Wesley R. Dean

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

OBJECTIVE 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. DESIGN 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. SETTING One urban and 6 contiguous rural counties. PARTICIPANTS This study involved 2,556 residents of the Brazos Valley, Texas, who were selected through random-digit dialing. MAIN OUTCOME MEASURE Two-item scale of FV intake. ANALYSIS Data were analyzed using chi-square analysis, 2-sample t tests, and linear regression. RESULTS 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). CONCLUSIONS AND IMPLICATIONS 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.

Neighborhood deprivation, vehicle ownership, and potential spatial access to a variety of fruits and vegetables in a large rural area in Texas.

ObjectiveThere has been limited study of all types of food stores, such as traditional (supercenters, supermarkets, and grocery stores), convenience stores, and non-traditional (dollar stores, mass merchandisers, and pharmacies) as potential opportunities for purchase of fresh and processed (canned and frozen) fruits and vegetables, especially in small-town or rural areas.MethodsData from the Brazos Valley Food Environment Project (BVFEP) are combined with 2000 U.S. Census data for 101 Census block groups (CBG) to examine neighborhood access to fruits and vegetables. BVFEP data included identification and geocoding of all food stores (n = 185) in six rural counties in Texas, using ground-truthed methods and on-site assessment of the availability and variety of fresh and processed fruits and vegetables in all food stores. Access from the population-weighted centroid of each CBG was measured using proximity (minimum network distance) and coverage (number of shopping opportunities) for a good selection of fresh and processed fruits and vegetables. Neighborhood inequalities (deprivation and vehicle ownership) and spatial access for fruits and vegetables were examined using Wilcoxon matched-pairs signed-rank test and multivariate regression models.ResultsThe variety of fruits or vegetables was greater at supermarkets compared with grocery stores. Among non-traditional and convenience food stores, the largest variety was found at dollar stores. On average, rural neighborhoods were 9.9 miles to the nearest supermarket, 6.7 miles and 7.4 miles to the nearest food store with a good variety of fresh fruits and vegetables, respectively, and 4.7 miles and 4.5 miles to a good variety of fresh and processed fruits or vegetables. High deprivation or low vehicle ownership neighborhoods had better spatial access to a good variety of fruits and vegetables, both in the distance to the nearest source and in the number of shopping opportunities.ConclusionSupermarkets and grocery stores are no longer the only shopping opportunities for fruits or vegetables. The inclusion of data on availability of fresh or processed fruits or vegetables in the measurements provides robust meaning to the concept of potential access in this large rural area.

Children's very low food security is associated with increased dietary intakes in energy, fat, and added sugar among Mexican-origin children (6-11 y) in Texas border Colonias

BackgroundFood insecurity among Mexican-origin and Hispanic households is a critical nutritional health issue of national importance. At the same time, nutrition-related health conditions, such as obesity and type 2 diabetes, are increasing in Mexican-origin youth. Risk factors for obesity and type 2 diabetes are more common in Mexican-origin children and include increased intakes of energy-dense and nutrient-poor foods. This study assessed the relationship between childrens experience of food insecurity and nutrient intake from food and beverages among Mexican-origin children (age 6-11 y) who resided in Texas border colonias.MethodsBaseline data from 50 Mexican-origin children were collected in the home by trained promotora-researchers. All survey (demographics and nine-item child food security measure) and 24-hour dietary recall data were collected in Spanish. Dietary data were collected in person on three occasions using a multiple-pass approach; nutrient intakes were calculated with NDS-R software. Separate multiple regression models were individually fitted for total energy, protein, dietary fiber, calcium, vitamin D, potassium, sodium, Vitamin C, and percentage of calories from fat and added sugars.ResultsThirty-two children (64%) reported low or very low food security. Few children met the recommendations for calcium, dietary fiber, and sodium; and none for potassium or vitamin D. Weekend intake was lower than weekday for calcium, vitamin D, potassium, and vitamin C; and higher for percent of calories from fat. Three-day average dietary intakes of total calories, protein, and percent of calories from added sugars increased with declining food security status. Very low food security was associated with greater intakes of total energy, calcium, and percentage of calories from fat and added sugar.ConclusionsThis paper not only emphasizes the alarming rates of food insecurity for this Hispanic subgroup, but describes the associations for food insecurity and diet among this sample of Mexican-origin children. Child-reported food insecurity situations could serve as a screen for nutrition problems in children. Further, the National School Lunch and School Breakfast Programs, which play a major beneficial role in childrens weekday intakes, may not be enough to keep pace with the nutritional needs of low and very low food secure Mexican-origin children.

