Summary

Background:
A growing body of cross-sectional, smallsample
research has led to policy strategies to reduce food
deserts—neighborhoods with little or no access to healthy
foods—by limiting fast food restaurants and small food
stores and increasing access to supermarkets in lowincome
neighborhoods.

Methods:
We used 15 years of longitudinal data from
the Coronary Artery Risk Development in Young Adults
(CARDIA) study, a cohort of US young adults (aged 18-30
years at baseline) (n=5115), with linked time-varying geographic
information system-derived food resource measures.
Using repeated measures from 4 examination periods
(n=15 854 person-examination observations) and
conditional regression (conditioned on the individual),
we modeled fast food consumption, diet quality, and adherence
to fruit and vegetable recommendations as a function
of fast food chain, supermarket, or grocery store availability
(counts per population) within less than 1.00 km,
1.00 to 2.99 km, 3.00 to 4.99 km, and 5.00 to 8.05 km
of respondents’ homes. Models were sex stratified, controlled
for individual sociodemographic characteristics
and neighborhood poverty, and tested for interaction by
individual-level income.

Results:
Fast food consumption was related to fast food
availability among low-income respondents, particularly
within 1.00 to 2.99 km of home among men (coefficient,
0.34; 95% confidence interval, 0.16-0.51). Greater supermarket
availability was generally unrelated to diet quality
and fruit and vegetable intake, and relationships between
grocery store availability and diet outcomes were mixed.

Conclusion:
Our findings provide some evidence for zoning
restrictions on fast food restaurants within 3 km of
low-income residents but suggest that increased access
to food stores may require complementary or alternative
strategies to promote dietary behavior change.