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BACKGROUND: Few studies have investigated the relationship between the food and physical activity environment and odds of gestational diabetes mellitus (GDM). This study quantifies the association between densities of several types of food establishments and fitness centers with the odds of having GDM. METHODS: The density of supermarkets, fast-food restaurants, full-service restaurants, convenience stores and fitness centers at 500, 1000 and 1500 m (m) buffers was counted at residential addresses of 68,779 pregnant individuals from Eastern Massachusetts during 2000-2016. The healthy food index assessed the relative availability of healthy (supermarkets) vs unhealthy (fast-food restaurants, convenience stores) food retailers. Multivariable logistic regression quantified the cross-sectional association between exposure variables and the odds of having GDM, adjusting for individual and area-level characteristics. Effect modification by area-level socioeconomic status (SES) was assessed. FINDINGS: In fully adjusted models, pregnant individuals living in the highest density tertile of fast-food restaurants had higher GDM odds compared to those living in the lowest density tertile (500 m: odds ratio (OR):1.17 95% CI: [1.04, 1.31]; 1000 m: 1.33 95% CI: [1.15, 1.53]); 1500 m: 1.18 95% CI: [1.01, 1.38]). Greater residential density of supermarkets was associated with lower odds of GDM (1000 m: 0.86 95% CI: [0.74, 0.99]; 1500 m: 0.86 95% CI: [0.72, 1.01]). Similarly, living in the highest fitness center density tertile was associated with decreased GDM odds (500 m:0.87 95% CI: [0.76, 0.99]; 1500 m: 0.89 95% CI: [0.79, 1.01]). There was no evidence of effect modification by SES and no association found between the healthy food index and GDM odds. INTERPRETATION: In Eastern Massachusetts, living near a greater density of fast-food establishments was associated with higher GDM odds. Greater residential access to supermarkets and fitness centers was associated with lower the odds of having GDM. FUNDING: NIH.

Deciding what, where, when and how much to feed a child occupies much of a mother's time, energy, and financial resources. This study aids our understanding of the effects of legislation promoting healthier eating on mothers from low socioeconomic groups and on their families. We interview mothers and nutrition experts in Santiago, Chile – the site of the most recent and comprehensive effort to change a population's food habits via legislation. We introduce the notions of 'desired diets' – ideal diets promoted by health experts and public policy discourses that moralise food consumption and promote consumer responsibilisation for health-related issues; and 'possible diets' – diets that mothers can adapt to and habituate in the household, considering their life realities. We argue that the notions of possible and desired diets often find themselves at odds, leading to mothers facing moral scrutiny, anxiety, and stress, which affects their sense of self, shaping notions of 'good mothering'. [ABSTRACT FROM AUTHOR]

Background: Changes to the food environment during the Covid-19 pandemic significantly influenced food acquisition and consumption, contributing to a higher prevalence of food insecurity. We assessed the perception of the food environment and its association with food insecurity in households of Brazilian schoolchildren during the Covid-19 pandemic. Methods: We conducted a cross-sectional telephone survey between March and May 2021 with adults (n = 475) responsible for purchasing and/or preparing food at the students' homes aged between 6 months and 17 years enrolled in public school from two Brazilian municipalities. We assessed outcomes using the Brazilian Food Insecurity Scale (EBIA). We measured perceptions of the food environment by evaluating the perceived availability, price, and quality of fruits and vegetables (FV) and ultra-processed foods (UPF) sold in the neighbourhood. Results: The results indicate that 55.1% of respondents experienced mild food insecurity, and 14.5% experienced moderate or severe food insecurity. The perception of the ease of purchase (8.5% vs. 64.2%) and variety (78.9% vs. 57.9%) of UPF was higher at all levels of food security and insecurity compared to the same questions on FV. The level of food insecurity was associated with the perceived price of FV (p < 0.05). A negative perception of the quality (OR:1.92; CI:1.04–3.56) and the price of FV (OR:3.56; CI:1.41–8.98) were associated with moderate/severe food insecurity. Conclusions: The affordability of FV is important for food-insecure households. Social protection policies for vulnerable families are crucial interventions that can strengthen and promote healthier food environments with greater availability of fresh foods such as fruits and vegetables. [ABSTRACT FROM AUTHOR]

Background: Racial discrimination is linked to unhealthy food environments and a higher prevalence of food insecurity. However, no study has explored their interrelated effects. We analyzed the relationship between racial discrimination, community food environment, and food insecurity in adults of different socioeconomic status. We also investigated the potential modifying effect of the food environment on the relationship between racism and food insecurity. Methods: This was a cross-sectional study of 400 adults aged 20–70 years residing in the central area of ​​Porto Alegre, the capital of Rio Grande do Sul state. Race and racial discrimination were assessed by self-reported race/skin color using the Experiences of Discrimination scale (EOD), respectively. The food environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S) tool. Food insecurity was assessed using the short version of the Brazilian Food Insecurity Scale (EBIA for short, in Portuguese). Poisson regression with robust variance was employed for the multivariate analysis. Results: The prevalence of food insecurity was higher in areas with a poorer food environment (areas 1 and 3; 56.6% and 58.8%, respectively). Racial discrimination was associated with food insecurity, where every 1-point increase in the racial discrimination score increased the likelihood of food insecurity by 7% (prevalence ratio [PR] 1.07; 95% CI, 1.03–1.20). When stratifying the analyses by food environment, racial discrimination was associated with food insecurity only in areas with a poorer food environment (PR 1.06; 95% CI, 1.01–1.10). Conclusions: Experiences of racial discrimination were associated with a higher prevalence of food insecurity in the study population. The community food environment was an effect modifier of this relationship, highlighting the relevance of interventions in the food environment focused on areas with a greater presence of Black people as a way of combating racism and food insecurity. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results Conclusions So What? Food environments surrounding schools have a strong influence on the adolescent's food choices. Moreover, the prevalence of diet‐related chronic diseases is higher in regional than metropolitan areas in Australia. Understanding school food environments in these different settings is crucial for informing future strategies to improve adolescent health.Google Street View was used to identify food outlets within 1.6 km around all secondary schools in Wagga Wagga and Blacktown in New South Wales which were selected as regional and metropolitan case study areas. Based on food outlet type, healthfulness categories were assigned, and Chi‐squared tests were performed. The Health Advisory Panel for Youth at the University of Sydney (HAPYUS) were engaged to obtain their perspectives on findings.Unhealthful food outlets were consistently most prevalent around schools in Wagga Wagga and Blacktown over 17 years. In 2023, these were predominantly restaurants (19.4% vs. 21.1%), cafés (16.8% vs. 11.1%), fast‐food franchise outlets (15.1% vs. 17.4%) and independent takeaway stores (14.1% vs. 9.6%). No significant difference in healthfulness between regional and metropolitan areas was found. Youth advisors recognised price and social reasons as major contributors to food choices.Google Street View was used as a novel resource to examine school food environments in regional and metropolitan areas which have remained consistently unhealthful for nearly two decades.Unhealthful school food environments may encourage poor diets and exacerbate rates of adolescent overweight and obesity. Critical government action is needed to improve school food environments. [ABSTRACT FROM AUTHOR]

Background: A voluntary National Healthy Food and Drink Policy (the Policy) was introduced in public hospitals in New Zealand in 2016. This study assessed the changes in implementation of the Policy and its impact on providing healthier food and drinks for staff and visitors in four district health boards between 1 and 5 years after the initial Policy introduction. Methods: Repeat, cross-sectional audits were undertaken at the same eight sites in four district health boards between April and August 2017 and again between January and September 2021. In 2017, there were 74 retail settings audited (and 99 in 2021), comprising 27 (34 in 2021) serviced food outlets and 47 (65 in 2021) vending machines. The Policy's traffic light criteria were used to classify 2652 items in 2017 and 3928 items in 2021. The primary outcome was alignment with the Policy guidance on the proportions of red, amber and green foods and drinks (≥ 55% green 'healthy' items and 0% red 'unhealthy' items). Results: The distribution of the classification of items as red, amber and green changed from 2017 to 2021 (p < 0.001) overall and in serviced food outlets (p < 0.001) and vending machines (p < 0.001). In 2021, green items were a higher proportion of available items (20.7%, n = 815) compared to 2017 (14.0%, n = 371), as were amber items (49.8%, n = 1957) compared to 2017 (29.2%, n = 775). Fewer items were classified as red in 2021 (29.4%, n = 1156) than in 2017 (56.8%, n = 1506). Mixed dishes were the most prevalent green items in both years, representing 11.4% (n = 446) of all items in 2021 and 5.5% (n = 145) in 2017. Fewer red packaged snacks (11.6%, n = 457 vs 22.5%, n = 598) and red cold drinks (5.2%, n = 205 vs 12.5%, n = 331) were available in 2021 compared to 2017. However, at either time, no organisation or setting met the criteria for alignment with the Policy (≥ 55% green items, 0% red items). Conclusions: Introduction of the Policy improved the relative healthiness of food and drinks available, but the proportion of red items remained high. More dedicated support is required to fully implement the Policy. [ABSTRACT FROM AUTHOR]

Food environments are important determinants of healthy diets among young people. This study explored young people's perspectives on their food environment, their recommendations to policymakers and views on youth engagement in policy processes. There is limited research on young people's perspectives on their involvement in developing food environment policies. Youth engagement in policymaking processes can lead to greater policy integrity and inclusivity. Four focus group discussions were conducted with 39 young people (12–21 years) from a town in North West England and a metropolitan area in the English Midlands. Participants were recruited through youth organizations. Data were analysed using inductive thematic analysis. Young people reported concerns about the density of fast food outlets in their local area, the unaffordability of healthier food, and fast food advertisement. These issues were not believed to be prioritized in local and national policymaking. Accordingly, policy recommendations were mainly for structural food environment policies, including restrictions on fast food outlet density and incentives for menu reformulation. Young people did not feel involved in local decisions about the food environment. They expressed a need for more meaningful engagement beyond consultation. Young people have repeatedly shown to have a deep understanding of the social, commercial and political factors that influence diet and health. It is essential that policymakers aiming to improve young people's diets take their unique views and concerns into account to create effective policies that resonate with young people. [ABSTRACT FROM AUTHOR]

