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Countywide BMI surveillance and community-level approaches to improve access to nutritious food among low-income residents in San Diego, California


Background: Policy, systems, and environmental approaches are being implemented in San Diego to promote healthy choices by improving access to healthy food among low-income populations. Also, the County of San Diego Health and Human Services Agency has developed a registry-based BMI surveillance system.

Objectives: Study one examined the demographic representativeness of the County of San Diego BMI Surveillance System. Study two determined independent predictors of ongoing use of Fresh Fund, a farmers market monetary incentive program for government nutrition assistance recipients. Study three examined monthly patterns of food insecurity among families and children attending Summer Meals, a Summer Food Service Program for low-income children.

Methods: Study one compared demographics of the BMI surveillance sample to the general population of San Diego in 2011 by sub-regional area (SRA). Study two used Poisson regression to examine the relationship of characteristics with the number of Fresh Fund visits from 2010 to 2012, and mixed effects modeling to explore the within-individual changes over time in self-reported fruit and vegetable (FV) consumption and perception of diet quality. Study three examined the association of month of Summer Meals attendance with food security in 2011.

Results: Study one: Younger (2-11 and 12-17 years old) and older (≥65 years old) aged groups in the surveillance sample (n=302,691) were representative of the general population among males and females in 90%, 75%, and 85% of SRAs, respectively; and 71% were representative for at least one racial/ethnic group. Study two: Among 7,298 participants, those who reported more servings of FV/day at baseline came to Fresh Fund a greater number of times, but only among those who came ≤6 months. The odds of an increasing number of servings of FV consumed and improved perception of diet quality increased by 2% and 10% per month of Fresh Fund use, respectively. Study three: 65% of households, 54% of adults, and 47% of children had low/very-low food security (n=325).

Conclusion: The value of San Diego BMI Surveillance System is its ability to estimate and monitor neighborhood-level BMI. In addition, this dissertation provides evidence that reassures the need for community-level programs to improve access to nutritious food among government assistance recipients and children from low-income families.

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