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ObjectivesUnhealthy diets and inadequate exercise are associated with chronic health conditions and excess mortality. Older African Americans do not meet dietary and exercise guidelines, and this may have worsened during the COVID-19 pandemic due to individual and environmental factors, including food insecurity. Studies evaluating these dynamics are essential for developing interventions. This narrative details a study protocol and data collection experiences during the pandemic.MethodsParticipants > 55 years African American old completed detailed food frequency, exercise, and food access questionnaires between October 2020 and July 2021. Observations of the study administrators (authors of this manuscript) for the duration of the study are presented. Details on the study design and reflections on the opportunities, challenges, and lessons learned are summarized. Future manuscripts will report data analysis of study findings.ResultsA total of 123 older African American adults participated in the study, and 118 (70% female) completed all three questionnaires. More than 50% of the participants had at least two primary chronic conditions. About 85% were fully vaccinated against COVID-19. Applying community-based participatory approaches, leveraging partnerships, and exercising flexibility approaches were pivotal to successfully implementing the study protocol.ConclusionsDespite challenges related to the COVID-19 pandemic, detailed data on older African American adults' diet and exercise habits were obtained. Our study design and experiences will benefit future researchers. More importantly, results from our study will inform interventions and policies aimed at minimizing consequences associated with poor diet and exercise habits during the pandemic among this vulnerable population.

AbstractThe technological revolution has driven food retail towards self-service technologies (SSTs). The supermarket concept thrived due to consumer convenience and direct food access. This qualitative study explored the modernization of food retail through new technologies, focusing on Canadian stakeholders’ perceptions. Using a grounded theory approach, it aimed to create a sustainable digital food system model addressing social and moral food access aspects. Findings revealed that digitalization in food retail is driven by economic motives and stakeholders’ desire for collaboration and partnership to support food access. [ABSTRACT FROM AUTHOR]

Introduction: Dietary restrictions for patients with end‐stage kidney disease (ESKD) are burdensome. Kidney transplantation (KT) candidates who lack neighborhood resources and are burdened by dietary restrictions may have decreased access to KT. Methods: In our two‐center prospective cohort study (2014–2023), 2471 ESKD patients who were evaluated for KT (candidates) reported their perceived burden of dietary restrictions (not at all, somewhat/moderately, or extremely bothered). Neighborhood‐level socioeconomic factors were derived from residential ZIP codes. We quantified the association of perceived burden of the dietary restrictions with a chance of listing using Cox models and risk of waitlist mortality using competing risks models. Then we tested whether these associations differed by neighborhood‐level socioeconomic factors. Results: At evaluation, 18% of KT candidates felt extremely bothered by dietary restrictions. Those who felt extremely bothered were less likely to be listed for KT (adjusted hazard ratio [aHR] = 0.75, 95% confidence interval [CI]: 0.64–0.87); this association did not differ by neighborhood‐level socioeconomic factors. Overall, the burden of dietary restrictions was not associated with waitlist mortality (p = 0.62). However, among candidates living in high food insecurity neighborhoods, those who felt extremely bothered had higher waitlist mortality (adjusted subhazard ratio [aSHR] = 2.07, 95% CI: 1.14–3.75, p[interaction] = 0.02). The association between dietary burden and waitlist mortality did not differ by neighborhood‐level healthy food access. Conclusion: The perceived burden of dietary restrictions is associated with a lower chance of listing for KT, and higher waitlist mortality only among candidates residing in neighborhoods with high food insecurity. Transplant centers should identify vulnerable patients and support them with nutrition education and access to food assistance programs. [ABSTRACT FROM AUTHOR]

Better diet quality regardless of community food access was associated with a higher likelihood of glycemic control in early pregnancy among nulliparous individuals with pregestational diabetes. These findings highlight the need for interventions that address nutrition insecurity for pregnant individuals living with diabetes. • Better diet quality was associated with glycemic control in early pregnancy among nulliparous individuals with pregestational diabetes. • Community food access was not associated with glycemic control. • Interventions that address nutrition insecurity for pregnant individuals living with diabetes are needed. [ABSTRACT FROM AUTHOR]

Background: Household food waste significantly contributes to overall food waste. While the relationship between food security and food waste has been extensively studied at the macro level, there is a need for research focusing on the quantitative association between food security and food waste at the household level in developing countries, particularly in Southeast Asia. This study aims to estimate the prevalence of household food insecurity and household food waste and to examine the association between household food security and food waste using direct measurements. Subjects and methods: A total of 215 households in Bogor Regency, Indonesia, participated in this cross-sectional study. Food waste was measured using waste composition analysis and a 7-day diary. The Food Insecurity Experience Scale (FIES) questionnaire was used to assess household food security, while household income and the proportion of food expenditure were considered confounding factors. The association between food security and food waste was examined using Kendall tau-b and ordinal logistic regression. Results: The prevalence of household food insecurity was 18.6%, and the average household food waste was 77 kg/cap/year. Cereals, tubers, and their derivatives (especially rice) and vegetables were major contributors to edible waste, while fruits dominated inedible waste. A negative association was observed between food waste and household food security (edible FW: p = 0.044, r = -0.110; total FW: p = 0.038, r = -0.114), suggesting that household food waste decreases as the severity of food insecurity increases. However, after adjusting for household income, the proportion of food expenditure, and the education levels of spouses, this association became statistically insignificant (p > 0.05). Conclusion: There was no significant association between household food security status and food waste. Household income plays a significant role in determining the quantity of household food waste, as higher income is associated with increased food waste. Strategies to prevent and reduce food waste should focus on major contributors such as rice and vegetables, especially among families with higher food accessibility. [ABSTRACT FROM AUTHOR]

The disappearance of food shops in small towns and villages is a common feature in many European areas. The food habits of rural inhabitants are affected by the limitations on their food supply, posing a challenge to how they organise their daily eating. Although this represents a major problem for the quality of life in rural areas, food access problems have been understudied in Europe. This paper presents some research notes to encourage the study of the effects of the shortfall in food businesses in depopulated rural areas of Europe as a guide for research on this phenomenon. The paper reviews the international literature, drawing attention to the theoretical problems and methodological limitations involved in this type of study. A series of recommendations are given with the aim of enabling future research to record the food situation of the inhabitants of impoverished and depopulated territories with greater precision and depth. [ABSTRACT FROM AUTHOR]

