Supermarket Density Research Articles

Abstract P533: Food Shopping Practices of Low-income African American Women: Associations With Features of the Food Environment

Introduction: The food environment has received considerable attention as a potential correlate of diet-related CV health. Features of the food environment are assumed to influence the places where people shop, which in turn affect the types of foods purchased and ultimately consumed. However, this assumption remains largely untested due to limited data on where people actually shop. Leveraging unique spatial data on food shopping destinations, we examine whether features of the food environment are associated with the food shopping practices of low-income African American women in Atlanta, Georgia (n=199). Hypothesis: Access to food retailers will be positively associated with their use. Methods: We collected spatial data on locations visited in the past month using a Google Maps-driven questionnaire. Food shopping practices, including the number of retailers, trip frequency, and average distance traveled from home, were assessed separately for supermarkets, convenience stores, and discount (e.g. dollar) stores. We used secondary data on retail food outlets to calculate three measures of food access: density, proximity, and quality. GEE estimated adjusted associations between food access and food shopping practices, controlling for correlation within census tracts. Adjusted models examined supermarket shopping practices, the only outlet used by a majority of women. Results: Only 12.1% of women had a supermarket located within 1 mile of home, compared to 53.8% for convenience and 22.6% for discount stores. Women lived farthest from supermarkets ( Mdn =1.6 mi, IQR =0.9-2.3), followed by discount ( Mdn =1.0 mi, IQR =0.6-1.3) and convenience ( Mdn =0.4 mi, IQR =0.2-0.7) stores. Women also traveled farthest to shop at supermarkets ( Mdn =3.6 mi, IQR =2.5-5.3), traveling over twice the distance of the closest outlet. Nearly all women (97%) shopped at supermarkets, 33% at discount stores, and 25% at convenience stores. In adjusted models, exposure to higher supermarket density was associated with a 13% decrease in distance traveled from home to utilized supermarkets ( e β =0.87, 95% CI : 0.80-0.94). Living farther away from a supermarket was weakly associated with distance traveled from home to utilized supermarkets ( e β =1.04, 95% CI : 1.03-1.06). Conclusions: Women may seek to overcome limited access to supermarkets, rather than rely on more accessible, but less healthy retailers. While women exposed to a higher density of supermarkets used supermarkets closer to home, living in closer proximity to a supermarket minimally affected how close to home they shopped. Higher retail density offers a greater number of supermarket choices, making it more likely that women will find one closer to home aligned with their personal preferences (e.g. affordability, hours, access from public transport). Interventions to improve food access must acknowledge that proximity alone may not drive outlet use.

Associations of area characteristics at birth with overweight and obesity among school-aged children in the south of England: an analysis of a population-based cohort

BackgroundGeographical inequalities in the prevalence of overweight and obesity among children are well established in cross-sectional research. We aimed to examine how area-level characteristics at birth are related to these outcomes in childhood. MethodsAnonymised antenatal and birth data recorded by University Hospital Southampton (2003–18) linked to school-measured weight and height data for children within Southampton, UK were used (14 084 children at ages 4–5 years, and 5 637 at ages 10–11 years). Children's home address at birth was provided at the lower layer super output area level (areas with average populations of 1500). Area-level indices (walkability, unhealthy or healthy food outlets, and spaces for social interaction), natural greenspace coverage, supermarket density, and measures of air pollution (PM2·5, PM10, and NOx) were constructed for lower layer super output areas using data from Ordnance Survey and open sources. Overweight or obesity was defined as a BMI greater than the 85th centile for sex and age. Population-average generalised estimating equations estimated the risk of being overweight or obese for children at both time points. Confounders accounted for included maternal BMI and smoking in early pregnancy, educational attainment, ethnicity, and parity. This project was approved by the NHS Health Research Authority (242031). FindingsNo significant associations were noted between area characteristics at birth and overweight or obesity at ages 4–5 years. The proportion of the lower layer super output area covered by greenspace was negatively associated with the risk of being overweight or obese at ages 10–11 years (relative risk ratio 0·997, 95% CI 0·995–0·999). This finding was consistent in a subgroup of children who moved residence (between different lower layer super output areas) between birth and time of measurement. InterpretationLocal access to natural greenspaces at the time of birth was negatively associated with becoming overweight or obese by the end of primary school, regardless of migration. However, the size of this protective effect is small. Access to and protection of greenspace might have a role in early prevention of childhood obesity. FundingSupported by an Academy of Medical Sciences and Wellcome Trust grant to NAA and the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre.

