Food swamps and food deserts in Baltimore City, MD, USA: associations with dietary behaviours among urban adolescent girls

Objective: To determine whether living in a food swamp (>= 4 corner stores within 0.40km (0.25 miles) of home) or a food desert (generally, no supermarket or access to healthy foods) is associated with consumption of snacks/desserts or fruits/vegetables, and if neighbourhood-level socio-economic status (SES) confounds relationships. Design: Cross-sectional. Assessments included diet (Youth/Adolescent FFQ, skewed dietary variables normalized) and measured height/weight (BMI-for-age percentiles/Z-scores calculated). A geographic information system geocoded home addresses and mapped food deserts/food swamps. Associations examined using multiple linear regression (MLR) models adjusting for age and BMI-for-age Z-score. Setting: Baltimore City, MD, USA. Subjects: Early adolescent girls (6th/7th grade, n 634; mean age 12.1 years; 90.7% African American; 52.4% overweight/obese), recruited from twenty-two urban, low-income schools. Results: Girls' consumption of fruit, vegetables and snacks/desserts: 1.2, 1.7 and 3.4 servings/d, respectively. Girls' food environment: 10.4% food desert only, 19.1% food swamp only, 16.1% both food desert/swamp and 54.4% neither food desert/swamp. Average median neighbourhood-level household income: $US 35 298. In MLR models, girls living in both food deserts/swamps consumed additional servings of snacks/desserts v. girls living in neither (beta=0.13, P=0.029; 3.8 v. 3.2 servings/d). Specifically, girls living in food swamps consumed more snacks/desserts than girls who did not (beta=0.16, P= 0.003; 3.7 v. 3.1 servings/d), with no confounding effect of neighbourhood-level SES. No associations were identified with food deserts or consumption of fruits/vegetables. Conclusions: Early adolescent girls living in food swamps consumed more snacks/desserts than girls not living in food swamps. Dietary interventions should consider the built environment/food access when addressing adolescent dietary behaviours.