Jared T. McGuirt

Farmers’ market use is associated with fruit and vegetable consumption in diverse southern rural communities

BackgroundWhile farmers’ markets are a potential strategy to increase access to fruits and vegetables in rural areas, more information is needed regarding use of farmers’ markets among rural residents. Thus, this study’s purpose was to examine (1) socio-demographic characteristics of participants; (2) barriers and facilitators to farmers’ market shopping in southern rural communities; and (3) associations between farmers’ market use with fruit and vegetable consumption and body mass index (BMI).MethodsCross-sectional surveys were conducted with a purposive sample of farmers’ market customers and a representative sample of primary household food shoppers in eastern North Carolina (NC) and the Appalachian region of Kentucky (KY). Customers were interviewed using an intercept survey instrument at farmers’ markets. Representative samples of primary food shoppers were identified via random digit dial (RDD) cellular phone and landline methods in counties that had at least one farmers’ market. All questionnaires assessed socio-demographic characteristics, food shopping patterns, barriers to and facilitators of farmers’ market shopping, fruit and vegetable consumption and self-reported height and weight. The main outcome measures were fruit and vegetable consumption and BMI. Descriptive statistics were used to examine socio-demographic characteristics, food shopping patterns, and barriers and facilitators to farmers’ market shopping. Linear regression analyses were used to examine associations between farmers’ market use with fruit and vegetable consumption and BMI, controlling for age, race, education, and gender.ResultsAmong farmers’ market customers, 44% and 55% (NC and KY customers, respectively) reported shopping at a farmers’ market at least weekly, compared to 16% and 18% of NC and KY RDD respondents. Frequently reported barriers to farmers’ market shopping were market days and hours, “only come when I need something”, extreme weather, and market location. Among the KY farmers’ market customers and NC and KY RDD respondents, fruit and vegetable consumption was positively associated with use of farmers’ markets. There were no associations between use of farmers’ markets and BMI.ConclusionsFruit and vegetable consumption was associated with farmers’ market shopping. Thus, farmers’ markets may be a viable method to increase population-level produce consumption.

Associations between access to farmers’ markets and supermarkets, shopping patterns, fruit and vegetable consumption and health indicators among women of reproductive age in eastern North Carolina, USA

OBJECTIVE We examined associations between access to food venues (farmers’ markets and supermarkets), shopping patterns, fruit and vegetable consumption and health indicators among women of reproductive age in eastern North Carolina, U.S.A. DESIGN Access to food venues was measured using a Geographic Information System incorporating distance, seasonality and business hours, to quantify access to farmers’ markets. Produce consumption was assessed by self-report of eating five or more fruits and vegetables daily. BMI and blood pressure were assessed by clinical measurements. Poisson regression with robust variance was used for dichotomous outcomes and multiple linear regression was used for continuous outcomes. As the study occurred in a university town and university students are likely to have different shopping patterns from non-students, we stratified analyses by student status. SETTING Eastern North Carolina. SUBJECTS Low-income women of reproductive age (18–44 years) with valid address information accessing family planning services at a local health department (n 400). RESULTS Over a quarter reported ever shopping at farmers’ markets (114/400). A larger percentage of women who shopped at farmers’ markets consumed five or more fruits and vegetables daily (42.1%) than those who did not (24.0%; P < 0.001). The mean objectively measured distance to the farmers’ markets where women reported shopping was 11.4 (SD 9.0) km (7.1 (SD 5.6) miles), while the mean distance to the farmers’ market closest to the residence was 4.0 (SD 3.7) km (2.5 (SD 2.3) miles). CONCLUSIONS Among non-students, those who shopped at farmers’ markets were more likely to consume five or more servings of fruits and vegetables daily. Future research should further explore potential health benefits of farmers’ markets.

Measuring the retail food environment in rural and urban North Carolina counties.

BACKGROUND Development of accurate and sensitive methods to characterize the food environment is needed. Thus, we examined convergent and criterion validity of 2 retail food environment data sources and then examined differences in predictive validity between 3 ways of measuring the rural and urban food environment. METHODS Ten counties were selected in each of 3 North Carolina regions (n = 30). Number of fast-food restaurants and chain supermarkets were calculated using 2 data sources. Convergent validity was percent agreement between the 2 sources. Criterion validity was percent agreement between each source and the most accurate venue count. Predictive validity of food environment measures (Retail Food Environment Index, fast-food restaurants/capita, and supermarkets/capita) was calculated by associations with county-level mean-weighted body mass index (BMI). RESULTS Percent agreement for fast-food restaurants ranged from 50% to 100% (mean = 87%) and for supermarkets ranged from 58% to 100% (mean = 89%). The 2 data sources had similar percent agreement with the most accurate count. Retail Food Environment Index was positively associated with BMI, while fast-food restaurants per capita were negatively associated with BMI. CONCLUSIONS Our results lend support to studies using both food environment data sources examined.

