Neighborhood characteristics and availability of healthy foods in Baltimore.
BACKGROUND
Differential access to healthy foods may contribute to racial and economic health disparities. The availability of healthy foods has rarely been directly measured in a systematic fashion. This study examines the associations among the availability of healthy foods and racial and income neighborhood composition.


METHODS
A cross-sectional study was conducted in 2006 to determine differences in the availability of healthy foods across 159 contiguous neighborhoods (census tracts) in Baltimore City and Baltimore County and in the 226 food stores within them. A healthy food availability index (HFAI) was determined for each store, using a validated instrument ranging from 0 points to 27 points. Neighborhood healthy food availability was summarized by the mean HFAI for the stores within the neighborhood. Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood characteristics with healthy food availability.


RESULTS
Forty-three percent of predominantly black neighborhoods and 46% of lower-income neighborhoods were in the lowest tertile of healthy food availability versus 4% and 13%, respectively, in predominantly white and higher-income neighborhoods (p<0.001). Mean differences in HFAI comparing predominantly black neighborhoods to white ones, and lower-income neighborhoods to higher-income neighborhoods, were -7.6 and -8.1, respectively. Supermarkets in predominantly black and lower-income neighborhoods had lower HFAI scores than supermarkets in predominantly white and higher-income neighborhoods (mean differences -3.7 and -4.9, respectively). Regression analyses showed that both store type and neighborhood characteristics were independently associated with the HFAI score.


CONCLUSIONS
Predominantly black and lower-income neighborhoods have a lower availability of healthy foods than white and higher-income neighborhoods due to the differential placement of types of stores as well as differential offerings of healthy foods within similar stores. These differences may contribute to racial and economic health disparities.
Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205-2217, USA. mfranco@jhsph.edu
Manuel
M
Franco
Ana V
AV
Diez Roux
Thomas A
TA
Glass
Benjamín
B
Caballero
Frederick L
FL
Brancati
D015142:Baltimore / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005502:Food / Q000145:classification*; D019649:Food Industry / Q000145:classification* / Q000592:standards; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D008913:Minority Groups / Q000706:statistics & numerical data; D009753:Nutritive Value; D044469:Racial Groups; D012044:Regression Analysis; D012111:Residence Characteristics / Q000145:classification / Q000706:statistics & numerical data*; D012147:Restaurants / Q000706:statistics & numerical data*; D012931:Social Environment; D012959:Socioeconomic Factors; D014481:United States