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  1. Author: Byrd-Bredbenner C, Lagiou P, Trichopoulou A
    Title: A comparison of household food availability in 11 countries.
    Journal: J Hum Nutr Diet. 13(3):197-204
    Date: 2000 Jun
    Abstract: OBJECTIVE: To identify intercountry food intake patterns, we compared the household food availability data collected by the Nationwide Food Consumption Survey (NFCS) in the United States and the Household Budget Surveys (HBS) from 10 European countries that participated in the DAta Food NEtworking (DAFNE) project, namely Belgium, Germany, Greece, Hungary, Ireland, Luxembourg, Norway, Poland, Spain and the United Kingdom. METHODOLOGY: The DAFNE project harmonized European household food availability data by clarifying which food items were included in each country's HBS, and then defining comparable food categories among countries. NFCS household data were harmonized with the HBS data by applying the same procedures used in the DAFNE project. RESULTS: The results presented in this paper reveal a number of similarities and differences in household food availability among 11 nations. In nearly all countries studied, red meat was available in greater quantities than poultry and seafood combined. Most countries favoured bread and rolls over other types of grain products, had a low to moderate availability of seafood and legumes, had a moderate amount of sugar available, and consumed approximately two-thirds or more of fruits and vegetables in a fresh form. Milk availability tended to be inversely correlated with cheese availability. Only in Mediterranean households was vegetable oil, namely olive oil, the primary type of added lipid available. While the data presented in this paper can do much to improve our understanding of food availability in US and European households, it is important to remember that these data do not include foods purchased and consumed away from home. APPLICATIONS: Despite the limitations of household food availability data, the results presented in this paper can help health professionals develop a more international perspective.
  2. Author: Block D, Kouba J
    Title: A comparison of the availability and affordability of a market basket in two communities in the Chicago area.
    Journal: Public Health Nutr. 9(7):837-45
    Date: 2006 Oct
    Abstract: OBJECTIVE: The purpose of the present study was to characterise the food landscape of an inner city African American neighbourhood and its mixed-race suburban neighbour. Detailed analysis focuses on the relationship between community store mix and price, availability and produce quality. DESIGN: A market basket study was completed by members of the Chicago Food Systems Collaborative. The US Department of Agriculture's standard market basket survey and methodology were used. Additional items and analyses were added in consultation with community members. SETTING: Austin is a lower-middle-class African American community of 117,500 on the western edge of Chicago. Oak Park, which borders Austin, is an upper-middle-income suburb of 52,500 with a mixed racial profile.Subjects: A market basket survey of every retail food store in Austin and Oak Park was completed. A total of 134 were included. RESULTS: Results indicate that Austin has many grocery stores and few supermarkets. Many Austin groceries stores carry produce that is usually competitively priced, but often of unacceptable quality. Supermarkets had the best selection. Prices were lowest at discount supermarkets. Prices of packaged items were higher at independent stores than at chain supermarkets, but fresh items were cheaper. CONCLUSIONS: Food access is related more to store type than number. In this study, item availability and produce quality varied greatly between store types. Price differences were complicated and varied by store type and food category. This has consequences in terms of food purchasing decisions and dietary quality that public health professionals should acknowledge.
  3. Author: Song HJ, Gittelsohn J, Kim M, Suratkar S, Sharma S, Anliker J
    Title: A corner store intervention in a low-income urban community is associated with increased availability and sales of some healthy foods.
    Journal: Public Health Nutr. 12(11):2060-7
    Date: 2009 Nov
    Abstract: OBJECTIVE: While corner store-based nutrition interventions have emerged as a potential strategy to increase healthy food availability in low-income communities, few evaluation studies exist. We present the results of a trial in Baltimore City to increase the availability and sales of healthier food options in local stores. DESIGN: Quasi-experimental study. SETTING: Corner stores owned by Korean-Americans and supermarkets located in East and West Baltimore. SUBJECTS: Seven corner stores and two supermarkets in East Baltimore received a 10-month intervention and six corner stores and two supermarkets in West Baltimore served as comparison. RESULTS: During and post-intervention, stocking of healthy foods and weekly reported sales of some promoted foods increased significantly in intervention stores compared with comparison stores. Also, intervention storeowners showed significantly higher self-efficacy for stocking some healthy foods in comparison to West Baltimore storeowners. CONCLUSIONS: Findings of the study demonstrated that increases in the stocking and promotion of healthy foods can result in increased sales. Working in small corner stores may be a feasible means of improving the availability of healthy foods and their sales in a low-income urban community.
  4. Author: Larsen K, Gilliland J
    Title: A farmers' market in a food desert: Evaluating impacts on the price and availability of healthy food.
    Journal: Health Place. 15(4):1158-62
    Date: 2009 Dec
    Abstract: Several studies have examined supermarket access for low-income residents, but few have explored how access to healthy food changes when a new food retailer such as a farmers' market opens in a place previously known as a 'food desert'. This paper uses a 'before and after' approach to examine the impact of the introduction of a farmers' market on the price and availability of healthy food in an underserved urban neighbourhood. The farmers' market had a major impact on grocery prices in the neighbourhood, which decreased by almost 12% in 3 years.
  5. Author: Satia JA, Patterson RE, Kristal AR, Hislop TG, Pineda M
    Title: A household food inventory for North American Chinese.
    Journal: Public Health Nutr. 4(2):241-7
    Date: 2001 Apr
    Abstract: OBJECTIVE: To determine whether a short set of questions about foods in the household can provide information about the fat-related dietary behaviour of individual household members in less-acculturated Chinese populations. DESIGN: Cross-sectional survey. PARTICIPANTS: The study population included 244 adult females of Chinese ethnicity in Seattle, WA, and Vancouver, BC, Canada. SETTING: Bilingual interviewers collected information on the presence of 14 high-fat foods and seven reduced-fat foods in the household. Respondents were also asked about the consumption of foods and behaviour reflective of adoption of Western dietary practices, fat-related dietary behaviour, changes in consumption of high-fat foods since immigration, and sociodemographic characteristics. RESULTS: Although this was a less-acculturated sample, many households had Western foods such as butter (58%), lunchmeats (36%), snack chips (43%), and 1% or skim milk (48%). Households with respondents who were younger, married, employed outside the home, and lived with young children had significantly more high-fat foods, while high education and longer percentage of life in North America were significantly associated with having more reduced-fat foods (P , or = 0.05). Participants living in households with more high-fat foods had higher-fat dietary behaviour than those with fewer high-fat foods (fat-related dietary behaviour score, 1.54 versus 1.28; P
  6. Author: Neuhouser ML, Thompson B, Coronado G, Martinez T, Qu P
    Title: A household food inventory is not a good measure of fruit and vegetable intake among ethnically diverse rural women.
    Journal: J Am Diet Assoc. 107(4):672-7
    Date: 2007 Apr
    Abstract: Environmental measures of food availability are surrogates of consumption. Such measures may be useful among populations for whom standard dietary assessment is difficult. The objective of this cross-sectional study was to test whether a measure of the household dietary environment would perform as well as or better than a standard fruit and vegetable assessment among ethnically diverse rural women. Participants were 154 non-Hispanic white, 157 Hispanic, and 102 Native American adult women residing in rural Washington state. Participants completed an interviewer-administered household inventory of fruits and vegetables and a standard measure of fruit and vegetable intake used in the 5 A Day for Better Health Program. Pearson correlation coefficients assessed the validity of the measures against biomarkers of fruit and vegetable consumption (serum carotenoids). Pearson correlations were poor to modest between the household inventory and serum carotenoids (r=0.06 to 0.22) and between the 5 A Day responses and serum carotenoids (r=-0.08 to 0.17). There were no differences by ethnic group; both short tools performed poorly compared with the biomarkers across Hispanic, non-Hispanic white, and Native-American participants. In conclusion, both the household inventory and the popular 5 A Day measure were poor indicators of fruit and vegetable intake in this sample of ethnically diverse rural women.
  7. Author: Prince SA, Kristjansson EA, Russell K, Billette JM, Sawada M, Ali A, Tremblay MS, Prud'homme D
    Title: A multilevel analysis of neighbourhood built and social environments and adult self-reported physical activity and body mass index in Ottawa, Canada.
    Journal: Int J Environ Res Public Health. 8(10):3953-78
    Date: 2011 Oct
    Abstract: Canadian research examining the combined effects of social and built environments on physical activity (PA) and obesity is limited. The purpose of this study was to determine the relationships among built and social environments and PA and overweight/obesity in 85 Ottawa neighbourhoods. Self-reported PA, height and weight were collected from 3,883 adults using the International PA Questionnaire from the 2003-2007 samples of the Rapid Risk Factor Surveillance System. Data on neighbourhood characteristics were obtained from the Ottawa Neighbourhood Study; a large study of neighbourhoods and health in Ottawa. Two-level binomial logistic regression models stratified by sex were used to examine the relationships of environmental and individual variables with PA and overweight/obesity while using survey weights. Results identified that approximately half of the adults were insufficiently active or overweight/obese. Multilevel models identified that for every additional convenience store, men were two times more likely to be physically active (OR = 2.08, 95% CI: 1.72, 2.43) and with every additional specialty food store women were almost two times more likely to be overweight or obese (OR = 1.77, 95% CI: 1.33, 2.20). Higher green space was associated with a reduced likelihood of PA (OR = 0.93, 95% CI: 0.86, 0.99) and increased odds of overweight and obesity in men (OR = 1.10, 95% CI: 1.01, 1.19), and decreased odds of overweight/obesity in women (OR = 0.66, 95% CI: 0.44, 0.89). In men, neighbourhood socioeconomic scores, voting rates and sense of community belonging were all significantly associated with overweight/obesity. Intraclass coefficients were low, but identified that the majority of neighbourhood variation in outcomes was explained by the models. Findings identified that green space, food landscapes and social cohesiveness may play different roles on PA and overweight/obesity in men and women and future prospective studies are needed.
  8. Author: Ahern M, Brown C, Dukas S
    Title: A national study of the association between food environments and county-level health outcomes.
    Journal: J Rural Health. 27(4):367-79
    Date: 2011 Winter
    Abstract: PURPOSE: This national, county-level study examines the relationship between food availability and access, and health outcomes (mortality, diabetes, and obesity rates) in both metro and non-metro areas. METHODS: This is a secondary, cross-sectional analysis using Food Environment Atlas and CDC data. Linear regression models estimate relationships between food availability and access variables (direct-to-consumer farm sales, per capita grocery stores, full-service restaurants, fast food restaurants, and convenience stores) with health outcomes. Controls include smoking, race/ethnicity, gender, age, education, poverty, primary care availability, recreational facility availability, and mobility/distance-from-grocery-store. FINDINGS: Non-metro findings: Lower adjusted mortality rates were associated with more per capita full-service restaurants and grocery stores, and greater per capita direct farm sales. Lower adjusted diabetes rates were associated with a lower per capita supply of fast food restaurants and convenience stores, and more per capita full-service restaurants and grocery stores. Lower adjusted obesity rates were associated with more per capita full-service restaurants and grocery stores. Unexpectedly, obesity rates were positively associated with per capita grocery stores and negatively associated with fast food restaurants. Metro findings: More per capita full-service restaurants, grocery stores, and direct farm sales are associated with positive health outcomes; fast food restaurants and convenience stores are associated with negative health outcomes. CONCLUSIONS: The food access/availability environment is an important determinant of health outcomes in metro and non-metro areas. Future research should focus on more refined specifications that capture variability across non-metro settings.
  9. Author: Pearce J, Hiscock R, Blakely T, Witten K
    Title: A national study of the association between neighbourhood access to fast-food outlets and the diet and weight of local residents.
    Journal: Health Place. 15(1):193-7
    Date: 2009 Mar
    Abstract: Differential locational access to fast-food retailing between neighbourhoods of varying socioeconomic status has been suggested as a contextual explanation for the social distribution of diet-related mortality and morbidity. This New Zealand study examines whether neighbourhood access to fast-food outlets is associated with individual diet-related health outcomes. Travel distances to the closest fast-food outlet (multinational and locally operated) were calculated for all neighbourhoods and appended to a national health survey. Residents in neighbourhoods with the furthest access to a multinational fast-food outlet were more likely to eat the recommended intake of vegetables but also be overweight. There was no association with fruit consumption. Access to locally operated fast-food outlets was not associated with the consumption of the recommended fruit and vegetables or being overweight. Better neighbourhood access to fast-food retailing is unlikely to be a key contextual driver for inequalities in diet-related health outcomes in New Zealand.
  10. Author: Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE
    Title: A picture of the healthful food environment in two diverse urban cities.
    Journal: Environ Health Insights
    Date: 2010
    Abstract: BACKGROUND: Local food environments influence fresh produce purchase and consumption, and previous research has found disparities in local food environments by income and ethnicity. Other existing studies have begun to quantify the distribution of food sources, but there has been limited attention to important features or types of healthful food that are available or their quality or cost. Two studies assessed the type, quantity, quality and cost of healthful food from two diverse urban cities, Kansas City, Kansas and Missouri and Honolulu, Hawaii, and evaluated differences by neighborhood income and ethnic composition. METHOD: A total of 343 food stores in urban neighborhoods were assessed using the one-page Understanding Neighborhood Determinants of Obesity (UNDO) Food Stores Assessment (FSA) measuring healthful foods. US Census data were used to define median household income and ethnic minority concentration. RESULTS: In Study 1, most low socioeconomic status (SES), high ethnic minority neighborhoods had primarily convenience, liquor or small grocery stores. Quality of produce was typically lower, and prices of some foods were more than in comparison neighborhoods. In Study 2, low SES neighborhoods had more convenience and grocery stores. Farmers' markets and supermarkets had the best produce availability and quality, and farmers' markets and pharmacies had the lowest prices. CONCLUSIONS: Messages emphasizing eating more fruits and vegetables are not realistic in urban, low SES, high ethnic concentration neighborhoods. Farmers' markets and supermarkets provided the best opportunities for fresh produce. Increasing access to farmers' markets and supermarkets or reducing prices could improve the local food environment.
  11. Author: French SA, Jeffery RW, Story M, Hannan P, Snyder MP
    Title: A pricing strategy to promote low-fat snack choices through vending machines.
    Journal: Am J Public Health. 87(5):849-51
    Date: 1997 May
    Abstract: OBJECTIVES: This study examined the role of price on purchases of low-fat snacks from vending machines. METHODS: Sales of low-fat and regular snacks were monitored in nine vending machines during a 4-week baseline, a 3-week intervention in which prices of low-fat snacks were reduced 50%, and 3 weeks postintervention. RESULTS: The proportion of low-fat snacks purchased was 25.7%, 45.8%, and 22.8% in the three periods, respectively. Total snack purchases did not vary by period. CONCLUSIONS: Reducing relative prices may be effective in promoting lower-fat food choices in the population. Vending machines may be a feasible method for implementing such nutrition interventions.
  12. Author: Hannan P, French SA, Story M, Fulkerson JA
    Title: A pricing strategy to promote sales of lower fat foods in high school cafeterias: acceptability and sensitivity analysis.
    Journal: Am J Health Promot. 17(1):1-6, ii
    Date: 2002 Sep-Oct
    Abstract: Prices of four low fat foods were reduced about 25% and prices of three high fat foods were increased about 10% to determine the impact on food purchases in a Midwestern suburban high school cafeteria to explore the impact of price on purchases. Low fat foods averaged about 13% of total sales. Sensitivity analysis was used to estimate that low fat foods would probably have averaged about 9% of total sales without the reduced price.
  13. Author: Kegler MC, Escoffery C, Alcantara I, Ballard D, Glanz K
    Title: A qualitative examination of home and neighborhood environments for obesity prevention in rural adults.
    Journal: Int J Behav Nutr Phys Act
    Date: 2008
    Abstract: BACKGROUND: The home and neighborhood environments may be important in obesity prevention by virtue of food availability, food preparation, cues and opportunities for physical activity, and family support. To date, little research has examined how home and neighborhood environments in rural communities may support or hinder healthy eating and physical activity. This paper reports characteristics of rural homes and neighborhoods related to physical activity environments, availability of healthy foods, and family support for physical activity and maintaining an ideal body weight. METHODS: In-depth interviews were conducted with 60 African American and White adults over 50 years of age in two rural counties in Southwest Georgia. Interviews were transcribed verbatim and coded independently by two members of the research team using standard methods of qualitative analysis. Themes were then identified and data matrices were used to identify patterns by gender or race. RESULTS: Neighborhood features that supported physical activity were plenty of land, minimal traffic and living in a safe and friendly neighborhood. The major barrier was lack of recreational facilities. The majority of participants were not physically active with their family members due to schedule conflicts and lack of time. Family member-initiated efforts to encourage physical activity met with mixed results, with refusals, procrastination, and increased activity all reported. Participants generally reported it was easy to get healthy foods, although cost barriers and the need to drive to a larger town for a supermarket with good variety were noted as obstacles. Family conversations about weight had occurred for about half of the participants, with reactions ranging from agreement about the need to lose weight to frustration. CONCLUSION: This study suggests that successful environmental change strategies to promote physical activity and healthy eating in rural neighborhoods may differ from those used in urban neighborhoods. The findings also provide insight into the complexities of family support for physical activity and maintaining a healthy weight. Addressing socio-ecologic factors has the potential to increase healthy behaviors and decrease the prevalence of obesity among rural residents.
  14. Author: Perry CL, Bishop DB, Taylor GL, Davis M, Story M, Gray C, Bishop SC, Mays RA, Lytle LA, Harnack L
    Title: A randomized school trial of environmental strategies to encourage fruit and vegetable consumption among children.
    Journal: Health Educ Behav. 31(1):65-76
    Date: 2004 Feb
    Abstract: The Cafeteria Power Plus project examined whether a cafeteria-based intervention would increase the fruit and vegetable (FV) consumption of children. Twenty-six schools were randomly assigned to either an intervention or control condition. Baseline lunch observations of a sample (N = 1668) of first- and third-grade students occurred in the spring of 2000; follow-up was in the spring of 2002. The intervention took place during two consecutive school years beginning in the fall of 2000 and consisted of daily activities (increasing the availability, attractiveness, and encouragement for FV) and special events (kick-offs, samplings, challenge weeks, theater production, and finale meal). Training of food-service staff and cook managers was ongoing throughout the intervention phase. Students in the intervention schools significantly increased their total fruit intake. Process measures indicated that verbal encouragement by food-service staff was associated with outcomes. The outcomes suggest that multicomponent interventions are more powerful than cafeteria programs alone with this age group.
  15. Author: Cummins S, Macintyre S
    Title: A systematic study of an urban foodscape: the price and availability of food in greater Glasgow
    Journal: Urban studies. 39(11):2115-30
    Date: 2002
    Abstract: Previous research has suggested that foods which are beneficial to health may be more expensive, and more difficult to obtain, in deprived compared with more affluent areas, and that this may help to explain the greater adherence to healthy eating guidelines consistently reported in more affluent areas of the UK. In this paper, we report on an investigation of the price and availability of 57 foods, previously defined as representing a 'modest but adequate diet', in different retail formats and areas differing in socioeconomic deprivation within Greater Glasgow. In this setting, shop type was the main predictor of food price and availability, cheaper prices and greater availability being mainly found in multiple and discount stores, which were more likely to be located in more deprived rather than affluent areas. Prices did not vary greatly by area deprivation and, when they did, they tended to be lower in poorer areas. Foods cheaper in poorer areas tended towards the high-fat, high-sugar types, the consumption of which current dietary guidelines suggest need to be reduced. We suggest that these findings point to the need for more systematic, empirical, large-scale studies of variations in food price and availability, and their public health consequences.
  16. Author: Weinstein JL, Phillips V, MacLeod E, Arsenault M, Ferris AM
    Title: A universal product code scanner is a feasible method of measuring household food inventory and food use patterns in low-income families.
    Journal: J Am Diet Assoc. 106(3):443-5
    Date: 2006 Mar
    Abstract: This study assesses the feasibility of using a Universal Product Code (UPC) scanner to record the home food inventory of limited-resource families. Feasibility was based on UPC scanner accuracy, time involved, and researcher/study participant feedback. Program staff members completed a traditional line-item inventory and UPC scan of 5,920 food items during 51 separate visits to the homes of 32 families. Foods reported from the UPC scanner were compared with the manual line-item food inventory. The UPC scanner report had an accuracy of 95.6% (5,661/5,920). Further, the UPC scanning technique offered a 31.8% time savings over the traditional line-item inventory approach. The UPC scanner was easy to use and participants reported that scanning food items was non-intrusive. A UPC scanner is a feasible method of recording the home food inventory, and the accuracy and simplicity of this approach can provide useful information on foods available for consumption within a home.
  17. Author: Powell LM, Auld MC, Chaloupka FJ, O'Malley PM, Johnston LD
    Title: Access to fast food and food prices: relationship with fruit and vegetable consumption and overweight among adolescents.
    Journal: Adv Health Econ Health Serv Res
    Date: 2007
    Abstract: We examine the extent to which food prices and restaurant outlet density are associated with adolescent fruit and vegetable consumption, body mass index (BMI), and the probability of overweight. We use repeated cross-sections of individual-level data on adolescents from the Monitoring the Future Surveys from 1997 to 2003 combined with fast food and fruit and vegetable prices obtained from the American Chamber of Commerce Researchers Association and fast food and full-service restaurant outlet density measures obtained from Dun & Bradstreet. The results suggest that the price of a fast food meal is an important determinant of adolescents' body weight and eating habits: a 10% increase in the price of a fast food meal leads to a 3.0% increase in the probability of frequent fruit and vegetable consumption, a 0.4% decrease in BMI, and a 5.9% decrease in probability of overweight. The price of fruits and vegetables and restaurant outlet density are less important determinants, although these variables typically have the expected sign and are often statistically associated with our outcome measures. Despite these findings, changes in all observed economic and socio-demographic characteristics together only explain roughly one-quarter of the change in mean BMI and one-fifth of the change in overweight over the 1997-2003 sampling period.
  18. Author: Wang R, Shi L
    Title: Access to food outlets and children's nutritional intake in urban China: a difference-in-difference analysis.
    Journal: Ital J Pediatr
    Date: 2012
    Abstract: BACKGROUND: In recent years supermarkets and fast food restaurants have been replacing those "wet markets" of independent vendors as the major food sources in urban China. Yet how these food outlets relate to children's nutritional intake remains largely unexplored. METHOD: Using a longitudinal survey of households and communities in China, this study examines the effect of the urban built food environment (density of wet markets, density of supermarkets, and density of fast food restaurants) on children's nutritional intake (daily caloric intake, daily carbohydrate intake, daily protein intake, and daily fat intake). Children aged 6-18 (n = 185) living in cities were followed from 2004 to 2006, and difference-in-difference models are used to address the potential issue of omitted variable bias. RESULTS: Results suggest that the density of wet markets, rather than that of supermarkets, positively predicts children's four dimensions of nutritional intake. In the caloric intake model and the fat intake model, the positive effect of neighborhood wet market density on children's nutritional intake is stronger with children from households of lower income. CONCLUSION: With their cheaper prices and/or fresher food supply, wet markets are likely to contribute a substantial amount of nutritional intake for children living nearby, especially those in households with lower socioeconomic status. For health officials and urban planners, this study signals a sign of warning as wet markets are disappearing from urban China's food environment.
  19. Author: D'Angelo H, Suratkar S, Song HJ, Stauffer E, Gittelsohn J
    Title: Access to food source and food source use are associated with healthy and unhealthy food-purchasing behaviours among low-income African-American adults in Baltimore City.
    Journal: Public Health Nutr. 14(9):1632-9
    Date: 2011 Sep
    Abstract: OBJECTIVE: Although previous research has shown limited availability of healthy food in low-income urban neighbourhoods, the association between food source use and food-purchasing patterns has not yet been examined. We explored food-purchasing patterns in the context of food source use and food source access factors in low-income areas of Baltimore City. DESIGN: Cross-sectional survey. SETTING: Predominantly low-income neighbourhoods in East and West Baltimore City. SUBJECTS: A total of 175 low-income African-American adult residents. RESULTS: Supermarkets and corner stores were the most frequently used food sources. Walking was the main form of transportation used by 57 % of all respondents, 97 % of corner-store shoppers and 49 % of supermarket shoppers. Multiple linear regression models adjusting for demographic factors, type of food source used and transportation type found that corner-store use was associated with obtaining more unhealthy food (P = 0·005), whereas driving to the food source was associated with obtaining more healthy food (P = 0·012). CONCLUSIONS: The large number of corner stores compared with supermarkets in low-income neighbourhoods makes them an easily accessible and frequently used food source for many people. Interventions to increase the availability and promotion of healthy food in highly accessed corner stores in low-income neighbourhoods are needed. Increased access to transportation may also lead to the use of food sources beyond the corner store, and to increased healthy food purchasing.
  20. Author: Freedman DA, Bell BA
    Title: Access to healthful foods among an urban food insecure population: perceptions versus reality.
    Journal: J Urban Health. 86(6):825-38
    Date: 2009 Nov
    Abstract: The influence of local food environments on the risk for obesity is important overall, but may be particularly important for food insecure populations in urban settings. Access to healthful foods is most limited among racial and ethnic minorities and low-income populations; these same populations experience the highest rates of obesity and food insecurity. Few valid and reliable measures have been developed to assess the quality of local food environments. This research addresses this gap by introducing an inventory for measuring self-reported perceptions of food access and then compares the perceptions measure to objective assessments of local food environments. Data are focused on an urban population experiencing disproportionate rates of food insecurity. The four-item perceptions of food access inventory had high internal consistency (Cronbach's alpha = 0.80). Participants' perceptions of access to healthful foods mirrored the reality of their food environment; however, perceptions of access to alcohol and tobacco were less accurate. Findings suggest that people living in low-income, urban, minority, and food insecure communities can validly assess (in)access to healthful foods. Future research is needed to further validate the perceptions of food access measure introduced and, more importantly, to develop strategies for increasing access to healthful foods in food insecure contexts.
  21. Author: Zenk S
    Title: Activity space environment and dietary and physical activity behaviors: a pilot study
    Journal: Health & Place
    Date:
    Abstract:
  22. Author: MacFarlane A, Crawford D, Ball K, Savige G, Worsley A
    Title: Adolescent home food environments and socioeconomic position.
    Journal: Asia Pac J Clin Nutr. 16(4):748-56
    Date: 2007
    Abstract: Many adolescents have diets that are less than optimal, particularly adolescents of low socioeconomic position (SEP). The determinants of SEP differences in adolescent dietary intake are poorly understood. This study examined the home food environments of adolescents and specifically investigated whether low SEP adolescents have less supportive home meal environments, fewer eating rules and poorer home availability of fruit and vegetables than adolescents of high SEP. A cross-sectional, self-reported survey was administered to 3,264 adolescents in years 7 and 9, from 37 secondary schools in Victoria, Australia. Adolescent perceptions of the home meal environment, eating rules and home food availability were described and compared across SEP, which was measured using maternal education. Maternal education was linked to various aspects of the home meal environment, as well as home food availability, but not to eating rules. Low SEP adolescents were more likely to report that they were always allowed to watch television during meal times, and that unhealthy foods were always or usually available at home. In contrast, high SEP adolescents were more likely to report that vegetables were always served at dinner, that the evening meal was never an unpleasant time and always or usually a time for family connectedness, and that fruit was always or usually available at home. This study highlights aspects of the home food environment that might explain SEP variation in adolescent diets. Feasible ways of increasing home availability of healthy foods, and encouraging home meal environments to be supportive of healthy eating should be explored, particularly in households of low SEP adolescents.
  23. Author: Lewis LB, Sloane DC, Nascimento LM, Diamant AL, Guinyard JJ, Yancey AK, Flynn G, REACH Coalition of the African Americans Building a Legacy of Health Project
    Title: African Americans' access to healthy food options in South Los Angeles restaurants.
    Journal: Am J Public Health. 95(4):668-73
    Date: 2005 Apr
    Abstract: OBJECTIVES: We examined availability and food options at restaurants in less affluent (target area) and more affluent (comparison area) areas of Los Angeles County to compare residents' access to healthy meals prepared and purchased away from home. We also considered environmental prompts that encourage the purchase of various foods. METHODS: We designed an instrument to assess the availability, quality, and preparation of food in restaurants. We also assessed advertisements and promotions, cleanliness, and service for each restaurant. We assessed 659 restaurants: 348 in the target area and 311 in the comparison area. RESULTS: The nutritional resource environment in our target area makes it challenging for residents to eat healthy away from home. Poorer neighborhoods with a higher proportion of African American residents have fewer healthy options available, both in food selections and in food preparation; restaurants in these neighborhoods heavily promote unhealthy food options to residents. CONCLUSIONS: Environment is important in understanding health status: support for the healthy lifestyle associated with lower risks for disease is difficult in poorer communities with a higher proportion of African American residents.
  24. Author: Pettinger C, Holdsworth M, Gerber M
    Title: 'All under one roof?' differences in food availability and shopping patterns in Southern France and Central England.
    Journal: Eur J Public Health. 18(2):109-14
    Date: 2008 Apr
    Abstract: BACKGROUND: This study investigates patterns of food shopping and availability of fruit and vegetables and snack foods in a northern European (Central England) and southern European region (Southern France). METHODS: Two studies were conducted in England (Nottingham) and France (Montpellier): (i) Cross-sectional population surveys using self-administered postal questionnaires to assess type of outlets used for food shopping in random population samples (England: n = 826; Montpellier: n = 766). (ii) Food availability studies to determine: the number of food outlets in defined comparable geographical areas; the number stocking fruit and vegetables, their quality and energy dense snacks. RESULTS: The English respondents used supermarkets most regularly (P
  25. Author: Sadler RC, Gilliland JA, Arku G
    Title: An application of the edge effect in measuring accessibility to multiple food retailer types in southwestern Ontario, Canada.
    Journal: Int J Health Geogr
    Date: 2011
    Abstract: BACKGROUND: Trends in food retailing associated with the consolidation of smaller-format retailers into fewer, larger-format supercentres have left some rural areas with fewer sources of nutritious, affordable food. Access to nutritious, affordable food is essential for good dietary habits and combating health issues such as type-2 diabetes, obesity, and cardiovascular disease. Many studies on food environments use inaccurate or incomplete methods for locating food retailers, which may be responsible for mischaracterising food deserts. This study uses databases of every residence in and every food retailer in and around Middlesex County, Ontario, Canada. Residences were geocoded to their precise address, and network analysis techniques were performed in a geographic information system (GIS) to determine distances between every residence and different types of food retailers (grocery stores, fast food, fruit and vegetable sources, grocery stores plus fruit and vegetable sources, variety stores), both when considering and neglecting facilities outside the area of study, to account for a deficiency in analysis termed the 'edge effect'. RESULTS: Analysis of household accessibility to food outlets by neighbourhood socioeconomic distress level indicated that residents in the most distressed neighbourhoods tended to have better accessibility to all types of food retailers. In the most distressed neighbourhoods, 79 percent of residences were within walking distance of a grocery store, compared to only 10 percent in the least distressed neighbourhoods. When the edge effect was neglected, 37 percent of distance estimates proved inaccurate. Average accessibility to all food retailer types improved dramatically when food outlets adjacent to the study area were considered, thereby controlling for the edge effect. CONCLUSION: By neglecting to consider food retailers just outside study area boundaries, previous studies may significantly over-report the actual distance necessary to travel for food. Research on food access spanning large rural regions requires methods that accurately geocode residents and their food sources. By implementing methods akin to those in this paper, future research will be better able to identify areas with poor food accessibility. Improving identification of food desert communities is a first step in facilitating more effective deployment of food policies and programs in those communities.
  26. Author: Reidpath DD, Burns C, Garrard J, Mahoney M, Townsend M
    Title: An ecological study of the relationship between social and environmental determinants of obesity.
    Journal: Health Place. 8(2):141-5
    Date: 2002 Jun
    Abstract: There is growing concern with the increasing prevalence of obesity in industrialised countries, a trend that is more apparent in the poor than in the rich. In an ecological study, the relationship between an area measure of socioeconomic status (SES) and the density of fast-food outlets was examined as one possible explanation for the phenomenon. It was found that there was a dose-response between SES and the density of fast-food outlets, with people living in areas from the poorest SES category having 2.5 times the exposure to outlets than people in the wealthiest category. The findings are discussed.
  27. Author: Gordon-Larsen P, Guilkey DK, Popkin BM
    Title: An economic analysis of community-level fast food prices and individual-level fast food intake: a longitudinal study.
    Journal: Health Place. 17(6):1235-41
    Date: 2011 Nov
    Abstract: BACKGROUND: While dietary intake is shaped by cost, there is minimal research on the association between community-level food prices and dietary intake. METHODS: We used nationally representative, longitudinal data to examine how community-level food price variation was associated with individual-level fast food intake by race/ethnicity and income across waves II (1996) and III (2001-2002) of the National Longitudinal Study of Adolescent Health (n=11,088) from 158 baseline and 363 follow-up US counties. RESULTS: Negative binomial regression models predicting the number of fast food meals per week show strong relationships between fast food consumption and prices of fast food and soda that varied by gender and race/ethnicity. We found relatively stronger association between food prices and fast food intake for males and relatively greater price sensitivity for soda versus burgers. In the group with strongest associations (black males), a 20% increase in the price of soda was associated with a decrease of 0.25 visits to a fast food restaurant per week. CONCLUSIONS: Economic incentives may be an effective mechanism to address fast food intake in an age group at high risk for obesity.
  28. Author: Jeffery RW, French SA, Raether C, Baxter JE
    Title: An environmental intervention to increase fruit and salad purchases in a cafeteria.
    Journal: Prev Med. 23(6):788-92
    Date: 1994 Nov
    Abstract: BACKGROUND: This study explored the hypothesis that consumption of fruit and salad in a cafeteria setting would increase if the variety of offerings was increased and their price reduced. METHOD: Food purchases in a cafeteria setting were observed during 3 weeks of baseline observation, 3 weeks of intervention, and 3 weeks of return to baseline conditions. Intervention consisted of doubling the number of fruit choices, increasing salad ingredient selections by three, and reducing the price of both fruit and salad by 50%. The primary outcome measures in the study were daily sales of fruit and salad as assessed by cash register receipts. RESULTS: Fruit and salad purchases increased threefold in the intervention period compared to those in the nonintervention periods. Women and those trying to control their weight were most likely to make these nutritious food choices. CONCLUSION: Results of this study support the argument that increasing the number of nutritious food choices and making them more attractive economically may be important to changing food choice behavior. Further exploration of the practical application of the concept is recommended.
  29. Author: French SA, Story M, Fulkerson JA, Hannan P
    Title: An environmental intervention to promote lower-fat food choices in secondary schools: outcomes of the TACOS Study.
    Journal: Am J Public Health. 94(9):1507-12
    Date: 2004 Sep
    Abstract: OBJECTIVES: We evaluated an environmental intervention intended to increase sales of lower-fat foods in secondary school cafeterias. METHODS: Twenty secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-year period. The intervention increased the availability of lower-fat foods and implemented student-based promotions. RESULTS: A steeper rate of increase in sales of lower-fat foods in year 1 (10% intervention vs -2.8% control, P =.002) and a higher percentage of sales of lower-fat foods in year 2 (33.6% intervention vs 22.1% control, P =.04) were observed. There were no significant changes in student self-reported food choices. CONCLUSIONS: School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents.
  30. Author: Whitaker RC, Wright JA, Finch AJ, Psaty BM
    Title: An environmental intervention to reduce dietary fat in school lunches.
    Journal: Pediatrics. 91(6):1107-11
    Date: 1993 Jun
    Abstract: OBJECTIVE: To determine whether making a low-fat entree available as one of two choices in an elementary school lunch program would reduce the fat content of meals selected by children. DESIGN: In this before-after trial, students had a daily choice between two entrees, one of which was sometimes low-fat. For 93% of school days during 14 consecutive school months, daily entree choices were recorded for 619,976 student meals. The fat content of entrees was assessed with a computerized nutrient database supplemented by food manufacturer's data. SETTING: Sixteen elementary schools in the Bellevue (Washington) School District. PARTICIPANTS: The number of students eating school lunch averaged 2440 per day, of whom 25% were less than 185% of poverty. INTERVENTION: After a baseline period of 6 months, the intervention increased the number of days per month when one of the two entrees had 30% or fewer calories from fat. MAIN OUTCOME MEASURES: Data for the entire district were combined to estimate for each month the percent of students who selected low-fat entrees and the percent of calories from fat in the average meal selected by students. RESULTS: During the 6 months before the intervention, a low-fat entree was available on 23% of days; it was selected by 39% of students; and the average meal selected by students had 36% of calories from fat. By the end of the 8-month intervention, a low-fat option was available on 71% of days; it was selected by 29% of students; and the fat content of the average meal dropped from 36% to 30% of calories from fat (P = .02). CONCLUSIONS: In this school district, many students, given the choice, selected low-fat entrees. Recommendations for dietary fat were met simply by the environmental intervention of increasing the availability of low-fat foods.
  31. Author: Van Meter EM, Lawson AB, Colabianchi N, Nichols M, Hibbert J, Porter DE, Liese AD
    Title: An evaluation of edge effects in nutritional accessibility and availability measures: a simulation study.
    Journal: Int J Health Geogr
    Date: 2010
    Abstract: BACKGROUND: This paper addresses the statistical use of accessibility and availability indices and the effect of study boundaries on these measures. The measures are evaluated via an extensive simulation based on cluster models for local outlet density. We define outlet to mean either food retail store (convenience store, supermarket, gas station) or restaurant (limited service or full service restaurants). We designed a simulation whereby a cluster outlet model is assumed in a large study window and an internal subset of that window is constructed. We performed simulations on various criteria including one scenario representing an urban area with 2000 outlets as well as a non-urban area simulated with only 300 outlets. A comparison is made between estimates obtained with the full study area and estimates using only the subset area. This allows the study of the effect of edge censoring on accessibility measures. RESULTS: The results suggest that considerable bias is found at the edges of study regions in particular for accessibility measures. Edge effects are smaller for availability measures (when not smoothed) and also for short range accessibility CONCLUSIONS: It is recommended that any study utilizing these measures should correct for edge effects. The use of edge correction via guard areas is recommended and the avoidance of large range distance-based accessibility measures is also proposed.
  32. Author: Ward D, Hales D, Haverly K, Marks J, Benjamin S, Ball S, Trost S
    Title: An instrument to assess the obesogenic environment of child care centers.
    Journal: Am J Health Behav. 32(4):380-6
    Date: 2008 Jul-Aug
    Abstract: OBJECTIVES: To describe protocol and interobserver agreements of an instrument to evaluate nutrition and physical activity environments at child care. METHODS: Interobserver data were collected from 9 child care centers, through direct observation and document review (17 observer pairs). RESULTS: Mean agreement between observer pairs was 87.26% and 79.29% for the observation and document review, respectively. Items with lower agreement were primarily staff behavior, counting across the day/week, and policy classifications. CONCLUSIONS: Although some revisions are required, the interobserver agreement for the environment and policy assessment and observation (EPAO instrument) appears to be quite good for assessing the nutrition and physical activity environment of child care centers.
  33. Author: Ammerman AS, Ward DS, Benjamin SE, Ball SC, Sommers JK, Molloy M, Dodds JM
    Title: An intervention to promote healthy weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) theory and design.
    Journal: Prev Chronic Dis. 4(3):A67
    Date: 2007 Jul
    Abstract: Health professionals are faced with the growing challenge of addressing childhood overweight. Few overweight prevention efforts have targeted young children, particularly children in child care settings. We describe the theory and development of a novel nutrition and physical activity environmental intervention. On the basis of findings from interviews and focus groups, a review of national recommendations and standards, and a review of the literature, we developed a nutrition and physical activity environmental self-assessment instrument to assess physical activity and nutrition policies and practices in child care settings. An intervention model was built around existing public health infrastructure to support use of the self-assessment instrument and encourage environmental changes at the child care level, and this intervention model became the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program. The NAP SACC program was designed for dissemination and has potential for implementation in many settings. Broad interest in NAP SACC has been expressed by a number of states and institutions, and many groups are using NAP SACC intervention and materials. The NAP SACC program shows promise as a useful approach to promoting healthy weight behaviors in child care settings.
  34. Author: Furey S, Farley H, Strugnell C
    Title: An investigation into the availability and economic accessibility of food items in rural and urban areas of Northern Ireland
    Journal: International journal of consumer studies. 26(4):313-21
    Date: 2002
    Abstract: The question of access to food has three components: physical access to food, financial access to food and access to information about food. This study explores the issue of financial access to food. The affordability of food is a major consideration for consumers, an important marketing tool for retailers and a principal theme in food policy. Research methods included a comparative shopping exercise (shopping basket analysis) in 109 stores across four towns (two urban and two rural) in Northern Ireland. Store type included multiples (major supermarket chains) and symbol group stores (those stores operating under a franchise from one main buying group). Results indicate that in the main it is cheaper to buy from the multiples, shopping from a symbol group store can incur cost penalties of up to 39.4% above the multiples prices. Price disparities, analysed using z-scores, were apparent between towns and across store types. Similarly, an availability audit of foodstuffs portrayed the multiples as the most comprehensive from which to shop, whereas symbol group stores fared poorly in the availability of fresh green vegetables, carcass meat and wholemeal breads. This is an important issue because it plays an integral part in the health inequality debate and also relates to social exclusion. Fundamentally, financial access to food impinges upon the whole question of food-purchasing behaviour in terms of accessibility, affordability and availability. Therefore, economic access to food can be used as a useful precursor to a comprehensive analysis of food access in its entirety. It is also useful as an indicator of social exclusion. This study seeks to inform and influence the food policy debate.
  35. Author: Furey S, Strugnell C, McIlveen H
    Title: An investigation of the potential existence of ``food deserts'' in rural and urban areas of Northern Ireland
    Journal: Agriculture and human values. 18(4):447-57
    Date: 2001
    Abstract: Food Deserts have recently been identified in the United Kingdom. They have been defined by Tessa Jowell, UK Government Health Minister, as an area "where people do not have easy access to healthy, fresh foods, particularly if they are poor and have limited mobility." The above definition is particularly relevant in Northern Ireland, where it is estimated that 32% of households do not have easy access to a car and it is recognized that certain groups in Northern Ireland are amongst the poorest consumers in the United Kingdom. The phenomenon has been further exacerbated by the effect of large grocery retailers locating on the periphery of towns and the subsequent displacement effect of independent retailers in the town center. The resultant effect is such that disadvantaged consumers cannot access fresh, quality, nutritious foods at an affordable price. Preliminary research indicates that certain consumer groups are excluded from equitable shopping provision possibly to the detriment of their health status. Research methodology includes a consumer questionnaire, consumer focus groups, interviews, and comparative shopping exercises that confirm an inability among vulnerable consumer groups to achieve an affordable, healthy diet. This was further complicated by non-car owners' and lower-income family units needing to shop locally and more frequently than their higher-income, car-owner counterparts. This was demonstrated with the use of shopping diaries. Future research to be conducted includes a large-scale survey across Northern Ireland to ascertain accessibility, availability, and affordability of quality fresh foods and to distinguish the consumer groups who are most vulnerable.
  36. Author: Cole S, Filomena S, Morland K
    Title: Analysis of fruit and vegetable cost and quality among racially segregated neighborhoods in Brooklyn, New York
    Journal: Journal of Hunger & Environmental Nutrition. 5(2):202-15
    Date: 2010
    Abstract:
  37. Author: French SA, Wall M, Mitchell NR, Shimotsu ST, Welsh E
    Title: Annotated receipts capture household food purchases from a broad range of sources.
    Journal: Int J Behav Nutr Phys Act
    Date: 2009
    Abstract: BACKGROUND: Accurate measurement of household food purchase behavior (HFPB) is important for understanding its association with household characteristics, individual dietary intake and neighborhood food retail outlets. However, little research has been done to develop measures of HFPB. The main objective of this paper is to describe the development of a measure of HFPB using annotated food purchase receipts. METHODS: Households collected and annotated food purchase receipts for a four-week period as part of the baseline assessment of a household nutrition intervention. Receipts were collected from all food sources, including grocery stores and restaurants. Households (n = 90) were recruited from the community as part of an obesity prevention intervention conducted in 2007-2008 in Minneapolis, Minnesota, USA. Household primary shoppers were trained to follow a standardized receipt collection and annotation protocol. Annotated receipts were mailed weekly to research staff. Staff coded the receipt data and entered it into a database. Total food dollars, proportion of food dollars, and ounces of food purchased were examined for different food sources and food categories. Descriptive statistics and correlations are presented. RESULTS: A total of 2,483 receipts were returned by 90 households. Home sources comprised 45% of receipts and eating-out sources 55%. Eating-out entrees were proportionally the largest single food category based on counts (16.6%) and dollars ($106 per month). Two-week expenditures were highly correlated (r = 0.83) with four-week expenditures. CONCLUSION: Receipt data provided important quantitative information about HFPB from a wide range of sources and food categories. Two weeks may be adequate to reliably characterize HFPB using annotated receipts.
  38. Author: Brener ND, Pejavara A, Barrios LC, Crossett L, Lee SM, McKenna M, Michael S, Wechsler H
    Title: Applying the School Health Index to a nationally representative sample of schools.
    Journal: J Sch Health. 76(2):57-66
    Date: 2006 Feb
    Abstract: The School Health Index (SHI) is a self-assessment and planning tool that helps individual schools identify the strengths and weaknesses of their health policies and programs. To determine the percentage of US schools meeting the recommendations in the SHI, the present study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000. The SHPPS 2000 data were collected through computer-assisted personal interviews with faculty and staff in a nationally representative sample of schools. The SHPPS 2000 questions were then matched to SHI items to calculate the percentage of schools meeting the recommendations in 4 areas: school health and safety policies and environment, health education, physical education and other physical activity programs, and nutrition services. Although schools nationwide are meeting a few SHI items in each of these areas, few schools are addressing the entire breadth of items. A more coordinated approach to school health would help schools reinforce health messages.
  39. Author: Jeffery RW, Baxter J, McGuire M, Linde J
    Title: Are fast food restaurants an environmental risk factor for obesity?
    Journal: Int J Behav Nutr Phys Act
    Date: 2006
    Abstract: OBJECTIVE: Eating at "fast food" restaurants has increased and is linked to obesity. This study examined whether living or working near "fast food" restaurants is associated with body weight. METHODS: A telephone survey of 1033 Minnesota residents assessed body height and weight, frequency of eating at restaurants, and work and home addresses. Proximity of home and work to restaurants was assessed by Global Index System (GIS) methodology. RESULTS: Eating at "fast food" restaurants was positively associated with having children, a high fat diet and Body Mass Index (BMI). It was negatively associated with vegetable consumption and physical activity. Proximity of "fast food" restaurants to home or work was not associated with eating at "fast food" restaurants or with BMI. Proximity of "non-fast food" restaurants was not associated with BMI, but was associated with frequency of eating at those restaurants. CONCLUSION: Failure to find relationships between proximity to "fast food" restaurants and obesity may be due to methodological weaknesses, e.g. the operational definition of "fast food" or "proximity", or homogeneity of restaurant proximity. Alternatively, the proliferation of "fast food" restaurants may not be a strong unique cause of obesity.
  40. Author: Nigg CR, Albright C, Williams R, Nichols C, Renda G, Stevens VJ, Vogt TM
    Title: Are physical activity and nutrition indicators of the checklist of health promotion environments at worksites (CHEW) associated with employee obesity among hotel workers?
    Journal: J Occup Environ Med
    Date: 2010 Jan
    Abstract: OBJECTIVE: Worksites provide opportunities to reach more than 60% of adults in the United States, including populations diverse in race, ethnicity, gender, age, occupation, income, and health status. Employers that provide worksite weight management interventions have the potential to reduce sick leave, health care costs, and workers compensation costs, and increase employee morale and worker efficiency. Hotels specifically, represent a broad cross-section of job categories, and most hotels are staffed and operated similarly around the world. However, from our literature review, there have been no investigations of the association between the hotel environment and employees' obesity. METHODS: For this study, we tested the relationship between environmental factors in hotels and employees' body mass index (BMI). RESULTS: Overall no substantial correlations were found on any environmental variable. However, hotel size affected some relationships. Higher BMI was related to greater number of stairs, stair facilitation, and the healthy eating facilitation variables (excluding nutrition signs or posters) in medium sized hotels. Lower BMI was found with greater stair facilitation in small hotels; and with greater number of physical activity (PA) signs, lunch room nutrition signs, and hotel nutrition signs in large hotels. Unionized status affected only two environmental variables. For unionized hotels, BMI was negatively correlated with PA signs and positively correlated with the healthy eating facilitation. CONCLUSIONS: No logical pattern of association was found between workplace environmental factors and hotel employee BMI levels. Further research should investigate the interaction of the size and structure of the workplace with the impact of environmental efforts to reduce overweight and obesity.
  41. Author: Hayes LR
    Title: Are prices higher for the poor in New York City?
    Journal: Journal of consumer policy. 23(2):127-52
    Date: 2000
    Abstract: Despite earlier evidence to the contrary, recent inquiries appear to reach a consensus that the poor pay more for food. However, these studies utilize samples drawn on the basis of prior knowledge of unfair pricing strategies, proximity of volunteer surveyors, or selected by other non-random methods. This paper revisits the issue of price discrimination by analyzing price data collected using a stratified, random sample design to answer the question of whether prices are higher in poor, urban neighborhoods. Contrary to the recent literature, it is found that market prices in poor neighborhoods are not higher than those in more affluent areas.
  42. Author: Cummins S, Macintyre S
    Title: Are secondary data sources on the neighbourhood food environment accurate? Case-study in Glasgow, UK.
    Journal: Prev Med. 49(6):527-8
    Date: 2009 Dec
    Abstract: OBJECTIVES: To assess the validity of a publicly available list of food stores through field observations of their existence, in order to contribute to research on neighbourhood food environments and health. METHODS: All multiple-owned supermarkets, and a 1 in 8 sample of other food outlets, listed in 1997 and 2007 in the public register of food premises held by Glasgow City Council, Scotland, were visited to establish whether they were trading as foodstores. Postcode sectors in which foodstores were located were classified into least, middling and most deprived neighbourhoods. RESULTS: In total, 325 listed foodstores were visited in 1997 and 508 in 2007. Of these 87% and 88%, respectively, were trading as foodstores. There was a very slight gradient in validity by deprivation, with validity higher in least deprived neighbourhoods, though this was not statistically significant. CONCLUSIONS: There was reasonable, but not perfect, agreement between the list of food premises and field observations, with nearly 1 in 9 of sampled foodstores not present on the ground. Since the use of inaccurate secondary data sources may affect estimates of relationships between the neighbourhood food environment and health, further work is required to establish the validity of such data in different contexts.
  43. Author: Pearce J, Witten K, Hiscock R, Blakely T
    Title: Are socially disadvantaged neighbourhoods deprived of health-related community resources?
    Journal: Int J Epidemiol. 36(2):348-55
    Date: 2007 Apr
    Abstract: BACKGROUND: Recent work in a number of countries has identified growing geographical inequalities in health between deprived and non-deprived neighbourhoods. The health gaps observed cannot be entirely explained by differences in the characteristics of individuals living in those neighbourhoods, which has led to a concerted international public health research effort to determine what contextual features of neighbourhoods matter. This article reports on access to potentially health-promoting community resources across all neighbourhoods in New Zealand. Prevailing international opinion is that access to community resources is worse in deprived neighbourhoods. METHODS: Geographical Information Systems were used to calculate geographical access to 16 types of community resources (including recreational amenities, and shopping, educational and health facilities) in 38,350 small census areas across the country. The distribution of these access measures by neighbourhood socioeconomic deprivation was determined. RESULTS: For 15 out of 16 measures of community resources, access was clearly better in more deprived neighbourhoods. For example, the travel time to large supermarkets was approximately 80% greater in the least deprived quintile of neighbourhoods compared with the most deprived quintile. CONCLUSIONS: These results challenge the widely held, but largely untested, view that areas of high social disadvantage have poorer access to community resources. Poor locational access to community resources among deprived neighbourhoods in New Zealand does not appear to be an explanation of poorer health in these neighbourhoods. If anything, a pro-equity distribution of community resources may be preventing even wider disparities in neighbourhood inequalities in health.
  44. Author: Hurvitz PM, Moudon AV, Rehm CD, Streichert LC, Drewnowski A
    Title: Arterial roads and area socioeconomic status are predictors of fast food restaurant density in King County, WA.
    Journal: Int J Behav Nutr Phys Act
    Date: 2009
    Abstract: BACKGROUND: Fast food restaurants reportedly target specific populations by locating in lower-income and in minority neighborhoods. Physical proximity to fast food restaurants has been associated with higher obesity rates. OBJECTIVE: To examine possible associations, at the census tract level, between area demographics, arterial road density, and fast food restaurant density in King County, WA, USA. METHODS: Data on median household incomes, property values, and race/ethnicity were obtained from King County and from US Census data. Fast food restaurant addresses were obtained from Public Health-Seattle & King County and were geocoded. Fast food density was expressed per tract unit area and per capita. Arterial road density was a measure of vehicular and pedestrian access. Multivariate logistic regression models containing both socioeconomic status and road density were used in data analyses. RESULTS: Over one half (53.1%) of King County census tracts had at least one fast food restaurant. Mean network distance from dwelling units to a fast food restaurant countywide was 1.40 km, and 1.07 km for census tracts containing at least one fast food restaurant. Fast food restaurant density was significantly associated in regression models with low median household income (p
  45. Author: Beto JA, Sheth G, Rewers P
    Title: Assessing food purchase behavior among low-income black and Hispanic clients using a self-reported shelf inventory.
    Journal: J Am Diet Assoc. 97(1):69-70
    Date: 1997 Jan
    Abstract:
  46. Author: Hosler AS, Rajulu DT, Fredrick BL, Ronsani AE
    Title: Assessing retail fruit and vegetable availability in urban and rural underserved communities.
    Journal: Prev Chronic Dis. 5(4):A123
    Date: 2008 Oct
    Abstract: INTRODUCTION: Fruits and vegetables (F&Vs) are important parts of a healthy, balanced diet. Consumption of F&Vs is low among residents of socioeconomically disadvantaged communities. We investigated and compared retail F&V availability in urban and rural underserved communities in New York State. METHODS: All food retail stores and farmers' markets (N = 263) in downtown Albany and in Columbia and Greene counties in New York State were visited and surveyed. Food stores were classified as F&V stores if they stocked more than the minimum varieties of fresh F&Vs defined by this study and as fruit-for-snack stores if they had ready-to-eat fruits only. Store density per 10,000 residents was calculated as a standardized measure of F&V availability. Adjustment weights were created to incorporate store size and business hours into the analysis. RESULTS: The weight-adjusted density (per 10,000 residents) of F&V stores was 4.6 in Albany's minority neighborhood (reference category), 11.4 in Albany's racially mixed neighborhood (P = .01), 7.8 in Columbia and Greene counties' rural community (P = .10), and 9.8 in Columbia and Greene counties' small-town community (P = .02). Significant differences were not found in fruit-for-snack stores, which ranged from 2.0 per 10,000 in the mixed neighborhood to 3.4 per 10,000 in the rural community. CONCLUSION: The urban minority neighborhood had the most barriers to fresh F&Vs in retail outlets, even when compared with the rural community. The low availability of retail F&Vs in the minority neighborhood was attributed to the lack of supermarkets and not the absolute lack of food stores. Public health intervention strategies to increase retail F&V availability in urban minority neighborhoods may aid in mitigating these disparities.
  47. Author: Mujahid MS, Diez Roux AV, Morenoff JD, Raghunathan T
    Title: Assessing the measurement properties of neighborhood scales: from psychometrics to ecometrics.
    Journal: Am J Epidemiol. 165(8):858-67
    Date: 2007 Apr 15
    Abstract: Most studies examining the relation between residential environment and health have used census-derived measures of neighborhood socioeconomic position (SEP). There is a need to identify specific features of neighborhoods relevant to disease risk, but few measures of these features exist, and their measurement properties are understudied. In this paper, the authors 1) develop measures (scales) of neighborhood environment that are important in cardiovascular disease risk, 2) assess the psychometric and ecometric properties of these measures, and 3) examine individual- and neighborhood-level predictors of these measures. In 2004, data on neighborhood conditions were collected from a telephone survey of 5,988 residents at three US study sites (Baltimore, Maryland; Forsyth County, North Carolina; and New York, New York). Information collected covered seven dimensions of neighborhood environment (aesthetic quality, walking environment, availability of healthy foods, safety, violence, social cohesion, and activities with neighbors). Neighborhoods were defined as census tracts or census clusters. Cronbach's alpha coefficient ranged from 0.73 to 0.83, with test-retest reliabilities of 0.60-0.88. Intraneighborhood correlations were 0.28-0.51, and neighborhood reliabilities were 0.64-0.78 for census tracts for most scales. The neighborhood scales were strongly associated with neighborhood SEP but also provided information distinct from neighborhood SEP. These results illustrate a methodological approach for assessing the measurement properties of neighborhood-level constructs and show that these constructs can be measured reliably.
  48. Author: Burgoine T, Alvanides S, Lake AA
    Title: Assessing the obesogenic environment of North East England.
    Journal: Health Place. 17(3):738-47
    Date: 2011 May
    Abstract: This study examines the influence of the environment (defined as 'walkability', food availability and deprivation), alongside individual factors, on Body Mass Index (BMI) and fruit and vegetable consumption. The aim of this unique study was to objectively scrutinise the concept of the obesogenic environment in the North East of England. A set of theoretical obesogenic indices based on the availability of food to consume within and outside of the home, residential density, street connectivity and land use mix were created for North East England. A pooled sample of 893 individuals (aged 16+) over 3 years (2003, 2004, 2005) from the Health Survey for England (HSE) was isolated for further analysis and correlation with the obesogenic indices. Results suggest that few elements of both walkability and food availability are significantly associated with BMI and fruit and vegetable intake. Some methodological concerns are highlighted, such as the appropriateness of walkability calculations for rural areas. The study concludes by strongly recommending a multi-faceted approach be taken when trying to tackle current levels of obesity.
  49. Author: Kirkpatrick SI, Tarasuk V
    Title: Assessing the relevance of neighbourhood characteristics to the household food security of low-income Toronto families.
    Journal: Public Health Nutr. 13(7):1139-48
    Date: 2010 Jul
    Abstract: OBJECTIVE: Although the sociodemographic characteristics of food-insecure households have been well documented, there has been little examination of neighbourhood characteristics in relation to this problem. In the present study we examined the association between household food security and neighbourhood features including geographic food access and perceived neighbourhood social capital. DESIGN: Cross-sectional survey and mapping of discount supermarkets and community food programmes. SETTING: Twelve high-poverty neighbourhoods in Toronto, Ontario, Canada. SUBJECTS: Respondents from 484 low-income families who had children and who lived in rental accommodations. RESULTS: Food insecurity was pervasive, affecting two-thirds of families with about a quarter categorized as severely food insecure, indicative of food deprivation. Food insecurity was associated with household factors including income and income source. However, food security did not appear to be mitigated by proximity to food retail or community food programmes, and high rates of food insecurity were observed in neighbourhoods with good geographic food access. While low perceived neighbourhood social capital was associated with higher odds of food insecurity, this effect did not persist once we accounted for household sociodemographic factors. CONCLUSIONS: Our findings raise questions about the extent to which neighbourhood-level interventions to improve factors such as food access or social cohesion can mitigate problems of food insecurity that are rooted in resource constraints. In contrast, the results reinforce the importance of household-level characteristics and highlight the need for interventions to address the financial constraints that underlie problems of food insecurity.
  50. Author: Lesser LI, Hunnes DE, Reyes P, Arab L, Ryan GW, Brook RH, Cohen DA
    Title: Assessment of food offerings and marketing strategies in the food-service venues at California Children's Hospitals.
    Journal: Acad Pediatr. 12(1):62-7
    Date: 2012 Jan-Feb
    Abstract: OBJECTIVE: Marketing strategies and food offerings in hospital cafeterias can impact dietary choices. Using a survey adapted to assess food environments, the purpose of this study was to assess the food environment available to patients, staff, and visitors at the food-service venues in all 14 California children's hospitals. METHODS: We modified a widely-used tool to create the Nutritional Environment Measures Survey for Cafeterias (NEMS-C) by partnering with a hospital wellness committee. The NEMS-C summarizes the number of healthy items offered, whether calorie labeling is present, if there is signage promoting healthy or unhealthy foods, pricing structure, and the presence of unhealthy combination meals. The range of possible scores is zero (unhealthy) to 37 (healthy). We directly observed the food-service venues at all 14 tertiary care children's hospitals in California and scored them. RESULTS: Inter-rater reliability showed 89% agreement on the assessed items. For the 14 hospitals, the mean score was 19.1 (SD = 4.2; range, 13-30). Analysis revealed that nearly all hospitals offered diet drinks, low-fat milk, and fruit. Fewer than one-third had nutrition information at the point of purchase and 30% had signs promoting healthy eating. Most venues displayed high calorie impulse items such as cookies and ice cream at the registers. Seven percent (7%) of the 384 entrees served were classified as healthy according to NEMS criteria. CONCLUSIONS: Most children's hospitals' food venues received a mid-range score, demonstrating there is considerable room for improvement. Many inexpensive options are underused, such as providing nutritional information, incorporating signage that promotes healthy choices, and not presenting unhealthy impulse items at the register.
  51. Author: Thornton LE, Kavanagh AM
    Title: Association between fast food purchasing and the local food environment.
    Journal: Nutr Diabetes
    Date: 2012
    Abstract: Objective:In this study, an instrument was created to measure the healthy and unhealthy characteristics of food environments and investigate associations between the whole of the food environment and fast food consumption.Design and subjects:In consultation with other academic researchers in this field, food stores were categorised to either healthy or unhealthy and weighted (between +10 and -10) by their likely contribution to healthy/unhealthy eating practices. A healthy and unhealthy food environment score (FES) was created using these weightings. Using a cross-sectional study design, multilevel multinomial regression was used to estimate the effects of the whole food environment on the fast food purchasing habits of 2547 individuals.Results:Respondents in areas with the highest tertile of the healthy FES had a lower likelihood of purchasing fast food both infrequently and frequently compared with respondents who never purchased, however only infrequent purchasing remained significant when simultaneously modelled with the unhealthy FES (odds ratio (OR) 0.52; 95% confidence interval (CI) 0.32-0.83). Although a lower likelihood of frequent fast food purchasing was also associated with living in the highest tertile of the unhealthy FES, no association remained once the healthy FES was included in the models. In our binary models, respondents living in areas with a higher unhealthy FES than healthy FES were more likely to purchase fast food infrequently (OR 1.35; 95% CI 1.00-1.82) however no association was found for frequent purchasing.Conclusion:Our study provides some evidence to suggest that healthier food environments may discourage fast food purchasing.
  52. Author: Arcan C, Kubik MY, Fulkerson JA, Davey C, Story M
    Title: Association between food opportunities during the school day and selected dietary behaviors of alternative high school students, Minneapolis/Saint Paul, Minnesota, 2006.
    Journal: Prev Chronic Dis. 8(1):A08
    Date: 2011 Jan
    Abstract: INTRODUCTION: Availability of competitive foods in schools has been linked to unhealthful dietary behaviors of students. Little is known about the food environment of alternative high schools, schools that enroll students at risk of academic failure. We examined correlations between food opportunities during the school day and selected dietary behaviors of students attending alternative high schools. METHODS: Baseline data were collected in fall 2006 as part of the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention trial. Students (n = 145) attending 6 alternative high schools in Minneapolis/Saint Paul, Minnesota, completed a survey on food opportunities during the school day and selected dietary behaviors. We used mixed-model multivariate cross-sectional analysis and adjusted for demographic characteristics to examine associations of interest. RESULTS: Food opportunities during the school day were positively associated with overall consumption of sugar-sweetened beverages, high-fat foods, and fast-food restaurant use. CONCLUSION: Having many food opportunities during the school day at alternative high schools was linked to the consumption of foods and beverages high in sugar and fat and low in nutrients. School-based interventions should focus on changing the food environment in alternative high schools to decrease less healthful eating opportunities and to increase the availability of healthful foods and beverages.
  53. Author: Sharkey JR, Horel S, Han D, Huber JC Jr
    Title: Association between neighborhood need and spatial access to food stores and fast food restaurants in neighborhoods of colonias.
    Journal: Int J Health Geogr
    Date: 2009
    Abstract: OBJECTIVE: To determine the extent to which neighborhood needs (socioeconomic deprivation and vehicle availability) are associated with two criteria of food environment access: 1) distance to the nearest food store and fast food restaurant and 2) coverage (number) of food stores and fast food restaurants within a specified network distance of neighborhood areas of colonias, using ground-truthed methods. METHODS: Data included locational points for 315 food stores and 204 fast food restaurants, and neighborhood characteristics from the 2000 U.S. Census for the 197 census block group (CBG) study area. Neighborhood deprivation and vehicle availability were calculated for each CBG. Minimum distance was determined by calculating network distance from the population-weighted center of each CBG to the nearest supercenter, supermarket, grocery, convenience store, dollar store, mass merchandiser, and fast food restaurant. Coverage was determined by calculating the number of each type of food store and fast food restaurant within a network distance of 1, 3, and 5 miles of each population-weighted CBG center. Neighborhood need and access were examined using Spearman ranked correlations, spatial autocorrelation, and multivariate regression models that adjusted for population density. RESULTS: Overall, neighborhoods had best access to convenience stores, fast food restaurants, and dollar stores. After adjusting for population density, residents in neighborhoods with increased deprivation had to travel a significantly greater distance to the nearest supercenter or supermarket, grocery store, mass merchandiser, dollar store, and pharmacy for food items. The results were quite different for association of need with the number of stores within 1 mile. Deprivation was only associated with fast food restaurants; greater deprivation was associated with fewer fast food restaurants within 1 mile. CBG with greater lack of vehicle availability had slightly better access to more supercenters or supermarkets, grocery stores, or fast food restaurants. Increasing deprivation was associated with decreasing numbers of grocery stores, mass merchandisers, dollar stores, and fast food restaurants within 3 miles. CONCLUSION: It is important to understand not only the distance that people must travel to the nearest store to make a purchase, but also how many shopping opportunities they have in order to compare price, quality, and selection. Future research should examine how spatial access to the food environment influences the utilization of food stores and fast food restaurants, and the strategies used by low-income families to obtain food for the household.
  54. Author: Erinosho TO, Oh AY, Moser RP, Davis KL, Nebeling LC, Yaroch AL
    Title: Association between perceived food environment and self-efficacy for fruit and vegetable consumption among US adults, 2007.
    Journal: Prev Chronic Dis
    Date: 2012
    Abstract: Consumption of diets high in fruits and vegetables is associated with reduced risk of chronic diseases, and self-efficacy and the food environment influence consumption of fruits and vegetables. We analyzed data from 3,021 non-Hispanic white (n = 2,187) and non-Hispanic black (n = 834) US adults who responded to National Cancer Institute's 2007 Food Attitudes and Behaviors Survey to assesss self-efficacy and perception of the food environment. Adults who perceived that it was easy to obtain fruits and vegetables when they ate out reported greater self-efficacy to consume fruits and vegetables than did participants who did not have this perception (odds ratio [OR] = 1.56, 95% confidence interval [CI], 1.24-1.97). However, adults who perceived that fruits were not available at restaurants where they ate out (OR = 0.65, 95% CI, 0.50-0.86) or that other (ie, non-fast food) restaurants offered enough choices of fruits and vegetables on their menus (OR = 0.76, 95% CI, 0.61-0.97) reported lower self-efficacy to consume fruits and vegetables than did participants who did not have these perceptions. Findings suggest that perceptions about availability of fruits and vegetables in restaurants are important to promote self-efficacy for consuming fruits and vegetables among adults.
  55. Author: Sharkey JR, Johnson CM, Dean WR, Horel SA
    Title: Association between proximity to and coverage of traditional fast-food restaurants and non-traditional fast-food outlets and fast-food consumption among rural adults.
    Journal: Int J Health Geogr
    Date: 2011
    Abstract: OBJECTIVE: The objective of this study is to examine the relationship between residential exposure to fast-food entrées, using two measures of potential spatial access: proximity (distance to the nearest location) and coverage (number of different locations), and weekly consumption of fast-food meals. METHODS: Traditional fast-food restaurants and non-traditional fast-food outlets, such as convenience stores, supermarkets, and grocery stores, from the 2006 Brazos Valley Food Environment Project were linked with individual participants (n = 1409) who completed the nutrition module in the 2006 Brazos Valley Community Health Assessment. RESULTS: Increased age, poverty, increased distance to the nearest fast food, and increased number of different traditional fast-food restaurants, non-traditional fast-food outlets, or fast-food opportunities were associated with less frequent weekly consumption of fast-food meals. The interaction of gender and proximity (distance) or coverage (number) indicated that the association of proximity to or coverage of fast-food locations on fast-food consumption was greater among women and opposite of independent effects. CONCLUSIONS: Results provide impetus for identifying and understanding the complex relationship between access to all fast-food opportunities, rather than to traditional fast-food restaurants alone, and fast-food consumption. The results indicate the importance of further examining the complex interaction of gender and distance in rural areas and particularly in fast-food consumption. Furthermore, this study emphasizes the need for health promotion and policy efforts to consider all sources of fast-food as part of promoting healthful food choices.
  56. Author: Fox MK, Dodd AH, Wilson A, Gleason PM
    Title: Association between school food environment and practices and body mass index of US public school children.
    Journal: J Am Diet Assoc. 109(2 Suppl):S108-17
    Date: 2009 Feb
    Abstract: BACKGROUND: With the ongoing interest in implementing school policies to address the problem of childhood obesity, there is a need for information about the relationships between school food environments and practices and children's weight status. OBJECTIVE: To examine the association between school food environments and practices and children's body mass index (BMI; calculated as kg/m(2)). DESIGN: The study used data from the third School Nutrition Dietary Assessment Study, a cross-sectional study that included a national sample of public school districts, schools, and children in the 2004-2005 school year. Data on school food environments and practices were collected through on-site observations and interviews with school principals, and children were weighed and measured by trained data collectors. SUBJECTS/SETTING: The study included 287 schools and 2,228 children in grades 1 through 12. STATISTICAL ANALYSES PERFORMED: Ordinary least squares regression was used to estimate the associations between school food environments and practices and BMI z scores and logistic regression was used to estimate associations between school food environments and practices and the likelihood of obesity (defined as BMI-for-age >or=95th percentile). Models included controls for sociodemographic characteristics of schools and children, to control for potential endogeneity of school environments and practices, as well as controls for children's dietary and physical activity behaviors outside of school. RESULTS: Among elementary school children, offering french fries and similar potato products in subsidized school meals more than once per week and offering dessert more than once per week were each associated with a significantly higher likelihood of obesity. Among middle school children, the availability of low-nutrient, energy-dense foods in vending machines in or near the foodservice area was associated with a higher BMI z score, and the availability of such foods for à la carte purchase in the cafeteria was associated with a lower BMI z score. CONCLUSIONS: Findings from this analysis suggest that limiting children's access to low-nutrient, energy-dense foods at school may hold promise as a tactic for reducing children's total calorie intake and controlling children's BMI.
  57. Author: Seliske LM, Pickett W, Boyce WF, Janssen I
    Title: Association between the food retail environment surrounding schools and overweight in Canadian youth.
    Journal: Public Health Nutr. 12(9):1384-91
    Date: 2009 Sep
    Abstract: INTRODUCTION: There is growing interest in how the physical environment influences obesity. Few studies have considered how the food retail environment surrounding schools influences overweight in students. OBJECTIVE: To determine whether there is a relationship between food retailers surrounding schools and overweight among Canadian youth. DESIGN: Cross-sectional study. SETTING/METHODS/SUBJECTS: The number of food retailers was obtained within a 1 km and 5 km radius around 178 schools in Canada. Retailers included full-service restaurants, fast-food restaurants, sub/sandwich retailers, doughnut/coffee shops, convenience stores and grocery stores. An index of total food retailer exposure was also created. Multilevel analyses were used to control for individual- and area-level covariates. RESULTS: None of the individual food retailers was associated with an increased likelihood of overweight. The total food retailer index was most strongly related to overweight, but in the opposite direction to that hypothesized. At 1 km, students attending schools with at least one food retailer had a lower relative odds of overweight (OR = 0.70, 95% CI 0.61, 0.81). At 5 km, students attending schools with the highest exposure to the total food retailer index had a lower relative odds of overweight (OR = 0.56, 95% CI 0.47, 0.68) compared with students attending schools with no exposure. CONCLUSIONS: Exposure to various types of food retailers in school neighbourhoods was not associated with an increased likelihood of overweight in Canadian school-aged youth. The opportunity to make healthy choices from a variety of options and the unique Canadian context may explain the findings.
  58. Author: Daniel M, Paquet C, Auger N, Zang G, Kestens Y
    Title: Association of fast-food restaurant and fruit and vegetable store densities with cardiovascular mortality in a metropolitan population.
    Journal: Eur J Epidemiol. 25(10):711-9
    Date: 2010 Oct
    Abstract: Most studies that link neighbourhoods to disease outcomes have represented neighbourhoods as area-level socioeconomic status. Where objective contextual attributes of urban environments have been measured, few studies of food availability have evaluated mortality as an outcome. We sought to estimate associations between the availability of fast-food restaurants (FFR), fruit and vegetable stores (FVS), and cardiovascular mortality in an urban area. Food business data were extracted from a validated commercial database containing all businesses and services in the Montréal Census Metropolitan Area (MCMA). Mortality data (1999-2003) were obtained for the MCMA (3.4 million residents). Directly standardised mortality rates for cardiovascular deaths (n = 30,388) and non-cardiovascular deaths (all causes - cardiovascular deaths) (n = 91,132) and FFR and FVS densities (n/km²) were analysed for 845 census tracts. Generalised additive models and generalised linear models were used to analyse food source-mortality relationships. FVS density was not associated with cardiovascular or non-cardiovascular mortality (relative risk (RR) = 1.02, 95% confidence interval (CI): 0.76, 1.36, and RR = 1.14, 95% CI: 0.87, 1.50, respectively). Higher FFR density was associated with mortality in bivariate and multivariable analyses. Relative risks of death (95% CI) per 10% increase in FFR density were similar for both cardiovascular and non-cardiovascular mortality: 1.39 (1.19, 1.63) and 1.36 (1.18, 1.57), respectively, accounting for socio-demographic covariates. FFR density is associated with cardiovascular mortality but this relationship is no different in magnitude than that for non-cardiovascular mortality. These results together with null associations between FVS density and mortality do not support a major role for food source availability in cardiovascular outcomes.
  59. Author: Downs SM, Arnold A, Marshall D, McCargar LJ, Raine KD, Willows ND
    Title: Associations among the food environment, diet quality and weight status in Cree children in Québec.
    Journal: Public Health Nutr. 12(9):1504-11
    Date: 2009 Sep
    Abstract: OBJECTIVE: To explore the relationship among children's diet quality, weight status and food environment in subarctic Canada. DESIGN: In the cross-sectional study, children's BMI was calculated, diet quality was assessed using three 24 h dietary recalls and children were asked about their home food environment and source of meals. SETTING: Two Aboriginal Cree communities in northern Québec. SUBJECTS: Two hundred and one children in grades 4-6. RESULTS: The majority (64.2%) of children were overweight (29.9%) or obese (34.3%). Weight status was not associated with reported restaurant meal frequency or the home food environment. The 18% of children who consumed three or more restaurant meals in the three days of recall consumed, on average, 2004 kJ (479 kcal) more energy daily than children consuming no restaurant meals and had higher intakes of fat, saturated fat, Ca and soda. Most foods contributing to energy and dietary fat were energy-dense market foods of low nutritional value such as sweetened beverages and snack foods. Only 68% of children reported often having fruits and vegetables in the home and 98.5% of children consumed less than 5 fruits and vegetables daily. Many children (42.8%) were at risk of Zn inadequacy. Only 19% of children consumed 2 or more servings of milk daily, and the mean intakes of Ca and vitamin D were below the recommended adequate intake. Traditional game meat was consumed infrequently, but contributed significantly to Fe and Zn intake. CONCLUSIONS: Childhood obesity in subarctic communities prevailed in a food environment typified by high-energy-density commercial foods of low nutritional value.
  60. Author: Powell LM, Auld MC, Chaloupka FJ, O'Malley PM, Johnston LD
    Title: Associations between access to food stores and adolescent body mass index.
    Journal: Am J Prev Med. 33(4 Suppl):S301-7
    Date: 2007 Oct
    Abstract: BACKGROUND: Environmental factors such as the availability of local-area food stores may be important contributors to the increasing rate of obesity among U.S. adolescents. METHODS: Repeated cross-sections of individual-level data on adolescents drawn from the Monitoring the Future surveys linked by geocode identifiers to data on food store availability were used to examine associations between adolescent weight and the availability of four types of grocery food stores that include chain supermarkets, nonchain supermarkets, convenience stores, and other grocery stores, holding constant a variety of other individual- and neighborhood-level influences. RESULTS: Increased availability of chain supermarkets was statistically significantly associated with lower adolescent Body Mass Index (BMI) and overweight and that greater availability of convenience stores was statistically significantly associated with higher BMI and overweight. The association between supermarket availability and weight was larger for African-American students compared to white or Hispanic students and larger for students in households in which the mother worked full time. CONCLUSIONS: Economic and urban planning land use policies which increase the availability of chain supermarkets may have beneficial effects on youths' weight outcomes.
  61. Author: Wyse R, Campbell E, Nathan N, Wolfenden L
    Title: Associations between characteristics of the home food environment and fruit and vegetable intake in preschool children: a cross-sectional study.
    Journal: BMC Public Health
    Date: 2011
    Abstract: BACKGROUND: Early childhood is critical to the development of lifelong food habits. Given the high proportion of children with inadequate fruit and vegetable consumption, identification of modifiable factors associated with higher consumption may be useful in developing interventions to address this public health issue. This study aimed to identify the characteristics of the home food environment that are associated with higher fruit and vegetable consumption in a sample of Australian preschool children. METHODS: A cross-sectional telephone survey was conducted with 396 parents of 3 to 5 year-old children attending 30 preschools within the Hunter region, New South Wales, Australia. Children's fruit and vegetable consumption was measured using a valid and reliable subscale from the Children's Dietary Questionnaire. Associations were investigated between children's fruit and vegetable intake and characteristics of the home food environment including parental role-modeling, parental providing behaviour, fruit and vegetable availability, fruit and vegetable accessibility, pressure to eat, family eating policies and family mealtime practices. Characteristics of the home food environment that showed evidence of an association with children's fruit and vegetable consumption in simple regression models were entered into a backwards stepwise multiple regression analysis. The multiple regression analysis used generalised linear mixed models, controlled for parental education, household income and child gender, and was adjusted for the correlation between children's fruit and vegetable consumption within a preschool. RESULTS: The multiple regression analysis found positive associations between children's fruit and vegetable consumption and parental fruit and vegetable intake (p=0.005), fruit and vegetable availability (p=0.006) and accessibility (p=0.012), the number of occasions each day that parents provided their child with fruit and vegetables (p
  62. Author: Boutelle KN, Birkeland RW, Hannan PJ, Story M, Neumark-Sztainer D
    Title: Associations between maternal concern for healthful eating and maternal eating behaviors, home food availability, and adolescent eating behaviors.
    Journal: J Nutr Educ Behav. 39(5):248-56
    Date: 2007 Sep-Oct
    Abstract: OBJECTIVE: Evaluate the relationship between maternal concern for healthful eating and maternal and adolescent dietary intake, eating behavior, and home food environment. DESIGN: Mothers of a subsample of adolescents who participated in a school-based survey (Project Eating Among Teens [EAT]) completed telephone interviews. PARTICIPANTS: Seven hundred fourteen mother-adolescent pairs. VARIABLES MEASURED: Mothers responded to a question regarding how much they are personally concerned with eating healthfully, and adolescents responded to a question regarding perceptions of their mothers' concern about eating healthfully. Dependent variables included adolescent and parent food intake and home food environment. ANALYSIS: Multinomial cumulative logistic regression models, adjusted for maternal race/ethnicity, socioeconomic status (SES), and adolescent grade level. RESULTS: A positive association was found between maternal concern for healthful eating and maternal fruit and vegetable intake, maternal breakfast and lunch consumption, and serving fruits and vegetables in the home. Maternal concern for healthful eating (as reported by mothers) was not associated with adolescent behavior. Adolescent perception of maternal concern for healthful eating was positively associated with adolescent fruit and vegetable intake. CONCLUSIONS AND IMPLICATIONS: Mother's concern for healthful eating is associated with maternal eating behavior and the home food environment. Adolescent perceptions of maternal attitudes are a stronger predictor than actual maternal attitudes of adolescent behavior. Parents should be encouraged to share their beliefs regarding the importance of healthful eating with their adolescents.
  63. Author: Izumi BT, Zenk SN, Schulz AJ, Mentz GB, Wilson C
    Title: Associations between neighborhood availability and individual consumption of dark-green and orange vegetables among ethnically diverse adults in Detroit.
    Journal: J Am Diet Assoc. 111(2):274-9
    Date: 2011 Feb
    Abstract: Diets rich in dark-green and orange vegetables have been associated with a reduction in chronic diseases. However, most Americans do not consume the number of daily servings recommended by the 2005 Dietary Guidelines for Americans. An increasing number of studies suggest that changes to the neighborhood food environment may be critical to achieving population-wide improvements in eating. The objective of this study was to examine the relationship between observed neighborhood availability and individual consumption of dark-green and orange vegetables among low- to moderate-income and ethnically diverse adults in Detroit. This study used a cross-sectional design that drew upon a 2002-2003 community survey and 2002 in-person audit of food stores. A total of 919 adults (mean age 46.3 years, 52.2% female) including African Americans (56.7 %), Latinos (22.2%), and whites (18.7%) residing in three Detroit communities participated in the survey. Two-level weighted, hierarchical linear regression was used to analyze the data. On average, survey respondents ate 0.61 daily servings of dark-green and orange vegetables. Residents of neighborhoods with no stores carrying five or more varieties of dark-green and orange vegetables were associated with an average of 0.17 fewer daily servings of these foods compared with residents of neighborhoods with two stores carrying five or more varieties of dark-green and orange vegetables (P=0.047). These findings suggest that living in a neighborhood with multiple opportunities to purchase dark-green and orange vegetables may make an important contribution toward meeting recommended intakes.
  64. Author: MacFarlane A, Crawford D, Worsley A
    Title: Associations between parental concern for adolescent weight and the home food environment and dietary intake.
    Journal: J Nutr Educ Behav. 42(3):152-60
    Date: 2010 May-Jun
    Abstract: OBJECTIVE: Examine associations between parental concern about adolescent weight and adolescent perceptions of their dietary intake, home food availability, family mealtime environment, and parents' feeding practices. DESIGN: Cross-sectional study. SETTING: Adolescents, aged 12-15 years from 37 secondary schools in Victoria, Australia, and their parents completed surveys in 2004-2005. PARTICIPANTS: 1,448 adolescent-parent pairs. MAIN OUTCOME MEASURES: Parental concern about adolescent weight; adolescent perceptions of their food intake and home food environment. ANALYSIS: Chi-square tests, exploratory factor analysis, independent t tests (P
  65. Author: Hanson NI, Neumark-Sztainer D, Eisenberg ME, Story M, Wall M
    Title: Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods.
    Journal: Public Health Nutr. 8(1):77-85
    Date: 2005 Feb
    Abstract: OBJECTIVE: This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods. DESIGN: Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes. SUBJECTS/SETTING: The study sample included 902 adolescents and their parent or guardian. RESULTS: Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend=2.70, P
  66. Author: Robinson-O'Brien R, Burgess-Champoux T, Haines J, Hannan PJ, Neumark-Sztainer D
    Title: Associations between school meals offered through the National School Lunch Program and the School Breakfast Program and fruit and vegetable intake among ethnically diverse, low-income children.
    Journal: J Sch Health. 80(10):487-92
    Date: 2010 Oct
    Abstract: BACKGROUND: Despite evidence in support of the health benefits associated with fruit and vegetable (FV) intake, national data indicate that FV consumption among school-aged children is below recommended levels, particularly among low-income children. School meals offered through the School Breakfast Program and National School Lunch Program can provide an important contribution to child FV intake. This study examines the proportion of fruits and vegetables consumed from school meals programs among ethnically diverse, low socioeconomic status children. METHODS: Participants (n = 103) included fourth to sixth grade boys and girls from 4 urban elementary schools in St. Paul, Minnesota serving primarily low-income populations. Research staff interviewed children during school hours and recorded dietary intake via 24-hour recall. Analysis included descriptive statistics using cross tabulations and means. RESULTS: Average reported mean (SD) daily FV intake was 3.6 (2.5) servings, with 80% of children consuming fewer than 5 daily servings of FV. On average, children consumed over half of their daily FV intake within school. Children with low FV intake (
  67. Author: Koui E, Jago R
    Title: Associations between self-reported fruit and vegetable consumption and home availability of fruit and vegetables among Greek primary-school children.
    Journal: Public Health Nutr. 11(11):1142-8
    Date: 2008 Nov
    Abstract: OBJECTIVE: To examine whether the self-reported fruit and vegetable consumption of Greek primary-school children is associated with the home availability of fruit and vegetables. DESIGN: Cross-sectional study. SETTING: Five primary schools in the city of Pyrgos in south-west Greece. SUBJECTS: One hundred and sixty-seven students in fifth and sixth grades. METHODS: Fruit and vegetable consumption was assessed using an FFQ. Home availability of fruit and vegetables was assessed using a modified version of a US home availability questionnaire. Participant BMI was assessed and parental education obtained by self-report. Hierarchical regression models that took account of the clustering of participants in schools were used to examine the relationship between consumption and availability after controlling for parental education and BMI. RESULTS: Regression analyses showed that home availability of fruit was a significant predictor of consumption (beta=0.524, Z=9.77, P
  68. Author: Campbell KJ, Crawford DA, Salmon J, Carver A, Garnett SP, Baur LA
    Title: Associations between the home food environment and obesity-promoting eating behaviors in adolescence.
    Journal: Obesity (Silver Spring). 15(3):719-30
    Date: 2007 Mar
    Abstract: OBJECTIVE: This study examines relationships between multiple aspects of the home food environment and obesity-promoting characteristics of 12- to 13-year-old adolescents' diets, specifically frequency of consumption of high-energy fluids, sweet snacks, savory snacks, and take-out foods. RESEARCH METHODS: This was a cross-sectional study including 347 adolescents 12 to 13 years of age and their parents. Data were collected via self-completed surveys. The adolescents' diets were assessed using a Food Frequency Questionnaire derived from existing age-appropriate National Nutrition Survey data. An extensive range of domains within the home food environment were assessed. Bivariate linear regression analyses were run split by gender. Forced entry multiple linear regression analyses (adjusting for all variables significant in bivariate analyses as well as for maternal education) were also performed, stratified by the sex of the child. RESULTS: The influence of mothers, either as models for eating behaviors or as the providers of food, was pervasive. Mothers' intake of high-energy fluids (p = 0.003), sweet snacks (p = 0.010), savory snacks (p = 0.008), and take-out food (p = 0.007) was positively associated with boys' intake of all these foods. In addition, mothers' intake of high-energy fluids was positively associated with daughters' consumption of these drinks (p = 0.025). Furthermore, availability of unhealthy foods at home was positively associated with girls' sweet snack (p = 0.001), girls' savory snack (p
  69. Author: Minaker LM, Storey KE, Raine KD, Spence JC, Forbes LE, Plotnikoff RC, McCargar LJ
    Title: Associations between the perceived presence of vending machines and food and beverage logos in schools and adolescents' diet and weight status.
    Journal: Public Health Nutr. 14(8):1350-6
    Date: 2011 Aug
    Abstract: OBJECTIVE: The increasing prevalence of obesity among youth has elicited calls for schools to become more active in promoting healthy weight. The present study examined associations between various aspects of school food environments (specifically the availability of snack- and beverage-vending machines and the presence of snack and beverage logos) and students' weight status, as well as potential influences of indices of diet and food behaviours. DESIGN: A cross-sectional, self-administered web-based survey. A series of multinomial logistic regressions with generalized estimating equations (GEE) were constructed to examine associations between school environment variables (i.e. the reported presence of beverage- and snack-vending machines and logos) and self-reported weight- and diet-related behaviours. SETTING: Secondary schools in Alberta, Canada. SUBJECTS: A total of 4936 students from grades 7 to 10. RESULTS: The presence of beverage-vending machines in schools was associated with the weight status of students. The presence of snack-vending machines and logos was associated with students' frequency of consuming vended goods. The presence of snack-vending machines and logos was associated with the frequency of salty snack consumption. CONCLUSIONS: The reported presence of snack- and beverage-vending machines and logos in schools is related to some indices of weight status, diet and meal behaviours but not to others. The present study supported the general hypothesis that the presence of vending machines in schools may affect students' weight through increased consumption of vended goods, but notes that the frequency of 'junk' food consumption does not seem to be related to the presence of vending machines, perhaps reflecting the ubiquity of these foods in the daily lives of students.
  70. Author: Lamichhane AP, Puett R, Porter DE, Bottai M, Mayer-Davis EJ, Liese AD
    Title: Associations of built food environment with body mass index and waist circumference among youth with diabetes.
    Journal: Int J Behav Nutr Phys Act
    Date: 2012
    Abstract: BACKGROUND: Youth with diabetes are at increased risk for obesity and cardiovascular disease complications. However, less is known about the influence of built food environment on health outcomes in this population. The aim of this study was to explore the associations of accessibility and availability of supermarkets and fast food outlets with Body Mass Index (BMI) z-score and waist circumference among youth with diabetes. METHODS: Information on residential location and adiposity measures (BMI z-score and waist circumference) for 845 youths with diabetes residing in South Carolina was obtained from the South Carolina site of the SEARCH for Diabetes in Youth study. Food outlets data obtained from the South Carolina Department of Health and Environmental Control and InfoUSA were merged based on names and addresses of the outlets. The comprehensive data on franchised supermarket and fast food outlets was then used to construct three accessibility and availability measures around each youth's residence. RESULTS: Increased number and density of chain supermarkets around residence location were associated with lower BMI z-score and waist circumference among youth with diabetes. For instance, for a female child of 10 years of age with height of 54.2 inches and weight of 70.4 pounds, lower supermarket density around residence location was associated with about 2.8-3.2 pounds higher weight, when compared to female child of same age, height and weight with highest supermarket density around residence location. Similarly, lower supermarket density around residence location was associated with a 3.5-3.7 centimeter higher waist circumference, when compared to residence location with the highest supermarket density. The associations of number and density of chain fast food outlets with adiposity measures, however, were not significant. No significant associations were observed between distance to the nearest supermarket and adiposity measures. However, contrary to our expectation, increased distance to the nearest fast food outlet was associated with higher BMI z-score, but not with waist circumference. CONCLUSIONS: Food environments conducive to healthy eating may significantly influence health behaviors and outcomes. Efforts to increase the availability of supermarkets providing options/selections for health-promoting foods may significantly improve the dietary intake and reduce adiposity among youth with diabetes.
  71. Author: Lamichhane AP, Mayer-Davis EJ, Puett R, Bottai M, Porter DE, Liese AD
    Title: Associations of built food environment with dietary intake among youth with diabetes.
    Journal: J Nutr Educ Behav. 44(3):217-24
    Date: 2012 May-Jun
    Abstract: OBJECTIVE: To evaluate the associations of supermarket and fast-food outlet accessibility and availability with dietary intake among youth with diabetes. DESIGN: Subjects' residential location and dietary intake was obtained from the SEARCH for Diabetes in Youth study. Food outlet data obtained from the South Carolina Department of Health and Environmental Control and InfoUSA were merged based on names and addresses of the outlets. The comprehensive data were then used to construct accessibility and availability measures for each participant. SETTING: State of South Carolina. PARTICIPANTS: Three hundred fifty-nine youths with diabetes (10 years old and older) from the SEARCH for Diabetes in Youth study. PHENOMENA OF INTEREST: Supermarket and fast-food outlet accessibility and availability; dietary intake represented by Dietary Approaches to Stop Hypertension (DASH) score. ANALYSIS: Generalized estimating equations analyses. RESULTS: Increased availability and accessibility of supermarkets were significantly associated with higher DASH score, even after adjusting for individual-level correlates, urbanicity, and fast-food outlet accessibility or availability. Fast-food accessibility, however, was associated only with specific food groups (meat, sweets, and low-fat dairy intake), not with the DASH score. CONCLUSIONS AND IMPLICATIONS: Efforts to promote environments conducive to healthful eating may significantly improve the overall dietary intake and reduce diet-related health complications among youth with diabetes.
  72. Author: Hickson DA, Diez Roux AV, Smith AE, Tucker KL, Gore LD, Zhang L, Wyatt SB
    Title: Associations of fast food restaurant availability with dietary intake and weight among African Americans in the Jackson Heart Study, 2000-2004.
    Journal: Am J Public Health
    Date: 2011 Dec
    Abstract: OBJECTIVES: We examined the associations of fast food restaurant (FFR) availability with dietary intake and weight among African Americans in the southeastern United States. METHODS: We investigated cross-sectional associations of FFR availability with dietary intake and body mass index (BMI) and waist circumference in 4740 African American Jackson Heart Study participants (55.2 ± 12.6 years, 63.3% women). We estimated FFR availability using circular buffers with differing radii centered at each participant's geocoded residential location. RESULTS: We observed no consistent associations between FFR availability and BMI or waist circumference. Greater FFR availability was associated with higher energy intake among men and women younger than 55 years, even after adjustment for individual socioeconomic status. For each standard deviation increase in 5-mile FFR availability, the energy intake increased by 138 kilocalories (confidence interval [CI] = 70.53, 204.75) for men and 58 kilocalories (CI = 8.55, 105.97) for women. We observed similar associations for the 2-mile FFR availability, especially in men. FFR availability was also unexpectedly positively associated with total fiber intake. CONCLUSIONS: FFR availability may contribute to greater energy intake in younger African Americans who are also more likely to consume fast food.
  73. Author: Lipsky LM, Nansel TR, Haynie DL, Mehta SN, Laffel LM
    Title: Associations of food preferences and household food availability with dietary intake and quality in youth with type 1 diabetes.
    Journal: Appetite. 59(2):218-23
    Date: 2012 Oct
    Abstract: The objective of this study was to examine associations of food preferences and availability with dietary intake in youth with type 1 diabetes, for whom dietary intake and quality are essential to disease management. Youth (n=252, age 13.2±2.8 y, diabetes duration 6.3±3.4 y) reported preferences and parents reported household availability for 61 food items categorized as fruit, vegetables, whole grains, refined grains and fats/sweets. Youth energy-adjusted daily servings of food groups, Healthy Eating Index-2005 and Nutrient Rich Foods 9.3 scores were calculated from 3-day diet records. Associations of dietary intake and quality variables with preference and availability of all food groups were evaluated by linear regressions adjusted for sociodemographic characteristics. Fruit and whole grain intake were positively related to corresponding preference and availability; whole grain intake and refined grain availability were inversely related. Vegetable, refined grain and fats/sweets intake were unrelated to preference and availability. Diet quality measures were related positively to fruit preference and whole grain availability and inversely to refined grains availability. Findings indicate associations of dietary intake with food preference and availability vary by food group in youth with type 1 diabetes. Measures of overall dietary quality were more consistently associated with food group availability than preferences.
  74. Author: Arcan C, Hannan PJ, Fulkerson JA, Himes JH, Rock BH, Smyth M, Story M
    Title: Associations of home food availability, dietary intake, screen time and physical activity with BMI in young American-Indian children.
    Journal: Public Health Nutr. 16(1):146-55
    Date: 2013 Jan
    Abstract: OBJECTIVE: To evaluate associations between home environmental factors and BMI of young American-Indian children. DESIGN: Cross-sectional and prospective study. SETTING: School-based obesity prevention trial (Bright Start) on a Northern Plains Indian reservation in South Dakota. Mixed model multivariable analysis was used to examine associations between child BMI categories (normal, overweight and obese) and home food availability, children's dietary intake and physical activity. Analyses were adjusted for age, gender, socio-economic status, parent BMI and school; prospective analyses also adjusted for study condition and baseline predictor and outcome variables. SUBJECTS: Kindergarten children (n = 424, 51 % male; mean age = 5.8 years, 30 % overweight/obese) and parents/caregivers (89 % female; 86 % overweight/obese) had their height and weight measured and parents/caregivers completed surveys on home environmental factors (baseline and 2 years later). RESULTS: Higher fast-food intake and parent-perceived barriers to physical activity were marginally associated with higher probabilities of a child being overweight and obese. Vegetable availability was marginally associated with lower probabilities of being overweight and obese. The associations between home environmental factors and child weight status at follow-up were not significant. CONCLUSIONS: Findings indicate that selected aspects of the home environment are associated with weight status of American-Indian children. Obesity interventions with this population should consider helping parents to engage and model healthful behaviours and to increase availability of healthful foods at home.
  75. Author: Moore LV, Diez Roux AV
    Title: Associations of neighborhood characteristics with the location and type of food stores.
