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Rogus S, Guthrie J, Niculescu M, Xu L. The impact of a healthy checkout intervention on fruit and vegetable 'micro-pack' purchases in New Mexico. Public Health Nutr 2022; 25:1-9. [PMID: 36093640 PMCID: PMC9991551 DOI: 10.1017/s1368980022002026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 07/14/2022] [Accepted: 08/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Produce sold as plastic-wrapped packs of two to four individual items (i.e., produce micro-packs) that are low cost and placed at checkout may appeal to shoppers with budget constraints and provide a second chance to purchase items available elsewhere in the store. This study examined the impact of an intervention that placed produce micro-packs at checkout and promoted them in grocery stores across New Mexico, USA. DESIGN This quasi-experimental study placed produce micro-packs at checkout end-caps in thirteen stores (group 1), with eight stores serving as controls (group 2) from 1 July 2019 through 31 January 2020 (first phase). The intervention was extended to group 2 stores from 1 February 2020 through 30 June 2020 (second phase). Cashiers were directed to upsell the micro-packs to Special Supplemental Nutrition Program for Women, Infants, and Children recipients who had unspent cash value benefits for produce purchases. SETTING Twenty-one grocery stores across New Mexico. PARTICIPANTS Twenty-one produce items sold as micro-packs in stores from July 2019 through June 2020. RESULTS A random effects model showed that the daily sales of micro-packs increased by 47 % during each intervention period. Group 2 stores had lower sales than group 1 stores during the first phase of the intervention. Once extended to group 2 stores, sales of micro-packs in those stores increased and sales in group 1 stores continued at the higher level. CONCLUSIONS Placing produce micro-packs at checkout may increase produce sales and support health promotion efforts by public and private stakeholders.
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Affiliation(s)
- Stephanie Rogus
- Department of Family and Consumer Sciences, New Mexico State University, MSC 3470, P.O. Box 30003, Las Cruces, NM88003, USA
| | - Joanne Guthrie
- Economic Research Service, U.S. Department of Agriculture, Washington, DC, USA
| | - Mihai Niculescu
- Marketing Department, New Mexico State University, Las Cruces, NM, USA
| | - Lina Xu
- Marketing Department, The Pennsylvania State University, Abington, PA, USA
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Duong MC, Nguyen-Viet H, Grace D, Ty C, Sokchea H, Sina V, Young MF. Perceived neighbourhood food access is associated with consumption of animal-flesh food, fruits and vegetables among mothers and young children in peri-urban Cambodia. Public Health Nutr 2022; 25:717-28. [PMID: 34593072 DOI: 10.1017/S1368980021004122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine whether mothers' perceived neighbourhood food access is associated with their own and their young children's consumption of animal-flesh food, fruits and vegetables in peri-urban areas of Cambodia. DESIGN A cross-sectional survey measured food consumption frequency and perceived neighbourhood food access, the latter including six dimensions of food availability, affordability, convenience, quality, safety and desirability. Multivariate logistic regression was used to assess the association between perceived food access and food consumption. SETTING Peri-urban districts of Phnom Penh and Siem Reap, Cambodia. PARTICIPANTS 198 mothers of children between 6 and 24 months old. RESULTS Over 25 % of the mothers and 40 % of the children had low consumption (< once a day) of either animal-flesh food or fruits and vegetables. Compared with perceived high food access, perceived low food access was associated with an adjusted 5·6-fold and 4·3-fold greater odds of low animal-flesh food consumption among mothers (95 % CI 2·54, 12·46) and children (95 % CI 2·20, 8·60), respectively. Similarly, relative to perceived high food access, perceived low food access was associated with 7·6-times and 5·1-times higher adjusted odds of low fruits and vegetables consumption among mothers (95 % CI 3·22, 18·02) and children (95 % CI 2·69, 9·83), respectively. CONCLUSIONS Mothers' perceived neighbourhood food access was an important predictor of their own and their young children's nutrient-rich food consumption in peri-urban Cambodia. Future work is needed to confirm our findings in other urban settings and examine the role of neighbourhood food environment in the consumption of both nutrient-rich and nutrient-poor food.
