No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
What does SNAP benefit usage tell us about food access in low-income neighborhoods?
Abstract
Current GIS based research on food access has focused primarily on the proximity of food sources to places of residence in low-income communities, with relatively little attention given to actual practices of food procurement. This project addresses this issue by using dasymetric mapping techniques to develop fine scale estimates of benefit usage for the Supplemental Nutrition Assistance Program (SNAP) in the Twin Cities of Minneapolis and St. Paul, Minnesota, drawing from existing zip code level data on benefit distribution and redemptions. Based on this data, this research shows that while supermarkets receive almost all SNAP benefits in suburban areas, these stores have a smaller share of all SNAP redemptions in low-income core neighborhoods. In these latter areas, both convenience stores and mid-sized grocers (e.g., discount grocers, food cooperatives, ethnic markets) play a much larger role in residents' food shopping, even when supermarkets are also present. In addition, these core neighborhoods have a net “outflow” of SNAP dollars, meaning that residents of these areas receive more in benefits than is spent at neighborhood food retailers. This finding confirms existing research showing that low-income residents often travel outside their neighborhoods to get food, regardless of the presence or absence of supermarkets. Rather than simply increasing the number of large food outlets in low-access areas, this research suggests that efforts to improve food access and community health must take into account the geographically complex ways residents interact with the food system.
... According to the 2017 SNAP retailer management year-end summary (USDA 2018c), while eighty-two percent of the redemptions were made at supermarkets and supercenters, which stock a wide selection of healthy, perishable food items, these stores accounted for only fourteen percent of all the authorized retailers, implying that access to healthy SNAP food is actually limited. The dilemma of food quantity vs. quality is exacerbated in areas of high poverty, where many eligible participants are faced with the issue of significantly fewer green retailers (Racine et al. 2018;Shannon 2014). The need to restructure the program can also be justified from the perspective of participants: compared to the existing system, participants prefer a nutritionally enhanced program that incentivizes the consumption of healthy foods while discouraging high-energy options, primarily sugar-sweetened beverages (Basu et al. 2014;Leung et al. 2017). ...
... Research on the effectiveness of the SNAP has primarily been based on national survey data (Basu et al. 2014;Todd and Ver Ploeg 2014) or proprietary household assessments (e.g., Leung et al., 2017), which focus on the nutritional benefits of the program or the attitudes of the participants. Unlike GIS-based food access studies, existing discussion about the SNAP lacks a spatial perspective, overlooking if healthy foods are attainable in the neighborhoods where benefits are distributed (Laska et al. 2015;Shannon 2014). This demarcation of healthy foods goes beyond a simple measure of store density, and it should take the benefit recipients into account. ...
... Very few SNAPrelated projects focus on the complex matrix between food supply and demand. One exception refers to Shannon (2014) that applied dasymetric mapping on SNAP authorized retailers and transaction data to the Twin Cities metropolitan area, indicating that healthy SNAP food provisions and benefit redemptions are geographically unmatched. In a similar study, Rachine et al. (2018) focused on the spatial inequality of SNAP accessibility among neighborhoods with different demographic and socioeconomic statuses in North Carolina, concluding that areas with higher SNAP participation rates have an arbitrarily smaller number of healthy food stores. ...
In this paper, a Gaussian-based two-step floating catchment area (2SFCA) model is applied to evaluate the geographical accessibility to the Supplemental Nutrition Assistance Program (SNAP) authorized retailers. First, the proposed method considers the interaction between the food supply (in terms of categorized benefit redemptions) and demand (in terms of benefit receiving households). Second, the model is used to visualize food access patterns at the level of refined administrative units (i.e., census block groups). The developed food access metric was compared to the U.S. Department of Agriculture (USDA) Food Access Research Atlas, justifying the validity of this new method for small area estimation. The following are important observations: (1) the choice of catchment size had a considerable impact on the accessibility measure in urban areas (or when small statistical units are used); (2) the 2SFCA measurement had a higher level of correspondence with that of the USDA Atlas at a smaller catchment size for identifying low food access units; (3) there was no significant inequality regarding SNAP accessibility with respect to different socioeconomic deprivation variables. This new method can better assist the SNAP administration with store authorization on a refined geographic scale.
... As some of the arterial roads also serve as the boundaries for unit delineation, it is likely that a food store situated along the road but in the adjacent unit will not be included in the enumeration of business establishments. Also, the edge effect obfuscates data on the SNAP store redemptions, since a certified SNAP retailer can straddle two zip code zones (Shannon, 2014). ...
... Although the edge effect has been mentioned or evaluated in numerous food access studies (Fraser & Edwards, 2010;Ledoux & Vojnovic, 2013;Sadler, Gilliland, & Arku, 2011;Shannon, 2014;Van Meter et al., 2010), it is of relative difficulty to address it using traditional food access measures. This gap is likely the result that discussion on food environment assessments cannot be separated from SES variables, such as household income and poverty rate that intrinsically mediate access. ...
... With modifications, this method can serve as an effective instrument for customized food environment assessments. It can even provoke equity questions that target a selected consumer group and a specialized food environment, for example, linking the SNAP user distribution to credited SNAP stores (Rose & Richards, 2004;Shannon, 2014) as well as integrating Hispanic populations with Hispanic groceries and restaurants (Park, Quinn, Florez, Jacobson, Neckerman, & Rundle, 2011). As a result, this paper may provide a useful first step towards developing health strategies that ameliorate an intervention group at risk of food insecurity. ...
Measures of geographic food access overlook an important source of statistical biases, termed the edge effect. The edge effect refers to the fallacy that events contributing to the spatial pattern of an analysis unit may be outside of that unit; thus merely summarizing events within the unit may lead to distortion of the estimation. Food procurement activities can happen beyond existing administrative boundaries. Delineating food access using unit-based metrics may misrepresent the true space within which food stores are accessible. To overcome this problem, this paper proposes a gravity-based accessibility measure to improve unit-based statistical approaches in food access research. In addition, this method accounts for the spatial interaction between food supply (e.g., food items in stock) and demand (e.g., population) as well as how this interaction is mediated by the spatiotemporal separation (e.g., travel time, modality). The method is applied to the case of Franklin County, OH and has revealed the food access inequity for African Americans by modes of transport, including walking, biking, and driving. The analysis of the correlation between mode-specific food access and socioeconomic status (SES) variables reveals that using a single modality in food access research may not fully capture the travel behavior and its relationship with local food environments. With modifications, the proposed method can help evaluate food access for a target population group, such as Supplemental Nutrition Assistance Program (SNAP) users or selected ethnic minorities who may face acute difficulties in procuring economically affordable and culturally appropriate foods.
... Many SNAP households are faced with challenges such as consistent and reliable transportation (18); longer travel times to stores (19); limited stores accepting electronic benefit transfer (EBT) cards (20,21), among other financial and geographic constraints. Several studies have suggested that SNAP households shop outside their neighborhood for food at gas stations, convenience stores, and mid-size grocers a majority of the time (19,20,22), regardless if a supermarket is available (22). These results taken together highlight the complex way that SNAP households interact with their food environment which can have direct effects on food shopping behaviors and thus food purchases, such as less fruits and vegetables and more processed foods (23). ...
... Many SNAP households are faced with challenges such as consistent and reliable transportation (18); longer travel times to stores (19); limited stores accepting electronic benefit transfer (EBT) cards (20,21), among other financial and geographic constraints. Several studies have suggested that SNAP households shop outside their neighborhood for food at gas stations, convenience stores, and mid-size grocers a majority of the time (19,20,22), regardless if a supermarket is available (22). These results taken together highlight the complex way that SNAP households interact with their food environment which can have direct effects on food shopping behaviors and thus food purchases, such as less fruits and vegetables and more processed foods (23). ...
... This type of shopping behavior may lead to lower odds of purchasing healthier items such as milk and instead purchasing more shelf-stable items such as high calorie snack items (27). Policies aiming to improve neighborhoods for SNAP residents need to consider where SNAP residents reside (40); their unique shopping practices as it evolves into online retail (41); and how to create a consumer food environment which supports healthy shopping practices (22). These results are not suggesting that supercenters cause poor food purchases or obesity, but rather this result is one example of many complicated pathways which helps to explore the role of the food environment among low income and SNAP households. ...
Highlights
• SNAP households are influenced by proximity to stores in predicting store choice.
• Store choice among SNAP households predicted beverage purchases.
• SNAP households are more likely to purchase sugar-sweetened beverages at supercenters and convenience stores.
... This rulemaking could have an effect on a wide array of food outlets. Nationally, 20% of SNAP transactions occur in small stores, such as convenience stores or other small food stores, where availability of healthy foods may be limited (13). Benefit redemptions at small stores are more frequent in areas with poor health outcomes, such as low-income and nonmetropolitan areas, as well as among single-adult and minority households (13,14). ...
... Nationally, 20% of SNAP transactions occur in small stores, such as convenience stores or other small food stores, where availability of healthy foods may be limited (13). Benefit redemptions at small stores are more frequent in areas with poor health outcomes, such as low-income and nonmetropolitan areas, as well as among single-adult and minority households (13,14). Furthermore, previous research has shown that purchases from convenience stores in particular tend to consist of calorie-dense, prepackaged products of poor nutritional quality (15,16). ...
... Increasing minimum stocking standards for retailers would be expected to have an impact on only a limited subset of SNAP participants and SNAP-related purchases. For example, 64% of SNAP benefits nationwide are redeemed at supermarkets and supercenters (13), which are stores that would be unaffected by increases in stocking standards. However, research indicates that smaller retailers receive a larger percentage of SNAP benefit redemptions in low-income urban areas compared with high-income suburban areas. ...
Introduction:
The US Department of Agriculture has stocking criteria for healthy foods among Supplemental Nutrition Assistant Program (SNAP)-authorized retailers. Increased access to healthy food could improve diet quality among SNAP participants, which has implications for chronic disease prevention. The objective of this study was to quantify healthy foods stocked in small-size to mid-size retailers who are authorized under SNAP but not under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Methods:
We used formative, cross-sectional data from a large policy evaluation to conduct secondary analyses. Store audits were conducted in 2014 in 91 randomly selected, licensed food stores in Minneapolis and St. Paul, Minnesota. Supermarkets and retailers participating in WIC, which are required to stock healthy foods, were excluded as were other stores not reasonably expected to stock staple foods, such as specialty stores or produce stands. Availability of milk, fruits, vegetables, and whole-grain-rich foods was assessed.
Results:
The 91 stores studied were corner stores, food-gas marts, dollar stores, and pharmacies. More than half carried 1 or more varieties of fat-free or low-fat milk, fresh or canned fruit, and whole-grain-rich cereal. However, only one-third stocked 1 or more varieties of fresh vegetables and only one-quarter stocked whole-grain-rich products, such as whole-grain-rich bread (26%) or tortillas (21%) or brown rice (25%). Few stores stocked at least 2 varieties of each product.
Conclusions:
Many stores did not stock a variety of healthy foods. The US Department of Agriculture should change policies to improve minimum stocking requirements for SNAP-authorized retailers.
... As with failure to thrive, obesity is the result of a complex interplay of biological and environmental factors including genetics, nutrition, physical activity, and the caregiving environment. Families in lowincome neighborhoods tend to have less access to nutritious foods and often have poorer dietary habits than their counterparts in middle-income neighborhoods (Shannon 2014). They also are less likely to encourage physical activity in their children due to residing in housing with limited space and neighborhoods that may be violent (Echeverria et al. 2014). ...
... It is also critical to consider the inequalities in resources and opportunities for healthy development across neighborhoods based on family SES (Acevedo-Garcia et al. 2020). For example, there are fewer grocery stores in low-SES neighborhoods, and the available grocery stores are often devoid of fresh food (Mabli & Worthington 2014, Shannon 2014). Access to high-quality food is related to children's nutritional intake, food security, and overall health. ...
Given the high rates of child poverty in the United States, socioeconomic disparities exist regarding children's physical and mental health. These disparities are particularly pronounced for children of color, who are more likely to experience poverty compounded by the vestiges of historical and systemic racism. Physical health disparities include higher rates of mortality, growth impairments, allergies, respiratory difficulties, tooth decay, and injuries. Disparities have also been found in the mental health arena, including a higher likelihood of internalizing and externalizing disorders, as well as trauma symptoms, and differences in the timing of diagnosis of, types of, and treatments for mental health disorders. Familial, neighborhood, service, and systemic contextual factors further solidify these disparities. It is critical to address the structural causes of these disparities and their consequences to promote more positive outcomes in affected children. A system of care that integrates economic programs, child care and education supports, parenting interventions, and appropriate physical and mental health care is essential to meet the health needs of children from impoverished backgrounds.
