The association between accessibility of local convenience stores and unhealthy diet

Association between density of convenience and small grocery stores with diet quality in adults living in Mexico City: A cross sectional study

There is evidence of the association between different retail stores and food consumption, yet research is still limited in low- and medium-income countries, where the context of the food retail environment is different from that observed in high-income countries. Specifically, less is known about how convenience and small grocery stores, which offer products with immediate access, are associated with the diet as a whole. The present study assessed the association between density of convenience and small grocery stores and diet quality in adults from the Mexico City Representative Diabetes Survey 2015. A final sample size of 1,023 adults aged 20–69 years was analyzed. The density of stores was measured using Euclidean buffers within 500 meters of each participant's home. The Mexican Alternate Healthy Eating Index (MxAHEI) was used to assess diet quality. Multivariable Poisson models were used to test the association of convenience and small grocery stores densities with the MxAHEI. Although our results were not statistically significant, we observed a lower diet quality score among adults from Mexico City living in areas with a higher density of small grocery and convenience stores. More research is needed on the influence of environmental food retail on food consumption.

Neighborhood environment is associated with unhealthy food intake in a Brazilian urban area

Unhealthy food intake is one of the main risk factors for morbidity and mortality for non-communicable diseases (NCDs), and is associated with multiple factors, including the neighborhood environment. The present study aimed to examine the association between the neighborhood context and unhealthy food intake in adults. This is a cross-sectional study, carried out in Belo Horizonte, Brazil. This study used the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), which was georeferenced and linked to a database with information on the physical and social realities of a neighborhood context. The administrative boundary of the basic health units (ABBHU) was used as a neighborhood unit. Unhealthy food intake was assessed by the regular consumption of meat with excess fat, soft drinks, and red meat, as well as the irregular consumption of fruits and vegetables. To characterize the physical and social realities of a neighborhood, this study used georeferenced data of establishments selling foods, population density, homicide rates, health vulnerability Index, and total income. For data analysis, multilevel logistic regression was used. The sample consisted of 5783 adults. It was observed that younger, males, people with a lower-level education, who were inactive during leisure time, who had abusive alcohol consumption, and who were current smokers, were associated with a greater chance of having an unhealthy food intake. After adjusting for individual characteristics, it was observed that living in ABBHU, with a low mean income and an extremely high vulnerability, increases the individual's chances of having an unhealthy food intake. An unhealthy food intake is partially explained by demographic characteristics and socioeconomic conditions in the neighborhood. The present study can contribute to improving the understanding of the importance of the urban environment in food choices.

Proximity and High Density of Convenience Stores Was Associated With Obesity in Children of a Rural Community of Mexico: Using a Geographic Information System Approach

BACKGROUND

Food environment (FE) has been linked to obesity in urban areas, but there is limited information in rural areas, particularly in developing countries, where prevalence of obesity is high.

OBJECTIVE

To determine the association between FE and childhood obesity using Geographic Information Systems (GIS).

METHODS

A total of 218 (8-10 years) children participated in a cross-sectional study. Weight, height, and body fat were measured. Geolocation of convenience stores (CS) and participants' households was collected, and the amount of processed food (PF) in the stores was measured. The proximity to the nearest CS and the number of CS within a 250-m buffer from each participant's household was calculated using GIS. Linear regression models between obesity measurements and FE were performed.

RESULTS

The combined prevalence of overweight and obesity was 32%. A total of 91% of the children had access to a CS within 250 m. On average, 48% of the shelf-space of the CS were occupied with PF. A positive association between the density of CS with body fat % (β = .145; 95% CI, 0.048-0.241, P = .004), abdominal fat % (β = .206; 95% CI, 0.048-0.241, P = .003), and body mass index (BMI)-for-age z-score (BMIz; β = .028; 95% CI, 0.005-0.062, P = .005) was found. Living closer to CS was associated with increases in body fat % (β = -0.009; 95% CI, -0.017 to -0.001, P = 0.025), abdominal fat % (β = -0.012; 95% CI, -0.023 to -0.001, P = 0.033), and BMIz (β = -0.002, 95% CI, -0.004 to -0.001, P = 0.003).

CONCLUSION

In a rural community in Mexico, a high density and low proximity to CS is associated with obesity in school-aged children.

[Food environment in São Leopoldo, Rio Grande do Sul, Brazil: the association with neighborhood sociodemographic variables]

The scope of this study is to describe the food environment of a medium-sized municipality in southern Brazil and compare the availability of different types of food outlets in neighborhood socioeconomic and demographic environments. An ecological study was carried out in 45 buffers of 400m in São Leopoldo county, RS. The buffer was calculated from the center point of the residences of women participating in a larger research project. All streets were surveyed to identify food stores and record their geographical coordinates, as well as apply the NEMS questionnaire on the availability, price and quality of 108 items. The commercial outlets were classified as supermarkets, grocery stores, fruit stores and convenience stores. Supermarkets and grocery stores were present in higher quantity in lower income buffers and grocery stores were more prevalent in those with higher population tertiles. Another result was a direct relationship between NEMS and tertile income scores for supermarkets, grocery stores and fruit stores, and an indirect relationship for the same stores and population tertile. The availability of healthy food was higher in areas with higher income and lower numbers of inhabitants, indicating the need for better distribution of food stores and availability of varieties of food in the municipality.

