NYMC Student Theses and Dissertations

Date of Award

6-10-2025

Document Type

Doctoral Dissertation - Open Access

Degree Name

Doctor of Public Health

Department

Public Health

First Advisor

Dr. Adam Block

Second Advisor

Dr. Kenneth Knapp

Third Advisor

Dr. Justin Wu

Abstract

This study investigates the relationship between the availability of fast food in US territories and mental health outcomes. Utilizing a cross-sectional design, the study examines data from the 2011 and 2016 Behavioral Risk Factor Surveillance System (BRFSS) from the CDC, along with data from the U.S. Department of Agriculture’s Food Environment Atlas. The analysis included a nationally representative sample of 351,823 participants across all 50 US states. Multiple regression models examined the association between fast food availability and two primary mental health outcomes: the number of self-reported poor mental health days and the likelihood of being diagnosed with a depressive disorder by a medical provider. Findings of the study indicate that fast food availability was not a significant predictor of the number of poor mental health days reported in a month or being told you have a depressive disorder in both 2011 and 2016. However, several sociodemographic and health behavior variables—such as younger age, female gender, lower income and education levels, unemployment, smoking, lack of physical activity, and higher BMI were consistently and significantly associated with worse mental health outcomes. The number of poor mental health days increased from 2011 to 2016, highlighting a potential concern of declining mental well-being in the U.S. population. Secondary analysis revealed specific relationships in certain subgroups. For example, among employed individuals and college graduates, higher fast food availability was associated with more poor mental health days per month. While fast food availability alone may not be a predictor of mental health outcomes, this study highlights the importance and need for further longitudinal research to explore environmental influences on mental well-being over time.

Keywords

mental health outcomes, fast food availability, brfss, depressive disorders

Disciplines

Community Health | Community Health and Preventive Medicine | Environmental Public Health | Medicine and Health Sciences | Other Mental and Social Health | Other Public Health

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