Chips for some, tofu for others

Community activists in Los Angeles have long complained about the challenges of finding healthful foods in lower-income and minority neighborhoods, but a first-of-its-kind study may finally give new weight to the issue.

A coalition of academic and community researchers compared grocery store selections in South Los Angeles, Inglewood and North Long Beach with those in the more affluent West Los Angeles. Researchers found that stores in the lower-income neighborhoods were far less likely to carry meats, fresh fruits and vegetables, nonfat milk and low-fat snacks.

“We live with this all the time in our communities,” said Lark Galloway-Gilliam, executive director of Community Health Councils Inc., a health promotion organization in the Crenshaw district that helped organize the study. “Now we have data we can point to, evidence of our frustrations and concerns.”

Researchers at USC, UCLA and the health councils group trained about 90 students and members of community organizations to survey more than 400 local food markets for their cleanliness, quality of service and foods. South L.A., Inglewood and North Long Beach -- areas chosen for their racial makeup -- were more likely to have convenience stores or small neighborhood markets than supermarkets and chain stores more common in West L.A. They were also dirtier and about 30% less likely to have good service, the researchers found.

But even more surprising, said David Sloane, associate professor of policy, planning and development at USC and one of the study’s investigators, was the marked difference in food selections among the stores. Stores in the study’s low-income areas carried about half the variety of fruits and vegetables as stores in West L.A. Also, produce items such as apples, grapes, strawberries and lettuce were more likely to be damaged or dirty. All stores surveyed in West L.A. carried whole milk and most carried skim milk. But among stores in the other study neighborhoods, some didn’t carry milk at all, and a minority carried skim or reduced-fat milks.

The study also showed that it’s hard to find more healthful food items such as soy milk, tofu, whole-grain pasta, low-fat mayonnaise, low-fat potato chips and sugar-free cookies in South L.A., Inglewood and North Long Beach. The stores in those neighborhoods were also much less likely to have sections specializing in products for people on low-salt diets or those with diabetes.

That’s significant because African Americans are twice as likely as whites to suffer from diabetes, according to federal statistics. There is mounting scientific evidence on the role of good nutrition in preventing disease and illness. Doctors and nutritionists recommend diets rich in fresh fruits and vegetables to decrease the risk of cancer. And low-fat diets are believed to cut the risks of heart disease, diabetes and obesity -- all of which are leading causes of death or disability in the U.S. The Centers for Disease Control and Prevention estimates that obesity alone, caused by poor diets and inactivity, accounts for about 300,000 deaths a year.

Although the study found fewer chain stores in South L.A., Inglewood and North Long Beach than in West L.A., representatives of several major California grocery chains said they have locations in neighborhoods of varying demographics and maintain equivalent produce standards for all stores. Ralphs’ spokesman Terry O’Neil said the chain prides itself on serving all communities equally. “We’re one of the few companies that doesn’t shy away from the inner city,” he said.

O’Neil added that all food items come from the same warehouses and are sorted for delivery by employees who aren’t aware of which items go to which store. He acknowledged that smaller stores may have less variety than larger ones, simply due to lack of space. He also said types of products may vary by location, but only according to customer demand.

No grocery chains were named in the published study, though the Community Health Councils said it plans to release store names later this summer.

The study, published in the July issue of the Journal of General Internal Medicine, is one piece of a larger project called African Americans Building a Legacy of Health, a program that’s attempting to reduce cardiovascular disease and diabetes in African American communities by improving nutrition and physical activity. Researchers are also comparing restaurants and recreational areas in the study area with those in West L.A.

The project is supported by a national CDC program to address minority health issues through community involvement in research.

Research collaborations between academics and community members, called community-based participatory research, have generated policy changes across the country, said Meredith Minkler, a professor of health and social behavior at UC Berkeley. The approach helped hotel-room cleaners in San Francisco lobby for less stressful workloads and helped community activists in West Harlem, New York get tighter regulations on diesel emissions from public buses, she said.

Sloane said the research approach is effective because community members have a stake in defining and studying a problem in their neighborhood and deciding how to use the results effectively. The study investigators plan to distribute a tool kit -- an outline of their methods along with their results -- to groups in cities throughout California, said Sloane, so other communities can do similar surveys.

Community Health Councils’ Galloway-Gilliam said she believes there’s a lot of power in the data the group has collected. “We’re hoping we’ll be able to sit down with the food industry and say, ‘OK, enough. We need healthier options in our stores.’ We’re just looking for equity here,” she said.

“If a store doesn’t offer a product someone wants,” said Ralphs’ O’Neil, “all that customer has to do is make their demand known to store management.”

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A healthful selection near you?

A recent survey of several hundred grocery stores in Los Angeles found that large supermarket chain stores tended to offer more variety and more healthful foods than local or convenience markets. The survey also found that chain stores are relatively scarce in Inglewood, South L.A. and North Long Beach compared with West Los Angeles.

Percentage of store types

*--* Inglewood, South L.A. and N. Long Beach West L.A

Convenience store 35% 26% Local market 60 45 Supermarket 5 29

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Percentage of stores carrying health-oriented food products

*--* Inglewood, South L.A. and N. Long West L.A Beach Fresh fruit or vegetables 70% 94% Lean beef 20 31 2% fat milk 50 81 Low-fat cheese 20 50 Soy milk 22 50 Tofu 11 50 Whole-grain pasta 2 31 Sugar-free cookies 17 50 Diabetic food section 4 33 Low-salt food section 4 27

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Source: Journal of General Internal Medicine, July 2003.