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Objectives: We examined population-level impact on customer awareness and use and explored potential disparities in outcomes regarding the King County, Washington, regulation requiring chain restaurants to provide calorie information., Methods: We analyzed 2008 to 2010 Behavioral Risk Factor Surveillance System data from 3132 English-speaking King County residents aged 18 years and older who reported eating at a regulated chain. We used regression models to assess changes in calorie information awareness and use from prepolicy to postpolicy implementation by customer demographics, health status, and restaurant type., Results: Calorie information awareness and use increased significantly from 2008 to 2010. Unadjusted analyses indicated that the proportion who saw and used calorie information tripled, from 8.1% to 24.8%. Fully adjusted analyses confirmed significant increases. After policy implementation, White, higher income, and obese respondents had greater odds of seeing calorie information. Women, higher income groups, and those eating at a fast-food versus a sit-down chain restaurant were more likely to use this information., Conclusions: Significant increases in calorie information awareness and use following regulation support the population-wide value of this policy. However, improvements varied across race, income, and gender.

Objectives: To compare restaurant marketing by restaurant and neighborhood type., Methods: All restaurants (61=fast food, FF; 72=table service, TS) within an 800-meter radius of 13 public housing developments (HD) and 4 comparison neighborhoods were audited using the Restaurant Assessment Tool©2010. HD neighborhoods were lower income and higher minority than comparison neighborhoods with similar density and street connectivity., Results: Restaurants in HD neighborhoods had fewer healthy entrées than comparison neighborhoods. FF restaurants had cheaper beverages and more children's meals, supersize drinks, free prize with purchase, super-size items, special characters, and more items geared to driving than TS restaurants., Conclusions: Residents of lower socioeconomic neighborhoods may be differentially exposed to unhealthy food options.

Background: Outside of the United States, evidence for associations between exposure to fast-food establishments and risk for obesity among adults is limited and equivocal. The purposes of this study were to investigate whether the relative availability of different types of food retailers around people's homes was associated with obesity among adults in Edmonton, Canada, and if this association varied as a function of distance between food locations and people's homes., Methods: Data from a population health survey of 2900 adults (18 years or older) conducted in 2002 was linked with geographic measures of access to food retailers. Based upon a ratio of the number of fast-food restaurants and convenience stores to supermarkets and specialty food stores, a Retail Food Environment Index (RFEI) was calculated for 800 m and 1600 m buffers around people's homes. In a series of logistic regressions, associations between the RFEI and the level of obesity among adults were examined., Results: The median RFEI for adults in Edmonton was 4.00 within an 800 m buffer around their residence and 6.46 within a 1600 m buffer around their residence. Approximately 14% of the respondents were classified as being obese. The odds of a resident being obese were significantly lower (OR = 0.75, 95%CI 0.59 - 0.95) if they lived in an area with the lowest RFEI (below 3.0) in comparison to the highest RFEI (5.0 and above). These associations existed regardless of the covariates included in the model. No significant associations were observed between RFEI within a 1600 m buffer of the home and obesity., Conclusion: The lower the ratio of fast-food restaurants and convenience stores to grocery stores and produce vendors near people's homes, the lower the odds of being obese. Thus the proximity of the obesogenic environment to individuals appears to be an important factor in their risk for obesity.

Purpose: Examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast food outlets and residents' behavioral, psychosocial, and sociodemographic characteristics., Design: Cross-sectional and multilevel design., Setting: Census block groups, used as a proxy for neighborhoods, within the metropolitan region's Urban Growth Boundary in Portland, Oregon., Subjects: A total of 1221 residents (mean age, 65 years) recruited randomly from 120 neighborhoods (48% response rate)., Measures: A geographic information system-based measure of fast food restaurant density across 120 neighborhoods was created. Residents within the sampled neighborhoods were assessed with respect to their body mass indices (BMI), frequency of visits to local fast food restaurants, fried food consumption, levels of physical activity, self-efficacy of eating fruits and vegetables, household income, and race/ethnicity., Analyses: Multilevel logistic regression analyses., Results: Significant associations were found between resident-level individual characteristics and the likelihood of being obese (BMI > or = 30) for neighborhoods with a high-density of fast food restaurants in comparison with those with a low density: odds ratios for obesity, 95% confidence intervals (CI), were 1.878 (CI, 1.006-3.496) for weekly visits to local fast food restaurants; 1.792 (CI, 1.006-3.190) for not meeting physical activity recommendations; 1.212 (CI, 1.057-1.391) for low confidence in eating healthy food; and 8.057 (CI, 1.705-38.086) for non-Hispanic black residents., Conclusion: Increased density of neighborhood fast food outlets was associated with unhealthy lifestyles, poorer psychosocial profiles, and increased risk of obesity among older adults.

