Barriers and Enablers for Equitable Healthy Food Access in Baltimore Carryout Restaurants: A Qualitative Study in Healthy Food Priority Areas
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Context
2.2. Sampling and Participant Recruitment
2.3. Data Collection
2.4. Data Management and Analysis
3. Results
3.1. Interpersonal Drivers
3.1.1. Perceptions of Consumer Preferences
3.1.2. Care for Consumer Well-Being
3.1.3. Maximizing Transactions
3.2. Sociocultural Drivers
Multicultural Ownership Shapes Food Offerings
3.3. Business Drivers
Cost of Business Impacts Carryouts’ Ability to Offer Healthy Options
3.4. Policy Drivers
3.4.1. Taxation
3.4.2. Government Regulations and Policy
3.4.3. Information Challenges
3.4.4. Uneven Investment across Neighborhoods
4. Discussion
4.1. Implications for Policy
4.2. Limitations and Strengths
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Saksena, M.J.; Okrent, A.M.; Anekwe, T.D.; Cho, C.; Dicken, C.; Effland, A.; Elitzak, H.; Guthrie, J.; Hamrick, K.S.; Hyman, J.; et al. America’s Eating Habits: Food Away From Home; EIB-196; U.S. Department of Agriculture: Washington, DC, USA, 2018. Available online: https://www.ers.usda.gov/webdocs/publications/90228/eib-196.pdf?v=7152 (accessed on 17 March 2024).
- U.S. Department of Agriculture. Food Prices and Spending. 2024. Available online: https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-prices-and-spending/ (accessed on 8 April 2024).
- Duffey, K.J.; Popkin, B.M. Energy Density, Portion Size, and Eating Occasions: Contributions to Increased Energy Intake in the United States, 1977–2006. PLoS Med. 2011, 8, e1001050. [Google Scholar] [CrossRef] [PubMed]
- Kirkpatrick, S.I.; Reedy, J.; Kahle, L.L.; Harris, J.L.; Ohri-Vachaspati, P.; Krebs-Smith, S.M. Fast-Food Menu Offerings Vary in Dietary Quality, but Are Consistently Poor. Public Health Nutr. 2014, 17, 924–931. [Google Scholar] [CrossRef] [PubMed]
- Liu, J.; Rehm, C.D.; Micha, R.; Mozaffarian, D. Quality of Meals Consumed by US Adults at Full-Service and Fast-Food Restaurants, 2003–2016: Persistent Low Quality and Widening Disparities. J. Nutr. 2020, 150, 873–883. [Google Scholar] [CrossRef] [PubMed]
- Powell, L.M.; Chaloupka, F.J.; Bao, Y. The Availability of Fast-Food and Full-Service Restaurants in the United States. Am. J. Prev. Med. 2007, 33, S240–S245. [Google Scholar] [CrossRef]
- Braveman, P.A.; Arkin, E.; Proctor, D.; Kauh, T.; Holm, N. Systemic And Structural Racism: Definitions, Examples, Health Damages, And Approaches To Dismantling: Study Examines Definitions, Examples, Health Damages, and Dismantling Systemic and Structural Racism. Health Aff. 2022, 41, 171–178. [Google Scholar] [CrossRef]
- Hines, A.L.; Brody, R.; Zhou, Z.; Collins, S.V.; Omenyi, C.; Miller, E.R.; Cooper, L.A.; Crews, D.C. Contributions of Structural Racism to the Food Environment: A Photovoice Study of Black Residents With Hypertension in Baltimore, MD. Circ Cardiovasc. Qual. Outcomes 2022, 15, e009301. [Google Scholar] [CrossRef]
- Lee-Kwan, S.H.; Bleich, S.N.; Kim, H.; Colantuoni, E.; Gittelsohn, J. Environmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting. Am. J. Health Promot. 2015, 29, 357–364. [Google Scholar] [CrossRef]
- Ayala, G.X.; Castro, I.A.; Pickrel, J.L.; Williams, C.B.; Lin, S.-F.; Madanat, H.; Jun, H.-J.; Zive, M. A Restaurant-Based Intervention to Promote Sales of Healthy Children’s Menu Items: The Kids’ Choice Restaurant Program Cluster Randomized Trial. BMC Public Health 2016, 16, 250. [Google Scholar] [CrossRef]
