Spatial inequalities of retail food stores may determine availability of healthful food choices in a Brazilian metropolis

Objective: To examine the association between economic residential segregation and food environment. Design: Ecological. Food stores categorized according to the NOVA classification were geocoded, and absolute availability was calculated for each neighborhood. Segregation was measured using local Gi* statistic, a measure of the standard deviation (SD) between the economic composition of a neighborhood (the proportion of heads of households in neighborhoods earn monthly income of 0 to 3 minimum wages) and larger metropolitan area, weighted by the economic composition of surrounding neighborhoods. Segregation was categorized as high [most segregated], medium [integrated], and low [less segregated or integrated]. A proportional odds models were used to model the association between segregation and food environment. Setting: Belo Horizonte, Brazil. Participants: Food stores. Results: After adjustment for covariates, neighborhoods characterized by high economic segregation had fewer food stores overall compared to neighborhoods characterized by low segregation [OR=0.56;CI95%=0.45-0.69]. In addition, high segregated neighborhoods were 49% (OR=0.51;95%CI=0.42–0.61) and 45% (OR=0.55;95% CI=0.45–0.67) less likely to have a high number of food stores that predominantly marketed ultra-processed foods and mixed food stores, respectively, as compared to their counterparts. Conclusions: Economic segregation is associated with differences in the distribution of food stores. Both low and high segregation territories should be prioritized by public policies to ensure healthy and adequate nutrition as a right for all communities. The former must continue to be protected from access to unhealthy commercial food outlets while the latter must be the locus of actions that limit the availability of unhealthy commercial food store.

Perceptions of SNAP and Stocking Standards: A Qualitative Study of California Small Food Store Owners and Managers

The Supplemental Nutrition Assistance Program (SNAP) is critical to alleviating food insecurity, but low diet quality among program participants is a concern. Nutrition-related interventions have focused on SNAP-authorized food retailers, but the perspectives of small food store owners and managers have not been represented in national policy discussions. This study aimed to explore the opinions of store owners/managers of SNAP-authorized small food stores about their overall perceptions of the program and the stricter stocking standards previously proposed in 2016. We conducted in-depth, semi-structured interviews with 33 small food store owners and managers in San Francisco and Oakland, California in 2016. Interviews were analyzed for thematic content using the general inductive approach. Four themes emerged from owners/managers’ discussion of their overall perceptions of SNAP: the beneficial impact of SNAP on their business, how SNAP enables them to connect with the broader community, the importance of SNAP in preventing hunger, and the nutrition-related struggles that SNAP participants face. Store owners/managers had a generally favorable response towards the proposed stricter stocking standards. Additional themes discussed pertained to the concern about whether stocking changes would lead SNAP participants to purchase more healthful food and some logistical challenges related to sourcing and storing perishable foods.

Designing Online Grocery Stores to Support Healthy Eating for Weight Loss

Objectives To begin development of online grocery store design features that could support healthful food purchasing by shoppers who are trying to lose weight, using a Value Proposition Design approach to product development. Methods One-on-one interviews were conducted with adults who reported they were trying to lose weight (n = 25) to gain insight into their shopping needs and perceptions. Interview results were used to identify four potential online grocery shopping features that could support healthful food purchase decisions. Prototypes were developed for each feature, and one-on-one interviews were conducted with a different sample of adults who reported trying to lose weight (n = 25) to gather feedback on the prototypes. Results Based on customer needs identified through insight interview, the following four potential online grocery store features were devised and prototyped by the research team: 1) Nutritional quality rating of shopping cart items purchased, with suggestions for improvement provided; 2) Menu planning support tool to provide menu and recipe suggestions tailored to individual preferences; 3) An interactive virtual grocery aisle designed as a fun way to discover healthy products and meal ideas; and 4) A healthy shopping preference option to opt into a shopping experience that prioritizes the display and advertising of foods that align with the shopper's health and nutrition goals. Results from feedback interviews indicated that the menu planning support tool and the healthy shopping preference option were both highly positively rated and believed to be effective in helping support healthy food choices by most participants. Conclusions Further development and evaluation work is warranted for the online grocery store features found to be most highly rated. This study illustrates application of a design thinking approach to developing nutrition promotion related products/programs. Funding Sources University of Minnesota JB Hawley Faculty Research Award.

