Neighborhood Food Availability, Disparities, and Childhood Obesity Risk

1. Neighborhood Food Availability, Disparities, and Childhood Obesity Risk Helen Lee Senior Research Associate, MDRC helen.lee@mdrc.org

2. Scientists Sound the Alarm on Obesity Early • “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 Childhood Obesity Prevalence Rates SOURCE: National Health and Nutrition Examination Surveys (NHANES)

4. And Disparities are Large Percent obese by race/ethnicity Percent 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 • 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 • 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

8. But Empirical Foundation and Evidence is Inconclusive… Research Questions: • Are there distinct patterns in food access by neighborhood poverty and race? • 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 • Longitudinal database of children (Early Childhood Longitudinal Study – Kindergarten Cohort (ECLS-K)) • Nationally-representative study of 20,000 kindergarteners attending school in 1998-1999 • Looked at kids followed from K to 5th 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 • 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).

13. How One Measures Food Environments Might Matter

14. Null Findings for Food Availability and Child Weight Outcomes SOURCE: ECLS-K, Kindergarten to 5th grade panel, 1999-2004, and NETS, 1998-2004 NOTES: First panel estimates show associations between food outlet density (stores per sq mile) and child BMI percentile at kindergarten wave, from cross-classified random-effects models adjusted for other covariates. Second panel estimates show associations between change in prevalence of food outlets (growth or decline) and change in BMI percentile over elementary school, from cross-classified random-effects models adjusted for other covariates, and time.

15. Implications • 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)

17. Conclusion • 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?