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Yunita, Yudhistira MH, Kurniawan YR. Does a sprawling neighborhood affect obesity? Evidence from Indonesia. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:231-256. [PMID: 38554221 DOI: 10.1007/s10754-024-09371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/05/2024] [Indexed: 04/01/2024]
Abstract
While the causes of obesity have been widely discussed from various perspectives, studies that examine how the physical form of a neighborhood could causally affect obesity remain limited. This study combined individual-level longitudinal data from the Indonesian Family Life Survey and subdistrict-level land cover data to investigate whether a neighborhood's physical form affects individuals' obesity status. We controlled for individual and location fixed-effect to account for individuals' sorting preferences and unobserved heterogeneity at the subdistrict level. Our results suggest that a sprawling neighborhood corresponds to a lower body mass index, particularly among males. We also show that consumption behavior can explain this mechanism.
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Affiliation(s)
- Yunita
- Statistics Indonesia, Jakarta, Republic of Indonesia
| | - Muhammad Halley Yudhistira
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Depok, Indonesia.
- Research Cluster of Urban and Transportation Economics, Department of Economics, Universitas Indonesia, Depok, Indonesia.
| | - Yusuf Reza Kurniawan
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Depok, Indonesia
- Research Cluster of Urban and Transportation Economics, Department of Economics, Universitas Indonesia, Depok, Indonesia
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García Bulle Bueno B, Horn AL, Bell BM, Bahrami M, Bozkaya B, Pentland A, de la Haye K, Moro E. Effect of mobile food environments on fast food visits. Nat Commun 2024; 15:2291. [PMID: 38480685 PMCID: PMC10937966 DOI: 10.1038/s41467-024-46425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/26/2024] [Indexed: 03/17/2024] Open
Abstract
Poor diets are a leading cause of morbidity and mortality. Exposure to low-quality food environments saturated with fast food outlets is hypothesized to negatively impact diet. However, food environment research has predominantly focused on static food environments around home neighborhoods and generated mixed findings. In this work, we leverage population-scale mobility data in the U.S. to examine 62M people's visits to food outlets and evaluate how food choice is influenced by the food environments people are exposed to as they move through their daily routines. We find that a 10% increase in exposure to fast food outlets in mobile environments increases individuals' odds of visitation by 20%. Using our results, we simulate multiple policy strategies for intervening on food environments to reduce fast-food outlet visits. This analysis suggests that optimal interventions are informed by spatial, temporal, and behavioral features and could have 2x to 4x larger effect than traditional interventions focused on home food environments.
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Affiliation(s)
| | - Abigail L Horn
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
- Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, 90089, USA
- Information Sciences Institute, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, 90292, USA
| | - Brooke M Bell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Mohsen Bahrami
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Burçin Bozkaya
- Sabanci Business School, Sabanci University, 34956, Tuzla, Istanbul, Turkey
| | - Alex Pentland
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kayla de la Haye
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, 90089, USA
| | - Esteban Moro
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
- Grupo Interdisciplinar de Sistemas Complejos (GISC), Department of Mathematics and GISC, Universidad Carlos III de Madrid, 28911, Leganés, Spain.
- Network Science Institute, Northeastern University, Boston, MA, 02115, USA.
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Miller S, Shier V, Wong E, Datar A. A natural experiment: The opening of a supermarket in a public housing community and impacts on children's dietary patterns. Prev Med Rep 2024; 39:102664. [PMID: 38426038 PMCID: PMC10901910 DOI: 10.1016/j.pmedr.2024.102664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Objective The aim of the present study is to utilize a natural experiment and examine changes in dietary patterns of predominantly low-income, racial and ethnic minority children who live in a public housing community following the opening of a new supermarket. Methods Data comes from the Watts Neighborhood Health Study (WNHS), an ongoing study in South Los Angeles, United States, that follows residents of Jordan Downs, a public housing community undergoing redevelopment. Surveys were administered to children aged 9-17 years (n = 297), as well as an adult in the household. The second baseline data collection was conducted June-December 2019, and follow-up was conducted June 2020-April 2021, shortly after the introduction of the new supermarket in January 2020. ANCOVA linear regression models were estimated to examine the association between children's proximity to the new supermarket with dietary outcomes at follow-up. Interactions with barriers to food access were also explored. Results Living close to the new supermarket was not significantly associated with dietary outcomes at follow-up. However, for children who lived in households with no vehicle access, living close to the new supermarket was associated with increased fruit and vegetable consumption, compared to children in the comparison group. Conclusion Proximity to the new supermarket was not associated with improved dietary outcomes among children unless they had transportation barriers. This adds to the growing body of literature that suggests that the effects of neighborhood food environments may be modified by individuals' mobility, and that comprehensive interventions are needed.
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Affiliation(s)
- Sydney Miller
- Dornsife School of Public Health, Drexel University, United States
- Keck School of Medicine, University of Southern California, United States
| | - Victoria Shier
- Price School of Public Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, United States
| | - Elizabeth Wong
- Center for Economic and Social Research, University of Southern California, United States
| | - Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, United States
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Bailey J, Baker E, Schechter MS, Robinson KJ, Powers KE, Dasenbrook E, Hossain M, Durham D, Brown G, Clemm C, Reno K, Oates GR. Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States. J Cyst Fibros 2023:S1569-1993(23)00875-5. [PMID: 37666711 PMCID: PMC10907545 DOI: 10.1016/j.jcf.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/18/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND As the nutritional status of people with CF (PwCF) is associated with their socioeconomic status, it is important to understand factors related to food security and food access that play a role in the nutritional outcomes of this population. We assessed the contributions of CF program-level food insecurity screening practices and area-level food access for nutritional outcomes among PwCF. METHODS We conducted a cross-sectional analysis of 2019 data from the U.S. CF Patient Registry (CFFPR), linked to survey data on CF program-level food insecurity screening and 2019 patient zip code-level food access. Pediatric and adult populations were analyzed separately. Nutritional outcomes were assessed with annualized BMI percentiles (CDC charts) for children and BMI (kg/m2) for adults, with underweight status defined as BMIp <10% for children and BMI <18.5 kg/m2 for adults, and overweight or obese status defined as BMIp >85% for children and BMI >25 kg/m2 for adults. Analyses were adjusted for patient sociodemographic and clinical characteristics. RESULTS The study population included 11,971 pediatric and 14,817 adult PwCF. A total of 137 CF programs responded to the survey, representing 71% of the pediatric sample and 45% of the CFFPR adult sample. The joint models of nutritional status as a function of both program-level food insecurity screening and area-level food access produced the following findings. Among children with CF, screening at every visit vs less frequently was associated with 39% lower odds of being underweight (OR 0.61, p = 0.019), and the effect remained the same and statistically significant after adjusting for all covariates (aOR 0.61, p = 0.047). Residence in a food desert was associated both with higher odds of being underweight (OR 1.66, p = 0.036; aOR 1.58, p = 0.008) and with lower BMIp (-4.81%, p = 0.004; adjusted -3.73%, p = 0.014). Among adults with CF, screening in writing vs verbally was associated with higher odds of being overweight (OR 1.22, p = 0.028; aOR 1.36, p = 0.002) and higher BMI (adjusted 0.43 kg/m2, p = 0.032). Residence in a food desert was associated with higher odds of being underweight (OR 1.48, p = 0.025). CONCLUSIONS Food insecurity screening and local food access are independent predictors of nutritional status among PwCF. More frequent screening is associated with less underweight among children with CF, whereas screening in writing (vs verbally) is associated with higher BMI among adults. Limited food access is associated with higher odds of being underweight in both children and adults with CF, and additionally with lower BMI among children with CF. Study results highlight the need for standardized, evidence-based food insecurity screening across CF care programs and for equitable food access to optimize the nutritional outcomes of PwCF.
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Affiliation(s)
- Julianna Bailey
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States
| | - Elizabeth Baker
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States
| | - Michael S Schechter
- Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, VA, United States
| | - Keith J Robinson
- University of Vermont Children's Hospital, Burlington, VT, United States
| | | | - Elliot Dasenbrook
- Cleveland Clinic Respiratory Institute, Cleveland, OH, United States
| | - Monir Hossain
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States
| | - Dixie Durham
- St. Luke's Cystic Fibrosis Center of Idaho, United States
| | - Georgia Brown
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Cristen Clemm
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Kim Reno
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Gabriela R Oates
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States.
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Nicholas KM, Thompson AL, Wasser HM, Bentley ME. Healthy home food environments of pregnant Black women are shaped by food outlet access and participation in nutrition assistance programs. Am J Hum Biol 2023; 35:e23903. [PMID: 37025042 DOI: 10.1002/ajhb.23903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
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.
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Affiliation(s)
- Khristopher M Nicholas
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda L Thompson
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Heather M Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret E Bentley
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Yankey O, Lee J, Gardenhire R, Borawski E. Neighborhood Racial Segregation Predict the Spatial Distribution of Supermarkets and Grocery Stores Better than Socioeconomic Factors in Cleveland, Ohio: a Bayesian Spatial Approach. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01669-4. [PMID: 37368191 DOI: 10.1007/s40615-023-01669-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION The food environment influences the availability and affordability of food options for consumers in a given neighborhood. However, disparities in access to healthy food options exist, affecting Black and low-income communities disproportionately. This study investigated whether racial segregation predicted the spatial distribution of supermarkets and grocery stores better than socioeconomic factors or vice versa in Cleveland, Ohio. METHOD The outcome measure was the count of supermarket and grocery stores in each census tract in Cleveland. They were combined with US census bureau data as covariates. We fitted four Bayesian spatial models. The first model was a baseline model with no covariates. The second model accounted for racial segregation alone. The third model looked at only socioeconomic factors, and the final model combined both racial and socioeconomic factors. RESULTS Overall model performance was better in the model that considered only racial segregation as a predictor of supermarkets and grocery stores (DIC = 476.29). There was 13% decrease in the number of stores for a census tract with a higher majority of Black people compared to areas with a lower number of Black people. Model 3 that considered only socioeconomic factors was less predictive of the retail outlets (DIC = 484.80). CONCLUSIONS These findings lead to the conclusion that structural racism evidenced in policies like residential segregation has a significant influence on the spatial distribution of food retail in the city of Cleveland.
