Objective: Urban agriculture (UA), the growing of fruits and vegetables in urban and peri-urban areas, has potential as a means of improving food security, public health and dietary quality on both a broad and personal scale. However, there is little research on the relationship between UA and diet, and potential mediating factors are also unclear. The purpose of this study was to assess if proximity to and engagement with UA is associated with healthy and sustainable dietary choices and what accounts for this relationship.

Methods: UK-based adults (N=583, 69% Female) completed measures of proximity to and engagement with UA, perceived access to fruits and vegetables, health and ethical food motivations, connection with nature, psychological distress and dietary quality in an online survey. Participants were recruited from UA-related groups and the general public. The study protocol and analysis plan were preregistered via Open Science Framework: https://osf.io/4zrhy/

Results: Proposed relationships were analysed using a structural equation model (CFI=.948, IFI=.949, NFI=.932, RMSEA=.070, SRMR=0.719). Greater proximity to and engagement with UA was associated with greater perceived access to fruits and vegetables (B=.017, SE=.004, p<.001), more health-related food choice motivations (B=.003, SE=.001, p<.001), more ethical-related food choice motivations (B=.008, SE=.001, p<.001), feeling more connected with nature (B=.009, SE=.001, p<.001) and, unexpectedly, with greater psychological distress (B=.032, SE=.014, p=.027). More health-related food choice motivations were, in turn, associated with better diet quality (B=2.541, SE=.515, p<.001), as was more ethical food choice motivations (B=.887, SE=.431, p=.039). The direct pathway between proximity to and engagement with UA and diet quality (i.e. not including the mediators) was not significant (p=.665).

Conclusions: Results indicate that proximity to and engagement with UA is associated with better dietary quality, and this was partly explained by healthier and ethical food choice motivations. Upscaling UA may have benefits for dietary quality via these factors, and more research is needed to test these causal relationships and to understand these complex interactions.

Purpose: In many high-income countries people living in regional areas have higher rates of chronic disease compared to people living in urban areas, with diet a known contributor to these inequities. Food purchasing provides a potential pathway linking residential location with dietary intake and health outcomes. Little is known about geographic differences in food purchasing behaviours. This study examined the relationship between geographic location and food expenditure on a range of foods. This is the first known Australian study to examine the relationship between geographic location and food expenditure.

Methods: Data from the 2015-16 Australian Household Expenditure Survey (n=9827) was used to examine weekly household food expenditure and proportion of total food expenditure on fourteen categories of food items. Foods were classified using the Australian Guide to Healthy Eating. Two-part models and zero-one inflated beta regression models were used to assess the association between geographic area and food expenditure.

Results: Average fruit expenditure was more for households located in major cities ($13.35, 95% CI = 12.28;14.41) compared to households located in inner regional ($11.81, 95% CI = 10.67;12.96) and outer regional areas ($11.31, 95% CI = 10.13;12.48). Furthermore, compared with households located in major cities, households located in inner and outer regional areas spent less on fresh fruit, fish and meals out. Households located in outer regional areas spent less on all core foods except meat. Households located in inner regional areas spent more on sweet cakes, biscuits, puddings, desserts, chocolate and ice-cream compared to households located in major cities and outer regional areas.

Purpose: While walkable neighbourhoods are beneficial for active living, some adverse associations between walkability and cardio-metabolic health indicators have been reported. Potential explanations include detrimental health impacts of other behaviours that may take place in walkable neighbourhoods, such as dietary behaviours. Since walkable neighbourhoods have more commercial destinations, residents of such neighbourhoods may have easy access to unhealthy food outlets. We examined the association of walkability with energy intake; and, potential moderating effects of area-level socioeconomic status (SES) on this association, given that accessibility of unhealthy food outlets have been found different by area-level SES.

Methods: We used the 2011–12 wave of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab3) data from 2,354 participants (54% women, mean age = 63.0 years) who had not changed their residential locations since the 1999-2000 baseline survey. The outcome variable was daily energy intake (kJ/day) assessed using a food frequency questionnaire, and higher values reflected the consumption of energy-dense foods. A walkability index was calculated, using dwelling density, intersection density, and destination density, all within 1 km street-network buffer around participants’ residence. Area-level SES was determined from Census data. Multilevel linear models estimated main and interaction effects.

Results: The average energy intake was 7087.8 kJ/day. After adjusting for potential confounders, walkability was not associated with energy intake (b= -81.8 kJ/day, p = 0.154). We found statistically significant interactions of walkability and area-level SES with energy intake (p = 0.003). Higher walkability was associated with lower energy intake in high SES areas (b= -276.4 kJ/day, p = 0.055), whereas higher walkability was associated with greater energy intake in low SES areas (b= 433.4 kJ/day, p = 0.018). 

Conclusions: These findings suggest that dietary behaviours may also contribute partially to the relationship of walkability with cardio-metabolic health. However, the role of dietary behaviours may differ by area-level SES. The development of walkability-focused strategies to reduce the burden of cardio-metabolic diseases should take into account multiple health behaviours, which may differentially influence the disease risk.

PURPOSE

Within the United States, food pantries are one support service for food insecure individuals to obtain food at no cost. Many individuals experiencing food insecurity have compromised diet quality which can lead to poor health. There is support that the broader consumer nutrition environment (CNE) of the pantry can influence patrons’ food selections and could play a role in addressing dietary quality. This research describes the implementation and adoption of recommended policy, system, and environmental (PSE) supports that influence the pantry CNE, specifically using a validated assessment tool, Nutrition Environment Food Pantry Assessment Tool (NEFPAT). While others have described adoption of specific recommendations qualitatively, this research quantitatively describes the implementation and adoption across multiple recommendations for a statewide network of pantries. 

