Caractériser l'environnement alimentaire d'une municipalité régionale de comté pour identifier les zones prioritaires d'intervention en matière de sécurité alimentaire.

In today's society there is evidence of a culture of the 'empowered consumer' -- an image of the consumer as a citizen rather than a subordinate. In fact, human rights language is increasingly coming to the fore in the consumption debate. The consumer has been allocated rights by the United Nations whereby all human beings are born free and equal and have civil, political, economic and social rights (McGregor 44). However, as citizens we also have responsibilities of an environmental and social concern. Food retailing and equality of shopping provision is one such concern. Food is a basic right. According to the Universal Declaration of Human Rights everyone has a fundamental right to be free from hunger and have access to safe and nutritious food. Social exclusion refers to those in the population who are unable to participate in economic, political, social and cultural life. Social exclusion is different from, but related to, poverty since it further marginalises the most disadvantaged -- for example, those who cannot access a large supermarket. In keeping with the rights/responsibilities language, the consumer has a basic right to food and the retailer has the social responsibility to supply the needs of the consumer. It is in this respect that food is an ethical issue and has social justice implications. Inability to consume, or have access to, sufficient food of nutritional quality is a global concern. In North America the issue is one of 'food insecurity' or 'food poverty' due to inadequate finance to purchase sufficient food. In the United Kingdom the same problem arises within the context of access to food stores. This is identified as a 'food (shopping) desert', where due to restricted access social exclusion can arise. The term 'food deserts' was first used by the Low Income Project Team of the Nutrition Task Force in 1996 and was succinctly defined by Tessa Jowell (Government Health Minister) in 1997 when she stated that a food desert was an area "where people do not have easy access to healthy, fresh foods particularly if they are poor and have limited mobility". The term 'food desert' is an emotive one referring to a unique tool of social polarisation and exclusion (Lang 5). The issues compounding the problem include low income, locational policy of supermarkets with the acquisition of edge-of-town / out-of-town sites, consumer mobility, car ownership levels and food availability. This research study focuses on Northern Ireland -- a region of the UK on the periphery of Europe. The Province of Northern Ireland (Ulster) is a sparsely populated (122 people per km²), predominantly rural area with the highest unemployment and poverty statistics in the United Kingdom. Similarly, Northern Ireland has a proportionately high degree of non-car ownership (35%) which further complicates the equation since shopping is increasingly becoming a car-borne activity necessitating transportation to edge-of-town superstores. Those not able to avail themselves of large edge-of-town superstores are being socially excluded, since inner-city areas are becoming denuded of food stores. Those that do exist usually have a limited range of food items, usually non-perishable, or are specialist shops stocking high priced items. It is the aim of the study to identify the characteristics, extent and location of food deserts in both rural and urban areas of Northern Ireland. It is a particularly apt time to do so since Northern Ireland is experiencing a 'retail revolution' with the arrival of the major UK grocery multiples and subsequent situational policies to locate off-centre. Similarly, there are plans to curtail out-of-town developments which has been viewed by some smaller retailers as "too little, too late". With the above in mind, it is a timely study for Northern Ireland. Multiple research tools of both a qualitative and a quantitative nature have been employed including consumer focus groups, shopping diaries, comparative shopping exercises, consumer questionnaires and retail interviews. This will enable sufficient validation of results. The focus groups provide qualitative depth (Colquhoun 39) and serve to highlight the issues of shopping inequality from the point of view of different consumer groups which could be identified as potentially vulnerable in the food poverty stakes; the elderly, the disabled, the unemployed or low income families, lone-parent families and females in general; to whom falls the responsibility for provisioning the household, organising the kitchen and doing the household's cooking (Murcott 11). Basically, food is gendered -- women are mainly in charge (Vaines 13). The respondents in this study demonstrate exactly that point since 77% of the sample were female and reported that they were responsible for household shopping. This point is particularly prevalent with regard to access to cars. In fact over 50% of women in 1991-1993 either lived in households without a car or were non-drivers in a household with a car. Similarly, although there is a rising proportion of women who work they still do most of the shopping and spend twice as much time as men provisioning the household (Piachaud & Webb 18). Ultimately, anything that affects the purchaser also affects the purchasing experience -- in this case physical access to the foodstore. Comparative shopping exercises illustrate the availability and price indices of food and reiterate the price differences between the smaller independents, the local corner shops and the supermarkets. Initial research using the British Ministry of Agriculture, Fisheries and Food's "Low Cost, Healthy Diet" (Leather 75) provides evidence of a cost differential of £1.41, or a 26% cost penalty by shopping at a corner store rather than a superstore. Availability among corner shops similarly compared unfavourably with the supermarkets, with the smallest stores offering minimal fresh fruit and vegetables and regularly offering no 'economy' branded equivalent to an established manufacturer's brand. This supports previous research which found that in areas where small shops do exist they offer only a limited overpriced range of processed foods (Elliott 5), and it is generally accepted that those who can shop at supermarkets can generally benefit from lower prices and more choice (Piachaud & Webb 32). The benefits of supermarkets are not therefore available to all. Shopping diaries further illustrate this point with the dichotomy existing where the lower-income consumer shops more frequently and locally than does her higher-income counterpart and it is these same consumers who patronise the smaller, often more expensive corner shop. Many consumers like the convenience of large supermarkets where they have access to a vast range of items and do not mind paying premium prices on some items for this convenience. Supermarkets do not offer low prices on all items, but do stock economy lines as well as premium priced items. The consumer questionnaire provides some quantitative analysis and statistical weight to the data and was analysed using the χ-square test on SPSS for Windows Version 8. With the χ-square test the important detail is the significance level (reported as a p-value). A p-value of less than 0.05 indicates that the two groups are significantly different at a confidence level of 95% -- in other words, it can be concluded that the author is 95% certain that the result is statistically significant and free from error. Four areas of the Province were sampled -- two rural and two urban. The sample was 77% female and the median age group fell between 45 to 54 years. The social class status was skewed towards the lower socio-economic classes and only 12% fell into social classes A or B. The mean household income was £151 to £200 per week. The survey was interviewer-assisted and pointed to some interesting correlations between levels of satisfaction with store location and distance travelled, product choice and the decision to continue shopping in the town centre. Thirty percent of the sample stated that they shop at off-centre complexes and 70% of the sampled households shop in the town centre or closer to home. This sample also provides evidence that shopping is largely a car-borne activity with 58% of the sample using the family car. Journey distance is significantly influenced by degree of satisfaction with locality: p<0.01 and is supported with the evidence that 64% of the respondents stated that they shop less than fifteen minutes from home. Similar relationships exist between reported satisfaction with locality and differing degrees of satisfaction for product choice: p<0.01. A significant bias similarly exists between those who continue to shop in the town centre after the advent of the UK multiples into Northern Ireland in 1996 and those who do not: p<0.05 with a bias towards those continuing to shop in the town centre reporting high satisfaction levels. Ultimately, perceived adequacy of shopping provision influences satisfaction with store locality: p<0.05. Although the majority of respondents' weekly shopping is conducted at a multiple there is still an identified need for the local corner shops and independents since approximately 29% of respondents buy essentials like bread, milk and other basic grocery provision there. In fact, 98% of those surveyed reported that every town centre should have a food store, and 82% noticed a reduction in the number of food stores locally in recent years. In a concluding open question in the survey attitudes towards off-centre supermarkets were gauged. Responses ranged from positive in nature ("better parking facilities") to indifferent ("I never bother with them") to negative ("they [out-of-town supermarkets] only suit people with cars" and "they h

