Beyond food swamps and food deserts: Exploring urban Australian food retail environment typologies

Objective: ‘Food deserts’ and ‘food swamps’ are food retail environment typologies associated with unhealthy diet and obesity. This study aimed to identify more complex food retail environment typologies and examine temporal trends. Design: Measures of food retail environment accessibility and relative healthy food availability were defined for small areas (SA2s) of Melbourne, Australia from a census of food outlets operating in 2008, 2012, 2014 and 2016. SA2s were classified into typologies using a two-stage approach: 1) SA2s were sorted into 20 clusters according to accessibility and availability; 2) clusters were grouped using evidence-based thresholds. Setting: This study was set in Melbourne, the capital city of the state of Victoria, Australia. Subjects: Food retail environments in 301 small areas (Statistical Area 2) located in Melbourne in 2008, 2012, 2014 and 2016. Results: Six typologies were identified based on access (low, moderate and high) and healthy food availability including one where zero food outlets were present. Over the study period SA2s experienced an overall increase in accessibility and healthiness. Distribution of typologies varied by geographic location and area-level socioeconomic position. Conclusion: Multiple typologies with contrasting access and healthiness measures exist within Melbourne and these continue to change over time, the majority of SA2s were dominated by the presence of unhealthy relative to healthy outlets; with SA2s experiencing growth and disadvantage having the lowest access and to a greater proportion of unhealthy outlets.

Consumers' Perceptions of Healthy Food Availability in Online Food Delivery Applications (OFD Apps) and Its Association With Food Choices Among Public University Students in Malaysia

This retrospective cross-sectional study was conducted to study consumers' perceptions of healthy food availability in online food delivery applications (OFD apps) among public university students in Malaysia and its association with their food choices. A total of 290 subjects aged 19–29 years old were recruited from 20 public universities in Malaysia via snowball sampling. Data was collected through an online questionnaire which consisted of socio-demographic status, use of OFD apps (most frequently used brand, usage frequency, food choice, and expenditure per transaction), factors affecting food choice in OFD apps, consumers' perceptions of healthy food availability in OFD apps and recommendation for improvements. The most frequently used apps among the subjects was Food Panda (46.6%), however, majority of the subjects in this study (41.4%) rarely used OFD apps. Also, most of the subjects ordered unhealthy food (77.6%) and spent up to RM15–RM19 for each transaction (43.1%). There was no significant difference between the use of OFD apps and gender (p > 0.05). Among the five food choice motives, “price and convenience” motive was the most influencing food choice factor in OFD apps. Majority of the subjects (76.9%) had a negative perception of healthy food availability (variety, price, and quality of healthy food) in OFD apps. No significant association was found between consumers' perceptions of healthy food availability in OFD apps and their food choices made in OFD apps among the subjects in this study (p > 0.05). Also, majority (85.9%) responded they are keen to purchase healthy foods through OFD apps if they are given an option. However, most Malaysian public university students perceived that there were not much variety of healthy food, of good quality and affordable price, available in OFD apps. This finding suggests that the online food environment in Malaysia are perceived as unhealthy. Future studies can explore the online food environment particularly its impact on community health and well-being. Public health professionals and policymakers need to address the online food environment issues as part of the obesogenic food environment in Malaysia especially when OFD is one of the most convenient service in this country.

A Quantitative Assessment of Changes in the Consumer Nutrition Environments of New York City Hispanic Caribbean Restaurants During the COVID-19 Pandemic

