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The Neighborhood Food Resource Environment and the Health of Residents with Chronic Conditions

The Food Resource Environment and the Health of Residents

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Abstract

Background

Residence in disadvantaged neighborhoods is associated with poorer access to healthy foods.

Objective

To understand associations between the neighborhood food resource environment and residents’ health status and body mass index (BMI) for adults with and without chronic conditions.

Design

Cross-sectional multilevel analysis.

Participants

2,536 adults from the 2000–2001 Los Angeles Family and Neighborhood Survey.

Measurements

The food resource environment was defined as the number of chain supermarkets, independent supermarkets, small markets, or convenience stores per roadway miles in the census tract. The main dependent variables were self-rated health, dichotomized as excellent or fair/poor, and body mass index (BMI). Multilevel regression models examined the association between the food resource environment and both BMI and the odds of reporting excellent health after adjustment for neighborhood SES and individual characteristics.

Results

More chain supermarkets per roadway mile in a census tract was associated with higher adjusted rates of reporting excellent health (33%, 38%, and 43% for those in the lowest, middle, and highest tertiles of chain supermarkets) and lower adjusted mean BMI (27, 26, and 25 kg/m2) for residents without a chronic condition, but not those with a chronic condition. In contrast, having more convenience stores per roadway mile was associated with lower health ratings only among adults with a chronic condition (39%, 32%, and 27% for the lowest to highest tertile of convenience stores).

Conclusion

Health status and BMI are associated with the local food environment, but the associations differ by type of market and presence of a chronic condition.

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References

  1. CurtisKA,McClellanS. Falling through the safety net: poverty, food assistance and shopping constraints in an American city. Urban Anthropol. 1995;24:93–135.

    Google Scholar 

  2. MackerrasD. Disadvantage, and the cost of food. Aust N Z J Public Health. 1997;212218.

    Article  PubMed  CAS  Google Scholar 

  3. MooneyC. Cost and the availability of healthy foods in a London health district. J Hum Nutr Diet. 1986;86:1684–93.

    Google Scholar 

  4. SallisJF,NaderPR,RuppJW,AtkinsCJ,WilsonWC. San Diego surveyed for heart-healthy foods and exercise facilities. Public Health Rep. 1986;1012216–9.

    PubMed  CAS  Google Scholar 

  5. SloaneDC,DiamantAL,LewisLB, et al.. Improving the nutritional resource environment for healthy living through community-based participatory research. J Gen Intern Med. 2003;187568–75.

    Article  PubMed  Google Scholar 

  6. SoomanA,MacintyreS,AndersonA. Scotland’s health—a more difficult challenge for some? The price and availability of healthy foods in socially contrasting localities in the west of Scotland. Health Bull (Edinb). 1993;515276–84.

    CAS  Google Scholar 

  7. TurrellG. Structural, material and economic influences on the food-purchasing choices of socioeconomic groups. Aust N Z J Public Health. 1996;206611–7.

    Article  PubMed  CAS  Google Scholar 

  8. ZenkSN,SchulzAJ,Hollis-NeelyT, et al.. Fruit and vegetable intake in African Americans income and store characteristics. Am J Prev Med. 2005;2911–9.

    Article  PubMed  Google Scholar 

  9. HorowitzCR,ColsonKA,HebertPL,LancasterK. Barriers to buying healthy foods for people with diabetes: evidence of environmental disparities. Am J Public Health. 2004;9491549–54.

    PubMed  Google Scholar 

  10. ZenkSN,SchulzAJ,IsraelBA,JamesSA,BaoS,WilsonML. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005;954660–7.

    Article  PubMed  Google Scholar 

  11. MooreLV,Diez RouxAV. Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health. 2006;962325–31.

    Article  PubMed  Google Scholar 

  12. MorlandK,WingS,Diez RouxA. The contextual effect of the local food environment on residents’ diets: the atherosclerosis risk in communities study. Am J Public Health. 2002;92111761–7.

