International Journal ofEnvironmental Researchand Public Health
Review

The Retail Food Sector and Indigenous Peoples in
High-Income Countries: A Systematic
Scoping Review
Tiff-Annie Kenny 1,2, *, Matthew Little 3 , Tad Lemieux 4 , P. Joshua Griffin 5,6 , Sonia D. Wesche 7 ,Yoshitaka Ota 5,8 , Malek Batal 9,10 , Hing Man Chan 11 and Melanie Lemire 1,2,12
1
2
3
4
5
6
7
8
9
10
11
12

*

Département de médecine sociale et préventive, Faculté de médecine, Université Laval,
Quebec, QC G1V 0A6, Canada; Melanie.Lemire@CRCHUdeQuebec.uLaval.ca
Centre de recherche du CHU de Québec, Université Laval, Axe santé des populations et pratiques optimales
en santé, Quebec, QC G1E 6W2, Canada
School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada;
MatthewLittle@uVic.ca
Department of English Language and Literature, Carleton University, Ottawa, ON K1S 5B6, Canada;
Tad.Lemieux@Carleton.ca
School of Marine and Environmental Affairs, University of Washington, Seattle, WA 98105, USA;PJGriff@uW.edu (P.J.G.); Yota1@uW.edu (Y.O.)
Department of American Indian Studies, University of Washington, Seattle, WA 98195, USA
Department of Geography, Environment and Geomatics, Faculty of Arts, University of Ottawa,
Ottawa, ON K1N 6N5, Canada; SWesche@uOttawa.ca
Nippon Foundation Ocean Nexus Center, EarthLab, University of Washington; Seattle, WA 98195, USA
Département de nutrition, Faculté de médecine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
Malek.Batal@uMontreal.ca
Centre de recherche en santé publique (CReSP), Montreal, Quebec, QC H3N 1X9, Canada
Department of Biology, University of Ottawa, Ottawa, ON K1N 9A7, Canada; Laurie.Chan@uOttawa.ca
Institut de biologie intégrative et des systèmes (IBIS), Université Laval, Quebec, QC G1V 0A6, Canada
Correspondence: Tiffannie.Kenny.1@uLaval.ca or Tiffannie.Kenny@mail.mcgill.ca

Received: 14 October 2020; Accepted: 18 November 2020; Published: 27 November 2020


Abstract: Indigenous Peoples in high-income countries experience higher burdens of food insecurity,
obesity, and diet-related health conditions compared to national averages. The objective of
this systematic scoping review is to synthesize information from the published literature on themethods/approaches, findings, and scope for research and interventions on the retail food sector
servicing Indigenous Peoples in high-income countries. A structured literature search in two
major international databases yielded 139 relevant peer-reviewed articles from nine countries.
Most research was conducted in Oceania and North America, and in rural and remote regions.
Several convergent issues were identified across global regions including limited grocery store
availability/access, heightened exposure to unhealthy food environments, inadequate market foodsupplies (i.e., high prices, limited availability, and poor quality), and common underlying structural
factors including socio-economic inequality and colonialism. A list of actions that can modify thenature and structure of retailing systems to enhance the availability, accessibility, and quality ofhealthful foods is identified. While continuing to (re)align research with community priorities,
international collaboration may foster enhanced opportunities to strengthen the evidence base forpolicy and practice and contribute to the amelioration of diet quality and health at the population level.
Keywords: indigenous peoples; food environment; food price; food supply; food and nutrition;
consumer; affordability; food security; obesity; health equity

Int. J. Environ. Res. Public Health 2020, 17, 8818; doi:10.3390/ijerph17238818

www.mdpi.com/journal/ijerph

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1. Introduction
Indigenous Peoples represent approximately 6% (476 million) of the world’s total population [1].
They reside in over 70 countries where diverse ecosystems have traditionally provided the foundation
for diet, cultural identity, and social cohesion [2], and where they retain distinct social, cultural,
economic, and political characteristics [3].
Despite the rich diversity of identities, histories, socio-economic, and environmental realities,
Indigenous Peoples account for up to one-third of the world’s extremely poor, and some of theworld’s most disadvantaged and marginalized peoples [4]. While international commitments to global
health, such as the sustainable development goals (SDGs), were largely conceived around issues inlow- and middle-income countries (LMICs) [5], pronounced health disparities among Indigenous
Peoples persist in high-income countries (HICs).
In Canada [6] and Australia [7] for instance, Indigenous Peoples experience lower life expectancy,higher infant mortality rates, and a greater burden of chronic diseases such as obesity, Type 2
diabetes, and cardiovascular disease—conditions for which diet and nutrition are key determinants [8].
Marked disparities in food security also exist [9,10]. Health disparities in these contexts derive fromsocioeconomic inequality and systemic political disempowerment related to enduring legacies ofcolonization and contemporary neo-colonial influence [11]. Collectively, colonization, globalization,and development have resulted in challenges to land-based ways of life, and the increased adoption of
a “Western” diet (i.e., high in saturated fats, sugar, and processed foods) [12–15]. While traditional
foods remain strongly culturally preferred, market foods (in particular those of limited nutritional
quality) represent a major fraction of contemporary diets [16–19].
Health disparities are particularly serious among Indigenous Peoples living in remote regions
where the high price, low quality, and limited availability of nutritious perishable food is compounded bysocioeconomic disadvantage to severely constrain food access/security [20–22]. The population-level dietof Indigenous people in remote regions is characteristically low in consumption of nutritious perishable
market foods, such as fruits and vegetables [16,23]. Pervasive inadequacies and insufficiencies of
dietary fiber, fatty acids, and several micronutrients are documented among Indigenous populations inremote areas [23,24]. Meanwhile, refined nonnutrient dense foods and beverages (hereafter beverages
are captured with the term “food”) represent a significant fraction of the total diet, and of monetary
expenditure on market food [19,25,26]. These issues are also significant health challenges for Indigenous
Peoples in nonremote areas, such as in urban centers [10].
In most HICs, Indigenous Peoples are considered minority populations.. For example, in Canada
and Australia, Indigenous Peoples comprise less than 5% of the total population [27]. Notable exceptions
include Greenland and some Oceanic countries, where Inuit (90% of the population) and PacificIslanders (Polynesians, Melanesians, Micronesians), respectively, form majority populations [27].
Many Indigenous communities, particularly those in rural/remote areas, have only one or two local
stores (including small general/department stores, and nontraditional food retailers such as gas
stations, convenience stores, and trading posts), while some have none. These stores are often
small, service a small population base, and experience high operating costs and complex logistics.
Stores are operated with various degrees of community governance and may have direct or indirect
lineages to colonial enterprises—the Northwest Company, for example, “traces its roots back to1668 with many... store locations in Northern Canada and Alaska having been in operation forover 200 years” [28]. In addition to food from the national and global agri-food sector, such stores
may sell locally sourced/harvested food, as well as equipment and supplies for harvest and othergoods (e.g., clothing). While individuals can place food orders through online retailers or travel(sometimes significant distances) to larger population centers with greater food diversity and lower
prices, limited resources (e.g., access to a vehicle, credit card, and adequate food storage space)and capacity (e.g., time, internet access/literacy) may preclude or limit the use of nonlocal retailers,particularly for the most socioeconomically disadvantaged and/or marginalized.

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The local retail food environment plays a key role in shaping food access and choice [29].
The food environment is the interface between food systems and diet. Inadequate food environments,
such as grocery store inaccessibility, have been associated with poorer diet quality and obesity [30,31]
and are believed to exert a particularly important influence in contexts where people experiencefood insecurity [32]. Food environments that provide adequate and/or excessive access todietary energy, but lack essential micronutrients, represent a distinct concern for population
health—including risks of both under-nutrition (i.e., dietary deficiencies related to inadequate intakeof healthful foods) and over-nutrition (e.g., excessive caloric and sodium intake) [33–35]. To date,however, food environment research has predominantly been conducted in larger population centersof HICs [36,37], with a burgeoning literature in LMICs [38,39]. Research from the latter has shown thatfood environment and diet dynamics differ between countries due to variation in economic factors [39].
Such dynamics, therefore, also likely differ within countries where economic, geographic, and culturalcontexts diverge significantly from national averages. Thus, literature published for national andgeneral populations in HICs may not apply to Indigenous populations. Yet, retail food environments inthese settings are a priority area for research, intervention, and policy as they may foster and exacerbate
diet-related health inequities, food insecurity, and poverty [8,40–42]. Indeed, the High-Level Panel ofExperts (HLPE) on food security and nutrition has recommended the need to promote nutrition-focused,
policy-relevant research on food systems and take specific measures, to ensure that marginalizedgroups, including Indigenous Peoples, are able to access or achieve a sufficient, diverse, nutritious dietthat is culturally appropriate [43].
The present article systematically synthesizes literature pertaining to the retail food sector
and Indigenous Peoples in HICs. At the time of defining this review, establishing the search
protocol, and undertaking the screening/data charting, there were no published syntheses ofretail food environments relevant to Indigenous populations at an international scale. Two recent
reviews [44,45] have addressed retail food environments as they pertain to Indigenous populations,
globally, focusing on: the contribution of retail food environments to diets and nutrition-related healthoutcomes; the effectiveness of food and nutrition policies; and the incorporation of Indigenous
methods and participation in such research. This review complements, and furthers, these important
contributions by responding to the calls of HLPE, to understand the drivers and determinants offood environments using an interdisciplinary systems approach, and by drawing on the knowledge,
experience, and insights of individuals such as community leaders [43]. In accordance, the “retail foodenvironment” is here conceptualized as the combined community food environment (type, location,
and accessibility of retail food outlets), the consumer food environment (what consumers encounter
within and around retail food outlets, including relevant characteristics of nutritional qualities,
nutritional information, affordability, promotions, placement, range of choices, and freshness),and consumer characteristics (relative convenience and desirability of food products, taking into
consideration personal and cultural factors that influence an individuals’ actions within theirenvironment). Meanwhile, retail food sector is here understood to include the retail food environment
and the food supply chain.
This synthesis focuses, therefore, on mapping key concepts derived through diverse forms ofevidence, and identifying common/divergent issues, best practices, and points of intervention andpolicy to improve retail food environments across global regions and contexts. We hypothesizethat these contexts share commonalities in several structural factors that uniquely shape the foodenvironment. Ultimately, the goal is to support communities, researchers, and policymakers in moving
towards a more equity-oriented research and policy agenda for improving the retail food environmentsof Indigenous Peoples in HICs.

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2. Methods
2. Methods
2.1. Context: Indigenous Peoples in HICs
2.1. Context: Indigenous Peoples in HICs
This review draws on the breadth of published scholarly knowledge that exists on the retail foodThisreviewto
draws
on the breadthscholarly
knowledgedefinition
that existsofon
the retail foodsector as
it relates
Indigenous
Peoplesof
inpublished
HICs (Figure1). A universal“Indigenous”
sectorhas
as itnotrelates
to adopted
Indigenous
in HICs (Figure
A universal
definition“Indigenous”
peoplebeen
by Peoples
any UN-systembody. 1).
Instead,the system
has ofdevelopedapeople has notunderstanding
been adopted byofany
UN-system
body.onInstead,thefactors
system suchhas developed
a contemporary
contemporary
thisterm based
severalas self-identification,
understandingof thistermbased on several
such asself-identification,
historicalcontinuity
historicalcontinuity
withpre-colonial
and/orfactors
pre-settler
societies,
distinct social,economicorwith pre-colonial
and/or pre-settler
distinct
political
languages,
political
systems, languages,
cultures societies,
and beliefs[3]. Insocial,some economic
countries,orthere
may systems,
be preferenceforculturesandincluding
beliefs [3].tribes,
In somecountries,
there may etc.
be preference
othertheterms
includingtribes,
other
terms
first
peoples/nations,
Consistentforwith
UnitedNations
first peoples/nations,etc. Consistentwith
the United
Nations
recommendationof identifying,rather thanrecommendationof identifying,ratherthan
defining,
Indigenous
Peoples [3],we systematicallydefining,each
Indigenous
we systematicallyto identify
Indigenous
Peoples,searched
HIC to Peoples
identify [3],Indigenous
Peoples, searchedfollowingeachthe HIC
approachdescribed
by Cisneros
following thedescribed
by Cisneros Montemayor
et al. S1).
2016The[46]objective(see Supplementary
Material
Montemayor
et approachal. 2016 [46](see Supplementary
Material Figure
was to define
theFigureobjectivewasto definethe scope of the review
andidentify
population-specificscopeof S1).
the Thereviewand toidentify
population-specifictermsfortotheliteraturesearch. First, terms
wefor the literaturesearch.
First,bywecountry
conducted
searches bycountry in
2 majorconducted
systematic
searchesin 2 systematic
major international
databases:
The
Worldinternational
Directory
TheIndigenous
World Directoryof[47]
Minorities
Indigenous
Peoplesdatabase[47] and[48].
the eHRAF
Worldof databases:
Minorities andPeoplesand the and
eHRAF
World Cultures
Populations
database both[48]. state-recognized
Populations of interest
included bothstate-recognized
and thatunrecognizedof Culturesinterest included
and unrecognizedethnic/culturalgroupsare theethnic/culturalgroupsthat arethe originalof thatan area,
and/or populations
original
or earliest
known
inhabitantsof oranearliest
area, known
and/or inhabitants
populations
maintainhistoricalthat maintainhistorical continuity
with precolonialpre-settler
societies[3].
Database searches
continuity
with precolonial
and/or pre-settler
societiesand/or[3]. Databasesearches
werecomplementedbywere complemented
referring to
key documents
Indigenous Peoples’
health—notably,referringto other key by
documents
onother
Indigenous
Peoples’on
health—notably,
the Lancet–Lowitja
the Lancet–Lowitja
InstituteonGlobal
Collaboration
Indigenous
peoples’health[49].
Institute
Global Collaboration
Indigenous
and tribalon
peoples’health and[49]. tribal
Ultimately
19 HICs
with
Ultimatelypopulations
19 HICs with
Indigenous
populations
across
5 globalfor
regions,
were retained
for this review
Indigenous
across
5 global
regions, wereretained
this review(see Supplementary(see Supplementary
Material Table S1).
Material
Table S1).

FigureMapcountries
withhighincomeeconomies
andIndigenous
populations,
identified
Figure
1. 1.
Map
of of
countries
withhighincomeeconomies
andIndigenous
populations,
as asidentified
throughthemethodsofthisstudy.
High-income
countries
aredefined
by
the
World
Bank
Atlas
through the methods of this study. High-income countries are defined by the World Bank Atlas
method(Grossnational
income(GNI)
percapitaof
USD
12,376)
for
2020.
As
of
2020,
there
are
80
HICs
method (Gross national income (GNI) per capita of USD 12,376) for 2020. As of 2020, there are 80 HICs
(including
unincorporated/overseas
territories)
acrossglobalregions.
(including
unincorporated/overseas
territories)
acrosssixsixglobalregions.

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2.2. Literature Review
2.2.1. Systematic Scoping Review
A systematic scoping review deemed appropriate for synthesizing a body of previously
unreviewed literature [50] was undertaken following established protocols [51], and abiding by
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping
Reviews (PRISMA-ScR) guidelines [52]. Detailed methodology for the review is detailed in the
Supplementary Material (Tables S2–S6).
2.2.2. Search Strategy
The search strategy aimed to identify peer-reviewed publications involving the retail foodsector and Indigenous Peoples in HICs. Two major online databases (Ovid MEDLINE andScopus) were systematically searched using a combination of keywords pertaining to: i. Country;ii. Indigenous Peoples; and iii. the Food retail sector (see Supplementary Material Tables S3 and S4).
Search terms were developed based on the results of Section 2.1 and a priori knowledge of the field
and were refined through an iterative process. The search was conducted in August 2019 and updated
in April 2020.
2.2.3. Eligibility Criteria
The search was restricted to English language journal articles published over the last thirty years(1990–2020, inclusively)—a timeframe determined through an initial search with no date restrictions.
To be eligible for inclusion, original peer-reviewed articles must have satisfied the geographic(HIC), populational (Indigenous population), and thematic focus (retail sector), as defined by the
inclusion criteria (see Supplementary Material Table S5). Reviews, commentaries, study protocols,
and grey literature were excluded. Articles focusing on other community/neighborhood foodenvironment settings (e.g., schools) were excluded. Likewise, studies focusing exclusively on traditional
foods and harvesting were excluded. Assessments of diet, food security, health, and psychosocial(e.g., knowledge and attitudes) factors, as well as community social, economic, and cultural conditions
were excluded unless they incorporated a direct link to the retail food sector within study results.
2.2.4. Screening
In total, 1073 records were identified from the search process following deduplication (n = 288)
and database filters (n = 399) (Figure 2). In the first round of determination, 2 authors (TK and TL)
independently screened the titles and abstracts of all records based on the eligibility criteria.
The screening protocol and eligibility criteria were piloted on the first 50 articles and refined toensure consistency. In the second round of determination, both authors independently scanned thefull manuscript texts of the 485 retained articles to ascertain relevance, leading to the exclusion ofan additional 348 articles. Ultimately 137 articles were included in the review.

Identification

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399 records eliminated through postsearch database subject filters

Screening

485 full-text articles assessed for eligibility

Included1073 unique records screened

Eligibility

288 duplicates automatically removed

588 studies excluded•
28 additional duplicates manually identified•
543 outside of geographic scope and/or subject area•
17 focus on Indigenous fisheries and/or country food markets

348 studies excluded•
3 could not identify full text article•
33 ineligible article/study types (e.g. reviews, commentaries)•
312 outside of scope (e.g. gardens, schools, non-Indigenous
populations/regions, no consideration of retail sector)

137 articles included inqualitative synthesis

Figure 2. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow
Figurediagram
2. Preferred
ReportingItems for
Systematicand Meta-Analyses(PRISMA)flow anddepictingthe four-stage
articleprocessReviews
used identify,
include and exclude(including
diagramfour-stagearticles
article onprocess
usedfood
identify,
and exclude(includingandthe depicting
reasons forthe
exclusions)the retailsectorinclude
and Indigenous
Peoplesin highincomethe reasonsforexclusions)articlesontheretailfood
sectorandIndigenous
Peoplesinhighincomecountries (HICs).
countries (HICs).

2.2.5. Data Charting
2.2.5. DataFor
Charting
each retained article, key geographic, populational, methodological, and topical characteristics
were eachrecordedby onearticle,
author into
electronic spreadsheet(seemethodological,
Supplementary Material
Table S6).
For
retained
key angeographic,
populational,
and topicalStudyattributes
weretabulatedbyfrequency,
andfigureswere
generatedtosummarize
trendscharacteristics were recorded by one author into an electronic spreadsheet (see Supplementaryin theliterature.
The Study
data abstraction
includingidentification/classificationof major themes
Material
Table S6).
attributes scheme,
were tabulatedby thefrequency,
and figures were generated
toused to structure
results, was The
developed
the first author
throughincluding
an iterativethe
processsummarize
trends thein reviewthe literature.
data byabstraction
scheme,that involved inductiveofand
deductiveand drewthe
onreview
existingresults,
frameworks
of consumer
identification/classification
major
themesreasoning
used to structure
was developed
by foodenvironments
and food
access [29,43,53,54].
thisis included
the conceptual
framework
the first
author throughan iterative
process thatNotably
involved
inductive
andindeductive
reasoningand ofsystemsframeworks
for diets andby the HLPE
retained Notably
articles were
drewfoodon existingof nutrition
consumerpresented
food environments
and[43].
food Ultimately,access [29,43,53,54].
based on levelof the retailfood
sector:for diets and nutrition presented by thethis isclassified
includedbroadly,in the conceptual
frameworkof foodsystems
HLPE [43]. Ultimately, retained articles were classified broadly, based on level of the retail food•
Retail food supply, including supply chain (i.e., food processing, distribution, transport,
sector:warehousing); stores (i.e., characteristics of local food stores, including the geographic•
Retaildensity/distribution,
food supply, including
supplycharacteristics);
chain (i.e., foodtransport,
and vendor
foodprocessing,supply (i.e.,distribution,items available
in the store,
warehousing);
stores(i.e., characteristics
of localfood stores,
includinggeographic
including theiravailability(i.e., the presence
and diversityof food
items in thethe stores
surveyed),density/distribution,andvendorcharacteristics);
foodsupply(i.e.,
items
available
inthestore,
affordability (function of food prices, income, and perceptions of value), quality/acceptability
includingtheir availability(i.e., theand diversity
food items inthe stores
surveyed),(i.e., structured
assessments
ofpresence
product properties
andofperceptions
about
the appeal,value andaffordability(function
foodsupply)
prices,andincome,andplacement/promotion
perceptions of value),(e.g.,quality/acceptability
convenienceof theoffood
in-storeshelf space allocation,(i.e., structured
assessments
of product properties
and perceptions about the appeal, value andlabels and posters,announcements,etc.));
convenienceof thefood
supply)and in-store
placement/promotion(e.g., shelf space allocation,•
Consumers(e.g.,
store
sale records,
shopping
behavior)labels and posters, announcements, etc.));•Consumers (e.g., store sale records, shopping behavior)

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Interventions and initiatives (e.g., store-based and multisectoral interventions, food pricing
policies and subsidies).
Interventions
and initiatives (e.g., store-based and multisectoral interventions, food pricing

policies
subsidies).
All dataand
werecharted by 1 author (TK), and 20% of entries were double entered by a second
author (TL) to ensure validity.
All data were charted by 1 author (TK), and 20% of entries were double entered by a second
author (TL) to ensure validity.
3. Results

18
16
14
12
10
8
6
4
2
0

1993
1994
1995
1996
1997
1998
2000
2001
2002
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020

Number of articles

3. Results
3.1. Overview of Included Studies
3.1. Overview of Included Studies
Key characteristics of the 137 articles included in the review are summarized in the
Supplementary
Material
Supplementary
Material
S7).
number ofinrelevant
articles has
Key characteristicsof (seethe 137
articles includedin theTable
review
areThesummarized
the Supplementary
increased
overthe last 30 years,
withTable
approximately
half ofofall
studiesarticles
publishedin the lastover
5 years
Material(see
Supplementary
Material
S7). The number
relevant
has increasedthe(2014–2019)3).
last
30 years, (Figure
with approximately
half of all studies published in the last 5 years (2014–2019) (Figure 3).

