Investigating the Spatial Dimension of Food Access

The Retail Food Environment Index and its association with dietary patterns, body mass index, and socioeconomic position: A multilevel assessment in Mexico

In Mexico, 75% of the population are affected by overweight or obesity, and the availability and affordability of high-calorie-dense foods and beverages are high. This study tested the association between the retail food environment index (RFEI), dietary patterns, body mass index (BMI), and socioeconomic position (SEP) in Mexico. Cross-sectional diet, health, and sociodemographic population-based secondary data analyses were conducted. The RFEI was calculated by dividing the total number of fast-food outlets and convenience stores by the total number of supermarkets and fruit and vegetable stores per census tract area. Associations between BMI, dietary patterns, SEP and the RFEI were tested using multilevel linear regression, including interactions of the RFEI with SEP, gender, and age. Living in neighbourhoods with a higher RFEI was associated with a 0.01kg/m2 higher BMI (β = 0.01, 95%CI: 0.0005, 0.02, p = 0.04), equivalent to a mean 0.046 weight gain for a 1.60m tall person per 10% higher RFEI. Unhealthy dietary patterns were more likely in neighbourhoods with a higher RFEI (β = 0.100, 95%CI: 0.03, 0.12, p = 0.001). Multilevel linear regression showed that lower SEP households had a higher RFEI compared to higher SEP households (β = 0.020, 95% CI: -0.006 to 0.04, p = 0.10). Generalised structural equation models revealed a graded relationship between RFEI and SEP, showing that lower SEP households were exposed to a higher RFEI (β = 0.060, 95% CI: 0.05 to 0.07, p < 0.001.) The study identified significant associations between higher proportions of fast-food outlets and convenience stores, higher BMI, and unhealthy dietary patterns. It was particularly evident that low-income populations are more likely to be exposed to obesogenic food environments.

Convenience stores: an obesogenic promoter in a metropolitan area of northern Mexico?

Introduction

The prevalence of obesity in the Mexican school-age (5-11 years old) population increased from 8.9 to 18.1% between 1999 and 2022. Although overweight and obesity (OW + Ob) is a complex and multifactorial phenomenon, alongside its increasing trend, changes in eating patterns as a result of obesogenic environments that promote higher energy intake have been documented. The objective of the present study was to detect possible associations between schools and their proximity to and density of convenience stores in Monterrey, Mexico from 2015 to 2018.

Materials and methods

Anthropometric data were obtained from a subset of measurements of the National Registry of Weight and Height (RNPT) performed in the Monterrey Mexico metropolitan area in 2015 and 2018, and obesity prevalence was computed and classified into quintiles at the school level. Convenience store data were obtained from the National Directory of Economic Units (DNUE). The analyses consisted of densities within 400-800 m buffers, distance to the nearest stores, and cartographic visualization of the store's kernel density versus OW + Ob hotspots for both periods.

Results

A total of 175,804 children in 2015 and 175,964 in 2018 belonging to 1,552 elementary schools were included in the study; during this period, OW + Ob prevalence increased from 38.7 to 39.3%, and a directly proportional relationship was found between the quintiles with the higher OW + Ob prevalence and the number of stores for both radii. Hotspots of OW + Ob ranged from 63 to 91 between 2015 and 2018, and it was visually confirmed that such spots were associated with areas with a higher density of convenience stores regardless of socioeconomic conditions.

Conclusion

Although some relationships between the store's proximity/density and OW + Ob could be identified, more research is needed to gather evidence about this. However, due to the trends and the magnitude of the problem, guidelines aimed at limiting or reducing the availability of junk food and sweetened beverages on the school's periphery must be implemented to control the obesogenic environment.

Identifying Areas of High Vulnerability for Rural Veteran Food Insecurity

INTRODUCTION/OBJECTIVES

Americans, including veterans, living in rural areas experience higher rates of food insecurity than the general population in the United States, but rural veteran food insecurity remains an understudied subject. Due to a lack of data on the subject, this project aimed to use geographic information systems (GIS) mapping of proxy variables for rural veteran food insecurity in order to identify areas of high vulnerability where future research could be targeted.

METHODS

Key factors which may indicate vulnerability to rural veteran food insecurity were identified in a review of the literature. These factors were mapped in ArcGIS Pro, including veteran population, community health, county rurality, and locations of food deserts.

RESULTS

After areas were identified that met search criteria, 3 sites were identified which serve a highly rural patient population and whose population has the highest vulnerability to rural veteran food insecurity based on search criteria.

CONCLUSIONS

This project demonstrates how GIS mapping can be used to identify regions in the United States at high vulnerability for rural veteran food insecurity. Findings from this project will be used by the project team to develop interventions for rural veteran food insecurity which can be implemented at the local or national level.

