Journal of Urban Health

, Volume 94, Issue 2, pp 180–189 | Cite as

FEAST: Empowering Community Residents to Use Technology to Assess and Advocate for Healthy Food Environments

  • Jylana L. SheatsEmail author
  • Sandra J. Winter
  • Priscilla Padilla Romero
  • Abby C. King


Creating environments that support healthy eating is important for successful aging, particularly in light of the growing population of older adults in the United States. There is an urgent need to identify innovative upstream solutions to barriers experienced by older adults in accessing and buying healthy food. FEAST (Food Environment Assessment STudy) is an effort that is part of the global Our Voice initiative, which utilizes a combination of technology and community-engaged methods to empower citizen scientists (i.e., community residents) to: (1) use the Healthy Neighborhood Discovery Tool (Discovery Tool) mobile application to collect data (geocoded photos, audio narratives) about aspects of their environment that facilitate or hinder healthy living; and (2) use findings to advocate for change in partnership with local decision and policy makers. In FEAST, 23 racially/ethnically diverse, low-income, and food-insecure older adults residing in urban, North San Mateo County, CA, were recruited to use the Discovery Tool to examine factors that facilitated or hindered their access to food as well as their food-related behaviors. Participants collectively reviewed data retrieved from the Discovery Tool and identified and prioritized important, yet feasible, issues to address. Access to affordable healthy food and transportation were identified as the major barriers to eating healthfully and navigating their neighborhood food environments. Subsequently, participants were trained in advocacy skills and shared their findings with relevant decision and policymakers, who in turn dispelled myths and discussed and shared resources to address relevant community needs. Proximal and distal effects of the community-engaged process at 3, 6, 12, and 24 months were documented and revealed individual-, community-, and policy-level impacts. Finally, FEAST contributes to the evidence on multi-level challenges that low-income, racially/ethnically diverse older adults experience when accessing, choosing and buying healthy foods.


Food environment Food access Community-based participatory research Mobile health Urban health Minority health Advocacy Food security Aging 



We greatly acknowledge and thank the FEAST citizen scientists, as well as the assistance and support of the following individuals and organizations in FEAST activities: Marigold Vu, Leah Mamaril, Martell Hesketh, Nkeiruka Umeh, Angela Waters, Angelo Ignacio, Beverly Karnatz, Linda Coleman, Doris Estremera, Jennifer Gross, Jasneet Sharma, Cristina Ugaitafa, Arlene Aquino, Susan Takalo, Pat Bohm, as well as San Mateo County Board of Supervisors, San Mateo County Health System, Second Harvest Food Bank of Santa Clara and San Mateo Counties, the United Way of the Bay Area, San Mateo Transportation District, San Mateo Mobility Ambassadors, Daly City Partnership, Get Up and Go Transportation Service, and local community and senior centers in North San Mateo County, California.

Compliance with Ethical Standards


FEAST was supported in part by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (NIH) (UL1RR025774) through two Clinical Translational Science Seed Grants awarded through the Stanford Office of Community Health (King, and Winter), and Get Healthy San Mateo County Implementation Funding (King and Sheats). Sheats was funded in part by the US Public Health Service Grant 5T32HL007034 from the National Heart, Blood, and Lung Institute and by Award K12HD043451 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Scholar Program (Krousel-Wood-PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr. Winter was funded in part by the US Public Health Service Grant 5T32HL007034 from the National Heart, Blood, and Lung Institute for this research. As the Director of the Wellness Living Laboratory (WELL) at Stanford School of Medicine she was also funded through an unrestricted gift for WELL from Amway to Stanford University from the Nutrilite Health Institute Wellness Fund.


