Neighbourhood socioeconomic inequalities in food access and affordability

This study investigated whether the availability and accessibility of supermarkets and fruit and vegetable stores, and the availability, variety and price of foods within these stores, varied across areas of different levels of socioeconomic disadvantage in Melbourne, Australia. Data on food store locations, and food variety and price within stores were obtained through objective audits of 45 neighbourhoods of varying socioeconomic disadvantage. Geographical accessibility of healthy food stores was mostly better amongst those living in more advantaged neighbourhoods. Availability of healthy foods within stores only slightly favoured those in advantaged neighbourhoods. However food prices favoured those living in disadvantaged areas.     

“Healthy”/“Unhealthy” Food Brands Influence Health,Calorie, and Price Ratings of Food

ObjectiveTo assess the effect of healthy or unhealthy food brands on consumer ratings of a food's perceived healthfulness, caloric content, and estimated price.MethodsUsing a crossover design, 35 adults aged 18–25 years scored a variety of healthy and unhealthy foods paired with “healthy” or “unhealthy” brands or with no brand present, on their healthfulness, caloric content, and estimated price. For each outcome measure, ANOVA was used to evaluate the effect of brand condition on healthy and unhealthy foods.ResultsPairing an unhealthy food with a “healthy brand” led to increased ratings of healthfulness (P < .001), decreased estimates of caloric content (P < .001), and increased price (P < .001). Pairing a healthy food with an “unhealthy brand” led to decreased ratings of healthfulness (P < .001), increased estimates of caloric content (P < .001), and decreased price (P < .001).Conclusions and ImplicationsThese findings extend previous research showing that brands may influence perceptions of food products. Future studies are needed to understand the implications of pairing healthy foods with “unhealthy brands” on actual food intake.     

Price and maternal obesity influence purchasing of low- and high-energy-dense foods

BACKGROUND: Price can influence food purchases, which can influence consumption. Limited laboratory research has assessed the effect of price changes on food purchases, and no research on individual differences that may interact with price to influence purchases exists. OBJECTIVE: We aimed to assess the influence of price changes of low-energy-density (LED) and high-energy-density (HED) foods on mother's food purchases in a laboratory food-purchasing analogue. DESIGN: Mothers were randomly assigned to price conditions in which the price of either LED or HED foods was manipulated from 75% to 125% of the reference purchase price, whereas the price of the alternative foods was kept at the reference value. Mothers completed purchases for 2 income levels ($15 or $30 per family member). RESULTS: Purchases were reduced when prices of LED (P < 0.01) and HED (P < 0.001) foods were increased. Maternal BMI interacted with price to influence purchases of HED foods when the price of HED foods increased (P = 0.016) and interacted with price to influence purchases of LED foods when the price of HED foods increased (P = 0.008). CONCLUSION: These results show the relevance of considering price change as a way to influence food purchases of LED compared with HED foods and the possibility that individual differences may influence the own-price elasticity of HED foods and substitution of LED for HED foods.     

Socioeconomic inequalities in food purchasing: the contribution of respondent-perceived and actual (objectively measured) price and availability of foods

BACKGROUND: Research has shown that lower socioeconomic groups purchase foods that are less consistent with dietary recommendations. The price and availability of foods are thought to be important mediating factors between socioeconomic position and food purchasing. OBJECTIVES: We examined the relative contribution of the perceived and objectively measured price and availability of recommended foods to household income differences in food purchasing. METHODS: Using a face-to-face interview, a random sample of Brisbane residents (n=812) were asked about their food purchasing choices in 2000. They were also asked about their perceptions of the price and availability of 'recommended' foods (i.e. choices lower in fat, saturated fat, sugar, salt or higher in fibre) in the supermarkets where they usually shopped. Audits measuring the actual availability and price of identical foods were conducted in the same supermarkets. RESULTS: Lower socioeconomic groups were less likely to make food purchasing choices consistent with dietary guideline recommendations. Objective availability and price differences were not associated with purchasing choices, nor did they contribute to socioeconomic inequalities in food purchasing choices. Perceived availability and price differences were associated with the purchase of recommended foods. Perceived availability made a small contribution to inequalities in food purchasing, however perceived price differences did not. CONCLUSION: Socioeconomic inequalities in food purchasing are not mediated by differential availability of recommended foods and differences in price between recommended and regular foods in supermarkets, or by perceptions of their relative price. However, differential perceptions of the availability of recommended foods may play a small role in food purchasing inequalities.     