Expected final online publication date for the Annual Review of Developmental Psychology, Volume 4 is December 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... 10 SNAP participants redeem the vast majority of their benefits at supermarkets, 11 where some participants also do a larger-thanaverage proportion of their food shopping. 12 Compared with larger retailers, the small and midsize retailers that accept SNAP benefits tend to stock fewer healthy food items. This has been confirmed among retailers in Minneapolis-St. ...
... 18 Yet studies have also found that SNAP participants tend to travel farther than the nearest SNAP-participating retailer to redeem their benefits. 12,[19][20][21][22][23][24] Given the mixed findings within the literature on the relationship between SNAP participation and geographic access to retail food outlets, we had a unique opportunity to examine whether the opening of a new full-service supermarket in a food desert improved diet and food security for SNAP participants who lived in that neighborhood relative to similar SNAP participants in a comparison neighborhood where a new supermarket did not open. ...
The Supplemental Nutrition Assistance Program (SNAP) is the largest US food and nutrition assistance program, tasked with improving food security among low-income households. Another federal effort to improve food access is the Healthy Food Financing Initiative (HFFI), which invested tens of millions of dollars to incentivize healthy food retail outlets in areas lacking access to nutritious, fresh food. We explore the intersection of these programs, testing the impact of a new, HFFI-financed full-service supermarket on SNAP participants in an urban food desert. After the supermarket's opening, SNAP participants' food security improved and intake of added sugars declined in the intervention neighborhood, but both were unchanged in a comparison neighborhood without a new supermarket. Intervention neighborhood participants also experienced relative declines in the percentage of daily calories from solid fats, alcoholic beverages, and added sugars. Our findings suggest that HFFI amplifies the effects of SNAP participation on improving food security and dietary quality in food deserts.
... SNAP benefits, which average $126 per person per month, can be redeemed at any SNAP-authorized food vendor nationwide (1). A common concern regarding SNAP vendors has been low availability of healthy foods (2,3). In lowincome communities in particular, SNAP vendors are usually convenience stores and small grocers (4)(5)(6), where the availability of fresh fruits and vegetables (FFV) is low (5,7,8). ...
... For the SNAP vendor participation analysis, we first examined longitudinal SNAP vendor participation status by data collection cohort. We grouped stores into 4 mutually exclusive categories: 1) continuous SNAP vendor, 2) continuous non-SNAP vendor, 3) changed SNAP status at least once, and 4) no longer a food store. Next, we obtained cross-sectional counts and proportions of SNAP vendors overall and by store characteristics in each data collection wave. ...
Introduction:
In January 2018, new vendor eligibility standards for the Supplemental Nutrition Assistance Program (SNAP) were fully implemented to increase availability of healthy staple and perishable foods. We examined changes in SNAP vendor participation and availability of fresh fruits and vegetables (FFV) both short-term (2015 vs 2018) and long term (2003 vs 2018) in an urban, low-income community.
Methods:
We conducted food store assessments from late June through early September of 2003, 2009, 2012, 2015, and 2018 in Albany, New York. SNAP status was assessed by using the US Department of Agriculture's list of SNAP-authorized stores and in-store verification.
Results:
Numbers of SNAP vendors were 77 in 2003, 92 in 2009, 103 in 2012, 115 in 2015, and 109 in 2018. We observed a marginally significant (P = .049) short-term (2015, 85.9% vs 2018, 73.9%) decline in SNAP participation among convenience stores but no significant short-term changes in FFV availability among either SNAP or non-SNAP vendors. In long-term (2003 through 2018) trends, we found significant (P < .01) increases in SNAP participation among farmers markets and nonprofit organizations. The proportion of SNAP vendors stocking only 1 type of FFV also significantly increased, which was likely related to a consumer trend of favoring bananas as a grab-and-go snack.
Conclusion:
Despite the decline of SNAP participation among convenience stores, which primarily came from increased program withdrawals, the new SNAP rule did not substantially alter FFV availability after 6 to 8 months of its full implementation. Long term, policy efforts increased SNAP participation among farmers markets.
... Some authors have incorporated time budgets rather than simple measures of distance to create a space-time accessibility framework [7], while others have explored individual person-based approaches that contrast with the more common place-based approaches [10]. Recent researchers have interviewed or directly observed shoppers [14], analyzed mobile GPS data to document patterns of food purchase trips [11,12], mapped flows of SNAP grocery expenditures and accessibility [13,18,19], incorporated transit schedules into their estimations of access [8] and utilized Twitter data to understand local food environments [20]. A growing consensus of researchers agree that proximity-or density-based food desert methods that only account for trips originating from place of residence oversimplify food environments and the choices offered to shoppers within them, whether they are wealthy or comparatively disadvantaged. ...
... This paper has relied on several assumptions that may affect the validity of our approach. First, recent descriptive analyses of food deserts have placed an emphasis on incorporating the quality and pricing of food into determinations of access [11,12,18]. However, beyond differentiating between different types of stores, there is no estimation of food pricing or quality incorporated into this research. ...
Scholars are in agreement that the local food environment is shaped by a multitude of factors from socioeconomic characteristics to transportation options, as well as the availability and distance to various food establishments. Despite this, most place-based indicators of “food deserts”, including those identified as so by the US Department of Agriculture (USDA), only include a limited number of factors in their designation. In this article, we adopt a geodemographic approach to classifying the food access landscape that takes a multivariate approach to describing the food access landscape. Our method combines socioeconomic indicators, distance measurements to Supplemental Nutrition Assistance Program (SNAP) participating stores, and neighborhood walkability using a k-means clustering approach and North Carolina as a case study. We identified seven distinct food access types: three rural and four urban. These classes were subsequently prioritized based on their defining characteristics and specific policy recommendations were identified. Overall, compared to the USDA’s food desert calculation, our approach identified a broader swath of high-needs areas and highlights neighborhoods that may be overlooked for intervention when using simple distance-based methods.
... The theory assumes that the concept of a 'threshold' is the determinant of the location of services such as food stores. The threshold concept suggests that services such as grocery stores will be situated in neighborhoods with the local capacity to support profit maximization, hence the existence of food deserts (Dawson, At the individual level, individual choices amidst transportation systems or travel distance as a factor of accessibility play a significant role in discussing the dynamics of food accessibility among geographers (Shannon, 2014(Shannon, , 2016Widener & Shannon, 2014). Individuals with access to vehicles, and/or live within walkable distance to nutritious food outlets turn to have more access to fresh fruits and vegetables compared to individuals with limited access to healthy food outlets or vehicles (Dutko et al., 2012;Widener & Shannon, 2014). ...
... These approaches can be categorized into two types; individual-based and placebased approaches. Studies that apply the individualbased approach examine the relationship between socio-economic characteristics of persons such as income, vehicle ownership, race, etc. and distance or access to food stores (Shannon, 2014(Shannon, , 2016. The place-based approach, which appears as the commonly used approach in measuring food accessibility among geographers focuses on neighborhood socioeconomic characteristics and how they are related to access to food for residents ( ...
... Specifically, the authors highlight the need to understand how the neighborhood accessibility (and quality) of SNAP stores would affect SNAP participants' weight status [3]. In recent years, the food environment has been studied in reference to both obesity [6] and SNAP [7,8], with some studies focused on the role of the food environment (particularly the healthy component) in the SNAP participationobesity relationship [9]. Moreover, a recent evaluation on the adequacy of SNAP allotments concluded that aspects of the nutritional environment need to be taken into account when evaluating and revising such allotments [10], highlighting the importance of the food environment for SNAP participants. ...
... Moreover, Rigby et al. [7] found that the majority of SNAP-authorized p-values obtained from weighted bivariate logistic regressions stores in low-income and black and mixed-race neighborhoods in Leon County, Florida were not supermarkets or grocery stores but convenience and other stores, accounting for 69-75% of the SNAP-authorized stores available. Similarly, Shannon [8] found that in lowincome, minority neighborhoods in Minnesota, 46% of SNAP redemptions take place in convenience stores. In addition, Laska et al. [25] found that SNAP-authorized small-to mid-size retailers in Minneapolis-St. ...
Background
Participation in the Supplemental Nutrition Assistance Program (SNAP) has been linked to an increased risk of obesity, but not much is known about the mechanisms behind this association. The objective of this study was to determine if the neighborhood density of unhealthy food outlets modifies the association between obesity and participation in SNAP.
Methods
Data comes from the first wave of the Los Angeles Family and Neighborhood Survey; included are a subsample of adults (18+ years) who were SNAP participants or eligible non-participants (N = 1,176). We carried out multilevel analyses with obesity (BMI ≥ 30 Kg/m²), SNAP participation, and the neighborhood density of unhealthy food outlets as dependent, independent and modifying variables, respectively, controlling for age, gender, race/ethnicity, marital status, working status, mental health, and neighborhood poverty.
Results
SNAP participants had double the odds of obesity compared to eligible non-participants (OR = 2.02; 95%CI = 1.44-2.83). However, the neighborhood density of unhealthy food outlets did not modify this association.
Conclusions
SNAP participation was associated with higher odds of obesity in our primarily Hispanic sample in Los Angeles County, with no effect modification found for the unhealthy portion of the food environment. More research is needed with additional food environment measures to confirm our null findings. Additional research is needed to elucidate the mechanisms linking SNAP participation and obesity as they remain unclear.
... Originally expressed by Short, Guthman, and Raskin (2007) and expanded upon by Breyer and Voss-Andreae (2013), the term represents an area in which residents have geographic access to food sources but lack the economic or cultural means to take advantage of them. Indeed, low-income residents often travel outside their neighborhoods to purchase groceries at a lower price (LeDoux & Vojnovic, 2014;Shannon, 2014;Walker, Fryer, Butler, Keane, Kriska, & Burke, 2011), demonstrating that cost supersedes convenience in determining where to purchase food (Alkon, Block, Moore, Gillis, DiNuccio, & Chavez, 2013;Barnes, 2005). ...
... Concerns about this have led to calls for greater emphasis on the types of food offered at various sources when mapping food access (Van Hoesen, Bunkley, & Currier, 2013). Furthermore, because low-income residents purchase food from sources other than supermarkets, such as small-scale grocers (Raja, Ma, & Yadav, 2008), convenience stores, discount grocers, ethnic markets, food co-ops (Shannon, 2014), and mobile markets (Robinson, Weissman, Adair, Potteiger, & Villanueva 2016;Widener, Metcalf, & Bar-Yam, 2012, 2013Zepeda & Reznickova, 2013), a narrow focus on the supermarket as the benchmark for food access oversimplifies the food environment experienced by vulnerable populations. While some choose cost over convenience-exemplified by the Rockwood residents who drive six miles to a store with lower prices than the one in their neighborhood-those without the ability to travel by personal automobile or effective public transit are limited to the food sources in their immediate surroundings, whose fresh food may prove too expensive. ...
While Portland, Oregon, gains renown for supporting locally grown, sustainably produced, healthy, or otherwise "good" food, it has failed to ensure equitable access to said food. As parts of the city gentrify, dislocated Portlanders find themselves without access to fresh produce, contributing to health disparities among low-income and minority residents. This research sought to understand issues of food access among populations displaced by gentrification and determine the best locations for produce stands as a method to increase access to fresh produce. It examines the concept of the food mirage by studying the coverage of grocery stores in Portland and proposes an alternative intervention, produce stands, as a pedestrian-scale approach to address gaps in grocery store accessibility for those without transportation. Calculations using geographic information systems (GIS) determine the ideal locations for produce stands in walkable areas not served by transit or fruit and vegetable markets and that house a high number of residents displaced by gentrification. The methodology returns appropriate sites in East Portland, a historically underserved area of the city facing disparities in obesity-related chronic disease. This paper contributes to the research and practice of food systems planning by incorporating indicators of gentrification-driven displacement as well as the built environment into a process of spatial analysis to expand consumption of affordable produce while providing entrepreneurship opportunities for disadvantaged residents. Food justice activists can use this methodology to determine areas of need and account for assets of the built environment in order to site a food access intervention that remains largely underutilized in North American cities.
... Despite this, there appears to be more to food and food store choice than just proximity. Shannon has shown that low-income families that receive supplemental nutritional benefits are more likely to shop in convenience stores, even when there are supermarkets present, and that there is a net outflow of monies from these social benefits to discount food retailers beyond neighborhood borders [23]. This is confirmed by a recent study from California, in which persons from low-income communities were prepared to drive further to access lower-priced and foods of lower dietary quality, and were three times more likely to be overweight, than their more well-resourced counterparts [21]. ...
