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Sanjeevi N, Monsivais P. WIC Participation and Coping Strategies Adopted by Families During the Infant Formula Shortage Crisis. J Acad Nutr Diet 2024; 124:372-378. [PMID: 37797732 DOI: 10.1016/j.jand.2023.09.019] [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] [Received: 04/24/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Availability of benefits and expanded flexibilities to obtain formula, granted by the US Department of Agriculture shortly after the onset of infant formula shortage in February 2022, could have mitigated adverse experiences related to the shortage in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) families. OBJECTIVE To examine association of household WIC participation with formula shortage experiences and coping strategies adopted by families using Household Pulse Survey data. DESIGN Cross-sectional. PARTICIPANTS The current study utilized Phase 3.7 of the Household Pulse Survey with the following data collection periods: December 9 through 19, 2022, January 4 through 16, 2023, and February 1 through 13, 2023. The primary analytic sample (N = 1,542) consisted of households with income ≤185% of the federal poverty level and children younger than age 18 months. MAIN OUTCOME MEASURES Experiences and coping strategies during the formula shortage. STATISTICAL ANALYSES Logistic regression examined associations of WIC participation with odds of being affected by formula shortage and difficulty in obtaining formula during the past week. Among those affected by the shortage, association of WIC participation with odds of utilizing coping strategies was examined. RESULTS No statistically significant differences were observed in the rates of being affected by formula shortage and having difficulty in obtaining formula during the past week between WIC participants and income-eligible nonparticipants. However, among those affected by the shortage, WIC participation was related to significantly lower odds of using suboptimal practices as a coping strategy (odds ratio 0.38, 95% CI 0.20 to 0.71; P = 0.003). WIC participants also had significantly higher odds of solely changing formula type, brand, or method of receipt (odds ratio 2.63, 95% CI 1.20 to 5.73; P = 0.02). CONCLUSIONS Findings from this study suggest that WIC participants may have utilized more optimal coping strategies during the infant formula shortage compared with income-eligible nonparticipants. Additional research is needed to determine whether or not these findings could be attributed to expanded flexibilities to maximize formula access among WIC participants during the shortage.
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Baker K, Burd L, Figueroa R. Consumer nutrition environment measurements for nutrient-dense food availability and food sustainability: a scoping review. Arch Public Health 2024; 82:7. [PMID: 38225657 PMCID: PMC10789067 DOI: 10.1186/s13690-023-01231-y] [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: 07/19/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024] Open
Abstract
Consumer nutrition environments are defined as places in which consumers interact with the food they eat; these food choices can impact human and planetary health. Assessment measures for consumer nutrition environments are numerous, and vary widely on what, and how, they assess the food environment. The objective of this scoping review was to synthesize existing evidence on nutrition environment measurements and their capacity to assess nutrient-dense food access and food sustainability capacity. Eligibility criteria were developed to capture relevant peer-reviewed literature about auditing measures designed to assess nutrient-dense foods and food sustainability capacity in the consumer nutrition environment. A search strategy was conducted to collect articles published between January 1, 2002-June 4, 2022, using PubMed, Web of Science, Scopus, PsycINFO and the Cochrane library electronic databases. After screening 2457 manuscripts, 58 met inclusion criteria. Study aims, funding source(s), types of retailers assessed, assessment format and name, constructs measured, food categories measured, assessment of validity and/or reliability, and other relevant data were extracted from each manuscript. Results showed that most measures use checklists, surveys, questionnaires or similar methods to assess availability, quality, and price of select food items as assessment constructs. Most do not assess nutrient-dense food availability, and even fewer assess food sustainability. Development of comprehensive, reliable, and valid consumer nutrition environment measures that assess nutrient-dense food availability and food sustainability is important for research, planning, evaluation and advocacy aimed at improving consumer food environments for human and planetary health.
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Affiliation(s)
- Katherine Baker
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA.
