the influence of community retail food environment on
TRANSCRIPT
The Influence of Community Retail Food Environment on Household Food Access, Food Choice, and Dietary Intake of Mexican-origin Children in Colonias
along the South Texas Border with Mexico
Joseph R. Sharkey Wesley R. Dean
Program for Research in Nutrition and Health Disparities, School of Rural Public Health, Texas A&M Health Science Center Funded by the Food Assistance and Nutrition Research Innovation and Development Grants in Economics Program Grant awarded by the Southern Rural Development Center, Mississippi State University
INTRODUCTION
The burden of obesity and nutrition-related health conditions disproportionately
affects marginalized populations that face increased vulnerability to food insecurity and
poor nutritional health.1 One such marginalized population is Mexican American families
who reside in impoverished colonias along the Texas-Mexico border.2 Many of these
families rely on food assistance programs, such as the Supplemental Nutrition
Assistance Program, School Breakfast and Lunch Programs, and the Special
Supplemental Nutrition Program for Women, Infants, and Children, to help meet
household food needs. Colonias, developed from subdivided agricultural lands in
response to a deficit in low-income housing,3 are substandard residential areas with
inadequate roads, variable housing conditions, and limited access to safe water and
sewer sources.4
The Texas-Mexico border region is medically underserved and poor; almost 75%
of adults are overweight or obese; and the prevalence of type 2 diabetes is greater than
the national rate in Mexico and the United States.5,6 Although colonias can be found
along the Arizona, California, New Mexico, and Texas borders with Mexico, the largest
number of colonias (more than 2,290) and colonia population (approximately 400,000)
reside along Texas’ 1,248 mile border with Texas.7 More than half of Texas colonias are
located in the Lower Rio Grande Valley. In this area, almost 20% of these largely
Mexican households have a female head, and 50% of children are food insecure.8,9
Mexican American children in the Lower Rio Grande Valley of Texas are consuming
diets higher in total energy, fat, carbohydrates, and sodium.10
Among Mexican immigrant destinations, the archetype is the more than 2,500
colonias along the 1,969-mile southwestern U.S. border with Mexico. Most of these
colonias are in Texas, especially in the persistent-poverty border county of Hidalgo.11
Similar to new destination immigrant communities, colonias are smaller, more dispersed
communities comprised of a heterogeneous, disproportionately poor population of
immigrants and their families with limited access to the kinds of resources necessary for
facilitating economic and social mobility in a region characterized by adverse social
conditions.12 Many colonias lack public transportation; have limited access to
community food resources; and include neighborhoods of greater overall deprivation
and a greater percentage of residents who lack an available vehicle.2 However, colonias
are distinct. These Mexican immigrant settlements have existed since the 1960’s and
now include native and immigrant residents of Mexican-origin.4,11
Although obesity has risen at alarming rates among all segments of the
population, prevalence is significant among Mexican Americans and continues to
increase among the poor and near-poor.5,13,14 Among children 6-11 years, the
prevalence for overweight and obesity was greater among Mexican American children
(42.8%) than Non-Hispanic Black (36.9%) or Non-Hispanic White (31.6%) children.15
As illustrated in an IOM report, ecological factors, such as home, school, and
community settings influence childhood obesity through food and beverage choices and
intake.16 To promote healthy eating and prevent obesity among high-risk Mexican
American children, individual, family, and neighborhood characteristics must be
addressed.
