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2. Healthy Kids, Healthy Communities Supporting Community Action to Prevent Childhood Obesity Childhood Obesity Prevention GIS: A Mapping Tool Conference call April 20, 2011

3. Agenda • Welcome and Context • Tim Schwantes, Project Manager, Healthy Kids, Healthy Communities • Childhood Obesity GIS Website Demo • Chris Fulcher, Monte Roulier and Roxanne Medina-Fulcher, The Childhood Obesity Prevention GIS team, Center for Applied Research and Environmental Systems (CARES), University of Missouri • Using Primary Data for Mapping • Nicole Rioles, Project Coordinator, Somerville, MA • Creating Quick Maps for Long-term Impact • Melissa Watford, Project Director, Moore/Montgomery Counties, NC • Kathy Liles, Planning Director, Town of Aberdeen, NC • Q&A, Discussion and Next Steps Healthy Kids, Healthy Communities 2

4. Welcome and Context Healthy Kids, Healthy Communities 4 3

5. Aliza Sandberg Tufts Department of Civil and Environmental Engineering Cataldo Scholar 2009 Do Somerville Residents Lack Access to Fruits and Vegetables? Objective: Assess and map the availability of fruits and vegetables in Somerville supermarkets using Geographic Information Systems http://heersuperstore.com/wp-content/uploads/image/subpage_photo_fresh_produce Background In 2003-2004, 32% of all adults in the United States were obese, with an additional 34% overweight1. In general, ethnic minorities and people with lower incomes have higher rates of obesity than the average2. Access to supermarkets can be an indicator of healthful eating and lower rates of obesity. A study in Nova Scotia found that children in neighborhoods having the best access to shops with moderately priced fresh produce compared to children in those with the worst access had higher fruit and vegetable consumption, lower fat consumption, 26% less chance of being overweight and 33% less chance of being obese3. A study in San Diego isolated increased access to supermarkets as a factor associated with improved dietary quality and access to heart-healthy (low-fat and low-sodium) foods as compared to grocery stores or convenience stores. Census tracts with at least one supermarket had a 32% higher rate of fruit and vegetable intake over those tracts with no supermarkets4. A study on population based samples in four different American cities found that even after adjustment for individual level factors, the presence of supermarkets was correlated with lower overweight and obesity rates, while the presence of convenience stores were associated with higher rates of overweight and obesity5. Participants of the U.S. food stamp program with better access to supermarkets reported more total household fruit consumption. This study found an inverse relationship between distance from primary food store and consumption of fruit6. Another study found an association between access to stores with low fruit and vegetable prices and smaller increases in BMI between kindergarten and 3rd grade7. The positive associations between health and the presence of stores with healthy food choices are relevant when considering disparities in access to such stores based on racial and socioeconomic composition of neighborhoods, which may be a contributing factor to the increasing prevalence of overweight among low-income children8. A 2008 report found that having a high socioeconomic status was likely to provide individuals with more economic, social, and cultural resources that protect them from poor food consumption patterns9. Correlations exist in which neighborhoods with high concentrations of racial/ethnic minorities experience a lack of access to stores with affordable healthy food options. A study in East Harlem focusing on disparities in the presence of supermarkets or grocery stores in African-American, Latino, and racially mixed neighborhoods noted that obesity rates were 34% for African Americans and 33% for Latinos compared to 18% for white residents10. A 2008 report in Nutrition Reviews used six recent studies to support the association between socioeconomically disadvantaged neighborhoods with high proportions of racial/ethnic minorities and poorer retail access to healthy foods when compared with more affluent neighborhoods with smaller minority populations9. According to the 2000 Census Data, 23% of Somerville residents belong to a racial minority. 