Healthy Food Access Research Articles

Increasing Healthy Food Access for Low-Income Communities: Protocol of the Healthy Community Stores Case Study Project.

Improving healthy food access in low-income communities continues to be a public health challenge. One strategy for improving healthy food access has been to introduce community food stores, with the mission of increasing healthy food access; however, no study has explored the experiences of different initiatives and models in opening and sustaining healthy food stores. This study used a case study approach to understand the experiences of healthy food stores in low-income communities. The purpose of this paper is to describe the methodology used and protocol followed. A case study approach was used to describe seven healthy food stores across urban settings in the U.S. Each site individually coded their cases, and meetings were held to discuss emerging and cross-cutting themes. A cross-case analysis approach was used to produce a series of papers detailing the results of each theme. Most case studies were on for-profit, full-service grocery stores, with store sizes ranging from 900 to 65,000 square feet. Healthy Food Availability scores across sites ranged from 11.6 (low) to 26.5 (high). The papers resulting from this study will detail the key findings of the case studies and will focus on the challenges, strategies, and experiences of retail food stores attempting to improve healthy food access for disadvantaged communities. The work presented in this special issue will help to advance research in the area of community food stores, and the recommendations can be used by aspiring, new, and current community food store owners.

Community support for policy interventions targeting unhealthy food environments in public institutions.

Understanding community support for obesity prevention policy is important for developing effective preventive health action. This study assessed support for a range of obesity prevention interventions, including food environment policies designed to improve healthy food and drink availability and promotion within public institutions. An online cross-sectional survey was completed by 2006 NSW adults. Questions explored attitudes and beliefs about obesity, the importance of government-led prevention and support for eight obesity prevention interventions. Regression analyses examined associations between intervention support and sociodemographic, attitudinal and behavioural characteristics. Most respondents (80%) believed obesity was a large problem and that poor individual choices (86%) and the widespread availability of unhealthy food and drink (78%) contributed to the issue. There was moderate to high support for most (n=7) initiatives. Support for food environment policies was highest for schools (76%-82%) and hospitals (67%-79%). Supporters and opponents rationalised opinions based on perceived effectiveness, the government's role and cost benefits. Opponents were a minority, but principles of autonomy were predominant. Attributing obesity to environment-related factors, and personal lower SSB consumption strongly predicted support. There is a significant recognition of the obesity issue and strong support for policies designed to improve the availability and promotion of healthy food and drink in public institutions, particularly in schools and hospitals. SO WHAT?: Substantial community support for healthy food environment policies in schools and hospitals warrants continued implementation in NSW. This may foster further acceptance for wider implementation. Our findings could inform the framing of policy advocacy messages.

Teachers’ and Parents’ Perspectives on the Feasibility of a Preschool-Based Behavioral Intervention to Prevent Obesity: An Embedded Qualitative Study within ToyBox Study Malaysia

The aim of this qualitative study, an embedded component of ToyBox Study Malaysia (TSM), was to elicit the perspectives of teachers and parents regarding the implementation of TSM. TSM is a preschool-based behavioral intervention program aimed at improving healthy energy balance-related behaviors among young children attending preschools. The qualitative study adopted a descriptive-interpretive methodology, and triangulated data collected through semi-structured focus groups with artifacts collected. The setting involved rural and metropolitan preschools in Sarawak and Peninsular Malaysia, respectively. In Sarawak, 11 teachers and 20 parents from six intervention preschools participated in this study. In Peninsular Malaysia, 14 preschool teachers and seven assistant teachers representing all 15 intervention preschools participated in the study. Data were analyzed thematically and four overarching themes were identified: impact of TSM on the children’s knowledge and practices of healthy energy balance-related behaviors; spheres of influence upon the children’s energy balance-related behaviors; constraints and affordances related to the implementation of TSM; and prospective sustainability of TSM. The triangulation of data from teachers, parents, and the artifacts related to TSM enabled the corroboration of evidence to support the themes identified. This study provides evidence on the reciprocal interactions between the teachers and parents who played key roles in facilitating behavioral change in the children, and the children who, in turn, served as change agents beyond the preschool. Furthermore, the mediational tools such as the TSM crockery and availability of healthy food and water led to the reported behavioral changes at both rural and metropolitan settings.

