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Background: Patterns of food security persistently vary by race, yet limited research has examined how community-specific experiences of race and racism are associated with nutritional outcomes. Objectives: This analysis describes a novel approach for classifying experiences of race and racism and explores the relationship between identified classes and measures of food security and diet quality. Methods: Cross-sectional self-reported survey data from 306 African American adults living in two urban midwestern cities were collected in 2017-2018. Measures of racialized experiences assessed consciousness of race, perceived discrimination, and health effects of perceived discrimination. Food security was measured with a six-item screener and diet quality with the Healthy Eating Index-2010. Latent class analysis was used to generate racialized classes. Bivariate analyses were conducted to examine differences in class membership by sociodemographics and nutrition outcomes. Results: Participants were majority women who were receiving Supplemental Nutrition Assistance Program benefits. Three racialized classes were identified: Class 1 reported few racialized experiences (42.8% of the sample), Class 2 was racially conscious with few experiences of discrimination (45.1%), and Class 3 was both racially conscious and affected by racialized actions (12.1%). Racialized classes were significantly different in mean household income, level of education, home ownership, and job loss in the past year. Class 3 was the least represented among those that were food secure and the most represented among those that were very low food secure. There were no differences by class in Healthy Eating Index-2010 scores. Discussion: Findings offer an innovative method for measuring exposures to racism and for assessing its relationship to food security. Findings highlight heterogeneity of racialized experiences in similar contexts as well as potential root cause targets such as wages, education, home ownership, and employment that may be modulated to mitigate the effects of racism on food insecurity. [ABSTRACT FROM AUTHOR]

Diet is critical to chronic disease prevention, yet there are persistent disparities in diet quality among Americans. The socioecological model suggests multiple factors, operating at multiple levels, influence diet quality. The goal was to model direct and indirect relationships among healthy eating identity, perceived control of healthy eating, social support for healthy eating, food retail choice block scores, perceptions of healthy food availability, and food shopping behaviors and diet quality measured using Healthy Eating Index-2010 scores (HEI-2010) for residents living in two urban communities defined as food deserts. A cross-sectional design was used including data collected via self-reported surveys, 24-dietary recalls, and through objective observations of food retail environments. Data collection occurred in 2015-2016 in two low-income communities in Cleveland (n=243) and Columbus (n=244), OH. HEI-2010 scores were calculated based on the average of three 24-hour dietary recalls using the Nutrition Data System for Research. Separate path models, controlled for income, were run for each community. Analysis was guided by a conceptual model with 15 hypothesized direct and indirect effects on HEI-2010 scores. Associations were considered statistically significant at P <0.05 and P <0.10 because of modest sample sizes in each community. Across both models, significant direct effects on HEI-2010 scores included healthy eating identity (β=.295, Cleveland; β=.297, Columbus, P <0.05) and distance traveled to primary food store (β=.111, Cleveland, P <0.10; β=.175, Columbus, P <0.05). Perceptions of healthy food availability had a significant, inverse effect in the Columbus model (β=−.125, P <0.05). The models explained greater variance in HEI-2010 scores for the Columbus community compared with Cleveland (R 2=.282 and R 2=.152, respectively). Findings highlight the need for tailored dietary intervention approaches even within demographically comparable communities. Interventions aimed at improving diet quality among residents living in food deserts may need to focus on enhancing healthy eating identity using culturally relevant approaches while at the same time addressing the need for transportation supports to access healthy food retailers located farther away. [ABSTRACT FROM AUTHOR]

