Diet and nutrition-related factors including obesity are second only to tobacco as determinants of cancer risk. Researchers and health professionals increasingly are recognizing the influence of the built environment on health outcomes and behaviors such as diet and physical activity. Several studies now provide evidence that the types of food outlets present in a community are related to diet behaviors such as eating the recommended amounts of fruit and vegetables and meeting the dietary fat recommendations. Distance to a supermarket also may influence dietary intake quality. The advent of geographic information systems (GIS) technology has made the exploration of spatial attributes like the nutritional environment a novel and promising domain for epidemiologic research. To facilitate such research, methodology to characterize and quantify the nutritional environment must be developed through a rigorous and comprehensive process. The proposed study has the following aims: 1) To construct a spatially and temporally accurate and verified GIS database on the nutritional environment of one urban and seven rural counties utilizing available data sources verified by ground-truthing field work. 2) To develop and apply meaningful accessibility measures to the spatial nutritional environment database. These will include the cumulative index, the cumulative opportunity index and sophisticated gravity measures. 3) To evaluate the statistical properties of the nutritional accessibility measures in their applications to the underlying database for both research and public health purposes. 4) To evaluate the association of Census-based demographic and socio-economic characteristics with the accessibility measures of the nutritional environment. The proposed study will be groundbreaking in several ways. It will be the first to rigorously evaluate the statistical properties of the nutritional accessibility measures using GIS technology, thereby leading to improvements in the measurement and assessment of this novel dimension in nutritional epidemiology. Furthermore, it will be conducted on both rural and urban nutritional environments, which is important because rural areas, largely overlooked to date, present additional methodological challenges embedded in the underlying geography and data quality. The methodology developed in the proposed study has the potential to make a highly innovative contribution to both research and public health practice. Multi-level observational studies and intervention programs will be able to build upon these measures of community-level influences on individual dietary behaviors in their study design phase. Furthermore, our research will allow public health planners to identify and target communities with inadequate nutrition environments. Project Narrative The proposed study on accessibility measures of the nutritional environment can serve as the foundation for both epidemiologic research and public health practice. Multi-level observational studies and intervention programs will be able to build upon these measures of community-level influences on individual dietary behaviors in their study design phase. Furthermore, our research will allow public health planners to identify and target communities with inadequate nutrition environments.
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