Search Results (9)

Background: Breast cancer disparities persist globally, with growing evidence implicating neighborhood and built environmental factors in disease outcomes. Methods: This study investigates the associations between neighborhood disadvantage, environmental exposures, and breast tumor characteristics and survival among 3041 stage I–III breast cancer patients treated at the University of Virginia Comprehensive Cancer Center (2014–2024). Neighborhood disadvantage was assessed via the Area Deprivation Index (ADI), while environmental exposures included PM2.5, green space (NDVI), and food indices (modified retail food environment index (mRFEI), retail food activity index (RFAI)). Multivariable regression and Cox models adjusted for demographic, socioeconomic, and clinical covariates were employed. Results: A higher ADI score was associated with aggressive tumor characteristics, including advanced stage (Odds Ratio (OR) = 1.06, 95% Confidence Interval (CI):1.01–1.11), poor differentiation (OR = 1.07, 1.01–1.15), ER-negative status (OR = 1.06, 1.01–1.12), and triple-negative breast cancer (TNBC) (OR = 1.08, 1.02–1.16), as well as younger diagnosis age (β = −0.22, −0.36 to −0.09). PM2.5 exposure was correlated with advanced tumor stage (OR = 1.24, 1.09–1.40 for stage III) but paradoxically predicted improved survival (Hazard Ratio (HR) = 0.71, 0.63–0.82). The food environment indices showed subtype-specific survival benefits: higher mRFEI and RFAI scores were linked to reduced mortality in ER-negative (HR = 0.45, 0.23–0.85 and HR = 0.61, 0.38–0.97) and TNBC (HR = 0.40, 0.18–0.90 and HR = 0.48, 0.26–0.87) patients. NDVI scores exhibited no significant associations. Conclusion: Our findings underscore the dual role of neighborhood disadvantage and the built environmental in breast cancer outcomes. While neighborhood disadvantage and PM2.5 exposure elevate tumor aggressiveness, survival disparities may be mediated by other factors. Improved food environments may enhance survival in aggressive subtypes, highlighting the need for integrated interventions addressing socioeconomic inequities, environmental risks, and nutritional support needs. Full article

Deserts, swamps and food oases terms have been used to characterize the food environment according to the identified food availability. Food swamps are defined as neighborhoods with a predominance of food establishments selling ultra-processed foods compared to establishments selling healthy options. In contrast, food oases are areas with easy access to healthy and nutritious foods, such as fruits, vegetables, and other fresh foods. Food deserts describe densely populated urban areas where residents face difficulty obtaining healthy food. In this context, this work aimed to map deserts, swamps, and food oases around federal schools in Bahia, Brazil, emphasizing the importance of implementing the Brazilian National School Feeding Program (PNAE) in these schools, to guarantee food security and nutrition. An ecological study was carried out in all 35 federal schools in Bahia, Brazil, using an 800 m buffer analysis, with the school as the centroid. The geographic coordinates of schools and food establishments were initially obtained using Google Maps and later confirmed onsite. To evaluate food deserts and swamps, the methodology proposed by the CDC was used and the Modified Retail Food Environment Index (mRFEI) was calculated; when the result was equal to zero, the surrounding area was considered a food desert and values between 0.01 and 20 determined food swamps; for values above 20, the neighborhood was classified as mixed. Food oases were considered regions containing at least one supermarket within the analyzed buffer. Descriptive analyses were carried out with frequency measurements, measures of central tendency (mean and median) and dispersion (standard deviation). The food environment of schools was compared considering the number of students impacted, the area where the school was located (urban or rural) and the size of the municipalities. The average number of food establishments found was 22.39 (±13.03), with the highest averages for snack bars (7.33 ± 4.43), grocery stores (5.83 ± 4.09) and restaurants (2.94 ± 2.19). Food deserts and mixed environments were identified in 40% of the sample, while swamps represented 20% and oases 65%. An association was observed between food deserts and social vulnerability, making it necessary to emphasize the importance of adequate implementation of the PNAE in these schools to reduce food and nutritional insecurity, guaranteeing the human right to adequate and healthy food and providing better nutrition and health perspectives within the school environment and impact on students’ lives through food and nutrition education actions, which are also part of the context of PNAE activities. Full article

