Determinants of food retail outlet choice in an urban food environment: a qualitative study in Indonesia

PROTOCOL: Impact of the food environment on diet-related health outcomes in school-age children and adolescents in low- and middle-income countries: a systematic review.

The obesity rate in Chicago has increased up to more than 30% in the last two decades. Obesity is a major problem in Chicago, where 36% of the city’s high school students and 61% of adults in the metropolitan area are overweight or obese. Simultaneously, Chicago remains highly segregated by race—a phenomenon that begs for spatial analysis of health. Extant work exploring associations between the food retail environment and obesity has provided mixed findings, and virtually, none of this work has been done with the effects of the interaction between racial segregation and the food retail environment on obesity, where obesity rates are among the highest in the segregation area for the city defined by racial segregation. This study explores whether being overweight or obese is associated with urban food environments, such as access to different types of food retail outlets, and how its associations interact with racial factors, at the community level. This study uses the 2016–2018 data from the Healthy Chicago Survey to investigate the spatial variations in obesity and their association with food environments in Chicago. Also, this study examines the moderating effects of racial segregation on associations between obesity and access to food retail outlets. Using spatial statistics and regression models with interaction terms, this study assesses how the urban food environment can interact with racial segregation to explain the spatial distribution of obesity. The results indicate that the obesity population is highly concentrated in the African American community. In Chicago, each additional convenience store in a community is associated with a 0.42% increase in the obesity rate. Fast food restaurant access is predictive of a greater obesity rate, and grocery store access is predictive of less obesity rate in a community with a higher percentage of African American population. Findings can be used to promote equitable access to food retail outlets, which may help reduce broader health inequities in Chicago.

Validity of secondary retail food outlet data: a systematic review.

BackgroundBased on the need for better measurement of the retail food environment in rural settings and to examine how deprivation may be unique in rural settings, the aims of this study were: 1) to validate one commercially available data source with direct field observations of food retailers; and 2) to examine the association between modified neighborhood deprivation and the modified retail food environment score (mRFEI).MethodsSecondary data were obtained from a commercial database, InfoUSA in 2011, on all retail food outlets for each census tract. In 2011, direct observation identifying all listed food retailers was conducted in 14 counties in Kentucky. Sensitivity and positive predictive values (PPV) were compared. Neighborhood deprivation index was derived from American Community Survey data. Multinomial regression was used to examine associations between neighborhood deprivation and the mRFEI score (indicator of retailers selling healthy foods such as low-fat foods and fruits and vegetables relative to retailers selling more energy dense foods).ResultsThe sensitivity of the commercial database was high for traditional food retailers (grocery stores, supermarkets, convenience stores), with a range of 0.96-1.00, but lower for non-traditional food retailers; dollar stores (0.20) and Farmer’s Markets (0.50). For traditional food outlets, the PPV for smaller non-chain grocery stores was 38%, and large chain supermarkets was 87%. Compared to those with no stores in their neighborhoods, those with a supercenter [OR 0.50 (95% CI 0.27. 0.97)] or convenience store [OR 0.67 (95% CI 0.51, 0.89)] in their neighborhood have lower odds of living in a low deprivation neighborhood relative to a high deprivation neighborhood.ConclusionThe secondary commercial database used in this study was insufficient to characterize the rural retail food environment. Our findings suggest that neighborhoods with high neighborhood deprivation are associated with having certain store types that may promote less healthy food options.

(1) Background: To date, there are limited data in low- and middle-income countries (LMICs) that collect, monitor, and evaluate food environments in standardized ways. The development of a pilot survey tool, tailored to LMICs and focused on retail food environments, is necessary for improving public health nutrition. (2) Methods: A novel survey tool was developed and piloted in a sample of village retail food environments (n = 224) in Matiari, Pakistan between October 2020 to April 2021. Villages were randomly selected, and food outlets were surveyed within a 500-m radius from each village center. Descriptive statistics (counts and percentages) were used to describe the characteristics of food outlets and the availability of food. To test whether there was a difference in characteristics or in the mean of number of healthy, unhealthy, and total food items available by village size, a χ2 test or one-way ANOVA was conducted, respectively. (3) Results: In total, 1484 food outlets were surveyed for food accessibility, availability, and promotion across small (n = 54), medium (n = 112), and large villages (n = 58). In small and medium-sized villages, mobile food vendors were the predominant food outlet type (47.8% and 45.1%, respectively), whereas in large villages, corner stores (36%) were more prominent. The mean number of total food items (p < 0.006) and unhealthy food items (p < 0.001) available in food outlets differed by village size. The proportion of food outlets with available fruits, meat and poultry, water, and sugar-sweetened beverages also differed by village size (p < 0.001). (4) Conclusions: This study informs the global evidence gap in the current understanding of food environments in various ethnically diverse and dynamic LMICs, and the developed methodology will be useful to other LMICs for measuring and monitoring the food environment, especially among vulnerable population groups. This work complements current national and provincial survey efforts in Pakistan.

