Loneliness, Social Isolation, and All-Cause Mortality in a Large Sample of Older Adults.

OBJECTIVES: Using data from a large random sample of U.S. older adults (N = 7982), the effect of loneliness and social isolation on all-cause mortality was examined considering their separate and combined effects. METHODS: The UCLA-3 Loneliness Scale and the Social Network Index (SNI) were used to define loneliness and social isolation. Cox proportional hazards regression models were performed. RESULTS: Among study participants, there were 548 deaths. In separate, adjusted models, loneliness (severe and moderate) and social isolation (limited and moderate social network) were both associated with all-cause mortality. When modeled together, social isolation (limited and moderate social network) along with severe loneliness remained significantly associated with mortality. DISCUSSION: Results demonstrate that both loneliness and social isolation contribute to greater risk of mortality within our population of older adults. As the COVID-19 pandemic continues, loneliness and social isolation should be targeted safely in efforts to reduce mortality risk among older adults.

Cumulative effect of loneliness and social isolation on health outcomes among older adults.

OBJECTIVES: Loneliness and social isolation are described similarly yet are distinct constructs. Numerous studies have examined each construct separately; however, less effort has been dedicated to exploring the impacts in combination. This study sought to describe the cumulative effects on late-life health outcomes. METHOD: Survey data collected in 2018-2019 of a randomly sampled population of US older adults, age 65+, were utilized (N = 6,994). Survey measures included loneliness and social isolation using the UCLA-3 Loneliness Scale and Social Network Index. Participants were grouped into four categories based on overlap. Groups were lonely only, socially isolated only, both lonely and socially isolated, or neither. Bivariate and adjusted associations were examined. RESULTS: Among participants (mean age = 76.5 years), 9.8% (n = 684) were considered lonely only, 20.6% (n = 1,439) socially isolated only, 9.1% (n = 639) both lonely and socially isolated, and 60.5% (n = 4,232) neither. Those considered both lonely and socially isolated were more likely to be older, female, less healthy, depressed, with lower quality of life and greater medical costs in bivariate analyses. In adjusted results, participants who were both lonely and socially isolated had significantly higher rates of ER visits and marginally higher medical costs. CONCLUSION: Results demonstrate cumulative effects of these constructs among older adults. Findings not only fill a gap in research exploring the impacts of loneliness and social isolation later in life, but also confirm the need for approaches targeting older adults who are both lonely and socially isolated. As the COVID-19 pandemic continues, this priority will continue to be urgent for older adults.

Perceptions of a healthier neighborhood food environment linked to greater fruit and vegetable purchases at small and non-traditional food stores.

The aim of this study was to examine associations between perceived neighborhood food environments and food purchasing at small and non-traditional food stores. Intercept interviews of 661 customers were conducted in 105 small and non-traditional food stores. We captured (1) customer perceptions of the neighborhood food environment, (2) associations between customer perceptions and store-level characteristics, and (3) customers' perceptions and shopping behaviors. Findings suggest that customers with more favorable perceptions of the neighborhood food environment were more likely to purchase fruits and vegetables, despite no significant association between perceptions of the neighborhood and objectively measured store characteristics.

Attributes of children and adolescents with avoidant/restrictive food intake disorder.

BACKGROUND: Avoidant/Restrictive Food Intake Disorder (ARFID) is a comparatively new DSM-5 diagnosis. In an effort to better understand this heterogeneous patient group, this study aimed to describe the physical and psychological attributes of children and adolescents with ARFID, and to compare them to patients with full-threshold or atypical anorexia nervosa (AN). METHODS: Children and adolescents aged 7-to-19 years (N = 193) were examined upon presenting at a pediatric eating disorder center between July 2015 and December 2017. Data included diagnosis assessed via the semi-structured Eating Disorder Examination interview along with measures of anthropometrics, depression, anxiety, self-esteem, perfectionism and clinical impairment. RESULTS: Compared to AN and atypical AN (n = 87), patients with ARFID (n = 106) were significantly younger (12.4 vs. 15.1 years, p < .0001), male (41% vs. 15%, p < .0002), and were more likely to be diagnosed with at least one co-morbid DSM-5 diagnosis (75% vs. 61%, p = .04). Patients with ARFID were less likely to be bradycardic (4.7% vs. 24.1%, p < .0001), amenorrheic (11.1 and 34.7%, p = .001), admitted to the hospital (14.2% vs. 27.6%, p = .02), and have a diagnosis of depression (18.9% vs. 48.3%, p < .0001). Patients with ARFID were significantly less likely to experience acute weight loss vs. chronic weight loss as compared with those with AN or atypical AN (p = .0001). On self-report measures, patients with ARFID reported significantly fewer symptoms of depression, anxiety, perfectionism, clinical impairment, concerns about weight and shape, and higher self-esteem than patients with AN or atypical AN (all ps < .0001). No differences were observed by race, anxiety disorder, orthostatic instability, suicidal ideation, and history of eating disorder treatment. CONCLUSIONS: Study results highlight the clinical significance of ARFID as a distinct DSM-5 diagnosis and the physical and psychological differences between ARFID and AN/atypical AN. The novel finding that ARFID patients are more likely than those diagnosed with AN to experience chronic, rather than acute, weight loss suggests important related treatment considerations.

