Elsevier

Health & Place

Volume 14, Issue 3, September 2008, Pages 415-423
Health & Place

Structural violence, urban retail food markets, and low birth weight

https://doi.org/10.1016/j.healthplace.2007.08.008Get rights and content

Abstract

This paper investigates urban retail food markets and health in Syracuse, New York. A structured observational analysis found that a majority of corner markets do not sell fresh produce or low fat dairy products, but conduct a lively business selling lottery tickets, cigarettes, and liquor. A comparison of census tracts with and without access to supermarkets that sell fresh produce and other healthy food found that pregnant women living in proximity to a supermarket had significantly fewer low birth weight births than other pregnant women regardless of income level.

Introduction

This article examines urban retail food markets and health in Syracuse, New York. Concerns about food markets initially came up during a series of focus groups of community members who were brought together in March and July 1999. At those meetings the focus group participants expressed concerns about local access to healthy foods and called attention to the lack of supermarkets in much of urban Syracuse. Focus group results suggested that small corner stores, the only source of food for many of the focus group participants, were predominately selling pagers, beer and non-food items. Also, according to these participants, the food items were often spoiled and overpriced.

In light of the community focus group findings we systematically investigated the marketing of health-promoting food, and non-food items such as cigarettes, alcohol and lottery tickets, in urban Syracuse in two types of retail outlets, corner stores and supermarkets. Then, through the use of individual-level and census tract-level quantitative data we compared the presence or absence of a full service supermarket in a given census tract, and the per capita sale of lottery tickets, to a specific type of prenatal medical condition—intrauterine growth restriction (IUGR)—known to cause low birth weight.

IUGR is defined as fetal growth that falls below the 10th percentile for gestational age (on standardized growth charts). Using IUGR of full-term infants is more precise than using low birth weight alone, because IUGR of full-term births avoids the bias of including premature births in the analysis (Gilbert and Danielsen, 2003).

The data presented in this article are part of a larger study on maternal and child health, funded by the Health Resources and Services Administration, titled “Innovative Models to Analyze and Address Racial, Ethnic and Geographic Disparities in Maternal and Child Health Outcomes.” The goal of this larger study was to use population-level data and program data to identify areas for further analysis in the area of racial and ethnic health disparities. This work integrates epidemiological, environmental, and ethnographic methods, to examine racial and ethnic inequality in low birth weight, premature births, and infant death, as well as the risk factors associated with those disparities. IRB approval was obtained from the Upstate Medical University.

Section snippets

Low birth weight and IUGR

Low birth weight is a key aspect of the disparity in birth outcomes between white babies and babies of color (Lane et al., 2003). Obstetricians count the pregnancy gestational period as lasting 40 weeks; a pregnancy that lasts until the end of the 37th week is said to be “full term” and a baby that emerges prior to 37 weeks is said to be “premature.” Babies whose growth falls below the 10th percentile for their gestational age (on standardized growth charts) have IUGR (Steward and Moser, 2004).

Methods

This work uses a multilevel methodological approach to investigate the impact of urban retail food markets and health—specifically low birth weight—in Syracuse, New York (Rubinstein et al., 2000). The research integrates epidemiological, environmental, and structured observational methods.

The setting: Syracuse, the Onondaga County seat, is the fifth largest city in New York, with a 2000 population of 147 306, which is comprised of 64% European Americans, 25.3% African Americans, 3.4% Asian, 1.1%

Corner stores

The median family income of the low-risk census tracts ($44 572) is about 60% above the median family income in the high-risk census tracts ($17 632), a finding that is expected because poverty was one of the variables by which the categories were chosen. Although race/ethnicity was not a variable to determine the categories of high- and low-risk, people of color comprise nearly three times the proportion of residents in the high risk compared with the low-risk census tracts. The higher

Discussion/conclusion

Several health risks are associated with the location and business practices of retail food outlets in Syracuse, which constitute forms of structural violence. There is a paucity of fruits, vegetables, and low fat dairy in many neighborhoods. Consumers who do not own cars must take city buses or arrange for help with transportation to get to supermarkets to purchase these items. The corner stores rack up extensive sales of the New York State-run lottery and per capita lotto purchases are

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