摘要：Objectives . We examined availability and food options at restaurants in less affluent (target area) and more affluent (comparison area) areas of Los Angeles County to compare residents’ access to healthy meals prepared and purchased away from home. We also considered environmental prompts that encourage the purchase of various foods. Methods . We designed an instrument to assess the availability, quality, and preparation of food in restaurants. We also assessed advertisements and promotions, cleanliness, and service for each restaurant. We assessed 659 restaurants: 348 in the target area and 311 in the comparison area. Results . The nutritional resource environment in our target area makes it challenging for residents to eat healthy away from home. Poorer neighborhoods with a higher proportion of African American residents have fewer healthy options available, both in food selections and in food preparation; restaurants in these neighborhoods heavily promote unhealthy food options to residents. Conclusions. Environment is important in understanding health status: support for the healthy lifestyle associated with lower risks for disease is difficult in poorer communities with a higher proportion of African American residents. Researchers and community activists have recognized the link between ecological factors (e.g., access to quality food) and the onset of medical conditions (e.g., cardiovascular disease, diabetes). 1, 2 Disparities exist across different neighborhoods in terms of access to healthy or higher quality foods; these disparities put certain communities at higher risk for illnesses. Studies have shown that neighborhoods with a higher proportion of African American residents have fewer supermarkets and fewer high-quality food options, 3, 4 as well as a disproportionate number of fast food restaurants. 5 Numerous studies have demonstrated that regular consumption of fast food can lead to higher body mass index scores, which contributes to obesity and related illnesses. 6, 7 However, few studies have focused on the availability of healthy options in a community’s nutritional resource environment. 8 Meals purchased away from home continue to play an increasingly important role in American diets. Guthrie et al. 9 reported that between 1977–1978 and 1994–1996, consumption of food prepared away from home increased from 18% to 32% of total calories consumed. Typically, meals purchased away from home contain high calorie content and large portion sizes. 6, 9, 10 Health care providers and researchers have expressed concern that the increase in eating away from home has contributed to the growing epidemic of obesity in the United States. 11 Understanding the range of choices available in different communities may help public health advocates develop a strategy to reduce the adverse health effects of meals purchased away from home for groups at elevated risk within our society. Individual food choices also are influenced by a sociocultural environment in which commercial advertising, marketing, and promotion attempt to influence the food and beverage preferences and purchasing behaviors of target audiences. A growing body of literature documents cultural variations across the range of commercial advertisements that may contribute to health risk behavior disparities. 12– 21 A pattern of findings demonstrates significantly fewer advertisements for healthier food and beverage products (e.g., fruits, vegetables, and dairy products) in magazines and television shows that target African Americans specifically compared with those that target more general audiences. In addition, a significantly greater number of advertisements for unhealthy products (e.g., sodas, candy, and alcoholic beverages) appear in magazines and television shows that target African Americans. 14, 20 In the only “successful” litigation in this arena to date, General Foods settled a class action suit to address advertising of high-fat/high-sugar breakfast cereals with false claims of healthfulness that targeted low-income children of color. 1 An ecological approach to health promotion examines people’s opportunities to choose. This approach includes health care options, such as access to hospitals and other health care providers, and food services in the form of markets and restaurants. A rich resource environment provides greater opportunities for people to make choices that will lead to a healthier life. 1 Conversely, when nutritional resources are limited, such as in those areas researchers have termed “food deserts,” the environment makes it more difficult for residents to sustain any effort to eat a healthy diet. 22, 23 The richness of an area’s resource environment can be measured by the services offered and by residents’ access to those services. We suggest that access to healthy options in a restaurant, in addition to counting the types of restaurants, is a critical measure of the richness of an environment that supports healthy living. We examined the availability of restaurants and food options within these restaurants in more affluent and less affluent areas of Los Angeles County. We hypothesized that residents in South Los Angeles (target area) would have fewer healthy options in neighborhood restaurants than residents of West Los Angeles (comparison area). In addition, we examined the environmental prompts that encourage the purchase of various foods (e.g., point-of-sale posters and other print advertisements at the restaurants), postulating that healthy food choices would be promoted less in South versus West Los Angeles.