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Sadler RC, Sanders-Jackson AN, Introne J, Adams R. A method for assessing links between objectively measured food store scores and store & neighborhood favorability. Int J Health Geogr 2019; 18:31. [PMID: 31881888 PMCID: PMC6935152 DOI: 10.1186/s12942-019-0195-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/20/2019] [Indexed: 11/10/2022] Open
Abstract
Worldwide, interest in research on methods to define access to healthy food at the local level has grown, given its central connection to carrying out a healthy lifestyle. Within this research domain, papers have examined the spatial element of food access, or individual perceptions about the food environment. To date, however, no studies have provided a method for linking a validated, objective measure of the food environment with qualitative data on how people access healthy food in their community. In this study, we present a methodology for linking scores from a modified Nutrition Environment Measures Survey in Stores (conducted at every store in our study site of Flint, Michigan) with perceptions of the acceptability of food stores and shopping locations drawn from seven focus groups (n = 53). Spatial analysis revealed distinct patterns in visiting and avoidance of certain store types. Chain stores tended to be rated more highly, while stores in neighborhoods with more African-American or poor residents were rated less favorably and avoided more frequently. Notably, many people avoided shopping in their own neighborhoods; participants traveled an average of 3.38 miles to shop for groceries, and 60% bypassed their nearest grocery store when shopping. The utility of our work is threefold. First, we provide a methodology for linking perceived and objective definitions of food access among a small sample that could be replicated in cities across the globe. Second, we show links between perceptions of food access and objectively measured food store scores to uncover inequalities in access in our sample to illustrate potential connections. Third, we advocate for the use of such data in informing the development of a platforms that aim to make the process of accessing healthy food easier via non-food retail based interventions. Future work can replicate our methods to both uncover patterns in distinct food environments and aid in advocacy around how to best intervene in the food environment in various locales.
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Affiliation(s)
- Richard C Sadler
- Division of Public Health, Michigan State University, 200 E 1st St Room 337, Flint, MI, 48502, USA.
| | | | - Josh Introne
- Department of Media and Information, Michigan State University, East Lansing, USA
| | - Robyn Adams
- Department of Advertising + Public Relations, Michigan State University, East Lansing, USA
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Carins JE, Rundle-Thiele S, Storr RJ. Appraisal of short and long versions of the Nutrition Environment Measures Survey (NEMS-S and NEMS-R) in Australia. Public Health Nutr 2019; 22:564-70. [PMID: 30375297 DOI: 10.1017/S1368980018002732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Research has begun to take a more ecological view of eating behaviour, examining multiple levels of influence: personal, social and environmental. The food environment is a major influence on eating behaviour, attracting the attention of researchers who have measured it in a number of ways. The present paper examines the short-form version, in comparison to the long-form version, of the Nutrition Environment Measures Survey (NEMS) - an observational food outlet audit tool. DESIGN Both the short-form and long-form were examined to qualitatively appraise the dimensions of the food environment assessed by each measure. Data from 135 food outlets in Australia were then used to compare results obtained using the short-form with the results from the long-form method, to consider the utility of the short-form measure. SETTING The retail food environment in Australia.ParticipantsOne hundred and thirty-five food outlets in Australia. RESULTS Results indicate that the short-form predominantly assessed availability of healthful foods (one aspect of the food environment). Several critical dimensions of the food environment known to influence eating behaviour were not assessed. For this data set, the short-form produced scores inconsistent with the longer version of the measure, delivering inflated estimates for stores and deflated estimates for restaurants. CONCLUSIONS Scores between the long-form and short-form versions were not comparable in this Australian study. Further development of food environment measures is recommended and must balance instrument brevity with the need to accurately capture important aspects of the food environment known to influence eating behaviour.
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Abstract
OBJECTIVE To assess the evidence of the impact of new food store (supermarket/grocery store) interventions on selected health-related outcomes. DESIGN A systematic review following the Effective Public Health Practice Project guidelines. All quantitative studies were assessed for their methodological quality. Results were synthesized narratively. SETTING Eight electronic databases - MEDLINE, EMBASE, CINAHL, ProQuest Public Health, Web of Science, Scopus, PsycINFO and Cochrane Library - were searched to identify relevant records. SUBJECTS Peer-reviewed scholarly journal articles on new grocery store/supermarket interventions with adult study populations, published in the English language after 1995. RESULTS Eleven records representing seven new grocery store interventions were identified. Six were assessed having 'weak' methodological quality, one as 'moderate' and two as 'strong'. All studies reported fruit and vegetable consumption but results were not consistent, some studies reporting significantly more and others no increase in consumption. BMI and self-rated health did not show significant improvements. Perceptions of food access, neighbourhood satisfaction and psychological health showed significant improvements. CONCLUSIONS Improved food access through establishment of a full-service food retailer, by itself, does not show strong evidence towards enhancing health-related outcomes over short durations. Presently the field is developing and the complex linking pathways/mechanisms are yet to be elucidated. Further evidence, in the form of high-quality research in different communities with longer follow-up periods, is needed to inform policy decisions.