METHODS

The study included a sample of pantries in Illinois that were interested in receiving programming support in FY2019. The repeated measures design included a baseline NEFPAT assessment, support to implement PSE interventions, and NEFPAT post-assessment. The NEFPAT measured the implementation of recommended practices, scored as one point for each practice (total = 47). Pantries self-selected into the intervention, consisting of technical assistance, where adopted recommended practices were logged into a database.

RESULTS

61 pantries completed a baseline assessment, scores ranged from 9-40 (Mean 22.62). 233 recommended changes were adopted across 54% of pantries. The greatest frequency of adopted recommendations was at the supply-level or using promotion tactics. Policy adoption was most infrequent (n=16). 31 pantries completed a post-intervention assessment, scores ranged from 16-41 (Mean 28.45), for an average score improvement of 5.83.

CONCLUSION

Overall there was modest implementation of recommended practices within the CNE for study pantries. During the intervention, pantries were most likely to adopt supply-level and promotion practices in the CNE. The higher adoption of these practices may indicate they are more feasible for pantries to implement.  As changes across PSE levels are important to improve the CNE, this information of pantry uptake will empower implementation support staff to understand which recommendations to first implement before engaging on more complex levels. More pantries adopting various PSE practices could greatly impact the diet quality of pantry clients.

Purpose: To examine changes in NSW hospital staff and visitors’ food purchasing behaviour following the introduction of an innovative state-wide policy, which aimed to increase the availability and promotion of healthy food for sale in NSW hospitals.

Methods: Two repeated cross-sectional surveys were conducted in 10 randomly selected NSW hospitals in March-May 2018 and again in April-June 2019, following the target date for initial implementation (1 January 2019). The time period represented the initial phase of an ongoing intervention. Interviewer-administered intercept surveys were conducted with hospital staff and visitors at hospital entrances and main cafés, including questions on awareness, support, and usual purchasing behaviour, and observations of foods purchased (café only). Food items were coded as ‘Everyday’ (healthy) or ‘Occasional’ (unhealthy). Mixed effects logistic regression analyses explored the difference in ‘Everyday’ food items purchased over the initial intervention period, controlling for sex, staff/visitor status, age group and education.

Results: Most staff (91.1%) and visitors (89.8%) supported the policy. There were significant increases over the study period in awareness of the policy, for both staff (29.3% vs 59.2%; p<0.0001) and visitors (15.8% vs 34.9%; p<0.0001), and for staff, noticing more healthy food items for sale (38.0% vs 57.5%; p=0.0007).

Of 3,551 food purchases observed, the proportion of ‘Everyday’ items increased slightly in this period (56.3% vs 59.2%; p=0.3). ‘Everyday’ purchases increased slightly for snack items (36.0% vs 40.0%; p=0.5), hot meal items (55.9% vs 57.4%; p=0.4), and cold meal items (85.3% vs 91.6%; p=0.1). Visitors, younger adults (18-35 years), and non-tertiary educated participants were significantly less likely to purchase ‘Everyday’ food items than staff (OR 0.8 95%CI 0.7-0.9), older adults (aged 55+) (OR 0.7 95%CI 0.6-0.9), and tertiary educated participants (OR 0.7 95%CI 0.6-0.8), respectively.

Conclusions: This study shows promising short-term impacts of a policy implemented at scale, with significantly increased staff and visitor awareness of more healthy food availability, and a slight increase in ‘Everyday’ food item purchases. Longer-term follow-up is recommended, with continued efforts targeting ‘Everyday’ healthy food availability and promotion.

Purpose: Sugar-sweetened beverage (SSB) availability is a key driver of SSB consumption, and in turn, non-communicable diseases (NCDs), including obesity, type 2 diabetes and dental caries. Most Pacific Island Countries and Territories (PICTs), including Tonga, are in the midst of a NCD crisis. Little is known about Tongan children’s SSB availability and consumption. Using wearable cameras, this study aimed to objectively assess the nature of the drinks available to, and consumed by, Tongan children from the capital Nuku’alofa and the island of Ha'apai, which is less impacted by westernisation.

Methods: In 2016-17, 38 randomly-selected children (aged 11y) from Nuku’alofa (n=19) and Ha’apai (n=19) wore wearable cameras that captured images every 7s over three days (Friday – Sunday). Image data were coded and analysed using content analysis to determine drink type, and the children’s daily beverage availability and consumption. Tongan researchers led the research in partnership with the Tonga government. 

Results: On average, drink availability was higher for children from Nuku’alofa (12.0 (95% CI 9.8, 14.8) than from Ha’apai (6.9 (95% CI 5.7, 8.5). Significantly more non-core drinks (predominantly SSBs) were available to Nuku’alofa children (4.9 (95% CI 3.4, 7.1)/day) than Ha’apai children (1.2 (95% CI 0.8, 1.8)/day). Reflecting this difference, children from Nuku’alofa consumed 0.7 (95% CI 0.4, 1.2) non-core drinks/day and Ha’apai children consumed 0.5 (0.3, 0.8) non-core drinks/day. Non-core drinks were most commonly available at the fale koloa (convenience store), home and supermarket; they were also available in schools.

Conclusion: SSB availability and consumption is higher among Tongan children from Nuku’alofa, than from Ha’apai, an island. SSBs were available in all locations in which the children spent time. The findings suggest the impact of westernisation in Tonga. They support efforts by the Tonga government to implement healthy drink policies, and to maintain/increase taxes on, and/or ban the importation of, sugary drinks, and provide evidence for Tonga’s new NCD Strategy 2020-25. The findings also support the implementation of the Pacific Legislative Framework for NCDs and are likely relevant to other PICTs.