We evaluated the available literature on the association between characteristics of the food environment and household food insecurity. Systematic review. Studies published until January 9th, 2023, were searched in the PubMed, Web of Science, Science Direct, EMBASE and LILACS databases. The included studies were summarized with a narrative synthesis with information on the study location, population studied, prevalence and type of measure/instrument used to assess food (in)security, method of evaluating the food environment and measure between food insecurity and food environment. Twenty-two articles were included. Different methods were used to measure food security and the food environment. Most food insecurity assessment tools assessed the dimension of access to food, more precisely economic access. The dimensions of the food environment most evaluated were food availability and affordability. An association between characteristics of the food environment and food insecurity was found in 18 of these studies. Homes with food insecurity have a greater availability of unhealthy foods, more frequent purchasing of foods in convenience stores and small markets as well as a lower availability of healthy foods, such as fruits and vegetables. This review revealed that household food insecurity was associated with the food environment, highlighting the importance of policies to promote healthy diets, especially in vulnerable communities. Few studies were found in the Global South, demonstrating the gap in this knowledge in these locations. [ABSTRACT FROM AUTHOR]

Summary Background Methods Results Conclusions Focussing on appetitive traits associated with obesity, this study aimed to estimate the association between the fast‐food environment and satiety responsiveness, enjoyment of food and food responsiveness.We used data from the Generation R Study. We included 2008 children with repeated measurements at the age of 4–10 years old. Three eating behaviour subscales from the Child Eating Behaviour Questionnaire (CEBQ) were used as outcomes. Geographical Information System data were used to map individual‐level exposure to fast‐food outlets within 400 m from home. Random Effect Within Between (REWB) models were used to derive estimates. We tested for moderation of the associations with parental restriction at baseline using the parent‐reported Child Feeding Questionnaire (CFQ).We did not find evidence of between‐associations of fast‐food exposure and eating behaviour subscales. Considering within‐associations, an increase in absolute fast‐food exposure was associated with a significant marginal increase in satiety responsiveness (β: 0.02 [95% confidence interval: 0.00–0.03]). No moderation by parental restriction was found.In environments with ubiquitous fast‐food outlets, an increased exposure to fast‐food outlets does not seem to have a substantial impact on eating behaviour. Further research is needed to better understand how fast‐food exposure contributes to overweight. [ABSTRACT FROM AUTHOR]

Background: Rapid urbanisation without concomitant infrastructure development has led to the creation of urban slums throughout sub-Saharan Africa. People living in urban slums are particularly vulnerable to food insecurity due to the lack of physical and economic accessibility to food. Hence, it is important to explore how vulnerable groups living in slums interact with the food environment. This study assessed the relationships between food insecurity, including restrictive coping strategies, food purchasing patterns and perceptions about the food environment among dwellers of selected urban slums in Ibadan, Nigeria. Methods: This community-based cross-sectional study was conducted with people responsible for food procurement from 590 randomly selected households in two urban slums in Ibadan. Food insecurity and restrictive coping strategies were assessed using the Household Food Insecurity Access Scale and the Coping Strategy Index, respectively. We examined purchasing patterns of participants by assessing the procurement of household foodstuffs in different categories, as well as by vendor type. Participants' perceptions of the food environment were derived through a five-item composite score measuring food availability, affordability and quality. Chi-square tests and logistic regression models analysed associations between food insecurity, purchasing patterns and perceptions of the food environment. Results: The prevalence of food insecurity in the sample was 88%, with 40.2% of the households experiencing severe food insecurity. Nearly a third (32.5%) of the households used restrictive coping strategies such as limiting the size of food portions at mealtimes, while 28.8% reduced the frequency of their daily meals. Participants purchased food multiple times a week, primarily from formal and informal food markets rather than from wholesalers and supermarkets. Only a few households grew food or had livestock (3.2%). Food insecure households had a lower perceived access to the food environment, with an approximate 10% increase in access score per one-unit decrease in food insecurity (AOR = 0.90, 95% CI: 0.84, 0.96). The most procured foods among all households were fish (72.5%), bread (60.3%), rice (56.3%), yam and cassava flours (50.2%). Food-secure households procured fruit, dairy and vegetable proteins more frequently. Conclusion: Food insecurity remains a serious public health challenge in the urban slums of Ibadan. Perceptions of greater access to the food environment was associated with increasing food security. Interventions should focus on creating more robust social and financial protections, with efforts to improve livelihoods to ensure food security among urban slum-dwellers. [ABSTRACT FROM AUTHOR]

Background: Food and beverage companies play a central role in shaping the healthfulness of food environments. Methods: The BIA-Obesity tool was used to evaluate and benchmark the specificity, comprehensiveness and transparency of the food environment-related policies and commitments of leading food and beverage manufacturing and retailing companies in Canada. Policies and commitments related to the healthfulness of food environments within 6 action areas were assessed: 1) corporate nutrition strategy; 2) product (re)formulation; 3) nutrition information and labelling; 4) product and brand promotion; 5) product accessibility; and 6) disclosure of relationships with external organizations. Data were collected from publicly available sources, and companies were invited to supplement and validate information collected by the research team. Each company was then assigned a score out of 100 for each action area, and an overall BIA-Obesity score out of 100. Results: Overall BIA-Obesity scores for manufacturers ranged from 18 to 75 out of 100 (median = 49), while scores for retailers ranged from 21 to 25 (median = 22). Scores were highest within the product (re)formulation (median = 60) followed by the corporate nutrition strategy (median = 59) domain for manufacturers, while retailers performed best within the corporate nutrition strategy (median = 53), followed by the disclosure of relationships with external organizations (median = 47) domain. Companies within both sectors performed worst within the product accessibility domain (medians = 8 and 0 for manufacturers and retailers, respectively). Conclusions: This study highlights important limitations to self-regulatory approaches of the food and beverage industry to improve the healthfulness of food environments. Although some companies had specific, comprehensive, and transparent policies and commitments to address the healthfulness of food environments in Canada, most fell short of recommended best-practice. Additional mandatory government policies and regulations may be warranted to effectively transform Canadian food environments to promote healthier diets and prevent related non-communicable diseases. [ABSTRACT FROM AUTHOR]

Background: In 2016, a voluntary National Healthy Food and Drink Policy was released to improve the healthiness of food and drinks for sale in New Zealand health sector organisations. The Policy aims to role model healthy eating and demonstrate commitment to health and well-being of hospital staff and visitors and the general public. This study aimed to understand the experiences of hospital food providers and public health dietitians/staff in implementing the Policy, and identify tools and resources needed to assist with the implementation. Methods: A maximum variation purposive sampling strategy (based on a health district's population size and food outlet type) was used to recruit participants by email. Video conference or email semi-structured interviews included 15 open-ended questions that focused on awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. Data was analysed using a reflexive thematic analysis approach. Results: Twelve participants (eight food providers and four public health dietitians/staff) were interviewed; three from small (< 100,000 people), four from medium (100,000-300,000 people) and five from large (> 300,000 people) health districts. There was agreement that hospitals should role model healthy eating for the wider community. Three themes were identified relating to the implementation of the Policy: (1) Complexities of operating food outlets under a healthy food and drink policy in public health sector settings; (2) Adoption, implementation, and monitoring of the Policy as a series of incoherent ad-hoc actions; and (3) Policy is (currently) not achieving the desired impact. Concerns about increased food waste, loss of profits and an uneven playing field between food providers were related to the voluntary nature of the unsupported Policy. Three tools could enable implementation: a digital monitoring tool, a web-based database of compliant products, and customer communication materials. Conclusions: Adopting a single, mandatory Policy, provision of funding for implementation actions and supportive tools, and good communication with customers could facilitate implementation. Despite the relatively small sample size and views from only two stakeholder groups, strategies identified are relevant to policy makers, healthcare providers and public health professionals. [ABSTRACT FROM AUTHOR]

