Review and special article
Neighborhood Environments: Disparities in Access to Healthy Foods in the U.S.

https://doi.org/10.1016/j.amepre.2008.09.025Get rights and content

Background

Poor dietary patterns and obesity, established risk factors for chronic disease, have been linked to neighborhood deprivation, neighborhood minority composition, and low area population density. Neighborhood differences in access to food may have an important influence on these relationships and health disparities in the U.S. This article reviews research relating to the presence, nature, and implications of neighborhood differences in access to food.

Methods

A snowball strategy was used to identify relevant research studies (n=54) completed in the U.S. and published between 1985 and April 2008.

Results

Research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower levels of obesity. Results from studies examining the accessibility of restaurants are less consistent, but there is some evidence to suggest that residents with limited access to fast-food restaurants have healthier diets and lower levels of obesity. National and local studies across the U.S. suggest that residents of low-income, minority, and rural neighborhoods are most often affected by poor access to supermarkets and healthful food. In contrast, the availability of fast-food restaurants and energy-dense foods has been found to be greater in lower-income and minority neighborhoods.

Conclusions

Neighborhood disparities in access to food are of great concern because of their potential to influence dietary intake and obesity. Additional research is needed to address various limitations of current studies, identify effective policy actions, and evaluate intervention strategies designed to promote more equitable access to healthy foods.

Introduction

A growing body of evidence indicates that residential segregation by income, race, and ethnicity contributes to health disparities in the U.S. 1, 2, 3, 4, 5, 6, 7 In addition, substantial research shows disparities in health between urban and rural areas. 8 Poor dietary patterns and obesity, established risk factors for chronic disease, have been linked to neighborhood deprivation, neighborhood minority composition, and low area population density (as found in more rural areas). 9, 10, 11, 12, 13, 14, 15 Neighborhood differences in access to foods may be an important influence on these relationships. Establishing the presence, nature, and implications of neighborhood differences in the physical availability of more- and less-healthy foods is necessary to properly inform the development of responsive public health policies and interventions that may help reduce inequalities in health.

Recent reviews have drawn attention to relationships among neighborhood food availability, dietary intake, and obesity, but to our knowledge, a detailed review of disparities in food access has not been completed. 16, 17 For this review, neighborhood is broadly defined to be “the area around one's place of residence,” and research relating to both micro- (e.g., stores within walking distance from home) and macro-level characteristics (e.g., restaurants within county boundaries) of the physical food environment are considered. This article briefly reviews the current evidence base regarding (1) the relationship between neighborhood access to more- and less-healthy foods and dietary intake and (2) the relationship between neighborhood access to foods and weight status. In addition, this article presents a comprehensive review of disparities across the U.S. according to income, race, ethnicity, and urbanization in neighborhood access to more- and less-healthy foods. Studies relating to both food stores and restaurants are summarized separately and discussed in terms of their limitations and implications for future research and practice.

Section snippets

Methods

A snowball strategy was used to identify relevant research studies completed in the U.S. and published between 1985 and April 2008. Searches were completed in PubMed and MEDLINE using the following key words: neighborhood; environment; food store; supermarket; restaurant; dietary intake; obesity; overweight; disparity; inequality; deprivation; income; poverty; rural; race; and ethnicity. The references cited in articles (n=43) indexed in these search engines were also checked; and all

Retail Food Stores and Dietary Intake

Supermarkets, as compared to other food stores, tend to offer the greatest variety of high-quality products at the lowest cost. 18, 19, 20, 21, 22, 23 In contrast, convenience stores sell mostly prepared, high-calorie foods and little fresh produce, at higher prices. 24 Studies of adults 18, 25, 26, 27, 28, 29 and adolescents 30 have examined associations between neighborhood access to food stores and intake of fruits and vegetables, calories from dietary fat, and overall diet quality. The

Discussion

The aim of this review is to describe and evaluate research relating to neighborhood differences in the physical availability of food stores, restaurants, and healthy foods. Associations of neighborhood food access with dietary intake and obesity were found to vary according to the type of food store or restaurant. In general, research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower

References (110)

  • S. Zenk et al.

    Fruit and vegetable intake in African Americans: income and store characteristics

    Am J Prev Med

    (2005)
  • J. Edmonds et al.

    Ecological and socioeconomic correlates of fruit, juice, and vegetable consumption among African-American boys

    Prev Med

    (2001)
  • K. Morland et al.

    Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study

    Am J Prev Med

    (2006)
  • S. Inagami et al.

    You are where you shopGrocery store locations, weight, and neighborhoods

    Am J Prev Med

    (2006)
  • L. Powell et al.

    Associations between access to food stores and adolescent body mass index

    Am J Prev Med

    (2007)
  • R. Sturm et al.