    Journal: Am J Public Health. 96(2):325-31
    Date: 2006 Feb
    Abstract: OBJECTIVES: We investigated associations between local food environment and neighborhood racial/ethnic and socioeconomic composition. METHODS: Poisson regression was used to examine the association of food stores and liquor stores with racial/ethnic composition and income in selected census tracts in North Carolina, Maryland, and New York. RESULTS: Predominantly minority and racially mixed neighborhoods had more than twice as many grocery stores as predominantly White neighborhoods (for predominantly Black tracts, adjusted stores per population ratio [SR]=2.7; 95% confidence interval [CI]=2.2, 3.2; and for mixed tracts, SR=2.2; 95% CI=1.9, 2.7) and half as many supermarkets (for predominantly Black tracts, SR=0.5; 95% CI=0.3, 0.7; and for mixed tracts, SR=0.7; 95% CI=0.5, 1.0, respectively). Low-income neighborhoods had 4 times as many grocery stores as the wealthiest neighborhoods (SR=4.3; 95% CI=3.6, 5.2) and half as many supermarkets (SR=0.5; 95% CI=0.3, 0.8). In general, poorer areas and non-White areas also tended to have fewer fruit and vegetable markets, bakeries, specialty stores, and natural food stores. Liquor stores were more common in poorer than in richer areas (SR=1.3; 95% CI=1.0, 1.6). CONCLUSIONS: Local food environments vary substantially by neighborhood racial/ethnic and socioeconomic composition and may contribute to disparities in health.
  76. Author: Michimi A, Wimberly MC
    Title: Associations of supermarket accessibility with obesity and fruit and vegetable consumption in the conterminous United States.
    Journal: Int J Health Geogr
    Date: 2010
    Abstract: BACKGROUND: Limited access to supermarkets may reduce consumption of healthy foods, resulting in poor nutrition and increased prevalence of obesity. Most studies have focused on accessibility of supermarkets in specific urban settings or localized rural communities. Less is known, however, about how supermarket accessibility is associated with obesity and healthy diet at the national level and how these associations differ in urban versus rural settings. We analyzed data on obesity and fruit and vegetable (F/V) consumption from the Behavioral Risk Factor Surveillance System for 2000-2006 at the county level. We used 2006 Census Zip Code Business Patterns data to compute population-weighted mean distance to supermarket at the county level for different sizes of supermarket. Multilevel logistic regression models were developed to test whether population-weighted mean distance to supermarket was associated with both obesity and F/V consumption and to determine whether these relationships varied for urban (metropolitan) versus rural (nonmetropolitan) areas. RESULTS: Distance to supermarket was greater in nonmetropolitan than in metropolitan areas. The odds of obesity increased and odds of consuming F/V five times or more per day decreased as distance to supermarket increased in metropolitan areas for most store size categories. In nonmetropolitan areas, however, distance to supermarket had no associations with obesity or F/V consumption for all supermarket size categories. CONCLUSIONS: Obesity prevalence increased and F/V consumption decreased with increasing distance to supermarket in metropolitan areas, but not in nonmetropolitan areas. These results suggest that there may be a threshold distance in nonmetropolitan areas beyond which distance to supermarket no longer impacts obesity and F/V consumption. In addition, obesity and food environments in nonmetropolitan areas are likely driven by a more complex set of social, cultural, and physical factors than a single measure of supermarket accessibility. Future research should attempt to more precisely quantify the availability and affordability of foods in nonmetropolitan areas and consider alternative sources of healthy foods besides supermarkets.
  77. Author: Chaix B, Bean K, Daniel M, Zenk SN, Kestens Y, Charreire H, Leal C, Thomas F, Karusisi N, Weber C, Oppert JM, Simon C, Merlo J, Pannier B
    Title: Associations of supermarket characteristics with weight status and body fat: a multilevel analysis of individuals within supermarkets (RECORD study).
    Journal: PLoS One. 7(4):e32908
    Date: 2012
    Abstract: PURPOSE: Previous research on the influence of the food environment on weight status has often used impersonal measures of the food environment defined for residential neighborhoods, which ignore whether people actually use the food outlets near their residence. To assess whether supermarkets are relevant contexts for interventions, the present study explored between-residential neighborhood and between-supermarket variations in body mass index (BMI) and waist circumference (WC), and investigated associations between brands and characteristics of supermarkets and BMI or WC, after adjustment for individual and residential neighborhood characteristics. METHODS: Participants in the RECORD Cohort Study (Paris Region, France, 2007-2008) were surveyed on the supermarket (brand and exact location) where they conducted their food shopping. Overall, 7 131 participants shopped in 1 097 different supermarkets. Cross-classified multilevel linear models were estimated for BMI and WC. RESULTS: Just 11.4% of participants shopped for food primarily within their residential neighborhood. After accounting for participants' residential neighborhood, people shopping in the same supermarket had a more comparable BMI and WC than participants shopping in different supermarkets. After adjustment for individual and residential neighborhood characteristics, participants shopping in specific supermarket brands, in hard discount supermarkets (especially if they had a low education), and in supermarkets whose catchment area comprised low educated residents had a higher BMI/WC. CONCLUSION: A public health strategy to reduce excess weight may be to intervene on specific supermarkets to change food purchasing behavior, as supermarkets are where dietary preferences are materialized into definite purchased foods.
  78. Author: Moore LV, Diez Roux AV, Nettleton JA, Jacobs DR Jr
    Title: Associations of the local food environment with diet quality--a comparison of assessments based on surveys and geographic information systems: the multi-ethnic study of atherosclerosis.
    Journal: Am J Epidemiol. 167(8):917-24
    Date: 2008 Apr 15
    Abstract: There is growing interest in understanding how food environments affect diet, but characterizing the food environment is challenging. The authors investigated the relation between global diet measures (an empirically derived "fats and processed meats" (FPM) dietary pattern and the Alternate Healthy Eating Index (AHEI)) and three complementary measures of the local food environment: 1) supermarket density, 2) participant-reported assessments, and 3) aggregated survey responses of independent informants. Data were derived from the baseline examination (2000-2002) of the Multi-Ethnic Study of Atherosclerosis, a US study of adults aged 45-84 years. A healthy diet was defined as scoring in the top or bottom quintile of AHEI or FPM, respectively. The probability of having a healthy diet was modeled by each environment measure using binomial regression. Participants with no supermarkets near their homes were 25-46% less likely to have a healthy diet than those with the most stores, after adjustment for age, sex, race/ethnicity, and socioeconomic indicators: The relative probability of a healthy diet for the lowest store density category versus the highest was 0.75 (95% confidence interval: 0.59, 0.95) for the AHEI and 0.54 (95% confidence interval: 0.42, 0.70) for FPM. Similarly, participants living in areas with the worst-ranked food environments (by participants or informants) were 22-35% less likely to have a healthy diet than those in the best-ranked food environments. Efforts to improve diet may benefit from combining individual and environmental approaches.
  79. Author: Cullen KW, Baranowski T, Owens E, Marsh T, Rittenberry L, de Moor C
    Title: Availability, accessibility, and preferences for fruit, 100% fruit juice, and vegetables influence children's dietary behavior.
    Journal: Health Educ Behav. 30(5):615-26
    Date: 2003 Oct
    Abstract: The relationships among home fruit (F), 100% fruitjuice (J), and vegetable (V) availability and accessibility separately, as reported by 225 fourth- through sixth-grade children and their parents (n = 88), separately, and FJV preferences to child-reported FJV consumption were assessed. For girls, child-reported FJV availability and accessibility accounted for 35% of the variability in FJV consumption. Child-reported availability and parent-reported accessibility were significantly correlated with child FJV consumption in a combined model. For children with high FJV preferences, FJV availability was the only significant predictor, whereas both availability and accessibility were significantly related to consumption for children with low FJV preferences. Interventions targeting child dietary behaviors may need to tailor to the home environment, separately by gender. Extra efforts are necessary by parents to enhance accessibility among children who do not like FJV.
  80. Author: Fox MK, Gordon A, Nogales R, Wilson A
    Title: Availability and consumption of competitive foods in US public schools.
    Journal: J Am Diet Assoc. 109(2 Suppl):S57-66
    Date: 2009 Feb
    Abstract: BACKGROUND: With ongoing efforts to develop and implement school wellness policies, there is a need for information about the availability and consumption of competitive foods in schools. OBJECTIVE: To describe the availability of competitive foods in US public schools, consumption of competitive foods by children, and contributions of competitive foods to energy intakes. DESIGN: The study used data from the third School Nutrition Dietary Assessment Study, a cross-sectional study that included a national sample of public school districts, schools, and children in the 2004-2005 school year. On-site observations were used to document the availability of competitive foods and a 24-hour recall was used to assess children's consumption of competitive foods. SUBJECTS/SETTING: The study included 287 schools and 2,314 children in grades 1 through 12. STATISTICAL ANALYSES PERFORMED: Most analyses were limited to estimation of means and proportions. Two-tailed t tests were used to test the significance of differences between children who did and did not eat a school lunch. RESULTS: In school year 2004-2005, competitive foods were widely available in public schools. Overall, 40% of children consumed one or more competitive foods on a typical school day. The most commonly consumed competitive foods were foods and beverages that were low in nutrients and energy-dense. Children who ate a school lunch were significantly less likely than children who did not eat a school lunch to consume competitive foods (36% vs 45%; P
  81. Author: Travers KD, Cogdon A, McDonald W, Wright C, Anderson B, MacLean DR
    Title: Availability and cost of heart healthy dietary changes in Nova Scotia
    Journal: Journal of the Canadian Dietary Association. 58(4):176-83
    Date: 1997
    Abstract: Available tools to assess food costs do not reflect nutrition recommendations for lower fat consumption. We developed and validated food baskets to examine the accessibility of recommended dietary changes given the availability and costs of foods in Nova Scotia. A Consumption Food Basket (CFB) was developed from commonly consumed foods identified from the NS Nutrition Survey. The CFB was validated for acceptability in four focus groups. An Alternate Food Basket (AFB) was developed by substituting commercially available modified products for foods in Agriculture Canada's Nutritious Food Basket (NFB). A survey of food prices was conducted in 86 stores systematically sampled to reflect provincial diversity. Data were analyzed using regression to compare costs of the CFB and AFB to Agriculture Canada's NFB and Thrifty Nutritious Food Basket (TNFB) by geographic area, population density and income, within the province of Nova Scotia. The cost of implementing nutrition recommendations was between 12% (CFB) to 18% (AFB) higher than the cost of a basic adequate diet (NFB). Food costs were significantly lower and a greater variety of recommended foods were available in urban areas and large stores. There were no significant differences in costs of baskets priced in low-income versus mixed-income neighbourhood stores. Variations in price and availability suggest that rural Nova Scotians may be experiencing barriers to implementing recommended dietary changes.
  82. Author: Andreyeva T, Blumenthal DM, Schwartz MB, Long MW, Brownell KD
    Title: Availability and prices of foods across stores and neighborhoods: the case of New Haven, Connecticut.
    Journal: Health Aff (Millwood). 27(5):1381-8
    Date: 2008 Sep-Oct
    Abstract: Two studies compared food availability and prices in large and small stores across neighborhoods of varying income levels in New Haven, Connecticut. The findings suggest that supermarket access in lower-income neighborhoods has improved since 1971, and average food prices are comparable across income areas. Despite this progress, stores in lower-income neighborhoods (compared to those in higher-income neighborhoods) stock fewer healthier varieties of foods and have fresh produce of much lower quality. Policies are needed not only to improve access to supermarkets, but also to ensure that stores in lower-income neighborhoods provide high-quality produce and healthier versions of popular foods.
  83. Author: Harnack L, Snyder P, Story M, Holliday R, Lytle L, Neumark-Sztainer D
    Title: Availability of a la carte food items in junior and senior high schools: a needs assessment.
    Journal: J Am Diet Assoc. 100(6):701-3
    Date: 2000 Jun
    Abstract:
  84. Author: Grigsby-Toussaint DS, Zenk SN, Odoms-Young A, Ruggiero L, Moise I
    Title: Availability of commonly consumed and culturally specific fruits and vegetables in African-american and Latino neighborhoods.
    Journal: J Am Diet Assoc. 110(5):746-52
    Date: 2010 May
    Abstract: Although the importance of culture in shaping individual dietary behaviors is well-documented, cultural food preferences have received limited attention in research on the neighborhood food environment. The purpose of this study was to assess the availability of commonly consumed and culturally specific fruits and vegetables in retail food stores located in majority African-American and Latino neighborhoods in southwest Chicago, IL. A cross-sectional survey of 115 stores (15% grocery stores, 85% convenience/corner stores) in African-American neighborhoods and 110 stores (45% grocery stores, 55% convenience/corner stores) in Latino neighborhoods was conducted between May and August of 2006. chi(2) tests were used to assess differences in the availability (presence/absence) of commonly consumed (n=25) and culturally specific fruits and vegetables for African Americans (n=16 varieties) and Latinos (n=18 varieties). Stores located in neighborhoods in which the majority of residents were African American or Latino were more likely to carry fresh fruits and vegetables that were culturally relevant to the dominant group. For example, grocery stores located in Latino neighborhoods were more likely to carry chayote (82.0% vs 17.6%, P
  85. Author: Creel JS, Sharkey JR, McIntosh A, Anding J, Huber JC Jr
    Title: Availability of healthier options in traditional and nontraditional rural fast-food outlets.
    Journal: BMC Public Health
    Date: 2008
    Abstract: BACKGROUND: Food prepared away from home has become increasingly popular to U.S. families, and may contribute to obesity. Sales have been dominated by fast food outlets, where meals are purchased for dining away from home or in the home. Although national chain affiliated fast-food outlets are considered the main source for fast food, fast foods are increasingly available in convenience stores and supermarkets/grocery stores. In rural areas, these nontraditional fast-food outlets may provide most of the opportunities for procurement of fast foods. METHODS: Using all traditional and nontraditional fast-food outlets identified in six counties in rural Texas, the type and number of regular and healthier menu options were surveyed using on-site observation in all food venues that were primarily fast food, supermarket/grocery store, and convenience store and compared with 2005 Dietary Guidelines. RESULTS: Traditional fast-food outlets represented 84 (41%) of the 205 opportunities for procurement of fast food; 109 (53.2%) were convenience stores and 12 (5.8%) supermarkets/grocery stores. Although a similar variety of regular breakfast and lunch/dinner entrées were available in traditional fast-food outlets and convenience stores, the variety of healthier breakfast and lunch/dinner entrées was significantly greater in fast food outlets. Compared with convenience stores, supermarkets/grocery stores provided a greater variety of regular and healthier entrées and lunch/dinner side dishes. CONCLUSION: Convenience stores and supermarkets/grocery stores more than double the potential access to fast foods in this rural area than traditional fast-food outlets alone; however, traditional fast food outlets offer greater opportunity for healthier fast food options than convenience stores. A complete picture of fast food environment and the availability of healthier fast food options are essential to understand environmental influences on diet and health outcomes, and identify potential targets for intervention.
  86. Author: Franco M, Diez-Roux AV, Nettleton JA, Lazo M, Brancati F, Caballero B, Glass T, Moore LV
    Title: Availability of healthy foods and dietary patterns: the Multi-Ethnic Study of Atherosclerosis.
    Journal: Am J Clin Nutr. 89(3):897-904
    Date: 2009 Mar
    Abstract: BACKGROUND: Inadequate availability of healthy foods may be a barrier to achieving recommended diets. OBJECTIVE: The objective was to study the association between the directly measured availability of healthy foods and diet quality. DESIGN: We conducted a cross-sectional study of 759 participants from the Baltimore site of the Multi-Ethnic Study of Atherosclerosis. Diet was characterized by using a food-frequency questionnaire and summarized by using 2 empirically derived dietary patterns reflecting low- and high-quality diets. For each participant, the availability of healthy foods was directly assessed by using 3 measures: in all food stores within their census tract, in their closest food store, and in all food stores within 1 mile (1.6 km) of their residence. RESULTS: Twenty-four percent of the black participants lived in neighborhoods with a low availability of healthy food compared with 5% of white participants (P
  87. Author: Bustillos B, Sharkey JR, Anding J, McIntosh A
    Title: Availability of more healthful food alternatives in traditional, convenience, and nontraditional types of food stores in two rural Texas counties.
    Journal: J Am Diet Assoc. 109(5):883-9
    Date: 2009 May
    Abstract: Limited research has focused on the availability of more healthful food alternatives in traditional food stores (supermarkets and grocery stores) in rural areas. Current market trends suggest that food items may be available for purchase in stores other than traditional food stores. An observational survey was developed and used on-site to document the availability and variety of fruit and vegetables (fresh, canned, and frozen), meats (meat, poultry, fish, and eggs), dairy (milk, yogurt, and cheese), and grains (whole grains and refined grains) in all traditional food stores, convenience stores, and nontraditional food stores (dollar stores and mass merchandisers) in two rural Texas counties. Descriptive statistics and t tests identified that although the widest selection of more healthful food items was available in supermarkets, not all supermarkets carried all items. Grocery stores carried less variety of fresh fruits (8+/-0.7 vs 4.7+/-0.3; P
  88. Author: Delva J, O'Malley PM, Johnston LD
    Title: Availability of more-healthy and less-healthy food choices in American schools: a national study of grade, racial/ethnic, and socioeconomic differences.
    Journal: Am J Prev Med. 33(4 Suppl):S226-39
    Date: 2007 Oct
    Abstract: BACKGROUND: The purposes of this study are to examine the extent to which (1) more-healthy and less-healthy food choices are available to American secondary students in their schools, and (2) there are differences in the availability of such foods as a function of grade, racial/ethnic background, and socioeconomic status (SES). METHODS: United States nationally representative samples of over 37,000 students in 345 secondary schools were surveyed in 2004 and 2005 as part of the Youth, Education, and Society (YES) study and the Monitoring the Future (MTF) study. In the YES study, school administrators and food service managers completed self-administered questionnaires on food policies and food offerings in their schools. In the MTF study, students in the same schools completed self-administered questionnaires. Data were analyzed in 2006. RESULTS: A greater percent of high school students have access to both more-healthy and less-healthy food choices than middle school students. Compared to white students, fewer black students have access to certain healthy foods (lowfat salty snacks, lowfat cookies and pastries). Hispanic high school students have greater access to regular ice cream and to fruits and vegetables. Otherwise the racial/ethnic group differences are modest. However, there is a positive linear association between SES (as indicated by parental education) and (1) access to most types of healthier snacks from vending machines, school/student stores, or snack bars/carts and (2) the number of healthier foods offered à la carte in the cafeteria. The association between SES and access to less-healthy snacks varies more by item. CONCLUSIONS: Indisputably, less-healthy foods are more available than more-healthy foods in the nation's schools. At a time when food and beverage offerings are under intense policy scrutiny, this study provides a comprehensive assessment of the types of foods made available to students. While it is encouraging to see schools offering healthy food alternatives, such as lowfat snacks and fruits and vegetables, the findings strongly suggest that the availability of more-healthy snacks needs to be increased, particularly for racial/ethnic minorities and youth of lower SES. Simultaneously, schools could considerably decrease the availability of less-healthy snack choices available to students. Future monitoring is needed to evaluate the effectiveness of the food industry's recent agreement to play a role in helping to solve these problems.
  89. Author: Wootan MG, Osborn M
    Title: Availability of nutrition information from chain restaurants in the United States.
    Journal: Am J Prev Med. 30(3):266-8
    Date: 2006 Mar
    Abstract: BACKGROUND: Although obesity and poor dietary habits are complex multifactorial problems, away-from-home food has been identified as one likely and important contributor. Restaurants provide a growing and substantial portion of the average American's diet, yet the Nutrition Labeling and Education Act (NLEA), which went into effect in 1994, explicitly exempts restaurants from most labeling requirements. Thus, this study examined the availability of nutrition information from the largest chain restaurants in the United States. METHODS: Between January and August 2004, we surveyed the 300 largest chain restaurants by telephone, e-mail, or examining company websites (response rate was 96%). The top chains, as ranked by revenue, were selected based on 2002 ratings in Restaurants and Institutions. RESULTS: Fifty-four percent of the 287 largest chain restaurants made some nutrition information available. Forty-four percent had nutrition information for the majority of their standard menu items. We found no significant differences in the availability of nutrition information based on the size of the restaurant chain. Of those restaurants with nutrition information, 86% provided information on the company website. CONCLUSIONS: The number of restaurants providing nutrition information has increased over the last 10 years. However, making informed and healthful food choices is hampered by the absence of nutrition information at many restaurants. Given the growing and significant role that away-from-home foods play in Americans' diets, the Surgeon General and the National Academies' Institute of Medicine recommend that nutrition information be available to customers at restaurants, and state legislatures and the U.S. Congress are beginning to address the issue.
  90. Author: Whitehouse A, Simon A, French SA, Wolfson J
    Title: Availability of snacks, candy and beverages in hospital, community clinic and commercial pharmacies.
    Journal: Public Health Nutr. 15(6):1117-23
    Date: 2012 Jun
    Abstract: OBJECTIVE: The purpose of the present study was to measure the availability of energy-dense foods and sugar-sweetened beverages in pharmacies and to examine differences by pharmacy type and presence of a food policy. DESIGN: Trained research staff visited pharmacies (n 37) to measure shelf space and variety of snacks, candy and sugar-sweetened beverages available within 10 ft (3·05 m) of the pharmacy register. SETTING: Community clinic, hospital and commercial pharmacies in Minneapolis, MN, USA. SUBJECTS: Employees were interviewed regarding pharmacy food policies. RESULTS: Approximately 60 % of pharmacies had foods and/or sugar-sweetened beverages available for purchase within 10 ft (3·05 m) of the pharmacy register. Total shelf space (P = 0·02) and variety (P = 0·0003) differed significantly by pharmacy type and were greatest among community clinic pharmacies. Over half of pharmacies had no food policy (58·3 %). Pharmacies with food policies were less likely to have foods/beverages available within 10 ft (3·05 m) of the pharmacy register than pharmacies with no food policies (P = 0·03). CONCLUSIONS: Candy, snacks and sugar-sweetened beverages are highly available in the pharmacy environment. Presence of a policy is associated with less food availability within 10 ft (3·05 m) of the pharmacy register and represents an important potential intervention strategy.
  91. Author: Horowitz CR, Colson KA, Hebert PL, Lancaster K
    Title: Barriers to buying healthy foods for people with diabetes: evidence of environmental disparities.
    Journal: Am J Public Health. 94(9):1549-54
    Date: 2004 Sep
    Abstract: OBJECTIVES: A community coalition compared the availability and cost of diabetes-healthy foods in a racial/ethnic minority neighborhood in East Harlem, with those in the adjacent, largely White and affluent Upper East Side in New York City. METHODS: We documented which of 173 East Harlem and 152 Upper East Side grocery stores stocked 5 recommended foods. RESULTS: Overall, 18% of East Harlem stores stocked recommended foods, compared with 58% of stores in the Upper East Side (P <.0001 only="" of="" east="" harlem="" bodegas="" stores="" carried="" all="" items="" upper="" side="" though="" had="" more="" bodegas.="" residents="" were="" likely="" than="" vs="" to="" have="" on="" their="" block="" that="" did="" not="" stock="" recommended="" foods="" and="" less="" stocked="" foods.="" conclusions:="" a="" greater="" effort="" needs="" be="" made="" make="" available="" carry="" diabetes-healthy="">
  92. Author: Raja S, Ma C, Yadav P
    Title: Beyond Food Deserts: Measuring and Mapping Racial Disparities in Neighborhood Food Environments
    Journal: Journal of planning education and research
    Date: 2008
    Abstract: Given the emerging focus on improving food environments and food systems through planning, this article investigates racial disparities in neighborhood food environments. An empirical case of Erie County, New York tests the hypothesis that people belonging to different racial groups have access to different neighborhood food destinations. Using multiple methodsGini coefficients, Poisson regression, and Geographic Information Systems analysiswe show that contrary to studies elsewhere in the country there are no food deserts in Erie County. However, like other studies, we find an absence of supermarkets in neighborhoods of color when compared to white neighborhoods. Nonetheless, our study reveals an extensive network of small grocery stores in neighborhoods of color. Rather than soliciting supermarkets, supporting small, high-quality grocery stores may be a more efficient strategy for ensuring access to healthful foods in minority neighborhoods.
  93. Author: Sturm R, Datar A
    Title: Body mass index in elementary school children, metropolitan area food prices and food outlet density.
    Journal: Public Health. 119(12):1059-68
    Date: 2005 Dec
    Abstract: OBJECTIVE: The aim of this study was to examine the association between food prices and food outlet density and changes in the body mass index (BMI) among elementary school children in the USA. METHODS: The Early Childhood Longitudinal Study followed a nationally representative sample of kindergarten children over 4 years. We merged individual-level data to (a) metropolitan data on food prices and (b) per capita number of restaurants, grocery stores and convenience stores in the child's home and school zip code. The dependent variables were BMI changes over 1 and 3 years. We analysed mean changes with least-squares regression, and median changes and 85th percentile changes with quantile regression. We controlled for baseline BMI, age, real family income and sociodemographic characteristics. RESULTS: Lower real prices for vegetables and fruits were found to predict a significantly lower gain in BMI between kindergarten and third grade; half of that effect was found between kindergarten and first grade. Lower meat prices had the opposite effect, although this effect was generally smaller in magnitude and was insignificant for BMI gain over 3 years. Differences across subgroups were not statistically significant due to smaller sample sizes in subgroup analyses, but the estimated effects were meaningfully larger for children in poverty, children already at risk for overweight or overweight in kindergarten, and Asian and Hispanic children. There were no significant effects for dairy or fast-food prices, nor for outlet density, once we had controlled for individual characteristics and random intercepts to adjust standard errors for the sampling design. DISCUSSION: The geographic variation in fruit and vegetable prices is large enough to explain a meaningful amount of the differential gain in BMI among elementary school children across metropolitan areas. However, as consumption information was not available, we cannot confirm that this is the actual pathway. We found no effects of food outlet density at the neighbourhood level, possibly because availability is not an issue in metropolitan areas.
  94. Author: Inagami S, Cohen DA, Brown AF, Asch SM
    Title: Body mass index, neighborhood fast food and restaurant concentration, and car ownership.
    Journal: J Urban Health. 86(5):683-95
    Date: 2009 Sep
    Abstract: Eating away from home and particularly fast food consumption have been shown to contribute to weight gain. Increased geographic access to fast food outlets and other restaurants may contribute to higher levels of obesity, especially in individuals who rely largely on the local environment for their food purchases. We examined whether fast food and restaurant concentrations are associated with body mass index and whether car ownership might moderate this association. We linked the 2000 US Census data and information on locations of fast food and other restaurants with the Los Angeles Family and Neighborhood Study database, which consists of 2,156 adults sampled from 63 neighborhoods in Los Angeles County. Multilevel modeling was used to estimate associations between body mass index (BMI), fast food and restaurant concentration, and car ownership after adjustment for individual-level factors and socioeconomic characteristics of residential neighborhoods. A high concentration of local restaurants is associated with BMI. Car owners have higher BMIs than non-car owners; however, individuals who do not own cars and reside in areas with a high concentration of fast food outlets have higher BMIs than non-car owners who live in areas with no fast food outlets, approximately 12 lb more (p = 0.02) for an individual with a height of 5 ft. 5 in. Higher restaurant density is associated with higher BMI among local residents. The local fast food environment has a stronger association with BMI for local residents who do not have access to cars.
  95. Author: Winson A
    Title: Bringing political economy into the debate on the obesity epidemic
    Journal: Agriculture and human values. 21(4):299-312
    Date: 2004
    Abstract: This paper takes what has been termed the "epidemic of obesity" as the point of departure to examine the way in which political economic factors intersect with diet and nutrition to determine adverse health outcomes. The paper proposes several concepts to better understand the dynamics of the "foodscape" -- institutional sites for the merchandising and consumption of food. These include the concepts of "spatial colonization" and "pseudo foods". With a focus on critical dimensions of the contemporary "foodscape", principally supermarket merchandising practices, as well as trends in other food vending operations, the paper explores incentives that motivate capital to "spatially colonize" the foodscape with aggressively promoted high fat/high sugar "pseudo foods". The paper reports on extensive research on trade industry publications as well as data collected through onsite investigations of supermarket practices of the three largest Canadian retail supermarket operations. In addition, current merchandising practices of convenience chain store operations and some non-traditional food vending sites are examined. In concluding, it is argued that the rapidly evolving interdisciplinary debate around the obesity crisis would benefit considerably from the insights to be gained from political economic analysis of retail food industry practices and trends.
  96. Author: Li F, Harmer P, Cardinal BJ, Bosworth M, Johnson-Shelton D, Moore JM, Acock A, Vongjaturapat N
    Title: Built environment and 1-year change in weight and waist circumference in middle-aged and older adults: Portland Neighborhood Environment and Health Study.
    Journal: Am J Epidemiol. 169(4):401-8
    Date: 2009 Feb 15
    Abstract: This study examined neighborhood built environment characteristics (fast-food restaurant density, walkability) and individual eating-out and physical activity behaviors in relation to 1-year change in body weight among adults 50-75 years of age at baseline. The authors surveyed 1,145 residents recruited from 120 neighborhoods in Portland, Oregon. During the 1-year follow-up (2006-2007 to 2007-2008), mean weight increased by 1.72 kg (standard deviation, 4.3) and mean waist circumference increased by 1.76 cm (standard deviation, 5.6). Multilevel analyses revealed that neighborhoods with a high density of fast-food outlets were associated with increases of 1.40 kg in weight (P
  97. Author: Larson NI, Story M, Wall M, Neumark-Sztainer D
    Title: Calcium and dairy intakes of adolescents are associated with their home environment, taste preferences, personal health beliefs, and meal patterns.
    Journal: J Am Diet Assoc. 106(11):1816-24
    Date: 2006 Nov
    Abstract: OBJECTIVE: To identify correlates of calcium, dairy, and milk intakes among male and female adolescents. DESIGN: Cross-sectional study design. Adolescents self-reported measures pertaining to correlates on the Project EAT (Eating Among Teens) survey and completed a food frequency questionnaire at school. SUBJECTS/SETTING: Subjects were a total of 4,079 middle and high school students from Minneapolis/St Paul, MN, public schools. STATISTICAL ANALYSES PERFORMED: Multiple linear regression models based on social cognitive theory were examined by sex. RESULTS: Male adolescents reported higher daily intakes of calcium (male: 1,217+/-663 mg; female: 1,035+/-588 mg; P
  98. Author: Heim S, Bauer KW, Stang J, Ireland M
    Title: Can a community-based intervention improve the home food environment? parental perspectives of the influence of the delicious and nutritious garden.
    Journal: J Nutr Educ Behav. 43(2):130-4
    Date: 2011 Mar-Apr
    Abstract: OBJECTIVE: To examine changes in parental report of the home food environment during the course of a garden-based fruit and vegetable (FV) intervention for grade school children. METHODS: Self-administered pre-post surveys were completed by parents/caregivers (n = 83). Main outcome measures included: child asking behavior, FV availability/accessibility, parental encouragement, and value of FV consumption. RESULTS: Process evaluation results indicate children shared their garden experiences at home, and as a result, the children's home food environment became increasingly supportive of FV consumption. Parents reported an increase (P
  99. Author: Cheadle A, Psaty BM, Curry S, Wagner E, Diehr P, Koepsell T, Kristal A
    Title: Can measures of the grocery store environment be used to track community-level dietary changes?
    Journal: Prev Med. 22(3):361-72
    Date: 1993 May
    Abstract: BACKGROUND: This article examines whether an in-store unobtrusive survey of grocery store product displays can be used to track community-level dietary behavior. METHODS: The survey was conducted in 12 western communities two different times to measure two aspects of the grocery store environment: (a) the relative availability of low-fat and high-fiber products and (b) the amount of store-provided health-education information. Self-reported dietary intake of residents was obtained in the same 12 communities using a telephone survey. We compared the individual and store-level measures both cross-sectionally and over time. RESULTS: We found positive and statistically significant correlations between the availability of healthful products in stores and the reported healthfulness of individual diets in cross-sectional analyses, but correlations between changes over time in the two measures were weaker and not statistically significant. The variance of the grocery store measures was nonetheless sufficiently small that a grocery store survey of 15 stores in each of 8 communities (n = 120 surveys) had power comparable to that of a telephone survey of 200 individuals/community (n = 1,600) surveys, at a fraction of the cost. CONCLUSION: Although the results provide further validation of cross-sectional measures of the grocery store environment, additional efforts are required to establish the validity of the grocery store survey as a method of measuring dietary change.
  100. Author: Hoerr SM, Louden VA
    Title: Can nutrition information increase sales of healthful vended snacks?
    Journal: J Sch Health. 63(9):386-90
    Date: 1993 Nov
    Abstract: Snack selections from unrefrigerated vending machines were studied in relation to increasing availability of nutrient-dense snack options and providing nutrient information at four selected vending sites on a large university campus. Only four of 133 different snacks available for unrefrigerated vending met the criterion for nutrient-dense snacks. When snack proportion was changed to increase availability of nutrient-dense snacks, sales dropped. When nutrition information in bar graph form was posted on the machines, sales increased but not back to the original level. Although snack sales increased after graphic nutrition information was posted, sales were primarily for the least nutrient-dense, perhaps because few well-liked, nutrient-dense snacks were available for unrefrigerated vending. Schools concerned about providing a selection of vended snacks in agreement with the U.S. Dietary Guidelines might be advised to maintain refrigerated vending or to pursue a "healthy snack" machine concept.
  101. Author: Bere E, Klepp KI
    Title: Changes in accessibility and preferences predict children's future fruit and vegetable intake.
    Journal: Int J Behav Nutr Phys Act
    Date: 2005 Oct 10
    Abstract: BACKGROUND: Most children eat fewer fruits and vegetables than recommended. To be able to design effective interventions, understanding the aetiology of the behaviour is important. Accessibility and preferences have shown to be strong correlates of fruit and vegetable intake in several cross-sectional studies. The aim of this study was to identify predictors of future fruit and vegetable intake and to explore longitudinal patterns of interactions between accessibility and preferences. METHODS: Data presented are based on baseline (September 2001) and follow-up (May/June 2002) surveys of 20 control schools in the Norwegian intervention study Fruits and Vegetables Make the Marks. A total of 816 pupils (77%) completed both baseline and follow-up questionnaires. The average age of the sample at baseline was 11.8 years. The research instrument assessing potential predictor variables was guided by Social Cognitive Theory, and included Accessibility at home, Accessibility at school, Modelling, Intention, Preferences, Self-Efficacy and Awareness of the 5-a-day recommendations. Multiple regression analyses were performed. RESULTS: All independent variables (measured at baseline) were significantly correlated to future fruit and vegetable intake (measured at follow-up). When reported fruit and vegetable intake at baseline (past intake) was included in this model, the effect of the other independent variables diminished. Together with past intake, the observed change in the independent variables from baseline to follow-up explained 43% of the variance in the reported intake at follow-up. Past intake remained the strongest predictor, but changes in accessibility at home and at school, as well as changes in preferences for fruits and vegetables, also explained significant amounts of the variance in fruit and vegetable intake at follow-up. In addition, baseline accessibility was found to moderate the relationship between change in preferences and change in intake. CONCLUSION: Change in accessibility and preferences appear to be important predictors of future fruit and vegetable intake among school children. Interventions should focus on strategies to modify these factors.
  102. Author: Wang MC, Cubbin C, Ahn D, Winkleby MA
    Title: Changes in neighbourhood food store environment, food behaviour and body mass index, 1981--1990.
    Journal: Public Health Nutr. 11(9):963-70
    Date: 2008 Sep
    Abstract: OBJECTIVE: This paper examines trends in the neighbourhood food store environment (defined by the number and geographic density of food stores of each type in a neighbourhood), and in food consumption behaviour and overweight risk of 5779 men and women. DESIGN: The study used data gathered by the Stanford Heart Disease Prevention Program in four cross-sectional surveys conducted from 1981 to 1990. SETTING: Four mid-sized cities in agricultural regions of California. SUBJECTS: In total, 3154 women and 2625 men, aged 25-74 years. RESULTS: From 1981 to 1990, there were large increases in the number and density of neighbourhood stores selling sweets, pizza stores, small grocery stores and fast-food restaurants. During this period, the percentage of women and men who adopted healthy food behaviours increased but so did the percentage who adopted less healthy food behaviours. The percentage who were obese increased by 28% in women and 24% in men. CONCLUSION: Findings point to increases in neighbourhood food stores that generally offer mostly unhealthy foods, and also to the importance of examining other food pattern changes that may have a substantial impact on obesity, such as large increases in portion sizes during the 1980s.
  103. Author: Phillips MM, Raczynski JM, West DS, Pulley L, Bursac Z, Gauss CH, Walker JF
    Title: Changes in school environments with implementation of Arkansas Act 1220 of 2003.
    Journal: Obesity (Silver Spring)
    Date: 2010 Feb
    Abstract: Changes in school nutrition and physical activity policies and environments are important to combat childhood obesity. Arkansas Act 1220 of 2003 was among the first and most comprehensive statewide legislative initiatives to combat childhood obesity through school-based change. Annual surveys of principals and superintendents have been analyzed to document substantial and important changes in school environments, policies, and practices. For example, results indicate that schools are more likely to require that healthy options be provided for student parties (4.5% in 2004, 36.9% in 2008; P
  104. Author: Osganian SK, Ebzery MK, Montgomery DH, Nicklas TA, Evans MA, Mitchell PD, Lytle LA, Snyder MP, Stone EJ, Zive MM, Bachman KJ, Rice R, Parcel GS
    Title: Changes in the nutrient content of school lunches: results from the CATCH Eat Smart Food service Intervention.
    Journal: Prev Med. 25(4):400-12
    Date: 1996 Jul-Aug
    Abstract: BACKGROUND: The Child and Adolescent Trial for Cardiovascular Health (CATCH) tested the effectiveness of a multilevel intervention aimed at promoting a healthful school environment and positive eating and physical activity behaviors in children. The CATCH Eat Smart Program targeted the school food service staff and aimed to lower the total fat, saturated fat, and sodium content of school meals. METHODS: The Eat Smart intervention was conducted in 56 intervention schools over a 2(1/2)-year period.+Five consecutive days of school menu, recipe, and vendor product information were collected from intervention and control schools at three intervals, Fall 1991, Spring 1993, and Spring 1994, to assess the nutrient content of school menus as offered. RESULTS: There was a significantly greater mean reduction in the percentage of calories from total fat (adjusted mean difference -4.1%; P
  105. Author: Story M, Snyder MP, Anliker J, Weber JL, Cunningham-Sabo L, Stone EJ, Chamberlain A, Ethelbah B, Suchindran C, Ring K
    Title: Changes in the nutrient content of school lunches: results from the Pathways study.
    Journal: Prev Med. 37(6 Pt 2):S35-45
    Date: 2003 Dec
    Abstract: BACKGROUND: Pathways, a randomized trial, evaluated the effectiveness of a school-based multicomponent intervention to reduce fatness in American-Indian schoolchildren. The goal of the Pathways food service intervention component was to reduce the fat in school lunches to no more than 30% of energy from fat while maintaining recommended levels of calories and key nutrients. METHODS: The intervention was implemented by school food service staff in intervention schools over a 3-year period. Five consecutive days of school lunch menu items were collected from 20 control and 21 intervention schools at four time periods, and nutrient content was analyzed. RESULTS: There was a significantly greater mean reduction in percent energy from fat and saturated fat in the intervention schools compared to the control schools. Mean percentages of energy from fat decreased from 33.1% at baseline to 28.3% at the end of the study in intervention schools compared to 33.2% at baseline and 32.2% at follow-up in the control schools (P
  106. Author: Burgoine T, Lake AA, Stamp E, Alvanides S, Mathers JC, Adamson AJ
    Title: Changing foodscapes 1980-2000, using the ASH30 Study.
    Journal: Appetite. 53(2):157-65
    Date: 2009 Oct
    Abstract: There has been a dramatic change in the UK 'foodscape', accompanied by increasing rates of overweight and obesity. This study explores dietary change and change in BMI recorded longitudinally (1980-2000) against the change in food availability recorded retrospectively. Over 20 years the foodscape changed dramatically, with the total number of food outlets increasing by 79.4%. Analysis did not find a relationship between the foodscape and food intake patterns in 1980 or 2000. However statistically significant associations were found between 1980 foodscape and percent change in BMI. Adding geographical elements to a dietary study adds an interesting dimension in exploring the change in eating and BMI from adolescence to adulthood.
  107. Author: Evans AE, Dave J, Tanner A, Duhe S, Condrasky M, Wilson D, Griffin S, Palmer M, Evans M
    Title: Changing the home nutrition environment: effects of a nutrition and media literacy pilot intervention.
    Journal: Fam Community Health. 29(1):43-54
    Date: 2006 Jan-Mar
    Abstract: The specific aim for this pilot study was to evaluate the effectiveness of a nutrition and media literacy intervention targeting elementary students and their parents. The purpose of the intervention was to increase child fruit and vegetables (FV) consumption and change the home nutrition environment (measured with FV availability and accessibility and parental social support). During the intervention, students learned about nutrition, the role media plays in shaping values concerning nutrition, and developed a media campaign for their parents. A quasi-experimental research design was used to evaluate the effectiveness of the intervention. The media intervention was effective in changing the home environment.
  108. Author: Lee SH, Rowan MT, Powell LM, Newman S, Klassen AC, Frick KD, Anderson J, Gittelsohn J
    Title: Characteristics of prepared food sources in low-income neighborhoods of Baltimore City.
    Journal: Ecol Food Nutr. 49(6):409-30
    Date: 2010 Nov-Dec
    Abstract: The food environment is associated with obesity risk and diet-related chronic diseases. Despite extensive research conducted on retail food stores, little is known about prepared food sources(PFSs). We conducted an observational assessment of all PFSs(N = 92) in low-income neighborhoods in Baltimore. The most common PFSs were carry-outs, which had the lowest availability of healthy food choices. Only a small proportion of these carry-outs offered healthy sides, whole wheat bread, or entrée salads (21.4%, 7.1%, and 33.9%, respectively). These findings suggest that carry-out-specific interventions are necessary to increase healthy food availability in low-income urban neighborhoods.
  109. Author: Oldenburg B, Sallis JF, Harris D, Owen N
    Title: Checklist of Health Promotion Environments at Worksites (CHEW): development and measurement characteristics.
    Journal: Am J Health Promot. 16(5):288-99
    Date: 2002 May-Jun
    Abstract: PURPOSE: Health promotion policy frameworks, recent theorizing, and research all emphasize understanding and mobilizing environmental influences to change particular health-related behaviors in specific settings. The workplace is a key environmental setting. The Checklist of Health Promotion Environments at Worksites (CHEW) was designed as a direct observation instrument to assess characteristics of worksite environments that are known to influence health-related behaviors. METHODS: The CHEW is a 112-item checklist of workplace environmental features hypothesized to be associated, both positively and negatively, with physical activity, healthy eating, alcohol consumption, and smoking. The three environmental domains assessed are (1) physical characteristics of the worksite, (2) features of the information environment, and (3) characteristics of the immediate neighborhood around the workplace. The conceptual rationale and development studies for the CHEW are described, and data from observational studies of 20 worksites are reported. RESULTS: The data on CHEW-derived environmental attributes showed generally good reliability and identified meaningful sets of variables that plausibly may influence health-related behaviors. With the exception of one information environment attribute, intraclass correlation coefficients ranged from 0.80 to 1.00. Descriptive statistics on selected physical and information environment characteristics indicated that vending machines, showers, bulletin boards, and signs prohibiting smoking were common across worksites. Bicycle racks, visible stairways, and signs related to alcohol consumption, nutrition, and health promotion were relatively uncommon. CONCLUSIONS: These findings illustrate the types of data on environmental attributes that can be derived, their relevance for program planning, and how they can characterize variability across worksites. The CHEW is a promising observational measure that has the potential to assess environmental influences on health behaviors and to evaluate workplace health promotion programs.
  110. Author: Mellor JM, Dolan CB, Rapoport RB
    Title: Child body mass index, obesity, and proximity to fast food restaurants.
    Journal: Int J Pediatr Obes. 6(1):60-8
    Date: 2011 Feb
    Abstract: Objectives. Using a sample of elementary and middle school students, we examined the associations between body mass index (BMI), obesity, and measures of the proximity of fast food and full service restaurants to students' residences. We controlled for socioeconomic status using a novel proxy measure based on housing values. Methods. We used BMI and obesity measures based on height and weight data collected as part of a school health assessment along with geocoded data on addresses of residences and food establishments. We constructed a proxy measure of socioeconomic status from public records of residential property assessments. These data were used to estimate logistic regression models of overweight and ordinary least squares models of BMI. Results. Students residing in homes with higher assessment values were significantly less likely to be obese, and had significantly lower BMIs. Upon controlling for socioeconomic status and other characteristics, the associations of BMI and obesity with proximity to food service establishments were reduced. Nonetheless, students who resided within one-tenth or one-quarter of a mile from a fast food restaurant had significantly higher values of BMI. The proximity of full service restaurants to residences did not have a significant positive association with either BMI or overweight. Conclusion. Public health efforts to limit access to fast food among nearby residents could have beneficial effects on child obesity. Public data on property value assessments may serve as useful approximations for socioeconomic status when address data are available.
  111. Author: Galvez MP, Hong L, Choi E, Liao L, Godbold J, Brenner B
    Title: Childhood obesity and neighborhood food-store availability in an inner-city community.
    Journal: Acad Pediatr. 9(5):339-43
    Date: 2009 Sep-Oct
    Abstract: OBJECTIVE: Prior studies have shown an association between fast-food restaurants and adolescent body size. Less is known about the influence of neighborhood food stores on a child's body size. We hypothesized that in the inner-city, minority community of East Harlem, New York, the presence of convenience stores and fast-food restaurants near a child's home is associated with increased risk for childhood obesity as measured by body mass index (BMI). DESIGN: Baseline data of 6- to 8-year-old East Harlem boys and girls (N=323) were used. Anthropometry (height and weight) was conducted with a standardized protocol. Food-store data were collected via a walking survey. Stores located within the same census block as the child's home address were identified by using ArcGIS 8.3. We computed age- and sex-specific BMI percentiles by using national norms of the Centers for Disease Control and Prevention. Using odds ratios, we estimated risk of a child's BMI percentile being in the top tertile based on number and types of food stores on their census blocks. RESULTS: Convenience stores were present in 55% of the surveyed blocks in which a study particpant lived and fast-food restaurants were present in 41%. Children (n=177) living on a block with 1 or more convenience stores (range, 1-6) were more likely to have a BMI percentile in the top tertile (odds ratio 1.90, 95% confidence interval, 1.15-3.15) compared with children having no convenience stores (n=146). CONCLUSIONS: The presence of convenience stores near a child's residence was associated with a higher BMI percentile. This has potential implications for both child- and neighborhood-level childhood obesity interventions.
  112. Author: Holsten JE, Compher CW
    Title: Children's food store, restaurant, and home food environments and their relationship with body mass index: a pilot study.
    Journal: Ecol Food Nutr. 51(1):58-78
    Date: 2012
    Abstract: This pilot research assessed the feasibility and utility of a study designed to examine the relationship between children's BMI and food store, restaurant, and home food environments. Home visits were conducted with sixth-grade children (N = 12). BMI z-scores were calculated with weight and height measurements. Nutrition Environment Measures Surveys evaluated children's food environments. The study protocol involved a feasible time duration, minimal missing data for primary variables, and participant satisfaction. Potential design problems included the homogeneous store environments and low restaurant exposure of the sample recruited from one school, and the adequacy of a single cross-sectional measure of the home environment.
  113. Author: Timperio A, Ball K, Roberts R, Campbell K, Andrianopoulos N, Crawford D
    Title: Children's fruit and vegetable intake: associations with the neighbourhood food environment.
    Journal: Prev Med. 46(4):331-5
    Date: 2008 Apr
    Abstract: OBJECTIVE: To examine associations between availability of different types of food outlets and children's fruit and vegetable intake. METHOD: Parents of 340 5-6 and 461 10-12 year-old Australian children reported how frequently their child ate 14 fruits and 13 vegetables in the last week in 2002/3. A geographic information system (GIS) was used to determine the availability of the following types of food outlets near home: greengrocers; supermarkets; convenience stores; fast food outlets; restaurants, cafés and takeaway outlets. Logistic regression analyses examined the likelihood of consuming fruit >or=2 times/day and vegetables >or=3 times/day, according to access to food outlets. RESULTS: Overall, 62.5% of children ate fruit >or=2 times/day and 46.4% ate vegetables >or=3 times/day. The more fast food outlets (OR=0.82, 95%CI=0.67-0.99) and convenience stores (OR=0.84, 95%CI=0.73-0.98) close to home, the lower the likelihood of consuming fruit >or=2 times/day. There was also an inverse association between density of convenience stores and the likelihood of consuming vegetables >or=3 times/day (OR=0.84, 95%CI=0.74-0.95). The likelihood of consuming vegetables >or=3 times/day was greater the farther children lived from a supermarket (OR=1.27, 95%CI=1.07-1.51) or a fast food outlet (OR=1.19, 95%CI=1.06-1.35). CONCLUSION: Availability of fast food outlets and convenience stores close to home may have a negative effect on children's fruit and vegetable intake.
  114. Author: Timperio AF, Ball K, Roberts R, Andrianopoulos N, Crawford DA
    Title: Children's takeaway and fast-food intakes: associations with the neighbourhood food environment.
    Journal: Public Health Nutr. 12(10):1960-4
    Date: 2009 Oct
    Abstract: OBJECTIVE: The present study aimed to examine associations between availability of outlets where takeaway or fast food could be purchased and consumption of takeaway or fast food among children. DESIGN: Cross-sectional. Parents completed a questionnaire regarding the frequency per week their child usually ate takeaway or fast foods. The availability of outlets where these foods could be purchased close to home and en route to school was determined with a Geographic Information System (presence of any outlets and density of outlets within 800 m from home and along the route to school, and distance from home to closest outlet). SETTING: Greater Melbourne and Geelong, Australia. SUBJECTS: Three hundred and fifty-three children aged 5-6 years and 463 children aged 10-12 years. RESULTS: Overall, 69.4% of children consumed takeaway or fast foods once weekly or more often. Only one measure of availability of outlets close to home was associated with consumption; each additional outlet within 800 m was associated with 3% lower odds of consuming takeaway or fast foods at least once weekly (OR = 0.97, 95% CI 0.95, 1.00). There were no associations between availability en route to school and the likelihood of consuming takeaway or fast food at least once weekly. CONCLUSIONS: Access to outlets where takeaway or fast food could be purchased did not predict frequency of consumption of takeaway or fast food in the expected direction. Such relationships appear to be complex and may not be adequately captured by the measures of access included in the current study.
  115. Author: Simmons D, McKenzie A, Eaton S, Cox N, Khan MA, Shaw J, Zimmet P
    Title: Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia.
    Journal: Int J Obes (Lond). 29(6):703-10
    Date: 2005 Jun
    Abstract: OBJECTIVES: To establish whether choice and availability of takeaway and restaurant food consumption are associated with increased obesity. DESIGN: Crossroads Undiagnosed Disease Study: a cross-sectional study undertaken between June 2001 and March 2003. SETTING: A regional centre and six shire capitals of variables size in rural Victoria, Australia. PARTICIPANTS: In total, 1454 residents of randomly selected households. MEASUREMENTS: Obesity (by body mass index (BMI) or waist circumference), weekly recreational activity, self-reported frequency of takeaway consumption, number of local takeaway and restaurant food outlets in the area. RESULTS: The prevalence of obesity ranged from 25.5-30.8% and was higher than the general Australian population among both men and women. Those in the regional centre were less likely than those in large and small shire capitals to participate in recreational activity of 150 min or more (39.7 vs 48.4%, 46.0% respectively, P=0.023) and yet reported better access to facilities and amenities for physical activity. Recreational activity of > or =150 min/week was associated with 0.75 (0.58-0.97) fold less risk of obesity. BMI was unrelated to takeaway consumption. Waist circumference was significantly lower among those eating no takeaways, but similar whether takeaways were consumed or =1/week. Increased takeaway consumption was associated with increased consumption of higher fat preparations of dairy and meat products. Availability of takeaway outlets and restaurants was unrelated to obesity. CONCLUSION: The obesity epidemic exists among those without significant consumption of or availability to takeaway foods. In a setting of easy availability of food, the obesity epidemic relates strongly to reduced physical activity, but not to consumption of takeaway food.
  116. Author: Austin SB, Melly SJ, Sanchez BN, Patel A, Buka S, Gortmaker SL
    Title: Clustering of fast-food restaurants around schools: a novel application of spatial statistics to the study of food environments.
    Journal: Am J Public Health. 95(9):1575-81
    Date: 2005 Sep
    Abstract: OBJECTIVES: We examined the concentration of fast food restaurants in areas proximal to schools to characterize school neighborhood food environments. METHODS: We used geocoded databases of restaurant and school addresses to examine locational patterns of fast-food restaurants and kindergartens and primary and secondary schools in Chicago. We used the bivariate K function statistical method to quantify the degree of clustering (spatial dependence) of fast-food restaurants around school locations. RESULTS: The median distance from any school in Chicago to the nearest fast-food restaurant was 0.52 km, a distance that an adult can walk in little more than 5 minutes, and 78% of schools had at least 1 fast-food restaurant within 800 m. Fast-food restaurants were statistically significantly clustered in areas within a short walking distance from schools, with an estimated 3 to 4 times as many fast-food restaurants within 1.5 km from schools than would be expected if the restaurants were distributed throughout the city in a way unrelated to school locations. CONCLUSIONS: Fast-food restaurants are concentrated within a short walking distance from schools, exposing children to poor-quality food environments in their school neighborhoods.
  117. Author: Ezendam NP, Evans AE, Stigler MH, Brug J, Oenema A
    Title: Cognitive and home environmental predictors of change in sugar-sweetened beverage consumption among adolescents.
    Journal: Br J Nutr. 103(5):768-74
    Date: 2010 Mar
    Abstract: Sugar-sweetened beverage (SSB) consumption may increase risk for unnecessary weight gain. To develop interventions discouraging consumption, more insight is needed about cognitive and environmental predictors related to the decrease in SSB consumption. The present paper aims (1) to describe the relationship between potential cognitive determinants of change (attitudes, subjective norms, perceived behavioural control and intentions) and perceived environmental factors (family food rule and home availability of SSB) with changes in SSB consumption between baseline and 4-month follow-up and (2) to study whether the relationships between the environmental factors and SSB consumption are mediated by the cognitive determinants. Information on possible predictors and SSB intake at baseline and 4-month follow-up was provided by 348 Dutch adolescents (aged 12-13 years) through online questionnaires that were completed at school. Multilevel logistic regression and mediation analyses were used to determine direct and indirect associations between predictors and behaviour. The present results show that a high perceived behavioural control to decrease intake at baseline was associated with a decrease in consumption of SSB between baseline and follow-up (OR = 0.53). Low availability and a stricter family food rule were associated with a decrease in SSB consumption between baseline and follow-up (OR = 2.39, 0.54). The association between availability and decrease in SSB consumption was for 68 % mediated by perceived behavioural control to drink less. In conclusion, interventions to decrease SSB intake should focus on improving attitudes and perceived behavioural control to reduce intake, and on limiting home availability and stimulating stricter family food rules regarding SSB consumption.
  118. Author: Ding D, Sallis JF, Norman GJ, Saelens BE, Harris SK, Kerr J, Rosenberg D, Durant N, Glanz K
    Title: Community food environment, home food environment, and fruit and vegetable intake of children and adolescents.
    Journal: J Nutr Educ Behav. 44(6):634-8
    Date: 2012 Nov-Dec
    Abstract: OBJECTIVES: To determine (1) reliability of new food environment measures; (2) association between home food environment and fruit and vegetable (FV) intake; and (3) association between community and home food environment. METHODS: In 2005, a cross-sectional survey was conducted with readministration to assess test-retest reliability. Adolescents, parents of adolescents, and parents of children (n = 458) were surveyed in San Diego, Boston, and Cincinnati. RESULTS: Most subscales had acceptable reliability. Fruit and vegetable intake was positively associated with availability of healthful food (r = 0.15-0.27), FV (r = 0.22-0.34), and ratio of more-healthful/less-healthful food in the home (r = 0.23-0.31) and was negatively associated with less-healthful food in the home (r = -0.17 to -0.18). Home food environment was associated with household income but not with community food environment. CONCLUSIONS AND IMPLICATIONS: A more healthful home food environment was related to youth FV intake. Higher income households had more healthful food in the home. The potential influence of neighborhood food outlets warrants further study.
  119. Author: Wong F, Stevens D, O'Connor-Duffany K, Siegel K, Gao Y, Community Interventions for Health (CIH) collaboration
    Title: Community Health Environment Scan Survey (CHESS): a novel tool that captures the impact of the built environment on lifestyle factors.
    Journal: Glob Health Action
    Date: 2011
    Abstract: BACKGROUND: Novel efforts and accompanying tools are needed to tackle the global burden of chronic disease. This paper presents an approach to describe the environments in which people live, work, and play. Community Health Environment Scan Survey (CHESS) is an empirical assessment tool that measures the availability and accessibility, of healthy lifestyle options lifestyle options. CHESS reveals existing community assets as well as opportunities for change, shaping community intervention planning efforts by focusing on community-relevant opportunities to address the three key risk factors for chronic disease (i.e. unhealthy diet, physical inactivity, and tobacco use). METHODS: The CHESS tool was developed following a review of existing auditing tools and in consultation with experts. It is based on the social-ecological model and is adaptable to diverse settings in developed and developing countries throughout the world. RESULTS: For illustrative purposes, baseline results from the Community Interventions for Health (CIH) Mexico site are used, where the CHESS tool assessed 583 food stores and 168 restaurants. Comparisons between individual-level survey data from schools and community-level CHESS data are made to demonstrate the utility of the tool in strategically guiding intervention activities. CONCLUSION: The environments where people live, work, and play are key factors in determining their diet, levels of physical activity, and tobacco use. CHESS is the first tool of its kind that systematically and simultaneously examines how built environments encourage/discourage healthy eating, physical activity, and tobacco use. CHESS can help to design community interventions to prevent chronic disease and guide healthy urban planning.
  120. Author: Fisher BD, Strogatz DS
    Title: Community measures of low-fat milk consumption: comparing store shelves with households.
    Journal: Am J Public Health. 89(2):235-7
    Date: 1999 Feb
    Abstract: OBJECTIVES: This study examined the relationship between the proportion of milk in food stores that is low-fat and consumption of low-fat milk in the community. METHODS: Data were gathered from 503 stores across 53 New York State zip codes. In 19 zip codes, a telephone survey measured household low-fat milk use. Census data were obtained to examine sociodemographic predictors of the percentage of low-fat milk in stores. RESULTS: The proportion of low-fat milk in stores was directly related to low-fat milk consumption in households and to the median income and urban level of the zip code. CONCLUSIONS: These results support using food store shelf-space observations to estimate low-fat milk consumption.
  121. Author: Cheadle A, Psaty BM, Curry S, Wagner E, Diehr P, Koepsell T, Kristal A
    Title: Community-level comparisons between the grocery store environment and individual dietary practices.
    Journal: Prev Med. 20(2):250-61
    Date: 1991 Mar
    Abstract: BACKGROUND: This article examines the relationship at the community level between individual dietary practice and the grocery store environment. METHODS: Individual dietary practice was measured in 12 communities using a telephone survey to obtain self-reported diet. A protocol was developed to measure two aspects of the grocery store environment in these same 12 communities: the relative availability of healthful (low-fat and high-fiber) products, and the amount of health-education information provided. Comparisons were made between individual and store-level measures at two levels of geographic aggregation: community (typically a county) and zip code within community (n = 34). RESULTS: We found positive and statistically significant correlations at both the community and the zip code level between the availability of healthful products in stores and the reported healthfulness of individual diets. Positive correlations were also found between measures of the amount of health-education material provided by stores and the healthfulness of individual diets, but these correlations did not reach statistical significance. CONCLUSIONS: The results provide support for including measures of the grocery store environment as part of a community-level assessment of dietary behavior.
  122. Author: Sparks AL, Bania N, Leete L
    Title: Comparative approaches to measuring food access in urban areas: the case of Portland, Oregon.
    Journal: Urban Stud. 48(8):1715-737
    Date: 2011
    Abstract: GIS methods are used to construct measures of food access for neighbourhoods in the Portland, Oregon, US metropolitan area and the sensitivity of such measures to methodological variation is examined. The level of aggregation of data inputs is varied and the effect of using both Euclidean and street network distances is tested. It is found that, regardless of the level of geographical disaggregation, distance-based measures generate approximately the same conclusions about the distribution of food access in the area. It is also found that, while the relationship between street network and Euclidean distances varies with population density, measures computed with either construct generate the same relative patterns of food access. These findings suggest that results from food access studies employing disparate methodologies can often be compared.
  123. Author: Moore LV, Diez Roux AV, Brines S
    Title: Comparing Perception-Based and Geographic Information System (GIS)-based characterizations of the local food environment.
    Journal: J Urban Health. 85(2):206-16
    Date: 2008 Mar
    Abstract: Measuring features of the local food environment has been a major challenge in studying the effect of the environment on diet. This study examined associations between alternate ways of characterizing the local food environment by comparing Geographic Information System (GIS)-derived densities of various types of stores to perception-based measures of the availability of healthy foods. Survey questions rating the availability of produce and low-fat products in neighborhoods were aggregated into a healthy food availability score for 5,774 residents of North Carolina, Maryland, and New York. Densities of supermarkets and smaller stores per square mile were computed for 1 mile around each respondent's residence using kernel estimation. The number of different store types in the area was used to measure variety in the food environment. Linear regression was used to examine associations of store densities and variety with reported availability. Respondents living in areas with lower densities of supermarkets rated the selection and availability of produce and low-fat foods 17% lower than those in areas with the highest densities of supermarkets (95% CL, -18.8, -15.1). In areas without supermarkets, low densities of smaller stores and less store variety were associated with worse perceived availability of healthy foods only in North Carolina (8.8% lower availability, 95% CL, -13.8, -3.4 for lowest vs. highest small-store density; 10.5% lower 95% CL, -16.0, -4.7 for least vs. most store variety). In contrast, higher smaller store densities and more variety were associated with worse perceived healthy food availability in Maryland. Perception- and GIS-based characterizations of the environment are associated but are not identical. Combinations of different types of measures may yield more valid measures of the environment.
  124. Author: Crockett EG, Clancy KL, Bowering J
    Title: Comparing the cost of a thrifty food plan market basket in three areas of New York state
    Journal: Journal of nutrition education. 24(1):71S-78S
    Date: 1992
    Abstract:
  125. Author: Lassen A, Hansen K, Trolle E
    Title: Comparison of buffet and à la carte serving at worksite canteens on nutrient intake and fruit and vegetable consumption.
    Journal: Public Health Nutr. 10(3):292-7
    Date: 2007 Mar
    Abstract: OBJECTIVE: To evaluate the nutritional composition of worksite canteen lunches and to examine the impact of two meal serving systems on employee intake, i.e. buffet style with a fixed price for a varied number of dishes and à la carte style with a separate price for each item on the menu. DESIGN: Laboratory technicians observed employees' food selection and collected identical dishes. Food items were weighed separately to calculate the content of fruit and vegetables. The content of protein, fat and ash of each dish was chemically analysed and the carbohydrate and energy content calculated. SETTING: Fifteen randomly chosen worksite canteens in Denmark: eight canteens serving buffet style and seven canteens with an à la carte line. SUBJECTS: one hundred and eighty randomly chosen employees having lunch at the worksite canteens. RESULTS: The average percentage energy from fat was 37 +/- 12 among men and 33 +/- 12 among women. No association was found between the meal serving system and energy intake or macronutrient composition. Eating at canteens serving buffet style, on the other hand, was associated with an increased intake of fruit and vegetables, on average 76 g, and a lower energy density of the food for both genders. CONCLUSION: The results highlight the possibilities of promoting healthy food choices in the catering sector and the need to identify models of healthy catering practice. Serving buffet style appears to be a promising strategy in order to increase fruit and vegetable consumption in food served away from home.
  126. Author: Mercille G, Richard L, Gauvin L, Kestens Y, Payette H, Daniel M
    Title: Comparison of two indices of availability of fruits/vegetable and fast food outlets.
    Journal: J Urban Health. 90(2):240-5
    Date: 2013 Apr
    Abstract: Studies of food environment often examine single dimensions of areas that may not account for complexity of exposure to all food sources. With respect to the deprivation amplification hypothesis, particular needs are to assess whether relative or absolute measures of the food environment are related to characteristics of social environment. The objective of this study was to compare absolute availability (AA) of fast food outlets (FFO) and stores selling fresh fruits and vegetables (FVS) with the relative availability (RA) of the same food sources in relation to area-level poverty and ethnic diversity in 248 selected census tracts (CT) in Montreal, Canada. AA of FFO and FVS were expressed as areal densities of food sources within CTs. RA indices were calculated as the proportion of FVSs relative to total food stores and the proportion of FFOs relative to all restaurants within CTs, respectively. Whereas the AA of FFO was positively associated with area-level poverty and ethnic diversity, the RA of FFO was inversely associated with area-level poverty and not associated with ethnic diversity. Both measures of FVS were positively associated with area-level poverty and ethnic diversity. These findings do not support a model of deprivation amplification. Furthermore, results of FFO suggest that the alternate measure of RA can complement information based on AA indicators of the food environment, with potential utility in predicting eating practices.
  127. Author: Kann L, Grunbaum J, McKenna ML, Wechsler H, Galuska DA
    Title: Competitive foods and beverages available for purchase in secondary schools--selected sites, United States, 2004.
    Journal: J Sch Health. 75(10):370-4
    Date: 2005 Dec
    Abstract: School Health Profiles is conducted biennially to assess characteristics of school health programs. State and local departments of education and health select either all public secondary schools within their jurisdictions or a systematic, equal-probability sample of public secondary schools to participate in School Health Profiles. At each school, the principal and lead health education teacher were sent questionnaires to be self-administered and returned to the state or local agency conducting the survey. In 2004, a total of 27 states and 11 large urban school districts obtained weighted data from their survey of principals. The findings in this report indicate that the majority of secondary schools in 27 states and 11 large urban school districts allow students to purchase snack foods or beverages from vending machines or at the school store, canteen, or snack bar. The types of competitive foods and beverages available for purchase varied across states and large urban school districts. Overall, fruits or vegetables were less likely to be available for purchase than the other types of foods or beverages. Bottled water and soft drinks, sports drinks, or fruit drinks that are not 100% juice were most likely to be available for purchase.
  128. Author: Probart C, McDonnell E, Weirich JE, Hartman T, Bailey-Davis L, Prabhakher V
    Title: Competitive foods available in Pennsylvania public high schools.
    Journal: J Am Diet Assoc. 105(8):1243-9
    Date: 2005 Aug
    Abstract: OBJECTIVE: This study examined the types and extent of competitive foods available in public high schools in Pennsylvania. DESIGN: We developed, pilot tested, and distributed surveys to school foodservice directors in a random sample of 271 high schools in Pennsylvania. SUBJECTS: Two hundred twenty-eight surveys were returned, for a response rate of 84%. Statistical analyses were performed: Descriptive statistics were used to examine the extent of competitive food sales in Pennsylvania public high schools. The survey data were analyzed using SPSS software version 11.5.1 (2002, SPSS base 11.0 for Windows, SPSS Inc, Chicago, IL). RESULTS: A la carte sales provide almost dollar 700/day to school foodservice programs, almost 85% of which receive no financial support from their school districts. The top-selling a la carte items are "hamburgers, pizza, and sandwiches." Ninety-four percent of respondents indicated that vending machines are accessible to students. The item most commonly offered in vending machines is bottled water (71.5%). While food items are less often available through school stores and club fund-raisers, candy is the item most commonly offered through these sources. CONCLUSIONS: Competitive foods are widely available in high schools. Although many of the items available are low in nutritional value, we found several of the top-selling a la carte options to be nutritious and bottled water the item most often identified as available through vending machines.
  129. Author: Nollen NL, Befort C, Davis AM, Snow T, Mahnken J, Hou Q, Story M, Ahluwalia JS
    Title: Competitive foods in schools: availability and purchasing in predominately rural small and large high schools.
    Journal: J Am Diet Assoc. 109(5):857-64
    Date: 2009 May
    Abstract: OBJECTIVES: Schools have an important role to play in obesity prevention, but little is known about the food environment in small, predominately rural schools. The primary purpose of this study was to compare the availability and student purchasing of foods sold outside of the reimbursable meals program through à la carte or vending (ie, competitive foods) in small (n=7) and large (n=6) Kansas high schools. METHODS: A cross-sectional observational study design was used to capture the number of à la carte and vending items available and purchased, and the fat and energy content of all available and purchased items on a single school day between January and May 2005. RESULTS: Small schools had significantly fewer vending machines than large schools (median 3.0 [range 2.0 to 5.0] vs 6.5 [range 4.0 to 8.0], P
  130. Author: Grunseit AC, Taylor AJ, Hardy LL, King L
    Title: Composite measures quantify households' obesogenic potential and adolescents' risk behaviors.
    Journal: Pediatrics. 128(2):e308-16
    Date: 2011 Aug
    Abstract: OBJECTIVE: The aims of this study were to generate composite measures quantifying a household's obesogenic potential and to examine the relationship of the composite variables with older children's eating, physical activity (PA), and small screen recreation. METHODS: Data were from surveys with 1685 child-parent pairs in which the child was in grade 6, 8, or 10 (mean age: 14 years). Composite measures of the obesogenic household environment were generated from 11 measures using nonlinear principal components analysis. Associations between the composite measures and the children's healthy and unhealthy food intake, PA, and screen time were tested (adjusting for demographic characteristics). RESULTS: Two scales were generated: (1) obesogenic control, which clustered together factors that mitigate risk; and (2) obesogenic risk. Higher scores on the control scale were associated with higher adolescent intake of healthy foods, lower intake of unhealthy foods, higher PA, and less screen time. Higher scores on the risk scale were associated with lower adolescent intake of healthy foods, higher intake of unhealthy foods, lower PA, and more screen time. There were significant 2-way interactions between the scales for soft drink consumption and PA. CONCLUSIONS: Household obesogenic potential may be quantified as 2 factors reflecting cumulative risk and control practices. These factors have both additive associations with obesogenic behaviors and, in some cases, modify each other, suggesting that a healthy home environment requires attention to both. Health promotion messages could incorporate these 2 different but interacting factors that parents can use to modify the obesogenic potential of their household.
  131. Author: Golaszewski T, Barr D, Blodgett C, Delprino R
    Title: Continued development of an organizational heart-health assessment
    Journal: Worksite health
    Date: 1996
    Abstract:
  132. Author: Gebauer H, Laska MN
    Title: Convenience stores surrounding urban schools: an assessment of healthy food availability, advertising, and product placement.
    Journal: J Urban Health. 88(4):616-22
    Date: 2011 Aug
    Abstract: Adolescent obesity is a national public health problem, particularly among urban populations. Recent evidence has linked neighborhood food environments to health and nutrition status, with easier access to convenience stores being associated with increased risk for obesity. Little is known about the availability of healthy purchasing options within small, urban food stores, or the extent to which these factors are relevant to youth. The objective of this research was to characterize various features of the food environment within small convenience stores located nearby urban junior high and high schools. In-store audits were conducted in 63 stores located within 800 m of 36 urban Minnesota public secondary schools. Results indicated that a limited number of healthier beverages (i.e., water and 100% fruit juice) and snack options (i.e., nuts and pretzels) were available at most stores (≥85%). However, a wide range of healthy snack options were typically not available, with many specific items stocked in less than half of stores (e.g., low-fat yogurt in 27% of stores and low-fat granola bars in 43%). Overall, 51% of stores had fresh fruit and 49% had fresh vegetables. Few stores carried a range of healthier snack alternatives in single-serving packages. All stores had less healthful impulse purchase items available (e.g., candy) while only 46% carried healthier impulse items (e.g., fruit). Most stores (97%) had food/beverage advertising. Overall, convenience stores located in close proximity to secondary schools represent an important and understudied component of the youth food environment.
  133. Author: Dave JM, Evans AE, Pfeiffer KA, Watkins KW, Saunders RP
    Title: Correlates of availability and accessibility of fruits and vegetables in homes of low-income Hispanic families.
    Journal: Health Educ Res. 25(1):97-108
    Date: 2010 Feb
    Abstract: Availability and accessibility (AA) has been consistently shown across studies as the most important correlate of fruits and vegetables (FV) intake. However, there is little data on factors that influence AA of FV, especially in Hispanic families. The objective of this cross-sectional study was to examine the association between parental factors, child's preferences for FV and AA of FV in homes of low-income Hispanic families with children 5-12 years old. A convenience sample of 184 parents of low socioeconomic status recruited through public elementary schools completed a self-administered questionnaire about demographics, language spoken at home and food insecurity (FI). Parental factors and child's preferences were measured using a 16-item questionnaire, which was developed specifically for the study. AA of FV was measured using a validated nine-item index. Hierarchical multiple regression analysis indicated that language spoken at home, parental practices that promote consumption of FV, parental role modeling and perceived benefits of fast food had significant and independent associations with AA of FV at home. Intervention programs should take into consideration the language spoken at home and target at improving parental factors in order to improve AA of FV.
  134. Author: Neumark-Sztainer D, Wall M, Perry C, Story M
    Title: Correlates of fruit and vegetable intake among adolescents. Findings from Project EAT.
    Journal: Prev Med. 37(3):198-208
    Date: 2003 Sep
    Abstract: BACKGROUND: This study aims to identify correlates of fruits and vegetables from within the domains of personal factors (taste preferences, health/nutrition attitudes, weight/body concerns, and self-efficacy), behavioral factors (meal frequency, fast food intake, and weight control behaviors), and socio-environmental factors (social support for healthy eating, family meal patterns, food security, socio-economic status, and home availability of fruits/vegetables). This study further aims to identify correlates of home availability and taste preferences for fruits/vegetables, and to explore patterns of interaction between availability and taste preferences. METHODS: The population included 3957 adolescents from 31 public middle and high schools in Minnesota. Structural equation modeling was used for model testing. RESULTS: The strongest correlates of fruit/vegetable intake were home availability of fruits/vegetables and taste preferences of fruits/vegetables. The final model explained 13% of the variance in fruit/vegetable intake, 45% of the variance in home availability, and 28% of the variance in taste preferences. Correlates of home availability included social support for healthy eating, family meal patterns, family food security, and socio-economic status. Correlates of taste preferences included health/nutrition attitudes and home availability of fruits/vegetables. A test of interaction effects indicated that when home availability of fruits/vegetables was low, intake patterns did not differ, regardless of taste preferences. In contrast, even when taste preferences for fruits/vegetables were low, if fruits/vegetables were available, intake increased. CONCLUSIONS: Interventions to increase fruit/vegetable intake in adolescents need to target socio-environmental factors such as greater availability of fruits/vegetables.
  135. Author: Ward PR, Coveney J, Verity F, Carter P, Schilling M
    Title: Cost and affordability of healthy food in rural South Australia.
    Journal: Rural Remote Health
    Date: 2012
    Abstract: INTRODUCTION: As in many other countries, Australian consumers have recently had to accommodate increases in costs of basic food, and during the financial year 2007-2008 overall food prices rose by nearly 4%. Food costs are mediating factors in food choice, especially for low-income groups, where food security is often tenuous. There are reports that rural populations may have higher levels of food insecurity, although the evidence is often contradictory. METHODS: To assess cost and affordability of food in rural areas this study used the Healthy Food Basket (HFB) methodology, which has been applied in a number of settings. The HFBs were costed at supermarkets and stores in different locations with different degrees of rurality. RESULTS: Compared with metropolitan areas, healthy food is more expensive in rural areas; costs are even higher in more remote areas. The overall affordability of HFB in rural areas was not significantly different from metro areas. The main difference concerned low socio-economic status (SES) groups, where the proportion of household income spent on the HFB was three times that of higher SES groups. CONCLUSIONS: The unaffordability of healthy food, or 'food stress' in low SES groups is a concern, especially when this group carries the greatest burden of diet-related disease. Findings suggest that there is a need to consider both rurality and SES when developing policy responses to decrease the cost and increase the affordability of healthy foods in rural and remote areas.
  136. Author: Mooney C
    Title: Cost and availability of healthy food choices in a London health district
    Journal: Journal of human nutrition and dietetics. 3(2):111-20
    Date: 1990
    Abstract: To assess whether the foods and diet being promoted by the local Food Health Policy are affordable by and available to all sections of the community, cost and availability of a wide range of foods was recorded in the main supermarkets in Hampstead, an Inner London Health District. It was found that the recommended foods and diet were more expensive and less available than alternatives, particularly in deprived areas. This is a constraint to changing over to a healthier diet, particularly for people on very low levels of income i.e. those on pensions and benefits. Healthy eating programmes should take these constraints into consideration and efforts to increase the availability of cheap, healthy food should be a priority at national and local level. Higher pensions and benefit levels would also create more equitable access to healthy diets.
  137. Author: Forsyth A, Van Riper D, Larson N, Wall M, Neumark-Sztainer D
    Title: Creating a replicable, valid cross-platform buffering technique: the sausage network buffer for measuring food and physical activity built environments.
    Journal: Int J Health Geogr. 11(1):14
    Date: 2012
    Abstract: BACKGROUND: Obesity researchers increasingly use geographic information systems to measure exposure and access in neighborhood food and physical activity environments. This paper proposes a network buffering approach, the "sausage" buffer. This method can be consistently and easily replicated across software versions and platforms, avoiding problems with proprietary systems that use different approaches in creating such buffers. METHODS: In this paper, we describe how the sausage buffering approach was developed to be repeatable across platforms and places. We also examine how the sausage buffer compares with existing alternatives in terms of buffer size and shape, measurements of the food and physical activity environments, and associations between environmental features and health-related behaviors. We test the proposed buffering approach using data from EAT 2010 (Eating and Activity in Teens), a study examining multi-level factors associated with eating, physical activity, and weight status in adolescents (n=2,724) in the Minneapolis/St. Paul metropolitan area of Minnesota. RESULTS: Results show that the sausage buffer is comparable in area to the classic ArcView 3.3 network buffer particularly for larger buffer sizes. It obtains similar results to other buffering techniques when measuring variables associated with the food and physical activity environments and when measuring the correlations between such variables and outcomes such as physical activity and food purchases. CONCLUSIONS: Findings from various tests in the current study show that researchers can obtain results using sausage buffers that are similar to results they would obtain by using other buffering techniques. However, unlike proprietary buffering techniques, the sausage buffer approach can be replicated across software programs and versions, allowing more independence of research from specific software.
  138. Author: Hendrie GA, Coveney J, Cox DN
    Title: Defining the complexity of childhood obesity and related behaviours within the family environment using structural equation modelling.
    Journal: Public Health Nutr. 15(1):48-57
    Date: 2012 Jan
    Abstract: OBJECTIVE: The present study aimed to define the complexity of the relationships between the family environment, health behaviours and obesity. A conceptual model that quantifies the relationships and interactions between parent factors, family environment, and certain aspects of children's behaviour and weight status is presented. DESIGN: Exploratory structural equation modelling was used to quantitatively model the relationships between parent, child and family environmental factors. SETTING: Adelaide, South Australia. SUBJECTS: Families (n 157) with children aged 5-10 years completed self-reported questionnaires, providing data on parents' knowledge, diet quality and activity habits; child feeding and general parenting styles; and the food and physical activity environments. Outcome variables included children's fruit and vegetable intake, activity and sedentary habits and weight status. RESULTS: The proposed model was an acceptable fit (normed fit index = 0·457; comparative fit index = 0·746; root-mean-squared error associated = 0·044). Parents' BMI (β = 0·32) and nutrition and physical activity knowledge (β = 0·17) had the strongest direct associations with children's BMI Z-score. Parents' dietary intake and energy expenditure behaviours were indirectly associated with children's behaviour through the creation of the home environment. The physical activity and food environments were associated with children's sedentary (β = -0·44) and activity habits (β = 0·29), and fruit and vegetable intake (β = 0·47), respectively. CONCLUSIONS: A conceptual model that quantifies the complex network of family environment factors influencing children's behaviour and weight status is presented. The model provides a basis for future research on larger representative samples with a view to guiding obesity prevention interventions.
  139. Author: Daniel M, Kestens Y, Paquet C
    Title: Demographic and urban form correlates of healthful and unhealthful food availability in Montréal, Canada.
    Journal: Can J Public Health. 100(3):189-93
    Date: 2009 May-Jun
    Abstract: OBJECTIVE: This study sought to extend previous analyses of food insecurity in Montreal by examining the relationship between neighbourhood sociodemographic and urban form variables and sources of food both unhealthful (fast-food outlets, FFO) and healthful (stores selling fruits and vegetables, FVS). METHODS: Densities of FFO and FVS were computed for 862 Census tract areas (CTA) (defined as census tract with a 1-km buffer around its limits) for the Montréal Census Metropolitan Area (CMA). Predictor variables included CTA socio-demographic characteristics reflecting income, household structure, language, and education, and urban form measures, specifically, densities of local roads, main roads, expressways and highways. Food source densities were regressed on CTA characteristics using stepwise regression. RESULTS: Socio-demographic and urban form measures explained 60% and 73% of the variance in densities of FFO and FVS, respectively. FFO were more prevalent in CTA with higher proportions of full-time students and households speaking neither French nor English; lower proportions of married individuals, children and older adults; and more high-traffic roads. FVS were more prevalent in CTA with higher proportions of single residents, university-educated residents and households speaking neither French nor English; lower proportion of French-speakers; and more local roads. Median household income was not related to the density of FFO or FVS. CONCLUSION: The availability of healthful and unhealthful food varies across the Montréal CMA. Areas with lower education and more French-speaking households have a lesser availability of FVS. The association of FFO with high-traffic roadways and areas with high school attendance suggests a point for intervention via commercial zoning changes.
  140. Author: Seliske LM, Pickett W, Boyce WF, Janssen I
    Title: Density and type of food retailers surrounding Canadian schools: variations across socioeconomic status.
    Journal: Health Place. 15(3):903-7
    Date: 2009 Sep
    Abstract: Lower socioeconomic status (SES) neighbourhoods may have differential access to food retailers, potentially explaining the varying area-level obesity rates. The food retail environment around 188 schools across Canada was examined, including full-service restaurants, fast food restaurants, sub/sandwich retailers, donut/coffee shops, convenience stores, and grocery stores. School addresses were linked to census data to obtain area-level SES measures. Access to food retailers was generally not associated with the neighbourhood SES in the immediate proximity. Within the broader neighbourhood, lower SES neighbourhoods had access to fewer food retailers of all types. This effect was diminished after taking population density into account.
  141. Author: Kelly B, Flood VM, Bicego C, Yeatman H
    Title: Derailing healthy choices: an audit of vending machines at train stations in NSW.
    Journal: Health Promot J Austr. 23(1):73-5
    Date: 2012 Apr
    Abstract: ISSUE ADDRESSED: Train stations provide opportunities for food purchases and many consumers are exposed to these venues daily, on their commute to and from work. This study aimed to describe the food environment that commuters are exposed to at train stations in NSW. METHODS: One hundred train stations were randomly sampled from the Greater Sydney Metropolitan region, representing a range of demographic areas. A purpose-designed instrument was developed to collect information on the availability, promotion and cost of food and beverages in vending machines. Items were classified as high/low in energy according to NSW school canteen criteria. RESULTS: Of the 206 vending machines identified, 84% of slots were stocked with high-energy food and beverages. The most frequently available items were chips and extruded snacks (33%), sugar-sweetened soft drinks (18%), chocolate (12%) and confectionery (10%). High energy foods were consistently cheaper than lower-energy alternatives. CONCLUSIONS: Transport sites may cumulatively contribute to excess energy consumption as the items offered are energy dense. Interventions are required to improve train commuters' access to healthy food and beverages.
  142. Author: Clarke G, Eyre H, Guy C
    Title: Deriving indicators of access to food retail provision in British cities: studies of Cardiff, Leeds and Bradford
    Journal: Urban studies. 39(11):2041-60
    Date: 2002
    Abstract: This paper attempts to quantify patterns of access to food retailing in two urban areas (Leeds/Bradford and Cardiff). We introduce, first, a locally based mapping approach and, secondly, a systematic city-wide modelling approach. This quantifies provision levels in terms of modelling shopping flows, in order to identify areas of poor access to food retailing. The paper then compares these contrasting methods of identifying 'food deserts', using the study areas of Leeds/Bradford and Cardiff. Two 'what if' type analyses are also undertaken (one in Leeds, one in Cardiff) to investigate the impact on 'food deserts' of opening new food retailing stores.
  143. Author: Latham J, Moffat T
    Title: Determinants of variation in food cost and availability in two socioeconomically contrasting neighbourhoods of Hamilton, Ontario, Canada.
    Journal: Health Place. 13(1):273-87
    Date: 2007 Mar
    Abstract: This study addresses links between economic and nutritional variation in an urban North American setting. We employed a mixed-methods approach including mapping, semi-structured interviews, and food outlet surveys to investigate the public health impact of variation in the cost and availability of food between two socioeconomically distinct neighbourhoods of the City of Hamilton, Ontario, Canada. Food cost in supermarkets was not found to be higher in the low-income neighbourhood, though it was much higher in the variety stores that predominate in the low-income neighbourhood. Moreover, there was a very low availability of produce in the variety stores. Reduced fresh produce availability and lower incomes have the potential to negatively influence public health in the less-affluent study area by increasing the difficulty of acquiring healthy foods.
  144. Author: Widener MJ, Metcalf SS, Bar-Yam Y
    Title: Developing a mobile produce distribution system for low-income urban residents in food deserts.
    Journal: J Urban Health. 89(5):733-45
    Date: 2012 Oct
    Abstract: Low-income households in the contemporary city often lack adequate access to healthy foods, like fresh produce, due to a variety of social and spatial barriers that result in neighborhoods being underserved by full-service supermarkets. Because of this, residents commonly resort to purchasing food at fast food restaurants or convenience stores with poor selections of produce. Research has shown that maintaining a healthy diet contributes to disease prevention and overall quality of life. This research seeks to increase low-income residents' access to healthy foods by addressing spatial constraints through the characterization of a mobile market distribution system model that serves in-need neighborhoods. The model optimally locates mobile markets based on the geographic distribution of these residents. Using data from the medium-sized city of Buffalo, New York, results show that, with relatively few resources, the model increases these residents' access to healthy foods, helping to create a healthier city.
  145. Author: Krukowski RA, Philyaw Perez AG, Bursac Z, Goodell M, Raczynski JM, Smith West D, Phillips MM
    Title: Development and evaluation of the school cafeteria nutrition assessment measures.
    Journal: J Sch Health. 81(8):431-6
    Date: 2011 Aug
    Abstract: BACKGROUND: Foods provided in schools represent a substantial portion of US children's dietary intake; however, the school food environment has proven difficult to describe due to the lack of comprehensive, standardized, and validated measures. METHODS: As part of the Arkansas Act 1220 evaluation project, we developed the School Cafeteria Nutrition Assessment (SCNA) measures to assess food availability in public school cafeterias (n = 113). The SCNA provides a measure to evaluate monthly school lunch menus and to observe foods offered in school cafeterias during the lunch period. These measures provide information on the availability of fruit, vegetables, grains (whole or white), chips (reduced fat or regular), side dishes, main dishes, beverages, à la carte selections, and desserts, as well as information on healthier preparation of these items. Using independent raters, the inter-rater reliability of the measure was determined among a subsample of these schools (n = 32). RESULTS: All food categories assessed, with the exception of the side dish and chip categories, had inter-rater reliability rates of 0.79 or greater, regardless of school type. The SCNA scores encompassed the majority of the possible scores, indicating the ability for the measures to differentiate between school cafeterias in the availability of healthier options. CONCLUSION: These measures allow comprehensive, rapid measurement of school cafeteria food availability with high inter-rater reliability for public health and school health professionals, communities, and school personnel. These measures have the potential to contribute to school health efforts to evaluate cafeteria offerings and/or the impact of policy changes regarding school foods.
  146. Author: Golaszewski T, Blodgett C, Barr D, Delprino R
    Title: Development and preliminary testing of an organizational heart health support assessment
    Journal: Journal of health education. 27(1):25-29
    Date: 1996
    Abstract: Because of a growing need in the area of worksite health promotion to assess the employer as well as the employee, an organizational heart health support instrument and data collection process was developed and field tested. Modeled after criteria found in the 1992 National Survey of Worksite Health Promotion, the instrument was reviewed by experts in the field and found to have sufficient content and face validity. Following training of a group of 14 advanced health promotion majors serving as independent raters, the instrument was field tested at four cooperating worksites. Significant differences were observed by mean organizational support scores across these worksites. Of 134 total items, 133 were found to have inter-rater agreement of 80 percent or greater. Additionally, internal consistency reliability ranged from 0.83 to 0.97 for the instrument's six sub-scales. Taken in total, the instrument was judged acceptable for field use to assess organizational need, heighten management's awareness of programming options, plan initiatives, and evaluate progress. For more sophisticated efforts, continued research is needed for this relatively unexplored area of activity.
  147. Author: Rimkus L, Powell LM, Zenk SN, Han E, Ohri-Vachaspati P, Pugach O, Barker DC, Resnick EA, Quinn CM, Myllyluoma J, Chaloupka FJ
    Title: Development and reliability testing of a food store observation form.
    Journal: J Nutr Educ Behav. 45(6):540-8
    Date: 2013 Nov-Dec
    Abstract: OBJECTIVE: To develop a reliable food store observational data collection instrument to be used for measuring product availability, pricing, and promotion. DESIGN: Observational data collection. SETTING: A total of 120 food stores (26 supermarkets, 34 grocery stores, 54 gas/convenience stores, and 6 mass merchandise stores) in the Chicago metropolitan statistical area. MAIN OUTCOME MEASURES: Inter-rater reliability for product availability, pricing, and promotion measures on a food store observational data collection instrument. ANALYSIS: Cohen's kappa coefficient and proportion of overall agreement for dichotomous variables and intra-class correlation coefficient for continuous variables. RESULTS: Inter-rater reliability, as measured by average kappa coefficient, was 0.84 for food and beverage product availability measures, 0.80 for interior store characteristics, and 0.70 for exterior store characteristics. For continuous measures, average intra-class correlation coefficient was 0.82 for product pricing measures; 0.90 for counts of fresh, frozen, and canned fruit and vegetable options; and 0.85 for counts of advertisements on the store exterior and property. CONCLUSIONS AND IMPLICATIONS: The vast majority of measures demonstrated substantial or almost perfect agreement. Although some items may require revision, results suggest that the instrument may be used to reliably measure the food store environment.
  148. Author: Fulkerson JA, Lytle L, Story M, Moe S, Samuelson A, Weymiller A
    Title: Development and validation of a screening instrument to assess the types and quality of foods served at home meals.
    Journal: Int J Behav Nutr Phys Act
    Date: 2012
    Abstract: BACKGROUND: Although there is growing interest in assessing the home food environment, no easy-to-use, low cost tools exist to assess the foods served at home meals, making it difficult to assess the meal component of the food environment. The aim of this study was to develop and validate a user-friendly screener to assess the types of foods served at home meals. METHODS: Primary food preparing adults (n = 51) participated in a validation study in their own homes. Staff and participants independently completed a screener as participants cooked dinner. The screener assessed the types of foods offered, method(s) of preparation, and use of added fats. Two scale scores were created: 1) to assess offerings of foods in five food groups (meat and other protein, milk, vegetables, fruit, grains), 2) to assess the relative healthfulness of foods based on types offered, preparation method, and added fats. Criterion validity was assessed comparing staff and participant reports of individual foods (kappa (k)) and scale scores (Spearman correlations). RESULTS: Criterion validity was high between participants' and staffs' record of whether major food categories (meat and other protein, bread and cereal, salad, vegetables, fruits, dessert) were served (k = 0.79-1.0), moderate for reports of other starches (e.g., rice) being served (k = 0.52), and high for the Five Food Group and Healthfulness scale scores (r = 0.75-0.85, p
  149. Author: Miller C, Edwards L
    Title: Development and validation of a shelf inventory to evaluate household food purchases among older adults with diabetes mellitus.
    Journal: J Nutr Educ Behav. 34(5):261-7
    Date: 2002 Sep-Oct
    Abstract: OBJECTIVE: Valid measures of behavioral outcomes are needed to evaluate interventions. The purpose of this research was to validate a shelf inventory and evaluate food purchases using the inventory among older adults with diabetes. DESIGN: A 166-item shelf inventory of household food was assessed for face, content, and criterion validity. The sensitivity and specificity of the inventory were determined by comparing participant- and interviewer-completed inventories. A randomized pretest/post-test control group design was used to evaluate household food purchases following an intervention. Setting: The intervention was held in an outpatient setting. PARTICIPANTS: Study participants were > or = 65 years old with type 2 diabetes mellitus for > or = 1 year. INTERVENTION: The intervention included 10 weekly group sessions and emphasized applying food label information to food purchases. MAIN OUTCOME MEASURES: Each food on the inventory was defined as "encouraged" or "discouraged" according to intervention messages. ANALYSIS: Inventory sensitivity was the proportion of foods present in households that were accurately identified on the self-reported inventory as present; specificity was the proportion of foods not present that were accurately identified as not present. Two-sample t tests compared intervention scores for encouraged/discouraged foods by treatment group. RESULTS: Overall sensitivity and specificity were.90 and.97, respectively. Intervention results found more encouraged than discouraged foods present at post-test (t [91] = 2.3, P =.02). CONCLUSIONS AND IMPLICATIONS: The shelf inventory is a sensitive, specific, and valid tool for assessing household food purchases and can be used to evaluate food choice interventions among older adults with type 2 diabetes mellitus.
  150. Author: Freedman MR
    Title: Development, evaluation, and validation of environmental assessment tools to evaluate the college nutrition environment.
    Journal: J Am Coll Health. 58(6):565-8
    Date: 2010 May-Jun
    Abstract: OBJECTIVE: To develop, evaluate, and validate 2 nutrition environment assessment tools (surveys), for specific use in combating overweight on college/university campuses. PARTICIPANTS AND METHODS: Invitations to complete surveys were e-mailed to food service and health center directors at 47 universities, Winter 2008. Overall response rate was 48%. Responses from the 39 individuals who completed tool evaluations at the end of each survey were analyzed. Follow-up interviews and site visits performed through Summer 2008 validated responses. RESULTS: The majority of respondents (64%) indicated tools were effective at assessing their nutrition environments; 78% believed these types of assessment tools to be important to their school. CONCLUSION: Food service and health center directors support use of nutrition environment assessment tools and found them effective at clarifying existing nutrition programs, policies, and food offerings on their campuses. Conducting assessments using these tools could improve university nutrition environments by identifying areas needing improvement.
  151. Author: Stewart JE, Battersby SE, Lopez-De Fede A, Remington KC, Hardin JW, Mayfield-Smith K
    Title: Diabetes and the socioeconomic and built environment: geovisualization of disease prevalence and potential contextual associations using ring maps.
    Journal: Int J Health Geogr
    Date: 2011
    Abstract: BACKGROUND: Efforts to stem the diabetes epidemic in the United States and other countries must take into account a complex array of individual, social, economic, and built environmental factors. Increasingly, scientists use information visualization tools to "make sense" of large multivariate data sets. Recently, ring map visualization has been explored as a means of depicting spatially referenced, multivariate data in a single information graphic. A ring map shows multiple attribute data sets as separate rings of information surrounding a base map of a particular geographic region of interest. In this study, ring maps were used to evaluate diabetes prevalence among adult South Carolina Medicaid recipients. In particular, county-level ring maps were used to evaluate disparities in diabetes prevalence among adult African Americans and Whites and to explore potential county-level associations between diabetes prevalence among adult African Americans and five measures of the socioeconomic and built environment--persistent poverty, unemployment, rurality, number of fast food restaurants per capita, and number of convenience stores per capita. Although Medicaid pays for the health care of approximately 15 percent of all diabetics, few studies have examined diabetes in adult Medicaid recipients at the county level. The present study thus addresses a critical information gap, while illustrating the utility of ring maps in multivariate investigations of population health and environmental context. RESULTS: Ring maps showed substantial racial disparity in diabetes prevalence among adult Medicaid recipients and suggested an association between adult African American diabetes prevalence and rurality. Rurality was significantly positively associated with diabetes prevalence among adult African American Medicaid recipients in a multivariate statistical model. CONCLUSIONS: Efforts to reduce diabetes among adult African American Medicaid recipients must extend to rural African Americans. Ring maps can be used to integrate diverse data sets, explore attribute associations, and achieve insights critical to the promotion of population health.
  152. Author: Nelson Laska M, Larson NI, Neumark-Sztainer D, Story M
    Title: Dietary patterns and home food availability during emerging adulthood: do they differ by living situation?
    Journal: Public Health Nutr. 13(2):222-8
    Date: 2010 Feb
    Abstract: OBJECTIVE: The objective of the present work was to cross-sectionally examine and compare dietary behaviours and home food environments by young adults' living situation. DESIGN: Using data from Project EAT (Eating Among Teens)-II, a large diverse youth cohort originally sampled in Minnesota, linear regression was used to examine self-reported meal frequency, dietary intake and home food availability outcomes by living situation (i.e. living with parents, renting an apartment/house or living on a college campus). SUBJECTS: Young adults (n 1687), mean age 20.5 years. RESULTS: Results suggested that young adults living with their parents or in rented apartments/houses had less frequent meals, poorer dietary intake and less healthy home food availability compared with those living on campus. These findings were evident even after controlling for sociodemographic factors (e.g. race/ethnicity, socio-economic status), particularly among females. CONCLUSIONS: Although few emerging adults consume diets that are consistent with national recommendations, those living with parents and in rented apartments/houses may represent particularly at-risk groups. These differences in dietary factors across living situations appear to exist beyond the sociodemographic differences in these populations. Effective nutrition and healthy eating promotion strategies are needed for young adults.
  153. Author: van Assema P, Glanz K, Martens M, Brug J
    Title: Differences between parents' and adolescents' perceptions of family food rules and availability.
