ESSAYS ON ASSOCIATIONS OF BUILT ENVIRONMENT WITH USE OF RESTAURANTS AND FOOD STORES AND FOOD PURCHASE IN THE UNITED STATES

Planners often focus on changing the built environment (e.g., availability of supermarkets) to improve diet-related behaviors. It is, however, unclear how built environment is related to the use of different types of outlets by individuals and to purchasing decisions by households with different outlet options, both of which in turn affect diet-related behavior and ultimately health outcomes. In the first chapter, I examined the associations between neighborhood restaurant/food store availability, the frequency of using such restaurants/food stores and whether such associations differed by neighborhood street connectivity, using data from the Coronary Artery Risk Development in Young Adults study. I found that, while individuals living in neighborhoods with more sit-down restaurants frequented sit-down restaurants more, such a relationship was absent for fast-food restaurants. Greater degree of neighborhood street connectivity was associated with less frequent use of neighborhood fast food restaurants and grocery stores. In the second chapter, I expanded my focus from one commonly-studied key component of built environment—the availability of neighborhood food stores—to include regional destination accessibility, neighborhood street connectivity, neighborhood destination diversity, availability of neighborhood destinations for the neighborhoods in which these stores were located and examined whether such factors and the presence of neighborhood supermarkets and convenience stores were associated with the amount as well as types of food purchased. I found that households which lived in neighborhoods with greater neighborhood street connectivity reported more expenditures on fresh fruits and vegetables; households with greater numbers of convenience stores in their neighborhood purchased less fruits while the number of supermarkets in a household’s neighborhood was not associated with expenditures on fruit and vegetables. In the third chapter, I examined the differences in the availability of restaurants and food stores and their association with neighborhoods type in the Twin Cities Region of Minnesota between 1993 and 2011. Sit down restaurants were increasingly more likely to be situated in inner city neighborhoods than fast food restaurants over time compared to other neighborhoods. My results suggested that both the type of food outlets and the broader built environment context were important factors relevant to explaining the usage of food outlets and food purchase. Interventions focusing on a single type of food outlet to increase access to healthy food should proceed with caution.Doctor of Philosoph