Access To Supermarkets Research Articles

Application of Geographic Information Systems to Address Chronic Disease Priorities: Experiences in State and Local Health Departments.

Application of Geographic Information Systems to Address Chronic Disease Priorities: Experiences in State and Local Health Departments.

WIC Participation and Relative Quality of Household Food Purchases: Evidence from FoodAPS

We examine the effect of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the quality of household food purchases using the National Household Food Acquisition and Purchase Survey (FoodAPS) and propensity score matching. A healthy purchasing index (HPI) is used to measure nutritional quality of household food purchases. WIC foods explain the improvement in quality of food purchases, not self‐selection of more nutrition‐conscious households into the program. The improvement in purchase quality was driven entirely by WIC participating households who redeemed WIC foods during the interview week. There was no significant difference between WIC participants who did not redeem WIC foods and eligible nonparticipants. In this sample, there is no evidence that lack of access to clinics has adverse effects on participation nor is there evidence that HPI depends on supermarket access. A supervised machine learning process supports our main conclusion on the importance of WIC foods.

Association between neighbourhood convenience stores and independent living in older people in Japan.

On ageing, and as physical functionality declines, shopping for food and commodities can become a challenge. In Japan, convenience stores (CVSs) play an important role in older people's daily lives. This study investigated the relationship between the geographical accessibility of CVSs, supermarkets and grocery stores and shopping independence. We used the administrative long-term care insurance data from a sample of 7703 older adults. The spatial coverages of the stores were calculated using a geographic information system. A multilevel regression analysis was conducted to examine the association between neighbourhood spatial coverage and individual shopping independence. After adjusting for demographic characteristics, individual functioning and neighbourhood-level population density, the regression analysis revealed that the CVSs spatial coverage was negatively associated with a risk of shopping dependence (odds ratio=0.73, P=0.03). The findings suggest that geographical accessibility of CVSs may be beneficial for maintaining shopping independence.

Supermarket access and childhood bodyweight: Evidence from store openings and closings

Retail food environment is increasingly considered in relation to obesity. This study investigates the impacts of access to supermarkets, the primary source of healthy foods in the United States, on the bodyweight of children. Empirical analysis uses individual-level panel data covering health screenings of public schoolchildren from Arkansas with annual georeferenced business lists, and utilizes the variations of supermarket openings and closings. There is little overall impact in either case. However, supermarket openings are found to reduce the BMI z-scores of low-income children by 0.090 to 0.096 standard deviations. Such impact remains in a variety of robustness exercises. Therefore, improvement in healthy food access could at least help reduce childhood obesity rates among certain population groups.

Urban foodscape trends: Disparities in healthy food access in Chicago, 2007–2014

We investigated changes in supermarket access in Chicago between 2007 and 2014, spanning The Great Recession, which we hypothesized worsened local food inequity. We mapped the average street network distance to the nearest supermarket across census tracts in 2007, 2011, and 2014, and identified spatial clusters of persistently low, high or changing access over time. Although the total number of supermarkets increased city-wide, extremely low food access areas in segregated, low income regions did not benefit. Among black and socioeconomically disadvantaged residents of Chicago, access to healthy food is persistently poor and worsened in some areas following recent economic shocks.

Family food purchases of high- and low-calorie foods in full-service supermarkets and other food retailers by Black women in an urban US setting.

Public health interventions to increase supermarket access assume that shopping in supermarkets is associated with healthier food purchases compared to other store types. To test this assumption, we compared purchasing patterns by store-type for certain higher-calorie, less healthy foods (HCF) and lower-calorie, healthier foods (LCF) in a sample of 35 black women household shoppers in Philadelphia, PA. Data analyzed were from 450 food shopping receipts collected by these shoppers over four-week periods in 2012. We compared the likelihood of purchasing the HCF (sugar-sweetened beverages, sweet/salty snacks, and grain-based snacks) and LCF (low-fat dairy, fruits, and vegetables) at full-service supermarkets and six other types of food retailers, using generalized estimating equations. Thirty-seven percent of participants had household incomes at or below the poverty line, and 54% had a BMI >30. Participants shopped primarily at full-service supermarkets (55%) or discount/limited assortment supermarkets (22%), making an average of 11 shopping trips over a 4-week period and spending mean (SD) of $350 ($222). Of full-service supermarket receipts, 64% included at least one HCF item and 58% at least one LCF. Most trips including HCF (58%) and LCF (60%) expenditures were to full-service or discount/limited assortment supermarkets rather than smaller stores. Spending a greater percent of total dollars in full-service supermarkets was associated with spending more on HCF (p = 0.03) but not LCF items (p = 0.26). These findings in black women suggest a need for more attention to supermarket interventions that change retailing practices and/or consumer shopping behaviors related to foods in the HCF categories examined.