    Journal: J Nutr Educ Behav. 39(2):84-9
    Date: 2007 Mar-Apr
    Abstract: OBJECTIVE: To test the hypotheses that adolescents have different perceptions of family-environmental factors than do their parents, and that dietary intake of adolescents is more highly associated with the adolescent's own perceptions than those of their parents. DESIGN: Data from self-administered questionnaires were used. PARTICIPANTS: Five-hundred two students aged 12 to 14 years, and one of each student's parents. MAIN OUTCOME MEASURES: Two types of family-environmental factors (ie, family food rules and home availability and accessibility of food) for 3 self-reported dietary behaviors (ie, fruit, snack, and breakfast intake). ANALYSIS: Unpaired t tests, chi-square tests, percentage (gross) disagreement, standardized regression coefficients, and linear regression analyses. RESULTS: For most rules and most perceptions of availability and accessibility, considerable disagreement was found between parents and students. Self-reported intake of fruit and snacks was more highly associated with student measures, but breakfast intake was more highly associated with parent measures of rules and availability. IMPLICATIONS FOR RESEARCH AND PRACTICE: The findings might explain mixed results on the associations between family-environmental factors and children's dietary intake that were found in earlier studies. Researchers need to be aware that in studies into family-environmental determinants of dietary habits using self-reports, the results are possibly influenced by whether the data were reported by parents or by children.
  154. Author: Byrd-Bredbenner C, Abbot JM
    Title: Differences in food supplies of U.S. households with and without overweight individuals.
    Journal: Appetite. 52(2):479-84
    Date: 2009 Apr
    Abstract: Household food supplies of families with at least one child 12 years or younger (n=100) were inventoried in order to describe its nutrient content and compare food supplies of families with and without overweight individuals (i.e., healthy vs. overweight mothers; healthy vs. overweight fathers; healthy vs. overweight child[ren]). Nutrient adequacy ratios (NAR) for carbohydrate, dietary fiber, calcium, iron, total fat, and saturated fat were approximately one indicating amounts available per 2000 calories approximately equaled the Daily Value. NARs for protein, sugar, vitamin A, vitamin C, and sodium exceeded one and cholesterol NAR was less than one. Households were similar in number of household members, days until they planned to grocery shop again, and total days of meals and snacks to be served from household food supplies until the next grocery shopping trip. Frozen vegetables contributed significantly greater amounts of calories, carbohydrates, fat, and protein and meat supplied significantly more fat and protein in households with overweight fathers than in households with healthy weight fathers. In households with an overweight child, grains supplied significantly more protein and carbohydrate than in comparison households. Encouraging healthful changes to the home food supply may result in improvements in dietary intake and overall weight status.
  155. Author: Krukowski RA, Harvey-Berino J, West DS
    Title: Differences in home food availability of high- and low-fat foods after a behavioral weight control program are regional not racial.
    Journal: Int J Behav Nutr Phys Act
    Date: 2010
    Abstract: BACKGROUND: Few studies, if any, have examined the impact of a weight control program on the home food environment in a diverse sample of adults. Understanding and changing the availability of certain foods in the home and food storage practices may be important for creating healthier home food environments and supporting effective weight management. METHODS: Overweight adults (n = 90; 27% African American) enrolled in a 6-month behavioral weight loss program in Vermont and Arkansas. Participants were weighed and completed measures of household food availability and food storage practices at baseline and post-treatment. We examined baseline differences and changes in high-fat food availability, low-fat food availability and the storage of foods in easily visible locations, overall and by race (African American or white participants) and region (Arkansas or Vermont). RESULTS: At post-treatment, the sample as a whole reported storing significantly fewer foods in visible locations around the house (-0.5 ± 2.3 foods), with no significant group differences. Both Arkansas African Americans (-1.8 ± 2.4 foods) and Arkansas white participants (-1.8 ± 2.6 foods) reported significantly greater reductions in the mean number of high-fat food items available in their homes post-treatment compared to Vermont white participants (-0.5 ± 1.3 foods), likely reflecting fewer high-fat foods reported in Vermont households at baseline. Arkansas African Americans lost significantly less weight (-3.6 ± 4.1 kg) than Vermont white participants (-8.3 ± 6.8 kg), while Arkansas white participants did not differ significantly from either group in weight loss (-6.2 ± 6.0 kg). However, home food environment changes were not associated with weight changes in this study. CONCLUSIONS: Understanding the home food environment and how best to measure it may be useful for both obesity treatment and understanding patterns of obesity prevalence and health disparity.
  156. Author: Scholtens S, Middelbeek L, Rutz SI, Buijs G, Bemelmans WJ
    Title: Differences in school environment, school policy and actions regarding overweight prevention between Dutch schools. A nationwide survey.
    Journal: BMC Public Health
    Date: 2010
    Abstract: BACKGROUND: Schools are regarded as an important setting for the prevention of overweight. This study presents a nationally representative picture of the obesogenity of the school environment, the awareness of schools regarding overweight, and actions taken by the schools aiming at overweight prevention. In addition, differences between school levels were studied. METHODS: In 2006-2007, questionnaires were sent to all Dutch secondary schools (age group 12-18 years). Prevalences of the outcome variables were calculated for the schools in total and by school level. The association between school level and outcome variables were analysed by a log linear regression. RESULTS: Unhealthy foods and drinks are widely available at secondary schools. One third of the schools indicated that overweight has increased among students and half of the schools agreed that schools were (co)responsible for the prevention of overweight. Only 3% of the schools have a policy on overweight prevention. Small differences were observed between vocational education schools and higher education schools. The presence of vending machines did not differ by school level, but at vocational education schools, the content of the vending machines was less healthy. CONCLUSION: This study describes the current situation at schools which is essential for the development and evaluation of future overweight prevention policies and interventions. In general, secondary schools are not actively involved in overweight prevention and the nutritional environment at most schools could be improved. The small differences between school levels do not give reason for a differential approach for a certain school level for overweight prevention.
  157. Author: Sánchez BN, Sanchez-Vaznaugh EV, Uscilka A, Baek J, Zhang L
    Title: Differential associations between the food environment near schools and childhood overweight across race/ethnicity, gender, and grade.
    Journal: Am J Epidemiol. 175(12):1284-93
    Date: 2012 Jun 15
    Abstract: Epidemiologic studies have observed influences of the food environment near schools on children's overweight status but have not systematically assessed the associations by race, sex, and grade. The authors examined whether the associations between franchised fast food restaurant or convenience store density near schools and overweight varied by these factors using data for 926,018 children (31.3% white, 55.1% Hispanic, 5.7% black, and 8% Asian) in fifth, seventh, or ninth grade, nested in 6,362 schools. Cross-sectional data were from the 2007 California physical fitness test (also known as "Fitnessgram"), InfoUSA, the California Department of Education, and the 2000 US Census. In adjusted models, the overweight prevalence ratio comparing children in schools with 1 or more versus 0 fast food restaurants was 1.02 (95% confidence interval (CI): 1.01, 1.03), with a higher prevalence ratio among girls compared with boys. The association varied by student's race/ethnicity (P = 0.003): Among Hispanics, the prevalence ratio = 1.02 (95% CI: 1.01, 1.03); among blacks, the prevalence ratio = 1.03 (95% CI: 1.00, 1.06), but among Asians the prevalence ratio = 0.94 (95% CI: 0.91, 0.97). For each additional convenience store, the prevalence ratio was 1.01 (95% CI: 1.00, 1.01), with a higher prevalence ratio among fifth grade children. Nuanced understanding of the impact of food environments near schools by race/ethnicity, sex, and grade may help to elucidate the etiology of childhood overweight and related race/ethnic disparities.
  158. Author: Algert SJ, Agrawal A, Lewis DS
    Title: Disparities in access to fresh produce in low-income neighborhoods in Los Angeles.
    Journal: Am J Prev Med. 30(5):365-70
    Date: 2006 May
    Abstract: BACKGROUND: Access to fresh produce and other healthy foods differs between poor ethnic and wealthier non-ethnic neighborhoods. Given the need to improve access, emergency food organizations, such as food pantries, can provide assistance. Food pantry clients, many living in poor ethnic neighborhoods, are at highest risk for inadequate intake of fruits and vegetables as emergency food assistance often does not include a supply of fresh produce. This study examines the extent to which food pantry clients live within reasonable walking distance of stores carrying fresh produce, and it proposes a strategy to increase accessibility of produce to those clients. METHODS: Addresses for 3,985 food pantry clients residing in Pomona, California, in 2003 and 84 food stores categorized as selling a "variety of produce" or "limited produce" were geocoded using geographic information systems technology in 2004. A 0.8-km network buffer was used to measure access to stores. Cluster areas with high densities of food pantry clients, or hot spots, were determined. RESULTS: Forty-one percent of Pomona food pantry clients were within walking distance of a store with fresh produce. Eighty-three percent were within walking distance of stores with limited produce, and 13% were not within walking distance of either store type. Seventeen cluster areas of food pantry clients accounted for 48% of clients with no access to a produce store. CONCLUSIONS: Using individual-level data allowed for the identification of significant numbers of food pantry clients with limited access to stores carrying a variety of fresh produce. Identification of the location of high concentrations of food pantry clients provides a potential solution to increase fresh fruit and vegetable access via mobile produce trucks.
  159. Author: Nelson MC, Larson NI, Barr-Anderson D, Neumark-Sztainer D, Story M
    Title: Disparities in dietary intake, meal patterning, and home food environments among young adult nonstudents and 2- and 4-year college students.
    Journal: Am J Public Health. 99(7):1216-9
    Date: 2009 Jul
    Abstract: We examined whether young adult meal patterning, dietary intake, and home food availability differed among nonstudents, 2-year college students, and 4-year college students (N = 1687; mean age = 20.5 years). Unadjusted analyses showed that few young adults consumed optimal diets and, compared with 4-year college students, nonstudents and 2-year students consumed fewer meals and poorer diets. After controlling for sociodemographics and living arrangements, we found that over half of the observed associations remained significant (P
  160. Author: Bodor JN, Rice JC, Farley TA, Swalm CM, Rose D
    Title: Disparities in food access: does aggregate availability of key foods from other stores offset the relative lack of supermarkets in African-American neighborhoods?
    Journal: Prev Med. 51(1):63-7
    Date: 2010 Jul
    Abstract: OBJECTIVE: Recent work demonstrates the importance of in-store contents, yet most food access disparity research has focused on differences in store access, rather than the foods they carry. This study examined in-store shelf space of key foods to test whether other types of stores might offset the relative lack of supermarkets in African-American neighborhoods. METHODS: New Orleans census tract data were combined with health department information on food stores open in 2004-2005. Shelf space of fruits, vegetables, and energy-dense snacks was assessed using a measuring wheel and established protocols in a sample of stores. Neighborhood availability of foods was calculated by summing shelf space in all stores within 2km of tract centers. Regression analyses assessed associations between tract racial composition and aggregate food availability. RESULTS: African-American neighborhoods had fewer supermarkets and the aggregate availability of fresh fruits and vegetables was lower than in other neighborhoods. There were no differences in snack food availability. CONCLUSIONS: Other store types did not offset the relative lack of supermarkets in African-American neighborhoods in the provision of fresh produce, though they did for snack foods. Altering the mix of foods offered in such stores might mitigate these inequities.
  161. Author: Pouliot N, Hamelin AM
    Title: Disparities in fruit and vegetable supply: a potential health concern in the greater Québec City area.
    Journal: Public Health Nutr. 12(11):2051-9
    Date: 2009 Nov
    Abstract: OBJECTIVE: The present study explores the spatial distribution and in-store availability of fresh fruits and vegetables from a socio-environmental perspective in terms of the type of food store, level of deprivation and the setting (urban/rural) where the food outlets are located. DESIGN: Seven types of fresh fruit and vegetable stores (FVS) were identified then visited in six districts (urban setting) and seven communities (rural setting). The quantity and diversity of fresh fruits and vegetables (F&V) were also assessed. SETTING: Québec City, Canada. RESULTS: The FVS spatial distribution showed differences between the two settings, with accessibility to supermarkets being more limited in rural settings. The quantity and diversity of fresh F&V in-store availability were associated with the type of FVS, but not with setting or its level of deprivation. Greengrocers and supermarkets offered a greater quantity and diversity of fresh F&V than the other FVS. CONCLUSIONS: The results suggest that inequalities in physical access to fresh F&V across the region could have an impact on public health planning considering that supermarkets, which are one of the excellent sources of F&V, are less prevalent in rural settings.
  162. Author: Bader MD, Purciel M, Yousefzadeh P, Neckerman KM
    Title: Disparities in neighborhood food environments: implications of measurement strategies.
    Journal: Econ Geogr. 86(4):409-30
    Date: 2010
    Abstract: Public health researchers have begun to map the neighborhood “food environment” and examine its association with the risk of overweight and obesity. Some argue that “food deserts”—areas with little or no provision of fresh produce and other healthy food—may contribute to disparities in obesity, diabetes, and related health problems. While research on neighborhood food environments has taken advantage of more technically sophisticated ways to assess distance and density, in general, it has not considered how individual or neighborhood conditions might modify physical distance and thereby affect patterns of spatial accessibility. This study carried out a series of sensitivity analyses to illustrate the effects on the measurement of disparities in food environments of adjusting for cross-neighborhood variation in vehicle ownership rates, public transit access, and impediments to pedestrian travel, such as crime and poor traffic safety. The analysis used geographic information systems data for New York City supermarkets, fruit and vegetable markets, and farmers' markets and employed both kernel density and distance measures. We found that adjusting for vehicle ownership and crime tended to increase measured disparities in access to supermarkets by neighborhood race/ethnicity and income, while adjusting for public transit and traffic safety tended to narrow these disparities. Further, considering fruit and vegetable markets and farmers' markets, as well as supermarkets, increased the density of healthy food outlets, especially in neighborhoods with high concentrations of Hispanics, Asians, and foreign-born residents and in high-poverty neighborhoods.
  163. Author: Morland K, Filomena S
    Title: Disparities in the availability of fruits and vegetables between racially segregated urban neighbourhoods.
    Journal: Public Health Nutr. 10(12):1481-9
    Date: 2007 Dec
    Abstract: OBJECTIVE: Public health professionals continue to see the benefits of fruit and vegetable consumption on population health. While studies that evaluate the availability of produce are sparse in the medical literature, disparities in availability may explain the disproportional intake of produce for some people. Therefore, the purpose of this study was to evaluate the availability and variety of produce located in two racially and economically diverse urban neighbourhoods. DESIGN: A cross-sectional study was conducted in which 50% of the supermarkets, small grocery stores, delicatessens, and fruit and vegetable markets located in specific neighbourhoods were randomly sampled and surveyed between September 2004 and July 2005. Food stores were evaluated for the availability of 20 types of fresh fruits and 19 types of fresh vegetables, as well as their varieties and whether they were canned, frozen or previously prepared. 2000 US Census information was used to determine characteristics of the geo-coded census tracts where the food stores were located. SETTING: Brooklyn, New York. RESULTS: A supermarket was located in approximately every third census tract in predominantly white areas (prevalence = 0.33) and every fourth census tract in racially mixed areas (prevalence = 0.27). There were no supermarkets located in the predominantly black areas. With the exception of bananas, potatoes, okra and yucca, a lower proportion of predominantly black area stores carried fresh produce, while supermarkets carried the largest variety of produce types. Canned and frozen fruits and vegetables were found in the majority of stores, whereas prepared and organic produce was limited to predominantly white area stores. CONCLUSIONS: These data demonstrate that the availability and variety of fresh produce is associated with neighbourhood racial composition and may be a factor contributing to differences in intake among residents.
  164. Author: Sturm R
    Title: Disparities in the food environment surrounding US middle and high schools.
    Journal: Public Health. 122(7):681-90
    Date: 2008 Jul
    Abstract: BACKGROUND: Disparities in the type and density of food retail outlets have been hypothesized as a possible cause of differential obesity rates across racial/ethnic and income groups. Several local studies have documented differences in business environments by sociodemographic neighbourhood characteristics, but no data specific for youth have been published. This study analyses the food environment surrounding all public middle and high schools in the USA. METHODS: Buffers were calculated with a radius of 400 and 800 m from the main entrance of public secondary schools in the USA (n=31,622), and business establishments within those buffers were identified using InfoUSA proprietary business listings. Indicators of any convenience store, limited-service restaurant, snack store or off-licences/liquor store and counts of businesses were regressed on the proportion of students eligible for free school meals, Title I eligibility of the school, racial/ethnic composition, location and student/teacher ratio. RESULTS: Hispanic youth are particularly likely to attend schools that are surrounded by convenience stores, restaurants, snack stores or off-licences. This effect is independent and in addition to poverty (i.e. students eligible for free school meals or schools that are Title I eligible) or location (urban core, suburban, town, rural). The association between other racial groups and nearby businesses is weaker, with the exception of off-licences, where a higher proportion of minority groups increases the probability of off-licences in close proximity to the school. Middle schools have fewer surrounding businesses than high schools, and larger schools have fewer surrounding businesses than smaller schools. CONCLUSIONS: Easy availability of snacks, sodas and fast food in the immediate vicinity of a school could easily negate school food policies, especially among students who can leave campus. Surrounding food outlets could also lower the effectiveness of health education in the classroom by setting a highly visible example that counters educational messages. There are several clear differences across sociodemographic groups with, arguably, the most pernicious being the location of off-licences. These disparities may represent an important type of environmental injustice for minorities and lower-income youth, with potential adverse consequences for dietary behaviours.
  165. Author: Neckerman KM, Bader MD, Richards CA, Purciel M, Quinn JW, Thomas JS, Warbelow C, Weiss CC, Lovasi GS, Rundle A
    Title: Disparities in the food environments of New York City public schools.
    Journal: Am J Prev Med. 39(3):195-202
    Date: 2010 Sep
    Abstract: BACKGROUND: Studies of the food environment near schools have focused on fast food. Research is needed that describes patterns of exposure to a broader range of food outlet types and that examines the influence of neighborhood built environments. PURPOSE: Using data for New York City, this paper describes the prevalence of five different food outlet types near schools, examines disparities by economic status and race/ethnicity in access to these food outlets, and evaluates the extent to which these disparities are explained by the built environment surrounding the school. METHODS: National chain and local fast-food restaurants, pizzerias, small grocery stores ("bodegas"), and convenience stores within 400 m of public schools in New York City were identified by matching 2005 Dun & Bradstreet data to 2006-2007 school locations. Associations of student poverty and race/ethnicity with food outlet density, adjusted for school level, population density, commercial zoning, and public transit access, were evaluated in 2009 using negative binomial regression. RESULTS: New York City's public school students have high levels of access to unhealthy food near their schools: 92.9% of students had a bodega within 400 m, and pizzerias (70.6%); convenience stores (48.9%); national chain restaurants (43.2%); and local fast-food restaurants (33.9%) were also prevalent within 400 m. Racial/ethnic minority and low-income students were more likely to attend schools with unhealthy food outlets nearby. Bodegas were the most common source of unhealthy food, with an average of nearly ten bodegas within 400 m, and were more prevalent near schools attended by low-income and racial/ethnic minority students; this was the only association that remained significant after adjustment for school and built-environment characteristics. CONCLUSIONS: Nearly all New York City public school students have access to inexpensive, energy-dense foods within a 5-minute walk of school. Low-income and Hispanic students had the highest level of exposure to the food outlets studied here.
  166. Author: Jago R, Baranowski T, Baranowski JC, Cullen KW, Thompson D
    Title: Distance to food stores & adolescent male fruit and vegetable consumption: mediation effects.
    Journal: Int J Behav Nutr Phys Act
    Date: 2007
    Abstract: BACKGROUND: The physical environments in which adolescents reside and their access to food stores may influence their consumption of fruit and vegetables. This association could either be direct or mediated via psychosocial variables or home availability of fruit and vegetables. A greater understanding of these associations would aide the design of new interventions. The purpose of this study was to examine associations between distance to food stores and restaurants and fruit and vegetable consumption and the possible mediating role of psychosocial variables and home availability. METHODS: Fruit and vegetable consumption of 204 Boy Scouts was assessed by a food frequency questionnaire in 2003. Participant addresses were geo-coded and distance to different types of food stores and restaurants calculated. Fruit and vegetable preferences, home availability and self-efficacy were measured. Regression models were run with backward deletion of non-significant environmental and psychosocial variables. Mediation tests were performed. RESULTS: Residing further away from a small food store (SFS) (convenience store and drug store) was associated with increased fruit and juice and low fat vegetable consumption. Residing closer to a fast food restaurant was associated with increased high fat vegetable and fruit and juice consumption. Vegetable preferences partially mediated (26%) the relationship between low fat vegetable consumption and distance to the nearest SFS. CONCLUSION: Distance to SFS and fast food restaurants were associated with fruit and vegetable consumption among male adolescents. Vegetable preferences partially mediated the distance to low fat vegetable relationship. More research is needed to elucidate how environmental variables impact children's dietary intake.
  167. Author: Pearson T, Russell J, Campbell MJ, Barker ME
    Title: Do 'food deserts' influence fruit and vegetable consumption?--A cross-sectional study.
    Journal: Appetite. 45(2):195-7
    Date: 2005 Oct
    Abstract: Lack of access to affordable healthy foods has been suggested to be a contributory factor to poor diet. This study investigated associations between diet and access to supermarkets, transport, fruit and vegetable price and deprivation, in a region divergent in geography and socio-economic indices. A postal survey of 1000 addresses (response rate 42%) gathered information on family demographics, supermarket and shop use, car ownership, mobility and previous day's fruit and vegetable intake. Postcode information was used to derive road travel distance to nearest supermarket and deprivation index. Fruit and vegetable prices were assessed using a shopping basket survey. Generalised linear regression models were used to ascertain predictors of fruit and vegetable intake. Male grocery shoppers ate less fruit than female grocery shoppers. Consumption of vegetables increased slightly with age. Deprivation, supermarket fruit and vegetable price, distance to nearest supermarket and potential difficulties with grocery shopping were not significantly associated with either fruit or vegetable consumption. These data suggest that the three key elements of a food desert, fruit and vegetable price, socio-economic deprivation and a lack of locally available supermarkets, were not factors influencing fruit or vegetable intake. We suggest that food policies aimed at improving diet should be orientated towards changing socio-cultural attitudes towards food.
  168. Author: Emond JA, Madanat HN, Ayala GX
    Title: Do Latino and non-Latino grocery stores differ in the availability and affordability of healthy food items in a low-income, metropolitan region?
    Journal: Public Health Nutr. 15(2):360-9
    Date: 2012 Feb
    Abstract: OBJECTIVE: To compare non-ethnically based supermarkets and Latino grocery stores (tiendas) in a lower-income region with regard to the availability, quality and cost of several healthy v. unhealthy food items. DESIGN: A cross-sectional study conducted by three independent observers to audit twenty-five grocery stores identified as the main source of groceries for 80 % of Latino families enrolled in a childhood obesity study. Stores were classified as supermarkets and tiendas on the basis of key characteristics. SETTING: South San Diego County. SUBJECTS: Ten tiendas and fifteen supermarkets. RESULTS: Tiendas were smaller than supermarkets (five v. twelve aisles, P = 0·003). Availability of fresh produce did not differ by store type; quality differed for one fruit item. Price per unit (pound or piece) was lower in tiendas for most fresh produce. The cost of meeting the US Department of Agriculture's recommended weekly servings of produce based on an 8368 kJ (2000 kcal)/d diet was $US 3·00 lower in tiendas compared with supermarkets (P
  169. Author: Ellaway A, Macdonald L, Lamb K, Thornton L, Day P, Pearce J
    Title: Do obesity-promoting food environments cluster around socially disadvantaged schools in Glasgow, Scotland?
    Journal: Health Place. 18(6):1335-40
    Date: 2012 Nov
    Abstract: Increase in the consumption of food and drinks outside the home by adolescents and young people and associations with rising levels of obesity is a significant concern worldwide and it has been suggested that the food environment around schools may be a contributory factor. As few studies have explored this issue in a UK setting, we examined whether different types of food outlets are clustered around public secondary schools in Glasgow, and whether this pattern differed by social disadvantage. We found evidence of clustering of food outlets around schools but a more complex picture in relation to deprivation was observed. Across all schools there were numerous opportunities for pupils to purchase energy dense foods locally and the implications for policy are discussed.
  170. Author: Chung C, Myers SL
    Title: Do the poor pay more for food? An analysis of grocery store availability and food price disparities
    Journal: Journal of consumer affairs. 33(2):276-96
    Date: 1999
    Abstract: Do the poor pay more for food? To answer this question, this study was conducted to provide an empirical analysis of grocery store access and prices across inner city and suburban communities within the Minneapolis and St. Paul metropolitan area. The comparison among different types of grocers and geographic areas is drawn from a survey of approximately fifty grocery items for fifty-five stores. Results indicate that the poor pay only slightly more in the Twin Cities grocery market. More significantly, those who shop in non-chain stores pay a significant premium, and the poor have less access to chain stores. This study reveals that the biggest factor contributing to higher grocery costs in poor neighborhoods is that large chain stores, where prices tend to be lower, are not located in these neighborhoods.
  171. Author: MacDonald JM, Nelson PE
    Title: Do the poor still pay more? Food price variations in large metropolitan areas
    Journal: Journal of urban economics. 30(3):344-59
    Date: 1991
    Abstract:
  172. Author: Lhila A
    Title: Does access to fast food lead to super-sized pregnant women and whopper babies?
    Journal: Econ Hum Biol. 9(4):364-80
    Date: 2011 Dec
    Abstract: Rise in the availability of fast-food restaurants has been blamed, at least partly, for the increasing obesity in the U.S. The existing studies of obesity have focused primarily on children, adolescents, and adults, and this paper extends the literature by raising a little-studied question and using nationally representative data to answer it. It examines the relationship between the supply of fast-food restaurants and weight gain of pregnant women and their newborns. I study prenatal weight gain because excessive weight gain has been linked to postpartum overweight/obesity and I study both tails of the birthweight distribution because the origin of obesity may be traced to the prenatal period and both tail outcomes have been associated with obesity later in life. I merge the 1998 and 2004 Natality Detail Files with the Area Resource File, and County Business Patterns, which provide data on the number of fast-food restaurants in the metropolitan area where the mother resides. The empirical model includes an extensive list of MSA characteristics and MSA fixed effects to control for factors that may be correlated with both health outcomes and restaurants' location decision. Results reveal that the fast-food and weight gain relationship is robust to the inclusion of these controls but these controls greatly mitigate the fast food-infant health relationship. Greater access to fast-food restaurants is positively related to mothers' probability of excessive weight gain but it does not share a statistically significant relationship with birthweight. These relationships hold in all the socioeconomic and demographic subgroups studied.
  173. Author: Winkler E, Turrell G, Patterson C
    Title: Does living in a disadvantaged area entail limited opportunities to purchase fresh fruit and vegetables in terms of price, availability, and variety? Findings from the Brisbane Food Study.
    Journal: Health Place. 12(4):741-8
    Date: 2006 Dec
    Abstract: Understanding the role environmental factors may play in the dietary behaviours of socioeconomic groups is relevant for efforts to reduce health inequalities. In contrast with international research, earlier findings from the Brisbane Food Study (BFS), Australia, found no relationship between area socioeconomic characteristics and dietary behaviours or location of food shops. This paper examines whether the price and availability of fruits and vegetables are socioeconomically patterned using data from the BFS. Fifty census collection districts were randomly sampled and all local (i.e. within 2.5 km) supermarkets, greengrocers and convenience stores were observed. Little or no differences in price and availability were found on the basis of area socioeconomic characteristics.
  174. Author: Winkler E, Turrell G, Patterson C
    Title: Does living in a disadvantaged area mean fewer opportunities to purchase fresh fruit and vegetables in the area? Findings from the Brisbane food study.
    Journal: Health Place. 12(3):306-19
    Date: 2006 Sep
    Abstract: Understanding the particularly low intake of fruits and vegetables among socioeconomically disadvantaged groups is an important issue for public health. This study investigated whether access to retail outlets is similar across areas of varying socioeconomic disadvantage in an Australian urban setting, in terms of distance, the numbers of local shops, and their opening hours. This ecological cross-sectional study used 50 randomly sampled census collection districts and their nearby shopping environment (i.e. within 2.5 km), and generally found minimal or no socioeconomic differences in shopping infrastructure. Important methodological and social/economic issues may explain this contrast with overseas findings.
  175. Author: Krølner R, Due P, Rasmussen M, Damsgaard MT, Holstein BE, Klepp KI, Lynch J
    Title: Does school environment affect 11-year-olds' fruit and vegetable intake in Denmark?
    Journal: Soc Sci Med. 68(8):1416-24
    Date: 2009 Apr
    Abstract: It is often found that adolescents eat too little fruit and vegetables. We examined the importance of school for 11-year-olds' daily intake measured by food frequency- and 24-h recall questionnaires in Danish data from the European 2003 Pro Children Survey. Multilevel logistic regression analyses included matched student-parent-school questionnaire data (N=1410) from a random sample of 59 schools and were conducted for fruit and vegetables separately: 1) without explanatory variables, to decompose the between-school and within-school variance; 2) with individual level covariates (socioeconomic position, parental intake, etc.) to examine if the between-school variance was attributable to different student compositions of schools; and 3) with individual- and school-level covariates (school availability of fruit/vegetables and unhealthy food) to examine the effect of context. Additional analyses stratified by gender and home availability of fruit/vegetables examined if school food availability influenced subgroups differently. Between-school variations were quantified by intra class correlations and median odds ratios. We found that 40% of the students ate > or = 200 g fruit/day and 25% ate > or = 130 g vegetables/day. Most of the total variance in students' intake occurred at the individual level (93-98%). There were larger between-school variations in vegetable intake than in fruit intake. Fruit and vegetable consumption clustered within schools to a larger degree for boys than girls. The between-school variance did not differ by home availability. Boys and students from high availability homes consumed more fruit and/or vegetables if enrolled in schools with access to fruit/vegetables and unhealthy food or contrarily with no food available versus schools with only fruit/vegetables available. The small school-level effects on 11-year-olds' fruit and vegetable intake imply that family level interventions may be more important and that the success of school interventions will rely on the degree of parental involvement.
  176. Author: Smith D, Cummins S, Clark C, Stansfeld S
    Title: Does the local food environment around schools affect diet? Longitudinal associations in adolescents attending secondary schools in East London.
    Journal: BMC Public Health. 13(1):70
    Date: 2013 Jan 24
    Abstract: BACKGROUND: The local retail food environment around schools may act as a potential risk factor for adolescent diet. However, international research utilising cross-sectional designs to investigate associations between retail food outlet proximity to schools and diet provides equivocal support for an effect. In this study we employ longitudinal perspectives in order to answer the following two questions. First, how has the local retail food environment around secondary schools changed over time and second, is this change associated with change in diet of students at these schools? METHODS: The locations of retail food outlets and schools in 2001 and 2005 were geo-coded in three London boroughs. Network analysis in a Geographic Information System (GIS) ascertained the number, minimum and median distances to food outlets within 400 m and 800 m of the school location. Outcome measures were 'healthy' and 'unhealthy' diet scores derived from adolescent self-reported data in the Research with East London Adolescents: Community Health Survey (RELACHS). Adjusted associations between distance from school to food retail outlets, counts of outlets near schools and diet scores were assessed using longitudinal (2001-2005 n=757) approaches. RESULTS: Between 2001 and 2005 the number of takeaways and grocers/convenience stores within 400 m of schools increased, with many more grocers reported within 800 m of schools in 2005 (p
  177. Author: Widener MJ, Metcalf SS, Bar-Yam Y
    Title: Dynamic urban food environments a temporal analysis of access to healthy foods.
    Journal: Am J Prev Med. 41(4):439-41
    Date: 2011 Oct
    Abstract: BACKGROUND: Low-income, urban populations' limited access to healthy foods is often pointed to as a key barrier to improving nutrition. Although much has been written on identifying urban "food deserts," little has been done to examine how the food environment changes over the course of 1 year. PURPOSE: This study was designed to dynamically describe the urban food environment as a means to identify when at-risk neighborhoods are without access to healthy food. METHODS: Demographic and road data of Buffalo NY from the 2000 U.S. Census, a 2010 listing of city supermarkets, and 2011 government records of the time and location of urban farmers' markets are mapped. Road network distances from block groups to supermarkets and farmers' markets are calculated. A computer simulation, written in 2011, examines the market closest to each block group for 52 weeks. RESULTS: The average distance to markets with produce from block groups with poverty levels in the top 10th percentile is greater than that across all block groups during winter and spring months. However, during the farmers' market season, the same impoverished block groups are on average closer to markets when compared to all block groups. CONCLUSIONS: Including the temporal dimension in an analysis of healthy food access generates a more complex picture of urban food-desert locations. The implications are that spatiotemporal factors should be used to inform appropriate interventions for creating an equitable food environment.
  178. Author: Edmonds J, Baranowski T, Baranowski J, Cullen KW, Myres D
    Title: Ecological and socioeconomic correlates of fruit, juice, and vegetable consumption among African-American boys.
    Journal: Prev Med. 32(6):476-81
    Date: 2001 Jun
    Abstract: BACKGROUND: Investigators have reported that the availability of foods in local grocery stores correlated with consumption when using large geopolitical units of analysis, e.g., zip codes. Associations across smaller geopolitical units, e.g., census tracts, have not been tested, nor has this work focused on restaurant availability, child consumption, or specific ethnic groups. METHODS: This study examined whether median family income and fruit, juice, and vegetable (FJV) availability in grocery stores, restaurants, and homes in 11 census tracts correlated with FJV consumption among 11- to 14-year-old African-American Boy Scouts. FJV consumption was measured in 90 scouts using two 24-h food recalls. Instruments were developed to measure the availability of FJV at area grocery stores, restaurants, and homes where troop members resided. RESULTS: Median household income (from 1990 census) was significantly correlated with restaurant fruit availability. Significant correlations were found between restaurant juice and vegetable availability and Boy Scout reported consumption of juice and vegetables. CONCLUSION: Census tract may be a useful unit when studying restaurant, but not grocery store, FJV availability. Within a census tract, restaurant FJV availability may be a significant target for community intervention and process evaluation.
  179. Author: Thomas JG, Doshi S, Crosby RD, Lowe MR
    Title: Ecological momentary assessment of obesogenic eating behavior: combining person-specific and environmental predictors.
    Journal: Obesity (Silver Spring). 19(8):1574-9
    Date: 2011 Aug
    Abstract: Obesity has been promoted by a food environment that encourages excessive caloric intake. An understanding of how the food environment contributes to obesogenic eating behavior in different types of individuals may facilitate healthy weight control efforts. In this study, Ecological Momentary Assessment (EMA) via palmtop computers was used to collect real-time information about participants' environment and eating patterns to predict overeating (i.e., greater than usual intake during routine meals/snacks, and eating outside of a participant's normal routine) that could lead to weight gain. Thirty-nine women (BMI = 21.6 ± 1.8; age = 20.1 ± 2.0 years; 61% white) of normal weight (BMI 18.5-25) completed the Three Factor Eating Questionnaire and the Power of Food Scale (PFS), and carried a palmtop computer for 7-10 days, which prompted them to answer questions about eating events, including a count of the types of good tasting high-calorie foods that were available. None of the self-report measures predicted overeating, but BMI interacted with the number of palatable foods available to predict overeating (P = 0.035). Compared to leaner individuals who reported a relatively low frequency of overeating regardless of the availability of palatable food, the probability of overeating among heavier individuals was very low in the absence of palatable food, but quickly increased in proportion to the number of palatable foods available. Our findings suggest that the eating behavior of those with higher relative weights is susceptible to the presence of palatable foods in the environment. Individuals practicing weight control may benefit from limiting their exposure to good tasting high-calorie food in their immediate environment.
  180. Author: Drouin S, Hamelin AM, Ouellet D
    Title: Economic access to fruits and vegetables in the greater Quebec City: do disparities exist?
    Journal: Can J Public Health. 100(5):361-4
    Date: 2009 Sep-Oct
    Abstract: OBJECTIVES: To examine the cost of fruits and vegetables (FV) with respect to different food store types, urbanization level and material deprivation for various urban areas of greater Quebec City. METHODS: A sample of 85 food stores was selected. They represented five store types (small, conventional, and large grocery stores; greengrocers; convenience stores) in four geographic areas reflecting three different socio-economic levels. We identified three FV baskets (grocery, fresh FV, convenience) by drawing on data on household food spending and consumption, and food supply in the five store types. Four investigators were trained to conduct a survey of prices for the week of September 17-23, 2007. Analysis of variance and t tests were conducted to examine variations in food baskets with regard to the variables defined in this study. A chi-square test was used to measure the frequency distribution of stores throughout the greater Quebec City. RESULTS: Only food store type had a significant influence on FV cost: cost was much lower in large grocery stores and greengrocers. Convenience stores, where prices are higher, outnumbered all others in deprived urban areas, supporting the contention that there are inequities in economic access. DISCUSSION: Economic access to FV may differ by area in the greater Quebec City, putting rural inhabitants and less privileged urban dwellers at the greatest disadvantage; this may, in turn, contribute to health disparities. The results point to the need to improve our understanding of the way components of the food environment at the regional level affect social inequality.
  181. Author: McGowan L, Croker H, Wardle J, Cooke LJ
    Title: Environmental and individual determinants of core and non-core food and drink intake in preschool-aged children in the United Kingdom.
    Journal: Eur J Clin Nutr. 66(3):322-8
    Date: 2012 Mar
    Abstract: BACKGROUND/OBJECTIVES: Strategies to achieve healthier diets for children are likely to benefit from an understanding of the determinants. We examined environmental and individual predictors of children's intake of 'core' foods (fruit and vegetables) and 'non-core' foods (snacks and sweetened beverages). Predictors included parental intake, home availability, parental feeding styles (Encouragement and Monitoring) and children's food preferences. Based on research with older children, we expected intake of both food types to be associated with maternal intake, core foods to be more associated with children's preferences and non-core food intake more with the home environment. SUBJECTS/METHODS: Primary caregivers (n=434) of children (2-5 years) from preschools and Children's Centres in London, UK, completed a self-report survey in 2008. RESULTS: Multiple regression analyses indicated children's fruit intake was associated with maternal fruit intake (B=0.29; P=0.000), children's liking for fruit (B=0.81; P=0.000) and a Monitoring style of parental feeding (B=0.13; P=0.021). Children's vegetable intake was similarly associated with maternal intake (B=0.39; P=0.000), children's liking for vegetables (B=0.77; P=0.000), Encouragement (B=0.19; P=0.021) and Monitoring (B=0.11; P=0.029). Non-core snack intake was associated with maternal intake (B=0.25; P=0.029), Monitoring (B=-0.16; P=0.010), home availability (B=0.10; P=0.022) and television viewing (TV) (B=0.28; P=0.012). Non-core drink intake was associated with maternal intake (B=0.32; P=0.000) and TV (B=0.20; P=0.019). CONCLUSIONS: Results indicate commonalities and differences in the predictors of core and non-core food intake, with only maternal intake being important across all types. Effective interventions to improve young children's diets may need to call on different strategies for different foods.
  182. Author: Pérez-Lizaur AB, Kaufer-Horwitz M, Plazas M
    Title: Environmental and personal correlates of fruit and vegetable consumption in low income, urban Mexican children.
    Journal: J Hum Nutr Diet. 21(1):63-71
    Date: 2008 Feb
    Abstract: BACKGROUND: Epidemiological evidence suggests that populations with high fruit and vegetable (FV) consumption have a lower risk for childhood obesity, cancer and cardiovascular diseases. There are no studies that address the correlates of FV intake in Mexican children; therefore, the aim of this study was to identify the frequency of FV consumption by children in Mexico City's low income state schools and their personal (preferences, expectancy, knowledge and self-efficacy) and environmental (accessibility and person in charge of cooking at home) correlates. METHODS: A validated questionnaire to assess accessibility, expectancy, self-efficacy, preference and knowledge; and a 2-day dietary recall were used to assess the FV intake and its correlates in 327 children. Statistical analysis included chi-square and stepwise logistic regression. RESULTS: Average consumption of FV was once a day with a higher proportion of girls consuming FV 3 or more times per day (15.2% versus 6.7%; P
  183. Author: Mojtahedi MC, Boblick P, Rimmer JH, Rowland JL, Jones RA, Braunschweig CL
    Title: Environmental barriers to and availability of healthy foods for people with mobility disabilities living in urban and suburban neighborhoods.
    Journal: Arch Phys Med Rehabil. 89(11):2174-9
    Date: 2008 Nov
    Abstract: OBJECTIVE: To assess the impact of the built environment on access to healthy foods for people with mobility disabilities by measuring wheelchair accessibility of grocery stores and availability of healthy affordable foods. DESIGN: A survey consisting of 87 questions. SETTING: A low-income, multiracial urban Chicago neighborhood with a 3-mile radius was compared with a suburban neighborhood of the same size in which the population is similar in income level and racial distribution. PARTICIPANTS: Not applicable. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Accessibility issues outside and within grocery stores and the availability of healthy affordable food items in these grocery stores. RESULTS: The urban area had more stores (n=48) than the suburban area (n=34); however, only 46% of urban stores had an entrance that would allow an individual requiring a ramp or level entrance to gain access compared with 88% of suburban stores (P<.001 wheelchair="" accessibility="" characteristics="" of="" grocery="" and="" convenience="" stores="" did="" not="" differ="" between="" the="" urban="" suburban="" areas.="" availability="" healthy="" affordable="" foods="" in="" was="" relatively="" low="" with="" only="" to="" items="" available="" stores.="" conclusions:="" people="" mobility="" impairments="" are="" at="" a="" disadvantage="" maintaining="" food="" choices="" because="" limited="" access="" foods.="">
  184. Author: Harrison F, Jones AP, van Sluijs EM, Cassidy A, Bentham G, Griffin SJ
    Title: Environmental correlates of adiposity in 9-10 year old children: considering home and school neighbourhoods and routes to school.
    Journal: Soc Sci Med. 72(9):1411-9
    Date: 2011 May
    Abstract: The rapid speed of the recent rise in obesity rates suggest environmental causes. There is therefore a need to determine which components of the environment may be contributing to this increase. In this cross-sectional study, we examined the associations between adiposity and the characteristics of areas around homes, schools and routes to school among 1995 9-10 year old boys and girls in Norfolk, UK. The relationships between Fat Mass Index (FMI, calculated as fat mass (kg)/height (m)(2)) and objectively computed environmental indicators describing access to food outlets and physical activity facilities, the safety and connectivity of the road network, and the mix of land uses present were investigated. Multivariable hierarchical regression models were fitted with log-transformed FMI as the outcome, and stratification by gender and mode of travel to school. Among girls, better access to healthy food outlets (supermarkets and greengrocers) in the home environment was associated with lower FMI while better access to unhealthy outlets (takeaways and convenience stores) around homes and schools was associated with higher FMI. Also in girls, a higher proportion of accessible open land and a lower mix of land uses around the school were associated with higher FMI. Among boys the presence of major roads in the home neighbourhood was associated with higher FMI among non-active travellers, while major roads in the school neighbourhood were associated with lower FMI among active travellers. No significant associations were seen between FMI and any of the route characteristics. While the relative paucity of associations provides few indicators for the design of effective interventions, there was some evidence that environmental characteristics may be more important among active travellers than non-active travellers, and among girls than boys, suggesting that future interventions should be sensitive to such differences.
  185. Author: Mau MK, Wong KN, Efird J, West M, Saito EP, Maddock J
    Title: Environmental factors of obesity in communities with native Hawaiians.
    Journal: Hawaii Med J. 67(9):233-6
    Date: 2008 Sep
    Abstract: OBJECTIVE: To compare the fast food outlets and exercise resources across 3 communities with varying percentages of Native Hawaiians (NH) and to correlate these findings with obesity prevalence. METHODS: Data on all food and exercise resources were collected from January through July 2006 within a 1-mile radius in 3 distinct communities (site A = higher % NH to site C = lower % NH). Comparisons between communities were analyzed in 2007 using Fisher's Exact and ANOVA. RESULTS: Trends in obesity prevalence paralleled the percentage of NHs. After adjusting for population size, site B had a greater number of fast food outlets (p
  186. Author: Hearn MD, Baranowski T, Baranowski J, Doyle C, Matthew S, Lin LS, Resnicow K
    Title: Environmental influences on dietary behavior among children: availability and accessibility of fruits and vegetables enable consumption
    Journal: Journal of Health Education. 29(1):26-32
    Date: 1998
    Abstract:
  187. Author: Kapinos KA, Yakusheva O
    Title: Environmental influences on young adult weight gain: evidence from a natural experiment.
    Journal: J Adolesc Health. 48(1):52-8
    Date: 2011 Jan
    Abstract: OBJECTIVES: This study investigated the importance of environmental influences in explaining weight gain and related behaviors among freshman college students. METHODS: We exploited a natural experiment that takes place on most college campuses in the United States--randomized dormitory assignments. We estimated the effects of living in dormitories with varying physical environment characteristics on weight gain and related behaviors (daily number of meals and snacks, weekly frequency of exercise) among randomly assigned freshman students. RESULTS: We found strong evidence linking weight and related behaviors to individual dormitories, as well as to specific characteristics of the dormitories. On average, students assigned to dormitories with on-site dining halls gained more weight and exhibited more behaviors consistent with weight gain during the freshman year as compared with students not assigned to such dormitories. Females in such dormitories weighed .85 kg (p = .03) more and exercised 1.43 (p
  188. Author: Chow CK, Lock K, Madhavan M, Corsi DJ, Gilmore AB, Subramanian SV, Li W, Swaminathan S, Lopez-Jaramillo P, Avezum A, Lear SA, Dagenais G, Teo K, McKee M, Yusuf S
    Title: Environmental Profile of a Community's Health (EPOCH): an instrument to measure environmental determinants of cardiovascular health in five countries.
    Journal: PLoS One. 5(12):e14294
    Date: 2010
    Abstract: BACKGROUND: The environment in which people live is known to be important in influencing diet, physical activity, smoking, psychosocial and other risk factors for cardiovascular (CV) disease. However no instrument exists that evaluates communities for these multiple environmental factors and is suitable for use across different communities, regions and countries. This report describes the design and reliability of an instrument to measure environmental determinants of CV risk factors. METHOD/PRINCIPAL FINDINGS: THE ENVIRONMENTAL PROFILE OF COMMUNITY HEALTH (EPOCH) INSTRUMENT COMPRISES TWO PARTS: (I) an assessment of the physical environment, and (II) an interviewer-administered questionnaire to collect residents' perceptions of their community. We examined the inter-rater reliability amongst 3 observers from each region of the direct observation component of the instrument (EPOCH I) in 93 rural and urban communities in 5 countries (Canada, Colombia, Brazil, China and India). Data collection using the EPOCH instrument was feasible in all communities. Reliability of the instrument was excellent (Intraclass Correlation Coefficient--ICC>0.75) for 24 of 38 items and fair to good (ICC 0.4-0.75) for 14 of 38 items. CONCLUSION: This report shows data collection with the EPOCH instrument is feasible and direct observation of community measures reliable. The EPOCH instrument will enable further research on environmental determinants of health for population studies from a broad range of settings.
  189. Author: Skala K, Chuang RJ, Evans A, Hedberg AM, Dave J, Sharma S
    Title: Ethnic differences in the home food environment and parental food practices among families of low-income Hispanic and African-American preschoolers.
    Journal: J Immigr Minor Health. 14(6):1014-22
    Date: 2012 Dec
    Abstract: The family and home environment are important in shaping the dietary patterns of children, yet research among low-income, minority groups is limited. We examined ethnic differences in the home food environment and parental practices among 706 low-income, African-American and Hispanic families of preschoolers. Questionnaires measured the access and availability of various foods in the home, parental practices, and meal consumption behaviors. Mixed model logistic regression and ANCOVA were used to assess ethnic differences. Unhealthy foods were available for both groups. Hispanic families were more likely to have fresh vegetables (AOR = 2.9, P ≤ 0.001), fruit (AOR = 2.0, P = 0.004), and soda available (AOR = 1.40, P = 0.001) compared to African-Americans. African-Americans families were more likely to restrict (AOR = 0.63, P ≤ 0.001) and reward with dessert (AOR = 0.69, P ≤ 0.001). Hispanic families consumed more family meals together (P = 0.003) and less meals in front of the television (P ≤ 0.006). Health promotion interventions should consider the behavioral differences between ethnicities.
  190. Author: Cheadle A, Psaty B, Wagner E, Diehr P, Koepsell T, Curry S, Von Korff M
    Title: Evaluating community-based nutrition programs: assessing the reliability of a survey of grocery store product displays.
    Journal: Am J Public Health. 80(6):709-11
    Date: 1990 Jun
    Abstract: A pilot test of a survey of grocery store product displays was conducted to measure the amount of health-education information provided and the proportion of the display devoted to "healthier" products. Inter-rater reliability ranged between 0.73 and 0.78 for the healthiness indices and between 0.30 and 0.67 for the health education measures. Test-retest reliability ranged from 0.44 to 1.0.
  191. Author: Cheadle A, Psaty BM, Diehr P, Koepsell T, Wagner E, Curry S, Kristal A
    Title: Evaluating community-based nutrition programs: comparing grocery store and individual-level survey measures of program impact.
    Journal: Prev Med. 24(1):71-9
    Date: 1995 Jan
    Abstract: BACKGROUND: This paper examines whether an "environmental indicator"--a survey of grocery store product displays--can provide a realistic alternative to individual-level telephone surveys for the evaluation of community-based nutrition programs. METHODS: Telephone and grocery store measures were used separately to evaluate three community-level dietary interventions that were part of the Kaiser Family Foundation Community Health Promotion Grants Program (CHPGP). Both surveys were conducted in the three intervention and seven control communities at three points in time: 1988, 1990, and 1992. The grocery store survey recorded the relative availability of low-fat and high-fiber products and the amount of store-provided health-education information. Self-reported dietary intake of residents was obtained in the same communities using a telephone survey. RESULTS: In the one community in which the intervention seemed to have contributed to reduced fat consumption, the grocery store and telephone surveys showed very similar relative changes for the only variable they had in common, low-fat milk consumption. In another community, both survey approaches indicated that there was no change or perhaps a slight worsening in the treatment relative to the controls. The third community produced the only contradictory results: the telephone survey suggested no change or perhaps a worsening, while the grocery store results were generally positive, though not statistically significant. CONCLUSION: These results, combined with the much lower cost of the grocery store survey, justify further pursuit of environmental indicators as an evaluation tool.
  192. Author: Reedy J, Krebs-Smith SM, Bosire C
    Title: Evaluating the food environment: application of the Healthy Eating Index-2005.
    Journal: Am J Prev Med. 38(5):465-71
    Date: 2010 May
    Abstract: BACKGROUND: The Healthy Eating Index-2005 (HEI-2005), a tool designed to evaluate concordance with the 2005 Dietary Guidelines, has been used to monitor the quality of foods consumed by Americans. Because the HEI-2005 is not tied to individual requirements and is scored on a per 1000 kcal basis, it can be used to assess the overall quality of any mix of foods. PURPOSE: The goal of this paper is to examine whether the HEI-2005 can be applied to the food environment. METHODS: Two examples were selected to examine the application of the HEI-2005 to the food environment: the dollar menu displayed at a fast-food restaurant (coded and linked to the MyPyramid Equivalents Database and the Food and Nutrient Database for Dietary Studies) to represent the community level and the 2005 U.S. Food Supply (measured with food availability data, loss-adjusted food availability data, nutrient availability data, and Salt Institute data) to represent the macro level. RESULTS: The dollar menu and the 2005 U.S. Food Supply received 43.4 and 54.9 points, respectively (100 possible points). According to the HEI-2005, for the offerings at a local fast-food restaurant and the U.S. Food Supply to align with national dietary guidance, substantial shifts would be necessary: a concomitant addition of fruit, dark-green vegetables, orange vegetables, legumes, and nonfat milk; replacement of refined grains with whole grains; and reduction in foods and food products containing sodium, solid fats, and added sugars. CONCLUSIONS: Because the HEI-2005 can be applied to both environmental- and individual-level data, it provides a useful metric for studies linking data across various levels of the socioecologic framework of dietary behavior. The present findings suggest that new dietary guidance could target not only individuals but also the architects of our food environment.
  193. Author: Long MW, Henderson KE, Schwartz MB
    Title: Evaluating the impact of a Connecticut program to reduce availability of unhealthy competitive food in schools.
    Journal: J Sch Health. 80(10):478-86
    Date: 2010 Oct
    Abstract: BACKGROUND: This article seeks to inform state and local school food policies by evaluating the impact of Connecticut's Healthy Food Certification (HFC), a program which provides monetary incentives to school districts that choose to implement state nutrition standards for all foods sold to students outside reimbursable school meals. METHODS: Food service directors from all school districts participating in the National School Lunch Program (NSLP) (N = 151) in Connecticut were surveyed about the availability of competitive foods before and after the 2006-2007 implementation of HFC. Food categories were coded as healthy or unhealthy based on whether they met the Connecticut Nutrition Standards. Data on NSLP participation were provided by the State Department of Education. Changes in NSLP participation and availability of unhealthy competitive foods in elementary, middle, and high schools were compared pre- and post-HFC across districts participating (n = 74) versus not participating (n = 77) in HFC. RESULTS: On average, all districts in Connecticut reduced the availability of unhealthy competitive foods, with a significantly greater reduction among HFC districts. Average NSLP participation also increased across the state. Participating in HFC was associated with significantly greater NSLP participation for paid meals in middle school; however, implementing HFC did not increase overall NSLP participation beyond the statewide upward trend. CONCLUSION: The 2006-2007 school year was marked by a significant decrease in unhealthy competitive foods and an increase in NSLP participation across the state. Participation in Connecticut's voluntary HFC further reduced the availability of unhealthy competitive foods in local school districts, and had either a positive or neutral effect on NSLP participation.
  194. Author: Pulos E, Leng K
    Title: Evaluation of a voluntary menu-labeling program in full-service restaurants.
    Journal: Am J Public Health. 100(6):1035-9
    Date: 2010 Jun
    Abstract: OBJECTIVES: We assessed whether labeling restaurant menus with information on the nutrient content of menu items would cause customers to alter their ordering patterns. METHODS: Six full-service restaurants in Pierce County, Washington, added nutrition information to their menus, and they provided data on entrée sales for 30 days before and 30 days after the information was added. We assessed the prelabeling versus postlabeling difference in nutrient content of entrées sold, and we surveyed restaurant patrons about whether they noticed the nutrition information and used it in their ordering. RESULTS: The average postlabeling entrée sold contained about 15 fewer calories, 1.5 fewer grams of fat, and 45 fewer milligrams of sodium than did the average entrée sold before labeling. Seventy-one percent of patrons reported noticing the nutrition information; 20.4% reported ordering an entrée lower in calories as a result, and 16.5% reported ordering an entrée lower in fat as a result. CONCLUSIONS: The concentration of calorie reduction among 20.4% of patrons means that each calorie-reducing patron ordered about 75 fewer calories than they did before labeling. Thus, providing nutrition information on restaurant menus may encourage a subset of restaurant patrons to significantly alter their food choices.
  195. Author: Jilcott SB, Keyserling T, Crawford T, McGuirt JT, Ammerman AS
    Title: Examining associations among obesity and per capita farmers' markets, grocery stores/supermarkets, and supercenters in US counties.
    Journal: J Am Diet Assoc. 111(4):567-72
    Date: 2011 Apr
    Abstract: Fruit and vegetable consumption is an important component of a healthful diet, yet fruits and vegetables are underconsumed, especially among low-income groups with high prevalence rates of obesity. This study used data from the US Department of Agriculture Economic Research Service Food Environment Atlas to examine county-level associations among obesity prevalence and per capita farmers' markets, grocery stores/supermarkets, and supercenters, adjusted for natural amenities, percent black, percent Hispanic, median age, and median household income, stratified by county metropolitan status. In models that included all three of the food venues, supercenters and grocery stores per capita were inversely associated with obesity in the combined (metro and nonmetro) and metro counties. Farmers' markets were not significant in the model for combined (metro and nonmetro) or for metro counties alone, but were significantly inversely related to obesity rates in the model for nonmetro counties. In this ecologic study, density of food venues was inversely associated with county-level obesity prevalence. Thus, future research should examine similar associations at the individual-level.
  196. Author: Walton M, Pearce J, Day P
    Title: Examining the interaction between food outlets and outdoor food advertisements with primary school food environments.
    Journal: Health Place. 15(3):811-8
    Date: 2009 Sep
    Abstract: Schools are commonly seen as a site of intervention to improve children's nutrition, and prevent excess weight gain. Schools may have limited influence over children's diets; however, with home and community environments also exerting an influence within schools. This study considered the environment of food outlets and outdoor food advertisements surrounding four case study primary schools in New Zealand, and the impact of that external environment on within-school food environments. The shortest travel route between school and home addresses, and the number of food outlets and advertisements passed on that route, was calculated for each student. Interviews with school management were conducted. The schools with a higher percentage of students passing food outlets and advertisements considered that their presence impacted on efforts within schools to improve the food environment. Limiting students' exposure to food outlets and outdoor food adverts through travel route planning, reducing advertising, or limiting the location of food outlets surrounding schools could be explored as intervention options to support schools in promoting nutrition.
  197. Author: Stevens J, Bryant M, Wang L, Borja J, Bentley ME
    Title: Exhaustive measurement of food items in the home using a universal product code scanner.
    Journal: Public Health Nutr. 14(2):314-8
    Date: 2011 Feb
    Abstract: OBJECTIVE: We aimed to develop, test and describe the Exhaustive Home Food Inventory (EHFI), which measures foods in the home using scanning of the universal product code (UPC) and EHFI software to link codes to food identities and energy values. DESIGN: Observational design with up to three repeated measures in each household yielded a total of 218 inventories. SETTING: Eighty private households in North Carolina. SUBJECTS: Low-income African-American women with an infant between the ages of 12 and 18 months. Recruitment rate was 71 %. RESULTS: Approximately 12 200 different food items were successfully recorded using the EHFI method. The average number of food items within a household was 147. The time required for the first measurement in a home declined from 157 to 136 min (P
  198. Author: Reinaerts E, de Nooijer J, Candel M, de Vries N
    Title: Explaining school children's fruit and vegetable consumption: the contributions of availability, accessibility, exposure, parental consumption and habit in addition to psychosocial factors.
    Journal: Appetite. 48(2):248-58
    Date: 2007 Mar
    Abstract: We studied the contributions of parental fruit and vegetable (F&V) consumption, availability and accessibility of F&V in the home, exposure to F&V, and habit, in addition to psychosocial factors, in explaining F&V consumption in 4-12-year-old children. Furthermore, we looked for effect modification by ethnicity and gender. Children's parents (n = 1739) completed a questionnaire assessing psychosocial and additional factors regarding their children's F&V consumption. Consumption was assessed by a food-frequency questionnaire. The model explained the children's F&V consumption better when the additional factors were included (R2 = .49 and R2 = .50 for fruit consumption, and R2 = .33 and R2 = .33 for vegetable consumption). Stepwise multi-level regression analyses revealed that habit was the most influential correlate of F&V consumption. It is concluded that nutrition education interventions aimed at stimulating F&V consumption among children should take into account that the consumption of fruit and that of vegetables are clearly different behaviors, with different influencing factors for boys and girls and children of native or non-native background. Furthermore, interventions to increase F&V consumption should include strategies aimed at making these behaviors habitual.
  199. Author: Cullen KW, Watson K, Zakeri I, Ralston K
    Title: Exploring changes in middle-school student lunch consumption after local school food service policy modifications.
    Journal: Public Health Nutr. 9(6):814-20
    Date: 2006 Sep
    Abstract: OBJECTIVE: This study assessed the impact of changes in school food policy on student lunch consumption in middle schools. METHODS: Two years of lunch food records were collected from students at three middle schools in the Houston, Texas area. During the first year, no changes occurred in the school food environment. After that school year was completed, chips and dessert foods were removed from the snack bars of all schools by the Food Service Director. Students recorded the amount and source of food and beverage items consumed. Point-of-service purchase machines provided a day-by-day electronic data file with food and beverage purchases from the snack bars during the 2-year period. Independent t-tests and time series analyses were used to document the impact of the policy change on consumption and sales data between the two years. RESULTS: In general, student consumption of sweetened beverages declined and milk, calcium, vitamin A, saturated fat and sodium increased after the policy change. Snack chips consumption from the snack bar declined in year 2; however, consumption of snack chips and candy from vending increased and the number of vending machines in study schools doubled during the study period. Ice cream sales increased significantly in year 2. CONCLUSIONS: Policy changes on foods sold in schools can result in changes in student consumption from the targeted environments. However, if all environments do not make similar changes, compensation may occur.
  200. Author: Hemphill E, Raine K, Spence JC, Smoyer-Tomic KE
    Title: Exploring obesogenic food environments in Edmonton, Canada: the association between socioeconomic factors and fast-food outlet access.
    Journal: Am J Health Promot. 22(6):426-32
    Date: 2008 Jul-Aug
    Abstract: PURPOSE: To explore the relationship between the placement of fast-food outlets and neighborhood-level socioeconomic variables by determining if indicators of lower socioeconomic status were predictive of exposure to fast food. DESIGN: A descriptive analysis of the fast-food environment in a Canadian urban center, using secondary analysis of census data and Geographic Information Systems technology. SETTING: Edmonton, Alberta, Canada. MEASURES: Neighborhoods were classified as High, Medium, or Low Access based on the number of fast-food opportunities available to them. Neighborhood-level socioeconomic data (income, education, employment, immigration status, and housing tenure) from the 2001 Statistics Canada federal census were obtained. ANALYSIS: A discriminant function analysis was used to determine if any association existed between neighborhood demographic characteristics and accessibility of fast-food outlets. RESULTS: Significant differences were found between the three levels of fast-food accessibility across the socioeconomic variables, with successively greater percentages of unemployment, low income, and renters in neighborhoods with increasingly greater access to fast-food restaurants. A high score on several of these variables was predictive of greater access to fast-food restaurants. CONCLUSION: Although a causal inference is not possible, these results suggest that the distribution of fast-food outlets relative to neighborhood-level socioeconomic status requires further attention in the process of explaining the increased rates of obesity observed in relatively deprived populations.
  201. Author: Briggs L, Lake AA
    Title: Exploring school and home food environments: perceptions of 8-10-year-olds and their parents in Newcastle upon Tyne, UK.
    Journal: Public Health Nutr. 14(12):2227-35
    Date: 2011 Dec
    Abstract: OBJECTIVE: To use an innovative mixed-method approach to analyse and describe 8-10-year-olds' home and school food environments. DESIGN: A mixed-method approach to collect qualitative and quantitative data was used, in which pupils took photographs over four days to record their food intake and food environment. The photographs were discussed in focus groups. A combination of lunchtime observations and questionnaires completed by parents were used to build up a picture of the children's home and school food environments. SETTING: A primary school in a suburb of Newcastle upon Tyne, UK. SUBJECTS: Twenty-seven children aged 8-10 years consented to take part in the study. Twenty-four returned cameras, and eighteen parents completed questionnaires. RESULTS: Photographs illustrated a range of locations throughout the home where children consumed food. Children's photographs revealed they ate less often with family and more often in front of the television than reported in parental questionnaires. Emergent themes during focus group discussions revealed a strong preference for packed lunches and dissatisfaction with school dinners. In this small sample, children's eating habits and preferences showed few associations with either gender or the deprivation level of the area in which they lived. CONCLUSIONS: The children's home food environments showed a great deal of variation, with parents being key moderators of food availability and consumption. While the school's food provisions met national nutritional standards, the social aspects of having a packed lunch appeared to be a positive aspect of eating at school.
  202. Author: Black JL, Carpiano RM, Fleming S, Lauster N
    Title: Exploring the distribution of food stores in British Columbia: associations with neighbourhood socio-demographic factors and urban form.
    Journal: Health Place. 17(4):961-70
    Date: 2011 Jul
    Abstract: Several studies have identified disparities in access to food retailers among urban neighbourhoods with varied socio-demographic characteristics; but few studies have examined whether key zoning and siting mechanisms described in the urban planning literature explain differences in food store access. This study assessed associations between socio-demographic and urban planning variables with the availability of large supermarkets and stores selling fresh food within one kilometre buffers from residential addresses and the proximity to the closest food stores across 630 census tracts in British Columbia, Canada. Multivariate regression results indicated that neighbourhoods with higher median household income had significantly decreased access to food stores. Inclusion of urban planning factors in multivariate models, particularly housing and transportation considerations, explained much of the relation between area income and food store access, and were significant predictors of food store availability and proximity. Public health research and practice addressing food availability would benefit by incorporating theoretical perspectives from urban planning theory.
  203. Author: Terry-McElrath YM, O'Malley PM, Johnston LD
    Title: Factors affecting sugar-sweetened beverage availability in competitive venues of US secondary schools.
    Journal: J Sch Health. 82(1):44-55
    Date: 2012 Jan
    Abstract: BACKGROUND: This study explores sugar-sweetened beverage (SSB) availability in US secondary school competitive venues during the first 3 years following the school wellness policy requirement (2007-2009). Furthermore, analyses examine associations with school policy and SSB availability. METHODS: Analyses use questionnaire data from 757 middle and 762 high schools in the nationally representative Youth, Education, and Society study to examine soda and non-soda SSB availability associations with school policy including (1) beverage bottling contracts and related incentives, (2) individuals/organizations responsible for decisions regarding beverages available in vending machines, and (3) school wellness policies and nutrition guidelines. RESULTS: Non-soda SSBs made up the majority of SSBs in both middle and high schools. Soda was especially likely to be found in vending machines; non-soda SSBs were widely available across competitive venues. Access to soda decreased significantly over time; however, non-soda SSB access did not show a similar decrease. School policy allowing beverage supplier contractual involvement (bottling contract incentives and beverage supplier "say" in vending machine beverage choices) was related to increased SSB access. However, the existence of developed nutritional guidelines was associated with lower SSB availability. CONCLUSIONS: Students had high access to SSBs across competitive school venues, with non-soda SSBs making up the majority of SSB beverage options. Efforts to reduce access to SSBs in US secondary schools should include a focus on reducing both soda and non-soda SSBs, reducing beverage supplier involvement in school beverage choices, and encouraging the development of targeted nutritional guidelines for all competitive venues.
  204. Author: Grimm GC, Harnack L, Story M
    Title: Factors associated with soft drink consumption in school-aged children.
    Journal: J Am Diet Assoc. 104(8):1244-9
    Date: 2004 Aug
    Abstract: OBJECTIVE: To identify factors associated with nonalcoholic carbonated beverage (soft drink) consumption in children. DESIGN: Mail-in surveys collected by Dragonfly, a children's educational magazine distributed nationally to elementary and middle schools, were analyzed. The survey included questions about frequency of soft drink consumption and factors related to soft drink consumption. SUBJECTS AND PARTICIPANTS: The sample consisted of 560 children, 8 to 13 years old, who completed and mailed in the survey. There was an equal distribution of boys and girls (51% and 49%, respectively). STATISTICAL ANALYSES: Frequency distributions were calculated and chi(2) tests were conducted to determine whether soft drink consumption and related factors varied by sex and age. Multivariate logistic regression analyses were conducted to examine the association of soft drink consumption with each factor after adjustment for potential confounders. RESULTS: Preference for the taste of soft drinks was the strongest predictor in the analysis, with those who reported the strongest taste preference 4.50 times more likely (95% confidence interval=2.89-7.04) to consume soft drinks five or more times per week than those with a lower taste preference. Youth whose parents regularly drank soft drinks were 2.88 times more likely (95% confidence interval=1.76-4.72) to consume soft drinks five or more times per week compared with those whose parents did not regularly drink soft drinks. CONCLUSIONS: Results suggest that several factors may be associated with soft drink intake in school-aged children, most notably taste preferences, soft drink consumption habits of parents and friends, soft drink availability in the home and school, and television viewing. Additional research is needed to verify these findings in a representative sample of children.
  205. Author: Probart C, McDonnell E, Hartman T, Weirich JE, Bailey-Davis L
    Title: Factors associated with the offering and sale of competitive foods and school lunch participation.
    Journal: J Am Diet Assoc. 106(2):242-7
    Date: 2006 Feb
    Abstract: OBJECTIVE: The objective of this study was to identify factors that predict offering and sale of competitive foods, as well as factors that predict average daily participation in school lunch. DESIGN: Surveys were distributed to 271 school foodservice directors in a random sample of high schools in Pennsylvania that were selected to be representative of the entire population of high schools in Pennsylvania based on chosen demographic characteristics. SUBJECTS: Two hundred twenty-eight school foodservice directors (84%) returned surveys. STATISTICAL ANALYSES: Descriptive and multiple regression analyses were done using SPSS version 11.5 (2002, SPSS Inc, Chicago, IL). RESULTS: Percentage of students eligible for free or reduced-price meals and timing of lunch were significant predictors of a la carte sales. Enrollment was negatively associated with number of vending machines per student. The number of less nutritious food items offered in vending machines and existence of soft drink machines owned by soft drink companies, for which the school receives a percent of sales, both predicted number of vending machines per student. Enrollment was inversely related to average daily participation in school lunch. The percentage of students eligible for free/reduced-price meals and enforcement of a policy prohibiting parents or students from bringing food into the cafeteria from local fast-food establishments positively predicted average daily participation in school lunch. CONCLUSIONS: These findings may be useful to school wellness councils in developing wellness policies as mandated by the Child Nutrition and WIC Reauthorization Act of 2004, as well as in structuring school environments to promote more healthful food choices by students.
  206. Author: Bauer KW, Neumark-Sztainer D, Fulkerson JA, Hannan PJ, Story M
    Title: Familial correlates of adolescent girls' physical activity, television use, dietary intake, weight, and body composition.
    Journal: Int J Behav Nutr Phys Act
    Date: 2011
    Abstract: BACKGROUND: The family environment offers several opportunities through which to improve adolescents' weight and weight-related behaviors. This study aims to examine the cross-sectional relationships between multiple factors in the family environment and physical activity (PA), television use (TV), soft drink intake, fruit and vegetable (FV) intake, body mass index (BMI), and body composition among a sample of sociodemographically-diverse adolescent girls. METHODS: Subjects included girls (mean age=15.7), 71% of whom identified as a racial/ethnic minority, and one of their parents (dyad n=253). Parents completed surveys assessing factors in the family environment including familial support for adolescents' PA, healthful dietary intake, and limiting TV use; parental modeling of behavior; and resources in the home such as availability of healthful food. Girls' PA and TV use were measured by 3-Day Physical Activity Recall (3DPAR) and dietary intake by survey measures. BMI was measured by study staff, and body fat by dual-energy X-ray absorptiometry (DXA). Hierarchical linear regression models tested individual and mutually-adjusted relationships between family environment factors and girls' outcomes. RESULTS: In the individual models, positive associations were observed between family support for PA and girls' total PA (p=.011) and moderate-to-vigorous PA (p=.016), home food availability and girls' soft drink (p<.001 and="" fv="" intake="" family="" meal="" frequency="" girls="" across="" the="" individual="" mutually-adjusted="" models="" parental="" modeling="" of="" pa="" tv="" soft="" drink="" was="" consistently="" associated="" with="" behavior.="" conclusions:="" helping="" parents="" improve="" their="" physical="" activity="" dietary="" as="" well="" reduce="" time="" watching="" television="" may="" be="" an="" effective="" way="" to="" promote="" healthful="" behaviors="" weight="" among="" adolescent="" girls.="">
  207. Author: Campbell KJ, Crawford DA, Ball K
    Title: Family food environment and dietary behaviors likely to promote fatness in 5-6 year-old children.
    Journal: Int J Obes (Lond). 30(8):1272-80
    Date: 2006 Aug
    Abstract: BACKGROUND: The family food environment (FFE) is likely to exert important influences on young children's eating. Examination of multiple aspects of the FFE may provide useful insights regarding which of these might most effectively be targeted to prevent childhood obesity. OBJECTIVE: To assess the associations between the FFE and a range of obesity-promoting dietary behaviors in 5-6-year-old children. DESIGN: Cross-sectional study. SUBJECTS: Five hundred and sixty families sampled from three socio-economically distinct areas. MEASUREMENTS: Predictors included parental perceptions of their child's diet, food availability, child feeding practices, parental modeling of eating and food preparation and television (TV) exposure. Dietary outcomes included energy intake, vegetable, sweet snack, savory snack and high-energy (non-dairy) fluid consumption. RESULTS: Multiple linear regression analyses, adjusted for all other predictor variables and maternal education, showed that several aspects of the FFE were associated with dietary outcomes likely to promote fatness in 5-6-year-old children. For example, increased TV viewing time was associated with increased index of energy intake, increased sweet snack and high-energy drink consumption, and deceased vegetable intake. In addition, parent's increased confidence in the adequacy of their child's diet was associated with increased consumption of sweet and savory snacks and decreased vegetable consumption. CONCLUSION: This study substantially extends previous research in the area, providing important insights with which to guide family-based obesity prevention strategies.
  208. Author: Jones J, Terashima M, Rainham D
    Title: Fast food and deprivation in Nova Scotia.
    Journal: Can J Public Health. 100(1):32-5
    Date: 2009 Jan-Feb
    Abstract: OBJECTIVE: To examine the relationship between density of fast food restaurants and measures of social and material deprivation at the community level in Nova Scotia, Canada. METHODS: Census information on population and key variables required for the calculation of deprivation indices were obtained for 266 communities in Nova Scotia. The density of fast food restaurants per 1000 individuals for each community was calculated and communities were divided into quintiles of material and psychosocial deprivation. One-way analysis of variance was used to investigate associations between fast food outlet densities and deprivation scores at the community level. RESULTS: A statistically significant inverse association was found between community-level material deprivation and the mean number of fast food restaurants per 1000 people for Nova Scotia (p
  209. Author: Morgenstern LB, Escobar JD, Sánchez BN, Hughes R, Zuniga BG, Garcia N, Lisabeth LD
    Title: Fast food and neighborhood stroke risk.
    Journal: Ann Neurol. 66(2):165-70
    Date: 2009 Aug
    Abstract: OBJECTIVE: To investigate the association between the number of fast food restaurants and ischemic stroke in neighborhoods. METHODS: This work was a prespecified part of the Brain Attack in Corpus Christi (BASIC) project. Ischemic stroke cases were prospectively ascertained in Nueces County, Texas. Home addresses were geocoded and used to establish the census tract for each stroke case. Census tracts were used as proxies for neighborhoods (n = 64). Using a standard definition, fast food restaurants were identified from a commercial list. Poisson regression was used to study the association between the number of fast food restaurants in the neighborhood, using a 1-mile buffer around each census tract, and the risk of stroke in the neighborhood. Models were adjusted for demographics and neighborhood socioeconomic status (SES). RESULTS: There were 1,247 completed ischemic strokes from January 2000 through June 2003 and 262 fast food restaurants. The median number of fast food restaurants per census tract including buffer was 22 (interquartile range, 12-33). Adjusting for neighborhood demographics and SES, the association of fast food restaurants with stroke was significant (p = 0.02). The association suggested that the risk of stroke in a neighborhood increased by 1% for every fast food restaurant (relative risk, 1.01; 95% confidence interval [CI], 1.00-1.01). The relative risk of stroke comparing neighborhoods in the 75th to the 25th percentile of the distribution of fast food restaurants was 1.13 (95% CI, 1.02-1.25). INTERPRETATION: Controlling for demographic and SES factors, there was a significant association between fast food restaurants and stroke risk in neighborhoods in this community-based study.
  210. Author: Fraser LK, Clarke GP, Cade JE, Edwards KL
    Title: Fast food and obesity: a spatial analysis in a large United Kingdom population of children aged 13-15.
    Journal: Am J Prev Med. 42(5):e77-85
    Date: 2012 May
    Abstract: BACKGROUND: The childhood obesity epidemic is a current public health priority in many countries, and the consumption of fast food has been associated with obesity. PURPOSE: This study aims to assess the relationship between fast-food consumption and obesity as well as the relationship between fast-food outlet access and consumption in a cohort of United Kingdom teenagers. METHODS: A weighted accessibility score of the number of fast-food outlets within a 1-km network buffer of the participant's residence at age 13 years was calculated. Geographically weighted regression was used to assess the relationships between fast-food consumption at age 13 years and weight status at ages 13 and 15 years, and separately between fast-food accessibility and consumption. Data were collected from 2004 to 2008. RESULTS: The consumption of fast food was associated with a higher BMI SD score (β=0.08, 95% CI=0.03, 0.14); higher body fat percentage (β=2.06, 95% CI=1.33, 2.79); and increased odds of being obese (OR=1.23, 95% CI=1.02, 1.49). All these relationships were stationary and did not vary over space in the study area. The relationship between the accessibility of outlets and consumption did vary over space, with some areas (more rural areas) showing that increased accessibility was associated with consumption, whereas in some urban areas increased accessibility was associated with lack of consumption. CONCLUSIONS: There is continued need for nutritional education regarding fast food, but public health interventions that place restrictions on the location of fast-food outlets may not uniformly decrease consumption.
  211. Author: Khan T, Powell LM, Wada R
    Title: Fast food consumption and food prices: evidence from panel data on 5th and 8th grade children.
    Journal: J Obes
    Date: 2012
    Abstract: Fast food consumption is a dietary factor associated with higher prevalence of childhood obesity in the United States. The association between food prices and consumption of fast food among 5th and 8th graders was examined using individual-level random effects models utilizing consumption data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99 (ECLS-K), price data from American Chamber of Commerce Researchers Association (ACCRA), and contextual outlet density data from Dun and Bradstreet (D&B). The results found that contextual factors including the price of fast food, median household income, and fast food restaurant outlet densities were significantly associated with fast food consumption patterns among this age group. Overall, a 10% increase in the price of fast food was associated with 5.7% lower frequency of weekly fast food consumption. These results suggest that public health policy pricing instruments such as taxes may be effective in reducing consumption of energy-dense foods and possibly reducing the prevalence of overweight and obesity among US children and young adolescents.
  212. Author: Powell LM
    Title: Fast food costs and adolescent body mass index: evidence from panel data.
    Journal: J Health Econ. 28(5):963-70
    Date: 2009 Sep
    Abstract: This study draws on four waves of the 1997 National Longitudinal Survey of Youth and external data to examine the relationship between adolescent body mass index (BMI) and fast food prices and fast food restaurant availability using panel data estimation methods to account for individual-level unobserved heterogeneity. Analyses also control for contextual factors including general food prices and the availability of full-service restaurants, supermarkets, grocery stores, convenience stores and commercial physical activity-related facilities. The longitudinal individual-level fixed effects results confirm cross-sectional findings that the price of fast food but not the availability of fast food restaurants has a statistically significant effect on teen BMI with an estimated price elasticity of -0.08. The results suggest that the cross-sectional model over-estimates the price of fast food BMI effect by about 25%. There is evidence that the weight of teens in low- to middle-socioeconomic status families is most sensitive to fast food prices.
  213. Author: Boutelle KN, Fulkerson JA, Neumark-Sztainer D, Story M, French SA
    Title: Fast food for family meals: relationships with parent and adolescent food intake, home food availability and weight status.
    Journal: Public Health Nutr. 10(1):16-23
    Date: 2007 Jan
    Abstract: OBJECTIVE: The purpose of the present study was to examine the prevalence of fast-food purchases for family meals and the associations with sociodemographic variables, dietary intake, home food environment, and weight status in adolescents and their parents. DESIGN: This study is a cross-sectional evaluation of parent interviews and adolescent surveys from Project EAT (Eating Among Teens). SUBJECTS: Subjects included 902 middle-school and high-school adolescents (53% female, 47% male) and their parents (89% female, 11% male). The adolescent population was ethnically diverse: 29% white, 24% black, 21% Asian American, 14% Hispanic and 12% other. RESULTS: Results showed that parents who reported purchasing fast food for family meals at least 3 times per week were significantly more likely than parents who reported purchasing fewer fast-food family meals to report the availability of soda pop and chips in the home. Adolescents in homes with fewer than 3 fast-food family meals per week were significantly more likely than adolescents in homes with more fast-food family meals to report having vegetables and milk served with meals at home. Fast-food purchases for family meals were positively associated with the intake of fast foods and salty snack foods for both parents and adolescents; and weight status among parents. Fast-food purchases for family meals were negatively associated with parental vegetable intake. CONCLUSIONS: Fast-food purchases may be helpful for busy families, but families need to be educated on the effects of fast food for family meals and how to choose healthier, convenient family meals.
  214. Author: Thornton LE, Bentley RJ, Kavanagh AM
    Title: Fast food purchasing and access to fast food restaurants: a multilevel analysis of VicLANES.
    Journal: Int J Behav Nutr Phys Act
    Date: 2009 May
    Abstract: ABSTRACT: BACKGROUND: While previous research on fast food access and purchasing has not found evidence of an association, these studies have had methodological problems including aggregation error, lack of specificity between the exposures and outcomes, and lack of adjustment for potential confounding. In this paper we attempt to address these methodological problems using data from the Victorian Lifestyle and Neighbourhood Environments Study (VicLANES) - a cross-sectional multilevel study conducted within metropolitan Melbourne, Australia in 2003. METHODS: The VicLANES data used in this analysis included 2547 participants from 49 census collector districts in metropolitan Melbourne, Australia. The outcome of interest was the total frequency of fast food purchased for consumption at home within the previous month (never, monthly and weekly) from five major fast food chains (Red Rooster, McDonalds, Kentucky Fried Chicken, Hungry Jacks and Pizza Hut). Three measures of fast food access were created: density and variety, defined as the number of fast food restaurants and the number of different fast food chains within 3 kilometres of road network distance respectively, and proximity defined as the road network distance to the closest fast food restaurant.Multilevel multinomial models were used to estimate the associations between fast food restaurant access and purchasing with never purchased as the reference category. Models were adjusted for confounders including determinants of demand (attitudes and tastes that influence food purchasing decisions) as well as individual and area socio-economic characteristics. RESULTS: Purchasing fast food on a monthly basis was related to the variety of fast food restaurants (odds ratio 1.13; 95% confidence interval 1.02 - 1.25) after adjusting for individual and area characteristics. Density and proximity were not found to be significant predictors of fast food purchasing after adjustment for individual socio-economic predictors. CONCLUSION: Although we found an independent association between fast food purchasing and access to a wider variety of fast food restaurant, density and proximity were not significant predictors. The methods used in our study are an advance on previous analyses.
  215. Author: Block JP, Scribner RA, DeSalvo KB
    Title: Fast food, race/ethnicity, and income: a geographic analysis.
    Journal: Am J Prev Med. 27(3):211-7
    Date: 2004 Oct
    Abstract: BACKGROUND: Environmental factors may contribute to the increasing prevalence of obesity, especially in black and low-income populations. In this paper, the geographic distribution of fast food restaurants is examined relative to neighborhood sociodemographics. METHODS: Using geographic information system software, all fast-food restaurants within the city limits of New Orleans, Louisiana, in 2001 were mapped. Buffers around census tracts were generated to simulate 1-mile and 0.5-mile "shopping areas" around and including each tract, and fast food restaurant density (number of restaurants per square mile) was calculated for each area. Using multiple regression, the geographic association between fast food restaurant density and black and low-income neighborhoods was assessed, while controlling for environmental confounders that might also influence the placement of restaurants (commercial activity, presence of major highways, and median home values). RESULTS: In 156 census tracts, a total of 155 fast food restaurants were identified. In the regression analysis that included the environmental confounders, fast-food restaurant density in shopping areas with 1-mile buffers was independently correlated with median household income and percent of black residents in the census tract. Similar results were found for shopping areas with 0.5-mile buffers. Predominantly black neighborhoods have 2.4 fast-food restaurants per square mile compared to 1.5 restaurants in predominantly white neighborhoods. CONCLUSIONS: The link between fast food restaurants and black and low-income neighborhoods may contribute to the understanding of environmental causes of the obesity epidemic in these populations.
  216. Author: Boone-Heinonen J, Gordon-Larsen P, Kiefe CI, Shikany JM, Lewis CE, Popkin BM
    Title: Fast food restaurants and food stores: longitudinal associations with diet in young to middle-aged adults: the CARDIA study.
    Journal: Arch Intern Med. 171(13):1162-70
    Date: 2011 Jul 11
    Abstract: BACKGROUND: A growing body of cross-sectional, small-sample research has led to policy strategies to reduce food deserts--neighborhoods with little or no access to healthy foods--by limiting fast food restaurants and small food stores and increasing access to supermarkets in low-income neighborhoods. METHODS: We used 15 years of longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of US young adults (aged 18-30 years at baseline) (n = 5115), with linked time-varying geographic information system-derived food resource measures. Using repeated measures from 4 examination periods (n = 15,854 person-examination observations) and conditional regression (conditioned on the individual), we modeled fast food consumption, diet quality, and adherence to fruit and vegetable recommendations as a function of fast food chain, supermarket, or grocery store availability (counts per population) within less than 1.00 km, 1.00 to 2.99 km, 3.00 to 4.99 km, and 5.00 to 8.05 km of respondents' homes. Models were sex stratified, controlled for individual sociodemographic characteristics and neighborhood poverty, and tested for interaction by individual-level income. RESULTS: Fast food consumption was related to fast food availability among low-income respondents, particularly within 1.00 to 2.99 km of home among men (coefficient, 0.34; 95% confidence interval, 0.16-0.51). Greater supermarket availability was generally unrelated to diet quality and fruit and vegetable intake, and relationships between grocery store availability and diet outcomes were mixed. CONCLUSION: Our findings provide some evidence for zoning restrictions on fast food restaurants within 3 km of low-income residents but suggest that increased access to food stores may require complementary or alternative strategies to promote dietary behavior change.
  217. Author: Moore LV, Diez Roux AV, Nettleton JA, Jacobs DR, Franco M
    Title: Fast-food consumption, diet quality, and neighborhood exposure to fast food: the multi-ethnic study of atherosclerosis.
    Journal: Am J Epidemiol. 170(1):29-36
    Date: 2009 Jul 1
    Abstract: The authors examined associations among fast-food consumption, diet, and neighborhood fast-food exposure by using 2000-2002 Multi-Ethnic Study of Atherosclerosis data. US participants (n = 5,633; aged 45-84 years) reported usual fast-food consumption (never, or =1 times/week) and consumption near home (yes/no). Healthy diet was defined as scoring in the top quintile of the Alternate Healthy Eating Index or bottom quintile of a Western-type dietary pattern. Neighborhood fast-food exposure was measured by densities of fast-food outlets, participant report, and informant report. Separate logistic regression models were used to examine associations of fast-food consumption and diet; fast-food exposure and consumption near home; and fast-food exposure and diet adjusted for site, age, sex, race/ethnicity, education, and income. Those never eating fast food had a 2-3-times higher odds of having a healthy diet versus those eating fast food > or =1 times/week, depending on the dietary measure. For every standard deviation increase in fast-food exposure, the odds of consuming fast food near home increased 11%-61% and the odds of a healthy diet decreased 3%-17%, depending on the model. Results show that fast-food consumption and neighborhood fast-food exposure are associated with poorer diet. Interventions that reduce exposure to fast food and/or promote individual behavior change may be helpful.
  218. Author: Longacre MR, Drake KM, MacKenzie TA, Gibson L, Owens P, Titus LJ, Beach ML, Dalton MA
    Title: Fast-food environments and family fast-food intake in nonmetropolitan areas.
    Journal: Am J Prev Med. 42(6):579-87
    Date: 2012 Jun
    Abstract: BACKGROUND: Little is known about the influence of in-town fast-food availability on family-level fast-food intake in nonmetropolitan areas. PURPOSE: The purpose of the current study was to determine whether the presence of chain fast-food outlets was associated with fast-food intake among adolescents and parents, and to assess whether this relationship was moderated by family access to motor vehicles. METHODS: Telephone surveys were conducted with 1547 adolescent-parent dyads in 32 New Hampshire and Vermont communities between 2007 and 2008. Fast-food intake in the past week was measured through self-report. In-town fast-food outlets were located and enumerated using an onsite audit. Family motor vehicle access was categorized based on the number of vehicles per licensed drivers in the household. Poisson regression was used to determine unadjusted and adjusted risk ratios (RRs). Analyses were conducted in 2011. RESULTS: About half (52.1%) of adolescents and 34.7% of parents consumed fast food at least once in the past week. Adolescents and parents who lived in towns with five or more fast-food outlets were about 30% more likely to eat fast food compared to those in towns with no fast-food outlets, even after adjusting for individual, family, and town characteristics (RR=1.29, 95% CI= 1.10, 1.51; RR=1.32, 95% CI=1.07, 1.62, respectively). Interaction models demonstrated that the influence of in-town fast-food outlets on fast-food intake was strongest among families with low motor vehicle access. CONCLUSIONS: In nonmetropolitan areas, household transportation should be considered as an important moderator of the relationship between in-town fast-food outlets and family intake.
  219. Author: Chiang PH, Wahlqvist ML, Lee MS, Huang LY, Chen HH, Huang ST
    Title: Fast-food outlets and walkability in school neighbourhoods predict fatness in boys and height in girls: a Taiwanese population study.
    Journal: Public Health Nutr. 14(9):1601-9
    Date: 2011 Sep
    Abstract: OBJECTIVE: There is increasing evidence that the school food environment contributes to childhood obesity and health in various locations. We investigated the influence of fast-food stores and convenience food stores (FS and CS, respectively) on growth and body composition in a range of residential densities for North-east Asian food culture. DESIGN: Anthropometrics and birth weight of schoolchildren were obtained. Geocoded mapping of schools and food outlets was conducted. Multivariable linear regression models, adjusted for father's ethnicity and education, as well as for household income, pocket money, birth weight, physical activity, television watching, food quality and region, were used to predict body composition from school food environments. SETTING: Elementary schools and school neighbourhoods in 359 townships/districts of Taiwan. SUBJECTS: A total of 2283 schoolchildren aged 6-13 years from the Elementary School Children's Nutrition and Health Survey in Taiwan conducted in 2001-2002. RESULTS: Remote and socially disadvantaged locations had the highest prevalence of lower weight, BMI, waist circumference and triceps skinfold thickness. Food store densities, FS and CS, were highest in urban Taiwan and lowest in remote Taiwan. In the fully adjusted models, FS densities predicted weight and BMI in boys; there was a similar association for waist circumference, except when adjusted for region. FS densities also predicted height for girls. Except for weight and BMI in boys, CS did not have effects evident with FS for either boys or girls. CONCLUSIONS: A high FS density, more than CS density, in Taiwan increased the risk of general (BMI) and abdominal (waist circumference) obesity in boys and stature in girls. These findings have long-term implications for chronic disease in adulthood.
  220. Author: Wildey MB, Pampalone SZ, Pelletier RL, Zive MM, Elder JP, Sallis JF
    Title: Fat and sugar levels are high in snacks purchased from student stores in middle schools.
    Journal: J Am Diet Assoc. 100(3):319-22
    Date: 2000 Mar
    Abstract: OBJECTIVE: Children consume about one third of their daily energy at school, mostly from cafeteria food and bag lunches. Students also shop at student-run stores that generate revenue for extracurricular activities; yet the nutritional value of snacks sold at student stores has not been documented to our knowledge. DESIGN: Cross-sectional study of foods sold at student stores in middle schools. SUBJECTS/SETTING: Twenty-four San Diego County (Calif) public middle schools, grades 6 through 8 (age 11 to 13), from 9 school districts. The schools represent a diversity of ethnic groups and socioeconomic levels. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, Pearson product moment correlations, analysis of variance. RESULTS: Snacks averaged 8.7 g fat and 23.0 g sugar. Overall, 88.5% of store inventory was high in fat and/or high in sugar. Sugar candy accounted for one third of store sales. Chocolate candy was highest in fat content: 15.7 g. Fourteen of the 24 schools had stores that sold food and were run by student organizations. Stores were open daily for about 90 minutes; half sold food during lunch. CONCLUSIONS: Adolescents need opportunities to supplement main meals; however, student stores in middle schools sell primarily high-fat, high-sugar snacks. Key intervention possibilities include limiting sales of chocolate candy and substituting low-fat varieties of cakes, cookies, chips, and crackers. Competition with cafeterias for sales at lunchtime should be addressed.
  221. Author: Paquet C, Daniel M, Kestens Y, Léger K, Gauvin L
    Title: Field validation of listings of food stores and commercial physical activity establishments from secondary data.
    Journal: Int J Behav Nutr Phys Act
    Date: 2008
    Abstract: BACKGROUND: Food- and activity-related establishments are increasingly viewed as neighbourhood resources that potentially condition health-related behaviour. The primary objective of the current study was to establish, using ground truthing (on-site verification), the validity of measures of availability of food stores and physical activity establishments that were obtained from commercial database and Internet searches. A secondary objective was to examine differences in validity results according to neighbourhood characteristics and commercial establishment categories. METHODS: Lists of food stores and physical activity-related establishments in 12 census tracts within the Montreal metropolitan region were compiled using a commercial database (n = 171 establishments) and Internet search engines (n = 123 establishments). Ground truthing through field observations was performed to assess the presence of listed establishments and identify those absent. Percentage agreement, sensitivity (proportion of establishments found in the field that were listed), and positive predictive value (proportion of listed establishments found in the field) were calculated and contrasted according to data sources, census tracts characteristics, and establishment categories. RESULTS: Agreement with field observations was good (0.73) for the commercial list, and moderate (0.60) for the Internet-based list. The commercial list was superior to the Internet-based list for correctly listing establishments present in the field (sensitivity), but slightly inferior in terms of the likelihood that a listed establishment was present in the field (positive predictive value). Agreement was higher for food stores than for activity-related establishments. CONCLUSION: Commercial data sources may provide a valid alternative to field observations and could prove a valuable tool in the evaluation of commercial environments relevant to eating behaviour. In contrast, this study did not find strong evidence in support of commercial and Internet data sources to represent neighbourhood opportunities for active lifestyle.
  222. Author: Powell LM, Han E, Zenk SN, Khan T, Quinn CM, Gibbs KP, Pugach O, Barker DC, Resnick EA, Myllyluoma J, Chaloupka FJ
    Title: Field validation of secondary commercial data sources on the retail food outlet environment in the U.S.
    Journal: Health Place. 17(5):1122-31
    Date: 2011 Sep
    Abstract: This study used direct field observations with interior assessments of outlets to validate food store and restaurant data from two commercial business lists conditional on classification of outlet type, including supermarkets, grocery stores, convenience stores, full-service restaurants and fast food restaurants. The study used a stratified random sample that included 274 urban census tracts across 9 counties from the Chicago Metropolitan Statistical Area (MSA) and 46 suburban and 61 rural census tracts across 13 counties from a 50-mile buffer surrounding the MSA. Results showed that agreement between the field observations and the commercial business lists for the food store and restaurant outlets was generally moderate (ranging from fair to good). However, when the listed data were validated based on an exact classification match, agreement was only fair (ranging from poor to moderate) and, in particular, poor for fast food restaurants. The study also found that agreement levels for some outlet types differed by tract characteristics. Commercial databases must be used with caution as substitutes for on the ground data collection.
  223. Author: Sharkey JR, Johnson CM, Dean WR, Horel SA
    Title: Focusing on fast food restaurants alone underestimates the relationship between neighborhood deprivation and exposure to fast food in a large rural area.
    Journal: Nutr J
    Date: 2011
    Abstract: BACKGROUND: Individuals and families are relying more on food prepared outside the home as a source for at-home and away-from-home consumption. Restricting the estimation of fast-food access to fast-food restaurants alone may underestimate potential spatial access to fast food. METHODS: The study used data from the 2006 Brazos Valley Food Environment Project (BVFEP) and the 2000 U.S. Census Summary File 3 for six rural counties in the Texas Brazos Valley region. BVFEP ground-truthed data included identification and geocoding of all fast-food restaurants, convenience stores, supermarkets, and grocery stores in study area and on-site assessment of the availability and variety of fast-food lunch/dinner entrées and side dishes. Network distance was calculated from the population-weighted centroid of each census block group to all retail locations that marketed fast food (n = 205 fast-food opportunities). RESULTS: Spatial access to fast-food opportunities (FFO) was significantly better than to traditional fast-food restaurants (FFR). The median distance to the nearest FFO was 2.7 miles, compared with 4.5 miles to the nearest FFR. Residents of high deprivation neighborhoods had better spatial access to a variety of healthier fast-food entrée and side dish options than residents of low deprivation neighborhoods. CONCLUSIONS: Our analyses revealed that identifying fast-food restaurants as the sole source of fast-food entrées and side dishes underestimated neighborhood exposure to fast food, in terms of both neighborhood proximity and coverage. Potential interventions must consider all retail opportunities for fast food, and not just traditional FFR.
  224. Author: Sharkey JR, Johnson CM, Dean WR
    Title: Food access and perceptions of the community and household food environment as correlates of fruit and vegetable intake among rural seniors.
    Journal: BMC Geriatr
    Date: 2010
    Abstract: BACKGROUND: Although the importance of fruit and vegetable consumption to health has been well established, few studies have focused on access to fruits and vegetables in rural areas; even fewer examined the relationship between food access and fruit and vegetable consumption among seniors. METHODS: To examine the spatial challenges to good nutrition faced by seniors who reside in rural areas and how spatial access influences fruit and vegetable intake. A cross-sectional analysis using data from the 2006 Brazos Valley Health Assessment (mailsurvey) for 582 rural seniors (60-90 years), who were recruited by random digit dialing; food store data from the 2006-2007 Brazos Valley Food Environment Project that used ground-truthed methods to identify, geocode, and inventory fruit and vegetables in all food stores. RESULTS: Few of the BVHA seniors consumed the recommended intakes of fruits or vegetables; women consumed more servings of fruit (1.49 +/- 0.05 vs. 1.29 +/- 0.07, p = 0.02), similar servings of vegetables (2.18 +/- 0.04 vs. 2.09 +/- 0.07, p = 0.28), and more combined fruit and vegetables (3.67 +/- 0.08 vs. 3.38 +/- 0.12, p = 0.04) than men. The median distances to fresh fruit and vegetables were 5.5 miles and 6.4 miles, respectively. When canned and frozen fruit and vegetables were included in the measurement of overall fruit or vegetables, the median distance for a good selection of fruit or vegetables decreased to 3.4 miles for overall fruit and 3.2 miles for overall vegetables. Almost 14% reported that food supplies did not last and there was not enough money to buy more. Our analyses revealed that objective and perceived measures of food store access--increased distance to the nearest supermarket, food store with a good variety of fresh and processed fruit, or food store with a good variety of fresh and processed vegetables--were associated with decreased daily consumption of fruit, vegetables, and combined fruit and vegetables, after controlling for the influence of individual characteristics and perceptions of community and home food resources. CONCLUSIONS: Findings suggest that interventions designed to increase fruit and vegetable consumption among rural seniors should consider strategies to ameliorate differential access to healthy food due to food store distance.
