BackgroundAlthough the importance of fruit and vegetable consumption to health has been well established, few studies have focused on access to fruits and vegetables in rural areas; even fewer examined the relationship between food access and fruit and vegetable consumption among seniors.MethodsTo examine the spatial challenges to good nutrition faced by seniors who reside in rural areas and how spatial access influences fruit and vegetable intake.A cross-sectional analysis using data from the 2006 Brazos Valley Health Assessment (mailsurvey) for 582 rural seniors (60-90 years), who were recruited by random digit dialing; food store data from the 2006-2007 Brazos Valley Food Environment Project that used ground-truthed methods to identify, geocode, and inventory fruit and vegetables in all food stores.ResultsFew of the BVHA seniors consumed the recommended intakes of fruits or vegetables; women consumed more servings of fruit (1.49 ± 0.05 vs. 1.29 ± 0.07, p = 0.02), similar servings of vegetables (2.18 ± 0.04 vs. 2.09 ± 0.07, p = 0.28), and more combined fruit and vegetables (3.67 ± 0.08 vs. 3.38 ± 0.12, p = 0.04) than men. The median distances to fresh fruit and vegetables were 5.5 miles and 6.4 miles, respectively. When canned and frozen fruit and vegetables were included in the measurement of overall fruit or vegetables, the median distance for a good selection of fruit or vegetables decreased to 3.4 miles for overall fruit and 3.2 miles for overall vegetables. Almost 14% reported that food supplies did not last and there was not enough money to buy more. Our analyses revealed that objective and perceived measures of food store access - increased distance to the nearest supermarket, food store with a good variety of fresh and processed fruit, or food store with a good variety of fresh and processed vegetables - were associated with decreased daily consumption of fruit, vegetables, and combined fruit and vegetables, after controlling for the influence of individual characteristics and perceptions of community and home food resources.ConclusionsFindings suggest that interventions designed to increase fruit and vegetable consumption among rural seniors should consider strategies to ameliorate differential access to healthy food due to food store distance.

INTRODUCTIONThe consumption of fruits and vegetables (FV) is a key indicator of a healthy diet associated with positive health outcomes such as the reduction in incidence of cardiovascular disease and cancer.1 , 2 The 2005 Dietary Guidelines for Americans call for 4.5 cups (9 servings) of FV daily based on a 2,000 calorie level.3 This compares unfavorably to a nationwide assessment of total FV consumption that indicates mean per-capita consumption of FV is roughly 2.6 cups, not accounting for losses resulting from cooking or other factors.4 The majority of Americans do not meet the 4.5 cup minimum, making the increase of FV intake a key target for healthy eating interventions.5 , 6Research on health promotion often frames explanations for individual health decisions within an ecological context.7 In the case of food choices such as FV consumption, the ecological context has been conceptualized as the nutritional or food environment.8 -12 The food environment, specifically the accessibility of healthy foods, has been determined to influence a range of dietary health indicators including obesity rates, and the consumption of FV and low-fat dairy products. 13 -18 Research on food access often examines spatial disparity, which refers to the unequal distribution of goods among different spatially embedded populations.19 These studies often focus on urban rather than rural environments.9 Spatial disparity in access to essential goods and services is exacerbated by living in a rural rather than an urban setting.19 -21 However, little work has been done on the spatial distribution of food resources in rural communities. 13 -17 , 22 , 23 Even less work has been conducted on comparisons between urban and rural food environments. One exception is the work of Pearce et al. who found that more-deprived urban and semi-urban neighborhoods in New Zealand had better access to community resources than better off neighborhoods, but that access was worse for the more-deprived rural environments.24 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAlthough previous research has examined the association between accessibility measures of the local food environment and measures of dietary health, few studies have compared these associations across urban and rural settings. This study aims to extend research in this area by 1) determining the extent of inadequacy of household and community food resources, and 2) identifying the varying sociodemographic, household, and community characteristics that influ...

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 1,803 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.

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.