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Sadler RC, Saxe-Custack A. 'Nobody Shops at the Neighborhood Store': Leveraging a Community's Pediatric Fresh Produce Prescription Program to Inform Future Participating Store Redemption Locations. CITIES & HEALTH 2023; 8:70-81. [PMID: 38585045 PMCID: PMC10997326 DOI: 10.1080/23748834.2023.2281764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/06/2023] [Indexed: 04/09/2024]
Abstract
Research examining the nature of food shopping often considers proximity to the nearest or overall distance travelled to multiple stores. Such studies make up a portion of new work on so-called 'food deserts' and the issues inherent in the term, including that most people do not shop at their nearest store, and mobility challenges vary vastly from one person to the next. Increasing the knowledge base on shopping characteristics could be useful for behavioral interventions and programs aimed at increasing healthy food shopping. In this study, we examined the shopping characteristics of 627 caregivers whose children were enrolled in a pediatric fresh produce prescription program at one of three large pediatric clinics in Flint, Michigan. We compared these characteristics to the potential of a new food cooperative to improve geographic accessibility to healthy food. In particular, we propose the expansion of the prescription program to this new cooperative for health-related as well as local economic development reasons. Our work bridges topics of interest to researchers and practitioners working in nutrition, food access, and economic development.
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Affiliation(s)
- Richard C. Sadler
- Departments of Public Health and Family Medicine, Michigan State University, Flint, MI, USA
| | - Amy Saxe-Custack
- Departments of Public Health and Food Science & Human Nutrition, Michigan State University, Flint, MI, USA
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Leslie IS, Carson J, Bruce A. LGBTQ+ food insufficiency in New England. AGRICULTURE AND HUMAN VALUES 2022; 40:1-16. [PMID: 36530207 PMCID: PMC9735207 DOI: 10.1007/s10460-022-10403-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
As a group, LGBTQ+ people experience food insecurity at a disproportionately high rate, yet food security scholars and practitioners are only beginning to uncover patterns in how food insecurity varies by subgroups of this diverse community. In this paper, we use data from the U.S. Census Bureau's Household Pulse Survey-which added measures of gender identity and sexuality for the first time in 2021-to analyze New Englanders' food insufficiency rates by gender, sexuality, race, and ethnicity. We find that (1) in the past seven days, 13.0 percent of LGB + (lesbian, gay, bisexual, and other non-heterosexual) New Englanders experience food insufficiency-which is nearly twice the rate of heterosexual people-and 19.8 percent of transgender+ (transgender, genderqueer, gender non-binary, and other non-cisgender people) New Englanders experience food insufficiency-which is two to three times the rate of cisgender men and women. (2) Whereas cisgender New Englanders experience food insufficiency at a lower rate than their counterparts in the rest of the nation (about two percentage points lower for both cisgender men and women), transgender+ New Englanders experience no such New England advantage compared to transgender+ people in the country as a whole. (3) LGBTQ+ New Englanders of color experience devastatingly high rates of food insufficiency, with, for example, one in three Black transgender+ New Englanders not having enough food to eat in the past seven days. These findings suggest that addressing food insecurity in New England demands approaching the problem with an intersectional queer lens, with attention to the ways in which racism, cissexism, and heterosexism are creating a systemic, ongoing food crisis for LGBTQ+ New Englanders, especially those who are transgender+ and/or people of color.
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Affiliation(s)
- Isaac Sohn Leslie
- University of Vermont Extension, 130 Austine Dr. #300, Brattleboro, VT 05301 USA
| | - Jessica Carson
- Carsey School of Public Policy, University of New Hampshire, 73 Main Street, Durham, NH 03824 USA
| | - Analena Bruce
- Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire, 129 Main Street, Durham, NH 03824 USA
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Hutton NS, McLeod G, Allen TR, Davis C, Garnand A, Richter H, Chavan PP, Hoglund L, Comess J, Herman M, Martin B, Romero C. Participatory mapping to address neighborhood level data deficiencies for food security assessment in Southeastern Virginia, USA. Int J Health Geogr 2022; 21:17. [PMCID: PMC9640904 DOI: 10.1186/s12942-022-00314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Food is not equitably available. Deficiencies and generalizations limit national datasets, food security assessments, and interventions. Additional neighborhood level studies are needed to develop a scalable and transferable process to complement national and internationally comparative data sets with timely, granular, nuanced data. Participatory geographic information systems (PGIS) offer a means to address these issues by digitizing local knowledge.