Does Improvement of Low Serum Ferritin Improve Symptoms of Restless Legs Syndrome in a Cohort of Pediatric Patients?

STUDY OBJECTIVES: To determine whether an oral iron supplement improves restless leg/restless sleep symptoms in a pediatric population. METHODS: In a cohort study, 47 patients (age 5-18 years) exhibiting restless legs/restless sleep symptoms and low serum ferritin levels (< 50 ng/mL) were given a daily oral iron supplement (ferrous sulfate + vitamin C) and re-evaluated 8 weeks later. A diagnosis of definite Restless Legs Syndrome (RLS) was determined based on criteria established by the International RLS Study Group. Using Wilcoxon signed-rank tests and Spearman rho, the change and association between the measures of Pediatric Restless Legs Syndrome Severity Scale and serum ferritin levels were also examined. RESULTS: Overall, the median change and distribution of ferritin was statistically significantly different after 8 weeks of treatment (40.0 versus 23.0 ng/mL, P < .0001). Median RLS score was also statistically significantly lower from baseline to follow-up (4.0 versus 6.0, P = .0283). Sixteen patients met criteria for definite RLS; however, the change in RLS score was not determined to be significant in our population (9.5 versus 7.0, P = .0558), despite significant change in ferritin (25.0 versus 42.5 ng/mL, P < .0001). In addition, no correlation was observed between change in RLS score and ferritin level (rho = -.39, P = .1362). CONCLUSIONS: In preliminary findings, we found a modest, yet nonsignificant improvement in children exhibiting restless sleep and RLS symptomatology, despite significant improvement in ferritin levels. Though not statistically significant, the findings can lend to the suggested benefit of iron supplementation in patients with RLS; however, clinical judgment and further research is necessary. CITATION: Rosen GM, Morrissette S, Larson A, Stading P, Barnes TL. Does improvement of low serum ferritin improve symptoms of restless legs syndrome in a cohort of pediatric patients? J Clin Sleep Med. 2019;15(8):1149-1154.

Youth with Avoidant/Restrictive Food Intake Disorder: Examining Differences by Age, Weight Status, and Symptom Duration.

The primary purpose of this study was to examine differences among youth with avoidant/restrictive food intake disorder (ARFID) by age, weight status, and symptom duration. A secondary goal was to report the frequencies of ARFID using DSM-5 clinical presentations (i.e., fear of aversive consequences, lack of interest in food, sensory sensitivities). Participants (N = 102), ages 8-18 years, were recruited through an eating disorder service within a pediatric hospital. They were evaluated using semi-structured interviews and questionnaires. Patients were assigned to groups according to age, weight status, and symptom duration. Frequencies of clinical presentations, including combinations of DSM-5 categories, were also examined. Our findings suggest that adolescents presented with higher rates of Depression (p = 0.04). Youth with chronic ARFID symptoms presented with significantly lower weight (p = 0.03), and those with acute symptoms rated significantly higher suicidal ideation and/or self- harm (p = 0.02). Half of patients met criteria for more than one ARFID symptom presentation. This study provides preliminary evidence that youth with ARFID differ in clinical presentation depending on age, weight status, and symptom duration, and highlights safety concerns for those with acute symptoms of ARFID. High rates of overlapping symptom presentations might suggest a dimensional approach in the conceptualization of ARFID.