Publication year
FigureFigure3.3. Overview
Overview ofof thethe literatureliteratureby
byyearyearofofpublication.
publication.

3.1.1. Where has the research been conducted, and which populations have been involved?
3.1.1. Where has the research been conducted, and which populations have been involved?
Published literature was available from less than half (8 countries) of the 19 HICs eligible for
Published literature was available from less than half (8 countries) of the 19 HICs eligible forinclusion in the review (Figure 4), 95% of studies conducted in four countries: Australia (31%; 42 articles),inclusion in the review (Figure 4), 95% of studies conducted in four countries: Australia (31%; 42
the United States (US) (28%; 38 articles), Canada (27%; 37 articles), and Aotearoa/New Zealandarticles), the United States (US) (28%; 38 articles), Canada (27%; 37 articles), and Aotearoa/New(NZ) (9%; 13 articles) (Figure 4).
Literature pertained to five major Indigenous groups,
Zealand (NZ) (9%; 13 articles) (Figure 4). Literature pertained to five major Indigenous groups,
including: Aboriginal and Torres Strait Islanders (42 articles), American Indians (AIs) (35 articles),including: Aboriginal and Torres Strait Islanders (42 articles), American Indians (AIs) (35 articles),First Nations (FNs) (20 articles), and Inuit (14 articles) (Figure 5). Most research (99 articles) was set
First Nations (FNs) (20 articles), and Inuit (14 articles) (Figure 5). Most research (99 articles) was set
in rural, remote, and/or northern/Arctic regions and involved distinct Indigenous communities orin rural, remote, and/or northern/Arctic regions and involved distinct Indigenous communities orpopulations (Figures 4 and 6). Few studies were conducted in urban areas (15 articles) and/or involved
populations (Figure 4 and Figure 6). Few studies were conducted in urban areas (15 articles) and/or
multiethnic populations (Figures 4 and 6). Importantly, the definitions and use of the term’s “rurality”,
involved multiethnic populations (Figure 4 and Figure 6). Importantly, the definitions and use of the“remoteness”, and “northern”, can vary considerably across studies, countries and contexts, based onterm’s “rurality”, “remoteness”, and “northern”, can vary considerably across studies, countries andtechnical and social factors. Nevertheless, remoteness is generally understood in terms of geography
contexts, based on technical and social factors. Nevertheless, remoteness is generally understood in
and access to health, education, energy supply, and other public and private services, each of whichterms of geography and access to health, education, energy supply, and other public and private
are often most highly concentrated in major contemporary population centers.
services, each of which are often most highly concentrated in major contemporary population centers.

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Environ.Res.
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2020,17,
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45
45
40
40
35
35
30
Number of articles
Number of articles

30
25
25
20
20
15
15
10
10
5
5
0
0

Australia

United States

CanadaNew Zealand

Guam

Greenland

Australia

United States

CanadaNew Zealand
GuamCountry

Greenland

FrenchNew Caledonia
Polynesia
FrenchNew Caledonia
Polynesia

Country

Figure 4. Overview of the literature by country.
Figure 4. Overview of the literature by country.
Figure 4. Overview of the literature by country.
45
45
40
40
35
35

Number of articles
Number of articles

30
30
25
25
20
20
15
15
10
10
5
5
0
0

Australian
American Indian and First Nation andAboriginal andAlaska Native
Métis
Torres AustralianStrait Islander American Indian and First Nation andAboriginal andAlaska Native
Métis
Torres Strait Islander

Inuit
Inuit

Māori
Māori

Population - group
Population - group

Pacific
General/National
Islander,Chamorros,
General/National
NativePacific
Hawaiian
Islander,Chamorros,
Native Hawaiian

Not specified
Not specified

Figure 5. Overview of the literature by populational focus—Indigenous Peoples concerned.
Figure 5. Overview of the literature by populational focus—Indigenous Peoples concerned.
Figure 5. Overview of the literature by populational focus—Indigenous Peoples concerned.

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Int. J. Environ. Res. Public Health 2020, 17, x

9 of 48

45

40

35

Number of articles

30

25

20

15

10

5

0
RemoteArctic andNorthern

Rural

Urban

General/National

IslandNot specified

Study setting (geography)

Figure 6. Overview of the literature by geography (as defined in the article).
Figure 6. Overview of the literature by geography (as defined in the article).

3.1.2. How Has the Research Been Undertaken (Indigenous Participation and Study Design)?
3.1.2. How Has the Research Been Undertaken (Indigenous Participation and Study Design)?
Most research has been undertaken through collaborative and participatory processes involving
Most researchhas been
undertaken
throughand participatory
processes
involving
Indigenous
communities
andorganizations.
Acollaborativesmaller numberof studies either
do notspecify
Indigenous
communities
andorganizations.
A
smallernumberofstudieseitherdonot
Indigenous participation and/or involve desktop research (e.g., secondary data analyses). Most specify
studies
Indigenous
participation
and/orinvolvedesktopresearchsecondarydata(30%;
analyses).
Most
involved
quantitative
study
designs(55%;
76 articles)with(e.g.,
fewer
qualitative
41 articles)
studies
involved quantitative
study designs(55%;
76 articles)
andmixed/multi-method
approaches(15%; 20
articles)(Table with
S7). fewer qualitative (30%; 41 articles)
and mixed/multi-method approaches (15%; 20 articles) (Table S7).
3.1.3. What Dimensions and Domains of the Retail Food Sector Have Been Examined?
3.1.3. What Dimensions and Domains of the Retail Food Sector Have Been Examined?
Most studies (60 articles) focused on initiatives (policies, programs, and community
Most studies (60and
articles)focusedon initiatives(policies,
programs,
and community
planning/prioritization)interventions
to improve
community
health and/or
food systems
involvingplanning/prioritization)and interventions
improvecommunity
healthfoodtheretail sector. Many studies
also focusedtoon
consumer
perceptions
and and/or
behavior(45 systems
articles)involvingthe market
retail sector.
Many studies
also focused
onpurchasing.
consumer perceptions
and behavior(45
relatedto thefood supply,
store access,and food
A smaller bodyof literaturearticles)relatedtothemarketfood
supply,store
access,andfoodpurchasing.
A
smallerbodyoffocused on assessments of the food supply (33 articles), store-level factors, and the retail workforce
literature
focusedon assessments of the food supply (33 articles), store-level factors, and the retail(18
articles)(Table S7).
workforce (18 articles) (Table S7).
3.2. Retail Food Sector—Food Supply Chains and Food Imports
3.2. Retail Food Sector—Food Supply Chains and Food Imports
The retail food supply chain has largely been included as a descriptive or contextual factor
in theTheliterature
withsupply
limitedresearch
explicitly
focusedon as
thisdomain [55].
Qualitativefactor
studiesretail foodchain
has largely
been
includeda descriptive
or contextualindocumenting
the local
retail workforce(storeand distributors)
the literature perspectives
with limitedfrom
research
explicitly
focused on
thisowners/managers
domain [55]. Qualitative
studies
andcommunity
members fromhighlight
severalcommonissuesaffectingfood supplies
remotedocumenting
perspectives
the local
retailworkforce(storeowners/managers
andacrossdistributors)
Indigenous
communities
Australia,
Canada,Greenland,
the US[22,56–60].
and community
membersinhighlightseveralcommonissues andaffectingfoodsupplies These
across include
remotetransportation
logistics andincosts,
inadequate
localGreenland,
infrastructure,
challenges.
Indigenous communities
Australia,
Canada,and andthe operating
US [22,56–60].
These include
Despite community/store
policies,and interest
on behalf of both
members and storetransportation
logistics and costs,
inadequate
local infrastructure,
andcommunity
operating challenges.
managers
toprocure
food
from
local
and
Indigenous
producers,inpracticeseveralconstraints
Despite community/store policies, and interest on behalf of both community members
and store(e.g.,
decision-making
authority,
supplychain logistics)
can restrict
thisseveral
possibility[58,61,62].
managers
to procure foodfrom local
and Indigenous
producers,
in practiceconstraints(e.g.,
Meanwhile,
localauthority,
producerssupply
can experiencechallenges
in sellingto small local
storesMeanwhile,
compareddecision-making
chain logistics)
can restrict
this possibility[58,61,62].
local producers can experience challenges in selling to small local stores compared to central
distributors (e.g., higher costs, lower turnover), and/or may be unable to supply requisite volumes

Int. J. Environ. Res. Public Health 2020, 17, 8818

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to central distributors (e.g., higher costs, lower turnover), and/or may be unable to supply requisite
volumes [61,63]. Furthermore, the provenance of store foods may be driven by broader factors suchas globalization and economic/political relationships. In Guam, for example, available (processed)
food has derived from an increasing number of countries over time; however, most products originate
from the US, which of which Guam is an “unincorporated territory” [64].
3.3. Retail Food Sector—Food Stores
A total of nine articles mapped and/or inventoried the number/density, type, and/or location offood stores in (or in proximity to) Indigenous communities [65–70] (Table 1). These were based on both
empirical (e.g., existing data sources, on-site observations) and respondent-based methods involving
community knowledge/perceptions (e.g., asset mapping). A single study used both empirical andrespondent-based methods with convergent results between approaches [65]. These approaches arecomplementary to studies which document consumer experiences and perceptions of store access andshopping behaviors (see Section 3.5).

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Table 1. Summary of studies examining food store availability and access.
Reference[66]

Setting 1
CountryCA

Conclusion

Relationship to Food
Supply and/or Health

Retail competition (presence ofa second retailer)
Retail and shopping experience

There is limited retailcompetition in mostcommunities which lackyear-round road accessRespondents expressed
concerns regarding foodsupply (availability, cost,quality and freshness)

Distance to, and density of,retail outlets (healthy vs.
unhealthy) in relation totribal area
Perceptions and experiences ofthe food environment

Lower density ofhealthy food outlets intribal areas compared to
nontribal areas

Respondents perceived
food environment
negatively and ported
barriers to theacquisition of healthy
food-

Places where youth acquire
food (how they are perceived,
and how to improve them for
healthy living)Gas station andconvenience store were
the only place topurchase groceries in
the community

Available food wasperceived to be of poor
quality andrecommended that
healthier food be sold-

Rural; Urban

Inventorying(secondary
data;
ground-truthing/ site visitation)

Enumerating food outlets andmatch rate for secondary dataand on-site observations fordifferent types of food outlets

Secondary data sources
both over- and underestimate the foodenvironment especiallyfor nontraditional
retailers-

Rural; Remote

Inventorying(secondary
data; telephonesurvey)Vendor characteristics(type, ownership)
Food supply assessment(availability and price)

General characteristics
of available stores (onNavajo Nation and
Border Towns) are
reported

Geography
Arctic andnorthern

Methods
Empirical

Mapping

Outcomes Examined

Respondent-Based
Survey of retailexperience

-

[65]

USA

Not specified

Mapping

Interviews(Tribal members)
-

[67]

[68]

[71]

CA

USA

USA

Asset mapping(youth)Rural-

Navajo convenience
stores offered fewer
healthier food options
compared to Navajo
supermarket

Int. J. Environ. Res. Public Health 2020, 17, 8818

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Table 1. Cont.
Reference

Setting 1
Country

Geography

Methods
Empirical

[72]

[73]

[69]

[70]

Guam

USA

CA

CA

IslandNot specified

Urban

On siteobservations

Inventorying(secondary
data; telephonesurvey; site
visitation)

Mapping(census andstore location
data)

General/National Internet search

Conclusion

Relationship to Food
Supply and/or Health

Map of food stores (by type) in
relation to participants
Association to food supply, diet,and health

The majority of storeswithin a mile fromparticipants were small
markets

Living near a small
market was negatively
correlated with bodymass index (BMI);
while living near aconvenience store waspositively correlated

Type number and location offood stores
Availability and cost of food

Half of stores identified
on 22 American Indian
reservations wereconvenience stores. A
total of 17
reservations did nothave a supermarket on
their reservation, andthe nearest
off-reservation
supermarket was 10
miles from the tribe’s
headquarters

Across all stores, about
38% of checklist items
were available,with foods from thedairy and sugars/sweets
groups being the mostavailable, while fresh
fruits/vegetables being
the least available. Costof the most commonly
available items waslowest in supermarkets

Outcomes Examined

Respondent-Based

-

-

-

Supermarket within 800 meters Supermarket exposure
did not differ inby percentage of Indigenous
neighborhoods with aresidents (and othersocio-economic/demographic info) higher percentage ofIndigenous residents-

Alternative food procurement
locations (Indigenous
food co-ops)

In total, 42 Indigenous
food co-ops wereidentified (notably innorthern Canada)

1 Countries: CA = Canada; GU = Guam; USA = United States; Geography as self-defined in the study (except for Island states). ‘Arctic and northern’ includes the provincial North of Canada.

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3.3.1. Store Availability and Geographic Accessibility (Type, Number, and/or Location of Stores)
Several studies conducted in North America highlight issues of store availability in Indigenous
communities—notably, the absence or limited availability of supermarkets and grocery stores, and,in several cases, the presence of nontraditional food retailers such as gas stations and convenience
stores, particularly in AI and FN reservations (see for example [65,67,68,71,73]). In one study,
tribal areas in the US had significantly lower densities of healthy food outlets compared to nontribal
areas even after controlling for socio-economic and demographic variables [65]. Meanwhile, in a
multi-ethnic urban setting (Edmonton, Alberta), supermarket density did not differ in neighborhoods
with a greater percentage of Indigenous residents [69]. Although mapping community location andthe distribution/density of stores provides insights into potential geographic barriers to store access,consumer surveys (e.g., shopping behavior, transportation access) are requisite to appraising store
accessibility—including heterogeneous (and socially-patterned) experiences of store access acrosspopulations. Issues of store availability in northern Canada were often described in terms of limited
retail competition (monopolies or oligopolies) [62,66,74]. One study that directly examined this issue(i.e., presence of a second retailer by community) in the provincial north of Canada found that over
90% of remote FN communities surveyed are serviced by a single corporate food retailer [66]. This canbe problematic, as communities with a single food retailer exhibit higher food costs, and though thepresence of a second retailer may still not render food prices affordable, increased competition ofgrocery stores has been associated with better food pricing and quality [74,75].
3.3.2. Vendor Characteristics (Store Operation and Management)
An additional attribute of local stores which may impact local food supplies involves
store operating practices/philosophies, community governance, and involvement of the healthsector in defining retail practices and policies—all of which vary markedly across stores andregions. The need to include Indigenous priorities in store management and operations ishighlighted in several studies—including the need for ongoing communication between stores andcommunities, community co-operatives, and Indigenous-owned businesses [56,63,70]. Many storesin Indigenous communities, however, are associated with corporate chains and/or are managed by
non-Indigenous people [71,76]. While store managers may acknowledge their role in the local foodsupply, and recognize the financial constraints of community members, several factors such as manager
ideologies, supply chain challenges, and constrained managerial authority/choices may influence
their stocking practices [22,56–58,77]. Furthermore, despite the potential benefits of establishingcollaboration and building capacity between the retail and health sectors [78], as evidenced ina number of policies and intervention studies (e.g., appointment by the Looma Community Council(remote Australian Aboriginal community) of a store manager with a mandate to improve the foodsupply [79]), the role of the public health sector and local nutritionists may not be comprehensively
apprehended or appreciated by the retail sector [22,56]. Moreover, although store owners and managers
have shown willingness to participate in health-related interventions, they may do so provided it does
not consume store resources and employee time [80]. The financial effects of health-related policies onretail performance remains poorly understood [81].
3.3.3. Relating Store-Level Factors to Food Supply and HealthStore level factors (including store type/size and management/operating practices) have been
related to both the food supply and consumer health among Indigenous Peoples in HICs. Small storesand nontraditional food retailers tend have higher prices and carry fewer healthful items such as
fresh produce and lower-sodium products than do larger stores and supermarkets, which tend to
be less present in these settings [56,67,71,73,77,82,83]. For example, in a study conducted on an AI
reservation, convenience stores carried approximately one-fifth of the items in a standard checklist(compared to 86% of items in supermarkets) [73]. Even still, across all store types, on-reservation stores

Int. J. Environ. Res. Public Health 2020, 17, 8818

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had, on average, roughly half of the items on the checklist, with significant disparities in fresh produce
availability [73]. Relatedly, proximity to convenience stores and high reliance on nontraditional foodretailers has been associated with weight-related variables and diabetes [72,84], although consumptionof food from nontraditional retailers has been inconsistently associated with food security status [85,86].
3.4. Retail Food Sector—Food Supply
Food supply assessments have included both empirical store audits/checklists (15 articles),as well as respondent-based assessments of the perceived food supply (>20 articles) (Tables 2 and 3).
The former has mostly involved cross-sectional study designs based on standardized tools, such as
the Nutrition Environment Measures Survey in stores (NEMS-S) scoring system and other predefined
healthful market baskets, variously adapted to local contexts [87]. Among empirical food environment
assessments, most examined food availability (10 articles) and cost (12 articles), (Table 2). Meanwhile,in qualitative respondent-based studies, various dimensions of the food supply are discussed collectively(i.e., that healthful food is expensive, of poor quality, and limitedly available), and include considerationof both healthful and discretionary foods, as well as impacts these factors have on community dietand health [59,62,88].
3.4.1. Food Availability
In several studies, community members perceive deficits in the availability and selectionof healthful (notably, nutritious perishable, bulk, and special dietary) foods, contrasted by theoverabundance of nutrient-poor discretionary food items [57,63,88]. This deficit is perceived as abarrier to health [89], and the “right to food” for people with pre-existing health conditions, such as
diabetes [62]. There is also concern regarding the availability of foods for specialized needs and diets,
such as high-iron infant foods [90]. While qualitative, respondent-based studies highlight the ubiquity
of non-nutrient dense foods in local stores [67], few empirical studies have examined the availability ofsuch items in these contexts.
Store food availability audits conducted in Australia [91], Canada [92], Greenland [56], Guam [82],and the US [71,73,83,93,94] also capture these issues, with dramatic disparities in northern and remotestores. In Greenland, for example, some remote stores do not carry any fresh items (e.g., produce, dairy,
and/or meat) [56] and variety can be extremely limited among those that do. Results are similar in
Alaska [93], where less than half of fruits (20–40%) and vegetables (20–30%) in a standard checklist areavailable, and in Guam [82], where less than half (47%) of stores surveyed sold more than two varietiesof fresh fruit.
3.4.2. Food Affordability
In respondent-based studies, community members across several global regions
describe food, particularly fresh healthful items, as being overly-priced and prohibitively
expensive [57,62,63,89,95–97]—especially when compared to less healthful options likeprocessed/convenience foods. Participants also perceive variations in prices between local andout-of-town food stores [59], including higher prices on-reserve vs. off-reserve [98]. Participants havereported that the unaffordability of healthful food is a barrier to improving their diets [96] and,indeed, higher rates of obesity have been documented among participants who report that the priceof fruits and vegetables is cost-prohibitive [84]. Similarly, high food costs have been associatedwith greater likelihoods of adult and child food insecurity among American Indian adults [85].
While issues of food affordability are discussed by study respondents in terms of their implications
for socio-economically vulnerable community members, including those on income support [57,99],
empirical studies have typically been restricted to assessments of food costs with limited considerationof income and basic living expenses (e.g., housing) [100].
The relative price between more/less healthful food (e.g., nutrient/energy density,
reduced-sodium items [77]) is observed in empirical pricing studies [26,101], with a few exceptions [82].

