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Marketing strategies for sweetened beverages (SBs) are pervasive across food retail. Yet few studies have examined how these strategies associate with planned and unplanned SB purchasing.This study aimed to examine whether customers with greater exposure to SB retail marketing (eg, advertisements and product placement) were more likely to purchase an SB and whether this varied by customer characteristics.This was an observational, cross-sectional study using objective customer purchasing and store assessment data from convenience and other small food stores.Participants were 1,604 food and beverage customers at 144 randomly sampled convenience and other small food stores in Minneapolis-St Paul, MN.Marketing strategies, including SB advertisements, placement, and shelf space were included.We determined the probability of customers purchasing ≥4 fluid ounces of a ready-to-drink sugar and/or artificially sweetened beverage.Associations between marketing strategies and purchasing were estimated using mixed regression models, controlling for customer characteristics and accounting for customers nested within stores.Fifty-six percent of customers purchased an SB; 14% also specified that it was an unplanned purchase. Customers were more likely to purchase an SB when exterior advertisements (Plt; .001) and advertisements hanging from the ceiling (Plt; .001) that promoted SBs were present. Customers with moderate and high cumulative exposure to SB marketing were significantly more likely to purchase SBs (51.2% and 54.9%, respectively) than those with lower exposure (34%); this effect was particularly salient for men. There were no significant associations between retail marketing strategies and unplanned purchases.Findings demonstrate that feasible and sustainable approaches are required from policy makers, retailers, and public health professionals to shift store environments away from cues that promote unhealthy beverage selections. Given that numerous retail actors are invested in the availability, promotion, and sales of SBs, changing the predominance of SB marketing in convenience stores will likely be challenging and require cross-sector collaboration.

Food insecurity (FI) has negative implications across the life course that include poor health outcomes among both children and adults. However, the behavioral mechanisms by which FI impacts health behaviors are not clear. By understanding how FI is related to cognitive function/brain structure across the life course, we can design more targeted interventions. A systematic literature review was performed by conducting comprehensive database searches in Google Scholar and PubMed. Inclusion criteria required studies to include measures of FI and cognitive function/brain structure in humans. Study sample, design, outcomes, and biases were extracted. In total, 17 studies met the inclusion criteria. Cognitive domains included general cognition (n = 13), executive function (n = 10), visuospatial abilities (n = 4), and verbal memory (n = 8). No studies examined brain structure. Most studies (88%) indicated significant inverse associations between FI and cognitive function across all stages of the life course, particularly for general cognition and executive function. Significant inverse associations were observed between FI and either general cognition or executive function among children (n = 3) and adults (n = 12). All studies considered confounding variables; however, given that all were observational, no causality can be inferred from the findings. These findings indicate that FI is related to lower cognitive function across the life course. Research should explore how changes in food security status impacts cognitive function and brain structure to develop optimal FI interventions and improve cognitive health.

Objective In this study, we examine associations between objectively measured weekend night vs. school night sleep patterns, weight status, and weight-related behaviors among adolescents. Design Cross-sectional study. Setting Five Minnesota high schools that started early (7:30 or 7:45 AM) in Spring 2016. Participants Ninth grade students, ages 14.5-16 years (n = 284). Measurements Students completed surveys, had body measurements taken, and wore sleep (wrist) actigraphs for 1 week (n = 284). We examined weekend night-school night differences in sleep duration and sleep timing. We then assessed whether these factors were related to weight status and weight-related behaviors (eating behaviors, food consumption, physical activity, beverage consumption) using generalized linear mixed models. Results On average, students slept 1.5 hours (95% confidence interval 1.3-1.7) more and had a sleep midpoint 1.9 hours (1.8-2.1) later on weekend nights compared to school nights. Female students had larger increases in sleep duration on weekend nights than males but similar timing differences. Sleep duration differences were uncorrelated with sleep timing differences (r = 0.01). Neither duration nor timing differences were associated with overweight, obesity, or any of the eating behaviors we examined. However, sleeping longer on weekend nights than on school nights was associated with lower probability of being active 6-7 days per week (p = .02). Conclusions Adolescents have substantial sleep duration and sleep timing differences on weekend nights vs. school nights. While these differences may not be associated with weight status or weight-related behaviors, they reflect the reality that most adolescents have schedules that restrict their sleep.

Purpose of review This review describes research addressing sexual orientation disparities in obesity and their sequelae, with a focus on new findings from the past year and areas for future work. Recent findings Sexual minority people of color experience important health disparities related to obesity. Sexual minority women may be at greater risk of developing type 2 diabetes than their heterosexual counterparts, potentially because of obesity-related disparities. Bisexual men also appear to experience more obesity and potential greater risk for type 2 diabetes than heterosexual men. Stigma and discrimination are important emerging areas for additional research to better understand sexual orientation disparities in obesity-related health. There is a need for intersectional research and longitudinal research that connects existing sexual orientation disparities in obesity with subsequent chronic disease development. Additionally, upstream efforts to understand the impact of stigma and discrimination on the weight-related health of sexual minority groups are needed.

