Public Policy Institute of California, 500 Washington Street, Suite 800, San Francisco, CA 94111, USA.
Soc Sci Med. 2012 Apr;74(8):1193-203. doi: 10.1016/j.socscimed.2011.12.036. Epub 2012 Feb 10.
In recent years, research and public policy attention has increasingly focused on understanding whether modifiable aspects of the local food environment - the types and composition of food outlets families have proximate access to - are drivers of and potential solutions to the problem of childhood obesity in the United States. Given that much of the earlier published research has documented greater concentrations of fast-food outlets alongside limited access to large grocery stores in neighborhoods with higher shares of racial/ethnic minority groups and residents living in poverty, differences in retail food contexts may indeed exacerbate notable child obesity disparities along socioeconomic and racial/ethnic lines. This paper examines whether the lack of access to more healthy food retailers and/or the greater availability of "unhealthy" food purveyors in residential neighborhoods explains children's risk of excessive weight gain, and whether differential food availability explains obesity disparities. I do so by analyzing a national survey of U.S. children followed over elementary school (Early Childhood Longitudinal Study - Kindergarten Cohort) who are linked to detailed, longitudinal food availability measures from a comprehensive business establishment database (the National Establishment Time Series). I find that children who live in residentially poor and minority neighborhoods are indeed more likely to have greater access to fast-food outlets and convenience stores. However, these neighborhoods also have greater access to other food establishments that have not been linked to increased obesity risk, including large-scale grocery stores. When examined in a multi-level modeling framework, differential exposure to food outlets does not independently explain weight gain over time in this sample of elementary school-aged children. Variation in residential food outlet availability also does not explain socioeconomic and racial/ethnic differences. It may thus be important to reconsider whether food access is, in all settings, a salient factor in understanding obesity risk among young children.
近年来，研究和公共政策越来越关注了解当地食品环境的可改变方面——家庭就近获得的食品店的类型和组成——是否是美国儿童肥胖问题的驱动因素和潜在解决方案。鉴于早期发表的许多研究都记录了在少数族裔和贫困居民比例较高的社区中，快餐店的集中程度更高，而大型杂货店的供应却有限，因此零售食品环境的差异确实可能加剧社会经济和种族/族裔方面显著的儿童肥胖差异。本文探讨了缺乏获取更健康食品零售商的机会和/或居住社区中“不健康”食品供应商的更多供应是否解释了儿童过度体重增加的风险，以及食品供应的差异是否解释了肥胖差异。我通过分析一项针对美国儿童的全国性调查来做到这一点，这些儿童在小学期间（幼儿纵向研究 - 幼儿园队列）进行了跟踪调查，并与来自全面商业机构数据库（国家机构时间序列）的详细、纵向食品供应数据相关联。我发现，居住在贫穷和少数民族社区的儿童确实更有可能更容易获得快餐店和便利店。然而，这些社区也更容易获得其他与肥胖风险增加无关的食品店，包括大型杂货店。在多层次建模框架中进行检查时，在这个小学年龄儿童样本中，对食品店的不同接触并不能独立解释随时间的体重增加。居住食品店供应的差异也不能解释社会经济和种族/族裔差异。因此，重新考虑在所有情况下，食品获取是否是理解幼儿肥胖风险的一个重要因素可能很重要。