    PubMed  Google Scholar 

  13. AlwittLF,DonleyTD. Retail stores in poor urban neighborhoods. J Consum Aff. 1997;311139–64.

    Article  Google Scholar 

  14. Kaufman PR, MacDonald JM, Lutz SF, Smallwood DM. Do the poor pay more for food? Item selection and price differences affect low-income household food costs. Agricultural Economic Report No. 759. Food and rural economics division, Economic Research Service, U.S. Department of Agriculture Washington, DC 2002.

  15. ChungC,MyersSL. Do the poor pay more for food? An analysis of grocery store availability and food price disparities. J Consum Aff. 1999;332276–96.

    Google Scholar 

  16. EisenhauerE. In poor health: supermarket redlining and urban nutrition. GeoJournal. 2001;532125–33.

    Article  Google Scholar 

  17. MacDonaldJM,NelsonPE. Do the poor still pay more? Food price variations in large metropolitan areas. J Urban Econ. 1991;303344–59.

    Article  Google Scholar 

  18. CumminsS,MacintyreS. Food environments and obesity—neighbourhood or nation? Int J Epidemiol. 2006;351100–4.

    Article  PubMed  Google Scholar 

  19. Diez-RouxAV,NietoFJ,CaulfieldL,TyrolerHA,WatsonRL,SzkloM. Neighbourhood differences in diet: the Atherosclerosis Risk in Communities (ARIC) Study. J Epidemiol Community Health. 1999;53155–63.

    PubMed  CAS  Google Scholar 

  20. LaraiaBA,Siega-RizAM,KaufmanJS,JonesSJ. Proximity of supermarkets is positively associated with diet quality index for pregnancy. Prev Med. 2004;395869–75.

    Article  PubMed  Google Scholar 

  21. PowellLM,AuldMC,ChaloupkaFJ,O’MalleyPM,JohnstonLD. Associations between access to food stores and adolescent body mass index. Am J Prev Med. 2007;334 SupplS301–7.

    Article  PubMed  Google Scholar 

  22. RoseD,RichardsR. Food store access and household fruit and vegetable use among participants in the US Food Stamp Program. Public Health Nutr. 2004;781081–8.

    Article  PubMed  Google Scholar 

  23. WrigleyN,WarmD,MargettsB,WhelanA. Assessing the impact of improved retail access on diet in a “food desert”: a preliminary report. Urban Stud. 2002;39112061–82.

    Article  Google Scholar 

  24. SloaneD,NascimentoL,FlynnG, et al.. Assessing resource environments to target prevention interventions in community chronic disease control. J Health Care Poor Underserved. 2006;172 Suppl146–58.

    PubMed  Google Scholar 

  25. ZenkSN,SchulzAJ,IsraelBA,JamesSA,BaoS,WilsonML. Fruit and vegetable access differs by community racial composition and socioeconomic position in Detroit, Michigan. Ethn Dis. 2006;161275–80.

    PubMed  Google Scholar 

  26. InagamiS,CohenDA,FinchBK,AschSM. You are where you shop: grocery store locations, weight, and neighborhoods. Am J Prev Med. 2006;31110–7.

    Article  PubMed  Google Scholar 

  27. WangMC,KimS,GonzalezAA,MacLeodKE,WinklebyMA. Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index. J Epidemiol Community Health. 2007;616491–8.

    Article  PubMed  Google Scholar 

  28. CliftonKJ. Mobility strategies and food shopping for low-income families. J Plann Educ Res. 2004;23:402–13.

    Article  Google Scholar 

  29. GrzywaczJG,AlmeidaDM,NeupertSD,EttnerSL. Socioeconomic status and health: a micro-level analysis of exposure and vulnerability to daily stressors. J Health Soc Behav. 2004;4511–16.

