PRB

(July 2006) Although recent research has established links between the kinds of foods available in a neighborhood and the health of that neighborhood’s residents, this research has rarely addressed the effects of food marketing on children—especially children in low-income neighborhoods.

A number of studies summarized in a 2005 report from the Institute of Medicine (IOM)—Food Marketing to Children and Youth: Threat or Opportunity—do document how food is marketed differently to rich and poor neighborhoods in the United States. But while the IOM report finds that “the food environment in poorer neighborhoods makes it difficult for residents to eat healthful foods away from home,” it does not highlight this conclusion in its summary findings, mainly because these studies did not focus on children.

Table 1
Persons Under Age 18 in Severely Distressed Neighborhoods, by Race and Hispanic Origin, 2000

Source: Population Reference Bureau, analysis of data from 2000 Census; and B. O’Hare and M. Mather, The Growing Number of Kids in Severely Distressed Neighborhoods: Evidence from the 2000 Census (2003).

However, the characteristics of the neighborhood food environment are still important considerations for children’s health behaviors. Indeed, several facts suggest that neighborhood differences in food marketing practices should be given greater consideration in the fight against increasing childhood obesity:

• Poor children have higher rates of obesity (around 20 percent of all poor children) than do nonpoor children (around 15 percent).
• African American children (21 percent) and Mexican American children (23 percent) have higher rates of obesity than non-Hispanic white children (13 percent).
• Hispanic and African American children are more concentrated in socioeconomically distressed neighborhoods than are non-Hispanic white children (see Table 1).¹

Improving access to healthier foods is critical to decreasing childhood obesity in the United States—which affects more than 7 million children ages 6 and older and has tripled among adolescents in the last two decades.² Yet public health strategies largely neglect the specific needs of these communities. Tailoring public education messages and other efforts to promote healthy eating to reach low-income communities as well as racial and ethnic minorities would more effectively address the threat of increasing childhood obesity.

Access Denied—Supermarkets and Food Variety Less Plentiful in Minority Areas

Marketing consists of the following four components:

• Place—geographic location, types of retail outlets, and distribution points used to reach target audiences;
• Product—food attributes, quality, quantity, and packaging;
• Price—amount charged, discounts offered, and factors considered in setting levels; and
• Promotion—advertising, consumer promotion, trade promotion, and public relations.

For each of these categories, research shows that in the United States, residentially and economically segmented food marketing is facilitating less-healthy diets among residents of low-income neighborhoods.

Place. There is a direct link between access to supermarkets—which are usually the least expensive sources of food—and healthier dietary intake.³ Individuals living near stores stocking such products tend to eat more healthy foods.⁴ And for both blacks and whites, the presence of at least one neighborhood supermarket is associated with self-reported food intake meeting dietary recommendations.⁵ Interestingly, the association is much stronger among blacks than whites: With each additional supermarket in a neighborhood, fruit and vegetable intake increased 32 percent among African Americans and 11 percent among whites living there.

But across a variety of states, studies show that middle- and higher-income neighborhoods have two to four times as many supermarkets as do low-income neighborhoods.⁶ Poorer and nonwhite neighborhoods also have fewer fruit and vegetable markets, bakeries, specialty stores, and natural food stores (see Table 2).⁷ In the Detroit metropolitan area, for example, the poorest African American neighborhoods are an average of 1.1 miles further from the nearest supermarket than are impoverished white neighborhoods.⁸

Table 2
Ratio of Food Stores in Minority and White U.S. Neighborhoods, 2005

White neighborhoods=1.0

Note: Adjusted for census tract population and size. Any tract with 60 percent of residents in any racial/ethnic group is defined as predominantly that group.
Source: L. Moore and A. Diez Roux, American Journal of Public Health (2006).

Product. Another difference between food marketing in low-income and more-affluent neighborhoods is in the kinds of foods sold. For instance, one study in the IOM report found that, while 58 percent of food stores on New York City ‘s Upper East Side stocked the low-fat, high-fiber foods health professionals recommend as part of a diet to control diabetes, only 18 percent of stores in East Harlem stocked these foods.⁹

Similarly, a 2003-2004 survey taken in Los Angeles and Sacramento uncovered limited availability of healthy foods in the small grocery stores located in low-income neighborhoods.¹⁰ Other studies find more fast-food restaurants per square mile in both low-income and predominantly black neighborhoods and less selection in terms of items and food preparation (such as steamed, roasted, grilled, baked, or broiled options).¹¹

Promotion. In poor neighborhoods, less-healthy food options also tend to be heavily promoted.¹² For example, in a Los Angeles County study, one-third of the restaurants in the poorer African American neighborhood promoted specific menu items. However, these restaurants were less likely to have labels indicating healthy food or to offer more healthful items such as green salads, fresh fruit, and baked as opposed to fried foods. Meanwhile, restaurant customers in the more-affluent comparison area were exposed to significantly fewer advertisements and promotions in the restaurants. These customers were also offered more-healthy food options than their less-affluent counterparts.

