The Retail Food Landscape in Mendocino County€¦ · and diabetes.1 Community Health Services of...

Summary: Unhealthy diets are associated with overweight, obesity, and a host of chronic diseases. Whether people eat healthy foods is a result of many di!erent factors. One factor receiving increasing attention concerns the kind of foods that are available in a neighborhood. Research suggests that people living in neighborhoods with more fast food restaurants and convenience stores, and fewer grocery stores or produce vendors have higher rates of obesity and diabetes.1 Community Health Services of the Mendocino County Health and Human Services Agency found that there are two fast food restaurants or convenience stores for every one grocery store or produce vendor in the county as a whole while Fort Bragg has 2.1, Ukiah has 4.3 and Willits has 5.2. Not everyone has equal access to sources of healthier foods. Many communities across the nation are making changes to improve access to healthy foods, so that the healthy choice becomes easier to make.

By the Prevention and Planning Unit, Community Health Services of the

Mendocino County Health & Human Services Agency

The Retail Food Landscapein Mendocino County

RESEARCH BRIEF, DECEMBER 2010

are associated with lower body mass index [weight], especially for low-income Americans, while lack of supermarkets and long distances to supermarkets are associated with higher body mass index. Finally, limited but consistent evidence suggests that increased geographic density of fast food restaurants and convenience stores is also related to increased body mass index.3

!e collection of neighborhood retail businesses where food may be purchased is called “the retail food environ-ment”. One measure developed to describe the relative abundance of di"erent types of retail food outlets in a given area is the Retail Food Environment Index (RFEI). !e RFEI is calculated by dividing the total number of fast-food restaurants and convenience stores by the total number of grocery stores and produce vendors (including farmers’ markets) within a given area. !e higher the RFEI, the greater the number of fast food restaurants and convenience stores compared to supermarkets and farmers’ markets. !e Prevention and Planning Unit and the Environmental Health Division of Community Health Services collaborated to calculate the RFEI for Mendocino County as a whole and for the largest cities within the county. !e RFEI data shown were compiled from January through April 2009.

ccording to the California Health Interview Survey (CHIS) 2007, 59% of Mendocino County adults and teens are overweight or obese. Overweight and obesity can lead to health problems including heart disease, stroke, high blood pressure, bone problems, depression, diabetes and some cancers. !e costs of obesity and overweight in Mendocino County were approximately $23.7 million in 2006 due to direct health care costs, worker's compensa-tion, absenteeism and presenteeism (not being productive at work).2

To halt rising rates of chronic diseases linked to unhealthy diet, the Surgeon General, doctors and nutrition experts recommend that Americans eat more fresh fruits, vegetables and whole grains, and less added sugars, fats, and fewer processed foods. However, many residents do not have ready access to these recommended foods, but instead are surrounded by fast food restaurants and convenience stores. Studies increasingly show that individuals’ diets are strongly a"ected by what foods are available in their neighborhoods. !e 2010 Dietary Guidelines for Americans concluded that:

Moderately strong evidence now indicates that the food environment is associated with dietary intake, especially less consumption of vegetables and fruits and higher body weight. !e presence of supermarkets in local neighborhoods and other sources of vegetables and fruits

A

Below is a map of Mendocino County with Retail Food Establishments noted by colored symbols. RFEIs are calculated for the county as a whole and for selected cities and towns. !e Mendocino County RFEI is 2.0,

indicating that there are twice as many convenience stores and fast food restaurants as grocery stores and farmer’s markets.

The Retail Food Landscape in Mendocino County

2

HWY

1

HWY 1

HWY 1

US 101

US 101

US 101 HWY 162

HWY 20

HWY 20

HWY 128

HWY 253

HWY 1

NavarroNavarro

CalpellaCalpella

UkiahUkiahTalmageTalmage

HoplandHoplandYorkvilleYorkville

PhiloPhiloBoonvilleBoonville

GualalaGualalaAnchor BayAnchor Bay

Point ArenaPoint Arena

ManchesterManchester

ElkElk

AlbionAlbion

Little RiverLittle River

MendocinoMendocinoComptcheComptche Redwood ValleyRedwood Valley

Potter ValleyPotter Valley

WillitsWillits

LaytonvilleLaytonville

CoveloCovelo

LeggetLegget

PiercyPiercy

WestportWestport

CleoneCleone

Fort BraggFort Bragg

HWY 175

County RFEI* = 2.0

RFEI = Retail Food Environment Index(# Convenience Stores + # Fast Food Restaurants) / (# Grocery Stores + # Farmers Markets)

