Grocery gap


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Food Trust's important study on fresh food access needs in poor communities

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Grocery gap

  1. 1. PolicyLink is a national research and action instituteadvancing economic and social equityby Lifting Up What Works®.The Food Trust, founded in 1992, is a nonpro torganization working to ensure that everyone hasaccess to affordable, nutritious food.Design by: Leslie YangCOVER PHOTOS COURTESY OF (from left to right, top to bottom): Zejica; Lorie Slater; image100 Photography;Richard Beebe.PHOTOS COURTESY OF: p.4: David Gomez Photography; p.6: Lorie Slater; p.10: Victor Melniciuc; p.12:Bart Sadowski; p.24: Plush Studios/Blend.
  2. 2. PolicyLink The Food Trust Sarah Treuhaft PolicyLink Allison Karpyn The Food Trust
  3. 3. PolicyLink The Food TrustAcknowledgmentsPolicyLink and The Food Trust are grateful to thefunders who supported the development and publication of this report, including the ConvergencePartnership and the Kresge Foundation. The research for this study was conducted withindispensable assistance from Diana Fischmann(former intern, The Food Trust), who initially collected, reviewed, and summarized manyof the studies, and Allison Hagey (PolicyLink)who adeptly assisted with the data analysis andmanuscript development. Many thanks to Jennefer Keller, Jon Jeter, and Leslie Yang (PolicyLink), andLance Loethen (The Reinvestment Fund) for theirassistance. Our gratitude also extends to Judith Bell and Rebecca Flournoy (PolicyLink), JohnWeidman (The Food Trust), and Ira Goldstein (TheReinvestment Fund) who provided helpful guidance and feedback throughout the research process. 2
  4. 4. PolicyLink The Food TrustContents 5 Preface 7 Executive Summary 11 Introduction 13 Findings 21 Implications for Policy 23 Methods 25 References 32 Notes 3
  5. 5. PolicyLink The Food TrustImproving access to healthy food is acritical component of an agenda to buildan equitable and sustainable food system. 4
  6. 6. PolicyLink The Food TrustPrefaceFor decades, low-income communities of color have Centers for Disease Control and Prevention, adultsuffered as grocery stores and fresh, affordable obesity rates are 51 percent higher for Africanfood disappeared from their neighborhoods. Americans than whites, and 21 percent higherAdvocates have long drawn attention to this critical for Latinos. Black and Latino children are moreissue and crafted policy solutions, but access to likely to become obese than white children. Thehealthy food is just now entering the national policy lack of healthy food retail also hinders communitydebate. While the problem is obvious to impacted economic development in neighborhoods thatcommunities, good policy must also be based on need private investment, activity hubs, and jobs.solid data about the issue and its consequences. Thankfully, the tide is beginning to turn. ResearchersUnfortunately, it often takes years for the research and policymakers are coming to consensus thatto catch up with pressing needs in historically this is a critical issue. And they are recognizing thatunderserved communities. Sometimes information is communities have developed innovative, sustainablenot available. Other times, evidence is accumulating solutions that can work in other locales and at largerbut it is buried in journals not widely read by scales. In December 2009, 39 members of Congresspolicymakers. Or it is produced by practitioners and from both political parties issued a resolution in theadvocates for local action campaigns and not accepted House of Representatives recognizing the need forby researchers or shared with policymakers or the national policy to address limited access to healthybroader field. Too often, research focusing on low- food in underserved communities. The President’sincome people and communities of color, informed 2011 budget calls for more than $400 million toby their experiences, or conducted in partnership establish a national Healthy Food Financing Initiative,with them, is perceived as a political strategy, and this initiative is a key component of the Firstrather than as a legitimate search to understand Lady’s Let’s Move campaign to reduce childhoodproblems and inform strategies for change. obesity. Legislation to create a Healthy Food Financing Initiative is expected to be introduced inPolicyLink and The Food Trust conducted this both the House and the Senate in Spring 2010.inquiry to summarize the existing evidence base,carefully reviewing more than 132 studies. We This report presents powerful data. It confirmsfound that a large and consistent body of evidence that as a nation we must answer the appeals ofsupports what residents have long observed: many community activists seeking access to healthy foodlow-income communities, communities of color, for their families and their neighborhoods. Weand sparsely populated rural areas do not have hope that it provides policymakers, advocates,sufficient opportunities to buy healthy, affordable philanthropists, and others with information,food. The consequences are also clear: decreased evidence, and analysis that can inform their effortsaccess to healthy food means people in low-income to eliminate “food deserts” from neighborhoodscommunities suffer more from diet-related diseases and communities across the obesity and diabetes than those in higher-income neighborhoods with easy access to healthyfood, particularly fresh fruits and vegetables.Inequitable access to healthy food is a major Angela Glover Blackwell Yael Lehmanncontributor to health disparities. According to the Founder and CEO Executive Director PolicyLink The Food Trust 5
  7. 7. PolicyLink The Food TrustIn hundreds of neighborhoodsacross the country, nutritious,affordable, and high qualityfood is out of reach—particularly low-incomeneighborhoods, communitiesof color, and rural areas. 6
  8. 8. PolicyLink The Food Trust Executive SummaryAn apple a day? the past 20 years. This bibliography incorporates a total of 132 studies: Sixty-one published in peer-F or millions of Americans—especially people reviewed journals and primarily conducted by living in low-income communities of color— university-based researchers and 71 conductedfinding a fresh apple is not so easy. Full-service by practitioners or policy researchers, sometimesgrocery stores, farmers’ markets, and other vendors in collaboration with academic researchers, andthat sell fresh fruits, vegetables, and other healthy self-published (also known as “grey literature”).foods cannot be found in their neighborhoods. The studies include three nationwide analysesWhat can be found, often in great abundance, of food store availability and neighborhood,are convenience stores and fast food restaurants city, county, regional, statewide, and multistatethat mainly sell cheap, high-fat, high-sugar, analyses covering 22 states across the country.processed foods and offer few healthy options.  Without access to healthy foods, a nutritious Findingsdiet and good health are out of reach. Andwithout grocery stores and other fresh 1. Accessing healthy food is a challengefood retailers, communities are missing the for many Americans—particularly thosecommercial hubs that make neighborhoodslivable, and help local economies thrive. living in low-income neighborhoods, communities of color, and rural areas. InFor decades, community activists have organized hundreds of neighborhoods across the country,around the lack of access to healthy foods as nutritious, affordable, and high quality foodan economic, health, and social justice issue. As is largely missing. Studies that measure foodconcerns grow over healthcare and the country’s store availability and availability of healthy foodsworsening obesity epidemic, “food deserts” — areas in nearby stores find major disparities in foodwhere there is little or no access to healthy and access by race and income and for low-density,affordable food—have catapulted to the forefront rural areas.of public policy discussions. Policymakers at • Lack of supermarkets. A 2009 study bythe local, state, and national level have begun the U.S. Department of Agriculture foundrecognizing the role that access to healthy food that 23.5 million people lack access to aplays in promoting healthy local economies, supermarket within a mile of their home.healthy neighborhoods, and healthy people. A recent multistate study found that low- income census tracts had half as manyThis report, a summary of our current knowledge supermarkets as wealthy tracts. Anotherabout food deserts and their impacts on multistate study found that eight percentcommunities, provides evidence to inform this of African Americans live in a tract with apolicymaking. supermarket, compared to 31 percent of whites. And a nationwide analysis foundTo assess the current evidence base in this there are 418 rural “food desert” countiesdynamic and fast-growing field of research, we where all residents live more than 10 milescompiled the most comprehensive bibliography from a supermarket or supercenter—to date of studies examining food access and its this is 20 percent of rural counties.implications conducted in the United States over 7
