Primary Food Store Research Articles

Intake of Snacks and Sweets in a National Study of Built and Social Environments: the REasons for Geographic And Racial Differences in Stroke Study

BackgroundFew national studies across the United States’ rural-urban continuum examine neighborhood effects on snacks and sweets intake among adults. ObjectivesThis study examines associations of urbanicity/rurality-tailored measures of food store availability and neighborhood socioeconomic status (NSES) with the intake of snacks and sweets in a national sample of middle and older age adults. MethodsThis cross-sectional study used food frequency questionnaire data collected in the REasons for Geographic And Racial Differences in Stroke study (N = 21,204). What We Eat in America food group categorizations guided outcome classification into 1 main category (total snacks and sweets) and 4 subcategories (savory snacks and crackers; sweet bakery products; candy and desserts; nutrition bars and low-fat snacks and sweets). NSES and food store availability were determined using geographic information systems. Food store availability was characterized as geographic access to primary food stores (e.g., supermarkets, supercenters, and select food retailers) in urbanicity/rurality-tailored neighborhood-based buffers. Multiple linear regression was used to predict each outcome. ResultsLiving in neighborhoods with a high density of primary food stores was associated with 8.6%, 9.5%, and 5.8% lower intake of total snacks and sweets, sweet bakery products, and candy and desserts, respectively. Living in the highest NSES quartile was associated with 11.3%, 5.8%, and 18.9% lower intake of total snacks and sweets, savory snacks and crackers, and sweet bakery products, respectively. Depending on primary food store availability, higher household income was associated with significantly greater intake of nutrition bars and low-fat snacks and sweets. Living in a United States Department of Agriculture-defined food desert was not associated with intake. ConclusionsIn a geographically diverse sample of middle and older age United States adults, living in neighborhoods with no primary food stores or neighborhoods of low-SES was associated with higher intake of total snacks and sweets and subgroups of snacks and sweets.

Exploring food shopping behaviours in 20-minute neighbourhoods: a cross-sectional analysis of ProjectPLAN

ABSTRACT Cities worldwide have adopted the ‘20-minute neighbourhood’ concept to promote local healthy living through the provision of everyday services close to home. However, evidence on their impact beyond active travel is lacking. This study investigates whether 20-minute neighbourhoods shape people’s interactions with food stores. Data were from 769 participants from the 2018-2019 Places and Locations for Activity and Nutrition study (ProjectPLAN) conducted in Melbourne and Adelaide, Australia. Outcomes were distance from home to different food stores, frequency of store visits, transport mode to food stores, and reasons for shopping at primary food store. Comparisons were made between those in 20-minute neighbourhoods and non-20-minute neighbourhoods. Visited stores were closer to home for those in 20-minute neighbourhoods. Residents of 20-minute neighbourhoods more frequently visited an additional fruit and vegetable outlet than those of non-20-minute neighbourhoods. While car travel prevailed across neighbourhood types, walking to food stores was more common in 20-minute neighbourhoods. Differences were observed in reasons for shopping at primary food store between residents of 20-minute neighbourhoods and non-20-minute neighbourhoods. This study suggests 20-minute neighbourhoods offer opportunities for greater engagement with local food stores. Whilst walking to stores is more common in 20-minute neighbourhoods, car use remains a dominant travel mode.

Food Acquisition Practices, Body Mass Index, and Dietary Outcomes by Level of Rurality.

Rural residents are more likely to be obese than urban residents. Research on how people navigate their local food environments through food acquisition behaviors, such as food shopping and restaurant use, in different types of communities may help to create a deeper understanding of the multilevel determinants of obesity. Data are from a national sample of US adults ages 18-75. Respondents were recruited from an online survey panel in 2015 and asked about food shopping, restaurant use, diet and weight (N = 3,883). Comparisons were made by level of rurality as assessed by Rural-Urban Continuum Codes (RUCC) and self-reported rurality of the area around their home. Food acquisition behaviors varied minimally by RUCC-defined level of rurality, with the exceptions of type and distance to primary food store. Rural residents drove further and were more likely to shop at small grocery stores and supercenters than were residents of semiurban or urban counties. In contrast, all of the food acquisition behaviors varied by self-reported rurality of residential areas. Respondents living in rural areas shopped for groceries less frequently, drove further, more commonly shopped at small grocery stores and supercenters, and used restaurants less frequently. In multivariable analyses, rural, small town, and suburban areas were each significantly associated with BMI and fruit and vegetable intake, but not percent energy from fat. Findings show that self-reported rurality of residential area is associated with food acquisition behaviors and may partly explain rural-urban differences in obesity and diet quality.

