Understanding Relationships Between Child Care Workers' Eating Habits and Spatial Access to Food Outlets Around Workers' Homes, Workplaces, and Along Commute

Research examining spatial access to food outlets in non-residential settings is rare, especially among at-risk populations. This dissertation examined associations between child care workers' eating habits and spatial access to supermarkets/grocery stores, convenience stores, and fast food restaurants around home, work, and along commutes; and, explored moderation of these associations by self-efficacy for healthy eating and home and workplace census tract-level poverty.;Baseline data were analyzed from 638 child care workers enrolled in the CARE study, a cluster-randomized trial promoting healthy behaviors among child care workers in North Carolina. An Eating Habits Score (0-20) was derived from food intake frequency of 10 items, with higher scores reflecting healthier eating habits. Food outlet data from ReferenceUSA were analyzed within ArcGIS to create density measures of food outlets within 5 road network miles of home and work and along commutes (shortest network distance between home and work). Generalized Estimating Equations were used to analyze associations.;Food outlet densities were greater around workplaces (vs. homes), with longer commutes, and in urban areas (vs. rural). Eating Habits scores averaged 9.3 (SD=3.4). Greater access to small grocery stores around homes was associated with healthier eating habits for the sample (beta=0.037, p=0.046), and among urban residents (beta=0.040, p=0.035), and greater access to supermarkets around work was associated with healthier eating habits among rural workers (beta=0.323, p=0.017). Surprisingly, greater access to convenience stores (beta=0.129, p=0.017), and fast food restaurants (beta=0.078, p=0.012) around work were also associated with better eating habits among rural workers. Food outlet density along commutes and eating habits were unrelated. More convenience stores (beta=0.274, p=0.006) and fast food restaurants (beta=0.100, p=0.010) along commutes were associated with healthier eating habits among participants who were 'moderately/very/extremely confident' in eating healthy. Moreover, more small grocery stores around home was associated with poorer eating habits for participants living in medium poverty home census tracts (beta=-0.167, p=0.016) (vs. low poverty).;Understanding child care workers' food access is vital to helping them make healthier food choices and to reduce obesity and chronic disease risks. Future research should consider healthy/unhealthy food availability within locations, and shopping behaviors to further elucidate findings.