Food insecurity, social capital and perceived personal disparity in a predominantly rural region of Texas: an individual-level analysis

Few studies have addressed the association of food insecurity with place of residence and perceptions of collective social functioning such as perceived social capital and perceived personal disparity. This study assessed the association between food insecurity and measures of perceived personal disparity and perceived social capital in a region of Central Texas, USA comprised of one urban and six rural counties. Food insecurity, perceived social capital, perceived personal disparity, and sociodemographic control measures were derived from the 2006 Brazos Valley Community Health Assessment on an analytic sample of 1803 adult participants (74% response rate). Robust multinomial regression models examined associations between food insecurity and perceived personal disparity, perceived social capital, education, age, residence in a poor or low-income household, minority group membership, and rural residence. A model was estimated for food insecurity (n = 1803, p < 0.0001). Residents with low social capital, higher levels of perceived personal disparity, rural residence, residence in a low-income or poor household, minority group membership, and lower levels of educational attainment were more likely to experience food insecurity. Rural residence (p = 0.021) was significant only for the comparison between those who never, and those who often experienced food insecurity, and findings for the stratified rural and urban samples were roughly equivalent to the combined sample. Individual level measures of collective social functioning are important correlates of food insecurity. In this study, both perceived personal disparity and perceived social capital play an important role, regardless of rural or urban residence.

Convenience Stores and the Marketing of Foods and Beverages Through Product Assortment

BACKGROUND Product assortment (presence and variety) is a key in-store marketing strategy to influence consumer choice. Quantifying the product assortment of healthier and less-healthy foods and beverages in convenience stores can inform changes in the food environment. PURPOSE To document product assortment (i.e., presence and variety of specific foods and beverages) in convenience stores. METHODS Observational survey data were collected onsite in 2011 by trained promotora-researchers in 192 convenience stores. Frequencies of presence and distributions of variety were calculated in 2012. Paired differences were examined using the Wilcoxon matched-pairs signed-rank test. RESULTS Convenience stores displayed a large product assortment of sugar-sweetened beverages (median 86.5 unique varieties); candy (76 varieties); salty snacks (77 varieties); fried chips (44 varieties); cookies and pastries (19 varieties); and frozen sweets (21 varieties). This compared with 17 varieties of non-sugar sweetened beverages and three varieties of baked chips. The Wilcoxon signed-rank test confirmed a (p<0.001) greater variety of sugar-sweetened than non-sugar-sweetened beverages, and of fried chips compared with baked chips. Basic food items provided by convenience stores included milk (84% of stores); fresh fruit (33%); fresh vegetables (35%); canned vegetables (78%); white bread (71%); and deli-style packaged meat (57%). Healthier versions of milk, canned fruit, canned tuna, bread, and deli-style packaged meat were displayed in 17%-71% of convenience stores. CONCLUSIONS Convenience stores in this area provide a greater assortment of less-healthy compared with healthier foods and beverages. There are opportunities to influence consumer food choice through programs that alter the balance between healthier and less-healthy foods and beverages in existing convenience stores that serve rural and underserved neighborhoods and communities.

Association of Household and Community Characteristics with Adult and Child Food Insecurity among Mexican-Origin Households in Colonias along the Texas-Mexico Border

BackgroundFood insecurity is a critical problem in the United States and throughout the world. There is little published data that provides insights regarding the extent and severity of food insecurity among the hard-to-reach Mexican-origin families who reside in the growing colonias along the Texas border with Mexico. Considering that culture, economics, and elements of the environment may increase the risk for food insecurity and adverse health outcomes, the purpose of this study was to examine the relation between household and community characteristics and food insecurity.MethodsThe study used data from the 2009 Colonia Household and Community Food Resource Assessment (C-HCFRA). The data included 610 face-to-face interviews conducted in Spanish by promotoras (indigenous community health workers) in forty-four randomly-identified colonias near the towns of Progreso and La Feria in Hidalgo and Cameron counties along the Texas border with Mexico. C-HCFRA included demographic characteristics, health characteristics, food access and mobility, food cost, federal and community food and nutrition assistance programs, perceived quality of the food environment, food security, eating behaviors, and alternative food sources.Results78% of participants experienced food insecurity at the level of household, adult, or child. The most severe - child food insecurity was reported by 49% of all households and 61.8% of households with children. Increasing levels of food insecurity was associated with being born in Mexico, increasing household composition, decreasing household income, and employment. Participation in federal food assistance programs was associated with reduced severity of food insecurity. Greater distance to their food store and perceived quality of the community food environment increased the odds for food insecurity.ConclusionsThe Mexican-origin population is rapidly expanding; record numbers of individuals and families are experiencing food insecurity; and for those living in rural or underserved areas such as the colonias, the worst forms of food insecurity are an ongoing reality. The rates of households with adult and child food insecurity in this border area are alarming and among the highest reported. Clearly, systematic and sustained action on federal, state, and community levels is needed to reduce household, adult, and child food insecurity that integrates cultural tailoring of interventions and programs to address food and management skills, multi-sector partnerships and networks, expansion of food and nutrition assistance programs, and enhanced research efforts.

