Recurrent Flooding and Household Food Access in Central Java, Indonesia.

It is unknown how recurring flooding impacts household diet in Central Java. We aimed to assess how recurrent flooding influenced household food access over 22 years in Central Java by linking the Global Surface Water dataset (GSW) to the Indonesian Family Life Survey. We examined linear and nonlinear relationships and joint effects with indicators of adaptive capacity. We measured recurrent flooding as the fraction of district raster cells with episodic flooding from 1984-2015 using GSW. Food access outcomes were household food expenditure share (FES) and dietary diversity score (DDS). We fit generalized linear mixed models and random forest regression models. We detected joint effects with flooding and adaptive capacity. Wealth and access to credit were associated with improved FES and DDS. The effect of wealth on FES was stronger in households in more flood-affected districts, while access to credit was associated with reduced odds of DDS in more flood-affected districts. Flooding had more predictive importance for FES than for DDS. Access to credit, a factor that ordinarily improves food access, may not be effective in flood-prone areas. Wealthier households may be better able to adapt in terms of food access. Future research should incorporate land use data to understand how different locales are affected and further understand the complexity of these relationships.

Navigating the online food environment: policy pathways for promoting food access, transparency, and healthy food choices online.

The internet is drastically changing how U.S. consumers shop for groceries, order food from restaurants, and interact with food marketing. There is an urgent need for new policies to help ensure that the internet is a force for good when it comes to food access, transparency, and nutrition. This article outlines actions that federal agencies-like the U.S. Department of Agriculture (USDA), U.S. Food and Drug Administration (FDA), and Federal Trade Commission (FTC)-and state and local governments can take to improve the online food environment. We recommend policies in three settings: online grocery retail, online restaurant ordering, and marketing on social media and other online platforms. For example, USDA could finalize regulations increasing access to online WIC and remove barriers to accessing online SNAP by requiring large retailers to waive online delivery and service fees for SNAP purchases. FDA could improve access to nutrition information by issuing guidance describing what product information should be available at the online point of selection. FTC could give better guidance on appropriate tactics when marketing to children and collect better data on how companies are marketing food to children online. Finally, state governments could pass laws like New York's recently introduced Predatory Marketing Prevention Act to address false and misleading advertising of unhealthy foods aimed at children and other vulnerable groups.

Exploring the Association Between Minimum Wage Policy, Income Inequality, and Obesity Rates in US Counties.

OBJECTIVE: To examine the interaction between minimum wage policy, income inequality, and obesity rates among U.S. counties, and how this relationship is shaped by policy, place, and racial/ethnic composition in a county. METHODS: We used the County Health Rankings Data for obesity ratio (measured by Body Mass Index ≥ 30 kg/m2) in US counties and combined it with the American Community Survey to include the Gini coefficient (GC) and population characteristics. The analytical sample included 3129 counties between 2015 and 2019. We ran several sets of regression analyses, controlling for county characteristics, access to healthy foods, and minimum wage categories as a policy influencer on the obesity ratio. RESULTS: In total, 31.7% of the population were obese, with wide variations across counties; during this time, counties' average GC was 0.442. Our findings showed that in the lack of any other predictors, GC has a positive association with the county obesity ratio (OLS 0.147, CI 0.122-0.173). Counties with minimum wage between $7.26-$9.0 and $9 + had lower obesity ratios by - 0.6 and - 2.8 percentage points, respectively, and counties with lower access to healthy foods had higher obesity ratio (Coeff = 0.022, CI 0.019-0.025). CONCLUSIONS: Income inequality is positively associated with the obesity ratio in counties. Access to healthy foods and state minimum wage policy predict obesity rates, with a lack of healthy foods increasing the ratio, while a higher minimum wage reduces it.

Monitoring the Cost and Affordability of a Healthy Diet within Countries: Building Systems in Ethiopia, Ghana, Malawi, Nigeria, Pakistan, Tanzania, and Viet Nam.

