Community Food Environment Research Articles

Spatial and Social Determinants of Household Food Environments in Central North Carolina

Abstract Objectives This study explores sociodemographic predictors of household food environments and tests the hypothesis that they are associated with community food environments. Methods Data are from the baseline visit of the Mothers & Others study, an early life obesity prevention trial among 430 African-American mothers in central North Carolina. Healthy Homes Survey (HHS) data assessed household food availability, type and variety. Exploratory factor analysis (EFA) with oblique rotations consolidated 45 HHS variables into household food environment (HFE) types. From data retailer InfoUSA we obtained geocoded data containing all food outlets in the study area to assess proximity and density of food outlets near households. Linear regressions tested associations between maternal and household characteristics and HFE factor scores. Adjusted models tested the association between HFE factor scores, community food environment exposures, and sociodemographic interactions. Results EFA retained four HFE types: Factor 1, the healthiest, contained fresh fruits/vegetables (F/V), Factor 2 contained canned F/V, sweets, and salty snacks, Factor 3 contained frozen F/V, candy and sweetened drinks and Factor 4, the least healthful, contained (diet) soda, candy and sweets. SNAP participation was associated with a 23% (CI: –0.42, –0.04) z-score reduction for Factor 1 only. Each additional education level was associated with a 20% (CI: 0.10, 0.31) and 18% (CI: 0.07, 0.29) z-score increase for Factors 1 and 3, respectively. Each 1-unit increase in household size and maternal age accompanied a 6% (CI: 0.001, 0.11) and 3% (CI: 0.01, 0.05) respective z-score increase for Factor 3 only. Each additional dollar store within a 1-mile radius was associated with a 13.8% (CI: –0.22, –0.06) z-score reduction for Factor 3 while each mile closer to a grocery store accompanied a 12.1% (CI: 0.003, 0.24) z-score increase for Factor 3. Among households not receiving SNAP or WIC benefits, each mile closer to a grocery store accompanied a 27% (CI: 0.05, 0.47) and 30% (CI: 0.04, 0.55) respective z-score increase for Factor 1. Conclusions Healthy food environments are associated with local food outlet access and household characteristics. However, enrollment in nutrition assistance programs strongly modifies this relationship. Funding Sources National Institute of Child Health and Human Development.

Children-and-Partner’s Food Preferences and Role of Woman as Caregiver: Key Elements of Food Choice Linked to Social Environment in a Consumer Population of Hermosillo City

Abstract Objectives The main objective was to identify determinants of food choice linked to the community food environment in a marginalized consumer population in the city of Hermosillo, Mexico. The specific objectives were to develop group interviews with women and to frame the data analysis within the field of research in food and nutrition security. Methods In this qualitative study design, we employed the focus group technique to ask participants “How do you decide which foods to obtain for your family's diet?”. To investigate further we asked, “What are those reasons that explain the selection of those foods?” Women who regularly attended a community center localized in a neighborhood with a very high grade of urban marginalization participated in the focus groups. Interviews were transcribed verbatim and three distinct methods were used to perform analysis: (1) content analysis (2) data organization, using software QSR NVivo, in relation to five dimensions of food and nutrition security: affordability, accessibility, acceptability, food quality, and care; and (3) triangulation between five co-authors (A.C.N., P.B.C., A.D.C.P., G.E.P.A., and M.I.O.V.). Results From May to November of 2019, four focus groups were conducted by a single facilitator in two community centers of Hermosillo (n = 27 participants). Reasons that explained the participant's food choices within the community food environment and that showed the highest number of mentions in the interviews were identified in relation to acceptability factors: children's food preferences, partner's food preferences, all household-members’ food preferences. The following extract reflects the main study findings: “When I can't do a certain thing it is because it's very expensive, but if there is a way, even if it's a little… for example, my middle-aged son really likes peppers and he eats them alone. So, I know that when I go to the store, I have to bring at least one, for him to eat other things.” Conclusions The study of food choice in this group of women denotes that their role as caregiver of food and nutrition in relation to their children-and-partner's food preferences are key elements of food decision-making processes, preceding the socioeconomic factors and constraints, they certainly face. Funding Sources Institutional small grant C.I.A.D., A.C.

