{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:45:05Z","timestamp":1777052705745,"version":"3.51.4"},"reference-count":50,"publisher":"Korean Society of Epidemiology","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010700","name":"National Institute of Environmental Research","doi-asserted-by":"publisher","award":["NIER-2021-03-03-007"],"award-info":[{"award-number":["NIER-2021-03-03-007"]}],"id":[{"id":"10.13039\/501100010700","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003562","name":"Ministry of Environment","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003562","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2024-00355637"],"award-info":[{"award-number":["RS-2024-00355637"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["e-epih.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol Health"],"abstract":"<jats:p>OBJECTIVES: Although environmental factors influence lifestyle choices, few studies have examined how individual-level and neighborhood-level socio-demographic factors interact to affect diet quality in Korea. We investigated the associations between multilevel factors and diet quality among Korean adults and explored potential interactions by gender and age.METHODS: We conducted a cross-sectional analysis of 42,035 adults from 1,671 towns using data from the Korea National Health and Nutrition Examination Survey (2010-2019) and the Population and Housing Census of Korea (2010-2019). Individual-level variables included gender, age, education, income, number of household members, smoking, drinking, physical activity, and subjective health status. Neighborhood-level variables included residential area, housing type, number of restaurants per capita, population size, and the proportion of low-income households and older adults. Associations with the Korean Healthy Eating Index (KHEI) were assessed using 2-level hierarchical models.RESULTS: Of the total variance in KHEI, 5.2% was attributable to neighborhood-level differences. Individual-level factors explained 48.1% of variance at the neighborhood-level, while neighborhood-level factors accounted for an additional 12.4%. Individuals living in rural areas, non-apartment housing, neighborhoods with higher proportions of low-income households and older adults, or in areas with smaller populations, had lower KHEI scores than their counterparts. In random slope models with cross-level interaction terms, diet quality among adults aged 70 years and older varied significantly according to neighborhood- level characteristics.CONCLUSIONS: Both individual-level and neighborhood-level factors influence diet quality in Korea, with older adults being especially vulnerable to neighborhood characteristics. Multilevel approaches are needed to identify at-risk populations and improve dietary outcomes.<\/jats:p>","DOI":"10.4178\/epih.e2025043","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T08:49:33Z","timestamp":1755593373000},"page":"e2025043","update-policy":"https:\/\/doi.org\/10.4178\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Individual- and neighborhood-level factors influencing diet quality: a multilevel analysis using Korea National Health and Nutrition Examination Survey data, 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