Purpose: The rapid increase in obesity over the past two decades suggests that behavioral and environmental influences, including poor nutrition and physical inactivity, are fueling what is now widely recognized as a public health crisis. Yet, limited research has been conducted to examine how environmental factors, such as neighborhood-level characteristics, may be associated with increased risk for obesity., Methods: Community-level risk associated with childhood obesity was examined in East Los Angeles, a community with one of the highest rates of childhood obesity in Los Angeles by triangulating: 1) spatial data for the number and location of food establishments relative to the location of schools; 2) observations regarding the availability and quality of fruits and vegetables in local grocery stores; and 3) observations regarding the quality and utilization of local parks., Results: The findings revealed that there were 190 food outlets in the study community, of which 93 (49%) were fast-food restaurants. Of the fast-food restaurants, 63% were within walking distance of a school. In contrast, there were 62 grocery stores, of which only 18% sold fresh fruits and/or vegetables of good quality. Of the stores that did sell fruits and/or vegetables, only four were within walking distance of a school. Although well maintained, the five parks in this community accounted for only 37.28 acres, or 0.543 acres per 1000 residents., Conclusions: These findings suggest that children have easy access to fast food, and limited access to both healthy food options and parks in which to engage in physical fitness activities. This was particularly true in areas around schools. The implications for these findings with regards to policy-related prevention and future research are discussed.

Purpose: Obesity accounts for approximately 300,000 deaths a year in the United States, and prevalence rates have been increasing over the past decade. The nutrition environment may be contributing to this epidemic. This study examined the relationship between fast food restaurants and obesity on a state-wide basis., Design: A one-time cross-sectional analysis of secondary data was used for this study., Setting: The setting for this study was the United States., Subjects: State-level data were used as the unit of analysis. Alaska was excluded as an outlier, and the District of Columbia was added (N = 50)., Measures: Measures included aggregate state-level means for square miles per fast food restaurant, population per fast food restaurant, population density, ethnicity, age, gender, physical inactivity, fruit and vegetable intake, and obesity rates. Data were obtained from the 2002 Behavioral Risk Factor and Surveillance Survey, the 2000 U.S. Census, and the 2002 U.S. Yellow Pages., Results: Multiple hierarchal regressions revealed that square miles per fast food restaurants and residents per restaurant accounted for 6% of the variance in state obesity rates after controlling for population density, ethnicity, age, gender, physical inactivity, and fruit and vegetable intake. The entire model explained 70% of the total variance in state obesity rates., Conclusions: These results indicate a correlational relationship between both the number of residents per fast food restaurant and the square miles per fast food restaurants with state-level obesity prevalence. Limitations include the use of correlational aggregate data.

Background: We examined the relationship between overweight in preschool children and three environmental factors--the proximity of the children's residences to playgrounds and to fast food restaurants and the safety of the children's neighborhoods. We hypothesized that children who lived farther from playgrounds, closer to fast food restaurants, and in unsafe neighborhoods were more likely to be overweight., Methods: This was a cross-sectional study of 7,020 low-income children, 36 through 59 months of age living in Cincinnati, OH. Overweight was defined as a measured body mass index > or =95th percentile. The distance between each child's residence and the nearest public playground and fast food restaurant was determined with geographic information systems. Neighborhood safety was defined by the number of police-reported crimes per 1,000 residents per year in each of 46 city neighborhoods., Results: Overall, 9.2% of the children were overweight, 76% black, and 23% white. The mean (+/- SD) distances from a child's home to the nearest playground and fast food restaurant were 0.31 (+/- 0.22) and 0.70 (+/- 0.38) miles, respectively. There was no association between child overweight and proximity to playgrounds, proximity to fast food restaurants, or level of neighborhood crime. The association between child overweight and playground proximity did not differ by neighborhood crime level., Conclusions: Within a population of urban low-income preschoolers, overweight was not associated with proximity to playgrounds and fast food restaurants or with the level of neighborhood crime.