Objective:To examine associations between geographic information systems (GIS)-assessed accessibility to small food stores, shopping patterns and dietary behaviours among small food store customers.Design:Residential addresses and customer shopping patterns (frequency of shopping, and previous purchase of fruits and vegetables) were gathered through customer intercept surveys. Addresses were geocoded, and GIS-assessed distance and driving time from the participants’ residence to the store were calculated. Dietary status and behaviours were assessed using an objective non-invasive measure of skin carotenoids, the National Cancer Institute Fruit and Vegetable Screener, and items to assess sugary beverage intake. Associations between distance and driving time, demographics, shopping frequency, prior reported purchase of fruits and vegetables at the store and dietary behaviours were examined.Setting:Small food stores (n 22) across North Carolina.Participants:Cross-sectional convenience samples of English-speaking customers aged 18 years or older (n 692).Results:Participants living closer to the small store had lower income and formal education, were more likely to be Black, more likely to have previously bought fruits and vegetables at the store and more frequently shopped at the store. In adjusted models, skin carotenoids (n 644) were positively associated with distance to the store from home in miles (P = 0·01).Conclusions:Customers who lived closer to the stores were more frequent shoppers and more likely to have previously purchased fruits and vegetables at the store yet had lower skin carotenoids. These results support continued efforts to examine how to increase the availability and promotion of healthful foods at small food retail stores.

Research conducted before coronavirus disease-2019 illustrated high rates of food insecurity among college students. The pandemic has likely increased student food insecurity because of factors like unemployment and closure of campus resources, and many students cannot access federal food assistance because of long-standing student restrictions. This perspective reviews federal legislation on college food insecurity introduced in the 116th legislative session (2019-2020) immediately before coronavirus disease-2019 in the US, as well as pandemic-related stimulus bills and their implications for future policies and practice. Food insecurity promises to become more pressing as colleges try to reopen and the country grapples with economic recovery.

PurposeTo estimate the effect of Healthy, Hunger-Free Kids Act of 2010 (HHFKA) implementation on dietary quality of all US school-aged children and adolescents, and examine whether those effects differed by demographic group.MethodsWe used survey regression on 2007-2016 National Health and Nutrition Examination Survey (NHANES) data to estimate the proportion of energy intake from school foods and the association between school food intake and dietary quality, before and after HHFKA passage/implementation. To account for demographic changes in the US population over time, inverse probability weighting was employed. The product of the proportion of energy from school foods and the association between school food intake and dietary quality estimated the effect of HHFKA implementation on dietary quality.ResultsSchool food intake quantity remained stable during the study period. HHFKA implementation improved students’ dietary quality by 4.3 Healthy Eating Index-2010 (HEI) points (95% CI: 2.5, 6.1) on days when school foods were eaten, and by 1.3 HEI points (95% CI: 0.73, 1.8) averaged over all days annually.ConclusionsHHFKA implementation improved the total dietary quality of US school students. US students would benefit from eating school meals in the post-HHFKA era, and HHFKA regulations should not be relaxed.

Background Policies to improve healthy food retail have been recognized as a potential means of reducing diet-related health disparities. The revised 2014 Minneapolis Staple Foods Ordinance instituted minimum stocking standards for healthy, staple foods. The objective of this study was to examine retailer compliance with the policy, and whether compliance varied by neighborhood and store characteristics. Methods In this natural experiment, audits were conducted annually pre- and post-ordinance (2014–2017) in 155 small/nontraditional stores in Minneapolis, MN and a comparison city (St. Paul, MN). Compliance measures for 10 product categories included: (1) met requirements for ≥8 categories; (2) 10-point scale (one point for each requirement met); and (3) carried any item in each category. Store characteristics included store size and ownership status. Neighborhood characteristics included census-tract socioeconomic status and low-income/low-access status. Analyses were conducted in 2018. Results All compliance measures increased in both Minneapolis and St. Paul from pre- to post-policy; Minneapolis increases were greater only for carrying any item in each category (p Conclusions Overall trends suggest broad movement among Minneapolis stores towards providing a minimum level of staple foods. Increases were greater in corporate stores. Trends do not suggest neighborhood-level disparities in compliance. Study registration ClinicalTrials.gov NCT02774330, retrospectively registered May 17, 2016.

Objective: In this study, we examined small food store retailers' perspectives on tobacco company agreements specifying tobacco product display and promotion. Methods: We interviewed owners/managers of small food stores (N = 63) in lower-income neighborhoods in 4 US cities using open-and closed-ended questions between October 2013 and July 2014. We coded qualitative interview data and calculated descriptive statistics. Results: Most retailers had a formal contract with a tobacco company (87%). Retailers perceived that tobacco products generated low profits, but were important to attract customers. Nearly 95% with contracts reported receiving an incentive, including marketing materials (86.8%), displays (79%), and free/discounted products (50.9%). Contract requirements included placing branded displays and marketing materials in prime locations and setting cigarette prices. Retailers in urban, African-American neighborhoods felt pressure to maintain menthol cigarette contracts to stay in business. Conclusion: Contracts with tobacco companies were common among the small food stores in this study, and retailers felt they needed the contracts to keep prices competitive. Given the reliance of retailers on tobacco industry contracts, states and localities may need to adopt measures to counter their effects, especially the financial incentives that lead to lower cigarette prices and more prominent displays of promotions and marketing materials.

