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1.  Changes in Diet after Introduction of a Full Service Supermarket in a Food Desert 
Health affairs (Project Hope)  2015;34(11):1858-1868.
Placing full-service supermarkets in food deserts (areas with limited access to healthy foods) has been proposed as an important policy strategy to confront inequalities in healthy food access. Capitalizing on a natural experiment, we enrolled n=1,372 randomly selected households from two comparable neighborhoods, one of which received a full-service supermarket in 2013. We looked at the impact on residents’ diet, perceived access to healthy foods and satisfaction with one’s neighborhood as a place to live. Baseline data was collected in 2011, and follow-up in 2014. Relative to the comparison neighborhood, we found a net positive change in the intervention neighborhood in overall dietary quality, total kilocalories, added sugars, and solid fats, alcohol and added sugars (SoFAAS). However, we did not observe differential improvement in fruit and vegetable intake, whole grain consumption or body mass index (BMI). Regular users of the new supermarket had significantly improved perceived access to healthy foods compared to others, but use of the new supermarket was not related to dietary changes or to improvements with neighborhood satisfaction. Our study is the first to our knowledge to have found significant improvements in multiple dietary outcomes and neighborhood satisfaction among residents of a food desert, following the opening of a supermarket. Our study supports the Healthy Food Financing Initiative and other policies that incentivize food retail venues to locate in food deserts, but we recommend further efforts proceed with caution until research has clarified the mechanisms through which diet is improved and associations with weight status/obesity have been observed.
PMCID: PMC4977027  PMID: 26526243
2.  A randomized pilot study of a community-based weight loss intervention for African-American women: Rationale and study design of Doing Me! Sisters Standing Together for a Healthy Mind and Body 
Contemporary clinical trials  2015;43:200-208.
Despite the high prevalence of obesity among African-American women and modest success in behavioral weight loss interventions, the development and testing of weight management interventions using a community-based participatory research (CBPR) approach have been limited. Doing Me!: Sisters Standing Together for Healthy Mind and Body (Doing Me!) is an intervention adapted from an evidence-based behavioral obesity intervention using a CBPR approach. The purpose of Doing Me! is to test the feasibility and acceptability of this adapted intervention and determine its efficacy in achieving improvements in anthropometrics, diet, and physical activity.
Sixty African-American women, from a low-income, urban community, aged 30–65 years will be randomized to one of two arms: 16-week Doing Me! (n = 30) or waitlist control (n = 30). Doing Me! employs CBPR methodology to involve community stakeholders and members during the planning, development, implementation, and evaluation phases of the intervention. There will be thirty-two 90-minute sessions incorporating 45 min of instruction on diet, physical activity, and/or weight management plus 45 min of physical activity. Data will be collected at baseline and post-intervention (16 weeks).
Doing Me! is one of the first CBPR studies to examine the feasibility/acceptability of an adapted evidence-based behavioral weight loss intervention designed for obese African-American women. CBPR may be an effective strategy for implementing a weight management intervention among this high-risk population.
PMCID: PMC4669053  PMID: 26079196
African-American women; Obesity; Community-based participatory research (CBPR); weight loss; Behavioral intervention
3.  The Impact of Neighborhood Environment, Social Support and Avoidance Coping on Depressive Symptoms of Pregnant African American Women 
Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birthweight infants, postpartum depression and maladaptive mother-infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman’s transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African American women.
Pregnant African American women (N = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 15-25 weeks and 25-37 weeks. The self-administered instruments measured perceived neighborhood environment, social support, avoidance coping, and depressive symptoms using items from existing scales. Objective measures of the neighborhood environment were derived using geographic information systems.
Perceived neighborhood environment, social support, avoidance coping and depressive symptoms were significantly correlated in the expected directions. Objective physical disorder and crime were negatively related to social support. Social support at time one (20 ± 2.6 weeks) mediated associations between the perceived neighborhood environment at time one and depressive symptoms at time two (29 ± 2.7 weeks). An increase in avoidance coping between time one and time two also mediated the effects of perceived neighborhood environment at time one on depressive symptoms at time two.
Pregnant African American women’s negative perceptions of their neighborhoods in the second trimester were related to higher levels of depressive symptoms in the third trimester. If these results are replicable in prospective studies with larger sample sizes, intervention strategies could be implemented at the individual level to support pregnant women in their ability to cope with adverse neighborhood conditions and ultimately improve their mental health.