The Proportion and Type of Carbohydrates in the Diets of Children in Early Adolescence.

Background:Carbohydrates are mainly substrates for energy metabolism and can affect satiety, blood glucose levels, insulin secretion, and fat metabolism. Their amount and type in the diet affect metabolic responses. High-carbohydrate diets, particularly high sugar consumption, are considered particularly harmful because of their specific characteristics related to postprandial metabolism, effects on hunger and satiety, and thus on caloric intake and energy balance. The European Food Safety Authority has suggested that the reference intake for carbohydrates should be between 45 and 60% of total energy requirements and less than 10% should be added sugars, especially for children.Objective:Investigate the proportion and type of carbohydrates in the diets of children in early adolescence in two territorially distinct areas, the continental and the Mediterranean.Methods:The study was conducted as part of a longitudinal cohort study. The survey was conducted in elementary schools in two regions: continental and Mediterranean. The School Physical Activity and Nutrition Survey was used for research purposes. Descriptive and inferential statistical tests were applied for data analysis.Results:A total of 1,411 respondents of both sexes aged 12-15 years, 729 boys and 678 girls, participated in the study. The intake of carbohydrates in the total sample is represented in the daily intake of 59%. The proportion of natural sugar in the diet of boys is statistically significantly higher in the continental compared to the Mediterranean region at the age of 12-13 years (p = 0.002), 13-14 years (p = 0.049), and 14-15 years (p = 0.002). Added sugars in total carbohydrate intake are statistically significantly higher in girls in the Mediterranean region compared to the continental region at ages 12-13 years (p = 0.048), 13-14 years (p = 0.001), and 14-15 years (p = 0.001).Conclusion:The high intake of added sugars in children in the Mediterranean region is of concern, although the intake in the continental area is well above current recommendations. Therefore, one of the public health goals is to promote proper nutrition as well as the availability of healthy foods in schools, especially during early adolescence when proper eating habits are adopted.

Responding to Food Insecurity and Community Crises through Food Policy Council Partnerships in a Rural Setting.

Food insecurity is a constant struggle for many communities and food needs are often amplified during times of crisis. The objective of this article is to describe the progress in our community food policy council partnership by presenting the elements of success in facilitating policy change and programs that have helped our community in rural Pennsylvania respond to a variety of challenges, including the coronavirus disease 2019 (COVID-19) crisis. We also critically examine ongoing challenges and implications for our work. The elements that have contributed to sustaining our collective work include having a common agenda; collaboration; maintaining independent but mutually supporting member organizational goals; valuing those who are most impacted; and continuous communication. By applying these elements of partnership, the council remains focused on healthy food access, particularly during this COVID-19 crisis and ongoing food-related inequities.

How Food Insecurity and Financial Difficulty Relate to Emotional Well-Being and Social Functioning.

Medically uninsured individuals living in poverty experience poor health and face social barriers that negatively affect their health. The purpose of this study was to examine the association between social barriers, particularly healthy food availability and financial difficulty, and well-being among uninsured free clinic patients in the United States. Data were collected using a self-administered paper survey at a free clinic from adult patients who spoke and read English or Spanish (N = 666) from January to April 2019. Better neighborhood healthy food availability is associated with better self-reported general health. Food security is related to better emotional well-being and social functioning. Having difficulty paying rent or a mortgage is linked to worse emotional well-being and social functioning. Providing health education programs may not be sufficient to promote healthy eating among underserved populations because of the social barriers that they experience, such as food insecurity and financial difficulty. Future research could be performed to determine how these social factors influence those of different social and cultural backgrounds than the participants in this study.