Exploring Undergraduate Indigenous Students’ Experiences with Institutional and Community Food Systems in a Canadian Urban Setting

Abstract Objectives Due to the high prevalence rates of food insecurity among university students and Indigenous Peoples in Canada, a qualitative study was designed to investigate the experiences of self-identified Indigenous students accessing local food environments. Research objectives included: 1) exploring undergraduate Indigenous students' experiences with institutional and community food systems in an urban setting; and 2) examining programs in place or in development on and off-campus that address circumstances of food insecurity and the needs of Indigenous students. Methods Data collection included face-to-face semi-structured interviews with eight students who self-identified as First Nations, Inuit or Métis. A focus group was conducted with four service providers, including stakeholders from institutional and local urban communities. Data was analyzed using thematic analysis. Results Participants identified several themes that were organized into individual, interpersonal organizational and community levels according to the socio-ecological model. Themes included: food and nutrition knowledge, financial capacity, convenience, social influences, campus food environment, cultural and institutional support. A model was also created to represent the results based on the themes from the focus group data. Focus group participants discussed linkages of social support and connectedness to increase Indigenous student access to food systems beyond the parameters of the university institution. Barriers to local food systems for students were lack of awareness of local resources and stigma associated with emergency food assistance. Conclusions Results suggest that Indigenous students are primarily focused on individual food and interpersonal social environments at the university and have limited awareness and exposure to the services available in the wider community and local food environment. Indigenous students and community members require an increased level of organizational and community awareness to support urban Indigenous food security programming across food environments to sustainably address circumstances of food insecurity experienced by Indigenous university students. Funding Sources The Department of Family Relations and Applied Nutrition, The University of Guelph, Ontario, Canada.

Socioeconomic Disparities in the Community Food Environment of a Medium-Sized City of Brazil

Objective: The purpose of this ecological study was to characterize the community food environment according to the socioeconomic condition of census tracts (CTs) in the urban area of a medium-sized city of southeastern Brazil in 2016.Method: Food establishments were identified on the streets covered by raters and information about type was collected through objective assessment. Geocoding was carried out from address observed by raters. Food establishments were categorized into establishments with predominant sale of natural or minimally processed foods, mixed establishments, and establishments with predominant sale of ultra-processed foods. The distribution of the number of establishments, by category, was evaluated according to tertiles of per capita income of the CT. The kernel estimation was used to analyze the density of establishments by category. The spatial pattern of the categories of establishments was investigated using the univariate Ripley’s K-function.Results: A total of 656 establishments were evaluated. In all, 11.1% had predominant sale of natural or minimally processed foods, 44.5% were mixed, and 44.4% had predominant sale of ultra-processed foods. The average of establishments with predominant sale of natural or minimally processed foods, of ultra-processed foods, and all categories increased according to the income of the CT. There was a clustering of all categories of establishments in high-income CTs downtown. However, peripheral and low-income CTs were composed of a higher number of mixed establishments or those with predominant sale of ultra-processed foods than establishments with predominant sale of natural or minimally processed foods.Conclusions: On average, the number of all categories of establishments increased according to the per capita income of the CT and were clustered in central and higher-income regions of the city. These findings may have practical implications for the development of public policies to increase the availability of healthy foods and to reduce the sale of unhealthy foods.

Relationship between different levels of the Mexican food environment and dietary intake: a qualitative systematic review.

To investigate the possible associations between the food environment and dietary intake in the Mexican population. Four databases (PubMed, PsychInfo, Web of Science and SCIelo) were used to retrieve relevant articles using an open timeframe. Articles were reviewed if they contained a systematic measure (i.e. food checklist) of the food environment (e.g. food availability) and dietary intake. Urban and rural communities in Mexico. Population-based studies of Mexican communities. Twenty studies that assessed at least one food environment level, and at least one dietary outcome, were reviewed. Findings from these studies showed that changes in the Mexican food environment seem to be associated with higher availability of energy-dense foods. Energy-dense foods can be linked to a high consumption in household, environment and community food environments. When both nutrient-dense and energy-dense foods were present, individuals were more likely to consume foods with added sugars, fats and salt options than nutrient-dense items. The various levels of the food environment (i.e. household, school, community) exposed participants to energy-dense foods. Although nutrient-dense foods were present in all three levels, individuals were more likely to consume energy-dense food items. Not all three levels of the food environment are well represented in the urban and rural settings. Most studies on the community food environment were done in rural areas, whereas most studies on the school food environment were done in urban settings. Additional rigorously designed studies are needed to document the relationship between the food environment and dietary intake in the Mexican population.