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Thorndike AN, Bright OM, Dimond MA, Fishman R, Levy DE. Choice architecture to promote fruit and vegetable purchases by families participating in the Special Supplemental Program for Women, Infants, and Children (WIC): randomized corner store pilot study. Public Health Nutr 2017; 20:1297-305. [PMID: 27890020 DOI: 10.1017/S1368980016003074] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To conduct a pilot study to determine if improving the visibility and quality of fresh produce (choice architecture) in corner stores would increase fruit/vegetable purchases by families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN Six stores were randomly assigned to choice architecture intervention or control. Store-level WIC sales data were provided by the state. Primary outcomes were WIC fruit/vegetable voucher and non-fruit/vegetable voucher sales, comparing trends from baseline (December 2012-October 2013) with the five-month intervention period (December 2013-April 2014). Secondary outcomes were differences in customer self-reported fruit/vegetable purchases between baseline and end of the intervention. SETTING Chelsea, MA, USA, a low-income urban community. SUBJECTS Adult customers (n 575) completing store exit interviews. RESULTS During baseline, WIC fruit/vegetable and non-fruit/vegetable sales decreased in both intervention and control stores by $US 16/month. During the intervention period, WIC fruit/vegetable sales increased in intervention stores by $US 40/month but decreased in control stores by $US 23/month (difference in trends: $US 63/month; 95 % CI 4, 121 $US/month; P=0·036); WIC non-fruit/vegetable sales were not different (P=0·45). Comparing baseline and intervention-period exit interview responses by customers participating in WIC (n 134), intervention store customers reported increased fruit/vegetable purchases compared with control store customers (18 v. -2 %), but this did not achieve statistical significance (P=0·11). CONCLUSIONS Placement of fruits/vegetables near the front of corner stores increased purchase of produce by customers using WIC. New policies that incentivize stores to stock and prominently display good-quality produce could promote healthier food choices of low-income families.
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Frndak SE. An ecological study of food desert prevalence and 4th grade academic achievement in new york state school districts. J Public Health Res 2014; 3:319. [PMID: 25553313 PMCID: PMC4274497 DOI: 10.4081/jphr.2014.319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/24/2014] [Indexed: 12/01/2022] Open
Abstract
Background This ecological study examines the relationship between food desert prevalence and academic achievement at the school district level. Design and methods Sample included 232 suburban and urban school districts in New York State. Multiple open-source databases were merged to obtain: 4th grade science, English and math scores, school district demographic composition (NYS Report Card), regional socioeconomic indicators (American Community Survey), school district quality (US Common Core of Data), and food desert data (USDA Food Desert Atlas). Multiple regression models assessed the percentage of variation in achievement scores explained by food desert variables, after controlling for additional predictors. Results The proportion of individuals living in food deserts significantly explained 4th grade achievement scores, after accounting for additional predictors. School districts with higher proportions of individuals living in food desert regions demonstrated lower 4th grade achievement across science, English and math. Conclusions Food deserts appear to be related to academic achievement at the school district level among urban and suburban regions. Further research is needed to better understand how food access is associated with academic achievement at the individual level. Significance for public health The prevalence of food deserts in the United States is of national concern. As poor nutrition in United States children continues to spark debate, food deserts are being evaluated as potential sources of low fruit and vegetable intake and high obesity rates. Cognitive development and IQ have been linked to nutrition patterns, suggesting that children in food desert regions may have a disadvantage academically. This research evaluates if an ecological relationship between food desert prevalence and academic achievement at the school district level can be demonstrated. Results suggest that food desert prevalence may relate to poor academic performance at the school district level. Significant variation in academic achievement among urban and suburban school districts is explained by food desert prevalence, above additional predictors. This research lays the groundwork for future studies at the individual level, with possible implications for community interventions in school districts containing food desert regions.
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Affiliation(s)
- Seth E Frndak
- Graduate School of Education, University at Buffalo-State, University of New York Buffalo , NY, USA
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Abstract
Neighborhood environments have received considerable attention in recent local, state, and national obesity prevention initiatives, with a particular focus on food deserts, or areas with poor access to healthy foods. Yet, there are inconsistencies in the evidence base, suggesting a nuanced association between neighborhood environment, food availability, diet behaviors, and obesity. There is heterogeneity in associations between environmental exposures and health outcomes across race/ethnicity, gender, region, and urbanicity, which results in complexity in the interpretation of findings. There are several limitations in the literature, including a predominance of cross-sectional studies, reliance on commercial business listings, lack of attention to the process by which diet resources are established and expanded within neighborhoods and the potential for individuals to selectively migrate to locate near such facilities, a predominant focus on residential neighborhoods, and lack of information about the decision-making process underlying purchasing patterns. More research is needed to address the complexity of individual-level residential decision making as well as the purposeful placement of food environment resources across social and geographic space using longitudinal data and complex statistical approaches. In addition, improvements in data quality and depth related to food access and availability are needed, including behavioral data on purchase patterns and interactions with the food environment, and greater attention to heterogeneity across subpopulations. As policy changes to the food environment move forward, it is critical that there is rigorous and scientific evaluation of environmental changes and their impact on individual-level diet choices and behaviors, and their further influence on body weight.
