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

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).

Food outlet availability differs according to area socioeconomic status in Denmark

BACKGROUND

Disparities in access to specific foods may contribute to inequalities in diet-related diseases seen at a global and National level.

METHODS

Based on aggregated population data on income, education, and employment, area-level socioeconomic differences in food outlet availability were analyzed for 53,368 study participants residing across parishes in the Capital Region of Denmark. Validated data on fast-food outlets, convenience stores, supermarkets, and restaurants were used. Information on individual characteristics, home address and corresponding parishes were linked to the participants through the Danish Civil Registration System. Three multilevel hurdle models were applied for each food outlet type to analyze food outlet density (count/km²) within an 800-meter network buffer around participants' homes across four levels of parish socioeconomic status (SES). Model 1 provided a basic examination of the association between density and area SES. Model 2 adjusted for individual characteristics while Model 3 further included urbanity at the area level. The structure of the chosen hurdle models included was Part (1) a logistic multilevel regression modelling the probability of food outlet presence by using the entire dataset and, Part (2) a standard linear multilevel regression modelling the 10 base logarithmic transformation of only positive food outlet densities with a lognormal distribution.

RESULTS

No statistically significant spatial patterning of food outlets across area SES was found in Model 1 and 2, however positive and strong significant odds were seen in part 1 of Model 3 for supermarkets, convenience stores and fast-food outlets. Thus, residents in more disadvantaged SES areas had higher odds of having a supermarket, convenience store, or fast-food outlet near their homes compared to those living in the most advantaged areas. No differences were seen in the density across area SES.

CONCLUSION

Area SES influenced the presence of supermarkets, convenience stores, and fast-food outlets, but not the density of these establishments.

Transit bus access to healthy, affordable food: A novel geographic information system (GIS) and community-informed analysis

Good nutrition reduces the risk of chronic disease, but many vulnerable populations do not have equitable access to healthy food. People who are lower-income, non-White, older, or disabled, have increased likelihood of not owning a vehicle and of being dependent on public buses to source healthy, affordable food. Our study took place in three municipalities targeted by the Rhode Island Department of Health for equity-focused interventions. Our methodology aimed to overcome limitations of prior analyses of public transit food access. We determined healthy food sources, stratifying their affordability with market basket pricing data and community input. Using a geographic information system (GIS), we identified the transit bus service areas of the sources. Our novel approach included employing a fixed bus wait time, determining bus travel times based on schedule combined with historical data, and determining acceptable travel times through a community leader survey. We analyzed access by subgroups including those experiencing poverty, older adults, those without cars, and those with disabilities. We found that 45% of the population in the most urban municipality had bus access to discounted healthy food, and no one in the two less urban municipalities did. Bus access to six food pantries was limited to 15%-28% of the population. Our approach, combining spatial analysis informed by surveys and community input, can increase the ease and accuracy of analyzing bus access to healthy, affordable food and is replicable in other regions and extensible to other types of destinations and services and to rail transit.

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.

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.

The change in food service costs associated with increasing the healthiness of ready-to-eat food provision: A systematic scoping review

Increasing the healthiness of food retail environments is an identified mechanism to help halt rising rates of diet-related non-communicable diseases. Previous studies on healthy food environment adoption report that retailers' perceptions of loss of profitability and higher food costs are often barriers to change. Despite this, actual changes to profitability and food costs have not been fully explored. This study aimed to systematically scope the evidence relating to changes to food costs or profitability when changes are made to increase the healthiness of food and drinks sold by food service retailers. Nine databases were searched, with studies included from settings that sold ready-to-consume items, with interventions to increase the healthiness of menus, and reporting food environment/nutrition outcomes, and cost/profit outcomes. Of the 12 studies included, the majority were conducted in the United States and in school settings. Most studies indicated that increasing the healthiness of food service retail environments resulted in neutral or favorable financial outcomes. Food costs and/or profit changes were most often monitored via simple accounting measures. While further research is needed to strengthen the evidence on financial outcomes of healthier food provision, this review indicates that some perceived barriers to change may not be warranted.

Measuring characteristics of wild and cultivated food environments: a scoping review

BACKGROUND

Global food systems are essential to sustain life; however, unhealthy diets are the leading cause of poor health and death worldwide. Natural food environments are a critical source of healthful food such as fresh fruit and vegetables, lean meat and aquatic foods, particularly in low- and middle-income countries (LMICs) and Indigenous food systems. Understanding and monitoring natural food environments is critical to protecting the supply of healthy food, and the land and water it comes from, for current and future generations.

METHODS

A scoping review was applied to classify and summarise empirical methods and measures used for characterising natural food environments. The ways in which food environment characteristics are conceptualised and measured for natural (wild and cultivated) food environments were explored. Data were extracted from the included studies using the following fields: study country, aim/objective(s), type of natural food environment (wild vs. cultivated), method or measure used to measure the food environment, key food environment characteristic/s (up to four) measured and key findings in relation to the food environment measurement.

RESULTS

One hundred forty seven studies were found to be relevant in this review. Most studies investigated food environments in LMICs, with almost two-thirds of all studies focussing on middle-income countries (n = 89, 61%). There was a strong focus on food security and home-based agriculture from studies that measured the cultivated food environment in LMICs, while the majority of studies on the cultivated food environment from high-income countries focussed on urban and community gardening. In addition to the most common survey-based methodological approaches, our review yielded a broad range of both qualitative and quantitative methods for measuring natural food environments, such as geospatial analysis; biochemical analysis of food, soil and water; citizen science; photovoice and food availability calendars.