Walking for transportation and built environment in Sao Paulo city, Brazil

ObjectiveTo describe the profile of adults who walk for transportation in Sao Paulo city, and to explore the built environment features that are associated with transport walking. Material and methodsThis study was a cross-sectional analysis of the Sao Paulo Health Survey dataset (n = 3145 people aged 18 years or older) that measured walking for transportation in a usual week by questionnaire. Residential addresses were geocoded and types and mix of destinations were assessed in 500 m and 1,000 m buffers. We conducted Poisson regression to calculate the prevalence ratio and we used multilevel models to examine relationships between the built environment and walking for transportation. ResultsPeople with higher levels of education and who were not obese were significantly more likely to walk for transportation. The cars or motorcycle ownership in families and aged 60 years old or more were significantly less likely to walk for transportation. After adjustment by social, demographic, and environmental variables, the main result showed that the highest tertiles of the mix of destinations within 500 m increased the likelihood of walking for transportation (OR = 1.40 CI95%1.01–1.93). The presence of public transportation stations within 1,000 m was significantly associated with walking for transportation for 150 min or more per week (OR = 1.65 CI95%1.02–2.68). The presence of different types of destinations such as primary health care units, train or subway stations, bakeries, and the high density of supermarkets within 1,000 m were significantly associated with some walking for transportation. The presence of bakeries in 500 m was strongly associated with some walking for transportation. ConclusionsThe mix of destinations within 500 m and some types of destinations within 1,000 m are important to promote walking trips in adults living in a megalopolis like Sao Paulo. These results can foster discussion of healthy cities in Latin American countries.

Improvement in food environments may help prevent childhood obesity: Evidence from a 9-year cohort study.

SummaryBackgroundEffects of food environments (FEs) on childhood obesity are mixed.ObjectivesTo examine the association of residential FEs with childhood obesity and variation of the association across gender and urbanicity.MethodsWe used the US Early Childhood Longitudinal Study—Kindergarten Cohort data, with 9440 kindergarteners followed up from 1998 to 2007. The Dun and Bradstreet commercial datasets in 1998 and 2007 were used to construct 12 FE measures of children, ie, changes in the food outlet mix and density of supermarkets, convenience stores, full‐service restaurants, fast‐food restaurants, retail bakery, dairy‐product stores, health/dietetic food stores, confectionery stores, fruit/vegetable markets, meat/fish markets, and beverage stores. Two‐level mixed‐effect and cluster robust logistic regression models were fitted to examine associations.ResultsDecreased exposures to full‐service restaurants, retail bakeries, fruit/vegetable markets, and beverage stores were generally obesogenic, while decreased exposure to dairy‐product stores was generally obesoprotective; the magnitude and statistical significance of these associations varied by gender and urbanicity of residence. Higher obesity risk was associated with increased exposure to full‐service restaurants among girls, and with decreased exposures to fruit/vegetable markets in urban children, to beverage stores in suburban children, and to health/dietetic food stores in rural children. Mixed findings existed between genders on the associations of fruit/vegetable markets with child weight status.ConclusionIn the United States, exposure to different FEs seemed to lead to different childhood obesity risks during 1998 to 2007; the association varied across gender and urbanicity. This study has important implications for future urban design and community‐based interventions in fighting the obesity epidemic.

Association between Availability of Neighborhood Fast Food Outlets and Overweight Among 5⁻18 Year-Old Children in Peninsular Malaysia: A Cross-Sectional Study.

