Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Subjects (MESA Data)
2.2. Food Frequency Questionnaire (FFQ)
2.3. Outcome: Healthy Eating Index-2010 (HEI)
2.4. Price Data
2.5. Census Data
2.6. Cost of Living Data and Supermarket Density
2.7. Data Linkage
2.8. Statistical Methods
3. Results
3.1. Primary Analysis
3.2. Instrumental Variable Analyses
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Characteristic | All Participants | Lowest Ratio, Smallest Differential | Middle Ratio | Highest Ratio, Largest Differential | ||||
---|---|---|---|---|---|---|---|---|
(1.55–1.88) | (1.88–2.01) | (2.01–2.39) | ||||||
n or Mean | Col % or SD | n or Mean | Col % or SD | n or Mean | Col % or SD | n or Mean | Col % or SD | |
Number of participants (n) | 2765 | 938 | 903 | 924 | ||||
MESA recruitment site (n, %) a | ||||||||
Forsyth County, NC | 539 | 19.5% | 239 | 25.5% | 299 | 33.1% | 1 | 0.1% |
New York, NY | 538 | 19.5% | 262 | 27.9% | 226 | 25.0% | 50 | 5.4% |
Baltimore, MD | 464 | 16.8% | 339 | 36.1% | 122 | 13.5% | 3 | 0.3% |
St. Paul, MN | 8 | 0.3% | 6 | 0.6% | 0 | 0.0% | 2 | 0.2% |
Chicago, IL | 651 | 23.5% | 89 | 9.5% | 221 | 24.5% | 341 | 36.9% |
Los Angeles, CA | 565 | 20.4% | 3 | 0.3% | 35 | 3.9% | 527 | 57.0% |
Region of residence (n, %) | ||||||||
Northeast | 534 | 19.3% | 259 | 27.6% | 226 | 25.0% | 49 | 5.3% |
Midwest | 642 | 23.2% | 85 | 9.1% | 220 | 24.4% | 337 | 36.5% |
South | 1021 | 36.9% | 593 | 63.2% | 421 | 46.6% | 7 | 0.8% |
West | 568 | 20.5% | 1 | 0.1% | 36 | 4.0% | 531 | 57.5% |
Supermarket density (3 mile) (mean, SD) | 1.19 | 1.42 | 1.51 | 1.88 | 1.22 | 1.3 | 0.84 | 0.74 |
Female (n, %) | 1466 | 53.0% | 483 | 51.5% | 502 | 55.6% | 481 | 52.1% |
Age (mean, SD) | 70.3 | 9.5 | 70.6 | 9.1 | 70.3 | 9.3 | 69.9 | 9.9 |
Race/ethnicity (n, %) | ||||||||
White | 1101 | 39.8% | 422 | 45.0% | 485 | 53.7% | 194 | 21.0% |
Chinese American | 359 | 13.0% | 10 | 1.1% | 56 | 6.2% | 293 | 31.7% |
Black | 834 | 30.2% | 413 | 44.0% | 231 | 25.6% | 190 | 20.6% |
Hispanic | 471 | 17.0% | 93 | 9.9% | 131 | 14.5% | 247 | 26.7% |
Education (n, %) | ||||||||
High school diploma or less | 777 | 28.1% | 231 | 24.6% | 251 | 27.8% | 295 | 31.9% |
Some college | 761 | 27.5% | 259 | 27.6% | 233 | 25.8% | 269 | 29.1% |
Bachelor’s degree or more | 1227 | 44.4% | 448 | 47.8% | 419 | 46.4% | 360 | 39.0% |
Income | ||||||||
Per capita household income (in $10k) (mean, SD) | 2.6 | 1.9 | 2.8 | 1.8 | 2.8 | 1.9 | 2.3 | 1.8 |
Wealth index | 2.6 | 1.2 | 2.6 | 1.2 | 2.6 | 1.2 | 2.5 | 1.2 |
Income/wealth index | 5.1 | 2.2 | 5.3 | 2.1 | 5.2 | 2.2 | 4.9 | 2.3 |
Marital status (n, %) | ||||||||
Not married or living with partner | 1107 | 40.0% | 419 | 44.7% | 364 | 40.3% | 324 | 35.1% |
Married/Living w. partner | 1658 | 60.0% | 519 | 55.3% | 539 | 59.7% | 600 | 64.9% |
Body mass index (mean, SD) | 28.2 | 5.6 | 28.9 | 5.5 | 28.4 | 5.9 | 27.2 | 5.2 |
<25 (n, %) | 855 | 30.9% | 236 | 25.2% | 268 | 29.7% | 351 | 38.0% |
25–29.9 (n, %) | 1043 | 37.7% | 347 | 37.0% | 341 | 37.8% | 355 | 38.4% |
≥30 (n, %) | 867 | 31.4% | 355 | 37.8% | 294 | 32.6% | 218 | 23.6% |
Smoking status (n, %) | ||||||||
Never smoked | 1281 | 46.3% | 366 | 39.0% | 412 | 45.6% | 503 | 54.4% |
Former smoker | 1283 | 46.4% | 487 | 51.9% | 433 | 48.0% | 363 | 39.3% |
Current smoker | 201 | 7.3% | 85 | 9.1% | 58 | 6.4% | 58 | 6.3% |
Physical activity, MET min per week (mean, SD) | 2774 | 3552 | 3239 | 4237 | 2765 | 3441 | 2310 | 2749 |
Variable | All Participants | Lowest Ratio (1.55–1.88) | Middle Ratio (1.88–2.01) | Highest Ratio (2.01–2.39) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of participants (n) | 2765 | 938 | 903 | 924 | ||||||||
Number with high-quality diet (n, %) | 545 | 19.7% | 165 | 17.6% | 161 | 17.8% | 219 | 23.7% | ||||
