Food Environment Research Articles

Conceptualising food environments as social activity spaces: Insights from lived experience research in Thailand and Laos.

To examine policy processes and industry opposition surrounding the first U.S. Healthy Checkout Ordinances (HCOs), which mandate nutritional standards for foods and beverages displayed in grocery checkout areas. Qualitative case study comparison using Kingdon's Multiple Streams Framework, triangulating city records, advocacy materials, and key informant interviews. Local governments of Berkeley and Perris, California, USA. Informants, identified from documents and snowball sampling, included community-based organization members/local advocates (Berkeley n=6; Perris n=1), staff from national nongovernmental organizations providing assistance (Berkeley n=2; Perris n=2), city councilmembers (Berkeley n=2; Perris n=2), city commissioner (Berkeley n=1), and city staff (Perris n=2). We described and compared each city's HCO enactment process. In both, prior commitments to community-led food environment reforms enabled advocates to garner financial and technical support for early coalition building. Berkeley used soda tax proceeds for a youth-led citizen science project to formulate an enforceable HCO and assess public support. These experiences fostered political commitment to define applicable stores, checkout areas, and nutritional standards. Campaigns emphasized protecting children and parents from predatory marketing and impulse buying. Berkeley's campaign quietly and cautiously engaged mostly independent retailers, attracting limited industry attention; Perris engaged all retailers, and after enactment, faced open opposition from a chain store and trade associations. Perris' amended HCO included concessions allowing unhealthy items at many endcaps and long checkout lanes. HCO enactment may be facilitated by prior food policy experience, community capacity, early coalition building, careful policy design and framing, and anticipating and managing industry opposition.

The persistent problem of food insecurity has been a major global concern. Understanding the relationship between the food environment and how it affects food security is crucial for improving the overall health and well-being of the population. This study utilized secondary cross-sectional data from the 2016 Local Level Food Health and Nutrition Survey (LFHNS) conducted by the Department of Science and Technology- Food and Nutrition Research Institute (DOST-FNRI) in the Municipality of Pulilan, Bulacan. Logistic regression was used to determine the association between the density of food stores, perceived nutrition environment, and food security status. The study’s results showed no association between the density of food stores, perceived nutrition environment, and food security; however, a positive association was found with the number of food stores. Findings showed that for every unit increase in the number of food stores, an increase of 1.9 food-secure households (p=<0.05, 95% C.I. 1.3-2.7) was noted. The “sari-sari store” was the most common type of food store and the most accessible among the poor and poorest households. Further studies should include other food environment factors affecting food security, such as typology, proximity, and other food retail outlets available in the community, including traditional restaurants or carinderia and fast-food chains.

Background: Emerging evidence links the local food environment to chronic disease outcomes, yet its relationship with cardiac mortality remains under explored at the population level. This study examines the association between the Retail Food Environment Index (RFEI), a marker of community food healthiness, and cardiac death rates across U.S. counties. Hypothesis: We propose that higher RFEI scores are significantly linked to greater cardiac mortality, independent of socioeconomic status, lifestyle behaviours, and demographic characteristics. Methods: A cross-sectional ecological study was conducted using county-level data from 2,793 U.S. counties, integrating cardiac mortality information from the CDC WONDER database for the years 2018–2020 and the food accessibility data from the USDA Food Environment Atlas. The primary outcome was age-adjusted cardiac mortality per 100,000 population. The main exposure variable was the Retail Food Environment Index (RFEI), defined as the ratio of fast-food outlets and convenience stores to supermarkets and farmers' markets. To test the robustness of the RFEI, two alternate indices (RFEI1 and RFEI2) were developed by varying the inclusion criteria for superstore classification. Descriptive statistics, along with univariable and multivariable regression analyses, were performed, adjusting for socioeconomic indicators, racial/ethnic composition, health behaviours, metabolic risk factors, and food accessibility. Results: The mean cardiac mortality rate was 246.6 per 100,000 (SD = 58.3). RFEI showed a positive association with cardiac mortality in both univariate (β = 1.75; 95% CI, 1.25–2.24; P < 0.001) and multivariable analyses (β = 0.96; 95% CI, 0.60–1.34; P < 0.001). RFEI1 and RFEI2 yielded consistent results (β = 2.17 and 2.37, respectively; both P < 0.001). Among covariates, smoking (β = 5.47; P < 0.001), diabetes (β = 2.26; P = 0.008), and poverty rate (β = 0.76; P = 0.008) were significant predictors. The final model explained 50% of the variation in mortality (adjusted R square = 0.50). Conclusion: A higher density of unhealthy food outlets is independently associated with increased cardiac mortality across U.S. counties. These findings underscore the importance of local food environments as modifiable population-level determinants of cardiovascular health and support public health strategies aimed at improving equitable access to nutritious food.

