within 400 m from home. Random Effect Within Between (REWB) models were used to derive estimates. We tested for moderation of the associations with parental restriction at baseline using the parent-reported Child Feeding Questionnaire (CFQ).

RESULTS

We did not find evidence of between-associations of fast-food exposure and eating behaviour subscales. Considering within-associations, an increase in absolute fast-food exposure was associated with a significant marginal increase in satiety responsiveness (β: 0.02 [95% confidence interval: 0.00-0.03]). No moderation by parental restriction was found.

CONCLUSIONS

In environments with ubiquitous fast-food outlets, an increased exposure to fast-food outlets does not seem to have a substantial impact on eating behaviour. Further research is needed to better understand how fast-food exposure contributes to overweight.

Food Outlets in Montevideo: Implications for Retail Food Environment Research in the Majority World

OBJECTIVE

To identify food outlets in Montevideo, Uruguay and to compare the types of outlets selling different food groups across areas of the city with different socioeconomic status (SES).

DESIGN

Cross-sectional field survey of outlets selling foods and beverages conducted between September, 2023 and February, 2024.

SETTING

A sample of 106 census tracts was obtained using probability proportional to size sampling.

PARTICIPANTS

All outlets selling foods and beverages within the census tracts.

MAIN OUTCOME MEASURE

Number, density, and distribution of food outlets selling different food groups.

ANALYSIS

Kruskal-Wallis, Fisher exact test, and chi-square test of independence were used to compare outcome measures in census tracts with different SES.

RESULTS

A total of 1,217 food outlets were identified. Small stores corresponded to a relevant share of the outlets selling unprocessed foods, whereas ultraprocessed products were ubiquitous. The proportion and density of food outlets selling fruits and vegetables and fresh meat were significantly higher (P < 0.05) in low SES tracts. The distribution of outlets selling different food groups significantly (P < 0.01) differed across tracts.

CONCLUSIONS AND IMPLICATIONS

Results highlight the importance of capturing the local food sources that shape the availability of healthy and unhealthy foods in the majority world.

Association of activity-based food environment index with obesity-related cancer mortality in the US

BACKGROUND

Obesity and obesity-related cancers contribute to rising healthcare costs and declining life expectancy in the US and improving diet quality plays a crucial role in reversing such trends. Existing studies on the relationship between healthy food access and obesity-related cancer mortality present mixed findings, whereas food procurement activities are largely overlooked. The paper aims to construct a novel food environment index based on residents' food retailer visits, and then compare it with the location-based food environment index regarding the strength of associations with obesity-related cancer mortality rates.

METHODS

This cross-sectional ecologic study used business location data from InfoGroup and aggregated GPS-based food retailer visit data from SafeGraph in 2018-2019, and mortality data from the Centers for Disease Control and Prevention in 2015-2020. A total of 2925 counties or equivalents with complete information were included. Activity-based index was calculated as the percentage of visits to healthy food retailers out of total visits to all qualified food retailers for residents in each county. Location-based index was calculated as the percentage of healthy food retailers out of all qualified food retailers in each county. The main outcome is age-adjusted obesity-related cancer (13 types of cancer based on evidence from the International Agency for Research on Cancer) mortality rates, which were calculated for each county and counties were further categorized into high- and low-risk (≥ 60.2 and < 60.2 cases per 100,000 population) areas. Linear, non-linear, logistic, and spatial regression analyses were performed to examine the association between each food environment index and obesity-related cancer mortality rates.

RESULTS

The activity-based index demonstrated significant negative association with the 2015-2020 obesity-related cancer mortality rates (coefficient [95% CI]: - 0.980 [- 1.385, - 0.575], P < 0.001), and each standard deviation increase in the activity-based index was associated with an 18% decrease in the odds of being in a high-risk area (odds ratio [95% CI]: 0.821 [0.749, 0.900], P < 0.001), while the location-based index showed much weaker and non-significant effects.

CONCLUSIONS

Our findings suggest that health policies and initiatives that combat obesity and obesity-related cancers should consider incorporating food retailer visits into policy formation.

The emergence of meal delivery applications: a research agenda to advance the next decade of progress in nutrition

The United Nations Decade of Nutrition was declared on 1 April 2016 to accelerate action to achieve global nutrition and diet-related non-communicable disease targets by 2025. Meal delivery applications offering takeaway meals and ready-to-eat foods from restaurant kitchen to doorstep via a third-party courier, have proliferated as a new digital dimension to traditional food environments. These digital platforms threaten to disrupt progress towards creating a health-enabling food environment. This article outlines the emergence of the digital food environment-its dimensions, actors and target users, and critically appraises the research on the public health impact of meal delivery applications to-date. We propose a research agenda to measure, monitor and mitigate the risks which meal delivery applications pose to population health and wellbeing, which may impact the United Nation's Decade of Action on Nutrition. The rapidly evolving digital era of new technologies and innovation presents a unique window of opportunity for public health research and policy.

The rural food environment and its association with diet, nutrition status, and health outcomes in low-income and middle-income countries (LMICs): a systematic review

BACKGROUND

The food environment consists of external and personal domains that shape food purchasing decisions. While research on food environments has grown rapidly within high-income countries (HICs) in response to increasing rates of overweight, obesity, and non-communicable diseases (NCDs), critical research gaps remain. The role of food environment on diet, health and nutrition has been understudied in LMICs. To date, there has not been a systematic review specifically focusing on rural LMICs. This systematic review aims to synthesize findings from studies examining the association between rural food environment domains and diet, nutrition and health in LMICs or effects of food environment interventions on these outcomes.

METHODS

Searches were conducted from 9 databases: Medline (PubMed), Embase (Ovid), Global Health (Ovid), PsycINFO (Ovid), EconLit (EBSCOhost), Web of Science (Social Science Citation Index), Scopus, CINAHL (EBSCOhost), and Applied Social Sciences Index and Abstracts (ProQuest) to identify studies published between 2000 and 2023 that reported associations between this/these dimensions with diets, nutrition or health outcomes. Both quantitative and qualitative studies that were published in English were included. Data extraction and quality appraisal was conducted independently by two authors, before the study findings were collated and summarized through a narrative data synthesis.

RESULTS

Nineteen eligible studies were identified from 9 databases covering 11 LMICs. The included studies employed quantitative (n = 12), mixed method (n = 6) and qualitative (n = 1) designs in the neighbourhood food environment. In this review, availability dimension of the external food environment featured most prominently, followed by accessibility, affordability, desirability, and convenience dimensions of the personal food environment. Food availability was positively associated with diet (n = 10), nutrition (n = 7) and health (n = 1). There was good evidence regarding associations between food accessibility, diet (n = 7) and nutrition (n = 3). We identified some evidence that food price and affordability (n = 8) were considered key barriers to achieving healthy diets. Desirability (n = 4) and convenience (n = 2) dimensions were also associated with dietary outcomes, although we found only a few studies. Only one South African qualitative study was identified which highlighted limited availability and accessibility to local supermarkets and surrounding informal fruit and vegetable vendors to be a barrier to expensive, healthy foods consumption. Finally, evidence regarding health outcomes, sustainability dimension, impacts of food environment interventions on relevant outcomes and interactions between food environment dimensions was missing. Overall, seven out of nineteen studies were rated as good quality, six were rated as fair and six were rated as poor.

CONCLUSIONS

Future interventions should consider improving availability and accessibility of nutritious foods to improve public health nutrition in rural LMICs. Evidence from studies assessing the workplace, home, and school food environments, food environment interventions, sustainability dimension and other key dimensions of the external food environment such as prices, vendor and product properties and marketing and regulation is needed to identify effective interventions to address malnutrition in all its forms characterized by the coexistence of undernutrition, overnutrition, undernutrition and diet-related non-communicable diseases (NCDs).

Diet, fruit and vegetables and One Health: benefits for health, environment, society and the consumer-proceedings of the 9th edition of EGEA conference

PURPOSE

To present the outcomes of the EGEA Conference on the state of knowledge regarding the contribution of diets rich in fruit and vegetables (FV) to human and planetary health, commonly included in the One Health concept.