Use of a Probiotic to Enhance Iron Absorption in a Randomized Trial of Pediatric Patients Presenting with Iron Deficiency.

OBJECTIVE: To evaluate the efficacy of low dose ferrous sulfate for the treatment of iron deficiency and if the probiotic Lactobacillus plantarum 299v (LP299v) enhances treatment. STUDY DESIGN: This randomized, double-blinded, controlled trial of the treatment of iron deficiency in children compared the use of low-dose ferrous sulfate (1-3 mg/kg/day), with or without probiotic (LP299v). RESULTS: Serum ferritin level increased in all children from a baseline of 23.7 ng/mL to 45.4 ng/mL after 6-8 weeks of treatment. There was no significant difference in the increase in serum ferritin in children taking the probiotic LP299v compared with controls (23.2 vs 20.0 ng/mL, respectively). Additionally, an increase in ferritin level was not significantly associated with probiotic use when controlling for other factors, including child weight and dosing. Overall, the treatments were well-tolerated, with mild side effects. CONCLUSIONS: Treatment with low-dose ferrous sulfate is well-tolerated and effective in correcting iron deficiency in children. However, the probiotic LP299v did not enhance treatment. Further attention should examine the dose-response effect in children, including an alternate day dosing schedule. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01617044.

Hippotherapy in Rehabilitation Care for Children With Neurological Impairments and Developmental Delays: A Case Series.

PURPOSE: This report assesses functional mobility in children with neurological impairments and documented gross motor delays, before and after receiving either hippotherapy or standard outpatient physical therapy (PT). SUMMARY OF KEY POINTS: This is a case-series report using data previously collected for a discontinued randomized controlled trial, in which participants received hippotherapy or standard outpatient clinic PT for a 12-week treatment period. Results demonstrated both subjective and objective functional mobility improvements after treatment in participants receiving hippotherapy and standard outpatient PT, as determined by the Peabody Developmental Motor Scales-2, the Pediatric Evaluation of Disability Inventory, and the Goal Attainment Scaling. STATEMENT OF CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE:: When compared with standard outpatient PT, hippotherapy appears to be a viable treatment strategy for children aged 2 to 5 years with neurological impairments and gross motor delays, but additional research in this area is needed to validate findings.

Case-based simulation empowering pediatric residents to communicate about diagnostic uncertainty.

Background Uncertainty is ubiquitous in medical practice. The Pediatrics Milestones from the Accreditation Council on Graduate Medical Education state that advanced learners should acknowledge and communicate about clinical uncertainty. If uncertainty is not acknowledged, patient care may suffer. There are no described curricula specifically aimed to improve learners' ability to acknowledge and discuss clinical uncertainty. We describe an educational intervention designed to fill this gap. Methods Second-year pediatric residents engaged in a two-phase simulation-based educational intervention designed to improve their ability to communicate about diagnostic uncertainty with patients and caregivers. In each phase, residents engaged in two simulated cases and debriefs. Performance was assessed after each simulated patient encounter using standardized metrics, along with learner perceptions of the experience. Results Residents' skills in communicating with patients and families about diagnostic uncertainty improved after this intervention (mean score post 3.84 vs. 3.28 pre on a five-point Likert scale, p<0.001). Residents rated the experience as relevant, challenging and positive. Conclusions This prospective study suggests that a simulation-based intervention was effective in improving resident physicians' skills in communicating about diagnostic uncertainty with patients and families. Further study is needed to determine how learners perform in real clinical environments.

What does a person's eating identity add to environmental influences on fruit and vegetable intake?