Determinants of fruits, vegetables, and ultra-processed foods consumption among infants

The objective was to evaluate the influence of individual and contextual determinants on infant's consumption of fruits and vegetables (FV), and ultra-processed foods (UPF). The data was obtained from the Survey of Prevalence of Breastfeeding in Brazilian Municipalities, 2008. A representative sample of 14,326 infants 6-11.9 months old, from seventy-five municipalities of São Paulo state was evaluated. The influence of determinants on FV and UPF consumption was analyzed using Poisson multilevel regression. Mother's educational level and maternal age had positive dose-response effect for the consumption of FV (p trend < 0.001) and negative for UPF (p trend < 0.001). Infants of multiparous women and those who received outpatient care in public medical system showed lower prevalence of FV (p < 0.001 for both) and higher prevalence of UPF (respectively, p < 0.001 and p = 0.001). Moreover, the contextual variable related to population size indicated that the prevalence of consumption of FV decreased (p < 0.001) and UPF increased (p = 0.081) with decreased population size. Therefore, infants born to women with low education levels, who received outpatient care in the public health network, and who reside in small municipalities should be prioritized for educational programs related to feeding practices.

Association between Neighborhood Food Access, Household Income, and Purchase of Snacks and Beverages in the United States

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.

Convenience Store Use and the Health of Urban Adolescents in Seoul, South Korea

To improve urban adolescents' dietary behaviors and health, factors that influence them to buy meals in convenience stores with regard to urban food environments must be determined. This study investigated the factors which influence adolescents' substitution of meals with convenience store meals and its impact on their health in Seoul (South Korea). Multilevel analysis and logistic regression analysis were conducted using data from the Korea Youth Risk Behavior Survey, a national health survey with a representative sample of Korean adolescents. Among 17,624 teenagers who responded to surveys in 2017 and 2019, 30.5% of them substituted meals with convenience store meals more than three times a week. Girls and students with a lower family economic level were more likely to frequently consume food from convenience stores. Unhealthy lifestyles and poor mental health status also influenced their decisions to substitute meals with convenience store food. Those who frequently consumed meals from convenience stores were more likely to have unhealthy lifestyles, featuring bad diets, smoking, drinking, and sedentary behaviors. They also reported significantly poorer self-rated health and mental health. To promote healthy lifestyles among adolescents, efforts to raise awareness and develop supportive environments for healthy diets are strongly recommended.

Appalachian Store Owners' and Managers' Perspectives on the Role of Their Store in the Community and in Providing Healthier Food to the Community

Appalachian communities have lower access to healthier food sources like grocery stores. Through semi-structured interviews with owner/managers of convenience stores in Appalachian communities, this qualitative study explored perceived roles and business practices of small food retailers using a grounded theory approach. Five themes emerged including strong relationships between stores and customers, the role of the store in community, food and beverage stocking decisions, store owner/managers' perceived demand for healthier options, and federal food assistance program participation. The themes provide insight to store owner/manager perspectives on community-focused and business-focused priorities in Appalachian convenience stores and can inform healthy retail interventions.

Calorie changes among food items sold in U.S. convenience stores and pizza restaurant chains from 2013 to 2017

The aim of this study was to describe trends in calories among food items sold in U.S. convenience stores and pizza restaurant chains from 2013 to 2017 - a period leading up to the implementation of the federal menu labeling mandate. Using data from the MenuStat project, we conducted quantile regression analyses in 2018 to estimate the predicted median per-item calories among menu items available at convenience stores (n = 1522) and pizza restaurant chains (n = 2085) - two retailers that have been openly resistant to implementing menu labeling - and assessed whether core food items were reformulated during the study period. We also compared calories in food items available for sale on convenience store and pizza restaurant menus to calories in items that were newly added or dropped. We found that leading up to the national menu labeling implementation date, convenience stores showed a significant decreasing trend in median calories of overall menu items (390 kcals in 2013 vs. 334 kcals in 2017, p-value for trend <0.01) and among appetizers and sides (367 kcals in 2013 vs. 137 kcals in 2017, p-value for trend = 0.02). Pizza restaurants introduced lower-calorie pizza options in 2017, but no other significant changes in calories were observed. Going forward, it will be important to track calorie changes in convenience stores and pizza restaurant chains as both food establishments represent significant sources of calories for Americans.