Background: Governments around the world collect food price data on a frequent basis, often monthly, for the purpose of monitoring inflation. These routine economic data can be used with a nutrition-sensitive lens for understanding economic access to a healthy diet. The Food and Agriculture Organization of the United Nations has adopted the cost and affordability of a healthy diet (CoAHD) for annual tracking alongside other food security indicators. This indicator is relevant in many countries for informed decision-making and accountability toward Food Systems Summit pathways. National governments may wish to include this indicator in their own monitoring systems, using existing subnational price and income data. Objectives: We describe emerging systems in several countries for monitoring CoAHD and analytical tools that facilitate the calculation of CoAHD. We discuss reasons why the indicator may differ when calculated using subnational data compared with the global monitoring system and how to interpret differences. Methods: Between June 2016 and February 2024, 19 workshops were held in 7 countries (Ethiopia, Ghana, Malawi, Nigeria, Pakistan, Tanzania, and Viet Nam), where stakeholder discussions covered sources of food price data, institutions involved, policy uses, and direct training in calculation of CoAHD. Food price data collected by national organizations were used to calculate CoAHD in partnership with government agencies. Results: Calculating CoAHD using subnational data uses the same methods across settings, but the mechanisms for monitoring and dissemination are different in each country, illustrating heterogeneity in how the metric can most effectively be incorporated within existing structures. Results from national and global monitoring systems have expected differences based on data sources, healthy diet standards, and affordability standards. Conclusions: CoAHD can be calculated with existing data and resources, facilitated by new software tools and user tutorials. In the future, it can be further streamlined, leveraging technical assistance from global institutions and aligning national and global monitoring systems.

Perceived Food-Related Responsibilities Among Adults Aged 60 Years and Older.

Food citizenship states individuals, organizations, and governments have responsibilities for their actions and policies around food. We conducted twenty semi-structured interviews with older adults as an exploratory study about perceived food-related responsibilities. The government and agribusiness were seen as responsible for food safety and how healthy foods are. The government, agribusiness, and emergency food providers were seen as responsible for availability and accessibility. Individuals were seen as having a personal responsibility to access and choose healthy, safe foods. These results have important implications for understanding how older adults think about the roles themselves and others play in the food system.

Dietary Restriction, Socioeconomic Factors, Access to Kidney Transplantation, and Waitlist Mortality.

INTRODUCTION: Dietary restrictions for patients with end-stage kidney disease (ESKD) are burdensome. Kidney transplantation (KT) candidates who lack neighborhood resources and are burdened by dietary restrictions may have decreased access to KT. METHODS: In our two-center prospective cohort study (2014-2023), 2471 ESKD patients who were evaluated for KT (candidates) reported their perceived burden of dietary restrictions (not at all, somewhat/moderately, or extremely bothered). Neighborhood-level socioeconomic factors were derived from residential ZIP codes. We quantified the association of perceived burden of the dietary restrictions with a chance of listing using Cox models and risk of waitlist mortality using competing risks models. Then we tested whether these associations differed by neighborhood-level socioeconomic factors. RESULTS: At evaluation, 18% of KT candidates felt extremely bothered by dietary restrictions. Those who felt extremely bothered were less likely to be listed for KT (adjusted hazard ratio [aHR] = 0.75, 95% confidence interval [CI]: 0.64-0.87); this association did not differ by neighborhood-level socioeconomic factors. Overall, the burden of dietary restrictions was not associated with waitlist mortality (p = 0.62). However, among candidates living in high food insecurity neighborhoods, those who felt extremely bothered had higher waitlist mortality (adjusted subhazard ratio [aSHR] = 2.07, 95% CI: 1.14-3.75, p[interaction] = 0.02). The association between dietary burden and waitlist mortality did not differ by neighborhood-level healthy food access. CONCLUSION: The perceived burden of dietary restrictions is associated with a lower chance of listing for KT, and higher waitlist mortality only among candidates residing in neighborhoods with high food insecurity. Transplant centers should identify vulnerable patients and support them with nutrition education and access to food assistance programs.

Perspective: Food Access at Dollar Stores and its Implications for Public Health: Report of a Workshop on Identifying Research Priorities.

