Journal of Urban Health

, Volume 87, Issue 3, pp 394–409

Storing Empty Calories and Chronic Disease Risk: Snack-Food Products, Nutritive Content, and Manufacturers in Philadelphia Corner Stores

Article

Abstract

Corner stores are part of the urban food environment that may contribute to obesity and diet-related diseases, particularly for low-income and minority children. The snack foods available in corner stores may be a particularly important aspect of an urban child’s food environment. Unfortunately, there is little data on exactly what snack foods corner stores stock, or where these foods come from. We evaluated snack foods in 17 Philadelphia corner stores, located in three ethnically distinct, low-income school neighborhoods. We recorded the manufacturer, calories, fat, sugar, and sodium for all snack items, excluding candy and prepared foods. We then compared the nutritive content of assessed snack items to established dietary recommendations and a school nutrition standard. In total, stores stocked 452 kinds of snacks, with only 15% of items common between all three neighborhoods. Total and unique snacks and snack food manufacturers varied by neighborhood, but distributions in snack type varied negligibly: overall, there were no fruit snacks, no vegetable snacks, and only 3.6% of all snacks (by liberal definition) were whole grain. The remainder (96.4% of snacks) was highly processed foods. Five of 65 manufacturers supplied 73.4% of all kinds of snack foods. Depending on serving size definition, 80.0-91.5% of snack foods were “unhealthy” (by the school nutrition standard), including seven of 11 wholegrain products. A single snack item could supply 6-14% of a day’s recommended calories, fat, sugar, and sodium on average (or 56-169% at the extreme) for a “typical” child. We conclude that corner store snack food inventories are almost entirely unhealthful, and we discuss possible implications and next steps for research and intervention.

Keywords

Corner stores Food environment/built environment Urban Minority Low income Nutrition Calories Fat Sugar Sodium Snacks Food manufacturers Dietary risk Dietary guidelines 

