Assessing Community Needs: Food Access in Detroit, Michigan Among Youth

Emily Compton

NUTR 642

November 14, 2016

BACKGROUND

Engorged shirtless bellies, dirt covered faces with sad expressions: these are faces of poverty and
hunger. If you live in the United States and have a television you are likely not ignorant to advertisements
like these, pleading viewers to help feed hungry children all over the world. In 2013, 800 million people
were estimated to be food insecure globally1. Although hunger occurs all over the world, it may appear
differently to different nations. Even in the United States of America we have populations who suffer
from hunger.
While there is variation in defining food security, the United States Department of Agriculture
(USDA) in the Economic Research Service identities food security as, "having access to enough food for
an active, healthy life"2. The USDA identifies levels of food security into food secure families with high
and marginal food security, and food insecure families with low and very low food security. High food
security would indicate there are no limitations to food access, and marginal indicating little limitations to
food access. Low food security is identified when there is a reduction in food quality, variety or
desirability, but no reduction in actual intake. In contrast very low food secure families indicate reduced
food intake or disrupted eating patterns2. Food access is hugely related to food security and is usually
identified by indicators like: accessibility to healthy food sources (measured by distance to a store or
number of stores in a particular area), an individuals income or access to a vehicle, or public
transportation and average income in a given area2. Problems with food security and food access are often
very complex, involving problems across an entire social ecological model, but despite the challenges in
addressing these issues, they are important to solve since they have massive effects on health on
individuals and populations.
Poverty and food access have a strong relationship with health, it has been seen that the poorer
the individual the unhealthier they probably are. It has been noted that, "premature death is more then
twice as likely for middle income Americans as for those at the top of the income ladder"3. This is a
staggering statistic, especially because it refers to middle income families, imagine the implications for
low income families. Food security is thought to be associated with physical and psychological conditions
among adults and children. Some physical conditions thought to be associated with food access include
obesity, chronic disease and pregnancy complications4. Although there is a high importance in helping the
whole population suffering from food insecurity, children and adolescents are especially at risk and need
assistance. Research shows that children and adolescents suffer from mental health conditions related to
food security in the household5. Children from low income families with chronic health conditions like
asthma or diabetes have worse overall health, spend more days in bed, and face more hospitalizations than
the children of higher income status with the same health conditions3. Additionally, it has been shown that
children who experience food insecurity learn less in a school year compared to students who do not
experience food insecurity6. These findings emphasize how important food security is from a public
health prospective, affecting individuals and communities, physically and psychologically.
In this community needs assessment I will be looking at food security among the youth
population in Detroit, Michigan in order to better understand resources available to youth and to identify
potential areas of intervention. Detroit also known as the "Motor City" is an urban population in
southeastern Michigan. According to the 2015 U.S. Census Bureau, Detroit has a population of 677,1167.
7% of those individuals are under the age of five and 26.7% are under the age of 18. 82.7% of the
population identifies as Black or African American and 10.6% identify as white7. As of 2015 21.4% of
individuals under 65 years old reported they have no health insurance. 39.8% of individuals live in
poverty, and the median household income in 2014 was $26,0957.

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CHARACTERIZE THE COMMUNITY

DEMOGRAPHIC & ECONOMIC DATA

In order to best understand the community of Detroit and to try to get insight into the youth
population, it is important to conduct secondary research to see what resources are available in the
community. Demographic and economic data is important in understanding the population as a whole and
helps see patterns of disparities.
According to the US Census Bureau as of 2010, Detroit has a population of 713,777 people.
Wayne County as a whole has a population of 1,820,584 individuals. Michigan as a whole state has a
population of 9,883,640. That means about 18% of people who live in Michigan live in Wayne County,
and about 7% of the total population in Michigan lives in Detroit proper.

Population Totals
Detroit 713,777
Wayne 1,820,584
Michigan 9,883,640
Table 1- Population Totals in 2010
Source: US Census Bureau, American FactFinder, 2010-2014.