CONCLUSIONS

Our review demonstrated that the concept and characteristics of the food environment are a promising conceptualization for measuring natural food environments, particularly in relation to food availability, healthiness and food security. Mapping the currently used methods and measures to assess natural food environments is important to help identify critical leverage points for strengthening policy interventions, and monitoring and evaluation of progress.

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.

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.

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.

University Food Environment Assessment Methods and Their Implications: Protocol for a Systematic Review

BACKGROUND

While the retail food environment has been well studied, research surrounding the university food environment is still emerging. Existing research suggests that university food environments can influence behavioral outcomes such as students' dietary choices, which may be maintained long-term. Despite a growing interest in assessing university food environments, there is no standardized tool for completing this task. How researchers define "healthy" when assessing university food environments needs to be clarified. This paper describes the protocol for systematically reviewing literature involving university food environment assessments.

OBJECTIVE

This paper aimed to describe the protocol for a systematic review of the assessments of university food environments. The review will summarize previously used tools or methods and their implications.

METHODS

Electronic databases, including PubMed (NLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycINFO (EBSCO), CINAHL (Cumulative Index to Nursing & Allied Health) Complete (EBSCO), ProQuest Nursing and Allied Health, and Google Scholar were searched for papers published between 2012 and 2022 using combinations of related medical subject headings terms and keywords. The electronic databases were supplemented by reviewing the reference list for all included papers and systematic reviews returned with our search results. The review will include all study types, including randomized controlled trials, observational studies, and other pre-post designs. Papers that examine at least 1 aspect of the university food environment, such as cafeterias, campus convenience stores, and vending machines, were considered for inclusion. A total of 2 reviewers will independently screen titles and abstracts, complete a full-text review, extract data, and perform a quality assessment of included papers, with a third reviewer resolving any conflicts. The Quality Assessment for Diverse Studies (QuADS) tool was used to determine the methodological quality of selected studies. A narrative and tabular summary of the findings were presented. There will not be a meta-analysis due to the methodological heterogeneity of the included papers.

RESULTS

The initial queries of 4502 records have been executed, and papers have been screened for inclusion. Data extractions were completed in December 2023. The results of the review were accepted for publication in May 2024. The systematic review generated from this protocol will offer evidence for using different assessment tools to examine the campus food environment.

CONCLUSIONS

This systematic review will summarize the tools and methods used to assess university food environments where many emerging adults spend a significant part of their young adult lives. The findings will highlight variations in practice and how "healthy" has been defined globally. This review will provide an understanding of this unique organizational food environment with implications for practice and policy.

TRIAL REGISTRATION

PROSPERO CRD42023398073; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=398073.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54955.

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

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

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Transforming food environments: a global lens on challenges and opportunities for achieving healthy and sustainable diets for all

Food environments are rapidly changing globally, both in developed and developing contexts, contributing to poor dietary habits and environmental concerns. As a result, more than 80% of countries in the world face different forms of malnutrition, while the environment faces further degradation due to unsustainable production and consumption patterns. Understanding food environments in diverse settings via a global lens is critical for facilitating the global transition to sustainable and healthy food environments. A virtual workshop was held with stakeholders from five nations (Germany, Ghana, Malaysia, South Africa, and Tanzania) representing varying levels of development to interrogate global food environment concerns and propose cross cutting thematic areas that may be explored and addressed through policy change and intervention. The workshop initiated a transdisciplinary project to shape food environments for sustainable and healthy diets. The Reference Manual for Convenors of Food Systems Summit Dialogues for United Nations Food Systems Summit (UNFSS) (United Nations, 2020) was used as guidance to ensure that an inclusive mix of stakeholders were invited. The stakeholders included key players from public and private sectors in disciplines of agriculture, agro-forestry, environment and ecology, education, food retail and market, trade and commerce, health care and nutrition. Following the workshop discussion, the findings were analyzed using a general inductive approach. Through triangulation of findings, we identified the common challenges and opportunities for achieving collective nutritional, social and environmental sustainability in the modern food environments, which have become more universal globally. It is evident that research and data are essential for sustainable development of food systems, while Sustainable Development Goal (SDG) 17 - Partnership for the Goals - should be placed at the core of the transformative process. We proposed several research-driven transdisciplinary interventions to facilitate a paradigm shift from the profit logic model over everything else, and to counter the existing policy fragmentation and systemic challenges to making food environments nutrition-sensitive and socially and environmentally sustainable.

Study on the impact of smart city construction on the health of the elderly population--A quasi-natural experiment in China

In the context of global aging, promoting the health of the elderly has become a critical issue. However, whether the development of smart cities can impact the health of older adults remains to be further validated. In this paper, based on panel data from the China Health and Retirement Longitudinal Study (CHARLS), a difference in difference model is used to empirically investigate whether smart city construction improves the health of older people in the region. The results show that smart city construction enhances the health of the elderly. Specifically, the construction achieved a significant improvement in the physical health of the elderly who did not live with their children. The health promotion effect of the smart city was more significant for the urban elderly than for the rural elderly. The elucidated mechanisms of influence suggest that smart cities bring about their effects through the promotion of urban leisure infrastructure, enhancement of medical service provision, advancement in urban environmental protection and stimulation of urban information and communication technology infrastructure development.