Abstract P283: Where You Shop and Neighborhood Access to Fruit and Vegetables are Associated With Self-rated and Cardiometabolic Health

Introduction: The food environment, including food retail venues, has been shown to be associated with diet, and many disadvantaged neighborhoods lack access to high quality and affordable healthy foods. Research has sought to understand whether and how the food retail environment influences diet, and it is possible that shopping at different types of stores (e.g. full-service vs discount grocery store) influences diet and self-reported health outcomes. There is limited understanding of whether factors of the food environment and primary shopping location impact cardiometabolic health (blood pressure, HbA1c, cholesterol) and self-rated health. Methods: We report on 459 individuals who participated in a blood draw in 2018 as part of the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health, a longitudinal natural-experiment study among African American adults from two socioeconomically similar neighborhoods. Participants reported their perceived access to fruit and vegetables within their neighborhood and where they did their primary food shopping. Outcomes include measured height, weight, blood pressure, cholesterol (HDL, Total), HbA1c, and participant’s self-rated health. We employed logistic regression to examine associations between 1) perceived fruit and vegetable availability, quality, and price and 2) primary food shopping store type and reason for shopping there, with cardiometabolic and self-rated health outcomes. Covariates were neighborhood, years lived in neighborhood, age, race, income, education, and marital status. Results: Participants were on average, 60.7 years old (SD=13.9); 81.7% (375 of 459) female; 80.4% (369 of 459) overweight/obese. After covariate adjustment, both more perceived accessibility of purchasing (OR: 0.47, 95% CI: 0.28, 0.79) and pricing of fruits and vegetables (OR: 0.59, 95% CI: 0.36, 0.96) within one’s neighborhood were associated with lower odds of high blood pressure. More accessible purchasing (OR: 0.59, 95% CI: 0.39, 0.90), pricing (OR: 0.62, 95% CI: 0.41, 0.94), and higher quality of fruits and vegetables (OR: 0.64, 95% CI: 0.42, 0.97) within one’s neighborhood were associated with lower odds of poor self-rated health. Doing one’s primary food shopping at a discount grocery store compared to a full-service grocery store was associated with lower odds of being overweight (OR: 0.51, 95% CI: 0.26, 0.99). Choosing a primary food store based on price rather than quality of food was associated with increased odds of high cholesterol (OR: 2.02, 95% CI: 1.19, 3.45). Conclusion: These results suggest that higher perceptions of access to fruits and vegetables in one’s neighborhood and choice of primary food shopping store are important correlates of cardiometabolic health. Further research should look towards understanding how direct food choices made at stores impact cardiometabolic outcomes within this population.

Socioecological Path Analytic Model of Diet Quality among Residents in Two Urban Food Deserts