Local Food Environments, Suburban Development, and BMI: A Mixed Methods Study

More than half the world’s population now live in urban settlements. Worldwide, cities are expanding at their fringe to accommodate population growth. Low-density residential development, urban sprawl, and car dependency are common, contributing to physical inactivity and obesity. However, urban design and planning can modify urban form and enhance health by improving access to healthy food, public transport, and services. This study used a sequential mixed methods approach to investigate associations between food outlet access and body mass index (BMI) across urban-growth and established areas of Melbourne, Australia, and identify factors that influence local food environments. Population survey data for 3141 adults were analyzed to examine associations, and 27 interviews with government, non-government, and private sector stakeholders were conducted to contextualize results. Fast food density was positively associated with BMI in established areas and negatively associated in urban-growth areas. Interrelated challenges of car dependency, poor public transport, and low-density development hampered healthy food access. This study showed how patterns of suburban development influence local food environments and health outcomes in an urbanized city context and provides insights for other rapidly growing cities. More nuanced understandings of the differential effect of food environments within cities have potential to guide intra-city planning for improving health and reducing inequities.

Utilization of food outlets and intake of minimally processed and ultra-processed foods among 7 to 14-year-old schoolchildren. A cross-sectional study

BACKGROUND

Access to food retailers is an environmental determinant that influences what people consume. This study aimed to test the association between the use of food outlets and schoolchildren's intake of minimally processed and ultra-processed foods.

DESIGN AND SETTING

This was a cross-sectional study conducted in public and private schools in Florianópolis, state of Santa Catarina, southern Brazil, from September 2012 to June 2013.

METHODS

The sample consisted of randomly selected clusters of schoolchildren aged 7 to 14 years, who were attending 30 schools. Parents or guardians provided socioeconomic and demographic data and answered questions about use of food outlets. Dietary intake was surveyed using a dietary recall questionnaire based on the previous day's intake. The foods or food groups were classified according to the level of processing. Negative binomial regression was used for data analysis.

RESULTS

We included 2,195 schoolchildren in the study. We found that buying foods from snack bars or fast-food outlets was associated with the intake frequency of ultra-processed foods among 11-14 years old in an adjusted model (incidence rate ratio, IRR: 1.11; 95% confidence interval, CI: 1.01;1.23). Use of butchers was associated with the intake frequency of unprocessed/minimally processed foods among children 11-14 years old in the crude model (IRR: 1.11; 95% CI: 1.01;1.22) and in the adjusted model (IRR: 1.11; 95% CI: 1.06;1.17).

CONCLUSIONS

Use of butchers was associated with higher intake of unprocessed/minimally processed foods while use of snack bars or fast-food outlets may have a negative impact on schoolchildren's dietary habits.

Neighborhood Environments: Links to Health Behaviors and Obesity Status in Vulnerable Children

This study aimed to identify the actual and perceived features of neighborhood environments linked to health behaviors and obesity status in vulnerable children by using geographic information systems, walking surveys, and focus group interviews. The participants were 126 children registered at community child centers and 10 mothers of study participants. Increased availability of fast food outlets and convenience stores was significantly and positively associated with fast food and sugar-sweetened beverage consumption and inversely with physical activity. Reduced availability of physical activity outlets was significantly and positively associated with sedentary behaviors. Mothers' perceptions of their neighborhoods fell into three content categories: (a) changed to be unfriendly for children, (b) adapted to fast food and convenience eating, and (c) confined to physically inactive living. Based on these findings, community-level environmental strategies for reducing unhealthy behaviors linked to neighborhood environments should be prioritized to prevent childhood obesity in vulnerable populations.

Health research needs more comprehensive accessibility measures: integrating time and transport modes from open data

Background

In this paper, we demonstrate why and how both temporality and multimodality should be integrated in health related studies that include accessibility perspective, in this case healthy food accessibility. We provide evidence regarding the importance of using multimodal spatio-temporal accessibility measures when conducting research in urban contexts and propose a methodological approach for integrating different travel modes and temporality to spatial accessibility analyses. We use the Helsinki metropolitan area (Finland) as our case study region to demonstrate the effects of temporality and modality on the results.

Methods

Spatial analyses were carried out on 250 m statistical grid squares. We measured travel times between the home location of inhabitants and open grocery stores providing healthy food at 5 p.m., 10 p.m., and 1 a.m. using public transportation and private cars. We applied the so-called door-to-door approach for the travel time measurements to obtain more realistic and comparable results between travel modes. The analyses are based on open access data and publicly available open-source tools, thus similar analyses can be conducted in urban regions worldwide.

Results

Our results show that both time and mode of transport have a prominent impact on the outcome of the analyses; thus, understanding the realities of accessibility in a city may be very different according to the setting of the analysis used. In terms of travel time, there is clear variation in the results at different times of the day. In terms of travel mode, our results show that when analyzed in a comparable manner, public transport can be an even faster mode than a private car to access healthy food, especially in central areas of the city where the service network is dense and public transportation system is effective.

Conclusions

This study demonstrates that time and transport modes are essential components when modeling health-related accessibility in urban environments. Neglecting them from spatial analyses may lead to overly simplified or even erroneous images of the realities of accessibility. Hence, there is a risk that health related planning and decisions based on simplistic accessibility measures might cause unwanted outcomes in terms of inequality among different groups of people.