OBJECTIVE: To evaluate whether knowledge of a person's eating identity (EI) can explain any additional variation in fruit and vegetable intake above and beyond that explained by food environment characteristics, perceptions of the food environment, and shopping behaviors. DESIGN: Cross-sectional study. SETTING: A total of 968 adults were recruited for a telephone survey by the Survey Research Laboratory in an eight-county region in South Carolina. SUBJECTS: The survey queried information on shopping behaviors, perceptions of the food environment, demographic and address information, fruit and vegetable intake, and EI. EI was assessed using the Eating Identity Type Inventory, a 12-item instrument that differentiates four eating identity types: healthy, emotional, meat, and picky. Statistical analyses were restricted to 819 participants with complete data. RESULTS: Healthy EI and picky EI were significantly and directly related to fruit and vegetable intake, with coefficients of 0.31 (p-value<0.001) for healthy EI and -0.16 (p-value<0.001) for picky EI, whereas emotional EI (ß = 0.00, p-value = 0.905) and meat EI (ß = -0.04, p-value = 0.258) showed no association. Shopping frequency also directly and significantly influenced fruit and vegetable intake (ß = 0.13, p-value = 0.033). With the inclusion of EI, 16.3% of the variation in fruit and vegetable intake was explained. CONCLUSIONS: Perceptions and GIS-based measures of environmental factors alone do not explain a substantial amount of variation in fruit and vegetable intake. EI, especially healthy EI and picky EI, is an important, independent predictor of fruit and vegetable intake and contributes significantly to explaining the variation in fruit and vegetable intake.

Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores.

BACKGROUND: Purchases at small/non-traditional food stores tend to have poor nutritional quality, and have been associated with poor health outcomes, including increased obesity risk The purpose of this study was to examine whether customers who shop at small/non-traditional food stores with more health promoting features make healthier purchases. METHODS: In a cross-sectional design, data collectors assessed store features in a sample of 99 small and non-traditional food stores not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Minneapolis/St. Paul, MN in 2014. Customer intercept interviews (n = 594) collected purchase data from a bag check and demographics from a survey. Store measures included fruit/vegetable and whole grain availability, an overall Healthy Food Supply Score (HFSS), healthy food advertisements and in-store placement, and shelf space of key items. Customer nutritional measures were analyzed using Nutrient Databases System for Research (NDSR), and included the purchase of ≥1 serving of fruits/vegetables; ≥1 serving of whole grains; and overall Healthy Eating Index-2010 (HEI-2010) score for foods/beverages purchased. Associations between store and customer measures were estimated in multilevel linear and logistic regression models, controlling for customer characteristics and store type. RESULTS: Few customers purchased fruits and vegetables (8%) or whole grains (8%). In fully adjusted models, purchase HEI-2010 scores were associated with fruit/vegetable shelf space (p = 0.002) and the ratio of shelf space devoted to healthy vs. less healthy items (p = 0.0002). Offering ≥14 varieties of fruit/vegetables was associated with produce purchases (OR 3.9, 95% CI 1.2-12.3), as was having produce visible from the store entrance (OR 2.3 95% CI 1.0 to 5.8), but whole grain availability measures were not associated with whole grain purchases. CONCLUSIONS: Strategies addressing both customer demand and the availability of healthy food may be necessary to improve customer purchases. TRIAL REGISTRATION: ClinialTrials.gov: NCT02774330 . Registered May 4, 2016 (retrospectively registered).

Food and beverage purchases in corner stores, gas-marts, pharmacies and dollar stores.

OBJECTIVE: Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type. DESIGN: Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store. SETTING: Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA. SUBJECTS: Customers (n 661) from 105 food retailers. RESULTS: Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of $US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4. CONCLUSIONS: Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.

Do GIS-derived measures of fast food retailers convey perceived fast food opportunities? Implications for food environment assessment.

PURPOSE: Geographic information systems (GISs) have been used to define fast food availability, with higher availability perhaps promoting poorer quality diets. Alternative measures involve perceptions; however, few studies have examined associations between GIS-derived and perceived measures of the food environment. METHODS: Telephone surveys of 705 participants within an eight-county region in South Carolina were analyzed using logistic regression to examine relationships between geographic presence of and distance to various types of food retailers and perceived fast food availability. RESULTS: The mean distance to the nearest fast food restaurant was 6.1 miles, with 16% of participants having a fast food restaurant within 1 mile of home. The geographic presence of and distance to all food retailer types were significantly associated with perceived availability of fast food in unadjusted models. After adjustment, only the presence of a fast food restaurant or pharmacy was significantly associated with greater odds of higher perceived availability of fast food. Greater odds of lower perceived availability of fast food were observed with the presence of a dollar store and increasing distance to the nearest supermarket or pharmacy. CONCLUSIONS: Measures of fast food availability, whether objective or perceived, may not be interchangeable. Researchers should carefully decide on the appropriate measurement tool-GIS-derived or perceived-in food environment studies.

