and specialty stores—in three Detroit communities and an adjacent suburb. The communities surveyed varied in racial/ethnic composition and socioeconomic characteristics and exhibited different health profiles for diet and obesity-related diseases. Among the findings was that produce quality was lower in low-income African American communities than in more affluent or racially mixed neighborhoods. Moreover, the low-income African American communities had more than four times more liquor stores and fewer grocery stores per 100,000 residents compared with the racially mixed communities.

Overall, this body of evidence suggests that supermarket access is poorer among low-income and minority populations, and that individuals without ready access to supermarkets have more difficulty finding fruits and vegetables in their neighborhood. In addition, individuals with supermarkets in their neighborhood are more likely than those lacking nearby supermarkets to eat more fruits and vegetables.

Disparities in the Quality of Food Available for Purchase

In a cross-sectional study of 25 stores in South San Diego County, California, Emond and colleagues (2012) examined associations between the availability, quality, and cost of healthy and unhealthy food items and store location—specifically, non-ethnically based supermarkets and Latino grocery stores (tiendas) in low-income areas. They found no difference in the availability of fresh produce by store type and quality differences for only one fruit item. Further, the price per pound for fresh produce was lower in the tiendas than in the supermarkets. However, the cost of skim milk was significantly higher in the tiendas and lean ground beef was significantly less available than in the supermarkets surveyed. Similarly, Andreyeva and colleagues (2008), conducted two studies examining changes in price differences between large grocery stores and small neighborhood markets over the past 35 years (study 1), and price and nutritional quality as a function of income and neighborhood (study 2) in New Haven, Connecticut. In assessing the results of both studies, they concluded that the availability of many healthful food items was lower and produce quality was worse in lower-income than in higher-income areas even though average prices were not significantly different between the two types of neighborhoods. In Baltimore, Maryland, Franco and colleagues (2007) conducted a small observational study to determine the availability and price of food in 240 stores in area neighborhoods. In the neighborhoods surveyed, 94.4 percent of residents were African American; 64.4 percent of family households were female headed; the unemployment rate of residents was 23.5 percent, with a median household income of $15,493; and only 53.6 percent of adults had completed high school. Of the 187 food stores located within the city,



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