Snapshots of urban and rural food environments: EPOCH-based mapping in a high-, middle-, and low-income country from a non-communicable disease perspective

A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high income), with one matched pair of urban–rural sites per country. Fifty formal and informal food retail outlets were assessed, and descriptive and comparative statistical analyses were performed

Aravinda Berggreen-Clausen's Quick Files

The Quick Files feature was discontinued and it’s files were migrated into this Project on March 11, 2022. The file URL’s will still resolve properly, and the Quick Files logs are available in the Project’s Recent Activity

Food environments in socioeconomically disadvantaged and immigrant populations through a non-communicable disease lens

Background: Globally, non-communicable diseases are increasing. With an evidenced link to the social determinants of health, this highlights a social gradient, whereby socioeconomic status, ethnicity and other factors influence poorer health outcomes. They are also linked to food environments, the interface of interaction between the food system and consumers. Aim: The aim of this thesis is to improve understanding of the food environment and its interactions with a focus on socioeconomic disadvantage and immigrant populations through a non-communicable disease lens. Methods: In Study I-III, the external food environment was mapped using a modified version of the Environmental Profile of a Community’s Health observation tool. Study I included under-resourced and socioeconomically disadvantaged sites, one urban and one rural, in a low- (Uganda), middle- (South Africa) and high-income (Sweden) country. Further, twenty-two lower and middle socioeconomic status neighborhoods of Stockholm were mapped in Study II and III. Descriptive and inferential statistical analyses were carried out. Study IV, a scoping review, used the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to analyze and interpret the data on the interaction between personal and external food environments. Results: Across countries, food environments differed in the number of informal outlets present, the most found in Uganda and the least in Sweden. Primarily supermarkets, as well as other stores, were a source of both unhealthy and healthy food items, while advertising unhealthy items in store. Overall, outdoor advertisements of unhealthy foods were the most common and more prevalent in areas of higher socioeconomic disadvantage. Fruits and vegetables had similar prices across countries, though in the Swedish context, these cost less with lower neighborhood socioeconomic status. Structural and social factors like income, time, mobility and children’s preferences influenced the healthiness of foods acquired by immigrants from low-and middle-income countries living in high-income countries. Conclusion: Unhealthy items were both widely prevalent, as well as advertised across settings, at a higher rate in areas of higher disadvantage. Combined with structural and social factors that push consumers towards unhealthy practices, this could exacerbate existing health and nutrition inequities. Further research to better understand the food environment and its interactions with consumers are needed to facilitate healthier choices and improve health

Food environments in socioeconomically disadvantaged and immigrant populations through a non-communicable disease lens

Background: Globally, non-communicable diseases are increasing. With an evidenced link to the social determinants of health, this highlights a social gradient, whereby socioeconomic status, ethnicity and other factors influence poorer health outcomes. They are also linked to food environments, the interface of interaction between the food system and consumers. Aim: The aim of this thesis is to improve understanding of the food environment and its interactions with a focus on socioeconomic disadvantage and immigrant populations through a non-communicable disease lens. Methods: In Study I-III, the external food environment was mapped using a modified version of the Environmental Profile of a Community’s Health observation tool. Study I included under-resourced and socioeconomically disadvantaged sites, one urban and one rural, in a low- (Uganda), middle- (South Africa) and high-income (Sweden) country. Further, twenty-two lower and middle socioeconomic status neighborhoods of Stockholm were mapped in Study II and III. Descriptive and inferential statistical analyses were carried out. Study IV, a scoping review, used the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to analyze and interpret the data on the interaction between personal and external food environments. Results: Across countries, food environments differed in the number of informal outlets present, the most found in Uganda and the least in Sweden. Primarily supermarkets, as well as other stores, were a source of both unhealthy and healthy food items, while advertising unhealthy items in store. Overall, outdoor advertisements of unhealthy foods were the most common and more prevalent in areas of higher socioeconomic disadvantage. Fruits and vegetables had similar prices across countries, though in the Swedish context, these cost less with lower neighborhood socioeconomic status. Structural and social factors like income, time, mobility and children’s preferences influenced the healthiness of foods acquired by immigrants from low-and middle-income countries living in high-income countries. Conclusion: Unhealthy items were both widely prevalent, as well as advertised across settings, at a higher rate in areas of higher disadvantage. Combined with structural and social factors that push consumers towards unhealthy practices, this could exacerbate existing health and nutrition inequities. Further research to better understand the food environment and its interactions with consumers are needed to facilitate healthier choices and improve health

Interactions with the food environment in immigrants from low- and middle-income countries living in high-income countries: a scoping review protocol

A scoping review was conducted to identify relevant literature on the food environment and immigrants in high-income countries; in order to understand the relatively current knowledge, literature published in English on a scientific database between 01 January 2007 to 09 April 2020 was eligible for inclusion. Three electronic databases (EMBASE, PubMed and Web of Science) were used as primary search sources. A scoping review was conducted in order to systematically map the research in the area and to identify gaps in the knowledge. The aim was to understand and characterize the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries

Food environment interactions after migration : a scoping review on low- and middle-income country immigrants in high-income countries

Objective:  To map and characterise the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries. Design:  A scoping review was carried out following the framework outlined by Arksey and O'Malley, as well as Levac et al. Peer-reviewed studies in English published between 2007 and 2021 were included. Two reviewers screened and selected the papers according to predefined inclusion criteria and reporting of results follows the PRISMA-ScR guidelines. A 'Best fit' framework synthesis was carried out using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Setting:  High-income countries. Participants:  Immigrants from low- and middle-income countries. Results:  A total of sixty-eight articles were included, primarily based in the USA, as well as Canada, Australia and Europe, with immigrants originating from five regions of the globe. The analysis identified three overarching themes that interconnected different aspects of the food environment in addition to the four themes of the ANGELO framework. They demonstrate that in valuing fresh, healthy and traditional foods, immigrants were compelled to surpass barriers in order to acquire these, though children's demands, low incomes, time scarcity and mobility influenced the healthiness of the foods acquired. Conclusion:  This study brought together evidence on interactions between immigrant populations and the food environment. Immigrants attempted to access fresh, traditional, healthier food, though they faced structural and family-level barriers that impacted the healthiness of the food they acquired. Understanding the food environment and interactions therein is key to proposing interventions and policies that can potentially impact the most vulnerable

Can Self-Determination Explain Dietary Patterns Among Adults at Risk of or with Type 2 Diabetes? : A Cross-Sectional Study in Socio-Economically Disadvantaged Areas in Stockholm

Type 2 Diabetes (T2D) is a major health concern in Sweden, where prevalence rates have been increasing in socioeconomically disadvantaged areas. Self-Determination Theory (SDT) is posited as an optimal framework to build interventions targeted to improve and maintain long-term healthy habits preventing and delaying the onset of T2D. However, research on SDT, T2D and diet has been widely overlooked in socio-economically disadvantaged populations. This study aims to identify the main dietary patterns of adults at risk of and with T2D from two socio-economically disadvantaged Stockholm areas and to determine the association between those patterns and selected SDT constructs (relatedness, autonomy motivation and competence). Cross-sectional data of 147 participants was collected via questionnaires. Exploratory Factor Analysis was used to identify participants' main dietary patterns. Multiple linear regressions were conducted to assess associations between the SDT and diet behaviours, and path analysis was used to explore mediations. Two dietary patterns (healthy and unhealthy) were identified. Competence construct was most strongly associated with healthy diet. Autonomous motivation and competence mediated the effect of relatedness on diet behaviour. In conclusion, social surroundings can promote adults at high risk of or with T2D to sustain healthy diets by supporting their autonomous motivation and competence