INTRODUCTION: Short sleep duration is exceedingly common among adolescents and has implications for healthy youth development. We sought to document associations between to adolescents’ sleep duration and characteristics of their schedules, behaviors, and wellbeing. METHODS: We used data from the baseline wave (9(th) grade year) of the START study, a cohort of 2,134 students in five Minnesota high schools to assess how self-reported sleep duration was associated with the prevalence of time-use characteristics (i.e. activity schedules, screen use), sleep-wake problems behaviors (i.e. trouble waking in the morning, calling asleep in class, etc.), and risk of depression. RESULTS: Shorter sleep duration was associated with various behaviors including greater computer/screen time and screen use after bed, a lower probability of doing homework, sports, and chores on school nights, and reporting that it takes at least 20 minutes to fall asleep on school days (p < 0.05). Suboptimal sleep duration was also associated with a higher probability of all reported sleep-wake problems as well as high risk of depressive symptoms (p < 0.05). CONCLUSIONS: Given that getting an optimal amount of sleep can protect youth from risk and promote healthy youth development, it is critical that we gain a greater understanding of correlates and consequences of short sleep duration in order to develop a sleep-friendly culture for youth.

Most studies of food-related parenting practices, parental meal involvement, and adolescent dietary intake have focused on maternal influences, studies of paternal influences, particularly among marginalized groups, are lacking. This study examined lower-income, Latino fathers’ food parenting practices and involvement in planning meals, buying/preparing foods, and family meal frequency, separately and in combination, to identify relationships with adolescent food intake. Baseline data were used from Latino adolescents (10–14 years, n = 191, 49% boys) participating with their fathers in a community-based overweight/obesity prevention intervention. Fathers reported sociodemographic characteristics. Adolescents reported frequency of fathers’ food parenting practices, fathers’ food/meal involvement, and family meals and participated in 24 h dietary recalls. The analysis included regression models using GLM (generalized linear mixed model) and PLM (post GLM processing) procedures. Most fathers were married, employed full-time, and had annual incomes below USD 50,000. Favorable fathers’ food parenting practices were associated with adolescent intake of more fruit and vegetables and fewer sugar-sweetened beverages, sweets/salty snacks, and less fast food (p &lt, 0.05 or p &lt, 0.01). No independent effects of family meal frequency or fathers’ food/meal involvement were observed on adolescent dietary outcomes. Additional analyses showed favorable food parenting practices in combination with frequent family meals were associated with adolescents having a higher intake of fruit (p = 0.011). Latino fathers can have an important positive influence on adolescent dietary intake.

Background The North Carolina Healthy Food Small Retailer Program (NC HFSRP) was established through a policy passed by the state legislature to provide funding for small food retailers located in food deserts with the goal of increasing access to and sales of healthy foods and beverages among local residents. The purpose of this study was to qualitatively examine perceptions of the NC HFSRP among store customers. Methods Qualitative interviews were conducted with 29 customers from five NC HFSRP stores in food deserts across eastern NC. Interview questions were related to shoppers’ food and beverage purchases at NC HFSRP stores, whether they had noticed any in-store efforts to promote healthier foods and beverages, their suggestions for promoting healthier foods and beverages, their familiarity with and support of the NC HFSRP, and how their shopping and consumption habits had changed since implementation of the NC HFSRP. A codebook was developed based on deductive (from the interview guide questions) and inductive (emerged from the data) codes and operational definitions. Verbatim transcripts were double-coded and a thematic analysis was conducted based on code frequency, and depth of participant responses for each code. Results Although very few participants were aware of the NC HFSRP legislation, they recognized changes within the store. Customers noted that the provision of healthier foods and beverages in the store had encouraged them to make healthier purchase and consumption choices. When a description of the NC HFSRP was provided to them, all participants were supportive of the state-funded program. Participants discussed program benefits including improving food access in low-income and/or rural areas and making healthy choices easier for youth and for those most at risk of diet-related chronic diseases. Conclusions Findings can inform future healthy corner store initiatives in terms of framing a rationale for funding or policies by focusing on increased food access among vulnerable populations.

