title: Environmental influences on fruit and vegetable intake: results from a path analytic model.
abstract: OBJECTIVE
  Fruit and vegetable (F&V) intake is influenced by behavioural and environmental factors, but these have rarely been assessed simultaneously. We aimed to quantify the relative influence of supermarket availability, perceptions of the food environment and shopping behaviour on F&V intake.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  Eight counties in South Carolina, USA, with verified locations of all supermarkets.
  
  
  METHODS
  A telephone survey of 831 household food shoppers ascertained F&V intake with a seventeen-item screener, primary food store location, shopping frequency and perceptions of healthy food availability, and supermarket availability was calculated with a geographic information system. Path analysis was conducted. We report standardized beta coefficients on paths significant at the 0·05 level.
  
  
  RESULTS
  Frequency of grocery shopping at primary food store (β = 0·11) was the only factor exerting an independent, statistically significant direct effect on F&V intake. Supermarket availability was significantly associated with distance to utilized food store (β = -0·24) and shopping frequency (β = 0·10). Increased supermarket availability was significantly and positively related to perceived healthy food availability in the neighbourhood (β = 0·18) and ease of shopping access (β = 0·09). Collectively considering all model paths linked to perceived availability of healthy foods, this measure was the only other factor to have a significant total effect on F&V intake.
  
  
  CONCLUSIONS
  While the majority of the literature to date has suggested an independent and important role of supermarket availability for F&V intake, our study found only indirect effects of supermarket availability and suggests that food shopping frequency and perceptions of healthy food availability are two integral components of a network of influences on F&V intake.
authors.affiliation: 1Center for Research in Nutrition and Health Disparities,Arnold School of Public Health,Department of Epidemiology and Biostatistics,University of South Carolina,921 Assembly Street,Columbia,SC 29208,USA.
authors.forename: Angela D
authors.initials: AD
authors.lastname: Liese
authors.affiliation: 2College of Education,University of South Carolina,Columbia,SC,USA.
authors.forename: Bethany A
authors.initials: BA
authors.lastname: Bell
authors.affiliation: 1Center for Research in Nutrition and Health Disparities,Arnold School of Public Health,Department of Epidemiology and Biostatistics,University of South Carolina,921 Assembly Street,Columbia,SC 29208,USA.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Barnes
authors.affiliation: 3Institute for Social Research,University of Michigan,Ann Arbor,MI,USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Colabianchi
authors.affiliation: 1Center for Research in Nutrition and Health Disparities,Arnold School of Public Health,Department of Epidemiology and Biostatistics,University of South Carolina,921 Assembly Street,Columbia,SC 29208,USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Hibbert
authors.affiliation: 4Department of Health Promotion,Education,and Behavior,University of South Carolina,Columbia,SC,USA.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Blake
authors.affiliation: 5College of Social Work,University of South Carolina,Columbia,SC,USA.
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Freedman
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D005523:Food Supply; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012931:Social Environment; D013022:South Carolina; D014675:Vegetables