PMCID: PMC4431761  PMID: 25840930
4.  Does territoriality modify the relationship between perceived neighborhood challenges and physical activity? A multilevel analysis 
Annals of epidemiology  2014;25(2):107-112.
Individuals who perceive more neighborhood challenges are less physically active. Territoriality, an observable positive marker of social presence and defensible space in the neighborhood, may influence the association between neighborhood challenges and physical activity. We hypothesized that greater territoriality would reduce the negative effects of neighborhood challenges on physical activity levels.
Data were collected by the Healthy Environments Partnership in an urban Midwestern city. Multilevel regressions were employed to test associations in a sample of 696 White, Black, and Hispanic adults aged 25+.
Territoriality moderated associations between residents’ perceptions of neighborhood challenges and physical activity. Contrary to our hypothesis, individuals who perceived more neighborhood challenges and lived in areas with more territoriality markers (e.g. buildings with decorations, buildings with security signage, neighborhood watch signs) were less physically active than other respondents. (b= −2.41, SE=0.84, p<0.01).
Our findings suggest that associations between perceived neighborhood challenges and physical activity are shaped by the context in which the individual lives. Our study provides empirical evidence that individual perceptions and observed neighborhood characteristics are joint contributors to physical activity, and suggest the need for continued research to characterize the complexity of individual and contextual factors that contribute to physical activity.
PMCID: PMC4317295  PMID: 25533154
Territoriality; neighborhoods; physical activity
5.  Small Retailer Perspectives of the 2009 Women, Infants and Children Program Food Package Changes 
To understand vendor perspectives regarding changes made in 2009 to the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) food package.
Fifty-two in-depth, qualitative interviews with owners or managers of small stores in 8 urban areas across 7 states conducted 6-12 months after the changes.
Store owners experienced implementation challenges, but felt the changes increased the number of customers, sales, and profits.
This research provides vendor perspectives on the 2009 WIC policy changes and may enhance policy implementation directed at increasing healthy food availability, particularly in urban communities.
PMCID: PMC4703098  PMID: 22584093
WIC; qualitative research; storeowner perspectives; food policy; sales
6.  Ecological momentary assessment of environmental and personal factors and snack food intake in African American women 
Appetite  2014;83:333-341.
This study examined contributions of environmental and personal factors (specifically, food availability and expense, daily hassles, self-efficacy, positive and negative affect) to within-person and betweenperson variations in snack food intake in 100 African American women. Participants were signaled at random five times daily for seven days to complete a survey on a study-provided smartphone. Women reported consuming snack foods at 35.2% of signals. Easier food availability accounting for one's usual level was associated with higher snack food intake. Being near outlets that predominately sell snacks (e.g., convenience stores), while accounting for one's usual proximity to them, was associated with higher snack food intake. Accounting for one's usual daily hassle level, we found that on days with more frequent daily hassles snack food intake was higher. The positive association between within-person daily hassles frequency and snack food intake was stronger when foods were easily available. Public and private policies to curb ubiquitous food availability and mobile health interventions that take into account timevarying influences on food choices and provide real-time assistance in dealing with easy food availability and coping with stressors may be beneficial in improving African American women's day to day food choices.
PMCID: PMC4376474  PMID: 25239402
Stress; Affect; Diet; Self-Efficacy; Food availability; Food prices
7.  Distance to Store, Food Prices, and Obesity in Urban Food Deserts 
Lack of access to healthy foods may explain why residents of low-income neighborhoods and African Americans in the U.S. have high rates of obesity. The findings on where people shop and how that may influence health are mixed. However, multiple policy initiatives are underway to increase access in communities that currently lack healthy options. Few studies have simultaneously measured obesity, distance, and prices of the store used for primary food shopping.
To examine the relationship among distance to store, food prices, and obesity.
The Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health study conducted baseline interviews with 1,372 households between May and December 2011 in two low-income, majority African American neighborhoods without a supermarket. Audits of 16 stores where participants reported doing their major food shopping were conducted. Data were analyzed between February 2012 and February 2013.
Distance to store and prices were positively associated with obesity (p<0.05). When distance to store and food prices were jointly modeled, only prices remained significant (p<0.01), with higher prices predicting a lower likelihood of obesity. Although low- and high-price stores did not differ in availability, they significantly differed in their display and marketing of junk foods relative to healthy foods.
