Methods: The Healthy Communities Study (HCS; 2013-2015, N=3,516) was linked to the Census 2000 and the American Community Survey 2009-2013. In HCS, trained field data collectors evaluated neighborhood safety by driving a vehicle down the participant’s street segment, and 10-14 key informants per community were interviewed to identify nutrition-promoting policies and programs conducted in the community over the past three years. The three independent variables were (1) neighborhood socioeconomic histories (coded as neighborhoods with consistently low SES; consistently moderate SES; consistently high SES; increasing from low to moderate SES or from moderate to high SES; or decreasing from moderate to low SES or from high to moderate SES), (2) directly measured neighborhood safety, and (3) intensity of nutrition-promoting community policies and programs. The three dependent variables were (1) availability of healthy foods in the home (higher scores indicating more availability), (2) availability of unhealthy foods in the home (higher scores indicating more availability), and (3) household food insecurity. Multilevel regression models were used to examine the association between multifaceted neighborhood characteristics and each dependent variable, after adjusting for parental race/ethnicity, marital status, and education level and household income.
Results: Families residing in neighborhoods with consistently moderate, consistently high, increasing, or decreasing SES had greater availability of healthy foods in the home compared to neighborhoods with consistently low SES (b=0.09, 0.19, 0.17, 0.14, respectively, p< 0.05). Families in safer neighborhoods and neighborhoods with more nutrition-promoting community policies and programs had greater availability of healthy foods in the home (b=0.05 and b=0.20, respectively, p< 0.05). In addition, living in neighborhoods with consistently high SES was associated with a lower likelihood of household food insecurity (OR=0.65, p< 0.05). No neighborhood characteristics were significantly associated with availability of unhealthy foods in the home.
Conclusions/Implications: Findings support that neighborhood contexts were associated with home food environments independent of family SES. It indicates that social workers need to give special attention to low-SES families living in low-SES neighborhoods, unsafe neighborhoods, or neighborhoods with fewer nutrition-promoting community policies and programs. Addressing neighborhood-level interrelated inequality issues—poverty, safety, health-promoting services, and racial disparity— can help reduce family-level socioeconomic disparities in the home food environment.