... To the contrary, public policy should be directed not so much to a final product nor to establishing a final normative environment to which health identities conform, rather to the offering of tools that enable the individual to better evaluate and weigh the factors that comprise their choice set. Shannon's example of perpetuating poor food choices under the United States Supplemental Nutrition Assistance Program applies here [23]. Policy cannot accommodate individual choice sets, but can recognise how they work, how they are influenced by meso-level relationships, and how they incorporate the community paradigm that informs and optimizes choice sets, without imposing normative health expectations that disregard local sociocultural values. ...
Using the nexus between food consumption, food security and obesity, this paper addresses the complexity of health behavior decision-making moments that reflect relational social dynamics in context-specific dialogues, often in choice-constrained conditions.
A pragmatic review of literature regarding social determinants of health in relation to food consumption, food security and obesity was used to advance this theoretical model.
Results and discussion
We suggest that health choice, such as food consumption, is based on more than the capacity and volition of individuals to make “healthy” choices, but is dialogic and adaptive. In terms of food consumption, there will always be choice-constrained conditions, along a continuum representing factors over which the individual has little or no control, to those for which they have greater agency. These range from food store geographies and inventories and food availability, logistical considerations such as transportation, food distribution, the structure of equity in food systems, state and non-government food and nutrition programs, to factors where the individual exercises a greater degree of autonomy, such as sociocultural foodways, family and neighborhood shopping strategies, and personal and family food preferences. At any given food decision-making moment, many factors of the continuum are present consciously or unconsciously when the individual makes a decision. These health behavior decision-making moments are mutable, whether from an individual perspective, or within a broader social or policy context. We review the construct of “choice set”, the confluence of factors that are temporally weighted by the differentiated and relationally-contextualized importance of certain factors over others in that moment. The choice transition represents an essential shift of the choice set based on the conscious and unconscious weighting of accumulated evidence, such that people can project certain outcomes. Policies and interventions should avoid dichotomies of “good and bad” food choices or health behaviors, but focus on those issues that contribute to the weightedness of factors influencing food choice behavior at a given decision-making moment and within a given choice set.
... Dasymetric interpolation is considered one of the best approaches for processing data on the spatial distribution of population due to its feasibility and accuracy (Mennis & Hultgren, 2006;Wu, Qiu, & Wang, 2005). This approach has been successfully used in various studies, such as tourism analysis (Vaz & Campos, 2013), accessibility assessment (Langford, Higgs, Radcliffe, & White, 2008;Shannon, 2014), and crisis management (Linard & Tatem, 2012). ...
Analyses utilizing mobile positioning data rarely provide an exact method of data transformation to target spatial units. A common reason is likely the fact that researchers have already worked with spatially aggregated data prepared by the mobile operator or processing company. The article demonstrates the critical importance of employing an appropriate method to transform data from the mobile network into target spatial units, ensuring the precision and accuracy of the results. By evaluating ten different methods of data transformation from the mobile network topology to a population grid of 1x1 km, the optimal transformation has been sought. The most promising results were obtained through the methods using auxiliary information. While a dasymetric transformation utilizing building volume as the ancillary layer proved to be the most accurate, the utilization of free data from the Global Human Settlement Layer project also exhibits encouraging potential. Frequently used interpolation methods such as point-to-polygon (the user's location is considered to be the same as the base transceiver station's position.) or areal weighting are in fact the least appropriate methods of data transformation at a subregional level.
... Food desert research has generally defined access based on proximity to food retailers, particularly supermarkets (Beaulac et al., 2009;Ver Ploeg et al., 2009). Critiques, however, note the limits of proximity-based conceptualizations of food access (De Master & Daniels, 2019;Shannon, 2014), highlighting the importance of other factors like affordability and variety of foods available at retailers (e.g., Farley et al., 2009). These studies emphasized that the presence of supermarkets did not guarantee equitable food access: Lower-income neighborhoods often face higher prices and limited selection (Block & Kouba, 2006) and may actually find variety and affordability at smaller retailers (Short et al., 2007), which are often excluded from food desert analyses. ...
... However, research suggested that it may not solve the problem for all. Studies found that low-income individuals do not necessarily shop or use their government benefits [e.g., Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps] at the stores closest to their homes and rather shop at small groceries and corner stores that are far from home (LeDoux & Vojnovic, 2013;Shannon, 2014). When a new supermarket opened in a "food desert" neighborhood, it increased awareness of food access but did not alter dietary habits or intake of fruit and vegetables (e.g., Allcott et al., 2019;Chrisinger, 2016;Dubowitz et al., 2015). ...
Access to emergency food is critical for the survival and health of vulnerable populations, but its importance is not understood in the context of food deserts. Using a cross-sectional survey based on Albany and Troy, New York, we compared the two food desert models, one based on paid (e.g., grocery stores) and the other based on free food options (e.g., emergency food sites such as pantries and soup kitchens). Structural equation modeling was conducted to identify pathways among people’s access to food sites, food consumption patterns, food insecurity, and health conditions. Access to grocery stores did not show significant links to food insecurity or health conditions, whereas access to emergency food, especially time taken to such food outlets, was found to be a significant factor for increased consumption of fresh food. Among the diet-related variables, food insecurity showed the strongest link to negative health outcomes. Access to free or low-cost options needs to be taken into consideration when designing research and practice concerning food deserts, food insecurity, and subsequent health effects.
... SNAP benefit receipt may allow families to engage in healthful food purchasing habits that are then maintained by children as they transition into adulthood and begin to purchase and prepare their own food (Anderson & Butcher, 2016;D'Angelo et al., 2011;Laska et al., 2010). Shannon (2014) found that in suburban, more economically robust areas, SNAP benefits tend to be spent at grocery stores with an abundance of fresh foods at higher rates relative to less economically robust areas. As previously discussed, researchers have observed that, in economically disadvantaged areas meeting food desert criteria where healthful food choices are few, inflexible SNAP income is subsequently spent on the available low-nutrient and energy-dense foods. ...
... Thus, although many census tracts do not have fast-food restaurants, fast food could still be procured from adjacent tracts. The edge effect further affects the quality of data on the food stamp redemptions, as a credited SNAP store may be cross-listed under two zip codes ( (Chen, 2019;Major, Delmelle, & Delmelle, 2018;Shannon, 2014). While there is no simple solution to address the issue (Caspi et al., 2012;Charreire et al., 2010), a solution to moderate the edge effect is the 2SFCA method (Chen, 2019;Dai & Wang, 2011). ...
Geospatial models can facilitate the delineation of food access patterns, which is particularly relevant for urban planning and health policymaking. Because community food environmental studies use different analysis units or study scales, the rigor and consistency of their evaluations cannot be ensured. This issue is known as the modifiable areal unit problem (MAUP). The paper provides a systematic review of past literature on place-based community food environmental research using different analysis units or geospatial models as they pertain to the MAUP. We identify these key findings: (1) the ZIP code zone is not recommended as an appropriate analysis unit for modeling community food access, as it did not have significant correlations with health indicators; (2) using a circular buffer of less than 0.5 km around household locations is most likely to reveal health correlations, compared with network buffers or container-based measures; (3) to reveal health effects of the community food environment, it is recommended to focus in selected regions or partitions of a study area with similar socioeconomic statuses, such as the central city or low socioeconomic status areas; (4) for studies utilizing a single statistical unit or distance measure, it is suggested to discuss the existence of the MAUP, such as evaluating the sensitivity of the model to the change of the unit or the distance measure. By highlighting the MAUP, this paper has policy implications—given that geospatial modeling of food accessibility provides support for health policy intervention, using different metrics may lead to different interpretations of health disparities and could thus misinform policy decisions. Therefore, any assessment of community food environments that may potentially lead to a policy change should consider the effects of the MAUP.
... But the exact mechanism for the improvement was largely unexplored. Our findings are consistent with a diverse array of studies that have found that people are willing and prefer to travel outside their own neighborhood for food shopping based on price and their individual taste preferences [10,22,23]. For example, LeDoux and Vojnovic found that residents of a disadvantaged food dessert in Detroit, Michigan were more likely to shop at independent, discount, and regional supermarkets located outside of their neighborhood [24]. ...
Lack of geographic access to foods has been postulated as a cause for food insecurity, which has been linked to poor nutrition, obesity, and chronic disease. Building on an established cohort of randomly selected households from a low-income, predominantly Black neighborhood, we examined household food security, distance to where study participants reported doing their major food shopping, and prices at stores where they shopped. Data from the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health study for years 2011, 2014 and 2018 was limited to residents of the neighborhood that began as a food desert (i.e., low access to healthy foods), but acquired a full-service supermarket in 2013. We calculated descriptive statistics and compared study participants in the former food desert neighborhood whose food security improved to those whose food security did not improve across survey waves. We estimated cross sectional linear regressions using all waves of data to assess food security level among study participants. Distance to major food shopping store was positively associated with food security (p < 0.05) while food-store prices were not significantly associated with food security. Findings suggest that for predominantly low-income residents, food secure individuals traveled further for their major food shopping.
... SNAP-authorized retailers are currently required to either stock three units of three different varieties for each staple food category (vegetables or fruits; dairy products; meat, poultry, or fish; breads or cereals) on a continuous basis or a store must have more than 50% of its total gross retail sales from the sale of staple foods [44]. Despite these requirements, research shows that SNAP authorized retailers offer comparatively fewer fresh fruits and vegetables, whole-grain foods and low-fat dairy products in lower income communities than retailers in higher income communities [51][52][53][54][55]. SNAP retailers should be prohibited from in-store (brick and mortar and on-line) marketing of unhealthy foods such as sugar-sweetened beverages (SSBs) (e.g. ...
Purpose of review:
In 2020, obesity prevalence among US children reached 19.7%, impacting about 14.7 million children and adolescents. Food insecurity among children is also a public health concern but has largely decreased or remained stable over the past decade, reaching 6.2% of US households with children in 2021. Given food insecurity and obesity's interconnected nature and their negative consequences on children's health, it is of interest to assess the Supplemental Nutrition Assistance Program's (SNAP's) impact on childhood food security, dietary quality, disease risk, and health outcomes.
Recent findings:
Evidence suggests that SNAP participants, including children, struggle to meet key dietary guidelines and perform poorly on key health indicators when compared with income-eligible and higher income nonparticipants. Children participating in SNAP were more likely to have elevated disease risk and consume more sugar-sweetened beverages (SSBs), more high-fat dairy, and more processed meats than income-eligible nonparticipants. However, research suggests that federal food assistance programs with more stringent nutrition standards - the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the National School Lunch Program (NSLP) and School Breakfast Program (SBP) - improve dietary quality, increase birth weight and gestation periods, and reduce childhood obesity, infant mortality and healthcare costs.
Summary:
After reviewing the evidence on SNAP's impacts on food insecurity, dietary quality, and health as well as research on the health impacts of other more successful federal food assistance programs, we provide three policy recommendations to strengthen SNAP's effectiveness as a health intervention for children and families.
... Food deserts research has emphasized proximity to supermarkets as an indicator of access but has often neglected the other locations where people acquire food (Shannon 2014;Short et al. 2007;Taylor and Ard 2015), including food pantries. In contrast to the extensive research on access to food retailers, few studies have employed spatially explicit approaches to characterize access to food pantries. ...
Food pantries play a growing role in supporting households facing or at risk of food insecurity in the United States. They also support emergency response and recovery following disasters and extreme weather events. Although food pantries are often placed in close proximity to communities with the highest rates of poverty and risk of food insecurity, access to these facilities can be disrupted during and after extreme events. Decreased access to food pantries following disasters can be particularly problematic as the need for these services is also likely to grow after such events. Despite the vast body of research on food retail access and food environments, relatively little research has utilized spatial analysis to understand food pantry access, particularly after extreme events. Using Geographic Information Systems (GIS), we characterize changes in access to food pantries following flooding events in Harris County, Texas—a highly populated and flood prone region with high levels of food insecurity and poverty. Specifically, our study models disruptions in road networks due to flooding and assesses the impacts of these disruptions on proximity to food pantries. The results reveal that much of Harris County sees only small increases in travel distance to food pantries due to extreme flooding, but some areas may be unable to access food pantries at all. This research highlights the potential and some of the limits of private food assistance networks to support emergency response efforts.
... Although the majority of SNAP benefits are redeemed at supermarkets and supercenters, small food stores comprise over 45% of all SNAP-authorized retailers and are fundamental to the local food environment, particularly in low-income communities and areas without large grocery stores [14,15]. The owners and managers of small SNAP-authorized food retailers are important stakeholders in the ongoing discussion regarding improving the nutritional landscape for low-income families receiving SNAP; however, their voices have not been typically represented in national policy discussions. ...
