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• To assess the nutritional resource environment in targeted African-American communities in Los Angeles and to compare the findings with the nutritional resources available in a predominantly white area
• To use community-based participatory research to build health promotion capacity among community residents.

A coalition of African-American community residents and health and social service organizations held a series of conversations and identified three target communities to study. To complete the inventories of food markets in the identified areas, community groups submitted applications in a mini-grant process to receive up to $5,000 in funding. Applicants described how they would inventory the stores, who would complete the inventory and a budget. Applications were reviewed by the Economic Parity advisory group, made up of community members and supplemented by the Community Health Council staff and evaluators. The applications were scored for relevance, appropriateness, scope of work and three other categories not disclosed.

 None discussed.

Recruitment

The community coalition determined the three target African-American communities to inventory for their nutrition resource environment. Community groups applied for grants to conduct the inventories; a community advisory group selected the six grantees. Students from the University of Southern California were hired to inventory nutrition resource environment in the contrasting, predominantly white area.

Design

• The community coalition determined three target areas to study and an advisory group selected grantees to conduct the nutrition resource environment inventories
• Community and student surveyors were trained by the Community Health Council and project evaluators on the project's mission, the inventory methodology, surveying techniques and instrument procedures. Those completing inventories in the target areas were asked to focus attention on smaller markets and convenience stores, and were required to inventory every third store on their list of markets. Project staff supplemented inventorying  larger stores.
• The instruments used to inventory were the "Shopping List," a one-page survey providing an overview of services and healthy items, and "The Healthy Food Assessment," a 12-page survey detailing the availability or vegetables, fruits, meats, other items and special food sections
• For quality control, group coordinators from the community groups receiving grants checked the completed inventory forms for mis-coding and omissions, then sent the inventories to the Community Health Council community liaison for review
• The project evaluation staff then further cleaned and entered data into a database. The data were shared with study participants, community residents and policy makers; the findings were presented by grant recipients in a community dialog called an Indaba
• The intention of the dialog was to garner support in the community for challenging issues identified by the study.

Intervention

The instruments used to inventory were the "Shopping List," a one-page survey profiling the conditions of the store and the availability of a small selection of healthy items. The second instrument used was "The Healthy Food Assessment," a 12-page survey detailing the availability or vegetables, fruits, meats, other items and special food sections. The evaluation team and an academic sub-contractor developed the template of the instruments, both were finalized by the community advisory group. "The Healthy Food Assessment" was adapted from an existing, validated instrument.  

Statistical Analysis

Bivariate significance tests utilizing chi-squared and Fisher's exact tests. Statistical comparisons were made between combined target areas and the contrast area, as well as between the individual target areas.

Timing of Measurements

The timeframe in which surveys were conducted was not discussed.

Dependent Variables

Availability of healthy food products. 

Independent Variables

• "Shopping List" survey
• "The Healthy Food Assessment" survey.

Control Variables

A quality control process was put into place; completed surveys were reviewed by each group coordinator, then the Community Health Council Community Liaison and finally the project evaluation staff.

• Initial N: 261 stores in the target area (Inglewood, N=28; North Long Beach, N=75; South Los Angeles, N=156) and 69 stores in the contrast area were inventoried using the "Shopping List" instrument (total, N=331). The "Healthy Food Assessment" instrument was completed in 54 stores in the target area and 17 stores in the contrast area (total, N=71).
• Ethnicity:
  • In the target areas:
    • North Long Beach is 23.2% African-American
    • Inglewood is 46.7% African- American
    • South Los Angeles is 49.2% African-American
  • In the contrast area: West Los Angeles is 8.1% African-American
• Other relevant demographics: In the contrast area, the median household income is $45,917 and 17% of the population live below the poverty line. As a whole, the target areas have a median household income of $29,237 and a poverty rate of 28%.
• Anthropometrics: The target areas have a total population of 679,148 and are an average of 47% African-American. In the target areas there are 114 grocery stores, meaning there are 5,957 people per store. The contrast area has a total population of 222,019 and is an average of 8% African-American. In this area there are 59 grocery  stores, meaning there are 3,763 people per store.
• Location: North Long Beach, Inglewood, South Los Angeles and West Los Angeles, all located in California.