  225. Author: Azuma AM, Gilliland S, Vallianatos M, Gottlieb R
    Title: Food access, availability, and affordability in 3 Los Angeles communities, Project CAFE, 2004-2006.
    Journal: Prev Chronic Dis. 7(2):A27
    Date: 2010 Mar
    Abstract: INTRODUCTION: Racial/ethnic minority communities are at increasingly high risk for chronic diseases related to obesity. Access to stores that sell affordable, nutritious food is a prerequisite for adopting a healthful diet. The objective of this study was to evaluate food access, availability, and affordability in 3 nonoverlapping but similar low-income communities in urban Los Angeles, California. METHODS: Using a community-based participatory research approach, we trained community members to conduct a food assessment to 1) map the number and type of retail food outlets in a defined area and 2) survey a sample of stores to determine whether they sold selected healthful foods and how much those foods cost. We used descriptive statistics to summarize findings. RESULTS: Of the 1,273 food establishments mapped in the 3 neighborhoods, 1,023 met the criteria of "retail food outlet." The most common types of retail food outlets were fast-food restaurants (30%) and convenience/liquor/corner stores (22%). Supermarkets made up less than 2% of the total. Convenience/liquor/corner stores offered fewer than half of the selected healthful foods and sold healthful foods at higher prices than did supermarkets. CONCLUSION: Access to stores that sell affordable healthful food is a problem in urban Los Angeles communities. Healthful food strategies should focus on changing food environments to improve overall community health.
  226. Author: Bullock SL, Craypo L, Clark SE, Barry J, Samuels SE
    Title: Food and beverage environment analysis and monitoring system: a reliability study in the school food and beverage environment.
    Journal: J Am Diet Assoc. 110(7):1084-8
    Date: 2010 Jul
    Abstract: States and school districts around the country are developing policies that set nutrition standards for competitive foods and beverages sold outside of the US Department of Agriculture's reimbursable school lunch program. However, few tools exist for monitoring the implementation of these new policies. The objective of this research was to develop a computerized assessment tool, the Food and Beverage Environment Analysis and Monitoring System (FoodBEAMS), to collect data on the competitive school food environment and to test the inter-rater reliability of the tool among research and nonresearch professionals. FoodBEAMS was used to collect data in spring 2007 on the competitive foods and beverages sold in 21 California high schools. Adherence of the foods and beverages to California's competitive food and beverage nutrition policies for schools (Senate Bills 12 and 965) was determined using the data collected by both research and nonresearch professionals. The inter-rater reliability between the data collectors was assessed using the intraclass correlation coefficient. Researcher vs researcher and researcher vs nonresearcher inter-rater reliability was high for both foods and beverages, with intraclass correlation coefficients ranging from .972 to .987. Results of this study provide evidence that FoodBEAMS is a promising tool for assessing and monitoring adherence to nutrition standards for competitive foods sold on school campuses and can be used reliably by both research and nonresearch professionals.
  227. Author: Kipke MD, Iverson E, Moore D, Booker C, Ruelas V, Peters AL, Kaufman F
    Title: Food and park environments: neighborhood-level risks for childhood obesity in east Los Angeles.
    Journal: J Adolesc Health. 40(4):325-33
    Date: 2007 Apr
    Abstract: PURPOSE: The rapid increase in obesity over the past two decades suggests that behavioral and environmental influences, including poor nutrition and physical inactivity, are fueling what is now widely recognized as a public health crisis. Yet, limited research has been conducted to examine how environmental factors, such as neighborhood-level characteristics, may be associated with increased risk for obesity. METHODS: Community-level risk associated with childhood obesity was examined in East Los Angeles, a community with one of the highest rates of childhood obesity in Los Angeles by triangulating: 1) spatial data for the number and location of food establishments relative to the location of schools; 2) observations regarding the availability and quality of fruits and vegetables in local grocery stores; and 3) observations regarding the quality and utilization of local parks. RESULTS: The findings revealed that there were 190 food outlets in the study community, of which 93 (49%) were fast-food restaurants. Of the fast-food restaurants, 63% were within walking distance of a school. In contrast, there were 62 grocery stores, of which only 18% sold fresh fruits and/or vegetables of good quality. Of the stores that did sell fruits and/or vegetables, only four were within walking distance of a school. Although well maintained, the five parks in this community accounted for only 37.28 acres, or 0.543 acres per 1000 residents. CONCLUSIONS: These findings suggest that children have easy access to fast food, and limited access to both healthy food options and parks in which to engage in physical fitness activities. This was particularly true in areas around schools. The implications for these findings with regards to policy-related prevention and future research are discussed.
  228. Author: Turner L, Chriqui JF, Chaloupka FJ
    Title: Food as a reward in the classroom: school district policies are associated with practices in US public elementary schools.
    Journal: J Acad Nutr Diet. 112(9):1436-42
    Date: 2012 Sep
    Abstract: The use of food as a reward for good student behavior or academic performance is discouraged by many national organizations, yet this practice continues to occur in schools. Our multiyear cross-sectional study examined the use of food as a reward in elementary schools and evaluated the association between district policies and school practices. School data were gathered during the 2007-2008, 2008-2009, and 2009-2010 school years via mail-back surveys (N=2,069) from respondents at nationally representative samples of US public elementary schools (1,525 unique schools, 544 of which also participated for a second year). During every year, the corresponding district policy for each school was gathered and coded for provisions pertaining to the use of food as a reward. School practices did not change over time and as of the 2009-2010 school year, respondents in 42.1% and 40.7% of schools, respectively, indicated that food was not used as a reward for academic performance or for good student behavior. In multivariate logistic regression analyses controlling for school characteristics and year, having a district policy that prohibited the use of food as a reward was significantly associated with school respondents reporting that food was not used as a reward for academic performance (P
  229. Author: Millstein RA, Yeh HC, Brancati FL, Batts-Turner M, Gary TL
    Title: Food availability, neighborhood socioeconomic status, and dietary patterns among blacks with type 2 diabetes mellitus.
    Journal: Medscape J Med. 11(1):15
    Date: 2009
    Abstract: CONTEXT: High diabetes prevalence among low-income and urban African American populations. OBJECTIVES & MAIN OUTCOME MEASURES: This study aimed to determine associations between neighborhood-level food sources and socioeconomic status (SES), and dietary patterns and body-mass index (BMI). The hypotheses were that the presence of food stores in neighborhoods would be associated with better dietary habits and BMI, and that the presence of convenience stores, and lower neighborhood SES, would be associated with poorer dietary habits and BMI. DESIGN, SETTING, & PATIENTS: Black adults (n = 132) with type 2 diabetes in Project Sugar 2 (Baltimore, Maryland) underwent the Ammerman dietary assessment: total dietary risk score and subscores for meat, dairy, starches, and added fat. Food source availability (food stores, convenience stores, other food stores, restaurants, and other food service places) and SES data from the 2000 US census at the tract-level were linked to individual-level data. Linear mixed-effects regression models with random intercepts were used to account for neighborhood clustering and for individual-level SES and potential confounders. RESULTS: The presence of restaurants and other food service places in census tracts were associated with better dietary patterns (adjusted added fat subscore beta = -1.1, 95% confidence interval [CI] = -1.8, -0.4, and beta = -1.0, 95% CI = -1.7, -0.3, respectively). The presence of convenience stores and lower neighborhood SES was not significantly associated with worse dietary patterns or body-mass index, although trends were in the hypothesized direction. CONCLUSIONS: These findings provide some evidence for structural improvements to food environments in urban and low-income black neighborhoods.
  230. Author: Burns CM, Gibbon P, Boak R, Baudinette S, Dunbar JA
    Title: Food cost and availability in a rural setting in Australia.
    Journal: Rural Remote Health. 4(4):311
    Date: 2004 Oct-Dec
    Abstract: INTRODUCTION: The burden of chronic diseases is rapidly increasing worldwide. In Australia rural populations have a greater burden of disease. Chronic diseases are largely preventable with diet as a key risk factor. With respect to diet-related chronic disease, dietary risk may be due to poor food access, namely, poor availability and/or the high cost of healthy food. It is likely that poor food access is an issue in rural areas. OBJECTIVE: To assess food access in rural south-west (SW) Victoria, Australia. METHODS: A total of 53 supermarkets and grocery stores in 42 towns participated in a survey of food cost and availability in the rural area of SW Victoria. The survey assessed availability and cost of a Healthy Food Access Basket (HFAB) which was designed to meet the nutritional needs of a family of 6 for 2 weeks. RESULTS: Seventy-two percent of the eligible shops in SW Victoria were surveyed. The study found that the complete HFAB was significantly more likely to be available in a town with a chain-owned store (p
  231. Author: Gartin M
    Title: Food deserts and nutritional risk in Paraguay.
    Journal: Am J Hum Biol. 24(3):296-301
    Date: 2012 May-Jun
    Abstract: OBJECTIVES: The purpose of this case study in San Lorenzo, Paraguay is to identify a food desert in a developing context and to test if food deserts shape residential obesity risk. This article reviews some of the debate surrounding whether food deserts really exist; and, if so, what are the dietary implications of living in a food desert. METHODS: The research is an exploratory/explanatory design. The author mapped the downtown food retail district and the neighborhood food environment to identify what stores/markets. The author assessed each type of food store using an adapted version of the Nutrition Environment Measure Survey for Stores (NEMS-S) for Paraguay. Body mass index and household characteristics were collected with 68 households in a small neighborhood; and, the author matched the NEMS-S scores to the store reported by households as their primary grocery store for regression tests. RESULTS: The results suggest that a tradeoff exists in the local food environment between food stores which negatively impact obesity risk for local residents. Exposure to this tradeoff appears to worsen as people live longer in the food desert. Thus, the results support the location of a food desert finding in Paraguay. CONCLUSIONS: The underlying factors of a food desert extend beyond food access to focus on the issues of justice. A way to improve upon future research to build scholarship on the relationship between deprivation and obesity requires that sample sizes are either large or representative of the population and that the research should be based on multiple neighborhood and city sites.
  232. Author: Rigby S, Leone AF, Kim H, Betterley C, Johnson MA, Kurtz H, Lee JS
    Title: Food deserts in Leon County, FL: disparate distribution of Supplemental Nutrition Assistance Program-accepting stores by neighborhood characteristics.
    Journal: J Nutr Educ Behav. 44(6):539-47
    Date: 2012 Nov-Dec
    Abstract: OBJECTIVE: Examine whether neighborhood characteristics of racial composition, income, and rurality were related to distribution of Supplemental Nutrition Assistance Program (SNAP)-accepting stores in Leon County, Florida. DESIGN: Cross-sectional; neighborhood and food store data collected in 2008. SETTING AND PARTICIPANTS: Forty-eight census tracts as proxy of neighborhoods in Leon County, Florida. All stores and SNAP-accepting stores were identified from a commercial business directory and a United States Department of Agriculture SNAP-accepting store list, respectively (n = 288). MAIN OUTCOME MEASURES: Proportion of SNAP-accepting stores across neighborhoods. ANALYSIS: Descriptive statistics to describe distribution of SNAP-accepting stores by neighborhood characteristics. Proportions of SNAP-accepting stores were compared by neighborhood characteristics with Wilcoxon-Mann-Whitney and Kruskal-Wallis tests. RESULTS: Of 288 available stores, 45.1% accepted SNAP benefits. Of the 48 neighborhoods, 16.7% had no SNAP-accepting stores. Proportions of SNAP-accepting grocery stores were significantly different by neighborhood racial composition and income. Primarily black neighborhoods did not have any supermarkets. Results were mixed with regard to distribution of food stores and SNAP-accepting stores by neighborhood racial composition, income, and rurality. CONCLUSIONS AND IMPLICATIONS: This study suggests disparities in distribution of SNAP-accepting stores across neighborhood characteristics of racial composition, income, and rurality.
  233. Author: Smoyer-Tomic KE, Spence JC, Amrhein C
    Title: Food deserts in the prairies? Supermarket accessibility and neighborhood need in Edmonton, Canada
    Journal: The professional geographer. 58(3):307-26
    Date: 2006
    Abstract: The U.S. and U.K. literatures have discussed "food deserts," reflecting populated, typically urban, low-income areas with limited access to full-service supermarkets. Less is known about supermarket accessibility within Canadian cities. This article uses the minimum distance and coverage methods to determine supermarket accessibility within the city of Edmonton, Canada, with a focus on high-need and inner-city neighborhoods. The results show that for 1999 both of these areas generally had higher accessibility than the remainder of the city, but six high-need neighborhoods had poor supermarket accessibility. We conclude by examining potential reasons for differences in supermarket accessibility between Canadian, U.S., and U.K. cities.
  234. Author: Short A, Guthman J, Raskin S
    Title: Food Deserts, Oases, or Mirages? Small Markets and Community Food Security in the Bay Area
    Journal: Journal of Planning Education and Research. 26(3):352-364
    Date: 2007
    Abstract: In light of claims that many low-income urban neighborhoods are "food deserts," this article reports on pilot research to assess whether and how small, full-service food retailers contribute to urban food security. It demonstrates that such stores meet many of the criteria for community food security by providing a wide variety of relatively low-cost foods. At the same time, their geographic unevenness, tendency to target particular ethnic clienteles, and inability to address affordability in an absolute sense place some caveats on the conclusions and suggest the need for more fine-grained research regarding how the unique economic development histories and cultural politics of neighborhoods affect food availability.
  235. Author: French SA, Story M, Fulkerson JA, Gerlach AF
    Title: Food environment in secondary schools: a la carte, vending machines, and food policies and practices.
    Journal: Am J Public Health. 93(7):1161-7
    Date: 2003 Jul
    Abstract: OBJECTIVES: This study described the food environment in 20 Minnesota secondary schools. METHODS: Data were collected on school food policies and the availability and nutritional content of foods in school à la carte (ALC) areas and vending machines (VMs). RESULTS: Approximately 36% and 35% of foods in ALC areas and in VMs, respectively, met the lower-fat criterion (
  236. Author: Nelson MC, Story M
    Title: Food environments in university dorms: 20,000 calories per dorm room and counting.
    Journal: Am J Prev Med. 36(6):523-6
    Date: 2009 Jun
    Abstract: BACKGROUND: Few young adults meet national dietary recommendations. Although home food availability likely has important influences on dietary intake, little research has examined this issue among young adults. The objective of this research was to conduct a detailed, observational assessment of food and beverages available in college-student dormitory rooms. METHODS: Dormitory-residing students (n=100) were recruited from a large, public university. Research staff completed a detailed inventory of food and beverages in the dorm rooms, including nutrient contents and purchasing sources. Data were collected and analyzed in 2008. RESULTS: The mean number of food and beverage items per participant was 47 (range: 0-208), with 4% of participants not having any food or beverages. More than 70% of students had each of the following types of items: salty snacks, cereal or granola bars, main dishes, desserts or candy, and sugar-sweetened beverages. Fewer students had low-calorie beverages, fruits and vegetables, dairy products, tea/coffee, and 100% fruit/vegetable juice. The average number of calories per dorm room was 22,888. Items purchased by parents had a higher calorie and fat content than items purchased by students. CONCLUSIONS: Findings indicate that students maintain a wide array of food and beverages in their dormitory rooms. Parents purchased a substantial amount of food for their children's dormitory rooms, and these food items were less healthful than the food that students purchased. The foods observed in college students' living spaces may have an important impact on eating habits. Overall, young adult-oriented obesity prevention efforts are needed, and improving the various facets of campus food environments may mark an important component of such strategies.
  237. Author: Babey SH, Wolstein J, Diamant AL
    Title: Food environments near home and school related to consumption of soda and fast food.
    Journal: Policy Brief UCLA Cent Health Policy Res
    Date: 2011 Jul
    Abstract: In California, more than 2 million adolescents (58%) drink soda or other sugar-sweetened beverages every day, and more than 1.6 million adolescents (46%) eat fast food at least twice a week. Adolescents who live and go to school in areas with more fast food restaurants and convenience stores than healthier food outlets such as grocery stores are more likely to consume soda and fast food than teens who live and go to school in areas with healthier food environments. State and local policy efforts to improve the retail food environment may be effective in improving adolescents' dietary behaviors.
  238. Author: Dennisuk LA, Coutinho AJ, Suratkar S, Surkan PJ, Christiansen K, Riley M, Anliker JA, Sharma S, Gittelsohn J
    Title: Food expenditures and food purchasing among low-income, urban, African-American youth.
    Journal: Am J Prev Med. 40(6):625-8
    Date: 2011 Jun
    Abstract: BACKGROUND: Low-income, urban African-American youth are at higher risk for obesity and less likely to meet dietary recommendations than white, higher-income youth. Patterns of food purchasing among youth likely contribute to these disparities, but little published information is available. PURPOSE: To investigate food purchasing behaviors of low-income, urban African-American youth. METHODS: A total of 242 African-American youth, aged 10-14 years, were recruited from 14 recreation centers in low-income, predominantly African-American neighborhoods in Baltimore MD. Youth reported the amount of money typically spent on food, the source of this money, the place of purchase, and frequency of purchase for 29 foods and beverages. Data were collected in 2008-2009 and analyzed in 2009-2010. RESULTS: Youth reported spending an average of $3.96 on foods and beverages in a typical day. Corner stores were the most frequently visited food source (youth made purchases at these stores an average of 2.0 times per week). Chips, candy, and soda were the most commonly purchased items, with youth purchasing these an average of 2.5, 1.8, and 1.4 times per week, respectively. Older age was associated with more money spent on food in a typical day (p
  239. Author: Kaiser LL, Melgar-Quiñonez H, Townsend MS, Nicholson Y, Fujii ML, Martin AC, Lamp CL
    Title: Food insecurity and food supplies in Latino households with young children.
    Journal: J Nutr Educ Behav. 35(3):148-53
    Date: 2003 May-Jun
    Abstract: OBJECTIVE: To examine the relationship between food insecurity and food supplies in Latino households. DESIGN: Cross-sectional survey, conducted February to May 2001. SETTING: Six California counties. PARTICIPANTS: Convenience sampling was used to recruit 274 low-income Latino families with preschool children from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Head Start, and other community-based organizations. Complete data were available for 256 families. Variables Measured: Food security, household food scores. ANALYSIS: Pearson correlations, Kruskal-Wallis test, and logistics regression. Significance level at P <.05. results:="" controlling="" for="" maternal="" education="" food="" insecurity="" over="" the="" past="" months="" was="" associated="" with="" lower="" household="" supplies:="" dairy="" r="-.18," p="" fruit="" grains="" meats="" snack="" foods="" and="" vegetables="" conclusions="" implications:="" in="" latino="" households="" greater="" is="" a="" variety="" of="" most="" particularly="" fruits="" vegetables.="" future="" research="" should="" explore="" effects="" seasonal="" shortages="" on="" intake="" individual="" members="" especially="" young="" children.="">
  240. Author: Hackett M, Zubieta AC, Hernandez K, Melgar-Quiñonez H
    Title: Food insecurity and household food supplies in rural Ecuador.
    Journal: Arch Latinoam Nutr. 57(1):10-7
    Date: 2007 Mar
    Abstract: The objective of this research is to assess the validity of a modified US Household Food Security Survey Module (HFSSM) through its correlation with food supply and demographic factors, and its fitness using Rasch model analysis in rural Ecuador. This study examines the relationship between household food insecurity and household food supplies in 52 Ecuadorian households. The sample was drawn from four rural communities participating in the project PLAN in Cantón Quijos. Questionnaires included a modified HFSSM, a household food shelf-inventory and demographic characteristics. Multiple ANOVA analysis resulted in statistically significant inverse relationships between household food insecurity and total food supply, as well as the supply of meat, vegetables, legumes, oils, and other food products (p=0.05). Rasch model measure values on the HFSSM illustrated food insecurity at different levels of severity. The majority of the items (>75%) presented adequate infit values. This study affirms that the proposed modified HFSSM may be useful to measure food insecurity and thus be used as a tool to monitor and evaluate programs aimed at improving quantity and variety of food items in rural Ecuador.
  241. Author: Ollberding NJ, Nigg CR, Geller KS, Horwath CC, Motl RW, Dishman RK
    Title: Food outlet accessibility and fruit and vegetable consumption.
    Journal: Am J Health Promot. 26(6):366-70
    Date: 2012 Jul-Aug
    Abstract: PURPOSE: To examine if spatial access to healthy and unhealthy outlets comprising the local food environment was associated with fruit and vegetable consumption. DESIGN: Cross-sectional. SETTING: Population-based sample residing in Hawaii. Subjects . Three hundred and eighty-four adults (36% Asian-American, 33% non-Hispanic white, 31% other/mixed race). MEASURES: A spatial model of the local food environment was constructed using radial buffers extending from participants' place of residence. Fruit and vegetable intake was estimated using the National Cancer Institute Fruit and Vegetable All-Day Screener. ANALYSIS: Mean intakes of fruits and vegetables were compared for spatial access to total, healthy, and unhealthy food outlets at distances of .5 to 3.5 km. Multiple linear regression was used to estimate differences in fruit and vegetable intake for residing further from a food outlet or for residing in an area with a greater number of food outlets. RESULTS: Residing in an area with a greater density of total or healthy food outlets was associated with a higher mean intake of fruits and vegetables (p
  242. Author: Fraser LK, Edwards KL, Tominitz M, Clarke GP, Hill AJ
    Title: Food outlet availability, deprivation and obesity in a multi-ethnic sample of pregnant women in Bradford, UK.
    Journal: Soc Sci Med. 75(6):1048-56
    Date: 2012 Sep
    Abstract: The obesogenic environment model would suggest that increased availability or access to energy dense foods which are high in saturated fat may be related to obesity. The association between food outlet location, deprivation, weight status and ethnicity was analysed using individual level data on a sample of 1198 pregnant women in the UK Born in Bradford cohort using geographic information systems (GIS) methodology. In the non South Asian group 24% were obese as were 17% of the South Asian group (BMI > 30). Food outlet identification methods revealed 886 outlets that were allocated into 5 categories of food shops. More than 95% of all participants lived within 500 m of a fast food outlet. Women in higher areas of deprivation had greater access to fast food outlets and to other forms of food shops. Contrary to hypotheses, there was a negative association between BMI and fast food outlet density in close (250 m) proximity in the South Asian group. Overall, these women had greater access to all food stores including fast food outlets compared to the non South Asian group. The stronger association between area level deprivation and fast food density than with area level deprivation and obesity argues for more detailed accounts of the obesogenic environment that include measures of individual behaviour.
  243. Author: Powell LM, Bao Y
    Title: Food prices, access to food outlets and child weight.
    Journal: Econ Hum Biol. 7(1):64-72
    Date: 2009 Mar
    Abstract: This study examines the importance of food prices and restaurant and food store outlet availability for child body mass index (BMI). We use the 1998, 2000 and 2002 waves of the child-mother merged files from the 1979 cohort of the National Longitudinal Survey of Youth combined with fruit and vegetable and fast food price data obtained from the American Chamber of Commerce Researchers Association and outlet density data on fast food and full-service restaurants and supermarkets, grocery stores and convenience stores obtained from Dun & Bradstreet. Using a random effects estimation model, we found that a 10% increase in the price of fruits and vegetables was associated with a 0.7% increase in child BMI. Fast food prices were not found to be statistically significant in the full sample but were weakly negatively associated with BMI among adolescents with an estimated price elasticity of -0.12. The price estimates were robust to whether we controlled for outlet availability based on a per capita or per land area basis; however, the association between food outlets and child BMI differed depending on the definition. The associations of fruit and vegetable and fast food prices with BMI were significantly stronger both economically and statistically among low- versus high-socioeconomic status children. The estimated fruit and vegetable and fast food price elasticities were 0.14 and -0.26, respectively, among low-income children and 0.09 and -0.13, respectively, among children with less educated mothers.
  244. Author: Powell LM, Zhao Z, Wang Y
    Title: Food prices and fruit and vegetable consumption among young American adults.
    Journal: Health Place. 15(4):1064-70
    Date: 2009 Dec
    Abstract: Multivariate negative binomial count models were estimated to examine associations between young adults' fruit and vegetable (FV) consumption and the prices of FV, other food at home grocery items, and fast food and the availability of restaurants and food stores. This study used the 2002 wave of data collected from US young adults aged 18-23 years in the 1997 National Longitudinal Survey of Youth merged by geocode identifiers with food prices and restaurant and food store availability. The results showed that higher levels of FV consumption were associated with lower FV prices (price elasticity of -0.32) and that this own-price effect was robust to the inclusion of other food prices and food outlet availability. Lower income and lower educated young adults and those with lower educated mothers and middle-income parents were found to be most price sensitive. No statistically significant cross-price effects on FV consumption were found with other grocery food (meat, dairy and bread) prices or fast food prices. Fiscal policy instruments such as FV subsidies may help to increase FV intake, particularly among young adults of lower socioeconomic status.
  245. Author: Beydoun MA, Powell LM, Chen X, Wang Y
    Title: Food prices are associated with dietary quality, fast food consumption, and body mass index among U.S. children and adolescents.
    Journal: J Nutr. 141(2):304-11
    Date: 2011 Feb
    Abstract: Food prices are expected to affect dietary intakes, however, previous findings are mixed and few are based on nationally representative data. We examined the associations of price indices of fast foods (FF-PI) and fruits and vegetables (FV-PI) with dietary intakes and BMI among U.S. children and adolescents using data from the Continuing Survey of Food Intakes by Individuals (CSFII; 1994-1998) for 6759 children (2-9 y) and 1679 adolescents (10-18 y). FF-PI and FV-PI were linked to individuals' CSFII dietary data through city-level geocodes. Main outcomes included intakes of selected nutrients and food groups, a fast food consumption index (FF-CI), diet quality using the 2005 Healthy Eating Index (HEI), and BMI. Among children (2-9 y), a higher FF-PI (by $1) was associated with intakes of lower FF-CI (β ± SE: -0.9 ± 0.3 count/d), higher HEI (6.6 ± 2.5), higher intakes of fiber (2.7 ± 0.7 g/d), calcium (225.7 ± 52.3 mg/d), dairy (172.5 ± 36.2 g/d), and fruits and vegetables (113.3 ± 23.4 cup equivalents/d). FV-PI was inversely related to fiber intake (β ± SE: -3.3 ± 1.5 g/d) and positively associated with BMI (4.3 ± 1.2 kg/m(2)). Less consistent findings were ascribed to FV-PI and among adolescents (10-18 y). Significant associations were almost equally balanced between low and high family income groups, with some significant interactions between food prices and family income observed, particularly among children (2-9 y). Our findings suggest that among U.S. children aged 2-9 y, higher FF-PI is associated with better dietary quality, whereas higher FV-PI is linked to higher BMI and lower fiber intake. Associations varied by family income in children for many dietary intake variables.
  246. Author: Guy C, Clarke G, Eyre H
    Title: Food retail change and the growth of food deserts: a case study of Cardiff
    Journal: International journal of retail & distribution management. 32(2):72-88
    Date: 2004
    Abstract: "Food deserts" in British cities are partly the result of the expansion of multiple food retailing. New large stores force smaller stores to close down, thus depriving local residents of food shopping opportunities. Examines this proposition through an analysis of changes in consumer access to food shopping in Cardiff over the last 20 years. Shows that although accessibility scores have increased in Cardiff since 1980 they have increased at a faster rate in higher income areas. In a pocket of deprived areas accessibility has declined over the decade. Thus, there has been a polarisation effect with a widening gap in accessibility scores across the city.
  247. Author: Morris PM, Neuhauser L, Campbell C
    Title: Food security in rural america: a study of the availability and costs of food
    Journal: Journal of nutrition education. 24(1):52S-58S
    Date: 1992
    Abstract:
  248. Author: Wechsler H, Brener ND, Kuester S, Miller C
    Title: Food service and foods and beverages available at school: results from the School Health Policies and Programs Study 2000.
    Journal: J Sch Health. 71(7):313-24
    Date: 2001 Sep
    Abstract:
  249. Author: Rovner AJ, Nansel TR, Wang J, Iannotti RJ
    Title: Food sold in school vending machines is associated with overall student dietary intake.
    Journal: J Adolesc Health. 48(1):13-9
    Date: 2011 Jan
    Abstract: PURPOSE: To examine the association between food sold in school vending machines and the dietary behaviors of students. METHODS: The 2005-2006 U.S. Health Behavior in School-aged Children survey was administered to 6th to 10th graders and school administrators. Dietary intake in students was estimated with a brief food frequency measure. School administrators completed questions regarding food sold in vending machines. For each food intake behavior, a multilevel regression analysis modeled students (level 1) nested within schools (level 2), with the corresponding food sold in vending machines as the main predictor. Control variables included gender, grade, family affluence, and school poverty index. Analyses were conducted separately for 6th to 8th and 9th-10th grades. RESULTS: In all, 83% of the schools (152 schools; 5,930 students) had vending machines that primarily sold food of minimal nutritional values (soft drinks, chips, and sweets). In younger grades, availability of fruit and/or vegetables and chocolate and/or sweets was positively related to the corresponding food intake, with vending machine content and school poverty index providing an explanation for 70.6% of between-school variation in fruit and/or vegetable consumption and 71.7% in sweets consumption. Among the older grades, there was no significant effect of food available in vending machines on reported consumption of those food. CONCLUSION: Vending machines are widely available in public schools in the United States. In younger grades, school vending machines were either positively or negatively related to the diets of the students, depending on what was sold in them. Schools are in a powerful position to influence the diets of children; therefore, attention to the food sold at school is necessary to try to improve their diets.
  250. Author: Rose D, Richards R
    Title: Food store access and household fruit and vegetable use among participants in the US Food Stamp Program.
    Journal: Public Health Nutr. 7(8):1081-8
    Date: 2004 Dec
    Abstract: OBJECTIVE: Recent research on access to food among low-income populations in industrialised countries has begun to focus on neighbourhood food availability as a key determinant of dietary behaviour. This study examined the relationship between various measures of food store access and household fruit and vegetable use among participants in the Food Stamp Program, America's largest domestic food assistance programme. DESIGN: A secondary data analysis was conducted using the 1996-97 National Food Stamp Program Survey. The survey employed a 1-week food inventory method, including two at-home interviews, to determine household food use. Separate linear regression models were developed to analyse fruit and vegetable use. Independent variables included distance to store, travel time to store, ownership of a car and difficulty of supermarket access. All models controlled for a full set of socio-economic variables. SUBJECTS: A nationally representative sample of participants (n=963) in the Food Stamp Program. RESULTS: After controlling for confounding variables, easy access to supermarket shopping was associated with increased household use of fruits (84 grams per adult equivalent per day; 95% confidence interval 5, 162). Distance from home to food store was inversely associated with fruit use by households. Similar patterns were seen with vegetable use, though associations were not significant. CONCLUSIONS: Environmental factors are importantly related to dietary choice in a nationally representative sample of low-income households, reinforcing the importance of including such factors in interventions that seek to effect dietary improvements.
  251. Author: Powell LM, Slater S, Mirtcheva D, Bao Y, Chaloupka FJ
    Title: Food store availability and neighborhood characteristics in the United States.
    Journal: Prev Med. 44(3):189-95
    Date: 2007 Mar
    Abstract: OBJECTIVE: This study provides a multivariate analysis of the availability of food store outlets in the US and associations with neighborhood characteristics on race, ethnicity and socioeconomic status (SES). METHOD: Commercial food store outlet data are linked across 28,050 zip codes to Census 2000 data. Multivariate regression analyses are used to examine associations between the availability of chain supermarkets, non-chain supermarkets, grocery stores and convenience stores and neighborhood characteristics on race, ethnicity and SES including additional controls for population size, urbanization and region. RESULTS: Low-income neighborhoods have fewer chain supermarkets with only 75% (p
  252. Author: Gustafson AA, Sharkey J, Samuel-Hodge CD, Jones-Smith JC, Cai J, Ammerman AS
    Title: Food Store Environment Modifies Intervention Effect on Fruit and Vegetable Intake among Low-Income Women in North Carolina.
    Journal: J Nutr Metab
    Date: 2012
    Abstract: Background. The aim of the study is to determine how the food store environment modifies the effects of an intervention on diet among low-income women. Study Design. A 16-week face-to-face behavioral weight loss intervention was delivered among low income midlife women. Methods. The retail food environment for all women was characterized by (1) the number and type of food stores within census tracts; (2) availability of healthy foods in stores where participants shop; (3) an aggregate score of self-reported availability of healthy foods in neighborhood and food stores. Statistical Analyses. Multivariable linear regression was used to model the food store environment as an effect modifier between the intervention effect of fruit and vegetable serving change. Results. Among intervention participants with a low perception of availability of healthy foods in stores, the intervention effect on fruit and vegetable serving change was greater [1.89, 95% CI (0.48, 3.31)] compared to controls. Among intervention participants residing in neighborhoods with few super markets, the intervention effect on fruit and vegetable serving change was greater [1.62, 95% CI (1.27, 1.96)] compared to controls. Conclusion. Results point to how the food store environment may modify the success of an intervention on diet change among low-income women.
  253. Author: Liese AD, Weis KE, Pluto D, Smith E, Lawson A
    Title: Food store types, availability, and cost of foods in a rural environment.
    Journal: J Am Diet Assoc. 107(11):1916-23
    Date: 2007 Nov
    Abstract: OBJECTIVE: To characterize the built nutritional environment in terms of types and number of food stores, availability, and cost of selected food items in a rural area. DESIGN: A cross-sectional survey of food stores conducted in 2004. SUBJECTS/SETTING: We selected a rural county (population 91,582; 1,106 square miles). Food stores identified from a database were mapped and presence, location, and store type verified by ground-truthing. Stores were surveyed for availability and cost of selected foods. MAIN OUTCOME MEASURES: Price and availability of a limited number of staple foods representing the main food groups. STATISTICAL ANALYSES PERFORMED: Availability comparisons used least square means models and price comparisons used t tests. RESULTS: Of 77 stores identified, 16% were supermarkets, 10% grocery stores, and 74% convenience stores. There were seven stores per 100 square miles and eight stores per 10,000 residents. Availability of more healthful foods was substantially higher at supermarkets and grocery stores. For instance, low-fat/nonfat milk, apples, high-fiber bread, eggs, and smoked turkey were available in 75% to 100% of supermarkets and groceries and at 4% to 29% of convenience stores. Foods that were available at both supermarkets and convenience stores tended to be substantially more expensive at convenience stores. The healthful version of a food was typically more expensive than the less healthful version. CONCLUSIONS: In this rural environment, stores offering more healthful and lower-cost food selections were outnumbered by convenience stores offering lower availability of more healthful foods. Our findings underscore the challenges of shopping for healthful and inexpensive foods in rural areas.
  254. Author: Connell CL, Yadrick MK, Simpson P, Gossett J, McGee BB, Bogle ML
    Title: Food supply adequacy in the Lower Mississippi Delta.
    Journal: J Nutr Educ Behav. 39(2):77-83
    Date: 2007 Mar-Apr
    Abstract: OBJECTIVE: To assess food supply adequacy within 3 food store types in the Lower Mississippi Delta. DESIGN: Regional food store survey to determine availability and quality of 102 food items in 62 supermarkets, 77 small/medium stores, and 86 convenience stores. SETTING: Lower Mississippi Delta region of the United States. PARTICIPANTS: 225 food stores in 18 counties. MAIN OUTCOME MEASURES: Percentage of Thrifty Food Plan (TFP) food items available and quality ratings of 6 food sections across store types. RESULTS: On average, supermarkets carried 96% of the items that compose the TFP. Mean percentage of TFP carried in small/medium stores was 50%. Convenience stores carried 28% of the TFP items. Supermarkets had higher overall quality ratings and quality ratings for fresh and frozen foods compared to small/medium and convenience stores (P<.01 implications="" for="" research="" and="" practice:="" although="" supermarkets="" carried="" a="" large="" percentage="" of="" items="" surveyed="" the="" number="" in="" this="" region="" is="" limited.="" community="" residents="" with="" limited="" transportation="" to="" reach="" may="" experience="" food="" supply="" adequacy.="" therefore="" community-based="" nutrition="" interventions="" should="" include="" partnerships="" small="" retailers="" while="" trying="" impact="" choices="" within="" those="" stores.="">
  255. Author: Franzen L, Smith C
    Title: Food system access, shopping behavior, and influences on purchasing groceries in adult Hmong living in Minnesota.
    Journal: Am J Health Promot. 24(6):396-409
    Date: 2010 Jul-Aug
    Abstract: PURPOSE: To investigate influences on shopping and eating behavior of Hmong adults living in St. Paul/Minneapolis, Minnesota. DESIGN AND SETTING: Conducted a mapping project, food surveys, food frequency questionnaire (FFQ), and focus groups (n = 11). SUBJECTS: Subjects were assigned to three groups. The B-TL(1) group was made up of subjects who were born in Thailand/Laos and had lived in the US 5 years (n = 20). The B-US group was made up of subjects who were born and/or raised in the US (n = 30). METHODS: Using Geographical Informational Systems software, 15 grocery stores were mapped and surveyed. Food prices were compared with the consumer price index (CPI). The FFQ assessed food consumption patterns. Focus group transcripts were evaluated for themes and coded. Degree of acculturation was assessed by adapting a previously developed instrument. RESULTS: The population is concentrated in St. Paul, coinciding with store density. Limited foods had CPIs and some CPIs were outdated. B-US had significantly higher levels of dietary acculturation than B-TL(2) and B-TL(1), with B-TL(2) also having a higher dietary acculturation level compared with B-TL(1). Acculturation of the Hmong into the American food system, determinants of store type, and Hmong food's having a mainstream factor were identified themes. CONCLUSIONS: B-US and B-TL(2) shopped at American stores more than did B-TL(1) because of convenience, one-stop shopping, and increased English fluency. Hmong foods have entered the American food system and are sold at Asian and American stores.
  256. Author: Kubik MY, Lytle LA, Hannan PJ, Story M, Perry CL
    Title: Food-related beliefs, eating behavior, and classroom food practices of middle school teachers.
    Journal: J Sch Health. 72(8):339-45
    Date: 2002 Oct
    Abstract: This study examined classroom food practices and eating behavior of middle school teachers from 16 schools in a metropolitan area, located in the upper Midwest. In winter 1999-2000, teachers in sixth, seventh, and eighth grade were surveyed (response rate = 70%; n = 490/701). Questions addressed teachers' classroom food practices, eating behavior while at school, personal health, and attitudes about the school food environment. Use of food as an incentive/reward for students was a common classroom practice in middle schools, and most foods did not support development of health eating patterns by young adolescents. Candy was the most frequently used food item, reported by 73% of teachers, followed by cookies/doughnuts (37%), sweetened drinks (35%), and pizza (28%). Many middle school teachers did not role model healthy eating behavior at school. Prevalent use of vending was a particular concern, with beverage and snack vending use reported by 62% and 35% of teachers, respectively. Most vending items purchased were sweetened drinks (57%) and high-fat or high-sugar snacks (85%). Low perceived personal health, high-fat scores, and low support for the school food environment were some of the significant correlates of teachers' eating behavior. School and health professionals should continue to advocate for schoolwide policies and programs that support students and teachers if the goal of an integrated healthy school food environment is to be realized.
  257. Author: Ohri-Vachaspati P, Turner L, Chaloupka FJ
    Title: Fresh Fruit and Vegetable Program participation in elementary schools in the United States and availability of fruits and vegetables in school lunch meals.
    Journal: J Acad Nutr Diet. 112(6):921-6
    Date: 2012 Jun
    Abstract: Dietary intake among children in the United States falls short of national recommendations. Schools can play an important role in improving children's preferences and food consumption patterns. The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) aims to improve children's nutrient intake patterns by offering fresh fruits and vegetables as snacks outside the reimbursable meals programs in elementary schools that serve large numbers of low-income children. Using a nationally representative sample of public elementary schools, this cross-sectional study investigated FFVP participation patterns among schools by demographic and school characteristics. Further, the study investigated the association between FFVP participation and availability of fresh fruits, salads, and vegetables at lunch as reported by school administrators and foodservice staff. Data collected via a mail-back survey from 620 public elementary schools participating in the National School Lunch Program during 2009-2010 were analyzed. Almost 70% of the FFVP-participating schools had a majority of students (>50%) eligible for free and reduced-cost meals. Participating in US Department of Agriculture Team Nutrition Program and having a registered dietitian or a nutritionist on staff were significantly associated with FFVP participation. Based on the results from logistic regression analyses schools participating in the FFVP were significantly more likely (odds ratio 2.07; 95% CI 1.12 to 3.53) to serve fresh fruit during lunch meals. Slightly >25% of public elementary schools across the United States participated in the FFVP, and participation was associated with healthier food availability in school lunches.
  258. Author: Pearlman DN, Dowling E, Bayuk C, Cullinen K, Thacher AK
    Title: From concept to practice: using the School Health Index to create healthy school environments in Rhode Island elementary schools.
    Journal: Prev Chronic Dis
    Date: 2005 Nov
    Abstract: INTRODUCTION: The prevalence of childhood obesity is increasing, and schools are ideal places to support healthy eating and physical activity. In 2000, the Centers for Disease Control and Prevention (CDC) developed the School Health Index, a self-assessment and planning tool that helps schools evaluate and improve physical activity and nutrition programs and policies. Although many state education agencies, health departments, and individual schools have used the School Health Index, few systematic evaluations of the tool have been performed. We examined the physical activity and nutrition environments in Rhode Island's public elementary schools with high and low minority student enrollments and evaluated a school-based environmental and policy intervention that included implementation of the School Health Index. METHODS: As part of a CDC Division of Nutrition and Physical Activity cooperative agreement awarded to the Rhode Island Department of Health, we conducted a needs assessment of 102 elementary schools and implemented an intervention in four inner-city elementary schools. In phase 1, we analyzed the Rhode Island Needs Assessment Tool (RINAT), a telephone survey of principals in approximately 50% of all Rhode Island public elementary schools in the state during the 2001-2002 school year (n = 102). Comparisons of the nutrition and physical activity environments of schools with low and high minority enrollment were calculated by cross-tabulation with the chi-square test. In phase 2, we used process and outcome evaluation data to assess the use of the School Health Index in creating healthier environments in schools. Our intervention--Eat Healthy and Get Active!--involved implementing three of the eight School Health Index modules in four Rhode Island elementary schools. RESULTS: Survey data revealed that schools with high minority enrollment (student enrollment of > or =10% black, > or =25% Hispanic, or both) offered few programs supporting healthy eating and physical activity (P
  259. Author: Cerin E, Frank LD, Sallis JF, Saelens BE, Conway TL, Chapman JE, Glanz K
    Title: From neighborhood design and food options to residents' weight status.
    Journal: Appetite. 56(3):693-703
    Date: 2011 Jun
    Abstract: This study examined associations of accessibility, availability, price, and quality of food choices and neighborhood urban design with weight status and utilitarian walking. To account for self-selection bias, data on adult residents of a middle-to-high-income neighborhood were used. Participants kept a 2-day activity/travel diary and self-reported socio-demographics, height, and weight. Geographic Information Systems data were used to objectively quantify walking-related aspects of urban design, and number of and distance to food outlets within respondents' 1km residential buffers. Food outlets were audited for availability, price, and quality of healthful food choices. Number of convenience stores and in-store healthful food choices were positively related to walking for errands which, in turn, was predictive of lower risk of being overweight/obese. Negative associations with overweight/obesity unexplained by walking were found for number of grocery stores and healthful food choices in sit-down restaurants. Aspects of urban form and food environment were associated with walking for eating purposes which, however, was not predictive of overweight/obesity. Access to diverse destinations, food outlets and healthful food choices may promote pedestrian activity and contribute to better weight regulation. Accessibility and availability of healthful food choices may lower the risk of overweight/obesity by providing opportunities for healthier dietary patterns.
  260. Author: Zenk SN, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML
    Title: Fruit and vegetable access differs by community racial composition and socioeconomic position in Detroit, Michigan.
    Journal: Ethn Dis. 16(1):275-80
    Date: 2006 Winter
    Abstract: OBJECTIVE: To compare the availability, selection, quality, and price of fresh fruit and vegetables at food stores in four Detroit-area communities: 1) predominately African-American, low socioeconomic position (SEP); 2) racially heterogeneous, low SEP; 3) predominately African-American, middle SEP; and 4) racially heterogeneous, middle SEP. DESIGN: Cross-sectional observational survey, conducted fall 2002. SETTING: Detroit, Michigan SAMPLE: Overall, 304 food stores located in the four communities were evaluated: chain grocery, large independent grocery, "mom-and-pop" grocery, specialty (meat, fruit and vegetable markets), convenience without gasoline, and liquor stores. MAIN OUTCOME MEASURES: Availability was indicated by whether a store carried fresh fruit or vegetables, selection was based on a count of 80 fruit and vegetables, quality was evaluated according to USDA guidelines for a subset of 20 fruit and vegetables, and price was assessed for 20 fruit and vegetables by using the lowest-cost method. RESULTS: Mean quality of fresh produce was significantly lower in the predominately African-American, low-SEP community than in the racially heterogeneous, middle-SEP community. Differences in the types of stores present only partially explained this quality differential. The predominately African-American, low-SEP community had more than four times more liquor stores and fewer grocery stores per 100,000 residents than the racially heterogeneous, middle-SEP community. Mean overall selection and price of fresh produce at stores did not differ among communities. CONCLUSIONS: Increasing access to high-quality fresh produce in low-income communities of color is a critical first step toward improving health through better dietary practices in this population.
  261. Author: Hendrickson D, Smith C, Eikenberry N
    Title: Fruit and vegetable access in four low-income food deserts communities in Minnesota
    Journal: Agriculture and human values. 23(3):371-83
    Date: 2006
    Abstract: Access to fruits and vegetables by low-income residents living in selected urban and rural Minnesotan communities was investigated. Communities were selected based on higher than state average poverty rates, limited access to grocery stores, and urban influence codes (USDA ERS codes). Four communities, two urban and two rural, were selected. Data were gathered from focus group discussions (n = 41), responses to a consumer survey (n = 396 in urban neighborhoods and n = 400 in rural communities), and an inventory of foodstuffs available at stores located in all the communities and at large grocery stores in neighborhoods adjacent to the urban communities. In the two urban neighborhoods, a significant number of foods (26% and 52%) were significantly more expensive than the Thrifty Food Plan's (TFP) market basket price (MBP). Additionally, a significant number of foods in the two rural communities were more expensive (11% and 26%). In focus groups, participants identified major barriers to shopping in their community to be cost, quality of food, and food choice limitations. Results of the food inventory show that foods within the communities were costly, of fair or poor quality, and limited in number and type available, supporting complaints verbalized by focus group participants. Through focus groups and surveys, participants expressed concern that healthy food choices were not affordable within their communities and believed that people in their community suffered from food insecurity. The absence of quality, affordable food for low-income residents in these four Minnesota communities prevents or diminishes their ability to choose foods that help maintain a healthy lifestyle.
  262. Author: Zenk SN, Schulz AJ, Hollis-Neely T, Campbell RT, Holmes N, Watkins G, Nwankwo R, Odoms-Young A
    Title: Fruit and vegetable intake in African Americans income and store characteristics.
    Journal: Am J Prev Med. 29(1):1-9
    Date: 2005 Jul
    Abstract: BACKGROUND: The purpose of this study was to examine whether the characteristics of retail food stores where African-American women shopped mediated the association between their income and intake of fruits and vegetables. Food store characteristics included store type (supermarket, specialty store, limited assortment store, independent grocer), store location (suburbs, city of Detroit), and perceptions of the selection/quality and affordability of fresh produce for sale. METHODS: The analysis drew upon data from a probability sample of 266 African-American women living in 2001 in eastside Detroit, which had no supermarkets. Structural equation modeling was used to calculate a path model of direct and indirect effects. RESULTS: Women shopping at supermarkets and specialty stores consumed fruit and vegetables more often, on average, than those shopping at independent grocers. More positive perceptions of the selection/quality, but not affordability, of fresh produce at the retail outlet where they shopped was positively associated with intake, independent of store type and location as well as age, per capita income, and years of education. The results suggested an indirect association between income and fruit and vegetable intake; women with higher per capita incomes were more likely to shop at supermarkets than at other grocers, which in turn was associated with intake. CONCLUSIONS: Previous studies have shown that few supermarkets are located in the city of Detroit, a symptom of economic divestment over the past several decades. Results of this study suggest this may have negative implications for dietary quality, particularly among lower-income women.
  263. Author: Ard JD, Perumean-Chaney S, Desmond R, Sutton B, Cox TL, Butsch WS, Allison DB, Franklin F, Baskin ML
    Title: Fruit and vegetable pricing by demographic factors in the Birmingham, Alabama, metropolitan area, 2004-2005.
    Journal: Prev Chronic Dis. 7(4):A78
    Date: 2010 Jul
    Abstract: INTRODUCTION: Fruit and vegetable cost may influence consumption. Because the contextual environment influences food outlet type and availability, we wanted to determine whether neighborhood demographics were associated with prices of fruits and vegetables. METHODS: We surveyed 44 grocery stores in the Birmingham, Alabama, metropolitan area to determine prices of 20 fruits and vegetables. Stores were geocoded and linked to the corresponding Census 2000 block group to obtain data for the independent variables - percentage African American, percentage with at least a high school diploma, and percentage of households below the poverty level. We conducted multiple linear regressions to estimate these predictors for each fruit and vegetable's mean price per serving during 2 seasons (fall/winter 2004, spring/summer 2005). RESULTS: In the fall, we found no significant relationships between the predictors and prices of any fruits and vegetables in the survey. In the spring, the percentage who had at least a high school diploma was a predictor of price per serving for potatoes (beta = 0.001, P = .046). CONCLUSION: Neighborhood demographics have little consistent influence on fruit and vegetable prices in Birmingham, Alabama, which may be a function of grocery store density, transportation patterns, and shopping patterns. The regional setting of the food environment has implications for food availability, variety, and price.
  264. Author: Reid M, MacArthur S, Stirling C, Clarke I, Birtwistle G
    Title: Fruit and vegetable retailing and consumption in two disparate neighbourhoods
    Journal: Nutrition bulletin. 22(3):167-77
    Date: 1997
    Abstract:
  265. Author: Jaeger SR, Bava CM
    Title: Fruit consumption among people living in a high deprivation New Zealand neighbourhood.
    Journal: Aust N Z J Public Health. 33(5):471-6
    Date: 2009 Oct
    Abstract: OBJECTIVE: To investigate fruit consumption in a high deprivation population in New Zealand. METHOD: In 2007, 99 door-to-door interviews were conducted in a high deprivation neighbourhood in Auckland with a focus on measuring self-reported fruit consumption. RESULTS: On average, participants reported eating a serving of fresh fruit five to six times per week. At the time of the interview, more than a third of participants (38%) did not have any fresh fruit in the house and 60% of respondents reported that in the past month they had thrown out fruit between one to four times per week because it was considered to be past its best in terms of eating quality. Fruit juice was consumed on average one to two times per week. Self-efficacy for fruit consumption was positively associated with consumption. Relative to participants with lower levels of self-efficacy for fruit consumption, those with higher levels of self-efficacy were more likely to achieve the target of consuming two or more servings of fruit daily. CONCLUSION: Strategies that aim to increase self-efficacy beliefs for fruit consumption may contribute to improving compliance with the recommended two or more servings daily. Together with strategies that give consideration to the social and cultural context and community level interventions (involving schools, churches and local community groups) they represent a holistic approach that is likely to be necessary for improving fruit consumption in high deprivation populations.
  266. Author: Befort C, Kaur H, Nollen N, Sullivan DK, Nazir N, Choi WS, Hornberger L, Ahluwalia JS
    Title: Fruit, vegetable, and fat intake among non-Hispanic black and non-Hispanic white adolescents: associations with home availability and food consumption settings.
    Journal: J Am Diet Assoc. 106(3):367-73
    Date: 2006 Mar
    Abstract: OBJECTIVE: This study sought to explore home food availability and common settings of food consumption as correlates of fruit, vegetable, and fat intake among a sample of non-Hispanic black and non-Hispanic white adolescents. PARTICIPANTS AND DESIGN: Adolescents (n=144 black, 84 white) and their parents completed a cross-sectional survey in an urban adolescent health clinic. The adolescent survey included screening measures for fruit, vegetable, and fat intake and items on frequency of eating meals with family, while watching television, and at three types of restaurants. Parents provided information on home availability of foods. MAIN OUTCOMES: Correlates of fruit, vegetable, and fat consumption. STATISTICAL ANALYSIS: Spearman correlations for associations among variables, t tests for mean comparisons, and multiple stepwise regression conducted separately for black and white adolescents. RESULTS: In multiple regression, home availability was not significantly associated with fruit, vegetable, or fat intake except for fruit intake among white adolescents only. Use of non-fast-food restaurants was the strongest positive predictor of vegetable intake. For both black and white adolescents, fast-food and buffet restaurant use and eating while watching television were the strongest predictors of fat intake. CONCLUSIONS: Compared with restaurant use and eating while watching television, home availability had a relatively small impact on fruit, vegetable, and fat consumption for both black and white adolescents. Intervention programs on adolescent nutrition should target not just availability of healthful foods, but also ease of access, such as the preparation of fruits and vegetables so that they are flavorful and ready to eat.
  267. Author: Robinson-O'Brien R, Neumark-Sztainer D, Hannan PJ, Burgess-Champoux T, Haines J
    Title: Fruits and vegetables at home: child and parent perceptions.
    Journal: J Nutr Educ Behav. 41(5):360-4
    Date: 2009 Sep-Oct
    Abstract: OBJECTIVE: Examine child and parent perceptions of home food environment factors and associations with child fruit and vegetable (FV) intake. DESIGN: Research staff administered surveys to children during after-school sessions, and parents completed surveys by mail or over the phone. SETTING: Four urban elementary schools in St. Paul, Minnesota, serving primarily low-income populations. PARTICIPANTS: Seventy-three children (55 girls, 18 boys) and 1 parent/guardian per child participated in a theater-based intervention aimed at obesity prevention. MAIN OUTCOME MEASURES: Perceptions of home food environment factors (home FV availability, home FV accessibility; parental encouragement to eat FV; family meal frequency). ANALYSIS: Descriptive statistics and paired t tests. RESULTS: On average, child and parent perceptions of the home food environment were similar. When comparing child-parent dyad perceptions of home food environment, a moderate to high level of agreement (56%-86%) was found. Child report of home FV availability, home FV accessibility, parental encouragement to eat FV, and family meal frequency explained 26.7% of the variance in child FV intake, whereas parent report of these factors explained 4.9% of the variance. CONCLUSIONS AND IMPLICATIONS: It is important to understand both child and parent perceptions of the home food environment when developing interventions aimed at increasing child FV intake.
  268. Author: Simen-Kapeu A, Kuhle S, Veugelers PJ
    Title: Geographic differences in childhood overweight, physical activity, nutrition and neighbourhood facilities: implications for prevention.
    Journal: Can J Public Health. 101(2):128-32
    Date: 2010 Mar-Apr
    Abstract: BACKGROUND: Childhood overweight is a major public health concern. Whereas various studies have documented higher prevalence rates in rural areas compared to urban areas, little is known about what is causing these differences. We sought to identify the factors underlying the overweight differentials by examining physical activity and nutrition behaviours as well as neighbourhood characteristics of urban areas, towns and rural areas across Alberta. METHODS: In 2008, we surveyed 3,421 grade five students and their parents from 148 randomly selected schools. Students completed the Harvard Food Frequency Questionnaire, questions on physical activities, and had their height and weight measured. Parents completed questions on socioeconomic background, child's lifestyle, and neighbourhood perception. We applied multilevel regression methods to quantify the geographic differentials in physical activity, nutrition and neighbourhood facilities. RESULTS: The prevalence of overweight was 28.5% among Albertan grade five students, with 6.7% being obese. Among students attending schools in towns and rural areas, the prevalence of overweight (obesity) was 29.8% (7.9%) and 30.6% (8.0%), respectively. Compared with students attending urban schools, those attending schools in towns and rural areas reported more physical activity despite perceiving less access to playgrounds/parks and recreational programs (p
  269. Author: Baranowski T, Davis M, Resnicow K, Baranowski J, Doyle C, Lin LS, Smith M, Wang DT
    Title: Gimme 5 fruit, juice, and vegetables for fun and health: outcome evaluation.
    Journal: Health Educ Behav. 27(1):96-111
    Date: 2000 Feb
    Abstract: A theory-based multicomponent intervention (Gimme 5) was designed and implemented to impact fourth- and fifth-grade children's fruit, juice, and vegetable (FJV) consumption and related psychosocial variables. Gimme 5 was a randomized controlled intervention trial with school (n = 16 elementary) as unit of random assignment and analysis. Participants included the cohort of students who were in the third grade in the winter of 1994 and students who joined them in the fourth and fifth grades. The intervention included a curriculum, newsletters, videotapes, and point-of-purchase education. Evaluation included 7-day food records and psychosocial measures from students, telephone interviews with parents, and observational assessments. Favorable results were observed for consumption of FJV combined, FJV consumed at weekday lunch, eating FJV self-efficacy, social norms, asking behaviors, and knowledge. A theory-based school nutrition education program can help change children's FJV consumption and impact factors at home that predispose to FJV consumption, but changes were small, and their persistence is unknown.
  270. Author: Lucan SC, Maroko A, Shanker R, Jordan WB
    Title: Green Carts (mobile produce vendors) in the Bronx--optimally positioned to meet neighborhood fruit-and-vegetable needs?
    Journal: J Urban Health. 88(5):977-81
    Date: 2011 Oct
    Abstract: Poor access to fresh produce likely contributes to disparities in obesity and diet-related diseases in the Bronx. New York City's Green Cart program is a partial response to the problem. We evaluated this program (permitting street vendors to sell fresh produce) by canvassing the Bronx for carts, interviewing vendors, and analyzing their locations and food offerings. Green Carts were clustered in areas of probable high pedestrian traffic, covering only about 57% of needy areas by liberal estimates. Some carts sold outside allowed boundaries; a few sold sugary snacks. Vendor locations and their food offerings suggest possible areas for program improvement.
  271. Author: Liu GC, Wilson JS, Qi R, Ying J
    Title: Green neighborhoods, food retail and childhood overweight: differences by population density.
    Journal: Am J Health Promot. 21(4 Suppl):317-25
    Date: 2007 Mar-Apr
    Abstract: PURPOSE: This study examines relationships between overweight in children and two environmentalfactors--amount of vegetation surrounding a child's place of residence and proximity of the child's residence to various types of food retail locations. We hypothesize that living in greener neighborhoods, farther from fast food restaurants, and closer to supermarkets would be associated with lower risk of overweight. DESIGN: Cross-sectional study. SETTING: Network of primary care pediatric clinics in Marion County, Indiana. SUBJECTS: We acquired data for 7334 subjects, ages 3 to 18 years, presenting for routine well-child care. MEASURES: Neighborhood vegetation and proximity to food retail were calculated using geographic information systems for each subject using circular and network buffers. Child weight status was defined using body mass index percentiles. Analysis. We used cumulative logit models to examine associations between an index of overweight, neighborhood vegetation, and food retail environment. RESULTS: After controlling for individual socio-demographics and neighborhood socioeconomic status, measures of vegetation and food retail significantly predicted overweight in children. Increased neighborhood vegetation was associated with decreased risk for overweight, but only for subjects residing in higher population density regions. Increased distance between a subject's residence and the nearest large brand name supermarkets was associated with increased risk of overweight, but only for subjects residing in lower population density regions. CONCLUSIONS: This research suggests that aspects of the built environment are determinants of child weight status, ostensibly by influencing physical activity and dietary behaviors.
  272. Author: Krebs-Smith SM, Reedy J, Bosire C
    Title: Healthfulness of the U.S. food supply: little improvement despite decades of dietary guidance.
    Journal: Am J Prev Med. 38(5):472-7
    Date: 2010 May
    Abstract: BACKGROUND: Every 5 years for the past several decades, the USDHHS and the U.S. Department of Agriculture have issued and updated the Dietary Guidelines for Americans, which form the basis of federal nutrition policy and have shown remarkable consistency across various editions among the major themes. PURPOSE: This paper examines whether the U.S. food supply is sufficiently balanced to provide the recommended proportions of various foods and nutrients per the amount of energy, whether this balance has shifted over time, and which areas of the food supply may have changed more than others. METHODS: The Healthy Eating Index-2005 (HEI-2005) was used to measure the dietary quality of the U.S. food supply, from 1970 to 2007. Sources of data were the USDA's food availability data, loss-adjusted food availability data, and nutrient availability data, and the U.S. Salt Institute's data on salt sold for human consumption. RESULTS: Total HEI-2005 scores improved by about 10 points between 1970 and 2007, but they never achieved even 60 points on a scale from 0 to 100. Although meats and total grains were supplied generally in recommended proportions, total vegetables, total fruit, whole fruit, and milk were supplied in suboptimal proportions that changed very little over time. Saturated fat, sodium, and calories from solid fat, alcoholic beverages, and added sugars were supplied in varying degrees of unhealthy abundance over the years. Supplies of dark-green/orange vegetables and legumes and whole grains were entirely insufficient relative to recommendations, with virtually no change over time. CONCLUSIONS: Deliberate efforts on the part of policymakers, the agriculture sector, and the food industry are necessary to provide a supply of foods consistent with nutrition recommendations and to make healthy choices available to all.
  273. Author: Gorton D, Carter J, Cvjetan B, Ni Mhurchu C
    Title: Healthier vending machines in workplaces: both possible and effective.
    Journal: N Z Med J. 123(1311):43-52
    Date: 2010 Mar 19
    Abstract: AIM: To develop healthier vending guidelines and assess their effect on the nutrient content and sales of snack products sold through hospital vending machines, and on staff satisfaction. METHODS: Nutrition guidelines for healthier vending machine products were developed and implemented in 14 snack vending machines at two hospital sites in Auckland, New Zealand. The guidelines comprised threshold criteria for energy, saturated fat, sugar, and sodium content of vended foods. Sales data were collected prior to introduction of the guidelines (March-May 2007), and again post-introduction (March-May 2008). A food composition database was used to assess impact of the intervention on nutrient content of purchases. A staff survey was also conducted pre- and post-intervention to assess acceptability. RESULTS: Pre-intervention, 16% of staff used vending machines once a week or more, with little change post-intervention (15%). The guidelines resulted in a substantial reduction in the amount of energy (-24%), total fat (-32%), saturated fat (-41%), and total sugars (-30%) per 100 g product sold. Sales volumes were not affected, and the proportion of staff satisfied with vending machine products increased. CONCLUSIONS: Implementation of nutrition guidelines in hospital vending machines led to substantial improvements in nutrient content of vending products sold. Wider implementation of these guidelines is recommended.
  274. Author: Dannefer R, Williams DA, Baronberg S, Silver L
    Title: Healthy bodegas: increasing and promoting healthy foods at corner stores in New York City.
    Journal: Am J Public Health. 102(10):e27-31
    Date: 2012 Oct
    Abstract: OBJECTIVES: We assessed the effectiveness of an initiative to increase the stock and promotion of healthy foods in 55 corner stores in underserved neighborhoods. METHODS: We evaluated the intervention through in-store observations and preintervention and postintervention surveys of all 55 store owners as well as surveys with customers at a subset of stores. RESULTS: We observed an average of 4 changes on a 15-point criteria scale. The most common were placing refrigerated water at eye level, stocking canned fruit with no sugar added, offering a healthy sandwich, and identifying healthier items. Forty-six (84%) store owners completed both surveys. Owners reported increased sales of healthier items, but identified barriers including consumer demand and lack of space and refrigeration. The percentage of customers surveyed who purchased items for which we promoted a healthier option (low-sodium canned goods, low-fat milk, whole-grain bread, healthier snacks and sandwiches) increased from 5% to 16%. CONCLUSIONS: Corner stores are important vehicles for access to healthy foods. The approach described here achieved improvements in participating corner stores and in some consumer purchases and may be a useful model for other locales.
  275. Author: Cummins S, Findlay A, Petticrew M, Sparks L
    Title: Healthy cities: the impact of food retail-led regeneration on food access, choice and retail structure
    Journal: Built environment. 31(4):288-301
    Date: 2005
    Abstract: The health, social and planning policy agendas which have focused on the issue of food deserts, food access and food choice provide the context for this study of the outcomes of a large-scale food retail intervention in Springburn, Glasgow. An analysis of changing retail structure and foodscape health impacts on food provision, food choice and physical and economic accessibility is presented. This is set within the regeneration context of the Tesco St Rollox Partnership. Conclusions are reached on the potential for such schemes to deliver a range of diet, health, social, regeneration and planning policy goals.
  276. Author: Tester JM, Yen IH, Pallis LC, Laraia BA
    Title: Healthy food availability and participation in WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) in food stores around lower- and higher-income elementary schools.
    Journal: Public Health Nutr. 14(6):960-4
    Date: 2011 Jun
    Abstract: OBJECTIVE: The nutritional intake of schoolchildren is affected not only by what is consumed at school but also by what is available in food outlets near schools. The present study surveys the range of food outlets around schools and examines how the availability of healthy food in the food stores encountered varies by income status of the school and by store participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food assistance programme. DESIGN: Network buffer zones were created to reflect a quarter-mile (400 m) walk from elementary schools with lower- and higher-income student populations in Oakland, CA, USA. All food outlets within these zones were categorised by type, and audits were conducted within food stores using a checklist to assess for the presence or absence of twenty-eight healthy items (in five domains). SETTING: Mid-sized city in the USA. SUBJECTS: Food outlets near public elementary schools. RESULTS: There were considerably more food outlets around lower-income schools. Food stores near higher-income schools had higher scores in two of the five domains (healthy beverages/low-fat dairy and healthy snacks). However, there were more food stores near lower-income schools that accepted WIC vouchers. Stratification showed that WIC stores scored higher than non-WIC stores on four of the five domains. CONCLUSIONS: Although higher-income students have more access to healthy food in the environment surrounding their school, this disparity appears to be mitigated by stores that accept WIC and offer more healthy snacking options. Federal programmes such as this may be particularly valuable for children in lower-income areas.
  277. Author: Casagrande SS, Franco M, Gittelsohn J, Zonderman AB, Evans MK, Fanelli Kuczmarski M, Gary-Webb TL
    Title: Healthy food availability and the association with BMI in Baltimore, Maryland.
    Journal: Public Health Nutr. 14(6):1001-7
    Date: 2011 Jun
    Abstract: OBJECTIVE: To study the association between the availability of healthy foods and BMI by neighbourhood race and socio-economic status (SES). DESIGN: Trained staff collected demographic information, height, weight and 24 h dietary recalls between 2004 and 2008. Healthy food availability was determined in thirty-four census tracts of varying racial and SES composition using the Nutrition Environment Measures Survey-Stores in 2007. Multilevel linear regression was used to estimate associations between healthy food availability and BMI. SETTING: Baltimore City, Maryland, USA. SUBJECTS: Adults aged 30-64 years (n 2616) who participated in the Healthy Aging in Neighborhoods of Diversity across the Life Span study. RESULTS: Among individuals living in predominantly white neighbourhoods, high availability of healthy foods was associated with significantly higher BMI compared with individuals living in neighbourhoods with low availability of healthy food after adjustment for demographic variables (β = 3.22, P = 0.001). Associations were attenuated but remained significant after controlling for dietary quality (β = 2.81, P = 0.012). CONCLUSIONS: Contrary to expectations, there was a positive association between the availability of healthy food and higher BMI among individuals living in predominantly white neighbourhoods. This result could be due to individuals in neighbourhoods with low healthy food availability travelling outside their neighbourhood to obtain healthy food.
  278. Author: Laska MN, Borradaile KE, Tester J, Foster GD, Gittelsohn J
    Title: Healthy food availability in small urban food stores: a comparison of four US cities.
    Journal: Public Health Nutr. 13(7):1031-5
    Date: 2010 Jul
    Abstract: OBJECTIVE: Given that small food stores may be important retail food sources in low-income urban communities, our objective was to examine cross-city comparative data documenting healthy food availability within such facilities, particularly those located in low-income areas and nearby schools. DESIGN: Food stores in Baltimore, Maryland; Minneapolis/St. Paul, Minnesota; Oakland, California; and Philadelphia, Pennsylvania were selected for assessment based on proximity to low-income schools. Stores were defined as: (i) single-aisle (n 45); (ii) small (2-5 aisles; n 52); and (iii) large (> or = 6 aisles; n 8). Staff conducted in-store audits to assess the presence/absence of twenty-eight healthy items, organized within five categories: (i) fresh fruits/vegetables, (ii) processed fruits/vegetables, (iii) healthy beverages/low-fat dairy, (iv) healthy snacks and (v) other healthy staple foods. RESULTS: The availability of healthy food items was low, particularly in single-aisle and small stores, and there was significant cross-site variability in the availability of healthy snacks (P
  279. Author: Bovell-Benjamin AC, Hathorn CS, Ibrahim S, Gichuhi PN, Bromfield EM
    Title: Healthy food choices and physical activity opportunities in two contrasting Alabama cities.
    Journal: Health Place. 15(2):429-38
    Date: 2009 Jun
    Abstract: Food and physical activity access and availability in two contrasting cities in Alabama were investigated. An in-outlet, observational, cross-sectional design was utilized to assess the opportunities for healthy food choices and physical activity. Thirty retail food outlets and 29 physical activity outlets were inventoried. None of the convenience stores carried frozen, low-sodium or dark-green, yellow vegetables, low-fat milk or yogurt, low-sodium and low-fat cheese, while none of the supermarkets in Tuskegee stocked low-sodium vegetables. In Tuskegee, the single public recreational area, which offered activities such as basketball, fees ranged from $25 to $35/month. Tuskegee has a shortage of "chain" supermarkets and a dominance of convenience stores which stocked few healthy foods. Overall, there are limited opportunities for healthy food and physical activity choices, which could be a barrier for chronic disease prevention efforts.
  280. Author: Surkan PJ, Coutinho AJ, Christiansen K, Dennisuk LA, Suratkar S, Mead E, Sharma S, Gittelsohn J
    Title: Healthy food purchasing among African American youth: associations with child gender, adult caregiver characteristics and the home food environment.
    Journal: Public Health Nutr. 14(4):670-7
    Date: 2011 Apr
    Abstract: OBJECTIVE: To examine how factors related to the home food environment and individual characteristics are associated with healthy food purchasing among low-income African American (AA) youth. SUBJECTS: A total of 206 AA youth (ninety-one boys and 115 girls), aged 10-14 years, and their primary adult caregivers. SETTING: Fourteen Baltimore recreation centres in low-income neighbourhoods. DESIGN: Cross-sectional study. We collected information about food purchasing, the home food environment, sociodemographic and psychosocial factors drawn from social cognitive theory. Multivariable logistic regression was used to examine the factors associated with the frequency and proportion of healthy food purchases in all youth and stratified by gender. Low-fat or low-sugar foods were defined as healthy. RESULTS: Youth purchased an average of 1.5 healthy foods (range=0-15) in the week before the interview, comprising an average of 11.6% (range=0-80%) of total food purchases. The most commonly purchased healthy foods included water and sunflower seeds/nuts. Healthier food-related behavioural intentions were associated with a higher frequency of healthy foods purchased (OR=1.4, P
  281. Author: Fulkerson JA, Rydell S, Kubik MY, Lytle L, Boutelle K, Story M, Neumark-Sztainer D, Dudovitz B, Garwick A
    Title: Healthy Home Offerings via the Mealtime Environment (HOME): feasibility, acceptability, and outcomes of a pilot study.
    Journal: Obesity (Silver Spring)
    Date: 2010 Feb
    Abstract: The primary objective was to develop and test the feasibility and acceptability of the Healthy Home Offerings via the Mealtime Environment (HOME) program, a pilot childhood obesity prevention intervention aimed at increasing the quality of foods in the home and at family meals. Forty-four child/parent dyads participated in a randomized controlled trial (n = 22 in intervention and n = 22 in control conditions). The intervention program, held at neighborhood facilities, included five, 90-min sessions consisting of interactive nutrition education, taste testing, cooking skill building, parent discussion groups, and hands-on meal preparation. Children (8-10-year olds) and parents (89% mothers) completed assessments at their home at baseline, postintervention, and 6-month follow-up, including psychosocial surveys, anthropometry, 24-h dietary recalls, and home food availability and meal offering inventories. Feasibility/acceptability was assessed with participant surveys and process data. All families completed all three home-based assessments. Most intervention families (86%) attended at least four of five sessions. Nearly all parents (95%) and 71% of children rated all sessions very positively. General linear models indicated that at postintervention, compared to control children, intervention children were significantly more likely to report greater food preparation skill development (P
  282. Author: Golaszewski T, Fisher B
    Title: Heart check: the development and evolution of an organizational heart health assessment.
    Journal: Am J Health Promot. 17(2):132-53
    Date: 2002 Nov-Dec
    Abstract: PURPOSE: The purpose of this article is to document the development, testing, and application of an organizational assessment tool used to measure employer support for heart health. Additional information is presented on its future research and applications plan. DESIGN: This article represents the pooling of results from multiple studies using a variety of designs, including pilot tests, cross-sectional analyses, and quasi-experiments. SETTING: Worksites covering the spectrum of employers across industry types and size, and throughout all of New York State. SUBJECTS: Over 10,000 New York employees and 1000 New York employers are represented in the multiple phases of this research. MEASURES: Heart Check is a 226-item inventory designed to measure such features in the worksite as organizational foundations, administrative supports, tobacco control, nutrition support, physical activity support, stress management, screening services, and company demographics. Additional side studies used professional judgments and behavioral surveys. RESULTS: As an assessment tool Heart Check shows evidence for reliability and validity. Applications of the instrument show characteristics that define high-scoring companies, quasi standards for New York employers, and, when applied during interventions, positive changes in organizational support levels. CONCLUSIONS: A relatively inexpensive, easy-to-use, and metrically tested instrument exists for measuring the construct of organizational support for employee heart health. The instrument shows promise as part of a system to enhance heart health through public health-based interventions in the workplace.
  283. Author: Park Y, Quinn J, Florez K, Jacobson J, Neckerman K, Rundle A
    Title: Hispanic immigrant women's perspective on healthy foods and the New York City retail food environment: A mixed-method study.
    Journal: Soc Sci Med. 73(1):13-21
    Date: 2011 Jul
    Abstract: Much has been written about the role of dietary acculturation in the epidemic of obesity among Hispanic immigrants in the United States. Yet little is known about the role of beliefs and preferences in immigrants' dietary practices and their relationship to the retail food environment in which the practices occur. We conducted a mixed-methods convergence study of these issues. Twenty-eight foreign-born Hispanic adult women, recruited from families enrolled in a childhood asthma study and mainly living in New York City took part in 60-90 min, semi-structured interviews regarding their dietary beliefs, preferences, and practices. The findings were then used to formulate hypotheses for analyses of food frequency questionnaire (FFQ) data collected from the 345 New York Hispanic women enrolled in the asthma study. Generalized estimating equations were used to determine whether characteristics of the retail food environment within 0.5 km of the home predicted diet, adjusting for individual and neighborhood socio-demographic characteristics. In the interviews, healthy food was rarely discussed in terms of nutritional content. Instead, considerations of freshness, as indicated by time since harvest or slaughter and thus local sourcing; purity, as indicated by the absence of preservatives and processing; and naturalness, as indicated by chemical free farming practices, were the primary axes around which healthy food was defined. Quantitative results were consistent with the qualitative findings: 1) the presence of a farmers' market within the home neighborhood was associated with consumption of more total servings per day of fruit, vegetables, and juice, and 2) the presence of a farmers' market and/or a livestock market was associated with consumption of more servings per day of meat. Proximity to supermarkets or medium-sized grocery stores was not associated with consumption. The results suggest that the availability of fresh produce and meat from local farms may influence diet among Hispanic women in urban neighborhoods.
  284. Author: Crawford DA, Ball K, Cleland VJ, Campbell KJ, Timperio AF, Abbott G, Brug J, Baur LA, Salmon JA
    Title: Home and neighbourhood correlates of BMI among children living in socioeconomically disadvantaged neighbourhoods.
    Journal: Br J Nutr. 107(7):1028-36
    Date: 2012 Apr
    Abstract: A detailed understanding of the underlying drivers of obesity-risk behaviours is needed to inform prevention initiatives, particularly for individuals of low socioeconomic position who are at increased risk of unhealthy weight gain. However, few studies have concurrently considered factors in the home and local neighbourhood environments, and little research has examined determinants among children from low socioeconomic backgrounds. The present study examined home, social and neighbourhood correlates of BMI (kg/m2) in children living in disadvantaged neighbourhoods. Cross-sectional data were collected from 491 women with children aged 5-12 years living in forty urban and forty rural socioeconomically disadvantaged areas (suburbs) of Victoria, Australia in 2007 and 2008. Mothers completed questionnaires about the home environment (maternal efficacy, perceived importance/beliefs, rewards, rules and access to equipment), social norms and perceived neighbourhood environment in relation to physical activity, healthy eating and sedentary behaviour. Children's height and weight were measured at school or home. Linear regression analyses controlled for child sex and age. In multivariable analyses, children whose mothers had higher efficacy for them doing physical activity tended to have lower BMI z scores (B = - 0·04, 95 % CI - 0·06, - 0·02), and children who had a television (TV) in their bedroom (B = 0·24, 95 % CI 0·04, 0·44) and whose mothers made greater use of food as a reward for good behaviour (B = 0·05, 95 % CI 0·01, 0·09) tended to have higher BMI z scores. Increasing efficacy among mothers to promote physical activity, limiting use of food as a reward and not placing TV in children's bedrooms may be important targets for future obesity prevention initiatives in disadvantaged communities.
  285. Author: Ledoux TA, Mama SK, O'Connor DP, Adamus H, Fraser ML, Lee RE
    Title: Home Availability and the Impact of Weekly Stressful Events Are Associated with Fruit and Vegetable Intake among African American and Hispanic/Latina Women.
    Journal: J Obes
    Date: 2012
    Abstract: Background. Mediating and moderating variables may interfere with the association between neighborhood availability of grocery stores (NAG) and supermarkets (NAS) and fruit and vegetable (FV) intake. Objective. The purpose of this study was to test mediation of home availability of FV (HAFV) and moderation of impact of weekly stressful events (IWSE) on the association between NAG and NAS with FV consumption among African American (AA) and Hispanic/Latina (HL) women. Methods. Three hundred nine AA and HL, 25-60 year old women in the Health Is Power (HIP) randomized controlled trial completed validated measures of HAFV, IWSE, and FV intake at baseline. Trained field assessors coded NAG and NAS. Institutional Review Board approval was obtained. Results. NAG and NAS were not associated with FV intake or HAFV, so HAFV was not a mediator. HAFV (std. Beta = .29, P
  286. Author: Gorin AA, Phelan S, Raynor H, Wing RR
    Title: Home food and exercise environments of normal-weight and overweight adults.
    Journal: Am J Health Behav. 35(5):618-26
    Date: 2011 Sep
    Abstract: OBJECTIVE: To examine the home environments of overweight and normal-weight adults and the relationships between the environment and weight-regulating behaviors. METHODS: Overweight (n=201) and normal-weight adults (n=213) assessed their homes via checklist and self-reported their eating and activity habits. RESULTS: OW adults had less exercise equipment, fewer low-fat snacks and fruits/vegetables, and more TVs, high-fat snacks, and spreads than did NW adults (Ps<.01 these="" variables="" were="" associated="" with="" weight-regulating="" behaviors.="" conclusions:="" increasing="" healthy="" foods="" and="" opportunities="" for="" physical="" activity="" within="" the="" home="" may="" improve="" weight-control="" efforts="" in="" adults.="">
  287. Author: Anyanwu UO, Sharkey JR, Jackson RT, Sahyoun NR
    Title: Home food environment of older adults transitioning from hospital to home.
    Journal: J Nutr Gerontol Geriatr. 30(2):105-21
    Date: 2011
    Abstract: Only anecdotal information is known about foods available in the home of hospital-discharged older adults. This study describes the home food environment of this population and examines associations between health/nutrition risk factors and ability to shop and prepare meals. Data were collected from 512 hospital-discharged older adults residing in 6 U.S. states; food available within the home was assessed. Most households had a variety of food present; however, 20% of households lacked fresh fruit, 15% lacked fresh vegetables, and 35% had no fresh meat. About 35% of participants reported an inability to both prepare meals and shop for food. Among those unable to do both activities, the prevalence of depressive symptoms, food-related anxiety, and poor self-rated health was significantly (p
  288. Author: Baranowski T, Missaghian M, Watson K, Broadfoot A, Cullen K, Nicklas T, Fisher J, O'Donnell S
    Title: Home fruit, juice, and vegetable pantry management and availability scales: a validation.
    Journal: Appetite. 50(2-3):266-77
    Date: 2008 Mar-May
    Abstract: Home fruit, 100% juice, and vegetables (FJV) availability is related to increased FJV consumption by children. While FJV must be purchased for use in the home, no scales have been reported on home FJV pantry management practices. A scale for home FJV pantry management practices was generated from focus group discussions with diverse 162 food shoppers. A commonly used scale of home FJV availability was also assessed. A grocery store intercept survey recruited 171 food shoppers with children in front of supermarkets and grocery stores. Survey instruments were administered twice, separated by 6 weeks. Single dimensionality was observed for each scale. Item Response Theory parameter estimates revealed easily interpreted patterns in the sequence of items by difficulty of response. These scales are available to help better understand influences on family FJV purchase decisions.
  289. Author: Gorin AA, Raynor HA, Niemeier HM, Wing RR
    Title: Home grocery delivery improves the household food environments of behavioral weight loss participants: results of an 8-week pilot study.
    Journal: Int J Behav Nutr Phys Act
    Date: 2007
    Abstract: BACKGROUND: Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. METHODS: Overweight participants (N = 28; BMI = 31.7 +/- 3.6 kg/m2; 89.3% women, 47.9 +/- 9.5 years) were randomly assigned to 8-weeks of standard behavioral weight loss (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. RESULTS: Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01) and number of foods that were high in fat (p = .002). While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08). Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. CONCLUSION: Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.
  290. Author: Giskes K, van Lenthe FJ, Kamphuis CB, Huisman M, Brug J, Mackenbach JP
    Title: Household and food shopping environments: do they play a role in socioeconomic inequalities in fruit and vegetable consumption? A multilevel study among Dutch adults.
    Journal: J Epidemiol Community Health. 63(2):113-20
    Date: 2009 Feb
    Abstract: BACKGROUND: Fruit and vegetables are protective of a number of chronic diseases; however, their intakes have been shown to vary by socioeconomic position (SEP). Household and food shopping environmental factors are thought to contribute to these differences. To determine whether household and food shopping environmental factors are associated with fruit and vegetable (FV) intakes, and contribute to socioeconomic inequalities in FV consumption. METHODS: Cross-sectional data were obtained by a postal questionnaire among 4333 adults (23-85 years) living in 168 neighbourhoods in the south-eastern Netherlands. Participants agreed/disagreed with a number of statements about the characteristics of their household and food shopping environments, including access, prices and quality. Education was used to characterise socioeconomic position (SEP). Main outcome measures were whether or not participants consumed fruit or vegetables on a daily basis. Multilevel logistic regression models examined between-area variance in FV consumption and associations between characteristics of the household and food shopping environments and FV consumption. RESULTS: Only a few household and food shopping environmental factors were significantly associated with fruit and vegetable consumption, and their prevalence was low. Participants who perceived FV to be expensive were more likely to consume them. There were significant socioeconomic inequalities in fruit and vegetable consumption (ORs of not consuming fruit and vegetables were 4.26 and 5.47 among the lowest-educated groups for fruit and vegetables, respectively); however, these were not explained by any household or food shopping environmental factors. CONCLUSIONS: Improving access to FV in the household and food shopping environments will only make a small contribution to improving population consumption levels, and may only have a limited effect in reducing socioeconomic inequalities in their consumption.
  291. Author: Matheson DM, Varady J, Varady A, Killen JD
    Title: Household food security and nutritional status of Hispanic children in the fifth grade.
    Journal: Am J Clin Nutr. 76(1):210-7
    Date: 2002 Jul
    Abstract: BACKGROUND: Food insecurity is a critical variable for understanding the nutritional status of low-income populations. However, limited research is available on the relation between household food insecurity and children's nutritional status. OBJECTIVE: Our objective was to examine the relations among household food insecurity, household food supplies, and school-age children's dietary intakes and body mass indexes (BMIs). DESIGN: A sample of 124 predominantly Hispanic, fifth-grade children and their mothers were surveyed as part of a school-based obesity-prevention program. Data on the children's weights and heights were collected and three 24-h dietary recalls were conducted. The mothers provided reports of household food insecurity and household food supplies. RESULTS: Food insecurity was negatively associated with the children's BMIs and household food supplies but not with the children's food intakes. However, a secondary analysis showed that as payday approached, children from the most food-insecure households had significant decreases in energy intakes and meat consumption. CONCLUSIONS: This is one of the first studies to report a significant association between food insecurity and children's nutritional status. The ages and sex-adjusted BMIs of the food-insecure children were lower than those of the food-secure children but were still within the normal range. The lower BMIs in the food-insecure children may have been due to short-term, yet periodic food restrictions that resulted as household food supplies diminished before payday. Future research is needed to assess the physiologic and psychological effects of periodic food restriction on children's health.
  292. Author: French SA, Wall M, Mitchell NR
    Title: Household income differences in food sources and food items purchased.
    Journal: Int J Behav Nutr Phys Act
    Date: 2010
    Abstract: BACKGROUND: The present study examined income-related household food purchases among a sample of 90 households from the community. METHODS: Annotated food purchase receipts were collected for a four-week period by the primary household shopper. Receipt food source and foods items were classified into specific categories, and food quantities in ounces were recorded by research staff. For home sources, a limited number of food/beverage categories were recorded. For eating out sources, all food/beverage items were recorded. Median monthly per person dollars spent and per person ounces purchased were computed. Food sources and food categories were examined by household income tertile. SUBJECTS AND SETTING: A community-based sample of 90 households. RESULTS: Higher income households spent significantly more dollars per person per month from both home and eating out sources compared with lower income households ($163 versus $100, p
  293. Author: French SA, Gerlach AF, Mitchell NR, Hannan PJ, Welsh EM
    Title: Household obesity prevention: Take Action--a group-randomized trial.
    Journal: Obesity (Silver Spring). 19(10):2082-8
    Date: 2011 Oct
    Abstract: The purpose of the present study was to evaluate an intervention to prevent weight gain among households (HHs) in the community. Ninety HHs were randomized to intervention or control group for 1 year. Intervention consisted of six face-to-face group sessions, placement of a television (TV) locking device on all home TVs, and home-based intervention activities. Measures were collected in person at baseline and 1 year. Weight, height, eating behaviors, physical activity (PA), and TV viewing were measured among HH members ages ≥ 12 years. Follow-up rate at 1 year was 96%. No significant intervention effects were observed for change in HH BMI-z score. Intervention HHs significantly reduced TV viewing, snacks/sweets intake, and dollars per person spent eating out, and increased (adults only) PA and self-weighing frequency compared with control HHs. A 1 year obesity prevention intervention targeting entire HHs was effective in reducing TV viewing, snack/sweets intake and eating out purchases. Innovative methods are needed to strengthen the home food environment intervention component. Longer intervention durations also need to be evaluated.
  294. Author: Hillier A, Cannuscio CC, Karpyn A, McLaughlin J, Chilton M, Glanz K
    Title: How far do low-income parents travel to shop for food? Empirical evidence from two urban neighborhoods
    Journal: Urban Geography. 32(5):712-729
    Date: 2011
    Abstract:
  295. Author: Toft U, Erbs-Maibing P, Glümer C
    Title: Identifying fast-food restaurants using a central register as a measure of the food environment.
    Journal: Scand J Public Health. 39(8):864-9
    Date: 2011 Dec
    Abstract: OBJECTIVE: To validate the identification and location of fast-food restaurants according to a government list of inspected food stores and restaurants. METHODS: Fast-food restaurants in the Capital Region of Denmark were identified using a government list of inspected food stores and restaurants (the Smiley register, spring 2010). Ground-truthing was used as the validation method and was performed in May and June 2010 in 125 randomly selected 250×250 m grid cells. RESULTS: A total of 186 fast-food restaurants was identified by ground-truthing and 99% of these were registered in the same grid cell by the Smiley register. However, only 152 restaurants of these were categorised as fast-food restaurants by both methods. The sensitivity was 82% and the positive predictive value was 92%. The mean±standard deviation position accuracy was 15±24 m. CONCLUSIONS: Using a government list of inspected restaurants was found to be a valid and useful alternative to expensive and time-consuming field observation and provided a relatively accurate tool for identifying and locating fast-food restaurants in communities.
  296. Author: Hosler AS, Dharssi A
    Title: Identifying retail food stores to evaluate the food environment.
    Journal: Am J Prev Med. 39(1):41-4
    Date: 2010 Jul
    Abstract: BACKGROUND: The availability of food stores is the most frequently used measure of the food environment, but identifying them poses a technical challenge. PURPOSE: This study evaluated eight administrative lists of retailers for identifying food stores in an urban community. METHODS: Lists of inspected food stores (IFS), cigarette retailers, liquor licenses, lottery retailers, gasoline retailers, farmers' markets, and authorized WIC (Program for Women, Infants, and Children) and Supplemental Nutrition Assistance Program (SNAP) retailers for Albany NY were obtained from government agencies. Sensitivity and positive predictive value (PPV) were assessed, using ground-truthing as the validation measure. Stores were also grouped by the number of lists they were documented on, and the proportion of food stores in each group was obtained. Data were collected and analyzed in 2009. RESULTS: A total of 166 stores, including four from ground-truthing, were identified. Forty-three stores were disqualified, as a result of having no targeted foods (n=17); being in the access-restricted area of a building (n=15); and being out of business (n=11). Sensitivity was highest in IFS (87.0%), followed by the cigarette retailers' list (76.4%). PPV was highest in WIC and farmers' markets lists (100%), followed by SNAP (97.8%). None of the lists had both sensitivity and PPV greater than 90%. All stores that were listed by four or more lists were food stores. The proportion of food stores was lowest (33.3%) for stores listed by only one list. CONCLUSIONS: Individual lists had limited utility for identifying food stores, but when they were combined, the likelihood of a retail store being a food store could be predicted by the number of lists the store was documented on. This information can be used to increase the efficiency of ground-truthing.
  297. Author: Bandoni DH, Sarno F, Jaime PC
    Title: Impact of an intervention on the availability and consumption of fruits and vegetables in the workplace.
    Journal: Public Health Nutr. 14(6):975-81
    Date: 2011 Jun
    Abstract: OBJECTIVE: To evaluate the impact of an educational and environmental intervention on the availability and consumption of fruits and vegetables in workplace cafeterias. DESIGN: This was a randomized intervention study involving a sample of companies that were divided into intervention and control groups. The intervention, which focused on change in the work environment, was based on an ecological model for health promotion. It involved several different aspects including menu planning, food presentation and motivational strategies to encourage the consumption of fruits and vegetables. The impact of the intervention was measured by changes (between baseline and follow-up) in the availability of fruits and vegetables that were eaten per consumer in meals and the consumption of fruits and vegetables in the workplace by workers. We also evaluated the availability of energy, macronutrients and fibre. SETTINGS: Companies of São Paulo, Brazil. SUBJECTS: Twenty-nine companies and 2510 workers. RESULTS: After the intervention we found an average increase in the availability of fruits and vegetables of 49 g in the intervention group, an increase of approximately 15 %, whereas the results for the control group remained practically equal to baseline levels. During the follow-up period, the intervention group also showed reduced total fat and an increase in fibre in the meals offered. The results showed a slight but still positive increase in the workers' consumption of fruits and vegetables (about 11 g) in the meals offered by the companies. CONCLUSIONS: Interventions focused on the work environment can be effective in promoting the consumption of healthy foods.
  298. Author: Skidmore P, Welch A, van Sluijs E, Jones A, Harvey I, Harrison F, Griffin S, Cassidy A
    Title: Impact of neighbourhood food environment on food consumption in children aged 9-10 years in the UK SPEEDY (Sport, Physical Activity and Eating behaviour: Environmental Determinants in Young people) study.
    Journal: Public Health Nutr. 13(7):1022-30
    Date: 2010 Jul
    Abstract: OBJECTIVE: Poor diet in childhood increases risk of obesity but the relationship between access to food and children's food choice is underexplored. We determined relationships between distance to and density of food outlets on children's food choice. DESIGN: Children (n 1721) aged 9-10 years who participated in a cross-sectional study from a sample of state and private schools across urban and rural areas. Food consumption was reported using a short validated FFQ. A Geographic Information System was used to determine proximity to local food outlets. Multivariable regression analyses were performed to determine associations between food consumption and distance to and density of local food outlets. SETTING: Norfolk, England. SUBJECTS: Boys (n 754) and girls (n 967) aged 9-10 years. RESULTS: The impact of distance to or density of food outlets on food choice was small after adjustment. Living further away from a supermarket increased portions of fruit (0.11 portions/week per 1 km increase in distance to nearest supermarket, P
  299. Author: Casey AA, Elliott M, Glanz K, Haire-Joshu D, Lovegreen SL, Saelens BE, Sallis JF, Brownson RC
    Title: Impact of the food environment and physical activity environment on behaviors and weight status in rural U.S. communities.
    Journal: Prev Med. 47(6):600-4
    Date: 2008 Dec
    Abstract: OBJECTIVE: To examine the association between weight status and characteristics of the food and physical activity environments among adults in rural U.S. communities. METHOD: Cross-sectional telephone survey data from rural residents were used to examine the association between obesity (body mass index [BMI] >30 kg/m(2)) and perceived access to produce and low-fat foods, frequency and location of food shopping and restaurant dining, and environmental factors that support physical activity. Data were collected from July to September 2005 in Missouri, Arkansas, and Tennessee. Logistic regression models (N=826) adjusted for age, education and gender comparing normal weight to obese respondents. RESULTS: Eating out frequently, specifically at buffets, cafeterias, and fast food restaurants was associated with higher rates of obesity. Perceiving the community as unpleasant for physical activity was also associated with obesity. CONCLUSION: Adults in rural communities were less likely to be obese when perceived food and physical activity environments supported healthier behaviors. Additional environmental and behavioral factors relevant to rural adults should be examined in under-studied rural U.S. populations.
  300. Author: Biener L, Glanz K, McLerran D, Sorensen G, Thompson B, Basen-Engquist K, Linnan L, Varnes J
    Title: Impact of the Working Well Trial on the worksite smoking and nutrition environment.
    Journal: Health Educ Behav. 26(4):478-94
    Date: 1999 Aug
    Abstract: This article reports the effect of a worksite cancer control intervention on aspects of the physical and social environment related to dietary and smoking behaviors of employees. Data are from 111 intervention and control worksites that participated in the Working Well Trial. Employee surveys and interviews with key organizational informants assessed environmental and normative changes relevant to nutrition and tobacco use. Results indicated significant effects of the intervention on all nutrition outcomes: access to healthy food, nutritional information at work, and social norms regarding dietary choice. Significant benefits were not found for smoking norms or smoking policies. However, changes occurred in both the control and intervention sites on these variables. This first large analysis of environmental and normative effects of a worksite intervention is consistent with the employee behavior change findings for the trial and serves as a model for future analyses of multilevel worksite health promotion programs.
  301. Author: Sacks G, Tikellis K, Millar L, Swinburn B
    Title: Impact of 'traffic-light' nutrition information on online food purchases in Australia.
    Journal: Aust N Z J Public Health. 35(2):122-6
    Date: 2011 Apr
    Abstract: OBJECTIVE: 'Traffic-light' nutrition labelling has been proposed as a potential tool for improving the diet of the population, yet there has been little published research on the impact of traffic-light nutrition labelling on purchases in a supermarket environment. This study examined changes to online consumer food purchases in response to the introduction of traffic-light nutrition information (TLNI). METHODS: The study consisted of a 10-week trial in a major Australian online grocery store. For the duration of the trial TLNI in the form of four colour-coded indicators representing the products' relative levels of fat, saturated fat, sugar and sodium content, was displayed on the product listing page of 53 of the retailer's own-brand products in five food categories (milk, bread, breakfast cereals, biscuits and frozen meals). The changes in sales before and after the introduction of TLNI were examined both within the intervention store and in a comparison store. RESULTS: TLNI had no discernible impact on sales, with the change in sales in the intervention store corresponding to changes in sales in the comparison store. No relationship was observed between changes in sales and the relative healthiness of products. CONCLUSION AND IMPLICATIONS: This limited, short-term study found no evidence to support the notion that TLNI is likely to influence behaviour change. Further research is needed to examine the impact of providing TLNI in different contexts, for a longer duration and on more products, with and without complementary awareness and information campaigns.
  302. Author: Zhang X, van der Lans I, Dagevos H
    Title: Impacts of fast food and the food retail environment on overweight and obesity in China: a multilevel latent class cluster approach.