METHODS

The 9th edition of EGEA Conference (20-22 September 2023, Barcelona) provided a transversal and multidisciplinary perspective on the contribution of FV to One Health, in particular to the health of individuals, society and the planet. Nearly 150 international scientists and stakeholders discussed the current state of knowledge. These proceedings are based both on a literature review and the scientific studies presented by the speakers.

RESULTS

Scientific evidence confirms the role of FV in preventing cardiovascular diseases and type 2 diabetes; more evidence is needed on the effects and mechanisms of FV in cancer prevention. FV production and consumption helps ensure territorial cohesion and provides a denser, nutrient-rich diet with less environmental impact (except water use) than other food groups, but use of synthetic pesticides in FV production remains a challenge that could be addressed with agro-ecological solutions. Various factors influence consumer choice and behaviour towards FV consumption across the lifespan, with specific periods being more conducive to change. New research is emerging on the role of FV consumption in regulating gut microbiota and on both mental and brain health; the potential role of FV production and supply in tackling biodiversity loss and climate change; and better monitoring of FV consumption.

CONCLUSION

Sufficient evidence confirms the contribution of diet rich in FV to One Health, with some emerging research on this topic. Concerted actions are required towards an increased consumption of FV and a more diversified and environmentally neutral FV production.

Does outdoor advertising correlate with retail food purchases made by adolescents? A cross-sectional study in Canada

Food marketing plays a substantial role in shaping adolescent diets, having wide-ranging ramifications for health behaviours and outcomes throughout the life course. Yet, there remains a dearth of research about how outdoor advertising as a specific channel of food marketing affects purchasing behaviours. We examine self-reported purchases made at retail food outlets by adolescents as it relates to the availability of outdoor food and beverage advertising around each participant's home, school, and along the journey to and from school. We also consider the impacts of sociodemographics and consumption attitudes on purchasing, as compared to the geographic availability of outdoor advertising. Data are drawn from a survey completed by 545 adolescents in 2018 across four secondary schools in the Middlesex-London region of Ontario, Canada. The availability of outdoor advertising in the home and school environment is marginally correlated with self-reported purchases made at fast food, table-based, grocery, and variety retail outlets. However, consumption attitudes, cultural background, and gender are significantly correlated with purchases, with substantially larger effect sizes. The overall results were consistent between estimating the availability of outdoor advertising in the immediate area surrounding the home and along the journey to and from school. There is considerable health promotion policy interest in regulating outdoor advertising around child-serving locations. However, scarce health promotion resources would be better allocated to educational programming that addresses the substantial role of consumption attitudes in affecting adolescent purchasing behaviour, as compared to the considerably weaker impact of outdoor food advertising observed in our analysis.

The association of neighborhood walkability and food environment with incident cardiovascular disease in The Maastricht Study

Built environmental determinants can drive lifestyle behaviors and potentially reduce chronic disease prevalence. Few studies exist that have examined the association of obesogenic environment exposures with cardiovascular disease (CVD) outcomes. We aim to specifically examine the association between neighborhood walkability, food environment and CVD. Data from 6117 Dutch participants of The Maastricht Study, between the ages of 40 and 75 years in the Netherlands were examined. Home addresses were linked to geographic information systems data from the Geoscience and Health Cohort Consortium to create neighborhood exposures of walkability and food environment. Perceived walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. An 11-year incidence of CVD was defined by self-reported non-fatal or fatal event (as registered by Statistics Netherlands). Cox regression models examined the association of environment exposures with incident CVD adjusted for demographic and socioeconomic variables. There was lower incidence of CVD using the perceived walkability questionnaire in those living in the most walkable neighborhood (Quartile 4 HR: .77; 95% CI = .62, .97) but not using the objective walkability index (Quartile 4 HR: 1.10; 95% CI = .89, 1.38). There was no association between the food environment and incident CVD (Quartile 4 HR: .82; 95% CI = .65, 1.04). The discordant findings between walkability measures suggest integrating residential feedback and accounting for lived experiences should be prioritized by policymakers when designing equitable neighborhoods to prevent CVD.

Making the Healthy Choice the Easy Choice: Examining the Food Environments Surrounding South Carolina's Historically Black Colleges and Universities (HBCUs)

PURPOSE

To understand the distribution of healthy and unhealthy food stores and restaurants around historically Black colleges and universities (HBCUs) in South Carolina.

DESIGN

DatabaseUSA and ArcGIS Pro were used to identify, classify, and map food stores and restaurants near each HBCU.

SETTING

The study area included a 3-mile buffer radius around the eight South Carolina HBCUs.

SUBJECTS

A total of 654 food stores and restaurants were identified within a 3-mile radius of the HBCUs.

MEASURES

Demographic data for each HBCU was collected from the National Center for Education Statistics. The food stores and restaurants were identified using Standard Industrial Classification (SIC) codes and descriptions, and they were classified using previous research methodologies.

RESULTS

Based on the analysis, 19 (2.9%), 237 (36.2%), and 398 locations (60.9%) were classified as healthy, intermediate, and unhealthy, respectively. Within a 0.5-mile radius of the HBCUs, there were no retail food stores classified as healthy, followed by 14 (2.1%) and 23 (3.5%) retail food stores and restaurants that were classified as intermediate and unhealthy, respectively.

CONCLUSIONS

This study shows that most food options around South Carolina HBCUs are unhealthy and that few places are available to purchase healthy food. Eating well will be difficult in the current food environment. Increasing healthy options should be part of a comprehensive approach to promoting good nutrition.

Validation of a Novel Method to Evaluate Community-Based Interventions That Improve Access to Fruits and Vegetables

BACKGROUND

Current evaluation tools are inadequate for assessing the impact of small-scale interventions, such as farmer's markets or community meal programs, on fruit and vegetable consumption. This study analyzes the pilot data of a novel tool designed to evaluate community-based programs' impact on fruit and vegetable consumption. Our research addresses the gap in effective evaluation methods for dietary behaviors within underserved populations.

METHODS

The survey tool was developed through a participatory research approach involving interest holders and community members. We conducted a pilot survey across four community-based programs, validated the findings, and compared them against the data from the Behavioral Risk Factor Surveillance System.

RESULTS

This pilot survey demonstrated a high completion rate of 98.2%. Notably, 62.5% of respondents reported an increased consumption of fruits and vegetables since participating in the programs and cited cost, time, and accessibility as primary barriers to healthy eating. There is a strong, though not significant, correlation of 0.876 (p = 0.12) between the pilot data of prevalence of daily fruit and vegetable consumption and the national average.

CONCLUSION

Our findings suggest the survey tool effectively captures dietary behaviors and the influence of community-based programs. Further research is required to enhance its applicability in diverse settings and extend robust impact evaluation methods for these programs.

The campus food environment and postsecondary student diet: a systematic review

Objective: Examine the impact of the campus food environment on postsecondary students' dietary behaviors (e.g., dietary intake) and food purchasing. Participants: Students currently attending a postsecondary institution, all ages and geographic locations included. Methods: A systematic search from January 2000-October 2022 was conducted in six databases using postsecondary education, food environment, and diet related keywords. Results: In total, 25 quantitative and 10 qualitative studies were extracted. All quantitative studies that conducted statistical analyses (n = 15) reported a statistically significant relationship between the campus food environment and dietary intake, including both positive and negative effects. All qualitative studies (n = 10) discussed students' experience of the campus food environment influencing their diet. Conclusions: This review found moderate evidence that the campus food environment has an impact on postsecondary students' dietary behaviors. A campus environment that has healthy foods accessible, affordable, and acceptable for postsecondary students may have a beneficial impact on students' dietary intake.

Convenience of opening hours of commercial food establishments: barrier or facilitator to healthy food?