BackgroundFood retail and food service outlets can be part of a chain, or independently operated. Chain food outlets are likely to have the most influence over community food environments but have not been routinely identified in studies which map and monitor access to food, highlighting an important knowledge gap. This study aimed to identify the food retail and food service outlets present within metropolitan Perth, including presence of chain and independent food outlets; and examine differences across local governments.MethodsA nutrition-focused classification framework was applied to all food businesses registered by 32 local governments in Perth, Western Australia, in 2022. All food retail and food service outlets (n = 9069) were identified and classified as part of a chain or independently operated. Chain food outlets were further classified as major or minor. Descriptive statistics summarised access to major and minor chain food outlets within metropolitan Perth and across local governments.ResultsA total of 9069 food outlets (food retail = 2908; food service = 6161) provided access to food in metropolitan Perth. Convenience stores (n = 498, 17.1%) and supermarkets (n = 441, 15.2%) were the most common food retail categories. Fast food outlets (n = 2494, 40.5%) were the most common food service category. Chains (n = 205) represented 28.5% of all food outlets present and were more prevalent in some categories (e.g., 79.6% of all supermarkets present). Across local governments the proportion of food outlets that were chains ranged from 4.9% to 43.1%. The mean density of chain food outlets was 11.62 per 10,000 population (range 2.41, 49.89).ConclusionsThis study of the community food environment in an Australian capital city is the first to examine all food retail and food service outlets present and identify chains, using high quality data provided by local governments. The findings can be used to support evidence-based policies to improve population diets. Government policy which focuses on action within chain food outlets has potential to positively influence public health.

Objectives To determine the barriers and facilitators to using real world data (RWD) in healthcare settings in low-and middle-income countries (LMICs). Method We conducted a systematic review through searching MEDLINE, EMBASE, Global Health Database and CINAHL. We searched for qualitative studies that address the use of RWD, barriers and facilitators, and its applications in LMICs. Study participants included healthcare settings/organizations in LMICs which collect and use RWD. Primary outcomes are the roles of using RWD, and barriers/facilitators affecting the applications of RWD in healthcare settings in LMICs. Data extraction included contextual and methodological data. Quality of review will be assessed using the CASP Qualitative checklist, and we will follow the ENTREQ checklist for synthesis of qualitative research. Risk of bias will be assessed using GRADE-CERQual to determine the level of confidence from qualitative evidence synthesis. Qualitative data synthesis will be done as narrative/descriptive synthesis of the roles of using RWD in healthcare settings in LMICs; thematic synthesis and conceptual framework of the barriers/facilitators of using RWD and its applications. Results The review addressed the use of real-world data in healthcare settings in LMICs, according to World Bank classification including 137 countries as per World Bank country classification. Initial search across the four databases showed a total of 2,245 search results. The results were separated into three sets; systematic reviews (n = 27) from 2012 until 2018; primary studies (n = 2,048) from 1988 until 2019; and conference abstracts (n = 170) from 2004 until 2018. Preliminary searches are completed, and piloting of the study selection process was done. Formal screening of results against eligibility criteria is underway and will be presented in conference. Conclusions The use of RWD in healthcare settings in LMICs is important to make evidence-based improvements in care delivery and health outcomes. Results from this systematic review will address the gap in evidence about what real world data is used in LMICs and the barriers and facilitators to its use. This review will generate qualitative evidence about the roles, barriers and facilitators and real-world applications of using RWD in healthcare settings in LMICs.