What “Price” Means When Buying Food: Insights From a Multisite Qualitative Study With Black Americans

Objectives. We explored the role of price in the food purchasing patterns of Black adults and youths.Methods. We analyzed qualitative data from interviews and focus groups with socioeconomically diverse, primarily female, Black adults or parents (n = 75) and youths (n = 42) in 4 US cities. Interview protocols were locality specific, but all were designed to elicit broad discussion of food marketing variables. We performed a conventional qualitative content analysis by coding and analyzing data from each site to identify common salient themes.Results. Price emerged as a primary influence on food purchases across all sites. Other value considerations (e.g., convenience, food quality, healthfulness of product, and family preferences) were discussed, providing a more complex picture of how participants considered the price of a product.Conclusions. Food pricing strategies that encourage consumption of healthful foods may have high relevance for Black persons across income or education levels. Accounting for how price intersects with other value considerations may improve the effectiveness of these strategies.In recent years, increasing attention has been given to the role that the marketing of high-calorie, low-nutrient foods and beverages has in the development of obesity, especially childhood obesity.1,2 Marketing is multifaceted, including the types of products available, where they are available, where and how they are promoted, and what they cost (the “marketing mix”).3 Food marketing variables shape the environments in which food preferences develop and in which consumers make purchasing decisions. These variables must be understood to design policies and programs to facilitate calorically and nutritionally appropriate eating patterns.Although much of the concern about food marketing has focused on children, evidence suggests that food and beverage marketing practices contribute to the higher-than-average risk of obesity and other diet-related diseases in Black persons at all ages.4,5 Black persons are more likely than White persons to be exposed to advertising and other promotions for high-calorie, low-nutrient foods and beverages, and less likely to encounter promotions for healthier alternatives.6–9 In addition, on average, Black neighborhoods have relatively fewer retail food stores that offer a wide variety of foods and relatively more fast-food outlets than other types of restaurants compared with predominantly White neighborhoods.10–15 A higher percentage of Black than White Americans have incomes near the poverty line16 and are, therefore, also affected by the disproportionate promotion and availability of high-calorie, low-nutrient foods in lower-income neighborhoods.10,13,15,17 However, the excess risks of obesity and other diet-related diseases in Black persons are not confined to the lower-income segment of the population.18–21The objective of this study was to explore the role of price in the food purchasing patterns of Black adults and youths. Price is among the strongest, if not the strongest, influences on food purchases (particularly among low-income consumers) and on caloric overconsumption.22,23 Food price may affect caloric consumption through the types or quantities of foods purchased. For example, people may buy relatively inexpensive snack foods and convenience foods that are high in fat and sugar.24 They also may feel less guilty about buying unhealthy foods if they are discounted and may eat relatively more of the products acquired at low cost or stockpiled because of quantity discounts.22,23 Price is mentioned routinely as a major influence on food purchasing decisions by Black consumers and by consumers in general.22,25–31 However, compared with other aspects of marketing, ways in which the price of products affects diet-related disparities experienced by Black adults and youths have been less well studied.Although the foods available and marketed in Black neighborhoods are relatively less healthful compared with foods marketed in White neighborhoods, available evidence does not support the hypothesis of systematic differences in food prices between Black and White neighborhoods.9,32–35 Yet these price comparison studies have not adjusted for neighborhood differences in income, which would determine what prices residents might consider affordable. Nor have they considered several other factors such as the mix of retail outlets available, availability of time and transportation to shop in other neighborhoods, price discounts, consumer food preferences, or food-specific or more general shopping patterns, all of which might influence what people buy at a given cost.22,36 This dearth of comprehensive inquiry calls for a deeper understanding of the role of food prices in purchasing behavior among Black consumers, which will inform potential marketing-related strategies for addressing obesity.     

