Does exposure to the food environment differ by socioeconomic position? Comparing area-based and person-centred metrics in the Fenland Study,UK

Background

Retail food environments (foodscapes) are a recognised determinant of eating behaviours and may contribute to inequalities in diet. However, findings from studies measuring socioeconomic inequality in the foodscape have been mixed, which may be due to methodological differences. The aim of this cross-sectional study was to compare exposure to the foodscape by socioeconomic position using different measures, to test whether the presence, direction or amplitude of differences was sensitive to the choice of foodscape metric or socioeconomic indicator.

Methods

A sample of 10,429 adults aged 30–64 years with valid home address data were obtained from the Fenland Study, UK. Of this sample, 7270 participants also had valid work location data. The sample was linked to data on food outlets obtained from local government records. Foodscape metrics included count, density and proximity of takeaway outlets and supermarkets, and the percentage of takeaway outlets relative to all food outlets. Exposure metrics were area-based (lower super output areas), and person-centred (proximity to nearest; Euclidean and Network buffers at 800 m, 1 km, and 1 mile). Person-centred buffers were constructed using home and work locations. Socioeconomic status was measured at the area-level (2010 Index of Multiple Deprivation) and the individual-level (highest educational attainment; equivalised household income). Participants were classified into socioeconomic groups and average exposures estimated. Results were analysed using the statistical and percent differences between the highest and lowest socioeconomic groups.

Results

In area-based measures, the most deprived areas contained higher takeaway outlet densities (p < 0.001). However, in person-centred metrics lower socioeconomic status was associated with lower exposure to takeaway outlets and supermarkets (all home-based exposures p < 0.001) and socioeconomic differences were greatest at the smallest buffer sizes. Socioeconomic differences in exposure was similar for home and combined home and work measures. Measuring takeaway exposure as a percentage of all outlets reversed the socioeconomic differences; the lowest socioeconomic groups had a higher percentage of takeaway outlets compared to the middle and highest groups (p < 0.001).

Conclusions

We compared approaches to measuring socioeconomic variation in the foodscape and found that the association was sensitive to the metric used. In particular, the direction of association varied between area- and person-centred measures and between absolute and relative outlet measures. Studies need to consider the most appropriate measure for the research question, and may need to consider multiple measures as a single measure may be context dependent.

     

Images of foodscapes: introduction to foodscape studies and their application in the study of healthy eating out-of-home environments

The notion of foodscape is increasingly being used within health promotion, public health nutrition and food studies as a tool to describe our food environments and to assess the potential impact on food choice and food behaviour. This paper takes a closer look at the growing number of foodscape studies (FSS) and traces the origin of the idea of foodscapes. It reflects on the different contributions and discusses the applicability within food research. In particular it discusses how the notion can be applied in the growing number of studies that investigate the role that captive eating out-of-home environments (CEOE) in public welfare systems has on the health of the individual and on the sustainability of the environment. The paper concludes that the idea of foodscapes is a convenient tool that has many applications in food research. The foodscape framework offers obvious advantages in that it enables scholars to analyse how food, places and people are interconnected and how they interact. In particular the paper concludes that the foodscape notion is well suited to the study of foodscapes in CEOEs such as schools, kindergartens and institutions. I finally suggest that such foodscapes can be defined as physical, organizational and sociocultural spaces in which clients/guests encounter meals, food and food-related issues including health messages.     

The evolution of local food environments within established neighbourhoods and new developments in Perth,Western Australia

