title: Neighborhood Food Access and Birth Outcomes in South Carolina.
abstract: OBJECTIVE
  Evidence of the association between food environment and birth outcomes is limited. This study aimed to examine the association between individual-level food access measures and birth outcomes.
  
  
  METHODS
  All birth certificates (N = 15,786) from January 1, 2008 to December 31, 2009 in eight counties in South Carolina were included. Access to food was evaluated by the distance to the nearest food store and the number of each type of store within a 1-mile (1.6-km) radius from the women's homes. Birth outcomes included birth weight, low birth weight, gestational age, and preterm birth (PTB).
  
  
  RESULTS
  A further distance to the nearest convenience store was associated with higher birth weight and gestational age. Birth weight in areas with two or more convenience stores within a 1-mile (1.6-km) buffer was less [two stores: β = -46.2, 95 % confidence interval (CI) -76.5, -15.9; three or more stores: β = -48.6, 95 % CI -78.8, -18.5], and gestational age was shorter in areas with one or two convenience stores (one store: β = -0.11, 95 % CI -0.21, -0.00; two or more stores: β = -0.13, 95 % CI -0.25, 0.00) than in areas without convenience stores in the neighborhood. Having three or more convenience stores in the neighborhood was associated with increased risk of PTB compared with no convenience stores. Accessibility and availability of supermarkets and grocery stores were not associated with any birth outcomes.
  
  
  CONCLUSIONS
  This analysis suggests that access to unhealthy foods is associated with adverse birth outcomes. Future investigations with more comprehensive measures of food environment are warranted.
authors.affiliation: Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China. mxg@zju.edu.cn.|Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. mxg@zju.edu.cn.|Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. mxg@zju.edu.cn.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Jihong
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Hardin
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Guang
authors.initials: G
authors.lastname: Zhao
authors.affiliation: Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.|Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Angela D
authors.initials: AD
authors.lastname: Liese
keywords: Accessibility; Availability; Food store; Low birthweight; Preterm birth