The role of the contextual food environment and community programs and policies on diet and dietary disparities in the national Healthy Communities Study

摘要 不健康的饮食与许多有害的健康后果有关。然而，大多数儿童并不这样做。 食用健康的饮食，特别是黑人/非裔美国人和西班牙裔儿童，以及低收入儿童 社会经济地位(SES)。以前的研究发现，社区特征会影响 饮食，但社区计划和政策(CPP)影响饮食的有效性并不一致 各社区按种族/民族构成和社区社会经济地位分列。与环境相关的食物 在理解CPP对饮食的有效性时，环境是一个重要的考虑因素，可能 在一定程度上，解释不同分组之间CPP的不同影响。然而，很少有研究表明 研究了哪些干预措施最有效地改善了社区环境和 关于背景因素如何影响食品环境干预的全国性研究更少 结果。拟议的研究将利用现有的NHLBI数据集和关于CPP的信息， 与环境相关的食物环境，以及儿童、家庭、邻里、学校和社区 会影响儿童饮食的特征。这项研究包括4500多名K-8年级的儿童 美国130个社区的不同种族/民族和社会经济地位背景。近万人 从社区内对1400多名关键线人的访谈中记录了国家方案。情境式食物 环境测量(例如，超市的密度)在家庭周围的1、3、5和8公里的缓冲区中， 在以学校为中心的缓冲区中，来自5800多万个企业列表。其中的具体目标 这项研究的目的是：1)确定CPP和相关的食物环境对饮食的影响，包括 摄取营养价值极低的高能量食物；总的添加糖摄入量；从 SSB；水果和蔬菜摄入量；全谷物消费；和快餐消费，以及2) 确定在CPP之间的关系中是否存在种族、民族和SES的差异 和饮食，一旦考虑到背景食物环境数据。为了评估我们的目标，一个广义的 具有随机截距和斜率的线性混合模型将被估计为控制在 社区层面。拟议的研究具有成本效益，因为它需要使用以下方法进行二次数据分析 将之前两项研究的数据联系起来。这项研究在使用CPP和上下文食物方面是独一无二的 在全国范围内对大量不同的儿童进行多地理尺度的环境测量 以及儿童、家庭、邻里、学校和社区层面的控制变量。这个 预计这些发现将有助于塑造未来社区对计划、干预和 制定和实施政策，以改善儿童的饮食并解决与饮食有关的健康问题 生命早期的差异。

ABSTRACT Unhealthy diets are associated with numerous deleterious health outcomes. Yet, most children do not consume a healthy diet, in particular Black/African American and Hispanic children, and children of low socio-economic status (SES). Previous studies have found that community characteristics influence diet but the effectiveness of community programs and policies (CPPs) to influence diet is not consistent across communities by racial/ethnic composition and community SES. The contextual food environment is an important consideration in understanding the effectiveness of CPPs on diet and may explain, in part, the differential effect of CPPs across subgroups. However, very few studies have examined what interventions are most effective for improving diet within community settings and there are even fewer national studies of how contextual factors influence food environment intervention outcomes. The proposed study will leverage existing NHLBI datasets with information on CPPs, contextual food environments, and child, household, neighborhood, school, and community characteristics that can affect child diet. The study includes over 4,500 children in grades K – 8 from diverse racial/ethnic and SES backgrounds in 130 communities in the United States. Nearly 10,000 CPPs were documented from over 1,400 key informant interviews within communities. Contextual food environment measures (e.g., density of supermarkets) in 1, 3, 5, and 8 km buffers around the home, and in a school-centric buffer, were derived from over 58 million business listings. The specific aims in this study are to 1) determine the effect of CPPs and the contextual food environment on diet including intake of energy-dense foods of minimal nutritional value; total added sugar intake; sugar intake from SSBs; fruit and vegetable intake; whole grain consumption; and fast food consumption, and 2) determine whether differences persist by race, ethnicity, and SES in the relationship between CPPs and diet once contextual food environment data are considered. To assess our aims, a generalized linear mixed model with random intercepts and slopes will be estimated controlling for clustering at the community level. The proposed study is cost-effective in that it entails secondary data analyses using linked data from two previous studies. The study is unique in its use of CPPs and contextual food environment measures at multiple geographic scales in a large, diverse national sample of children along with control variables at the child, household, neighborhood, school, and community levels. The findings are expected to help shape how future community investments in programs, interventions, and policies are tailored and implemented to improve children’s diets and to address diet-related health disparities early in life.