Characteristics of built food environments associated with alternative protein food choices: a systematic review

BACKGROUND

This systematic review contributes to the understanding of the characteristics of built food environments that may be associated with choices of alternative protein foods (APF). Using the built food environment typology proposed by Downs et al., we investigated various environmental structures (e.g., supermarkets, other retailers, farmers' markets, restaurants, schools, and online vendors) and the characteristics that may facilitate or hinder consumers' choices. For example, facilitators and barriers may refer to the physical characteristics of environmental structures, food presentation practices, the organizational strategies or policies operating in the setting, or the actions that retailers or consumers engage in while selling, serving, choosing, trying, or purchasing APF in these environmental structures.

METHODS

A systematic review (PROSPERO database preregistration; no. CRD42023388700) was conducted by searching 13 databases for peer-reviewed journals focusing on the fields of economics and business, agriculture, medical sciences, and social sciences. Data searches, coding, and quality evaluations were conducted by at least 2 researchers. A total of 31 papers (36 original studies) were included. The risk of bias was evaluated with the Joanna Briggs Institute quality evaluation tool, with 24 publications presenting low risk of bias.

RESULTS

The findings indicate that perceived and actual availability facilitate consumers' APF choices across a built food environment. Several barriers/facilitators were associated with APF choices in specific types of built food environments: the way food is presented in produce sections (supermarkets), consumer habits in terms of green and specialty shopping (grocery stores), and mismatches among retailer actions in regard to making APF available in one type of food environment structure (e-commerce) and consumers' preferences for APF being available in other food environment structures (supermarkets, grocery stores). The effect of a barrier/facilitator may depend on the APF type; for example, social norms regarding masculinity were a barrier affecting plant-based APF choices in restaurants, but these norms were not a barrier affecting the choice of insect-based APF in restaurants.

CONCLUSIONS

Addressing barriers/facilitators identified in this review will help in developing environment-matching interventions that aim to make alternative proteins mainstream.

TRIAL REGISTRATION

PROSPERO database registration: #CRD42023388700.

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

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

Development and testing of two tools to assess point-of-sale food and beverage marketing to children in restaurants

OBJECTIVE

To describe the development and testing of two assessment tools designed to assess exterior (including drive-thru) and interior food and beverage marketing in restaurants with a focus on marketing to children and teens.

DESIGN

A scoping review on restaurant marketing to children was undertaken, followed by expert and government consultations to produce a draft assessment tool. The draft tool was mounted online and further refined into two separate tools: the Canadian Marketing Assessment Tool for Restaurants (CMAT-R) and the CMAT-Photo Coding Tool (CMAT-PCT). The tools were tested to assess inter-rater reliability using Cohen's Kappa and per cent agreement for dichotomous variables, and intra-class correlation coefficients (ICCs) for continuous or rank-order variables.

SETTING

Waterloo, Ontario, Canada.

PARTICIPANTS

Restaurants of all types were assessed using the CMAT-R (n 57), and thirty randomly selected photos were coded using the CMAT-PCT.

RESULTS

The CMAT-R collected data on general promotions and restaurant features, drive-thru features, the children's menu and the dollar/value menu. The CMAT-PCT collected data on advertisement features, features considered appealing to children and teens, and characters. The inter-rater reliability of the CMAT-R tool was strong (mean per cent agreement was 92·4 %, mean Cohen's κ = 0·82 for all dichotomous variables and mean ICC = 0·961 for continuous/count variables). The mean per cent agreement for the CMAT-PCT across items was 97·3 %, and mean Cohen's κ across items was 0·91, indicating very strong inter-rater reliability.

CONCLUSIONS

The tools assess restaurant food and beverage marketing. Both showed high inter-rater reliability and can be adapted to better suit other contexts.

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

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

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

Background

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

Methods

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

Findings

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

Conclusions

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

PROSPERO registration number

CRD42018111652.

Mapping lock-ins and enabling environments for agri-food sustainability transitions in Europe

European agri-food systems must overcome structural lock-ins to achieve more sustainable modes of production and consumption. Yet European regions are highly diverse, and we lack understanding of how different regional characteristics may enable or inhibit sustainability transitions. This hinders the development of context-tailored governance strategies. In this paper, we identify and apply sets of spatial indicators to map the regional potentials for agri-food transitions. We first analyse the strength of lock-in to the incumbent agro-industrial paradigm. We then map the enabling environments for two alternative agri-food networks-multifunctional value chains and civic food networks-that each embed distinct social-ecological qualities of agriculture and food. Results demonstrate a large spatial diversity in transition potential, with stronger lock-ins throughout North and Western Europe and stronger enabling environments for agri-food transitions in Italy, France, Switzerland, and Southwest Germany. We find that lock-ins are strongest in livestock-dominated regions and are associated with higher GHG emissions and excess nitrogen levels. Our study demonstrates the need for coordinated public policies that (1) leverage region-specific transition potentials and (2) enable complementary innovations in market-based and community-led networks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11625-024-01480-y.