In the colonias of southern Texas, increases in overweight and obesity among
children and adolescents are of great concern.17-19 Notably, the border population is
growing at a rate nearly double that of the rest of Texas, outpacing the availability of
healthy foods and beverages in homes, neighborhoods, and communities.2,20 The 2009
Colonia Household and Community Food Resource Assessment (C-HCFRA) of 610
households found 61.8% of households with children experienced severe food
insecurity; 54% participated in school nutrition programs; 55% received Supplemental
Nutrition Assistance Program (SNAP) benefits; 35% were overweight; 34.7% were
obese; and 79% of women consumed at least one SSB each day.21
The colonias of the Texas border region are characterized by individual, group,
and environmental obstacles that limit the ability of families and children to make
healthy food and beverage choices. This area presents an opportunity for critical
research, intervention, and much-needed extension by teams of investigators and
promotoras de salud with established, secure relationships with the communities. The
premise of this comprehensive proposal is that physical, economic, and sociocultural
contextual dimensions of the multi-level food and family environments are important
influences on children’s food and beverage choices and intake (Figure 1). The ultimate
reduction in the incidence and prevalence of overweight and obesity requires a multi-
level, integrated perspective.22-26 As a result, the relationships shown between
household, neighborhood, and home food environments and characteristics of family
and children, and children’s access to foods and beverages must be characterized to
identify factors that act as barriers or facilitators to healthy and unhealthy food and
beverage choices by children.
Several barriers make it difficult for individuals to consume healthier foods and
beverages, and these barriers operate in three contextual dimensions – physical,
economic, and sociocultural, within the household, family, neighborhood and community
environments. We know that personal, structural, and neighborhood characteristics
serve as barriers or enhancements to healthy eating.1,2,27-30 Additionally, residents of
rural and poor areas face the greatest structural and neighborhood disadvantages.2,30,31
Educational and behavioral interventions targeting individuals have produced limited
success.32 As a result, the paradigm has shifted from targeting individuals only to
recognize that the prevention and reduction of obesity and nutrition-related health
conditions are dependent upon supportive environments, such as access to food
resources.33,34 Geographic access to food resources is especially critical for limited
resource families who rely on food assistance programs, especially in areas without
public transportation. Lack of geographic access makes it particularly difficult to
establish or maintain healthy nutrition behaviors that are essential for the prevention of
obesity and nutrition-related disease conditions. The local food environment may affect
nutritional health by influencing food choices as a function of food cost and
availability.35-38 In order to make healthy food choices, food resources need to be
accessible (located near neighborhoods or with transportation available), available
(include a variety of healthful food, such as low-fat, high-fiber, or fruits and vegetables in
local stores), and affordable (reasonably priced healthful foods).37-39 Food costs and
convenience, especially in neighborhoods without supermarkets, may negatively
influence the quality and quantity of food available to eat, thereby compelling an
individual to choose foods that are more energy-dense and less nutrient-dense. In
Latino (Hispanic or Mexican American) households, limited food accessibility is
associated with a lower variety of most foods, particularly fruits and vegetables. This
influences overall food intake of individual household members, especially children.40
While recent research examined environmental influences on obesity, limited
progress has been made in areas of persistent poverty, such as the growing areas of
colonias along the Texas Rio Grande. Clearly, new approaches must be developed for
examinations of food choice in the colonias, which take into consideration the cultural
context in which people access food resources. Thus, an understanding of the multiple
levels influencing access and availability of foods and beverages, along with family and
children’s behaviors, is essential in developing and implementing interventions to
reduce dietary intake of added sugars.
Using data from an ongoing study of nutrition behaviors among Mexican-origin
children in Texas border colonias, the goals of this research were (1) to evaluate the
food environment (neighborhood and household), household food supplies, and dietary
intake in a sample of Mexican American dyads (mother-child) in the study area colonias;
and (2) to examine the influence of household food supplies and neighborhood food
stores on children’s food consumption.
METHODS
Study area
The study was conducted in two large areas of colonias in Hidalgo County near
the small towns of San Carlos and Alton, located in the Lower Rio Grande Valley of
Texas along the Mexico border. Based on 2005-2009 estimates, San Carlos (population
2913) is 95.6% Hispanic, with 34.3% of individuals below the poverty line;41 Alton
(population 10882) is 97.4% Hispanic, with 38.6% below the poverty line.42 From prior
work and in consultation with community partners, 10 census block groups (CBG) were
identified in the western part of the county and 10 in the eastern portion of the county. In
both areas, a majority of CBGs are considered to be highly deprived neighborhoods.2
Highly deprived neighborhoods are those with overall high proportions of unemployed
adults, households without telephone service, families receiving public assistance,
households lacking complete kitchen facilities, households lacking complete plumbing
facilities, adults with less than 10 years of education, or those living below the poverty
threshold.2 Forty colonias were spatially selected, with at least one colonia in each of
the 20 CBGs.