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The higher relative cost of healthful vs. less healthful foods—such as the price of water compared tosugar-sweetened beverages—has been associated with health outcomes like obesity among Māori [87].
Empirical pricing surveys conducted across global regions also consistently document significantly higher
food prices in remote Indigenous communities compared to referent locations (e.g., capital cities, national
averages). Food prices in Indigenous communities in remote Australia [102] and the Canadian Arctic [26]were over 60% higher than referent locations. Price disparities have been associated with community andgeographic factors such as road access [91,103]. Remoteness category, for example, explained over half(58%) of the total variance in food basket price in Queensland (Australia), but was less marked for produce
than for other food groups such as dairy and meat [91]. It is unclear how these dynamics manifest in rural
settings. In a food pricing study conducted in a large rural AI community, the cost of purchasing a market
basket ranged between -3% +24% relative to the national average between stores [83]. Other contextual
factors such as season and store nutrition policies are less examined in the literature but are believed to playa role in food costs [91,103]. For example, changes in food prices in northern First Nation communities(Canada) were two times higher between fall and winter than in the provincial capital [103]. In Australia,
relative improvements in food prices have been seen over time in very remote stores, hypothesized to berelated to factors such as the implementation of store nutrition policies and quality retailing practices [91].
Food prices collected from local retail outlets have, in combination with purchase and eating
patterns described in population-based surveys, also been used to estimate actual and theoretical dietcosts, and demand elasticities using diet optimization and econometric models [19,25,104–110]. In the
Canadian Arctic, remote Australian Aboriginal communities, and among Māori and Pacific households,
non-nutrient-dense foods account for one-to-two-thirds of estimated diet costs [25,105,106]. Due tohigh consumption of discretionary items, the cost of theoretical diets modelled to meet nutritional
requirements for Aboriginal and Torres Strait Islander and Māori and Pacific households in NZ is often
similar and, in some cases, less expensive than current, less-healthful, diets [104–106]. Importantly,
current and theoretical diets may remain unaffordable for some households, notably those on income
support [104]3.4.3. Food Quality
Issues of food quality have largely been ascertained by surveying community perspectivesof the food supply; few store audits involving food quality indicators appear in the literature.
Community members in several global regions express concerns related to the quality andfreshness of available foods, including the presence of past-date and expired items [57,62,66,84],
although the ubiquity of such items has been limitedly examined in empirical store-based assessments.
These perceptions may affect purchasing behavior (see Section 3.5) as some consumers may avoid
purchasing fresh items for their short shelf-life and for the risk that they may be moldy—particularly inlight of less expensive foods with longer shelf lives [57]. In store food-quality assessments conductedin Australia, approximately one-third (30%) of very remote stores did not meet quality criteria for
fresh produce [111]. A notable exception was for oranges, believed to be due to local production.
Similarly, in Guam, produce was rated “unacceptable” for 25–50% of fruits and up to two-thirdsof vegetables [93].
3.4.4. Point of Purchase Promotion and Information
While community members have expressed concerns regarding what is sold and how it ispromoted [63], and point-of-purchase media constitutes a main dimension of store-based public healthinterventions in Indigenous communities in both the US and Canada (see Section 3.6), few observational
studies have examined these factors in the literature, and most have emphasized nutritionallabels—notably the importance of culturally/ethnically appropriate information in Indigenous
languages [56,89,112]. Among available studies, store signage in Guam more commonly promoted
less-healthy eating than healthy eating [82].

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Table 2. Summary of literature involving empirical food supply assessments
Setting 1

Store(s) Surveyed

Food Supply 2

Methods

Country

Geography

Number ofStores/Communities

Store TypeTimepoints

Survey Tools 3(Number and/or Type of
Items)

[94]

US

Rural

18/2

Convenience store

SingleNEMS-TCS(ready to eat foods)

X

X

[83]

US

Rural

27/1

Several store types

SingleNEMS-S(68 items)

X

X

[87]

NZ

Rural;
Urban

392/98Supermarket

SingleNEMS-S(5 items—regular vs.
healthier choice)

X

X
Relative
price

[82]

GU

Not
specified114/

Large and small
storesSingleNEMS-S(Healthful and lesshealthful)

X

X
Relative
price

[26]

CA

Arctic andnorthern/6Community stores

Seasonal

RNFB(+items based on local diets)

[93]

US

Arctic andnorthern/13

Community storesSingleNEMS-S (Fresh produce
only)
Alaska Food Cost Survey

[73]

US

Not
specified.
Comparison
on vs. off
reservation

50/22

Several store types

Single[91]

AU

Severalcategories

92/

Not specified (storespreviously
surveyed)

[111]

AU

Severalcategories

144/

[71]

US

Rural;
Remote

[64]

GU,
NC

Reference

Capital city

Availability

Affordability(Cost)

Quality

Point of Purchase
Promotion

X

X

X
BMI

X

X
Nutrition
economics

X
Not reported

X

X

X

TFP market basket(68 items)

X

X

Single(compared to
1998)

HFAB

X

X

Grocery stores andcommunity storesSingle

HFAB(430 items costed;13 items
for quality)

72/

Several store types

SingleNEMS-S(Healthful and lesshealthful)

X

Country-level

Large stores (orchains)SingleProtocol based oncollaboration on nutrients inprocessed foods(3438 items)

X
Country oforiginX

X
Relative
price

Connection toDiet and Health

BMI and dietreported but not
related to foodsupplyX
Based onindustry
standards
X
X
Food labels(nutrient data,
promotional
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Table 2. Cont.
Setting 1

Store(s) Surveyed

Food Supply 2

Methods

Country

Geography

Number ofStores/Communities

Store TypeTimepoints

Survey Tools 3(Number and/or Type of
Items)

[77]

GU

Not
specified100/

Large and small
storesSingleIn style of NEMS-S(9 items)

[102]

AU

Remote-comparedto capitalcities20/

Community storesSingle453 items(63% of food expenditure)

X

[103]

CA

Remote-comparedto capital
city

/3

Community stores

Fall andwinter

TNFB + additional foods(22 items)

X

[56]

GL

Arctic andnorthern

5/5Community storesSingleNEMS-S
Freedman Grocery Store
SurveyReference

Availability

Affordability(Cost)

Quality

Point of Purchase
Promotion

Connection toDiet and Health

X
Sodiumcontent

X

1 Countries: AU = Australia; CA = Canada; GL = Greenland; GU = Guam; NC = New Caledonia; NZ = New Zealand; US = United States; Geographic setting as self-defined in the article.
‘Arctic and northern’ includes the provincial North of Canada; 2 Checkmark indicates studies which assessed the dimension of the food supply named; 3 HFAB = Healthy Food Access
Basket; NEMS-TCS= Nutrition Environment Measures Survey for Tribal Convenience; NEMS-S=Nutrition Environment Measures Survey for Stores; RNFB= Revised Northern Food
Basket; TFP = Thrifty food plan; TNFB= Thrifty Nutritious Food Basket (Agriculture Canada).

Table 3. Summary of respondent-based studies that highlight issues of food supply and consumer experiences.
Setting 1

Reference[113]

Country

Geography

CA

Arctic and northern

Dene/Métis adults

[59]

US

Food Supply 2

Participants

Rural
-

Primary household
shoppers(American Indian)
Other stakeholders

Availability

Affordability

Quality

X

X
Expensive

X
Lack offreshness

X

X
Higher cost ofhealthy foodX
Quality of meat

Point of Purchase
Promotion

Consumer andShopping-Related Issues
Discussed by Respondents-

Shopping location
Care accessGovernment assistanceprograms (on the type andtiming of foods purchase)Int. J. Environ. Res. Public Health 2020, 17, 8818

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Table 3. Cont.
Setting 1
Reference

Food Supply 2
Participants

Country

Geography

Availability

Affordability

Quality

Point of Purchase
Promotion

Consumer andShopping-Related Issues
Discussed by Respondents
-

[96]

CA

Urban

X
Unaffordability ofboth healthy andunhealthy

Caregivers of Métis andoff-reserve First Nations
children

-

[98]

CA

Six Nations of theGrand River

[89]

NZ

Auckland andWellington

Adults (from Six Nations
Reserve)Māori and Pacificshoppers

X

X

[84]

US

Rural

American Indian adults

[114]

US

Urban; Rural

Tribal leaders (American
Indian)[115]

AU

Remote[60]

CA

Arctic and northern

X

Inuit adults
Other stakeholders

X
Higher cost ofhealthy food

X

X

X

X

-

Shopping locationand frequency-

Difficulty changing shopping
behavior / habit
Cost as a major barrier-

X

X
High cost of foodand competing
demands for money

Adults (Aboriginal)-X
CAD 151/week tofeed household

X

Reliance on energy-dense,
nutrient-poor foods, as thesetended to be more affordable
and lasted longer than more
nutritious, fresh food options
Transportation-related issues-

Frequency and locationof shopping-

Shopping location-

Long-shelf-life food
Pay cycles
Available funds purchaseless more expensive
healthful foods-

High price making it
challenging to obtain food of
sufficient quality

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Table 3. Cont.
Setting 1
Reference

Food Supply 2
Participants

Country

Geography

[116]

CA

Arctic and northern

[117]

US

Urban

[57]

CA

Arctic and northern-

Inuit adults
Other stakeholders-

Parents
Other stakeholders-

Inuit women
Other stakeholders

Availability

Affordability

Quality

X

X

X

Point of Purchase
Promotion

Consumer andShopping-Related Issues
Discussed by Respondents-

Environmental constructs
related to food purchasing,
behaviour and bodymass index-

Cost and quality mainbarriers to purchasing-

Shopping when monthly
support checks
are distributed-

Location of food purchase-

Location of food purchaseAmerican Indian women

X
X
Predominant foods
available areconvenient andunhealthy

X

X

X

[88]

US

Navajo Nation

[62]

CA

Arctic and northernCommunity members

[118]

CA

Arctic and northern-

Inuit women
Other stakeholders

X

[95]

CA

Arctic and northern

Indigenous women (First
Nation, Dene/Métis,Inuit)

X

[119]

CA

Arctic and northern(Rural)Adults (First Nations)XX

1 Countries: AU = Australia; CA = Canada; GL = Greenland; GU = Guam; NC = New Caledonia; NZ = New Zealand; US = United States; Geographic setting as self-defined in the article.
‘Arctic and northern’ includes the provincial North of Canada. If geographic setting was not stated in the study, the location of the intervention is included. 2 Checkmark indicates studies
which respondents discussed issues related to the dimension of the food supply named.

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3.5. Consumers
Several articles examined consumer-related factors, including shopping behavior(e.g., shopping frequency, location, and cycles), factors influencing purchase (e.g., psychosocial factors),
and the use of store-sales records (e.g., as proxies for community diet and in intervention studies).
Studies on consumer-related factors were available from North America and Australia, exclusively.
3.5.1. Shopping Location (in/out of Community and by Store Type)In several studies, a high percentage of community members report shopping outside thereserve/community, sometimes travelling considerable distances (an hour or more one way) to accesssupermarkets/grocery stores [59,98,120,121]. Still, challenges related to food store access, and a highreliance on foods purchased locally is reported in several studies [63,97,98,122]. For example, most (58%)
Havasupai adults (and in particular, older adults) report consuming only food purchased on thereservation [122]. Transportation-related barriers (e.g., lack of vehicle access and/or time or moneyfor fuel), often related to socio-economic circumstance, are cited by community members in several
studies as barriers to shopping and purchasing healthful foods at locations beyond the community thatmight have a wider selection of foods at lower prices [59,62,63,96,121,123]. Other factors influencing“out-shopping” include geography (e.g., the more remote a community, the fewer residents reportconsuming purchasing food outside the community [124]) and seasonality (e.g., availability andconditions of roads [103], including seasonal roads like ice roads. Though store access challenges arepronounced for people in remote areas, these issues are also noted in studies involving Indigenous
Peoples in nonremote areas—notably, for individuals who rely on public transportation [96], as wellas individuals who live further away from town centers or food retailers [59], including those
who reside in social housing [62]. As noted previously, given the relationship between store typeand food supply, understanding consumer use of different store types is relevant to public health,particularly since convenience stores are a primary source of food for some community members [119].
Consumers shopping in grocery stores and trading posts on Navajo Nation land, for example,
were significantly more likely (520% and 120% higher odds, respectively) to purchase produce thancustomers shopping in convenience stores [125]. Nevertheless, some consumers may favor shoppingin stores where credit is available (e.g., trading posts), even though food may be more expensive [120].
Meanwhile, AI children from food-insecure households were more likely to eat some less healthfultypes of foods, including items purchased at convenience stores [86]. As most studies have relied on
observational designs, they cannot distinguish the direction of association.
3.5.2. Shopping Frequency and Cycles
Five studies highlight the importance of describing shopping frequency and cycles—including theirdrivers, such as cycles of income (e.g., arrival of social support payments [59,126,127],
wildlife harvesting [128], food shipments [129], and store access—as these may influence patterns offood purchase, particularly for healthful perishable items (e.g., individuals who shop infrequently may
favor purchasing items with longer shelf-lives [96]). Shopping patterns also relate to food security
status [59]. For example, community members in Australia and the USA reported purchasing fresh fruits
and vegetables almost exclusively in the week(s) when income support checks are distributed [59,115].
As families run out of funds during off-pay weeks, they report relying on foods with long shelf lives,and foods that are inexpensive and often less healthful [59,115]. By contrast, a study examining
patterns of food purchasing in a remote Australian Aboriginal community found no association
between consumer economic constraints and purchasing but did find a significant association between
time since the last shop delivery (defined as food scarcity) and money spent in the shop [129].

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3.5.3. Consumer Decision-Making
Diverse factors influence the type of foods that individuals/families purchase and consume,
including personal (e.g., taste/food preference, familiarity and purchasing habits, ease/convenience,
intentions, intolerance to certain items, specialized diets), household (e.g., the presence of children),and food supply (e.g., food cost, availability, and quality, as well as marketing and promotions such as
coupons) factors (see for example [57,59,89,113,116,119,130]. In particular, several studies emphasize
consumer decision-making in relation to food supply constraints (e.g., high cost of food) and financial
strain (e.g., low income, competing demands for money like high electricity bills) [100,115,131].
Many participants reported that high price was a barrier to buying healthful food [89] and that, contrary
to their preferences, they purchased cheaper processed and/or low-cost brands, as these were perceived
to be more affordable and/or longer-lasting than fresher, more nutritious options [57,89,115,131]
Furthermore, one study reported that such lower-cost options ensured that children had something to
eat at each meal when “money was tight” [100]. Some participants indicated that they would only buy
healthier food if the benefit was two-fold (i.e., the price cheaper, and the food healthier) [89].
3.5.4. Store Sales Records
Store sales records have been used for several decades to assess the nutrient quality of local foodsupplies and as a proxy for consumption (i.e., ‘apparent diet’ through the ‘store turnover method’)among Indigenous People in remote communities in Australia (10 articles) [19,23,79,101,124,132–136].
This method has been shown to yield high congruence with classic dietary assessments and has beenvalidated against nutritional biochemical indicators [133,137]. When compared with other dietary intake
methods, store sales records are reported to hold several advantages, including greater acceptability
among community members, reduced potential for bias, relative objectivity, being minimally invasive,
speed, ease of data collection, and low cost [133,137]. While the structure of the local food supplies ischanging in remote Indigenous communities [138], proxy dietary estimates derived from stores closelyalign with those obtained from a complete set of community food providers [135]. This approach has
shown to be a viable way to measure the effects of interventions on food purchases in supermarkets [136]and to assess changes in consumption and food preparation methods over time [79].
3.6. Improving the Retail Sector
3.6.1. Food System/Security/Sovereignty Priority Setting and Planning
Several studies (12 articles) document community and multi-stakeholder priorities identified
through participatory public health and food system/security/sovereignty planning andpriority-setting activities [139–150]. These processes highlight several common desired improvements
in retail food sectors across several global regions—including the need for improvements in thelocation of supermarkets, mobile venders, food transportation/delivery, infrastructure, retail competition,
store management practices and policies, and subsidies to reduce cost and improve availability,
among others addressing equity. Providing access to healthful food, at prices comparable to elsewhere in
the country, was also identified as a policy priority [151].
3.6.2. Multi-Sector/Strategies Involving the Retail Sector
Several multistrategy/sector public health interventions (e.g., involving food stores, schools,
healthcare providers)—such as Apache Healthy Stores [152,153], Healthy Foods North [154–156],
Navajo Healthy Stores [157], the Healthy Navajo Stores Initiative [125], the Tribal Health andResilience in Vulnerable Environments (THRIVE) [61,94], Zhiwaapenewin Akino!Maagewin [158,159],
OPREVENT [160]—have been implemented in Indigenous communities, notably in rural andremote areas across North America (Table 4). A number of interventions, including Healthy Foods
Hawaii [161] and the Child Health Initiative for Lifelong Eating and Exercise (CHILE) [80,162]
have also been conducted in ethnically diverse populations with a preponderance of minority

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and low-income consumers [136,163,164]. In several cases, these initiatives were developed
through collaboration and multisectoral partnerships, and by integrating the results of formative
research [59,90,153,154,162].
These interventions worked with local stores to improve the food-purchasing
environment—namely, by enhancing the availability of healthful foods (including specialty or priority
items such as healthful ready-made meals and snacks), and/or their placement (e.g., placing fruitat the checkout) and point-of-purchase promotions (e.g., placing stickers on shelves at eyelevel, organizing tasting demonstrations, providing recipe cards, and undertaking cooking
demonstrations) [80,90,152,154,155,161,165–167] (Table 4). Few interventions focused directly on
reducing food cost (see Section 3.6.3); nevertheless, food affordability may have been targeted indirectly
by enhancing the selection and promotion of affordable healthful items [152]. One intervention(Healthy Navajo Stores Initiative) sought to enhance food quality by offering staff training on produce
handling to maintain freshness and promote longevity [125], while another (Healthy Foods Hawaii)
involved local producers/distributors to enhance the availability of local food [161]. While mostinterventions focused on promoting select/priority healthful foods, others targeted the demotionof discretionary items. The Healthy Communities Project, which successfully decreased the sales
volume of sugar-sweetened beverages in an Aboriginal and Torres Strait Islander population, is one
example [168]. Process evaluations suggest such interventions are implemented with different levels ofdose, reach, and fidelity [80,152,158] while outcome evaluations have demonstrated positive changes
in several individual outcomes, including psychosocial (e.g., increased food literacy, perception that
healthful foods are convenient, food-related self-efficacy, and intentions) and behavioral measures(e.g., healthful food acquisition and purchase of healthful items like fruits and vegetables), as well as
indicators of diet quality and health (e.g., nutritional biomarkers, reduction of adult body mass index(BMI)) [79,125,157,159,161,166]. Nevertheless, several interventions did not yield significant results onbody weight and energy, sugar, or fat consumption. Moreover, most interventions were conducted aspilot/temporary projects and/or assessed outcomes at a single time point. However, one intervention toprovide healthier choices for children demonstrated an improvement in the quality of foods purchasedby children at the time of a second survey, two years after the initial intervention [165].
3.6.3. Food Pricing Policies (Discounts/Subsidies, Taxes, and Vouchers)
Price discounts and subsidies provide economic incentives for consumers to purchasemore healthful food and may have the potential to improve population-level diets [151,169].
These approaches have been viewed positively by community members in available studies [169,170];
however, there may be a number of challenges related to their implementation (e.g., limited local
nutrition/store workforce capacity). Meanwhile, taxation (consumer and import taxes) on products
such as sugar-sweetened beverages and confectionaries may be used to disincentivize purchase
and/or to raise funds for health promotion, such as has been done in the South Pacific [171].
Studies regarding food pricing policies and strategies across global regions have involved different
designs (e.g., government and store program/policy evaluations, feasibility studies, randomized control
trials, epidemiological models) reflecting differences in the availability and delivery of such initiatives
across global regions. In Canada, for example, where the Nutrition North Canada government subsidy
is available to retailers operating in remote northern communities, evaluation research is limited,
but underscores issues with the program’s accountability structure (e.g., gaps in food cost reporting),
and absence of price caps and other means of ensuring food is affordable and equitably priced incommunities [74]. In contrast, in settings where such policies/initiatives do not exist, and/or are
not implemented comprehensively by communities, government, or retailers, intervention andmodelling studies are reported in the literature. Notably, two randomized controlled trials(and related pilot studies)—Stores Healthy Options Program (SHOP) [112,136,164,172] and SHOP@RIC(Remote Indigenous Communities) [81] involving Māori and Pacific Islander populations (NZ)
and Australian Aboriginal populations, respectively—assessed the effectiveness of price discounts on

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food purchasing, both when paired with nutrition education and without. These demonstrated an
association between price discounts and healthy food purchasing; however, either no, or a small additiveeffect, was recorded when combined with nutrition education, and no effect was seen, with nutrition
education alone [81,164]. The Healthy Choice Rewards program, a mixed methods study to investigate
the feasibility of a monetary incentive (store vouchers) to promote fruit and vegetable purchasing ina remote Australian Aboriginal community did not yield significant increases in fruit or vegetablepurchases [169]. Meanwhile, a weekly fruit and vegetable subsidy program, organized throughan Australian Aboriginal medical service, was associated with improvements in some biomarkersof short-term health status among Aboriginal children [173,174]. Cost-effectiveness analyses havebeen conducted both by modelling theoretical discount/tax-induced changes in food purchases
based on published price elasticity data and alongside intervention trials (e.g., SHOP@RIC) [175–177].
Modelled food pricing policies could improve diets and reduce mortality from diet-related diseases were
estimated to be cost-effective, providing good ‘value-for-money’ [175,177]. By contrast, results fromthe intervention trial demonstrate that small and complex dietary changes leading to unintended
health consequences (i.e., increases in sodium, energy and estimated change in BMI) can occur when
adopting single focus price discount strategies and would not be deemed cost-effective [176].
3.6.4. Other Initiatives
Other initiatives to improve the food purchasing environment include two studies involving theimplementation of novel retail outlets—a mobile grocery to provide access to subsidized healthfulfoods [178], and a not-for-profit cooperative grocery store in a former food desert [179]. A significant
proportion of shoppers at the latter were Indigenous people and used the store as their primary grocery
store [179]. A small body of literature set in Australia and NZ (including intervention-trails [180,181]
and epidemiological modelling studies [182,183], also examined environmental sodium reduction
strategies (namely, through modifications in food processing) in both Indigenous and multiethnic
community contexts. For example, an intervention trial in 26 remote Indigenous community storesin Australia demonstrated that a 25% salt reduction in a top-selling bread product did not affectsales; if implemented across all bread products, this could lead to significant health gains at the
population-level [180]. In NZ, findings from the modelling (using a Markov macrosimulation model)of eight sodium reduction interventions using administrative cost data suggested that intervention
strategies could achieve major health gains for Māori [182].

