Food Outlets Research Articles

Population mobility data provides meaningful indicators of fast food intake and diet-related diseases in diverse populations

The characteristics of food environments people are exposed to, such as the density of fast food (FF) outlets, can impact their diet and risk for diet-related chronic disease. Previous studies examining the relationship between food environments and nutritional health have produced mixed findings, potentially due to the predominant focus on static food environments around people’s homes. As smartphone ownership increases, large-scale data on human mobility (i.e., smartphone geolocations) represents a promising resource for studying dynamic food environments that people have access to and visit as they move throughout their day. This study investigates whether mobility data provides meaningful indicators of diet, measured as FF intake, and diet-related disease, evaluating its usefulness for food environment research. Using a mobility dataset consisting of 14.5 million visits to geolocated food outlets in Los Angeles County (LAC) across a representative sample of 243,644 anonymous and opted-in adult smartphone users in LAC, we construct measures of visits to FF outlets aggregated over users living in neighborhood. We find that the aggregated measures strongly and significantly correspond to self-reported FF intake, obesity, and diabetes in a diverse, representative sample of 8,036 LAC adults included in a population health survey carried out by the LAC Department of Public Health. Visits to FF outlets were a better predictor of individuals’ obesity and diabetes than their self-reported FF intake, controlling for other known risks. These findings suggest mobility data represents a valid tool to study people’s use of dynamic food environments and links to diet and health.

Australian adults cooked more and tried new recipes during COVID-19 restrictions and lockdowns

The lockdowns and restrictions due to COVID-19 caused changes in both food accessibility and availability for people around the globe resulting in changes in food habits and behaviours. To enable a better public health response to the next pandemic, lessons must be learnt from this most recent emergency. This study aimed to examine self-reported changes in food habits and behaviours, of Australian adults during COVID-19 restrictions in 2020. A cross-sectional, convenience, Australia-wide survey, with open-ended and closed-ended questions was conducted online. Respondents were asked to report their demographic characteristics, positive food habit development, worst food-related experiences, changes in food habits and behaviours and cooking and food preparation practices during the COVID-19 restriction period. Adult Australian residents, recruited through social media advertising of the survey. Respondents (n = 764) were mostly female (86%), over 55 years of age (57%, mean age (SD) 53.4 (18.1) years), and half (51%) were not in paid employment. Nearly two-thirds (63%) developed positive food habits, including trying new recipes (54%), eating less take-away (53%) and cooking from scratch (46%) during the COVID-19 restrictions. Furthermore, respondents reported including family members in food preparation and eating together as a family. Negative experiences included being unable to buy certain foods (due to lack of stock and store limits), cooking at home, and being unable to access some food outlets. Australians experienced both positive and negative food experiences during the COVID-19 pandemic and associated lockdown periods, with most experiencing positive changes such as cooking at home from scratch and trying new recipes and relying on less take-away. Females and those who experienced a change in employment status were more likely to develop positive new food habits.

Environmental characteristics and type 1 diabetes: students' perspectives on diabetes management in college

IntroductionType 1 diabetes is a chronic illness requiring immense lifestyle changes to reduce the chance of life-threatening complications, which can be especially challenging during the time of transition to college. This study applies a communication design perspective to explore how students with type 1 diabetes interpret their experiences in college and what meanings they attribute to those experiences. Specifically, this study sheds light on physical and social environmental components affecting students' diabetes management.MethodsStudy participants were recruited from the College Diabetes Network (CDN). A total of twenty students with type 1 diabetes participated in the study. A qualitative descriptive study design with an ethnographic interview approach was applied.ResultsFour cultural themes emerged from the analysis: (1) Food environment, (2) Structural environment, (3) Academic life, and (4) Social life. The findings illustrate how food outlets and food accessibility, safe spaces for insulin injections, comfortable living spaces, availability of health support services, and diabetes-friendly classroom regulations constitute a higher-level environmental system affecting students' wellbeing. They also highlight a complex relationship between structural barriers to diabetes management, health disclosure, and public stigma.DiscussionResults from this study advance scholarship on diabetes care in the population of emerging adults by offering insights into how college students with T1D transition to college and manage type 1 diabetes. Overall, students with T1D have specific needs beyond those of the general student population. Thus, necessary modifications in the designs of existing structures should be introduced to facilitate students' assimilation into new organizational environments.