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

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

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

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

Convenience as a dimension of food environments: A systematic scoping review of its definition and measurement

Convenience is a major driver of food choice throughout the world, yet it is often inconsistently conceptualised, defined and measured. This limits the scope for food systems policy and interventions to leverage convenience to improve diet and nutrition outcomes. We conducted a systematic literature review to determine how convenience is both defined and measured in food environment and nutrition research. Six databases were systematically searched and studies were screened by two independent reviewers based on pre-defined eligibility criteria, yielding 243 studies for inclusion in the final review. 77% of studies did not explicitly define convenience. Among those that did, the dimensions and components within definitions varied. 83% of studies used perceived measures of convenience rather than objective measures. Convenience was most commonly measured in high income countries (64%) and in relation to the home food environment (53%), followed by formal retail (40%). Very few studies measured convenience in relation to the informal retail or cultivated food environments, and no studies considered convenience in relation to wild food environments. The vast majority of studies did not consider the validity or reliability of the measures of convenience. Based on our findings we propose a definition of convenience as a characteristic that results in reduced requirement for resources including time, physical effort, mental effort and skills by the consumer in relation to the planning, acquisition, preparation, storage, transport, consumption or clean-up of food. This definition can be used to help guide the development of measurement tools that can be used to assess convenience across different dimensions and contexts in a more comprehensive way. We also propose a framework for considering convenience as an entry point in food systems to improve diets and nutrition outcomes.

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

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

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

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

Instruments and indicators for assessing organisational food environments: a scoping review protocol

INTRODUCTION

Many studies have explored the food environment to characterise it and understand its role in food practices. Assessment of the organisational food environment can contribute to the development of more effective interventions to promote adequate and healthy eating. However, few instruments and indicators have been developed and validated for assessing this type of setting. The systematisation of those can be useful to support the planning of future assessments and the development of wide-ranging instruments. This study aims to conduct a scoping review to systematise evidence on instruments and indicators for assessing organisational food environments.

METHODS AND ANALYSIS

This scoping review was planned according to the methodological framework for scoping reviews proposed by Arksey and O'Malley and subsequently enhanced by Levac et al. For the report of the review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) checklist and guidelines will be used. The search will be conducted using PubMed, Embase, Web of Science, PsycINFO, Scopus and Google Scholar databases. The studies to be included were required to have been published in peer-reviewed journals since January 2005. No geographical, population or language restrictions will be applied given the desired breadth of the review. Two researchers will select the articles and extract the data independently. The conceptual model proposed by Castro and Canella will guide the data extraction and analysis. The results will be presented with narrative synthesis for the extracted data accompanying the tabulated and charted results.

ETHICS AND DISSEMINATION

This study is based on the analysis of published scientific literature and did not involve patients, medical research, or any type of personal information; therefore, no ethical approval was obtained for this study. The results of this scoping review will be submitted for publication in an international peer-reviewed journal, preferably open access.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Consumer nutrition environment measurements for nutrient-dense food availability and food sustainability: a scoping review

Consumer nutrition environments are defined as places in which consumers interact with the food they eat; these food choices can impact human and planetary health. Assessment measures for consumer nutrition environments are numerous, and vary widely on what, and how, they assess the food environment. The objective of this scoping review was to synthesize existing evidence on nutrition environment measurements and their capacity to assess nutrient-dense food access and food sustainability capacity. Eligibility criteria were developed to capture relevant peer-reviewed literature about auditing measures designed to assess nutrient-dense foods and food sustainability capacity in the consumer nutrition environment. A search strategy was conducted to collect articles published between January 1, 2002-June 4, 2022, using PubMed, Web of Science, Scopus, PsycINFO and the Cochrane library electronic databases. After screening 2457 manuscripts, 58 met inclusion criteria. Study aims, funding source(s), types of retailers assessed, assessment format and name, constructs measured, food categories measured, assessment of validity and/or reliability, and other relevant data were extracted from each manuscript. Results showed that most measures use checklists, surveys, questionnaires or similar methods to assess availability, quality, and price of select food items as assessment constructs. Most do not assess nutrient-dense food availability, and even fewer assess food sustainability. Development of comprehensive, reliable, and valid consumer nutrition environment measures that assess nutrient-dense food availability and food sustainability is important for research, planning, evaluation and advocacy aimed at improving consumer food environments for human and planetary health.

Integrating the Physical Environment Within a Population Neuroscience Perspective

Population neuroscience recognises the role of the environment in shaping brain, behaviour, and mental health. An overview of current evidence from neuroscientific and epidemiological studies highlights the protective effects of nature on cognitive function and stress reduction, the detrimental effects of urban living on mental health, and emerging concerns relating to extreme weather events and eco-anxiety. Despite the growing body of evidence in this area, knowledge gaps remain due to inconsistent measures of exposure and a reliance on small samples. In this chapter, attention is given to the physical environment and population-level studies as a necessary starting point for exploring the long-term impacts of environmental exposures on mental health, and for informing future research that may capture immediate emotional and neural responses to the environment. Key data sources, including remote sensing imagery, administrative, sensor, and social media data, are outlined. Appropriate measures of exposure are advocated for, recognising the value of area-level measures for estimating exposure over large study samples and spatial and temporal scales. Although integrating data from multiple sources requires consideration for data quality and completeness, deep learning and the increasing availability of high-resolution data present opportunities to build a more complete picture of physical environments. Advances in leveraging detailed locational data are discussed as a subsequent approach for building upon initial observations from population studies and improving understanding of the mechanisms underlying behaviour and human-environment interactions.

Assessing the healthiness of menus of all out-of-home food outlets and its socioeconomic patterns in Great Britain

Food environment research predominantly focuses on the spatial distribution of out-of-home food outlets. However, the healthiness of food choices available within these outlets has been understudied, largely due to resource constraints. In this study, we propose an innovative, low-resource approach to characterise the healthiness of out-of-home food outlets at scale. Menu healthiness scores were calculated for food outlets on JustEat, and a deep learning model was trained to predict these scores for all physical out-of-home outlets in Great Britain, based on outlet names. Our findings highlight the "double burden" of the unhealthy food environment in deprived areas where there tend to be more out-of-home food outlets, and these outlets tend to be less healthy. This methodological advancement provides a nuanced understanding of out-of-home food environments, with potential for automation and broad geographic application.

