Association of county-level food deserts and food swamps on postoperative outcomes among patients undergoing colorectal surgery.

BACKGROUND: Although malnutrition has been linked to worse healthcare outcomes, the broader context of food environments has not been examined relative to surgical outcomes. We sought to define the impact of food environment on postoperative outcomes of patients undergoing resection for colorectal cancer (CRC). METHODS: Patients who underwent surgery for CRC between 2014 and 2020 were identified from the Medicare database. Patient-level data were linked to the United States Department of Agriculture data on food environment. Multivariable regression was used to examine the association between food environment and the likelihood of achieving a textbook outcome (TO). TO was defined as the absence of an extended length of stay (≥75th percentile), postoperative complications, readmission, and mortality within 90 days. RESULTS: A total of 260,813 patients from 3017 counties were included in the study. Patients from unhealthy food environments were more likely to be Black, have a higher Charlson Comorbidity Index, and reside in areas with higher social vulnerability (all P < .01). Patients residing in unhealthy food environments were less likely to achieve a TO than that of patients residing in the healthiest food environments (food swamp: 48.8% vs 52.4%; food desert: 47.9% vs 53.7%; P < .05). On multivariable analysis, individuals residing in the unhealthy food environments had lower odds of achieving a TO than those of patients living in the healthiest food environments (food swamp: OR, 0.86; 95% CI, 0.83-0.90; food desert: OR, 0.79; 95% CI, 0.76-0.82); P < .05). CONCLUSION: The surrounding food environment of patients may serve as a modifiable sociodemographic risk factor that contributes to disparities in postoperative CRC outcomes.

Social inequities in food deserts and food swamps in a northeastern Brazilian capital.

This study identified food deserts and swamps, investigating their associations with socioeconomic and demographic conditions. This ecological study was conducted using data from urban census tracts in the city of Recife, which were considered the unit of analysis. Information on food retail was obtained from government sources in 2019. Census tracts below the 25th percentile in the density of healthy food retail (i.e., those that predominantly sell natural or minimally processed foods, mixed businesses, and super- and hypermarkets) were classified as food deserts. Census tracts above the 25th percentile in the density of unhealthy food retail (i.e., those selling primarily ultra-processed foods) were considered food swamps. The socioeconomic and demographic conditions of the census tracts were evaluated using variables from the 2010 census (per capita income, average income, race, literacy of the head of household, and the availability of essential services) and the Health Vulnerability Index. Census tracts considered food deserts (28.5%) were more vulnerable, characterized by lower income and access to essential services, more illiterate residents and more minorities (Black/Indigenous/mixed race). Food swamps (73.47%) were more prevalent in less vulnerable neighbourhoods characterized by higher percentages of literate residents and Whites, greater purchasing power, and better basic sanitation. The characteristics of Recife's food deserts and swamps demonstrate social inequalities in the food environment. Public facilities could play a vital role in promoting healthy eating within food deserts. Additionally, future implementation of taxes on ultra-processed foods and the provision of tax subsidies to natural or minimally processed food sellers might contribute to fostering healthier dietary choices.

Association of County-Level Food Deserts and Food Swamps with Hepatopancreatobiliary Cancer Outcomes.

BACKGROUND: Malnutrition has been linked to the development of hepatopancreatobiliary (HPB) cancer. We sought to examine the association between food swamps and food deserts on surgical outcomes of patients with HPB cancer. METHODS: Patients who underwent surgery for HPB cancer between 2014 and 2020 were identified from the Medicare Standard Analytic Files. Patient-level data were linked to the United States Department of Agriculture data on food swamps and deserts. Multivariable regression was performed to examine the association between the food environment and outcomes. RESULTS: Among 53,426 patients, patients from the worse food environment were more likely to be Black, have a higher Charlson Comorbidity Index, and reside in areas with high social vulnerability. Following surgery, the overall incidence of textbook outcome (TO) was 41.6% (n = 22,220). Patients residing in the worse food environments less often achieved a TO versus individuals residing in the healthiest food environments (food swamp: 39.4% vs. 43.9%; food desert: 38.5% vs 42.2%; p < 0.05). On multivariable analysis, individuals residing in the poorest food environments were associated with lower odds of achieving TO compared with individuals living in healthiest food environments (food swamp: OR 0.83, 95%CI 0.75-0.92, food desert: OR 0.86, 95%CI 0.76-0.97; both p < 0.05). CONCLUSION: The surrounding food environment of patients may serve as a modifiable socio-demographic risk factor that contributes to disparities in surgical outcomes of HPB cancer.