Background: Dietary factors are among the largest and costliest drivers of chronic diseases in England. As a response, the government implements a range of population interventions to promote healthy diets by targeting food environments. Objectives: This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches. Data sources: Fourteen relevant English-language databases were searched in November 2020 for studies published between 2010 and 2020. Methods: Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments. Results: A total of 483 primary research evaluations and 14 evidence syntheses were included. The study reveals considerable geographic, methodological and other imbalances across the literature, with, for example, 81% of publications focusing only on 12 countries. The systematic reviews also reveal the effectiveness and cost-effectiveness of reviewed regulatory approaches designed to improve health, consumer behaviour and food environment outcomes while public–private partnerships and voluntary approaches to improve diets via reformulation, advertising and promotion restrictions or other changes to the environment were limited in their effectiveness and cost-effectiveness. The study also revealed key enabling and impeding factors across regulatory, voluntary and public–private partnership approaches. Conclusion: From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness. These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations. We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets. Limitations: This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest. Future work: Priorities include the need for guidance for appraising risk of bias and quality of non-clinical studies, for reporting policy characteristics in evaluations, for supporting evaluations of real-world policies equitably across geographic regions, for capturing equity dimensions in policy evaluations, and for guideline development for quality and risk of bias of policy evaluations. Study registration: This study is registered as PROSPERO CRD42020170963. Funding: This award project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607) and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information. Plain language summary: Poor diet is a leading cause of death, globally, including in the United Kingdom. It also causes many types of illness and is one of the biggest drains on the United Kingdom National Health Service budget. Governments act in various ways to promote healthy diets by improving food environments: these are the physical and social surroundings that influence what and how much people eat. Some actions are regulated by government, for example, to control food production, marketing and promotions. Other actions are led by, or with, food businesses, making voluntary changes to the foods they produce, for example, by reducing salt content; this can be done by businesses alone or in partnership with government (referred to as 'public–private partnerships'). The six reviews of published research look at whether, and how, these actions to improve diets work, and whether they can provide value for money. Most regulations appear to be effective at supporting better diets. However, voluntary changes led by businesses had limited success. There were not many evaluations that assessed the effectiveness of public–private partnerships. Of those that did, partnerships with the food industry had limited effectiveness, resulting in largely unchanged outcomes. When looking at how these actions improve diets, we found that clear leadership, public support for the policy, the use of the best evidence and of local expertise helped with getting actions implemented. Factors that appear to make it harder to implement policy actions include a lack of evidence specific to the context, conflicting beliefs about what works, limited human or financial resources, lack of engagement by key people. Although the findings may help us to think about the ways forward to improve diets, more research is needed to understand whether actions to reduce diet-related ill health work, and provide value for money. Scientific summary: Background: Unhealthy diets are now estimated to be responsible for more deaths than any other risk globally, including in England. Dietary factors underpin many of the major chronic diseases currently faced by the population and are estimated both to be the largest contributor to overall disease and to have the highest impact on the NHS budget. It is in this context that the English government has implemented a range of population interventions to promote healthy diets by improving food environments. These range from public–private partnerships (PPPs) and voluntary programmes to regulatory policies, aiming to reduce ingredients like sodium and sugars in foods through interventions, such as reformulation, advertising reduction/bans and labelling. Governance arrangements in policy are broadly defined here as whether or not a policy intervention is voluntary, PPP or government led. Governance is a key overlooked mechanism in these interventions, and also in reviews of policy responses, and it is a fundamental part of the context, which is insufficiently discussed. It is essential to understand how governance arrangements in policy have an impact on effectiveness, by understanding what factors relating to interventions, providers, populations and settings affect the implementation of such population interventions to improve diet. Aims: This study, cost-effectiveness and policy processes of population interventions to improve diet with a focus on governance, and with a view to informing the most effective responses to unhealthy diets, formulating implications for diets in England. Research questions: How are regulatory interventions, voluntary approaches and PPPs to improve diet assumed to work in theory? What regulatory interventions, voluntary approaches and PPPs to improve diet, and reduce inequalities in diet improvement, have been evaluated? What factors relating to interventions, providers, populations and settings affect implementation of such population interventions to improve diet? Have such population interventions improved process, impact (intermediate and distal) and cost outcomes? Are there any reported unanticipated effects of such population interventions? What is the cost-effectiveness of such population interventions? How can the findings of the evidence review be translated into recommendations for improved interventions? Methods: This evidence synthesis consists of six individual evidence syntheses based on a common systematic literature search [see Figure A (Figure 2 in main text)]. The evidence syntheses consisted of a systematic evidence map of primary research, an overview of reviews on the effectiveness of regulatory, voluntary and PPP approaches, two systematic reviews on the effectiveness of PPPs, and voluntary approaches by private actors to fill gaps in the overview of review, as well as another systematic review on the cost-effectiveness of regulatory, voluntary and PPP approaches, and a qualitative evidence synthesis of the policy process. FIGURE A Relationships between review outputs. We ran searches of real-world evaluations of policies (defined as evaluations conducted while the policy was adopted or implemented, or as part of a state or national public consultation) aiming to improve diets by targeting the food environments, and published between 2010 and 2020, across 14 databases in November 2020. Records were uploaded to the Evidence for Policy and Practice Information-Reviewer Web for the removal of duplicates, screening, as well as part of the data extractions for the different reviews of the series. About 12% of titles and abstracts and 33% of full texts eligible for the overarching project were screened by at least two reviewers independently. The remainder were screened by one reviewer after reaching a 90% agreement rate, except for those excluded because they were not about real-world policy (all were checked by a second reviewer). Disagreements were discussed with a third reviewer. Depending on the review, data were either extracted by one reviewer and checked by another or extracted by two independent reviewers. The specific methods and results for each review are presented in their respective chapters. All papers included in one of the four effectiveness or cost-effectiveness reviews were independently critically appraised by two reviewers. The quality of evidence syntheses in the overview of reviews was appraised using the checklist by the Scottish Intercollegiate Guidelines Network. For the systematic reviews of PPP evaluations and of voluntary approaches, study quality was assessed using a modified version of the Newcastle–Ottawa Scale for cross-sectional studies. The review of voluntary approaches included 10 single cross-sectional studies and 5 repeat cross-sectional studies, all about food items, advertising material and other non-human 'participants'. The studies in the PPP review consisted of two single cross-sectional studies, nine repeat cross-sectional studies, one interrupted time series and five policy document analyses; five of which involved human participants. The quality of the cost-effectiveness analyses was assessed with Drummond's 10-criteria checklist version 2015. For the policy process review, their contributions were moderated on the basis of three criteria: relevance, rigour and richness. Data for the five reviews that used quantitative data were synthesised using narrative approaches since they were not suitable for statistical pooling techniques, such as meta-analysis. In the systematic reviews and overview of reviews about effectiveness, we also used an effect direction plot to represent the summary findings graphically. We had planned to use the Grading of Recommendations, Assessment, Development and Evaluation approach in the three reviews about effectiveness but did not for different reasons explained in the respective chapters. Data in the qualitative review about policy process were analysed using a thematic analysis. Results: Literature search and screening for the overarching project: A total of 38,209 records were retrieved from the databases; 27,887 remained after removing duplicates and had their title and abstract screened against the eligibility criteria. Of these, 1859 met the criteria and had their full text screened, resulting in 500 records included. In parallel, 72 additional full texts were retrieved by screening websites and reference lists. Of these, 33 met the eligibility criteria, contributing to a total of 533 publications: 483 reporting on primary research evaluations and 50 on evidence syntheses. All 483 primary studies were included in the evidence map. All evidence syntheses were screened for inclusion in the overview of reviews. Of the 483 publications on primary research, all those assessing the effectiveness of PPPs (n = 18) were considered for the systematic review on the latter, and all those assessing the cost-effectiveness of policies (n = 4) were included in the systematic review on the latter. For the systematic review of the effectiveness of voluntary approaches by private actors, given the high number of potential primary studies (n = 186), only those comparing outcomes between participants and non-participants (NP) in the policies and that were published in journals in the most recent 4 years (2017–20) were considered (n = 15). Lastly, the review of policy process included both primary studies and evidence syntheses of both qualitative and mixed-methods design that assessed factors influencing policy development or implementation. Again, due to their high number (n = 87), only those published in 2019 and 2020 were considered (n = 33). Systematic evidence map: We found imbalances across the 483 included studies, suggesting that policy evaluations are conducted and published inequitably across the world both in terms of quantity and quality. Though 70 countries were represented overall, 81% of publications focused on only 12 countries (USA, UK, Australia, Canada, Mexico, Brazil, Chile, France, Spain, Denmark, New Zealand and South Africa), and 30% included the USA. Few evaluations were found about Africa, Central and South Asia, and the Middle East. Inequities were also detected in the study designs, with the most quantitative robust methods mainly documenting the abovementioned 12 dominant countries. Few publications reported on PPPs (n = 31), and only one assessed the development of voluntary policies led by the public and private sectors each. Using a generous interpretation of the PROGRESS-Plus equity dimensions, we found that not only 50% of publications assessing policy effectiveness did not compare outcomes by any equity domain, but that the proportion of those doing so has decreased over time. Age was the most frequently assessed dimension, while occupation, religion and culture, social capital and disability were barely considered. Overview of reviews: An overview of reviews of 11 systematic reviews was conducted to review the effectiveness of policies by governance approach. Three additional systematic reviews were considered for addressing questions about equity. The 11 systematic reviews primarily assessed regulatory policies (especially taxation) and a few voluntary approaches by the public sector, food retailers and restaurant chains. No PPP was included, and few regulatory and voluntary initiatives could be directly compared. Overall, the results suggest that, except for salt-related taxes, most regulatory approaches designed to improve health, consumer behaviour (e.g. food intake, purchases), and food environment outcomes were effective. These mainly consisted of trans-fat bans, taxes on sugar-sweetened beverages (SSBs) and non-essential foods (except for salt intake), and front-of-pack labelling (FOPL). Effects for voluntary approaches by public and private actors were also generally positive for salt and trans-fat reformulation (but regulatory trans-fat bans were more promising), labelling on products and supermarket shelves, and changing defaults in children's menus in restaurants, although some of them relied on single cross-sectional studies in the USA. Results for voluntary menu labelling and multicomponent commitments by large retail chains were mixed. The findings by PROGRESS-Plus categories indicate a lack of reporting of outcomes in systematic reviews for population groups that are prone to health inequalities: overall, evidence on equity is patchy, incomplete, mainly inconsistent and largely relies on single studies (although some evaluations had large samples) rather than aggregated bodies of evidence. Review of PPPs: This systematic review aimed to complement the overview of reviews by assessing the effectiveness of PPPs targeting the food environment since the overview of reviews did not include data on the latter. We reviewed 17 studies evaluating seven PPPs to improve population diets and food environments. Five involved humans or data about human behaviours (sales and purchases) using cross-sectional design (single or repeat) or intermittent time series, seven assessed food products or labelling practices (all single and repeat cross-sectional), and five examined policy content and progress using documents. Overall, studies found that partnerships with the food industry to improve diets via reformulation or other changes to the environment have limited effect at achieving this aim. Review of voluntary approaches by private actors: This systematic review aimed to complement the overview of reviews by assessing the effectiveness of voluntary approaches by private actors between participants and NPs. Sixteen studies evaluating nine voluntary approaches were included. Policies were mainly about advertising and marketing control, reformulation, and the retail and catering sectors. All were cross-sectional: nine single and seven post–post. All measured effects or associations on the food environment, such as product or advertising characteristics using cross-sectional designs. None evaluated humans. When comparing the commitment's participants to NPs, the direction of effect or of association for most outcomes was either inconclusive or worse for participants. There is no evidence to suggest that policies designed as voluntary approaches led by commercial actors are effective at reducing advertising and other promotion of unhealthy products to children, improving the nutritional composition of food and beverages, encouraging calorie menu labelling in chain restaurants, or reducing marketing targeting children on food packages. Review of cost-effectiveness: Four studies of the cost-effectiveness of real-world policies to promote healthy diets were identified. Two studies suggested positive impacts for the fiscal measure of the Mexican SSB tax, and one for the voluntary government-led Health Star Rating FOPL intervention in Australia. The fourth one showed a lack of effectiveness and cost–benefit for the PPP intervention to reduce salt consumption in England as part of the Public Health Responsibility Deal. There is a pressing need to build on the extensive literature on the effectiveness of interventions with high-quality evidence on cost-effectiveness, to support meaningful action to tackle the scourge of diet-related ill health. Review of the policy process: We included 33 papers studying the policy process (factors shaping from design to implementation) of regulatory, voluntary and PPP approaches. The studies on regulatory policy processes highlighted key enabling factors, including clear leadership; policy entrepreneurs, champions and strategists; policy supporters' coalitions; the active use of best evidence and local expertise; institutional and financial capacity; and harnessing focusing events. They also pointed to impeding factors, including practical considerations often around policy implementation and the generation of context-specific evidence; differing ideological positions; capacity constraints; the role of evidence; lack of key stakeholder engagement, and the deployment by the food and beverage industry of frames and framing strategies to ultimately oppose a policy process. This review also advanced the understanding of phenomena and mechanisms underpinning the policy process for improving diet, in particular how large food and beverage industries have become legitimate actors in policy interventions to improve diets. Conclusion: To our knowledge, this is the first review of real-world evaluations of policies to improve food environments. From the available evidence reviewed, regulatory appears to be the most effective approach, and voluntary industry approaches and PPPs have limited effectiveness. The geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations should be redressed. Food policy should be designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets. The role and interests of policy stakeholders, and the accepted legitimacy of corporate actors in food policy, should be critically interrogated with healthy diets for the population as the first priority. Implications for future work: Implications for public health policy include prioritising structural changes through regulation as they are found to be the most effective approach to improve the food environment; expanding geographical representation of the evidence, capturing dimensions of health equity as policy outcomes; taking a systems approach across policies to improve food environments. Implications for future policy evaluations include developing guidance for appraising risk of bias and quality of non-clinical studies and for reporting policy characteristics in evaluations. Implications for future research and research funding include conducting studies on the role of corporate actors in food policy, conducting evaluations of real-world policies equitably across geographic regions, capturing equity dimensions in policy evaluations, and developing guidelines for quality and risk of bias of policy evaluations. Study registration: This study is registered as PROSPERO CRD42020170963. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607) and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information. [ABSTRACT FROM AUTHOR]