29.3% of people living in Somerville are foreign born, while 35.6% speak a language other than English at home. These numbers compare with the total U.S. population of 11.1% foreign born and 17.9% of people speaking a foreign language at home11. To serve the foods needs of this population, there are 6 full-scale supermarkets, 22 small retail food stores, 2 farmers’ markets (open less than half the year), and 29 convenience stores. • Method • At each of the 6 Somerville supermarkets, the following data was gathered: • Number of fresh fruits and vegetables, canned fruits and vegetables, and frozen vegetables. • Varieties within the same product were counted as one (e.g., green, red delicious, and granny smith apples were recorded as “apples”) • Linear feet of space devoted to fruits and vegetables (fresh, frozen, and canned). • Price per pound of the three most commonly consumed fresh fruits and vegetables12: apples, bananas, oranges, onions, potatoes, and tomatoes. • Price was recorded for loose items and for bulk pre-packaged bags greater than 1 pound. Map 3.Due to the variety of ethnicities among Somerville residents, the variety of produce available could be an indicator of a supermarket’s ability to meet the food needs of its population. The greatest variety of produce seems to be inversely related to median income. This may indicate that immigrants with lower incomes do have access to a greater variety of produce. Map 2. To quantify the amount of produce available at each supermarket, the linear space devoted to fresh, frozen and canned produce was measured in feet. This data was geocoded to overlay a map of population per census block in order to visualize the number of people that might be served by each supermarket. Map 1. The six supermarkets overlaying a Somerville neighborhood map. Sample of a completed in-store survey. Full survey lists approximately 100 fruits and vegetables. Map 5. Apples, oranges, onions, and potatoes are often sold in pre-packaged bags weighing more than one pound. Apples were sold in 3 pound bags at all but one store; potatoes were sold in 5 pound bags at all stores. The “bulk produce basket” is a sum of one pound of each of the six produce items, using the cheapest price per pound of bulk items, where applicable. Comparing maps 3 and 4, the supermarkets maintain their rankings of most expensive to least expensive even after taking bulk prices into account. Map 4. To compare the cost of fresh produce at the six supermarkets, the price per pound of the cheapest apples, bananas, oranges, onions, potatoes, and tomatoes was recorded. The sum of the cost for one pound of each loose produce item creates the price of a “loose produce basket.” Here, the basket costs overlay a map of the median household income per census tract to display the affordability of fresh produce throughout Somerville. Conclusions and Recommendations Data from the six Somerville supermarkets is insufficient to describe the food environment. More information is needed on existing food sources and modes of transportation. Although West Somerville has only one Supermarket, ranking second from the bottom in linear feet of produce, variety, bulk produce basket, and last in loose produce basket, its closest patrons are those from higher income areas, allowing for a greater possibility that they own cars with which to travel to other grocery stores. A future Cataldo scholar could investigate the following: Food sources: 22 small retail food stores in Somerville 29 convenience stores in Somerville 2 Somerville Farmers’ markets: Davis square (open ~6 months/year) and Union Square (open ~5 months/year) 8 Somerville community gardens 4 supermarkets plus other food stores located outside of city limits that serve the Somerville population Community Supported Agriculture programs (households receive a weekly share of a local farm’s produce) Modes of Transportation: Walk-ability of neighborhoods Bus routes Car ownership Notes and References Data for maps was taken from MassGIS, City of Somerville, and U.S. Census 2000 Data. Data on food stores was collected during February and March 2009. Pricing and variety count were collected on day of surveying and included discount sales. Foodmaster Supermarkets at 105 Alewife Brook Parkway was visited on 2/13/09 and 2/23/09; prices and linear feet measured were equal for the repeat trip. Farmers’ markets were not included in maps because they are open for less than half of the year. Other food stores were labeled as small retail or convenience based on calling stores and asking them to self identify. An exemption from the Medford Social, Behavioral and Education Institutional Review Board was granted for this study (#0903003). 