Obesity and Metabolic Risk Disparities: Underlying Food Environment Factors

说明(申请人提供)：虽然差异研究的主要重点一直是按种族、族裔和社会经济地位亚群理解健康决定因素和结果的模式，但在理解如何利用公共政策缩小这些差距方面存在重大差距。拟议的项目审查了食品价格和食品环境因素，这两个领域的政策变化潜力很大。我们将使用纵向数据来了解食品价格变化、可获得性和获得外出就餐和食品购物选择对饮食的影响，进而了解体重增加和代谢风险因素。我们将最终确定一个纵向数据集，将食品价格和食品环境指标与青年冠状动脉风险发展(CARDIA)受访者的居住地点在地理和时间上联系起来。CARDIA研究是一项在种族、年龄和性别平衡的队列中对5,115名18-30岁的黑人和白人年轻成年人(1985-86年)进行跟踪调查，直至2010-11年的25年后，心血管疾病的前因和风险因素的研究。我们利用与个人数据相关联的邻里层面数据，采用多学科方法，将空间分析方法与传统的流行病学和经济学方法相结合。我们研究了食品价格、社区食品和社会环境因素如何与个人水平的家庭收入和教育相互作用，以影响对饮料和饮食质量的总体衡量标准的采用和维持。此外，我们将考察这些行为对体重和代谢风险因素(例如空腹血糖、腰围、收缩和舒张压、甘油三酯以及低密度脂蛋白和高密度脂蛋白胆固醇)在25年内变化的影响。我们具体研究了这些关系在个人级别的种族/民族、收入和教育方面的差异。这项拟议的研究建立在我们创建CARDIA邻里水平数据集的基础上，该数据集包括考试年1-20年的价格和经济数据，以及1-15年的食品环境数据集(我们目前没有20年的食品环境数据)。具体目标包括：1)增加第20年(2005-06年)相同的食物环境数据，届时我们将有第三波个人水平的饮食数据；2)建立和实施一个完整的结构方程模型，具体侧重于种族-种族(黑人与白人)、收入(高与低)、教育(高与低)之间的比较，以联合检查经济和食物环境因素对以下方面的时间影响：(A)个人水平的饮料摄入量和总体饮食质量，(B)体重维持和增加的模式，以及(C)上述代谢风险因素的发生率、持久性和逆转(控制居住选择、怀孕和婚姻状况、体力活动和吸烟)。使用这个完整的系统，我们将能够检查食品价格和食品环境因素与饮食、体重和代谢风险因素之间的全套关系。我们的总体影响是确定与健康相关的经济和食品环境因素，这些因素可以作为干预措施的潜在目标，以减少肥胖和代谢风险方面的差异。

DESCRIPTION (provided by applicant): While a major focus of disparities research has been on understanding patterns of health determinants and outcomes by race-ethnic and SES subpopulations, there are major gaps in understanding how to use public policy to reduce these gaps. The proposed project examines food prices and food environment factors, two areas with great potential for policy change. We will use longitudinal data to understand the effects of changes in food prices, and availability and access to away-from-home food eateries and food shopping options on diet, and in turn, weight gain and metabolic risk factors. We will finalize a longitudinal data set that geographically and temporally links food price and food environment measures to residential locations of respondents of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a study of the antecedents and risk factors for cardiovascular disease in an ethnicity-, age-, and sex-balanced cohort of 5,115 black and white young adults aged 18-30 years at baseline (1985-86) and followed over 25 years into 2010-11. We capitalize upon neighborhood-level data linked to individual data using a multidisciplinary approach melding spatial analysis methodologies with traditional epidemiological and economic methods. We examine how food prices and neighborhood food and social environmental factors interact with individual-level household income and education to affect the adoption and maintenance of overall measures of beverage and diet quality. Furthermore, we will examine the effect of these behaviors on change in weight and metabolic risk factors (e.g., fasting glucose, waist circumference, systolic and diastolic blood pressure, triglycerides, and LDL and HDL cholesterol) over 25 years. We specifically examine how these relationships differ by individual-level race/ethnicity, income, and education. The proposed study builds on work we have done to create a CARDIA neighborhood-level dataset consisting of price and economic data for Exam Years 1-20 and a food environment dataset for years 1-15 (we currently do not have food environment data for year 20). Specific aims include: 1) Add identical food environment data for Year 20 (2005-06) when we will have the third wave of individual-level dietary data; 2) Create and implement a full structural equations model with a specific focus on comparisons within race-ethnicity (black versus white), income (high versus low), education (high versus low) to jointly examine the temporal impact of economic and food environment factors on: (a) individual-level beverage intake and overall diet quality, (b) patterns of weight maintenance and gain, and (c) the incidence, persistence, and reversal on the above metabolic risk factors (controlling for residential choice, pregnancy and marriage status, physical activity and smoking). Using this full system we will be able to examine the full set of relationships between food prices and food environment factors with diet, weight and metabolic risk factors. Our overall impact is to identify economic and food environment factors that are associated with health and can be addressed as potential targets for intervention to reduce disparities in obesity and metabolic risk.