摘要：Objectives. We investigated associations between local food environment and neighborhood racial/ethnic and socioeconomic composition. Methods. Poisson regression was used to examine the association of food stores and liquor stores with racial/ethnic composition and income in selected census tracts in North Carolina, Maryland, and New York. Results. Predominantly minority and racially mixed neighborhoods had more than twice as many grocery stores as predominantly White neighborhoods (for predominantly Black tracts, adjusted stores per population ratio [SR]=2.7; 95% confidence interval [CI]=2.2, 3.2; and for mixed tracts, SR=2.2; 95% CI=1.9, 2.7) and half as many supermarkets (for predominantly Black tracts, SR=0.5; 95% CI=0.3, 0.7; and for mixed tracts, SR=0.7; 95% CI=0.5, 1.0, respectively). Low-income neighborhoods had 4 times as many grocery stores as the wealthiest neighborhoods (SR=4.3; 95% CI=3.6, 5.2) and half as many supermarkets (SR=0.5; 95% CI=0.3, 0.8). In general, poorer areas and non-White areas also tended to have fewer fruit and vegetable markets, bakeries, specialty stores, and natural food stores. Liquor stores were more common in poorer than in richer areas (SR=1.3; 95% CI=1.0, 1.6). Conclusions. Local food environments vary substantially by neighborhood racial/ethnic and socioeconomic composition and may contribute to disparities in health. Recent evidence from epidemiological studies suggests that neighborhood characteristics are related to health after individual-level confounders are taken into account. 1 , 2 Many factors have been proposed to explain neighborhood health effects, including physical access to the resources necessary to develop and maintain healthy lifestyles. In particular, neighborhood factors related to healthy foods recommended by the 2005 US Department of Agriculture Dietary Guidelines for Americans , 3 sometimes termed the local food environment, have received increasing attention 4 – 7 in part because of the high and increasing prevalence of obesity and overweight. 8 Although scientific proof of a causal effect of the local food environment on individual diets is difficult to obtain, local food environments and residents’ diets have been linked in observational studies. 5 , 9 , 10 Preliminary data from natural experiments also suggests that changes in the local food environment result in changes in people’s diets. 11 The presence of strong residential segregation by income and race/ethnicity in the United States 12 , 13 also suggests that the local food environment may contribute to socioeconomic and racial/ethnic differences in health. Healthy foods including whole-grain products, low-fat dairy foods, and fresh fruits and vegetables, may be less available, and relatively more costly, in poor and minority neighborhoods than in wealthier and White neighborhoods. The combination of the migration of supermarkets, which often offer nutritious foods at lower costs, 14 – 18 from urban to suburban areas and the lack of private or convenient transportation among the urban poor may contribute to health disparities in heart disease, obesity, and diabetes. Nevertheless, there is still limited evidence of how the local food environment varies across neighborhoods and the extent to which it is associated with features of neighborhoods such as racial/ethnic composition. 4 , 7 Using data from 3 large and ethnically diverse areas in the United States, we investigated differences in the local food environment across neighborhoods associated with neighborhood racial/ethnic composition. Differences by neighborhood income were also examined.
