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© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.105262
IMAGES OF HEALTH |
Manuel Franco, Arijit Nandi, and Thomas Glass are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. Ana Diez-Roux is with the Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor.
Correspondence: Requests for reprints should be sent to Manuel Franco, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Suite 2-607, Baltimore, MD 21205-2217 (e-mail: mfranco{at}jhsph.edu).
THE GROCERY STORE IN THE image represents a typical store in Baltimore’s inner city. This store is located in the "Middle East" neighborhood of East Baltimore, within 5 blocks of the Johns Hopkins Bloomberg School of Public Health. Census data from 2000 show that, in this neighborhood, 94.4% of residents are African American, 64.4% of family households are female-run households with no husband present, the unemployment rate is 23.5%, the median household income is $15 493, and only 53.6% of adults have completed high school.
As part of our study addressing the association between the availability and price of food and diabetes and obesity, we spent 5 months identifying the type and location of food stores, interviewing store managers, and collecting data on the availability and price of foods in 240 stores located in the Baltimore-area neighborhoods where the 963 participants in our study resided.1 Out of the 187 food stores located within the city, 17 were classified as supermarkets, 136 as grocery stores, and 34 as convenience stores. A total of 25 participants in the study live within 1 mile of the grocery store in the image. We asked the grocery store managers what items they sold the most of. Cigarettes were consistently at the top of the list. The image shows a store where cigarettes are advertised, but no sign exists that shows that this is an actual grocery store.
The 2005 Dietary Guidelines for Americans, published jointly every 5 years by the US Department of Health and Human Services and the US Department of Agriculture, recommend increasing the consumption of fruits, vegetables, whole grains, and fat-free dairy products.2 No fresh fruits or vegetables, whole wheat bread, or skim milk are sold in the city’s grocery stores. Only "convenience food" items, such as whole milk, sodas, chips, and canned foods are typically available. The store in the image is not the exception but the rule in Baltimore inner city neighborhoods. We found that the price of whole milk, cereal, and white bread in this store was 20% higher than in the closest supermarket 0.9 miles away.
Several studies support the hypothesis that economic and racial disparities in obesity and diabetes may be, at least partially, explained by the food environment.3,4 Public health research and interventions on obesity and diabetes should include the local food environment (measured by the availability and prices of recommended foods) as determinants of poor diets and, most importantly, as barriers to the prevention and treatment of these common conditions. Interventions and policies aimed at improving the food environment by making recommended foods available and affordable are crucial to stopping the current trends in obesity and diabetes.
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Acknowledgments |
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Manuel Franco was funded by the Ful-bright Commission, the Welch Center, and the Center for a Livable Future, both at the Johns Hopkins Bloomberg School of Public Health.
The authors thank Carles Lerín for taking photographs during the field work and all the food store managers in Baltimore.
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Footnotes |
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Contributors
M. Franco was responsible for the design of the study, collection and analysis of the data, and preparation of the article. A. Nandi helped to analyze the data and write the article. T. Glass and A. Diez-Roux helped to design the study, interpret the data, and write the article.
Accepted for publication November 26, 2006.
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References |
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 TOP References |
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1. Bild DE, Bluemke DA, Burke GL, et al. Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol. 2002;156:871–881.
2. Dietary Guidelines for Americans 2005. Washington, DC: US Department of Agriculture and US Department of Health and Human Services; 2005. Available at: http://www.healthierus.gov/dietaryguidelines. Accessed March 8, 2007.
3. Morl andand K, Wing S, Diez Roux A. The contextual effect of the local food environment on residents’ diets: the atherosclerosis risk in communities study. Am J Public Health. 2002;92:1761–1767.
4. Moore LV, Diez Roux AV. Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health. 2006;96:325–331.
This article has been cited by other articles:
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  M. Franco MD PhD, P. Ordunez MD PhD, B. Caballero MD PhD, and R. S. Cooper MD Obesity reduction and its possible consequences: What can we learn from Cuba's Special Period? Can. Med. Assoc. J., April 8, 2008; 178(8): 1032 - 1034. [Full Text] [PDF]
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