Improving access to healthful foods such as fruits, vegetables, and whole grains has been an important policy strategy, intended to improve diet and reduce obesity among vulnerable populations. In our parent grant (Does a New Supermarket Improve Dietary Behaviors of Low-income African Americans? R01CA149105), our team capitalized on a natural experiment in which a Healthy Food Financing Initiative (HFFI)-supported full-service supermarket (FSS) was opened in an underserved area. In 2011, we enrolled a cohort (N=1,372) of randomly selected households from an intervention neighborhood (that received the new FSS) and a similar comparison neighborhood and followed the cohort from prior to the FSS?s opening through one year post-opening. We found that intervention neighborhood residents had some dietary improvements ? lower added sugars, calories, and saturated fats, alcohols and added sugars (SoFAAS). However, use of the new FSS, the hypothesized mediator, was not associated with dietary changes. The proposed renewal grant seeks to examine whether the socioeconomic impact that the new FSS or anticipation of it and other developments among investors, had on the neighborhood might be responsible for the dietary improvements we observed. It also taps into a new opportunity to examine the effect of much larger ongoing and impending revitalization of the intervention neighborhood on neighborhood socioeconomic conditions and diet. Addressing these research questions will help us to better understand and to replicate the dietary improvements of placing an FSS in a food desert. Results will speak to the substantial literature linking neighborhood socioeconomic conditions, diet, and weight, largely limited to cross-sectional studies. We will also examine the extent to which the dietary improvements we observed in our parent study are maintained, and the pathways by which neighborhood socioeconomic conditions may impact diet. To achieve this, we will obtain and merge secondary retrospective and prospective data concerning neighborhood socioeconomic conditions (NSEC) of the intervention and control neighborhoods with existing survey data and neighborhood audits, and collect two additional waves of survey and audit data capturing the impending major neighborhood revitalization projects that are underway or in development. Data will be analyzed using difference in difference and structural modeling approaches to test the impact of these natural experiments and the hypothesized causal pathway from neighborhood change to dietary improvement. Thus, the proposed renewal will capitalize on our existing data, cohort, and research infrastructure to address critically important follow-on questions and will be the first study, to our knowledge, to test whether SES improvements at the neighborhood and individual level are associated with improved diet and weight status.
Improving access to healthful foods such as fruits, vegetables, and whole grains has been a highly touted policy strategy, intending to improve diet and reduce obesity among vulnerable populations. Our parent study documented some improvements in diet among residents after the opening of a full-service supermarket in a low-income, predominantly African American neighborhood in Pittsburgh, PA. However, we found no association between use of the new supermarket and the dietary improvements. Our proposed study will continue to follow the randomly selected cohort to examine whether dietary changes are maintained, and to what degree a very large additional investment in the neighborhood results in dietary improvements. It is possible that the opening of the new supermarket created a neighborhood-level shift in socioeconomic conditions and, although much literature exists around neighborhood socioeconomic status (SES) and its association with diet and weight status, we know of no studies that have linked shifts in SES to changes in diet or weight. Should neighborhood SES improvement underlie dietary improvements, neighborhood investments other than increased access to healthful food might serve the same function and should be considered.
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