Conceptualizing and Comparing Neighborhood and Activity Space Measures for Food Environment Research

Greater accessibility to geospatial technologies has led to a surge of spatialized public health research, much of which has focused on food environments. The purpose of this study was to analyze differing spatial measures of exposure to supermarkets and farmers׳ markets among women of reproductive age in eastern North Carolina. Exposure measures were derived using participant-defined neighborhoods, investigator-defined road network neighborhoods, and activity spaces incorporating participants׳ time space behaviors. Results showed that mean area for participant-defined neighborhoods (0.04 sq. miles) was much smaller than 2.0 mile road network neighborhoods (3.11 sq. miles) and activity spaces (26.36 sq. miles), and that activity spaces provided the greatest market exposure. The traditional residential neighborhood concept may not be particularly relevant for all places. Time-space approaches capturing activity space may be more relevant, particularly if integrated with mixed methods strategies.

Associations between Body Mass Index, Shopping Behaviors, Amenity Density, and Characteristics of the Neighborhood Food Environment among Female Adult Supplemental Nutrition Assistance Program (SNAP) Participants in Eastern North Carolina

We examined associations between body mass index (BMI) and the food environment among adult female Supplemental Nutrition Assistance Program (SNAP) participants (N = 197) in eastern North Carolina. Food venue proximity to residential addresses was calculated using a geographic information system. Walk Score was used as a measure of amenity density. Correlation and linear regression analyses were used to examine associations between BMI and distance to and use of food venues, and residential amenity density. Frequency of supercenter use was significantly inversely associated with distance to supercenters. Walk Score was significantly inversely associated with BMI. BMI was not associated with distance to or use of any particular food venue. Future studies should examine specific health-promoting elements of amenity-dense neighborhoods accessible to limited-income populations.

Formative Evaluation for a Healthy Corner Store Initiative in Pitt County, North Carolina: Engaging Stakeholders for a Healthy Corner Store Initiative, Part 2

Introduction We examined the feasibility of increasing access to healthful food in corner stores to inform a Communities Putting Prevention to Work (CPPW) initiative by engaging stakeholders (corner store owners and customers) in a formative evaluation. Methods Qualitative interviews were conducted with corner store owners and managers (n = 11). Customer intercept surveys (n = 179) were also conducted with customers of 9 stores. Corner stores were located in rural food deserts (municipalities without a chain supermarket) and in low-income, urban municipalities in eastern North Carolina. Interviews were transcribed verbatim and double-coded. Qualitative themes related to feasibility of increasing access to healthful foods were extracted. Shopping patterns of rural and urban customers were compared by using t tests. Results Corner store owners were willing to stock more healthful foods, but they perceived that customer demand for these foods was low. Rural customers reported more frequently shopping at corner stores than urban customers and more frequently stated that the reason they do not eat more fruits and vegetables is that the stores in which they shop do not sell them. Most customers reported they would be very or somewhat likely to purchase fresh produce at a corner store. Conclusion Corner stores may be an important source of food for rural and low-income residents and thus a good place in which to intervene. The results of this formative evaluation were used to plan and evaluate a CPPW healthy corner store initiative.

Formative Evaluation for a Healthy Corner Store Initiative in Pitt County, North Carolina: Assessing the Rural Food Environment, Part 1

Introduction Obesity prevalence in the rural United States is higher than in urban or suburban areas, perhaps as a result of the food environment. Because rural residents live farther from supermarkets than their urban- and suburban-dwelling counterparts, they may be more reliant on smaller corner stores that offer fewer healthful food items. Methods As part of a Communities Putting Prevention to Work (CPPW) healthy corner store initiative, we reviewed audit tools in the fall of 2010 to measure the consumer food environment in eastern North Carolina and chose the NEMS-S-Rev (Nutrition Environment Measures Survey-Stores-Revised) to assess 42 food stores. During the spring and summer of 2011, 2 trained graduate assistants audited stores, achieving interrater reliability of at least 80%. NEMS-S-Rev scores of stores in rural versus urban areas were compared. Results Overall, healthful foods were less available and of lower quality in rural areas than in urban areas. NEMS-S-Rev scores indicated that healthful foods were more likely to be available and had similar pricing and quality in rural corner stores than in urban corner stores. Conclusion Food store audit data provided a baseline to implement and evaluate a CPPW healthy corner store initiative in Pitt County. This work serves as a case study, providing lessons learned for engaging community partners when conducting rural food store audits.