Payday lenders and premature mortality

Relationships between debt and poor health are worrisome as access to expensive credit expands and population health worsens along certain metrics. We focus on payday lenders as one type of expensive credit and investigate the spatial relationships between lender storefronts and premature mortality rates. We combine causes of death data from the Centers for Disease Control and Prevention (CDC) and payday lender locations at the county-level in the United States between 2000 and 2017. After accounting for county socioeconomic and demographic characteristics, the local presence of payday lenders is associated with an increased incidence risk of all-cause and specific-cause premature mortality. State regulations may attenuate these relationships, which provides insights on policy strategies to mitigate health impacts.

Mapping the spatial dimension of food insecurity using GIS-based indicators: A case of Western Kenya

Food insecurity elimination is a major focus of the Sustainable Development Goals and addresses one of the most pressing needs in developing countries. With the increasing incidence of food insecurity, poverty, and inequalities, there is a need for realignment of agriculture that aims to empower especially the rural poor smallholders by increasing productivity to improving food security conditions. Repositioning the agricultural sector should avoid general statements about production improvement, instead, it should tailor to location-specific recommendations that fully acknowledge the local spatial diversity of the natural resource base that largely determines production potentials under current low input agriculture. This paper aims to deconstruct the complex and multidimensional aspect of food insecurity and provides policymakers with an approach for mapping the spatial dimension of food insecurity. Using a set of GIS-based indicators, and a small-area approach, we combine Principal Component Analysis and GIS spatial analysis to construct one composite index and four individual indices based on the four dimensions of food security (access, availability, stability, and utilization) to map the spatial dimension of food insecurity in Vihiga County, Kenya. Data were collected by the use of a geocoded household survey questionnaire. The results reveal the existence of a clear and profound spatial disparity of food insecurity. Mapping food insecurity using individual dimension indices provides a more detailed picture of food insecurity as compared to the single composite index. Spatially disaggregated data, a small area approach, and GIS-based indicators prove valuable for mapping local-level causative factors of household food insecurity. Effective policy approaches to combat food insecurity inequalities should integrate spatially targeted interventions for each dimension of food insecurity.

Food Access, Diet Quality, and Nutritional Status of Older Adults During COVID-19: A Scoping Review

Background: COVID-19 has imposed challenges for older adults to access food, particularly in minority, lower income, and rural communities. However, the impact of COVID-19 on food access, diet quality, and nutrition of diverse older adult populations has not been systematically assessed. Objective: To examine changes in food access, diet quality, and nutritional status among older adults during the COVID-19 pandemic and the potential differential impacts of the COVID-19 pandemic on these nutrition-related outcomes using the framework of the socio-ecological model. Methods: An electronic search was conducted on 3 databases (PubMed, CINAHL, and Web of Science) on March 7, 2021. Original, peer-reviewed English-language studies published 10/1/2019-3/1/2021 were considered for which the mean age of participants was 50 years and older. In order to be considered, studies must have examined food access, food security, or nutrition constructs as an outcome. Results: The initial search yielded 13,628 results, of which 9,145 were duplicates. Of the remaining 4,483 articles, 13 articles were in scope and therefore selected in the final analysis, which can be characterized as descriptive (n = 5), analytical (n = 6), and correlational (n = 2). Studies were conducted among community-dwelling older adult populations (n = 7) as well as those temporarily residing in hospital settings (n = 6) in 10 countries. None of the in-scope studies examined the impact of food programs or specific public policies or disaggregated data by race/ethnicity. Conclusions: More research is needed to examine the impact of COVID-19 on food access/security and the differential barriers experienced by older adult populations.

Geospatial Analysis of Sodium and Potassium Intake: A Swiss Population-Based Study

Inadequate sodium and potassium dietary intakes are associated with major, yet preventable, health consequences. Local public health interventions can be facilitated and informed by fine-scale geospatial analyses. In this study, we assess the existence of spatial clustering (i.e., an unusual concentration of individuals with a specific outcome in space) of estimated sodium (Na), potassium (K) intakes, and Na:K ratio in the Bus Santé 1992–2018 annual population-based surveys, including 22,495 participants aged 20–74 years, residing in the canton of Geneva, using the local Moran’s I spatial statistics. We also investigate whether socio-demographic and food environment characteristics are associated with identified spatial clustering, using both global ordinary least squares (OLS) and local geographically weighted regression (GWR) modeling. We identified clear spatial clustering of Na:K ratio, Na, and K intakes. The GWR outperformed the OLS models and revealed spatial variations in the associations between explanatory and outcome variables. Older age, being a woman, higher education, and having a lower access to supermarkets were associated with higher Na:K ratio, while the opposite was seen for having the Swiss nationality. Socio-demographic characteristics explained a major part of the identified clusters. Socio-demographic and food environment characteristics significantly differed between individuals in spatial clusters of high and low Na:K ratio, Na, and K intakes. These findings could guide prioritized place-based interventions tailored to the characteristics of the identified populations.

The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: a systematic review

A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.