FOOD IN THE U.S.
IN HUNDREDS OF NEIGHBORHOODS
ACROSS THE COUNTRY, NUTRITIOUS,
AFFORDABLE, AND HIGH QUALITY
FOOD IS OUT OF REACH—
PARTICULARLY LOW-INCOME
NEIGHBORHOODS, COMMUNITIES
OF COLOR, AND RURAL AREAS.
FOOD ENVIRONMENT: STATISTICS
Of all U.S. households, 2.3 million (2.2%) live more than a mile from a supermarket
and do not have access to a vehicle.
An additional 3.4 million households (3.2%), live between one-half to 1 mile and do
not have access to a vehicle.
23.5 million people live in low-income areas (areas where more than 40 percent of
the population has income at or below 200 percent of Federal poverty thresholds)
that are more than 1 mile from a supermarket or large grocery store.
Data on time use and travel mode show that people living in low-income areas with
limited access spend significantly more time (19.5 minutes) traveling to a grocery
store than the national average (15 minutes).
CONTEXT
NEIGHBORHOOD AND COMMUNITIES
Contribute to racial disparities in weight status
 Access to supermarkets linked to healthy food consumption
and overall dietary quality
 Less access to supermarkets and diverse food outlets in lowincome, African-American, and Native American communities
 Lower availability of healthful options in low-income and
African-American communities (most FV)
Sources: (Cheadle, 1991; Morland, Wing and Diez Roux, 2002; Morland et al.,
2002; Laraia et al., 2004; Blair et al, 2005; Zenk et al, 2005)
INEQUALITY IN FOOD ACCESS
Chicago
“You go all the way out to the
suburbs…and you find
everything…It’s even a better
variety in [chain supermarkets]
when you go to their stores. There’s
a difference.”
Detroit
“You’ve got to go out in the suburbs now
to get some decent food. And therefore,
it’s not available for us in this community.
By the time you get to that store and get
some fresh fruits and vegetables, you’re
going to pass about 30 fast food joints
and about 100 liquor stores.”
FOOD AS ECONOMIC DISINVESTMENT
CHALLENGES TO DIETARY BEHAVIORS
RISK FOR POOR DIETS
Low Access
Low Affordability
High Exposure to Marketing
Cycles of Food Deprivation
and Overeating
High Levels of Stress
Based on ANGELO –Analysis Grid for Environments Linked to Obesity Swinburn et al, Preventive Medicine, 1999. From Yancey AK et al, Prev
Chronic Dis. 2004 Jan;1(1):A09.
RACE AND ETHNICITY
INCOME/SES
FOOD ACCESS
FOOD JUSTICE
FOOD EQUITY
Excess mortality in marginalized populations could be both a cause and an
effect of political processes.
SOCIAL PRODUCTION OF HEALTH AND ILLNESS
“Do we not always
find the disease of
the populace
traceable to defects
in society.”
1821-1902
Rudolf Virchow
“Father” of Social Medicine
PARADIGM SHIFT: SOCIAL DETERMINANTS OF HEALTH
Social determinants of health are the economic and
social conditions that influence the health of individuals,
communities, and jurisdictions as a whole.
Social determinants of health are about the quantity
and quality of a variety of resources that a society
makes available to its members.
PARADIGM SHIFT: AVOID THE LIFESTYLE TRAP
 Lifestyle choices are heavily structured by life circumstances
 Lifestyle choices by themselves account for modest proportions
of health status
 Lifestyle choices are difficult to change without considering life
contexts
 Lifestyle choice emphases can have unintended side-effects that
work against health
A COMMUNITY-CENTERED VIEW OF INFLUENCES ON EATING, ACTIVITY, AND BODY
WEIGHT
Influences of Culture and Mindset
What are our social values?
What do we believe in?
What gives us pleasure?
Environments to Navigate
What gives comfort?
How do we cope with stresses?
What is fair treatment?
What is our history? How
does it affect the way we live now?
Who earns our trust
and our loyalty?
Do we have money
to buy the things we need?
What are our neighborhoods like?
What kinds of social institutions do
we have?
What type of food is available?
How much does it cost?
How do our faith communities
support us?
Where are opportunities for recreation
and outdoor activities?
What are our families like?
Who sponsors community events?
What are our community strengths?
What messages do we get
from TV, radio,
outdoor ads, the web?
What is our collective strength
for taking action?