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Affiliation(s)
- Ortis Yankey
- WorldPop Research Group, School of Geography and Environmental Science, University Road, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Jay Lee
- Department of Geography, Kent State University, 413 McGilvrey Hall, 325 S. Lincoln Street, Kent, OH, 44240, USA
| | - Rachel Gardenhire
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Ave, Cleveland, OH, 44106, USA
| | - Elaine Borawski
- Department of Population & Quantitative Health Sciences and Nutrition, Case Western Reserve University, 2103 Cornell Road, Cleveland, OH, 44106, USA
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Leveraging Food-Related Values for Impact in Community Nutrition Education Programs (Interventions). Foods 2023; 12:foods12040714. [PMID: 36832789 PMCID: PMC9956100 DOI: 10.3390/foods12040714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/10/2023] Open
Abstract
This study draws attention to the potential benefits of leveraging food values to amplify the impact of nutrition education programs. The study has collected data via a telephone survey from 417 randomly selected residents in Guilford County in the state of North Carolina. In our analysis, we have identified and used three underlying dimensions (ethical, social environmental and sensory) that summarize and capture the meaning of food-related values instead of a list of food values commonly used in the literature. Researchers have then used these dimensions as clustering variables to produce three segments from the data: value-positive, value-negative, and hedonic. Results show that residents in the value positive segment had positive perceptions of all values, those in value negative segment had negative perception of all values, and those in the hedonic segment had only positive perception of sensory values. A key finding is that value-positive residents have healthier food-related lifestyles and food-related behaviors than residents in the other segments. Interventions should focus on value-negative and hedonic residents and emphasize value-based education tailored to strengthening social/environmental and ethical food values. To ensure success, interventions should graft healthier lifestyle habits and behaviors on familiar behaviors and lifestyle.
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Garg G, Tedla YG, Ghosh AS, Mohottige D, Kolak M, Wolf M, Kho A. Supermarket Proximity and Risk of Hypertension, Diabetes, and CKD: A Retrospective Cohort Study. Am J Kidney Dis 2023; 81:168-178. [PMID: 36058428 DOI: 10.1053/j.ajkd.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/15/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE & OBJECTIVE Living in environments with low access to food may increase the risk of chronic diseases. We investigated the association of household distance to the nearest supermarket (as a measure of food access) with the incidence of hypertension, diabetes, and chronic kidney disease (CKD) in a metropolitan area of the United States. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 777,994 individuals without hypertension, diabetes, or CKD at baseline within the HealthLNK Data Repository, which contains electronic health records from 7 health care institutions in Chicago, Illinois. EXPOSURE Zip code-level average distance between households and nearest supermarket. OUTCOME Incidence of hypertension, diabetes, and CKD based on presence of ICD-9 code and/or blood pressure≥140/90mm Hg, hemoglobin A1c≥6.5%, and eGFR<60mL/min/1.73m2, respectively. ANALYTICAL APPROACH Average distance to nearest supermarket was aggregated from street-level metrics for 56 Chicagoland zip codes. The cumulative incidence of hypertension, diabetes, and CKD from 2007-2012 was calculated for each zip code in patients free of these diseases in 2006. Spatial analysis of food access and disease incidence was performed using bivariate local indicator of spatial association (BiLISA) maps and bivariate local Moran I statistics. The relationship between supermarket access and outcomes was analyzed using logistic regression. RESULTS Of 777,994 participants, 408,608 developed hypertension, 51,380 developed diabetes, and 56,365 developed CKD. There was significant spatial overlap between average distance to supermarket and incidence of hypertension and diabetes but not CKD. Zip codes with large average supermarket distances and high incidence of hypertension and diabetes were clustered in southern and western neighborhoods. Models adjusted only for neighborhood factors (zip code-level racial composition, access to vehicles, median income) revealed significant associations between zip code-level average distance to supermarket and chronic disease incidence. Relative to tertile 1 (shortest distance), ORs in tertiles 2 and 3, respectively, were 1.27 (95% CI, 1.23-1.30) and 1.38 (95% CI, 1.33-1.43) for diabetes, 1.03 (95% CI, 1.02-1.05) and 1.04 (95% CI, 1.02-1.06) for hypertension, and 1.18 (95% CI, 1.15-1.21) and 1.33 (95% CI, 1.29-1.37) for CKD. Models adjusted for demographic factors and health insurance showed significant and positive association with greater odds of incident diabetes (tertile 2: 1.29 [95% CI, 1.26-1.33]; tertile 3: 1.35 [95% CI, 1.31-1.39]) but lesser odds of hypertension (tertile 2: 0.95 [95% CI, 0.94-0.97]; tertile 3: 0.91 [95% CI, 0.89-0.92]) and CKD (tertile 2: 0.80 [95% CI, 0.78-0.82]; tertile 3: 0.73 [95% CI, 0.72-0.76]). After adjusting for both neighborhood and individual covariates, supermarket distance remained significantly associated with greater odds of diabetes and lesser odds of hypertension, but there was no significant association with CKD. LIMITATIONS Unmeasured neighborhood and social confounding variables, zip code-level analysis, and limited individual-level information. CONCLUSIONS There are significant disparities in supermarket proximity and incidence of hypertension, diabetes, and CKD in Chicago, Illinois. The relationship between supermarket access and chronic disease is largely explained by individual- and neighborhood-level factors.
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Affiliation(s)
- Gaurang Garg
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Yacob G Tedla
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Anika S Ghosh
- Center for Health Information Partnership, Institute for Public Health and Medicine, Division of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dinushika Mohottige
- Division of Nephrology, Department of Medicine and Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Myles Wolf
- Division of Nephrology, Department of Medicine and Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Abel Kho
- Center for Health Information Partnership, Institute for Public Health and Medicine, Division of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ramphul R, Highfield L, Sharma S. Examining neighborhood-level hot and cold spots of food insecurity in relation to social vulnerability in Houston, Texas. PLoS One 2023; 18:e0280620. [PMID: 36917592 PMCID: PMC10013905 DOI: 10.1371/journal.pone.0280620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 01/04/2023] [Indexed: 03/15/2023] Open
Abstract
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.
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Affiliation(s)
- Ryan Ramphul
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- * E-mail:
| | - Linda Highfield
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Shreela Sharma
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
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Doxey RS, Wolferz RH, Stewart KL, Goossen R, Imber L. Building Flavor and Confidence in the Kitchen: A Pilot Virtual Cooking Class on Healthy Snacking. Am J Lifestyle Med 2023; 17:64-70. [PMID: 36636388 PMCID: PMC9830242 DOI: 10.1177/15598276221125686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Cooking meals at home is associated with more healthful eating and even other healthy behaviors, such as increased physical activity, but for many there are numerous barriers to making this a reality. Healthy teaching kitchen interventions aim to help patients overcome these barriers. Our pilot program worked to address this issue by demonstrating the feasibility and acceptability of a virtual culinary medicine session designed for outpatient clinic patients. Participants were recruited from a single community primary care clinic for a virtual culinary medicine session. Of the 29 subjects who attended the class, 13 (45%) filled out the pre-course survey, and 8 (26%) filled out the post-course survey. Average participant confidence in preparing snacks at home from fresh ingredients increased from 3.62 to 4.38 out of 5 after attending this session, though the results were not statistically (OR .47; P = .172; 95% CI .16 to 1.3). Post-participation comments were overwhelmingly positive. This study showed that a virtual cooking class is feasible in a community clinic setting and is positively received. In addition, a culinary class teaching healthy cooking techniques paired with nutrition training may improve patient's confidence in the kitchen.
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Affiliation(s)
- Richmond S. Doxey
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
| | - Richard H. Wolferz
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
| | - Kelly L. Stewart
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
| | - Rachel Goossen
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
| | - Lindsey Imber
- Internal Medicine, University of Utah Health, Salt Lake City, UT, USA (RSD); Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA (RHW, RG); Nutrition Care Services
Department, University of Utah Health Hospitals and
Clinics, Salt Lake City, UT, USA (KLS, LI)
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Fernández-Escobar C, Díez J, Martínez-García A, Bilal U, O'Flaherty M, Franco M. Food availability and affordability in a Mediterranean urban context: associations by store type and area-level socio-economic status. Public Health Nutr 2022; 26:1-9. [PMID: 36274648 DOI: 10.1017/s1368980022002348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although food environments have been highlighted as potentially effective targets to improve population diets, evidence on Mediterranean food environments is lacking. We examined differences in food availability and affordability in Madrid (Spain) by store type and area-level socio-economic status (SES). DESIGN Cross-sectional study. Trained researchers conducted food store audits using the validated Nutrition Environment Measures Survey in Stores for Mediterranean contexts (NEMS-S-MED) tool to measure the availability and price of twelve food groups (specific foods = 35). We computed NEMS-S-MED scores and summarised price data with a Relative Price Index (RPI, comparing prices across stores) and an Affordability Index (normalising prices by area-level income). We compared the availability and affordability of 'healthier-less healthy' food pairs, scores between food store types (supermarkets, specialised, convenience stores and others) and area-level SES using ANOVA and multi-level regression models. SETTING City of Madrid. 2016 and 2019 to cover a representative sample. PARTICIPANTS Food stores within a socio-economically diverse sample of sixty-three census tracts (n 151). RESULTS Supermarkets had higher food availability (37·5/49 NEMS-S-MED points), compared to convenience stores (13·5/49) and specialised stores (8/49). Supermarkets offered lower prices (RPI: 0·83) than specialised stores (RPI: 0·97) and convenience stores (RPI: 2·06). Both 'healthy' and 'less healthy' items were more available in supermarkets. We found no differences in food availability or price by area-level SES, but affordability was higher in higher-income areas. CONCLUSIONS Supermarkets offered higher food availability and affordability for healthy and less healthy food items. Promoting healthy food availability through supermarkets and specialised stores and/or limiting access to convenience stores are promising policy options to achieve a healthier food environment.
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Affiliation(s)
- Carlos Fernández-Escobar
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Alba Martínez-García
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690Alicante, Spain
| | - Usama Bilal
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Manuel Franco
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Agarwal S, Fertig AR, Trofholz AC, Tate AD, Robinson J, Berge JM. Exploring the associations between neighbourhood food environment, household food insecurity and child weight-related outcomes in socio-economically and racially/ethnically diverse families. Public Health Nutr 2022; 25:1-10. [PMID: 36210770 PMCID: PMC9991713 DOI: 10.1017/s1368980022002130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/15/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine associations among neighbourhood food environments (NFE), household food insecurity (HFI) and child's weight-related outcomes in a racially/ethnically diverse sample of US-born and immigrant/refugee families. DESIGN This cross-sectional, observational study involving individual and geographic-level data used multilevel models to estimate associations between neighbourhood food environment and child outcomes. Interactions between HFI and NFE were employed to determine whether HFI moderated the association between NFE and child outcomes and whether the associations differed for US-born v. immigrant/refugee groups. SETTING The sample resided in 367 census tracts in the Minneapolis/St. Paul, MN metropolitan area, and the data were collected in 2016-2019. PARTICIPANTS The sample was from the Family Matters study of families (n 1296) with children from six racial/ethnic and immigrant/refugee groups (African American, Latino, Hmong, Native American, Somali/Ethiopian and White). RESULTS Living in a neighbourhood with low perceived access to affordable fresh fruits and vegetables was found to be associated with lower food security (P < 0·01), poorer child diet quality (P < 0·01) and reduced availability of a variety of fruits (P < 0·01), vegetables (P < 0·05) and whole grains in the home (P < 0·01). Moreover, residing in a food desert was found to be associated with a higher child BMI percentile if the child's household was food insecure (P < 0·05). No differences in associations were found for immigrant/refugee groups. CONCLUSIONS Poor NFE were associated with worse weight-related outcomes for children; the association with weight was more pronounced among children with HFI. Interventions aiming to improve child weight-related outcomes should consider both NFE and HFI.
