Assessing the Healthfulness of University Food Environments: A Systematic Review of Methods and Tools.

The availability, promotion, and price of healthy foods within the university food environment may impact students' dietary choices. This systematic review summarizes the tools and methods used to assess the healthfulness of university food environments where many students spend a significant portion of their emerging adulthood. Thirty-six global studies published between 2012 and 2022 were sourced from PubMed (NNLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycInfo (EBSCO), CINHAL Complete (EBSCO), ProQuest Nursing, and Allied Health, following PRISMA 2020 guidelines. Of the included studies, 58% were institutional-level audits, 17% examined individual-level perceptions, and 25% combined both. Most institutional-level audits focused on one aspect of the food environment (e.g., eateries, vending machines). For studies examining multiple spaces within the campus environment (38%), comprehensive assessments were limited, and most studies had to employ a combination of assessment tools. Surveys were most often used to gather individual perceptions about the food environment. The Nutrition Environment Measures Survey (NEMS) was the most commonly used tool across all studies. This review highlights the need for a standardized tool, method, or a "healthy" benchmark for specific use at universities to improve methodological rigor and comparability of findings across institutions.

Association of mobile health (mHealth) use with health status and COVID-19-related concerns by people with mobility impairments.

PURPOSE: Mobile health (mHealth) technology has increased dramatically in the wake of the pandemic. Less research has focused on people with mobility impairing (PMI) disabilities. This study determined the prevalence of mHealth use among PMI adults during the COVID-19 escalation and examines demographic, health and COVID-19 concerns correlates. METHODS: PMI adults (N = 304) completed an online survey investigating mHealth use and COVID-19 concerns related to food access in June of 2020. Smartphone and mHealth use were measured with an adapted version of the survey used in the Pew Internet & American Life project. Descriptive and multivariable analyses were conducted to determine associations of demographics, health status, and COVID-19 concerns with mHealth use. About two-thirds (N = 201) of the sample were mHealth users (owned a smartphone and engaged in health-promoting behaviors with the smartphone; e.g., sought online information, tracked health behaviors, used patient portals). RESULTS: Having hypertension was associated with higher mHealth use, and having higher COVID-19 concerns about food access was associated with higher mHealth use. Those who used mHealth were also more engaged with smartphone apps for communication, services, and entertainment. Only the association between educational attainment and mHealth use remained significant after adjusting for other covariates in multivariable logistic regression models. DISCUSSION: PMIs continue to need support in the use of mHealth technology to help maximize access to potentially important tools for rehabilitation and health management. There is a need to continue to investigate mHealth and its applications for people with disabilities.Implications for RehabilitationMany people with mobility impairing disabilities may be missing opportunities for mHealth rehabilitation and healthcare.COVID-19 has widened existing gaps in access and use of mHealth technology among people with mobility impairing disabilities.Focused education is needed to help people with disabilities exploit the full range of services of their smartphones to increase access to care, social connectivity, and other important goods and services to enhance rehabilitation and health management.

"Everyone's struggling right now": Impact of COVID-19 on addressing food insecurity in rural primary care.

BACKGROUND: Primary care practices can address food insecurity (FI) through routine screening, practice-based food programmes, and referrals to community resources. The COVID-19 pandemic had disproportionate impacts on health outcomes for food-insecure households. OBJECTIVE: To describe the impact of the COVID-19 pandemic on FI screening and interventions in rural primary care practices in northern New England. METHODS: We conducted semi-structured interviews with thirteen providers and staff regarding changes to FI screening and interventions, community resources and partnerships, and patient food needs during the pandemic. Themes and exemplar quotations were identified through iterative discussion. RESULTS: Practices reported more frequent informal discussions with patients about FI during the pandemic. Despite limitations in site operations, practices created programmes to distribute food at practice locations or through food deliveries. The adoption of telemedicine had variable impacts on FI screening, creating challenges for some while facilitating screening outside of scheduled visits for others. Practices reported increased food availability due to new or expanded community programmes, but lack of transportation and delivery availability were challenges. New and stronger connections formed between practices and community partners. Increased awareness of FI among both patients and practice staff resulted in decreased stigma. CONCLUSION: Screening for and addressing FI was a priority for rural primary care practices during the pandemic. The implementation of practice-based FI interventions was supported by stronger practice-community connections and a decrease in stigma. The experiences of providers and staff during the pandemic provide insight into best practices for engaging primary care practices in reducing FI.

