The Grocery Gap: Who Has Access to Healthy - The Food Trust

PolicyLinkThe Food TrustAcknowledgmentsPolicyLink and The Food Trust are grateful to thefunders who supported the development andpublication of this report, including the ConvergencePartnership and the Kresge Foundation.The research for this study was conducted withindispensable assistance from Diana Fischmann(former intern, The Food Trust), who initiallycollected, reviewed, and summarized manyof the studies, and Allison Hagey (PolicyLink)who adeptly assisted with the data analysis andmanuscript development. Many thanks to JenneferKeller, Jon Jeter, and Leslie Yang (PolicyLink), andLance Loethen (The Reinvestment Fund) for theirassistance. Our gratitude also extends to JudithBell and Rebecca Flournoy (PolicyLink), JohnWeidman (The Food Trust), and Ira Goldstein (TheReinvestment Fund) who provided helpful guidanceand feedback throughout the research process.2

PolicyLinkThe Food TrustContents57111321232532PrefaceExecutive SummaryIntroductionFindingsImplications for PolicyMethodsReferencesNotes3

PolicyLinkThe Food TrustImproving access to healthy food is acritical component of an agenda to buildan equitable and sustainable food system.4

PolicyLinkThe Food TrustPrefaceFor decades, low-income communities of color havesuffered as grocery stores and fresh, affordablefood disappeared from their neighborhoods.Advocates have long drawn attention to this criticalissue and crafted policy solutions, but access tohealthy food is just now entering the national policydebate. While the problem is obvious to impactedcommunities, good policy must also be based onsolid data about the issue and its consequences.Unfortunately, it often takes years for the researchto catch up with pressing needs in historicallyunderserved communities. Sometimes information isnot available. Other times, evidence is accumulatingbut it is buried in journals not widely read bypolicymakers. Or it is produced by practitioners andadvocates for local action campaigns and not acceptedby researchers or shared with policymakers or thebroader field. Too often, research focusing on lowincomepeople and communities of color, informedby their experiences, or conducted in partnershipwith them, is perceived as a political strategy,rather than as a legitimate search to understandproblems and inform strategies for change.PolicyLink and The Food Trust conducted thisinquiry to summarize the existing evidence base,carefully reviewing more than 132 studies. Wefound that a large and consistent body of evidencesupports what residents have long observed: manylow-income communities, communities of color,and sparsely populated rural areas do not havesufficient opportunities to buy healthy, affordablefood. The consequences are also clear: decreasedaccess to healthy food means people in low-incomecommunities suffer more from diet-related diseaseslike obesity and diabetes than those in higherincomeneighborhoods with easy access to healthyfood, particularly fresh fruits and vegetables.Centers for Disease Control and Prevention, adultobesity rates are 51 percent higher for AfricanAmericans than whites, and 21 percent higherfor Latinos. Black and Latino children are morelikely to become obese than white children. Thelack of healthy food retail also hinders communityeconomic development in neighborhoods thatneed private investment, activity hubs, and jobs.Thankfully, the tide is beginning to turn. Researchersand policymakers are coming to consensus thatthis is a critical issue. And they are recognizing thatcommunities have developed innovative, sustainablesolutions that can work in other locales and at largerscales. In December 2009, 39 members of Congressfrom both political parties issued a resolution in theHouse of Representatives recognizing the need fornational policy to address limited access to healthyfood in underserved communities. The President’s2011 budget calls for more than $400 million toestablish a national Healthy Food Financing Initiative,and this initiative is a key component of the FirstLady’s Let’s Move campaign to reduce childhoodobesity. Legislation to create a Healthy FoodFinancing Initiative is expected to be introduced inboth the House and the Senate in Spring 2010.This report presents powerful data. It confirmsthat as a nation we must answer the appeals ofcommunity activists seeking access to healthy foodfor their families and their neighborhoods. Wehope that it provides policymakers, advocates,philanthropists, and others with information,evidence, and analysis that can inform their effortsto eliminate “food deserts” from neighborhoodsand communities across the country.Inequitable access to healthy food is a majorcontributor to health disparities. According to theAngela Glover BlackwellFounder and CEOPolicyLinkYael LehmannExecutive DirectorThe Food Trust5

PolicyLinkThe Food TrustIn hundreds of neighborhoodsacross the country, nutritious,affordable, and high qualityfood is out of reach —particularly low-incomeneighborhoods, communitiesof color, and rural areas.6

PolicyLinkThe Food TrustExecutive SummaryAn apple a day?For millions of Americans—especially peopleliving in low-income communities of color—finding a fresh apple is not so easy. Full-servicegrocery stores, farmers’ markets, and other vendorsthat sell fresh fruits, vegetables, and other healthyfoods cannot be found in their neighborhoods.What can be found, often in great abundance,are convenience stores and fast food restaurantsthat mainly sell cheap, high-fat, high-sugar,processed foods and offer few healthy options.Without access to healthy foods, a nutritiousdiet and good health are out of reach. Andwithout grocery stores and other freshfood retailers, communities are missing thecommercial hubs that make neighborhoodslivable, and help local economies thrive.For decades, community activists have organizedaround the lack of access to healthy foods asan economic, health, and social justice issue. Asconcerns grow over healthcare and the country’sworsening obesity epidemic, “food deserts” — areaswhere there is little or no access to healthy andaffordable food—have catapulted to the forefrontof public policy discussions. Policymakers atthe local, state, and national level have begunrecognizing the role that access to healthy foodplays in promoting healthy local economies,healthy neighborhoods, and healthy people.This report, a summary of our current knowledgeabout food deserts and their impacts oncommunities, provides evidence to inform thispolicymaking.To assess the current evidence base in thisdynamic and fast-growing field of research, wecompiled the most comprehensive bibliographyto date of studies examining food access and itsimplications conducted in the United States overthe past 20 years. This bibliography incorporates atotal of 132 studies: Sixty-one published in peerreviewedjournals and primarily conducted byuniversity-based researchers and 71 conductedby practitioners or policy researchers, sometimesin collaboration with academic researchers, andself-published (also known as “grey literature”).The studies include three nationwide analysesof food store availability and neighborhood,city, county, regional, statewide, and multistateanalyses covering 22 states across the country.Findings1. Accessing healthy food is a challengefor many Americans—particularly thoseliving in low-income neighborhoods,communities of color, and rural areas. Inhundreds of neighborhoods across the country,nutritious, affordable, and high quality foodis largely missing. Studies that measure foodstore availability and availability of healthy foodsin nearby stores find major disparities in foodaccess by race and income and for low-density,rural areas.• Lack of supermarkets. A 2009 study bythe U.S. Department of Agriculture foundthat 23.5 million people lack access to asupermarket within a mile of their home.A recent multistate study found that lowincomecensus tracts had half as manysupermarkets as wealthy tracts. Anothermultistate study found that eight percentof African Americans live in a tract with asupermarket, compared to 31 percent ofwhites. And a nationwide analysis foundthere are 418 rural “food desert” countieswhere all residents live more than 10 milesfrom a supermarket or supercenter—this is 20 percent of rural counties.7

PolicyLinkThe Food Trust• Lack of healthy, high quality foodsin nearby food stores. In Detroit andNew Haven, produce quality is lowerin low-income communities of colorcompared to more affluent or raciallymixed neighborhoods. In Albany, NewYork, 80 percent of nonwhite residentscannot find low-fat milk or high-fiberbread in their neighborhoods. And inBaltimore, 46 percent of lower-incomeneighborhoods have limited access tohealthy food (based on a healthy foodavailability survey) compared to 13 percentof higher-income neighborhoods.• Predominance of convenience/corner/liquor stores. Nationally, low-income zipcodes have 30 percent more conveniencestores, which tend to lack healthyitems, than middle-income zip codes.• Lack of transportation access to stores.Residents in many urban areas (includingSeattle, Central and South Los Angeles, andEast Austin, Texas) have few transportationoptions to reach supermarkets. Inadequatetransportation can be a major challenge forrural residents, given the long distances tostores. In Mississippi—which has the highestobesity rate of any state—over 70 percentof food stamp eligible households travelmore than 30 miles to reach a supermarket.2. Better access corresponds withhealthier eating. Studies find that residentswith greater access to supermarkets or a greaterabundance of healthy foods in neighborhoodfood stores consume more fresh produce andother healthful items.• For every additional supermarket ina census tract, produce consumptionincreases 32 percent for AfricanAmericans and 11 percent for whites,according to a multistate study.• A survey of produce availability in NewOrleans’ small neighborhood stores foundthat for each additional meter of shelfspace devoted to fresh vegetables, residentseat an additional 0.35 servings per day.• In rural Mississippi, adults living in “fooddesert” counties lacking large supermarketsare 23 percent less likely to consume therecommended fruits and vegetables thanthose in counties that have supermarkets,controlling for age, sex, race, andeducation.3. Access to healthy food is associatedwith lower risk for obesity and otherdiet-related chronic diseases. Researchersfind that residents who live near supermarketsor in areas where food markets sellingfresh produce (supermarkets, grocery stores,farmers’ markets, etc.) outnumber food storesthat generally do not (such as corner stores)have lower rates of diet-related diseases thantheir counterparts in neighborhoods lackingfood access.• A multistate study found that peoplewith access to only supermarkets orto supermarkets and grocery storeshave the lowest rates of obesity andoverweight and those without access tosupermarkets have the highest rates.• In California and New York City, residentsliving in areas with higher densities of freshfood markets, compared to conveniencestores and fast food restaurants, havelower rates of obesity. In California,obesity and diabetes rates are 20 percenthigher for those living in the least healthy“food environments,” controlling forhousehold income, race/ethnicity, age,gender, and physical activity levels.• Using statistical modeling techniques thatcontrol for a variety of factors, researchersestimate that adding a new grocery store toa high poverty neighborhood in Indianapoliswould lead to a three pound weightdecrease among residents, while eliminatinga fast food restaurant in a neighborhoodwith a high density of fast food wouldlead to a one pound weight decrease.• In Chicago and Detroit, residents wholive farther from grocery stores thanfrom convenience stores and fast food8

PolicyLinkThe Food Trustrestaurants have significantly higher rates ofpremature death from diabetes.4. New and improved healthy food retailin underserved communities createsjobs and helps to revitalize low-incomeneighborhoods. Though the economicimpacts of food retailers are understudied,we know that grocery stores contribute tocommunity economic development. Analysisof a successful statewide public-privateinitiative to bring new or revitalized grocerystores to underserved neighborhoods inPennsylvania provides positive evidence thatfresh food markets can create jobs, bolster localeconomies, and revitalize neighborhoods. Theeffort has created or retained 4,860 jobs in78 underserved urban and rural communitiesthroughout the state. Analyses of storessupported by the effort find they lead toincreased economic activity in surroundingcommunities.Implications for PolicyThe evidence is clear that many communities—predominantly low-income, urban communitiesof color and rural areas—lack adequate access tohealthy food, and the evidence also suggests thatthe lack of access negatively impacts the healthof residents and neighborhoods. These findingsindicate that policy interventions to increaseaccess to healthy food in “food deserts” willhelp people eat a healthy diet, while contributingto community economic development.For many years, impacted communities andtheir advocates have been implementinga variety of strategies to increase access tofresh, wholesome foods, including:• Attracting or developing grocerystores and supermarkets;• Developing other retail outlets suchas farmers’ markets, public markets,cooperatives, farmstands, communitysupportedagriculture programs, andmobile vendors (and ensuring publicbenefits can be used at these venues);• Increasing the stock of fruits, vegetables,and other healthy foods at neighborhoodcorner stores or small groceries;• Growing food locally through backyardand community gardens and largerscaleurban agriculture; and• Improving transportation to grocerystores and farmers’ markets.Improving access to healthy food is a criticalcomponent of an agenda to build an equitableand sustainable food system. It is time fora nationwide focus to ensure that healthyfood choices are available to all, buildingon these local efforts and innovations.Smart public policies and programs should supportcommunities in their efforts to develop, implement,and test strategies that increase healthy foodaccess. Government agencies at the local, state,and federal level should prioritize the issue ofinequitable food access in low-income, underservedareas. Programs and policies that are workingshould be expanded and new programs shouldbe developed to bring more grocery stores andother fresh food retail outlets to neighborhoodswithout access to healthy foods. Transportationbarriers to fresh food outlets should be addressed.Whenever possible, policies to address fooddeserts should link with comprehensive efforts tobuild strong regional food and farm systems.Residents of low-income communities andcommunities of color in urban and rural areashave suffered for too long from a lack ofaccess to healthy food. With local and stateprograms showing enormous promise, now isthe time for policymakers to enact policies thatwill catalyze the replication of local and stateinnovations and bring them to a national scale.9

PolicyLinkThe Food TrustThe presence of stores sellinghealthy, affordable food makesit possible to eat “five a day”and consume a healthful diet.10

PolicyLinkThe Food TrustTo assess the current evidence base, we gatheredthe studies conducted in the United States over thepast 20 years to create the most comprehensivebibliography on this topic to date. 2 We founda total of 132 studies that examined access tohealthy food and its impacts. They include threenationwide analyses of food store availabilityand neighborhood, city, county, regional,statewide, and multistate analyses covering 22states throughout the country. The bibliographyalso includes three review studies. 3, 4, 5 Sixty-oneof the studies were published in peer-reviewedjournals and generally conducted by academicresearchers, and 71 were self-published andgenerally conducted by practitioners. (See pages23-24 for a full description of our methodology.)Studies find that residentswith greater access tosupermarkets or a greaterabundance of healthy foodsin neighborhood food storesconsume more fresh produceand other healthful items.12