The rapid growth of dollar stores as retail sources of food in the United States is a phenomenon with implications for diets, nutrition, and well-being. We convened a broadly interdisciplinary group of researchers and experts from government and academia at the 2-day Food Access at Dollar Stores (FADS) workshop, held in Boston, MA in 2022. The event brought together economists, social scientists, public health researchers and advocates to discuss the concerns and research questions raised by the growth of dollar stores, and their increased role in food retail and access. In-person, moderated discussions on day two of the workshop generated a range of topics considered important for future research. A subsequent survey, using a modified Delphi approach, identified priority research areas. Nine research area categories emerged as a result of discussion at the FADS workshop and received prioritization from the experts: Local Community Impacts; Health and Nutrition Impacts; Policy and Programs; Systemic Issues - Racism, Poverty, and Food Access; Store Offerings and Locations; Shoppers and Customers; Employees and Employment; Corporate Distribution, Strategy, and Marketing; and Dollar Stores vs. Other Food Sources. The growth of dollar stores as food retailers remains an under-researched area of study for food access and nutrition that requires interdisciplinary expertise and collaboration to understand. STATEMENT OF SIGNIFICANCE: Dollar stores have grown rapidly as food retailers in the United States over the past decade. This work reports the findings of a research workshop and provides a roadmap for prioritizing research topics and tools related to understanding the public health, equity and economic impacts of this important change in how many consumers are accessing food.

Caregiver-reported barriers to engagement in a paediatric fresh fruit and vegetable prescription programme.

Paediatric fruit and vegetable prescription programmes hold promise in improving food security and dietary patterns among youth. However, programme success is largely dependent upon caregiver and family engagement. The current study sought to gain a better understanding of environmental barriers to engagement in a paediatric fruit and vegetable prescription programme in one low-income, urban community (Flint, Michigan, USA). Following the implementation of a paediatric fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers explored caregivers' understanding of the fruit and vegetable prescription programme, barriers to programme engagement, and recommendations for improvement. Telephone interviews were transcribed for textual analysis. Researchers used thematic analysis to examine qualitative data, determine patterns across transcripts, and develop emerging themes. Researchers concluded interviews when data saturation was reached. The majority of participants were female (94%), African American (66%), and residents of Flint (72%). Five recurrent themes emerged: (1) nutrition security; (2) prescription distribution; (3) prescription redemption; (4) educational supports; and (5) programme modifications. Although caregivers indicated that the prescription programme addressed household food insecurity, environmental barriers to engagement were apparent. Caregivers provided suggestions, such as partnering with large grocery stores and developing digital prescriptions, to address programme engagement challenges. Fundamental to the success of fruit and vegetable prescription programmes is the understanding of barriers to engagement from the perspective of participants. This study explores challenges with one paediatric fruit and vegetable prescription programme and provides actionable solutions, from the viewpoint of caregivers, to address these challenges.

Prevalence of household food insecurity and its association with food waste.

BACKGROUND: Household food waste significantly contributes to overall food waste. While the relationship between food security and food waste has been extensively studied at the macro level, there is a need for research focusing on the quantitative association between food security and food waste at the household level in developing countries, particularly in Southeast Asia. This study aims to estimate the prevalence of household food insecurity and household food waste and to examine the association between household food security and food waste using direct measurements. SUBJECTS AND METHODS: A total of 215 households in Bogor Regency, Indonesia, participated in this cross-sectional study. Food waste was measured using waste composition analysis and a 7-day diary. The Food Insecurity Experience Scale (FIES) questionnaire was used to assess household food security, while household income and the proportion of food expenditure were considered confounding factors. The association between food security and food waste was examined using Kendall tau-b and ordinal logistic regression. RESULTS: The prevalence of household food insecurity was 18.6%, and the average household food waste was 77 kg/cap/year. Cereals, tubers, and their derivatives (especially rice) and vegetables were major contributors to edible waste, while fruits dominated inedible waste. A negative association was observed between food waste and household food security (edible FW: p = 0.044, r = -0.110; total FW: p = 0.038, r = -0.114), suggesting that household food waste decreases as the severity of food insecurity increases. However, after adjusting for household income, the proportion of food expenditure, and the education levels of spouses, this association became statistically insignificant (p > 0.05). CONCLUSION: There was no significant association between household food security status and food waste. Household income plays a significant role in determining the quantity of household food waste, as higher income is associated with increased food waste. Strategies to prevent and reduce food waste should focus on major contributors such as rice and vegetables, especially among families with higher food accessibility.

Individual- and environmental-level determinants of fruit and vegetable intakes in rural Georgia.

