Disparities in the Availability of Farmers Markets in the United States

Examining Geographic Food Access, Food Insecurity, and Urbanicity among Diverse, Low-Income Participants in Austin, Texas

The purpose of this study was to explore the association between geographic food access and food insecurity and the potential role of race/ethnicity, income, and urbanicity among a low-income, diverse sample in Central Texas. Utilizing a cross-sectional study design, secondary data analysis of an existing cohort was used to examine the association between food insecurity; geographic food access; and sociodemographic factors of race/ethnicity, income, urbanicity, and additional covariates using binomial logistic regression models. The existing cohort was recruited from lower-income communities in Travis County, Texas. The sample (N = 393) was predominantly Hispanic, lived in urban areas, and nearly 40% were food insecure. Geographic food access was not found to be significantly associated with food insecurity. However, rural residents had greater odds of being food insecure than urban residents. Also, participants who earned USD 45,000-64,999 and over USD 65,000 had lower odds of being food insecure than participants who earned under USD 25,000. These findings add to the inconsistent literature about the association between geographic food access and food insecurity and contribute to urbanicity and income disparities in food-insecurity literature. Future work should consider urbanicity, income, and utilize community-specific data to gain greater understanding of the association between geographic food access and food insecurity.

Fruit and Vegetable Intake Among Older African American and Hispanic Adults With Cardiovascular Risk Factors

African Americans and Hispanics are disproportionately burdened by cardiovascular risk factors including hypertension, diabetes mellitus, and obesity. There is evidence that fruits and vegetables have protective benefits for cardiovascular health. Factors associated with fruit and vegetable intake among older minority adults are not well established. A cross-sectional analysis of African American and Hispanic adults >55 years with diagnosis of hypertension and/or diabetes was conducted. Daily intake of fruits and vegetables was analyzed by socio-demographic, health status, health behaviors, and access to fruits and vegetables. 77% of participants did not meet the United States Department of Agriculture ≥5 a day serving guidelines. Fruit and vegetable consumption was not associated with having hypertension or diabetes. Body mass index >25 and regular exercise were significantly associated with more vegetable intake, but not fruit. African Americans consumed significantly less fruits and vegetables than Hispanics. Among those with access to fruits and vegetables, 78% did not meet the guidelines. Many older African American and Hispanic adults with cardiovascular disease risk factors do not meet the fruit and vegetable intake guidelines. Inadequate intake is worse among African Americans, sedentary, and non-overweight/obese adults. Studies are needed to understand the barriers associated with fruit and vegetable intake in this population.

Neighborhood immigrant density and population health among native-born Americans

The healthy immigrant effect-whereby immigrants are on average healthier than the native-born-have been well studied. However, little is known about the relationship between immigration and the health of the native-born. This study fills this important research gap by examining the association between neighborhood immigrant density and several population health measures among native-born Americans. We used data from the Los Angeles County Health Survey to analyze four individual-level health behaviors and outcomes, including regular fast food consumption, fruit and vegetable consumption, body mass index, and hypertension. We conducted multilevel logistic regressions to assess the association between neighborhood immigrant density and the four health behaviors and outcomes. The results showed that neighborhood immigrant density was negatively associated with regular fast food consumption (OR = 0.33; 95% CI, 0.18-0.59), BMI (β = -2.16, 95% CI, -3.13 to -1.19), and hypertension (OR = 0.58; 95% CI, 0.38-0.89), and positively associated with fruit/vegetable consumption (OR = 1.64; 95% CI, 1.01-2.66) among native-born Americans. In conclusion, native-born Americans who lived in a neighborhood with a high density of immigrants had healthier behaviors and better health outcomes compared to those who lived in a neighborhood with a low density of immigrants.

WIC Cash Value Voucher Redemption Behavior in Jefferson County, Alabama, and Its Association With Fruit and Vegetable Consumption

PURPOSE

To examine cash value voucher (CVV) redemption behavior and its association with fruit and vegetable (FV) consumption among women who participate in the Supplemental Nutrition Program for Women, Infants, and Children (WIC).

DESIGN

Cross-sectional.

SETTING

Jefferson County, Alabama.

PARTICIPANTS

Between October 2014 and January 2015, 300 women (mean age: 27.6 years; 66.8% non-Hispanic black; 45.1% obese) who participated in the Birmingham WIC program were surveyed.

MEASURES

Self-reported information on demographics, produce shopping behaviors, and residential access to fresh produce retailers (eg, supermarkets and farmers markets) was examined. Fruit and vegetable intake was collected via the Block Fruit-Vegetable-Fiber screener. Participants who self-reported redeeming the WIC CVV in each of the 3 prior months were classified as regular redeemers.