"Zero Hunger", the second Sustainable Development Goal, is one of humanity's most critical challenges and is deeply interlinked with food security. Food security encompasses multiple levels, from food availability to access to food stability. However, for most residents in rural areas of developing and underdeveloped countries, food security primarily means physical, economic, and sustained access to food. Thus, evaluations of food security in rural areas should differ from those in urban areas. This original study introduces a novel approach and an integrated index to assess and present access to food (AFI) using fuzzy and weighted mean techniques. It analyzed 300 rural households in southern Iran. The findings revealed that the AFI of the studied community was 0.551, indicating a moderate level of food security. Most households had intermediate physical, economic, and sustainable access to food, which means that they did not face any critical situations regarding food security. This study suggests that achieving food security requires a hierarchical approach. Realizing the goal of zero hunger in rural areas of less developed countries necessitates a distinct strategy compared to urban areas for policymakers to focus more on food availability and access as the initial levels of the food security pyramid. [ABSTRACT FROM AUTHOR]

Food security among rural veteran populations is an understudied subject. This study uses qualitative data from 106 semi-structured interviews conducted with staff from programs at the United States Department of Veterans Affairs (VA) and other federal agencies, staff from non-governmental organizations (NGOs), food security researchers, and food insecure veterans to identify the barriers to and facilitators for rural veteran food security. Barriers identified included external, structural barriers that exist in rural areas; internal barriers to using food assistance, such as feeling stigmatized; and barriers related to other social determinants of health, including a lack of education, employment, or housing stability. [ABSTRACT FROM AUTHOR]

The August 2014 murder of unarmed Black teenager Michael Brown at the hands of the police in the streets of Ferguson, Missouri, USA, sparked international attention, ignited a surge in #BlackLivesMatter protests, and reconfigured national discussions about race, police brutality, and state-sanctioned violence. Black food activists on the frontlines of the food justice movement grappled with Brown's murder by joining together on a national call to address the question: What does Ferguson mean for the food justice movement? Answers to this question manifested into the 2015-2016 special digital series entitled "What Ferguson Means for the Food Justice Movement," published online in the Food Justice Voices section of the WhyHunger organization website. In this article, we use a qualitative critical content analysis of the series to examine how Black food activists reframed agricultural and food systems in the context of the Ferguson struggle. We draw on intersectional agriculture theory to illuminate how Black food activists draft visions of food justice through three intersecting pathways: (1) critical Black agrarianism, (2) radical Black mothering, and (3) Black futures. Our research reveals that Black visions of food justice in the wake of Ferguson are instructive and offer a fresh lens to understand the evolving landscape of Black food activism, given a set of racial, gendered, social, political, and economic realities. We conclude with a brief discussion on how these visions compel us to reconsider racial equity at the nexus of agriculture, food, and various forms of unrest in Black communities, providing insights for scholars, practitioners, and activists who work on issues of food justice. [ABSTRACT FROM AUTHOR]

Given the centrality of philanthropic funding to the work of nonprofit food access and food justice organizations, it is surprising how little we know about how foundations conceptualize and assess their grant-making across the food system. Based on an analysis of interviews with program officers at foundations that support food system interventions in New England, this paper describes foundations' initial (and evolving) motivations for grant-making, the outcomes that they expect from investments, and the kinds of information that they see as convincing evidence for such outcomes. At the same time, it explores how program officers' experiences of responding to the COVID-19 pandemic and to contemporaneous calls to redress systemic racism have shaped their practices. This paper points to opportunities for new relationships between community-based organizations and foundations, especially as program officers experiment with practices of trust-based philanthropy. It also highlights, however, the challenges posed by philanthropic board members' assumptions about quantifiable program outcomes and concerns about supporting overtly "political" work. [ABSTRACT FROM AUTHOR]

Food insecurity affects 1 in 10 Americans and has significant health implications. The University of California, San Diego Student-Run Free Clinic Project implemented the Food Prescription Project providing nutritious food at no cost to patients during medical clinic visits. In a cohort of 409 participants, we utilized the 6-item USDA Food Security Survey throughout our program implementation. At baseline, only 23.2% of participants were food secure, which improved to 41.3% participants over a median follow-up of 33.6 months (p < 0.0001). This model is an effective, low-cost intervention addressing food insecurity in an underserved medical setting. [ABSTRACT FROM AUTHOR]

“Zero Hunger”, the second Sustainable Development Goal, is one of humanity’s most critical challenges and is deeply interlinked with food security. Food security encompasses multiple levels, from food availability to access to food stability. However, for most residents in rural areas of developing and underdeveloped countries, food security primarily means physical, economic, and sustained access to food. Thus, evaluations of food security in rural areas should differ from those in urban areas. This original study introduces a novel approach and an integrated index to assess and present access to food (AFI) using fuzzy and weighted mean techniques. It analyzed 300 rural households in southern Iran. The findings revealed that the AFI of the studied community was 0.551, indicating a moderate level of food security. Most households had intermediate physical, economic, and sustainable access to food, which means that they did not face any critical situations regarding food security. This study suggests that achieving food security requires a hierarchical approach. Realizing the goal of zero hunger in rural areas of less developed countries necessitates a distinct strategy compared to urban areas for policymakers to focus more on food availability and access as the initial levels of the food security pyramid.

Abstract Background Household food waste significantly contributes to overall food waste. While the relationship between food security and food waste has been extensively studied at the macro level, there is a need for research focusing on the quantitative association between food security and food waste at the household level in developing countries, particularly in Southeast Asia. This study aims to estimate the prevalence of household food insecurity and household food waste and to examine the association between household food security and food waste using direct measurements. Subjects and methods A total of 215 households in Bogor Regency, Indonesia, participated in this cross-sectional study. Food waste was measured using waste composition analysis and a 7-day diary. The Food Insecurity Experience Scale (FIES) questionnaire was used to assess household food security, while household income and the proportion of food expenditure were considered confounding factors. The association between food security and food waste was examined using Kendall tau-b and ordinal logistic regression. Results The prevalence of household food insecurity was 18.6%, and the average household food waste was 77 kg/cap/year. Cereals, tubers, and their derivatives (especially rice) and vegetables were major contributors to edible waste, while fruits dominated inedible waste. A negative association was observed between food waste and household food security (edible FW: p = 0.044, r = -0.110; total FW: p = 0.038, r = -0.114), suggesting that household food waste decreases as the severity of food insecurity increases. However, after adjusting for household income, the proportion of food expenditure, and the education levels of spouses, this association became statistically insignificant (p > 0.05). Conclusion There was no significant association between household food security status and food waste. Household income plays a significant role in determining the quantity of household food waste, as higher income is associated with increased food waste. Strategies to prevent and reduce food waste should focus on major contributors such as rice and vegetables, especially among families with higher food accessibility.

