The use and misuse of ratio and proportion exposure measures in food environment research

Thornton, Lukar; Lamb, Karen E.; White, Simon R.

doi:10.1186/s12966-020-01019-1

Cited by 29 publications

(27 citation statements)

References 53 publications

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“…Studies that have captured the density of fast food outlets close to schools are likely to miss the availability of fast food in other outlets, be that small corner stores or supermarket chains. Similarly, the availability of sweets in a variety of stores in our study questions the protocol of categorising supermarkets as ‘healthy’ and fast food outlets as ‘unhealthy’ in food environment studies [ 10 , 37 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 94%

‘It’s Hard to Make Good Choices and It Costs More’: Adolescents’ Perception of the External School Food Environment

2021

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Research on the impact of school and community food environments on adolescent food choice is heavily reliant on objective rather than subjective measures of food outlets around schools and homes. Gaining the perspective of adolescents and how they perceive and use food environments is needed. The aim of this study was to explore adolescent’s perception and use of the food environment surrounding their schools. Purposive sampling was used to recruit schools. Mapping exercises and discussion groups were facilitated with 95 adolescents from six schools. Thematic analysis showed that adolescents are not loyal to particular shops but are attracted to outlets with price discounts, those with ‘deli’ counters and sweets. Cost, convenience and choice are key factors influencing preference for food outlets and foods. Quality, variety and health were important factors for adolescents but these features, especially affordable healthy food, were hard to find. Social factors such as spending time with friends is also an important feature of food environments that deserves further attention. Adolescents’ perceptions of their food environment provide insights into features that can be manipulated to enable healthy choices.

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Section: Discussionmentioning

confidence: 94%

‘It’s Hard to Make Good Choices and It Costs More’: Adolescents’ Perception of the External School Food Environment

2021

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“…A plethora of evidence, with a diverse range of different methods, has investigated links between environmental features, social outcomes, and health outcomes [ 16 , 30 ]. With increasing attention paid to the inclusion of multiple environmental features, recent studies have developed small area indices or used relative measures such as ratios and proportions [ 12 , 27 , 50 ]. There is no clear consensus on the most appropriate measure, yet there is evidence to suggest that environmental features such as fast-food and alcohol outlets co-occur or cluster within neighbourhoods [ 26 , 51 , 52 ].…”

Section: Introductionmentioning

confidence: 99%

“…While the evidence base around multiple environmental exposures is developing with no recognised gold standard [ 16 ], there is a need to add to this in order to accurately demonstrate how the wider environment influences human behaviour and health. We therefore respond to calls from other researchers who request a continued search for better ways of representing population exposure to the environment [ 50 , 54 ].…”

Section: Introductionmentioning

confidence: 99%

The good, the bad, and the environment: developing an area-based measure of access to health-promoting and health-constraining environments in New Zealand

et al. 2021

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Background Accounting for the co-occurrence of multiple environmental influences is a more accurate reflection of population exposure than considering isolated influences, aiding in understanding the complex interactions between environments, behaviour and health. This study examines how environmental ‘goods’ such as green spaces and environmental ‘bads’ such as alcohol outlets co-occur to develop a nationwide area-level healthy location index (HLI) for New Zealand. Methods Nationwide data were collected, processed, and geocoded on a comprehensive range of environmental exposures. Health-constraining ‘bads’ were represented by: (i) fast-food outlets, (ii) takeaway outlets, (iii) dairy outlets and convenience stores, (iv) alcohol outlets, (v) and gaming venues. Health-promoting ‘goods’ were represented by: (i) green spaces, (ii) blue spaces, (iii) physical activity facilities, (iv) fruit and vegetable outlets, and (v) supermarkets. The HLI was developed based on ranked access to environmental domains. The HLI was then used to investigate socio-spatial patterning by area-level deprivation and rural/urban classification. Results Results showed environmental ‘goods’ and ‘bads’ co-occurred together and were patterned by area-level deprivation. The novel HLI shows that the most deprived areas of New Zealand often have the most environmental ‘bads’ and less access to environmental ‘goods’. Conclusions The index, that is now publicly available, is able to capture both inter-regional and local variations in accessibility to health-promoting and health-constraining environments and their combination. Results in this study further reinforce the need to embrace the multidimensional nature of neighbourhood and place not only when designing health-promoting places, but also when studying the effect of existing built environments on population health.

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“…Food swamps , more common for the majority of urban settings in Canada, are communities where there is an oversaturation of unhealthy food retailers that crowd out more nutritious offerings ( Minaker, 2016 ; Minaker et al, 2016 ; Rose et al, 2009 ). While ratio and proportion measures are widely used in the food environment literature, they are limited in their ability to discern the differences between food retailers (and the kinds of exposures they present) potentially misleading researchers toward an inaccurate reading of the healthfulness of food environments ( Thornton et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Seeing the food swamp for the weeds: Moving beyond food retail mix in evaluating young people's food environments

Brown

Ferdinands

Prowse

et al. 2021

SSM - Population Health

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Nutritional health of children and youth is an increasing cause for concern in Canada. Through food and beverage messaging in multiple environments, young people develop eating behaviours with ramifications throughout their life course. Unhealthy food retailers near schools, recreation facilities, and childcare centres—key activity settings for healthy eating promotion—present repeated, compounding exposures to commercial geomarketing. Geomarketing impacts nutritional health by promoting highly processed, calorie-dense, and nutrient-poor foods and beverages across urban landscapes. While food retail mix (as a ratio of healthy to unhealthy food retailers) can be used to assess food environments at multiple scales, such measures may misrepresent young people's unique experience of these geographic phenomena. Moving beyond uniform conceptualization of food environments, new research methods and tools are needed for children and youth. We investigated young people's food environments in the major Canadian cities of Calgary and Edmonton. Using government-initiated nutrition guidelines, we categorized 55.8% of all food retailers in Calgary, and 59.9% in Edmonton as ‘unhealthy’. A Bernoulli trial at the 0.05 alpha level indicated few differences in prevalence proximal to activity settings versus elsewhere in both cities, demonstrating the limited applicability of food retail mix for characterizing young people's food environments. To model unhealthy food retailers geomarketing to children and youth, we considered their proximity to multiple activity settings, using overlapping radial buffers at the 250 m, 500 m, 1000 m, and 1500 m scales. Examining young people's food environments relative to the spaces where they learn and play, we determined that as many as 895 out of 2663 unhealthy food retailers fell within 1500 m of 21+ activity settings. By conceptualizing, measuring, and problematizing these “super-proximal” unhealthy food retailers, urban planners and public health researchers can use these techniques to pinpoint unhealthy food retailers, or “weeds in the food swamp,” as a critical site for healthy eating promotion in municipalities.

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The use and misuse of ratio and proportion exposure measures in food environment research

Cited by 29 publications

References 53 publications

‘It’s Hard to Make Good Choices and It Costs More’: Adolescents’ Perception of the External School Food Environment

‘It’s Hard to Make Good Choices and It Costs More’: Adolescents’ Perception of the External School Food Environment

The good, the bad, and the environment: developing an area-based measure of access to health-promoting and health-constraining environments in New Zealand

Seeing the food swamp for the weeds: Moving beyond food retail mix in evaluating young people's food environments

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