Price Trends of Healthy and Less Healthy Foods and Beverages in Mexico from 2011–2018

BackgroundCost is one of the main drivers of food selection; thus it is important to monitor food prices. Evidence from low- and middle-income countries such as Mexico is limited.ObjectiveThe aim of this study was to evaluate the prices and price trends of healthy and less healthy food/beverage groups in Mexico from 2011 to 2018.DesignThis study used a time series of the prices of foods and beverages classified by 1) healthiness, 2) processing level, and 3) pairs of healthy/less healthy substitutes.SettingFood and beverage prices used to estimate the Consumer Price Index were obtained. Prices were collected weekly from 46 cities (>20,000 habitants) distributed across the country.Main outcome measuresPrice trend (% change/year) from 2011 to 2018 for all food/beverage groups and price/100 g in 2018 for pairs of healthy/less healthy substitutes were obtained.Statistical analysesLinear regression models were used for each food/beverage group, with the logarithm of deflated price as the dependent variable and time (years) as the independent variable.ResultsOn average, prices for less healthy foods and beverages increased more than prices of healthy foods and beverages (foods: 1.72% vs 0.70% change/year; beverages: 1.61% vs ?0.19% change/year). The price change was similar for unprocessed/minimally processed foods and ultraprocessed foods (1.95% vs 1.85% change/year); however, within each processing category, the price of less healthy foods increased more. By pairs of substitutes (within food/beverage groups), the healthier option for bread, sodas, and poultry was more expensive (price/100 g) in 2018, whereas for red meat, cheese, mayonnaise, and milk, the healthier option was cheaper.ConclusionsOverall, the food prices of less healthy foods and beverages increased more than the food prices of healthy foods and beverages. However, by processing level there was no difference, and for pairs of healthy/less healthy substitutes results were mixed. Continued monitoring of food prices is warranted, and future research is needed to understand how these price changes affect dietary quality.     

Positive influence of the revised Special Supplemental Nutrition Program for Women, Infants, and Children food packages on access to healthy foods

BackgroundThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has important potential for preventing diet-related disease in low-income children. WIC food packages were recently revised to offer foods that better reflect dietary recommendations for Americans.ObjectiveThis article reports on how implementation of the new healthier WIC food packages affected access of low-income populations to healthy foods (eg, whole grains, fruit and vegetables, and lower-fat milk).DesignA pre–post store inventory was completed using a standardized instrument to assess availability, variety, quality and prices of WIC-approved foods (65 food items). Stores were assessed before (spring 2009) and shortly after the new WIC package implementation (spring 2010).Participants/settingAll convenience stores and nonchain grocery stores located in five towns of Connecticut (N=252), including 33 WIC-authorized stores and 219 non-WIC stores.Statistical analyses performedThe healthy food supply score was constructed to summarize postrevision changes in availability, variety, prices of healthy foods, and produce quality. The effect of the WIC food package revisions was measured by differential changes in the scores for stores authorized to accept WIC benefits and stores not participating in WIC, including differences by neighborhood income. Multivariate multilevel regression models were estimated.ResultsThe 2009 introduction of the revised WIC food packages has significantly improved availability and variety of healthy foods in WIC-authorized and (to a smaller degree) non-WIC convenience and grocery stores. The increase in the composite score of healthy food supply varied from 16% in WIC convenience and grocery stores in higher-income neighborhoods to 39% in lower-income areas. Improved availability and variety of whole-grain products were responsible for most of the increase in the composite score of healthy food supply.ConclusionsDesigned as cost-neutral changes, the WIC food package revisions have improved access to healthy foods for WIC participants and society at large.     