Objectives (1) Examine changes in healthy food availability among Hispanic Caribbean restaurants (HCR) in response to COVID-19. (2) Assess the association between changes and restaurant type. Methods A random sample of HCRs (n = 89) offering Cuban, Dominican, Puerto Rican cuisine, were examined in Summer 2019 (T1) using the NEMS-HCR, an adapted version of the Nutrition Environment Measures Survey for Restaurants (NEMS-R) and reassessed after the onset of COVID-19 in January 2021 (T2, n = 76) using online menus. We examined menu changes between T1 and T2 data sets in the NEMS-HCR overall healthy food availability (HFA) score, and specific variables: the number of healthy main dish salads (HMDS) and the menu proportion of nonfried foods (NFF) on the menu. We then examined changes by restaurant type (sit-down vs. counter-style) using repeated measures ANOVA. Results Between T1 and T2, 7 HRCs permanently closed, 1 closed for the season, and 5 were excluded due to lack of online menus. Mean proportion of NFF significantly decreased from 71.7% ± 17.5 (T1) to 66.1% ± 17.8 (T2) (P = 0.002). Changes in HFA scores (4.5 ± 2.0 to 4.1 ± 2.2) and HMDS (1.7 ± 2.8 to 1.8 ± 3.0) were not statistically significant (P = 0.06 and P = 0.65, respectively). Repeated measures ANOVA indicated no correlation between the decrease in availability of NFF between T1 and T2 and restaurant type (P = 0.29). Conclusions Restaurants can play a significant role in the mitigation of diet-related diseases such as cardiovascular disease and diabetes by providing customers with healthy menu offerings. Our study showed a decrease in healthier menu options, particularly non-fried entrees, contributing to our understanding of how restaurants may need to adapt for their own survival in times of crisis such as a pandemic or disaster. Because unfavorable menu options can contribute to the rising incidence of diet-related chronic diseases within the community, more research is needed to understand how restaurants respond to crises in order to better support the preservation of HFA within their menu selections, and the effects of these changes in customers’ diets. Funding Sources CUNY PSC Award and NIH National Heart, Lung, and Blood Institute

Ensuring the right to food for indigenous children: a case study of stakeholder perspectives on policy options to ensure the rights of tamariki Māori to healthy food

Background The United Nations Convention on the Rights of the Child confirms a child’s right to adequate food, and to the highest attainable standard of health. For indigenous children, these rights are also recognised in the UN Declaration on the Rights of Indigenous Peoples. However, Indigenous children endure higher rates of obesity and related health conditions than non-indigenous children, including in Aotearoa New Zealand (NZ). For indigenous tamariki (Māori children) in NZ, high levels of obesity are interconnected with high rates of food insecurity. Therefore there is a need for action. This study aimed to investigate policy options that would safeguard the rights of indigenous children to healthy food. We explored with key stakeholder’s policy options to ensure the rights of indigenous children to healthy food, through a case study of the rights of tamariki. Methods Interviews were conducted with 15 key stakeholders, with experience in research, development or delivery of policies to safeguard the rights of tamariki to healthy food. Iterative thematic analysis of the transcripts identified both deductive themes informed by Kaupapa Māori theory and literature on rights-based approaches and inductive themes from the interviews. Results The analysis suggests that to ensure the right to adequate food and to healthy food availability for tamariki, there needs to be: a comprehensive policy response that supports children’s rights; an end to child poverty; food provision and food policy in schools; local government policy to promote healthy food availability; and stronger Māori voices and values in decision-making. Conclusions The right to food for indigenous children, is linked to political and economic systems that are an outcome of colonisation. A decolonising approach where Māori voices and values are central within NZ policies and policy-making processes is needed. Given the importance of food to health, a broad policy approach from the NZ government to ensure the right to adequate food is urgent. This includes economic policies to end child poverty and specific strategies such as food provision and food policy in schools. The role of Iwi (tribes) and local governments needs to be further explored if we are to improve the right to adequate food within regions of NZ.

OPPORTUNITIES AND BARRIERS TO THE DEVELOPMENT OF TOURISM IN RURAL AREAS

he aim of the study is to present the opportunities and barriers to the development of tourism in the rural areas of Lower Silesia. The basis for developing the empirical part was research conducted in 2018 in 30 rural tourism and agritourism facilities. The facilities were located in Kłodzko Land (Kłodzko Poviat) and the Barycz Valley Landscape Park. A standardized interview was conducted with owners of accommodation facilities with the use of an interview questionnaire. The research results show that the development of entrepreneurship in the provision of tourist services in rural areas is effectively limited by a financial barrier, difficulties in obtaining external capital and a low level of technical and utility infrastructure. According to the respondents, the obstacles to receiving guests primarily include: a lack of a full and interesting offer and its low quality as well as a lack of food provision and, in the case of foreign tourists, insufficient knowledge of foreign languages. The factors favouring the development of tourism in these rural areas are a growing tendency to participate in rural tourism of both compatriots and foreign tourists, the growing interest of tourists in healthy food, availability of European Union funds and tax privileges. Due to the advantages of the Polish countryside, the main goal should be a continuous focus on combining agritourism with an active farm.

