Food availability and food access in rural agricultural communities: use of mixed methods

Abstract

BackgroundHispanics bear some of the highest burden of the obesity epidemic and the disparities gap is bigger among Hispanics in rural communities. This mixed methods study examined the objective and subjective assessment of food availability and food access in four rural, agricultural, and predominantly Hispanic communities.MethodsIn this convergent parallel mixed methods study, we used the Nutrition Environment Measures Survey (NEMS) of Food Stores and Restaurants to objectively assess 57 food stores and 69 restaurants in four rural agricultural communities in Washington State. To complement the objective assessment findings, we conducted semi-structured interviews with 32 community residents. The data were collected from 2013 to 2014. Frequencies and means were calculated for quantitative data and content analysis conducted for interview data.ResultsParticipants (n = 32) had a mean age of 35.6 (SD 6.2) years, were mostly women, uninsured, low income, and had less than a high school education. Grocery and convenience stores had low NEMS composite scores indicating low overall availability of food items, low quality, and high food prices. Composite scores for sit-down restaurants, fast casual restaurants, and fast-food restaurants were similarly low in all four towns indicating limited availability of healthier options. Semi-structured interviews revealed participants perceived high availability and accessibility of quality fresh produce. Most participants reported eating out regularly several times a week, frequenting restaurant chains that serve buffets or fast foods, and allowing children to make decisions regarding their own food choices.ConclusionsCommunity members’ perception of food availability and food access may be different from the objective assessment of food environment. This information can be used to inform community-wide interventions to address food environment in these rural communities.

Measurement of Nutrition Environments in Grocery Stores, Convenience Stores, and Restaurants in the Lower Mississippi Delta

“…Conversely, the mean NEMS-S total score (24; possible range, −9 to 54) was lower for grocery stores located in rural Montana counties, where half the stores measured were on an Indian reservation (26), than for grocery stores in our study. Mean NEMS-S total scores for grocery stores located in rural Washington towns varied from 15 to 35 (possible range, −8 to 62), whereas mean total scores for convenience stores varied from 3 to 4 (possible range, −8 to 62) (26). Collectively, results from these studies suggest that the retail nutrition environment in the rural United States is uniformly low; grocery and convenience stores score no more than two-thirds to less than one-quarter of maximum points for indicators of healthful nutrition environments.…”

A Model Depicting the Retail Food Environment and Customer Interactions: Components, Outcomes, and Future Directions

“…Both the absolute and relative availability and prices of healthful and unhealthy foods, as well as availability of culturally-appropriate products [ 49 , 50 ], may be relevant for consumers’ purchasing decisions [ 69 , 70 , 71 ]. Often, unhealthy products are more available [ 72 , 73 , 74 , 75 ] and less expensive than healthful products [ 76 ]. Product quality and variety (i.e., number of options), such as for produce or milk options, also influence purchasing decisions [ 77 , 78 , 79 , 80 , 81 ] and can vary across source type and neighborhood [ 82 , 83 , 84 ].…”

Knowledge Visualizations to Inform Decision Making for Improving Food Accessibility and Reducing Obesity Rates in the United States

“…Research on the external domain and personal domain of the food environment in rural census tracts can help develop solutions to reduce obesity rates. Some recent publications that could be replicated or customized include assessment of nutrition environment [61,62], food environment for children [63], factors influencing food choices among older adults [64] and participation in food assistance programs for women, infants and children [65].…”