Department of Parks, Recreation & Tourism Management, North Carolina State University, Raleigh, North Carolina, United States of America.
Department of Parks, Recreation & Tourism, University of Utah, Salt Lake City, Utah, United States of America.
PLoS One. 2024 Apr 18;19(4):e0301121. doi: 10.1371/journal.pone.0301121. eCollection 2024.
To prevent obesity and diabetes environmental interventions such as eliminating food deserts, restricting proliferation of food swamps, and improving park access are essential. In the United States, however, studies that examine the food and park access relationship with obesity and diabetes using both global and local regression are lacking. To guide county, state, and federal policy in combating obesity and diabetes, there is a need for cross-scale analyses to identify that relationship at national and local levels. This study applied spatial regression and geographically weighted regression to the 3,108 counties in the contiguous United States. Global regression show food deserts exposure and density of fast-food restaurants have non-significant association with obesity and diabetes while park access has a significant inverse association with both diseases. Geographically weighted regression that takes into account spatial heterogeneity shows that, among southern states that show high prevalence of obesity and diabetes, Alabama and Mississippi stand out as having opportunity to improve park access. Results suggest food deserts exposure are positively associated with obesity and diabetes in counties close to Alabama, Georgia, and Tennessee while density of fast-food restaurants show positive association with two diseases in counties of western New York and northwestern Pennsylvania. These findings will help policymakers and public health agencies in determining which geographic areas need to be prioritized when implementing public interventions such as promoting healthy food access, limiting unhealthy food options, and increasing park access.
为了预防肥胖和糖尿病，环境干预措施如消除食物荒漠、限制垃圾食品泛滥以及改善公园可达性至关重要。然而，在美国，缺乏使用全局和局部回归来研究食物和公园可达性与肥胖和糖尿病之间关系的研究。为了指导县、州和联邦政府的政策来对抗肥胖和糖尿病，需要进行跨尺度分析，以在国家和地方层面识别这种关系。本研究应用空间回归和地理加权回归分析了美国连续的 3108 个县。全局回归表明，食物荒漠暴露和快餐店密度与肥胖和糖尿病没有显著关联，而公园可达性与这两种疾病呈显著负相关。考虑到空间异质性的地理加权回归表明，在肥胖和糖尿病发病率较高的南部各州中，阿拉巴马州和密西西比州有机会改善公园可达性。结果表明，在靠近阿拉巴马州、佐治亚州和田纳西州的县，食物荒漠暴露与肥胖和糖尿病呈正相关，而在纽约西部和宾夕法尼亚州西北部的县，快餐店密度与这两种疾病呈正相关。这些发现将帮助政策制定者和公共卫生机构确定在实施公共干预措施（如促进健康食品获取、限制不健康食品选择和增加公园可达性）时需要优先考虑哪些地理区域。