Abstract Introduction Globally, the COVID-19 pandemic upended healthcare services and created economic vulnerability for many. Criminalization of sex work meant sex workers were largely ineligible for Canada’s government-based financial pandemic relief, the Canadian Emergency Response Benefit. Sex workers’ loss of income and inability to access financial support services during the pandemic resulted in many unable to pay rent or mortgage, and in need of assistance with basic needs items including food. Little is known about the unique experiences of sex workers who faced challenges in accessing food during the pandemic and its impact on healthcare access. Thus, we aimed to identify the association between pandemic-related challenges accessing food and primary healthcare among sex workers. Methods Prospective data were drawn from a cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers’ Health Access, AESHA; 2010-present). Data were collected via questionnaires administered bi-annually from October 2020-August 2021. We used univariate and multivariable logistic regression with generalized estimating equations to assess the association between pandemic-related challenges accessing food and challenges accessing primary healthcare over the study period. Results Of 170 participants, 41% experienced pandemic-related challenges in accessing food and 26% reported challenges accessing healthcare. Median age was 45 years (IQR:36–53), 56% were of Indigenous ancestry, 86% experienced intimate partner violence in the last six months, and 62% reported non-injection substance use in the last six months. Experiencing pandemic-related challenges accessing food was positively associated with challenges accessing primary healthcare (Adjusted Odds Ratio: 1.99, 95% Confidence Interval: 1.02–3.88) after adjustment for confounders. Conclusions Findings provide insight about the potential role community-based healthcare delivery settings (e.g., community clinics) can play in ameliorating access to basic needs such as food among those who are highly marginalized. Future pandemic response efforts should also take the most marginalized populations’ needs into consideration by establishing strategies to ensure continuity of essential services providing food and other basic needs. Lastly, policies are needed establishing basic income support and improve access to food resources for marginalized women in times of crisis.

Despite the numerous food studies conducted in Detroit, none have assessed changes in the food landscape over a decade. No previous study has systematically analyzed food store closures in the city either. We will address these oversights by examining the distribution of food outlets in the city ten years apart. This paper probes the following questions: (1) How has the distribution of Detroit's food outlets changed in the decade between 2013 and 2023? (2) Does Detroit fit the definition of a food desert in 2013 or 2023? (3) Does Detroit fit the definition of a food swamp in 2013 or 2023? (4) Has supermarket redlining occurred in Detroit in 2013 or 2023? (5) How is population decline related to food outlet distribution? (6) How do food store closures impact food store distribution? We conducted exhaustive searches to collect information on thousands of food outlets from Data Axle, Google, and Bing. The data were analyzed and mapped in SPSS 28 and ArcGIS 10.8. We compared 3499 food outlets identified in 2013 with 2884 identified in 2023. We expanded our search for food outlets in 2023 and found an additional 611 food outlets in categories not studied in 2013. The study's findings are significant as they unearth evidence of extensive population decline—driven by Black flight—and a vanishing food infrastructure. Detroit lost more than 600 food outlets between 2013 and 2023, a staggering number that underscores the severity of the issue. Moreover, in 2023, we documented food store closures and found 1305 non-operational or closed food outlets in the city. Regardless of the neighborhood's racial composition, the household median income, or the educational attainment of residents, food store closures were widespread in 2023; 27.3% of the food outlets identified that year were defunct. Despite the massive food store closures, Detroit did not fit the description of a food desert; each of the city's 54 neighborhoods had between 7 and 300 food outlets. The food swamp thesis did not accurately describe the city either, as supermarkets/large grocery stores were intermingled with convenience and corner stores in both study periods. The data did not find evidence of supermarket redlining, as supermarkets/large grocery stores were found in formerly redlined neighborhoods alongside dollar stores and variety stores in both study periods. [ABSTRACT FROM AUTHOR]

To examine the components of successful food assistance programs for college students. Focus groups conducted during the fall 2019 semester included undergraduate students who accessed a food assistance program on campus (n = 26). Key informant interviews were conducted with professionals working with campus-based food assistance programs (n = 5). Student insight regarding experiences on campus-based food assistance programs was gathered. Key informant interviews were conducted to gain an understanding of strategies put in place to alleviate food insecurity among college students. Emerging focus group themes included financial stressors, eating strategies, struggling to feed dependents, utilization of university-based food assistance programs, and SNAP enrollment. Key informant interviews revealed six strategies of effective food assistance programs: increasing access, securing funding, procurement/distribution of healthy foods, partnerships, outreach, and decreasing stigmatization. A "mission driven" approach has the potential to meet the complex needs of food insecure college students. [ABSTRACT FROM AUTHOR]

Objective: The goal of this research was to uncover narratives around food access and consumption among Black women who attend HBCUs before and during the COVID-19 pandemic. Participants: Black women, ages 18–25. Methods: Focus groups were used to understand how participants defined healthy foods as well as barriers and facilitators of consumption. During the pandemic follow-up focus groups uncovered how COVID-19 impacted their access and consumption patterns. Results: Findings revealed that HCBU women faced similar and distinct concerns around food access prior to and during the pandemic. Students were limited by price, budgets, proximity to healthy foods, kitchen access, and cooking tools. However, proximity or transportation both before and during the COVID-19 pandemic encouraged students to access healthy foods. Conclusion: For students who are already at a societal disadvantage and attend a university located in a food desert, access to nutritious foods can be an exacerbated plight. [ABSTRACT FROM AUTHOR]

As cities increasingly adopt diverse ethnic, social, and cultural characteristics, there is an emerging logic for planning and policy to reflect this hyper-diversity (inclusion) while resolving the looming sustainability-related challenges. However, what is not adequately addressed in the current literature on urban planning – which could also solidify the justification for more citizen inclusion – is what happens when citizens are involved in planning from the perspective of sustainability. In response, this paper asks a key question: "What are the implications, in the case of urban foodscape, when citizens are involved in planning from the perspective of sustainability?" This question is investigated in this paper in the domain of urban foodscapes and through qualitative interviews, with the support of maps, in the Dutch city of Almere. A novel theoretical combination of just sustainabilities and social licence to operate (SLO) was utilised to frame citizen inclusion in foodscape planning. The findings showed that based on everyday practical experiences of food access in the city, citizens were more concerned about social interaction, the representation of food from cultural origins, and local food production. This theoretical combination, as a way of deepening inclusion, would help avoid the tendency of urban planning being used as an instrument for glossing over social injustice under the guise of citizen participation. This paper, therefore, argues that SLO can be a key pathway for actualising just sustainabilities in both urban planning research and policy. [ABSTRACT FROM AUTHOR]