BackgroundSchools play a crucial role in shaping children’s growth and development. In Indonesia, however, school food environments face major challenges in promoting nutrition and healthy lifestyles. These environments are increasingly dominated by unhealthy ultra-processed products (UPPs), limited nutritious options and inadequate opportunities for physical activity—key contributors to rising childhood obesity rates.MethodsWe explored the drivers of childhood obesity and barriers to prevention in selected school food environments using qualitative data from in-depth interviews and focus group discussions with 165 purposefully selected participants across four study areas, field observations and a desk review of relevant regulations. Data were analysed through an iterative content analysis approach, using a predefined variable indicator matrix outlining key study themes.ResultsFindings show frequent consumption of unhealthy snacks and sweetened drinks in and around schools, driven by a lack of food environment regulations. Barriers to healthier diets include children’s food preferences, limited parental time and the widespread availability of UPPs. While school-based physical activity was generally adequate, sedentary behaviours at home were common. Key gaps include limited teacher capacity, inadequate health education materials and weak data sharing and referral mechanisms for obesity between schools and community health services.ConclusionStrengthening school food environments regulations in Indonesia is urgently needed. Priorities include developing national canteen guidelines, restricting the sale and marketing of UPPs and high-fat, salt and sugar foods, adopting interpretative front-of-pack labelling schemes and promoting equitable physical activity opportunities. Improving knowledge, capacity and coordination among schools, parents and health workers is also critical.

Background: Food insecurity is associated with chronic disease and remains a key focus for population health interventions. Most research has focused on food insecurity at an individual level, without recognizing the role the food environment in an individual’s neighborhood plays in development of chronic disease. This study examined the pathway between food access measured at a census tract level and stroke prevalence to identify targets for interventions and inform policy efforts at the population level. Methods: Census tract level data were combined to create a final analytic dataset of 11,457 census tracts. Structural racism was defined as historic residential redlining using Home Owners’ Loan Corporation (HOLC) residential security maps from the Mapping Inequality project (score between 1=best to 4=redlined). Food access was defined using the modified retail food environment index (mRFEI) calculated as the number of healthy food retailers divided by the number of healthy and less healthy food retailers per census tract. Prevalence of stroke in each census tract was based on CDC PLACES data. Direct and indirect relationships between redlining and stroke via food access was investigated using structural equation modeling run in Stata v17, controlling for population of each census tract. Results: Mean prevalence of stroke was 31.8%. Redlining (0.19, 95%CI 0.17, 0.21, p<0.001) and lower food access (-0.10, 95%CI -0.12, -0.09, p<0.001) were directly associated with higher prevalence of stroke. Redlining was also indirectly associated with stroke via lower food access within a census tract (-0.10, 95%CI -0.12, -0.08, p<0.001). See Figure 1. Conclusions: Structural racism measured using historical redlining was directly and indirectly associated with the prevalence of stroke via food access in a census tract. Based on these results, interventions to improve access to healthy food options at the community level may help address the impact of structural racism on the health of individuals, particularly those at risk for stroke living in historically redlined neighborhoods.