    Body mass index in elementary school children, metropolitan area food prices and food outlet density

    Public Health

    (2005)
  • L. Powell et al.

    Food store availability and neighborhood characteristics in the United States

    Prev Med

    (2007)
  • A. Liese et al.

    Food store types, availability, and cost of foods in a rural environment

    J Am Diet Assoc

    (2007)
  • J. Sharkey et al.

    Neighborhood socioeconomic deprivation and minority composition are associated with better potential spatial access to the ground-truthed food environment in a large rural area

    J Nutr

    (2008)
  • K. Jetter et al.

    The availability and cost of healthier food alternatives

    Am J Prev Med

    (2006)
  • K. Morland et al.

    Neighborhood characteristics associated with the location of food stores and food service places

    Am J Prev Med

    (2002)
  • S. Zenk et al.

    secondary schools and food outlets

    Health Place

    (2008)
  • R. Sturm

    Disparities in the food environment surrounding U.S. middle and high schools

    Public Health

    (2008)
  • M. Wootan et al.

    Availability of nutrition information from chain restaurants in the United States

    Am J Prev Med

    (2006)
  • S. Paeratakul et al.

    Fast-food consumption among U.S. adults and children: dietary and nutrient intake profile

    J Am Diet Assoc

    (2003)
  • C. Befort et al.

    Fruit, vegetable, and fat intake among non-Hispanic black and non-Hispanic white adolescents: associations with home availability and food consumption settings

    J Am Diet Assoc

    (2006)
  • J. Wiecha et al.

    School vending machine use and fast-food restaurant use are associated with sweetened beverage intake in youth

    J Am Diet Assoc

    (2006)
  • N. Mehta et al.

    Weight status and restaurant availability: a multilevel analysis

    Am J Prev Med

    (2008)
  • H. Niemeier et al.

    Fast food consumption and breakfast skipping: predictors of weight gain from adolescence to adulthood in a nationally representative sample

    J Adolesc Health

    (2006)
  • M. Pereira et al.

    Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis

    Lancet

    (2005)
  • K. Duffey et al.

    Differential associations of fast food and restaurant food consumption with 3-y change in body mass index: the coronary artery risk development in young adults study

    Am J Clin Nutr

    (2007)
  • S.Y. Chou et al.

    An economic analysis of adult obesity: results from the behavioral risk factor surveillance system

    J Health Econ

    (2004)
  • H.L. Burdette et al.

    Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children

    Prev Med

    (2004)
  • J.P. Block et al.

    Fast food, race/ethnicity, and income: a geographic analysis

    Am J Prev Med

    (2004)
  • L. Powell et al.

    The availability of fast-food and full-service restaurants in the United Statesassociations with neighborhood characteristics

    Am J Prev Med

    (2007)
  • P. Simon et al.

    Proximity of fast food restaurants to schools: do neighborhood income and type of school matter?

    Prev Med

    (2008)
  • M. Kipke et al.

    Food and park environments: neighborhood-level risks for childhood obesity in East Los Angeles

    J Adolesc Health

    (2007)
  • J. Boone et al.

    Validation of a GIS facilities database: quantification and implications of error

    Ann Epidemiol

    (2008)
  • M. Schootman et al.

    Positional accuracy and geographic bias of four methods of geocoding in epidemiologic research

    Ann Epidemiol

    (2007)
  • L. Weiss et al.

    Defining neighborhood boundaries for urban health research

    Am J Prev Med

    (2007)
  • B. Saelens et al.

    Nutrition environment measures study in restaurants (NEMS-R): development and evaluation

    Am J Prev Med

    (2007)
  • A. Diez Roux et al.

    Neighborhood of residence and incidence of coronary heart disease

    N Engl J Med

    (2001)
  • T. LaVeist

    Racial segregation and longevity among African Americans: an individual-level analysis

    Health Serv Res

    (2003)
  • S. Jackson et al.

    The relation of residential segregation to all-cause mortality: a study in black and white

    Am J Public Health

    (2000)
  • P. Lobmayer et al.

    Inequality, residential segregation by income, and mortality in U.S. cities

    J Epidemiol Community Health

    (2002)
  • K. Hart et al.

    Metropolitan governance, residential segregation, and mortality among African Americans

    Am J Public Health

    (1998)
  • L. Gamm et al.

    Rural Healthy People 2010: a companion document to Healthy People 2010. Volume 2

    (2003)
  • A. Rundle et al.

    The urban built environment and obesity in New York City: a multilevel analysis

    Am J Health Promot

    (2007)
  • A. Diez Roux et al.

    Neighborhood differences in diet: the atherosclerosis risk in communities (ARIC) study

    J Epidemiol Community Health

    (1999)
  • R. Lopez

    Neighborhood risk factors for obesity

    Obesity

    (2007)
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