    Journal: Public Health Nutr. 15(1):88-96
    Date: 2012 Jan
    Abstract: OBJECTIVE: To simultaneously identify consumer segments based on individual-level consumption and community-level food retail environment data and to investigate whether the segments are associated with BMI and dietary knowledge in China. DESIGN: A multilevel latent class cluster model was applied to identify consumer segments based not only on their individual preferences for fast food, salty snack foods, and soft drinks and sugared fruit drinks, but also on the food retail environment at the community level. SETTING: The data came from the China Health and Nutrition Survey (CHNS) conducted in 2006 and two questionnaires for adults and communities were used. SUBJECTS: A total sample of 9788 adults living in 218 communities participated in the CHNS. RESULTS: We successfully identified four consumer segments. These four segments were embedded in two types of food retail environment: the saturated food retail environment and the deprived food retail environment. A three-factor solution was found for consumers' dietary knowledge. The four consumer segments were highly associated with consumers' dietary knowledge and a number of sociodemographic variables. CONCLUSIONS: The widespread discussion about the relationships between fast-food consumption and overweight/obesity is irrelevant for Chinese segments that do not have access to fast food. Factors that are most associated with segments with a higher BMI are consumers' (incorrect) dietary knowledge, the food retail environment and sociodemographics. The results provide valuable insight for policy interventions on reducing overweight/obesity in China. This study also indicates that despite the breathtaking changes in modern China, the impact of 'obesogenic' environments should not be assessed too strictly from a 'Western' perspective.
  303. Author: Olstad DL, Downs SM, Raine KD, Berry TR, McCargar LJ
    Title: Improving children's nutrition environments: a survey of adoption and implementation of nutrition guidelines in recreational facilities.
    Journal: BMC Public Health
    Date: 2011
    Abstract: BACKGROUND: Although the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release. METHODS: A cross-sectional telephone survey was conducted from June - December, 2009 (n = 151) with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalgh's model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study. RESULTS: One half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11%) of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational) context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability. CONCLUSIONS: If fully adopted and implemented, the ANGCY have the potential to make a significant and sustained contribution to improving the recreational facility food environment, however one year following their release, awareness, adoption and implementation of the ANGCY remained low. A mandated policy approach could offer an efficacious, cost-effective means of improving the food environment within recreational facilities.
  304. Author: Ohri-Vachaspati P, Martinez D, Yedidia MJ, Petlick N
    Title: Improving data accuracy of commercial food outlet databases.
    Journal: Am J Health Promot. 26(2):116-22
    Date: 2011 Nov-Dec
    Abstract: PURPOSE. Assessing food environments often requires using commercially available data. Disparate methods used for classifying food outlets in these databases call for creating a classification approach using common definitions. A systematic strategy for reclassifying food stores and restaurants, as they appear in commercial databases, into categories that differentiate the availability of healthy options is described here. DESIGN AND SETTING. Commercially available data on food outlets including names, addresses, North American Industry Classification System codes, and associated characteristics was obtained for five New Jersey communities. ANALYSIS. A reclassification methodology was developed using criteria and definitions from the literature to categorize food outlets based on availability of healthy options. Information in the database was supplemented by systematic Internet and key word searches, and from phone calls to food outlets. RESULTS. The methodology resulted in 622 supermarket/grocery stores, 183 convenience stores, and 148 specialty stores in the original data to be reclassified into 58 supermarkets, 30 grocery stores, 692 convenience stores, and 115 specialty stores. Outlets from the original list of 1485 full-service restaurants and 506 limited-service restaurants were reclassified as 563 full-service restaurants and 1247 limited-service restaurants. Reclassification resulted in less than one-seventh the number of supermarkets and grocery stores, more than three times the number of convenience stores, and twice as many limited-service restaurants-a much less healthy profile than the one generated by using exclusively the commercial databases. CONCLUSION. An explicit and replicable strategy is proposed for reclassifying food outlets in commercial databases into categories that differentiate on the basis of healthy food availability. The intent is to contribute towards building a consensus among researchers on definitions used in public health research for characterizing different types of food outlets.
  305. Author: Lassen AD, Thorsen AV, Sommer HM, Fagt S, Trolle E, Biltoft-Jensen A, Tetens I
    Title: Improving the diet of employees at blue-collar worksites: results from the 'Food at Work' intervention study.
    Journal: Public Health Nutr. 14(6):965-74
    Date: 2011 Jun
    Abstract: OBJECTIVE: To examine the impact of a 6-month participatory and empowerment-based intervention study on employees' dietary habits and on changes in the canteen nutrition environment. DESIGN: Worksites were stratified by company type and by the presence or absence of an in-house canteen, and randomly allocated to either an intervention group (five worksites) or a minimum intervention control group (three worksites). The study was carried out in partnership with a trade union and guided by an ecological framework targeting both individual and environment levels. Outcome measures included: (i) changes in employees' dietary habits derived from 4 d pre-coded food diaries of a group of employees at the worksites (paired-data structure); and (ii) the canteen nutrition environment as identified by aggregating chemical nutritional analysis of individual canteen lunches (different participants at baseline and at endpoint). SETTING: Eight blue-collar worksites (five of these with canteens). SUBJECTS: Employees. RESULTS: In the intervention group (n 102), several significant positive nutritional effects were observed among employees, including a median daily decrease in intake of fat (-2.2 %E, P = 0.002) and cake and sweets (-18 g/10 MJ, P = 0.002) and a median increase in intake of dietary fibre (3 g/10 MJ, P
  306. Author: Sloane DC, Diamant AL, Lewis LB, Yancey AK, Flynn G, Nascimento LM, McCarthy WJ, Guinyard JJ, Cousineau MR, REACH Coalition of the African American Building a Legacy of Health Project
    Title: Improving the nutritional resource environment for healthy living through community-based participatory research.
    Journal: J Gen Intern Med. 18(7):568-75
    Date: 2003 Jul
    Abstract: OBJECTIVES: To build health promotion capacity among community residents through a community-based participatory model, and to apply this model to study the nutritional environment of an urban area to better understand the role of such resources in residents' efforts to live a healthy life. DESIGN: A multiphase collaborative study that inventoried selected markets in targeted areas of high African-American concentration in comparison with markets in a contrasting wealthier area with fewer African Americans. SETTING: A community study set in the Los Angeles metropolitan area. PARTICIPANTS: African-American community organizations and community residents in the target areas. INTERVENTIONS: Two surveys of market inventories were conducted. The first was a single-sheet form profiling store conditions and the availability of a small selection of healthy foods. The second provided detailed information on whether the store offered fruit, vegetables, low-fat dairy products, dried goods and other items necessary for residents to consume a nutritious diet. RESULTS: The targeted areas were significantly less likely to have important items for living a healthier life. The variety and quality of fresh fruit and vegetable produce was significantly lower in the target areas. Such products as 1% milk, skim milk, low-fat and nonfat cheese, soy milk, tofu, whole grain pasta and breads, and low-fat meat and poultry items were significantly less available. CONCLUSIONS: Healthy food products were significantly less available in the target areas. The authors conclude from these results that the health disparities experienced by African-American communities have origins that extend beyond the health delivery system and individual behaviors inasmuch as adherence to the healthy lifestyle associated with low chronic disease risk is more difficult in resource-poor neighborhoods than in resource-rich ones.
  307. Author: Cullen KW, Hartstein J, Reynolds KD, Vu M, Resnicow K, Greene N, White MA, Studies to Treat or Prevent Pediatric Type 2 Diabetes Prevention Study Group
    Title: Improving the school food environment: results from a pilot study in middle schools.
    Journal: J Am Diet Assoc. 107(3):484-9
    Date: 2007 Mar
    Abstract: Our objective for this study was to examine the feasibility of instituting environmental changes during a 6-week pilot in school foodservice programs, with long-term goals of improving dietary quality and preventing obesity and type 2 diabetes in youth. Participants included students and staff from six middle schools in three states. Formative assessment with students and school staff was conducted in the spring of 2003 to inform the development of school foodservice policy changes. Thirteen potential policy goals were delineated. These formed the basis for the environmental change pilot intervention implemented during the winter/spring of 2004. Questionnaires were used to assess the extent to which the 13 foodservice goals were achieved. Success was defined as achieving 75% of goals not met at baseline. Daily data were collected on goal achievement using the schools' daily food production and sales records. Qualitative data were also collected after the pilot study to obtain feedback from students and staff. Formative research with staff and students identified potential environmental changes. Most schools made substantial changes in the National School Lunch Program meal and snack bar/a la carte offerings. Vending goals were least likely to be achieved. Only one school did not meet the 75% goal achievement objective. Based on the objective data as well as qualitative feedback from student focus groups and interviews with students and school staff, healthful school foodservice changes in the cafeteria and snack bar can be implemented and were acceptable to the staff and students. Implementing longer-term and more ambitious changes and assessing cost issues and the potential enduring impact of these changes on student dietary change and disease risk reduction merits investigation.
  308. Author: Bell J, Burlin BM
    Title: In urban areas: many of the poor still pay more for food
    Journal: Journal of public policy and marketing. 12(2):268-70
    Date: 1993
    Abstract:
  309. Author: Bartholomew JB, Jowers EM
    Title: Increasing frequency of lower-fat entrees offered at school lunch: an environmental change strategy to increase healthful selections.
    Journal: J Am Diet Assoc. 106(2):248-52
    Date: 2006 Feb
    Abstract: OBJECTIVE: A two-phase study was conducted to determine the effect of an environmental intervention aimed to increase the selection of low- and moderate-fat entrees at school. DESIGN: An evaluation of a school-wide intervention followed for two semesters. SUBJECTS: Two schools of similar size and demographic data were randomly assigned to either intervention or control. Participants were the children in these schools. INTERVENTION: In Phase 1, the rotation of existing entrees was modified such that one of three entree choices was low or moderate in fat. In Phase 2, the number of competing high-fat entrees was reduced from two choices to one. MAIN OUTCOME MEASURES: Data were: (a) entree fat content (determined by a registered dietitian) and (b) the aggregate entree selections compiled from daily selection reports. STATISTICAL ANALYSES PERFORMED: Frequency distributions were used to describe entree availability. Two-way analysis of variance indicated differences in the mean daily selection of low-, moderate-, and high-fat entrees. RESULTS: In Phase 1 in the intervention school, the number of days that a low-fat entree was offered increased by 70%, with no increase in the rate of selection of the low- or moderate-fat entrees. In Phase 2, both low- and moderate-fat entrees were selected at a higher rate in the intervention school (32.1% and 26.4%, respectively) than the control school (13.8% and 7.5%, respectively), P
  310. Author: Thornton LE, Bentley RJ, Kavanagh AM
    Title: Individual and area-level socioeconomic associations with fast food purchasing.
    Journal: J Epidemiol Community Health. 65(10):873-80
    Date: 2011 Oct
    Abstract: BACKGROUND: It has been suggested that those with lower socioeconomic characteristics would be more likely to seek energy-dense food options such as fast food because of cheaper prices; however, to date the evidence has been inconsistent. This study examines both individual- and area-level socioeconomic characteristics and their independent associations with chain-brand fast food purchasing. METHODS: Data from the 2003 Victorian Lifestyle and Neighbourhood Environments Study (VicLANES); a multilevel study of 2,547 adults from 49 small-areas in Melbourne, Australia, were used. Multilevel multinomial models adjusted for confounders were used to assess associations between individual socioeconomic position (education, occupation and income) and area socioeconomic characteristics in relation to fast food purchasing from five major fast food chains with outcome categories: never, at least monthly and at least weekly. The study finally assessed whether any potential area-level associations were mediated by fast food access. RESULTS: Increased fast food purchasing was independently associated with lower education, being a blue-collar employee and decreased household income. Results for area-level disadvantage were marginally insignificant after adjustment for individual-level characteristics, although they were suggestive that living in an area with greater levels of disadvantage increased an individual's odds of more frequent fast food purchasing. This effect was further attenuated when measures of fast food restaurant access were included in the models. CONCLUSION: Independent effects of lower individual-level socioeconomic characteristics and more frequent fast food purchasing for home consumption are demonstrated. Although evidence was suggestive of an independent association with area-level disadvantage this did not reach statistical significance.
  311. Author: Hermstad AK, Swan DW, Kegler MC, Barnette JK, Glanz K
    Title: Individual and environmental correlates of dietary fat intake in rural communities: a structural equation model analysis.
    Journal: Soc Sci Med. 71(1):93-101
    Date: 2010 Jul
    Abstract: Total dietary fat and saturated fat intake are associated with obesity, elevated cholesterol, and heart disease. This study tested a multi-group structural equation model to explore differences in the relative influence of individual, social, and physical environment factors on dietary fat intake amongst adults aged 40-70 years. Participants from four rural Georgia, U.S., counties (n=527) completed a cross-sectional survey that included questions about eating patterns and individual and social influences on healthy eating. Observational measures of nutrition environments in stores and restaurants in these counties also were completed. Models for both women and men found significant positive relationships between self-efficacy for healthy eating and perceived nutrition environments and family support for healthy eating. The association between self-efficacy for eating a low-fat diet and frequency of eating out and grocery shopping was negative for both genders. The home nutrition environment was associated with dietary fat intake for women but not men. The results indicate that the influence of individual and environmental factors on dietary fat intake differs for men and women, with the home environment playing a larger role for women in rural communities.
  312. Author: Vue H, Reicks M
    Title: Individual and environmental influences on intake of calcium-rich food and beverages by young Hmong adolescent girls.
    Journal: J Nutr Educ Behav. 39(5):264-72
    Date: 2007 Sep-Oct
    Abstract: OBJECTIVE: To identify individual and environmental factors affecting intake of calcium-rich food and beverages by early adolescent Hmong girls. DESIGN: Cross-sectional survey of girls, in-depth interviews with parents. SETTING: Girl Scout and 4-H programs in the Minneapolis/St. Paul metropolitan area. PARTICIPANTS: Convenience samples of 10-13-year-old Hmong girls (n = 102) and their parents (n = 20). ANALYSIS: Spearman correlation analysis, constant comparative method. VARIABLES MEASURED: Individual and environmental factors for girls and reported intake of calcium-rich food and beverages. RESULTS: Few girls observed parents drinking milk or were encouraged by parents to drink milk. Many reported low intake of milk with dinner meals and snacks. Only one third reported that calcium-rich food such as yogurt, cheese, and tofu were available at home, and intake of these food items was associated with availability. Parents accommodated child preferences and had few expectations for their child to eat certain calcium-rich food items. Parents did not commonly consume dairy products but indicated they made milk available for children. Knowledge of calcium requirements was limited, but most parents related calcium to bone health. CONCLUSIONS AND IMPLICATIONS: Environmental factors may limit calcium intake by Hmong girls. Education should involve parents and children and address environmental factors that affect intake.
  313. Author: Cardoso Lde O, de Castro IR, Gomes Fda S, Leite Ida C
    Title: Individual and school environment factors associated with overweight in adolescents of the municipality of Rio de Janeiro, Brazil.
    Journal: Public Health Nutr. 14(5):914-22
    Date: 2011 May
    Abstract: OBJECTIVE: To identify the association of individual and school environment factors with overweight among adolescents. DESIGN: Cross-sectional study. Sociodemographic and behavioural information was collected using an anonymous self-administered questionnaire. Indicators on human and physical resources of the schools were based on information collected in interviews with school principals. Overweight was defined based on the BMI Z-score for age and sex recommended by WHO. Logistic regression models were used for statistical analysis. SETTING: Rio de Janeiro, Brazil. SUBJECTS: By means of a two-stage (classrooms and students) probabilistic sampling, subjects comprised 1632 students enrolled in the last year of primary education of the municipal public school network, stratified by city region. RESULTS: The mean prevalence of overweight at schools was 17·2%, ranging from 0% to 50%. Adolescents more likely to be overweight were those who attended schools without knives and forks or ceramic/glass plates for students in the school refectory (prevalence odds ratio (POR) = 1·40; P = 0·04), those whose head of household had completed between 8 and 10 years of schooling (POR = 1·46; P = 0·03), those who did not live with both parents (POR = 1·24; P = 0·06) and those who had not practised physical activity outside school on at least 1 d in the 7 d before the study (POR = 1·56; P = 0·04). CONCLUSIONS: Sociodemographic and behavioural variables of adolescents and school characteristics were associated with overweight, confirming individual and context effects on this health disorder. Studies such as the present one, identifying variables in context, may support actions to prevent overweight among adolescents.
  314. Author: Elder JP, Arredondo EM, Campbell N, Baquero B, Duerksen S, Ayala G, Crespo NC, Slymen D, McKenzie T
    Title: Individual, family, and community environmental correlates of obesity in Latino elementary school children.
    Journal: J Sch Health. 80(1):20-30; quiz 53-5
    Date: 2010 Jan
    Abstract: BACKGROUND: The prevalence of overweight children has reached epidemic proportions, and affects Latinos youth more than other subgroups in the United States. Given the prevalence of obesity and its economic consequences, community health initiatives have shifted toward primary prevention at younger ages. METHODS: Data representing all levels of the ecological systems theory were collected using diverse methods. Participants were children enrolled in K-2nd grade and their parents. RESULTS: Overweight children were less active compared to normal weight children. The parents of overweight children provided less instrumental support to engage in activity and set fewer limits on their child's activities. Similarly, parents of overweight children were less likely to control, but more likely to set limits on their child's diet compared to parents of normal weight children. Parents who rated their health more positively and were less acculturated were more likely to have children who were overweight. School and community level variables were not significantly correlated with children's weight. Adjusting for the aforementioned variables, parents' weight status was positively associated with children's weight. CONCLUSIONS: Social and structural environments in which Hispanic children are reared may play an important role in determining their risk for obesity and related behaviors. Parents' weight was among the strongest correlate of child weight; however, the extent to which this influence functions primarily through biological or social/structural influences is not entirely clear. The role of school and community factors on child's health practices and body mass index needs to be further examined.
  315. Author: Kwate NO, Yau CY, Loh JM, Williams D
    Title: Inequality in obesigenic environments: fast food density in New York City.
    Journal: Health Place. 15(1):364-73
    Date: 2009 Mar
    Abstract: The high prevalence of obesity in African American populations may be due to the food environment in residential communities, and the density of fast food restaurants is an important aspect of the restaurant landscape in US cities. This study investigated racial and socioeconomic correlates of fast food density in New York City. We found that predominantly Black areas had higher densities of fast food than predominantly White areas; high-income Black areas had similar exposure as low-income Black areas; and national chains were most dense in commercial areas. The results highlight the importance of policy level interventions to address disparities in food environments as a key goal in obesity prevention efforts.
  316. Author: Lytle LA, Kubik MY, Perry C, Story M, Birnbaum AS, Murray DM
    Title: Influencing healthful food choices in school and home environments: results from the TEENS study.
    Journal: Prev Med. 43(1):8-13
    Date: 2006 Jul
    Abstract: BACKGROUND: The purpose of this research is to examine the effects of an intervention designed to increase the availability of fruits, vegetables and lower fat foods in homes and schools. This research is part of the TEENS study, a school-based intervention study. METHODS: Sixteen schools in Minnesota were recruited to be in the study, and approximately 3600 middle school students in the eight intervention schools were exposed to a multi-component intervention. The TEENS intervention included classroom-based curricula, family newsletters, and changes in the school food environment including increasing more healthful options on a la carte and on the school lunch line. In addition to student-level outcomes, changes in availability of fruits, vegetables, and lower fat snacks in home and school environments were evaluated. The TEENS study was conducted from 1997 to 2000. RESULTS: Parents of students in intervention schools reported making healthier choices when grocery shopping as compared to parents of students in control schools (P = 0.01). No intervention effects were evident from a home food inventory. Compared to control schools, intervention schools offered (P = 0.04) and sold (P = 0.07) a higher proportion of healthier foods on a la carte, but no effects were seen for fruit and vegetables sales as part of the regular meal pattern lunch. CONCLUSION: Our results show mixed results for positively influencing adolescents' school and home environments.
  317. Author: Izumi BT, Zenk SN, Schulz AJ, Mentz GB, Sand SL, de Majo RF, Wilson C, Odoms-Young A
    Title: Inter-rater reliability of the food environment audit for diverse neighborhoods (FEAD-N).
    Journal: J Urban Health. 89(3):486-99
    Date: 2012 Jun
    Abstract: Studies have shown that neighborhood food environments are important influences on dietary intake and may contribute to health disparities. While instruments with high reliability have been developed to assess food availability, price, and quality, few measures to assess items associated with the physical and social features of food stores have been developed. Yet, recent qualitative studies have documented aspects associated with such features of urban food stores that are barriers to food acquisition. We assessed the reliability of measures to assess multiple components of the food environment-including physical and social store features--in three geographically distinct and diverse communities in Detroit, Michigan, using the Food Environment Audit for Diverse Neighborhoods (FEAD-N). Using the FEAD-N, four trained observers conducted observations of 167 food stores over a 10-week period between October and December 2008. To assess inter-rater reliability, two trained observers independently visited, on the same day, a random subset of 44 food stores. Kappa statistics and percent agreement were used to evaluate inter-rater reliability. Overall, the instrument had mostly high inter-rater reliability with more than 75% of items with kappa scores between 0.80 and 1.00, indicating almost perfect reliability. More than half of the physical store features and 47% of the social store features had almost perfect reliability and about 37% and 47%, respectively, had substantial reliability. Measuring factors associated with the physical and social environment of food stores with mostly high reliability is feasible. Systematic documentation of the physical and social features of food stores using objective measures may promote a more comprehensive understanding of how neighborhood food environments influence health.
  318. Author: Paquet C, Daniel M, Knäuper B, Gauvin L, Kestens Y, Dubé L
    Title: Interactive effects of reward sensitivity and residential fast-food restaurant exposure on fast-food consumption.
    Journal: Am J Clin Nutr. 91(3):771-6
    Date: 2010 Mar
    Abstract: BACKGROUND: Local fast-food environments have been increasingly linked to obesity and related outcomes. Individuals who are more sensitive to reward-related cues might be more responsive to such environments. OBJECTIVE: This study aimed to assess the moderating role of sensitivity to reward on the relation between residential fast-food restaurant exposure and fast-food consumption. DESIGN: Four hundred fifteen individuals (49.6% men; mean age: 34.7 y) were sampled from 7 Montreal census tracts stratified by socioeconomic status and French/English language. The frequency of fast-food restaurant visits in the previous week was self-reported. Sensitivity to reward was self-reported by using the Behavioral Activation System (BAS) scale. Fast-food restaurant exposure within 500 m of the participants' residence was determined by using a Geographic Information System. Main and interactive effects of the BAS and fast-food restaurant exposure on fast-food consumption were tested with logistic regression models that accounted for clustering of observations and participants' age, sex, education, and household income. RESULTS: Regression results showed a significant interaction between BAS and fast-food restaurant exposure (P
  319. Author:
    Title: Interactive three-dimensional geovisualization of space–time access to food
    Journal: Applied Geography
    Date:
    Abstract: A majority of literature about food deserts is focused on geographic access to food retailers by a buffered distance differentiating high and low access. An overlooked facet in this representation is that food acquisition is not only geographically dictated, but it is also temporally constrained. Food retailers invariably have limited opening hours that create a temporal restriction for shoppers. In this paper, a three-dimensional (3D) construct was proposed to delineate the limited food access to a retailer location across space and over its time of operation. Food retailer data in Columbus, OH, USA were collected for examining the variation of food access on both spatial and temporal scales. This study also employed the technique of interactive 3D modeling in a geographic information system (GIS) to visualize the food environment to delimit where and when food is accessible on a daily basis. The interactive 3D geovisualization (visualization of geographic information) of space–time access contributed to improving the representation of food environment and exploring the inequity of food access across space and over time. The development of this geovisualization context for food science studies could assist public health professionals and government stakeholders in understanding the effect of temporal access and improving food access for regions with limited operation hours in policy formulation.
  320. Author: Evans AE, Jennings R, Smiley AW, Medina JL, Sharma SV, Rutledge R, Stigler MH, Hoelscher DM
    Title: Introduction of farm stands in low-income communities increases fruit and vegetable among community residents.
    Journal: Health Place. 18(5):1137-43
    Date: 2012 Sep
    Abstract: The purpose of this longitudinal pilot study was to measure the impact of introducing farm stands in low-income communities with limited access to fresh and quality fruits and vegetables (F&V) on residents' F&V consumption. Two farm stands were placed outside two local community sites one day a week for 12 weeks. A variety of locally grown, culturally appropriate produce was sold at the stands. Data on F&V intake, awareness and usage of farmers' markets, family behaviors, and importance of eating F&V were collected from individuals (n=61) before and after farm stands were placed in the two communities. Paired sample t-tests, chi-square and McNemar tests were used to evaluate the impact of the intervention on the outcome variables. Significance level was set at p<.05. significant="" increases="" were="" found="" for="" participants="" consumption="" of="" fruit="" juice="" tomatoes="" green="" salad="" and="" other="" vegetables="" additionally="" also="" reported="" in="" mediating="" variables="" f="" consumption.="" this="" study="" underscores="" the="" potential="" farmers="" markets="" to="" increase="" through="" increasing="" access="" low-income="" communities.="">
  321. Author: Hearst MO, Lytle LA, Pasch KE, Heitzler CD
    Title: Inventory versus checklist approach to assess middle school à la carte food availability.
    Journal: J Sch Health. 79(12):593-8; quiz 603-5
    Date: 2009 Dec
    Abstract: BACKGROUND: The purpose of this research is to evaluate 2 methods of assessing foods available on school à la carte lines for schools' ability to assess the proportion of foods that are healthful options. METHODS: This observational study used data collected at 38 middle schools, October 2006-May 2007. An inventory method was used to collect detailed information of items available on each school's à la carte line, followed by a simplified checklist form. Using the detailed inventory method, the proportion of items meeting the Institute of Medicine's (IOM) nutrition standards for foods available at each school was calculated. From the checklists, we calculated the proportion of categories representing more healthful foods. Schools were independently ranked according to the percentage of items meeting the IOM criteria, (inventory data) and the percentage of food categories considered "healthy" (checklist data). Wilcoxon rank sum test was used to compare school rankings. RESULTS: The inventory and checklist approaches showed a good level of agreement when both methods were independently used to rank the level of healthy foods available on à la carte (Wilcoxon rank sum = 32.5, p = .62). CONCLUSION: For purposes of ranking schools along a continuum of "healthfulness of foods on à la carte lines," especially when resources are limited, a checklist approach appears to be satisfactory. This method may also be useful to school stakeholders needing an inexpensive à la carte assessment tool.
  322. Author: Layte R, Harrington J, Sexton E, Perry IJ, Cullinan J, Lyons S
    Title: Irish exceptionalism? Local food environments and dietary quality.
    Journal: J Epidemiol Community Health. 65(10):881-8
    Date: 2011 Oct
    Abstract: OBJECTIVE: To explore whether distance to and density of food outlets within the local area have an impact on individual dietary quality, controlling for the socioeconomic characteristics of individuals and their households. METHODS: An analysis of the Survey of Lifestyle, Attitudes and Nutrition in Ireland (SLÁN), a two-stage clustered sample of 10,364 individuals aged 18+ from the Republic of Ireland. Socioeconomic status was measured using net household income and highest level of education. Diet was assessed via a food frequency questionnaire and the results scored in terms of cardiovascular risk. Food availability was measured in terms of distance to (Euclidean and network) and density of different types of food outlets. Dietary quality was decomposed using fixed effects regression models. RESULTS: There is a pronounced gradient in distances to nearest food store and quality of diet by socioeconomic status. Controlling for individual and household socioeconomic status and demographic characteristics, individuals who live closer to a larger food outlet or who live in an area with a higher density of larger food outlets have a significantly better diet in terms of cardiovascular risk. CONCLUSIONS: Studies outside of North America have failed to find that the physical availability of food plays a significant role in socioeconomic gradients in diet and nutrition. This study suggests that food availability in the Republic of Ireland plays a small but statistically significant role in influencing the diets of individuals and communities and, as such, may also influence socioeconomic inequalities in health.
  323. Author: Raynor HA, Polley BA, Wing RR, Jeffery RW
    Title: Is dietary fat intake related to liking or household availability of high- and low-fat foods?
    Journal: Obes Res. 12(5):816-23
    Date: 2004 May
    Abstract: OBJECTIVE: Despite the increasing availability of low- and reduced-fat foods, Americans continue to consume more fat than recommended, which may be a contributing factor to the obesity epidemic. This investigation examined relationships between liking and household availability of high- and low-fat foods and their association with dietary fat intake. RESEARCH METHODS AND PROCEDURES: A food frequency questionnaire assessed percent calories from fat consumed over the past year in 85 men and 80 women. Participants reported their degree of liking 22 "high-fat foods" (>45% calories from fat) and 22 "low-fat foods" (
  324. Author: Banks J, Williams J, Cumberlidge T, Cimonetti T, Sharp DJ, Shield JP
    Title: Is healthy eating for obese children necessarily more costly for families?
    Journal: Br J Gen Pract. 62(594):e1-5
    Date: 2012 Jan
    Abstract: BACKGROUND: During consultations on weight management in childhood obesity clinics, the additional costs incurred by healthy eating are often cited, as an economic barrier to achieving a better nutritional balance. AIM: To examine whether adopting an improved theoretical, balanced diet compared to current dietary habits in children incurs additional cost. DESIGN AND SETTING: Children aged 5-16 years (body mass index [BMI] ≥98th percentile) recruited to a randomised trial comparing a hospital-based and primary care childhood obesity clinics provided data for this study. METHOD: Three-day dietary diaries collected at baseline were analysed for energy and fat intake and then compared to a theoretical, adjusted healthy-eating diet based on the Food Standards Agency, 'Eatwell plate'. Both were priced contemporaneously using the appropriate portion size, at a neighbourhood, mid-range supermarket, at a budget supermarket, and on the local high street. RESULTS: The existing diet purchased at a budget supermarket was cheapest (£2.48/day). The healthier, alternative menu at the same shop cost an additional 33 pence/day (£2.81). The same exercise in a mid-range supermarket, incurred an additional cost of 4 pence per day (£3.40 versus £3.44). Switching from an unhealthy mid-range supermarket menu to the healthier, budget-outlet alternative saved 59 pence per day. The healthier, alternative menu was cheaper than the existing diet if purchased on the high street (£3.58 versus £3.75), although for both menus this was most expensive. CONCLUSION: For many obese children, eating healthily would not necessarily incur prohibitive, additional financial cost, although a poor diet at a budget supermarket remains the cheapest of all options. Cost is a possible barrier to healthy eating for the most economically disadvantaged.
  325. Author: Macdonald L, Ellaway A, Ball K, Macintyre S
    Title: Is proximity to a food retail store associated with diet and BMI in Glasgow, Scotland?
    Journal: BMC Public Health
    Date: 2011
    Abstract: BACKGROUND: Access to healthy food is often seen as a potentially important contributor to diet. Policy documents in many countries suggest that variations in access contribute to inequalities in diet and in health. Some studies, mostly in the USA, have found that proximity to food stores is associated with dietary patterns, body weight and socio-economic differences in diet and obesity, whilst others have found no such relationships. We aim to investigate whether proximity to food retail stores is associated with dietary patterns or Body Mass Index in Glasgow, a large city in the UK. METHODS: We mapped data from a 'Health and Well-Being Survey' (n = 991), and a list of food stores (n = 741) in Glasgow City, using ArcGIS, and undertook network analysis to find the distance from respondents' home addresses to the nearest fruit and vegetable store, small general store, and supermarket. RESULTS: We found few statistically significant associations between proximity to food retail outlets and diet or obesity, for unadjusted or adjusted models, or when stratifying by gender, car ownership or employment. CONCLUSIONS: The findings suggest that in urban settings in the UK the distribution of retail food stores may not be a major influence on diet and weight, possibly because most urban residents have reasonable access to food stores.
  326. Author: Williams LK, Thornton L, Ball K, Crawford D
    Title: Is the objective food environment associated with perceptions of the food environment?
    Journal: Public Health Nutr. 15(2):291-8
    Date: 2012 Feb
    Abstract: OBJECTIVE: The present study examined whether objective measures of the food environment are associated with perceptions of the food environment and whether this relationship varies by socio-economic disadvantage. DESIGN: The study is a cross-sectional analysis of self-report surveys and objective environment data. Women reported their perceptions on the nutrition environment. Participants' homes and food stores were geocoded to measure the objective community nutrition environment. Data on the average price and variety of fruit and vegetables were used to measure the objective consumer nutrition environment. SETTING: The study was conducted in Melbourne, Australia, in 2003-2004. SUBJECTS: Data presented are from a sample of 1393 women aged 18-65 years. RESULTS: Overall the match between the perceived and objective environment was poor, underscoring the limitations in using perceptions of the environment as a proxy for the objective environment. Socio-economic disadvantage had limited impact on the relationship between perceived and objective nutrition environment. CONCLUSIONS: Further research is needed to understand the determinants of perceptions of the nutrition environment to enhance our understanding of the role of perceptions in nutrition choices and drivers of socio-economic inequalities in nutrition.
  327. Author: Woodward-Lopez G, Gosliner W, Samuels SE, Craypo L, Kao J, Crawford PB
    Title: Lessons learned from evaluations of California's statewide school nutrition standards.
    Journal: Am J Public Health. 100(11):2137-45
    Date: 2010 Nov
    Abstract: OBJECTIVES: We assessed the impact of legislation that established nutrition standards for foods and beverages that compete with reimbursable school meals in California. METHODS: We used documentation of available foods and beverages, sales accounts, and surveys of and interviews with students and food service workers to conduct 3 studies measuring pre- and postlegislation food and beverage availability, sales, and student consumption at 99 schools. RESULTS: Availability of nutrition standard-compliant foods and beverages increased. Availability of noncompliant items decreased, with the biggest reductions in sodas and other sweetened beverages, regular chips, and candy. At-school consumption of some noncompliant foods dropped; at-home consumption of selected noncompliant foods did not increase. Food and beverage sales decreased at most venues, and food service à la carte revenue losses were usually offset by increased meal program participation. Increased food service expenditures outpaced revenue increases. CONCLUSIONS: Regulation of competitive foods improved school food environments and student nutritional intake. Improvements were modest, partly because many compliant items are fat- and sugar-modified products of low nutritional value. Additional policies and actions are needed to achieve more substantive improvements in school nutrition environments and student nutrition and health.
  328. Author: Vericker TC
    Title: Limited evidence that competitive food and beverage practices affect adolescent consumption behaviors.
    Journal: Health Educ Behav. 40(1):19-23
    Date: 2013 Feb
    Abstract: Childhood obesity is emerging as a considerable public health problem with no clear antidote. The school food environment is a potential intervention point for policy makers, with competitive food and beverage regulation as a possible policy lever. This research examines the link between competitive food and beverage availability in school and adolescent consumption patterns using data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999. Results from value-added multivariate regression models reveal limited evidence that competitive food policy affects fruit and vegetable consumption. Findings suggest a stronger link between competitive beverage policy and consumption of sweetened beverages for population subgroups.
  329. Author: Ford PB, Dzewaltowski DA
    Title: Limited supermarket availability is not associated with obesity risk among participants in the Kansas WIC Program.
    Journal: Obesity (Silver Spring). 18(10):1944-51
    Date: 2010 Oct
    Abstract: Socioecological theory and a growing body of research suggests that geographic, racial, ethnic, and socioeconomic disparities in the prevalence of obesity are linked to disparities in the availability of food retail outlets that provide healthy food options. We examined the availability of food stores for low-income women in Kansas and tested whether food store availability was associated with obesity using cross-sectional, geocoded data from women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 21,166) in Kansas. The availability and density of food stores within a 1, 3, and 5 mile radius of residence was determined, and multivariate logistic regression was used to examine the association of food store availability with obesity. The availability of convenience, grocery stores, and supermarkets varied across the urban-rural continuum, but the majority of WIC recipients lived within a 1 mile radius of a small grocery store. WIC participants in micropolitan areas had the greatest availability of food stores within a 1 mile radius of residence. Availability and density of food stores was not associated with obesity in metropolitan and rural areas, but availability and density of any type of food store was associated with an increased risk of obesity among WIC recipients in micropolitan areas. These results suggest that limited spatial availability of grocery stores and supermarkets does not contribute to obesity risk among low-income WIC recipients in Kansas, and that urban influence moderates the contribution of food environments to obesity.
  330. Author: Lebel A, Kestens Y, Pampalon R, Thériault M, Daniel M, Subramanian SV
    Title: Local context influence, activity space, and foodscape exposure in two canadian metropolitan settings: is daily mobility exposure associated with overweight?
    Journal: J Obes
    Date: 2012
    Abstract: It has become increasingly common to attribute part of the obesity epidemic to changes in the environment. Identification of a clear and obvious role for contextual risk factors has not yet been demonstrated. The objectives of this study were to explain differences in local overweight risk in two different urban settings and to explore sex-specific associations with estimated mobility patterns. Overweight was modeled within a multilevel framework using built environmental and socioeconomic contextual indicators and individual-level estimates of activity space exposure to fast-food restaurants (or exposure to visited places). Significant variations in local levels in overweight risk were observed. Physical and socioeconomic contexts explained more area-level differences in overweight among men than among women and among inhabitants of Montreal than among inhabitants of Quebec City. Estimated activity space exposure to fast-food outlets was significantly associated with overweight for men in Montreal. Local-level analyses are required to improve our understanding of contextual influences on obesity, including multiple influences in people's daily geographies.
  331. Author: Freedman DA
    Title: Local food environments: they're all stocked differently.
    Journal: Am J Community Psychol. 44(3-4):382-93
    Date: 2009 Dec
    Abstract: The obesity epidemic has widened the aims of prevention research to include the influence of local food environments on health outcomes. This mixed methods study extends existing research focused on local food environments by examining whether community members' find food accessible. Data from food store audits and one-on-one interviews were analyzed. Results reveal that most of the food stores surrounding the three research sites were convenience stores and non-chain grocery stores; interviewees did not perceive these stores to be "real" food stores. Tobacco and alcohol products were more prevalent in the food stores than all varieties of milk, fresh fruits, or fresh vegetables. Food access varied by site in a manner that was designed to appeal to customers' race, class, gender, or environment. Findings reveal that local food environments are reflections of social hierarchies. Unraveling the politics of space ought to be a part of broader efforts to promote the public's health.
  332. Author: MacFarlane A, Cleland V, Crawford D, Campbell K, Timperio A
    Title: Longitudinal examination of the family food environment and weight status among children.
    Journal: Int J Pediatr Obes. 4(4):343-52
    Date: 2009
    Abstract: OBJECTIVE: To examine whether aspects of the family food environment were associated with body mass index (BMI) z-score and weight status in children, cross-sectionally and prospectively over 3 years. METHODS: Four aspects of the family food environment (breakfast eating patterns, food consumption while watching television, parental provision of energy-dense foods and child consumption of energy-dense food at home and away from home) were assessed with a questionnaire completed by parents of 161 children aged 5-6 years and 132 children aged 10-12 years in Melbourne, Australia in 2002/03. In 2002/03 and 2006, children's BMI z-score and weight status (non-overweight or overweight) was calculated from measured height and weight. RESULTS: At baseline, 19% of younger and 21% of older children were overweight. Three years later, a greater proportion of younger (now aged 8-9 years) compared with older (aged 13-15 years) children were classified as overweight (28% versus 18%). Few of the family food environment variables were associated with children's BMI z-score and weight status cross-sectionally and longitudinally. However, among older children, more frequent dinner consumption while watching television was associated with a higher BMI z-score longitudinally (B=0.3, 95% CI=0.0, 0.6), less frequent breakfast consumption was associated with higher odds of overweight longitudinally (OR=2.2, 95% CI=1.1-4.7), and more frequent fast food consumption at home was associated with higher odds of overweight cross-sectionally (OR=3.1, 95% CI=1.4-7.0). CONCLUSIONS: This study found few significant associations between aspects of the family food environment and BMI z-score or weight status in a sample of Australian children.
  333. Author: Hosler AS, Varadarajulu D, Ronsani AE, Fredrick BL, Fisher BD
    Title: Low-fat milk and high-fiber bread availability in food stores in urban and rural communities.
    Journal: J Public Health Manag Pract. 12(6):556-62
    Date: 2006 Nov-Dec
    Abstract: As part of the Albany Prevention Research Center's Core Project to understand environmental influences on a healthy lifestyle, all food stores in downtown Albany (N=79) and rural Columbia and Greene counties (N=177) in New York State were visited and surveyed for their availability of low-fat milk and high-fiber bread. Stores in the rural community were significantly (P
  334. Author: Dibsdall LA, Lambert N, Bobbin RF, Frewer LJ
    Title: Low-income consumers' attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables.
    Journal: Public Health Nutr. 6(2):159-68
    Date: 2003 Apr
    Abstract: OBJECTIVE: To determine low-income consumers' attitudes and behaviour towards fruit and vegetables, in particular issues of access to, affordability of and motivation to eat fruit and vegetables. DESIGN AND SETTING: Questionnaire survey mailed to homes owned by a large UK housing association. PARTICIPANTS: Participants were 680 low-income men and women, aged 17-100 years. RESULTS: Age, employment, gender, smoking and marital status all affected attitudes towards access, affordability and motivation to eat fruit and vegetables. Few (7%) participants experienced difficulty in visiting a supermarket at least once a week, despite nearly half having no access to a car for shopping. Fruit and vegetables were affordable to this low-income group in the amounts they habitually bought; purchasing additional fruits and vegetables was seen as prohibitively expensive. Less than 5% felt they had a problem with eating healthily and yet only 18% claimed to eat the recommended 5 or more portions of fruit and vegetables every day. CONCLUSIONS: Supported by research, current UK Government policy is driven by the belief that low-income groups have difficulties in access to and affordability of fruit and vegetables. Findings from this particular group suggest that, of the three potential barriers, access and affordability were only a small part of the 'problem' surrounding low fruit and vegetable consumption. Thus, other possible determinants of greater consequence need to be identified. We suggest focusing attention on motivation to eat fruit and vegetables, since no dietary improvement can be achieved if people do not recognise there is a problem.
  335. Author: Sanigorski AM, Bell AC, Kremer PJ, Swinburn BA
    Title: Lunchbox contents of Australian school children: room for improvement.
    Journal: Eur J Clin Nutr. 59(11):1310-6
    Date: 2005 Nov
    Abstract: OBJECTIVE: In light of the increasing prevalence of obesity in children and the potential of schools as a setting for intervention, we aimed to identify the main foods and beverages consumed at primary school and to determine differences in consumption patterns between children who used the school canteen and those who did not. DESIGN: Cross-sectional survey of school foods in 1681 5-12 y old children, 2003-2004. SETTING: Barwon South-Western region of Victoria, Australia. RESULTS: The school food provided an average (+/-s.e.m.) of 3087+/-26 kJ. Bread was the most frequently consumed food and contributed 20% of total energy at school, biscuits 13%, fruit 10%, muesli/fruit bars 8%, packaged snacks 7%, and fruit juice/cordial 6%. About 10% of children used the school canteen and these children obtained more total energy and more energy from cakes, fast foods and soft drink than noncanteen users (P
  336. Author: Donkin AJ, Dowler EA, Stevenson SJ, Turner SA
    Title: Mapping access to food at a local level
    Journal: British food journal. 101(7):554-564
    Date: 1999
    Abstract: Access to food is currently on the political agenda. This paper presents a quantitative method for local level use to help identify the geographic location of areas with inadequate access to food. A census of retail outlets selling food of any kind was carried out in a deprived area within a 2km radius from a central point between two estates. Information on the price and availability of healthy food lists, acceptable to each of the four major ethnic groups in the area, was collected. The food lists were not mutually exclusive. Food shops were mapped in terms of food availability and price indices using Geographical Information System (GIS) software. Maps show, progressively: roads within/outside 500m of a postcode with any outlet selling food; any outlet selling more than 50 per cent of the food list, below the area mean price, acceptable to a Gujarati Hindu; the latter in relation to population density. Within the area analysed there appears to be reasonable walking access to the more reasonably priced shops within the area, however the cost of a healthy diet would still require more than 50 per cent of the income of someone in receipt of income support.
  337. Author: Donkin AJ, Dowler EA, Stevenson SJ, Turner SA
    Title: Mapping access to food in a deprived area: the development of price and availability indices.
    Journal: Public Health Nutr. 3(1):31-8
    Date: 2000 Mar
    Abstract: OBJECTIVE: To develop and map indices to illustrate variation in the cost and availability of healthy food. DESIGN: Two contiguous wards in London were selected by virtue of their high Carstairs deprivation scores. A 2-km area was defined around a randomly chosen central point. All retail outlets selling food within the area were visited and their location recorded. A list of foods, acceptable to the local ethnically diverse population, which met current dietary guidelines, was devised. Data on the availability and price of 71 food items were collected. Indices were developed using SPSS and mapped using Geographic Information System (GIS) software. RESULTS: Information on availability and prices were collected from 199 outlets. The mean price index shows how expensive a shop is relative to other shops in the area. The least cost index shows the relative expense of a shop using the cheapest ways of buying their range of foods. Shorthand indices were tested, using data on 19 of the 71 prices. Availability indices are also discussed, including a green availability index and a fresh green availability index. Illustrative maps of the shop locations and the mean price index and fresh green availability index are shown. CONCLUSIONS: Data can be collected and indices developed which indicate geographic variation in shop 'expensiveness', and in the price and availability of healthy food. GIS software can be used to map these indices, to identify areas with high food prices or low availability.
  338. Author: Hackett A, Boddy L, Boothby J, Dummer TJ, Johnson B, Stratton G
    Title: Mapping dietary habits may provide clues about the factors that determine food choice.
    Journal: J Hum Nutr Diet. 21(5):428-37
    Date: 2008 Oct
    Abstract: BACKGROUND: Food deserts are thought to be a barrier to making healthier food choices. This concept has been challenged. The interaction between the physical environment and children's food choice has received little attention. The present study used food intake data to generate hypotheses concerning the role of the physical environment in food choice. METHODS: A cross-sectional analysis was conducted of the dietary habits of Year 5 (9-10-year-old) children from 90 of Liverpool's 118 primary schools. Individuals with the 'best' and 'worst' food choices were mapped and two areas associated with these extreme choices located. RESULTS: One thousand five hundred and thirty-five children completed the dietary questionnaire and supplied a full and valid postcode. Two adjacent areas with relatively large numbers of children in the 'best' and 'worst' food choice groups were chosen. Both areas had very similar socio-economic profiles. The contrast in the physical environments was striking, even on visual inspection. CONCLUSIONS: Food deserts as a cause of poor food choice did not stand scrutiny; the area located by the worst food choices had a plethora of shops selling food (better termed a food prairie), whereas the area located by the best food choices had no shops in evidence but did have more 'space'.
  339. Author: Wang J, Williams M, Rush E, Crook N, Forouhi NG, Simmons D
    Title: Mapping the availability and accessibility of healthy food in rural and urban New Zealand--Te Wai o Rona: Diabetes Prevention Strategy.
    Journal: Public Health Nutr. 13(7):1049-55
    Date: 2010 Jul
    Abstract: OBJECTIVE: Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable 'healthy' foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of 'healthy' foods in rural and urban New Zealand. DESIGN: We identified and visited ('mapped') 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of 'healthy' foods (e.g. wholemeal bread) and compared their cost with those of comparable 'regular' foods (e.g. white bread). RESULTS: Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, 'healthy' foods were more expensive than 'regular' foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a 'healthy' food basket (without sugar) was 29.1% more expensive than the 'regular' basket ($NZ 176.72 v. $NZ 136.84). The difference between the 'healthy' and 'regular' basket was greater in urban ($NZ 49.18) than rural areas ($NZ 36.27) in adjusted analysis. CONCLUSIONS: 'Healthy' foods were more expensive than 'regular' choices in both urban and rural areas. Although urban areas had higher availability of 'healthy' foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices.
  340. Author: Larsen K, Gilliland J
    Title: Mapping the evolution of 'food deserts' in a Canadian city: supermarket accessibility in London, Ontario, 1961-2005.
    Journal: Int J Health Geogr
    Date: 2008
    Abstract: BACKGROUND: A growing body of research suggests that the suburbanization of food retailers in North America and the United Kingdom in recent decades has contributed to the emergence of urban 'food deserts', or disadvantaged areas of cities with relatively poor access to healthy and affordable food. This paper explores the evolution of food deserts in a mid-sized Canadian city (London, Ontario) by using a geographic information system (GIS) to map the precise locations of supermarkets in 1961 and 2005; multiple techniques of network analysis were used to assess changing levels of supermarket access in relation to neighbourhood location, socioeconomic characteristics, and access to public transit. RESULTS: The findings indicate that residents of inner-city neighbourhoods of low socioeconomic status have the poorest access to supermarkets. Furthermore, spatial inequalities in access to supermarkets have increased over time, particularly in the inner-city neighbourhoods of Central and East London, where distinct urban food deserts now exist. CONCLUSION: Contrary to recent findings in larger Canadian cities, we conclude that urban food deserts exist in London, Ontario. Policies aimed at improving public health must also recognize the spatial, as well as socioeconomic, inequities with respect to access to healthy and affordable food. Additional research is necessary to better understand how supermarket access influences dietary behaviours and related health outcomes.
  341. Author: Cummins SC, McKay L, MacIntyre S
    Title: McDonald's restaurants and neighborhood deprivation in Scotland and England.
    Journal: Am J Prev Med. 29(4):308-10
    Date: 2005 Nov
    Abstract: BACKGROUND: Features of the local fast food environment have been hypothesized to contribute to the greater prevalence of obesity in deprived neighborhoods. However, few studies have investigated whether fast food outlets are more likely to be found in poorer areas, and those that have are local case studies. In this paper, using national-level data, we examine the association between neighborhood deprivation and the density of McDonald's restaurants in small census areas (neighborhoods) in Scotland and England. METHODS: Data on population, deprivation, and the location of McDonald's Restaurants were obtained for 38,987 small areas in Scotland and England (6505 "data zones" in Scotland, and 32,482 "super output areas" in England) in January 2005. Measures of McDonald's restaurants per 1000 people for each area were calculated, and areas were divided into quintiles of deprivation. Associations between neighborhood deprivation and outlet density were examined during February 2005, using one-way analysis of variance in Scotland, England, and both countries combined. RESULTS: Statistically significant positive associations were found between neighborhood deprivation and the mean number of McDonald's outlets per 1000 people for Scotland (p
  342. Author: Crepinsek MK, Gordon AR, McKinney PM, Condon EM, Wilson A
    Title: Meals offered and served in US public schools: do they meet nutrient standards?
    Journal: J Am Diet Assoc. 109(2 Suppl):S31-43
    Date: 2009 Feb
    Abstract: BACKGROUND: Concerns about the diets of school-aged children and new nutrition recommendations for the US population have increased interest in the nutritional quality of meals available through the National School Lunch Program and School Breakfast Program. OBJECTIVE: This article updates national estimates of the food energy and nutrient content of school meals and compares these estimates to federal nutrient standards established under the 1995 School Meals Initiative for Healthy Children. DESIGN: Data were collected as part of the third School Nutrition Dietary Assessment Study, a nationally representative cross-sectional study fielded during school year 2004-2005. Menu and recipe data for a typical school week were collected in a mail survey with telephone assistance. Nutrient information for common commercially prepared food items was obtained from manufacturers, to supplement the Food and Nutrient Database for Dietary Studies used to analyze the data. Analyses were conducted for meals offered and meals served to (selected by) children. SUBJECTS/SETTING: Samples of 130 public school districts that offered federally subsidized school meals, and 398 schools within those districts, participated in the study. Foodservice managers in each school completed a menu survey. STATISTICAL ANALYSES PERFORMED: Descriptive tabulations present weighted means, proportions, and standard errors for elementary, middle, and high schools, and for all schools combined. RESULTS: Most schools offered and served meals that met the standards for protein, vitamins, and minerals. Fewer than one third of schools met the standards for energy from fat or saturated fat in the average lunch, whereas three fourths or more met the fat standards in school breakfasts. For both meals, average levels of sodium were high and fiber was low relative to Dietary Guidelines for Americans 2005 recommendations. CONCLUSIONS: For school meals to meet nutrient standards and promote eating behaviors consistent with the Dietary Guidelines, future policy, practice, and research should focus on reducing levels of fat and sodium and increasing fiber.
  343. Author: Bader MD, Ailshire JA, Morenoff JD, House JS
    Title: Measurement of the local food environment: a comparison of existing data sources.
    Journal: Am J Epidemiol. 171(5):609-17
    Date: 2010 Mar 1
    Abstract: Studying the relation between the residential environment and health requires valid, reliable, and cost-effective methods to collect data on residential environments. This 2002 study compared the level of agreement between measures of the presence of neighborhood businesses drawn from 2 common sources of data used for research on the built environment and health: listings of businesses from commercial databases and direct observations of city blocks by raters. Kappa statistics were calculated for 6 types of businesses-drugstores, liquor stores, bars, convenience stores, restaurants, and grocers-located on 1,663 city blocks in Chicago, Illinois. Logistic regressions estimated whether disagreement between measurement methods was systematically correlated with the socioeconomic and demographic characteristics of neighborhoods. Levels of agreement between the 2 sources were relatively high, with significant (P
  344. Author: Bertrand L, Thérien F, Cloutier MS
    Title: Measuring and mapping disparities in access to fresh fruits and vegetables in Montréal.
    Journal: Can J Public Health. 99(1):6-11
    Date: 2008 Jan-Feb
    Abstract: OBJECTIVE: This study was conducted to evaluate disparities in access to healthy food in Montreal, focusing on the availability of fresh fruits and vegetables (F/V) as an indicator. METHOD: F/V selling area was measured in all food retail stores and public markets offering more than 75 square feet of fresh fruits and vegetables. An accessibility index was elaborated, taking into account motorization rates and the total surface of these fresh foods for sale within an easily accessible zone. The extent of that zone was determined differently for motorized (3 km) and non-motorized (500 m) consumers. Measures were calculated and georeferenced at the level of "Dissemination Areas" according to the 2001 Census. RESULTS: In general, access to healthy foods is quite good for consumers who shop by car. But 40% of the population have poor access to fruits and vegetables within a walkable distance from home. No relationship is observed between median income in dissemination areas and food supply. CONCLUSION: Improved access to healthy food by non-motorized consumers is needed in many areas of Montreal. Implications of differential access to fresh fruits and vegetables for health and environmental sustainability are discussed.
  345. Author: Moore LV, Diez Roux AV, Franco M
    Title: Measuring availability of healthy foods: agreement between directly measured and self-reported data.
    Journal: Am J Epidemiol. 175(10):1037-44
    Date: 2012 May 15
    Abstract: A major challenge in studies of the impact of the local food environment is the accuracy of measures of healthy food access. The authors assessed agreement between self-reported and directly measured availability of healthful choices within neighborhood food stores and examined the validity of reported availability using directly measured availability as a "gold standard." Reported availability was measured via a phone survey of 1,170 adults in Baltimore, Maryland, in 2004. Directly measured availability was assessed in 226 food stores in 2006 using a modified Nutrition Environment Measures Survey in Stores (NEMS-S). Whites, college-educated individuals, and higher income households (≥$50,000) had significantly higher reported and directly measured availability than did blacks, those with less education, and lower income households. Persons in areas with above average directly measured availability reported above average availability 70%-80% of the time (sensitivity = 79.6% for all stores within 1 mile (1.6 km) of participants' homes and 69.6% for the store with the highest availability within 1 mile). Those with below average directly measured availability reported low availability only half the time. With revisions to improve specificity, self-reported measures can be reasonable indicators of healthy food availability and provide feasible proxy measures of directly assessed availability.
  346. Author: Cassady D, Housemann R, Dagher C
    Title: Measuring cues for healthy choices on restaurant menus: development and testing of a measurement instrument.
    Journal: Am J Health Promot. 18(6):444-9
    Date: 2004 Jul-Aug
    Abstract: PURPOSE: To develop and test the Menu Checklist, an instrument to be used by community members to assess cues for healthy choices in restaurants. DESIGN: Menus from 14 restaurants were coded independently by two trained community reviewers to test the interrater reliability of the instrument. SETTING: A low-income, urban, African-American community in Los Angeles, California. SUBJECTS: Restaurants were selected based on community perceptions of their potential to be included in a nutrition education and advocacy program to improve the availability of healthy foods. MEASURES: The Menu Checklist was adapted from previously tested measurement tools developed by the Prevention Research Center at Saint Louis University. Intraclass correlation coefficients (ICCs), kappa statistics, and percent agreements were calculated to assess interrater reliability. Descriptive statistics were calculated to show the availability of cues for healthy foods. RESULTS: The interrater reliability coefficients for the majority of items were high (.93-1.0). Labeling on restaurant menus was rare, as were low-fat choices. Fruits and vegetables were readily available: 31% of all entrees included one serving and 39% of all appetizers were primarily fruits and vegetables. CONCLUSIONS: The Menu Checklist is a reliable, low-cost means for community members to collect data on influences on food choices in restaurants.
  347. Author: Burns CM, Inglis AD
    Title: Measuring food access in Melbourne: access to healthy and fast foods by car, bus and foot in an urban municipality in Melbourne.
    Journal: Health Place. 13(4):877-85
    Date: 2007 Dec
    Abstract: Access to healthy food can be an important determinant of a healthy diet. This paper describes the assessment of access to healthy and unhealthy foods using a GIS accessibility programme in a large outer municipality of Melbourne. Access to a major supermarket was used as a proxy for access to a healthy diet and fast food outlet as proxy for access to unhealthy food. Our results indicated that most (>80%) residents lived within an 8-10 min car journey of a major supermarket i.e. have good access to a healthy diet. However, more advantaged areas had closer access to supermarkets, conversely less advantaged areas had closer access to fast food outlets. These findings have application for urban planners, public health practitioners and policy makers.
  348. Author: Gordon C, Purciel-Hill M, Ghai NR, Kaufman L, Graham R, Van Wye G
    Title: Measuring food deserts in New York City's low-income neighborhoods.
    Journal: Health Place. 17(2):696-700
    Date: 2011 Mar
    Abstract: There has been growing interest in the environmental factors that contribute to poor health outcomes, particularly in areas where health disparities are pronounced. The locations of food deserts, or unhealthy food environments, correspond to areas with the highest proportions of African-American/Black residents, a population suffering from higher rates of many chronic conditions, including obesity and diabetes in our study area. This study seeks to enhance our understanding of the role of the neighborhood environment on residents' health, by examining neighborhood food availability and access in low-income and wealthier neighborhoods of New York City. We documented the neighborhood food environment and areas we call "food deserts" by creating methodological innovations. We calculated the lowest scores within East and Central Harlem and North and Central Brooklyn-areas with the highest proportions of Black residents and the lowest median household incomes. By contrast, the most favorable food desert scores were on the Upper East Side, a predominantly white, middle and upper-income area.
  349. Author: Guy CM, David G
    Title: Measuring physical access to 'healthy foods' in areas of social deprivation: a case study in Cardiff
    Journal: International journal of consumer studies. 28(3):222-34
    Date: 2004
    Abstract: This paper examines some characteristics of food deserts areas of social deprivation which have poor physical access to food shopping in a large British city, Cardiff. The stereotype of the food desert is critically examined, emphasizing the importance attached by residents of such areas to easy access to food shopping, especially in multiple supermarkets. The case study of Cardiff briefly discusses the identification of potential food deserts, and then examines the structures of healthy food availability and prices in four areas of the city (two in the inner city, two in the outer city) where physical access to large multiple supermarkets is poor. The analysis shows that the local shops in these areas cannot compete generally with large supermarkets on either availability of items or their prices, but that the local shops in the inner city areas are rather more competitive than those in the outer areas. Implications for research and policy formulation are finally discussed.
  350. Author: Ribisl KM, Reischl TM
    Title: Measuring the climate for health at organizations. Development of the worksite health climate scales.
    Journal: J Occup Med. 35(8):812-24
    Date: 1993 Aug
    Abstract: Worksite health promotion research has overemphasized the impact of individual behaviors on employee well-being and neglected the important influence of the work environment. In the present research effort, measures of the health climate at the worksite were developed, administered to employees at a newspaper company, and then tested for their psychometric properties. After revising the original scales, several health outcome variables and an improved version of the measure were administered to employees at seven small worksites. The results indicated that the health climate differed significantly across worksites and that health climate perceptions were significantly related to measures of physical symptoms; exercise, nutrition, and smoking habits; job stress; and job satisfaction.
  351. Author: Farley TA, Rice J, Bodor JN, Cohen DA, Bluthenthal RN, Rose D
    Title: Measuring the food environment: shelf space of fruits, vegetables, and snack foods in stores.
    Journal: J Urban Health. 86(5):672-82
    Date: 2009 Sep
    Abstract: Dietary patterns may be influenced by the availability and accessibility within stores of different types of foods. However, little is known about the amount of shelf space used for healthy and unhealthy foods in different types of stores. We conducted measurements of the length of shelf space used for fruits, vegetables, and snack foods items in 419 stores in 217 urban census tracts in southern Louisiana and in Los Angeles County. Although supermarkets offered far more shelf space of fruits and vegetables than did other types of stores, they also devoted more shelf space to unhealthy snacks (mean 205 m for all of these items combined) than to fruits and vegetables (mean 117 m, p
  352. Author: Minaker LM, Raine KD, Cash SB
    Title: Measuring the food service environment: development and implementation of assessment tools.
    Journal: Can J Public Health. 100(6):421-5
    Date: 2009 Nov-Dec
    Abstract: OBJECTIVE: The food environment is increasingly being implicated in the obesity epidemic, though few reported measures of it exist. In order to assess the impact of the food environment on food intake, valid measures must be developed and tested. The current study describes the development of a food service environment assessment tool and its implementation in a community setting. METHODS: A descriptive study with mixed qualitative and quantitative methods at a large, North American university campus was undertaken. Measures were developed on the basis of a conceptual model of nutrition environments. Measures of community nutrition environment were the number, type and hours of operation of each food service outlet on campus. Measures of consumer nutrition environment were food availability, food affordability, food promotion and nutrition information availability. Seventy-five food service outlets within the geographic boundaries were assessed. RESULTS: Assessment tools could be implemented in a reasonable amount of time and showed good face and content validity. The food environments were described and measures were grouped so that food service outlet types could be compared in terms of purchasing convenience, cost/value, healthy food promotion and health. Food service outlet types that scored higher in purchasing convenience and cost/value tended to score lower in healthy food promotion and health. CONCLUSION: This study adds evidence that food service outlet types that are convenient to consumers and supply high value (in terms of calories per dollar) tend to be less health-promoting. Results from this study also suggest the possibility of characterizing the food environment according to the type of food service outlet observed.
  353. Author: Leung CW, Gregorich SE, Laraia BA, Kushi LH, Yen IH
    Title: Measuring the neighborhood environment: associations with young girls' energy intake and expenditure in a cross-sectional study.
    Journal: Int J Behav Nutr Phys Act
    Date: 2010
    Abstract: BACKGROUND: Neighborhood environments affect children's health outcomes. Observational methods used to assess neighborhoods can be categorized as indirect, intermediate, or direct. Direct methods, involving in-person audits of the neighborhoods conducted by trained observers, are recognized as an accurate representation of current neighborhood conditions. The authors investigated the associations of various neighborhood characteristics with young girls' diet and physical activity. METHODS: This study is based on a subset of participants in the Cohort Study of Young Girls' Nutrition, Environment and Transitions (CYGNET). In-person street audits were conducted within 215 girls' residential neighborhoods using a modified St. Louis Audit Tool. From the street audit data, exploratory factor analysis revealed five neighborhood scales: "mixed residential and commercial," "food and retail," "recreation," "walkability," and "physical disorder." A Neighborhood Deprivation Index was also derived from census data. The authors investigated if the five neighborhood scales and the Neighborhood Deprivation Index were associated with quartiles of total energy intake and expenditure (metabolic equivalent (MET) hours/week) at baseline, and whether any of these associations were modified by race/ethnicity. RESULTS: After adjustment for demographic characteristics, there was an inverse association between prevalence of "food and retail" destinations and total energy intake (for a one quartile increase, OR = 0.84, 95% CI 0.74, 0.96). Positive associations were also observed between the "recreation" and "walkability" scales with physical activity among Hispanic/Latina girls (for a one quartile increase in MET, OR = 1.94, 95% CI 1.31, 2.88 for recreation; OR = 1.71, 95% CI 1.11, 2.63 for walkability). Among African-American girls, there was an inverse association between "physical disorder" and physical activity (OR = 0.31, 95% CI 0.12, 0.80). CONCLUSIONS: These results suggest that neighborhood food and retail availability may be inversely associated with young girls' energy intakes in contrast to other studies' findings that focused on adults. There is considerable variation in neighborhoods' influences on young girls' physical activity behaviors, particularly for young girls of different racial/ethnic backgrounds.
  354. Author: Carter MA, Swinburn B
    Title: Measuring the 'obesogenic' food environment in New Zealand primary schools.
    Journal: Health Promot Int. 19(1):15-20
    Date: 2004 Mar
    Abstract: Childhood obesity is an increasing health problem in New Zealand and many other countries. Information is needed to guide interventions that reduce the 'obesogenic' (obesity-promoting) elements of school environments. The aim of this study was to identify and measure the obesogenic elements of the school environment and the canteen sales of energy-dense foods and drinks. A self-completion questionnaire was developed for assessing each school's nutrition environment and mailed to a stratified random sample of New Zealand schools. The responses from primary schools (n = 200, response rate 61%) were analysed. Only 15.5% of schools had purpose-built canteen facilities and over half ran a food service for profit (31% profit to the school, 24.5% profit for the contractors). Only 16.5% of schools had a food policy, although 91% of those rated the policy as effective or very effective. The most commonly available foods for sale were pies (79%), juice (57%) and sausage rolls (54.5%). Filled rolls were the most expensive item (mean dollars 1.79) and fruit the least expensive (mean dollars 0.47). The ratio of 'less healthy' to 'more healthy' main choices was 5.6:1, for snacks it was 9.3:1 and for drinks it was 1.4:1. In contrast, approximately 60% of respondents said that nutrition was a priority for the school. Only 50% felt there was management support for healthy food choices and only 39% agreed that mainly nutritious food was offered by the food service. 'Less healthy' choices dominated food sales by more than 2:1, with pies being the top selling item (>55000 per week). We found that the food environment was not conducive to healthy food choices for the children at New Zealand schools and that this was reflected in the high sales of relatively unhealthy foods from the school food services. Programmes that improve school food through policies, availability, prices and school ethos are urgently needed.
  355. Author: Jilcott SB, McGuirt JT, Imai S, Evenson KR
    Title: Measuring the retail food environment in rural and urban North Carolina counties.
    Journal: J Public Health Manag Pract. 16(5):432-40
    Date: 2010 Sep-Oct
    Abstract: BACKGROUND: Development of accurate and sensitive methods to characterize the food environment is needed. Thus, we examined convergent and criterion validity of 2 retail food environment data sources and then examined differences in predictive validity between 3 ways of measuring the rural and urban food environment. METHODS: Ten counties were selected in each of 3 North Carolina regions (n = 30). Number of fast-food restaurants and chain supermarkets were calculated using 2 data sources. Convergent validity was percent agreement between the 2 sources. Criterion validity was percent agreement between each source and the most accurate venue count. Predictive validity of food environment measures (Retail Food Environment Index, fast-food restaurants/capita, and supermarkets/capita) was calculated by associations with county-level mean-weighted body mass index (BMI). RESULTS: Percent agreement for fast-food restaurants ranged from 50% to 100% (mean = 87%) and for supermarkets ranged from 58% to 100% (mean = 89%). The 2 data sources had similar percent agreement with the most accurate count. Retail Food Environment Index was positively associated with BMI, while fast-food restaurants per capita were negatively associated with BMI. CONCLUSIONS: Our results lend support to studies using both food environment data sources examined.
  356. Author: Fisher B, Golaszewski T, Barr D
    Title: Measuring worksite resources for employee heart health.
    Journal: Am J Health Promot. 13(6):325-32
    Date: 1999 Jul-Aug
    Abstract: PURPOSE: Intervention at the organizational rather than the individual level is gaining greater attention in worksite health promotion efforts. However, little research has been done on instruments to measure this domain. Therefore, the purpose of this study was to further test the utility of an existing organizational heart health support instrument by examining relationships among worksite structural characteristics and comparing these results to other survey findings. DESIGN: One-time cross-sectional. SETTING: New York State. SUBJECTS: One hundred fifteen volunteer worksites in the New York State Healthy Heart Program, representing manufacturing, government, education, health care, and other industries. MEASURES: A survey was conducted using HeartCheck, an organizational assessment of employee support for heart health. HeartCheck contains 175 items measuring organizational support for tobacco control, nutrition, physical activity, stress, screening, and administrative support structure. RESULTS: On average, only 22% of all worksite resources assessed were present in the sample. Having a workforce greater than 250 provided a 12% increase in predicted overall worksite resources. A predominantly female workforce (> 75%) provided 10% higher levels of worksite stress resources. Worksites with unions had higher levels of resources for physical activity (10%), screening (13%), and general supportive structures (10%). The presence of manual labor diminished support for tobacco control resources (-13%). Finally, manufacturing worksites demonstrated a clear advantage for all types of worksite resources, except for stress. CONCLUSION: A number of trends found in this study are consistent with earlier work. Industry type and size both predict worksite supports similar to previous studies. Other findings that appear to contradict previous work, including the relatively low level of support observed in this sample, can be explained by the comprehensive nature of the instrument. Overall, these findings demonstrate the utility of HeartCheck.
  357. Author: Valdez Z, Dean WR, Sharkey JR
    Title: Mobile and home-based vendors' contributions to the retail food environment in rural South Texas Mexican-origin settlements.
    Journal: Appetite. 59(2):212-7
    Date: 2012 Oct
    Abstract: A growing concern with high rates of obesity and overweight among immigrant minority populations in the US has focused attention on the availability and accessibility to healthy foods in such communities. Small-scale vending in rural, impoverished and underserved areas, however, is generally overlooked; yet, this type of informal activity and source for food is particularly important in such environs, or "food desserts," where traditional forms of work and mainstream food outlets are limited or even absent. This exploratory study investigates two types of small-scale food vending that take place in rural colonias, or Mexican-origin settlements along the South Texas border with Mexico: mobile and home-based. Using a convenience sample of 23 vendors who live and work in Texas colonias, this study identifies the characteristics associated with mobile and home-based food vendors and their businesses and its contributions to the rural food environment. Findings reveal that mobile and home-based vending provides a variety of food and beverage options to colonia residents, and suggests that home-based vendors contribute a greater assortment of food options, including some healthier food items, than mobile food vendors, which offer and sell a limited range of products. Findings may contribute to the development of innovative policy solutions and interventions aimed at increasing healthy food options or reducing health disparities in immigrant communities.
  358. Author: Zenk SN, Schulz AJ, Lachance LL, Mentz G, Kannan S, Ridella W, Galea S
    Title: Multilevel correlates of satisfaction with neighborhood availability of fresh fruits and vegetables.
    Journal: Ann Behav Med. 38(1):48-59
    Date: 2009 Aug
    Abstract: BACKGROUND: Little is known about influences on perceptions of neighborhood food environments, despite their relevance for food-shopping behaviors and food choices. PURPOSE: This study examined relationships between multilevel factors (neighborhood structure, independently observed neighborhood food environment, and individual socioeconomic position) and satisfaction with neighborhood availability of fruits and vegetables. METHODS: The multilevel regression analysis drew on data from a community survey of urban adults, in-person audit and mapping of food stores, and the 2000 Census. RESULTS: Satisfaction with neighborhood availability of fruits and vegetables was lower in neighborhoods that were farther from a supermarket and that had proportionately more African-American residents. Neighborhood poverty and independently observed neighborhood fruit and vegetable characteristics (variety, prices, and quality) were not associated with satisfaction. Individual education modified relationships between neighborhood availability of smaller food stores (small grocery stores, convenience stores, and liquor stores) and satisfaction. CONCLUSIONS: Individual-level and neighborhood-level factors affect perceptions of neighborhood food environments.
  359. Author: Cutler GJ, Flood A, Hannan P, Neumark-Sztainer D
    Title: Multiple sociodemographic and socioenvironmental characteristics are correlated with major patterns of dietary intake in adolescents.
    Journal: J Am Diet Assoc. 111(2):230-40
    Date: 2011 Feb
    Abstract: BACKGROUND: Few studies have used dietary pattern analysis, a useful method to summarize dietary intake, in adolescents. OBJECTIVE: Examine sociodemographic and socioenvironmental correlates of habitual dietary patterns. DESIGN: Data for this cross-sectional/prospective analysis were drawn from Project EAT (Eating Among Teens), a population-based study. SUBJECTS/SETTING: Project EAT-I (Time 1), collected data on 4,746 adolescents in 1998-1999. Project EAT-II (Time 2) resurveyed 53% (n=2,516) of the original cohort 5 years later in 2003-2004. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire. MAIN OUTCOME MEASURES/STATISTICAL ANALYSIS PERFORMED: Factor analysis identified four dietary patterns at Time 1 (vegetable, fruit, starchy food, and snack food) and Time 2 (vegetable and fruit, fast food, starchy food, and snack food). Linear regression was used to examine the relationship of Time 1 socioeconomic status and race (mutually adjusted) on factor scores for each dietary pattern, and then of Time 1 socioenvironmental characteristics (adjusted for socioeconomic status and race) on these factor scores. RESULTS: In prospective analyses, socioeconomic status, family meal frequency, and home availability of healthy food were positively associated with the vegetable and fruit and starchy food patterns and inversely associated with the fast food pattern. Home availability of unhealthy food was inversely associated with the vegetable and fruit and starchy food patterns and positively associated with the fast food and snack food patterns. Maternal, paternal, and peer support for healthy eating were positively associated with the vegetable and fruit pattern and inversely associated with the fast food pattern. Similar associations were seen in cross-sectional analyses. CONCLUSIONS: Multiple correlates of dietary patterns were identified. Health professionals should target these factors to improve the dietary quality of habitual eating practices in adolescents by encouraging parents to decrease home availability of unhealthy food while increasing availability of healthy food, family meal frequency, and parental support for healthy eating.
  360. Author: Gary-Webb TL, Baptiste-Roberts K, Pham L, Wesche-Thobaben J, Patricio J, Pi-Sunyer FX, Brown AF, Jones L, Brancati FL, Look Research Group AHEAD
    Title: Neighborhood and weight-related health behaviors in the Look AHEAD (Action for Health in Diabetes) study.
    Journal: BMC Public Health. 10(1):312
    Date: 2010 Jun 4
    Abstract: BACKGROUND: Previous studies have shown that neighborhood factors are associated with obesity, but few studies have evaluated the association with weight control behaviors. This study aims to conduct a multi-level analysis to examine the relationship between neighborhood SES and weight-related health behaviors. METHODS: In this ancillary study to Look AHEAD (Action for Health in Diabetes) a trial of long-term weight loss among individuals with type 2 diabetes, individual-level data on 1219 participants from 4 clinic sites at baseline were linked to neighborhood-level data at the tract level from the 2000 US Census and other databases. Neighborhood variables included SES (% living below the federal poverty level) and the availability of food stores, convenience stores, and restaurants. Dependent variables included BMI, eating patterns, weight control behaviors and resource use related to food and physical activity. Multi-level models were used to account for individual-level SES and potential confounders. RESULTS: The availability of restaurants was related to several eating and weight control behaviors. Compared to their counterparts in neighborhoods with fewer restaurants, participants in neighborhoods with more restaurants were more likely to eat breakfast (prevalence Ratio [PR] 1.29 95% CI: 1.01-1.62) and lunch (PR = 1.19, 1.04-1.36) at non-fast food restaurants. They were less likely to be attempting weight loss (OR = 0.93, 0.89-0.97) but more likely to engage in weight control behaviors for food and physical activity, respectively, than those who lived in neighborhoods with fewer restaurants. In contrast, neighborhood SES had little association with weight control behaviors. CONCLUSION: In this selected group of weight loss trial participants, restaurant availability was associated with some weight control practices, but neighborhood SES was not. Future studies should give attention to other populations and to evaluating various aspects of the physical and social environment with weight control practices.
  361. Author: Franco M, Diez Roux AV, Glass TA, Caballero B, Brancati FL
    Title: Neighborhood characteristics and availability of healthy foods in Baltimore.
    Journal: Am J Prev Med. 35(6):561-7
    Date: 2008 Dec
    Abstract: BACKGROUND: Differential access to healthy foods may contribute to racial and economic health disparities. The availability of healthy foods has rarely been directly measured in a systematic fashion. This study examines the associations among the availability of healthy foods and racial and income neighborhood composition. METHODS: A cross-sectional study was conducted in 2006 to determine differences in the availability of healthy foods across 159 contiguous neighborhoods (census tracts) in Baltimore City and Baltimore County and in the 226 food stores within them. A healthy food availability index (HFAI) was determined for each store, using a validated instrument ranging from 0 points to 27 points. Neighborhood healthy food availability was summarized by the mean HFAI for the stores within the neighborhood. Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood characteristics with healthy food availability. RESULTS: Forty-three percent of predominantly black neighborhoods and 46% of lower-income neighborhoods were in the lowest tertile of healthy food availability versus 4% and 13%, respectively, in predominantly white and higher-income neighborhoods (p
  362. Author: Morland K, Wing S, Diez Roux A, Poole C
    Title: Neighborhood characteristics associated with the location of food stores and food service places.
    Journal: Am J Prev Med. 22(1):23-9
    Date: 2002 Jan
    Abstract: BACKGROUND: Although the relationship between diet and disease is well established, sustainable dietary changes that would affect risk for disease have been difficult to achieve. Whereas individual factors are traditional explanations for the inability of some people to change dietary habits, little research has investigated how the physical availability of healthy foods affects individuals' diets. This study examines the distribution of food stores and food service places by neighborhood wealth and racial segregation. METHODS: Names and addresses of places to buy food in Mississippi, North Carolina, Maryland, and Minnesota were obtained from respective departments of health and agriculture. Addresses were geocoded to census tracts. Median house values were used to estimate neighborhood wealth, while the proportion of black residents was used to measure neighborhood racial segregation. RESULTS: Compared to the poorest neighborhoods, large numbers of supermarkets and gas stations with convenience stores are located in wealthier neighborhoods. There are 3 times fewer places to consume alcoholic beverages in the wealthiest compared to the poorest neighborhoods (prevalence ratio [PR]=0.3, 95% confidence interval [CI]=0.1-0.6). Regarding neighborhood segregation, there are 4 times more supermarkets located in white neighborhoods compared to black neighborhoods (PR=4.3, 95% CI=1.5-12.5). CONCLUSIONS: Without access to supermarkets, which offer a wide variety of foods at lower prices, poor and minority communities may not have equal access to the variety of healthy food choices available to nonminority and wealthy communities.
  363. Author: Veugelers P, Sithole F, Zhang S, Muhajarine N
    Title: Neighborhood characteristics in relation to diet, physical activity and overweight of Canadian children.
    Journal: Int J Pediatr Obes. 3(3):152-9
    Date: 2008
    Abstract: BACKGROUND: Neighborhood infrastructure may provide an important opportunity to prevent overweight among children. In the present study we investigated whether access to shops for modestly priced fresh produce, access to parks and playgrounds, access to recreational facilities and neighborhood safety are related to children's diet, physical and sedentary activities, and body weights. METHODS: Data were obtained from the Children's Lifestyle and School-performance Study, a survey including 5,471 grade five students and their parents in the province of Nova Scotia, Canada. Students completed the Harvard Food Frequency Questionnaire and had their height and weight measured. Parents completed questions on socio-economic background and how they perceived their neighborhood. We applied multilevel regression methods to relate these neighborhood characteristics with children's fruit and vegetable consumption, dietary fat intake, diet quality, frequency of engaging in sports with and without a coach, screen time, overweight and obesity. RESULTS: Children in neighborhoods with greater perceived access to shops had healthier diets and were less likely to be overweight or obese. Children in neighborhoods with good access to playgrounds, parks and recreational facilities were reportedly more active and were less likely to be overweight or obese, whereas children in safe neighborhoods engaged more in unsupervised sports. CONCLUSIONS: The study demonstrated associations between neighborhood characteristics, health behaviors and childhood overweight. This contributes to the knowledge base that is still too narrow to justify informed preventative public health policy. We advocate the evaluation of natural experiments created by new policy that affect neighborhood infrastructures as the optimal opportunity to enlarge this knowledge base.
  364. Author: Pearce J, Blakely T, Witten K, Bartie P
    Title: Neighborhood deprivation and access to fast-food retailing: a national study.
    Journal: Am J Prev Med. 32(5):375-82
    Date: 2007 May
    Abstract: BACKGROUND: Obesogenic environments may be an important contextual explanation for the growing obesity epidemic, including its unequal social distribution. The objective of this study was to determine whether geographic access to fast-food outlets varied by neighborhood deprivation and school socioeconomic ranking, and whether any such associations differed to those for access to healthier food outlets. METHODS: Data were collected on the location of fast-food outlets, supermarkets, and convenience stores across New Zealand. The data were geocoded and geographic information systems used to calculate travel distances from each census meshblock (i.e., neighborhood), and each school, to the closest fast-food outlet. Median travel distances are reported by a census-based index of socioeconomic deprivation for each neighborhood, and by a Ministry of Education measure of socioeconomic circumstances for each school. Analyses were repeated for outlets selling healthy food to allow comparisons. RESULTS: At the national level, statistically significant negative associations were found between neighborhood access to the nearest fast-food outlet and neighborhood deprivation (p
  365. Author: Ford PB, Dzewaltowski DA
    Title: Neighborhood deprivation, supermarket availability, and BMI in low-income women: a multilevel analysis.
    Journal: J Community Health. 36(5):785-96
    Date: 2011 Oct
    Abstract: High levels of neighborhood deprivation and lack of access to supermarkets have been associated with increased risk of obesity in women. This multilevel study used a statewide dataset (n = 21,166) of low-income women in the Special Supplemental Nutrition Program for Women, Infants, and Children to determine whether the association between neighborhood deprivation and BMI is mediated by the availability of retail food stores, and whether this relationship varied across the urban rural continuum. Residence in a high deprivation neighborhood was associated with a 0.94 unit increase in BMI among women in metropolitan areas. The relationship between tract deprivation and BMI was not linear among women in micropolitan areas, and no association was observed in rural areas. The presence of supermarkets or other retail food stores did not mediate the association between deprivation and BMI among women residing in any of the study areas. These results suggest that level of urbanity influences the effect of neighborhood condition on BMI among low-income women, and that the availability of supermarkets and other food stores does not directly influence BMI among low-income populations.
  366. Author: Sharkey JR, Horel S, Dean WR
    Title: Neighborhood deprivation, vehicle ownership, and potential spatial access to a variety of fruits and vegetables in a large rural area in Texas.
    Journal: Int J Health Geogr
    Date: 2010
    Abstract: OBJECTIVE: There has been limited study of all types of food stores, such as traditional (supercenters, supermarkets, and grocery stores), convenience stores, and non-traditional (dollar stores, mass merchandisers, and pharmacies) as potential opportunities for purchase of fresh and processed (canned and frozen) fruits and vegetables, especially in small-town or rural areas. METHODS: Data from the Brazos Valley Food Environment Project (BVFEP) are combined with 2000 U.S. Census data for 101 Census block groups (CBG) to examine neighborhood access to fruits and vegetables. BVFEP data included identification and geocoding of all food stores (n = 185) in six rural counties in Texas, using ground-truthed methods and on-site assessment of the availability and variety of fresh and processed fruits and vegetables in all food stores. Access from the population-weighted centroid of each CBG was measured using proximity (minimum network distance) and coverage (number of shopping opportunities) for a good selection of fresh and processed fruits and vegetables. Neighborhood inequalities (deprivation and vehicle ownership) and spatial access for fruits and vegetables were examined using Wilcoxon matched-pairs signed-rank test and multivariate regression models. RESULTS: The variety of fruits or vegetables was greater at supermarkets compared with grocery stores. Among non-traditional and convenience food stores, the largest variety was found at dollar stores. On average, rural neighborhoods were 9.9 miles to the nearest supermarket, 6.7 miles and 7.4 miles to the nearest food store with a good variety of fresh fruits and vegetables, respectively, and 4.7 miles and 4.5 miles to a good variety of fresh and processed fruits or vegetables. High deprivation or low vehicle ownership neighborhoods had better spatial access to a good variety of fruits and vegetables, both in the distance to the nearest source and in the number of shopping opportunities. CONCLUSION: Supermarkets and grocery stores are no longer the only shopping opportunities for fruits or vegetables. The inclusion of data on availability of fresh or processed fruits or vegetables in the measurements provides robust meaning to the concept of potential access in this large rural area.
  367. Author: Hanibuchi T, Kondo K, Nakaya T, Nakade M, Ojima T, Hirai H, Kawachi I
    Title: Neighborhood food environment and body mass index among Japanese older adults: results from the Aichi Gerontological Evaluation Study (AGES).
    Journal: Int J Health Geogr. 10(1):43
    Date: 2011
    Abstract: BACKGROUND: The majority of studies of the local food environment in relation to obesity risk have been conducted in the US, UK, and Australia. The evidence remains limited to western societies. The aim of this paper is to examine the association of local food environment to body mass index (BMI) in a study of older Japanese individuals. METHODS: The analysis was based on 12,595 respondents from cross-sectional data of the Aichi Gerontological Evaluation Study (AGES), conducted in 2006 and 2007. Using Geographic Information Systems (GIS), we mapped respondents' access to supermarkets, convenience stores, and fast food outlets, based on a street network (both the distance to the nearest stores and the number of stores within 500 m of the respondents' home). Multiple linear regression and logistic regression analyses were performed to examine the association between food environment and BMI. RESULTS: In contrast to previous reports, we found that better access to supermarkets was related to higher BMI. Better access to fast food outlets or convenience stores was also associated with higher BMI, but only among those living alone. The logistic regression analysis, using categorized BMI, showed that the access to supermarkets was only related to being overweight or obese, but not related to being underweight. CONCLUSIONS: Our findings provide mixed support for the types of food environment measures previously used in western settings. Importantly, our results suggest the need to develop culture-specific approaches to characterizing neighborhood contexts when hypotheses are extrapolated across national borders.
  368. Author: Rundle A, Neckerman KM, Freeman L, Lovasi GS, Purciel M, Quinn J, Richards C, Sircar N, Weiss C
    Title: Neighborhood food environment and walkability predict obesity in New York City.
    Journal: Environ Health Perspect. 117(3):442-7
    Date: 2009 Mar
    Abstract: BACKGROUND: Differences in the neighborhood food environment may contribute to disparities in obesity. OBJECTIVES: The purpose of this study was to examine the association of neighborhood food environments with body mass index (BMI) and obesity after control for neighborhood walkability. METHODS: This study employed a cross-sectional, multilevel analysis of BMI and obesity among 13,102 adult residents of New York City. We constructed measures of the food environment and walkability for the neighborhood, defined as a half-mile buffer around the study subject's home address. RESULTS: Density of BMI-healthy food outlets (supermarkets, fruit and vegetable markets, and natural food stores) was inversely associated with BMI. Mean adjusted BMI was similar in the first two quintiles of healthy food density (0 and 1.13 stores/km2, respectively), but declined across the three higher quintiles and was 0.80 units lower [95% confidence interval (CI), 0.27-1.32] in the fifth quintile (10.98 stores/km2) than in the first. The prevalence ratio for obesity comparing the fifth quintile of healthy food density with the lowest two quintiles combined was 0.87 (95% CI, 0.78-0.97). These associations remained after control for two neighborhood walkability measures, population density and land-use mix. The prevalence ratio for obesity for the fourth versus first quartile of population density was 0.84 (95% CI, 0.73-0.96) and for land-use mix was 0.91 (95% CI, 0.86-0.97). Increasing density of food outlets categorized as BMI-unhealthy was not significantly associated with BMI or obesity. CONCLUSIONS: Access to BMI-healthy food stores is associated with lower BMI and lower prevalence of obesity.
  369. Author: Rose D, Hutchinson PL, Bodor JN, Swalm CM, Farley TA, Cohen DA, Rice JC
    Title: Neighborhood food environments and Body Mass Index: the importance of in-store contents.
    Journal: Am J Prev Med. 37(3):214-9
    Date: 2009 Sep
    Abstract: BACKGROUND: Most public health studies on the neighborhood food environment have focused on types of stores and their geographic placement, yet marketing research has long documented the influence of in-store shelf-space on consumer behavior. PURPOSE: This paper combines these two strands of research to test whether the aggregate availability of specific foods in a neighborhood is associated with the BMIs of its residents. METHODS: Fielded from October 2004 to August 2005, this study combines mapping of retail food outlets, in-store surveys, and telephone interviews of residents from 103 randomly sampled urban census tracts in southeastern Louisiana. Linear shelf-space of fruits, vegetables, and energy-dense snack foods was measured in 307 food stores in the study tracts. Residential addresses, demographic information, and heights and weights were obtained from 1243 respondents through telephone interviews. Cumulative shelf-space of foods within defined distances of each respondent was calculated using observations from the in-store survey and probability-based assignments of shelf-space to all unobserved stores in the area. RESULTS: After controlling for sociodemographic variables, income, and car ownership, regression analysis, conducted in 2008, showed that cumulative shelf-space availability of energy-dense snack foods was positively, although modestly, associated with BMI. A 100-meter increase in shelf-space of these foods within 1 kilometer of a respondent's household was associated with an additional 0.1 BMI points. Fruit and vegetable shelf-space was not significantly related to BMI. CONCLUSIONS: Interventions that seek to improve the neighborhood food environment may need to focus on more than just increasing access to healthy foods, because the results suggest that the availability of energy-dense snack foods plays a role in weight status.
  370. Author: Murakami K, Sasaki S, Takahashi Y, Uenishi K, Japan Dietetic Students' Study for Nutrition and Biomarkers Group
    Title: Neighborhood food store availability in relation to food intake in young Japanese women.
    Journal: Nutrition. 25(6):640-6
    Date: 2009 Jun
    Abstract: OBJECTIVE: Information on the association between the local food environment and the diet of individuals is limited, particularly in settings with high population density and, hence, high food-store density, such as Japan. This cross-sectional study examined the association between neighborhood food-store availability and individual food intake in a group of young Japanese women. METHODS: Participants were 990 female Japanese dietetic students 18-22 y of age. Neighborhood food-store availability was defined as the number of food stores within a 1-km mesh-block of residence, derived from the census of commerce. Dietary intake was estimated using a validated, comprehensive self-administered diet-history questionnaire. RESULTS: After adjustment for potential confounding factors, including household socioeconomic status, geographic variables, and the frequency of eating out, neighborhood store availability for confectioneries and bread (based on confectionery stores/bakeries, supermarkets, and grocery and convenience stores) was significantly positively associated with the intake of confectioneries and bread. No significant independent association was seen between neighborhood store availability for the other foods examined, including meat (meat stores, supermarkets, and grocery stores), fish (fish stores, supermarkets, and grocery stores), fruit and vegetables (fruit/vegetable stores, supermarkets, and grocery stores), and rice (rice stores, supermarkets, and grocery and convenience stores) with intake of each food. CONCLUSION: In a group of young Japanese women, increasing neighborhood store availability for confectioneries and bread was independently associated with higher intake of confectioneries and bread. In contrast, no association between availability and intake was seen for meat, fish, fruit and vegetables, or rice.
  371. Author: Auchincloss AH, Mujahid MS, Shen M, Michos ED, Whitt-Glover MC, Diez Roux AV
    Title: Neighborhood health-promoting resources and obesity risk (the Multi-Ethnic Study of Atherosclerosis).
    Journal: Obesity (Silver Spring)
    Date: 2012 Apr 19
    Abstract: While behavioral change is necessary to reverse the obesity epidemic, it can be difficult to achieve and sustain in unsupportive residential environments. This study hypothesized that environmental resources supporting walking and a healthy diet are associated with reduced obesity incidence. Data came from 4008 adults aged 45-84 at baseline who participated in a neighborhood ancillary study of the Multi-Ethnic Study of Atherosclerosis. Participants were enrolled at 6 study sites at baseline (2000-2002) and neighborhood scales were derived from a supplementary survey that asked community residents to rate availability of healthy foods and walking environments for a one-mile buffer area. Obesity was defined as body mass index (BMI) >=30 kg/m(2). Associations between incident obesity and neighborhood exposure were examined using proportional hazards and generalized linear regression. Among 4008 non-obese participants, 406 new obesity cases occurred during 5 years of follow-up. Neighborhood healthy food environment was associated with 10% lower obesity incidence per standard deviation increase neighborhood score. The association persisted after adjustment for baseline BMI and individual level covariates (HR 0.88, 95% CI: 0.79, 0.97), and for correlated features of the walking environment but confidence intervals widened to include the null (HR 0.89, 95% CI: 0.77, 1.03). Associations between neighborhood walking environment and lower obesity were weaker and did not persist after adjustment for correlated neighborhood healthy eating amenities (HR 0.98, 95% CI 0.84, 1.15). Altering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a pre-condition for sustaining existing healthy behaviors and for adopting new healthy behaviors.
  372. Author: Krukowski RA, West DS, Harvey-Berino J, Elaine Prewitt T
    Title: Neighborhood impact on healthy food availability and pricing in food stores.
    Journal: J Community Health. 35(3):315-20
    Date: 2010 Jun
    Abstract: Availability and price of healthy foods in food stores has the potential to influence purchasing patterns, dietary intake, and weight status of individuals. This study examined whether demographic factors of the store neighborhood or store size have an impact on the availability and price of healthy foods in sample of grocery stores and supermarkets. The Nutrition Environment Measures Study-Store (NEMS-S) instrument, a standardized observational survey, was utilized to evaluate food stores (N = 42) in a multi-site (Vermont and Arkansas) study in 2008. Census data associated with store census tract (median household income and proportion African-American) were used to characterize store neighborhood and number of cash registers was used to quantify store size. Median household income was significantly associated with the NEMS healthy food availability score (r = 0.36, P 0.05). Even among supermarkets, healthier foods are less available in certain neighborhoods, although, when available, the quality of healthier options did not differ, suggesting that targeting availability may offer promise for policy initiatives. Furthermore, increasing access to larger stores that can offer lower prices for healthier foods may provide another avenue for enhancing food environments to lower disease risk.
  373. Author: Burdette HL, Whitaker RC
    Title: Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children.
    Journal: Prev Med. 38(1):57-63
    Date: 2004 Jan
    Abstract: BACKGROUND: We examined the relationship between overweight in preschool children and three environmental factors--the proximity of the children's residences to playgrounds and to fast food restaurants and the safety of the children's neighborhoods. We hypothesized that children who lived farther from playgrounds, closer to fast food restaurants, and in unsafe neighborhoods were more likely to be overweight. METHODS: This was a cross-sectional study of 7,020 low-income children, 36 through 59 months of age living in Cincinnati, OH. Overweight was defined as a measured body mass index > or =95th percentile. The distance between each child's residence and the nearest public playground and fast food restaurant was determined with geographic information systems. Neighborhood safety was defined by the number of police-reported crimes per 1,000 residents per year in each of 46 city neighborhoods. RESULTS: Overall, 9.2% of the children were overweight, 76% black, and 23% white. The mean (+/- SD) distances from a child's home to the nearest playground and fast food restaurant were 0.31 (+/- 0.22) and 0.70 (+/- 0.38) miles, respectively. There was no association between child overweight and proximity to playgrounds, proximity to fast food restaurants, or level of neighborhood crime. The association between child overweight and playground proximity did not differ by neighborhood crime level. CONCLUSIONS: Within a population of urban low-income preschoolers, overweight was not associated with proximity to playgrounds and fast food restaurants or with the level of neighborhood crime.
  374. Author: Zenk SN, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML
    Title: Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit.
    Journal: Am J Public Health. 95(4):660-7
    Date: 2005 Apr
    Abstract: OBJECTIVES: We evaluated the spatial accessibility of large "chain" supermarkets in relation to neighborhood racial composition and poverty. METHODS: We used a geographic information system to measure Manhattan block distance to the nearest supermarket for 869 neighborhoods (census tracts) in metropolitan Detroit. We constructed moving average spatial regression models to adjust for spatial autocorrelation and to test for the effect of modification of percentage African American and percentage poor on distance to the nearest supermarket. RESULTS: Distance to the nearest supermarket was similar among the least impoverished neighborhoods, regardless of racial composition. Among the most impoverished neighborhoods, however, neighborhoods in which African Americans resided were, on average, 1.1 miles further from the nearest supermarket than were White neighborhoods. CONCLUSIONS: Racial residential segregation disproportionately places African Americans in more-impoverished neighborhoods in Detroit and consequently reduces access to supermarkets. However, supermarkets have opened or remained open close to middle-income neighborhoods that have transitioned from White to African American. Development of economically disadvantaged African American neighborhoods is critical to effectively prevent diet-related diseases among this population.
  375. Author: Auchincloss AH, Diez Roux AV, Mujahid MS, Shen M, Bertoni AG, Carnethon MR
    Title: Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: the Multi-Ethnic study of Atherosclerosis.
    Journal: Arch Intern Med. 169(18):1698-704
    Date: 2009 Oct 12
    Abstract: BACKGROUND: Despite increasing interest in the extent to which features of residential environments contribute to incidence of type 2 diabetes mellitus, no multisite prospective studies have investigated this question. We hypothesized that neighborhood resources supporting physical activity and healthy diets are associated with a lower incidence of type 2 diabetes. METHODS: Person-level data came from 3 sites of the Multi-Ethnic Study of Atherosclerosis, a population-based, prospective study of adults aged 45 to 84 years at baseline. Neighborhood data were derived from a population-based residential survey. Type 2 diabetes was defined as a fasting glucose level of 126 mg/dL or higher (> or =7 mmol/L) or taking insulin or oral hypoglycemic agents. We estimated the hazard ratio of type 2 diabetes incidence associated with neighborhood (US Census tract) resources. RESULTS: Among 2285 participants, 233 new type 2 diabetes cases occurred during a median of 5 follow-up years. Better neighborhood resources, determined by a combined score for physical activity and healthy foods, were associated with a 38% lower incidence of type 2 diabetes (hazard ratio corresponding to a difference between the 90th and 10th percentiles for resource distribution, 0.62; 95% confidence interval, 0.43-0.88 adjusted for age, sex, family history of diabetes, race/ethnicity, income, assets, educational level, alcohol use, and smoking status). The association remained statistically significant after further adjustment for individual dietary factors, physical activity level, and body mass index. CONCLUSION: Better neighborhood resources were associated with lower incidence of type 2 diabetes, which suggests that improving environmental features may be a viable population-level strategy for addressing this disease.
