Australian Stakeholder Perspectives on Healthier Retail Food Environments for Toddlers-The Era of "Band Aids and Small Inroads"

Background

A healthy diet in young children is crucial for optimal growth and development. However, many toddlers (1-3 y) consume suboptimal diets, and as a result, are at a high risk of experiencing negative health outcomes. Moreover, minimal progress has been made to improve the healthiness of retail food environments for toddlers to date despite the potential and advocacy for the issue.

Objectives

To gain insight into stakeholder perceptions and opinions on the healthiness of Australian retail food environments for toddlers, as well as perspectives on the options and barriers to improve their healthiness.

Methods

Qualitative, online study utilizing semi-structured individual interviews with 27 key stakeholders from food industry, academia, nongovernment organizations, public health, and government in Australia.

Results

Most stakeholders agreed that retail food environments for toddlers were not health promoting. Stakeholders identified that a multifaceted approach including nutrition education and strong government mandated regulation were essential to improve the healthiness of retail food environments for toddlers. Interviews also highlighted the main perceived barriers to progress, and reasons for policy inaction in this area are the food industry and government support. Many stakeholders were concerned that child health is being undermined due to the government favoring business needs over public health.

Conclusions

Stakeholders in this study overwhelmingly agreed that there is more that can and should be done to create health promoting retail food environments for toddlers in Australia. Stakeholders identified a range of strategies that can be used to improve the healthiness of toddler food environments, but advocacy efforts are being undermined due to government inaction. Stakeholders believed that strong governance is required to create equitable, sustainable healthy retail food environments for young children. Improving the healthiness of retail food environments for young children will not only reduce diet related disease across the lifespan but will help to address financial and societal costs of a poor diet.

Trends in food and beverage purchases in informal, mixed, and formal food outlets in Mexico: ENIGH 1994-2020

Background

The retail food environment in Mexico is characterized by the co-existence of both, formal and informal food outlets. Yet, the contribution of these outlets to food purchases over time has not been documented. Understanding the longitudinal trends where Mexican households purchase their foods is critical for the development of future food retail policies.

Methods

We used data from Mexico's National Income and Expenditure Survey from 1994 to 2020. We categorized food outlets as formal (supermarkets, chain convenience stores, restaurants), informal (street markets, street vendors, acquaintances), and mixed (fiscally regulated or not. i.e., small neighborhood stores, specialty stores, public markets). We calculated the proportion of food and beverage purchases by food outlet for each survey for the overall sample and stratified by education level and urbanicity.

Results

In 1994, the highest proportion of food purchases was from mixed outlets, represented by specialty and small neighborhood stores (53.7%), and public markets (15.9%), followed by informal outlets (street vendors and street markets) with 12.3%, and formal outlets from which supermarkets accounted for 9.6%. Over time, specialty and small neighborhood stores increased 4.7 percentage points (p.p.), while public markets decreased 7.5 p.p. Street vendors and street markets decreased 1.6 p.p., and increased 0.5 p.p. for supermarkets. Convenience stores contributed 0.5% at baseline and increased to 1.3% by 2020. Purchases at specialty stores mostly increased in higher socioeconomic levels (13.2 p.p.) and metropolitan cities (8.7 p.p.) while public markets decreased the most in rural households and lower socioeconomic levels (6.0 p.p. & 5.3 p.p.). Supermarkets and chain convenience stores increased the most in rural localities and small cities.

Conclusion

In conclusion, we observed an increase in food purchases from the formal sector, nonetheless, the mixed sector remains the predominant food source in Mexico, especially small-neighborhood stores. This is concerning, since these outlets are mostly supplied by food industries. Further, the decrease in purchases from public markets could imply a reduction in the consumption of fresh produce. In order to develop retail food environment policies in Mexico, the historical and predominant role of the mixed sector in food purchases needs to be acknowledged.