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Table 4. Summary of intervention research 1 involving the retail sector 2 and Indigenous Peoples in HICs 3 .
Setting 4Intervention Name
Goal/Type

Number ofIntervention
Stores/Communities 5Intervention 6Country

Geography
or Location

AHS: Apache
Healthy Stores[152,153]
Food store-based
obesity and chronic
disease risk reduction
program (dietary
improvement)

US

White
Mountain and
San Carlos
Reservation

11 (6)/2
reservations

X

CHILE: Child
Health Initiative forLifelong Eating andExercise[80,162,163,166]
Multicomponent
obesity prevention
intervention forchildren in Head
Start Centers

US

Rural

/6 American
Indian sites

X

HealthyCommunities
Project [168]Multicomponent
pilot healthpromotion project(reduce sugary drink
consumption andincrease water
consumption)
HFH: Healthy Foods
Hawaii [161]Multicomponent
obesity risk reduction
and dietary
improvement
intervention forchildren (includes
local
producers/distributors)

Availability Affordability

Quality

Evaluation and Impacts Examined 6
Point ofProcess Evaluation
Purchase
Promotion

DesignPsychosocial

Diet or
Purchase

X

Differed by level.
At the store level:high level of doseand reach, and amoderate to highlevel of fidelity

Quasi-experimental
design(pre-test/post-test
longitudinal study)

X

X

X

Participant
engagement,
recruitment andretention

Group randomized
controlled trial

X
BMI

X
AU

US

RemoteHawaii/3

5/2 (2)

Qualitative andquantitativeevaluation

X
Drinkavailability

X

X

High fidelity andmoderate reachand dose reported

Pre/post-assessmentof child-caregiver
dyads in intervention
and comparison
communities

Health-Community readiness
Awareness of social
marketing messages

X
Knowledge and theperception that healthy foods
are convenient (caregiver)

X
Store drink
sales(water vs.
sugary drink)

X
Healthy
Eating Index(HEI) score(children)Int. J. Environ. Res. Public Health 2020, 17, 8818

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Table 4. Cont.
Setting 4Intervention Name
Goal/Type
HFN: Healthy Foods
North [154–156]
Multicomponent
chronic disease risk
reduction and dietary
improvement
intervention(nutrition andphysical activity)
Looma HealthyLifestyle Program[79]
Community-directed
healthy lifestyleprogram to reducerisk of chronic
disease (reduce
coronary heartdisease throughdietary modification)
NHSI: Healthy
Navajo Stores
Initiative [125]Multifacetedintervention drawing
from National“Healthy CornerStore” best practices(including a fruit andvegetable
prescription/voucher
program)

Country

Geography
or Location

CA

Arctic andnorthern

AU

US

RemoteNavajoNation(rural/remote)Number ofIntervention
Stores/Communities 5

9 food stores +3 convenience
stores /4(2)1/1Stores across
Navajo Nation
were invited toparticipate

Intervention 6
Availability Affordability

Quality

X

X

Evaluation and Impacts Examined 6
Point ofProcess Evaluation
Purchase
Promotion

X

DesignPsychosocial

Diet or
Purchase

HealthPre/post-assessment
in intervention andcomparison
communities

X
Food related self-efficacy
and intentions

X
Unhealthyfoodacquisition
frequency

X
BMI

X
Plasmamarkers ofcoronary
heart diseaserisk that areassociatedwith dietX
Appointmentof community
member as
store manager
to improve
quality of thefood supply

Trends in risk factors
across thecommunity after thestart of theintervention were
examined in 3
cross-sectional
surveysX
Apparent diet(storeturnovermethod)X
Staff training
on produce
handling tomaintainfreshness

Multi-phaselongitudinal study;
Cross sectional
survey of shoppers atparticipatingcompared to
non-participating
storesX
Fruit andvegetablepurchasing

X

Food environment
assessment (fruits
and vegetableindex score)Int. J. Environ. Res. Public Health 2020, 17, 8818

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Table 4. Cont.
Setting 4Intervention Name
Goal/Type
NHS: Navajo
Healthy Stores [157]
Multicomponent
food environment
intervention toincrease theavailability ofhealthier foods and
OPREVENT:
Obesity Prevention
and Evaluation ofInterVention
Effectiveness in
NaTive North
Americans [160]Multicomponent
obesity (and relatedcomorbidity)
reduction initiative
SHOP: Supermarket
Healthy Options[112,136,164,172]
Multicomponent(price discountand nutrition
education)intervention (andpilot study) topromote healthierfood purchasing
SHOP: Supermarket
Healthy Options
Project @RIC(Remote Indigenous
Communities)[81,176]
Multicomponent(price discountand nutrition
education)intervention topromote healthierfood purchasing

CountryUS

Geography
or Location

NavajoNation(rural/remote)Number ofIntervention
Stores/Communities 5

Total of 10 store
regions acrossthe Navajo
Nation (5immediate, 5delayed)Intervention 6
Availability Affordability

X

Quality

Evaluation and Impacts Examined 6
Point ofProcess Evaluation
Purchase
Promotion

X

-

US

Rural

25/total 5 (3immediate, 2delayed)

X

X

-

8/3
NZ

Urban
(pilot: 1/1)

NZ

Not specified

20/20

DesignPsychosocial

Diet or
Purchase

HealthStore-region
randomized
controlledintervention/
Pre-post differencesby intervention
group and byintervention
exposure level

X
Healthy food intentions

X
Healthy foodacquisition

X
BMI

X

X
Dietaryassessment

X
Anthropometry

Food
store
environmental
checklist
Community
Food
store
randomized
process form
controlled trial
Intervention
exposure evaluationX
Pricediscounts(with andwithout
nutrition
education)

Factorial randomized
controlled trial

X
Individualized
electronic
shopping
data (healthy
foodpurchasing
andpercentage
energy fromsaturated fat)X
Pricediscounts(with andwithout
nutrition
education)

A stepped wedge
randomized
controlled trial

X
Weekly store
sales data on
all food anddrinks soldX
Disability
Adjusted Life
Years (andcosteffectiveness)

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Table 4. Cont.
Setting 4Intervention Name
Goal/TypeTHRIVE: Tribal
Health andResilience in
Vulnerable
Environments[61,94]
Initiative to improve
the tribal foodenvironment throughinterventions intribally owned
convenience stores

CountryUSZATPD:Zhiiwapenewin
Akino’maagewin:
Teaching to Prevent
Diabetes [158,159]
Multicomponent
diabetes preventionCA(feasibility study)
building on the
Sandy Lake Healthand Diabetes
Program and others[184]

Geography
or Location

Number ofIntervention
Stores/Communities 5Rural

4 (4)/2 Nations

Arctic andnorthern(remote andsemi-remote)/7 First Nationsin 4 sites total (2delayedintervention)

Intervention 6
Availability Affordability

X
X
Variety
Reducedandpricing
convenienceX

Quality

Evaluation and Impacts Examined 6
Point ofProcess Evaluation
Purchase
Promotion

X

X

Psychosocial

Diet or
Purchase. High fidelity
across strategies in
the intervention
reported

Cluster-controlled
trial design withtreatment conditions
at the store level;
Mixed-effects linear
regression pre- to
postintervention
changes

X

X
Purchasing
andfruit andvegetable
intakeModerate fidelity at
the store-level

Quasi-experimental
pretest/post-test
evaluation between
intervention andcomparison
communities

X

X
Healthy foodacquisition

DesignHealthX
Anthropometry

1 The table summarizes published studies related to the interventions, obtained and retained through this literature review. Other articles related to the initiative (e.g., trial registration,formative research) may exist in the literature. 2 The table reports on the store-based, and participant, component of multi-sector interventions (i.e., intervention aspects related to othercommunity food environment settings) are not reported here. 3 Global economies are commonly categorized by country across four income groupings: low, lower-middle, upper-middle,
and high [185]. A country with a high-income economy is defined by the World Bank as a country with a gross national income per capita of USD 12,535 or more in 2019. Income ismeasured using gross national income (GNI) per capita, in U.S. dollars, converted from local currency using the World Bank Atlas method. 4 Countries: AU = Australia; CA = Canada;
NZ = New Zealand; US = United States; Geographic setting as self-defined in the article. If geographic setting was not stated in the study, the location of the intervention is included.
5 Number of comparison/control communities and/or stores is indicated in brackets. 6 Checkmark indicates inclusion of element in study intervention or evaluation. Intervention outcome
results are not reported in the table.

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4. Discussion
Indigenous Peoples consist globally of numerous and diverse communities with distinct andcomplex structures and histories of self-governance, dispossession, independence, and recognition vis
a vis settler states. As ascertained through results of both empirical and respondent-based approaches,
this review identifies several common retail food sector issues across Indigenous regions (and/or regionswith a high prepotency of Indigenous Peoples) in HICs. Importantly, this review also identifies
significant geographic, populational, methodological, conceptual, and temporal research gaps inknowledge (see Section 4.4). Thus, interpretation of this discussion must be situated within theconstraints of these deficits in the state of available scholarly evidence, as well as the study limitations(Section 4.4).
4.1. Retail/Consumer Food Environment/Supply Issues
At the food supply level, several common challenges are noted across regions—notably,
the high cost (in some contexts, several times higher than referent locations), poor quality(e.g., damaged and/or close to or exceeding their expiry date after arrival), and limited availability
and choices of healthful foods, compounded by the ready accessibility of less healthful and processed
options. Relatedly, at the store-level, retail food environments across these settings diverge in many
respects, from general conditions prevalent in HICs [29,37,186,187] but share features that mirror
aspects of both “food deserts” (e.g., absence of an accessible supermarket) and “food swamps”(e.g., increased exposure to convenience stores and stores replete with discretionary food items) [188].
Moreover, although this review did not focus on other community food environments, Indigenous
Peoples may also experience heightened exposure to other “unhealthy” food outlets, such as
fast-food restaurants [69]. Limited availability of supermarkets and grocery stores, compoundedby transportation related barriers to their access, and high exposure and dependence on, small andnontraditional food retailers—marked issues in rural and remote areas, although they also present
in urban centers [189]—is highlighted in several studies across global regions [190]. In this review,
associations between store type and food supply, and/or community health are documented in several
studies (Table 2). Less considered, however, is the impact of other vendor characteristics such as store
governance, industry codes of practice and marketing, and private/public interests in shaping store
operations, policies, and the resultant food supply [191,192]. Market forces (which drive factors such as
store locations, supply–demand dynamics, buying power) and private sector structures may constrain
the options available to local and Indigenous governments seeking to self-determine the quality andcharacteristics of their food environments. Although store managers can positively influence thenutritional quality of the food supply in remote communities [193], local store managers may not beable to set prices locally and may be beholden to corporate policies and retailing practices.
By severely constraining the available opportunities for healthful diets the retail food sector
may play a strong role in shaping dietary patterns and health—particularly in rural and remoteregions where individuals/households lack access to culturally valued traditional/subsistence foods.
Constraints in local food supplies are perceived by community members to represent major barriers
to food security, healthy food purchasing/eating, and health [57,89,116,123,145,194]. Although fooddeserts and food swamps have been associated with increased consumption of less healthful foods(e.g., snacks/desserts), and obesity [195,196] in the literature, most studies have been set in urban,
low-income areas, and have involved non-Indigenous minority populations [197]. Studies relating theretail food environment/supply to consumer health and health-related behaviors and psychosocial
factors, among Indigenous Peoples in HICs are few. Nevertheless, available evidence finds associations
with obesity [84,87] and food security status [85]. Furthermore, constraints in the retail food sector
are mirrored by the significant burdens of poor dietary quality, obesity and chronic disease, and foodinsecurity, documented in cross-sectional population health surveys—see for example [21,198,199].

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4.2. Common Structural Issues Across Regions
There exists today a wide diversity in the degree to which Indigenous communities exercise
self-governance over their land and territory, including the local food supply. Amid ongoingstruggles for Indigenous self-determination, several common factors persist across regions to
structure contemporary food environments. In particular, geography (rurality and remoteness [200]),
supply-chain logistics, inequitable market exchange, and settler colonialism, may create particularchallenges for contemporary retail food environments from a public health perspective. For example,
studies examining food supply in relation to indices of geographic remoteness find that foods typically
cost more, and the availability and quality of fresh produce is lower with increasing geographic
remoteness, as well as in the absence of all-weather roads [92,111,201]. Food retail systems in several
regions involve high dependence on distal food imports [64] and challenging supply chain logistics(e.g., transportation, infrastructure, cost) [56–58,60,111]. While these issues are recognized to affectretailing operations across remote Indigenous communities—from the Arctic to Australia, including thepotential for similar dynamics in the Pacific Islands—their impact on food supply and community
health remains limitedly examined in the literature. Despite successful examples in the literaturesof alternative food supply streams (e.g., direct exchanges between northern fishers and southern
farmers [148], bulk ordering for community [70,142], and sourcing food from local producers [161,202],
there are considerable challenges to practical implementation. Furthermore, there may be community
concern that such initiatives undermine more locally controlled food systems [148].
While the locality and cultural relevance of the food supply have seldom been assessed inquantitative and empirical research (see [119] for a notable exception), such topics feature inseveral qualitative studies involving community perspectives (Table 3). Indeed, qualitative studies
underscore the need to interrogate and address historical underpinnings of contemporary foodsystem issues. Settler colonialism, in particular, has been conceptualized as a form of domination
specifically targeting Indigenous food sovereignty, by undermining the reciprocal relationshipsthat uphold Indigenous self-determination and “collective continuance” [203]. For decades,
Indigenous Peoples have actively resisted the adverse impacts of colonialism, while emphasizing theright to self-directed cultural change and economic development [204–206]. Complex socioeconomic
dynamics characterize food systems in contemporary Indigenous communities, including themaintenance of Indigenous values, kinship ties/relationships, and cultural norms when integrating new
inputs (e.g., market-based/cash economies) [207,208]. Although in many HICs, Indigenous Peoples
exert varying forms of self-governance over defined regions, territories, or reservations, in manycases, Indigenous communities have neither consented to, nor benefited equitably from, developmentson their ancestral territories that have served to enrich contemporary settler colonial nation-states,
while compromising local food systems (e.g., contamination, wildlife decline) [209–211]. Furthermore,
as stated previously, some stores in Indigenous regions retain direct and indirect lineages to colonial
enterprises. There is limited examination in the public health literature of how such histories and theirenduring legacies have shaped contemporary food supplies, shopping experiences, and consumer
demand among Indigenous Peoples, although these themes feature strongly in the work of Indigenous
scholars and in other humanities scholarship–see for example [203,212,213].
4.3. Towards Equitable Food Systems
A spectrum of environmental interventions, policies, and priorities involving the retailsector—including actively stocking healthful low-cost food items, point-of-purchase promotions(e.g., nutrition labelling), economic tools (e.g., subsidies and taxes), and supply chaininterventions—have, in conjunction with approaches targeting behavioral and psychosocial dimensions(e.g., information campaigns, nutrition advice and counselling, education/skills development),
been reported in the literature for these contexts. In the general literature, store-based nutrition
environment interventions are identified as having less impact on point-of-purchase behavior thanthose set within other community food environments (e.g., worksites and schools) [214]. In this review,Int. J. Environ. Res. Public Health 2020, 17, 8818

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several multisector strategy/interventions involving store-based components have been associatedwith improvements in a range of psychosocial, behavioral, and nutrition-related health outcomesamong Indigenous People (Table 4). This divergence from general patterns in the literature mayunderscore the pronounced influence of the retail food environment in shaping community diets inthese contexts. Although a few intervention studies (set in Australia and NZ) suggest that food pricing
policies can improve population health and reduce inequalities [81,170,177,215] the effectiveness ofnational subsidies such as the Nutrition North Canada program, remains largely unassessed [74,216].
More fundamentally, supporting healthful and sustainable food systems for Indigenous Peoples in HICs
requires efforts predicated upon Indigenous (food and political) sovereignty and self-determination,
human rights (e.g., the recognition of food as a human right, and stores in remote communities as
essential services), and (health and social) equity.
For example, FN community members have suggested that improvements in the local foodenvironment may lie outside the model of capitalist exchange, which is perceived as a significant barrier
to affordable food [217,218]. With the understanding that the way remote community stores operate
and the quality of food they provide plays a strong role in shaping the diet and health of Indigenous
people [78], the provision of basic healthy food is considered to be a governmental responsibility
in Greenland. Meanwhile, remote community stores in Australia are community-owned andoperate as an “essential service”, rather than as privately held businesses [219,220]. These stores
generally fund long-term policies, such as fruit and vegetables discounts, although more recently
implemented policies have partly been funded by suppliers and manufacturers [151]. In Canada
and the United States, a more complex pattern of subsidized market mechanisms and government
food/social support exist [221]. In northern Canada and rural AI communities, where supermarkets
are rare, locally owned and operated co-operatives and convenience stores are an important foodsource [222]. Community ownership of retail food stores provides an opportunity to uniquely influence
the food supply and implement interventions/policies to support public health, in a manner that ispredicated upon community values [223,224]. Yet, limited resources have been allocated to build
capacity in a local community-based workforce dedicated to nutrition and food security in the retailand other food-related sectors in Indigenous community contexts.
Indigenous peoples globally are involved in efforts to decolonize diets [225,226] and affirm
the importance of Indigenous food systems and food sovereignty for various facets of health andwellbeing [203,205,206,212,213,227–229]. Food sovereignty efforts recognize that food is not simply amarket commodity, but also, a politically embedded process [228]. Accordingly, Indigenous movements
for food sovereignty undergird struggles for broader political sovereignty, Indigenous resistance andresurgence [212], as well as reconciliation, [148,228]. Although traditional food systems remain
fundamental to Indigenous food sovereignty, respondents in the few available studies to examine theissue, have expressed a preference for diets that involve both traditional and market foods [230–232].
Thus, improvements in the retail food sector may play a role in supporting enabling conditions for thesustained and improved health of Indigenous Peoples in HICs and initiatives to foster community foodsecurity and community health must consider overlapping social, economic, and environmental factors
and the complex interplay between subsistence and market-based food systems. Thus, research andpolicy aimed at improving the retail food sector requires population-specific modes of reference andconceptualization as well as approaches and tools, distinct from Western approaches, and predicatedupon Indigenous knowledge, priorities and worldviews, and respectful of Indigenous rights [43,44].
This includes, but is not limited to, integrating issues of accommodation (i.e., the capacity of the foodsector to accommodate and adapt to local needs) within the retail food sector [53].
4.4. Research Gaps, Methodological Considerations and Future Research
The findings from this review illustrate temporal, geographic, and topical gaps and areas ofconcentration in the published literature to date (Table 5). Despite widespread concern about thelack of healthful food availability and high food prices in Indigenous communities across several

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HICs, research about the retail food sector remains limited. Furthermore, although rural and remotecommunities are an important priority for health equity, there are also important gaps in urban andsemiurban settings. These results highlight the need to better understand the impact of the retailfood sector/environment on dietary choice and health, as well as in driving dietary change among
Indigenous Peoples [233]. They underscore, furthermore, the need to develop methods and tools toassess and better account for disparities in food environments within, and across, HICs. Building
upon the knowledge gaps identified, we propose several key recommendations for future research,monitoring, and interventions, involving the retail food sector and Indigenous Peoples in HICs.