Sources: Poverty Level: Census 2000; Food Establishments data: Mendocino Environmental Health

Farmers’ Markets

Grocery Stores Fast Food Restaurants

Convenience Stores

0 3Miles

6

N

1.5

RFEI = 1.0

RFEI = 5.2

RFEI = 1.5

RFEI = 1.3

RFEI = 0.3

RFEI = 2.5

RFEI = 2.1

RFEI = 4.3

RFEI = 0.4RFEI = 5.0RFEI = 3.0

Mendocino County Retail Food Environment

RFEI = 0.3

HWY 1

Below are maps of the 3 largest cities in Mendocino County highlighting the details of the retail food establishments.

Willits and Ukiah have high RFEIs while Fort Bragg's RFEI is close to the County RFEI.

Ukiah has a population of over 15,000 and is the county seat with a surrounding area that includes several small towns with over 20,000 additional residents. People come to Ukiah to do business with the courts, government, and others, to shop at large and small stores and to eat out. The density of convenience stores and fast food restaurants is highest along State Street and US 101.

Hopland, south of Ukiah on U.S. Hwy 101, has a high RFEI of 5.0, but only 6 retail food establishments, the majority of which are convenience stores.

Willits is a small town with a large surrounding rural area of more than 13,000 residents. The highest density of fast food restaurants and convenience stores is concen-trated along US 101, also known as Main Street. This high density gives Willits the distinction of having the highest RFEI in the county.

Fort Bragg is the largest city on the north coast. The Fort Bragg area has a total population of about 12,000. The highest density of fast food restaurants and convenience stores is concentrated along Highway 1 which runs through the middle of the shopping district.

Research Brief, December 2010

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WillitsWillits

UkiahUkiah

TalmageTalmage

US 101

US 101

HWY 20

HWY 20

RFEI = 2.1

RFEI = 5.2

RFEI = 4.3

How Does the Retail Food Environment A!ect Health?Grocery Stores and Produce VendorsPeople who have grocery stores near their homes tend to eat more fruits and vegetables,5,6 and are less likely to be obese or have diabetes.7,8 !ere is a connection between the availability of healthful products in stores and the reported healthfulness of individuals’ diets.9 Residents with no supermarkets near their homes are 25%-46% less likely to consume a healthy diet than residents with nearby access to supermarkets.10

Fast FoodFast food makes up an increasing share of many families’ food intake. On a typical day, 30% of children eat fast food at least once.11 Many fast food restaurants have expanded their menus to include options such as salads and fruit. However, a study in the American Journal of Clinical Nutrition found that only 3% of kids’ meals at major fast food companies met the nutrition standards of the National School Lunch Program.12 Multiple studies have found that fast foods tend to be high in fat content and energy dense (meaning many calories per weight of the food). 13,14,15 Eating fast food is associated with consuming more calories,16 more sweetened beverages,17 and higher rates of diabetes.18 Strong and consistent evidence indicates that children and adults who eat fast food are at increased risk of weight gain, overweight, and obesity, according to the Dietary Guidelines for Americans.3 !ere is evidence to suggest that residents who live close to fast food restaurants and farther from grocery stores have higher rates of premature death due to diabetes, cancer and cardiovascular disease,19 and conversely that residents with limited access to fast food have healthier diets and lower levels of obesity.5

Convenience StoresA study of mostly low-income children outside corner convenience stores found that the items the children most frequently purchased were high-calorie, low-nutrition

Local food environments in!uence the choices made by children, families and community members.” — Institute of Medicine, 20094

foods such as chips, candy and sweetened beverages.20 A four-state study found that the presence of convenience stores is associated with a higher prevalence of obesity and overweight.21 For children and adolescents, living in a neighborhood with higher convenience store density is associated with being more overweight.22

