Rural and Urban Differences in the Associations between Characteristics of the Community Food Environment and Fruit and Vegetable Intake

Program for Research in Nutrition and Health Disparities, Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX 77843-1266, USA.
Journal of nutrition education and behavior (Impact Factor: 1.36). 05/2011; 43(6):426-33. DOI: 10.1016/j.jneb.2010.07.001
Source: PubMed


To examine the relationship between measures of the household and retail food environments and fruit and vegetable (FV) intake in both urban and rural environmental contexts.
A cross-sectional design was used. Data for FV intake and other characteristics were collected via survey instrument and geocoded to the objective food environment based on a ground-truthed (windshield audit) survey of the retail food environment.
One urban and 6 contiguous rural counties.
This study involved 2,556 residents of the Brazos Valley, Texas, who were selected through random-digit dialing.
Two-item scale of FV intake.
Data were analyzed using chi-square analysis, 2-sample t tests, and linear regression.
Distance to supermarket or supercenter was insignificant in the urban model, but significant in the rural model (β = -.014, P < .010, confidence interval = -.024, -.003).
Retail food environments have different impacts on FV intake in urban and rural settings. Interventions to improve FV intake in these settings should account for the importance of distance to the retail food environment in rural settings.

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    • "Given the interrelated and multi-level determinants of rural food access [11,45,50-52], a comprehensive and systematic approach is needed to plan research to support the development of effective rural food policies. To date, rural food research has not emphasized the impact of policy changes on rural food access, but has focused on individual-level topics such as factors influencing food choice [21], disparities [49], and trip chaining patterns [53,54], and community-level influences such as non-traditional food retailers [35,38,55], food venue types [28,56], and rural culture and context [47,57]. In concert with extant research, existing conceptual models of food access [2,58] do not fully address the influence of macro-level policies on the food choices of rural residents. "
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    ABSTRACT: Background Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. Methods This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Results Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access. Conclusions This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities.
    BMC Public Health 06/2014; 14(1):592. DOI:10.1186/1471-2458-14-592 · 2.26 Impact Factor
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    • "Previous studies assessing the macro-level food environment, such as number and type of food outlets in a neighborhood, may have introduced bias by not conducting validation studies. This may explain why results of such studies examining association and between the retail food environment and neighborhood characteristics have been conflicting [34,40,57-59]. "
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    ABSTRACT: Background Based on the need for better measurement of the retail food environment in rural settings and to examine how deprivation may be unique in rural settings, the aims of this study were: 1) to validate one commercially available data source with direct field observations of food retailers; and 2) to examine the association between modified neighborhood deprivation and the modified retail food environment score (mRFEI). Methods Secondary data were obtained from a commercial database, InfoUSA in 2011, on all retail food outlets for each census tract. In 2011, direct observation identifying all listed food retailers was conducted in 14 counties in Kentucky. Sensitivity and positive predictive values (PPV) were compared. Neighborhood deprivation index was derived from American Community Survey data. Multinomial regression was used to examine associations between neighborhood deprivation and the mRFEI score (indicator of retailers selling healthy foods such as low-fat foods and fruits and vegetables relative to retailers selling more energy dense foods). Results The sensitivity of the commercial database was high for traditional food retailers (grocery stores, supermarkets, convenience stores), with a range of 0.96-1.00, but lower for non-traditional food retailers; dollar stores (0.20) and Farmer’s Markets (0.50). For traditional food outlets, the PPV for smaller non-chain grocery stores was 38%, and large chain supermarkets was 87%. Compared to those with no stores in their neighborhoods, those with a supercenter [OR 0.50 (95% CI 0.27. 0.97)] or convenience store [OR 0.67 (95% CI 0.51, 0.89)] in their neighborhood have lower odds of living in a low deprivation neighborhood relative to a high deprivation neighborhood. Conclusion The secondary commercial database used in this study was insufficient to characterize the rural retail food environment. Our findings suggest that neighborhoods with high neighborhood deprivation are associated with having certain store types that may promote less healthy food options.
    BMC Public Health 08/2012; 12(1):688. DOI:10.1186/1471-2458-12-688 · 2.26 Impact Factor
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    • "Over the past decade, there has been a large increase in research on the neighborhood food environment, with a number of studies documenting associations between the food environment and dietary intake or weight status [1–13]. These and other studies have led to recommendations by scientific panels and policy makers that promote improvements in neighborhood access as a strategy for dealing with the obesity epidemic. "
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    ABSTRACT: Marketing research has documented the influence of in-store characteristics—such as the number and placement of display stands—on consumer purchases of a product. However, little information exists on this topic for key foods of interest to those studying the influence of environmental changes on dietary behavior. This study demonstrates a method for characterizing the food environment by measuring the number of separate displays of fruits, vegetables, and energy-dense snack foods (including chips, candies, and sodas) and their proximity to cash registers in different store types. Observations in New Orleans stores ( N = 172 ) in 2007 and 2008 revealed significantly more displays of energy-dense snacks than of fruits and vegetables within all store types, especially supermarkets. Moreover, supermarkets had an average of 20 displays of energy-dense snacks within 1 meter of their cash registers, yet none of them had even a single display of fruits or vegetables near their cash registers. Measures of the number of separate display stands of key foods and their proximity to a cash register can be used by researchers to better characterize food stores and by policymakers to address improvements to the food environment.
    Journal of Environmental and Public Health 06/2012; 2012(11):707860. DOI:10.1155/2012/707860
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