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Background and Objectives: Research on how urbanization has influenced the food environment in China is limited. The study aimed to examine the impact of urbanization on the food environment in China. Methods and Study Design: Longitudinal data collected during 1989-2009 from the China Health and Nutrition Survey were used, which covered 9 provinces in China. Urbanicity index (0-10) was assessed using an urbanicity scale. Final analyses included 216 communities. Random-effect models were used in analyses. Results: Urbanization (higher urbanicity index) increased the odds of having fast food restaurants (OR=2.78, 95% CI: 2.18-3.54) and other indoor restaurants (OR=2.93, 95% CI: 2.28-3.76) within the community, the odds of having supermarkets (OR=2.43, 95% CI: 2.04-2.89) and free markets (OR=2.56, 95% CI: 1.77-3.70) within 30 minutes' bus ride from the community. Food prices for apples (ß=0.06, 95% CI: 0.04-0.08) and lean pork (ß =0.02, 95% CI: 0.01-0.03) increased with urbanicity, while prices for other food did not. Urbanicity was positively associated with community norms for fast food consumption (RR=1.28, 95% CI: 1.22-1.33), fast food preferences (RR=1.09, 95% CI: 1.06-1.12) and nutrition knowledge (RR=1.02, 95% CI: 1.01-1.03). Conclusions: Urbanization is associated with food environment in China. The findings provide insight for future economic development and public health efforts related to urbanization.
Key Words: urbanization, food environment, fast food, policy, China
INTRODUCTION
Urbanization has been taking place in many developing countries although it is at a faster rate in some countries compared with others, which likely has many impacts on people's behaviors and health. China has been undergoing urbanization at an accelerating pace in the past three decades. The level of urbanization, as illustrated by the proportion of urban dwellers, rose from less than 20% in 1978 to almost 50% in 2009.1 This has brought dramatic changes to both the environment and to individuals' lifestyles as well as health outcomes in China. For example, physical activity (PA) levels of Chinese adults declined by a third between 1991 and 2006, especially occupational PA due to changes in the work structure.2,3 About half of the decline could be explained by urbanization factors, including dynamics in the housing infrastructure, sanitation and availability of higher education institutions.2
Changes in the environment and lifestyles induced by urbanization entail new health challenges for the country, in...