Methods
The objectives of this study were two-fold: (i) identify granular locations missing from food source and risk datasets and (ii) examine the relation between the spatial, socio-economic, and agency contributors to food security. Twenty-nine subject matter experts from three cities in Southeastern Virginia with backgrounds in food distribution, nutrition management, human services, and associated research engaged in a participatory mapping process.
Results
Results show that publicly available and other national datasets are not inclusive of non-traditional food sources or updated frequently enough to reflect changes associated with closures, expansion, or new programs. Almost 6 percent of food sources were missing from publicly available and national datasets. Food pantries, community gardens and fridges, farmers markets, child and adult care programs, and meals served in community centers and homeless shelters were not well represented. Over 24 km2 of participant identified need was outside United States Department of Agriculture low income, low access areas. Economic, physical, and social barriers to food security were interconnected with transportation limitations. Recommendations address an international call from development agencies, countries, and world regions for intervention methods that include systemic and generational issues with poverty, incorporate non-traditional spaces into food distribution systems, incentivize or regulate healthy food options in stores, improve educational opportunities, increase data sharing.
Conclusions
Leveraging city and regional agency as appropriate to capitalize upon synergistic activities was seen as critical to achieve these goals, particularly for non-traditional partnership building. To address neighborhood scale food security needs in Southeastern Virginia, data collection and assessment should address both environment and utilization issues from consumer and producer perspectives including availability, proximity, accessibility, awareness, affordability, cooking capacity, and preference. The PGIS process utilized to facilitate information sharing about neighborhood level contributors to food insecurity and translate those contributors to intervention strategies through discussion with local subject matter experts and contextualization within larger scale food systems dynamics is transferable.
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Retail System Scenario Modeling Using Fuzzy Cognitive Maps. INFORMATION 2022. [DOI: 10.3390/info13050251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A retail business is a network of similar-format grocery stores with a sole proprietor and a well-established logistical infrastructure. The retail business is a stable market, with low growth, limited customer revenues, and intense competition. On the system level, the retail industry is a dynamic system that is challenging to represent due to uncertainty, nonlinearity, and imprecision. Due to the heterogeneous character of retail systems, direct scenario modeling is arduous. In this article, we propose a framework for retail system scenario planning that allows managers to analyze the effect of different quantitative and qualitative factors using fuzzy cognitive maps. Previously published fuzzy retail models were extended by adding external factors and combining expert knowledge with domain research results. We determined the most suitable composition of fuzzy operators for the retail system, highlighted the system’s most influential concepts, and how the system responds to changes in external factors. The proposed framework aims to support senior management in conducting flexible long-term planning of a company’s strategic development, and reach its desired business goals.
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Saxe-Custack A, Todem D, Anthony JC, Kerver JM, LaChance J, Hanna-Attisha M. Effect of a pediatric fruit and vegetable prescription program on child dietary patterns, food security, and weight status: a study protocol. BMC Public Health 2022; 22:150. [PMID: 35062926 PMCID: PMC8778506 DOI: 10.1186/s12889-022-12544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although nutrients in fruits and vegetables are necessary for proper development and disease prevention, most US children consume fewer servings than recommended. Prescriptions for fruits and vegetables, written by physicians to exchange for fresh produce, address access and affordability challenges while emphasizing the vital role of diet in health promotion and disease prevention. Michigan’s first fruit and vegetable prescription program (FVPP) exclusively for children was introduced in 2016 at one large pediatric clinic in Flint and expanded to a second clinic in 2018. The program provides one $15 prescription for fresh produce to all pediatric patients at every office visit. Prescriptions are redeemable at a year-round farmers’ market or a local mobile market. The current study will assess the impact of this FVPP on diet, food security, and weight status of youth.
Methods
Demographically similar pediatric patient groups with varying levels of exposure to the FVPP at baseline will be compared: high exposure (> 24 months), moderate exposure (12–24 months), and no previous exposure. Data collection will focus on youth ages 8–16 years. A total of 700 caregiver-child dyads (one caregiver and one child per household) will be enrolled in the study, with approximately 200 dyads at clinic 1 (high exposure); 200 dyads at clinic 2 (moderate exposure), and 300 dyads at clinic 3 (no previous exposure). Children with no previous exposure will be introduced to the FVPP, and changes in diet, food security, and weight status will be tracked over two years. Specific aims are to (1) compare baseline diet, food security, and weight status between pediatric patients with varying levels of exposure to the FVPP; (2) measure changes in diet, food security, and weight status before and after never-before-exposed children are introduced to the FVPP; and (3) compare mean 12- and 24-month follow-up measures of diet, food security, and weight status in the initial no exposure group to baseline measures in the high exposure group.
