Date of Award

Fall 2019

Degree Type

Open Access Dissertation

Degree Name

Health Promotion Sciences, PhD


School of Community and Global Health

Advisor/Supervisor/Committee Chair

C. Anderson Johnson

Dissertation or Thesis Committee Member

Bin Xie

Dissertation or Thesis Committee Member

Eusebio Alvaro

Dissertation or Thesis Committee Member

Brian Hilton

Terms of Use & License Information

Terms of Use for work posted in Scholarship@Claremont.

Rights Information

© 2019 Emily Kiresich


Diabetes, Ecology, Environment, Food, Nutrition, Obesity

Subject Categories

Public Health


Despite existing knowledge about lifestyle choices and their relationships to obesity and diabetes, the prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing, and the number of Americans at risk is greater than 70% (CDC, 2019). Obesity is a complex, multifactorial, and largely preventable disease, affecting, along with overweight, over a third of the world's population today. A significant factor in lifestyle management is the ecology of food choice. Literature suggests that environment and exposure can predict food-related health risk behaviors and health outcomes. The objective of this dissertation was to conceptualize and carry out a series of pilot studies relative to the refinement of nutrition ecological issues, methodologies, and measures. After a review of methodological difficulties, gaps, and unresolved issues, I propose methodological solutions, present the methodologies and results of pilot studies about the feasibility of these solutions. Study one involved database and windshield survey of more than 200 retail food locations in Jurupa Valley, CA. After redefining criteria for good quality food providers, this area was found to have an abundance of fast food and convenience stores and limited access to stores of the best nutritional quality. Study two included adaptations and implementation of a direct measure of the nutrition environment in Pomona, CA. The target area was a high-risk corridor with a concentration of both community activity and retail locations. Using database analysis and visual assessment, a list of stores was compiled, and of the 91 stores in the target area, 60 were surveyed for overall scores, which was a sum score of quality, accessibility, availability of fresh fruits and vegetables, and price. The results indicated that Grocery, Independent Market, and Ethnic Food outlets could be considered together as high-quality or at least higher quality in that they provided overall, price, access, and quality scores in the modified NEMS survey that were not statistically different from one another in quality of offerings (Kruskal-Wallis H X2(2) .386-6.726, p=. 035 to .832 (only significant value was for availability of fresh fruits and vegetables). Furthermore, all sub-types of convenience stores, including independent locations, those associated with a gas station, and liquor stores can be considered together, Kruskal-Wallis test X2(1.788-5.535) p= .63 to .409 (near-significant values for Price and Quality). Study three presents a methodology for accurately assessing the retail food environment using walking surveys on a GIS enabled mapping application. Results revealed significant inconsistencies between database (GIS) data and survey data acquired from current observations of the actual locations in the community; there was a 31% error in database findings. Additional comparisons were made between GIS results and participant data, which indicated possible patterns of positive or negative health and intake outcomes with neighborhood retail food availability. Results from this series of developmental studies indicated a need for primary data sources whenever possible for compiling information about retail food locations. As well, the methodology for collecting business-types from databases and for completing a safe and thorough environmental scan for retail food locations was presented in this dissertation. Additional findings indicated that a refined methodology to score store quality identified considerable variation between store types. These results may have implications for city planning, diabetes prevention, and lifestyle management programs.

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