The Supplemental Nutrition Assistance Program (SNAP) is critical to alleviating food insecurity, but low diet quality among program participants is a concern. Nutrition-related interventions have focused on SNAP-authorized food retailers, but the perspectives of small food store owners and managers have not been represented in national policy discussions. This study aimed to explore the opinions of store owners/managers of SNAP-authorized small food stores about their overall perceptions of the program and the stricter stocking standards previously proposed in 2016. We conducted in-depth, semi-structured interviews with 33 small food store owners and managers in San Francisco and Oakland, California in 2016. Interviews were analyzed for thematic content using the general inductive approach. Four themes emerged from owners/managers’ discussion of their overall perceptions of SNAP: the beneficial impact of SNAP on their business, how SNAP enables them to connect with the broader community, the importance of SNAP in preventing hunger, and the nutrition-related struggles that SNAP participants face. Store owners/managers had a generally favorable response towards the proposed stricter stocking standards. Additional themes discussed pertained to the concern about whether stocking changes would lead SNAP participants to purchase more healthful food and some logistical challenges related to sourcing and storing perishable foods.
... Sites that were located adjacent to streets with public bus routes did not serve more meals than others. Previous research established that socioeconomically disadvantaged residents of urban areas often travel outside of their neighborhood to obtain food, 37,38 suggesting easy access to public transit would help these sites reach more children. However, the density of LunchStop sites and standardization of meals may have increased participants' willingness to simply walk to the site closest to their residence. ...
Background
One in six US households with children experiences food insecurity, with higher rates in the summer. Approximately 3 million children receive free meals each summer weekday through the US Department of Agriculture’s Summer Nutrition Programs. However, participation in these programs has been declining in recent years and is lower than participation in programs that serve free or reduced-price meals during the school year.
Objective
To identify school and site characteristics associated with greater reach by school-based free summer meals program sites.
Design
This observational study combined program data, public school data, and Google Maps data to determine factors associated with site reach.
Participants/setting
LunchStop Summer Meals Program sites (N=100) and schools at which they were based during summer 2018 in Chicago, IL.
Main outcome measures
Reach of sites was measured by the mean daily meals served at each site throughout summer 2018.
Statistical analyses performed
Associations between site reach and each independent variable were evaluated using Mann-Whitney tests and simple linear regressions. Variables significantly associated with site reach in bivariate analyses (P<0.05) were included in a multivariate linear regression.
Results
In bivariate analyses, sites with greater reach were significantly more likely to be based at schools with higher attendance percentages, higher percentages of Hispanic/Latino students, larger student populations, and locations in a network of southwest Chicago schools. Those with greater reach were also significantly more likely to have continuity in program staff and more years of site operation (all P values ≤0.01). The last four factors remained significant in multivariate analysis.
Conclusions
School-based summer meals programs may be able to reach more vulnerable children by taking into account continuity among sites and staff. Further research is needed to clarify whether the relationships between these variables and increased reach is causal.
... Factors such as racial composition (Thibodeaux, 2015) have also been used to probe for answers. Shannon (2014) revealed that suburban supermarkets receive almost all SNAP benefits, while only a small portion of SNAP redemptions are realized in low-income core neighborhoods. Here, the presence or absence of neighborhood supermarkets may be less important than expected because low-income residents often travel outside their neighborhoods to obtain food. ...
While several studies have explored geographic relationships within the Supplemental Nutrition Assistance Program (SNAP), results have been mixed. Findings have revealed an imbalanced SNAP participation rate among eligible populations in both suburban and rural areas. Studies on SNAP accessibility have often focused on store locations, but few have examined issues of traveling to SNAP offices. In this study, we focused on SNAP office accessibility and its association with rurality. Using Google Map API, we calculated road travel time and distance to the most conveniently located SNAP office for each block group in the conterminous United States. We investigated the degree to which the SNAP office accessibility is linked to rurality, participant demographics, socioeconomic characteristics, and the program's overall participation rate. Results showed that at the block-group level, the SNAP-eligible average driving time to the most convenient SNAP office is 15.28 min, while the SNAP-eligible average distance is 8.57 miles. More than 75% of the SNAP-income eligible population lives within a 20-min drive to a SNAP office, and 91.8% lives within 30 min. Every ten percentage points of increase in rurality decreases SNAP office accessibility by one additional minute of car travel time. We designed a Rurality-Travel Clock (RTC) visualization tool to provide a graphic description of the urban-rural setting and SNAP office accessibility. Other observations include a noticeable cross-relationship between population concentration (e.g., white or black) and SNAP office accessibility. The findings help us to understand the dynamic relationships between SNAP participation rate and SNAP accessibility factors, including eligibility, employment status, population, and rurality at the county and state levels.
... These investigators concluded that, at best, food store density explained only a small fraction of the variation in the nutritional quality of foods purchased. Although people purchased outside their closest supermarket (14,15) , people were still more likely to use stores closer to home (5,11,16) even when the regional food market environment matters. In the present paper, we examine both availability of neighbourhood food stores and potential access to food stores in the region. ...
Objective:To determine whether neighbourhood supermarket and convenience store availability and broader built environment context are associated with food purchasing behaviour in a national population.
Design:We used observational data to perform a cross-sectional study of food purchases for US households in 2010. We used three-level mixed-effect regression models to determine whether the associations between the number of neighbourhood supermarkets and convenience stores and the self-reported annual household expenditures for fruits and vegetables were affected by regional destination accessibility, neighbourhood destination diversity, availability of neighbourhood destinations and neighbourhood street connectivity.
Setting:Metropolitan statistical areas (n 378) in the USA.
Participants:Households (n 22 448).
Results:When we controlled for broader built environment context, there was no significant association between availability of neighbourhood supermarkets and expenditures on fruits and vegetables; instead, we observed an inverse association between the number of convenience stores and expenditures for fruits (P = 0·001). The broader built environment context was associated with food purchase, although the magnitude was small: (i) higher regional destination accessibility was associated with higher expenditures for fruits (P < 0·001); (ii) higher neighbourhood destination diversity was associated with lower expenditures for vegetables (P = 0·002); and (iii) higher neighbourhood street connectivity was associated with higher expenditures for fruits (P < 0·001).
Conclusions:The broader built environment factors contributed to understanding how people use neighbourhood food stores. However, there was only a small relationship between the broader environment context and fruit and vegetable expenditures. Policy interventions that focus exclusively on increasing the availability of neighbourhood supermarkets likely will not promote fruit and vegetable consumption.
... Places that are targeted for community development investments are more likely to face multiple health disadvantages related to the social determinants of health. For example, high-poverty communities are less likely to have access to fresh and nutritious foods, 15 have higher rates of chronic conditions, including diabetes, obesity, heart disease, and sexually transmitted diseases, 16,17 and are more likely to experience violence. 17 Some community development organizations are addressing these health disparities across the United States, especially in food and environmental health. ...
Purpose: Achieving health equity requires addressing the social determinants of health, which philanthropy has supported through community development grants. This study analyzes health topics that have been integrated into community development grants.
Methods: Community development grants from 2010 to 2017 were analyzed for health topics in Baltimore, MD.
Results: Food and nutrition, chronic disease, reproductive health, adolescent health, violence prevention, health care access, and infectious disease were the least common health topics in community development grants.
Conclusion: To support health equity efforts, funders should consider a broader range of health issues to integrate into community development investments.
... To encourage consumption of healthful foods among SNAP participants, public health efforts have promoted multiple interventions that aim at improving food purchasing behavior. One successful effort which was instrumental in informing the development of SNAP inventory requirements was expanding the provision of healthful foods in small food retailers [23][24][25][26][27][28]. Several attempts have been made at increasing the variety and quantity of staple foods that SNAP-authorized stores are required to carry. ...
Inventory requirements for authorized Supplemental Nutrition Assistance Program (SNAP) retailers have undergone several revisions to increase the availability of healthful foods. A proposed rule of 84 staple food items was not implemented due to concerns that stores would not withstand this expansion, resulting in a final rule requiring 36 items. This study used the Food Access Research Atlas data to characterize food provisions in 30 small retailers in areas with high and low proportions of SNAP and racial minority residents in Providence, Rhode Island (RI). Stores were assessed with an audit instrument to tally variety, perishability, and depth of stock of four staple food categories. Descriptive, analysis of variance, and chi-square analyses were performed. Across stores, 80% were compliant with the final rule, but 66.7% would need to expand their offerings to meet the proposed rule. Mean dairy variety was lowest among all categories (p < 0.05). Most stores met the perishability (92.3%) and depth-of-stock requirements (96.1%) under both rules. No difference was detected between areas with high and low proportions of SNAP and racial minority residents. Future expansion of requirements may increase healthful food availability without imposing undue burdens on retailers in Providence, RI, excluding increased requirements for dairy variety.
... In Ohio, this is the store format that increased 101.5% in SNAP authorization during our study period. Although the majority of SNAP participants identify a supermarket as their primary location for food shopping (Mabli et al. 2013), in a study of the Twin Cities, Shannon (2014) found that more SNAP benefits are redeemed at convenience stores and small groceries in low-income areas, particularly when compared to middle-class, suburban neighborhoods. Furthermore, although 84% of SNAP benefits were redeemed at supermarkets and supercenters, only 64% of the transactions occurred at these stores, compared to 4% and 15%, respectively, for convenience stores (Castner and Henke 2011). ...
The largest public assistance program in the United States, the Supplemental Nutrition Assistance Program (SNAP), relies on private retailers for program access. We analyze geo-coded SNAP-authorized convenience and grocery stores in 2000 and 2010 to determine factors associated with their accessibility. Results demonstrate that accessibility was higher in areas with high rates of SNAP income-eligible individuals, but that some spatial disparity persists, particularly in areas with lower initial access and rural areas. Findings highlight the importance of SNAP-authorized convenience stores if markets continue to determine the location of SNAP access points.
... 283 Urban planning interventions should account for local context and address ways in which residents of low-income areas interact with local food systems, such as their ability or desire to travel to different areas to buy food. 284 In low-income countries, ensuring adequate infrastructure (eg, roads, bridges, and transportation) to remote or rural areas can improve access to sellers of healthy food and reduce food prices, food price volatility in local markets, 285 and food losses during transport. Agricultural extension programmes that focus on nutrition and food security can help ensure that rural farmers and women in rural households are equipped with the information and skills they need to obtain healthy diets from sustainable food systems. ...
... Another study found that low-income shoppers in a large metropolitan area redeemed 33% of their SNAP benefits, and as high as 85% in some neighborhoods, at stores likely to be ethnic markets (Shannon, 2014). ...
This paper presents findings from our longitudinal study of food environments in two exemplary, contrasting urban neighborhoods in Downtown Albany, New York. The “minority neighborhood” (74% racial/ethnic minority population) is a “food desert” by the United States Department of Agriculture's definition, whereas the adjacent “mixed neighborhood” (33% minority population) is not. The long‐term trend analysis (1970–2018) of the macro‐level food environment found that although the minority neighborhood lost all supermarkets and remains supermarket‐less since the late 1990s, the mixed neighborhood was able to retain several supermarkets and since 2008, it gained a new supermarket every 3–5 years. The medium‐term trend analysis (2003–2015) of the micro‐level food environment revealed a more complex picture of changing food environments. The total number of food stores in the minority neighborhood increased in much greater rates than the mixed neighborhood in the 12‐year period, and accordingly, the standardized availability measures for “any” fresh fruits and fresh vegetables increased significantly in the minority neighborhood. The standardized availability measure for adequate (five or more) varieties of nutritionally desirable fresh fruits and vegetables, however, did not increase in the minority neighborhood. Because the mixed neighborhood saw steady increases in such measures, disparities between the two neighborhoods grew incrementally and reached the highest point (rate ratio of over 5.0) in 2015. In this paper, there are also sections to provide historical and contextual background of our food environment research, as well as discussion on intervention ideas to address the disparities in fresh produce availability focusing on ethnic markets.
... However, selection of food items available may not be the healthiest choice which would prevent youth from increasing their healthy eating self-efficacy (Robaina & Martin, 2013). Furthermore, both schools that youth participants attended were located in food deserts (USDA, 2015), or areas that have limited access to nutritious and affordable food (Shannon, 2014). Because youth tend to live in the same geographical location as their school, youth's families may not have access to stores with healthy food items available. ...