Placing supermarkets in food deserts to improve access may not be as important as simultaneously offering better prices for healthy foods relative to junk foods, actively marketing healthy foods, and enabling consumers to resist the influence of junk food marketing.
PMCID: PMC4205193  PMID: 25217097
8.  Associations between observed neighborhood characteristics and physical activity: findings from a multiethnic urban community 
There is growing interest in the contributions of characteristics of the neighborhood environment to inequalities in physical activity. However, few studies have examined the relationship between observed neighborhood environmental characteristics and physical activity in a multiethnic urban area.
The purpose of this study was to assess relationships between neighborhood environments and physical activity and the extent to which these associations varied by demographic characteristics or perceptions of the physical and social environment.
Cross-sectional analyses drew upon data collected from a stratified proportional probability sample of non-Hispanic Black, Hispanic and non-Hispanic White (NHW) adults (n = 919) in low-to-moderate income neighborhoods in Detroit, Michigan. Physical activity was assessed as self-reported duration and frequency of vigorous and moderate physical activity. Observed physical environment was assessed through systematic social observation by trained observers on blocks adjacent to survey respondents' residences.
We find a positive association of sidewalk condition with physical activity, with stronger effects for younger compared with older residents. In addition, physical disorder was more negatively associated with physical activity among NHW and older residents.
These findings suggest that sidewalk improvements and reductions in physical disorder in urban communities may promote greater equity in physical activity.
PMCID: PMC4181423  PMID: 24159053
environment; physical activity
9.  Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet, and body mass index 
Public health nutrition  2014;18(12):2220-2230.
Provide a richer understanding of food access and purchasing practices among U.S. urban food desert residents and their association with diet and body mass.
Data on food purchasing practices, dietary intake, height, and weight from the primary food shopper in randomly selected households (n=1372) was collected. Audits of all neighborhood food stores (n=24) and the most-frequented stores outside the neighborhood (n=16) were conducted. Aspects of food access and purchasing practices and relationships among them were examined and tests of their associations with dietary quality and body mass index (BMI) were conducted.
Two low-income predominantly African-American neighborhoods with limited access to healthy food in Pittsburgh, Pennsylvania.
Household food shoppers.
Only one neighborhood outlet sold fresh produce; nearly all respondents did major food shopping outside the neighborhood. Although the nearest full-service supermarket was an average of 2.6 km from their home, respondents shopped an average of 6.0 km from home. The average trip was by car, took approximately two hours roundtrip, and occurred two to four times per month. Respondents spent approximately $37 per person per week on food. Those who made longer trips had access to cars, shopped less often, and spent less money per person. Those who traveled further when they shopped had higher BMIs, but most residents already shopped where healthy foods were available, and physical distance from full service groceries was unrelated to weight or dietary quality.
Improved access to healthy foods is the target of current policies meant to improve health. However, distance to the closest supermarket might not be as important as previously thought and thus policy and interventions that focus merely on improving access may not be effective.
PMCID: PMC4457716  PMID: 25475559
food desert; food purchasing practices; dietary quality; body mass index
10.  Neighbourhood socioeconomic disadvantage and fruit and vegetable consumption: a seven countries comparison 
Low fruit and vegetable consumption is a risk factor for poor health. Studies have shown consumption varies across neighbourhoods, with lower intakes in disadvantaged neighbourhoods. However, findings are inconsistent, suggesting that socio-spatial inequities in diet could be context-specific, highlighting a need for international comparisons across contexts.
This study examined variations in fruit and vegetable consumption among adults from neighbourhoods of varying socioeconomic status (SES) across seven countries (Australia, Canada, Netherlands, New Zealand, Portugal, Scotland, US).
Data from seven existing studies, identified through literature searches and knowledge of co-authors, which collected measures of both neighbourhood-level SES and fruit and vegetable consumption were used. Logistic regression was used to examine associations between neighbourhood-level SES and binary fruit and vegetable consumption separately, adjusting for neighbourhood clustering and age, gender and education. As much as possible, variables were treated in a consistent manner in the analysis for each study to allow the identification of patterns of association within study and to examine differences in the associations across studies.