BackgroundDiet is critical to chronic disease prevention, yet there are persistent disparities in diet quality among Americans. The socioecological model suggests multiple factors, operating at multiple levels, influence diet quality. ObjectiveThe goal was to model direct and indirect relationships among healthy eating identity, perceived control of healthy eating, social support for healthy eating, food retail choice block scores, perceptions of healthy food availability, and food shopping behaviors and diet quality measured using Healthy Eating Index-2010 scores (HEI-2010) for residents living in two urban communities defined as food deserts. DesignA cross-sectional design was used including data collected via self-reported surveys, 24-dietary recalls, and through objective observations of food retail environments. Participants/settingData collection occurred in 2015-2016 in two low-income communities in Cleveland (n=243) and Columbus (n=244), OH. Main outcome measureHEI-2010 scores were calculated based on the average of three 24-hour dietary recalls using the Nutrition Data System for Research. AnalysisSeparate path models, controlled for income, were run for each community. Analysis was guided by a conceptual model with 15 hypothesized direct and indirect effects on HEI-2010 scores. Associations were considered statistically significant at P<0.05 and P<0.10 because of modest sample sizes in each community. ResultsAcross both models, significant direct effects on HEI-2010 scores included healthy eating identity (β=.295, Cleveland; β=.297, Columbus, P<0.05) and distance traveled to primary food store (β=.111, Cleveland, P<0.10; β=.175, Columbus, P<0.05). Perceptions of healthy food availability had a significant, inverse effect in the Columbus model (β=−.125, P<0.05). The models explained greater variance in HEI-2010 scores for the Columbus community compared with Cleveland (R2=.282 and R2=.152, respectively). ConclusionsFindings highlight the need for tailored dietary intervention approaches even within demographically comparable communities. Interventions aimed at improving diet quality among residents living in food deserts may need to focus on enhancing healthy eating identity using culturally relevant approaches while at the same time addressing the need for transportation supports to access healthy food retailers located farther away.

P141 - Examining the Real and Perceived Food Environment, Shopping Behaviors, and Predictors of Dietary Behavior Among a Group of Older, Racially Diverse Off-Campus College Students

Background (Background, Rationale, Prior Research, and/or Theory): College students face unique challenges to engaging in healthy dietary behaviors, often leading to weight gain or nutrient deficiencies that may have long-term implications. More research is needed to understand the food environment of off-campus students and its impact on shopping, cooking, and diet, particularly in a sample of older and more racially diverse students. Objective: Examine relationships between off-campus student food environment, shopping behaviors, and dietary behaviors and outcomes. Study Design, Setting, Participants, Intervention: Cross-sectional survey of off-campus college students at a designated minority-serving institution. Students (non-Freshman, living off campus) were recruited through targeted emails, and selected by random and convenience sample. Participants (n = 418) reported demographic information, consumption (validated 26-item Dietary Screener Questionnaire (DSQ)), shopping habits, and perceptions of external food environment. Participant addresses were geocoded, and GIS was used to map proximal food stores and derive a modified-Retail Food Environment Index (m-RFEI) score for each participant, a ratio of healthy to less-healthy stores. Outcome Measures and Analysis: Univariate, Bivariate, and Linear Regression analyses performed. Results: Students perceived limited (39%) and low quality (32%) fresh fruits and vegetables and abundant fast food near their home (84%). Students mostly consumed food not requiring cooking (63.2%) or fast food (61%). Students shopped at their primary food store on average less than four times per month. Low average m-RFEI (8.15) indicated an environment of mostly fast food and convenience stores. After controlling for other factors, m-RFEI scores were positively associated with student age (.03) and income (.02), and BMI was positively associated with age, sugar sweetened beverage frequency, and having financial aid, and higher among racial minorities. Most students (76%) desired to eat healthier. Conclusions and Implications: Strategies are needed to help low-income off-campus college students, particularly racial minorities, overcome limited healthy food access for a healthier dietary pattern. Funding: UNC-Greensboro Internal Faculty Research Award.

Impact on Dietary Choices After Discount Supermarket Opens in Low-Income Community

ObjectiveTo examine (1) the association of a new supermarket opening with dietary intake and perceptions of healthy food availability, and (2) associations of distance to the primary food store and mean prices of fruits, vegetables, and sugary beverages with levels of consumption of these foods and body mass index in a low-income, southeastern community. MethodsThe researchers used cross-sectional, self-administered questionnaire data and supermarket audit data collected in the supermarket community and comparison community before (2015) and after (2016) the supermarket opening. A difference-in-difference analysis employed propensity scores to compare pretest and posttest differences between communities. ResultsThere were no significant differences between communities on dietary behaviors. There was a significant cross-sectional, inverse association between distance to the primary food store and fruit and vegetable consumption among all respondents in 2016. Conclusions and ImplicationsThe results suggest that adding a new discount supermarket is not necessarily associated with improvements in residents' fruit, vegetable, or sugary beverage consumption, or in their perceptions of the availability of healthy food in the neighborhood. However, distance to the store may be important.