Development of a Scoring Tool for Australian Rural Food Retail Environments.

Current tools scoring the healthiness of food retail outlets do not reflect outlets found in rural locations. This study aimed to adapt pre-existing Australian scoring tools to represent non-metropolitan areas. Rural nutrition experts were identified, and a modified Delphi technique was used to adapt two pre-existing, food-scoring tools in five iterative stages. Stages included identifying all relevant outlets, providing a description and score for each, ensuring consistency between outlet scores and pre-existing, metro-centric tools, and providing instructions for correct use. Six rural nutrition experts were identified and engaged in the modified Delphi technique. The final tool consisted of 12 categories of food outlets and listed 35 individual outlets. Consistent with pre-existing Australian tools, scores ranged from +10 to -10 and included descriptions reflective of rural retail outlets. Scores were based on whether the majority of foods offered within the outlet were consistent with foods recommended in national health guidelines. The developed tool was designed to accommodate the diverse nature of food retail outlets found in non-metropolitan areas. This study assists in explaining the link between the food environment and health in populations living rurally.

Penerapan Algoritma C.45 Dalam Pengklasifikasian Data Penjualan Gerai Makanan Cepat Saji Berbasis Website

With the development of technology, there are many methods that can be used to analyze various kinds of problems, both in the world of education, social and even the business world. One method that can be used is the data mining method. Fast food is one example of a business that is being built by many people today, especially in the city of Batam. With so many fast food outlets in the city of Batam, this study aims to classify the types of food that are in demand and not in demand in the city of Batam. To assist the writer in classifying the best-selling and not-selling food types, in this study the authors used the data mining method, namely applying the C.45 Algorithm approach. Apart from using the C.45 Algorithm to test the calculation results, the author uses a website-based information system. From the research that has been carried out, the results obtained are that the best-selling food for children is the Original Burger (BO) and for adults the best-selling type of food is Kebab (K), while the less popular type of food for all ages is Burger Crispy.

Associations between retail food environment and organic food purchases in French households

Abstract Background The aim of our study was to assess the associations between organic food purchases of French households and their exposure to food outlets that sell organic foods, including organic food stores (selling only organic products) and standard food outlets, independently from households’ characteristics. Methods This cross-sectional study included 462 households from a quota sampling survey conducted in France. Share of expenditures for organic foods over a one-month period was assessed using food supply diaries and grocery receipts. The objective retail food environment (RFE) was assessed around the home and in activity space (AS) (i.e. areas around places of main activity and commuting journeys) using geographic information systems. Associations between RFE indicators and organic food purchases were assessed using multinomial logistic regression models, adjusted for households’ characteristics. Results Households exposed to organic food outlets around their home (OR presence vs. absence [95% CI]=2.27 [1.33; 3.89]) had higher expenses in organic foods. Households exposed to organic food outlets in their AS were also more likely to have medium (OR ≥ 3 organic food outlets vs. absence [95% CI]=2.52 [1.34;4.76]) or high organic food purchases (OR [95% CI]=1.90 [1.04;3.47]). The models that included different types of organic food stores confirmed the first ones: households who were exposed to organic specialized food stores (greengrocers, bakeries and butcher's stores) around home and in their AS were more likely to have medium or high organic food purchases. In addition, the distance to the nearest organic grocery food store was inversely associated with high expenses in organic foods (OR [95% CI]=0.57 [0.41; 0.80]). Conclusions These results suggest exposure to organic food outlets and their use are related, providing knowledge for cities’ commercial planning with the aim of promoting spatial access to organic food for their inhabitants. Key messages • Exposure to organic food outlets and their use are related. • Food environment may influence consumers’ grocery shopping behaviors.