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Affiliation(s)
- Sarthak Agarwal
- Humphrey School of Public Affairs, University of Minnesota, 130 Hubert H. Humphrey Center, 301 19th Ave South, Minneapolis, MN55455, USA
| | - Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota, 130 Hubert H. Humphrey Center, 301 19th Ave South, Minneapolis, MN55455, USA
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Allan D Tate
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Jenna Robinson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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13
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Colson-Fearon B, Versey HS. Urban Agriculture as a Means to Food Sovereignty? A Case Study of Baltimore City Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12752. [PMID: 36232052 PMCID: PMC9566707 DOI: 10.3390/ijerph191912752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
A large body of research suggests that neighborhood disparities in food access persist. Emerging evidence suggests that the global COVID-19 pandemic likely exacerbated disparities in food access. Given the potential role that alternative food networks (AFNs) and local food sources may play during times of extreme scarcity, this study examines urban agriculture (e.g., community farms and gardens) as a sustainable strategy to address food insecurity. In-depth qualitative interviews with fifteen community stakeholders revealed several major themes including food insecurity as a feature of systemic racism, food affordability and distance to food as major barriers to food security, and the role of AFNs in creating community empowerment. Our findings indicate that urban agricultural practices help build social capital, inform and educate community members about healthy eating behaviors, and facilitate the distribution of affordable food. Implications for future research and policy targeting sustainable food distribution in marginalized communities of color are discussed.
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14
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Shier V, Miller S, Datar A. Heterogeneity in grocery shopping patterns among low-income minority women in public housing. BMC Public Health 2022; 22:1612. [PMID: 36002848 PMCID: PMC9404610 DOI: 10.1186/s12889-022-14003-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public housing residents, who tend to be predominantly female and racial/ethnic minorities, are at a particularly high risk for chronic health conditions. Prior studies have suggested that a lack of access to healthy and affordable food may be an important barrier in public housing communities, but evidence is mixed on the association between the neighborhood food environment and dietary quality, suggesting the need to examine food access patterns in low-income, minority communities more deeply. The purpose of this study was to examine the variability in grocery shopping patterns, and the factors that predict them, among low-income minority women in public housing. METHODS Interviewer-administered surveys and body composition measurements were collected in the Watts Neighborhood Health Study, an ongoing longitudinal cohort study of low-income urban public housing residents located in South Los Angeles. Descriptive analyses were conducted to understand the variation in grocery shopping patterns among women. Logistic and ordered logistic regression models were estimated to examine the association between resident characteristics and grocery shopping patterns. RESULTS There was considerable variability in grocery shopping patterns, including the types of grocery stores accessed, distance travelled, frequency of shopping, and reasons behind grocery store choice. Grocery shopping patterns were associated with several participant characteristics, including race/ethnicity, working status, access to a car, income, and education. Hispanic participants were less likely to shop at a supermarket, travel further distances to shop, shop more frequently, and were more likely to prioritize price in their choice of primary grocery store than non-Hispanic Black women participants. CONCLUSIONS There was considerable variability in grocery shopping patterns, even within this low-income, minority community despite access to the same neighborhood food environment. Convenience and quality, in addition to price, were priorities for choice of primary grocery store, and differences by race/ethnicity suggest that initiatives to improve the neighborhood food environment should consider quality of food, cultural factors, and availability of foods desired by the surrounding community, in addition to price and proximity of grocery stores.
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Affiliation(s)
- Victoria Shier
- Price School of Public Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, USA.
| | - Sydney Miller
- Department of Population and Public Health Sciences, University of Southern California, 2001 N Soto St, Los Angeles, CA, 90033, USA
| | - Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, USA
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15
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de Menezes RCE, Oliveira JS, Almendra R, de Lira PIC, Costa EC, Leal VS, Santana P. Influence of food environment on ultra-processed drinks consumption among an economically vulnerable population in a metropolitan area in Brazil: A multilevel analysis. Health Place 2022; 77:102869. [PMID: 35932598 DOI: 10.1016/j.healthplace.2022.102869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/26/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022]
Abstract
Ultra-processed drinks (UPDs) consumption is increasing, and this intake has been associated with the risk of illness and death. Data on individuals (n = 430) and food stores (n = 231) were collected in an economically vulnerable area in Recife-Brazil, and multilevel regression models were applied to assess the association between UPDs consumption with food environment characteristics. The results show 29.5% of individuals consume UPDs, higher UPD consumption was significantly associated with age (OR: 0.96), lower educational levels (OR:2.06), high density of stores predominantly selling UPFs (OR:2.34) and lower availability of FV in stores (OR:0.49). The applied methodology can inform food environment interventions to reduce UPDs consumption.
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Affiliation(s)
| | | | - Ricardo Almendra
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Portugal; Department of Geography and Turism, University of Coimbra, Portugal.
| | | | - Emília Chagas Costa
- Physical Education and Sports Science Unit, Vitória Academic Center, Federal University of Pernambuco, Brazil.
| | - Vanessa Sá Leal
- Nutrition Unit, Vitória Academic Center, Federal University of Pernambuco, Brazil.
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Portugal; Department of Geography and Turism, University of Coimbra, Portugal.
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16
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Impact of Neighborhood Sociodemographic Characteristics on Food Store Accessibility in the United States Based on the 2020 US Census Data. Dela J Public Health 2022; 8:94-101. [PMID: 36177172 PMCID: PMC9495479 DOI: 10.32481/djph.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background It has been previously reported that access to quality food is greatly impacted by neighborhood food store quality and availability, which in turn is determined by a complex interplay of sociodemographic factors. Low-income predominantly Black neighborhoods face the most limited access to quality food. The purpose of this study was to examine the newly available 2020 Census to see if any significant change has occurred to this pattern and if any new insights can be gained by analyzing these data. Methods 2020 US Census and current ReferenceUSATM food store data were merged and multivariate Negative Binomial Count Regression Models were used to establish the relationship between different types of food stores (high, medium, and low quality) and neighborhood characteristics including urbanicity, poverty level, and race/ethnicity. Results 11.5% of the predominantly Non-Hispanic (NH) White census tracts (CT) (6,486 out of 56,192), 61.3% (4,002 out of 6,531) of the predominantly Non-Hispanic Black CTs, and 44.1% (3,644 out of 8,258) of the predominantly Hispanic CTs were in the high poverty category. Compared to the reference group of NH White/low-poverty group, the incident rate ratio (IRR) and 95% Confidence interval [CI] of having access to high quality food stores for NH Black was significantly lower starting at the low poverty level (0.57 [0.48, 0.67], p<0.001) and decreasing further with increasing poverty: NH Black/medium poverty (0.48 [0.42, 0.55], p<0.001); NH Black/high poverty (0.38, [0.34, 0.42], p<0.001). A similar pattern was seen with the Hispanic groups as well, though to a lesser degree. We further examined access to computer/electronic devices including smartphones from 2017 to 2020. High poverty NH Black households experienced the fastest growth from 73.6% access rate in 2017 to 82.6% in 2020, compared with 87.0% to 92.0% in the total population. Conclusion Analyses of the 2020 Census data reveal that access to high-quality food stores in high-poverty minority neighborhoods, NH Black neighborhoods in particular, remains severely limited. Innovative interventions and emerging technologies, online grocery shopping for example, warrant further evaluation as potential strategies to improve access and decrease disparities in social determinants of healthy eating.
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17
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John S, Winkler MR, Kaur R, DeAngelo J, Hill AB, Sundermeir SM, Colon-Ramos U, Leone LA, Dombrowski RD, Lewis EC, Gittelsohn J. Balancing Mission and Margins: What Makes Healthy Community Food Stores Successful. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8470. [PMID: 35886315 PMCID: PMC9315622 DOI: 10.3390/ijerph19148470] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022]
Abstract
Mission-driven, independently-owned community food stores have been identified as a potential solution to improve access to healthy foods, yet to date there is limited information on what factors contribute to these stores' success and failure. Using a multiple case study approach, this study examined what makes a healthy community food store successful and identified strategies for success in seven community stores in urban areas across the United States. We used Stake's multiple case study analysis approach to identify the following key aims that contributed to community store success across all cases: (1) making healthy food available, (2) offering healthy foods at affordable prices, and (3) reaching community members with limited economic resources. However, stores differed in terms of their intention, action, and achievement of these aims. Key strategies identified that enabled success included: (1) having a store champion, (2) using nontraditional business strategies, (3) obtaining innovative external funding, (4) using a dynamic sourcing model, (5) implementing healthy food marketing, and (6) engaging the community. Stores did not need to implement all strategies to be successful, however certain strategies, such as having a store champion, emerged as critical for all stores. Retailers, researchers, philanthropy, and policymakers can utilize this definition of success and the identified strategies to improve healthy food access in their communities.
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Affiliation(s)
- Sara John
- Center for Science in the Public Interest, Washington, DC 20005, USA
| | - Megan R. Winkler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Ravneet Kaur
- Division of Health Research and Evaluation, Department of Family and Community Medicine, University of Illinois College of Medicine, Rockford, IL 61107, USA;
| | - Julia DeAngelo
- Departments of Health Policy Management & Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA;
| | - Alex B. Hill
- Urban Studies and Planning and Detroit Food Map Initiative, Wayne State University, Detroit, MI 48202, USA;
| | - Samantha M. Sundermeir
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (S.M.S.); (E.C.L.); (J.G.)
| | - Uriyoan Colon-Ramos
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA;
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14260, USA;
| | - Rachael D. Dombrowski
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA;
| | - Emma C. Lewis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (S.M.S.); (E.C.L.); (J.G.)
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (S.M.S.); (E.C.L.); (J.G.)
