Measuring the Local Food Environment and its Associations with Diet Quality.

Using data from multiple economic sources and the Multi-Ethnic Study of Atherosclerosis, this series of studies examined associations of various features of the local food environment with sociodemographic characteristics of neighborhoods (study 1), agreement between alternative assessments of the food environment (study 2), and the relation between the food environment (characterized in several different but complementary ways) and the diet of residents (study 3). Results from study 1 indicate that in addition to fewer supermarkets in minority and poor areas there were also fewer fruit and vegetable markets, bakeries, specialty stores, and natural food stores. One of the major challenges in studying the effect of the environment on diet is the measurement of the local food environment. Most studies have used the presence of supermarkets as a proxy for the availability of healthy foods in neighborhoods, but the quality of supermarkets can vary substantially and other stores may also offer healthier options. Study 2 investigated the interrelation of two alternative ways of characterizing the local food environment. Measures of the availability of healthy foods in neighborhoods based on the survey responses of residents were found to be positively associated but not synonymous with GIS derived densities of supermarkets. Alternative ways of representing the environment may help to create more representative pictures of what resources are available. Empirical evidence relating the local food environment to diet quality is limited. Study 3 found that having better spatial access to supermarkets was associated with meeting dietary fat recommendations and following the types of diets associated with better health outcomes. Similarly when assessing the food environment using the survey responses of the participants and the aggregated responses of those who live in the same area, those living in the worst ranked areas were significantly less likely to follow a healthy diet. The local food environment varies across neighborhoods and may contribute to disparities and social inequalities in health. Research is needed to evaluate additive and synergistic effects of individual-level and neighborhood-level interventions order to identify more effective approaches to stem the tide of obesity in the United States.Ph.D.Epidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/55685/2/lvmoore_1.pd

Associations of the Local Food Environment with Diet Quality—A Comparison of

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.http://deepblue.lib.umich.edu/bitstream/2027.42/58345/1/Associations of the local food environment with diet quality - A comparison of Assessments based on surveys .pd

Availability of Recreational Resources in Minority and Low Socioeconomic Status Areas

Differences in availability of recreational resources may contribute to racial and SES disparities in physical activity. Variations in the location and density of recreational resources were examined by SES and racial composition of neighborhoods

Fast-food consumption, diet quality, and neighborhood exposure to fast food: the multi-ethnic study of atherosclerosis

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.http://deepblue.lib.umich.edu/bitstream/2027.42/78522/1/MooreDiezRoux2009_AmJEpidemiol.pd

Availability of healthy foods and dietary patterns:The Multi-Ethnic Study of Atherosclerosis

Background: Inadequate availability of healthy foods may be a barrier to achieve 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 < 0.01). After adjustment for age, sex, income, and education, a lower availability of healthy foods in the tract of residence or in the closest store was associated with higher scores on the low-quality dietary pattern (P < 0.05). Less consistent associations were observed for the high-quality dietary pattern. Conclusions: Healthy foods were less available for black participants. Low availability of healthy foods was associated with a lower quality diet. The extent to which improvements in the availability of healthy foods results in higher quality diets deserves further investigation.http://deepblue.lib.umich.edu/bitstream/2027.42/61834/1/Availability of healthy foods and dietary patterns. the Multi-Ethnic Study of Atherosclerosis.pd

Comparing perception-based and geographic information systems (GIS) based characterizations of the local food environment

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.http://deepblue.lib.umich.edu/bitstream/2027.42/58001/1/Comparing perception based and geographic informatin systems GIS based characterizations of the local food environment.pd

