Associations of the Local Food Environment with Diet Quality--A Comparison of Assessments based on Surveys and Geographic Information Systems: The Multi-Ethnic Study of Atherosclerosis

Abstract

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.

Access to Healthful Foods among an Urban Food Insecure Population: Perceptions versus Reality

“…The rubric of a 1-mi radius represented a walkable distance for accessing the stores located near each Boys and Girls Club. 18 Food stores included supermarkets (i.e., chain food stores that sell a wide variety of items including food, medicine, toiletries, and alcohol); local markets (i.e., nonchain food stores selling a modest variety of items); and convenience stores (i.e., chain or nonchain stores selling a limited variety of items). A total of 42 food stores were identified and audits were conducted inside 33 of the stores.…”

“…15 Moreover, participants living in neighborhoods characterized as having low perceived levels of availability of healthy foods were 22% to 25% less likely to have a healthy diet compared to those living in the highest-ranked neighborhoods. 27 In an Australian study by Giskes and colleagues, perceptions of food price and availability, rather than actual (objective) measures of the local food environment, were significantly associated with food-purchasing patterns. 26 …”

“…15,16 The most common method for assessing local food environments involves a process of counting food stores and then geographically anchoring the stores in space using geographic information system (GIS) software; this method typically involves food store identification through existing commercial databases and address books. [17][18][19][20] Limitations related to this method include the risk of misidentification of food stores in the commercial database, store closure between the creation of the data source and mapping, and GIS mapping errors. Observational approaches represent another method for examining local food environments.…”

“…24 Limited efforts have been made to assess perceptions of food access. 15,25,26,27 A three-item scale was developed by Moore and colleagues to assess perceived availability of healthy foods within a 1-mi radius (20-min walk) of participants' residence. 15 Perceived availability of access to healthy foods was then compared to actual access to supermarkets and other smaller food stores identified through InfoUSA®, a comprehensive commercial database of businesses in the US.…”

Social disparities in dietary habits among women: Geographic Research on Wellbeing (GROW) Study

“…Second, ethnicity's role in influencing dietary behaviour can be expected to change with length of time in the USA as migrant populations acculturate to a new environment (14) . Third, residential segregation (by race/ethnicity and SES) in the USA is high and there is a considerable body of literature that alludes to the influence of the neighbourhood environment on food consumption patterns (15)(16)(17) . Specifically, fresh produce may be less accessible in lower-income and/or segregated neighbourhoods (16)(17)(18) while energy-dense, nutrient-poor foods such as those offered in convenience stores may be more accessible in these same neighbourhoods (19)(20)(21) .…”