Percepção dos residentes de favelas brasileiras sobre o ambiente alimentar: um estudo qualitativo / Perception of the food environment by Brazilian slum residents: a qualitative study / Percepción de los residentes de favelas brasileñas sobre el entorno alimentario: un estudio cualitativo

Resumo A disponibilidade de venda de alimentos no território pode influenciar no consumo alimentar da população. Entretanto, é importante compreender como as pessoas percebem o seu ambiente alimentar para se entender como essa disponibilidade afeta seu consumo em contextos distintos. O objetivo foi avaliar a percepção dos moradores de favelas brasileiras sobre o ambiente alimentar em suas vizinhanças. Estudo qualitativo, em que foram realizados grupos focais online guiados por um roteiro para reunir discursos coletivos sobre o acesso aos alimentos em favelas brasileiras. O convite ocorreu por meio das redes sociais e do contato com líderes comunitários e organizações não governamentais que atuam em favelas, por meio da técnica de amostragem "bola de neve". Para a análise, foi utilizada a abordagem grounded theory (teoria fundamentada) e, como técnica, foi empregada a análise de redes temáticas. O acesso aos alimentos por moradores de favelas é permeado pela falta de recursos e elementos fundamentais para uma alimentação adequada e saudável, como: a falta de informação sobre alimentação; a renda insuficiente; e a baixa disponibilidade de estabelecimentos que comercializam alimentos saudáveis a preços acessíveis. São necessários programas e políticas públicas que incentivem a ampliação de equipamentos de segurança alimentar e nutricional, como hortas e feiras, e que aumentem a oferta de alimentos saudáveis com valores baixos nas favelas. Também são necessárias ações que abordem a complexidade das barreiras enfrentadas por moradores de favelas para ter acesso aos alimentos saudáveis.

Abstract Food availability in the territory can influence food consumption by the population. However, it is important to understand how people perceive their food environment to see how food availability affects consumption in different contexts. This study aimed to assess the perception of the food environment by Brazilian slum residents in their neighborhoods. This is a qualitative study, with online focus groups guided by a script in order to gather collective discourses about access to food in Brazilian slums. The invitation to participate in this study was made through social media, and community leaders and nongovernmental organizations with actions in slums were contacted using the snowball sampling technique. Grounded theory analysis was applied with the technique of thematic networks. Access to food for slum residents involves lack of resources and essential elements for an adequate and healthy diet, such as lack of information about food, low income, and low availability of stores that sell healthy food at affordable prices. Public programs and policies are required to encourage the expansion of food and nutritional security resources, such as vegetable gardens and markets, to increase the supply and sell healthy food at affordable prices in slums. Actions are also required to address the complexity of obstacles faced by slum residents in the access to healthy foods.

Resumen La disponibilidad de venta de alimentos en el territorio puede influir en el consumo alimentario de la población. Sin embargo, es importante comprender la manera en que las personas perciben su entorno alimentario para comprender cómo esta disponibilidad afecta su consumo en diferentes contextos. El objetivo fue evaluar la percepción de los residentes de favelas brasileñas sobre el entorno alimentario en sus vecindarios. Estudio cualitativo, en el que se formaron grupos focales en línea orientados por un guion con el objetivo de reunir discursos colectivos sobre el acceso a los alimentos en favelas brasileñas. La invitación se dio por medio de las redes sociales y mediante el contacto con líderes comunitarios y organizaciones no gubernamentales que trabajan en favelas, utilizando la técnica de muestreo "bola de nieve". Para el análisis, se utilizó el enfoque de la grounded theory (teoría fundamentada) y, como técnica, se empleó el análisis de redes temáticas. El acceso a los alimentos de los habitantes de las favelas está permeado por la falta de recursos y elementos fundamentales para una alimentación adecuada y sana, tales como: la falta de información sobre la alimentación, los bajos ingresos y la poca disponibilidad de establecimientos que vendan alimentos sanos a precios asequibles. Se necesitan programas y políticas públicas para fomentar la ampliación de equipos de seguridad alimentaria y nutricional, como huertas y mercadillos, que aumenten la oferta y vendan alimentos sanos a precios asequibles en las favelas. También se necesitan acciones para abordar la complejidad de las barreras que enfrentan los residentes de las favelas para acceder a alimentos sanos.