Summary Background Methods Results Conclusion Childhood obesity is a growing worldwide epidemic that requires a biopsychosocial treatment approach to achieve a healthy lifestyle. This study on children in a weight management program examines the relationship between obesity, disease complications, and social determinants of health. We expect that children with higher degrees of obesity are more likely to live in areas lacking access to healthy food and have similar behavioural and socioeconomic characteristics.Program participants were identified by neighbourhood food access status based on their home address. The prevalence of comorbidities in the participants was analyzed according to neighbourhood food accessibility. Multivariate regressions evaluated the association between participants' health outcomes and their sociodemographic and geographical characteristics.A total of 283 (98.3%) participants had a BMI ≥95th percentile for their age and sex and 68 (23.6%) lived in neighbourhoods with limited food access. Almost a third (Adj. R2 = 0.3302; p < 0.01) of the variability in study population's BMI was driven by sociodemographic factors, self‐reported eating and physical activity behaviours, and had a positive relationship with access to healthy food. Nonetheless, HbA1c had a negative relationship with access to healthy food given the limited variation in the sample of participants with HbA1c levels indicating diabetes.Children living in neighbourhoods with limited food access had higher BMIs than other program participants. Thus, it is critical to identify children with limited neighbourhood food accessibility and promote societal and legislative change to improve access to healthy food. [ABSTRACT FROM AUTHOR]

To understand the perspectives of individuals living within food swamps and how they may perceive their access to healthy vs. unhealthy foods before and during the COVID-19 pandemic. Additionally, we examine how they may navigate their food environment to feed themselves and their families. We recruited women of color living within a food swamp neighborhood to share their perspectives on healthy and unhealthy food access, healthy eating, neighborhood resources, and community support. We employed the Photovoice model to engage participants to take photographs and document their experiences through two surveys. A focus group was completed to identify solutions and priorities to improve healthy food access. Nine themes related to food access including marketing, food quality, and affordability were identified. Participants conveyed the “saddening” or “frustrating” experience of taking images, which allowed them to document what they feel is the unfair experience of purchasing food in their own neighborhood. Participants highlighted goals they believed would improve outcomes for their neighborhood while discussing potential stakeholders who may assist the community. Participants identified several existing community assets such as local markets and schools that should be leveraged and expanded to enhance the overall health-promoting aspects of their neighborhood. Community members are able to identify the prevalence of unhealthy foods in their neighborhoods and work diligently to combat issues of food access. After completion of the Photovoice study, participants felt more confident about their ability to influence community. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate household food security (access) level and the dietary diversity of households in the Nsukka Local Government Area in South‐eastern Nigeria. From 20 local communities of Nsukka, 390 women were randomly sampled from the women's group and asked to complete a survey that determined the Household Food Insecurity Access Scale scores and the Household Dietary Diversity Scores (HDDS). The descriptive results indicated a high level of food insecurity with 82.6% households reporting various degrees of food insecurity. Over half of the sampled population experienced insufficient food quality. They either ate unwanted food (65.9%), limited variety (63.1%), or unpreferred food (64.6%). Some households experienced insufficient food intake by going a whole day without food (38.2%), go to sleep hungry (45.1%), or have no food of any kind (49%). The analysis of variance showed no significant difference (p = 0.428) in the food security level of households headed by males as compared with those headed by females. Approximately 53.6% of households fell at or below the average HDDS; males headed 48% of these households, while females headed 64%. The chi‐square test indicated factors associated with household food security including age, education, work status and income, whereas the gender of the household head, household size and marital status were not significantly associated. Public–private partnerships, nutrition orientation and food intervention programs could improve food security in this area. Key messages: This study found a high level of household food insecurity in Nsukka Local Government Area (NLGA) at 82.6%, with 60.3% of households being severely food insecure and 13.3% and 9% mildly and moderately food insecure, respectively, resulting in anxiety for most households.The majority ate limited variety, unwanted and unpreferred food, with more households consuming starchy foods than protein‐rich foods. About 53.6% households fell at or below average dietary diversity.There was no difference in household food security based on the gender of the household head.Food security was associated with education, age, income and work status.Rural households within NLGA require food intervention programs to alleviate food insecurity. [ABSTRACT FROM AUTHOR]

Small food retailers often stock energy-dense convenience foods, and they are ubiquitous in low-income urban settings. With the rise in e-commerce, little is known about the acceptability of online grocery shopping from small food retailers. To explore perceptions of the role of small food retailers (bodegas) in food access and the acceptability of online grocery shopping from bodegas among customers and owners in a diverse New York City urban neighborhood with low incomes. In-depth interviews were conducted with bodega owners and adult customers between May and July 2022. Bodega owners who either had (n = 4) or had not (n = 2) implemented a locally designed online grocery system. Customers (n = 25) were recruited through purposive sampling and were eligible if they purchased at bodegas (>once per month), had low income (household income ≤130% of the federal poverty level or Supplemental Nutrition Assistance Program [SNAP] participants), and owned smartphones. All interviews were transcribed and analyzed in MAXQDA (Verbi Software, Berlin, Germany), using grounded theory. To owners and customers, bodegas were seen as good neighbors providing culturally appropriate foods and an informal financial safety net. Their perceptions concerning food cost and availability of healthy foods in bodegas diverged. Although most perceived online grocery from bodegas as a positive community resource, they also believed it was not suited to their own community because of the bodega's proximity to customers' homes and the low digital literacy of some community members. Customers reported social norms of pride in not using online grocery shopping. Owners and customers believed the service would more likely be used if government benefits such as SNAP allowed payment for online orders. Both suggested improved outreach to increase program awareness and uptake. Online grocery shopping from small food retailers may be acceptable in urban communities with low income and was perceived as a community resource. However, important barriers need to be addressed, such as social norms related to pride in not using online grocery services, digital literacy, program awareness, and allowing SNAP payment for online orders from bodegas. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has exacerbated the food insecurity issue across the nation, especially for vulnerable population groups. As an important way to access food, online grocery shopping has gained substantial popularity during COVID-19. However, it is not clear how COVID-19 impacted both the in-store and online grocery shopping simultaneously and how the impacts varied among different population groups. To gain a comprehensive understanding of the impacts of COVID-19 on food access, we conducted two rounds of online survey during the initial and middle stages of COVID-19 in Maricopa County, Arizona, United States. In addition to the factors that have been examined in the literature, we examined how travel behavior, food environment, and lifestyle change affected both in-store and online shopping during COVID-19 when compared with before COVID-19. Analysis results suggest that the methods people used for grocery shopping varied with different stages of COVID-19 and among different population groups. Changes of people's daily life and travel behavior during COVID-19 are found to be associated with people's grocery shopping method selection. While people with better food environment were more likely to keep in-store grocery shopping, as the pandemic progressed, food environment became less important as a factor influencing the adoption of online grocery shopping. Food assistance program participants had a higher demand for the online grocery shopping service. However, the barriers associated with redeeming their benefits online prohibited them from becoming new online grocery shoppers during COVID-19. The study provides important insights into planning of food provision and formulating effective intervention strategies during future shocks. [ABSTRACT FROM AUTHOR]

