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Yankey O, Lee J, Gardenhire R, Borawski E. Neighborhood Racial Segregation Predict the Spatial Distribution of Supermarkets and Grocery Stores Better than Socioeconomic Factors in Cleveland, Ohio: a Bayesian Spatial Approach. J Racial Ethn Health Disparities 2024; 11:2009-2021. [PMID: 37368191 PMCID: PMC11236921 DOI: 10.1007/s40615-023-01669-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION The food environment influences the availability and affordability of food options for consumers in a given neighborhood. However, disparities in access to healthy food options exist, affecting Black and low-income communities disproportionately. This study investigated whether racial segregation predicted the spatial distribution of supermarkets and grocery stores better than socioeconomic factors or vice versa in Cleveland, Ohio. METHOD The outcome measure was the count of supermarket and grocery stores in each census tract in Cleveland. They were combined with US census bureau data as covariates. We fitted four Bayesian spatial models. The first model was a baseline model with no covariates. The second model accounted for racial segregation alone. The third model looked at only socioeconomic factors, and the final model combined both racial and socioeconomic factors. RESULTS Overall model performance was better in the model that considered only racial segregation as a predictor of supermarkets and grocery stores (DIC = 476.29). There was 13% decrease in the number of stores for a census tract with a higher majority of Black people compared to areas with a lower number of Black people. Model 3 that considered only socioeconomic factors was less predictive of the retail outlets (DIC = 484.80). CONCLUSIONS These findings lead to the conclusion that structural racism evidenced in policies like residential segregation has a significant influence on the spatial distribution of food retail in the city of Cleveland.
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Affiliation(s)
- Ortis Yankey
- WorldPop Research Group, School of Geography and Environmental Science, University Road, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Jay Lee
- Department of Geography, Kent State University, 413 McGilvrey Hall, 325 S. Lincoln Street, Kent, OH, 44240, USA
| | - Rachel Gardenhire
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 11000 Cedar Ave, Cleveland, OH, 44106, USA
| | - Elaine Borawski
- Department of Population & Quantitative Health Sciences and Nutrition, Case Western Reserve University, 2103 Cornell Road, Cleveland, OH, 44106, USA
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2
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Testa A, Mungia R, van den Berg A, C Hernandez D. Food deserts and dental care utilization in the United States. J Public Health Dent 2023; 83:389-396. [PMID: 38073040 DOI: 10.1111/jphd.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/15/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES Although food deserts are known to impact health and healthcare utilization, no research has investigated the relationship between food deserts and dental care utilization. This study aimed to fill this gap by assessing the relationship between living in a food desert and self-reported dental care utilization in the past year. METHODS Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 10,495). The association between food deserts and dental care utilization was assessed using covariate-adjusted multiple logistic regression. RESULTS Living in a food desert was associated with higher odds of not utilizing dental care in the past year. This association was concentrated among high-poverty areas (≥20% poverty rate). CONCLUSIONS The current study is the first to assess the relationship between living in a food desert and dental care utilization. The findings demonstrate that individuals living in low-income urban food deserts may be at increased risk for not utilizing dental care.
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Affiliation(s)
- Alexander Testa
- School of Public Health, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rahma Mungia
- School of Dentistry, Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alexandra van den Berg
- School of Public Health, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Daphne C Hernandez
- Cizik School of Nursing, Department of Research, University of Texas Health Science Center at Houston, Houston, Texas, USA
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3
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Chaves CDS, Camargo JT, Zandonadi RP, Nakano EY, Ginani VC. Nutrition Literacy Level in Bank Employees: The Case of a Large Brazilian Company. Nutrients 2023; 15:nu15102360. [PMID: 37242243 DOI: 10.3390/nu15102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Nutrition Literacy (NL) positively impacts diet quality and has the potential to promote health and prevent nutrition-related chronic diseases. Brazil is one of the countries with the highest rates of nutrition-related chronic diseases. Nevertheless, in Brazil, few studies have explored the NL levels of its population. To provide remote access to the Nutrition Literacy Assessment Instrument for Brazilians (NLit-Br) and assess Brazilian bank employees, we conducted a study to estimate the validity of the NLit-Br online and to investigate whether bank employees have an adequate NL level. In the first step, we randomly assigned 21 employees from three financial institution branches to two groups to complete NLit-Br paper and online versions. After an interval period, both groups completed the NLit-Br with an opposite delivery method (paper vs. online). We compared the validity of the digital and paper versions of the NLit-Br by the Intraclass Correlation Coefficient (ICC), and the reliability by Kuder-Richardson formula 20. Second, we evaluated 1174 bank employees using the NLit-Br online version. We found an excellent absolute agreement (ICC ≥ 0.75) between the paper and online versions. The questionnaire had good internal consistency (KR-20 = 0.64). The sample was characterized as mostly male (61.0%), married/cohabitant (73.8%), and white (69.8%), with high household income (85.2%), and graduated or postgraduate (97.4%). The mean age of the population was 42.1 (SD = 7.6) years. Subjects predominantly had possibly inadequate NL (62.3%). The online NLit-Br total score was significantly associated with gender, age, and household income (p < 0.05). Women and individuals with higher incomes had a higher degree of NL. Subjects over 50 years old had a lower degree of NL. There was no significant association between the NLit-Br score and the participants' education. The NLit-Br online is a valid instrument to assess NL remotely. The population studied showed a high prevalence of inadequacy of the NL. Therefore, there is a need for targeted actions to improve the NL of bank employees.