Perception of pregnant women in Primary Health Care about healthy eating

Pregnancy promotes several transformations in the female organism, leading to a greater energetic and nutritional demand. If the demand is not met, there will be a competition between the fetus and the mother, which can cause harm to fetal development. Although widely discussed, it is not very clear how pregnant women see healthy eating and whether they can follow it during their daily life. Therefore, it is important to know how pregnant women understand this theme, whether they are receiving guidance, what they do with the acquired knowledge, and what factors are influencing their dietary choices. The aim of this study was to verify the knowledge of pregnant women assisted in primary health care in Belém, PA concerning healthy eating, such as characterizing the socioeconomic and demographic profile and nutritional status of the participants. This is a quantitative-qualitative study conducted with 27 pregnant women enrolled at MHC Guamá using a questionnaire with socioeconomic and demographic data and a semi-structured form with questions about their perception of healthy eating and self-declared weight, height, and gestational age. Qualitative data were analyzed using the Similitude Analysis and Word Cloud methods. The study pointed out that most pregnant women are young, have a high school education, are single, have one minimum wage income, and know how to achieve a healthy diet. However, several factors influence their food choices such as the conditions of their food, nutrition, and health, and the access and consumption of healthy foods on a daily basis. Regarding nutritional status, the same percentage of eutrophic and overweight pregnant women was observed, which may be related to the various factors that influence their dietary choices.

Availability of foods according to the degree of processing in families with young elderly and oldest-old (POF 2017-2018)

ABSTRACT Objective To compare the availability of healthy and unhealthy foods in families with and without elderly and oldest-old people. Methods This is an observational, cross-sectional study with secondary data from the Household Budget Survey, conducted by the Brazilian Institute of Geography and Statistics between 2017 and 2018. Families were characterized based on the oldest member: Control (without elderly and oldest-old) or with elderly and oldest-old. The sociodemographic characteristics of the families and the foods purchased by the families were obtained, according to the Nova classification (in natura, processed and ultra-processed foods, in addition to culinary ingredients). Results Families with elderly and oldest-old people had greater availability of fresh foods and fewer ultra-processed foods. In contrast, young families showed greater acquisition of all ultra-processed food items. Conclusion The unfavorable nutritional transition process with fewer in natura foods seemed to be less evident in families with higher age groups. It is concluded that the presence of the elderly and oldest-old in the family could be related to a better quality of the family diet, with a greater presence of fresh foods and a lower acquisition of ultra-processed foods.

Microbiological Analysis of Tilapia Fillet Stored Under Refrigerated Conditions

Fish is a food susceptible to deterioration and contamination by microorganisms through the food chain, affecting its quality and safety. Fish is subjected to various processing and preservation methods in order to maintain availability, quality and safety for a longer time. The objective of the study was the microbiological analysis of tilapia fillets in refrigeration for 12 days. The tilapia processing was carried out to obtain fillets. The fillets were packed in polyethylene bags and later in an isothermal polystyrene container and kept in refrigeration for 12 days and the microbiological analysis was carried out through quality and safety indicators. The results of the microbiological analysis indicated a regular growth dynamic during storage, reaching maximums for Aerobic Mesophylls (AM) and Aerobic Psychrophiles (AP) of 12.5 and 8.6 Log CFU/g respectively, Fungi and Yeast (FY) 9 Log CFU/g, Lactic Acid Bacteria (LAB) 9 Log CFU/g, Total Coliforms (TC) 8.3 Log CFU/g and Pseudomonas (P) 7 Log CFU/g. According to different microbiological criterion related to deterioration and acceptability in food, the counts obtained in fillet reached maximum values on day 4 of storage for AM, day 6 for AP, day 8 for P, day 2 for TC and after day 2 for LAB. The analysis of microbial growth in fillet under refrigeration through quality and safety indicators, allow estimating conditions and periods of availability of healthy and nutritious food.

Mushroom Production in the Southern Cone of South America: Bioeconomy, Sustainable Development and Its Current Bloom.

