THE JECH GALLERY

Money orders and alcohol yes; fruits, vegetables and skimmed milk no

Manuel Franco¹, Frederick Brancati¹, Ana Diez-Roux²

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;
² Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA

Correspondence to:
Correspondence to:
Dr Manuel Franco
Johns Hopkins School of Public Health 2024 E. Monument, St Baltimore, MD 21205, USA; mfranco{at}jhsph.edu

Neighbourhood socioeconomic characteristics are associated with differences in food intake after adjusting for individual characteristics.¹ Neighbourhood-level characteristics could contribute to ethnic and economic differences in dietary patterns. Systematic measurement of environmental variables is a challenge in epidemiology.²

In Baltimore, we are studying the effect of availability and price of food on cardiovascular risk by visiting 366 food stores in neighbourhoods of 1000 participants in a cardiovascular study.³

Within 1 mile of the grocery store (fig 1) reside 83 of the study participants. This store offers money orders, alcohol and lottery tickets, but no fruits or vegetables, no wholewheat bread and no skimed milk. The price of milk, cereal and bread was 20% higher than that in the closest supermarket 1.7 miles away. This store is not an exception.

View larger version (166K): in this window | in a new window | PowerPoint for Teaching   Figure 1  Grocery store in Baltimore City, USA.

 

A poor diet resulting in obesity is a major factor in the epidemic of non-communicable diseases, which disproportionately affects the poor.⁴ Epidemiologists need to deal with this problem, if recommended diets based on fruits and vegetables, wholewheat bread, and low-fat dairy products are to be made available and affordable to both the high-risk and general populations.⁵

1. Diez-Roux AV, Nieto FJ, Caulfield L, et al. Neighbourhood differences in diet: the Atherosclerosis Risk in Communities (ARIC) Study. J Epidemiol Community Health 1999;53:55–63.[Abstract]
2. Diez Roux AV. The study of group-level factors in epidemiology: rethinking variables, study designs, and analytical approaches. Epidemiol Rev 2004;26:104–11.[Free Full Text]
3. Bild DE, Bluemke DA, Burke GL, et al. Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol 2002;156:871–81.[Abstract/Free Full Text]
4. Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 2004;79:6–16.[Abstract/Free Full Text]
5. Editorial. Curbing the obesity epidemic. Lancet 2006;367:1549.[CrossRef][Medline]

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