  9. 9. PolicyLink The Food Trust • Lack of healthy, high quality foods • In rural Mississippi, adults living in “food in nearby food stores. In Detroit and desert” counties lacking large supermarkets New Haven, produce quality is lower are 23 percent less likely to consume the in low-income communities of color recommended fruits and vegetables than compared to more affluent or racially those in counties that have supermarkets, mixed neighborhoods. In Albany, New controlling for age, sex, race, and York, 80 percent of nonwhite residents education. cannot find low-fat milk or high-fiber bread in their neighborhoods. And in 3. Access to healthy food is associated Baltimore, 46 percent of lower-income with lower risk for obesity and other neighborhoods have limited access to diet-related chronic diseases. Researchers healthy food (based on a healthy food find that residents who live near supermarkets availability survey) compared to 13 percent or in areas where food markets selling of higher-income neighborhoods. fresh produce (supermarkets, grocery stores, farmers’ markets, etc.) outnumber food stores • Predominance of convenience/corner/ that generally do not (such as corner stores) liquor stores. Nationally, low-income zip have lower rates of diet-related diseases than codes have 30 percent more convenience their counterparts in neighborhoods lacking stores, which tend to lack healthy food access. items, than middle-income zip codes. • A multistate study found that people • Lack of transportation access to stores. with access to only supermarkets or Residents in many urban areas (including to supermarkets and grocery stores Seattle, Central and South Los Angeles, and have the lowest rates of obesity and East Austin, Texas) have few transportation overweight and those without access to options to reach supermarkets. Inadequate supermarkets have the highest rates. transportation can be a major challenge for rural residents, given the long distances to • In California and New York City, residents stores. In Mississippi—which has the highest living in areas with higher densities of fresh obesity rate of any state—over 70 percent food markets, compared to convenience of food stamp eligible households travel stores and fast food restaurants, have more than 30 miles to reach a supermarket. lower rates of obesity. In California, obesity and diabetes rates are 20 percent2. Better access corresponds with higher for those living in the least healthy healthier eating. Studies find that residents “food environments,” controlling for with greater access to supermarkets or a greater household income, race/ethnicity, age, abundance of healthy foods in neighborhood gender, and physical activity levels. food stores consume more fresh produce and • Using statistical modeling techniques that other healthful items. control for a variety of factors, researchers • For every additional supermarket in estimate that adding a new grocery store to a census tract, produce consumption a high poverty neighborhood in Indianapolis increases 32 percent for African would lead to a three pound weight Americans and 11 percent for whites, decrease among residents, while eliminating according to a multistate study. a fast food restaurant in a neighborhood with a high density of fast food would • A survey of produce availability in New lead to a one pound weight decrease. Orleans’ small neighborhood stores found that for each additional meter of shelf • In Chicago and Detroit, residents who space devoted to fresh vegetables, residents live farther from grocery stores than eat an additional 0.35 servings per day. from convenience stores and fast food 8
  10. 10. PolicyLink The Food Trust restaurants have significantly higher rates of supported agriculture programs, and premature death from diabetes. mobile vendors (and ensuring public benefits can be used at these venues);4. New and improved healthy food retail • Increasing the stock of fruits, vegetables, in underserved communities creates and other healthy foods at neighborhood jobs and helps to revitalize low-income corner stores or small groceries; neighborhoods. Though the economic impacts of food retailers are understudied, • Growing food locally through backyard we know that grocery stores contribute to and community gardens and larger- community economic development. Analysis scale urban agriculture; and of a successful statewide public-private initiative to bring new or revitalized grocery • Improving transportation to grocery stores to underserved neighborhoods in stores and farmers’ markets. Pennsylvania provides positive evidence that fresh food markets can create jobs, bolster local Improving access to healthy food is a critical economies, and revitalize neighborhoods. The component of an agenda to build an equitable effort has created or retained 4,860 jobs in and sustainable food system. It is time for 78 underserved urban and rural communities a nationwide focus to ensure that healthy throughout the state. Analyses of stores food choices are available to all, building supported by the effort find they lead to on these local efforts and innovations. increased economic activity in surrounding communities. Smart public policies and programs should support communities in their efforts to develop, implement, and test strategies that increase healthy foodImplications for Policy access. Government agencies at the local, state, and federal level should prioritize the issue of inequitable food access in low-income, underservedThe evidence is clear that many communities— areas. Programs and policies that are workingpredominantly low-income, urban communities should be expanded and new programs shouldof color and rural areas—lack adequate access to be developed to bring more grocery stores andhealthy food, and the evidence also suggests that other fresh food retail outlets to neighborhoodsthe lack of access negatively impacts the health without access to healthy foods. Transportationof residents and neighborhoods. These findings barriers to fresh food outlets should be addressed.indicate that policy interventions to increase Whenever possible, policies to address foodaccess to healthy food in “food deserts” will deserts should link with comprehensive efforts tohelp people eat a healthy diet, while contributing build strong regional food and farm community economic development. Residents of low-income communities andFor many years, impacted communities and communities of color in urban and rural areastheir advocates have been implementing have suffered for too long from a lack ofa variety of strategies to increase access to access to healthy food. With local and statefresh, wholesome foods, including: programs showing enormous promise, now is the time for policymakers to enact policies that • Attracting or developing grocery will catalyze the replication of local and state stores and supermarkets; innovations and bring them to a national scale. • Developing other retail outlets such as farmers’ markets, public markets, cooperatives, farmstands, community- 9
  11. 11. PolicyLink The Food TrustThe presence of stores sellinghealthy, affordable food makesit possible to eat “five a day”and consume a healthful diet. 10