Of the 713,777 residents of Detroit about 7% of them are under the age of five, and 23.5% are
under the age of 20, 54.8% of them are between the ages of 20-65 and finally, 11.5% of them are over 65.
Compared to data of the State of Michigan, Detroit has more young people. The data for the State of
Michigan shows that 6% of residents are under the age of five, 20.8% of people are under the age of 20,
59.4% of people are between the ages of 20-65 and 13.7% of people are over the age of 65. Depending on
more data to come, the age of the population could have implications for public health interventions,
especially nutrition interventions. Since there are more young people in Detroit compared to the State,
maybe we should focus on early child-hood and youth interventions.

Age Distribution of Residents in Detroit

Compared to the State of Michigan
70
Percent of Individuals

60
50
40

30
Detroit
20
10 Michigan

0
Persons Under Persons Under Persons Persons Over 65
5 20 Between 20-65
Agre Group of Individuals

Figure 1- Age Distribution of Residents in Detroit Compared to the State of Michigan

Source: US Census Bureau, American FactFinder, 2010-2014.

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 The distribution between males and females across the total population in Detroit is 47.3% males
and 52.7% females. This is not overly abnormal and does not have great significance in relation to the rest
of the data.

Distrubution of Gender in
Detroit, MI

Female

47.3 Male
52.7

Figure 2- Distribution of Gender in Detroit, MI

Source: US Census Bureau, American FactFinder, 2010-2014.

The distribution of race in Detroit is starkly different than the distribution of race in Michigan as
a whole. In Detroit 82.7% of the population is black or African American, 10.6% is white, 0.4% is
Alaskan Indian or Alaskan Native, 1.1% is Asian and 2.2% identifying as having more than one race. In
Michigan as a whole, 78.9% of people are white, 14.2% are black, 0.6% is Alaskan Indian or Alaskan
Native, 2.4% is Asian and 2.3% identifying as having more than one race. The largest difference is the
proportion of black people and white people in both populations. Detroit has almost six times the amount
of black residents compared to Michigan as a whole. As research has shown, cultural competency has a
positive effect on intervention strategies8. If planning an intervention to improve health in Detroit it would
be important to consider methods to be culturally competent.

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 Distrubution of Race in Detroit, MI
0.4 1.1 2.2

10.6

White alone

Black or African
American alone
American Indian or
Alaska Native alone
Asian alone

Two or More Races

82.7

Figure 3- Distribution of Race and Hispanic Origin in Detroit, MI

Source: US Census Bureau, American FactFinder, 2010-2014.

Distribution of Race in Michigan

0.6 2.4 2.3

White alone
14.2

Black or African American

alone
American Indian or Alaska
Native alone
Asian alone

Two or More Races

78.9

Figure 4- Distribution of Race and Hispanic Origin in Michigan

Source: US Census Bureau, American FactFinder, 2010-2014.

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 In Detroit 77.8% of people graduated high school or higher, in Wayne County it was 84.4% and
in Michigan it was 89.3%. The percent of individuals who attained a bachelors degree or higher is 13.1%
in Detroit, 21.6% in Wayne County and 26.4% statewide. Michigan as a whole State has double the
individuals who attained bachelors degrees compared to Detroiters. Looking at gender statistics, more
women earn higher degrees in each category for both Detroit and Wayne County. Educational attainment
can also be important in predicting health outcomes. We know that poverty and income go hand in hand
with health outcomes, and often educational attainment and poverty can go hand in hand as well3.

Wayne
Michigan County Detroit
Total Male Female Total Male Female Total Male Female

Percent High School Graduate or
Higher 89.3 88.5 90 84.4 83.5 85.2 77.8 75.1 80
Percent Bachelors Degree or Higher 26.4 26.6 26.3 21.6 21.5 21.7 13.1 10.9 15
Table 2- Educational Attainment Status in 2014
Source: US Census Bureau, American FactFinder, 2010-2014.

The industries of employment in Detroit vary. The majority of people work in educational services, health
care and social assistance at 25.2%. The next largest industry is manufacturing, with 13.2%. The next
industry is arts, entertainment, and recreation, and accommodation and food services with 12%.
Professional, scientific, management, and administrative and waste management services follow with
11.1%. Different jobs may affect different health outcomes. The higher the stress job the more likely it
may be associated with negative health outcomes.

