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NEIGHBORHOOD FOOD AVAILABILITY, DISPARITIES, AND CHILDHOOD OBESITY RISK Helen Lee Senior Research Associate, MDRC

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Presentation on theme: "NEIGHBORHOOD FOOD AVAILABILITY, DISPARITIES, AND CHILDHOOD OBESITY RISK Helen Lee Senior Research Associate, MDRC"— Presentation transcript:

1 NEIGHBORHOOD FOOD AVAILABILITY, DISPARITIES, AND CHILDHOOD OBESITY RISK Helen Lee Senior Research Associate, MDRC

2 Scientists Sound the Alarm on Obesity Early 2  “It is clear that weight control is a major public health problem”  Experts at the American Public Health Association Annual Meetings declare obesity as problem #1  The year is 1952:  1 McDonald’s in the nation  6 pack of Coca Cola contains fewer ounces than one Big Gulp  10% of the nation is estimated to be obese

3 Despite Warnings, Obesity Rates Rise Dramatically 3 SOURCE: National Health and Nutrition Examination Surveys (NHANES) Childhood Obesity Prevalence Rates

4 And Disparities are Large 4 Percent obese by race/ethnicityPercent obese by maternal education SOURCE: Early Childhood Longitudinal Study – Kindergarten Cohort (ECLS-K), 1999 and 2004

5 Concerns Are Multi-faceted, but Framing Becomes Simplified 5  Most research suggests increased calorie consumption explains rise in obesity (Cutler et al. 2003; Lakdawalla et al. 2005)  Parallels to tobacco control drawn (e.g, “toxic” exposure)  Focus efforts upstream: Obesity risk is involuntary and universal (Lawrence, 2004)  “Obesogenic” environments arguably potential culprits  Advertising and media exposure  Supersizing of the food industry  Agri-business (e.g., high fructose corn syrup)  Pricing policy

6 Policymakers Respond 6  Increasing discussion in policy circles of “food deserts” and their consequences for disparities  Poor, minority neighborhoods more likely to lack access to healthy food (Gallagher 2006; Moore & Diez-Roux 2006; Powell et al. 2007)  First Lady’s “Let’s Move” campaign  Federal Healthy Food Financing Initiative  Policy efforts to decrease exposure to “toxic” vendors  L.A.’s fast food establishment moratorium in South Central  NYC’s super-size soda ban

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8 But Empirical Foundation and Evidence is Inconclusive… 8 Research Questions: 1) Are there distinct patterns in food access by neighborhood poverty and race? 2) Do differences in residential food availability explain obesity risk over young childhood?  Do they explain disparities?

9 Merged Individual Data on Children with Neighborhood Food Establishments 9  Longitudinal database of children (Early Childhood Longitudinal Study – Kindergarten Cohort (ECLS-K))  Nationally-representative study of 20,000 kindergarteners attending school in  Looked at kids followed from K to 5 th grade (7,730 out of ~11,000 children in full K-5 sample)  Longitudinal national database of all business establishments (National Establishment Time Series Data (NETS))  Use industry codes, trade name, HQ, sales, and size to isolate food vendors

10 Key Measures 10  Child outcome: changes in BMI percentile  BMI is weight in kg/ height in meters squared  Used BMI-sex-age specific growth charts to calculate where child falls in percentile distribution  Food availability: density per sq. mile  Supermarkets/large-scale grocery stores At least $2 million in sales; Appended warehouse clubs, supercenters  Corner grocery stores Grocery stores operated by 3 employees or less  Convenience stores Sell limited line of goods; Also includes gas stations  Full-service restaurants Provide food to patrons who are served and pay after eating  Fast-food restaurants Limited service, chain restaurants (based on top 100 list)

11 11 Minority Neighborhoods Have Higher Concentrations of Various Food Vendors SOURCE: NETS 2006 and Census 2000 NOTES: Based on all U.S. non-rural Census tracts, weighted by population. Similar patterns are found when tracts restricted to ECLS-K children in K-5 analytic sample. * denotes difference is significant in reference to majority white neighborhoods (p<0.05). * * * *

12 12 Poorer Areas Do Not Have Worse Access to Healthy Food Stores SOURCE: NETS 2006 and Census 2000 NOTES: Based on all U.S. non-rural Census tracts, weighted by population. Similar patterns are found when tracts restricted to ECLS-K children in K-5 analytic sample. * denotes difference is significant in reference to majority white neighborhoods (p<0.05).

13 How One Measures Food Environments Might Matter 13 Food availability measureNon- poor PoorVery poor WhiteBlackHispanic Density per 1,000 pop Supermarkets Corner stores Convenience stores Fast food Minimum distance (miles) Supermarkets Corner stores Convenience stores Fast food Shares (% out of all food stores) Supermarkets 3%2%1%3%2% Corner stores 8%17%21%8%21%18% Convenience stores 14%17%15%14%18%15% Fast food 10%8%6%10%8%7%

14 Null Findings for Food Availability and Child Weight Outcomes 14 Food availability (density per square mile)CoefP

15 Implications 15  How problematic are food deserts?  SSM study: Easy access to food retailers of all types, rather than lack of access, better portrays the food environments of disadvantaged communities  We need to do better job at thinking through the behavioral mechanisms of our policy solutions  Food access likely less important than other factors  “A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man does not… When you are unemployed you don’t want to eat dull wholesome food. You want to eat something a little tasty. There is always some cheap pleasant thing to tempt you.” -- George Orwell, quoted in Banerjee and Duflo (Poor Economics)

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17 Conclusion 17  Tobacco control may not be the right parallel:  While overall smoking has declined, SES disparities have increased  Disparities in obesity rates have narrowed, disparities in health outcomes associated with obesity grown  If poverty is heart of the concern, weigh benefits and costs of other strategies to improve health  Instead of food deserts, what about income deserts? Education deserts? Health care deserts?


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