BackgroundFood environment characterization in health studies often requires data on the location of food stores and restaurants. While commercial business lists are commonly used as data sources for such studies, current literature provides little guidance on how to use validation study results to make decisions on which commercial business list to use and how to maximize the accuracy of those lists. Using data from a retrospective cohort study [Weight And Veterans’ Environments Study (WAVES)], we (a) explain how validity and bias information from existing validation studies (count accuracy, classification accuracy, locational accuracy, as well as potential bias by neighborhood racial/ethnic composition, economic characteristics, and urbanicity) were used to determine which commercial business listing to purchase for retail food outlet data and (b) describe the methods used to maximize the quality of the data and results of this approach.MethodsWe developed data improvement methods based on existing validation studies. These methods included purchasing records from commercial business lists (InfoUSA and Dun and Bradstreet) based on store/restaurant names as well as standard industrial classification (SIC) codes, reclassifying records by store type, improving geographic accuracy of records, and deduplicating records. We examined the impact of these procedures on food outlet counts in US census tracts.ResultsAfter cleaning and deduplicating, our strategy resulted in a 17.5% reduction in the count of food stores that were valid from those purchased from InfoUSA and 5.6% reduction in valid counts of restaurants purchased from Dun and Bradstreet. Locational accuracy was improved for 7.5% of records by applying street addresses of subsequent years to records with post-office (PO) box addresses. In total, up to 83% of US census tracts annually experienced a change (either positive or negative) in the count of retail food outlets between the initial purchase and the final dataset.DiscussionOur study provides a step-by-step approach to purchase and process business list data obtained from commercial vendors. The approach can be followed by studies of any size, including those with datasets too large to process each record by hand and will promote consistency in characterization of the retail food environment across studies.

Rapid urbanisation in the Asia-Pacific region is associated with complex changes to urban food environments. The impact of changing food environments on food purchasing and consumption and the diets and nutritional status of vulnerable groups, especially women and young children, is not well researched in low- and middle-income country cities. This paper aimed to examine: the risks and opportunities for healthy diets for low income populations offered by modernising urban centres; the concept of food deserts in relation to urban food environments in the Asia-Pacific region and how these could be mitigated; and measures to strengthen the resilience of food environments in the region using a case study of the impact of COVID-19 on informal food vendors. Our findings indicate that the dynamic changes in urban food environments in the Asia- Pacific region need to be understood by examining not only modern retail food outlets but also wet markets and informal food outlets, including street foods. Efforts should be made to ensure both modern and traditional outlets provide complementary platforms for convenient, affordable and accessible nutritious foods for urban populations. The resilience of urban food environments to environmental, physical and socio-economic shocks can be strengthened by shortening food supply chains and maximising food production in cities. Support mechanisms targeting urban informal food outlets and street vendors can also strengthen resilience and improve food security. Further research is needed on the impact of urbanising food environments on consumer choices, preferences, diets and health outcomes.

Background: There have been mixed findings on the relationships between childhood obesity and macroscale retail food environments. The current study investigates associations of the neighborhood retail food environment with changes in children's weight status over 6 years in the Kansas City Metropolitan area. Methods: Anthropometrics and home addresses were collected during routine well-child visits in a large pediatric hospital (n = 4493; >75% were Black or Latinx children). Children had measures collected during two time periods ([Time 1] 2012-2014, [Time 2] 2017-2019). Establishment-level food environment data were used to determine the number of four types of food outlets within a 0.5-mile buffer from the children's residence: supermarkets/large grocery stores, convenience stores/small grocery stores, limited-service restaurants, and full-service restaurants. Children who moved residences between periods were "movers" (n = 1052). Associations of baseline and changes in food environment status with Time 2 weight status were assessed using mixed-effects models. Results: Movers who experienced no change in the number of convenience stores or small grocery stores within a 0.5-mile of their home had increased likelihoods of having overweight/obesity and less favorable BMIz changes, compared with movers who experienced a decrease in convenience stores/small grocery stores within a 0.5-mile distance. No associations were observed among nonmovers. Conclusion: Findings suggest that moving to an area with fewer unhealthy retail food outlets (e.g., convenience stores) is associated with a lower risk of obesity in children. Future research is needed to determine whether larger-scale changes to the retail food environment within a neighborhood can support children's healthy weight.

