Structural Drivers of Neighborhood Food Access: Implications for Policy Change.

Abstract

This study investigated structural drivers of neighborhood food access to identify possible pathways at a census tract level. Data from 9597 census tracts across 201 counties, within 38 states, tested potential pathways including the built environment, criminal justice, education, housing, social cohesion, transportation, wealth, and income/poverty. Historic residential redlining was defined using Home Owners' Loan Corporation residential security maps. Food access was defined using the modified retail food environment index. Direct and indirect relationships were investigated using structural equation modeling (SEM) run in Stata v18, controlling for the population of each census tract. Standardized estimates were used with p < 0.05 considered statistically significant. Redlining was directly associated with higher disadvantage across all tested pathways. Higher disadvantage in the built environment (-0.06, p < 0.001), criminal justice (-0.11, p < 0.001), housing (-0.04, p < 0.01), and social cohesion (-0.18, p < 0.001) was associated with lower food access, while higher disadvantage in education was associated with higher food access (0.07, p < 0.001), and transportation, wealth, and income were not significant pathways. The strongest neighborhood-level drivers were social cohesion, criminal justice, and education. Policies that focus on a holistic approach to the neighborhood environment may be needed to improve access to healthy food options at the neighborhood level.