Morland Kimberly, Wing Steve, Diez Roux Ana, Poole Charles
Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
Am J Prev Med. 2002 Jan;22(1):23-9. doi: 10.1016/s0749-3797(01)00403-2.
Although the relationship between diet and disease is well established, sustainable dietary changes that would affect risk for disease have been difficult to achieve. Whereas individual factors are traditional explanations for the inability of some people to change dietary habits, little research has investigated how the physical availability of healthy foods affects individuals' diets. This study examines the distribution of food stores and food service places by neighborhood wealth and racial segregation.
Names and addresses of places to buy food in Mississippi, North Carolina, Maryland, and Minnesota were obtained from respective departments of health and agriculture. Addresses were geocoded to census tracts. Median house values were used to estimate neighborhood wealth, while the proportion of black residents was used to measure neighborhood racial segregation.
Compared to the poorest neighborhoods, large numbers of supermarkets and gas stations with convenience stores are located in wealthier neighborhoods. There are 3 times fewer places to consume alcoholic beverages in the wealthiest compared to the poorest neighborhoods (prevalence ratio [PR]=0.3, 95% confidence interval [CI]=0.1-0.6). Regarding neighborhood segregation, there are 4 times more supermarkets located in white neighborhoods compared to black neighborhoods (PR=4.3, 95% CI=1.5-12.5).
Without access to supermarkets, which offer a wide variety of foods at lower prices, poor and minority communities may not have equal access to the variety of healthy food choices available to nonminority and wealthy communities.
尽管饮食与疾病之间的关系已得到充分证实，但能影响疾病风险的可持续饮食改变却难以实现。虽然个人因素是一些人无法改变饮食习惯的传统解释，但很少有研究调查健康食品的实际可获取性如何影响个人饮食。本研究按社区财富和种族隔离情况考察食品商店和食品服务场所的分布。
从密西西比州、北卡罗来纳州、马里兰州和明尼苏达州的卫生和农业部门获取购买食品场所的名称和地址。地址经地理编码转换为普查区。用房屋价值中位数来估计社区财富，同时用黑人居民比例来衡量社区种族隔离情况。
与最贫困社区相比，大量超市以及设有便利店的加油站位于较富裕社区。与最贫困社区相比，最富裕社区中提供酒精饮料的场所数量减少了三分之二（患病率比[PR]=0.3，95%置信区间[CI]=0.1 - 0.6）。关于社区隔离，白人社区的超市数量是黑人社区的四倍（PR=4.3，95% CI=1.5 - 12.5）。
由于无法进入能以较低价格提供各类食品的超市，贫困社区和少数族裔社区可能无法像非少数族裔和富裕社区那样平等地获得各种健康食品选择。
