Can the introduction of a full-service supermarket in a food desert improve residents' economic status and health?

doi:10.1016/j.annepidem.2017.10.011

Annals of Epidemiology

Volume 27, Issue 12, December 2017, Pages 771-776

https://doi.org/10.1016/j.annepidem.2017.10.011 Get rights and content

Abstract

Purpose

To estimate the impacts of a new supermarket in a low-income desert, on residents' economic status and health.

Methods

We surveyed a randomly selected cohort in two low-income Pittsburgh neighborhoods before and about 1 year following the opening of a supermarket. We used difference-in-difference approach to test changes across the two neighborhoods in residents' food security, United States Department of Agriculture Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women Infant and Children participation, employment, income, and self-reported health/chronic disease diagnoses.

Results

We observed declines in food insecurity (−11.8%, P < .01), Supplemental Nutrition Assistance Program participation (−12.2%, P < .01), and fewer new diagnoses of high cholesterol (−9.6%, P = .01) and arthritis (−7.4%, P = .02) in the neighborhood with the new supermarket relative to residents of the comparison neighborhood. We also found suggestive evidence that residents' incomes increased more ($1550, P = .09) and prevalence of diabetes increased less in the neighborhood with the supermarket than in the comparison neighborhood (−3.6%, P = .10).

Conclusions

Locating a new supermarket in a low-income neighborhood may improve residents' economic well-being and health. Policymakers should consider broad impacts of neighborhood investment that could translate into improved health for residents of underserved neighborhoods.

Section snippets

Background

Research examining associations between poverty and poor health has largely focused on individuals' economic status. Recent work identified links between neighborhood economics and health (e.g., mortality) [1], [2]. Neighborhood characteristics that have been tied to health include educational quality, access to social and economic services, and access to healthy foods [3]. Yet, the evidence is not fully consistent with respect to cardiometabolic health (e.g., obesity) [4], [5], [6], [7], and

Study design and participants

Pittsburgh Hill/Homewood Research on Eating, Shopping and Health (PHRESH) study used a quasi-experimental prepost design to investigate the effects of opening a HFFI (S.1926, H.R. 3525) supported FSS. We compared two neighborhoods, Hill District (intervention neighborhood) and Homewood (comparison neighborhood). The two neighborhoods were chosen to match in terms of (1) proportion of the neighborhood that is African-American (about 95 percent of the population in each categorized themselves as

Characteristics of study participants

Our study sample was predominantly non-Hispanic African–American/black (95.2%), female (75%), and middle-aged (mean age at baseline was 53 years; Table 1).

On average, residents were economically disadvantaged. At baseline, only one-third reported being employed full- or part-time, relative to not employed. Households had low incomes with a mean annual household per capita income of $13,608 and close to half (44.7%) were below the FPL. Similarly, about half reported receiving SNAP benefits;

Discussion

Using a quasi-experimental design with a randomly selected cohort in intervention and comparison neighborhoods, we found that the introduction of a FSS in a neighborhood that previously did not have FSS may have positively impacted resident economic status and health. Our findings suggest that residents living in the intervention neighborhood saw greater reduction in food insecurity and SNAP participation, and a slower growth in diagnosed high cholesterol and arthritis incidence, relative to

Acknowledgments

The authors express sincere appreciation and gratitude to La'Vette Wagner, field coordinator of the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health (PHRESH) study and the data collection staff. The authors thank the Hill House Association, Operation Better Block, and Homewood Children's Village. Without their participation, the study could not have happened.

Funding was provided by the National Cancer Institute (R01CA164137 “Impact of Greenspace Improvement on Physical Activity

