标题：Neighborhood Availability of Convenience Stores and Diet Quality: Findings From 20 Years of Follow-Up in the Coronary Artery Risk Development in Young Adults Study
摘要：Objectives. We examined the association between neighborhood convenience stores and diet outcomes for 20 years of the Coronary Artery Risk Development in Young Adults study. Methods. We used dietary data from the Coronary Artery Risk Development in Young Adults study years 1985–1986, 1992–1993, and 2005–2006 (n = 3299; Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA) and geographically and temporally matched neighborhood-level food resource and US Census data. We used random effects repeated measures regression to estimate associations between availability of neighborhood convenience stores with diet outcomes and whether these associations differed by individual-level income. Results. In multivariable-adjusted analyses, greater availability of neighborhood convenience stores was associated with lower diet quality (mean score = 66.3; SD = 13.0) for participants with lower individual-level income (b = −2.40; 95% CI = −3.30, −1.51); associations at higher individual-level income were weaker. We observed similar associations with whole grain consumption across time but no statistically significant associations with consumption of sugar-sweetened beverages, artificially sweetened beverages, snacks, processed meats, fruits, or vegetables. Conclusions. The presence of neighborhood convenience stores may be associated with lower quality diets. Low-income individuals may be most sensitive to convenience store availability. Although evidence from interventions and randomized controlled trials is rare, observational epidemiological studies suggest that fruit, vegetable, and whole grain consumption are cardioprotective 1–5 and that intake of processed meats, sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and snack foods are associated with an elevated risk of cardiometabolic health-related outcomes. 6–12 In addition to single foods, poor adherence to nutritional guidelines and lower diet quality are associated with obesity, weight gain, and other cardiometabolic outcomes, 13–17 with minorities and individuals of low socioeconomic status (SES) particularly affected. 18–20 A majority of behavioral interventions to reduce SSB and snack food intake and to increase diet quality have not been successful. 21–24 Thus, researchers have called for policies and initiatives to modify the retail food environment to provide healthy options for consumers, 25–28 including a focus on convenience stores and corner stores. 29 Several studies suggest that convenience stores and small urban stores provide energy-dense, nutrient-poor snacks and sugar-sweetened drinks and offer few healthy snack options and other nutritious food items (e.g., fruit, vegetables, whole grains). 30–36 Studies that have examined access to convenience stores in relation to obesity-related and diet outcomes provide mixed findings. 37–49 Furthermore, with few exceptions, 46–49 previous studies are cross-sectional 37–47,49 or do not examine potential differences by SES. 37–45,48 In addition, none have focused on racially diverse young- to middle-aged adults across a variety of metropolitan areas. To address these gaps, we used longitudinal physical examination–based, anthropometric, and biomarker data from the Coronary Artery Risk Development in Young Adults (CARDIA) study spanning 20 years. Using temporally and geographically matched neighborhood food outlet locations, we estimated the association between diet and percentage of convenience stores within 3 kilometers of CARDIA respondents’ homes. To address the potential role of convenience stores in socioeconomic disparities in cardiometabolic risk factors, we explicitly examined how associations between percentage of neighborhood convenience stores, diet quality, and consumption of single food items differ by individual-level SES.