The obesogenic environment and incident cardiovascular disease in The Maastricht Study

Abstract Background The built environment has been identified as an upstream determinant of cardiovascular disease (CVD) in which neighborhood walkability and healthy food environments may promote increased physical activity and healthier dietary intake. Our aim is to determine if these neighborhood environments are associated with decreased incidence. Methods Data from 6,563 participants of The Maastricht Study and Geoscience and Health Cohort Consortium between the ages of 40-75 without history of CVD were analyzed. Objective walkability was measured by the 7-component Dutch Walkability Index while the food environment was an aggregate score of available food outlets, within 1000m Euclidian buffers around residential addresses of participants. Perceived walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. Incident CVD was obtained from a follow-up questionnaire. A Cox regression analysis was performed with CVD morbidity time to event outcomes adjusting for demographic and socioeconomic covariates. Results Over a median follow-up of 7.2 years (1.0-12.0 years), 975 cases were reported. The most walkable neighborhoods were not associated with incident CVD for both perceived (HR: .80; 95% CI = .64, 1.00) and objective (HR: 1.14; 95% CI = .91, 1.43) neighborhood environment measures compared to those living in the least walkable neighborhoods. When considering individual CVD conditions, participants had statistically significant lower incidence of peripheral vascular disease in the highest perceived walkable neighborhoods (HR: .57; 95% CI = .41, .78). The healthiest food environments (HR: .84; 95% CI = .66, 1.06) were not related to incident CVD. Conclusions Objectively measured walkability and neighborhood food environment were not associated with overall incident CVD with participants in our study. We found perceived neighborhood walkability to be associated with lower incident peripheral vascular disease. Key messages • Research on the obesogenic environment should additionally be carried out in other regions to gain additional understanding of its effect on cardiovascular disease. • Further study on the impact of walkable environments on individuals with peripheral vascular disease should be considered to understand its effect with this population.

Geospatial mapping of food advertisements in three low-income communities in Cape Town, South Africa

Abstract Background The South African food environment is characterized by pervasive marketing on television and in print media of unhealthy food and beverages. Little is known about the extent of outdoor food and beverage marketing (product, spatial advertising, branding) at transport interchange areas, community food outlets, and schools. Our study aimed to map outdoor food and beverage marketing within the vicinities of these areas in three low-income communities in Cape Town. Methods Data on food and beverage-related branding, product type, placement, pictures, and Global Positioning System coordinates were captured using a web-based questionnaire. Geographic Information System software was used to delimit the target communities and areas, geospatially map the physical food environment, and perform spatial analysis of the data. Results Overall, 986 food and beverage advertisement entries were observed. Preliminary results depicted trends of advertisements clustering around retailers. Spatial trends depicted that fast food and sugar-sweetened beverage (SSB) advertisements were likely to collocate around transport interchange areas, while SSB advertisements were more likely to collocate near schools. The spatial trend for alcohol advertisements indicated a clustering near main roads. Spatial trends for product types varied by location. Few advertisements for fruit and vegetables were captured. Further spatial analysis is underway to assess advertisement density and proximity to youth-related areas, food outlets, and transport interchange areas. Conclusions Low-income communities, commuters, and schoolchildren in South Africa are targeted by advertisements for unhealthy foods and SSBs, indicating the need for policy intervention to regulate food marketing. Key messages • Geospatial mapping of food and beverage advertisements indicated the promotion of unhealthy products in low-income communities in South Africa. • Food and beverage adverts target school children and commuters using public transport in poorer communities.

Public's calorie literacy and perceived effectiveness of restaurant menu calorie labeling in the United Arab Emirates.

Restaurant menu calorie labeling is regarded as a promising, cost-effective, and innovative method that will have an impact on the food environment, raise awareness among consumers, and aid in global efforts to prevent obesity. This study aimed to assess the public's calorie literacy, dining practices, and perceived effectiveness of restaurant menu labeling implementation in the United Arab Emirates (UAE). A descriptive, web-based cross-sectional study was conducted among 1279 adults in the UAE. Socio-demographic characteristics, calorie literacy, and perceived effectiveness of restaurant menu labeling among participants were investigated. Chi-square analysis was used to compare indicators across demographic characteristics. More females than males completed the online survey, (56.1% and 43.9%). Most of the participants aged < 30 years old (54.8%), The majority of participants reported eating away from home at least once per week (89.6%). 66.0% of participants were knowledgeable about calorie definition, but only 37.1% knew about average daily energy requirements. Younger participants, with a normal BMI, and higher education levels reported a significantly higher likelihood of eating at a chain restaurant with caloric information on the menu (p <0.05). The majority of participants (76.0%) preferred to see calorie information and other nutrition information on menus. To conclude, menu labeling is a welcomed policy to be implemented in food outlets. Further investigation is necessary to ascertain the most efficacious method of presenting nutrition information to consumers to facilitate informed purchasing decisions considering the potential benefits of mandating calorie declaration in obesity prevention efforts.

