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: Household food waste significantly contributes to overall food waste. While the relationship between food security and food waste has been extensively studied at the macro level, there is a need for research focusing on the quantitative association between food security and food waste at the household level in developing countries, particularly in Southeast Asia. This study aims to estimate the prevalence of household food insecurity and household food waste and to examine the association between household food security and food waste using direct measurements.
METHODS: A total of 215 households in Bogor Regency, Indonesia, participated in this cross-sectional study. Food waste was measured using waste composition analysis and a 7-day diary. The Food Insecurity Experience Scale (FIES) questionnaire was used to assess household food security, while household income and the proportion of food expenditure were considered confounding factors. The association between food security and food waste was examined using Kendall tau-b and ordinal logistic regression.
RESULTS: The prevalence of household food insecurity was 18.6%, and the average household food waste was 77 kg/cap/year. Cereals, tubers, and their derivatives (especially rice) and vegetables were major contributors to edible waste, while fruits dominated inedible waste. A negative association was observed between food waste and household food security (edible FW: p = 0.044, r = -0.110; total FW: p = 0.038, r = -0.114), suggesting that household food waste decreases as the severity of food insecurity increases. However, after adjusting for household income, the proportion of food expenditure, and the education levels of spouses, this association became statistically insignificant (p > 0.05).
CONCLUSIONS: There was no significant association between household food security status and food waste. Household income plays a significant role in determining the quantity of household food waste, as higher income is associated with increased food waste. Strategies to prevent and reduce food waste should focus on major contributors such as rice and vegetables, especially among families with higher food accessibility.

OBJECTIVE: To inform food retail interventions, this study explored food shopping strategies employed by people constrained by limited budgets but residing in an urban environment offering numerous retail options.
METHODS: Qualitative study incorporating semi-structured interviews and shop-alongs.
METHODS: East Harlem, New York City.
METHODS: 37 East Harlem residents participated in interviews, of whom 15 participated in shop-alongs.
METHODS: Interviews and shop-alongs were conducted in English, Spanish, and Mandarin Chinese. Interview transcripts were analyzed using a grounded theory approach. Data from shop-alongs were used to supplement interview findings.
RESULTS: Participants shopped 1-2 times at an average of 4 retail locations per week. Two key themes emerged: (1) planning trips and choosing venues; and (2) shopping experiences and perceptions of stores. Price was the primary driver of store choice, followed by product quality and variety. Substantial time was invested in shopping. Most English- and Spanish-speaking participants shopped in East Harlem. Chinese American participants shopped in Chinatown due to language concordance, availability of culturally-preferred foods, and proximity to other services.
CONCLUSIONS: East Harlem residents invested substantial planning, time and effort in food shopping to acquire sufficient food for their households on limited budgets. These findings offer insight into how residents interact with food environments and key drivers of decision-making about food shopping that affect decisions about where to shop and what to purchase.

Food security among rural veteran populations is an understudied subject. This study uses qualitative data from 106 semi-structured interviews conducted with staff from programs at the United States Department of Veterans Affairs (VA) and other federal agencies, staff from non-governmental organizations (NGOs), food security researchers, and food insecure veterans to identify the barriers to and facilitators for rural veteran food security. Barriers identified included external, structural barriers that exist in rural areas; internal barriers to using food assistance, such as feeling stigmatized; and barriers related to other social determinants of health, including a lack of education, employment, or housing stability.