Food security moderates relationship between perceived food environment and diet quality among adults in communities with low access to healthy food retail

Objective: To examine the relationship between food security status, diet quality measured using Healthy Eating Index-2010 (HEI-2010) scores, demographics and the following factors: perceptions of healthy food availability, healthy eating identity and perceived control of healthy eating. Design: A cross-sectional study in 2016–2017 using three 24-h dietary recalls and one psychosocial survey. Setting: Two urban communities in Cleveland and Columbus, Ohio, USA, with low access to healthy food retailers. Participants: Primary food shoppers living in the targeted geographic areas (N 450). Results: Our results indicated that high school graduates had lower HEI-2010 scores compared with participants who had some college education or more (β = –2·77, P = 0·02). Participants receiving Supplemental Nutrition Assistance Program (SNAP) benefits had lower HEI-2010 scores (β = –2·69, P = 0·03). Healthy eating identity was associated with higher HEI-2010 scores (β = 1·85, P = 0·004). Food security status moderated the relationship between perception of healthy food availability and HEI-2010 scores. Among participants with very low food security (VLFS), greater perceptions of healthy food availability were associated with higher HEI-2010 scores (β = 3·25, P = 0·03), compared with food secure participants. Only 14 % of VLFS participants used a personal vehicle as transportation to their primary food shopping store. Conclusions: Findings offer targets for future intervention development and evaluation to promote community nutrition. These targets include strategies to improve the value of SNAP benefits, promote access to quality education, increase transportation options to healthy food retailers and develop nutrition programming to promote healthy eating identity.

Association of Home Food Availability with Prediabetes and Diabetes among Adults in the United States

This study examined associations of home food availabilities with prediabetes and diabetes among 8929 adults (20–70 years) participating in 2007–2010 National Health and Nutrition Examination Surveys. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression. Relative to non-diabetic participants (individuals without diabetes or prediabetes), prediabetes participants were associated with lower availabilities of green vegetables (OR = 0.82; 95% CI = 0.73–0.91; p = 0.0006) and fat-free/low-fat milk (OR = 0.80, 95% CI = 0.65–0.89; p = 0.001) and higher sugary drink availability (OR = 1.24, 95% CI = 1.04–1.48; p = 0.02), adjusting for age, sex, and ethnicity (Model 1). The associations remained significant for vegetables (p = 0.005) and fat-free/low-fat milk (p = 0.02) adjusting for additional confounders (body mass index, education, Model 2). Adjusting for dietary components did not change the above results (in model 2) significantly. Participants with high healthy food availability scores had approximately 31% reduction (p = 0.003) in odds of prediabetes compared to those with low scores in Model 1. No associations were detected for diabetes except for fat-free/low-fat milk availability, for which an inverse association was observed in Model 1 (OR = 0.80, 95% CI = 0.65–0.99; p = 0.04). The results show prediabetes participants had lower availability of healthy foods and higher availability of unhealthy foods, suggesting the need to improve healthy food availability at home for this population.

One-Year Follow-Up Examination of the Impact of the North Carolina Healthy Food Small Retailer Program on Healthy Food Availability, Purchases, and Consumption

We examined the short-term impact of the North Carolina Healthy Food Small Retailer Program (HFSRP), a legislatively appropriated bill providing funding up to $25,000 to small food retailers for equipment to stock and promote healthier foods, on store-level availability and purchase of healthy foods and beverages, as well as customer dietary patterns, one year post-policy implementation. We evaluated healthy food availability using a validated audit tool, purchases using customer bag-checks, and diet using self-reported questionnaires and skin carotenoid levels, assessed via Veggie Meter™, a non-invasive tool to objectively measure fruit and vegetable consumption. Difference-in-difference analyses were used to examine changes in HFSRP stores versus control stores after 1 year. There were statistically significant improvements in healthy food supply scores (availability), with the Healthy Food Supply HFS score being −0.44 points lower in control stores and 3.13 points higher in HFSRP stores pre/post HFSRP (p = 0.04). However, there were no statistically significant changes in purchases or self-reported consumption or skin carotenoids among customers in HFSRP versus control stores. Additional time or other supports for retailers (e.g., marketing and promotional materials) may be needed for HFSRP implementation to influence purchase and consumption.