Introducing the Facility List Coder: A New Dataset/Method to Evaluate Community Food Environments

Community food environments have been shown to be important determinants to explain dietary patterns. This data descriptor describes a typical dataset obtained after applying the Facility List Coder (FLC), a new tool to asses community food environments that was validated and presented. The FLC was developed in Python 3.7 combining GIS analysis with standard data techniques. It offers a low-cost, scalable, efficient, and user-friendly way to indirectly identify community nutritional environments in any context. The FLC uses the most open access information to identify the facilities (e.g., convenience food store, bar, bakery, etc.) present around a location of interest (e.g., school, hospital, or university). As a result, researchers will have a comprehensive list of facilities around any location of interest allowing the assessment of key research questions on the influence of the community food environment on different health outcomes (e.g., obesity, physical inactivity, or diet quality). The FLC can be used either as a main source of information or to complement traditional methods such as store census and official commercial lists, among others.

Engaging Ethnic Restaurants to Improve Community Nutrition Environments: A Qualitative Study with Hispanic Caribbean Restaurants in New York City

ABSTRACT This study used interviews with New York City Hispanic Caribbean (HC) restaurant owners, managers, and cooks/chefs (n=19) to examine perceptions concerning the healthfulness of the HC diet and diet-related disparities in the HC community, and document factors potentially influencing their engagement in community nutrition interventions. The interviews revealed high awareness of diet-related issues. Respondents had mixed notions concerning their role in improving community food environments, noting important barriers for collaboration to consider in future interventions. The study underscores the important role of ethnic restaurants, providing information to facilitate engagement with this largely untapped sector in immigrant/ethnic communities in the US.

Sociocultural Influences on Dietary Practices and Physical Activity Behaviors of Rural Adolescents-A Qualitative Exploration.

In the aftermath of nutrition transition and ever-increasing sedentarism, adolescents globally are exposed to negative health consequences. Diverse sociocultural influences play a critical role in their adoption of unhealthy dietary practices and suboptimal physical activity behaviors. Context-specific understandings of how these sociocultural influences shape adolescents’ dietary and physical activity patterns in a rural, resource-limited setting remained elusive. Aiming to address the gap, this qualitative study explored adolescents’ and mothers’ perception of broader sociocultural aspects that sculpt the food choices, eating habits and physical activity behaviors of adolescents in Matlab, Bangladesh. Six digitally-recorded focus group discussions were transcribed verbatim, translated into English and analyzed thematically. Marked taste-driven dietary preference of adolescents and its prioritization within family by the mothers, popularity of street foods, better understanding of the importance of food hygiene and safety contrasting with narrow perception of balance and diversity in diet, peer influence along with deficient school and community food environment, internalization and rigidity of gender norms were found to be exerting major influence. The findings highlighted key targets for community-based nutrition interventions and endorsed thorough consideration of socio-cultural factors in formulating strategies to promote healthful eating and physical activity behaviors among the adolescents.

Validity and Reliability of the Facility List Coder, a New Tool to Evaluate Community Food Environments.

A community food environment plays an essential role in explaining the healthy lifestyle patterns of its community members. However, there is a lack of compelling quantitative approaches to evaluate these environments. This study introduces and validates a new tool named the facility list coder (FLC), whose purpose is to assess food environments based on data sources and classification algorithms. Using the case of Mataró (Spain), we randomly selected 301 grids areas (100 m2), in which we conducted street audits in order to physically identify all the facilities by name, address, and type. Then, audit-identified facilities were matched with those automatically-identified and were classified using the FLC to determine its quality. Our results suggest that automatically-identified and audit-identified food environments have a high level of agreement. The intra-class correlation coefficient (ICC) estimates and their respective 95% confidence intervals for the overall sample yield the result “excellent” (ICC ≥ 0.9) for the level of reliability of the FLC.