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Affiliation(s)
- Penny Gordon-Larsen
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Abstract
National and local policies to improve diet in low-income US populations include increasing physical access to grocery stores and supermarkets in underserved neighborhoods. In a pilot study that evaluated the impacts of opening a new supermarket in a Philadelphia community considered a "food desert"-part of the Pennsylvania Fresh Food Financing Initiative-we found that the intervention moderately improved residents' perceptions of food accessibility. However, it did not lead to changes in reported fruit and vegetable intake or body mass index. The effectiveness of interventions to improve physical access to food and reduce obesity by encouraging supermarkets to locate in underserved areas therefore remains unclear. Nevertheless, the present findings suggest that simply improving a community's retail food infrastructure may not produce desired changes in food purchasing and consumption patterns. Complementary policy changes and interventions may be needed to help consumers bridge the gap between perception and action. The replication of our findings in other settings and research into the factors that influence community residents' receptivity to improved food access are urgently required.
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Affiliation(s)
- Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, in the United Kingdom ()
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Casey R, Oppert JM, Weber C, Charreire H, Salze P, Badariotti D, Banos A, Fischler C, Hernandez CG, Chaix B, Simon C. Determinants of childhood obesity: What can we learn from built environment studies? Food Qual Prefer 2014. [DOI: 10.1016/j.foodqual.2011.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Boone-Heinonen J, Diez-Roux AV, Goff DC, Loria CM, Kiefe CI, Popkin BM, Gordon-Larsen P. The neighborhood energy balance equation: does neighborhood food retail environment + physical activity environment = obesity? The CARDIA study. PLoS One 2013; 8:e85141. [PMID: 24386458 PMCID: PMC3874030 DOI: 10.1371/journal.pone.0085141] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent obesity prevention initiatives focus on healthy neighborhood design, but most research examines neighborhood food retail and physical activity (PA) environments in isolation. We estimated joint, interactive, and cumulative impacts of neighborhood food retail and PA environment characteristics on body mass index (BMI) throughout early adulthood. METHODS AND FINDINGS We used cohort data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study [n=4,092; Year 7 (24-42 years, 1992-1993) followed over 5 exams through Year 25 (2010-2011); 12,921 person-exam observations], with linked time-varying geographic information system-derived neighborhood environment measures. Using regression with fixed effects for individuals, we modeled time-lagged BMI as a function of food and PA resource density (counts per population) and neighborhood development intensity (a composite density score). We controlled for neighborhood poverty, individual-level sociodemographics, and BMI in the prior exam; and included significant interactions between neighborhood measures and by sex. Using model coefficients, we simulated BMI reductions in response to single and combined neighborhood improvements. Simulated increase in supermarket density (from 25(th) to 75(th) percentile) predicted inter-exam reduction in BMI of 0.09 kg/m(2) [estimate (95% CI): -0.09 (-0.16, -0.02)]. Increasing commercial PA facility density predicted BMI reductions up to 0.22 kg/m(2) in men, with variation across other neighborhood features [estimate (95% CI) range: -0.14 (-0.29, 0.01) to -0.22 (-0.37, -0.08)]. Simultaneous increases in supermarket and commercial PA facility density predicted inter-exam BMI reductions up to 0.31 kg/m(2) in men [estimate (95% CI) range: -0.23 (-0.39, -0.06) to -0.31 (-0.47, -0.15)] but not women. Reduced fast food restaurant and convenience store density and increased public PA facility density and neighborhood development intensity did not predict reductions in BMI. CONCLUSIONS Findings suggest that improvements in neighborhood food retail or PA environments may accumulate to reduce BMI, but some neighborhood changes may be less beneficial to women.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Ana V. Diez-Roux
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - David C. Goff
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Catherine M. Loria
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Maryland, United States of America
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worchester, Massachusetts, United States of America
| | - Barry M. Popkin
- Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Penny Gordon-Larsen
- Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Cannuscio CC, Tappe K, Hillier A, Buttenheim A, Karpyn A, Glanz K. Urban food environments and residents' shopping behaviors. Am J Prev Med 2013; 45:606-14. [PMID: 24139774 DOI: 10.1016/j.amepre.2013.06.021] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/25/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Food environments may promote or undermine healthy behaviors, but questions remain regarding how individuals interact with their local food environments. PURPOSE This study incorporated an urban food environment audit as well as an examination of residents' food shopping behaviors within that context. METHODS In 2010, the research team audited the variety and healthfulness of foods available in 373 Philadelphia stores, using the validated Nutrition Environment Measures Survey in Stores (NEMS-S); higher scores indicate more diverse and healthful food inventories. The team also surveyed urban residents (n=514) regarding their food shopping. Descriptive and multivariate analyses (conducted in 2012) assessed variation in retail food environments and in shoppers' store choices. RESULTS Corner and convenience stores were common (78.6% of food retail outlets) and had the lowest mean NEMS-S scores of any store type. Most participants (94.5%) did their primary food shopping at higher-scoring chain supermarkets, and the majority of participants did not shop at the supermarket closest to home. Supermarket offerings varied, with significantly fewer healthful foods at supermarkets closest to the homes of disadvantaged residents. In multivariate analyses, participants were significantly more likely to shop at supermarkets closest to home if those supermarkets had higher NEMS-S scores. CONCLUSIONS These data suggest that, when possible, shoppers chose supermarkets that offered more variety and more healthful foods. Findings from this study also reinforce concern regarding unhealthy immediate food environments for disadvantaged residents, who disproportionately relied on nearby stores with more limited food items. Interventions to improve nutrition and health should address not only food store proximity but also diversity of healthful foods available.