- Perepezko, K.; Tingey, L.; Sato, P.; Rastatter, S.; Ruggiero, C.; Gittelsohn, J. Partnering with Carryouts: Implementation of a Food Environment Intervention Targeting Youth Obesity. Health Educ. Res. 2018, 33, 4–13. [Google Scholar] [CrossRef]
- Valdivia Espino, J.N.; Guerrero, N.; Rhoads, N.; Simon, N.-J.; Escaron, A.L.; Meinen, A.; Nieto, F.J.; Martinez-Donate, A.P. Community-Based Restaurant Interventions to Promote Healthy Eating: A Systematic Review. Prev. Chronic Dis. 2015, 12, 140455. [Google Scholar] [CrossRef]
- Fuster, M.; Handley, M.A.; Alam, T.; Fullington, L.A.; Elbel, B.; Ray, K.; Huang, T.T.-K. Facilitating Healthier Eating at Restaurants: A Multidisciplinary Scoping Review Comparing Strategies, Barriers, Motivators, and Outcomes by Restaurant Type and Initiator. Int. J. Environ. Res. Public Health 2021, 18, 1479. [Google Scholar] [CrossRef]
- Noormohamed, A.; Lee, S.H.; Batorsky, B.; Jackson, A.; Newman, S.; Gittelsohn, J. Factors Influencing Ordering Practices at Baltimore City Carryouts: Qualitative Research to Inform an Obesity Prevention Intervention. Ecol. Food Nutr. 2012, 51, 481–491. [Google Scholar] [CrossRef]
- Glanz, K.; Resnicow, K.; Seymour, J.; Hoy, K.; Stewart, H.; Lyons, M.; Goldberg, J. How Major Restaurant Chains Plan Their Menus. Am. J. Prev. Med. 2007, 32, 383–388. [Google Scholar] [CrossRef]
- Ogungbe, O.; Yeh, H.-C.; Cooper, L.A. Living Within the Redlines: How Structural Racism and Redlining Shape Diabetes Disparities. Diabetes Care 2024, 47, 927–929. [Google Scholar] [CrossRef]
- Power, G. Apartheid Baltimore Style: The Residential Segregation Ordinances of 1910–1913. Md. Law Rev. 1983, 42, 309. Available online: https://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=2498&context=mlr (accessed on 20 June 2024).
- Misiaszek, C.; Buzogany, S.; Freishtat, H. Baltimore City’s Food Environment: 2018 Report; Johns Hopkins Center for a Livable Future: Baltimore, MD, USA, 2018; p. 53. Available online: https://clf.jhsph.edu/sites/default/files/2019-01/baltimore-city-food-environment-2018-report.pdf (accessed on 20 June 2024).
- Cullum Clark, J.H. Immigrants and Opportunity in America’s Cities (Blueprint for Opportunity Series No. 3); The George W. Bush Institute: Dallas, TX, USA, 2022; Available online: https://gwbushcenter.imgix.net/wp-content/uploads/Immigrants-and-Opp-3.pdf (accessed on 20 June 2024).
- Department of Planning Policy & Data Analysis Division. Baltimore City Foreign Born Demographics Dashboard. Available online: https://baltplanning.maps.arcgis.com/apps/dashboards/e8ee9a972a16408a810418955f173f6b (accessed on 20 June 2024).
- Kallick, D.D. Immigrant Small Business Owners: A Significant and Growing Part of the Economy; FISCAL POLICY INSTITUTE: Washington, DC, USA, 2012; Available online: https://fiscalpolicy.org/wp-content/uploads/2012/06/immigrant-small-business-owners-FPI-20120614.pdf (accessed on 20 June 2024).
- Song, H.-J.; Gittelsohn, J.; Kim, M.; Suratkar, S.; Sharma, S.; Anliker, J. A Corner Store Intervention in a Low-Income Urban Community Is Associated with Increased Availability and Sales of Some Healthy Foods. Public Health Nutr. 2009, 12, 2060–2067. [Google Scholar] [CrossRef]
- Chang, C.; Minkler, M.; Salvatore, A.L.; Lee, P.T.; Gaydos, M.; Liu, S.S. Studying and Addressing Urban Immigrant Restaurant Worker Health and Safety in San Francisco’s Chinatown District: A CBPR Case Study. J. Urban Health 2013, 90, 1026–1040. [Google Scholar] [CrossRef] [PubMed]
- Sandelowski, M. Sample Size in Qualitative Research. Res. Nurs. Health 1995, 18, 179–183. [Google Scholar] [CrossRef] [PubMed]
- Scribie. 2024. Available online: https://www.scribie.com/ (accessed on 20 June 2024).
