Perceptions of the food environment are associated with fast-food (not fruit-and-vegetable) consumption: Findings from multi-level models

Objectives Diets low in fruits and vegetables and/or high in fast foods are associated with obesity and chronic diseases. Such diets may relate to different aspects of neighborhood food environments. We sought to evaluate if people's perceptions of their neighborhood food environment are associated with reported fruit-and-vegetable and fast-food consumption. Methods Cross-sectional analysis of a community health survey from Philadelphia, PA and four surrounding suburban counties (n = 10,450 individuals). We used mixedeffects multi-level Poisson models, nesting individuals within neighborhoods-i.e. census tracts (n = 991). Results Negative perceptions of the food environment (perceived difficulty finding fruits and vegetables, having to travel outside of one's neighborhood to get to a supermarket, and perceived poor grocery quality) were each directly associated with fast-food consumption (incident rate ratios [IRRs] 1.31, 1.06, 1.20; p\0.001, 0.04,\0.001 respectively), but not significantly associated with fruit-andvegetable consumption. Conclusions Perceived difficulty finding or accessing produce and high-quality groceries may support the eating of more fast food. Neighborhoods where food-environment perceptions are worst might benefit from interventions to improve availability, accessibility, and quality of healthy foods, towards shifting consumption away from fast foods.