Food Insecurity and ObesityFood Insecurity and Obesityin AppalachiappJennifer Chubinski, MSPPM

l h d fHealth Foundation of Greater Cincinnati

Mark A. Carrozza, MA,HealthLandscape, LLC

Appalachian RegionAppalachian Region

Includes all of West Virginia and parts of 12 other states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia.

Follows the Appalachian Mountains from southern New York to northern Mississippi

Appalachian RegionAppalachian Region

• 25 Million People

• 420 Counties420 Counties

• 42% population rural (compared to 20% in US)

• Historically mining and manufacturing based economies

• Economy transitioning to services, tourism, di ifi d f t idiversified manufacturing

Questions?Questions?

• Do Appalachians (or Appalachian counties) have higher rates of obesity?g y

Wh d A l hi i S ll• What does Appalachian Economic Status tell us about obesity rates?

H d th il bilit f f d i t• How does the availability of food impact obesity?

Appalachian Economic RegionsAppalachian Economic Regions

County Economic Levels

County Economic Indicator Thresholds 

Alternate CriteriaThree‐Year Average Unemployment Rate

Per Capita Market Income Poverty Rate

Distressed 150% or more of U.S.  67% or less of U.S.  150% or more of U.S. 

At least twice the U.S. poverty rate and meet the threshold of oneDistressed average average average the threshold of one other distressed‐level 

indicator.

At‐Risk  125% or more of U.S. average 

67% or less of U.S. average 

125% or more of U.S. average 

Meet the threshold of two of the three distressed‐level indicators.

Transitional All counties that are worse than the national average for one or more indicator but do not meet the criteria for the distressed or at‐risk levels. 

Competitive 100% or less of U.S. average

80% or more of U.S. average

100% or less of U.S. average

Attainment 100% or less of U.S. average

100% or more of U.S. average

100% or less of U.S. average

MeasuresmentMeasuresment

• Obesity – County‐level (or county grouping) data Behavioral Risk Factor Surveillance System (BRFSS). www.cdc.gov/BRFSS/ and Individual site and calls to state healthIndividual site and calls to state health agencies

MeasuresmentMeasuresment

• Food availability ‐‐ County Business Patterns. http://www.census.gov/econ/cbp/index.htmlp g p

• Appalachian Economic Status and Planning Subregions Appalachian RegionalSubregions – Appalachian Regional Commission.  www.arc.gov

• Food Stamps and TANF benefits – USDA/ERC http://www.ers.usda.gov/Data/FoodStamps/http://www.ers.usda.gov/Data/FoodStamps/

Appalachian Sub regionsAppalachian Sub‐regions

OLS Regression ResultsOLS Regression Results

i Si S d iEstimate Sig Std. Estimate

Distressed/At Risk 1.9 *** 0.14

Attainment ‐0 2 ‐0 01Attainment 0.2 0.01

Northern ‐1.7 *** ‐0.13

Southern ‐1.6 *** ‐0.13

Supermarkets 0.01 ** 0.151

Convenience Stores ‐0.2 ‐0.10

Full Restaurants ‐0.0 * ‐0.25

Limited Restaurants 0.0 0.05

Food Stamp Benefits 6 2 *** 0 43Food Stamp Benefits 6.2 0.43

TANF Benefits ‐8.1 *** ‐0.54

Intercept 28.8

DiscussionDiscussion

• Limitations– Obesity Measurementy

– Food Scarcity Measurement

• Food Stamp Benefitsp

• Good benefits  /  ‘Junk’ food

TANF B fi• TANF Benefits– Causal linkage ???

Next StepsNext Steps

• Integrate USDA Food Security Survey– Limited Geographyg p y

• Focus Analysis on Ohio2008 Ohi F il H l h S– 2008 Ohio Family Health Survey

– Food Security

– County‐level geography

• Geographically Weighted Regression• Geographically Weighted Regression

QuestionsQuestions

• Questions

• CommentsComments

• Concerns