Introduction Digitalization, through smartphones and online platforms, has become deeply embedded in daily life, beginning to exert significant effects on eating habits and psychological health. Online food delivery (OFD) applications (app) provide easy access to fast food and processed products, exposing individuals to a constant digital food environment. Examining the relationship of these applications with eating behaviors and conditions such as depression is particularly important in the context of increasing mental health problems among young adults. This study aims to examine the relationship between the frequency of use of OFD apps and user attitudes toward these apps, with depression level and eating behaviors in young adults. Methods Participants’ demographic information, frequency of use of OFD apps, and attitudes toward these apps were determined by questionnaire questions; depression status was assessed using the Beck Depression Inventory; and eating behaviors were assessed using the Three-Factor Eating Scale (TFEQ-R21). Results A total of 383 young adults aged 18–35 years participated in our study. The group with the lowest frequency of OFD apps use (21.2 ± 0.4) had significantly lower uncontrolled eating scores than the other groups (23.4 ± 0.7 and 23.3 ± 0.6; p = 0.005). In addition, a significant decrease in cognitive restraint levels was observed as the frequency of OFD apps use increased ( p = 0.031). In addition, depression scores of individuals with more OFD apps (4–6) on their phones (14.1 ± 1.3) were found to be higher than those of individuals who did not use any apps (8.8 ± 1.4; p = 0.025). Discussion The findings of our study suggest that the digital food environment can be a determinant not only of individuals’ physical health but also of their psychological health and behavioral eating habits.

BackgroundWe describe the development of a comprehensive proof-of-concept index of environmental exposures for children based on evidence-informed connections to health behaviours– the Healthy Environments Index for Children (HEIC) - with two sub-indices relating to the food environment (HEIC-FE) and physical activity environment (HEIC-PA) in Taranaki, New Zealand. Associations between this theory-informed index and health outcomes in a cohort of children and adolescents identified with overweight or obesity and enrolled in a community-based healthy lifestyle programme and randomised controlled trial were examined.MethodsThe HIEC was developed using Geographic Information Systems (GIS) and 15 variables selected from a series of systematic literature reviews identifying environmental factors associated with childhood obesity. Activity spaces around each participant’s residential address, and the route to their nearest school were created and used to estimate environmental exposure. Health data from the Whānau Pakari randomised controlled trial (n = 179 at baseline, 121 at 12-months, 95 at 24-months) was integrated to test associations between HEIC and health outcomes. Statistical analyses included spearman rank correlations, multinomial linear regression, and geographically weighted regression.ResultsHigher HEIC scores (indicating health-promoting environments) tended to be clustered within the cities and towns, while rural areas had low HEIC scores. Strong and consistent associations were not identified between HEIC indices and health outcomes in our study population. However, higher HEIC food environments were associated with increased water intake and decreased sweet drink intake at 24-months.ConclusionsThe theory-informed HEIC and its two subindices may be useful tools for policy and practice aiming at improving child health outcomes. However, they require validation in larger studies in other areas of New Zealand.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12942-025-00409-7.

Listeria monocytogenes is a globally relevant foodborne pathogen and a major public health concern because of its ability to cause severe invasive disease and persist in food processing environments. This study aimed to characterize the genomic diversity of L. monocytogenes isolates collected in Uruguay from food and clinical cases of listeriosis between 2010 and 2019. The genomes sequences of 142 isolates representatives from a national collection were obtained and used for comparative genomic and phylogenetic analysis along with other 55 genomes from different geographical regions. The isolates belonged to lineages I (88%) and II (12%) and were distributed across 20 clonal complexes. The clonal complexes CC3, CC2, and CC1 were predominant. Notably, CC3 accounted for nearly one-third of the isolates and was evenly distributed between food and clinical sources, contrasting with its relatively low frequency in most international datasets. A novel sequence type (ST2832) and 112 new core genome MLST profiles were identified. The circulation of the rare clonal complex CC517 was detected, with evidence of persistence in food environments and a potential link to a human case. Comparative analysis revealed considerable virulence gene diversity, including specific distribution of LIPI-3 and LIPI-4 among lineages and clonal complexes, and the presence of truncated allelic variants of the inlA gene in food-derived lineage II isolates. Phylogenetic analysis showed strong concordance with MLST-based classification and reveals linkage among isolates form different sources suggesting epidemiological relation between food and human cases of listeriosis. This study provides the first comprehensive genomic overview of L. monocytogenes in Uruguay, revealing the predominance of lineage I isolates from food and clinical sources, a particular high prevalence of CC3 and the local circulation of the rare CC517. The results highlight the importance of whole genome and phylogenetic analysis as molecular epidemiology tools and show the contribution of including isolates from underrepresented regions in global genomic databases.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-22190-0.