Childhood obesity rates have dramatically increased since the 1980’s. This has become major public health concern because children who are overweight or obese are more likely to have obesity-related health issues and are more likely to be overweight or obese as adults. Obesity is also associated with poor dietary habits. Currently, children have dietary patterns that are low in fruits, vegetables, and whole grains. In addition, many Americans lack the knowledge on how to prepare healthful meals and because of this there is a lack of a meal preparation knowledge being transferred to children. To help address these issues it has been suggested that there is a need to teach youth not only nutrition knowledge but also basic cooking skills. The objective of this study was to examine the impact of a 12-week afterschool cooking and nutrition club on youth nutrition knowledge, eating behavior and self-efficacy, and cooking attitude and self-efficacy among 4th and 5th grade students attending two Title I elementary schools. A secondary objective was to evaluate the novel healthy plate photo to assess youths’ nutrition knowledge. After participating in the WeCook program, 84.1% of youth reported they really liked to cook and 56% reported they could read a recipe by themselves. Youth significantly increased their knowledge about why breakfast is important and healthy snack options. At post-intervention there was a significant increase in the healthy plate photo scores from pre- to post-intervention with 55.1% of youth scoring the maximum score. Finally, mixed results were seen for healthy eating behaviors and self-efficacy. Further research is needed to understand the effects cooking and nutrition programs have on youth participants related to nutrition knowledge, healthy eating behaviors and self-efficacy, and cooking attitude and self-efficacy. Advisor: Weiwen Chai
... Given the feasibility and reliability of widely used dasymetric mapping, the dasymetric interpolation technique is one of the best approaches for refining the spatial resolution of population data (Wu et al. 2005, Mennis andHultgren 2006). The dasymetric technique for refining population distribution is successfully applied, for example, for studying tourism (Vaz and Campos 2013), accessibility (Langford et al. 2008, Shannon 2014, risk exposures and disaster management (Linard andTatem 2012, Smith et al. 2014). ...
Novel digital data sources allow us to attain enhanced knowledge about locations and mobilities of people in space and time. Already a fast-growing body of literature demonstrates the applicability and feasibility of mobile phone-based data in social sciences for considering mobile devices as proxies for people. However, the implementation of such data imposes many theoretical and methodological challenges. One major issue is the uneven spatial resolution of mobile phone data due to the spatial configuration of mobile network base stations and its spatial interpolation. To date, different interpolation techniques are applied to transform mobile phone data into other spatial divisions. However, these do not consider the temporality and societal context that shapes the human presence and mobility in space and time. The paper aims, first, to contribute to mobile phone-based research by addressing the need to give more attention to the spatial interpolation of given data, and further by proposing a dasymetric interpolation approach to enhance the spatial accuracy of mobile phone data. Second, it contributes to population modelling research by combining spatial, temporal and volumetric dasymetric mapping and integrating it with mobile phone data. In doing so, the paper presents a generic conceptual framework of a multi-temporal function-based dasymetric (MFD) interpolation method for mobile phone data. Empirical results demonstrate how the proposed interpolation method can improve the spatial accuracy of both night-time and daytime population distributions derived from different mobile phone data sets by taking advantage of ancillary data sources. The proposed interpolation method can be applied for both location- and person-based research, and is a fruitful starting point for improving the spatial interpolation methods for mobile phone data. We share the implementation of our method in GitHub as open access Python code.
... When the WIC food package was revised, it showed a positive impact on home food availability and intake among participating households (Odoms-Young, Kong, Schiffer, et al., 2014). We have a good understanding that SNAP participation improves food access (e.g., Shannon, 2014;Mancino, Ver Ploeg, Guthrie & Lin, 2016); through receipts analyses, we know what SNAP participants purchase using their benefits (e.g., Mancino, Ver Ploeg, Guthrie & Lin, 2016). Andreyeva et al. (2012) examined beverage expenditures by WIC and SNAP participants and found that WIC participants purchased more juice as compared to SNAP participants; SNAP participants purchased more sugar-sweetened beverages (Andreyeva, Luedicke, Henderson, & Tripp, 2012). ...
Objective:
Little nutrition research has been conducted among families with unstable housing. The objective of this study was to examine the role of food stamps (i.e., Supplemental Nutrition Assistance Program; SNAP) in home food availability and dietary intake among WIC families who experienced unstable housing.
Design and sample:
Cross-sectional study among vulnerable families. Low-income, multiethnic families with children participating in WIC (n = 54).
Measures:
Dietary intake was assessed with 24-hr recalls. Home food availability was assessed with an adapted home food inventory for low-income, multiethnic families. Validation results from adapted home food inventory for these families are also reported.
Results:
SNAP households had more foods than non-SNAP households; few significant associations were observed between food availability and child dietary intake.
Conclusions:
With few exceptions, the home food environment was not related to children's dietary intake among these vulnerable families. More research is needed on food access for families facing unstable housing.
... In Minnesota, where SNAP transactions are similarly distributed across store type compared with nationally, the use of SNAP benefits at small and non-traditional stores may be even higher in certain neighbourhoods. A study in the Twin Cities metropolitan area showed that a far greater share of SNAP benefit redemptions occur outside supermarkets and supercentres in low-income and high-minority areas (35) . ...
Objective:
Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type.
Design:
Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store.
Setting:
Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA.
Subjects:
Customers (n 661) from 105 food retailers.
Results:
Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of $US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4.
Conclusions:
Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.
... Further, a singular focus on locational proximity is likely to obscure the varied ways that people procure food and the broader political economic processes that contribute to the distribution of material resources and power across urban space and societies (Alkon et al. 2013;Block et al. 2011;Pine & Bennett 2014;Shannon 2014). Spatial models, however sophisticated, may not be able to fully account for the complexities of access and how individuals actually interact with or experience their surroundings (Hillier et al. 2011). ...
This paper develops a theoretical and conceptual framework for research on urban geographies of food and dietary health. This framework conceptualizes urban dietary health inequities as produced relationally through multiscalar social, political, economic, and biological processes intersecting in place-specific ways. It synthesizes perspectives from spatial analytical food access research, relational health geographies, political ecologies, and critical geographic information science (GIS). Recognizing the importance of relational, dynamic conceptions of both spatial context and human health, it suggests extending current approaches by integrating critical GIS methodologies for producing alternative spatial representations and political ecology's theorization of urban spaces as produced through the intersection of multiscalar social and ecological processes. Reflecting political ecological and critical GIS perspectives, it also emphasizes that (spatial) knowledge production processes materially impact urban environments and human health.
... These results highlight that there may be an overall lack of resources in specific areas or neighborhoods, which likely influence health outcomes and contribute to health disparities in low resource settings. Previously, these disparities have been identified as physical gaps in health care and food access [45][46][47]. This study suggests that sexual health resources should also be included in assessing the needed resources in physical environments that serve as barriers to positive health outcomes. ...
Identifying predictors that contribute to geographic disparities in sexually transmitted infections (STIs) is necessary in order to reduce disparities. This study assesses the spatial relationship condom availability and accessibility in order to better identify determinants of geographic disparities in STIs. We conducted a telephone-based audit among potential-condom selling establishments. Descriptive analyses were conducted to detect differences in condom-selling characteristics by stores and by store type. Geocoding, mapping, and spatial analysis were conducted to measure the availability of condoms. A total of 850 potential condom-selling establishments participated in the condom availability and accessibility audit in St. Louis city; 29 % sold condoms. There were several significant geographic clusters of stores identified across the study area. The first consisted of fewer convenience stores and gas stations that sold condoms in the northern section of the city, whereas condoms were less likely to be sold in non-convenience store settings in the southwestern and central parts of the city. Additionally, locations that distributed free condoms clustered significantly in city center. However, there was a dearth of businesses that were neither convenience stores nor gas stations in the northern region of the city, which also had the highest concentration of condoms sold. This initial study was conducted to provide evidence that condom availability and accessibility differ by geographic region, and likely are a determinant of social norms surrounding condom use and ultimately impact STI rates.
... An earlier phase of this research project included an analysis of data on food assistance benefit usage for the Twin Cities metropolitan area during fiscal year 2010 (Shannon 2014), using data from the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps). In that analysis, ZIP code data on benefit enrollment were interpolated at a finer scale using dasymetric mapping techniques. ...
Most research on urban food deserts has employed spatial measures of accessibility, recording distances to various food stores from place of residence. Despite the popularity of this approach, empirical support for its prediction of dietary and health outcomes has been inconsistent. One reason might be the ways in which food deserts frame food access as fundamentally an issue of food supply. This article suggests a complementary approach that examines how store characteristics, neighborhood context, and individual mobility interact to shape food provisioning practices. I recruited thirty-eight participants living in two low-income neighborhoods of Minneapolis, Minnesota, tracking their daily mobility and the food sources they used over a five-day study period. Follow-up interviews gathered more information on the food stores used by participants. Project results show that participants were highly mobile in their food shopping, visiting 153 different locations on 217 different shopping trips at an average distance of 3.4 km from home. Reported store quality was closely tied to neighborhoods' economic and racial composition, and in several cases, food purchasing and consumption occurred en route to other destinations. Future research on urban food access could benefit by studying how food access is intertwined with broader livability issues such as housing and transportation.
... Small food store purchases may be a particularly important source of food for lower-income adults (6) . It has been estimated that 20 % of Supplemental Nutrition Assistance Program (SNAP) transactions for low-income households occurred at convenience stores or other small food stores (10) , and SNAP benefit redemptions at convenience stores occur with much greater frequency in low-income urban areas compared with high-income suburban areas (11) . Such shopping patterns are important to health, as frequent small food store shopping has been associated with unhealthy food purchases, lower vegetable intake and increased obesity risk (6,(12)(13)(14)(15)(16) . ...
Objective:
Little is known about the practices for stocking and procuring healthy food in non-traditional food retailers (e.g. gas-marts, pharmacies). The present study aimed to: (i) compare availability of healthy food items across small food store types; and (ii) examine owner/manager perceptions and stocking practices for healthy food across store types.
Design:
Descriptive analyses were conducted among corner/small grocery stores, gas-marts, pharmacies and dollar stores. Data from store inventories were used to examine availability of twelve healthy food types and an overall healthy food supply score. Interviews with managers assessed stocking practices and profitability.
Setting:
Small stores in Minneapolis and St. Paul, MN, USA, not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.
Subjects:
One hundred and nineteen small food retailers and seventy-one store managers.
Results:
Availability of specific items varied across store type. Only corner/small grocery stores commonly sold fresh vegetables (63 % v. 8 % of gas-marts, 0 % of dollar stores and 23 % of pharmacies). More than half of managers stocking produce relied on cash-and-carry practices to stock fresh fruit (53 %) and vegetables (55 %), instead of direct store delivery. Most healthy foods were perceived by managers to have at least average profitability.
Conclusions:
Interventions to improve healthy food offerings in small stores should consider the diverse environments, stocking practices and supply mechanisms of small stores, particularly non-traditional food retailers. Improvements may require technical support, customer engagement and innovative distribution practices.
The overall objective of this research is to use spatial methods to better understand food insecurity and SNAP under-participation in Texas. Paper 1 assesses whether a sample of community dwelling Medicare and Medicaid beneficiaries, who screen positive for food insecurity at healthcare locations in Harris County, exhibit a spatial pattern in terms of where they live. In other words, it tests whether or not there are statistically significant neighborhood hot spots or cold spots of food insecurity against a null hypothesis of complete spatial randomness. This approach is novel because it uses address-level data on patients who report being food insecure to test for statistically significant neighborhood hot spots or cold spots, instead of relying on extant factors like neighborhood poverty rates, or the presence of grocery stores. Using address-level food insecurity screening data is often difficult because few organizations screen for food insecurity, and even fewer are willing to share their data due to privacy concerns. Paper 2 utilizes geographical information systems (GIS) to map census tract-level clusters and outliers of households that are eligible but not enrolled (EBNE) in the SNAP program. The implications of this analysis are vast. Knowing the locations of neighborhood-level clusters and outliers of SNAP EBNE households can inform interventions to address the “SNAP GAP” more effectively. Additionally, this method of identifying neighborhood-level clusters and outliers of SNAP EBNE households can be applied to other safety net programs including Medicaid, the Children’s Health Insurance Program (CHIP), Healthy Texas Women, and the Women, Infant, and Children (WIC) Program.
This cross-sectional descriptive study utilized spatial statistics to test for hot/cold spots of SNAP under-participation in Texas. First, we estimated the percentage of SNAP eligible but not enrolled (EBNE) households, by census tract. Next, we utilized the Anselin’s Local Moran’s I statistic to identify statistically significant hot/cold spots of SNAP EBNE tracts throughout Texas and in Harris County. We found that hot spot census tracts had significantly higher densities, income levels, and lower poverty rates than other census tracts. Using spatial statistics to identify hot/cold spots of SNAP under-participation offers a novel method for understanding area SNAP utilization.
