neighbourhood food environments, diet and health · • 1380/35053 (3.9%) adverts were for food •...
TRANSCRIPT
Neighbourhood food environments, diet and health
Martin White MRC Epidemiology Unit & CEDAR
4th November 2014
• What is a neighbourhood?
• What is a neighbourhood food environment?
• How have these changed over time?
• What are the emerging challenges for public health?
• What are the implications for public health research?
Overview
The rise of the car
Does food retailing influence dietary intake? FSA ‘food deserts’ study
• Setting: city of Newcastle upon Tyne, 2001-2
• Cross-sectional survey of all retail outlets selling food in the city (n=530), using food basket method (33 items)
• Cross-sectional surveys of:
• food purchasing behaviour, kitchen facilities and socio-economic factors at household level (n=2500)
• diet, health, other health related behaviours, knowledge, attitudes and socio-economic factors at individual level (n=4500)
• Spatial and statistical analyses
Travel to and from main food store
Journeys FROM main food store by:
Car Bus Metro Taxi Bicycle Foot All Modes
Jo
urn
eys T
O m
ain
foo
d
sto
re b
y:
Car 1909 (63.7)
1 (0.0)
2 (0.1)
1 (0.0)
1913 (63.9)
Bus 11 (0.3)
320 (10.7)
1 (0.0)
60 (2.0)
7 (0.2)
399 (13.3)
Metro 1 (0.0)
3 (0.1)
28 (0.9)
11 (0.3)
43 (1.4)
Taxi 34 (1.1)
34 (1.1)
Bicycle 12 (0.4)
12 (0.4)
Foot 13 (0.4)
52 (1.7)
1 (0.0)
48 (1.5)
481 (16.1)
595 (19.9)
All Modes
1934 (64.6)
376 (12.6)
30 (1.0)
155 (7.8)
12 (0.4)
489 (16.3)
2996 (100.0)
Travel distance to main food store
Distance from home to main food shop (metres)
Main shop type Number of households
Median Inter-quartile range
Multiple supermarkets 2440 2081 1020-3846
Asda 677 2569 1330-4053
Co-op 214 1389 570-3431
Morrison 106 7712 6661-8627
Safeway 633 1356 781-2205
Sainsbury 13 9726 8781-10420
Tesco 753 2555 1138-3808
Discount supermarkets 435 1077 539-1965
Kwiksave 284 879 412-1707
Netto 114 1393 806-2491
Department stores 82 3418 2302-4653
All other stores 47 1060 539-1965
All types of store 2988 1865 885-3701
Number (%) of households trip-chaining usually or sometimes by household composition
Visiting family/ friends
Via school Via non-
food shopping
Via gym Via work Via other activity
Via any location / activity
1 adult 374 (35.0) 11 (1.0) 492 (46.0) 105 (9.8) 364 (34.1) 270 (25.3) 332 (31.1)
2 adults 335 (31.8) 27 (2.6) 531 (50.4) 115 (10.9) 396 (37.6) 272 (25.8) 285 (27.0)
3 or more adults
109 (33.1) 13 (4.0) 189 (57.4) 29 (8.8) 171 (52.0) 86 (26.1) 94 (28.6)
1 adult, 1 or more children
71 (47.0) 72 (47.7) 87 (57.6) 23 (15.2) 60 (39.7) 30 (19.9) 73 (48.3)
2 or more adults, 1 or more children
204 (37.1) 208 (37.8) 342 (62.2) 64 (11.6) 278 (50.5) 136 (24.7) 176 (32.0)
All 1093 (34.7) 331 (10.5) 1641 (52.0) 336 (10.7) 1269 (40.2) 794 (25.2) 960 (30.4)
Proximity to all shops selling food
<250m
<500m
<750m
<1000m
>1000m
% of shops selling all items in basket (median number of basket items available)*
No. of stores
All items (33) ‘Healthier’ basket (21)
‘Less Healthy’ basket (10)
All F&V (14) Fresh F&V (10)
Multiple Supermarket
20 70.0 (33) 95.0 (21) 75.0 (10) 100 (14) 100 (10)
Discount supermarket
18 22.2 (32) 27.8 (20) 50.0 (9.5) 44.4 (13) 50.0 (10)
Department store
2 50.0 (31) 50.0 (20) 50.0 (9) 100 (14) 100 (10)
Convenience store
216 1.4 (17) 1.4 (8) 13.9 (8) 2.3 3) 2.6 (0)
Freezer centre 13 0 (18) 0 (8) 15.4 (7) 0 (3) 0 (0)
Greengrocer 47 0 (13) 0 (11) 0 (1) 0 (10) 87.2 (10)
Specialist and Ethnic food stores
