Characterising food environment exposure at home, at work, and along commuting journeys using data on adults in the UK.

BACKGROUND: Socio-ecological models of behaviour suggest that dietary behaviours are potentially shaped by exposure to the food environment ('foodscape'). Research on associations between the foodscape and diet and health has largely focussed on foodscapes around the home, despite recognition that non-home environments are likely to be important in a more complete assessment of foodscape exposure. This paper characterises and describes foodscape exposure of different types, at home, at work, and along commuting routes for a sample of working adults in Cambridgeshire, UK. METHODS: Home and work locations, and transport habits for 2,696 adults aged 29-60 were drawn from the Fenland Study, UK. Food outlet locations were obtained from local councils and classified by type - we focus on convenience stores, restaurants, supermarkets and takeaway food outlets. Density of and proximity to food outlets was characterised at home and work. Commuting routes were modelled based on the shortest street network distance between home and work, with exposure (counts of food outlets) that accounted for travel mode and frequency. We describe these three domains of food environment exposure using descriptive and inferential statistics. RESULTS: For all types of food outlet, we found very different foodscapes around homes and workplaces (with overall outlet exposure at work 125% higher), as well as a potentially substantial exposure contribution from commuting routes. On average, work and commuting environments each contributed to foodscape exposure at least equally to residential neighbourhoods, which only accounted for roughly 30% of total exposure. Furthermore, for participants with highest overall exposure to takeaway food outlets, workplaces accounted for most of the exposure. Levels of relative exposure between home, work and commuting environments were poorly correlated. CONCLUSIONS: Relying solely on residential neighbourhood characterisation greatly underestimated total foodscape exposure in this sample, with levels of home exposure unrelated to levels of away from home exposure. Such mis-estimation is likely to be expressed in analyses as attenuated parameter estimates, suggesting a minimal 'environmental' contribution to outcomes of interest. Future work should aim to assess exposure more completely through characterising environments beyond the residential neighbourhood, where behaviours related to food consumption are likely to occur.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Supermarket Choice, Shopping Behavior, Socioeconomic Status and Food Purchases

Introduction. Both socioeconomic status and supermarket choice have been associated with diet quality. This study aimed to assess the contributions of: (1) supermarket choice and (2) shopping behaviors to (a) the healthfulness of purchases and (b) social patterning in purchases. Methods. Observational panel data on purchases of fruit and vegetables and less healthy foods/beverages from 2010 were obtained for 24,879 households, stratified by occupational social class (analyzed 2014). Households’ supermarket choice was determined by whether they ever visited market-defined high-price and/or low-price supermarkets. Analyses also explored extent of use within supermarket choice groups. Shopping behaviors included trip frequency, trip size, and number of store chains visited. Results. Households using low-price (and not high-price) supermarkets purchased significantly lower percentages of energy from fruit and vegetables and higher percentages of energy from less healthy foods/beverages than households using high-price (and not low-price) supermarkets. When controlling for socioeconomic status and shopping behaviors, the effect of supermarket choice was largely maintained for fruit and vegetables, but reduced for less healthy foods/beverages. The extent of use of low- or high-price supermarkets had limited effects on outcomes. More frequent trips and fewer small trips were associated with healthier purchasing for both outcomes, while visiting more store chains was associated with higher percentages of energy from fruit and vegetables. Conclusions. While both supermarket choice and shopping behaviors influence healthfulness of purchases, neither appeared to contribute to socioeconomic differences. Moreover, differences between supermarket environments may not be primary drivers of the influence of supermarket choice

Socioeconomic inequalities in the healthiness of food choices: Exploring the contributions of food expenditures.

