title: Objective food environments and health outcomes.
abstract: BACKGROUND
  Pathways by which food environments affect residents' diet-related outcomes are still unclear. Understanding pathways may help decision makers identify food environment strategies to promote healthy diets.
  
  
  OBJECTIVE
  To examine the hypothesis that residents' perceptions mediate the relationship between objective food environment and residents' diet quality and weight status.
  
  
  METHODS
  In the Waterloo Region, Ontario, objective food environment data were collected from 422 food stores and 912 restaurants using the Nutrition Environment Measure Survey in Stores and Restaurants, a shelf-space measure of fruits and vegetables, and the Retail Food Environment Index. Waterloo Region households (n=2223) completed a subjective food environment perception survey; household members (n=4102) self-reported weight, height, and waist circumference. A subsample (1170 individuals within 690 households) completed diet records. Food environment data were collected in 2010; respondent data were collected from 2009-2010; and data were analyzed in 2012. A series of gender-specific models were conducted to test mediation, adjusting for household income, car ownership, age, and education level.
  
  
  RESULTS
  Residents' perceptions did not mediate the relationship between objective measures and diet-related outcomes; instead, results revealed the direct effect of several objectively measured factors of the food environment (notably food access and relative food affordability) on outcomes. Perceptions generally were not associated with diet-related outcomes.
  
  
  CONCLUSIONS
  These results reveal that in this setting, strategies aimed at improving residents' perceptions may be less effective than those acting directly on food environments to improve food access and relative food affordability.
authors: School of Public Health, University of Alberta, Edmonton, Alberta.
authors: Leia M
authors: LM
authors: Minaker
authors: Kim D
authors: KD
authors: Raine
authors: T Cameron
authors: TC
authors: Wild
authors: Candace I J
authors: CI
authors: Nykiforuk
authors: Mary E
authors: ME
authors: Thompson
authors: Lawrence D
authors: LD
authors: Frank
mesh_terms: D000328:Adult; D001835:Body Weight; D003132:Commerce / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003625:Data Collection; D004032:Diet / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005523:Food Supply / Q000191:economics / Q000706:statistics & numerical data*; D005638:Fruit / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012147:Restaurants / Q000706:statistics & numerical data*; D012737:Sex Factors; D014675:Vegetables / Q000191:economics; D055105:Waist Circumference