PolicyLinkThe Food TrustFindings1. Accessing healthy food is achallenge for many Americans—particularly those living inlow-income neighborhoods,communities of color, andrural areasResearchers have measured geographic accessto healthy foods in many different ways, andat nearly every imaginable scale: from nationalsamples to detailed assessments of specificneighborhoods. Only one study has sought tocalculate the extent of the problem nationally.The U.S. Department of Agriculture’s 2009 “fooddesert” study examined access to supermarkets anddetermined that 23.5 million people cannot accessa supermarket within one mile of their home.Most studies (a total of 113) examine whethersupermarkets or healthy foods are equitablydistributed across communities according tosocioeconomic status, racial composition, orlevel of urbanization (population density). 6Their findings are remarkably consistent: peopleliving in low-income neighborhoods, minorityneighborhoods, and rural communities facemuch greater challenges finding healthy food,especially those who lack good transportationoptions to reach full-service grocery stores.Ninety-seven of these studies found inequitableaccess to healthy foods, 14 had some mixedresults, and two studies did not find inequities.Disparities in supermarket access inurban areas by race and incomeMany researchers use supermarkets as a proxy forfood access because they provide the most reliableaccess to a wide variety of nutritious and affordableproduce and other foods compared to other typesof food outlets such as convenience stores andsmaller grocery stores. Several of these studies lookat the distribution of different types of food stores,such as supermarkets, smaller grocery stores, and“fringe retailers” such as convenience and cornerstores across different community types. They findthat lower-income communities and communities ofcolor have fewer supermarkets, more conveniencestores, and smaller grocery stores than wealthierand predominantly white communities.Eighty-nine national and local studies documentuneven geographic access to supermarketsin urban areas according to income, race, orboth 7-87 and nine had mixed results. 88-96Nationwide study findings include:• Low-income zip codes have 25 percentfewer chain supermarkets and 1.3times as many convenience storescompared to middle-income zip codes.Predominantly black zip codes have abouthalf the number of chain supermarketscompared to predominantly whitezip codes, and predominantly Latinoareas have only a third as many. 46• Low-income neighborhoods have halfas many supermarkets as the wealthiestneighborhoods and four times as manysmaller grocery stores, according to anassessment of 685 urban and rural censustracts in three states. The same studyfound four times as many supermarketsin predominantly white neighborhoodscompared to predominantly black ones. 38Another multistate study found thateight percent of African Americanslive in a tract with a supermarketcompared to 31 percent of whites. 4213

PolicyLinkThe Food TrustLocal studies demonstrate similar trends:• In Los Angeles there are 2.3 times as manysupermarkets per household in low-povertyareas compared to high-poverty areas.Predominantly white areas have 3.2 timesas many supermarkets as black areas and1.7 times as many as Latino areas. 49• Among affluent neighborhoods inAtlanta, those that are predominantlywhite have better grocery store accessthan those that are predominantlyblack, indicating that race may be afactor independent of income. 30• In West Louisville, Kentucky, a low-incomeAfrican American community that suffersfrom high rates of diabetes, there is onesupermarket for every 25,000 residents,compared to the county average of onesupermarket for every 12,500 residents. 17• In Washington, DC, the city’s lowestincomewards (Wards 7 and 8) have onesupermarket for every 70,000 peoplewhile two of the three highest-incomewards (Wards 2 and 3) have one forevery 11,881 people. 20 One in five ofthe city’s food stamp recipients lives in aneighborhood without a grocery store. 37• In California and in New York City, lowincomeneighborhoods have fewerpurveyors of healthy foods (supermarkets,produce stands) compared to outlets thatprimarily sell unhealthy foods (conveniencestores, fast food restaurants). 14, 47 Lowincomeneighborhoods in Californiahave 20 percent fewer healthy foodsources than higher-income ones. 14• In unincorporated communities (colonias)located along the U.S.-Mexico borderin Texas, residents in neighborhoodswith higher levels of deprivation(measured by income, transportation,lack of infrastructure, etc.) travel fartherto reach the nearest supermarket orgrocery store and have lower accessto a variety of food stores. 51Disparities in access to healthyfood at neighborhood stores inurban areas by race and incomeOther studies gather much more detailed data,conducting in-store surveys to assess the availability,variety, quality, and price of particular healthy itemsor grocery “market baskets.” Such surveys offera more precise look at healthy food availability inneighborhoods, but they are labor-intensive sogenerally focus on smaller geographic areas.Among these studies, 21 found that food storesin lower-income neighborhoods and communitiesof color are less likely to stock healthy foods,offer lower quality items, and have higherprices compared to stores in higher-income or13, 15, 17, 18, 20-23,predominantly white communities,28, 31, 33, 35, 52, 68, 69, 96-99, 103, 105, 106and seven foundmixed results (for example, lower quality butsimilar prices and selection) 9, 81, 88, 89, 100, 102 or nodifference. 101 In addition, a study based on focusgroups with residents in East Baltimore (a lowincomecommunity of color) found that they werereliant on small neighborhood stores that chargedextremely high prices and lacked a good varietyand selection of healthy foods. 103 Findings include:• Stores carrying fruits and vegetables areunevenly distributed among different typesof communities in upstate New York: aminority neighborhood in Albany hasthe least access (4.6 stores per 10,000residents), followed by a rural community(7.8), a small town (9.8), and a raciallymixed neighborhood in Albany (11.4). 32The same researchers find that eight in10 of Albany’s nonwhite residents livein a neighborhood that lacks any storesselling low-fat milk or high-fiber bread. 33• Stores located in low-income and verylow-income zip codes in Los Angelesand Sacramento are less likely to stockhealthy foods than stores in higher-incomeareas. 34 Three in 10 food stores in a highpoverty,predominantly African Americancommunity in Los Angeles lacked fruits andvegetables while nearly all of the stores ina contrast area that was low poverty andpredominantly white sold fresh produce. 5214

PolicyLinkThe Food TrustShare of Baltimore Neighborhood Food Stores with Low Availability of Healthy Food,by Neighborhood Race and Income, 2006• Produce quality is lower in a predominantlyblack, low-income community in Detroitcompared to an adjacent suburbancommunity that is racially mixed andmiddle-income. 81 Produce quality isalso lower in New Haven, Connecticut’slow-income communities comparedto more affluent neighborhoods. 9• In Baltimore (see chart above), a healthyfood availability survey of 226 supermarkets,grocery stores, convenience stores, andbehind-glass stores in 106 census tractsfound that 43 percent of predominantlyblack neighborhoods and 46 percent oflower-income neighborhoods were in thebottom third of availability, compared tofour percent of predominantly white and 13percent of higher-income neighborhoods.The supermarkets in predominantly blackand lower-income neighborhoods scoredlower for healthy food availability as well. 23Disparities in food store access aroundschools by race and incomeIn addition to the residential environment, researchersare beginning to examine the “food environment”around schools because of the link between accessto convenience stores and adolescent health. 121 Twostudies looked at convenience stores in proximityto schools and found that schools with more lowincomeor nonwhite students or in urban areas, 104and schools located in low-income neighborhoodsor communities of color 107 are more likely tohave at least one convenience store nearby.Rural food desertsWhile the majority of food desert studies focuson urban communities, 21 studies examined ruralcommunities. Twenty of them found significantfood access challenges in rural communities 21,29, 32, 33, 36, 43, 46, 50, 51, 70, 75, 95, 108-114, 116and one (thatlooked at Springfield, Oregon) did not find urbanruraldisparities. 54 The major issues in rural areasare different than those in urban areas given thelow population density, longer distances betweenretailers, and rapid rise of supercenters and theirimpact on other food retailers. Key findings include:• Controlling for population density, ruralareas have fewer food retailers of any typecompared to urban areas, and only 14percent the number of chain supermarkets. 46(See chart, next page) Another nationwide15

PolicyLinkThe Food TrustAvailability of Food Stores in Rural Areas by Store Type, 2000analysis found that there are 418rural “food desert” counties where allresidents live 10 miles or more from thenearest supermarket or supercenter—20percent of all rural counties. 43• In the Mississippi Delta, over 70 percentof households eligible to receivefood stamp benefits needed to travelmore than 30 miles to reach a largegrocery store or supermarket. 36• In New Mexico, rural residents haveaccess to fewer grocery stores than urbanresidents, pay more for comparable items,and have less selection. The same marketbasket of groceries costs $85 for ruralresidents and $55 for urban residents. 113Transportation access2.Lack of transportation to supermarkets is a majorbarrier for residents in many communities. 115Assessments of Lexington (KY), Seattle (WA), Centraland South Los Angeles (CA), East Austin (TX), andTrinity County (CA) highlighted transportationchallenges. 11, 12, 22, 69, 116 Rural residents have highervehicle ownership generally, but those who lackreliable access to personal vehicles are particularlyisolated given the longer distances to stores and12, 51, 114, 116, 117lack of public transportation options.Better access to healthy foodcorresponds with healthier eatingConsistent with the conclusions of a recent reviewstudy, 4 we found strong and consistent evidenceindicating a positive relationship between accessto healthy food and eating behaviors. Withoutnearby access to healthy ingredients, familieshave a harder time meeting recommended dietaryguidelines for good health such as eating fruitsand vegetables and lowering fat intake. In asurvey of diabetic adults in New York’s East Harlemneighborhood, 40 percent said that they didnot follow the recommended dietary guidelinesbecause the necessary foods were less available andmore expensive in their neighborhood stores. 31Of 14 studies that examine food access andconsumption of healthy foods, all but one of themfound a correlation between greater access andbetter eating behaviors. All of the studies in thiscategory were conducted by academic researchersand published in peer-reviewed journals. 118Access to supermarketsEight studies analyzed access to nearby supermarketsor large grocery stores that sell a widevariety of healthy foods in relation to consumptionof fruits and vegetables, specific healthy foods (suchas low-fat milk or high-fiber bread), or a healthy diet(measured by an index of diet quality). Almost all16

PolicyLinkThe Food TrustAccess to Supermarkets and Consumption of Fruits and Vegetables by Race, 2002of these studies control for individual characteristicssuch as race and income and still find a relationshipbetween access and healthy eating. Six of thestudies found associations between supermarket42, 79, 91,access and healthy eating among adults109, 119, 120and one had mixed results. 78 Only onestudy examined access to food stores and eatingbehaviors of adolescents (specifically, boys aged10 to 14); this study did not find a relationshipbetween supermarket access and fruit andvegetable consumption but did find that proximityof convenience stores (where young people whodo not drive are more likely to shop) was associatedwith reduced fruit and vegetable intake. 121Some of the findings include:• African Americans living in a census tractwith a supermarket are more likely to meetdietary guidelines for fruits and vegetables,and for every additional supermarketin a tract, produce consumption rose32 percent. Among whites, eachadditional supermarket correspondedwith an 11 percent increase in produceconsumption (see chart above). 42 Thisstudy used a large sample: 10,230adults living in 208 urban, suburban,and rural census tracts in four states.• Adults with no supermarkets within a mileof their homes are 25 to 46 percent lesslikely to have a healthy diet than thosewith the most supermarkets near theirhomes, according to a study that useddata from North Carolina, Baltimore, andNew York City. A healthy diet was definedusing two different measures: the AlternateHealthy Eating Index, which measuresconsumption of foods related to low risk ofchronic disease, and a measure looking atconsumption of fats and processed meats. 91• Proximity to a supermarket is associatedwith increased fruit consumption amongfood stamp recipients (based on anationally representative sample). Similarpatterns were also seen with vegetableconsumption, though associationswere not statistically significant. 119• In rural Mississippi, adults living in “fooddesert” counties (defined as those lackinglarge supermarkets) are 23 percent lesslikely to consume the recommendedfruits and vegetables than those incounties that are not food deserts. 109• In Detroit’s East Side neighborhood, AfricanAmerican women with lower incomes areless likely to shop at supermarkets (whichare all located outside the neighborhood)and eat fruits and vegetables thanthose with higher incomes. 7917