Discussion
Completion of study aims will provide evidence for the effectiveness of pediatric FVPPs and insights regarding the duration and intensity of exposure necessary to influence change.
Trial registration
The study was registered through clinicaltrials.gov [ID: NCT04767282] on February 23, 2021.
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Saxe-Custack A, LaChance J, Hanna-Attisha M, Goldsworthy M, Ceja T. Household Supplemental Nutrition Assistance Program Participation is Associated With Higher Fruit and Vegetable Consumption. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:1060-1065. [PMID: 34479817 DOI: 10.1016/j.jneb.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Examine whether differences were present by Supplemental Nutrition Assistance Program (SNAP) participation in dietary patterns, achievement of dietary recommendations, and food security for children (aged 7-18 years) receiving free/reduced-price school meals. METHODS Cross-sectional study. Caregiver-child dyads at a pediatric clinic completed validated surveys. Food security, dietary patterns, and achievement of dietary recommendations were compared between child SNAP participants/nonparticipants. RESULTS Among 205 caregivers, 128 (62.4%) reported SNAP participation. Percentages of child SNAP participants/nonparticipants meeting recommendations were largely nonsignificantly different and overwhelmingly low. Supplemental Nutrition Assistance Program participants reported higher mean daily servings of vegetables (P = 0.01) and fruits (P = 0.01) than nonparticipants. Caregiver-reported household food security was not significantly different between SNAP participants and nonparticipants (P = 0.44). CONCLUSIONS AND IMPLICATIONS In this study, child-reported fruit/vegetable intakes were significantly higher among SNAP participants than nonparticipants, suggesting child SNAP participants may experience small but noteworthy benefits related to fruit/vegetable consumption. Additional supports are needed to achieve dietary recommendations.
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Affiliation(s)
- Amy Saxe-Custack
- Department of Food Science and Human Nutrition, Division of Public Health, Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI.
| | - Jenny LaChance
- Division of Public Health, Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI
| | - Mona Hanna-Attisha
- Department of Pediatrics and Human Development, Division of Public Health, Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI
| | - Mallory Goldsworthy
- Division of Public Health, Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI
| | - Tiffany Ceja
- Division of Public Health, Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI
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Influence of a Pediatric Fruit and Vegetable Prescription Program on Child Dietary Patterns and Food Security. Nutrients 2021; 13:nu13082619. [PMID: 34444778 PMCID: PMC8399668 DOI: 10.3390/nu13082619] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022] Open
Abstract
Limited access to fresh foods is a barrier to adequate consumption of fruits and vegetables among youth, particularly in low-income communities. The current study sought to examine preliminary effectiveness of a fruit and vegetable prescription program (FVPP), which provided one USD 15 prescription to pediatric patients during office visits. The central hypothesis was that exposure to this FVPP is associated with improvements in dietary patterns and food security. This non-controlled longitudinal intervention trial included a sample of caregiver–child dyads at one urban pediatric clinic who were exposed to the FVPP for 1 year. Patients received one USD 15 prescription for fresh produce during appointments. A consecutive sample of caregivers whose children were 8–18 years of age were invited to participate in the study. Dyads separately completed surveys that evaluated food security and dietary behaviors prior to receipt of their first prescription and again at 12 months. A total of 122 dyads completed surveys at baseline and 12-month follow-up. Approximately half of youth were female (52%), and most were African American (63%). Mean caregiver-reported household food security improved from baseline to 12 months (p < 0.001), as did mean child-reported food security (p = 0.01). Additionally, child-reported intake of vegetables (p = 0.001), whole grains (p = 0.001), fiber (p = 0.008), and dairy (p < 0.001) improved after 12 months of exposure to the FVPP. This study provides evidence that pediatric FVPPs may positively influence food security and the dietary patterns of children.