Challenges for obesity prevention: Study of the consumers' food environment around public schools in a small municipality / Desafios para a prevenção da obesidade: estudo do ambiente alimentar do consumidor no entorno de escolas públicas de um município de pequeno porte

ABSTRACT Objective Evaluate the consumer's food environment in food retailers around public schools in the municipality of Governador Celso Ramos, state of Santa Catarina, in southern Brazil. Methods A survey was carried out in the surroundings of three public schools, from March to May 2022. Food retailers located in a pre-established 800m buffer zone were identified. A location system device recorded latitude and longitude. An audit of the establishments was performed using a specific validated instrument for auditing the consumer food environment (AUDITNOVA). These establishments were grouped into: Group 1 - predominantly selling fresh foods, Group 2 - mixed establishments, and Group 3 - predominantly selling ultra-processed foods. These establishments were assessed using a Consumer Food Environment Healthiness Score evaluation system. The data were analyzed using the statistical software Stata version 16.0. Results The study audited 21 establishments, 47.6% of which were small neighborhood food markets, 23.8% bakeries, 14.3% butchers/fishmongers, 9.5% grocery stores and 4.8% supermarkets. It was found that privately-owned vegetable markets had a higher availability of fresh and minimally processed food categories, while the lowest scores for this category were found in bakeries. Regarding ultra-processed foods, the most commonly found items were sugary beverages and candies, chocolates, and filled cookies. Conclusion More audit studies ought to be carried out in the surroundings of schools to broaden the understanding of the relationship between access, availability, prices and food advertisement in order to support the construction of strategies aimed at preventing obesity in the population.

RESUMO Objetivo Avaliar o ambiente alimentar do consumidor em estabelecimentos de comercialização de alimentos no entorno de escolas públicas no município de Governador Celso Ramos, estado de Santa Catarina, no Sul do Brasil. Métodos Foi realizada, entre março e maio de 2022, no entorno de três escolas públicas, auditoria nos comércios varejistas localizados em uma zona pré-estabelecida de 800m. Um equipamento com sistema de localização realizou o registro da latitude e longitude. Esta auditoria foi realizada utilizando um instrumento validado próprio para auditoria do ambiente alimentar do consumidor (AUDITNOVA). Estes foram agrupados em Grupo 1 - com venda predominante de alimentos in natura; Grupo 2 - estabelecimentos mistos; Grupo 3 - com venda predominante de alimentos ultraprocessados. Os estabelecimentos foram avaliados por um sistema de avaliação de saudabilidade do ambiente alimentar do consumidor. Os dados foram analisados no programa estatístico Stata versão 16.0. Resultados O estudo auditou 21 estabelecimentos, sendo 47,6% mercados de bairro, 23,8% padarias, 14,3% açougues/peixarias, 9,5% sacolões/hortifrutis privados e 4,8% supermercados. Foi identificado que sacolões/hortifrutis privados apresentaram maior oferta de alimentos da categoria in natura e minimamente processados, enquanto os menores scores desta categoria de alimentos foram encontrados em padarias. Em relação aos alimentos ultraprocessados, os alimentos mais presentes foram bebidas açucaradas e balas, chocolates e biscoito recheado. Conclusão Sugere-se a realização de mais estudos de auditoria em comércios varejistas no entorno de escolas para ampliar a compreensão da relação entre o acesso, disponibilidade, preços e propagandas dos alimentos de modo a subsidiar a construção de estratégias que visem a prevenção da obesidade na população.

Experiences of Food Pantry Stakeholders and Emergency Food Providers in Rural Minnesota Communities.