Adjusted analyses showed evidence of an association between neighbourhood-level SES and fruit consumption in Canada, New Zealand and Scotland, with increased odds of greater fruit intake in higher SES neighbourhoods. In Australia, Canada, New Zealand and Portugal, those residing in higher SES neighbourhoods had increased odds of greater vegetable intake. The other studies showed no evidence of a difference by neighbourhood-level SES.
Acknowledging discrepancies across studies in terms of sampling, measures, and definitions of neighbourhoods, this opportunistic study, which treated data in a consistent manner, suggests that associations between diet and neighbourhood-level socioeconomic status vary across countries. Neighbourhood socioeconomic disadvantage may differentially impact on access to resources in which produce is available in different countries. Neighbourhood environments have the potential to influence behaviour and further research is required to examine the context in which these associations arise.
PMCID: PMC4456793  PMID: 25997451
Diet; Fruit; Vegetables; Socioeconomic Status; Neighbourhood; International
11.  Food Shopping Behaviors and Exposure to Discrimination 
Public health nutrition  2013;17(5):1167-1176.
This study examined food shopping behaviors, particularly distance to grocery shop, and exposure to discrimination.
Cross-sectional observational study utilizing data from a community survey, neighborhood food environment observations, and the decennial census.
Three communities in Detroit, Michigan, USA.
Probability sample of 919 African-American, Latino, and White adults in 146 census blocks and 69 census block groups.
On average, respondents shopped for groceries 3·1 miles from home, with 30·9% shopping within one mile and 22·3% more than five miles from home. Longer distance to shop was associated with being younger, African-American (compared to Latino), a woman, higher socioeconomic status, lower satisfaction with the neighborhood food environment, and living in a neighborhood with higher poverty, without a large grocery store, and farther from the nearest supermarket. African-Americans and those with the lowest incomes were particularly likely to report unfair treatment at food outlets. Each mile increase in distance to shop was associated with a 7% increase in the odds of unfair treatment; this relationship did not differ by race/ethnicity.
This study suggests that unfair treatment in retail interactions warrants investigation as a pathway by which restricted neighborhood food environments and food shopping behaviors may adversely affect health and contribute to health disparities. Efforts to promote “healthy” and equitable food environments should emphasize local availability and affordability of a range of healthy food products, as well as fair treatment while shopping regardless of race/ethnicity or socioeconomic status.
PMCID: PMC3701025  PMID: 23534814
Food shopping; Neighborhood food environment; Discrimination; Distance to Shop
12.  Impact of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Package Policy on Fruit and Vegetable Prices 
Obesity is generally inversely related to income among women in the United States. Less access to healthy foods is one way lower income can influence dietary behaviors and body weight. Federal food assistance programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), are an important source of healthy food for low-income populations. In 2009, as part of a nationwide policy revision, WIC added a fruit and vegetable (F/V) voucher to WIC food packages. This quasi-experimental study determined whether F/V prices at stores authorized to accept WIC (ie, WIC vendors) decreased after the policy revision in seven Illinois counties. It also examined cross-sectional F/V price variations by store type and neighborhood characteristics. Two pre-policy observations were conducted in 2008 and 2009; one post-policy observation was conducted in 2010. Small pre- to post-policy reductions in some F/V prices were found, particularly for canned fruit and frozen vegetables at small stores. Compared with chain supermarkets, mass merchandise stores had lower prices for fresh F/V and frozen F/V and small stores and non-chain supermarkets had higher canned and frozen F/V prices, but lower fresh F/V prices. Limited price differences were found across neighborhoods, although canned vegetables were more expensive in neighborhoods with higher concentrations of either Hispanics or blacks and fresh F/V prices were lower in neighborhoods with more Hispanics. Results suggest the WIC policy revision contributed to modest reductions in F/V prices. WIC participants’ purchasing power can differ depending on the type and neighborhood of the WIC vendor used.
PMCID: PMC4084875  PMID: 24183996
Special Supplemental Nutrition Program for Women; Infants; and Children (WIC); Food policy; Food environment; Food prices; Food assistance
13.  Do observed or perceived characteristics of the neighborhood environment mediate associations between neighborhood poverty and cumulative biological risk? 
Health & place  2013;24:10.1016/j.healthplace.2013.09.005.
To examine contributions of observed and perceived neighborhood characteristics in explaining associations between neighborhood poverty and cumulative biological risk (CBR) in an urban community.