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Saxe-Custack A, Goldsworthy M, Lofton HC, Hanna-Attisha M, Nweke O. Family Perceptions of a Cooking and Nutrition Program for Low-Income Children and Adolescents. Glob Pediatr Health 2021; 8:2333794X21989525. [PMID: 33614838 PMCID: PMC7868466 DOI: 10.1177/2333794x21989525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/04/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background. Flint Kids Cook, a nutrition and culinary program for children and adolescents, was created in October 2017 to address health concerns among youth and families in a low-income, urban community. In this study, researchers examined family experiences with the 6-week, chef-led program, which was taught in a farmers' market kitchen. Methods. At the conclusion of each session, researchers used an open-ended focus group format to assess program experiences, perceived impact on youth self-efficacy for cooking and healthy eating, and caregiver support. This qualitative study was guided by thematic analysis. Results. Between November 2017 and December 2018, 72 caregivers (n = 38) and students (n = 34) participated in separate focus groups. Caregivers were primarily female (74%) and African American (71%). Most students were African American (76%) and half were female. Recurrent themes included food acceptance, dietary modifications, confidence in the kitchen, and program design. Caregivers and students agreed that location and design of the program alongside facilitation by an experienced chef were important factors for program success. Conclusions. This study demonstrated that a chef-led healthy cooking program for youth was effective in improving perceived food acceptance, dietary habits, and confidence in the kitchen. The program could be modeled in similar communities to address diet and health of children and adolescents.
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Affiliation(s)
- Amy Saxe-Custack
- Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI, USA
| | - Mallory Goldsworthy
- Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI, USA
| | | | - Mona Hanna-Attisha
- Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Flint, MI, USA
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Saxe-Custack A, Sadler R, LaChance J, Hanna-Attisha M, Ceja T. Participation in a Fruit and Vegetable Prescription Program for Pediatric Patients is Positively Associated with Farmers' Market Shopping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124202. [PMID: 32545578 PMCID: PMC7344709 DOI: 10.3390/ijerph17124202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
Objectives: The primary objective was to investigate the association between participation in a farmers’ market fruit and vegetable prescription program (FVPP) for pediatric patients and farmers’ market shopping. Methods: This survey-based cross-sectional study assessed data from a convenience sample of 157 caregivers at an urban pediatric clinic co-located with a farmers’ market. Prescription redemption was restricted to the farmers’ market. Data were examined using chi-square analysis and independent samples t-tests. Results: Approximately 65% of respondents participated in the FVPP. Those who received one or more prescriptions were significantly more likely to shop at the farmers’ market during the previous month when compared to those who never received a prescription (p = 0.005). Conclusions: This is the first study to demonstrate that participation in a FVPP for pediatric patients is positively associated with farmers’ market shopping.
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Affiliation(s)
- Amy Saxe-Custack
- Department of Food Science and Human Nutrition, Division of Public Health, Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI 48502, USA
- Correspondence:
| | - Richard Sadler
- Department of Family Medicine, Division of Public Health, Michigan State University College of Human Medicine, Flint, MI 48502, USA;
| | - Jenny LaChance
- Division of Public Health, Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI 48502, USA; (J.L.); (T.C.)
| | - Mona Hanna-Attisha
- Department of Pediatrics and Human Development, Division of Public Health, Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI 48502, USA;
| | - Tiffany Ceja
- Division of Public Health, Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI 48502, USA; (J.L.); (T.C.)
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Gu T, Yuan J, Li L, Shao Q, Zheng C. Demand for community-based care services and its influencing factors among the elderly in affordable housing communities: a case study in Nanjing City. BMC Health Serv Res 2020; 20:241. [PMID: 32293427 PMCID: PMC7092588 DOI: 10.1186/s12913-020-5067-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 03/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background Community-based care services refers to the professional services provided at home to the elderly with formally assessed demands. The growth of the elderly population has increased the demand for these services, and this issue is even worse in the affordable housing community (AHC) of China. Understanding of elderly’s demands for different types of community-based care services and its determinations would enable the implementation of appropriate incentive schemes to promote utilization of community-based care services in the AHCs of China. Methods Guided by previous studies, a conceptual framework was developed. Then, a questionnaire was designed and a community based survey was conducted from May 10–20, 2018 in Daishan AHC of Nanjing City, China. Four hundred eight participants from 25,650 elderly people were selected by systematic random sampling technique. Binary logistic regression was applied to the data about the elderly’ primary demands for community-based care services in the AHC, to quantify the elderly’s demands and explore related individual-level factors. Results The finding indicates that more than 50% of respondents had the demand for an elderly care hotline, building health archives, on-call nursing and doctor visits, medical lectures, regular medical examinations and sporting fitness. The binary logistic regression models revealed that the primary demands of the elderly for community-based care services were influenced by distinct factors. Conclusions Our findings help clarify different types of community-based care services and provide fresh information about the demand for community-based care among the elderly in AHCs. Several policy implications are discussed to enhance the efficiency of community-based care service provision.
