ABSTRACT
Socioeconomic and place-based factors contribute to grocery shopping patterns which may be important for diet and health. Big data provide the opportunity to explore behaviours at the population level. We used data collected from Flipp, a free all-in-one savings and deals content app, to identify visitation to grocery stores and estimate home-to-store distances, monthly frequencies and number of unique stores visited in eight Canadian cities during 2020. Grocery shopping outcomes and associations with income, population density and percentage of car commuters were explored using data aggregated at the Aggregate Dissemination Area level in which app users lived. Changes in patterns of grocery shopping following restrictions implemented in response to the COVID-19 pandemic were also investigated. The median of average home-to-store distances ranged from 4 to 5 km across all cities throughout 2020. Shorter distances for grocery shopping were shown consistently for shoppers living in lower income, densely populated and low car-commuting ADAs. A maximum of three unique supermarkets were visited on average each month. Decreases in the frequency and variability of grocery store visits were shown across all cities in April 2020 following the implementation of restrictions in response to COVID-19, and pre-pandemic levels of shopping were rarely achieved by the end of the year. Ultimately, these results provide much needed information regarding the characteristics of grocery shopping trips in a high-income country, as well as how food shopping was impacted by the onset of the COVID-19 pandemic. This information will be useful for a range of future studies seeking to characterise access to food retail.
ABSTRACT
Background: During the COVID-19 pandemic, many urban residents stopped riding public transit despite their reliance on it to reach essential services like healthcare. Few studies have examined the implications of public transit reliance on riders' ability to reach healthcare when transit is disrupted. To understand how shocks to transportation systems impact healthcare access, this study measures the impact of avoiding public transit on the ability of riders to access healthcare and pharmacy services during lockdowns. Methods: We deployed a cross-sectional survey of residents of Toronto and Vancouver in May 2020 through Facebook advertisements and community list-serves. Eligibility criteria included riding transit at least weekly prior to the pandemic and subsequent cessation of transit use during the pandemic. We applied multivariable modified Poisson models to identify socio-demographic, transportation, health-related, and neighborhood predictors of experiencing increased difficulty accessing healthcare and getting prescriptions while avoiding public transit. We also predicted which respondents reported deferring medical care until they felt comfortable riding transit again. Results: A total of 4367 former transit riders were included (64.2% female, 56.1% Toronto residents). Several factors were associated with deferring medical care including: being non-White (Toronto, APR, 1.14; 95% CI, 1.00-1.29; Vancouver, APR, 1.52; 95% CI, 1.26-1.84), having a physical disability (Toronto, APR, 1.20; 95% CI, 1.00-1.45; Vancouver, APR, 1.42; 95% CI, 1.08-1.87), having no vehicle access (Toronto, APR, 1.74; 95% CI, 1.51-2.00; Vancouver, APR, 2.74; 95% CI, 2.20-3.42), and having low income (Toronto, APR, 1.77; 95% CI, 1.44-2.17; Vancouver, APR, 1.51; 95% CI, 1.06-2.14). Discussion: During COVID-19 in two major Canadian cities, former transit riders from marginalized groups were more likely to defer medical care than other former riders. COVID-19 related transit disruptions may have imposed a disproportionate burden on the health access of marginalized individuals. Policymakers should consider prioritizing healthcare access for vulnerable residents during crises.