Associations between the objective and perceived food environment and eating behavior in relation to socioeconomic status among adults in peri-urban settings: results from the CIVISANO study in Flanders, Belgium.

Obesity, a significant public health concern, disproportionately affects people with lower socioeconomic status (SES). Food environments have been identified as part of the causal chain of this disparity. This study investigated variations in the food environment across groups with different SES profiles residing in peri-urban municipal settings. In addition, it examined the association of the perceived and objective food environments with eating behaviour and assessed if these associations were moderated by SES. Utilizing GIS and survey data (n = 497, aged 25-65), results showed differences in the objective and perceived food environments based on SES. Respondents with higher SES perceived their food environments as better but resided farther from all food outlets compared to respondents with lower SES. However, there was no difference in outlet density or mRFEI between SES groups. SES moderated associations between the objective and perceived food environments and most eating behavior outcomes except fast food consumption frequency. For fruits and vegetables, SES moderated the association between neighborhood availability and consumption frequency (ß0.23,CI0.03;0.49). Stratified analysis revealed a positive association for both lower (ß0.15, CI0.03;0.27) and higher (ß0.37, CI 0.12;0.63) SES groups. For snack foods, SES moderated the association between healthy outlet density and consumption frequency (ß-0.60, CI-0.94; -0.23), showing statistical significance only for respondents with higher SES (ß0.36,CI 0.18;0.55). Similarly, for sugar-sweetened beverages, a statistically significant interaction was observed between unhealthy outlet density in the 1000m buffer and consumption frequency (ß 0.06, CI 0.02; 0.11). However, this association was only statistically significant for respondents with higher SES (ß-0.02,CI -0.05;-0.0002). These results emphasize the significance of SES as a crucial element in comprehending the connection between the food environment and eating behaviour. Indicating the need for policymakers to take SES into account when implementing food environment interventions, particularly when focusing on the neighborhood food environment without considering residents' SES and their perceptions.

Unhealthy food availability, prominence and promotion in a representative sample of supermarkets in Flanders (Belgium): a detailed assessment.

INTRODUCTION: The supermarket food environment is a key setting for potential public health interventions. This study assessed food availability, prominence and promotion in a representative sample of supermarkets in Flanders (Belgium). METHODS: A sample of 55 supermarkets across five chains and 16 Flemish municipalities was selected in 2022, about 64% in the most deprived socioeconomic areas. Healthiness indicators related to food availability (ratio of cumulative linear shelf length for healthy versus unhealthy foods), prominence (proportion of unhealthy foods at check-outs and end-of-aisle endcaps), and promotion (food marketing on food packages) were measured. RESULTS: Overall, the average ratio of healthy/unhealthy foods in supermarkets in Flanders was 0.36, meaning that for every 10m of shelf length of unhealthy foods there was 3.6m of healthy foods. There was a large variation in ratio's across supermarket chains. Of all foods available, 97.5% were ultra-processed at the check outs, while 72.2% and 58.5% were ultra-processed at the front and back end-of-aisle end-caps, respectively. Confectionery and sweet biscuits were the food categories with on average the highest number of marketing messages on pack per 10m of shelf length. CONCLUSION: Supermarket in-store food environments in Flanders were found generally unhealthy, with those located in low income areas having unhealthier in-store food environments than supermarkets located in medium and high income areas. Despite commitments of all large supermarket chains in Flanders to promote and create healthier in-store food environments, our findings indicate that currently consumers are incentivized to buy unhealthy rather than healthy food products.

The role of the perceived environment for recreational walking among adults in socioeconomically disadvantaged situations: A study using walk-along interviews.