Study Sample
The study sample consisted of 50 family dyads (mother and child 6-11 years),
who were recruited for a cohort study by team promotora-researchers; 25 dyads were
recruited from western area colonias (near Alton) and 25 from eastern area colonias
(near San Carlos). Letters of invitation were personally delivered by promotora-
researchers, and eligibility was determined by the presence of one child (age 6-11
years) residing in the household. The study was explained to each prospective adult
participant (e.g., inform about assessments, confidentiality, financial incentive, etc.), and
the first of three in-home assessments was scheduled within two days. The mother
provided consent for both members of the dyad to participate in the study, and the child
provided assent for participation. All materials and protocols were approved by the
Texas A&M University Institutional Review Board.
Data Collection
This analysis focuses on data collected March to June 2010 from all 50 mother-
child dyads during three in-home visits and two observational assessments of foods and
beverages present in the household. Survey data and anthropometrics were collected
during the first in-home visit and dietary recalls were collected from participant children
during three visits. The survey included sections on demographics and food security
and was interviewer-administered by promotora-researchers, who received training in
collection of survey, anthropometric measures, and 24-hour dietary recalls. All materials
were reviewed by community partners and were validated by local/area experts. A pilot
test was conducted in colonias not selected from the study area and necessary
modifications were made. Promotora-researchers received the equivalent of four full
days of training on data collection and protection of participant confidentiality. All
measures were translated into Spanish using translation-back translation method with
the following steps: 1) translation of the original English into Spanish, ensuring that the
English meaning is maintained; 2) back-translation into English by an independent
translator who is blinded and is not familiar with either the Spanish or English version; 3)
comparison of the two English versions; and 4) resolution of any discrepancies.
Community partners and promotora-researchers verified translation accuracy and
appropriateness to ensure semantic, conceptual, and normative equivalence. All survey
and 24-hour dietary recall data were collected in Spanish, which was the language
spoken in the homes of all participants.
Measures
Demographics included mother’s age, completed education, ethnicity, marital status,
country of birth, household composition, household income, car ownership, and
participation in school-based nutrition assistance programs, such as Supplemental
Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC), School Breakfast Program (SBP) and National
School Lunch Program (NSLP).
percentile), overweight (85th percentile to <95th percentile), or obese (95th percentile).43
Household food security was assessed using the 18-item USDA Food Security
Module.44 Participant mothers were asked by the promotora-researcher whether they
experienced each of the items during the last three months. Each item was constructed
as a binary variable; yes vs. no. Affirmative responses were summed into an ordinal
household food security score, which was used to categorize each household as having
high food security (score = 0), marginal food security (score = 1-2), low food security
(score = 3-7), or very low food security (score = 8-18).45
Dietary intake
Three 24-hour (previous day) dietary recalls occurring on randomly selected,
nonconsecutive days (one recall measured weekend intake and two measured weekday
intake) were collected in the home from each participant child by the same interviewer
(promotora-researcher). In most cases, the mother observed and assisted the children if
necessary. Dietary intake training for the interviewers included review of all protocols
and scripts, modeling of interviewing, practice interviews with children similar in age to
the study participants, use of tools for portion-size estimation, quality control, and focus
on children’s reporting of food items. The first recall occurred during the first in-home
visit, and the second and third recalls were collected in the home during the second and
third visits (within two weeks of the first visit). Detailed information on food and
beverage consumption, including description, brand name, location of preparation and