BMI and the Food Retail Environment in Melbourne, Australia: Associations and Temporal Trends.

Research into the link between food environments and health is scarce. Research in this field has progressed, and new comprehensive methods (i.e., incorporating all food retail outlets) for classifying food retail environments have been developed and are yet to be examined alongside measures of obesity. In this study, we examine the association and temporal trends between the food environment and BMI of a repeated cross-sectional sample of the adult population between 2008 and 2016. Methods: Food retail data for 264 postal areas of Greater Melbourne was collected for the years 2008, 2012, 2014, and 2016, and a container-based approach was used to estimate accessibility to supermarkets, healthy and unhealthy outlets. Data on BMI for postal areas was obtained from the Victorian Population Health Survey (n = 47,245). We estimated the association between the food environment and BMI using linear mixed models. Results indicated that BMI increased as accessibility to healthy outlets decreased by up to -0.69 kg/m2 (95%CI: -0.95, -0.44). BMI was lower with high and moderate access to supermarkets compared to low access by -0.33 kg/m2 (-0.63, -0.04) and -0.32 kg/m2 (-0.56, -0.07), and with high access to unhealthy outlets compared to low access (-0.38 kg/m2: -0.64, -0.12) and moderate access (-0.54 kg/m2: -0.78, -0.30). Conclusion: Our results show that increasing access and availability to a diverse range of food outlets, particularly healthy food outlets, should be an important consideration for efforts to support good health. This research provides evidence that Australia needs to follow suit with other countries that have adopted policies giving local governments the power to encourage healthier food environments.

Healthy ageing in a gentrified city: perspectives of older adults from Porto

Abstract Background Neighbourhood transformations like gentrification can affect health outcomes. Gentrification is understood as a set of processes of sociospatial change driven by investments in the built environment oriented to the preferences of affluent people. However, little is known about the impact of gentrification on older adults. We aimed to understand how older people perceive gentrification how it relates to healthy ageing. Methods This qualitative study, conducted in 2022, was based on nineteen semi-structured interviews of older adults (≥60 years) from the EPIPorto cohort living in Porto, a hotspot of gentrification. Individuals were selected through purposive sampling based on four features: sex, education, homeownership, and area of residence. Inductive thematic analysis was performed using NVivo. Results Most respondents identified changes in the physical environment and how it is used due to gentrification, namely concerning green and leisure spaces, food and beverages outlets, housing and commerce. It was also mentioned that gentrification leads to a shortage of affordable housing and weakens social cohesion. Participants described that changes in the physical environment due to gentrification can contribute positively to their well-being, while others admitted a higher cost of living and increased vulnerability to worse mental health. Yet, some interviewees revealed little or no influence of gentrification on healthy ageing. Conclusions Gentrification has dual and disparate effects on older adult's health and well-being. Policies should maximize the health benefits of gentrification, while protecting citizens from the negative effects. Key messages • Considering people’s perspectives on gentrification and healthy ageing is essential to plan age-friendly cities and achieving better health outcomes.

8.A. Round table: An exploration of the EAT Lancet Commission on healthy diets for sustainable food systems