Access after disasters to resources such as food poses planning problems that affect millions of people each year. Understanding how disasters disrupt and alter food access during the initial steps of the recovery process provides new evidence to inform both food system and disaster planning. Our research took a supply-side focus and explored the results from a survey of food retailers after Hurricane Harvey in three Texas counties. The survey collected information on how the disaster affected a store's property, people, and products and the length of time a store was closed, had reduced hours, and stopped selling fresh food items. We found that a focus only on store closures and property damage would underestimate the number of days residents had limited fresh food access by nearly 2 weeks. Further, stores in lower-income communities with chronically low access to supermarkets (food deserts) were closed longer than other stores, potentially compounding pre-existing inequalities. To plan for a more equitable food supply after a disaster, planners should embrace more dimensions of access, encourage retailer mitigation, and assess the types of retailers and their distribution within their communities. Practicing planners aspire to ensure equitable access to resources (e.g., food, education, and health care). In the context of food access, planners should consider that a) common proximity-based measures of accessibility (e.g., food deserts) may underestimate inequality and that the inclusion of multiple dimensions of access may provide a more accurate picture, b) efforts to encourage business resilience can complement food systems planning, and c) targeted engagement with local food retailers, food suppliers, and food aid agencies is important for both day-to-day community needs and for disaster planning. [ABSTRACT FROM AUTHOR]

This study assessed the quantity and quality of food consumed by Australian Capital Territory and Perth women living in poverty from July to October 2017. Sixty-six women, recruited through charitable food organizations, participated in one-on-one interviews and 24-hr dietary recall. Overall, diet quality was poor. Daily energy intakes ranged between 96 kJ-11450 kJ. 75% of women consumed below the minimum energy requirement for their age. Daily serve recommendations and Estimated Average Requirements for calcium, iron and potassium were not met. Urgent action is needed from government, health, food, and community sectors to address the ongoing challenges faced by women experiencing food insecurity. [ABSTRACT FROM AUTHOR]

Food citizenship states individuals, organizations, and governments have responsibilities for their actions and policies around food. We conducted twenty semi-structured interviews with older adults as an exploratory study about perceived food-related responsibilities. The government and agribusiness were seen as responsible for food safety and how healthy foods are. The government, agribusiness, and emergency food providers were seen as responsible for availability and accessibility. Individuals were seen as having a personal responsibility to access and choose healthy, safe foods. These results have important implications for understanding how older adults think about the roles themselves and others play in the food system. [ABSTRACT FROM AUTHOR]

Introduction: Globally, the COVID-19 pandemic upended healthcare services and created economic vulnerability for many. Criminalization of sex work meant sex workers were largely ineligible for Canada's government-based financial pandemic relief, the Canadian Emergency Response Benefit. Sex workers' loss of income and inability to access financial support services during the pandemic resulted in many unable to pay rent or mortgage, and in need of assistance with basic needs items including food. Little is known about the unique experiences of sex workers who faced challenges in accessing food during the pandemic and its impact on healthcare access. Thus, we aimed to identify the association between pandemic-related challenges accessing food and primary healthcare among sex workers. Methods: Prospective data were drawn from a cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers' Health Access, AESHA; 2010-present). Data were collected via questionnaires administered bi-annually from October 2020-August 2021. We used univariate and multivariable logistic regression with generalized estimating equations to assess the association between pandemic-related challenges accessing food and challenges accessing primary healthcare over the study period. Results: Of 170 participants, 41% experienced pandemic-related challenges in accessing food and 26% reported challenges accessing healthcare. Median age was 45 years (IQR:36–53), 56% were of Indigenous ancestry, 86% experienced intimate partner violence in the last six months, and 62% reported non-injection substance use in the last six months. Experiencing pandemic-related challenges accessing food was positively associated with challenges accessing primary healthcare (Adjusted Odds Ratio: 1.99, 95% Confidence Interval: 1.02–3.88) after adjustment for confounders. Conclusions: Findings provide insight about the potential role community-based healthcare delivery settings (e.g., community clinics) can play in ameliorating access to basic needs such as food among those who are highly marginalized. Future pandemic response efforts should also take the most marginalized populations' needs into consideration by establishing strategies to ensure continuity of essential services providing food and other basic needs. Lastly, policies are needed establishing basic income support and improve access to food resources for marginalized women in times of crisis. [ABSTRACT FROM AUTHOR]

Background and Aim: Food access is an important social determinant of health and refers to geographical and infrastructural aspects of food availability. Using publicly available data on food access from the United States Department of Agriculture (USDA), geospatial analyses can identify regions with variable food access, which may impact acute pancreatitis (AP), an acute inflammatory condition characterized by unpredictable outcomes and substantial mortality. This study aimed to investigate the association of clinical outcomes in patients with AP with geospatial food access. Methods: We examined AP-related hospitalizations at a tertiary center from January 2008 to December 2018. The physical addresses were geocoded through ArcGIS Pro2.7.0 (ESRI, Redlands, CA). USDA Food Access Research Atlas defined low food access as urban areas with 33% or more of the population residing over one mile from the nearest food source. Regression analyses enabled assessment of the association between AP outcomes and food access. Results: The study included 772 unique patients with AP residing in Massachusetts with 931 AP-related hospitalizations. One hundred and ninety-eight (25.6%) patients resided in census tracts with normal urban food access and 574 (74.4%) patients resided in tracts with low food access. AP severity per revised Atlanta classification [OR 1.88 (95%CI 1.21–2.92); p = 0.005], and 30-day AP-related readmission [OR 1.78(95%CI 1.11–2.86); p = 0.02] had significant association with food access, despite adjustment for demographics, healthcare behaviors, and comorbidities (Charlson Comorbidity Index). However, food access lacked significant association with AP-related mortality (p = 0.40) and length of stay (LOS: p = 0.99). Conclusion: Low food access had a significant association with 30-day AP-related readmissions and AP severity. However, mortality and LOS lacked significant association with food access. The association between nutrition, lifestyle, and AP outcomes warrants further prospective investigation. [ABSTRACT FROM AUTHOR]