Influence of food cost on diet quality and risk factors for chronic disease: A systematic review

Aim: To undertake a systematic literature review to examine the effect of food cost on diet quality and risk factors for chronic disease, specifically focusing on diet‐related lifestyle diseases affecting the Australian population. Methods: A search of six databases resulted in the inclusion of one systematic review, three cohort studies, 41 cross‐sectional studies and four modelling studies in this review. Results: Between 2000 and 2006, the price of healthy foods has increased more than the price of less healthy foods. Healthy Food Access Basket surveys show that a healthy diet may often be unaffordable for low‐ and average‐income households. Diets of higher energy density were associated with lower diet cost, whereas diets of higher nutrient density and nutritional quality were associated with higher diet cost. Recent studies report an inverse association between food price and food consumption. Consequently, an increase in food cost was associated with a significant reduction in weight, waist circumference, body mass index, obesity and insulin resistance. Conclusions: Manipulation of food cost may alter food consumption and therefore risk factors for chronic disease. Further longitudinal studies investigating the impact of pricing strategies on diet quality and disease risk are needed.     

Determinants of variation in food cost and availability in two socioeconomically contrasting neighbourhoods of Hamilton, Ontario, Canada

This study addresses links between economic and nutritional variation in an urban North American setting. We employed a mixed-methods approach including mapping, semi-structured interviews, and food outlet surveys to investigate the public health impact of variation in the cost and availability of food between two socioeconomically distinct neighbourhoods of the City of Hamilton, Ontario, Canada. Food cost in supermarkets was not found to be higher in the low-income neighbourhood, though it was much higher in the variety stores that predominate in the low-income neighbourhood. Moreover, there was a very low availability of produce in the variety stores. Reduced fresh produce availability and lower incomes have the potential to negatively influence public health in the less-affluent study area by increasing the difficulty of acquiring healthy foods.     

Food Environments and Their Influence on Food Choices: A Case Study in Informal Settlements in Nairobi,Kenya

The food environments that people have access to shape their food choices. The purpose of this study was to use mixed methods to characterize the external food environment in informal settlements in Nairobi, Kenya and to examine the individual factors that influence the way in which women interact with those environments to make food choices. We used a combination of food environment assessments (vendor mapping, collection of food prices, food quality assessments) and five focus group discussions with women (n = 26) in four villages within two informal settlements in Nairobi (Mukuru and Kibera) to better understand the drivers of food choice. We found a large number (n = 1163) of vendors selling a variety of food within the settlements. The highest number of vendors were selling fruits and/or vegetables; however, there was limited diversity of fruits available. Animal-source foods were considered relatively expensive as compared to plant-based foods, including prepared fried snacks. We found that the way women interacted with their food environments was influenced by individual factors such as income, time, convenience, and preferences. Our findings suggest that interventions targeting both the external food environment as well as individual factors such as income will be necessary to support healthy diets among low-income populations living in informal settlements in Kenya.     

Diets for Disease? Intraurban Variation in Reported Food Consumption in Glasgow

A recent official report on the Scottish Diet reviews evidence for poor health and poor diets among the Scots, and makes extensive and specific recommendations about dietary change. This paper examines the extent to which reported consumption of fifteen of the food groups discussed in that report vary among four neighbourhoods in Glasgow City. Some foods appear to be typical of a wider Glaswegian (or Scottish) diet and show little variation among neighbourhoods (e.g. semi-skimmed milk, white fish, confectionery, cakes and pastries, savoury snacks). Other foods however show marked differences between neighbourhoods after controlling for sex, age and social class; these include fruit, vegetables, meat (particularly processed meat products), bread, spreading fats, sugar, natural fruit juice and alcohol. This suggests that such intraurban variations in food consumption cannot be explained simply by socio-demographic or socio-economic factors in individuals and that cultural and supply factors also need to be taken into account.     