  376. Author: Auchincloss AH, Diez Roux AV, Brown DG, Erdmann CA, Bertoni AG
    Title: Neighborhood resources for physical activity and healthy foods and their association with insulin resistance.
    Journal: Epidemiology. 19(1):146-57
    Date: 2008 Jan
    Abstract: OBJECTIVE: : Little is known about the influence of the built environment, and in particular neighborhood resources, on health. We hypothesized that neighborhood resources for physical activity and healthy foods are associated with insulin resistance. METHODS: : Person-level data (n = 2026) came from 3 sites of The Multi-Ethnic Study of Atherosclerosis, a study of adults aged 45-84 years. Area-level data were derived from a population-based residential survey. The homeostasis model assessment index was used as an insulin resistance measure among persons not treated for diabetes. We used linear regression to estimate associations between area features and insulin resistance. RESULTS: : Greater neighborhood physical activity resources consistently were associated with lower insulin resistance. Adjusted for age, sex, family history of diabetes, race/ethnicity, income and education, insulin resistance was reduced by 17% (95% confidence interval = -31% to -1%) for an increase from the 10th to 90th percentiles of resources. Greater healthy food resources were also inversely related to insulin resistance, although the association was not robust to adjustment for race/ethnicity. Analyses including diet, physical activity, and body mass index suggested that these variables partly mediated observed associations. Results were similar when impaired fasting glucose/diabetes was considered as the outcome variable. CONCLUSION: : Diabetes prevention efforts may need to consider features of residential environment.
  377. Author: Zenk SN, Lachance LL, Schulz AJ, Mentz G, Kannan S, Ridella W
    Title: Neighborhood retail food environment and fruit and vegetable intake in a multiethnic urban population.
    Journal: Am J Health Promot. 23(4):255-64
    Date: 2009 Mar-Apr
    Abstract: PURPOSE: To examine relationships between the neighborhood food environment and fruit and vegetable intake in a multiethnic urban population. DESIGN: Analysis of cross-sectional survey and observational data. SETTING: One hundred forty-six neighborhoods within three large geographic communities of Detroit, Michigan. SUBJECTS: Probability sample of 919 African-American, Latino, and white adults. MEASURES: The dependent variable was mean daily fruit and vegetable servings, as measured by using a modified Block 98 food frequency questionnaire. Independent variables included the neighborhood food environment: store availability (i.e., large grocery, specialty, convenience, liquor, small grocery), supermarket proximity (i.e., street-network distance to nearest chain grocer), and perceived and observed neighborhood fresh fruit and vegetable supply (i.e., availability, variety, quality, affordability). ANALYSIS: Weighted, multilevel regression. RESULTS: Presence of a large grocery store in the neighborhood was associated with, on average, 0.69 more daily fruit and vegetable servings in the full sample. Relationships between the food environment and fruit and vegetable intake did not differ between whites and African-Americans. However, Latinos, compared with African-Americans, who had a large grocery store in the neighborhood consumed 2.20 more daily servings of fruits and vegetables. Presence of a convenience store in the neighborhood was associated with 1.84 fewer daily fruit and vegetable servings among Latinos than among African-Americans. CONCLUSION: The neighborhood food environment influences fruit and vegetable intake, and the size of this relationship may vary for different racial/ethnic subpopulations.
  378. Author: Lopez RP
    Title: Neighborhood risk factors for obesity.
    Journal: Obesity (Silver Spring). 15(8):2111-9
    Date: 2007 Aug
    Abstract: OBJECTIVE: The goal of this study was to explore neighborhood environmental factors associated with obesity in a sample of adults living in a major U.S. metropolitan area. RESEARCH METHODS AND PROCEDURES: This was a multi-level study combining data from the U.S. Behavioral Risk Factor Surveillance System with data from the U.S. Census. A total of 15,358 subjects living in 327 zip code tabulation areas were surveyed between 1998 and 2002. The outcome was obesity (BMI >30), and independent variables assessed included individual level variables (age, education, income, smoking status, sex, black race, and Hispanic ethnicity), and zip code level variables (percentage black, percentage Hispanic, percentage with more than a high school education, retail density, establishment density, employment density, population density, the presence of a supermarket, intersection density, median household income, and density of fast food outlets). RESULTS: After controlling for individual level factors, median household income [relative risk (RR) = 0.992; 95% confidence interval (CI) = 0.990, 0.994], population density (RR = 0.98; 95% CI = 0.972, 0.990), employment density (RR = 1.004; 95% CI = 1.001, 1.009), establishment density (RR = 0.981 95% CI = 0.964, 0.999), and the presence of a supermarket (RR = 0.893; 95% CI = 0.815, 0.978) were associated with obesity risk. Fast food establishment density was poorly associated with obesity risk. DISCUSSION: Where one lives may affect obesity status. Given the influence of the presence of a supermarket on obesity risk, efforts to address food access might be a priority for reducing obesity.
  379. Author: Sharkey JR, Horel S
    Title: Neighborhood socioeconomic deprivation and minority composition are associated with better potential spatial access to the ground-truthed food environment in a large rural area.
    Journal: J Nutr. 138(3):620-7
    Date: 2008 Mar
    Abstract: Little is known about spatial inequalities and potential access to the food environment in rural areas. In this study, we assessed the food environment in a 6-county rural region of Texas (11,567 km2) through ground-truthed methods that included direct observation and on-site Global Positioning System technology to examine the relationship between neighborhood inequalities (e.g., socioeconomic deprivation and minority composition) and network distance from all 101 rural neighborhoods to the nearest food store (FS). Neighborhood deprivation was determined from socioeconomic characteristics using 2000 census block group (CBG) data. Network distances were calculated from the population-weighted center of each CBG to the nearest supermarket, grocery, convenience, and discount store. Multiple regression models examined associations among deprivation, minority composition, population density, and network distance to the nearest FS. The median distance to the nearest supermarket was 14.9 km one way (range 0.12 to 54.0 km). The distance decreased with increasing deprivation, minority composition, and population density. The worst deprived neighborhoods with the greatest minority composition had better potential spatial access to the nearest FS. For >20% of all rural residents, their neighborhoods were at least 17.7 km from the nearest supermarket or full-line grocery or 7.6 km from the nearest convenience store. This makes food shopping a challenge, especially in rural areas that lack public transportation and where many have no vehicular access. Knowledge of potential access to the food environment is essential for combining environmental approaches and health interventions so that families, especially those in rural areas, can make healthier food choices.
  380. Author: Black JL, Macinko J, Dixon LB, Fryer GE Jr
    Title: Neighborhoods and obesity in New York City.
    Journal: Health Place. 16(3):489-99
    Date: 2010 May
    Abstract: Recent studies reveal disparities in neighborhood access to food and fitness facilities, particularly in US cities; but few studies assess the effects of multiple neighborhood factors on obesity. This study measured the multilevel relations between neighborhood food availability, opportunities and barriers for physical activity, income and racial composition with obesity (BMI> or =30 kg/m(2)) in New York City, controlling for individual-level factors. Obesity rates varied widely between neighborhoods, ranging from 6.8% to 31.7%. Obesity was significantly (p
  381. Author: Cummins S, Smith DM, Aitken Z, Dawson J, Marshall D, Sparks L, Anderson AS
    Title: Neighbourhood deprivation and the price and availability of fruit and vegetables in Scotland.
    Journal: J Hum Nutr Diet. 23(5):494-501
    Date: 2010 Oct
    Abstract: BACKGROUND: Previous research has suggested that fruits and vegetables are more expensive and less readily available in more deprived communities. However, this evidence is mainly based on small samples drawn from specific communities often located in urban settings and thus is not generalisable to national contexts. The present study explores the influence of neighbourhood deprivation and local retail structure on the price and availability of fruit and vegetables in a sample of areas representing the diversity of urban-rural environments across Scotland, UK. METHODS: A sample of 310 stores located in 10 diverse areas of Scotland was surveyed and data on the price and availability of a basket of 15 fruit and vegetable items were collected. The data were analysed to identify the influence of store type and neighbourhood deprivation on the price and availability of fruits and vegetables. RESULTS: Neighbourhood deprivation and store type did not significantly predict the price of a basket of fruit and vegetables within the sample, although baskets did decrease in price as store size increased. The highest prices were found in the smallest stores located in the most deprived areas. Availability of fruit and vegetables is lower in small shops located within deprived neighbourhoods compared to similar shops in affluent areas. Overall, availability increases with increasing store size. CONCLUSIONS: Availability of fruit and vegetables significantly varies by neighbourhood deprivation in small stores. Policies aimed at promoting sales of fruit and vegetable in these outlets may benefit residents in deprived areas.
  382. Author: Macdonald L, Cummins S, Macintyre S
    Title: Neighbourhood fast food environment and area deprivation-substitution or concentration?
    Journal: Appetite. 49(1):251-4
    Date: 2007 Jul
    Abstract: It has been hypothesised that deprived neighbourhoods have poorer quality food environments which may promote the development of obesity. We investigated associations between area deprivation and the location of the four largest fast-food chains in Scotland and England. We found statistically significant increases in density of outlets from more affluent to more deprived areas for each individual fast-food chain and all chains combined. These results provide support for a 'concentration' effect whereby plausible health-damaging environmental risk factors for obesity appear to be 'concentrated' in more deprived areas of England and Scotland.
  383. Author: Crawford DA, Timperio AF, Salmon JA, Baur L, Giles-Corti B, Roberts RJ, Jackson ML, Andrianopoulos N, Ball K
    Title: Neighbourhood fast food outlets and obesity in children and adults: the CLAN Study.
    Journal: Int J Pediatr Obes. 3(4):249-56
    Date: 2008
    Abstract: OBJECTIVE: We examined associations between density of and proximity to fast food outlets and body weight in a sample of children (137 aged 8-9 years and 243 aged 13-15 years) and their parents (322 fathers and 362 mothers). METHODS: Children's measured and parents' self-reported heights and weights were used to calculate body mass index (BMI). Locations of major fast food outlets were geocoded. Bivariate linear regression analyses examined associations between the presence of any fast food outlet within a 2 km buffer around participants' homes, fast food outlet density within the 2 km buffer, and distance to the nearest outlet and BMI. Each independent variable was also entered into separate bivariate logistic regression analyses to predict the odds of being overweight or obese. RESULTS: Among older children, those with at least one outlet within 2 km had lower BMI z-scores. The further that fathers lived from an outlet, the higher their BMI. Among 13-15-year-old girls and their fathers, the likelihood of overweight/obesity was reduced by 80% and 50%, respectively, if they had at least one fast food outlet within 2 km of their home. Among older girls, the likelihood of being overweight/obese was reduced by 14% with each additional outlet within 2 km. Fathers' odds of being overweight/obese increased by 13% for each additional kilometre to the nearest outlet. CONCLUSIONS: While consumption of fast food has been shown to be associated with obesity, this study provides little support for the concept that exposure to fast food outlets in the local neighbourhood increases risk of obesity.
  384. Author: Molaodi OR, Leyland AH, Ellaway A, Kearns A, Harding S
    Title: Neighbourhood food and physical activity environments in England, UK: does ethnic density matter?
    Journal: Int J Behav Nutr Phys Act
    Date: 2012
    Abstract: BACKGROUND: In England, obesity is more common in some ethnic minority groups than in Whites. This study examines the relationship between ethnic concentration and access to fast food outlets, supermarkets and physical activity facilities. METHODS: Data on ethnic concentration, fast food outlets, supermarkets and physical activity facilities were obtained at the lower super output area (LSOA) (population average of 1500). Poisson multilevel modelling was used to examine the association between own ethnic concentration and facilities, adjusted for area deprivation, urbanicity, population size and clustering of LSOAs within local authority areas. RESULTS: There was a higher proportion of ethnic minorities residing in areas classified as most deprived. Fast food outlets and supermarkets were more common and outdoor physical activity facilities were less common in most than least deprived areas. A gradient was not observed for the relationship between indoor physical activity facilities and area deprivation quintiles. In contrast to White British, increasing ethnic minority concentration was associated with increasing rates of fast food outlets. Rate ratios comparing rates of fast food outlets in high with those in low level of ethnic concentration ranged between 1.28, 95% confidence interval 1.06-1.55 (Bangladeshi) and 2.62, 1.46-4.70 (Chinese). Similar to White British, however, increasing ethnic minority concentration was associated with increasing rate of supermarkets and indoor physical activity facilities. Outdoor physical activity facilities were less likely to be in high than low ethnic concentration areas for some minority groups. CONCLUSIONS: Overall, ethnic minority concentration was associated with a mixture of both advantages and disadvantages in the provision of food outlets and physical activity facilities. These issues might contribute to ethnic differences in food choices and engagement in physical activity.
  385. Author: Smith DM, Cummins S, Taylor M, Dawson J, Marshall D, Sparks L, Anderson AS
    Title: Neighbourhood food environment and area deprivation: spatial accessibility to grocery stores selling fresh fruit and vegetables in urban and rural settings.
    Journal: Int J Epidemiol. 39(1):277-84
    Date: 2010 Feb
    Abstract: BACKGROUND: The 'deprivation amplification' hypothesis suggests that residents of deprived neighbourhoods have universally poorer access to high-quality food environments, which in turn contributes to the development of spatial inequalities in diet and diet-related chronic disease. This paper presents results from a study that quantified access to grocery stores selling fresh fruit and vegetables in four environmental settings in Scotland, UK. METHODS: Spatial accessibility, as measured by network travel times, to 457 grocery stores located in 205 neighbourhoods in four environmental settings (island, rural, small town and urban) in Scotland was calculated using Geographical Information Systems. The distribution of accessibility by neighbourhood deprivation in each of these four settings was investigated. RESULTS: Overall, the most deprived neighbourhoods had the best access to grocery stores and grocery stores selling fresh produce. Stratified analysis by environmental setting suggests that the least deprived compared with the most deprived urban neighbourhoods have greater accessibility to grocery stores than their counterparts in island, rural and small town locations. Access to fresh produce is better in more deprived compared with less deprived urban and small town neighbourhoods, but poorest in the most affluent island communities with mixed results for rural settings. CONCLUSIONS: The results presented here suggest that the assumption of a universal 'deprivation amplification' hypothesis in studies of the neighbourhood food environment may be misguided. Associations between neighbourhood deprivation and grocery store accessibility vary by environmental setting. Theories and policies aimed at understanding and rectifying spatial inequalities in the distribution of neighbourhood exposures for poor diet need to be context specific.
  386. Author: Ho SY, Wong BY, Lo WS, Mak KK, Thomas GN, Lam TH
    Title: Neighbourhood food environment and dietary intakes in adolescents: sex and perceived family affluence as moderators.
    Journal: Int J Pediatr Obes. 5(5):420-7
    Date: 2010 Oct
    Abstract: OBJECTIVE: To examine the effects of perceived availability of fast-food shops, restaurants, and convenience stores on adolescent dietary intakes. METHODS: Survey data from 34 369 students in 42 Hong Kong secondary schools were collected in 2006-7. Respondents reported the availability of fast-food shops, restaurants and convenience stores in the neighbourhood, and their intakes of fruit, vegetables, high-fat foods and junk food/soft drinks. For intakes of high-fat foods and junk food/ soft drinks, ≤ once a week was defined as low consumption and the rest moderate/high consumption. At least three servings of vegetables and two servings of fruit daily were defined as sufficient consumption. Logistic regression yielded adjusted odds ratios (OR) for each dietary intake in relation to the reported food shops. Potential effect modifications by socio-demographic factors were also examined. RESULTS: Perceived availability of fast-food shops and convenience stores were positively associated with moderate/high consumptions of high-fat foods (OR(fast) =1.10 and OR(con) =1.15) and junk food/soft drinks (OR(fast)=1.10 and OR(con) =1.10). Significant negative associations of the perceived availability of restaurants with intakes of vegetables and fruit were observed (OR(veg) =0.87 and OR(fruit) =0.83). The positive relationship between reporting fast-food shops with intake of junk food/soft drinks were observed only in boys and those with low perceived family affluence. The negative association of reporting restaurants with fruit consumption was found in those with low and middle perceived family affluence only. CONCLUSIONS: Perceived availability of neighbourhood fast-food shops, restaurants, and convenience stores may have a negative impact on adolescent dietary intakes particularly for those from poorer families.
  387. Author: Janevic T, Borrell LN, Savitz DA, Herring AH, Rundle A
    Title: Neighbourhood food environment and gestational diabetes in New York City.
    Journal: Paediatr Perinat Epidemiol. 24(3):249-54
    Date: 2010 May
    Abstract: The association between neighbourhood characteristics and gestational diabetes has not been examined previously. We investigated the relationship between the number of healthy food outlets (supermarkets; fruit/vegetable and natural food stores), and unhealthy food outlets (fast food; pizza; bodegas; bakeries; convenience, candy/nut and meat stores) in census tract of residence, and gestational diabetes in New York City. Gestational diabetes, census tract and individual-level covariates were ascertained from linked birth-hospital data for 210 926 singleton births from 2001 to 2002 and linked to commercial data on retail food outlets. Adjusted odds ratios (aOR) were estimated using a multilevel logistic model. No association between food environment measures and gestational diabetes was found, with aORs ranging from 0.95 to 1.04. However, an increased odds of pre-pregnancy weight >200 lbs for women living in a given neighbourhood with no healthy food outlets [aOR = 1.14, 95% CI 1.07, 1.21] or only one healthy food place [aOR = 1.10, 95% CI 1.04, 1.18] relative to two or more healthy food outlets was found. Due to probable misclassification of neighbourhood food environment and pre-pregnancy obesity results are likely to be biased towards the null. Future research, including validity studies, on the neighbourhood food environment, obesity during pregnancy and gestational diabetes is warranted.
  388. Author: Hutchinson PL, Nicholas Bodor J, Swalm CM, Rice JC, Rose D
    Title: Neighbourhood food environments and obesity in southeast Louisiana.
    Journal: Health Place. 18(4):854-60
    Date: 2012 Jul
    Abstract: Supermarkets might influence food choices, and more distal outcomes like obesity, by increasing the availability of healthy foods. However, recent evidence about their effects is ambiguous, perhaps because supermarkets also increase the availability of unhealthy options. We develop an alternative measure of food environment quality that characterizes urban neighborhoods by the relative amounts of healthy (e.g. fruits and vegetables) to unhealthy foods (e.g. energy-dense snacks). Using data from 307 food stores and 1243 telephone interviews with residents in urban southeastern Louisiana, we estimate a multilevel multinomial logistic model for overweight status. We find that higher quality food environments - but not food store types - decrease the risk of obesity (RR 0.474, 95% CI 0.269-0.835) and overweight (RR 0.532, 95% CI 0.312-0.907). The findings suggest a need to move beyond a sole consideration of food store types to a more nuanced view of the food environment when planning for change.
  389. Author: Laska MN, Hearst MO, Forsyth A, Pasch KE, Lytle L
    Title: Neighbourhood food environments: are they associated with adolescent dietary intake, food purchases and weight status?
    Journal: Public Health Nutr. 13(11):1757-63
    Date: 2010 Nov
    Abstract: OBJECTIVE: To examine neighbourhood food environments, adolescent nutrition and weight status. DESIGN: Cross-sectional, observational study. SETTING: Minneapolis/St. Paul metropolitan region, Minnesota, USA. SUBJECTS: A total of 349 adolescents were recruited to the study. Participants completed 24 h dietary recalls and had their weight and height measured. They also reported demographic information and other diet-related behaviours. Geographic Information Systems were used to examine the availability and proximity of food outlets, particularly those captured within the 800, 1600 and/or 3000 m network buffers around participants' homes and schools. RESULTS: Adjusting for gender, age and socio-economic status, adolescents' sugar-sweetened beverage intake was associated with residential proximity to restaurants (including fast food), convenience stores, grocery stores and other retail facilities within the 800 and/or 1600 m residential buffers (P ≤ 0·01). BMI Z-score and percentage body fat were positively associated with the presence of a convenience store within a 1600 m buffer. Other individual-level factors, such as energy, fruit and vegetable intake, as well as convenience store and fast food purchasing, were not significantly associated with features of the residential neighbourhood food environment in adjusted models. In addition, school neighbourhood environments yielded few associations with adolescent outcomes. CONCLUSIONS: Many factors are likely to have an important role in influencing adolescent dietary intake and weight status. Interventions aimed at increasing neighbourhood access to healthy foods, as well as other approaches, are needed.
  390. Author: Bodor JN, Rose D, Farley TA, Swalm C, Scott SK
    Title: Neighbourhood fruit and vegetable availability and consumption: the role of small food stores in an urban environment.
    Journal: Public Health Nutr. 11(4):413-20
    Date: 2008 Apr
    Abstract: OBJECTIVE: Previous studies on the relationship of dietary intake to the neighbourhood food environment have focused on access to supermarkets, quantified by geographic distance or store concentration measures. However, in-store food availability may also be an important determinant, particularly for urban neighbourhoods with a greater concentration of small food stores. This study synthesises both types of information - store access and in-store availability - to determine their potential relationship to fruit and vegetable consumption. DESIGN: Residents in four census tracts were surveyed in 2001 about their fruit and vegetable intake. Household distances to food stores in these and surrounding tracts were obtained using geographical information system mapping techniques. In-store fruit and vegetable availability was measured by linear shelf space. Multivariate linear regression models were used to measure the association of these neighbourhood availability measures with consumption. SETTING: Four contiguous census tracts in central-city New Orleans. SUBJECTS: A random sample of 102 households. RESULTS: Greater fresh vegetable availability within 100 m of a residence was a positive predictor of vegetable intake; each additional metre of shelf space was associated with 0.35 servings per day of increased intake. Fresh fruit availability was not associated with intake, although having a small food store within this same distance was a marginal predictor of fruit consumption. CONCLUSIONS: The findings suggest the possible importance of small neighbourhood food stores and their fresh produce availability in affecting fruit and vegetable intake.
  391. Author: Park Y, Neckerman K, Quinn J, Weiss C, Jacobson J, Rundle A
    Title: Neighbourhood immigrant acculturation and diet among Hispanic female residents of New York City.
    Journal: Public Health Nutr. 14(9):1593-600
    Date: 2011 Sep
    Abstract: OBJECTIVE: To identify predominant dietary patterns among Hispanic women and to determine whether adherence to dietary patterns is predicted by neighbourhood-level factors: linguistic isolation, poverty rate and the retail food environment. DESIGN: Cross-sectional analyses of predictors of adherence to dietary patterns identified from principal component analysis of data collected using the Study of Women's Health Across the Nation FFQ. Census data were used to measure poverty rates and the percentage of Spanish-speaking families in the neighbourhood in which no person aged ≥14 years spoke English very well (linguistic isolation) and the retail food environment was measured using business listings data. SETTING: New York City. SUBJECTS: A total of 345 Hispanic women. RESULTS: Two major dietary patterns were identified: a healthy dietary pattern loading high for vegetables, legumes, potatoes, fish and other seafood, which explained 17 % of the variance in the FFQ data and an energy-dense dietary pattern loading high for red meat, poultry, pizza, french fries and high-energy drinks, which explained 9 % of the variance in the FFQ data. Adherence to the healthy dietary pattern was positively associated with neighbourhood linguistic isolation and negatively associated with neighbourhood poverty. Presence of more fast-food restaurants per square kilometre in the neighbourhood was significantly associated with lower adherence to the healthy diet. Adherence to the energy-dense dietary pattern was inversely, but not significantly, associated with neighbourhood linguistic isolation. CONCLUSIONS: These results are consistent with the hypothesis that living in immigrant enclaves is associated with healthy dietary patterns among Hispanics.
  392. Author: Ball K, Timperio A, Crawford D
    Title: Neighbourhood socioeconomic inequalities in food access and affordability.
    Journal: Health Place. 15(2):578-85
    Date: 2009 Jun
    Abstract: This study investigated whether the availability and accessibility of supermarkets and fruit and vegetable stores, and the availability, variety and price of foods within these stores, varied across areas of different levels of socioeconomic disadvantage in Melbourne, Australia. Data on food store locations, and food variety and price within stores were obtained through objective audits of 45 neighbourhoods of varying socioeconomic disadvantage. Geographical accessibility of healthy food stores was mostly better amongst those living in more advantaged neighbourhoods. Availability of healthy foods within stores only slightly favoured those in advantaged neighbourhoods. However food prices favoured those living in disadvantaged areas.
  393. Author: Thornton LE, Crawford DA, Ball K
    Title: Neighbourhood-socioeconomic variation in women's diet: the role of nutrition environments.
    Journal: Eur J Clin Nutr. 64(12):1423-32
    Date: 2010 Dec
    Abstract: BACKGROUND/OBJECTIVES: Living in socioeconomically disadvantaged neighbourhoods is associated with increased risk of a poor diet; however, the mechanisms underlying associations are not well understood. This study investigated whether selected healthy and unhealthy dietary behaviours are patterned by neighbourhood-socioeconomic disadvantage, and if so, whether features of the neighbourhood-nutrition environment explain these associations. SUBJECTS/METHODS: A survey was completed by 1399 women from 45 neighbourhoods of varying levels of socioeconomic disadvantage in Melbourne, Australia. Survey data on fruit, vegetable and fast-food consumption were linked with data on food store locations (supermarket, greengrocer and fast-food store density and proximity) and within-store factors (in-store data on price and availability for supermarkets and greengrocers) obtained through objective audits. Multilevel regression analyses were used to examine associations of neighbourhood disadvantage with fruit, vegetable and fast-food consumption, and to test whether nutrition environment factors mediated these associations. RESULTS: After controlling for individual-level demographic and socioeconomic factors, neighbourhood disadvantage was associated with less vegetable consumption and more fast-food consumption, but not with fruit consumption. Some nutrition environmental factors were associated with both neighbourhood disadvantage and with diet. Nutrition environmental features did not mediate neighbourhood-disadvantage variations in vegetable or fast-food consumption. CONCLUSIONS: Although we found poorer diets among women living in disadvantaged neighbourhoods in Melbourne, the differences were not attributable to less supportive nutrition environments in these neighbourhoods.
  394. Author: Carter MA, Dubois L
    Title: Neighbourhoods and child adiposity: a critical appraisal of the literature.
    Journal: Health Place. 16(3):616-28
    Date: 2010 May
    Abstract: This paper critically appraised the published literature to determine the relationship between physical and social environmental features of neighbourhoods with child adiposity. MEDLINE, EMBASE, PsychINFO, and SCOPUS were searched from 1999 to July 2009 using a systematic search strategy. Twenty-seven primary studies were included based on a priori eligibility criteria. Socioeconomic disadvantage was consistently shown to increase child adiposity, while there was some evidence that high social capital protected against increased adiposity. It is unclear at this time if and how other neighbourhood environmental features play a role. Heterogeneity and methodological issues across studies limits our ability to draw overall conclusions.
  395. Author: Pearce J, Witten K, Bartie P
    Title: Neighbourhoods and health: a GIS approach to measuring community resource accessibility.
    Journal: J Epidemiol Community Health. 60(5):389-95
    Date: 2006 May
    Abstract: OBJECTIVE: Recent studies suggest an association between the contextual attributes of neighbourhoods and the health status of residents. However, there has been a scarcity of studies that have directly measured the material characteristics of neighbourhoods theorised to have an impact on health and health inequalities. This paper describes the development of an innovative methodology to measure geographical access to a range of community resources that have been empirically linked to health. Geographical information systems (GIS) were applied to develop precise measures of community resource accessibility for small areas at a national scale. DESIGN: Locational access to shopping, education, recreation, and health facilities was established for all 38,350 census meshblocks across New Zealand. Using GIS, distance measures were calculated from the population weighted centroid of each meshblock to 16 specific types of facilities theorised as potentially health related. From these data, indices of community resource accessibility for all New Zealand neighbourhoods were constructed. RESULTS: Clear regional variations in geographical accessibility to community resources exist across the country, particularly between urban and rural areas of New Zealand. For example, the average travel time to the nearest food shop ranged from less than one minute to more than 244 minutes. Noticeable differences were also apparent between neighbourhoods within urban areas. CONCLUSIONS: Recent advances in GIS and computing capacity have made it feasible to directly measure access to health related community resources at the neighbourhood level. The construction of access indices for specific community resources will enable health researchers to examine with greater precision, variations in the material characteristics of neighbourhoods and the pathways through which neighbourhoods impact on specific health outcomes.
  396. Author: Murakami K, Sasaki S, Takahashi Y, Uenishi K, Japan Dietetic Students' Study for Nutrition and Biomarkers Group
    Title: No meaningful association of neighborhood food store availability with dietary intake, body mass index, or waist circumference in young Japanese women.
    Journal: Nutr Res. 30(8):565-73
    Date: 2010 Aug
    Abstract: The affordability of food is considered as an important factor influencing people's diet and hence health status. The objective of this cross-sectional study was to test the hypothesis that neighborhood food store availability is associated with some aspects of dietary intake and thus possibly with body mass index (BMI) and waist circumference in young Japanese women. Subjects were 989 female Japanese dietetic students 18 to 22 years of age. Neighborhood food store availability was defined as the number of food stores within a 0.5-mile (0.8-km) radius of residence (meat stores, fish stores, fruit and vegetable stores, confectionery stores/bakeries, rice stores, convenience stores, and supermarkets/grocery stores). Dietary intake was estimated using a validated, comprehensive self-administered diet history questionnaire. No association was seen between any measure of neighborhood food store availability and dietary intake, except for a positive association between confectionery and bread availability (based on confectionery stores/bakeries, convenience stores, and supermarkets/grocery stores) and intake of these items (P for trend = .02). Further, no association was seen for BMI or waist circumference, except for an inverse relationship between availability of convenience stores and BMI and a positive relationship between store availability for meat (meat stores and supermarkets/grocery stores) and fish (fish stores and supermarkets/grocery stores) and waist circumference. In conclusion, this study of young Japanese women found no meaningful association between neighborhood food store availability and dietary intake, BMI, or waist circumference, with the exception of a positive relationship between availability and intake for confectionery and bread.
  397. Author: Schefske SD, Bellows AC, Byrd-Bredbenner C, Cuite CL, Rapport H, Vivar T, Hallman WK
    Title: Nutrient analysis of varying socioeconomic status home food environments in New Jersey.
    Journal: Appetite. 54(2):384-9
    Date: 2010 Apr
    Abstract: Home food inventories of Oaxacan Mexican-American and African-American families of low-socioeconomic status living in an urban area in New Jersey with at least one child under the age of 12 were conducted using Universal Product Code scanning. The African-American and Oaxacan household food supplies were compared with a sample of White households, also with at least one child under the age of 12, not of low-socioeconomic status. Nutrient Adequacy Ratios for total fat, saturated fat, cholesterol, sodium, total carbohydrate, sugar, dietary fiber, protein, vitamin A, vitamin C, calcium, and iron were used to quantify the adequacy of household food supplies per 2000 cal. The food supplies of the White households had significantly more calcium, vitamin A, and sugar and less total fat than the other two samples. The home food supplies of African-American households contained significantly less vitamin C than White and Oaxacan households. Compared to both other samples, Oaxacan household food supplies were lower in protein, sodium, and iron. Per 2000 cal, African-American households had the lowest supply of nutrients recommended to be maximized (i.e., vitamin A, vitamin C, calcium, iron, protein, and dietary fiber) and highest supply of nutrients to be minimized (i.e., total fat, cholesterol, sodium, and sugar). Overall household food quality scores were lowest for the African-American sample with no differences between Oaxacan and White household food supply quality scores.
  398. Author: Byrd-Bredbenner C, Abbot JM, Cussler E
    Title: Nutrient profile of household food supplies of families with young children.
    Journal: J Am Diet Assoc. 109(12):2057-62
    Date: 2009 Dec
    Abstract: Currently, little is known about the home food environment. This cross-sectional study was designed to describe the food sources of calories and key nutrients in the households of 100 families with at least one child aged 12 years or younger and compare nutrient availability to recommended levels. Participating households were food secure, ate dinner at home at least three times weekly, had parents who were married or living as domestic partners and not employed in a health-related profession, and resided in New Jersey. Researchers visited each household once during 2006/2007 to inventory all foods except alcoholic beverages, commercial baby food, infant formula, pet foods, refrigerated leftovers, foods of minimal nutrient and calorie content, condiments typically consumed in small quantities per eating occasion, and bulk supplies of staples. Inventories were taken using commercial diet analysis software customized to use barcode scanners for foods with standard barcodes and keyword searches for foods lacking barcodes. Protein, carbohydrate, and fat in the households supplied an average of approximately 15%, 57%, and 29% of calories, respectively. Saturated fat and total sugar accounted for an average of approximately 10% and 20%, respectively, of calories. Mean nutrient adequacy ratio for nutrients recommended to be maximized (ie, vitamins A and C, protein, dietary fiber, iron, calcium) was less than optimal, and mean ratio for those recommended to be minimized (ie, total fat, cholesterol, sodium, and sugar) exceeded recommendations. Categorization by food group revealed that the greatest availability of calories, carbohydrates, dietary fiber, total sugar, sodium, and iron was from grains. The greatest availability of total fat, cholesterol, and protein was from meat/protein foods. Dairy products contained the greatest quantities of saturated fat and calcium. This study expands the limited research on the home food supply and provides insights that may have important implications for health-promotion interventions.
  399. Author: McDonald CM, Karamlou T, Wengle JG, Gibson J, McCrindle BW
    Title: Nutrition and exercise environment available to outpatients, visitors, and staff in Children's hospitals in Canada and the United States.
    Journal: Arch Pediatr Adolesc Med. 160(9):900-5
    Date: 2006 Sep
    Abstract: BACKGROUND: Children's hospitals should advocate for children's health by modeling optimum health environments. OBJECTIVES: To determine whether children's hospitals provide optimum health environments and to identify associated factors. DESIGN: Telephone survey. SETTING: Canadian and US hospitals with accredited pediatric residency programs. PARTICIPANTS: Food services directors or administrative dietitians. MAIN OUTCOME MEASURES: Health environment grades as determined for 4 domains quantifying (1) the amount of less nutritious food sold at cafeterias (cafeteria grade), (2) the presence of fast food outlets (outlet grade), (3) the amount of nutritious food alternatives available (healthful alternative grade), and (4) the presence of patient obesity or employee exercise programs (program grade). RESULTS: The overall response rate was 87%. Compared with Canadian hospitals, US hospitals had more food outlets (89% vs 50%) and more snack/beverage vending machines (median, 16 vs 12) (P = .001 for both), despite equivalent consumer numbers. External companies managed more outlets at US vs Canadian hospitals (65% vs 14%; P = .01), and, generally, US hospitals recuperated more revenue from their outlets. Worst cafeteria grade was associated with US hospital location (odds ratio [OR], 8.9; 95% confidence interval [CI], 1.6-50; P = .01) and lower healthful alternative grade (OR, 0.016; 95% CI, 0.002-0.15; P<.001 lower="" grade="" in="" any="" domain="" was="" related="" to="" whether="" hospitals="" received="" more="" revenue="" from="" noncafeteria="" food="" outlets="" ci="" p=".03)" and="" the="" presence="" of="" internally="" operated="" cafeterias="" per="" cafeteria="" conclusions:="" children="" provide="" suboptimal="" health="" environments.="" reliance="" on="" may="" be="" an="" important="" motivating="" factor="" encouraging="" adoption="" that="" serve="" less="" nutritious="" food.="">
  400. Author: Benjamin SE, Ammerman A, Sommers J, Dodds J, Neelon B, Ward DS
    Title: Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention.
    Journal: J Nutr Educ Behav. 39(3):142-9
    Date: 2007 May-Jun
    Abstract: OBJECTIVE: To determine the feasibility, acceptability, and reported impact of a nutrition and physical activity environmental intervention in child care. DESIGN: Self-assessment instrument completed pre- and post-intervention by randomly assigned intervention and comparison child care centers. SETTING: Child care centers in 8 counties across North Carolina. PARTICIPANTS: A convenience sample of 19 child care centers (15 intervention and 4 comparison). INTERVENTION: Intervention centers completed the self-assessment instrument at baseline and then selected 3 environmental improvements to make over the 6-month intervention period with assistance from a trained NAP SACC Consultant. MAIN OUTCOME MEASURE: Changes in pre- and post-intervention self-assesment of the nutrition and physical activity child care environment with additional process measures to evaluate project implementation, feasibility and acceptability. ANALYSIS: Comparison of pre- and post-test scores for the intervention group using a Wilcoxon signed-rank test and descriptions of environmental changes. RESULTS: Intervention centers rated themselves higher at follow-up than at baseline, and relative to comparison centers, reported a variety of environmental nutrition and physical activity improvements confirmed by research staff. CONCLUSIONS AND IMPLICATIONS: The NAP SACC pilot intervention shows promise as an approach to promote healthy weight environments in preschool settings. Additional evaluation of the project is needed using a greater number of centers and a more objective outcome measure.
  401. Author: Saelens BE, Glanz K, Sallis JF, Frank LD
    Title: Nutrition Environment Measures Study in restaurants (NEMS-R): development and evaluation.
    Journal: Am J Prev Med. 32(4):273-81
    Date: 2007 Apr
    Abstract: BACKGROUND: Americans are increasingly eating out, but nutrition environments in restaurants are poorly understood. An observational measure was developed to assess factors believed to contribute to food choices in restaurants, including availability of more healthy foods, facilitators and barriers to healthful eating, pricing, and signage/promotion of healthy and unhealthy foods. METHODS: Inter-rater and test-retest reliability were assessed in 217 sit-down and fast-food restaurants in four neighborhoods in 2004 and 2005. RESULTS: Inter-rater reliability was generally high, with most kappa values greater than 0.80 (range 0.27-0.97) and all percent-agreement values greater than 75% (77.6-99.5). Test-retest reliability was high, with most kappa values greater than 0.80 (0.46-1.0) and all percent-agreement values greater than 80% (80.4-100). There were several differences (p
  402. Author: Glanz K, Sallis JF, Saelens BE, Frank LD
    Title: Nutrition Environment Measures Survey in stores (NEMS-S): development and evaluation.
    Journal: Am J Prev Med. 32(4):282-9
    Date: 2007 Apr
    Abstract: BACKGROUND: Eating, or nutrition, environments are believed to contribute to obesity and chronic diseases. There is a need for valid, reliable measures of nutrition environments. This article reports on the development and evaluation of measures of nutrition environments in retail food stores. METHODS: The Nutrition Environment Measures Study developed observational measures of the nutrition environment within retail food stores (NEMS-S) to assess availability of healthy options, price, and quality. After pretesting, measures were completed by independent raters to evaluate inter-rater reliability and across two occasions to assess test-retest reliability in grocery and convenience stores in four neighborhoods differing on income and community design in the Atlanta metropolitan area. Data were collected and analyzed in 2004 and 2005. RESULTS: Ten food categories (e.g., fruits) or indicator food items (e.g., ground beef) were evaluated in 85 stores. Inter-rater reliability and test-retest reliability of availability were high: inter-rater reliability kappas were 0.84 to 1.00, and test-retest reliabilities were .73 to 1.00. Inter-rater reliability for quality across fresh produce was moderate (kappas, 0.44 to 1.00). Healthier options were higher priced for hot dogs, lean ground beef, and baked chips. More healthful options were available in grocery than convenience stores and in stores in higher income neighborhoods. CONCLUSIONS: The NEMS-S tool was found to have a high degree of inter-rater and test-retest reliability, and to reveal significant differences across store types and neighborhoods of high and low socioeconomic status. These observational measures of nutrition environments can be applied in multilevel studies of community nutrition, and can inform new approaches to conducting and evaluating nutrition interventions.
  403. Author: O'Toole TP, Anderson S, Miller C, Guthrie J
    Title: Nutrition services and foods and beverages available at school: results from the School Health Policies and Programs Study 2006.
    Journal: J Sch Health. 77(8):500-21
    Date: 2007 Oct
    Abstract: BACKGROUND: Schools are in a unique position to promote healthy dietary behaviors and help ensure appropriate nutrient intake. This article describes the characteristics of both school nutrition services and the foods and beverages sold outside of the school meals program in the United States, including state- and district-level policies and school practices. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=944). RESULTS: Few states required schools to restrict the availability of deep-fried foods, to prohibit the sale of foods that have low nutrient density in certain venues, or to make healthful beverages available when beverages were offered. While many schools sold healthful foods and beverages outside of the school nutrition services program, many also sold items high in fat, sodium, and added sugars. CONCLUSIONS: Nutrition services program practices in many schools continue to need improvement. Districts and schools should implement more food preparation practices that reduce the total fat, saturated fat, sodium, and added sugar content of school meals. In addition, opportunities to eat and drink at school should be used to encourage greater daily consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy products.
  404. Author: Chen S, Florax RJ, Snyder S, Miller CC
    Title: Obesity and access to chain grocers.
    Journal: Econ Geogr. 86(4):431-52
    Date: 2010
    Abstract: Recent empirical work in the obesity literature has highlighted the role of the built environment and its potential influence in the increasing prevalence of obesity in adults and children. One feature of the built environment that has gained increasing attention is the role of access to chain grocers and their impact on body mass index (BMI). The assessment of the impacts of spatial access to chain grocers on BMI is complicated by two empirical regularities in the data. There is evidence that health outcomes such as BMI are clustered in space and that there is spatial dependence across individuals. In this article, we use an econometric model that takes into account the spatial dependence, and we allow the effect of access to differ for a person depending on whether he or she lives in a low-income community or peer group. We categorize this community using the characteristics of the people who immediately surround the individual rather than using census tracts. Using georeferenced survey data on adults in Marion County, Indiana, we find that the effect of improvements in chain grocer access on BMI varies depending on community characteristics.
  405. Author: Salois MJ
    Title: Obesity and diabetes, the built environment, and the 'local' food economy in the United States, 2007.
    Journal: Econ Hum Biol. 10(1):35-42
    Date: 2012 Jan
    Abstract: Obesity and diabetes are increasingly attributed to environmental factors, however, little attention has been paid to the influence of the 'local' food economy. This paper examines the association of measures relating to the built environment and 'local' agriculture with U.S. county-level prevalence of obesity and diabetes. Key indicators of the 'local' food economy include the density of farmers' markets and the presence of farms with direct sales. This paper employs a robust regression estimator to account for non-normality of the data and to accommodate outliers. Overall, the built environment is associated with the prevalence of obesity and diabetes and a strong local' food economy may play an important role in prevention. Results imply considerable scope for community-level interventions.
  406. Author: Drewnowski A, Aggarwal A, Hurvitz PM, Monsivais P, Moudon AV
    Title: Obesity and supermarket access: proximity or price?
    Journal: Am J Public Health. 102(8):e74-80
    Date: 2012 Aug
    Abstract: OBJECTIVES: We examined whether physical proximity to supermarkets or supermarket price was more strongly associated with obesity risk. METHODS: The Seattle Obesity Study (SOS) collected and geocoded data on home addresses and food shopping destinations for a representative sample of adult residents of King County, Washington. Supermarkets were stratified into 3 price levels based on average cost of the market basket. Sociodemographic and health data were obtained from a telephone survey. Modified Poisson regression was used to test the associations between obesity and supermarket variables. RESULTS: Only 1 in 7 respondents reported shopping at the nearest supermarket. The risk of obesity was not associated with street network distances between home and the nearest supermarket or the supermarket that SOS participants reported as their primary food source. The type of supermarket, by price, was found to be inversely and significantly associated with obesity rates, even after adjusting for individual-level sociodemographic and lifestyle variables, and proximity measures (adjusted relative risk=0.34; 95% confidence interval=0.19, 0.63) CONCLUSIONS: Improving physical access to supermarkets may be one strategy to deal with the obesity epidemic; improving economic access to healthy foods is another.
  407. Author: Oreskovic NM, Winickoff JP, Kuhlthau KA, Romm D, Perrin JM
    Title: Obesity and the built environment among Massachusetts children.
    Journal: Clin Pediatr (Phila). 48(9):904-12
    Date: 2009 Nov
    Abstract: BACKGROUND: The built environment may influence weight status. METHOD: Using cross-sectional data for children aged 2 to 18 years, the authors linked clinical and spatial data using geographic information systems and analyzed for associations between body mass index (BMI) and density of and distance to nearest built environment variable (schools, sidewalks, subway stations, bicycle trails, open space, and fast-food restaurants) using bivariate and multilevel analyses. RESULTS: The study sampled 21 008 children; 54% were white, 26% Hispanic, 37% overweight, and 20% obese. In bivariate analysis, distance to nearest fast-food restaurant was inversely associated with BMI, whereas density of fast-food restaurants was positively associated with BMI. Distance to school and subway station, amount of open space, and density of subway stations were inversely associated with BMI. Controlling for sociodemographic factors, only living near a greater density of subway stations was inversely associated with overweight (odds ratio, 0.87; 95% confidence interval, 0.81-0.94) and obesity (odds ratio, 0.90; 95% confidence interval, 0.82-0.99). CONCLUSION: Distance to nearest subway station is associated with BMI among Massachusetts children.
  408. Author: Li F, Harmer P, Cardinal BJ, Bosworth M, Johnson-Shelton D
    Title: Obesity and the built environment: does the density of neighborhood fast-food outlets matter?
    Journal: Am J Health Promot. 23(3):203-9
    Date: 2009 Jan-Feb
    Abstract: PURPOSE: Examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast food outlets and residents' behavioral, psychosocial, and sociodemographic characteristics. DESIGN: Cross-sectional and multilevel design. SETTING: Census block groups, used as a proxy for neighborhoods, within the metropolitan region's Urban Growth Boundary in Portland, Oregon. SUBJECTS: A total of 1221 residents (mean age, 65 years) recruited randomly from 120 neighborhoods (48% response rate). MEASURES: A geographic information system-based measure of fast food restaurant density across 120 neighborhoods was created. Residents within the sampled neighborhoods were assessed with respect to their body mass indices (BMI), frequency of visits to local fast food restaurants, fried food consumption, levels of physical activity, self-efficacy of eating fruits and vegetables, household income, and race/ethnicity. ANALYSES: Multilevel logistic regression analyses. RESULTS: Significant associations were found between resident-level individual characteristics and the likelihood of being obese (BMI > or = 30) for neighborhoods with a high-density of fast food restaurants in comparison with those with a low density: odds ratios for obesity, 95% confidence intervals (CI), were 1.878 (CI, 1.006-3.496) for weekly visits to local fast food restaurants; 1.792 (CI, 1.006-3.190) for not meeting physical activity recommendations; 1.212 (CI, 1.057-1.391) for low confidence in eating healthy food; and 8.057 (CI, 1.705-38.086) for non-Hispanic black residents. CONCLUSION: Increased density of neighborhood fast food outlets was associated with unhealthy lifestyles, poorer psychosocial profiles, and increased risk of obesity among older adults.
  409. Author: Morland KB, Evenson KR
    Title: Obesity prevalence and the local food environment.
    Journal: Health Place. 15(2):491-5
    Date: 2009 Jun
    Abstract: Disparities in access to healthy foods have been identified particularly in the United States. Fewer studies have measured the effects these disparities have on diet-related health outcomes. This study measured the association between the presence of food establishments and obesity among 1295 adults living in the southern region of the United States. The prevalence of obesity was lower in areas that had supermarkets and higher in area with small grocery stores or fast food restaurants. Our findings are consistent with other studies showing that types of food stores and restaurants influence food choices and, subsequently, diet-related health outcomes.
  410. Author: Day PL, Pearce J
    Title: Obesity-promoting food environments and the spatial clustering of food outlets around schools.
    Journal: Am J Prev Med. 40(2):113-21
    Date: 2011 Feb
    Abstract: BACKGROUND: The increasing prevalence of overweight and obesity in school-aged children is potentially linked to contextual influences such as the food environment around schools. The proximity of fast-food and convenience stores to schools may enhance access to unhealthy foods and have a negative impact on diet. PURPOSE: This study used spatial cluster analysis to determine whether food outlets are clustered around schools and evaluated the extent of food outlet clustering by school and school neighborhood sociodemographic characteristics. METHODS: The locations in 2008 of all schools, fast-food outlets, and convenience stores in five urban regions across New Zealand were geocoded. Using GIS analysis conducted in 2009, the number and proportion of outlets within 400-m and 800-m road distance around each school was calculated. The spatial clustering of food outlets within 1.5 km of schools was determined using a multi-type K-function. Food outlet type, school level, SES, the degree of population density, and commercial land use zoning around each school were compared. RESULTS: Primary/intermediate schools had a total proportion of 19.3 outlets per 1000 students within 800 m compared to 6.6 for secondary schools. The most socially deprived quintile of schools had three times the number and proportion of food outlets compared to the least-deprived quintile. There was a high degree of clustering of food outlets around schools, with up to 5.5 times more outlets than might be expected. Outlets were most clustered up to 800 m from schools and around secondary schools, socially deprived schools, and schools in densely populated and commercially zoned areas. CONCLUSIONS: Food environments in New Zealand within walking proximity to schools are characterized by a high density of fast-food outlets and convenience stores, particularly in more-socially deprived settings. These obesogenic environments provide ready access to obesity-promoting foods that may have a negative impact on student diet and contribute to inequalities in health.
  411. Author: He M, Tucker P, Irwin JD, Gilliland J, Larsen K, Hess P
    Title: Obesogenic neighbourhoods: the impact of neighbourhood restaurants and convenience stores on adolescents' food consumption behaviours.
    Journal: Public Health Nutr. 15(12):2331-9
    Date: 2012 Dec
    Abstract: OBJECTIVE: To examine the relationship between the neighbourhood food environment and dietary intake among adolescents. DESIGN: Cross-sectional design using: (i) a geographic information system to assess characteristics of the neighbourhood food environment and neighbourhood socio-economic status; (ii) the modified Healthy Eating Index (HEI) to assess participants' overall diet quality; and (iii) generalized linear models to examine associations between HEI and home and school food environmental correlates. SETTING: Mid-sized Canadian city in Ontario, Canada. Participants Grade 7 and 8 students (n 810) at twenty-one elementary schools. RESULTS: Students living in neighbourhoods with a lower diversity of land-use types, compared with their higher diversity counterparts, had higher HEI scores (P
  412. Author: Patel AI, Chandran K, Hampton KE, Hecht K, Grumbach JM, Kimura AT, Braff-Guajardo E, Brindis CD
    Title: Observations of drinking water access in school food service areas before implementation of federal and state school water policy, California, 2011.
    Journal: Prev Chronic Dis
    Date: 2012
    Abstract: INTRODUCTION: Recent legislation requires schools to provide free drinking water in food service areas (FSAs). Our objective was to describe access to water at baseline and student water intake in school FSAs and to examine barriers to and strategies for implementation of drinking water requirements. METHODS: We randomly sampled 24 California Bay Area public schools. We interviewed 1 administrator per school to assess knowledge of water legislation and barriers to and ideas for policy implementation. We observed water access and students' intake of free water in school FSAs. Wellness policies were examined for language about water in FSAs. RESULTS: Fourteen of 24 schools offered free water in FSAs; 10 offered water via fountains, and 4 provided water through a nonfountain source. Four percent of students drank free water at lunch; intake at elementary schools (11%) was higher than at middle or junior high schools (6%) and high schools (1%). In secondary schools when water was provided by a nonfountain source, the percentage of students who drank free water doubled. Barriers to implementation of water requirements included lack of knowledge of legislation, cost, and other pressing academic concerns. No wellness policies included language about water in FSAs. CONCLUSION: Approximately half of schools offered free water in FSAs before implementation of drinking water requirements, and most met requirements through a fountain. Only 1 in 25 students drank free water in FSAs. Although schools can meet regulations through installation of fountains, more appealing water delivery systems may be necessary to increase students' water intake at mealtimes.
  413. Author: Grigsby-Toussaint DS, Moise IK, Geiger SD
    Title: Observations of marketing on food packaging targeted to youth in retail food stores.
    Journal: Obesity (Silver Spring). 19(9):1898-900
    Date: 2011 Sep
    Abstract: There is growing evidence that exposure to food marketing influences dietary preferences among youth. Few studies exploring this association, however, have focused on the retail food store environment where families negotiate the influence of food and beverage marketing on purchasing practices. Consequently, we sought to examine: (i) the extent to which foods marketed on the internet and television to youth are also available and marketed in retail food stores, and (ii) whether differences exist in the marketing practices across store types and by neighborhood racial composition. In 2008, a cross-sectional survey of 118 food stores was conducted in four Midwestern cities in the United States. Results showed that 82% of stores assessed carried items commonly marketed to youth via television or the internet. The items most likely to have some type of marketing technique were noncarbonated drinks (97.7%), fruit and cereal bars (76.9%), and soda (62.2%). Grocery stores were significantly more likely than convenience stores to have marketing for breads and pastries (34.6% vs. 17.9%), breakfast cereals (52.0% vs. 22.9%), cookies and crackers (54.2% vs. 25.3%), dairy (70.8% vs. 42.7%), and ice cream (23.8% vs. 9.8%). Stores located in black neighborhoods were significantly more likely to have marketing, in comparison to white neighborhoods, for breads and pastries (35.7% vs. 17.1%), breakfast cereals (44.4% vs. 25.0%), and cookies and crackers (48.1% vs. 26.3%). Our results highlight the importance of examining food marketing techniques in the retail food store environment, where visual cues from television and the internet may be reinforced.
  414. Author: Macintyre S, McKay L, Cummins S, Burns C
    Title: Out-of-home food outlets and area deprivation: case study in Glasgow, UK.
    Journal: Int J Behav Nutr Phys Act
    Date: 2005 Oct 25
    Abstract: BACKGROUND: There is a popular belief that out-of-home eating outlets, which typically serve energy dense food, may be more commonly found in more deprived areas and that this may contribute to higher rates of obesity and related diseases in such areas. METHODS: We obtained a list of all 1301 out-of-home eating outlets in Glasgow, UK, in 2003 and mapped these at unit postcode level. We categorised them into quintiles of area deprivation using the 2004 Scottish Index of Multiple Deprivation and computed mean density of types of outlet (restaurants, fast food restaurants, cafes and takeaways), and all types combined, per 1000 population. We also estimated odds ratios for the presence of any outlets in small areas within the quintiles. RESULTS: The density of outlets, and the likelihood of having any outlets, was highest in the second most affluent quintile (Q2) and lowest in the second most deprived quintile (Q4). Mean outlets per 1,000 were 4.02 in Q2, 1.20 in Q4 and 2.03 in Q5. With Q2 as the reference, Odds Ratios for having any outlets were 0.52 (CI 0.32-0.84) in Q1, 0.50 (CI 0.31 - 0.80) in Q4 and 0.61 (CI 0.38 - 0.98) in Q5. Outlets were located in the City Centre, West End, and along arterial roads. CONCLUSION: In Glasgow those living in poorer areas are not more likely to be exposed to out-of-home eating outlets in their neighbourhoods. Health improvement policies need to be based on empirical evidence about the location of fast food outlets in specific national and local contexts, rather than on popular 'factoids'.
  415. Author: Arcan C, Neumark-Sztainer D, Hannan P, van den Berg P, Story M, Larson N
    Title: Parental eating behaviours, home food environment and adolescent intakes of fruits, vegetables and dairy foods: longitudinal findings from Project EAT.
    Journal: Public Health Nutr. 10(11):1257-65
    Date: 2007 Nov
    Abstract: OBJECTIVE: To examine longitudinal associations of parental report of household food availability and parent intakes of fruits, vegetables and dairy foods with adolescent intakes of the same foods. This study expands upon the limited research of longitudinal studies examining the role of parents and household food availability in adolescent dietary intakes. DESIGN: Longitudinal study. Project EAT-II followed an ethnically and socio-economically diverse sample of adolescents from 1999 (time 1) to 2004 (time 2). In addition to the Project EAT survey, adolescents completed the Youth Adolescent Food-Frequency Questionnaire in both time periods, and parents of adolescents completed a telephone survey at time 1. General linear modelling was used to examine the relationship between parent intake and home availability and adolescent intake, adjusting for time 1 adolescent intakes. Associations were examined separately for the high school and young adult cohorts and separately for males and females in combined cohorts. SUBJECTS/SETTING: The sample included 509 pairs of parents/guardians and adolescents. RESULTS: Vegetables served at dinner significantly predicted adolescent intakes of vegetables for males (P = 0.037), females (P = 0.009), high school (P = 0.033) and young adults (P = 0.05) at 5-year follow-up. Among young adults, serving milk at dinner predicted dairy intake (P = 0.002). Time 1 parental intakes significantly predicted intakes of young adults for fruit (P = 0.044), vegetables (P = 0.041) and dairy foods (P = 0.008). Parental intake predicted intake of dairy for females (P = 0.02). CONCLUSIONS: The findings suggest the importance of providing parents of adolescents with knowledge and skills to enhance the home food environment and improve their own eating behaviours.
  416. Author: Murnan J, Price JH, Telljohann SK, Dake JA, Boardley D
    Title: Parents' perceptions of curricular issues affecting children's weight in elementary schools.
    Journal: J Sch Health. 76(10):502-11
    Date: 2006 Dec
    Abstract: The purpose of this study was to examine Ohio parents' perceptions of the role of elementary schools in preventing childhood overweight. In the United States, overweight is the most widespread health threat facing children and adolescents. Schools may be a useful point of intervention in addressing the escalating prevalence of childhood overweight because children spend over half their day at school. A questionnaire was developed based primarily on the School Health Index, a tool developed by the Centers for Disease Control and Prevention to help schools assess and improve their physical activity, healthy eating, tobacco use prevention, and safety policies and programs. Seven hundred surveys were sent to a random sample of Ohio parents of elementary school-aged children. This study (53% response rate) found that the majority (51-73%) of parents identified 14 items as very important in preventing childhood overweight, which is indicative of their support for these curricular topics within the elementary school. All items from the physical education component had less than 50% of the parents identifying these items as very important. The item that was least supported (16%) by the parents was measuring a child's body mass index. The majority (51%) of parents indicated their preference for elementary students' access to vending machines only if they contained nutritious foods and beverages, while 42% of parents preferred that elementary students should not be allowed access to vending machines at all. The findings from this study suggest that Ohio parents would be supportive of school-based interventions focusing on healthy eating, physical activity, and the school environment to help reduce the prevalence of overweight in elementary children.
  417. Author: Mirtcheva DM, Powell LM
    Title: Participation in the national school lunch program: importance of school-level and neighborhood contextual factors.
    Journal: J Sch Health. 79(10):485-94
    Date: 2009 Oct
    Abstract: BACKGROUND: This study examined the effect of stigma (proxied by school-level peer participation), neighborhood food environment, and demographic characteristics on participation in the U.S. Department of Agriculture National School Lunch Program (NSLP). METHODS: The 1997 and 2003 waves of the Child Development Supplement to the Panel Study of Income Dynamics were linked to external data on school-level free lunch eligibility rate, fast food restaurant availability in the school zip code, and food store availability and neighborhood socioeconomic status in the home zip code. Probit models examined the effects of contextual and demographic factors on NSLP participation and free/reduced-price NSLP participation, conditional on eligibility. Differences were analyzed by grade. RESULTS: A 10% higher free lunch eligibility rate in a child's school was associated with a 1.8 percentage point increase in the probability of NSLP participation and 2.6 and 6.7 percentage points increase in free/reduced-price NSLP participation among all and high school eligible student, respectively. Fewer grocery stores and more convenience stores increased NSLP participation. Fast food restaurant availability in the school neighborhood decreased free/reduced-price NSLP participation for high school students only. The addition of the contextual factors reduced the estimated association with several of the demographic covariates, especially race. CONCLUSIONS: The significant positive association between NLSP participation and school-level free lunch eligibility, especially for the free/reduced-price NSLP participation, suggested that stigma, or possibly peers, affected participation. Neighborhood and school contextual variables had significant effects on school lunch take-up and the results differed between high school and elementary/middle school students.
  418. Author: Wall MM, Larson NI, Forsyth A, Van Riper DC, Graham DJ, Story MT, Neumark-Sztainer D
    Title: Patterns of obesogenic neighborhood features and adolescent weight: a comparison of statistical approaches.
    Journal: Am J Prev Med. 42(5):e65-75
    Date: 2012 May
    Abstract: BACKGROUND: Few studies have addressed the potential influence of neighborhood characteristics on adolescent obesity risk, and findings have been inconsistent. PURPOSE: Identify patterns among neighborhood food, physical activity, street/transportation, and socioeconomic characteristics and examine their associations with adolescent weight status using three statistical approaches. METHODS: Anthropometric measures were taken on 2682 adolescents (53% female, mean age=14.5 years) from 20 Minneapolis/St. Paul MN schools in 2009-2010. Neighborhood environmental variables were measured using GIS data and by survey. Gender-stratified regressions related to BMI z-scores and obesity to (1) separate neighborhood variables; (2) composites formed using factor analysis; and (3) clusters identified using spatial latent class analysis in 2012. RESULTS: Regressions on separate neighborhood variables found a low percentage of parks/recreation, and low perceived safety were associated with higher BMI z-scores in boys and girls. Factor analysis found five factors: away-from-home food and recreation accessibility, community disadvantage, green space, retail/transit density, and supermarket accessibility. The first two factors were associated with BMI z-score in girls but not in boys. Spatial latent class analysis identified six clusters with complex combinations of both positive and negative environmental influences. In boys, the cluster with highest obesity (29.8%) included low SES, parks/recreation, and safety; high restaurant and convenience store density; and nearby access to gyms, supermarkets, and many transit stops. CONCLUSIONS: The mix of neighborhood-level barriers and facilitators of weight-related health behaviors leads to difficulties disentangling their associations with adolescent obesity; however, statistical approaches including factor and latent class analysis may provide useful means for addressing this complexity.
  419. Author: Caldwell EM, Miller Kobayashi M, DuBow WM, Wytinck SM
    Title: Perceived access to fruits and vegetables associated with increased consumption.
    Journal: Public Health Nutr. 12(10):1743-50
    Date: 2009 Oct
    Abstract: OBJECTIVE: To examine the association between fruit and vegetable access in the community and change in fruit and vegetable consumption among participants in community-based health promotion programmes. DESIGN: Fruit and vegetable consumption and perceived access to fresh fruit and vegetables were measured by self-administered questionnaires at programme start, end and 1-year follow-up. Community produce availability was determined by grocery store assessments measuring the display space devoted to fruit and vegetable offerings, as well as price, variety and freshness. A total of nine communities were studied; 130 participants completed the fruit and vegetable portions of the questionnaires and could be linked to grocery store assessments. RESULTS: Participants made modest but significant increases in fruit and vegetable consumption from programme start to end: the average increase was 2.88 (95% CI 1.52, 4.25) servings weekly; the average increase from start to follow-up was 2.52 (95% CI 1.09, 3.95) servings weekly. Greater perceived access to fruits and vegetables was significantly associated with higher increases in fruit and vegetable consumption from programme start to programme end. Greater availability of produce was associated with greater increases in fruit and vegetable servings from programme start to programme end as measured by store assessments. CONCLUSIONS: Environmental factors, such as access to fruits and vegetables, can modify the effects of community interventions. Interventions with the goal of increasing fruit and vegetable consumption should consider focusing on increasing access to fresh fruits and vegetables in target communities. Similarly, researchers may want to study access as an intervention, not just a contextual variable.
  420. Author: Gustafson AA, Sharkey J, Samuel-Hodge CD, Jones-Smith J, Folds MC, Cai J, Ammerman AS
    Title: Perceived and objective measures of the food store environment and the association with weight and diet among low-income women in North Carolina.
    Journal: Public Health Nutr. 14(6):1032-8
    Date: 2011 Jun
    Abstract: OBJECTIVE: The present study aimed to highlight the similarities and differences between perceived and objective measures of the food store environment among low-income women and the association with diet and weight. DESIGN: Cross-sectional analysis of food store environment. Store level was characterized by: (i) the availability of healthy foods in stores where participants shop, using food store audits (objective); and (ii) summary scores of self-reported perception of availability of healthy foods in stores (perceived). Neighbourhood level was characterized by: (i) the number and type of food stores within the census tract (objective); and (2) summary scores of self-reported perception of availability of healthy foods (perceived). SETTING: Six counties in North Carolina. SUBJECTS: One hundred and eighty-six low-income women. RESULTS: Individuals who lived in census tracts with a convenience store and a supercentre had higher odds of perceiving their neighbourhood high in availability of healthy foods (OR = 6.87 (95 % CI 2.61, 18.01)) than individuals with no store. Overall, as the number of healthy foods available in the store decreased, the probability of perceiving that store high in availability of healthy foods increased. Individuals with a supercentre in their census tract weighed more (2.40 (95 % CI 0.66, 4.15) kg/m2) than individuals without one. At the same time, those who lived in a census tract with a supercentre and a convenience store consumed fewer servings of fruits and vegetables (-1.22 (95 % CI -2.40, -0.04)). CONCLUSIONS: The study contributes to a growing body of research aiming to understand how the food store environment is associated with weight and diet.
  421. Author: Williams LK, Thornton L, Crawford D, Ball K
    Title: Perceived quality and availability of fruit and vegetables are associated with perceptions of fruit and vegetable affordability among socio-economically disadvantaged women.
    Journal: Public Health Nutr. 15(7):1262-7
    Date: 2012 Jul
    Abstract: OBJECTIVE: Perceptions that fruit and vegetables are expensive have been found to be associated with lower consumption of fruit and vegetables among disadvantaged women; however, the determinants of these perceptions are relatively unknown. The purpose of the current paper is to examine whether perceived availability and quality of fruit and vegetables, and social support for healthy eating, are associated with perceptions of fruit and vegetable affordability among women residing in disadvantaged neighbourhoods. DESIGN: Cross-sectional self-report survey. SETTING: The study was conducted in Melbourne, Australia. SUBJECTS: An Australian sample of 4131 women, aged 18-45 years, residing in neighbourhoods ranked in the lowest Victorian tertile of relative disadvantage by the Australian Bureau of Statistics, an index that considers aspects of disadvantage such as residents' income, education, motor vehicle access and employment. RESULTS: Results showed that irrespective of education, income and other key covariates, women who perceived poor availability and quality of fruit and vegetables in their local neighbourhood were more likely to perceive fruit and vegetables as expensive. CONCLUSIONS: Our results suggest that perceptions of fruit and vegetable affordability are not driven exclusively by lack of financial or knowledge-related resources, but also by women's psychological response and interpretation of their local nutrition environment.
  422. Author: Hamdan S, Story M, French SA, Fulkerson JA, Nelson H
    Title: Perceptions of adolescents involved in promoting lower-fat foods in schools: associations with level of involvement.
    Journal: J Am Diet Assoc. 105(2):247-51
    Date: 2005 Feb
    Abstract: This article describes perceptions of adolescents involved in peer-led school-based nutrition promotions encouraging lower-fat food purchases and assesses the differences by level of student involvement. Surveys were administered at schools. Data were collected from 397 high school students from 10 Minnesota schools randomized to the intervention condition of the Trying Alternative Cafeteria Options in Schools study. Students were categorized as highly involved (n=54) or less involved (n=343) based on their level of involvement in promotional activity implementation. Chi 2 tests were conducted to measure the differences between highly-involved and less-involved students in perceptions and attitudes about lower-fat foods. Highly-involved students were significantly more likely than less-involved students to report more healthful eating behaviors and positive attitudes toward lower-fat foods. Student involvement in nutrition interventions should be integrated into programs aimed at increasing healthful food choices among adolescents.
  423. Author: Lucan SC, Mitra N
    Title: Perceptions of the food environment are associated with fast-food (not fruit-and-vegetable) consumption: findings from multi-level models.
    Journal: Int J Public Health. 57(3):599-608
    Date: 2012 Jun
    Abstract: OBJECTIVES: Diets low in fruits and vegetables and/or high in fast foods are associated with obesity and chronic diseases. Such diets may relate to different aspects of neighborhood food environments. We sought to evaluate if people's perceptions of their neighborhood food environment are associated with reported fruit-and-vegetable and fast-food consumption. METHODS: Cross-sectional analysis of a community health survey from Philadelphia, PA and four surrounding suburban counties (n = 10,450 individuals). We used mixed-effects multi-level Poisson models, nesting individuals within neighborhoods-i.e. census tracts (n = 991). RESULTS: Negative perceptions of the food environment (perceived difficulty finding fruits and vegetables, having to travel outside of one's neighborhood to get to a supermarket, and perceived poor grocery quality) were each directly associated with fast-food consumption (incident rate ratios [IRRs] 1.31, 1.06, 1.20; p
  424. Author: Blitstein JL, Snider J, Evans WD
    Title: Perceptions of the food shopping environment are associated with greater consumption of fruits and vegetables.
    Journal: Public Health Nutr. 15(6):1124-9
    Date: 2012 Jun
    Abstract: OBJECTIVE: The present study examined whether characteristics such as quality, selection and convenience are associated with dietary intake of fruits and vegetables independent of perceived costs in an inner-city, low-income population. DESIGN: Secondary analysis of baseline data from a social marketing intervention designed to change household dietary practices among parents of 3- to 7-year-old children. SETTING: A community sample drawn from six low-income, primarily minority neighbourhoods in Chicago, IL, USA. SUBJECTS: From the parent study, 526 respondents completed the baseline survey and were eligible for inclusion. Of this number, 495 provided complete data on sociodemographic characteristics, fruit and vegetable consumption, perceptions of the shopping environment, perceived costs of fruits and vegetables, and food shopping habits. RESULTS: Logistic regression analysis showed that more positive perceptions of the food shopping environment were associated with greater consumption of fruits and vegetables. There was an increase of approximately twofold in the likelihood of consuming three or more fruits and vegetables daily per level of satisfaction ascribed to the shopping environment. This association was independent of perceived cost, store type and sociodemographic characteristics. CONCLUSIONS: Our data show that among a generally minority and low-income population, quality, selection and convenience are important determinants of fruit and vegetable consumption. Nutrition promotion campaigns that aim to alter the built environment by increasing access to fruits and vegetables should recognize that simply increasing availability may not yield beneficial change when characteristics of the shopping context are ignored.
  425. Author: De Bourdeaudhuij I, te Velde S, Brug J, Due P, Wind M, Sandvik C, Maes L, Wolf A, Perez Rodrigo C, Yngve A, Thorsdottir I, Rasmussen M, Elmadfa I, Franchini B, Klepp KI
    Title: Personal, social and environmental predictors of daily fruit and vegetable intake in 11-year-old children in nine European countries.
    Journal: Eur J Clin Nutr. 62(7):834-41
    Date: 2008 Jul
    Abstract: OBJECTIVE: To investigate potential personal, social and physical environmental predictors of daily fruit intake and daily vegetable intake in 11-year-old boys and girls in nine European countries. SUBJECTS: The total sample size was 13 305 (90.4% participation rate). RESULTS: Overall, 43.2% of the children reported to eat fruit every day, 46.1% reported to eat vegetables every day. Daily fruit intake and daily vegetable intake was mainly associated with knowledge of the national recommendations, positive self-efficacy, positive liking and preference, parental modeling and demand and bringing fruit to school (odds ratio between 1.40 and 2.42, P
  426. Author: Jones SJ, Gonzalez W, Frongillo EA
    Title: Policies that restrict sweetened beverage availability may reduce consumption in elementary-school children.
    Journal: Public Health Nutr. 13(4):589-95
    Date: 2010 Apr
    Abstract: OBJECTIVE: We investigated whether having a policy regarding the availability of sweetened beverages in school was associated with children's purchase and total weekly and daily consumption of sweetened beverages. DESIGN: Data were obtained from 10 719 children aged 9-13 years and 2065 elementary schools in the Early Childhood Longitudinal Study-Kindergarten cohort. Multilevel logistic regression was used to determine the magnitude and significance of relationships between the availability of different beverages and purchase of sweetened beverages at school and overall consumption of beverages. RESULTS: The purchase of sweetened beverages by children in school was strongly associated with the administrative policy of sweetened beverage availability. Compared with children in schools without an administrative policy that allowed sweetened beverages, children in schools with the policy were three times more likely to be either occasional or frequent consumers of sweetened beverages. CONCLUSIONS: A policy of availability of sweetened beverages makes an independent contribution to children's purchase and consumption of sweetened beverages in the 5th grade year.
  427. Author: Andreyeva T, Luedicke J, Middleton AE, Long MW, Schwartz MB
    Title: Positive influence of the revised Special Supplemental Nutrition Program for Women, Infants, and Children food packages on access to healthy foods.
    Journal: J Acad Nutr Diet. 112(6):850-8
    Date: 2012 Jun
    Abstract: BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has important potential for preventing diet-related disease in low-income children. WIC food packages were recently revised to offer foods that better reflect dietary recommendations for Americans. OBJECTIVE: This article reports on how implementation of the new healthier WIC food packages affected access of low-income populations to healthy foods (eg, whole grains, fruit and vegetables, and lower-fat milk). DESIGN: A pre-post store inventory was completed using a standardized instrument to assess availability, variety, quality and prices of WIC-approved foods (65 food items). Stores were assessed before (spring 2009) and shortly after the new WIC package implementation (spring 2010). PARTICIPANTS/SETTING: All convenience stores and nonchain grocery stores located in five towns of Connecticut (N=252), including 33 WIC-authorized stores and 219 non-WIC stores. STATISTICAL ANALYSES PERFORMED: The healthy food supply score was constructed to summarize postrevision changes in availability, variety, prices of healthy foods, and produce quality. The effect of the WIC food package revisions was measured by differential changes in the scores for stores authorized to accept WIC benefits and stores not participating in WIC, including differences by neighborhood income. Multivariate multilevel regression models were estimated. RESULTS: The 2009 introduction of the revised WIC food packages has significantly improved availability and variety of healthy foods in WIC-authorized and (to a smaller degree) non-WIC convenience and grocery stores. The increase in the composite score of healthy food supply varied from 16% in WIC convenience and grocery stores in higher-income neighborhoods to 39% in lower-income areas. Improved availability and variety of whole-grain products were responsible for most of the increase in the composite score of healthy food supply. CONCLUSIONS: Designed as cost-neutral changes, the WIC food package revisions have improved access to healthy foods for WIC participants and society at large.
  428. Author: Gregson J
    Title: Poverty, sprawl, and restaurant types influence body mass index of residents in California counties.
    Journal: Public Health Rep
    Date: 2011 May-Jun
    Abstract: OBJECTIVES: This article examines the relationships between structural poverty (the proportion of people in a county living at
  429. Author: Everett Jones S, Brener ND, McManus T
    Title: Prevalence of school policies, programs, and facilities that promote a healthy physical school environment.
    Journal: Am J Public Health. 93(9):1570-5
    Date: 2003 Sep
    Abstract: OBJECTIVES: We examined the extent to which schools in the United States have health-promoting policies, programs, and facilities. METHODS: We analyzed data from the School Health Policies and Programs Study 2000. RESULTS: We found that public schools (vs private and Catholic schools), urban schools (vs rural and suburban schools), and schools with larger enrollments (vs smaller schools) had more health-promoting policies, programs, and facilities in place. On average, middle schools had 11.0 and middle/junior and high schools had 10.4 out of a possible 18 policies, programs, and facilities. CONCLUSIONS: Although some schools had many healthy physical environment features, room for improvement exists. Resources are available to help schools improve their health-promoting policies, programs, and facilities.
  430. Author: French SA, Jeffery RW, Story M, Breitlow KK, Baxter JS, Hannan P, Snyder MP
    Title: Pricing and promotion effects on low-fat vending snack purchases: the CHIPS Study.
    Journal: Am J Public Health. 91(1):112-7
    Date: 2001 Jan
    Abstract: OBJECTIVES: This study examined the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines. METHODS: Low-fat snacks were added to 55 vending machines in a convenience sample of 12 secondary schools and 12 worksites. Four pricing levels (equal price, 10% reduction, 25% reduction, 50% reduction) and 3 promotional conditions (none, low-fat label, low-fat label plus promotional sign) were crossed in a Latin square design. Sales of low-fat vending snacks were measured continuously for the 12-month intervention. RESULTS: Price reductions of 10%, 25%, and 50% on low-fat snacks were associated with significant increases in low-fat snack sales; percentages of low-fat snack sales increased by 9%, 39%, and 93%, respectively. Promotional signage was independently but weakly associated with increases in low-fat snack sales. Average profits per machine were not affected by the vending interventions. CONCLUSIONS: Reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent populations.
  431. Author: French SA, Story M, Jeffery RW, Snyder P, Eisenberg M, Sidebottom A, Murray D
    Title: Pricing strategy to promote fruit and vegetable purchase in high school cafeterias.
    Journal: J Am Diet Assoc. 97(9):1008-10
    Date: 1997 Sep
    Abstract:
  432. Author: Kocken PL, Eeuwijk J, Van Kesteren NM, Dusseldorp E, Buijs G, Bassa-Dafesh Z, Snel J
    Title: Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study.
    Journal: J Sch Health. 82(3):115-22
    Date: 2012 Mar
    Abstract: BACKGROUND: Vending machines account for food sales and revenue in schools. We examined 3 strategies for promoting the sale of lower-calorie food products from vending machines in high schools in the Netherlands. METHODS: A school-based randomized controlled trial was conducted in 13 experimental schools and 15 control schools. Three strategies were tested within each experimental school: increasing the availability of lower-calorie products in vending machines, labeling products, and reducing the price of lower-calorie products. The experimental schools introduced the strategies in 3 consecutive phases, with phase 3 incorporating all 3 strategies. The control schools remained the same. The sales volumes from the vending machines were registered. Products were grouped into (1) extra foods containing empty calories, for example, candies and potato chips, (2) nutrient-rich basic foods, and (3) beverages. They were also divided into favorable, moderately unfavorable, and unfavorable products. RESULTS: Total sales volumes for experimental and control schools did not differ significantly for the extra and beverage products. Proportionally, the higher availability of lower-calorie extra products in the experimental schools led to higher sales of moderately unfavorable extra products than in the control schools, and to higher sales of favorable extra products in experimental schools where students have to stay during breaks. Together, availability, labeling, and price reduction raised the proportional sales of favorable beverages. CONCLUSION: Results indicate that when the availability of lower-calorie foods is increased and is also combined with labeling and reduced prices, students make healthier choices without buying more or fewer products from school vending machines. Changes to school vending machines help to create a healthy school environment.
  433. Author: Simon PA, Kwan D, Angelescu A, Shih M, Fielding JE
    Title: Proximity of fast food restaurants to schools: do neighborhood income and type of school matter?
    Journal: Prev Med. 47(3):284-8
    Date: 2008 Sep
    Abstract: OBJECTIVES: To investigate the proximity of fast food restaurants to public schools and examine proximity by neighborhood income and school level (elementary, middle, or high school). METHODS: Geocoded school and restaurant databases from 2005 and 2003, respectively, were used to determine the percentage of schools with one or more fast food restaurants within 400 m and 800 m of all public schools in Los Angeles County, California. Single-factor analysis of variance (ANOVA) models were run to examine fast food restaurant proximity to schools by median household income of the surrounding census tract and by school level. Two-factor ANOVA models were run to assess the additional influence of neighborhood level of commercialization. RESULTS: Overall, 23.3% and 64.8% of schools had one or more fast food restaurants located within 400 m and 800 m, respectively. Fast food restaurant proximity was greater for high schools than for middle and elementary schools, and was inversely related to neighborhood income for schools in the highest commercial areas. No association with income was observed in less commercial areas. CONCLUSIONS: Fast food restaurants are located in close proximity to many schools in this large metropolitan area, especially high schools and schools located in low income highly commercial neighborhoods. Further research is needed to assess the relationship between fast food proximity and student dietary practices and obesity risk.
  434. Author: Davis B, Carpenter C
    Title: Proximity of fast-food restaurants to schools and adolescent obesity.
    Journal: Am J Public Health. 99(3):505-10
    Date: 2009 Mar
    Abstract: OBJECTIVES: We examined the relationship between fast-food restaurants near schools and obesity among middle and high school students in California. METHODS: We used geocoded data (obtained from the 2002-2005 California Healthy Kids Survey) on over 500,000 youths and multivariate regression models to estimate associations between adolescent obesity and proximity of fast-food restaurants to schools. RESULTS: We found that students with fast-food restaurants near (within one half mile of) their schools (1) consumed fewer servings of fruits and vegetables, (2) consumed more servings of soda, and (3) were more likely to be overweight (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.02, 1.10) or obese (OR = 1.07; 95% CI = 1.02, 1.12) than were youths whose schools were not near fast-food restaurants, after we controlled for student- and school-level characteristics. The result was unique to eating at fast-food restaurants (compared with other nearby establishments) and was not observed for another risky behavior (smoking). CONCLUSIONS: Exposure to poor-quality food environments has important effects on adolescent eating patterns and overweight. Policy interventions limiting the proximity of fast-food restaurants to schools could help reduce adolescent obesity.
  435. Author: Laraia BA, Siega-Riz AM, Kaufman JS, Jones SJ
    Title: Proximity of supermarkets is positively associated with diet quality index for pregnancy.
    Journal: Prev Med. 39(5):869-75
    Date: 2004 Nov
    Abstract: OBJECTIVES: To investigate the association between distance to the closest supermarket and a composite measure of diet, the diet quality index for pregnancy (DQI-P) was constructed. METHODS: Data from the Pregnancy, Infection and Nutrition (PIN) cohort, a prospective study of determinants of preterm birth, were analyzed. Food frequency questionnaires were used to construct DQI-P which includes: servings of grains, vegetables, fruits, folate, iron and calcium intake, percentage of calories from fat, and meal pattern score. Street address of residence, supermarkets, grocery and convenience stores were geocoded. Participants with complete food frequency and address data were included (n = 918). Multinomial logistic regression was used to estimate the conditional association of food outlets on diet quality, controlling for confounders and using a robust variance estimator to account for clustering of neighborhood characteristics. RESULTS: Women living greater than 4 miles from a supermarket were more than twice the odds (adjusted odds ratio = 2.16; 95% confidence interval = 1.2, 4.0) of falling into the lowest compared to highest DQI-P tertile compared to women living within 2 miles of a supermarket, after controlling for individual characteristics, other food retail outlets. CONCLUSION: These findings suggest that proximity of food retail outlets influences the diet quality of pregnant women.
  436. Author: Block JP, Christakis NA, O'Malley AJ, Subramanian SV
    Title: Proximity to food establishments and body mass index in the Framingham Heart Study offspring cohort over 30 years.
    Journal: Am J Epidemiol. 174(10):1108-14
    Date: 2011 Nov 15
    Abstract: Existing evidence linking residential proximity to food establishments with body mass index (BMI; weight (kg)/height (m)(2)) has been inconclusive. In this study, the authors assessed the relation between BMI and proximity to food establishments over a 30-year period among 3,113 subjects in the Framingham Heart Study Offspring Cohort living in 4 Massachusetts towns during 1971-2001. The authors used novel data that included repeated measures of BMI and accounted for residential mobility and the appearance and disappearance of food establishments. They calculated proximity to food establishments as the driving distance between each subject's residence and nearby food establishments, divided into 6 categories. The authors used cross-classified linear mixed models to account for time-varying attributes of individuals and residential neighborhoods. Each 1-km increase in distance to the closest fast-food restaurant was associated with a 0.11-unit decrease in BMI (95% credible interval: -0.20, -0.04). In sex-stratified analyses, this association was present only for women. Other aspects of the food environment were either inconsistently associated or not at all associated with BMI. Contrary to much prior research, the authors did not find a consistent relation between access to fast-food restaurants and individual BMI, necessitating a reevaluation of policy discussions on the anticipated impact of the food environment on weight gain.
  437. Author: Longacre MR, Primack BA, Owens PM, Gibson L, Beauregard S, Mackenzie TA, Dalton MA
    Title: Public directory data sources do not accurately characterize the food environment in two predominantly rural states.
    Journal: J Am Diet Assoc. 111(4):577-82
    Date: 2011 Apr
    Abstract: Communities are being encouraged to develop locally based interventions to address environmental risk factors for obesity. Online public directories represent an affordable and easily accessible mechanism for mapping community food environments, but may have limited utility in rural areas. The primary aim of this study was to evaluate the efficacy of public directories vs rigorous onsite field verification to characterize the community food environment in 32 geographically dispersed towns from two rural states covering 1,237.6 square miles. Eight types of food outlets were assessed in 2007, including food markets and eating establishments, first using two publically available online directories followed by onsite field verification by trained coders. χ(2) and univariate binomial regression were used to determine whether the proportion of outlets accurately listed varied by food outlet type or town population. Among 1,340 identified outlets, only 36.9% were accurately listed through public directories; 29.6% were not listed but were located during field observation. Accuracy varied by outlet type, being most accurate for big box stores and least accurate for farm/produce stands. Overall, public directories accurately identified fewer than half of the food outlets. Accuracy was significantly lower for rural and small towns compared to mid-size and urban towns (P
  438. Author: Naylor PJ, Bridgewater L, Purcell M, Ostry A, Wekken SV
    Title: Publically funded recreation facilities: obesogenic environments for children and families?
    Journal: Int J Environ Res Public Health. 7(5):2208-21
    Date: 2010 May
    Abstract: Increasing healthy food options in public venues, including recreational facilities, is a health priority. The purpose of this study was to describe the public recreation food environment in British Columbia, Canada using a sequential explanatory mixed methods design. Facility audits assessed policy, programs, vending, concessions, fundraising, staff meetings and events. Focus groups addressed context and issues related to action. Eighty-eighty percent of facilities had no policy governing food sold or provided for children/youth programs. Sixty-eight percent of vending snacks were chocolate bars and chips while 57% of beverages were sugar sweetened. User group fundraisers held at the recreation facilities also sold 'unhealthy' foods. Forty-two percent of recreation facilities reported providing user-pay programs that educated the public about healthy eating. Contracts, economics, lack of resources and knowledge and motivation of staff and patrons were barriers to change. Recreation food environments were obesogenic but stakeholders were interested in change. Technical support, resources and education are needed.
  439. Author: Dean WR, Sharkey JR, St John J
    Title: Pulga (flea market) contributions to the retail food environment of colonias in the South Texas border region.
    Journal: J Am Diet Assoc. 111(5):705-10
    Date: 2011 May
    Abstract: Accounts of the retail food environment have been limited by research that focused on supermarkets, grocery stores, and restaurants as the principal food sources for consumers. Little is known about alternative retail food sources, especially in rural and underserved areas such as the colonias along the South Texas border with Mexico. Many colonias are located near pulgas (flea markets). This is the first study to examine this alternative food source for colonia residents. This study's purpose is to provide preliminary data on food availability in this unstudied element of the retail food environment. Five pulgas were identified for study by local informants. Two separate teams of two promotores (indigenous community health workers) conducted observations, wrote field notes, and surveyed vendors in each pulga. Traditional foods, prepared foods, and fresh fruits and vegetables were available in the observed pulgas. Traditional foods included staples, meal items, and snacks and sweets. Prepared foods were available in small stands run by independent operators, and each pulga had permanent restaurants that served prepared foods. A large variety of fresh fruits and vegetables were also available. An emphasis on supermarkets and grocery stores will provide an incomplete account of the retail food environment. Further studies should attempt to provide a more complete account by identifying alternative retail sources used by local residents. One such alternative retail food source, the pulga, provides a range of traditional food stuffs, prepared food items, and fruits and vegetables that complement conventionally studied aspects of the retail food environment.
  440. Author: Galvez MP, Morland K, Raines C, Kobil J, Siskind J, Godbold J, Brenner B
    Title: Race and food store availability in an inner-city neighbourhood.
    Journal: Public Health Nutr. 11(6):624-31
    Date: 2008 Jun
    Abstract: BACKGROUND: A growing body of research has shown that disparities in resources, including food stores, exist at the neighbourhood level and the greatest disparities are seen in minority neighbourhoods, the same neighbourhoods at increased risk of obesity and diabetes. Less is known about whether differences in availability of resources by African American or Latino race/ethnicity exist within a single minority community. OBJECTIVE: The present study examined whether census blocks either 75% African American (AA) or 75% Latino (L) are associated with food store availability, as compared with racially mixed (RM) census blocks, in East Harlem, New York. DESIGN/METHODS: A cross-sectional study utilising a walking survey of East Harlem was performed. Food stores were classified into: supermarkets, grocery stores, convenience stores, specialty stores, full-service restaurants and fast-food stores. RESULTS: One hundred and sixty-five East Harlem census blocks were examined; 17 were AA, 34 were L and 114 were RM. Of AA census blocks, 100% had neither supermarkets nor grocery stores. AA census blocks were less likely to have convenience stores (prevalence ratio (PR) = 0.25, 95% confidence interval (CI) 0.07-0.86) compared with RM census blocks. In contrast, predominantly L census blocks were more likely to have convenience stores (PR = 1.8, 95% CI 1.20-2.70), specialty food stores (PR = 3.74, 95% CI 2.06-7.15), full-service restaurants (PR = 1.87, 95% CI 1.04-3.38) and fast-food restaurants (PR = 2.14, 95% CI 1.33-3.44) compared with RM census blocks. CONCLUSIONS: We found that inequities in food store availability exist by race/ethnicity in East Harlem, New York. This has implications for racial/ethnic differences in dietary quality, obesity and obesity-related disorders.
  441. Author: Helling A, Sawicki DS
    Title: Race and residential accessibility to shopping and services
    Journal: Housing policy debate. 14(1-2):69-101
    Date: 2003
    Abstract: Predominantly black, upper-income census tracts in the 10-county Atlanta region have lower accessibility to certain personal consumption opportunities than comparable white tracts do; black residents are more likely to have to leave their neighborhoods to eat out (other than at fast food restaurants), grocery shop, or see movies. Accessibility is calculated as a function of travel time to providers of local goods and services. Such accessibility is a desirable attribute and contributes to neighborhood quality and housing value. We find that differences in residential accessibility to shopping and services by race are not explained by income differences, but could result from real differences in consumption patterns, though these are more likely due to demographic differences between black and white populations of comparable incomes; inaccurate information on neighborhood attributes and personal consumption preferences; or racially biased business decisions. We conclude by summarizing the policy implications of our findings.
  442. Author: King DK, Glasgow RE, Leeman-Castillo B
    Title: Reaiming RE-AIM: using the model to plan, implement, and evaluate the effects of environmental change approaches to enhancing population health.
    Journal: Am J Public Health. 100(11):2076-84
    Date: 2010 Nov
    Abstract: The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, which provides a practical means of evaluating health interventions, has primarily been used in studies focused on changing individual behaviors. Given the importance of the built environment in promoting health, using RE-AIM to evaluate environmental approaches is logical. We discussed the benefits and challenges of applying RE-AIM to evaluate built environment strategies and recommended modest adaptations to the model. We then applied the revised model to 2 prototypical built environment strategies aimed at promoting healthful eating and active living. We offered recommendations for using RE-AIM to plan and implement strategies that maximize reach and sustainability, and provided summary measures that public health professionals, communities, and researchers can use in evaluating built environment interventions.
  443. Author: Snyder MP, Story M, Trenkner LL
    Title: Reducing fat and sodium in school lunch programs: the LUNCHPOWER! Intervention Study.
    Journal: J Am Diet Assoc. 92(9):1087-91
    Date: 1992 Sep
    Abstract: This study developed, implemented, and evaluated a healthful school lunch program that provided tasty food choices that were lower in fat and sodium. The LUNCHPOWER! Intervention Program was implemented in 34 elementary schools in four school districts that represented diverse geographic areas of Minnesota. A team of registered dietitians, foodservice directors, and cook managers reduced the fat and sodium content of school lunches by modifying recipes and food preparation methods and by identifying and selecting vendor products (prepared food products) that were lower in fat and sodium. Nutrition education messages for students and parents were developed for the 5-month intervention. Monthly menus were analyzed for fat, sodium, and energy content before and after the intervention. There was a significant decrease in both total grams of fat and percent of energy from fat between baseline and follow-up. At all 34 schools, mean daily amount of total fat in the lunch menu decreased 39% (from 32 g to 20 g) and percent of energy from fat decreased 29% (from 40% to 28%). We found that schools could serve lower-sodium and lower-fat meals and retain student participation in the school lunch program.
  444. Author: Cummins S, Findlay A, Higgins C, Petticrew M, Sparks L, Thomson H
    Title: Reducing inequalities in health and diet: findings from a study on the impact of a food retail development
    Journal: Environment and Planning A. 40(2):402-22
    Date: 2008
    Abstract: The health and diet impacts of a large-scale food retail development within a deprived area of Glasgow (Springburn) are reported. The study used a prospective quasi-experimental design which compared changes in diet and psychological health in an area where a new hypermarket was built (the intervention area), with a similarly-deprived comparison area in Glasgow (Shettleston). A postal survey was undertaken both before and one year after the hypermarket was built, to assess changes in diet, self-reported health, and perceptions of neighbourhood. Changes in the retail structure of both areas were assessed through a before and (repeated) after intervention shop count survey. Qualitative data on diet, the neighbourhood and the impact of the store were collected through focus groups. The quantitative study found limited improvements in diet and health. There was weak evidence for the impact of the hypermarket on population diet. There was weak evidence that poor psychological health in the intervention area reduced. Amongst those who switched to the new hypermarket there was weak evidence of a small improvement in mean fruit and vegetable consumption but good evidence of psychological health improvement. Qualitative and retail survey results reinforce this, identifying perceptions of areal improvement through redevelopment and a small positive impact of the new store on the intervention areas retail structure.
  445. Author: Den Hond EM, Lesaffre EE, Kesteloot HE
    Title: Regional differences in consumption of 103 fat products in Belgium: a supermarket-chain sales approach.
    Journal: J Am Coll Nutr. 14(6):621-7
    Date: 1995 Dec
    Abstract: OBJECTIVE: In Belgium, important regional differences in mortality exist which have been linked to differences in dietary consumption patterns. METHODS: To study regional food consumption in Belgium, sales data of 103 spreading and cooking fat products in 110 branch stores of a major supermarket chain (Colruyt) for 12 months (1991-92) were analyzed. RESULTS: Sale of more ordinary and polyunsaturated spreading margarine and of more polyunsaturated low-fat spread in the north in combination with a greater sale of butter and dairy low-fat spread in the south resulted in a P/S-ratio of 0.99 in the north vs. 0.40 in the south (p
  446. Author: Sturm R, Datar A
    Title: Regional price differences and food consumption frequency among elementary school children.
    Journal: Public Health. 125(3):136-41
    Date: 2011 Mar
    Abstract: OBJECTIVE: Food prices may affect diet and weight gain among youth and lead to geographic disparities in obesity. This paper examines the association between regional prices and consumption frequency of fruit/vegetables and snack items among elementary school children in the USA. STUDY DESIGN: Observational study using individual-level survey data of fifth-grade children (average age 11 years) and regional food prices based on store visits in 2004. METHODS: Dependent variables are self-reported consumption frequency in fifth grade; primary explanatory variables are metropolitan area food prices relative to cost of living. Multivariate regression analysis. RESULTS: Price variation across metropolitan areas exists, and lower real prices for vegetables and fruits predict significantly higher intake frequency. Higher dairy prices predict lower frequency of milk consumption, while higher meat prices predict increased milk consumption. Similar price effects were not found for fast food or soft drink consumption. DISCUSSION: The geographic variation in food prices across the USA is sufficiently large to affect dietary patterns among youth for fruit, vegetables and milk. The price variation is either too small to affect children's consumption frequency of fast food or soft drinks, or the consumption of these foods is less price sensitive.
  447. Author: Spence JC, Cutumisu N, Edwards J, Raine KD, Smoyer-Tomic K
    Title: Relation between local food environments and obesity among adults.
    Journal: BMC Public Health
    Date: 2009
    Abstract: BACKGROUND: Outside of the United States, evidence for associations between exposure to fast-food establishments and risk for obesity among adults is limited and equivocal. The purposes of this study were to investigate whether the relative availability of different types of food retailers around people's homes was associated with obesity among adults in Edmonton, Canada, and if this association varied as a function of distance between food locations and people's homes. METHODS: Data from a population health survey of 2900 adults (18 years or older) conducted in 2002 was linked with geographic measures of access to food retailers. Based upon a ratio of the number of fast-food restaurants and convenience stores to supermarkets and specialty food stores, a Retail Food Environment Index (RFEI) was calculated for 800 m and 1600 m buffers around people's homes. In a series of logistic regressions, associations between the RFEI and the level of obesity among adults were examined. RESULTS: The median RFEI for adults in Edmonton was 4.00 within an 800 m buffer around their residence and 6.46 within a 1600 m buffer around their residence. Approximately 14% of the respondents were classified as being obese. The odds of a resident being obese were significantly lower (OR = 0.75, 95%CI 0.59 - 0.95) if they lived in an area with the lowest RFEI (below 3.0) in comparison to the highest RFEI (5.0 and above). These associations existed regardless of the covariates included in the model. No significant associations were observed between RFEI within a 1600 m buffer of the home and obesity. CONCLUSION: The lower the ratio of fast-food restaurants and convenience stores to grocery stores and produce vendors near people's homes, the lower the odds of being obese. Thus the proximity of the obesogenic environment to individuals appears to be an important factor in their risk for obesity.
  448. Author: Bryant M, Stevens J, Wang L, Tabak R, Borja J, Bentley ME
    Title: Relationship between home fruit and vegetable availability and infant and maternal dietary intake in African-American families: evidence from the exhaustive home food inventory.
