The Importance of a Multi-Dimensional Approach for Studying the Links between Food Access and Consumption

Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112-2699, USA.
Journal of Nutrition (Impact Factor: 3.88). 06/2010; 140(6):1170-4. DOI: 10.3945/jn.109.113159
Source: PubMed


Research on neighborhood food access has focused on documenting disparities in the food environment and on assessing the links between the environment and consumption. Relatively few studies have combined in-store food availability measures with geographic mapping of stores. We review research that has used these multi-dimensional measures of access to explore the links between the neighborhood food environment and consumption or weight status. Early research in California found correlations between red meat, reduced-fat milk, and whole-grain bread consumption and shelf space availability of these products in area stores. Subsequent research in New York confirmed the low-fat milk findings. Recent research in Baltimore has used more sophisticated diet assessment tools and store-based instruments, along with controls for individual characteristics, to show that low availability of healthy food in area stores is associated with low-quality diets of area residents. Our research in southeastern Louisiana has shown that shelf space availability of energy-dense snack foods is positively associated with BMI after controlling for individual socioeconomic characteristics. Most of this research is based on cross-sectional studies. To assess the direction of causality, future research testing the effects of interventions is needed. We suggest that multi-dimensional measures of the neighborhood food environment are important to understanding these links between access and consumption. They provide a more nuanced assessment of the food environment. Moreover, given the typical duration of research project cycles, changes to in-store environments may be more feasible than changes to the overall mix of retail outlets in communities.

7 Reads
  • Source
    • "While most recent studies of food deserts have focused on geomapping the food environment by analyzing the density, location, and proximity of store types, earlier research took a marketbasket approach that examined within-store characteristics by analyzing the variety, quantity, quality, pricing, promotion, and placement of different foods (Beaulac et al., 2009). Few studies have taken a multidimensional approach, combining both geographic and within-store measures (Gustafson et al., 2013; Hermstad et al., 2010; Rose et al., 2010). Fewer still have combined multidimensional objective measures of food access with qualitative research that analyzes consumers' subjective perceptions of their food environments and interactions within them (Cannuscio et al., 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Differential access to healthy foods has been hypothesized to contribute to disparities in eating behaviors and health outcomes. While food deserts have been researched extensively in developed Anglophone countries, evidence from low- and middle-income countries is still scarce. In Mexico, prevalence of obesity is among the highest worldwide. As obesity has increased nationally and become a widespread public health issue, it is becoming concentrated in the low-income population. This mixed-methods study uses a multidimensional approach to analyze food environments in a low-, middle-, and high-income community in a Mexican city. The study advances understanding of the role that food environments may play in shaping eating patterns by analyzing the density and proximity of food outlet types as well as the variety, quantity, quality, pricing, and promotion of different foods. These measures are combined with in-depth qualitative research with families in the communities, including photo elicitation, to assess perceptions of food access. The central aims of the research were to evaluate physical and economic access and exposure to healthy and unhealthy foods in communities of differing socioeconomic status as well as participants' subjective perceptions of such access and exposure. The findings suggest a need to reach beyond a narrow focus on food store types and the distance from residence to grocery stores when analyzing food access. Results show that excessive access and exposure to unhealthy foods and drinks, or "food swamps," may be a greater concern than food deserts for obesity-prevention policy in Mexico. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Social Science [?] Medicine 08/2015; 142:202-213. DOI:10.1016/j.socscimed.2015.08.010 · 2.89 Impact Factor
  • Source
    • "There were eight separate author studies assessing the availability of energy dense snack food items or snack food items including fruits and vegetables within stores [5, 29, 59, 69, 70], or prepared foods or prepared and snack food [22, 54, 74, 19]. The studies addressing snack food availability were all conducted in urban areas; whereas the studies assessing availability of prepared foods were conducted in both rural (n = 3) and urban settings (n = 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Description of the consumer food environment has proliferated in publication. However, there has been a lack of systematic reviews focusing on how the consumer food environment is associated with the following: (1) neighborhood characteristics; (2) food prices; (3) dietary patterns; and (4) weight status. We conducted a systematic review of primary, quantitative, observational studies, published in English that conducted an audit of the consumer food environment. The literature search included electronic, hand searches, and peer-reviewed from 2000 to 2011. Fifty six papers met the inclusion criteria. Six studies reported stores in low income neighborhoods or high minority neighborhoods had less availability of healthy food. While, four studies found there was no difference in availability between neighborhoods. The results were also inconsistent for differences in food prices, dietary patterns, and weight status. This systematic review uncovered several key findings. (1) Systematic measurement of determining availability of food within stores and store types is needed; (2) Context is relevant for understanding the complexities of the consumer food environment; (3) Interventions and longitudinal studies addressing purchasing habits, diet, and obesity outcomes are needed; and (4) Influences of price and marketing that may be linked with why people purchase certain items.
    Journal of Community Health 12/2011; 37(4):897-911. DOI:10.1007/s10900-011-9524-x · 1.28 Impact Factor
  • Source
    • "In addition, an increased consumption of fruits and vegetables could also be related to how these products are displayed in supermarkets. Research shows that with more shelf-space for fruits and vegetables the purchase and consumption increases [25]. It is possible that fruits and vegetables are displayed differently in shops in Western countries compared to China. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Chinese individuals who have immigrated to a Western country initially tend to have a lower risk of cardiovascular disease (CVD) compared to people who are already living there. Some studies have found, however, that CVD risk increases over time in immigrants and that immigration to a western country is associated with changes in dietary patterns. This could have unfavourable effects on the risk of CVD. There is limited knowledge on the food patterns, awareness and knowledge about healthy nutrition among Chinese immigrants. The objective for this study is to explore changes in food patterns, and levels of awareness and knowledge of healthy nutrition by length of residence among Chinese immigrants to Canada. 120 Chinese individuals born in China but currently living in Canada completed an assessment on socio-demographic characteristics, changes in dietary patterns and variables of awareness and knowledge about healthy foods. With ordinal logistic regression the associations between the quartiles of length of residence and dietary patterns, variables of awareness and knowledge about healthy foods were explored, adjusting for age, sex, education and body mass index. More than 50% of the participants reported increasing consumption of fruits and vegetables, decreasing the use of deep-frying after immigration. Increased awareness and knowledge about healthy foods was reported by more than 50% of the participants. Ordinal regression indicated that Chinese immigrants who lived in Canada the longest, compared to Chinese immigrants who lived in Canada the shortest, consumed significant greater portion sizes (OR: 9.9; 95% CI: 3.11 - 31.15), dined out more frequently (OR: 15.8; 95% CI: 5.0 - 49.85), and consumed convenience foods more often (OR: 3.5; 95% CI: 1.23 - 10.01). Chinese immigrants reported some favourable changes in their dietary intake and greater awareness and more knowledge about healthy foods after immigration. However, an increase in portion size, an increased frequency of dining out and an increased consumption of convenience foods could indicate some unfavourable changes. These results suggest that health promotion strategies should build on the observed benefits of improved nutritional knowledge and target areas of portion size and convenience eating.
    International Journal of Behavioral Nutrition and Physical Activity 05/2011; 8(1):42. DOI:10.1186/1479-5868-8-42 · 4.11 Impact Factor
Show more


7 Reads
Available from