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Affiliation(s)
- Carolyn C Cannuscio
- Department of Family Medicine and Community Health, Philadelphia, Pennsylvania.
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Baldock K, Paquet C, Howard N, Coffee N, Hugo G, Taylor A, Adams R, Daniel M. Associations between resident perceptions of the local residential environment and metabolic syndrome. J Environ Public Health 2012; 2012:589409. [PMID: 23049574 DOI: 10.1155/2012/589409] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/14/2012] [Indexed: 11/17/2022]
Abstract
A substantial body of research has arisen concerning the relationships between objective residential area features, particularly area-level socioeconomic status and cardiometabolic outcomes. Little research has explored residents' perceptions of such features and how these might relate to cardiometabolic outcomes. Perceptions of environments are influenced by individual and societal factors, and may not correspond to objective reality. Understanding relations between environmental perceptions and health is important for the development of environment interventions. This study evaluated associations between perceptions of local built and social environmental attributes and metabolic syndrome, and tested whether walking behaviour mediated these associations. Individual-level data were drawn from a population-based biomedical cohort study of adults in Adelaide, South Australia (North West Adelaide Health Study). Participants' local-area perceptions were analysed in cross-sectional associations with metabolic syndrome using multilevel regression models (n = 1, 324). A nonparametric bootstrapping procedure evaluated whether walking mediated these associations. Metabolic syndrome was negatively associated with greater local land-use mix, positive aesthetics, and greater infrastructure for walking, and was positively associated with greater perceived crime and barriers to walking. Walking partially mediated associations between metabolic syndrome and perceived environmental features. Initiatives targeting residents' perceptions of local areas may enhance the utility of environmental interventions to improve population health.
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Evans AE, Jennings R, Smiley AW, Medina JL, Sharma SV, Rutledge R, Stigler MH, Hoelscher DM. Introduction of farm stands in low-income communities increases fruit and vegetable among community residents. Health Place 2012; 18:1137-43. [PMID: 22608130 DOI: 10.1016/j.healthplace.2012.04.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 04/16/2012] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
Abstract
The purpose of this longitudinal pilot study was to measure the impact of introducing farm stands in low-income communities with limited access to fresh and quality fruits and vegetables (F&V) on residents' F&V consumption. Two farm stands were placed outside two local community sites one day a week for 12 weeks. A variety of locally grown, culturally appropriate produce was sold at the stands. Data on F&V intake, awareness and usage of farmers' markets, family behaviors, and importance of eating F&V were collected from individuals (n=61) before and after farm stands were placed in the two communities. Paired sample t-tests, chi-square and McNemar tests were used to evaluate the impact of the intervention on the outcome variables. Significance level was set at p<.05. Significant increases were found for participants' consumption of fruit, fruit juice, tomatoes, green salad, and other vegetables (P<.05). Additionally, participants also reported increases in mediating variables of F&V consumption. This study underscores the potential of farmers' markets to increase F&V consumption through increasing F&V access in low-income communities.
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Affiliation(s)
- Alexandra E Evans
- University of Texas School of Public Health-Austin Regional Campus, Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Street, Suite 6.300 Austin, Texas 78701, USA.
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Glanz K, Bader MDM, Iyer S. Retail grocery store marketing strategies and obesity: an integrative review. Am J Prev Med 2012; 42:503-12. [PMID: 22516491 DOI: 10.1016/j.amepre.2012.01.013] [Citation(s) in RCA: 207] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 11/22/2011] [Accepted: 01/06/2012] [Indexed: 01/09/2023]
Abstract
CONTEXT In-store food marketing can influence food-purchasing behaviors and warrants increased attention given the dramatic rise in obesity. Descriptive and experimental studies of key marketing components have been conducted by consumer scientists, marketing researchers, and public health experts. This review synthesizes research and publications from industry and academic sources and provides direction for developing and evaluating promising interventions. EVIDENCE ACQUISITION Literature sources for the review were English-language articles published from 1995 to 2010, identified from multidisciplinary search indexes, backward searches of cited articles, review articles, industry reports, and online sources. Only articles that focused on physical grocery stores and food products were included. Data collection occurred in 2010 and 2011. EVIDENCE SYNTHESIS Articles were classified in the categories of product, price, placement, and promotion and divided into controlled laboratory experiments, observation, and field experiments; 125 primary peer-reviewed articles met the inclusion criteria. Narrative synthesis methods were used. Key findings were synthesized by category of focus and study design. Evidence synthesis was completed in 2011. CONCLUSIONS Findings suggest several strategies for in-store marketing to promote healthful eating by increasing availability, affordability, prominence, and promotion of healthful foods and/or restricting or de-marketing unhealthy foods. Key results of research in controlled laboratory studies should be adapted and tested in real-world in-store settings. Industry methods for assessing consumer behavior, such as electronic sales data and individually linked sales information from loyalty card holders, can help public health researchers increase the scientific rigor of field studies.