Healthfulness of Foods Advertised in Small and Nontraditional Urban Stores in Minneapolis-St. Paul, Minnesota, 2014.

INTRODUCTION: Shopping at small food stores, such as corner stores and convenience stores, is linked with unhealthful food and beverage purchases, poor diets, and high risk of obesity. However, information on how foods and beverages are marketed at small stores is limited. The objective of this study was to examine advertisements and product placements for healthful and less healthful foods and beverages at small stores in Minneapolis-St. Paul, Minnesota. METHODS: We conducted in-store audits of 119 small and nontraditional food retailers (corner/small grocery stores, food-gas marts, pharmacies, and dollar stores) randomly selected from licensing lists in Minneapolis-St. Paul in 2014. We analyzed data on exterior and interior advertisements of foods and beverages and product placement. RESULTS: Exterior and interior advertisements for healthful foods and beverages were found in less than half of stores (exterior, 37% [44 of 119]; interior, 20% [24 of 119]). Exterior and interior advertisements for less healthful items were found in approximately half of stores (exterior, 46% [55 of 119]); interior, 66% [78 of 119]). Of the 4 store types, food-gas marts were most likely to have exterior and interior advertisements for both healthful and less healthful items. Corner/small grocery stores and dollar stores had fewer advertisements of any type. Most stores (77%) had at least 1 healthful item featured as an impulse buy (ie, an item easily reached at checkout), whereas 98% featured at least 1 less healthful item as an impulse buy. CONCLUSION: Findings suggest imbalanced advertising and product placement of healthful and less healthful foods and beverages at small food stores in Minneapolis-St. Paul; less healthful items were more apt to be featured as impulse buys. Future interventions and polices should encourage reductions in advertisements and impulse-buy placements of unhealthful products, particularly in food-gas marts, and encourage advertisements of healthful products.

Scale effects in food environment research: Implications from assessing socioeconomic dimensions of supermarket accessibility in an eight-county region of South Carolina.

Choice of neighborhood scale affects associations between environmental attributes and health-related outcomes. This phenomenon, a part of the modifiable areal unit problem, has been described fully in geography but not as it relates to food environment research. Using two administrative-based geographic boundaries (census tracts and block groups), supermarket geographic measures (density, cumulative opportunity and distance to nearest) were created to examine differences by scale and associations between three common U.S. Census-based socioeconomic status (SES) characteristics (median household income, percentage of population living below poverty and percentage of population with at least a high school education) and a summary neighborhood SES z-score in an eight-county region of South Carolina. General linear mixed-models were used. Overall, both supermarket density and cumulative opportunity were higher when using census tract boundaries compared to block groups. In analytic models, higher median household income was significantly associated with lower neighborhood supermarket density and lower cumulative opportunity using either the census tract or block group boundaries, and neighborhood poverty was positively associated with supermarket density and cumulative opportunity. Both median household income and percent high school education were positively associated with distance to nearest supermarket using either boundary definition, whereas neighborhood poverty had an inverse association. Findings from this study support the premise that supermarket measures can differ by choice of geographic scale and can influence associations between measures. Researchers should consider the most appropriate geographic scale carefully when conducting food environment studies.

Geographic measures of retail food outlets and perceived availability of healthy foods in neighbourhoods.

OBJECTIVE: To examine associations between geographic measures of retail food outlets and perceived availability of healthy foods. DESIGN: Cross-sectional. SETTING: A predominantly rural, eight-county region of South Carolina, USA. SUBJECTS: Data from 705 household shoppers were analysed using ordinary least-squares regression to examine relationships between geographic measures (presence and distance) of food outlets obtained via a geographic information system and perceived availability of healthy foods (fresh fruits and vegetables and low-fat foods). RESULTS: The presence of a supermarket within an 8·05 km (5-mile) buffer area was significantly associated with perceived availability of healthy foods (ß=1·09, P=0·025) when controlling for all other food outlet types. However, no other derived geographic presence measures were significant predictors of perceived availability of healthy foods. Distances to the nearest supermarket (ß=-0·16, P=0·003), dollar and variety store (ß=-0·15, P=0·005) and fast-food restaurant (ß=0·11, P=0·015) were all significantly associated with perceptions of healthy food availability. CONCLUSIONS: Our results suggest that distance to food outlets is a significant predictor of healthy food perceptions, although presence is sensitive to boundary size. Our study contributes to the understanding and improvement of techniques that characterize individuals' food options in their community.