Historical and Social Factors
Health and wellness
High quality of life
Long life
© African American Collaborative Obesity Research Network
DEFINITION OF CBPR
“ A Partnership approach to research that
equitably involves community members,
organizational representatives and researchers
in all aspects of the research process” Israel,
BA et al. (2001)
VALUES AND PRINCIPLES OF CBPR
Recognizes community as self-determining unit
Builds on strengths and resources
Facilitates partnership in all research phases
Promotes co-learning and capacity building
Seeks balance between research and action
Disseminates findings and knowledge to all
Involves long-term process and commitment
Israel, Schulz, Parker, Becker, Allen, Guzman, “Critical Issues in developing and following CBPR principles,” Community-Based
Participatory Research in Health, Minkler and Wallerstein, Jossey Bass, 2000.
RATIONALE FOR CBPR
Complex health and social problems ill-suited to “outside expert”
research
History of research abuse and mistrust: “helicopter” or “drive-by”
research
Disappointing results in intervention research
Increasing understanding of importance of local and cultural
context/external validity
Increasing interest in use of research to improve best practices/best
processes
RATIONALE FOR CBPR
Eliminating health disparities is imperative
Translating evidence to practice requires the involvement of minority
populations in research
Involvement in research cannot be approached solely through
individuals
“There is nothing new about poverty. What is new, however, is that
we now have the resources to get rid of it. The time has come for
an all-out world war against poverty … The well off and the
secure have too often become indifferent and oblivious to the
poverty and deprivation in their midst. Ultimately a great nation is
a compassionate nation. No individual or nation can be great if it
does not have a concern for ‘the least of these.”
“Where Do We Go From Here: Chaos or
Community?”
DOING ME! SISTERS STANDING TOGETHER
FOR A HEALTHY MIND AND BODY
4 month weight loss intervention in low-income African
American neighborhood in Chicago
Based on the Obesity Reduction Behavioral Intervention TrialORBIT (NCI: Fitzgibbon)
University-based vs. Community-based
Targets women 30-65 years of age
Funded by American Cancer Society-Illinois Division (PI:
Odoms-Young)
BASELINE WEIGHT PERCEPTIONS
Measure
% Very/Mostly
Dissatisfied (n=60)
Face
15%
Hair
21%
Lower Torso
48%
Mid Torso
90%
Upper Torso
46%
Muscle Tone
72%
Weight
89%
Overall Appearance
25%
BASELINE PSYCHOSOCIAL MEASURES
Measure
Mean (SD) (n=60)
Minimum
Maximum
John Henryism
(0-48)
38.8 (5.6)
26
48
Acute Unfair
Treatment (0-9)
2.4 (2.1)
0
8
Everyday Unfair
Treatment (0-40)
12.3 (6.0)
0
28
Adverse Childhood
Experiences
(0-10)
2.7 (2.7)
0
10
BASELINE TOP 5 MOST REPORTED EVENTS OF
CRISYS
Questions
%
Class I
Class II
Class III
Did your hear violence outside
of your home?
58.1%
33.3%
30.6%
36.1%
Did you look for job?
46.9%
30%
26.7%
43.3%
Did anything happen in your
neighborhood or home that
made you feel unsafe?
42.8%
33.3%
26%
40.7%
Did you see drug dealing in your
building or neighborhood?
38.1%
33.3%
20.8%
45.8%
Did your income decrease by a
lot?
37.5%
33.3%
25%
41.7%
BASELINE WEIGHT PERCEPTIONS
Measure
% Very/Mostly
Dissatisfied (n=60)
Face
15%
Hair
21%
Lower Torso
48%
Mid Torso
90%
Upper Torso
46%
Muscle Tone
72%
Weight
89%
Overall Appearance
25%
BASELINE PSYCHOSOCIAL MEASURES
Measure
Mean (SD) (n=60)
Minimum
Maximum
John Henryism
(0-48)
38.8 (5.6)
26
48
Acute Unfair
Treatment (0-9)
2.4 (2.1)
0
8
Everyday Unfair
Treatment (0-40)
12.3 (6.0)
0
28
Adverse Childhood
Experiences
(0-10)
2.7 (2.7)
0
10
BASELINE TOP 5 MOST REPORTED EVENTS OF
CRISYS
Questions
%
Class I
Class II
Class III
Did your hear violence outside
of your home?
58.1%
33.3%
30.6%
36.1%
Did you look for job?
46.9%
30%
26.7%
43.3%
Did anything happen in your
neighborhood or home that
made you feel unsafe?
42.8%
33.3%
26%
40.7%
Did you see drug dealing in your
building or neighborhood?
38.1%
33.3%
20.8%
45.8%
Did your income decrease by a
lot?
37.5%
33.3%
25%
41.7%