A possible dose–response association between distance to farmers’ markets and roadside produce stands, frequency of shopping, fruit and vegetable consumption, and body mass index among customers in the Southern United States

BackgroundThe association between farmers’ market characteristics and consumer shopping habits remains unclear. Our objective was to examine associations among distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and body mass index (BMI). We hypothesized that the relationship between frequency of farmers’ market shopping and BMI would be mediated by fruit and vegetable consumption.MethodsIn 15 farmers’ markets in northeastern North Carolina, July–September 2015, we conducted a cross-sectional survey among 263 farmers’ market customers (199 provided complete address data) and conducted farmers’ market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent variables included farmers’ market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for age, race, sex, and education, were used to examine associations between distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and BMI.ResultsThose who reported shopping at farmers’ markets a few times per year or less reported consuming 4.4 (standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers’ market amenities, and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of the relationship between frequency of shopping and BMI by fruit and vegetable consumption.ConclusionsMore work should be done to understand factors within farmers’ markets that encourage fruit and vegetable purchases.

A Mixed Methods Comparison of Urban and Rural Retail Corner Stores

Efforts to transform corner stores to better meet community dietary needs have mostly occurred in urban areas but are also needed in rural areas. Given important contextual differences between urban and rural areas, it is important to increase our understanding of the elements that might translate successfully to similar interventions involving stores in more rural areas. Thus, an in-depth examination and comparison of corner stores in each setting is needed. A mixed methods approach, including windshield tours, spatial visualization with analysis of frequency distribution, and spatial regression techniques were used to compare a rural North Carolina and large urban (Los Angeles) food environment. Important similarities and differences were seen between the two settings in regards to food environment context, spatial distribution of stores, food products available, and the factors predicting corner store density. Urban stores were more likely to have fresh fruits (Pearson chi2 = 27.0423; p < 0.001) and vegetables (Pearson chi2 = 27.0423; p < 0.001). In the urban setting, corner stores in high income areas were more likely to have fresh fruit (Pearson chi2 = 6.00; p = 0.014), while in the rural setting, there was no difference between high and low income area in terms of fresh fruit availability. For the urban area, total population, no vehicle and Hispanic population were significantly positively associated (p < 0.05), and median household income (p < 0.001) and Percent Minority (p < 0.05) were significantly negatively associated with corner store count. For the rural area, total population (p < 0.05) and supermarket count were positively associated (p < 0.001), and median household income negatively associated (P < 0.001), with corner store count. Translational efforts should be informed by these findings, which might influence the success of future interventions and policies in both rural and urban contexts.

Disparities in healthy food zoning, farmers’ market availability, and fruit and vegetable consumption among North Carolina residents

BackgroundContext and purpose of the study. To examine (1) associations between county-level zoning to support farmers’ market placement and county-level farmers’ market availability, rural/urban designation, percent African American residents, and percent of residents living below poverty and (2) individual-level associations between zoning to support farmers’ markets; fruit and vegetable consumption and body mass index (BMI) among a random sample of residents of six North Carolina (NC) counties.MethodsZoning ordinances were scored to indicate supportiveness for healthy food outlets. Number of farmers’ markets (per capita) was obtained from the NC-Community Transformation Grant Project Fruit and Vegetable Outlet Inventory (2013). County-level census data on rural/urban status, percent African American, and percent poverty were obtained. For data on farmers’ market shopping, fruit and vegetable consumption, and BMI, trained interviewers conducted a random digit dial telephone survey of residents of six NC counties (3 urban and 3 rural). Pearson correlation coefficients and multilevel linear regression models were used to examine county-level and individual-level associations between zoning supportiveness, farmers’ market availability, and fruit and vegetable consumption and BMI.ResultsAt the county-level, healthier food zoning was greater in more urban areas and areas with less poverty. At the individual-level, self-reported fruit and vegetable consumption was associated with healthier food zoning.ConclusionsDisparities in zoning to promote healthy eating should be further examined, and future studies should assess whether amending zoning ordinances will lead to greater availability of healthy foods and changes in dietary behavior and health outcomes.