Temporal changes in the location of food outlets can result in disparities in the availability and access of food across geographic areas, contributing to health inequalities. This study used mixed linear models to investigate how the location of food outlets around the home evolved over time with respect to area-level socio-economic status (SES) and urban design within established neighbourhoods and new residential developments. Food outlet data (supermarket/greengrocers, convenience stores, café restaurants and takeaway/fast food) were sourced from commercial database listings (SENSIS Pty. Ltd.) in 2004, 2006, 2007, and 2011. Using 2468 addresses from the RESIDential Environments Project (RESIDE), in Perth, Western Australia (WA), a count of each food outlet type and percentage of healthy food outlets within a 1.6 km road network buffer around the home, along with the road network distance to nearest food outlet were generated relative to each address at each time point. Proximity to and count of all food outlets increased over time in both new developments and established neighbourhoods. However, unhealthy food outlets were always in greater numbers and proximity to the home. The percentage of healthy food outlets was significantly greater in established neighbourhoods compared to new developments at all four time points. There were significantly more food outlets, and within closer proximity to the home, in established neighbourhoods compared to new developments at each time point. In established neighbourhoods, there were more convenience stores, takeaway/fast food and café restaurants, a lower percentage of healthy food outlets, and closer proximity to convenience stores in lower compared to high SES areas. In new developments there were significantly less supermarket/greengrocers, a lower percentage of healthy food outlets and greater proximity to takeaway/fast food and café restaurants in low compared to high SES areas. New developments designed according to the WA government's “Liveable Neighbourhoods Community Design Guidelines” policy had significantly more of all food outlets compared to other new developments. As such, people living in new developments, and low SES areas of Perth, may be disadvantaged with poorer access to healthy food outlets and greater exposure to unhealthy food outlets. Future urban planning and policy should focus on providing incentives that support the early development of supermarkets and healthy food outlets within new developments and low SES areas of Perth.     

Web Data Mining: Validity of Data from Google Earth for Food Retail Evaluation

To overcome the challenge of obtaining accurate data on community food retail, we developed an innovative tool to automatically capture food retail data from Google Earth (GE). The proposed method is relevant to non-commercial use or scholarly purposes. We aimed to test the validity of web sources data for the assessment of community food retail environment by comparison to ground-truth observations (gold standard). A secondary aim was to test whether validity differs by type of food outlet and socioeconomic status (SES). The study area included a sample of 300 census tracts stratified by SES in two of the largest cities in Brazil, Rio de Janeiro and Belo Horizonte. The GE web service was used to develop a tool for automatic acquisition of food retail data through the generation of a regular grid of points. To test its validity, this data was compared with the ground-truth data. Compared to the 856 outlets identified in 285 census tracts by the ground-truth method, the GE interface identified 731 outlets. In both cities, the GE interface scored moderate to excellent compared to the ground-truth data across all of the validity measures: sensitivity, specificity, positive predictive value, negative predictive value and accuracy (ranging from 66.3 to 100%). The validity did not differ by SES strata. Supermarkets, convenience stores and restaurants yielded better results than other store types. To our knowledge, this research is the first to investigate using GE as a tool to capture community food retail data. Our results suggest that the GE interface could be used to measure the community food environment. Validity was satisfactory for different SES areas and types of outlets.     

Between exposure,access and use: Reconsidering foodscape influences on dietary behaviours

Good accessibility to both healthy and unhealthy food outlets is a greater reality than food deserts. Yet, there is a lack of conceptual insights on the contextual factors that push individuals to opt for healthy or unhealthy food outlets when both options are accessible. Our comprehension of foodscape influences on dietary behaviours would benefit from a better understanding of the decision-making process for food outlet choices. In this paper, we build on the fundamental position that outlet choices are conditioned by how much outlets’ attributes accommodate individuals’ constraints and preferences. We further argue that food outlets continuously experienced within individuals’ daily-path help people re-evaluate food acquisition possibilities, push them to form intentions, and shape their preferences for the choices they will subsequently make. Doing so, we suggest differentiating access, defined as the potential for the foodscape to be used at the time when individuals decide to do so, from exposure, which acts as a constant catalyst for knowledge, intention, preferences and routine tendency. We conclude with implications for future research, and discuss consequences for public policy.     

