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Background While prior studies have linked the neighborhood environment and development of subclinical atherosclerosis, it is unknown whether living in neighborhoods with greater availability of "unhealthy" food outlets (fast-food chain restaurants and convenience stores) is associated with risk of developing coronary artery calcification ( CAC ). Methods and Results We included 2706 CARDIA study (Coronary Artery Risk Development in Young Adults) participants who underwent CAC measurement during follow-up years 15 (2000-2001), 20 (2005-2006), and 25 (2010-2011). Neighborhood features examined included percentage of all food outlets that were convenience stores and fast-food chain restaurants within a 3-km Euclidean buffer distance from each participant's residence. Econometric fixed effects models, which by design control for all time-invariant covariates, were used to model the longitudinal association between simultaneous within-person change in percentage food outlet and change in CAC . At baseline (year 15), 9.7% of participants had prevalent CAC . During 10 years of follow-up, 21.1% of participants developed CAC . Each 1-SD increase in percentage of convenience stores was associated with a 1.34 higher odds of developing CAC (95% CI : 1.04, 1.72) after adjusting for individual- and neighborhood-level covariates; however, there was no significant association between increased percentage of fast-food chain restaurants and developing CAC (odds ratio=1.15; 95% CI : 0.96, 1.38). There were no significant associations between increases in either food outlet percentage and progression of CAC . Conclusions Our findings suggest that increases in the relative availability of convenience stores in participants' neighborhoods is related to the development of CAC over time.
BACKGROUND - Food deserts, areas that lack full-service grocery stores, may contribute to rising rates of obesity and chronic diseases among low-income and racial/ethnic minority residents. Our corner store project, part of the Centers for Disease Control and Prevention's Communities Putting Prevention to Work initiative, aimed to increase availability of healthful foods in food deserts in Nashville, Tennessee.
COMMUNITY CONTEXT - We identified 4 food deserts in which most residents are low-income and racially and ethnically diverse. Our objectives were to develop an approach to increase availability of fresh fruits and vegetables, low-fat or nonfat milk, and 100% whole-wheat bread in Nashville's food deserts and to engage community members to inform our strategy.
METHODS - Five corner stores located in food deserts met inclusion criteria for our intervention. We then conducted community listening sessions, proprietor surveys, store audits, and customer-intercept surveys to identify needs, challenges to retailing the products, and potential intervention strategies.
OUTCOME - Few stores offered fresh fruits, fresh vegetables, low-fat or nonfat milk, or 100% whole-wheat bread, and none stocked items from all 4 categories. Major barriers to retailing healthful options identified by community members are mistrust of store owners, history of poor-quality produce, and limited familiarity with healthful options. Store owners identified neighborhood crime as the major barrier. We used community input to develop strategies.
INTERPRETATION - Engaging community residents and understanding neighborhood context is critical to developing strategies that increase access to healthful foods in corner stores.
The 2000 edition of Nutrition and Your Health: Dietary Guidelines for Americans is the first to include a specific guideline for grain foods, separate from fruits and vegetables, and recognize the unique health benefits of whole grains. This paper describes and evaluates major tools for assessing intakes of total grains and whole grains, reviews current data on who consumes grain foods and where, and describes individual- and market-level factors that may influence grain consumption. Aggregate food supply data show that U.S. consumers have increased their intake of grain foods from record low levels in the 1970s, but consumption of whole-grain foods remains low. Data on individual intakes show that consumption of total grains was above the recommended 6 serving minimum in 1994-1996, but consumption of whole grains was only one third of the 3 daily servings many nutritionists recommend. Increased intake of whole-grain foods may be limited by a lack of consumer awareness of the health benefits of whole grains, difficulty in identifying whole-grain foods in the marketplace, higher prices for some whole-grain foods, consumer perceptions of inferior taste and palatability, and lack of familiarity with preparation methods. In July 1999, the U.S. Food and Drug Administration authorized a health claim that should both make it easier for consumers to identify and select whole-grain foods and have a positive effect on the availability of these foods in the marketplace.