OBJECTIVE: To investigate the ways in which food insecurity, food acquisition behaviors, and perceived and objective food access influence fruit and vegetable intakes among rural Georgians. DESIGN: A population-based survey was merged with USDA's Food Access Research Atlas, and multilevel modeling was used to determine individual-level (eg, food insecurity, food acquisition behaviors, perceived access) and environmental-level (eg, census tract food access) predictors of fruit and vegetable intakes. SETTING: Twenty-four rural census tracts in 6 counties in Georgia, USA. PARTICIPANTS: One thousand four hundred and seventy-four adults. RESULTS: Residing in a low food access census tract was not associated with fruit or vegetable intake. Food insecurity had negative effects on both fruit and vegetable intakes. Perceived access to fresh fruits and vegetables was positively associated with fruit intake, and obtaining fresh fruits and vegetables from community or home gardens was positively associated with both fruit and vegetable intakes. CONCLUSIONS: Findings are unique from previous research on census tract-level fruit and vegetable determinants, underscoring the need for a better understanding of influences on fruit and vegetable intakes among rural populations. Interventions to increase fruit and vegetable consumption in rural areas should prioritize food security.

Barriers and Enablers for Equitable Healthy Food Access in Baltimore Carryout Restaurants: A Qualitative Study in Healthy Food Priority Areas.

Black neighborhoods in the U.S., historically subjected to redlining, face inequitable access to resources necessary for health, including healthy food options. This study aims to identify the enablers and barriers to promoting equitable healthy food access in small, independently owned carryout restaurants in under-resourced neighborhoods to address health disparities. Thirteen in-depth interviews were conducted with restaurant owners in purposively sampled neighborhoods within Healthy Food Priority Areas (HFPAs) from March to August 2023. The qualitative data were analyzed using inductive coding and thematic analysis with Taguette software (Version 1.4.1). Four key thematic domains emerged: interpersonal, sociocultural, business, and policy drivers. Owners expressed mixed perspectives on customers' preferences for healthy food, with some perceiving a community desire for healthier options, while others did not. Owners' care for the community and their multicultural backgrounds were identified as potential enablers for tailoring culturally diverse menus to meet the dietary needs and preferences of their clientele. Conversely, profit motives and cost-related considerations were identified as barriers to purchasing and promoting healthy food. Additionally, owners voiced concerns about taxation, policy and regulation, information access challenges, and investment disparities affecting small business operations in HFPAs. Small restaurant businesses in under-resourced neighborhoods face both opportunities and challenges in enhancing community health and well-being. Interventions and policies should be culturally sensitive, provide funding, and offer clearer guidance to help these businesses overcome barriers and access resources needed for an equitable, healthy food environment.

Validation of secondary data sources of the retail food environment in the capital of Uruguay, an emerging Latin American country.

Secondary data sources are frequently used for characterizing physical access to food. Although several studies have reported that they tend to show a moderate agreement with field observation in WEIRD (Western Educated Industrialized Rich and Democratic) countries, little is known about their validity in non-WEIRD countries. The aim of the present research was to assess the validity of secondary data sources of the retail food environment in Montevideo, the capital of Uruguay, an emerging Latin American country. A random sample of 106 census tracts was obtained, covering 12% (62 km2) of the city's total area. Two secondary data sources were considered: administrative records and Google Maps. An aggregate database was created by manually removing duplicates. A total of 1051 unique outlets were listed in the database within the census tracts included in the sample. Field validation was performed by six teams of two observers. A total of 1200 food outlets were identified on the ground, including 463 (38.6%) outlets not listed on any database. On the contrary, 297 outlets listed in the databases (28.3%) were not found or were closed at the time of field validation. At the aggregate level, sensitivity and concordance were moderate (0.614 and 0.487, respectively), whereas positive predictive value was substantial (0.701). However, large heterogeneity in the validity of the database across census tracts was found. Sensitivity, positive predictive value, and concordance were positively associated with the socio-economic status index of the census tract. These results suggest that secondary data sources must be used with caution, particularly for the characterization of areas with low socio-economic status.

Social support for food access and budget construction predict food insecurity among university sophomores.