  12. 12. PolicyLink The Food Trust IntroductionI n hundreds of neighborhoods across the country, nutritious, affordable, and high quality foodis out of reach. Residents of many urban low- and in need of new or revitalized neighborhood- serving retailers and job opportunities. Grocery stores and supermarkets are also economicincome communities of color walk outside their anchors in a neighborhood—supplying local jobsdoors to find no grocery stores, farmers’ markets, and creating foot traffic for additional businesses.or other sources of fresh food. Instead they are Smaller food retailers and farmers’ markets canbombarded by fast food and convenience stores also bolster the local economy and contribute toselling high-fat, high-sugar, processed foods. a healthy neighborhood business environment.Rural residents often face a different type ofchallenge—a lack of any nearby food options. Although the lack of access to healthy foods has preoccupied residents of low-income urbanThis has been a persistent problem for communities. neighborhoods and rural areas for decades, andBeginning in the 1960s and 1970s, white, middle- many advocates have fought long and hard to bringclass families left urban centers for homes in in or develop new fresh food retailers, until recentlythe suburbs, and supermarkets fled with them. the issue was largely confined to the occasionalOnce they left the city, grocers adapted their local win or news story. But that is all changing.operations to suit their new environs, building “Food deserts”—areas with low access to healthyever-larger stores and developing chain-wide foods—have become a major topic of interestcontracts with large suppliers and distributors among public health advocates and the media, asto stock the stores with foods demanded by a well as a dynamic and fast-growing field of research.fairly homogeneous suburban population. Over With the recognition of the obesity (and childhoodthe past several decades, the structure of the obesity) crises and the increasing understandinggrocery industry has changed dramatically, with of how the neighborhood environment influencessignificant consolidation and growth in discount health, solving the food desert problem is nowstores and supercenters and specialty/natural food rising to the forefront of policy discussions.retailers.1 At the same time, alternative sourcesof fresh foods such as farmers’ markets, produce This report provides data to inform that debate.stands, and community-supported agriculture Across the country, dozens of studies haveprograms have proliferated, though predominantly examined the availability of nutritious, affordablein middle-class or affluent communities. foods in communities and/or the relationship between food access and health. These includeWhile some continue to be well-served, many studies authored by university-based researchers,have been left out. Without fresh food retailers, health departments, community groups, andthese communities miss out on the economic and nonprofit policy and research organizations. Ahealth benefits they bring to neighborhoods. The large number of studies, particularly local studiespresence of stores selling healthy, affordable food about geographic access to healthy food, aremakes it possible to eat “five a day” and consume conducted by practitioners who seek to understanda healthful diet. This is particularly important for the situation locally in order to take action. Thislow-income people of color given the vast disparities “grey literature” often provides important datain health that exist in areas including obesity, but is rarely included in academic reviews.diabetes, and other diet-related diseases. The samecommunities are often economically distressed 11
  13. 13. PolicyLink The Food TrustTo assess the current evidence base, we gathered statewide, and multistate analyses covering 22the studies conducted in the United States over the states throughout the country. The bibliographypast 20 years to create the most comprehensive also includes three review studies.3, 4, 5 Sixty-onebibliography on this topic to date.2 We found of the studies were published in peer-revieweda total of 132 studies that examined access to journals and generally conducted by academichealthy food and its impacts. They include three researchers, and 71 were self-published andnationwide analyses of food store availability generally conducted by practitioners. (See pagesand neighborhood, city, county, regional, 23-24 for a full description of our methodology.)Studies find that residentswith greater access tosupermarkets or a greaterabundance of healthy foodsin neighborhood food storesconsume more fresh produceand other healthful items. 12
  14. 14. PolicyLink The Food Trust Findings1. Accessing healthy food is a of food outlets such as convenience stores and smaller grocery stores. Several of these studies look challenge for many Americans— at the distribution of different types of food stores, particularly those living in such as supermarkets, smaller grocery stores, and low-income neighborhoods, “fringe retailers” such as convenience and corner communities of color, and stores across different community types. They find that lower-income communities and communities of rural areas color have fewer supermarkets, more convenience stores, and smaller grocery stores than wealthierResearchers have measured geographic access and predominantly white healthy foods in many different ways, andat nearly every imaginable scale: from national Eighty-nine national and local studies documentsamples to detailed assessments of specific uneven geographic access to supermarketsneighborhoods. Only one study has sought to in urban areas according to income, race, orcalculate the extent of the problem nationally. both7-87 and nine had mixed results.88-96The U.S. Department of Agriculture’s 2009 “fooddesert” study examined access to supermarkets and Nationwide study findings include:determined that 23.5 million people cannot accessa supermarket within one mile of their home. • Low-income zip codes have 25 percent fewer chain supermarkets and 1.3Most studies (a total of 113) examine whether times as many convenience storessupermarkets or healthy foods are equitably compared to middle-income zip codes.distributed across communities according to Predominantly black zip codes have aboutsocioeconomic status, racial composition, or half the number of chain supermarketslevel of urbanization (population density).6 compared to predominantly whiteTheir findings are remarkably consistent: people zip codes, and predominantly Latinoliving in low-income neighborhoods, minority areas have only a third as many.46neighborhoods, and rural communities facemuch greater challenges finding healthy food, • Low-income neighborhoods have halfespecially those who lack good transportation as many supermarkets as the wealthiestoptions to reach full-service grocery stores. neighborhoods and four times as manyNinety-seven of these studies found inequitable smaller grocery stores, according to anaccess to healthy foods, 14 had some mixed assessment of 685 urban and rural censusresults, and two studies did not find inequities. tracts in three states. The same study found four times as many supermarketsDisparities in supermarket access in in predominantly white neighborhoods compared to predominantly black ones.38urban areas by race and income Another multistate study found that eight percent of African AmericansMany researchers use supermarkets as a proxy for live in a tract with a supermarketfood access because they provide the most reliable compared to 31 percent of whites.42access to a wide variety of nutritious and affordableproduce and other foods compared to other types 13