Longitudinal study of Consumer Price Index (CPI) trends in core and non-core foods in Australia

Objective: This study examined trends in the price of healthy and less‐healthy foods from 1989 to 2007 using the Australian Consumer Price Index (CPI). Methods: CPI food expenditure classes were classified as ‘core’ or ‘non‐core’. Trends in the CPI were analysed to examine the rise in prices of core compared with non‐core foods. Results: On average, the CPI for core foods has risen at a slightly higher, though not statistically significant, rate than non‐core foods. Furthermore, selected groupings reveal interesting patterns. ‘Bread’ has risen in price significantly more than ‘cakes and biscuits’, and ‘milk’ has risen in price significantly more than ‘soft drinks, waters and juices’. Conclusions and implications: This investigation of food price trends reveals notable differences between core and non‐core foods. This should be investigated further to determine the extent to which this contributes to the higher prevalence of diet‐related diseases in low socio‐economic groups.     

Relationship of mother and child food purchases as a function of price: a pilot study

To our knowledge, there are no data on parental influences on child purchasing behavior of healthy or unhealthy foods. Mothers and children in ten families were given 5.00 US dollars to purchase portions of preferred fruits/vegetables and high energy-dense snack foods for each of ten trials of price manipulations. For five of the trials the price of the fruit/vegetable increased in price from 0.50 US dollars to 2.50 US dollars (in 0.50 US dollar increments), while the price of the energy-dense snack food remained constant at 1.00 US dollar. For the remaining five trials, the commodity that previously rose in price remained constant at 1.00 US dollars and the other commodity varied from 0.50 US dollars to 2.50 US dollars. Same-price elasticity was shown for both the child and parent purchases, and parent purchases were significantly related to child purchases of both healthy (regression estimate = 0.46, p < 0.001) and unhealthy (regression estimate = 0.12, p = 0.036) foods. Children's purchases of unhealthy snack food items were positively related to family socioeconomic status, and negatively related to child age. These results indicate that parental food choice and purchasing behaviors may play a role in the development of children's purchasing of both healthy and unhealthy foods.     

The Impact of Food Prices on Consumption: A Systematic Review of Research on the Price Elasticity of Demand for Food

In light of proposals to improve diets by shifting food prices, it is important to understand how price changes affect demand for various foods.We reviewed 160 studies on the price elasticity of demand for major food categories to assess mean elasticities by food category and variations in estimates by study design. Price elasticities for foods and nonalcoholic beverages ranged from 0.27 to 0.81 (absolute values), with food away from home, soft drinks, juice, and meats being most responsive to price changes (0.7–0.8). As an example, a 10% increase in soft drink prices should reduce consumption by 8% to 10%.Studies estimating price effects on substitutions from unhealthy to healthy food and price responsiveness among at-risk populations are particularly needed.THE INCREASING BURDEN OF diet-related chronic diseases has prompted policymakers and researchers to explore broad-based approaches to improving diets.^1,2 One way to address the issue is to change the relative prices of selected foods through carefully designed tax or subsidy policies. The potential of price changes to improve food choices is evident from growing research on how relative food prices affect dietary quality and obesity, particularly among young people, lower income populations, and those most at risk for obesity.³ Experience from tobacco tax regulation further underscores the power of price changes to influence purchasing behavior and, ultimately, public health.⁴Experimental research in both laboratory and intervention settings shows that lowering the price of healthier foods and raising the price of less healthy alternatives shift purchases toward healthier food options.^5–8 Although these studies demonstrate price effects in specific, isolated settings or on 1 or 2 individual product changes, to our knowledge, the expected effects of broader food price changes have not been systematically reviewed. Such information would be helpful in designing policies that change the relative food and beverage prices paid by all or many consumers.Relatively small-scale, cost-neutral approaches to improving nutrition in vulnerable populations include the 2009 changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages; whole grains, fruits and vegetables, and soy-based milk alternatives were added to these packages, indirectly subsidizing healthy foods for WIC participants.⁹ Another larger scale approach is to change prices directly through taxing products such as sugar-sweetened beverages^1,10 or subsidizing healthier foods (e.g., a refund on the costs of fruits and vegetables to Supplemental Nutrition Assistance Program participants).¹¹ Some states already tax soft drinks and snacks at higher rates than other foods, but thus far taxes have been small and designed to generate revenue rather than influence consumption.¹²We sought to estimate the effects of price changes on consumer demand for major commodity foods included in the Dietary Guidelines for Americans food categories.¹³ We identified all published US studies of food price elasticity of demand (the expected proportional change in product demand for a given percentage change in price) and combined their estimates into average estimated price elasticities for 16 major food and beverage groups. Our goal was to provide a comprehensive summary of research on food demand and consumption behavior in the United States over the past 7 decades, with particular attention to differences in price effects across income levels.One timely estimate that can be gained from our review is how altering the prices of soft drinks can alter their consumption, information that is of critical need for policymakers considering soft drink taxes. We compared the sensitivity of estimates across different analytic approaches to modeling food demand. We identify important gaps in the food demand analysis literature and suggest avenues for future research.     