Reformulation of Processed Yogurt and Breakfast Cereals over Time: A Scoping Review

Poor diet is responsible for a quarter of European non-communicable disease (NCD)-related deaths. The reformulation of sugar, salt, and saturated fat in processed packaged foods offers an opportunity to reduce consumption of nutrients of concern and also support a reduction in energy intake. To date, there have been no publications measuring progress in food reformulation by compiling published evidence for a food category. The aim of this scoping review was to identify, characterize and summarise the findings of studies analysing the reformulation of processed yogurt and breakfast cereals. The review answered the research question: "What is the impact of food reformulation on the nutrient quality of yogurt and breakfast cereals available in the retail environment?" The research protocol was defined based on PRISMA-ScR guidelines. Five databases were searched in May 2022. Thirteen studies, published between 2010 and 2021 and completed across seven countries were eligible for inclusion. There were sufficient eligible studies to identify trends in sodium, salt, and sugar reduction in breakfast cereals. However, there was minimal or no reduction in energy, which may bring into question the use of food reformulation as part of an overall health strategy for obesity reduction.

A Systematic Review of Marketing Practices Used in Online Grocery Shopping: Implications for WIC Online Ordering

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) plans to allow participants to redeem their food package benefits online, i.e., online ordering. As grocery shopping online has become more common, companies have developed strategies to market food products to customers using online (or mobile) grocery shopping platforms. There is a significant knowledge gap in how these strategies may influence WIC participants who choose to shop for WIC foods online. This review examines the relevant literature to (1) identify food marketing strategies used in online grocery shopping platforms, (2) understand how these strategies influence consumer behavior and consumer diet, and (3) consider the implications for WIC participants. A total of 1862 references were identified from a systematic database search, of which 83 were included for full-text screening and 18 were included for data extraction and evidence synthesis. The included studies provide policymakers and other stakeholders involved in developing WIC online order processes with valuable information about the factors that shape healthy food choices in the online food retail environment. Findings indicate that some marketing interventions, such as nutrition labeling and food swaps, may encourage healthier food choices in the online environment and could potentially be tailored to reinforce WIC messaging about a healthy diet.

Encouraging Healthier Food and Beverage Purchasing and Consumption: A Review of Interventions within Grocery Retail Settings

This review identifies the most promising intervention strategies for promoting the purchase and consumption of healthier items within U.S. grocery retail settings, with a particular focus on those strategies that may be most effective when implemented within SNAP-authorized retail settings. Searches of nine electronic databases, as well as forward and backward searches, yielded 1942 studies. After being screened, 73 peer-reviewed academic articles were identified for inclusion. Of these, 33 analyzed single-component interventions, while 40 assessed multi-component interventions. The following unique intervention types were considered as evaluated in these studies for their ability to increase healthy item purchasing and consumption: (1) nutrition scoring, (2) nutritional messaging, (3) non-nutritional messaging, (4) endcaps and secondary placement, (5) point-of-sale interventions, (6) increased stocking, (7) food tasting and demonstrations, (8) nutrition education, and (9) placement on shelf interventions. Nutritional scoring and nutritional messaging emerged as the most rigorously tested and effective intervention strategies. Other strategies warrant more research attention. Simple intervention strategies, as opposed to complex ones, yield the most successful results and minimize shopper burden. Therefore, these strategies should be reviewed for policy implementation within SNAP-authorized grocery retailers.

Balancing Mission and Margins: What Makes Healthy Community Food Stores Successful

Mission-driven, independently-owned community food stores have been identified as a potential solution to improve access to healthy foods, yet to date there is limited information on what factors contribute to these stores' success and failure. Using a multiple case study approach, this study examined what makes a healthy community food store successful and identified strategies for success in seven community stores in urban areas across the United States. We used Stake's multiple case study analysis approach to identify the following key aims that contributed to community store success across all cases: (1) making healthy food available, (2) offering healthy foods at affordable prices, and (3) reaching community members with limited economic resources. However, stores differed in terms of their intention, action, and achievement of these aims. Key strategies identified that enabled success included: (1) having a store champion, (2) using nontraditional business strategies, (3) obtaining innovative external funding, (4) using a dynamic sourcing model, (5) implementing healthy food marketing, and (6) engaging the community. Stores did not need to implement all strategies to be successful, however certain strategies, such as having a store champion, emerged as critical for all stores. Retailers, researchers, philanthropy, and policymakers can utilize this definition of success and the identified strategies to improve healthy food access in their communities.

