Comparing the Food Environment of Native American Tribal Areas to that of Non‐Tribal Areas in California
Authors: Shen Ye , Antiporta Daniel , Kodish Stephen , Oddo Vanessa M. , Chodur Gwen , Jones‐Smith Jessica C. 
Published: November 2023

ObjectiveTo compare the food environment of Native American tribal areas to that of non‐tribal areas in California.MethodsWe used food business data from California in 2013 to define types of food establishments and then categorized them as either healthy outlets (supermarkets, superstores, produce markets, and healthy specialty stores) or unhealthy outlets (fast food, carryout, unhealthy specialty stores) consistent with commonly‐used definitions. To assess the relative availability of healthy and unhealthy food sources in tribal areas compared to that in non‐tribal areas, two measures were estimated using ArcGIS. First, density per square‐mile of healthy and unhealthy food establishments was estimated for census tracts with tribal lands (n=52) and census tracts without tribal lands (n=2312) in the same counties. Second, the distance to food businesses along road networks was estimated for tribal census tracts (a Census‐defined geographical tract consisting of primarily the tribal reservation land; n=115) and census tracts without tribal lands (n=2294) in the same counties. Multivariable linear regression was used to estimate the difference in the density per square mile and distance to healthy and unhealthy outlets for tribal lands compared to non‐tribal lands, adjusting for tract‐level per capita income and urbanicity.ResultsTribal census tracts have an average per capita income of $21,955 with 30% urban households, while census tracts without tribal lands have an average per capita income of $26,449 with 90% urban households. Adjusted multivariable regression results indicated that there were significantly fewer healthy food outlets per square mile on census tracts with tribal lands as compared to census tracts without tribal lands in the same counties (b= −0.06; 95 % Confidence Interval [CI]: −0.11, −0.015). However, the density of unhealthy outlets was not significantly different between the two types of tracts (b= −0.20; 95 % CI: −0.47, 0.07). The distance to the nearest unhealthy outlet was 1.67 miles (95 % CI: 0.93, 2.47) longer for tribal census tracts as compared to census tracts without tribal lands in the same counties. However, the distance to the nearest healthy outlet did not significantly differ between the two types of tracts (b = −0.20; 95 % CI: −0.81, 0.42).ConclusionsTribal areas in California had significantly fewer healthy, but not unhealthy, food outlets per square mile, compared to non‐tribal areas in the same counties. At the same time, no significant differences were found for distances to healthy food options by tribal area, yet longer distances to unhealthy food outlets exist along road networks. In order to further explain these findings and their relevance for public health interventions, additional analyses may need to consider travel time and the level of food store acceptability by consumers in these settings.Support or Funding InformationSupported by the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (4R00HD073327).