Healthy Food Access in Low-Income High-Minority Communities: A Longitudinal Assessment-2009-2017

Abstract

Disparities in healthy food access are well documented in cross-sectional studies in communities across the United States. However, longitudinal studies examining changes in food environments within various neighborhood contexts are scarce. In a sample of 142 census tracts in four low-income, high-minority cities in New Jersey, United States, we examined the availability of different types of food stores by census tract characteristics over time (2009-2017). Outlets were classified as supermarkets, small grocery stores, convenience stores, and pharmacies using multiple sources of data and a rigorous protocol. Census tracts were categorized by median household income and race/ethnicity of the population each year. Significant declines were observed in convenience store prevalence in lower- and medium-income and majority black tracts (p for trend: 0.004, 0.031, and 0.006 respectively), while a slight increase was observed in the prevalence of supermarkets in medium-income tracts (p for trend: 0.059). The decline in prevalence of convenience stores in lower-income and minority neighborhoods is likely attributable to declining incomes in these already poor communities. Compared to non-Hispanic neighborhoods, Hispanic communities had a higher prevalence of small groceries and convenience stores. This higher prevalence of smaller stores, coupled with shopping practices of Hispanic consumers, suggests that efforts to upgrade smaller stores in Hispanic communities may be more sustainable.

Keywords: convenience store; food access; food environment; grocery store; low-income communities; supermarket.

Figure 1

Expected number of (a) supermarkets; (b) small grocery stores; (c) convenience stores; (d) pharmacies per census tract by income group. Year-by-year differences: Supermarkets: No differences were observed. Small grocery stores: In 2014 medium-income tracts had a significantly higher number of small grocery stores than did lower- and higher-income tracts. In 2015 small grocery stores were more prevalent in lower income tracts than they were in higher income tracts. Convenience stores: In 2009 and 2013 low-income and medium-income tracts had significantly more convenience stores than did higher-income tracts. Pharmacies: Lower-income tracts had significantly more pharmacies than medium-income tracts in 2015 and 2017. ↓: indicates a declining linear trend over time; ↑: indicates an increasing linear trend over time.

Figure 1

Expected number of (a) supermarkets; (b) small grocery stores; (c) convenience stores; (d) pharmacies per census tract by income group. Year-by-year differences: Supermarkets: No differences were observed. Small grocery stores: In 2014 medium-income tracts had a significantly higher number of small grocery stores than did lower- and higher-income tracts. In 2015 small grocery stores were more prevalent in lower income tracts than they were in higher income tracts. Convenience stores: In 2009 and 2013 low-income and medium-income tracts had significantly more convenience stores than did higher-income tracts. Pharmacies: Lower-income tracts had significantly more pharmacies than medium-income tracts in 2015 and 2017. ↓: indicates a declining linear trend over time; ↑: indicates an increasing linear trend over time.

Figure 2

Expected number of (a) supermarkets; (b) small grocery stores; (c) convenience stores; (d) pharmacies per census tract by racial/ethnic group. Year-by-year differences: Supermarkets: In 2012 majority white/mixed census tracts had significantly more supermarkets than did majority black tracts. Small grocery stores: Majority Hispanic census tracts had significantly more small grocery stores than did majority black tracts in 2009, 2013, and 2015. Convenience stores: Majority Hispanic tracts had significantly more convenience stores than did majority black tracts in 2009, 2013, 2015, and 2017, and more than majority white/mixed tracts in 2009, 2012, and 2013. Pharmacies: No differences were observed.

Figure 2

Expected number of (a) supermarkets; (b) small grocery stores; (c) convenience stores; (d) pharmacies per census tract by racial/ethnic group. Year-by-year differences: Supermarkets: In 2012 majority white/mixed census tracts had significantly more supermarkets than did majority black tracts. Small grocery stores: Majority Hispanic census tracts had significantly more small grocery stores than did majority black tracts in 2009, 2013, and 2015. Convenience stores: Majority Hispanic tracts had significantly more convenience stores than did majority black tracts in 2009, 2013, 2015, and 2017, and more than majority white/mixed tracts in 2009, 2012, and 2013. Pharmacies: No differences were observed.