Multilevel regression analyses were conducted using cross-sectional data from a probability sample survey (n=919), and observational and census data. Dependent variable: CBR. Independent variables: Neighborhood disorder, deterioration and characteristics; perceived neighborhood social environment, physical environment, and neighborhood environment. Covariates: Neighborhood and individual demographics, health-related behaviors.
Observed and perceived indicators of neighborhood conditions were significantly associated with CBR, after accounting for both neighborhood and individual level socioeconomic indicators. Observed and perceived neighborhood environmental conditions mediated associations between neighborhood poverty and CBR.
Findings were consistent with the hypothesis that neighborhood conditions associated with economic divestment mediate associations between neighborhood poverty and CBR.
PMCID: PMC3837295  PMID: 24100238
allostatic load; neighborhood environment; urban health inequalities; neighborhood poverty
14.  Independent and Joint Associations between Multiple Measures of the Built and Social Environment and Physical Activity in a Multi-Ethnic Urban Community 
Physical activity is associated with reduced risk of a number of health outcomes, yet fewer than half of adults in the United States report recommended levels of physical activity. Analyses of structural characteristics of the built environment as correlates of physical activity have yielded mixed results. We examine associations between multiple aspects of urban neighborhood environments and physical activity in order to understand their independent and joint effects, with a focus on the extent to which the condition of the built environment and indicators of the social environment modify associations between structural characteristics and physical activity. We use data from a stratified, multi-stage proportional probability sample of 919 non-Hispanic Black, non-Hispanic White, and Hispanic adults in an urban community, observational data from their residential neighborhoods, and census data to examine independent and joint associations of structural characteristics (e.g., street network connectivity), their condition (e.g., sidewalk condition), and social environments (e.g., territoriality) with physical activity. Our findings suggest that sidewalk condition is associated with physical activity, above and beyond structural characteristics of the built environment. Associations between some structural characteristics of the built environment and physical activity were conditional upon street condition, physical deterioration, and the proportion of parks and playgrounds in good condition. We found modest support for the hypothesis that associations between structural characteristics and physical activity are modified by aspects of the social environment. Results presented here point to the value of and need for understanding and addressing the complexity of factors that contribute to the relationships between the built and social environments and physical activity, and in turn, obesity and co-morbidities. Bringing together urban planners, public health practitioners and policy makers to understand and address aspects of urban environment associated with health outcomes is critical to promoting health and health equity.
PMCID: PMC3795195  PMID: 23435574
Built environment; Social environment; Physical activity
15.  Neighborhood food environment role in modifying psychosocial stress-diet relationships 
Appetite  2013;65:170-177.
Exposure to highly palatable foods may increase eating in response to stress, but this behavioral response has not been examined in relation to the neighborhood food environment. This study examined whether the neighborhood food environment modified relationships between psychosocial stress and dietary behaviors. Probability-sample survey (n=460) and in-person food environment audit data were used. Dietary behaviors were measured using 17 snack food items and a single eating-out-of-home item. Chronic stress was derived from five subscales; major life events was a count of 9 items. The neighborhood food environment was measured as availability of large grocery stores, small grocery stores, and convenience stores, as well as proportion of restaurants that were fast food. Two-level hierarchical regression models were estimated. Snack food intake was positively associated with convenience store availability and negatively associated with large grocery store availability. The measures of chronic stress and major life events were generally not associated with either dietary behavior overall, although Latinos were less likely to eat out at high levels of major life events than African Americans. Stress-neighborhood food environment interactions were not statistically significant. Important questions remain regarding the role of the neighborhood food environment in the stress-diet relationship that warrant further investigation.
PMCID: PMC3622780  PMID: 23415977
Neighborhood; Food environment; Psychosocial stress; Eating out; Fast food; Snack; Diet
16.  Feasibility of Using Global Positioning Systems (GPS) with Diverse Urban Adults: Before and After Data on Perceived Acceptability, Barriers, and Ease of Use 
Global positioning systems (GPS) have emerged as a research tool to better understand environmental influences on physical activity. This study examined the feasibility of using GPS in terms of perceived acceptability, barriers, and ease of use in a racially/ethnically diverse sample of lower socioeconomic position (SEP).
Data were from two pilot studies involving a total of 170 African American, Hispanic, and White urban adults with a mean (standard deviation) age of 47.8 (±13.1) years. Participants wore a GPS for up to seven days. They answered questions about GPS acceptability, barriers (wear-related concerns), and ease of use, before and after wearing the GPS.
