***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Environmental intervention represents an effective strategy to promote the purchase and consumption of healthful foods in community-based setting s. Three such studies promoted the consumption of healthier snacks and lower-fat foods at worksites and at schools . The first study examined lower prices and point-of-purchase promotion on sales of lower-fat snacks in vending machines in 12 worksites and 12 secondary schools . Price reductions of 10 % , 25 % and 50 % on lower-fat snacks result ed in an increase in sales of 9 % , 39 % and 93 % , respectively , as compared to usual-price conditions . The second study examined the impact of a 50 % price reduction on the consumption of fresh fruit and baby carrots in 2 secondary school cafeterias . In the third study , 20 secondary schools were r and omly assigned to either an environmental intervention or a control group for a 2-y period . The intervention increased the availability of lower-fat foods  and implemented student-based promotions . School-based environmental interventions to increase availability and promotion of lower-fat foods and healthier snacks can increase purchase of these foods among adolescents Objectives : To assess the effect on fruit and vegetable consumption , self reported , and psychological health of a “ natural experiment”—the introduction of large scale food retailing in a deprived Scottish community . Design : Prospect i ve quasi-experimental design comparing baseline and follow up data in an “ intervention ” community with a matched “ comparison ” community in Glasgow , UK . Participants : 412 men and women aged 16 or over for whom follow up data on fruit and vegetable consumption and GHQ-12 were available . Main outcome measures : Fruit and vegetable consumption in portions per day , poor self reported health , and poor psychological health ( GHQ-12 ) . Main results : Adjusting for age , sex , educational attainment , and employment status there was no population impact on daily fruit and vegetable consumption , self reported , and psychological health . There was some evidence for a net reduction in the prevalence of poor psychological health for residents who directly engaged with the intervention . Conclusions : Government policy has advocated using large scale food retailing as a social intervention to improve diet and health in poor communities . In contrast with a previous uncontrolled study this study did not find evidence for a net intervention effect on fruit and vegetable consumption , although there was evidence for an improvement in psychological health for those who directly engaged with the intervention . Although definitive conclusions about the effect of large scale retailing on diet and health in deprived communities can not be drawn from non-r and omised controlled study design s , evaluations of the impacts of natural experiments may offer the best opportunity to generate evidence about the health impacts of retail interventions in poor communities OBJECTIVE To examine associations between shopping , food preparation , meal and eating behaviours and fruit and vegetable intake among women . DESIGN Cross-sectional survey . SETTING Community-based sample from metropolitan Melbourne , Australia . SUBJECTS A sample of 1136 women aged 18 - 65 years , r and omly selected from the electoral roll . RESULTS Food-related behaviours reflecting organisation and forward-planning , as well as enjoyment of and high perceived value of meal shopping , preparation and consumption were associated with healthier intakes of fruits and vegetables . For example , women who more frequently planned meals before they went shopping , wrote a shopping list , enjoyed food shopping , planned in the morning what they will eat for dinner that night , planned what they will eat for lunch , reported they enjoy cooking , liked trying new recipes and who reported they sometimes prepare dishes ahead of time were more likely to consume two or more servings of vegetables daily . Conversely , women who frequently found cooking a chore , spent less than 15 minutes preparing dinner , decided on the night what they will eat for dinner , ate in a fast-food restaurant , ate takeaway meals from a fast-food restaurant , ate dinner and snacks while watching television and who frequently ate on the run were less likely to eat two or more servings of vegetables daily . CONCLUSIONS Practical strategies based on these behavioural characteristics could be trialled in interventions aim ed at promoting fruit and vegetable consumption among women Objective : To estimate variation between small areas in adult  body mass index ( BMI ) , and assess the importance of area level socioeconomic disadvantage in predicting BMI . Methods : We identified all census collector districts ( CCDs ) in the 20 innermost Local Government Areas in metropolitan Melbourne , Australia , and ranked them by the percentage of low income households ( < $ 400/week ) . In all , 50 CCDs were r and omly selected from the least , middle and most disadvantaged septiles of the ranked list and 4913 residents ( 61.4 % participation rate ) completed one of two surveys .  