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Affiliation(s)
| | - Juliana Teruel Camargo
- National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr/MSC 1825, Bethesda, MD 20892, USA
- School of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas, KS 66160, USA
| | - Renata Puppin Zandonadi
- University of Brasília, Faculty of Health Sciences, Department of Nutrition, Campus Universitario Darcy Ribeiro, Brasilia 70910-900, Brazil
| | | | - Verônica Cortez Ginani
- University of Brasília, Faculty of Health Sciences, Department of Nutrition, Campus Universitario Darcy Ribeiro, Brasilia 70910-900, Brazil
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"I Always Buy the Purple Ones … If I See Them": Socioecological Factors Influencing Anthocyanin-Rich Food Consumption for Cognitive Health in Older Adults. Nutrients 2023; 15:nu15051194. [PMID: 36904196 PMCID: PMC10005612 DOI: 10.3390/nu15051194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Despite the positive relationship between anthocyanin-rich foods and cognitive health, a dietary deficit exists in older adults. Effective interventions require an understanding of people's dietary behaviors situated in social and cultural contexts. Therefore, the aim of this study was to explore older adults' perceptions about increasing their consumption of anthocyanin-rich foods for cognitive health. Following an educational session and the provision of a recipe and information book, an online survey and focus groups with Australian adults aged 65 years or older (n = 20) explored the barriers and enablers towards eating more anthocyanin-rich foods and potential strategies to achieve dietary change. An iterative, qualitative analysis identified the themes and classified the barriers, enablers and strategies onto the Social-Ecological model levels of influence (individual, interpersonal, community, society). Enabling factors included a desire to eat healthily, taste preference and familiarity of anthocyanin-rich foods (individual), social support (community), and the availability of some anthocyanin-rich foods (society). The barriers included budget, dietary preferences and motivation (individual), household influences (interpersonal), limited availability and access to some anthocyanin-rich foods (community) and the cost and the seasonal variability (society). The strategies included increasing individual-level knowledge, skills, and confidence in utilizing anthocyanin-rich foods, educational initiatives about the potential cognitive benefits, and advocating to increase access to anthocyanin-rich foods in the food supply. This study provides for the first time, insight into the various levels of influence impacting older adults' ability to consume an anthocyanin-rich diet for cognitive health. Future interventions should be tailored to reflect the barriers and enablers and to provide targeted education about anthocyanin-rich foods.
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5
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Harris JE, Gleason PM. Application of Path Analysis and Structural Equation Modeling in Nutrition and Dietetics. J Acad Nutr Diet 2022; 122:2023-2035. [PMID: 35863617 DOI: 10.1016/j.jand.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Jeffrey E Harris
- Department of Nutrition, West Chester University, West Chester, PA
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6
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Yamaguchi M, Praditsorn P, Purnamasari SD, Sranacharoenpong K, Arai Y, Sundermeir SM, Gittelsohn J, Hadi H, Nishi N. Measures of Perceived Neighborhood Food Environments and Dietary Habits: A Systematic Review of Methods and Associations. Nutrients 2022; 14:1788. [PMID: 35565756 PMCID: PMC9099956 DOI: 10.3390/nu14091788] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 02/05/2023] Open
Abstract
Access to healthy food is a necessity for all people. However, there is still a lack of reviews on the assessment of respondent-based measures of neighborhood food environments (perceived food environments). The aim of this systematic review was to evaluate the measurement tools for perceived food environments by five dimensions of food access and to obtain the overview of their associations with dietary habits among people aged 18 years and older in middle- and high-income countries. Observational studies using perceived food environment measures were identified through a systematic review based on two databases for original studies published from 2010 to 2020. A total of 19 final studies were extracted from totally 2926 studies. Pertaining to the five dimensions of food access, 12 studies dealt with accessibility, 13 with availability, 6 with affordability, 10 with acceptability, 2 with accommodation, and 8 with a combination of two or more dimensions. Perceived healthy food environments were positively associated with healthy dietary habits in 17 studies, but 8 of them indicated statistically insignificant associations. In conclusion, this review found accessibility and availability to be major dimensions of perceived food environments. The relationship between healthy food environments and healthy diets is presumably positive and weak.