A Sustainable Development Goals (SDGs) based analysis is presented here for business development of the production of edible and medicinal mushrooms using agro-wastes in the Southern Cone of South America. This circular economy approach using edible and medicinal mushroom production on lignocellulosic residues is discussed by analysing both its advantages and drawbacks. Among its main benefits, it is notable that mushroom cultivation using lignocellulosic residues promotes innovation aimed at environmental sustainability, facilitating diversification of the labour supply and the transfer of science to the socio-cultural sphere, which also increases the availability of healthy foods. However, there are some bottlenecks in the process, such as the continuous supply chain of substrates for fungal growth, the lack of equipment and infrastructure for the implementation of cultivation systems in extreme habitats, as well as authorization requirements and other limitations related to a non-fungiphilic culture society. Therefore, this chapter tries to provide key tools for establishing sustainable guidelines for the procurement of local healthy food and other products derived from mushroom cultivation using agricultural residues in the region, which might bloom due to an SDGs-based circular economy approach.

Determinants and Consequences of Food and Nutrition Insecurity in Justice-Impacted Populations.

Purpose of ReviewThe purpose of this paper is to provide an overview of the state of the science of food and nutrition security among justice-impacted populations, identify who might be most at-risk and health consequences, and to highlight areas for continued research and policy implications.Recent FindingsThis population is at-risk for experiencing food and nutrition insecurity due to high rates of unemployment, parental history of incarceration, housing instability, depressive symptoms, and social isolation, which result from involvement with the corrections system. Health consequences associated with food insecurity include depressive symptoms, self-reporting lower health status, and engaging in HIV-risk behaviors.SummaryThe justice-impacted population has a disproportionately higher risk of chronic and infectious diseases compared to the general population. Compounding this with food and nutrition insecurity can exacerbate these outcomes and further contribute to poor health. Structural issues related to nutrition safety net programs and employment create barriers to healthy food access. More research related to food, employment, and corrections system policies are critical to improve the well-being of this population.

The Development of a Satellite Food Pantry Through Community-Based Participatory Action Research

Food for a Long Life (FFLL) is a community– university–extension project that utilizes intergenerational strategies and a communitybased participatory action research approach to increase healthy food access, consumption, and education for preschoolers and older adults. As a Children, Youth, and Families at Risk sustainable community project of the U.S. Department of Agriculture, FFLL is within its fifth and final year working collaboratively at an intergenerational site in a midwestern United States community identified as being food insecure. During Project Years 2–4, FFLL engaged in iterative communication and relationship-building with stakeholders and a local food bank to identify and address community needs, resulting in the creation of a satellite food pantry. Prior to the COVID-19 pandemic, the Food Satellite served approximately 60 family members each month. FFLL strives for program sustainability beyond the grant funding period by continuing community partnerships and training staff to facilitate the satellite food pantry operations.

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Responding to Intergenerational Food Security and Nutrition Education Needs With Remote Programming

In-person intergenerational programming focused on nutrition education and healthy food access among older adults and preschool children in care settings was abandoned last year when COVID forced center closures. Food for a Long Life (FFLL), a 5-year community-based participatory research (CBPR) project, re-oriented programming in response to heightened community food insecurity and social isolation during COVID. With county Extension agents, FFLL modified and initiated new partnerships to expand food pantry services for several hundred families and deliver nutrition programming to youth (n=28) and older adult (n=130) participants in two states. In this presentation we share how the CBPR method supported adaptive programming and evaluation while continuing to advance project goals, including to promote the sustainability of an intergenerational food pantry and nutrition programming delivery after funding ends in summer 2021.