We examined the relationship between two forms of ethnic discrimination—interpersonal and institutional—and smoking outcomes among Arab men in Israel, and whether social support buffered these associations. We used cross-sectional data of adult Arab men, current or former smokers (n = 954). Mixed-effects regression models estimated the association between discrimination and smoking status, and nicotine dependence among current smokers. Interpersonal discrimination was associated with higher likelihood of being a current smoker compared to a former smoker, whereas institutional group discrimination was not. Social support moderated the ethnic discrimination-nicotine dependence link. Among men with low social support, greater interpersonal discrimination was associated with greater nicotine dependence. Similarly, among smokers with high institutional group discrimination, those with high social support reported lower nicotine dependence compared to those with low social support. Ethnic discrimination should be considered in efforts to improve smoking outcomes among Arab male smokers in Israel. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine the association of both perceived and geographic neighbourhood food access with food security status among households with children.DesignThis was a cross-sectional study in which participants’ perceptions of neighbourhood food access were assessed by a standard survey instrument, and geographic food access was evaluated by distance to the nearest supermarket. Multinomial logistic regression models were used to examine the associations.SubjectsThe Midlands Family Study included 544 households with children in eight counties in South Carolina, USA. Food security status among participants was classified into three categories: food secure (FS), food insecure (FI) and very low food security among children (VLFS-C).ResultsCompared with FS households, VLFS-C households had lower odds of reporting easy access to adequate food shopping. VLFS-C households also had lower odds of reporting neighbourhood access to affordable fruits and vegetables compared with FS households and reported worse selection of fruits and vegetables, quality of fruits and vegetables, and selection of low-fat products. FI households had lower odds of reporting fewer opportunities to purchase fast food. None of the geographic access measures was significantly associated with food security status.ConclusionsCaregivers with children who experienced hunger perceived that they had less access to healthy affordable food in their community, even though grocery stores were present. Approaches to improve perceived access to healthy affordable food should be considered as part of the overall approach to improving food security and eliminating child hunger. [ABSTRACT FROM PUBLISHER]

Objective: To examine associations between geographic measures of retail food outlets and perceived availability of healthy foods.Design: Cross-sectional.Setting: A predominantly rural, eight-county region of South Carolina, USA.Subjects: Data from 705 household shoppers were analysed using ordinary least-squares regression to examine relationships between geographic measures (presence and distance) of food outlets obtained via a geographic information system and perceived availability of healthy foods (fresh fruits and vegetables and low-fat foods).Results: The presence of a supermarket within an 8·05 km (5-mile) buffer area was significantly associated with perceived availability of healthy foods (β=1·09, P=0·025) when controlling for all other food outlet types. However, no other derived geographic presence measures were significant predictors of perceived availability of healthy foods. Distances to the nearest supermarket (β=-0·16, P=0·003), dollar and variety store (β=-0·15, P=0·005) and fast-food restaurant (β=0·11, P=0·015) were all significantly associated with perceptions of healthy food availability.Conclusions: Our results suggest that distance to food outlets is a significant predictor of healthy food perceptions, although presence is sensitive to boundary size. Our study contributes to the understanding and improvement of techniques that characterize individuals' food options in their community. [ABSTRACT FROM AUTHOR]

Objective: To explore potential differences in food shopping behaviors and healthy food availability perceptions between residents living in areas with low and high food access. Design: A cross-sectional telephone survey to assess food shopping behaviors and perceptions. Data from an 8-county food environment field census used to define the Centers for Disease Control and Prevention (CDC) healthier food retail tract and US Department of Agriculture Economic Research Service food desert measure. Participants: A total of 968 residents in 8 South Carolina counties. Main Outcome Measures: Residents' food shopping behaviors and healthy food availability perceptions. Analysis: Linear and logistic regression. Results: Compared with residents in high food access areas, residents in low food access areas traveled farther to their primary food store (US Department of Agriculture Economic Research Service: 8.8 vs 7.1 miles, P = .03; CDC: 9.2 vs 6.1 miles, P < ,001), accumulated more total shopping miles per week (CDC: 28.0 vs 15.4 miles; P < .001), and showed differences in perceived healthy food availability (P < .001) and shopping access (P < .001). Conclusions and Implications: These findings lend support to ongoing community and policy interventions aimed at reducing food access disparities. [ABSTRACT FROM AUTHOR]