| | - Laura Burd
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Roger Figueroa
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Ohri-Vachaspati P, Acciai F, Melnick EM, Lloyd K, Martinelli S, DeWeese RS, DiSantis KI, Tulloch D, DeLia D, Yedidia MJ. Food Environments Within and Outside of Schools Play a Critical Role in Curtailing the Rise in Obesity among School-Aged Children over Time. J Nutr 2023; 153:3565-3575. [PMID: 37844841 PMCID: PMC10739773 DOI: 10.1016/j.tjnut.2023.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/28/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Sound evidence for effective community-based strategies is needed to curtail upward trends in childhood obesity in the United States (US). OBJECTIVES The aim of the study was to assess the association between school and community food environments and the prevalence of obesity over time. METHODS Data were collected from K-12 schools in 4 low-income New Jersey cities in the US. School-level obesity prevalence, calculated from nurse-measured heights and weights at 4 time points, was used as the outcome variable. Data on the school food environment (SFE) measured the healthfulness of school lunch and competitive food offerings annually. The community food environment (CFE), i.e., the number of different types of food outlets within 400 m of schools, was also captured annually. The count and presence of food outlets likely to be frequented by students were calculated. Exposure to composite environment profiles both within schools and in communities around schools was assessed using latent class analysis. Data from 106 schools were analyzed using multilevel linear regression. RESULTS The prevalence of obesity increased from 25% to 29% over the course of the study. Obesity rates were higher in schools that had nearby access to a greater number of limited-service restaurants and lower in schools with access to small grocery stores and upgraded convenience stores participating in initiatives to improve healthful offerings. Interaction analysis showed that schools that offered unhealthier, competitive foods experienced a faster increase in obesity rates over time. Examining composite food environment exposures, schools with unhealthy SFEs and high-density CFEs experienced a steeper time trend (β = 0.018, P < 0.001) in obesity prevalence compared to schools exposed to healthy SFE and low-density CFEs. CONCLUSIONS Food environments within and outside of schools are associated with differential obesity trajectories over time and can play an important role in curtailing the rising trends in childhood obesity.
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Affiliation(s)
| | - Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Emily M Melnick
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Kristen Lloyd
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
| | - Sarah Martinelli
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Robin S DeWeese
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | | | - David Tulloch
- Department of Landscape Architecture, Rutgers University, New Brunswick, NJ, United States
| | - Derek DeLia
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, United States
| | - Michael J Yedidia
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, 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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Huse O, Schultz S, Boelsen‐Robinson T, Ananthapavan J, Peeters A, Sacks G, Blake MR. The implementation and effectiveness of outlet-level healthy food and beverage accreditation schemes: A systematic review. Obes Rev 2023; 24:e13556. [PMID: 36756666 PMCID: PMC10909553 DOI: 10.1111/obr.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/20/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023]
Abstract
Healthy food outlet accreditation schemes represent an avenue for incentivizing food retailers to promote healthy eating patterns by improving the healthiness of food environments. This systematic review aimed to (i) assess the impact of food outlet-level accreditation schemes on outlet practices and customer purchases and (ii) identify barriers and enablers to scheme implementation. Peer-reviewed and grey literature were systematically searched. Eligible studies related to outlet-level food and beverage accreditation schemes across any food retail setting. Findings were narratively synthesized by retailer type according to (i) scheme characteristics (governance, targeted products, support, and monitoring); (ii) scheme outcomes (rate of uptake, proportion of certified retailers, impact on purchasing, customer perspectives, and retailer perspectives); and (iii) barriers and enablers to implementation. From 21,943 records screened, 48 were included, covering 26 schemes. Most (18) targeted restaurants or convenience stores. Average uptake was 65% of all outlets approached to participate. Implementation of accreditation schemes was associated with healthier customer purchases in convenience stores, schools, and hospitals, but evidence from restaurants was mixed. Enablers of scheme implementation included support for implementation and maintenance, flexible scheme criteria, and motivated retail staff. Healthy food outlet accreditation schemes represent a promising mechanism for engaging retailers to improve the healthiness of food retail environments.
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Affiliation(s)
- Oliver Huse
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | - Sally Schultz
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | - Tara Boelsen‐Robinson
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | - Jaithri Ananthapavan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
- Deakin Health Economics, Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | - Anna Peeters
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | - Miranda R. Blake
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
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Glanz K, Fultz AK, Sallis JF, Clawson M, McLaughlin KC, Green S, Saelens BE. Use of the Nutrition Environment Measures Survey: A Systematic Review. Am J Prev Med 2023:S0749-3797(23)00068-5. [PMID: 36990939 DOI: 10.1016/j.amepre.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION The Nutrition Environment Measurement Survey (NEMS) measures were developed to assess the consumer food environment in stores and restaurants. NEMS tools have been widely used in research and adapted for diverse settings and populations in the 15 years since they were created. This systematic review examines the use and adaptations of these measures and what can be learned from published studies using NEMS tools. METHODS A comprehensive search of bibliographic databases was conducted from 2007 to September 2021, supplemented by backward searches and communications with authors, to identify research articles using NEMS tools. Data on purpose, key findings, sample characteristics, NEMS characteristics, and modifications were abstracted. Articles were categorized on the basis of study goals, NEMS tool(s) used, variables measured, and common themes. RESULTS A total of 190 articles from 18 countries were identified. Most studies (69.5%, n=123) used a modified version of NEMS tools. There were 23 intervention studies that used measures from NEMS tools or adaptations as outcomes, moderators, or process assessments. A total of 41% (n=78) of the articles evaluated inter-rater reliability, and 17% (n=33) evaluated test-retest reliability. DISCUSSION NEMS measures have played an important role in the growth of research on food environments and have helped researchers to explore the relationships among healthy food availability, demographic variables, eating behaviors, health outcomes, and intervention-driven changes in food environments. The food environment is constantly changing, so NEMS measures should continue to evolve. Researchers should document data quality of modifications and use in new settings.