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18
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Rummo P, Sze J, Elbel B. Association Between a Policy to Subsidize Supermarkets in Underserved Areas and Childhood Obesity Risk. JAMA Pediatr 2022; 176:646-653. [PMID: 35532919 PMCID: PMC9086932 DOI: 10.1001/jamapediatrics.2022.1153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE The establishment and renovation of supermarkets may promote healthy diet practices among youth by increasing retail infrastructure for fresh foods. OBJECTIVE To estimate the association between the Food Retail Expansion to Support Health (FRESH) program and the weight status of children and adolescents. DESIGN, SETTING, AND PARTICIPANTS Using a difference-in-differences (DiD) design and including 12 months before and after a FRESH supermarket opened, data were analyzed for residentially stable public school students in kindergarten through 12th grade with objectively measured height and weight data from the academic years 2009 through 2016. Of the 8 FRESH-subsidized supermarkets in residential neighborhoods in New York City, New York, 5 were new and 3 were renovation projects between December 2011 and June 2014. Data were analyzed from June 2021 to January 2022. INTERVENTIONS The treatment group included students who resided within 0.50 miles of a FRESH-subsidized supermarket and had at least 1 body mass index (BMI) measurement within 12 months before and 3 to 12 months after the month a FRESH supermarket opened (n = 22 712 student-year observations). A 2-stage matching-weighting approach was used to construct a control group of students who resided more than 0.50 miles from a FRESH supermarket in a FRESH-eligible area (n = 86 744 student-year observations). MAIN OUTCOMES AND MEASURES BMI z score was calculated using objectively measured height and weight data from FITNESSGRAM, an annual, school-based, standardized fitness assessment of every New York City public school student. Obesity was defined as 95th percentile or greater of the BMI z score using Centers for Disease Control and Prevention growth charts. RESULTS The treatment group in the analytic sample had 11 356 students (22 712 student-year observations), and the control group had 43 372 students (86 744 student-year observations). The students were predominately Black (18.8%) and Hispanic and Latino (68.5%) and eligible for free or reduced-priced lunch (84.6%). There was a significant decrease in BMI z score among students who resided within 0.50 miles of a FRESH supermarket (vs control group students) in the 3- to 12-month follow-up period (DiD, -0.04; 95% CI, -0.06 to -0.02). This was true for those exposed to supermarkets that were either new (DiD, -0.07; 95% CI, -0.11 to -0.03) or renovated (DiD, -0.03; 95% CI, -0.06 to -0.01). A statistically significant decrease was also observed in the likelihood of obesity (DiD, -0.01; 95% CI, -0.02 to -0.002). CONCLUSIONS AND RELEVANCE Government-subsidized supermarkets may contribute to a small decrease in obesity risk among children residing near those supermarkets, if part of a comprehensive policy approach.
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Affiliation(s)
- Pasquale Rummo
- New York University Grossman School of Medicine, Department of Population Health, New York
| | - Jeremy Sze
- New York University Grossman School of Medicine, Department of Population Health, New York
| | - Brian Elbel
- New York University Grossman School of Medicine, Department of Population Health, New York,Wagner Graduate School of Public Service, New York University, New York
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19
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Falkowski TB, Jorgensen B, Rakow DA, Das A, Diemont SAW, Selfa T, Arrington AB. “Connecting With Good People and Good Plants”: Community Gardener Experiences in New York State During the COVID-19 Pandemic. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.854374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Community gardens are collective projects in which participants collaborate to maintain a garden. They provide many biophysical and cultural ecosystem services, contributing to individual and community resilience and wellbeing. These benefits may be even more appreciated during a crisis such as the COVID-19 pandemic. However, since community gardens require efforts from multiple gardeners in shared spaces, the pandemic also exposed some of their vulnerabilities. This study focuses on the benefits community gardens have offered during the COVID-19 pandemic, the challenges the pandemic posed to sustaining community garden activity, and recommendations to address these issues moving forward. We conducted our study in four cities in New York representing a gradient of socioeconomic and biophysical characteristics: Binghamton, Buffalo, Ithaca, and New York City. We collected data from surveys and semi-structured interviews with community gardeners and analyzed them using mixed models and thematic coding. The primary benefits gardeners derived from their community garden experiences were: a sense of connection with other gardeners, their communities, and nature; mental and physical wellbeing; and a safe space of refuge. In addition to material shortages (e.g., seeds), the biggest challenge gardeners faced due to the pandemic was the limited degree of socializing in the gardens resulting from personal behavioral changes and rules imposed by gardens. Despite the challenges, gardeners reported enjoying the 2020 garden season. The pandemic also created opportunities for gardens to serve their communities, such as organizing programs for composting, food donation and distribution, and home gardening. Our findings suggest that community gardens can be resilient sites of reprieve during crises such as the COVID-19 pandemic, providing essential benefits for gardeners and local residents. To sustain community garden resilience, we recommend community gardens and gardeners cultivate connections and diversity, within and between the biological and human communities of their gardens.
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Freedman DA, Clark JK, Lounsbury DW, Boswell L, Burns M, Jackson MB, Mikelbank K, Donley G, Worley-Bell LQ, Mitchell J, Ciesielski TH, Embaye M, Lee EK, Roche A, Gill I, Yamoah O. Food system dynamics structuring nutrition equity in racialized urban neighborhoods. Am J Clin Nutr 2022; 115:1027-1038. [PMID: 34792095 DOI: 10.1093/ajcn/nqab380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The food system is a social determinant of health and a leverage point for reducing diet-related racial inequities. Yet, food system interventions have not resulted in sustained improvement in dietary outcomes for underrepresented minorities living in neighborhoods with a history of disinvestment. Research is needed to illuminate the dynamics structuring food systems in racialized neighborhoods to inform intervention development. OBJECTIVES To conduct participatory research examining the complexity and inequity of food systems in historically redlined neighborhoods to identify feedback mechanisms to leverage in efforts to transform system outcomes for racial equity. METHODS We conducted a mixed-methods study in Cleveland, Ohio, USA from 2018 to 2021 using participatory system dynamic modeling with 30 academic and community partners, in-depth qualitative interviews with 22 key stakeholders, and public convenings with 250 local food policy council affiliates. Data were synthesized into causal loop diagrams depicting feedback mechanisms reinforcing or balancing neighborhood-level food system dynamics. RESULTS We identified 10 feedback mechanisms structuring nutrition equity, which was identified as a meta-goal for food systems in racialized neighborhoods. Feedback mechanisms were organized in 3 domains: 1) meeting basic food needs with dignity (i.e., side hustle, government benefits, emergency food assistance, stigma, and stereotypes); 2) local food supply and demand dynamics (i.e., healthy food retail, job security, food culture, and norms); and 3) community empowerment and food sovereignty (i.e., community power, urban agriculture, risk of gentrification). Five exogenous factors moderate feedback dynamics: neighborhood crisis, neighborhood investments, household costs, government benefit funding, and voter participation. CONCLUSIONS We identified nutrition equity as an overarching goal for local food systems, which reflects a state of having freedom, agency, and dignity in food traditions resulting in people and communities healthy in body, mind, and spirit. It is a transformative goal designed to spur system-level interventions that further racial equity through improved local food system dynamics.
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Affiliation(s)
- Darcy A Freedman
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jill K Clark
- Department of Geography, John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - David W Lounsbury
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | | | - Marilyn Burns
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Community Leader, Cleveland, OH, USA
| | - Michelle B Jackson
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Activist and Community Organizer, Cleveland, OH, USA
| | | | - Gwendolyn Donley
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Timothy H Ciesielski
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Milen Embaye
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Eun Kyung Lee
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Abigail Roche
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - India Gill
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Owusua Yamoah
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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21
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The Impact of a Grocery Store Closure in One Rural Highly Obese Appalachian Community on Shopping Behavior and Dietary Intake. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063506. [PMID: 35329193 PMCID: PMC8951354 DOI: 10.3390/ijerph19063506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
Abstract
Research has examined how the entry of grocery stores into neighborhoods influences dietary outcomes, yet limited evidence suggests a direct correlation between opening a store and changes in dietary intake. A factor that might influence individuals’ behavior more directly is the closing of a grocery store where residents shop. This study aims to examine how a grocery closure in a rural Appalachian high poverty county is associated with dietary intake. A cohort of n = 152 individuals were recruited to participate in a longitudinal study examining purchasing habits and dietary intake. At time point two, one year later, n = 74 individuals completed the survey via phone. Results indicate those that switched from shopping at a local grocery store to a supercenter significantly increased their dietary intake of fruit (0.2 ± 0.8), fruits and vegetables (1.4 ± 2.7), alcohol (grams) (17.3 ± 54.1), and tomato sauce (0.1 ± 0.3). A local grocery store closure was associated with a change in shopping behavior and dietary intake. Community-level interventions targeting dietary behaviors must account for neighborhood food environment influences, including grocery store availability. Policy aimed at improving food access in rural communities need to consider approaches to improving a variety of food venues with affordable healthy food, while addressing the evolving grocery shopping behaviors of consumers.
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Changes in the Retail Food Environment in Mexican Cities and Their Association with Blood Pressure Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031353. [PMID: 35162376 PMCID: PMC8834862 DOI: 10.3390/ijerph19031353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/20/2021] [Accepted: 01/18/2022] [Indexed: 01/11/2023]
Abstract
Shifting food environments in Latin America have potentially contributed to an increase in the consumption of ultra-processed foods and sugar-sweetened beverages, along with decreases in healthy foods, such as fruits and vegetables. Yet, little is known about the impact that such changes in the food environment have on blood pressure in low- and middle-income countries, including Mexico. We utilized individual-level systolic and diastolic blood pressure (SBP and DBP) measures from the 2016 Mexican Health and Nutrition Survey (ENSANUT, n = 2798 adults). Using an inventory of food stores based on the economic census for 2010 and 2016, we calculated the change in the density of fruit and vegetable stores, convenience stores, and supermarkets. Multilevel regression was used to estimate the association between the 2010–2016 food environment neighborhood-level changes with individual-level blood pressure measured in 2016. Declines in neighborhood-level density of fruit and vegetable stores were associated with higher individual SBP (2.67 mmHg, 95% CI: 0.1, 5.2) in unadjusted models, and marginally associated after controlling for individual-level and area-level covariates. Increases in the density of supermarkets were associated with higher blood pressure outcomes among adults with undiagnosed hypertension. Structural interventions targeting the retail food environment could potentially contribute to better nutrition-related health outcomes in Latin American cities.
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Abstract
In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ana V. Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Russell C, Whelan J, Love P. Assessing the Cost of Healthy and Unhealthy Diets: A Systematic Review of Methods. Curr Nutr Rep 2022; 11:600-617. [PMID: 36083573 PMCID: PMC9461400 DOI: 10.1007/s13668-022-00428-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Poor diets are a leading risk factor for chronic disease globally. Research suggests healthy foods are often harder to access, more expensive, and of a lower quality in rural/remote or low-income/high minority areas. Food pricing studies are frequently undertaken to explore food affordability. We aimed to capture and summarise food environment costing methodologies used in both urban and rural settings. RECENT FINDINGS Our systematic review of high-income countries between 2006 and 2021 found 100 relevant food pricing studies. Most were conducted in the USA (n = 47) and Australia (n = 24), predominantly in urban areas (n = 74) and cross-sectional in design (n = 76). All described a data collection methodology, with just over half (n = 57) using a named instrument. The main purpose for studies was to monitor food pricing, predominantly using the 'food basket', followed by the Nutrition Environment Measures Survey for Stores (NEMS-S). Comparatively, the Healthy Diets Australian Standardised Affordability and Price (ASAP) instrument supplied data on relative affordability to household incomes. Future research would benefit from a universal instrument reflecting geographic and socio-cultural context and collecting longitudinal data to inform and evaluate initiatives targeting food affordability, availability, and accessibility.