    Journal: J Am Diet Assoc. 111(10):1491-7
    Date: 2011 Oct
    Abstract: BACKGROUND: The availability of foods in the home is likely to be related to consumption. We know of no studies that have reported this association in African-American participants, and few studies have examined home food availability using objective methods. OBJECTIVE: This study aimed to assess the association between objective measures of fruits and vegetables in the home with reported infant and maternal diet in low-income African Americans. DESIGN: A cross-sectional study design was used to compare food availability and dietary intake. The Exhaustive Home Food Availability Inventory used barcode scanning to measure food availability in the home. Maternal and infant diet was assessed by 24-hour recall. SUBJECTS/SETTING: Eighty African-American first-time mother/infant dyads were recruited from Wake and Durham counties in North Carolina. STATISTICAL ANALYSES PERFORMED: Adjusted mean dietary intake of infants and mothers was calculated within tertiles of food and nutrient availability using analysis of variance. The bootstrap method was used to estimate P values and 95% confidence intervals. Models were adjusted for mother's age, household size, shopping and eating-out behavior. RESULTS: Infants and mothers living in homes in the highest tertile of availability of energy, nutrients, and fruits and vegetables tended to have the highest consumption, respectively; however, statistically significant associations were more likely to occur with infant diet than maternal diet. The relationship was strongest for infant consumption of fruit, with an average of 103.3 g consumed by infants who lived in homes in the highest tertile of availability, compared to 42.5 g in those living in homes in the lowest tertile (P
  449. Author: Kendall A, Olson CM, Frongillo EA Jr
    Title: Relationship of hunger and food insecurity to food availability and consumption.
    Journal: J Am Diet Assoc. 96(10):1019-24; quiz 1025-6
    Date: 1996 Oct
    Abstract: OBJECTIVE: To describe the relationship of new measures of hunger and food insecurity to household food supplies and individual food and nutrient intake. DESIGN AND SETTING: A questionnaire containing the Radimer/Cornell hunger and food insecurity items and questions on eating patterns and the frequency of fruit and vegetable consumption was administered to subjects during a personal interview in their homes. A 24-hour diet recall and a household food inventory were conducted at the initial interview and at a follow-up visit. SUBJECTS: Participants were 193 women drawn from a random sample of 308 women who had completed a previous health census in a rural New York State county. Subjects' ages ranged from 15 to 40 years. All had children living at home and less than 16 years of education. STATISTICAL ANALYSES: Regression analysis was used to test for linear trends across food insecurity groups for the household food inventory scores and for the frequency of consumption of fruits and vegetables. t Tests were used to assess differences between the food secure and food insecure groups for nutrient and food group means. A chi 2 test for trend was used to examine differences in the distribution of nutrient and fruit and vegetable intake between the food secure and food insecure groups. RESULTS: A significant decrease in the frequency of consumption of fruits and vegetables and the amount of food in the household and a significant increase in scores indicative of disordered eating patterns were associated with a worsening of food insecurity status. Potassium and fiber intake and fruit consumption differed significantly between the food secure and food insecure groups. The percentage of respondents consuming less than the Recommended Dietary Allowance for vitamin C and fewer than five fruits and vegetables per day was significantly greater among food insecure respondents than food secure respondents. APPLICATIONS/CONCLUSIONS: The quantity of food available in households and consumption of fruits and vegetables decreased with increasingly severe problems with food insecurity and hunger. In this rural population, the Radimer/ Cornell measures were useful in identifying households experiencing food insecurity and providing information about the nature of the food supply and the dietary intake problems experienced by food insecure households and persons, suggesting that these measures may be useful on community surveys designed to examine food insecurity issues.
  450. Author: Slater ME, Sirard JR, Laska MN, Pereira MA, Lytle LA
    Title: Relationships between energy balance knowledge and the home environment.
    Journal: J Am Diet Assoc. 111(4):556-60
    Date: 2011 Apr
    Abstract: Certain aspects of the home environment as well as individuals' knowledge of energy balance are believed to be important correlates of various dietary and physical activity behaviors, but no known studies have examined potential relationships between these correlates. This study evaluated cross-sectional associations between characteristics of the home environment and energy balance knowledge among 349 youth/parent pairs recruited from the Minneapolis/St Paul, MN, metropolitan area from September 2006 to June 2007. Linear regression models adjusted for student grade and highest level of parental education were used to compare data from home food, physical activity, and media inventories (parent-reported) with energy balance knowledge scores from youth and parent questionnaires. Paired energy balance knowledge (average of youth and parent knowledge scores) was associated with all home food availability variables. Paired knowledge was also significantly associated with a media equipment availability and accessibility summary score (β=-1.40, P=0.005), as well as an activity-to-media ratio score (β=0.72, P=0.003). Youth and/or parent knowledge alone was not significantly associated with most characteristics of the home environment, supporting the importance of developing intervention strategies that target the family as a whole.
  451. Author: Jago R, Baranowski T, Harris M
    Title: Relationships between GIS environmental features and adolescent male physical activity: GIS coding differences
    Journal: Journal of physical activity and health. 3(2):230-42
    Date: 2006
    Abstract: Background: It is not clear if relationships between GIS obtained environmental features and physical activity differ according to the method used to code GIS data. Methods: Physical activity levels of 210 Boy Scouts were measured by accelerometer. Numbers of parks, trails, gymnasia, bus stops, grocery stores, and restaurants within the commonly used 400 m and 1-mile (1609.3 m) buffers of subject residences and distance to the nearest feature were calculated. Residential density, connectivity, and crime rate were calculated. Regression models with minutes of sedentary, light, or moderate-to-vigorous activity as dependent variables and environmental and demographics as independent variables were run with backward deletion of environmental variables. Results: Park, crime, and gym variables were associated with physical activity, but relationships varied according to whether a 400 m, 1 mile, or nearest criteria was used. Conclusion: Environmental variables were associated with the physical activity of adolescent males, but the association was method dependent.
  452. Author: Spurrier NJ, Magarey AA, Golley R, Curnow F, Sawyer MG
    Title: Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study.
    Journal: Int J Behav Nutr Phys Act
    Date: 2008
    Abstract: OBJECTIVE: To assess relationships between characteristics of the home environment and preschool children's physical activity and dietary patterns. METHODS: Homes of 280 preschool children were visited and information obtained by direct observation and parent interview regarding physical and nutritional characteristics of the home environment. Children's physical activity, sedentary behaviour and dietary patterns were measured using standardised parent-report questionnaires. Associations were analysed using analysis of variance and correlation. RESULTS: Parental physical activity (p = 0.03-0.008), size of backyard (p = 0.001) and amount of outdoor play equipment (p = 0.003) were associated with more outdoor play. Fewer rules about television viewing (p
  453. Author: Paez A, Mercado RB, Farber S, Morency C, Roorda M
    Title: Relative accessibility deprivation indicators for urban settings: definitions and application to food deserts in Montreal
    Journal: Urban Studies. 47(7):1415-38
    Date: 2010 Feb 19
    Abstract: Accessibility research, within the context of the social exclusion dimensions of transport, has provided valuable tools to understand the potential of people to reach daily life activity locations. In this paper, model-based estimates of distance travelled are used to calculate a cumulative opportunities measure of accessibility. Multivariate, spatially expanded models produce estimates of distance travelled that are specific to both geographical location and type of individual. Opportunity landscapes obtained based on these estimates are used for comparative accessibility analysis by means of what are termed relative accessibility deprivation indicators. The indicators proposed are demonstrated with a case study of food deserts in the city of Montreal, Canada. The results of the analysis illustrate the variations in accessibility between individuals in low-income households and the reference group, and the effect of vehicle ownership for accessibility to food services, thus highlighting the social exclusion implications of these factors.
  454. Author: Benjamin SE, Neelon B, Ball SC, Bangdiwala SI, Ammerman AS, Ward DS
    Title: Reliability and validity of a nutrition and physical activity environmental self-assessment for child care.
    Journal: Int J Behav Nutr Phys Act
    Date: 2007
    Abstract: BACKGROUND: Few assessment instruments have examined the nutrition and physical activity environments in child care, and none are self-administered. Given the emerging focus on child care settings as a target for intervention, a valid and reliable measure of the nutrition and physical activity environment is needed. METHODS: To measure inter-rater reliability, 59 child care center directors and 109 staff completed the self-assessment concurrently, but independently. Three weeks later, a repeat self-assessment was completed by a sub-sample of 38 directors to assess test-retest reliability. To assess criterion validity, a researcher-administered environmental assessment was conducted at 69 centers and was compared to a self-assessment completed by the director. A weighted kappa test statistic and percent agreement were calculated to assess agreement for each question on the self-assessment. RESULTS: For inter-rater reliability, kappa statistics ranged from 0.20 to 1.00 across all questions. Test-retest reliability of the self-assessment yielded kappa statistics that ranged from 0.07 to 1.00. The inter-quartile kappa statistic ranges for inter-rater and test-retest reliability were 0.45 to 0.63 and 0.27 to 0.45, respectively. When percent agreement was calculated, questions ranged from 52.6% to 100% for inter-rater reliability and 34.3% to 100% for test-retest reliability. Kappa statistics for validity ranged from -0.01 to 0.79, with an inter-quartile range of 0.08 to 0.34. Percent agreement for validity ranged from 12.9% to 93.7%. CONCLUSION: This study provides estimates of criterion validity, inter-rater reliability and test-retest reliability for an environmental nutrition and physical activity self-assessment instrument for child care. Results indicate that the self-assessment is a stable and reasonably accurate instrument for use with child care interventions. We therefore recommend the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) instrument to researchers and practitioners interested in conducting healthy weight intervention in child care. However, a more robust, less subjective measure would be more appropriate for researchers seeking an outcome measure to assess intervention impact.
  455. Author: Bryant MJ, Ward DS, Hales D, Vaughn A, Tabak RG, Stevens J
    Title: Reliability and validity of the Healthy Home Survey: a tool to measure factors within homes hypothesized to relate to overweight in children.
    Journal: Int J Behav Nutr Phys Act
    Date: 2008
    Abstract: BACKGROUND: The contribution of the environment to the obesity epidemic is well recognized. Parents have control over their home environment and can, therefore, support healthy dietary and activity habits in their children by manipulating factors such as access to energy-dense foods, availability of physical activity equipment, and restricting screen time. This paper describes the development of the Healthy Home Survey and its reliability and validity. The Healthy Home Survey was designed to assess characteristics of the home environment that are hypothesized to influence healthy weight behaviors in children including diet and physical activity. METHODS: We recruited 85 families with at least one child between 3-8 years. The Healthy Home Survey was administered to parents via telephone and repeated in a random sample of 45 families after 7 days. In-home observations were performed within 14 days of the first Healthy Home Survey interview. Percent agreement, Kappa statistics, Intra-class correlation coefficients and sensitivity analyses were used to evaluate reliability and validity evidence. RESULTS: Reliability and validity estimates for the Healthy Home Survey were varied, but generally high (0.22-1.00 and 0.07-0.96 respectively), with lower scores noted for perishable foods and policy items. Lower scores were likely related to actual change in the perishable foods present and the subjective nature or clarity of policy questions and response categories. CONCLUSION: Initial testing demonstrated that the Healthy Home Survey is a feasible, reliable, and valid assessment of the home environment; however, it has also highlighted areas that need improvement. The Healthy Home Survey will be useful in future research exploring the relationship between the home environment and child weight.
  456. Author: Ghirardelli A, Quinn V, Sugerman S
    Title: Reliability of a retail food store survey and development of an accompanying retail scoring system to communicate survey findings and identify vendors for healthful food and marketing initiatives.
    Journal: J Nutr Educ Behav. 43(4 Suppl 2):S104-12
    Date: 2011 Jul-Aug
    Abstract: OBJECTIVE: To develop a retail grocery instrument with weighted scoring to be used as an indicator of the food environment. PARTICIPANTS/SETTING: Twenty six retail food stores in low-income areas in California. INTERVENTION: Observational. MAIN OUTCOME MEASURE(S): Inter-rater reliability for grocery store survey instrument. Description of store scoring methodology weighted to emphasize availability of healthful food. ANALYSIS: Type A intra-class correlation coefficients (ICC) with absolute agreement definition or a κ test for measures using ranges as categories. RESULTS: Measures of availability and price of fruits and vegetables performed well in reliability testing (κ = 0.681-0.800). Items for vegetable quality were better than for fruit (ICC 0.708 vs 0.528). Kappa scores indicated low to moderate agreement (0.372-0.674) on external store marketing measures and higher scores for internal store marketing. "Next to" the checkout counter was more reliable than "within 6 feet." Health departments using the store scoring system reported it as the most useful communication of neighborhood findings. CONCLUSIONS AND IMPLICATIONS: There was good reliability of the measures among the research pairs. The local store scores can show the need to bring in resources and to provide access to fruits and vegetables and other healthful food.
  457. Author: Cohen DA, Schoeff D, Farley TA, Bluthenthal R, Scribner R, Overton A
    Title: Reliability of a store observation tool in measuring availability of alcohol and selected foods.
    Journal: J Urban Health. 84(6):807-13
    Date: 2007 Nov
    Abstract: Alcohol and food items can compromise or contribute to health, depending on the quantity and frequency with which they are consumed. How much people consume may be influenced by product availability and promotion in local retail stores. We developed and tested an observational tool to objectively measure in-store availability and promotion of alcoholic beverages and selected food items that have an impact on health. Trained observers visited 51 alcohol outlets in Los Angeles and southeastern Louisiana. Using a standardized instrument, two independent observations were conducted documenting the type of outlet, the availability and shelf space for alcoholic beverages and selected food items, the purchase price of standard brands, the placement of beer and malt liquor, and the amount of in-store alcohol advertising. Reliability of the instrument was excellent for measures of item availability, shelf space, and placement of malt liquor. Reliability was lower for alcohol advertising, beer placement, and items that measured the "least price" of apples and oranges. The average kappa was 0.87 for categorical items and the average intraclass correlation coefficient was 0.83 for continuous items. Overall, systematic observation of the availability and promotion of alcoholic beverages and food items was feasible, acceptable, and reliable. Measurement tools such as the one we evaluated should be useful in studies of the impact of availability of food and beverages on consumption and on health outcomes.
  458. Author: Hosler AS, Dharssi A
    Title: Reliability of a survey tool for measuring consumer nutrition environment in urban food stores.
    Journal: J Public Health Manag Pract. 17(5):E1-8
    Date: 2011 Sep-Oct
    Abstract: OBJECTIVE: Despite the increase in the volume and importance of food environment research, there is a general lack of reliable measurement tools. This study presents the development and reliability assessment of a tool for measuring consumer nutrition environment in urban food stores. DESIGN: Cross-sectional design. SETTING: A racially diverse downtown portion (6 ZIP code areas) in Albany, New York. PARTICIPANTS: A sample of 39 food stores was visited by our research team in 2009 to 2010. These stores were randomly selected from 123 eligible food stores identified through multiple government lists and ground-truthing. MAIN OUTCOME MEASURES: The Food Retail Outlet Survey Tool was developed to assess the presence of selected food and nonfood items, placement, milk prices, physical characteristics of the store, policy implementation, and advertisements on outside windows. For in-store items, agreement of observations between experienced and lightly trained surveyors was assessed. For window advertisement assessments, inter-method agreement (on-site sketch vs digital photo), and inter-rater agreement (both on-site) among lightly trained surveyors were evaluated. Percent agreement, Kappa, and prevalence-adjusted bias-adjusted kappa were calculated for in-store observations. Interclass correlation coefficients were calculated for window observations. RESULTS: Twenty-seven of the 47 in-store items had 100% agreement. The prevalence-adjusted bias-adjusted kappa indicated excellent agreement (≥0.90) on all items, except aisle width (0.74) and dark-green/orange colored fresh vegetables (0.85). The store type (nonconvenience store), the order of visits (first half), and the time to complete survey (>10 minutes) were associated with lower reliability in these 2 items. Both the inter-method and inter-rater agreements for window advertisements were uniformly high (intraclass correlation coefficient ranged 0.94-1.00), indicating high reliability. CONCLUSIONS: The Food Retail Outlet Survey Tool is a reliable tool for quickly measuring consumer nutrition environment. It can be effectively used by an individual who attended a 30-minute group briefing and practiced with 3 to 4 stores.
  459. Author: Hosler AS
    Title: Retail food availability, obesity, and cigarette smoking in rural communities.
    Journal: J Rural Health. 25(2):203-10
    Date: 2009 Spring
    Abstract: CONTEXT: Disparities in the availability of nutritionally important foods and their influence on health have been studied in US urban communities. PURPOSE: To assess the availability of selected retail foods and cigarettes, and explore ecologic relationships of the availability with obesity and smoking in rural communities. METHODS: Inventories of all food stores (n = 182) in 2 rural New York counties were surveyed. The study area was divided into 4 regions through cluster analysis of 2000 Census and geographic information system data. Weight-adjusted per 10,000-population density of stores carrying selected foods was used as a standardized measure of availability. Prevalence of overweight/obesity (BMI > or =25.0 kg/m(2)) and smoking among adults was obtained from secondary data. Bivariate correlations among availability of foods and cigarettes, overweight/obesity, and smoking were analyzed at the regional level. Findings: Nutritionally important foods, including fresh fruit, vegetables (dark green or orange colored), low-fat ( or =2g per slice) bread, and fish were most available in the semiurbanized region, followed by the rural heartland, the remote mountains region, and the most urbanized inner-town. No significant difference was found in the availability of general food items and cigarettes. Overweight/obesity was inversely associated with the availability of fresh fruit, vegetables, and low-fat milk. Smoking was positively associated with the availability of cigarettes, white bread, whole milk, and eggs. CONCLUSIONS: The observed disparities in food availability and their ecologic association with health risks in rural adults expanded the knowledge base of built environment and its association with health beyond the urban setting.
  460. Author: Alwitt LF, Donley TD
    Title: Retail stores in poor urban neighbourhoods
    Journal: The journal of consumer affairs. 31(1):139-64
    Date: 1997
    Abstract:
  461. Author: Zick CD, Smith KR, Fan JX, Brown BB, Yamada I, Kowaleski-Jones L
    Title: Running to the store? The relationship between neighborhood environments and the risk of obesity.
    Journal: Soc Sci Med. 69(10):1493-500
    Date: 2009 Nov
    Abstract: We expand the search for modifiable features of neighborhood environments that alter obesity risk in two ways. First, we examine residents' access to neighborhood retail food options in combination with neighborhood features that facilitate physical activity. Second, we evaluate neighborhood features for both low income and non-low income neighborhoods (bottom quartile of median neighborhood income versus the top three quartiles). Our analyses use data from the Utah Population Database merged with U.S. Census data and Dun & Bradstreet business data for Salt Lake County, Utah. Linear regressions for BMI and logistic regressions for the likelihood of being obese are estimated using various measures of the individual's neighborhood food options and walkability features. As expected, walkability indicators of older neighborhoods and neighborhoods where a higher fraction of the population walks to work is related to a lower BMI/obesity risk, although the strength of the effects varies by neighborhood income. Surprisingly, the walkability indicator of neighborhoods with higher intersection density was linked to higher BMI/obesity risk. The expected inverse relationship between the walkability indicator of population density and BMI/obesity risk is found only in low income neighborhoods. We find a strong association between neighborhood retail food options and BMI/obesity risk with the magnitude of the effects again varying by neighborhood income. For individuals living in non-low income neighborhoods, having one or more convenience stores, full-service restaurants, or fast food restaurants is associated with reduced BMI/obesity risk, compared to having no neighborhood food outlets. The presence of at least one healthy grocery option in low income neighborhoods is also associated with a reduction in BMI/obesity risk relative to no food outlets. Finally, multiple food options within a neighborhood reduce BMI/obesity risk, relative to no food options, for individuals living in either low-income or non-low neighborhoods.
  462. Author: Dean WR, Sharkey JR
    Title: Rural and urban differences in the associations between characteristics of the community food environment and fruit and vegetable intake.
    Journal: J Nutr Educ Behav. 43(6):426-33
    Date: 2011 Nov-Dec
    Abstract: OBJECTIVE: To examine the relationship between measures of the household and retail food environments and fruit and vegetable (FV) intake in both urban and rural environmental contexts. DESIGN: A cross-sectional design was used. Data for FV intake and other characteristics were collected via survey instrument and geocoded to the objective food environment based on a ground-truthed (windshield audit) survey of the retail food environment. SETTING: One urban and 6 contiguous rural counties. PARTICIPANTS: This study involved 2,556 residents of the Brazos Valley, Texas, who were selected through random-digit dialing. MAIN OUTCOME MEASURE: Two-item scale of FV intake. ANALYSIS: Data were analyzed using chi-square analysis, 2-sample t tests, and linear regression. RESULTS: Distance to supermarket or supercenter was insignificant in the urban model, but significant in the rural model (β = -.014, P
  463. Author: Kaufman PR
    Title: Rural poor have less access to supermarkets, large grocery stores
    Journal: Rural development perspectives. 13(3):19-26
    Date: 1999
    Abstract: Poor households in rural areas rely more on smaller grocery stores and supermarkets than do metro area households, and they may face higher average food prices and reduced access to food as a result. Net accessibility -- a ratio of available large grocery store sales to potential food spending by households in a ZIP Code-based area -- was found to be lower for a greater percentage of low-income households compared with all households in the Lower Mississippi Delta. Over 70 percent of the total low-income population (eligible to receive food stamp benefits) in the 36-county area suffered accessibility shortfalls, requiring trips of more than 30 miles to reach a large retailer. Smaller foodstores typically offer less variety, fewer lower cost foods, and higher food prices.
  464. Author: Närhinen M, Nissinen A, Puska P
    Title: Sales data of a supermarket--a tool for monitoring nutrition interventions.
    Journal: Public Health Nutr. 1(2):101-7
    Date: 1998 Jun
    Abstract: OBJECTIVE: The aim of the study was to examine the daily variations in sales data for individual food items in a supermarket and to assess the usefulness of the computerized sales data of supermarkets for reliable monitoring and evaluation of shopping behaviour. DESIGN: Longitudinal observational study. SETTING: The study was carried out in one supermarket in Mikkeli, Finland. Seventy-nine packed food items from food groups important for salt and fat intake were monitored. In all food groups both 'healthier' and 'reference' products were included for assessment of both direct sales and proportional sales. The sales data were collected daily for 2 months in May and September 1996 by reading the European Article Numbering (EAN) codes of the packed foods. RESULTS: The proportional sales turned out to be a more stable and useful measure than the direct sales data and the variation remained the same when the monitoring time was increased from 1 week to 1 month. CONCLUSION: Proportional sales data are proposed as a tool for measuring the effect of nutrition interventions and also as a possible indirect assessment for population salt and fat intake.
  465. Author: Stevens J, Bryant M, Wang CH, Cai J, Bentley ME
    Title: Sample size and repeated measures required in studies of foods in the homes of African-American families.
    Journal: J Nutr. 142(6):1123-7
    Date: 2012 Jun
    Abstract: Measurement of the home food environment is of interest to researchers because it affects food intake and is a feasible target for nutrition interventions. The objective of this study was to provide estimates to aid the calculation of sample size and number of repeated measures needed in studies of nutrients and foods in the home. We inventoried all foods in the homes of 80 African-American first-time mothers and determined 6 nutrient-related attributes. Sixty-three households were measured 3 times, 11 were measured twice, and 6 were measured once, producing 217 inventories collected at ~2-mo intervals. Following log transformations, number of foods, total energy, dietary fiber, and fat required only one measurement per household to achieve a correlation of 0.8 between the observed and true values. For percent energy from fat and energy density, 3 and 2 repeated measurements, respectively, were needed to achieve a correlation of 0.8. A sample size of 252 was needed to detect a difference of 25% of an SD in total energy with one measurement compared with 213 with 3 repeated measurements. Macronutrient characteristics of household foods appeared relatively stable over a 6-mo period and only 1 or 2 repeated measures of households may be sufficient for an efficient study design.
  466. Author: Kubik MY, Lytle LA, Farbakhsh K
    Title: School and district wellness councils and availability of low-nutrient, energy-dense vending fare in Minnesota middle and high schools.
    Journal: J Am Diet Assoc. 111(1):150-5
    Date: 2011 Jan
    Abstract: The Child Nutrition and WIC Reauthorization Act of 2004 required school districts participating in the federal school meals program to establish by the start of the 2006-2007 school year policies that included nutrition guidelines for all foods sold on school campus during the school day and policy development involving key stakeholders. For many schools, policy development was done by wellness councils. This study examined the association between having a wellness council and availability of low-nutrient, energy-dense foods/beverages in school vending machines following enactment of the federal legislation. In 2006-2007, Minnesota middle (n=35) and high (n=54) school principals reported whether their school and district had a wellness council. Trained research staff observed foods/beverages in vending machines accessible to students. Low-nutrient, energy-dense foods/beverages (snacks >3 g fat or >200 calories/serving, and soda, fruit/sport drinks and reduced-fat/whole milk) were grouped into seven categories (eg, high-fat baked goods) and a food score was calculated. Higher scores indicated more low-nutrient, energy-dense vending fare. Multivariate linear regression, adjusted for school characteristics, was used to examine associations between scores and a three-category council variable (district-only; district and school; no council). Among schools, 53% had district-only councils, 38% district and school councils, and 9% had no council. Schools with both a district and school council had a significantly lower mean food score than schools without councils (P=0.03). The potential of wellness councils to impact availability of low-nutrient, energy-dense vending fare is promising. There may be an added benefit to having both a school and district council.
  467. Author: An R, Sturm R
    Title: School and residential neighborhood food environment and diet among California youth.
    Journal: Am J Prev Med. 42(2):129-35
    Date: 2012 Feb
    Abstract: BACKGROUND: Various hypotheses link neighborhood food environments and diet. Greater exposure to fast-food restaurants and convenience stores is thought to encourage overconsumption; supermarkets and large grocery stores are claimed to encourage healthier diets. For youth, empirical evidence for any particular hypothesis remains limited. PURPOSE: This study examines the relationship between school and residential neighborhood food environment and diet among youth in California. METHODS: Data from 8226 children (aged 5-11 years) and 5236 adolescents (aged 12-17 years) from the 2005 and 2007 California Health Interview Survey were analyzed in 2011. The dependent variables are daily servings of fruits, vegetables, juice, milk, soda, high-sugar foods, and fast food, which were regressed on measures of food environments. Food environments were measured by counts and density of businesses, distinguishing fast-food restaurants, convenience stores, small food stores, grocery stores, and large supermarkets within a specific distance (varying from 0.1 to 1.5 miles) from a respondent's home or school. RESULTS: No robust relationship between food environment and consumption is found. A few significant results are sensitive to small modeling changes and more likely to reflect chance than true relationships. CONCLUSIONS: This correlational study has measurement and design limitations. Longitudinal studies that can assess links between environmental, dependent, and intervening food purchase and consumption variables are needed. Reporting a full range of studies, methods, and results is important as a premature focus on correlations may lead policy astray.
  468. Author: Finkelstein DM, Hill EL, Whitaker RC
    Title: School food environments and policies in US public schools.
    Journal: Pediatrics. 122(1):e251-9
    Date: 2008 Jul
    Abstract: OBJECTIVE: The purpose of this study was to describe school food environments and policies in US public schools and how they vary according to school characteristics. METHODS: We analyzed cross-sectional data from the third School Nutrition and Dietary Assessment study by using a nationally representative sample of 395 US public schools in 129 school districts in 38 states. These 2005 data included school reports of foods and beverages offered in the National School Lunch Program and on-site observations, in a subsample of schools, of competitive foods and beverages (those sold in vending machines and a la carte and that are not part of the National School Lunch Program). Seventeen factors were used to characterize school lunches, competitive foods, and other food-related policies and practices. These factors were used to compute the food environment summary score (0 [least healthy] to 17 [most healthy]) of each school. RESULTS: There were vending machines in 17%, 82%, and 97% of elementary, middle, and high schools, respectively, and a la carte items were sold in 71%, 92%, and 93% of schools, respectively. Among secondary schools with vending and a la carte sales, these sources were free of low-nutrient energy-dense foods or beverages in 15% and 21% of middle and high schools, respectively. The food environment summary score was significantly higher (healthier) in the lower grade levels. The summary score was not associated with the percentage of students that was certified for free or reduced-price lunches or the percentage of students that was a racial/ethnic minority. CONCLUSIONS: As children move to higher grade levels, their school food environments become less healthy. The great majority of US secondary schools sell items a la carte in the cafeteria and through vending machines, and these 2 sources often contain low-nutrient, energy-dense foods and beverages, commonly referred to as junk food.
  469. Author: Briefel RR, Crepinsek MK, Cabili C, Wilson A, Gleason PM
    Title: School food environments and practices affect dietary behaviors of US public school children.
    Journal: J Am Diet Assoc. 109(2 Suppl):S91-107
    Date: 2009 Feb
    Abstract: BACKGROUND: Changes to school food environments and practices that lead to improved dietary behavior are a powerful strategy to reverse the childhood obesity epidemic. OBJECTIVES: To estimate the effects of school food environments and practices, characterized by access to competitive foods and beverages, school lunches, and nutrition promotion, on children's consumption of sugar-sweetened beverages, low-nutrient energy-dense foods, and fruits/vegetables at school. DESIGN: Cross-sectional study using data from the third School Nutrition Dietary Assessment Study, a nationally representative sample of public school districts, schools, and children in school year 2004-2005. Data from school principals and foodservice directors, school menu analysis, and on-site observations were used to characterize school food environments and practices. Dietary intake was assessed using 24-hour recalls. SUBJECTS/SETTING: The sample consists of 287 schools and 2,314 children in grades one through 12. STATISTICAL ANALYSES PERFORMED: Ordinary least squares regression was used to identify the association between school food environments and practices (within elementary, middle, and high schools) and dietary outcomes, controlling for other school and child/family characteristics. RESULTS: Sugar-sweetened beverages obtained at school contributed a daily mean of 29 kcal in middle school children and 46 kcal in high school children across all school children. Attending a school without stores or snack bars was estimated to reduce sugar-sweetened beverage consumption by 22 kcal per school day in middle school children (P
  470. Author: French SA, Story M, Fulkerson JA
    Title: School food policies and practices: a state-wide survey of secondary school principals.
    Journal: J Am Diet Assoc. 102(12):1785-9
    Date: 2002 Dec
    Abstract: OBJECTIVE: To describe food-related policies and practices in secondary schools in Minnesota. DESIGN: Mailed anonymous survey including questions about the secondary school food environment and food-related practices and policies. SUBJECTS/SETTING: Members of a statewide professional organization for secondary school principals (n = 610; response rate: 463/610 = 75%). Of the 463 surveys returned, 336 met the eligibility criteria (current position was either principal or assistant principal and school included at least one of the grades of 9 through 12). STATISTICAL ANALYSIS: Descriptive statistics examined the prevalence of specific policies and practices. Chi2 analysis examined associations between policies and practices and school variables. RESULTS: Among principals, 65% believed it was important to have a nutrition policy for the high school; however, only 32% reported a policy at their school. Principals reported positive attitudes about providing a healthful school food environment, but 98% of the schools had soft drink vending machines and 77% had contracts with soft drink companies. Food sold at school fundraisers was most often candy, fruit, and cookies. APPLICATIONS: Dietetics professionals who work in secondary school settings should collaborate with other key school staff members and parents to develop and implement a comprehensive school nutrition policy. Such a policy could foster a school food environment that is supportive of healthful food choices among youth.
  471. Author: Neumark-Sztainer D, French SA, Hannan PJ, Story M, Fulkerson JA
    Title: School lunch and snacking patterns among high school students: associations with school food environment and policies.
    Journal: Int J Behav Nutr Phys Act. 2(1):14
    Date: 2005 Oct 6
    Abstract: OBJECTIVES: This study examined associations between high school students' lunch patterns and vending machine purchases and the school food environment and policies. METHODS: A randomly selected sample of 1088 high school students from 20 schools completed surveys about their lunch practices and vending machine purchases. School food policies were assessed by principal and food director surveys. The number of vending machines and their hours of operation were assessed by trained research staff. RESULTS: Students at schools with open campus policies during lunchtime were significantly more likely to eat lunch at a fast food restaurant than students at schools with closed campus policies (0.7 days/week vs. 0.2 days/week, p
  472. Author: Condon EM, Crepinsek MK, Fox MK
    Title: School meals: types of foods offered to and consumed by children at lunch and breakfast.
    Journal: J Am Diet Assoc. 109(2 Suppl):S67-78
    Date: 2009 Feb
    Abstract: BACKGROUND: Children's food intakes do not meet dietary recommendations. Meals offered through the National School Lunch Program and School Breakfast Program make substantial contributions to school-aged children's diets. OBJECTIVES: This article describes foods offered in school meals and consumed by children at lunch and breakfast, and differences in foods consumed by children who did and did not participate in the school meal programs. DESIGN: Data were collected as part of the third School Nutrition Dietary Assessment Study, a cross-sectional, nationally representative study conducted in 2005. School menu surveys were used to identify the foods offered in school meals, and 24-hour dietary recalls were used to assess the foods children consumed. SUBJECTS/SETTING: Foodservice managers in 398 public schools and 2,314 children (grades 1 to 12) from 287 of these schools participated in the study. STATISTICAL ANALYSES PERFORMED: Descriptive tabulations report percentages of daily menus that offered and percentages of children that consumed specific food groups and foods at lunch and breakfast. Two-tailed t tests were used to assess differences between school meal program participants and nonparticipants. RESULTS: Most school menus offered nonfat or 1% milk, fruit or 100% juice, and vegetables daily. Starchy vegetables were more common than dark green/orange vegetables or legumes. School lunch participants were significantly more likely than nonparticipants to consume milk, fruit, and vegetables, and significantly less likely to consume desserts, snack items, and beverages other than milk or 100% juice. At breakfast, participants were significantly more likely than nonparticipants to consume milk and fruit (mainly 100% juice), and significantly less likely to consume beverages other than milk or 100% juice. CONCLUSIONS: Consumption of school meals is positively related to children's intakes of key food groups at lunch and breakfast. Offering more fresh fruit, whole grains, and a greater variety of vegetables could lead to additional health benefits.
  473. Author: Small ML, Jones SE, Barrios LC, Crossett LS, Dahlberg LL, Albuquerque MS, Sleet DA, Greene BZ, Schmidt ER
    Title: School policy and environment: results from the School Health Policies and Programs Study 2000.
    Journal: J Sch Health. 71(7):325-34
    Date: 2001 Sep
    Abstract:
  474. Author: Thompson OM, Yaroch AL, Moser RP, Finney Rutten LJ, Agurs-Collins T
    Title: School vending machine purchasing behavior: results from the 2005 YouthStyles survey.
    Journal: J Sch Health. 80(5):225-32
    Date: 2010 May
    Abstract: BACKGROUND: Competitive foods are often available in school vending machines. Providing youth with access to school vending machines, and thus competitive foods, is of concern, considering the continued high prevalence of childhood obesity: competitive foods tend to be energy dense and nutrient poor and can contribute to increased energy intake in children and adolescents. METHODS: To evaluate the relationship between school vending machine purchasing behavior and school vending machine access and individual-level dietary characteristics, we used population-level YouthStyles 2005 survey data to compare nutrition-related policy and behavioral characteristics by the number of weekly vending machine purchases made by public school children and adolescents (N = 869). Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were computed using age- and race/ethnicity-adjusted logistic regression models that were weighted on age and sex of child, annual household income, head of household age, and race/ethnicity of the adult in study. Data were collected in 2005 and analyzed in 2008. RESULTS: Compared to participants who did not purchase from a vending machine, participants who purchased >or=3 days/week were more likely to (1) have unrestricted access to a school vending machine (OR = 1.71; 95% CI = 1.13-2.59); (2) consume regular soda and chocolate candy >or=1 time/day (OR = 3.21; 95% CI = 1.87-5.51 and OR = 2.71; 95% CI = 1.34-5.46, respectively); and (3) purchase pizza or fried foods from a school cafeteria >or=1 day/week (OR = 5.05; 95% CI = 3.10-8.22). CONCLUSIONS: Future studies are needed to establish the contribution that the school-nutrition environment makes on overall youth dietary intake behavior, paying special attention to health disparities between whites and nonwhites.
  475. Author: Kubik MY, Lytle LA, Story M
    Title: Schoolwide food practices are associated with body mass index in middle school students.
    Journal: Arch Pediatr Adolesc Med. 159(12):1111-4
    Date: 2005 Dec
    Abstract: OBJECTIVE: To examine the association between body mass index in young adolescents and schoolwide food practices such as foods used in school fundraising and in the classroom as incentives and rewards. DESIGN: Using a cross-sectional study design, we collected data from both the schools and the students. School administrators provided information on schoolwide food policies and practices. Eighth-grade students provided self-reported heights and weights. SETTING: Sixteen middle schools in the Minneapolis-St Paul metropolitan area. PARTICIPANTS: The study included 3088 eighth-grade students. Students were participants in a school-based dietary intervention study. MAIN OUTCOME MEASURES: Body mass index was calculated from self-reported height and weight data. A 7-item schoolwide food practices scale (Cronbach alpha = 0.83) was created using data collected from school administrators. RESULTS: The mean number of food practices permitted by a school was 3 (range, 0-7). The most prevalent food practices were the use of food as incentives and rewards (69%) and in classroom fundraising (56%). Body mass index (BMI) [corrected] of the students increased a 0.10 BMI unit [corrected] for every additional food practice permitted in their school (P<.03 conclusions:="" schoolwide="" food="" practices="" that="" supported="" frequent="" snacking="" and="" the="" consumption="" of="" foods="" beverages="" high="" in="" calories="" low="" nutrients="" by="" students="" throughout="" school="" day="" were="" common="" adversely="" associated="" with="" body="" mass="" index="" students.="" prevention="" overweight="" childhood="" must="" include="" attention="" to="" nutrition="" integrity="" schools="" policies="" consistently="" support="" promote="" healthy="" dietary="" among="" young="" adolescents="" are="" urgently="" needed.="">
  476. Author: Sooman A, Macintyre S, Anderson A
    Title: Scotland's health--a more difficult challenge for some? The price and availability of healthy foods in socially contrasting localities in the west of Scotland.
    Journal: Health Bull (Edinb). 51(5):276-84
    Date: 1993 Sep
    Abstract: The recent White Paper, 'Scotland's Health: A Challenge To Us All', emphasises the importance of lifestyle factors, such as smoking, diet and exercise, in Scotland's poor health record. Targets are to be set for improvements in diet, and individuals will be encouraged to improve their eating habits. In this paper we suggest that attention should be given to the price and availability of healthy foods, particularly in socio-economically deprived areas. To illustrate the possible importance of this, we present findings from a small exploratory study of two socially contrasting and non-contiguous localities in Glasgow which indicates that price disincentives to eating healthy may be greater in poorer than in more affluent areas.
  477. Author: Thompson VJ, Bachman CM, Baranowski T, Cullen KW
    Title: Self-efficacy and norm measures for lunch fruit and vegetable consumption are reliable and valid among fifth grade students.
    Journal: J Nutr Educ Behav. 39(1):2-7
    Date: 2007 Jan-Feb
    Abstract: OBJECTIVE: To determine the reliability and validity of a questionnaire measuring fruit and vegetable (FV) self-efficacy and social norms during school lunch among 5th graders. DESIGN: In this cross-sectional study, students completed lunch food records and a psychosocial questionnaire measuring school lunch FV self-efficacy and social norms regarding consumption during the fall and spring semesters. Test-retest reliability was assessed between fall and spring semesters. The measurement model was cross-validated in the spring data. SETTING: One middle school in Houston, Texas. PARTICIPANTS: 275 fifth graders in the 1998 fall semester and 262 of these fifth graders in the 1999 spring semester. MAIN OUTCOME MEASURES: FV consumption and psychosocial variables. ANALYSES: Principal components analyses, confirmatory factor analyses and bivariate correlations. RESULTS: Three scales were identified: Fruit Self-Efficacy, Vegetable Self-Efficacy, and FV Social Norms. FV self-efficacy were positively correlated with low-fat vegetable and fruit consumption. Social norms were positively correlated with total vegetable, low-fat vegetable, fruit and total FV consumption. CONCLUSIONS AND IMPLICATIONS: Self-efficacy and norms for eating FV at school lunch are related to lunch FV consumption. Increasing self-efficacy and social norms about consuming FV at school appears to be important targets to improve FV consumption.
  478. Author: Paquet C, Dubé L, Gauvin L, Kestens Y, Daniel M
    Title: Sense of mastery and metabolic risk: moderating role of the local fast-food environment.
    Journal: Psychosom Med. 72(3):324-31
    Date: 2010 Apr
    Abstract: OBJECTIVE: To test the moderating role of the extent of fast-food restaurants in one's immediate environment in the association between mastery and metabolic risk. Higher sense of mastery (perceived control over one's circumstances) has been associated with better metabolic outcomes. Mastery may be instrumental in resisting unhealthful environmental food cues when these become ubiquitous, resulting in a greater health impact of mastery. METHODS: Blood samples were obtained from 344 individuals (50% men), aged 18 to 57 years (mean, 34.9 years), sampled from seven census tracts representing the spectrum of census tract-level socioeconomic status and language (French/English) in Montreal. Risk factors based on standards for high-density lipoprotein and total cholesterol, waist circumference, body mass index, triglycerides, and glycated hemoglobin were summed to obtain a cumulative metabolic risk score. Mastery was self-reported, using a validated scale. The proportion of restaurants classified as fast-food within 500 m of participants' residences was determined, using a geographic information system. Main and interactive effects were tested with Poisson regression, accounting for clustering of observations and participants' age, gender, education, and income. RESULTS: Mastery interacted with fast-food exposure in relation to metabolic risk (p = .03). Higher mastery was significantly associated with lower metabolic risk for participants surrounded by a high proportion of fast food (relative risk, 0.80; 95% confidence interval, 0.76-0.84; p
  479. Author: Kwate NO, Loh JM
    Title: Separate and unequal: the influence of neighborhood and school characteristics on spatial proximity between fast food and schools.
    Journal: Prev Med. 51(2):153-6
    Date: 2010 Aug
    Abstract: OBJECTIVE: Social science and health literature have identified residential segregation as a critical factor in exposure to health-related resources, including food environments. Differential spatial patterning of food environments surrounding schools has significant import for youth. We examined whether fast food restaurants clustered around schools in New York City, and whether any observed clustering varied as a function of school type, school racial demographics, and area racial and socioeconomic demographics. METHOD: We geocoded fast food locations from 2006 (n=817) and schools from 2004-2005 (n=2096; public and private, elementary and secondary) in the five boroughs of New York City. A point process model (inhomogeneous cross-K function) examined spatial clustering. RESULTS: A minimum of 25% of schools had a fast food restaurant within 400 m. High schools had higher fast food clustering than elementary schools. Public elementary and high schools with large proportions of Black students or in block groups with large proportions of Black residents had higher clustering than White counterparts. Finally, public high schools had higher clustering than private counterparts, with 1.25 to 2 times as many restaurants than expected by chance. CONCLUSION: The results suggest that the geography of opportunity as it relates to school food environments is unequal in New York City.
  480. Author: Zenk SN, Grigsby-Toussaint DS, Curry SJ, Berbaum M, Schneider L
    Title: Short-term temporal stability in observed retail food characteristics.
    Journal: J Nutr Educ Behav. 42(1):26-32
    Date: 2010 Jan-Feb
    Abstract: OBJECTIVE: Use of direct observation to characterize neighborhood retail food environments is increasing, but to date most studies have relied on a single observation. If food availability, prices, and quality vary over short time periods, repeated measures may be needed to portray these food characteristics. This study evaluated short-term (2-week), within-season temporal stability in retail food availability, prices, and quality. DESIGN: In-person observations of retail food stores at 2 time points, 2 weeks apart. SETTING: Southwest Chicago, IL. SAMPLE: 157 food stores. MAIN OUTCOME MEASURES: Availability and prices of food items selected from the following food groups: fruit, vegetables, grains, meats and beans, and dairy, as well as fresh produce quality. ANALYSIS: Temporal stability was tested for availability using a McNemar test and for price and quality using a Wilcoxon signed-rank test. RESULTS: Measures of food availability and prices as well as fresh produce quality at stores were generally stable at the 2 time points. CONCLUSIONS AND IMPLICATIONS: This study suggests that a single observation may be sufficient to accurately characterize within-season food availability, food prices, and fresh produce quality.
  481. Author: Turner L, Chaloupka FJ
    Title: Slow progress in changing the school food environment: nationally representative results from public and private elementary schools.
    Journal: J Acad Nutr Diet. 112(9):1380-9
    Date: 2012 Sep
    Abstract: BACKGROUND: Children spend much of their day in school, and authorities have called for improvements in the school food environment. However, it is not known whether changes have occurred since the federal wellness policy mandate took effect in 2006-2007. OBJECTIVE: We examined whether the school food environment in public and private elementary schools changed over time and examined variations by school type and geographic division. DESIGN AND PARTICIPANTS: Survey data were gathered from respondents at nationally representative samples of elementary schools during the 2006-2007 and 2009-2010 school years (respectively, 578 and 680 public schools, and 259 and 313 private schools). MAIN OUTCOME MEASURES: Topics assessed included competitive foods, school meals, and other food-related practices (eg, school gardens and nutrition education). A 16-item food environment summary score was computed, with possible scores ranging from 0 (least healthy) to 100 (healthiest). ANALYSES: Multivariate regression models were used to examine changes over time in the total school food environment score and component items, and variations by US census division. RESULTS: Many practices improved, such as participation in school gardens or farm-to-school programs, and availability of whole grains and only lower-fat milks in lunches. Although the school food environment score increased significantly, the magnitude of change was small; as of 2009-2010 the average score was 53.5 for public schools (vs 50.1 in 2006-2007) and 42.2 for private schools (vs 37.2 in 2006-2007). Scores were higher in public schools than in private schools (P
  482. Author: Kersten E, Laraia B, Kelly M, Adler N, Yen IH
    Title: Small food stores and availability of nutritious foods: a comparison of database and in-store measures, Northern California, 2009.
    Journal: Prev Chronic Dis
    Date: 2012
    Abstract: INTRODUCTION: Small food stores are prevalent in urban neighborhoods, but the availability of nutritious food at such stores is not well known. The objective of this study was to determine whether data from 3 sources would yield a single, homogenous, healthful food store category that can be used to accurately characterize community nutrition environments for public health research. METHODS: We conducted in-store surveys in 2009 on store type and the availability of nutritious food in a sample of nonchain food stores (n = 102) in 6 predominantly urban counties in Northern California (Alameda, Contra Costa, Marin, Sacramento, San Francisco, and Santa Clara). We compared survey results with commercial database information and neighborhood sociodemographic data by using independent sample t tests and classification and regression trees. RESULTS: Sampled small food stores yielded a heterogeneous group of stores in terms of store type and nutritious food options. Most stores were identified as convenience (54%) or specialty stores (22%); others were small grocery stores (19%) and large grocery stores (5%). Convenience and specialty stores were smaller and carried fewer nutritious and fresh food items. The availability of nutritious food and produce was better in stores in neighborhoods that had a higher percentage of white residents and a lower population density but did not differ significantly by neighborhood income. CONCLUSION: Commercial databases alone may not adequately categorize small food stores and the availability of nutritious foods. Alternative measures are needed to more accurately inform research and policies that seek to address disparities in diet-related health conditions.
  483. Author: Borradaile KE, Sherman S, Vander Veur SS, McCoy T, Sandoval B, Nachmani J, Karpyn A, Foster GD
    Title: Snacking in children: the role of urban corner stores.
    Journal: Pediatrics. 124(5):1293-8
    Date: 2009 Nov
    Abstract: OBJECTIVE: Childhood obesity is higher among ethnic minorities. One reason may be the limited access to affordable, healthy options. The disparate prevalence of urban corner stores in low-income and high-minority communities has been well documented. There are no data, however, on what children purchase in these environments before and after school. The purpose of this study was to document the nature of children's purchases in corner stores proximal to their schools. METHODS: This was an observational study from January to June 2008. Participants were children in grades 4 through 6 from 10 urban K-8 schools with >or=50% of students eligible for free or reduced-price meals. A total of 833 intercept surveys of children's purchases were conducted outside 24 corner stores before and after school. The main outcomes were type and energy content of items purchased. RESULTS: The most frequently purchased items were energy-dense, low-nutritive foods and beverages, such as chips, candy, and sugar-sweetened beverages. Students spent $1.07 +/- 0.93 on 2.1 +/- 1.3 items (1.6 +/- 1.1 food items and 0.5 +/- 0.6 beverage items) per purchase. The total number of calories purchased per trip was 1497.7 +/- 1219.3 kJ (356.6 +/- 290.3 kcal). More calories came from foods than from beverages. CONCLUSIONS: Purchases made in corner stores contribute significantly to energy intake among urban school children. Obesity prevention efforts, as well as broader efforts to enhance dietary quality among children in urban settings, should include corner store environments proximal to schools.
  484. Author: Kestens Y, Daniel M
    Title: Social inequalities in food exposure around schools in an urban area.
    Journal: Am J Prev Med. 39(1):33-40
    Date: 2010 Jul
    Abstract: BACKGROUND: The obesity epidemic among children and youth, and the social gradient in this relationship, could be related to differential exposure to food sources in primary environments. Although the positive association between area-level deprivation and fast-food outlets offering high-calorie foods has been well documented, few studies have evaluated food sources around school settings. PURPOSE: This study evaluated the relationships among food sources around schools, neighborhood income, and commercial density. METHODS: A GIS was used to derive measures of exposure to fast-food outlets, fruit and vegetable stores, and full-service restaurants near primary and secondary schools in Montreal, Canada, in 2005. Food source availability was analyzed in 2009 in relation to neighborhood income for the area around schools, accounting for commercial density. RESULTS: For the 1168 schools identified, strong neighborhood income gradients were observed in relation to food sources. Relative to the highest income-quartile schools, the odds of a fast-food outlet being located within 750 m of a low income-quartile school was 30.9 (95% CI=19.6, 48.9). Similar relationships were observed for full-service restaurants (OR=77, 95% CI=35, 169.3) and fruit and vegetable stores (OR=29.6, 95% CI=18.8, 46.7). These associations were reduced, but remained significant in models accounting for commercial density. CONCLUSIONS: Food source exposure around schools is inversely associated with neighborhood income, but commercial density partly accounts for this association. Further research is necessary to document food consumption among youth attending schools in relation to nearby food source opportunities.
  485. Author: Baranowski T, Watson K, Missaghian M, Broadfoot A, Cullen K, Nicklas T, Fisher J, Baranowski J, O'Donnell S
    Title: Social support is a primary influence on home fruit, 100% juice, and vegetable availability.
    Journal: J Am Diet Assoc. 108(7):1231-5
    Date: 2008 Jul
    Abstract: Children tend to eat more fruit and vegetables when more are available in the home. We proposed and tested a model that predicts the availability at home (hereinafter termed "home availability") of fruit, 100% juice, and vegetables, using new measures of frequency of food shopping, purchase, and comparative purchase outcome expectancies (ie, the perceived benefits and costs of purchasing fruit and vegetables), home food pantry management practices, family social support for purchasing fruit and vegetables, food shopping practices, and body mass index (BMI). Participants (N=98) were recruited in 2004 in front of grocery stores and completed two telephone interviews. Cross-sectional hierarchical regression was employed with backward deletion of nonsignificant variables. Despite many statistically significant bivariate correlations between the new variables and home fruit, 100% juice, and vegetable availability, social support was the primary predictor of home fruit availability in multivariate regression. BMI and home 100% juice pantry management were the primary predictors of home 100% juice availability. Social support, BMI, and shopping practices were the primary predictors of home vegetable availability. Social support for purchasing fruit, 100% juice, and vegetables was an important, consistent predictor of home availability. These findings need to be replicated in larger samples.
  486. Author: Utter J, Denny S, Crengle S, Ameratunga S, Clark T, Maddison R, Percival T
    Title: Socio-economic differences in eating-related attitudes, behaviours and environments of adolescents.
    Journal: Public Health Nutr. 14(4):629-34
    Date: 2011 Apr
    Abstract: OBJECTIVE: The aim of the present study was to investigate the relationship between area-level socio-economic status and healthy and less healthy eating behaviours among adolescents and to determine whether the relationship between area-level socio-economic status and dietary behaviours was related to the relevant attitudes and environments. DESIGN: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth. SETTING: New Zealand secondary schools, 2007. SUBJECTS: A total of 9107 secondary-school students in New Zealand. RESULTS: Students from more deprived areas perceived more supportive school environments and cared as much about healthy eating as students in more affluent areas. However, these students were significantly more likely to report consuming fast food, soft drinks and chocolates. CONCLUSIONS: Addressing area-level socio-economic disparities in healthy eating requires addressing the availability, affordability and marketing of unhealthy snack foods, particularly in economically deprived areas.
  487. Author: Ball K, Crawford D, Mishra G
    Title: Socio-economic inequalities in women's fruit and vegetable intakes: a multilevel study of individual, social and environmental mediators.
    Journal: Public Health Nutr. 9(5):623-30
    Date: 2006 Aug
    Abstract: OBJECTIVE: This study employed a multilevel design to test the contribution of individual, social and environmental factors to mediating socio-economic status (SES) inequalities in fruit and vegetable consumption among women. DESIGN: A cross-sectional survey was linked with objective environmental data. SETTING: A community sample involving 45 neighbourhoods. SUBJECTS: In total, 1347 women from 45 neighbourhoods provided survey data on their SES (highest education level), nutrition knowledge, health considerations related to food purchasing, and social support for healthy eating. These data were linked with objective environmental data on the density of supermarkets and fruit and vegetable outlets in local neighbourhoods. RESULTS: Multilevel modelling showed that individual and social factors partly mediated, but did not completely explain, SES variations in fruit and vegetable consumption. Store density did not mediate the relationship of SES with fruit or vegetable consumption. CONCLUSIONS: Nutrition promotion interventions should focus on enhancing nutrition knowledge and health considerations underlying food purchasing in order to promote healthy eating, particularly among those who are socio-economically disadvantaged. Further investigation is required to identify additional potential mediators of SES-diet relationships, particularly at the environmental level.
  488. Author: Dunn RA, Sharkey JR, Lotade-Manje J, Bouhlal Y, Nayga RM Jr
    Title: Socio-economic status, racial composition and the affordability of fresh fruits and vegetables in neighborhoods of a large rural region in Texas.
    Journal: Nutr J
    Date: 2011
    Abstract: BACKGROUND: Little is known about how affordability of healthy food varies with community characteristics in rural settings. We examined how the cost of fresh fruit and vegetables varies with the economic and demographic characteristics in six rural counties of Texas. METHODS: Ground-truthed data from the Brazos Valley Food Environment Project were used to identify all food stores in the rural region and the availability and lowest price of fresh whole fruit and vegetables in the food stores. Socioeconomic characteristics were extracted from the 2000 U.S. Census Summary Files 3 at the level of the census block group. We used an imputation strategy to calculate two types of price indices for both fresh fruit and fresh vegetables: a high variety and a basic index; and evaluated the relationship between neighborhood economic and demographic characteristics and affordability of fresh produce, using linear regression models. RESULTS: The mean cost of meeting the USDA recommendation of fruit consumption from a high variety basket of fruit types in our sample of stores was just over $27.50 per week. Relying on the three most common fruits lowered the weekly expense to under $17.25 per week, a reduction of 37.6%. The effect of moving from a high variety to a low variety basket was much less when considering vegetable consumption: a 4.3% decline from $29.23 to $27.97 per week. Univariate regression analysis revealed that the cost of fresh produce is not associated with the racial/ethnic composition of the local community. However, multivariate regression showed that holding median income constant, stores in neighborhoods with higher percentages of Black residents paid more for fresh fruits and vegetables. The proportion of Hispanic residents was not associated with cost in either the univariate or multivariate analysis. CONCLUSION: This study extends prior work by examining the affordability of fresh fruit and vegetables from food stores in a large rural area; and how access to an affordable supply of fresh fruit and vegetables differs by neighborhood inequalities. The approach and findings of this study are relevant and have important research and policy implications for understanding access and availability of affordable, healthy foods.
  489. Author: Pabayo R, Spence JC, Cutumisu N, Casey L, Storey K
    Title: Sociodemographic, behavioural and environmental correlates of sweetened beverage consumption among pre-school children.
    Journal: Public Health Nutr. 15(8):1338-46
    Date: 2012 Aug
    Abstract: OBJECTIVE: To identify sociodemographic and environmental correlates of sweetened beverages (regular soft drinks, fruit juice) among children of pre-school age. DESIGN: Children's dietary intake, food behaviours and screen time were measured by parental report. A Geographic Informational System was used to assess the number of grocery stores and fast-food restaurants available within 1 km of the children's residence. Multivariate log-binomial regression models were constructed to determine correlates of drinking soft drinks during the previous week. SETTING: Edmonton region, Canada. SUBJECTS: Children aged 4 and 5 years (n 2114) attending a public health unit for immunization were recruited for a cohort study on determinants of childhood obesity, between 2005 and 2007. RESULTS: Children from neighbourhoods with low socio-economic status (relative risk (RR) = 1·17, 95 % CI 0·98, 1·40) or who participated in >2 h of screen time daily (RR = 1·28, 95 % CI 1·13, 1·45) were significantly more likely to have consumed regular soft drinks within the last week. Those who lived within 1 km of a grocery store were significantly less likely to consume regular soft drinks (RR = 0·84, 95 % CI 0·73, 0·96). Children who participated in >2 h of screen time daily (RR = 1·16, 95 % CI 1·06, 1·27) were more likely to exceed the recommended weekly number of servings of fruit juice. CONCLUSIONS: Socio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. These findings may help health professionals to advocate for policies that reduce soft drink consumption among children.
  490. Author: Wang MC, Kim S, Gonzalez AA, MacLeod KE, Winkleby MA
    Title: Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index.
    Journal: J Epidemiol Community Health. 61(6):491-8
    Date: 2007 Jun
    Abstract: OBJECTIVE: To determine whether socioeconomic and food-related physical characteristics of the neighbourhood are associated with body mass index (BMI; kg/m(2)) independently of individual-level sociodemographic and behavioural characteristics. Design and METHODS: Observational study using (1) individual-level data previously gathered in five cross-sectional surveys conducted by the Stanford Heart Disease Prevention Program between 1979 and 1990 and (2) neighbourhood-level data from (a) the census to describe socioeconomic characteristics and (b) data obtained from government and commercial sources to describe exposure to different types of retail food stores as measured by store proximity, and count of stores per square mile. Data were analysed using multilevel modelling procedures. The setting was 82 neighbourhoods in agricultural regions of California. PARTICIPANTS: 7595 adults, aged 25-74 years. RESULTS: After adjusting for age, gender, ethnicity, individual-level socioeconomic status, smoking, physical activity and nutrition knowledge, it was found that (1) adults who lived in low socioeconomic neighbourhoods had a higher mean BMI than adults who lived in high socioeconomic neighbourhoods; (2) higher neighbourhood density of small grocery stores was associated with higher BMI among women; and (3) closer proximity to chain supermarkets was associated with higher BMI among women. CONCLUSION: Living in low socioeconomic neighbourhoods, and in environments where healthy food is not readily available, is found to be associated with increased obesity risk. Unlike other studies which examined populations in other parts of the US, a positive association between living close to supermarkets and reduced obesity risk was not found in this study. A better understanding of the mechanisms by which neighbourhood physical characteristics influence obesity risk is needed.
  491. Author: Giskes K, Van Lenthe FJ, Brug J, Mackenbach JP, Turrell G
    Title: Socioeconomic inequalities in food purchasing: the contribution of respondent-perceived and actual (objectively measured) price and availability of foods.
    Journal: Prev Med. 45(1):41-8
    Date: 2007 Jul
    Abstract: BACKGROUND: Research has shown that lower socioeconomic groups purchase foods that are less consistent with dietary recommendations. The price and availability of foods are thought to be important mediating factors between socioeconomic position and food purchasing. OBJECTIVES: We examined the relative contribution of the perceived and objectively measured price and availability of recommended foods to household income differences in food purchasing. METHODS: Using a face-to-face interview, a random sample of Brisbane residents (n=812) were asked about their food purchasing choices in 2000. They were also asked about their perceptions of the price and availability of 'recommended' foods (i.e. choices lower in fat, saturated fat, sugar, salt or higher in fibre) in the supermarkets where they usually shopped. Audits measuring the actual availability and price of identical foods were conducted in the same supermarkets. RESULTS: Lower socioeconomic groups were less likely to make food purchasing choices consistent with dietary guideline recommendations. Objective availability and price differences were not associated with purchasing choices, nor did they contribute to socioeconomic inequalities in food purchasing choices. Perceived availability and price differences were associated with the purchase of recommended foods. Perceived availability made a small contribution to inequalities in food purchasing, however perceived price differences did not. CONCLUSION: Socioeconomic inequalities in food purchasing are not mediated by differential availability of recommended foods and differences in price between recommended and regular foods in supermarkets, or by perceptions of their relative price. However, differential perceptions of the availability of recommended foods may play a small role in food purchasing inequalities.
  492. Author: Johnston LD, Delva J, O'Malley PM
    Title: Soft drink availability, contracts, and revenues in American secondary schools.
    Journal: Am J Prev Med. 33(4 Suppl):S209-25
    Date: 2007 Oct
    Abstract: BACKGROUND: Soft drinks have been widely available in the nation's schools for some years, but recently, in response to rising concern about the epidemic of obesity among youth, concerns have been raised as to whether they should be available, and if so, under what circumstances. This paper looks at how widespread soft drink availability is at present in schools, as well as the availability of other classes of beverages. Because overweight occurs disproportionately among minorities and those of lower socioeconomic status (SES), this paper also seeks to determine to what extent environmental conditions differ for these students. Differences between middle and high schools are also examined. METHODS: Data for 2004 and 2005 were used from two ongoing United States national surveys: the Youth, Education, and Society (YES) study of school administrators (N=345), and the Monitoring the Future (MTF) study of secondary school students in 8th, 10th, and 12th grades surveyed in those same schools (N=37,543). Data were gathered in YES on the availability of various beverages in schools from vending machines and other venues, as well as about the presence and nature of pouring rights contracts with soft drink bottlers. Data were analyzed in 2006. RESULTS: The vast majority of high school students today have soft drinks available to them in the school environment both through vending machines (88%) and in the cafeteria at lunch (59%), with middle schools providing somewhat less access. Diet soft drinks are less available, particularly at lunch. Most students (67% in middle and 83% in high school) are in schools that have a contract with a bottler. Revenues to schools generated by soft drink sales are quite modest. Hispanics are most likely to have soft drinks available throughout the school day. The SES of the students correlates negatively with whether the school allows advertising and promotion of soft drinks. CONCLUSIONS: Current school practices regarding soft drink availability, advertising, and sales would seem likely to be contributing to the extent of overweight among American young people, and to some extent to the higher risk faced by Hispanic and lower SES youth.
  493. Author: Kubik MY, Lytle LA, Story M
    Title: Soft drinks, candy, and fast food: what parents and teachers think about the middle school food environment.
    Journal: J Am Diet Assoc. 105(2):233-9
    Date: 2005 Feb
    Abstract: OBJECTIVE: To assess the opinions and beliefs of parents and teachers of middle school students regarding the school food environment. DESIGN: Surveys mailed to parents and placed in teachers' school mailboxes included questions about adolescents' eating practices, food choice at school, and school-related food policies and practices. SUBJECTS/SETTINGS: A convenience sample of parents (n=350; response rate: 350/526=66%) and teachers (n=490; response rate: 490/701=70%) of middle school students from 16 schools in the St Paul-Minneapolis metropolitan area who participated in the Teens Eating for Energy and Nutrition at School study. STATISTICAL ANALYSIS: Descriptive statistics examined the prevalence of parents' and teachers' opinions and beliefs about adolescents' eating practices, food choice at school, and school-related food policies and practices. RESULTS: Most parents and teachers agreed that the nutritional health of students should be a school priority. However, only 18% of parents and 31% of teachers believed schools give adequate attention to student nutrition. Among both parents and teachers, 90% agreed that more healthy snacks and beverages should be available in school vending machines and on school a la carte lines. CONCLUSIONS: Findings suggest that parents and teachers are concerned about the nutritional health of students and the "state of health" of the school food environment. Dietetic and other health professionals who work in school settings should actively engage parents and teachers in the process of affecting and monitoring policies and practices that foster a healthy school food environment.
  494. Author: Zive MM, Elder JP, Prochaska JJ, Conway TL, Pelletier RL, Marshall S, Sallis JF
    Title: Sources of dietary fat in middle schools.
    Journal: Prev Med. 35(4):376-82
    Date: 2002 Oct
    Abstract: BACKGROUND: The current study uses an ecological approach to describe the food environment at 24 middle schools and multiple food sources' dietary fat contribution. METHODS: Five consecutive days were sampled for collection of school meals, a la carte, and student store data. Bag lunch contents were observed on 3 days. Measurement included grams of saturated and total fat plus sales or participation data. RESULTS: Average total fat grams per meal were 21 g (SD = 2) for bag lunches, 14 g (SD = 5) for Type A breakfast, and 31 g (SD = 8) for Type A lunches. Average fat grams per item were 13 g (SD = 3) for a la carte and 6 g (SD = 2) for student stores. Students purchased or brought to school a mean of 26 g (SD = 3) of total and 8 g (SD = 1) of saturated fat. Contributions to total fat grams were 42% by Type A lunches, 27% by a la carte foods, 25% by bag lunches, 3% by Type A breakfast, and 2% by student stores. Findings for saturated fat were similar. CONCLUSIONS: Middle school students eat excessive amounts of fat at school, and multiple sources of food must be considered to understand the school food environment.
  495. Author: Van Meter E, Lawson AB, Colabianchi N, Nichols M, Hibbert J, Porter D, Liese AD
    Title: Spatial accessibility and availability measures and statistical properties in the food environment.
    Journal: Spat Spatiotemporal Epidemiol. 2(1):35-47
    Date: 2011 Mar
    Abstract: Spatial accessibility is of increasing interest in the health sciences. This paper addresses the statistical use of spatial accessibility and availability indices. These measures are evaluated via an extensive simulation based on cluster models for local food outlet density. We derived Monte Carlo critical values for several statistical tests based on the indices. In particular we are interested in the ability to make inferential comparisons between different study areas where indices of accessibility and availability are to be calculated. We derive tests of mean difference as well as tests for differences in Moran's I for spatial correlation for each of the accessibility and availability indices. We also apply these new statistical tests to a data example based on two counties in South Carolina for various accessibility and availability measures calculated for food outlets, stores, and restaurants.
  496. Author: Casey R, Chaix B, Weber C, Schweitzer B, Charreire H, Salze P, Badariotti D, Banos A, Oppert JM, Simon C
    Title: Spatial accessibility to physical activity facilities and to food outlets and overweight in French youth.
    Journal: Int J Obes (Lond). 36(7):914-9
    Date: 2012 Jul
    Abstract: OBJECTIVE: Some characteristics of the built environment have been associated with obesity in youth. Our aim was to determine whether individual and environmental socio-economic characteristics modulate the relation between youth overweight and spatial accessibility to physical activity (PA) facilities and to food outlets. DESIGN: Cross-sectional study.Subjects:3293 students, aged 12 ± 0.6 years, randomly selected from eastern France middle schools. MEASUREMENTS AND METHODS: Using geographical information systems (GIS), spatial accessibility to PA facilities (urban and nature) was assessed using the distance to PA facilities at the municipality level; spatial accessibility to food outlets (general food outlets, bakeries and fast-food outlets) was calculated at individual level using the student home address and the food outlets addresses. Relations of weight status with spatial accessibility to PA facilities and to food outlets were analysed using mixed logistic models, testing potential direct and interaction effects of individual and environmental socio-economic characteristics. RESULTS: Individual socio-economic status modulated the relation between spatial accessibility to PA facilities and to general food outlets and overweight. The likelihood of being overweight was higher when spatial accessibility to urban PA facilities and to general food outlets was low, but in children of blue-collar-workers only. The odds ratio (OR) (95% confidence interval) for being overweight of blue-collar-workers children compared with non-blue-collar-workers children was 1.76 (1.25-2.49) when spatial accessibility to urban PA facilities was low. This OR was 1.86 (1.20-2.86) when spatial accessibility to general food outlets was low. There was no significant relationship of overweight with either nature PA facilities or other food outlets (bakeries and fast-food outlets). CONCLUSION: These results indicate that disparities in spatial accessibility to PA facilities and to general food outlets may amplify the risk of overweight in socio-economically disadvantaged youth. These data should be relevant for influencing health policies and urban planning at both a national and local level.
  497. Author: Kubik MY, Wall M, Shen L, Nanney MS, Nelson TF, Laska MN, Story M
    Title: State but not district nutrition policies are associated with less junk food in vending machines and school stores in US public schools.
    Journal: J Am Diet Assoc. 110(7):1043-8
    Date: 2010 Jul
    Abstract: BACKGROUND: Policy that targets the school food environment has been advanced as one way to increase the availability of healthy food at schools and healthy food choice by students. Although both state- and district-level policy initiatives have focused on school nutrition standards, it remains to be seen whether these policies translate into healthy food practices at the school level, where student behavior will be impacted. OBJECTIVE: To examine whether state- and district-level nutrition policies addressing junk food in school vending machines and school stores were associated with less junk food in school vending machines and school stores. Junk food was defined as foods and beverages with low nutrient density that provide calories primarily through fats and added sugars. DESIGN: A cross-sectional study design was used to assess self-report data collected by computer-assisted telephone interviews or self-administered mail questionnaires from state-, district-, and school-level respondents participating in the School Health Policies and Programs Study 2006. The School Health Policies and Programs Study, administered every 6 years since 1994 by the Centers for Disease Control and Prevention, is considered the largest, most comprehensive assessment of school health policies and programs in the United States. SUBJECTS/SETTING: A nationally representative sample (n=563) of public elementary, middle, and high schools was studied. STATISTICAL ANALYSIS: Logistic regression adjusted for school characteristics, sampling weights, and clustering was used to analyze data. Policies were assessed for strength (required, recommended, neither required nor recommended prohibiting junk food) and whether strength was similar for school vending machines and school stores. RESULTS: School vending machines and school stores were more prevalent in high schools (93%) than middle (84%) and elementary (30%) schools. For state policies, elementary schools that required prohibiting junk food in school vending machines and school stores offered less junk food than elementary schools that neither required nor recommended prohibiting junk food (13% vs 37%; P=0.006). Middle schools that required prohibiting junk food in vending machines and school stores offered less junk food than middle schools that recommended prohibiting junk food (71% vs 87%; P=0.07). Similar associations were not evident for district-level polices or high schools. CONCLUSIONS: Policy may be an effective tool to decrease junk food in schools, particularly in elementary and middle schools.
  498. Author: Taber DR, Stevens J, Evenson KR, Ward DS, Poole C, Maciejewski ML, Murray DM, Brownson RC
    Title: State policies targeting junk food in schools: racial/ethnic differences in the effect of policy change on soda consumption.
    Journal: Am J Public Health. 101(9):1769-75
    Date: 2011 Sep
    Abstract: OBJECTIVES: We estimated the association between state policy changes and adolescent soda consumption and body mass index (BMI) percentile, overall and by race/ethnicity. METHODS: We obtained data on whether states required or recommended that schools prohibit junk food in vending machines, snack bars, concession stands, and parties from the 2000 and 2006 School Health Policies and Programs Study. We used linear mixed models to estimate the association between 2000-2006 policy changes and 2007 soda consumption and BMI percentile, as reported by 90 730 students in 33 states and the District of Columbia in the Youth Risk Behavior Survey, and to test for racial/ethnic differences in the associations. RESULTS: Policy changes targeting concession stands were associated with 0.09 fewer servings of soda per day among students (95% confidence interval [CI] = -0.17, -0.01); the association was more pronounced among non-Hispanic Blacks (0.19 fewer servings per day). Policy changes targeting parties were associated with 0.07 fewer servings per day (95% CI = -0.13, 0.00). Policy changes were not associated with BMI percentile in any group. CONCLUSIONS: State policies targeting junk food in schools may reduce racial/ethnic disparities in adolescent soda consumption, but their impact appears to be too weak to reduce adolescent BMI percentile.
  499. Author: Nanney MS, Nelson T, Wall M, Haddad T, Kubik M, Laska MN, Story M
    Title: State school nutrition and physical activity policy environments and youth obesity.
    Journal: Am J Prev Med. 38(1):9-16
    Date: 2010 Jan
    Abstract: BACKGROUND: With the epidemic of childhood obesity, there is national interest in state-level school policies related to nutrition and physical activity, policies adopted by states, and relationships to youth obesity. PURPOSE: This study develops a comprehensive state-level approach to characterize the overall obesity prevention policy environment for schools and links the policy environments to youth obesity for each state. METHODS: Using 2006 School Health Policies and Programs Study (SHPPS) state data, qualitative and quantitative methods were used (2008-2009) to construct domains of state-level school obesity prevention policies and practices, establish the validity and reliability of the domain scales, and examine their associations with state-level obesity prevalence among youth aged 10-17 years from the 2003 National Survey of Children's Health. RESULTS: Nearly 250 state-level obesity prevention-policy questions were identified from the SHPPS. Three broad policy topic areas containing 100 food service and nutrition (FSN) questionnaire items; 146 physical activity and education (PAE) items; and two weight assessment (WA) items were selected. Principal components analysis and content validity assessment were used to further categorize the items into six FSN, ten PAE, and one WA domain. Using a proportional scaled score to summarize the number of policies adopted by states, it was found that on average states adopted about half of the FSN (49%), 38% of the PAE, and 17% of the WA policies examined. After adjusting for state-level measures of ethnicity and income, the average proportion of FSN policies adopted by states was correlated with the prevalence of youth obesity at r =0.35 (p=0.01). However, no correlation was found between either PAE or WA policies and youth obesity (PAE policies at r =0.02 [p=0.53] and WA policies at r =0.16 [p=0.40]). CONCLUSIONS: States appear to be doing a better job adopting FSN policies than PA or WA policies, and adoption of policies is correlated with youth obesity. Continued monitoring of these policies seems to be warranted.
  500. Author: Ayala GX, Laska MN, Zenk SN, Tester J, Rose D, Odoms-Young A, McCoy T, Gittelsohn J, Foster GD, Andreyeva T
    Title: Stocking characteristics and perceived increases in sales among small food store managers/owners associated with the introduction of new food products approved by the Special Supplemental Nutrition Program for Women, Infants, and Children.
    Journal: Public Health Nutr. 15(9):1771-9
    Date: 2012 Sep
    Abstract: OBJECTIVE: The present study assessed the impact of the 2009 food packages mandated by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on perceived sales, product selection and stocking habits of small, WIC-authorized food stores. DESIGN: A cross-sectional study involving in-depth interviews with store managers/owners. SETTING: Small, WIC-authorized food stores in eight major cities in the USA. SUBJECTS: Fifty-two store managers/owners who had at least 1 year of experience in the store prior to study participation. RESULTS: The WIC-approved food products (fresh, canned and frozen fruits; fresh, canned and frozen vegetables; wholegrain/whole-wheat bread; white corn/whole-wheat tortillas; brown rice; lower-fat milk (
  501. Author: Leone AF, Rigby S, Betterley C, Park S, Kurtz H, Johnson MA, Lee JS
    Title: Store type and demographic influence on the availability and price of healthful foods, Leon County, Florida, 2008.
    Journal: Prev Chronic Dis. 8(6):A140
    Date: 2011 Nov
    Abstract: INTRODUCTION: The availability of healthful foods varies by neighborhood. We examined the availability and price of more healthful foods by store type, neighborhood income level, and racial composition in a community with high rates of diet-related illness and death. METHODS: We used the modified Nutrition Environment Measures Survey in Stores to conduct this cross-sectional study in 2008. We surveyed 73 stores (29% supermarkets, 11% grocery stores, and 60% convenience stores) in Leon County, Florida. We analyzed the price and availability of foods defined by the 2005 Dietary Guidelines for Americans as "food groups to encourage." We used descriptive statistics, t tests, analysis of variance, and χ(2) tests in the analysis. RESULTS: Measures of availability for all more healthful foods differed by store type (P
  502. Author: Lucan SC, Karpyn A, Sherman S
    Title: Storing empty calories and chronic disease risk: snack-food products, nutritive content, and manufacturers in Philadelphia corner stores.
    Journal: J Urban Health. 87(3):394-409
    Date: 2010 May
    Abstract: Corner stores are part of the urban food environment that may contribute to obesity and diet-related diseases, particularly for low-income and minority children. The snack foods available in corner stores may be a particularly important aspect of an urban child's food environment. Unfortunately, there is little data on exactly what snack foods corner stores stock, or where these foods come from. We evaluated snack foods in 17 Philadelphia corner stores, located in three ethnically distinct, low-income school neighborhoods. We recorded the manufacturer, calories, fat, sugar, and sodium for all snack items, excluding candy and prepared foods. We then compared the nutritive content of assessed snack items to established dietary recommendations and a school nutrition standard. In total, stores stocked 452 kinds of snacks, with only 15% of items common between all three neighborhoods. Total and unique snacks and snack food manufacturers varied by neighborhood, but distributions in snack type varied negligibly: overall, there were no fruit snacks, no vegetable snacks, and only 3.6% of all snacks (by liberal definition) were whole grain. The remainder (96.4% of snacks) was highly processed foods. Five of 65 manufacturers supplied 73.4% of all kinds of snack foods. Depending on serving size definition, 80.0-91.5% of snack foods were "unhealthy" (by the school nutrition standard), including seven of 11 wholegrain products. A single snack item could supply 6-14% of a day's recommended calories, fat, sugar, and sodium on average (or 56-169% at the extreme) for a "typical" child. We conclude that corner store snack food inventories are almost entirely unhealthful, and we discuss possible implications and next steps for research and intervention.
  503. Author: Lane SD, Keefe RH, Rubinstein R, Levandowski BA, Webster N, Cibula DA, Boahene AK, Dele-Michael O, Carter D, Jones T, Wojtowycz M, Brill J
    Title: Structural violence, urban retail food markets, and low birth weight.
    Journal: Health Place. 14(3):415-23
    Date: 2008 Sep
    Abstract: This paper investigates urban retail food markets and health in Syracuse, New York. A structured observational analysis found that a majority of corner markets do not sell fresh produce or low fat dairy products, but conduct a lively business selling lottery tickets, cigarettes, and liquor. A comparison of census tracts with and without access to supermarkets that sell fresh produce and other healthy food found that pregnant women living in proximity to a supermarket had significantly fewer low birth weight births than other pregnant women regardless of income level.
  504. Author: Turner LR, Chaloupka FJ
    Title: Student access to competitive foods in elementary schools: trends over time and regional differences.
    Journal: Arch Pediatr Adolesc Med. 166(2):164-9
    Date: 2012 Feb
    Abstract: OBJECTIVE: To examine the availability of competitive foods in elementary schools. DESIGN: Nationally representative mail-back survey. SETTING: United States public and private elementary schools during the 2006-2007, 2007-2008, 2008-2009, and 2009-2010 school years. PARTICIPANTS: Survey respondents at 2647 public and 1205 private elementary schools. MAIN OUTCOME MEASURE: The availability of foods offered in competitive venues. RESULTS: Elementary school students' access to foods in competitive venues on campus (vending machines, school stores, snack bars, or à la carte lines) remained constant over time. As of the 2009-2010 school year, approximately half of all public and private elementary school students could purchase foods in 1 or more competitive venues on campus. Sugary foods were available to almost all students with access to competitive foods on campus. Public elementary school students in the South had more access to competitive food venues and greater availability of salty and sweet products in those venues compared with students in other parts of the country; however, they also had greater availability of healthier foods, such as fruits and vegetables. CONCLUSIONS: Many elementary school students can purchase competitive foods on campus. Most students with access to competitive venues could purchase sweet products, but healthier foods were less widely available.
  505. Author: Svastisalee CM, Nordahl H, Glümer C, Holstein BE, Powell LM, Due P
    Title: Supermarket and fast-food outlet exposure in Copenhagen: associations with socio-economic and demographic characteristics.
    Journal: Public Health Nutr. 14(9):1618-26
    Date: 2011 Sep
    Abstract: OBJECTIVE: To investigate whether exposure to fast-food outlets and supermarkets is socio-economically patterned in the city of Copenhagen. DESIGN: The study was based on a cross-sectional multivariate approach to examine the association between the number of fast-food outlets and supermarkets and neighbourhood-level socio-economic indicators. Food business addresses were obtained from commercial and public business locators and geocoded using a geographic information system for all neighbourhoods in the city of Copenhagen (n 400). The regression of counts of fast-food outlets and supermarkets v. indicators of socio-economic status (percentage of recent immigrants, percentage without a high-school diploma, percentage of the population under 35 years of age and average household income in Euros) was performed using negative binomial analysis. SETTING: Copenhagen, Denmark. SUBJECTS: The unit of analysis was neighbourhood (n 400). RESULTS: In the fully adjusted models, income was not a significant predictor for supermarket exposure. However, neighbourhoods with low and mid-low income were associated with significantly fewer fast-food outlets. Using backwise deletion from the fully adjusted models, low income remained significantly associated with fast-food outlet exposure (rate ratio = 0·66-0·80) in the final model. CONCLUSIONS: In the city of Copenhagen, there was no evidence of spatial patterning of supermarkets by income. However, we detected a trend in the exposure to fast-food outlets, such that neighbourhoods in the lowest income quartile had fewer fast-food outlets than higher-income neighbourhoods. These findings have similarities with studies conducted in the UK, but not in the USA. The results suggest there may be socio-economic factors other than income associated with food exposure in Europe.
  506. Author: Morland K, Diez Roux AV, Wing S
    Title: Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study.
    Journal: Am J Prev Med. 30(4):333-9
    Date: 2006 Apr
    Abstract: BACKGROUND: Obesity is a leading public health concern, and although environmental factors have been hypothesized to play a role in the prevention of obesity, little empirical data exist to document their effects. The purpose of this study was to examine whether characteristics of the local food environment are associated with the prevalence of cardiovascular disease risk factors. METHODS: A cross-sectional study of men and women participating in the third visit (1993-1995) of the Atherosclerosis Risk in Communities (ARIC) Study was conducted in 2004. The analyses included 10,763 ARIC participants residing in one of the 207 eligible census tracts located in the four ARIC-defined geographic areas. Names and addresses of food stores located in Mississippi, North Carolina, Maryland, and Minnesota were obtained from departments of agriculture. Multilevel modeling was used to calculate prevalence ratios of the associations between the presence of specific types of food stores and cardiovascular disease risk factors. RESULTS: The presence of supermarkets was associated with a lower prevalence of obesity and overweight (obesity prevalence ratio [PR] = 0.83, 95% confidence interval [CI] = 0.75-0.92; overweight PR = 0.94, 95% CI = 0.90-0.98), and the presence of convenience stores was associated with a higher prevalence of obesity and overweight (obesity PR = 1.16, 95% CI = 1.05-1.27; overweight PR = 1.06, 95% CI = 1.02-1.10). Associations for diabetes, high serum cholesterol, and hypertension were not consistently observed. CONCLUSIONS: Results from this study suggest that characteristics of local food environments may play a role in the prevention of overweight and obesity.
  507. Author: Byrd-Bredbenner C, Johnson M, Quick VM, Walsh J, Greene GW, Hoerr S, Colby SM, Kattelmann KK, Phillips BW, Kidd T, Horacek TM
    Title: Sweet and salty. An assessment of the snacks and beverages sold in vending machines on US post-secondary institution campuses.
    Journal: Appetite. 58(3):1143-51
    Date: 2012 Jun
    Abstract: This study assessed the nutritional quality of snacks and beverages sold in vending machines. The contents of snack and beverage vending machines in 78 buildings on 11 US post-secondary education campuses were surveyed. Of the 2607 snack machine slots surveyed, the most common snacks vended were salty snacks (e.g., chips, pretzels) and sweets (i.e., candy and candy bars). The 1650 beverage machine slots assessed contained twice as many sugar-sweetened beverages as non-calorie-containing beverages. Only two institutions sold both milk and 100% juice in vending machines. The portion of snacks and beverages sold averaged more than 200 cal. Neither snacks nor beverages were nutrient dense. The majority of snacks were low in fiber and high in calories and fat and almost half were high in sugar. Most beverages were high in calories and sugar. This study's findings suggest that vending machines provide limited healthful choices. Findings from benchmark assessments of components of the food environment, like the vending options reported here, can provide valuable input to campus administrators, health services, food service, and students who want to establish campus policies to promote healthful eating.
  508. Author: Gloria CT, Steinhardt MA
    Title: Texas nutrition environment assessment of retail food stores (TxNEA-S): development and evaluation.
    Journal: Public Health Nutr. 13(11):1764-72
    Date: 2010 Nov
    Abstract: OBJECTIVE: Current nutrition environment instruments are typically designed to measure a small number of healthy foods based on national trends. They lack the depth to accurately measure the unique dietary choices of subpopulations, such as Texas consumers whose food preferences are influenced by Hispanic/Latino culture. Thus the purposes of the present study were to: (i) develop a comprehensive observational tool to measure the availability of healthy foods from retail stores in Texas; and (ii) conduct a pilot test to examine the tool's reliability, as well as differences in the availability of healthy foods in stores between high- and low-income neighbourhoods. DESIGN: Grocery and convenience stores were assessed for availability of healthy foods. Reliability was calculated using percentage agreement, and differences in availability were examined using 2 (store type) × 2 (neighbourhood income) ANOVA. SETTING: One high-income and one low-income neighbourhood in Austin, Texas. SUBJECTS: A sample of thirty-eight stores comprising twenty-five convenience stores and thirteen grocery stores. RESULTS: The low-income neighbourhood had 324 % more convenience stores and 56 % fewer grocery stores than the high-income neighbourhood. High inter-rater (mean = 0·95) and test-retest reliability (mean = 0·92) and a significant interaction (P = 0·028) between store type and neighbourhood income were found. CONCLUSIONS: The TxNEA-S tool includes 106 healthy food items, such as fruits, vegetables, dairy, proteins and grains. The tool is reliable and face validity is affirmed by the Texas Department of Health. Grocery stores have more healthy foods than convenience stores, and high-income grocery stores offer more healthy foods than low-income grocery stores.
  509. Author: Cullen KW, Thompson DI
    Title: Texas school food policy changes related to middle school a la carte/snack bar foods: potential savings in kilocalories.
    Journal: J Am Diet Assoc. 105(12):1952-4
    Date: 2005 Dec
    Abstract: The potential impact of a school food policy change reducing sweetened beverage and high-fat, salty, and sweet food portions on energy consumption of middle-school students was assessed. Snack bar sales for one school year were obtained from 23 schools. Energy content was calculated for each item and energy savings from reduced portion size was determined. Per student, about 111 kcal per day was purchased; 47 kcal per day was saved when reduced portion sizes were substituted for the large servings. These findings should provide some assurance that changes in food portion sizes in school food environments could impact energy balance.
  510. Author: Keegan TH, Hurley S, Goldberg D, Nelson DO, Reynolds P, Bernstein L, Horn-Ross PL, Gomez SL
    Title: The association between neighborhood characteristics and body size and physical activity in the California teachers study cohort.
    Journal: Am J Public Health. 102(4):689-97
    Date: 2012 Apr
    Abstract: OBJECTIVES: We considered interactions between physical activity and body mass index (BMI) and neighborhood factors. METHODS: We used recursive partitioning to identify predictors of low recreational physical activity (
  511. Author: Smoyer-Tomic KE, Spence JC, Raine KD, Amrhein C, Cameron N, Yasenovskiy V, Cutumisu N, Hemphill E, Healy J
    Title: The association between neighborhood socioeconomic status and exposure to supermarkets and fast food outlets.
    Journal: Health Place. 14(4):740-54
    Date: 2008 Dec
    Abstract: This study examines whether exposure to supermarkets and fast food outlets varies with neighborhood-level socioeconomic status in Edmonton, Canada. Only market area and fast food proximity predicted supermarket exposure. For fast food outlets, the odds of exposure were greater in areas with more Aboriginals, renters, lone parents, low-income households, and public transportation commuters; and lower in those with higher median income and dwelling value. Low wealth, renter-occupied, and lone parent neighborhoods had greater exposure to fast food outlets, which was not offset by better supermarket access. The implications are troubling for fast food consumption among lone parent families in light of growing obesity rates among children.
  512. Author: Bodor JN, Rice JC, Farley TA, Swalm CM, Rose D
    Title: The association between obesity and urban food environments.
    Journal: J Urban Health. 87(5):771-81
    Date: 2010 Sep
    Abstract: Several studies have examined associations between the food retail environment and obesity, though virtually no work has been done in the urban South, where obesity rates are among the highest in the country. This study assessed associations between access to food retail outlets and obesity in New Orleans. Data on individual characteristics and body weight were collected by telephone interviews from a random sample of adults (N = 3,925) living in New Orleans in 2004-2005. The neighborhood of each individual was geo-mapped by creating a 2-km buffer around the center point of the census tract in which they lived. Food retailer counts were created by summing the total number of each food store type and fast food establishment within this 2-km neighborhood. Hierarchical linear models assessed associations between access to food retailers and obesity status. After adjusting for individual characteristics, each additional supermarket in a respondent's neighborhood was associated with a reduced odds for obesity (OR 0.93, 95% CI 0.88-0.99). Fast food restaurant (OR 1.01, 95% CI 1.00-1.02) and convenience store (OR 1.01, 95% CI 1.00-1.02) access were each predictive of greater obesity odds. An individual's access to food stores and fast food restaurants may play a part in determining weight status. Future studies with longitudinal and experimental designs are needed to test whether modifications in the food environment may assist in the prevention of obesity.
  513. Author: Shi L
    Title: The association between the availability of sugar-sweetened beverage in school vending machines and its consumption among adolescents in California: a propensity score matching approach.
    Journal: J Environ Public Health
    Date: 2010
    Abstract: There is controversy over to what degree banning sugar-sweetened beverage (SSB) sales at schools could decrease the SSB intake. This paper uses the adolescent sample of 2005 California Health Interview Survey to estimate the association between the availability of SSB from school vending machines and the amount of SSB consumption. Propensity score stratification and kernel-based propensity score matching are used to address the selection bias issue in cross-sectional data. Propensity score stratification shows that adolescents who had access to SSB through their school vending machines consumed 0.170 more drinks of SSB than those who did not (P
  514. Author: Jilcott SB, Wade S, McGuirt JT, Wu Q, Lazorick S, Moore JB
    Title: The association between the food environment and weight status among eastern North Carolina youth.
    Journal: Public Health Nutr. 14(9):1610-7
    Date: 2011 Sep
    Abstract: OBJECTIVE: To examine associations between various measures of the food environment and BMI percentile among youth. DESIGN: Cross-sectional, observational. SETTING: Pitt County, eastern North Carolina. SUBJECTS: We extracted the electronic medical records for youth receiving well child check-ups from January 2007 to June 2008. We obtained addresses for food venues from two secondary sources and ground-truthing. A geographic information systems database was constructed by geocoding home addresses of 744 youth and food venues. We quantified participants' accessibility to food venues by calculating 'coverage', number of food venues in buffers of 0·25, 0·5, 1 and 5 miles (0·4, 0·8, 1·6 and 8·0 km) and by calculating 'proximity' or distance to the closest food venue. We examined associations between BMI percentile and food venue accessibility using correlation and regression analyses. RESULTS: There were negative associations between BMI percentile and coverage of farmers' markets/produce markets in 0·25 and 0·5 mile Euclidean and 0·25, 0·5 and 1 mile road network buffers. There were positive associations between BMI percentile and coverage of fast-food and pizza places in the 0·25 mile Euclidean and network buffers. In multivariate analyses adjusted for race, insurance status and rural/urban residence, proximity (network distance) to convenience stores was negatively associated with BMI percentile and proximity to farmers' markets was positively associated with BMI percentile. CONCLUSIONS: Accessibility to various types of food venues is associated with BMI percentile in eastern North Carolina youth. Future longitudinal work should examine correlations between accessibility to and use of traditional and non-traditional food venues.
  515. Author: Kubik MY, Lytle LA, Hannan PJ, Perry CL, Story M
    Title: The association of the school food environment with dietary behaviors of young adolescents.
    Journal: Am J Public Health. 93(7):1168-73
    Date: 2003 Jul
    Abstract: OBJECTIVES: We examined the association between young adolescents' dietary behaviors and school vending machines, à la carte programs, and fried potatoes' being served at school lunch. METHODS: Using a cross-sectional study design, we measured à la carte availability and the number of school stores, vending machines, and amounts of fried potatoes served to students at school lunch in 16 schools. Grade 7 students (n = 598) completed 24-hour dietary recall interviews. RESULTS: A la carte availability was inversely associated with fruit and fruit/vegetable consumption and positively associated with total and saturated fat intake. Snack vending machines were negatively correlated with fruit consumption. Fried potatoes' being served at school lunch was positively associated with vegetable and fruit/vegetable intake. CONCLUSIONS: School-based programs that aim to promote healthy eating among youths should target school-level environmental factors.
  516. Author: Jetter KM, Cassady DL
    Title: The availability and cost of healthier food alternatives.
    Journal: Am J Prev Med. 30(1):38-44
    Date: 2006 Jan
    Abstract: BACKGROUND: Many people, especially low-income consumers, do not successfully follow dietary recommendations to eat more whole grains and less fat and added sugar. The food environment may have a significant impact on the choice by low-income consumers to eat healthier foods, as both the availability and price of healthier food items may limit their ability to eat a healthier diet. We investigated the cost and availability of a standard market basket of foods, and a healthier basket that included low-fat meat and dairy and whole grain products. METHODS: Market-basket surveys were conducted in 25 stores in Los Angeles and Sacramento. Stores were selected from neighborhoods that were varied by income and surveyed three times from September 2003 to June 2004. The average cost of a standard market basket (based on the U.S. Department of Agriculture's Thrifty Food Plan [TFP]) and a healthier market basket was calculated from these prices and compared using a standard t-test to determine if they were significantly different from each other. The analysis was conducted in 2005. RESULTS: In neighborhoods served by smaller grocery stores, access to whole-grain products, low-fat cheeses, and ground meat with
  517. Author: Powell LM, Chaloupka FJ, Bao Y
    Title: The availability of fast-food and full-service restaurants in the United States: associations with neighborhood characteristics.
    Journal: Am J Prev Med. 33(4 Suppl):S240-5
    Date: 2007 Oct
    Abstract: BACKGROUND: Parallel to the rising obesity epidemic, food consumption patterns and household expenditures show a marked upward trend in total energy intake derived from away-from-home sources. METHODS: This study conducted cross-sectional multivariate analyses to examine associations between local-area racial, ethnic, and income characteristics and the availability of full-service and fast-food restaurants. Based on a U.S. national census of 28,050 ZIP codes that cover a population of 280,675,874 people, restaurant outlet data were linked to 2000 Census Bureau data based on ZIP code tabulation areas and analyses were undertaken using negative binomial count models and ordinary least squares regression analyses. RESULTS: Study results showed that higher- versus lower-income, predominantly black and racially mixed versus predominantly white and Hispanic versus non-Hispanic neighborhoods had fewer available full-service and fast-food restaurants. Near-low- and middle-income neighborhoods had the highest number of available restaurants with 1.24 and 1.22 times number of full-service restaurants and 1.34 and 1.28 times the number of fast-food restaurants compared to high-income neighborhoods. Predominantly black neighborhoods were found to have 58.2% and 59.3% of the number of full-service and fast-food restaurants available in predominantly white neighborhoods. No statistically significant differences were found in the relative availability of fast-food versus full-service restaurants by income, race, or ethnicity in the national sample used. However, across urban areas, near-low-, middle-, and near-high- versus high-income neighborhoods and predominantly black versus white neighborhoods were found to have moderately higher proportions of fast-food among total restaurants. CONCLUSIONS: In urban areas, higher proportions of available fast-food restaurants out of total restaurants in predominantly black versus predominantly white neighborhoods may contribute to racial differences in obesity rates.
  518. Author: Wechsler H, Basch CE, Zybert P, Lantigua R, Shea S
    Title: The availability of low-fat milk in an inner-city Latino community: implications for nutrition education.
    Journal: Am J Public Health. 85(12):1690-2
    Date: 1995 Dec
    Abstract: Substitution of low-fat for whole milk is an important strategy for reducing saturated fat consumption, but intake of whole milk remains high among Latinos. To assess whether this is related to the unavailability of low-fat milk, we surveyed 251 grocery stores (bodegas) and 25 supermarkets in a predominantly low-income, urban Latino community. Low-fat milk was available in 73% of bodegas and 96% of supermarkets, but it constituted only 15% of total milk volume in bodegas and 37% of that volume in supermarkets. Since lack of availability was not a major obstacle to increasing low-fat milk consumption, public health nutrition campaigns should focus on increasing consumer demand.
  519. Author: Salois MJ
    Title: The built environment and obesity among low-income preschool children.
    Journal: Health Place. 18(3):520-7
    Date: 2012 May
    Abstract: In spite of the evidence that adult obesity is influenced by environmental factors, the influence of the environment on childhood obesity remains under-investigated. This paper examines the association of the built environment with the prevalence of obesity in low-income preschool children. Built environment indicators include measures relating to food choice and physical activity. The relationship of the environment with childhood obesity is further stratified by urban-rural location. Overall, the built environment is associated with the prevalence of obesity in low-income preschool children, although the impact of the environment is affected by urban-rural status. Results imply broad-scope for community-level interventions.
  520. Author: Samuels SE, Craypo L, Boyle M, Crawford PB, Yancey A, Flores G
    Title: The California Endowment's Healthy Eating, Active Communities program: a midpoint review.