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Affiliation(s)
- Karen Glanz
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Amanda K Fultz
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James F Sallis
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California
| | - Margaret Clawson
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelly C McLaughlin
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Sarah Green
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian E Saelens
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
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Kogan K, Anand P, Gallo S, Cuellar AE. A Quasi-Experimental Assessment of the Effect of the 2009 WIC Food Package Revisions on Breastfeeding Outcomes. Nutrients 2023; 15:nu15020414. [PMID: 36678285 PMCID: PMC9862204 DOI: 10.3390/nu15020414] [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] [Received: 12/15/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Breastfeeding rates among infants participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are consistently lower than those of WIC nonparticipants. The 2009 WIC food package revisions were intended to incentivize breastfeeding among the WIC population. To examine the effectiveness of this policy change, we estimated an intent-to-treat regression-adjusted difference-in-difference model with propensity score weighting, an approach that allowed us to control for both secular trends in breastfeeding and selection bias. We used novel data from the Feeding Infants and Toddlers Survey from 2008 and 2016. We defined our treatment group as infants eligible for WIC based on household income and our control group as infants in households with incomes just above the WIC eligibility threshold. The breastfeeding outcomes we analyzed were whether the infants were ever breastfed, breastfed through 6 months, and breastfed exclusively through 6 months. We observed significant increases in infants that were ever breastfed in both the treatment group (10 percentage points; p < 0.01) and the control group (15 percentage points; p < 0.05); however, we did not find evidence that the difference between the two groups was statistically significant, suggesting that the 2009 revisions may not have had an effect on any of these breastfeeding outcomes.
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Affiliation(s)
- Kelly Kogan
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA 22030, USA
- Correspondence:
| | - Priyanka Anand
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA 22030, USA
| | - Sina Gallo
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA 30602, USA
| | - Alison Evans Cuellar
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA 22030, USA
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Houghtaling B, Cater M, Bryant D, Brooks A, Holston D. What is the availability, affordability, and quality of foods and beverages aligned with dietary guidance in Louisiana Supplemental Nutrition Assistance Program (SNAP) authorized stores? Prev Med Rep 2021; 24:101578. [PMID: 34976640 PMCID: PMC8683981 DOI: 10.1016/j.pmedr.2021.101578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
Healthy food retail strategies are delivered by Cooperative Extension Services in Louisiana to improve public health among communities with lower income. To guide Cooperative Extension Services Programming, the aim of this study was to assess healthy food access among SNAP-authorized stores. This included comparing the availability, affordability, and quality of healthy foods sold in these stores by geography, ownership, and store type. Seventy-five Louisiana SNAP-authorized stores were selected for measurement. Between October 2019 and March 2020 (prior to the COVID-19 national emergency declaration), trained researchers used the Nutrition Environment Measures Survey in Stores (NEMS-S) to assess the availability, affordability, and quality of healthy versus less healthy foods and beverages in 42 SNAP-authorized stores, including: grocery (n = 12, 29%), convenience (n = 17, 41%), drug (n = 1, 2%), dollar (n = 11, 26%), and butcher/meat (n = 1, 2%). Multivariate analysis of variance (a priori, p < 0.05) determined if differences in total NEMS-S scores or subscores existed by geography (urban versus rural), ownership (corporate/chain versus independent), or store type. No urban/rural differences were identified. Corporate/chain SNAP-authorized stores scored higher on average than independent SNAP-authorized stores for the total NEMS-S score (17.2 versus 8.1; p = 0.009) and availability subscore (13.1 versus 6.1; p = 0.02). SNAP-authorized grocery stores scored higher than all other store types (total NEMS-S score 27.6), followed by SNAP-authorized dollar stores (total NEMS-S score 10.7), and SNAP-authorized convenience stores (total NEMS-S score 5) (p < 0.001). Louisiana Cooperative Extension Services should explore ways to scale healthy food retail strategies statewide with a specific emphasis on independent and smaller SNAP-authorized retailers.