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Affiliation(s)
- Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jillian Whelan
- School of Medicine, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia ,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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25
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Cohen N. Roles of Cities in Creating Healthful Food Systems. Annu Rev Public Health 2021; 43:419-437. [PMID: 34936824 DOI: 10.1146/annurev-publhealth-052220-021059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past several decades, cities worldwide have attempted to reconfigure their food systems to improve public health, advance social justice, and promote environmental resilience using diverse municipal policies, often with the support of stakeholder-led governance mechanisms such as food policy councils. This article reviews the roles that cities have played in creating healthful urban food systems and the effects of those policies on public health. It explains that despite wide-ranging policy initiatives, disparities in food insecurity and malnourishment persist. It concludes by describing several promising pathways for urban food policy: engaging in food-focused urban planning to create equitable food environments; treating policies to address inequality and social justice as upstream food policies; considering the effects of new business models such as online food retail in urban food policy making; and using food procurement as a lever to influence regional, national, and global food systems. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Nevin Cohen
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA;
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Lynch M, Mah CL. “Fronts for Drugs, Money Laundering, and Other Stuff”: Convenience Stores in the Retail Food Environment. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.2002747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M. Lynch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C. L. Mah
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- School of Health Administration, Dalhousie University, Halifax, Canada
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Lynch M, Knezevic I, Mah CL. Exploring food shopping behaviours through a study of Ottawa social media. Appetite 2021; 168:105695. [PMID: 34534591 DOI: 10.1016/j.appet.2021.105695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
Abstract
This study explored the important attributes of the local food retail environments that residents from Ottawa, Ontario, Canada, used in recommending where to purchase fresh produce, including fruits and vegetables, in the Ottawa area. Drawing upon an approach originating in marketing and consumer research, qualitative thematic analysis was used to analyze 79 discussions from three social media platforms that occurred between 2015 and 2018. We identified three patterns of conversations about food shopping, characterized by participants describing important factors of their local retail food environments that shaped their recommendations for different retail food establishments: 1) Pleasant represented discussions where having a pleasurable food shopping experience was the main discussion point. 2) Thrifty discussions were marked primarily by economical management and discussed food shopping in pragmatic terms. 3) Compromise represented a group where discussions described needing to find a middle ground between affordability and quality. While not without limitations, our study was the first exploration of whether social media data could be useful for qualitatively evaluating local retail food environments. Our findings add to the conclusions of other researchers that social media data does not compromise on the breadth of views captured and can parallel findings from traditional methods. These findings have implications for nutrition researchers and practitioners who we encourage to consider social media discussion data in their work.
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Affiliation(s)
- Meghan Lynch
- Dalla Lana School of Public Health, 155 College St, University of Toronto, Toronto, M5T 3M7, Canada.
| | - Irena Knezevic
- School of Journalism and Communication, Carleton University, Ottawa, Canada
| | - Catherine L Mah
- School of Health Administration, Dalhousie University, Halifax, Canada
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Shannon J, Reese AM, Ghosh D, Widener MJ, Block DR. More Than Mapping: Improving Methods for Studying the Geographies of Food Access. Am J Public Health 2021; 111:1418-1422. [PMID: 34464170 PMCID: PMC8489630 DOI: 10.2105/ajph.2021.306339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jerry Shannon
- Jerry Shannon is with the Departments of Geography/Financial Planning, Housing, and Consumer Economics, University of Georgia, Athens. Ashantè M. Reese is with the Department of African and African Diaspora Studies, University of Texas at Austin. Debarchana Ghosh is with the Department of Geography, University of Connecticut, Storrs. Michael J. Widener is with the Department of Geography and Planning, University of Toronto, Toronto, ON, Canada. Daniel R. Block is with the Department of Geography, Sociology, History, and African-American Studies, Chicago State University, Chicago, IL
| | - Ashantè M Reese
- Jerry Shannon is with the Departments of Geography/Financial Planning, Housing, and Consumer Economics, University of Georgia, Athens. Ashantè M. Reese is with the Department of African and African Diaspora Studies, University of Texas at Austin. Debarchana Ghosh is with the Department of Geography, University of Connecticut, Storrs. Michael J. Widener is with the Department of Geography and Planning, University of Toronto, Toronto, ON, Canada. Daniel R. Block is with the Department of Geography, Sociology, History, and African-American Studies, Chicago State University, Chicago, IL
| | - Debarchana Ghosh
- Jerry Shannon is with the Departments of Geography/Financial Planning, Housing, and Consumer Economics, University of Georgia, Athens. Ashantè M. Reese is with the Department of African and African Diaspora Studies, University of Texas at Austin. Debarchana Ghosh is with the Department of Geography, University of Connecticut, Storrs. Michael J. Widener is with the Department of Geography and Planning, University of Toronto, Toronto, ON, Canada. Daniel R. Block is with the Department of Geography, Sociology, History, and African-American Studies, Chicago State University, Chicago, IL
| | - Michael J Widener
- Jerry Shannon is with the Departments of Geography/Financial Planning, Housing, and Consumer Economics, University of Georgia, Athens. Ashantè M. Reese is with the Department of African and African Diaspora Studies, University of Texas at Austin. Debarchana Ghosh is with the Department of Geography, University of Connecticut, Storrs. Michael J. Widener is with the Department of Geography and Planning, University of Toronto, Toronto, ON, Canada. Daniel R. Block is with the Department of Geography, Sociology, History, and African-American Studies, Chicago State University, Chicago, IL
| | - Daniel R Block
- Jerry Shannon is with the Departments of Geography/Financial Planning, Housing, and Consumer Economics, University of Georgia, Athens. Ashantè M. Reese is with the Department of African and African Diaspora Studies, University of Texas at Austin. Debarchana Ghosh is with the Department of Geography, University of Connecticut, Storrs. Michael J. Widener is with the Department of Geography and Planning, University of Toronto, Toronto, ON, Canada. Daniel R. Block is with the Department of Geography, Sociology, History, and African-American Studies, Chicago State University, Chicago, IL
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Examining changes to food and beverage availability and marketing in a low-income community after the opening of a new supermarket. Public Health Nutr 2021; 24:5837-5846. [PMID: 34342260 DOI: 10.1017/s1368980021003165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In 2016, a Whole Foods Market© opened in the Englewood community of Chicago, IL - a predominately low-income African American community. This study aimed to examine changes to food and beverage availability and marketing in Englewood's existing food stores after the opening of this supermarket. DESIGN Quasi-experimental study. SETTING Two low-income African American communities in Chicago, IL. PARTICIPANTS Fieldworkers audited all small grocery and limited service stores (e.g. convenience stores, liquor stores and dollar/discount stores) located within one-square mile of the new supermarket and a one-square mile area of a demographically comparable community that also lacked a supermarket. Stores were audited before (2016) and after (2017 and 2018) the supermarket opened. RESULTS Of the 78 stores audited at baseline, 71·8 % were limited service stores and 85·9 % accepted Supplemental Nutrition Assistance Program (SNAP) benefits. Overall, the availability of healthy food and beverage options in nearby small stores was low at baseline and both follow-up periods. Difference-in-difference regression models revealed a significant increase in: (1) the percentage of stores in the intervention community (i.e. Englewood) offering regular cheese and promoting salty snacks at check-out from 2016 to 2017; and (2) the percentage of stores in the comparison community with interior store promotions for other sweetened beverages from 2016 to 2018. CONCLUSIONS Minimal changes in food and beverage availability and marketing occurred 1 and 2 years after the opening of a new supermarket. However, the wide range of staple food items offered by the supermarket expanded healthy food retail in Chicago's Englewood community.
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High BMI Predicts Attention to Less Healthy Product Sets: Can a Prompt Lead to Consideration of Healthier Sets of Products? Nutrients 2021; 13:nu13082620. [PMID: 34444780 PMCID: PMC8400244 DOI: 10.3390/nu13082620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
While the food environment has been implicated in diet-related health disparities, individuals’ ability to shape the food environment by limiting attention to a subset of products has not been studied. We examine the relationship between BMI category and consideration set—the products the individual considers before making a final choice—in an online hypothetical shopping experiment. Specifically, we focus on the healthiness of the consideration set the individual selected. Secondly, we examined the interaction of a health prompt (versus a no-prompt control) with BMI category on the healthiness of the consideration set. We used linear probability models to document the relationship between weight status and consideration set, between prompt and consideration set, and the effect of the interaction between prompt and weight status on consideration set. We found that (1) obese individuals are 10% less likely to shop from a consideration set that includes the healthy options, (2) viewing the prompt increased the probability of choosing a healthy consideration set by 9%, and (3) exposure to the prompt affected individuals in different BMI categories equally. While obese individuals are more likely to ignore healthier product options, a health-focused prompt increases consideration of healthy options across all BMI categories.
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31
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Gray HL, Berumen JH, Lovett SM, Himmelgreen D, Biswas D, Bohn J, Peacock C, Buro AW. A Mixed-methods Study to Understand Food Environments and Grocery Shopping Patterns of Community Residents in Underserved Neighborhoods in Tampa, Florida. Ecol Food Nutr 2021; 60:435-453. [PMID: 33356564 DOI: 10.1080/03670244.2020.1862098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A mixed methods study was conducted to better understand food access, food retail store environment, and perspectives of community residents on their grocery store shopping patterns and access to healthy foods in underserved, predominantly African American neighborhoods. GIS mapping, grocery store observations (n = 4), a food access and grocery store environment survey (n = 126), and focus groups (n = 48) were used. The results indicate that these neighborhoods have a low density of grocery stores, and only two out of four grocery stores meet the standard for a healthy retail store. Barriers to getting healthy foods and solutions to improve food access are discussed.