Food desert residence has limited impact on veteran fecal microbiome composition: a U.S. Veteran Microbiome Project study.

IMPORTANCE: Social and economic inequities can have a profound impact on human health. The inequities could result in alterations to the gut microbiome, an important factor that may have profound abilities to alter health outcomes. Moreover, the strong correlations between social and economic inequities have been long understood. However, to date, limited research regarding the microbiome and mental health within the context of socioeconomic inequities exists. One particular inequity that may influence both mental health and the gut microbiome is living in a food desert. Persons living in food deserts may lack access to sufficient and/or nutritious food and often experience other inequities, such as increased exposure to air pollution and poor access to healthcare. Together, these factors may confer a unique risk for microbial perturbation. Indeed, external factors beyond a food desert might compound over time to have a lasting effect on an individual's gut microbiome. Therefore, adoption of a life-course approach is expected to increase the ecological validity of research related to social inequities, the gut microbiome, and physical and mental health.

Combining crowd-sourcing, census data, and public review forums for real-time, high-resolution food desert estimation.

BACKGROUND: It has been hypothesized that low access to healthy and nutritious food increases health disparities. Low-accessibility areas, called food deserts, are particularly commonplace in lower-income neighborhoods. The metrics for measuring the food environment's health, called food desert indices, are primarily based on decadal census data, limiting their frequency and geographical resolution to that of the census. We aimed to create a food desert index with finer geographic resolution than census data and better responsiveness to environmental changes. MATERIALS AND METHODS: We augmented decadal census data with real-time data from platforms such as Yelp and Google Maps and crowd-sourced answers to questionnaires by the Amazon Mechanical Turks to create a real-time, context-aware, and geographically refined food desert index. Finally, we used this refined index in a concept application that suggests alternative routes with similar ETAs between a source and destination in the Atlanta metropolitan area as an intervention to expose a traveler to better food environments. RESULTS: We made 139,000 pull requests to Yelp, analyzing 15,000 unique food retailers in the metro Atlanta area. In addition, we performed 248,000 walking and driving route analyses on these retailers using Google Maps' API. As a result, we discovered that the metro Atlanta food environment creates a strong bias towards eating out rather than preparing a meal at home when access to vehicles is limited. Contrary to the food desert index that we started with, which changed values only at neighborhood boundaries, the food desert index that we built on top of it captured the changing exposure of a subject as they walked or drove through the city. This model was also sensitive to the changes in the environment that occurred after the census data was collected. CONCLUSIONS: Research on the environmental components of health disparities is flourishing. New machine learning models have the potential to augment various information sources and create fine-tuned models of the environment. This opens the way to better understanding the environment and its effects on health and suggesting better interventions.

Association of Living in a Food Desert and Poor Periconceptional Diet Quality in a Cohort of Nulliparous Pregnant Individuals.