Table 3- Occupations of Residents of Detroit

Source: US Census Bureau, American FactFinder, 2010-2014.

Unemployment rates in Detroit are much higher than Michigan's State average. Males in Detroit
are experiencing unemployment at a rate of 14.3% compared to only 6.4% overall in the State of
Michigan. Females who live in Detroit are also experiencing a rate of unemployment at 12.9% whereas
on a statewide level it is only 5% unemployment. For both of these populations in Detroit unemployment
is more than doubled! Again, with the close relation of poverty and health outcomes this is important to
monitor.

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 Unemployment Rates in Detroit
Compared to the State of Michigan
Percent of Unemployed Individuals

16
14
12
10
8
6 Detroit
4 Michigan
2
0
Percent Male Percent Female
Gender

Figure 5- Unemployment Rates in Detroit Compared to the State of Michigan

Source: US Census Bureau, American FactFinder, 2010-2014.

In 2014, the median family income is $31,566 in Detroit (Figure 4). The median family income in
Michigan is $61,684 (Figure 5). Nonfamily household incomes follow the same trend being lower in
Detroit than in Michigan, $18,463 and $28,923. When looking at the specific breakdown, the majority of
families, 16.9%, in Detroit make less than $10,000 per year and the next most frequent being between
$15,000-$24,999 with 15.8% of families. The distribution of money across the whole state is again very
different, the most frequent income contains 20.4% of the population and they make between $50,000-
$74,000.

Table 4- Median Family Income in Detroit

Source: US Census Bureau, American FactFinder, 2010-2014.

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Table 5- Median Family Income in Michigan
Source: US Census Bureau, American FactFinder, 2010-2014.

The percentage of all families whose income is below the poverty level is 34.8% in Detroit. The
percentage of all people, not included in families, whose income is below the poverty line, is 39.8%
(Figure 6). In Michigan as a whole, the percentage of all families whose income is below the poverty
level is 12.1% (Figure 7). The percentage of all people, not included in families, whose income is below
the poverty line, is 16.9%. For families, the frequency of poverty in Detroit is almost three times that of
the State. Aside from the direct connections between poverty and health, this information is valuable
because it helps indicate how many families are eligible for benefits like Medicare and SNAP-Ed. Since
there is such a large proportion of families and individuals who live in poverty in Detroit, aiming
interventions there would be useful.

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Table 6- Percentage of Families and People Below the Poverty Level in Detroit
Source: US Census Bureau, American FactFinder, 2010-2014.

Table 7- Percentage of Families and People Below the Poverty Level in Michigan
Source: US Census Bureau, American FactFinder, 2010-2014.

The percentage of owner-occupied housing compared to renter-occupied housing is quite

different in Detroit than in the rest of Michigan. In Detroit there is a higher percentage of homeowners
compared to renters, 50.7% and 49.3% respectively. In Michigan 71.5% of individuals own their homes
compared to only 28.5% who rent. Since the two categories are much more even in Detroit and there is
little difference between them, this may suggest that not a lot of people have money to buy their own
houses.

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 Owned or Rented Housing
80
70
Percent of Individuals

60
50
40 Detroit

30 Michigan

20
10
0
Owner Occupied Renter Occupied

Figure 6- Owner or Renter Occupied Housing Comparing Detroit and the State of Michigan
Source: US Census Bureau, American FactFinder, 2010-2014.

HEALTH STATISTIC DATA

Mortality is important to assess in a community to determine frequent cause of death. Heart disease and
diabetes are both thought to be largely life-style related diseases, which may involve nutritional status.
Figure 7 refers to mortality rates by cause that are separated by race and gender. You can see across the
board heart disease and cancer are the highest causes of death, besides "other causes". This trend is also
seen in the population in Michigan, where heart disease and cancer are both the leading causes of death. It
is important to note the overall death rates are higher in Detroit at 994,100 compared to Michigan as a
whole with 781,600. The prevalence of heart disease in Detroit is also higher, heart disease contributing
to 31.4% of deaths. For the State about 25.6% of deaths were caused by heart disease, so while prevalence
is still high, the percentage of deaths is less in Michigan compared to Detroit. Diabetes accounts for 3% of
the deaths in Michigan and in Detroit the rate hovers around the same area with 3.3%. Across the board
males have higher death rates than females.