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Key Words
- Beverages
- CDC, Centers for Disease Control and Prevention
- DGA, 2020–2025 Dietary Guidelines for Americans
- EFNEP, Expanded Food and Nutrition Education Program
- Food
- Food access
- Food assistance
- Food security
- NEMS-S, Nutrition Environment Measures Survey in Stores
- PSE, policy, systems, and environmental
- Public health
- RUCC, Rural-Urban Continuum Code
- SNAP, Supplemental Nutrition Assistance Program
- SNAP-Ed, Supplemental Nutrition Assistance Program Education
- WIC, Special Supplemental Nutrition Assistance Program for Women, Infants, and Children
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Affiliation(s)
- Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - Melissa Cater
- Agricultural and Extension Education and Evaluation, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - De'Jerra Bryant
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - Allie Brooks
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - Denise Holston
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
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Cantor J, Beckman R, Collins RL, Dastidar MG, Richardson AS, Dubowitz T. SNAP Participants Improved Food Security And Diet After A Full-Service Supermarket Opened In An Urban Food Desert. Health Aff (Millwood) 2021; 39:1386-1394. [PMID: 32744934 DOI: 10.1377/hlthaff.2019.01309] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) is the largest US food and nutrition assistance program, tasked with improving food security among low-income households. Another federal effort to improve food access is the Healthy Food Financing Initiative (HFFI), which invested tens of millions of dollars to incentivize healthy food retail outlets in areas lacking access to nutritious, fresh food. We explore the intersection of these programs, testing the impact of a new, HFFI-financed full-service supermarket on SNAP participants in an urban food desert. After the supermarket's opening, SNAP participants' food security improved and intake of added sugars declined in the intervention neighborhood, but both were unchanged in a comparison neighborhood without a new supermarket. Intervention neighborhood participants also experienced relative declines in the percentage of daily calories from solid fats, alcoholic beverages, and added sugars. Our findings suggest that HFFI amplifies the effects of SNAP participation on improving food security and dietary quality in food deserts.
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Affiliation(s)
- Jonathan Cantor
- Jonathan Cantor is an associate policy researcher in the Department of Economics, Sociology, and Statistics, RAND Corporation, in Santa Monica, California
| | - Robin Beckman
- Robin Beckman is a resident programmer in information services, RAND Corporation, in Santa Monica
| | - Rebecca L Collins
- Rebecca L. Collins is a senior behavioral scientist in the Department of Behavioral and Policy Sciences, RAND Corporation, in Santa Monica
| | - Madhumita Ghosh Dastidar
- Madhumita Ghosh Dastidar is a senior statistician in the Department of Economics, Sociology, and Statistics, RAND Corporation, in San Francisco, California
| | - Andrea S Richardson
- Andrea S. Richardson is a policy researcher in the Department of Behavioral and Policy Sciences, RAND Corporation, in Pittsburgh, Pennsylvania
| | - Tamara Dubowitz
- Tamara Dubowitz is a senior policy researcher in the Department of Behavioral and Policy Sciences, RAND Corporation, in Pittsburgh
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Landry MJ, Phan K, McGuirt JT, Ostrander A, Ademu L, Seibold M, McCallops K, Tracy T, Fleischhacker SE, Karpyn A. USDA Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Vendor Criteria: An Examination of US Administrative Agency Variations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3545. [PMID: 33805495 PMCID: PMC8037245 DOI: 10.3390/ijerph18073545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 01/09/2023]
Abstract
The food retail environment has been directly linked to disparities in dietary behaviors and may in part explain racial and ethnic disparities in pregnancy-related deaths. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), administered by the United States Department of Agriculture, is associated with improved healthy food and beverage access due to its requirement for minimum stock of healthy foods and beverages in WIC-eligible stores. The selection and authorization criteria used to authorize WIC vendors varies widely from state to state with little known about the specific variations. This paper reviews and summarizes the differences across 16 of these criteria enacted by 89 WIC administrative agencies: the 50 states, the District of Columbia, five US Territories, and 33 Indian Tribal Organizations. Vendor selection and authorization criteria varied across WIC agencies without any consistent pattern. The wide variations in criteria and policies raise questions about the rational for inconsistency. Some of these variations, in combination, may result in reduced access to WIC-approved foods and beverages by WIC participants. For example, minimum square footage and/or number of cash register criteria may limit vendors to larger retail operations that are not typically located in high-risk, under-resourced communities where WIC vendors are most needed. Results highlight an opportunity to convene WIC stakeholders to review variations, their rationale, and implications thereof especially as this process could result in improved policies to ensure and improve healthy food and beverage access by WIC participants. More work remains to better understand the value of state WIC vendor authorization authority, particularly in states that have provided stronger monitoring requirements. This work might also examine if and how streamlining WIC vendor criteria (or at least certain components of them) across regional areas or across the country could provide an opportunity to advance interstate commerce and promote an equitable supply of food across the food system, while ensuring the protection for local, community-oriented WIC vendors.
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Affiliation(s)
- Matthew J. Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA 94305, USA;
| | - Kim Phan
- Harvard College, Harvard University, Cambridge, MA 02138, USA;
| | - Jared T. McGuirt
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC 27412, USA;
| | - Alek Ostrander
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Lilian Ademu
- College of Liberal Arts and Sciences, University of North Carolina Charlotte, Charlotte, NC 28223, USA;
| | - Mia Seibold
- Center for Research in Education & Social Policy, College of Education & Human Development, University of Delaware, Newark, DE 19716, USA; (M.S.); (K.M.); (T.T.)
| | - Kathleen McCallops
- Center for Research in Education & Social Policy, College of Education & Human Development, University of Delaware, Newark, DE 19716, USA; (M.S.); (K.M.); (T.T.)
| | - Tara Tracy
- Center for Research in Education & Social Policy, College of Education & Human Development, University of Delaware, Newark, DE 19716, USA; (M.S.); (K.M.); (T.T.)
| | | | - Allison Karpyn
- Center for Research in Education & Social Policy, College of Education & Human Development, University of Delaware, Newark, DE 19716, USA; (M.S.); (K.M.); (T.T.)