Key Findings

• The target areas had a higher proportion of convenience stores and local markets than the contrast area, which had larger franchised markets
• Fruits and vegetables, non-fat milk and low-fat snacks were less often available in the target areas as compared to the contrast area
• Meat was sold less in the target areas than in the contrast area
• 70.4% of stores in the target areas sold fresh fruits and vegetables, compared with 93.8% in the contrast area (P<0.05)
• Target areas had about half the selection of fruits and vegetables that the contrast area did (13 types of fruit vs. 26, P<0.05; 21 types of vegetables vs. 38, P<0.05). In target areas fruit and vegetable sections were significantly less likely than contrast areas to be in the front of the store (53% vs. 87%, P<0.05). 
• Color, texture, consistency, damage and cleanliness of apples, grapes, strawberries, lettuce, green beans, avocados and celery were found to be inferior in target area markets compared to contrast area markets
• The availability of meat, poultry and fish products, including lower-fat meat options, was similar in all areas
• There was significant variation in the availability of lower-fat milk products between target and contrast areas. Half of stores in the target area carried 2% milk (50.0% vs. 81.3%, P<0.05), 29.6% carried 1% milk (compared with 56.3% in contrast area, P<0.05), and 37.0% carried skim milk (vs. 81.3% in contrast area, P<0.01). In addition, low-fat cheese and non-fat cheeses were more commonly found in the contrast area (P<0.05).
• Whole grain pasta was found in only 1.9% of target area markets vs. 31.3% in the contrast area (P<0.01)
• Target areas were less likely to have low-fat potato chips (33.3% vs. 68.8%, P<0.05), sugar-free cookies (16.7% vs. 50.0%, P<0.05) or have a diabetic food section (3.9% vs. 33.3%, P<0.01) or a low-salt food section (3.9% vs. 26.7%, P<0.05).  

Shopping List Survey	Target Area	Contrast Area	Statistical Significance of Group Difference
Store type			P<0.001
Convenience	34.8	26.1
Local market	60.2	44.9
Supermarket	5.0	46.0
Chain store, percentage	18.3	46.2	P<0.001
Meat sold, percentage	41.0	71.0	P<0.001
Fruit and vegetables sold, percentage	49.4	66.7	P<0.05
Non-fat milk sold, percentage	37.9	79.7	P<0.001
Low-fat snacks sold, percentage	42.2	69.6	P<0.001

 

 

Healthy Food Assessment survey	Target Areas	Contrast Area	Statistical Significance of Group Difference
Not a chain store, percentage	69.2	46.7	P<0.05
Service: Excellent/good, percentage	70.4	100.0	P<0.05
Sells fresh fruit or vegetables, percentage	70.4	93.8	P<0.05
Sells milk, percentage
Whole	88.9	100.0	NS
2%	50.0	81.3	P<0.05
1%	29.6	56.3	P<0.05
Skim	37.0	81.3	P<0.01
Sells cheese, percentage
Regular	68.5	68.8	NS
Low-fat	20.4	50.0	P<0.05
Non-fat	7.4	31.3	P<0.05
Sells whole-grain pasta, percentage	1.9	31.3	P<0.01
Sells low-fat potato chips, percentage	33.3	68.8	P<0.05
Sells sugar-free cookies, percentage	16.7	50.0	P<0.05
Has a diabetic food section, percentage	3.9	33.3	P<0.01
Has a low-salt food section, percentage	3.9	26.7	P<0.05

 

Health disparities found in African-American communities extend beyond the health care system and may be rooted in the fact that a healthier lifestyle is more difficult in nutrition-resource-poor neighborhoods than in nutrition-resource-rich ones. South Los Angeles residents are significantly less likely to have access to healthy food items encouraged by health advocates, such as low-fat or skim milk, low-fat or non-fat cheese, whole grain pasta and a greater variety of fruits and vegetables. The community-based participatory research process used in this study provides an opportunity to develop a collaborative project that could improve the health of communities confronting such inequities.

Government:

Centers for Disease Control and Prevention

The authors mention that the participatory research method poses threats to the validity and reliability of the data, as the method requires less elaborate survey instruments and less control over the data collection process. The authors also state that this study experienced problems in the quality of the initial inventories.