Balancing act: Approaches to healthy eating and physical activity among Boston public housing residents

Residents of government-subsidized public housing in the US are more likely than the community at large to be poor and members of a racial or ethnic minority. Additionally, Boston public housing residents are more likely to report fair or poor health status, to have been diagnosed with obesity, and to be physically inactive compared with other Boston residents. However, they report similar levels of access to and utilization of health care. Providing affordable and easy access to healthy foods and physical activity has been proposed as a way to prevent obesity in the general population. Residents of public housing, however, receive relatively little research attention in this area, despite the fact that they are particularly vulnerable to the economic, environmental, structural and behavioral risk factors for obesity. Little is known about perceptions of and opportunities for healthy eating and physical activity in this population. We conducted eight focus groups at public housing developments to explore residents' views regarding definitions of healthy foods; access to, quality, and affordability of healthy foods; and preferences, affordability, and access to opportunities for physical activity. Sixty-seven participants included 32 English speakers and 35 Spanish speakers. Transcripts were analyzed using qualitative content analysis. All residents described the challenge of balancing considerations of food quality, access and affordability. Participants in all groups discussed efforts to travel distances to markets where they could find price and quality, and unanimously disregarded bodegas and corner stores as practical options. Other findings included underutilized nutritional resources; abundant availability of unhealthy food; and economic and structural barriers to exercise. Transportation related challenges were a dominant theme. Immediate needs and opportunities for interventions focused on transportation to low-cost, high quality food purchasing options and gyms, and may be important for promoting health among public housing residents.