BACKGROUND: A poor diet can result from adverse social determinants of health and increases the risk of adverse pregnancy outcomes. OBJECTIVE: We aimed to assess, using data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be prospective cohort, whether nulliparous pregnant individuals who lived in a food desert were more likely to experience poorer periconceptional diet quality compared with those who did not live in a food desert. METHODS: The exposure was living in a food desert based on a spatial overview of food access indicators by income and supermarket access per the Food Access Research Atlas. The outcome was periconceptional diet quality per the Healthy Eating Index (HEI)-2010, analyzed by quartile (Q) from the highest or best (Q4, reference) to the lowest or worst dietary quality (Q1); and secondarily, nonadherence (yes or no) to 12 key aspects of dietary quality. RESULTS: Among 7,956 assessed individuals, 24.9% lived in a food desert. The mean HEI-2010 score was 61.1 of 100 (SD: 12.5). Poorer periconceptional dietary quality was more common among those who lived in a food desert compared with those who did not live in a food desert (Q4: 19.8%, Q3: 23.6%, Q2: 26.5%, and Q1: 30.0% vs. Q4: 26.8%, Q3: 25.8%, Q2: 24.5%, and Q1: 22.9%; overall P < 0.001). Individuals living in a food desert were more likely to report a diet in lower quartiles of the HEI-2010 (i.e., poorer dietary quality) (aOR: 1.34 per quartile; 95% CI: 1.21, 1.49). They were more likely to be nonadherent to recommended standards for 5 adequacy components of the HEI-2010, including fruit, total vegetables, greens and beans, seafood and plant proteins, and fatty acids, and less likely to report excess intake of empty calories. CONCLUSIONS: Nulliparous pregnant individuals living in a food desert were more likely to experience poorer periconceptional diet quality compared with those who did not live in a food desert.

Ecological study of the association between socioeconomic inequality and food deserts and swamps around schools in Rio de Janeiro, Brazil.

BACKGROUND: Previous research suggests that unhealthy community food environments around schools contribute to unhealthy eating habits and negative health outcomes among the youth. However, little is known about how socioeconomic inequalities in those community food environments are associated with food deserts and food swamps across schools' neighborhoods. METHODS: An ecological study was carried out in all 3,159 public and private schools in Rio de Janeiro, Brazil. Three measures of socioeconomic inequality were evaluated: per capita income, segregation index and deprivation index. The community school food environment was analyzed by metrics of food swamps and food deserts. RESULTS: Food deserts and food swamps were simultaneously more prevalent in neighborhoods of the lowest income, high deprivation, and high segregation. Spatial socioeconomic disparities at the neighborhoods of schools were associated with food deserts and food swamps in Rio de Janeiro. CONCLUSIONS: Our results point to a spatial socioeconomic inequality of establishments that sell food around schools in a Brazilian metropolis, indicating that the areas of greatest deprivation of food services are also the areas with the worst socioeconomic characteristics.

Using Social Media to Predict Food Deserts in the United States: Infodemiology Study of Tweets.

BACKGROUND: The issue of food insecurity is becoming increasingly important to public health practitioners because of the adverse health outcomes and underlying racial disparities associated with insufficient access to healthy foods. Prior research has used data sources such as surveys, geographic information systems, and food store assessments to identify regions classified as food deserts but perhaps the individuals in these regions unknowingly provide their own accounts of food consumption and food insecurity through social media. Social media data have proved useful in answering questions related to public health; therefore, these data are a rich source for identifying food deserts in the United States. OBJECTIVE: The aim of this study was to develop, from geotagged Twitter data, a predictive model for the identification of food deserts in the United States using the linguistic constructs found in food-related tweets. METHODS: Twitter's streaming application programming interface was used to collect a random 1% sample of public geolocated tweets across 25 major cities from March 2020 to December 2020. A total of 60,174 geolocated food-related tweets were collected across the 25 cities. Each geolocated tweet was mapped to its respective census tract using point-to-polygon mapping, which allowed us to develop census tract-level features derived from the linguistic constructs found in food-related tweets, such as tweet sentiment and average nutritional value of foods mentioned in the tweets. These features were then used to examine the associations between food desert status and the food ingestion language and sentiment of tweets in a census tract and to determine whether food-related tweets can be used to infer census tract-level food desert status. RESULTS: We found associations between a census tract being classified as a food desert and an increase in the number of tweets in a census tract that mentioned unhealthy foods (P=.03), including foods high in cholesterol (P=.02) or low in key nutrients such as potassium (P=.01). We also found an association between a census tract being classified as a food desert and an increase in the proportion of tweets that mentioned healthy foods (P=.03) and fast-food restaurants (P=.01) with positive sentiment. In addition, we found that including food ingestion language derived from tweets in classification models that predict food desert status improves model performance compared with baseline models that only include socioeconomic characteristics. CONCLUSIONS: Social media data have been increasingly used to answer questions related to health and well-being. Using Twitter data, we found that food-related tweets can be used to develop models for predicting census tract food desert status with high accuracy and improve over baseline models. Food ingestion language found in tweets, such as census tract-level measures of food sentiment and healthiness, are associated with census tract-level food desert status.