Preferred Healthy Food Nudges, Food Store Environments, and Customer Dietary Practices in 2 Low-Income Southern Communities

ObjectiveTo examine how food store environments can promote healthful eating, including (1) preferences for a variety of behavioral economics strategies to promote healthful food purchases, and (2) the cross-sectional association between the primary food store where participants reported shopping, dietary behaviors, and body mass index. MethodsIntercept survey participants (n = 342) from 2 midsized eastern North Carolina communities completed questionnaires regarding preferred behavioral economics strategies, the primary food store at which they shopped, and consumption of fruits, vegetables, and sugary beverages. ResultsFrequently selected behavioral economic strategies included: (1) a token and reward system for fruit and vegetable purchases; and (2) price discounts on healthful foods and beverages. There was a significant association between the primary food store and consumption of fruits and vegetables (P = .005) and sugary beverages (P = .02). Conclusions and ImplicationsFuture studies should examine associations between elements of the in-store food environment, purchases, and consumption.

Differences in food environment perceptions and spatial attributes of food shopping between residents of low and high food access areas.

To explore potential differences in food shopping behaviors and healthy food availability perceptions between residents living in areas with low and high food access. A cross-sectional telephone survey to assess food shopping behaviors and perceptions. Data from an 8-county food environment field census used to define the Centers for Disease Control and Prevention (CDC) healthier food retail tract and US Department of Agriculture Economic Research Service food desert measure. A total of 968 residents in 8 South Carolina counties. Residents' food shopping behaviors and healthy food availability perceptions. Linear and logistic regression. Compared with residents in high food access areas, residents in low food access areas traveled farther to their primary food store (US Department of Agriculture Economic Research Service: 8.8 vs 7.1 miles, P = .03; CDC: 9.2 vs 6.1 miles, P < .001), accumulated more total shopping miles per week (CDC: 28.0 vs 15.4 miles; P < .001), and showed differences in perceived healthy food availability (P < .001) and shopping access (P < .001). These findings lend support to ongoing community and policy interventions aimed at reducing food access disparities.

Environmental influences on fruit and vegetable intake: results from a path analytic model

Fruit and vegetable (F&V) intake is influenced by behavioural and environmental factors, but these have rarely been assessed simultaneously. We aimed to quantify the relative influence of supermarket availability, perceptions of the food environment and shopping behaviour on F&V intake. A cross-sectional study. Eight counties in South Carolina, USA, with verified locations of all supermarkets. A telephone survey of 831 household food shoppers ascertained F&V intake with a seventeen-item screener, primary food store location, shopping frequency and perceptions of healthy food availability, and supermarket availability was calculated with a geographic information system. Path analysis was conducted. We report standardized beta coefficients on paths significant at the 0·05 level. Frequency of grocery shopping at primary food store (β = 0·11) was the only factor exerting an independent, statistically significant direct effect on F&V intake. Supermarket availability was significantly associated with distance to utilized food store (β = -0·24) and shopping frequency (β = 0·10). Increased supermarket availability was significantly and positively related to perceived healthy food availability in the neighbourhood (β = 0·18) and ease of shopping access (β = 0·09). Collectively considering all model paths linked to perceived availability of healthy foods, this measure was the only other factor to have a significant total effect on F&V intake. While the majority of the literature to date has suggested an independent and important role of supermarket availability for F&V intake, our study found only indirect effects of supermarket availability and suggests that food shopping frequency and perceptions of healthy food availability are two integral components of a network of influences on F&V intake.

Does transportation mode modify associations between distance to food store, fruit and vegetable consumption, and BMI in low-income neighborhoods?