“We have a roof over our head,but we have to eat too:” Exploring shifting foodscapes from homelessness into Housing First in Kingston,Ontario

BackgroundPeople facing extended periods of homelessness exhibit a remarkable degree of agency and resilience in procuring food. The literature on foodscapes considers the sociospatial contexts of food procurement, finding that what happens within and along the way to sites of food acquisition and consumption are important considerations in fully understanding and realizing food security.PurposeThis study explores the shift in foodscapes of people who are transitioning from homelessness into scattered-site independent housing via a municipal Housing First program and considers implications for health and wellbeing.MethodsOur mixed-method approach included observational research at 11 local food providers and drop-in centres that provided context for semi-structured interviews with 10 Housing First clients in Kingston, Ontario between November 2016 and March 2017.ResultsThe findings confirm that the provision of stable housing makes it possible for people to store, prepare, and consume food at home. An increased ability to have control over when, where, and what is eaten had a positive impact on people's sense of health and wellbeing. However, other effective markers of wellbeing were enacted along people's everyday routines and activities that had negative impacts. Interviewees remained heavily dependent on charitable food programs, including increased use of foodbanks. Others reported increasing detachment and social isolation from previously established food routines. Finally, the structured transition perpetuated a circuit of dependence and marginalization that fell short of contributing to improved food security as well as health and wellbeing.ImplicationsUnderstanding the relational geography of foodscape transitions is critical to the design of effective Housing First programs. Addressing the root causes of homelessness and poverty requires investments in comprehensive housing strategies including adequate social assistance and community supports that take a sociospatially holistic approach to wellbeing.     

Does availability of physical activity and food outlets differ by race and income? Findings from an enumeration study in a health disparate region

ABSTRACT: BACKGROUND: Low-income, ethnic/racial minorities and rural populations are at increased risk for obesity and related chronic health conditions when compared to white, urban and higher-socio-economic status (SES) peers. Recent systematic reviews highlight the influence of the built environment on obesity, yet very few of these studies consider rural areas or populations. Utilizing a CBPR process, this study advances community-driven causal models to address obesity by exploring the difference in resources for physical activity and food outlets by block group race and income in a small regional city that anchors a rural health disparate region. To guide this inquiry we hypothesized that lower income and racially diverse block groups would have fewer food outlets, including fewer grocery stores and fewer physical activity outlets. We further hypothesized that walkability, as defined by a computed walkability index, would be lower in the lower income block groups. METHODS: Using census data and GIS, base maps of the region were created and block groups categorized by income and race. All food outlets and physical activity resources were enumerated and geocoded and a walkability index computed. Analyses included one-way MANOVA and spatial autocorrelation. RESULTS: In total, 49 stores, 160 restaurants and 79 physical activity outlets were enumerated. There were no differences in the number of outlets by block group income or race. Further, spatial analyses suggest that the distribution of outlets is dispersed across all block groups. CONCLUSIONS: Under the larger CPBR process, this enumeration study advances the causal models set forth by the community members to address obesity by providing an overview of the food and physical activity environment in this region. This data reflects the food and physical activity resources available to residents in the region and will aid many of the community-academic partners as they pursue intervention strategies targeting obesity.     

An ecological study of the relationship between social and environmental determinants of obesity

There is growing concern with the increasing prevalence of obesity in industrialised countries, a trend that is more apparent in the poor than in the rich. In an ecological study, the relationship between an area measure of socioeconomic status (SES) and the density of fast-food outlets was examined as one possible explanation for the phenomenon. It was found that there was a dose-response between SES and the density of fast-food outlets, with people living in areas from the poorest SES category having 2.5 times the exposure to outlets than people in the wealthiest category. The findings are discussed.     