Unequal Access to Grocery Stores and Produce Vendors!e Institute of Medicine has found that nationwide, the availability of fast food and energy-dense foods is greater in lower-income and minority neighborhoods, and that residents in lower-income, minority and rural neighbor-hoods are more likely to be overweight or obese.23 A study in Health A!airs found that the quality of the fresh produce in low-income neighborhood stores was signi"-cantly worse than in high-income neighborhoods, and that there were fewer healthier foods such as low-fat dairy, lean meats or whole grains in low-income versus high-income stores.24

De"nitions

Grocery stores are de!ned as any full-line self-service grocery store that sells fresh fruits and vegetables as well as prepackaged goods.

Produce vendors include produce stands and farmers’ markets (both certi!ed and non-certi!ed).

Fast food restaurants are restaurants o"ering quick or counter service, meal service (versus snacks, desserts and co"ee only) and prices usually less than $7 per meal. Restaurants with more than !ve locations with the same name are included.

Convenience stores are businesses that sell a wide array of consumable and prepackaged products. A gasoline or other fuel station may be included.

Lower-income and minority neighborhoods and communities su"er disproportionately high rates of preventable, diet-related diseases, including obesity, and inequalities in access to a"ordable, healthy and nutritious food contribute to those disparities.” — Ford and Dzewaltowski, 2008; Morland and Evenson, 2009, in Institute of Medicine, 20093


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Analysis of Mendocino County’s food environment reveals a statistically signi!cant correlation between the percent-age of the population below the poverty level and the RFEI in the county’s census block groups (rs=.386, p=.026, n=33). "is means that, in general, there is a tendency for

there to be more fast food and convenience stores in lower-income neighborhoods, and fewer grocery stores and farmers’ markets. "is may result in diets higher in fats and sugars, and lower in fresh fruits and vegetables among low-income populations in Mendocino County.


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County RFEI* = 2.0

RFEI = Retail Food Environment Index(# Convenience Stores + # Fast Food Restaurants) / (# Grocery Stores + # Farmers Markets)Note: Towns with RFEI=0.0 are not noted on the map. RFEIs are for cities, not census block groups

Mendocino County Retail Food EnvironmentRelated To Percent Population Below Poverty Level

% Population Below Poverty Level by Census Block Group

0%– 8%

16%– 25%25%– 36%

8%– 16%

0 3Miles

6

N

1.5

Sources: Poverty Level: Census 2000; Food Establishments data: Mendocino Environmental Health

HWY 1

HWY 1

US 101

US 101 HWY 162

HWY 20

HWY 20

HWY 128

HWY 253

HWY 175

HWY 1

NavarroNavarro

CalpellaCalpella

UkiahUkiah

TalmageTalmage

HoplandHoplandYorkvilleYorkville

PhiloBoonvilleBoonville




ElkElk

AlbionAlbion




WillitsWillits


CoveloCovelo

LeggetLegget

PiercyPiercy

WestportWestport

CleoneCleone


US 101

HWY

1

RFEI = 5.2RFEI = 2.1

RFEI = 4.3

RFEI = 5.0RFEI = 3.0

RFEI = 0.3

RFEI = 0.3

RFEI = 1.0

RFEI = 1.5

RFEI = 2.5

RFEI = 1.3

RFEI = 0.4

HW

Y1

5

64

7

1925

26

5

21

Total Fast Food Restaurants = 69Total Convenience Stores = 61

0%– 7%

14%– 25%

25%– 53%

7%– 14%

Sources: Hispanic Population: Census 2000; Food Establishments data: Mendocino Environmental Health

Number of Fast Food Restaurantsand Convenience Stores#

N

0 4 82

In Mendocino County there is a statistically signi!cant correlation between the percentage of Latino residents and the number of fast food and convenience stores in the county’s census block groups (rs=.319, p=.004, n=78).25 "is means that, in general, there is a tendency for there to

be a high number of fast food and convenience stores in areas with a high percentage of Latino residents. "is may contribute to diets higher in fats and sugars, and lower in fresh fruits and vegetables among this population.