Background Valid biomarkers of fruit and vegetable (FV) intake are needed for field-based nutrition research. Objective To examine criterion-related validity of pressure-mediated reflection spectroscopy as a proxy measure of FV intake, using plasma carotenoids and self-reported FV and carotenoid intake as primary and secondary criterion measures, respectively. Methods Healthy adults 18-65 years of age, self-identifying as African American/ black (n = 61), Asian (n = 53), white (n = 70), or Hispanic (n = 29) in North Carolina and Minnesota were recruited. Skin carotenoids were assessed via pressure-mediated reflection spectroscopy (Veggie Meter ®), skin melanin via spectrophotometer, and total plasma carotenoid concentration by HPLC-PDA. Self-reported carotenoid and FV intake was assessed using a semi-quantitative food frequency questionnaire. Relationships between skin carotenoids, plasma carotenoids, FV and carotenoid intake, with differences by race or ethnicity, age, sex, weight status, cholesterol, and melanin index, were examined by bivariate correlations and adjusted multivariate linear regressions. Results The overall unadjusted correlation between skin and total plasma carotenoids was r = 0.71 and ranged from 0.64 (non-Hispanic black) to 0.80 (Hispanic). Correlations between skin carotenoids and self-reported FV intake ranged from 0.24 (non-Hispanic black) to 0.53 (non-Hispanic white), with an overall correlation of r = 0.35. In models adjusted for age, sex, racial or ethnic group, and body mass index, skin carotenoids were associated with plasma carotenoids (R2 = 0.55), FV (R2 = 0.17), and carotenoid intake (R2 = 0.20). For both plasma carotenoid and FV measures, associations with skin carotenoids did not vary by race; but these relationships did differ by skin melanin - those with lower melanin had a lower correlation between skin and plasma carotenoids. Conclusions Reflection spectroscopy-assessed skin carotenoids may be a reasonable alternative to measurement of plasma carotenoids, a biomarker used to approximate FV intake.

BACKGROUND: Sleep duration, quality, and timing may influence dietary quality. In adults, poor dietary quality is a risk factor for numerous chronic diseases. It is unclear how these various sleep domains influence adolescents’ diets because prior population-based studies have not effectively manipulated sleep, did not include objective sleep measures, and had short follow-up times. OBJECTIVES: The objectives of this study were to examine 1) how adolescent sleep characteristics relate to dietary quality; and 2) how delay in high school start times (which lengthened sleep duration) affects dietary quality over 2 y. METHODS: In the START study, adolescents (grades 9–11, n = 423) attending 5 high schools in the Minneapolis, Minnesota metropolitan area were annually assessed in 3 waves (2016–2018). At Baseline, all schools started “early” (07:30 or 07:45). From Follow-up 1 through Follow-up 2, 2 “policy change schools” shifted to later start times (to 08:20 and 08:50). Three “comparison schools” maintained their early start throughout. Sleep characteristics were measured with actigraphy. Mixed-effect regression models were used to examine cross-sectional and longitudinal associations of sleep characteristics with dietary quality, and school start time policy change with dietary quality change. RESULTS: Cross-sectionally, later sleep midpoint and onset were associated with dietary quality scores 1.6–1.7 lower (both P

Retail food environments (RFEs) are complex systems with important implications for population health. Studying the complexity within RFEs comes with challenges. Complex systems models are computational tools that can help. We performed a systematic scoping review of studies that used complex systems models to study RFEs for population health. We examined the purpose for using the model, RFE features represented, extent to which the complex systems approach was maximized, and quality and transparency of methods employed. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Studies using agent-based modeling, system dynamics, discrete event simulations, networks, hybrid, or microsimulation models were identified from 7 multidisciplinary databases. Fifty-six studies met the inclusion criteria, including 23 microsimulation, 13 agent-based, 10 hybrid, 4 system dynamics, 4 network, and 2 discrete event simulation models. Most studies (n = 45) used models for experimental purposes and evaluated effects of simulated RFE policies and interventions. RFE characteristics simulated in models were diverse, and included the features (e.g., prices) customers encounter when shopping (n = 55), the settings (e.g., restaurants, supermarkets) where customers purchase food and beverages (n = 30), and the actors (e.g., store managers, suppliers) who make decisions that influence RFEs (n = 25). All models incorporated characteristics of complexity (e.g., feedbacks, conceptual representation of multiple levels), but these were captured to varying degrees across model types. The quality of methods was adequate overall; however, few studies engaged stakeholders (n = 10) or provided sufficient transparency to verify the model (n = 12). Complex systems models are increasingly utilized to study RFEs and their contributions to public health. Opportunities to advance the use of these approaches remain, and areas to improve future research are discussed. This comprehensive review provides the first marker of the utility of leveraging these approaches to address RFEs for population health.

Chronic health inequities for communities of color is partially attributed to a lack of healthy preferred food access. This manuscript explores whether corner stores and non-traditional food stores stock fruits, vegetables and whole grain foods that the area cultural communities may prefer as part of complying with a local ordinance. This exploratory analysis identified corner and non-traditional food stores located in immigrant populations of color and African American neighborhoods as part of a larger study. Culturally preferred foods were identified from a list of food items in the parent (STORE) study and used to assess changes in availability. Stores did not have a great variety of culturally relevant foods pre- or post-ordinance, and overall findings show no significant changes over time and/or between ordinance and control community. Further interventions are needed to address cultural food availability in stores near communities of color.