Neighborhood promotions are just part of the story. One study in the IOM report finds that cookies and candy are the second-most advertised category of items in magazines and cable channels targeting African American consumers.¹³ Earlier studies not reviewed in the IOM report find fewer advertisements for healthy foods in magazines and television shows that target African Americans.¹⁴

Price. Although the IOM report indicates that food costs may be a barrier to the adoption of healthier diets by low-income households, none of the studies reviewed compare these costs in low-income and high-income neighborhoods. Based on a recent U.S. Department of Agriculture (USDA) analysis of retail prices for 85 types of fruits and vegetables prices, IOM concludes that the cost of consuming fresh fruits and vegetables would not be prohibitive to low-income households.¹⁵

However, a more recent survey in Los Angeles and Sacramento grocery stores found that a two-week supply of healthier foods in these cities costs more on average ($230) than a two-week supply based on the USDA thrifty food plan ($194).¹⁶ The $36 difference is attributable to the higher cost of whole grains, lean ground beef, and skinless poultry. Switching to the healthier food market basket would increase by 30 percent to 40 percent the average amount ($2,410) that U.S. low-income consumers spend each year on food.

In an economic analysis of diet health and diet cost, Adam Drewnowski and Nicole Darmon have shown that budget constraints lead people to higher-fat and higher-calorie diets.¹⁷ The authors conclude that the cost associated with prudent diet choices is one likely barrier to healthy eating among poor families.

Which Policies and Interventions Can Improve Low-Income Food Environments?

Industry. Food producers and distributors respond to the tastes and budget constraints of specific target groups—leading them to sell more affordable, less-healthy foods in poorer neighborhoods. But food marketing also has the potential to influence tastes, and the food industry has already demonstrated innovation in how foods are processed, packaged, and distributed.

Some food companies already target ethnic groups through development and placement of new products—for instance, hot and spicy flavors—intended to appeal to specific market segments.¹⁸ In contrast, public nutrition education is directed toward the general population and is not specifically directed at minority or low-income groups.¹⁹

Marketing campaigns to promote better nutrition should reach more racial and ethnic minorities in low-income communities.²⁰ More information about healthy food choices could be placed in magazines and television shows targeting minority audiences. Point-of-purchase information identifying healthy food choices in grocery stores and supermarkets in low-income neighborhoods would also help parents compare nutritional value as easily as they compare prices. This type of intervention has been shown to enhance the image of participating stores and, in New Zealand, to aid in the development of healthier processed food.²¹

Food producers and distributors also already use bonus space and quality locations in grocery stores to promote nonfood items.²² Applying such strategies to the display of healthy choices could also be an effective way of promoting these foods. Such efforts are better designed by professional marketers than the government, but government incentives could build momentum among vendors for adopting these strategies, particularly in low-income areas.

Government. Given the public health threat posed by obesity and the cost employers and the government ultimately pay to subsidize chronic-disease management, the government has a strong interest in making healthy eating an easier choice for poor families.

Because educating low-income consumers will not remove disparities in financial and physical access to healthy food, analysts have proposed tax-related policy options to modify the food environment experienced by low-income groups.²³ These options include subsidizing the cost of healthy foods by making discount coupons available to low-income groups, shifting agricultural farm subsidies to healthy food crops, and tax incentives to stores and/or distributors for posting point-of-purchase information.

Shaping Tastes Rather Than Simply Targeting Them

The growing size and purchasing power of racial and ethnic minorities make these groups an appealing target market for the food and beverage industry. And as potential future customers, children in these communities are an even more appealing target. The food and beverage industry not only can cater to the existing preferences of these target groups, they can also help shape their tastes.

While pricing interventions may have greater potential for increasing access to healthy foods among low-income groups, almost no research to support these solutions exists, and such changes are likely to be more difficult to implement. On the other hand, public education campaigns could feasibly be implemented in low-income communities now and could take advantage of existing private-sector expertise in marketing. Without such campaigns, the epidemic of obesity among minority U.S. children might continue to accelerate.

Marlene Lee is a senior policy analyst at the Population Reference Bureau.