    Article  PubMed  Google Scholar 

  30. SteptoeA,FeldmanPJ. Neighborhood problems as sources of chronic stress: development of a measure of neighborhood problems, and associations with socioeconomic status and health. Ann Behav Med. 2001;233177–85.

    Article  PubMed  CAS  Google Scholar 

  31. BrownAF,AngA,PebleyAR. The relationship between neighborhood characteristics and self-rated health for adults with chronic conditions. Am J Public Health. 2007;975926–32.

    Article  PubMed  Google Scholar 

  32. SastryN,Ghosh-DastidarB,AdamsJ,PebleyAR. The design of a multilevel survey of children, families, and communities: the Los Angeles Family and Neighborhood Survey. Soc Sci Res. 2006;3541000–24.

    Article  Google Scholar 

  33. Sastry N, Pebley AR. Non-Response in the Los Angeles Family and Neighborhood Survey. Labor and Population Working Group Paper DRU-2400/7-LAFANS, RAND Corporation. http://www.rand.org/pubs/drafts/2006/DRU2400.7.pdf. Accessed March 9, 2008.

  34. BurdetteHL,WhitakerRC. Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children. Prev Med. 2004;38157–63. Jan.

    Article  PubMed  Google Scholar 

  35. GuagliardoMF. Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr. 2004;3(1):3.

    Article  PubMed  Google Scholar 

  36. MorlandK,WingS,Diez RouxA,PooleC. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22123–9.

    Article  PubMed  Google Scholar 

  37. NAICS. Economic Classification Policy Committee USBotC. U.S. Bureau of the Census. NAICS: new data for a new economy. Washington DC: NAICS; 1998.

    Google Scholar 

  38. WinklebyMA,CubbinC. Influence of individual and neighbourhood socioeconomic status on mortality among black, Mexican-American, and white women and men in the United States. J Epidemiol Community Health. 2003;576444–52.

    Article  PubMed  CAS  Google Scholar 

  39. BranchLG,LuL. Transition probabilities to dependency, institutionalization and death among the elderly over a decade. J Aging Health. 1989;1:370–408.

    Article  Google Scholar 

  40. OkosunIS,ChoiS,MatamorosT,DeverGE. Obesity is associated with reduced self-rated general health status: evidence from a representative sample of white, black, and Hispanic Americans. Prev Med. 2001;325429–36.

    Article  PubMed  CAS  Google Scholar 

  41. DeSalvoKB,BloserN,ReynoldsK,HeJ,MuntnerP. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med. 2006;213267–75.

    Article  PubMed  Google Scholar 

  42. FlegalKM,GraubardBI,WilliamsonDF,GailMH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293151861–7.

    Article  PubMed  CAS  Google Scholar 

  43. FordES,MoriartyDG,ZackMM,MokdadAH,ChapmanDP. Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System. Obes Res. 2001;9121–31.

    Article  PubMed  CAS  Google Scholar 

  44. IdlerEL,RussellLB,DavisD. Survival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992. First National Health and Nutrition Examination Survey. Am J Epidemiol. 2000;1529874–83.

    Article  PubMed  CAS  Google Scholar 

  45. MosseyJM,ShapiroE. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982;728800–8.

    PubMed  CAS  Google Scholar 

  46. CottCA,GignacMA,BadleyEM. Determinants of self rated health for Canadians with chronic disease and disability. J Epidemiol Community Health. Nov 1999;5311731–6.

    Article  PubMed  CAS  Google Scholar 

  47. FroomP,MelamedS,TriberI,RatsonNZ,HermoniD. Predicting self-reported health: the CORDIS study. Prev Med. 2004;392419–23.

    Article  PubMed  Google Scholar 

  48. MolariusA,JansonS. Self-rated health, chronic diseases, and symptoms among middle-aged and elderly men and women. J Clin Epidemiol. Apr 2002;554364–70.