Forms of Community Engagement in Neighborhood Food Retail: Healthy Community Stores Case Study Project

Community engagement is well established as a key to improving public health. Prior food environment research has largely studied community engagement as an intervention component, leaving much unknown about how food retailers may already engage in this work. The purpose of this study was to explore the community engagement activities employed by neighborhood food retailers located in lower-income communities with explicit health missions to understand the ways stores involve and work with their communities. A multiple case study methodology was utilized among seven retailers in urban U.S. settings, which collected multiple sources of data at each retailer, including in-depth interviews, store manager sales reports, store observations using the Nutrition Environment Measures Survey for Stores, public documents, and websites. Across-case analysis was performed following Stake's multiple case study approach. Results indicated that retailers employed a wide variety of forms of community engagement within their communities, including Outreach, Building Relationships through Customer Relations, Giving Back, Partnering with Community Coalitions, and Promoting Community Representation and Inclusiveness. Strategies that built relationships through customer relations were most common across stores; whereas few stores demonstrated community inclusiveness where members participated in store decision making. Findings provide a more comprehensive view of the ways local food retailers aim to develop and sustain authentic community relationships. Additional research is needed to evaluate the impact of community engagement activities on improving community health.

Sixty Percent of Foods Advertised in Grocery Store Flyers are Not In-line with Canada's Food Guide

Purpose: To evaluate foods advertised in discount and premium grocery flyers for their alignment with Canada's 2007 Food Guide (CFG) and assess if alignment differed by food category, season, page location, and price.Methods: Weekly flyers (n = 192) were collected from discount and premium grocery chains from each of 4 seasons. Health Canada's Surveillance Tool was used to assess food items as in-line or not in-line with CFG.Results: Of 35 576 food items, 39.7% were in-line with CFG. There were no differences in proportions of foods not in-line in discount versus premium flyers (60.9% and 60.0%, respectively). Other Foods and Meat & Alternatives were advertised most (28.0% and 26.3%, respectively; P < 0.001). Milk & Alternatives were the least advertised food group (10.3%). Vegetables & Fruit (19.6%), Grains (21.6%), Milk & Alternatives (20.6%), and Meat & Alternatives (20.2%) were promoted least in Fall (P < 0.001). A higher proportion of foods advertised on middle pages were not in-line (61.0%) compared with front (56.6%) and back (58.8%) pages (P < 0.001). Not in-line foods were more expensive ($3.49, IQR = $2.82) than in-line foods ($3.28, IQR = $2.81; P < 0.001).Conclusions: While there was no difference in healthfulness of foods advertised in discount versus premium flyers, grocers advertised more foods not in-line with CFG. Government policies to improve the food environment should consider grocery flyers.

Unhealthy Foods at Supermarkets in Buenos Aires, Argentina

There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions.

Improving Consumption and Purchases of Healthier Foods in Retail Environments: A Systematic Review

This review examines current research on manipulations of U.S. food retail environments to promote healthier food purchasing and consumption. Studies reviewed use marketing strategies defined as the 4Ps (product, price, placement, promotion) to examine results based on single- and multi-component interventions by study design, outcome, and which of the “Ps” was targeted. Nine electronic databases were searched for publications from 2010 to 2019, followed by forward and backward searches. Studies were included if the intervention was initiated by a researcher or retailer, conducted in-store, and manipulated the retail environment. Of the unique 596 studies initially identified, 64 studies met inclusion criteria. Findings show that 56 studies had at least one positive effect related to healthier food consumption or purchasing. Thirty studies used single-component interventions, while 34 were multi-component. Promotion was the most commonly utilized marketing strategy, while manipulating promotion, placement, and product was the most common for multi-component interventions. Only 14 of the 64 studies were experimental and included objective outcome data. Future research should emphasize rigorous designs and objective outcomes. Research is also needed to understand individual and additive effects of multi-component interventions on sales outcomes, substitution effects of healthy food purchases, and sustainability of impacts.

