What is known about consumer nutrition environments in Australia? A scoping review of the literature.

OBJECTIVE: Food environments can influence food selection and hold the potential to reduce obesity, non-communicable diseases and their inequalities. 'Consumer nutrition environments' describe what consumers encounter within a food retail outlet, including products, price, promotion and placement. This study aimed to summarize the attributes that have been examined in existing peer-reviewed studies of Australian consumer nutrition environments, identify knowledge gaps and provide recommendations for future research. METHODS: A systematic search of peer-reviewed literature was conducted. Sixty-six studies that assessed an aspect of within-store consumer nutrition environments were included. RESULTS: Most studies were published from 2011 onwards and were conducted in capital cities and in supermarkets. Studies assessed the domains of product (40/66), price (26/66), promotion (16/66) and placement (6/66). The most common research themes identified were assessment of the impact of area socioeconomic status (13/66), remoteness (9/66) and food outlet type (7/66) on healthy food prices; change in price of healthy foods (6/66); variety of healthy foods (5/66); and prevalence of unhealthy child-orientated products (5/66). CONCLUSIONS: This scoping review identified a large number of knowledge gaps. Recommended priorities for researchers are as follows: (1) develop consistent observational methodology, (2) consider consumer nutrition environments in rural and remote communities, (3) develop an understanding of food service outlets, (4) build on existing evidence in all four domains of product, price, placement and promotion and (5) determine effective policy and store-based interventions to increase healthy food selection.

Does food store access modify associations between intrapersonal factors and fruit and vegetable consumption?

BACKGROUND/OBJECTIVES: Existing theoretical frameworks suggest that healthy eating is facilitated by an individual's ability, motivation and environmental opportunities. It is plausible, although largely untested, that the importance of factors related to ability and motivation differ under varied environmental conditions. This study aimed to determine whether the magnitude of associations between fruit and vegetable consumption and intrapersonal factors (ability and motivation) were modified by differences in access to stores selling these items (environmental opportunities). SUBJECTS/METHODS: Cross-sectional analysis of 4335 women from socioeconomically disadvantaged neighbourhoods in the state of Victoria, Australia. Self-reported fruit and vegetable consumption was assessed against a number of ability- and motivation-related factors. To examine whether associations were modified by store access, interactions with access to supermarkets and greengrocers within 2 km of participants' households were tested. RESULTS: Of the two factors related to ability and seven factors related to motivation, almost all were associated with fruit and vegetable consumption. In general, associations were not modified by store access suggesting that these factors were not tempered by environmental opportunities. CONCLUSIONS: This study provides little support for the hypothesis that the importance of intra-personal factors to fruit and vegetable consumption is modified by food store access. Further research on this topic is required to inform behaviour change interventions.

Is access to alcohol associated with alcohol/substance abuse among people diagnosed with anxiety/mood disorder?

OBJECTIVES: To investigate the relationship between access to off-license alcohol outlets and areas with dual treatment for alcohol/drug abuse and anxiety/mood disorder compared to areas with anxiety/mood disorder only in an urban setting in New Zealand. STUDY DESIGN: Ecologic study. METHODS: Within small areas (2840 meshblocks, mean size 0.05 km(2)) in the city of Auckland, New Zealand, counts of adults receiving anxiety/mood disorder treatment (2008-9) were identified and the proportions of these individuals also receiving treatment for alcohol/drug abuse were generated. Access to off-license alcohol outlets were defined as: 1) shortest road distance from the population-weighted centroid of each small area to an outlet; 2) count of outlets within a 3 km road network buffer; and 3) relative density of outlets across Auckland (determined through kernel density estimates). To test for the relationship between access to alcohol outlets and dual diagnosis, meshblocks without any cases of anxiety/mood disorder were excluded from analyses. Remaining meshblocks were dichotomized into any or no dual diagnosis. Logistic regression was used to estimate the association between access to alcohol outlets and treatment for the dual conditions. RESULTS: Neighbourhoods with dual diagnosis were generally similar to those with anxiety/mood disorder only, in terms of ethnic and gender/age composition. Regression analyses indicated statistically significant decreased risk of dual diagnosis for those areas with the lowest density (using a buffer) of alcohol outlets (OR = 0.75, P-value = 0.027) compared with areas with the highest density, after adjustment for deprivation and population density. All access measures also indicated significant linear trends where dual diagnosis was more likely in areas with greater access. CONCLUSIONS: Generally, decreased access to alcohol outlets was associated with decreased odds of dual diagnosis of alcohol/drug abuse and anxiety/mood disorder. Measures to control access to alcohol outlets may be an important area for alcohol/substance abuse intervention, particularly for vulnerable sub-populations.

Effect of changes to the school food environment on eating behaviours and/or body weight in children: a systematic review.