Background: Food insecurity means having limited or uncertain access to an adequate, nutritious, and safe diet. Rates among US college students range from 10% to 75%, and the problem is associated with mental and physical health disorders and unfavorable academic outcomes. Aims: This study examined the associations between the food security status of sophomores attending a university in the Southeastern US and their need for social support, food access behaviors, and budgeting knowledge. Methods: Data were collected during the spring 2019 semester using an online questionnaire. Food security was measured using the United States Department of Agriculture (USDA) Food Security Survey, and the independent variables were measured from scales grounded in pertinent literature. Descriptive and inferential procedures were applied, and significance was p ≤ 0.05. Results: Participants were 222 sophomores (75% female and 85% white). Food insecurity was 46.4%, and significant predictors (p < 0.001) were need for social support accessing food and the requested educational activity "learning how to make a budget." Mean budgeting knowledge scores of food secure and insecure students, respectively, were 11.5 ± 1.8 versus 11.1 ± 2.4 (p = 0.42) out of 14 points. Food access behaviors used "sometimes" or "often" by food secure and insecure sophomores included buying food on sale and buying the store brand of a food, while creating a budget that includes food purchases and getting free food from food pantries were "seldom" or "never" used. Conclusions: Food insecurity was high. Learning activities, such as budgeting education, should be tested as strategies for decreasing food insecurity.

The Impact of Living in a Low Food Access/Low Income Area on Obstructive Sleep Apnea.

OBJECTIVE: To assess differences in obstructive sleep apnea (OSA)-related health parameters between residents of low income/low access (LILA) census tracts-food deserts-and non-LILA residents STUDY DESIGN: Retrospective review. SETTING: Single institution serving a large region in Southern California from 2017 to 2023. METHODS: Census tracts are defined as LILA if a significant proportion of residents live below the poverty threshold and far from healthy food vendors. Adults newly diagnosed with OSA on polysomnography were included. Food access status was determined by searching patient addresses in the US Department of Agriculture Food Access Research Atlas. Baseline and 1-year follow-up body mass index (BMI) and vitals were collected and compared based on food access and other demographic variables. RESULTS: A total of 379 patients in the LILA+ group and 2281 patients in the LILA- group met inclusion criteria. BMI was higher in the LILA group (36.6 ± 9.4 vs 35.2 ± 8.9; P = .006). The effect of food access was most significant in certain demographic groups: patients aged < 65, males, Asian/Pacific Islanders, Hispanics, and patients with Medicaid coverage all had a higher BMI when in the LILA+ group compared to the LILA- group. When considering insurance, LILA+ patients with Medicaid coverage had a significantly higher BMI than LILA- patients with non-Medicaid coverage (40.4 ± 10.3 vs 34.2 ± 8.4, P < .001. Blood pressure, heart rate, and apnea-hypopnea index were also significantly higher in LILA+/Medicaid group. BMI change across all demographic groups was minimal at 1-year follow-up. CONCLUSION: Living in a LILA census tract may result in worse OSA-related health parameters. When accounting for insurance status, the effects are even more profound. Intensive counseling on the importance of weight management should begin at the diagnosis of OSA.

Food Shopping Strategies Among a Diverse Sample of East Harlem Residents: A Qualitative Study.

PURPOSE: To inform food retail interventions, this study explored food shopping strategies employed by people constrained by limited budgets but residing in an urban environment offering numerous retail options. APPROACH: Qualitative study incorporating semi-structured interviews and shop-alongs. SETTING: East Harlem, New York City. PARTICIPANTS: 37 East Harlem residents participated in interviews, of whom 15 participated in shop-alongs. METHODS: Interviews and shop-alongs were conducted in English, Spanish, and Mandarin Chinese. Interview transcripts were analyzed using a grounded theory approach. Data from shop-alongs were used to supplement interview findings. RESULTS: Participants shopped 1-2 times at an average of 4 retail locations per week. Two key themes emerged: (1) planning trips and choosing venues; and (2) shopping experiences and perceptions of stores. Price was the primary driver of store choice, followed by product quality and variety. Substantial time was invested in shopping. Most English- and Spanish-speaking participants shopped in East Harlem. Chinese American participants shopped in Chinatown due to language concordance, availability of culturally-preferred foods, and proximity to other services. CONCLUSION: East Harlem residents invested substantial planning, time and effort in food shopping to acquire sufficient food for their households on limited budgets. These findings offer insight into how residents interact with food environments and key drivers of decision-making about food shopping that affect decisions about where to shop and what to purchase.

"Just Food doesn't Do It": Understanding Food Insecurity Among Rural Veterans in the United States.

