June 24, 2007

1. Representations of the Childhood Overweight Problem in Los Angeles County Supplement: Parallels to California’s Agricultural Communities County of Los Angeles Public Health Department Nutrition Program Christopher J. Jarosz, Ph.D. June 24, 2007

2. Background • Agricultural regions of California have some of the highest rates of overweight children: • Of the 24 cities with the highest overweight patterns, 83 percent are either in Los Angeles County or in agricultural areas • Of the 24 cities with the lowest overweight patterns (<=15 percent), 21 percent are either in Los Angeles County or agricultural areas • Only two agricultural communities (Davis and Chico) are among the 24 cities with the lowest overweight patterns. They also have large public universities (UC Davis and CSU Chico) • High childhood overweight rates have been found across all major agricultural regions: • Imperial Valley • Coachella Valley • Oxnard Plain • Santa Clarita River Valley • Santa Maria Valley • Salinas Valley • San Joaquin Valley • Sacramento Valley

3. Background (continued) • What is the extent of the high childhood overweight problem in agricultural areas in California? • What are the parallels with high childhood overweight rates in Los Angeles County? • Are the contributing factors similar for Los Angeles County and agricultural areas? • “Cities” and “communities” are used interchangeably in this analysis based on what seems to fit the context best.

4. Childhood Overweight RatesCalifornia’s Agricultural Communities Davis—14.3 Oroville—29.6 Brawley—34.3 Chico—18.9 Galt—30.1 Sanger—34.8 Clovis—22.6 Hanford—30.1 Oxnard—35.0 Elk Grove—23.3 Reedley—30.1 Madera—35.1 Santa Maria—24.2 Modesto—30.3 Lompoc—35.4 Tracy—25.8 Fresno—30.5 El Centro—35.9 Manteca—26.1 Hollister—30.6 Watsonville—36.1 Oakdale—27.4 Marysville—31.0 Calexico—36.5 Yuba City—27.7 Merced—31.2 Salinas—37.7 Ceres—27.9 Woodland—31.2 Coachella—37.8 Red Bluff—28.5 Gilroy—31.3 Selma—38.1 Lodi—28.6 Stockton—31.8 Santa Paula—38.8 Lemoore—29.1 Atwater—32.2 Patterson—39.3 Visalia—29.1 Porterville—32.6 Los Banos—39.8 Bakersfield—29.4 Arvin—32.7 Delano—40.4 Rio Linda—29.4 Dinuba—34.0 Wasco—42.0 Tulare—29.5 Shafter—34.2 Percentage of overweight children listed after each city name Median of median family incomes = $40,915 (all 50 cities) Range = $24,818 to $74,051 (Arvin lowest and Davis highest) Data Sources: Economic data from the U.S. 2000 Census, and childhood overweight data from the California Center for Public Health Advocacy, “Overweight Children in California, 2004.” http://www.publichealthadvocacy.org.

5. These cities supply fruits, vegetables, grains, and nuts to the rest of California and the United States Red Bluff Chico Oroville Yuba City Marysville Rio Linda Woodland Elk Grove Davis Galt Lodi Stockton Tracy, Manteca (both green) Oakdale Patterson, Los Banos (both red) Modesto (yellow), Ceres (yellow) Gilroy Atwater (red) Merced Madera (red), Clovis (green) Watsonville (red), Hollister (yellow) Fresno Sanger (red), Selma (red), Reedley (yellow), Dinuba (red) Salinas Hanford Visalia Lemoore Tulare Porterville Legend (quartile standing of 50 cities and CDP derived from the 2004 study): Delano Wasco Shafter Bakersfield Blue—first quartile, lowest overweight Arvin Santa Maria Green—second quartile Lompoc Yellow—third quartile Santa Paula Red—fourth quartile, highest overweight Coachella Median of median family incomes (2000) = $40,915 Oxnard Brawley Map is pictorial and not precisely to scale; North to the top El Centro Calexico Childhood Overweight Rates Geographic Distribution of Agricultural Communities