References

  1. 1.
    Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-1245.CrossRefPubMedGoogle Scholar
  2. 2.
    Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: actual causes of death in the United States, 2000. JAMA. 2005;293(3):293-294.CrossRefPubMedGoogle Scholar
  3. 3.
    Michaud CM, Murray CJ, Bloom BR. Burden of disease—implications for future research. JAMA. 2001;285(5):535-539.CrossRefPubMedGoogle Scholar
  4. 4.
    Gracey M. Child health implications of worldwide urbanization. Rev Environ Health. 2003;18(1):51-63.PubMedGoogle Scholar
  5. 5.
    Miller DK, Carter ME, Sigmund RH, et al. Nutritional risk in inner city-dwelling older black Americans. J Am Geriatr Soc. 1996;44(8):959-962.PubMedGoogle Scholar
  6. 6.
    Candib LM. Obesity and diabetes in vulnerable populations: reflection on proximal and distal causes. Ann Fam Med. 2007;5(6):547-556.CrossRefPubMedGoogle Scholar
  7. 7.
    Sharma S, Malarcher AM, Giles WH, Myers G. Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors. Ethn Dis Winter. 2004;14(1):43-48.Google Scholar
  8. 8.
    Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004;291(23):2847-2850.CrossRefPubMedGoogle Scholar
  9. 9.
    Bolen JC, Rhodes L, Powell-Griner EE, Bland SD, Holtzman D. State-specific prevalence of selected health behaviors, by race and ethnicity—behavioral risk factor surveillance system, 1997. MMWR CDC Surveill Summ. 2000;49(2):1-60.Google Scholar
  10. 10.
    Recent trends in mortality rates for four major cancers, by sex and race/ethnicity--United States, 1990-1998. MMWR Morb Mortal Wkly Rep. Jan 25 2002;51(3):49-53Google Scholar
  11. 11.
    Disparities in premature deaths from heart disease--50 States and the District of Columbia, 2001. MMWR Morb Mortal Wkly Rep. Feb 20 2004;53(6):121-125Google Scholar
  12. 12.
    Racial/ethnic disparities in prevalence, treatment, and control of hypertension--United States, 1999-2002. MMWR Morb Mortal Wkly Rep. Jan 14 2005;54(1):7-9Google Scholar
  13. 13.
    Age-specific excess deaths associated with stroke among racial/ethnic minority populations--United States, 1997. MMWR Morb Mortal Wkly Rep. Feb 11 2000;49(5):94-97Google Scholar
  14. 14.
    Kumanyika S. Nutrition and chronic disease prevention: priorities for US minority groups. Nutr Rev. 2006;64(2 Pt 2):S9-S14.CrossRefPubMedGoogle Scholar
  15. 15.
    Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US children and adolescents, 2003-2006. JAMA. 2008;299(20):2401-2405.CrossRefPubMedGoogle Scholar
  16. 16.
    Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr. 2007;150(1):12-17. e12.CrossRefPubMedGoogle Scholar
  17. 17.
    Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA. 2002;288(14):1728-1732.CrossRefPubMedGoogle Scholar
  18. 18.
    Fagot-Campagna A. Emergence of type 2 diabetes mellitus in children: epidemiological evidence. J Pediatr Endocrinol Metab. 2000;13(Suppl 6):1395-1402.PubMedGoogle Scholar
  19. 19.
    Freedman DS, Bowman BA, Otvos JD, Srinivasan SR, Berenson GS. Levels and correlates of LDL and VLDL particle sizes among children: the Bogalusa heart study. Atherosclerosis. 2000;152(2):441-449.CrossRefPubMedGoogle Scholar
  20. 20.
    Phares V, Curley J, Rojas A. Development of eating patterns. In: Jelalian E, ed. Handbook of child and adolescent obesity. New York: Springer; 2008.Google Scholar
  21. 21.
    Birch LL, Fisher JO. Development of eating behaviors among children and adolescents. Pediatrics. 1998;101(3 Pt 2):539-549.PubMedGoogle Scholar
  22. 22.
    Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337(13):869-873.CrossRefPubMedGoogle Scholar
  23. 23.
    Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics. 2001;108(3):712-718.CrossRefPubMedGoogle Scholar
  24. 24.
    Blundell JE, MacDiarmid JI. Fat as a risk factor for overconsumption: satiation, satiety, and patterns of eating. J Am Diet Assoc. 1997;97(7 Suppl):S63-S69.CrossRefPubMedGoogle Scholar
  25. 25.
    Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292(8):927-934.CrossRefPubMedGoogle Scholar
  26. 26.