The objective was to evaluate the opening hours of establishments selling in natura and mixed foods, located in areas with and without Food and Nutrition Public Establishments (FNPE). A cross-sectional study, carried out in Belo Horizonte, Brazil. Average hours of operation were recorded, and compared between in natura and mixed food establishments (Student's t-test). The functioning of establishments was divided into status and compared between types of establishments (Chi-square). The average operation hours of the establishments were compared according to their location in areas with or without FNPE (Student's t-test). Mixed establishments were open, on average, longer hours than in natura food establishments (p<0.001). The number of mixed establishments open at extended hours (after 18 hours) was significantly higher than the number of in natura establishments (p<0.001), on weekdays (90.9% vs. 67.8%), Saturdays (84. 1% vs. 55.9%) and Sundays (40.9% vs. 3.4%). On weekdays operation of in natura food establishments was lower in areas with FNPE (p<0.05). Mixed establishments open longer hours and are more available during extended hours and on Sundays. Areas with FNPE had lower average opening hours for in natura food establishments.

Identifying mechanisms that shape the food environment in long-term healthcare facilities in the Netherlands: a participatory system dynamics approach

BACKGROUND

Creating healthy and sustainable food environments within long-term healthcare facilities asks for a systemic approach. This study aimed to: (1) identify system dynamics underlying the food environment of long-term healthcare facilities, (2) formulate actions for changing the system to promote a healthy and sustainable food environment and (3) evaluate stakeholder perspectives about the process and progress towards action implementation up to one-year follow-up.

METHODS

A group model building (GMB) approach was used during two workshops with stakeholders of five different long-term healthcare facilities in the Netherlands. Stakeholders created a causal loop diagram (CLD) and formulated actions for change. Interviews were conducted at six- and twelve months to evaluate perspectives on the GMB process and progress towards action implementation.

RESULTS

The developed CLD consisted of 30 factors influencing the food environment in long-term healthcare facilities and four interrelated subsystems (patient; healthcare organization; national governance and policy; purchasing, procurement and budget). Stakeholders formulated 40 corresponding actions. After one year follow-up, small steps towards action implementation were observed (e.g., agenda setting, raising internal awareness, formulating plans), with several barriers hindering implementation being noted (e.g., lack of time, budget, priority).

CONCLUSIONS

This study gained a comprehensive, collectively acknowledged understanding of the system dynamics underlying the food environment in Dutch long-term healthcare institutions. The results underscore the importance of crafting a coherent set of actions that addresses various factors and underlying mechanisms to initiate systemic change. However, achieving actual system changes in long-term healthcare facilities requires prolonged efforts and overcoming barriers towards implementation.

A mixed-methods exploration of the food retail environment of a low-income area of Montevideo, Uruguay

Creating supportive food environments has been identified as one of the most effective strategies to promote healthy diets. In this context, the present work aimed to characterize the retail food environment in a low-income area of the city of Montevideo (Uruguay). The study relied on a mixed-methods approach. A survey of food retail outlets was conducted. All the outlets were geocoded, and service areas were created considering a 600 m threshold. Quantitative information was supplemented with qualitative information from semi-structured interviews with residents and grocery store owners. A total of 415 outlets selling a variety of foods were identified. Adequate physical access to the foods recommended by the Uruguayan dietary guidelines was found in most of the residential areas. Small behind-the-counter grocery stores were identified as the key source of healthy foods in the area. However, the accounts of residents highlighted problems related to the price, variety and quality of the foods sold by the local grocery stores. Therefore, strategies to ensure access to healthy food in the study area should go beyond physical access and tackle food affordability, variety and quality. The promotion of short food supply chains in the area should be a key element of the strategies to achieve sustainable urban food systems in Montevideo.

The "uneven road" to food: Socioeconomic disparities in the mobility burden of food purchasing behavior in major US cities, 2019-2023

Socioeconomic factors contribute to distinct patterns of food-purchasing behaviors, placing a higher burden of mobility on vulnerable, deprived populations. Traditional approaches often overlook the dynamics of human activity as contextual influences, simulating a perceived food environment that contradicts the actual use thereof. The rise of large-scale mobile phone data presents a unique opportunity to capture real behavioral patterns and their mobility implications at a fine-grained level. Using a Time-Weighted Kernel Density Estimation (TWKDE) model on mobile phone data, this study introduces two novel measures - the Spatial Engel's Coefficient (SEC) index and the Distance-to-Activity Curve (DAC) - to assess the equity of food-purchasing travel across nine U.S. cities over five years, analyzed by socioeconomic status, time period, and location. Our findings reveal that lower socioeconomic status is strongly associated with greater mobility burdens in food-purchasing travel. This mobility gap between the highest and lowest socioeconomic groups was further exacerbated during the COVID-19 pandemic, manifesting in the form of spatial segregation of opportunities within cities. This paper contributes to the literature by developing novel activity-based tools that offer a more nuanced understanding of the behavioral characteristics of food-purchasing activities. These empirical insights can help policymakers identify the communities facing the greatest mobility burdens and guide targeted, place-based interventions to promote equity in food access.

Combined associations of takeaway food availability and walkability with adiposity: Cross-sectional and longitudinal analyses

BACKGROUND

Diet and physical activity are important determinants of energy balance, body weight and chronic health conditions. Peoples' health and behaviour are shaped by their environment. For example, the availability of unhealthy takeaway food in residential neighbourhoods and the ability to easily walk to a range of local destinations (high "walkability") influence diets and physical activity levels. Most existing evidence on the associations between residential neighbourhood and adiposity is cross-sectional and examines either walkability or takeaway availability, but not both in combination.We examined the cross-sectional and longitudinal associations of residential neighbourhood walkability and takeaway food availability with markers of adiposity separately and combined.

METHODS

With data from the Fenland Study (Cambridgeshire, UK; n = 12,435), we used linear regression to estimate associations for walkability and takeaway availability separately and in mutually adjusted models, in addition to combining both into a measure of neighbourhood supportiveness for active living and healthy eating. Objective measures of BMI were examined cross-sectionally at baseline (2005-2015) and as change between baseline and follow-up (2014-2020). Additional outcomes (percentage body fat, waist circumference and hip circumference) were also examined both cross-sectionally and longitudinally.

RESULTS

Complete case analyses indicated that neighbourhoods with greater walkability and lower takeaway availability were associated with lower BMI (n = 10,607) and more favourable trends over time (n = 5508). For example, compared with the lowest exposure group (Q1), Q4 of walkability and takeaway food availability was associated with a difference in BMI of -0.69 kg/m2 (95% CI = -1.09 to -0.29) and 0.99 kg/m2 (95% CI = 0.58 to 1.39) respectively. These associations were more consistent when both neighbourhood measures were included in mutually adjusted models. The combined supportiveness measure was associated with lower BMI. High walkability and low takeaway availability were also associated with lower body fat percentage, waist circumference and hip circumference.

CONCLUSIONS

These findings are consistent with the residential environment having a role in shaping people's health and behaviour. Living in an area that supports walking and cycling and affords less access to unhealthy food may support people to maintain a healthy lifestyle. It was important to consider walkability and takeaway food availability together because to examine them separately risks unobserved confounding by the other. Future research could incorporate additional environmental measures, especially those likely to be correlated.

Trends in Adults' Intake of Un-processed/Minimally Processed, and Ultra-processed foods at Home and Away from Home in the United States from 2003-2018

BACKGROUND

Ultraprocessed foods (UPFs) comprise >50% of United States adults' energy intake, with the proportion of calories from UPFs increasing over time and the proportion of unprocessed/minimally processed foods (MPFs) decreasing over time. Whether UPFs are primarily consumed at home (AH) or away from home (AFH) is important to inform policies and messages to improve dietary quality.

OBJECTIVES

We examined trends in consumption of UPFs and MPFs AH and AFH in a nationally representative sample of United States adults and within sociodemographic subgroups.