Objective and perceived food environment and household economic resources related to food insecurity in older adults living alone in rural areas

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.

Multiplicity and complexity of food environment in China: full-scale field census of food outlets in a typical district.

Community food environment is closely associated with residents' health status, and it has received substantial research attention in recent years. However, such studies are sparse in China. This study aims to reveal the characteristics of food environment in China. A ground-truthing field census of food outlets was conducted in Xi Hu district, Hangzhou. A novel categorizing system was developed to better characterize food outlets in the study area. Geocoding and food environment analysis were performed by Arc-GIS software. A total of 9274 food outlets were identified, of these, 6161 (66.43%) were food service places and 3113 (33.57%) were food stores. Fast-food restaurants (2692) and convenience stores (1764) were the two most numerous outlet types. The density of food outlets was 29.72/km2 and 113.97/10,000 people. Availability of BMI-unhealthy food outlets was four times greater than that of BMI-healthy ones. Further, 41.86% of total food outlets provided food-delivery services; among them, fast-food restaurants were the highest (65.53%) providers. In the urban area, the average density of food outlets was 104/km2. While, it was only 29/km2 in the rural area. Availability of food outlets was excellent in our study area, though it showed regional imbalance. Food environment tends to be obesogenic and high prevalence of food delivery service might increase this trend. Thus, policy makers should guarantee the smooth development of catering industry in China, so as to ensure a balanced nutrition environment.

Measuring Rural Food Environments for Local Action in Australia: A Systematic Critical Synthesis Review.

Poor diet is a significant contributor to obesity and chronic disease. With all being more prevalent in rural than urban Australia, modifying the food environment is a potential intervention point to improve the health of rural populations. This review examined the applicability of measurement tools used in rural food environment research for rural Australia. Six electronic databases were searched for peer-reviewed literature, published in English between 2006 and 2018, including at least one objective measure of the Community or Consumer Food Environment in a rural or mixed rural/urban context. One-hundred and seventy-seven papers were returned after removal of duplicates, with a final review of 25. Most studies were cross-sectional, with one intervention study of quasi-experimental design. Nine studies employed a conceptual model; there was considerable variability in tools used; and few described psychometric testing. The most common attribute measured was price, followed by available healthy options. The findings of this review do not offer a suite of ‘gold standard’ measurement tools known to be reliable, valid and sensitive to change to assess the community or consumer food environments in rural Australian towns. However, recommendations are proposed to progress this important area of research within a rural context.

Community food environment moderates association between health care provider advice to lose weight and eating behaviors.

Patients who receive weight loss advice from a health care provider (HCP) are more likely to eat healthy. The food environment affects eating behaviors. This study explored how the community food environment may moderate the relationship between HCP advice to lose weight and eating behaviors. Data were obtained from a household telephone survey in 4 New Jersey cities from two cross-sectional panels (2009–10 and 2014). Analyses were limited to 1427 overweight and obese participants. Self-reports assessed frequency of consumption of fruits, vegetables, sugar sweetened beverages, and fast food. Community food data were purchased from InfoUSA and Nielsen and classified according to previously established protocol. Stratified gamma regression analysis determined the differences in the association between receiving weight loss advice and eating behaviors stratified by community food environment. Stratified analyses revealed that receiving advice to lose weight from a HCP was associated with lower reported consumption of total sugar-sweetened beverages, soda, and sweetened fruit drinks when participants lived near a small grocery store, or far from a supermarket, limited service restaurant, or convenience store. There were no associations between receiving weight loss advice and sugar sweetened beverage consumption when participants lived near supermarkets, limited service restaurants, or convenience stores. There were no associations with fruit, vegetable, salad or fast-food consumption, regardless of the community food environment. Food environment may play a critical role in moderating the association between HCP advice and eating behaviors. Interventions that enhance the community food environment may help convert HCP advice into improved eating behaviors.