PolicyLinkThe Food TrustAccess to fresh produce and otherhealthful foods in nearby storesSeveral recent studies go beyond usingsupermarkets as proxies for healthy food accessand conduct in-store surveys to more accuratelymeasure the availability of healthy food items innearby stores. 13, 21, 91, 122, 123 Others use residentsurveys to measure access to nutritious andquality foods and eating behaviors. 5, 124 Of the sixstudies in this category, all of them found thatincreased availability of produce or of specifichealthy foods (such as low-fat milk as a percentageof all milk) is associated with the increasedconsumption of those foods. Findings include:• In New Orleans, proximity to storesstocking more fresh produce isassociated with higher vegetableconsumption. Each additional meter ofshelf space devoted to fresh vegetablesis associated with an additional 0.35servings of vegetables per day. 13• For participants in a communitybasedhealth promotion program inColorado, greater shelf space allocatedto fresh produce correspondedwith greater increases in fruit andvegetable consumption. 122• The proportion of low-fat milk in storesis positively and directly related to itsconsumption according to a New Yorkstate study 21 and a study that examinedareas of California and Hawaii. 123• One study asked residents to ranktheir access to healthy food and thenexamined their rankings in relation totheir diets. Residents living in areas rankedby themselves or others as having theworst food environments were 22 to35 percent less likely to eat a healthydiet than those living in areas ranked ashaving the best food environments. 913. Access to healthy food isassociated with diet-relateddiseaseIn addition to making it possible—and evenmore likely—for residents to eat healthy diets,the availability of healthy food in communitiesis related to a host of diet-related diseasesincluding obesity and overweight, diabetes, andcardiovascular disease. Seventeen studies examinedthe relationship between healthy food accessand diet-related health outcomes; approximatelyhalf were conducted by academics and half wereconducted by policy researchers. Twelve found14, 24, 25, 27, 34, 45, 47, 72, 73, 125,a positive relationship,126, 128 127, 129, 145three studies had mixed results,78, 104and two studies had contrary findings.Access to supermarketsFive studies found that proximity to supermarketscorresponds with a lower body mass index (BMI),or rates of obesity, diabetes, or diet-related deathamong adults, 27, 71-73, 125 and one found the samecorrelation among adolescents. 45 Only two studiesfocused on children. One found that supermarketaccess was associated with lower BMI amongchildren in lower-density counties in Indianapolis(but not in higher-density ones). 127 The other trackedkindergarteners over four years and found that,controlling for individual characteristics, higherfruit and vegetable prices in their city or metrocorresponded with weight gain, but the density ofrestaurants, convenience stores, or grocery storesaround their schools did not make a difference. 145• Adults living in neighborhoods withsupermarkets or with supermarkets andgrocery stores have the lowest rates ofobesity (21 percent) and overweight(60–62 percent) and those living inneighborhoods with no supermarketsand access to only convenience stores,smaller grocery stores, or both had thehighest rates (32–40 percent obesity;73–78 percent overweight), according toa study of more than 10,000 adults. 125• The lack of supermarket accesscorresponds with higher rates of dietrelateddeath in Philadelphia. 2718

PolicyLinkThe Food TrustThe Economic Impacts of Fresh Food RetailersDirect Economic Impacts:• Job opportunities• Local tax revenuesIndirect Economic Impacts:• Revitalized neighborhood housing markets• Asset-building for low-income homeowners (via appreciating real estate assets)• Workforce training and development• New businesses surrounding the store• Additional spending in the local economy generated by the store and the new jobs itcreates (the “multiplier effect”)• In Los Angeles, a longer distancetraveled to reach a grocery store wasassociated with higher BMI. Thosewho traveled more than 1.75 miles toa supermarket weighed 0.8 BMI unitsmore (4.8 pounds for a 5’5” person). 34• A national study of more than 70,000teens also found that increased availabilityof chain supermarkets was associatedwith lower rates of overweight. 45Food outlet mixSeveral studies 14, 24, 25, 47, 126 have found thatthe mix of food stores available to residents isassociated with diet-related health outcomes:• Californians and New Yorkers living inareas with higher densities of fresh foodmarkets compared to convenience storesand fast food restaurants have lowerrates of obesity. In California, obesity anddiabetes rates were 20 percent higherfor those living in the least healthy “foodenvironments,” controlling for individualfactors. 14 In New York City, increasing“BMI-healthy” food stores in New Yorkneighborhoods corresponded withlower obesity rates (though decreasing“BMI-unhealthy” stores did not). 47• In Indianapolis, BMI values correspondwith access to supermarkets and fastfood restaurants. Researchers estimatethat adding a new grocery store to ahigh-poverty neighborhood translatesinto a three pound weight decrease, andeliminating a fast food restaurant from afast food dense neighborhood (six or morefast food restaurants per square kilometer)translates into a one pound decrease. 126• A 2009 study of Chicago’s food desertsfound that as the distance to the nearestgrocer increases relative to the distance tothe nearest fringe food outlet, the Years ofPotential Life Loss (YPLL) due to diseasessuch as cancer, cardiovascular disease,diabetes, and liver disease increases. Thisrelationship is significant in AfricanAmerican communities, but less clear forwhite and Hispanic communities. 254. New and improved healthyfood retail in underservedcommunities creates jobs andhelps to revitalize low-incomeneighborhoodsBeyond the benefits to individual health describedabove, fresh food markets contribute to the overallhealth of neighborhoods and communities.Grocery stores are known by economic developmentpractitioners to be high-volume “anchors” thatgenerate foot traffic and attract complementarystores and services like banks, pharmacies, videorentals, and restaurants. 131 Yet compared to thestudy of food access and its health impacts, thestudy of economic impacts related to food retaildevelopment is an area of relatively limited research.Several methods have been developed to estimatethe demand for food retail in underserved19

PolicyLinkThe Food TrustThe Pennsylvania Fresh Food Financing Initiative hashelped develop supermarkets and other fresh foodoutlets in 78 underserved urban and rural areas,increasing access to healthy food for nearly 500,000residents and creating or retaining 4,860 jobs.communities. Studies that use local datasources find that these neighborhoods have thepotential to support thousands of square feetin additional grocery retail space. 56-67, 134 Onestudy estimated $8.7 billion dollars in annualgrocery leakage in inner-city neighborhoods. 135Some have also investigated the impact of newsupermarkets on nearby real estate values. Whennew food retailers enter areas that were previouslyunder-retailed, they can bring viability to urbanneighborhoods’ commercial real estate markets,and can change perceptions that economicallydistressed urban areas are undesirable places tooperate businesses. 133 An assessment of the impactof new supermarkets on neighborhood housingvalues in Philadelphia found that the values ofhomes located within one-quarter to one-halfmile of the new supermarkets increase by four toseven percent (an average of $1,500) after thestores open, mitigating the downward trend in realestate values. In addition, the effect was larger inneighborhoods with weaker housing markets. 130Recent analyses of efforts to bring new grocerystores into underserved communities find that thesebusinesses are viable (even thriving), offer a goodselection of nutritious and affordable foods, andcontribute greatly to local economic development.An examination of the first full-service supermarketto locate in New York City’s Harlem neighborhood(thanks in part to a $2.5 million loan from the cityto cover construction costs), four years after itsopening, found that the store allocated the sameamount of space to a similar variety of fresh fruitsand vegetables, fish, and meat as typical suburbansupermarkets, at similar prices. 136 The store has beencredited with catalyzing the revitalization of theneighborhood. 137Studies of the Pennsylvania Fresh Food FinancingInitiative (FFFI), a statewide public-private effortthat has helped develop 78 supermarkets andother fresh food outlets in underserved urbanand rural areas, also demonstrate the positiveimpacts of healthy food retailing. In additionto increasing access to healthy food for nearly500,000 residents, the effort resulted in:• Job creation. The initiative created orretained 4,860 jobs throughout the state. Arecent case study of selected supermarketsin the Philadelphia region found that thevast majority of jobs created through theinitiative (75 percent) were filled by localresidents living within three miles of theirworkplace. 138 A new store assisted bythe initiative that is part of the regionalShopRite chain created 258 jobs and morethan half were filled by local residents. 139When you add in the additional jobs thatare created through a new store’s multipliereffect, the total number of jobs becomesmuch higher: one grocery store that theeffort helped launch is estimated to havecreated 660 jobs directly and indirectly. 140• Economic development. New andimproved grocery stores can catalyzecommercial revitalization in a community.An analysis of the economic impacts of fivenew stores that opened with FFFI assistancefound that, for four of the stores, totalemployment surrounding the supermarketincreased at a faster rate than citywidetrends. This suggests a positive effect onoverall economic activity resulting from theintroduction of a new supermarket. 13820

PolicyLinkThe Food TrustImplications for PolicyExisting research provides clear evidence thatfood deserts exist in numerous low-incomecommunities and communities of color across thecountry, and that they have significant negativeimpacts on health, social equity, and local economicdevelopment. The balance of the research stronglysuggests that making affordable, healthy foodsmore available to underserved residents will lead totheir making healthier choices about what to eatand, ultimately, better health, while contributingto economic and neighborhood revitalization.While there is general agreement in theliterature about the lack of access to healthyfoods and increasing evidence about itsconsequences, fewer researchers have focusedon the question of what are the most effectivesolutions. This search has largely been taken upby impacted communities and their advocatesand supporters. Across the country, they are:• Attracting or developing grocerystores and supermarkets;• Developing other retail outlets suchas farmers’ markets, public markets,cooperatives, farmstands, communitysupportedagriculture programs, andmobile vendors (and ensuring publicbenefits can be used at these venues);• Increasing the stock of fruits, vegetables,and other healthy foods at neighborhoodcorner stores or small groceries;• Growing food locally through backyardand community gardens and largerscaleurban agriculture; and• Improving transportation to grocerystores and farmers’ markets.Communities are using a variety of strategies toincrease access to healthy foods, and theirefforts provide several lessons for policymakersat the local, state, and federal level. 143Until more systemic solutions are instituted,transportation barriers to fresh food markets needto be removed. Community groups and plannersshould evaluate existing transportation routes andimprove coordination of bus routes, bus stops, andschedules or add vanpools or shuttles to maximizetransit access to grocery stores and farmers’ markets.Longer-term transportation and land use planningshould promote the co-location of food retail,transit access, and affordable homes. Communitiesand retailers can launch programs such as mobilemarkets, grocery shuttles, and grocery vandeliveryto improve access to healthy food.Community groups, residents, researchers, andgovernment agencies should work together toidentify areas that lack access to healthy food and tounderstand local economic conditions and regionalfood systems. Areas lacking access should beprioritized, strategies for action need to identified,and then advocates need to demand the resources,programs, and policies to solve the access problem.Once underway, efforts should be monitored toexamine progress over time, and advocates shouldseek the expansion of successful approaches.Cities have many policy tools they can use toincentivize and promote healthy food retailincluding land use planning, zoning, economicdevelopment and redevelopment, and nutritionassistance. A recent analysis of retailers’ locationdecisions found that the land availability, marketdemand (and data demonstrating that demand),construction and operations costs, and approval/zoning requirements all pose barriers to locatingin underserved urban areas. 141 Cities can help21

PolicyLinkThe Food TrustWhat Type of Food Access Will Make a Difference?One question the research begins to address is whether supermarkets are the only solution to the “grocery gap” inlow-income communities.The majority of studies use supermarkets (typically defined by a sales volume of more than $2 million or more than50 employees) as a proxy for access to healthy foods. This makes sense because most Americans do the bulk of theirgrocery shopping at these stores (and increasingly at larger supercenters) 142 and supermarkets more consistently36, 44offer a good variety and selection of affordable and nutritious foods compared to other types of food retailers.But more and more studies are using in-store surveys to examine the availability of particular healthy items or healthy“market baskets” and their consumption. These studies find the same relationship between access and diet as studiesthat look at supermarkets.This suggests that health could be improved through many different food access strategies.overcome these barriers by providing publiclyowned land for food retailers, helping with landassembly, and identifying and marketing sites forgrocery store development. Several cities haveconducted internal assessments to understandhow their agencies and departments can fosterhealthy food retail in underserved neighborhoods.In New York City, the departments of health,planning, housing, economic development, andthe Mayor’s office all played a role in developingand implementing several innovative programsincluding: Green Carts, to help produce vendorslocate in underserved neighborhoods with highrates of obesity and diabetes; Healthy Bodegas, toimprove healthy offerings in corner stores; HealthBucks, to promote produce purchasing at farmers’markets; and FRESH, to provide zoning and financialincentives to promote grocery store development,upgrading, and expansion in underserved areas.At the state and national level, fresh foodfinancing initiatives—based on Pennsylvania’ssuccessful program (described on page 20)—thatcreate public-private partnerships to supportthe development, renovation, and expansionof retail outlets offering fresh healthy food(such as grocery stores, farmers’ markets, andcooperatives) should be developed. 144 The successof the Pennsylvania Fresh Food Financing Initiativedemonstrates that public investments can leveragesignificant private investment and dramaticallyimprove healthy food access. Policy replicationefforts have been successful in Illinois, New York,and New Orleans, and numerous replicationefforts are underway in states across the country.Given the national scope of the problem, thissuccessful state policy should be brought toa national scale so this innovative financingmechanism can be available to all communities.Successful policies and programs need to bereplicated and brought to a greater scale toincrease healthy food access. A problem withsuch broad and negative impacts on health,economy, and equity warrants a focus at alllevels—community, state, and national. Now isthe time for bold, nationwide efforts to ensurethat healthy food choices are available to all.22

