Obesogenic and youth oriented restaurant marketing in public housing neighborhoods.

OBJECTIVES: To compare restaurant marketing by restaurant and neighborhood type. METHODS: All restaurants (61=fast food, FF; 72=table service, TS) within an 800-meter radius of 13 public housing developments (HD) and 4 comparison neighborhoods were audited using the Restaurant Assessment Tool©2010. HD neighborhoods were lower income and higher minority than comparison neighborhoods with similar density and street connectivity. RESULTS: Restaurants in HD neighborhoods had fewer healthy entrées than comparison neighborhoods. FF restaurants had cheaper beverages and more children's meals, supersize drinks, free prize with purchase, super-size items, special characters, and more items geared to driving than TS restaurants. CONCLUSIONS: Residents of lower socioeconomic neighborhoods may be differentially exposed to unhealthy food options.

Store and restaurant advertising and health of public housing residents.

OBJECTIVES: To determine relationships between food and beverage signs and health. METHODS: In 12 public housing neighborhoods, food and alcohol signs were counted for stores and restaurants. Health and demographic data were from 373 adults. RESULTS: Multilevel modeling showed higher BMI was related to more store and restaurant alcohol signs, higher blood pressure, nonsmokers, and females. Higher dietary fat consumption was related to more store and restaurant alcohol and fewer low-calorie healthy signs, lower fruit consumption, fewer minutes walked, and white and Hispanic/Latino ethnicity. CONCLUSIONS: Signs in stores and restaurants are related to BMI and dietary fat consumption among residents.

A picture of the healthful food environment in two diverse urban cities.

BACKGROUND: Local food environments influence fresh produce purchase and consumption, and previous research has found disparities in local food environments by income and ethnicity. Other existing studies have begun to quantify the distribution of food sources, but there has been limited attention to important features or types of healthful food that are available or their quality or cost. Two studies assessed the type, quantity, quality and cost of healthful food from two diverse urban cities, Kansas City, Kansas and Missouri and Honolulu, Hawaii, and evaluated differences by neighborhood income and ethnic composition. METHOD: A total of 343 food stores in urban neighborhoods were assessed using the one-page Understanding Neighborhood Determinants of Obesity (UNDO) Food Stores Assessment (FSA) measuring healthful foods. US Census data were used to define median household income and ethnic minority concentration. RESULTS: In Study 1, most low socioeconomic status (SES), high ethnic minority neighborhoods had primarily convenience, liquor or small grocery stores. Quality of produce was typically lower, and prices of some foods were more than in comparison neighborhoods. In Study 2, low SES neighborhoods had more convenience and grocery stores. Farmers' markets and supermarkets had the best produce availability and quality, and farmers' markets and pharmacies had the lowest prices. CONCLUSIONS: Messages emphasizing eating more fruits and vegetables are not realistic in urban, low SES, high ethnic concentration neighborhoods. Farmers' markets and supermarkets provided the best opportunities for fresh produce. Increasing access to farmers' markets and supermarkets or reducing prices could improve the local food environment.

How does the built environment relate to body mass index and obesity prevalence among public housing residents?

PURPOSE: This study examined associations of environmental variables with obesity prevalence and individual body mass index (BMI) among impoverished residents of public housing developments. DESIGN: Cross-sectional data were drawn from two studies in the same Midwestern metropolitan area of participants within neighborhoods. SETTING: Pathways to Health interviewed housing development residents and Understanding Neighborhood Determinants of Obesity assessed built environment factors in the surrounding neighborhoods (i.e., 800-m radius from center of housing development). SUBJECTS: Four hundred twenty-one residents participated (mean age = 43.8 years; 72.0% women, 59.6% high school degree, 79.6% African-American). Fifty-five physical activity resources were identified and assessed. MEASURES: Demographics and measured weights and heights were obtained for participants. The Physical Activity Resource Assessment measured the type, accessibility, features, amenities, qualities, and incivilities of physical activity resources. Neighborhood street connectivity was also measured. RESULTS: Average age-adjusted BMI was 31.4 (SD = 1.3), with 45% of residents obese. High negative correlations were found between BMI and street connectivity (p = .05) and between obesity prevalence and resource accessibility (p = .09), number of amenities (p = .04), and amenity quality (p = .04). Higher resource accessibility, feature quality, number of amenities, and fewer incivilities per resource accounted for 71% of obesity variance (p < .05). Male gender and higher feature quality, F(11, 407) 37.19 and 12.66, p < .001, predicted lower BMI among residents. CONDUSION: Supportive neighborhood environments were related to lower obesity prevalence and lower BMI among residents.

Physical access in urban public housing facilities.