consumption, and preparation method during the previous day was collected using
standardized protocols following a modification of the multiple-pass interview technique
of the Nutrition Data System for Research (NDS-R).46 Data were collected on hard copy
in Spanish, modified from an approach previously used,47 and then entered into NDS-R
2009 in English. Children were first asked to provide a quick list of generic food and
beverage items consumed during the previous day based on short time intervals (e.g.,
before breakfast, at breakfast, between breakfast and lunch, and at dinner); prompts
included food consumption occasions and locations. This was followed by a review of
the quick list. During this pass, the interviewer probed for forgotten foods by asking
about snacks and beverages (including water) and about the source of the food or
beverage. The third pass provided food details such as the time and place of the eating
occasion, food descriptions, brand name, ingredients and preparation, and portion size
and quantity consumed. As a result of pilot testing, multiple approaches were used for
estimation of portion size and included measurement of typically-used cups, glasses,
bowls, and containers in the home, food and beverage models, geometric shapes
(circles, rectangles, and wedges), and three-dimensional thickness aides. The fourth
pass was a final and comprehensive review of the previous-day’s intake. Nutrient
calculations were performed using NDS-R 2009 software. Three-day mean nutrient
intakes, with equal weighting for each of the three days (2 weekdays and 1 weekend) of
dietary recall were calculated for each child for total energy (kcal), protein (g), dietary
fiber (g), calcium (mg), vitamin D (mcg), potassium (mg), sodium (mg), Vitamin C (mg),
percentage of calories from fat, percentage of calories from added sugars, and
percentage of calories from saturated fat.
Household food supplies
Household food supplies (HFS) were measured using a modification of the
Household Food Inventory used in the pilot Household Food Availability Project.20 This
measure captured the amount of each food item present. Two HFS measurements (two
week interval) were collected. Nutrient calculations were performed using NDS-R 2009
software. Two-time mean nutrient availability, with equal weighting were calculated for
each household for total energy (kcal), protein (g), dietary fiber (g), calcium (mg),
vitamin D (mcg), potassium (mg), sodium (mg), Vitamin C (mg), percentage of calories
from fat, percentage of calories from added sugars, and percentage of calories from
saturated fat.
Spatial access
Using locational data on traditional, convenience, and non-traditional food stores
that were collected in the 2009-2010 Colonia Food Environment Project, two measures
of spatial access were calculated from the residence of each participate: 1) proximity
and 2) coverage. Proximity: ESRI's Network Analyst extension in ArcInfo 9.2 was used
to calculate the shortest network distance along the road network between paired point
data (residential address of participant household and the nearest corresponding food
store within the study area). Separate distances were calculated to each type of
shopping opportunity – the nearest supercenter, supermarket, grocery store,
convenience store, mass merchandiser, and dollar store in miles. Coverage: Network
Analyst computed the total number of each type of food store within a one-mile, three-
mile, and five-mile buffer of each participant household, using the shortest network
distance from the residence. Coverage distances were selected that represented a long
walk (1 mile) and reachable by car (within 3 and 5 miles). Proximity measured the
shortest distance needed to travel to a specific type of food store, while coverage
indicates the number of shopping opportunities.2
Use of convenience stores
Since convenience stores are the most prevalent type of retail food store in the
study area, three questions were asked to determine the regular use of convenience
stores: 1) how frequently do you eat food from a convenience store? 2) how frequently
do you purchase food from a convenience store for your child? 3) how frequently does
your child purchase food from a convenience store on their own? Each variable was
coded as at least once a week vs. never.
Statistical analysis
All analyses were performed using Stata Statistical Software: Release 11
(College Station, TX: Stata Corp, 2009). Descriptive statistics were calculated for each
child’s baseline characteristics, BMI status, food security status, and nutrient intake.