Research suggests an important role for planners and policymakers in enhancing neighborhood access to healthy food. Spatial analysis is often used to explore relationships between proximity to sources of food and health outcomes such as food security and risk for diet-related disease. Spatial models often account for proximity based on walking distance or automobile but advancements in geospatial technologies now allow for estimates of access by transit as well as travel time to understand neighborhood level food security. One approach for addressing this gap is to employ real-time travel estimates over transit and road networks to more precisely measure food access. In this paper, we compare the Google Distance Matrix API calculating both the distance and time between origins and destinations, with other spatial approaches to understanding grocery store and full-service supermarket access in this case study of San Diego, California. Results suggest that distances between residents and food outlets are constant across modes of transport but travel times are highly differentiated by mode. Trips to stores by transit are on average, three times longer than trips by car. This paper offers a new understanding of the potential for incongruence between spatial proximity and true accessibility in the built environment.
The Supplemental Nutrition Assistance Program (SNAP) has been shown to have positive benefits for children. Families may face fewer barriers to accessing food they can purchase with their benefits if more stores in their neighborhoods accept SNAP benefits. We examine whether proximity to stores accepting SNAP benefits is related to child maltreatment (abuse and neglect) reports, particularly those related to food insecurity. We combine geographically identified child maltreatment report data from the state of Connecticut from 2011 through 2015 with state SNAP-authorized retailer data. Using within-Census block group changes in the presence of a SNAP-authorized store, we find that in large, rural areas, one additional SNAP store is associated with a 4.4 percent decrease in the child maltreatment report rate (p < 0.05), and an 11.3 percent decrease in substantiated cases of maltreatment (p < 0.10), even net of changing zip code level factors and time-invariant neighborhood characteristics. The relationship between a neighborhood SNAP store and child maltreatment reports in these rural areas is largely driven by neglect, concentrated among young and school-aged children (ages 0-9), and primarily due to fewer reports by medical personnel. We find no effects of a neighborhood SNAP store on child maltreatment reports in smaller, more densely populated neighborhoods. Sensitivity checks affirm these results. Results indicate the benefits of access to SNAP retailers on the child welfare system and child well-being more broadly, especially in rural areas.
Past research finds that living in a food desert is associated with an unhealthy diet and poor health; however, more recent studies of urban food deserts suggest that these findings may be spurious. In this article, we leverage the flooding and subsequent closing of the only grocery store in a small town to examine the effects of living in a small-town food desert. Using difference-in-difference methods, we find that opening a grocery store in a small-town food desert is not associated with changes in diet, but we find that opening a grocery store in a food desert is associated with improved food access. Findings from in-depth interviews shed further light on how residents of a small-town food desert decide where to shop and how routine activities provide access to a range of nonlocal grocery stores. Moreover, we find that the absence of a grocery store negatively affects social relationships. While the findings add to growing skepticism about food desert effects on diet, the findings reveal important food desert effects on food access and also the social consequences of living in a food desert.
There is a gap in the literature around promotion of healthy and low-cost food options for WIC recipients. Ten semi-structured interviews were conducted with retailers to explore the challenges and opportunities of promotions to WIC recipients. Retailers reported doing little to no promotions targeted at WIC recipients at the time of interview. The possibility of increased revenue, particularly for fruits and vegetables, presents an area of potential collaboration between public health officials and retailers. The main barriers to increased promotions were restrictions around promotions directly marketed to WIC recipients and concern by retailers and policymakers about potential stigmatization.
Objective
To determine the efficacy of an interactive, home visiting curriculum tailored to low socioeconomic status families in improving parental knowledge of pediatric nutrition and healthy lifestyle
Methods
Parents of toddlers aged 13‐16 months living with a household income below 200% of the federal poverty line were randomized into healthy lifestyle intervention and control home visiting curriculum groups. Each curriculum consisted of twelve one‐on‐one educational sessions with parents facilitated by a trained home‐visitor that were administered over a 6‐month intervention period. Knowledge assessments were administered before and after the intervention period.
Results
Results of a one‐way ANCOVA analysis showed that parents in the intervention group (M = 26.05, SD = 4.24) scored significantly higher than control parents (M = 23.84, SD = 4.26) post‐intervention, controlling for parent education level, F (1, 102) = 7.494, 95% confidence interval: [‐3.68, ‐0.59]. One‐way ANCOVA analysis showed no significant mean difference between the parents in the intervention group (M = 24.13, SD = 4.37) and the control group (M = 23.93, SD = 4.16) at baseline, controlling for parent education level, F (1, 163) = 0.002, 95% confidence interval: [‐1.28, 1.22].
Conclusions
An interactive healthy lifestyle intervention focused on low‐SES families significantly improved parental knowledge of pediatric healthy lifestyle. Changes in parental knowledge is a key preliminary step in behavior change to ultimately affect behavior. Informing and encouraging parents of toddlers to guide healthy lifestyle development early remains a promising point of intervention for prevention, rather than remediation, of childhood obesity.
This reports on our project to develop rural typologies that differentiate areas based on theoretically-specified variables and to explore the relationship between these typologies and health outcomes
A cross-sectional self-administered survey was conducted with adult participants from Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Education Program class series (n = 194) to assess respondents’ perceptions about their primary grocery store and food pantry environments that are potentially influential in obtaining fruits and vegetables (F&V). Survey design followed the Model of Community Nutrition Environments. Perceived availability, access, and affordability of F&V in the retail environment were assessed including factors potentially influencing greater purchase of F&V. The survey sample included respondents from diverse ethnic/racial groups. Findings provide guidance to retail and food pantry partners for promoting healthier choices in ways meaningful to respondents.
Background:
The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program in the United States. Participants receive electronic benefits that are redeemable at a variety of food stores. Previous research notes that low-income neighborhoods often lack supermarkets with high-quality, affordable food.
Objective:
The first aim of this study was to explore the number and spatial distribution of SNAP stores by type and to assess how SNAP benefit redemption is linked to store type in North Carolina in 2015. The second aim was to compare the demographics of populations living in areas with a high concentration of SNAP participants vs areas with a lower concentration of SNAP participants. The third aim was to test for disparities in the availability of and access to SNAP-authorized stores in areas with high vs low concentration of SNAP participants stratified by rural/urban status.
Design:
US Department of Agriculture and US Census data were used to explore the spatial distribution of SNAP stores at the census block group level utilizing a Geographic Information System.
Participants:
The 9,556 North Carolina SNAP stores in 2015 categorized into full-variety and limited-variety stores.
Outcome measures:
Proximity to limited-variety SNAP food stores and full-variety SNAP food stores within access range (1 mile in urban areas and 10 miles in rural areas).
Statistical analyses:
Wilcoxon rank sum and χ2 tests are used to compare the distance to and concentration of SNAP stores by rurality and SNAP participant concentration at census block group scale.
Results:
Among the SNAP stores in North Carolina, 83% are limited-variety stores and 17% are full-variety stores. There are disparities in the demographics of individuals living in census block groups with a high proportion of SNAP participants compared to census block groups with a lower proportion of SNAP participants. More households in higher SNAP participant census block groups were non-white, did not have a car, and had children compared to census block groups with lower SNAP participation. Residents in high SNAP participant census block groups typically had access to 0 full-variety stores and 4 limited-variety stores in urban areas and 3 full-variety stores and 17 limited-variety stores in rural areas.
Conclusions:
SNAP participant access to a variety of stores should be considered when approving food stores for SNAP authorization. More research is essential to disentangle the relationship between access to SNAP store type and SNAP food choice and to estimate geographical disparities.
This study surveys 900 supplemental nutrition assistance program recipient or eligible households and 300 supplemental nutrition assistance program ineligible households in local food deserts to identify the effects of different dimensions of access on fresh fruit and vegetables (FFV) consumption. While proximity and access to one's own car were not significant predictors of FFV consumption, realized access to nonsupermarket outlets did have a positive effect on fresh vegetable consumption. Among food insecure respondents, limited car access had a negative effect on FFV consumption. This research underlines the importance of focusing on dimensions of access other than proximity when considering interventions designed to improve nutrition and health outcomes in food deserts.
Food and nutrition policy in the United States relies heavily on convincing individual household food provisioners to make healthy choices to improve their eating behavior. This policy strategy has not only been unsuccessful in encouraging healthy eating but also ignores the labor involved in this work of provisioning the household. This focus on individual behavior change meshes well with the ideology of consumer sovereignty, which is the belief in the power of the individual consumer to influence the food system by what they purchase. Using the Let’s Move! Program, initiated by Michelle Obama, as an example of mainstream nutrition policy, this article highlights the problems with our current food and nutrition policy, especially with regard to the gendered work involved in provisioning, and offers examples of more effective policies for promoting health through public provisioning policies and programs.
Analyses aimed at identifying food deserts-defined as areas with limited access to healthy food-have garnered much recent attention from the news media, policy makers, and non-profit groups. Much of this research relies on the proximity of large grocery stores as a measure of food access. These studies have been limited by poor data quality, boundary effects, and scale dependence. Drawing on data from the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps), we suggest an alternative approach that incorporates the distribution and redemption of food assistance benefits in low-income neighborhoods. This data is publically available, but at the zip code level, limiting its usefulness for neighborhood analysis. We use a three-class areal interpolation method to develop three disaggregation techniques that increase the usability of this data. These utilize several external data sources to weight the distribution of this data, including the U.S. Census, U.S. Geological Survey satellite imagery, and existing cadastral data. Our analysis, focused on the Twin Cities metropolitan region for federal fiscal year 2010, thus allows for a more accurate depiction of how residents actually access the food system.
Research on the impact of the built environment on obesity and access to healthful foods often fails to incorporate information about how individuals interact with their environment. A sample of 198 low-income WIC recipients from two urban neighborhoods were interviewed about where they do their food shopping and surveys were conducted of food stores in their neighborhoods to assess the availability of healthful foods. Results indicate that participants rarely shop at the closest supermarket, traveling on average 1.58 miles for non-WIC food shopping and 1.07 miles for WIC shopping. Findings suggest that access to healthful foods is not synonymous with geographic proximity.
In light of claims that many low-income urban neighborhoods are “food deserts,” this article reports on pilot research to assess whether and how small, full-service food retailers contribute to urban food security. It demonstrates that such stores meet many of the criteria for community food security by providing a wide variety of relatively low-cost foods. At the same time, their geographic unevenness, tendency to target particular ethnic clienteles, and inability to address affordability in an absolute sense place some caveats on the conclusions and suggest the need for more fine-grained research regarding how the unique economic development histories and cultural politics of neighborhoods affect food availability.
Food environments may promote or undermine healthy behaviors, but questions remain regarding how individuals interact with their local food environments.
This study incorporated an urban food environment audit as well as an examination of residents' food shopping behaviors within that context.
In 2010, the research team audited the variety and healthfulness of foods available in 373 Philadelphia stores, using the validated Nutrition Environment Measures Survey in Stores (NEMS-S); higher scores indicate more diverse and healthful food inventories. The team also surveyed urban residents (n=514) regarding their food shopping. Descriptive and multivariate analyses (conducted in 2012) assessed variation in retail food environments and in shoppers' store choices.
Corner and convenience stores were common (78.6% of food retail outlets) and had the lowest mean NEMS-S scores of any store type. Most participants (94.5%) did their primary food shopping at higher-scoring chain supermarkets, and the majority of participants did not shop at the supermarket closest to home. Supermarket offerings varied, with significantly fewer healthful foods at supermarkets closest to the homes of disadvantaged residents. In multivariate analyses, participants were significantly more likely to shop at supermarkets closest to home if those supermarkets had higher NEMS-S scores.
These data suggest that, when possible, shoppers chose supermarkets that offered more variety and more healthful foods. Findings from this study also reinforce concern regarding unhealthy immediate food environments for disadvantaged residents, who disproportionately relied on nearby stores with more limited food items. Interventions to improve nutrition and health should address not only food store proximity but also diversity of healthful foods available.