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Affiliation(s)
- Karen Glanz
- Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, 19104, USA.
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Boone-Heinonen J, Gordon-Larsen P, Kiefe CI, Shikany JM, Lewis CE, Popkin BM. Fast food restaurants and food stores: longitudinal associations with diet in young to middle-aged adults: the CARDIA study. ACTA ACUST UNITED AC 2011; 171:1162-70. [PMID: 21747011 DOI: 10.1001/archinternmed.2011.283] [Citation(s) in RCA: 251] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND A growing body of cross-sectional, small-sample research has led to policy strategies to reduce food deserts--neighborhoods with little or no access to healthy foods--by limiting fast food restaurants and small food stores and increasing access to supermarkets in low-income neighborhoods. METHODS We used 15 years of longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of US young adults (aged 18-30 years at baseline) (n = 5115), with linked time-varying geographic information system-derived food resource measures. Using repeated measures from 4 examination periods (n = 15,854 person-examination observations) and conditional regression (conditioned on the individual), we modeled fast food consumption, diet quality, and adherence to fruit and vegetable recommendations as a function of fast food chain, supermarket, or grocery store availability (counts per population) within less than 1.00 km, 1.00 to 2.99 km, 3.00 to 4.99 km, and 5.00 to 8.05 km of respondents' homes. Models were sex stratified, controlled for individual sociodemographic characteristics and neighborhood poverty, and tested for interaction by individual-level income. RESULTS Fast food consumption was related to fast food availability among low-income respondents, particularly within 1.00 to 2.99 km of home among men (coefficient, 0.34; 95% confidence interval, 0.16-0.51). Greater supermarket availability was generally unrelated to diet quality and fruit and vegetable intake, and relationships between grocery store availability and diet outcomes were mixed. CONCLUSION Our findings provide some evidence for zoning restrictions on fast food restaurants within 3 km of low-income residents but suggest that increased access to food stores may require complementary or alternative strategies to promote dietary behavior change.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA
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Duarte CS, Chambers EC, Rundle A, Must A. Physical characteristics of the environment and BMI of young urban children and their mothers. Health Place 2010; 16:1182-7. [PMID: 20729127 PMCID: PMC3574552 DOI: 10.1016/j.healthplace.2010.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 07/02/2010] [Accepted: 07/27/2010] [Indexed: 11/30/2022]
Abstract
The study examined whether characteristics of the urban physical environment are associated with child and maternal body mass index (BMI) in a sample of 3 year-old children and their mothers from 18 US cities (N=1997 dyads). BMI was determined based on measured height and weight. Characteristics of the interior and exterior physical environment, assessed and rated by trained interviewers, were related to child BMI at age 3 and to their mother's BMI. Negative aspects of the physical environment were more strongly related to maternal BMI among whites than among African-Americans or Hispanics.
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Affiliation(s)
- Cristiane S Duarte
- Division of Child & Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY 10032, USA.
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Tessier S, Traissac P, Bricas N, Maire B, Eymard-duvernay S, El Ati J, Delpeuch F. Food shopping transition: socio-economic characteristics and motivations associated with use of supermarkets in a North African urban environment. Public Health Nutr 2010; 13:1410-8. [DOI: 10.1017/s1368980010000601] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveIn the context of the nutrition transition and associated changes in the food retail sector, to examine the socio-economic characteristics and motivations of shoppers using different retail formats (large supermarkets (LSM), medium-sized supermarkets (MSM) or traditional outlets) in Tunisia.DesignCross-sectional survey (2006). Socio-economic status, type of food retailer and motivations data were collected during house visits. Associations between socio-economic factors and type of retailer were assessed by multinomial regression; correspondence analysis was used to analyse declared motivations.SettingPeri-urban area around Tunis, Tunisia, North Africa.SubjectsClustered random sample of 724 households.ResultsOne-third of the households used LSM, two-thirds used either type of supermarket, but less than 5 % used supermarkets only. Those who shopped for food at supermarkets were of higher socio-economic status; those who used LSM were much wealthier, more often had a steady income or owned a credit card, while MSM users were more urban and had a higher level of education. Most households still frequently used traditional outlets, mostly their neighbourhood grocer. Reasons given for shopping at the different retailers were most markedly leisure for LSM, while for the neighbourhood grocer the reasons were fidelity, proximity and availability of credit (the latter even more for lower-income customers).ConclusionsThe results pertain to the transition in food shopping practices in a south Mediterranean country; they should be considered in the context of growing inequalities in health linked to the nutritional transition, as they differentiate use and motivations for the choice of supermarkets v. traditional food retailers according to socio-economic status.