Poor food environments are considered to trigger obesity and related health complications by restricting the local food options to predominantly low quality, energy-dense foods. This study investigated the impact of the food environment on obesity with a focus on any changes that might have occurred around the COVID lockdown period in the UK when majority of the population relied on food delivery and the local food environments. The proportion of fast-food retailers in the area and the Retail Food Environment Index (RFEI) were calculated for participants of the 1970 British Cohort Study (BCS70) at three timepoints: pre-COVID (2016), the first UK nation-wide lockdown (April–May 2020) and post lockdown (September–October 2020). The association of the food environment and the odds of obesity was estimated through multivariable logistic regression, with adjustments being made for selected socioeconomic variables. A model using the fast-food proportion as the sole predictor estimated that higher fast-food proportion increased the odds of obesity by 2.41 in 2016, 2.89 during the lockdown and 1.34 post lockdown, compared with 1.87, 2.23, and 0.73, respectively, for the same three periods with adjustments being made for select socioeconomic variables. On the other hand, RFEI increased the odds of obesity only slightly at 1.01, 1.02 and 1.03, respectively, with the model with adjustments yielding respective similar values. The fast-food proportion model indicates that proximity to a poor food environment is linked to obesity, especially during the COVID lockdown period, but the impact of a poor-food environment is limited if the RFEI is used as its indicator. The findings will add much needed insights on the UK data and will inform public health planning and policy. Full article

The Retail Food Environment Index (RFEI) and its variants have been widely used in public health to measure people’s accessibility to healthy food. These indices are purely environmental as they only concern the geographic distribution of food retailers, but fail to include human factors, such as demographics, socio-economy, and mobility, which also shape the food environment. The exclusion of human factors limits the explanatory power of RFEIs in identifying neighborhoods of the greatest concern. In this study, we first proposed a hybrid approach to integrate human and environmental factors into the RFEI. We then demonstrated this approach by incorporating neighborhood commuting patterns into a traditional RFEI: we devised a multi-origin RFEI (MO_RFEI) that allows people to access food from both homes and workplaces, and further an enhanced RFEI (eRFEI) that allows people to access food with different transportation modes. We compared the traditional and proposed RFEIs in a case study of Florida, USA, and found that the eRFEI identified fewer and more clustered underserved populations, allowing policymakers to intervene more effectively. The eRFEI depicts more realistic human shopping behaviors and better represents the food environment. Our study enriches the literature by offering a new and generic approach for assimilating a neighborhood context into food environment measures. Full article

Research into the potential impact of the food environment on liver cancer incidence has been limited, though there is evidence showing that specific foods and nutrients may be potential risk or preventive factors. Data on hepatocellular carcinoma (HCC) cases were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registries. The county-level food environment was assessed using the Modified Retail Food Environment Index (mRFEI), a continuous score that measures the number of healthy and less healthy food retailers within counties. Poisson regression with robust variance estimation was used to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between mRFEI scores and HCC risk, adjusting for individual- and county-level factors. The county-level food environment was not associated with HCC risk after adjustment for individual-level age at diagnosis, sex, race/ethnicity, year, and SEER registry and county-level measures for health conditions, lifestyle factors, and socioeconomic status (adjusted IRR: 0.99, 95% CI: 0.96, 1.01). The county-level food environment, measured using mRFEI scores, was not associated with HCC risk. Full article

Because supermarkets are a critical part of the community food environment, the purpose of this paper is to examine the association between accessibility to the supermarket where participants were surveyed, frequency of shopping at the supermarket, and self-reported and objectively-assessed fruit and vegetable consumption. Accessibility was assessed using Geographic Information Systems (GIS) measured distance and multiple versions of the modified Retail Food Environment Index (mRFEI), including a localized road network buffer version. Frequency of shopping was assessed using self-report. The National Cancer Institute Fruit and Vegetable screener was used to calculate daily servings of fruits and vegetables. Skin carotenoids were assessed using the “Veggie Meter™” which utilizes reflection spectroscopy to non-invasively assess skin carotenoids as an objective measure of fruit and vegetable consumption. Bivariate and multivariable statistics were used to examine the associations in RStudio. There was a positive association between skin carotenoids and the Special Supplemental Nutrition Program for Women Infants and Children (WIC) and mRFEI scores, suggesting that WIC participation and a healthier food environment were associated with objectively-assessed fruit and vegetable consumption (skin carotenoids). Future research should examine these associations using longitudinal study designs and larger sample sizes. Full article