Food insecurity in an important public health issue and affects 13% of Canadian households. It is associated with poor accessibility to fresh, diverse and affordable food products. However, measurement of the food environment is challenging in rural settings since the proximity of food supply sources is unevenly distributed. The objective of this study was to develop a methodology to identify food deserts in rural environments. In-store evaluations of 25 food products were performed for all food stores located in four contiguous rural counties in Quebec. The quality of food products was estimated using four indices: freshness, affordability, diversity and the relative availability. Road network distance between all residences to the closest food store with a favourable score on the four dimensions was mapped to identify residential clusters located in deprived communities without reasonable access to a "good" food source. The result was compared with the food desert parameters proposed by the US Department of Agriculture (USDA), as well as with the perceptions of a group of regional stakeholders. When food quality was considered, food deserts appeared more prevalent than when only the USDA definition was used. Objective measurements of the food environment matched stakeholders' perceptions. Food stores' characteristics are different in rural areas and require an in-store estimation to identify potential rural food deserts. The objective measurements of the food environment combined with the field knowledge of stakeholders may help to shape stronger arguments to gain the support of decision-makers to develop relevant interventions.

Liver transplant (LT) recipients are at risk of post-transplant diabetes mellitus (PTDM), and the incidence varies by region. We explored the relationship between county-level food environment and PTDM and whether food insecurity mediates regional variation. First-time LT recipients from July 2004 to December 2022 without pre-existing diabetes were identified in the UNOS SRTR database. Data on 3 measures of healthy food access at the county level were obtained: population experiencing food insecurity, low-income population with low access to grocery stores (food deserts), and ratio of unhealthy to healthy food options (food swamps), all expressed by quartile. The primary endpoint was PTDM. Subdistribution hazard models were used to estimate associations, adjusting for demographic and clinical characteristics and county-level social vulnerability. Mediation analyses quantified the extent to which the food environment explained regional variation in PTDM. A total of 68,273 LT recipients met the inclusion criteria; 15.5% developed PTDM. All 3 food environment measures were independently associated with higher PTDM risk, even after adjustment for recipient, donor, and county-level factors. These measures were also significant mediators of regional variation in PTDM. Food insecurity mediated 48% of regional variation in PTDM, while food deserts and food swamps mediated 20% and 23%, respectively. LT recipients in counties with decreased access to healthy foods were significantly more likely to develop PTDM. Food environment accounted for a meaningful proportion of regional differences in PTDM. Identifying and addressing food insecurity among LT recipients may represent a modifiable pathway to improve long-term outcomes.

Conceptualisations of 'food deserts' (areas lacking healthful food/drink) and 'food swamps' (areas overwhelm by less-healthful fare) may be both inaccurate and incomplete. Our objective was to more accurately and completely characterise food/drink availability in urban areas. Cross-sectional assessment of select healthful and less-healthful food/drink offerings from storefront businesses (stores, restaurants) and non-storefront businesses (street vendors). Two areas of New York City: the Bronx (higher-poverty, mostly minority) and the Upper East Side (UES; wealthier, predominantly white). All businesses on 63 street segments in the Bronx (n 662) and on 46 street segments in the UES (n 330). Greater percentages of businesses offered any, any healthful, and only less-healthful food/drink in the Bronx (42·0 %, 37·5 %, 4·4 %, respectively) than in the UES (30 %, 27·9 %, 2·1 %, respectively). Differences were driven mostly by businesses (e.g. newsstands, gyms, laundromats) not primarily focused on selling food/drink - 'other storefront businesses' (OSBs). OSBs accounted for 36·0 % of all food/drink-offering businesses in the Bronx (more numerous than restaurants or so-called 'food stores') and 18·2 % in the UES (more numerous than 'food stores'). Differences also related to street vendors in both the Bronx and the UES. If street vendors and OSBs were not captured, the missed percentages of street segments offering food/drink would be 14·5 % in the Bronx and 21·9 % in the UES. Of businesses offering food/drink in communities, OSBs and street vendors can represent substantial percentages. Focusing on only 'food stores' and restaurants may miss or mischaracterise 'food deserts', 'food swamps', and food/drink-source disparities between communities.

BackgroundLimited attention has been paid to an association between food environment and household economic resources related to food expenditure in food-insecure seniors. The aim of the study was to investigate the relationship between factors of economic resource, food environment, and food insecurity in single seniors residing in rural areas of South Korea.MethodsA cross-sectional study was conducted in 170 single senior households aged 65 years or over residing in rural areas. Face-to-face interviews were performed to collect data on demographic characteristics, household economic resources/expenditure, food environmental factors, and food insecurity.ResultsAmong economic resources, generally limited food expenditures due to housing fees and heating costs during the winter were positively related to food insecurity. Among food environmental factors, food accessibility at community level such as food stores located far from home and inconvenient bus routes was related to food insecurity. The most explainable economic and food environment factors related to food insecurity by stepwise logistic regression analysis were the percentage of total expenditure on housing fee (OR = 1.021, 95% CI: 1.008–1.034), foods purchasing at super supermarket (OR = 0.398, 95% CI: 0.166–0.951), having difficulties in food purchasing due to food stores being located far from home (OR = 14.487, 95% CI: 5.139–40.842) and inconvenient bus routes (OR = 0.083, 95% CI: 0.015–0.460).ConclusionInadequate community food environment as well as limited household food resources were an important risk factor for food insecurity in Korean single rural seniors. Findings of this study could help us better understand how characteristics of household food resources and community food environment can serve as barriers or facilitators of food security among single older adults residing in rural areas.