Abstract Sustainable food systems are those that are healthy, sustainable, and equitable, while also addressing environmental challenges. The 2019 EAT-Lancet Commission on Healthy Diets for Sustainable Food Systems provides comprehensive recommendations for transforming the global food system to address malnutrition, reduce the use of antibiotics in animal agriculture, environmental degradation and climate change. However, the implementation of the EAT-Lancet recommendations has been slow and uneven across different regions and sectors. Holistic approaches to achieve food system sustainability are needed, emphasising the interconnectedness of different systems and the need for multidisciplinary approaches. One Health, Health Impact Assessment (HIA), and mandatory food fortification are all approaches that can contribute to the implementation of EAT-Lancet recommendations. The One Health approach recognizes that human health, animal health, and environmental sustainability are interconnected and that collaboration across sectors is necessary to address complex health challenges. By considering the health of animals and the environment in addition to human health, the One Health approach can inform the development of sustainable food systems that promote health for all. Health Impact Assessment (HIA) is a structured process that evaluates the potential health impacts of policies, programs, and projects. HIAs can be used to identify and address potential health risks associated with food systems and help to promote policies and interventions that support healthy and sustainable food systems. Mandatory food fortification is a strategy that involves adding essential vitamins and minerals to food products to address nutrient deficiencies. Mandatory fortification can be used to ensure that essential nutrients are present in the food supply, which can have significant impacts on public health, when consumed passively. The objective of this round table session is to show how multisectoral approaches can be used to achieve better human and planetary health and promote more sustainable and healthy food systems. This session will bring together experts from different disciplines to explore how holistic approaches can promote healthy and sustainable food systems. There will be three short presentations followed by a round table discussion in which the audience is invited to interact with the discussants. First, the One Health approach of AMR will be discussed outlining the need for a binding international legal framework. Second, a presentation on Health Impact Assessment, planning and public health in relation to the food environment in the UK will be conducted. Finally, the case for a mandatory approach of folic acid supplementation in Ireland with strict regulation, monitoring and oversight with penalties for non-compliance by the food industry is presented. Panellists will share lessons learnt from the Netherlands, the UK, Ireland and Bulgaria and the case for EU-wide approaches will be made. Key messages • Holistic approaches to achieve food system sustainability are needed, emphasising the interconnectedness of different systems and the need for multidisciplinary approaches from local to transnational. • There is a clear role for binding international legal frameworks to tackle challenges related to the food system, such as AMR, fast food outlet density and folic acid fortification. Speakers/Panelists Thom Geertsema Groningen Center Health Law, Faculty of Law, University of Groningen, Groningen, Netherlands Ben Cave Ben Cave Associates Ltd, Leeds, UK Mary Rose Sweeney Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland Desislava Vankova Medical University of Varna, Varna, Bulgaria Nikhil Gokani University of Essex, Colchester, UK

Race, Socioeconomic Status, and Food Access in Two Predominantly White Cities: The Case of Lansing, East Lansing, and Surrounding Townships in Michigan

Access to fresh, healthy, affordable foods is a pressing concern in cities worldwide. American cities are no exception. Although many scholars study food access in large cities, small and mid-sized American cities can provide valuable information about inequities in the food system. This paper focuses on two adjoining, racially mixed Mid-Michigan cities—Lansing and East Lansing. It examines the extent to which different food outlets exist in the cities and surrounding townships. It probes the following questions: (1) How are food outlets distributed throughout the cities and suburbs? (2) What is the relationship between neighborhood demographic characteristics and the distribution of food outlet types? We collected data on food outlets from September 2020 to June 2022 using Data Axle as our primary source of information. We used ArcGIS 10.8.1 for the spatial mapping and SPSS 28 for statistical analyses. We conducted regression analyses to identify the difference in the likelihood of finding food retailers in census tracts where 0–20% of the residents were People of Color (VL-POC), 20.01–40% of the inhabitants were People of Color (L-POC), 40.1–60% of the residents were People of Color (H-POC), and more than 60% of residents were People of Color (VH-POC). There were 1647 food outlets in the study area: 579 were in Lansing, 220 were in East Lansing, and the remaining 848 were in the surrounding townships. Restaurants dominated the food landscape, while small groceries and convenience stores were the grocery sector’s most common food outlet types. Supermarkets and large grocery stores comprised only 5.6% of the study area’s food outlets. The study finds a nonlinear relationship between the racial composition of census tracts and the prevalence of food outlets. The VH-POC census tracts had very few food outlets. For instance, the tracts had no supermarkets, mass merchandisers or supercenters, small grocery or convenience stores, pharmacies or drug stores, or farmers’ markets. The findings illustrate the diversity and complexity of the Lansing–East Lansing metropolitan area’s food landscape.

