Candace Young

The food environment is well documented as an important emphasis for public health intervention. While theoretical models of the relationship between the food environment and dietary outcomes have been proposed, empirical testing of conceptual models has been limited. The purpose of this study was to explore which factors in nutrition environments are significantly associated with dietary outcomes in two urban, low-income, and minority food desert communities. This study analyzed cross-sectional data based on 796 participants from the Food in Our Neighborhood Study. Participants were recruited based on a random sample of addresses in neighborhood study areas, Philadelphia, PA (n = 393) and Trenton, NJ (n = 403). Main dietary outcomes were Healthy Eating Index (HEI) scores and fruit and vegetable consumption subscores computed from ASA24^® assessments. Exploratory factor analysis was conducted and yielded a model of four factors with 22 items. Among four factors that emerged, three factors (Perceptions of Neighborhood Food Availability; and Household Food Challenges) were significantly correlated with dietary outcomes. My Store’s Quality and Perceptions of Neighborhood Food Availability were positively correlated with vegetable consumption subscore. The Household Food Challenges factor was negatively correlated with both vegetable subscore and overall HEI score (i.e., more household challenges were associated with lower dietary scores). These findings confirmed the importance of perceived nutrition environments and household food challenges in predicting dietary outcomes among residents of two urban, low-income, and minority food desert communities.

Background Understanding the most important elements of nutrition environments that affect eating behaviors can inform public health nutrition policy and programs Conceptual models depict interrelationships between these elements. However, empirical testing of conceptual models of nutrition environments and eating behaviors has been limited. The purpose of this study was to explore which factors in nutrition environments are significantly associated with dietary outcomes in two urban, low-income, and minority food desert communities.Methods This study analyzed cross-sectional baseline data from the Food in Our Neighborhood Study (FIONS). FIONS data were from adults recruited based on a random sample of addresses in neighborhood study areas of Philadelphia, PA and Trenton, NJ that were each three square miles and designated as low supermarket access areas. Study participants were required to live within one of the study areas and be the primary adult food shopper for the household. Study participants responded to a survey with ten domains that included shopping preferences, grocery spending, home food availability, perceived neighborhood nutrition environment, background characteristics, and ASA24® dietary assessments. Store audits were conducted in both study areas to estimate observed nutrition environments. Exploratory factor analysis (EFA) was conducted on over 120 survey items and yielded a model of four factors with 22 items. MIMIC model analyses were performed on these four factors controlling for covariates. Main dietary outcomes were Healthy Eating Index (HEI) scores and fruit and vegetable consumption subscores computed from ASA24® assessments.Results The sample included 796 participants (n = 393, Philadelphia, PA; n = 403, Trenton, NJ) with demographics representative of urban, minority and low-income food desert communities: 60% were African-American, 55% had annual household incomes <$30,000, 45% participated in SNAP or WIC, and 58% experienced at least some food insecurity. Among four factors that emerged in EFA, three (My Store’s Quality; Perceptions of Neighborhood Food Availability; and Household Food Challenges) were significantly correlated with vegetable consumption subscores, and one (Household Food Challenges) was significantly associated with HEI scores.Conclusions This research tested and confirmed the importance of perceived nutrition environments and household food challenges in predicting dietary outcomes among residents of two urban, low-income, and minority food desert communities.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Public health obesity prevention experts have recently emphasized a policy systems and environmental change approach. Absent, however, are studies describing how practitioners transition from policy adoption to implementation. In the realm of food policy, financing programs to incentivize healthy food retail development in communities classified as “underserved” are underway at the local, state, and national levels. Implementing these policies requires a clear definition of eligibility for program applicants and policy administrators. This article outlines a methodology to establish eligibility for healthy food financing programs by describing the work of The Food Trust to coadminister programs in 3 distinct regions. To determine program eligibility, qualitative assessments of community fit are needed and national data sources must be locally verified. Our findings have broad implications for programs that assess need to allocate limited public/private financing resources.

We evaluated whether Philly Food Bucks, a bonus incentive program at farmers markets, is associated with increased fruit and vegetable consumption and Supplemental Nutrition Assistance Program (SNAP) sales at farmers markets in low-income areas. A convenience sample of 662 customers at 22 farmers markets in low-income neighborhoods in Philadelphia, Pennsylvania, was surveyed via face-to-face interviews. Questions addressed shopping characteristics, self-reported change in fruit and vegetable consumption, whether customers tried new fruits or vegetables, use of Philly Food Bucks, and demographic information. Market-level SNAP sales and Philly Food Bucks redemption data were also collected to monitor sales patterns. Philly Food Bucks users were significantly more likely than nonusers to report increasing fruit and vegetable consumption (OR, 2.4; 95% CI, 1.6-3.7; P < .001) and to report trying new fruits or vegetables (OR 1.8; 95% CI, 1.2-2.7; P = .006). At the market level, average SNAP sales more than doubled at farmers markets in low-income areas in the first 2 years of the Philly Food Bucks program. At the city's largest farmers market in a low-income area, the program was associated with an almost 5-fold higher increase in annual SNAP sales compared with baseline. Results from this study demonstrate that a bonus incentive program tied to SNAP was associated with self-reported increases in fruit and vegetable consumption and increased SNAP sales at participating farmers markets in low-income communities. More research is warranted to evaluate the long-term impact of bonus incentives on farmers market use, dietary behaviors, and health outcomes.