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Affiliation(s)
- Miwa Yamaguchi
- International Center for Nutrition and Information, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan;
| | - Panrawee Praditsorn
- Institute of Nutrition, Mahidol University, 999 Phuttamonthon 4, Salaya, Phuttamonthon, Nakhon Pathom 73170, Thailand; (P.P.); (K.S.)
| | - Sintha Dewi Purnamasari
- Alma Ata Graduate School of Public Health, University of Alma Ata, Jl. Brawijaya 99, Tamantirto, Yogyakarta 55183, Indonesia; (S.D.P.); (H.H.)
| | - Kitti Sranacharoenpong
- Institute of Nutrition, Mahidol University, 999 Phuttamonthon 4, Salaya, Phuttamonthon, Nakhon Pathom 73170, Thailand; (P.P.); (K.S.)
| | - Yusuke Arai
- Department of Nutrition, Chiba Prefectural University of Health Sciences, 2-10-1 Wakaba, Mihama-ku, Chiba-shi 261-0014, Japan;
| | - Samantha M. Sundermeir
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, 615 North Wolfe St, Baltimore, MD 21205, USA; (S.M.S.); (J.G.)
| | - Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, 615 North Wolfe St, Baltimore, MD 21205, USA; (S.M.S.); (J.G.)
| | - Hamam Hadi
- Alma Ata Graduate School of Public Health, University of Alma Ata, Jl. Brawijaya 99, Tamantirto, Yogyakarta 55183, Indonesia; (S.D.P.); (H.H.)
| | - Nobuo Nishi
- International Center for Nutrition and Information, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan;
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Khan MAF, Sohaib M, Iqbal S, Haider MS, Chaudhry M. Nutritional assessment of servicemen in relation to area of duty and feeding habits: a Pakistani prospective. BRAZ J BIOL 2021; 83:e250789. [PMID: 34468536 DOI: 10.1590/1519-6984.250789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/24/2021] [Indexed: 11/22/2022] Open
Abstract
The present study was carried out to determine incidence of overweight and obesity in Pakistani servicemen with reference to their area of duty, feeding habits and also to identify risk factors. Accordingly, 2,501 servicemen selected from all over Pakistan using multiple stage stratified sampling protocol. Nutrition assessment performed using body mass index (BMI), waist to hip ratio (WHR) and dietary assessment using food frequency questionnaire. Collected data was analyzed using the SPSS version 25. Regression was used to find risk factors of obesity and WHR. Results indicated that about 1/4th of servicemen were smokers. Approximately, 1/5th of them were overweight and about one quarter were eating fruits and vegetables for <3 days/ week and <4 days/week, respectively. Only 1/3rd of them were physically active for at least <40 minutes per day. Age and fruits intake were significantly predicting BMI with a direct relation and vegetable intake was negatively correlated to BMI of the servicemen. Age and rank were significant predictors of WHR while, physical activity was negatively correlated to WHR. It is concluded and suggested from our study that there is a need to modify eating patterns and habits as well as improving physical activity on daily basis for healthy and long life of the servicemen.
