Bibliography of Literature on Food Environments
Otto, Master's Student
of Community, Agriculture, Recreation and Resource Studies
pdf version here
Dewar, J., Marshall, D., Cummins, S., Taylor, M., Dawson, J. Sparks, L.
(2007). The development of a healthy eating indicator shopping basket
tool (HEISB) for use in food access studies—identification of key food
Health Nutrition, 10(12),
literature review of UK designations of "healthy food" in Scotland
helps create objective criteria of "healthy food." The healthy eating
indicator shopping basket (HEISB) was created through the review of
surveys done throughout the UK. HEISB isbased on UK Food Standards
Assessment nutrient content, cultural acceptance, use of foods in
previous models, price, convenience, variety. Using this model
effectively would take much ethnographic field-work to account for
cultural acceptance of foods. Also, it is limited to only a specific
list of foods and can ignore other healthy foods. Possibly food groups
would be easier to manage and be more encompassing. However, the
creation of a salient food basket is important for food access studies
in the US that have been relying on the US Thrifty Food Plan (TFP)
which is based on more policy than reality (See Block & Kouba 2006 for a
modification of the TFP for cultural-appropriateness).
& Crawford, D. (2006). Socio-economic factors in obesity: a
case of slim chance in a fat world? Asia Pacific
Journal of Clinical Nutrition, 15 (Suppl),
is a review of the literature (mostly European; they are Australian)
concerning socio-economic status and obesity. While the studies may not
be applicable to US cases, they provide some suggestions for future
research such as understanding the complexity of a socio-cultural
model, understanding why some low socio-economic status populations are
resilient to obesity, and use multi-level statistical modeling to find
what variables are influencing obesity in low socio-economic status
Timperio, A., & Crawford, D. (2006a). Understanding
environmental influences on nutrition and physical activity behaviors:
where should we look and what should we count? International
Journal of Behavioral Nutrition and Physical Activity, 3, 33-42.
et al. reviewed studies of nutrition and environment. They asked what
is environment and conclude that it is made up of multiple nested
contexts (e.g. neighborhood inside city inside state, etc.; see Wang et al. 2007 for
a good definition of neighborhood in a food environment study)
selection and conceptualization of data is lacking in many studies.
Perception and objectivity must be taken into account. See Perceptions section.
lack of explicit evidence-based theoretical models is arguably the
major limitation of work in this field to date and perhaps the greatest
challenge we face in advancing research"
S., Whitt-Glover, M. C., Lancaster, K. J., Odoms-Young, A. M.,
& Gary, T. L. (2009). Built environment and health behaviors
among African-Americans: A systematic review. American
Journal of Preventive Medicine, 36(2), 174-181.
(2001). In poor health: Supermarket redlining and urban nutrition. GeoJournal,
provides an historical overview of supermarkets in the urban US. She
comes from an environmental theoretical perspective and is arguing that
the environment has been ignored as a health issue among policy makers
because of racism. However, this article was written before many
studies had been conducted on retail food access and her assumptions
are based on mostly economic studies that were on a national level.
Baranowski, T., & Baranowski, J. C. (2007a). Fruit and
vegetable availability: a micro environmental mediating variable? Public
Health Nutrition, 10(07), 681-689.
is a review of literature that studies fruit and vegetable
(F&V) consumption as it relates to availability, mostly from a
household level. The majority of studies have found that consumption is
most greatly influenced by the amount of, and availability of
vegetables in homes. This reflects the idea that food environments are
nested (See Ball et
al. 2006a) and distance to stores is only one
aspect of availability.
K., Obarzanek, E., Stettler, N., Bell, R., Field, A. E., Fortmann, S.
P., et al. (2008). Population-based prevention of obesity: The need for
comprehensive promotion of healthful eating, physical activity, and
energy balance: A scientific statement from American Heart Association
Council on Epidemiology and Prevention, Interdisciplinary Committee for
Prevention (Formerly the Expert Panel on Population and Prevention
release from the American Heart Association calls for prevention of
obesity through individual and
population approaches that they call “universal prevention.” It is an
extensive review of the literature concerned with obesity prevention in
the last few years, including over 400 citations. They cite Morland et al. 2002a
and Zenk et al.
2005b as examples of food retail access studies
that have influenced the need for population prevention of obesity.
upstream/downstream analogy to prevention is helpful to understand the
theory behind population prevention based in an ecological approach:
One must not just help those drowning as they attempt to go downstream,
but also find where people are “falling in” upstream.”
Larson, N. I.,
Story, M. T., & Nelson, M. C. (2009). Neighborhood
environments: Disparities in access to healthy foods in the U.S. American
Journal of Preventive Medicine, 36(1), 74-81.e10.
is a comprehensive review of food access studies in the US from 1985 to
al. 2007a; Morton 2007),
& Meyers 1999, Zenk et al. 2006a, Baker et al. 2006, Horowitz et al. 2004,
& Diez-Roux 2006, Jetter & Cassady 2006,
et al. 2002a), and minority groups (Block & Kouba 2006,
et al. 2002a, Powell et al. 2007a,
Baker et al 2006, Horowitz et al. 2004,
Zenk et al. 2005a, Moore & Diez Roux 2006,
& Filomena 2007, Hosler et al. 2006)
have been shown to have limited access to supermarkets, chain stores,
and healthful food.
limitations found by the authors are most valuable. Some problems are
the validity and reliability of measures (See Lytle
2009 for a discussion of psychometric tests),
neighborhood definitions, and the cross-sectional nature of most
studies. Commercially available lists of stores are also seen as
problematic and suggest more truth-grounded or walking surveys. Also,
distance people travel outside the neighborhood is not usually
measured. They call for more longitudinal (See
Li et al. 2009), multi-level, and intervention
review is an excellent collection of sources with a useful appendix.
(2007). Deprivation amplification revisited; or, is it always true that
poorer places have poorer access to resources for healthy diets and
physical activity? International
Journal of Behavioral and Physical Activity, 4(32). 1-7
argues through research that has been done in the UK that food access
should be cautiously approached. Theory should be more evidence-based
and broad assumptions such as supermarkets provide better food
environments should be avoided without empirical evidence.
claims that "there does not seem to be any consistent pattern in
whether or not resources are located to the disadvantage of households
in poorer communities.” However, she cites Morland 2002a, Zenk et al 2005a,
& Meyers 1999, where it is found that
socio-economic status factors, most notably race, do reflect access to
supermarkets and other outlets of healthy food. She does claim that
there are differences between countries, but ignores the consistency of
US studies. Her only example from the US that strengthens her argument
is from 1991.
Alberg, A., Ewing, R., Helzlsouer, K., Gary, T., & Klassen, A.
(2007). The built environment and obesity. Epidemiology
Review, 29, 129-143.
is a review of studies of built environment and obesity between 2001
& 2005. It was found that 17 of the 20 articles reviewed found
statistically significant relationships between obesity and the built
majority of studies have concentrated on physical activity and not
food. Those that have studied food either use density or distance to
stores and not both. Some newer studies have done this (e.g. Ball & Crawford 2009;
Bodor et al. 2007).
(2004). Community Food Assessment: A First Step in Planning for
Community Food Security. Journal
of Planning Education and Research, 23(4), 356-377.
review of seven Community Food Assessments (CFA) helps to illuminate
the relevance of spatial and density measurements of food access for
local planning. Pothukuchi realistically sees local food sources as not
taking over the existing conventional system, but influencing it.
Studies of food access allow for local communities to find where
communities can improve and provide an opportunity for academic,
government, private, and non-profit trans-disciplinary discourse. This,
Pothukuchi argues, is most easily accomplished with the help of urban
planners that can bridge the gap between academic research and policy.
whole issue 23(4) of JPER is focused on Community Food Security]
(2007). Food access and obesity. Obesity
Reviews, 8 Supplement 1, 99-107.
is a review of the literature regarding food access with suggestions
for future research focusing on “studies where both retail factors
(e.g. access, availability and price) and diet are measured as
applicable to individuals, preferably longitudinally, so that the
direction of causation can be inferred, and preferably with an
experimental component, so that change in diet can be observed,
contingent on change in retail access.”
Measures of Food
Environment Inequality in the US
Agrawal, A., & Lewis, D. (2006). Disparities in access to fresh
produce in low-income neighborhoods in Los Angeles. American
Journal of Preventive Medicine, 30(5), 365-370.
stores were mapped in relation to food pantry clients living within
"reasonable walking distance of store" (0.8 km Based on Bolen & Hecht 2003).
Individual residences provided a finer scale than zip codes or census
units and the network distance through street layers provided a
realistic measure of distance.
California Nutrition Network database was used to geocode stores by
"variety of produce" or "limited produce"/ excluding liquor stores and
gas station convenience; some on-site inspection, telephone interview,
and inference was conducted, however, much of the categories are
subjective, (e.g. stores with produce in the name carry produce?). As
with other studies, measuring what is healthy and where it is actually
sold is difficult.
was found that clusters of food pantry clients do not have access to
produce and part of this study is to decide where mobile trucks should
be used to supply produce. Over half of those studied did not live
within walking distance of stores with a variety of produce.
Austin, S. B.,
Melly, S. J., Sanchez, B. N., Patel, A., Buka, S., & Gortmaker,
S. L. (2005). Clustering of fast-food restaurants around schools: A
novel application of spatial statistics to the study of food
Journal of Public Health, 95(9), 1575-1581.
et al. collected lists of fast food restaurants in Chicago through the
Technomic Top 100 which is a database that keeps track of the leading
chains of fast food. They cross-referenced this information with
fastfoodsource.com and other private websites. Distance models and
clustering models were used with the geographic data found on fast food
restaurant in relation to schools.
a fixed population like schools and comparing them with a fixed
location like fast food restaurants created a fine spatial unit that
can measure proximity and density. While this obviously was a limited
snapshot of a particular population at a particular time, the
clustering of fast food restaurants around schools may account for
rates of obesity among younger populations. Interestingly, the
concentration of fast foods around restaurants was less in lower-income
neighborhoods (See Rundle
et al. 2009 for similar results).
Schootman, M., Barnidge, E., & Kelly, C. (2006). The role of
race and poverty in access to foods that enable individuals to adhere
to dietary guidelines. Preventing
Chronic Disease, 3(3), 1-11.
clustering analysis was used to measure the amount of supermarkets
within particular St. Louis census tracts. Audits of supermarkets and
fast food restaurants in the St. Louis area were conducted using the
USDA Continuing Survey of Food Intakes. This is similar to the Anderson 2007
model’s use of the healthy eating indicator shopping basket (HEISB) in
the UK. Such audits help in weighting food stores. Tertiles of
clustering were created and compared to racial composition of census
tract. None of the supermarkets in the highest tertile of fruit and
vegetable (F&V) availability were in the African-American
neighborhoods. Spatial clustering models showed the expected clustering
of supermarkets indicating that Whites have a much better distribution.
Fast food clustering was not different between racial groups.
qualitative measurements are called for to find causality. Behavior
among groups may reflect density of healthy food. They also call for
more land-use patterns such as highways and airports to include in
study (See Dunn 2008).
Block, J. P.,
Scribner, R. A., & DeSalvo, K. B. (2004). Fast food,
race/ethnicity, and income: A geographic analysis. American
Journal of Preventive Medicine, 27(3), 211-217.
et al used 2 types of geographic levels to measure fast food restaurant
density (FFRD) in New Orleans: census tract and shopping area. To make
sure that neighborhoods were urban and residential, census tracts with
alcohol outlet density above 200 per 1000 people were excluded, but
restaurants were not, on account of "shopping area" designation.