Objective: Numerous localities have mandated that chain restaurants post nutrition information at the point of purchase. However, some studies suggest that consumers are not highly responsive to menu labelling. The present qualitative study explored influences on full-service restaurant customers’ noticing and using menu labelling.Design: Five focus groups were conducted with thirty-six consumers. A semi-structured script elicited barriers and facilitators to using nutrition information by showing excerpts of real menus from full-service chain restaurants.Setting: Participants were recruited from a full-service restaurant chain in Philadelphia, Pennsylvania, USA, in September 2011.Subjects: Focus group participants were mostly female, African American, with incomes <$US 60 000, mean age 36 years and education 14·5 years. At recruitment, 33 % (n 12) reported changing their order after seeing nutrition information on the menu.Results: Three themes characterized influences on label use in restaurants: nutrition knowledge, menu design and display, and normative attitudes and behaviours. Barriers to using labels were low prior knowledge of nutrition; displaying nutrition information using codes; low expectations of the nutritional quality of restaurant food; and restaurant discounts, promotions and social influences that overwhelmed interest in nutrition and reinforced disinterest in nutrition. Facilitators were higher prior knowledge of recommended daily intake; spending time reading the menu; having strong prior interest in nutrition/healthy eating; and being with people who reinforced dietary priorities.Conclusions: Menu labelling use may increase if consumers learn a few key recommended dietary reference values, understand basic energy intake/expenditure scenarios and if chain restaurants present nutrition information in a user-friendly way and promote healthier items.

Objective: To evaluate whether food behaviours of parents are associated with children's dietary intakes outside the child-care setting, and to compare children's dietary intakes at home with foods and beverages consumed when they are at child-care centres.Design: In 2005–2006, a survey was completed by parents of at least one child between 3 and 5 years old who attended group child-care centres. Surveys about nutrition practices were completed by centre directors. Research assistants observed foods and beverages consumed by children at lunchtime at the centres.Setting: Sixteen licensed group child-care centres in three underserved New York City communities (South Bronx, East/Central Harlem, Central Brooklyn) and the Lower East Side of Manhattan.Subjects: Two hundred parents.Results: Children were more likely to consume healthful foods including fruits or vegetables if parents reported purchasing food from produce stands/farmers’ markets, shopped for frozen or canned fruits frequently and ate family meals or meals prepared at home daily. Children were more likely to consume less healthful foods such as French fries, or fruit drinks, more frequently if parents reported eating meals from fast-food or other restaurants at least once weekly, or if children ate while watching television. Types of foods and beverages offered to children at home (e.g. higher-fat milk, soft drinks and desserts) were less healthful than those offered at child-care centres.Conclusions: Children's dietary intakes at home need to be improved. Parents need to understand the importance of providing home environments that support healthful food behaviours in children.

The term "food desert" was formally introduced into the lexicon in 1995 and has come to describe areas with limited access to affordable nutritious foods, particularly areas in lower-income neighborhoods. The definition has led to the development of national and regional maps that focus efforts on equity in food access. Recognition of food deserts also marks a strategic change in public health's approach to obesity prevention. Today's emphasis on prevention has shifted away from individual responsibility to the role of the environment in health promotion. A number of solutions are underway to address food deserts, including public–private financing programs, industry commitments, as well as local and regional efforts to put healthy food within reach. The promise of financing programs to facilitate development of healthy food markets in underserved communities is rooted in their potential to alleviate the grocery gap and address underlying environmental contributors to obesity and diet-related diseases, such as obesity and diabetes. As food desert mapping and related interventions expand, there remains a need for ongoing investigation of impacts and the mechanisms by which impacts are achieved.

Farmers' markets are an increasing priority for communities and health advocates. They contribute to the health of community members and the economic livelihood of small farms. Despite increasing recognition of the positive impact that farmers' markets have in revitalizing communities, relatively little is published on strategies that sustain markets in lower income communities. This paper describes how community level factors, federal food assistance programs and related public policies have an effect on farmers' markets in underserved areas. Best practices for developing and maintaining markets are discussed, as well as strategies to help sustain markets, such as expanded access to federal food assistance programs and use of bonus vouchers. Policy issues for improving healthy food access in low income communities are also discussed.