City Level of Income and Urbanization and Availability of Food Stores and Food Service Places in China

Chunxiao Liao,Liming Li,Canqing Yu,Chaoqun Wu,Yayun Tan,Weihua Cao,Jun Lv,Wenjing Gao,Shengfeng Wang,Qing Song

doi:10.1371/journal.pone.0148745

Abstract

ObjectiveThe contribution of unhealthy dietary patterns to the epidemic of obesity has been well recognized. Differences in availability of foods may have an important influence on individual eating behaviors and health disparities. This study examined the availability of food stores and food service places by city characteristics on city level of income and urbanization.MethodsThe cross-sectional survey was comprised of two parts: (1) an on-site observation to measure availability of food stores and food service places in 12 cities of China; (2) an in-store survey to determine the presence of fresh/frozen vegetables or fruits in all food stores. Trained investigators walked all the streets/roads within study tracts to identify all the food outlets. An observational survey questionnaire was used in all food stores to determine the presence of fresh/frozen vegetables or fruits. Urbanization index was determined for each city using a principal components factor analysis. City level of income and urbanization and numbers of each type of food stores and food service places were examined using negative binomial regression models.ResultsLarge-sized supermarkets and specialty retailers had higher number of fresh/frozen vegetables or fruits sold compared to small/medium-sized markets. High-income versus low-income, high urbanized versus low urbanized areas had significantly more large-sized supermarkets and fewer small/medium-sized markets. In terms of restaurants, high urbanized cities had more western fast food restaurants and no statistically significant difference in the relative availability of any type of restaurants was found between high- and low-income areas.ConclusionsThe findings suggested food environment disparities did exist in different cities of China.

Highlights

The world’s obesity epidemic has risen threefold or more since the 1980s [1]
High urbanized cities had more western fast food restaurants and no statistically significant difference in the relative availability of any type of restaurants was found between high- and low-income areas
In parallel with the rising obesity epidemic, data based on nationwide surveys of food consumption patterns and household expenditures showed a marked upward trend in total energy intake derived from processed and pre-packaged foods for home use and meals away from home [2,3]

Summary

Introduction

The world’s obesity epidemic has risen threefold or more since the 1980s [1]. In parallel with the rising obesity epidemic, data based on nationwide surveys of food consumption patterns and household expenditures showed a marked upward trend in total energy intake derived from processed and pre-packaged foods for home use and meals away from home [2,3]. China has seen significant increases in prevalence of obesity and overweight over the past decades[6], and the food expenditures spent on eating away from home have risen threefold or more in city residents since 1991[3]. The prevalence of these unhealthy dietary behaviors is associated with higher intake of daily energy and has been related to the rising obesity epidemic [7,8]. With respect to food service place, studies reported that fast food consumption was related to fast food availability [19] whereas no consistent evidence was found between food outlets near homes and dietary intake or BMI [20] which may suggest that eating out often happens outside the residential neighborhood and definitions of the neighborhood food environment should be in line with individual travel patterns [21]

Methods

Results

Conclusion