Negative perceptions of the food environment and unhealthy dietary patterns: Findings from the Philadelphia area

BACKGROUND - The leading causes of death in this country are diet-related chronic diseases. Dietary patterns high in fast foods tend to promote disease; dietary patterns high in fruits and vegetables tend to promote health. While determinants of dietary patterns are multi-factorial, research increasingly focuses on the food environment.

METHODS - To evaluate if perceptions of the food environment are associated with dietary patterns, we conducted cross-sectional analyses of the Public Health Management Corporation's 2004 Household Health Survey. We analyzed individual-level data aggregated to the level of the census tract to allow for mapping. We then corroborated aggregate analyses with multi-level modeling.

RESULTS - After adjusting for age, race, ethnicity, gender, education, poverty status, and household size, negative food-environment perceptions (difficulty finding fruits and vegetables, poor grocery quality, and having to travel outside of one's neighborhood to get to a supermarket) were all strongly correlated with each other, and each directly associated with fast-food consumption (number of times eating fast food in the past week). Negative food-environment perceptions were also inversely associated with fruit-and-vegetable consumption (number of servings of fruits and vegetables eaten in a typical day), but only in aggregate analyses. Census-tract level maps corroborated statistical correlations.

DISCUSSION - Findings imply that negative perceptions of the food environment are associated with less healthy dietary patterns. Aggregate analyses for fruit-and-vegetable consumption may suffer from individualistic fallacy. Future work should correlate people's food-environment perceptions with objective measures.