Any study that examines the effects of area-based attributes on individual behaviors or outcomes faces another fundamental methodological problem besides the modifiable areal unit problem (MAUP). It is the problem that results about these effects can be affected by how contextual units or neighborhoods are geographically delineated and the extent to which these areal units deviate from the true geographic context. The problem arises because of the spatial uncertainty in the actual areas that exert the contextual influences under study and the temporal uncertainty in the timing and duration in which individuals experienced these contextual influences. Using neighborhood effects and environmental health research as a point of departure, this article clarifies the nature and sources of this problem, which is referred to as the uncertain geographic context problem (UGCoP). It highlights some of the inferential errors that the UGCoP might cause and discusses some means for mitigating the problem. It reviews recent studies to show that both contextual variables and research findings are sensitive to different delineations of contextual units. The article argues that the UGCoP is a problem as fundamental as the MAUP but is a different kind of problem. Future research needs to pay explicit attention to its potential confounding effects on research results and to methods for mitigating the problem.
This paper takes up the challenge of "reconstructing GIS" by examining GIS and governmental rationality. As an aspect of government, mapping is a vital source of geographic knowledge that informs political decision-making. Of particular importance to geographic governance and management are population distributions such as health, wealth, education, density, or criminality. Yet how these distributions have been mapped has shifted and been contested historically. Whereas in the early nineteenth century populations merely filled in pre-existing political areas, by the early twentieth century populations were understood as themselves defining areas and boundaries. Today, GIS has returned to the earlier unproblematic politics of space. I explain these shifts by identifying similar shifts between the choropleth and the dasymetric map. Although commonly used, the choropleth is inadequate and misleading. I discuss the possible reasons for these shifts by re-emphasizing mapping as an aspect of geographic governance.
This paper forms part of the 'Food Deserts in British Cities' project. It reports on the findings of a series of focus groups conducted with residents in the Seacroft 'food desert' (in Leeds) in the period prior to a major improvement in their food retail accessibility. The paper explores individual food shopping behaviour, consumption patterns and attitudes towards a healthy diet and, in so doing, begins to develop an understanding of how different demographic groups adapt to living within a 'food desert'. The focus is on the perceived economic and physical constraints of residents in the area, but interwoven with this are other considerations such as motivation to consider health, family responsibilities and individual smoking status.
This paper provides an introduction to the 'food deserts' theme by outlining how the problem of access to food, particularly foods integral to a healthy diet, for low-income households in poor neighbourhoods in British cities, became an increasingly important issue in the social exclusion and health inequalities debates, during the late 1990s. It documents the emergence of a policy response by UK government to this issue and the way in which policy development ran somewhat ahead of systematic research on key facets of the problem. The paper outlines the research priorities which became apparent by the end of the 1990s and some of the projects which have been funded by the UK research councils and by government departments and agencies to meet this need for fundamental research.
Concurs with earlier research showing that most low-income households live close to grocery stores or supermarkets although those in rural areas may be much farther away. Also examines attitudinal data related to shopping patterns and shows that many engage in careful shopping to stretch their food-buying resources. Call the Food and Nutrition Service at 703-305-2133 for printed copies.
Background
Proximity of food stores is associated with dietary intake and obesity; however, individuals frequently shop at stores that are not the most proximal. Little is known about other factors that influence food store choice. The current research describes the development of the Food Store Selection Questionnaire (FSSQ) and describes preliminary results of field testing the questionnaire.
Methods
Development of the FSSQ involved a multidisciplinary literature review, qualitative analysis of focus group transcripts, and expert and community reviews. Field testing consisted of 100 primary household food shoppers (93% female, 64% African American), in rural and urban Arkansas communities, rating FSSQ items as to their importance in store choice and indicating their top two reasons. After eliminating 14 items due to low mean importance scores and high correlations with other items, the final FSSQ questionnaire consists of 49 items.
Results
Items rated highest in importance were: meat freshness; store maintenance; store cleanliness; meat varieties; and store safety. Items most commonly rated as top reasons were: low prices; proximity to home; fruit/vegetable freshness; fruit/vegetable variety; and store cleanliness.
Conclusions
The FSSQ is a comprehensive questionnaire for detailing key reasons in food store choice. Although proximity to home was a consideration for participants, there were clearly other key factors in their choice of a food store. Understanding the relative importance of these different dimensions driving food store choice in specific communities may be beneficial in informing policies and programs designed to support healthy dietary intake and obesity prevention.
Several studies have demonstrated relationships between neighborhood-level retail food environments and obesity, race/ethnicity, and socioeconomic status. Most, however, have been limited by the use of residential neighborhoods to define food environments. This study recruited 121 participants to supply three days of Global Positioning System (GPS) tracking data to explore daily activity spaces and food environments. Participants also answered two surveys regarding personal characteristics, and diet and food purchasing. Several food environment measures were calculated for food locations within a half-mile of their GPS tracks. Non-parametric statistics examined (1) differences between activity- and neighborhood-based food environments, (2) associations between personal characteristics and activity-based food environments, and (3) associations between diet, purchasing, and activity-based food environments. Activity- and neighborhood-based food environments were significantly different. Several associations were observed among activity-based food environment measures and personal characteristics. Dietary intake, food purchasing, and obesity were associated with some activity-based food environment measures.
A growing body of cross-sectional, small-sample research has led to policy strategies to reduce food deserts--neighborhoods with little or no access to healthy foods--by limiting fast food restaurants and small food stores and increasing access to supermarkets in low-income neighborhoods.
We used 15 years of longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of US young adults (aged 18-30 years at baseline) (n = 5115), with linked time-varying geographic information system-derived food resource measures. Using repeated measures from 4 examination periods (n = 15,854 person-examination observations) and conditional regression (conditioned on the individual), we modeled fast food consumption, diet quality, and adherence to fruit and vegetable recommendations as a function of fast food chain, supermarket, or grocery store availability (counts per population) within less than 1.00 km, 1.00 to 2.99 km, 3.00 to 4.99 km, and 5.00 to 8.05 km of respondents' homes. Models were sex stratified, controlled for individual sociodemographic characteristics and neighborhood poverty, and tested for interaction by individual-level income.
Fast food consumption was related to fast food availability among low-income respondents, particularly within 1.00 to 2.99 km of home among men (coefficient, 0.34; 95% confidence interval, 0.16-0.51). Greater supermarket availability was generally unrelated to diet quality and fruit and vegetable intake, and relationships between grocery store availability and diet outcomes were mixed.
Our findings provide some evidence for zoning restrictions on fast food restaurants within 3 km of low-income residents but suggest that increased access to food stores may require complementary or alternative strategies to promote dietary behavior change.
Recently, public health agents and the popular media have argued that rising levels of obesity are due, in part, to "obesogenic" environments, and in particular to the clustering of fast food establishments in Western urban centers that are poor and working class. Our findings from a multi-site, cross-national qualitative study of teenaged Canadians' eating practices in urban and rural areas offer another perspective on this topic, showing that fast food consumption is not simply a function of the location of fast food outlets, and that Canadian teens engage in complex ways with the varied dimensions of choosing (or rejecting) fast foods. Drawing on evidence gleaned from semi-structured interviews with 132 teenagers (77 girls and 55 boys, ages 13-19 years) carried out between 2007 and 2009, we maintain that no easy relationship exists between the geographical availability of fast food and teen eating behaviors. We use critical obesity literature that challenges widely accepted understandings about obesity prevalence and etiology, as well as Lamont's (1992, 2000) concept of "moral boundary work," to argue that teen fast food consumption and avoidance is multifaceted and does not stem exclusively nor directly from spatial proximity or social class. Through moral boundary work, in which teens negotiated with moralistic notions of healthy eating, participants made and re-made themselves as "good" and successful subjects by Othering those who were "bad" in references to socially derived discourses of healthy eating.
Eating away from home and particularly fast food consumption have been shown to contribute to weight gain. Increased geographic access to fast food outlets and other restaurants may contribute to higher levels of obesity, especially in individuals who rely largely on the local environment for their food purchases. We examined whether fast food and restaurant concentrations are associated with body mass index and whether car ownership might moderate this association. We linked the 2000 US Census data and information on locations of fast food and other restaurants with the Los Angeles Family and Neighborhood Study database, which consists of 2,156 adults sampled from 63 neighborhoods in Los Angeles County. Multilevel modeling was used to estimate associations between body mass index (BMI), fast food and restaurant concentration, and car ownership after adjustment for individual-level factors and socioeconomic characteristics of residential neighborhoods. A high concentration of local restaurants is associated with BMI. Car owners have higher BMIs than non-car owners; however, individuals who do not own cars and reside in areas with a high concentration of fast food outlets have higher BMIs than non-car owners who live in areas with no fast food outlets, approximately 12 lb more (p = 0.02) for an individual with a height of 5 ft. 5 in. Higher restaurant density is associated with higher BMI among local residents. The local fast food environment has a stronger association with BMI for local residents who do not have access to cars.
Earlier research on health promotion has emphasized behavior change strategies rather than environmentally focused interventions. The advantages of integrating lifestyle modification, injury control, and environmental enhancement strategies of health promotion are substantial. The author offers a social ecological analysis of health promotive environments, emphasizing the transactions between individual or collective behavior and the health resources and constraints that exist in specific environmental settings. Directions for future research on the creation and maintenance of health promotive environments also are examined.
The increasing prevalence of obesity in many countries means that it should now be considered a pandemic.1 One estimate from Australia suggests that over the past decade the average adult has been adding 1 gram a day to body weight.2 This has occurred in the face of increasing knowledge, awareness, and education about obesity, nutrition, and exercise. It has been suggested that a paradigm shift is necessary if future progress is to be made.3
Traditionally, weight gain was thought of as caused by eating too much or exercising too little, or both (changes in weight=energy intake-energy expenditure). This led to the search for small deficiencies in energy metabolism such as a reduced thermic effect of food to explain obesity.4 Treatment was dominated by calorie counting, and public health messages extolled people to balance their intake and output. This paradigm has changed with the increasing understanding of the dynamic relations between energy stores, appetite mechanisms, and energy metabolism and of the wider recognition of nutrient partitioning.5 6 From studies which have shown that fat balance is equivalent to energy balance,7 the fat balance equation was developed (rate of change of fat stores=rate of fat intake-rate of fat oxidation).5 This equation is more dynamic than the original static equation and reflects energy balance under normal conditions of free access to foods. Because fat intake and oxidation are not closely balanced,8 this approach does not need metabolic abnormalities or genetic mutations to explain weight gain. Indeed, the differences in body fat between people living in the same environment could be better described as normal physiological variation. This paradigm is more helpful in explaining changes in body fat within an individual over time, but it does not account for the wider influences within and around individuals …
Aggregated demographic datasets are associated with analytical and cartographic problems due to the arbitrary nature of areal unit partitioning. This article describes a methodology for generating a surface-based representation of population that mitigates these problems. This methodology uses dasymetric mapping and incorporates areal weighting and empirical sampling techniques to assess the relationship between categorical ancillary data and population distribution. As a demonstration, a 100-meter-resolution population surface is generated from U.S. Census block group data for the southeast Pennsylvania region. Remote-sensing-derived urban land-cover data serve as ancillary data in the dasymetric mapping.
Working-poor women face many challenges in their quest for economic self-sufficiency. Although welfare reform promises jobs, women do not have equal access to necessary services, including transportation. With the 2010 reauthorization of TANF (Temporary Asssistance for Needy Women), there is a need to develop a methodology that uses qualitative individual-level data to evaluate whether public transportation will serve working-poor single mothers in this quest for self-sufficiency. Using ethnography, travel diaries, and a GIS for a sample of women in the process of leaving welfare in Knoxville, Tennessee, travel behavior is examined both qualitatively and quantitatively in order to understand why they rarely use public transportation. Further research into the ways these women move around in a sprawling, medium-sized city reinforces and seeks to understand the extensive social networks working-poor mothers rely on. These women create communities of spatial necessity, bartering for basic needs to overcome transportation constraints.
The aim of this study is to investigate the extent to which perceptions of the quality, variety and affordability of local food retail provision predict fruit and vegetable intake. Secondary analysis of baseline data from the Philadelphia Neighbourhood Food Environment Study was undertaken. This study investigating the role of the neighbourhood food environment on diet and obesity comprised a random sample of households from two low-income Philadelphia neighbourhoods, matched on socio-demographic characteristics and food environment. The analytic sample comprised adult men and women aged 18-92 (n=1263). Perception of the food environment was measured using five related dimensions pertaining to quality, choice and expense of local food outlets and locally available fruits and vegetables. The outcome, portions of fruits and vegetables consumed per day, was measured using the Block Food Frequency Questionnaire. Results from multivariate regression analyses suggest that measured dimensions of perceived neighbourhood food environment did not predict fruit and vegetable consumption. Further investigation of what constitutes an individual's 'true' food retail environment is required.