Supermarkets are scarce in many under-resourced urban communities, and small independently owned retail stores often carry few fresh or healthy items. The Baltimore Urban food Distribution (BUD) mobile application (app) was previously developed to address supply-side challenges in moving healthy foods from local suppliers to retailers. In-app opportunities for consumers to indicate demand for these foods are crucial, but remain absent. We sought to understand community members' perspectives on the overall role, function and features of a proposed consumer-engagement module (BUDConnect) to expand the BUD app. A series of initial high-fidelity wireframe mockups were developed based on formative research. In-depth interviews (n = 20) were conducted and thematically analyzed using ATLAS.ti Web. Participants revealed a desire for real-time crowd-sourced information to navigate their food environments safely and effectively, functionality to help build community and social networks among store owners and their customers, opportunities to share positive reviews and ratings of store quality and offerings, and interoperability with existing apps. Rewards and referral systems resulting in the discounted purchasing of promoted healthy items were suggested to increase adoption and sustained app use. Wireframe mockups were further refined for future development and integration into the BUD app, the program and policy implications of which are discussed. [ABSTRACT FROM AUTHOR]

This study provides evidence that retail prices of US fresh produce (fruits and vegetables) and fresh meat products are similar across stores within the same chain even though unique characteristics of fresh produce products might lend to more localization in pricing. The results show the median price difference of fresh produce is 5% within‐chain stores compared to 20% between‐chain stores. Furthermore, the results show no significant differences in fresh produce prices between‐chain stores that serve areas of differing food access nor significant differences in chain prices between Metropolitan Statistical Areas with implications to federal nutrition programs. [ABSTRACT FROM AUTHOR]

In 2020, a mobile application (app) was developed to connect small food retailers with local pro­ducers, recognizing the underutilization of direct-to-retail sales channels. Before piloting the app, formative research was conducted in Charles County, Maryland, to gain an understanding of existing direct-to-retail sales channels for locally grown produce. Seven stores were surveyed to explore current local produce stocking, and four farmers participated in in-depth interviews to pro­vide insights into their experiences with direct-to-retail marketing channels. The results indicate a limited stocking of local produce in the small food stores, some of which was self-procured to obtain adequate quantities. Farmers expressed a passion for contributing to food security in their commu­nity and a willingness to collaborate with store owners to strengthen their direct sales; however, they cited barriers such as the impact of the COVID-19 pandemic, competition with large distributors, and logistical challenges. Considering these existing barriers and facilitators, small food stores may still possess a unique potential to establish direct sale relationships with local farms. Such relationships could be effectively facilitated through the implementation of a digital strategy.

The internet is drastically changing how U.S. consumers shop for groceries, order food from restaurants, and interact with food marketing. There is an urgent need for new policies to help ensure that the internet is a force for good when it comes to food access, transparency, and nutrition. This article outlines actions that federal agencies—like the U.S. Department of Agriculture (USDA), U.S. Food and Drug Administration (FDA), and Federal Trade Commission (FTC)—and state and local governments can take to improve the online food environment. We recommend policies in three settings: online grocery retail, online restaurant ordering, and marketing on social media and other online platforms. For example, USDA could finalize regulations increasing access to online WIC and remove barriers to accessing online SNAP by requiring large retailers to waive online delivery and service fees for SNAP purchases. FDA could improve access to nutrition information by issuing guidance describing what product information should be available at the online point of selection. FTC could give better guidance on appropriate tactics when marketing to children and collect better data on how companies are marketing food to children online. Finally, state governments could pass laws like New York’s recently introduced Predatory Marketing Prevention Act to address false and misleading advertising of unhealthy foods aimed at children and other vulnerable groups.

Background: Governments around the world collect food price data on a frequent basis, often monthly, for the purpose of monitoring inflation. These routine economic data can be used with a nutrition-sensitive lens for understanding economic access to a healthy diet. The Food and Agriculture Organization of the United Nations has adopted the cost and affordability of a healthy diet (CoAHD) for annual tracking alongside other food security indicators. This indicator is relevant in many countries for informed decision-making and accountability toward Food Systems Summit pathways. National governments may wish to include this indicator in their own monitoring systems, using existing subnational price and income data. Objectives: We describe emerging systems in several countries for monitoring CoAHD and analytical tools that facilitate the calculation of CoAHD. We discuss reasons why the indicator may differ when calculated using subnational data compared with the global monitoring system and how to interpret differences. Methods: Between June 2016 and February 2024, 19 workshops were held in 7 countries (Ethiopia, Ghana, Malawi, Nigeria, Pakistan, Tanzania, and Viet Nam), where stakeholder discussions covered sources of food price data, institutions involved, policy uses, and direct training in calculation of CoAHD. Food price data collected by national organizations were used to calculate CoAHD in partnership with government agencies. Results: Calculating CoAHD using subnational data uses the same methods across settings, but the mechanisms for monitoring and dissemination are different in each country, illustrating heterogeneity in how the metric can most effectively be incorporated within existing structures. Results from national and global monitoring systems have expected differences based on data sources, healthy diet standards, and affordability standards. Conclusions: CoAHD can be calculated with existing data and resources, facilitated by new software tools and user tutorials. In the future, it can be further streamlined, leveraging technical assistance from global institutions and aligning national and global monitoring systems.

Given the centrality of philanthropic funding to the work of nonprofit food access and food justice organizations, it is surprising how little we know about how foundations conceptualize and assess their grant-making across the food system. Based on an analysis of interviews with program officers at foundations that support food system interven­tions in New England, this paper describes founda­tions’ initial (and evolving) motivations for grant-making, the outcomes that they expect from investments, and the kinds of information that they see as convincing evidence for such outcomes. At the same time, it explores how program officers’ experiences of responding to the COVID-19 pan­demic and to contemporaneous calls to redress systemic racism have shaped their practices. This paper points to opportunities for new relationships between community-based organizations and foundations, especially as program officers ex­periment with practices of trust-based philan­thropy. It also highlights, however, the challenges posed by philanthropic board members’ assump­tions about quantifiable program outcomes and concerns about supporting overtly “political” work.