Persons in socioeconomically disadvantaged situations are more susceptible and disproportionally exposed to unhealthy food environments, which results in limited access to healthy foods and poorer dietary outcomes. This qualitative paper examines the various dimensions of perceived food access to healthy and unhealthy foods (i.e., availability, affordability, accessibility, accommodation, desirability, convenience and acceptability) within the local food environment among persons in socioeconomically disadvantaged situations. A total of 23 participants in socioeconomically disadvantaged situations expressed their perceptions of food access within their local food environment and its role in their eating behaviour through participant-driven photo-elicitation in a focus group context (n=7) and researcher-driven photo-elicitation interviews (n=16). Reflexive thematic analysis has been used to analyse our data through an access framework. Four overarching themes were constructed. The first two themes concern barriers to perceived food access in respectively the home and community food environment - including the importance of kitchen infrastructure, household composition and transport options. The third theme encompasses the interaction of perceived food access with the sociocultural environment, highlighting its dual role as facilitator (e.g., through food sharing practices) and barrier (e.g., through social stigma and shame). The fourth theme concerns awareness and the ability to navigate within the information food environment, which has also been proposed as a novel dimension of food access. This study emphasizes the complexity of food access and the need for a multifaceted approach that integrates perceptions to ensure equitable access to healthy foods.

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.

BACKGROUND: Households experiencing food insecurity may use dynamic strategies to meet food needs. Yet, the relationship between household food sourcing behaviors and food security, particularly in rural settings, is understudied.
OBJECTIVE: To identify food sourcing patterns and their associations with food insecurity among households in rural Appalachian Ohio during the COVID-19 pandemic.
METHODS: Survey data were collected from a cohort of households in Athens County, OH, in July 2020, October 2020, January 2021, and April 2021.
METHODS: The sample included 663 households with household food sourcing and food security information for ≥1 survey wave.
METHODS: Household food sourcing patterns. Households reported the frequency with which they obtained food from various retailers and charitable sources, classified as supercenters, supermarkets, convenience stores, farmers markets, or charitable sources.
METHODS: Principal component analysis was used to identify food sourcing patterns. Linear mixed models were used to assess changes in food sourcing behaviors over the study period and to determine whether food sourcing behaviors differed according to food security status.
RESULTS: Two patterns were identified: Convenience Stores and Charitable Food and Supermarkets and Farmers Markets, not Supercenters. Relative to July 2020, alignment of households\' food sourcing behaviors with the Supermarkets and Farmers Markets, not Supercenters pattern was higher in October 2020 (β .07, 95% CI .02 to .12) and alignment with the Convenience Stores and Charitable Food pattern was lower in April 2021 (β -.06, 95% CI -.11 to -.02). Compared with food-secure households, food sourcing behaviors of food-insecure households were more closely aligned with the Convenience Stores and Charitable Food pattern (β .07, 95% CI .00 to .13); no statistically significant difference in scores was observed for the Supermarkets and Farmers Markets, not Supercenters pattern (β -.07, 95% CI -.15 to .02).
CONCLUSIONS: These findings support efforts to increase access to healthy, affordable options at venues where food-insecure households may be likely to obtain food, such as convenience stores and charitable sources.

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The aim of the present study was to critically analyze operational definitions of food deserts and food swamps included in empirical studies published in peer-reviewed journals. A scoping review was conducted following the recommendations of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. A search of the scientific literature was performed on August 2023 to identify empirical studies including operational definitions of food deserts and/or food swamps in three databases: Scopus, PubMed, and Scielo. A total of 932 scientific articles were identified in the three databases, from which 157 articles, published between 2002 and 2023, were included in the review. The included studies were mainly conducted in WEIRD (Western, Educated, Industrilaized, Rich and Democractic) countries. They presented a total of 107 operational definitions of food deserts and 30 operational definitions of food swamps. Large heterogeneity in the operational definitions of food deserts and food swamps was found. Published studies differed in all the elements of the operational definitions analyzed in the present work. Results stress the need for standardization and the development of more objective and multivariate continuous measures of physical food accessibility that reflect the complexity of modern food environments globally. A series of recommendations to advance food environment research are derived.

Better diet quality regardless of community food access was associated with a higher likelihood of glycemic control in early pregnancy among nulliparous individuals with pregestational diabetes. These findings highlight the need for interventions that address nutrition insecurity for pregnant individuals living with diabetes.