Does the Environment Affect the Consumption of Sugar-Sweetened Beverages? Evidence from a Natural Experiment
*Names in bold indicate Presenter
Frequent consumption of sugar-sweetened beverages such as soda is associated with higher risk for chronic diseases such as diabetes and hypertension. The food environment(the physical environment, or settings, in which there are opportunities to eat or buy foods) may have an impact on diet and chronic diseases, but the research on this relationship has been mixed. This study examines the relationship between several definitions of the food environment and diet, focusing specifically on store characteristics and sugar-sweetened beverage (SSB) consumption.
The Pittsburgh Hill/Homewood Research on Eating, Shopping & Health (PHRESH) study is a natural experiment longitudinally examining the impact of a new full-service supermarket in a predominantly low-income, African American, urban neighborhood in Pittsburgh. Data were collected in 2011 from a random sample of residents from two socio-demographically matched neighborhoods. Participants completed a household and a 24-hour dietary recall, including consumption of SSBs. Store characteristics, such as the type of store and the number of promotional displays for SSBs, were collected from every food outlet in the two neighborhoods and the food stores where participants reported shopping at most frequently.
The food environment was defined and tested in multiple ways including the density (count and percent of “unhealthy” stores such as convenience stores) within 0.25mi and 0.5mi buffers, the distance to the closest unhealthy store, SSB availability at the preferred stores for shopping, and exposure to SSB advertising.
Bivariate analyses showed no relationship between density (count or %) and SSB consumption for either size buffer. There was also no relationship between distance and SSB consumption. Participants who shopped at stores where SSBs were available at checkout or SSBs were seen from the main entrance consumed a similar amount of SSBs as those who shopped at stores without those characteristics, however after adjusting for the frequency of shopping, there were small but significant correlations between SSB consumption and SSBs at checkout (R=0.1383, p<0.001) and SSBs (R=0.1266, p<0.001). Exposure to in-store displays advertising SSBs was also correlated with SSB consumption (R=0.0843, p<0.001).
The lack of a consistent relationship between different definitions of the food environment and sugar-sweetened beverage intake suggests that policies to change the food environment, such as First Lady Michelle Obama’s pledge to eliminate “food deserts” or the Healthy Food Financing Initiative (HFFI) which encourages businesses to establish or expand supermarkets in low-resource neighborhoods, may be unsuccessful if they do not address other important drivers of dietary behaviors. Improving diet is a complex problem and will likely need a multi-pronged, systems-level approach to solve it.