title: Food availability, neighborhood socioeconomic status, and dietary patterns among blacks with type 2 diabetes mellitus.
abstract: BACKGROUND
  High diabetes prevalence among low-income and urban African American populations. OBJECTIVES & MAIN OUTCOME MEASURES: This study aimed to determine associations between neighborhood-level food sources and socioeconomic status (SES), and dietary patterns and body-mass index (BMI). The hypotheses were that the presence of food stores in neighborhoods would be associated with better dietary habits and BMI, and that the presence of convenience stores, and lower neighborhood SES, would be associated with poorer dietary habits and BMI. DESIGN, SETTING, & PATIENTS: Black adults (n = 132) with type 2 diabetes in Project Sugar 2 (Baltimore, Maryland) underwent the Ammerman dietary assessment: total dietary risk score and subscores for meat, dairy, starches, and added fat. Food source availability (food stores, convenience stores, other food stores, restaurants, and other food service places) and SES data from the 2000 US census at the tract-level were linked to individual-level data. Linear mixed-effects regression models with random intercepts were used to account for neighborhood clustering and for individual-level SES and potential confounders.
  
  
  RESULTS
  The presence of restaurants and other food service places in census tracts were associated with better dietary patterns (adjusted added fat subscore beta = -1.1, 95% confidence interval [CI] = -1.8, -0.4, and beta = -1.0, 95% CI = -1.7, -0.3, respectively). The presence of convenience stores and lower neighborhood SES was not significantly associated with worse dietary patterns or body-mass index, although trends were in the hypothesized direction.
  
  
  CONCLUSIONS
  These findings provide some evidence for structural improvements to food environments in urban and low-income black neighborhoods.
authors.affiliation: Department of Epidemiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. rmillste@jhsph.edu
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Millstein
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
authors.forename: Marian
authors.initials: M
authors.lastname: Batts-Turner
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Gary
mesh_terms: D000368:Aged; D015142:Baltimore; D044383:Black People; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000191:economics* / Q000517:prevention & control; D005247:Feeding Behavior; D005260:Female; D005502:Food / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012923:Social Class; D014504:Urban Health; D001741:Black or African American