We have been studying how differences in neighborhood retail food environments are associated with body mass index (BMI) and diet. Our primary tool for study neighborhood food environments has been Dunn & Bradstreet business listing data which we used to develop measures of the density of retail outlets we consider BMI Healthy, BMI Unhealthy and BMI Neutral . We have also performed methodological research to understand how neighborhood level differences in vehicle ownership rates, public transit access, and impediments to pedestrian travel, such as crime and poor traffic safety, might exacerbate or reduce neighborhood level disparities in access to supermarkets .
In our NIEHS funded study of BMI in ~13,000 residents of NYC we found that the density of BMI Healthy retail outlets within 0.5 miles of the subject’s home was associated with significantly lower BMI . However, BMI was not associated with the density of BMI Unhealthy retail outlets. In a second study using NYC birth record data we found that a higher number of BMI Healthy retail outlets in a mother’s Census tract was associated with a lower odds of maternal obesity . These findings on BMI Healthy outlets were used as part of the scientific rational for the NYC FRESH initiative to bring supermarkets into neighborhoods under served by retail outlets selling healthy food.
Results from our qualitative interview study showed that foreign-born, Hispanic mothers of children in Head Start distrusted and were dissatisfied with food purchased in supermarkets . They felt that produce and meats in supermarkets was not fresh, was likely to be contaminated with chemicals and had poor flavor. Their descriptions of what constituted healthy food aligned with the the organic farming, slow food and locavore movements, food systems they reported experiencing in their countries of origin. These women reported that they preferred to shop at farmers markets and live small animal markets in NYC. The map below shows the distribution of farmers markets and live animal markets in NYC.
Our analyses of food frequency questionnaire data from a larger group of Hispanic women showed that having a farmers market with 0.5 Km of the home was associated with higher consumption of fruits and vegetables and that having a farmers market or slaughter house within this distance of home was associated with higher meat consumption . Consumption of fruit and vegetables and meat was not associated with the presence of a supermarket in their neighborhoods.
In our NIDDK funded research using the NYC Community Health Survey data, we found that only ~10% of the survey respondents reported eating five or more servings of fruit and vegetables in the day prior to the survey . The odds of having eaten five or more servings was positively associated with education and income, and among women, there was an interaction between the poverty rate of the residential zip code and the woman’s education in predicting fruit and vegetable consumption. The association between education and consumption was significantly stronger if the woman lived in a low poverty zip code. This finding parallels our prior finding that among women neighborhood-level poverty rates and individual-level socio-economic status interaction to predict BMI . Differences in zip code level access to supermarkets and fruit and vegetable markets did not explain the disparities in consumption by education and income .
We were also funded by NIDDK to study the quality of grab-and-go and take-out food in convenience stores and Bodegas and to compare these food outlets to traditional fast food outlets. Much of the literature on food environments has focused on fast food and has ignored the possible contributions of these other retail outlets as sources of energy dense convenience foods. We audited the nutritional quality and promotion of food in fast food outlets, convenience stores and Bodegas in lower and higher income neighborhoods using the Nutrition Environment Measures Survey for restaurants.