ANALYSIS

Multivariable-adjusted regression models were used to examine associations between variables of interest and regular WIC CVV redemption.

RESULTS

There were 189 (63.0%) study participants classified as regular WIC CVV redeemers. Regular redeemers and other participants (ie, irregular redeemers and nonredeemers) were similar with respect to demographics. Regular redeemers were more likely to use grocery stores to purchase FVs ( P = .003) and consumed significantly more servings of FVs per day (β = .67; standard error = 0.24; P = .007).

CONCLUSION

Regular WIC CVV redemption was associated with some produce shopping behaviors and increased FV consumption and among WIC participants in Jefferson County, Alabama.

Participation in a farmers' market fruit and vegetable prescription program at a federally qualified health center improves hemoglobin A1C in low income uncontrolled diabetics

Fruit and vegetable prescription programs have been shown to increase consumption of fresh produce, but whether they have an impact on medical outcomes is unknown. The purpose of this study was to examine the role of participation in a farmers' market and fruit and vegetable prescription program on changes in hemoglobin A1C (HbA1C), blood pressure (BP) and weight in patients with uncontrolled type 2 diabetes at a federally qualified health center (FQHC) in Detroit, MI. The 13-week Fresh Prescription program (June 2015-October 2015) was designed to improve access and consumption of produce among low-income patients with uncontrolled type 2 diabetes. The program allotted up to $40 ($10 per week for up to four weeks) for purchase of produce from a FQHC located farmers' market. Adult, non-pregnant patients with a history of type 2 diabetes that had an elevated HbA1C > 6.5 within three months before Fresh Prescription program were eligible to participate. HgA1c, BP and weight were collected within three months of program start and within three months of completion. There were 65 eligible participants with complete biometric data. A statistically significant (p = 0.001) decrease in HbA1C was found (9.54% to 8.83%). However, weight (208.3 lbs. to 209.0 lbs.) and BP (135.1/79.3 mm Hg to 135.8/77.6 mm Hg) did not change from pre- to post-study (p > 0.05). Access to a fruit and vegetable prescription program over a 13-week period led to decreased HbA1C concentrations in uncontrolled type 2 diabetic patients living in an urban area of predominately-lower socioeconomic status.

Pricing of Staple Foods at Supermarkets versus Small Food Stores

Prices affect food purchase decisions, particularly in lower-income communities, where access to a range of food retailers (including supermarkets) is limited. The aim of this study was to examine differences in staple food pricing between small urban food stores and the closest supermarkets, as well as whether pricing differentials varied based on proximity between small stores and larger retailers. In 2014, prices were measured for 15 staple foods during store visits in 140 smaller stores (corner stores, gas-marts, dollar stores, and pharmacies) in Minneapolis/St. Paul, MN and their closest supermarket. Mixed models controlling for store type were used to estimate the average price differential between: (a) smaller stores and supermarkets; (b) isolated smaller stores (>1 mile to closest supermarket) and non-isolated smaller stores; and (c) isolated smaller stores inside versus outside USDA-identified food deserts. On average, all items except white bread were 10-54% more expensive in smaller stores than in supermarkets (p < 0.001). Prices were generally not significantly different in isolated stores compared with non-isolated stores for most items. Among isolated stores, there were no price differences inside versus outside food deserts. We conclude that smaller food stores have higher prices for most staple foods compared to their closest supermarket, regardless of proximity. More research is needed to examine staple food prices in different retail spaces.

Perceived Barriers and Facilitators of Farm-to-Consumer Retail Outlet Use Among Participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Alabama

This research aimed to identify perceived barriers and facilitators of farm-to-consumer (FTC) retail outlet (eg, farmers' markets, farm/roadside stands) usage among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants residing in Birmingham, Alabama. Additionally, associations between barriers and facilitators reported and daily fruit and vegetable (F&V) intake were examined. A sample of 312 lower income women (mean age = 27.6; 67.0% non-Hispanic black; 45.3% obese) who participate in the Birmingham WIC program were surveyed between October 2014 and January 2015. Fischer's exact test was used to assess associations between barriers (eg, outlet location, price, transportation), facilitators (eg, produce quality, produce variety), and high F&V intake (ie, consuming ≥ 5 servings per day). Approximately 81 (26.1%) participants reported using an FTC outlet to purchase produce in 2014. Lack of awareness (39.3%), outlet location (32.8%), and lack of interest (28.4%) were the barriers most often reported. Produce quality (69.1%), produce variety (49.4%), and price (39.5%) were the facilitators most often reported. Barriers and facilitators mentioned were not associated with high F&V intake. Lack of awareness and lack of interest are key barriers to FTC outlet usage among Birmingham WIC recipients. Interventions aiming to promote use of FTC outlets should consider the perceived barriers and facilitators to usage.