  1. 1.
    Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States. US Census Bureau. 2014; 24: 25–1140.Google Scholar
  2. 2.
    Sheats JL, Winter SJ, King AC. Nutrition interventions for aging populations. In: Bales C, Locher JL, Saltzman E, eds. Handbook of clinical nutrition and aging. 3rd ed. New York, NY: Springer; 2015: 3–19.Google Scholar
  3. 3.
    Freeland-Graves JH, Nitzke S. Position of the academy of nutrition and dietetics: total diet approach to healthy eating. J Acad Nutr Diet. 2013; 113(2): 307–17.CrossRefPubMedGoogle Scholar
  4. 4.
    National Council on Aging. United States of Aging Survey: 2015 Results. Accessed 1 June 2016.
  5. 5.
    Vesnaver E, Keller HH. Social influences and eating behavior in later life: a review. J Nutr Gerontol Geriat. 2011; 30(1): 2–3.CrossRefGoogle Scholar
  6. 6.
    Shatenstein B, Gauvin L, Keller H, et al. Baseline determinants of global diet quality in older men and women from the NuAge cohort. J Nutr Health Aging. 2013; 17(5): 419–25.CrossRefPubMedGoogle Scholar
  7. 7.
    Dean M, Raats MM, Grunert KG, Lumbers M. Factors influencing eating a varied diet in old age. Public Health Nutr. 2009; 12(12): 2421–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Keller HH. Nutrition and health-related quality of life in frail older adults. J Nutr Health Aging. 2003; 8(4): 245–52.Google Scholar
  9. 9.
    Keller HH, Gibbs AJ, Boudreau LD, et al. Prevention of weight loss in dementia with comprehensive nutritional treatment. J Am Geriat Soc. 2003; 51(7): 945–52.CrossRefPubMedGoogle Scholar
  10. 10.
    Anderson GF. Chronic care: making the case for ongoing care. Robert Wood Johnson Foundation. 2010.Google Scholar
  11. 11.
    Host A, McMahon AT, Walton K, Charlton K. Factors influencing food choice for independently living older people—a systematic literature review. J Nutr Gerontol Geriat. 2016; 35(2): 67–94.CrossRefGoogle Scholar
  12. 12.
    Morland K, Filomena S. The utilization of local food environments by urban seniors. Prev Med. 2008; 47(3): 289–93.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Bernstein M, Munoz N. Position of the academy of nutrition and dietetics: food and nutrition for older adults: Promoting health and wellness. J Acad Nutr Diet. 2012; 112(8): 1255–77.CrossRefPubMedGoogle Scholar
  14. 14.
    Kamphuis CB, de Bekker-Grob EW, van Lenthe FJ. Factors affecting food choices of older adults from high and low socioeconomic groups: a discrete choice experiment. Am J Clin Nutr. 2015; 101(4): 768–74.CrossRefPubMedGoogle Scholar
  15. 15.
    Ziliak JP, Gundersen C. Food insecurity among older adults: A report submitted to AARP Foundation. AARP. 2011.Google Scholar
  16. 16.
    Rose D, Bodor JN, Hutchinson PL, Swalm CM. The importance of a multi-dimensional approach for studying the links between food access and consumption. J Nutr. 2010; 140(6): 1170–4.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kamphuis CB, van Lenthe FJ, Giskes K, Brug J, Mackenbach JP. Perceived environmental determinants of physical activity and fruit and vegetable consumption among high and low socioeconomic groups in the Netherlands. Health Place. 2007; 13(2): 493–503.CrossRefPubMedGoogle Scholar
  18. 18.
    Cannuscio CC, Hillier A, Karpyn A, Glanz K. The social dynamics of healthy food shopping and store choice in an urban environment. Soc Sci Med. 2014; 122: 13–20.CrossRefPubMedGoogle Scholar
  19. 19.
    Centers for Disease Control and Prevention. National Center for Environmental Health - Healthy Places. (2014). Accessed September 1, 2016
  20. 20.
    Munoz-Plaza CE, Morland KB, Pierre JA, et al. Navigating the urban food environment: challenges and resilience of community-dwelling older adults. J Nutr Educ Behav. 2013; 45(4): 322–31.CrossRefPubMedGoogle Scholar
  21. 21.
    Munoz-Plaza CE, Morland KB, Pierre JA, Spark A, Filomena SE, Noyes P. Navigating the urban food environment: challenges and resilience of community-dwelling older adults. J Nutr Educ Behav. 2013;45(4): 322–31Google Scholar
  22. 22.