Shopping area is defined by buffers around census tracts that people
would travel into to purchase food. (1 mile and half-mile buffers were
analyzed.) "Shopping areas" create a more realistic and dynamic measure
of density than census tracts. However, their subjective nature would
make generalizability difficult. Race, not income, was associated with
the number of fast food outlets. Fast food density was twice as high in
the African-American shopping areas (see Powell et al. 2007a for similar results
et al. 2008 for conflicting results).
Powell et al. 2007a
claim that the regression model used for this study did not explicitly
account for population size.
Bodor, J., Rose,
D., Farley, T., Swalm, C., & Scott, S. (2007). Neighbourhood
fruit and vegetable availability and consumption: the role of small
food stores in an urban environment. Public
Health Nutrition, 11(4), 413-420.
density and distance to supermarkets and grocers were measured in
relation to particular residences in New Orleans (Similar to Ball & Crawford 2009).
The distance was straight-line (Euclidean), which is not as accurate as
studies such as Ball et
al 2009 that use roadway distance. The in-store
measurements make this study interesting.
of F&V retail was measured by shelf-space in stores dedicated
to produce. Multivariate regression was employed using gender,
ethnicity and age of the individual, as well as car ownership, income
of the household and food assistance programs as predictor variables
and distance to supermarket and local shelf space as independents.
Similar to Block
& Kouba 2006 and Ball et al 2009,
supermarket proximity was not as important to vegetable consumption
among African-Americans as small grocers that act as fill-ins
complementing the large packaged foods from supermarkets (See Raja et al 2008).
One limitation of this study was that the response rates of those that
participated did not fit the census demographics. This is admitted, and
can be a problem for researchers wanting to do residence-level studies.
They also admit that this was only an exploratory study and inferences
cannot be made between availability and intake of F&V.
Franco, M., Diez Roux,
A. V., Glass, T. A., Caballero, B., & Brancati, F. L. (2008).
Neighborhood characteristics and availability of healthy foods in
Journal of Preventive Medicine, 35(6), 561-567.
et al. utilized the Nutrition Environment Measures Survey (NEMS-S) (See Glanz et al. 2007 for description)
to investigate food stores in 158 Baltimore census tracts in relation
to race. InfoUSA data was used to find stores. Checks were made with
phone books, Health Dept. records, and driving through neighborhoods. A
Healthy Food Availability Index (HFAI) was created for each store. The
index was compared with census tract characteristics through
multi-level modeling. 43% of African-American census tracts had poor
access as opposed to 4% of White, while 19% of African-American tracts
had high availability as opposed to 68% White. High-income areas also
had better access. HFAI was 7.6 points higher in White tracts, with
supermarkets scoring highest. However, supermarkets in African-American
areas still scored lower than White areas.
Galvez, M. P.,
Raines, C., Kobil, J., Siskind, J., Godbold, J., et al. (2008). Race
and food store availability in an inner-city neighbourhood. Public
Health Nutrition, 11(06), 624-631.
blocks were studied in East Harlem of Manhattan. Through GIS mapping
and multi-level regression, they found that African-Americans have no
supermarkets or grocery stores, and also less convenience stores.
Interestingly, Latinos had more access to all food stores than mixed
race neighborhoods. They admit that adjacency was not taken into
account, but it is telling that none of the African-American census
blocks had access to large stores with healthy food. These findings
were independent of median income, median rent and population density.
Howard, P. H.,
& Fulfrost, B. (2007). The density of retail food outlets in
the central coast region of California: Associations with income and
Latino ethnic composition. Journal
of Hunger and Environmental Nutrition, 2(4), 3-18.
modeling was used to asses the retail density of three counties in CA
in relation to income and ethnicity. Also, locations for fruit and
vegetable stands were recommended. Census data is used on the census
block level for ethnicity and the block group level for income. This is
a much finer scale than others using Census tracts or zip codes (Also
used byRaja et al
& Horel 2008, Li
et al 2009, Wang et al 2007, Galvez et al 2008)
CA Dept. of Health data is used to identify and classify stores. Also,
stores are weighted by sales volume. No truth-grounded research was
done to check reliability of store classification. Latino neighborhoods
had less retail food density. However, as median income decreased,
retail density increased.
weighting of stores by sales volume may preclude the assumption that
volume equals fruit and vegetable access. A small ethnic store with
limited stock may provide more healthy food for some minority groups
than a large supermarket. While it is true that two large supermarkets
may provide more food, they may not fit the foodways of the local
population (see Short et al.
2007). Also, some studies have found that
supermarkets may not be the only important contributor to healthy
eating (See Short et al.
& Kouba 2006; Bodor et al 2007; Glanz et al. 2007; Jago et al. 2007; Raja et al 2008).
Hosler, A. S.,
T Rajulu, D., Ronsani, A. E., & Fredrick, B. L. (2008).
Assessing retail fruit and vegetable availability in urban and rural
underserved communities. Preventing
Chronic Disease, 5(4), 9.
and urban areas in New York State (Albany) were mapped for F&V
availability. Farmers markets were included with food stores. The field
work is a strength of this study. Every store was visited and analyzed
by criteria created by researchers (10 or more F&V was
considered a large selection. Also it was noted if there were dark
green and orange vegetables. Such an evaluation was created when they
found irregularities using Morland
et al’s 2002a classification of food stores.
However, they did not use these criteria in their analysis. Store
Howard & Fulfrost 2007 for a different weighting system)
was created using the number of cash registers and hours of operation.
Each store was recorded with a GPS device at the front door. While the
broad cross-section of this study may be a limitation, the comparative
nature provides for further inquiry. The urban minority was much less
serviced than the mixed urban, rural and small-town communities with
and without the weighting of food stores.
Baranowski, T., Baranowski, J. C., Cullen, K. W., & Thompson,
D. (2007b). Distance to
food stores & adolescent male fruit and vegetable consumption:
mediation effects. The
International Journal of Behavioral Nutrition and Physical Activity, 4(35), 35.
Boy Scouts were studied in the greater Houston area. 12-week surveys
were done to assess home F&V availability, Cullen Food
Questionnaires were used for intake (high and low fat vegetables,
fruits and juices), and homes were geo-coded. A one-mile radius was
used to assess food retail access. They decided on this distance
because kids are likely to cut across vacant lots and parking lots.
found that access to smaller grocers was positively related to
F&V intake and home availability, but supermarkets did not have
any effect (Timperio
2008; Raja et al
2008). Fast food increased high-fat vegetable
intake such as French fries and lower F&V home availability,
but did increase fruit juice consumption.
finding that supermarkets did not affect consumption contrasts with
other studies, but they suggest that adolescent, Texan males are a
group that has not been well-studied. The use of in-home surveys is a
good step toward investigating causality between distance to stores and
& Diez Roux, A. (2006). Associations of neighborhood
characteristics with the location and type of food stores. American
Journal of Public Health, 96(2), 325-331.
tracts were investigated for food retail density in Forsyth County NC,
Baltimore, Manhattan and the Bronx. While supermarket measures were
similar to other studies, i.e. minorities had less access, it was also
found that there were less health food stores, bakeries and specialty
stores in minority neighborhoods. Also there were more meat and fish
stores in minority tracts than White tracts. Low-income areas had 4x as
many grocery stores, and half as many supermarkets as high-income.
There was no difference in the amount of liquor stores between White
and minority tracts (In contrast to Sturm
2008 and Zenk et al
2006). An interesting finding is that refusal
rates are 12% for InfoUSA numbers, meaning that some stores are not
allowing themselves to be counted in database. This indicates a need to
cross-check food store data.
Wing, S., Diez Roux, A., & Poole, C. (2002a). Neighborhood
characteristics associated with the location of food stores and food
service places. American
Journal of Preventive Medicine, 22(1), 23-29.
tracts from 1990 were used in Jackson City, Mississippi; Forsyth
County, North Carolina; Washington County, Maryland; and selected
suburbs of Minneapolis, Minnesota as part of the Atherosclerosis Risk
in Communities Study (ARIC) (Morland
2002b). Food stores were found through local
departments of environmental health and state departments of
agriculture. North American Industry Classification System (NAICS)
codes were used to categorize food stores. Number of stores was
compared against wealth and racial composition (Poisson models).
were 4 times more likely to be found in White neighborhoods than
African-American and racially mixed neighborhoods. Three times as many
supermarkets are also found in wealthier neighborhoods. Wealthier
neighborhoods also had fewer small grocery stores, convenience stores
(without gas stations), and specialty food stores. All types of food
establishments were more prevalent in White and racially mixed
neighborhoods except for bars and taverns. The addition of bars and
taverns is interesting in this study. They also found that
African-Americans have much less access to private transportation.
Powell, L. M.,
Slater, S., Mirtcheva, D., Bao, Y., & Chaloupka, F. J. (2007a).
Food store availability and neighborhood characteristics in the United
Medicine, 44(3), 189-195.
et al. conducted a multivariate analysis of populations across 28,050
zip codes in
the US in relation to access to supermarkets,
grocers, and convenience stores. They admit that many limitations are
inherent in such a large sample with such coarse measurements. The
multivariate analysis took into account ethnicity, race, socio-economic
status and income. The findings are consistent with earlier studies
that African-Americans have greatly disadvantaged access to
supermarkets even when controlling for income. Latinos and Asians had
many smaller stores which may reflect cultural preferences (See Short et al 2007 for similar results).
Rural areas were the most disadvantaged and suburban had the most chain
Powell, L. M.,
Chaloupka, F. J., & Bao, Y. (2007b). The availability of
fast-food and full-service restaurants in the United States:
associations with neighborhood characteristics. American
Journal of Preventive Medicine, 33(4 Suppl),
zip codes were measured across the US for restaurant density in
relation to income and ethnicity. Restaurant information came from Dun
& Bradstreet. Population density was also taken into account to
separate urban measurements from rural as control variables. Through
multivariate analysis they found that African-American areas actually
had less density of fast food and any other restaurants. Near-low and
middle income had the highest numbers of restaurants. However, the
ratio of fast food restaurants to all restaurants was much more
significant among African-American areas. An interesting statistic is
added in the conclusion: The percentage of fast food restaurants out of
total restaurants increased from 20% to 30% between 2003 and 2006.
Their use of zip codes as geographic areas is extremely coarse.
Raja, S., Changxing,
M., & Yadav, P. (2008). Beyond food deserts: Measuring and
mapping racial disparities in neighborhood food environments. Journal
of Planning Education and Research, 27(4), 469-482.
in Erie County NY were investigated to test the hypothesis that areas
of color have less access to healthy food. Gini coefficients were used
to assess inequality (have not seen this used in any other study).
Census block data was used. All but 14 blocks were studied across the
county (this creates a more random sample than some other targeted
studies.) Access is defined as the number of food destinations
available within a 5-min travel time of the census tract centroid. 24
regression models were included (6 types of food destinations, three
modes of travel, and the 6 types of food destinations provided by Moore & Diez 2006
for comparison). The Reference USA database was used to identify food
destinations. This was cross-checked through phone books and phone
interviews of establishments. Direct markets such as farmers markets
were also incorporated. Distance was measured by street layers through
GIS. They found 26 restaurants per 10k people, and only .4 supermarkets
per 10k people in the county. 60% of blocks only have restaurants as
compared the Thrifty Food Plan between Erie County grocery store and
supermarkets and found that they are equally affordable and claim that
the Hispanic community may be providing healthy food through small
stores (See Short et al. 2007). [The methods section in this article is
extremely clear and the statistical analysis is presented simply.] Much of their methods were culled from
Moore & Diez Roux 2006.
study was conducted with the hope that planners would use this info.
The Gini coefficients help put this information into a language that is
recognized by economists and planners.
