Assessing the Influence of Food Insecurity and Retail Environments as a Proxy for Structural Racism on the COVID-19 Pandemic in an Urban Setting

Abstract

A collaborative partnership launched the Great Grocer Project (GGP) in March 2021 in Detroit, Michigan where health inequities, including deaths due to COVID-19, have historically been politically determined and informed by socially entrenched norms. Institutional and structural racism has contributed to a lack of diversity in store ownership among Detroit grocers and limited access to high-quality, affordable healthy foods as well as disparate food insecurity among Detroit residents. The GGP seeks to promote Detroit’s healthy grocers to improve community health and economic vitality through research, programs, and policies that have the potential to advance health equity. A cross-sectional design was used to explore relationships between scores from the Nutrition Environment Measures Surveys-Stores (NEMS-S) in 62 stores and city-level data of COVID-19 cases and deaths as well as calls to 211 for food assistance. Regression and predictive analyses were conducted at the ZIP code level throughout the city to determine a relationship between the community food environment and food insecurity on COVID-19 cases and deaths. COVID-19 cases and deaths contributed to greater food insecurity. The use of ZIP code data and the small sample size were limitations within this study. Causation could not be determined in this study; therefore, further analyses should explore the potential effects of individual grocery stores on COVID-related outcomes since a cluster of high-scoring NEMS-S stores and calls to 211 for food security resources inferred a potential protective factor. Poor nutrition has been shown to be associated with increased hospitalizations and deaths due to COVID-19. It is important to understand if a limited food environment can also have a negative effect on COVID-19 rates and deaths. Lessons learned from Detroit could have implications for other communities in using food environment improvements to prevent an uptick in food insecurity and deaths due to COVID-19 and other coronaviruses.

Enhanced Measurement of Sugar-Sweetened Beverage Marketing to Young Immigrant Children in Grocery Store Environments

“…Additionally, access to healthier grocery food environments is associated with access to high-quality and healthy foods and beverages and can serve as a potential contributor to healthy food security within communities of color in Metro Detroit [16]. Other research studies have indicated that food stores are health promotion agents and can aid in improving the healthy eating behavior of families [16,70,[74][75][76]. The comparison of the NEMS-SSB scores revealed the negative influence of SSB marketing on children's improving or deteriorating nutritional behaviors.…”

“…Since genetic changes cannot appear this quickly, environmental factors are the primary determinants for this shift and for shaping nutritionrelated behaviors [12][13][14][15]. This is especially true for low-income ethnic minority families who have limited access to healthy food resources, often because of financial, transportation, and linguistic barriers, and who thus rely on convenience and corner stores within close neighborhoods for purchasing food and beverages [16][17][18][19][20][21][22][23]. Grocery stores within lowincome neighborhoods typically have lower-quality foods with less variety and are the main source of energy-dense nutrition-poor foods and sugar-sweetened beverages [18,22,24].…”

Enhanced Measurement of Sugar-Sweetened Beverage Marketing to Young Immigrant Children in Grocery Store Environments

“…Additionally, access to healthier grocery food environments is associated with access to high-quality and healthy foods and beverages and can serve as a potential contributor to healthy food security within communities of color in Metro Detroit [16]. Other research studies have indicated that food stores are health promotion agents and can aid in improving the healthy eating behavior of racial and ethnic minority families [16,60,64,65,66]. The comparison of the NEMS-SSB scores revealed the negative influence of SSB marketing on children's improving or deteriorating nutritional behaviors.…”

“…Since genetic changes cannot appear this quickly, environmental factors are the primary determinants for this shift and for shaping nutrition-related behaviors [12][13][14][15]. This is especially true for low-income ethnic minority families who have limited access to healthy food resources, often because of financial, transportation, and linguistic barriers, and who thus rely on convenience and corner stores within close neighborhoods for purchasing food and beverages [16][17][18][19][20][21][22][23]. Grocery stores within low-income neighborhoods typically have lower-quality foods with less variety and are the main source of energy-dense nutrition-poor foods and sugar-sweetened beverages [18,22,24].…”

Community Solutions to Increase the Healthfulness of Grocery Stores: Perspectives of Immigrant Parents

“…Participant grocery stores in this study were all large-format, full-service grocery stores with an abundant selection of food offerings. Given that the stores are independently owned vs. corporately owned and located in an urban environment, some food products may sell at higher prices in their stores than competitors (e.g., Wal-Mart) [77][78][79][80]. Participating grocers were located in Hispanic and Latino enclaves in Southwest Detroit and Arab and Chaldean enclaves in North Central Detroit (N = 8 stores), Dearborn (N = 13 stores), Hamtramck (N = 3 stores), and Warren, MI (N = 6 stores).…”