Multilevel correlates of satisfaction with neighborhood availability of fresh fruits and vegetables.

BACKGROUND: Little is known about influences on perceptions of neighborhood food environments, despite their relevance for food-shopping behaviors and food choices. PURPOSE: This study examined relationships between multilevel factors (neighborhood structure, independently observed neighborhood food environment, and individual socioeconomic position) and satisfaction with neighborhood availability of fruits and vegetables. METHODS: The multilevel regression analysis drew on data from a community survey of urban adults, in-person audit and mapping of food stores, and the 2000 Census. RESULTS: Satisfaction with neighborhood availability of fruits and vegetables was lower in neighborhoods that were farther from a supermarket and that had proportionately more African-American residents. Neighborhood poverty and independently observed neighborhood fruit and vegetable characteristics (variety, prices, and quality) were not associated with satisfaction. Individual education modified relationships between neighborhood availability of smaller food stores (small grocery stores, convenience stores, and liquor stores) and satisfaction. CONCLUSIONS: Individual-level and neighborhood-level factors affect perceptions of neighborhood food environments.

Neighborhood retail food environment and fruit and vegetable intake in a multiethnic urban population.

PURPOSE: To examine relationships between the neighborhood food environment and fruit and vegetable intake in a multiethnic urban population. DESIGN: Analysis of cross-sectional survey and observational data. SETTING: One hundred forty-six neighborhoods within three large geographic communities of Detroit, Michigan. SUBJECTS: Probability sample of 919 African-American, Latino, and white adults. MEASURES: The dependent variable was mean daily fruit and vegetable servings, as measured by using a modified Block 98 food frequency questionnaire. Independent variables included the neighborhood food environment: store availability (i.e., large grocery, specialty, convenience, liquor, small grocery), supermarket proximity (i.e., street-network distance to nearest chain grocer), and perceived and observed neighborhood fresh fruit and vegetable supply (i.e., availability, variety, quality, affordability). ANALYSIS: Weighted, multilevel regression. RESULTS: 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, who had a large grocery store in the 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 among African-Americans. CONCLUSION: The neighborhood food environment influences fruit and vegetable intake, and the size of this relationship may vary for different racial/ethnic subpopulations.

Healthy eating and exercising to reduce diabetes: exploring the potential of social determinants of health frameworks within the context of community-based participatory diabetes prevention.

OBJECTIVES: We examined a community-based participatory diabetes intervention to identify facilitators of and barriers to sustained community efforts to address social factors that contribute to health. METHODS: We conducted a case study description and analysis of the Healthy Eating and Exercising to Reduce Diabetes project in the theoretical context of a conceptual model of social determinants of health. RESULTS: We identified several barriers to and facilitators of analysis of social determinants of a community-identified disease priority (in this case, diabetes). Barriers included prevailing conceptual models, which emphasize health behavioral and biomedical paradigms that exclude social determinants of health. Facilitating factors included (1) opportunities to link individual health concerns to social contexts and (2) availability of support from diverse partners with a range of complementary resources. CONCLUSIONS: Partnerships that offer community members tangible resources with which to manage existing health concerns and that integrate an analysis of social determinants of health can facilitate sustained engagement of community members and health professionals in multilevel efforts to address health disparities.