    Hooper L, Summerbell CD, Higgins JP, et al. Dietary fat intake and prevention of cardiovascular disease: systematic review. BMJ. 2001;322(7289):757-763.CrossRefPubMedGoogle Scholar
  27. 27.
    Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344(1):3-10.CrossRefPubMedGoogle Scholar
  28. 28.
    Howard BV, Wylie-Rosett J. Sugar and cardiovascular disease: a statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 2002;106(4):523-527.CrossRefPubMedGoogle Scholar
  29. 29.
    Boyd NF, Stone J, Vogt KN, Connelly BS, Martin LJ, Minkin S. Dietary fat and breast cancer risk revisited: a meta-analysis of the published literature. Br J Cancer. 2003;89(9):1672-1685.CrossRefPubMedGoogle Scholar
  30. 30.
    Koh-Banerjee P, Rimm EB. Whole grain consumption and weight gain: a review of the epidemiological evidence, potential mechanisms and opportunities for future research. Proc Nutr Soc. 2003;62(1):25-29.PubMedGoogle Scholar
  31. 31.
    Bazzano LA, Serdula MK, Liu S. Dietary intake of fruits and vegetables and risk of cardiovascular disease. Curr Atheroscler Rep. 2003;5(6):492-499.CrossRefPubMedGoogle Scholar
  32. 32.
    Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009;151(5):306-314.PubMedGoogle Scholar
  33. 33.
    Appleby PN, Thorogood M, Mann JI, Key TJ. The Oxford vegetarian study: an overview. Am J Clin Nutr. 1999;70(3 Suppl):525S-531S.PubMedGoogle Scholar
  34. 34.
    Jacobs DR Jr, Meyer KA, Kushi LH, Folsom AR. Is whole grain intake associated with reduced total and cause-specific death rates in older women? The Iowa Women's Health Study. Am J Public Health. 1999;89(3):322-329.CrossRefPubMedGoogle Scholar
  35. 35.
    Vainio H, Weiderpass E. Fruit and vegetables in cancer prevention. Nutr Cancer. 2006;54(1):111-142.CrossRefPubMedGoogle Scholar
  36. 36.
    National Institutes of Health (NIH)/Food and Drug Administration (FDA). Healthy People 2010—Nutrition and Overweight: Food and Nutrient Composition. Acessed on: October 10, 2007. Available at: http://www.healthypeople.gov/Document/HTML/Volume2/19Nutrition.htm#_Toc490383124
  37. 37.
    U.S. Department of Health and Human Services (DHHS)/National Institutes of Health (NIH)/National Heart Lung and Blood Institute (NHLBI). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Bethesda, MD: National Heart, Lung, and Blood Institute (NHLBI); 2003.Google Scholar
  38. 38.
    American Diabetes Association (ADA). Food Guidelines. Accessed on: October 10, 2007. Available at: http://www.diabetes.org/for-parents-and-kids/diabetes-care/food-guidelines.jsp.
  39. 39.
    American Institute for Cancer Research (AICR). Diet and health guidelines for cancer prevention. Accessed on: October 10, 2007. Available at: http://www.aicr.org/site/PageServer?pagename = home_guides&printer_friendly=1.
  40. 40.
    American Cancer Society (ACS). ACS Recommendations for nutrition and physical activity for cancer prevention 2006. Accessed on: October 10, 2007. Available at: http://www.cancer.org/docroot/PED/content/PED_3_2X_Recommendations.asp?sitearea = PED.
  41. 41.
    American Heart Association (AHA). Dietary Guidelines. Accessed on: October 10, 2007. Available at: http://www.americanheart.org/presenter.jhtml?identifier = 851.
  42. 42.
    US Department of Health and HUman Services (DHHS)/US Department of Agriculture (USDA). Dietary guidelines for Americans—key recommendations for the general population, 2005. Accessed on: October 10, 2007. Available at: http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm.
  43. 43.
    Egger G, Swinburn B. An "ecological" approach to the obesity pandemic. BMJ. 1997;315(7106):477-480.PubMedGoogle Scholar
  44. 44.
    Glanz K, Sallis JF, Saelens BE, Frank LD. Healthy nutrition environments: concepts and measures. Am J Health Promot. 2005;19(5):330-333. ii.PubMedGoogle Scholar
  45. 45.
    Booth SL, Sallis JF, Ritenbaugh C, et al. Environmental and societal factors affect food choice and physical activity: rationale, influences, and leverage points. Nutr Rev. 2001;59(3 Pt 2):S21-S39. discussion S57-S65.PubMedGoogle Scholar
  46. 46.
    Wetter AC, Goldberg JP, King AC, et al. How and why do individuals make food and physical activity choices? Nutr Rev. 2001;59(3 Pt 2):S11-S20. discussion S57-S65.PubMedGoogle Scholar
