Susan E. Chen

Obesity and access to chain grocers.

abstract Recent empirical work in the obesity literature has highlighted the role of the built environment and its potential influence in the increasing prevalence of obesity in adults and children. One feature of the built environment that has gained increasing attention is the role of access to chain grocers and their impact on body mass index (BMI). The assessment of the impacts of spatial access to chain grocers on BMI is complicated by two empirical regularities in the data. There is evidence that health outcomes such as BMI are clustered in space and that there is spatial dependence across individuals. In this article, we use an econometric model that takes into account the spatial dependence, and we allow the effect of access to differ for a person depending on whether he or she lives in a low-income community or peer group. We categorize this community using the characteristics of the people who immediately surround the individual rather than using census tracts. Using georeferenced survey data on adults in Marion County, Indiana, we find that the effect of improvements in chain grocer access on BMI varies depending on community characteristics.

Zoning for Health: The Obesity Epidemic and Opportunities for Local Policy Intervention

Several states and local communities have started to experiment with policy initiatives that affect the built-up environment in an attempt to decrease the prevalence of obesity. The focus of these policy measures has generally been to eliminate geographical disparities in access to food. Recent policy proposals include the use of zoning laws to create a healthier food environment by providing incentives for chain grocers to open stores in disadvantaged, underserved areas and providing incentives for existing food retailers to offer healthier products. The economic feasibility of implementing these types of interventions depends on the policymakers ability to identify communities most at need. We use computer simulations, based on introducing new chain grocers in targeted areas, to map the effects on BMI of this modification in the food environment. In this study, we show that targeting economically disadvantaged communities with high prevalence of obesity-related diseases can provide an effective means of identifying areas where policy implementation will be most beneficial for improvements in health outcomes such as BMI.

Effects and determinants of mild underweight among preschool children across countries and over time

Research on malnutrition typically focuses on extreme cases which pose the greatest individual health risks, but researchers comparing populations might find that variation in mild malnutrition conveys valuable information about public health. This paper constructs and compares new measures of the prevalence, depth and severity of both mild and extreme underweight in children from three months to three years of age, as measured by 130 DHS surveys for 53 countries over a period from 1986 to 2006. We find that variance in mild underweight has a larger and more robust correlation with child mortality than variance in severe underweight, and is itself more closely correlated with local agricultural output, over a wide range of regression specifications. We conclude that the prevalence of mild underweight deserves greater attention as a useful signal of changing public health conditions among preschool children in developing countries.

Food stamp participation is associated with fewer meals away from home, yet higher body mass index and waist circumference in a nationally representative sample.

OBJECTIVE To examine associations between Food Stamp (FS) participation, meals away from home (MAFH), body mass index (BMI), and waist circumference (WC). DESIGN Cross-sectional study. SETTING Nationally representative. PARTICIPANTS Data from low-income, FS-eligible individuals (N = 945) ages 20-65 years, responding to the 2005-2006 National Health and Nutrition Examination Survey. MAIN OUTCOME MEASURE(S) MAFH per week, BMI, and WC. ANALYSIS Multiple linear regression models were used to examine associations between FS participation and MAFH, BMI, and WC, adjusting for age, sex, race, and education level. RESULTS Food Stamp authorization was associated with fewer MAFH (P = .004). Among females, FS authorization was associated with higher BMI (P = .04) and WC (P = .04). Among females reporting amount of benefits in the prior month, more FS benefits received were associated with lower BMI (P = .03) and WC (P < .001). CONCLUSIONS AND IMPLICATIONS Seemingly contradictory results regarding associations between FS authorization and FS benefits received in the previous month and BMI and WC should be explored further. Effective nutrition education and environmental change strategies are needed, particularly among female FS recipients.

An Exploration of the Relationship Between Income and Eating Behavior

This paper explores the relationship between income and eating behavior. To do this we examine choice in two food categories: milk and soft drinks. These categories have varieties differing in health qualities but either no differences in cost or lower cost for the healthier types. By examining food choices when there are no measurable cost differences but clear health differences, we are able to isolate the association between income and healthy eating behavior. We find a negative association between income and dietary intake of higher-calorie types of milk and soft drinks. Our estimates are consistent across the five sets of the National Health and Nutrition Examination Survey and the Continuing Survey of Food Intakes by Individuals data that we study. For 2005 we estimate that an income increase of

Quality of health care provided at a pediatric nurse-managed clinic.

10,000 is linked to a reduction in 377 calories from milk and 2,555 calories from soft drinks per year. Our results suggest that the cost of food may not be the only reason why low income people have less healthy diets.

Associations between maternal employment and time spent in nutrition-related behaviours among German children and mothers

Purpose: The purpose of this study is to assimilate evidence regarding quality of care received at nurse‐managed clinics (NMCs), particularly a pediatric NMC that provides health care for the underserved pediatric population. Data sources: A nonexperimental design was used in this study. Quality of care data were collected at Trinity Nursing Center for Child Health (TNCCH), a pediatric NMC. Evidence included whether a pediatric NMC met selected national benchmark pediatric Healthcare Effectiveness and Data Information Set (HEDIS) quality indicators as well as HEDIS targets set by the Office of Medicaid Policy and Planning (OMPP) in Indiana. Conclusions: Findings suggest that TNCCH met or exceeded national HEDIS benchmark standards of care and targets set by OMPP. This study offers further evidence that NMCs provide a high quality of care. Implications for practice: Benefits of addressing the research question in this study include the preservation of the nurse‐managed healthcare safety net, increased access to health care for the medically underserved population resulting in improved health outcomes, and evidence to suggest that NMCs can assist private practice physicians to support this population of patients.

Determinants of contraceptive method choice in rural Tanzania between 1991 and 1999

OBJECTIVE To examine associations between maternal employment and time spent engaging in nutrition-related behaviours among mothers and children using a nationally representative sample of households in West and East Germany. DESIGN A cross-sectional analysis was performed using time-use data for a sample of mother-child dyads. Associations between maternal employment and time spent in nutrition-related activities such as eating at home, eating away from home and food preparation were estimated using a double-hurdle model. SETTING German Time Budget Survey 2001/02. SUBJECTS The overall sample included 1071 households with a child between 10 and 17 years of age. The time-use data were collected for a 3 d period of observation (two weekdays and one weekend day). RESULTS Maternal employment was associated with the time children spent on nutrition-related behaviours. In households with employed mothers, children spent more time eating alone at home and less time eating meals with their mothers. Moreover, employed mothers spent less time on meal preparation compared with non-employed mothers. There were regional differences in time spent on nutrition-related behaviours, such that East German children were more likely to eat at home alone than West German children. CONCLUSIONS Maternal employment was associated with less time spent eating with children and preparing food, which may be related to the increasing childhood obesity rates in Germany. Future national surveys that collect both time-use data and health outcomes could yield further insight into mechanisms by which maternal time use might be associated with health outcomes among children.