Healthful and less-healthful foods and drinks from storefront and non-storefront businesses: implications for ‘food deserts’, ‘food swamps’ and food-source disparities

Objective:Conceptualisations of ‘food deserts’ (areas lacking healthful food/drink) and ‘food swamps’ (areas overwhelm by less-healthful fare) may be both inaccurate and incomplete. Our objective was to more accurately and completely characterise food/drink availability in urban areas.Design:Cross-sectional assessment of select healthful and less-healthful food/drink offerings from storefront businesses (stores, restaurants) and non-storefront businesses (street vendors).Setting:Two areas of New York City: the Bronx (higher-poverty, mostly minority) and the Upper East Side (UES; wealthier, predominantly white).Participants:All businesses on 63 street segments in the Bronx (n 662) and on 46 street segments in the UES (n 330).Results:Greater percentages of businesses offered any, any healthful, and only less-healthful food/drink in the Bronx (42·0 %, 37·5 %, 4·4 %, respectively) than in the UES (30 %, 27·9 %, 2·1 %, respectively). Differences were driven mostly by businesses (e.g. newsstands, gyms, laundromats) not primarily focused on selling food/drink – ‘other storefront businesses’ (OSBs). OSBs accounted for 36·0 % of all food/drink-offering businesses in the Bronx (more numerous than restaurants or so-called ‘food stores’) and 18·2 % in the UES (more numerous than ‘food stores’). Differences also related to street vendors in both the Bronx and the UES. If street vendors and OSBs were not captured, the missed percentages of street segments offering food/drink would be 14·5 % in the Bronx and 21·9 % in the UES.Conclusions:Of businesses offering food/drink in communities, OSBs and street vendors can represent substantial percentages. Focusing on only ‘food stores’ and restaurants may miss or mischaracterise ‘food deserts’, ‘food swamps’, and food/drink-source disparities between communities.

Associations between Food Group Intake, Cognition, and Academic Achievement in Elementary Schoolchildren

Nutrition plays an important role in proper physical and cognitive functioning. However, there is limited evidence on the relationship between overall diet, cognition, and academic success in children, particularly among low-income and diverse groups. The objective of this study was to examine the relationships between healthful versus less healthful food group intake, cognitive performance, and academic achievement in a diverse sample of schoolchildren. 868 urban schoolchildren (age 8 to 10 years) participated in the study. Intake of healthful (fruits, vegetables, unsweetened beverages) and less healthful (sweet and salty snacks, sugar-sweetened beverages) food groups was determined via a food frequency questionnaire. Digit Span and Stroop test scores were used to assess cognitive performance. Academic achievement was assessed via standardized test scores. Multiple Poisson and multiple linear regression were used to test the associations between diet and cognitive scores. Multiple ordered logistic regression was used to assess the associations between diet and academic achievement. Potential confounders (age, sex, body mass index (BMI) z-score, race/ethnicity, English language learner status, individualized education plan enrollment, physical activity, and parent education level) were tested for inclusion in all models. The sample included 868 children (56.7% girls; 33.2% non-Hispanic white, 26.2% Hispanic, 17.1% multiracial/other, 8.3% non-Hispanic black; 40.5% overweight/obese). The most frequently consumed foods were fruits and sweet snacks (1.9 and 1.6 servings per day, respectively). There were no statistically significant associations between diet and cognitive test scores. Greater intake of less healthful food groups (sweet snacks, salty snacks, and sweetened beverages) was associated with lower math (OR = 0.91, CI [0.84, 0.98], p = 0.014) and English standardized test scores (OR = 0.87, CI [0.80, 0.94, p = 0.001). Greater intake of sweet snacks and fruits was associated with lower English scores (OR = 0.72, 95% CI [0.59, 0.88] p = 0.001; and OR = 0.75, 95% CI [0.72, 0.94] p = 0.003, respectively). Consumption of less healthful food groups was associated with poorer academic achievement. Further research may shed light on unexpected associations between fruit consumption and achievement. Policies targeting multiple dietary components may positively influence child academic achievement and development.

Online Grocery Shopping Behaviors, Knowledge and Attitudes of SNAP Participants (P04-194-19)

Objectives To inform policy proposals to allow online grocery shopping with SNAP benefits by examining relevant behaviors, knowledge and attitudes of SNAP recipients. Methods This qualitative study used a purposive recruitment strategy to conduct four one-hour focus groups with three to six participants each from March through May 2018 in Las Cruces, New Mexico. Participants were SNAP recipients with children who do the shopping for their family. Focus groups were video and audio recorded, transcribed, and coded, with coding cross-checked by coders to establish reliability. Results Few participants had shopped for groceries online although all were familiar with online shopping more generally. Participants were generally uninterested in grocery shopping online themselves but considered it could have value for the elderly or disabled. Identified barriers were cost, quality control for produce and perishable foods in particular, and distrust of the overall process. Participants suggested services such as a shopping list builder, filters for dietary restrictions, or healthy recipe ideas to increase interest in online grocery shopping. Conclusions SNAP recipients in this study have not adopted online grocery shopping for various reasons. Additional research could inform policy by investigating which participants would benefit from using SNAP benefits online and what strategies would encourage healthful food purchases. Funding Sources This research was not supported by any funding.