Protocol - Healthy Food Environments

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The Perceived Availability of Healthy Foods Scale from the Multi-Ethnic Study of Atherosclerosis (MESA) is a three-item, interviewer-administered scale that measures the quality and availability of fresh fruit and vegetables and low-fat products in the local neighborhood. Higher mean scores indicate greater availability of healthy foods in the neighborhood (i.e., low-fat products, fruits, and vegetables).

Specific Instructions:

Although used in the context of a personal interview, the questions and response categories are straightforward and can be adapted to a self-administered format.


The respondents are asked to think of their neighborhood as the area within a 20‑minute walk (approximately 1 mile) from their home and then to indicate the extent to which they agree with the following statements:

1. The fresh fruits and vegetables in my neighborhood are of high quality.

1[ ]strongly agree

2[ ]agree

3[ ]neither agree nor disagree

4[ ]disagree

5[ ]strongly disagree

2. A large selection of fresh fruits and vegetables is available in my neighborhood.

1[ ]strongly agree

2[ ]agree

3[ ]neither agree nor disagree

4[ ]disagree

5[ ]strongly disagree

3. A large selection of low-fat products is available in my neighborhood.

1[ ]strongly agree

2[ ]agree

3[ ]neither agree nor disagree

4[ ]disagree

5[ ]strongly disagree

Scoring Instructions

The Perceived Availability of Healthy Foods Scale is estimated by taking the average across the three items (note that only respondents with complete information for all three items can be assigned a scale score).

Lower mean scores indicate better availability of healthy foods (i.e., low-fat products, fruits, and vegetables).

Note that in papers by Moore, Diez Roux, and Brines (2008) and Moore et al. (2008), the five-point Likert scale was reported as follows: 0 = strongly agree; 1 = agree; 2 = neither agree nor disagree; 3 = disagree; and 4 = strongly disagree.

Protocol Name from Source:

Multi-Ethnic Study of Atherosclerosis (MESA), 2000, Neighborhood Section


Publicly available

Personnel and Training Required

No specific training is needed if data are collected through a self-administered questionnaire. If interviewers administer the questionnaire, the interviewer must be trained to conduct personal interviews with individuals from the general population and found competent to administer these particular questions (i.e., tested by an expert) at the completion of this training. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided.

Equipment Needs

These questions can be administered in a computerized or noncomputerized format (i.e., paper-and pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer or handheld computer to administer or to allow the respondent to self-administer a computer-assisted questionnaire.

Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Life Stage:



Adults, aged 18 years and older.

The respondent should be the primary food shopper in the household.

Selection Rationale

The protocol was selected because it is low burden, has good reported psychometric properties (Mujahid et al., 2007), and has been shown to be associated with higher-burden measures derived from secondary data and Geographic Information System (GIS) characterizations of the local food environments (Moore, Diez Roux, & Brines, 2008).



Common Data Elements (CDE) Social Environment Healthy Food Environment Assessment Score 3144974 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Healthy food environments proto 63024-4 LOINC
Derived Variables


Process and Review

The Expert Review Panel #2 (ERP 2) reviewed the measures in the Demographics, Environmental Exposures, and Social Environments domains.

Guidance from ERP 2 includes:

• Revised descriptions of the measure

Back-compatible: no changes to Data Dictionary

Previous version in Toolkit archive (link)


U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung and Blood Institute. (2000). Multi-Ethnic Study of Atherosclerosis (MESA). Neighborhood Section. Seattle, WA: Author. www.mesa-nhlbi.org

General References

Charreire, H., Casey, R., Salze, P., Simon, C., Chaix, B., Banos, A., Badariotti, D., Weber, C., & Oppert, J. M. (2010). Measuring the food environment using geographical information systems: A methodological review. Public Health Nutrition, 13(11), 1773-1785.

Davison, K. K., & Birch, L. L. (2001). Childhood overweight: A contextual model and recommendations for future research. Obesity Reviews, 2, 159-171.

Diez Roux, A. V. (1998). Bringing context back into epidemiology: Variables and fallacies in multilevel analysis. American Journal of Public Health, 88(2), 216-222.

Egger, G., & Swinburn, B. (1997). An "ecological" approach to the obesity pandemic. British Medical Journal, 315, 477-480.

Lyttle, L. A. (2009). Measuring the food environment: State of the science. American Journal of Preventive Medicine, 36(4, Suppl.), S134-S144.

McKinnon, R. A., Reedy, J., Morrissette, M. A., Lytle, L. A., & Yaroch, A. L. (2009). Measures of the food environment: A compilation of the literature, 1990-2007. American Journal of Preventive Medicine, 36(4, Suppl.), S124-S133.

Moore, L. V., Diez Roux, A. V., & Brines, S. (2008). Comparing perception-based and Geographic Information System (GIS)-based characterizations of the local food environment. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 85(2), 206-216.

Moore, L. V., Diez Roux, A. V., Nettleton, J. A., & Jacobs, D. R., Jr. (2008). Associations of the local food environment with diet quality: A comparison of assessments based on surveys and Geographic Information Systems. American Journal of Epidemiology, 167(8), 917-924.

Mujahid, M. S., Diez Roux, A. V., Morenoff, J. D., & Raghunathan, T. (2007). Assessing the measurement properties of neighborhood scales: From psychometrics to ecometrics. American Journal of Epidemiology, 165(8), 858-867.

National Cancer Institute. (2010). Risk factor monitoring and methods, measures of the food environment. Bethesda, MD: Author. Available from https://riskfactor.cancer.gov/mfe/.

Walker, S., Poston, C., II, & Foreyt, J. P. (1999) Obesity is an environmental issue. Atherosclerosis, 146, 201-209.

Protocol ID:


Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX210701_Large_Selection_Fresh_Fruits_Vegetables PX210701020000 A large selection of fresh fruits and more
vegetables is available in my neighborhood. show less
Variable Mapping
PX210701_Large_Selection_Low_Fat_Products PX210701030000 A large selection of low-fat products is more
available in my neighborhood. show less
Variable Mapping
PX210701_Quality_Fresh_Fruits_Vegetables PX210701010000 The fresh fruits and vegetables in my more
neighborhood are of high quality. show less
Variable Mapping
Social Environments
Measure Name:

Healthy Food Environments

Release Date:

May 31, 2016


This measure utilizes a questionnaire to assess a respondent’s access to healthy foods and healthy eating alternatives in his or her local neighborhood.


Obesity and being overweight are major public health issues, and it is well established that obesity is associated with a wide range of serious health outcomes, such as coronary heart disease, cancer, and diabetes. Until quite recently, food purchasing behavior and diet have been regarded purely as matters of individual free choice, and most intervention studies have targeted changing individual behavior (e.g., encouraging healthy eating). This perspective neglects social and material contexts in which food purchasing and diet decisions are made (Diez Roux, 1998). There is now considerable interest in the role of the built and social environments in promoting obesity and being overweight (Egger & Swinburn, 1997; Walker et al., 1999; Davison & Birth, 2000).


Social environments, healthy food availability, fresh foods, food, restaurant, grocery store, neighborhood, community, obesity, Multi-Ethnic Study of Atherosclerosis, MESA, Perceived Availability of Healthy Foods Scale, National Heart, Lung and Blood Institute, NHLBI