Abstract Background Little is known about the food acquisition and shopping habits of residents living in food deserts. Objective To identify distinct food acquisition and shopping patterns among residents, most of whom (81%) live in food desert (low income and low access) census tracts, and characterize these patterns with respect to the residents' socioeconomic status, nutrition knowledge, and perceptions of their food environment. Design This is a cross-sectional study. Participants/setting Four hundred sixty-six primary food shoppers were included from two counties in South Carolina during 2013-2014. Main outcome measures Participants' self-reported food acquisition and shopping habits, including shopping distance; frequency; store type; transportation mode; use of farmers' markets, food banks/pantries, and church/social service organizations, were used to develop shopping patterns and group residents. Supplemental Nutrition Assistance Program participation, food security, income, and education, nutrition knowledge, and perceptions of the food environment were used to characterize these groups. Statistical analyses performed Latent class analysis and multinomial logistic regression were used to identify and characterize patterns, respectively. Results Three patterns were identified, including those who use community food resources, are infrequent grocery shoppers, and use someone else's car or public transportation when shopping (Class 1) (35%), those who use community food resources and are more frequent and proximal shoppers (Class 2) (41%), and those who do not use community food resources and are distal shoppers (Class 3) (24%). Compared with Class 3, Class 1 had comparatively lower socioeconomic status. Class 2 also had comparatively lower socioeconomic attributes except for income. Class 2 was not significantly different from Class 1 except that a higher proportion in Class 1 saw food access as a problem. No significant differences across classes were found regarding fruit and vegetable recommendation knowledge. Conclusions Shopping frequency, use of community food resources, transportation methods, and shopping distance were the key factors that defined distinct patterns among residents living in low-income areas. Future interventions to increase healthy food access in underserved areas should not only consider accessibility but also community food resource use. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether knowledge of a person's eating identity (EI) can explain any additional variation in fruit and vegetable intake above and beyond that explained by food environment characteristics, perceptions of the food environment, and shopping behaviors.Design: Cross-sectional study.Setting: A total of 968 adults were recruited for a telephone survey by the Survey Research Laboratory in an eight-county region in South Carolina.Subjects: The survey queried information on shopping behaviors, perceptions of the food environment, demographic and address information, fruit and vegetable intake, and EI. EI was assessed using the Eating Identity Type Inventory, a 12-item instrument that differentiates four eating identity types: healthy, emotional, meat, and picky. Statistical analyses were restricted to 819 participants with complete data.Results: Healthy EI and picky EI were significantly and directly related to fruit and vegetable intake, with coefficients of 0.31 (p-value<0.001) for healthy EI and -0.16 (p-value<0.001) for picky EI, whereas emotional EI (β = 0.00, p-value = 0.905) and meat EI (β = -0.04, p-value = 0.258) showed no association. Shopping frequency also directly and significantly influenced fruit and vegetable intake (β = 0.13, p-value = 0.033). With the inclusion of EI, 16.3% of the variation in fruit and vegetable intake was explained.Conclusions: Perceptions and GIS-based measures of environmental factors alone do not explain a substantial amount of variation in fruit and vegetable intake. EI, especially healthy EI and picky EI, is an important, independent predictor of fruit and vegetable intake and contributes significantly to explaining the variation in fruit and vegetable intake. [ABSTRACT FROM AUTHOR]

Purpose: Geographic information systems (GISs) have been used to define fast food availability, with higher availability perhaps promoting poorer quality diets. Alternative measures involve perceptions; however, few studies have examined associations between GIS-derived and perceived measures of the food environment.Methods: Telephone surveys of 705 participants within an eight-county region in South Carolina were analyzed using logistic regression to examine relationships between geographic presence of and distance to various types of food retailers and perceived fast food availability.Results: The mean distance to the nearest fast food restaurant was 6.1 miles, with 16% of participants having a fast food restaurant within 1 mile of home. The geographic presence of and distance to all food retailer types were significantly associated with perceived availability of fast food in unadjusted models. After adjustment, only the presence of a fast food restaurant or pharmacy was significantly associated with greater odds of higher perceived availability of fast food. Greater odds of lower perceived availability of fast food were observed with the presence of a dollar store and increasing distance to the nearest supermarket or pharmacy.Conclusions: Measures of fast food availability, whether objective or perceived, may not be interchangeable. Researchers should carefully decide on the appropriate measurement tool-GIS-derived or perceived-in food environment studies. [ABSTRACT FROM AUTHOR]

Objective To examine the strategies and behaviors caregivers use to manage the household food supply when their children experience food insecurity as measured by the US Department of Agriculture's Household Food Security Survey Module. Design Cross-sectional survey with open-ended questions collected in person. Setting Urban and nonurban areas, South Carolina, US. Participants Caregivers who reported food insecurity among their children (n = 746). Phenomenon of interest Strategies and behaviors used to manage the household food supply. Analysis Emergent and thematic qualitative coding of open-ended responses. Results The top 3 strategies and behaviors to change meals were (1) changes in foods purchased or obtained for the household, (2) monetary and shopping strategies, and (3) adaptations in home preparation. The most frequently mentioned foods that were decreased were protein foods (eg, meat, eggs, beans), fruits, and vegetables. The most frequently mentioned foods that were increased were grains and starches (eg, noodles), protein foods (eg, beans, hot dogs), and mixed foods (eg, sandwiches). Conclusions and Implications Caregivers use a wide variety of strategies and behaviors to manage the household food supply when their children are food insecure. Future work should examine how these strategies might affect dietary quality and well-being of food-insecure children. [ABSTRACT FROM AUTHOR]