Investigations of the contribution of food costs to socioeconomic inequalities in diet quality may have been limited by the use of estimated (vs. actual) food expenditures, not accounting for where individuals shop, and possible reverse mediation between food expenditures and healthiness of food choices. This study aimed to explore the extent to which food expenditure mediates socioeconomic inequalities in the healthiness of household food choices. Observational panel data on take-home food and beverage purchases, including expenditure, throughout 2010 were obtained for 24,879 UK households stratified by occupational social class. Purchases of (1) fruit and vegetables and (2) less-healthy foods/beverages indicated healthiness of choices. Supermarket choice was determined by whether households ever visited market-defined high-price and/or low-price supermarkets. Results showed that higher occupational social class was significantly associated with greater food expenditure, which was in turn associated with healthier purchasing. In mediation analyses, 63% of the socioeconomic differences in choices of less-healthy foods/beverages were mediated by expenditure, and 36% for fruit and vegetables, but these figures were reduced to 53% and 31% respectively when controlling for supermarket choice. However, reverse mediation analyses were also significant, suggesting that 10% of socioeconomic inequalities in expenditure were mediated by healthiness of choices. Findings suggest that lower food expenditure is likely to be a key contributor to less-healthy food choices among lower socioeconomic groups. However, the potential influence of cost may have been overestimated previously if studies did not account for supermarket choice or explore possible reverse mediation between expenditure and healthiness of choices.The work was supported by the Department of Health Policy Research Programme (http://prp.dh.gov.uk/) (Policy Research Unit in Behaviour and Health [PR-UN-0409-10109]). PM also received support from the Centre for Diet and Activity Research, a United Kingdom Clinical Research Collaboration Public Health Research Centre of Excellence funded by the British Heart Foundation, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust.This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.ypmed.2016.04.012

Socio-economic dietary inequalities in UK adults: an updated picture of key food groups and nutrients from national surveillance data.

Socio-economic differences in diet are a potential contributor to health inequalities. The present study provides an up-to-date picture of socio-economic differences in diet in the UK, focusing on the consumption of three food groups and two nutrients of public health concern: fruit and vegetables; red and processed meat; oily fish; saturated fats; non-milk extrinsic sugars (NMES). We analysed data for 1491 adults (age ≥ 19 years) from the National Diet and Nutrition Survey 2008-2011. Socio-economic indicators were household income, occupational social class and highest educational qualification. Covariate-adjusted estimates for intakes of fruit and vegetables, red and processed meat, and both nutrients were estimated using general linear models. Covariate-adjusted OR for oily fish consumption were derived with logistic regression models. We observed consistent socio-economic gradients in the consumption of the three food groups as estimated by all the three indicators. Contrasting highest and lowest levels of each socio-economic indicator, we observed significant differences in intakes for the three food groups and NMES. Depending on the socio-economic indicator, highest socio-economic groups consumed up to 128 g/d more fruit and vegetables, 26 g/d less red and processed meat, and 2·6% points less NMES (P< 0·05 for all). Relative to lowest socio-economic groups, highest socio-economic groups were 2·4 to 4·0 times more likely to eat oily fish. No significant patterns in saturated fat consumption were apparent. In conclusion, socio-economic differences were identified in the consumption of food groups and one nutrient of public health importance. Aligning dietary intakes with public health guidance may require interventions specifically designed to reduce health inequalities.Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.This is the final version of the article. It first appeared from Cambridge University Press via http://dx.doi.org/10.1017/S000711451400262

Time spent on home food preparation and indicators of healthy eating.

BACKGROUND: The amount of time spent on food preparation and cooking may have implications for diet quality and health. However, little is known about how food-related time use relates to food consumption and spending, either at restaurants or for food consumed at home. PURPOSE: To quantitatively assess the associations among the amount of time habitually spent on food preparation and patterns of self-reported food consumption, food spending, and frequency of restaurant use. METHODS: This was a cross-sectional study of 1,319 adults in a population-based survey conducted in 2008-2009. The sample was stratified into those who spent 2 hours/day on food preparation and cleanup. Descriptive statistics and multivariable regression models examined differences between time-use groups. Analyses were conducted in 2011-2013. RESULTS: Individuals who spent the least amount of time on food preparation tended to be working adults who placed a high priority on convenience. Greater amount of time spent on home food preparation was associated with indicators of higher diet quality, including significantly more frequent intake of vegetables, salads, fruits, and fruit juices. Spending <1 hour/day on food preparation was associated with significantly more money spent on food away from home and more frequent use of fast food restaurants compared to those who spent more time on food preparation. CONCLUSIONS: The findings indicate that time might be an essential ingredient in the production of healthier eating habits among adults. Further research should investigate the determinants of spending time on food preparation.This work was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (grant No. R01 DK076608). Pablo Monsivais also received support from the Centre for Diet and Activity Research, a UKCRC Public Health Research Centre of Excellence funded by the British Heart Foundation, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust.This is the final version. It was first published by Elsevier in The American Journal of Preventive Medicine at http://www.ajpmonline.org/article/S0749-3797%2814%2900400-0/abstract

Potential population-level nutritional impact of replacing whole and reduced-fat milk with low-fat and skim milk among US children aged 2-19 years.