Sharkey, J. R.,
& Horel, S. (2008). Neighborhood socioeconomic deprivation and
minority composition are associated with better potential spatial
access to the ground-truthed food environment in a large rural area. The
Journal of Nutrition, 138(3), 620.
stores in 101 Census blocks in rural Texas were Geocoded using
windshield surveys and GPS measurements at each location. A government
database and phone books were then compared with ground-truthing. A
population-weighted center was used to find proximity to stores.
Density may have been a better measurement for such sparsely populated
large census blocks. They test public listing versus ground-truth
results and find that public lists created significantly longer
distances from population centers to food stores. Also
geographic-centered proximities were significantly larger. Unlike other
studies, this study of rural populations finds that lower-income,
minority groups in densely populated areas had better access than other
groups to all types of food stores. However, even closer distances were
relatively far compared to urban dwellers (about 4 km), expressing the
access issues that are apparent among rural populations. This is one of
the only studies concentrating on rural food access.
(2008). Disparities in the food environment surrounding US middle and
high schools. Public
Health, 122(7), 681-690.
and density of retail food establishments are counted within a 400m
(walking distance) and 800m (used because of the size of campuses)
buffer radius around middle and high schools across the US. Info USA
was used to identify stores and there is a good description of the
North American Industry Classification System (NAICS) used to classify
stores. Schools are classified by racial majority, location (urban,
suburban, town, or rural), and income (Type I eligible, free meals).
Enrollment population was not significant. While minorities, especially
Latinos, are found to have more convenience stores, restaurants, and
liquor stores around their schools, rural and urban may confound the
finding of more off-licenses (liquor stores) around low-income,
minority schools (they admit this limitation).
Schulz, A., Israel, B., James, S., Bao, S., & Wilson, M.
(2005a). Neighborhood racial composition, neighborhood poverty, and the
spatial accessibility of supermarkets in metropolitan Detroit. American Journal
of Public Health, 95(4), 660-667.
was found that race does have an effect on access to supermarkets, even
when adjusted for income. African Americans had significantly less
study comes from an historical theoretical context based on the
white-flight of urban areas in the northern industrial cities. They
call for more longitudinal studies to assess the changes in food access
as neighborhoods change racially.
Zenk, S., Schulz, A.,
Israel, B., James, S., Bao, S., & Wilson, M. (2006). Fruit and
vegetable access differs by community racial composition and
socioeconomic position in Detroit, Michigan. Ethnicity
& Disease, 16(1), 275-280.
communities were studied in the Detroit area with differing race and
socio-economic status. Food stores were identified through the USDA and
surveys were conducted throughout the year in the stores to evaluate
the availability and quality of F&V. One-mile Euclidean buffers
were used around stores. While overall selection and price of
F&V was similar across the communities, quality was much worse
among African-American and lower socio-economic status communities.
Four times more liquor stores were also found in African-American
authors claim that larger samples with more stores are necessary to
find whether access is based on race and socio-economic status.
Zenk, S. N.,
& Powell, L. M. (2008). US secondary schools and food outlets. Health
& Place, 14(2), 336-346.
food and convenience store density was measured around (805m walking
distance) secondary schools in the US to determine if neighborhoods
(census tracts) with a school are more likely to have these
establishments. Race, income, and school level were used as independent
variables. Over 30,000 schools were used from the National Center for
Education Statistics and food outlets were found through Dun &
Bradstreet. Given the magnitude of this study, finer and more accurate
data would have been impossible.
Austin et al.’s 2005
study of Chicago schools, it is found that the number of fast food and
convenience store outlets decrease as income increases. Fewer fast food
outlets were also found around African-American schools (see Morland et al. 2002a, Powell et al. 2007
for similar results). It is also found that tracts with schools are
more likely to have fast food restaurants.
the Food Environment and its Associations with Health
& Matsa, D.A.. (2009) Are restaurants really supersizing
America? Department of Agricultural & Resource Economics,
University of California, Berkeley.
neo-classical economic approach of consumer optimization between
satiation and caloric intake was applied to the existence of highway
interchanges as an instrument of fast food accessibility and obesity in
rural counties across 11 states. It is found through their model that
obesity is not related to the existence of interchanges in zip codes
and the authors suggest that legislating fast food would be a waste of
Mass Index (BMI) and overweight info is found through the Behavioral
Risk Factor Surveillance System (BRFSS). This study has provoked
similar studies (Dunn 2009;
Currie et al 2009).
Boumtje, P. I.,
Huang, C. L., Lee, J.-Y., & Lin, B.-H. (2005). Dietary habits,
demographics, and the development of overweight and obesity among
children in the United States. Food
Policy, 30(2), 115-128.
et al. used the USDA's Continuing Survey of Food Intake by Individuals
(CSFII) 1994-96 and 1998 to investigate youths at-risk of obesity and
obese. Being African-American and Hispanic was positively associated
with obesity. Soft-drink consumption was also found to shift children
from normal weight to obesity, indicating that access to soft drinks
(e.g. fast food and liquor stores) may affect health.
N., Fulkerson, J. A., Neumark-Sztainer, D., Story, M., &
French, S. A. (2007). Fast food for family meals: relationships with
parent and adolescent food intake, home food availability and weight
Health Nutrition, 10(01), 16-23.
et al. found through surveying the parents of 902 adolescents in
Minneapolis that the amount of fast food purchased by families relates
to the amount of soft drinks consumed in the home, which in turn raises
the risk of obesity among children (see Boumtje et al 2005).
DellaVigna, S., Moretti, E., Pathania, V. (2009). The effect of fast
food restaurants on obesity. National Bureau of Economic Research.
the other economic studies of fast food and obesity (Dunn
2008; Anderson & Matsa 2009),
specific residences of new mothers and specific locations of 9th
graders’ schools were compared with fast food restaurants, as opposed
to using an instrument such as highway interchanges. Restaurant data
was collected from Dun & Bradstreet. Straight line distances of
.1, .25, and .5 miles were used from new mothers’ residences and
schools. A fast food outlet within .1 miles from a school resulted in a
5.2 percent increase in the incidence of obesity. They found that
mothers that live near fast food restaurants are more likely to be
minorities. A potential strength of this study is the use of body fat
measurements found through the Fitnessgram data collected on 9th
graders in CA. This is a much better estimate of obesity than BMI;
especially self-reported BMI, although it does not apply to all the
Heron, M., Bird, C. E., Lurie, N., Finch, B. K., Basurto-Davila, R., et
al. (2008). Neighborhood socioeconomic status and fruit and vegetable
intake among whites, African-Americans, and Mexican Americans in the
United States. American
Journal of Clinical Nutrition, 87(6), 1883-1891.
is a national survey of F&V intake compared with socio-economic
status and racial composition of neighborhoods. Using a 24 hr recall
from the National Health and Nutrition Examination NHANES III) and
Census Tracts as neighborhood proxies (a limitation, but useful for
such a large investigation) they concluded that socio-economic status
affects intake of F&V among African-Americans more than Whites.
While the gap between Whites and African-Americans halved as
socio-economic status increased, it was still significant at p < .05.
Interestingly, African-Americans and Non-Native people consumed more
fruits than US-born people (See
Dubowitz et al 2007). The positive association
found with higher socio-economic status and F&V consumption
gives a national cross-sectional overview of trends in food access and
local environment. Mexican-Americans had comparable intakes of
F&V with Whites across socio-economic status.
(2008). Obesity and the availability of fast-food: an instrumental
variables approach. 2007
6th World Congress: Explorations in Health Economics Paper.
study is similar to Anderson
& Matsa. (2009), where highway
interchanges accounted for fast food access. However, it is on a county
level. It was found that BMI is most significantly affected among
minorities, and rural and suburban whites are not affected.
S., Cohen, D., Finch, B., Asch, S. (2006). You are where you shop.
Grocery store locations, weight, and neighborhoods. American
Journal of Preventive Medicine, 31(1),
data was used from the LA Family and Neighborhood Study, which asked
where people from particular census tracts shopped for food. Also, they
were asked where they worshipped, went for medical care, recreated, and
worked. It was found through multi-level regression that those who shop
in disadvantaged census tracts have higher BMI. No other factors
affected BMI. While this study did not use exact locations of residence
and shopping, the comparison with other places for services makes a
strong suggestion that where one shops affects health. Proximity was
measured using census tract centroids.
the impact of food deserts on public health in Detroit: Mari
Gallagher Research & Consulting Group. Chicago IL.
mapping of retail outlets and their relation to census tract centroids,
a Food Balance score was created in Detroit by dividing the distance to
grocers with that of fringe stores (liquor stores, conveniences stores,
fast food etc). This was compared with a Years of Potential Life Lost
(YPLL) indicator. It was found that over half of the city’s populations
have to travel twice as far to mainstream grocers. It is also claimed
that fast food was not as negative for health as food stamp retailers,
because the majority of food stamp retailers concentrate on selling
liquor, cigarettes, and lottery tickets (See Gallagher 2007b).
Truth-grounded reviews were done of all retailers that use food stamps,
and were recoded if they specialized in the above products. Using the
food balance model allows for studies to be conducted across different
geographical areas (e.g. rural residents may have to travel far for a
grocer, but also travel far for a fringe store).
B., Siega-Riz, M., Kaufman, J. S., Jones, S. J. (2004). Proximity of
supermarkets is positively associated with diet quality index for
study has been cited many times as justification for measuring access
to supermarkets. Laraia et al. measure proximity to food retail outlets
among pregnant women in North Carolina in the Raleigh area. Distance to
food stores is compared with a diet quality index for pregnancy based
on the Dietary Guidelines for Americans and the Food Pyramid. This was
measured through questionnaires. Food stores were identified and
Geocoded using the USDA 2000 inspection registry. They found
that distance to supermarkets greatly affects the nutrition of these
women. As distance to supermarkets increased diet quality decreased.
The opposite was true for convenience stores.
use of resident locations gives a precise scale.
Li, F., Harmer,
P., Cardinal, B. J., Bosworth, M., Johnson-Shelton, D., Moore, J. M.,
et al. (2009). Built environment and 1-year change in weight and waist
circumference in middle-aged and older adults: Portland neighborhood
environment and health study. American
Journal of Epidemiology, 169(4), 401-408.
longitudinal study of obesity in Portland in relation to fast food
restaurants and physical activity was conducted. Fast food retail
density was found with INFO USA numbers at a census block level. While
the study does not make very strong associations between fast food
density and increase in obesity (those that had increased BMIs lived in
the high density areas and ate at a fast food restaurant once a week),
the methods used are a step toward providing less cross-sectional
research and creating studies of causality.
Liu, G. C.,
Wilson, J. S., Rong, Q., & Jun, Y. (2007). Green neighborhoods,
food retail and childhood overweight: Differences by population
Journal of Health Promotion, 21(4 suppl),
amount of vegetation and proximity of supermarkets was compared with
BMI of children with a mean age of 8 in Marion County IN. Proximity
measured along streets (Euclidean) based on a 2 km buffer. Higher
population density areas had an inverse relationship between obesity
and supermarkets, while distance to convenience and grocery stores and
fast food restaurants saw no significance. Lower density populations
had a positive relationship for higher BMI with closer proximity to
J. (2004). The relationship between obesity and the prevalence of fast
food restaurants: state-level analysis. American
Journal of Health Promotion,
was a national study using secondary data. Data was collected from the
Behavioral Risk Factors Surveillance system, the Census, and the US
Yellow pages. Square miles per fast food restaurant and the density of
fast food were compared against the BMI of residents. The density of
fast food restaurants was significantly associated with higher BMIs.
The huge sample and use of Yellow Pages make this study fairly weak.