BackgroundLack of access to adequate, safe, and nutritious food is a major concern for the Afghan population due to ongoing war and humanitarian crises. Recently resettled Afghan refugees in the US continue to face challenges securing adequate, nutritious food resources in new environments. This study examined Afghan refugees' food access and insecurity in the San Joaquin Valley, California.MethodsSemi-structured, in-depth interviews were conducted to collect the perspectives and experiences of key informants and newly arrived Afghan refugees.ResultsThis study highlights environmental and structural factors (availability and accessibility of grocery stores; availability of religious-appropriate items in the stores; the public benefit received by a family; and public transportation) and individual factors (religious and cultural practices; financial and language barriers) as major determinants of post-resettlement food insecurity.ConclusionIncreasing the accessibility and affordability of culturally and religiously appropriate food items within the US food system, enhancing the collaboration of community volunteers and resettlement organizations in the direct assistance of new families, and providing continuous access to public benefits are possible steps to mitigate the risk of food insecurity among Afghan refugees. This study suggests a continuous examination of the degree of food insecurity in this population and its attendant health impacts.

Introduction: The onset of the COVID-19 pandemic has disrupted food access, resulting in substantial consequences for food insecurity and contributing to adverse individual and public health outcomes. To comprehensively evaluate these challenges and grasp their implications for food security, this study aimed to evaluate the contributing determinants of food insecurity among rural households in the southwestern region of Bangladesh. Study design: A cross-sectional study was conducted using a validated questionnaire in selected 310 rural household respondents from the southwestern region of Bangladesh. Methods: Household food insecurity status was the outcome variable for the analysis. Multinomial logistic regression analysis was used to explore and predict risk factors correlated with food insecurity among southwestern Bangladeshi households. Results: We found that 59 % and 27.5 % of households were suffering from moderate food insecurity and severe food insecurity, respectively. The multinomial regression model revealed that respondents residing in Kusthia (RRR = 5.56 CI:2.67–8.4 and RRR = 6.65, CI:3.37–9.22) aged between 30 and 40 years (RRR = 2.32, 95 % CI:1.84–3.77 and RRR = 1.87, 95 % CI:1.48–3.97) and 40–50 years (RRR = 1.86 95 % CI:1.46–3.82 and RRR = 1.95, 95 % CI:1.75–3.26) were significantly associated with mild-to-moderate and severe food insecurity. Respondents with a monthly family income of

Migrants who work seasonally in agriculture face living and working conditions that significantly impact their health. Some of these conditions are related to inadequate food access or food preservation and preparation hygiene. This study aimed to explore how migrant and seasonal agricultural farmworkers access food in Spain from the perspective of professionals supporting this population. We conducted a qualitative study in 2021 based on semistructured interviews with 92 social and health service professionals involved in the care of seasonal migrant workers in 4 Spanish provinces. We identified three themes through reflective thematic analysis: (1) Access to food depends on NGOs and institutions, especially after the COVID-19 pandemic; (2) Relevant cultural differences in diet depending on North African or sub-Saharan origin; (3) Seasonal migrant workers frequently suffer from nutritional and other health problems related to food security. The professionals interviewed described the diet of seasonal migrant workers as based on food with little variety, insufficient protein content, and obesogenic products. They also reported a generalized lack of hygiene in food storage and preparation. This study calls for encouraging dietary support strategies to reduce challenges in food accessibility, which would prevent health problems in this population and bring them social justice.

• Screening for food insecurity by CF care programs and local food access are independent predictors of nutritional status among children and adults with CF in the United States. • More frequent food insecurity screening is associated with less underweight in children with CF, and screening in writing (vs verbally) is associated with higher BMI in adults with CF. • Residence in a food desert is associated with higher odds of underweight in both children and adults with CF, as well as with lower BMI percentile in children with CF. • Standardized, evidence-based food insecurity screening across CF care programs and equitable food access are needed to optimize the nutritional outcomes of people with CF. As the nutritional status of people with CF (PwCF) is associated with their socioeconomic status, it is important to understand factors related to food security and food access that play a role in the nutritional outcomes of this population. We assessed the contributions of CF program-level food insecurity screening practices and area-level food access for nutritional outcomes among PwCF. We conducted a cross-sectional analysis of 2019 data from the U.S. CF Patient Registry (CFFPR), linked to survey data on CF program-level food insecurity screening and 2019 patient zip code-level food access. Pediatric and adult populations were analyzed separately. Nutritional outcomes were assessed with annualized BMI percentiles (CDC charts) for children and BMI (kg/m2) for adults, with underweight status defined as BMIp <10% for children and BMI <18.5 kg/m2 for adults, and overweight or obese status defined as BMIp >85% for children and BMI >25 kg/m2 for adults. Analyses were adjusted for patient sociodemographic and clinical characteristics. The study population included 11,971 pediatric and 14,817 adult PwCF. A total of 137 CF programs responded to the survey, representing 71% of the pediatric sample and 45% of the CFFPR adult sample. The joint models of nutritional status as a function of both program-level food insecurity screening and area-level food access produced the following findings. Among children with CF, screening at every visit vs less frequently was associated with 39% lower odds of being underweight (OR 0.61, p = 0.019), and the effect remained the same and statistically significant after adjusting for all covariates (aOR 0.61, p = 0.047). Residence in a food desert was associated both with higher odds of being underweight (OR 1.66, p = 0.036; aOR 1.58, p = 0.008) and with lower BMIp (-4.81%, p = 0.004; adjusted -3.73%, p = 0.014). Among adults with CF, screening in writing vs verbally was associated with higher odds of being overweight (OR 1.22, p = 0.028; aOR 1.36, p = 0.002) and higher BMI (adjusted 0.43 kg/m2, p = 0.032). Residence in a food desert was associated with higher odds of being underweight (OR 1.48, p = 0.025). Food insecurity screening and local food access are independent predictors of nutritional status among PwCF. More frequent screening is associated with less underweight among children with CF, whereas screening in writing (vs verbally) is associated with higher BMI among adults. Limited food access is associated with higher odds of being underweight in both children and adults with CF, and additionally with lower BMI among children with CF. Study results highlight the need for standardized, evidence-based food insecurity screening across CF care programs and for equitable food access to optimize the nutritional outcomes of PwCF. [ABSTRACT FROM AUTHOR]