BACKGROUND: public housing facilities play an important role in housing individuals with physical disabilities, including older adults, who are unable to afford private housing. This study assessed general features of physical access in the common use areas of 14 federally subsidized, urban public housing facilities. METHODS: fourteen public housing facilities were assessed by trained field assessors for 6 features of accessibility. RESULTS: most housing facilities had at least 1 parking space designated with a vertical sign (86%), an entrance that was level or had a ramp (86%), and a 32-inch wide exterior door (71%). Half (50%) had a public restroom designated by signage as accessible, and most of these bathrooms had 32-inch-wide doorways and at least 1 grab bar near the toilet (86%). Most housing managers were able to identify building modifications that had been made to satisfy accessibility regulations. CONCLUSION: the results suggest that relatively large proportions (14%-29%) of federally funded housing facilities are not complying with federal regulations. Better education and compliance are needed to ensure access for all in public housing facilities.

Associations between the built environment and physical activity in public housing residents.

BACKGROUND: Environmental factors may influence the particularly low rates of physical activity in African American and low-income adults. This cross-sectional study investigated how measured environmental factors were related to self-reported walking and vigorous physical activity for residents of low-income public housing developments. METHODS: Physical activity data from 452 adult residents residing in 12 low-income housing developments were combined with measured environmental data that examined the neighborhood (800 m radius buffer) around each housing development. Aggregated ecological and multilevel regression models were used for analysis. RESULTS: Participants were predominately female (72.8%), African American (79.6%) and had a high school education or more (59.0%). Overall, physical activity rates were low, with only 21% of participants meeting moderate physical activity guidelines. Ecological models showed that fewer incivilities and greater street connectivity predicted 83% of the variance in days walked per week, p < 0.001, with both gender and connectivity predicting days walked per week in the multi-level analysis, p < 0.05. Greater connectivity and fewer physical activity resources predicted 90% of the variance in meeting moderate physical activity guidelines, p < 0.001, and gender and connectivity were the multi-level predictors, p < 0.05 and 0.01, respectively. Greater resource accessibility predicted 34% of the variance in days per week of vigorous physical activity in the ecological model, p < 0.05, but the multi-level analysis found no significant predictors. CONCLUSION: These results indicate that the physical activity of low-income residents of public housing is related to modifiable aspects of the built environment. Individuals with greater access to more physical activity resources with fewincivilities, as well as, greater street connectivity, are more likely to be physically active.

Obesogenic influences in public housing: a mixed-method analysis.

BACKGROUND: Obesity prevalence is higher among those who live in impoverished environments. This investigation identified obesogenic factors in urban neighborhoods surrounding public housing developments (HDs). DESIGN: Cross-sectional quantitative survey data from 14 HD neighborhoods and qualitative interviews of the HD managers. SETTING: Kansas City, Kansas, and Kansas City, Missouri. SUBJECTS: Environmental data were collected from HDs and surrounding neighborhoods, an area enclosed by an 800-m radius line drawn from the HD centroid. Qualitative data were collected from all 14 HD managers. MEASURES: HDs were rated by a brief environmental audit. HD managers were assessed in a structured 45- to 60-minute interview about neighborhood factors influencing resident obesity. RESULTS: The properties were typically modern and well maintained; however, there were few physical activity (PA) resources and food sources on site. Most HD managers cited the availability of PA resources near the HD; however, there was wide variability in the type and accessibility of the resources. Only two HDs had a store that sold groceries within one block. Interviews identified fast food restaurants as common food sources, with few other food sources available. DISCUSSION: Data suggested that although strides have been made to increase safety and comfort in public housing, there remains poor access to PA resources and healthful food sources. Interventions and policies should consider access to PA resources and food sources.

The Physical Activity Resource Assessment (PARA) instrument: evaluating features, amenities and incivilities of physical activity resources in urban neighborhoods.

BACKGROUND: Neighborhood environment factors may influence physical activity (PA). The purpose of this study was to develop and test a brief instrument to systematically document and describe the type, features, amenities, quality and incivilities of a variety of PA resources. METHOD: The one-page Physical Activity Resource Assessment (PARA) instrument was developed to assess all publicly available PA resources in thirteen urban lower income, high ethnic minority concentration neighborhoods that surrounded public housing developments (HDs) and four higher income, low ethnic minority concentration comparison neighborhoods. Neighborhoods had similar population density and connectivity. Trained field coders rated 97 PA resources (including parks, churches, schools, sports facilities, fitness centers, community centers, and trails) on location, type, cost, features, amenities, quality and incivilities. Assessments typically took about 10 minutes to complete. RESULTS: HD neighborhoods had a mean of 4.9 PA resources (n = 73) with considerable variability in the type of resources available for each neighborhood. Comparison neighborhoods had a mean of 6 resources (n = 24). Most resources were accessible at no cost (82%). Resources in both types of neighborhoods typically had about 2 to 3 PA features and amenities, and the quality was usually mediocre to good in both types of neighborhoods. Incivilities at PA resources in HD neighborhoods were significantly more common than in comparison neighborhoods. CONCLUSION: Although PA resources were similar in number, features and amenities, the overall appearance of the resources in HD neighborhoods was much worse as indicated by substantially worse incivilities ratings in HD neighborhoods. The more comprehensive assessment, including features, amenities and incivilities, provided by the PARA may be important to distinguish between PA resources in lower and higher deprivation areas.