Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond (A.L.H., S.V.C.).
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.L.H., R.B., Z.Z., C.O., E.R.M., L.A.C., D.C.C.).
Circ Cardiovasc Qual Outcomes. 2022 Nov;15(11):e009301. doi: 10.1161/CIRCOUTCOMES.122.009301. Epub 2022 Nov 15.
Disproportionate exposure to poor food environments and food insecurity among Black Americans may partially explain critical chronic disease disparities by race and ethnicity. A complex set of structural factors and interactions between Black residents and their food environments, including store types, quantity, proximity, and quality of goods and consumer interactions within stores, may affect nutritional behaviors and contribute to higher cardiovascular and kidney disease risk.
We used the Photovoice methodology to explore the food environment in Baltimore, MD, through the perspectives of Black residents with hypertension between August and November 2019. Twenty-four participants were enrolled in the study (mean age: 65.1 years; 67% female). After a brief photography training, participants captured photos of their food environment, which they discussed in small focus groups over the course of 5 weeks. Discussions were audiotaped and analyzed for emergent themes using a line-by-line inductive approach. Themes were, then, organized into a collective narrative.
Findings describe physical and social features of the food environment as well as participants' perceptions of its origins and holistic and generational health effects. The study illustrates the interrelationships among the broader socio-political environment, the quality and quantity of stores in the food landscape, and the ways in which they engage with the food environment as residents and consumers who have been marginalized due to their race and/or social class. The following meta-themes emerged from the data: (1) social injustice; (2) structural racism and classism; (3) interpersonal racism; (4) generational effects; (5) mistrust; (6) social programs; and (7) community asset-based approaches, including advocacy and civic engagement.
Understanding residents' perceptions of the foundations and effects of the food environment on their health may help stakeholders to cocreate multilevel interventions alongside residents to improve access to healthy food and health outcomes among disparities affected populations.
美国黑人面临着不成比例的不良食物环境和食物不安全问题，这可能部分解释了种族和民族之间存在的严重慢性疾病差异。一系列复杂的结构性因素以及黑人员工与其食物环境之间的相互作用，包括商店类型、数量、接近度、商品质量以及店内消费者互动等，可能会影响营养行为，并导致更高的心血管和肾脏疾病风险。
我们使用影像法（Photovoice methodology），通过 2019 年 8 月至 11 月期间，24 名患有高血压的巴尔的摩黑人居民的视角，来探索马里兰州巴尔的摩的食物环境。参与者（平均年龄：65.1 岁；67%为女性）参与了简短的摄影培训，然后拍摄了他们食物环境的照片，在接下来的 5 周内，他们通过小型焦点小组讨论这些照片。讨论过程进行了录音，并采用逐行归纳法进行了分析，以提取主题。然后，将主题组织成一个集体叙述。
研究结果描述了食物环境的物质和社会特征，以及参与者对其起源和整体及代际健康影响的看法。本研究说明了更广泛的社会政治环境、食物环境中商店的质量和数量以及他们作为因种族和/或社会阶层而被边缘化的居民和消费者与食物环境互动的方式之间的相互关系。数据中出现了以下元主题：（1）社会不公；（2）结构性种族主义和阶级主义；（3）人际种族主义；（4）代际影响；（5）不信任；（6）社会项目；（7）基于社区资产的方法，包括宣传和公民参与。
了解居民对食物环境对其健康的基础和影响的看法，可能有助于利益相关者与居民共同创造多层次干预措施，以改善受差异影响人群获得健康食品和改善健康结果的机会。