PolicyLinkThe Food TrustMethodsBetween May and July 2009, PolicyLink andThe Food Trust created a comprehensivebibliography of studies related to food accessand/or food access and health across theUnited States. Unlike previous review studies,which typically only include published work, wesought to include “grey literature,” or studies,reports, and analyses that are not published inpeer-reviewed journals. Public health agencies,community-based organizations, and policygroups frequently conduct primary data analysesof retail food access to inform their activities,but generally do not take the additional steps tosubmit their studies to journals for publication.We used the following search methodsto compile the bibliography:• Sent requests for information to relevantlistservs, e.g., COMFOOD, the NationalNeighborhood Indicators Partnership(NNIP), American Evaluation Association(EVALTALK), and agency email lists;• Wrote to 80 food policy councils acrossthe country that are listed on the NorthAmerican Food Policy Council websiteand the Community Food SecurityCoalition Food Policy Council Database;• Contacted several foundations andleaders working in the food access field;• Searched PubMed and other librarydatabases related to the fields ofplanning, community development, andgeography to identify formally publishedwork related to urban and rural foodaccess and health implications; and• Reviewed reference lists of included studies.In order to be included, each study neededto meet the following criteria:• Related directly or indirectly to identifyingdisparities in access to food retailersor healthy food, and the relationshipbetween food retail and health;• Either included original research onthese topics or reviewed other studies;• Conducted in the United States (while therehave been studies conducted outside ofthe United States, the persistent trend ofresidential segregation by race/ethnicity andincome in this country makes extrapolationfrom these studies of limited value); and• Published during or after 1995 (althoughwe included a few important studies thatwere conducted between 1990 and 1994).One hundred and thirty-two studies were ultimatelyincluded in the database, of 168 articles initiallygathered through the search methods above. Weincluded studies that use random and nonrandomsampling methods and quantitative and qualitativetechniques (such as resident interviews). We alsoincluded studies that examine single communities ofinterest (alone or in comparison to other areas). Weexcluded newsletters, policy statements, and studiesthat focused on methods and measurements. Inone case we found two policy papers, one shorterthan the other, based on the same study and data;they were counted as one study in the database.Of the studies selected for the database, 61 werepublished in peer-reviewed journals, and 71 fellinto the grey literature category. We did notsystematically review the evidence quality (e.g.,sample size, strength of methods used) of each23

PolicyLinkThe Food Truststudy for this review, but note that to date, thestudies that examine the health impacts of accessto healthy food have primarily used cross-sectionalresearch designs (examining survey data) and therehave been few longitudinal or intervention studies.We also noted some systematic differencesbetween the content of the peer-reviewed studiescompared to those conducted by practitioners.None of the practitioner studies examined therelationship between food access and eatingbehaviors, likely due to the difficulty of accessingdata on eating behaviors for small geographies orindividuals. Only one of the peer-reviewed studiesexamined the economic impacts of grocery stores.24

PolicyLinkThe Food TrustReferencesPeer-Reviewed Journal ArticlesAlwitt, L., and Donley, T. “Retail Stores inPoor Urban Neighborhoods.” Journal ofConsumer Affairs 31 (1997): 139–164.Andrews, M., Kantor, L., Lino, M., andRipplinger, D. “Using USDA’s Thrifty Food Planto Assess Food Availability and Affordability.”Food Access 24, no.2 (2001): 45-53.Andreyeva, T., Blumenthal, D., Schwartz, M.,Long, M., and Brownell, K. “Availability and Pricesof Foods Across Stores And Neighborhoods:The Case Of New Haven, Connecticut.” HealthAffairs 27, no.5 (2008): 1381–1388.Auchincloss, A., Diez-Roux, A., Brown, D.,Erdmann, C., Bertoni, A. “NeighborhoodResources for Physical Activity and Healthy Foodsand Their Association with Insulin Resistance.”Epidemiology, 19 (2008):146–157.Baker, E., Schootman, M., Barnidge, E., andKelly, C. “The Role of Race and Poverty in Accessto Foods that Enable Individuals to Adhere toDietary Guidelines.” Preventing Chronic Disease:Public Health Research, Practice and Policy 3,no. 3 (2006): 1-11. Available at http://www.cdc.gov/pcd/issues/2006/jul/05_0217.htm.Beaulac, J., Kristjansson, E., and Cummins, S.“A Systematic Review of Food Deserts, 1966-2007.” Preventing Chronic Disease: PublicHealth Research, Practice and Policy 6, no.3 (2009): 1-10. Available at http://www.cdc.gov/pcd/issues/2009/Jul/08_0163.htm.Block, D., and Kouba, J. “A Comparison of theAvailability and Affordability of a Market Basketin Two Communities in the Chicago Area.” PublicHealth Nutrition 9, no.7 (2006): 837–845.Bodor, J. N., Rose, D., Farley, T. A., Swalm,C., and Scott, S.K. “Neighbourhood Fruit andVegetable Availability and Consumption: The Roleof Small Food Stores in an Urban Environment.”Public Health Nutrition 11 (2008): 413-420.Caldwell E., Kobayashi, M., DuBow,W., and Wytinck, S. “Perceived Accessto Fruits and Vegetables Associatedwith Increased Consumption.” PublicHealth Nutrition (2008): 1743-50.Cheadle A., Psaty, B., Curry, S., Wagner, E., Diehr,P., Koepsell, T., and Kristal, A. “Community-Level Comparisons Between Grocery StoreEnvironment and Individual Dietary Practices.”Preventive Medicine 20, no.2 (1991): 250-61.Clifton, K. “Mobility Strategies and FoodShopping for Low-Income Families: A CaseStudy.” Journal of Planning Educationand Research 23 (2004): 402-413.Cotterill, R., and Franklin, A. “The UrbanGrocery Store Gap.” Food Marketing PolicyCenter, University of Connecticut. FoodMarketing Policy Issue Paper 8 (1995).Fisher, B., and Strogatz, D. “Community Measuresof Low-Fat Milk Consumption: Comparing StoreShelves with Households.” American Journalof Public Health 89, no.2 (1999): 235–237.Franco, M., Roux, A., Glass, T., Caballero, B.,and Brancati, F. “Neighborhood Characteristicsand Availability of Healthy Foods inBaltimore.” American Journal of PreventiveMedicine 35, no.6 (2008): 561–567.Galvez, M., Morland, K., Raines, C., etal. “Race and Food Store Availability inan Inner-City Neighbourhood.” PublicHealth Nutrition 11 (2007): 624–631.Giang, T., Karpyn, A., Laurison, H., Hillier, A.,Burton, M., and Perry, D. “Closing the GroceryGap in Underserved Communities: The Creationof the Pennsylvania Fresh Food FinancingInitiative.” Journal of Public Health Managementand Practice 14, no.3 (2008): 272-279.25

PolicyLinkThe Food TrustGittelsohn, J., Franceschini, M., Rasooly, I., Ries, A.,Ho, L., Pavlovich, W., Santos, V., Jennings, S., andFrick, K. “Understanding the Food Environmentin a Low-Income Urban Setting: Implications forFood Store Interventions.” Journal of Hunger &Environmental Nutrition 2, no.2 (2008): 33-50.Glanz, K., Sallis, J., Saelens, B., and Frank,L. “Nutrition Environment Measures Surveyin Stores (NEMS-S) Development andEvaluation.” American Journal of PreventiveMedicine 32, no.4 (2007): 282-289.Helling, A., and Sawicki, D. “Race and ResidentialAccessibility to Shopping and Services.” HousingPolicy Debate 14, no.1 (2003): 69-101.Horowitz, C., Colson, K., Hebert, P., andLancaster K. “Barriers to Buying HealthyFoods for People with Diabetes: Evidence ofEnvironmental Disparities.” American Journalof Public Health 94 (2004): 1549–1554.Hosler, A., Rajulu, D., Fredrick, B., and Ronsani,A. “Assessing Retail Fruit and VegetableAvailability in Urban and Rural UnderservedCommunities.” Preventing Chronic Disease5, no.4 (2008): 1-9. Available at http://www.cdc.gov/pcd/issues/2008/oct/07_0169.htm.Hosler, A., Varadarajulu, D., Ronsani, A., Fredrick,B., and Fisher, B. “Low-Fat Milk and High-FiberBread Availability in Food Stores in Urban andRural Communities.” Journal of Public HealthManagement Practice 12 (2006): 556–562.Inagami, S., Cohen, D., Finch K. B., and Asch, S.“You are Where You Shop: Grocery Store Locations,Weight, and Neighborhoods.” American Journalof Preventive Medicine 31, no.1 (2006): 10-17.Jago, R., Baranowski, T., Baranowski, J.,Cullen, K., and Thompson, D. “Distance toFood Stores and Adolescent Male Fruit andVegetable Consumption: Mediation Effects.”International Journal of Behavioral Nutritionand Physical Activity 4 (2007): 4-35. Availableat http://www.ijbnpa.org/content/4/1/35.Jetter, K., and Cassady, D. “The Availability andCost of Healthier Food Alternatives.” AmericanJournal of Preventive Medicine 30 (2006): 38–44.Kaufman, P. “Rural Poor Have Less Accessto Supermarkets, Large Grocery Stores.”Rural Development Perspectives 13 (1998):19–26. Available at http://www.ers.usda.gov/publications/rdp/rdp1098/rdp1098c.pdf.Laraia, B., Siega-Riz, A., Kaufman, J. and Jones, S.“Proximity of Supermarkets Is Positively Associatedwith Diet Quality Index for Pregnancy.” AmericanJournal of Preventive Medicine 39 (2004): 869–875.Larson, N., Story, M., and Nelson, M.“Neighborhood Environments Disparities in Accessto Healthy Foods in the U.S.” American Journal ofPreventative Medicine 36, no.1 (2009): 74-81.Lavin, M. “Supermarket Access and ConsumerWell-Being: The Case of Pathmark in Harlem.”International Journal of Retail and DistributionManagement 33, no.5 (2005): 388-398.Liese, A., Weis, K., Pluto, D., Smith, E., and Lawson,A. “Food Store Types, Availability, and Cost of Foodsin a Rural Environment.” Journal of the AmericanDietetic Association 107 (2007): 1916–1923.Liu, G., Wilson, J., Qi, R., and Ying, J. “GreenNeighborhoods, Food Retail and ChildhoodOverweight: Differences by PopulationDensity.” American Journal of HealthPromotion 21, no.4 (2007): 317-325.Moore, L., and Roux, A. “Associations ofNeighborhood Characteristics with the Locationand Type of Food Stores.” American Journalof Public Health 96 (2006): 325–331.Moore, L., Roux, A., and Brines, S. “ComparingPerception-Based and Geographic InformationSystem (GIS)-Based Characterizations ofthe Local Food Environment.” Journal ofUrban Health: Bulletin of the New YorkAcademy of Medicine 85, no.2 (2008).Moore, L., Roux, A., Nettleton, J., andJacobs, D. “Associations of the Local FoodEnvironment with Diet Quality—A Comparison ofAssessments Based on Surveys and GeographicInformation Systems: The Multi-Ethnic Studyof Atherosclerosis.” American Journal ofEpidemiology 167 (2008): 917–924.Morland, K., and Filomena, S. “Disparities in theAvailability of Fruits and Vegetables BetweenRacially Segregated Urban Neighbourhoods.” PublicHealth Nutrition 10, no.12 (2007): 1481-1489.Morland, K., Roux, A., and Wing, S. “Supermarkets,Other Food Stores, and Obesity: The Atherosclerosis26

PolicyLinkThe Food TrustRisk in Communities Study.” American Journal ofPreventive Medicine 30, no.4 (2006): 333-339.Morland, K., and Evenson, K. “ObesityPrevalence and the Local Food Environment.”Health & Place 15, no.2 (2009): 491-495.Morland, K., Wing, S., Roux, A., and Poole,C. “Neighborhood Characteristics Associatedwith the Location of Food Stores andFood Service Places.” American Journal ofPreventive Medicine 22 (2002): 23–29.Morland, K., Wing, S., and Roux, A. “TheContextual Effect of the Local Food Environmenton Residents’ Diets: The Atherosclerosis Riskin Communities Study.” American Journal ofPublic Health 92, no.11 (2002): 1761-67.Morton, L., and Blanchard, T. “Starved forAccess: Life in Rural America’s Food Deserts.”Rural Realities 1, no.4 (2007). Available at www.ruralsociology.org/pubs/ruralrealities/issue4.html.Nayga, M., and Weinberg, Z. “SupermarketAccess in the Inner Cities.” Journal of Retailingand Consumer Services 6, no.3 (1999): 141-145.Powell, L., Auld, C., Chaloupka, F., O’Malley,P. M., and Johnston, L. D. “AssociationsBetween Access to Food Stores and AdolescentBody Mass Index,” American Journal ofPreventive Medicine 33, no.4 (2007).Powell, L., Slater, S., Mirtcheva, D., Bao, Y.,and Chaloupka, F. “Food Store Availabilityand Neighborhood Characteristics inthe United States.” American Journal ofPreventive Medicine 44 (2007): 189–195.Raja, S., Ma, C., and Yadav, P. “BeyondFood Deserts: Measuring and MappingRacial Disparities in Neighborhood FoodEnvironments.” Journal of Planning Educationand Research 27 (2008): 469-482.Rose, D., and Richards, R. “Food Store Accessand Household Fruit and Vegetable Use amongParticipants in the US Food Stamp Program.” PublicHealth Nutrition 7, no. 8 (2004): 1081-1088.Rundle, A., Neckerman, K., Freeman, L.,Lovasi, G., Purciel, M., Quinn, J., Richards,C., Sircar, N., and Weiss, C. “NeighborhoodFood Environment and Walkability PredictObesity in New York City.” EnvironmentalHealth Perspectives 117 (2009): 442–447.Sekhobo, J., and Berney, B. “The Relation ofCommunity Occupational Structure and Prevalenceof Obesity in New York City Neighborhoods—An Ecological Analysis.” Journal of Hunger &Environmental Nutrition 3, no.1 (2008): 76-83.Sharkey J., and Horel, S. “NeighborhoodSocioeconomic Deprivation and MinorityComposition are Associated with BetterPotential Spatial Access to the Ground-TruthedFood Environment in a Large Rural Area.” TheJournal of Nutrition 138 (2008): 620–627.Sharkey, J., Scott, H., Daikwon, H., and Huber,J. “Association Between NeighborhoodNeed and Spatial Access to Food Stores andFast Food Restaurants in Neighborhoods ofColonias.” International Journal of HealthGeographics 8, no.9 (2009): 1-17.Short, A., Guthman, J., and Raskin, S. “FoodDeserts, Oases, or Mirages? Small Marketsand Community Food Security in the SanFrancisco Bay Area.” Journal of PlanningEducation and Research 26 (2007): 352.Sloane, D., Diamount, A., Lewis, L, et al.“Improving the Nutritional Resource Environmentfor Healthy Living Through Community-BasedParticipatory Research.” The Journal of GeneralInternal Medicine 18 (2003): 568–575.Small, M. L., and McDermott, M. “ThePresence of Organizational Resources inPoor Urban Neighborhoods: An Analysisof Average and Contextual effects.”Social Forces 84 (2006): 1697-1724.Sturm, R. “Disparities in the FoodEnvironment Surrounding U.S. Middleand High Schools.” American Journal ofPublic Health 122 (2008): 681–690.Sturm, R., and Datar, A. “Body Mass Index inElementary School Children, Metropolitan AreaFood Prices and Food Outlet Density.” Journalof Public Health 119 (2005): 1059–1068.Wang, M., Kim, S., Gonzalez, A., MacLeod,K., and Winkleby, M. “Socioeconomic andFood-Related Physical Characteristics of theNeighborhood Environment are Associated withBody Mass Index.” Journal of Epidemiologyand Community Health 61 (2007): 491–498.Zenk, S., and Powell, L. “U.S. Secondary Schools andFood Outlets.” Health & Place, 14 (2008): 336–346.27