METHODS

Data are from 34,628 adults (aged ≥20 y) with two 24-h dietary recalls from the 2003-2018 National Health and Nutrition Examination Survey. We examined trends over time in intake from MPFs and UPFs as a proportion of total energy intake and as a proportion of AH energy intake and AFH energy intake using generalized linear models adjusted for sex, age, race/ethnicity, education, and household income. We examined differences in trends by sociodemographic subgroups using interaction terms and stratified models.

RESULTS

Overall, and for most demographic subgroups, UPFs comprised >50% of AH energy intake and >50% of AFH energy intake, with UPFs increasing and MPFs decreasing over time as a proportion of energy intake AH and AFH. The proportion of total energy intake from UPFs increased for food consumed AH (33.6%-37.1%, P-trend < 0.001), but not for UPFs consumed AFH (19.5%-18.8%, P-trend = 0.88). From 2003-2004 to 2017-2018, the proportion of total energy intake from MPFs declined for foods consumed AH (23.6%-20.8%, P-trend <0.001) and AFH (9.7%-7.5%, P-trend <0.001). Interaction terms testing differences in trends of MPF and UPF intake AH and AFH by sociodemographic subgroups were mostly nonsignificant.

CONCLUSIONS

Findings highlight the ubiquity and increasing proportion of UPFs in United States adults' diets regardless of whether foods are consumed AH or AFH.

Residential food environment and dietary antioxidant consumption among pregnant women: Modifying effects of socioeconomic factors and ethnic identity

BACKGROUND

Residential food environment influences dietary patterns, however the impact of individuals' perceived social identity on their antioxidant intake, an indicator of healthy dietary patterns, remains underexplored.

OBJECTIVE

We conducted a cross-sectional analysis using data collected in a longitudinal cohort. In the study, we aimed to investigate the interactions between the food environment and two indicators of social identity, specifically a subjective ladder measure of socioeconomic status (SES) and the Multigroup Ethnic Identity Measure (MEIM) score, in relation to dietary antioxidant intake (DAI) among n = 512 Boston and NYC-resident pregnant women.

METHODS

The modified Retail Food Environment Index (mRFEI) was calculated using the Centers for Disease Control and Prevention's equation, with higher scores indicating a healthier food environment. DAI was estimated by summing standardized data from six micronutrients (magnesium, selenium, zinc, and vitamins A, C, and E) obtained through the Block98 Food Frequency Questionnaires administered during pregnancy, with higher scores indicating increased intake. The mRFEI and DAI were dichotomized based on a median split. Multivariable-adjusted logistic regressions were used to analyze associations, both with and without considering women's subjective SES or MEIM levels as effect modifiers.

RESULTS

Women were racially/ethnically mixed (19.2 % White, 42.7 % Black, and 33.1 % Hispanic) with 32.2 % reporting more than high school education. In the main effect models, no significant association was observed between mRFEI and DAI. Women with higher MEIM scores exhibited higher DAI [Odds ratio (OR) =1.85, 95 % Confidence interval (CI) = 1.26-2.73]. Exploratory interaction models showed that subjective SES significantly modified the association (p-value for interaction = 0.03), specifically, women perceiving themselves to have a lower SES compared to their community (n = 45) exhibited a significantly positive association between mRFEI and DAI.

CONCLUSION

These findings suggest that women perceiving their SES to be lower than their neighborhoods may benefit from better access to healthy food.

What is in a food store name? Leveraging large language models to enhance food environment data

Introduction

It is not uncommon to repurpose administrative food data to create food environment datasets in the health department and research settings; however, the available administrative data are rarely categorized in a way that supports meaningful insight or action, and ground-truthing or manually reviewing an entire city or neighborhood is rate-limiting to essential operations and analysis. We show that such categorizations should be viewed as a classification problem well addressed by recent advances in natural language processing and deep learning-with the advent of large language models (LLMs).

Methods

To demonstrate how to automate the process of categorizing food stores, we use the foundation model BERT to give a first approximation to such categorizations: a best guess by store name. First, 10 food retail classes were developed to comprehensively categorize food store types from a public health perspective.

Results

Based on this rubric, the model was tuned and evaluated (F1micro = 0.710, F1macro = 0.709) on an extensive storefront directory of New York City. Second, the model was applied to infer insights from a large, unlabeled dataset using store names alone, aiming to replicate known temporospatial patterns. Finally, a complimentary application of the model as a data quality enhancement tool was demonstrated on a secondary, pre-labeled restaurant dataset.

Discussion

This novel application of an LLM to the enumeration of the food environment allowed for marked gains in efficiency compared to manual, in-person methods, addressing a known challenge to research and operations in a local health department.

The moderating effect of access to food facilities and recreational activity space on mHealth multiple health behavior change intervention

OBJECTIVE

To evaluate whether the neighborhood social and built environment moderates response to a mobile health multiple health behavior change intervention targeting fruit/vegetable intake, sedentary behavior, and physical activity.

METHODS

Participants were 156 Chicago-residing adults with unhealthy lifestyle behaviors. Using linear mixed models, we evaluated whether access to food facilities (fast food restaurants and grocery stores) and recreational activity spaces (gyms and parks) moderated the difference in behavior change between the active intervention condition relative to control. Using spatial data analysis (cross K functions), we also assessed whether participants who achieved goal levels of behaviors ("responders") were more or less likely than those who did not achieve intervention goals ("non-responders") to reside near fast food restaurants, grocery stores, gyms, or parks.

RESULTS

According to linear mixed models, none of the neighborhood social and built environment factors moderated the difference in behavior change between the active intervention condition and the control condition (Likelihood Ratio (χ²[1] = 0.02-2.33, P-values > 0.05). Cross K functions showed that diet behavior change responders were more likely than non-responders to reside near fast food restaurants, but not grocery stores. The results for activity behavior change were more variable. Sedentary screen time responders were more likely to reside around recreational activity spaces than non-responders. Moderate-vigorous physical activity responders had greater and lesser clustering than non-responders around parks, dependent upon distance from the park to participant residence.

CONCLUSIONS

A complex relationship was observed between residential proximity to Chicago facilities and response to multiple health behavior change intervention. Replication across diverse geographic settings and samples is necessary.

Exploring the multiple dimensions of perceived food access in the local food environment in Flanders: Perceptions of adults in socioeconomically disadvantaged situations

Persons in socioeconomically disadvantaged situations are more susceptible and disproportionally exposed to unhealthy food environments, which results in limited access to healthy foods and poorer dietary outcomes. This qualitative paper examines the various dimensions of perceived food access to healthy and unhealthy foods (i.e., availability, affordability, accessibility, accommodation, desirability, convenience and acceptability) within the local food environment among persons in socioeconomically disadvantaged situations. A total of 23 participants in socioeconomically disadvantaged situations expressed their perceptions of food access within their local food environment and its role in their eating behaviour through participant-driven photo-elicitation in a focus group context (n = 7) and researcher-driven photo-elicitation interviews (n = 16). Reflexive thematic analysis has been used to analyse our data through an access framework. Four overarching themes were constructed. The first two themes concern barriers to perceived food access in respectively the home and community food environment - including the importance of kitchen infrastructure, household composition and transport options. The third theme encompasses the interaction of perceived food access with the sociocultural environment, highlighting its dual role as facilitator (e.g., through food sharing practices) and barrier (e.g., through social stigma and shame). The fourth theme concerns awareness and the ability to navigate within the information food environment, which has also been proposed as a novel dimension of food access. This study emphasizes the complexity of food access and the need for a multifaceted approach that integrates perceptions to ensure equitable access to healthy foods.

Influence of Socioeconomic Status on the Retail Food Environment in Alicante

BACKGROUND/OBJECTIVES

Unhealthy dietary habits are associated with chronic non-communicable diseases and may contribute to increased mortality in all countries of the world. Food environments determine the accessibility, availability, and promotion of food, thus playing an important role in people's diets, but they are context-dependent. The aim of this study was to evaluate the availability and accessibility of food in food outlets in different neighborhoods of the city of Alicante.