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Mendocino County Fast Food & Convenience StoresRelated To Percent Hispanic Population

% Hispanic Population Level by Census Block Group

HWY

1

HWY 1

HWY 1

US 101 HWY 162

HWY 20

HWY 1

NavarroNavarro

CalpellaCalpella

UkiahUkiah

TalmageTalmage

HoplandHopland

YorkvilleYorkville

PhiloPhiloBoonvilleBoonville




ElkElk

AlbionAlbion




WillitsWillits


CoveloCovelo

LeggetLegget

PiercyPiercy

WestportWestport

CleoneCleone


US 101HWY 253

HWY 128

US 101

RFEI = Retail Food Environment Index(# Convenience Stores + # Fast Food Restaurants) / (# Grocery Stores + # Farmers Markets)Note: Towns with RFEI=0.0 are not noted on the map. RFEIs are for cities, not census block groups

HWY 20

Steps Communities Can Take to Improve Availability of Healthy FoodsIndividuals can make better nutritional choices when healthy foods are a!ordable and within easy reach. Policymakers and municipalities have a key role to play in creating environments that make the healthy choice the easy choice.

Healthy Corner Store Programs provide loans, grants or technical assistance to convenience stores and corner stores to purchase refrigeration equipment for fresh produce, or increase display or shelf space. Healthy Corner Store programs can also o!er assistance in marketing of healthy foods. See http://healthycornerstores.org/

Municipalities can allow farmers’ markets, community gardens and produce stands “by right” or on an expedited basis in appropriate land use zones, so that it is easier to create these facilities.

New York City’s Green Cart Program gives expedited permits to mobile or street vendors to sell fruits and vegetables, and allows extra permits in areas where the residents eat few fruits and veggies, according to popula-tion surveys. See http://www.nyc.gov/html/doh/html/cdp/cdp_pan_green_carts.shtml

Many municipalities throughout the US limit the number, location or density of fast food outlets or drive-thrus. Concord, MA prohibits fast food and drive-thrus. Carlsbad, CA, Weymouth, MA, Westerly, Bainbridge Island, WA and Newport, RI prohibit drive-thru restau-rants. Davis, CA, Arcata, CA, Bainbridge Island, WA, Elmsford, NY & Warner, NH, regulate fast food outlet density, number and location. Detroit, MI requires at least 500 feet between fast food and schools. Arden Hills, MN requires at least 400 feet between fast food and schools, parks, churches and residential property.26 In 2008 Los Angeles enacted a one-year moratorium on new fast food restaurants and drive-thrus in 32 square miles of area, based on health concerns due to over-concentration of fast food outlets in low-income neighborhoods.27 While that moratorium has expired, it marks the "rst prohibition on fast food enacted due to health concerns.

Los Angeles has proposed an ordinance limiting new convenience stores within # mile of each other unless they carry a certain amount of fruits and vegetables.28

A 2010 White House Task Force on Child Obesity report recommended that29

$e federal and state governments “analyze the e!ect of state and local sales taxes on less healthy, energy-dense foods.”

Local governments create incentives to attract supermarkets and grocery stores to underserved neighborhoods and improve transportation routes to healthy food retailers.

Communities provide fruits and vegetables in a variety of settings and encourage the establishment and use of direct–to-consumer outlets such as farmers’ markets and community supported agriculture programs.

The failure of individual-based nutrition and physical activity e!orts can be explained, in part, because the environments where they have been implemented are not conducive to healthful choices.” — Booth et al., 2001, in Institute of Medicine, 2009 3


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Westside Renaissance Market Holly and Scott Cratty bought the last “mom and pop” neighborhood store in Ukiah in 2009. !ey had no previous retail experience, but much passion about promoting the bounty of locally sourced food — organic produce and meats, handmade jams and honey, breads, pastries and pie, herbs and spices, wine, olive oil, cheeses, fresh "owers and more! !eir great pride is their produce from Mendocino Organics — seasonal, biodynamically produced, health-giving and delicious. “Neighborhood markets have become one of the missing links in the food system,” says Scott, referring to the glut of convenience stores selling “quick-#x” foods with little nutritional value, and few distribution sites for small farmers to sell their fresh fare locally. !e Westside Renaissance Market fosters a slowing down process in a rushed world - fresh food, local art, and community.