A growing number of fast-food outlets in close proximity to residential areas raises a question as to its impact on childhood overweight and obesity. This study aimed at determining the relationship between the availability of fast-food outlets that were in close proximity to residential areas and overweight among Malaysian children aged 5 to 18 years. Measurement data on the weight and height of 5544 children (2797 boys, 2747 girls) were obtained from the National Health and Morbidity Survey 2011. Overweight (including obesity) is defined as BMI-for-age z-score > +1 SD based on the WHO growth reference. Geographic information system geospatial analysis was performed to determine the number of fast-food outlets within 1000 m radius from the children’s residential address. Multiple logistic regression was conducted to examine the association between the availability of fast-food outlets (none or more than one outlet) and overweight with adjustment for age, sex, ethnicity, monthly household income, parental educational level, residential area and supermarket density. Our results showed that the prevalence of overweight was 25.0% and there was a statistically significant association between the density of fast-food outlets and overweight (odds ratio: 1.23, 95% confidence interval: 1.03, 1.47). Our study suggested that the availability of fast-food outlets with close proximity in residential areas was significantly associated with being overweight among children. Limiting the number of fast-food outlets in residential areas could have a significant effect in reducing the prevalence of overweight among Malaysian children.

Association of Fast Food and Supermarket Density with Neonatal Outcomes of Pregnancies Affected by Gestational Diabetes.

To measure the association of fast food density (FFD) and supermarket density (SD) with adverse neonatal outcomes in pregnancies with gestational diabetes mellitus (GDM). This was a retrospective cohort study of women with GDM who delivered at a tertiary care center in a large metropolitan area (1/2010-2/2016). ZIP codes were used to link women with surrounding food environment. FFD and SD were calculated as the number of establishments per 100,000 residents for each ZIP code and classified into quartiles. Quartile 1 represented lowest FFD or SD. Four neonatal outcomes were assessed: large for gestational age (LGA) neonate, shoulder dystocia, neonatal hypoglycemia, and neonatal intensive care unit admission > 3 days. Bivariable and multivariable analyses estimated associations of FFD and SD with outcomes. A total of 2,373 women met eligibility criteria. Insurance, race/ethnicity, language, and body mass index differed between quartiles, although GDM type did not. High FFD was associated with lower odds of LGA but not with other outcomes. Low SD and FFD:SD ratios were not associated with any outcomes. Among women with GDM, high FFD was associated with some neonatal outcomes, but low SD and FFD:SD ratio was not. Food environment may not be the only social determinant of neonatal outcomes in pregnancies with GDM.

Physical Activity in the Prevention of Childhood Obesity

Childhood obesity is a public health concern that threatens the health and well-being of children worldwide and is associated with several of their chronic health conditions. Although a positive energy balance leads to excess body weight in children, there are several factors that influence their weight status. Dietary intake and physical activity greatly contribute to the energy balance in children. Mental health is also associated with their weight status and physical activity. Further, race and ethnicity, family structure, and the built environment contribute to the amount of physical activity achieved by children. One purpose of the current review is to summarize the connection between physical activity and weight status in children, and highlight key factors influencing this relationship, such as mental health and race, ethnicity, family structure and the built environment. Another purpose of this review is to highlight interventions and policies that may influence the relationship between physical activity and weight status in children. Policies that influence the surrounding environment may enhance children’s accessibility for physical activity and affect neighborhood safety, the density of supermarkets and commercial physical activity facilities available, as well as the provision of structured physical activity opportunities for children. Policies that influence the school environment also provide the opportunity to facilitate additional physical activity for students. Therefore, the overall purpose of this review is to discuss the many factors that influence weight status in children and provide ideas for future research.

Assessments of residential and global positioning system activity space for food environments, body mass index and blood pressure among low-income housing residents in New York City.

Research has examined how the food environment affects the risk of cardiovascular disease (CVD). Many studies have focused on residential neighbourhoods, neglecting the activity spaces of individuals. The objective of this study was to investigate whether food environments in both residential and global positioning system (GPS)-defined activity space buffers are associated with body mass index (BMI) and blood pressure (BP) among low-income adults. Data came from the New York City Low Income Housing, Neighborhoods and Health Study, including BMI and BP data (n=102, age=39.3±14.1 years), and one week of GPS data. Five food environment variables around residential and GPS buffers included: fast-food restaurants, wait-service restaurants, corner stores, grocery stores, and supermarkets. We examined associations between food environments and BMI, systolic and diastolic BP, controlling for individual- and neighbourhood-level sociodemographics and population density. Within residential buffers, a higher grocery store density was associated with lower BMI (β=- 0.20 kg/m2, P<0.05), and systolic and diastolic BP (β =-1.16 mm Hg; and β=-1.02 mm Hg, P<0.01, respectively). In contrast, a higher supermarket density was associated with higher systolic and diastolic BP (β=1.74 mm Hg, P<0.05; and β=1.68, P<0.01, respectively) within residential buffers. In GPS neighbourhoods, no associations were documented. Examining how food environments are associated with CVD risk and how differences in relationships vary by buffer types have the potential to shed light on determinants of CVD risk. Further research is needed to investigate these relationships, including refined measures of spatial accessibility/exposure, considering individual's mobility.