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Affiliation(s)
- Tiantian Gu
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China
| | - Jingfeng Yuan
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China.
| | - Lingzhi Li
- School of Civil Engineering, Nanjing Tech University, Nanjing, 211816, China
| | - Qiuhu Shao
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China
| | - Chuanjun Zheng
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China
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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] [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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Child Consumption of Whole Fruit and Fruit Juice Following Six Months of Exposure to a Pediatric Fruit and Vegetable Prescription Program. Nutrients 2019; 12:nu12010025. [PMID: 31877635 PMCID: PMC7019436 DOI: 10.3390/nu12010025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022] Open
Abstract
Public health recommendations suggest limiting child consumption of fruit juice in favor of whole fruit due to juice’s high sugar content, lack of fruit fiber, and potential for excess intake. However, replacing juice with whole fruit may be particularly challenging for low-income and minority children, who report the highest intake of 100% juice. To address access and affordability challenges among low-income children, researchers partnered with pediatricians in an urban food desert community, to introduce a fruit and vegetable prescription program (FVPP) that provided a $15 prescription for fresh produce to every child during each office visit. Participating vendors included a farmers’ market and local mobile market. This study assessed changes in daily consumption of total fruit and whole fruit among 108 pediatric patients following six months of exposure to the FVPP. Child-reported mean daily intake of whole fruit increased significantly from the baseline to the 6-month follow-up (p = 0.03): 44% of children reported an increased intake of at least ¼ cup per day, and 30% reported an increased intake of at least ½ cup per day. Changes in total fruit intake (including fruit juice) were not significant. Results suggest a pediatric FVPP may have meaningful impacts on children’s dietary behaviors, particularly with regard to the intake of whole fruits.
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Saxe-Custack A, Lofton HC, Hanna-Attisha M, Tata Z, Ceja T, LaChance J. Caregiver Experiences With an Innovative Farmers' Market Incentive Program for Children in Flint, Michigan. Glob Pediatr Health 2019; 6:2333794X19870989. [PMID: 31489342 PMCID: PMC6712753 DOI: 10.1177/2333794x19870989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 01/21/2023] Open
Abstract
An innovative farmers’ market incentive program designed specifically for children was implemented to address persistent challenges with accessing fresh, nutrient-rich foods in a food desert community. The current study sought to qualitatively examine caregiver perceptions of the incentive program. Following distribution of farmers’ market incentives to all children (ages 0 to 15 years) at 43 Flint-area early childcare facilities and elementary schools, researchers conducted semistructured interviews with 37 caregivers (mean age = 39.59 ± 11.73 years). The majority were female (87%) and African American (53%). Through these interviews, researchers explored family experiences with the farmers’ market incentive program, as well as changes in environmental factors that may have resulted from program participation. Interviews were audio recorded and transcribed verbatim for textual analysis. Thematic analysis was used to identify patterns across transcripts and formulate emerging themes. Four recurrent themes emerged during interviews: (1) fruit and vegetable access, (2) child influence, (3) autonomous grocery shopping, and (4) program expansion. Interview participants indicated that the farmers’ market incentive program was an effective tool to both encourage families to visit the farmers’ market and purchase fresh foods there. Program design, particularly distribution to children, was credited with introducing families to the local farmers’ market. The current study suggests that a farmers’ market incentive program targeting children who reside in a food desert community may have meaningful impacts on access to fresh, nutrient-rich foods.
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Affiliation(s)
| | | | - Mona Hanna-Attisha
- Michigan State University, Flint, MI, USA.,Hurley Children's Hospital at Hurley Medical Center, Flint, MI, USA
| | | | - Tiffany Ceja
- Michigan State University, Flint, MI, USA.,Hurley Research Center, Hurley Medical Center, Flint, MI, USA
| | - Jenny LaChance
- Michigan State University, Flint, MI, USA.,Hurley Research Center, Hurley Medical Center, Flint, MI, USA
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Fruit and Vegetable Prescriptions for Pediatric Patients Living in Flint, Michigan: A Cross-Sectional Study of Food Security and Dietary Patterns at Baseline. Nutrients 2019; 11:nu11061423. [PMID: 31242555 PMCID: PMC6627167 DOI: 10.3390/nu11061423] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/31/2023] Open
Abstract
Though fruit and vegetable consumption is essential for disease prevention and health maintenance, intake among children fails to meet dietary recommendations. Limited access to and the affordability of fresh produce, particularly among low-income youth, are barriers to adequate intake. To address these challenges, researchers and pediatricians in Flint, Michigan, expanded a successful fruit and vegetable prescription program that provides one $15 prescription for fresh fruits and vegetables to every child at every office visit. Vendors include the downtown farmers' market and a local mobile market. This study describes baseline characteristics, dietary patterns, food access, and food security among 261 caregiver-child dyads enrolled August 2018-March 2019. The child-reported mean daily intake of vegetables (0.72 cups ± 0.77), dairy products (1.33 cups ± 1.22), and whole grains (0.51 ounces ± 0.49) were well below recommendations. Furthermore, 53% of children and 49% of caregivers who completed the food security module indicated low or very low food security. However, there were no statistically significant differences in the child consumption of fruits and vegetables between households that reported high versus low food security (p > 0.05). Results validate and raise deep concerns about poor dietary patterns and food insecurity issues facing Flint children, many of whom continue to battle with an ongoing drinking water crisis. Additional poverty-mitigating efforts, such as fruit and vegetable prescription programs, are necessary to address these gaps.