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Table 5. Summary of research gaps and challenges and proposed research needs and/or future directions.
Dimension

Research Gaps and/or Challenge

Proposed Research Needs and/or Future Directions--

Most research was set in Australia, the United States,
Canada and New Zealand; few studies were available fromall other HICs-

Most research and interventions focus on issues within ageographically defined community—mostly in rural,
remote, and northern regions
Research involving Indigenous people in multi-ethnic andurban areas is limited and available research has
highlighted the challenges of generating a valid evidencebase by ethnic/social groups—notably challenges related to
the recruitment and retention ofunder-represented populations

Country

Geographic and populational setting

Temporal-Research approach and study design-

Most studies were observational, involving cross-sectional
designs and/or were conducted during a single time point,
making it impossible to ascertain differences across seasons
and/or over time

While most studies involved some level of community
engagement and participation, we did not systematicallyappraise or characterize Indigenous involvement inresearch in this review
There are few mixed and multi-method studies that include
both empirical observations of the retail sector andcommunity knowledge and perceptions thereof
While community conceptualizations of food sector issues
are often very broad (and include multiple overlapping
dimensions and various scales), empirical assessments
conducted in these settings are typically focused/ narrow(e.g., don’t take into consideration cultural context
and preferences)-

There is a need for studies examining the retail food sector
among Indigenous Peoples in several HICs(e.g., French Polynesia, Panama, etc.)
Through international collaboration, there is potential fordeveloping and implementing comprehensive, adapted,
and standardized tools, metrics, and frameworks forassessing and monitoring the retail food sector (and theimpact of interventions therein) at local, national, andinternational levels-

Indigenous Peoples living outside of tribal/reservation
lands, as well as landless tribes and Métis communities,
comprise an important fraction of the Indigenous
population in several HIC settings, and more research isneeded to understand their experiences and interactions
with the retail food sector-

Seasonal and longitudinal frameworks for assessing andmonitoring the retail food sector and interventions overtime and across contexts are needed-

Enhance reporting structures (as well as journal
expectations for reporting structures) for Indigenous
engagement in food-related research. Ideally,
research should meaningfully support community capacity
in research and the development of evidence-based policies
that responds to local priorities
Use qualitative and mixed/multimethod study designs(with a focus on Indigenous and decolonizing
methodologies) to better capture complex community foodissues. These study designs can play a key role in bridging
the gap between local priorities/needs, nutrition and healthassessments, food environment measures, andpolicies/interventions-

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Table 5. Cont.
Dimension

Research Gaps and/or Challenge-

Research tools

Domains of the food sector assessed-

Food items included

Most studies involved standardized or adapted tools (fewstudies developed research instruments expressly for the
local context). Although there is a wide range of foodenvironment assessment instruments reported in thegeneral literature, conventional methodologies can be
ill-suited to Indigenous community settings, and the degree
to which these measures are appropriate and relevant to
Indigenous community contexts remains under-assessed

Few studies have included multiple dimensions of the foodsupply, such as both food cost and quality, within theirassessments and or included mixed-methods or multiple
data sources (e.g., store audits, point-of-sale data, as welland dietary and health data)

Assessments of food environments often consider
exclusively the presence of healthful items (based on
checklists focusing on fruits, vegetables and other fresh andhealthful items). Items included in food supply assessments
are not necessarily representative of the complete store
inventory, nor are they necessarily representative ofcommunity food purchasing patterns. Pricing surveys, forexample, have often reported on food basket (or adaptedfood basket) costs, which include a limited subset ofavailable foods, typically exclude discretionary items, andare not representative of food consumption or expenditurepatterns. For example, although ultra-processed foods areprevalent in Indigenous Peoples diets [234], these havebeen limitedly examined in the retail environment literature

Proposed Research Needs and/or Future Directions-

There is a need for research instruments that areculturally-relevant, as well as valid and reliable for thesecontexts—in particular for small and nontraditional
retailers and rural and remote contexts where secondary
data sources both over- and under-represent such
community food environment-

Comprehensive assessments of multiple dimensions of thefood supply (e.g., cost, availability), including how theseinteract with consumer factors (e.g., affordability,
preferences, purchase), are needed. For example, theaffordability of a theoretical healthy diet compared to thecurrent diet (particularly when combined with detailed
income and expense information) can be used for social
policy planning and to advocate for fiscal policies(e.g., subsidies)
Data derived from multiple sources (e.g., till receipts andstore sales data and dietary information), particularly whenrepresenting different dimensions/levels of the food sector,
can be highly complementary in developing food andnutrition policies and initiatives, and in monitoringchanges in the food environment over time

-

-

-

Utilize a more holistic list of available items, including
those highly consumed (e.g., discretionary energy-dense
foods, prepared/convenience, processed foods), thosewhich represent a good nutritional value for price, andthose which are otherwise valued by community members(e.g., branded vs. generic products, foods that can be taken“on-the-land” during harvesting activities)
Other metrics of food availability, such as the amount ofretailer shelf-space allocated to healthful vs. discretionary
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Table 5. Cont.
Dimension

Research Gaps and/or Challenge

Proposed Research Needs and/or Future Directions-

Contextual factors

Few studies include contextual factors or drivers
influencing the local food environment and supply (e.g.,geography, logistics, store operation andmanagement practices)-

Equity informed methods

Few studies explicitly assess disparities in the foodenvironment/supply (e.g., between Indigenous
communities and other settings). There exist few (objective
and subjective) measures that capture the opportunities andconstraints to accessing food and health in these settings

HICs = High income countries.

Studies should include the impact of circumstantial
constraints (e.g., seasonal flooding/freezing and other
weather-related dynamics in food shipping), and othersocial and economic dynamics (e.g., income support cycles)on the food supply (both market and traditional foods andtheir interactions), purchasing (e.g., compensatory
purchasing), food security, and diet quality
As the logistics of food retailing will be affected by climatechange (e.g., shipping seasons) and related investments(e.g., new harbors in the Arctic), climate change should be
included as an important determinant of local foodsupplies, and, ultimately, health, within research, policies
and adaptation planning, involving the retail, and other,related sectors

Respond to the call to apply a health equity lens topopulation-level food environment policies [41] and bringhealth and social equity issues to the forefront of retail foodsector research. Such assessments may also be used tocompare food environments across settings and over time,to evaluate policy (e.g., compliance with Indigenous andgovernment food policies, guidelines, or voluntary codes ofpractice) and assess the impact of retail food environmentson health outcomesInt. J. Environ. Res. Public Health 2020, 17, 8818

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Ultimately, fostering learning across contexts and among different actors and stakeholders
in the food sector is needed, and may benefit from a global community of practice driven by
Indigenous-identified priorities, and centering Indigenous scholarship and scholars. Such an approach
must be predicated upon “relationships, reciprocity and self-determination” and advocating fordecolonizing research methodologies [44], sharing best practices, resources, and creating new
knowledge to advance evidence-based policy and practices [78].
4.5. Limitations
Several limitations of this study should be acknowledged. First, only peer-reviewed academic
literature was reviewed; gray literature was excluded. While reports from Indigenous organizations outsideacademia may have been captured with a search which included the latter (see for example, [235,236]),
the goal of this review was first to synthesize studies and findings in the published academic
literature. Relatedly, the literature search strategy was developed in English, and results were limited toEnglish-language articles. Thus, literature that was not indexed in English was excluded. The exclusionof papers for linguistic reasons can yield different study conclusions [237]. Second, although the searchterms were global in scope and were based on a systematic method to identify Indigenous Peoples,
we neither defined, nor identified, any additional populations/groups. Thus, Indigenous Peoples includedin the search strategy was based exclusively on the prior identification of such populations in the
databases and documents searched. Although we used general and specific search terms for Indigenous
population in the literature review, it is not feasible to comprehensively include terminology specific to
all Indigenous groups. In the U.S., for example, there are over 500 federally recognized tribal entities.
Furthermore, given the geographic scope, only two major academic databases were systematicallysearched. Thus, the search was not exhaustive and other relevant articles may not have been identified.
Third, this review was restricted to Indigenous Peoples in HICs, recognizing that Indigenous Peoples in
middle and upper-middle income countries (e.g., Mexico, Brazil, Russia) may experience similar retailfood sector issues and challenges. Similarly, other minority groups in HICs may share in experiences of
having distinct communities, languages, cultures, beliefs, social, economic, and political systems thanthe dominant society that could affect food security, health, and nutrition, through their experienceand interactions with the retail food sector [3]. There is still much to be learned about how to improve
the food environment for sociodemographic groups with above-average obesity risks [238]. Moreover,definitions of HIC are dynamic, as they may change with country economic status through time. Fourth,this review focused exclusively on the retail food sector (i.e., stores that sell food from the local and global
agri-food sector), which does not explicitly include other types of markets, such as farmer’s markets.
This definition also excluded formal or informal country food markets such as those in Greenland or
on social media advertising/selling food within, or between, communities [239,240]. Results from thisreview underscore the need to consider interacting dynamics among agricultural and wildlife harvesting
activities with local and regional markets, and the respective involvement and governance of Indigenous
Peoples and public governments in relevant policies and activities. They underscore furthermore the needto consider other forms of food provision (e.g., food supplied through government aid) and sourcing(e.g., food ordered over the internet), which circumvent local retail food stores. Fifth, this review did
not incorporate a gender-based lens/analysis. Gender dynamics are also important to understand,as Indigenous women may play a greater role than men in food purchasing [126]. Sixth, based on theobjectives and scope of this review (i.e., to synthesize knowledge to inform future research, as opposed toanswering a specific question), and as is customary with scoping review methodologies, articles were notassessed for methodological or data quality [51]. Nevertheless, not all studies involved statistical analyses,
and intervention studies may not have adjusted results for relevant covariates, which can significantly
impact study conclusions [197]. Although we categorized articles based on the involvement of Indigenous
Peoples in the research, we did so broadly, and did not distinguish based on the level of engagement andparticipation. Indicators exist for systematically appraising and scaling levels of Indigenous community
engagement in research [241]. Their incorporation in future knowledge syntheses and original research

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studies may support a foundation for more reflexive and responsible research practice with Indigenous
communities. Finally, this review employed an inductive and deductive thematic classification scheme,
and accordingly, the major themes presented may have been biased towards those reported in existing
conceptual frameworks and literature derived principally from non-Indigenous contexts. There is a needfor Indigenous-specific frameworks of local food systems (see for example [227,242,243]) to inform future
research and knowledge syntheses on this topic.
5. Conclusions
Food environments that support equitable access to healthy diets (with varying contributions ofmarket, and traditional foods—based on local preferences and other factors) are requisite to overcoming
the systemic disparities in diet quality, food security, and diet-related health conditions experienced
by Indigenous Peoples, especially in remote community contexts [8]. Efforts to support Indigenous
population health in HICs must emphasize the urgent need for adequate food environments andrecognize underlying structural challenges. Unless inadequacies and inequities in the market foodsector are addressed, expensive poor quality food supplies, and food globalization, will continue
to constrain access to healthy diets for Indigenous Peoples in HICs [244]. This review provides abaseline for future syntheses and may help movement towards more global collaborations on thesematters. It emphasizes the need for a greater understanding of the key structural factors contributing
to food supply issues (namely, interacting logistic, economic, governance, and policy factors) to informthe development of effective policies and interventions, as well as barriers to, and opportunities for,building more healthy, affordable, and culturally appropriate food systems. Results from the literature
also confirm that food supply monitoring can be used strategically to advocate, lobby, and build local
capacity towards health equity. Nevertheless, research on these issues must, be sensitive to enduring
disparities in power and participation of Indigenous Peoples in matters that concern their local foodsystems (despite considerable advances in Indigenous self-governance in some regions). More work
is also needed to better understand factors contributing to inadequacies in food supply and theirmultidimensional impacts on health and wellbeing in order to inform effective policy development at
multiple scales.
Food stores in Indigenous communities, and indeed the retail food sector more generally, have thepotential to play a more positive and supportive role in health promotion. There is a need to understandhow profit- and health-driven models of food retailing can mutually satisfy health, socio-cultural,and economic objectives. There also remain important questions regarding the opportunities andconstraints for communities to influence their own retail food system and thereby exercise foodsovereignty in the retail sector. Local decision-making is a key dimension of enabling community
members to shape the qualities and characteristics of their local food environment and critical forfood system improvement. Improving the retail food sector necessitates horizontal and verticalcollaborative actions involving coordination with traditional food systems, between Indigenous andother governments, the private sector, and other actors at various scales. Factors such as community
ownership are central to culturally appropriate policy and program development and implementationand may also support Indigenous self-determination. This also will ultimately require efforts predicatedupon Indigenous cultural, economic and political resurgence, dietary decolonization, and Indigenous
food sovereignty. Of course, focusing exclusively on the retail sector could not be sufficient on its own
to heal the continued disruptions to Indigenous ecologies and foodways, driven by the histories ofcolonial expansion, the persistence of neo-colonial architecture in the nation-state, and the persistentand accelerating economic inequalities produced and upheld by the capitalist world system and with
its logics of exchange and accumulation. However, closing the gap on all forms of inequalities, income,structural, or otherwise, may yet contribute to overall improvements in population health.

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Supplementary Materials: The following are available online at http://www.mdpi.com/1660-4601/17/23/8818/s1,
Figure S1: Process of identifying Indigenous Peoples in high income countries, Table S1: Identification ofIndigenous Peoples in high income countries, Table S2: PRISMA-ScR Checklist, Table S3: Literature search themes
and combinations of search terms, Table S4: Literature search strategy and results, Table S5: Eligibility criteria forscreening, Table S6: Data charting scheme, Table S7: Key characteristics of the articles included in the review.
Author Contributions: Conceptualization, T.-A.K., M.L. (Matthew Little), and S.D.W.; investigation, T.-A.K.
and T.L.; methodology, T.-A.K. and M.L. (Matthew Little); validation, T.L.; formal analysis, T.-A.K.; data curation,
T.-A.K.; writing—original draft preparation, T.-A.K.; writing—review and editing, M.L. (Matthew Little), T.L.,
P.J.G., Y.O., M.B., H.M.C., and M.L. (Melanie Lemire); supervision, M.L. (Melanie Lemire). All authors have readand agreed to the published version of the manuscript.
Funding: This research received no external funding.
Acknowledgments: T.-A.K. is supported by a Canadian Institute of Health Research (CIHR) Banting postdoctoral
fellowship. Y.O. is supported by Nippon Foundation Ocean Nexus Center at UW EarthLab. M.L. (Melanie Lemire)is supported by a Junior 2 salary fellowship from the Fonds de recherche du Québec—Santé (FRQS) and is titularof the Littoral Research Chair—The Sentinel North partnership Research Chair in Ecosystem Approaches to
Health, primarily funded by Sentinel North (Apogee Canada) and the Northern Contaminant Program of the
Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC). M.B. and H.M.C. are supported by the
Canada Research Chair program.
Conflicts of Interest: The authors declare no conflict of interest.

References
1.
2.

3.
4.

5.

6.
7.
8.
9.
10.

11.
12.
13.

14.

World Bank Indigenous Peoples Overview.
Available online: https://www.worldbank.org/en/topic/
indigenouspeoples (accessed on 4 October 2020).
Kuhnlein, H.V.; Erasmus, B.; Spigelski, D. Indigenous Peoples’ Food Systems: The Many Dimensions of Culture,
Diversity and Environment for Nutrition and Health; Food and Agriculture Organization of the United Nations,
Centre for Indigenous Peoples’ Nutrition and Environment: Rome, Italy, 2009; ISBN 9789251060711.
UNPFII Indigenous Peoples, Indigenous Voices. Fact Sheet. Who are Indigenous Peoples? Available online:
https://www.un.org/esa/socdev/unpfii/documents/5session_factsheet1.pdf (accessed on 25 May 2020).
APF; OHCHR. The United Nations Declaration on the Rights of Indigenous Peoples: A Manual for National
Human Rights Institutions; Asia Pacific Forum of National Human Rights Institutions and the Office of theUnited Nations High Commissioner for Human Rights: Sydney, Australia; Geneva, Switzerland, 2013;
pp. 1–152.
Osborn, D.; Cutter, A.; Ullah, F. Universal Sustainable Development Goals: Understanding theTransformational Challenge for Developed Countries. Available online: https://sustainabledevelopment.un.
org/content/documents/1684SF_-_SDG_Universality_Report_-_May_2015.pdf (accessed on 5 January 2020).
Reading, C.L.; Wien, F. Health Inequalities and the Social Determinants of Aboriginal Peoples’ Health; National
Collaborating Centre for Aboriginal Health: Prince George, BC, Canada, 2009.
Vos, T.; Barker, B.; Begg, S.; Stanley, L.; Lopez, A.D. Burden of disease and injury in Aboriginal and Torres
Strait Islander Peoples: The Indigenous health gap. Int. J. Epidemiol. 2009, 38, 470–477. [CrossRef] [PubMed]
Browne, J.; Hayes, R.; Gleeson, D. Aboriginal health policy: Is nutrition the ‘gap’ in ‘Closing the Gap’?
Aust. N. Zeal. J. Public Health 2014, 38, 362–369. [CrossRef] [PubMed]
Council of Canadian Academies. Aboriginal Food Security in Northern Canada: An Assessment of the Stateof Knowledge; Council of Canadian Academies: Ottawa, ON, Canada, 2014; p. 290.
Jernigan, V.B.B.; Huyser, K.R.; Valdes, J.; Simonds, V.W. Food Insecurity Among American Indians and Alaska
Natives: A National Profile Using the Current Population Survey–Food Security Supplement. J. Hunger.
Environ. Nutr. 2016, 12, 1–10. [CrossRef] [PubMed]
Paradies, Y. Colonisation, racism and indigenous health. J. Popul. Res. 2016, 33, 83–96. [CrossRef]
Albala, C.; Vio, F.; Kain, J.; Uauy, R. Nutrition transition in Chile: Determinants and consequences.
Public Health Nutr. 2002, 5, 123–128. [CrossRef] [PubMed]
Lourenço, A.E.P.; Santos, R.V.; Orellana, J.D.Y.; Coimbra, C.E.A., Jr. Nutrition transition in Amazonia:
Obesity and socioeconomic change in the Suruí Indians from Brazil. Am. J. Hum. Biol. 2008, 20, 564–571.
[CrossRef] [PubMed]
Hughes, R.G.; Lawrence, M. Globalisation, food and health in Pacific Island countries. Asia Pac. J. Clin. Nutr.
2005, 14, 298–305. [PubMed]

Int. J. Environ. Res. Public Health 2020, 17, 8818

15.
16.

17.

18.
19.
20.

21.
22.
23.
24.
25.

26.
27.
28.
29.
30.
31.

32.
33.
34.
35.
36.
37.

38.