Outside of western countries, the study of the local food environment and evidence for its association with dietary behavior is limited. The aim of this paper was to examine the association between the local retail food environment and consumption of fruit and vegetables (FV) among adults in Hong Kong. Local retail food environment was measured by density of different types of retail food outlets (grocery stores, convenience stores, and fast food restaurants) within a 1000 m Euclidean buffer around individual’s homes using a geographic information system (GIS). The Retail Food Environment Index (RFEI) was calculated based on the relative density of fast-food restaurants and convenience stores to grocery stores. Logistic regressions were performed to examine associations using cross-sectional data of 1977 adults (18 years or older). Overall, people living in an area with the highest RFEI (Q4, >5.76) had significantly greater odds of infrequent FV consumption (<7 days/week) after covariates adjustment (infrequent fruit consumption: OR = 1.36, 95% CI 1.04–1.78; infrequent vegetable consumption: OR = 1.72, 95% CI 1.11–2.68) in comparison to the lowest RFEI (Q1, <2.25). Highest density of fast food restaurants (Q4, >53) was also significantly associated with greater odds of infrequent fruit consumption (<7 days/week) (unadjusted model: OR = 1.34, 95% CI 1.04–1.73), relative to lowest density of fast food restaurants (Q1, <13). No significant association of density of grocery stores or convenience stores was observed with infrequent FV consumption regardless of the covariates included in the model. Our results suggest that the ratio of fast-food restaurants and convenience stores to grocery stores near people’s home is an important environmental factor in meeting fruit and vegetable consumption guidelines. “Food swamps” (areas with an abundance of unhealthy foods) rather than “food deserts” (areas where there is limited access to healthy foods) seems to be more of a problem in Hong Kong’s urban areas. We advanced international literature by providing evidence in a non-western setting. Full article

High prevalence of obesity and non-communicable diseases is a global public health problem, in which the quality of food environments is thought to play an important role. Current scientific evidence is not consistent regarding the impact of food environments on diet. The relationship between local food environments and diet quality was assessed across 10 Australian suburbs, using Australian-based indices devised to measure the two parameters. Data of dietary habits from the participants was gathered using a short questionnaire. The suburbs’ Food Environment Score (higher being healthier) was associated with higher consumption of fruit (χ² (40, 230) = 58.8, p = 0.04), and vegetables (χ² (40, 230) = 81.3, p = 0.03). The Food Environment Score identified a significant positive correlation with four of the diet scores: individual total diet score (r_s = 0.30, p < 0.01), fruit and vegetable score (r_s = 0.43, p < 0.01), sugary drink score (r_s = 0.13, p < 0.05), and discretionary food score (r_s = 0.15, p < 0.05). Moreover, the suburbs’ RFEI (Retail Food Environment Index, higher being unhealthier) showed a significant association with higher consumption of salty snacks (χ² (24, 230) = 43.9, p = 0.04). Food environments dominated by food outlets considered as ‘healthier’ were associated with healthier population food intakes, as indicated by a higher consumption of fruit, vegetables, and water, as well as a lower consumption of junk food, salty snacks, and sugary drinks. This association suggests that healthier diet quality is associated with healthier food environments in regional Australia. Full article

Purpose: The purpose of this paper is to describe the food landscape of Texas using the CDC’s Modified Retail Food Environment (mRFEI) and to make comparisons by border/non-border. Methods: The Modified Retail Food Environment index (mRFEI (2008)) is an index developed by the CDC that measures what percent of the total food vendors in a census track sell healthy food. The range of values is 0 (unhealthy areas with limited access to fruits and vegetables) to (100—Healthy). These data were linked to 2010 US Census socioeconomic and ethnic concentration data. Spatial analysis and GIS techniques were applied to assess the differences between border and non-border regions. Variables of interest were mRFEI score, median income, total population, percent total population less than five years, median age, % receiving food stamps, % Hispanic, and % with a bachelor degree. Results: Findings from this study reveal that food environment in Texas tends to be characteristic of a “food desert”. Analysis also demonstrates differences by border/non-border location and percent of the population that is foreign born and by percent of families who receive food stamps. Conclusions: Identifying the relationship between socioeconomic disparity, ethnic concentration and mRFEI score could be a fundamental step in improving health in disadvantage communities, particularly those on the Texas-Mexico border. Full article