PolicyLinkThe Food TrustZenk, S. H., Schulz, A., Hollis-Neely, T., Campbell, R.T., Watkins, G., Nwankwo, R., and Odoms-Yound,A. “Fruit and Vegetable Intake in African AmericansIncome and Store Characteristics.” AmericanJournal of Preventive Medicine 20, no.1 (2005).Zenk, S., Schulz, A., Israel, B., James, S., Bao, S.,and Wilson, M. “Neighborhood Racial Composition,Neighborhood Poverty, and the Spatial Accessibilityof Supermarkets in Metropolitan Detroit.” AmericanJournal of Public Health 95 (2005): 660–667.Zenk, S., Schulz, A., Israel, B., Sherman, J., Bao,S., and Wilson, M. “Fruit and Vegetable AccessDiffers by Community Racial Composition andSocioeconomic Position in Detroit, Michigan.”Ethnicity & Disease 16 (2006): 75-280.Grey LiteratureAlameda Point Collaborative, Alameda PointCollaborative Food Security Findings andRecommendations. Alameda, CA: Alameda PointCollaborative, 2006. Available at http://www.apcollaborative.org/images/APC_GrowingYouth.pdf.Alberti, P., Hadi, E., Cespedes, A., Grimshaw,V., and Bedell, J. Farmers’ Markets—BringingFresh, Nutritious Food to the South Bronx.New York, NY: New York City Department ofHealth and Mental Hygiene, 2008. Available athttp://www.ci.nyc.ny.us/html/doh/downloads/pdf/dpho/dpho-farmersmarket.pdf.Beatley, T., et al. The Charlottesville RegionFood System: A Preliminary Assessment.Charlottesville, VA: University of Virginia,2006. Available at http://www.virginia.edu/ien/docs/06FINALRept_Jun06_CvilleFood.pdf.Birnbach, K. Food for Thought. Access andAvailability of Health Food in East Austin. Austin,TX: University of Texas at Austin, 2008.Bjorn, A., Lee, B., Born, B., Monsivais, P., Kantor,S., Sayre, R. At the Table with the AFPC. MappingFood Insecurity and Access in Seattle and KingCounty Issue. Seattle, WA: Seattle and KingCounty Acting Food Policy Council, 2008.Blanchard, T., and Lyson, T. “Access to LowCost Groceries in Nonmetropolitan Counties:Large Retailers and the Creation of FoodDeserts.” Mississippi, MS: Southern RuralDevelopment Center, 2006. Available at http://srdc.msstate.edu/measuring/blanchard.pdf.Blanchard, T., and Lyson, T. “Food Availability &Food Deserts in the Nonmetropolitan South.”Mississippi, MS: Southern Rural DevelopmentCenter, 2006. Available at http://srdc.msstate.edu/focusareas/health/fa/fa_12_blanchard.pdf.Blanchard, T., and Lyson, T. “Retail Concentration,Food Deserts, and Food DisadvantagedCommunities in Rural America.” Mississippi,MS: Southern Rural Development Center,2009. Available at http://srdc.msstate.edu/focusareas/health/fa/blanchard02_final.pdf.California Center for Public Health Advocacy.Searching for Healthy Food: The Food Landscape inCalifornia Cities and Counties. Davis, CA: CaliforniaCenter for Public Health Advocacy, 2007.California Center for Public Health Advocacy,PolicyLink, and the UCLA Center for HealthPolicy Research. Designed for Disease: The LinkBetween Local Food Environments and Obesity andDiabetes. Davis, CA: California Center for PublicHealth Advocacy, 2008. Available at http://www.policylink.org/documents/DesignedforDisease.pdf.Chen, S., Raymond, F., and Snyder, S. “Obesity inUrban Food Markets: Evidence from GeoreferencedMicro Data.” West Lafayette, IN: Purdue University,2009. Available at http://www.npc.umich.edu/news/events/food-access/chen_et_al_revised.pdf.City Harvest. Mount Hope Community FoodAssessment Report. New York, NY: City Harvest,2009. Available at http://www.cityharvest.org/images/pdf/Mount_Hope_CFA.pdf.City Harvest. The Melrose Community FoodAssessment. New York, NY: City Harvest,2009. Available at http://www.cityharvest.org/images/pdf/Melrose_CFA_2007.pdf.Community Farm Alliance. Bridging theDivide. Growing Self-Sufficiency in OurFood Supply: Community Food Assessment.A Regional Approach for Food Systems inLouisville KY. Frankfort, KY: Community FarmAlliance, 2007. Available at http://www.communityfarmalliance.org/BridgingTheDivide.pdf.Community Health Councils Inc. Does RaceDefine What’s in the Shopping Cart? CommunityHealth and Education. Los Angeles, CA:Community Health Councils Inc., 2008.28

PolicyLinkThe Food TrustD.C. Hunger Solutions. Healthy Food, HealthyCommunities: An Assessment and Scorecardof Community Food Security In the Districtof Columbia. Washington, DC: D.C. HungerSolutions, 2006. Available at http://www.dchunger.org/pdf/healthfoodcomm.pdf.Fresno Metro Ministry. Fresno Fresh Access:Community Food Assessment Report. 2003-2005. Fresno, CA: Fresno Metro Ministry,2005. Available at http://fresnometmin.org/fmm/pdfs/CFA_Summary_9-14-05.pdf.Frontier Nutrition Project. Trinity CountyFood Security Assessment. Weaverville,CA: Frontier Nutrition Project, 2001.Available at http://www.foodsecurity.org/cfa/trinity_cty_food_assessment.pdf.Fulfrost, B. Mapping the Markets: The RelativeDensity of Retail Food Stores in Densely PopulatedCensus Blocks in the Central Coast Region ofCalifornia. Santa Cruz, CA: University of California,Santa Cruz, 2006. Available at http://casfs.ucsc.edu/research/MappingTheMarkets.pdf.Gallagher, M. The Chicago Food Desert Report.Chicago, IL: Mari Gallagher Research and ConsultingGroup, 2009. Available at www.marigallagher.com.Gallagher, M. Examining the Impact of FoodDeserts on Public Health in Chicago. Chicago,IL: Mari Gallagher Research and ConsultingGroup, 2006. Available at http://www.marigallagher.com/site_media/dynamic/project_files/1_ChicagoFoodDesertReport-Full_.pdf.Gallagher, M. Examining the Impact of FoodDeserts on Public Health in Detroit. Chicago,IL: Mari Gallagher Research and ConsultingGroup, 2007. Available at http://www.marigallagher.com/site_media/dynamic/project_files/1_DetroitFoodDesertReport_Full.pdf.Goldstein, I., Loethen, L., Kako, E., andCalifano, C. CDFI Financing of Supermarketsin Underserved Communities: A Case Study.Philadelphia, PA: The Reinvestment Fund, 2008.Available at http://www.trfund.com/resource/downloads/policypubs/CDFIStudySummary.pdf.Gordon, C., Ghai, N., Purciel, M., Talwalkar, A., andGoodman, A. Eating Well in Harlem: How AvailableIs Healthy Food? New York, NY: New York CityDepartment of Health and Mental Hygiene, 2007.Graham, R., Kaufman, L., Novoa, Z., and Karpati,A. Eating In, Eating Out, Eating Well: Access toHealthy Food in North and Central Brooklyn.New York, NY: New York City Departmentof Health and Mental Hygiene, 2006.Hartford Food System. Connecticut’sSupermarkets: Can New Strategies Addressthe Geographic Gaps? Hartford, CT: HartfordFood System, 2006. Available at http://www.hartfordfood.org/pubs/supermarkets.pdf.Hatfield, D., and Gunnell, A. Food Accessin California Today. Portland, OR: Ecotrust,2005. Available at http://www.vividpicture.net/documents/12_Food_Access_in_CA_Today.pdf.Hrisanti, A., Chong, T., Dang, J., et al. TheEast Baltimore Nutritional Environment:Formative Research with Community Leaders.Baltimore, MD: Healthy Stores Project, 2003.Available at http://www.healthystores.org/images/downloads/eastbalt.pdf.Hunger Task Force of Milwaukee. Hunger inMilwaukee, Some Food for Thought. Milwaukee,WI: Hunger Task Force of Milwaukee, 2002.Available at http://www.hungertaskforce.org/userimages/publications_foodforthought_report.pdf.Kaiser, C. Healthy Food Access in Minneapolis:Initial Conversations with Residents. Minneapolis,MN: Institute for Agriculture and Trade Policy,2009. Available at http://www.iatp.org/iatp/publications.cfm?accountID=258&refID=104952.Kaufman, L., and Karpati, A. Food Matters: WhatBushwick Families’ Food Habits Teach Us aboutChildhood Obesity. New York, NY: New York CityDepartment of Health and Mental Hygiene, 2007.King, R., Leibtag, E., and Behl, A. “SupermarketCharacteristics and Operating Costs In Low-Income Areas,” Agricultural Economics Reports.Washington, DC: United States Department ofAgriculture, Economic Research Service, 2004.Lopez, R. Community Food Security in Connecticut:An Evaluation and Ranking of 169 Towns. Storrs,CT: Hartford Food System, 2005. Available at http://www.hartfordfood.org/pubs/cfs_connecticut.pdf.Manjarrez, C., and Cigna, J. Food StampParticipation and Market Access in the District ofColumbia. Discussion Brief No. 3. Washington, DC:Urban Institute, 2006. Available at http://www.urban.org/UploadedPDF/311343_dcfoodstamp.pdf.Morton, L., Oakland, J., Bitto, E., Sand, M., andMichaels, B. Iowa Community Food Assessment29

PolicyLinkThe Food TrustProject Report 2001-02. Ames, IA: Iowa StateUniversity Family Nutrition Program, 2002. Availableat http://www.soc.iastate.edu/extension/pub/tech/IowaCommunityFoodAssessmentReport.pdf.Neckerman, K., Bader, M., Purciel, M., andYousefzadeh, P. “Measuring Food Access in UrbanAreas.” New York, NY: Columbia University,2009. Available at http://www.npc.umich.edu/news/events/food-access/neckerman_et_al.pdf.New Mexico Food and Agriculture Policy Council.Closing New Mexico’s Rural Food Gap. SantaFe, NM: New Mexico Food and AgriculturePolicy Council, 2006. Available at http://www.farmtotablenm.org/closing_nm_food_gap_4pgs.pdf.New York City Department of City Planning.Going to Market: New York City’s NeighborhoodGrocery Store and Supermarket Shortage. NewYork, NY, 2008. Available at http://www.nyc.gov/html/dcp/html/supermarket/index.shtml.Papavasiliou, F., Essig, C., Barlett, P., and Rolls, A.Is Healthy Eating Possible in DeKalb County? AnAssessment of Food Availability, Access, and Cost inTwo Neighborhoods. Atlanta Local Food Initiative.Decatur, GA: DeKalb County Board of Health, 2007.Rose, D., Bodor, N., Swalm, C., Rice, J., Farley,T., and Hutchinson, P. Deserts in New Orleans?Illustrations of Urban Food Access and Implicationsfor Policy. Ann Arbor, MI: University of MichiganNational Poverty Center/USDA Economic ResearchService, 2009. Available at http://www.npc.umich.edu/news/events/food-access/rose_et_al.pdf.Sacramento Hunger Coalition. The Avondale/GlenElder Community Food Assessment. Food Securityin a South Sacramento Neighborhood. Sacramento,CA: Sacramento Hunger Coalition, 2004.San Francisco Food Alliance. 2005 San FranciscoCollaborative Food System Assessment.San Francisco, CA: San Francisco FoodAlliance, 2005. Available at http://www.sffoodsystems.org/pdf/FSA-online.pdf.Shaffer, A. The Persistence of L.A.’s GroceryGap: The Need for a New Food Policy andApproach to Market Development. Occidental,CA: Center for Food and Justice, 2002.Available at www.departments.oxy.edu/uepi/publications/the_persistence_of.htm.Sharkey, J., and Horel, S. “Characteristics ofPotential Spatial Access to a Variety of Fruitsand Vegetables in a Large Rural Area.” CollegeStation, TX: Texas A&M Health Science Center,2009. Available at http://www.npc.umich.edu/news/events/food-access/sharkey.pdf.Smith, D. Food Deserts in the Willamette: A Studyof Food Access in Lane County, Oregon. [Master’sthesis]. Eugene, OR: University of Oregon, 2003.Social Compact Inc., Baltimore NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.Social Compact Inc., Cincinnati NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2007.Social Compact Inc., Detroit Grocery InitiativeCatalyzing Grocery Retail Investment inInner-City Neighborhoods. Washington,DC: Social Compact Inc., 2008.Social Compact Inc., City of Fresno NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2009.Social Compact Inc., City of Tampa NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.Social Compact Inc., Harlem NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.Social Compact Inc., Houston NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2007.Social Compact Inc., Los Angeles NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.Social Compact Inc., Louisville MetroNeighborhood Market DrillDown. CatalyzingBusiness Investment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.Social Compact Inc., San Francisco NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.30