Participation in the Supplemental Nutrition Assistance Program and Dietary Behaviors: Role of Community Food Environment

BackgroundThe United States Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) is the country’s largest nutrition assistance program for low-income populations. Although SNAP has been shown to reduce food insecurity, research findings on the diet quality of program participants are inconsistent. ObjectiveThis study evaluated whether the community food environment is a potential moderator of the association between SNAP participation and eating behaviors. DesignThis cross-sectional study used participant data from a telephone survey of 2,211 households in four cities in New Jersey. Data were collected from two cross-sectional panels from 2009 to 2010 and 2014. Food outlet data were purchased from commercial sources and classified as supermarkets, small grocery stores, convenience stores, or limited service restaurants. Participants/settingAnalysis is limited to 983 respondents (588 SNAP participants) with household incomes below 130% of the federal poverty level. Main outcome measuresEating behaviors were assessed as frequency of consumption of fruit, vegetables, salad, and sugar-sweetened beverages. Statistical analyses performedInteraction and stratified analyses using gamma regression determined the differences in the association between SNAP participation and eating behaviors by the presence or absence of food outlets adjusted for covariates. ResultsSNAP participation was associated with a higher frequency of consuming sugar-sweetened beverages (P<0.05) when respondents lived within ¼ to ½ mile of a small grocery store, supermarket, and limited service restaurant. SNAP participants who did not live close to a convenience store reported a lower frequency of sugar-sweetened beverage consumption (P=0.01), and those living more than ½ mile away from a supermarket reported a lower frequency of fruit consumption (P=0.03). ConclusionsThe findings from this study suggest that the community food environment may play a role in moderating the association between SNAP participation and eating behaviors. Although SNAP participation is associated with some unhealthy behaviors, this association may only hold true when respondents live in certain food environments.

Association between Spatial Access to Food Outlets, Frequency of Grocery Shopping, and Objectively-Assessed and Self-Reported Fruit and Vegetable Consumption.

Because supermarkets are a critical part of the community food environment, the purpose of this paper is to examine the association between accessibility to the supermarket where participants were surveyed, frequency of shopping at the supermarket, and self-reported and objectively-assessed fruit and vegetable consumption. Accessibility was assessed using Geographic Information Systems (GIS) measured distance and multiple versions of the modified Retail Food Environment Index (mRFEI), including a localized road network buffer version. Frequency of shopping was assessed using self-report. The National Cancer Institute Fruit and Vegetable screener was used to calculate daily servings of fruits and vegetables. Skin carotenoids were assessed using the “Veggie Meter™” which utilizes reflection spectroscopy to non-invasively assess skin carotenoids as an objective measure of fruit and vegetable consumption. Bivariate and multivariable statistics were used to examine the associations in RStudio. There was a positive association between skin carotenoids and the Special Supplemental Nutrition Program for Women Infants and Children (WIC) and mRFEI scores, suggesting that WIC participation and a healthier food environment were associated with objectively-assessed fruit and vegetable consumption (skin carotenoids). Future research should examine these associations using longitudinal study designs and larger sample sizes.

Healthy Food Options at Dollar Discount Stores Are Equivalent in Quality and Lower in Price Compared to Grocery Stores: An Examination in Las Vegas, NV.

Food deserts indicate limited access to and affordability of healthy foods. One potential mediator is the availability of healthy food in non-traditional outlets such as dollar-discount stores, stores selling produce at the fixed $1 price. The purpose of this study was to compare availability, quality, price differences in ‘healthier’ versus ‘regular’ food choices, price per each food item, and summary score in dollar-discount stores to grocery stores in Las Vegas using the NEMS-S; a protocol consisting of three subscores—availability, quality, price of healthier versus regular food, and a summary score. A 25% sample of grocery stores (n = 40) and all dollar-discount stores (n = 14) were evaluated. t-tests showed that dollar-discount stores were less likely to price healthy options lower than their unhealthy alternatives (mean (M) = 1.0 vs. M = 2.5; p < 0.001) and had reduced availability (M = 20.50 vs. M = 23.80; p < 0.001) compared to grocery stores. The quality of produce did not differ (M = 5.93 vs. M = 6.00; p = 0.34). Price comparisons revealed that 84.2% of produce and 89.5% of other food items were significantly less expensive at the dollar-discount stores, with only two items being more expensive. While dollar-discount stores did have lower availability, they provided quality fresh and healthy foods which were usually less expensive. Findings indicate that dollar discount stores may be an existing community asset, and considering them as such may aid in efforts to strengthen the overall food system. Practitioners should consider dollar discount stores when assessing the community food environment and designing and implementing outreach programs, as they may bridge some disparities in access.