We found high ratings of GPS acceptability and ease of use and low levels of wear-related concerns, which were maintained after data collection. While most were comfortable with their movements being tracked, older participants (p<0.05) and African Americans (p<0.05) reported lower comfort levels. Participants who were younger, with higher education, and low incomes were more likely to indicate that the GPS made the study more interesting (p<0.05). Participants described technical and wear-related problems, but few concerns related to safety, loss, or appearance.
Use of GPS was feasible in this racially/ethnically diverse, lower SEP sample.
PMCID: PMC3397153  PMID: 21952361
Global positioning system; Environment; Physical activity; Feasibility; Perceptions
17.  “You have to hunt for the fruits, the vegetables”: Environmental Barriers and Adaptive Strategies to Acquire Food in a Low-Income African-American Neighborhood 
This qualitative study sought to understand food acquisition behaviors and environmental factors that influence those behaviors among women in a low-income African American community with limited food resources. We drew upon in-depth interviews with 30 women ages 21 to 45 recruited from a community health center in Chicago, Illinois. Data were analyzed using qualitative content analysis. Emergent themes revealed that women identified multiple environmental barriers—material, economic, and social-interactional—to acquiring food in an acceptable setting. In response, they engaged in several adaptive strategies to manage or alter these challenges including optimizing, settling, being proactive, and advocating. These findings indicate that efforts to improve neighborhood food environments should address not only food availability and prices, but also the physical and social environments of stores as well.
PMCID: PMC3709968  PMID: 21511955
Neighborhood; Food environment; African Americans; Nutrition; Food shopping
18.  Inter-Rater Reliability of the Food Environment Audit for Diverse Neighborhoods (FEAD-N) 
Studies have shown that neighborhood food environments are important influences on dietary intake and may contribute to health disparities. While instruments with high reliability have been developed to assess food availability, price, and quality, few measures to assess items associated with the physical and social features of food stores have been developed. Yet, recent qualitative studies have documented aspects associated with such features of urban food stores that are barriers to food acquisition. We assessed the reliability of measures to assess multiple components of the food environment—including physical and social store features—in three geographically distinct and diverse communities in Detroit, Michigan, using the Food Environment Audit for Diverse Neighborhoods (FEAD-N). Using the FEAD-N, four trained observers conducted observations of 167 food stores over a 10-week period between October and December 2008. To assess inter-rater reliability, two trained observers independently visited, on the same day, a random subset of 44 food stores. Kappa statistics and percent agreement were used to evaluate inter-rater reliability. Overall, the instrument had mostly high inter-rater reliability with more than 75% of items with kappa scores between 0.80 and 1.00, indicating almost perfect reliability. More than half of the physical store features and 47% of the social store features had almost perfect reliability and about 37% and 47%, respectively, had substantial reliability. Measuring factors associated with the physical and social environment of food stores with mostly high reliability is feasible. Systematic documentation of the physical and social features of food stores using objective measures may promote a more comprehensive understanding of how neighborhood food environments influence health.
PMCID: PMC3368052  PMID: 22350513
Inter-rater reliability; Food environment; Physical store features; Social store features; Community-based participatory research
19.  Activity Space Environment and Dietary and Physical Activity Behaviors: A Pilot Study 
Health & place  2011;17(5):1150-1161.
This study examined relationships among individual demographics, environmental features (e.g., fast food outlet density, park land use) of residential neighborhoods and activity spaces, and obesity-related behaviors (diet, physical activity). Participants’ movement was tracked for seven days using global positioning systems (GPS). Two activity space measures (one standard deviation ellipse, daily path area) were derived from the GPS data. Activity spaces were generally larger than residential neighborhoods; environmental features of residential neighborhoods and activity spaces were weakly associated; and some activity space environmental features were related to dietary behaviors. Activity spaces may provide new insights into environmental influences on obesity-related behaviors.