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Affiliation(s)
- Heewon L Gray
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Jessica H Berumen
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Sharonda M Lovett
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - David Himmelgreen
- Department of Anthropology and the Center for the Advancement of Food Security & Healthy Communities, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Dipayan Biswas
- School of Marketing and Innovation, Muma College of Business, University of South Florida, Tampa, Florida, USA
| | - Joe Bohn
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Acadia W Buro
- College of Public Health, University of South Florida, Tampa, Florida, USA
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32
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Lee A, Patay D, Herron LM, Parnell Harrison E, Lewis M. Affordability of current, and healthy, more equitable, sustainable diets by area of socioeconomic disadvantage and remoteness in Queensland: insights into food choice. Int J Equity Health 2021; 20:153. [PMID: 34193163 PMCID: PMC8243618 DOI: 10.1186/s12939-021-01481-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022] Open
Abstract
Background Poor diet is the leading preventable risk factor contributing to the burden of disease globally and in Australia, and is inequitably distributed. As the price of healthy foods is a perceived barrier to improved diets, evidence on the cost and affordability of current (unhealthy) and recommended (healthy, more equitable and sustainable) diets is required to support policy action. Methods This study applied the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to measure the cost, cost differential and affordability of current and recommended diets for a reference household in Queensland, Australia. Food prices were collected in 18 randomly selected locations stratified by area of socioeconomic disadvantage and remoteness. Diet affordability was calculated for three income categories. Results Surprisingly, recommended diets would cost 20% less than the current diet in Queensland as a whole. Households spent around 60% of their food budget on discretionary choices (that is, those not required for health that are high in saturated fat, added sugar, salt and/or alcohol). Queensland families would need to spend around 23% of their income on recommended diets. However, recommended diets would not be affordable in low socioeconomic or very remote areas, costing 30 and 35% of median household income respectively. The government supplements due to the SARS-CoV-2 pandemic would improve affordability of recommended diets by 29%. Conclusions Study findings highlight that while price is one factor affecting consumer food choice, other drivers such as taste, convenience, advertising and availability are important. Nevertheless, the study found that recommended diets would be unaffordable in very remote areas, and that low-income families are likely experiencing food stress, irrespective of where they live in Queensland. Policy actions, such as increasing to 20% the current 10% tax differential between basic healthy, and unhealthy foods in Australia, and supplementing incomes of vulnerable households, especially in remote areas, are recommended to help improve diet equity and sustainability, and health and wellbeing for all. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01481-8.
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Affiliation(s)
- Amanda Lee
- School of Public Health, Faculty of Medicine, University of Queensland, 266 Herston Rd, Herston, QLD, 4006, Australia.
| | - Dori Patay
- School of Public Health, Faculty of Medicine, University of Queensland, 266 Herston Rd, Herston, QLD, 4006, Australia
| | - Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, University of Queensland, 266 Herston Rd, Herston, QLD, 4006, Australia
| | - Ella Parnell Harrison
- School of Public Health, Faculty of Medicine, University of Queensland, 266 Herston Rd, Herston, QLD, 4006, Australia
| | - Meron Lewis
- School of Public Health, Faculty of Medicine, University of Queensland, 266 Herston Rd, Herston, QLD, 4006, Australia
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Di Noia J, Monica D, Sikorskii A. Process Evaluation of a Farm-to-WIC Intervention. J Acad Nutr Diet 2021; 121:2021-2034. [PMID: 34144918 DOI: 10.1016/j.jand.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the promise of farm-to-institution interventions for addressing limited vegetable access as a barrier to intake, programs designed for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are lacking. As such, little is known about the implementation of, and mechanisms of action through which, farm-to-WIC interventions affect vegetable intake and participant satisfaction with such programs. OBJECTIVE To examine whether a farm-to-WIC intervention to promote vegetable intake was implemented as intended, differences between participants who received the intervention relative to those in a usual-care control group in intermediate outcomes of vegetable-related knowledge, attitudes, and behaviors, and secondary outcomes of physical activity and weight status; and participant satisfaction with the intervention. DESIGN A process evaluation encompassing descriptive and comparative analyses of implementation fidelity logs and survey data collected as part of a pilot study was conducted. PARTICIPANTS/SETTING The setting was a large, New Jersey-based, urban WIC agency. Recruited between June 3 and August 1, 2019 through 3 of the agency's 17 sites (1 intervention and 2 control sites), participants were 297 primarily Hispanic adults (160 enrolled at the intervention site and 137 at control sites). INTERVENTION The intervention combined behaviorally focused instruction and handouts with the introduction of a WIC-based farmers' market, field trips to an area farmers' market, telephone coaching and support, and recipe demonstrations and tastings. MAIN OUTCOME MEASURES Primary outcomes were vegetable intake (measured via self-report and objectively using dermal carotenoids as a biomarker of intake) and the redemption of vouchers provided by WIC for fruit and vegetable purchases at farmers' markets (measured objectively using data provided by WIC). For the process evaluation, logs were used to document program activities. Vegetable-related knowledge, attitudes, and behaviors, physical activity, and satisfaction with the intervention were assessed with participant questionnaires. Weight status was assessed with direct measures of height and weight. Data were collected at baseline and at mid- and post-intervention (3 and 6 months post-baseline, respectively). STATISTICAL ANALYSES PERFORMED Descriptive statistics were used to characterize implementation fidelity. Associations between intermediate and secondary outcomes and vegetable intake were examined at baseline with Pearson correlations. Post-baseline between-group differences in the outcomes were examined with linear mixed-effects models adjusted for baseline values and covariates. Satisfaction with the intervention was assessed with inferential and thematic analyses. RESULTS Post-intervention, measures of vegetable intake were higher in the intervention relative to the control study group. Receipt of the intervention was also associated with a greater likelihood of voucher redemption. Nearly all participants (≥94%) received the intervention as intended at the WIC-based farmers' market; smaller percentages completed 1 or more planned trips to the area farmers' market (28%) and telephone coaching and support calls (88%). Although most intermediate and secondary outcomes were associated with measures of vegetable intake at baseline, the variables did not differ between study groups post-intervention. Mean satisfaction ratings were ≥6.8 on a 7-point scale. Recipe demonstrations, learning about vegetables, field trips, and the rapport with staff were liked most about the program. Although adding days and times for field trips was suggested, limited market days and hours of operation limited the ability to do so. CONCLUSIONS Preliminary data highlight the promise of this well-received intervention. Intermediate outcome findings suggest that other potential intervention mechanisms of action should be considered in future large-scale trials of this program. Broad-scale initiatives are needed to improve access to farmers' markets in underserved communities.
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Richardson AS, Collins RL, Ghosh-Dastidar B, Ye F, Hunter GP, Baird MD, Schwartz H, Sloan JC, Nugroho A, Beckman R, Troxel WM, Gary-Webb TL, Dubowitz T. Improvements in Neighborhood Socioeconomic Conditions May Improve Resident Diet. Am J Epidemiol 2021; 190:798-806. [PMID: 33047782 DOI: 10.1093/aje/kwaa220] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 12/31/2022] Open
Abstract
Neighborhood socioeconomic conditions (NSECs) are associated with resident diet, but most research has been cross-sectional. We capitalized on a natural experiment in Pittsburgh, Pennsylvania, in which 1 neighborhood experienced substantial investments and a sociodemographically similar neighborhood that did not, to examine pathways from neighborhood investments to changed NSECs and changed dietary behavior. We examined differences between renters and homeowners. Data were from a random sample of households (n = 831) in each of these low-income Pittsburgh neighborhoods that were surveyed in 2011 and 2014. Structural equation modeling tested direct and indirect pathways from neighborhood to resident dietary quality, adjusting for individual-level sociodemographics, with multigroup testing by homeowners versus renters. Neighborhood investments were directly associated with improved dietary quality for renters (β = 0.27, 95% confidence interval (CI): 0.05, 0.50) and homeowners (β = 0.51, 95% CI: 0.10, 0.92). Among renters, investments also were associated with dietary quality through a positive association with commercial prices (β = 0.34, 95% CI: 0.15, 0.54) and a negative association with residential prices (β = -0.30, 95% CI: -0.59, -0.004). Among homeowners, we did not observe any indirect pathways from investments to dietary quality through tested mediators. Investing in neighborhoods may support resident diet through improvements in neighborhood commercial environments for renters, but mechanisms appear to differ for homeowners.
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O’Mara J, Waterlander W, Nicolaou M. Exploring the Role of the Food Environment in Dietary Acculturation: A Study amongst Moroccan Immigrants in The Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073328. [PMID: 33804810 PMCID: PMC8037909 DOI: 10.3390/ijerph18073328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
Food environments play a role in immigrants’ dietary acculturation, but little is known about the directionality of the relationship. The objective was to explore the interaction between the food environment and food procurement behaviors in the process of dietary acculturation. A qualitative study design using in-depth interviews and a mapping exercise was conducted. The immigrant group studied used a variety of factors to select which foods to procure. Traditional foods were readily available, shifting the determining factors to a combination of affordability, acceptability and accessibility. The food environment is dynamic and responds to shifting market demands. Policies regarding food procurement behaviors should consider these upstream effects and be aware of the availability of traditional foods for immigrant groups.
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Freedman DA, Bell BA, Clark J, Ngendahimana D, Borawski E, Trapl E, Pike S, Sehgal AR. Small Improvements in an Urban Food Environment Resulted in No Changes in Diet Among Residents. J Community Health 2021; 46:1-12. [PMID: 32170531 PMCID: PMC7487057 DOI: 10.1007/s10900-020-00805-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Living in a low-income neighborhood with low access to healthy food retailers is associated with increased risk for chronic disease. The U.S. Healthy Food Financing Initiative (HFFI) provides resources to support the development of infrastructure to improve neighborhood food environments. This natural experiment examined a HFFI funded food hub that was designed to be implemented by a community development corporation in an urban neighborhood in Cleveland, Ohio. It was intended to increase access to affordable, local, and healthy foods; establish programs to increase social connections and support for healthy eating; and create job opportunities for residents. We used a quasi-experimental, longitudinal design to externally evaluate food hub implementation and its impact on changes to the built and social environment and dietary patterns among residents living in the intervention neighborhood (n = 179) versus those in a comparison (n = 150) neighborhood. Overall, many of the food hub components were not implemented fully, and dose and reach of the executed food hub components was low. There were statistically significant improvements in observed availability of healthy foods in the intervention neighborhood versus the comparison neighborhood. There were no changes over time in diet quality scores, total caloric intake, or fruit and vegetable intake in the intervention neighborhood. In conclusion, low dose implementation of a food hub led to small improvements in availability of healthy foods but not in dietary patterns. Findings highlight challenges to implementing a food hub in neighborhoods with low access to healthy food retailers.
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Affiliation(s)
- Darcy A Freedman
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44122, USA.
| | - Bethany A Bell
- College of Social Work, University of South Carolina, Columbia, SC, 29208, USA
| | - Jill Clark
- John Glenn College of Public Affairs, Ohio State University, Columbus, OH, 43210, USA
| | - David Ngendahimana
- Mary Ann Swetland Center for Environmental Health, Case Western Reserve University, Cleveland, OH, 44122, USA
| | - Elaine Borawski
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44122, USA
| | - Erika Trapl
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44122, USA
| | - Stephanie Pike
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44122, USA
| | - Ashwini R Sehgal
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44122, USA
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Giordani R, Bezerra da Costa I. The Pandemic Health Crisis and Its Implications for Food and Nutritional Security in Latin America. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000512958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The inequalities in health are directly linked to food and to the nutritional profile; hunger and malnutrition, as well as overweight and obesity, increase in proportion to poverty. In the current COVID-19 pandemic scenario, social isolation measures implemented in several countries to prevent the collapse of health systems impose new rhythms on people’s lives and their daily routines, implying a reorganization of their vital structure and the necessary activities for its maintenance and reproduction. The restriction of circulation with the requirement to prepare food inside the home imposes food planning with options with some degree of industrial processing. In the diet of isolation, among the likely changes in food consumption models, there will certainly be an increase in ultraprocessed foods, mainly because containment measures have altered the dynamics of circulation and local trade of fresh products.