The Impact of Neighborhoods on CV Risk

Cardiovascular disease (CVD) continues to be the leading cause of death and a major source of health disparities in the Unites States and globally. Efforts to reduce CVD risk and eliminate cardiovascular health disparities have increasingly emphasized the importance of the social determinants of health. Neighborhood environments have emerged as a possible target for prevention and policy efforts. Hence there is a need to better understand the role of neighborhood environments in shaping cardiovascular risk. The MESA (Multi-Ethnic Study of Atherosclerosis) Neighborhood Study provided a unique opportunity to build a comprehensive place-based resource for investigations of associations between specific features of neighborhood physical and social environments and cardiovascular risk factors and outcomes. This review summarizes the approaches used to characterize residential neighborhood environments in the MESA cohort, provides an overview of key findings to date, and discusses challenges and opportunities in neighborhood health effects research. Results to date suggest that neighborhood physical and social environments are related to behavioral and biomedical risk factors for CVD and that cardiovascular prevention efforts may benefit from taking neighborhood context into account

Are neighbourhood restaurants related to frequency of restaurant meals and dietary quality? Prevalence and changes over time in the Multi-Ethnic Study of Atherosclerosis

ObjectiveTo examine whether the density of neighbourhood restaurants affected the frequency of eating restaurant meals and subsequently affected diet quality.DesignCross-sectional and longitudinal designs. Structural equation models assessed the indirect relationship between restaurant density (≤3 miles (4·8 km) of participant addresses) and dietary quality (Healthy Eating Index 2010 (HEI)) via the frequency of eating restaurant meals, after adjustment for sociodemographics, select health conditions, region, residence duration and area-level income.SettingUrbanised areas in multiple regions of the USA, years 2000-2002 and 2010-2012.ParticipantsParticipants aged 45-84 years were followed for 10 years (n 3567).ResultsMedian HEI (out of 100) was fifty-nine at baseline and sixty-two at follow-up. The cross-sectional analysis found that residing in areas with a high density of restaurants (highest-ranked quartile) was associated with 52 % higher odds of frequently eating restaurant meals (≥3 times/week, OR: 1·52, 95 % CI 1·18, 1·98) and 3 % higher odds of having lower dietary quality (HEI lowest quartile &lt; 54, OR: 1·03, 95 % CI 1·01, 1·06); associations were not sustained in longitudinal analyses. The cross-sectional analysis found 34 % higher odds of having lower dietary quality for those who frequently ate at restaurants (OR: 1·34, 95 % CI 1·12, 1·61), and more restaurant meals (over time increase ≥ 1 time/week) were associated with higher odds of having worse dietary quality at follow-up (OR: 1·21, 95 % CI 1·00, 1·46).ConclusionsRestaurant density was associated with frequently eating out in cross-sectional and longitudinal analyses but was associated with the lower dietary quality only in cross-sectional analyses. Frequent restaurant meals were negatively related to dietary quality. Interventions that encourage less frequent eating out may improve population dietary quality

Longitudinal associations between objective and perceived healthy food environment and diet: The Multi-Ethnic Study of Atherosclerosis

IntroductionResearch examining the influence of neighborhood healthy food environment on diet has been mostly cross-sectional and has lacked robust characterization of the food environment. We examined longitudinal associations between features of the local food environment and healthy diet, and whether associations were modified by race/ethnicity.MethodsData on 3634 adults aged 45-84 followed for 10 years were obtained from the Multi-Ethnic Study of Atherosclerosis. Diet quality was assessed using the Alternative Healthy Eating Index at Exam 1 (2000-2002) and Exam 5 (2010-2012). We assessed four measures of the local food environment using survey-based measures (e.g. perceptions of healthier food availability) and geographic information system (GIS)-based measures (e.g. distance to and density of healthier food stores) at Exam 1 and Exam 5. Random effects models adjusted for age, sex, education, moving status, per capita adjusted income, and neighborhood socioeconomic status, and used interaction terms to assess effect measure modification by race/ethnicity.ResultsNet of confounders, one standard z-score higher average composite local food environment was associated with higher average AHEI diet score (β=1.39, 95% CI: 1.05, 1.73) over the follow-up period from Exam 1 to 5. This pattern of association was consistent across both GIS-based and survey-based measures of local food environment and was more pronounced among minoritized racial/ethnic groups. There was no association between changes in neighborhood environment and change in AHEI score, or effect measure modification by race/ethnicity.ConclusionOur findings suggest that neighborhood-level food environment is associated with better diet quality, especially among racially/ethnically minoritized populations