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

Abstract

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...

The Association of Health Literacy with Physical Activity and Nutritional Behavior in Older Adults, and Its Social Cognitive Mediators

“…The intervention group came from the center of Veendam (a small city with around 20,000 inhabitants), but the control group came from several smaller villages in a more rural area. Dean and Sharkey (2011) have shown that fruit and vegetable consumption depends on different factors in rural and urban environments. In their study, they suggest that food security and distance to food sources play a larger role in rural settings, as compared with urban settings (Dean & Sharkey, 2011).…”

“…Dean and Sharkey (2011) have shown that fruit and vegetable consumption depends on different factors in rural and urban environments. In their study, they suggest that food security and distance to food sources play a larger role in rural settings, as compared with urban settings (Dean & Sharkey, 2011). Also, possibly more people in rural areas cultivate their own fruits and vegetables.…”

Developing and testing the reliability of a measurement tool for an urban area food environment in Korea: Focusing on food stores

“…9 6) 1.00 6) 0.82 6) 95.5 ± 2. 1.00 6) 0.64 6) 100.0 ± 0.0 89.4 ± 2.1 1.00 ± 0.00 0.71 ± 0.05 Snacks 97.0 6) 93.9 6) 0.89 6) 0.86 6) 97 Fat and oils 95.5 ± 2.1 93.9 6) 0.85 ± 0.12 0.88 6) 94.7 ± 2.9 97.0 ± 0.0 0.82 ± 0.14 0.94 ± 0.00 P value 0.0027 7) 0.0095 7) 0.0081 8) 0.0290 8) 1) Only for 12 food subgroups(except vegetables, fruits, fish and shellfish) which have both general food and food with healthy option. 2) Agreement of inter-observer, n = number of food store 3) Agreement of intra-observer, n = number of food store 4) Food with healthy option: whole grains and processed foods with healthy option such as low sodium, low sugar, low fat, low calorie, no fat, calcium enriched, food for weight management, decaffeinated coffee, cold-chain juice, see ' Table 3 …”

Global growth of “big box” stores and the potential impact on human health and nutrition

“…70 The overall effect is to create pockets with minimal proximal food access, where residents must either pay higher prices at gas stations, convenience stores, or small grocers or have access to a vehicle and the time required to reach a major grocery outlet, 71 which is a major barrier for low-income households. 72,73 In addition, work from Sharkey et al 74 shows that Texas residents in more deprived neighborhoods and rural areas must travel farther to reach a supercenter, 75 although in Louisiana, income level is not associated with supercenter locations. 41 Kaufman 76 showed that, across the United States, low-income and urban populations have lower access to both supermarkets and supercenters.…”