Childhood obesity rates appear to be more pronounced among youth in rural areas of the USA. The availability of retail food outlets in rural communities that sell quality, affordable, nutritious foods may be an important factor for encouraging rural families to select a healthy diet and potentially reduce obesity rates. Researchers use the term 'food desert' to describe communities where access to healthy and affordable food is limited. Understanding the ways in which the food environment and food deserts impact childhood obesity may be a key component to designing interventions that increase the availability of healthy and affordable foods, thus improving the health of rural communities. The food environment was investigated in 6 rural low-income Maine communities to assess how food environments affect eating behaviors and obesity rates of rural children enrolled in Medicaid/State Children's Health Insurance Program in Maine ('MaineCare'). Focus groups were conducted with low-income parents of children enrolled in MaineCare to ask them about their food shopping habits, barriers faced when trying to obtain food, where they get their food, and what they perceive as healthy food. Cost, travel distance, and food quality were all factors that emerged as influential in rural low-income family's efforts to get food. Parents described patterns of thoughtful and creative shopping habits that involve coupons and sales. Grocery shopping is often supplemented with food that is harvested, hunted, and bartered. The use of large freezers for storing bulk items was reported as necessary for survival in 'tough' times. Families often travel up to 128.8 km (80 miles) to purchase good quality, affordable food, recognizing that in rural communities travelling these distances is a reality of rural life. Parents appeared to know what qualities describe 'healthy food'. Rural families may have greater flexibility and opportunity to be methodical in their food shopping than urban families since many have access to cars and large freezers. This creates a buffer around these rural communities that might otherwise be considered food deserts. Although the meaning of food desert may be different in rural areas than in urban, it does not negate the fact that low-income rural families are struggling. The combination of challenges that rural low-income families face call for more rigorous study to identify promising interventions for increasing food access and quality in these communities. Participants have developed creative skills for getting food on the table and they know what healthy food is. Despite having acquired this knowledge and these skills, rural families are struggling. With these struggles in mind, policy-makers should consider the shopping patterns reported in this study when thinking about how to help rural residents better access affordable, healthy and quality foods. Customary approaches to remedying the problem of food deserts in urban areas, such as building more grocery stores, may not be necessary in rural areas. More creative approaches for food-access policy changes, subsidies and incentives are needed to match the complex and multi-faceted strategies that low-income residents utilize to feed their families.

Association of County-Level Food Deserts and Food Swamps with Hepatopancreatobiliary Cancer Outcomes