The Earliest Food Deserts: Availability of Infant and Follow-on Formula, and Lactation Support Products among Stores in Black and Non-Hispanic White Zip Codes in Los Angeles County.

OBJECTIVES: This study investigates the availability, accessibility, and product depth of in-store infant feeding and galactagogues products in majority Black and majority white zip codes in Los Angeles County. METHODS: A cross-sectional study was conducted to determine racial/ethnic neighborhood differences in the availability of infant and follow-on formula and galactagogues products in 47 retail stores in 21 zip codes. Store-level data were collected in June 2019 and an observational tool for galactagogues products and infant/follow-on formula (availability, accessibility, product depth) was employed at each store. RESULTS: Most of the stores were grocery stores (87.2%). Stores in majority Black zip codes had less availability of infant formula ready-to-use (p = 0.001), less accessibility of follow-on powder (p = 0.028), and availability of galactagogues beverages (p = 0.036) versus majority white zip codes. Product depth (number of brands sold) of stores with one or more brands of the aforementioned products was consistently higher in majority white zip codes compared to majority Black zip codes. Stores in majority Black zip codes were most likely to have lower availability of infant formula and galactagogues products, an important part of the food environment for infant feeding options, in particular, for lactation support. CONCLUSIONS FOR PRACTICE: Most studies investigating the association of the food environment and health outcomes have focused only on solid foods. However, additional food products (e.g., liquids, powders) may be contributors to extensive disparities in infant mortality between Black and white infants and may lead to health disparities beyond infant stage (e.g., children, adolescents, and adults). Lastly, for breastfeeding inequities to decrease, pregnant and postpartum Black persons need equitable access and education on safe and quality galactagogues products.

Using Ecological Diversity Analyses to Characterize the Availability of Healthy Food and Socio-Economic Food Deserts.

"Food deserts" are usually defined as geographic areas without local access to fresh, healthy food. We used community ecology statistics in supermarkets to quantify the availability of healthy food and to potentially identify food deserts as areas without a diverse selection of food, rather than a binary as to whether fresh food is present or not. We test whether produce diversity is correlated with neighborhood income or demographics. Abundance and diversity of fresh produce was quantified in supermarkets in Broward County, Florida, USA. Neighborhood income level and racial/ethnic makeup were retrieved from the U.S. Census and American Community Survey. Although diversity varied, there were no communities that had consistently less available fresh food, although the percent of a neighborhood identifying as "white" was positively correlated with produce diversity. There may be fewer choices in neighborhoods with a higher proportion of minorities, but there were no consistent patterns of produce diversity in Broward County. This method demonstrates an easy, inexpensive way to characterize food deserts beyond simple distance, and results in precise enough information to identify gaps in the availability of healthy foods.

Social inequalities in the surrounding areas of food deserts and food swamps in a Brazilian metropolis.

BACKGROUND: Food deserts are neighborhoods with little or no access to healthy food, whereas food swamps are neighborhoods where unhealthy food options prevail over healthy ones. The main aims of the current study are to feature and compare the neighborhoods of food deserts and food swamps based on social inequality. METHODS: Ecological study carried out in Belo Horizonte City, Minas Gerais State, Brazil. Information about commercial food establishments derived from two different databases. It was measured by secondary governmental databases, which were virtually conferred in the present study. Census tracts were considered as analysis units and classified as food deserts and food swamps, based on the Brazilian methodology. Take into consideration the density of establishments classified as selling fresh or minimally-processed food, mixed establishments, and establishments selling ultra-processed food. The Brazilian methodology evaluates food deserts by the density of healthy establishments (establishments classified as mostly selling fresh or minimally-processed food and mixed establishments) per 10 thousand inhabitants. And the metric to evaluate food swamps considers the density of unhealthy establishments (establishments mostly selling ultra-processed food) per 10 thousand inhabitants. Information about social inequalities comprised aspects such as income, population count, number of households, number of literate individuals, race, water and energy supply, and garbage collection. The Health Vulnerability Index (HVI) was used as a synthetic social vulnerability indicator. RESULTS: Neighborhoods of food deserts presented worse essential service availability, lower income per capita, and smaller mean number of literate individuals. Census tracts classified as food swamps presented better socio-demographic conditions than those areas food deserts. Neighborhoods simultaneously classified as food deserts and food swamps presented lower income per capita and were more often observed in census sectors presenting medium and high HVI. CONCLUSION: The food environment in Belo Horizonte was featured by the strong presence of food deserts and food swamps. However, the potential influence of these areas on food intake has changed depending on social inequalities.

