This review summarizes growing evidence of disparities in the social and physical environments of U.S. children and adolescents that likely contribute to increased risk for obesity and poor nutrition. The review examines literature on disparities in nutrition and healthy food access in school, child-care, and residential neighborhood environments, food production and marketing practices, and cultural norms and discrimination, according to socioeconomic status, race/ethnicity, and urbanization. Studies about school environments examined policies, nutritional quality of meals, access to competitive foods, and food access in surrounding neighborhoods. Most literature about child-care environments focused on the nutritional quality of foods and beverages served to children. A review of neighborhood environments concluded that lower-income, ethnic/racial minority, and rural neighborhoods are most often affected by poor access to supermarkets and healthful food and greater availability of fast-food restaurants and energy-dense foods. The evidence from studies about food marketing shows that ethnic/racial minority children have greater exposure to advertisements for energy-dense, nutrient-poor foods. Literature suggests that cultural norms shape body image perceptions, feeding practices, and food preferences, and discrimination against certain ethnic/racial groups may influence access to healthy, affordable foods and stress-related food behaviors. The authors conclude with a discussion of future research needs.
Barriers to Equity in Nutritional Health for U.S. Children and Adolescents: A Review of the Literature
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