Previous research has identified significant sexual orientation disparities in obesity. Contextual factors, like lack of anti-discrimination policies and gay-straight alliances, have been shown to be associated with health outcomes like poor mental health and substance use for lesbian, gay, and bisexual (LGB) individuals moreso than their heterosexual counterparts; however, little work to date has explored the role of contextual factors on sexual orientation disparities in obesity. Individual-level, serial cross-sectional data from the 2009-2013 College Student Health Survey, which includes 2- and 4-year college students (n = 29,118) attending 46 Minnesota colleges, were used. College-level data on LGB context were primarily collected through college websites. Multinomial logistic regression models were fit to examine associations between LGB college climate scores (including non-discrimination policies, presence of LGB or diversity-related student groups, LGB courses offered, LGB housing accommodations, and prevalence of LGB students) and students' weight status (underweight, healthy weight, overweight, and obese), based on self-reported height and weight. Higher LGB climate scores (i.e., more supportive environments) were associated with lower risk of overweight and obesity among all students. Sexual orientation-stratified findings among female students suggested that the association between LGB climate scores and weight status was similar to the overall female sample. Sexual orientation-stratified findings among male students showed a more complex relationship between LGB climate scores and weight status. More work is needed to disentangle the observed associations, and to investigate other contextual factors, like state- and city-level policies, social networks and norms, and individual resiliency within these contexts to better understand the contextual influences on sexual orientation disparities in obesity.

Low-income communities often lack access to supermarkets and healthy foods. Enhanced stocking requirements for staple foods for Supplemental Nutrition Assistance Program (SNAP)-authorized retailers may increase availability of healthy foods in smaller stores which are prevalent in low-income areas. This study aimed to evaluate the extent that small food stores located in low-income areas met the U.S. Department of Agriculture's 2016 final rule on SNAP-authorized retailer stocking requirements, which increased the minimum number of required staple food varieties from three to seven for each staple food category, required a depth of stock of three units of each variety, and increased the required number of categories with perishables from two to three. A multisite research project was conducted in 2017. Nine research teams located in seven U.S. states audited the availability of perishable and nonperishable staple foods and beverages in 351 small food stores in low-income areas. Analyses determined the extent to which stores met all or part of the stocking requirements and tested differences by store type. 30.2% of stores met all of the 2016 final rule requirements; 86.3% met the requirements for fruits and vegetables, whereas only 30.5% met requirements for dairy. 53.1% of non-chain small grocery stores met all requirements compared to 17.1% of convenience stores (p < .0001). Less than one half of the food stores audited met the U.S. Department of Agriculture's 2016 final rule that would expand SNAP-authorized retailer stocking requirements suggesting that, if implemented, the rule may generate increased offerings of staple foods in small stores in low-income areas.

Food-based community organizations (FBCO) have positive impacts on community health, yet little is known about best practices that facilitate organization sustainability. To identify strategies among FBCOs used to facilitate member engagement/retention, reach future members/participants, and support organizational growth, key informants from four FBCOs in Texas participated in in-depth interviews. Semi-structured interviews were informed by grounded theory, voice recorded, and transcribed. Results from eight interviews, representing four organizations, indicated five themes for organization sustainability: commitment to a mission, supportive leadership, physical meeting space, clear communication, and community partnerships. Implementation of these strategies may benefit other FBCOs by helping them create sustainable organizations.

ObjectiveWe examined differences in consumer-level characteristics and structural resources and capabilities of small and non-traditional food retailers (i.e. corner stores, gas-marts, pharmacies, dollar stores) by racial segregation of store neighbourhood and corporate status (corporate/franchise-v. independently owned).DesignObservational store assessments and manager surveys were used to examine availability-, affordability- and marketing-related characteristics experienced by consumers as well as store resources (e.g. access to distributors) and perceived capabilities for healthful changes (e.g. reduce pricing on healthy foods). Cross-sectional regression analyses of store and manager data based on neighbourhood segregation and store corporate status were conducted.SettingSmall and non-traditional food stores in Minneapolis and St. Paul, MN, USA.ParticipantsOne hundred and thirty-nine stores; seventy-eight managers.ResultsSeveral consumer- and structural-level differences occurred by corporate status, independent of residential segregation. Compared with independently owned stores, corporate/franchise-owned stores were more likely to: not offer fresh produce; when offered, receive produce via direct delivery and charge higher prices; promote unhealthier consumer purchases; and have managers that perceived greater difficulty in making healthful changes (P≤0·05). Only two significant differences were identified by residential racial segregation. Stores in predominantly people of colour communities (P≤0·05).ConclusionsCorporate status appears to be a relevant determinant of the consumer-level food environment of small and non-traditional stores. Policies and interventions aimed at making these settings healthier may need to consider multiple social determinants to enable successful implementation.

OBJECTIVE: To develop an informed, reliable data collection tool to code restaurants found within the youth food environment. METHODS: Registered Dietitians were surveyed and academic literature review was reviewed to determine health centric food environment features. Features were incorporated into an electronic data collection tool. Inter-rater reliability was tested across coders of varying nutrition training on all restaurants located within a half-mile of three high schools. RESULTS: Sixteen restaurant food environment codes were generated. Data collection had a mean inter-rater reliability of 90.7% agreement (range=81.3–100%), suggesting that regardless of nutrition training, the restaurant food environment can be reliability coded. CONCLUSIONS: Academic and public health professionals can use this tool to collect reliable, informed local restaurant food environment data.