  15. 15. PolicyLink The Food TrustLocal studies demonstrate similar trends: Disparities in access to healthy food at neighborhood stores in • In Los Angeles there are 2.3 times as many urban areas by race and income supermarkets per household in low-poverty areas compared to high-poverty areas. Other studies gather much more detailed data, Predominantly white areas have 3.2 times conducting in-store surveys to assess the availability, as many supermarkets as black areas and variety, quality, and price of particular healthy items 1.7 times as many as Latino areas.49 or grocery “market baskets.” Such surveys offer a more precise look at healthy food availability in • Among affluent neighborhoods in neighborhoods, but they are labor-intensive so Atlanta, those that are predominantly generally focus on smaller geographic areas. white have better grocery store access than those that are predominantly Among these studies, 21 found that food stores black, indicating that race may be a in lower-income neighborhoods and communities factor independent of income.30 of color are less likely to stock healthy foods, • In West Louisville, Kentucky, a low-income offer lower quality items, and have higher African American community that suffers prices compared to stores in higher-income or from high rates of diabetes, there is one predominantly white communities,13, 15, 17, 18, 20-23, supermarket for every 25,000 residents, 28, 31, 33, 35, 52, 68, 69, 96-99, 103, 105, 106 and seven found compared to the county average of one mixed results (for example, lower quality but supermarket for every 12,500 residents.17 similar prices and selection)9, 81, 88, 89, 100, 102 or no difference.101 In addition, a study based on focus • In Washington, DC, the city’s lowest- groups with residents in East Baltimore (a low- income wards (Wards 7 and 8) have one income community of color) found that they were supermarket for every 70,000 people reliant on small neighborhood stores that charged while two of the three highest-income extremely high prices and lacked a good variety wards (Wards 2 and 3) have one for and selection of healthy foods.103 Findings include: every 11,881 people.20 One in five of the city’s food stamp recipients lives in a • Stores carrying fruits and vegetables are neighborhood without a grocery store.37 unevenly distributed among different types of communities in upstate New York: a • In California and in New York City, low- minority neighborhood in Albany has income neighborhoods have fewer the least access (4.6 stores per 10,000 purveyors of healthy foods (supermarkets, residents), followed by a rural community produce stands) compared to outlets that (7.8), a small town (9.8), and a racially primarily sell unhealthy foods (convenience mixed neighborhood in Albany (11.4).32 stores, fast food restaurants).14, 47 Low- The same researchers find that eight in income neighborhoods in California 10 of Albany’s nonwhite residents live have 20 percent fewer healthy food in a neighborhood that lacks any stores sources than higher-income ones.14 selling low-fat milk or high-fiber bread.33 • In unincorporated communities (colonias) • Stores located in low-income and very located along the U.S.-Mexico border low-income zip codes in Los Angeles in Texas, residents in neighborhoods and Sacramento are less likely to stock with higher levels of deprivation healthy foods than stores in higher-income (measured by income, transportation, areas.34 Three in 10 food stores in a high- lack of infrastructure, etc.) travel farther poverty, predominantly African American to reach the nearest supermarket or community in Los Angeles lacked fruits and grocery store and have lower access vegetables while nearly all of the stores in to a variety of food stores.51 a contrast area that was low poverty and predominantly white sold fresh produce.52 14
  16. 16. PolicyLink The Food Trust Share of Baltimore Neighborhood Food Stores with Low Availability of Healthy Food, by Neighborhood Race and Income, 2006 • Produce quality is lower in a predominantly around schools because of the link between access black, low-income community in Detroit to convenience stores and adolescent health.121 Two compared to an adjacent suburban studies looked at convenience stores in proximity community that is racially mixed and to schools and found that schools with more low- middle-income.81 Produce quality is income or nonwhite students or in urban areas,104 also lower in New Haven, Connecticut’s and schools located in low-income neighborhoods low-income communities compared or communities of color107 are more likely to to more affluent neighborhoods.9 have at least one convenience store nearby. • In Baltimore (see chart above), a healthy Rural food deserts food availability survey of 226 supermarkets, grocery stores, convenience stores, and While the majority of food desert studies focus behind-glass stores in 106 census tracts on urban communities, 21 studies examined rural found that 43 percent of predominantly communities. Twenty of them found significant black neighborhoods and 46 percent of food access challenges in rural communities21, lower-income neighborhoods were in the 29, 32, 33, 36, 43, 46, 50, 51, 70, 75, 95, 108-114, 116 and one (that bottom third of availability, compared to looked at Springfield, Oregon) did not find urban- four percent of predominantly white and 13 rural disparities.54 The major issues in rural areas percent of higher-income neighborhoods. are different than those in urban areas given the The supermarkets in predominantly black low population density, longer distances between and lower-income neighborhoods scored retailers, and rapid rise of supercenters and their lower for healthy food availability as well.23 impact on other food retailers. Key findings include: Disparities in food store access around • Controlling for population density, ruralschools by race and income areas have fewer food retailers of any type compared to urban areas, and only 14In addition to the residential environment, researchers percent the number of chain supermarkets.46are beginning to examine the “food environment” (See chart, next page) Another nationwide 15
  17. 17. PolicyLink The Food Trust Availability of Food Stores in Rural Areas by Store Type, 2000 analysis found that there are 418 2. Better access to healthy food rural “food desert” counties where all residents live 10 miles or more from the corresponds with healthier eating nearest supermarket or supercenter—20 percent of all rural counties.43 Consistent with the conclusions of a recent review study,4 we found strong and consistent evidence • In the Mississippi Delta, over 70 percent indicating a positive relationship between access of households eligible to receive to healthy food and eating behaviors. Without food stamp benefits needed to travel nearby access to healthy ingredients, families more than 30 miles to reach a large have a harder time meeting recommended dietary grocery store or supermarket.36 guidelines for good health such as eating fruits and vegetables and lowering fat intake. In a • In New Mexico, rural residents have survey of diabetic adults in New York’s East Harlem access to fewer grocery stores than urban neighborhood, 40 percent said that they did residents, pay more for comparable items, not follow the recommended dietary guidelines and have less selection. The same market because the necessary foods were less available and basket of groceries costs $85 for rural more expensive in their neighborhood stores.31 residents and $55 for urban residents.113 Of 14 studies that examine food access andTransportation access consumption of healthy foods, all but one of them found a correlation between greater access andLack of transportation to supermarkets is a major better eating behaviors. All of the studies in thisbarrier for residents in many communities.115 category were conducted by academic researchersAssessments of Lexington (KY), Seattle (WA), Central and published in peer-reviewed journals.118and South Los Angeles (CA), East Austin (TX), andTrinity County (CA) highlighted transportation Access to supermarketschallenges.11, 12, 22, 69, 116 Rural residents have highervehicle ownership generally, but those who lack Eight studies analyzed access to nearby super-reliable access to personal vehicles are particularly markets or large grocery stores that sell a wideisolated given the longer distances to stores and variety of healthy foods in relation to consumptionlack of public transportation options.12, 51, 114, 116, 117 of fruits and vegetables, specific healthy foods (such as low-fat milk or high-fiber bread), or a healthy diet (measured by an index of diet quality). Almost all 16