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

OBJECTIVE

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

DESIGN

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

SETTING

The Netherlands.

PARTICIPANTS

1461 adults aged 18-65 years.

RESULTS

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

CONCLUSIONS

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

Determinants of dietary diversity and drivers of food choice among low-income consumers in urban Kenya, Malawi and Zimbabwe

INTRODUCTION

Rapid urbanisation affects lifestyle and eating habits, predominantly causing a dietary shift that adds challenges to meet dietary recommendations within a complex food system. This research investigated dietary diversity and food choice drivers among low-income consumers in three urban settlements (Nairobi, Kenya; Bulawayo, Zimbabwe and Lilongwe, Malawi, representing rapid, moderate and slow urban growth patterns, respectively) as a first step towards improving diets across cultures and geographies.

METHODS

Mixed methods data collection was employed for this study. Qualitative methods such as rapid foodscape appraisal workshops and food stories in selected low-income settlements in Nairobi, Bulawayo and Lilongwe were utilised to collect information on the food environments (food balances, infrastructure, safety, policies and institutions). Quantitative data such as socio-demographic characteristics and dietary diversity were collected via structured questionnaires using Cognitive Edge's SenseMaker® (n = 890, 450 and 440 for Nairobi, Bulawayo and Lilongwe, respectively). The dietary intake of respondents was assessed using a 24-h recall, which was then converted to the food group diversity score (FGDS).

RESULTS

Different levels of compounded stress affected dietary diversity and quality, including high food prices, concerns about sanitation and hygiene and the role of food standards regulation bodies. The mean FGDS across all locations was lower than the recommended cut-off of 5 (4.5, 2.8 and 2.6 across Nairobi, Zimbabwe and Lilongwe, respectively). Additionally, in Nairobi, there were gender differences in diet diversity, with men having a higher dietary diversity score than women (4.6% vs. 4.3%; p = 0.004). The majority of respondents in Lilongwe (65%) reported price as the most important driver of food choice, compared to 38% in Nairobi and 42% in Bulawayo.

DISCUSSION/CONCLUSIONS

Our observation of poor-quality diets provides further evidence of the need for food policies that are cognisant of the nutrition and health of the growing population of the urban poor. Such policies would focus on lowering the costs of nutritious foods as well as ensuring food safety within the complex food system observed in the urban low-income environment.

Development of a Scoring Tool for Australian Rural Food Retail Environments

Current tools scoring the healthiness of food retail outlets do not reflect outlets found in rural locations. This study aimed to adapt pre-existing Australian scoring tools to represent non-metropolitan areas. Rural nutrition experts were identified, and a modified Delphi technique was used to adapt two pre-existing, food-scoring tools in five iterative stages. Stages included identifying all relevant outlets, providing a description and score for each, ensuring consistency between outlet scores and pre-existing, metro-centric tools, and providing instructions for correct use. Six rural nutrition experts were identified and engaged in the modified Delphi technique. The final tool consisted of 12 categories of food outlets and listed 35 individual outlets. Consistent with pre-existing Australian tools, scores ranged from +10 to -10 and included descriptions reflective of rural retail outlets. Scores were based on whether the majority of foods offered within the outlet were consistent with foods recommended in national health guidelines. The developed tool was designed to accommodate the diverse nature of food retail outlets found in non-metropolitan areas. This study assists in explaining the link between the food environment and health in populations living rurally.

Using Crowdsourced Food Image Data for Assessing Restaurant Nutrition Environment: A Validation Study

Crowdsourced online food images, when combined with food image recognition technologies, have the potential to offer a cost-effective and scalable solution for the assessment of the restaurant nutrition environment. While previous research has explored this approach and validated the accuracy of food image recognition technologies, much remains unknown about the validity of crowdsourced food images as the primary data source for large-scale assessments. In this paper, we collect data from multiple sources and comprehensively examine the validity of using crowdsourced food images for assessing the restaurant nutrition environment in the Greater Hartford region. Our results indicate that while crowdsourced food images are useful in terms of the initial assessment of restaurant nutrition quality and the identification of popular food items, they are subject to selection bias on multiple levels and do not fully represent the restaurant nutrition quality or customers' dietary behaviors. If employed, the food image data must be supplemented with alternative data sources, such as field surveys, store audits, and commercial data, to offer a more representative assessment of the restaurant nutrition environment.

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

Background

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

Objective

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

Methods

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

Results

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

Discussion

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

Conclusions

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

Scientific research on food environments in Brazil: a scoping review

OBJECTIVE

To map the scientific research on food environments in Brazil, based on the following questions: How many studies have addressed food environments?; What study designs and methodological approaches were applied?; What is the geographic scope of the studies?; What scenarios and dimensions of food environments were studied?; Which population groups were studied?; How were food environments conceptualised?; What are the main limitations of the studies?

DESIGN

Scoping review conducted in four databases, from January 2005 to December 2022, using different food environment-related terms to cover the main types and dimensions proposed in the literature. The studies were independently selected by two authors. A narrative synthesis was used to summarise the findings.

SETTING

Brazil.

PARTICIPANTS

130 articles.

