Richard J. Volpe

Food Environments and Obesity: Household Diet Expenditure Versus Food Deserts

OBJECTIVES To examine the associations between obesity and multiple aspects of the food environments, at home and in the neighborhood. METHODS Our study included 38,650 individuals nested in 18,381 households located in 2104 US counties. Our novel home food environment measure, USDAScore, evaluated the adherence of a households monthly expenditure shares of 24 aggregated food categories to the recommended values based on US Department of Agriculture food plans. The US Census Bureaus County Business Patterns (2008), the detailed food purchase information in the IRi Consumer Panel scanner data (2008-2012), and its associated MedProfiler data set (2012) constituted the main sources for neighborhood-, household-, and individual-level data, respectively. RESULTS After we controlled for a number of confounders at the individual, household, and neighborhood levels, USDAScore was negatively linked with obesity status, and a census tract-level indicator of food desert status was positively associated with obesity status. CONCLUSIONS Neighborhood food environment factors, such as food desert status, were associated with obesity status even after we controlled for home food environment factors.

Relationships between Diet, Alcohol Preference, and Heart Disease and Type 2 Diabetes among Americans.

Although excessive alcohol consumption is a recognized cause of morbidity and mortality, many studies have linked moderate alcohol consumption to improved cardiovascular health and a lower risk of Type 2 Diabetes (T2D). Self-reported alcohol and diet data used to generate these results suffer from measurement error due to recall bias. We estimate the effects of diet, alcohol, and lifestyle choices on the prevalence and incidence of cardiovascular disease and T2D among U.S. adults using a nationally representative cohort of households with scanner data representing their food-at-home, alcohol, and tobacco purchases from 2007-2010, and self-reported health surveys for the same study participants from 2010-2012. Multivariate regression models were used to identify significant associations among purchase data and lifestyle/demographic factors with disease prevalence in 2010, and with incidence of new disease from 2011-2012. After controlling for important confounders, respondents who purchased moderate levels of wine were 25% less likely than non-drinkers to report heart disease in 2010. However, no alcohol-related expenditure variables significantly affected the likelihood of reporting incident heart disease from 2011-2012. In contrast, many types of alcohol-related purchases were associated with a lower prevalence of T2D, and respondents who purchased the greatest volumes of wine or beer—but not liquor—were less likely to report being diagnosed with T2D in 2011-2012 than non-drinkers.

Store Formats, Market Structure, and Consumers’ Food Shopping Decisions

A growing literature in health and nutrition suggests that healthy foods are less available and more expensive at nontraditional store formats such as supercenters, convenience stores, and drug stores. We use Nielsen Homescan data to investigate the relationship between store format and the healthfulness of consumers’ grocery shopping. Accounting for a rich set of controls, as well as food retail market structure, we simultaneously estimate the healthfulness of consumers’ food purchases and the shares of food expenditure at traditional and nontraditional store formations. We find that healthier food choices are generally associated with higher food expenditure shares at supermarkets and supercenters and lower shares at drug stores and convenience stores. In addition, market concentration has a negative effect on shopping healthfulness.

The Healthfulness of Food-at-Home Expenditures, the Local Food Environment, and Childhood Obesity

Purpose: Despite the growth of food-away-from-home expenditures, food-at-home (FAH) expenditures still constitute the majority of American families’ food dollars. The FAH expenditures may have important impacts on children’s diets and, consequently, their weight statuses. This study examined the association between the composition of FAH expenditures and childhood overweight or obesity. Design: We compiled a longitudinal data set from the 2010 to 2012 IRI Consumer Panel and its associated MedProfiler surveys. Setting: This study took place in the United States. Participants: One thousand seven hundred thirty-one households across the United States, with 2645 children aged 2 to 17, were surveyed over 3 years (2010-2012). Measures: The binary outcome variable indicated whether a child was overweight or obese. The key predictor variable—composition of FAH expenditures—was an index reflecting households’ adherence to expenditure shares for 24 food categories recommended by the United States Department of Agriculture (USDA) Thrifty Food Plans. The key control variables were FAH expenditure shares from different food stores. Analysis: Data were analyzed by multilevel logistic regressions that controlled for a number of individual-level and household-level characteristics. Results: Higher compliance with the USDA Thrifty Food Plans was associated with lower risk of childhood overweight or obesity. Channel expenditure shares were not significantly associated with the weight outcomes. Conclusion: To prevent childhood obesity, the USDA Thrifty Food Plans can provide potential guidelines for households to decide the composition of their FAH expenditures.