Alcohol outlet density and alcohol related hospital admissions in England: a national small-area level ecological study.

Background and aimsExcessive alcohol consumption has a substantial impact on public health services. A key element determining alcohol availability is alcohol outlet density. This study investigated the relationship between on‐trade and off‐trade outlets and hospital admission rates in local neighbourhoods.DesignNational small‐area level ecological study.Setting and participantsAll 32 482 lower layer super output census areas (LSOAs) in England (42 227 108 million people aged 15+ years). Densities for six outlet categories (outlets within a 1‐km radius of residential postcode centroids, averaged for all postcodes within each LSOA) were calculated.MeasurementsMain outcome measures were admissions due to acute or chronic conditions wholly or partially attributable to alcohol consumption from 2002/03 to 2013/14.FindingsThere were 1 007 137 admissions wholly, and 2 153 874 admissions partially, attributable to alcohol over 12 years. After adjustment for confounding, higher densities of on‐trade outlets (pubs, bars and nightclubs; restaurants licensed to sell alcohol; other on‐trade outlets) and convenience stores were associated with higher admission rate ratios for acute and chronic wholly attributable conditions. For acute wholly attributable conditions, admission rate ratios were 13% (95% confidence interval = 11–15%), 9% (7–10%), 12% (10–14%) and 10% (9–12%) higher, respectively, in the highest relative to the lowest density categories by quartile. For chronic wholly attributable conditions, rate ratios were 22% (21–24%), 9% (7–11%), 19% (17–21%) and 7% (6–9%) higher, respectively. Supermarket density was associated with modestly higher acute and chronic admissions but other off‐trade outlet density was associated only with higher admissions for chronic wholly attributable conditions. For partially attributable conditions, there were no strong patterns of association with outlet densities.ConclusionsIn England, higher densities of several categories of alcohol outlets appear to be associated with higher hospital admission rates for conditions wholly attributable to alcohol consumption.

Food environment, social deprivation and obesity among students from Brazilian public schools.

To investigate the relationship between social deprivation and the food environment. Furthermore, to evaluate if the food environment is associated with the prevalence of obesity among students in Brazilian public schools. Cross-sectional. For the classification of obesity, weight and height were measured, and the cut-off point of BMI-for-age Z-score &gt;+2 was adopted. Social deprivation level was determined from the Health Vulnerability Index (HVI). To assess the food environment, the density of food establishments in urban residential areas was calculated. Associations between the food environment and the presence of obesity were estimated by binary logistic regression through a generalized estimating equations model. Juiz de Fora, Minas Gerais, Brazil. Children and adolescents (n 661) aged 7-14 years. The lowest social deprivation level showed a higher density of all types of establishments that sold predominantly unhealthy foods. An inverse association was found between the density of supermarkets and hypermarkets and the presence of obesity (OR=0·58; 95 % CI 0·36, 0·93). For the other categories of food retailers, no significant differences were found. The findings reinforce the need for public policies that promote equality in the food environments of the city. Also, further investigations into the influence of the presence of supermarkets on the nutritional status of children and adolescents are required.

Supermarket access, transport mode and BMI: the potential for urban design and planning policy across socio-economic areas.

