title: Fast-food environments and family fast-food intake in nonmetropolitan areas.
abstract: BACKGROUND
  Little is known about the influence of in-town fast-food availability on family-level fast-food intake in nonmetropolitan areas.
  
  
  OBJECTIVE
  The purpose of the current study was to determine whether the presence of chain fast-food outlets was associated with fast-food intake among adolescents and parents, and to assess whether this relationship was moderated by family access to motor vehicles.
  
  
  METHODS
  Telephone surveys were conducted with 1547 adolescent-parent dyads in 32 New Hampshire and Vermont communities between 2007 and 2008. Fast-food intake in the past week was measured through self-report. In-town fast-food outlets were located and enumerated using an onsite audit. Family motor vehicle access was categorized based on the number of vehicles per licensed drivers in the household. Poisson regression was used to determine unadjusted and adjusted risk ratios (RRs). Analyses were conducted in 2011.
  
  
  RESULTS
  About half (52.1%) of adolescents and 34.7% of parents consumed fast food at least once in the past week. Adolescents and parents who lived in towns with five or more fast-food outlets were about 30% more likely to eat fast food compared to those in towns with no fast-food outlets, even after adjusting for individual, family, and town characteristics (RR=1.29, 95% CI= 1.10, 1.51; RR=1.32, 95% CI=1.07, 1.62, respectively). Interaction models demonstrated that the influence of in-town fast-food outlets on fast-food intake was strongest among families with low motor vehicle access.
  
  
  CONCLUSIONS
  In nonmetropolitan areas, household transportation should be considered as an important moderator of the relationship between in-town fast-food outlets and family intake.
authors.affiliation: Community Health Research Program, Hood Center for Children and Families, Department of Pediatrics, The Geisel School of Medicine at Dartmouth, HB 7465, One Medical Center Drive, Lebanon NH 03756-0001, USA. Meghan.R.Longacre@dartmouth.edu
authors.forename: Meghan R
authors.initials: MR
authors.lastname: Longacre
authors.forename: Keith M
authors.initials: KM
authors.lastname: Drake
authors.forename: Todd A
authors.initials: TA
authors.lastname: MacKenzie
authors.forename: Lucinda
authors.initials: L
authors.lastname: Gibson
authors.forename: Peter
authors.initials: P
authors.lastname: Owens
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Titus
authors.forename: Michael L
authors.initials: ML
authors.lastname: Beach
authors.forename: Madeline A
authors.initials: MA
authors.lastname: Dalton
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005190:Family; D057140:Fast Foods / Q000706:statistics & numerical data*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009513:New Hampshire; D012424:Rural Population; D013383:Suburban Population; D014707:Vermont