    Journal: Am J Public Health. 100(11):2114-23
    Date: 2010 Nov
    Abstract: OBJECTIVES: We conducted a midpoint review of The California Endowment's Healthy Eating, Active Communities (HEAC) program, which works in 6 low-income California communities to prevent childhood obesity by changing children's environments. The HEAC program conducts interventions in 5 key childhood environments: schools, after-school programs, neighborhoods, health care, and marketing and advertising. METHODS: We measured changes in foods and beverages sold at schools and in neighborhoods in HEAC sites; changes in school and after-school physical activity programming and equipment; individual-level changes in children's attitudes and behaviors related to food and physical activity; and HEAC-related awareness and engagement on the part of community members, stakeholders, and policymakers. RESULTS: Children's environments changed to promote healthier lifestyles across a wide range of domains in all 5 key childhood environments for all 6 HEAC communities. Children in HEAC communities are also engaging in more healthy behaviors than they were before the program's implementation. CONCLUSIONS: HEAC sites successfully changed children's food and physical activity environments, making a healthy lifestyle a more viable option for low-income children and their families.
  521. Author: Apparicio P, Cloutier MS, Shearmur R
    Title: The case of Montréal's missing food deserts: evaluation of accessibility to food supermarkets.
    Journal: Int J Health Geogr
    Date: 2007
    Abstract: BACKGROUND: Access to varied, healthy and inexpensive foods is an important public health concern that has been widely documented. Consequently, there is an increasing interest in identifying food deserts, that is, socially deprived areas within cities that have poor access to food retailers. In this paper we propose a methodology based on three measures of accessibility to supermarkets calculated using geographic information systems (GIS), and on exploratory multivariate statistical analysis (hierarchical cluster analysis), which we use to identify food deserts in Montréal. RESULTS: First, the use of three measures of accessibility to supermarkets is very helpful in identifying food deserts according to several dimensions: proximity (distance to the nearest supermarket), diversity (number of supermarkets within a distance of less than 1000 metres) and variety in terms of food and prices (average distance to the three closest different chain-name supermarkets). Next, the cluster analysis applied to the three measures of accessibility to supermarkets and to a social deprivation index demonstrates that there are very few problematic food deserts in Montréal. In fact, census tracts classified as socially deprived and with low accessibility to supermarkets are, on average, 816 metres away from the nearest supermarket and within 1.34 kilometres of three different chain-name supermarkets. CONCLUSION: We conclude that food deserts do not represent a major problem in Montréal. Since geographic accessibility to healthy food is not a major issue in Montréal, prevention efforts should be directed toward the understanding of other mechanisms leading to an unhealthy diet, rather than attempting to promote an even spatial distribution of supermarkets.
  522. Author: Black JL, Macinko J
    Title: The changing distribution and determinants of obesity in the neighborhoods of New York City, 2003-2007.
    Journal: Am J Epidemiol. 171(7):765-75
    Date: 2010 Apr 1
    Abstract: Obesity (body mass index >or=30 kg/m(2)) is a growing urban health concern, but few studies have examined whether, how, or why obesity prevalence has changed over time within cities. This study characterized the individual- and neighborhood-level determinants and distribution of obesity in New York City from 2003 to 2007. Individual-level data from the Community Health Survey (n = 48,506 adults, 34 neighborhoods) were combined with neighborhood measures. Multilevel regression assessed changes in obesity over time and associations with neighborhood-level income and food and physical activity amenities, controlling for age, racial/ethnic identity, education, employment, US nativity, and marital status, stratified by gender. Obesity rates increased by 1.6% (P
  523. Author: Krukowski RA, Eddings K, West DS
    Title: The children's menu assessment: development, evaluation, and relevance of a tool for evaluating children's menus.
    Journal: J Am Diet Assoc. 111(6):884-8
    Date: 2011 Jun
    Abstract: Restaurant foods represent a substantial portion of children's dietary intake, and consumption of foods away from home has been shown to contribute to excess adiposity. This descriptive study aimed to pilot-test and establish the reliability of a standardized and comprehensive assessment tool, the Children's Menu Assessment, for evaluating the restaurant food environment for children. The tool is an expansion of the Nutrition Environment Measures Survey-Restaurant. In 2009-2010, a randomly selected sample of 130 local and chain restaurants were chosen from within 20 miles of Little Rock, AR, to examine the availability of children's menus and to conduct initial calibration of the Children's Menu Assessment tool (final sample: n=46). Independent raters completed the Children's Menu Assessment in order to determine inter-rater reliability. Test-retest reliability was also examined. Inter-rater reliability was high: percent agreement was 97% and Spearman correlation was 0.90. Test-retest was also high: percent agreement was 91% and Spearman correlation was 0.96. Mean Children's Menu Assessment completion time was 14 minutes, 56 seconds ± 10 minutes, 21 seconds. Analysis of Children's Menu Assessment findings revealed that few healthier options were available on children's menus, and most menus did not provide parents with information for making healthy choices, including nutrition information or identification of healthier options. The Children's Menu Assessment tool allows for comprehensive, rapid measurement of the restaurant food environment for children with high inter-rater reliability. This tool has the potential to contribute to public health efforts to develop and evaluate targeted environmental interventions and/or policy changes regarding restaurant foods.
  524. Author: Pearce J, Hiscock R, Blakely T, Witten K
    Title: The contextual effects of neighbourhood access to supermarkets and convenience stores on individual fruit and vegetable consumption.
    Journal: J Epidemiol Community Health. 62(3):198-201
    Date: 2008 Mar
    Abstract: BACKGROUND: It is often suggested that neighbourhood access to food retailers affects the dietary patterns of local residents, but this hypothesis has not been adequately researched. We examine the association between neighbourhood accessibility to supermarkets and convenience stores and individuals' consumption of fruit and vegetables in New Zealand. METHODS: Using geographical information systems, travel times from the population-weighted centroid of each neighbourhood to the closest supermarket and convenience store were calculated for 38,350 neighbourhoods. These neighbourhood measures of accessibility were appended to the 2002-3 New Zealand Health Survey of 12,529 adults. RESULTS: The consumption of the recommended daily intake of fruit was not associated with living in a neighbourhood with better access to supermarkets or convenience stores. Similarly, access to supermarkets was not related to vegetable intake. However, individuals in the quartile of neighbourhoods with the best access to convenience stores had 25% (OR 0.75, 95% CI 0.60% to 0.93%) lower odds of eating the recommended vegetable intake compared to individuals in the base category (worst access). CONCLUSION: This study found little evidence that poor locational access to food retail provision is associated with lower fruit and vegetable consumption. However, before rejecting the common sense notion that neighbourhood access to fruit and vegetables affects personal consumption, research that measures fruit and vegetable access more precisely and directly is required.
  525. Author: Haerens L, Craeynest M, Deforche B, Maes L, Cardon G, De Bourdeaudhuij I
    Title: The contribution of psychosocial and home environmental factors in explaining eating behaviours in adolescents.
    Journal: Eur J Clin Nutr. 62(1):51-9
    Date: 2008 Jan
    Abstract: OBJECTIVE: The present study aimed at investigating the influence of food availability, rules and television viewing habits on eating behaviours in adolescents. DESIGN: Cross-sectional study. SETTING: Four randomly selected middle schools. SUBJECTS: A sample of 534 seventh and eighth graders. INTERVENTIONS: Validated questionnaires were used to measure the family environment and fat, soft drink and fruit consumption. Hierarchical regression analyses on fat, soft drink and fruit consumption, with demographic and psychosocial variables entered as the first and environmental factors as the second block were conducted in boys and girls. RESULTS: Boys with more unhealthy products available at home consumed more fat (P
  526. Author: Barratt J
    Title: The cost and availability of healthy food choices in southern Derbyshire
    Journal: Journal of human nutrition and dietetics. 10(1):63-9
    Date: 1997
    Abstract: There has been general agreement among experts over the last decade on what constitutes a healthy diet for the prevention of many of the major causes of morbidity and mortality in the UK, and for the treatment of diabetes mellitus and hyperlipidaemias. People are generally aware of the link between diet and health, but there is concern that foods which need to be included in the diet for it to meet current recommendations may be difficult to find and expensive. The 7-day intake of an adult woman, which matched many of the current diet targets (including those of NACNE, the Department of Health and the British Diabetic Association), was costed in supermarkets in southern Derbyshire in 1990, 1992 and 1994, and also in smaller retail outlets in 1994. Whilst the availability of foods making up a healthy diet has improved in supermarkets in southern Derbyshire over the years of the study, and the cost to supermarket shoppers is coming down, a healthy diet is still more expensive than the average diet. Also, those who shop with smaller retailers (usually those on lower incomes and at higher risk of diet related disease) will still have difficulty finding some food items, and will find a healthy diet prohibitively expensive.
  527. Author: Powell LM, Han E
    Title: The costs of food at home and away from home and consumption patterns among U.S. adolescents.
    Journal: J Adolesc Health. 48(1):20-6
    Date: 2011 Jan
    Abstract: PURPOSE: This study examined the associations of prices of food at home groceries, prices of fast food away from home and the availability of food stores and restaurants with the number of days over the past week that adolescents consumed fruit and fruit juices, vegetables, meat, nonmeat protein, dairy, grains, and sweets. METHODS: Individual-level data on adolescents were drawn from the Child Development Supplement of the Panel Study of Income Dynamics combined at the zip code level with external economic contextual data. Multivariate regression analyses were used to estimate the associations between food consumption categories and the economic contextual factors. Regressions were also estimated by households' poverty status. RESULTS: Fast food and food at home prices were not significantly associated with any of the food consumption categories in the full sample. However, among poor adolescents, higher fast food prices were associated with higher levels of nonmeat protein consumption. Food store outlet availability was found to have very small significant associations with some food consumption categories but no significant associations were found for restaurant outlets. CONCLUSIONS: Food away from home prices, such as fast food prices and supermarket and grocery store availability, were associated with some food consumption categories among low-income youths and related policies deserve further examination.
  528. Author: Walsh JR, Hebert A, Byrd-Bredbenner C, Carey G, Colby S, Brown-Esters ON, Greene G, Hoerr S, Horacek T, Kattelmann K, Kidd T, Koenings M, Phillips B, Shelnutt KP, White AA
    Title: The development and preliminary validation of the behavior, environment, and changeability survey (BECS).
    Journal: J Nutr Educ Behav. 44(6):490-9
    Date: 2012 Nov-Dec
    Abstract: OBJECTIVE: To develop and test the validity of the Behavior, Environment, and Changeability Survey (BECS) for identifying the importance and changeability of nutrition, exercise, and stress management behavior and related aspects of the environment. DESIGN: A cross-sectional, online survey of the BECS and selected validated instruments. SETTING: Ten state universities. PARTICIPANTS: A convenience sample of college students (n = 1,283), ages 18-24 years. ANALYSIS: Principal component analysis was used to confirm a 6-component structure of the BECS in 2 independent samples for the purpose of cross-validation. Internal consistency was measured and construct and criterion-related analyses were conducted to test the reliability and validity of the BECS subscales. RESULTS: Six components representing 34 BECS items were revealed from the original 69 items and explained 64% of the total variance. Six scales were retained, and internal consistency of each ranged from α = .82 to .93. BECS Nutrition Behavior and Nutrition Changeability scale scores were highest for participants in action/maintenance Stages of Change for fruit and vegetable intake. CONCLUSIONS AND IMPLICATIONS: There is strong support for the use of the BECS when planning health programs to gain insight into behavior that young adults are willing to improve, specifically related to nutrition, exercise, and sleep.
  529. Author: Anderson A, Dewar J, Marshall D, Cummins S, Taylor M, Dawson J, Sparks L
    Title: The development of a healthy eating indicator shopping basket tool (HEISB) for use in food access studies-identification of key food items.
    Journal: Public Health Nutr. 10(12):1440-7
    Date: 2007 Dec
    Abstract: OBJECTIVES: To develop an objective, nutrient-based, healthy eating indicator shopping basket (HEISB) tool for use in studies of access to healthy food. DESIGN: Tool development used a literature search to identify previous practice, web information on current definition of healthy foods by the UK Food Standards Agency, and population-based dietary surveys to identify culturally acceptable foods. These findings were then appraised with respect to practical fieldwork considerations. SETTING: The review took account of surveys undertaken in a range of geographical areas. RESULTS: Previous tools have varied in the foods selected and the rationale for inclusion. Most have considered nutritional composition but no systematic definition has been used and foods have been subjectively classified as 'less healthy' or 'more healthy'. Recent UK work on nutrient profiling enabled individual food items to be objectively assessed for inclusion. Data from national food surveys enabled commonly consumed and culturally acceptable foods to be identified. Practical considerations included item use in meals, convenience, price, and fieldwork constraints. Other issues including health and price discriminators as well as regional preferences were considered. The final HEISB tool comprised 35 items within the following categories - 17 from fruit and vegetables, nine from potatoes, bread and cereal, five from fish/meats, three from dairy, and one from fatty and sugary foods. CONCLUSIONS: The tool provides a rational basis for examining access and availability of healthy foods in cross-sectional and longitudinal retail and consumer studies.
  530. Author: Kim K, Hong SA, Yun SH, Ryou HJ, Lee SS, Kim MK
    Title: The effect of a healthy school tuck shop program on the access of students to healthy foods.
    Journal: Nutr Res Pract. 6(2):138-45
    Date: 2012 Apr
    Abstract: The objective of this study was to evaluate the effect of a healthy school tuck shop program, developed as a way of creating a healthy and nutritional school environment, on students' access to healthy foods. Five middle schools and four high schools (775 students) participated in the healthy school tuck shop program, and nine schools (1,282 students) were selected as the control group. The intervention program included restriction of unhealthy foods sold in tuck shops, provision of various fruits, and indirect nutritional education with promotion of healthy food products. The program evaluation involved the examination of students' purchase and intake patterns of healthy foods, satisfaction with the available foodstuffs, and utilization of and satisfaction with nutritional educational resources. Our results indicated that among of the students who utilized the tuck shop, about 40% purchased fruit products, showing that availability of healthy foods in the tuck shop increased the accessibility of healthy foods for students. Overall food purchase and intake patterns did not significantly change during the intervention period. However, students from the intervention schools reported higher satisfaction with the healthy food products sold in the tuck shop than did those from the control schools (all P
  531. Author: Dunn RA, Sharkey JR, Horel S
    Title: The effect of fast-food availability on fast-food consumption and obesity among rural residents: an analysis by race/ethnicity.
    Journal: Econ Hum Biol. 10(1):1-13
    Date: 2012 Jan
    Abstract: Rural areas of the United States tend to have higher obesity rates than urban areas, particularly in regions with high proportions of non-white residents. This paper analyzes the effect of fast-food availability on the level of fast-food consumption and obesity risk among both white and non-white residents of central Texas. Potential endogeneity of fast-food availability is addressed through instrumental variables regression using distance to the nearest major highway as an instrument. We find that non-whites tend to exhibit higher obesity rates, greater access to fast-food establishments and higher consumption of fast-food meals compared to their white counterparts. In addition, we found that whites and non-whites respond differently to the availability of fast-food in rural environments. Greater availability is not associated with either greater consumption of fast-food meals or a higher obesity risk among the sample of whites. In contrast, greater availability of fast-food is positively associated with both the number of meals consumed for non-white rural residents and their obesity. While our results are robust to specification, the effect of availability on weight outcomes is notably weaker when indirectly calculated from the implied relationship between consumption and caloric intake. This highlights the importance of directly examining the proposed mechanism through which an environmental factor influences weight outcomes.
  532. Author: Rose D, Bodor JN, Rice JC, Swalm CM, Hutchinson PL
    Title: The effects of Hurricane Katrina on food access disparities in New Orleans.
    Journal: Am J Public Health. 101(3):482-4
    Date: 2011 Mar
    Abstract: Disparities in neighborhood food access are well documented, but little research exists on how shocks influence such disparities. We examined neighborhood food access in New Orleans at 3 time points: before Hurricane Katrina (2004-2005), in 2007, and in 2009. We combined existing directories with on-the-ground verification and geographic information system mapping to assess supermarket counts in the entire city. Existing disparities for African American neighborhoods worsened after the storm. Although improvements have been made, by 2009 disparities were no better than prestorm levels.
  533. Author: Lawrence S, Boyle M, Craypo L, Samuels S
    Title: The food and beverage vending environment in health care facilities participating in the healthy eating, active communities program.
    Journal: Pediatrics
    Date: 2009 Jun
    Abstract: BACKGROUND: Little has been done to ensure that the foods sold within health care facilities promote healthy lifestyles. Policies to improve school nutrition environments can serve as models for health care organizations. OBJECTIVE: This study was designed to assess the healthfulness of foods sold in health care facility vending machines as well as how health care organizations are using policies to create healthy food environments. METHODS: Food and beverage assessments were conducted in 19 California health care facilities that serve children in the Healthy Eating, Active Communities sites. Items sold in vending machines were inventoried at each facility and interviews conducted for information on vending policies. Analyses examined the types of products sold and the healthfulness of these products. RESULTS: Ninety-six vending machines were observed in 15 (79%) of the facilities. Hospitals averaged 9.3 vending machines per facility compared with 3 vending machines per health department and 1.4 per clinic. Sodas comprised the greatest percentage of all beverages offered for sale: 30% in hospital vending machines and 38% in clinic vending machines. Water (20%) was the most prevalent in health departments. Candy comprised the greatest percentage of all foods offered in vending machines: 31% in clinics, 24% in hospitals, and 20% in health department facilities. Across all facilities, 75% of beverages and 81% of foods sold in vending machines did not adhere to the California school nutrition standards (Senate Bill 12). Nine (47%) of the health care facilities had adopted, or were in the process of adopting, policies that set nutrition standards for vending machines. CONCLUSIONS: According to the California school nutrition standards, the majority of items found in the vending machines in participating health care facilities were unhealthy. Consumption of sweetened beverages and high-energy-density foods has been linked to increased prevalence of obesity. Some health care facilities are developing policies that set nutrition standards for vending machines. These policies could be effective in increasing access to healthy foods and beverages in institutional settings.
  534. Author: Lucan SC, Mitra N
    Title: The food environment and dietary intake: demonstrating a method for GIS-mapping and policy-relevant research
    Journal: Journal of Public Health
    Date: 2011 Dec
    Abstract: Aims The aims of this paper are are (1) to assess if perceptions of the food environment are associated with select dietary intake by neighborhood, and (2) to map neighborhood-specific findings, demonstrating a method for policy-relevant research.Methods Using pre-collected data from a Philadelphia, PA community health survey, we aggregated individual-level data (n = 4,434 respondents) to neighborhoods (n = 381 census tracts), adjusting for conceptually-relevant socio-demographic factors. We estimated Spearman correlations between multivariable adjusted food-environment perceptions (perceived produce availability, supermarket accessibility, grocery quality) and select dietary intake (reported fruit-and-vegetable and fast-food consumption), and mapped variables by neighborhood using geographic information systems (GIS).Results Difficulty finding fruits and vegetables, having to travel outside of one’s neighborhood to get to a supermarket, and poor grocery quality were each directly correlated with fast-food intake (rho = 0.21, 0.34, 0.64 respectively; p values
  535. Author: Langellier BA
    Title: The food environment and student weight status, Los Angeles County, 2008-2009.
    Journal: Prev Chronic Dis
    Date: 2012 Feb
    Abstract: INTRODUCTION: One factor believed to affect overweight status is the food environment, or the distribution of outlets that serve healthful or unhealthful foods in residential areas, workplaces, and schools. Few studies have investigated the association between the food environment and the prevalence of overweight among children and adolescents. The objective of this study was to investigate the association between the distribution of corner stores and fast food restaurants around Los Angeles County public schools and the prevalence of overweight among students. METHODS: Hierarchical linear models were used to assess the association between the presence of corner stores or fast food restaurants within a half-mile of Los Angeles County schools (N = 1,694) and overweight prevalence among students in grades 5, 7, and 9. RESULTS: The presence of corner stores and fast food restaurants varied significantly by schools' racial/ethnic composition, Title 1 eligibility, and rural/suburban vs urban location. After adjustment for other factors, overweight prevalence was 1.6 percentage points higher at majority-Latino schools that had at least 1 corner store within a half-mile than at majority-Latino schools that did not have a corner store within a half-mile. The association between corner stores and overweight prevalence varied significantly between majority-Latino schools and schools that were majority-white or that had no racial/ethnic majority. The presence of fast food restaurants within a half-mile of schools was not associated with overweight prevalence among students. CONCLUSION: This study underscores the importance of interventions that seek to improve the healthfulness of corner store inventories and of student purchases.
  536. Author: Lisabeth LD, Sánchez BN, Escobar J, Hughes R, Meurer WJ, Zuniga B, Garcia N, Brown DL, Morgenstern LB
    Title: The food environment in an urban Mexican American community.
    Journal: Health Place. 16(3):598-605
    Date: 2010 May
    Abstract: The objective was to determine whether ethnic composition of neighborhoods is associated with number and type of food stores in an urban, Mexican American US community. Data were from a commercial food store data source and the US Census. Multivariate count models were used to test associations with adjustment for neighborhood demographics, income, and commercialization. Neighborhoods at the 75th percentile of percent Mexican American (76%) had nearly four times the number of convenience stores (RR=3.9, 95% CI: 2.2-7.0) compared with neighborhoods at the 25th percentile (36%). Percent Mexican American in the neighborhood was not associated with the availability of other food store types (supermarkets, grocery stores, specialty stores, convenience stores with gas stations) in the adjusted model. The impact of greater access to convenience stores on Mexican American residents' diets requires exploration.
  537. Author: Macdonald L, Ellaway A, Macintyre S
    Title: The food retail environment and area deprivation in Glasgow City, UK.
    Journal: Int J Behav Nutr Phys Act
    Date: 2009
    Abstract: It has previously been suggested that deprived neighbourhoods within modern cities have poor access to general amenities, for example, fewer food retail outlets. Here we examine the distribution of food retailers by deprivation in the City of Glasgow, UK.We obtained a list of 934 food retailers in Glasgow, UK, in 2007, and mapped these at address level. We categorised small areas (data zones) into quintiles of area deprivation using the 2006 Scottish Index of Multiple Deprivation Income sub-domain score. We computed mean number of retailers per 1000 residents per data zone, and mean network distance to nearest outlet from data zone centroid, for all retailers combined and for each of seven categories of retailer separately (i.e. bakers, butchers, fruit and vegetable sellers, fishmongers, convenience stores, supermarkets and delicatessens).The most deprived quintile (of areas) had the greatest mean number of total food retailers per 1000 residents while quintile 1 (least deprived) had the least, and this difference was statistically significant (Chi-square p
  538. Author: Lake AA, Burgoine T, Greenhalgh F, Stamp E, Tyrrell R
    Title: The foodscape: classification and field validation of secondary data sources.
    Journal: Health Place. 16(4):666-73
    Date: 2010 Jul
    Abstract: The aims were to: develop a food environment classification tool and to test the acceptability and validity of three secondary sources of food environment data within a defined urban area of Newcastle-Upon-Tyne, using a field validation method. A 21 point (with 77 sub-categories) classification tool was developed. The fieldwork recorded 617 establishments selling food and/or food products. The sensitivity analysis of the secondary sources against fieldwork for the Newcastle City Council data was good (83.6%), while Yell.com and the Yellow Pages were low (51.2% and 50.9%, respectively). To improve the quality of secondary data, multiple sources should be used in order to achieve a realistic picture of the foodscape.
  539. Author: Lake AA, Burgoine T, Stamp E, Grieve R
    Title: The foodscape: classification and field validation of secondary data sources across urban/rural and socio-economic classifications in England.
    Journal: Int J Behav Nutr Phys Act
    Date: 2012
    Abstract: BACKGROUND: In recent years, alongside the exponential increase in the prevalence of overweight and obesity, there has been a change in the food environment (foodscape). This research focuses on methods used to measure and classify the foodscape. This paper describes the foodscape across urban/rural and socio-economic divides. It examines the validity of a database of food outlets obtained from Local Authority sources (secondary level & desk based), across urban/rural and socio-economic divides by conducting fieldwork (ground-truthing). Additionally this paper tests the efficacy of using a desk based classification system to describe food outlets, compared with ground-truthing. METHODS: Six geographically defined study areas were purposively selected within North East England consisting of two Lower Super Output Areas (LSOAs; a small administrative geography) each. Lists of food outlets were obtained from relevant Local Authorities (secondary level & desk based) and fieldwork (ground-truthing) was conducted. Food outlets were classified using an existing tool. Positive predictive values (PPVs) and sensitivity analysis was conducted to explore validation of secondary data sources. Agreement between 'desk' and 'field' based classifications of food outlets were assessed. RESULTS: There were 438 food outlets within all study areas; the urban low socio-economic status (SES) area had the highest number of total outlets (n = 210) and the rural high SES area had the least (n = 19). Differences in the types of outlets across areas were observed. Comparing the Local Authority list to fieldwork across the geographical areas resulted in a range of PPV values obtained; with the highest in urban low SES areas (87%) and the lowest in Rural mixed SES (79%). While sensitivity ranged from 95% in the rural mixed SES area to 60% in the rural low SES area. There were no significant associations between field/desk percentage agreements across any of the divides. CONCLUSION: Despite the relatively small number of areas, this work furthers our understanding of the validity of using secondary data sources to identify and classify the foodscape in a variety of geographical settings. While classification of the foodscape using secondary Local Authority food outlet data with information obtained from the internet, is not without its difficulties, desk based classification would be an acceptable alternative to fieldwork, although it should be used with caution.
  540. Author: Coleman KJ, Shordon M, Caparosa SL, Pomichowski ME, Dzewaltowski DA
    Title: The healthy options for nutrition environments in schools (Healthy ONES) group randomized trial: using implementation models to change nutrition policy and environments in low income schools.
    Journal: Int J Behav Nutr Phys Act
    Date: 2012
    Abstract: BACKGROUND: The Healthy Options for Nutrition Environments in Schools (Healthy ONES) study was an evidence-based public health (EBPH) randomized group trial that adapted the Institute for Healthcare Improvement's (IHI) rapid improvement process model to implement school nutrition policy and environmental change. METHODS: A low-income school district volunteered for participation in the study. All schools in the district agreed to participate (elementary = 6, middle school = 2) and were randomly assigned within school type to intervention (n = 4) and control (n =4) conditions following a baseline environmental audit year. Intervention goals were to 1) eliminate unhealthy foods and beverages on campus, 2) develop nutrition services as the main source on campus for healthful eating (HE), and 3) promote school staff modeling of HE. Schools were followed across a baseline year and two intervention years. Longitudinal assessment of height and weight was conducted with second, third, and sixth grade children. Behavioral observation of the nutrition environment was used to index the amount of outside foods and beverages on campuses. Observations were made monthly in each targeted school environment and findings were presented as items per child per week. RESULTS: From an eligible 827 second, third, and sixth grade students, baseline height and weight were collected for 444 second and third grade and 135 sixth grade students (51% reach). Data were available for 73% of these enrolled students at the end of three years. Intervention school outside food and beverage items per child per week decreased over time and control school outside food and beverage items increased over time. The effects were especially pronounced for unhealthy foods and beverage items. Changes in rates of obesity for intervention school (28% baseline, 27% year 1, 30% year 2) were similar to those seen for control school (22% baseline, 22% year 1, 25% year 2) children. CONCLUSIONS: Healthy ONES adaptation of IHI's rapid improvement process provided a promising model for implementing nutrition policy and environmental changes that can be used in a variety of school settings. This approach may be especially effective in assisting schools to implement the current federally-mandated wellness policies.
  541. Author: Mensink F, Schwinghammer SA, Smeets A
    Title: The Healthy School Canteen programme: a promising intervention to make the school food environment healthier.
    Journal: J Environ Public Health
    Date: 2012
    Abstract: The environment can exert a strong influence on people's food decisions. In order to facilitate students to make more healthy food choices and to develop healthy eating habits, it is important that the school food environment is healthy. The Healthy School Canteen programme of The Netherlands Nutrition Centre is an intervention that helps schools to make their cafeteria's offering healthier. A descriptive study was conducted by an independent research agency to survey the perceptions, experiences, and opinions of users of the programme (school directors, parents, students, and health professionals). Results show that directors and students of participating schools perceive their cafeteria's offering to be healthier after implementing the programme than prior to implementation. Next, further important results of the study are highlighted and relations with other projects, caveats, and practical recommendations are discussed. It is concluded that the Healthy School Canteen programme is a promising intervention to change the school food environment but that further research is needed to ultimately establish its effectiveness. Also, it will be a challenge to motivate all schools to enroll in the programme in order to achieve the goal of the Dutch Government of all Dutch school cafeterias being healthy by 2015.
  542. Author: Ard JD, Fitzpatrick S, Desmond RA, Sutton BS, Pisu M, Allison DB, Franklin F, Baskin ML
    Title: The impact of cost on the availability of fruits and vegetables in the homes of schoolchildren in Birmingham, Alabama.
    Journal: Am J Public Health. 97(2):367-72
    Date: 2007 Feb
    Abstract: OBJECTIVES: Fruit and vegetable cost is a presumed barrier to intake. We sought to determine whether fruit and vegetable cost and consumers' race and income would predict availability of fruits and vegetables in homes of schoolchildren in the Birmingham, Ala, area. METHODS: Data on availability of 27 fruit and vegetable items were obtained from homes of 1355 children (32% African American) in the Birmingham area. Fruit and vegetable costs were obtained from the US Department of Agriculture. We used discrete choice analysis with the dependent variable represented as presence or absence of the fruit or vegetable item. Explanatory variables included fruit and vegetable price per serving; child's gender, race, and age; and parent's body mass index and income. RESULTS: Higher cost was inversely related to fruit and vegetable availability. Higher income, African American race, and female gender were positively related to availability. Cost per serving was stratified into 3 categories-low, medium, and high. Relative to low-cost items, only high-cost items decreased the odds of availability significantly. CONCLUSIONS: Fruit and vegetable cost does impact availability and has the greatest impact for high-cost items. Although cost was inversely related to availability, African Americans reported higher fruit and vegetable availability than Whites. Additional studies are needed to determine whether food items of lower nutritive value and comparable cost impact availability.
  543. Author: Park S, Sappenfield WM, Huang Y, Sherry B, Bensyl DM
    Title: The impact of the availability of school vending machines on eating behavior during lunch: the Youth Physical Activity and Nutrition Survey.
    Journal: J Am Diet Assoc. 110(10):1532-6
    Date: 2010 Oct
    Abstract: Childhood obesity is a major public health concern and is associated with substantial morbidities. Access to less-healthy foods might facilitate dietary behaviors that contribute to obesity. However, less-healthy foods are usually available in school vending machines. This cross-sectional study examined the prevalence of students buying snacks or beverages from school vending machines instead of buying school lunch and predictors of this behavior. Analyses were based on the 2003 Florida Youth Physical Activity and Nutrition Survey using a representative sample of 4,322 students in grades six through eight in 73 Florida public middle schools. Analyses included χ2 tests and logistic regression. The outcome measure was buying a snack or beverage from vending machines 2 or more days during the previous 5 days instead of buying lunch. The survey response rate was 72%. Eighteen percent of respondents reported purchasing a snack or beverage from a vending machine 2 or more days during the previous 5 school days instead of buying school lunch. Although healthier options were available, the most commonly purchased vending machine items were chips, pretzels/crackers, candy bars, soda, and sport drinks. More students chose snacks or beverages instead of lunch in schools where beverage vending machines were also available than did students in schools where beverage vending machines were unavailable: 19% and 7%, respectively (P≤0.05). The strongest risk factor for buying snacks or beverages from vending machines instead of buying school lunch was availability of beverage vending machines in schools (adjusted odds ratio=3.5; 95% confidence interval, 2.2 to 5.7). Other statistically significant risk factors were smoking, non-Hispanic black race/ethnicity, Hispanic ethnicity, and older age. Although healthier choices were available, the most common choices were the less-healthy foods. Schools should consider developing policies to reduce the availability of less-healthy choices in vending machines and to reduce access to beverage vending machines.
  544. Author: Hillier A, McLaughlin J, Cannuscio CC, Chilton M, Krasny S, Karpyn A
    Title: The impact of WIC food package changes on access to healthful food in 2 low-income urban neighborhoods.
    Journal: J Nutr Educ Behav. 44(3):210-6
    Date: 2012 May-Jun
    Abstract: OBJECTIVE: To evaluate the impact of the 2009 food package changes for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the availability of healthful food. DESIGN: Survey of all food stores in the study area before and after the changes were implemented. SETTING: Two low-income neighborhoods in Philadelphia, 1 predominantly African-American, the other predominantly Hispanic. PARTICIPANTS: One hundred forty one supermarkets, grocery stores, and non-chain corner stores identified through field enumeration. MAIN OUTCOME MEASURES: Nutrition Environment Measure Survey for Stores (NEMS-S) to determine availability, price, and quality of fruit, vegetables, milk, cereal, beans, canned fish, meat, whole grains, and juice. ANALYSIS: Comparison of NEMS-S scores before and after food package changes using t tests and ordinary least squares regression to understand the role of supermarket status, WIC participation, and racial and income composition in predicting NEMS-S scores; geographic information systems to calculate proximity of residents to food stores. RESULTS: The availability of healthful food increased significantly in stores, overall, with more substantial increases in WIC-authorized stores. Supermarket status, WIC retail status, and NEMS-S scores at baseline were significant predictors of NEMS-S scores after the food package changes. CONCLUSIONS AND IMPLICATIONS: Changes in the WIC food package were associated with increased availability of healthful food in 2 low-income neighborhoods.
  545. Author: He M, Tucker P, Gilliland J, Irwin JD, Larsen K, Hess P
    Title: The influence of local food environments on adolescents' food purchasing behaviors.
    Journal: Int J Environ Res Public Health. 9(4):1458-71
    Date: 2012 Apr
    Abstract: This study examined the relationship between the neighborhood food environment and the food purchasing behaviors among adolescents. Grade 7 and 8 students (n = 810) at 21 elementary schools in London, Ontario, Canada completed a questionnaire assessing their food purchasing behaviors. Parents of participants also completed a brief questionnaire providing residential address and demographic information. A Geographic Information System (GIS) was used to assess students' home and school neighborhood food environment and land use characteristics. Logistic regression analysis was conducted to assess the influence of the home neighborhood food environment on students' food purchasing behaviors, while two-level Hierarchical Non-Linear Regression Models were used to examine the effects of school neighborhood food environment factors on students' food purchasing behaviors. The study showed that approximately 65% of participants reported self-purchasing foods from fast-food outlets or convenience stores. Close proximity (i.e., less than 1 km) to the nearest fast-food outlet or convenience store in the home neighborhood increased the likelihood of food purchasing from these food establishments at least once per week by adolescents (p
  546. Author: Leung CW, Laraia BA, Kelly M, Nickleach D, Adler NE, Kushi LH, Yen IH
    Title: The influence of neighborhood food stores on change in young girls' body mass index.
    Journal: Am J Prev Med. 41(1):43-51
    Date: 2011 Jul
    Abstract: BACKGROUND: As the prevalence of childhood obesity has risen in past decades, more attention has been given to how the neighborhood food environment affects children's health outcomes. PURPOSE: This exploratory study examined the relationship between the presence of neighborhood food stores within a girl's neighborhood and 3-year risk of overweight/obesity and change in BMI, in girls aged 6 or 7 years at baseline. METHODS: A longitudinal analysis of participants in the Cohort Study of Young Girls' Nutrition, Environment and Transitions (CYGNET) was conducted from 2005 to 2008. Neighborhood food stores were identified from a commercial database and classified according to industry codes in 2006. Generalized linear and logistic models were used to examine how availability of food stores within 0.25-mile and 1.0-mile network buffers of a girl's residence were associated with BMI z-score change and risk of overweight or obesity, adjusting for baseline BMI/weight and family sociodemographic characteristics. Data were analyzed in 2010. RESULTS: Availability of convenience stores within a 0.25-mile network buffer of a girl's residence was associated with greater risk of overweight/obesity (OR=3.38, 95% CI=1.07, 10.68) and an increase in BMI z-score (β=0.13, 95% CI=0.00, 0.25). Availability of produce vendors/farmer's markets within a 1.0-mile network buffer of a girl's residence was inversely associated with overweight/obesity (OR=0.22, 95% CI=0.05, 1.06). A significant trend was observed between availability of produce vendors/farmer's markets and lower risk of overweight/obesity after 3 years. CONCLUSIONS: Although food store inventories were not assessed and food store indices were not created, the availability of neighborhood food stores may affect a young girl's weight trajectory over time.
  547. Author: Cummins S, Macintyre S
    Title: The location of food stores in urban areas: a case study in Glasgow
    Journal: British food journal. 101(7):545-53
    Date: 1999
    Abstract: During the late 1990s there has been an increasing interest in the concept of food deserts (populated areas with little or no food retail provision). It has been suggested that they are more likely to be found in deprived areas; however there has been little systematic research on their prevalence and distribution. This paper describes a preliminary analysis of the location of food outlets in the Greater Glasgow Health Board Area. Data were collected as part of a project on spatial variations in the price and availability of food. Based on all 79 multiple stores, and a 1 in 9 sample (n = 246) of all non-multiple stores in the area, we did not find any evidence for the existence of food deserts, and found that food stores were more numerous in the more deprived localities and postcode districts in the study site.
  548. Author: Snelling AM, Korba C, Burkey A
    Title: The national school lunch and competitive food offerings and purchasing behaviors of high school students.
    Journal: J Sch Health. 77(10):701-5
    Date: 2007 Dec
    Abstract: BACKGROUND: Across the nation, schools have become actively involved in developing obesity prevention strategies both in classrooms and in cafeterias. We sought to determine the type of foods being offered during lunch in the cafeteria of 3 public high schools in 1 county and if this reflects the purchasing patterns of students. By labeling foods based on nutrient density using a stoplight approach of green, yellow, and red colors, we were able to categorize all foods including the National School Lunch Program (NSLP) and competitive foods available in the cafeteria. METHODS: Over a 4-week cycle, daily food purchases were gathered and the proportions of green, yellow, and red foods offered and purchased was compared. RESULTS: Findings from this study suggest that students in these 3 high schools purchased foods in relative proportion to what was available in the school cafeteria for the NSLP. Green and yellow foods included in the NSLP comprised 77% of the offerings and 73% of the purchases. In contrast, 61% of the competitive foods were classified as red foods, and the purchasing of red foods made up 83% of competitive food sales. These results indicate that students purchase foods of minimal nutritional value at greater proportions in the school cafeteria. CONCLUSIONS: These results suggest that the nutritional policy for the NSLP promotes the offerings of a wide array of foods. Schools should consider a nutrition policy that regulates the sale of competitive foods.
  549. Author: Gibson DM
    Title: The neighborhood food environment and adult weight status: estimates from longitudinal data.
    Journal: Am J Public Health. 101(1):71-8
    Date: 2011 Jan
    Abstract: OBJECTIVES: I used longitudinal data to consider the relationship between the neighborhood food environment and adult weight status. METHODS: I combined individual-level data on adults from the 1998 through 2004 survey years of the National Longitudinal Survey of Youth 1979 with zip code-level data on the neighborhood food environment. I estimated ordinary least squares models of obesity, body mass index (BMI), and change in BMI. RESULTS: For residents of urban areas, the neighborhood density of small grocery stores was positively and significantly related to obesity and BMI. For individuals who moved from a rural area to an urban area over a 2-year period, changes in neighborhood supermarket density, small grocery store density, and full-service restaurant density were significantly related to the change in BMI over that period. CONCLUSIONS: Residents of urban neighborhoods with a higher concentration of small grocery stores may be more likely to patronize these stores and consume more calories because small grocery stores tend to offer more unhealthy food options than healthy food options. Moving to an urban area may expose movers to a wider variety of food options that may influence calorie consumption.
  550. Author: Wang MC, Gonzalez AA, Ritchie LD, Winkleby MA
    Title: The neighborhood food environment: sources of historical data on retail food stores.
    Journal: Int J Behav Nutr Phys Act
    Date: 2006
    Abstract: With the rapidly increasing prevalence of obesity in the United States, and the minimal success of education-based interventions, there is growing interest in understanding the role of the neighborhood food environment in determining dietary behavior. This study, as part of a larger study, identifies historical data on retail food stores, evaluates strengths and limitations of the data for research, and assesses the comparability of historical retail food store data from a government and a commercial source. Five government and commercial listings of retail food stores were identified. The California State Board of Equalization (SBOE) database was selected and then compared to telephone business directory listings. The Spearman's correlation coefficient was used to assess the congruency of food store counts per census tract between the SBOE and telephone business directory databases. The setting was four cities in Northern California, 1979-1990. The SBOE and telephone business directory databases listed 127 and 351 retail food stores, respectively. The SBOE listed 36 stores not listed by the telephone business directories, while the telephone business directories listed 260 stores not listed by the SBOE. Spearman's correlation coefficients between estimates of stores per census tract made from the SBOE listings and those made from the telephone business directory listings were approximately 0.5 (p
  551. Author: Brown AF, Vargas RB, Ang A, Pebley AR
    Title: The neighborhood food resource environment and the health of residents with chronic conditions: the food resource environment and the health of residents.
    Journal: J Gen Intern Med. 23(8):1137-44
    Date: 2008 Aug
    Abstract: BACKGROUND: Residence in disadvantaged neighborhoods is associated with poorer access to healthy foods. OBJECTIVE: To understand associations between the neighborhood food resource environment and residents' health status and body mass index (BMI) for adults with and without chronic conditions. DESIGN: Cross-sectional multilevel analysis. PARTICIPANTS: 2,536 adults from the 2000-2001 Los Angeles Family and Neighborhood Survey. MEASUREMENTS: The food resource environment was defined as the number of chain supermarkets, independent supermarkets, small markets, or convenience stores per roadway miles in the census tract. The main dependent variables were self-rated health, dichotomized as excellent or fair/poor, and body mass index (BMI). Multilevel regression models examined the association between the food resource environment and both BMI and the odds of reporting excellent health after adjustment for neighborhood SES and individual characteristics. RESULTS: More chain supermarkets per roadway mile in a census tract was associated with higher adjusted rates of reporting excellent health (33%, 38%, and 43% for those in the lowest, middle, and highest tertiles of chain supermarkets) and lower adjusted mean BMI (27, 26, and 25 kg/m(2)) for residents without a chronic condition, but not those with a chronic condition. In contrast, having more convenience stores per roadway mile was associated with lower health ratings only among adults with a chronic condition (39%, 32%, and 27% for the lowest to highest tertile of convenience stores). CONCLUSION: Health status and BMI are associated with the local food environment, but the associations differ by type of market and presence of a chronic condition.
  552. Author: Edwards KL, Clarke GP, Ransley JK, Cade J
    Title: The neighbourhood matters: studying exposures relevant to childhood obesity and the policy implications in Leeds, UK.
    Journal: J Epidemiol Community Health. 64(3):194-201
    Date: 2010 Mar
    Abstract: BACKGROUND: Reducing childhood obesity is a key UK government target. Obesogenic environments are one of the major explanations for the rising prevalence and thus a constructive focus for preventive strategies. Spatial analysis techniques are used to provide more information about obesity at the neighbourhood level in order to help to shape local obesity-prevention policies. METHODS: Childhood obesity was defined by body mass index, using cross-sectional height and weight data for children aged 3-13 years (obesity>98th centile; British reference dataset). Relationships between childhood obesity and 12 simulated obesogenic variables were assessed using geographically weighted regression. These results were applied to three wards with different socio-economic backgrounds, tailoring local obesity-prevention policy. RESULTS: The spatial distribution of childhood obesity varied, with high prevalence in deprived and affluent areas. Key local covariates strongly associated with childhood obesity differed: in the affluent ward, they were perceived neighbourhood safety and fruit and vegetable consumption; in the deprived ward, expenditure on food, purchasing school meals, multiple television ownership and internet access; in all wards, perceived access to supermarkets and leisure facilities. Accordingly, different interventions/strategies may be more appropriate/effective in different areas. CONCLUSIONS: These analyses identify the covariates with the strongest local relationships with obesity and suggest how policy can be tailored to the specific needs of each micro-area: solutions need to be tailored to the locality to be most effective. This paper demonstrates the importance of small-area analysis in order to provide health planners with detailed information that may help them to prioritise interventions for maximum benefit.
  553. Author: Snyder P, Anliker J, Cunningham-Sabo L, Dixon LB, Altaha J, Chamberlain A, Davis S, Evans M, Hurley J, Weber JL
    Title: The Pathways study: a model for lowering the fat in school meals.
    Journal: Am J Clin Nutr. 69(4 Suppl):810S-815S
    Date: 1999 Apr
    Abstract: We describe the development and implementation of the Pathways school food service intervention during the feasibility phase of the Pathways study. The purpose of the intervention was to lower the amount of fat in school meals to 30% of energy to promote obesity prevention in third- through fifth-grade students. The Pathways nutrition staff and the food service intervention staff worked together to develop 5 interrelated components to implement the intervention. These components were nutrient guidelines, 8 skill-building behavioral guidelines, hands-on materials, twice yearly trainings, and monthly visits to the kitchens by the Pathways nutrition staff. The components were developed and implemented over 18 mo in a pilot intervention in 4 schools. The results of an initial process evaluation showed that 3 of the 4 schools had implemented 6 of the 8 behavioral guidelines. In an analysis of 5 d of school menus from 3 control schools, the lunch menus averaged from 34% to 40% of energy from fat; when the menus were analyzed by using the food preparation and serving methods in the behavioral guidelines, they averaged 31% of energy from total fat. This unique approach of 5 interrelated food service intervention components was accepted in the schools and is now being implemented in the full-scale phase of the Pathways study in 40 schools for 5 y.
  554. Author: Parker L, Fox A
    Title: The Peterborough Schools Nutrition Project: a multiple intervention programme to improve school-based eating in secondary schools.
    Journal: Public Health Nutr. 4(6):1221-8
    Date: 2001 Dec
    Abstract: OBJECTIVE: To evaluate over two years the effectiveness of multiple interventions targeted at lunches in secondary schools with the aim of increasing the consumption of healthier foods by children during the school day. DESIGN: Controlled comparison study of two intervention schools targeted with multiple interventions to increase both the availability and the number of pupils consuming healthier foods, and one control school with no interventions but with the same observations over a two-year period. SETTING: Three secondary schools in Peterborough, England. SUBJECTS: Secondary school children in the three schools taking school lunches between 1996 and 1998. RESULTS: School Food Groups (SFGs) were set up in both intervention schools. All catering interventions were actioned via the SFGs. Of the food availability targets, only the target to increase the availability of high-fibre bread in both intervention schools was met. The availability of food items at the control school remained stable. The proportion of pupils consuming fruit and vegetables/salad was very low in all schools at baseline. There were positive changes for consumption of fruit and non-fried potato in one intervention school, and for high-fibre bread and non-cream cakes at the other in the short term, but only that for high-fibre bread was close to being sustained at the end of the two years. The dietary consumption target for vegetables/salad was achieved by the final monitoring period in one school. CONCLUSION: Overall there were no significant changes in school-based eating at the end of the study. Some positive changes were made, with some of the dietary targets being achieved at an early stage but not sustained. Ultimately this study has shown how difficult it is to achieve sustained dietary changes in the eating habits of secondary school children, even with considerable input.
  555. Author: Haire-Joshu D, Yount BW, Budd EL, Schwarz C, Schermbeck R, Green S, Elliott M
    Title: The quality of school wellness policies and energy-balance behaviors of adolescent mothers.
    Journal: Prev Chronic Dis. 8(2):A34
    Date: 2011 Mar
    Abstract: INTRODUCTION: In this study, we 1) compared the quality of school wellness policies among schools participating in Moms for a Healthy Balance (BALANCE), a school- and home-based weight loss study conducted with postpartum adolescents in 27 states; and 2) assessed the relationship between policy quality with energy-balance behaviors and body mass index z scores of postpartum adolescents. METHODS: As a part of BALANCE, we collected data on high-calorie food and beverage consumption, minutes spent walking, and height and weight for 647 participants. The School Wellness Policy Coding Tool was used to assess the strength and comprehensiveness of school district wellness policies from 251 schools attended by participating adolescent mothers. RESULTS: Schools averaged low scores for wellness policy comprehensiveness and strength. When compared with participants in schools with the lowest policy comprehensiveness scores, adolescent mothers in schools with the highest scores reported consuming significantly fewer daily calories from sweetened beverages while reporting higher consumption of water (P = .04 and P = .01, respectively). School wellness policy strength was associated with lower BMI z scores among adolescent mothers (P = .01). CONCLUSION: School wellness policies associated with BALANCE may be limited in their ability to promote a healthy school environment. Future studies are needed to evaluate the effect of the strength and comprehensiveness of policy language on energy balance in high-risk postpartum adolescents. Evidence from this work can provide additional guidance to federal or state government in mandating not only policy content, but also systematic evaluation.
  556. Author: Witten K, Exeter D, Field A
    Title: The quality of urban environments: mapping variation in access to community resources
    Journal: Urban studies. 40(1):161-77
    Date: 2003
    Abstract: This paper describes the development of an area-based index of locational access to community services, facilities and amenities. The index enables comparisons to be made across urban neighbourhoods and provides a starting-point from which to identify relationships between opportunity structures in the local environment and residents' health and well-being. The index is based on six domains: recreational amenities, public transport and communication, shopping and banking facilities, educational services, health services, and social and cultural services. The inclusion of specific resources was determined by their relevance to the daily lives of parents/caregivers of young children. However, the methodology has applicability to diverse population groups. Construction of the index, using geographical information systems, and its potential use for locality-based policy and planning are discussed.
  557. Author: Vereecken C, Haerens L, De Bourdeaudhuij I, Maes L
    Title: The relationship between children's home food environment and dietary patterns in childhood and adolescence.
    Journal: Public Health Nutr. 13(10A):1729-35
    Date: 2010 Oct
    Abstract: OBJECTIVE: To identify the correlates of the home food environment (parents' intake, availability and food-related parenting practices) at the age of 10 years with dietary patterns during childhood and in adolescence. SETTING: Primary-school children of fifty-nine Flemish elementary schools completed a questionnaire at school in 2002. Four years later they completed a questionnaire by e-mail or mail at home. Their parents completed a questionnaire on food-related parenting practices at baseline. DESIGN: Longitudinal study. SUBJECTS: The analyses included 609 matched questionnaires. STATISTICS: Multi-level regression analyses were used to identify baseline parenting practices (pressure, reward, negotiation, catering on demand, permissiveness, verbal praise, avoiding negative modelling, availability of healthy/unhealthy food items and mothers' fruit and vegetable (F&V) and excess scores) associated with children's dietary patterns (F&V and excess scores). RESULTS: Mother's F&V score was a significant positive independent predictor for children's F&V score at baseline and follow-up, whereas availability of unhealthy foods was significantly negatively associated with both scores. Negotiation was positively associated with children's follow-up score of F&V, while permissiveness was positively associated with children's follow-up excess score. Availability of unhealthy foods and mother's excess score were positively related to children's excess score at baseline and follow-up. CONCLUSIONS: Parental intake and restricting the availability of unhealthy foods not only appeared to have a consistent impact on children's and adolescents' diets, but also negotiating and less permissive food-related parenting practices may improve adolescents' diets.
  558. Author: Caspi CE, Kawachi I, Subramanian SV, Adamkiewicz G, Sorensen G
    Title: The relationship between diet and perceived and objective access to supermarkets among low-income housing residents.
    Journal: Soc Sci Med. 75(7):1254-62
    Date: 2012 Oct
    Abstract: In the U.S., supermarkets serve as an important source of year-round produce (Chung & Myers, 1999), and yet access to supermarkets may be scarce in "food deserts," or poor, urban areas that lack sources of healthy, affordable food (Cummins & Macintyre, 2002). This study examined objective distance to the nearest supermarket and participant-report of supermarket access in relation to fruit and vegetable intake. Street-network distance to the closest supermarket was calculated using GIS mapping. Perceived access was assessed by a survey question asking whether participants had a supermarket within walking distance of home. Cross-sectional survey data were collected from 828 low-income housing residents in three urban areas in greater-Boston. Generalized estimating equations were used to estimate the association between perceived and objective supermarket access and diet. Fruit and vegetable consumption was low (2.63 servings/day). Results suggest that most low-income housing residents in greater-Boston do not live in "food deserts," as the average distance to a supermarket was 0.76 km (range 0.13-1.22 km). Distance to a supermarket was not associated with fruit and vegetable intake (p = 0.22). Perceived supermarket access was strongly associated with increased fruit and vegetable intake (0.5 servings/day) after controlling for socio-demographic covariates (p
  559. Author: Burns JJ, Goff S, Karamian G, Walsh C, Hobby L, Garb J
    Title: The relationship between local food sources and open space to body mass index in urban children.
    Journal: Public Health Rep. 126(6):890-900
    Date: 2011 Nov-Dec
    Abstract:
  560. Author: Maddock J
    Title: The relationship between obesity and the prevalence of fast food restaurants: state-level analysis.
    Journal: Am J Health Promot. 19(2):137-43
    Date: 2004 Nov-Dec
    Abstract: PURPOSE: Obesity accounts for approximately 300,000 deaths a year in the United States, and prevalence rates have been increasing over the past decade. The nutrition environment may be contributing to this epidemic. This study examined the relationship between fast food restaurants and obesity on a state-wide basis. DESIGN: A one-time cross-sectional analysis of secondary data was used for this study. SETTING: The setting for this study was the United States. SUBJECTS: State-level data were used as the unit of analysis. Alaska was excluded as an outlier, and the District of Columbia was added (N = 50). MEASURES: Measures included aggregate state-level means for square miles per fast food restaurant, population per fast food restaurant, population density, ethnicity, age, gender, physical inactivity, fruit and vegetable intake, and obesity rates. Data were obtained from the 2002 Behavioral Risk Factor and Surveillance Survey, the 2000 U.S. Census, and the 2002 U.S. Yellow Pages. RESULTS: Multiple hierarchal regressions revealed that square miles per fast food restaurants and residents per restaurant accounted for 6% of the variance in state obesity rates after controlling for population density, ethnicity, age, gender, physical inactivity, and fruit and vegetable intake. The entire model explained 70% of the total variance in state obesity rates. CONCLUSIONS: These results indicate a correlational relationship between both the number of residents per fast food restaurant and the square miles per fast food restaurants with state-level obesity prevalence. Limitations include the use of correlational aggregate data.
  561. Author: Hang CM, Lin W, Yang HC, Pan WH
    Title: The relationship between snack intake and its availability of 4th-6th graders in Taiwan.
    Journal: Asia Pac J Clin Nutr
    Date: 2007
    Abstract: The purpose of this study was to examine the relationship between the snack intake and snack availability of elementary school children. Data analyzed were from 722 4th to 6th graders' food availability and food intake questionnaires collected in the Nutrition and Health Survey in Taiwan Elementary School Children 2001-2002. The snacks commonly eaten were divided into two groups. Healthy snacks included dairy products, 100% fruit juice and fresh fruits. Unhealthy snacks included high fat/sugar snacks, cookies, candy, carbonated/sugared beverages and fast food. Structural equating modeling was used to test the models that describe the availability and intake of two snack groups. Results indicated that parents' intake and children's preference were major predictors of children intake of both healthy and unhealthy snacks. Other than that, the intake of unhealthy snacks was positively associated with "purchase by children themselves" but not the intake of healthy snacks, which was influenced predominantly by "present in home". The results support the perception that a positive family food environment is important for improving children's diet quality. To build a healthy family food environment, parents have to not only provide healthy snacks but also limit the unhealthy snacks in home. In addition to that, the role modeling of parents as eating healthy snacks instead of unhealthy snacks themselves may help children to develop similar behaviors.
  562. Author: Evans A, Dowda M, Saunders R, Buck J, Hastings L, Kenison K
    Title: The relationship between the food environment and fruit and vegetable intake of adolescents living in Residential Children's Homes.
    Journal: Health Educ Res. 24(3):520-30
    Date: 2009 Jun
    Abstract: The purpose of this study was to examine the relationship between food environments and fruit and vegetable (FV) consumption of adolescents (n=246) living in Residential Children's Homes (RCHs) in North and South Carolina, USA. Administrators of 21 RCHs completed the Physical Activity and Dietary Environmental Assessment (PADEA), an instrument assessing FV-related environmental variables of RCHs: (i) policies, (ii) availability, (iii) social environment, (iv) community collaboration and (v) administrative support. Two different approaches using mixed-effects regression models were used to compare FV consumption of adolescents living in RCHs with more conducive food environments compared with adolescents living in RCHs with less conducive environments. Using one approach, PADEA variables were analyzed as categorical data and in the second approach, PADEA variables were analyzed as continuous data. Results indicated greater FV consumption among adolescents residing in RCHs with more conducive food environments compared with less conducive RCHs. Specifically, adolescents living in RCHs with higher levels of administrative support and more FV policies reported greater FV intake compared with adolescents living in RCHs with less support and fewer policies. Food environments are related to adolescents' dietary behaviors and interventions targeting FV consumption should include strategies to increase administrative support and the development of FV-related policies.
  563. Author: Farley TA, Mason K, Rice J, Habel JD, Scribner R, Cohen DA
    Title: The relationship between the neighbourhood environment and adverse birth outcomes.
    Journal: Paediatr Perinat Epidemiol. 20(3):188-200
    Date: 2006 May
    Abstract: Intrauterine growth retardation and preterm birth are more frequent in African-American women and women of lower socio-economic status, but the reasons for these disparities are not fully understood. The physical and social environments in which these women live may contribute to these disparities. We conducted a multilevel study to explore whether conditions of mothers' neighbourhood of residence contribute to adverse birth outcomes independent of individual-level determinants. We analysed data from 105 111 births in 1015 census tracts in Louisiana during 1997-98, merging it with data from other existing sources on neighbourhood socio-economic status, neighbourhood physical deterioration, and neighbourhood density of retail outlets selling tobacco, alcohol and foods. After controlling for individual-level sociodemographic factors, tract-level median household income was positively associated with both birthweight-for-gestational-age and gestational age at birth. Neighbourhood physical deterioration was associated with these birth outcomes in ecological analyses but only inconsistently associated with them after controlling for individual-level factors. Neither gestational age nor birthweight-for-gestational-age was associated with the neighbourhood density of alcohol outlets, tobacco outlets, fast-food restaurants or grocery supermarkets. We conclude that measures of neighbourhood economic conditions are associated with both fetal growth and the length of gestation independent of individual-level factors, but that readily available measures of neighbourhood retail outlets are not. Additional studies are needed to better understand the nature of environmental influences on birth outcomes.
  564. Author: Alter DA, Eny K
    Title: The relationship between the supply of fast-food chains and cardiovascular outcomes.
    Journal: Can J Public Health. 96(3):173-7
    Date: 2005 May-Jun
    Abstract: OBJECTIVE: To examine the extent to which inter-regional differences in fast-food concentrations account for variations in all-cause mortality and acute coronary syndromes throughout Ontario, Canada. METHODS: Nine distinct fast-food chains were selected based on top sales data in 2001. The per capita rate of fast-food outlets per region was calculated for each of 380 regions throughout Ontario. Outcome measures, obtained using 2001 vital statistics data and hospital discharge abstracts, included regional per capita mortality rates and acute coronary syndrome hospitalization rates; head trauma served as a comparator. All regional outcomes were adjusted for age, gender, and socio-economic status, and were analyzed as continuous and rank-ordered variables as compared with the provincial average. RESULTS: Mortality and admissions for acute coronary syndromes were higher in regions with greater numbers of fast-food services after adjustment for risk. Risk-adjusted outcomes among regions intensive in fast-food services were more likely to be high outliers for both mortality (Adjusted Odds Ratio (OR): 2.52, 95% confidence intervals (CI): 1.54 - 4.13, p
  565. Author: Kratt P, Reynolds K, Shewchuk R
    Title: The role of availability as a moderator of family fruit and vegetable consumption.
    Journal: Health Educ Behav. 27(4):471-82
    Date: 2000 Aug
    Abstract: The public health objective to improve the diet of Americans includes increasing the consumption of fruits and vegetables (F&V). The availability of F&V in the home has been suggested but not confirmed as one environmental factor that influences the types and quantities of F&V eaten by family members. Using a model of parental and child influences on a child's intake of F&V, the authors investigated F&V availability as a moderating variable for the relationships between the model constructs and how the relationships might change with varying levels of F&V availability. Path analysis and multigroup structural equation modeling were the analytic tools. Results indicated that homes with more F&V available had a richer and generally stronger set of motivating factors for parent and child F&V consumption than homes with low F&V availability. Findings have implications for parental involvement in interventions to enhance the diet of fourth-grade children.
  566. Author: Lee H
    Title: The role of local food availability in explaining obesity risk among young school-aged children.
    Journal: Soc Sci Med. 74(8):1193-203
    Date: 2012 Apr
    Abstract: In recent years, research and public policy attention has increasingly focused on understanding whether modifiable aspects of the local food environment - the types and composition of food outlets families have proximate access to - are drivers of and potential solutions to the problem of childhood obesity in the United States. Given that much of the earlier published research has documented greater concentrations of fast-food outlets alongside limited access to large grocery stores in neighborhoods with higher shares of racial/ethnic minority groups and residents living in poverty, differences in retail food contexts may indeed exacerbate notable child obesity disparities along socioeconomic and racial/ethnic lines. This paper examines whether the lack of access to more healthy food retailers and/or the greater availability of "unhealthy" food purveyors in residential neighborhoods explains children's risk of excessive weight gain, and whether differential food availability explains obesity disparities. I do so by analyzing a national survey of U.S. children followed over elementary school (Early Childhood Longitudinal Study - Kindergarten Cohort) who are linked to detailed, longitudinal food availability measures from a comprehensive business establishment database (the National Establishment Time Series). I find that children who live in residentially poor and minority neighborhoods are indeed more likely to have greater access to fast-food outlets and convenience stores. However, these neighborhoods also have greater access to other food establishments that have not been linked to increased obesity risk, including large-scale grocery stores. When examined in a multi-level modeling framework, differential exposure to food outlets does not independently explain weight gain over time in this sample of elementary school-aged children. Variation in residential food outlet availability also does not explain socioeconomic and racial/ethnic differences. It may thus be important to reconsider whether food access is, in all settings, a salient factor in understanding obesity risk among young children.
  567. Author: Baker EA, Schootman M, Barnidge E, Kelly C
    Title: The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines.
    Journal: Prev Chronic Dis. 3(3):A76
    Date: 2006 Jul
    Abstract: INTRODUCTION: The increase in obesity and disparities in obesity and related chronic diseases across racial and ethnic and income groups have led researchers to focus on the social and environmental factors that influence dietary intake. The question guiding the current study was whether all communities have equal access to foods that enable individuals to make healthy dietary choices. METHODS: We conducted audits of community supermarkets and fast food restaurants to assess location and availability of food choices that enable individuals to meet the dietary guidelines established by the U.S. Department of Agriculture (e.g., fruit and vegetable consumption, low-fat options). We used 2000 census data to assess the racial distribution and the percentage of individuals living below the federal poverty level in a defined area of St Louis, Mo. Spatial clustering of supermarkets and fast food restaurants was determined using a spatial scan statistic. RESULTS: The spatial distribution of fast food restaurants and supermarkets that provide options for meeting recommended dietary intake differed according to racial distribution and poverty rates. Mixed-race or white high-poverty areas and all African American areas (regardless of income) were less likely than predominantly white higher-income communities to have access to foods that enable individuals to make healthy choices. CONCLUSION: Without access to healthy food choices, individuals cannot make positive changes to their diets. If certain eating behaviors are required to reduce chronic disease and promote health, then some communities will continue to have disparities in critical health outcomes unless we increase access to healthy food.
  568. Author: Terry-McElrath YM, O'Malley PM, Delva J, Johnston LD
    Title: The school food environment and student body mass index and food consumption: 2004 to 2007 national data.
    Journal: J Adolesc Health. 45(3 Suppl):S45-56
    Date: 2009 Sep
    Abstract: PURPOSE: This study identifies trends in the availability of various food choices in United States' middle and high schools from 2004 to 2007, and examines the potential associations between such food availability and students' self-reported eating habits and body mass index (BMI)-related outcomes. METHODS: Data are based on nationally representative samples of 78,442 students in 684 secondary schools surveyed from 2004 to 2007 as part of the Youth, Education, and Society (YES) study and the Monitoring the Future (MTF) study. In the YES study, school administrators and food service managers completed self-administered questionnaires on their school's food environment. In the MTF study, students in the same schools completed self-administered questionnaires, providing data used to construct BMI and food consumption measures. RESULTS: Overall, there was a decrease in the availability of regular-sugar/fat food items in both middle and high schools, and some indication of an increase in high school availability of reduced-fat food items through school lunch or a la carte. Some minimal evidence was found for relationships between the school food environment and student BMI-related outcomes and food consumption measures. CONCLUSIONS: United States secondary schools are making progress in the types of foods offered to students, with food items of lower nutritional value becoming less prevalent in recent years. Continued monitoring of food environment trends may help clarify whether and how such factors relate to youth health outcomes.
  569. Author: van der Horst K, Timperio A, Crawford D, Roberts R, Brug J, Oenema A
    Title: The school food environment associations with adolescent soft drink and snack consumption.
    Journal: Am J Prev Med. 35(3):217-23
    Date: 2008 Sep
    Abstract: BACKGROUND: Because students may purchase food and drinks in and around their schools, the school food environment may be important for obesity-related eating behaviors such as soft drink and snack consumption. However, research exploring the associations between school environments and specific eating behaviors is sparse. METHODS: Associations of the availability of canteen food and drinks, the presence of food stores around schools, and individual cognitions (attitudes, norms, modeling, perceived behavioral control, and intentions) with soft drink and snack consumption were examined in a cross-sectional study (2005-2006) among 1,293 adolescents aged 12-15 years. Soft drink and snack consumption and related cognitions were assessed with self-administered questionnaires. The presence of food stores and the distance to the nearest food store were calculated within a 500-meter buffer around each school. Data on the availability of soft drinks and snacks in school canteens were gathered by observation. In 2007, multilevel regression models were run to analyze associations and mediation pathways between cognitions, environmental factors, and behaviors. RESULTS: Adolescents' attitudes, subjective norms, parental and peer modeling, and intentions were positively associated with soft drink and snack consumption. There was an inverse association between the distance to the nearest store and the number of small food stores with soft drink consumption. These effects were mediated partly by cognitions. CONCLUSIONS: This study provided little evidence for associations of environmental factors in the school environment with soft drink and snack consumption. Individual cognitions appeared to be stronger correlates of intake than physical school-environmental factors. Longitudinal research is needed to confirm these findings.
  570. Author: Gordon AR, Cohen R, Crepinsek MK, Fox MK, Hall J, Zeidman E
    Title: The third School Nutrition Dietary Assessment Study: background and study design.
    Journal: J Am Diet Assoc. 109(2 Suppl):S20-30
    Date: 2009 Feb
    Abstract: OBJECTIVE: This article describes the background and design of the third School Nutrition Dietary Assessment Study (SNDA-III). DESIGN: SNDA-III is a nationally representative cross-sectional study of the National School Lunch Program and the School Breakfast Program in 2005. The three-stage sample design allowed description of district and school food environments and policies, analysis of foods and nutrients in school lunches and breakfasts, and assessment of the role of school meals and competitive foods in students' diets. Surveys of district and school staff were by telephone or in person; school menu data were collected in a mail survey with telephone assistance; and student and parent interviews were conducted in person and in school, except that parents of secondary-school students were interviewed by telephone. Student interviews included a 24-hour dietary recall, as well as measurement of height and weight. Response rates were 83% for districts, 95% for schools, and 63% for students, whose participation was constrained by consent issues and school schedules. SUBJECTS/SETTING: Data were collected from 130 public school food authorities (districts that offer federally subsidized school meals), 398 schools within those districts, and 2,314 public-school students in grades 1 through 12 in these schools. Of the 2,314 students, a random subset of 666 (29%) completed a second recall to permit estimation of usual nutrient intake distributions. STATISTICAL ANALYSES PERFORMED: Descriptive tabulations were used to summarize the background characteristics of schools and students and most study outcomes. Multivariate regression models and propensity score matching were used to compare the nutrient intakes of school meal participants and nonparticipants. CONCLUSIONS: SNDA-III data provide a rich resource for examining interactions among the school meal programs, the school food environment, students' diets, and child obesity. Subsequent articles in this Supplement present analyses in all these areas.
  571. Author: Chaufan C, Davis M, Constantino S
    Title: The twin epidemics of poverty and diabetes: understanding diabetes disparities in a low-income Latino and immigrant neighborhood.
    Journal: J Community Health. 36(6):1032-43
    Date: 2011 Dec
    Abstract: In the United States, low-income immigrant groups experience greater health disparities and worse health-related outcomes than Whites, including but not limited to higher rates of type 2 diabetes (T2DM). The prevention and adequate management of T2DM are, to a great extent, contingent on access to healthy food environments. This exploratory study examines "upstream" antecedent factors contributing to "downstream" health disparities, with a focus on disparities in the structural sources of T2DM risk, especially food environments. Our target group is Latino immigrants receiving services from a non-profit organization (NGO) in Northern California. Methods are mixed and data include focus groups and surveys of our target group, interviews to NGO staff members, and estimation of the thrifty food market basket in local grocery stores. We find that while participants identify T2DM as the greatest health problem in the community, access to healthy foods is severely restricted, geographically, culturally, and economically, with 100% of participants relying on formal or informal food assistance and local food stores offering limited variety of healthy foods and at unaffordable prices. While this article is empirical, its goal is primarily conceptual--to integrate empirical findings with the growing literature underscoring the sociopolitical context of the social determinants of health in general and of T2DM disparities in particular. We propose that interventions to reduce T2DM and comparable health disparities must incorporate a social justice perspective that guarantees a right to adequate food and other health-relevant environments, and concomitantly, a right to health.
  572. Author: Farley TA, Baker ET, Futrell L, Rice JC
    Title: The ubiquity of energy-dense snack foods: a national multicity study.
    Journal: Am J Public Health. 100(2):306-11
    Date: 2010 Feb
    Abstract: OBJECTIVES: We assessed the availability and accessibility of energy-dense snacks in retail stores whose primary merchandise was not food and whether these varied by store type, region, or socioeconomic factors. METHODS: We conducted systematic observations of 1082 retail stores in 19 US cities and determined the availability and accessibility of 6 categories of energy-dense snack foods. RESULTS: Snack food was available in 41% of the stores; the most common forms were candy (33%), sweetened beverages (20%), and salty snacks (17%). These foods were often within arm's reach of the cash register queue. We observed snack foods in 96% of pharmacies, 94% of gasoline stations, 22% of furniture stores, 16% of apparel stores, and 29% to 65% of other types of stores. Availability varied somewhat by region but not by the racial or socioeconomic characteristics of nearby census tracts. CONCLUSIONS: Energy-dense snack foods and beverages, implicated as contributors to the obesity epidemic, are widely available in retail stores whose primary business is not food. The ubiquity of these products may contribute to excess energy consumption in the United States.
  573. Author: Morland K, Filomena S
    Title: The utilization of local food environments by urban seniors.
    Journal: Prev Med. 47(3):289-93
    Date: 2008 Sep
    Abstract: OBJECTIVE: The objective of this study was to describe food shopping patterns for urban seniors and measure the influence of neighborhood and individual level factors on intake of fresh fruits and vegetables. METHOD: Between September 2005 and August 2006, 314 Black, White and Latino participants from ten Brooklyn Senior Centers were interviewed about types of produce recently purchased, satisfaction with selection, cost and quality of produce, intake of produce, and location of food store used to purchase produce. RESULTS: Individual level factors (race/ethnicity and age) were significantly associated with produce intake. Although environmental and distance factors did not reach statistical significance in multivariate models, living or shopping in a Black or racially mixed neighborhood was positively associated with the reported number of servings per day of fruits and vegetables. Also, a greater proportion of Blacks traveled more than a mile to do primary food shopping and most seniors do not shop within their residential census tract. Blacks and Latinos consumed less produce than Whites. CONCLUSION: This study illuminates a number of important factors about the delivery of foods to urban seniors and how those seniors navigate their local environment to obtain healthy diets, measured here as intake of fruits and vegetables. The albeit small increase in servings per day associated with distance traveled to primary food stores does suggest that fruits and vegetables are not locally available and therefore presents an opportunity for policy makers and city planners to develop areas where healthy food options are convenient for consumers.
  574. Author: Fulkerson JA, Nelson MC, Lytle L, Moe S, Heitzler C, Pasch KE
    Title: The validation of a home food inventory.
    Journal: Int J Behav Nutr Phys Act
    Date: 2008
    Abstract: BACKGROUND: Home food inventories provide an efficient method for assessing home food availability; however, few are validated. The present study's aim was to develop and validate a home food inventory that is easily completed by research participants in their homes and includes a comprehensive range of both healthful and less healthful foods that are associated with obesity. METHODS: A home food inventory (HFI) was developed and tested with two samples. Sample 1 included 51 adult participants and six trained research staff who independently completed the HFI in participants' homes. Sample 2 included 342 families in which parents completed the HFI and the Diet History Questionnaire (DHQ) and students completed three 24-hour dietary recall interviews. HFI items assessed 13 major food categories as well as two categories assessing ready-access to foods in the kitchen and the refrigerator. An obesogenic household food availability score was also created. To assess criterion validity, participants' and research staffs' assessment of home food availability were compared (staff = gold standard). Criterion validity was evaluated with kappa, sensitivity, and specificity. Construct validity was assessed with correlations of five HFI major food category scores with servings of the same foods and associated nutrients from the DHQ and dietary recalls. RESULTS: Kappa statistics for all 13 major food categories and the two ready-access categories ranged from 0.61 to 0.83, indicating substantial agreement. Sensitivity ranged from 0.69 to 0.89, and specificity ranged from 0.86 to 0.95. Spearman correlations between staff and participant major food category scores ranged from 0.71 to 0.97. Correlations between the HFI scores and food group servings and nutrients on the DHQ (parents) were all significant (p
  575. Author: Dunford E, Webster J, Woodward M, Czernichow S, Yuan WL, Jenner K, Ni Mhurchu C, Jacobson M, Campbell N, Neal B
    Title: The variability of reported salt levels in fast foods across six countries: opportunities for salt reduction.
    Journal: CMAJ. 184(9):1023-8
    Date: 2012 Jun 12
    Abstract: BACKGROUND: Several fast food companies have made commitments to reduce the levels of salt in the foods they serve, but technical issues are often cited as a barrier to achieving substantial reductions. Our objective was to examine the reported salt levels for products offered by leading multinational fast food chains. METHODS: Data on salt content for products served by six fast food chains operating in Australia, Canada, France, New Zealand, the United Kingdom and the United States were collected by survey in April 2010. Mean salt contents (and their ranges) were calculated and compared within and between countries and companies. RESULTS: We saw substantial variation in the mean salt content for different categories of products. For example, the salads we included in our survey contained 0.5 g of salt per 100 g, whereas the chicken products we included contained 1.6 g. We also saw variability between countries: chicken products from the UK contained 1.1 g of salt per 100 g, whereas chicken products from the US contained 1.8 g. Furthermore, the mean salt content of food categories varied between companies and between the same products in different countries (e.g., McDonald's Chicken McNuggets contain 0.6 g of salt per 100 g in the UK, but 1.6 g of salt per 100 g in the US). INTERPRETATION: The salt content of fast foods varies substantially, not only by type of food, but by company and country in which the food is produced. Although the reasons for this variation are not clear, the marked differences in salt content of very similar products suggest that technical reasons are not a primary explanation. In the right regulatory environment, it is likely that fast food companies could substantially reduce the salt in their products, translating to large gains for population health.
  576. Author: Davee AM, Blum JE, Devore RL, Beaudoin CM, Kaley LA, Leiter JL, Wigand DA
    Title: The vending and à la carte policy intervention in Maine public high schools.
    Journal: Prev Chronic Dis
    Date: 2005 Nov
    Abstract: BACKGROUND: A healthy school nutrition environment may be important for decreasing childhood overweight. This article describes a project to make healthier snacks and beverages available in vending machines and à la carte programs in Maine public high schools. CONTEXT: Seven public high schools in Maine volunteered to participate in this project. Four schools made changes to the nutrition environment, and three schools that served as controls did not. The nutrition guidelines were to offer only low-fat (not more than 30% of total calories from fat) and low-sugar (not more than 35% by weight of sugar) items in vending machines and à la carte programs. METHODS: Strategies to implement the project included early communications with school officials, monetary stipends for participation, identification of a school liaison, and a committee at each school to promote the healthy changes. Baseline nutrient content and sales of all competitive foods and beverages were assessed to develop the guidelines for changes in the four schools. Student volunteers at all seven schools were measured for height, weight, diet quality, and physical activity level to assess the impact of the change to the nutrition environment. Baseline measures were taken in the spring semester of 2004. Nutrition changes were made to the à la carte programs and vending machines in the four intervention schools at the start of the fall semester of 2004. Follow-up nutrition assessment and student data collection occurred in the spring semester of 2005. CONSEQUENCES: Healthy changes in vending machines were more easily achieved than those made in the à la carte programs. Technical assistance and ongoing support were essential for successful implementation of this intervention. INTERPRETATION: It is possible to improve the nutrition environment of Maine public high schools. Stakeholder support is essential to sustain healthy changes.
  577. Author: Waterlander WE, Scarpa M, Lentz D, Steenhuis IH
    Title: The virtual supermarket: an innovative research tool to study consumer food purchasing behaviour.
    Journal: BMC Public Health
    Date: 2011
    Abstract: BACKGROUND: Economic interventions in the food environment are expected to effectively promote healthier food choices. However, before introducing them on a large scale, it is important to gain insight into the effectiveness of economic interventions and peoples' genuine reactions to price changes. Nonetheless, because of complex implementation issues, studies on price interventions are virtually non-existent. This is especially true for experiments undertaken in a retail setting. We have developed a research tool to study the effects of retail price interventions in a virtual-reality setting: the Virtual Supermarket. This paper aims to inform researchers about the features and utilization of this new software application. RESULTS: The Virtual Supermarket is a Dutch-developed three-dimensional software application in which study participants can shop in a manner comparable to a real supermarket. The tool can be used to study several food pricing and labelling strategies. The application base can be used to build future extensions and could be translated into, for example, an English-language version. The Virtual Supermarket contains a front-end which is seen by the participants, and a back-end that enables researchers to easily manipulate research conditions. The application keeps track of time spent shopping, number of products purchased, shopping budget, total expenditures and answers on configurable questionnaires. All data is digitally stored and automatically sent to a web server. A pilot study among Dutch consumers (n = 66) revealed that the application accurately collected and stored all data. Results from participant feedback revealed that 83% of the respondents considered the Virtual Supermarket easy to understand and 79% found that their virtual grocery purchases resembled their regular groceries. CONCLUSIONS: The Virtual Supermarket is an innovative research tool with a great potential to assist in gaining insight into food purchasing behaviour. The application can be obtained via an URL and is freely available for academic use. The unique features of the tool include the fact that it enables researchers to easily modify research conditions and in this way study different types of interventions in a retail environment without a complex implementation process. Finally, it also maintains researcher independence and avoids conflicts of interest that may arise from industry collaboration.
  578. Author: Dubowitz T, Ghosh-Dastidar M, Eibner C, Slaughter ME, Fernandes M, Whitsel EA, Bird CE, Jewell A, Margolis KL, Li W, Michael YL, Shih RA, Manson JE, Escarce JJ
    Title: The Women's Health Initiative: The food environment, neighborhood socioeconomic status, BMI, and blood pressure.
    Journal: Obesity (Silver Spring). 20(4):862-71
    Date: 2012 Apr
    Abstract: Using data (n = 60,775 women) from the Women's Health Initiative Clinical Trial (WHI CT)-a national study of postmenopausal women aged 50-79 years-we analyzed cross-sectional associations between the availability of different types of food outlets in the 1.5 miles surrounding a woman's residence, census tract neighborhood socioeconomic status (NSES), BMI, and blood pressure (BP). We simultaneously modeled NSES and food outlets using linear and logistic regression models, adjusting for multiple sociodemographic factors, population density and random effects at the tract and metropolitan statistical area (MSA) level. We found significant associations between NSES, availability of food outlets and individual-level measurements of BMI and BP. As grocery store/supermarket availability increased from the 10th to the 90th percentile of its distribution, controlling for confounders, BMI was lower by 0.30 kg/m(2). Conversely, as fast-food outlet availability increased from the 10th to the 90th percentile, BMI was higher by 0.28 kg/m(2). When NSES increased from the 10th to the 90th percentile of its distribution, BMI was lower by 1.26 kg/m(2). As NSES increased from the 10th to the 90th percentile, systolic and diastolic BP were lower by 1.11 mm Hg and 0.40 mm Hg, respectively. As grocery store/supermarket outlet availability increased from the 10th and 90th percentiles, diastolic BP was lower by 0.31 mm Hg. In this national sample of postmenopausal women, we found important independent associations between the food and socioeconomic environments and BMI and BP. These findings suggest that changes in the neighborhood environment may contribute to efforts to control obesity and hypertension.
  579. Author: Samuels SE, Bullock SL, Woodward-Lopez G, Clark SE, Kao J, Craypo L, Barry J, Crawford PB
    Title: To what extent have high schools in California been able to implement state-mandated nutrition standards?
    Journal: J Adolesc Health. 45(3 Suppl):S38-44
    Date: 2009 Sep
    Abstract: PURPOSE: To determine extent and factors associated with implementation of California's school nutrition standards 1 year after standards became active. METHODS: Information on competitive foods and beverages available in schools was collected from a representative sample of 56 public high schools in California. Adherence to nutrition standards was calculated for each item and summarized for each school by venue. The association between schools' sociodemographic characteristics and adherence to standards was determined by multivariate analysis. RESULTS: The majority of schools were adhering to the required beverage standards. None of the schools selling competitive foods were 100% adherent to the food standards. Adherence to both standards tended to be highest in food service venues. In univariate analyses, percent nonwhite enrollment, population density, percent free/reduced-price (FRP) meal eligibility, and school size were significantly correlated with the beverage adherence rate. Percent nonwhite enrollment and population density remained significant in the multivariate regression model. Percent nonwhite enrollment and percent FRP meal eligibility were significantly correlated with the food adherence rate in univariate analysis, but neither remained significant in the multiple regression model. CONCLUSIONS: California high schools are making progress toward implementation of the state nutrition standards. Beverage standards appear easier to achieve than nutrient-based food standards. Additional support is needed to provide schools with resources to implement and monitor these policies. Simpler standards and/or a reduction in the foods and beverages sold could better enable schools to achieve and monitor adherence.
  580. Author: Honeycutt S, Davis E, Clawson M, Glanz K
    Title: Training for and dissemination of the Nutrition Environment Measures Surveys (NEMS).
    Journal: Prev Chronic Dis. 7(6):A126
    Date: 2010 Nov
    Abstract: INTRODUCTION: Researchers believe that nutrition environments contribute to obesity and may explain some health disparities. The Nutrition Environment Measures Surveys (NEMS) are valid and reliable observational measures of the nutrition environment. This article describes the dissemination of the measures, including the development, implementation, and evaluation of training workshops, and a follow-up survey of training participants. METHODS: To disseminate the NEMS measures, we developed a 2-day intensive, participatory workshop. We used an immediate postcourse evaluation and a structured telephone follow-up interview to evaluate the workshops and the dissemination strategy. Topics included use of the NEMS measures, reactions to the workshops, and participants' training others on the measures. RESULTS: During the study period, 173 people participated in 14 workshops. Participants indicated a high level of satisfaction with the training workshops. Almost two-thirds of respondents reported using the measures to train an additional 292 people and to rate more than 3,000 food outlets. The measures have been used in diverse locations across the United States for various purposes. Respondents have reported NEMS results in peer-reviewed journals, master's theses, newspaper articles, and presentations. CONCLUSION: The NEMS measures are the only nutrition environment measures that have been packaged for distribution and widely disseminated. The measures fill a need in the worlds of research and community action, and dissemination was successful in accelerating diffusion and promoting adoption of the measures. The use of an ongoing, continual process to improve workshops and measures contributes to the usefulness of the surveys and accelerates their adoption and continued use.
  581. Author: Guy CM
    Title: Urban and rural contrasts in food prices and availability -- a case study in Wales
    Journal: Journal of rural studies. 7(3):311-25
    Date: 1991
    Abstract: This paper examines variations in the prices and availability of a selection of commonly required food and grocery items, in contrasting rural and urban areas of wales. The data are derived from a survey carried out for the Welsh Consumer Council in September 1988. The analysis reveals that, as in previous such studies, the main source of variation in food prices is the ownership category of the shop concerned: multiple and co-operative stores are generally cheaper than stores affiliated to a wholesale organisation, which in turn cheaper than wholly independent stores. Holding these ownership categories constant there is little if any difference between typical food prices in urban and rural areas. In other words, rural isolation as such does not appear to cause higher prices. Similarly, variations in the availability of food item are shown to be related mainly to store ownership type. It appears that rural dwellers who can gain access to a multiple or cooperative store in a nearby town can buy a good selection of food at prices similar to those found in larger urban areas, but those who rely on small local shops are faced with a more limited choice of goods, at higher prices.
  582. Author: Hearst MO, Pasch KE, Laska MN
    Title: Urban v. suburban perceptions of the neighbourhood food environment as correlates of adolescent food purchasing.
    Journal: Public Health Nutr. 15(2):299-306
    Date: 2012 Feb
    Abstract: OBJECTIVE: To assess the relationship between adolescent perception of time to walk to neighbourhood food retail outlets and purchasing of sugar-sweetened beverages (SSB), fast and convenience food items, and to test for differences by urban v. suburban environment. DESIGN: Cross-sectional observational study. SETTING: Twin Cities Metropolitan Area, Minnesota, USA. SUBJECTS: Adolescents from two studies completed survey-based measures on perceptions of time to walk to food retail outlets from home, purchasing patterns of SSB and fast and convenience store items, perceptions of personal safety and pedestrian infrastructure, and demographic characteristics. Descriptive analysis, Spearman correlations and multivariate linear regression, accounting for clustering, were conducted. RESULTS: There were 634 adolescents, approximately half male, predominantly white, with a middle-class background. Greater perceived time to food outlets was associated with less frequent purchasing of SSB, convenience store foods and fast-food items. Multivariate models showed that a perceived shorter walking time (i.e. 1-5 v. 31+ min) was significantly associated with more SSB purchasing. SSB purchases were also significantly associated with the number of food outlets within a 10 min walk (B = 0·05, P = 0·02). CONCLUSIONS: A reduction in consumption of SSB and other energy-dense snacks is an important obesity prevention approach. An approach offering alternatives or reducing exposure in addition to education to alter purchasing habits may contribute to improving dietary habits and reducing the obesity epidemic.
  583. Author: Zenk SN, Powell LM
    Title: US secondary schools and food outlets.
    Journal: Health Place. 14(2):336-46
    Date: 2008 Jun
    Abstract: We examined the availability of fast food restaurants and convenience stores within walking distance (0.5 miles or 805 m) of US public secondary schools. We found that one-third of schools nationwide have at least one fast food restaurant or convenience store within walking distance. In multivariate analyses, schools in the lowest-income versus the highest-income neighborhoods have more fast food restaurants and convenience stores, while schools in African-American versus White neighborhoods generally have fewer food outlets. Furthermore, urban neighborhoods with a high school versus no secondary school have more food outlets. Curbing the obesity epidemic among adolescents requires addressing the food environment surrounding schools.
  584. Author: Sharkey JR, Dean WR, Johnson CM
    Title: Use of vendedores (mobile food vendors), pulgas (flea markets), and vecinos o amigos (neighbors or friends) as alternative sources of food for purchase among Mexican-origin households in Texas border colonias.
    Journal: J Acad Nutr Diet. 112(5):705-10
    Date: 2012 May
    Abstract: There is a paucity of studies acknowledging the existence of alternative food sources, and factors associated with food purchasing from three common alternative sources: vendedores (mobile food vendors), pulgas (flea markets), and vecinos/amigos (neighbors/friends). This analysis aims to examine the use of alternative food sources by Mexican-origin women from Texas-border colonias and determine factors associated with their use. The design was cross-sectional. Promotora-researchers (promotoras de salud trained in research methods) recruited 610 Mexican-origin women from 44 colonias and conducted in-person surveys. Surveys included participant characteristics and measures of food environment use and household food security. Statistical analyses included separate logistic regressions, modeled for food purchase from mobile food vendors, pulgas, or neighbors/friends. Child food insecurity was associated with purchasing food from mobile food vendors, while household food security was associated with using pulgas or neighbors/friends. School nutrition program participants were more likely to live in households that depend on alternative food sources. Efforts to increase healthful food consumption such as fruits and vegetables should acknowledge all potential food sources (traditional, convenience, nontraditional, and alternative), especially those preferred by colonia residents. Current findings support the conceptual broadening of the retail food environment, and the importance of linking use with spatial access (proximity) to more accurately depict access to food sources.
  585. Author: Patterson RE, Kristal AR, Shannon J, Hunt JR, White E
    Title: Using a brief household food inventory as an environmental indicator of individual dietary practices.
    Journal: Am J Public Health. 87(2):272-5
    Date: 1997 Feb
    Abstract: OBJECTIVES: This study examined whether foods in household pantries are an indicator of house-hold members' diet. METHODS: In a random-digit-dial survey, the presence in the house of 15 high-fat foods was assessed with whoever answered the phone. A randomly selected household member was surveyed about diet-related behaviors (n = 1002). RESULTS: Individuals in the precontemplation stage of dietary change had more high-fat foods in their pantry than those in maintenance (means of 7.4 and 5.8, respectively). Individuals with low-fat pantries had an intake of 32% energy from fat vs 37% for those with high-fat pantries. CONCLUSIONS: Household food inventories are a practical and valid approach to monitoring dietary behaviors in community-based studies.
  586. Author: Abarca J, Ramachandran S
    Title: Using community indicators to assess nutrition in Arizona-Mexico border communities.
    Journal: Prev Chronic Dis. 2(1):A06
    Date: 2005 Jan
    Abstract: INTRODUCTION: Community indicators are used to measure and monitor factors that affect the well-being of a community or region. Community indicators can be used to assess nutrition. Evaluating nutrition in communities along the Arizona-Mexico border is important because nutrition is related to an individual's risk of overweight or obesity; obesity is a risk factor for developing type 2 diabetes. METHODS: Local grocery store purchases were selected as a community indicator for nutrition. A structured 26-question interview was developed and administered to grocery store managers in communities along the Arizona-Mexico border that were targeted by the Border Health Strategic Initiative, a program implemented by community groups and the University of Arizona. In addition, data from milk distributors serving the border communities were collected. RESULTS: Residents of these communities favor food items with a higher fat and higher caloric content. This trend held across several food categories. Major barriers to customer acceptance of healthier food items include lack of knowledge concerning healthy foods and their prices. CONCLUSION: The demand for healthy food items is relatively low along the Arizona-Mexico border. Interventions should continue to target this population with the aim of changing dietary patterns as one method of improving the health of the community and preventing and controlling diabetes.
  587. Author: Sharkey JR, Dean WR, St John JA, Huber JC Jr
    Title: Using direct observations on multiple occasions to measure household food availability among low-income Mexicano residents in Texas colonias.
    Journal: BMC Public Health
    Date: 2010
    Abstract: BACKGROUND: It has been recognized that the availability of foods in the home are important to nutritional health, and may influence the dietary behavior of children, adolescents, and adults. It is therefore important to understand food choices in the context of the household setting. Considering their importance, the measurement of household food resources becomes critical.Because most studies use a single point of data collection to determine the types of foods that are present in the home, which can miss the change in availability within a month and when resources are not available, the primary objective of this pilot study was to examine the feasibility and value of conducting weekly in-home assessments of household food resources over the course of one month among low-income Mexicano families in Texas colonias. METHODS: We conducted five in-home household food inventories over a thirty-day period in a small convenience sample; determined the frequency that food items were present in the participating households; and compared a one-time measurement with multiple measurements.After the development and pre-testing of the 252-item culturally and linguistically- appropriate household food inventory instrument that used direct observation to determine the presence and amount of food and beverage items in the home (refrigerator, freezer, pantry, elsewhere), two trained promotoras recruited a convenience sample of 6 households; administered a baseline questionnaire (personal info, shopping habits, and food security); conducted 5 in-home assessments (7-day interval) over a 30-day period; and documented grocery shopping and other food-related activities within the previous week of each in-home assessment. All data were collected in Spanish. Descriptive statistics were calculated for mean and frequency of sample characteristics, food-related activities, food security, and the presence of individual food items. Due to the small sample size of the pilot data, the Friedman Test and Kendall's W were used to assess the consistency of household food supplies across multiple observations. RESULTS: Complete data were collected from all 6 Mexicano women (33.2y +/- 3.3; 6.5 +/- 1.5 adults/children in household (HH); 5 HH received weekly income; and all were food insecure. All households purchased groceries within a week of at least four of the five assessments. The weekly presence and amounts of fresh and processed fruits and vegetables, dairy, meats, breads, cereals, beverages, and oils and fats varied. Further, the results revealed the inadequacy of a one-time measurement of household food resources, compared with multiple measures. The first household food inventory as a one-time measure would have mistakenly identified at least one-half of the participant households without fresh fruit, canned vegetables, dairy, protein foods, grains, chips, and sugar-sweetened beverages. CONCLUSIONS: This study highlights the value of documenting weekly household food supplies, especially in households where income resources may be more volatile. Clearly, the data show that a single HFI may miss the changes in availability--presence and amount--that occur among low-income Mexicano households who face challenges that require frequent purchase of foods and beverages. Use of multiple household food inventories can inform the development and implementation of nutrition-related policies and culturally sensitive nutrition education programs.
  588. Author: Kestens Y, Lebel A, Daniel M, Thériault M, Pampalon R
    Title: Using experienced activity spaces to measure foodscape exposure.
    Journal: Health Place. 16(6):1094-103
    Date: 2010 Nov
    Abstract: Researchers are increasingly interested in understanding how food environments influence eating behavior and weight-related health outcomes. Little is known about the dose-response relationship between foodscapes and behavior or weight, with measures of food exposure having mainly focused on fixed anchor points including residential neighborhoods, schools, or workplaces. Recent calls have been made to extend the consideration of environmental influences beyond local neighborhoods and also to shift away from place-based, to people-based, measures of exposure. This report presents analyses of novel activity-space measures of exposure to foodscapes, combining travel survey data with food store locations in Montreal and Quebec City, Canada. The resulting individual activity-space experienced foodscape exposure measures differ from traditional residential-based measures, and show variations by age and income levels. Furthermore, these activity-space exposure measures once modeled, can be used as predictors of health outcomes. Hence, travel surveys can be used to estimate environmental exposure for health survey participants.
  589. Author: Ghirardelli A, Quinn V, Foerster SB
    Title: Using geographic information systems and local food store data in California's low-income neighborhoods to inform community initiatives and resources.
    Journal: Am J Public Health. 100(11):2156-62
    Date: 2010 Nov
    Abstract: OBJECTIVES: We examined conditions in California low-income neighborhoods that affect obesity to inform program planning, nutrition education, community participation, investment of resources, and involvement of stakeholders. METHODS: Staff members in 18 local health departments were trained to use an online geographic information system (GIS) and conduct field surveys. GIS data were aggregated from 68 low-income neighborhoods of 1 or more census tracts. Data were collected in 2007 to 2009 from 473 grocery stores in 62 neighborhoods. RESULTS: Thirty-one percent of neighborhoods mapped had no supermarket within any of their census tract boundaries, but health department staff members estimated that 74.2% of residents had access to a large grocery store within 1 mile. Eighty-one percent of small markets sold produce, and 67.6% offered 4 or more types of fresh vegetables. CONCLUSIONS: Small markets and corner stores in California's low-income neighborhoods often have fresh produce available for sale. Stores providing healthy options in typically underserved areas can be part of community efforts to promote healthy eating behaviors.
  590. Author: Clarke P, Ailshire J, Melendez R, Bader M, Morenoff J
    Title: Using Google Earth to conduct a neighborhood audit: reliability of a virtual audit instrument.
    Journal: Health Place. 16(6):1224-9
    Date: 2010 Nov
    Abstract: Over the last two decades, the impact of community characteristics on the physical and mental health of residents has emerged as an important frontier of research in population health and health disparities. However, the development and evaluation of measures to capture community characteristics is still at a relatively early stage. The purpose of this work was to assess the reliability of a neighborhood audit instrument administered in the city of Chicago using Google Street View by comparing these "virtual" data to those obtained from an identical instrument administered "in-person". We find that a virtual audit instrument can provide reliable indicators of recreational facilities, the local food environment, and general land use. However, caution should be exercised when trying to gather more finely detailed observations. Using the internet to conduct a neighborhood audit has the potential to significantly reduce the costs of collecting data objectively and unobtrusively.
  591. Author: Tester JM, Yen IH, Laraia B
    Title: Using mobile fruit vendors to increase access to fresh fruit and vegetables for schoolchildren.
    Journal: Prev Chronic Dis
    Date: 2012
    Abstract: This study explored the extent to which schoolchildren purchased precut and bagged fruits and vegetables from a mobile fruit vendor (frutero). During 14 days in fall 2008, a frutero sold fruits and vegetables at the entrance of an elementary school; 59% of the frutero's 233 consumers of 248 items were elementary-school students. With each successive day, an average of 1 additional bag of fruits and vegetables was sold by the frutero and 1.5 fewer nonnutritious foods by a competing vendor. Policies encouraging the sale of nutritious foods from mobile food vendors may increase access for schoolchildren.
  592. Author: Sisk C, Sharkey JR, McIntosh WA, Anding J
    Title: Using multiple household food inventories to measure food availability in the home over 30 days: a pilot study.
    Journal: Nutr J
    Date: 2010
    Abstract: BACKGROUND: The consumption of foods, especially by children, may be determined by the types of foods that are available in the home. Because most studies use a single point of data collection to determine the types of foods in the home, which can miss the change in availability when resources are not available, the primary objective of this study was to determine the extent to which the weekly availability of household food items changed over one month by 1) developing the methodology for the direct observation of the presence and amount of food items in the home; 2) conducting five in-home household food inventories over a thir