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Sadler RC, Hippensteel C, Nelson V, Greene-Moton E, Furr-Holden CD. Community-engaged development of a GIS-based healthfulness index to shape health equity solutions. Soc Sci Med 2019; 227:63-75. [PMID: 30037592 PMCID: PMC6339605 DOI: 10.1016/j.socscimed.2018.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/14/2018] [Accepted: 07/18/2018] [Indexed: 12/20/2022]
Abstract
Addressing health disparities requires both community engagement and an understanding of the social determinants of health. Although elements of the built environment can influence behavior change in public health interventions, such determinants have not been explicitly teased out via participatory mapping. An opportunity exists to integrate community voice in the development of such metrics. To fill this gap and inform the deployment of public health interventions in the Flint (USA) Center for Health Equity Solutions (FCHES), we created a means of assessing spatially-varying community needs and assets in a geographic information system (GIS), what we refer to as a healthfulness index. We engaged community and academic partners in their expert opinions on features of Flint's built environment that may promote or inhibit healthy behaviors via a multiple-criteria decision analysis framework. Experts selected from and ranked 29 variables in 6 categories (including amenities, environment, greenspace, housing, infrastructure, and social issues) using the analytic hierarchy process. The resulting matrices of expert opinions were aggregated and appended as weights for each variable's corresponding map layer. When combined through map algebra, composite scores yield spatially-varying healthfulness indices which signal any neighborhood's relative health promoting qualities (along a 0-100 scale). Results varied substantially across Flint, with the middle belt scoring highest and older neighborhoods in the northeast and north center of the city scoring lowest. Scores were aggregated to 38 Flint neighborhoods; for each of two project-specific indices, these ranged from lows of 38.7 (Hilborn Park) and 41.8 (Columbia Heights) to highs of 52.9 (College Cultural) and 58.0 (University Ave Corridor). We hypothesize that-even when controlling for individual-level factors-we will measure better and more sustained behavior change among participants living in neighborhoods with high healthfulness scores. Future work will examine this hypothesis and determine the importance of such indices in other similar communities.
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Hsiao BS, Sibeko L, Troy LM. A Systematic Review of Mobile Produce Markets: Facilitators and Barriers to Use, and Associations with Reported Fruit and Vegetable Intake. J Acad Nutr Diet 2019; 119:76-97.e1. [DOI: 10.1016/j.jand.2018.02.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
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Gu T, Li L, Li D. A two-stage spatial allocation model for elderly healthcare facilities in large-scale affordable housing communities: a case study in Nanjing City. Int J Equity Health 2018; 17:183. [PMID: 30541553 PMCID: PMC6291974 DOI: 10.1186/s12939-018-0898-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background As the proportion of elderly residents living in large-scale affordable housing communities (LAHCs) increases in China, serious problems have become apparent related to the spatial allocation of elderly healthcare facilities (EHFs), e.g., insufficient provision and inaccessibility. To address these issues, this study developed a location allocation model for EHFs to ensure equitable and efficient access to healthcare services for the elderly in LAHCs. Methods Based on discrete location theory, this paper develops a two-stage optimization model for the spatial allocation of EHFs in LAHCs. In the first stage, the candidate locations of EHFs are specified using geographic information system (GIS) techniques. In the second stage, the optimal location and size of each EHF are determined based on the greedy algorithm (GA). Finally, the proposed two-stage optimization model is tested using the Daishan LAHC in Nanjing, Eastern China. Results The demand of the elderly for accessibility to EHFs is in line with Nanjing’s planning standards. Deep insights into spatial data are revealed by GIS techniques that enable candidate locations of EHFs to be obtained. In addition, the model helps EHF planners achieve equity and efficiency simultaneously. Two optimal locations for EHFs in the Daishan LAHC are identified, which in turn verifies the validity of the model. Conclusions As a strategy for allocating EHFs, this two-stage model improves the equity and efficiency of access to healthcare services for the elderly by optimizing the potential sites for EHFs. It can also be used to assist policymakers in providing adequate healthcare services for the low-income elderly. Furthermore, the model can be extended to the allocation of other public-service facilities in different countries or regions.