METHODS

Cross-sectional study. Trained researchers conducted food store audits using the validated Nutrition Environment Measures Survey in Stores for Mediterranean contexts (NEMS-S-MED) tool. Data were collected from food stores within a socioeconomically diverse sample in Alicante (n = 63). We compared the availability and affordability of "healthier-less healthy" food pairs, scores between food store types (supermarkets, specialized, convenience stores, and others), and socioeconomic levels in Alicante in 2022.

RESULTS

The present study highlights that the food stores with the greatest availability and accessibility to healthy foods are supermarkets, as opposed to specialized stores and convenience stores. In addition, differences were found in the accessibility and availability of healthy foods by neighborhoods with different income levels, being more accessible in the residential neighborhood with the highest income level. Tourism could explain the differences in the food retail environment, with a high-income neighborhood showing similar results to low-income neighborhoods.

CONCLUSIONS

The results obtained invite reflection on the development and adoption of policy strategies that promote the availability and accessibility of healthy food in the most disadvantaged areas.

Changes in Availability and Affordability on the University Food Environment: The Potential Influence of the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has had an impact on the eating habits of the general population, among other reasons, because it has affected access to commercial establishments since some of them closed. This study aimed to describe potential changes that occurred between 2019 and 2022 in the availability and affordability of food and beverages in the food environment of a Brazilian public university.

METHODS

Cross-sectional and descriptive study conducted at a public university located in Rio de Janeiro, Brazil. Audits were carried out in all establishments selling food and beverages at the university's main campus in 2019 and 2022. Descriptive analysis with frequencies and means was carried out and the 95% confidence intervals were compared.

RESULTS

Over the period, there was a decrease in the on-campus number of establishments, dropping from 20 to 14, and ultra-processed foods became more prevalent. In general, the decrease in the number of establishments led to a reduction in the supply of fresh or minimally processed foods and beverages, and higher average prices were noted.

CONCLUSIONS

The pandemic seems to have deteriorated the availability and the prices of healthy food in the university food environment, making healthy choices harder for students and the university community.

Development of an approach to forecast future takeaway outlet growth around schools and population exposure to takeaways in England

BACKGROUND

Neighbourhood exposure to takeaways can contribute negatively to diet and diet-related health outcomes. Urban planners within local authorities (LAs) in England can modify takeaway exposure through denying planning permission to new outlets in management zones around schools. LAs sometimes refer to these as takeaway "exclusion zones". Understanding the long-term impacts of this intervention on the takeaway retail environment and health, an important policy question, requires methods to forecast future takeaway growth and subsequent population-level exposure to takeaways. In this paper we describe a novel two-stage method to achieve this.

METHODS

We used historic data on locations of takeaways and a time-series auto-regressive integrated moving average (ARIMA) model, to forecast numbers of outlets within management zones to 2031, based on historical trends, in six LAs with different urban/rural characteristics across England. Forecast performance was evaluated based on root mean squared error (RMSE) and mean absolute scaled error (MASE) scores in time-series cross-validation. Using travel-to-work data from the 2011 UK census, we then translated these forecasts of the number of takeaways within management zones into population-level exposures across home, work and commuting domains.

RESULTS

Our ARIMA models outperformed exponential smoothing equivalents according to RMSE and MASE. The model was able to forecast growth in the count of takeaways up to 2031 across all six LAs, with variable growth rates by RUC (min-max: 39.4-79.3%). Manchester (classified as a non-London urban with major conurbation LA) exhibited the highest forecast growth rate (79.3%, 95% CI 61.6, 96.9) and estimated population-level takeaway exposure within management zones, increasing by 65.5 outlets per capita to 148.2 (95% CI 133.6, 162.7) outlets. Overall, urban (vs. rural) LAs were forecast stronger growth and higher population exposures.

CONCLUSIONS

Our two-stage forecasting approach provides a novel way to estimate long-term future takeaway growth and population-level takeaway exposure. While Manchester exhibited the strongest growth, all six LAs were forecast marked growth that might be considered a risk to public health. Our methods can be used to model future growth in other types of retail outlets and in other areas.

Validation of secondary data sources of the retail food environment in the capital of Uruguay, an emerging Latin American country

Secondary data sources are frequently used for characterizing physical access to food. Although several studies have reported that they tend to show a moderate agreement with field observation in WEIRD (Western Educated Industrialized Rich and Democratic) countries, little is known about their validity in non-WEIRD countries. The aim of the present research was to assess the validity of secondary data sources of the retail food environment in Montevideo, the capital of Uruguay, an emerging Latin American country. A random sample of 106 census tracts was obtained, covering 12% (62 km2) of the city's total area. Two secondary data sources were considered: administrative records and Google Maps. An aggregate database was created by manually removing duplicates. A total of 1051 unique outlets were listed in the database within the census tracts included in the sample. Field validation was performed by six teams of two observers. A total of 1200 food outlets were identified on the ground, including 463 (38.6%) outlets not listed on any database. On the contrary, 297 outlets listed in the databases (28.3%) were not found or were closed at the time of field validation. At the aggregate level, sensitivity and concordance were moderate (0.614 and 0.487, respectively), whereas positive predictive value was substantial (0.701). However, large heterogeneity in the validity of the database across census tracts was found. Sensitivity, positive predictive value, and concordance were positively associated with the socio-economic status index of the census tract. These results suggest that secondary data sources must be used with caution, particularly for the characterization of areas with low socio-economic status.

Perceptions of the neighbourhood food environment and food insecurity of families with children during the Covid-19 pandemic

BACKGROUND

Changes to the food environment during the Covid-19 pandemic significantly influenced food acquisition and consumption, contributing to a higher prevalence of food insecurity. We assessed the perception of the food environment and its association with food insecurity in households of Brazilian schoolchildren during the Covid-19 pandemic.

METHODS

We conducted a cross-sectional telephone survey between March and May 2021 with adults (n = 475) responsible for purchasing and/or preparing food at the students' homes aged between 6 months and 17 years enrolled in public school from two Brazilian municipalities. We assessed outcomes using the Brazilian Food Insecurity Scale (EBIA). We measured perceptions of the food environment by evaluating the perceived availability, price, and quality of fruits and vegetables (FV) and ultra-processed foods (UPF) sold in the neighbourhood.

RESULTS

The results indicate that 55.1% of respondents experienced mild food insecurity, and 14.5% experienced moderate or severe food insecurity. The perception of the ease of purchase (8.5% vs. 64.2%) and variety (78.9% vs. 57.9%) of UPF was higher at all levels of food security and insecurity compared to the same questions on FV. The level of food insecurity was associated with the perceived price of FV (p < 0.05). A negative perception of the quality (OR:1.92; CI:1.04-3.56) and the price of FV (OR:3.56; CI:1.41-8.98) were associated with moderate/severe food insecurity.

CONCLUSIONS

The affordability of FV is important for food-insecure households. Social protection policies for vulnerable families are crucial interventions that can strengthen and promote healthier food environments with greater availability of fresh foods such as fruits and vegetables.

Changes in urbanicity and household availability of and proximity to food vendors from 2004 to 2020 in a rural district of northwestern Bangladesh

BACKGROUND

The nutrition transition underway in South Asia is likely mediated by changes to the food environment. Yet, few studies have been conducted in rural areas of South Asia to describe how the food environment has changed.

OBJECTIVE

This analysis assessed changes in household availability of and proximity to markets, grocery shops, and tea shops over a 16-year time period in Gaibandha, Bangladesh.

METHODS

We analyzed household demographic and geospatial data collected at 3 time points from 2004 to 2020 in a contiguous rural area (435 km2). We defined availability as number of food vendors within 400- and 1600-m radius of households and proximity as distance to nearest vendor. We used linear and Poisson models to estimate associations between household socioeconomic status (SES) and food vendor availability and proximity. We used multi-level models to conduct similar analyses for community-level urbanicity.