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Figure 7- Mortality by Cause, Sex and Race in Detroit in 2014
Michigan Department of Health and Human Services, Division for Vital Records and Health Statistics,
2014
Note: CLRD is chronic lower respiratory disease

Figure 8- Michigan Mortality by Cause and Race 2014

Michigan Department of Health and Human Services, Division for Vital Records and Health Statistics,
2014
Note: CLRD is chronic lower respiratory disease

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Without taking into consideration race, the breakdown of disease by age is documented here for the State
of Michigan. This data follows the graph with the highest disease prevalence being in heart disease,
followed by "all other causes" and cancer.

Figure 9- All Age Mortality in Michigan

1. Heart Disease
All Age Mortality in Michigan
2. Cancer

3. Chronic Lower Respiratory

Diseases
4. Stroke
24% 26%
5. Unintentional Injuries

6. Alzheimer's Disease
1%
2% 7. Diabetes Mellitus
2%
3% 8. Pneumonia/InZluenza
22%
4%
5% 9. Kidney Disease
5% 6%
10. Intentional Self-harm
(Suicide)

Michigan Department of Health and Human Services, Division for Vital Records and Health Statistics,
2014

Since I am interested in food access for youth I wanted to check on the mortality for younger
people, under the age of 25 years old. The biggest difference between this age group and the total data is
that the leading cause of death is unintentional injuries at 54%. Heart disease is still prevalent at 26%,
which is exactly the same as the statewide data not separating by age. Cancer rates are much lower for the
group younger than 25, with a prevalence of 0% compared to 22% of all ages. Deaths by stroke are also
double with the age group. Poor nutrition could certainly be part of the reason for high rates of heart
disease, this would be a great topic of further research and potential intervention.

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 Mortality for Ages <25 1. Heart Disease

0% 2. Cancer
3%
1% 3. Chronic Lower
5% Respiratory Diseases
4. Stroke

5. Unintentional
Injuries
26% 6. Alzheimer's Disease

7. Diabetes Mellitus
54%
8. Pneumonia/
0% InZluenza
0% 1% 9. Kidney Disease
10% 0%
10. Intentional Self-
harm (Suicide)
All Other Causes

Figure 10- Mortality Rates in Michigan for the Population of People Under 25 Years Old
Michigan Department of Health and Human Services, Division for Vital Records and Health Statistics,
2014

Detroit has higher numbers of low birth weight, neonatal mortality, post-neonatal mortality as
well as infant mortality compared to data from the State of Michigan. Infant mortality in Detroit is 13.2
per 1000 live births, compared to 6.9 per 1000 live births. This has health implications for both early
childhood nutrition and prenatal nutrition.

Infant Mortality from 2012-2014

14
Number per 1000 live births

12
10
8
6
4
2
0
Low Birth Weight Neonatal Mortality Post-Neonatal Infant Mortality
Mortality

Detroit Michigan
'
Figure 11- Infant Mortality Rates in Detroit and Michigan
Michigan Department of Health and Human Services, Division for Vital Records and Health Statistics,
2014

13
 Other health data that is of interest is the percentage of people without insurance. In Michigan the
number of people without health insurance is 7.1% compared to Detroit which is 21.4%. This has massive
implications on who in the community can afford health care. One fifth of people don't have insurance,
which is a lot! This encourages the idea that intervention might be helpful in Detroit since they are at a
much higher risk of disease, especially with no insurance for treatment.

Table 8- Persons without Health Insurance in Michigan and Detroit

Source: US Census Bureau, QuickFacts, 2010-2014.

