FOOD CHOICE I Access to Healthy Food in Philadelphia
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Running head: FOOD CHOICE i Access to Healthy Food in Philadelphia Neighborhoods: How Corner Stores Impact Food Choices Steve O’Connor Master of Science Degree Candidate Science, Technology, and Society Department of History & Politics Drexel University Thesis Adviser: Professor Christian Hunold March 2013 _______________________________________________________________________ A Thesis Presented to the Faculty of the Drexel University Department of History & Politics in Partial Fulfillment of the Requirements for the Master of Science ________________________________________________________________________ FOOD CHOICE ii Acknowledgements Thank you to all of my professors and classmates in the Science, Technology, and Society program for providing a wonderful learning experience over the last two years. I am also extremely thankful to everyone I have had the pleasure to work alongside or get to know through my experiences, and to the participants who agreed to be a part of this study. To my thesis adviser Professor Christian Hunold, I greatly appreciate all of your help and encouragement throughout this process. Thank you for introducing me to the wonderful world of research and challenging and inspiring me. I’d also like to thank Jen Britton and Katy Travaline for all of your advice, support, listening, and most importantly, introducing me to the STS program. Finally, thank you to my family and friends, with special thanks to Kelly, my wonderful wife. Thank you for all your patience, proofreading, and the tremendous amount of support you have given me over the last few years. I am grateful. FOOD CHOICE iii Abstract Over the last fifteen years, access to fresh and nutritious food has been recognized as a growing problem within the United States, specifically in low-income, urban neighborhoods. These areas are often described as “food deserts” in which healthy food options are not available within 0.6-mile walk. Typically, "food deserts" lack full service supermarkets. Residents instead have to make do with corners stores that specialize in processed foods while offering few, if any, fresh fruit and vegetables. The purpose of this study was to determine where and how residents of West Philadelphia obtain their food, specifically to better understand the role of corner stores in their food purchases. Using a mixed-methods approach of 100 quantitative surveys and 9 qualitative interviews this study found that residents of Mantua, West Powelton, and Belmont obtain most of their food from supermarkets located outside the neighborhood and do not rely on corner stores for the majority of their purchases. This paper finds that the Healthy Corner Store Initiative (HCSI) alone may do little to improve residents' diet since this program does not respond to how residents actually obtain their food. Coupling the HCSI with alternative food systems, such as urban gardens, can build social capital and stakeholder participation that has greater potential to increase the likelihood that residents will consume healthier foods. FOOD CHOICE iv Table of Contents Introduction……………………………………………………………………………….…..1 Food Systems in the Literature………………………………………………....……….........15 Research Design…………………………………………………………………...........…….22 Findings.………………………..…………………………………………………..........……29 Discussion………………………..…………………………………………………..........….51 Conclusion……………………………………………….………….………….........……….60 References………………………………………………………………........………….…...64 Appendix A: Quantitative Survey. ………………....………………....……….……...……..70 Appendix B: Qualitative Interview Summaries……………………………………………...78 FOOD CHOICE v List of Tables and Figures Tables Table 1: Survey Breakdown………………………..………………………………...…..34 Table 2: Neighborhood Demographics…………..………………………………….…...34 Figures Figure 1: Map of Neighborhoods…………………………………………….……..........29 Figure 2: Corner Stores in the Neighborhoods…………….…….....................................30 Figure 3: Healthy Corner Stores…………………………………………………............31 Figure 4: Neighborhood Gardens……………………………………….……..…...........32 Figure 5: Total Walk Radius……………………………………….……........................33 Figure 6: Emerging Qualitative Themes……………………………………….……..…39 Figure 7: Interview Participants Fruit and Vegetable Consumption……………….........45 Figure 8: Corner Store Consumption……………………………………….……...........51 Figure 9: Corner Store Inventory……………………………………….