  18. 18. PolicyLink The Food TrustAccess to Supermarkets and Consumption of Fruits and Vegetables by Race, 2002of these studies control for individual characteristics likely to have a healthy diet than thosesuch as race and income and still find a relationship with the most supermarkets near theirbetween access and healthy eating. Six of the homes, according to a study that usedstudies found associations between supermarket data from North Carolina, Baltimore, andaccess and healthy eating among adults42, 79, 91, New York City. A healthy diet was defined109, 119, 120 and one had mixed results.78 Only one using two different measures: the Alternatestudy examined access to food stores and eating Healthy Eating Index, which measuresbehaviors of adolescents (specifically, boys aged consumption of foods related to low risk of10 to 14); this study did not find a relationship chronic disease, and a measure looking atbetween supermarket access and fruit and consumption of fats and processed meats.91vegetable consumption but did find that proximityof convenience stores (where young people who • Proximity to a supermarket is associateddo not drive are more likely to shop) was associated with increased fruit consumption amongwith reduced fruit and vegetable intake.121 food stamp recipients (based on a nationally representative sample). SimilarSome of the findings include: patterns were also seen with vegetable consumption, though associations • African Americans living in a census tract were not statistically significant.119 with a supermarket are more likely to meet • In rural Mississippi, adults living in “food dietary guidelines for fruits and vegetables, desert” counties (defined as those lacking and for every additional supermarket large supermarkets) are 23 percent less in a tract, produce consumption rose likely to consume the recommended 32 percent. Among whites, each fruits and vegetables than those in additional supermarket corresponded counties that are not food deserts.109 with an 11 percent increase in produce consumption (see chart above).42 This • In Detroit’s East Side neighborhood, African study used a large sample: 10,230 American women with lower incomes are adults living in 208 urban, suburban, less likely to shop at supermarkets (which and rural census tracts in four states. are all located outside the neighborhood) and eat fruits and vegetables than • Adults with no supermarkets within a mile those with higher incomes.79 of their homes are 25 to 46 percent less 17
  19. 19. PolicyLink The Food TrustAccess to fresh produce and other 3. Access to healthy food ishealthful foods in nearby stores associated with diet-relatedSeveral recent studies go beyond using diseasesupermarkets as proxies for healthy food accessand conduct in-store surveys to more accurately In addition to making it possible—and evenmeasure the availability of healthy food items in more likely—for residents to eat healthy diets,nearby stores.13, 21, 91, 122, 123 Others use resident the availability of healthy food in communitiessurveys to measure access to nutritious and is related to a host of diet-related diseasesquality foods and eating behaviors.5, 124 Of the six including obesity and overweight, diabetes, andstudies in this category, all of them found that cardiovascular disease. Seventeen studies examinedincreased availability of produce or of specific the relationship between healthy food accesshealthy foods (such as low-fat milk as a percentage and diet-related health outcomes; approximatelyof all milk) is associated with the increased half were conducted by academics and half wereconsumption of those foods. Findings include: conducted by policy researchers. Twelve found a positive relationship,14, 24, 25, 27, 34, 45, 47, 72, 73, 125, • In New Orleans, proximity to stores 126, 128 three studies had mixed results,127, 129, 145 stocking more fresh produce is and two studies had contrary findings.78, 104 associated with higher vegetable consumption. Each additional meter of Access to supermarkets shelf space devoted to fresh vegetables is associated with an additional 0.35 Five studies found that proximity to supermarkets servings of vegetables per day.13 corresponds with a lower body mass index (BMI), or rates of obesity, diabetes, or diet-related death • For participants in a community- among adults,27, 71-73, 125 and one found the same based health promotion program in correlation among adolescents.45 Only two studies Colorado, greater shelf space allocated focused on children. One found that supermarket to fresh produce corresponded access was associated with lower BMI among with greater increases in fruit and children in lower-density counties in Indianapolis vegetable consumption.122 (but not in higher-density ones).127 The other tracked • The proportion of low-fat milk in stores kindergarteners over four years and found that, is positively and directly related to its controlling for individual characteristics, higher consumption according to a New York fruit and vegetable prices in their city or metro state study21 and a study that examined corresponded with weight gain, but the density of areas of California and Hawaii.123 restaurants, convenience stores, or grocery stores around their schools did not make a difference.145 • One study asked residents to rank their access to healthy food and then • Adults living in neighborhoods with examined their rankings in relation to supermarkets or with supermarkets and their diets. Residents living in areas ranked grocery stores have the lowest rates of by themselves or others as having the obesity (21 percent) and overweight worst food environments were 22 to (60–62 percent) and those living in 35 percent less likely to eat a healthy neighborhoods with no supermarkets diet than those living in areas ranked as and access to only convenience stores, having the best food environments.91 smaller grocery stores, or both had the highest rates (32–40 percent obesity; 73–78 percent overweight), according to a study of more than 10,000 adults.125 • The lack of supermarket access corresponds with higher rates of diet- related death in Philadelphia.27 18
  20. 20. PolicyLink The Food TrustThe Economic Impacts of Fresh Food RetailersDirect Economic Impacts: Indirect Economic Impacts: • Job opportunities • Revitalized neighborhood housing markets • Local tax revenues • Asset-building for low-income homeowners (via appreciating real estate assets) • Workforce training and development • New businesses surrounding the store • Additional spending in the local economy generated by the store and the new jobs it creates (the “multiplier effect”) • In Los Angeles, a longer distance fast food dense neighborhood (six or more traveled to reach a grocery store was fast food restaurants per square kilometer) associated with higher BMI. Those translates into a one pound decrease.126 who traveled more than 1.75 miles to a supermarket weighed 0.8 BMI units • A 2009 study of Chicago’s food deserts more (4.8 pounds for a 5’5” person).34 found that as the distance to the nearest grocer increases relative to the distance to • A national study of more than 70,000 the nearest fringe food outlet, the Years of teens also found that increased availability Potential Life Loss (YPLL) due to diseases of chain supermarkets was associated such as cancer, cardiovascular disease, with lower rates of overweight.45 diabetes, and liver disease increases. This relationship is significant in AfricanFood outlet mix American communities, but less clear for white and Hispanic communities.25Several studies14, 24, 25, 47, 126 have found thatthe mix of food stores available to residents isassociated with diet-related health outcomes: 4. New and improved healthy • Californians and New Yorkers living in food retail in underserved areas with higher densities of fresh food communities creates jobs and markets compared to convenience stores helps to revitalize low-income and fast food restaurants have lower neighborhoods rates of obesity. In California, obesity and diabetes rates were 20 percent higher for those living in the least healthy “food Beyond the benefits to individual health described environments,” controlling for individual above, fresh food markets contribute to the overall factors.14 In New York City, increasing health of neighborhoods and communities. “BMI-healthy” food stores in New York neighborhoods corresponded with Grocery stores are known by economic development lower obesity rates (though decreasing practitioners to be high-volume “anchors” that “BMI-unhealthy” stores did not).47 generate foot traffic and attract complementary stores and services like banks, pharmacies, video • In Indianapolis, BMI values correspond rentals, and restaurants.131 Yet compared to the with access to supermarkets and fast study of food access and its health impacts, the food restaurants. Researchers estimate study of economic impacts related to food retail that adding a new grocery store to a development is an area of relatively limited research. high-poverty neighborhood translates into a three pound weight decrease, and Several methods have been developed to estimate eliminating a fast food restaurant from a the demand for food retail in underserved 19