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Jilcott Pitts SB, Wu Q, Truesdale KP, Rafferty AP, Haynes-Maslow L, Boys KA, McGuirt JT, Fleischhacker S, Johnson N, Kaur AP, Bell RA, Ammerman AS, Laska MN. A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017-2020. Int J Behav Nutr Phys Act 2021; 18:44. [PMID: 33761952 PMCID: PMC7990380 DOI: 10.1186/s12966-021-01109-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The North Carolina (NC) Healthy Food Small Retailer Program (HFSRP) was passed into law with a $250,000 appropriation (2016-2018) providing up to $25,000 in funding to small food stores for equipment to stock healthier foods and beverages. This paper describes an observational natural experiment documenting the impact of the HFSRP on store food environments, customers' purchases and diets. METHODS Using store observations and intercept surveys from cross-sectional, convenience customer samples (1261 customers in 22 stores, 2017-2020; 499 customers in 7 HFSRP stores, and 762 customers in 15 Comparison stores), we examined differences between HFSRP and comparison stores regarding: (1) change in store-level availability, quality, and price of healthy foods/beverages; (2) change in healthfulness of observed food and beverage purchases ("bag checks"); and, (3) change in self-reported and objectively-measured (Veggie Meter®-assessed skin carotenoids) customer dietary behaviors. Differences (HFSRP vs. comparison stores) in store-level Healthy Food Supply (HFS) and Healthy Eating Index-2010 scores were assessed using repeated measure ANOVA. Intervention effects on diet were assessed using difference-in-difference models including propensity scores. RESULTS There were improvements in store-level supply of healthier foods/beverages within 1 year of program implementation (0 vs. 1-12 month HFS scores; p = 0.055) among HFSRP stores only. Comparing 2019 to 2017 (baseline), HFSRP stores' HFS increased, but decreased in comparison stores (p = 0.031). Findings indicated a borderline significant effect of the intervention on self-reported fruit and vegetable intake (servings/day), though in the opposite direction expected, such that fruit and vegetable intake increased more among comparison store than HFSRP store customers (p = 0.05). There was no significant change in Veggie Meter®-assessed fruit and vegetable intake by customers shopping at the intervention versus comparison stores. CONCLUSIONS Despite improvement in healthy food availability, there was a lack of apparent impact on dietary behaviors related to the HFSRP, which could be due to intervention dose or inadequate statistical power due to the serial cross-sectional study design. It may also be that individuals buy most of their food at larger stores; thus, small store interventions may have limited impact on overall eating patterns. Future healthy retail policies should consider how to increase intervention dose to include more product marketing, consumer messaging, and technical assistance for store owners.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA.
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC, 27834, USA
| | - Kimberly P Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Healthy Weight Research Center, University of Minnesota School of Public Health, Minneapolis, MN, 55454, USA
| | - Ann P Rafferty
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural & Human Sciences, North Carolina State University, Raleigh, 27695, USA
| | - Kathryn A Boys
- Department of Agricultural & Resource Economics, North Carolina State University, Raleigh, 27695, USA
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, 27412, NC, USA
| | | | - Nevin Johnson
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - Archana P Kaur
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, 27157, USA
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, 27157, USA
| | - Alice S Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Melissa N Laska
- Healthy Weight Research Center, University of Minnesota School of Public Health, Minneapolis, MN, 55454, USA
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Ohri-Vachaspati P, Acciai F, Lloyd K, Tulloch D, DeWeese RS, DeLia D, Todd M, Yedidia MJ. Evidence That Changes in Community Food Environments Lead to Changes in Children's Weight: Results from a Longitudinal Prospective Cohort Study. J Acad Nutr Diet 2021; 121:419-434.e9. [PMID: 33309589 PMCID: PMC8742245 DOI: 10.1016/j.jand.2020.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Strategies to improve the community food environment have been recommended for addressing childhood obesity, but evidence substantiating their effectiveness is limited. OBJECTIVE Our aim was to examine the impact of changes in availability of key features of the community food environment, such as supermarkets, small grocery stores, convenience stores, upgraded convenience stores, pharmacies, and limited service restaurants, on changes in children's body mass index z scores (zBMIs). DESIGN We conducted a longitudinal cohort study. PARTICIPANTS/SETTING Two cohorts of 3- to 15-year-old children living in 4 low-income New Jersey cities were followed during 2- to 5-year periods from 2009 through 2017. Data on weight status were collected at 2 time points (T1 and T2) from each cohort; data on food outlets in the 4 cities and within a 1-mile buffer around each city were collected multiple times between T1 and T2. MAIN OUTCOME MEASURES We measured change in children's zBMIs between T1 and T2. STATISTICAL ANALYSIS Changes in the food environment were conceptualized as exposure to changes in counts of food outlets across varying proximities (0.25 mile, 0.5 mile, and 1.0 mile) around a child's home, over different lengths of time a child was exposed to these changes before T2 (12 