Due to the high prevalence of childhood obesity, it is imperative to assess the relationship children's access to food retailers and obesity. However, the influence of methodological decisions on these associations has been understudied. We examined relationships between different measures of geospatial food environment (using 4 data sources, and 2 data processing methods), and BMI in a sample of low-income children in Baltimore, Maryland. The choice of data sources and data processing methods produced large differences in estimates of children's exposures to certain store types, such as supermarket-like stores, but had less impact on associations with BMI z-scores. [ABSTRACT FROM AUTHOR]

Abstract Background Changes to the food environment during the Covid-19 pandemic significantly influenced food acquisition and consumption, contributing to a higher prevalence of food insecurity. We assessed the perception of the food environment and its association with food insecurity in households of Brazilian schoolchildren during the Covid-19 pandemic. Methods We conducted a cross-sectional telephone survey between March and May 2021 with adults (n = 475) responsible for purchasing and/or preparing food at the students' homes aged between 6 months and 17 years enrolled in public school from two Brazilian municipalities. We assessed outcomes using the Brazilian Food Insecurity Scale (EBIA). We measured perceptions of the food environment by evaluating the perceived availability, price, and quality of fruits and vegetables (FV) and ultra-processed foods (UPF) sold in the neighbourhood. Results The results indicate that 55.1% of respondents experienced mild food insecurity, and 14.5% experienced moderate or severe food insecurity. The perception of the ease of purchase (8.5% vs. 64.2%) and variety (78.9% vs. 57.9%) of UPF was higher at all levels of food security and insecurity compared to the same questions on FV. The level of food insecurity was associated with the perceived price of FV (p

Abstract Background Racial discrimination is linked to unhealthy food environments and a higher prevalence of food insecurity. However, no study has explored their interrelated effects. We analyzed the relationship between racial discrimination, community food environment, and food insecurity in adults of different socioeconomic status. We also investigated the potential modifying effect of the food environment on the relationship between racism and food insecurity. Methods This was a cross-sectional study of 400 adults aged 20–70 years residing in the central area of ​​Porto Alegre, the capital of Rio Grande do Sul state. Race and racial discrimination were assessed by self-reported race/skin color using the Experiences of Discrimination scale (EOD), respectively. The food environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S) tool. Food insecurity was assessed using the short version of the Brazilian Food Insecurity Scale (EBIA for short, in Portuguese). Poisson regression with robust variance was employed for the multivariate analysis. Results The prevalence of food insecurity was higher in areas with a poorer food environment (areas 1 and 3; 56.6% and 58.8%, respectively). Racial discrimination was associated with food insecurity, where every 1-point increase in the racial discrimination score increased the likelihood of food insecurity by 7% (prevalence ratio [PR] 1.07; 95% CI, 1.03–1.20). When stratifying the analyses by food environment, racial discrimination was associated with food insecurity only in areas with a poorer food environment (PR 1.06; 95% CI, 1.01–1.10). Conclusions Experiences of racial discrimination were associated with a higher prevalence of food insecurity in the study population. The community food environment was an effect modifier of this relationship, highlighting the relevance of interventions in the food environment focused on areas with a greater presence of Black people as a way of combating racism and food insecurity.

Abstract Background A voluntary National Healthy Food and Drink Policy (the Policy) was introduced in public hospitals in New Zealand in 2016. This study assessed the changes in implementation of the Policy and its impact on providing healthier food and drinks for staff and visitors in four district health boards between 1 and 5 years after the initial Policy introduction. Methods Repeat, cross-sectional audits were undertaken at the same eight sites in four district health boards between April and August 2017 and again between January and September 2021. In 2017, there were 74 retail settings audited (and 99 in 2021), comprising 27 (34 in 2021) serviced food outlets and 47 (65 in 2021) vending machines. The Policy’s traffic light criteria were used to classify 2652 items in 2017 and 3928 items in 2021. The primary outcome was alignment with the Policy guidance on the proportions of red, amber and green foods and drinks (≥ 55% green ‘healthy’ items and 0% red ‘unhealthy’ items). Results The distribution of the classification of items as red, amber and green changed from 2017 to 2021 (p

Abstract Background Rapid urbanisation without concomitant infrastructure development has led to the creation of urban slums throughout sub-Saharan Africa. People living in urban slums are particularly vulnerable to food insecurity due to the lack of physical and economic accessibility to food. Hence, it is important to explore how vulnerable groups living in slums interact with the food environment. This study assessed the relationships between food insecurity, including restrictive coping strategies, food purchasing patterns and perceptions about the food environment among dwellers of selected urban slums in Ibadan, Nigeria. Methods This community-based cross-sectional study was conducted with people responsible for food procurement from 590 randomly selected households in two urban slums in Ibadan. Food insecurity and restrictive coping strategies were assessed using the Household Food Insecurity Access Scale and the Coping Strategy Index, respectively. We examined purchasing patterns of participants by assessing the procurement of household foodstuffs in different categories, as well as by vendor type. Participants’ perceptions of the food environment were derived through a five-item composite score measuring food availability, affordability and quality. Chi-square tests and logistic regression models analysed associations between food insecurity, purchasing patterns and perceptions of the food environment. Results The prevalence of food insecurity in the sample was 88%, with 40.2% of the households experiencing severe food insecurity. Nearly a third (32.5%) of the households used restrictive coping strategies such as limiting the size of food portions at mealtimes, while 28.8% reduced the frequency of their daily meals. Participants purchased food multiple times a week, primarily from formal and informal food markets rather than from wholesalers and supermarkets. Only a few households grew food or had livestock (3.2%). Food insecure households had a lower perceived access to the food environment, with an approximate 10% increase in access score per one-unit decrease in food insecurity (AOR = 0.90, 95% CI: 0.84, 0.96). The most procured foods among all households were fish (72.5%), bread (60.3%), rice (56.3%), yam and cassava flours (50.2%). Food-secure households procured fruit, dairy and vegetable proteins more frequently. Conclusion Food insecurity remains a serious public health challenge in the urban slums of Ibadan. Perceptions of greater access to the food environment was associated with increasing food security. Interventions should focus on creating more robust social and financial protections, with efforts to improve livelihoods to ensure food security among urban slum-dwellers.

Abstract Background In 2016, a voluntary National Healthy Food and Drink Policy was released to improve the healthiness of food and drinks for sale in New Zealand health sector organisations. The Policy aims to role model healthy eating and demonstrate commitment to health and well-being of hospital staff and visitors and the general public. This study aimed to understand the experiences of hospital food providers and public health dietitians/staff in implementing the Policy, and identify tools and resources needed to assist with the implementation. Methods A maximum variation purposive sampling strategy (based on a health district’s population size and food outlet type) was used to recruit participants by email. Video conference or email semi-structured interviews included 15 open-ended questions that focused on awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. Data was analysed using a reflexive thematic analysis approach. Results Twelve participants (eight food providers and four public health dietitians/staff) were interviewed; three from small ( 300,000 people) health districts. There was agreement that hospitals should role model healthy eating for the wider community. Three themes were identified relating to the implementation of the Policy: (1) Complexities of operating food outlets under a healthy food and drink policy in public health sector settings; (2) Adoption, implementation, and monitoring of the Policy as a series of incoherent ad-hoc actions; and (3) Policy is (currently) not achieving the desired impact. Concerns about increased food waste, loss of profits and an uneven playing field between food providers were related to the voluntary nature of the unsupported Policy. Three tools could enable implementation: a digital monitoring tool, a web-based database of compliant products, and customer communication materials. Conclusions Adopting a single, mandatory Policy, provision of funding for implementation actions and supportive tools, and good communication with customers could facilitate implementation. Despite the relatively small sample size and views from only two stakeholder groups, strategies identified are relevant to policy makers, healthcare providers and public health professionals.