RESULTS

From 2004 to 2020, the numbers of markets, grocery shops and tea shops increased by 21%, 66% and 270%, respectively. Food vendor proximity did not change by household SES, but less urban households witnessed larger increases in proximity to markets (p for interaction<0.001) and tea shops (p for interaction<0.001) over time. Grocery shop and tea shop availability was initially higher and increased more over time for households in higher urbanicity areas (p for interaction<0.001).

CONCLUSION

Over a 16-year period, this rural area of Bangladesh became more urbanized, increasing the availability of and proximity to markets, grocery shops, and tea shops. Further research is needed to see how these changes impact rural residents' intake and nutritional status.

Conceptual Model on Access to Food in the Favela Food Environment

The inequalities of Brazilian society are amplified in favelas, affecting access to basic sanitation, health, education services, and food. More research is needed to better understand the favela food environment and propose appropriate public food and nutrition policies to increase the availability of and access to healthy food. In this context, this study aimed to develop a conceptual model of the relationship between access to food and the favela food environment and its determinants. In developing the conceptual model, this study undertook a bibliographical survey of the food environment, and a preliminary version was submitted to an expert panel. The model represents a set of dimensions (individual, micro-environment, macro-environment, and decision-making) and elements that interact in a complex manner and help understand access to food in areas subject to multiple social vulnerabilities. This model can guide future research and aid policymakers in designing effective strategies to improve the food security and health of populations in areas of high socio-spatial vulnerability.

Measuring Environmental and Behavioral Drivers of Chronic Diseases Using Smartphone-Based Digital Phenotyping: Intensive Longitudinal Observational mHealth Substudy Embedded in 2 Prospective Cohorts of Adults

BACKGROUND

Previous studies investigating environmental and behavioral drivers of chronic disease have often had limited temporal and spatial data coverage. Smartphone-based digital phenotyping mitigates the limitations of these studies by using intensive data collection schemes that take advantage of the widespread use of smartphones while allowing for less burdensome data collection and longer follow-up periods. In addition, smartphone apps can be programmed to conduct daily or intraday surveys on health behaviors and psychological well-being.

OBJECTIVE

The aim of this study was to investigate the feasibility and scalability of embedding smartphone-based digital phenotyping in large epidemiological cohorts by examining participant adherence to a smartphone-based data collection protocol in 2 ongoing nationwide prospective cohort studies.

METHODS

Participants (N=2394) of the Beiwe Substudy of the Nurses' Health Study 3 and Growing Up Today Study were followed over 1 year. During this time, they completed questionnaires every 10 days delivered via the Beiwe smartphone app covering topics such as emotions, stress and enjoyment, physical activity, access to green spaces, pets, diet (vegetables, meats, beverages, nuts and dairy, and fruits), sleep, and sitting. These questionnaires aimed to measure participants' key health behaviors to combine them with objectively assessed high-resolution GPS and accelerometer data provided by participants during the same period.

RESULTS

Between July 2021 and June 2023, we received 11.1 TB of GPS and accelerometer data from 2394 participants and 23,682 survey responses. The average follow-up time for each participant was 214 (SD 148) days. During this period, participants provided an average of 14.8 (SD 5.9) valid hours of GPS data and 13.2 (SD 4.8) valid hours of accelerometer data. Using a 10-hour cutoff, we found that 51.46% (1232/2394) and 53.23% (1274/2394) of participants had >50% of valid data collection days for GPS and accelerometer data, respectively. In addition, each participant submitted an average of 10 (SD 11) surveys during the same period, with a mean response rate of 36% across all surveys (SD 17%; median 41%). After initial processing of GPS and accelerometer data, we also found that participants spent an average of 14.6 (SD 7.5) hours per day at home and 1.6 (SD 1.6) hours per day on trips. We also recorded an average of 1046 (SD 1029) steps per day.

CONCLUSIONS

In this study, smartphone-based digital phenotyping was used to collect intensive longitudinal data on lifestyle and behavioral factors in 2 well-established prospective cohorts. Our assessment of adherence to smartphone-based data collection protocols over 1 year suggests that adherence in our study was either higher or similar to most previous studies with shorter follow-up periods and smaller sample sizes. Our efforts resulted in a large dataset on health behaviors that can be linked to spatial datasets to examine environmental and behavioral drivers of chronic disease.

Time-varying exposure to food retailers and cardiovascular disease hospitalization and mortality in the netherlands: a nationwide prospective cohort study

BACKGROUND

Very few studies to date investigated the prospective association of changes in exposure to the food environment with cardiovascular disease (CVD) risk. We aim to explore if time-varying exposure to the food environment was associated with hospitalization and mortality due to total and specific types of CVD in The Netherlands.

METHODS

In this prospective cohort study, 4,641,435 Dutch adults aged 35 + years who did not change residence in 2002-2018 were identified through registry data. Exposure to the food environment was defined as time-varying Food Environment Healthiness Index (FEHI) scores (range: - 5 to 5) and time-varying kernel density of specific food retailers (e.g., fast food outlets, supermarkets) around the home location between 2004 and 2018. The main outcome measures were hospitalization and mortality due to overall CVD, stroke, HF, and CHD occurring between 2004 and 2020, based on hospital and death registries.

RESULTS

In Cox regression models, each unit increase in the FEHI was associated with a lower hospitalization and mortality of CVD (hospitalization hazard ratio (HRh) = 0.90 (0.89 to 0.91), mortality hazard ratio (HRm) = 0.85 (0.82 to 0.89)), CHD (HRh = 0.88 (0.85 to 0.91), HRm = 0.80 (0.75 to 0.86)), stroke (HRh = 0.89 (0.84 to 0.93)), HRm = 0.89 (0.82 to 0.98)), and HF (HRh = 0.90 (0.84-0.96), HRm = 0.84 (0.76 to 0.92)). Increased density of local food shops, fast food outlets, supermarkets, and convenience stores and decreased density of food delivery outlets and restaurants were associated with a higher risk of CVD, CHD, stroke, and HF hospitalization and mortality.

CONCLUSIONS

In this observational longitudinal study, changes in exposure to a healthier food environment over 14 years were associated with a risk reduction in CVD hospitalization and mortality, in particular in urbanized areas and for younger adults and those with higher incomes.

What does it take for healthy food retail programmes to be successful? Lessons learned in New York City

OBJECTIVE

Healthy food retail programmes (HFRP) in the USA generally aim to increase healthy foods access to improve diet quality and health, yet the impact is mixed. These programmes primarily target adults, even though adolescents frequently and independently visit stores to purchase snacks. This study's aims are to explore successes and challenges of implementing HFRP (Aim 1) and examine how HFRP can be tailored to adolescents (Aim 2).

DESIGN

One-time, virtual, semi-structured interviews with individuals who were involved in a HFRP, followed by a socio-demographic characteristics survey. Interviews were designed based on the RE-AIM framework and the Hexagon Tool and analysed using Braun and Clark's (2006) thematic analysis approach. Descriptive statistics were used to summarise participants' socio-demographic characteristics.

SETTING

New York City (NYC).

PARTICIPANTS

Adults (18 years or older) who have designed, implemented and/or evaluated an HFRP in NYC and speak/understand English (n 21).

RESULTS

Aim 1: For successes, strategies to build relationships with the community were most discussed. Regarding challenges, securing reliable funding was the hardest to overcome. Suggested solutions included designing profitable HFRP, targeting shortcomings in food distribution systems and increasing consumer demand. Aim 2: Most participants had not considered adolescents in previous HFRP but suggested involving youth in developing HFRP to encourage youth-driven solutions and promote youth advocacy.

CONCLUSIONS

Future HFRP should focus on activities that help store owners purchase affordable healthy foods from distributors, which translates to affordability for customers. Federal and local policies can assist by funding complementary programmes. Additionally, adolescents should be considered in these efforts.

Patients with diabetes struggling to afford food and control their HbA1c in food-insecure areas in Bronx, NY

OBJECTIVE

To characterise the association between risk of poor glycaemic control and self-reported and area-level food insecurity among adult patients with type 2 diabetes.

