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

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


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

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    • "Women living in rural areas tend to be uninsured, older, poorer, less educated, and have higher rates of chronic health conditions, and disabilities than their urban coun- terparts[9]. Rural midlife and older women are often isolated, without access to appropriate physical activity opportunities, affordable healthy food, and healthcare services6781011121314151617181920212223242526. Importantly, women are also 20 % more likely than men to die of heart disease; despite this, many women are unaware that they are at risk for CVD[27]. "
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    ABSTRACT: Background Cardiovascular disease is the leading cause of death in the United States and places substantial burden on the health care system. Rural populations, especially women, have considerably higher rates of cardiovascular disease, influenced by poverty, environmental factors, access to health care, and social and cultural attitudes and norms. Methods/Design This community-based study will be a two-arm randomized controlled efficacy trial comparing a multi-level, community program (Strong Hearts, Healthy Communities) with a minimal intervention control program (Strong Hearts, Healthy Women). Strong Hearts, Healthy Communities was developed by integrating content from three evidence-based programs and was informed by extensive formative research (e.g. community assessments, focus groups, and key informant interviews). Classes will meet twice weekly for one hour for 24 weeks and focus on individual-level skill building and behavior change; social and civic engagement are also core programmatic elements. Strong Hearts, Healthy Women will meet monthly for hour-long sessions over the 24 weeks covering similar content in a general, condensed format. Overweight, sedentary women 40 years of age and older from rural, medically underserved communities (12 in Montana and 4 in New York) will be recruited; sites, pair-matched based on rurality, will be randomized to full or minimal intervention. Data will be collected at baseline, midpoint, intervention completion, and six-month, one-year, and eighteen months post-intervention. The primary outcome is change in body weight; secondary outcomes include physiologic, anthropometric, behavioral, and psychosocial variables. In the full intervention, engagement of participants’ friends and family members in partnered activities and community events is an intervention target, hypothesizing that there will be a reciprocal influence of physical activity and diet behavior between participants and their social network. Family members and/or friends will be invited to complete baseline and follow-up questionnaires about their health behaviors and environment, height and weight, and attitudes and beliefs. Discussion Strong Hearts, Healthy Communities aims to reduce cardiovascular disease morbidity and mortality, improve quality of life, and reduce cardiovascular disease-related health care burden in underserved rural communities. If successful, the long-term goal is for the program to be nationally disseminated, providing a feasible model to reduce cardiovascular disease in rural settings. Trial registration Identifier: NCT02499731 Registered on July 1, 2015.
    Full-text · Article · Dec 2015 · BMC Public Health
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    • "Given the interrelated and multi-level determinants of rural food access [11,45,50-52], a comprehensive and systematic approach is needed to plan research to support the development of effective rural food policies. To date, rural food research has not emphasized the impact of policy changes on rural food access, but has focused on individual-level topics such as factors influencing food choice [21], disparities [49], and trip chaining patterns [53,54], and community-level influences such as non-traditional food retailers [35,38,55], food venue types [28,56], and rural culture and context [47,57]. In concert with extant research, existing conceptual models of food access [2,58] do not fully address the influence of macro-level policies on the food choices of rural residents. "
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    ABSTRACT: Background Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. Methods This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Results Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access. Conclusions This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities.
    Full-text · Article · Jun 2014 · BMC Public Health
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    • "Previous studies assessing the macro-level food environment, such as number and type of food outlets in a neighborhood, may have introduced bias by not conducting validation studies. This may explain why results of such studies examining association and between the retail food environment and neighborhood characteristics have been conflicting [34,40,57-59]. "
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    ABSTRACT: Background Based on the need for better measurement of the retail food environment in rural settings and to examine how deprivation may be unique in rural settings, the aims of this study were: 1) to validate one commercially available data source with direct field observations of food retailers; and 2) to examine the association between modified neighborhood deprivation and the modified retail food environment score (mRFEI). Methods Secondary data were obtained from a commercial database, InfoUSA in 2011, on all retail food outlets for each census tract. In 2011, direct observation identifying all listed food retailers was conducted in 14 counties in Kentucky. Sensitivity and positive predictive values (PPV) were compared. Neighborhood deprivation index was derived from American Community Survey data. Multinomial regression was used to examine associations between neighborhood deprivation and the mRFEI score (indicator of retailers selling healthy foods such as low-fat foods and fruits and vegetables relative to retailers selling more energy dense foods). Results The sensitivity of the commercial database was high for traditional food retailers (grocery stores, supermarkets, convenience stores), with a range of 0.96-1.00, but lower for non-traditional food retailers; dollar stores (0.20) and Farmer’s Markets (0.50). For traditional food outlets, the PPV for smaller non-chain grocery stores was 38%, and large chain supermarkets was 87%. Compared to those with no stores in their neighborhoods, those with a supercenter [OR 0.50 (95% CI 0.27. 0.97)] or convenience store [OR 0.67 (95% CI 0.51, 0.89)] in their neighborhood have lower odds of living in a low deprivation neighborhood relative to a high deprivation neighborhood. Conclusion The secondary commercial database used in this study was insufficient to characterize the rural retail food environment. Our findings suggest that neighborhoods with high neighborhood deprivation are associated with having certain store types that may promote less healthy food options.
    Full-text · Article · Aug 2012 · BMC Public Health
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