  47. 47.
    Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253-272.CrossRefPubMedGoogle Scholar
  48. 48.
    French SA, Story M, Jeffery RW. Environmental influences on eating and physical activity. Annu Rev Public Health. 2001;22:309-335.CrossRefPubMedGoogle Scholar
  49. 49.
    Jeffery RW, Utter J. The changing environment and population obesity in the United States. Obes Res. 2003;11 Suppl:12S–22SGoogle Scholar
  50. 50.
    Raja S, Ma C, Yadav P. Beyond food deserts: measuring and mapping racial disparities in neighborhood food environments. J Plann Educ Res. 2008;27:469-482.CrossRefGoogle Scholar
  51. 51.
    Pothunkuchi K. Attracting supermarkets to the inner city: economic development outside the box. Econ Dev Q. 2005;19(32):232-244.CrossRefGoogle Scholar
  52. 52.
    Morland K, Wing S, Diez Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. Jan 2002;22(1):23-29.CrossRefPubMedGoogle Scholar
  53. 53.
    Gittelsohn J, Kumar MB. Preventing childhood obesity and diabetes: is it time to move out of the school? Pediatr Diabetes. 2007;8(Suppl 9):55-69.CrossRefPubMedGoogle Scholar
  54. 54.
    Sturm R. Disparities in the food environment surrounding US middle and high schools. Public Health. 2008;122(7):681-690.CrossRefPubMedGoogle Scholar
  55. 55.
    Borradaile KE, Sherman S, Vander Veur SS, et al. Snacking in children: The role of urban corner stores. Pediatrics. 2009;124(5):1292-1297.CrossRefGoogle Scholar
  56. 56.
    Graham R, Kaufman L, Novoa Z, Karpati A. Eating in, eating out, eating well: acess to healthy food in North and Central Brooklyn. New York, NY: New York City Department of Health and Mental Hygiene; 2006.Google Scholar
  57. 57.
    Glanz K, Sallis JF, Saelens BE, Frank LD. Nutrition environment measures survey in stores (NEMS-S): development and evaluation. Am J Prev Med. 2007;32(4):282-289.CrossRefPubMedGoogle Scholar
  58. 58.
    Bovell-Benjamin AC, Hathorn CS, Ibrahim S, Gichuhi PN, Bromfield EM. Healthy food choices and physical activity opportunities in two contrasting Alabama cities. Health Place. 2009;15(2):429-438.CrossRefPubMedGoogle Scholar
  59. 59.
    Jetter KM, Cassady DL. The availability and cost of healthier food alternatives. Am J Prev Med. 2006;30(1):38-44.CrossRefPubMedGoogle Scholar
  60. 60.
    Horowitz CR, Colson KA, Hebert PL, Lancaster K. Barriers to buying healthy foods for people with diabetes: evidence of environmental disparities. Am J Public Health. 2004;94(9):1549-1554.CrossRefPubMedGoogle Scholar
  61. 61.
    Algert SJ, Agrawal A, Lewis DS. Disparities in access to fresh produce in low-income neighborhoods in Los Angeles. Am J Prev Med. 2006;30(5):365-370.CrossRefPubMedGoogle Scholar
  62. 62.
    Zenk SN, Lachance LL, Schulz AJ, Mentz G, Kannan S, Ridella W. Neighborhood retail food environment and fruit and vegetable intake in a multiethnic urban population. Am J Health Promot. 2009;23(4):255-264.PubMedCrossRefGoogle Scholar
  63. 63.
    Fisher BD, Strogatz DS. Community measures of low-fat milk consumption: comparing store shelves with households. Am J Public Health. 1999;89(2):235-237.CrossRefPubMedGoogle Scholar
  64. 64.
    Kipke MD, Iverson E, Moore D, et al. Food and park environments: neighborhood-level risks for childhood obesity in east Los Angeles. J Adolesc Health. 2007;40(4):325-333.CrossRefPubMedGoogle Scholar
  65. 65.
    Wechsler H, Basch CE, Zybert P, Lantigua R, Shea S. The availability of low-fat milk in an inner-city Latino community: implications for nutrition education. Am J Public Health. 1995;85(12):1690-1692.CrossRefPubMedGoogle Scholar
  66. 66.
    Zenk SN, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML. Fruit and vegetable access differs by community racial composition and socioeconomic position in Detroit, Michigan. Ethn Dis. 2006;16(1):275-280.PubMedGoogle Scholar
  67. 67.
    Friel S, Walsh O, McCarthy D. The irony of a rich country: issues of financial access to and availability of healthy food in the Republic of Ireland. J Epidemiol Community Health. 2006;60(12):1013-1019.CrossRefPubMedGoogle Scholar
  68. 68.