PMCID: PMC3224849  PMID: 21696995
Global positioning system; Activity space; Neighborhood; Diet; Physical activity; Environment
20.  Availability of commonly consumed and culturally specific fruits and vegetables in African-American and Latino neighborhoods 
Although the importance of culture in shaping individual dietary behaviors is well documented, cultural food preferences have received limited attention in research on the neighborhood food environment. The purpose of this study was to assess the availability of commonly consumed and culturally specific fruits and vegetables in retail food stores located in majority African-American and Latino neighborhoods in southwest Chicago. A cross-sectional survey of 115 stores (15% grocery stores, 85% convenience/corner stores) in African-American neighborhoods and 110 stores (45% grocery stores, 55% convenience/corner stores) in Latino neighborhoods was conducted between May and August 2006. Chi-square tests were used to test for differences in the availability (presence/absence) of commonly consumed (n=25) and culturally specific fruits and vegetables for African-Americans (n=16 varieties) and Latinos (n=18 varieties). Stores located in neighborhoods in which the majority of residents were African-American or Latino residents were more likely to carry fresh fruits and vegetables that were culturally relevant to the dominant group. For example, grocery stores located in Latino neighborhoods were more likely to carry chayote (82.0% vs. 17.6%, p <0.05), while grocery stores located in African-American neighborhoods were more likely to carry black-eyed peas (52.9% vs. 20%, p<0.05). Most stores, however, carried less than 50% of commonly consumed or culturally specific fruits and vegetables. Findings from this study highlight that limited availability of culturally specific as well as commonly consumed fruits and vegetables in the neighborhood may serve as a barrier to fruit and vegetable consumption among African-Americans and Latinos.
PMCID: PMC3427830  PMID: 20430136
fruits; vegetables; African-American; Latinos; neighborhoods
Diets rich in dark-green and orange vegetables have been associated with a reduction in chronic diseases. However, most Americans do not consume the number of daily servings recommended by the 2005 Dietary Guidelines for Americans. An increasing number of studies suggest that changes to the neighborhood food environment may be critical to achieving population-wide improvements in eating. The objective of this study was to examine the relationship between observed neighborhood availability and individual consumption of dark-green and orange vegetables among low- to moderate-income and ethnically diverse adults in Detroit. This study used a cross-sectional design that drew upon a 2002–2003 community survey and 2002 in-person audit of food stores. A total of 919 adults (mean age 46.3 years, 52.2% female) including African Americans (56.7 %), Latinos (22.2%), and whites (18.7%) residing in three Detroit communities participated in the survey. Two-level weighted, hierarchical linear regression was used to analyze the data. On average, survey respondents ate 0.61 daily servings of dark-green and orange vegetables. Residents of neighborhoods with no stores carrying five or more varieties of dark-green and orange vegetables were associated with an average of 0.17 fewer daily servings of these foods compared with residents of neighborhoods with two stores carrying five or more varieties of dark-green and orange vegetables (P=0.047). These findings suggest that living in a neighborhood with multiple opportunities to purchase dark-green and orange vegetables may make an important contribution toward meeting recommended intakes.
PMCID: PMC3369621  PMID: 21272702
22.  Classification bias in commercial business lists for retail food stores in the U.S. 
Aspects of the food environment such as the availability of different types of food stores have recently emerged as key modifiable factors that may contribute to the increased prevalence of obesity. Given that many of these studies have derived their results based on secondary datasets and the relationship of food stores with individual weight outcomes has been reported to vary by store type, it is important to understand the extent to which often-used secondary data correctly classify food stores. We evaluated the classification bias of food stores in Dun & Bradstreet (D&B) and InfoUSA commercial business lists.
We performed a full census in 274 randomly selected census tracts in the Chicago metropolitan area and collected detailed store attributes inside stores for classification. Store attributes were compared by classification match status and store type. Systematic classification bias by census tract characteristics was assessed in multivariate regression.
D&B had a higher classification match rate than InfoUSA for supermarkets and grocery stores, while InfoUSA was higher for convenience stores. Both lists were more likely to correctly classify large supermarkets, grocery stores, and convenience stores with more cash registers and different types of service counters (supermarkets and grocery stores only). The likelihood of a correct classification match for supermarkets and grocery stores did not vary systemically by tract characteristics whereas convenience stores were more likely to be misclassified in predominately Black tracts.
Researches can rely on classification of food stores in commercial datasets for supermarkets and grocery stores whereas classifications for convenience and specialty food stores are subject to some systematic bias by neighborhood racial/ethnic composition.
PMCID: PMC3425161  PMID: 22512874
Commercial business lists; Food stores; Classification error
23.  Associations of Supermarket Characteristics with Weight Status and Body Fat: A Multilevel Analysis of Individuals within Supermarkets (RECORD Study) 
PLoS ONE  2012;7(4):e32908.