OBJECTIVES: The fit of measured variables into a social-ecological model of correlates of physical activity is rarely tested. In this study, we examined the factor structure of correlates of moderate/vigorous physical activity (MVPA) within a hypothesized social-ecological model. METHODS: We measured 46 possible personal, social and environmental correlates of MVPA in 2779 adolescents participating in the Project EAT-2010 study. Confirmatory (CFA) and exploratory factor analyses (EFA) were used to determine the factor structure. Associations of factor scores with self-reported MVPA were calculated with linear regression. RESULTS: A 6-factor CFA model did not show adequate fit. Eight factors were identified using EFA (Root Mean Square Error [RMSEA] 90% CI: 0.053 to 0.055; CFI = 0.82). A factor representing the mix of personal and social correlates showed the strongest association with MVPA. CONCLUSIONS: The 8-factor model supports independent clustering of possible environmental correlates of MVPA, but indicates that social and personal correlates may not cluster independently. The factor most strongly correlated with MVPA represented a mix of personal and social correlates. Future work will be needed to better understand how mechanisms for developing physical activity work within and across levels of the social-ecological framework.

The aim of this study was to examine associations between perceived neighborhood food environments and food purchasing at small and non-traditional food stores. Intercept interviews of 661 customers were conducted in 105 small and non-traditional food stores. We captured (1) customer perceptions of the neighborhood food environment, (2) associations between customer perceptions and store-level characteristics, and (3) customers’ perceptions and shopping behaviors. Findings suggest that customers with more favorable perceptions of the neighborhood food environment were more likely to purchase fruits and vegetables, despite no significant association between perceptions of the neighborhood and objectively measured store characteristics.

Background The North Carolina (NC) Healthy Food Small Retailer Program (HFSRP) was passed into law with a $250,000 appropriation (2016–2018) providing up to $25,000 in funding to small food stores for equipment to stock healthier foods and beverages. This paper describes an observational natural experiment documenting the impact of the HFSRP on store food environments, customers’ purchases and diets. Methods Using store observations and intercept surveys from cross-sectional, convenience customer samples (1261 customers in 22 stores, 2017–2020; 499 customers in 7 HFSRP stores, and 762 customers in 15 Comparison stores), we examined differences between HFSRP and comparison stores regarding: (1) change in store-level availability, quality, and price of healthy foods/beverages; (2) change in healthfulness of observed food and beverage purchases (“bag checks”); and, (3) change in self-reported and objectively-measured (Veggie Meter®-assessed skin carotenoids) customer dietary behaviors. Differences (HFSRP vs. comparison stores) in store-level Healthy Food Supply (HFS) and Healthy Eating Index-2010 scores were assessed using repeated measure ANOVA. Intervention effects on diet were assessed using difference-in-difference models including propensity scores. Results There were improvements in store-level supply of healthier foods/beverages within 1 year of program implementation (0 vs. 1–12 month HFS scores; p = 0.055) among HFSRP stores only. Comparing 2019 to 2017 (baseline), HFSRP stores’ HFS increased, but decreased in comparison stores (p = 0.031). Findings indicated a borderline significant effect of the intervention on self-reported fruit and vegetable intake (servings/day), though in the opposite direction expected, such that fruit and vegetable intake increased more among comparison store than HFSRP store customers (p = 0.05). There was no significant change in Veggie Meter®-assessed fruit and vegetable intake by customers shopping at the intervention versus comparison stores. Conclusions Despite improvement in healthy food availability, there was a lack of apparent impact on dietary behaviors related to the HFSRP, which could be due to intervention dose or inadequate statistical power due to the serial cross-sectional study design. It may also be that individuals buy most of their food at larger stores; thus, small store interventions may have limited impact on overall eating patterns. Future healthy retail policies should consider how to increase intervention dose to include more product marketing, consumer messaging, and technical assistance for store owners.

Customers who frequently shop in small food stores (e.g., convenience stores) may face numerous challenges to procuring healthful food for their household, and these may vary by food security status. The purpose of this study is to examine associations between food security and food shopping-related behaviors among frequent shoppers at small stores. Our sample included participants from customer intercept interviews at small food stores in an urban area. A follow-up in-home visit with a subset of customers who reported frequently shopping in these stores (≥1/week; n = 78) included a survey and researcher-administered home food inventory. Food security status was identified via the U.S. Household Food Security Survey Six-Item Short Form. Outcomes included shopping frequency and money spent by store type (e.g., small vs. large), home-to-store distance, and observed home availability of fruits, vegetables, and obesogenic foods. We estimated associations between food security status and each outcome, adjusting for demographic and poverty-related confounders. Participants were 56% female and 65% people of color; 45% received Supplemental Nutrition Assistance Program benefits and 54% experienced food insecurity in the past year. Unadjusted models indicated several significant associations: compared to those who were food secure, food-insecure participants shopped for food/beverages at small stores more times per month, spent more on food/beverages at dollar stores, and had less home availability of fruit and obesogenic foods. Associations remained significant (p = .04) between food insecurity and shopping frequency in adjusted models. Interventions requiring or incentivizing small food stores to stock healthful products could be important for improving access to nutritious food for food-insecure persons.

The process of feeding is complex and highly dependent on parent, child, social, and environmental factors. Given the rising rates of food insecurity and concomitant poor nutrition and health, the purpose of this article was to outline the important and complex ways in which the context of food insecurity can impact parent feeding practices. Key factors discussed here include the impact of food insecurity on: expectations for motherhood, structural constraints, stress and depression, parents’ perceptions of health and child weight, and intergenerational transmission of parent feeding practices. Future research needs are also identified and discussed.