The Need for Investment in Rigorous Interventions to Improve Child Food Security

DIET AND PANCREATIC CANCER Environmental and lifestyle factors are known to have causal roles in pancreatic cancer pathogenesis. An estimated 5% to 10% of patients with pancreatic cancer have an underlying germline disorder, whereas the remainder of cases is thought to result from damage to genes occurring during the life span of the individual.1 Smoking is a clear risk factor, implicated in 20% to 25% of pancreatic cancers. The interaction of diet and physical activity and the potentially associated diseases of obesity and diabetes are complex and can contribute to 30% of pancreatic cancers. However, most studies find little to no association between alcohol consumption and pancreatic cancer, except for the increased risk in patients with alcoholic chronic pancreatitis, but types 1 and 2 diabetes mellitus increase the risk of pancreatic cancer with a latency period of more than 5 years.2 A number of reviews have summarized the nutritional and lifestyle factors that have been associated with pancreatic cancer risk.3 The report from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) "Food Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective" summarizes the evidence base of reported associations between food, nutrition, physical activity, and cancer of the pancreas.4 The expert panel determined that there is a probable association between foods containing folate and decreased risk of pancreatic cancer, whereas convincing evidence that higher body fatness, abdominal fatness, and adult attained height increase risk. Limited evidence suggests that fruit intake and physical activity decreases risk, whereas red meat intake increases risk. The nutritional links to plausible mechanisms underlying pancreatic cancer were the subject of a National Cancer Institute Nutritional Science Research group conference.5 The primary dietary themes that were discussed included: (1) the relationship between insulin resistance, diabetes, obesity, and dietary macronutrients on the development of pancreatic cancer; (2) the impact of dietary methyl donors and DNA methylation status on cellular differentiation and growth in pancreatic carcinogenesis; and (3) the effect of dietary antioxidants on oxidative DNA damage and repair in pancreatic cancer cells. These and other factors are currently actively investigated as mechanisms for the linkages between dietary and lifestyle factors and pancreatic cancer risk. Current studies rely on newly developed tools and resources that represent substantial progress since the first pancreatic cancer "think tank" convened on September 16, 1999.6 New animal models are now available, which more accurately replicate the human disease, and researchers have mapped premalignant histologic and molecular events in pancreatic carcinogenesis in both human cancer and animal models.7 In addition, the relationship between cancer and stroma, as well as the role of cancer stem cells, has been more clearly defined, and new biomarkers to identify early disease are in development. These findings have been used to inform the recently developed consensus report of the National Cancer Institute Clinical Trial on Pancreatic Cancer treatment to provide a roadmap for new clinical trial development.8 However, despite the increased understanding of the mechanisms and risks for pancreatic cancer, incidence rates have not diminished during the last 30 years of surveillance, and pancreatic cancer still remains one of the most deadly cancers. To truly impact the incidence of pancreatic (and other) cancers, primary prevention remains the key. The current epidemic of obesity illustrates that nutrition and physical activity among the US population are far less than optimal and the necessity of sound population-level guidance is needed now more than ever. DGA 2010 AND DISEASE PREVENTION The primary guidance for federal nutrition policy and nutrition education activities is the Dietary Guidelines for Americans (DGA); the DGA 2010 was released on January 31, 2011. The DGA has been published jointly every 5 years since 1980 by the Departments of Health and Human Services and Agriculture, as required by federal legislation. A Dietary Guidelines Advisory Committee (DGAC) composed of prominent experts in nutrition and health is convened every 5 years to review the evidence base for the recommendations and to write a report for the secretaries of the Departments of Health and Human Services and Agriculture. The DGAC Report is used as the basis for the policy document which is the DGA (http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf). The stated purpose of the DGA is "to be used in developing educational materials and aiding policymakers in designing and carrying out nutrition-related programs, including Federal nutrition assistance and education programs. The Dietary Guidelines also serve as the basis for nutrition messages and consumer materials developed by nutrition educators and health professionals for the general public and specific audiences, such as children."9 For the report presented to the secretaries in 2005, the DGAC used a new approach for updating the guidelines. The committee members initially posed 40 specific research questions that were put through an extensive evidence-based search and review of the scientific literature. Issues relating diet and physical activity to health promotion and chronic disease prevention were examined. In fact, the DGAC report used as the basis of DGA 2005 was the first to take into account chronic disease risk, including cancer risk, when defining nutrient requirements. What Is New in DGA 2010 The process for writing the DGAC 2010 Report was informed in several different ways new to this report. First, a new resource was commissioned-a state-of-the-art Web-based electronic system for systematic literature reviews called the Nutrition Evidence Library. Multidisciplinary teams reviewed the literature to answer specific questions posed by the DGAC for the Nutrition Evidence Library. This key resource on food and nutrition research remains freely accessible to the public at http://www.nutritionevidencelibrary.com/. Additional resources used for drafting the DGAC 2010 Report included independent analyses of surveillance and other data, food pattern modeling, and review of other evidence-based reports, including the 2008 Physical Activity Guidelines for Americans (http://www.health.gov/paguidelines/default.aspx). The chapters of the report summarize current evidence related to specific topics using these resources and present the highlights. Another addition to the 2010 report is 2 newly developed chapters. One focuses on the total diet and how to integrate all of the report's nutrient and energy recommendations into practical terms. The approach used is to foster personal choice but encourage an eating pattern that is nutrient dense and calorie balanced. The second new chapter focuses on translating the scientific conclusions reached at the individual level and focuses on the broader environmental and societal aspects that influence individual dietary choices. The DGA 2010 recognizes that most Americans are obese/overweight yet undernourished in several key nutrients, and weight control is an emphasis in the current report. The 2 overarching concepts of the recommendations in DGA 2010 are to9: Maintain calorie balance over time to achieve and sustain a healthy weight; Focus on consuming nutrient-dense foods and beverages. Key recommendations discuss strategies to balance calories to manage weight and to choose healthful meal patterns. One of the most important aspects of the DGA 2010 is the recognition that promoting individual behavior change is not enough to realize these goals. The socioecological framework for nutrition and physical activity decisions is presented to remind us that multiple elements of society help shape an individual's food and physical activity choices and, ultimately, calorie balance and chronic disease risk. This sets the stage for a call to action that includes 3 guiding principles9: Ensure that all Americans have access to nutritious foods and opportunities for physical activity; Facilitate individual behavior change through environmental strategies; Set the state for lifelong healthy eating, physical activity, and weight management behaviors. Importantly, a primary message