Previous research on the influence of the food environment on weight status has often used impersonal measures of the food environment defined for residential neighborhoods, which ignore whether people actually use the food outlets near their residence. To assess whether supermarkets are relevant contexts for interventions, the present study explored between-residential neighborhood and between-supermarket variations in body mass index (BMI) and waist circumference (WC), and investigated associations between brands and characteristics of supermarkets and BMI or WC, after adjustment for individual and residential neighborhood characteristics.
Participants in the RECORD Cohort Study (Paris Region, France, 2007–2008) were surveyed on the supermarket (brand and exact location) where they conducted their food shopping. Overall, 7 131 participants shopped in 1 097 different supermarkets. Cross-classified multilevel linear models were estimated for BMI and WC.
Just 11.4% of participants shopped for food primarily within their residential neighborhood. After accounting for participants' residential neighborhood, people shopping in the same supermarket had a more comparable BMI and WC than participants shopping in different supermarkets. After adjustment for individual and residential neighborhood characteristics, participants shopping in specific supermarket brands, in hard discount supermarkets (especially if they had a low education), and in supermarkets whose catchment area comprised low educated residents had a higher BMI/WC.
A public health strategy to reduce excess weight may be to intervene on specific supermarkets to change food purchasing behavior, as supermarkets are where dietary preferences are materialized into definite purchased foods.
PMCID: PMC3319546  PMID: 22496738
24.  Neighborhood Retail Food Environment and Fruit and Vegetable Intake in a Multiethnic Urban Population 
To examine relationships between the neighborhood food environment and fruit and vegetable intake in a multiethnic urban population.
Analysis of cross-sectional survey and observational data.
146 neighborhoods within three large geographic communities of Detroit, Michigan.
Probability sample of 919 African-American, Latino, and White adults.
The dependent variable was mean daily fruit and vegetable servings measured using a modified Block 98 food frequency questionnaire. Independent variables included the neighborhood food environment: store availability (large grocery, specialty, convenience, liquor, small grocery), supermarket proximity (street-network distance to nearest chain grocer), and perceived and observed neighborhood fresh fruit and vegetable supply (availability, variety, quality, affordability).
Weighted multilevel regression.
Presence of a large grocery store in the neighborhood was associated with, on average, 0.69 more daily fruit and vegetable servings in the full sample. Relationships between the food environment and fruit and vegetable intake did not differ between Whites and African-Americans. However, Latinos compared with African-Americans with a large grocery store in their neighborhood consumed 2.20 more daily servings of fruits and vegetables. Presence of a convenience store in the neighborhood was associated with 1.84 fewer daily fruit and vegetable servings among Latinos than African-Americans.
The neighborhood food environment influences fruit and vegetable intake, and the size of this relationship may vary for different racial/ethnic subpopulations.
PMCID: PMC3305995  PMID: 19288847
African Americans; Diet; Hispanic Americans; Residence Characteristics; Urban Population; Format: Research; Purpose: Modeling/relationship testing; Design: Non-experimental; Outcome: Behavioral; Setting: Local community; Health focus: Nutrition; Strategy: Built environment; Age: Adults; Population circumstances: Range of education and income levels, 3 geographic communities in Detroit, Michigan, African-Americans, Latinos, and non-Hispanic Whites
25.  Short-Term Temporal Stability in Observed Retail Food Characteristics 
Use of direct observation to characterize neighborhood retail food environments is increasing but to date most studies have relied on a single observation. If food availability, prices, and quality vary over short time periods, repeated measures may be needed to portray these food characteristics. This study evaluated short-term (2-week), within-season temporal stability in retail food availability, prices, and quality.
In-person observations of retail food stores at 2 time points, 2 weeks apart.
Southwest Chicago, IL.
157 food stores.
Main Outcome Measures
Availability and prices of foods selected from the following food groups: fruits, vegetables, grains, meats and beans, and dairy, as well as fresh produce quality.
Temporal stability was tested for availability using a McNemar test and for price and quality using a Wilcoxon signed rank test.
We found that measures of food availability and prices as well as fresh produce quality at stores were generally stable at the 2 time points.
Conclusions and Implications
This study suggests that a single observation may be sufficient to accurately characterize within-season food availability, food prices, and fresh produce quality.
PMCID: PMC2913966  PMID: 20129186

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