- Rampin, R.; Rampin, V. Taguette: Open-Source Qualitative Data Analysis. J. Open Source Softw. 2021, 6, 3522. [Google Scholar] [CrossRef]
- Baltimore Office of Sustainability. Baltimore City Foam Ban. 2018. Available online: https://www.baltimoresustainability.org/baltimore-city-foam-ban/ (accessed on 20 June 2024).
- U.S. Department of Agriculture. Supplemental Nutrition Assistance Program (SNAP). 2024. Available online: https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program (accessed on 13 April 2024).
- U.S. Department of Agriculture. Restaurant Meals Program. 2024. Available online: https://www.fns.usda.gov/snap/retailer/restaurant-meals-program (accessed on 13 April 2024).
- Ravikumar, D.; Spyreli, E.; Woodside, J.; McKinley, M.; Kelly, C. Parental Perceptions of the Food Environment and Their Influence on Food Decisions among Low-Income Families: A Rapid Review of Qualitative Evidence. BMC Public Health 2022, 22, 9. [Google Scholar] [CrossRef]
- Gittelsohn, J.; Trude, A.; Poirier, L.; Ross, A.; Ruggiero, C.; Schwendler, T.; Anderson Steeves, E. The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area. Int. J. Environ. Res. Public Health 2017, 14, 1371. [Google Scholar] [CrossRef] [PubMed]
- Sumlin, L.L.; Brown, S.A. Culture and Food Practices of African American Women With Type 2 Diabetes. Diabetes Educ. 2017, 43, 565–575. [Google Scholar] [CrossRef] [PubMed]
- Namkung, Y.; Jang, S. Are Consumers Willing to Pay More for Green Practices at Restaurants? J. Hosp. Tour. Res. 2017, 41, 329–356. [Google Scholar] [CrossRef]
- U.S. Small Business Administration. COVID-19 Relief Options. Available online: https://www.sba.gov/funding-programs/loans/covid-19-relief-options (accessed on 25 May 2024).
- Madanaguli, A.; Dhir, A.; Kaur, P.; Srivastava, S.; Singh, G. Environmental Sustainability in Restaurants. A Systematic Review and Future Research Agenda on Restaurant Adoption of Green Practices. Scand. J. Hosp. Tour. 2022, 22, 303–330. [Google Scholar] [CrossRef]
- Piekara, A. Sugar Tax or What? The Perspective and Preferences of Consumers. Int. J. Environ. Res. Public Health 2022, 19, 12536. [Google Scholar] [CrossRef]
- Huang, S.J.; Sehgal, N.J. Association of Historic Redlining and Present-Day Health in Baltimore. PLoS ONE 2022, 17, e0261028. [Google Scholar] [CrossRef]
- Mui, Y.; Ballard, E.; Lopatin, E.; Thornton, R.L.J.; Pollack Porter, K.M.; Gittelsohn, J. A Community-Based System Dynamics Approach Suggests Solutions for Improving Healthy Food Access in a Low-Income Urban Environment. PLoS ONE 2019, 14, e0216985. [Google Scholar] [CrossRef]
- Mui, Y.; Gittelsohn, J.; Jones-Smith, J.C. Longitudinal Associations between Change in Neighborhood Social Disorder and Change in Food Swamps in an Urban Setting. J. Urban Health 2017, 94, 75–86. [Google Scholar] [CrossRef]
- Gibson, M.; Hearty, W.; Craig, P. The Public Health Effects of Interventions Similar to Basic Income: A Scoping Review. Lancet Public Health 2020, 5, e165–e176. [Google Scholar] [CrossRef]
- Robertson, B. Food Equity through Restaurant Meals: An Evaluation of Los Angeles County’s Restaurant Meals Program; Occidental College, Urban and Environmental Policy: Los Angeles, CA, USA, 2020; Available online: https://www.oxy.edu/sites/default/files/assets/UEP/Comps/2020/barbara_robertson_food_equity_through_restaurant_meals.pdf (accessed on 4 July 2024).