Should we use absolute or relative measures when assessing foodscape exposure in relation to fruit and vegetable intake? Evidence from a wide-scale Canadian study

ObjectiveThis paper explores which of absolute (i.e. densities of “healthy” and “unhealthy” food outlets taken separately) or relative (i.e. the percentage of “healthy” outlets) measures of foodscape exposure better predicts fruit and vegetable intake (FVI), and whether those associations are modified by gender and city in Canada.MethodsSelf-reported FVI from participants of four cycles (2007–2010) of the repeated cross-sectional Canadian Community Health Survey living in the five largest metropolitan areas of Canada (n = 49,403) was analyzed. Absolute and relative measures of foodscape exposure were computed at participants' residential postal codes. Linear regression models, both in the whole sample and in gender- and city-stratified samples, were used to explore the associations between exposure measures and FVI.ResultsThe percentage of healthy outlets was strongly associated with FVI among men both in Toronto/Montreal (β = 0.012; P < 0.001), and in Calgary/Ottawa/Vancouver (β = 0.008; P < 0.001), but not among women. Observed associations of absolute measures with FVI were either weak or faced multicollinearity issues. Overall, models with the relative measure showed the best fit.ConclusionsRelative measures should be more widely used when assessing foodscape influences on diet. The absence of a single effect of the foodscape on diet positions sub-group analysis as a promising avenue for research.     

Examining the interaction between food outlets and outdoor food advertisements with primary school food environments

Schools are commonly seen as a site of intervention to improve children's nutrition, and prevent excess weight gain. Schools may have limited influence over children's diets; however, with home and community environments also exerting an influence within schools. This study considered the environment of food outlets and outdoor food advertisements surrounding four case study primary schools in New Zealand, and the impact of that external environment on within-school food environments. The shortest travel route between school and home addresses, and the number of food outlets and advertisements passed on that route, was calculated for each student. Interviews with school management were conducted. The schools with a higher percentage of students passing food outlets and advertisements considered that their presence impacted on efforts within schools to improve the food environment. Limiting students’ exposure to food outlets and outdoor food adverts through travel route planning, reducing advertising, or limiting the location of food outlets surrounding schools could be explored as intervention options to support schools in promoting nutrition.     

Diet and eating habits in high and low socioeconomic groups

OBJECTIVE: We measured the difference of dietary intake and eating habits across socioeconomic statuses (SESs) in Israel. METHODS: Participants were randomly recruited from three high SES municipalities and three low SES municipalities in the Negev. Participants were interviewed at home with 24-h food questionnaires that included additional questions regarding health and eating habits. Nutrient and energy intakes were compared between groups, as were major contributors to the energy and food groups. RESULTS: One hundred sixteen participants from the high SES group and 206 from the low SES entered the study. Those in the low SES group were older, heavier, less educated, and less physically active. Dietary intake among the participants in the low SES group was significantly lower in protein, monounsaturated fat, and most vitamins and minerals (thiamine, riboflavin, niacin, vitamin C, calcium, magnesium, and iron). Conversely, vitamin E intake was higher in the low SES group. In the low SES group, the main contributors to energy intake were breads, oils, and sugars. Oils, fats, and citrus fruits were consumed more among subjects in the low SES group, whereas dairy products, grains, and legumes were consumed less by subjects in the high SES group. CONCLUSION: In a detailed survey conducted in two distinct populations, we found poorer diet quality in the low SES group. The root causes for such divergence need further study. As smoking declines in the modern world, nutrition will become the key risk factor in many diseases. Further research and educational and legislative initiatives are needed to curtail this risk.     

Socioeconomic inequalities in children’s diet: the role of the home food environment

Background

It is well documented in the literature that low socioeconomic status (SES) is associated with lower consumption of healthy foods and that these differences in consumption patterns are influenced by neighborhood food environments. Less understood is the role that SES differences in physical and social aspects of the home food environment play in consumption patterns.

Methods

Using data on 4^th grade children from the 2009–2011 Texas School Physical Activity and Nutrition (SPAN) study, we used mixed-effects regression models to test the magnitude of differences in the SPAN Health Eating Index (SHEI) by parental education as an indicator of SES, and the extent to which adjusting for measures of the home food environment, and measures of the neighborhood environment accounted for these SES differences.

Results

Small but significant differences in children’s SHEI by SES strata exist (-1.33 between highest and lowest SES categories, p<0.01). However, incorporating home food environment and neighborhood environment measures in this model eliminates these differences (-0.7, p=0.145). Home food environment explains a greater portion of the difference. Both social (mealtime structure) and physical aspects (food availability) of the home food environment are strongly associated with consumption of healthy and unhealthy foods.