Fast-food consumption, diet quality and body weight: cross-sectional and prospective associations in a community sample of working adults.

OBJECTIVE: To examine the association between fast-food consumption, diet quality and body weight in a community sample of working adults. DESIGN: Cross-sectional and prospective analysis of anthropometric, survey and dietary data from adults recruited to participate in a worksite nutrition intervention. Participants self-reported frequency of fast-food consumption per week. Nutrient intakes and diet quality, using the Healthy Eating Index-2010 (HEI-2010), were computed from dietary recalls collected at baseline and 6 months. SETTING: Metropolitan medical complex, Minneapolis, MN, USA. SUBJECTS: Two hundred adults, aged 18-60 years. RESULTS: Cross-sectionally, fast-food consumption was significantly associated with higher daily total energy intake (ß=72·5, P=0·005), empty calories (ß=0·40, P=0·006) and BMI (ß=0·73, P=0·011), and lower HEI-2010 score (ß=-1·23, P=0·012), total vegetables (ß=-0·14, P=0·004), whole grains (ß=-0·39, P=0·005), fibre (ß=-0·83, P=0·002), Mg (ß=-6·99, P=0·019) and K (ß=-57·5, P=0·016). Over 6 months, change in fast-food consumption was not significantly associated with changes in energy intake or BMI, but was significantly inversely associated with total intake of vegetables (ß=-0·14, P=0·034). CONCLUSIONS: Frequency of fast-food consumption was significantly associated with higher energy intake and poorer diet quality cross-sectionally. Six-month change in fast-food intake was small, and not significantly associated with overall diet quality or BMI.

Do people really know what food retailers exist in their neighborhood? Examining GIS-based and perceived presence of retail food outlets in an eight-county region of South Carolina.

Measures of neighborhood food environments have been linked to diet and obesity. However, the appropriate measurement methods and how people actually perceive their food environments are still unclear. In a cross-sectional study of 939 adults, the perceived presence of food outlets was compared to the geographic-based presence of outlets within a participant's neighborhood, utilizing percent agreement and Kappa statistics. Perceived presence was based on survey-administered questions, and geographic-based presence was characterized using 1-, 2-, 3- and 5-mile (1-mile=1.6km) Euclidean- and network-based buffers centered on each participant's residence. Analyses were also stratified by urban and non-urban designations. Overall, an individual's perceived neighborhood food environment was moderately correlated with the geographic-based presence of outlets. The performance of an individual's perception was most optimal using a 2- or 3-mile geographic-based neighborhood boundary and/or when the participant lived in a non-urban neighborhood. This study has implications for how researchers measure the food environment.

Neighborhood fast food availability and fast food consumption.

Recent nutritional and public health research has focused on how the availability of various types of food in a person's immediate area or neighborhood influences his or her food choices and eating habits. It has been theorized that people living in areas with a wealth of unhealthy fast-food options may show higher levels of fast-food consumption, a factor that often coincides with being overweight or obese. However, measuring food availability in a particular area is difficult to achieve consistently: there may be differences in the strict physical locations of food options as compared to how individuals perceive their personal food availability, and various studies may use either one or both of these measures. The aim of this study was to evaluate the association between weekly fast-food consumption and both a person's perceived availability of fast-food and an objective measure of fast-food presence - Geographic Information Systems (GIS) - within that person's neighborhood. A randomly selected population-based sample of eight counties in South Carolina was used to conduct a cross-sectional telephone survey assessing self-report fast-food consumption and perceived availability of fast food. GIS was used to determine the actual number of fast-food outlets within each participant's neighborhood. Using multinomial logistic regression analyses, we found that neither perceived availability nor GIS-based presence of fast-food was significantly associated with weekly fast-food consumption. Our findings indicate that availability might not be the dominant factor influencing fast-food consumption. We recommend using subjective availability measures and considering individual characteristics that could influence both perceived availability of fast food and its impact on fast-food consumption. If replicated, our findings suggest that interventions aimed at reducing fast-food consumption by limiting neighborhood fast-food availability might not be completely effective.