Association for Public Policy Analysis & Management

Researchers are increasingly turning attention to the role of place in explaining disparities in health across racial and ethnic groups and to explain the income gradient for health.  Diet-related illnesses such as obesity and diabetes may be more pronounced in some poor and rural American communities because there is limited access to affordable and nutritious foods.  A primary concern is that these areas do not have access to supermarkets, grocery stores, or other food retailers that offer the large variety of foods needed for a healthy diet.  The lack of access to full-service grocery stores and the easier access to fast and convenience foods may be linked to poor diets and, ultimately, to obesity and other  diet-related diseases. 

Several studies have found an association between access to healthy food and diet and health outcomes, however, most of these studies are cross-sectional. Cross-sectional studies are particularly limited in this context because people move from neighborhood to neighborhood and neighborhoods change.  Plus, many of the health outcomes that are of most interest are conditions that are best viewed as the result of long-term behaviors.  For example, obesity and diabetes are often the result of long-term poor diet or other health behaviors and possibly long-term exposure to poor food environments.  Further, the effects of living neighborhoods with poor food environments may have different effects over an individual’s life span (e.g. young children vs. adolescents vs. working age vs. elderly).  Thus, a point-in-time measure is a weak measure of exposure to the food environment. A few studies have exploited longitudinal data and other methods to tease out cause and effect with mixed findings, but a limitation of these longitudinal studies is that data cover only segments of the U.S. population. 

We match Panel Study of Income Dynamics (PSID) data, which are unique in the length of time for which a national sample of individuals are surveyed, to indicators of the food environment to quantify exposure to poor food environments.  Store density measures by store type are constructed for each census tract beginning in 1989 and for every other year up through 2010, based on a list of stores authorized to accept benefits from the Supplemental Nutrition Assistance Program (SNAP). These data are supplemented with information on the food environment from the Food Access Research Atlas (http://www.ers.usda.gov/data-products/food-access-research-atlas.aspx ) and the Food Environment Atlas: http://www.ers.usda.gov/data-products/food-environment-atlas.aspx) for available years.  Census tract data on population characteristics from the Neighborhood Change Database from 1990, 2000, and 2010, and the American Community Survey will also be linked with PSID respondents and their families.

The paper describes exits, entries, spell length, and accumulated exposure to neighborhoods with poor food environments.  The results are important for understanding how long individuals are exposed to poor food environments and to poor neighborhoods. The results will also add contextual information about which subgroups have the greatest exposure to poor food environments, for example, by racial or ethnic group or by the level of family income.