months, 18 months, and 24 months). Multivariate models examined patterns in relationships between changes in zBMI and changes in the food environment. RESULTS Increased zBMIs were observed in children with greater exposure to convenience stores over time, with a consistent pattern of significant associations across varying proximities and lengths of exposure. For example, exposure to an additional convenience store over 24 months within 1 mile of a child's home resulted in 11.7% higher odds (P = 0.007) of a child being in a higher zBMI change category at T2. Lower zBMIs were observed in children with increased exposure to small grocery stores selling an array of healthy items, with exposure to an additional small grocery store within 1 mile over 24 months, resulting in 37.3% lower odds (P < 0.05) of being in a higher zBMI change category at T2. No consistent patterns were observed for changes in exposure to supermarkets, limited service restaurants, or pharmacies. CONCLUSIONS Increased availability of small grocery stores near children's homes may improve children's weight status, whereas increased availability of convenience stores is likely to be detrimental.
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Affiliation(s)
| | - Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Kristen Lloyd
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ
| | - David Tulloch
- Center for Remote Sensing and Spatial Analysis, Department of Landscape Architecture, Rutgers University, New Brunswick, NJ
| | - Robin S DeWeese
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Derek DeLia
- MedStar Health Research Institute, Hyattsville, MD; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix
| | - Michael J Yedidia
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ
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Earnshaw VA, Karpyn A. Understanding stigma and food inequity: a conceptual framework to inform research, intervention, and policy. Transl Behav Med 2020; 10:1350-1357. [PMID: 33421077 PMCID: PMC8218858 DOI: 10.1093/tbm/ibaa087] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
There is increasing understanding that stigma associated with poverty, race, nationality, gender, obesity, and other intersecting, socially devalued characteristics is a key social determinant of health that plays a role in food inequities; yet, the processes linking stigma with food inequities are poorly defined. Building on prior conceptual and empirical stigma research in public health, this paper introduces The Stigma and Food Inequity Framework. Supporting empirical evidence for the associations proposed by the framework is reviewed. The framework proposes that stigma is manifested at the structural (e.g., neighborhood infrastructure and targeted marketing) and individual (e.g., internalized stigma and stereotypes) levels. These stigma manifestations are associated with food inequities via a series of mediating mechanisms, including access to resources, the home food environment, and psychosocial and behavioral processes, which ultimately undermine healthy food consumption, contribute to food insecurity, and impact diet quality. The framework further proposes that processes linking stigma with food inequities are situated within contexts of history, culture, and human development. Future directions to address stigma and enhance food equity include the value of addressing the broad range of underlying structural stigma manifestations when creating policy to promote food equity.
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Affiliation(s)
- Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Allison Karpyn
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
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Hudak KM, Paul R, Gholizadeh S, Zadrozny W, Racine EF. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) authorization of discount variety stores: leveraging the private sector to modestly increase availability of healthy foods. Am J Clin Nutr 2020; 111:1278-1285. [PMID: 32412583 DOI: 10.1093/ajcn/nqaa097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many lower-income communities in the United States lack a full-line grocery store. There is evidence that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) increases the availability of healthy foods in stores. One national discount variety store chain (DVS) that is often located in low-income neighborhoods became an authorized WIC vendor in 8 pilot stores. OBJECTIVES The objective of this study was to evaluate how implementing WIC in DVS pilot stores affected sales of healthy, WIC-eligible foods. METHODS We used DVS sales data and difference-in-differences regression to evaluate how WIC authorization affected sales of WIC-eligible foods in 8 DVS pilot stores, compared with 8 matched comparison stores. RESULTS DVS added 18 new WIC-approved foods to become an authorized vendor. Results indicate that becoming a WIC vendor significantly increased sales of healthy, WIC-eligible foods that DVS carried before authorization. WIC implementation in DVS led to a 31-unit increase in sales of the original WIC foods per week on average (P < 0.01). Lower socioeconomic status, assessed using a summary measure, is associated with increased sales of WIC foods. Yet sales of non-WIC eligible foods (e.g., salty snack foods, candy bars, soda, and processed meats) were not affected by WIC authorization. CONCLUSIONS Encouraging DVS stores to become WIC-authorized vendors has the potential to modestly increase DVS sales and the availability of healthy foods in low-income neighborhoods. If WIC authorization is financially viable for small-format variety stores, encouraging similar small-format variety stores to become WIC-authorized has the potential to improve food access.