A Neighborhood Market Provides Healthy Food to Local Residents

!e state of California requires chain restaurants with 20 or more outlets to list calorie counts on fast food menu boards. Table-service chains must list calories, saturated fat, trans fat, sodium, and carbohydrate content next to each menu choice.30 Non-chain restaurants could volun-tarily provide nutrition information in menus and on menu boards, or could be required to do so by local policy.

Healthy Food Financing Initiatives have been proposed at the state and federal level to help grocers and farmers' markets open new locations in poor neighborhoods and help existing corner stores expand to stock more fresh produce. Similar programs have been implemented in other states such as Pennsylvania.31

Municipalities could provide discounted bus passes for those who receive food stamps to ensure that they have access to the healthiest food available.

Municipalities could make transportation options, such as bus routes, more available for people in areas without grocery stores or with high RFEIs.

Individual behavior change can only occur in a supportive environment with accessible and a!ordable healthy food choices...” — Former Surgeon General David Satcher, 2001


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Methods!is research brief draws on a previous study by the California Center for Public Health Advocacy entitled “Searching for Healthy Food: !e Food Landscape in California Cities and Counties”.32 !at study determined the RFEIs for California cities and counties with more than 250,000 residents. Mendocino County with a population of about 90,000 was not included.

!is brief di"ers from the statewide study in that the Mendocino County RFEI includes convenience stores at gasoline stations and many markets that would not have met the $1 million per year sales volume used to de#ne grocery stores in the statewide study. !ese businesses were included because of anecdotal evidence that signi#-cant portions of daily calories are purchased at gas station convenience stores in rural areas. !erefore, it is not possible to compare Mendocino County with the results in the statewide study.

!is research and report were made possible by a grant from !e California Endowment, as well as support from Community Health Services of the Mendocino County Health & Human Services Agency, and technical assistance from the California Center for Rural Policy. Special thanks go to Jessica Van Arsdale and Melissa Jones of California Center for Rural Policy at Humboldt State University for peer review. !e report can be downloaded from http://www.co.mendocino.ca.us/hhsa/chs/prevention.htm .


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Endnotes1 California Center for Public Health Advocacy, PolicyLink, UCLA Center for Health Policy Research. Designed for Disease: !e Link Between Local Food Environments and Obesity and Diabetes. April 2008.

2 California Center for Public Health Advocacy. !e Economic Costs of Overweight, Obesity and Physical Inactivity Among California Adults – 2006. July 2009.

3 Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. Appendix E-1 - Major Conclusions. Washington DC: US Department of Agricul-ture. 2010. Available at http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm Accessed October 18, 2010.

4 Institute of Medicine. Local Government Actions to Prevent Childhood Obesity. Washington, D.C.: National Academies Press. 2009.

5 Morland K, Wing S, Diez Roux A. !e contextual e"ect of the local food environment on residents’ diets: the atherosclerosis risk in communities study. American Journal of Public Health. 2002; 92:1761-1767.

6 Larson N, Story M, Nelson M. Neighborhood environ-ments: disparities in access to healthy foods in the US. American Journal of Preventive Medicine. 2009; 36(1):71-81.

7 Auchincloss AH, Diez Rouz AV, Brown DG, Erdmann CA, Bertoni AG. Neighborhood resources for physical activity and health foods and their association with insulin resistance. Epidemiology. 2008; 19(1):146-157.

8 Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. Am J Prev Med. 2006; 30(4):333-339.

9 Cheadle A, Psaty B, Curry S, Wagner E, Diehr P, Koep-sell T, Kristal A. Community-level comparisons between the grocery store environment and individual dietary practices. Prev Med. 1991; 20:250-61.

10 Moore LV, Diez Rouz AV, Nettleton JA, Jacobs DR. Associations of the local food environment with diet quality – a comparison of assessments based on surveys and geographic information systems : the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2008; 167(8):917-924.

11 Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. E"ects of fast food consumption on energy intake and diet quality among children in a national household survey. Pediatrics. January 2004; 113(1):112-118.