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Wilcox S, Sharpe PA, Liese AD, Dunn C, Hutto B. Socioeconomic factors associated with diet quality and meeting dietary guidelines in disadvantaged neighborhoods in the Southeast United States. ETHNICITY & HEALTH 2020; 25:1115-1131. [PMID: 29966432 PMCID: PMC6314910 DOI: 10.1080/13557858.2018.1493434] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
Objective: To examine diet quality and dietary intake among residents of disadvantaged neighborhoods in the Southeast United States (U.S.) and to examine associations between dietary and socioeconomic factors. Design: We examined baseline data from an evaluation study of a healthy food access initiative. Participants were recruited from two urban settings comprising seven neighborhoods of high household poverty (17% to 62%). Participants completed in-person interviews with measures of education, household income, and food security and one unannounced 24-hour dietary recall by telephone with trained registered dietitians. Food desert residence was coded based on U.S. Census data. Proportions meeting 2010 Dietary Guidelines for Americans and Healthy Eating Index 2010 (HEI-2010) scores were computed. Associations between dietary variables and participant's education, household income, food security, and food desert residence were tested. Results: Participants (n = 465) were predominantly African American (92%), women (80%), and overweight or obese (79%), and 52 ± 14 years of age. Sixty-three percent had low or very low food security, and 82% lived in census tracts of low income and low access to supermarkets (urban food desert). HEI-2010 scores averaged 48.8 ± 13.1. A minority of participants met dietary guidelines. Diet quality was lower among participants with lower education and among those from food insecure households (p < .05). Household income and food security were positively associated with meeting several dietary guidelines (p < .05). Food desert residence was unrelated to diet variables. Conclusions: In this disadvantaged population, significant nutritional concerns were observed, and socioeconomic factors were associated with diet quality and meeting dietary guidelines. Interventions must address broader economic, social, and policy issues such as access to affordable healthy foods.
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Affiliation(s)
- Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208.
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208
| | - Patricia A. Sharpe
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208
| | - Caroline Dunn
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208
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Association between Neighborhood Food Access, Household Income, and Purchase of Snacks and Beverages in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207517. [PMID: 33076500 PMCID: PMC7602560 DOI: 10.3390/ijerph17207517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
Considerable research on the risk factors of obesity and chronic diseases has focused on relationships between where people live, where they shop, and the types of food they purchase. Rarely have investigators used a national sample and explicitly addressed the amount of energy-dense and nutrient-poor foods purchased in different types of neighborhood food stores. Even more rarely have studies accounted for the characteristics of the broader built environment in which food stores are located and which affect the convenience of using neighborhood food stores. We used a large population-based cohort of predominantly white U.S. households from the Nielsen Homescan Consumer Panel 2010 dataset to examine whether there were positive cross-sectional associations between availability of neighborhood convenience stores and supermarkets and self-reported household annual expenditures for snacks and beverages. We examined this relationship separately for poor and non-poor households as defined by the 2010 U.S. federal poverty threshold. We used mixed error-component regression models to examine associations between availability of neighborhood food stores and the expenditures on snacks and beverages, controlling for regional destination accessibility, availability and diversity of neighborhood destinations, and neighborhood street connectivity. In multivariate analyses, we observed that poor households in neighborhoods with few convenience stores purchased more snacks than poor households in neighborhoods with many convenience stores (b = -0.008, p < 0.05). Non-poor households in neighborhoods with many convenience stores and fewer supermarkets purchased more snacks than non-poor households in neighborhoods with few convenience stores and many supermarkets (b = 0.002, p < 0.05 for convenience stores; b = -0.027, p < 0.05 for supermarkets). Increase in number of convenience stores decreased the purchase of snacks by poor households, but increased in non-poor households. On other hand, increase in number of supermarkets discouraged purchase of snacks by non-poor households but had no effect on the purchasing behavior of the poor-households.Therefore, evaluation of access to energy-dense and nutrient-poor foods should include a consideration of geographic proximity. Local governments should consider strategies to expand the availability and access to nutrient-rich food and beverage products in convenience stores for consumers.
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Pérez-Ferrer C, Auchincloss AH, Barrientos-Gutierrez T, Colchero MA, de Oliveira Cardoso L, Carvalho de Menezes M, Bilal U. Longitudinal changes in the retail food environment in Mexico and their association with diabetes. Health Place 2020; 66:102461. [PMID: 33039800 PMCID: PMC7705211 DOI: 10.1016/j.healthplace.2020.102461] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/05/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
The retail food environment is a potential population-level determinant of diet and nutrition-related chronic diseases, yet little is known about its composition and association with diabetes in low- and middle-income countries. Our objectives were: (1) to describe changes in the composition of the retail food environment in Mexican neighborhoods from 2010 to 2016 and (2) to examine the association between these changes and diabetes cases diagnosed over the same period. Individual level data came from the 2016 Mexican Health and Nutrition Survey (N = 2808 adults). Neighborhood level retail food environment data for 2010 and 2016 came from the National Directory of Economic Units of Mexico. Multilevel logistic regression was used to examine the adjusted association between changes in the neighborhood density per km2 of fruit and vegetable stores, chain convenience stores and supermarkets with diabetes. Small store formats still predominate in Mexico's food environment, however there is evidence of fast increase in chain convenience stores and supermarkets. Adults living in neighborhoods that saw a decline in fruit and vegetable store density and a simultaneous increase in chain convenience store density experienced higher odds of diabetes, compared to adults who lived in neighborhoods where fruit and vegetable and convenience stores did not change (OR 3.90, 95% CI 1.61, 9.48). Considering the complex interplay between store types, understanding the mechanisms and confirming the causal implications of these findings could inform policies that improve the quality of food environments in cities. We examined changes in the retail food environment in Mexican cities. We also examined whether those changes were associated with new diabetes cases. Small food stores still predominate but evidence of fast increase in chain convenience stores and supermarkets. Odds of diabetes were highest when fruit and vegetable stores declined and chain convenience stores increased. Changes in the density of supermarkets were not associated with diabetes.
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Affiliation(s)
- Carolina Pérez-Ferrer
- National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico; National Council for Science and Technology (CONACYT), Mexico
| | - Amy H Auchincloss
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - M Arantxa Colchero
- National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | | | | | - Usama Bilal
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Comparison of food and beverage products' availability, variety, price and quality in German and US supermarkets. Public Health Nutr 2020; 23:3387-3393. [PMID: 32912374 PMCID: PMC7737043 DOI: 10.1017/s1368980020002645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: To assess availability, variety, price and quality of different food products in a convenience sample of supermarkets in Germany and the USA. Design: Cross-sectional study using an adapted version of the Bridging the Gap Food Store Observation Form. Setting: Information on availability, quality, price and variety of selected food products in eight German and seven US supermarkets (discount and full service) was obtained and compared by country. Results: A general tendency for lower prices of fruits and vegetables in Germany was observed, while produce quality and variety did not seem to differ between countries, with the exception of the variety of some vegetables such as tomatoes. Chips and cereals did not differ significantly in variety nor price. In both countries, high energy-dense foods were lower in energy costs than lower energy-dense foods. Conclusions: The influence of food prices and availability on consumption should be further explored, including the impact of country differences.
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Availability and placement of healthy and discretionary food in Australian supermarkets by chain and level of socio-economic disadvantage. Public Health Nutr 2020; 24:203-214. [PMID: 32792022 DOI: 10.1017/s1368980020002505] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The current study aimed to investigate availability and placement of healthy and discretionary (less healthy) food in supermarkets in Victoria, Australia, and examine variation by supermarket chain and area-level socio-economic disadvantage. DESIGN Cross-sectional supermarket audit. Measures included: (i) proportion of shelf space (in square metres) allocated to selected healthy and discretionary food and beverages; (ii) proportion of end-of-aisle, checkout and island bin displays containing discretionary food and beverages and (iii) proportion of space within end-of-aisle, checkout and island bin displays devoted to discretionary food and beverages. SETTING Metropolitan areas of Melbourne and Geelong, Australia. Assessment: June-July 2019. PARTICIPANTS Random sample of 104 stores, with equal numbers from each supermarket group (Coles, Woolworths, Aldi and Independent stores) within strata of area-level socio-economic position. RESULTS Proportion of shelf space devoted to selected discretionary foods was greater for Independent stores (72·7 %) compared with Woolworths (65·7 %), Coles (64·8 %) and Aldi (63·2 %) (all P < 0·001). Proportion of shelf space devoted to selected discretionary food for all Coles, Woolworths and Aldi stores was 9·7 % higher in the most compared with the least disadvantaged areas (P = 0·002). Across all stores, 90 % of staff-assisted checkout displays and 50 % of end-of-aisle displays included discretionary food. Aldi was less likely to feature discretionary food in end-of-aisle and checkout displays compared with other supermarket groups. CONCLUSIONS Extensive marketing of discretionary food in all Australian supermarket chains was observed, which is likely to strongly influence purchasing patterns and population diets. Findings should be used to inform private and public sector policies to reduce marketing of discretionary food in supermarkets.
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Ogojiaku CN, Allen JC, Anson-Dwamena R, Barnett KS, Adetona O, Im W, Hood DB. The Health Opportunity Index: Understanding the Input to Disparate Health Outcomes in Vulnerable and High-Risk Census Tracts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5767. [PMID: 32785046 PMCID: PMC7459470 DOI: 10.3390/ijerph17165767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
The Health Opportunity Index (HOI) is a multivariate tool that can be more efficiently used to identify and understand the interplay of complex social determinants of health (SDH) at the census tract level that influences the ability to achieve optimal health. The derivation of the HOI utilizes the data-reduction technique of principal component analysis to determine the impact of SDH on optimal health at lower census geographies. In the midst of persistent health disparities and the present COVID-19 pandemic, we demonstrate the potential utility of using 13-input variables to derive a composite metric of health (HOI) score as a means to assist in the identification of the most vulnerable communities during the current pandemic. Using GIS mapping technology, health opportunity indices were layered by counties in Ohio to highlight differences by census tract. Collectively we demonstrate that our HOI framework, principal component analysis and convergence analysis methodology coalesce to provide results supporting the utility of this framework in the three largest counties in Ohio: Franklin (Columbus), Cuyahoga (Cleveland), and Hamilton (Cincinnati). The results in this study identified census tracts that were also synonymous with communities that were at risk for disparate COVID-19 related health outcomes. In this regard, convergence analyses facilitated identification of census tracts where different disparate health outcomes co-exist at the worst levels. Our results suggest that effective use of the HOI composite score and subcomponent scores to identify specific SDH can guide mitigation/intervention practices, thus creating the potential for better targeting of mitigation and intervention strategies for vulnerable communities, such as during the current pandemic.