Food Environments Within and Outside of Schools Play a Critical Role in Curtailing the Rise in Obesity among School-Aged Children over Time

BackgroundSound evidence for effective community-based strategies is needed to curtail upward trends in childhood obesity in the United States (US). ObjectivesThe aim of the study was to assess the association between school and community food environments and the prevalence of obesity over time. MethodsData were collected from K–12 schools in 4 low-income New Jersey cities in the US. School-level obesity prevalence, calculated from nurse-measured heights and weights at 4 time points, was used as the outcome variable. Data on the school food environment (SFE) measured the healthfulness of school lunch and competitive food offerings annually. The community food environment (CFE), i.e., the number of different types of food outlets within 400 m of schools, was also captured annually. The count and presence of food outlets likely to be frequented by students were calculated. Exposure to composite environment profiles both within schools and in communities around schools was assessed using latent class analysis. Data from 106 schools were analyzed using multilevel linear regression. ResultsThe prevalence of obesity increased from 25% to 29% over the course of the study. Obesity rates were higher in schools that had nearby access to a greater number of limited-service restaurants and lower in schools with access to small grocery stores and upgraded convenience stores participating in initiatives to improve healthful offerings. Interaction analysis showed that schools that offered unhealthier, competitive foods experienced a faster increase in obesity rates over time. Examining composite food environment exposures, schools with unhealthy SFEs and high-density CFEs experienced a steeper time trend (β = 0.018, P < 0.001) in obesity prevalence compared to schools exposed to healthy SFE and low-density CFEs. ConclusionsFood environments within and outside of schools are associated with differential obesity trajectories over time and can play an important role in curtailing the rising trends in childhood obesity.

Socioeconomic distribution of food outlet availability through online food delivery services in seven European countries: A cross-sectional study

This area-level cross-sectional study examined online food outlet availability through the most popular online food delivery service platforms (OFDS) across seven European countries, and explored how this online food outlet availability was socioeconomically distributed. Data collection of online food outlet availability was automated in England, Italy, Luxembourg, the Netherlands, Portugal, Spain and Switzerland. We used a geographic information system to join online food outlet availability to socio-demographic information. Median number of food outlets delivering through OFDS was highest in England and lowest in Italy, Portugal and Spain. We also found that high-income areas have the greatest online food outlet availability in most countries. In England, areas with a middle income had the least online food outlets available and no income data was available for Switzerland. Further work is needed to understand drivers of disparities in online food outlet availability, as well as possible implications for public health.

Consumption Behaviors and Awareness of fast food among the Young Generation: An Empirical Study on Hostel Living Students in Kathmandu Valley

This research aims to study the fast-food habits of the young generation, who are staying in hostels. It intends to study the role of parents and advertisement regarding on consumption behaviours and awareness of fast food. Food is considered as an important representation of all social groups. Although the trend has changed, its impacts exist on the whole society, whether it belongs to the lower middle class or elite class. Fast food is considered as easy to make and ready to eat, so in present days, the young generation is attracted to fast food outlets as hanging places with friends in search of new tastes and places. Hostel life is entirely different and independent from the in-home, especially in terms of food eating. Keeping this view in mind, this research was conducted in two hostels in Kathmandu metropolitan city. This is qualitative research. Based on my research I argue that there is a link between food, parents’ roles, behaviors pattern of hostellers, and advertising.

The association between food environment, diet quality and malnutrition in low- and middle-income adult populations across the rural-Urban gradient in Vietnam.

