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结果有关。然而，大多数孩子并不 消费健康的饮食，特别是黑人/非洲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，社区特征影响 但社区计划和政策（CPP）影响饮食的有效性并不一致 按种族/族裔构成和社区社会经济地位划分。食物的上下文 环境是了解CPP对饮食有效性的重要考虑因素， 部分解释了CPP在不同亚组中的差异效应。然而，很少有研究 研究了在社区环境中改善饮食最有效的干预措施， 关于环境因素如何影响食品环境干预的国家研究就更少了 结果。拟议的研究将利用现有的NHLBI数据集和CPP信息， 背景食物环境，以及儿童、家庭、邻里、学校和社区 这些特征会影响儿童的饮食。该研究包括4，500多名K - 8年级的儿童， 在美国的130个社区中，有不同的种族/民族和社会经济地位背景。近1万 在社区内对1，400多名关键线人的访谈中记录了社区伙伴关系。情境食物 环境措施（例如，超市密度）在家庭周围1、3、5和8公里缓冲区， 在以学校为中心的缓冲区中，来自超过5800万个企业列表。具体目标是 这项研究是为了1）确定CPP和周围食物环境对饮食的影响，包括 摄入的能量密集的食物的营养价值最低;总添加糖摄入量;糖摄入量从 SSB;水果和蔬菜摄入量;全谷物消费量;和快餐消费量，以及2） 确定CPP之间的关系是否存在种族、民族和SES差异 和饮食，一旦上下文食物环境数据被考虑。为了评估我们的目标， 将估计具有随机截距和斜率的线性混合模型，以控制 社区一级。拟议的研究具有成本效益，因为它需要使用 从两个先前的研究数据。这项研究在使用CPP和背景食物方面是独一无二的 环境措施在多个地理尺度在一个大的，不同的国家样本的儿童 沿着儿童、家庭、邻里、学校和社区层面的控制变量。的 研究结果预计将有助于塑造未来社区如何投资于计划，干预措施， 制定和实施政策，以改善儿童的饮食和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.