Disparities in Access to Healthy and Unhealthy Foods in Central Massachusetts: Implications for Public Health Policy

Abstract

Objectives: To analyze geographic and income disparities in access to healthy foods in central Massachusetts.

Methods: We surveyed 106 (92% of all) food stores longitudinally in the study area between 2007 and 2010. We analyzed the geographic and temporal variations in community- and store-level healthy food availability indices (HFAI) and unhealthy food availability indices (UFAI) overall and by select store and community characteristics.

Results: Twenty-seven of 68 communities in the study area (39.7%) had no food store and 5 (8.3%) had one or few stores with very limited availability of healthy foods, affecting 23.7% of the county population. Lack of food stores was associated strongly with lower housing density and upper tertile of median household income. About 45% of the surveyed stores had inadequate availabilities of healthy food. Store-level HFAI and UFAI scores were highly correlated, and higher among larger stores affiliated with a chain (vs independent). Though healthy foods were usually most available in larger stores, unhealthy foods were widely available in all stores.

Conclusions: Over half of central Massachusetts communities, mostly rural and small, had either no food store or few stores with limited availabilities of healthy foods. Immediate policy interventions on the food environment are necessary in these communities. Further, without examining what is actually sold in stores, analysis of disparities in access to healthy food relies on the number of food stores, which can lead to a distorted picture of accessibility and mislead community health policies.

Key words:

• access to healthy foods
• food environment
• geographic disparity
• food stores

ACKNOWLEDGMENTS

The authors thank the numerous undergraduate and graduate interns for their contributions to field data collection, Lili Chen for her assistance in data management and statistical analysis, and Jeff Cheng for making the map for this article. The opinions expressed in this work are the authors’ and do not reflect those of Massachusetts Department of Public Health.

AUTHOR CONTRIBUTIONS

W.L. and B.O. conceived the study. B.O., W.L., and V.P. developed the survey instruments. W.L. obtained funding, led the data analysis, and led the writing of the article. B.O. and V.P. managed the field surveys. B.O. derived the scoring algorithms. H.Z. developed the data management system. E.P.G. and W.L. conducted the statistical analysis. W.L. conducted the geographic analysis. W.L. and E.P.G. interpreted the statistical analysis results. W.L., B.O., E.P.G., and N.M.W. drafted the article. T.L. contributed to the discussions on implications to public health policy and practice. All authors contributed to the writing of the Methods and Discussion sections and reviewed drafts of the article.