of the DGA 2010 is that everyone has a role in the movement to make Americans healthy, and a coordinated system-wide approach engages all sectors of society-individuals, families, educators, communities and organizations, health professionals, small and large business, and policymakers-is required. The focus on environmental change strategies is very important and represents a shift away from an emphasis on personal responsibility toward making "the healthy choice the easy choice." Increasingly, health professionals are focusing on the fact that, in order for people to make healthy choices, they need to have the opportunities to do so. For example, much recent work has cataloged the presence of "food deserts," geographic locations, both urban and rural, where affordable nutritious food is not accessible due to lack of grocery stores, farmers' markets, and other retail outlets. Additional constraints in food deserts for low-income individuals can include lack of transportation to food stores and affordability of healthful foods.10 The US Department of Agriculture has summarized state and county-level data on food insecurity, as well as other indicators, in the Food Environment Atlas (http://maps.ers.usda.gov/FoodAtlas/). Public health nutrition programs increasingly emphasize optimizing the food environment, which includes the quality of food available to a person, a person's proximity to food store locations, the distribution of food stores and food service, and the supply chain that provides food to a location (http://www.cdc.gov/healthyplaces/healthtopic/healthyfood/general.htm). Federal programs such as the CDC's Communities Putting Prevention to Work program (funded by the American Recovery and Reinvestment Act of 2009) strive to prevent chronic disease by producing sustainable, positive and improved health outcomes through the implementation of programmatic efforts through policy, systems, and environmental-level change. Tactics can include using media to promote healthful foods, restricting advertising of unhealthful foods and using counteradvertising, increasing access to healthy food drink/choices and opportunities for physical activity, improving the built environment, and using point-of-decision labeling/signage/placement along with pricing structure to benefit consumption of healthy foods/drinks (http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/strategies/index.htm). First Lady Michelle Obama's Let's Move Initiative is providing leadership in bringing together efforts of many different stakeholder groups to tackle the multifactorial causes of childhood obesity through programs that create a healthy start for children, empower parents and caregivers, provide healthy foods in schools, improve access to healthy, affordable foods, and increase physical activity (http://www.letsmove.gov/). In addition, a proposed federal Healthy Food Financing Initiative will bring grocery stores and other healthy food retailers to underserved urban and rural communities across America (http://www.hhs.gov/news/press/2010pres/02/20100219a.html). What Is Not Addressed in DGA 2010 Both DGA 2005 and 2010 highlight the importance of fruits, vegetables, and whole grains in the diet. The relationships between these foods and cancer risk are also outlined in the WCRF/AICR report. However, active research programs in pancreatic cancer focus on the role of phytochemicals from plant foods on pancreatic carcinogenesis. Interesting results in preclinical studies show potential efficacy in inhibiting pancreatic carcinogenesis for a number of compounds, including curcumin, green tea polyphenols, genistein, isothiocyanates, and others.3 However, as noted in the DGAC Report, phytochemicals are thought not to be essential to the diet, so no daily requirement has been established for them. There are as many as 100,000 different phytochemicals, a large proportion of which are bioactive.9 Much more research is needed to fully assess the mechanisms of action, as well as the health-supporting properties of these compounds; only then can a public health recommendation around phytochemical intake be formulated. In the meantime, the DGA's emphasis on increasing not only the total quantity but also the variety of fruit and vegetables in the diet to provide a range of phytochemical and nutrient resources is well founded. Another area not well addressed in the current report is the potential carcinogenic and other deleterious effects of toxic chemicals accumulating in the food chain. In the context of seafood consumption, a benefit-to-risk ratio analysis was conducted, weighing the positive health benefits of consuming seafood, including reducing the risk of cardiovascular disease and supporting child neurologic development, against the risks from exposure to persistent organic pollutants, including methyl mercury. The evidence assessment was particularly important in providing information about populations vulnerable to methyl mercury exposure, such as pregnant and breast-feeding women and young children. The potential benefits of consuming foods produced through organic growing practices were also raised, but the DGAC concluded that current scientific evidence did not warrant a question on this topic. A short review of the topic by the Food Safety and Technology subcommittee was produced summarizing the literature on nutritional value of organically grown produce (http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/Report/Resource3-Organics.pdf). Rightly so, the conclusion of the subcommittee is that inconsistencies seen between studies in nutrient and phytochemical levels in produce are mostly related to agronomic and storage considerations, including cultivar choice, fertilizer use, and postharvest storage, rather than with organic growing practices per se. However, the important public health benefits of reduced pesticide use in diminished residue accumulation and decreased occupational exposure for agricultural workers were not detailed. For example, there is no mention of the growing literature describing the demonstrable pesticide load in children, which is decreased with consumption of organic foods.11,12 The 2008-2009 Annual Report of the President's Cancer Panel noted that occupational and environmental pesticide exposure is suspected to be associated with pancreatic cancer risk.13 IMPLEMENTATION OF DGA 2010 Implementation and translation of the DGA are proceeding in a number of different approaches. Consumer messages have been formulated to promote different aspects of the guidance for individuals (http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/SelectedMessages.pdf). For example, one message advising consumers to fill half their plate with fruits and vegetables is easy-to-follow advice, similar to the New American Plate concept promoted by AICR that advocates for two-thirds (or more) of the plate is vegetables, fruits, whole grains, or beans and one-third (or less) animal protein (http://www.aicr.org/site/PageServer?pagename=reduce_diet_new_american_plate_portion). Updated nutrition standards for the National School Lunch Program to bring them in alignment with DGA 2010 have completed a public comment period (http://www.fns.usda.gov/cnd/governance/regulations.htm); others for the Child and Adult Care Food Program are pending. The recently released "Health and Sustainability Guidelines for Federal Concessions and Vending Operations" applies the DGA 2010 to federal food service operations and assists contractors in increasing healthy food and beverage choices and sustainable practices at federal worksites (http://www.cdc.gov/chronicdisease/resources/guidelines/food-service-guidelines.htm). A critical legacy of the DGA 2010 is the use of the Guidelines not only for providing individual nutrition education but also for informing public health nutrition programs to improve the food environment. The DGA 2010 provides an action plan for sustainable changes in food access and availability that must occur in multiple settings to support the efforts of all Americans to meet the updated dietary recommendations. As we continue to identify the various risk factors and the important dietary, physical activity, lifestyle, and environmental influences in the development of pancreatic cancer, formulation and implementation of disease prevention strategies at the community level also will continue to be of utmost importance.