PolicyLinkThe Food TrustSocial Compact Inc., Southeast Fort WorthNeighborhood Market DrillDown. CatalyzingBusiness Investment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.Social Compact Inc., Washington DCNeighborhood Market DrillDown. CatalyzingBusiness Investment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.Southeast Food Access Working Group. FoodPreferences in San Francisco’s Southeast Sector: ASurvey Conducted by the Southeast Food AccessWorking Group. San Francisco, CA: SoutheastFood Access Working Group, 2007. Availableat http://www.sfgov.org/site/uploadedfiles/shapeupsf/SEFASurveyReport-FINAL.pdf.Sparks, A., Bania, N., and Leete, L. “FindingFood Deserts: Methodology and Measurementof Food Access in Portland, Oregon.”Washington, DC: National Poverty Center andUSDA Economic Research Service, 2009.Sustainable Food Center. Access Denied. AnAnalysis of Problems Facing East Austin Residentsin Their Attempts To Obtain Affordable, NutritiousFood. Austin, TX: Sustainable Food Center, 1995.Available at http://www.sustainablefoodcenter.org/library/Access_Denied.pdf.Tanaka, K., Mooney, P., et al. LexingtonCommunity Food Assessment: 2004-2007.Lexington, KY: University of Kentucky, 2008.Available at http://www.uky.edu/Ag/CLD/doc/CommunityFoodAssessmentReport04-07.pdf.Tchumtchoua, A. Town-Level Assessment ofCommunity Food Security in Connecticut. Storrs, CT:Food Marketing Policy Center, 2005. Available athttp://digitalcommons.uconn.edu/cgi/viewcontent.cgi?article=1000&context=fpmc_mono.The Food Trust. Stimulating SupermarketDevelopment: A New Day for Philadelphia.Philadelphia, PA: The Food Trust, 2004.Available at http://www.thefoodtrust.org/pdf/SupermktReport_F.pdf.The Food Trust. The Need for More Grocery Stores inNew York. Special Report. Philadelphia, PA: The FoodTrust, 2008. Available at http://www.thefoodtrust.org/catalog/download.php?product_id=147.The Food Trust. The Need for More Supermarketsin Chicago. Philadelphia, PA: The Food Trust,2008. Available at http://www.thefoodtrust.org/catalog/download.php?product_id=147.The Reinvestment Fund. The EconomicImpacts of Supermarkets on their SurroundingCommunities, Philadelphia, PA: The ReinvestmentFund, 2008. http://www.trfund.com/resource/downloads/policypubs/supermarkets.pdf.Thurman, S. Measuring Access to Food inCharlottesville, VA. Charlottesville, VA: Universityof Virginia, 2007. Available at http://www.virginia.edu/ien/docs/07FoodClassFINAL%20PAPERS/AccessTransportation.pdf.Tsai, S. Needs Assessment: Access to NutritiousFoods in East Oakland and South Hayward. [Master’sThesis]. Berkeley, CA: University of California atBerkeley School of Public Health and AlamedaCounty Public Health Department, 2003.Unger., S., and Wooten., H. A Food SystemsAssessment For Oakland, CA: Toward ASustainable Food Plan. [Master’s Thesis]. Berkeley,CA: Oakland Mayor’s Office of Sustainabilityand University of California, Berkeley, 2006.Urban and Environmental Policy Institute.Food Access in Central and South Los Angeles:Mapping Injustice, Agenda for Action. 2007:A Report on Project CAFE: Community Actionon Food Environments. Los Angeles, CA:Urban and Environmental Policy Institute2007. Available at http://departments.oxy.edu/uepi/cfj/publications/project_cafe.pdf.USDA Economic Research Service. Access toAffordable and Nutritious Food: Measuringand Understanding Food Deserts and TheirConsequences. Report to Congress. Washington,DC: U.S. Department of Agriculture,2009. Available at http://www.ers.usda.gov/Publications/AP/AP036/AP036.pdf.Williams, D. Food Security and Accessin Akron Ohio. [Master’s Thesis]. Akron,OH: University of Akron, 2002.31

PolicyLinkThe Food TrustNotes1Martinez, S. “The U.S. Food Marketing System:Recent Developments, 1997-2006,” Washington,DC: United States Department of Agriculture,Economic Research Service, 2007. Availableat www.ers.usda.gov/publications/err42/.2Contact the authors for summaries of thestudy findings that can be sorted by place andsubtopic (e.g. race, income, eating behaviors).3Beaulac, J., Kristjansson, E., and Cummins, S.“A Systematic Review of Food Deserts, 1966-2007.” Preventing Chronic Disease: PublicHealth Research, Practice and Policy 6, no.3(2009): 1-10. Available at http://www.cdc.gov/pcd/issues/2009/Jul/08_0163.htm.4Larson, N., Story, M., and Nelson, M.“Neighborhood Environments Disparities in Accessto Healthy Foods in the U.S.” American Journal ofPreventative Medicine 36, no.1 (2009): 74-81.5Nayga, M., and Weinberg, Z. “SupermarketAccess in the Inner Cities.” Journal of Retailingand Consumer Services 6, no.3 (1999): 141-145.6One study interviewed Minneapolis residentsabout access to healthy food and found challenges,but did not examine differences according totheir race, income, or neighborhood of residence.Kaiser, C. Healthy Food Access in Minneapolis:Initial Conversations with Residents, Minneapolis,MN: Institute for Agriculture and Trade Policy,2009. Available at http://www.iatp.org/iatp/publications.cfm?accountID=258&refID=104952.7Alameda Point Collaborative. Alameda PointCollaborative Food Security Findings andRecommendations. Alameda, CA: Alameda PointCollaborative, 2006. Available at http://www.apcollaborative.org/images/APC_GrowingYouth.pdf.8Alwitt, L., and Donley, T. “Retail Stores inPoor Urban Neighborhoods.” Journal ofConsumer Affairs 31 (1997):139–64.9Andreyeva, T., Blumenthal, D., Schwartz, M.,Long, M., and Brownell, K. “Availability andPrices of Foods Across Stores and Neighborhoods:The Case Of New Haven, Connecticut.” HealthAffairs 27, no.5 (2008): 1381–1388.10Baker, E., Schootman, M., Barnidge, E., andKelly, C. “The Role of Race and Poverty in Accessto Foods that Enable Individuals to Adhere toDietary Guidelines.” Preventing Chronic Disease:Public Health Research, Practice and Policy 3,no.3 (2006): 1-11. Available at http://www.cdc.gov/pcd/issues/2006/jul/05_0217.htm.11Birnbach, K. Food for Thought. Access andAvailability of Health Food in East Austin. Austin,TX: University of Texas at Austin, 2008.12Bjorn, A., Lee, B., Born, B., Monsivais, P., Kantor,S., and Sayre, R. At the Table with the AFPC.Mapping Food Insecurity and Access in Seattleand King County Issue. Seattle, WA: Seattle andKing County Acting Food Policy Council, 2008.13Bodor, J. N., Rose, D., Farley, T. A., Swalm,C., and Scott, S. K. “Neighbourhood Fruit andVegetable Availability and Consumption: The Roleof Small Food Stores in an Urban Environment.”Public Health Nutrition 11 (2008): 413-420.14California Center for Public Health Advocacy,PolicyLink, and the UCLA Center for HealthPolicy Research. Designed for Disease: The LinkBetween Local Food Environments and Obesity andDiabetes. Davis, CA: California Center for PublicHealth Advocacy, 2008. Available at http://www.policylink.org/documents/DesignedforDisease.pdf.15Chung, C., and Myers, J. “Do the Poor PayMore for Food? An Analysis of Grocery StoreAvailability and Food Price Disparities.” Journalof Consumer Affairs 33 (1999): 276–296.16Clifton, K. “Mobility Strategies and FoodShopping for Low-Income Families: A CaseStudy.” Journal of Planning Educationand Research 23 (2004): 402-413.17Community Farm Alliance. Bridging theDivide. Growing Self-Sufficiency in our Food32

PolicyLinkThe Food TrustSupply: Community Food Assessment. ARegional Approach for Food Systems inLouisville KY. Frankfort, KY: Community FarmAlliance, 2007. Available at http://www.communityfarmalliance.org/BridgingTheDivide.pdf.18Community Health Councils Inc. DoesRace Define What’s in the Shopping Cart?Community Health and Education. Los Angeles,CA: Community Health Councils Inc., 2008.19Cotterill, R., and Franklin, A. “The UrbanGrocery Store Gap.” Food Marketing PolicyCenter, University of Connecticut. FoodMarketing Policy Issue Paper 8 (1995).20D.C. Hunger Solutions. Healthy Food, HealthyCommunities: An Assessment and Scorecardof Community Food Security In the Districtof Columbia. Washington, DC: D.C. HungerSolutions, 2006. Available at http://www.dchunger.org/pdf/healthfoodcomm.pdf.21Fisher, B., and Strogatz, D. “Community Measuresof Low-Fat Milk Consumption: Comparing StoreShelves with Households.” American Journalof Public Health 89, no.2 (1999): 235–237.22Urban and Environmental Policy Institute. FoodAccess in Central and South Los Angeles: MappingInjustice, Agenda for Action. A Report on ProjectCAFE: Community Action on Food Environments.Los Angeles, CA: Urban and Environmental PolicyInstitute, 2007. Available at http://departments.oxy.edu/uepi/cfj/publications/project_cafe.pdf.23Franco, M., Roux, A., Glass, T., Caballero, B.,and Brancati, F. “Neighborhood Characteristicsand Availability of Healthy Foods inBaltimore.” American Journal of PreventiveMedicine 35, no.6 (2008): 561–567.24Gallagher, M. Examining the Impact of FoodDeserts on Public Health in Chicago. Chicago,IL: Mari Gallagher Research and ConsultingGroup, 2006. Available at http://www.marigallagher.com/site_media/dynamic/project_files/1_ChicagoFoodDesertReport-Full_.pdf.25Gallagher, M. The Chicago Food Desert Report.Chicago, IL: Mari Gallagher Research and ConsultingGroup, 2009. Available at www.marigallagher.com.26Galvez, M., Morland, K., Raines, C.,et al. “Race and Food Store Availabilityin an Inner-City Neighbourhood.” PublicHealth Nutrition 11 (2007): 624–631.27Giang, T., Karpyn, A., Laurison, H., Hillier, A.,Burton, M., and Perry, D. “Closing the GroceryGap in Underserved Communities: The Creationof the Pennsylvania Fresh Food FinancingInitiative.” Journal of Public Health Managementand Practice 14, no.3 (2008): 272-279.28Glanz, K., Sallis, J., Saelens, B., andFrank, L. “Nutrition Environment MeasuresSurvey in Stores (NEMS-S) Development andEvaluation.” American Journal of PreventiveMedicine 32, no. 4 (2007): 282-289.29Hartford Food System. Connecticut’sSupermarkets: Can New Strategies Addressthe Geographic Gaps? Hartford, CT: HartfordFood System, 2006. Available at http://www.hartfordfood.org/pubs/supermarkets.pdf.30Helling, A., and Sawicki, D. “Race and ResidentialAccessibility to Shopping and Services.” HousingPolicy Debate 14, no.1 (2003): 69-101.31Horowitz, C., Colson, K., Hebert, P., andLancaster, K. “Barriers to Buying HealthyFoods for People with Diabetes: Evidence ofEnvironmental Disparities.” American Journalof Public Health 94 (2004): 1549–1554.32Hosler, A., Rajulu, D., Fredrick, B., and Ronsani,A. “Assessing Retail Fruit and VegetableAvailability in Urban and Rural UnderservedCommunities.” Preventing Chronic Disease5, no.4 (2008): 1-9. Available at http://www.cdc.gov/pcd/issues/2008/oct/07_0169.htm.33Hosler, A., Varadarajulu, D., Ronsani, A., Fredrick,B., and Fisher, B. “Low-Fat Milk and High-FiberBread Availability in Food Stores in Urban andRural Communities.” Journal of Public HealthManagement Practice 12 (2006): 556–562.34Inagami, S., Cohen, D., Finch K. B., and Asch, S.“You are Where you Shop: Grocery Store Locations,Weight, and Neighborhoods.” American Journalof Preventive Medicine 31, no.1 (2006): 10-17.35Jetter, K., and Cassady, D. “The Availability andCost of Healthier Food Alternatives.” AmericanJournal of Preventive Medicine 30 (2006): 38–44.36Kaufman, P. “Rural Poor Have Less Accessto Supermarkets, Large Grocery Stores.”Rural Development Perspectives 13 (1998):19–26. Available at http://www.ers.usda.gov/publications/rdp/rdp1098/rdp1098c.pdf.33