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Affiliation(s)
- Katelin M Hudak
- Public Policy Department, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Shafie Gholizadeh
- Department of Computer Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Wlodek Zadrozny
- Department of Computer Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
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15
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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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Healthy Food Access in Low-Income High-Minority Communities: A Longitudinal Assessment-2009-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132354. [PMID: 31277250 PMCID: PMC6650883 DOI: 10.3390/ijerph16132354] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/22/2022]
Abstract
Disparities in healthy food access are well documented in cross-sectional studies in communities across the United States. However, longitudinal studies examining changes in food environments within various neighborhood contexts are scarce. In a sample of 142 census tracts in four low-income, high-minority cities in New Jersey, United States, we examined the availability of different types of food stores by census tract characteristics over time (2009-2017). Outlets were classified as supermarkets, small grocery stores, convenience stores, and pharmacies using multiple sources of data and a rigorous protocol. Census tracts were categorized by median household income and race/ethnicity of the population each year. Significant declines were observed in convenience store prevalence in lower- and medium-income and majority black tracts (p for trend: 0.004, 0.031, and 0.006 respectively), while a slight increase was observed in the prevalence of supermarkets in medium-income tracts (p for trend: 0.059). The decline in prevalence of convenience stores in lower-income and minority neighborhoods is likely attributable to declining incomes in these already poor communities. Compared to non-Hispanic neighborhoods, Hispanic communities had a higher prevalence of small groceries and convenience stores. This higher prevalence of smaller stores, coupled with shopping practices of Hispanic consumers, suggests that efforts to upgrade smaller stores in Hispanic communities may be more sustainable.
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Availability of neighbourhood supermarkets and convenience stores, broader built environment context, and the purchase of fruits and vegetables in US households. Public Health Nutr 2019; 22:2436-2447. [PMID: 31130150 DOI: 10.1017/s1368980019000910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether neighbourhood supermarket and convenience store availability and broader built environment context are associated with food purchasing behaviour in a national population. DESIGN We used observational data to perform a cross-sectional study of food purchases for US households in 2010. We used three-level mixed-effect regression models to determine whether the associations between the number of neighbourhood supermarkets and convenience stores and the self-reported annual household expenditures for fruits and vegetables were affected by regional destination accessibility, neighbourhood destination diversity, availability of neighbourhood destinations and neighbourhood street connectivity. SETTING Metropolitan statistical areas (n 378) in the USA. PARTICIPANTS Households (n 22 448). RESULTS When we controlled for broader built environment context, there was no significant association between availability of neighbourhood supermarkets and expenditures on fruits and vegetables; instead, we observed an inverse association between the number of convenience stores and expenditures for fruits (P = 0·001). The broader built environment context was associated with food purchase, although the magnitude was small: (i) higher regional destination accessibility was associated with higher expenditures for fruits (P < 0·001); (ii) higher neighbourhood destination diversity was associated with lower expenditures for vegetables (P = 0·002); and (iii) higher neighbourhood street connectivity was associated with higher expenditures for fruits (P < 0·001). CONCLUSIONS The broader built environment factors contributed to understanding how people use neighbourhood food stores. However, there was only a small relationship between the broader environment context and fruit and vegetable expenditures. Policy interventions that focus exclusively on increasing the availability of neighbourhood supermarkets likely will not promote fruit and vegetable consumption.
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Seligman HK, Berkowitz SA. Aligning Programs and Policies to Support Food Security and Public Health Goals in the United States. Annu Rev Public Health 2019; 40:319-337. [PMID: 30444684 PMCID: PMC6784838 DOI: 10.1146/annurev-publhealth-040218-044132] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Food insecurity affects 1 in 8 US households and has clear implications for population health disparities. We present a person-centered, multilevel framework for understanding how individuals living in food-insecure households cope with inadequate access to food themselves and within their households, communities, and broader food system. Many of these coping strategies can have an adverse impact on health, particularly when the coping strategies are sustained over time; others may be salutary for health. There exist multiple opportunities for aligning programs and policies so that they simultaneously support food security and improved diet quality in the interest of supporting improved health outcomes. Improved access to these programs and policies may reduce the need to rely on individual- and household-level strategies that may have negative implications for health across the life course.
