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Disparities in healthy food access are well documented in cross-sectional studies in communities across the United States. However, longitudinal studies examining changes in food environments within various neighborhood contexts are scarce. In a sample of 142 census tracts in four low-income, high-minority cities in New Jersey, United States, we examined the availability of different types of food stores by census tract characteristics over time (2009–2017). Outlets were classified as supermarkets, small grocery stores, convenience stores, and pharmacies using multiple sources of data and a rigorous protocol. Census tracts were categorized by median household income and race/ethnicity of the population each year. Significant declines were observed in convenience store prevalence in lower- and medium-income and majority black tracts (p for trend: 0.004, 0.031, and 0.006 respectively), while a slight increase was observed in the prevalence of supermarkets in medium-income tracts (p for trend: 0.059). The decline in prevalence of convenience stores in lower-income and minority neighborhoods is likely attributable to declining incomes in these already poor communities. Compared to non-Hispanic neighborhoods, Hispanic communities had a higher prevalence of small groceries and convenience stores. This higher prevalence of smaller stores, coupled with shopping practices of Hispanic consumers, suggests that efforts to upgrade smaller stores in Hispanic communities may be more sustainable.
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Objective: The Social Ecological Model (SEM) has been used to describe the aetiology of childhood obesity and to develop a framework for prevention. The current paper applies the SEM to data collected at multiple levels, representing different layers of the SEM, and examines the unique and relative contribution of each layer to children's weight status.
Design: Cross-sectional survey of randomly selected households with children living in low-income diverse communities.
Setting: A telephone survey conducted in 2009-2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a child's residence to food and physical activity outlets.
Subjects: Analysis based on 560 children whose parents participated in the survey and provided measured heights and weights.
Results: Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting children's weight status.
Conclusions: The approach used herein supports using the SEM for predicting child weight status and uncovers some of the most promising domains and strategies for childhood obesity prevention that can be used for designing interventions.
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The epidemic of overweight and obesity and its multiple causes have captured the attention of researchers, program administrators, politicians, and the public alike. Recently, many stakeholder groups have started investigating the role that food and nutrition assistance programs play in the etiology of the problem and in identifying possible solutions. As a result, policy changes have been recommended and implemented for programs such as the National School Lunch Program (NSLP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to improve the nutritional quality of foods they offer to their participants. The Supplemental Nutrition Assistance Program (SNAP) is also attracting attention as a potential vehicle to reduce the burden of obesity among its users. Because of the tough economic and political climate in which all federal programs currently operate, the need for making nutrition assistance programs more efficient and effective in addressing health and nutrition related problems affecting the country has never been greater.
This document proposes a set of strategies to improve the effectiveness and efficiency of SNAP. These strategies are based on a review of research literature, recommendations from expert groups, and the experiences of other communities and states. We include information that pertains to potential stakeholder arguments for and against each strategy, as well as the political feasibility, financial impact, and logistical requirements for implementation. We drew candidate strategies from the range of options that have been tested through research and from policies that have been implemented around the country. The order of strategies in this document is based on overall strength of supportive research, as well as political and implementation feasibility. The four proposed strategies are improving access to healthy foods to provide better choices, incentivizing the purchase of healthy foods, restricting access to unhealthy foods, and maximizing education to more effectively reach a larger population of SNAP participants.
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Disparities in access to healthy food are a key public health concern in the United States (U.S.) Food access is considered as a critical element of food insecurity. Food insecurity can often be prevalent in a region due to lack of healthy food outlets as well as inequitable access to healthy food outlets. A large body of literature pertaining to access to healthy food has reported that conventional food outlets such as supermarkets and large grocery stores may not be equitably distributed across different neighborhoods in a region. There has been limited research on local food access patterns. Despite the few studies focused on access to individual types of local food outlets, such as farmers markets, little is known about whether such access varies among different types of local food outlets and how such access patterns compare with the uneven access to conventional food outlets. This study uses Maricopa County, one of the largest counties in Arizona, as a case study to examine the spatial patterns of access to conventional food markets (i.e. supermarkets or large grocery stores) and four different types of local food outlets, including farmers market, community garden, community supported agriculture (CSA) and mobile food markets. By analyzing the association between healthy food access and neighborhood characteristics, the study suggests that the local food system has a great potential in providing healthy food access to low-income and minority populations of the County than conventional food outlets. The study provides important insights into the way different types of local food outlets offer their availability in space and whether they are more equitable in serving underserved neighborhoods. The findings from this study can assist both government agencies and city planner formulate strategies to improve access to healthy food in disadvantaged neighborhoods.
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