According to the County Health rankings Wayne County is 83/83. It is of worst health in many
outcomes. Some of the orange boxes in Table 9 indicate the County Health ranking's priorities, or areas of
higher need. Some of these statistics like obesity and physical activity we will go over in a later section.
The County Health Ranking indicates that Detroit has a Food Environment Index of 6.1. The Food
Environment Index is ranked on a scale of 0-10, 0 being the worst and 10 being the best, and rates food
access which it defines as in an urban area, living less than one mile from the grocery store. The Food
Environment Index also looks at food insecurity, which it defines as the percentage of the population who
did not have access to a reliable source of food during the past year. So overall it got a ranking of 6.1
compared to that of Michigan that got a ranking of 7.1. Another related health statistic is food security
which is at 21% in Detroit compared to 16% overall in Michigan. Access to healthy food is hugely
important in many health outcomes.
The County Health rankings also identified Detroit as having 94% access for opportunities to
exercise compared to Michigan that was 84%. Detroit also had lower alcohol-impaired driving deaths
compared to State data, 25% and 30% respectively.

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Table 9- Wayne County Health Ranking- Health Behavior Data
County Health Rankings, Michigan, Wayne (WY), 2016

15
NUTRITION/PHYSICAL ACTIVITY ASSESSMENT DATA

In Detroit we see a larger percentage of the population is obese compared to the rest of the state,
36.8% and 31.1% respectively. For overweigh individuals the data is 33.5% and 34.9% in Detroit and
Michigan respectively. So the rate of overweight individuals is actually lower, but this could be because
more people fall into the obese category. The percent of individuals of a health weighty status is also
lower in Detroit compared to Michigan 28.2% compared to 32.4% respectively. Thinking about
intervention strategies knowing the weight status of individuals in Detroit is important.

Weight Status of Individuals in Detroit

Compared to Michigan
40 36.8
34.9
32.4 33.5
35 31.1
Percent of Individuals

30 28.2

25

20
Detroit
15
Michigan
10

0
Healthy Overweight Obese
Weight Status (determined by BMI)

Figure 12- Weight Status of Individuals in Detroit Compared to Michigan

Michigan Department of Health and Human Services, Michigan Behavioral Risk Factor Surveillance
System (BRFSS), 2013-2015

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 Overall the difference in fruit and vegetable consumption between Detroit and Michigan is not
huge. The biggest difference is in the frequency of vegetables consumed by about 10%. In Detroit
individuals who eat vegetable less than once per day is 33.3%, compared to State data at 24.7%. In
Detroit individuals who eat fruit less than once per day is higher than vegetables, but State data is also
higher, 40.8% in Detroit compared to 38.7% statewide. The percent of individuals who eat fruits and
vegetables five times a day or more is 15.8% in Detroit compared to 14.9% statewide. This data is
especially valuable for current interventions and future ones. Many school interventions, like a program
from Missouri University called Show Me Nutrition, is a program designed to increase the frequency and
variety of vegetables and fruits consumed9. Programs like this need data on frequency of fruits and
vegetables eaten. Theoretically, the more fruits and vegetables consumed, the healthier the individuals
and communities!

Fruit and Vegetable Consumption

in Detroit Compared to Michigan
45 40.8
38.7
40
33.3
35
30
24.7
Percent

25
20 15.8 14.9
Detroit
15
10 Michigan

5
0
Fruits (<1x/day) Vegetables (<1x/ Fruits and
day) Vegetables (>5x/
day)
Frequency of Food Consumed

Figure 13- Fruit and Vegetable Consumption in Detroit Compared to Michigan

Michigan Department of Health and Human Services, Michigan Behavioral Risk Factor Surveillance
System (BRFSS), 2013-2015

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In Detroit, 44.9% of the population had told they have high blood pressure compared to only 33.9% in
Michigan. CVD is higher in Detroit than in Michigan, 11.3% compared to 9.7% respectively. Frequency
of diabetes is 13.5% in Detroit compared to 10.5% in Michigan. Otherwise, statistics for stroke and high
cholesterol are lower in Detroit than Michigan.