Abstract Background Food and beverage companies play a central role in shaping the healthfulness of food environments. Methods The BIA-Obesity tool was used to evaluate and benchmark the specificity, comprehensiveness and transparency of the food environment-related policies and commitments of leading food and beverage manufacturing and retailing companies in Canada. Policies and commitments related to the healthfulness of food environments within 6 action areas were assessed: 1) corporate nutrition strategy; 2) product (re)formulation; 3) nutrition information and labelling; 4) product and brand promotion; 5) product accessibility; and 6) disclosure of relationships with external organizations. Data were collected from publicly available sources, and companies were invited to supplement and validate information collected by the research team. Each company was then assigned a score out of 100 for each action area, and an overall BIA-Obesity score out of 100. Results Overall BIA-Obesity scores for manufacturers ranged from 18 to 75 out of 100 (median = 49), while scores for retailers ranged from 21 to 25 (median = 22). Scores were highest within the product (re)formulation (median = 60) followed by the corporate nutrition strategy (median = 59) domain for manufacturers, while retailers performed best within the corporate nutrition strategy (median = 53), followed by the disclosure of relationships with external organizations (median = 47) domain. Companies within both sectors performed worst within the product accessibility domain (medians = 8 and 0 for manufacturers and retailers, respectively). Conclusions This study highlights important limitations to self-regulatory approaches of the food and beverage industry to improve the healthfulness of food environments. Although some companies had specific, comprehensive, and transparent policies and commitments to address the healthfulness of food environments in Canada, most fell short of recommended best-practice. Additional mandatory government policies and regulations may be warranted to effectively transform Canadian food environments to promote healthier diets and prevent related non-communicable diseases.

Placement of products at food store checkouts has been shown to trigger impulse purchases and child purchasing requests. Therefore, food companies pay substantial amounts of money to ensure their products are placed at checkout, and these products are mostly unhealthy (e.g., sugar-sweetened beverages [SSBs], candy, chips). To improve the healthfulness of store environments, Berkeley, CA, U.S. became the first jurisdiction globally to implement a healthy checkout policy. This study examined associations between store neighborhood characteristics and healthfulness of foods and beverages offered at checkout to understand the potential for healthy checkout policies, such as Berkeley's healthy checkout ordinance (HCO), to promote equitable food environments. Data on a near census of food and beverage facings (n = 26,758) at sampled checkouts were collected from 102 food stores (supermarkets, grocery stores, drugstores, dollar stores, specialty food stores, and mass merchandisers) across four Northern California cities (Berkeley, Oakland, Davis, and Sacramento) in February 2021. Bivariate regression analyses revealed that neighborhoods with lower socioeconomic status (SES) and higher Black and Hispanic residential composition had a higher prevalence of foods and beverages that did not meet HCO standards, including associations with a higher prevalence of sweets, higher prevalence of SSBs, and/or lower prevalence of healthy foods at checkout. Findings suggest that the checkout environment may be one of many contributors to diet-related health disparities. Additionally, healthy checkout policies may have the potential to increase nutrition equity by improving food environments across neighborhoods and especially in areas with lower SES and higher Black and Hispanic composition.

Abstract Background Frequent consumption of Energy Drinks (EDs) is associated with numerous health problems, including overweight and obesity, particularly among children and adolescents. The extensive promotion, wide accessibility, and relatively low cost of EDs have significantly increased their popularity among this age group. This paper examines policies/programs that, directly and indirectly, contribute to reducing ED consumption in children and adolescents and shares global experiences to help policymakers adopt evidence-based policies. Methods A systematic search was performed using PubMed, Scopus, and Web of Science databases from January 2000 to June 2024, along with reputable international organization websites, to find literature on policies aimed at reducing ED consumption among children and adolescents. All sources meeting the inclusion criteria were included without restrictions. Titles and abstracts were initially screened, followed by a full-text review. After evaluating the quality of the selected studies, data were extracted and, along with information from the selected documents, compiled into a table, detailing the country, policy type, and the effectiveness and weaknesses of each policy. Results Out of 12166 reviewed studies and documents, 84 studies and 70 documents met the inclusion criteria. 73 countries and territories have implemented policies like taxation, sales bans, school bans, labeling, and marketing restrictions on EDs. Most employ fiscal measures, reducing consumption despite enforcement challenges. Labeling, access restrictions, and marketing bans are common but face issues like black markets. Conclusion This scoping review outlines diverse strategies adopted by countries to reduce ED consumption among children and teenagers, such as taxation, school bans, sales restrictions, and labeling requirements. While heightened awareness of ED harms has reinforced policy efforts, many Asian and African nations lack such measures, some policies remain outdated for over a decade, and existing policies face several challenges. These challenges encompass industry resistance, governmental disagreements, public opposition, economic considerations, and the intricacies of policy design. Considering this, countries should tailor policies to their cultural and social contexts, taking into account each policy's strengths and weaknesses to avoid loopholes. Inter-sectoral cooperation, ongoing policy monitoring, updates, and public education campaigns are essential to raise awareness and ensure effective implementation.

Abstract Background A food environment intervention using nudge tactics was implemented at a hospital convenience store (CVS) in Tokyo to improve employees’ eating habits. The objective of this study was to evaluate its effects on the urinary sodium-to-potassium ratio (Na/K), food intake, eating attitude, and behavior. Methods Using a pre–post design; the intervention incorporated nudge tactics, healthier options, easy-to-pick food placement, and eye-catching information. We also used price incentives. The primary outcomes included changes in Na/K and sodium and potassium excretion assessed using spot urine samples at health checkups. Secondary outcomes were changes in staff food intake, eating attitude, and behavior which were assessed using questionnaire surveys. All outcomes were evaluated statistically. Furthermore, we investigated how the intervention led to outcomes using path analysis. Results A total of 140 participant (52men and 88women) were analyzed. Significant changes were observed in Na/K (3.16 to 2.98 in median, p = 0.02) and potassium excretion (43.4 to 45.2 mmol/day in mean, p = 0.03). However, sodium excretion did not change significantly. The intake of fruits and dairy products increased with improved self-efficacy. The most influential factor for lowering Na/K and increasing potassium excretion was information from the CVS; purchasing “balanced meals” to lower Na/K and salads to increase potassium excretion were second. Conclusions Food environment intervention using nudge tactics can improve staff’s food intake and lower Na/K. Trial registration Registration number: UMIN000049444 (UMIN-CTR). Date of registration: November. 7. 2022.

The study of chronic non-communicable diseases has gone from having a biomedical approach which was emphasized in epidemiological models proposed before the 1970s. After the 1970s, emphasis has been placed on the study of environments as part of the determinants of health. The study of environments has seen the need to focus on specific topics. This is the case of food environments. Food environments have been associated with nutritional health outcomes. For the explanation of food environments, the exposition of the variables and scope that compose them, there have been various proposals for explanatory models. Through this work, the elements and dimensions of the INFORMAS model, Retail Food Environment, Domains of the Food Environment Model, FAO Model, about Urbanization and food security, Organizational Food Environment Model, Types of Food Environment Model and The Innocenti Framework on Food Systems for Children and Adolescents, considering in each of them the elements and dimensions of the food environment, as well as the perspectives from which the concept of food environment is understood.

Abstract Food insecurity is a global public health issue associated with noncommunicable diseases. Individual factors are strongly associated with food insecurity, but there is limited literature on the broader impact of both the social and food environments on food insecurity in non-English speaking European countries, given that the research was predominantly conducted in Anglophone settings. In addition, these studies have mostly been conducted in urban areas. Therefore, this study aimed to identify the main determinants of food insecurity among adults living in peri-urban areas in Flanders, Belgium. Data on socio-demographics, neighborhood social cohesion, social isolation, and perceived food environments were collected from 567 adults through a self-administered questionnaire, and objective data on the food environment were obtained through (commercial) databases on food outlets. Food insecurity was measured using the USDA Household Food Security Survey Module. Multivariable logistic regression models revealed that lower socioeconomic status (OR14.11,95%CI:4.72;61.11), reasonable (OR4.16,95%CI: 2.11;8.47) to poor and very poor (OR6.54,95%CI: 2.11;8.47) subjective health status, and living in private (OR7.01, 95% CI:3.0;17.0) or government-assisted (OR6.32,95%CI: 3.13;13.26) rental housing significantly increased the odds of food insecurity. Additionally, residing in a neighborhood with low (OR2.64, 95% CI:1.13;6.26) to medium (OR2.45,95% CI:1.21;5.11) social cohesion, having a neutral opinion (OR4.12,95%CI:1.51;11.54) about the availability of fruit and vegetables in one's neighborhood, and having an opinion that fruit and vegetable prices are too expensive (OR5.43,95% CI 2.26;14.4) significantly increased the odds of experiencing food insecurity. This study underscores the need for policies that consider factors related to social and food environments, in addition to individual factors, to effectively address food insecurity.

Abstract Background Despite the many benefits of school meals, not all students participate. One reason students may not participate in school meals is because they instead purchase breakfast or lunch from food outlets located around schools that mostly carry unhealthy items. This study examined whether school participation in the Community Eligibility Provision (CEP), which allows qualifying schools to serve free meals to all students, moderated the association between the community food environment around schools and student meal participation. Methods This study employed a longitudinal repeated-measures design using school-level data collected between 2014 and 2020 within four low-income school districts (n = 126 schools) in the US. We obtained meal participation data from state records and created a measure characterizing the community food environment within 0.25 miles of schools (characterized as low-density of unhealthy food outlets vs. high-density of unhealthy food outlets) through a latent class analysis. Regression analysis estimated associations between community food environments, CEP participation, and participation rates in school breakfast and school lunch, assessed in separate models. Results While no moderating effect of school CEP status was observed for breakfast or lunch participation, school breakfast participation was predicted to be 4% lower in high-density food environments than in low-density environments (P-value = .049) among non-CEP schools, and there was no difference in participation by the community food environment among CEP-participating schools. Differences in breakfast participation by the community food environment among non-CEP schools were mostly attributable to middle/high schools, with participation predicted to be 10% lower in high-density environments than in low-density environments among non-CEP middle/high schools (P-value

Abstract Background Children and adolescents are exposed to a high volume of unhealthy food marketing across digital media. No previous Canadian data has estimated child exposure to food marketing across digital media platforms. This study aimed to compare the frequency, healthfulness and power of food marketing viewed by children and adolescents across all digital platforms in Canada. Methods For this cross-sectional study, a quota sample of 100 youth aged 6–17 years old (50 children, 50 adolescents distributed equally by sex) were recruited online and in-person in Canada in 2022. Each participant completed the WHO screen capture protocol where they were recorded using their smartphone or tablet for 30-min in an online Zoom session. Research assistants identified all instances of food marketing in the captured video footage. A content analysis of each marketing instance was then completed to examine the use of marketing techniques. Nutritional data were collected on each product viewed and healthfulness was determined using Health Canada’s 2018 Nutrient Profile Model. Estimated daily and yearly exposure to food marketing was calculated using self-reported device usage data. Results 51% of youth were exposed to food marketing. On average, we estimated that children are exposed to 1.96 marketing instances/child/30-min (4067 marketing instances/child/year) and adolescents are exposed to 2.56 marketing instances/adolescent/30-min (8301 marketing instances/adolescent/year). Both children and adolescents were most exposed on social media platforms (83%), followed by mobile games (13%). Both age groups were most exposed to fast food (22% of marketing instances) compared to other food categories. Nearly 90% of all marketing instances were considered less healthy according to Health Canada’s proposed 2018 Nutrient Profile Model, and youth-appealing marketing techniques such as graphic effects and music were used frequently. Conclusions Using the WHO screen capture protocol, we were able to determine that child and adolescent exposure to the marketing of unhealthy foods across digital media platforms is likely high. Government regulation to protect these vulnerable populations from the negative effects of this marketing is warranted.