Upstream socioeconomic circumstances including food insecurity and food desert are important drivers of community-level health disparities in cardiovascular mortality let alone traditional risk factors. The studyassessed the association between differences in food environment quality and cardiovascular mortality in US adults. Retrospective analysis of the association between cardiovascular mortality among US adults aged 45 and above and food environment quality, measured as the food environment index (FEI), in 2615 US counties. FEI was measured by equal weights of food insecurity (limited access to a reliable food source) and food desert (limited access to healthy food), ranging from 0 (worst) to 10 (best).Age-adjusted cardiovascular mortality rates per 100,000 adults aged 45 and above in the calendar year 2017-2019. County-level association between CVD mortality rate and FEI was modeled using generalized linear regression. Data were weighted using county population. Median CVD deaths per 100,000 population were 645.4 (IQR 561.5, 747.0) among adults aged 45years and above across US counties in 2017-2019. About 12.8% (IQR 10.7%, 15.1%) of residents were food insecure and 6.3% (IQR 3.6%, 9.9%) were living in food desert areas. Comparing counties by FEI quartiles, the CVD mortality rate was higher in the least healthy FE counties (704.3 vs 598.6 deaths per 100,000 population) compared to the healthiest FE counties. One unit increase in FEI was associated with - 12.95 CVD deaths/100,000 population. In the subgroup analysis of counties with higher income inequality, the healthiest food environment was associated with 46.4 lower CVD deaths/100,000 population than the least healthy food environment. One unit increase in FEI in counties with higher income inequality was associated with a fivefold decrease in CVD mortality difference in African American counties (- 18.4 deaths/100,000 population) when compared to non-African American counties (- 3.63 deaths/100,000 population). In this retrospective multi-county study in the USA, a higher food environment index was significantly associated with lower cardiovascular mortality.