Associations between Governmental Policies to Improve the Nutritional Quality of Supermarket Purchases and Individual, Retailer, and Community Health Outcomes: An Integrative Review

Supermarkets are natural and important settings for implementing environmental interventions to improve healthy eating, and governmental policies could help improve the nutritional quality of purchases in this setting. This review aimed to: (1) identify governmental policies in the United States (U.S.), including regulatory and legislative actions of federal, tribal, state, and local governments, designed to promote healthy choices in supermarkets; and (2) synthesize evidence of these policies' effects on retailers, consumers, and community health. We searched five policy databases and developed a list of seven policy actions that meet our inclusion criteria: calorie labeling of prepared foods in supermarkets; increasing U.S. Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) benefits; financial incentives for the purchase of fruit and vegetables; sweetened beverage taxes; revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package; financial assistance for supermarkets to open in underserved areas; and allowing online purchases with SNAP. We searched PubMed, Econlit, PsycINFO, Web of Science, and Business Source Ultimate to identify peer-reviewed, academic, English-language literature published at any time until January 2020; 147 studies were included in the review. Sweetened beverage taxes, revisions to the WIC food package, and financial incentives for fruits and vegetables were associated with improvements in dietary behaviors (food purchases and/or consumption). Providing financial incentives to supermarkets to open in underserved areas and increases in SNAP benefits were not associated with changes in food purchasing or diet quality but may improve food security. More research is needed to understand the effects of calorie labeling in supermarkets and online SNAP purchasing.

Healthy Food Retail during the COVID-19 Pandemic: Challenges and Future Directions

Disparities in dietary behaviors have been directly linked to the food environment, including access to retail food outlets. The Coronavirus Disease of 2019 (COVID-19) pandemic has led to major changes in the distribution, sale, purchase, preparation, and consumption of food in the United States (US). This paper reflects on those changes and provides recommendations for research to understand the impact of the pandemic on the retail food environment (RFE) and consumer behavior. Using the Retail Food Environment and Customer Interaction Model, we describe the impact of COVID-19 in four key areas: (1) community, state, tribal, and federal policy; (2) retail actors, business models, and sources; (3) customer experiences; and (4) dietary intake. We discuss how previously existing vulnerabilities and inequalities based on race, ethnicity, class, and geographic location were worsened by the pandemic. We recommend approaches for building a more just and equitable RFE, including understanding the impacts of changing shopping behaviors and adaptations to federal nutrition assistance as well as how small food business can be made more sustainable. By better understanding the RFE adaptations that have characterized the COVID-19 pandemic, we hope to gain greater insight into how our food system can become more resilient in the future.

Field Validation of Commercially Available Food Retailer Data in the Netherlands

The aim of this study was to validate a Dutch commercial dataset containing information on the types and locations of food retailers against field audit data. Field validation of a commercial dataset ("Locatus") was conducted in February 2019. Data on the location and classification of food retailers were collected through field audits in 152 streets from four urban and four rural neighborhoods in the Netherlands. The classification of food retailers included eight types of grocery stores (e.g., supermarkets, bakeries) and four types of food outlets (e.g., cafés, take away restaurants). The commercial dataset in the studied area listed 322 food retailers, whereas the field audit counted 315 food retailers. Overall, the commercially available data showed "good" to "excellent" agreement statistics (>0.71) with field audit data for all three levels of analysis (i.e., location, classification and both combined) and across urban as well as rural areas. The commercial dataset under study provided an accurate description of the measured food environment. Therefore, policymakers and researchers should feel confident in using this commercial dataset as a source of secondary data.

