title: Perceptions of the food environment are associated with fast-food (not fruit-and-vegetable) consumption: findings from multi-level models.
abstract: OBJECTIVE
  Diets low in fruits and vegetables and/or high in fast foods are associated with obesity and chronic diseases. Such diets may relate to different aspects of neighborhood food environments. We sought to evaluate if people's perceptions of their neighborhood food environment are associated with reported fruit-and-vegetable and fast-food consumption.
  
  
  METHODS
  Cross-sectional analysis of a community health survey from Philadelphia, PA and four surrounding suburban counties (n = 10,450 individuals). We used mixed-effects multi-level Poisson models, nesting individuals within neighborhoods-i.e. census tracts (n = 991).
  
  
  RESULTS
  Negative perceptions of the food environment (perceived difficulty finding fruits and vegetables, having to travel outside of one's neighborhood to get to a supermarket, and perceived poor grocery quality) were each directly associated with fast-food consumption (incident rate ratios [IRRs] 1.31, 1.06, 1.20; p < 0.001, 0.04, < 0.001 respectively), but not significantly associated with fruit-and-vegetable consumption.
  
  
  CONCLUSIONS
  Perceived difficulty finding or accessing produce and high-quality groceries may support the eating of more fast food. Neighborhoods where food-environment perceptions are worst might benefit from interventions to improve availability, accessibility, and quality of healthy foods, towards shifting consumption away from fast foods.
authors.affiliation: Department of Family and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA. slucan@yahoo.com
authors.forename: Sean C
authors.initials: SC
authors.lastname: Lucan
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D057140:Fast Foods / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015143:Philadelphia; D012111:Residence Characteristics