Abstract Background A shift away from diets high in animal-based foods towards diets high in plant-based foods is desirable considering human health, environmental sustainability, and animal welfare. As the food environment plays a crucial role in shaping consumption patterns, understanding of how changes in the food environment can facilitate plant-based consumption is crucial for the so-called protein transition. The current study aims to garner insight into barriers and facilitators for food outlet managers to take action to stimulate plant-based consumption within a local food environment. Methods Using a maximum-variation sample approach, we examined possible barriers and facilitators to promote plant-based consumption across different types of food outlets located within a geographically shared food environment (a city in the Netherlands). We conducted in-depth semi-structured interviews among food outlet managers and applied multi-stage thematic analysis to the interview transcripts. Results Most managers underscored the urgency of shifting towards more plant-based diets, and perceived a growing demand for plant-based products. However, three barriers hindered most of them from taking decisive action: Managers’ perception of low consumer demand for plant-based food options; fear of consumer resistance when stimulating plant-based food options; and limited behavioral agency to offer attractive plant-based food options. The few managers who made changes, or intend to make changes, are individuals with high intrinsic motivation, knowledge and skills. Conclusions The present work suggests the key for change towards a food environment stimulating plant-based consumption lies in addressing three (perceived) barriers shared among diverse outlets. These are partly different from barriers for stimulating healthy consumption in general. Furthermore, current changes appear to be driven incidentally by individuals who are motivated and able to stimulate more plant-based purchases among a small targeted group of consumers.

Abstract Background Supermarket interventions are promising to promote healthier dietary patterns, but not all individuals may be equally susceptible. We explored whether the effectiveness of nudging and pricing strategies on diet quality differs by psychological and grocery shopping characteristics. Methods We used data of the 12-month Supreme Nudge parallel cluster-randomised controlled supermarket trial, testing nudging and pricing strategies to promote healthier diets. Participants were Dutch speaking adults aged 30–80 years and regular shoppers of participating supermarkets (n = 12) in socially disadvantaged neighbourhoods. Data on psychological characteristics (food-related behaviours; price sensitivity; food decision styles; social cognitive factors; self-control) and grocery shopping characteristics (time spent in the supermarket; moment of the day; average supermarket visits; shopping at other retailers; supermarket proximity) were self-reported at baseline. These characteristics were tested for their moderating effects of the intervention on diet quality (scored 0–150) in linear mixed models. Results We included 162 participants from intervention supermarkets and 199 from control supermarkets (73% female, 58 (± 10.8) years old, 42% highly educated). The interventions had no overall effect on diet quality. Only five out of 23 potential moderators were statistically significant. Yet, stratified analyses of these significant moderators showed no significant effects on diet quality for one of the subgroups and statistically non-significant negative effects for the other. Negative effects were suggested for individuals with lower baseline levels of meal planning (β − 2.6, 95% CI − 5.9; 0.8), healthy shopping convenience (β − 3.0, 95% CI − 7.2; 1.3), and healthy food attractiveness (β − 3.5, 95% CI − 8.3; 1.3), and with higher levels of price consciousness (β − 2.6, 95% CI − 6.2; 1.0) and weekly supermarket visits (β − 2.4, 95% CI − 6.8; 1.9). Conclusions Adults with varying psychological and grocery shopping characteristics largely seem equally (un)susceptible to nudging and pricing strategies. It might be that certain characteristics lead to adverse effects, but this is not plausible, and the observed negative effects were small and statistically non-significant and may be explained by chance findings. Verification of these findings is needed in real-world trials based on larger sample sizes and with the use of more comprehensive interventions. Trial registration Dutch Trial Register ID NL7064, 30th of May, 2018, https://onderzoekmetmensen.nl/en/trial/20990

Background: Frequent consumption of Energy Drinks (EDs) is associated with numerous health problems, including overweight and obesity, particularly among children and adolescents. The extensive promotion, wide accessibility, and relatively low cost of EDs have significantly increased their popularity among this age group. This paper examines policies/programs that, directly and indirectly, contribute to reducing ED consumption in children and adolescents and shares global experiences to help policymakers adopt evidence-based policies. Methods: A systematic search was performed using PubMed, Scopus, and Web of Science databases from January 2000 to June 2024, along with reputable international organization websites, to find literature on policies aimed at reducing ED consumption among children and adolescents. All sources meeting the inclusion criteria were included without restrictions. Titles and abstracts were initially screened, followed by a full-text review. After evaluating the quality of the selected studies, data were extracted and, along with information from the selected documents, compiled into a table, detailing the country, policy type, and the effectiveness and weaknesses of each policy. Results: Out of 12166 reviewed studies and documents, 84 studies and 70 documents met the inclusion criteria. 73 countries and territories have implemented policies like taxation, sales bans, school bans, labeling, and marketing restrictions on EDs. Most employ fiscal measures, reducing consumption despite enforcement challenges. Labeling, access restrictions, and marketing bans are common but face issues like black markets. Conclusion: This scoping review outlines diverse strategies adopted by countries to reduce ED consumption among children and teenagers, such as taxation, school bans, sales restrictions, and labeling requirements. While heightened awareness of ED harms has reinforced policy efforts, many Asian and African nations lack such measures, some policies remain outdated for over a decade, and existing policies face several challenges. These challenges encompass industry resistance, governmental disagreements, public opposition, economic considerations, and the intricacies of policy design. Considering this, countries should tailor policies to their cultural and social contexts, taking into account each policy's strengths and weaknesses to avoid loopholes. Inter-sectoral cooperation, ongoing policy monitoring, updates, and public education campaigns are essential to raise awareness and ensure effective implementation. [ABSTRACT FROM AUTHOR]

Background: A food environment intervention using nudge tactics was implemented at a hospital convenience store (CVS) in Tokyo to improve employees' eating habits. The objective of this study was to evaluate its effects on the urinary sodium-to-potassium ratio (Na/K), food intake, eating attitude, and behavior. Methods: Using a pre–post design; the intervention incorporated nudge tactics, healthier options, easy-to-pick food placement, and eye-catching information. We also used price incentives. The primary outcomes included changes in Na/K and sodium and potassium excretion assessed using spot urine samples at health checkups. Secondary outcomes were changes in staff food intake, eating attitude, and behavior which were assessed using questionnaire surveys. All outcomes were evaluated statistically. Furthermore, we investigated how the intervention led to outcomes using path analysis. Results: A total of 140 participant (52men and 88women) were analyzed. Significant changes were observed in Na/K (3.16 to 2.98 in median, p = 0.02) and potassium excretion (43.4 to 45.2 mmol/day in mean, p = 0.03). However, sodium excretion did not change significantly. The intake of fruits and dairy products increased with improved self-efficacy. The most influential factor for lowering Na/K and increasing potassium excretion was information from the CVS; purchasing "balanced meals" to lower Na/K and salads to increase potassium excretion were second. Conclusions: Food environment intervention using nudge tactics can improve staff's food intake and lower Na/K. Trial registration: Registration number: UMIN000049444 (UMIN-CTR). Date of registration: November. 7. 2022. [ABSTRACT FROM AUTHOR]

Inequalities in diets contribute to overall inequalities in health. Economic inequality and inequalities in access to healthy food are key drivers of poor diet and ill health among young people (YP). Despite mounting evidence of structural barriers to healthy eating, less is known about how YP view and experience these inequalities where they live, and how to address them. To explore YP's perspectives on the drivers of diet-related health inequalities, we conducted three interlinked focus groups with YP aged 13–21 years from six youth groups across three geographical areas in England. We analysed the data inductively and deductively using reflexive thematic analysis and generated themes by examining how social structure, context and agency interact and impact YP's diet. YP were aware of how inequalities in employment conditions impact their families' income and ability to eat a healthy diet. They cited the high availability of hot food takeaways in their local areas as a significant barrier to healthy eating but did not support closing or restricting these outlets. They held strong views on policies to tackle diet inequality and showed a nuanced understanding of the strengths and limitations of universal and targeted approaches. Our study showed that YP have an awareness and understanding of food as important in relation to health, and of diet-related inequalities. However, further efforts are needed to shape and promote policies that resonate with YP and address both their health and wider social concerns. [ABSTRACT FROM AUTHOR]