Economic reforms and trade liberalisation in Vietnam have transformed the food environment, influencing dietary patterns and malnutrition status. The present study focuses on the relationship between food environments (proximity and density of food outlets) and malnutrition (underweight, overweight, obesity) through diet quality in adult populations across urban, periurban and rural areas of Vietnam. We evaluated food environment by geospatial mapping of food outlets through a transect walk across the "food ecosystem" from rural to urban areas. Diet quality was assessed using the Diet Quality Index - Vietnamese (DQI-V) comprising Variety, Adequacy, Moderation and Balance components. Malnutrition status was determined using body mass index. We performed a mediation analysis utilising mixed effect models to control for neighbourhood clustering effects. Confounders included age, education, income and nutrition knowledge score. Analysis of data from 595 adult participants (mean ± SD age: 31.2 ± 6.4 years; 50% female) found that longer distance to the nearest food outlet was associated with higher overall DQI-V (β = 2.0; 95% confidence interval = 0.2-3.8; p = 0.036) and the Moderation component (β = 2.6; 95% confidence interval = 1.2-4.0; p = 0.001). Outlet density shows a negative association with the odds of underweight among women (odds ratio = 0.62; 95% confidence interval = 0.37-0.96). However, we did not observe statistically significant relationships between diet quality and malnutrition. Education and nutrition knowledge scores were positively associated with diet diversity, while income was negatively associated with diet moderation. The findings of the present study have important implications for nutrition and dietetics practice in Vietnam and globally. It emphasises the need to consider various dimensions of sustainable diets, including economic, health and socio-cultural/political factors. Longer distances to food outlets are associated with higher diet quality, whereas lower food outlet density increases the odds of underweight among women. This poses challenges in balancing modernisation and its adverse effects on sustainable food systems. Socio-economic status consistently correlated with diet quality and malnutrition, necessitating further research to promote healthy diets across socio-economic strata.

Assessing the association between food environment and dietary inflammation by community type: a cross-sectional REGARDS study

BackgroundCommunities in the United States (US) exist on a continuum of urbanicity, which may inform how individuals interact with their food environment, and thus modify the relationship between food access and dietary behaviors.ObjectiveThis cross-sectional study aims to examine the modifying effect of community type in the association between the relative availability of food outlets and dietary inflammation across the US.MethodsUsing baseline data from the REasons for Geographic and Racial Differences in Stroke study (2003–2007), we calculated participants’ dietary inflammation score (DIS). Higher DIS indicates greater pro-inflammatory exposure. We defined our exposures as the relative availability of supermarkets and fast-food restaurants (percentage of food outlet type out of all food stores or restaurants, respectively) using street-network buffers around the population-weighted centroid of each participant’s census tract. We used 1-, 2-, 6-, and 10-mile (~ 2-, 3-, 10-, and 16 km) buffer sizes for higher density urban, lower density urban, suburban/small town, and rural community types, respectively. Using generalized estimating equations, we estimated the association between relative food outlet availability and DIS, controlling for individual and neighborhood socio-demographics and total food outlets. The percentage of supermarkets and fast-food restaurants were modeled together.ResultsParticipants (n = 20,322) were distributed across all community types: higher density urban (16.7%), lower density urban (39.8%), suburban/small town (19.3%), and rural (24.2%). Across all community types, mean DIS was − 0.004 (SD = 2.5; min = − 14.2, max = 9.9). DIS was associated with relative availability of fast-food restaurants, but not supermarkets. Association between fast-food restaurants and DIS varied by community type (P for interaction = 0.02). Increases in the relative availability of fast-food restaurants were associated with higher DIS in suburban/small towns and lower density urban areas (p-values < 0.01); no significant associations were present in higher density urban or rural areas.ConclusionsThe relative availability of fast-food restaurants was associated with higher DIS among participants residing in suburban/small town and lower density urban community types, suggesting that these communities might benefit most from interventions and policies that either promote restaurant diversity or expand healthier food options.

The impact of calorie labelling and proportional pricing on out of home food orders: a randomised controlled trial study using a virtual food and drink delivery app

BackgroundMandatory calorie labelling in the out-of-home food sector was introduced in England in 2022, and menu pricing strategies that ensure cost is equivalent to portion size (proportional pricing) have been proposed as a policy to reduce obesity. Food delivery app-based platforms now contribute significantly to diet, and evidence suggests that those at a socioeconomic disadvantage may have greater exposure to unhealthy options on these platforms. However, public health policies to improve nutritional quality of food ordered from food delivery apps has received limited examination.ObjectiveThis experimental study assessed the impact of calorie labelling and proportional pricing on item and meal size selection, calories ordered, and money spent when selecting food and drinks from three outlet types on a virtual delivery app.MethodsUK adult participants (N = 1126, 49% female), stratified by gender and education level completed an online study where they ordered items from three branded food and beverage outlets (coffee shop, sandwich outlet, fast food outlet) using a virtual delivery app. Participants were presented food and beverage options with vs. without calorie labels and with value (larger portions are proportionally cheaper) vs. proportional pricing.ResultsCalorie labelling did not influence portion size selection for any outlets, but significantly reduced calories ordered from the coffee shop (-18.95kcals, 95% CI -33.07 to -4.84) and fast food outlet (-54.19kcals, 95% CI -86.04 to -22.33). Proportional pricing reduced the likelihood of choosing a larger beverage from the coffee shop (OR = 0.58, 95% CI 0.45 to 0.75), but was associated with increased calories ordered from the fast food outlet (51.25kcals, 95% CI 19.59 to 82.90). No consistent interactions were observed with participant characteristics, suggesting that effects of calorie labelling and pricing on outcomes were similar across sociodemographic groups.ConclusionsCalorie labelling on food delivery platforms may effectively reduce calories ordered. Proportional pricing may be useful in prompting consumers to select smaller portion sizes, although further research in real-world settings will now be valuable.