Socioeconomic and Geographic Disparities in Idiopathic Intracranial Hypertension.

OBJECTIVE: To identify relationships between idiopathic intracranial hypertension (IIH) and socioeconomic determinants of health, such as low-income status and proximity to healthy food. METHODS: This retrospective case-control study of adult female neuro-ophthalmology patients from one institution identified 223 women with and 4,783 women without IIH. Street addresses were geocoded and merged with US census data to obtain census tract-level information on income and food access. Choropleth maps visualized IIH clusters within certain neighborhoods. Logistic regression compared the proportion of patients with IIH from racial and ethnic minority backgrounds, low-income census tracts, and food deserts and swamps to controls without IIH. RESULTS: In our cohort, when adjusted for age, women with IIH were more likely to be Black (odds ratio [OR] 3.96, 95% confidence interval [CI] 2.98-5.25), Hispanic (OR 2.23, 95% CI 1.14-4.36), and live in low-income tracts (OR 2.24, 95% CI 1.71-2.95) or food swamps (OR 1.54, 95% CI 1.15-2.07). Patients with IIH were less likely to live in food deserts than controls (OR 0.61, 95% CI 0.45-0.83). The association between Black race and IIH remained significant even after adjusting for other variables. CONCLUSION: IIH is more common among Black and Hispanic women than expected even when accounting for the demographics of a metropolitan city. Some of this relationship is driven by the association of obesity and IIH incidence with low income and proximity to unhealthy foods.

The COVID-19 Pandemic and Children's Environmental Health.

The coronavirus disease 2019 pandemic has dramatically altered the health and well-being of children, particularly as they have been isolated indoors and in their homes as a result of social distancing measures. In this article, we describe several of the environmental threats that are affecting the health of children during the pandemic. These include increased exposure to household cleaning products, chemicals and lead in dust, indoor air pollutants, screen time, family stress, and firearms, as well as decreased availability of food, social supports, and routine childhood screenings. Importantly, many of these threats disproportionately affect children of racial or ethnic minorities or who have low socioeconomic status. Pediatric health care providers will need to screen and treat children and counsel their parents and/or other caregivers during well-child visits with an eye for these new or worsened environmental threats. [Pediatr Ann. 2020;49(12):e537-e542.].

Identifying Food Deserts and People with Low Food Access, and Disparities in Dietary Habits and Health in Korea.

This study aims to identify the regions and people with low food access (LFA) for Korea at the national level and to examine disparities in food consumption, dietary behavior, and health outcome for those regions and people. Based on the distance to the nearest grocery store from residence, the regions and people with LFA are identified through geographical information system (GIS) analysis. To examine disparities between the regions and people with LFA and without LFA, a consumer survey is conducted and data from National Health and Nutrition Examination Survey and Community Health Survey are analyzed. This study found that there exists a serious access to food issue in Korea, especially for the aged. Moreover, there also exist significant disparities between the regions and people with and without LFA in the distance and one-way travel time to the grocery store that is mainly visited, frequency of offline/online grocery shopping, availability of various foods, dietary habits such as eating regularly, eating nutritionally balanced foods, and eating sufficient fruit/vegetable/whole grains, the acquisition and utilization of food-related information, and health outcomes. This study suggests that, to resolve such a serious food access problem, assistance policies, such as mobile grocery stores and lunch-box delivery, need to be activated in countries similar to Korea since this problem could potentially deteriorate the national medical finances as well as the regional and individual disparities.