Multilevel linear regression was used to estimate area level variance in BMI and the importance of area level socioeconomic disadvantage in predicting BMI . Results : There were significant variations in BMI between CCDs for women , even after adjustment for individual and area SES ( P=0.012 ) ; significant area variation was not found for men . Living in the most versus least disadvantaged areas was associated with an average difference in BMI of 1.08 kg/m2 ( 95 % CI : 0.48–1.68 kg/m2 ) for women , and of 0.93 kg/m2 ( 95 % CI : 0.32–1.55 kg/m2 ) for men . Living in the mid versus least disadvantaged areas were associated with an average difference in BMI of 0.67 kg/m2 ( 95 % CI : 0.09–1.26 kg/m2 ) for women , and 0.43 kg/m2 for men ( 95 % CI : −0.16–1.01 ) . Conclusion : These findings suggest that area disadvantage is an important predictor of adult BMI , and support the need to focus on improving local environments to reduce socioeconomic inequalities in overweight and obesity OBJECTIVE To determine the association between household participation in a community garden and fruit and vegetable consumption  among urban adults . DESIGN Data were analyzed from a cross-sectional r and om phone survey conducted in 2003 . A quota sampling strategy was used to ensure that all census tracts within the city were represented . SETTING Flint , Michigan . PARTICIPANTS 766 adults . VARIABLES MEASURED Fruit and vegetable intake was measured using question naire items from the Behavioral Risk Factor Surveillance System . Household participation in a community garden  was assessed by asking the respondent if he or she , or any member of the household , had participated in a community garden project in the last year . ANALYSIS Generalized linear models and logistic regression models assessed the association between household participation in a community garden and fruit and vegetable intake , controlling for demographic , neighborhood participation , and health variables . RESULTS Adults with a household member who participated in a community garden  consumed fruits and vegetables 1.4 more times per day than those who did not participate , and they were 3.5 times more likely to consume fruits and vegetables at least 5 times daily . CONCLUSIONS AND IMPLICATION S Household participation in a community garden may improve fruit and vegetable intake among urban adults Purpose . Examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast food outlets and residents ' behavioral , psychosocial , and sociodemographic characteristics . Design . Cross-sectional and multilevel design . Setting . Census block groups , used as a proxy for neighborhoods , within the metropolitan region 's Urban Growth Boundary in Portl and , Oregon . Subjects . A total of 1221 residents ( mean age , 65 years ) recruited r and omly from 120 neighborhoods ( 48 % response rate ) . Measures . A geographic information system-based measure of fast food restaurant density across 120 neighborhoods was created . Residents within the sample d neighborhoods were assessed with respect to their body mass indices ( BMI ) , frequency of visits to local fast food restaurants , fried food consumption , levels of physical activity , self-efficacy of eating fruits and vegetables , household income , and race/ethnicity . Analyses . Multilevel logistic regression analyses . Results . Significant associations were found between resident-level individual characteristics and the likelihood of being obese ( BMI ≥ 30 ) for neighborhoods with a high-density of fast food restaurants in comparison with those with a low density : odds ratios for obesity , 95 % confidence intervals ( CI ) , were 1.878 ( CI , 1.006–3.496 ) for weekly visits to local fast food restaurants ; 1.792 ( CI , 1.006–3.190 ) for not meeting physical activity recommendations ; 1.212 ( CI , 1.057–1.391 ) for low confidence in eating healthy food ; and 8.057 ( CI , 1.705–38.086 ) for non-Hispanic black residents . Conclusion . Increased density of neighborhood fast food outlets was associated with unhealthy lifestyles , poorer psychosocial profiles , and increased risk of obesity among older adults OBJECTIVES : To establish whether choice and availability of takeaway and restaurant food consumption are associated with increased obesity .  