Improving Diet in Low-Income Neighborhoods

Chronic diseases are a serious public health problem in America, but risk for many chronic diseases can be modified by diet. The "food environment" (the physical environment, or settings, in which there are opportunities to eat or buy foods) has been identified as having a potential impact on diet and health outcomes. Recent policies propose changing the food environment, for example, building new supermarkets in poor neighborhoods. This dissertation examines the role of the food environment as a policy lever to improve diet, with a focus on sugar sweetened beverage (SSB) consumption.

Using data from the Pittsburgh Hill/Homewood Research on Eating, Shopping & Health (PHRESH) study, I looked at whether aspects of the food environment — distance, density, shopping frequency, and store characteristics — were associated with adult SSB consumption and whether these relationships changed over time. I found no longitudinal associations and only one cross-sectional association between eating at fast food restaurants and higher SSB consumption.

In a subset of PHRESH participants with children (5-13 years old), I examined the role of the food environment on children's SSB consumption by considering whether in-store marketing characteristics influence both children's "pestering" and parents' purchase decisions about junk foods. The in-store marketing characteristics were not related to child or parent behaviors, however, frequency of children's pestering and home availability of soda were both positively associated with child soda consumption.

Finally, I described how the public discusses different policies to change the food environment by analyzing online comments about a policy to decrease access to unhealthy foods (by limiting portion sizes of SSBs) and a policy to increase access to healthy foods (by expanding infrastructure for food stores). Comments about limiting portion sizes used negative language and frequently used words like "freedom", "rights", and "choice", while comments about expanding food stores used narrative language and suggested barriers to healthy eating.

Taken together, this dissertation provides a better understanding of the food environment, identifies needs for future research, and offers policymakers recommendations for how to improve diet and health for a vulnerable population.