MEASURING SOCIO-SPATIAL INEQUITIES TO RETAIL FOOD ACCESS IN HAWAII

Elise Dela Cruz-TalbertBuilding a Food Environment Community of Practice

November 16, 2016

Agenda■ Obesity and Retail Food Environment studies

■ Mapping the Retail Food Environment (mRFE calculation)

■ Results

■ Food System Discussion

Obesity risks and rates■ Underweight and obesity status were

both associated with excess deaths when compared to normal weight, while overweight was not (Flegal et al., 2005).

■ Obesity contributes to cardiovascular disease, Type II diabetes, osteoarthritis, and some cancers (Foster, Burton, & Van Itallie, 1985; Must et al., 1999; Flegal et al., 2005).

■ Global adult obesity prevalence, rates nearly doubled from 4.8% to 9.8% for men and 7.9% to 13.8% for women in the span of 1980 to 2008 (Finucane et. al, 2011).

■ In the US, obesity prevalence among adults aged 20 years and older, from 23% to 34% for the years 1988-1994 compared to 2007-2008 (Flegal et al., 2010; Ogden and Caroll, 2010).

■ Among children ages 2-8y in Hawaii, Alaska, and the US-Affiliated Pacific Islands, OWOB to be higher than the global estimate (~7%) and that rates increased with age, from 21% at age 2 years to 29% at age 8 years (Novotny et al., 2015).

Obesity and poverty spatial disparitiesCounty-level Estimates of Obesity among Adults aged 20 years or older, 2009

County-level poverty prevalence, all ages, by nonmetro and metro county; U.S. Census, 2015

County-level poverty prevalence, for <18 years, by nonmetro and metro county; U.S. Census, 2015

US Childhood Obesity Prevalence Estimated at the Census Block Level, 2011

Obesity and poverty spatial disparities

Can community retail food environments help explain spatial obesity disparities?

Research Questions:1. Are there geographic differences in the access and availability of foods or

disparities in the retail food environment?2. Do neighborhoods of low socioeconomic status with high concentrations of

racial/ethnic minorities have limited accessibility and availability of healthy foods (poor-quality retail food environment)?

3. Are individuals exposed to poor-quality retail food environments more likely to have diets that include foods of low nutritional quality and high caloric density, and higher rates of obesity and other health outcomes, as compared to individuals exposed to high-quality food environments?

Definitions: ■ Healthier food: include fruits, vegetables, whole grains, fat-free and low-

fat dairy products, and seafood, as well as foods with less sodium (salt), saturated fats, trans fats, cholesterol, added sugars, and refined grains

■ Healthier beverages: include fat-free or low-fat milk and milk products, fortified soy beverages and other lactose-free products, 100% juice, and water

■ Food Desert: geographic areas marked by limited healthy food options ■ Food Swamp: geographic areas marked by high availability of unhealthy

food options■ Home Food: food prepared at home■ Away Food: food prepared away from the home, such as at restaurants

Home Food:

■Grocery stores have greater availability and quality of healthier food than convenience stores.

■Supermarkets have more fresh food items compared to small and medium grocery stores.

Away Food:

■Total calories consumed from away food has increased.

■Fast foods were found to be the highest in fat content and energy density among away food sources.

■A systematic review of 28 studies found a positive association between eating out and obesity.

Energy density, and fat content, of menus in the UK, compared between Fast foods, Supermarket, and the traditional Gambian diet

Source: Prentice and Jebb, 2004

Modified Retail Food Environment Index

CDC Children’s Food Environment Report

% HS Students Who Drank ≥1

Soda/Day

% Children Ages 12-17 Not Eating Family Meals Most

Days of Week

Modified Retail Food

Environment Index

Modified Retail Food

Environment Index -

Impoverished Census Tracts

Hawaii 20.8 25.0 12 12

US Average 29.2 30.7 10 7

Source: Centers for Diseases Control and Prevention, Children’s Food Environment State Indicator Report, 2011.

Insights and Limitations■Summary

– Honolulu and Kapolei are food swamps!– The zip codes with the lowest mRFE score do not correspond to

neighborhoods with higher percentage of NHPI and higher percentage of poverty (top quintile, adjusted by populations size).

■Data Limitations– Underlying assumptions that nutrition based on outlet type– Doesn’t capture how individuals interact with their environment– Doesn’t capture non-retail sources of food (hunting, fishing,

gathering, gardening)