Interplay of Socioeconomic Status and Supermarket Distance Is Associated with Excess Obesity Risk: A UK Cross-Sectional Study.

U.S. policy initiatives have sought to improve health through attracting neighborhood supermarket investment. Little evidence exists to suggest that these policies will be effective, in particular where there are socioeconomic barriers to healthy eating. We measured the independent associations and combined interplay of supermarket access and socioeconomic status with obesity. Using data on 9702 UK adults, we employed adjusted regression analyses to estimate measured BMI (kg/m2), overweight (25 ≥ BMI < 30) and obesity (≥30), across participants’ highest educational attainment (three groups) and tertiles of street network distance (km) from home location to nearest supermarket. Jointly-classified models estimated combined associations of education and supermarket distance, and relative excess risk due to interaction (RERI). Participants farthest away from their nearest supermarket had higher odds of obesity (OR 1.33, 95% CI: 1.11, 1.58), relative to those living closest. Lower education was also associated with higher odds of obesity. Those least-educated and living farthest away had 3.39 (2.46–4.65) times the odds of being obese, compared to those highest-educated and living closest, with an excess obesity risk (RERI = 0.09); results were similar for overweight. Our results suggest that public health can be improved through planning better access to supermarkets, in combination with interventions to address socioeconomic barriers.

Supermarket access, transport mode and BMI: the potential for urban design and planning policy across socio-economic areas.

To investigate dietary intake, BMI and supermarket access at varying geographic scales and transport modes across areas of socio-economic disadvantage, and to evaluate the implementation of an urban planning policy that provides guidance on spatial access to supermarkets. Cross-sectional study used generalised estimating equations to investigate associations between supermarket density and proximity, vegetable and fruit intake and BMI at five geographic scales representing distances people travel to purchase food by varying transport modes. A stratified analysis by area-level disadvantage was conducted to detect optimal distances to supermarkets across socio-economic areas. Spatial distribution of supermarket and transport access was analysed using a geographic information system. Melbourne, Australia. Adults (n 3128) from twelve local government areas (LGA) across Melbourne. Supermarket access was protective of BMI for participants in high disadvantaged areas within 800 m (P=0·040) and 1000 m (P=0·032) road network buffers around the household but not for participants in less disadvantaged areas. In urban growth area LGA, only 26 % of dwellings were within 1 km of a supermarket, far less than 80-90 % of dwellings suggested in the local urban planning policy. Low public transport access compounded disadvantage. Rapid urbanisation is a global health challenge linked to increases in dietary risk factors and BMI. Our findings highlight the importance of identifying the most appropriate geographic scale to inform urban planning policy for optimal health outcomes across socio-economic strata. Urban planning policy implementation in disadvantaged areas within cities has potential for reducing health inequities.

Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009–14

In recent years, various levels of government in the United States have adopted or discussed subsidies, tax breaks, zoning laws, and other public policies that promote geographic access to healthy food. However, there is little evidence from large-scale longitudinal or quasi-experimental research to suggest that the local mix of food outlets actually affects body mass index (BMI). We used a longitudinal design to examine whether the proximity of food outlets, by type, was associated with BMI changes between 2009 and 2014 among 1.7million veterans in 382 metropolitan areas. We found no evidence that either absolute or relative geographic accessibility of supermarkets, fast-food restaurants, or mass merchandisers was associated with changes in an individual's BMI over time. While policies that alter only geographic access to food outlets may promote equitable access to healthy food and improve nutrition, our findings suggest they will do little to combat obesity in adults.