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Investments in historically oppressed neighborhoods through food retail, housing, and commercial development are hypothesized to improve residents’ health, nutrition, and perceptions of their neighborhood as a place to live. Although place-based development (e.g., housing, retail, business assistance) is happening in many communities, there is little evidence of the long-term correlates of multiple investments such as health and nutrition among residents.
A quasi-experimental longitudinal study was conducted using a cohort of randomly sampled households in two low-income, predominantly African American neighborhoods in Pittsburgh, PA, with surveys assessing residents’ food insecurity, perception of their neighborhood as a place to live, perception of access to healthy foods, and dietary outcomes in 2011 and seven years later (2018), with an interim assessment in 2014. Analyses conducted in 2022 compared changes among residents of one neighborhood which had 2.6 times the investments over a 7-year period with changes among residents of a socio-demographically similar neighborhood that received fewer investments.
It was found that residents in the neighborhood receiving substantial investments demonstrated statistically significant improvements in neighborhood satisfaction (12.6% improvement compared with a 2.2% decrease) and perceived access to healthy food (52% improvement compared with 18.2% improvement), and marginally significant change in food security (14% compared with 4.8% improvement) compared with residents in the neighborhood receiving fewer investments.
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This research studies the social and spatial inequalities of contemporary food deserts in England and Wales. Two indices of the Store Food Desert Index and Online Food Desert Index are measured to examine store access and online access to food at the Lower Layer Super Output Areas geographical level. A detailed analysis is conducted to (i) identify “priority areas” where there is relatively lower store access and online access to food, (ii) synthesize population to understand the characteristics of “at-risk communities” that are disproportionately affected by food deserts, and (iii) examine the association between self-reported health conditions and a compound of store and online access to food. Three insights are provided. First, there is a clear urban-rural divide in which urban areas generally benefit from better provision of both store and online access to food. Second, about 23% of the population (13.8 million people) live in priority areas with limited access to both physical stores and online groceries. Within this group, 0.06% (8000 individuals) do not have cars, 2.17% (300,000 individuals) are Black, and 14.5% (2 million individuals) reside in deprived neighborhoods. This is an alarming picture. Third, people residing in areas with high store and online access to food reported better health conditions, and online access is as effective as store access in improving health conditions. The findings highlight the potential of combining online and store access to bridge geographical and economic gaps, thereby providing healthier food options to those in food deserts.
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As neighborhood characteristics such as supermarket proximity are modifiable risk factors in disease development, initiatives to increase supermarket access have been proposed but have yielded mixed results. In some studies, enhanced supermarket access in urban environments increased awareness of healthy food options and consumption of fruits and vegetables by minority groups, reduced participation in SNAP (Supplemental Nutrition Assistance Program, ie, government nutrition assistance), reduced levels of obesity and high cholesterol, provided a safe environment for positive social interaction and social support among shoppers, and was a potential source for neighborhood investment.51-55 Other studies reported more modest effects of increasing supermarket access alone, including concerns that despite providing better access and reduced prices, supermarket introduction did not increase healthy food and vegetable intake, did not alter BMI, and increased exposure to unhealthy items.54,56,57
Living in environments with low access to food may increase the risk of chronic diseases. We investigated the association of household distance to the nearest supermarket (as a measure of food access) with the incidence of hypertension, diabetes, and chronic kidney disease (CKD) in a metropolitan area of the United States.
Retrospective cohort study.
777,994 individuals without hypertension, diabetes, or CKD at baseline within the HealthLNK Data Repository, which contains electronic health records from 7 health care institutions in Chicago, Illinois.
Zip code–level average distance between households and nearest supermarket.
Incidence of hypertension, diabetes, and CKD based on presence of ICD-9 code and/or blood pressure ≥ 140/90 mm Hg, hemoglobin A1c ≥ 6.5%, and eGFR < 60 mL/min/1.73m², respectively.
Average distance to nearest supermarket was aggregated from street-level metrics for 56 Chicagoland zip codes. The cumulative incidence of hypertension, diabetes, and CKD from 2007-2012 was calculated for each zip code in patients free of these diseases in 2006. Spatial analysis of food access and disease incidence was performed using bivariate local indicator of spatial association (BiLISA) maps and bivariate local Moran I statistics. The relationship between supermarket access and outcomes was analyzed using logistic regression.
Of 777,994 participants, 408,608 developed hypertension, 51,380 developed diabetes, and 56,365 developed CKD. There was significant spatial overlap between average distance to supermarket and incidence of hypertension and diabetes but not CKD. Zip codes with large average supermarket distances and high incidence of hypertension and diabetes were clustered in southern and western neighborhoods. Models adjusted only for neighborhood factors (zip code–level racial composition, access to vehicles, median income) revealed significant associations between zip code–level average distance to supermarket and chronic disease incidence. Relative to tertile 1 (shortest distance), ORs in tertiles 2 and 3, respectively, were 1.27 (95% CI, 1.23-1.30) and 1.38 (95% CI, 1.33-1.43) for diabetes, 1.03 (95% CI, 1.02-1.05) and 1.04 (95% CI, 1.02-1.06) for hypertension, and 1.18 (95% CI, 1.15-1.21) and 1.33 (95% CI, 1.29-1.37) for CKD. Models adjusted for demographic factors and health insurance showed significant and positive association with greater odds of incident diabetes (tertile 2: 1.29 [95% CI, 1.26-1.33]; tertile 3: 1.35 [95% CI, 1.31-1.39]) but lesser odds of hypertension (tertile 2: 0.95 [95% CI, 0.94-0.97]; tertile 3: 0.91 [95% CI, 0.89-0.92]) and CKD (tertile 2: 0.80 [95% CI, 0.78-0.82]; tertile 3: 0.73 [95% CI, 0.72-0.76]). After adjusting for both neighborhood and individual covariates, supermarket distance remained significantly associated with greater odds of diabetes and lesser odds of hypertension, but there was no significant association with CKD.
Unmeasured neighborhood and social confounding variables, zip code–level analysis, and limited individual-level information.
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Creating stores in underserved locations—increasing the number of grocery stores in a given region is one way to increase the number of people who have access to healthy food. This disruptor was implemented by creating new grocery store agents in various places within the case study regions to understand how increasing the number of stores and varying their location influences accessibility (Richardson et al., 2017; Rogus et al., 2018). While this is not an intervention that decision makers can implement directly, incentive structures such as tax breaks can be put in place to influence the number of stores that open in a given region.
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: The authors have no conflicts of interest to disclose.

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Original articleCan the introduction of a full-service supermarket in a food desert improve residents' economic status and health?

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Background

Study design and participants

Characteristics of study participants

Discussion

Acknowledgments

Soc Sci Med

Social Science & Medicine

Soc Sci Med

J Retailing Consum Serv

Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts

Am J Public Health

Neighborhoods and health

Ann N Y Acad Sci

Neighborhood characteristics and components of the insulin resistance syndrome in young adults: the coronary artery risk development in young adults (CARDIA) study

Diabetes care

Neighborhood health-promoting resources and obesity risk (the multi-ethnic study of atherosclerosis)

Obesity (Silver Spring)

Investigating neighborhood and area effects on health