OBJECTIVE: To assess differences in obstructive sleep apnea (OSA)-related health parameters between residents of low income/low access (LILA) census tracts-food deserts-and non-LILA residents STUDY DESIGN: Retrospective review.
METHODS: Single institution serving a large region in Southern California from 2017 to 2023.
METHODS: Census tracts are defined as LILA if a significant proportion of residents live below the poverty threshold and far from healthy food vendors. Adults newly diagnosed with OSA on polysomnography were included. Food access status was determined by searching patient addresses in the US Department of Agriculture Food Access Research Atlas. Baseline and 1-year follow-up body mass index (BMI) and vitals were collected and compared based on food access and other demographic variables.
RESULTS: A total of 379 patients in the LILA+ group and 2281 patients in the LILA- group met inclusion criteria. BMI was higher in the LILA group (36.6 ± 9.4 vs 35.2 ± 8.9; P = .006). The effect of food access was most significant in certain demographic groups: patients aged < 65, males, Asian/Pacific Islanders, Hispanics, and patients with Medicaid coverage all had a higher BMI when in the LILA+ group compared to the LILA- group. When considering insurance, LILA+ patients with Medicaid coverage had a significantly higher BMI than LILA- patients with non-Medicaid coverage (40.4 ± 10.3 vs 34.2 ± 8.4, P < .001. Blood pressure, heart rate, and apnea-hypopnea index were also significantly higher in LILA+/Medicaid group. BMI change across all demographic groups was minimal at 1-year follow-up.
CONCLUSIONS: Living in a LILA census tract may result in worse OSA-related health parameters. When accounting for insurance status, the effects are even more profound. Intensive counseling on the importance of weight management should begin at the diagnosis of OSA.

BACKGROUND: Childhood obesity is a growing worldwide epidemic that requires a biopsychosocial treatment approach to achieve a healthy lifestyle. This study on children in a weight management program examines the relationship between obesity, disease complications, and social determinants of health. We expect that children with higher degrees of obesity are more likely to live in areas lacking access to healthy food and have similar behavioural and socioeconomic characteristics.
METHODS: Program participants were identified by neighbourhood food access status based on their home address. The prevalence of comorbidities in the participants was analyzed according to neighbourhood food accessibility. Multivariate regressions evaluated the association between participants\' health outcomes and their sociodemographic and geographical characteristics.
RESULTS: A total of 283 (98.3%) participants had a BMI ≥95th percentile for their age and sex and 68 (23.6%) lived in neighbourhoods with limited food access. Almost a third (Adj. R2 = 0.3302; p < 0.01) of the variability in study population\'s BMI was driven by sociodemographic factors, self-reported eating and physical activity behaviours, and had a positive relationship with access to healthy food. Nonetheless, HbA1c had a negative relationship with access to healthy food given the limited variation in the sample of participants with HbA1c levels indicating diabetes.
CONCLUSIONS: Children living in neighbourhoods with limited food access had higher BMIs than other program participants. Thus, it is critical to identify children with limited neighbourhood food accessibility and promote societal and legislative change to improve access to healthy food.

Nutrition is a vital factor that exerts a profound and direct impact on health. Food environments significantly influence individuals\' dietary behaviors, health outcomes, and overall food security. Individuals in food deserts and food swamps do not have access to healthier food options. And in both cases, the emphasis is primarily on the physical configuration of the environment as it relates to food availability. This quasi-experimental study aims to investigate the impact of two different food environments (defined to include a social component) on food choices. A total of 246 participants were surveyed by telephone, half of whom were primed with Scenario A (a food environment deficient in healthy options and cues that support and reinforce healthier choices) and half were primed with Scenario B (an environment with an abundance of healthy food options and cues that support and reinforce healthy eating). Ordered logit regression was used for analysis. The results show significant differences in likely food consumption between the groups. Individuals in Scenario B were found to be 4.48 times more likely to consume fruits and vegetables. In addition, it was determined that being a woman increases the probability of consuming more fruits and vegetables by 0.92 times (1/0.52-1), and adherence to a healthy diet increases by 3.64 times. Age and race were not significant predictors. This study highlights the crucial role of environmental factors in shaping dietary habits and underscores the importance of the social components of the food environment in promoting the adoption of healthier dietary habits. Based on these findings, policymakers should prioritize developing strategies that go beyond providing physical access and consider social aspects of the environment in promoting healthy eating habits to improve public health and bolster the food security of communities.