To investigate dietary intake, BMI and supermarket access at varying geographic scales and transport modes across areas of socio-economic disadvantage, and to evaluate the implementation of an urban planning policy that provides guidance on spatial access to supermarkets. Cross-sectional study used generalised estimating equations to investigate associations between supermarket density and proximity, vegetable and fruit intake and BMI at five geographic scales representing distances people travel to purchase food by varying transport modes. A stratified analysis by area-level disadvantage was conducted to detect optimal distances to supermarkets across socio-economic areas. Spatial distribution of supermarket and transport access was analysed using a geographic information system. Melbourne, Australia. Adults (n 3128) from twelve local government areas (LGA) across Melbourne. Supermarket access was protective of BMI for participants in high disadvantaged areas within 800 m (P=0·040) and 1000 m (P=0·032) road network buffers around the household but not for participants in less disadvantaged areas. In urban growth area LGA, only 26 % of dwellings were within 1 km of a supermarket, far less than 80-90 % of dwellings suggested in the local urban planning policy. Low public transport access compounded disadvantage. Rapid urbanisation is a global health challenge linked to increases in dietary risk factors and BMI. Our findings highlight the importance of identifying the most appropriate geographic scale to inform urban planning policy for optimal health outcomes across socio-economic strata. Urban planning policy implementation in disadvantaged areas within cities has potential for reducing health inequities.

Does exposure to the food environment differ by socioeconomic position? Comparing area-based and person-centred metrics in the Fenland Study, UK

BackgroundRetail food environments (foodscapes) are a recognised determinant of eating behaviours and may contribute to inequalities in diet. However, findings from studies measuring socioeconomic inequality in the foodscape have been mixed, which may be due to methodological differences. The aim of this cross-sectional study was to compare exposure to the foodscape by socioeconomic position using different measures, to test whether the presence, direction or amplitude of differences was sensitive to the choice of foodscape metric or socioeconomic indicator.MethodsA sample of 10,429 adults aged 30–64 years with valid home address data were obtained from the Fenland Study, UK. Of this sample, 7270 participants also had valid work location data. The sample was linked to data on food outlets obtained from local government records. Foodscape metrics included count, density and proximity of takeaway outlets and supermarkets, and the percentage of takeaway outlets relative to all food outlets. Exposure metrics were area-based (lower super output areas), and person-centred (proximity to nearest; Euclidean and Network buffers at 800 m, 1 km, and 1 mile). Person-centred buffers were constructed using home and work locations. Socioeconomic status was measured at the area-level (2010 Index of Multiple Deprivation) and the individual-level (highest educational attainment; equivalised household income). Participants were classified into socioeconomic groups and average exposures estimated. Results were analysed using the statistical and percent differences between the highest and lowest socioeconomic groups.ResultsIn area-based measures, the most deprived areas contained higher takeaway outlet densities (p < 0.001). However, in person-centred metrics lower socioeconomic status was associated with lower exposure to takeaway outlets and supermarkets (all home-based exposures p < 0.001) and socioeconomic differences were greatest at the smallest buffer sizes. Socioeconomic differences in exposure was similar for home and combined home and work measures. Measuring takeaway exposure as a percentage of all outlets reversed the socioeconomic differences; the lowest socioeconomic groups had a higher percentage of takeaway outlets compared to the middle and highest groups (p < 0.001).ConclusionsWe compared approaches to measuring socioeconomic variation in the foodscape and found that the association was sensitive to the metric used. In particular, the direction of association varied between area- and person-centred measures and between absolute and relative outlet measures. Studies need to consider the most appropriate measure for the research question, and may need to consider multiple measures as a single measure may be context dependent.

Changes in the food environment over time: examining 40\xa0years of data in the Framingham Heart Study

BackgroundResearch has explored associations between diet, body weight, and the food environment; however, few studies have examined historical trends in food environments.MethodsIn the Framingham Heart Study Offspring (N = 3321) and Omni (N = 447) cohorts, we created food environment metrics in four Massachusetts towns utilizing geocoded residential, workplace, and food establishment addresses from 1971 to 2008. We created multilevel models adjusted for age, sex, education, and census tract poverty to examine trends in home, workplace, and commuting food environments.ResultsProximity to and density of supermarkets, fast-food, full service restaurants, convenience stores, and bakeries increased over time for residential, workplace, and commuting environments; exposure to grocery stores decreased. The greatest increase in access was for supermarkets, with residential distance to the closest supermarket 1406 m closer (95% CI 1303 m, 1508 m) by 2005–2008 than in 1971–1975. Although poorer census tracts had higher access to fast-food restaurants consistently across follow-up, this disparity dissipated over time, due to larger increases in proximity to fast-food in wealthier neighborhoods.ConclusionsAccess to most food establishment types increased over time, with similar trends across home, workplace, and commuter environments.

