The restaurant food environment : defining and distinguishing restaurants and their association with weight status of youth

Childhood obesity is a top public health priority. Recent obesity prevention efforts have begun to focus on environmental determinants, such as the food environment. Specifically, by focusing on the food environment around schools, research can identify factors within the environment that may be influential for youth. Therefore, this dissertation aimed to 1) create an informed, reliable electronic data collection tool that will appropriately represent restaurants found within the food environment of youth, and 2) determine associations between the restaurant food environment and school-level BMI. Variables included on the electronic data collection tool were created based on survey responses from nutrition experts and a literature review. The tool was tested for inter-rater reliability. Percent agreement between coders ranged from 75 to 100% (m=90.6%), suggesting this tool can be used reliability to code the restaurant food environment near high schools. To examine possible healthfulness and youth-oriented restaurant features that may be associated with obesity among youth, a healthfulness index (HI) and youth-oriented index (YOI) were created based on codes included within the tool. A higher score represented a more healthful or more youth-oriented restaurant, respectfully. ANOVA models were used to examine differences in BMI, HI, and YOI by order location. Unadjusted and adjusted linear regression models were used to test relationships between BMI and each index while controlling for SES. Within a half-mile of 9 high schools, 58 restaurants were documented. The rank order of restaurants was significantly different according to index measures (p=0.03), suggesting restaurants that scored higher on the HI were different than those that scored high on the YOI. Both indices were significantly different according to order location (p<0.01), such that full service and fast causal restaurants had more healthful features and fewer youth-oriented features when compared to fast food restaurants. Index measures were not associated with school-level BMI in unadjusted or adjusted models. Identifying health and youth-oriented features of restaurants is important and may help explain associations of the restaurant food environment and youth weight status. Future research should consider use of this data collection tool to continue to document and identify aspects of the food environment.