Frequency of Disease in Detroit and

Michigan
50 44.9
45 39.4
40 35.8 33.9
35
Percent

30
25
20 13.5 Detroit
15 10.5 11.3 9.7
10 5.6 Michigan
3.4
5
0
Diabetes CVD Stroke High High Blood
Cholesterol Pressure
Disease or Health Concern

Figure 14- Frequency of Disease in Detroit and Michigan

Michigan Department of Health and Human Services, Michigan Behavioral Risk Factor Surveillance
System (BRFSS), 2013-2015

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 In Detroit 17.9% of individuals reported they get adequate physical activity. The definition of
physical activity in this scenario is defined by the individual reporting they do 150 minutes per week of
moderate physical activities, vigorous physical activities for at least 75 minutes per week, or an
equivalent combination of moderate and vigorous physical activities and also participate in muscle
strengthening activities on two or more days per week. It is important to note these numbers are self-
reported and may not be the most accurate due to self-reporter bias. Either way, 17.9% of Detroit
participants self-reported they get adequate physical activity compared to 19.5% of Michigan participants.
This might be important for health implications because we know studies have shown a sedentary
lifestyle can be harmful.

Adequate Physical Activity

20
19.5
19.5

19
Percent

18.5
17.9
18

17.5

17
Detroit Michigan
Location

Figure 15- Adequate Activity Levels in Detroit and Michigan

Michigan Department of Health and Human Services, Michigan Behavioral Risk Factor Surveillance
System (BRFSS), 2013-2015

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 Lastly, the homeless population in Michigan in 2012 is shown below. Of the 12,592 homeless
people in the State, 3,115 of them live in Detroit. That's almost a quarter of all the homeless people in the
State. This is important for interventions, but also may give us insight in where some of our clients are
coming from. Inevitably a portion of these homeless people are youth.

Homeless Population in Michigan

in 2012

Detroit

Other Places in Michigan

(Not Detroit)

Figure 16- Homeless Population in Detroit Compared to the Rest of Michigan

US Department of Veteran Affairs and US Department of Housing and Urban Development, Homeless
Analytics

COMMUNITY ASSETS AND RESOURCES

Now that we have a better understanding of the community of Detroit, we will look at additional
resources residents have access to. According to FoodPantries.Org Detroit has 144 available Food
Pantries, including Gleaners Food Bank, which is one of the biggest in the area and distributes 34 million
pounds of food throughout southeastern Michigan10. The abundance of food pantries indicates to me that
the City of Detroit, the State of Michigan and other health-related stakeholders realized the need for
nutrition assistance due to high poverty rates.

Detroit also has access to grocery stores throughout the city. Figure 17 is a map designed by a non-profit
called Detroit Food Map that shows the number and location of grocery stores in Detroit. The map
indicates there are 79 grocery stores in Detroit, although the map does not show all 79 locations since it is
zoomed out. This is important because in order to live healthily and to eat healthily one must have access
to places to access healthy foods. Detroit Food Map did not indicate exact details about each location, so
it is unknown the composition of each grocery store (like if some were more like convenient stores versus
real grocery stores) but some Aldi and Save-a-Lot grocery stores were noted.

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Figure 17- Map of Grocery Stores in Detroit
Detroit Food Map, Open Street Map of Grocery Stores, 2013-2015

In addition to noting grocery stores and food pantries, Detroit has19 WIC Clinics throughout the city11.
WIC Clinics are resources for moms and futures moms to help stretch their food dollars by providing
support for the eligible. Regarding other healthcare, Detroit has 7 hospitals in the city itself11.

Figure 18 is a map of SMART bus routes in Detroit. To me this does not seem extraordinarily extensive.
There are not many routes that reach out to different areas of the residential areas. This could imply
transportation to grocery stores is limited, which could ultimately affect food access in the city.