The interaction between individual, social and environmental factors and their influence on dietary intake among adults in Toronto

AbstractHealth outcomes related to vegetable and fruit consumption are widely recognized in the literature. This study investigates how dietary intake is influenced by individual, social, and environmental factors in the Toronto Census Metropolitan Area. The analysis and findings are based on data from the Canadian Community Health Survey which provides self‐reported vegetable and fruit intake from 6,513 adults in 2009‐2010. Food environment measures were constructed from commercial databases using kernel density estimates and network drive times. Spatial and multivariable techniques were used to determine the associations between diet, the food environment, and other health and socioeconomic factors. Particular emphasis was given to understanding the interaction between the food environment and socioeconomic position. Unexpectedly, supermarket density was found to have an inverse association with vegetable and fruit intake. Interaction terms for individuals with low income and reduced mobility produced different responses in men and women, confirming that the influence of the food environment is not uniform for all subgroups.

Neighborhood Physical Environment and Changes in Body Mass Index: Results From the Multi-Ethnic Study of Atherosclerosis.

Longitudinal associations between neighborhood characteristics and body mass index (BMI; weight (kg)/height (m)2) were assessed from 2000 to 2011 among 5,919 participants in the Multi-Ethnic Study of Atherosclerosis. The perceived availability of healthy food and walking environment were assessed via surveys, and 1-mile (1.6-km) densities of supermarkets, fruit-and-vegetable stores, and recreational facilities were obtained through a commercial database. Econometric fixed-effects models were used to estimate the association between within-person changes in neighborhood characteristics and within-person change in BMI. In fully adjusted models, a 1-standard-deviation increase in the healthy food environment index was associated with a 0.16-kg/m2 decrease in BMI (95% confidence interval (CI): -0.27, -0.06) among participants with obesity at baseline. A 1-standard-deviation increase in the physical activity environment index was associated with 0.13-kg/m2 (95% CI: -0.24, -0.02) and 0.14-kg/m2 (95% CI: -0.27, -0.01) decreases in BMI for participants who were overweight and obese at baseline, respectively. Paradoxically, increases in the physical activity index were associated with BMI increases in persons who were normal-weight at baseline. This study provides preliminary longitudinal evidence that favorable changes in neighborhood physical environments are related to BMI reductions in obese persons, who comprise a substantial proportion of the US population.

Food deserts? Healthy food access in Amsterdam

Healthy food environments are imperative for public health. Access to supermarkets that offer wholesome food products at low prices varies across space and over socioeconomic status and ethnic neighborhoods. This research examined food inequalities in Amsterdam, the Netherlands. Supermarket accessibility was calculated and linked to property prices and the share of native Dutch people on a geographic micro-scale with a spatial resolution of 100 meters. Mann–Whitney tests and Spearman correlations were used to test differences and associations between accessibility, property prices, and the share of natives per area. The spatially explicit contextual neural gas approach was used for data clustering. The results show access differences in supermarkets in favor of areas with high property prices and those areas with a large share of native Dutch people. The correlations indicate that low-priced areas and those with a low share of native Dutch people have a lower supermarket density, but the results are the opposite when proximity to and variety of supermarkets are examined. The clustering revealed no evidence of undersupplied areas. Pronounced inequalities in access to healthy food could not be confirmed. On the basis of this analysis, there is no urgent need for policymakers to intervene in the geographies of supermarkets.

Abstract P289: The Neighborhood Food Environment and Change in Body Mass Index: A Systematic Review and Meta-Analysis of Longitudinal Studies