Racial Differences in Perceived Food Swamp and Food Desert Exposure and Disparities in Self-Reported Dietary Habits.

Both food swamps and food deserts have been associated with racial, ethnic, and socioeconomic disparities in obesity rates. Little is known about how the distribution of food deserts and food swamps relate to disparities in self-reported dietary habits, and health status, particularly for historically marginalized groups. In a national U.S. sample of 4305 online survey participants (age 18+), multinomial logistic regression analyses were used to assess by race and ethnicity the likelihood of living in a food swamp or food desert area. Predicted probabilities of self-reported dietary habits, health status, and weight status were calculated using the fitted values from ordinal or multinomial logistic regression models adjusted for relevant covariates. Results showed that non-Hispanic, Black participants (N = 954) were most likely to report living in a food swamp. In the full and White subsamples (N = 2912), the perception of residing in a food swamp/desert was associated with less-healthful self-reported dietary habits overall. For non-Hispanic Blacks, regression results also showed that residents of perceived food swamp areas (OR = 0.66, p < 0.01, 95% CI (0.51, 0.86)) had a lower diet quality than those not living in a food swamp/food desert area. Black communities in particular may be at risk for environment-linked diet-related health inequities. These findings suggest that an individual's perceptions of food swamp and food desert exposure may be related to diet habits among adults.

Spatial clustering of food insecurity and its association with depression: a geospatial analysis of nationally representative South African data, 2008-2015.

While food insecurity is a persistent public health challenge, its long-term association with depression at a national level is unknown. We investigated the spatial heterogeneity of food insecurity and its association with depression in South Africa (SA), using nationally-representative panel data from the South African National Income Dynamics Study (years 2008-2015). Geographical clusters ("hotpots") of food insecurity were identified using Kulldorff spatial scan statistic in SaTScan. Regression models were fitted to assess association between residing in food insecure hotspot communities and depression. Surprisingly, we found food insecurity hotspots (p < 0.001) in high-suitability agricultural crop and livestock production areas with reliable rainfall and fertile soils. At baseline (N = 15,630), we found greater likelihood of depression in individuals residing in food insecure hotspot communities [adjusted relative risk (aRR) = 1.13, 95% CI:1.01-1.27] using a generalized linear regression model. When the panel analysis was limited to 8,801 participants who were depression free at baseline, residing in a food insecure hotspot community was significantly associated with higher subsequent incidence of depression (aRR = 1.11, 95% CI:1.01-1.22) using a generalized estimating equation regression model. The association persisted even after controlling for multiple socioeconomic factors and household food insecurity. We identified spatial heterogeneity of food insecurity at a national scale in SA, with a demonstrated greater risk of incident depression in hotspots. More importantly, our finding points to the "Food Security Paradox", food insecurity in areas with high food-producing potential. There is a need for place-based policy interventions that target communities vulnerable to food insecurity, to reduce the burden of depression.

SNAP Participants Improved Food Security And Diet After A Full-Service Supermarket Opened In An Urban Food Desert.

The Supplemental Nutrition Assistance Program (SNAP) is the largest US food and nutrition assistance program, tasked with improving food security among low-income households. Another federal effort to improve food access is the Healthy Food Financing Initiative (HFFI), which invested tens of millions of dollars to incentivize healthy food retail outlets in areas lacking access to nutritious, fresh food. We explore the intersection of these programs, testing the impact of a new, HFFI-financed full-service supermarket on SNAP participants in an urban food desert. After the supermarket's opening, SNAP participants' food security improved and intake of added sugars declined in the intervention neighborhood, but both were unchanged in a comparison neighborhood without a new supermarket. Intervention neighborhood participants also experienced relative declines in the percentage of daily calories from solid fats, alcoholic beverages, and added sugars. Our findings suggest that HFFI amplifies the effects of SNAP participation on improving food security and dietary quality in food deserts.