- Ettinger De Cuba, S.; Chilton, M.; Bovell-Ammon, A.; Knowles, M.; Coleman, S.M.; Black, M.M.; Cook, J.T.; Cutts, D.B.; Casey, P.H.; Heeren, T.C.; et al. Loss of SNAP Is Associated with Food Insecurity and Poor Health in Working Families with Young Children. Health Aff. 2019, 38, 765–773. [Google Scholar] [CrossRef]
- Miller, D.P.; Morrissey, T.W. SNAP Participation and the Health and Health Care Utilisation of Low-Income Adults and Children. Public Health Nutr. 2021, 24, 6543–6554. [Google Scholar] [CrossRef] [PubMed]
- Canning, P.; Stacy, B. The Supplemental Nutrition Assistance Program (SNAP) and the Economy: New Estimates of the SNAP Multiplier. 2019. Available online: https://ageconsearch.umn.edu/record/291963/?v=pdf (accessed on 25 May 2024). [CrossRef]
- Moynihan, D.; Herd, P.; Harvey, H. Administrative Burden: Learning, Psychological, and Compliance Costs in Citizen-State Interactions. J. Public Adm. Res. Theory 2015, 25, 43–69. [Google Scholar] [CrossRef]
- Banaji, M.R.; Fiske, S.T.; Massey, D.S. Systemic Racism: Individuals and Interactions, Institutions and Society. Cogn. Res. 2021, 6, 82. [Google Scholar] [CrossRef] [PubMed]
- Huse, O.; Schultz, S.; Boelsen-Robinson, T.; Ananthapavan, J.; Peeters, A.; Sacks, G.; Blake, M.R. The Implementation and Effectiveness of Outlet-level Healthy Food and Beverage Accreditation Schemes: A Systematic Review. Obes. Rev. 2023, 24, e13556. [Google Scholar] [CrossRef]
Characteristics | n (%) | |
---|---|---|
Carryout Level | Type of Cuisine | |
Italian | 3 (23) | |
Seafood | 3 (23) | |
General/Mixed/American | 2 (15) | |
Chicken Meals | 2 (15) | |
Soul Food | 1 (8) | |
Caribbean | 1 (8) | |
Asian | 1 (8) | |
Neighborhood or Zip Code Level 1 | Average HFAI | |
>9.5 | 5 (38) | |
≤9.5 | 8 (62) | |
Median Household Income (in dollars) | ||
>40,000 | 9 (69) | |
≤40,000 | 4 (31) | |
Household without Vehicles Available (%) | ||
>30% | 13 (100) | |
≤30% | 0 | |
Total Amount Invested in Small Businesses per 50 Businesses (in dollars) | ||
>1,000,000 | 4 (31) | |
750,000–1,000,000 | 4 (31) | |
<750,000 | 5 (38) |
Themes | Sub-Themes | Supporting Examples |
---|---|---|
Interpersonal Drivers | Perceptions of consumer preferences |
|
Care for consumer well-being |
| |
Maximizing transactions |
|
Themes | Sub-Themes | Supporting Examples |
---|---|---|
Sociocultural Drivers | Multicultural Ownership Shapes Food Offerings |
|
Themes | Sub-Themes | Supporting Examples |
---|---|---|
Business Drivers | Cost of business impacts carryouts’ ability to offer healthy options |
|
Themes | Sub-Themes | Supporting Examples |
---|---|---|
Policy Drivers | Taxation |
|
Government regulations and policy |
| |
Information Challenges |
| |
Uneven investment across neighborhoods |
|
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Hua, S.; Vong, V.; Thomas, A.E.; Mui, Y.; Poirier, L. Barriers and Enablers for Equitable Healthy Food Access in Baltimore Carryout Restaurants: A Qualitative Study in Healthy Food Priority Areas. Nutrients 2024, 16, 3028. https://doi.org/10.3390/nu16173028
Hua S, Vong V, Thomas AE, Mui Y, Poirier L. Barriers and Enablers for Equitable Healthy Food Access in Baltimore Carryout Restaurants: A Qualitative Study in Healthy Food Priority Areas. Nutrients. 2024; 16(17):3028. https://doi.org/10.3390/nu16173028
Chicago/Turabian StyleHua, Shuxian, Vicky Vong, Audrey E. Thomas, Yeeli Mui, and Lisa Poirier. 2024. "Barriers and Enablers for Equitable Healthy Food Access in Baltimore Carryout Restaurants: A Qualitative Study in Healthy Food Priority Areas" Nutrients 16, no. 17: 3028. https://doi.org/10.3390/nu16173028
APA StyleHua, S., Vong, V., Thomas, A. E., Mui, Y., & Poirier, L. (2024). Barriers and Enablers for Equitable Healthy Food Access in Baltimore Carryout Restaurants: A Qualitative Study in Healthy Food Priority Areas. Nutrients, 16(17), 3028. https://doi.org/10.3390/nu16173028