12 O’Donnell SI, Hoerr SL, Mendoza JA, Goh ET. Nutrient quality of fast food kids meals. American Journal of Clinical Nutrition. 2008; 88(5):1388-1395.

13 Prentice AM, Jebb SA. Fast foods, energy density and obesity: a possible mechanistic link. Obesity Reviews. 2003; 4(4):187-194.

14 Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. E"ects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics. 2004; 113(1):112-118.

15 French SA, Story M, Je"ery RW. Environmental in#uences on eating and physical behavior. Annual Review of Public Health. 2001;22:309-335.

16 Satia JA, Galanko JA, Siega-Riz AM. Eating at fast food restaurants is associated with dietary intake, demo-graphic, psychological and behavioral factors among African Americans in North Carolina. Public Health Nutr. 2004;7(8):1089-1096.

17 Taveras EM, Berkey CA, Rifas-Shiman SL, et al. Asso-ciation of consumption of fried food away from home with body mass index and diet quality in older children and adolescents. Pediatrics. 2005; 116(4):e518-524.

18 Je"ery RW, Baxter J, McGuire M, Linde J. Are fast food restaurants an environmental risk factor for obesity? Int J Behav Nutr Phys Act. 2006;3(2):doi:10.1186/1479-5868-3-35.

19 Gallagher M. Examining the impact of food desserts on public health in Chicago. 2006. Available at: http://asap.sustainability.uiuc.edu/members/sagra/LaSalleBank_FoodDesert_ExecSummary.pdf/view Accessed December 3, 2009.

20 Borradaile KE, Sherman S, Vander Veur SS, et al. Snacking in children: the role of urban corner stores. Pediatrics. 2009;124(5):1293-1298.


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21 Morland K, Wing S, Diez Roux AV, Poole G. Neighbor-hood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002; 22:23-9.

22 Grafova IB. Overweight children: assessing the contribu-tion of the built environment. Prev Med. 2008; doi:10.1016/j.ypmed.2008.04.012.

23 Baker at al., 2006, Larson et al., 2009, Black and Macinko 2008; Story et al., 2008 as cited in Institute of Medicine. Local Government Actions to Prevent Childhood Obesity. Washington, D.C.: National Academies Press. 2009.

24 Andreyeva T, Blumenthal DM, Schwartz MB, Long MW, Brownell KD. Availability and prices of foods across stores and neighborhoods. Health A!airs. 2008: 27(5):1381-88.

25 !e correlation between the percentage of Latino residents and RFEI was not statistically signi"cant, likely due to the fact that RFEI cannot be calculated for census block groups that only have fast food and convenience stores.

26 Mair JS, Pierce MW, Teret SP. !e Use of Zoning to Restrict Fast Food Outlets: A Potential Strategy to Combat Obesity. October 2005.

27 Strategic Alliance. Los Angeles fast food moratorium. Enact Local Policy Database. 2008. Available at: http://www.preventioninstitute.org/sa/policies/policy_detail.php?s_Search=Los+Angeles&policyID=293 . Accessed December 7, 2009.

28 Hirsch J. War on obesity has new target: studies focusing on convenience stores bring calls to limit the density of such small markets in South L.A. Los Angeles Times. October 12, 2009:B.1.

29 White House Task Force on Childhood Obesity. Solving the problem of childhood obesity within a generation. 2010. Available at http://www.letsmove.gov/pdf/TaskForce_on_Childhood_Obesity_May2010_FullReport.pdf . Accessed May 14, 2010.

30 California Center for Public Health Advocacy. Resources: menu labeling. Available at: http://www.publichealthadvocacy.org/resources_menulabeling.html . Accessed December 7, 2009.

31 !e Food Trust – Pennsylvania Fresh Food Financing Initiative. Available at: http://www.thefoodtrust.org/php/programs/f#.php. Accessed August 31, 2010.

32 California Center for Public Health Advocacy. Searching for Healthy Food: "e Food Landscape in California Cities and Counties. January 2007.


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The Retail Food Landscape in Mendocino County€¦ · and diabetes.1 Community Health Services of...

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