DESIGN

We performed a retrospective, observational analysis of cross-sectional data routinely collected within a health system. Logistic regressions estimated the association between glycaemic control and the dual effect of self-reported and area-level measures of food insecurity.

SETTING

The health system included a network of ambulatory primary and speciality care sites and hospitals in Bronx County, NY.

PARTICIPANTS

Patients diagnosed with type 2 diabetes who completed a health-related social need (HRSN) assessment between April 2018 and December 2019.

RESULTS

5500 patients with type 2 diabetes were assessed for HRSN with 7·1 % reporting an unmet food need. Patients with self-reported food needs demonstrated higher odds of having poor glycaemic control compared with those without food needs (adjusted OR (aOR): 1·59, 95 % CI: 1·26, 2·00). However, there was no conclusive evidence that area-level food insecurity alone was a significant predictor of glycaemic control (aOR: 1·15, 95 % CI: 0·96, 1·39). Patients with self-reported food needs residing in food-secure (aOR: 1·83, 95 % CI: 1·22, 2·74) and food-insecure (aOR: 1·72, 95 % CI: 1·25, 2·37) areas showed higher odds of poor glycaemic control than those without self-reported food needs residing in food-secure areas.

CONCLUSIONS

These findings highlight the importance of utilising patient- and area-level social needs data to identify individuals for targeted interventions with increased risk of adverse health outcomes.

Young people's perspectives on policies to create healthier food environments in England

Food environments are important determinants of healthy diets among young people. This study explored young people's perspectives on their food environment, their recommendations to policymakers and views on youth engagement in policy processes. There is limited research on young people's perspectives on their involvement in developing food environment policies. Youth engagement in policymaking processes can lead to greater policy integrity and inclusivity. Four focus group discussions were conducted with 39 young people (12-21 years) from a town in North West England and a metropolitan area in the English Midlands. Participants were recruited through youth organizations. Data were analysed using inductive thematic analysis. Young people reported concerns about the density of fast food outlets in their local area, the unaffordability of healthier food, and fast food advertisement. These issues were not believed to be prioritized in local and national policymaking. Accordingly, policy recommendations were mainly for structural food environment policies, including restrictions on fast food outlet density and incentives for menu reformulation. Young people did not feel involved in local decisions about the food environment. They expressed a need for more meaningful engagement beyond consultation. Young people have repeatedly shown to have a deep understanding of the social, commercial and political factors that influence diet and health. It is essential that policymakers aiming to improve young people's diets take their unique views and concerns into account to create effective policies that resonate with young people.

The relationship between food insecurity, purchasing patterns and perceptions of the food environment in urban slums in Ibadan, Nigeria

BACKGROUND

Rapid urbanisation without concomitant infrastructure development has led to the creation of urban slums throughout sub-Saharan Africa. People living in urban slums are particularly vulnerable to food insecurity due to the lack of physical and economic accessibility to food. Hence, it is important to explore how vulnerable groups living in slums interact with the food environment. This study assessed the relationships between food insecurity, including restrictive coping strategies, food purchasing patterns and perceptions about the food environment among dwellers of selected urban slums in Ibadan, Nigeria.

METHODS

This community-based cross-sectional study was conducted with people responsible for food procurement from 590 randomly selected households in two urban slums in Ibadan. Food insecurity and restrictive coping strategies were assessed using the Household Food Insecurity Access Scale and the Coping Strategy Index, respectively. We examined purchasing patterns of participants by assessing the procurement of household foodstuffs in different categories, as well as by vendor type. Participants' perceptions of the food environment were derived through a five-item composite score measuring food availability, affordability and quality. Chi-square tests and logistic regression models analysed associations between food insecurity, purchasing patterns and perceptions of the food environment.

RESULTS

The prevalence of food insecurity in the sample was 88%, with 40.2% of the households experiencing severe food insecurity. Nearly a third (32.5%) of the households used restrictive coping strategies such as limiting the size of food portions at mealtimes, while 28.8% reduced the frequency of their daily meals. Participants purchased food multiple times a week, primarily from formal and informal food markets rather than from wholesalers and supermarkets. Only a few households grew food or had livestock (3.2%). Food insecure households had a lower perceived access to the food environment, with an approximate 10% increase in access score per one-unit decrease in food insecurity (AOR = 0.90, 95% CI: 0.84, 0.96). The most procured foods among all households were fish (72.5%), bread (60.3%), rice (56.3%), yam and cassava flours (50.2%). Food-secure households procured fruit, dairy and vegetable proteins more frequently.

CONCLUSION

Food insecurity remains a serious public health challenge in the urban slums of Ibadan. Perceptions of greater access to the food environment was associated with increasing food security. Interventions should focus on creating more robust social and financial protections, with efforts to improve livelihoods to ensure food security among urban slum-dwellers.

A qualitative exploration of ultra-processed foods consumption and eating out behaviours in an Indonesian urban food environment

Background: Increased consumption of ultra-processed foods and drinks high in unhealthy fats, salt and sugar is a major driver behind rising non-communicable disease rates in Asia-Pacific. Urban residence is considered a risk factor for increased consumption of these products; yet, evidence on consumption behaviours and drivers from urban populations in the region remains limited. Aim: To understand perceptions and drivers of unhealthy fats, salt and sugar foods and drinks consumption and eating out behaviours in Yogyakarta city, Indonesia. Methods: In-depth qualitative data were collected through open-ended interviews and prolonged interactions in the local food environment, from a purposeful sample (N = 45) equally distributed across three urban communities. Data were analysed according to the principles of content analysis and following an iterative approach. Results: Despite showing high nutritional health awareness, respondents and their household members consumed ultra-processed foods high in unhealthy fats, salt and sugar regularly. Home consumption of these products was based primarily on economic considerations and convenience, but also related to attending requests from other family members, individual preferences and tastes, and social functions. Similarly, despite a reported preference for home-cooked traditional foods, several participants or their family members would frequently eat ready-made meals away from home, due to conflicting school or work commitments. Discussion: Results suggest that public health interventions focused on nutrition education among Indonesian communities should be coupled with measures addressing urban food environment characteristics that promote the consumption of unhealthy diets, be tailored to specific age groups, and leverage traditional food cultures.

WEIRD and non-consensual food deserts and swamps: A scoping review of operational definitions

The aim of the present study was to critically analyze operational definitions of food deserts and food swamps included in empirical studies published in peer-reviewed journals. A scoping review was conducted following the recommendations of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. A search of the scientific literature was performed on August 2023 to identify empirical studies including operational definitions of food deserts and/or food swamps in three databases: Scopus, PubMed, and Scielo. A total of 932 scientific articles were identified in the three databases, from which 157 articles, published between 2002 and 2023, were included in the review. The included studies were mainly conducted in WEIRD (Western, Educated, Industrilaized, Rich and Democractic) countries. They presented a total of 107 operational definitions of food deserts and 30 operational definitions of food swamps. Large heterogeneity in the operational definitions of food deserts and food swamps was found. Published studies differed in all the elements of the operational definitions analyzed in the present work. Results stress the need for standardization and the development of more objective and multivariate continuous measures of physical food accessibility that reflect the complexity of modern food environments globally. A series of recommendations to advance food environment research are derived.

A multi-dimensional access index: Exploring emergency food assistance in New York City

Access to resources and services needs to be considered from a multi-dimensional perspective to capture the complex landscape of human experience. The robust body of research exploring food access has multiple limitations that create an incomplete view of food access, like studies limited to only one mode of transit and inconsistent methods across studies which limit generalizability. This study proposes a framework to formulate a multi-dimensional access index that considers travel time, operating hours, and availability of transit infrastructure across space. We use food pantries in New York City as a case study since there are relatively few of them and they have limited opening hours. We propose an index that quantifies spatiotemporal access by different modes of transportation and takes operating hours of food pantries into account during a one week time period. We compare our results to two traditional access measures and demonstrate that our index provides a significantly different measure of access. We utilize this index to highlight areas of high need but low resources, which shows the importance of this tool to policy makers and service providers. We use our experience of developing this index to highlight the challenges with quantitative analysis of human experience. Our tool is reproducible through an open-access software, which allows researchers and policy-makers to utilize it with parameters that reflect their communities.