Conclusions

Our findings suggest that modifiable parent behaviors at home can improve children’s eating habits and that the neighborhood may impact diet in ways other than through access to healthy food.

     

Children's fruit and vegetable intake: associations with the neighbourhood food environment

OBJECTIVE: To examine associations between availability of different types of food outlets and children's fruit and vegetable intake. METHOD: Parents of 340 5-6 and 461 10-12 year-old Australian children reported how frequently their child ate 14 fruits and 13 vegetables in the last week in 2002/3. A geographic information system (GIS) was used to determine the availability of the following types of food outlets near home: greengrocers; supermarkets; convenience stores; fast food outlets; restaurants, cafés and takeaway outlets. Logistic regression analyses examined the likelihood of consuming fruit >or=2 times/day and vegetables >or=3 times/day, according to access to food outlets. RESULTS: Overall, 62.5% of children ate fruit >or=2 times/day and 46.4% ate vegetables >or=3 times/day. The more fast food outlets (OR=0.82, 95%CI=0.67-0.99) and convenience stores (OR=0.84, 95%CI=0.73-0.98) close to home, the lower the likelihood of consuming fruit >or=2 times/day. There was also an inverse association between density of convenience stores and the likelihood of consuming vegetables >or=3 times/day (OR=0.84, 95%CI=0.74-0.95). The likelihood of consuming vegetables >or=3 times/day was greater the farther children lived from a supermarket (OR=1.27, 95%CI=1.07-1.51) or a fast food outlet (OR=1.19, 95%CI=1.06-1.35). CONCLUSION: Availability of fast food outlets and convenience stores close to home may have a negative effect on children's fruit and vegetable intake.     

Children's active free play in local neighborhoods: a behavioral mapping study

Many Australian children are more sedentary than they should be, and almost one in five are currently overweight or obese. Some children may face difficulties finding opportunities to be active, having poor access to safe public open spaces or having low independent mobility limiting their access to places to play. This study aimed to examine children's access to places in their neighborhood for active free play and how these vary by age, sex and socioeconomic status (SES). Behavioral maps of the local neighborhood were completed by children (8-12 years) from five primary schools across different areas of Melbourne. Children living in low SES outer-urban neighborhoods had to travel greater distances to access local parks compared with those in inner-urban mid and high SES areas. One-third (32%) of children reported an independent mobility range of <100 m from home. In conclusion, for some children opportunities to engage in active free play in the local neighborhood may be limited due to lack of parks in close proximity to home and restricted independent mobility. It is important to collaborate with local governments, urban planners and community groups to improve access to neighborhood parks and to promote a sense of neighborhood safety.     

Is a Healthy Diet Affordable and Accessible in the City of Yarra,Victoria-Australia? An Analysis of Cost Disparity and Nutritional Choices

This study aimed to examine cost disparity and nutritional choices within the City of Yarra (Yarra), targeting three suburbs that have low- and high-rise estates: Richmond, Fitzroy, and Collingwood. The healthy food basket (HFB) was modeled on the Queensland Healthy Food Access Basket for a six-person family for a fortnight and was constructed to include food items that are common to ethnic groups living in Yarra. The HFB food item costs were sampled across 29 food outlets in Yarra. The average cost of HFB per fortnight for a family of six was significantly lower in Richmond (Mean?=?$419.26) than in Collingwood (Mean?=?$519.28) and in Fitzroy (Mean?=?$433.98). While costs for cereal groups, dairy, meats and alternatives, and non-core were comparable across the suburbs, significant differences were noticed for fruit, legumes and vegetables. Geographic location alone explained 54% of the variance in HFB price (F_2,26?=?15.23, p < 0.001) and 32.7% in the variance of fruit, vegetable and legumes (F_2,26?=?7.72, p < 0.001). The effect of geographic location remained consistent after controlling for the type of food outlets. The type of food outlets had a non-significant effect on the variance of prices. Richmond had a greater number variety of fruit, vegetables, and legumes (F_{2, 26}?=?5.7, p < 0.01) and an overall lower number of missing items (F_{2, 26}?=?3.9, p < 0.05) than Collingwood and Fitzroy. The diversity of food available in the three suburbs was more likely to reflect the Vietnamese, Chinese and East-Timorese shopping pattern than the rest of other ethnic groups. These findings indicate that there is inequality in food access in terms of cost and availability in Yarra and such inequality is function of location and not the type of food outlets. The differential economic access to a HFB in Yarra could be addressed using a multi-faceted approach, including implementing policies that encourage diversity of food outlets and putting in place incentive-based policies to encourage the consumption of fruit, vegetables and legumes, and taking actions toward promoting supply of ethnic foods.     