  21. 21. PolicyLink The Food TrustThe Pennsylvania Fresh Food Financing Initiative hashelped develop supermarkets and other fresh foodoutlets in 78 underserved urban and rural areas,increasing access to healthy food for nearly 500,000residents and creating or retaining 4,860 jobs.communities. Studies that use local data Studies of the Pennsylvania Fresh Food Financingsources find that these neighborhoods have the Initiative (FFFI), a statewide public-private effortpotential to support thousands of square feet that has helped develop 78 supermarkets andin additional grocery retail space.56-67, 134 One other fresh food outlets in underserved urbanstudy estimated $8.7 billion dollars in annual and rural areas, also demonstrate the positivegrocery leakage in inner-city neighborhoods.135 impacts of healthy food retailing. In addition to increasing access to healthy food for nearlySome have also investigated the impact of new 500,000 residents, the effort resulted in:supermarkets on nearby real estate values. Whennew food retailers enter areas that were previously • Job creation. The initiative created orunder-retailed, they can bring viability to urban retained 4,860 jobs throughout the state. Aneighborhoods’ commercial real estate markets, recent case study of selected supermarketsand can change perceptions that economically in the Philadelphia region found that thedistressed urban areas are undesirable places to vast majority of jobs created through theoperate businesses.133 An assessment of the impact initiative (75 percent) were filled by localof new supermarkets on neighborhood housing residents living within three miles of theirvalues in Philadelphia found that the values of workplace.138 A new store assisted byhomes located within one-quarter to one-half the initiative that is part of the regionalmile of the new supermarkets increase by four to ShopRite chain created 258 jobs and moreseven percent (an average of $1,500) after the than half were filled by local residents.139stores open, mitigating the downward trend in real When you add in the additional jobs thatestate values. In addition, the effect was larger in are created through a new store’s multiplierneighborhoods with weaker housing markets.130 effect, the total number of jobs becomes much higher: one grocery store that theRecent analyses of efforts to bring new grocery effort helped launch is estimated to havestores into underserved communities find that these created 660 jobs directly and indirectly.140businesses are viable (even thriving), offer a goodselection of nutritious and affordable foods, and • Economic development. New andcontribute greatly to local economic development. improved grocery stores can catalyzeAn examination of the first full-service supermarket commercial revitalization in a locate in New York City’s Harlem neighborhood An analysis of the economic impacts of five(thanks in part to a $2.5 million loan from the city new stores that opened with FFFI assistanceto cover construction costs), four years after its found that, for four of the stores, totalopening, found that the store allocated the same employment surrounding the supermarketamount of space to a similar variety of fresh fruits increased at a faster rate than citywideand vegetables, fish, and meat as typical suburban trends. This suggests a positive effect onsupermarkets, at similar prices.136 The store has been overall economic activity resulting from thecredited with catalyzing the revitalization of the introduction of a new supermarket.138neighborhood.137 20
  22. 22. PolicyLink The Food Trust Implications for PolicyE xisting research provides clear evidence that food deserts exist in numerous low-incomecommunities and communities of color across the Communities are using a variety of strategies to increase access to healthy foods, and their efforts provide several lessons for policymakerscountry, and that they have significant negative at the local, state, and federal level.143impacts on health, social equity, and local economicdevelopment. The balance of the research strongly Until more systemic solutions are instituted,suggests that making affordable, healthy foods transportation barriers to fresh food markets needmore available to underserved residents will lead to to be removed. Community groups and plannerstheir making healthier choices about what to eat should evaluate existing transportation routes andand, ultimately, better health, while contributing improve coordination of bus routes, bus stops, andto economic and neighborhood revitalization. schedules or add vanpools or shuttles to maximize transit access to grocery stores and farmers’ markets.While there is general agreement in the Longer-term transportation and land use planningliterature about the lack of access to healthy should promote the co-location of food retail,foods and increasing evidence about its transit access, and affordable homes. Communitiesconsequences, fewer researchers have focused and retailers can launch programs such as mobileon the question of what are the most effective markets, grocery shuttles, and grocery van-solutions. This search has largely been taken up delivery to improve access to healthy impacted communities and their advocatesand supporters. Across the country, they are: Community groups, residents, researchers, and government agencies should work together to • Attracting or developing grocery identify areas that lack access to healthy food and to stores and supermarkets; understand local economic conditions and regional food systems. Areas lacking access should be • Developing other retail outlets such prioritized, strategies for action need to identified, as farmers’ markets, public markets, and then advocates need to demand the resources, cooperatives, farmstands, community- programs, and policies to solve the access problem. supported agriculture programs, and Once underway, efforts should be monitored to mobile vendors (and ensuring public examine progress over time, and advocates should benefits can be used at these venues); seek the expansion of successful approaches. • Increasing the stock of fruits, vegetables, Cities have many policy tools they can use to and other healthy foods at neighborhood incentivize and promote healthy food retail corner stores or small groceries; including land use planning, zoning, economic • Growing food locally through backyard development and redevelopment, and nutrition and community gardens and larger- assistance. A recent analysis of retailers’ location scale urban agriculture; and decisions found that the land availability, market demand (and data demonstrating that demand), • Improving transportation to grocery construction and operations costs, and approval/ stores and farmers’ markets. zoning requirements all pose barriers to locating in underserved urban areas.141 Cities can help 21
  23. 23. PolicyLink The Food TrustWhat Type of Food Access Will Make a Difference? One question the research begins to address is whether supermarkets are the only solution to the “grocery gap” in low-income communities. The majority of studies use supermarkets (typically defined by a sales volume of more than $2 million or more than 50 employees) as a proxy for access to healthy foods. This makes sense because most Americans do the bulk of their grocery shopping at these stores (and increasingly at larger supercenters)142 and supermarkets more consistently offer a good variety and selection of affordable and nutritious foods compared to other types of food retailers.36, 44But more and more studies are using in-store surveys to examine the availability of particular healthy items or healthy “market baskets” and their consumption. These studies find the same relationship between access and diet as studies that look at supermarkets. This suggests that health could be improved through many different food access strategies.overcome these barriers by providing publicly the development, renovation, and expansionowned land for food retailers, helping with land of retail outlets offering fresh healthy foodassembly, and identifying and marketing sites for (such as grocery stores, farmers’ markets, andgrocery store development. Several