Background: Persons in socioeconomically disadvantaged situations (PSEDS) are generally less likely to engage in recreational walking (RW) compared to higher socioeconomic groups and are often more dependent on their local environment. Studies on RW have primarily focused on the role of the built environment for the general adult population and the older population in urban areas. The aim of this study is to qualitatively identify the perceived environmental factors affecting RW among PSEDS in peri-urban areas. Methods: In two peri-urban municipalities in Belgium, walk-along interviews were conducted until data saturation with a purposeful convenience sampling of 38 PSEDS (25-65y/o) to identify local environmental factors affecting RW. A subsample of 22 participants joined a focus group (n = 4) to categorize the identified factors into environmental types (physical, sociocultural, political, and economic) of the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The interviews were transcribed and analyzed thematically using Maxqda 2022.0. Results: The information environment (dissemination, retrieving and understanding of information) was added to the ANGELO framework, highlighting the importance of digital literacy. Availability and accessibility of well-maintained walking surfaces, toilets, street lighting and seating options (physical environment), social support, dog-ownership, stigmatization, social isolation, and a sense of belonging (sociocultural environment) and indirect costs (economic environment) were identified as important environmental factors in RW among PSEDS. The identified political and economic factors are intertwined with the other environments. Conclusions: Perceived environmental factors affect RW among PSEDS and peri-urban settings offer specific challenges. Local governments should incorporate citizen perception into decision-making processes to create supportive environments that have the potential to promote RW among PSEDS in a peri-urban setting.

The CIVISANO protocol: a mixed-method study about the role of objective and perceived environmental factors on physical activity and eating behavior among socioeconomically disadvantaged adults.

BACKGROUND: Overweight and obesity have a strong socioeconomic profile. Unhealthy behaviors like insufficient physical activity and an unbalanced diet, which are causal factors of overweight and obesity, tend to be more pronounced in socioeconomically disadvantaged groups in high income countries. The CIVISANO project aims to identify objective and perceived environmental factors among different socioeconomic population groups that impede or facilitate physical activity and healthy eating behavior in the local context of two peri-urban Flemish municipalities in Belgium. We also aim to identify and discuss possible local interventions and evaluate the participatory processes of the project. METHODS: This study (2020-2023) will use community-based participatory tools, involving collaborative partnerships with civic and stakeholder members of the community and regular exchanges among all partners to bridge knowledge development and health promotion for socioeconomically disadvantaged citizens. Furthermore, a mixed-methods approach will be used. A population survey and geographic analysis will explore potential associations between the physical activity and eating behaviors of socioeconomically disadvantaged adults (25-65 years old) and both their perceived and objective physical, food and social environments. Profound perceptive context information will be gathered from socioeconomically disadvantaged adults by using participatory methods like photovoice, walk-along, individual map creation and group model building. An evaluation of the participatory process will be conducted simultaneously. DISCUSSION: The CIVISANO project will identify factors in the local environment that might provoke inequities in adopting a healthy lifestyle. The combination of perceived and objective measures using validated strategies will provide a robust assessment of the municipality environment. Through this analysis, the project will investigate to what extent community engagement can be a useful strategy to reduce health inequities. The strong knowledge exchange and capacity-building in a local setting is expected to contribute to our understanding of how to maximize research impact in this field and generate evidence about potential linkages between a health enhancing lifestyle among socioeconomically disadvantaged groups and their physical, food and social environments.

Risk factors for hazardous drinking in university students from South Africa and Belgium: a cross-cultural comparison study.

BACKGROUND: Previous studies have associated certain risk factors with hazardous drinking in students. However, big cultural and geographical differences exist regarding alcohol use. OBJECTIVES: To determine whether or not there was a difference in hazardous drinking between Belgian and South African university students and to establish the risk factors that contribute to hazardous drinking in university students (calculated using the AUDIT-C) from a developing country (South Africa) and a developed country (Belgium). METHODS: An online survey assessing hazardous drinking among university students in South Africa (University of KwaZulu-Natal, UKZN) and Belgium (University of Antwerp, UoA) was conducted, using the shortened version of the Alcohol Use Disorder Identification Test (AUDIT-C). Risk factors in males and females for hazardous drinking were explored using multivariate logistic regression analysis. RESULTS: In total, 499 students were included in the study (250 UoA and 249 UKZN students). A significant higher amount of male (94.8%) as well as female (92.4%) UoA students drank alcohol in the last year compared to the male (66.2%) and female (67.8%) UKZN students (p<0.001). Additionally, a significant higher amount of UoA students were hazardous drinkers, compared to the UKZN students (p<0.001). Multivaiate analysis showed that male UoA students were almost 6 times more likely to be hazardous drinkers than male UKZN students (OR=5.611, p=0.005). Female UoA students were more than twice as likely to be hazardous drinkers than female UKZN students (OR=2.371, p=0.016). CONCLUSION: This study found a significant difference in hazardous drinking between Belgian and South African university students.