From the Lunch Table,to the Family Table: A Grounded Theory Approach to Understanding Urban Adolescents’ Experiences of Food Culture Mismatch between School and Home Environments

Based on a participatory action research project in New York City from 2012 to 2014, our study compares the experience of black and Latino adolescents between their school and home food environments. Following a photovoice approach, adolescents participated in a “food justice” curriculum, photographed foodscapes, and conducted photo-elicited interviews. Using a grounded theory approach, we found that adolescents had mismatched experiences between school and home food environments under two conditions: sensory-emotional and sociopolitical. Mismatch suggested psychological and behavioral consequences, including skipping or wasting school lunch entrées and consuming energy-dense, nutrient-poor snack foods. We named this middle-range substantive theory food culture mismatch.     

Perceptions of mothers and use of breastmilk substitutes in Dhaka,Bangladesh

To explore the actual practices and perceptions of giving breastmilk and breastmilk substitutes (BMS), this cross-sectional study was conducted among 326 mothers of low (income/month < Tk 4,000, n = 163) and middle (income/month > Tk 4,000, n = 163) socioeconomic status (SES) with infants aged 6-12 months in Dhaka city during February-April 2001. Qualitative data on perceptions of mothers on appropriate breast-feeding practices were also documented through focus-group discussions (FGDs). The prevalence of exclusive breast-feeding was low in both the socioeconomic groups but was comparatively higher among the mothers of middle SES (3.1% vs 12.3%, p < 0.001), although predominant breast-feeding was high among the mothers of low SES. In addition, the use of BMS was higher among the mothers of middle SES than among the mothers of low SES (55.8% vs. 43.5%, p < 0.001). The majority (62.3%) of the mothers mentioned insufficiency of breastmilk as the main reason for introducing BMS. Perception on appropriate feeding practices was also significantly different between the two groups. Approximately, 90% of the mothers of low SES could not differentiate between infant formula and milk powder compared to 70% of the mothers of middle SES (p < 0.001). The findings of FGDs revealed that some middle-class mothers thought that infant formula was the best food for their infants. Programmes to impart proper knowledge on breast-feeding practices should be strengthened.     

Adult food intake patterns are related to adult and childhood socioeconomic status

Our objective was to examine the influence of adult and childhood socioeconomic status (SES) on attained adult food intake patterns. We used data from a 20- to 22-y follow-up study of 1904 Danish teenagers. The baseline survey was conducted partly in 1983 and partly in 1985 and the follow-up survey was conducted in 2005. Dietary data were collected at follow-up using a 195-item FFQ. Food patterns were derived from principal component analysis. Two food patterns labeled "traditional-western food pattern" and "green food pattern" were identified. In men, adult SES was inversely associated with adherence to the traditional-western food pattern. High adherence to the green food pattern was positively related to high adult SES in both sexes. Among women, those with high SES in childhood had higher green food pattern factor scores than those with low childhood SES, regardless of adult SES. Among men, those with high adult SES had higher green food pattern factor scores than those with low adult SES, regardless of childhood SES. In conclusion, socioeconomic position is important for the development of adult food intake patterns. However, childhood SES seems more important for adult female food intake patterns, whereas adult SES seems more important for adult male food intake patterns.