Exploring the traditional foodways for nutritional well-being amongst vulnerable communities: Insights from Ho indigenous community of Jharkhand, India

Nutritional well-being of Indigenous Peoples is shaped by foodways through their relationship with culturally vital indigenous foods. An exploratory mixed-methods study was conducted among Ho community of Jharkhand to get an insight into their traditional foodways. Study sites included ten randomly selected villages from three geographically distant blocks of West Singhbhum, including Sonua, Khuntpani and Chakradharpur. Qualitative enquiries included focus group discussions and village transect walk interviews which captured diverse information including food access from natural sources, market access, livelihood sources, social and cultural norms around foods, environmental factors, hygiene and sanitation conditions, and community health. Seasonal market surveys (monsoon and winter) in ten local markets provided information on food diversity and local prices. The findings revealed that foodways of Ho community are based on foraging, hunting, and traditional farming through use of available ecosystem resources. However, their traditional foodways are under threats due to livelihood and nutrition transitions. They have unique food traditions and cultures, yet their meals lack variety in terms of the foods consumed. Their smallholder farming systems are not profitable, pushing them towards rural-to-urban migration. Thus, it is crucial to promote traditional foodways of Hos to support bio-cultural knowledge, food justice and nutrition in this community.

Developing the DIGIFOOD Dashboard to Monitor the Digitalization of Local Food Environments: Interdisciplinary Approach

BACKGROUND

Online food delivery services (OFDS) enable individuals to conveniently access foods from any deliverable location. The increased accessibility to foods may have implications on the consumption of healthful or unhealthful foods. Concerningly, previous research suggests that OFDS offer an abundance of energy-dense and nutrient-poor foods, which are heavily promoted through deals or discounts.

OBJECTIVE

In this paper, we describe the development of the DIGIFOOD dashboard to monitor the digitalization of local food environments in New South Wales, Australia, resulting from the proliferation of OFDS.

METHODS

Together with a team of data scientists, we designed a purpose-built dashboard using Microsoft Power BI. The development process involved three main stages: (1) data acquisition of food outlets via web scraping, (2) data cleaning and processing, and (3) visualization of food outlets on the dashboard. We also describe the categorization process of food outlets to characterize the healthfulness of local, online, and hybrid food environments. These categories included takeaway franchises, independent takeaways, independent restaurants and cafes, supermarkets or groceries, bakeries, alcohol retailers, convenience stores, and sandwich or salad shops.

RESULTS

To date, the DIGIFOOD dashboard has mapped 36,967 unique local food outlets (locally accessible and scraped from Google Maps) and 16,158 unique online food outlets (accessible online and scraped from Uber Eats) across New South Wales, Australia. In 2023, the market-leading OFDS operated in 1061 unique suburbs or localities in New South Wales. The Sydney-Parramatta region, a major urban area in New South Wales accounting for 28 postcodes, recorded the highest number of online food outlets (n=4221). In contrast, the Far West and Orana region, a rural area in New South Wales with only 2 postcodes, recorded the lowest number of food outlets accessible online (n=7). Urban areas appeared to have the greatest increase in total food outlets accessible via online food delivery. In both local and online food environments, it was evident that independent restaurants and cafes comprised the largest proportion of food outlets at 47.2% (17,437/36,967) and 51.8% (8369/16,158), respectively. However, compared to local food environments, the online food environment has relatively more takeaway franchises (2734/16,158, 16.9% compared to 3273/36,967, 8.9%) and independent takeaway outlets (2416/16,158, 14.9% compared to 4026/36,967, 10.9%).

CONCLUSIONS

The DIGIFOOD dashboard leverages the current rich data landscape to display and contrast the availability and healthfulness of food outlets that are locally accessible versus accessible online. The DIGIFOOD dashboard can be a useful monitoring tool for the evolving digital food environment at a regional scale and has the potential to be scaled up at a national level. Future iterations of the dashboard, including data from additional prominent OFDS, can be used by policy makers to identify high-priority areas with limited access to healthful foods both online and locally.

Exploring the relationship between the food environment and preferences among schoolchildren in a low socioeconomic community in Sri Lanka: A GIS-based assessment

The food environment in school neighborhoods plays a crucial role in manipulating the food choices of schoolchildren. This study investigated the relationship between the food environment in neighborhoods and the dietary practices of government school students in a low socioeconomic setting in Sri Lanka. This cross-sectional study surveyed the neighborhood food environment of selected schools (n = 30) in the Monaragala District, Sri Lanka, using geographical information system (GIS) data and collected dietary information from a representative sample of schoolchildren (n = 603). Chi-square and Spearman correlation tests were performed using SPSS version 23.0 to estimate the associations between the food environment and BMI, while ArcGIS 10.4.1 was used to analyze the GIS data. The majority of the students (35.5%) were 15 years old, and approximately 51% were females. The mean BMI of the study participants was 18.14 (±3.28). More than 90% of outlets within proximity sold unhealthy foods. Consumption of confectionaries was 72.3% of the students, whereas healthy food choices ranged from 5% to 12%. A positive correlation between consuming unhealthy food and distance to outlets from school was observed (p<0.05). The risk of consuming low-nutrition food doubled (OR = 2.47, 95% CI: 1.52-3.89) among the students studying in schools where a larger proportion of energy-dense food was sold in closer proximity. In conclusion, the density and proximity of outlets that sell food with low nutrients in the school neighborhood environment were positively associated with students' unhealthy food item choices.

Applying Systems Thinking to Improve a Hospital Food Retail Environment

OBJECTIVE

To identify factors influencing the availability and sales of healthy food and drinks in a café located in a hospital setting in a rural area.

METHODS

Three online and 1 in-person group model building workshops were conducted with hospital staff members to develop a causal loop diagram.

RESULTS

Four areas in the causal loop diagram were identified, 5 teams were created to implement 15 identified action ideas, and an action registry was created to track their progress. By May 2023, 4 actions were active, 6 inactive, 4 completed, and 1 abandoned.

CONCLUSIONS AND IMPLICATIONS

The group model building process identified factors and actions to improve the healthiness of the hospital's café and motivated staff members to act for change. However, progress was limited by staff turnover, recruitment, and inadequate participation from decision-makers. Better leadership and support by senior management can ensure that long-term objectives are achieved and healthier hospital food environments are sustained.

Diet Quality of Community Café Meals Among Guests With Food Insecurity

OBJECTIVE

Compare the diet quality of a meal consumed at a community café (café meals), a pay-what-you-can restaurant, to a meal consumed for an equivalent eating occasion on the day before (comparison meal) by guests with food insecurity.

METHODS

Dietary recalls were collected from café guests with food insecurity to determine the Healthy Eating Index-2020 (HEI-2020) total and component scores. Healthy Eating Index-2020 scores were compared between meals using paired-sample t tests and Wilcoxon signed-rank tests.

RESULTS

Most participants (n = 40; 80% male; 42.5% Black) had very low food security (70.0%). Café meal had a higher HEI-2020 total score (46.7 ± 10.5 vs 34.4 ± 11.6; P < 0.001) and total vegetables (2.6 ± 2.0 vs 1.2 ± 1.7; P = 0.004), total fruits (2.1 ± 2.2 vs 0.6 ± 1.5; P < 0.001), whole fruits (1.6 ± 2.0 vs 0.3 ± 0.9; P < 0.001), and refined grains (7.8 ± 3.5 vs 3.9 ± 3.9; P < 0.001) scores than comparison meals.

CONCLUSIONS AND IMPLICATIONS

The café meal had better diet quality than the comparison meal, suggesting its potential for improving diet quality among guests with food insecurity.

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

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