Presentation on theme: "NEIGHBORHOOD FOOD AVAILABILITY, DISPARITIES, AND CHILDHOOD OBESITY RISK Helen Lee Senior Research Associate, MDRC"— Presentation transcript:
NEIGHBORHOOD FOOD AVAILABILITY, DISPARITIES, AND CHILDHOOD OBESITY RISK Helen Lee Senior Research Associate, MDRC
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
Despite Warnings, Obesity Rates Rise Dramatically 3 SOURCE: National Health and Nutrition Examination Surveys (NHANES) Childhood Obesity Prevalence Rates
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
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
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
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?
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
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 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 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).
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%
Null Findings for Food Availability and Child Weight Outcomes 14 Food availability (density per square mile)CoefP
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)
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?