38 of 49

Whiting, S.J.; MacKenzie, M.L. Assessing the changing diet of indigenous peoples. Nutr. Rev. 1998,
56, 248–250. [CrossRef] [PubMed]
Kenny, T.-A.; Hu, X.F.; Kuhnlein, H.V.; Wesche, S.; Chan, H.M. Dietary sources of energy and nutrients in thecontemporary diet of Inuit adults: Results from the 2007–08 Inuit Health Survey. Public Health Nutr. 2018,21, 1319–1331. [CrossRef]
Ferguson, M.; Brown, C.; Georga, C.; Miles, E.; Wilson, A.; Brimblecombe, J. Traditional food availability
and consumption in remote Aboriginal communities in the Northern Territory, Australia. Aust. N. Zeal. J.
Public Health 2017, 25, 585. [CrossRef] [PubMed]
Neitzel, A.L.; Smalls, B.L.; Walker, R.J.; Dawson, A.Z.; Campbell, J.A.; Egede, L.E. Examination of dietary
habits among the indigenous Kuna Indians of Panama. Nutr. J. 2019, 18, 1–8. [CrossRef] [PubMed]
Brimblecombe, J.; Ferguson, M.; Liberato, S.C.; O’Dea, K.; Riley, M. Optimisation Modelling to Assess Costof Dietary Improvement in Remote Aboriginal Australia. PLoS ONE 2013, 8, e83587. [CrossRef] [PubMed]
Rosol, R.; Huet, C.; Wood, M.; Lennie, C.; Osborne, G.; Egeland, G.M. Prevalence of affirmative responses toquestions of food insecurity: International Polar Year Inuit Health Survey, 2007–2008. Int. J. Circumpolar Health2011, 70, 488–497. [CrossRef] [PubMed]
Huet, C.; Rosol, R.; Egeland, G.M. The Prevalence of Food Insecurity Is High and the Diet Quality Poor in
Inuit Communities. J. Nutr. 2012, 142, 541–547. [CrossRef]
Pollard, C.M.; Nyaradi, A.; Lester, M.; Sauer, K. Understanding food security issues in remote Western
Australian Indigenous communities. Health Promot. J. Aust. 2014, 25, 83–89. [CrossRef]
Brimblecombe, J.; Ferguson, M.M.; Liberato, S.C.; O’Dea, K. Characteristics of the community-level diet of
Aboriginal people in remote northern Australia. Med. J. Aust. 2013, 198, 380–384. [CrossRef]
Kuhnlein, H.V.; Receveur, O.; Soueida, R.; Berti, P.R. Unique patterns of dietary adequacy in three cultures ofCanadian Arctic indigenous peoples. Public Health Nutr. 2007, 11, 349–360. [CrossRef]
Pakseresht, M.; Lang, R.; Rittmueller, S.; Roache, C.; Sheehy, T.; Batal, M.; Corriveau, A.; Sharma, S. Food
expenditure patterns in the Canadian Arctic show cause for concern for obesity and chronic disease. Int. J.
Behav. Nutr. Phys. Act. 2014, 11, 51. [CrossRef]
Kenny, T.-A.; Fillion, M.; MacLean, J.; Wesche, S.D.; Chan, H.M. Calories are cheap, nutrients are
expensive—The challenge of healthy living in Arctic communities. Food Policy 2018, 80, 39–54. [CrossRef]
CIA. The World Factbook; CIA: Langley, VA, USA, 2020.
The Northwest Company. Our Community Promise. Available online: https://www.northwest.ca/about-us/
company-profile (accessed on 5 January 2020).
Caspi, C.E.; Sorensen, G.; Subramanian, S.; Kawachi, I. The local food environment and diet: A systematic
review. Health Place 2012, 18, 1172–1187. [CrossRef]
Morland, K.B.; Evenson, K.R. Obesity prevalence and the local food environment. Health Place 2009,
15, 491–495. [CrossRef] [PubMed]
Caspi, C.E.; Lenk, K.; Pelletier, J.E.; Barnes, T.L.; Harnack, L.; Erickson, D.J.; Laska, M.N. Association between
store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar
stores. Int. J. Behav. Nutr. Phys. Act. 2017, 14, 1–11. [CrossRef] [PubMed]
Freedman, D.A. Local Food Environments: They’re All Stocked Differently. Am. J. Community Psychol. 2009,
44, 382–393. [CrossRef] [PubMed]
Drewnowski, A. Nutrient density: Addressing the challenge of obesity. Br. J. Nutr. 2017, 120, S8–S14. [CrossRef]
Drewnowski, A.; Darmon, N. The economics of obesity: Dietary energy density and energy cost. Am. J.
Clin. Nutr. 2005, 82, 265S–273S. [CrossRef]
Drewnowski, A.; Specter, S.E. Poverty and obesity: The role of energy density and energy costs. Am. J.
Clin. Nutr. 2004, 79, 6–16. [CrossRef]
Pulker, C.E.; Thornton, L.E.; Trapp, G. What is known about consumer nutrition environments in Australia?
A scoping review of the literature. Obes. Sci. Pr. 2018, 4, 318–337. [CrossRef]
Ni Mhurchu, C.; Vandevijvere, S.; Waterlander, W.; Thornton, L.E.; Kelly, B.; Cameron, A.J.;
Snowdon, W.; Swinburn, B.; INFORMAS. Monitoring the availability of healthy and unhealthy foods
and non-alcoholic beverages in community and consumer retail food environments globally. Obes. Rev. 2013,
14, 108–119. [CrossRef]
Turner, C.; Kalamatianou, S.; Drewnowski, A.; Kulkarni, B.; Kinra, S.; Kadiyala, S. Food Environment Researchin Low- and Middle-Income Countries: A Systematic Scoping Review. Adv. Nutr. 2019, 18, 93. [CrossRef]

Int. J. Environ. Res. Public Health 2020, 17, 8818

39.

40.
41.

42.
43.
44.

45.
46.
47.
48.
49.

50.
51.
52.

53.
54.
55.

56.

57.
58.

59.

39 of 49

Turner, C.; Aggarwal, A.; Walls, H.; Herforth, A.; Drewnowski, A.; Coates, J.; Kalamatianou, S.; Kadiyala, S.
Concepts and critical perspectives for food environment research: A global framework with implications foraction in low- and middle-income countries. Glob. Food Secur. 2018, 18, 93–101. [CrossRef]
Olstad, D.L.; Campbell, N.R.; Raine, K.D. Diet quality in Canada: Policy solutions for equity. Can. Med.
Assoc. J. 2019, 191, E100–E102. [CrossRef] [PubMed]
Lana, V.; Guest, E.; Dana, L.O.; Vanderlee, L.; Olstad, D.L. Commentary—Food environment and vulnerable
populations: Challenges and opportunities for policy. Health Promot. Chronic Dis. Prev. Can. 2018, 37,
321–322. [CrossRef]
Pollard, C.M.; Begley, A.; Landrigan, T.J. The Rise of Food Inequality in Australia. Food Poverty Insecurity Int.
Food Inequal. 2015, 38, 89–103. [CrossRef]
HLPE. Nutrition and Food Systems; A Report by the High Level Panel of Experts on Food Security andNutrition of the Committee on World Food Security (HLPE); HLPE: Rome, Italy, 2017.
Luongo, G.; Skinner, K.; Phillipps, B.; Yu, Z.; Martin, D.H.; Mah, C.L. The Retail Food Environment,
Store Foods, and Diet and Health among Indigenous Populations: A Scoping Review. Curr. Obes. Rep. 2020,
374, 1–19. [CrossRef]
Browne, J.; Lock, M.; Walker, T.; Egan, M.; Backholer, K. Effects of food policy actions on Indigenous Peoples’
nutrition-related outcomes: A systematic review. BMJ Glob. Health 2020, 5, e002442. [CrossRef]
Cisneros-Montemayor, A.M.; Pauly, D.; Weatherdon, L.V.; Ota, Y. A Global Estimate of Seafood Consumption
by Coastal Indigenous Peoples. PLoS ONE 2016, 11, e0166681. [CrossRef]
Litvinoff, M.P.T.; Anderson, B. World Directory of Minorities and Indigenous Peoples. Available online: https://www.emerald.com/insight/content/doi/10.1108/RR-12-2015-0298/full/html (accessed on 11 March 2019).
eHRAF World Cultures.
Available online: https://ehrafworldcultures.yale.edu/ehrafe/ (accessed on
1 October 2019).
Anderson, I.; Robson, B.; Connolly, M.; Al-Yaman, F.; Bjertness, E.; King, A.; Tynan, M.; Madden, R.;
Bang, A.; Coimbra, C.E.A.; et al. Indigenous and tribal peoples’ health (The Lancet–Lowitja Institute Global
Collaboration): A population study. Lancet 2016, 388, 131–157. [CrossRef]
Grant, M.J.; Booth, A. A typology of reviews: An analysis of 14 review types and associated methodologies.
Health Inf. Libr. J. 2009, 26, 91–108. [CrossRef]Peters, M.D.; Godfrey, C.M.; Khalil, H.; McInerney, P.; Parker, D.; Soares, C.B. Guidance for conducting
systematic scoping reviews. Int. J. Evid. Based Health 2015, 13, 141–146. [CrossRef]
Shamseer, L.; Moher, D.; Clarke, M.; Ghersi, D.; Liberati, A.; Petticrew, M.; Shekelle, P.; Stewart, L.A.
Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaborationand explanation. BMJ 2015, 350, g7647. [CrossRef]
Penchansky, R.; Thomas, J.W. The concept of access: Definition and relationship to consumer satisfaction.
Med. Care 1981, 19, 127–140. [CrossRef] [PubMed]
Glanz, K.; Sallis, J.F.; Saelens, B.E.; Frank, L.D. Healthy Nutrition Environments: Concepts and Measures.
Am. J. Health Promot. 2005, 19, 330–333. [CrossRef] [PubMed]
Goldhar, C.; Ford, J.D.; Berrang-Ford, L. Prevalence of food insecurity in a Greenlandic community and theimportance of social, economic and environmental stressors. Int. J. Circumpolar Health 2012, 69, 285–303.
[CrossRef] [PubMed]
Watson, Z.A.; Shanks, C.B.; Miles, M.P.; Rink, E. The Grocery Store Food Environment in Northern
Greenland and Its Implications for the Health of Reproductive Age Women. J. Community Health 2018,
43, 175–185. [CrossRef]
Mead, E.; Gittelsohn, J.; Kratzmann, M.; Roache, C.; Sharma, S. Impact of the changing food environment on
dietary practices of an Inuit population in Arctic Canada. J. Hum. Nutr. Diet. 2010, 23, 18–26. [CrossRef]
Piltch, E.M.; Shin, S.S.; Houser, R.F.; Griffin, T. The complexities of selling fruits and vegetables in remote
Navajo Nation retail outlets: Perspectives from owners and managers of small stores. Public Health Nutr.
2020, 23, 1638–1646. [CrossRef]
Brown, M.C.; Shrestha, U.; Huber, C.; Best, L.G.; O’Leary, M.; Howard, B.; Beresford, S.; Fretts, A.M.
Characterizing the local food environment and grocery-store decision making among a large American
Indian community in the north-central USA: Qualitative results from the Healthy Foods Healthy Families
Feasibility Study. Public Health Nutr. 2019, 22, 2653–2661. [CrossRef]

Int. J. Environ. Res. Public Health 2020, 17, 8818

60.
61.

62.

63.

64.
65.

66.

67.

68.

69.

70.
71.

72.

73.
74.
75.

76.

77.
78.

40 of 49

Ford, J.D.; Beaumier, M. Feeding the family during times of stress: Experience and determinants of foodinsecurity in an Inuit community. Geogr. J. 2011, 177, 44–61. [CrossRef]
Jernigan, V.B.B.; Salvatore, A.L.; Williams, M.; Wetherill, M.; Taniguchi, T.; Jacob, T.; Cannady, T.;
Grammar, M.; Standridge, J.; Fox, J.; et al. A Healthy Retail Intervention in Native American Convenience
Stores: The THRIVE Community-Based Participatory Research Study. Am. J. Public Health 2019,109, 132–139. [CrossRef]
Parker, B.; Burnett, K.; Hay, T.; Skinner, K. The Community Food Environment and Food Insecurity inSioux Lookout, Ontario: Understanding the Relationships between Food, Health, and Place. J. Hunger.
Environ. Nutr. 2018, 14, 762–779. [CrossRef]
Jernigan, V.B.B.; Salvatore, A.L.; Styne, D.M.; Winkleby, M. Addressing food insecurity in a Native
American reservation using community-based participatory research. Health Educ. Res. 2012, 27, 645–655.
[CrossRef] [PubMed]
Snowdon, W.; Raj, A.; Reeve, E.; Guerrero, R.L.; Fesaitu, J.; Cateine, K.; Guignet, C. Processed foods available
in the Pacific Islands. Glob. Health 2013, 9, 53. [CrossRef] [PubMed]
Chodur, G.M.; Shen, Y.; Kodish, S.; Oddo, V.M.; Antiporta, D.A.; Jock, B.; Jones-Smith, J.C. Food Environments
around American Indian Reservations: A Mixed Methods Study. PLoS ONE 2016, 11, e0161132.
[CrossRef] [PubMed]
Burnett, K.; Skinner, K.; Hay, T.; Leblanc, J.; Chambers, L. Retail food environments, shopping experiences,
First Nations and the provincial Norths. Health Promot. Chronic Dis. Prev. Can. 2017, 37, 333–341.
[CrossRef] [PubMed]
DyckFehderau, D.; Holt, N.; Ball, G.D.; Willows, N.D. Feasibility study of asset mapping withchildren: Identifying how the community environment shapes activity and food choices in AlexanderFirst Nation. Rural. Remote. Health 2013, 13, 2289. [PubMed]
Fleischhacker, S.E.; Rodriguez, D.A.; Evenson, K.R.; Henley, A.C.; Gizlice, Z.; Soto, D.; Ramachandran, G.
Evidence for validity of five secondary data sources for enumerating retail food outlets in seven American
Indian Communities in North Carolina. Int. J. Behav. Nutr. Phys. Act. 2012, 9, 137. [CrossRef]
Smoyer-Tomic, K.E.; Spence, J.C.; Raine, K.D.; Amrhein, C.; Cameron, N.; Yasenovskiy, V.; Cutumisu, N.;
Hemphill, E.; Healy, J. The association between neighborhood socioeconomic status and exposure tosupermarkets and fast food outlets. Health Place 2008, 14, 740–754. [CrossRef]
Sumner, J.; Tarhan, M.D.; McMurtry, J.J. Eating in Place: Mapping Alternative Food Procurement in CanadianIndigenous Communities. J. Agric. Food Syst. Community Dev. 2019, 9, 239–250. [CrossRef]
Kumar, G.; Jim-Martin, S.; Piltch, E.; Onufrak, S.J.; McNeil, C.; Adams, L.N.; Williams, N.I.; Blanck, H.M.;
Curley, L. Healthful Nutrition of Foods in Navajo Nation Stores. Am. J. Health Promot. 2016,
30, 501–510. [CrossRef]
Matanane, L.; Fialkowski, M.K.; Silva, J.; Li, F.; Nigg, C.; Guerrero, R.T.L.; Novotny, R. Para I
Famagu’on-Ta: Fruit and Vegetable Intake, Food Store Environment, and Childhood Overweight/Obesity in
the Children’s Healthy Living Program on Guam. Hawai’i J. Med. Public Health J. Asia Pac. Med. Public Health2017, 76, 225–233.
O’Connell, M.; Buchwald, D.S.; Duncan, G.E. Food Access and Cost in American Indian Communities in
Washington State. J. Am. Diet. Assoc. 2011, 111, 1375–1379. [CrossRef] [PubMed]
Galloway, T. Canada’s northern food subsidy Nutrition North Canada: A comprehensive program evaluation.
Int. J. Circumpolar Health 2017, 76, 1279451. [CrossRef] [PubMed]
Thompson, S.; Kamal, A.G.; Alam, M.A.; Wiebe, J. Community Development to Feed the Family in Northern
Manitoba Communities: Evaluating Food Activities based on Their Food Sovereignty, Food Security, andSustainable Livelihood Outcomes. Can. J. Nonprofit Soc. Econ. Res. 2012, 3, 43. [CrossRef]
Brimblecombe, J.; Bailie, R.; Boogaard, C.V.D.; Wood, B.; Liberato, S.; Ferguson, M.; Coveney, J.; Jaenke, R.;
Ritchie, J. Feasibility of a novel participatory multi-sector continuous improvement approach to enhancefood security in remote Indigenous Australian communities. SSM—Popul. Health 2017, 3, 566–576.
[CrossRef] [PubMed]
Jackson, S.L. Sodium in Store and Restaurant Food Environments—Guam, 2015. MMWR. Morb. Mortal.
Wkly. Rep. 2016, 65, 510–513. [CrossRef] [PubMed]
Holden, S.; Ferguson, M.; Brimblecombe, J.; Palermo, C. Can a community of practice equip public healthnutritionists to work with remote retail to improve the food supply? Rural. Remote Health 2015, 15, 1–11.

Int. J. Environ. Res. Public Health 2020, 17, 8818

79.

80.

81.

82.

83.

84.

85.

86.

87.
88.

89.

90.
91.

92.

93.

94.

95.
96.

41 of 49

Rowley, K.G.; Su, Q.; Cincotta, M.; Skinner, M.; Skinner, K.; Pindan, B.; White, G.A.; O’Dea, K. Improvements
in circulating cholesterol, antioxidants, and homocysteine after dietary intervention in an Australian
Aboriginal community. Am. J. Clin. Nutr. 2001, 74, 442–448. [CrossRef] [PubMed]
Davis, S.M.; Sanders, S.G.; Fitzgerald, C.A.; Keane, P.C.; Canaca, G.F.; Volker-Rector, R.
CHILE: An evidence-based preschool intervention for obesity prevention in Head Start. J. Sch. Health 2013,83, 223–229. [CrossRef]
Brimblecombe, J.; Ferguson, M.M.; Chatfield, M.M.D.; Liberato, S.C.; Gunther, A.; Ball, K.; Moodie, D.P.M.;
Miles, E.; Magnus, P.A.; Ni Mhurchu, C.; et al. Effect of a price discount and consumer education strategy onfood and beverage purchases in remote Indigenous Australia: A stepped-wedge randomised controlled trial.
Lancet Public Health 2017, 2, e82–e95. [CrossRef]
Lundeen, E.A.; VanFrank, B.K.; Jackson, S.L.; Harmon, B.; Uncangco, A.; Luces, P.; Dooyema, C.; Park, S.
Availability and Promotion of Healthful Foods in Stores and Restaurants—Guam, 2015. Prev. Chronic Dis.
2017, 14, E56. [CrossRef]
Fretts, A.M.; Huber, C.; Best, L.G.; O’Leary, M.; Lebeau, L.; Howard, B.V.; Siscovick, D.S.;
Beresford, S.A. Availability and Cost of Healthy Foods in a Large American Indian Community in the
North-Central United States. Prev. Chronic Dis. 2018, 15, E03. [CrossRef]
Love, C.V.; Taniguchi, T.E.; Williams, M.B.; Noonan, C.J.; Wetherill, M.S.; Salvatore, A.L.; Jacob, T.;
Cannady, T.K.; Standridge, J.; Spiegel, J.; et al. Diabetes and Obesity Associated with Poor Food Environments
in American Indian communities: The THRIVE study. Curr. Dev. Nutr. 2019. [CrossRef]
Mullany, B.; Neault, N.; Tsingine, D.; Powers, J.; Lovato, V.; Clitso, L.; Massey, S.; Talgo, A.; Speakman, K.;
Barlow, A. Food insecurity and household eating patterns among vulnerable American-Indian families:
Associations with caregiver and food consumption characteristics. Public Health Nutr. 2013, 16, 752–760.
[CrossRef] [PubMed]
Bauer, K.W.; Widome, R.; Himes, J.H.; Smyth, M.; Rock, B.H.; Hannan, P.J.; Story, M. High Food Insecurity
and Its Correlates Among Families Living on a Rural American Indian Reservation. Am. J. Public Health2012, 102, 1346–1352. [CrossRef] [PubMed]
Jani, R.; Rush, E.; Crook, N.; Simmons, D. Availability and price of healthier food choices and association
with obesity prevalence in New Zealand Māori. Asia Pac. J. Clin. Nutr. 2018, 27, 1357–1365. [PubMed]
Cunningham-Sabo, L.; Bauer, M.; Pareo, S.; Phillips-Benally, S.; Roanhorse, J.; Garcia, L. Qualitative Investigationof Factors Contributing to Effective Nutrition Education for Navajo Families. Matern. Child. Health J. 2008, 12,
68–75. [CrossRef]
Eyles, H.; Ni Mhurchu, C.; Wharemate, L.; Funaki-Tahifote, M.; Lanumata, T.; Rodgers, A. Developing nutrition
education resources for a multi-ethnic population in New Zealand. Health Educ. Res. 2009, 24, 558–574.
[CrossRef] [PubMed]
Verrall, T.; Napash, L.; Leclerc, L.; Mercure, S.; Gray-Donald, K. Community-based communication strategies
to promote infant iron nutrition in northern Canada. Int. J. Circumpolar Health 2006, 65, 65–78. [CrossRef]
Lee, A.; Darcy, A.M.; Leonard, D.; Groos, A.D.; Stubbs, C.O.; Lowson, S.K.; Dunn, S.M.; Coyne, T.; Riley, M.D.
Food availability, cost disparity and improvement in relation to accessibility and remoteness in Queensland.
Aust. N. Zeal. J. Public Health 2002, 26, 266–272. [CrossRef]
Wendimu, M.A.; Desmarais, A.A.; Martens, T.R. Access and affordability of “healthy” foods in northern
Manitoba? The need for Indigenous food sovereignty. Can. Food Stud./La Revue Can. des Études sur
L’alimentation 2018, 5, 44–72. [CrossRef]
Johnson, J.S.; Nobmann, E.D.; Asay, E. Factors related to fruit, vegetable and traditional food consumption
which may affect health among Alaska Native People in Western Alaska. Int. J. Circumpolar Health 2012, 71,17345. [CrossRef] [PubMed]
Wetherill, M.S.; Williams, M.B.; Taniguchi, T.; Salvatore, A.L.; Jacob, T.; Cannady, T.; Grammar, M.;
Standridge, J.; Fox, J.; Spiegel, J.; et al. A Nutrition Environment Measure to Assess Tribal Convenience
Stores: The THRIVE Study. Health Promot. Pr. 2020, 21, 410–420. [CrossRef] [PubMed]
Lambden, J.; Receveur, O.; Marshall, J.; Kuhnlein, H.V. Traditional and market food access in Arctic Canada
is affected by economic factors. Int. J. Circumpolar Health 2006, 65, 331–340. [CrossRef] [PubMed]
Bhawra, J.; Cooke, M.J.; Hanning, R.M.; Wilk, P.; Gonneville, S.L.H. Community perspectives on foodinsecurity and obesity: Focus groups with caregivers of Métis and Off-reserve First Nations children. Int. J.
Equity Health 2015, 14, 1–10. [CrossRef]

Int. J. Environ. Res. Public Health 2020, 17, 8818

97.

