This document discusses measuring socio-spatial inequities in retail food access in Hawaii. It provides background on obesity rates and the relationship between poverty, race, and the retail food environment. The speaker then describes how she mapped the retail food environment (mRFE) in Hawaii by calculating scores based on the availability of healthy vs unhealthy food outlets. Her results found that Honolulu and Kapolei have many unhealthy food options ("food swamps") but the areas with the lowest mRFE scores did not necessarily correspond to neighborhoods with higher poverty or non-white populations. The speaker notes limitations in only considering retail sources and outlet types rather than how people interact with their environment or obtain food through other means.

1. MEASURING SOCIO-SPATIAL INEQUITIES
TO RETAIL FOOD ACCESS IN HAWAII
Elise Dela Cruz-Talbert
Building a Food Environment Community of Practice
November 16, 2016

2. Agenda
■ Obesity and Retail Food Environment studies
■ Mapping the Retail Food Environment (mRFE calculation)
■ Results
■ Food System Discussion

3. Obesity risks and rates
■ Underweight and obesity status were
both associated with excess deaths
when compared to normal weight,
while overweight was not (Flegal et al.,
2005).
■ Obesity contributes to cardiovascular
disease, Type II diabetes, osteoarthritis,
and some cancers (Foster, Burton, &
Van Itallie, 1985; Must et al., 1999;
Flegal et al., 2005).
■ Global adult obesity prevalence, rates nearly
doubled from 4.8% to 9.8% for men and 7.9% to
13.8% for women in the span of 1980 to 2008
(Finucane et. al, 2011).
■ In the US, obesity prevalence among adults aged
20 years and older, from 23% to 34% for the
years 1988-1994 compared to 2007-2008 (Flegal
et al., 2010; Ogden and Caroll, 2010).
■ Among children ages 2-8y in Hawaii, Alaska, and
the US-Affiliated Pacific Islands, OWOB to be
higher than the global estimate (~7%) and that
rates increased with age, from 21% at age 2 years
to 29% at age 8 years (Novotny et al., 2015).

4. Obesity and poverty spatial disparities
County-level Estimates of Obesity among Adults
aged 20 years or older, 2009
County-level poverty prevalence, all ages, by
nonmetro and metro county; U.S. Census, 2015

5. County-level poverty prevalence, for <18 years,
by nonmetro and metro county; U.S. Census,
2015
US Childhood Obesity Prevalence Estimated at
the Census Block Level, 2011
Obesity and poverty spatial disparities

6. Can community retail food environments
help explain spatial obesity disparities?
Research Questions:
1. Are there geographic differences in the access and availability of foods or
disparities in the retail food environment?
2. Do neighborhoods of low socioeconomic status with high concentrations of
racial/ethnic minorities have limited accessibility and availability of healthy foods
(poor-quality retail food environment)?
3. Are individuals exposed to poor-quality retail food environments more likely to have
diets that include foods of low nutritional quality and high caloric density, and
higher rates of obesity and other health outcomes, as compared to individuals
exposed to high-quality food environments?

7. Definitions:
■ Healthier food: include fruits, vegetables, whole grains, fat-free and
low-fat dairy products, and seafood, as well as foods with less sodium
(salt), saturated fats, trans fats, cholesterol, added sugars, and refined
grains
■ Healthier beverages: include fat-free or low-fat milk and milk products,
fortified soy beverages and other lactose-free products, 100% juice, and
water
■ Food Desert: geographic areas marked by limited healthy food options
■ Food Swamp: geographic areas marked by high availability of unhealthy
food options
■ Home Food: food prepared at home
■ Away Food: food prepared away from the home, such as at restaurants

8. Home Food:
■ Grocery stores have
greater availability
and quality of
healthier food than
convenience stores.
■ Supermarkets have
more fresh food
items compared to
small and medium
grocery stores.
Away Food:
■ Total calories consumed
from away food has
increased.
■ Fast foods were found to
be the highest in fat
content and energy
density among away
food sources.
■ A systematic review of 28
studies found a positive
association between
eating out and obesity.
Energy density, and fat content, of menus in the
UK, compared between Fast foods, Supermarket,
and the traditional Gambian diet
Source: Prentice and Jebb, 2004

9. Modified Retail Food Environment Index
CDC Children’s Food Environment Report
% HS Students
Who Drank ≥1
Soda/Day
% Children
Ages 12-17 Not
Eating Family
Meals Most
Days of Week
Modified
Retail Food
Environment
Index
Modified
Retail Food
Environment
Index -
Impoverished
Census Tracts
Hawaii 20.8 25.0 12 12
US Average 29.2 30.7 10 7
Source: Centers for Diseases Control and Prevention, Children’s
Food Environment State Indicator Report, 2011.

16. Insights and Limitations
■ Summary
– Honolulu and Kapolei are food swamps!
– The zip codes with the lowest mRFE score do not correspond to
neighborhoods with higher percentage of NHPI and higher
percentage of poverty (top quintile, adjusted by populations
size).
■ Data Limitations
– Underlying assumptions that nutrition based on outlet type
– Doesn’t capture how individuals interact with their environment
– Doesn’t capture non-retail sources of food (hunting, fishing,
gathering, gardening)