A Food Box Intervention to Reduce Blood Pressure in Native American Adults With Hypertension: The CHEERS Study

People join a customer-driven organization with motivations that may not be static over time, an important issue for long-term organizational viability. In this study, we examined motivations among members of ShareCare, the first Village for older adults in the U.S. Using qualitative data from a random sample of 91 members, we compared motivations for becoming a member and for continuing membership. Motivations to join and continue membership are not necessarily the same. Motivations were categorized as: instrumental, social, and altruistic motivation. We categorized length of membership as short-term: 8-years or less (51.63%) and long-term: 9-years and more (49.37%). While 36% of members joined only for instrumental motivation, 59% continued membership only for instrumental motivation. While about 52% joined with multiple motivations, only 35% of members mentioned multiple motivations when continuing their membership. Finally, 18% of short-term members mentioned altruistic motivation when continuing their membership, while 28% of long-term members mentioned altruistic motivation when continuing their membership. While people’s motivation might change over time, altruistic motivation may be the greatest motivating factor for long-term memberships. Long-term members may identify themselves as supporters rather than users of the organization and cultivate stronger connections with other members over time. Our findings inform how to recruit and retain members in Villages, and customer-driven organizations for older adults more broadly.

Health Behavior Changes Among Adults in the Supplemental Nutrition Assistance Program Education, Los Angeles County, California.

Purpose and ObjectivesThe Supplemental Nutrition Assistance Program Education (SNAP-Ed), the educational branch of SNAP, can play an important role in improving dietary outcomes, eliminating food insecurity, and preventing chronic disease among low-income populations. This study examined the effects of local SNAP-Ed efforts on self-reported health behaviors and body mass index (BMI) over a 1-year period, using data collected from intercept surveys of program-eligible adults.Intervention ApproachFrom 2016 to 2020, the Los Angeles County Department of Public Health partnered with 24 community-based organizations to provide nutrition education and to implement policy, systems, and environmental changes in the community.Evaluation MethodsA cross-sectional survey was conducted in 2018 and repeated in 2019 to measure 6 outcomes describing population-level changes in health behaviors and BMI. The study recruited 4 samples: 2 samples from outside selected supermarkets (2018, n = 2,098; 2019, n = 2,323) and 2 samples from participants at SNAP-Ed class sites (2018, n = 651; 2019, n = 569).ResultsWhile study results showed an increase in consumption of fruits and vegetables and in vigorous physical activity, they also showed an increase in BMI and high consumption of unhealthy foods. Participating in SNAP-Ed classes was positively associated with several health behaviors but no change in BMI. Participants who experienced food insecurity had worse health behavior outcomes than those who did not experience this condition.Implications for Public HealthSNAP-Ed interventions appear to have a favorable effect on fruit and vegetable consumption, but increases in BMI suggest that unhealthy food consumption is abundant and may be counteracting the benefits gained from eating more fruits and vegetables. Future efforts should take these results into consideration and optimize enrollment in nutrition assistance programs. These efforts should include coordinating with local programs to increase healthy food access for at-risk low-income populations in Los Angeles County.

Content Analysis of Online Grocery Retail Policies and Practices Affecting Healthy Food Access

ObjectiveTo describe policies and practices of online grocery retailers that may affect healthy food access, including retailers participating in the US Department of Agriculture's Supplemental Nutrition Assistance Program Online Purchasing Pilot. DesignCross-sectional, quantitative content analysis of 21 online grocery retail websites from November 2019 to January 2020. Main Outcome MeasuresData collected using a coding instrument capturing the presence of policies and practices related to (1) online purchasing and delivery access; (2) availability of features that allow price comparisons and provide nutrition information; and (3) data privacy. AnalysisDescriptive statistics for features, practices, and policies across online grocery retail websites. ResultsMost retailers (95%) added fees to online orders. Among pilot retailers, 38% added ≥ 3 fees, and 50% required a minimum order > $15. Few retailers (29%) displayed Nutrition Facts Labels on all products, including 50% of pilot retailers. All retailers collected personal information from shoppers and automatically shared data with affiliated companies. Conclusions and ImplicationsHigh fees, limited access to nutrition information on retailer sites, and lack of data privacy are prevalent in online grocery retail settings, including among Online Purchasing Pilot retailers. Online retail practices may perpetuate disparities in healthy food access by discouraging use through fees and making nutritious food choices difficult.