Descriptive statistics were also calculated for nutrients available in household food
supplies and spatial access to food stores in terms of proximity and coverage. The
primary outcome measures were household food supplies (two observational
measures) and children’s dietary intake (three 24-hour dietary recalls). Separate
multiple regression models with robust (White-corrected) Standard errors (SEs), were
individually fitted for household food supplies and dietary intake as total energy (kcal),
protein (g), dietary fiber (g), calcium (mg), vitamin D (mcg), potassium (mg), sodium
(mg), Vitamin C (mg), percentage of calories from fat, percentage of calories from
added sugars, and percentage of calories from saturated fat.
FINDINGS AND DISCUSSION
Table 1 shows the characteristics for the 50 study households, based on
responses from the participant mother during the baseline in-home assessment. On
average, the mothers were age 35 years and completed eight years of formal
education. Ninety-four percent were born in Mexico, and 96% reported a household
income below 100% federal poverty level (FPL). Although 80% reported car ownership,
56% reported that a car was available during the day. Seventy-four percent reported low
(40%) or very low food (34%) security. More than 80% purchased food from a
convenience store at least once a week. Nutrient intakes from three 24-hour dietary
recalls reported by the participant children are shown in Table 2. Children consumed
smaller amounts of calcium, vitamin D, potassium, and vitamin C on weekends
compared with weekdays; the intake of fat as a percent of calories was greater on
weekends. Table 3 shows nutrient availability in household food supplies. Spatial
access to food stores, in terms of proximity to the nearest and coverage (number of
different stores), from participant households are shown in Table 4. Convenience stores
or food marts provided best access to food and beverage items, followed by dollar-type
stores.
Unadjusted analyses (data not shown) indicated that distance to the nearest
supermarket or dollar store was not associated with household availability of any
nutrient; however, distance to the nearest convenience store was negatively associated
with household availability of total sugar and added sugars. Coverage for any of the
types of food stores was not associated with any of the nutrients. Table 5 presents the
result of multiple regression models for correlates of household nutrient availability.
Increasing household composition (total number of adults and children) was associated
with increased availability of total energy, protein, total fat, and saturated fat.
Participation in the NSLP was associated with lower household food supplies of energy,
protein, vitamin C, sodium, vitamin D, and saturated fat. Households with children who
purchased food on their own from a convenience store at least once a week had greater
household availability of energy, protein, sodium, and total fat. Finally, increasing
distance to the nearest convenience was associated with lower amounts of energy, total
sugar, added sugar, and saturated fat in household food supplies. Sample
characteristics associated with children’s dietary intake are shown in Table 6.
Participation in NSLP was the only variable associated with lower dietary intakes of total
energy, protein, and added sugar after controlling for household composition,
convenience store utilization and spatial access, and household food supplies. Spatial
access to convenience stores and household food supplies were not associated with
nutrient intake from the diet.
This study is the first step in understanding the influence of the food environment
on food choice and diet quality in Mexican-origin families who live in high or persistent
poverty areas, such as the growing number of colonias where there is limited or non-
existent public transportation and where many residents do not have access to a
vehicle. The results of this study further the knowledge of the role of NSLP and spatial
access to the food environment on household food supplies and children’s dietary
intake. The data suggest that participation in the NSLP allows families to maintain lower
household supplies of foods and beverages that provide total energy, protein, vitamin C,
sodium, vitamin D, and saturated fat. In addition, closer proximity to a convenience
store may support more frequent shopping and the less need for maintaining foods in
the household that provide energy, total sugar, added sugar, and saturated fat.
Enhanced research efforts are needed that will lead to better understanding of coping
strategies and the use of federal and community food and nutrition assistance
programs. Clearly, systematic and sustained action on multiple levels that integrates
multi-sector partnerships and networks is needed for culturally-tailored health promotion
and policy efforts. When it came to the intake of nutrients by children, participation in
the NSLP was the only characteristic associated with lower intakes of energy, protein,
and added sugar. At the same time, the presence of nutrients in the household was not
associated with nutrient intake.