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Affiliation(s)
- M A F Khan
- University of Veterinary and Animal Sciences, Faculty of Bio-Sciences, Department of Food Science and Human Nutrition, Lahore, Pakistan.,Armed Forces Institute of Nutrition, R.A Bazar Lahore Cantonment, Lahore Punjab, Pakistan
| | - M Sohaib
- University of Veterinary and Animal Sciences, Faculty of Bio-Sciences, Department of Food Science and Human Nutrition, Lahore, Pakistan
| | - S Iqbal
- University of Veterinary and Animal Sciences, Faculty of Bio-Sciences, Department of Food Science and Human Nutrition, Lahore, Pakistan
| | - M S Haider
- University of the Punjab, Faculty of Agriculture, Lahore, Pakistan
| | - M Chaudhry
- University of Veterinary and Animal Sciences, Department of Epidemiology and Public Health, Lahore, Pakistan
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8
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Dhakal CK, Khadka S. Heterogeneities in Consumer Diet Quality and Health Outcomes of Consumers by Store Choice and Income. Nutrients 2021; 13:1046. [PMID: 33804858 PMCID: PMC8063805 DOI: 10.3390/nu13041046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
Obesity and other diet-related health conditions have received much attention in the public health literature over the past two decades. This study investigates the relationship between household food budget shares at different food outlets with diet quality and weight-related health outcomes in the United States. Our analysis used event-level food purchase data from the national household food acquisition and purchases survey (FoodAPS). We find that, after controlling for observables, food purchase location is significantly associated with diet quality and body mass index (BMI). Our findings indicate that larger food budget shares at convenience stores and restaurants are linked with poor diet quality based on the healthy eating index-2015 (HEI-2015) scores and higher BMI. We further explored potential heterogeneity on outcomes of interest across income groups. Results suggest heterogeneous effects may exist across income groups: low-income households, who spent a larger share of their food budget at convenience stores and fast-food restaurants are related to poor diet quality and more likely to be obese. Our findings will help improve understanding of the causes of diet-related health problems and may illuminate potential avenues of intervention to address obesity.
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Affiliation(s)
- Chandra K. Dhakal
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA 30602, USA;
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9
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Contributions of Food Environments to Dietary Quality and Cardiovascular Disease Risk. Curr Atheroscler Rep 2021; 23:14. [PMID: 33594516 DOI: 10.1007/s11883-021-00912-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW To evaluate the multidimensional influence of food environments on food choice, dietary quality, and diet-related health and identify critical gaps necessary to develop effective population interventions that influence food choice. RECENT FINDINGS Multicomponent interventions that interact with multiple layers of the food environment show limited but consistent effects on dietary behaviors and may have wider and substantive population-level reach with greater incorporation of validated, holistic measurement tools. Opportunities to use smartphone technology to measure multiple components of the food environment will facilitate future interventions, particularly as food environments expand into online settings and interact with consumers in novel ways to shape food choice. While studies suggest that all dimensions of the food environment influence diet and health outcomes, robust and consistent measurements of food environments that integrate objective and subjective components are essential for developing stronger evidence needed to shift public policies.
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10
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Banks J, Fitzgibbon ML, Schiffer LA, Campbell RT, Antonic MA, Braunschweig CL, Odoms-Young AM, Kong A. Relationship Between Grocery Shopping Frequency and Home- and Individual-Level Diet Quality Among Low-Income Racial or Ethnic Minority Households With Preschool-Aged Children. J Acad Nutr Diet 2020; 120:1706-1714.e1. [PMID: 32828736 DOI: 10.1016/j.jand.2020.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The home food environment can shape the diets of young children. However, little is known about modifiable factors that influence home food availability and dietary intake. OBJECTIVE The purpose of this study was to examine the relationship between grocery shopping frequency with home- and individual-level diet quality. DESIGN This was a secondary, cross-sectional analyses of data from the Study on Children's Home Food Availability Using TechNology. Data were collected in the homes of participants from November 2014 through March 2016. PARTICIPANTS/SETTINGS A purposive sample of 97 low-income African American and Hispanic or Latinx parent-child dyads residing in Chicago, IL, enrolled in the study. MAIN OUTCOME MEASURES The main outcomes were home- and individual-level diet quality. Healthy Eating Index-2010 (HEI-2010) scores were calculated from home food inventory data collected in participants' homes to assess home-level diet quality. To assess individual-level diet quality, HEI-2010 scores were based on multiple 24-hour diet recalls from parent-child dyads. STATISTICAL ANALYSES Grocery shopping frequency was examined in relation to diet quality at the home and individual levels. Grocery shopping frequency was defined as the number of times households shopped on a monthly basis (ie, once a month, twice a month, 3 times a month, or 4 times or more a month). Multivariable linear regression analysis, controlling for covariates, tested the relationships between grocery shopping frequency and HEI-2010 total and component scores at the home and individual levels. RESULTS Grocery shopping frequency was positively associated with home-level HEI-2010 scores for total diet, whole grains, and empty calories (higher scores reflect better diet quality) and with individual-level HEI-2010 scores for total and whole fruit (parents only), vegetables (children only), and sodium (children only). CONCLUSIONS Grocery shopping frequency was associated with multiple dimensions of diet quality at the home and individual levels. These results offer a potential strategy to intervene on home food availability and individual dietary intake.