Figure 18- A Map of SMART Bus Routes in Detroit

City of Detroit, Go Data Program, 2015

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Figure 19 is a map of available bike routes throughout the city of Detroit. Compared to the bus routes, the
bike routes seem to be much more abundant. This is helpful for older adolescents and adults, but I
imagine there might be challenges for bigger families to get around the city if they do not have enough
bikes. These bike routes could increase food access, but they might also increase

Figure 19: A Map of Bike Routes in Detroit

City of Detroit, Go Data Program, 2015

Nutrition education programs are spread out throughout Wayne County. According to Map 2 Healthy
Living there are 772 locations that have recorded nutrition programming with youth (Figure 20). Please
note there are many times nutrition programming may be executed at a location but may not be recorded
properly, due to a variety of factors. However 772 programs teaching youth under the age of 18 in Wayne
county speaks to the effort the state and local governments, as well as stakeholders value the increase in
nutrition knowledge among youth.

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Figure 20: Map 2 Healthy Living Wayne County Youth Programs 2016 Source: Map2Healthy
Living, Michigan Nutrition Network and Michigan Fitness Foundation, 2016

In Detroit alone there are 520 nutrition education programs being executed with youth under the age of
18. The programs seem to be spread out throughout the city, which speaks to the increase of access
individuals have to programming. For future programming and interventions this website is a great tool to
see what programming agencies in the community are already doing and exactly where.

Figure 21: Map 2 Healthy Living Youth Programs Detroit 2016

Source: Map2Healthy Living, Michigan Nutrition Network and Michigan Fitness Foundation, 2016

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REFERENCES

1. Schmeer, K. K., & Piperata, B. A. (2016). Household food insecurity and child health. Maternal &
Child Nutrition, 113. https://doi.org/10.1111/mcn.12301

2. Alisha Coleman-Jensen, Christian Gregory, Matthew Rabbitt. (2016, September 6). USDA ERS - Food
Security in the U.S.: Definitions of Food Security. Retrieved October 05, 2016, from
http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-
food-security.aspx

3. Colchamiro, R., & Kallio, J. (2011). Nutrition in Public Health. New York: Aspen Publishers.

4. Sharpe, P. A., Whitaker, K., Alia, K. A., Wilcox, S., & Hutto, B. (2016). Dietary intake, behaviors and
psychosocial factors among women from food-secure and food-insecure households in the United
States. Ethnicity and Disease, 26(2), 139146. https://doi.org/10.18865/ed.26.2.139

5. Colchamiro, R., & Kallio, J. (2011). Nutrition in Public Health. New York: Aspen Publishers.

6. Cook, J. T., Black, M., Chilton, M., Cutts, D., Ettinger de Cuba, S., Heeren, T. C., Frank, D. a.
(2013). Are Food Insecurity s Health Impacts Underestimated in the U.S. Population? Marginal
Food Security Also Predicts Adverse Health Outcomes in Young U.S. Children and Mothers.
Advances in Nutrition, 4, 5161. https://doi.org/10.3945/an.112.003228.51

7. QuickFacts, Detroit City Michigan. Retrieved October 05, 2016, from

http://www.census.gov/quickfacts/table/DIS010214/2622000#flag-js-X

8. Sue, S., Zane, N., Hall, G. C. N., & Berger, L. K. (2009). The Case for Cultural Competency in
Psychotherapeutic Interventions. Annual Review of Psychology, 525548.
https://doi.org/10.1146/annurev.psych.60.110707.163651.

9. Gabel, C. (2013). Show Me Nutrition. Retrieved October 30, 2016, from

http://extension.missouri.edu/p/SMN100

10. Detroit, Michigan Food Pantries. (2016). Retrieved October 30, 2016, from
http://www.foodpantries.org/ci/mi-detroit

11. City of Detroit, Go Data Program. (2015). Retrieved October 30, 2016, from
https://data.detroitmi.gov/

12. Map2Healthy Living, Michigan Nutrition Network and Michigan Fitness Foundation, 2016. Retrieved
October 30, 2016, from http://map2healthyliving.org/index.html.

13. Double Up FoodBucks, Fair Food Network. Retrieved November 12, 2016, from
http://www.doubleupfoodbucks.org/how-it-works/

14. Your Weight and Diabetes, Obesity Society, 2015. Retrieved November 12, 2016 from
http://www.obesity.org/obesity/content/weight-diabetes

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