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标题：Barriers to Buying Healthy Foods for People With Diabetes: Evidence of Environmental Disparities
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作者：Carol R. Horowitz ; Kathryn A. Colson ; Paul L. Hebert 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：9
页码：1549-1554
语种：English
出版社：American Public Health Association
摘要：Objectives. A community coalition compared the availability and cost of diabetes-healthy foods in a racial/ethnic minority neighborhood in East Harlem, with those in the adjacent, largely White and affluent Upper East Side in New York City. Methods. We documented which of 173 East Harlem and 152 Upper East Side grocery stores stocked 5 recommended foods. Results. Overall, 18% of East Harlem stores stocked recommended foods, compared with 58% of stores in the Upper East Side (P < .0001). Only 9% of East Harlem bodegas (neighborhood stores) carried all items (vs 48% of Upper East Side bodegas), though East Harlem had more bodegas. East Harlem residents were more likely than Upper East Side residents (50% vs 24%) to have stores on their block that did not stock recommended foods and less likely (26% vs 30%) to have stores on their block that stocked recommended foods. Conclusions. A greater effort needs to be made to make available stores that carry diabetes-healthy foods. At least 16 million Americans have diabetes, and its prevalence is increasing, especially among Latinos. 1 African American and Latino adults are 1.3 to 1.9 times more likely to have diabetes than are White adults. 1– 3 Among adults 40 to 74 years of age, 26% of Puerto Ricans, 24% of Mexican Americans, and 19% of African Americans have diabetes, compared with 12% to 13% of Whites. In New York City, Latinos 18 to 39 years of age are 4 times more likely than Whites to have diabetes, and African Americans in this age group are 2 times more likely than Whites to have diabetes. 4 In the United States, Latinos and African Americans also are less likely than Whites to be in control of their blood sugar levels; they have 2 to 4 times Whites’ rate of diabetes complications, such as renal disease and blindness, and they have higher diabetes-specific mortality rates. 1– 3, 5– 8 Diabetes may disproportionately affect residents of communities of color, such as East Harlem in New York City. East Harlem’s population, which is 50% Latino and 40% African American, 9 faces both limited resources and a disproportionate burden of chronic diseases, including diabetes. In East Harlem, nearly one third of adults and half of children live in poverty, and residents have the highest prevalence of obesity and the highest all-cause death rate in New York City. The prevalence of diabetes in East Harlem is nearly double that in New York City overall. 4 Among people with diabetes, mortality and hospitalization rates in East Harlem are nearly double those of New York City as a whole. 10 The rate of hospitalizations for diabetes-related amputations among persons aged 65 years and older in East Harlem is nearly 5 times the rate in New York City overall. 11 Diet is an integral part of the treatment of diabetes and maintenance of glycemic control. The American Diabetes Association recommends that people with diabetes consume a diet low in fat and high in fiber-containing foods such as fruits, vegetables, and whole grains. The American Diabetes Association also recommends substitution of diet soft drinks and “lite” breads to reduce carbohydrate and calorie intake while allowing patients to enjoy their preferred foods. 12, 13 The availability of these and other recommended foods in neighborhood food stores may influence the food choices of African American and Latino adults with diabetes. 14 Evidence exists that foods recommended as part of a healthy diabetic diet are in short supply in low-income, non-White neighborhoods such as East Harlem. In 2002, researchers found more supermarkets overall in White, compared with African American, neighborhoods and a positive association between fruit and vegetable intake and number of supermarkets in African American neighborhoods. 15, 16 In addition, the availability of low-fat milk is not as prevalent in stores in non-White neighborhoods in New York State. 17, 18 In 1998, a community-centered coalition of health providers, community advocates, and researchers formed the East Harlem Diabetes Center of Excellence to examine and improve care for persons with diabetes living in East Harlem. 19 The coalition surveyed 939 adults who live in and receive care for diabetes in East Harlem. Results of the survey showed that 40% of respondents did not follow a diabetic diet because of financial concerns. In addition to these findings, coalition partners and community members repeatedly stated that diabetes-healthy foods are less available or more expensive in many East Harlem groceries, especially in comparison with neighboring nonminority communities. The coalition therefore shifted its attention from individual patients in clinical settings to patients’ local food environments. Through this new focus, coalition partners joined the ranks of groups working to address community-level risk factors for obesity and suboptimal dietary practices and choices by linking science and community action. 20– 23 To better understand the environmental barriers people with diabetes face in attempting to consume a healthy diet, we conducted a food availability survey. The purpose of this survey was to document and compare the availability and cost of foods recommended for people with diabetes in East Harlem and the adjacent, more affluent, and predominantly White Upper East Side neighborhood. Although these 2 neighborhoods are adjacent, East Harlem is 6% White, whereas the Upper East Side is 84% White. East Harlem has one of the lowest median household incomes in New York City; the Upper East Side has the highest. 9 East Harlem has the highest prevalence of diabetes and obesity and the highest diabetes hospitalization rate in New York City; the Upper East Side has the lowest percentages in all 3 categories (Table 1 ▶ ). 4, 10 TABLE 1— Population Characteristics of East Harlem and the Upper East Side, New York City, 1998 East Harlem (n = 121 000 9 ) Upper East Side (n = 243 000 9 ) Race/ethnicity, 9 % White, Non-Hispanic 6 84 Black 40 2 Hispanic 50 6 Other 4 8 Median annual household income, 9 $ 21 295 74 130 Persons in poverty, 9 % 37 6 Adults with diabetes, 4 % 15 2 Adults with obesity, 4 % 31 7 No. of diabetes-related amputations in adults ≥ 65 years per 10 000 population 11 16 1 Open in a separate window