SynthEco - A multi-layered digital ecosystem for analysing complex human behaviour in context

Introduction &amp; BackgroundHuman behaviour is multi-faceted and complex, with different dimensions interacting and impacting each other and individuals operating in an environmental context. In order to understand this behaviour better, the combination of data from different sources is useful to uncover some of those interactions and complexities. We present a multi-layered digital ecosystem based on a data platform providing statistically representative synthetic population derived from census data at different geo-spatial granularity, which we call SynthEco. This platform is enriched with individual data stemming from cohorts and cross-sectional surveys and geo-scanning of different layers of socio-environmental actors and conditions to create a complex digital ecosystem.&#x0D; Objectives &amp; ApproachThe objective of SynthEco is to allow for the analysis of behaviour, as well as health and wellbeing outcomes, through the integration of cohort and cross-sectional data into a geospatially anchored synthetic population embedded into environmental data which is forming the backdrop. We demonstrate the use of this platform on the example of Montreal, Canada. The synthetic population is first generated from census data using iterative proportional fitting, which allows for the creation of a population data set that is artificial yet statistically representative for a given geospatial granularity, such as a city. Each individual household is assigned a geospatial location, which allows for the consideration of their surrounding environment including enterprises or institutions such as schools, hospitals and the local food environment. Through fuzzy matching and statistical extrapolation, different cohort and cross-sectional survey data are then merged to individual records, in order to describe them in more detail. This includes health, as well as financial wellbeing or social environment descriptors.&#x0D; Relevance to Digital FootprintsThere are two important points made through the presented work in relation to Digital Footprints data: the first is the technical approach to merging multiple datasets describing different dimensions of interacting human characteristics and behaviour by anchoring them into a synthetic population through fuzzy record matching. The second is the consideration of a spatial dimension when describing human behaviour. This is especially important when describing behaviour within local environments, such as the interaction with local food outlets.&#x0D; ResultsRecent work in this context includes an analysis of the food environment in Montreal, Canada. It introduces a way of utilising the synthetic population to predict the healthfulness of their local environment in terms of healthy food outlets, as well as providing a platform for the analysis of food environment surveillance and intervention simulations. For this purpose, the healthfulness of different census tract regions in Montreal is calculated to identify food deserts, food swamps, as well as healthy areas as defined through the Modified Retail Food Environment Index. We test different machine learning approaches to then predict these healthfulness scores using census variables from the synthetic population in their respective census tract, achieving accuracy scores of around 0.53 to 0.60. This demonstrates that census data has some limited predictive power in explaining the healthiness of the local food environment, which could be especially relevant for situations in which no information on the retailers is available to local policy makers. Future work can extend this approach to also include further data describing the population, stemming from the integrated cohorts and survey data, which could improve the prediction accuracy or help in identifying areas of concern.&#x0D; Conclusions &amp; ImplicationsThe presented SynthEco platform views individuals as agents nested within modular systems of systems, trying to capture both internal systems and processes as well as environmental ones within which individuals are operating. The platform thus enables the application of computational systems modelling for the analysis of individual human behaviour in contexts. As demonstrated through the example of using SynthEco in the context of healthier food environments, the approach is especially relevant to practitioners and policy makers interested in local intervention strategies and identifying areas for targeted policy related to different dimensions of health and wellbeing.