…….................54 FOOD CHOICE 1 Chapter 1: INTRODUCTION Introduction & Aims of the Study Over the last fifteen years, food access has been recognized as a growing problem within the United States, specifically in low-income areas that have a perceived lack of access to fresh and healthy foods. With the rise in what is referred to as “food deserts”— areas that lack access to healthy and adequate foods to maintain a nutritious diet—many academics, policy makers, non-profits, and other organizations have developed initiatives to expand access to healthy, affordable foods for residents of such areas. Studies show that residents of food deserts are more likely to be at risk for chronic diseases, high-blood pressure, some cancers, obesity, and other health issues, especially in low-income communities (McKenna et al., 1998; Pi-Sunyer, 2002; Moreland, 2006; Blanck et al., 2007; Beaulac et al., 2009). One initiative right here in Philadelphia, the Healthy Corner Stores Initiative, proposes to fill the nutritional gap by supplying neighborhood corner stores with healthy food options. However, we cannot be certain that providing access to healthy food increases the likelihood that residents of a “food desert” will consume a diet consisting of healthier foods. Fueling this uncertainty is our limited knowledge about how and where residents obtain their food to begin with. In this context, the purpose of this research study was to determine how residents in three low-income West Philadelphia neighborhoods obtain access to food. A mixed- methods research design of 100 quantitative surveys and 9 qualitative interviews sought to identify where residents obtained their food as well as barriers to that access and, guided by content analysis techniques, to identify themes across and within respondent groups. The findings suggest that most residents obtain the majority of their food from FOOD CHOICE 2 supermarkets with minimal difficulty. Furthermore, the study participants report accessing food from the corner stores only occasionally for snacks, drinks, “emergency” items, and deli items and have negative impressions of the quality of the stores, which could impact the adoption of initiatives to sell fresh fruits and vegetables within these stores. The study also found that the majority of residents believe that it is difficult to obtain fruits and vegetables within their neighborhood, and significant opportunities exist to provide residents with resources and training to participate in community gardens. The purpose of this study is to fill in the knowledge gap on how low-income people in West Philadelphia food deserts obtain food by measuring and analyzing how residents navigate their neighborhood to purchase food. The results could • improve individual nutrition and general health as well as the physical environment in low-income neighborhoods, • help evaluate the effectiveness of programs such as the Healthy Corner Store Initiative, and • inform efforts to address food inequalities by building social capital. Background In a 2010, the Centers for Disease Control released a report stating that almost 36 percent of the population (78 million adults and 12 million children) is overweight or obese and at a higher risk for diabetes, hypertension, and other health related issues (Ogden et al. 2012). The USDA, along with the World Health Organization, claims that the increase in obesity and negative health issues relates directly to poor diets (USDA, 2009; WHO, 2002). In 2001, the US Department of Human Services argued that in the FOOD CHOICE 3 US, healthy foods were not adequately accessible and that the public relied on a variety of snack foods, sugary beverages, fast-foods, and other types of food that were high in sugar, fat, and calories, especially in low-income urban settings (USDHHS, 2001; Cohen & Farley, 2008). This has led to the idea that urban areas that lack access to healthy foods are essentially “food deserts. “ Food Deserts According to Cummins and Macintyre (2002), the term “food desert” was first used in the early 1990s to describe a Scotland housing project that lacked close, affordable access to nutritious foods. A clear consensus on the definition of a food desert has not emerged, however. Many scholars agree on the lack of food as the major criterion, but definitions vary. Morton and Blanchard (2007) consider food deserts as counties in which all residents must drive more than 10 miles while Larsen and Gilliland (2008) argue that grocery stores should be within a 0.6-mile walk or a single bus ride that includes a 0.3-mile walk. Other scholars classify food deserts by the number of grocery stores and employees (Hendrickson, 2006). The USDA similarly classifies a food desert as “a low-income census tract where a substantial number or share of residents has low access to a supermarket or large grocery store” (USDA, 2012). The USDA considers the area low-income when the 20 percent or more of the population within the census tract is below the poverty line and food access low when the area is more than one mile from the closest supermarket (USDA, 2012). These varying definitions overlap in their emphasis