References

1. William O’Hare and Mark Mather, The Growing Number of Kids in Severely Distressed Neighborhoods: Evidence from the 2000 Census (2003), accessed online at www.prb.org, on June 27, 2006. Severely distressed neighborhoods exhibit above-average levels of at least three of these four characteristics: poverty rates, female-headed families, high school dropouts, and low labor force participation among working-age males.
2. National Center for Health Statistics, Health United States, 2005 (Hyattsville, MD: Government Printing Office, 2005), accessed online at www.cdc.gov/nchs, on July 1, 2006.
3. Allen Cheadle et al., “Community-Level Comparisons Between the Grocery Store Environment and Individual Dietary Practices,” Preventive Medicine 20, no. 2 (1991): 250-61; Karen Glanz and Amy L. Yaroch, “Strategies for Increasing Fruit and Vegetable Intake in Grocery Stores and Communities: Policy, Pricing, and Environmental Change,” Preventive Medicine 39, suppl. 2 (2004): S75-S80; Kimberly Morland et al., “The Contextual Effect of the Local Food Environment on Residents’ Diets: The Atherosclerosis Risk in Communities Study,” American Journal of Preventive Medicine 92, no. 2 (2002): 1761-67; and Barbara A. Laraia et al., “Proximity of Supermarkets is Positively Associated with Diet Quality Index for Pregnancy,” Preventive Medicine 39, no. 5 (2004): 869-75.
4. Cheadle et al., “Community-Level Comparisons Between the Grocery Store Environment and Individual Dietary Practices”; Laraia et al., “Proximity of Supermarkets is Positively Associated with Diet Quality Index for Pregnancy”; and Shannon Zenk et al., “Fruit and Vegetable Intake in African Americans: Income and Store Characteristics,” American Journal of Preventive Medicine 29, no. 1 (2005): 1-9.
5. Morland et al., “The Contextual Effect of the Local Food Environment on Residents’ Diets.”
6. Kimberly Morland et al., “Neighborhood Characteristics Associated with the Location of Food Stores and Food Service Places,” American Journal of Preventative Medicine 22, no. 1 (2002): 23-29; Carol Horowitz et al., “Barriers to Buying Healthy Foods for People with Diabetes: Evidence of Environmental Disparities,” American Journal of Public Health 94, no. 9 (2004): 1549-54; Shannon N. Zenk et al., “Neighborhood Racial Composition, Neighborhood Poverty, and the Spatial Accessibility of Supermarkets in Metropolitan Detroit,” American Journal of Public Health 95, no. 4 (2005): 600-67; Adam Drewnowski and Nicole Darmon, “Food Choices and Diet Costs: An Economic Analysis,” The Journal of Nutrition 135, no. 4 (2005): 900-4; and Latetia Moore and Ana V. Dize Roux, “Associations of Neighborhood Characteristics with the Location and Type of Food Stores,” American Journal of Public Health 96, no. 2 (2006): 325-31.
7. Moore et al., “Associations of Neighborhood Characteristics with the Location and Type of Food Stores.”
8. Zenk et al., “Neighborhood Racial Composition, Neighborhood Poverty, and the Spatial Accessibility of Supermarkets in Metropolitan Detroit.”
9. Horowitz et al., “Barriers to Buying Healthy Foods for People with Diabetes: Evidence of Environmental Disparities.”
10. Karen Jetter and Diana Cassady, “The Availability and Cost of Healthier Food Alternatives,” American Journal of Preventive Medicine 30, no. 1 (2006): 38-44.
11. Jason Block et al., “Fast Food, Race/Ethnicity, and Income: A Geographic Analysis,” American Journal of Preventive Medicine 27, no. 3 (2004): 211–17; and LaVonna Blair Lewis et al., “African Americans’ Access to Healthy Food Options in South Los Angeles Restaurants,” American Journal of Public Health 95, no. 4 (2005): 668-73.
12. Lewis et al., “African Americans’ Access to Healthy Food Options in South Los Angeles Restaurants.”
13. Jerome Williams, ” Advertising of Food and Beverage Products to Children, Teen, and Adult Multicultural Markets,” University of Texas at Austin Working Paper (Austin: University of Texas, 2005).
14. Charlotte A. Pratt and Cornelius B. Pratt. “Comparative Content Analysis of Food and Nutrition Advertisements in Ebony, Essence, and Ladies’ Home Journal,” Journal of Nutrition Education 27 (1995): 11-17; and Manasai A. Tirodkar and Anjali Jain, “Food Messages on African American Television Shows,” American Journal of Public Health 93, no. 3 (2003): 439-41.
15. Jane Reed et al., “How Much Do Americans Pay for Fruits and Vegetables?” Agriculture Information Bulletin 790 (Washington, DC: U.S. Department of Agriculture and Economic Research Service, 2004).
16. Jetter and Cassady, “The Availability and Cost of Healthier Food Alternatives.”
17. Drewnowski and Darmon, “Food Choices and Diet Costs: An Economic Analysis.”
18. R.C. Endicott et al., “Hispanic Pact Pack,” Advertising Age Supplement (July 18, 2005): 1-51, accessed online at www.adage.com, on May 30, 2006; and Magazine Publishers of America, Hispanic/Latino Market Profile (2004), accessed online at www.magazine.org, on May 30, 2006.
19. Federal Trade Commission (FTC) and Department of Health & Human Services (HHS), Perspectives on Marketing, Self-Regulation, & Childhood Obesity: A Report on a Joint Workshop of the Federal Trade Commission & the Department of Health and Human Services (2006), accessed online at www.ftc.gov, on May 30, 2006.
20. FTC and HHS, Perspectives on Marketing, Self-Regulation, & Childhood Obesity.
21. FTC and HHS, Perspectives on Marketing, Self-Regulation, & Childhood Obesity .
22. Glanz and Yaroch, “Strategies for Increasing Fruit and Vegetable Intake in Grocery Stores and Communities.”
23. Glanz and Yaroch, “Strategies for Increasing Fruit and Vegetable Intake in Grocery Stores and Communities.”
24. Glanz and Yaroch, “Strategies for Increasing Fruit and Vegetable Intake in Grocery Stores and Communities”; and Drewnowski and Darmon, “Food Choices and Diet Costs: An Economic Analysis.”