42 of 49

Jahns, L.; McDonald, L.; Wadsworth, A.; Morin, C.; Liu, Y.; Nicklas, T. Barriers and facilitators to following
the Dietary Guidelines for Americans reported by rural, Northern Plains American-Indian children.
Public Health Nutr. 2015, 18, 482–489. [CrossRef] [PubMed]
98. Joseph, P.; Davis, A.D.; Miller, R.; Hill, K.; McCarthy, H.; Banerjee, A.; Chow, C.K.; Mente, A.; Anand, S.S.
Contextual determinants of health behaviours in an aboriginal community in Canada: Pilot project.
BMC Public Health 2012, 12, 952. [CrossRef] [PubMed]
99. Schiff, R.; Brunger, F. Northern Food Networks: Building Collaborative Efforts for Food Security in Remote
Canadian Aboriginal Communities. J. Agric. Food Syst. Community Dev. 2013, 121–138. [CrossRef]
100. McCarthy, L.; Chang, A.B.; Brimblecombe, J. Food Security Experiences of Aboriginal and Torres Strait
Islander Families with Young Children in An Urban Setting: Influencing Factors and Coping Strategies.
Int. J. Environ. Res. Public Health 2018, 15, 2649. [CrossRef]
101. Brimblecombe, J.K.; O’Dea, K. The role of energy cost in food choices for an Aboriginal population innorthern Australia. Med. J. Aust. 2009, 190, 549–551. [CrossRef]
102. Ferguson, M.; O’Dea, K.; Chatfield, M.; Moodie, M.; Altman, J.; Brimblecombe, J. The comparative costof food and beverages at remote Indigenous communities, Northern Territory, Australia. Aust. N. Zeal. J.
Public Health 2016, 40, S21–S26. [CrossRef]
103. Campbell, M.L.; Diamant, R.M.F.; MacPherson, B.D.; Halladay, J.L. The Contemporary Food Supply of Three
Northern Manitoba Cree Communities. Can. J. Public Health 1997, 88, 105–108. [CrossRef] [PubMed]
104. Mackay, S.; Buch, T.; Vandevijvere, S.; Goodwin, R.; Korohina, E.; Funaki-Tahifote, M.; Lee, A.; Swinburn, B.
Cost and Affordability of Diets Modelled on Current Eating Patterns and on Dietary Guidelines, for New
Zealand Total Population, Māori and Pacific Households. Int. J. Environ. Res. Public Health 2018, 15, 1255.
[CrossRef] [PubMed]
105. Vandevijvere, S.; Young, N.; Mackay, S.; Swinburn, B.; Gahegan, M. Modelling the cost differential between
healthy and current diets: The New Zealand case study. Int. J. Behav. Nutr. Phys. Act. 2018, 15, 1–10.
[CrossRef] [PubMed]
106. Lee, A.; Lewis, M. Testing the Price of Healthy and Current Diets in Remote Aboriginal Communities to
Improve Food Security: Development of the Aboriginal and Torres Strait Islander Healthy Diets ASAP
(Australian Standardised Affordability and Pricing) Methods. Int. J. Environ. Res. Public Health 2018,15, 2912. [CrossRef]
107. Johnson-Down, L.; Willows, N.; Kenny, T.-A.; Ing, A.; Fediuk, K.; Sadik, T.; Chan, H.M.; Batal, M.
Optimisation modelling to improve the diets of First Nations individuals. J. Nutr. Sci. 2019, 8, S32. [CrossRef]
108. Ni Mhurchu, C.; Eyles, H.; Schilling, C.; Yang, Q.; Kaye-Blake, W.; Genç, M.; Blakely, T. Food Prices andConsumer Demand: Differences across Income Levels and Ethnic Groups. PLoS ONE 2013, 8, e75934. [CrossRef]
109. Gawn, G.; Innes, R.; Rausser, G.C.; Zilberman, D. Nutrient demand and the allocation of time: Evidence from
Guam. Appl. Econ. 1993, 25, 811–830. [CrossRef]
110. Richards, T.J.; Patterson, P.M. Native American Obesity: An Economic Model of the “Thrifty Gene” Theory.
Am. J. Agric. Econ. 2006, 88, 542–560. [CrossRef]
111. Pollard, C.M.; Landrigan, T.J.; Ellies, P.L.; Kerr, D.A.; Lester, M.L.U.; Goodchild, S.E. Geographic factors as
determinants of food security: A Western Australian food pricing and quality study. Asia Pac. J. Clin. Nutr.
2014, 23, 1–11.
112. Eyles, H.; Rodgers, A.; Ni Mhurchu, C. Use of electronic sales data to tailor nutrition education resources foran ethnically diverse population. J. Hum. Nutr. Diet. 2010, 23, 38–47. [CrossRef]
113. Simoneau, N.; Receveur, O. Attributes of Vitamin A- and Calcium-Rich Food Items Consumed in K’asho
Got’ine, Northwest Territories, Canada. J. Nutr. Educ. 2000, 32, 84–93. [CrossRef]
114. Fleischhacker, S.E.; Vu, M.; Ries, A.; McPhail, A. Engaging Tribal Leaders in an American Indian Healthy Eating
Project Through Modified Talking Circles. Fam. Community Health 2011, 34, 202–210. [CrossRef] [PubMed]
115. Brimblecombe, J.; Maypilama, E.; Colles, S.; Scarlett, M.; Dhurrkay, J.G.; Ritchie, J.; O’Dea, K.
Factors Influencing Food Choice in an Australian Aboriginal Community. Qual. Health Res. 2014, 24, 387–400.
[CrossRef] [PubMed]
116. Beaumier, M.C.; Ford, J.D. Food Insecurity among Inuit Women Exacerbated by Socio-economic Stresses andClimate Change. Can. J. Public Health 2010, 101, 196–201. [CrossRef] [PubMed]

Int. J. Environ. Res. Public Health 2020, 17, 8818

43 of 49

117. Dammann, K.W.; Smith, C. Food-Related Environmental, Behavioral, and Personal Factors Associated with
Body Mass Index among Urban, Low-Income African-American, American Indian, and Caucasian Women.
Am. J. Health Promot. 2011, 25, e1–e10. [CrossRef]
118. Beaumier, M.C.; Ford, J.D.; Tagalik, S. The food security of Inuit women in Arviat, Nunavut: The role ofsocio-economic factors and climate change. Polar Rec. 2015, 51, 550–559. [CrossRef]
119. Stroink, M.L. Understanding Local Food Behaviour and Food Security in Rural First Nation
Communities: Implications for Food Policy. J. Rural Community Dev. 2012, 7, 65–82.
120. Gittelsohn, J.; Toporoff, E.G.; Story, M.; Evans, M.; Anliker, J.; Davis, S.; Sharma, A.; White, J. Food Perceptions
and Dietary Behavior of American-Indian Children, Their Caregivers, and Educators: Formative Assessment
Findings from Pathways. J. Nutr. Educ. 2000, 32, 2–13. [CrossRef]
121. Sowerwine, J.; Mucioki, M.; Sarna-Wojcicki, D.; Hillman, L. Reframing food security by and for Native
American communities: A case study among tribes in the Klamath River basin of Oregon and California.
Food Secur. 2019, 11, 579–607. [CrossRef]
122. Vaughan, L.A.; Benyshek, D.C.; Martin, J.F. Food Acquisition Habits, Nutrient Intakes, and Anthropometric
Data of Havasupai Adults. J. Am. Diet. Assoc. 1997, 97, 1275–1282. [CrossRef]
123. Genuis, S.K.; Willows, N.; Jardine, C.; Nation, A.F. Through the lens of our cameras: Children’s lived
experience with food security in a Canadian Indigenous community. Child. Care Health Dev. 2015, 41, 600–610.
[CrossRef] [PubMed]
124. Wycherley, T.P.; Van Der Pols, J.C.; Daniel, M.; Howard, N.J.; O’Dea, K.; Brimblecombe, J. Associations between
Community Environmental-Level Factors and Diet Quality in Geographically Isolated AustralianCommunities. Int. J. Environ. Res. Public Health 2019, 16, 1943. [CrossRef] [PubMed]
125. MacKenzie, O.W.; George, C.V.; Pérez-Escamilla, R.; Lasky-Fink, J.; Piltch, E.M.; Sandman, S.M.; Clark, C.;
Avalos, Q.J.; Carroll, D.S.; Wilmot, T.M.; et al. Healthy Stores Initiative Associated with Produce Purchasingon Navajo Nation. Curr. Dev. Nutr. 2019, 3, e80973. [CrossRef] [PubMed]
126. Rowse, T.; Scrimgeour, D.; Knight, S.; Thomas, D. Food-purchasing behaviour in an Aboriginal community.
1. Results of a survey. Aust. J. Public Health 1994, 18, 63–67. [CrossRef] [PubMed]
127. Wycherley, T.P.; Pekarsky, B.A.; Ferguson, M.M.; O’Dea, K.; Brimblecombe, J.K. Fluctuations in money
availability within an income cycle impacts diet quality of remote Indigenous Australians. Public Health Nutr.
2017, 80, 1–10. [CrossRef]
128. Scelza, B.A.; Bird, D.W.; Bird, R.B. Bush Tucker, Shop Tucker: Production, Consumption, and Diet at an
Aboriginal Outstation. Ecol. Food Nutr. 2014, 53, 98–117. [CrossRef] [PubMed]
129. Scelza, B.A. Food scarcity, not economic constraint limits consumption in a rural Aboriginal community.
Aust. J. Rural. Health 2012, 20, 108–112. [CrossRef]
130. Gittelsohn, J.; Anliker, J.A.; Sharma, S.; Vastine, A.E.; Caballero, B.; Ethelbah, B. Psychosocial Determinantsof Food Purchasing and Preparation in American Indian Households. J. Nutr. Educ. Behav. 2006,
38, 163–168. [CrossRef]
131. Dressler, H.; Smith, C. Health and Eating Behavior Differs between Lean/Normal and Overweight/Obese
Low-Income Women Living in Food-Insecure Environments. Am. J. Health Promot. 2013, 27, 358–365. [CrossRef]
132. Lee, A.J.; O’Dea, K.; Mathews, J.D. Apparent dietary intake in remote Aboriginal communities. Aust. J.
Public Health 2010, 18, 190–197. [CrossRef]
133. Brimblecombe, J.; Liddle, R.; O’Dea, K. Use of point-of-sale data to assess food and nutrient quality in remotestores. Public Health Nutr. 2012, 16, 1159–1167. [CrossRef] [PubMed]
134. McMahon, E.; Wycherley, T.; O’Dea, K.; Brimblecombe, J. A comparison of dietary estimates from the
National Aboriginal and Torres Strait Islander Health Survey to food and beverage purchase data. Aust. N.
Zeal. J. Public Health 2017, 41, 598–603. [CrossRef] [PubMed]
135. Wycherley, T.P.; Ferguson, M.; O’Dea, K.; McMahon, E.J.; Liberato, S.; Brimblecombe, J. Store turnover as apredictor of food and beverage provider turnover and associated dietary intake estimates in very remote
Indigenous communities. Aust. N. Zeal. J. Public Health 2016, 40, 569–571. [CrossRef]
136. Ni Mhurchu, C.; Blakely, T.; Wall, J.; Rodgers, A.; Jiang, Y.; Wilton, J. Strategies to promote healthier foodpurchases: A pilot supermarket intervention study. Public Health Nutr. 2007, 10, 608–615. [CrossRef] [PubMed]
137. Lee, A.J.; Smith, A.; Bryce, S.; O’Dea, K.; Rutishauser, I.H.; Mathews, J.D. Measuring dietary intake in remote
australian aboriginal communities. Ecol. Food Nutr. 1995, 34, 19–31. [CrossRef]

Int. J. Environ. Res. Public Health 2020, 17, 8818

44 of 49

138. Brimblecombe, J.; Mackerras, D.; Clifford, P.; O’Dea, K. Does the store-turnover method still provide a
useful guide to food intakes in Aboriginal communities? Aust. N. Zeal. J. Public Health 2006, 30, 444–447.
[CrossRef] [PubMed]
139. Wakegijig, J.; Osborne, G.; Statham, S.; Issaluk, M.D. Collaborating toward improving food security inNunavut. Int. J. Circumpolar Health 2013, 72. [CrossRef]
140. Rogers, A.; Ferguson, M.M.; Ritchie, J.; Boogaard, C.V.D.; Brimblecombe, J.K. Strengthening food systems withremote Indigenous Australians: Stakeholders’ perspectives. Health Promot. Int. 2018, 33, 38–48. [CrossRef]
141. Brimblecombe, J.; Boogaard, C.H.V.D.; Ritchie, J.; Bailie, R.; Coveney, J.; Liberato, S.C. From targets toripples: Tracing the process of developing a community capacity building appraisal tool with remote
Australian indigenous communities to tackle food security. BMC Public Health 2014, 14, 914. [CrossRef]
142. Skinner, K.; Hanning, R.M.; Desjardins, E.; Tsuji, L.J.S. Giving voice to food insecurity in a remote indigenous
community in subarctic Ontario, Canada: Traditional ways, ways to cope, ways forward. BMC Public Health2013, 13, 427. [CrossRef]
143. Calancie, L.; Stowers, K.C.; Palmer, A.; Frost, N.; Calhoun, H.; Piner, A.; Webb, K. Toward a Community
Impact Assessment for Food Policy Councils: Identifying Potential Impact Domains. J. Agric. Food Syst.
Community Dev. 2018, 8, 1–14. [CrossRef]
144. Signal, L.; Walton, M.D.; Ni Mhurchu, C.; Maddison, R.; Bowers, S.G.; Carter, K.N.; Gorton, D.; Heta, C.;
Lanumata, T.S.; McKerchar, C.W.; et al. Tackling ’wicked’ health promotion problems: A New Zealand casestudy. Health Promot. Int. 2013, 28, 84–94. [CrossRef] [PubMed]
145. Chan, H.M.; Fediuk, K.; Hamilton, S.; Rostas, L.; Caughey, A.; Kuhnlein, H.; Egeland, G.; Loring, E.
Food security in Nunavut, Canada: Barriers and recommendations. Int. J. Circumpolar Health 2006, 65,
416–431. [CrossRef] [PubMed]
146. Skinner, K.; Hanning, R.M.; Sutherland, C.; Edwards-Wheesk, R.; Tsuji, L.J.S. Using a SWOT Analysis toInform Healthy Eating and Physical Activity Strategies for a Remote First Nations Community in Canada.
Am. J. Health Promot. 2012, 26, e159–e170. [CrossRef] [PubMed]
147. Brimblecombe, J.; Boogaard, C.V.D.; Wood, B.; Liberato, S.C.; Brown, J.; Barnes, A.; Rogers, A.; Coveney, J.;
Ritchie, J.; Bailie, R. Development of the good food planning tool: A food system approach to food security
in indigenous Australian remote communities. Health Place 2015, 34, 54–62. [CrossRef] [PubMed]
148. Rudolph, K.R.; McLachlan, S.M. Seeking Indigenous food sovereignty: Origins of and responses to the foodcrisis in northern Manitoba, Canada. Local Environ. 2013, 18, 1079–1098. [CrossRef]
149. McDonald, E.L.; Bailie, R.S.; Morris, P.S. Participatory systems approach to health improvement in Australian
Aboriginal children. Health Promot. Int. 2017, 32, 62–72. [CrossRef]
150. Sowerwine, J.; Sarna-Wojcicki, D.; Mucioki, M.; Hillman, L.; Lake, F.K.; Friedman, E. Enhancing Food
Sovereignty: A Five-year Collaborative Tribal-University Research and Extension Project in California andOregon. J. Agric. Food Syst. Community Dev. 2019, 9, 1–24. [CrossRef]
151. Ferguson, M.; O’Dea, K.; Altman, J.; Moodie, M.; Brimblecombe, J. Health-Promoting Food Pricing Policies
and Decision-Making in Very Remote Aboriginal and Torres Strait Islander Community Stores in Australia.
Int. J. Environ. Res. Public Health 2018, 15, 2908. [CrossRef]
152. Curran, S.; Gittelsohn, J.; Anliker, J.; Ethelbah, B.; Blake, K.; Sharma, S.; Caballero, B. Process evaluation of astore-based environmental obesity intervention on two American Indian Reservations. Health Educ. Res.
2005, 20, 719–729. [CrossRef]
153. Vastine, A.; Gittelsohn, J.; Ethelbah, B.; Anliker, J.; Caballero, B. Formative Research and Stakeholder
Participation in Intervention Development. Am. J. Health Behav. 2005, 29, 57–69. [CrossRef]
154. Sharma, S.; Gittelsohn, J.; Rosol, R.; Beck, L. Addressing the public health burden caused by the nutritiontransition through the Healthy Foods North nutrition and lifestyle intervention programme. J. Hum.
Nutr. Diet. 2010, 23, 120–127. [CrossRef]
155. Gittelsohn, J. Participatory Research for Chronic Disease Prevention in Inuit Communities. Am. J. Health Behav.
2010, 34, 453–464. [CrossRef] [PubMed]
156. Mead, E.L.; Gittelsohn, J.; Roache, C.; Corriveau, A.; Sharma, S. A Community-Based, Environmental Chronic
Disease Prevention Intervention to Improve Healthy Eating Psychosocial Factors and Behaviors in Indigenous
Populations in the Canadian Arctic. Health Educ. Behav. 2013, 40, 592–602. [CrossRef] [PubMed]

Int. J. Environ. Res. Public Health 2020, 17, 8818

45 of 49

157. Gittelsohn, J.; Kim, E.M.; He, S.; Pardilla, M. A Food Store–Based Environmental Intervention Is Associatedwith Reduced BMI and Improved Psychosocial Factors and Food-Related Behaviors on the Navajo Nation.
J. Nutr. 2013, 143, 1494–1500. [CrossRef]
158. Rosecrans, A.M.; Gittelsohn, J.; Ho, L.S.; Harris, S.B.; Naqshbandi, M.; Sharma, S. Process evaluation of amulti-institutional community-based program for diabetes prevention among First Nations. Health Educ. Res.
2008, 23, 272–286. [CrossRef]
159. Ho, L.S.; Gittelsohn, J.; Rimal, R.; Treuth, M.S.; Sharma, S.; Rosecrans, A.; Harris, S.B. An Integrated
Multi-Institutional Diabetes Prevention Program Improves Knowledge and Healthy Food Acquisition in
Northwestern Ontario First Nations. Health Educ. Behav. 2008, 35, 561–573. [CrossRef] [PubMed]
160. Redmond, L.C.; Jock, B.; Gadhoke, P.; Chiu, D.T.; Christiansen, K.; Pardilla, M.; Swartz, J.; Platero, H.;
Caulfield, L.E.; Gittelsohn, J. OPREVENT (Obesity Prevention and Evaluation of InterVention Effectivenessin NaTive North Americans): Design of a Multilevel, Multicomponent Obesity Intervention for Native
American Adults and Households. Curr. Dev. Nutr. 2019, 3, 81–93. [CrossRef]
161. Gittelsohn, J.; Vijayadeva, V.; Davison, N.; Ramirez, V.; Cheung, L.W.; Murphy, S.; Novotny, R. A Food StoreIntervention Trial Improves Caregiver Psychosocial Factors and Children’s Dietary Intake in Hawaii. Obesity
2010, 18, S84–S90. [CrossRef]
162. Sussman, A.L.; Davis, S.M. Integrating Formative Assessment and Participatory Research. Am. J. Health Educ.
2010, 41, 244–249. [CrossRef]
163. Cruz, T.H.; Davis, S.M.; Fitzgerald, C.A.; Canaca, G.F.; Keane, P.C. Engagement, recruitment, and retention
in a trans-community, randomized controlled trial for the prevention of obesity in rural American Indianand Hispanic children. J. Prim. Prev. 2014, 35, 135–149. [CrossRef] [PubMed]
164. Blakely, T.; Ni Mhurchu, C.; Jiang, Y.; Matoe, L.; Funaki-Tahifote, M.; Eyles, H.; Foster, R.H.; McKenzie, S.;
Rodgers, A. Do effects of price discounts and nutrition education on food purchases vary by ethnicity, income
and education? Results from a randomised, controlled trial. J. Epidemiol. Community Health 2011, 65, 902–908.
[CrossRef] [PubMed]
165. Scrimgeour, D.; Rowse, T.; Knight, S. Food-purchasing behaviour in an Aboriginal community. 2. Evaluation of
an intervention aimed at children. Aust. J. Public Health 1994, 18, 67–70. [CrossRef] [PubMed]
166. Davis, S.M.; Myers, O.B.; Cruz, T.H.; Morshed, A.B.; Canaca, G.F.; Keane, P.C.; O’Donald, E.R.
CHILE: Outcomes of a group randomized controlled trial of an intervention to prevent obesity in preschool
Hispanic and American Indian children. Prev. Med. 2016, 89, 162–168. [CrossRef] [PubMed]
167. Morrison, N.; Dooley, J. The Sioux Lookout Diabetes Program: Diabetes prevention and management innorthwestern Ontario. Int. J. Circumpolar Health 1998, 57, 364–369. [PubMed]
168. Fehring, E.; Ferguson, M.; Brown, C.; Murtha, K.; Laws, C.; Cuthbert, K.; Thompson, K.; Williams, T.;
Hammond, M.; Brimblecombe, J. Supporting healthy drink choices in remote Aboriginal and Torres Strait
Islander communities: A community-led supportive environment approach. Aust. N. Zeal. J. Public Health2019, 43, 551–557. [CrossRef]
169. Brown, C.; Laws, C.; Leonard, D.; Campbell, S.; Merone, L.; Hammond, M.; Thompson, K.; Canuto, K.;
Brimblecombe, J. Healthy Choice Rewards: A Feasibility Trial of Incentives to Influence Consumer
Food Choices in a Remote Australian Aboriginal Community. Int. J. Environ. Res. Public Health 2019,16, 112. [CrossRef]
170. Ni Mhurchu, C.; Eyles, H.; Dixon, R.; Matoe, L.; Teevale, T.; Meagher-Lundberg, P. Economic incentives topromote healthier food purchases: Exploring acceptability and key factors for success. Health Promot. Int.
2012, 27, 331–341. [CrossRef]
171. Snowdon, W. Sugar-sweetened beverages in Pacific Island countries and territories: Problems and solutions?
Pac. Health Dialog 2014, 20, 43–46.
172. Ni Mhurchu, C.; Blakely, T.; Funaki-Tahifote, M.; McKerchar, C.; Wilton, J.; Chua, S.; Jiang, Y. Inclusion ofindigenous and ethnic minority populations in intervention trials: Challenges and strategies in a New Zealandsupermarket study. J. Epidemiol. Community Health 2009, 63, 850–855. [CrossRef]
173. Black, A.P.; Vally, H.; Morris, P.S.; Daniel, M.; Esterman, A.J.; Smith, F.E.; O’Dea, K. Health outcomes of a
subsidised fruit and vegetable program for Aboriginal children in northern New South Wales. Med. J. Aust.
2013, 199, 46–50. [CrossRef] [PubMed]