OBJECTIVE: This study aimed to describe the experiences influencing food pantry stakeholders' and emergency food providers' ability to meet their shoppers' needs. DESIGN: We conducted 5 focus groups. SETTING: Food pantries in Minnesota in late 2019 and early 2020. PARTICIPANTS: The sample included 37 participants with various roles in the emergency food system. PHENOMENON OF INTEREST: Barriers and challenges facing emergency food providers/stakeholders and practices and resources providers employ. ANALYSIS: We identified major themes using a thematic analysis approach. RESULTS: Participants reported multiple barriers to accessing food pantries, that shopper demographics were changing, and shoppers needed nonfood support, such as personal hygiene items and mental health services. Food pantries required appropriate and sustainable food supplies, additional financial, labor, technical support, and physical infrastructure improvements. Participants described the benefits of their relationship with the University of Minnesota Cooperative Extension, explained how pantries offered healthier foods, highlighted innovative service delivery models, and stressed that their organization connected to many facets of their community. CONCLUSION AND IMPLICATIONS: Food pantries serving rural areas reported meeting community needs by distributing food to their shoppers in an inclusive and health-promoting way but require additional support. These data support nutrition practitioners working to understand the local, place-based context and needs of emergency food providers while building wider and deeper connections between nutrition professionals and the emergency food system.

Distribution of fresh foods in food pantries: challenges and opportunities in Illinois during the COVID-19 pandemic.

BACKGROUND: The charitable food system distributes free food to clients across the U.S., but many nutrition and health-focused efforts encounter barriers to success, which were exacerbated during the COVID-19 pandemic. The objective of the current study was to understand barriers and facilitators to distributing nutritious, fresh foods in food pantries across Illinois during the COVID-19 pandemic. METHODS: Forty-nine pantry representatives participated in focus groups in October 2021. A codebook was created based on relevant literature, stakeholder interests, and an initial review of the recordings. Transcripts of each group were coded and analyzed using a basic interpretive approach. RESULTS: Pantries distribution of fresh foods was impacted by community partners, food bank policies and practices, and the quality of the donated fresh foods. Physical constraints of pantries limit fresh food storage capacity. The COVID-19 pandemic magnified stressors in the charitable food system which highlighted how community partners might improve fresh food distribution. CONCLUSION: Focus groups with food pantry representatives across Illinois provided key insights that can inform future efforts to facilitate fresh food distribution in the charitable food system. Future studies should evaluate the effects of the suggested initiatives and changes at the food pantry, food bank, and policy levels.

Food Security is Associated with Higher Diet Quality Among Children of the US-Affiliated Pacific Region.

BACKGROUND: The prevalence of food insecurity and its relationship to diet quality are factors impacting the health of persons living across the United States-affiliated Pacific region (USAP). OBJECTIVES: The aim of this study was to describe characterize the relationship between household food security status and diet quality of 2- to 8-y-old children across jurisdictions in the USAP. METHODS: Baseline data from 2- to 8-y-olds (n = 3099) enrolled in the Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific region, an obesity prevention study conducted in communities across Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawaii, and a concomitant prevalence study in communities across the Freely Associated States (FAS) (the Federated States of Micronesia: Kosrae, Pohnpei, Chuuk, Yap; Republic of Marshall Islands; Republic of Palau) were collected in 2012. Caregivers self-reported sociodemographic data and food insecurity. Assisted by their caregiver, children completed two dietary records on nonconsecutive, randomly assigned days. The Healthy Eating Index 2005 (HEI-2005) was used to assess the diet quality. Data were summarized overall and by jurisdiction. Differences in HEI-2005 and HEI component scores among jurisdictions and by household food security status were tested using 1-factor ANOVA. RESULTS: Half or more of participants from American Samoa, Guam, CNMI, and FAS reported household food insecurity (n = 295, 59.7%; n = 292, 49.9%; n = 267, 54.6%; n = 572, 69.0%, respectively). HEI-2005 scores varied by jurisdiction (P < 0.001) and were significantly lower among FAS participants (54.7 ± 1.2) than among all other jurisdictions (P < 0.05). Total diet quality scores did not differ by food security status (59.9 ± 0.8 food secure compared with 58.3 ± 1.1 food insecure, P = 0.07); however, most diet quality adequacy component scores were significantly higher and moderation component scores significantly lower among participants in food secure households than those in food insecure households. CONCLUSIONS: Significant differences in children's diet quality and household food security existed across USAP jurisdictions.

