Food Acquisition during the COVID-19 Lockdown and Its Associations with the Physical-Digital Integrated Community Food Environment: A Case Study of Nanjing, China.

The COVID-19 pandemic and measures such as lockdowns affect food access, dietary choices, and food security. We conducted an online survey among 517 respondents during early 2020 in Nanjing, China to explore respondents' food acquisition behaviors before and during the pandemic and associations with the community food environment. Using geographic analysis and binary logistic models, we revealed that despite inconvenience regarding food acquisition, no food security issues occurred during lockdown in Nanjing. The pandemic changed the access and frequency of obtaining food; meanwhile, pre-pandemic habits had a strong impact on food acquisition behavior. Online and in-store food acquisition showed a substitution relationship, with online food access playing a crucial role in food acquisition. Physical and digit food outlets are highly integrated in Chinese urban communities, and both objectively measured and perceived accessibility of these food outlets had a significant association with the food acquisition methods and transportation mode chosen by people during this public health crisis.