DESIGN : Crossroads Undiagnosed Disease Study : a cross-sectional study undertaken between June 2001 and March 2003 . SETTING : A regional centre and six shire capitals of variables size in rural Victoria , Australia . PARTICIPANTS : In total , 1454 residents of r and omly selected households . MEASUREMENTS : Obesity ( by body mass index ( BMI ) or waist circumference ) , weekly recreational activity , self-reported frequency of takeaway consumption , number of local takeaway and restaurant food outlets in the area . RESULTS : The prevalence of obesity ranged from 25.5–30.8 % and was higher than the general Australian population among both men and women . Those in the regional centre were less likely than those in large and small shire capitals to participate in recreational activity of 150 min or more ( 39.7 vs 48.4 % , 46.0 % respectively , P=0.023 ) and yet reported better access to facilities and amenities for physical activity . Recreational activity of ≥150 min/week was associated with 0.75 ( 0.58–0.97 ) fold less risk of obesity . BMI was unrelated to takeaway consumption . Waist circumference was significantly lower among those eating no takeaways , but similar whether takeaways were consumed < 1/month or ≥1/week . Increased takeaway consumption was associated with increased consumption of higher fat preparations of dairy and meat products . Availability of takeaway outlets and restaurants was unrelated to obesity . CONCLUSION : The obesity epidemic exists among those without significant consumption of or availability to takeaway foods . In a setting of easy availability of food , the obesity epidemic relates strongly to reduced physical activity , but not to consumption of takeaway food OBJECTIVE We examined whether associations between dietary components and , in particular , energy density ( ED ) predicted subsequent 5-year weight changes . RESEARCH METHODS AND PROCEDURES The present longitudinal population study was part of the Danish World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease ( MONICA ) and the 1936 cohort dietary studies . Effects of components were studied in relation to subsequent 5-year weight changes in 862 men and 900 women , 30 to 60 years old . Linear multiple regression analyses were conducted . RESULTS Mean 5-year changes in body weight ( BW ) were 1.2 + /- 3.9 and 1.3 + /- 4.6 kg for men and women , respectively . In general , neither ED nor any of the dietary components was associated with subsequent change in BW . In women , ED was positively associated with weight gain among the obese ( BMI > 30 kg/m2 ) and inversely associated with weight gain in normal-weight women ( BMI < 25 kg/m2 ) ( p = 0.01 ) . However , in men there was a non-significant inverse trend between ED and weight gain in the obese and no significant interaction . DISCUSSION To our knowledge , this is the first prospect i ve study to examine the associations between ED and subsequent changes in BW , and despite a general belief that ED is a major determinant of obesity , the present study did not generally lend support for an association . However , among certain subgroups , an energy-dense diet may be a risk factor for weight development OBJECTIVE Previous studies on the relationship of dietary intake to the neighbourhood food environment have focused on access to supermarkets , quantified by geographic distance or store concentration measures . However , in-store food availability may also be an important determinant , particularly for urban neighbourhoods with a greater concentration of small food stores . This study synthesis es both types of information - store access and in-store availability - to determine their potential relationship to fruit and vegetable consumption . DESIGN Residents in four census tracts were surveyed in 2001 about their fruit and vegetable intake . Household distances to food stores in these and surrounding tracts were obtained using geographical information system mapping techniques . In-store fruit and vegetable availability was measured by linear shelf space . Multivariate linear regression models were used to measure the association of these neighbourhood availability measures with consumption . SETTING Four contiguous census tracts in central -city New Orleans . SUBJECTS A r and om sample of 102 households . RESULTS Greater fresh vegetable availability within 100 m of a residence was a positive predictor of vegetable intake ; each additional metre of shelf space was associated with 0.35 servings per day of increased intake . Fresh fruit availability was not associated with intake , although having a small food store within this same distance was a marginal predictor of fruit consumption . CONCLUSIONS The findings suggest the possible importance of small neighbourhood food stores and their fresh produce availability in affecting fruit and vegetable intake This study evaluated the effect of adding fruit or oats to 
    Output:
    
Weight status was consistently associated with the food environment ; greater accessibility to supermarkets or less access to takeaway outlets were associated with a lower BMI or prevalence of overweight/obesity .
However , obesogenic dietary behaviours did not mirror these associations ; mixed associations were found between the environment and obesogenic dietary behaviours .
Living in a socioeconomically-deprived area was the only environmental factor consistently associated with a number of obesogenic dietary behaviours .
Associations between the environment and weight status are more consistent than that seen between the environment and dietary behaviours .
The environment may play an important role in the development of overweight/obesity , however the dietary mechanisms that contribute to this remain unclear and the physical activity environment may also play an important role in weight gain , overweight and obesity