Association between distance to nearest supermarket and provision of fruits and vegetables in English nurseries

With 796,500 places available for children in England, pre-school nurseries could serve as an important setting for population-wide dietary intervention. It is critical to understand the determinants of healthy food provision in this setting, which may include access to food stores. This study examined the association between objective, GIS-derived supermarket proximity and fruit and vegetable serving frequency, using data from 623 English nurseries. Overall, 116 (18%) nurseries served fruits and vegetables infrequently (<2–3 times/week), but provision differed by supermarket proximity. In adjusted multivariable regression models, nurseries farthest from their nearest supermarket (Q5, 1.7–19.8km) had 2.38 (95% CI 1.01–5.63) greater odds of infrequent provision. Our results suggest that supermarket access may be important for nurseries in meeting fruit and vegetable provision guidelines. We advance a growing body of international literature, for the first time linking the food practices of institutions to their neighbourhood food retail context.

Food deserts? Healthy food access in Amsterdam

Healthy food environments are imperative for public health. Access to supermarkets that offer wholesome food products at low prices varies across space and over socioeconomic status and ethnic neighborhoods. This research examined food inequalities in Amsterdam, the Netherlands. Supermarket accessibility was calculated and linked to property prices and the share of native Dutch people on a geographic micro-scale with a spatial resolution of 100 meters. Mann–Whitney tests and Spearman correlations were used to test differences and associations between accessibility, property prices, and the share of natives per area. The spatially explicit contextual neural gas approach was used for data clustering. The results show access differences in supermarkets in favor of areas with high property prices and those areas with a large share of native Dutch people. The correlations indicate that low-priced areas and those with a low share of native Dutch people have a lower supermarket density, but the results are the opposite when proximity to and variety of supermarkets are examined. The clustering revealed no evidence of undersupplied areas. Pronounced inequalities in access to healthy food could not be confirmed. On the basis of this analysis, there is no urgent need for policymakers to intervene in the geographies of supermarkets.

Accessibility and Affordability of Supermarkets: Associations With the DASH Diet

IntroductionIt is unknown whether there is an interplay of affordability (economic accessibility) and proximity (geographic accessibility) of supermarkets in relation to having a Dietary Approaches to Stop Hypertension (DASH)-accordant diet.MethodsData (collected: 2005–2015, analyzed: 2016) were from the cross-sectional, population-based Fenland Study cohort: 9,274 adults aged 29–64 years, living in Cambridgeshire, United Kingdom. Dietary quality was evaluated using an index of DASH dietary accordance, based on recorded consumption of foods and beverages in a validated 130-item, semi-quantitative food frequency questionnaire. DASH accordance was defined as a DASH score in the top quintile. Dietary costs (£/day) were estimated by attributing a food price variable to the foods consumed according to the questionnaire. Individuals were classified as having low-, medium-, or high-cost diets. Supermarket affordability was determined based on the cost of a 101-item market basket. Distances between home address to the nearest supermarket (geographic accessibility) and nearest economically-appropriate supermarket (economic accessibility) were divided into tertiles.ResultsHigher-cost diets were more likely to be DASH-accordant. After adjustment for key demographics and exposure to other food outlets, individuals with lowest economic accessibility to supermarkets had lower odds of being DASH-accordant (OR=0.59, 95% CI=0.52, 0.68) than individuals with greatest economic accessibility. This association was stronger than with geographic accessibility alone (OR=0.85, 95% CI=0.74, 0.98).ConclusionsResults suggest that geographic and economic access to food should be taken into account when considering approaches to promote adherence to healthy diets for the prevention of cardiovascular diseases and other chronic disease.

Neighborhood and home food environment and children's diet and obesity: Evidence from military personnel's installation assignment

Research and policy initiatives are increasingly focused on the role of neighborhood food environment in children's diet and obesity. However, existing evidence relies on observational data that is limited by neighborhood selection bias. The Military Teenagers' Environments, Exercise, and Nutrition Study (M-TEENS) leverages the quasi-random variation in neighborhood environment generated by military personnel's assignment to installations to examine whether neighborhood food environments are associated with children's dietary behaviors and BMI. Our results suggest that neither the actual nor the perceived availability of particular food outlets in the neighborhood is associated with children's diet or BMI. The availability of supermarkets and convenience stores in the neighborhood was not associated with where families shop for food or children's dietary behaviors. Further, the type of store that families shop at was not associated with the healthiness of food available at home. Similarly, availability of fast food and restaurants was unrelated to children's dietary behaviors or how often children eat fast food or restaurant meals. However, the healthiness of food available at home was associated with healthy dietary behaviors while eating at fast food outlets and restaurants were associated with unhealthy dietary behaviors in children. Further, parental supervision, including limits on snack foods and meals eaten as a family, was associated with dietary behaviors. These findings suggest that focusing only on the neighborhood food environment may ignore important factors that influence children's outcomes. Future research should also consider how families make decisions about what foods to purchase, where to shop for foods and eating out, how closely to monitor their children's food intake, and, ultimately how these decisions collectively impact children's outcomes.

