Review and special articleNeighborhood Environments: Disparities in Access to Healthy Foods in the U.S.
Introduction
A growing body of evidence indicates that residential segregation by income, race, and ethnicity contributes to health disparities in the U.S. 1, 2, 3, 4, 5, 6, 7 In addition, substantial research shows disparities in health between urban and rural areas. 8 Poor dietary patterns and obesity, established risk factors for chronic disease, have been linked to neighborhood deprivation, neighborhood minority composition, and low area population density (as found in more rural areas). 9, 10, 11, 12, 13, 14, 15 Neighborhood differences in access to foods may be an important influence on these relationships. Establishing the presence, nature, and implications of neighborhood differences in the physical availability of more- and less-healthy foods is necessary to properly inform the development of responsive public health policies and interventions that may help reduce inequalities in health.
Recent reviews have drawn attention to relationships among neighborhood food availability, dietary intake, and obesity, but to our knowledge, a detailed review of disparities in food access has not been completed. 16, 17 For this review, neighborhood is broadly defined to be “the area around one's place of residence,” and research relating to both micro- (e.g., stores within walking distance from home) and macro-level characteristics (e.g., restaurants within county boundaries) of the physical food environment are considered. This article briefly reviews the current evidence base regarding (1) the relationship between neighborhood access to more- and less-healthy foods and dietary intake and (2) the relationship between neighborhood access to foods and weight status. In addition, this article presents a comprehensive review of disparities across the U.S. according to income, race, ethnicity, and urbanization in neighborhood access to more- and less-healthy foods. Studies relating to both food stores and restaurants are summarized separately and discussed in terms of their limitations and implications for future research and practice.
Section snippets
Methods
A snowball strategy was used to identify relevant research studies completed in the U.S. and published between 1985 and April 2008. Searches were completed in PubMed and MEDLINE using the following key words: neighborhood; environment; food store; supermarket; restaurant; dietary intake; obesity; overweight; disparity; inequality; deprivation; income; poverty; rural; race; and ethnicity. The references cited in articles (n=43) indexed in these search engines were also checked; and all
Retail Food Stores and Dietary Intake
Supermarkets, as compared to other food stores, tend to offer the greatest variety of high-quality products at the lowest cost. 18, 19, 20, 21, 22, 23 In contrast, convenience stores sell mostly prepared, high-calorie foods and little fresh produce, at higher prices. 24 Studies of adults 18, 25, 26, 27, 28, 29 and adolescents 30 have examined associations between neighborhood access to food stores and intake of fruits and vegetables, calories from dietary fat, and overall diet quality. The
Discussion
The aim of this review is to describe and evaluate research relating to neighborhood differences in the physical availability of food stores, restaurants, and healthy foods. Associations of neighborhood food access with dietary intake and obesity were found to vary according to the type of food store or restaurant. In general, research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower
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