This paper investigates gender-based differences in food availability and perceptions of the food environment among university students. The study draws a cross-sectional survey conducted among 397 students at UiTM Dungun, Terengganu, Malaysia, and explores how male and female students differ in their access to healthy outlets, availability of nutritious snacks, exposure to unhealthy advertising, and perceptions of institutional nutrition information. Chi-square analysis revealed significant gender differences: female students reported easier access to healthy food outlets (²=18.739, =.003) and greater availability of healthy snacks (²=18.739, <.001), while male students experienced more exposure to unhealthy food advertisements (²=11.819, =.019), Females also perceived stringer institutional nutrition information (²=7.012, =.008). The findings underline the necessity of gender-sensitive food policies that consider the unique challenges faced by both groups. The paper contributes to the literature by contextualizing gendered food environments in Malaysia and offering policy recommendations to foster healthier eating practices in university settings.

Childhood obesity has emerged as a critical global health challenge with growing prevalence across Latin America, particularly in Mexico, Colombia, and Ecuador. This review synthesizes current international evidence on the biological, behavioral, and policy determinants of obesity and evaluates preventive strategies within clinical, educational, and governmental frameworks. Data reveal that fewer than one in five children meet physical activity guidelines, while sugar-sweetened beverage (SSB) consumption and inadequate sleep remain pervasive contributors to metabolic risk. Family-based behavioral programs with at least 26 contact hours and multicomponent school interventions—including daily physical activity, canteen reform, and sleep literacy—produce the most consistent reductions in BMI z-scores and metabolic markers. Fiscal and regulatory measures, such as SSB taxation and front-of-package labeling, complement these interventions by reshaping food environments and reducing health inequities when properly enforced. The integrated Clinic–School–Home–Policy framework proposed in this study offers a sustainable model that aligns individual behavior with supportive environments and governance mechanisms. Long-term success depends on cross-sector collaboration, continuous evaluation, and social participation to ensure equitable access to healthy food, safe physical activity, and sleep-promoting routines. By transforming policy and practice into a unified prevention ecosystem, Latin American nations can reverse current trends and safeguard the health and well-being of the next generation.

BackgroundUrbanisation and food system transformations in low- and middle-income countries (LMICs) are reshaping local food retail environments, influencing diets and nutrition outcomes. The expansion of ultra-processed products (UPPs) and changing food outlet landscapes are key drivers of the triple burden of malnutrition across LMICs, including rising rates of obesity and related non-communicable disease (NCD). Yet, qualitative insights into how local communities interact with evolving food retail environments remains limited.MethodsA qualitative study in three urban communities of Yogyakarta, Indonesia, between September 2018 and April 2019. A total of 45 semi-structured interviews lasting between 35 min and 1.5 h were conducted with individuals primarily responsible for household food purchasing and preparation, supported by transect walks to map food outlet types. Data were analysed iteratively, combining emic perspectives with pre-determined themes based on established urban food environments and food systems frameworks.ResultsParticipants accessed a wide range of formal and informal food retail outlets. Food acquisition strategies were diverse and dynamic, with respondents often relying on multiple outlets for different product types. Five main themes emerged as key drivers of food retail outlet choice: economic reasons, convenience, produce quality, product variety, and personal or social relationships with vendors. Supermarkets were visited infrequently and mainly used for bulk or non-perishable purchases, while markets and other traditional outlets were preferred for daily needs due to perceived freshness, affordability, and trust in sellers.ConclusionFindings highlight the complexity of urban food acquisition in LMIC settings, where residents navigate diverse food retail options shaped by economic, social, and contextual factors. Informal vendors remain central to everyday food access across socio-economic groups, pointing to the need for context-specific public health policies and programmes that do not assume a linear transition toward formalisation, but instead work with existing informal structures. Interventions should aim to regulate the availability and marketing of UPPs, support healthier retail environments across all outlet types, and leverage trust, familiarity, and local networks in shaping dietary behaviours through bottom-up approaches.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-23574-7.