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Table 1. Characteristics of Participant Households (n = 50), Using Mothers’ Responses to In-Home Survey
Mean ± SD % (n)
Age, ya 35.2 ± 7.0 Education, y 8.5 ± 3.1 Ethnicityb Hispanic 32 (16) Mexican 68 (34) Marriedc 82 (41) Country of birth Mexico 94 (47) Household compositiond 5.7 ± 1.5 Household income, % FPLe <50 78 (39) 50-74 16 (8) 75-99 2 (1) 100-130 4 (2) Car ownership 80 (40) Car availability during the day 56 (28) Nutrition program participation SNAP 88 (44) WIC 58 (29) School breakfast program 96 (48) National school lunch program 58 (29) Food security statusf Food secure 6 (3) Moderate food security 20 (10) Low food security 40 (20) Very low food security 34 (17) Use of convenience store Eat food from convenience store
at least once/week
78 (39) Purchase food from
convenience store for child at least once/week
84 (42)
Child purchases food from convenience store on their own at least once/week
26 (13)
a as of June 2010 b self-identified c Married or living with a partner d Total of adults and children living in the household e Based on 2010 criteria using household income and household composition f Based on 18-item USDA Food Security Module
Table 2. Nutrient intake (3-day average, weekday average, and weekend)a
3-day Average Weekday Weekend day
Total energy (kcal) 2034.9 (372.8) 2008.1 (375.8) 2097.5 (717.6)
Protein (g) 82.9 (19.7) 81.1 (19.9) 86.4 (36.7)
Dietary fiber (g) 15.2 (5.0) 15.5 (5.3) 14.6 (9.8)
Calcium (mg) 993.4 (300.5) 1056.3 (299.6) 898.2 (566.2)c2
Vitamin D (mcg) 6.9 (2.9) 7.5 (2.7) 5.8 (4.4)c3
Potassium (mg) 2530.1 (554.4) 2640.3 (602.8) 2332.9 (955.2)c1
Sodium (mg) 3450.7 (913.2) 3372.1 (994.8) 3553.5 (1695.0)
Vitamin C (mg) 101.1 (52.7) 110.5 (63.8) 81.4 (70.4)c2
Fatb 34.0 (4.1) 32.5 (4.2) 36.8 (7.8)c3
Added sugarsb 15.0 (5.5) 14.8 (6.3) 15.5 (7.7)
Saturated fatb 12.6 (2.0) 12.3 (2.2) 13.2 (4.2)
a Nutrient intake reported as mean (SD). b Percent of total calories cComparison of weekday and weekend day nutrient intake, using the Wilcoxon Signed-Ranks Test
Level of statistical significance: 1p<0.05 2p<0.01 3p<0.001
Table 3. Nutrient availability in 50 households based on two household food inventories
Mean ± SD Median
Energy, kcal 119,899 ± 37,678 117,320
Protein, g 3,363.4 ± 1,180.7 3,181.7
Dietary fiber, g 681.2 ± 354.9 943.7
Calcium, mg 20,516.9 ± 7,057.4 20,531.7
Potassium, mg 108,649.7 ± 42,659.4 99,325.3
Sodium, mg 110,220.5 ± 40,885.3 106,262.4
Vitamin C, mg 2,964.4 ± 1,370.4 2,570.3
Vitamin D, mcg 184.2 ± 64.4 181.1
Total sugars, g 2,920.9 ± 1,288.2 2,766.5
Added sugars, g 2,133.8 ± 1,240.3 1,692.4
Total fat, g 6,911 ± 2,559.2 6,905.4
Saturated fat, g 2,026.1 ± 748.1 2,018.4
SD = Standard Deviation
Table 4. Spatial accessibility to food for the participant households (n = 50)
Mean ± Standard Deviation Median
Proximity (distance in miles)a Traditional Food Stores Supermarkets 5.0 ± 2.5 5.5
Convenience Convenience stores/food marts 0.75 ± 0.56 0.67
Non-Traditional Food Stores Dollar Stores 3.1 ± 1.8 2.3
