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1 From the Department of Epidemiology (MF, ML, FB, and TG) and the Center for Human Nutrition (BC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD); the Department of Epidemiology, National Centre for Cardiovascular Research, Madrid, Spain (MF); the Division of General Internal Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, Baltimore, MD (FB); the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI (AVD-R and LVM); and the Division of Epidemiology and Disease Control, School of Public Health, University of Texas Health Sciences Center, Houston, TX (JAN).
2 The MESA is supported by contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute. AVD-R was supported by grant R01-HL071759 from the National Heart, Lung, and Blood Institute. FB was supported by the Mid-Career Mentorship Award in Patient-Oriented Research (K24 DK62222) and Diabetes Research and Training Center Grant P60 DK079637. MF was supported by the Center for a Livable Future at the Johns Hopkins Bloomberg School of Public Health and the Fulbright Program. 3 Reprints not available. Address correspondence to M Franco, Department of Epidemiology, National Centre for Cardiovascular Research, Madrid, Spain, Melchor Fernandez Almagro 3, E-28029 Madrid, Spain. E-mail: mfranco{at}cnic.es.
ABSTRACT
Background: Inadequate availability of healthy foods may be a barrier to achieve recommended diets.
Objective: The objective was to study the association between the directly measured availability of healthy foods and diet quality.
Design: We conducted a cross-sectional study of 759 participants from the Baltimore site of the Multi-Ethnic Study of Atherosclerosis. Diet was characterized by using a food-frequency questionnaire and summarized by using 2 empirically derived dietary patterns reflecting low- and high-quality diets. For each participant, the availability of healthy foods was directly assessed by using 3 measures: in all food stores within their census tract, in their closest food store, and in all food stores within 1 mile (1.6 km) of their residence.
Results: Twenty-four percent of the black participants lived in neighborhoods with a low availability of healthy food compared with 5% of white participants (P < 0.01). After adjustment for age, sex, income, and education, a lower availability of healthy foods in the tract of residence or in the closest store was associated with higher scores on the low-quality dietary pattern (P < 0.05). Less consistent associations were observed for the high-quality dietary pattern.
Conclusions: Healthy foods were less available for black participants. Low availability of healthy foods was associated with a lower quality diet. The extent to which improvements in the availability of healthy foods results in higher quality diets deserves further investigation.
Received for publication May 20, 2008. Accepted for publication December 1, 2008.
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