Promoting Healthy Food Access and Nutrition in Primary Care: A Systematic Scoping Review of Food Prescription Programs.

ObjectiveTo conduct a scoping review to synthesize evidence on food prescription programs.Data SourceA systematic search of PubMed, CINAHL, Web of Science, Embase, and the Cochrane Library was conducted using key words related to setting, interventions, and outcomes.Study Inclusion and Exclusion CriteriaPublications were eligible if they reported food prescription administered by a health care practitioner (HCP) with the explicit aim of improving healthy food access and consumption, food security (FS), or health.Data ExtractionA data charting form was used to extract relevant details on intervention characteristics, study methodology, and key findings.Data SynthesisStudy and intervention characteristics were summarized. We undertook a thematic analysis to identify and report on themes. A critical appraisal of study quality was conducted using the Mixed Methods Appraisal Tool (MMAT).ResultsA total of 6145 abstracts were screened and 23 manuscripts were included in the review. Food prescriptions may improve fruit and vegetable consumption and reduce food insecurity (FI). Evidence for impacts on diet-related health outcomes is limited and mixed. The overall quality of included studies was weak. Addressing barriers such as stigma, transportation, and poor nutrition literacy may increase utilization of food prescriptions.ConclusionFood prescriptions are a promising health care intervention. There is a need for rigorous studies that incorporate larger sample sizes, control groups, and validated assessments of dietary intake, food security, and health.

Do neighborhood food environments matter for eating through online-to-offline food delivery services?

Eating through online-to-offline (O2O) food delivery services has in recent years emerged as an important diet behavior especially amid the COVID-19 pandemic. There is not much understanding of this relatively new diet behavior and its influence factors. In an attempt to answer the research question if the neighborhood food environment matters for eating through O2O food delivery services, this research collects primary data on people's experience of using O2O food delivery services through a sample questionnaire survey and secondary data on foodscapes including the spatial distributions of food sources of various types in Shanghai. Personal sociodemographic characteristics, home and workplace food environments are considered as potential explanatory factors of eating through O2O food delivery services. The study reveals that there are significant differences between home and workplace food environments in Shanghai and that home food environments are more influential on eating through O2O food delivery services than workplace food environments; the healthy food availability and accessibility at residential neighborhoods are found to significantly reduce the probability of eating through O2O food delivery services; lack of healthy food choices and being in the suburb explain O2O food delivery service consumptions at workplace. Findings of this research are relevant for promoting healthy eating through urban planning and urban design practices.

A Market Basket Assessment: Prices and Availability of Healthy Foods Across SNAP-Authorized Food Outlets in Counties With High Obesity Rates in Mississippi.

IntroductionThe Mississippi Delta is predominantly rural and ranks among the US regions with the highest obesity rates. Throughout the US, rural and low-income communities have limited access to healthy foods. Given the interrelation between the quality of the food environment and the healthfulness of diets and obesity rates, the food environment is an important public health concern in these communities.MethodsWe conducted a retail assessment in July 2019 in the Delta region of Mississippi and evaluated prices and availability of healthy foods at Supplemental Nutrition Assistance Program–accepting retail establishments using the validated Market Basket Assessment Tool. We used regression analysis to identify differences in prices and availability of healthy foods across food retail formats.ResultsThe healthy foods availability and quality score for convenience stores, which comprise the highest proportion of store formats in the region, was 70% lower than for supermarkets. Compared with the prices at supermarkets, the prices at convenience stores were 48% higher for grains, 35% higher for fruit and vegetables, 73% higher for meats, and 95% higher for beans, seeds, and nuts. The healthfulness of foods available at dollar stores was also lower than the healthfulness at supermarkets, but prices were generally similar.ConclusionThe availability of supermarkets and grocery stores was limited in the study area, but the concentration of convenience stores was high. Overall, access and affordability of healthy foods were restricted in the counties studied; these findings are useful for intervention development.