Proximity to Fast-Food Outlets and Supermarkets as Predictors of Fast-Food Dining Frequency

BackgroundThis study used cross-sectional data to test the independent relationship of proximity to chain fast-food outlets and proximity to full-service supermarkets on the frequency of mealtime dining at fast-food outlets in two major urban areas, using three approaches to define access. Interactions between presence of a supermarket and presence of fast-food outlets as predictors of fast-food dining were also tested. MethodsResidential intersections for respondents in point-of-purchase and random-digit-dial telephone surveys of adults in Philadelphia, PA, and Baltimore, MD, were geocoded. The count of fast-food outlets and supermarkets within quarter-mile, half-mile, and 1-mile street network buffers around each respondent’s intersection was calculated, as well as distance to the nearest fast-food outlet and supermarket. These variables were regressed on weekly fast-food dining frequency to determine whether proximity to fast food and supermarkets had independent and joint effects on fast-food dining. ResultsThe effect of access to supermarkets and chain fast-food outlets varied by study population. Among telephone survey respondents, supermarket access was the only significant predictor of fast-food dining frequency. Point-of-purchase respondents were generally unaffected by proximity to either supermarkets or fast-food outlets. However, ≥1 fast-food outlet within a 1-mile buffer was an independent predictor of consuming more fast-food meals among point-of-purchase respondents. At the quarter-mile distance, ≥1 supermarket was predictive of fewer fast-food meals. ConclusionsSupermarket access was associated with less fast-food dining among telephone respondents, whereas access to fast-food outlets were associated with more fast-food visits among survey respondents identified at point-of-purchase. This study adds to the existing literature on geographic determinants of fast-food dining behavior among urban adults in the general population and those who regularly consume fast food.

Scale effects in food environment research: Implications from assessing socioeconomic dimensions of supermarket accessibility in an eight-county region of South Carolina

Choice of neighborhood scale affects associations between environmental attributes and health-related outcomes. This phenomenon, a part of the modifiable areal unit problem, has been described fully in geography but not as it relates to food environment research. Using two administrative-based geographic boundaries (census tracts and block groups), supermarket geographic measures (density, cumulative opportunity and distance to nearest) were created to examine differences by scale and associations between three common U.S. Census–based socioeconomic status (SES) characteristics (median household income, percentage of population living below poverty and percentage of population with at least a high school education) and a summary neighborhood SES z-score in an eight-county region of South Carolina. General linear mixed-models were used. Overall, both supermarket density and cumulative opportunity were higher when using census tract boundaries compared to block groups. In analytic models, higher median household income was significantly associated with lower neighborhood supermarket density and lower cumulative opportunity using either the census tract or block group boundaries, and neighborhood poverty was positively associated with supermarket density and cumulative opportunity. Both median household income and percent high school education were positively associated with distance to nearest supermarket using either boundary definition, whereas neighborhood poverty had an inverse association. Findings from this study support the premise that supermarket measures can differ by choice of geographic scale and can influence associations between measures. Researchers should consider the most appropriate geographic scale carefully when conducting food environment studies.

Global Challenges: Accessibility of Supermarkets to Senior Centers in Jersey City Using Geomapping Technology

Global Challenges: Accessibility of Supermarkets to Senior Centers in Jersey City Using Geomapping Technology

Implications of supermarket access, neighbourhood walkability and poverty rates for diabetes risk in an employee population.

Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of the present study was to examine the association between multiple aspects of environment and diabetes risk in an employee population. This was a retrospective cross-sectional analysis. Home environment variables were derived using employees' zip code. Descriptive statistics were run on all individual- and zip-code-level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk. Data were collected from employee health fairs in a Midwestern health system, 2009-2012. The data set contains 25 227 unique individuals across four years of data. From this group, using an individual's first entry into the database, 15 522 individuals had complete data for analysis. The prevalence of high diabetes risk in this population was 2·3 %. There was significant variability in individual- and zip-code-level variables across worksites. From the multivariable analysis, living in a zip code with higher percentage of poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk. Our study underscores the important relationship between poverty, home neighbourhood environment and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health.

Neighborhood Food Access and Birth Outcomes in South Carolina.

Evidence of the association between food environment and birth outcomes is limited. This study aimed to examine the association between individual-level food access measures and birth outcomes. All birth certificates (N=15,786) from January 1, 2008 to December 31, 2009 in eight counties in South Carolina were included. Access to food was evaluated by the distance to the nearest food store and the number of each type of store within a 1-mile (1.6-km) radius from the women's homes. Birth outcomes included birth weight, low birth weight, gestational age, and preterm birth (PTB). A further distance to the nearest convenience store was associated with higher birth weight and gestational age. Birth weight in areas with two or more convenience stores within a 1-mile (1.6-km) buffer was less [two stores: β=-46.2, 95% confidence interval (CI) -76.5, -15.9; three or more stores: β=-48.6, 95% CI -78.8, -18.5], and gestational age was shorter in areas with one or two convenience stores (one store: β=-0.11, 95% CI -0.21, -0.00; two or more stores: β=-0.13, 95% CI -0.25, 0.00) than in areas without convenience stores in the neighborhood. Having three or more convenience stores in the neighborhood was associated with increased risk of PTB compared with no convenience stores. Accessibility and availability of supermarkets and grocery stores were not associated with any birth outcomes. This analysis suggests that access to unhealthy foods is associated with adverse birth outcomes. Future investigations with more comprehensive measures of food environment are warranted.

CVD Prevention Through Policy: a Review of Mass Media, Food/Menu Labeling, Taxation/Subsidies, Built Environment, School Procurement, Worksite Wellness, and Marketing Standards to Improve Diet.

Poor diet is the leading cause of cardiovascular disease in the USA and globally. Evidence-based policies are crucial to improve diet and population health. We reviewed the effectiveness for a range of policy levers to alter diet and diet-related risk factors. We identified evidence to support benefits of focused mass media campaigns (especially for fruits, vegetables, salt), food pricing strategies (both subsidies and taxation, with stronger effects at lower income levels), school procurement policies (for increasing healthful or reducing unhealthful choices), and worksite wellness programs (especially when comprehensive and multicomponent). Evidence was inconclusive for food and menu labeling (for consumer or industry behavior) and changes in local built environment (e.g., availability or accessibility of supermarkets, fast food outlets). We found little empiric evidence evaluating marketing restrictions, although broad principles and large resources spent on marketing suggest utility. Widespread implementation and evaluation of evidence-based policy strategies, with further research on other strategies with mixed/limited evidence, are essential “population medicine” to reduce health and economic burdens and inequities of diet-related illness worldwide.

The relationship of the local food environment with obesity: A systematic review of methods, study quality, and results.

ObjectiveTo examine the relationship between local food environments and obesity and assess the quality of studies reviewed.MethodsSystematic keyword searches identified studies from US and Canada that assessed the relationship of obesity to local food environments. We applied a quality metric based on design, exposure and outcome measurement, and analysis.ResultsWe identified 71 studies representing 65 cohorts. Overall, study quality was low; 60 studies were cross-sectional. Associations between food outlet availability and obesity were predominantly null. Among non-null associations, we saw a trend toward inverse associations between supermarket availability and obesity (22 negative, 4 positive, 67 null) and direct associations between fast food and obesity (29 positive, 6 negative, 71 null) in adults. We saw direct associations between fast food availability and obesity in lower income children (12 positive, 7 null). Indices including multiple food outlets were most consistently associated with obesity in adults (18 expected, 1 not expected, 17 null). Limiting to higher quality studies did not affect results.ConclusionsDespite the large number of studies, we found limited evidence for associations between local food environments and obesity. The predominantly null associations should be interpreted cautiously due to the low quality of available studies.