However, it does give reason for further research on food environments
Wing, S., & Diez Roux, A. (2002b). The contextual effect of the
local food environment on residents' diets: the atherosclerosis risk in
communities study. American
Journal of Public Health, 92(11),
sample studied in this report was selected from the atherosclerosis
risk in communities study (ARIC)
et al 2002a) because “ (a) these data have
already been collected for a large population based sample with
extensive information on dietary intake, (b) the geographic area from
which the ARIC population was sampled is diverse with respect to the
wealth and racial makeup of residential census tracts, (c) the ARIC
participants are heterogeneous in terms of race, income, and education
(all characteristics known to be associated with dietary intake), and
(d) neighborhood differences in diet have been found for these
community members.” Food frequency questionnaires were compared with
the amount and type of food stores in census tracts. Stores were coded
based on the North American Industry Classification System (NAICS).
found that the existence of a supermarket within census tracts that are
African-American significantly increase F&V consumption, over
2x more than in White neighborhoods.
Diez Roux, A. V., & Wing, S. (2006). Supermarkets, other food
stores, and obesity: The atherosclerosis risk in communities study. American
Journal of Preventive Medicine, 30(4), 333-339.
sample of participants from Jackson City MS, Forsyth County NC,
Washington County MD, and selected suburbs of Minneapolis MN was used.
Census tracts were used to define each participant’s neighborhood. They
found that the presence of grocery stores and convenience stores is
associated with higher rates of obesity, diabetes, and hypertension in
relation to populations with only supermarkets. Store information was
departments of environmental health and state departments of
agriculture and was coded with the North American Industry
Classifications (NAICS) system. Although this is a cross-sectional
study with coarse units of analysis, the large sample size and
diversity of locations are strengths.
Morland, K. B.,
& Evenson, K. R. (2009). Obesity prevalence and the local food
& Place, 15(2), 491-495.
tracts were measured for food store type and density in two distinct
geographic locations of Forsyth County, NC, and the city of Jackson MS.
Telephone interviews were used to assess demographics and BMI of
specific residents. Distance from individual residences to food stores
is measured. However, they do not mention if these are Euclidean or
network. Results showed less prevalence of obesity with access to a
supermarket and more with access to more than one fast food store (See Rundle et al. 2009 for conflicting
results). However, obesity increased as distance
to supermarkets increased on an individual level. Also, obesity
decreased as distance to fast food increased. These results show that
utilization of stores may not correlate with prevalence of stores. This
research also used a sample with relatively high education and was
self-reported. Also, factors such as race and income were calculated as
individual-level variables but the majority of informants were white
and female which could reflect the nature of using home phone
Hiscock, R., Blakely, T., & Witten, K. (2009a). A national
study of the association between neighbourhood access to fast-food
outlets and the diet and weight of local residents. Health
& Place, 15(1), 193-197.
Zealand’s small size allows for very specific statistics to be used for
comparison of food access with BMI, fruit intake, and vegetable intake.
Multi-level models were used that included ethnicity, population
density, number of people in household, education and employment.
Confounding variables such as smoking and physical activity were used
in BMI analysis. Pearce et al. used the meshblock (similar to US Census
blocks) listings of fast food outlets and the New Zealand Health Survey
to compare individual health with the existence of fast food. This
allows for an average of 20 individuals for each 100 person meshblock.
They found that access to fast food outlets is not a significant
indicator of BMI or F&V intake. (Rundle et al. 2009
have similar results in US, while Morland & Evenson 2009
have conflicting results in the US). They claim that healthy food
outlets should also be included.
Powell, L. M.,
Auld, M. C., Chaloupka, F. J., O'Malley, P. M., & Johnston, L.
D. (2007c). Associations between access to food stores and adolescent
body mass index. American
Journal of Preventive Medicine, 33(4 suppl),
et al. compared data from the Monitoring the Future (MTF) study of BMI
graders with food prices and food retail density of zip codes where
schools were located. Food prices were found with the American Chamber
of Commerce Research Association (ACCRA) cost of living index reports
and food retail locations were found through Dun & Bradstreet
Market Place. A model was created that holds various socio-economic
status variables constant while estimating the association between BMI
and food store access. The existence of chain supermarkets had a
significant association with lower BMI with all control variables.
Convenience stores were associated with higher BMI. African-American
adolescents had a (3x) higher association between chain supermarkets
and lower BMI. Mother’s work status was also taken into account and it
was found that those with full-time working mothers were more
positively affected by supermarkets.
codes are used to place schools in geographical context. This assumes
that adolescents attending these schools live in the particular zip
codes. Nevertheless, these data sets are representative of the US
population and provide a solid beginning to further research.
suggests that urban planning land use should increase the availability
of chain supermarkets (see Pothukuchi
Neckerman, K. M., Freeman, L., Lovasi, G. S., Purciel, M., Quinn, J.,
Richards, C., Sircar, N., Weiss, C. (2009). Neighborhood Food
Environment and Walkability Predict Obesity in New York City. Environmental
Health Perspectives, 117(3), 442-447.
et al. used information collected on BMI of 14,147 residents to compare
food retail with obesity. They included the factors of walkability and
population density along with the prevalence of healthy-BMI,
moderate-BMI, and unhealthy-BMI weightings of food outlets. They
include all food outlets, including restaurants. Their information on
retail outlets was found through commercial datasets and there was no
ground-truthed investigation. Nevertheless, the availability of BMI
measurements allowed for a significant measurement of causality and
food access. The neighborhood buffer zone used was a half-mile radius
around each retail establishment. While this may be a valid measurement
in NYC, other areas may not be as pedestrian-oriented and neighborhood
definition may vary.
found that healthy-BMI outlets account for lower BMI, while
unhealthy-BMI outlets do not have significant effect on BMI. This
conflicts some other studies of fast food outlets and BMI (e.g. Morland et al. 2009).
They admit that the fact that unhealthy food is available in all
neighborhoods may confound this variable.
weighting analysis of stores is a strength of this study. The three
categories were created using previous studies of the effects of
store-type on obesity. Also, the coupling of walkability along with
food access represents the fact that there are many factors to obesity
that must be taken into account.
Butterfass, J., Richards, R. (2009) Environment influences food access
and resulting shopping and dietary behaviors among homeless Minnesotans
living in food deserts. Agriculture
and Human Values [online only].
and quantitative methods were used to investigate the BMI of homeless
women, mostly with children, in Minneapolis in relation to the
surrounding food environment. A Social Cognitive Theory framework was
used that takes into account behavioral, personal, and environmental
influences on food choice. Focus groups, behavior surveys, 24 hr. diet
recall, BMI measures, and store surveys were used. The Thrifty Food
Plan (TFP) was used to compare prices in a five block radius of two
different shelters. The environment inside the shelters had as much to
do with food choice as outside. Focus groups indicated that
participants know that they do not have good access to reasonably
priced healthy food. Many traveled on the bus outside the neighborhood
measures indicated that 80% of the women were overweight, and the food
surveys showed that local stores do not carry most of the TFP items and
are above the market basket price. The use of qualitative methods
allows for valuable triangulation of the data. They found that the
physical space and experiences with hunger may be significant causes of
obesity in low-income people.
Sturm R, Datar
A. (2005). Body mass index in elementary school children, metropolitan
area food prices and food outlet density. Public
national representative sample of kindergarteners was measured over
four years. BMI was compared with the price of food and the density of
outlets. Density was found as per capita number of restaurants, grocery
stores and convenience stores in the child's home and school zip code.
Prices were found through Council for Community and Economic Research.
Lower prices on vegetables accounted for lower gain of BMI. Lower meat
prices had the opposite effect. Retail density had no effect. Density
was measured at a large scale (zip codes).
Datar, A. (2008). Food prices and weight gain during elementary school:
5-year update. Public
is a follow-up of Sturm & Datar 2005. They measured the change
in BMI between the spring of kindergarten and the spring of fifth
grade. The main explanatory variable was the price index for
fruit/vegetables based on the fact that earlier density did not make a
difference (although they had some limitations). There was a constant
trend that higher prices of vegetables may account for higher rates of
obesity among children.
Ball, K., Roberts, R., Campbell, K., Andrianopoulos, N., &
Crawford, D. (2008). Children's fruit and vegetable intake:
Associations with the neighbourhood food environment. Preventive
Medicine, 46(4), 331-335.
of students 5-12 yrs old in Melbourne Catholic schools were surveyed to
find the amount of vegetables consumed by the children. This was
compared with the density and types of food stores within 800m (based
on roadways) of their homes through GIS mapping. They found that there
is a positive relation between distance of convenience stores, fast
food, and supermarkets and F&V consumption. Those further from
supermarkets actually consumed more F&V. (See Jago et al. 2007a; Raja et al 2008 for
Wang, M. C.,
Kim, S., Gonzalez, A. A., MacLeod, K. E., & Winkleby, M. A.
(2007). Socioeconomic and food-related physical characteristics of the
neighbourhood environment are associated with body mass index. Journal
of Epidemiology and Community Health, 61(6), 491-498.
et al. attempted to isolate food environments from individual
socio-economic status characteristics in relation to food access
utilizing information from 5 surveys done (1979-90) by the Stanford
Heart Disease Prevention Program in California on BMI, neighborhood
census block characteristics, and the CA State Board of Equalization
lists of businesses. They found that only women are affected by the
local food environment: closer proximity to supermarkets (See Jago et
al. 2007; Raja et al
2008 for similar results) and ethnic stores was
associated with higher BMI. A strength of this study was the
neighborhood definitions that were found through not only public
records, but also with local city planners. This provided more salient
measures than census tracts and census blocks alone.
Environment Perceptions & Food Purchasing Behavior
E. A., Schoster, B., Martin, K. R., Shreffler, J., & Callahan,
L. F. (2009). Perceptions of individual and community environmental
influences on fruit and vegetable intake, North Carolina, 2004. Preventing
Chronic Disease, 6(1), A04.
formative assessment was used that incorporates quantitative surveys
with qualitative interviews, focus groups, cursory mapping, and
photography conducted by participants. They found that income affects
people's perceptions of F&V availability. Race has no effect.
However, the majority of participants (75%) were White. Intrinsic
variables, such as taste preference, seemed to affect F&V
intake more than environmental variables. Interestingly, those with
higher BMI (which was self-reported), claimed that they had better
access to quality F&V. The qualitative dimension of this study
is solid and has creative elements like photography. However, the
mapping was extremely cursory (they took a drive through the
neighborhoods), and the survey did not ask specific questions about
where people shopped for food. They were just asked to assess the place
they shopped. Nevertheless, this is a good example of community
involvement in food environment studies.
J. (2004). Mobility Strategies and Food Shopping for Low-Income
Families: A Case Study. Journal
of Planning Education and Research, 23(4), 402-413.
interviews low-income residents in Austin, Texas to investigate how
transportation plays a role in food provisioning. The majority of the
participants shop in supermarkets that are not within walking distance
and have devised plans for finding transportation, including busses
there and taxis back, making only monthly trips, and borrowing cars.
Some participants had cars and had to decide between household needs
and maintenance. Most view shopping outside their own neighborhood as
more cost-effective and search out ways to get to these locations.
Findlay, A., Petticrew, M., & Sparks, L. (2008a). Retail-led
regeneration and store-switching behaviour. Journal
of Retailing and Consumer Services, 15(4), 288-295.
Similar to Wrigley et al. 2004,
Cummins et al. investigate the behavior of populations when given a new
option for shopping. It is found that although shoppers may use the new
store in a deprived area, they may not change eating behaviors. This is
used to express the idea that more than supermarket interventions are
needed to improve healthy food consumption. This may suggest that
market-based interventions like those in Bolen & Hecht 2003
may be more viable than the addition of supermarkets that still provide
the unhealthy foods being consumed at lower prices with more
Findlay, A., Higgins, C., Petticrew, M., Sparks, L., Thomson, H.
