Assessing the Food Environment of a Rural Community: Baseline Findings From the Heart of New Ulm Project, Minnesota, 2010–2011

Abstract

IntroductionChanges in the food environment in the United States during the past few decades have contributed to increased rates of obesity, diabetes, and heart disease. Improving the food environment may be an effective primary prevention strategy to address these rising disease rates. The purpose of this study was to assess the consumer food environment of a rural community with high rates of obesity and low levels of fruit and vegetable consumption. Findings were used to identify food environment intervention strategies to be implemented as part of a larger community-based heart disease prevention program.MethodsWe used the Nutrition Environment Measures Survey for Restaurants (NEMS-R) and Stores (NEMS-S) to assess 34 restaurants, 3 grocery stores, and 5 convenience stores in New Ulm, Minnesota.ResultsAt least half of the restaurants offered nonfried vegetables and 100% fruit juice. Only 32% had at least 1 entrée or 1 main dish salad that met standards for “healthy.” Fewer than half (41%) had fruit available and under one-third offered reduced-size portions (29%) or whole-grain bread (26%). Grocery stores had more healthful items available, but findings were mixed on whether these items were made available at a lower price than less healthful items. Convenience stores were less likely to have fruits and vegetables and less likely to carry more healthful products (except milk) than grocery stores.ConclusionBaseline findings indicated opportunities to improve availability, quality, and price of foods to support more healthful eating. A community-wide food environment assessment can be used to strategically plan targeted interventions.

You Can’t Find Healthy Food in the Bush: Poor Accessibility, Availability and Adequacy of Food in Rural Australia

“…Our findings are consistent with studies that have identified rural areas typically have smaller and fewer supermarkets which equates to less variety, poorer quality and higher prices than in urban areas [ 7 , 43 , 45 ]. In Australia, four major supermarket chains exist, only the smallest of these was present in this community, all food stores in this LGA would be considered small in an urban context.…”

“…While NEMS tools have been used internationally across a variety of settings including rural environments [ 42 , 43 ], many have adapted the tool to local context thereby limiting direct comparability of these findings with our study. There are also no similar studies within Australia either measuring the food environment of a whole rural LGA or using the NEMS tools to undertake a comprehensive food environment audit.…”

Changing the Food Environment for Obesity Prevention: Key Gaps and Future Directions

“…ground truthing different types of food outlets, mapping the distribution chain, surveying food availability and affordability), and often includes a combination of both approaches. Multiple examples exist of the use of formative research to develop environmental interventions [18–25]. Formative research is needed to identify core values for message development, audience segmentation, and identification of the best communications channels [26–30].…”

The Outdoor MEDIA DOT: The development and inter-rater reliability of a tool designed to measure food and beverage outlets and outdoor advertising

“…Many studies have examined the density of food outlets around schools and its relationship with obesity and diet quality (Austin et al, 2005, Kipke et al, 2007, Simon et al, 2008, Zenk and Powell, 2008, Davis and Carpenter, 2009, Larson and Story, 2009, Walton et al, 2009, Laska et al, 2010, Tester et al, 2010, Babey et al, 2011, Day and Pearce, 2011, Black and Day, 2012, Buck et al, 2013, Pereira et al, 2014, An and Sturm, 2012, Heroux et al, 2012, Laxer and Janssen, 2014, Tang et al, 2014). Schools are often a primary anchor for research related to youth as the environment around schools is likely to be experienced by youth on a daily basis.…”

“…While numerous studies have used the Nutritional Environment Measure Survey (NEMS) tool to document food and beverage products placement, price, and promotion within stores (Glanz et al, 2007, Saelens et al, 2007, Cannuscio et al, 2013, Pereira et al, 2014), few studies to our knowledge have focused on outdoor FB advertising on outlets and within the community in the United States (Hillier et al, 2009, Yancey et al, 2009, Hosler and Dharssi, 2011, Powell et al, 2012, Rimkus et al, 2013), and only a handful more have focused on areas outside of the United States (Maher et al, 2005, Kelly et al, 2008, Walton et al, 2009, Adams et al, 2011). Findings from this work suggest that there are a large number of unhealthy outdoor advertisements that do not reflect current dietary guidelines, while evidence appears to be mixed if unhealthy advertisements cluster in specific areas or among particular populations.…”