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Food security moderates relationship between perceived food environment and diet quality among adults in communities with low access to healthy food retail. Public Health Nutr 2020; 24:2975-2986. [PMID: 32611453 DOI: 10.1017/s1368980020001317] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the relationship between food security status, diet quality measured using Healthy Eating Index-2010 (HEI-2010) scores, demographics and the following factors: perceptions of healthy food availability, healthy eating identity and perceived control of healthy eating. DESIGN A cross-sectional study in 2016-2017 using three 24-h dietary recalls and one psychosocial survey. SETTING Two urban communities in Cleveland and Columbus, Ohio, USA, with low access to healthy food retailers. PARTICIPANTS Primary food shoppers living in the targeted geographic areas (N 450). RESULTS Our results indicated that high school graduates had lower HEI-2010 scores compared with participants who had some college education or more (β = -2·77, P = 0·02). Participants receiving Supplemental Nutrition Assistance Program (SNAP) benefits had lower HEI-2010 scores (β = -2·69, P = 0·03). Healthy eating identity was associated with higher HEI-2010 scores (β = 1·85, P = 0·004). Food security status moderated the relationship between perception of healthy food availability and HEI-2010 scores. Among participants with very low food security (VLFS), greater perceptions of healthy food availability were associated with higher HEI-2010 scores (β = 3·25, P = 0·03), compared with food secure participants. Only 14 % of VLFS participants used a personal vehicle as transportation to their primary food shopping store. CONCLUSIONS Findings offer targets for future intervention development and evaluation to promote community nutrition. These targets include strategies to improve the value of SNAP benefits, promote access to quality education, increase transportation options to healthy food retailers and develop nutrition programming to promote healthy eating identity.
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12
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Kaczynski AT, Eberth JM, Stowe EW, Wende ME, Liese AD, McLain AC, Breneman CB, Josey MJ. Development of a national childhood obesogenic environment index in the United States: differences by region and rurality. Int J Behav Nutr Phys Act 2020; 17:83. [PMID: 32615998 PMCID: PMC7330993 DOI: 10.1186/s12966-020-00984-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background Diverse environmental factors are associated with physical activity (PA) and healthy eating (HE) among youth. However, no study has created a comprehensive obesogenic environment index for children that can be applied at a large geographic scale. The purpose of this study was to describe the development of a childhood obesogenic environment index (COEI) at the county level across the United States. Methods A comprehensive search of review articles (n = 20) and input from experts (n = 12) were used to identify community-level variables associated with youth PA, HE, or overweight/obesity for potential inclusion in the index. Based on strength of associations in the literature, expert ratings, expertise of team members, and data source availability, 10 key variables were identified – six related to HE (# per 1000 residents for grocery/superstores, farmers markets, fast food restaurants, full-service restaurants, and convenience stores; as well as percentage of births at baby (breastfeeding)-friendly facilities) and four related to PA (percentage of population living close to exercise opportunities, percentage of population < 1 mile from a school, a composite walkability index, and number of violent crimes per 1000 residents). Data for each variable for all counties in the U.S. (n = 3142) were collected from publicly available sources. For each variable, all counties were ranked and assigned percentiles ranging from 0 to 100. Positive environmental variables (e.g., grocery stores, exercise opportunities) were reverse scored such that higher values for all variables indicated a more obesogenic environment. Finally, for each county, a total obesogenic environment index score was generated by calculating the average percentile for all 10 variables. Results The average COEI percentile ranged from 24.5–81.0 (M = 50.02,s.d. = 9.01) across US counties and was depicted spatially on a choropleth map. Obesogenic counties were more prevalent (F = 130.43,p < .0001) in the South region of the U.S. (M = 53.0,s.d. = 8.3) compared to the Northeast (M = 43.2,s.d. = 6.9), Midwest (M = 48.1,s.d. = 8.5), and West (M = 48.4,s.d. = 9.8). When examined by rurality, there were also significant differences (F = 175.86,p < .0001) between metropolitan (M = 46.5,s.d. = 8.4), micropolitan (M = 50.3,s.d. = 8.1), and rural counties (M = 52.9,s.d. = 8.8) across the U.S. Conclusion The COEI can be applied to benchmark obesogenic environments and identify geographic disparities and intervention targets. Future research can examine associations with obesity and other health outcomes.
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Affiliation(s)
- Andrew T Kaczynski
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA. .,Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Ellen W Stowe
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Marilyn E Wende
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Charity B Breneman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Michele J Josey
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
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