(2008b). Reducing inequalities in health and diet: findings from a
study on the impact of a food retail development. Environment
and Planning A, 40(2), 402-422
is a more in-depth study presented in the other Cummins 2008
article. Qualitative and quantitative data were collected on the
intervention and non-intervention populations in Glasgow. The largest
benefit of the addition of a hypermarket is the economic impact of
increased jobs according to focus groups. Yet, the intervention did not
have significant effects on F&V intake or self-perceived health.
(2007a). Commentary: Investigating neighbourhood effects on
health--avoiding the 'Local Trap'. International
Journal of Epidemiology, [online
is criticizing the local unit of analysis for food access and also the
Macintyre 2007) theoretical model. He claims that
individual behavior should be taken into account because many people
travel to stores outside their immediate neighborhood for varieties of
reasons. His argument is bolstered by the Pearce et al. 2007
study in New Zealand showing that access to food does not affect
health. However, he is ignoring the social aspects of the US; namely,
(2007b). Neighbourhood food environment and diet-Time for improved
conceptual models? Preventive
Medicine, 44(3), 196-197.
This is a reply to Powell et al. 2007a.
Cummins is questioning the "deprivation-amplification" (See Macintyre 2007)
theoretical model that views the non-existence of healthy food outlets
and the existence of unhealthy food outlets as the prime reason for
unhealthy eating among particular populations. He mentions Wrigley et al. 2003
and Cummins et
al. 2005 as examples of communities where
supermarket intervention did not significantly change food ways among
underserved populations. Basically, Powell is arguing that social
aspects must not be taken out of the theoretical models explaining food
Acevedo-Garcia, D.; Salkeld, J.; Lindsay, A. C.; Subramanian, S. V.;
Peterson, K. E. (2007). Lifecourse, immigrant status and acculturation
in food purchasing and preparation among low-income mothers. Public
Health Nutrition, 10(4), 396-404.
et al. used focus groups consisting of immigrant and native-born women
in the Boston area to help create a social context for food retail
access. The majority of the 44 interviewed were Latina and
Spanish-speaking. They found that the immigrant perspective is shaped
by experiences outside the US and they are willing to travel further
and take more time for food acquisition than US-born women. They say
access is good but quality is poor compared to their native countries.
Also, US-born women were more likely to purchase fast food and
convenience foods. This study, although limited by a small sample and
possible language barriers (they admit that the researchers did not
speak Spanish), indicates the importance of culture and social context
when investigating food access.
Smith, C. (2004). Healthful eating: perceptions, motivations, barriers,
and promoters in low-income Minnesota communities.
Journal of the American Dietetic Association, 104(7), 1158-1161.
developed through focus group participation were conducted in Minnesota
urban and rural public places to investigate motivations and barriers
to eating healthy among low-income populations. What was interesting
was that the barriers to F&V were consistently monetary (See Donkin et al 1999)
and behavioral and environmental accessibility was less of an issue.
Studies such as these reflect the need for community involvement when
studying food environments. Mapping food retail access should be
coupled with studies such as these.
(2004). Measuring convenience: Scots’ perceptions of local food and
retail provision. International
Journal of Retail & Distribution Management, 32(2), 8.
study utilized information from the Scottish Household Survey to
measure retail food access from resident perception as opposed to
geographic proximity. They found that rurality, mobility, and age are
related with convenience of food retailing. Studies like these are easy
in a country that supports such yearly surveys. Obtaining this data in
the US would be more difficult. However, perception is an important
aspect to food retail access. See Garesky 2005; Moore & Diez-Roux 2008
Morton, L., & Greder, K. (2005). The food environment and food
insecurity: Perceptions of rural, suburban, and urban food pantry
clients in Iowa. Family
and Economics Nutrition Review, 16(2), 41-48.
pantry clients were given questionnaires across Iowa and focus groups
were conducted to assess perception of food access. It is found that
transportation is the most important barrier to food access. It is also
found that the rural communities perceive the most food insecurity.
Suburban clients also viewed healthy food as more affordable.
Giskes, K., Van
Lenthe, F. J., Brug, J., Mackenbach, J. P., & Turrell, G.
(2007). Socioeconomic inequalities in food purchasing: The contribution
of respondent-perceived and actual (objectively measured) price and
availability of foods. Preventive
Medicine, 45(1), 41-48.
et al. investigated food availability as expressed by where people shop
and not where they live. Data was collected through interviews and
store audits. The combination of qualitative and quantitative methods
provides a decent comparison with perceived and objective access to
food. They found the perceptions of price and availability is
significant in regards to socio-economic status and food choice.
Objective access is not significant. This fits well with other studies
in the UK and Australia. However, objective access has been shown to be
a considerable hindrance to healthy food among particular populations
in the US (e.g. see Dubowitz
et al 2008).
James, D. C. S.
(2004). Factors influencing food choices, dietary intake, and
nutrition-related attitudes among African-Americans: application of a
culturally sensitive model. Ethnicity
& Health, 9(4), 349-367.
used focus groups to study the nutritional behaviors of
African-Americans of varied socio-economic status. It was found that
African-American populations view eating healthy as being associated
with the dominant White culture (See Freedman
2008) and do not want to lose their own cultural
identity. Soul food is important and a prevailing attitude of "you'll
die of something" is prevalent. This study reminds us that assumptions
of food access cannot be made without including cultural and social
Kirkup, M., De
Kervenoael, R., Hallsworth, A., Clarke, I. (2004). Inequalities in
retail choice: exploring consumer experiences in suburban
Journal of Retail & Distribution Management, 32(11), 511-522.
et al. conducted focus groups in an England suburb that has seen the
addition of large grocery stores that have taken the place of smaller
grocers. They found that the addition of supermarkets has varying
effects based on persons’ socio-economic status, car ownership, age,
etc., such as elderly folks do not like bulk deals and the size of
stores. This study shows that perceptions may not meet objective
accessibility. Whereas all of these areas have access to healthy foods,
many do not believe that it is convenient and were better off with the
smaller stores. They are pushing for studies to take the smallest
geographical level possible. They state, “We conclude that choice needs
to be articulated as a dynamic concept, and is as much to do with
having flexibility and options available than the extent of choice per
Moore, L., Diez
Roux, A., & Brines, S. (2008). Comparing perception-based and
Geographic Information System (GIS)-based characterizations of the
local food environment. Journal
of Urban Health, 85(2), 206-216.
census tracts in Forsyth County NC, Baltimore, the Bronx, and Manhattan
were chosen based on cardiovascular risk. Samples were chosen through
the multiple-ethnicity study of atherosclerosis (MESA). Surveys were
sent to assess perceptions of food access and mapping was done to
measure access to food stores. A 1-mile buffer was used (20 min walk in
surveys). InfoUSA was used to map stores. Non-whites had more smaller
stores and supermarkets were denser for higher-income. Those without
supermarkets rated their accessibility 17% less. Only NC respondents
associated more smaller stores with greater access. One neighborhood in
MD with lower density of smaller stores was positively associated with
food access, indicating that smaller stores may be important in
particular areas (See
Chung& Meyers 1999 ). While they admit
that there many be many measurement errors based on the aggregation of
stores under similar types without actually visiting them and the
subjectivity of perceptions, this study introduces a step toward
linking populations’ perceptions of food and objective measurements.
& Blanchard, T. (2007). Starved for access: life in rural
America's food deserts. Rural
Realities, 1(4), 1-10.
& Blanchard claim that poor diet in rural areas may be a result
of perceptions and buying behavior along with accessibility. They make
a claim that ‘food deserts’ are places where people do not have access
to supermarkets or superstores because these stores provide healthy
food at reasonable prices. However, a survey of superstores and small
grocers in an area in rural Iowa shows that healthy foods may actually
be cheaper at the smaller stores and those surveyed did not feel that
they did not have access to stores although they did not eat healthy.
While this is a small case study in Iowa, it does reflect the
differences between urban and rural food environments and the effects
on populations. (See
Sharkey & Horel 2008). Data was collected
on a county scale.
Kirk, C.; Cummins, S.; Collins, M.; Elliman, D.; Connolly, A. M.; Law,
C. (2009b). Gaining children's perspectives: A multiple method approach
to explore environmental influences on healthy eating and physical
& Place, 15(2), 614-621.
from a north London local authority were studied to find how they
perceive their own access to food and physical activity. While not much
was discovered in relation to socio-economic status differences in food
access, the mixed-methods approach of photos, maps, and focus groups
allowed for triangulation of qualitative methods with a few themes
emerging, such as why children may not eat healthy food and search out
places to be physically active.
& Richards, R. (2004). Food store access and household fruit
and vegetable use among participants in the US Food Stamp Program. Public
Health Nutrition, 7(8), 1081-1088.
National Food Stamp Program Survey (NFSPS) was used to assess food
stamp participant’s access to fruits and vegetables. Weekly household
F&V use were compared with self-reported access variables such
as car ownership, type of store, and round-trip travel time.
Urbanization, demographics, and personal behavior toward F&V
consumption were also used as independent variables. It was found that
the majority of those studied had “easy” access to a supermarket
(meaning that their round-trip was less than 30 min.) Only fruit
consumption was significantly related with living more than a 5 miles
from a supermarket. Employment levels and single-parent status were
taken into account. Those with jobs and single-parents consumed less
household F&V. Although this report lacks “objective”
measurements of food access, the addition of many demographic control
variables is a strength.
(2006). Food deserts: Towards the development of a classification. Geografiska
Annaler Series B - Human Geography, 88B(2), 231-247.
square meter blocks were mapped as to whether they contained food
stores carrying at least ten fruits and vegetables in Leeds. This
information was compared with interviews of residents, institutional
leaders, and store owners. A ternary model is created that takes into
account ability, asset, and attitude. This is a demand-side look into
food deserts. Creating models such as this would be extremely expensive
and do not take into account other factors of power such as racial
Warm, D.; Margetts, B. (2003). Deprivation, diet, and food-retail
access: findings from the Leeds 'food deserts' study. Environment
and Planning A, 35(1), 151-188 .
was the first study conducted to measure the effects that the
development of a large supercenter has on the eating habits of those in
a food retail-deprived area. They accomplished this through before and
after surveys of local residents in a Leeds neighborhood getting a new
large super market. They found that the new retail center did improve
access and slightly improved F&V consumption.
is a good introduction describing the history of food retail access
studies in the UK and how much policy was enacted to increase community
development for food access without solid evidence on “food
deserts,”and how their study shows that local-scale interventions may
not be the best way to increase food retail access among at-risk
Ickes, S. B., Lowenstein, L. M., Shuval, K., Ammerman, A. S., Farris,
R., et al. (2008). Understanding barriers and facilitators of fruit and
vegetable consumption among a diverse multi-ethnic population in the
Promotion International, 23(1), 42-51.
groups were conducted with urban and rural populations from North
Carolina and Connecticut to find what types of barriers exist to eating
healthy food. In regard to access, African-American participants
claimed that they do not have access to quality F&V because of
lack of supermarkets in neighborhoods and claim that it is easier to
eat unhealthy food. Other racial groups did not share this sentiment.
This study provides qualitative evidence for the racial disparity in
Baranowski, T., Missaghian, M., Baranowski, J., Cullen, K., Fisher, J.
O., et al. (2006). Food-purchasing patterns for home: a grocery
store-intercept survey. Public
Health Nutrition, 9(03), 384-393.
assess individual shopping behavior, participants were interviewed
quickly outside Houston area supermarkets. Ethnicity and family size
were related to the behaviors of F&V purchasing and the amount
of trips taken to supermarkets. African-Americans ate less F&V
and made less trips. Studies such as these can help provide a clearer
picture of food retail access that includes not only the food
environment but how individual behavior also affects food choice.
Schulz, A., Hollis-Neely, T., et al. (2005b). Fruit and vegetable
intake in African-Americans income and store characteristics. American
Journal of Preventive Medicine, 29(1), 1-9.
et al. compared 83 suburban women with 183 Detroit women to find where
they shop for food, if it is affordable, and F&V intake.