    Hosler AS, Varadarajulu D, Ronsani AE, Fredrick BL, Fisher BD. Low-fat milk and high-fiber bread availability in food stores in urban and rural communities. J Public Health Manag Pract. 2006;12(6):556-562.PubMedGoogle Scholar
  69. 69.
    Latham J, Moffat T. Determinants of variation in food cost and availability in two socioeconomically contrasting neighbourhoods of Hamilton, Ontario, Canada. Health Place. 2007;13(1):273-287.CrossRefPubMedGoogle Scholar
  70. 70.
    Bertrand L, Therien F, Cloutier MS. Measuring and mapping disparities in access to fresh fruits and vegetables in Montreal. Can J Public Health. 2008;99(1):6-11.PubMedGoogle Scholar
  71. 71.
    Bodor JN, Rose D, Farley TA, Swalm C, Scott SK. Neighbourhood fruit and vegetable availability and consumption: the role of small food stores in an urban environment. Public Health Nutr. 2008;11(4):413-420.CrossRefPubMedGoogle Scholar
  72. 72.
    Farley TA, Rice J, Bodor JN, Cohen DA, Bluthenthal RN, Rose D. Measuring the food environment: shelf space of fruits, vegetables, and snack foods in stores. J Urban Health. 2009;86(5):672-682.CrossRefPubMedGoogle Scholar
  73. 73.
    Laska MN, Borradaile KE, Tester J, Foster GD, Gittelsohn J. Healthy food availability in small urban food stores: a comparison of four US cities. Public Health Nutr. 2009;8:1-5.CrossRefGoogle Scholar
  74. 74.
    Franco M, Diez-Roux AV, Nettleton JA, et al. Availability of healthy foods and dietary patterns: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2009;89(3):897-904.CrossRefPubMedGoogle Scholar
  75. 75.
    Franco M, Diez Roux AV, Glass TA, Caballero B, Brancati FL. Neighborhood characteristics and availability of healthy foods in Baltimore. Am J Prev Med. 2008;35(6):561-567.CrossRefPubMedGoogle Scholar
  76. 76.
    Sloane DC, Diamant AL, Lewis LB, et al. Improving the nutritional resource environment for healthy living through community-based participatory research. J Gen Intern Med. 2003;18(7):568-575.CrossRefPubMedGoogle Scholar
  77. 77.
    Block D, Kouba J. A comparison of the availability and affordability of a market basket in two communities in the Chicago area. Public Health Nutr. 2006;9(7):837-845.CrossRefPubMedGoogle Scholar
  78. 78.
    Donkin AJ, Dowler EA, Stevenson SJ, Turner SA. Mapping access to food in a deprived area: the development of price and availability indices. Public Health Nutr. 2000;3(1):31-38.CrossRefPubMedGoogle Scholar
  79. 79.
    Ball K, Timperio A, Crawford D. Neighbourhood socioeconomic inequalities in food access and affordability. Health and Place. 2009;15(2):578-585.CrossRefPubMedGoogle Scholar
  80. 80.
    Bustillos B, Sharkey JR, Anding J, McIntosh A. Availability of more healthful food alternatives in traditional, convenience, and nontraditional types of food stores in two rural Texas counties. J Am Diet Assoc. 2009;109(5):883-889.CrossRefPubMedGoogle Scholar
  81. 81.
    Cheadle A, Psaty B, Wagner E, et al. Evaluating community-based nutrition programs: assessing the reliability of a survey of grocery store product displays. Am J Public Health. 1990;80(6):709-711.CrossRefPubMedGoogle Scholar
  82. 82.
    Cheadle A, Psaty BM, Curry S, et al. Can measures of the grocery store environment be used to track community-level dietary changes? Prev Med. 1993;22(3):361-372.CrossRefPubMedGoogle Scholar
  83. 83.
    Cohen DA, Schoeff D, Farley TA, Bluthenthal R, Scribner R, Overton A. Reliability of a store observation tool in measuring availability of alcohol and selected foods. J Urban Health. 2007;84(6):807-813.CrossRefPubMedGoogle Scholar
  84. 84.
    Connell CL, Yadrick MK, Simpson P, Gossett J, McGee BB, Bogle ML. Food supply adequacy in the Lower Mississippi Delta. J Nutr Educ Behav. 2007;39(2):77-83.CrossRefPubMedGoogle Scholar
  85. 85.
    Liese AD, Weis KE, Pluto D, Smith E, Lawson A. Food store types, availability, and cost of foods in a rural environment. J Am Diet Assoc. 2007;107(11):1916-1923.CrossRefPubMedGoogle Scholar
  86. 86.
    Morland K, Filomena S. Disparities in the availability of fruits and vegetables between racially segregated urban neighbourhoods. Public Health Nutr. 2007;10(12):1481-1489.CrossRefPubMedGoogle Scholar
