Food Outlet Density, Distance, and Food Quality Offered to Preschool-Aged Children at Family Child Care Homes

OBJECTIVE

To examine how food environments around family child care homes (FCCHs) are associated with the healthfulness of foods served to children.

DESIGN

Cross-sectional data from a mail survey of FCCH providers, InfoUSA.

PARTICIPANTS

The study included 132 Mississippi FCCHs (26% response).

MAIN OUTCOME MEASURES

Dependent: compliance with nutrition best practices for 9 food categories; composite healthfulness score. Independent: counts of supermarkets, small-medium grocery stores, produce stores, convenience stores within 5 miles; distance to supermarket.

ANALYSIS

Logistic regression estimated associations between best-practice compliance and food environment. Linear regression estimated associations between composite food healthfulness and food environment. Models stratified by rural/urban location.

RESULTS

Rural FCCHs with higher counts of supermarkets, convenience stores, and produce stores had lower compliance with selected best practices (fried/prefried potatoes, high-sugar/high-fat foods). Urban FCCHs with more supermarkets had higher compliance with fruit not canned in syrup; those with more small-medium grocery stores and convenience stores had lower compliance with selected best practices (fried/prefried potatoes, vegetables, low-fat meats).

CONCLUSIONS AND IMPLICATIONS

Food environment measures were associated with some nutrition best practices, though not consistently in the expected direction. Future research could examine food quality at stores near rural FCCHs. Programs that improve local food environments may improve foods served at FCCHs.

GIS-Based Home Neighborhood Food Outlet Counts, Street Connectivity, and Frequency of Use of Neighborhood Restaurants and Food Stores

Researchers have linked neighborhood food availability to the overall frequency of using food outlets without noting if those outlets were within or outside of participants' neighborhoods. We aimed to examine the association of neighborhood restaurant and food store availability with frequency of use of neighborhood food outlets, and whether such an association was modified by neighborhood street connectivity using a large and diverse population-based cohort of middle-aged U.S. adults. We used self-reported frequency of use of fast food restaurants, sit-down restaurants, and grocery stores in respondents' home neighborhoods using data from the Coronary Artery Risk Development in Young Adults study Year 20 exam in 2005-2006 (n = 2860; Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA) and geographically matched GIS-measured neighborhood-level food resource, street, and U.S. Census data. We used mixed-effects logistic regression to examine the associations of the GIS-measured count of neighborhood fast food restaurants, sit-down restaurants, and grocery stores with self-reported frequency of using neighborhood restaurants and food stores and whether such associations differed by GIS-measured neighborhood street connectivity among those who perceived at least one such food outlet. In multivariate analyses, we observed a positive association between the GIS-measured count of neighborhood sit-down restaurants (OR = 1.02, 95% CI 1.00-1.04) and the self-reported frequency of using neighborhood sit-down restaurants. We observed no statistically significant association between GIS-measured count of neighborhood fast food restaurants and self-reported frequency of using neighborhood fast food restaurants, nor did we observe a statistically significant association between GIS-measured count of neighborhood grocery stores and self-reported frequency of using neighborhood grocery stores. We observed inverse associations between GIS-measured neighborhood street connectivity and the self-reported frequencies of using neighborhood fast food restaurants (OR = 0.42, 95% CI 0.26-0.68) and grocery stores (OR = - 2.26, 95% CI - 4.52 to - 0.01). Neighborhood street connectivity did not modify the association between GIS-measured neighborhood restaurant and food store count and the self-reported frequency of using neighborhood restaurants and food stores. Our findings suggest that, for those who perceived at least one sit-down restaurant in their neighborhood, individuals who have more GIS-measured sit-down restaurants in their neighborhoods reported more frequent use of sit-down restaurants than those whose neighborhoods contain fewer such restaurants. Our results also suggest that, for those who perceived at least one fast food restaurant in their neighborhood, individuals who live in neighborhoods with greater GIS-measured street connectivity reported less use of neighborhood fast food restaurants than those who live in neighborhoods with less street connectivity. The count of neighborhood sit-down restaurants and the connectivity of neighborhood street networks appear important in understanding the use of neighborhood food resources.

Changes in walking, body mass index, and cardiometabolic risk factors following residential relocation: Longitudinal results from the CARDIA study

BACKGROUND

While many studies have found the built environment to be associated with walking, most have used cross-sectional research designs and few have examined more distal cardiometabolic outcomes. This study contributes longitudinal evidence based on changes in walking, body mass index (BMI), and cardiometabolic risk following residential relocation.

METHODS

We examined 1,079 participants in the CARDIA study who moved residential locations between 2000 and 2006 (ages 32-46 in 2000, 49% white/51% black, 55% female). We created a walkability index from measures of population density, street connectivity, and food and physical activity resources, measured at participants' pre- and post-move residential locations. Outcomes measured before and after the move included walking, BMI, waist circumference, blood pressure, insulin resistance, triglycerides, cholesterol, atherogenic dyslipidemia, and C-reactive protein. Fixed effects (FE) models were used to estimate associations between within-person change in walkability and within-person change in each outcome. These estimates were compared to those from random effects (RE) models to assess the implications of unmeasured confounding.

RESULTS

In FE models, a one-SD increase in walkability was associated with a 0.81 mmHg decrease in systolic blood pressure [95% CI: (-1.55, -0.07)] and a 7.36 percent increase in C-reactive protein [95% CI: (0.60, 14.57)]. Although several significant associations were observed in the RE models, Hausman tests suggested that these estimates were biased for most outcomes. RE estimates were most commonly biased away from the null or in the opposite direction of effect as the FE estimates.

CONCLUSIONS

Greater walkability was associated with lower blood pressure and higher C-reactive protein in FE models, potentially reflecting competing health risks and benefits in dense, walkable environments. RE models tended to overstate or otherwise misrepresent the relationship between walkability and health. Approaches that base estimates on variation between individuals may be subject to bias from unmeasured confounding, such as residential self-selection.

Walkability and cardiometabolic risk factors: Cross-sectional and longitudinal associations from the Multi-Ethnic Study of Atherosclerosis

We used data from 3227 older adults in the Multi-Ethnic Study of Atherosclerosis (2004-2012) to explore cross-sectional and longitudinal associations between walkability and cardiometabolic risk factors. In cross-sectional analyses, linear regression was used to estimate associations of Street Smart Walk Score® with glucose, triglycerides, HDL and LDL cholesterol, systolic and diastolic blood pressure, and waist circumference, while logistic regression was used to estimate associations with odds of metabolic syndrome. Econometric fixed effects models were used to estimate longitudinal associations of changes in walkability with changes in each risk factor among participants who moved residential locations between 2004 and 2012 (n=583). Most cross-sectional and longitudinal associations were small and statistically non-significant. We found limited evidence that higher walkability was cross-sectionally associated with lower blood pressure but that increases in walkability were associated with increases in triglycerides and blood pressure over time. Further research over longer time periods is needed to understand the potential for built environment interventions to improve cardiometabolic health.