Evaluation of Store Environment Changes of an In-Store Intervention to Promote Fruits and Vegetables in Latino/Hispanic-Focused Food Stores

Implementing interventions that manipulate food store environments are one potential strategy for improving dietary behaviors. The present study evaluated intervention effects, from the El Valor de Nuestra Salud (The Value of Our Health) study, on in-store environmental changes within Latino/Hispanic-focused food stores (tiendas). Sixteen tiendas were randomly assigned to either: a six-month structural and social food store intervention or a wait-list control condition. Store-level environmental measures of product availability, placement, and promotion were assessed monthly from baseline through six-months post-baseline using store audits. Linear mixed effects models tested for condition-by-time interactions in store-level environmental measures. Results demonstrated that the intervention was successful at increasing the total number of fruit and vegetable (FV) promotions (p < 0.001) and the number of FV promotions outside the produce department (p < 0.001) among tiendas in the intervention versus control condition. No changes in product availability or placement were observed. Results suggests changing the marketing mix element of promotions within small stores is measurable and feasible in an in-store intervention. Difficulties in capturing changes in product availability and placement may be due to intervention implementation methods chosen by tiendas. It is important to build upon the lessons learned from these types of interventions to disseminate evidence-based in-store interventions.

Neighbourhood retail food outlet access, diet and body mass index in Canada: a systematic review

INTRODUCTION

There is growing interest in the role of food environments in suboptimal diet and overweight and obesity. This review assesses the evidence for the link between the retail food environment, diet quality and body mass index (BMI) in the Canadian population.

METHODS

We conducted a systematic keyword search in two bibliometric databases. We tabulated proportions of conclusive associations for each outcome and exposure of interest. Absolute and relative measures of exposure to the food environment were compared and theoretical framing of the associations noted. We assessed two key methodological issues identified a priori-measurement of BMI, and validation of the underlying retail food environment data.

RESULTS

Seventeen studies were included in the review. There was little evidence of a food environment-diet quality relationship and modest evidence of a food environment-BMI relationship. Relative measures of the food environment were more often associated with an outcome in the expected direction than absolute measures, but many results were inconclusive. Most studies adopted ecological theoretical frameworks but methodologies were similar regardless of stated theoretical approaches. Self-reported BMI was common and there was no "gold standard" database of food outlets nor a consensus on best ways to validate the data.

CONCLUSION

There was limited evidence of a relationship between the food environment and diet quality, but stronger evidence of a relationship between the food environment and BMI for Canadians. Studies with broad geographic scope that adopt innovative methods to measure diet and health outcomes and use relative measures of the food environment derived in geographic information systems are warranted. Consensus on a gold standard food environment database and approaches to its validation would also advance the field.

Assessing the Retail Food Environment in Madrid: An Evaluation of Administrative Data against Ground Truthing

Previous studies have suggested that European settings face unique food environment issues; however, retail food environments (RFE) outside Anglo-Saxon contexts remain understudied. We assessed the completeness and accuracy of an administrative dataset against ground truthing, using the example of Madrid (Spain). Further, we tested whether its completeness differed by its area-level socioeconomic status (SES) and population density. First, we collected data on the RFE through the ground truthing of 42 census tracts. Second, we retrieved data on the RFE from an administrative dataset covering the entire city (n = 2412 census tracts), and matched outlets using location matching and location/name matching. Third, we validated the administrative dataset against the gold standard of ground truthing. Using location matching, the administrative dataset had a high sensitivity (0.95; [95% CI = 0.89, 0.98]) and positive predictive values (PPV) (0.79; [95% CI = 0.70, 0.85]), while these values were substantially lower using location/name matching (0.55 and 0.45, respectively). Accuracy was slightly higher using location/name matching (k = 0.71 vs 0.62). We found some evidence for systematic differences in PPV by area-level SES using location matching, and in both sensitivity and PPV by population density using location/name matching. Administrative datasets may offer a reliable and cost-effective source to measure retail food access; however, their accuracy needs to be evaluated before using them for research purposes.

Does unmeasured confounding influence associations between the retail food environment and body mass index over time? The Coronary Artery Risk Development in Young Adults (CARDIA) study

Background

Findings in the observational retail food environment and obesity literature are inconsistent, potentially due to a lack of adjustment for residual confounding.