OBJECTIVE: Dietary guidance emphasizes plain low-fat and skim milk over whole, reduced-fat, and flavored milk (milk eligible for replacement [MER]). The objective of this study was to evaluate the population-level impact of such a change on energy, macronutrient and nutrient intakes, and diet cost. DESIGN: Cross-sectional modeling study. SETTING: Data from the 2001-2002 and 2003-2004 National Health and Nutrition Examination Survey. PARTICIPANTS: A total of 8,112 children aged 2-19 years. MAIN OUTCOME MEASURES: Energy, macronutrient, and micronutrient intake before and after replacement of MER with low-fat or skim milk. ANALYSIS: Survey-weighted linear regression models. RESULTS: Milk eligible for replacement accounted for 46% of dairy servings. Among MER consumers, replacement with skim or low-fat milk would lead to a projected reduction in energy of 113 (95% confidence interval [CI], 107-119) and 77 (95% CI, 73-82) kcal/d and percent energy from saturated fat by an absolute value of 2.5% of total energy (95% CI, 2.4-2.6) and 1.4% (95% CI, 1.3-1.5), respectively. Replacement of MER does not change diet costs or calcium and potassium intake. CONCLUSIONS: Substitution of MER has the potential to reduce energy and total and saturated fat intake with no impact on diet costs or micronutrient density. The feasibility of such replacement has not been examined and there may be negative consequences if replacement is done with non-nutrient-rich beverages.This research was commissioned by the RobertWood Johnson Foundation through its Healthy Eating Research program. Additional support for this project came from National Institutes of Health grant R21 DK085406. Pablo Monsivais also received support from the Centre for Diet and Activity Research, a United Kingdom Clinical Research Collaboration Public Health Research Centre of Excellence funded by the British Heart Foundation, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust.This is the final published version. It first appeared at http://www.sciencedirect.com/science/article/pii/S1499404614007556#

Area deprivation and the food environment over time: A repeated cross-sectional study on takeaway outlet density and supermarket presence in Norfolk, UK, 1990-2008.

Socioeconomic disparities in the food environment are known to exist but with little understanding of change over time. This study investigated the density of takeaway food outlets and presence of supermarkets in Norfolk, UK between 1990 and 2008. Data on food retail outlet locations were collected from telephone directories and aggregated within electoral wards. Supermarket presence was not associated with area deprivation over time. Takeaway food outlet density increased overall, and was significantly higher in more deprived areas at all time points; furthermore, socioeconomic disparities in takeaway food outlet density increased across the study period. These findings add to existing evidence and help assess the need for environmental interventions to reduce disparities in the prevalence of unhealthy food outlets.Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, (ES/G007462/1), and the Wellcome Trust, (087636/Z/08/Z), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.This is the final published version. It first appeared at www.sciencedirect.com/science/article/pii/S1353829215000325

Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual Agency.

Jean Adams and colleagues argue that population interventions that require individuals to use a low level of agency to benefit are likely to be most effective and most equitable.his work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding for CEDAR from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The CEDAR grant is managed by the Medical Research Council (grant code MR/K023187/1) and the principal applicant is Prof NJ Wareham (who is not an author on this paper). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.This is the final version of the article. It first appeared from PLOS via http://dx.doi.org/10.1371/journal.pmed.1001990

Liberalising agricultural policy for sugar in Europe risks damaging public health.

Concerns about the health effects of dietary sugars have recently taken centre stage, reflecting an emerging understanding of the importance of sugars, and particularly sugary drinks, in the development of obesity and diabetes.1-4 Recent research estimates consumption of sugar sweetened beverages will cause about 80,000 excess cases of type 2 diabetes in the UK over 10 years. In early 2015, the World Health Organization recommended intake of free sugars should be less than 10% of daily calories, and preferably below 5%. In July, the UK Scientific Advisory Committee on Nutrition halved its recommendation for free sugars to no more than 5% of daily caloriesThis work was undertaken by the Centre for Diet and Activity Research (CEDAR, MR/K023187/1), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. EKA was also supported by Fulbright-Schuman grant and a Harvard Knox Fellowship from Harvard University