1 Centers for Disease Control and Prevention, “Overweight and Obesity” <http://www.cdc.gov/nccdphp/dnpa/obesity/faq.htm> Visited 12/3/08. Updated 6/20/08. 2 Anderson PM, Butcher KF. Childhood Obesity: Trends and Potential Causes. The Future of Children 2006; 16(1): 19-45. 3Veugelers P, Sithoel F, Zhang S, et al. Neighborhood Characteristics in relation to diet, physical activity and overweight of Canadian Children. International Journal of Pediatric Obesity 2008; 3(3):152-159. 4 Sallis JF, Nader PR, Rupp JW, Atkins CJ, Wilson WC. San Diego surveyed for heart-healthy foods and exercise facilities. Public Health Reports 1986; 101: 216–19. 5 Morland K, Roux AVD, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. American Journal of Preventative Medicine. 2006; 30: 333-9. 6 Rose D and Richards R. Food Store Access and Household Fruit and Vegetable Use among Participants in the U.S. Food Stamp Program. Public Health Nutrition 2004; 7:1081–88. 7 Sturm R, Datar A. Body mass index in elementary school children, metropolitan area food prices and food outlet density. Public Health 2005; 119: 1059–68. 8 Sherry B, Mei Z, Scanlon KS, et al. Trends in State-Specific Prevalence of Overweight and Underweight in 2- through 4-Year-Old Children from Low-Income Families from 1989 through 2000. Archives of Pediatric and Adolescent Medicine 158 (2004): 1116–24. 9 Ford PB, Dzewaltowski DA. Disparities in obesity prevalence due to variation in the retail food environment: three testable hypotheses. Nutrition Reviews. 2008; 66(4):216-228. 10Galvez, MP, Morland, K, Raines, C et al. Race and food store availability in an inner-city neighbourhood. Public Health Nutrition 2008: 11(6): 628. 11 City of Somerville. “About Somerville: Census 2000 Demographic Profile Highlights.” 2008. http://www.somervillema.gov/About.cfm?page=35. Visited 03/12/09. 12 Reed J, Frazão E, and Itskowitz R, “How Much Do Americans Pay for Fruits and Vegetables.” United States Department of Agriculture. Agriculture Information Bulletin No. (AIB790) 39, July 2004. Thank you to the following people for their help in making this project possible: John Cataldo, Advisor: Professor David M. Gute, Professor Christina Economos, Professor Kathleen Merrigan, Lisa Brukilacchio, Malek Al-Chalabi, Adam White Inspiration for maps and method from Laura Spring’s 2006 senior honors thesis, “Recommendations versus Reality: Assessing the Food Environment in Low-Income Communities. A study of the Local Food Environment in Mattapan, MA” Map 6. In addition to the six supermarkets, there are 22 small retail food stores and 29 conveniences stores in Somerville. Supermarkets alone cannot describe the food environment in Somerville. Small retail food stores and some convenience stores sell varying amounts of produce. The store denoted by the asterisk sells 88.7 feet of 57 total fruit and vegetable varieties, fresh and canned (no frozen). At $6.44 for a loose produce basket and $5.90 for a bulk one, it is less expensive than four of the six large supermarkets. http://peterimarkcomm.files.wordpress.com/2008/08/produce

7. Agenda Healthy Kids, Healthy Communities 6

8. Multi-Method Evaluation Approach HKHC Dashboard Action Reporting Document planning and implementation activities as well as intended and unintended changes Policy Assessment Describe the current policies planned or in place Environmental Audits Observe the condition of the environment Multi-Method Evaluation Approach Photos & Videos Visually illustrate the condition of the environment Direct Observation Track behaviors in the environment Surveys, Interviews, Focus Groups Gather perceptions of policies and environments GIS Mapping Use maps to represent social, economic, or environmental conditions Healthy Kids, Healthy Communities 7

9. ChildhoodObesityGIS.org Q&A, Discussion and Next Steps To unmute and mute your phone, please press *6 Chris Fulcher Roxanne Fulcher FulcherC@missouri.edurfulcher@mchsi.com The Childhood Obesity Prevention GIS Team Nicole Rioles NRioles@somervillema.gov Shape Up Somerville Coordinator Melissa Watford Kathy Liles mwatford@firsthealth.orgkliles@townofaberdeen.net FirstHealth of the Carolinas Planning Director, Aberdeen Tim Schwantes tschwant@email.unc.edu Project Manager, HKHC Healthy Kids, Healthy Communities 8