16 0 (3) 0 (2) 0 (3) 6.3 (1) 6.3 (0)
Market stall 3 0 (10) 0 (10) 0 (0) 0 (10) 66.7 (10)
News Agency or Post Office
58 0 (4) 0 (1) 0 (4) 0 (0,0) 0 (0)
All shops 560 3.9 (11) 5.0 (5) 10.2 (5) 6.4 (3) 14.6 (0)
Availability of food items by type of store
Proximity to shops selling 10/10 fruit &
veg of good quality & less than median
basket price (£6.35)
<250m
<500m
<750m
<1000m
>1000m
Newcastle: Townsend Deprivation Score
quintiles for Enumeration Districts
5km
N
What factors are associated with dietary intake at individual, household and community levels? Results of MLMs
Fruit & veg consumption
Age
Female
Physical activity
Dietary knowledge
Non-smoker
Alcohol
Vegetarian
Not on benefits
White/car, non-white/foot (interaction)
Total variance explained 11.7% Unexplained variance Individual 66% Household 32% Neighbourhood 0%
Fat consumption
Age
Male
Dietary knowledge
Smoker
Alcohol
Meat eater
Eating out
Cost of weekly shopping (per adult equivalent)
Total variance explained 9.6%
Unexplained variance
Individual 76%
Household 23%
Neighbourhood 5%
Food retail access and diet: interpretation
• Overall food availability very good - 99% had access to 14 F&V, at usual main food store or within 500m
• Most households bought their food at stores with good availability (e.g. 78% - all 33 items, 90% - 10 F&V) - but availability was socio-economically patterned (rich = more)
• The poor live as close to shops selling most basket items (e.g. Multiple supermarkets) as the more affluent, but are more likely to shop where the prices are lower (e.g. discounters), and thus where the availability and quality are also poorer
• Food choice appears to be most strongly associated with dietary knowledge, socio-demographic factors, attitudes to retailing and issues of cost, rather than local availability
• Better methods are needed to analyse complex multilevel data sets on the relationship between diet and the retail environment
The rise of internet food shopping
Food at checkouts
• 15% of outdoor advertising was for food
• Adverts tended to be for less healthy (HFSS) foods
• Significantly more adverts and food adverts in poorer areas
• No differences in types of food advertised by IMD 0
100
200
300
400
500
600
700
800
Least affluent Most affluent
Square metres of food adverts by IMD tertile
Food adverts in weekly magazines
• Adverts made up 23% of magazine pages in 118 issues
of 30 magazines with readership >500k/week in 1
month (Nov 2007)
• 443/2829 (15.7%) adverts were for food
• ‘meals, combination foods, soups and sauces’ - 26% /
‘foods containing fat/sugar’ - 23% of food adverts
• HFSS food adverts significantly more common in least
affluent tertile of magazines (by ratio of ABC1: C2DE)
Adams J, White M. Eur J Public Health 2009; 19(2): 144-9
Food adverts in monthly women’s magazines
• Adverts made up 40% of magazine pages in 213 issues
of 18 magazines with readership >500k/month in 12
months (2008-9)
• 1380/35053 (3.9%) adverts were for food
• ‘food and drinks high in fat and/or sugar’ - 28.0% of
food adverts / ‘fruits & vegetables’ - 2.0% of food
adverts
• HFSS food significantly adverts more common in least
affluent tertile of magazines (by ratio of ABC1: C2DE)
Adams J, Simpson E, White M. BMC Public Health 2011, 11:368
Obesity, TV & food advertising
Effects of food promotion
“…food promotion does have a modest
impact on nutrition knowledge, food
preferences & consumption...The evidence
that food promotion influences purchasing
behaviour is of modest strength.”
