title: Food swamps and food deserts in Baltimore City, MD, USA: associations with dietary behaviours among urban adolescent girls.
abstract: OBJECTIVE
  To determine whether living in a food swamp (≥4 corner stores within 0·40 km (0·25 miles) of home) or a food desert (generally, no supermarket or access to healthy foods) is associated with consumption of snacks/desserts or fruits/vegetables, and if neighbourhood-level socio-economic status (SES) confounds relationships.
  
  
  METHODS
  Cross-sectional. Assessments included diet (Youth/Adolescent FFQ, skewed dietary variables normalized) and measured height/weight (BMI-for-age percentiles/Z-scores calculated). A geographic information system geocoded home addresses and mapped food deserts/food swamps. Associations examined using multiple linear regression (MLR) models adjusting for age and BMI-for-age Z-score.
  
  
  METHODS
  Baltimore City, MD, USA.
  
  
  METHODS
  Early adolescent girls (6th/7th grade, n 634; mean age 12·1 years; 90·7 % African American; 52·4 % overweight/obese), recruited from twenty-two urban, low-income schools.
  
  
  RESULTS
  Girls' consumption of fruit, vegetables and snacks/desserts: 1·2, 1·7 and 3·4 servings/d, respectively. Girls' food environment: 10·4 % food desert only, 19·1 % food swamp only, 16·1 % both food desert/swamp and 54·4 % neither food desert/swamp. Average median neighbourhood-level household income: $US 35 298. In MLR models, girls living in both food deserts/swamps consumed additional servings of snacks/desserts v. girls living in neither (β=0·13, P=0·029; 3·8 v. 3·2 servings/d). Specifically, girls living in food swamps consumed more snacks/desserts than girls who did not (β=0·16, P=0·003; 3·7 v. 3·1 servings/d), with no confounding effect of neighbourhood-level SES. No associations were identified with food deserts or consumption of fruits/vegetables.
  
  
  CONCLUSIONS
  Early adolescent girls living in food swamps consumed more snacks/desserts than girls not living in food swamps. Dietary interventions should consider the built environment/food access when addressing adolescent dietary behaviours.
authors.affiliation: 1Department of Pediatrics,Growth and Nutrition Division,University of Maryland School of Medicine,737 West Lombard Street,Room 169B,Baltimore,MD 21201,USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Hager
authors.affiliation: 1Department of Pediatrics,Growth and Nutrition Division,University of Maryland School of Medicine,737 West Lombard Street,Room 169B,Baltimore,MD 21201,USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cockerham
authors.affiliation: 4School of Social Work, Boise State University,Boise,ID,USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: O'Reilly
authors.affiliation: 5School of Social Work,University of Maryland,Baltimore,MD,USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Harrington
authors.affiliation: 6Johns Hopkins Center for a Livable Future,Baltimore,MD,USA.
authors.forename: James
authors.initials: J
authors.lastname: Harding
authors.affiliation: 7Department of International Health,Human Nutrition Division,Center for Human Nutrition,Johns Hopkins Bloomberg School of Public Health,Baltimore,MD,USA.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Hurley
authors.affiliation: 1Department of Pediatrics,Growth and Nutrition Division,University of Maryland School of Medicine,737 West Lombard Street,Room 169B,Baltimore,MD 21201,USA.
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Black
mesh_terms: D001741:Black or African American; D000886:Anthropometry; D015142:Baltimore; D002648:Child; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D005523:Food Supply; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D009765:Obesity / Q000453:epidemiology*; D012111:Residence Characteristics; D062410:Snacks; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population; D014675:Vegetables
keywords: Adolescents; African American; Food desert/food swamp; Geographic information system; Snacks and desserts