We examined whether Central Texans shop at their nearest supermarket, how far they travel for groceries, and explored differences by race/ethnicity, urbanicity, motivations for store selection, and other demographic characteristics. Using cross-sectional data and GIS, continuous network distances from participants' homes to nearest and usual supermarkets were calculated and multivariate linear regression assessed differences. <19% shopped at their nearest supermarket. Regression models found that urbanicity played a large role in distance traveled to preferred supermarket, but other factors varied by race/ethnicity. Our findings demonstrate that racial/ethnic and urbanicity disparities in food access and multiple domains of food access need greater consideration. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected independently owned restaurants with implications for food access and health equity. Changes in healthy food availability (HFA) were examined in a randomly selected sample of Hispanic Caribbean restaurants in New York City, before and after the COVID-19 onset (n = 76), using an adapted Nutrition Environment Measurement Survey for Restaurants. An overall decrease in HFA scores was found and changes HFA components (fried foods and vegetarian options increased, 100% fruit juice decreased, p < 0.10). Changes were examined against restaurant characteristics. This work augments our understanding of ethnic restaurants and the nutrition implications of business adaptations when responding to emergencies. [ABSTRACT FROM AUTHOR]

Although adequate nutritional status during pregnancy is necessary to support optimal fetal development, many low-income women have poor access to fresh, high-nutrient foods. To address these challenges, a pediatric fruit and vegetable (FV) prescription program was expanded to include pregnant women, providing one prescription for fresh FVs worth 15 US dollars during each prenatal office visit for redemption at farmers'/mobile markets. This analysis describes baseline sociodemographic characteristics, food security, and dietary intake among 253 pregnant women in Flint, Michigan in 2022–23. Dietary recall data were collected and analyzed using the Automated Self-Administered 24-h Tool developed by the US National Cancer Institute, with nutrition output reported in relation to adherence to US Dietary Guidelines. Most participants (mean ± SD age 26.51 ± 4.90 years) identified as African American (53%) and were receiving publicly funded health insurance (66%). Most (75%) reported no food insecurity, yet the majority failed to meet dietary recommendations for whole grains (99.3%), vegetables (93.1%), dairy (93.1%), and fruits (69.4%). Moreover, most did not meet micronutrient recommendations through food sources, including vitamin D (100%), iron (98.6%), folic acid (98.6%), vitamin A (82.6%), calcium (68.8%), and vitamin C (62.5%). Results raise deep concerns regarding diet and nutrition among pregnant women in this US city. [ABSTRACT FROM AUTHOR]

Objective: Food insecurity is a growing concern to the health and wellbeing of college students. This study aims to examine the lived experiences of students at-risk of food insecurity and associated challenges in a public urban campus. Participants: The study recruited 21 college students at risk of food insecurity using purposive sampling. Methods: We performed qualitative interviews with three focus groups and conducted a thematic analysis to explore themes that emerged from participant discussions. Results: Three central themes emerged from our qualitative analysis: (a) barriers to accessing stable and healthy food; (b) impacts of food insecurity on academic performance and physical and mental health; and (c) coping strategies for navigating food insecurity. Conclusions: The study highlights the distinct natures of food hardship and responses specific to urban public college students. Suggestions for academics and college administrators to mitigate college food insecurity are discussed. [ABSTRACT FROM AUTHOR]

Background: Food access is associated with higher gastrointestinal (GI) cancer mortality; however, its association with frailty, which is a predictor of premature mortality among older adults with cancer, is less understood. Methods: The authors included 880 adults aged 60 years and older who were recently diagnosed with GI cancers and were undergoing self‐reported geriatric assessment at their first prechemotherapy visit to the University of Alabama at Birmingham oncology clinic. Food access was measured using the 2019 US Department of Agriculture Economic Research Service designation low‐income, low‐access (LILA), classifying census tracts based on income and/or access to food stores at various distances. The primary outcome was frailty on the CARE (Cancer and Aging Resilience Evaluation) Frailty Index, a composite of the proportion of impaired geriatric assessment measures. The authors examined the LILA‐frailty association with modified Poisson regression accounting for census‐tract clustering. Results: The median patient age was 69 years, 58.1% were men, 22.5% were non‐Hispanic Black, 29.2% had colorectal cancer, 28.0% had pancreatic cancer, 70.1% presented with stage III/IV disease, and 34.9% were frail. A higher proportion in LILA areas were non‐Hispanic Black (44.1% vs. 10.8%; p <.001) and had less education (high school or less: 48.1% vs. 37.9%; p =.020). Adjusting for age, race and ethnicity, sex, cancer type and stage, and education, an LILA designation was associated with 58% greater odds of worsening frailty status (95% confidence interval, 1.18–2.12). An analysis of LILA subcategories revealed that associations were maintained across all LILA measures. Conclusions: Poor food access was associated with a greater risk of frailty among newly diagnosed older adults with GI cancers before they received systemic treatment. Intervening on local food access, particularly in LILA areas, may be a target for improving rates of frailty and promoting health equity in this population. Poor food access at the census‐tract level is associated with frailty among older adults with gastrointestinal malignancies before they receive systemic treatment. Improving local food access may be a target for improving rates of frailty, a common outcome among older adults who have cancer with many adverse consequences. [ABSTRACT FROM AUTHOR]

Adolescents are often exposed to food retailers selling unhealthy food items during their lunch breaks and school commutes. This systematic review examines the influence of school neighborhood food retail environments on adolescent food purchasing. A systematic search of 6 databases. Observational studies published from January 2012 to December 2022 that measured food availability, accessibility, or exposure, measured food purchasing, and focused on adolescents (aged 10–19 years) were eligible for inclusion. Twelve studies with 97 findings were included. Thirty-one findings indicated that a school neighborhood with a high density of unhealthy food retail, a school with unhealthy food retail nearby, or exposure to unhealthy food retail on the journey to/from school was associated with higher prevalence and frequency of unhealthy food purchases. Adolescents' food purchasing behaviors may be meaningfully affected by their school neighborhood food retail environment; however, the included studies have many methodological shortcomings. Results identify the need for new studies that measure food purchasing, use comprehensive definitions of food retail environments, and adopt more rigorous methods to approximate exposure to food retail. More robust evidence would strengthen the rationale for policy or program interventions and potentially indicate specific targets for intervention. [ABSTRACT FROM AUTHOR]