The Community Food Environment and Food Insecurity in Sioux Lookout, Ontario: Understanding the Relationships between Food, Health, and Place

ABSTRACTThe purpose of this community-based research project was to explore the community food environment and food insecurity in the northern Ontario community of Sioux Lookout. Previous informal conversations with local organizations identified food insecurity as a serious concern with particularly impactful consequences for Indigenous well-being. Community members were invited to a feast at the Friendship Centre where individuals participated in surveys (N = 76) and talking circles (N = 100) around the question: “When it comes to food what do you think is the most important issue in Sioux Lookout?” Four related themes emerged including: (1) The Community Food Environment; (2) Indigenous Food Knowledge; (3) Concerns about Health; and (4) Moving Forward. This article considers the community food environment and the relationships between people, food, culture, health, and place.

Association of community food environment and obesity among US adults: a geographical information system analysis

BackgroundEmerging studies have investigated the contribution of food environment to obesity in the USA. However, the findings were inconsistent. Methodological explanations for the inconsistent findings included: (1) using individual store/restaurant...

Online grocery shopping: promise and pitfalls for healthier food and beverage purchases.

(i) To determine the current state of online grocery shopping, including individuals' motivations for shopping for groceries online and types of foods purchased; and (ii) to identify the potential promise and pitfalls that online grocery shopping may offer in relation to food and beverage purchases. PubMed, ABI/INFORM and Google Scholar were searched to identify published research. To be included, studies must have been published between 2007 and 2017 in English, based in the USA or Europe (including the UK), and focused on: (i) motivations for online grocery shopping; (ii) the cognitive/psychosocial domain; and (iii) the community or neighbourhood food environment domain. Our search yielded twenty-four relevant papers. Findings indicate that online grocery shopping can be a double-edged sword. While it has the potential to increase healthy choices via reduced unhealthy impulse purchases, nutrition labelling strategies, and as a method to overcome food access limitations among individuals with limited access to a brick-and-mortar store, it also has the potential to increase unhealthy choices due to reasons such as consumers' hesitance to purchase fresh produce online. Additional research is needed to determine the most effective ways to positively engage customers to use online grocery shopping to make healthier choices.

Food environment: validation of a method for measurement and characterization in the territory with the Health Academy Program

The study aimed to verify the validity of secondary data in the investigation of the food environment and to analyze the characteristics of the community environment and consumers in territories covered by a health promotion service. This was an ecological study in 18 units of the Health Academy Program in Belo Horizonte, Minas Gerais, Brazil, selected by simple cluster sampling. Validation of the establishments marketing fruits and vegetables, obtained from public databases, was done via telephone contact, Google Street View, and on-site audit. The following variables were investigated in the community food environment: type and location of the establishment; consumer's environment: availability, variety, price, and advertising of fruits and vegetables; availability and variety of ultra-processed foods; and hygienic and sanitary conditions. The access to healthy foods index was used to measure access to these foods. The on-site audit revealed weak concordance (45.7%) with the secondary databases. Of the 298 establishments, the majority were bulk grocery stores and open-air markets (61.3%), which showed the highest availability of healthy foods, but also marketed large amounts of ultra-processed foods (60.7%). One-third of the establishments showed substandard hygienic and sanitary conditions. The secondary databases showed low validity, emphasizing the need to audit the establishments. The establishments also showed a striking presence of ultra-processed foods and poor hygiene and sanitation.