Food insecurity is a global public health issue associated with noncommunicable diseases. Individual factors are strongly associated with food insecurity, but there is limited literature on the broader impact of both the social and food environments on food insecurity in non-English speaking European countries, given that the research was predominantly conducted in Anglophone settings. In addition, these studies have mostly been conducted in urban areas. Therefore, this study aimed to identify the main determinants of food insecurity among adults living in peri-urban areas in Flanders, Belgium. Data on socio-demographics, neighborhood social cohesion, social isolation, and perceived food environments were collected from 567 adults through a self-administered questionnaire, and objective data on the food environment were obtained through (commercial) databases on food outlets. Food insecurity was measured using the USDA Household Food Security Survey Module. Multivariable logistic regression models revealed that lower socioeconomic status (OR14.11,95%CI:4.72;61.11), reasonable (OR4.16,95%CI: 2.11;8.47) to poor and very poor (OR6.54,95%CI: 2.11;8.47) subjective health status, and living in private (OR7.01, 95% CI:3.0;17.0) or government-assisted (OR6.32,95%CI: 3.13;13.26) rental housing significantly increased the odds of food insecurity. Additionally, residing in a neighborhood with low (OR2.64, 95% CI:1.13;6.26) to medium (OR2.45,95% CI:1.21;5.11) social cohesion, having a neutral opinion (OR4.12,95%CI:1.51;11.54) about the availability of fruit and vegetables in one's neighborhood, and having an opinion that fruit and vegetable prices are too expensive (OR5.43,95% CI 2.26;14.4) significantly increased the odds of experiencing food insecurity. This study underscores the need for policies that consider factors related to social and food environments, in addition to individual factors, to effectively address food insecurity. [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]

Issue Addressed Methods Results Conclusion So What? While there has been an increased focus on how local governments can support the creation of healthy food environments through healthy public policy, little is known about how this is reflected in public health policy in regional areas. The aim of this study was to understand how improvements to the food environment are prioritised, implemented and evaluated by local governments in regional Victoria.Using a qualitative descriptive approach, content analysis was undertaken of Municipal Public Health and Wellbeing Plans and Council Plans from 10 regional local governments in Victoria, Australia.Seventeen policy documents were analysed including 10 Council Plans, 6 Municipal Public Health and Wellbeing Plans and 1 Food Systems Strategy. Findings highlight regional public health and wellbeing plans have very few concrete actions in place to improve food environments.There is an opportunity for Australian regional local governments to include in their public health and wellbeing plans a greater emphasis on supporting healthy food behaviours, and therefore seeking opportunities to improve food environments through clearly aligned priorities, objectives, actions and measures of success.Improving the quality of public health and wellbeing plans can support local government to use policy to drive improvements in food environments leading to improved health and wellbeing for regional communities. [ABSTRACT FROM AUTHOR]

Objective. Diet-related disease is rising, disproportionately affecting minority communities in which small food retail stores swamp supermarkets. Barriers to healthy food access were exacerbated by the pandemic. We examined the following: (1) individual- and household-level factors in a sample of Baltimore community members who regularly shop at corner stores and (2) how these factors are associated with indicators of dietary quality. Design. Cross-sectional data were collected using an online survey to capture sociodemographics, anthropometrics, and food sourcing, spending, and consumption patterns. Concurrent quantitative and qualitative analyses were conducted in Stata 18 and ATLAS.ti. Setting. This study was set in Baltimore, Maryland, USA. Participants. The participants included adults (n = 127) living or working in Baltimore who identified as regular customers of their neighborhood corner store. Results. The respondents were majority Black and low-income, with a high prevalence of food insecurity (62.2%) and overweight/obesity (66.9%). Most (82.76%) shopped in their neighborhood corner store weekly. One-third (33.4%) of beverage calories were attributed to sugar-sweetened beverages, and few met the recommended servings for fruits and vegetables or fiber (27.2% and 10.4%, respectively). Being Black and not owning a home were associated with lower beverage and fiber intake, and not owning a home was also associated with lower fruit and vegetable intake. Food insecurity was associated with higher beverage intake, while WIC enrollment was associated with higher fruit and vegetable and fiber intakes. Open-ended responses contextualized post-pandemic food sourcing and consumption in this setting. Conclusions. This paper helps characterize the consumers of a complex urban food system. The findings will inform future strategies for consumer-engaged improvement of local food environments. [ABSTRACT FROM AUTHOR]

Background: Despite the many benefits of school meals, not all students participate. One reason students may not participate in school meals is because they instead purchase breakfast or lunch from food outlets located around schools that mostly carry unhealthy items. This study examined whether school participation in the Community Eligibility Provision (CEP), which allows qualifying schools to serve free meals to all students, moderated the association between the community food environment around schools and student meal participation. Methods: This study employed a longitudinal repeated-measures design using school-level data collected between 2014 and 2020 within four low-income school districts (n = 126 schools) in the US. We obtained meal participation data from state records and created a measure characterizing the community food environment within 0.25 miles of schools (characterized as low-density of unhealthy food outlets vs. high-density of unhealthy food outlets) through a latent class analysis. Regression analysis estimated associations between community food environments, CEP participation, and participation rates in school breakfast and school lunch, assessed in separate models. Results: While no moderating effect of school CEP status was observed for breakfast or lunch participation, school breakfast participation was predicted to be 4% lower in high-density food environments than in low-density environments (P-value =.049) among non-CEP schools, and there was no difference in participation by the community food environment among CEP-participating schools. Differences in breakfast participation by the community food environment among non-CEP schools were mostly attributable to middle/high schools, with participation predicted to be 10% lower in high-density environments than in low-density environments among non-CEP middle/high schools (P-value <.001), whereas such a difference in participation was not observed among non-CEP elementary schools. Conclusions: Negative associations between food environment around schools and school breakfast participation were observed only among middle and high schools not participating in CEP, suggesting that policy actions to increase access to free school meals may benefit students, particularly older children and adolescents. [ABSTRACT FROM AUTHOR]

Adolescence is a critical period of physical, cognitive, and social development that needs to be supported with healthy diets. Dietary behaviours of adolescents can be shaped by their nutrition‐literacy and their interaction with parents and peers as well as their school food environment. Therefore, the present study aimed to assess factors that influence dietary behaviours of adolescents in urban Ethiopia. Sex‐disaggregated, focused group discussions (n = 70) were conducted in 36 private and government schools (n = 12/city) among adolescents (n = 432) 15–19 years of age in Addis Ababa, Bahir Dar, and Dire Dawa. Photovoice was applied in a subgroup of participants (n = 216) to gain further insights into adolescents' perception of their school food environment. Key informant interviews were conducted among school principals (n = 36). Adolescents had a relatively good nutrition knowledge and recognised the importance of diverse diets, but misperceptions also existed. They identified fruit and vegetables as healthy foods, but their consumption was deterred by food safety concerns. The adolescents identified foods high in salt, fat, and sugar, including processed/packaged foods as unhealthy, but still consumed them frequently due to their taste, affordability, availability and accessibility in and around schools. Both undernutrition and overweight/obesity were linked to social exclusion and bullying in school. Effective behavioural change communication is required to address common misperceptions. School nutrition programs should integrate water, sanitation and hygiene programs to ensure food safety. Regulations promoting healthy eating while discouraging unhealthy dietary behaviours are vital. Interventions to make nutrient‐dense and healthy foods available, accessible, and affordable are urgently needed to improve the nutrition and health outcome of adolescents. Key messages: Adolescents had a relatively good nutrition knowledge, but misperceptions also existedFoods high in fat, sugar, and salt, but also processed/packaged foods were considered unhealthy, but were frequently consumedUnhealthy foods were widely available/accessible in the school food environmentComprehensive food safety and nutrition interventions are needed at schoolsRegulations for availability and advertising of unhealthy foods in and around schools are needed. [ABSTRACT FROM AUTHOR]

This study examined how two different types of food environments—food deserts and food swamps—were associated with geographic disparities in obesity and diabetes in North Carolina using geographic information systems and spatial regression. To better identify the association between food swamps and health disparities, this study incorporated socioeconomic dimensions into the food swamp measure and considered dollar stores and gas stations with convenience stores as unhealthy food retailers, which were often overlooked in previous studies. It found that food deserts were concentrated in eastern North Carolina (ENC) and western North Carolina and food swamps in ENC, while obesity and diabetes hot spots were clustered in ENC. The results indicated that obesity and diabetes remained associated with food swamps even after spatial autocorrelation was controlled for, but the associations with food deserts—statistically significant in a nonspatial regression—became no longer significant when food swamps and spatial autocorrelation were controlled for. These results demonstrate that a food swamp might better explain health disparities in North Carolina than a food desert. Identifying ENC as a region containing both food deserts and food swamps illustrates the need for state and local governments to focus their efforts in this region to mitigate food insecurity and health disparities. [ABSTRACT FROM AUTHOR]

Background and Objectives Gentrification is a prevalent neighborhood development process in urban areas across the United States. Prior studies have identified the influence of gentrification on late-life health and quality of life, yet little is known about its relationship with food insecurity, an important public health issue for older adult populations. Using New York City as a case study, this study investigated associations between living in a gentrifying neighborhood and food insecurity, as well as the mediating roles of neighborhood environment factors—social cohesion, public transportation, and food environment. Research Design and Methods This study adopted 2 waves of annual data from the Poverty Tracker Study (2015–2016; N  = 703) merged with American Community Survey and spatial data sets to measure gentrification and neighborhood factors. Adjusted logistic regressions were used to examine the associations between gentrification and food insecurity. Further mediation analyses were conducted to test the mechanisms of such associations. Results Older adults in gentrifying neighborhoods were more likely to have food insecurity than those in moderate- to high-income neighborhoods. Compared to low-income neighborhoods, older adults in gentrifying neighborhoods had a lower likelihood of reporting food insecurity. Two significant mediators were found when comparing gentrification with moderate- to high-income neighborhoods: social cohesion and healthy food outlets. Discussion and Implications This study highlights the importance of gentrification in determining late-life food insecurity and identifies possible mechanisms with policy and social service implications to reduce the risk of food insecurity in urban areas. [ABSTRACT FROM AUTHOR]

Nutrition is a vital factor that exerts a profound and direct impact on health. Food environments significantly influence individuals' dietary behaviors, health outcomes, and overall food security. Individuals in food deserts and food swamps do not have access to healthier food options. And in both cases, the emphasis is primarily on the physical configuration of the environment as it relates to food availability. This quasi-experimental study aims to investigate the impact of two different food environments (defined to include a social component) on food choices. A total of 246 participants were surveyed by telephone, half of whom were primed with Scenario A (a food environment deficient in healthy options and cues that support and reinforce healthier choices) and half were primed with Scenario B (an environment with an abundance of healthy food options and cues that support and reinforce healthy eating). Ordered logit regression was used for analysis. The results show significant differences in likely food consumption between the groups. Individuals in Scenario B were found to be 4.48 times more likely to consume fruits and vegetables. In addition, it was determined that being a woman increases the probability of consuming more fruits and vegetables by 0.92 times (1/0.52–1), and adherence to a healthy diet increases by 3.64 times. Age and race were not significant predictors. This study highlights the crucial role of environmental factors in shaping dietary habits and underscores the importance of the social components of the food environment in promoting the adoption of healthier dietary habits. Based on these findings, policymakers should prioritize developing strategies that go beyond providing physical access and consider social aspects of the environment in promoting healthy eating habits to improve public health and bolster the food security of communities. [ABSTRACT FROM AUTHOR]

