title: Access to healthy food stores modifies effect of a dietary intervention.
abstract: BACKGROUND
  Recent evidence suggests that opening a grocery store in a food desert does not translate to better diet quality among community residents.
  
  
  OBJECTIVE
  This study evaluated the influence of proximity to a healthy food store on the effect of a dietary behavioral intervention on diet among obese adults randomized to either a high fiber or American Heart Association diet intervention.
  
  
  METHODS
  Participants were recruited from Worcester County, Massachusetts, between June 2009 and January 2012. Dietary data were collected via 24-hour recalls at baseline and 3, 6, and 12 months post-intervention. Based on in-store inspection data, a store was considered as having adequate availability of healthy foods if it had at least one item available in each of 20 healthy food categories. Linear models evaluated maximum change in dietary outcomes in relation to road distance from residence to the nearest June healthy food store. The analysis was conducted in January to June 2014.
  
  
  RESULTS
  On average, participants (N=204) were aged 52 years, BMI=34.9, and included 72% women and 89% non-Hispanic whites. Shorter distance to a healthy food store was associated with greater improvements in consumption of fiber (b=-1.07 g/day per mile, p<0.01) and fruits and vegetables (b=-0.19 servings/day per mile, p=0.03) with and without covariate adjustment.
  
  
  CONCLUSIONS
  The effectiveness of dietary interventions is significantly influenced by the presence of a supportive community nutrition environment. Considering the nationwide efforts on promotion of healthy eating, the value of improving community access to healthy foods should not be underestimated.
  
  
  BACKGROUND
  NCT00911885.
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Wedick
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Yunsheng
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Olendzki
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Procter-Gray
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Jie
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Kane
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Ira S
authors.initials: IS
authors.lastname: Ockene
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Pagoto
authors.affiliation: Massachusetts Department of Public Health, Boston, Massachusetts.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Land
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester. Electronic address: wenjun.li@umassmed.edu.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D003132:Commerce / Q000706:statistics & numerical data*; D004032:Diet; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D006293:Health Promotion; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D020377:Self Efficacy; D012959:Socioeconomic Factors