    Article  PubMed  Google Scholar 

  49. CarpenterJ,BithellJ. Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med. 2000;1991141–64.

    Article  PubMed  CAS  Google Scholar 

  50. ZhangJ,YuKF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280191690–1.

    Article  PubMed  CAS  Google Scholar 

  51. RaudenbushSW,ByrkAS,CheongYF,CongdonR. Hierarchical Linear and Nonlinear Modeling. 2nd ed. Lincolnwood, IL, USA: Scientific Software International; 2001.

    Google Scholar 

  52. Selvin M. South L.A.’s growing pain: plans to revive the area after the 1992 riots have been largely unfulfilled. Los Angeles Times. 27 April, 2007.

  53. BodenheimerT,WagnerEH,GrumbachK. Improving primary care for patients with chronic illness. JAMA. 2002;288141775–9.

    Article  PubMed  Google Scholar 

  54. GlasgowRE,WagnerEH,KaplanRM,VinicorF,SmithL,NormanJ. If diabetes is a public health problem, why not treat it as one? A population-based approach to chronic illness. Ann Behav Med. 1999;212159–70.

    Article  PubMed  CAS  Google Scholar 

  55. WagnerEH,AustinBT,DavisC,HindmarshM,SchaeferJ,BonomiA. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20664–78.

    Article  CAS  Google Scholar 

  56. MensahGA,MokdadAH,FordES,GreenlundKJ,CroftJB. State of disparities in cardiovascular health in the United States. Circulation. 2005;111101233–41.

    Article  PubMed  Google Scholar 

  57. MobleyLR,RootED,FinkelsteinEA,KhavjouO,FarrisRP,WillJC. Environment, obesity, and cardiovascular disease risk in low-income women. Am J Prev Med. 2006;304327–32.

    Article  PubMed  Google Scholar 

  58. SharmaS,MalarcherAM,GilesWH,MyersG. Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors. Ethn Dis. 2004;14143–8.

    PubMed  Google Scholar 

  59. BiermanAS,DunnJR. Swimming upstream. Access, health outcomes, and the social determinants of health. J Gen Intern Med. 2006;21199–100.

    Article  PubMed  Google Scholar 

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Acknowledgments

Dr. Brown received support from the Beeson Career Development Award (#K23 AG26748) and the UCLA Resource Center in Minority Aging Research (#AG02004). Drs. Brown and Vargas received support from the National Center on Minority Health and Health Disparities (#P20MD00148). The Los Angeles Family and Neighborhood Survey was funded by the National Institute of Child Health and Human Development (grant R01 HD35944); the Office of the Assistant Secretary for Planning and Evaluation (OASPE), US Department of Health and Human Services; the Office of Behavioral and Social Sciences Research, National Institutes of Health; the Los Angeles County Urban Research Group; and the Russell Sage Foundation.

The authors would like to thank Ms. Hope Watkins for her assistance with the preparation of the manuscript. An earlier version of this work was presented at the 2004 Annual Meeting of the Society of General Internal Medicine in Chicago, IL.

Human Participant Protection: The UCLA Institutional Review Board approved these analyses.

Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA, USA

    Arleen F. Brown MD, PhD, Roberto B. Vargas MD, MSPH & Alfonso Ang PhD

  2. RAND, Santa Monica, CA, USA

    Roberto B. Vargas MD, MSPH & Anne R. Pebley PhD

  3. Division of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA, USA

    Anne R. Pebley PhD

Authors
  1. Arleen F. Brown MD, PhD
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  2. Roberto B. Vargas MD, MSPH
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  3. Alfonso Ang PhD
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  4. Anne R. Pebley PhD
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Correspondence to Arleen F. Brown MD, PhD.

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Brown, A.F., Vargas, R.B., Ang, A. et al. The Neighborhood Food Resource Environment and the Health of Residents with Chronic Conditions. J GEN INTERN MED 23, 1137–1144 (2008). https://doi.org/10.1007/s11606-008-0601-5

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  • DOI: https://doi.org/10.1007/s11606-008-0601-5

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