Introduction: The neighborhood food environment - locations and density of different types of stores and restaurants - is of great interest to reduce obesity. However, prior meta-analyses have focused on cross-sectional studies, for which reverse causation is a major limitation. Meta-analyses restricted to longitudinal study designs evaluating the food environment and change in BMI have yet to be conducted. Hypothesis: We hypothesized that increased exposure to fast food restaurants would be associated with increased change in BMI. Methods: Eleven databases were searched for longitudinal studies evaluating convenience stores, fast food restaurants, grocery stores, or supermarkets and change in BMI. Inclusion criteria consisted of: (1) interventional, quasi-experimental, or cohort studies; (2) adult or children populations; (3) any country; (4) geographic density or distance of food outlets; (5) a multivariable-adjusted change in BMI over time and corresponding uncertainty. Data were extracted independently and in duplicate, and studies pooled using fixed and random-effects models. Heterogeneity was quantified using Cochrane’s Q, and publication bias using funnel plots, Egger’s test, and Begg’s test. Results: 13 studies including 98,268 subjects were identified. In random effects models, no significant association was seen between food environments and change in BMI ( Figure ). A nonsignificant trend was seen toward lower BMI with increasing density of supermarkets; however, a similar nonsignificant trend was also observed between increasing density of fast food restaurants and lower BMI. Evidence for publication bias was not identified. Conclusion: In available longitudinal studies,no significant relationships were identified between food environments and change in BMI. Our novel findings support the need for further longitudinal and especially interventional studies of how the built food environment, including new measures related to cost and accessibility, may influence health and weight.

How Does the Food Environment Affect Juvenile Obesity? A Study of Cleveland and Cuyahoga County, Ohio

It is well known that unhealthy food can contribute to obesity, diabetes, hypertension, and cardiovascular disease. It is also believed that the composition of the food environment (density and location of convenience stores, grocery stores, supermarkets, and restaurants in a neighborhood) can play a role in obesity and obesity-related diseases—further exacerbating or reducing health disparities that are already present in our society. To further our understanding of the role the food environment plays in health, this article will assess how the food environment may influence by utilizing geo-located individual electronic medical records (EMR) measured BMI percentile for juvenile patients in and around Cleveland, Ohio. The findings of this study demonstrate that in Cuyahoga County, Ohio (Cleveland) food deserts or availability of healthy food retailers nearby, have no statistically significant impact on juvenile obesity. The number of unhealthy food retailers, however, does have a statistically significant impact on juvenile BMI percentile—thus the more fast-food outlets or convenience stores present nearby will increase the likelihood of higher BMI percentile. However, the size of this effect is rather small, so policy makers should heed caution before seeking to dramatically reduce the number of unhealthy retailers in a community.

Scale effects in food environment research: Implications from assessing socioeconomic dimensions of supermarket accessibility in an eight-county region of South Carolina

Choice of neighborhood scale affects associations between environmental attributes and health-related outcomes. This phenomenon, a part of the modifiable areal unit problem, has been described fully in geography but not as it relates to food environment research. Using two administrative-based geographic boundaries (census tracts and block groups), supermarket geographic measures (density, cumulative opportunity and distance to nearest) were created to examine differences by scale and associations between three common U.S. Census–based socioeconomic status (SES) characteristics (median household income, percentage of population living below poverty and percentage of population with at least a high school education) and a summary neighborhood SES z-score in an eight-county region of South Carolina. General linear mixed-models were used. Overall, both supermarket density and cumulative opportunity were higher when using census tract boundaries compared to block groups. In analytic models, higher median household income was significantly associated with lower neighborhood supermarket density and lower cumulative opportunity using either the census tract or block group boundaries, and neighborhood poverty was positively associated with supermarket density and cumulative opportunity. Both median household income and percent high school education were positively associated with distance to nearest supermarket using either boundary definition, whereas neighborhood poverty had an inverse association. Findings from this study support the premise that supermarket measures can differ by choice of geographic scale and can influence associations between measures. Researchers should consider the most appropriate geographic scale carefully when conducting food environment studies.

Implications of supermarket access, neighbourhood walkability and poverty rates for diabetes risk in an employee population.

Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of the present study was to examine the association between multiple aspects of environment and diabetes risk in an employee population. This was a retrospective cross-sectional analysis. Home environment variables were derived using employees' zip code. Descriptive statistics were run on all individual- and zip-code-level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk. Data were collected from employee health fairs in a Midwestern health system, 2009-2012. The data set contains 25 227 unique individuals across four years of data. From this group, using an individual's first entry into the database, 15 522 individuals had complete data for analysis. The prevalence of high diabetes risk in this population was 2·3 %. There was significant variability in individual- and zip-code-level variables across worksites. From the multivariable analysis, living in a zip code with higher percentage of poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk. Our study underscores the important relationship between poverty, home neighbourhood environment and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health.