Many US college students experience food insecurity (FI). Given most students are excluded from receiving federal nutrition assistance, additional efforts are needed to alleviate student FI. This perspective discusses proposed and enacted state statutes, resolutions, and bills addressing college FI to date, which range in depth, breadth, and success. Overall, states have demonstrated their promising role in addressing FI; however, college FI promises to be a continuing challenge, particularly given continued widespread unemployment that began with the onset of coronavirus disease 2019 and the global struggle for economic recovery.

Objectives. To examine emerging adults’ experiences of food insecurity in relation to measures of diet quality, food literacy, home food availability, and health behaviors. Methods. We used EAT 2010–2018 (Eating and Activity over Time) study data on 1568 participants who completed surveys as adolescents in 2009 to 2010 and follow-up surveys in 2017 to 2018 (mean age = 22.0 ±2.0 years; 58% female). At baseline, participants were recruited from 20 urban schools in Minneapolis–St Paul, Minnesota. Food insecurity was defined by emerging adult report of both eating less than they thought they should and not eating when hungry because of lack of money. Results. The prevalence at follow up of experiencing food insecurity in the past year was 23.3% among emerging adults. Food insecurity was associated with poorer diet quality (e.g., less vegetables and whole grains, more sugar-sweetened drinks and added sugars), lower home availability of healthy foods, skipping breakfast, frequently eating at fast-food restaurants, binge eating, binge drinking, and substance use (all P Conclusions. Assistance programs and policies are needed to address food insecurity among emerging adults and should be coordinated with other services to protect health.

The aim of this paper was to better understand how child and adult adversities cluster together into classes, and how these classes relate to body weight and obesity. Analyses included 2015 and 2018 data from emerging adults (18–25 years old) who participated in a state surveillance system of 2- and 4-year college students in Minnesota (N = 7475 in 2015 and N = 6683 in 2018). Latent Class Analyses (LCA) of 12 child and adult adversities were run stratified by gender and replicated between 2015 and 2018. The distal outcome procedure and three-step Bolck-Croon-Hagenaars approach were used to estimate predicted BMI means and predicted probabilities of obesity for each class, adjusted for covariates. The LCA identified seven classes in women and 5 in men. In women, BMI ranged from 23.9 kg/m2 in the lowest-BMI class (“Adult Adversities and Childhood Household Dysfunction”; 95% CI: 22.6–25.1) to 27.3 kg/m2 in the highest-BMI class (“High Lifetime Adversities”; 95% CI: 25.9–28.7), a statistically significant difference of 3.4 kg/m2. In men, the adjusted BMIs ranged from 24.6 kg/m2 (“Low Adversities”; 95% CI: 24.3–25.0) to 26.0 kg/m2 (“Childhood Household Mental Illness”; 95% CI: 25.1–26.9), a statistically significant difference of 1.4 kg/m2. The pattern was similar for obesity. These results indicate that specific classes of child and adult adversities are strongly associated with BMI and obesity, particularly in women. A key contribution of LCA appeared to be identification of small classes at high risk for excess weight.

Small food retailers, including corner/convenience stores, pharmacies, gas-marts, and dollar stores, have historically stocked limited fruits and vegetables, though this may be changing. We examined increases in sales, customer purchasing, and stocking of fresh and/or frozen fruits and vegetables in small food stores over time and in relation to: (a) a local food policy (the Minneapolis Staple Foods Ordinance) and (b) neighborhood socioeconomic status (SES). We used longitudinal data (2014&ndash, 2017) from 147 randomly-sampled stores in Minneapolis/St. Paul, USA, collected using interviewer-administered manager surveys (measuring sales and stocking) and customer intercepts/observations (measuring purchasing, n = 3039). The local policy required Minneapolis stores to meet minimum stocking standards for fresh/frozen produce and other healthy foods. No ordinance existed in St. Paul. Mixed regression models examined overall change over time and change by city and neighborhood SES. We observed significant increases over time (p &lt, 0.05) in sales and purchasing of fresh fruit and in stocking of fresh fruit, frozen fruit, and frozen vegetables. We did not identify consistent statistical evidence for differential change in sales, purchasing, or stocking by city or neighborhood SES. Key study findings suggest limited differential effects of the local ordinance and/or neighborhood SES. However, findings also indicate significant time trends for some products, including consistent improvements in sales, customer purchasing, and stocking of fresh fruit. Given the ready-to-eat convenience of many fresh fruits and their broad appeal, fresh fruit appears a promising target for advancing the healthfulness of small food retailers.