Food security among rural veteran populations is an understudied subject. This study uses qualitative data from 106 semi-structured interviews conducted with staff from programs at the United States Department of Veterans Affairs (VA) and other federal agencies, staff from non-governmental organizations (NGOs), food security researchers, and food insecure veterans to identify the barriers to and facilitators for rural veteran food security. Barriers identified included external, structural barriers that exist in rural areas; internal barriers to using food assistance, such as feeling stigmatized; and barriers related to other social determinants of health, including a lack of education, employment, or housing stability.

Understanding the relationship between limited neighbourhood food access and health outcomes of children with obesity.

BACKGROUND: Childhood obesity is a growing worldwide epidemic that requires a biopsychosocial treatment approach to achieve a healthy lifestyle. This study on children in a weight management program examines the relationship between obesity, disease complications, and social determinants of health. We expect that children with higher degrees of obesity are more likely to live in areas lacking access to healthy food and have similar behavioural and socioeconomic characteristics. METHODS: Program participants were identified by neighbourhood food access status based on their home address. The prevalence of comorbidities in the participants was analyzed according to neighbourhood food accessibility. Multivariate regressions evaluated the association between participants' health outcomes and their sociodemographic and geographical characteristics. RESULTS: A total of 283 (98.3%) participants had a BMI ≥95th percentile for their age and sex and 68 (23.6%) lived in neighbourhoods with limited food access. Almost a third (Adj. R2 = 0.3302; p < 0.01) of the variability in study population's BMI was driven by sociodemographic factors, self-reported eating and physical activity behaviours, and had a positive relationship with access to healthy food. Nonetheless, HbA1c had a negative relationship with access to healthy food given the limited variation in the sample of participants with HbA1c levels indicating diabetes. CONCLUSION: Children living in neighbourhoods with limited food access had higher BMIs than other program participants. Thus, it is critical to identify children with limited neighbourhood food accessibility and promote societal and legislative change to improve access to healthy food.

Exploring the multiple dimensions of perceived food access in the local food environment in Flanders: Perceptions of adults in socioeconomically disadvantaged situations.

Persons in socioeconomically disadvantaged situations are more susceptible and disproportionally exposed to unhealthy food environments, which results in limited access to healthy foods and poorer dietary outcomes. This qualitative paper examines the various dimensions of perceived food access to healthy and unhealthy foods (i.e., availability, affordability, accessibility, accommodation, desirability, convenience and acceptability) within the local food environment among persons in socioeconomically disadvantaged situations. A total of 23 participants in socioeconomically disadvantaged situations expressed their perceptions of food access within their local food environment and its role in their eating behaviour through participant-driven photo-elicitation in a focus group context (n = 7) and researcher-driven photo-elicitation interviews (n = 16). Reflexive thematic analysis has been used to analyse our data through an access framework. Four overarching themes were constructed. The first two themes concern barriers to perceived food access in respectively the home and community food environment - including the importance of kitchen infrastructure, household composition and transport options. The third theme encompasses the interaction of perceived food access with the sociocultural environment, highlighting its dual role as facilitator (e.g., through food sharing practices) and barrier (e.g., through social stigma and shame). The fourth theme concerns awareness and the ability to navigate within the information food environment, which has also been proposed as a novel dimension of food access. This study emphasizes the complexity of food access and the need for a multifaceted approach that integrates perceptions to ensure equitable access to healthy foods.

A multi-dimensional access index: Exploring emergency food assistance in New York City.

Access to resources and services needs to be considered from a multi-dimensional perspective to capture the complex landscape of human experience. The robust body of research exploring food access has multiple limitations that create an incomplete view of food access, like studies limited to only one mode of transit and inconsistent methods across studies which limit generalizability. This study proposes a framework to formulate a multi-dimensional access index that considers travel time, operating hours, and availability of transit infrastructure across space. We use food pantries in New York City as a case study since there are relatively few of them and they have limited opening hours. We propose an index that quantifies spatiotemporal access by different modes of transportation and takes operating hours of food pantries into account during a one week time period. We compare our results to two traditional access measures and demonstrate that our index provides a significantly different measure of access. We utilize this index to highlight areas of high need but low resources, which shows the importance of this tool to policy makers and service providers. We use our experience of developing this index to highlight the challenges with quantitative analysis of human experience. Our tool is reproducible through an open-access software, which allows researchers and policy-makers to utilize it with parameters that reflect their communities.