BACKGROUND: Socioeconomic disparities play an important role in disease epidemiology and outcomes in pregnancy.
OBJECTIVE: The objective was to evaluate whether pregnant women with COVID-19 living in a food desert, are at increased risk of more severe disease reflected by symptoms at presentation and need for hospitalization.
METHODS: In this retrospective observational study, the electronic medical records of all pregnant patients with documented SARS-CoV-2 infection were reviewed. Food deserts were defined by the USDA and the patient\'s residence was mapped on the Food Access Research Atlas to determine whether each patient lived within a food desert. Comparisons between those with documented symptomatic COVID-19 required hospitalization to those with documented COVID-19 without need for hospitalization were made using univariate analysis and multivariable logistic regression analysis.
RESULTS: The cohort consisted of 129 pregnant patients with COVID-19, with 59.7% (n = 77) asymptomatic and 33.3% (n = 43) requiring admission due to disease severity. The majority were Hispanic (70.5%), and obese (median BMI 31.91 kg/m2), with 33.3% living in a food desert. Patients with disease severity necessitating admission were significantly more likely to reside in a food desert (46.5% vs. 27.9%, P 0.037, OR 2.246, 95% CI 1.048-4.814). No other significant differences were identified on univariate. Multivariable binary logistic regression modeling confirmed food desert residence to be the only independent predictor of more severe COVID-19.
CONCLUSIONS: There is a strong association between living in a food desert and the development of symptomatic COVID-19 requiring hospitalization in pregnancy.

BACKGROUND: Food desert (FD) residence has emerged as a risk factor for poor outcomes in breast, colon and esophageal cancers. The purpose of this retrospective study was to examine FD residence as an associated risk factor in nonsmall cell lung cancer (NSCLC) patients treated with anatomic lung resection (ALR).
METHODS: All consecutive ALRs for stage I-III NSCLC from January 2015 to December 2017 at a single institution were reviewed. The primary exposure of interest was FD residence as defined by the United States Department of Agriculture. The primary outcome was 5-y overall mortality. Secondary outcomes were 30-d complications and 1- and 3-y mortality. Cox proportional hazard analysis was used to model factors associated with each outcome, adjusted for covariates.
RESULTS: A total of 348 ALRs were included, with 101 (29%) patients residing in an FD. In the unadjusted Cox model, those residing in FD had an associated lower 5-year mortality risk compared to those not residing in an FD (hazard ratio = 0.56, 95% confidence interval (0.33-0.97); P = 0.04). That association was not statistically significant once adjusted for covariates (hazard ratio = 0.59, 95% confidence interval (0.34-1.04); P = 0.07).
CONCLUSIONS: In this study, FD residence was not associated with an increase in the risk of 5-y mortality. Selection bias of patients deemed healthy enough to undergo surgery may have mitigated the negative association of FD residence demonstrated in other cancers. Future work will evaluate all NSCLC patients undergoing treatments at our institution to further evaluate FDs as a risk factor for worse outcomes.

UNASSIGNED: This study explored the user experiences and satisfaction levels of students who participated in a healthy snacks program over eight months on a campus located in a food desert.
UNASSIGNED: Students at a suburban private university (N = 51).
UNASSIGNED: Using a descriptive cross-sectional design, participants scanned a Quick-Response code and responded to an online questionnaire. Mixed methods analyses were conducted.
UNASSIGNED: Most participants took snacks in the morning (44.4%). Satisfaction levels were highest [Mean (Standard deviation): 6.58 (0.90) out of 7.00 = high] among those feeling stressed. Five major themes from the open-ended responses were identified: (1) Being thankful; (2) Finding snacks to be tasty; (3) Inexpensive and healthy alternatives; (4) Feeling better; and (5) Needing better and additional snacks.
UNASSIGNED: Future research is needed to assess the long-term feasibility and effectiveness of this program and develop similar programs on other college campuses located in food deserts.

UNASSIGNED: In 2020, 13.8 million people in the United States struggled with food security. This means they were uncertain whether their food needs would be met. Where someone lives can influence struggles with food security. Food deserts are census tracts that experience high rates of poverty (20 percent of residents at/below poverty thresholds) and low access to grocery stores with nutritious foods. Food deserts and insecurity disproportionately affect disadvantaged communities and may contribute to health issues like diabetes, high blood pressure, and obesity. Public policies can be utilized to lessen the impact of food deserts and one way this can be achieved is through public transit.
UNASSIGNED: We characterized the role public transportation plays in connecting food desert residents with food by formulating network models from data on food deserts, grocery stores, and public transportation systems for five representative locations: Brown Deer, WI; Lawrence, KS; Albuquerque, NM; Charlotte, NC, and Raleigh, NC. We analyzed these networks by looking at centrality measures, specifically degree and closeness. These centrality measures provide insight on the situation regarding grocery store access for food deserts.
UNASSIGNED: Results of the degree centrality measure varied across study sites; one site (Lawrence) had at least 1 bus stop within 0.25 miles (0.40 kilometers) of the representative address for each food desert. Conversely, two sites (Charlotte and Raleigh) each had 2 representative addresses with 0 bus stops within 0.75 miles (1.21 kilometers). When using the closeness centrality measure, 2 food deserts in Albuquerque had the highest number of grocery stores within 30 min (22 and 9) while 44% of food deserts in Raleigh had 0 grocery stores within 30 minutes.
UNASSIGNED: Using these results, we identify how public transportation could better connect people with food and offer suggestions to city leaders as a way to help eradicate food deserts.