Association between proximity to and coverage of traditional fast-food restaurants and non-traditional fast-food outlets and fast-food consumption among rural adults

ObjectiveThe objective of this study is to examine the relationship between residential exposure to fast-food entrées, using two measures of potential spatial access: proximity (distance to the nearest location) and coverage (number of different locations), and weekly consumption of fast-food meals.MethodsTraditional fast-food restaurants and non-traditional fast-food outlets, such as convenience stores, supermarkets, and grocery stores, from the 2006 Brazos Valley Food Environment Project were linked with individual participants (n = 1409) who completed the nutrition module in the 2006 Brazos Valley Community Health Assessment.ResultsIncreased age, poverty, increased distance to the nearest fast food, and increased number of different traditional fast-food restaurants, non-traditional fast-food outlets, or fast-food opportunities were associated with less frequent weekly consumption of fast-food meals. The interaction of gender and proximity (distance) or coverage (number) indicated that the association of proximity to or coverage of fast-food locations on fast-food consumption was greater among women and opposite of independent effects.ConclusionsResults provide impetus for identifying and understanding the complex relationship between access to all fast-food opportunities, rather than to traditional fast-food restaurants alone, and fast-food consumption. The results indicate the importance of further examining the complex interaction of gender and distance in rural areas and particularly in fast-food consumption. Furthermore, this study emphasizes the need for health promotion and policy efforts to consider all sources of fast-food as part of promoting healthful food choices.

Focusing on fast food restaurants alone underestimates the relationship between neighborhood deprivation and exposure to fast food in a large rural area

BackgroundIndividuals and families are relying more on food prepared outside the home as a source for at-home and away-from-home consumption. Restricting the estimation of fast-food access to fast-food restaurants alone may underestimate potential spatial access to fast food.MethodsThe study used data from the 2006 Brazos Valley Food Environment Project (BVFEP) and the 2000 U.S. Census Summary File 3 for six rural counties in the Texas Brazos Valley region. BVFEP ground-truthed data included identification and geocoding of all fast-food restaurants, convenience stores, supermarkets, and grocery stores in study area and on-site assessment of the availability and variety of fast-food lunch/dinner entrées and side dishes. Network distance was calculated from the population-weighted centroid of each census block group to all retail locations that marketed fast food (n = 205 fast-food opportunities).ResultsSpatial access to fast-food opportunities (FFO) was significantly better than to traditional fast-food restaurants (FFR). The median distance to the nearest FFO was 2.7 miles, compared with 4.5 miles to the nearest FFR. Residents of high deprivation neighborhoods had better spatial access to a variety of healthier fast-food entrée and side dish options than residents of low deprivation neighborhoods.ConclusionsOur analyses revealed that identifying fast-food restaurants as the sole source of fast-food entrées and side dishes underestimated neighborhood exposure to fast food, in terms of both neighborhood proximity and coverage. Potential interventions must consider all retail opportunities for fast food, and not just traditional FFR.

Food Insecurity is Associated With Social Capital, Perceived Personal Disparity, and Partnership Status Among Older and Senior Adults in a Largely Rural Area of Central Texas

This study examined the association of compositional measures of collective social functioning, composed of community and familial social capital and perceived personal disparity, with food security among older (aged 50–59 y) and senior (aged ≥ 60 y) adult residents of the largely rural Brazos Valley in Central Texas using data from the 2006 Brazos Valley Community Health Assessment (analytic N = 1059, 74% response rate). Among older adults and seniors, 18.6% reported food insecurity (5.5% often and 13.1% sometimes), defined as running out of food and not having money to buy more. Low community social capital was reported by 22.4% of participants, and 30.8% indicated they were single, widowed, or divorced, an indicator of limited familial social capital. A robust multinomial regression model found the odds of reporting greater food insecurity increased for individuals who were women, African American, residents of a household with a low or poverty-level income, individuals who perceived themselves to be worse off than others within their community, and those who had low social capital. The odds of being food insecure decreased for older respondents, partnered respondents and persons with more education (pseudo r2 = 0.27, p < 0.0000). Compositional level measures of collective social functioning are important associates of food insecurity among older adults and seniors, regardless of severity.

Less-healthy eating behaviors have a greater association with a high level of sugar-sweetened beverage consumption among rural adults than among urban adults

Background Sugar-sweetened beverage (SSB) consumption is associated with the increasing prevalence of overweight and obesity in the United States; however, little is known about how less-healthy eating behaviors influence high levels of SSB consumption among rural adults. Objective We assessed the frequency of SSB consumption among rural and urban adults, examined the correlates of frequent SSB consumption, and determined difference in correlates between rural and urban adults in a large region of Texas. Design A cross-sectional study using data on 1,878 adult participants (urban=734 and rural=1,144), who were recruited by random digit dialing to participate in the seven-county 2006 Brazos Valley Community Health Assessment. Data included demographic characteristics, eating behaviors (SSB consumption, frequency of fast-food meals, frequency of breakfast meals, and daily fruit and vegetable intake), and household food insecurity. Results The prevalence of any consumption of SSB and the prevalence of high consumption of SSB were significantly higher among rural adults compared with urban counterparts. The multivariable logistic regression models indicated that a high level of SSB consumption (≥3 cans or glasses SSB/day) was associated with demographic characteristics (poverty-level income and children in the home), frequent consumption of fast-food meals, infrequent breakfast meals, low fruit and vegetable intake, and household food insecurity especially among rural adults. Conclusions This study provides impetus for understanding associations among multiple eating behaviors, especially among economically and geographically disadvantaged adults. New strategies are needed for educating consumers, not only about how to moderate their SSB intake, but also how to simultaneously disrupt the co-occurrence of undesirable eating and promote healthful eating.