Food environment near schools in the largest Brazilian metropolis: analyses and contributions based on census data / Ambiente alimentar próximo às escolas na maior metrópole brasileira: análises e contribuições com base em dados censitários / Entorno alimentario cerca de las escuelas en la mayor metrópoli brasileña: análisis y contribuciones a partir de datos censales

Abstract: We aimed to investigate and compare the distribution of establishments that sell food near municipal, state, and private schools in the municipality of São Paulo, Brazil. This cross-sectional, exploratory, and census study was conducted in 3,121 schools. Circular buffers were traced around schools and concentrations or dispersions of food stores (in absolute numbers and densities) were analyzed. A p-trend was calculated to analyze how food stores density behaved as the buffer radius distance increased. Stratified regression models were built to analyze the characteristics of the food environment. Snack bars and street vendors are the most common types of establishments surrounding schools. Some categories of food stores are concentrated (such as candy stores around municipal and private schools, mini markets around municipal schools, and snack bars around private schools), whereas others (such as super and hypermarkets and fruit and vegetable stores) are dispersed around public schools. The food environment around schools shows differences regarding the instance that administers them and private schools have more food stores around them. Poor-quality food environment around schools exposes students to risk factors regarding excessive unhealthy food consumption.

Resumo: Este estudo transversal, exploratório e censitário realizado em 3.121 escolas buscou investigar e comparar a distribuição de estabelecimentos de venda de alimentos no entorno de escolas municipais, estaduais e particulares da cidade de São Paulo, Brasil. Foram traçados buffers circulares ao redor das escolas e analisadas as concentrações ou dispersões de estoques de alimentos (em números absolutos e densidades). Foi calculado o valor de p de tendencia para analisar o comportamento das densidades dos estabelecimentos com o aumento da distância do raio do buffer. As características do ambiente alimentar foram analisadas por modelos de regressão estratificada. Lanchonetes e vendedores ambulantes são os tipos de estabelecimentos mais presentes nos entornos das escolas. Algumas categorias de lojas de alimentos estão concentradas (como lojas de doces em torno de escolas municipais e particulares, minimercados em torno de escolas municipais e lanchonetes em torno de escolas particulares), e outras (como super e hipermercados e hortifrútis) estão dispersas em torno de escolas públicas. O ambiente alimentar ao redor das escolas difere de acordo com a instância que as administra, e as particulares têm mais lojas de alimentos nos arredores. O ambiente alimentar de baixa qualidade ao redor das escolas expõe os alunos a fatores de risco para o consumo excessivo de alimentos não saudáveis.

Resumen: Este estudio transversal, exploratorio y censal realizado en 3.121 escuelas, buscó investigar y comparar la distribución de los establecimientos de venta de alimentos en el entorno de escuelas municipales, estatales y privadas de la ciudad de São Paulo, Brasil. Se trazaron buffers circulares alrededor de las escuelas y se analizaron las concentraciones o dispersiones de las existencias de alimentos (en números absolutos y densidades). Se calculó el valor de p de la tendencia para analizar el comportamiento de las densidades de los establecimientos al aumentar la distancia al radio del buffer. Las características del entorno alimentario se analizaron por medio de modelos de regresión estratificada. Las cafeterías y los vendedores ambulantes son los tipos de establecimientos más presentes en el entorno de las escuelas. Algunas categorías de tiendas de alimentos están concentradas (como tiendas de dulces alrededor de las escuelas municipales y privadas, minimercados alrededor de escuelas municipales y cafeterías alrededor de escuelas privadas), y otras (como super e hipermercados y tiendas de frutas y hortalizas) están dispersas alrededor de las escuelas públicas. El entorno alimentario alrededor de las escuelas difiere según la instancia que las administra, y hay más tiendas de alimentos en las inmediaciones de las escuelas privadas. El entorno alimentario de baja calidad alrededor de las escuelas expone a los estudiantes a factores de riesgo para el consumo excesivo de alimentos poco saludables.