Previous school obesity-prevention reviews have included multi-component interventions. Here, we aimed to review the evidence for the effect of isolated food environment interventions on both eating behaviours (including food purchasing) and/or body weight. Five electronic databases were searched (last updated 30 November 2013). Of the 1,002 unique papers identified, 55 reported on school food environment changes, based on a review of titles and abstracts. Thirty-seven further papers were excluded, for not meeting the inclusion criteria. The final selection consisted of 18 papers (14 United States, 4 United Kingdom). Two studies had a body mass index (BMI) outcome, 14 assessed purchasing or eating behaviours and two studies assessed both weight and behaviour. Seventeen of 18 papers reported a positive outcome on either BMI (or change in BMI) or the healthfulness of food sold or consumed. Two studies were rated as strong quality and 11 as weak. Only three studies included a control group. A school environment supportive of healthy eating is essential to combat heavy marketing of unhealthy food. Modification of the school food environment (including high-level policy changes at state or national level) can have a positive impact on eating behaviours. A need exists, however, for further high-quality studies.

Monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in community and consumer retail food environments globally.

Retail food environments are increasingly considered influential in determining dietary behaviours and health outcomes. We reviewed the available evidence on associations between community (type, availability and accessibility of food outlets) and consumer (product availability, prices, promotions and nutritional quality within stores) food environments and dietary outcomes in order to develop an evidence-based framework for monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in retail food environments. Current evidence is suggestive of an association between community and consumer food environments and dietary outcomes; however, substantial heterogeneity in study designs, methods and measurement tools makes it difficult to draw firm conclusions. The use of standardized tools to monitor local food environments within and across countries may help to validate this relationship. We propose a step-wise framework to monitor and benchmark community and consumer retail food environments that can be used to assess density of healthy and unhealthy food outlets; measure proximity of healthy and unhealthy food outlets to homes/schools; evaluate availability of healthy and unhealthy foods in-store; compare food environments over time and between regions and countries; evaluate compliance with local policies, guidelines or voluntary codes of practice; and determine the impact of changes to retail food environments on health outcomes, such as obesity.

Neighbourhood-socioeconomic variation in women's diet: the role of nutrition environments.

BACKGROUND/OBJECTIVES: Living in socioeconomically disadvantaged neighbourhoods is associated with increased risk of a poor diet; however, the mechanisms underlying associations are not well understood. This study investigated whether selected healthy and unhealthy dietary behaviours are patterned by neighbourhood-socioeconomic disadvantage, and if so, whether features of the neighbourhood-nutrition environment explain these associations. SUBJECTS/METHODS: A survey was completed by 1399 women from 45 neighbourhoods of varying levels of socioeconomic disadvantage in Melbourne, Australia. Survey data on fruit, vegetable and fast-food consumption were linked with data on food store locations (supermarket, greengrocer and fast-food store density and proximity) and within-store factors (in-store data on price and availability for supermarkets and greengrocers) obtained through objective audits. Multilevel regression analyses were used to examine associations of neighbourhood disadvantage with fruit, vegetable and fast-food consumption, and to test whether nutrition environment factors mediated these associations. RESULTS: After controlling for individual-level demographic and socioeconomic factors, neighbourhood disadvantage was associated with less vegetable consumption and more fast-food consumption, but not with fruit consumption. Some nutrition environmental factors were associated with both neighbourhood disadvantage and with diet. Nutrition environmental features did not mediate neighbourhood-disadvantage variations in vegetable or fast-food consumption. CONCLUSIONS: Although we found poorer diets among women living in disadvantaged neighbourhoods in Melbourne, the differences were not attributable to less supportive nutrition environments in these neighbourhoods.

Area variation in recreational cycling in Melbourne: a compositional or contextual effect?

OBJECTIVE: To examine whether compositional and/or contextual area characteristics are associated with area socioeconomic inequalities and between-area differences in recreational cycling. SETTING: The city of Melbourne, Australia. PARTICIPANTS: 2349 men and women residing in 50 areas (58.7% response rate). MAIN OUTCOME MEASURE: Cycling for recreational purposes (at least once a month vs never). DESIGN: In a cross-sectional survey participants reported their frequency of recreational cycling. Objective area characteristics were collected for their residential area by environmental audits or calculated with Geographic Information Systems software. Multilevel logistic regression models were performed to examine associations between recreational cycling, area socioeconomic level, compositional characteristics (age, sex, education, occupation) and area characteristics (design, safety, destinations or aesthetics). RESULTS: After adjustment for compositional characteristics, residents of deprived areas were less likely to cycle for recreation (OR 0.66; 95% CI 0.43 to 1.00), and significant between-area differences in recreational cycling were found (median odds ratio 1.48 (95% credibility interval 1.24 to 1.78). Aesthetic characteristics tended to be worse in deprived areas and were the only group of area characteristics that explained some of the area deprivation differences. Safety characteristics explained the largest proportion of between-area variation in recreational cycling. CONCLUSION: Creating supportive environments with respect to safety and aesthetic area characteristics may decrease between-area differences and area deprivation inequalities in recreational cycling, respectively.