Poverty is a known risk factor for burn injury and is associated with residency in food deserts and food swamps. Our aim was to determine the prevalence of residency in food deserts and food swamps and to investigate the relationship between food environment, comorbidities, and wound healing in patients with burns. We performed a retrospective chart review of all patients with burns aged ≥ 18 seen in the emergency department or admitted to the burn service at an American Burn Association-verified urban academic center between January 2016 and January 2022. Patient GeoIDs were used to classify residency in food deserts and food swamps, and comorbidities and demographics were recorded. A subset of patients with <20% total body surface area burns who underwent single-operation split-thickness skin grafting was identified for wound healing analysis. A total of 3063 patients were included, with 206 in the heal time analysis. In total, 2490 (81.3%) lived in food swamps and 96 (3.1%) lived in food deserts. Diabetes, hypertension, and tobacco smoking were more prevalent in food swamps than in food deserts or good access areas. While there was no significant effect of the food environment on wound healing, diabetes was associated with longer healing times. Most patients with burns reside in food swamps, which are associated with a higher prevalence of hypertension, diabetes, and smoking. The food environment was not significantly associated with wound healing. Not having diabetes was associated with a shorter time for wound healing. [ABSTRACT FROM AUTHOR]

Hunger and malnutrition in all forms continues to rise in Africa and Asia. Urban and rural communities' diets in Southeast Asia (SEA) are increasingly unhealthy, with consumption influenced by affordability and convenience. The cost of a healthy diet is a major barrier to accessing healthy foods in SEA. Wet markets are key places in food environments where people buy and sell a variety of foods. They are especially important for food and nutrition insecure communities. This mini narrative review explores the role that wet markets, in SEA food environments, play in providing local communities with access to healthy foods. Fourteen peer-review papers, published in English between 2017 and 2022, were identified during screening and analysed according to six food environment domains. Findings highlight that convenient access to wet markets facilitates access to fruits and vegetables in peri urban and urban areas. Fresh foods, most notably fruits, were viewed as being more expensive than processed foods which in turn influenced purchasing behavior. Divergent findings were presented in the identified papers regarding affordability of food in wet markets. Concerns about food quality and the use of chemicals and pesticides were raised. This review was constrained by several factors including the lack of consistent and meaningful definitions and typologies of the varied forms of wet markets. Looking ahead, better defined interpretations of wet markets can enhance the development and refinement of appropriate policies and actions and comparison of wet markets, in respect of access to diverse, healthy foods, vendor practices and consumer food choices. [ABSTRACT FROM AUTHOR]

Background: Supermarket interventions are promising to promote healthier dietary patterns, but not all individuals may be equally susceptible. We explored whether the effectiveness of nudging and pricing strategies on diet quality differs by psychological and grocery shopping characteristics. Methods: We used data of the 12-month Supreme Nudge parallel cluster-randomised controlled supermarket trial, testing nudging and pricing strategies to promote healthier diets. Participants were Dutch speaking adults aged 30–80 years and regular shoppers of participating supermarkets (n = 12) in socially disadvantaged neighbourhoods. Data on psychological characteristics (food-related behaviours; price sensitivity; food decision styles; social cognitive factors; self-control) and grocery shopping characteristics (time spent in the supermarket; moment of the day; average supermarket visits; shopping at other retailers; supermarket proximity) were self-reported at baseline. These characteristics were tested for their moderating effects of the intervention on diet quality (scored 0–150) in linear mixed models. Results: We included 162 participants from intervention supermarkets and 199 from control supermarkets (73% female, 58 (± 10.8) years old, 42% highly educated). The interventions had no overall effect on diet quality. Only five out of 23 potential moderators were statistically significant. Yet, stratified analyses of these significant moderators showed no significant effects on diet quality for one of the subgroups and statistically non-significant negative effects for the other. Negative effects were suggested for individuals with lower baseline levels of meal planning (β − 2.6, 95% CI − 5.9; 0.8), healthy shopping convenience (β − 3.0, 95% CI − 7.2; 1.3), and healthy food attractiveness (β − 3.5, 95% CI − 8.3; 1.3), and with higher levels of price consciousness (β − 2.6, 95% CI − 6.2; 1.0) and weekly supermarket visits (β − 2.4, 95% CI − 6.8; 1.9). Conclusions: Adults with varying psychological and grocery shopping characteristics largely seem equally (un)susceptible to nudging and pricing strategies. It might be that certain characteristics lead to adverse effects, but this is not plausible, and the observed negative effects were small and statistically non-significant and may be explained by chance findings. Verification of these findings is needed in real-world trials based on larger sample sizes and with the use of more comprehensive interventions. Trial registration: Dutch Trial Register ID NL7064, 30th of May, 2018, https://onderzoekmetmensen.nl/en/trial/20990 [ABSTRACT FROM AUTHOR]

African food systems are transforming due to rapid urbanization, growing food demand, and shifting dietary patterns reflected in increased consumption of processed foods. In the informal–formal African market system, shifting consumption trends are linked to various food marketing innovations. This study investigated the emergence of processed milk dispensing machines ("milk ATMs") in Kenya as a marketing innovation and their effect on consumption trends. Data was collected through surveying 162 ATM operators and 352 consumers and interviewing key informants. Findings indicate exponential growth of milk ATM enterprises, most (79%) of which are small, sole proprietorships. ATM milk is mostly purchased by low- and middle-income consumers, driven by affordability and convenience. ATM milk is 46% cheaper than packaged milk, but 15% more expensive than raw milk. However, perceived safety concerns deter some consumers from buying ATM milk. The study recommends scaling this inclusive business innovation but ensuring it delivers quality milk. [ABSTRACT FROM AUTHOR]

In January 2021, we assessed the implications of temporary regulations in the United Kingdom allowing pubs and restaurants to operate on a takeaway basis without instigating a change of use. Local authorities (LAs) across the North‐East of England were unaware of any data regarding the take‐up of these regulations, partially due to ongoing capacity issues; participants also raised health concerns around takeaway use increasing significantly. One year on, we repeated the study aiming to understand the impact of these regulations on the policy and practice of key professional groups. Specifically, we wanted to understand if LAs were still struggling with staff capacity to address the regulations, whether professionals still had public health trepidations, and if any unexpected changes had occurred across the local food environment because of the pandemic. We conversed with 16 public health professionals, planners and environmental health officers across seven LAs throughout the North‐East of England via focus groups and interviews. Data collated were analysed via an inductive and semantic, reflexive‐thematic approach. Through analysis of the data, three themes were generated and are discussed throughout: popular online delivery services as a mediator to increased takeaway usage; potential long‐term health implications and challenges; continued uncertainty regarding the temporary regulations. This paper highlights important changes to local food environments, which public health professionals should be aware of, so they are better equipped to tackle health inequalities across urban and sub‐urban areas. [ABSTRACT FROM AUTHOR]

Prior research shows that diets high in government subsidized foods may be associated with cardiometabolic disease risk factors. Our aim was to evaluate the relationship between diets high in subsidized foods and the development of chronic kidney disease (CKD) and other cardiometabolic risk factors in United States (US) Hispanics/Latinos. Using data from 16,172 Hispanics/Latino's living in the United States, we used the Cochran-Armitage test to assess the relationship between subsidized foods in the diets of participants and baseline characteristics. We used survey-weighted Poisson regression models to examine whether intake of subsidized foods was associated with incident CKD or cardiometabolic risk factors. Several baseline characteristics were associated with higher subsidized food scores. Higher subsidized food scores were not associated with incident CKD or cardiometabolic risk factors. These findings may be useful for future researchers, clinicians, and nutritional policy advocates who are interested in the way Hispanic and Latinos consume foods subsidized by the US government and the structural factors that may shape observed dietary and disease patterns. [ABSTRACT FROM AUTHOR]

Background Food insecurity and obesity are increasing both globally and in the UK. In this review we systematically assess the lived experiences of people with obesity who are food insecure and often turn to food banks. Methods We systematically searched electronic databases from January 2007 until October 2022. Data from eligible studies were extracted and the studies assessed for quality. Thematic analysis and narrative synthesis approach was used to analyse the extracted data. Results Six themes were identified among 25 included studies, including: the financial cost of food; psychological aspects related to food insecurity; geographical access and the food environment; food practices in the home; experience of food assistance; and parental-child relationships. The cost of healthy food and psychological factors were identified as key driving factors of the relationship between food insecurity and obesity. Psychological factors such as depression, low self-esteem and stress played an important part in the lived experience of people with obesity and food insecurity. Conclusion The food environment provides context in which food decisions are made, therefore, systems change is necessary to ensure families can afford the food that enables a healthy diet. For clinicians, identification, and attention to the impact of food insecurity on people with obesity are important. [ABSTRACT FROM AUTHOR]

There is a large amount of academic research to date on food environments that has been widely conducted in Western countries. This is due to the high population density of Asian megacities, the advancement of public transportation systems, and the relatively low dependence on private vehicles, which has led to a lack of attention, relatively, to the surrounding food environments. Thus, this study aimed to analyze food environments at the neighborhood level by considering demographics, households, land use, and physical environmental factors in Seoul, South Korea. We employed urban network analysis methods to assess food access and availability in various neighborhoods. The primary findings indicate that Seoul's food environment is significantly related to the elderly population, aging infrastructure, and proximity to public transportation. In particular, a higher concentration of elderly residents negatively affects food availability and access, irrespective of income level, potentially exacerbating social inequality based on income. Our findings identify various factors that contribute to spatial disparities in local food environments and provide policy implications to mitigate inequalities in neighborhood food environments. [ABSTRACT FROM AUTHOR]