Objective:Our objectives were to explore attitudes regarding food retail policy and government regulation among managers of small food stores and examine whether manager views changed due to the 2014 Minneapolis Staple Foods Ordinance, a city policy requiring retailers to stock specific healthy products.Design:Manager interviewer-administered surveys were used to assess views on food retail policy four times from 2014 to 2017. We examined baseline views across manager and store and neighbourhood characteristics using cross-sectional regression analyses and examined changes over time using mixed regression models. In 2017, open-ended survey questions asked about manager insights on the Minneapolis Staple Foods Ordinance.Setting:Minneapolis, MN, where the ordinance was enacted, and St. Paul, MN, a control community, USA.Participants:Managers from 147 small food retail stores.Results:At baseline, 48 % of managers were likely to support a policy requiring stores to stock healthy foods/beverages, 67·5 % of managers were likely to support voluntary programmes to help retailers stock healthy foods and 23·7 % agreed government regulation of business is good/necessary. There was a significant increase in overall support for food retail policies and voluntary programmes from 2014 to 2017 (P < 0·01); however, neither increase differed by city, suggesting no differential impact from the ordinance. Minneapolis store managers reported some challenges with ordinance compliance and offered suggestions for how local government could provide support.Conclusions:Findings suggest that managers of small food retail stores are becoming increasingly amenable to healthy food policies; yet, challenges need to be addressed to ensure healthy food is available to all customers.

Improving healthy food access in low-income communities continues to be a public health challenge. One strategy for improving healthy food access has been to introduce community food stores, with the mission of increasing healthy food access; however, no study has explored the experiences of different initiatives and models in opening and sustaining healthy food stores. This study used a case study approach to understand the experiences of healthy food stores in low-income communities. The purpose of this paper is to describe the methodology used and protocol followed. A case study approach was used to describe seven healthy food stores across urban settings in the U.S. Each site individually coded their cases, and meetings were held to discuss emerging and cross-cutting themes. A cross-case analysis approach was used to produce a series of papers detailing the results of each theme. Most case studies were on for-profit, full-service grocery stores, with store sizes ranging from 900 to 65,000 square feet. Healthy Food Availability scores across sites ranged from 11.6 (low) to 26.5 (high). The papers resulting from this study will detail the key findings of the case studies and will focus on the challenges, strategies, and experiences of retail food stores attempting to improve healthy food access for disadvantaged communities. The work presented in this special issue will help to advance research in the area of community food stores, and the recommendations can be used by aspiring, new, and current community food store owners.

Objective In response to recent national efforts to increase the availability of healthy food in small stores, we sought to understand the extent to which small food stores could implement the newly published Healthy Small Store Minimum Stocking Recommendations and reflect on the new US Department of Agriculture Food and Nutrition Service's final rule for stocking of staple foods for Supplemental Nutrition Assistance Program–approved retailers. Design We collected qualitative and quantitative data from 57 small stores in four states (Arizona, Delaware, Minnesota, and North Carolina) that accepted Supplemental Nutrition Assistance Program but not Special Supplemental Nutrition Assistance Program for Women, Infants, and Children benefits. Data from semistructured, in-depth interviews with managers/owners were transcribed, coded, and analyzed. We collected quantitative store inventory data onsite and later performed descriptive analyses. Results Store interviews revealed a reluctant willingness to stock healthy food and meet new recommendations. No stores met recommended fruit and vegetable stocking, although 79% carried at least one qualifying fruit and 74% carried at least one qualifying vegetable. Few stores met requirements for other food categories (ie, whole grains and low-fat dairy) with the exception of lean proteins, where stores carrying nuts or nut butter were more likely to meet the protein recommendation. Water and 100% juice were widely available and 68% met basic healthy beverage criteria. Conclusions In contrast to the inventory observed, most owners believed store stock met basic recommendations. Further, findings indicate that small stores are capable of stocking healthy products; however, technical and infrastructure support, as well as incentives, would facilitate shifts from staple to healthier staple foods. Retailers may need support to understand healthier product criteria and to drive consumer demand for new products.

Small food stores, like corner stores and limited assortment stores, often sell and promote unhealthy foods and beverages. Yet few studies have examined retailer participation in contracts or agreements with suppliers of energy-dense, high-sugar, and high-fat foods and beverages. Given that these agreements may influence the placement and promotion of unhealthy products, this study aimed to: (a) describe incentive-based agreements between food/beverage suppliers and small food store retailers, including monetary value of incentives; (b) assess retailers’ perceptions of these agreements, including issues related to importance and profitability. Both qualitative (open-ended) and structured interviews were conducted with 72 managers of small stores in four sites: Durham, NC; Baltimore, MD; Minneapolis/St. Paul, MN; and San Diego, CA. Interviews focused on incentivized agreements with suppliers of candy, salty snacks, sweet snacks, sugary beverages and frozen desserts. On average, retailers had 1–2 agreements per product category (range 0–5). For candy, salty snacks and sweet snacks, median one-time, lump-sum incentives were valued at $100–$120 for each product category, in contrast to $2000 for sugary beverages. Incentives included product displays, free/discounted products, marketing materials, and slotting payments/fees. Perceived advantages of agreements included rebates and suppliers’ support for product merchandizing, while disadvantages included minimum purchasing and product placement requirements. Retailers had mixed opinions about whether these incentives significantly contributed to profits overall. In summary, understanding the nature of these agreements and the ways in which they influence retailers’ decision making could be valuable in advancing efforts to partner with retailers and improve the healthfulness of food environments.