The cost of a healthy and sustainable diet – who can afford it?

Objective: Climate change is affecting the ability of food systems to provide sufficient nutritious and affordable foods at all times. Healthy and sustainable (H&S) food choices are important contributions to health and climate change policy efforts. This paper presents empirical data on the affordability of a food basket that incorporates principles of health and sustainability across different food sub‐systems, socioeconomic neighbourhoods and household income levels in Greater Western Sydney, Australia. Methods: A basket survey was used to investigate the cost of both a typical basket of food and a hypothetical H&S basket. The price of foods in the two baskets was recorded in five neighbourhoods, and the affordability of the baskets was determined across household income quintiles. Results: The cost of the H&S basket was more than the typical basket in all five socioeconomic neighbourhoods, with most disadvantaged neighbourhood spending proportionately more (30%) to buy the H&S basket. Within household income levels, the greatest inequity was found in the middle income neighbourhood, showing that households in the lowest income quintile would have to spend up to 48% of their weekly income to buy the H&S basket, while households in the highest income quintile would have to spend significantly less of their weekly income (9%). Conclusion: The most disadvantaged groups in the region, both at the neighbourhood and household level, experience the greatest inequality in affordability of the H&S diet. Implications: The results highlight the current inequity in food choice in the region and the underlying social issues of cost and affordability of H&S foods.     

Healthy and Unhealthy Food Prices across Neighborhoods and Their Association with Neighborhood Socioeconomic Status and Proportion Black/Hispanic

This paper evaluates variation in food prices within and between neighborhoods to improve our understanding of access to healthy foods in urbanized areas and potential economic incentives and barriers to consuming a higher-quality diet. Prices of a selection of healthier foods (dairy, fruit juice, and frozen vegetables) and unhealthy foods (soda, sweets, and salty snacks) were obtained from 1953 supermarkets across the USA during 2009–2012 and were linked to census block group socio-demographics. Analyses evaluated associations between neighborhood SES and proportion Black/Hispanic and the prices of healthier and unhealthy foods, and the relative price of healthier foods compared with unhealthy foods (healthy-to-unhealthy price ratio). Linear hierarchical regression models were used to explore geospatial variation and adjust for confounders. Overall, the price of healthier foods was nearly twice as high as the price of unhealthy foods ($0.590 vs $0.298 per serving; healthy-to-unhealthy price ratio of 1.99). This trend was consistent across all neighborhood characteristics. After adjusting for covariates, no association was found between food prices (healthy, unhealthy, or the healthy-to-unhealthy ratio) and neighborhood SES. Similarly, there was no association between the proportion Black/Hispanic and healthier food price, a very small positive association with unhealthy price, and a modest negative association with the healthy-to-unhealthy ratio. No major differences were seen in food prices across levels of neighborhood SES and proportion Black/Hispanic; however, the price of healthier food was twice as expensive as unhealthy food per serving on average.     