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Larsen K, Gilliland J. A farmers’ market in a food desert: Evaluating impacts on the price and availability of healthy food. Health Place 2009; 15:1158-62. [PMID: 19631571 DOI: 10.1016/j.healthplace.2009.06.007] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 06/16/2009] [Accepted: 06/22/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Kristian Larsen
- University of Toronto, Department of Geography and Planning, St. George Campus, Sidney Smith Hall, 100 St. George Street, Toronto, Ontario, Canada M5S 3G3.
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Larsen K, Gilliland J. Mapping the evolution of 'food deserts' in a Canadian city: supermarket accessibility in London, Ontario, 1961-2005. Int J Health Geogr 2008; 7:16. [PMID: 18423005 PMCID: PMC2387138 DOI: 10.1186/1476-072x-7-16] [Citation(s) in RCA: 214] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 04/18/2008] [Indexed: 12/02/2022] Open
Abstract
Background A growing body of research suggests that the suburbanization of food retailers in North America and the United Kingdom in recent decades has contributed to the emergence of urban 'food deserts', or disadvantaged areas of cities with relatively poor access to healthy and affordable food. This paper explores the evolution of food deserts in a mid-sized Canadian city (London, Ontario) by using a geographic information system (GIS) to map the precise locations of supermarkets in 1961 and 2005; multiple techniques of network analysis were used to assess changing levels of supermarket access in relation to neighbourhood location, socioeconomic characteristics, and access to public transit. Results The findings indicate that residents of inner-city neighbourhoods of low socioeconomic status have the poorest access to supermarkets. Furthermore, spatial inequalities in access to supermarkets have increased over time, particularly in the inner-city neighbourhoods of Central and East London, where distinct urban food deserts now exist. Conclusion Contrary to recent findings in larger Canadian cities, we conclude that urban food deserts exist in London, Ontario. Policies aimed at improving public health must also recognize the spatial, as well as socioeconomic, inequities with respect to access to healthy and affordable food. Additional research is necessary to better understand how supermarket access influences dietary behaviours and related health outcomes.
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Affiliation(s)
- Kristian Larsen
- The University of Western Ontario, London, ON, N6A 5C2, Canada.
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Galvez MP, Morland K, Raines C, Kobil J, Siskind J, Godbold J, Brenner B. Race and food store availability in an inner-city neighbourhood. Public Health Nutr 2008; 11:624-31. [PMID: 17935646 DOI: 10.1017/S1368980007001097] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A growing body of research has shown that disparities in resources, including food stores, exist at the neighbourhood level and the greatest disparities are seen in minority neighbourhoods, the same neighbourhoods at increased risk of obesity and diabetes. Less is known about whether differences in availability of resources by African American or Latino race/ethnicity exist within a single minority community. OBJECTIVE The present study examined whether census blocks either 75% African American (AA) or 75% Latino (L) are associated with food store availability, as compared with racially mixed (RM) census blocks, in East Harlem, New York. DESIGN/METHODS A cross-sectional study utilising a walking survey of East Harlem was performed. Food stores were classified into: supermarkets, grocery stores, convenience stores, specialty stores, full-service restaurants and fast-food stores. RESULTS One hundred and sixty-five East Harlem census blocks were examined; 17 were AA, 34 were L and 114 were RM. Of AA census blocks, 100% had neither supermarkets nor grocery stores. AA census blocks were less likely to have convenience stores (prevalence ratio (PR) = 0.25, 95% confidence interval (CI) 0.07-0.86) compared with RM census blocks. In contrast, predominantly L census blocks were more likely to have convenience stores (PR = 1.8, 95% CI 1.20-2.70), specialty food stores (PR = 3.74, 95% CI 2.06-7.15), full-service restaurants (PR = 1.87, 95% CI 1.04-3.38) and fast-food restaurants (PR = 2.14, 95% CI 1.33-3.44) compared with RM census blocks. CONCLUSIONS We found that inequities in food store availability exist by race/ethnicity in East Harlem, New York. This has implications for racial/ethnic differences in dietary quality, obesity and obesity-related disorders.