Coverage – 1 Mileb Traditional Food Stores Supermarkets 0.06 ± 0.24 0
Convenience Convenience stores/food marts 3.3 ± 2.4 2.5
Non-Traditional Food Stores Dollar Stores 0.1 ± 0.3 0
Coverage – 3 Milesc Traditional Food Stores Supermarkets 1.0 ± 1.3 0
Convenience Convenience stores/food marts 25.6 ± 8.6 29.5
Non-Traditional Food Stores Dollar Stores 1.7 ± 1.6 1.5
Coverage – 5 Milesd Traditional Food Stores Supermarkets 2.6 ± 2.2 2
Convenience Convenience stores/food marts 60.7 ± 20.5 66
Non-Traditional Food Stores Dollar Stores 5.9 ± 3.0 5.5 a Network distance calculated from the residence of each of the 50 participant families to the nearest food store b Number of food stores within 1 network mile of the residence c Number of food stores within 3 network miles of the residence d Number of food stores within 5 network miles of the residence
Table 5. Association of sample characteristics and spatial access to convenience stores with household availability of nutrients from food
Energy
(kcal)
Protein
(g)
Dietary
Fiber
(g)
Calcium
(mg)
Potassium
(mg)
Vitamin
C
(mg)
Sodium
(mg)
Vitamin
D
(g)
Total
Sugar
(g)
Added
Sugar
(g)
Total
Fat
(g)
Total
SFA
(g)
Household compositiona
9433***
260.1**
23.1 965.3 6774.9 92.4 5243.6 8.3 214.3 243.7 616.6**
157.3**
NSLPb
-19898*
-523.8*
-104.4 -4200.3 -11887 -1073**
-30755**
-42.6*
-217.6 -120.3 -1224.6 -436.8*
Convenience – Childc
28267**
772.8*
145.5 3327 22580.4 132.6 23141.7*
15.7 465.2 223.8 2126.3**
472.0*
Convenience Stored -17367
* -255.6 -63.1 -214.6 -10804.4 56.4 -9248.6 -24.0 -841.6
** -798.4
** -962.1 -345.5
**
R2
0.379 0.273 0.078 0.169 0.150 0.147 0.262 0.169 0.216 0.210 0.367 0.322
a Total number of adults and children living in the household
b Participate in the National School Lunch Program
c Child purchases food from a convenience on own at least once a week
d Network distance from the residence to the nearest convenience store
Table 6. Association of sample characteristics and spatial access to convenience stores with nutrient intake of children
Energy
(kcal)
Protein
(g)
Dietary
Fiber
(g)
Calcium
(mg)
Potassium
(mg)
Vitamin
C
(mg)
Sodium
(mg)
Vitamin
D
(g)
Total
Sugar
(g)
Added
Sugar
(g)
Total
Fat
(g)
Total
SFA
(g)
Household compositiona
44.07
1.91
-0.09 7.25 10.28 1.25 -128.15 0.04 2.14 4.50 1.50
1.41
NSLPb
-330.64**
-15.94**
-1.99 -47.72 -198.30 -1.39
-364.09
-0.10
-6.86 -25.57**
-12.28 -4.11
Convenience – Childc
-11.06
-5.56
-2.43 -50.65 -366.68 -29.11 -324.36
-0.67 12.01 11.61 -1.46
1.89
Convenience Stored -15.82
2.71 0.06 -62.96 22.69 -5.33 -151.41 -0.12 -11.53
2.80
-1.22 -2.02
Household foode
-0.001 -0.001 0.002 -0.009 0.001 -0.002 0.0004 -0.001 -0.004 -0.004 -0.001 -0.003
R2
0.158 0.136 0.094 0.067 0.096 0.070 0.155 0.012 0.049 0.187 0.089 0.117
a Total number of adults and children living in the household
b Participate in the National School Lunch Program
c Child purchases food from a convenience on own at least once a week
d Network distance from the residence to the nearest convenience store
e Nutrient availability within the household