PolicyLinkThe Food Trust37Manjarrez, C., and Cigna, J. Food StampParticipation and Market Access in the District ofColumbia. Discussion Brief No. 3. Washington, DC:Urban Institute, 2006. Available at http://www.urban.org/UploadedPDF/311343_dcfoodstamp.pdf.38Moore, L., and Roux, A. “Associations ofNeighborhood Characteristics with the Locationand Type of Food Stores.” American Journalof Public Health 96 (2006): 325–331.39Moore, L., Roux, A., and Brines, S. “ComparingPerception-Based and Geographic InformationSystem (GIS)-Based Characterizations ofthe Local Food Environment.” Journal ofUrban Health: Bulletin of the New YorkAcademy of Medicine 85, no.2 (2008).40Morland, K., and Filomena, S. “Disparities inthe Availability of Fruits and Vegetables BetweenRacially Segregated Urban Neighbourhoods.” PublicHealth Nutrition 10, no.12 (2007): 1481-1489.41Morland, K., Wing, S., Roux, A., andPoole, C. “Neighborhood CharacteristicsAssociated with the Location of Food Storesand Food Service Places.” American Journalof Preventive Medicine 22 (2002): 23–29.42Morland, K., Wing, S., and Roux, A. “TheContextual Effect of the Local Food Environmenton Residents’ Diets: The Atherosclerosis Riskin Communities Study.” American Journal ofPublic Health 92, no.11 (2002): 1761-1767.43Morton, L., and Blanchard, T. “Starved forAccess: Life in Rural America’s Food Deserts.”Rural Realities 1, no.4 (2007). Available at www.ruralsociology.org/pubs/ruralrealities/issue4.html.44Neckerman, K., Bader, M., Purciel, M., andYousefzadeh, P. Measuring Food Access in UrbanAreas. New York, NY: Columbia University, 2009.Available at http://www.npc.umich.edu/news/events/food-access/neckerman_et_al.pdf.45Powell, L., Auld, C., Chaloupka, F., O’Malley,P. M., and Johnston, L. D. “AssociationsBetween Access to Food Stores and AdolescentBody Mass Index,” American Journal ofPreventive Medicine 33, no.4 (2007).46Powell, L., Slater, S., Mirtcheva, D., Bao, Y.,and Chaloupka, F. “Food Store Availabilityand Neighborhood Characteristics inthe United States.” American Journal ofPreventive Medicine 44 (2007): 189–195.47Rundle, A., Neckerman, K., Freeman, L.,Lovasi, G., Purciel, M., Quinn, J., Richards,C., Sircar, N., and Weiss, C. “NeighborhoodFood Environment and Walkability PredictObesity in New York City.” EnvironmentalHealth Perspectives 117 (2009): 442–447.48Sacramento Hunger Coalition. The Avondale/GlenElder Community Food Assessment. Food Securityin a South Sacramento Neighborhood. Sacramento,CA: Sacramento Hunger Coalition, 2004.49Shaffer, A. The Persistence of L.A.’s Grocery Gap:The Need for a New Food Policy and Approach toMarket Development. Center for Food and Justice,Urban and Environmental Policy Institute, OccidentalCollege. 2002. Available at www.departments.oxy.edu/uepi/publications/the_persistence_of.htm.50Sharkey, J., and Horel, S. “NeighborhoodSocioeconomic Deprivation and MinorityComposition are Associated with BetterPotential Spatial Access to the Ground-TruthedFood Environment in a Large Rural Area.” TheJournal of Nutrition 138 (2008): 620–627.51Sharkey, J., Scott, H., Daikwon, H., andHuber, J. “Association Between NeighborhoodNeed and Spatial Access to Food Stores andFast Food Restaurants in Neighborhoods ofColonias.” International Journal of HealthGeographics 8, no.9 (2009): 1-17.52Sloane, D., Diamount, A., Lewis, L., et al.“Improving the Nutritional Resource Environmentfor Healthy Living Through Community-BasedParticipatory Research.” The Journal of GeneralInternal Medicine 18 (2003): 568–575.53Small, M. L, and McDermott, M. “The Presenceof Organizational Resources in Poor UrbanNeighborhoods: An Analysis of Average andContextual effects.” Social Forces 84 (2006):1697-1724.54Smith, D. Food Deserts in the Willamette: A Studyof Food Access in Lane County, Oregon. [Master’sthesis]. Eugene, OR: University of Oregon, 2003.55Sparks, A., Bania, N., and Leete, L. “FindingFood Deserts: Methodology and Measurementof Food Access in Portland, Oregon.” Paperprepared for Institute of Medicine, Workshopon the Public Health Effects of Food Deserts,January 26, 2009. Washington, DC, 2009.34

PolicyLinkThe Food Trust56Social Compact Inc. Baltimore NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.57Social Compact Inc. Cincinnati NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2007.58Social Compact Inc. Detroit GroceryInitiative Catalyzing Grocery Retail Investmentin Inner-City Neighborhoods. Washington,DC: Social Compact Inc., 2008.59Social Compact Inc. City of FresnoNeighborhood Market DrillDown. CatalyzingBusiness Investment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2009.60Social Compact Inc. City of TampaNeighborhood Market DrillDown. CatalyzingBusiness Investment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.61Social Compact Inc. Harlem NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.62Social Compact Inc. Houston NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2007.63Social Compact Inc. Los Angeles NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.64Social Compact Inc. Louisville MetroNeighborhood Market DrillDown. CatalyzingBusiness Investment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.65Social Compact Inc. San Francisco NeighborhoodMarket DrillDown. Catalyzing BusinessInvestment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.66Social Compact Inc. Southeast Fort WorthNeighborhood Market DrillDown. CatalyzingBusiness Investment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.67Social Compact Inc. Washington DCNeighborhood Market DrillDown. CatalyzingBusiness Investment in Inner-City Neighborhoods.Washington, DC: Social Compact Inc., 2008.68Sustainable Food Center. Access Denied. AnAnalysis of Problems Facing East Austin Residentsin Their Attempts To Obtain Affordable, NutritiousFood. Austin, TX: Sustainable Food Center, 1995.Available at http://www.sustainablefoodcenter.org/library/Access_Denied.pdf.69Tanaka, K., Mooney, P., et al. LexingtonCommunity Food Assessment: 2004-2007.Lexington, KY: Department of Community &Leadership Development, University of Kentucky,2008. Available at http://www.uky.edu/Ag/CLD/doc/CommunityFoodAssessmentReport04-07.pdf.70Tchumtchoua, A. Town-Level Assessmentof Community Food Security in Connecticut.Food Marketing Policy Center. Universityof Connecticut, 2005. Available at http://digitalcommons.uconn.edu/cgi/viewcontent.cgi?article=1000&context=fpmc_mono.71The Food Trust. Stimulating SupermarketDevelopment: A New Day for Philadelphia.Philadelphia, PA: The Food Trust, 2004.Available at http://www.thefoodtrust.org/pdf/SupermktReport_F.pdf.72The Food Trust. The Need for MoreGrocery Stores in New York. Special Report.Philadelphia, PA: The Food Trust, 2008.Available at http://www.thefoodtrust.org/catalog/download.php?product_id=147.73The Food Trust. The Need for More Supermarketsin Chicago. Philadelphia, PA: The Food Trust,2008. Available at http://www.thefoodtrust.org/catalog/download.php?product_id=147.74University of Virginia School of Architecture,Department of Urban and EnvironmentalPlanning. The Charlottesville Region FoodSystem: A Preliminary Assessment [StudentReport]. Charlottesville, VA: University ofVirginia School of Architecture, Departmentof Urban and Environmental Planning., 2006.Available at http://www.virginia.edu/ien/docs/06FINALRept_Jun06_CvilleFood.pdf.75Thurman, S. Measuring Access to Food inCharlottesville, VA. Charlottesville, VA: Universityof Virginia, 2007. Available at http://www.virginia.edu/ien/docs/07FoodClassFINAL%20PAPERS/AccessTransportation.pdf.35

PolicyLinkThe Food Trust76Tsai, S. Needs Assessment: Access to NutritiousFoods in East Oakland and South Hayward. [Master’sThesis]. Berkeley, CA: University of California atBerkeley School of Public Health and AlamedaCounty Public Health Department, 2003.77Unger, S., and Wooten, H. A Food SystemsAssessment For Oakland, CA: Toward ASustainable Food Plan. [Master’s Thesis]. Berkeley,CA: Oakland Mayor’s Office of Sustainabilityand University of California, Berkeley, 2006.78Wang, M., Kim, S., Gonzalez, A., MacLeod,K., and Winkleby, M. “Socioeconomic andFood-Related Physical Characteristics of theNeighborhood Environment are Associated withBody Mass Index.” Journal of Epidemiologyand Community Health 61 (2007): 491–498.79Zenk, S.H., Schulz, A. J., Hollis-Neely, T., Campbell,R.T., Watkins, G., Nwankwo, R., and Odoms-Yound,A. “Fruit and Vegetable Intake in African AmericansIncome and Store Characteristics.” AmericanJournal of Preventive Medicine 20, no.1 (2005).80Zenk, S., Schulz, A., Israel, B., James, S., Bao, S.,and Wilson, M. “Neighborhood Racial Composition,Neighborhood Poverty, and the Spatial Accessibilityof Supermarkets in Metropolitan Detroit.” AmericanJournal of Public Health 95 (2005): 660–667.81Zenk, S., Schulz, A., Israel, B., Sherman, J., Bao,S., and Wilson, M. “Fruit and Vegetable AccessDiffers by Community Racial Composition andSocioeconomic Position in Detroit, Michigan.”Ethnicity & Disease 16 (2006): 275-280.82Fresno Metro Ministry. Fresno Fresh Access:Community Food Assessment Report. 2003-2005. Fresno, CA: Fresno Metro Ministry,2005. Available at http://fresnometmin.org/fmm/pdfs/CFA_Summary_9-14-05.pdf.83Kaufman, L., and Karpati, A. Food Matters: WhatBushwick Families’ Food Habits Teach us aboutChildhood Obesity. New York, NY: New York CityDepartment of Health and Mental Hygiene, 2007.84Fulfrost, B. Mapping the Markets: The RelativeDensity of Retail Food Stores in Densely PopulatedCensus Blocks in the Central Coast Region ofCalifornia. Santa Cruz, CA: University of California,Santa Cruz, 2006. Available at http://casfs.ucsc.edu/research/MappingTheMarkets.pdf.85Williams, D. Food Security and Accessin Akron Ohio. [Master’s Thesis]. Akron,OH: University of Akron, 2002.86San Francisco Food Alliance. 2005 San FranciscoCollaborative Food System Assessment. SanFrancisco, CA: San Francisco Food Alliance, 2005.87California Center for Public Health Advocacy.Searching for Healthy Food: The Food Landscape inCalifornia Cities and Counties. Davis, CA: CaliforniaCenter for Public Health Advocacy, 2007.88Andrews, M., Kantor, L., Lino, M., andRipplinger, D. “Using USDA’s Thrifty Food Planto Assess Food Availability and Affordability.”Food Access 24, no.2. (2001): 45-53.89Block, D., and Kouba, J. “A Comparison of theAvailability and Affordability of a Market Basketin Two Communities in the Chicago Area.” PublicHealth Nutrition 9, no.7 (2006): 837–845.90Lopez, R. Community Food Security inConnecticut: An Evaluation and Rankingof 169 Towns. Storrs, CT: Hartford FoodSystem, 2005. Available at http://www.hartfordfood.org/pubs/cfs_connecticut.pdf.91Moore L., Roux, A., Nettleton, J., andJacobs, D. “Associations of the Local FoodEnvironment with Diet Quality—A Comparison ofAssessments Based on Surveys and GeographicInformation Systems: The Multi-Ethnic Studyof Atherosclerosis.” American Journal ofEpidemiology 167 (2008): 917–924.92Raja, S., Ma, C., and Yadav, P. “BeyondFood Deserts: Measuring and MappingRacial Disparities in Neighborhood FoodEnvironments.” Journal of Planning Educationand Research 27 (2008): 469-482.93Rose, D., Bodor, N., Swalm, C., Rice, J., Farley,T., and Hutchinson, P. Deserts in New Orleans?Illustrations of Urban Food Access and Implicationsfor Policy. Ann Arbor, MI: University of MichiganNational Poverty Center/USDA Economic ResearchService Research, 2009. Available at http://www.npc.umich.edu/news/events/food-access/rose_et_al.pdf.94Sekhobo, J., and Berney, B. “The Relation ofCommunity Occupational Structure and Prevalenceof Obesity in New York City Neighborhoods—An Ecological Analysis.” Journal of Hunger &Environmental Nutrition 3, no.1 (2008): 76-83.36