This research investigates the factors of obesity among Johor State civil servants. A qualitative research approach and case study design were employed, involving semi-structured, in-depth interviews with five informants aged 29 and above from diverse state departments in Johor, Malaysia. The research findings highlight four social factors that contributed to obesity, such as peer influence, inconsistent eating habits, lack of physical activity, and workplace food environment. The cost of healthy food was found to be the economic factor influencing food choices. Besides that, the findings also show how the selective implementation of health incentives led to obesity among the informants. The study further recommends that future research incorporate quantitative methods to provide a more comprehensive analysis of the prevalence of obesity. Furthermore, discussions should be facilitated through workshops or focus group discussions that enable individuals or experts to share experiences and strategies for addressing obesity’s social, economic, and policy factors. This approach aims to create healthier civil servants who can provide the best services to the community.

Adolescents in informal urban communities, defined as settlements that fall outside of formal governmental planning and regulatory frameworks, are at increasing risk of poor-quality diets and malnutrition in all its forms. The food environment is the interface of adolescent food choice and the broader food system, and food environment interventions have the potential to improve adolescent diets and nutritional outcomes. We will conduct a mixed-methods study, integrating methods from participatory systems science and nutritional epidemiology to characterise linkages among adolescents' neighbourhood and home food environments, and their food choices, diets and nutritional outcomes. We will recruit adolescents, caregivers, school staff and food system actors from five communities along a gradient of urban informality in Nairobi, Kenya, to participate in cognitive mapping, group-based modelling and a cohort study over one academic year to evaluate dietary choices and nutritional outcomes. The study has been approved by the Research Ethics Committee of Rutgers University (Pro2024001981) and Amref Health Africa (P1831-2025). Adult participants will provide written informed consent, and adolescents will provide written informed assent to participate in the study. Findings will be disseminated through peer-reviewed journals, conference presentations and to participants through planned participatory interaction throughout the study.

Social drivers of type 2 diabetes in Mexico: A spatial multilevel approach to urbanization and unhealthy food expenditure.

Adolescent nutritional influences on the brain: implications for eating behaviors.

Assessment of enzyme diversity in the fermented food microbiome.

Children's expectations about how others share food preferences and health-related information.

Urbanizing food environments in Africa: Challenges and opportunities for improving accessibility, affordability, convenience, and desirability of healthy diets

Objectives: The dietary habits of school-aged children play a critical role in their growth and development, and are strongly influenced by the home environment. Household income is closely associated with caregivers’ food literacy, social support, and food environment. This directly affects the nutritional status of children. This study aimed to provide evidence to inform policies and educational programs for improving dietary habits in children, and to establish a foundation for tailored support strategies for low-income families. Methods: This cross-sectional study included 846 primary caregivers of school-aged children from 17 regions across Korea, recruited through an online survey. Household income, caregivers’ food literacy, social support, and food environment were assessed. Nutritional status in children was measured using the Nutrition Quotient for Children (NQ-C). Statistical analyses included descriptive statistics, chi-square tests, one-way analysis of variance (ANOVA), analysis of covariance (ANCOVA), correlation analyses, and multiple linear regression.Results: Caregivers from higher income households demonstrated significantly greater food literacy and social support (P < 0.001). Children from these households showed high balance scores and a large proportion of these children were in the “high” NQ-C grade. The NQ-C score in children was positively correlated with food literacy (r = 0.425), social support (r = 0.471), and the food environment (r = 0.235) (P < 0.001). Multiple regression analysis showed that food literacy (β = 0.256) and social support (β = 0.348) were significant predictors of nutritional status in children.Conclusion: This study confirmed that the nutritional status in children is not only determined solely by household income but is also mediated by caregivers’ food literacy, social support, and food environment. These findings highlighted the limitations of providing only economic support. The findings underscore the need for multifaceted interventions such as strengthening parental nutrition education, expanding social support networks, and improving access to healthy foods.