Title: The Relationship between the Neighborhood Food Environment, Health Behaviors and Health Outcomes among Urban Hispanics in New York City
Description: Background: Hispanics account for more than half of the total United States (US) population growth between 2000 and 2010. To gain a comprehensive understanding of a predominantly Hispanic urban community in Northern Manhattan, the aims of this cross-sectional observational study were: (1) to characterize the actual and perceived neighborhood food environment in Northern Manhattan, (2) to understand the relationship between the actual and perceived neighborhood food environment, sociodemographic characteristics and the likelihood of consuming five or more servings of fruits and vegetables per day, and (3) to describe the contribution of participants’ sociodemographic characteristics and health behavior to their health outcomes. Methods: This cross-sectional observational study was undertaken as part of the larger Washington Heights/Inwood Informatics Infrastructure for Comparative Effectiveness Research (WICER) project. English or Spanish-speaking Hispanic participants (n=4,019) 18 years and older living in Northern Manhattan’s five ZIP codes were recruited and interviewed by English-Spanish bilingual community health workers.

Food outlets selling fruits and vegetables were identified using the North American Industry Classification System (NAICS) definitions obtained from the ReferenceUSA’s national business database. The neighborhood food environment was characterized by integrating the geocoded addresses of WICER study participants with external geographic-level data on food outlets present in the participants’ respective 0.25-mile and 0.5-mile residential radii. Data were analyzed using bivariate and multivariate binary logistic regressions. Results: The food outlet types that sell fruit and vegetable in Northern Manhattan include small and medium/large size Supermarket/Grocery store, Meat Market, and Fruit and Vegetable Market. The majority of these food outlets (91.5%) are single location stores that have a smaller store space. The presence of Fruit and Vegetable Markets (2+ Stores in 0.25-mile: OR=1.59, p = 0.003; 1 Store in 0.5-mile: OR=2.28, p = 0.008; 2+ Stores in 0.5-mile: OR=3.10, p = 0.00) significantly increase the odds of participant’s perception that a large selection of fresh fruits and vegetables is available in their neighborhood.

The presence of Fruit and Vegetable Markets (2+ Stores in 0.25-mile: OR=1.51, p = 0.003; 1 Store in 0.5-mile: OR=2.25, p = 0.004; 2+ Stores in 0.5-mile: OR=3.31, p = 0.00) as well as the presence of medium/large size Supermarket/Grocery in 0.25-mile (OR=1.05, p = 0.013) significantly increase the odds of participant’s perception that the fresh fruits and vegetables in their neighborhood are of high quality whereas the presence of Meat Market in the participant’s 0.25-mile (OR=0.74, p = 0.002) significantly lower the odds. The presence of Fruit and Vegetable Markets (1 Store in 0.25-mile: OR=1.23, p = 0.047; 2+ Stores in 0.25-mile: OR=1.37, p = 0.020; 2+ Stores in 0.5-mile: OR=1.94, p = 0.018) as well as the presence of medium/large size Supermarket/Grocery (0.25-mile: OR=1.05, p = 0.020; 0.5-mile: OR=1.05, p = 0.018) significantly increase the odds of participant’s perception that a large selection of low-fat products is available in their neighborhood whereas the presence of Meat Market in the participant’s 0.25-mile (OR=0.83, p = 0.042) significantly lowers the odds.

Variables that significantly increase the participants’ odds of consuming five or more servings of fruits and vegetables per day include having more than a high school education (0.25-mile and 0.5-mile models: OR=1.62, p = 0.004) and being foreign-born (0.25-mile model: Foreign-born in Dominican Republic: OR=1.77, p = 0.032; Foreign-born outside of the United States or the Dominican Republic: OR=2.44, p = 0.007; 0.5-mile model: Foreign-born in the Dominican Republic: OR=1.73, p = 0.040; Foreign-born outside of the United States or the Dominican Republic: OR=2.48, p = 0.006). In contrast, the participants’ perception that a large selection of fresh fruits and vegetables is available in their neighborhood (0.25-mile model: OR=0.63, p = 0.011; 0.5-mile model: OR=0.64, p = 0.016) and the presence of Fruit and Vegetable Market in their 0.5-mile radius (1 Store: OR=0.32, p = 0.006; 2+ Stores: OR=0.38, p = 0.009) significantly lower the odds. Variables that significantly increase the odds of body mass index (BMI) in the overweight range were age (OR=1.02, p = 0.00), being foreign-born outside of the United States or the Dominican Republic (OR=1.76, p = 0.006), self-reported diabetes (OR=1.37, p = 0.026), and perceived weight as overweight (OR=4.46, p = 0.00) whereas being female (OR=0.67, p = 0.00) significantly lowers the odds.

Variables that significantly increase the odds of BMI in the obese range were age (OR=1.02, p = 0.00), self-reported diabetes (OR=1.78, p = 0.00), and perceived weight as overweight (OR=19.39, p = 0.00) whereas having more than a high school education (OR=0.72, p = 0.021) significantly lowers the odds. Variables that significantly increase the odds of hypertension were age (OR = 1.04, p = 0.00) and self-reported diabetes (OR = 1.57, p = 0.00) whereas being female (OR = 0.72, p = 0.00) significantly lowers the odds. Education (>High School) significantly increases the odds (OR=1.43, p = 0.00) of self-report of good health. In contrast, variables that significantly lower the odds were age (OR=0.98, p = 0.00), being female (OR=0.60, p = 0.00), higher fruit and vegetable consumption (OR=0.66, p = 0.007), self-reported diabetes (OR=0.51, p = 0.00), and obesity (OR=0.64, p = 0.00). Variables that significantly increase the odds of self-report of good health include having more than a high school education (OR = 1.43, p = 0.00) whereas age (OR = 0.98, p = 0.00), female gender (OR = 0.60, p = 0.00), higher fruit and vegetable consumption (OR = 0.66, p = 0.007), self-reported diabetes (OR = 0.51, p = 0.00), and obesity (OR = 0.64, p = 0.00) significantly lower the odds.

Conclusion: This study contributed to our understanding of the relationships among neighborhood food environment, health behaviors, and health outcomes in a predominantly Hispanic underserved urban community in New York City. While most findings were similar to those reported in the literature, our findings related to the relationship between participants’ perceived neighborhood food environment and actual healthy food access and fruit and vegetable consumption were in contrast to other studies in that increased perceived availability and actual availability lowered the odds of consuming five or more servings of fruits and vegetables per day. This surprising finding merits additional qualitative and quantitative research to examine the complex relationships among perceived access, availability, and consumption of healthy foods as well as improved measures of fruit and vegetable consumption.