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Affiliation(s)
- Tiantian Gu
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China.,Lyles School of Civil Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Lingzhi Li
- School of Civil Engineering, Nanjing University of Technology, Nanjing, 211816, China
| | - Dezhi Li
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China.
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The Flint Food Store Survey: combining spatial analysis with a modified Nutrition Environment Measures Survey in Stores (NEMS-S) to measure the community and consumer nutrition environments. Public Health Nutr 2018; 21:1474-1485. [PMID: 29361993 DOI: 10.1017/s1368980017003950] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The goal of the present study was to use a methodology that accurately and reliably describes the availability, price and quality of healthy foods at both the store and community levels using the Nutrition Environment Measures Survey in Stores (NEMS-S), to propose a spatial methodology for integrating these store and community data into measures for defining objective food access. SETTING Two hundred and sixty-five retail food stores in and within 2 miles (3·2 km) of Flint, Michigan, USA, were mapped using ArcGIS mapping software. DESIGN A survey based on the validated NEMS-S was conducted at each retail food store. Scores were assigned to each store based on a modified version of the NEMS-S scoring system and linked to the mapped locations of stores. Neighbourhood characteristics (race and socio-economic distress) were appended to each store. Finally, spatial and kernel density analyses were run on the mapped store scores to obtain healthy food density metrics. RESULTS Regression analyses revealed that neighbourhoods with higher socio-economic distress had significantly lower dairy sub-scores compared with their lower-distress counterparts (β coefficient=-1·3; P=0·04). Additionally, supermarkets were present only in neighbourhoods with <60 % African-American population and low socio-economic distress. Two areas in Flint had an overall NEMS-S score of 0. CONCLUSIONS By identifying areas with poor access to healthy foods via a validated metric, this research can be used help local government and organizations target interventions to high-need areas. Furthermore, the methodology used for the survey and the mapping exercise can be replicated in other cities to provide comparable results.
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Mack EA, Tong D, Credit K. Gardening in the desert: a spatial optimization approach to locating gardens in rapidly expanding urban environments. Int J Health Geogr 2017; 16:37. [PMID: 29037243 PMCID: PMC5644113 DOI: 10.1186/s12942-017-0110-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/10/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Food access is a global issue, and for this reason, a wealth of studies are dedicated to understanding the location of food deserts and the benefits of urban gardens. However, few studies have linked these two strands of research together to analyze whether urban gardening activity may be a step forward in addressing issues of access for food desert residents. METHODS The Phoenix, Arizona metropolitan area is used as a case to demonstrate the utility of spatial optimization models for siting urban gardens near food deserts and on vacant land. The locations of urban gardens are derived from a list obtained from the Maricopa County Cooperative Extension office at the University of Arizona which were geo located and aggregated to Census tracts. Census tracts were then assigned to one of three categories: tracts that contain a garden, tracts that are immediately adjacent to a tract with a garden, and all other non-garden/non-adjacent census tracts. Analysis of variance is first used to ascertain whether there are statistical differences in the demographic, socio-economic, and land use profiles of these three categories of tracts. A maximal covering spatial optimization model is then used to identify potential locations for future gardening activities. A constraint of these models is that gardens be located on vacant land, which is a growing problem in rapidly urbanizing environments worldwide. RESULTS The spatial analysis of garden locations reveals that they are centrally located in tracts with good food access. Thus, the current distribution of gardens does not provide an alternative food source to occupants of food deserts. The maximal covering spatial optimization model reveals that gardens could be sited in alternative locations to better serve food desert residents. In fact, 53 gardens may be located to cover 96.4% of all food deserts. This is an improvement over the current distribution of gardens where 68 active garden sites provide coverage to a scant 8.4% of food desert residents. CONCLUSION People in rapidly urbanizing environments around the globe suffer from poor food access. Rapid rates of urbanization also present an unused vacant land problem in cities around the globe. This paper highlights how spatial optimization models can be used to improve healthy food access for food desert residents, which is a critical first step in ameliorating the health problems associated with lack of healthy food access including heart disease and obesity.