  87. 87.
    Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in energy intake in US. between 1977 and 1996: similar shifts seen across age groups. Obes Res. 2002;10(5):370-378.CrossRefPubMedGoogle Scholar
  88. 88.
    Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in food locations and sources among adolescents and young adults. Prev Med. 2002;35(2):107-113.CrossRefPubMedGoogle Scholar
  89. 89.
    Nutritionist Pro [computer program]. Stafford, TX2009.Google Scholar
  90. 90.
    Food and Nutrition Board of the Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (2002) and Dietary reference intakes for water, potassium, sodium, chloride, and sulfate (2004). Washington, D.C.: National Academies; 2002 and 2004Google Scholar
  91. 91.
    Torun B. Energy requirements of children and adolescents. Background paper prepared for the joint FAO/WHO/UNU Expert Consultation on Energy in Human Nutrition 2001.Google Scholar
  92. 92.
    Comprehensive School Nutrition Policy Task Force. Comprehensive school nutrition policy—promoting healthy eating in schools and communities. Philadelphia, PA: Supported by US Department of Agriculture/Food and Nutrition Services, P.A. Nutrition Education Program; 2002.Google Scholar
  93. 93.
    Centers for Disease Control (CDC)/National Cancer Institute (NCI). Fruits and Vegetables Matter. Accessed on: October 10, 2007. Available at: http://www.fruitsandveggiesmatter.gov/.
  94. 94.
    US Department of Health and Human Services and US Department of Agriculture. Dietary guidelines for Americans. Washington, DC January 2005.Google Scholar
  95. 95.
    Pearce J, Hiscock R, Blakely T, Witten K. The contextual effects of neighbourhood access to supermarkets and convenience stores on individual fruit and vegetable consumption. J Epidemiol Community Health. 2008;62(3):198-201.CrossRefPubMedGoogle Scholar
  96. 96.
    Gordon-Larsen P, McMurray RG, Popkin BM. Adolescent physical activity and inactivity vary by ethnicity: the national longitudinal study of adolescent health. J Pediatr. 1999;135(3):301-306.CrossRefPubMedGoogle Scholar
  97. 97.
    Molnar BE, Gortmaker SL, Bull FC, Buka SL. Unsafe to play? Neighborhood disorder and lack of safety predict reduced physical activity among urban children and adolescents. Am J Health Promot. 2004;18(5):378-386.PubMedGoogle Scholar
  98. 98.
    Joint Food and Agriculture Organization (FAO)/World Health Organization (WHO) expert consultation. Diet, nutrition and the prevention of chronic diseases (WHO Technical Report Series 916). Geneva, Switzerland: World Health Organization; 2003.Google Scholar
  99. 99.
    Institute of Medicine. Local government actions to prevent childhood obesity. Washington, DC: National Academy of Sciences; 2009.Google Scholar
  100. 100.
    New York City Department of Health and Mental Hygiene. NYC Starts a Nationwide Initiative to Cut the Salt in Restaurants and Processed Food. Accessed on: September 29, 2009. Available at: http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml.
  101. 101.
    Khan LK, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevent obesity in the United States. MMWR Recomm Rep. 2009;58(RR-7):1-26.PubMedGoogle Scholar
  102. 102.
    USDA Food and Nutrition Service. WIC Food Packages. Accessed on: September 29, 2009. Available at: http://www.fns.usda.gov/wic/benefitsandservices/foodpkg.HTM.
  103. 103.
    USDA National Institute of Food and Agriculture. USDA grant to create healthy urban food enterprise development center in Arkansas. 2009. Accessed on February 5, 2009. Available at: http://nifa.usda.gov/newsroom/news/2010news/01281_urban_food.html.
  104. 104.
    Grier SA, Kumanyika SK. The context for choice: health implications of targeted food and beverage marketing to African Americans. Am J Public Health. 2008;98(9):1616-1629.CrossRefPubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2010

Authors and Affiliations

  1. 1.Department of Family and Social MedicineMontefiore Medical Center/Albert Einstein College of MedicineBronxUSA
  2. 2.The Food TrustPhiladelphiaUSA

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