“I Didn’t Choose These Foods, My Built Environment Did”: An Association between the Built Environment and Access to Healthy Foods for Adolescents Open Access

Abstract

Background: Adolescent prevalence of obesity has risen in North America, triggering serious health concerns across the US. In 2016, obesity prevalence was reported as 20.6% among US adolescents (Hales et al., 2017). Some studies show that this percentage is different between socioeconomic groups. Obesity prevalence among Black youth (22%) and Hispanic youth (25%) is higher in the US than for White youth (14.1%) and Asians (11%). (Hales et al., 2017). Although there are many causes of adolescent obesity related to SES, genetics, and physical activity, this thesis posits that the built environment may affect adolescent’s access to healthy foods, placing them at risk for obesity. The goal of this thesis is to explain the relationship between food access and differences in the built environment of two neighborhoods in Atlanta, GA, and the role these neighborhood disparities play in the risk for adolescent obesity.

 

Methods: Two urban neighborhoods in Atlanta with different SES were chosen for this study. A network analysis using Geographic Information System identified proximity of food outlets to neighborhoods of adolescents. Additionally, four neighborhood audits were conducted using a Walkability Tool to observe eight attributes that determine an adolescent’s ability to walk to different food outlets.

 

Results: The analysis focused on two themes: 1) proximity of food outlets and 2) features of the built environment that indicate a person’s ability to walk to a nearby destination. In this analysis, the low-income neighborhood showed unhealthy food outlets in close proximity (0.77 miles) with low walkability scores versus the high-income neighborhood that had healthy food outlets in close proximity (0.83 miles) with high walkability scores. The findings highlighted disparity in the location, number of healthy food outlets, and built environment of a low-income vs high-income neighborhood in Atlanta.

 

Conclusion: We conclude that public health and public planning professionals need to address the built environment when developing interventions that target obesity prevention for adolescents.

Table of Contents

CHAPTER I: Introduction             9

Puberty and Adolescent Obesity 10

Adolescent Obesity and the Built Environment  12

Purpose of the Study     12

Research Questions      13

Significance of the Study             14

CHAPTER II: Literature Review   15

Known Factors Related to Food Access and Adolescent Obesity  15

Personal Factors and Food Access           15

School Environment and Food Access    18

Society Influence and Food Access          19

Gaps in the Relationship             20

Summary of the Literature Review          23

CHAPTER III: Methods   25

INTRODUCTION 25

Study Areas      25

INSTRUMENT DESIGN   27

Spatial Analysis 27

Neighborhood Audit     27

SELECTION OF DATA POINTS & INDICATORS       30

Spatial Analysis 30

Neighborhood Audit     32

DATA COLLECTION        33

Spatial Analysis 33

Neighborhood Audit     34

DATA MANAGEMENT   34

DATA ANALYSIS 35

Spatial Analysis 35

Neighborhood Audit     35

ETHICAL CONSIDERATIONS        36

CHAPTER IV: Results      37

Study Population           37

SPATIAL ANALYSIS          39

NEIGHBORHOOD AUDIT 49

Route 1: Walking to gas stations, convenience stores, and fast food restaurants in Mechanicsville    51

Route 2: Walking to gas stations, convenience stores, and fast food restaurants in Inman Park          61

Route 3: Walking to grocery stores, markets, and sit-down restaurants in Mechanicsville 70

Route 4: Walking to grocery stores, markets, and sit-down restaurants in Inman Park       77

CHAPTER V: Discussion 85

APPENDIX          93

REFERENCES     98

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Urban and Regional Planning Health Sciences, Nutrition
Keyword	built environment adolescents planning obesity walkability food access
Committee Chair / Thesis Advisor	Joanne McGriff, Emory University
Committee Members	Arthi Rao, Georgia Institute of Technology

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