Follow-up surveys from a previous study were conducted. Income did not
affect F&V intake. Higher educated women shopped at more
supermarkets. Most Detroit women shopped at small grocers, while
suburban women shopped at supermarkets. Supermarkets were associated
with more F&V intake. Specialty stores and shopping in suburbs
were indirectly associated with greater F&V intake through
better quality and selection.
study is based solely on perception of the participants, but does
provide a way to understand where shoppers are actually buying their
produce as opposed to a geographical assessment of proximity. Also,
stores were only based on chain affiliation and not size or other
variables, as they admit. Also they address the fact that the
statistics did not fit the hypothetical model. There is a good
discussion of the needed research in diverse neighborhoods, individual
determinants, and longitudinal studies.
& Kouba, J. (2006). A comparison of the availability and
affordability of a market basket in two communities in the Chicago
Health Nutrition, 9(7), 837-845.
is action research aimed at founding a community-owned food store.
Community involvement led methods and focus in creating market basket
price comparison of Austin and Oak Park in Chicago. USDA Thrifty Food
Plan was augmented with culturally appropriate African-American foods.
Stores were audited based on availability, cost, and quality; Focus
groups were conducted with some independent grocers. Block &
Kouba found that the small grocers and 'corner stores’ do a good job of
providing for the Austin community (See Raja et al 2008, Bolen & Hecht 2003,
Lavin 2005;). Store mix and
neighborhood characteristics are important.
A. C., Hathorn, C. S., Ibrahim, S., Gichuhi, P. N., &
Bromfield, E. M. (2009). Healthy food choices and physical activity
opportunities in two contrasting Alabama cities. Health
Place, 15(2), 429-438.
et al. did a comprehensive audit of food availability in two
contrasting Alabama cities. They use the Thrifty Food Plan to evaluate
what foods are available at convenience stores, supermarkets and
restaurants. Each store was physically surveyed for items at 9 in the
morning. Tuskegee was found to be more expensive with less variety.
Organics were not available. No convenience stores were present in
Auburn, while Tuskegee's main outlets for food were convenience stores
without much variety and higher prices. Collard greens and sweet
potatoes were actually more expensive in the predominately
African-American Tuskegee. This study provides an excellent example of
store auditing that provides a general idea of healthy food access in a
particular region. Such audits could be a good foundation for
researchers interested in measuring food access among certain
results reinforce the findings that African-American neighborhood
stores do not provide healthy foods.
Jetter, K. M., & Culp, J. (2007). Is Price a Barrier to Eating
More Fruits and Vegetables for Low-Income Families? Journal
of the American Dietetic Association, 107(11),
study is similar to Chung
& Meyers’ 1999 survey of food stores in
relation to the Thrifty Food Plan. They created a new TFP market basket
that fits the 2005 dietary guidelines to study the differences in price
between neighborhoods and the effects of the new guidelines on
low-income families. Only chain supermarkets, independent grocers, and
bulk supermarkets were measured within particular zip codes and five
miles outside (see Rose
& Richards 2004). A strength of these
surveys is the fact that they were conducted over a year to accommodate
for seasonality. The change in cost from the TFP to USDA dietary
guidelines was not significant.
the fruit and vegetable portion of the basket was investigated.
Lower-income areas actually had a lower average cost for the market
basket. However, the pricing was not consistent across stores (65 % in
LA and 75% in Sacramento). Also, to meet the new guidelines would
involve a 200 to 400% increase in expenditures for F&V. Quality
was not investigated and neither was retail density.
& Myers, S. J. (1999). Do the poor pay more for food? An
analysis of grocery store availability and food price disparities. The
Journal of Consumer Affairs, 33(2), 276-296.
and Meyers used grocery store surveys to what a "market basket" based
on the Thrifty Food Plan would cost in urban poor areas as opposed to
wealthier suburban areas in Minneapolis. Chain stores were
overwhelmingly based in the suburban areas with convenience stores in
the urban areas. OLS regression found that chains decrease the price
for the generalized market basket by $15.94 and the net impact of
poverty (based on 1990 Census records) increases the price by $3.41.
USDA food Stamp Retailers Likely to be Liquor Stores: Mari
Gallagher Research & Consulting Group. Chicago
study exemplifies the need for truth-grounded retail surveys. About 10%
of stores in Chicago classified as convenience, small, or medium-sized
grocery stores by the USDA were found to predominately sell liquor.
Sallis, J., Saelens, B., & Frank, L. (2007). Nutrition
Environment Measures Survey in stores (NEMS-S): development and
Journal of Preventive Med, 32(4), 282-289.
is an evaluation of the Nutrition Environment Measures Survey model
conducted in Atlanta. They tested inter-rater variability (See
Lytle 2009 for a discussion of the need for psychometric evaluations of
food environment instruments) by sending two
different researchers into the same stores to evaluate quantity of
healthy foods as defined by federal guidelines, quality of produce, and
price. Census tract socio-economic status was also taken into account.
As in many other studies, lower income areas had less healthy food. A
point-system was used to evaluate food stores. Inter-rater reliability
study was done multiple times with similar results indicating that
stable estimates can be created from single assessments using this
conceptual model, however seasonality must be taken into account. This
study, they admit, is expensive and labor-intensive.
interesting point is that small, walkable convenience stores provided
better food than out-of-the-way stores. This could indicate that
smaller stores could be important for contributing healthy food to
high-density, urban areas. (See Block & Kouba 2006,
Bolen & Hecht 2003,
Lavin 2005; Raja et al 2008).
Guy, C. M.,
& David, G. (2004). Measuring physical access to 'healthy
foods' in areas of social deprivation: a case study in Cardiff. International
Journal of Consumer Studies, 28(3), 222-234.
is part 2 of the Cardiff study. Product availability and price were
compared between supermarkets, affiliated stores, and small grocers.
Interestingly, the middle-sized stores had highest prices. This study
presents a good grounded truth approach to food access that has
extended out of qualitative and GIS methods that were applied earlier.
Behavioral aspects found earlier helped guide the list of foods studied
as opposed to the "market basket" approach that is based on
most-purchased items at supermarkets (See Block & Kouba 2006,
al 2007, Chung & Meyers 1999,
Short et al 2007).
Also, this is part of a longitudinal study investigating changing food
environments in Cardiff.
Colson KA, Hebert PL, Lancaster K. (2004).
Barriers to buying healthy foods for people with diabetes: evidence of
environmental disparities. American
Journal of Public Health, 94, 1549 –54.
were categorized by census blocks in NYC and surveyed for foods that
fit into a diet for persons with diabetes. A database from the New York
State Department of Agriculture and Markets was used to identify
stores. It is found that East Harlem (low-income/African-American) has
lower prices and as good of access as other areas. However, there are
not many large supermarkets.
Varadarajulu, D., Ronsani, A., Fredrick, B., & Fisher, B.
(2006). Low-fat milk
and high-fiber bread availability in food stores in urban and rural
of Public Health Management and Practice, 12(6), 556-562.
stores were visited in the Albany NY area and surrounding rural
counties to asses the availability of low-fat milk and high-fiber
bread. Each food store was mapped with handheld GPS. Existence of
F&V was also assessed, finding that stores with milk and bread
were more likely to sell cigarettes and alcohol than F&V.
composition of census blocks was the only variable that was significant
in relation to milk and bread access, with minority areas having less.
The healthy food stores in urban areas were more likely to be
convenience stores that accept food stamps (see Gallagher 2007b).
Jetter, K. M.,
& Cassady, D. L. (2005). The Availability and Cost of Healthier
Food Items. Preventive
Medicine, 30(1), 96-97.
& Cassady investigated stores in low-income, medium-income, and
high-income neighborhoods in LA and Sacramento. The Thrifty Food Plan
was used to evaluate whether food is more expensive in low-income
neighborhoods. They also investigated how much more it would cost to
replace some items on the TFP with healthier alternatives. This is an
improvement on studies that only use the TFP (See Block & Kouba 2006;
et al. 2009; Cassady et al. 2006;
& Meyers 1999; Jordan
found that access to the healthier alternatives is provided by the
smaller grocers in low-income areas and the price difference for the
alternatives is not much more significant in these areas as opposed to
others. Whole-wheat bread availability and small product sizes account
for most of the increased cost. This contrasts assumptions that chain
supermarkets are the best provider of healthy food.
(2007). Grocery gap project: race, hunger and food access: Solid
Ground. Seattle WA.
Food Plans were compared in Rainier Valley (low-income) and Queen Anne
(high-income) neighborhoods in Seattle. There was not a significant
difference in price. An earlier investigation in Seattle suggested that
supermarket access is fairly consistent across socio-economic status.
However, there were less healthy options in the low-income
aspect of this study was the unrealistic nature of the food stamp
program and TFP. Most food stamp participants talked to in focus groups
could not afford the TFP on the allotment of entitlements. Therefore,
access is not spatial, but economic.
(2005). Supermarket access and consumer well-being. International
Journal of Retail & Distribution Management, 33(5), 388-398.
a comparison of square-footage designated for healthy food in a
Pathmark store in Harlem with suburban and higher-income areas of
Manhattan, Lavin concluded that the Pathmark provides a comparable
amount and price of F&V to other supermarkets. She then went on
to assume that this indicates that the supermarket is providing where
other stores in Harlem are not. Such findings could reflect the
differing nature of food access across particular environments. Some
studies have shown that small markets provide F&V (Short et al 2007, Block & Kouba 2006,
Bodor et al 2007, Glanz et al. 2007, Raja et al 2008),
while most others have focused primarily on supermarkets (e.g. Zenk et al. 2005a, Clarke et al. 2002).
(2006). The impact of big-box stores on retail food prices and the
consumer price index. U.S. Dept. of Agriculture, Economic Research
Service, Economic Research Report Issue: 33
homes were studied across the US in an effort to find the discrepancies
in the Consumer Price Index (CPI) as related to “traditional” and
“non-traditional” stores, e.g. small grocers compared to Wal-Mart. The
reason for the study is to rectify the Bureau of Labor Statistics’
(BLI) CPI to better reflect real cost-of-living. The conclusion is that
these non-traditional retailers provide the same quality products at a
lower price and traditional retailers should follow this format to
compete. However, this study also illuminates the fact that those in
urban, low-income areas pay more for food. Superstores, regardless of
their impacts on local economies, do provide food at lower prices.
According to this study, prices can vary up to 50%.
& Filomena, S. (2007). Disparities in the availability of
fruits and vegetables between racially segregated urban neighbourhoods.
Health Nutrition, 10(12),
Community Districts were organized by census tract and 50% of food
stores were randomly evaluated based on 18 types of fruit and 21 types
of vegetables with in-store surveys. No supermarkets were found in the
African-American sections and F&V variety was much lower in
African-American and mixed districts. Canned produce was more prevalent
in the African-American Districts.The list of produce may not have
taken into account ethnic food choices, such as preferences for greens.
Guthman, J., & Raskin, S. (2007). Food deserts, oases, or
mirages? Small markets and community food security in the San Francisco
bay area. Journal
of Planning Education and Research, 26(3), 352-364.
full-service stores were evaluated as contributors to community food
security (CFS) as defined by the CFS Coalition: “all persons having
access to culturally acceptable, nutritionally adequate food through
local non-emergency sources at all times.” This study comes out of the
neglect of these small stores as viable outlets for healthy food as
opposed to supermarkets and alternative direct market outlets. Some
studies have found these stores as important outlets of food for
minority, urban populations (Block
& Kouba 2006; Bodor et al. 2007, Bolen & Hecht 2003,
Mapping of small food stores was triangulated with market basket
studies (based on the Thrifty Food Plan) and interviews of store
managers. Food store locations were found by physically walking through
neighborhoods and from the Department of Environmental Health and data
from a 2004 study prepared by the Alameda County Department of Public
was found that small Latino markets actually provide quality produce at
low prices in two of the areas studied. Interviews found that produce
is actually a loss-leader in the small markets to attract customers.