RESULTS

Scientific research on Brazilian food environments has been increasing. The analytical quantitative approach and the cross-sectional design were the most frequently used. Most articles were published in English. The majority of studies evaluated the community food environment, addressed aspects of the physical dimension, sampled the adult population, had food consumption as an outcome, used primary data, and were carried out in capital cities in the Southeast region. Furthermore, in most articles, no conceptual model was explicitly adopted.

CONCLUSIONS

Gaps in literature are related to the need for conducting studies in the Brazilian countryside, the support for the formulation of research questions based on conceptual models, the use of valid and reliable instruments to collect primary data, in addition to the need for a greater number of longitudinal, intervention and qualitative studies.

Empowering health geography research with location-based social media data: innovative food word expansion and energy density prediction via word embedding and machine learning

BACKGROUND

The exponential growth of location-based social media (LBSM) data has ushered in novel prospects for investigating the urban food environment in health geography research. However, previous studies have primarily relied on word dictionaries with a limited number of food words and employed common-sense categorizations to determine the healthiness of those words. To enhance the analysis of the urban food environment using LBSM data, it is crucial to develop a more comprehensive list of food-related words. Within the context, this study delves into the exploration of expanding food-related words along with their associated energy densities.

METHODS

This study addresses the aforementioned research gap by introducing a novel methodology for expanding the food-related word dictionary and predicting energy densities. Seed words are generated from official and crowdsourced food composition databases, and new food words are discovered by clustering food words within the word embedding space using the Gaussian mixture model. Machine learning models are employed to predict the energy density classifications of these food words based on their feature vectors. To ensure a thorough exploration of the prediction problem, ten widely used machine learning models are evaluated.

RESULTS

The approach successfully expands the food-related word dictionary and accurately predicts food energy density (reaching 91.62%.). Through a comparison of the newly expanded dictionary with the initial seed words and an analysis of Yelp reviews in the city of Toronto, we observe significant improvements in identifying food words and gaining a deeper understanding of the food environment.

CONCLUSIONS

This study proposes a novel method to expand food-related vocabulary and predict the food energy density based on machine learning and word embedding. This method makes a valuable contribution to building a more comprehensive list of food words that can be used in geography and public health studies by mining geotagged social media data.

A detour for snacks and beverages? A cross-sectional assessment of selective daily mobility bias in food outlet exposure along the commuting route and dietary intakes

The evidence of selective daily mobility bias distorting exposure-health associations is limited. Using 7-day smartphone-based global positioning system (GPS) tracking data for 67 Dutch adults aged 25-45, we conducted paired Wilcoxon tests to compare the absolute and relative exposure to food outlets along actual and modelled commuting routes. We fitted Tobit regressions to examine their associations with three daily snack and soft drink intake outcomes. We found significant differences in absolute food outlet exposure between two types of routes. Adjusted regression analyses yielded unexpected associations between dietary intakes and food outlet exposures. Our results suggested no evidence of a selective daily mobility bias in the association between the food environment along commuting routes and adults' snacks and soft drink consumption in this sample.

Healthy home food environments of pregnant Black women are shaped by food outlet access and participation in nutrition assistance programs

OBJECTIVES

Improving access to healthy food in Black communities is imperative to combat intergenerational health disparities. Pregnant Black women represent an especially vulnerable population to multiple (and overlapping) sources of socioeconomic and political disenfranchisement and thus for whom maternal nutrition is crucial. This study aimed to (1) define household food environment types, (2) determine whether the distribution of community food outlets is associated with these household food environment types, and (3) determine whether the community-household food environment relationship differs by maternal education or participation in nutrition assistance programs.

METHODS

Cross-sectional data for pregnant Black women in North Carolina (n = 429) come from the Mothers & Others study, an obesity-prevention randomized control trial, with linked spatial data on all community food outlets (n = 6312) in the study area in 2015. Factor analysis was used to define household food environment types. These factor scores were regressed on access metrics to community food outlets. Adjusted linear regressions tested interaction by maternal education and nutrition assistance programs.

RESULTS

Four household food environment types were defined: Factor 1 (fresh fruits and vegetables (F/V), low snack), Factor 2 (canned F/V, sweet drinks), Factor 3 (dried/frozen F/V, candy), and Factor 4 (low F/V, soda). Having more convenience stores within 0.25 miles was associated with higher Factor 4 scores. No food outlets were associated with higher Factor 1 scores overall. However, SNAP or WIC participating households saw higher Factor 1 scores with increased access to supermarkets, convenience stores, and dollar stores.

CONCLUSIONS

Nutrition assistance programs play an important role as buffers against unhealthy community food environments which influence household food environments and maternal nutrition.

What counts? Adding nuance to retail food environment measurement tools in a Canadian context

OBJECTIVE

Limitations of traditional geospatial measures, like the modified Retail Food Environment Index (mRFEI), are well documented. In response, we aimed to: (1) extend existing food environment measures by inductively developing subcategories to increase the granularity of healthy v. less healthy food retailers; (2) establish replicable coding processes and procedures; and (3) demonstrate how a food retailer codebook and database can be used in healthy public policy advocacy.

DESIGN

We expanded the mRFEI measure such that 'healthy' food retailers included grocery stores, supermarkets, hypermarkets, wholesalers, bulk food stores, produce outlets, butchers, delis, fish and seafood shops, juice/smoothie bars, and fresh and healthy quick-service retailers; and 'less healthy' food retailers included fast-food restaurants, convenience stores, coffee shops, dollar stores, pharmacies, bubble tea restaurants, candy stores, frozen dessert restaurants, bakeries, and food trucks. Based on 2021 government food premise licences, we used geographic information systems software to evaluate spatial accessibility of healthy and less healthy food retailers across census tracts and in proximity to schools, calculating differences between the traditional v. expanded mRFEI.