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Affiliation(s)
- Hilary K Seligman
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, California 94143, USA
- The UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California 94110, USA;
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina 27599-7590, USA;
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Availability, quality and price of produce in low-income neighbourhood food stores in California raise equity issues. Public Health Nutr 2018. [PMID: 29540244 PMCID: PMC5962882 DOI: 10.1017/s1368980018000058] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess produce availability, quality and price in a large sample of food stores in low-income neighbourhoods in California. DESIGN Cross-sectional statewide survey. SETTING Between 2011 and 2015, local health departments assessed store type, WIC (Supplemental Nutrition Program for Women, Infants, and Children)/SNAP (Supplemental Nutrition Assistance Program) participation, produce availability, quality and price of selected items in stores in low-income neighbourhoods. Secondary data provided reference chain supermarket produce prices matched by county and month. t Tests and ANOVA examined differences by store type; regression models examined factors associated with price. SUBJECTS Large grocery stores (n 231), small markets (n 621) and convenience stores (n 622) in 225 neighbourhoods. RESULTS Produce in most large groceries was rated high quality (97 % of fruits, 98 % of vegetables), but not in convenience stores (25 % fruits, 14 % vegetables). Small markets and convenience stores participating in WIC and/or SNAP had better produce availability, variety and quality than non-participating stores. Produce prices across store types were, on average, higher than reference prices from matched chain supermarkets (27 % higher in large groceries, 37 % higher in small markets, 102 % higher in convenience stores). Price was significantly inversely associated with produce variety, adjusting for quality, store type, and SNAP and WIC participation. CONCLUSIONS The study finds that fresh produce is more expensive in low-income neighbourhoods and that convenience stores offer more expensive, poorer-quality produce than other stores. Variety is associated with price and most limited in convenience stores, suggesting more work is needed to determine how convenience stores can provide low-income consumers with access to affordable, high-quality produce. WIC and SNAP can contribute to the solution.
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Patterns of food and physical activity environments related to children's food and activity behaviors: A latent class analysis. Health Place 2017; 49:19-29. [PMID: 29156415 DOI: 10.1016/j.healthplace.2017.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 11/20/2022]
Abstract
Relationships between food and physical activity (PA) environments and children's related behaviors are complex. Latent class analyses derived patterns from proximity to healthy and unhealthy food outlets, PA facilities and parks, and counts of residential dwellings and intersections. Regression analyses examined whether derived classes were related to food consumption, PA, and overweight among 404 low-income children. Compared to children living in Low PA-Low Food environments, children in High Intersection&Parks-Moderate Density&Food, and High Density-Low Parks-High Food environments, had significantly greater sugar-sweetened beverage consumption (ps<0.01) and overweight/obesity (ps<0.001). Children in the High Density-Low Parks-High Food environments were more likely to walk to destinations (p = 0.01) Recognizing and leveraging beneficial aspects of neighborhood patterns may be more effective at positively influencing children's eating and PA behaviors compared to isolating individual aspects of the built environment.
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21
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Fetal programming and eating disorder risk. J Theor Biol 2017; 428:26-33. [DOI: 10.1016/j.jtbi.2017.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 04/06/2017] [Accepted: 05/23/2017] [Indexed: 11/23/2022]
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Chaparro MP, Harrison GG, Wang MC, Seto EYW, Pebley AR. The unhealthy food environment does not modify the association between obesity and participation in the Supplemental Nutrition Assistance Program (SNAP) in Los Angeles County. BMC Public Health 2017; 17:81. [PMID: 28088219 PMCID: PMC5237482 DOI: 10.1186/s12889-016-4011-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/29/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Participation in the Supplemental Nutrition Assistance Program (SNAP) has been linked to an increased risk of obesity, but not much is known about the mechanisms behind this association. The objective of this study was to determine if the neighborhood density of unhealthy food outlets modifies the association between obesity and participation in SNAP. METHODS Data comes from the first wave of the Los Angeles Family and Neighborhood Survey; included are a subsample of adults (18+ years) who were SNAP participants or eligible non-participants (N = 1,176). We carried out multilevel analyses with obesity (BMI ≥ 30 Kg/m2), SNAP participation, and the neighborhood density of unhealthy food outlets as dependent, independent and modifying variables, respectively, controlling for age, gender, race/ethnicity, marital status, working status, mental health, and neighborhood poverty. RESULTS SNAP participants had double the odds of obesity compared to eligible non-participants (OR = 2.02; 95%CI = 1.44-2.83). However, the neighborhood density of unhealthy food outlets did not modify this association. CONCLUSIONS SNAP participation was associated with higher odds of obesity in our primarily Hispanic sample in Los Angeles County, with no effect modification found for the unhealthy portion of the food environment. More research is needed with additional food environment measures to confirm our null findings. Additional research is needed to elucidate the mechanisms linking SNAP participation and obesity as they remain unclear.
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Affiliation(s)
- M. Pia Chaparro
- Institute for Social and Economic Research (ISER), University of Essex, Wivenhoe Park, Colchester, Essex CO4 3SQ UK
| | - Gail G. Harrison
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA 90095 USA
| | - May C. Wang
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA 90095 USA
| | - Edmund Y. W. Seto
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Office: HSB F-226C, Box: 357234, Seattle, WA 98195 USA
| | - Anne R. Pebley
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA 90095 USA
- Department of Sociology, University of California Los Angeles (UCLA), Los Angeles, CA 90095 USA
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