Interestingly, the areas with the most African-Americans were found to
have store owners focusing on Latino populations. As the authors claim,
more questions are created by their study than answers. This study
uncovers a much-neglected aspect of food retail in urban areas and is a
clear, and easy to understand article.
Access Policy & Solutions
(2007). Making Healthy Food More Accessible for Low-Income People: Farm
and Food Policy Project.
is a report of the Farm and Food Policy Project to inform the Farm
Bill. It argues for a food environment perspective in health,
specifically on obesity and food insecurity. A report by the American
Heart Association (Kumanyaki
et al. 2008) reflects this changing attitude
toward population health. Anderson provides policy recommendations
based on the findings by Chung and
Meyers, 1999, among other 90s studies, for food
access among low-income populations, including expanding existing
programs that improve low-income people’s access to healthy foods by
allocating and appropriating adequate federal funds, improving public
transportation access to supermarkets, creating a national fund to
finance development of healthy food options in low income
neighborhoods, subsidizing Electronic Benefits Transfer (EBT)
technology for farmers markets, and increasing the minimum food stamp
benefit. This article helps support the reasoning for investigating
food environments as contributors to the health of populations along
with individual behavior.
& Hecht, K. (2003). Neighborhood
Groceries: New Access to Healthy Food in Low-Income Communities. California
Food Policy Advocates. San Francisco CA:
report produced by the California Food Policy Advocates provides three
case-studies of market-based solutions to food retail access. They
found that the most viable solutions involve careful understanding of
the local demographics and locations that are underserved either
through lack of retail outlets with fresh produce at reasonable prices
or a lack of public transit to supermarkets. Three case-studies of
improving a corner store, creating a produce market with support from
local policy, and the creation of a store with private capital showed
that the first two were most viable and that success is based on
partnerships between those that are familiar with the produce business,
existing business owners, and in the case of the second market, support
from local revitalization monies.
& Mohan, V. (2004). Doing Well by Doing Good? A Supermarket
Shuttle Feasibility Study. Journal
of Nutrition Education and Behavior, 36(2), 67-70.
feasibility of shuttles to supermarkets for transportation-dependent
people was investigated. The finding shows that only a 10%
participation rate among California zip codes with low
income, low vehicle ownership, and high population density
would create a profit for supermarkets. This may be a way to help those
in areas without good access to healthy foods.
S., Gittelsohn, J., Anlikers, J., Ethelbah, B. Blake, K., Sangita, S.,
Caballero, B. (2005). Process evaluation of a store-based environmental
obesity intervention on two American Indian Reservations. Health
Education Research, 20(6),
et al. used grocery store interventions on the Apache reservation in
east-central Arizona to prove that these types of interventions can
contribute to the health of a marginalized population. Store
surveys, mass media logging, cooking demonstrations and customer
evaluations were the instruments used. The reach and fidelity
of each intervention was measured by the customer evaluations. In-store
interventions that promoted new healthy products and the cooking
demonstrations were most effective. This article is an example of
process evaluation that is called for by to measure the efficacy of
(2008). Politics of food access in food insecure communities. Vanderbilt,
is Freedman's dissertation where food access was investigated through a
materialist-praxis theoretical orientation. She feels that qualitative
measures must be used to investigate the political aspects of food
access in food insecure communities. Through action-based methods she
investigated the creation of farmers markets around Boys and Girls
Clubs in Tennessee. She claims that GIS approaches are valuable, but
cannot uncover the social aspects of food access. Her theoretical
outlook is population-based as opposed to the popular notion of
individual behaviorist approaches to health issues. A part of her
mixed-methods research was to conduct food audits for a one-mile radius
of the clubs using store surveys and GIS. Stores were physically
visited and evaluated (Sharkey
& Horel 2008, Guy & David 2004,
Paquet et al 2008, Gallagher 2007a).
Both income and race were related with access to healthy food.
African-American areas of the study area had less access to healthy
food and more access to tobacco and alcohol. This was coupled with
participant-observation, interviews, and surveys of parents of those in
Boys & Girls Clubs. Focus groups were conducted with parents
and some with local stakeholders.
idea of the intersection between race and place became important
through Freedman's interviews. Eating healthy food was equated with
"being white." (See Zenk et al
2005b, James 2004).
provides a very thorough study of a particular population in a
particular space. She admits that generalizations can't be made across
communities. However, her creation of farmers markets through research
is an excellent example of community-involved research that uses
quantitative methods as a complement to
Freedman, D. A.
(2007a). Food oasis or food desert? An examination of food store
accessibility surrounding Boys and Girls Clubs: Food
Security Partners of Middle Tennessee.
is the retail density part of Freedman’s dissertation. It is discussed above.
Freedman, D. A.
(2007b). A community health case study: Creating a food oasis in a food
Community Psychologist, 40(2), 3.
is a report based on her thesis (Freedman
2008) that shows F&V consumption
increased in the neighborhood while the farmers market run by the local
kids existed. While this was a small case study in particular city and
causality can’t be inferred because of being a cross-sectional study,
it does suggest that there may be diverse options for bringing
F&V to underserved populations.
(2009). Local food environments: They're all stocked differently.
University of South Carolina.
article on the above study. Jetter & Cassady (2005)
are possibly misinterpreted as being used to support the assumption
that small stores do not provide healthy alternatives.
J., Dyckman, W., Tan, M. L., Boggs, M. K., Frick, K. D., Alfred, J.,
Winch, P. J., Haberle, H., Neal, P. A. (2006). Development and
implementation of food store-based intervention to improve diet in the
Republic of the Marshall Islands. Health
Promotion Practice, 7(4), 396-405.
Franceschini, M. C T., Rasooly, I. R., Ries, A. V., Ho, L. S.,
Pavlovich, W., Santos, V. T., Jennings, S. M., Frick, K. D. (2007).
Understanding the food environment in a low-income urban setting:
Implications for food store interventions. Journal
of Hunger & Environmental Nutrition, 2(2/3), 33-50.
is a formative study used to decide what interventions would best
improve food access in a Baltimore neighborhood.
& Instrumentation Issues
Black, J. L.
& Macinko, J. (2008). Neighborhoods and obesity. Nutrition
Reviews, 66(1), 2-20.
conceptual model for studying the environmental effects influences of
obesity that takes into account macro, meso, and individual-level
environments and behaviors was created. This review of obesity and
environment studies shows that lower physical activity is more
consistently associated with obesity than food environment.
Booth, S. L.,
Mayer, J., Sallis, J. F. et al. (2001). Environmental and societal
factors affect food choice and physical activity: Rationale,
influences, and leverage points. Nutrition
Reviews, 59(3), S21.
group of experts created a database of influences on eating and
physical activity. A conceptual model was created that maps influences
from a lifestyle center to external leverage points. Lifestyle, which
involves biological, cultural, social variables, and enablers of choice
such as cost, convenience, and time are the most important contributors
to food choice. According to their model, intervention takes place
outside the lifestyle center. While they admit that most behaviors
cannot easily be changed, environmental leverage points can meet at the
lifestyle needs to accommodate for positive changes in food choice.
a framework is good to keep in mind when measuring food access. The
lifestyle core should not be ignored as an important aspect to
behavior. Proper intervention must understand that the leverage points
for change exist outside and must accommodate to lifestyles.
N., Dowda, M., Pfeiffer, K., Porter, D., Almeida, M., & Pate,
R. (2007). Towards an understanding of salient neighborhood boundaries:
adolescent reports of an easy walking distance and convenient driving
Journal of Behavioral Nutrition and Physical Activity, 4(1), 66.
study is included just to mention the variability of neighborhood
boundaries among different populations and the difficulty of creating
units of analysis in spatial mapping. A few interesting points the
authors make through their results is that overweight girls actually
chose a longer convenient walking distance than others and Whites chose
a longer distance than African-American. This study shows that we must
be careful to generalize boundaries in studies, and that distances are
subjective according to populations
Sharma, S. (2009). Physical, consumer, and social aspects of measuring
the food environment among diverse low-income populations. American
Journal of Preventive Medicine, 36(4S),
is an assessment of the instruments used in food environment
interventions by the authors on Arizona reservations,
Islands, eight reservations in Canada, and inner-city Baltimore.
They recommend that formative assessments of the physical, consumer,
and social environments are necessary for measuring and assessing the
food environments. For example, neighborhood definitions should be used
cautiously because consumers may shop outside their own neighborhoods.
Accurate definitions of food stores are also important. Access should
also be measured inside the stores, not just based on geographic
location. Seasonality should be considered. Cultural and social
differences in food choice and behavior should also not be ignored.
conceptual framework dividing physical, consumer, and social aspects
used in this review is based on Glanz et al 2005.
Also, they define instruments and not methodologies. This distinction
is discussed in McKinnon
et al 2009.
K.,Sallis, J. F., Frank, L.D. (2005). Healthy nutrition environments:
Concepts and measures. American
Journal of Health Promotion, 19(5), 330-333.
et al create a conceptual model for conceptualizing and measuring food
environments based on:
Policy variables, including government and industry
Environmental variables, including community nutrition environments
(food store accessibility), Organizational environments (home, school,
work), Consumer Nutrition Environment, and the information environment
Individual variables, including psychosocial factors such as perceived
Lytle, L. A. (2009).
Measuring the food environment: State of the science. American
Journal of Preventive Medicine, 36(4S), S134-144.
small percentage of food environment studies that use psychometric
instruments have incorporated any sort of validation or reliability (See Glanz et al 2007).
The authors claim that environmental measures may not be useful for
hypothesis testing on account of the fact that most are
cross-sectional. More studies are called for that take into account the
behavior of individuals (Giskes et
al 2007 are used as an example of incorporating individual behavior).
Lytle provides four recommendations for future studies.
More construct validity is needed. She suggests that maybe the measures
should come from community involvement.
Provide more transparency in data-reduction
More rigorous study designs. For example, more multi-level analysis
More studies like Giskes et
al 2007 where the individual is put back in the
Reedy, J., Morrisette, M., Lytle, L. Yaroch. (2009). Measures of the
food environment: A compilation of the literature, 1990-2007. American
Journal of Preventive Medicine, 36(4S),
articles were reviewed that measure food environment. Of those studies,
68 were geographical analyses. 97 were from between 2002 and 2007. Only
18 of the studies tested for psychometric properties (See
Lytle 2009) of instruments. McKinnon et al. make
the distinction between instruments such as interviews and
methodologies such as geographic analyses. This list of articles was
compiled as a representation of the measures that have been used over
the last twenty years in studying the food environment.
Oakes, M. J.,
Masse, L. C., Messer, L. C. (2009) Work group III: Methodological
issues in research on the food and physical activity environments.
Addressing data complexity. American
Journal of Preventive Medicine, 36(4S),
challenges are presented in the studies of the effects of environment
on food and physical activity.
Conceptual models and theories: There are no elaborate theories or
models making research prone to mis-measurement leading to false
relationships. This is difficult given the transdisciplinary nature of
food environment studies.
Study designs are more observational than experimental and qualitative
methods are not being employed enough.
Analysis: Statistical inference and scientific explanation are not
properly understood. Assumptions should be recognized in analyses.
Measurement error: Validity concerns are superseded by reliability.
suggest that researchers need to think more about theoretical aspects
studies before and while they are conducting them, use more
cross-validation of data from different samples, and have a better
understanding of measurement error.