6. Legend (consisting of 53 cities and CDPs from the 2004 study): Purple—top 25 cities and CDPs Blue—next 28 cities and CDPs Median of median family incomes (2000) = $83,794 Chico Map is pictorial and not precisely to scale; North to the top Truckee Grass Valley Roseville, Rocklin (both blue) Grass Valley Granite Bay (purple), Folsom (blue), El Dorado Hills (purple) Davis Castro Valley (blue), Lafayette, Walnut Creek (both purple) San Ramon, Danville, Pleasanton (all purple) Belmont (blue), Palo Alto, Los Altos (both purple) Cupertino, Saratoga, Los Gatos (all purple) San Luis Obispo Tehachapi Agoura Hills, Calabasas (both purple) Yucaipa (not in correct position) Beverly Hills La Canada Flintridge (blue), South Pasadena (purple) Thousand Oaks, Simi Valley (both blue) Claremont, Diamond Bar (both blue) Manhattan Beach (purple), Rancho Palos Verdes (blue) Brea, Placentia, Yorba Linda (all blue) Los Alamitos, Huntington Beach, Newport Beach (all blue), Irvine (purple) Menifee, Temecula (both blue) Lake Forest, Mission Viejo (both blue), Aliso Viejo, Laguna Niguel, and Rancho Santa Margarita (all purple) Poway San Clemente, Carlsbad (both blue), Encinitas (purple) Childhood Overweight Rates Geographic Distribution of Communities, 20 percent or less

7. Childhood Overweight Rates Analysis • Many of California’s agricultural communities have high childhood overweight rates including some of the highest in the state. • The median of median family incomes is 105 percent higher in the 53 cities with the lowest childhood overweight rates than the 50 agricultural cities included in the 2004 study (Davis and Chico are listed in both categories). • Very little geographical overlap exists between the two sets of cities except in the Sacramento Valley; however, several cities with low childhood overweight rates are in the transition zone (low foothills) between the Sacramento Valley and the Sierra Nevada. • The patterns provide further support to the already demonstrated negative association between median family income and childhood overweight rates in Los Angeles County, suggesting an association that is generalized across the state. • Visual inspection of the distribution of agricultural cities indicates the southern portion of California is substantially more “red” and “yellow” than the northern portion.

8. Childhood Overweight RatesComparison ofDifferent Communities (continued) • The table contains median family income and childhood overweight data as contained in the two presentations. • A negative association is again evident between median family income and childhood overweight rates. • The categories are not mutually exclusive, and the results are not amenable to regression analysis. • The “all cities, entire state” median family income does not exactly match statewide economic figures since they include only 295 of the state’s cities from the 2004 childhood overweight study (including a few census designated places).

9. Childhood Overweight RatesComparison ofCity andCommunity Groupings Groupings are not mutually exclusive

10. Summary and Conclusions • California’s agricultural communities, and particularly those in the southern half of California, have high-to-very-high childhood overweight rates (up to 42 percent). • Median family income in these communities is generally well below the state median, and is lowest in the southern section including the San Joaquin and Imperial Valleys. • In both median family income and childhood overweight rates the agricultural communities are similar to a number of communities in Los Angeles County. • Two exceptions are Davis and Chico, which have large public universities. • Almost all of the other exceptions might be linked to their recent growth as bedroom communities for the San Francisco Bay Area (Manteca and Tracy) and Sacramento (Elk Grove). • Other than these exceptions agricultural areas are hardly represented among the communities with the lowest childhood overweight rates in California. • Los Angeles County, in comparison, has several communities with very low rates of childhood overweight, and in every instance they have high median family incomes.

11. Summary and Conclusions(continued) • Why would the communities that supply fresh agricultural products to the rest of California and United States have such a childhood overweight problem? • The compelling conclusion is that, once again, socioeconomic status has a profound influence on the childhood overweight problem and the availability of, and access, to healthy foods. • Informal observation suggest that the built environments in many agricultural communities are similar to those in many other communities including in Los Angeles County. • Many restaurant and eating chains exist in agricultural communities, but few full-line supermarkets are available despite an overabundance of agricultural goods grown locally. • Public parks and community open spaces can also be at a minimum, and public transportation is often limited for accessing these areas and sources of good nutrition. • These problems are similar to those in Los Angeles County, and may require local and statewide thinking on solutions for establishing healthy communities across the socioeconomic spectrum.