In order to achieve the Sustainable Development Goals, considerable dietary shifts, including an increase in the consumption of fruit and vegetables (FV) will be required. However, worldwide consumption of FV is far below international recommendations, including in many low- and middle-income countries (LMICs), particularly in Africa. Understanding what, where, when, and how people choose to eat requires an understanding of how individuals are influenced by factors in their social, physical, and macro-level environments. In order to develop effective interventions to increase fruit and vegetable consumption, the factors influencing consumer behavior need to be better understood. We conducted a rapid review to assess and synthesize data on individual, social, physical, and macro-level factors that enable or constrain fruit and vegetable consumption and purchase among adults living in sub-Saharan Africa. Our conceptual framework is based on a socio-ecological model which has been adapted to settings in LMICs and Africa. We systematically searched four electronic databases including Scopus, Medline (PubMed), PsycInfo, and African Index Medicus, and screened Google Scholar for gray literature. We included a total of 52 studies and narratively summarized the existing evidence for each identified factor across the different levels. We found that most studies assessed demographic factors at the individual level including household or family income, socio-economic status and education. Furthermore we identified a variety of important factors that influence FV consumption, in the social, physical, and macro environment. These include women's empowerment and gender inequalities, the influence of neighborhood and retail food environment such as distance to market and price of FV as well as the importance of natural landscapes including forest areas for FV consumption. This review identified the need to develop and improve indicators both for exposure and outcome variables but also to diversify research approaches.

There have been calls for more research to investigate the sociocultural context of retail food environments. This paper examines how a segment of Ottawa, Ontario, Canada, residents described convenience stores (CS) in their local retail food environments. 84 social media discussions from Ottawa residents pertaining to their local retail food outlets were qualitatively analyzed, and three themes were formulated: 1) CS are interchangeable, 2) CS are not ‘real stores,’ and 3) CS are dangerous retail food outlets. We argue that these social constructions of CS have implications for healthy food environments and offer suggestions for future research.

Several studies have examined associations between the food retail environment and obesity, though virtually no work has been done in the urban South, where obesity rates are among the highest in the country. This study assessed associations between access to food retail outlets and obesity in New Orleans. Data on individual characteristics and body weight were collected by telephone interviews from a random sample of adults (N = 3,925) living in New Orleans in 2004-2005. The neighborhood of each individual was geo-mapped by creating a 2-km buffer around the center point of the census tract in which they lived. Food retailer counts were created by summing the total number of each food store type and fast food establishment within this 2-km neighborhood. Hierarchical linear models assessed associations between access to food retailers and obesity status. After adjusting for individual characteristics, each additional supermarket in a respondent's neighborhood was associated with a reduced odds for obesity (OR 0.93, 95% CI 0.88-0.99). Fast food restaurant (OR 1.01, 95% CI 1.00-1.02) and convenience store (OR 1.01, 95% CI 1.00-1.02) access were each predictive of greater obesity odds. An individual's access to food stores and fast food restaurants may play a part in determining weight status. Future studies with longitudinal and experimental designs are needed to test whether modifications in the food environment may assist in the prevention of obesity.

Food availability affects eating habits, and in the Australian context, refers to the numbers and locations of food retail and food service outlets and the types and range of foods in those outlets. The aim of this study was to assess the community and consumer food environment in three small rural towns in New South Wales, Australia. Geographical analyses were used to measure the diversity, variety and locations of food outlets (community food environment); and checklists were used to assess the availability of selected indicator foods within food outlets (consumer food environment). Supermarkets provided access to the full range of healthy indicator foods, with convenience stores selling a more limited set of healthy food items. There were high numbers of take-away food outlets in each town that had no, or a limited number of, healthy food items. Energy-dense, nutrient-poor foods such as soft drinks and potato crisps were readily available across all food retail outlets in all towns. This study illustrates a valid, reliable and practical way of systematically describing food availability at a local level. The findings emphasise the ubiquity of energy-dense, nutrient-poor foods, and suggest that interventions to promote the availability of healthier food items in take-away food outlets are required. Further research is required to assess other factors which may affect residents' food access, such as cost and transport.

This cross-sectional study evaluated the retail food environment (FE) around early childhood education centers (ECEC) in Rio Largo/AL, Brazil. Food retail outlets (FRO) were identified through a city street survey and audited using the Brazilian version of the Nutrition Environment Measurement Survey for Stores (NEMS-S). The Department of Education provided the ECEC's addresses, which were validated and geocoded (n=21). Schools' surroundings were defined by 400- and 800-meter buffers. The FE was analyzed using the healthy food availability index (HFAI), average distance between FRO and ECEC, and distribution and density of FRO according to the predominant type of food marketed (healthy, mixed, and unhealthy). Respectively, 332 (57.7%) and 505 (87.8%) FRO were identified in the 400- and 800-meter buffers. On average, 23 (400 m) and 54 (800 m) FRO were around schools, where ~60% were unhealthy (clustered throughout the city). The HFAI was very low for both buffers (400m: -1 points [IQR -6; 10]; 800m: -2 points [IQR -6; 10]). In conclusion, the city does not offer a supportive community food environment for children to develop and maintain healthy eating patterns.