Cairns et al (2009)
who.int/dietphysicalactivity/Evidence_Update_2009.pdf
2007 Ofcom scheduling restrictions on TV food advertising to children
• Prohibition of:
»advertisements for HFSS foods
»during & around programmes “of
particular appeal to” children
• Phased introduction April 2007 - January
2009
• Aim to: “reduce significantly the exposure of
children under 16 to HFSS advertising”
Advertisements for HFSS foods
Results – all viewers
All ads Food ads HFSS food ads
PMV PMV % of all
OR (95% CI) PMV % of all
OR (95% CI)
Wk 1 704,426 14.8 1.00 5.7 1.00
Wk 2 967,991 14.5 0.96 (0.95-0.98) 8.7 1.54 (1.51-1.57)
Both 1,672, 417 14.6 - 7.5 -
Adams J, Tyrrell R, Adamson AJ, White M. PLoS ONE 2012; 7(2): e31578
Results – viewers aged 4-15 years
All ads Food ads HFSS food ads
PMV PMV % of all
OR PMV % of all
OR
Wk 1 84,264 14.2 1.00 6.1 1.00
Wk 2 106,691 12.6 0.85 (0.82-0.89) 7.0 1.05 (0.99-1.12)
Both 190,955 13.3 - 6.6 -
Adams J, Tyrrell R, Adamson AJ, White M. PLoS ONE 2012; 7(2): e31578
Summary of results
• Proportion of ads viewed that were for food
» decreased in children & all people
• Proportion of ads viewed that were for HFSS food
» didn’t change in children
» increased by 50% in all people
> No evidence that scheduling restrictions achieved aim to: “reduce significantly the exposure of children under 16 to HFSS advertising”
Adams J, Tyrrell R, Adamson AJ, White M. PLoS ONE 2012; 7(2): e31578
Industry tactics: context
Do TV foods advertisements portray advertised foods in a ‘healthy’ context?
Adams J, Tyrrell R, White M. Do television food advertisements portray advertised foods in a ‘healthy’ food context? British Journal of Nutrition, 2011; 105: 810-815
Brand awareness and advergaming
Access to the internet and social media
• 91% of the UK adult population owns an internet-ready mobile phone
• Coverage among the most deprived households is 87%
• Coverage among the 75+ age group is 58%
• 71% of UK households have access to the internet via PC
• Facebook has >900 million users and Twitter >500 million users worldwide
Corporate social responsibility
Conversation changing
Redefining the food environment
• Expansion of our physical reach through
easy access to mechanised transport
• Expansion of our virtual world through
radio, television, cinema, internet and
mobile devices
• Globalisation of economies, including the
food industry
• A subtle range of food industry influences
on our awareness of brands and products
What are the challenges for public health?
• To understand better the role of the food industry in determining what we eat
• To determine the best ways to engage with industry
• To focus on upstream, large scale interventions to change diet
• To develop programmes of research that embrace this wider concept of the food environment
Some research questions
• Where should we focus our energies?
• How important are each of the environmental influences on diet?
• How are these influences changing over time?
• What is the food industry thinking? What is their next move?
• What is the relationship between the food industry and regulatory bodies?
• Can the food industry be regulated effectively?
• What population level interventions can be pursued cost-effectively at a local level?
Acknowledgements Particular thanks to Jean Adams, who led our work on food advertising. Thanks also
to other colleagues in Newcastle, including Ashley Adamson, John Mathers, Simon
Raybould, Sarah Sowden, Emma Simpson, Rachel Tyrrell and Ellie Ganniti.
Work presented here was undertaken by members of Fuse, the Centre for
Translational research in Public Health at Newcastle University, and the Centre for
Diet and Activity Research (CEDAR), UKCRC Public Health Research Centres of
Excellence.
Funding from the British Heart Foundation, Cancer Research UK, Economic and
Social Research Council, Medical Research Council, the National Institute for Health
Research, and the Wellcome Trust, under the auspices of the UK Clinical Research
Collaboration, is gratefully acknowledged.