cities have cooperatives) should be developed.144 The successconducted internal assessments to understand of the Pennsylvania Fresh Food Financing Initiativehow their agencies and departments can foster demonstrates that public investments can leveragehealthy food retail in underserved neighborhoods. significant private investment and dramatically improve healthy food access. Policy replicationIn New York City, the departments of health, efforts have been successful in Illinois, New York,planning, housing, economic development, and and New Orleans, and numerous replicationthe Mayor’s office all played a role in developing efforts are underway in states across the country.and implementing several innovative programs Given the national scope of the problem, thisincluding: Green Carts, to help produce vendors successful state policy should be brought tolocate in underserved neighborhoods with high a national scale so this innovative financingrates of obesity and diabetes; Healthy Bodegas, to mechanism can be available to all communities.improve healthy offerings in corner stores; HealthBucks, to promote produce purchasing at farmers’ Successful policies and programs need to bemarkets; and FRESH, to provide zoning and financial replicated and brought to a greater scale toincentives to promote grocery store development, increase healthy food access. A problem withupgrading, and expansion in underserved areas. such broad and negative impacts on health, economy, and equity warrants a focus at allAt the state and national level, fresh food levels—community, state, and national. Now isfinancing initiatives—based on Pennsylvania’s the time for bold, nationwide efforts to ensuresuccessful program (described on page 20)—that that healthy food choices are available to all.create public-private partnerships to support 22
  24. 24. PolicyLink The Food Trust MethodsB etween May and July 2009, PolicyLink and The Food Trust created a comprehensivebibliography of studies related to food access In order to be included, each study needed to meet the following criteria:and/or food access and health across the • Related directly or indirectly to identifyingUnited States. Unlike previous review studies, disparities in access to food retailerswhich typically only include published work, we or healthy food, and the relationshipsought to include “grey literature,” or studies, between food retail and health;reports, and analyses that are not published inpeer-reviewed journals. Public health agencies, • Either included original research oncommunity-based organizations, and policy these topics or reviewed other studies;groups frequently conduct primary data analyses • Conducted in the United States (while thereof retail food access to inform their activities, have been studies conducted outside ofbut generally do not take the additional steps to the United States, the persistent trend ofsubmit their studies to journals for publication. residential segregation by race/ethnicity and income in this country makes extrapolationWe used the following search methods from these studies of limited value); andto compile the bibliography: • Published during or after 1995 (although • Sent requests for information to relevant we included a few important studies that listservs, e.g., COMFOOD, the National were conducted between 1990 and 1994). Neighborhood Indicators Partnership (NNIP), American Evaluation Association One hundred and thirty-two studies were ultimately (EVALTALK), and agency email lists; included in the database, of 168 articles initially gathered through the search methods above. We • Wrote to 80 food policy councils across included studies that use random and nonrandom the country that are listed on the North sampling methods and quantitative and qualitative American Food Policy Council website techniques (such as resident interviews). We also and the Community Food Security included studies that examine single communities of Coalition Food Policy Council Database; interest (alone or in comparison to other areas). We • Contacted several foundations and excluded newsletters, policy statements, and studies leaders working in the food access field; that focused on methods and measurements. In one case we found two policy papers, one shorter • Searched PubMed and other library than the other, based on the same study and data; databases related to the fields of they were counted as one study in the database. planning, community development, and geography to identify formally published Of the studies selected for the database, 61 were work related to urban and rural food published in peer-reviewed journals, and 71 fell access and health implications; and into the grey literature category. We did not systematically review the evidence quality (e.g., • Reviewed reference lists of included studies. sample size, strength of methods used) of each 23
  25. 25. PolicyLink The Food Trust study for this review, but note that to date, the studies that examine the health impacts of access to healthy food have primarily used cross-sectional research designs (examining survey data) and there have been few longitudinal or intervention studies. We also noted some systematic differences between the content of the peer-reviewed studies compared to those conducted by practitioners. None of the practitioner studies examined the relationship between food access and eating behaviors, likely due to the difficulty of accessing data on eating behaviors for small geographies or individuals. Only one of the peer-reviewed studies examined the economic impacts of grocery stores. 24
  26. 26. PolicyLink The Food Trust ReferencesPeer-Reviewed Journal Articles of Small Food Stores in an Urban Environment.” Public Health Nutrition 11 (2008): 413-420.Alwitt, L., and Donley, T. “Retail Stores in Caldwell E., Kobayashi, M., DuBow,Poor Urban Neighborhoods.” Journal of W., and Wytinck, S. “Perceived AccessConsumer Affairs 31 (1997): 139–164. to Fruits and Vegetables AssociatedAndrews, M., Kantor, L., Lino, M., and with Increased Consumption.” PublicRipplinger, D. “Using USDA’s Thrifty Food Plan Health Nutrition (2008): Assess Food Availability and Affordability.” Cheadle A., Psaty, B., Curry, S., Wagner, E., Diehr,Food Access 24, no.2 (2001): 45-53. P., Koepsell, T., and Kristal, A. “Community-Andreyeva, T., Blumenthal, D., Schwartz, M., Level Comparisons Between Grocery StoreLong, M., and Brownell, K. “Availability and Prices Environment and Individual Dietary Practices.”of Foods Across Stores And Neighborhoods: Preventive Medicine 20, no.2 (1991): 250-61.The Case Of New Haven, Connecticut.” Health Clifton, K. “Mobility Strategies and FoodAffairs 27, no.5 (2008): 1381–1388. Shopping for Low-Income Families: A CaseAuchincloss, A., Diez-Roux, A., Brown, D., Study.” Journal of Planning EducationErdmann, C., Bertoni, A. “Neighborhood and Research 23 (2004): 402-413.Resources for Physical Activity and Healthy Foods Cotterill, R., and Franklin, A. “The Urbanand Their Association with Insulin Resistance.” Grocery Store Gap.” Food Marketing PolicyEpidemiology, 19 (2008):146–157. Center, University of Connecticut. FoodBaker, E., Schootman, M., Barnidge, E., and Marketing Policy Issue Paper 8 (1995).Kelly, C. “The Role of Race and Poverty in Access Fisher, B., and Strogatz, D. “Community Measuresto Foods that Enable Individuals to Adhere to of Low-Fat Milk Consumption: Comparing StoreDietary Guidelines.” Preventing Chronic Disease: Shelves with Households.” American JournalPublic Health Research, Practice and Policy 3, of Public Health 89, no.2 (1999): 235– 3 (2006): 1-11. Available at Franco, M., Roux, A., Glass, T., Caballero, B., and Brancati, F. “Neighborhood CharacteristicsBeaulac, J., Kristjansson, E., and Cummins, S. and Availability of Healthy Foods in“A Systematic Review of Food Deserts, 1966- Baltimore.” American Journal of Preventive2007.” Preventing Chronic Disease: Public Medicine 35, no.6 (2008): 561–567.Health Research, Practice and Policy 6, no.3 (2009): 1-10. Available at http://www.cdc. Galvez, M., Morland, K., Raines, C., etgov/pcd/issues/2009/Jul/08_0163.htm. al. “Race and Food Store Availability in an Inner-City Neighbourhood.” PublicBlock, D., and Kouba, J. “A Comparison of the Health Nutrition 11 (2007): 624–631.Availability and Affordability of a Market Basketin Two Communities in the Chicago Area.” Public Giang, T., Karpyn, A., Laurison, H., Hillier, A.,Health Nutrition 9, no.7 (2006): 837–845. Burton, M., and Perry, D. “Closing the Grocery Gap in Underserved Communities: The CreationBodor, J. N., Rose, D., Farley, T. A., Swalm, of the Pennsylvania Fresh Food FinancingC., and Scott, S.K. “Neighbourhood Fruit and Initiative.” Journal of Public Health ManagementVegetable Availability and Consumption: The Role and Practice 14, no.3 (2008): 272-279. 25