    Hare C, Kirk D, Lang T. The food shopping experience of older consumers in Scotland: critical incidents. Int J Retail Distrib Manag. 2001; 29(1): 25–40.CrossRefGoogle Scholar
  23. 23.
    Bartali B, Salvini S, Turrini A, et al. Age and disability affect dietary intake. J Nutr. 2003; 133(9): 2868–73.PubMedGoogle Scholar
  24. 24.
    Hare C. The food-shopping experience: a satisfaction survey of older Scottish consumers. Int J Retail Distrib Manag. 2003; 31(5): 244–55.CrossRefGoogle Scholar
  25. 25.
    King AC, Winter SJ, Sheats JL, et al. Leveraging citizen science and information technology for population physical activity promotion. Transl J Am Coll Sports Med. 2016; 1(4): 30–44.PubMedGoogle Scholar
  26. 26.
    Buman MP, Winter SJ, Sheats JL, et al. The Stanford healthy neighborhood discovery tool. Am J Prev Med. 2013; 44(4): e41–7.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Winter SJ, Goldman RL, Romero PP, et al. Using citizen scientists to gather, analyze, and disseminate information about neighborhood features that affect active living. J Immigr Minor Health. 2015. doi: 10.1007/s10903-015-0241-x
  28. 28.
    Rosas LG, Salvo D, Winter SJ, Cortes D, Rivera J, Rodriguez NM, King AC. Harnessing technology and citizen science to support neighborhoods that promote active living in Mexico. J Urban Health. 2016; 93(6): 953–73.CrossRefPubMedGoogle Scholar
  29. 29.
    Moran MR Werner P, Doron I, HaGani N, Benvenisti Y, King AC, Winter SJ, Sheats JL, Garber R, Motro H, Egron, S. Exploring the objective and perceived environmental attributes of older adults’ neighborhood walking routes: a mixed methods analysis. J Aging Phys Activity. 2016; 1-36.Google Scholar
  30. 30.
    Sheats JL, Winter SJ, Romero PP, et al. Comparison of passive versus active photo capture of built environment features by technology naïve Latinos using the SenseCam and Stanford healthy neighborhood discovery tool. Assoc Comput Mach. 2013:8-15. doi:  10.1145/2526667.2526669.
  31. 31.
    Data – get healthy San Mateo county. Get Healthy San Mateo. Accessed June 1 2016.
  32. 32.
    Hekler EB, King AC, Banerjee B, Robinson T, Alonso M, Cirimele J. A case study of BSUED: behavioral science-informed user experience design. Vancouver, BC, Canada. 2011:1-4.Google Scholar
  33. 33.
    US Bureau of the Census. National health interview survey. Washington DC: U.S. Dept. of Commerce; 1988.Google Scholar
  34. 34.
    US Department of Agriculture. Economic Research Service – Food Security Supplement Questionnaire. Accessed January 12, 2013.
  35. 35.
    Blumberg SJ, Bialostosky K, Hamilton WL, Briefel RR. The effectiveness of a short form of the household food security scale. Am J Public Health. 1999; 89(8): 1231–4.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Winter SJ, Buman MP, Sheats JL, Hekler EB, Otten JJ, Baker C, Cohen D, Butler BA, King AC. Harnessing the potential of older adults to measure and modify their environments: long-term successes of the Neighborhood Eating and Activity Advocacy Team (NEAAT) Study. Translat Behav Med. 2014; 4(2): 226.CrossRefGoogle Scholar
  37. 37.
    Charmaz K. Grounded theory: objectivist and constructivist methods. In: Denzin NK, Lincoln YS, eds. Handbook of qualitative methods. Thousand Oaks, CA: Sage; 2000: 509–35.Google Scholar
  38. 38.
    Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. 2nd ed. Thousand Oaks, CA: Sage; 1998.Google Scholar
  39. 39.
    Cresswell JW. Research design: qualitative and quantitate approaches. Thousand Oaks, CA: Sage Publications; 1998.Google Scholar

Copyright information

© The New York Academy of Medicine 2017

Authors and Affiliations

  • Jylana L. Sheats
    • 1
    • 2
    Email author
  • Sandra J. Winter
    • 2
  • Priscilla Padilla Romero
    • 3
  • Abby C. King
    • 2
  1. 1.Department of Global Community Health and Behavioral ScienceTulane University School of Public Health & Tropical MedicineNew OrleansUSA
  2. 2.Healthy Aging Research and Technology Solutions (HARTS) LabStanford Prevention Research Center, Stanford University School of MedicinePalo AltoUSA
  3. 3.San Mateo Medical CenterSan MateoUSA

Personalised recommendations