Youth dietary intake and weight status: Healthful neighborhood food environments enhance the protective role of supportive family home environments
Introduction
While obesity rates among adolescents have started to plateau for some racial/ethnic groups, (Bethell et al., 2010, Wilson, 2009, NIH, 2007, Ogden et al., 2010a, Ogden et al., 2010b) the prevalence of adolescent obesity remains at an all-time high posing a major public health concern (Ogden et al., 2010a). A related concern is the dietary intake of adolescents. Fewer than 1 in 10 American adolescents meet the daily recommendation for fruit or vegetable intake Striegel-Moore et al., 2006; Kimmons et al., 2009. About 33% of children and adolescents in the United States consume fast food on a typical day, and intake increases with age Bowman et al., 2004; Paeratakul et al., 2003. Furthermore, it is estimated that on average, adolescents visit fast food restaurants approximately twice a week Bauer et al., 2009. Although the previous research has provided a good understanding of individual-level risk (e.g., fast food consumption) and protective factors (e.g. fruit and vegetable intake) that are associated with adolescent obesity, the relationship between multiple contexts, such as the home food environment (e.g., family meals, family functioning, and modeling of health behaviors) and the neighborhood built environment (e.g., density of fast food, and distance to closest supermarket) has been largely overlooked in relation to adolescent dietary intake patterns and obesity. Because these environments co-exist in adolescents' lives, it is important to understand the individual and joint relationships between the home environment and the neighborhood built environment and adolescent obesity in order to identify which combinations of factors within these two environments are associated with increased or decreased protection against adolescent obesity. Futhermore, NIH and other entities have called for such multi-contextual analyses to improve our understanding of the complex systems in which people live and by which they are influenced (National Institutes of Health Obesity Research Task Force, 2011).
The majority of previous research has examined associations between single contexts, such as, the home food environment or the built environment, and adolescent weight and weight-related outcomes. Prior research on the home environment has shown associations between a healthful family home environment and more healthful dietary intake, less fast food consumption and a lower prevalence of overweight/obesity in adolescents(Berge et al., 2009; Berge et al., 2010a; Berge, 2009; Videon and Manning, 2003; Neumark-Sztainer et al., 2010; Neumark-Sztainer et al., 2003b). Specifically, associations between characteristics of the home environment, such as parent modeling and encouraging of healthful eating, frequent family meals and high family functioning have been identified as protective, although not all associations are found consistently (Berge et al., 2010a, Videon and Manning, 2003, Neumark-Sztainer et al., 2010, Neumark-Sztainer et al., 2003b, Berge et al., 2010b, Berge et al., 2010c, Berge et al., 2010d, Berge et al., 2013, Wardle et al., 2002, Bauer et al., 2011, Bauer et al., 2008, Rhee et al., 2006, Rhee, 2008). Less research has examined associations between neighborhood characteristics (e.g. food access, and fast food density) and youth health behaviors and the findings have been mixed. For example, some studies have shown that close proximity/access to convenience stores and poor access/proximity to supermarkets are associated with increased overweight/obesity in youth and low fruit and vegetable intake; whereas other studies have shown a positive association between having fresh fruits and vegetables available in small food stores (i.e., convenience store) that are close to residential households and higher intake of fruits and vegetables in adolescents, and still other studies have shown no association or minimal relationships between environmental variables and adolescent weight and weight-related behaviors (; Morland et al., 2006, Bodor et al., 2008, Jago et al., 2007). Thus, in general, the previous research has found that the home environment is associated with dietary intake and weight status in adolescents, while associations between the neighborhood environment and similar outcomes are less consistent. A next step is to examine both the independent and joint relationships between the family home environment and the neighborhood built environment to characterize the relationships between these factors and to identify key factors across multiple contexts in the lives of adolescents that contribute to adolescent fruit and vegetable intake, fast food consumption, and weight status.
The Ecological framework (Sallis et al., 2008a, McLeroy et al., 1988) supports the importance of examining the multiple contexts within which adolescents' reside and are influenced in order to more clearly understand potential underlying mechanisms of adolescent obesity. Specifically, the Ecological framework indicates that there are multiple contexts of influence on adolescents' weight-related behaviors, such as one’s own individual behavior (e.g., fruit and vegetable intake), the home environment (e.g., family functioning, modeling of health behaviors, and availability of healthful foods), interpersonal relationships (i.e., communication, and connectedness), and neighborhood (e.g., built environment such as fast food establishments) and larger community forces (i.e., crime and politics). For example, an adolescent who lives in a home where there is higher family functioning (i.e., acceptance, problem solving), family meals eaten together, and who also lives in a neighborhood that has fewer fast food establishments or convenience stores close by would be expected to have lower weight status and healthier eating behaviors than an adolescent without this accumulation of supportive environments. Thus, being able to examine all of these factors independently and in combination will highlight more clearly the role of the multiple influences on adolescent weight and weight-related behaviors. The current study's design, measures, research questions and hypotheses are guided by this theoretical framework.
The main hypothesis of this paper is: adolescents who experience both health-supporting neighborhoods (i.e., fewer fast food establishments, fewer convenience stores, and nearby supermarkets) and family environments (i.e., higher family functioning, more family meals, parent encouraging and modeling of healthful eating) will have a higher intake of fruits and vegetables, lower fast food consumption and lower BMI. Examining this joint association will allow for identifying whether and how the surrounding built environment moderates the association between a healthful home environment and healthful dietary intake and risk for overweight/obesity in adolescents. Results from the current study are expected to inform future intervention research by guiding the implementation of multi-level interventions that simultaneously target family and neighborhood variables.
Section snippets
Study design and population
Data were drawn from EAT 2010 (Eating and Activity in Teens), a population-based study examining environmental and individual determinants of adolescents' dietary intake, physical activity, weight control behaviors, and weight status. The study population includes adolescents from 20 public middle schools and high schools in the Minneapolis/St. Paul metropolitan area of Minnesota, which serve socioeconomically and racially/ethnically diverse communities. There were 2682 adolescents who
BMI
Overall, there were several significant associations between characteristics of the family environment and adolescent BMI and few significant associations between the built neighborhood environment and BMI z-score for adolescents, after controlling for age, SES, and race/ethnicity (Table 1, Table 2). Specifically, for the family environment variables, higher frequency of family meals was associated with lower BMI z-score in adolescent boys (beta=−0.03; p=0.049) and girls (beta=−0.05; p<0.001).
Discussion
The main aim of this study was to investigate whether and how the home environment and the neighborhood built environment are individually and jointly associated with adolescent fruit and vegetable intake, fast food consumption and BMI z-score. Results from the current study support previous research showing significant independent associations between a healthful home environment and more healthful dietary intake in adolescents, less fast food consumption and lower BMI z-score (Berge et al.,
Conclusions
Results of the current study indicate that the association between a healthful home environment and adolescent healthier dietary intake and lower BMI may be enhanced when coupled with healthful neighborhood environments. Thus, it may be important for prevention efforts to tailor interventions for adolescents who live in certain environments that help or hinder their efforts for a healthful home environment in order to be more effective in reducing adolescent obesity. Additionally, findings from
Acknowledgments
Research is supported by grant number R01 HL093247 from the National Heart, Lung, and Blood Institute (PI: Dianne Neumark-Sztainer). Dr. Wall is supported by a grant from the National Institutes of Health (U01-HD061940). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung and Blood Institute, the National Institute of Child Health and Human Development, the National Cancer Institute or the National Institutes
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