  27. 27. PolicyLink The Food TrustGittelsohn, J., Franceschini, M., Rasooly, I., Ries, A., 19–26. Available at, L., Pavlovich, W., Santos, V., Jennings, S., and publications/rdp/rdp1098/rdp1098c.pdf.Frick, K. “Understanding the Food Environment Laraia, B., Siega-Riz, A., Kaufman, J. and Jones, a Low-Income Urban Setting: Implications for “Proximity of Supermarkets Is Positively AssociatedFood Store Interventions.” Journal of Hunger & with Diet Quality Index for Pregnancy.” AmericanEnvironmental Nutrition 2, no.2 (2008): 33-50. Journal of Preventive Medicine 39 (2004): 869–875.Glanz, K., Sallis, J., Saelens, B., and Frank, Larson, N., Story, M., and Nelson, M.L. “Nutrition Environment Measures Survey “Neighborhood Environments Disparities in Accessin Stores (NEMS-S) Development and to Healthy Foods in the U.S.” American Journal ofEvaluation.” American Journal of Preventive Preventative Medicine 36, no.1 (2009): 74-81.Medicine 32, no.4 (2007): 282-289. Lavin, M. “Supermarket Access and ConsumerHelling, A., and Sawicki, D. “Race and Residential Well-Being: The Case of Pathmark in Harlem.”Accessibility to Shopping and Services.” Housing International Journal of Retail and DistributionPolicy Debate 14, no.1 (2003): 69-101. Management 33, no.5 (2005): 388-398.Horowitz, C., Colson, K., Hebert, P., and Liese, A., Weis, K., Pluto, D., Smith, E., and Lawson,Lancaster K. “Barriers to Buying Healthy A. “Food Store Types, Availability, and Cost of FoodsFoods for People with Diabetes: Evidence of in a Rural Environment.” Journal of the AmericanEnvironmental Disparities.” American Journal Dietetic Association 107 (2007): 1916–1923.of Public Health 94 (2004): 1549–1554. Liu, G., Wilson, J., Qi, R., and Ying, J. “GreenHosler, A., Rajulu, D., Fredrick, B., and Ronsani, Neighborhoods, Food Retail and ChildhoodA. “Assessing Retail Fruit and Vegetable Overweight: Differences by PopulationAvailability in Urban and Rural Underserved Density.” American Journal of HealthCommunities.” Preventing Chronic Disease Promotion 21, no.4 (2007): 317-325.5, no.4 (2008): 1-9. Available at Moore, L., and Roux, A. “Associations of Neighborhood Characteristics with the LocationHosler, A., Varadarajulu, D., Ronsani, A., Fredrick, and Type of Food Stores.” American JournalB., and Fisher, B. “Low-Fat Milk and High-Fiber of Public Health 96 (2006): 325–331.Bread Availability in Food Stores in Urban andRural Communities.” Journal of Public Health Moore, L., Roux, A., and Brines, S. “ComparingManagement Practice 12 (2006): 556–562. Perception-Based and Geographic Information System (GIS)-Based Characterizations ofInagami, S., Cohen, D., Finch K. B., and Asch, S. the Local Food Environment.” Journal of“You are Where You Shop: Grocery Store Locations, Urban Health: Bulletin of the New YorkWeight, and Neighborhoods.” American Journal Academy of Medicine 85, no.2 (2008).of Preventive Medicine 31, no.1 (2006): 10-17. Moore, L., Roux, A., Nettleton, J., andJago, R., Baranowski, T., Baranowski, J., Jacobs, D. “Associations of the Local FoodCullen, K., and Thompson, D. “Distance to Environment with Diet Quality—A Comparison ofFood Stores and Adolescent Male Fruit and Assessments Based on Surveys and GeographicVegetable Consumption: Mediation Effects.” Information Systems: The Multi-Ethnic StudyInternational Journal of Behavioral Nutrition of Atherosclerosis.” American Journal ofand Physical Activity 4 (2007): 4-35. Available Epidemiology 167 (2008): 917– Morland, K., and Filomena, S. “Disparities in theJetter, K., and Cassady, D. “The Availability and Availability of Fruits and Vegetables BetweenCost of Healthier Food Alternatives.” American Racially Segregated Urban Neighbourhoods.” PublicJournal of Preventive Medicine 30 (2006): 38–44. Health Nutrition 10, no.12 (2007): 1481-1489.Kaufman, P. “Rural Poor Have Less Access Morland, K., Roux, A., and Wing, S. “Supermarkets,to Supermarkets, Large Grocery Stores.” Other Food Stores, and Obesity: The AtherosclerosisRural Development Perspectives 13 (1998): 26
  28. 28. PolicyLink The Food TrustRisk in Communities Study.” American Journal of Sekhobo, J., and Berney, B. “The Relation ofPreventive Medicine 30, no.4 (2006): 333-339. Community Occupational Structure and PrevalenceMorland, K., and Evenson, K. “Obesity of Obesity in New York City Neighborhoods—Prevalence and the Local Food Environment.” An Ecological Analysis.” Journal of Hunger &Health & Place 15, no.2 (2009): 491-495. Environmental Nutrition 3, no.1 (2008): 76-83.Morland, K., Wing, S., Roux, A., and Poole, Sharkey J., and Horel, S. “NeighborhoodC. “Neighborhood Characteristics Associated Socioeconomic Deprivation and Minoritywith the Location of Food Stores and Composition are Associated with BetterFood Service Places.” American Journal of Potential Spatial Access to the Ground-TruthedPreventive Medicine 22 (2002): 23–29. Food Environment in a Large Rural Area.” The Journal of Nutrition 138 (2008): 620–627.Morland, K., Wing, S., and Roux, A. “TheContextual Effect of the Local Food Environment Sharkey, J., Scott, H., Daikwon, H., and Huber,on Residents’ Diets: The Atherosclerosis Risk J. “Association Between Neighborhoodin Communities Study.” American Journal of Need and Spatial Access to Food Stores andPublic Health 92, no.11 (2002): 1761-67. Fast Food Restaurants in Neighborhoods of Colonias.” International Journal of HealthMorton, L., and Blanchard, T. “Starved for Geographics 8, no.9 (2009): 1-17.Access: Life in Rural America’s Food Deserts.”Rural Realities 1, no.4 (2007). Available at www. Short, A., Guthman, J., and Raskin, S. “ Deserts, Oases, or Mirages? Small Markets and Community Food Security in the SanNayga, M., and Weinberg, Z. “Supermarket Francisco Bay Area.” Journal of PlanningAccess in the Inner Cities.” Journal of Retailing Education and Research 26 (2007): 352.and Consumer Services 6, no.3 (1999): 141-145. Sloane, D., Diamount, A., Lewis, L, et al.Powell, L., Auld, C., Chaloupka, F., O’Malley, “Improving the Nutritional Resource EnvironmentP. M., and Johnston, L. D. “Associations for Healthy Living Through Community-BasedBetween Access to Food Stores and Adolescent Participatory Research.” The Journal of GeneralBody Mass Index,” American Journal of Internal Medicine 18 (2003): 568–575.Preventive Medicine 33, no.4 (2007). Small, M. L., and McDermott, M. “ThePowell, L., Slater, S., Mirtcheva, D., Bao, Y., Presence of Organizational Resources inand Chaloupka, F. “Food Store Availability Poor Urban Neighborhoods: An Analysisand Neighborhood Characteristics in of Average and Contextual effects.”the United States.” American Journal of Social Forces 84 (2006): 1697-1724.Preventive Medicine 44 (2007): 189–195. Sturm, R. “Disparities in the FoodRaja, S., Ma, C., and Yadav, P. “Beyond Environment Surrounding U.S. MiddleFood Deserts: Measuring and Mapping and High Schools.” American Journal ofRacial Disparities in Neighborhood Food Public Health 122 (2008): 681–690.Environments.” Journal of Planning Educationand Research 27 (2008): 469-482. Sturm, R., and Datar, A. “Body Mass Index in Elementary School Children, Metropolitan AreaRose, D., and Richards, R. “Food Store Access Food Prices and Food Outlet Density.” Journaland Household Fruit and Vegetable Use among of Public Health 119 (2005): 1059–1068.Participants in the US Food Stamp Program.” PublicHealth Nutrition 7, no. 8 (2004): 1081-1088. Wang, M., Kim, S., Gonzalez, A., MacLeod, K., and Winkleby, M. “Socioeconomic andRundle, A., Neckerman, K., Freeman, L., Food-Related Physical Characteristics of theLovasi, G., Purciel, M., Quinn, J., Richards, Neighborhood Environment are Associated withC., Sircar, N., and Weiss, C. “Neighborhood Body Mass Index.” Journal of EpidemiologyFood Environment and Walkability Predict and Community Health 61 (2007): 491–498.Obesity in New York City.” EnvironmentalHealth Perspectives 117 (2009): 442–447. Zenk, S., and Powell, L. “U.S. Secondary Schools and Food Outlets.” Health & Place, 14 (2008): 336–346. 27