Average food prices per serving | ||||||||||||
Healthy food price per serving a (mean [SD], median) | $0.60 | [$0.04] | $0.60 | $0.61 | [$0.06] | $0.57 | $0.59 | [$0.03] | $0.58 | $0.62 | [$0.03] | $0.62 |
Unhealthy food price per serving b (mean [SD], median) | $0.31 | [$0.03] | $0.30 | $0.33 | [$0.04] | $0.31 | $0.30 | [$0.01] | $0.30 | $0.29 | [$0.01] | $0.29 |
Ratio of healthy-to-unhealthy (mean [SD], median) | 1.97 | [0.14] | 1.93 | 1.83 | [0.05] | 1.85 | 1.95 | [0.05] | 1.93 | 2.14 | [0.09] | 2.13 |
Model Covariates | Exposure of Interest | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Healthy-To-Unhealthy Ratio | Healthy Food Price | Unhealthy Food Price | ||||||||||
95% CI | 95% CI | 95% CI | ||||||||||
Odds Ratio | Lower | Upper | p Value | Odds Ratio | Lower | Upper | p Value | Odds Ratio | Lower | Upper | p Value | |
Full sample (n = 2765) | ||||||||||||
Model 1: region, age, gender | 0.97 | 0.83 | 1.13 | 0.6978 | 0.98 | 0.88 | 1.10 | 0.7655 | 1.00 | 0.91 | 1.10 | 0.9639 |
Model 2: Model 1 plus income/wealth, education level, smoking status, and race | 0.86 | 0.73 | 1.01 | 0.0571 | 0.97 | 0.86 | 1.09 | 0.5709 | 1.03 | 0.93 | 1.13 | 0.6045 |
Final Model: Model 2 plus neighborhood SES a and neighborhood supermarket density | 0.76 | 0.64 | 0.91 | 0.0027 | 1.04 | 0.88 | 1.22 | 0.6371 | 1.16 | 1.02 | 1.33 | 0.0267 |
Socioeconomic Status Measure | Exposure of Interest | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Healthy-To-Unhealthy Ratio | Healthy Food Price | Unhealthy Food Price | ||||||||||
95% CI | 95% CI | 95% CI | ||||||||||
OR | Lower | Upper | p Value | OR | Lower | Upper | p Value | OR | Lower | Upper | p Value | |
Wealth/income tertile a | ||||||||||||
Lowest (1–4), n = 956 | 0.79 | 0.58 | 1.06 | 0.1149 | 0.99 | 0.76 | 1.28 | 0.9200 | 1.16 | 0.90 | 1.49 | 0.2654 |
Middle (5–6), n = 793 | 0.61 | 0.43 | 0.87 | 0.0067 | 1.13 | 0.81 | 1.57 | 0.4746 | 1.32 | 1.02 | 1.70 | 0.0365 |
Highest (7–8), n = 893 | 0.87 | 0.64 | 1.18 | 0.3621 | 1.11 | 0.83 | 1.49 | 0.4846 | 1.10 | 0.89 | 1.36 | 0.3825 |
Education level b | ||||||||||||
HS degree or less, n = 777 | 0.85 | 0.58 | 1.24 | 0.3897 | 0.79 | 0.58 | 1.09 | 0.1513 | 0.90 | 0.65 | 1.25 | 0.5354 |
Some college, n = 761 | 0.81 | 0.57 | 1.16 | 0.2552 | 1.11 | 0.78 | 1.59 | 0.5586 | 1.20 | 0.89 | 1.62 | 0.2339 |
Bachelor’s degree or more, n = 1227 | 0.77 | 0.59 | 0.99 | 0.0412 | 1.15 | 0.91 | 1.47 | 0.2512 | 1.18 | 0.99 | 1.41 | 0.0621 |
Price Outcome | n | n Events | Stage 1 | Stage 2 | |||
---|---|---|---|---|---|---|---|
t-Value | F-Statistic | Odds Ratio | Lower CL b | Upper CL b | |||
Healthy-to-unhealthy price ratio | 2765 | 543 | -33.36 | 1113 | 0.82 | 0.57 | 1.19 |
Healthy food price | 2765 | 543 | 59.86 | 3583 | 1.15 | 0.91 | 1.45 |
Unhealthy food price | 2765 | 543 | 98.59 | 9720 | 1.10 | 0.93 | 1.30 |
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Kern, D.M.; Auchincloss, A.H.; Stehr, M.F.; Diez Roux, A.V.; Moore, L.V.; Kanter, G.P.; Robinson, L.F. Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis. Int. J. Environ. Res. Public Health 2017, 14, 1394. https://doi.org/10.3390/ijerph14111394
Kern DM, Auchincloss AH, Stehr MF, Diez Roux AV, Moore LV, Kanter GP, Robinson LF. Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis. International Journal of Environmental Research and Public Health. 2017; 14(11):1394. https://doi.org/10.3390/ijerph14111394
Chicago/Turabian StyleKern, David M., Amy H. Auchincloss, Mark F. Stehr, Ana V. Diez Roux, Latetia V. Moore, Genevieve P. Kanter, and Lucy F. Robinson. 2017. "Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis" International Journal of Environmental Research and Public Health 14, no. 11: 1394. https://doi.org/10.3390/ijerph14111394