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Affiliation(s)
- Chinonso N. Ogojiaku
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, 408 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA; (C.N.O.); (O.A.)
| | - JC Allen
- Office of Health Equity, Ohio Department of Health, Columbus, OH 43215, USA;
| | | | - Kierra S. Barnett
- The Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, OH 43201, USA;
| | - Olorunfemi Adetona
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, 408 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA; (C.N.O.); (O.A.)
| | - Wansoo Im
- Division of Public Health, Meharry Medical College, Nashville, TN 37208, USA;
| | - Darryl B. Hood
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, 408 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA; (C.N.O.); (O.A.)
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Identifying and assessing factors affecting farmers' markets Electronic Benefit Transfer sales in Hawai'i. Public Health Nutr 2020; 23:1618-1628. [PMID: 32148207 DOI: 10.1017/s1368980019004051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Electronic Benefit Transfer (EBT) placement at farmers' markets can reduce access disparities for low-income consumers. However, resources needed to operate EBT programs may challenge markets' business models. A conceptual model of factors impacting EBT program success was developed from literature, and an exploratory study conducted to assess the impact of model variables on market EBT sales. DESIGN Annual EBT sales data were obtained for all Hawai'i farmers' markets with EBT programs (n 22). Key informant interviews (n 19), along with records review, were performed to gather data on model variables. Exploratory analysis was conducted to estimate the impact of individual model variables on EBT sales. SETTING Farmers' markets accepting EBT in the state of Hawai'i. PARTICIPANTS Market managers and EBT program partners (n 19). RESULTS Markets engaging in community partnerships $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ 852} \right)$, consumer education $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ {\rm{598}}} \right)$, social media promotion $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ {\rm{732}}} \right)$ or EBT incentives $\left( {{\mkern 1mu} {\mkern 1mu} \Delta \overline x = \$ {\rm{5}}0{\rm{9}}} \right)$ averaged higher sales than markets not reporting these practices. Sales increased by $3 for every ten additional SNAP-participating households and decreased by $35 for each competing EBT-accepting supermarket, grocery or farmers' market within the market's access area. Sales increased by $137/vendor for each additional hour/week the market was open. CONCLUSION Factors suggested by the model, particularly community engagement and partnership, marketing methods, consumer base and competition for EBT sales in the market area substantively affected EBT sales. Assessing these factors may identify markets with the greatest chance of EBT success and suggest ways to strengthen struggling EBT programs.
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Mooney SJ, Bobb JF, Hurvitz PM, Anau J, Theis MK, Drewnowski A, Aggarwal A, Gupta S, Rosenberg DE, Cook AJ, Shi X, Lozano P, Moudon AV, Arterburn D. Impact of Built Environments on Body Weight (the Moving to Health Study): Protocol for a Retrospective Longitudinal Observational Study. JMIR Res Protoc 2020; 9:e16787. [PMID: 32427111 PMCID: PMC7268006 DOI: 10.2196/16787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/20/2019] [Accepted: 01/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Studies assessing the impact of built environments on body weight are often limited by modest power to detect residential effects that are small for individuals but may nonetheless comprise large attributable risks. OBJECTIVE We used data extracted from electronic health records to construct a large retrospective cohort of patients. This cohort will be used to explore both the impact of moving between environments and the long-term impact of changing neighborhood environments. METHODS We identified members with at least 12 months of Kaiser Permanente Washington (KPWA) membership and at least one weight measurement in their records during a period between January 2005 and April 2017 in which they lived in King County, Washington. Information on member demographics, address history, diagnoses, and clinical visits data (including weight) was extracted. This paper describes the characteristics of the adult (aged 18-89 years) cohort constructed from these data. RESULTS We identified 229,755 adults representing nearly 1.2 million person-years of follow-up. The mean age at baseline was 45 years, and 58.0% (133,326/229,755) were female. Nearly one-fourth of people (55,150/229,755) moved within King County at least once during the follow-up, representing 84,698 total moves. Members tended to move to new neighborhoods matching their origin neighborhoods on residential density and property values. CONCLUSIONS Data were available in the KPWA database to construct a very large cohort based in King County, Washington. Future analyses will directly examine associations between neighborhood conditions and longitudinal changes in body weight and diabetes as well as other health conditions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16787.
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Affiliation(s)
- Stephen J Mooney
- Department of Epidemiology, University of Washington, Seattle, WA, United States.,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, United States
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Philip M Hurvitz
- Department of Urban Design and Planning, College of Built Environments, University of Washington, Seattle, WA, United States
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Adam Drewnowski
- Department of Epidemiology, University of Washington, Seattle, WA, United States.,Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Anju Aggarwal
- Department of Epidemiology, University of Washington, Seattle, WA, United States.,Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Shilpi Gupta
- Department of Epidemiology, University of Washington, Seattle, WA, United States.,Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Xiao Shi
- Department of Urban Design and Planning, College of Built Environments, University of Washington, Seattle, WA, United States
| | - Paula Lozano
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Anne Vernez Moudon
- Department of Urban Design and Planning, College of Built Environments, University of Washington, Seattle, WA, United States
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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Sharpe PA, Bell BA, Liese AD, Wilcox S, Stucker J, Hutto BE. Effects of a food hub initiative in a disadvantaged community: A quasi-experimental evaluation. Health Place 2020; 63:102341. [PMID: 32543428 PMCID: PMC7357735 DOI: 10.1016/j.healthplace.2020.102341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022]
Abstract
A quasi-experiment evaluated a food hub's (FH) impact in a low-income/low-access (food desert) setting on fruit and vegetable (F&V) intake, diet quality, kilocalories, perceived food environment, BMI, and farmers' market shopping versus a matched community (n = 265 FH, n = 262 Comparison). Comparison shoppers had better baseline perceptions of their food environment, but FH shoppers improved significantly more than Comparison shoppers. Comparison shoppers significantly increased F&V intake versus FH shoppers. Effects were not significant for other diet outcomes, BMI, or farmers' market shopping. Factors besides spacial access to healthy food need consideration to address dietary intake and obesity in disadvantaged communities.
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Affiliation(s)
- Patricia A Sharpe
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States.
| | - Bethany A Bell
- College of Social Work, University of South Carolina, 1512 Pendelton Street, Columbia, SC, 29208, United States.
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States.
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States.
| | - Jessica Stucker
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States.
| | - Brent E Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States.
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Neighborhood Food Outlet Access and Dietary Intake among Adults with Chronic Kidney Disease: Results from the Chronic Renal Insufficiency Cohort Study. J Acad Nutr Diet 2020; 120:1151-1162.e3. [PMID: 32146126 DOI: 10.1016/j.jand.2019.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/16/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Healthy diet is essential in the management of chronic kidney disease (CKD) and preventing related comorbidities. Food outlet access has been studied in the general population; however, the influence of the local food environment on dietary intake among people with CKD has not been evaluated. OBJECTIVES This study examined the associations of food outlet density and type of outlets with dietary intake in a multicenter cohort of racially and ethnically diverse patients with CKD. METHODS The Chronic Renal Insufficiency Cohort Study is a multicenter prospective study of patients with CKD that used a validated food frequency questionnaire to capture dietary intake at the baseline visit. This is a cross-sectional analysis of 2,484 participants recruited in 2003-2006 from seven Chronic Renal Insufficiency Cohort Study centers. Food outlet data were used to construct a count of the number of fast-food restaurants, convenience stores, and grocery stores per 10,000 population for each geocoded census block group. Multivariable linear and logistic regression models were used to evaluate the associations between measures of food outlet availability and dietary factors. RESULTS The proportion of participants living in zero-, low-, and high-food outlet density areas differed by gender, race or ethnicity, and income level. Among male subjects, living in areas with zero or the highest number of outlets was associated with having the highest caloric intakes in multivariable models. Male subjects living in areas with zero outlets consumed the highest levels of sodium and phosphorous. Female subjects living in areas with zero outlets had the lowest average intake of calories, sodium, and phosphorous. Among low-income female subjects, close proximity to more outlets was associated with higher calorie consumption. Among all participants, access to fast-food restaurants was not associated with an unhealthy diet score, and access to grocery stores was not associated with a healthy diet score. CONCLUSIONS Average caloric and nutrient intakes differed by outlet availability; however, there were no strong associations with type of food outlet. This should be considered when developing food-focused public health policies.
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Mozaffarian D. Dietary and policy priorities to reduce the global crises of obesity and diabetes. ACTA ACUST UNITED AC 2020. [DOI: 10.1038/s43016-019-0013-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Healthy diets and the retail food environment: A sociological approach. Health Place 2019; 61:102244. [PMID: 31748171 DOI: 10.1016/j.healthplace.2019.102244] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 11/24/2022]
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BeLue R, NDao F, McClure S, Alexander S, Walker R. The Role of Social Issues on Food Procurement among Corner Store Owners and Shoppers. Ecol Food Nutr 2019; 59:35-46. [PMID: 31475574 DOI: 10.1080/03670244.2019.1659789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We assessed corner store shopper and owner perceptions, barriers, and enablers related to food procurement in a sample of neighborhood corner stores where over 50% of families are SNAP eligible. DESIGN We conducted semi-structured interviews to identify inventory stocking, shopping and marketing approaches, and perspectives on healthy eating. PARTICIPANTS Five corner store owners and 20 corner store shoppers. RESULTS Corner store owners: 1) did not feel as though they belonged to the community where their corner store was located; 2) had difficulty in becoming authorized WIC retailers because of the perceived complexity of the process, and 3) stated tobacco products and hot food items are their best-selling items; fruits and vegetables were perceived as unmarketable. Corner store shoppers preferred shopping at local corner stores because: 1) lack of transportation made corner stores easier to access than full-service grocery stores; 2) hot foods are readily available and inexpensive; 3) some home kitchens lacked an oven or stovetop for meal preparation; 4) they need to shop daily for children or other family members. CONCLUSIONS Social issues such as housing quality, corner store owner sense of community, and acculturation should be addressed when considering food environment in limited resource communities.
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Affiliation(s)
- Rhonda BeLue
- Department of Health Management and Policy, Saint Louis University College of Public Health and Social Justice, Saint Louis, MO, USA
| | - Fatou NDao
- Penn State University College of Medicine, Hershey, PA, USA
| | - Stephanie McClure
- Department of Health Management and Policy, Saint Louis University College of Public Health and Social Justice, Saint Louis, MO, USA
| | - Suzanne Alexander
- Department of Health Management and Policy, Saint Louis University College of Public Health and Social Justice, Saint Louis, MO, USA
| | - Renee Walker
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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