Unequal access to healthy, affordable foods is hypothesized to be a key underlying cause of race- and class-based disparities in diet- and weight-related health in the United States. However, evidence for the specific pathways through which food environments affect health is inconclusive. Mixed findings may result from several methodological challenges, including: a reliance on residential neighborhood-based measures of exposure, a lack of data on actual food shopping practices, and limited attention to differences within underserved communities.
The present study uses an activity space approach, defined by the full extent of locations people routinely visit, to evaluate: 1) whether measures of food access, and their association with food shopping practices, differ by the use of residential neighborhood versus activity space measurement approaches, 2) whether associations between food access and dietary intake or body mass index (BMI) differ by the use of residential neighborhood versus activity space measurement approaches, 3) whether food shopping practices are associated with dietary intake or BMI, and 4) whether food access or food shopping practices differ by food security status.
We recruited African American women between the ages of 18-44 (n=199) from two safety-net health care clinics in Atlanta, Georgia. Activity space data were collected using an adapted version of the Visualization and Evaluation of Routine Itineraries, Travel destinations, and Activity Spaces (VERITAS) tool. We obtained retail food outlet data from the Georgia Departments of Public Health and Agriculture, and assessed three dimensions of food access: density, proximity, and quality. We measured dietary intake using a food frequency questionnaire and abstracted BMI from medical records. We used generalized estimating equations (GEE) to estimate adjusted associations between exposures and outcomes, controlling for the correlation of women within residential census tracts.
Food access differed between the residential neighborhood and activity space environments across all three dimensions of access. However, associations between food access and food shopping practices, dietary intake, and BMI did not differ by environment type. Food access in the residential neighborhood and the activity space was associated with food shopping practices and BMI, while food shopping practices were associated with dietary intake. Importantly, the most salient dimensions of access varied by outlet type. Finally, we found limited evidence that food access or food shopping practices varied by food security status.
While activity space approaches more precisely represent the environments to which people are exposed, they do not offer a magic bullet for understanding the complex pathways through which food environments affect health. Continued examination of exposure and use, acknowledgement of the multidimensionality of access, and attention to the unique food environments women experience as they move through their daily lives, will provide much needed insight into how food environments can be modified to be more supportive of healthy eating.
Table of Contents
Chapter 1: Introduction. 1
Specific aims, conceptual framework, and gaps addressed. 4
Literature review.. 8
Chapter 2: Crossing imaginary lines: An activity space approach to understanding how food environments affect the food shopping practices of low-income African American mothers in Atlanta, GA.. 31
Chapter 3: Leaving the food desert: An activity space approach to understanding how food access and food purchasing practices are associated with dietary intake and BMI among low-income African American women in Atlanta, GA.. 70
Chapter 4: Putting food insecurity into place: Associations between the community food environment, food shopping practices, and food insecurity among low-income African American women in Atlanta, GA 104
Chapter 5: Conclusion. 137
Summary of findings. 138
Implications for research. 145
Implications for practice. 149
Appendix. Retail food environment data cleaning protocol 156
About this Dissertation
|Committee Chair / Thesis Advisor|
|File download under embargo until 20 August 2021||2019-07-11||File download under embargo until 20 August 2021|