Caregivers' Perceived Impact of WIC's Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts.

Responding to the COVID-19 pandemic, the American Rescue Plan (2021) allowed state agencies of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) the option of temporarily increasing the Cash-Value Benefit (CVB) for fruit and vegetable (FV) purchases. To examine the impact of this enhancement on WIC caregiver experience, the MA WIC State Office invited 4600 randomly selected MA WIC caregivers to complete an online survey (February-March 2022). Eligible adults had at least one child, had been enrolled at least a year, and were aware of the increase. Of those who opened the screener (n = 545), 58.9% completed it (n = 321). We calculated the frequencies of reporting increased FV outcomes and tested whether responses differed by race/ethnicity, market access, and food security. Most caregivers perceived the CVB increase to benefit FV purchasing (amount and quality, 71.0% and 55.5%), FV consumption (offered to children and personally consumed, 70.1% and 63.2%), and satisfaction with the WIC food package (37.1% reported improved satisfaction, pre- vs. post-increase). Probability of reporting improved outcomes was not found to differ by race/ethnicity, market access, or food security. CVB increases may pose important implications for dietary behaviors and satisfaction with WIC. Policymakers should consider making this increase permanent.

Derecho a la alimentación en la Constitución chilena: elementos jurídicos, sociales y nutricionales para una propuesta / Right to food in the Chilean constitution: legal, social and nutritional elements for a proposal

BACKGROUND: The Human Right to Food is not incorporated in the Chilean Constitution. Aim: To identify the legal, social, and nutritional elements for its incorporation into the new Constitution, and to draft a text proposal for the constituent discussion. MATERIAL AND METHODS: Descriptive and qualitative study on the perceptions of experts and key actors of the food chain in Chile. The sample was for convenience and included civil society, academia, international organizations, parliamentarians, food traders and producers, and national and local authorities (n = 26). The research team, previously trained and standardized, applied semi-structured online surveys, which were recorded and transcribed. Through an inductive approach, a thematic analysis was carried out using the Atlas.ti 9.0 software. RESULTS: Eighty-one percent of the interviewees were in favor of the Constitutional incorporation of the Right to Food. According to interviews, a constitutional text was proposed considering the characteristics of adequate, healthy, safe, and nutritious foods. Also, the food items must be available, physically and economically accessible, and culturally relevant. A guaranteed citizen participation, food sovereignty, food security, and environmental sustainability must be considered. Conclusions: The high prevalence of malnutrition due to excess, poor diet, and food insecurity during the COVID-19 pandemic, and a current Constitution that does not explicitly guarantee physical and economic access to food, establish a factual and normative background that justifies the incorporation of this right in a new Constitution.

Disparities in access to healthy and unhealthy foods in central Massachusetts: implications for public health policy.

OBJECTIVES: To analyze geographic and income disparities in access to healthy foods in central Massachusetts. METHODS: We surveyed 106 (92% of all) food stores longitudinally in the study area between 2007 and 2010. We analyzed the geographic and temporal variations in community- and store-level healthy food availability indices (HFAI) and unhealthy food availability indices (UFAI) overall and by select store and community characteristics. RESULTS: Twenty-seven of 68 communities in the study area (39.7%) had no food store and 5 (8.3%) had one or few stores with very limited availability of healthy foods, affecting 23.7% of the county population. Lack of food stores was associated strongly with lower housing density and upper tertile of median household income. About 45% of the surveyed stores had inadequate availabilities of healthy food. Store-level HFAI and UFAI scores were highly correlated, and higher among larger stores affiliated with a chain (vs independent). Though healthy foods were usually most available in larger stores, unhealthy foods were widely available in all stores. CONCLUSIONS: Over half of central Massachusetts communities, mostly rural and small, had either no food store or few stores with limited availabilities of healthy foods. Immediate policy interventions on the food environment are necessary in these communities. Further, without examining what is actually sold in stores, analysis of disparities in access to healthy food relies on the number of food stores, which can lead to a distorted picture of accessibility and mislead community health policies.