PolicyLinkThe Food Trust95USDA Economic Research Service. Accessto Affordable and Nutritious Food: Measuringand Understanding Food Deserts and TheirConsequences. Report to Congress. Washington,DC: U.S. Department of Agriculture,2009. Available at http://www.ers.usda.gov/Publications/AP/AP036/AP036.pdf.96Gordon, C., Ghai, N., Purciel, M.,Talwalkar, A., and Goodman, A. Eating Wellin Harlem: How Available Is Healthy Food?New York, NY: New York City Departmentof Health and Mental Hygiene, 2007.97Graham, R., Kaufman, L., Novoa, Z., and Karpati,A. Eating In, Eating Out, Eating Well: Access toHealthy Food in North and Central Brooklyn.New York, NY: New York City Departmentof Health and Mental Hygiene, 2006.98Papavasiliou, F., Essig, C., Barlett, P., andRolls, A. Is Healthy Eating Possible in DeKalbCounty? An Assessment of Food Availability,Access, and Cost in Two Neighborhoods.Decatur, GA: Atlanta Local Food Initiative,DeKalb County Board of Health, 2007.99Gittelsohn, J., Franceschini, M., Rasooly, I., Ries,A., Ho, L., Pavlovich, W., Santos, V., Jennings, S.,and Frick, K. “Understanding the Food Environmentin a Low-Income Urban Setting: Implications forFood Store Interventions.” Journal of Hunger &Environmental Nutrition 2, no.2 (2008): 33-50.100Short, A., Guthman, J., and Raskin, S.“Food Deserts, Oases, or Mirages? SmallMarkets and Community Food Security in theSan Francisco Bay Area.” Journal of PlanningEducation and Research 26 (2007):352.101City Harvest. The Melrose Community FoodAssessment. New York, NY: City Harvest,2009. Available at http://www.cityharvest.org/images/pdf/Melrose_CFA_2007.pdf.102King, R., Leibtag, E., and Behl, A. “SupermarketCharacteristics and Operating Costs In Low-Income Areas,” Agricultural Economics Reports.Washington, DC: United States Department ofAgriculture, Economic Research Service, 2004.103Hrisanti, A., Chong, T., Dang, J., et al.The East Baltimore Nutritional Environment:Formative Research with Community Leaders.Baltimore, MD: Healthy Stores Project, 2003.Available at http://www.healthystores.org/images/downloads/eastbalt.pdf.104Sturm, R. “Disparities in the FoodEnvironment Surrounding U.S. Middleand High Schools.” American Journal ofPublic Health 122 (2008): 681–690.105Hunger Task Force of Milwaukee. Hunger inMilwaukee, Some Food for Thought. Milwaukee,WI: Hunger Task Force of Milwaukee, 2002.Available at http://www.hungertaskforce.org/userimages/publications_foodforthought_report.pdf.106City Harvest. Mount Hope Community FoodAssessment Report. New York, NY: City Harvest,2009. Available at http://www.cityharvest.org/images/pdf/Mount_Hope_CFA.pdf.107Zenk, S., and Powell, L. “U.S. Secondary Schoolsand Food Outlets.” Health & Place 14 (2008):336–346.108Blanchard, T., and Lyson, T. “Access to LowCost Groceries in Nonmetropolitan Counties:Large Retailers and the Creation of FoodDeserts.” Mississippi, MS: Southern RuralDevelopment Center, 2006. Available at http://srdc.msstate.edu/measuring/blanchard.pdf.109Blanchard, T., and Lyson, T. “Food Availability& Food Deserts in the Nonmetropolitan South.”Mississippi, MS: Southern Rural DevelopmentCenter, 2006. Available at http://srdc.msstate.edu/focusareas/health/fa/fa_12_blanchard.pdf.110Blanchard, T., and Lyson, T. “Retail Concentration,Food Deserts, and Food DisadvantagedCommunities in Rural America.” Mississippi,MS: Southern Rural Development Center,2009. Available at http://srdc.msstate.edu/focusareas/health/fa/blanchard02_final.pdf.111Hatfield, D., and Gunnell, A. Food Accessin California Today. Portland, OR: Ecotrust,2005. Available at http://www.vividpicture.net/documents/12_Food_Access_in_CA_Today.pdf.112Liese, A., Weis, K., Pluto, D., Smith,E., and Lawson, A. “Food Store Types,Availability, and Cost of Foods in a RuralEnvironment.” Journal of the American DieteticAssociation 107 (2007): 1916–1923.113New Mexico Food and Agriculture PolicyCouncil. Closing New Mexico’s Rural Food Gap.Santa Fe, NM: New Mexico Food and AgriculturePolicy Council, 2006. Available at http://www.farmtotablenm.org/closing_nm_food_gap_4pgs.pdf.37

PolicyLinkThe Food Trust114Sharkey, J., and Horel, S. “Characteristics ofPotential Spatial Access to a Variety of Fruits andVegetables in a Large Rural Area.” School ofRural Public Health, Texas A&M Health ScienceCenter, 2009. Available at http://www.npc.umich.edu/news/events/food-access/sharkey.pdf.115Vallianatos, M., Shaffer, A., and Gottlieb, R.“Transportation and Food: The Importance ofAccess.” Los Angeles, CA: Center for Food andJustice, Urban and Environmental Policy Institute,2002. Available at http://www.uepi.oxy.edu.116Frontier Nutrition Project. Trinity County FoodSecurity Assessment. Weaverville, CA: FrontierNutrition Project, 2001. Available at http://www.foodsecurity.org/cfa/trinity_cty_food_assessment.pdf.117Morton., L., Oakland, J., Bitto, E., Sand, M., andMichaels, B. Iowa Community Food AssessmentProject Report, 2001-02. Des Moines, IA: Iowa StateUniversity Family Nutrition Program, 2002. Availableat http://www.soc.iastate.edu/extension/pub/tech/IowaCommunityFoodAssessmentReport.pdf.118The lack of community-based studies on this topicis likely due to the difficulty of accessing data oneating behaviors for small geographies or individuals.119Rose, D., and Richards, R. “Food Store Accessand Household Fruit and Vegetable Use amongParticipants in the US Food Stamp Program.” PublicHealth Nutrition 7, no.8 (2004):1081-1088.120Laraia, B., Siega-Riz, A., Kaufman, J. and Jones, S.“Proximity of Supermarkets is Positively Associatedwith Diet Quality Index for Pregnancy.” AmericanJournal of Preventive Medicine 39 (2004): 869–875.121Jago, R., Baranowski, T., Baranowski, J., Cullen,K., and Thompson, D. “Distance to Food Storesand Adolescent Male Fruit and VegetableConsumption: Mediation Effects.” InternationalJournal of Behavioral Nutrition and Physical Activity4 (2007): 4-35. Available at http://www.ijbnpa.org/content/4/1/35.122Caldwell E., Kobayashi, M., DuBow, W., andWytinck, S. “Perceived Access to Fruits andVegetables Associated with IncreasedConsumption.” Public Health Nutrition,12, no.10 (2008): 1743-50.123Cheadle A., Psaty, B., Curry, S., Wagner, E.,Diehr, P., Koepsell, T., and Kristal, A. “Community-Level Comparisons Between Grocery StoreEnvironment and Individual Dietary Practices.”Preventive Medicine 20, no.2 (1991): 250-261.124Alberti, P., Hadi, E., Cespedes, A., Grimshaw,V., and Bedell, J. Farmers’ Markets—BringingFresh, Nutritious Food to the South Bronx.New York, NY: New York City Department ofHealth and Mental Hygiene, 2008. Available athttp://www.ci.nyc.ny.us/html/doh/downloads/pdf/dpho/dpho-farmersmarket.pdf.125Morland, K., Diex Roux, A., and Wing, S.“Supermarkets, Other Food Stores, and Obesity: TheAtherosclerosis Risk in Communities Study.”American Journal of Preventive Medicine 30, no.4(2006): 333-339.126Chen, S., Raymond, F., and Snyder, S. “Obesity inUrban Food Markets: Evidence from GeoreferencedMicro Data.” West Lafayette, IN: Purdue University,2009. Available at http://www.npc.umich.edu/news/events/food-access/chen_et_al_revised.pdf.127Liu, G., Wilson, J., Qi, R., and Ying, J. “GreenNeighborhoods, Food Retail and ChildhoodOverweight: Differences by Population Density.”American Journal of Health Promotion 21, no.4(2007): 317-325.128Auchincloss, A., Diez-Roux, A., Brown, D.,Erdmann, C., and Bertoni, A. “NeighborhoodResources for Physical Activity and Healthy Foodsand Their Association with Insulin Resistance.”Epidemiology, 19 (2008):146–157.129Morland, K., and Evenson, K. “ObesityPrevalence and the Local Food Environment.”Health & Place 15, no.2 (2009): 491-495.130Goldstein, I., Loethen, L., Kako, E., andCalifano, C. CDFI Financing of Supermarketsin Underserved Communities: A Case Study.Philadelphia, PA: The Reinvestment Fund, 2008.Available at http://www.trfund.com/resource/downloads/policypubs/CDFIStudySummary.pdf.131Anchor effects are commonly recognizedby practitioners and assumed in economicimpacts studies, but there are few empiricalstudies of their scale or scope.132Gallagher, M. Examining the Impact ofFood Deserts on Public Health in Detroit.Chicago, IL: Mari Gallagher Research andConsulting Group, 2007. Available at http://www.marigallagher.com/site_media/dynamic/project_files/1_DetroitFoodDesertReport_Full.pdf.133Several analyses have described how the lackof market activity in distressed urban communities38

PolicyLinkThe Food Trustserves as a barrier to business development. SeePeri Sabety, Using Information to Drive Change,Washington, DC: The Brookings Institution, 2004.Available at http://www.brookings.edu/~/media/Files/rc/reports/2004/07metropolitanpolicy_sabety/framingpaper.pdf. Also, Robert Weissbourd, TheMarket Potential of Inner-City Neighborhoods: Fillingthe Information Gap (Attracting Business Investmentto Neighborhood Markets). Washington, DC: TheBrookings Institution, 2004. Available at http://www.brookings.edu/~/media/Files/rc/reports/2004/07metropolitanpolicy_sabety/framingpaper.pdf.134Office of Housing and Urban Development.New Markets: The Untapped Retail Buying Powerin America’s Inner Cities. Washington, DC: TheOffice of Housing and Urban Development,1999.135Porter, M. “The Competitive Advantage of theInner City,” Harvard Business Review,73, no.3 (1995): 55-71.136Lavin, M. “Supermarket Access and ConsumerWell-Being: The Case of Pathmark in Harlem.”International Journal of Retail and DistributionManagement 33, no.5 (2005): 388-398.137Pristin, T. “Harlem’s Pathmark Anchors aCommercial Revival on 125th Street,” The NewYork Times, November 13, 1999. Available at:http://www.nytimes.com/1999/11/13/nyregion/harlem-s-pathmark-anchors-a-commercialrevival-on-125th-street.html?pagewanted=1.138The majority of supermarket jobs are part-time(84 percent of jobs analyzed in the study). TheReinvestment Fund. The Economic Impacts ofSupermarkets on their Surrounding Communities,Philadelphia, PA: The Reinvestment Fund, 2008.139The Food Trust. “The Pennsylvania Fresh FoodFinancing Initiative Providing Healthy Food Choicesto Pennsylvania’s Communities.” Philadelphia,PA: The Food Trust. Available at http://www.thefoodtrust.org/pdf/FFFI%20Brief.pdf.140This study did not account for the probabledisplacement effects associated with transferringsales from one store to another. The ReinvestmentFund. The Economic Impacts of Supermarketson their Surrounding Communities, Philadelphia,PA: The Reinvestment Fund, 2008.141Social Compact Inc., Inside Site Selection:Retailers’ Search for Strategic BusinessLocations. Washington, DC: Social CompactInc., 2008. Available at http://www.icsc.org/srch/government/briefs/200805_insidesite.pdf142Economic Research Service, Food CPIand Expenditures: Table 14, http://www.ers.usda.gov/Briefing/CPIFoodAndExpenditures/Data/Expenditures_tables/table14.htm.143For a more detailed discussion of strategiesto address the lack of access to healthy foodssee: Flournoy, R. and Treuhaft, S. Healthy Food,Healthy Communities: Improving Access andOpportunities through Food Retailing, Oakland, CA:PolicyLink, 2009. Available at www.policylink.org.144In 2004, child health and nutrition advocatesand Representative Dwight Evans successfullycampaigned for an initial infusion of $10 millionin state funds to launch Pennsylvania Fresh FoodFinancing Initiative (FFFI), a public-private partnershipwhich provides low-cost loans and grants to supportretail projects in underserved communities. (Anadditional $20 million followed.) An independentCommunity Development Financial Institution(The Reinvestment Fund) leveraged these publicfunds with private capital, tax credits, and othermechanisms to create a $165 million fund.145Sturm, R., and Datar, A. “Body Mass Index inElementary School Children, Metropolitan AreaFood Prices and Food Outlet Density.” Journalof Public Health 119 (2005):1059–1068.39

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