A consistent body of research has shown that the neighborhood food environment is associated with fruit and vegetable (F&V) consumption and obesity in deprived neighborhoods in the United States. However, these studies have often neglected to consider how transportation can moderate associations between food accessibility and diet-related outcomes. This study examined associations between distance to primary food store, fruit and vegetable consumption, and BMI and whether mode of transportation to the primary food store moderates this relation. Cross-sectional data from the baseline wave of the Philadelphia Neighborhood Food Environment Study were used. A telephone survey of adult (≥18 y of age) household primary food shoppers residing in 2 Philadelphia neighborhoods was conducted (n = 1440). In a bivariate linear regression analysis, distance to primary food store did not predict F&V consumption (β = 0.04; 95% CI: -0.00, 0.09). Linear regression analysis stratified by transportation mode to the main F&V store showed no difference in F&V consumption between car, public, and multimodal transportation users. Compared with respondents using multimodal transportation, those using public transit had a significantly lower BMI (β = -1.31; 95% CI: -2.50, -0.10), whereas those using an automobile did not (β = -0.41; 95% CI: -1.36, 0.54). The assumption that using an automobile to access food stores results in increased F&V consumption was not confirmed. Significant associations were found for the relation between transportation mode and BMI. Theory-based mechanisms explaining relationships between the primary transportation mode used to access food stores and BMI should be further explored.

Qualitative study of influences on food store choice

Previous research indicates food store choice influences dietary intake and may contribute to health disparities. However, there is limited knowledge about the reasons which prompt the choice of a primary food store, particularly among populations vulnerable to obesity and chronic diseases (e.g., individuals living in rural locations and African-Americans). Purposive sampling was used to select rural and urban communities (three African-American and two Caucasian focus groups; n=48) in Arkansas from June to November 2010, allowing examination of potential racial or rurality differences. Primary household food shoppers (n=48) (96% female, 63% African-American, mean age=48.1±13.9years old, mean BMI=30.5±7.8) discussed reasons for choosing their primary store. Qualitative analysis techniques—content analysis and constant comparison—were used to identify themes. Four themes emerged: proximity to home or work, financial considerations and strategies, availability/quality of fruits, vegetables, and meat, and store characteristics (e.g., safety, cleanliness/smell, customer service, non-food merchandise availability, and brand availability). While there were persistent rurality differences, the relevant factors were similar between African-American and Caucasian participants. These findings have important implications for future policies and programs promoting environmental changes related to dietary intake and obesity, particularly in rural areas that appear to have significant challenges in food store choice.

Restaurant and food shopping selections among Latino women in Southern California

ObjectiveThis study describes and examines determinants of restaurant and food store selections in a sample of Latino women. DesignData were collected at the baseline home-based interview from women involved in a randomized community trial to improve dietary behaviors. The interview consisted of both a structured interview and the measurements of height, weight, and waist-to-hip ratio. Subjects/settingParticipants included 357 Latino women recruited via random-digit dial in the Southern and Central areas of San Diego County, California. Women were included if they were between 18 and 67 years of age, not currently pregnant, and Spanish-language dominant; women were excluded if a family member was on a special diet or was planning to leave the area during the study. Statistical analyses performedMeans and frequencies were used to describe preference for various types of restaurants and food stores based on the North American Industry Classification System (NAICS). Independent samples t tests examined differences in levels of importance for preferring fast-food vs other restaurants and supermarkets/produce markets vs other grocery stores. Logistic regression models examined correlates of preferring fast-food restaurants vs all other restaurants and preferring supermarkets/produce markets vs all other grocery stores. ResultsMore women reported eating at fast-food restaurants, followed by full-service restaurants and cafeterias. Younger women, employed women, women living in higher income households, and women living in the United States for a greater number of years preferred fast food. Supermarkets; grocery stores; and discount, bulk-purchase stores were equally represented as the primary food store. Women who lived in smaller households, had a smaller measured body mass, were married, and were more acculturated to the Anglo culture were more likely to shop at supermarkets compared with women who shopped at other grocery stores. ConclusionsOur findings suggest specific recommendations for targeting dietary interventions for the growing Latino population that take into account differences in levels of acculturation. For example, young Latino women who more closely identify with the Anglo culture and/or who report living in the United States for a longer period of time may benefit from targeted information on healthy restaurant behavior. On the other hand, traditional Latino women may benefit from instrumental support interventions such as tours to large supermarkets.