This report presents findings showing that, from FY 2008 to FY 2009, the number of SNAP participants increased by 18 percent and the number of eligible individuals increased by 15 percent. The large increase in the number of participants was likely attributable to the deterioration of the economy, expansions in SNAP eligibility, and continued outreach efforts.
This research contributes to the body of literature on areal interpolation and dasymetric mapping by introducing algorithms that make use of local ancillary data sources. The address weighting (AW) and parcel distribution (PD) methods are based on county address points and parcels. The algorithms can be effectively applied in rural and transitional areas where geographies are large and population counts are low. These new methods were compared to existing algorithms that use nationally available land cover and street network datasets. Compared with existing methods, the new methods yielded significant improvement in reducing estimate error for the study areas. Both new methods succeeded in maintaining high accuracy in both urban and rural areas. The research presents opportunities for increasing the accuracy of both areal interpolation and dasymetric mapping in areas where accurate local data are available.
Dasymetric maps display statistical data in meaningful spatial zones. Such maps can be preferable to choropleth maps that show data by enumeration zones, because dasymetric zones more accurately represent underlying data distributions. Though dasymetric mapping has existed for well over a century, the methods for producing these maps have not been thoroughly examined. In contrast, research on areal interpolation has been more thorough and has examined methods of transferring data from one set of map zones to another, an issue that is applicable to dasymetric mapping. Inspired by this work, we tested five dasymetric mapping methods, including methods derived from work on areal interpolation. Dasymetric maps of six socio-economic variables were produced fm a study area of 159 counties in the eastern U.S. using county choropleth data and ancillary land-use data. Both polygonal (vector) and grid (raster) dasymetric methods were tested. We evaluated map accuracy using both statistical analyses and visual presentations of error. A repeated-measures analysis of variance showed that the traditional limiting variable method had significantly lower error than the other four methods. In addition, polygon methods had lower error than their grid-based counterparts, though the difference was not statistically significant. Error maps largely supported the conclusions from the statistical analysis, while also presenting patterns of error that were not obvious from the statistics.
Public policy discussion of the problem of food deserts has concentrated on proximity to retail food stores providing nutritious, affordable foods. Because they offer a wide array of healthful products at lower prices, physical access to a supermarket or supercenter has come to be the standard of adequacy. Less attention has been given to how economic incentives influence access to retail food stores in the wider food environment. The American Recovery and Reinvestment Act (ARRA) enacted a sizable increase in SNAP benefits effective April 2009. Though the primary purpose of the increase was to stimulate the economy, we argue that it had a secondary effect of encouraging SNAP participants to redeem more of their benefits at larger, lower-priced retailers. To investigate the effect of this policy change, we use county-level, administrative data on SNAP redemptions at different types of authorized food stores from May 2007 to May 2010. Data from the Economic Research Service’s Food Desert Locator are used to classify counties according to the percent of their population residing in food deserts. Results show that the SNAP benefit increase is associated with a greater percentage of redemptions at superstores. Estimates are stable across a number of specifications that also control for gas prices and store-type density. Within our sample of counties, we show that an $80 maximum SNAP benefit increased the percentage of benefits redeemed at supermarkets by 1.4 percentage points. In order to achieve a similar increase in redemptions at superstores, store density would have to increase from one superstore every 24 square miles to 1 superstore every 15 square miles. Impacts of the benefit increase were positive, but somewhat smaller in areas with more of their population residing in food deserts.
Background
Poor dietary patterns and obesity, established risk factors for chronic disease, have been linked to neighborhood deprivation, neighborhood minority composition, and low area population density. Neighborhood differences in access to food may have an important influence on these relationships and health disparities in the U.S. This article reviews research relating to the presence, nature, and implications of neighborhood differences in access to food.
Methods
A snowball strategy was used to identify relevant research studies (n=54) completed in the U.S. and published between 1985 and April 2008.
Results
Research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower levels of obesity. Results from studies examining the accessibility of restaurants are less consistent, but there is some evidence to suggest that residents with limited access to fast-food restaurants have healthier diets and lower levels of obesity. National and local studies across the U.S. suggest that residents of low-income, minority, and rural neighborhoods are most often affected by poor access to supermarkets and healthful food. In contrast, the availability of fast-food restaurants and energy-dense foods has been found to be greater in lower-income and minority neighborhoods.
Conclusions
Neighborhood disparities in access to food are of great concern because of their potential to influence dietary intake and obesity. Additional research is needed to address various limitations of current studies, identify effective policy actions, and evaluate intervention strategies designed to promote more equitable access to healthy foods.
The high prevalence of obesity among low income groups has led some to question the role of food assistance programs in contributing to the problem. The USDA's Food Stamp Program (now known as the Supplemental Nutrition Assistance Program – SNAP) is the largest food assistance program in the United States with over 40 million participants. This paper employed systematic realist review methods to determine whether participation in the Food Stamp Program causes obesity and the causal pathways through which this relationship may exist. Findings indicate a more consistent positive relationship for women than for men, especially for women who are long term users of the program. All studies discussed the ''food stamp cycle'' and an ''income effect'' as explanations for the role of food stamps in increased obesity yet evidence for these factors is limited. Curiously, the research in this field does not address obesogenic environments and we suggest that the absence of an understanding of household behavior in local contexts is a significant impediment to the reform of the Food Stamp Program.
Improving spatial access to healthy foods in urban regions is recognized as an important component of reducing the prevalence of chronic illness and achieving better health outcomes. Previously, researchers exploring this domain have calculated accessibility measures derived from the travel cost from home locations to nearby food stores. This approach disregards additional opportunities that present themselves as residents move throughout the city. A time-geographic accessibility measure is utilized to explore how single-occupancy automobile commuting affords access to supermarkets. Results show residents in some TAZs have more access when accounting for their commuting behavior than when measuring access from their home. This finding suggests more nuanced calculations of accessibility are necessary to fully understand which urban populations have greater access to healthy food.
Objective:
To examine the availability, quality, and price of key types of healthy and less-healthy foods found in corner stores in low-income urban neighborhoods and the associations between store characteristics and store food environments.
Method:
A sample of 246 corner stores was selected from all corner stores participating in the Philadelphia Healthy Corner Store Initiative (HCSI). The Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to assess the availability, quality, and price of foods and beverages in 11 common categories between February and May, 2011.
Results:
NEMS-CS measures were completed in 233 stores, 94.7% of the 246 stores approached. The healthier options were significantly less available in all food categories and often more expensive. Baked goods, bread, chips and cereals were sold at nearly all stores, with significantly fewer offering low-fat baked goods (5.7%, p<0.0001), whole grain bread (56.2%, p<0.0001), or baked chips (35.2%, p<0.0001). Number of aisles was positively associated with availability score (p<0.05).
Conclusion:
Findings from this study point toward potential targets for intervention to improve the corner store food environment and dietary choices among low-income urban populations. Availability of certain healthier foods could be improved.
This research employs household survey data and Geographic Information Systems (GIS) to explore the core assumption underlying much of the food desert discourse that socially and economically disadvantaged residents shop in their immediate neighborhood food environment. Findings indicate that disadvantaged consumers living on the lower eastside of Detroit, Michigan bypass their neighborhood food environments, which are disproportionately composed of convenience and party stores, to shop at independent, discount and regional supermarkets located in other parts of the city and in the suburbs. These trends hold despite various economic and physical constraints to their mobility. These findings complicate past assumptions that socially and economically disadvantaged residents living in a food desert shop within their neighborhood environment.
This population-based study examined whether residential or school neighborhood access to fast food restaurants is related to adolescents' eating frequency of fast food. A classroom-based survey of racially/ethnically diverse adolescents (n=2724) in 20 secondary schools in Minneapolis/St. Paul, Minnesota was used to assess eating frequency at five types of fast food restaurants. Black, Hispanic, and Native American adolescents lived near more fast food restaurants than white and Asian adolescents and also ate at fast food restaurants more often. After controlling for individual-level socio-demographics, adolescent males living near high numbers fast food restaurants ate more frequently from these venues compared to their peers.
Many people in developed countries fail to consume a healthy diet. This phenomenon has been linked to the contested existence of ‘food deserts’ in the UK, and the occurrence of ‘food insecurity’ in the USA and elsewhere. ‘Food deserts’ remain contested theoretical territory at least partly because no firm definition has been proposed. This paper argues that the barriers to consumption of a healthy diet may be classified according to whether such barriers are financial, physical, or derive from the mental attitude and knowledge of the consumer. The perception of ‘unsupportive food environments’ by some consumers is contrasted with the geographical existence of multiple sources of fresh fruit and vegetables in certain locations. Using a total of 234 semi—structured interviews in various UK locations, qualitative evidence is gathered for the existence of at least ten different types of ‘food desert’. The paper then goes on to show how such a three fold classification may be developed, using a modified ternary diagram, to assess the most appropriate initiatives to tackle ‘food deserts’ and to monitor progress in alleviating their effects.
In the U.S., supermarkets serve as an important source of year-round produce (Chung & Myers, 1999), and yet access to supermarkets may be scarce in "food deserts," or poor, urban areas that lack sources of healthy, affordable food (Cummins & Macintyre, 2002). This study examined objective distance to the nearest supermarket and participant-report of supermarket access in relation to fruit and vegetable intake. Street-network distance to the closest supermarket was calculated using GIS mapping. Perceived access was assessed by a survey question asking whether participants had a supermarket within walking distance of home. Cross-sectional survey data were collected from 828 low-income housing residents in three urban areas in greater-Boston. Generalized estimating equations were used to estimate the association between perceived and objective supermarket access and diet. Fruit and vegetable consumption was low (2.63 servings/day). Results suggest that most low-income housing residents in greater-Boston do not live in "food deserts," as the average distance to a supermarket was 0.76 km (range 0.13-1.22 km). Distance to a supermarket was not associated with fruit and vegetable intake (p = 0.22). Perceived supermarket access was strongly associated with increased fruit and vegetable intake (0.5 servings/day) after controlling for socio-demographic covariates (p < 0.0001). Patterns of mismatch between perceived and objective measures revealed that mismatch between the two measures were high (31.45%). Those who did not report a supermarket within walking distance from home despite the objective presence of a supermarket within 1 km consumed significantly fewer fruits and vegetables (0.56 servings/day) than those with a supermarket who reported one, even after controlling for socio-demographic variables (p = 0.0008). Perceived measures of the food environment may be more strongly related to dietary behaviors than objective ones, and may incorporate components of food access not captured in objective measures.
Despite growing attention to the problem of obesogenic environments, there has not been a comprehensive review evaluating the food environment-diet relationship. This study aims to evaluate this relationship in the current literature, focusing specifically on the method of exposure assessment (GIS, survey, or store audit). This study also explores 5 dimensions of "food access" (availability, accessibility, affordability, accommodation, acceptability) using a conceptual definition proposed by Penchansky and Thomas (1981). Articles were retrieved through a systematic keyword search in Web of Science and supplemented by the reference lists of included studies. Thirty-eight studies were reviewed and categorized by the exposure assessment method and the conceptual dimensions of access it captured. GIS-based measures were the most common measures, but were less consistently associated with diet than other measures. Few studies examined dimensions of affordability, accommodation, and acceptability. Because GIS-based measures on their own may not capture important non-geographic dimensions of access, a set of recommendations for future researchers is outlined.
The high prevalence of obesity among low income groups has led some to question the role of food assistance programs in contributing to the problem. The USDA's Food Stamp Program (now known as the Supplemental Nutrition Assistance Program - SNAP) is the largest food assistance program in the United States with over 40 million participants. This paper employed systematic realist review methods to determine whether participation in the Food Stamp Program causes obesity and the causal pathways through which this relationship may exist. Findings indicate a more consistent positive relationship for women than for men, especially for women who are long term users of the program. All studies discussed the "food stamp cycle" and an "income effect" as explanations for the role of food stamps in increased obesity yet evidence for these factors is limited. Curiously, the research in this field does not address obesogenic environments and we suggest that the absence of an understanding of household behavior in local contexts is a significant impediment to the reform of the Food Stamp Program.
Quantitative methods are necessary to compare spatial patterns and evaluate the performance of spatial simulation models. We present and review several approaches to the analysis and comparison of spatial patterns. The methods are readily applicable to digital data that are in matrix (i.e., grid cell or raster) format, and include: (a) indices of particular aspects of spatial pattern, including fractal dimension, contagion, and interface; (b) spatial predictability; and (c) a variable resolution approach for measuring the degree of fit between two patterns. Because these methods measure different aspects of spatial patterns, they may be differentially suited to particular modeling and analysis objectives. In this paper, we describe the methods, apply each method to a sample data set, then evaluate the information provided and appropriate situations for its use.