Nutrient profiling can help identify foods of good nutritional quality for their price: a validation study with linear programming

Nutrient profiling ranks foods based on their nutrient content. They may help identify foods with a good nutritional quality for their price. This hypothesis was tested using diet modeling with linear programming. Analyses were undertaken using food intake data from the nationally representative French INCA (enquête Individuelle et Nationale sur les Consommations Alimentaires) survey and its associated food composition and price database. For each food, a nutrient profile score was defined as the ratio between the previously published nutrient density score (NDS) and the limited nutrient score (LIM); a nutritional quality for price indicator was developed and calculated from the relationship between its NDS:LIM and energy cost (in euro/100 kcal). We developed linear programming models to design diets that fulfilled increasing levels of nutritional constraints at a minimal cost. The median NDS:LIM values of foods selected in modeled diets increased as the levels of nutritional constraints increased (P = 0.005). In addition, the proportion of foods with a good nutritional quality for price indicator was higher (P < 0.0001) among foods selected (81%) than among foods not selected (39%) in modeled diets. This agreement between the linear programming and the nutrient profiling approaches indicates that nutrient profiling can help identify foods of good nutritional quality for their price. Linear programming is a useful tool for testing nutrient profiling systems and validating the concept of nutrient profiling.     

Perceptions of the food environment are associated with fast-food (not fruit-and-vegetable) consumption: findings from multi-level models

Objectives

Diets low in fruits and vegetables and/or high in fast foods are associated with obesity and chronic diseases. Such diets may relate to different aspects of neighborhood food environments. We sought to evaluate if people??s perceptions of their neighborhood food environment are associated with reported fruit-and-vegetable and fast-food consumption.

Methods

Cross-sectional analysis of a community health survey from Philadelphia, PA and four surrounding suburban counties (n?=?10,450 individuals). We used mixed-effects multi-level Poisson models, nesting individuals within neighborhoods??i.e. census tracts (n?=?991).

Results

Negative perceptions of the food environment (perceived difficulty finding fruits and vegetables, having to travel outside of one??s neighborhood to get to a supermarket, and perceived poor grocery quality) were each directly associated with fast-food consumption (incident rate ratios [IRRs] 1.31, 1.06, 1.20; p?Conclusions Perceived difficulty finding or accessing produce and high-quality groceries may support the eating of more fast food. Neighborhoods where food-environment perceptions are worst might benefit from interventions to improve availability, accessibility, and quality of healthy foods, towards shifting consumption away from fast foods.     

Identifying Sustainable Foods: The Relationship between Environmental Impact,Nutritional Quality,and Prices of Foods Representative of the French Diet

BackgroundSustainable diets, as defined by the Food and Agriculture Organization, need to combine environment, nutrition, and affordability dimensions. However, it is unknown whether these dimensions are compatible, and no guidance is available in the official recommendations.ObjectiveTo identify foods with compatible sustainability dimensions.MethodsFor 363 of the most commonly consumed foods in the Second French Individual and National Study on Food Consumption, environmental impact indicators (ie, greenhouse gas [GHG] emissions, acidification, and eutrophication), and prices were collected. The nutritional quality of the foods was assessed by calculating the score for the nutritional adequacy of individual foods (SAIN) to score for disqualifying nutrients (LIM) ratio. A sustainability score based on the median GHG emissions, price, and SAIN:LIM was calculated for each food; the foods with the best values for all three variables received the highest score.ResultsThe environmental indicators were strongly and positively correlated. Meat, fish, and eggs and dairy products had the strongest influence on the environment; starchy foods, legumes, and fruits and vegetables had the least influence. GHG emissions were inversely correlated with SAIN:LIM (r=–0.37) and positively correlated with price per kilogram (r=0.59); the correlation with price per kilocalorie was null. This showed that foods with a heavy environmental impact tend to have lower nutritional quality and a higher price per kilogram but not a lower price per kilocalorie. Using price per kilogram, 94 foods had a maximum sustainability score, including most plant-based foods and excluding all foods with animal ingredients except milk, yogurt, and soups. Using price per kilocalorie restricted the list to 42 foods, including 52% of all starchy foods and legumes but only 11% of fruits and vegetables (mainly 100% fruit juices).ConclusionsOverall, the sustainability dimensions seemed to be compatible when considering price per kilogram of food. However, this conclusion is too simplistic when considering price per kilocalorie, which highlights the need to integrate the data at the diet level.