SETTING

Calgary and Edmonton, Canada.

PARTICIPANTS

N/A.

RESULTS

Of the 10 828 food retailers geocoded, 26 % were included using traditional mRFEI measures, while 53 % were included using our expanded categorisation. Changes in mean mRFEI across census tracts were minimal, but the healthfulness of food environments surrounding schools significantly decreased.

CONCLUSIONS

Overall, we show how our mRFEI adaptation, and transparent reporting on its use, can promote more nuanced and comprehensive food environment assessments to better support local research, policy and practice innovations.

The influence of food environments on dietary behaviour and nutrition in Southeast Asia: A systematic scoping review

Background: Food environments are crucial spaces within the food system for understanding and addressing many of the shared drivers of malnutrition. In recent years, food environment research has grown rapidly, however, definitions, measures, and methods remain highly inconsistent, leading to a body of literature that is notably heterogeneous and poorly understood, particularly within regions of the Asia-Pacific. Aim: This scoping review aims to synthesize the nature, extent, and range of published literature surrounding the role of the food environment on influencing dietary behaviour and nutrition in Southeast Asia. Methods: A systematic search of 5 databases was conducted following PRISMA guidelines for scoping reviews. Eligible studies included peer-reviewed research with adult participants living in Southeast Asia that examined the food environment as a determinant of dietary behaviour or nutrition. Results: A total of 45 articles were included. Overall, studies indicated that dietary behaviours in Southeast Asia were primarily driven by social, cultural, and economic factors rather than physical (e.g. geographical) features of food environments. Food price and affordability were most consistently identified as key barriers to achieving healthy diets. Conclusion: This work contributes to the establishment of more robust conceptualizations of food environments within diverse settings which may aid future policymakers and researchers identify and address the barriers or obstacles impacting nutrition and food security in their communities. Further research is needed to strengthen this knowledge, particularly research that explicitly explores the macro-level mechanisms and pathways that influence diet and nutrition outcomes.

Use of the Nutrition Environment Measures Survey: A Systematic Review

INTRODUCTION

The Nutrition Environment Measurement Survey (NEMS) measures were developed to assess the consumer food environment in stores and restaurants. NEMS tools have been widely used in research and adapted for diverse settings and populations in the 15 years since they were created. This systematic review examines the use and adaptations of these measures and what can be learned from published studies using NEMS tools.

METHODS

A comprehensive search of bibliographic databases was conducted from 2007 to September 2021, supplemented by backward searches and communications with authors, to identify research articles using NEMS tools. Data on purpose, key findings, sample characteristics, NEMS characteristics, and modifications were abstracted. Articles were categorized on the basis of study goals, NEMS tool(s) used, variables measured, and common themes.

RESULTS

A total of 190 articles from 18 countries were identified. Most studies (69.5%, n=123) used a modified version of NEMS tools. There were 23 intervention studies that used measures from NEMS tools or adaptations as outcomes, moderators, or process assessments. A total of 41% (n=78) of the articles evaluated inter-rater reliability, and 17% (n=33) evaluated test-retest reliability.

DISCUSSION

NEMS measures have played an important role in the growth of research on food environments and have helped researchers to explore the relationships among healthy food availability, demographic variables, eating behaviors, health outcomes, and intervention-driven changes in food environments. The food environment is constantly changing, so NEMS measures should continue to evolve. Researchers should document data quality of modifications and use in new settings.

Examining neighborhood-level hot and cold spots of food insecurity in relation to social vulnerability in Houston, Texas

Food insecurity is prevalent and associated with poor health outcomes, but little is known about its geographical nature. The aim of this study is to utilize geospatial modeling of individual-level food insecurity screening data ascertained in health care settings to test for neighborhood hot and cold spots of food insecurity in a large metropolitan area, and then compare these hot spot neighborhoods to cold spot neighborhoods in terms of the CDC's Social Vulnerability Index. In this cross-sectional secondary data analysis, we geocoded the home addresses of 6,749 unique participants screened for food insecurity at health care locations participating in CMS's Accountable Health Communities (AHC) Model, as implemented in Houston, TX. Next, we created census-tract level incidence profiles of positive food insecurity screens per 1,000 people. We used Anselin's Local Moran's I statistic to test for statistically significant census tract-level hot/cold spots of food insecurity. Finally, we utilized a Mann-Whitney-U test to compare hot spot tracts to cold spot tracts in relation to the CDC's Social Vulnerability Index. We found that hot spot tracts had higher overall social vulnerability index scores (P <0.001), higher subdomain scores, and higher percentages of individual variables like poverty (P <0.001), unemployment (P <0.001), limited English proficiency (P <0.001), and more. The combination of robust food insecurity screening data, geospatial modeling, and the CDC's Social Vulnerability Index offers a solid method to understand neighborhood food insecurity.