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Giskes K, Van Lenthe FJ, Brug J, Mackenbach JP, Turrell G. Socioeconomic inequalities in food purchasing: the contribution of respondent-perceived and actual (objectively measured) price and availability of foods. Prev Med 2007; 45:41-8. [PMID: 17532036 DOI: 10.1016/j.ypmed.2007.04.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 03/19/2007] [Accepted: 04/07/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research has shown that lower socioeconomic groups purchase foods that are less consistent with dietary recommendations. The price and availability of foods are thought to be important mediating factors between socioeconomic position and food purchasing. OBJECTIVES We examined the relative contribution of the perceived and objectively measured price and availability of recommended foods to household income differences in food purchasing. METHODS Using a face-to-face interview, a random sample of Brisbane residents (n=812) were asked about their food purchasing choices in 2000. They were also asked about their perceptions of the price and availability of 'recommended' foods (i.e. choices lower in fat, saturated fat, sugar, salt or higher in fibre) in the supermarkets where they usually shopped. Audits measuring the actual availability and price of identical foods were conducted in the same supermarkets. RESULTS Lower socioeconomic groups were less likely to make food purchasing choices consistent with dietary guideline recommendations. Objective availability and price differences were not associated with purchasing choices, nor did they contribute to socioeconomic inequalities in food purchasing choices. Perceived availability and price differences were associated with the purchase of recommended foods. Perceived availability made a small contribution to inequalities in food purchasing, however perceived price differences did not. CONCLUSION Socioeconomic inequalities in food purchasing are not mediated by differential availability of recommended foods and differences in price between recommended and regular foods in supermarkets, or by perceptions of their relative price. However, differential perceptions of the availability of recommended foods may play a small role in food purchasing inequalities.
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Affiliation(s)
- K Giskes
- Department of Public Health, Erasmus Medical Centre, The Netherlands.
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Cummins S, Petticrew M, Higgins C, Findlay A, Sparks L. Large scale food retailing as an intervention for diet and health: quasi-experimental evaluation of a natural experiment. J Epidemiol Community Health 2006; 59:1035-40. [PMID: 16286490 PMCID: PMC1732985 DOI: 10.1136/jech.2004.029843] [Citation(s) in RCA: 208] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effect on fruit and vegetable consumption, self reported, and psychological health of a "natural experiment"-the introduction of large scale food retailing in a deprived Scottish community. DESIGN Prospective quasi-experimental design comparing baseline and follow up data in an "intervention" community with a matched "comparison" community in Glasgow, UK. PARTICIPANTS 412 men and women aged 16 or over for whom follow up data on fruit and vegetable consumption and GHQ-12 were available. MAIN OUTCOME MEASURES Fruit and vegetable consumption in portions per day, poor self reported health, and poor psychological health (GHQ-12). MAIN RESULTS Adjusting for age, sex, educational attainment, and employment status there was no population impact on daily fruit and vegetable consumption, self reported, and psychological health. There was some evidence for a net reduction in the prevalence of poor psychological health for residents who directly engaged with the intervention. CONCLUSIONS Government policy has advocated using large scale food retailing as a social intervention to improve diet and health in poor communities. In contrast with a previous uncontrolled study this study did not find evidence for a net intervention effect on fruit and vegetable consumption, although there was evidence for an improvement in psychological health for those who directly engaged with the intervention. Although definitive conclusions about the effect of large scale retailing on diet and health in deprived communities cannot be drawn from non-randomised controlled study designs, evaluations of the impacts of natural experiments may offer the best opportunity to generate evidence about the health impacts of retail interventions in poor communities.
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Affiliation(s)
- Steven Cummins
- Department of Geography, Queen Mary, University of London, Mile End Road, London E1 4NS, UK.
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Abstract
OBJECTIVE To propose a paradigm shift in the role of the pharmacist by encouraging pharmacists' involvement in the achievement and maintenance of healthy lifestyles in their patients, thus reducing the need for long-term medications. DATA SOURCES Peer-reviewed medical literature, contemporary lay literature, news releases from health organizations/associations, United States health standards, and professional experiences of the authors. SUMMARY Our current paradigm for the management of chronic disease is malaligned. The medications we use are helpful for many patients with chronic disorders, but they are not curative and leave many individuals with unwanted adverse effects that are often treated with additional medication. The more effective approach to managing many patients with chronic diseases induced through unhealthy lifestyles would be to eat properly, exercise to maintain ideal body weight, and abstain from harmful substances. Managing the root causes of chronic disease would eliminate most of the unhealthy consequences and perhaps reduce the need for long-term medication. Pharmacists have the knowledge and capacity to assist in this endeavor. CONCLUSION Influencing patients to achieve ideal body weight through proper diet and exercise, encouraging people to stay well, and then helping them to keep well are roles for the pharmacist. If pharmacists made wellness and disease prevention part of their practices, they would have greater impact on improving patients' overall health. Without treating the primary cause of a condition and only treating the symptoms of unhealthy lifestyles, we are in many ways "spitting into the wind."
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Affiliation(s)
- Robert E Smith
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, AL 36849-5502, USA.
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Affiliation(s)
- Steven Cummins
- Department of Geography at Queen Mary, University of London, Mile End Road, London, UK.
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Cummins S, Findlay A, Petticrew M, Sparks L. Healthy Cities: The Impact of Food Retail-led Regeneration on Food Access, Choice and Retail Structure. ACTA ACUST UNITED AC 2005. [DOI: 10.2148/benv.2005.31.4.288] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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