Methods

Using data from the CARDIA study (n = 12 174 person-observations; 6 examinations; 1985-2011) across four US cities (Birmingham, AL; Chicago, IL; Minneapolis, MN; Oakland, CA), we used instrumental-variables (IV) regression to obtain causal estimates of the longitudinal associations between the percentage of neighbourhood food stores or restaurants (per total food outlets within 1 km network distance of respondent residence) with body mass index (BMI), adjusting for individual-level socio-demographics, health behaviours, city, year, total food outlets and market-level prices. To determine the presence and extent of bias, we compared the magnitude and direction of results with ordinary least squares (OLS) and random effects (RE) regression, which do not control for residual confounding, and with fixed effects (FE) regression, which does not control for time-varying residual confounding.

Results

Relative to neighbourhood supermarkets (which tend to be larger and have healthier options than grocery stores), a higher percentage of grocery stores [mean = 53.4%; standard deviation (SD) = 31.8%] was positively associated with BMI [β = 0.05; 95% confidence interval (CI) = 0.01, 0.10] using IV regression. However, associations were negligible or null using OLS (β = -0.001; 95% CI = -0.01, 0.01), RE (β = -0.003; 95% CI = -0.01, 0.0001) and FE (β = -0.003; 95% CI = -0.01, 0.0002) regression. Neighbourhood convenience stores and fast-food restaurants were not associated with BMI in any model.

Conclusions

Longitudinal associations between neighbourhood food outlets and BMI were greater in magnitude using a causal model, suggesting that weak findings in the literature may be due to residual confounding.

Exploring sales data during a healthy corner store intervention in Toronto: the Food Retail Environments Shaping Health (FRESH) project

INTRODUCTION

Population health interventions in the retail food environment, such as corner store interventions, aim to influence the kind of cues consumers receive so that they are more often directed toward healthier options. Research that addresses financial aspects of retail interventions, particularly using outcome measures such as store sales that are central to retail decision making, is limited. This study explored store sales over time and across product categories during a healthy corner store intervention in a lowincome neighbourhood in Toronto, Ontario.

METHODS

Sales data (from August 2014 to April 2015) were aggregated by product category and by day. We used Microsoft Excel pivot tables to summarize and visually present sales data. We conducted t-tests to examine differences in product category sales by "peak" versus "nonpeak" sales days.

RESULTS

Overall store sales peaked on the days at the end of each month, aligned with the issuing of social assistance payments. Revenue spikes on peak sales days were driven predominantly by transit pass sales. On peak sales days, mean sales of nonnutritious snacks and cigarettes were marginally higher than on other days of the month. Finally, creative strategies to increase sales of fresh vegetables and fruits seemed to substantially increase revenue from these product categories.

CONCLUSION

Store sales data is an important store-level metric of food environment intervention success. Furthermore, data-driven decision making by retailers can be important for tailoring interventions. Future interventions and research should consider partnerships and additional success metrics for retail food environment interventions in diverse Canadian contexts.

Comparing the accuracy of food outlet datasets in an urban environment

Studies that investigate the relationship between the retail food environment and health outcomes often use geospatial datasets. Prior studies have identified challenges of using the most common data sources. Retail food environment datasets created through academic-government partnership present an alternative, but their validity (retail existence, type, location) has not been assessed yet. In our study, we used ground-truth data to compare the validity of two datasets, a 2015 commercial dataset (InfoUSA) and data collected from 2012 to 2014 through the Maryland Food Systems Mapping Project (MFSMP), an academic-government partnership, on the retail food environment in two low-income, inner city neighbourhoods in Baltimore City. We compared sensitivity and positive predictive value (PPV) of the commercial and academic-government partnership data to ground-truth data for two broad categories of unhealthy food retailers: small food retailers and quick-service restaurants. Ground-truth data was collected in 2015 and analysed in 2016. Compared to the ground-truth data, MFSMP and InfoUSA generally had similar sensitivity that was greater than 85%. MFSMP had higher PPV compared to InfoUSA for both small food retailers (MFSMP: 56.3% vs InfoUSA: 40.7%) and quick-service restaurants (MFSMP: 58.6% vs InfoUSA: 36.4%). We conclude that data from academic-government partnerships like MFSMP might be an attractive alternative option and improvement to relying only on commercial data. Other research institutes or cities might consider efforts to create and maintain such an environmental dataset. Even if these datasets cannot be updated on an annual basis, they are likely more accurate than commercial data.

Monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in community and consumer retail food environments globally

Retail food environments are increasingly considered influential in determining dietary behaviours and health outcomes. We reviewed the available evidence on associations between community (type, availability and accessibility of food outlets) and consumer (product availability, prices, promotions and nutritional quality within stores) food environments and dietary outcomes in order to develop an evidence-based framework for monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in retail food environments. Current evidence is suggestive of an association between community and consumer food environments and dietary outcomes; however, substantial heterogeneity in study designs, methods and measurement tools makes it difficult to draw firm conclusions. The use of standardized tools to monitor local food environments within and across countries may help to validate this relationship. We propose a step-wise framework to monitor and benchmark community and consumer retail food environments that can be used to assess density of healthy and unhealthy food outlets; measure proximity of healthy and unhealthy food outlets to homes/schools; evaluate availability of healthy and unhealthy foods in-store; compare food environments over time and between regions and countries; evaluate compliance with local policies, guidelines or voluntary codes of practice; and determine the impact of changes to retail food environments on health outcomes, such as obesity.

Characterizing the food retail environment: impact of count, type, and geospatial error in 2 secondary data sources

OBJECTIVE

Commercial listings of food retail outlets are increasingly used by community members and food policy councils and in multilevel intervention research to identify areas with limited access to healthier food. This study quantified the amount of count, type, and geospatial error in 2 commercial data sources.

METHODS

InfoUSA and Dun and Bradstreet were compared with a validated field census and validity statistics were calculated.

RESULTS

Considering only completeness, Dun and Bradstreet data undercounted 24% of existing supermarkets and grocery stores, and InfoUSA, 29%. In addition, considering accuracy of outlet type assignment increased the undercount error to 42% and 39%, respectively. Marked overcount existed as well, and only 43% of existing supermarkets were correctly identified with respect to presence, outlet type, and location.

CONCLUSIONS AND IMPLICATIONS

Relying exclusively on secondary data to characterize the food environment will result in substantial error. Whereas extensive data cleaning can offset some error, verification of outlets with a field census is still the method of choice.

Neighborhood food environment and walkability predict obesity in New York City

BACKGROUND

Differences in the neighborhood food environment may contribute to disparities in obesity.

OBJECTIVES

The purpose of this study was to examine the association of neighborhood food environments with body mass index (BMI) and obesity after control for neighborhood walkability.

METHODS

This study employed a cross-sectional, multilevel analysis of BMI and obesity among 13,102 adult residents of New York City. We constructed measures of the food environment and walkability for the neighborhood, defined as a half-mile buffer around the study subject's home address.

RESULTS

Density of BMI-healthy food outlets (supermarkets, fruit and vegetable markets, and natural food stores) was inversely associated with BMI. Mean adjusted BMI was similar in the first two quintiles of healthy food density (0 and 1.13 stores/km2, respectively), but declined across the three higher quintiles and was 0.80 units lower [95% confidence interval (CI), 0.27-1.32] in the fifth quintile (10.98 stores/km2) than in the first. The prevalence ratio for obesity comparing the fifth quintile of healthy food density with the lowest two quintiles combined was 0.87 (95% CI, 0.78-0.97). These associations remained after control for two neighborhood walkability measures, population density and land-use mix. The prevalence ratio for obesity for the fourth versus first quartile of population density was 0.84 (95% CI, 0.73-0.96) and for land-use mix was 0.91 (95% CI, 0.86-0.97). Increasing density of food outlets categorized as BMI-unhealthy was not significantly associated with BMI or obesity.

CONCLUSIONS

Access to BMI-healthy food stores is associated with lower BMI and lower prevalence of obesity.