Retail Food Environment around Schools in Barcelona by Neighborhood Socioeconomic Status: Implications for Local Food Policy

Childhood obesity is a relevant public health problem. The school food environment has been identified as an important factor for promoting healthy eating behaviors. This study assessed the availability of and proximity to unhealthy food stores around schools (n = 22) in the city of Barcelona and its association with neighborhood socioeconomic status (NSES). We conducted this cross-sectional study between 2019 and 2020. First, we identified all food retailers (n = 153) within a 400-m buffer around each school and identified those selling unhealthy food products. Then, we used Poison regression models to measure the association between NSES and the healthy food availability index (HFAI), adjusting for population density and distance. A total of 95% of the food establishments studied were classified as unhealthy (n = 146). In all, 90% of schools that had, at least, two unhealthy retailers in their proximity. There were significant differences in the mean distance to unhealthy establishments according to neighborhood SES and population density (p < 0.05). We found a positive association between schools located in higher SES neighborhoods and a higher availability and affordability of healthy food products (IIR = 1.67, 95% CI = 1.45−1.91 p = 0.000). We found strong social inequalities in the supply of healthy foods in Barcelona. Local food policy interventions addressing retail food environment around schools should consider socioeconomic inequalities.

LGBTQ+ food insufficiency in New England

As a group, LGBTQ+ people experience food insecurity at a disproportionately high rate, yet food security scholars and practitioners are only beginning to uncover patterns in how food insecurity varies by subgroups of this diverse community. In this paper, we use data from the U.S. Census Bureau's Household Pulse Survey-which added measures of gender identity and sexuality for the first time in 2021-to analyze New Englanders' food insufficiency rates by gender, sexuality, race, and ethnicity. We find that (1) in the past seven days, 13.0 percent of LGB + (lesbian, gay, bisexual, and other non-heterosexual) New Englanders experience food insufficiency-which is nearly twice the rate of heterosexual people-and 19.8 percent of transgender+ (transgender, genderqueer, gender non-binary, and other non-cisgender people) New Englanders experience food insufficiency-which is two to three times the rate of cisgender men and women. (2) Whereas cisgender New Englanders experience food insufficiency at a lower rate than their counterparts in the rest of the nation (about two percentage points lower for both cisgender men and women), transgender+ New Englanders experience no such New England advantage compared to transgender+ people in the country as a whole. (3) LGBTQ+ New Englanders of color experience devastatingly high rates of food insufficiency, with, for example, one in three Black transgender+ New Englanders not having enough food to eat in the past seven days. These findings suggest that addressing food insecurity in New England demands approaching the problem with an intersectional queer lens, with attention to the ways in which racism, cissexism, and heterosexism are creating a systemic, ongoing food crisis for LGBTQ+ New Englanders, especially those who are transgender+ and/or people of color.

Regional Difference in the Effect of Food Accessibility and Affordability on Vegetable and Fruit Acquisition and Healthy Eating Behaviors for Older Adults

The food environment has been determined to affect a range of healthy eating and health indicators, but the study on the regional difference of food environment effects on these outcomes is limited. This study aimed to examine whether food environment factors influence vegetable and fruit acquisition and healthy eating behaviors in urban and rural areas using a nationwide dataset. The study participants were community-dwelling older adults aged 65 years and older (n = 830) who participated in the 2019 Consumer Behavior Survey for Food provided by the Korea Rural Economic Institute. Food environment factors were assessed using questionnaires measuring perceived food accessibility and affordability. The negative perceptions of food environment were related to lower vegetable and fruit acquisitions and poor healthy eating behaviors. The higher risks of low vegetable and fruit acquisitions in older rural adults were related to a negative perception of food accessibility only (odds ratio [OR]: 2.34, 95% confidence interval [CI]: 1.27-4.32 for vegetable; OR: 1.96, 95% CI: 1.02-3.75 for fruit). For older urban adults, negative perceptions of both food accessibility and food affordability were related to the increased risk of low vegetable acquisition (OR: 2.03, 95% CI: 1.07-3.83 for food accessibility; OR: 2.52, 95% CI: 1.26-5.04 for food affordability). In terms of healthy eating behaviors, for those who perceived that either food accessibility or affordability was poor, older urban adults were less likely to have various and healthy food eating behaviors when they had a negative perception of affordability (OR: 0.47, 95% CI: 0.25-0.90 for variety; OR: 0.23, 95% CI: 0.11-0.46 for eating healthy foods); however, older rural adults were less likely to have the behaviors when they had a negative perception of accessibility (OR: 0.49, 95% CI: 0.21-0.97 for variety; OR: 0.28, 95% CI: 0.13-0.63 for eating healthy foods). In conclusion, the negative perceptions of food accessibility and affordability were related to low vegetable acquisition and poor healthy eating behaviors. The effects of food accessibility and affordability on vegetable and fruit acquisitions and healthy eating behaviors were different between urban and rural areas.

Assessing changes in food pantry access after extreme events

Food pantries play a growing role in supporting households facing or at risk of food insecurity in the United States. They also support emergency response and recovery following disasters and extreme weather events. Although food pantries are often placed in close proximity to communities with the highest rates of poverty and risk of food insecurity, access to these facilities can be disrupted during and after extreme events. Decreased access to food pantries following disasters can be particularly problematic as the need for these services is also likely to grow after such events. Despite the vast body of research on food retail access and food environments, relatively little research has utilized spatial analysis to understand food pantry access, particularly after extreme events. Using Geographic Information Systems (GIS), we characterize changes in access to food pantries following flooding events in Harris County, Texas-a highly populated and flood prone region with high levels of food insecurity and poverty. Specifically, our study models disruptions in road networks due to flooding and assesses the impacts of these disruptions on proximity to food pantries. The results reveal that much of Harris County sees only small increases in travel distance to food pantries due to extreme flooding, but some areas may be unable to access food pantries at all. This research highlights the potential and some of the limits of private food assistance networks to support emergency response efforts.