BMJ Open 2:e000698 doi:10.1136/bmjopen-2011-000698
  • Epidemiology
    • Research

Are neighbourhood food resources distributed inequitably by income and race in the USA? Epidemiological findings across the urban spectrum

  1. Penny Gordon-Larsen1
  1. 1Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, USA
  1. Correspondence to Dr Penny Gordon-Larsen; pglarsen{at}
  • Received 20 December 2011
  • Accepted 12 March 2012
  • Published 13 April 2012


Objective Many recent policies focus on socioeconomic inequities in availability of healthy food stores and restaurants. Yet understanding of how socioeconomic inequities vary across neighbourhood racial composition and across the range from rural to urban settings is limited, largely due to lack of large, geographically and socio-demographically diverse study populations. Using a national sample, the authors examined differences in neighbourhood food resource availability according to neighbourhood-level poverty and racial/ethnic population in non-urban, low-density urban and high-density urban areas.

Design Cross-sectional data from an observational cohort study representative of the US middle and high school-aged population in 1994 followed into young adulthood.

Participants Using neighbourhood characteristics of participants in the National Longitudinal Study of Adolescent Health (Wave III, 2001–2002; n=13 995 young adults aged 18–28 years representing 7588 US block groups), the authors examined associations between neighbourhood poverty and race/ethnicity with neighbourhood food resource availability in urbanicity-stratified multivariable linear regression.

Primary and secondary outcome measures Neighbourhood availability of grocery/supermarkets, convenience stores and fast-food restaurants (measured as number of outlets per 100 km roadway).

Results Neighbourhood race and income disparities were most pronounced in low-density urban areas, where high-poverty/high-minority areas had lower availability of grocery/supermarkets (β coefficient (β)=–1.91, 95% CI –2.73 to –1.09) and convenience stores (β=–2.38, 95% CI –3.62 to –1.14) and greater availability of fast-food restaurants (β=4.87, 95% CI 2.26 to 7.48) than low-poverty/low-minority areas. However, in high-density urban areas, high-poverty/low-minority neighbourhoods had comparatively greater availability of grocery/supermarkets (β=8.05, 95% CI 2.52 to 13.57), convenience stores (β=2.89, 95% CI 0.64 to 5.14) and fast-food restaurants (β=4.03, 95% CI 1.97 to 6.09), relative to low-poverty/low-minority areas.

Conclusions In addition to targeting disproportionate fast-food availability in disadvantaged dense urban areas, our findings suggest that policies should also target disparities in grocery/supermarket and fast-food restaurant availability in low-density areas.


  • To cite: Richardson AS, Boone-Heinonen J, Popkin BM, et al. Are neighbourhood food resources distributed inequitably by income and race in the USA? Epidemiological findings across the urban spectrum. BMJ Open 2012;2:e000698. doi:10.1136/bmjopen-2011-000698

  • Contributors The authors have each made (1) substantial contributions to conception and design, acquisition of data or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content and (3) final approval of the version to be published.

  • Funding This work was funded by National Institutes of Health grant R01HD057194, R01HL104580, R01HD041375, R01HD39183 and R01HLI04580, a cooperative agreement with the Centers for Disease Control and Prevention (CDC SIP No. 5-00). The authors are also grateful to R24 HD050924 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) for broad support of the authors, although no funding was provided by this grant. Analysis and manuscript preparation was supported by the Interdisciplinary Obesity Training postdoctoral fellowship (T32MH075854-04).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Institutional Review Board at the University of North Carolina.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This research uses data from Add Health, a programme project designed by J Richard Udry, Peter S Bearman and Kathleen Mullan Harris and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgement is due Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, CPC, 123 W. Franklin Street, Chapel Hill, NC 27516-2524 (addhealth{at} No direct support was received from grant P01-HD31921 for this analysis.

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