M., Zenk, S, Mason, Maryann. (2009). Measuring food availability and
access in African-American communities: Implications for intervention
and policy. American
Journal of Preventive Medicine, 36(4S).
authors claim that no existing, over-arching tools are available to
study the food environment among African Americans. They offer four
Identification of relevant food outlets: Small retail outlets may not
be represented properly in databases (See Moore & Diez-Roux 2006).
Alternative stores such as street vendors may be important to African
American communities. The authors found through qualitative work in
Chicago African American neighborhoods that mobile food vendors and
other sources are important (the study is not published).
Social impacts of neighborhoods; The authors found through interviews
in Chicago that safety in neighborhoods can be a barrier to food
access. Relations with immigrant store owners have been shown to also
be a barrier.
Daniel, M., Kestens, Y., Léger, K., & Gauvin, L. (2008). Field
validation of listings of food stores and commercial physical activity
establishments from secondary data. International
Journal of Behavioral Nutrition and Physical Activity, 5:58.
reliability of commercial databases and Internet searches of food and
physical-related establishments were tested through ground truthing
with field observations in Canada. They found that in relation to food
establishments the commercial database had high positive predictive
values and the Internet was moderate. Socio-economic status did not
have a significant effect. Therefore, the authors claim that commercial
databases are an acceptable alternative to expensive field research.
However, Canada may be unique in comparison to the US. As Moore & Diez Roux 2006
state, Info USA claims that 12% of businesses refuse to be counted. (See Wang et al. 2006 also).
Saelens, B. E
& Glanz, K. (2009). Work Group I: Measures of the Food and
Physical Environment. Instruments. American
Journal of Preventive Medicine, 36(4S),
and Glanz provide three challenges to the instruments used for
measuring food and physical activity environments:
Balance between new and old instruments: fewer instruments have been
created for measuring the food environments, but researchers should be
aware of their existence. This is the main crux of their argument.
Information should be shared freely and some sort of depository should
be created that promotes this sharing.
Research should respond to community involvement and be sensitive to
changes in the environment.
Scale: In relation to food access, the biggest issue is what is a
neighborhood? Also, they suggest that more than a single environmental
unit should be utilized in studies.
offer common guidelines for reporting research that provides: a
rationale for the instrument used, the constructs purported to be
measured, reliability and validity testing, detailed protocols on the
use of the instrument, scoring and scaling, modifications added to the
instrument, the setting of the research, and ways to access the
few other suggestions are to keep environmental and individual
measurements separate and not concentrate only on obesity in food
Gonzalez, A., Ritchie, L., & Winkleby, M. (2006). The
neighborhood food environment: sources of historical data on retail
food stores. International
Journal of Behavioral Nutrition and Physical Activity, 3:15.
of historical food retail store data were investigated: two from
government sources (a city business licensing department, and the State
Board of Equalization, SBOE) and three from commercial sources (Dun
& Bradstreet, Trade Dimensions, and the telephone business
directory). They found that SBOE databases under-represent stores and
phone books over-represent by comparing the different types. This study
suggests that secondary data sources should be strengthened through
observation. (See Paquet et al. 2008 for an argument on the validity of
author qualitatively studied a socio-economically diverse group of
women and found that ethnic markets and not grocery stores are dominant
sources of quality, affordable food (this was kind of shoe-horned into
the discussion, but is reflected in other studies).
Food Environment Assessments outside the US
Cloutier, M., & Shearmur, R. (2007). The case of Montreal's
missing food deserts: evaluation of accessibility to food supermarkets.
Journal of Health Geographics, 6:4.
tract centroids were used as proxies for store access in Montreal with
1000m buffers. They conclude that there are not problems with food
access. Diversity was measured as the number of supermarkets and
variety was the mean distance to the 3 closest supermarkets.
quote reinforces the need for mixed methods and multiple levels in food
access studies: "The choice to take into account the geographic
position of supermarkets but not their characteristics could be
considered as a limitation in our study. In fact, supermarkets can vary
greatly in terms of floor areas and quality of products but these
variables are not taken into account in our accessibility measures, and
neither are potential qualitative data related to purchasing
behaviour." This study in Canada does not reflect what has been found
in US cities.
Crawford, D., & Mishra, G. (2006b). Socio-economic inequalities
in women's fruit and vegetable intakes: a multilevel study of
individual, social and environmental mediators. Public
Health Nutrition, 9(5), 623-630.
multi-level analysis of women in Melbourne suburbs found that
socio-economic status factors (namely education) and social support may
influence F&V intake more than environmental factors on account
of the fact that those with high F&V intake were not
necessarily better served by retail outlets. Supermarkets and food
stores were not weighted and were found through the Yellow Pages. What
is a fruit and vegetable store? A strength of this study is the use of
physical surveys given to the sample group. A weakness is the fact that
the women were from suburban areas where retail access may not
necessarily be an issue.
addresses of women in Melbourne from high, moderate, and low-income
an extremely precise population measurement. They
et al. 2007
measures of density, proximity, variety and price. A 2 km buffer zone
from each residence via roads was used based on Donkin et al. 1999
to measure density. Audits of supermarkets and food stores were
conducted similar to Baker et al.
2006 to ascertain variety and price. ANOVA
variance and Bonferroni adjustments found that lower socioeconomic
position (SEP) had less supermarket density, but the majority of
F&V was equal. This is inconsistent with most US studies and
they acknowledge that US cities are possibly unique (See Apparicio et al 2007).
High fat foods did not vary. F&V were cheaper in lower SEP
neighborhoods. They admit that this may reflect quality and more
research is needed in this area. This is a cross-sectional study, but
they did use regression analysis clustering and found no variation from
the cross-sectional results. Interestingly, the findings contradict the
perception that F&V are more expensive and less accessible to
low SEP households (see Giskes
et al. 2007 and Moore & Diez Roux. 2008).
Clarke, G., Eyre,
H., & Guy, C. (2002). Deriving
indicators of access to food retail provision in British cities:
Studies of Cardiff, Leeds and Bradford. Urban
Studies, 39(11), 2041.
et al. searched for food deserts as defined by areas that have
populations unable to access food by car and are under serviced in
regards to supermarkets. They admit that this may be unrealistic
because people may use stores outside the "food deserts." Economic
Spatial interaction models were created to estimate "shopping flow"
using square feet of retail as measure. The model takes into account
attractiveness of stores, social class, and distance to retailer and
size of retailer and predicts flows from residence to shopping
spatial indicators were used: simple provision indicators were used as
a coarse indicator of retail space per household. Accessibility
indicators were created through GIS measuring 500m around each retail
store (This distance was chosen based on Wrigley 2002 and policy
makers' suggestions). Model-based indicators used the spatial
indicators to determine where food deserts exist.
methods are based on the neo-classical economic assumption that people
behave particular ways based on socio-economic status and the presence
of retail establishments. While Clarke et al. do admit that their
assumptions about smaller retailers providing a reduced selection of
food as subjective, there is no admittance of the lack of interaction
with those being studied to investigate motivation and behavior.
scenarios that they provide based on the addition of large supermarkets
in less serviced areas are interesting. Their models show that the
supermarkets could actually decrease food access by shutting down small
McKay, L., & MacIntyre, S. (2005). McDonald's restaurants and
neighborhood deprivation in Scotland and England. American
Journal of Preventive Medicine, 29(4), 308-310.
is a very simple study of McDonald's restaurants found in the Yellow
Pages and Census data in Scotland and England. No measures of obesity
were incorporated and only general deprivation as defined by the census
was used as a measure of each area. It is found that those with higher
deprivation have more McDonald's. This study is in the context of
Cummins' argument that broader studies are needed that avoid the "local
trap." He mentions the study in New Orleans (Block & Kouba 2004)
and claims that their scale is too small.
Donkin, A. J. M.,
Dowler, E. A., Stevenson, S. J., & Turner, S. A. (1999).
Mapping access to food at a local level. British
Food Journal, 101(7), 554.
et al. provide a "first indicator" of food accessibility for two
estates in the UK. This initial overview used a straight-line 2km
radius from two groups of dwellings. While they admit that this does
not create a full picture of access, there are a couple of strengths to
this study. Four separate food lists were created based on ethnic
taste. Also, every store in the area was surveyed for availability and
price. One interesting finding is the fact that a UK white person on
welfare would have to spend 50% of his or her income to be provided
with a healthy diet. This expresses the fact that accessibility is not
only spatial, but economic.
Blakely, T., Witten, K., & Bartie, P. (2007). Neighborhood
deprivation and access to fast-food retailing: a national study. American
Journal of Preventive Medicine, 32(5), 375-382.
access and healthy food access (as defined by supermarkets, convenience
stores, and service stations) was measured in relation to meshblocks
(census blocks of 100 people) and schools in New Zealand.
Socio-economic deprivation was used as the independent variable, and it
was found that access is better for “deprived” blocks and schools for
fast food outlets. However, there was also better access to healthy
food outlets, indicating that population density may effect more access.
& Gilliland, J. (2008). Mapping the evolution of 'food deserts'
in a Canadian city: Supermarket accessibility in London, Ontario. International
Journal of Health Geographics, 7(16),
was used to map supermarkets in London, Ontario in relation to walking
and public transit. Also, a longitudinal perspective was used through
the mapping of supermarkets in 1961 as compared with 2005. A network
buffer of 1000m was used based on foot and bus paths (10 min bus ride)
to block centroids. Supermarket locations were found through phone
directories, websites, calling stores, air photos, maps, and site
visits. GIS was manually reviewed. Local business directories were used
for 1961 locations (see Wang et
al. 2006 et al. for a review of historical data use).
of Census tracts
were used to investigate disparities by income: walking access was
poorer in low-income, but better for low-income in relation to bussing.
Distance to supermarkets in general was not significantly different
between census tracts. Supermarket access in general has significantly
diminished since 1961.
Russell, J., Campbell, M., & Barker, M. (2005). Do 'food
deserts' influence fruit and vegetable consumption?--A cross-sectional
is a cross-sectional study of 1000 addresses in four wards of South
Yorkshire. Surveys were sent to homes asking demographics and a 24 hour
food recall. This was compared with road travel distance to nearest
supermarket. They found that gender and age have more to do with
F&V intake than poverty and distance to supermarkets. They also
found that those without a car did not have less consumption of
F&V. The small sample size of this study makes this only a
cursory look at this population. Nevertheless, it reflects other
studies from outside the US that reflect little inequality to food
access based on socio-economic status. They suggest that cultural
factors should be taken into account, bring the issue of food security
back to the individual level (See
& Blair, A. (2003). Unjust des(s)erts: food retailing and
neighbourhood health in Sandwell. International
Journal of Retail & Distribution Management, 31(9), 459-465.
codes were investigated in Sandwell for walking access (500m) to stores
carrying eight types of fruits and vegetables at reasonable prices.
This was accomplished by visiting every store because they claim that
shop type may not describe what is sold (see Sharkey & Horel 2008).
They found that it is much easier to purchase junk food and cigarettes
than F&V. They also interviewed shop owners and found that
demand does not account for the lack of F&V but is based on
shelf life of perishables. The inclusion of qualitative studies of
stores suggests that retail type and not personal behavior causes
Macintyre 2007 for opposing view).
study suggests that there are actually “food deserts” in the UK.
conclusions section includes community intervention strategies.
K. E., Spence, J. C., Raine, K. D., Amrhein, C., Cameron, N.,
Yasenovskiy, V., et al. (2008). The association between neighborhood
socioeconomic status and exposure to supermarkets and fast food
& Place, 14(4), 740-754.
supermarkets and fast food outlets were mapped by census blocks in
Edmonton and evaluated for race/ethnicity, income, employment,
education, age, housing tenure, and population density. They note that
income is the only significant indicator of food environment, most
notably access to fast food restaurants; lower income has easier access.
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