Ethnic-racial disparities in food environments contribute to food insecurity and diet-related health inequities. This systematic review and meta-analyses aimed to assess ethnic-racial inequities in the community and consumer food environments worldwide. MEDLINE, Embase, Web of Science, and LILACS databases were searched for studies published from inception to September 17, 2025. A total of 109 studies met the inclusion criteria, with 87.1% conducted in the United States. Findings indicated that Blacks were disproportionately affected by food deserts and food swamps, with lower availability of supermarkets and healthy food stores and greater exposure to unhealthy food retailers and advertising. Latinos/Hispanics and Indigenous/Natives also faced disadvantages, including higher exposure to unhealthy food outlets and increased likelihood of living in food deserts. Asians showed mixed results, with greater access to grocery stores but higher exposure to unhealthy food environments. In the meta-analysis, ethnic-racial minorities were 70% more likely to reside in food deserts (Pooled OR: 1.70; 95% CI: 1.17-2.45), and food deserts [Pooled Mean Difference (MD): 3.63; 95% CI: 1.44-5.81] and food swamps had higher proportion of ethnic-racial minorities (Pooled MD: 2.02; 95% CI: 0.09-3.96) than non-food deserts and non-food swamps, respectively. These findings highlight structural inequalities shaping food environments and the urgent need for policies addressing food access disparities. Future research should expand beyond the U.S. and adopt standardized methodologies to better understand global ethnic-racial food environment disparities and their health implications.

