Manuel Franco MD, PhD

CLF Innovation Grant 2006

Johns Hopkins Bloomberg School of Public Health

Department of Epidemiology

Availability of Healthy Foods in Baltimore:

Associations with Diet Quality and BMI

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Healthy Foods, Diet Quality and Obesity

2005 Dietary Guidelines: • A variety of fruits and vegetables • Whole grains• Fat-free or low-fat milk

Prevention of obesity, diabetes and heart disease

Large racial and economic health disparities

Hypotheses: Disparities in the availability of

healthy foods exist. Availability of healthy foods

relates to the quality of diet and body weight

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Specific Aims

Aim 1

Investigate the association of neighborhood availability of healthy foods with racial and income composition

of 159 neighborhoods in Baltimore

Aim 2

Investigate the cross-sectional association

between availability of healthy foods of 749 individuals’

and their diet quality and BMI

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• 226 food stores completed in 159 neighborhoods

• Supermarkets (41), Grocery stores (110), Convenience stores (54), Behind glass stores (21)

– Original list: 365

– Misclassified: 130 (34%)

– Refusals : 21 (8%)

– New Stores : 12

• Data Collectors: Amanda Rosecrans, Brooke Mickle, Gila Neta, Krissett Loya

Data Collection: May – July 2006

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Grocery Store in West Baltimore83 MESA participants

within 1 mile

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Bonus Picture

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Bonus Picture

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Healthy Foods Availability Index (HFAI) of two supermarkets

Location Baltimore City Baltimore County

Racial Composition 97% Black 93% White

Median HH Income $ 20,833 $ 57,391

Avail. Points Avail. Points

Skim milk Yes 2 Yes 3

Fruits 17 2 59 4

Vegetables 38 3 74 4

Lean meat No 2 Yes 3

Frozen foods No 0 Yes 3

Low Na foods No 0 Yes 2

100% whole wheat bread Yes 2 Yes 4

Low sugar cereals Yes 2 Yes 2

HFAI (0 to 27) 13 25

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749 men and women, free of CVD, 45 – 84 years

159 Baltimore census tracts

For each participant we built 3 complementary measures

of availability:

– Neighborhood = mean stores HFAI in CT

– Closest Store = HFAI closest store

– Availability in 1 mile radius

Availability of Healthy Foods in the Baltimore MESA participants

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Dietary Patterns and BMI

• “Fats and processed meats” pattern: high

consumption of “fats and oils,” “high-fat and

processed meats,” “fried potatoes”

• “Whole grains and fruit” pattern: high consumption

of whole-grain bread, fruit and low fat milk

• Weight and height measured using valid tools and

following a standard protocol. (BMI) = Kg/m2

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159 contiguous census tracts and the 226 food stores located within them

Availability of healthy foods and neighborhoods’ racial composition

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Availability of healthy foods in Baltimore

neighborhoods by racial compositions

Neighborhood

characteristics

% Low food availability

% Medium food

availability

% High food availability

%No Stores

Pred. Black 30%** 25% 13%** 32%

Mixed 11% 28% 39% 22%

Pred. White 2% 17% 41% 40%

**P<0.001, compared to predominantly white neighborhoods

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Means and 95 % CI of dietary patterns by availability of healthy foods assessments

"Fats and processed meats"

-0.1

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Low Medium High

Closest Food Store Neighborhood

"Whole grains and fruit "

Low Medium High

Die

tary

pa

tter

ns s

core

s

** P for trend < 0.05

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Availability of healthy foods and BMI

27.5

28

28.5

29

29.5

30

30.5

31

Low Medium High

Availability of healthy foods measured in:

Bo

dy

Ma

ss

Ind

ex

Neighborhood Closest Food Store All stores within 1 mile

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Policy Implications and following steps

• Support existing stores in inner city neighborhoods

• Encourage the distribution of locally farmed fruits and

vegetables to improve the HFAI in Baltimore stores

• Collaboration with Baltimore City Health Department

and Urban Planning Department

• 2009 CLF Report: Food Environment in Baltimore

• First city to have a full map of food stores (Data

collection currently ongoing)

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