Int. J. Environ. Res. Public Health 2020, 17, 8818

46 of 49

174. Black, A.P.; Vally, H.; Morris, P.; Daniel, M.; Esterman, A.; Karschimkus, C.S.; O’Dea, K. Nutritional impacts
of a fruit and vegetable subsidy programme for disadvantaged Australian Aboriginal children. Br. J. Nutr.
2013, 110, 2309–2317. [CrossRef]
175. Magnus, A.; Moodie, M.L.; Ferguson, M.; Cobiac, L.J.; Liberato, S.C.; Brimblecombe, J. The economic
feasibility of price discounts to improve diet in Australian Aboriginal remote communities. Aust. N. Zeal. J.
Public Health 2016, 40, S36–S41. [CrossRef] [PubMed]
176. Magnus, A.; Cobiac, L.; Brimblecombe, J.; Chatfield, M.; Gunther, A.; Ferguson, M.; Moodie, M.
The cost-effectiveness of a 20% price discount on fruit, vegetables, diet drinks and water, trialled inremote Australia to improve Indigenous health. PLoS ONE 2018, 13, e0204005. [CrossRef] [PubMed]
177. Ni Mhurchu, C.; Eyles, H.; Genç, M.; Scarborough, P.; Rayner, M.; Mizdrak, A.; Nnoaham, K.; Blakely, T.
Effects of Health-Related Food Taxes and Subsidies on Mortality from Diet-Related Disease in New Zealand:
An Econometric-Epidemiologic Modelling Study. PLoS ONE 2015, 10, e0128477. [CrossRef] [PubMed]
178. Cueva, K.; Lovato, V.; Nieto, T.; Neault, N.; Barlow, A.; Speakman, K. Increasing Healthy Food Availability,
Purchasing, and Consumption: Lessons Learned from Implementing a Mobile Grocery. Prog. Community
Health Partnersh. Res. Educ. Action 2018, 12, 65–72. [CrossRef] [PubMed]
179. Lotoski, L.C.; Engler-Stringer, R.; Muhajarine, N. Cross-sectional analysis of a community-based
cooperative grocery store intervention in Saskatoon, Canada. Can. J. Public Health 2015, 106, e147–e153.
[CrossRef] [PubMed]
180. McMahon, E.J.; Webster, J.; Brimblecombe, J. Effect of 25% Sodium Reduction on Sales of a Top-Selling
Bread in Remote Indigenous Australian Community Stores: A Controlled Intervention Trial. Nutrition 2017,9, 214. [CrossRef]
181. McMahon, E.J.; Clarke, R.; Jaenke, R.; Brimblecombe, J. Detection of 12.5% and 25% Salt Reduction in Breadin a Remote Indigenous Australian Community. Nutrition 2016, 8, 169. [CrossRef]
182. Nhung, N.T.H.; Blakely, T.; Cobiac, L.J.; Pearson, A.L.; Wilson, N. Health and Economic Impacts of Eight
Different Dietary Salt Reduction Interventions. PLoS ONE 2015, 10, e0123915. [CrossRef]
183. McMahon, E.J.; Webster, J.; O’Dea, K.; Brimblecombe, J. Dietary sodium and iodine in remote Indigenous
Australian communities: Will salt-reduction strategies increase risk of iodine deficiency? A cross-sectional
analysis and simulation study. BMC Public Health 2015, 15, 1318. [CrossRef] [PubMed]
184. Ho, L.S.; Gittelsohn, J.; Harris, S.B.; Ford, E. Development of an integrated diabetes prevention program withFirst Nations in Canada. Health Promot. Int. 2006, 21, 88–97. [CrossRef] [PubMed]
185. WorldBank. How Does the World Bank Classify Countries? Available online: https://datahelpdesk.
worldbank.org/knowledgebase/articles/378834-how-does-the-world-bank-classify-countries (accessed on
20 September 2019).
186. Lytle, L.A.; Sokol, R.L. Measures of the food environment: A systematic review of the field, 2007–2015.
Health Place 2017, 44, 18–34. [CrossRef] [PubMed]
187. Ploeg, M.V.; Wilde, P.E. How do food retail choices vary within and between food retail environments?
Food Policy 2018, 79, 300–308. [CrossRef]
188. Walker, R.E.; Keane, C.R.; Burke, J.G. Disparities and access to healthy food in the United States: A review offood deserts literature. Health Place 2010, 16, 876–884. [CrossRef] [PubMed]
189. Dammann, K.W.; Smith, C. Factors Affecting Low-income Women’s Food Choices and the Perceived Impact
of Dietary Intake and Socioeconomic Status on Their Health and Weight. J. Nutr. Educ. Behav. 2009,41, 242–253. [CrossRef]
190. Kaufman, P.; Dicken, C.; Williams, R. Measuring Access to Healthful, Affordable Food in American Indianand Alaska Native Tribal Areas; EIB-131; U.S. Department of Agriculture, Economic Research Service:
Washington, DC, USA, 2014; pp. 1–35.
191. Sacks, G.; Swinburn, B.; Kraak, V.I.; Downs, S.; Walker, C.; Barquera, S.; Friel, S.; Hawkes, C.; Kelly, B.;
Kumanyika, S.; et al. A proposed approach to monitor private-sector policies and practices related to foodenvironments, obesity and non-communicable disease prevention. Obes. Rev. 2013, 14, 38–48. [CrossRef]
192. Castellari, E.; Moro, D.; Platoni, S.; Sckokai, P. Retailers’ strategies and food price dynamics: Evidence fromdairy scanner data. Food Policy 2018, 74, 212–224. [CrossRef]
193. Lee, A.J.; Bonson, A.P.; Powers, J.R. The effect of retail store managers on Aboriginal diet in remotecommunities. Aust. N. Zeal. J. Public Health 1996, 20, 212–214. [CrossRef]

Int. J. Environ. Res. Public Health 2020, 17, 8818

47 of 49

194. Ford, J.D.; Lardeau, M.-P.; Vanderbilt, W. The characteristics and experience of community food program
users in arctic Canada: A case study from Iqaluit, Nunavut. BMC Public Health 2012, 12, 464. [CrossRef]
195. Cooksey-Stowers, K.; Schwartz, M.B.; Brownell, K.D. Food Swamps Predict Obesity Rates Better Than Food
Deserts in the United States. Int. J. Environ. Res. Public Health 2017, 14, 1366. [CrossRef] [PubMed]
196. Hager, E.R.; Cockerham, A.; O’Reilly, N.; Harrington, D.; Harding, J.; Hurley, K.M.; Black, M.M. Food swamps
and food deserts in Baltimore City, MD, USA: Associations with dietary behaviours among urban adolescent
girls. Public Health Nutr. 2016, 20, 2598–2607. [CrossRef] [PubMed]
197. Budzynska, K.; West, P.; Savoy-Moore, R.T.; Lindsey, D.; Winter, M.; Newby, P.K. A food desert in Detroit:
Associations with food shopping and eating behaviours, dietary intakes and obesity. Public Health Nutr.
2013, 16, 2114–2123. [CrossRef] [PubMed]
198. Trewin, D. National Aboriginal and Torres Strait Islander Health Survey, 2004–2005; Australian Bureau of
Statistics: Melbourne, Australia, 2006.
199. Zienczuk, N.; Young, T.K.; Cao, Z.R.; Egeland, G.M. Dietary correlates of an at-risk BMI among Inuit adults
in the Canadian high arctic: Cross-sectional international polar year Inuit health survey, 2007–2008. Nutr. J.
2012, 11, 73. [CrossRef]
200. Maru, Y.T.; Smith, M.S.; Sparrow, A.; Pinho, P.F.; Dube, O.P. A linked vulnerability and resilience
framework for adaptation pathways in remote disadvantaged communities. Glob. Environ. Chang.
2014, 28, 337–350. [CrossRef]
201. Singh-Peterson, L.; Lieske, S.; Underhill, S.J.R.; Keys, N. Food security, remoteness and consolidation ofsupermarket distribution centres: Factors contributing to food pricing inequalities across Queensland,
Australia. Aust Geogr. 2015, 47, 89–102. [CrossRef]
202. Novotny, R.; Vijayadeva, V.; Ramirez, V.; Lee, S.K.; Davison, N.; Gittelsohn, J. Development and
Implementation of a Food System Intervention to Prevent Childhood Obesity in Rural Hawai‘i. Hawaii Med. J.
2011, 70, 42–46.
203. Whyte, K. Food Sovereignty, Justice and Indigenous Peoples: An Essay on Settler Colonialism andCollective Continuance. In Oxford Handbook on Food Ethics; Barnhill, A., Doggett, T., Budolfson, M., Eds.;
Oxford University Press: Oxford, UK, 2017; pp. 1–21.
204. Daher, O.; Hannikainen, L.; Heikinheimo-Pérez, K. National Minorities in Finland–Richness of Culturesand Languages; Minority Rights Group Finland: London, UK, 2016.
205. Daigle, M. Tracing the terrain of Indigenous food sovereignties. J. Peasant. Stud. 2017, 18, 1–19. [CrossRef]
206. Coté, C. “Indigenizing” Food Sovereignty. Revitalizing Indigenous Food Practices and Ecological Knowledgesin Canada and the United States. Humanities 2016, 5, 57. [CrossRef]
207. Harder, M.T.; Wenzel, G.W. Inuit Subsistence, Social Economy and Food Security in Clyde River, Nunavut.
Arctic 2012, 65, 305–318. [CrossRef]
208. Wenzel, G.W. Inuit and modern hunter-gatherer subsistence. Études/Inuit/Studies 2013, 37, 181–200. [CrossRef]
209. Jonasson, M.E.; Spiegel, S.J.; Thomas, S.; Yassi, A.; Wittman, H.; Takaro, T.; Afshari, R.; Markwick, M.;
Spiegel, J.M. Oil pipelines and food sovereignty: Threat to health equity for Indigenous communities. J. Public
Health Policy 2019, 40, 504–517. [CrossRef] [PubMed]
210. Simpson, L. Toxic contamination undermining Indigenous food systems and Indigenous sovereignty.
Pimatiziwin J. Aborig. Indig. Community Health 2003, 1, 130–134.
211. Parlee, B.; Sandlos, J.; Natcher, D. Undermining subsistence: Barren-ground caribou in a “tragedy of open
access”. Sci. Adv. 2018, 4, e1701611. [CrossRef]
212. Whyte, K. Indigenous Food Sovereignty, Renewal and U.S. Settler Colonialism. In The Routledge Handbook ofFood Ethics; Routledge: New York, NY, USA, 2016; pp. 354–365.
213. Whyte, K. Indigenous Food Systems, Environmental Justice, and Settler-Industrial States. In Global Food,
Global Justice: Essays on Eating under Globalization; Rawlinson, M., Ward, C., Eds.; Cambridge Scholars
Publishing: Newcastle upon Tyne, UK, 2015; pp. 143–156.
214. Seymour, J.D. Impact of nutrition environmental interventions on point-of-purchase behavior inadults: A review. Prev. Med. 2004, 39, 108–136. [CrossRef]
215. Ni Mhurchu, C.; Blakely, T.; Jiang, Y.; Eyles, H.C.; Rodgers, A. Effects of price discounts and tailorednutrition education on supermarket purchases: A randomized controlled trial. Am. J. Clin. Nutr. 2010,
91, 736–747. [CrossRef]

Int. J. Environ. Res. Public Health 2020, 17, 8818

48 of 49

216. St-Germain, A.-A.F.; Galloway, T.; Tarasuk, V. Food insecurity in Nunavut following the introduction of
Nutrition North Canada. Can. Med. Assoc. J. 2019, 191, E552–E558. [CrossRef]
217. Socha, T.; Chambers, L.; Zahaf, M.; Abraham, R.; Fiddler, T. Food availability, food store management,
and food pricing in a northern community First Nation community. Int. J. Humanit. Soc. Sci. 2011, 1, 49–61.
218. Socha, T.; Zahaf, M.; Chambers, L.; Abraham, R.; Fiddler, T. Food Security in a Northern First Nations
Community: An Exploratory Study on Food Availability and Accessibility. J. Aborig. Health 2012, 8, 5–14.
219. Pollard, C.M. Selecting Interventions for Food Security in Remote Indigenous Communities. In Food Security
in Australia; Springer: Berlin/Heidelberg, Germany, 2012; Volume 100, pp. 97–112.
220. House of Representatives Standing Committee on Aboriginal and Torres Strait Islander Affairs. Everybody’s
Business: Remote Aboriginal and Torres Strait Community Stores; The Parliament of the Commonwealth ofAustralia: Canberra, Australia, 2009.
221. Niclasen, B.; Molcho, M.; Arnfjord, S.; Schnohr, C. Conceptualizing and contextualizing food insecurity
among Greenlandic children. Int. J. Circumpolar Health 2013, 72, 19928. [CrossRef]
222. Wetherill, M.S.; Williams, M.B.; Hartwell, M.L.; Salvatore, A.L.; Jacob, T.; Cannady, T.K.; Standridge, J.;
Fox, J.; Spiegel, J.; Anderson, N.; et al. Food choice considerations among American Indians living in rural
Oklahoma: The THRIVE study. Appetite 2018, 128, 14–20. [CrossRef] [PubMed]
223. Barr, T.L.; Reid, J.; Catska, P.; Varona, G.; Rout, M. Development of indigenous enterprise in a contemporary
business environment—The Ngāi Tahu Ahikā approach. J. Enterp. Communities People Places Glob. Econ. 2018,12, 454–471. [CrossRef]
224. Reid, J.; Rout, M. Getting to know your food: The insights of indigenous thinking in food provenance.
Agric. Hum. Values 2016, 33, 427–438. [CrossRef]
225. Bodirsky, M.; Johnson, J. Decolonizing Diet: Healing by Reclaiming Traditional Indigenous Foodways.
Cuizine J. Can. Food Cultures/Cuizine 2008, 1. [CrossRef]
226. Figueroa-Helland, L.; Thomas, C.; Aguilera, A.P. Decolonizing Food Systems: Food Sovereignty, Indigenous
Revitalization, and Agroecology as Counter-Hegemonic Movements. Perspect. Glob. Dev. Technol. 2018,17, 173–201. [CrossRef]
227. QIA. Food Sovereignty and Harvesting; Qikiqtani Inuit Association: Iqaluit, NU, Canada, 2019; pp. 1–24.
228. Grey, S.; Newman, L. Beyond culinary colonialism: Indigenous food sovereignty, liberal multiculturalism,
and the control of gastronomic capital. Agric. Hum. Values 2018, 35, 717–730. [CrossRef]
229. Kuhnlein, H.; Erasmus, B.; Creed-Kanashiro, H.M.; Englberger, L.; Okeke, C.; Turner, N.;
Allen, L.; Bhattacharjee, L. Indigenous peoples’ food systems for health: Finding interventions thatwork. Public Health Nutr. 2007, 9, 1013–1019. [CrossRef]
230. Egeland, G.M. Inuit Health Survey 2007–2008: Inuvialuit Settlement Region; Centre for Indigenous Peoples’
Nutrition and Environment (CINE): Montreal, QC, Canada, 2010.
231. Egeland, G.M. Inuit Health Survey 2007–2008: Nunatsiavut; Centre for Indigenous Peoples’ Nutrition andEnvironment (CINE): Montreal, QC, Canada, 2010.
232. Egeland, G.M. Inuit Health Survey 2007–2008: Nunavut; Centre for Indigenous Peoples’ Nutrition andEnvironment (CINE): Montreal, QC, Canada, 2010.
233. Reyes-García, V.; Powell, B.; Díaz-Reviriego, I.; Fernández-Llamazares, Á.; Gallois, S.; Gueze, M.
Dietary transitions among three contemporary hunter-gatherers across the tropics. Food Secur. 2019,11, 109–122. [CrossRef]
234. Batal, M.; Johnson-Down, L.; Moubarac, J.-C.; Ing, A.; Fediuk, K.; Sadik, T.; Tikhonov, C.; Chan, L.; Willows, N.
Quantifying associations of the dietary share of ultra-processed foods with overall diet quality in First Nations
peoples in the Canadian provinces of British Columbia, Alberta, Manitoba and Ontario. Public Health Nutr.
2017, 21, 103–113. [CrossRef]
235. First Nations Development Institute. Indian Country Food Price Index: Exploring Variation in Food Pricing
Across Native Communities—A Working Paper; First Nations Development Institute: Fredericksburg, VA, USA,2016; pp. 1–14.
236. First Nations Development Institute. Indian Country Food Price Index: Exploring Variation in Food Pricing Across
Native Communities—A Working Paper II; First Nations Development Institute: Fredericksburg, VA, USA,2018; pp. 1–41.
237. Grégoire, G.; Derderian, F.; Le Lorier, J. Selecting the language of the publications included in ameta-analysis: Is there a tower of babel bias? J. Clin. Epidemiol. 1995, 48, 159–163. [CrossRef]

Int. J. Environ. Res. Public Health 2020, 17, 8818

49 of 49

238. Kumanyika, S.K. Unraveling common threads in obesity risk among racial/ethnic minority and migrant
populations. Public Health 2019, 172, 125–134. [CrossRef] [PubMed]
239. Searles, N. To sell or not to sell: Country food markets and Inuit identity in Nunavut. Food Foodways
2016, 24, 194–212. [CrossRef]
240. Ford, J.D.; Macdonald, J.P.; Huet, C.; Statham, S.; MacRury, A. Food policy in the Canadian North: Is there arole for country food markets? Soc. Sci. Med. 2016, 152, 35–40. [CrossRef]
241. David-Chavez, D.M.; Gavin, M.C. A global assessment of Indigenous community engagement in climate
research. Environ. Res. Lett. 2018, 13, 123005. [CrossRef]
242. ITK. An Inuit-Specific Approach for the Canadian Food Policy; Inuit Tapiriit Kanatami (ITK): Ottawa, ON, Canada,
2017; pp. 1–40.
243. ICC-Alaska. Alaskan Inuit food SECURITY Conceptual Framework: How to assess the Arctic from an Inuit Perspective;
Inuit Circumpolar Council (ICC)-Alaska: Anchorage, AL, USA, 2015.
244. Ferguson, M.; King, A.; Brimblecombe, J. Time for a shift in focus to improve food affordability for remotecustomers. Med. J. Aust. 2016, 204, 409. [CrossRef] [PubMed]
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