The purpose of this case study in San Lorenzo, Paraguay is to identify a food desert in a developing context and to test if food deserts shape residential obesity risk. This article reviews some of the debate surrounding whether food deserts really exist; and, if so, what are the dietary implications of living in a food desert. The research is an exploratory/explanatory design. The author mapped the downtown food retail district and the neighborhood food environment to identify what stores/markets. The author assessed each type of food store using an adapted version of the Nutrition Environment Measure Survey for Stores (NEMS-S) for Paraguay. Body mass index and household characteristics were collected with 68 households in a small neighborhood; and, the author matched the NEMS-S scores to the store reported by households as their primary grocery store for regression tests. The results suggest that a tradeoff exists in the local food environment between food stores which negatively impact obesity risk for local residents. Exposure to this tradeoff appears to worsen as people live longer in the food desert. Thus, the results support the location of a food desert finding in Paraguay. The underlying factors of a food desert extend beyond food access to focus on the issues of justice. A way to improve upon future research to build scholarship on the relationship between deprivation and obesity requires that sample sizes are either large or representative of the population and that the research should be based on multiple neighborhood and city sites.

This article takes a new approach to studying food access. It combines environmental justice analysis with systems thinking in an examination of the food environment of Detroit. The article reviews food access literature and identifies how each body of scholarship’s underlying assumptions help or distort our understanding of urban food environments. The article argues for more comprehensive approaches to studying food access and demonstrates how such approaches can be implemented. We collected data from multiple sources, including ReferenceUSA, Orbis, and the Michigan Department of Agriculture, between 2011 and 2013 to build a database of food outlets in the city. We used SPSS 22 and ArcGIS 10.1 to analyze and map the data. The article analyzes the location of 3,499 food outlets in Detroit, comprising 34 categories food retailers, growers, supply chain, and food assistance programs. The study identified 96 supermarkets or full-line grocery stores; 1,110 small groceries, convenience stores, mini marts, and liquor stores; 279 specialty food stores; 306 pharmacies, dollar, and variety stores; 1,245 full-service and fast food restaurants and other food service outlets; 157 supply chain operations; 206 farms, community and school gardens, farmers’ markets, and produce markets; and 100 food assistance programs. The article finds that though Detroit has areas that lack food outlets, the portrayal of the entire city as a “food desert” is misleading. Moreover, the traditional approach of food desert research of using only or primarily the presence or absence of supermarkets and full-line grocery stores to study food access ignores many important venues from which people obtain food. It also ignores the strategies people use to cope with food insecurity and their responses to limited food access.Environmental Practice 17: 102–133 (2015)

The concept of the food desert, an area with limited access to retail food stores, has increasingly been used within social scientific and public health research to explore the dimensions of spatial inequality and community well‐being. While research has demonstrated that food deserts are frequently characterized by higher levels of poverty and food insecurity, there has been relatively little research examining the relationship between food deserts and obesity, particularly in rural areas. In this article we use Geographic Information System (GIS) techniques to identify food desert areas in rural Pennsylvania. We then analyze student body mass index (BMI) data along with census and school district‐level data to determine the extent to which the percentage of a school district's population residing within a food desert is positively associated with increased incidence of child overweight among students within the district. We find that school districts with higher percentages of populations located within food deserts are more likely to be structurally and economically disadvantaged. Net of these district‐level structural and economic characteristics, we additionally find a positive relationship between increased rates of child overweight and the percentage of the district population residing in a food desert.

Child Food Insecurity and Neighborhood Food Environment in Relation to Academic Performance and Behavior Problems Among a National Sample of Kindergarten Children (OR02-04-19)