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Affiliation(s)
- Elizabeth A. Mack
- Department of Geography, Environment and Spatial Sciences, Michigan State University, Geography Building, 673 Auditorium Rd, Room 202, East Lansing, MI 48824 USA
| | - Daoqin Tong
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ 85281 USA
| | - Kevin Credit
- Department of Geography, Environment and Spatial Sciences, Michigan State University, Geography Building, 673 Auditorium Rd, Room 202, East Lansing, MI 48824 USA
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Lawal O, Oyegun CU. Geographic information systems-based expert system modelling for shoreline sensitivity to oil spill disaster in Rivers State, Nigeria. JÀMBÁ: JOURNAL OF DISASTER RISK STUDIES 2017; 9:429. [PMID: 29955346 PMCID: PMC6014144 DOI: 10.4102/jamba.v9i1.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 06/06/2017] [Indexed: 11/01/2022]
Abstract
In the absence of adequate and appropriate actions, hazards often result in disaster. Oil spills across any environment are very hazardous; thus, oil spill contingency planning is pertinent, supported by Environmental Sensitivity Index (ESI) mapping. However, a significant data gap exists across many low- and middle-income countries in aspect of environmental monitoring. This study developed a geographic information system (GIS)-based expert system (ES) for shoreline sensitivity to oiling. It focused on the biophysical attributes of the shoreline with Rivers State as a case study. Data on elevation, soil, relative wave exposure and satellite imageries were collated and used for the development of ES decision rules within GIS. Results show that about 70% of the shoreline are lined with swamp forest/mangroves/nympa palm, and 97% have silt and clay as dominant sediment type. From the ES, six ranks were identified; 61% of the shoreline has a rank of 9 and 19% has a rank of 3 for shoreline sensitivity. A total of 568 km out of the 728 km shoreline is highly sensitive (ranks 7–10). There is a clear indication that the study area is a complex mixture of sensitive environments to oil spill. GIS-based ES with classification rules for shoreline sensitivity represents a rapid and flexible framework for automatic ranking of shoreline sensitivity to oiling. It is expected that this approach would kick-start sensitivity index mapping which is comprehensive and openly available to support disaster risk management around the oil producing regions of the country.
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Affiliation(s)
- Olanrewaju Lawal
- Department of Geography and Environmental Management, University of Port Harcourt, Nigeria
| | - Charles U. Oyegun
- Department of Geography and Environmental Management, University of Port Harcourt, Nigeria
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Chiang YC, Lei HY. Using expert decision-making to establish indicators of urban friendliness for walking environments: a multidisciplinary assessment. Int J Health Geogr 2016; 15:40. [PMID: 27846889 PMCID: PMC5111263 DOI: 10.1186/s12942-016-0071-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have suggested that friendly walking environments positively affect physical activity and health. Creating friendly walking environments in urban areas is a complex and wide-ranging topic, and no study has yet established a set of assessment indicators by drawing on the expertise of various disciplines. This study uses a multiple-criteria decision-making technique to elucidate the environmental factors that affect the friendliness of the walking environment. METHODS We conducted a two-phase expert questionnaire survey. Experts from the government sector, as well as the academic disciplines of urban planning, transportation, architecture, and landscape design, were recruited to establish a set of walking environment indicators; the degrees of importance assigned to these indicators by the experts were subsequently compared. In phase 1, the fuzzy Delphi method was used by 20 experts, whose responses were used to identify four dimensions and 22 indicators. In phase 2, an analytical network process approach was performed by 16 experts to determine the weights of the dimensions and indicators. RESULTS The results revealed that all of the experts ranked the four dimensions in the order of safety > facilities > aesthetics > land use mix. Of the 22 indicators, land use-diversity, land use-access, sidewalk width, sidewalk continuity, and cleanliness were considered the most important. CONCLUSIONS The results provide a reference for the management of walking environments by promoting pedestrian-oriented environments and public health.
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Affiliation(s)
- Yen-Cheng Chiang
- Department of Landscape Architecture, National Chiayi University, Chiayi, 60004, Taiwan, ROC. .,Department of Landscape Architecture, University of Illinois at Urbana Champaign, Champaign, IL, 61820, USA.
| | - Han-Yu Lei
- Department of Horticulture, National Chiayi University, Chiayi, 60004, Taiwan, ROC
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