BACKGROUND: Food deserts are a major public health concern. Inadequate access to healthy food has been associated with poor nutrition and the development of dietary related chronic conditions.
OBJECTIVE: To determine the association between geographic access to nutritious food and preterm birth and whether gestational hypertension mediates this relationship.
METHODS: Food access data was retrieved from the U.S. Department of Agriculture Food Access Research Atlas (2019) and used to quantify the percentage of Census tracts within each county that were food deserts: low-income tracts with limited access to grocery stores, supermarkets, or other sources of healthy, nutritious foods. These data were merged with US birth records from 2018 to 2019 by using the maternal county of residence (n = 7,533,319). We fit crude and adjusted logistic regression models with generalized estimating equations to determine the association between living in a food desert and the odds of preterm birth. We conducted a secondary within-group analysis by stratifying the fully adjusted model by race for non-Hispanic White and non-Hispanic Black birthing people.
RESULTS: In the fully adjusted model, we found a dose-response relationship. As the prevalence of tract-level food deserts within counties increased, so did the likelihood of preterm birth (mid-range: odds ratio (OR) = 1.04, 95% confidence interval (C.I.) 1.01-1.07; high: OR = 1.07, 95% C.I. 1.03-1.11). Similar results were seen in the White-Black stratified models. However, a disparity remained as Black birthing people had the highest odds for preterm birth. Lastly, gestational hypertension appears to mediate the relationship between nutritious food access and preterm birth (natural indirect effect (NIE) = 1.01, 95% CI = 1.00, 1.01).
CONCLUSIONS: It is salient, particularly for Black birthing people who experience high rates of adverse birth outcomes, that the role of food desert residency be explored within maternal and child health disparities.

Poverty is a known risk factor for burn injury and is associated with residency in food deserts and food swamps. Our aim was to determine the prevalence of residency in food deserts and food swamps and to investigate the relationship between food environment, comorbidities, and wound healing in patients with burns. We performed a retrospective chart review of all patients with burns aged ≥ 18 seen in the emergency department or admitted to the burn service at an American Burn Association-verified urban academic center between January 2016 and January 2022. Patient GeoIDs were used to classify residency in food deserts and food swamps, and comorbidities and demographics were recorded. A subset of patients with <20% total body surface area burns who underwent single-operation split-thickness skin grafting was identified for wound healing analysis. A total of 3063 patients were included, with 206 in the heal time analysis. In total, 2490 (81.3%) lived in food swamps and 96 (3.1%) lived in food deserts. Diabetes, hypertension, and tobacco smoking were more prevalent in food swamps than in food deserts or good access areas. While there was no significant effect of the food environment on wound healing, diabetes was associated with longer healing times. Most patients with burns reside in food swamps, which are associated with a higher prevalence of hypertension, diabetes, and smoking. The food environment was not significantly associated with wound healing. Not having diabetes was associated with a shorter time for wound healing.

Black pregnant women in Chicago are disproportionately affected by maternal morbidity and mortality and are more likely to reside in neighborhoods that experience greater economic hardships and food apartheid than any other race/ethnicity. Addressing social determinants of health such as structural inequities, economic environment, and food apartheid issues may provide insights into eliminating Black maternal morbidity and mortality disparities. This study explores food choice determinants and dietary perspectives of young, urban, Black pregnant women. Two audio-recorded focus groups were conducted in Chicago, IL between March 2019 and June 2019 to discuss pregnancy experiences and factors affecting maternal nutrition. Thematic analysis was used to identify the codes, themes, and subthemes of the data. Data analysis was guided by the Social Ecological Model (SEM) as a theoretical framework. Eleven, young, Black women were recruited. Three major themes were discussed across the SEM levels that influenced food choice including food access, stress and family influences on eating, and the need for nutritional education during pregnancy. These choices were primarily rooted in the detrimental effects of food apartheid experienced within the participants\' neighborhoods. Therefore, acknowledging, understanding, and addressing food apartheid and its impact on Black maternal health disparities is needed in clinical practice, research, and policy change.