Food Insecurity Moderates Association Between Perceived Fresh Fruit and Vegetable Access and Vegetable Intake in the Rural Southern US

Main Article Content

Cerra C. Antonacci April Hermstad Regine Haardörfer Michelle C. Kegler

Abstract

Objective. Assess associations between perceived fresh fruit and vegetable access and obtaining fresh fruit and vegetables from various food sources with meeting national recommendations for fruit and vegetable intakes and BMI, and whether associations differ by food insecurity.


Methods. Secondary data analysis of a cross-sectional survey evaluating a health equity initiative among 1,474 respondents in 6 rural Georgia counties. Logistic regressions assessed associations between perceived fresh fruit and vegetable access and fresh fruit and vegetable sources with meeting/not meeting fruit and vegetable recommendations and BMI, and interactions with food insecurity.


Results. Respondents who obtained fresh fruit and vegetables at small local grocery stores, farmer’s markets, and community/home gardens had twice the odds of meeting national vegetable recommendations. Food secure adults with greater perceived fresh fruit and vegetable access had 1.5 times the odds of meeting national vegetable recommendations.


Conclusions and Implications. Results highlight perceived access inequities for food insecure adults and the importance of food sources for vegetable consumption in the rural South.

Article Details

How to Cite
ANTONACCI, Cerra C. et al. Food Insecurity Moderates Association Between Perceived Fresh Fruit and Vegetable Access and Vegetable Intake in the Rural Southern US. Medical Research Archives, [S.l.], v. 11, n. 5, may 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3823>. Date accessed: 03 oct. 2024. doi: https://doi.org/10.18103/mra.v11i5.3823.
Section
Research Articles

References

1. Bryan S, Afful J, Carroll M, et al. National Health and Nutrition Examination Survey 2017–March 2020 Prepandemic Data Files Development of Files and Prevalence Estimates for Selected Health Outcomes. National Center for Health Statistics (U.S.); 2021. doi:10.15620/cdc:106273
2. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960–1962 through 2017–2018. NCHS Health E-Stats. Published online September 22, 2020. doi:10.1001/jama.2020.14590
3. Shiozawa M, Kaneko H, Itoh H, et al. Association of Body Mass Index with Ischemic and Hemorrhagic Stroke. Nutrients. 2021;13(7):2343. doi:10.3390/nu13072343
4. Fulton S, Décarie-Spain L, Fioramonti X, Guiard B, Nakajima S. The menace of obesity to depression and anxiety prevalence. Trends Endocrinol Metab. 2022;33(1):18-35. doi:10.1016/j.tem.2021.10.005
5. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;143(21). doi:10.1161/CIR.0000000000000973
6. Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes Metab Syndr Obes Targets Ther. 2010;3:285-295. doi:10.2147/DMSOTT.S7384
7. Tsai AG, Williamson DF, Glick HA. Direct medical cost of overweight and obesity in the USA: a quantitative systematic review. Obes Rev. 2011;12(1):50-61. doi:10.1111/j.1467-789X.2009.00708.x
8. Heo M, Kim RS, Wylie-Rosett J, Allison DB, Heymsfield SB, Faith MS. Inverse Association between Fruit and Vegetable Intake and BMI even after Controlling for Demographic, Socioeconomic and Lifestyle Factors. Obes Facts. 2011;4(6):449-455. doi:10.1159/000335279
9. Aljadani HM, Patterson A, Sibbritt D, Hutchesson MJ, Jensen ME, Collins CE. Diet Quality, Measured by Fruit and Vegetable Intake, Predicts Weight Change in Young Women. J Obes. 2013;2013:1-10. doi:10.1155/2013/525161
10. Wang T, Heianza Y, Sun D, et al. Improving fruit and vegetable intake attenuates the genetic association with long-term weight gain. Am J Clin Nutr. 2019;110(3):759-768. doi:10.1093/ajcn/nqz136
11. Dreher ML, Ford NA. A Comprehensive Critical Assessment of Increased Fruit and Vegetable Intake on Weight Loss in Women. Nutrients. 2020;12(7):1919. doi:10.3390/nu12071919
12. Lee-Kwan SH, Moore LV, Blanck HM, Harris DM, Galuska D. Disparities in State-Specific Adult Fruit and Vegetable Consumption — United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(45):1241-1247. doi:10.15585/mmwr.mm6645a1
13. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.
14. Caspi CE, Sorensen G, Subramanian SV, Kawachi I. The local food environment and diet: A systematic review. Health Place. 2012;18(5):1172-1187. doi:10.1016/j.healthplace.2012.05.006
15. Lim N, Majid M. Perceived Food Environment and Nutrition-Based Behavioural Outcomes: A Systematic Review. Paper presented at: 14th International Congress of Asian Planning Schools Association; Nov 2017; Beijing, China.
16. Yamaguchi M, Praditsorn P, Purnamasari SD, et al. Measures of Perceived Neighborhood Food Environments and Dietary Habits: A Systematic Review of Methods and Associations. Nutrients. 2022;14(9):1788. doi:10.3390/nu14091788
17. Turner G, Green R, Alae-Carew C, Dangour AD. The association of dimensions of fruit and vegetable access in the retail food environment with consumption; a systematic review. Glob Food Secur. 2021;29:100528. doi:10.1016/j.gfs.2021.100528
18. Swinburn B, Egger G, Raza F. Dissecting Obesogenic Environments: The Development and Application of a Framework for Identifying and Prioritizing Environmental Interventions for Obesity. Prev Med. 1999;29(6):563-570. doi:10.1006/pmed.1999.0585
19. Aggarwal A, Cook AJ, Jiao J, et al. Access to Supermarkets and Fruit and Vegetable Consumption. Am J Public Health. 2014;104(5):917-923. doi:10.2105/AJPH.2013.301763
20. Dubowitz T, Zenk SN, Ghosh-Dastidar B, et al. Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet and BMI. Public Health Nutr. 2015;18(12):2220-2230. doi:10.1017/S1368980014002742
21. Green SH, Glanz K. Development of the Perceived Nutrition Environment Measures Survey. Am J Prev Med. 2015;49(1):50-61. doi:10.1016/j.amepre.2015.02.004
22. Pitt E, Gallegos D, Comans T, Cameron C, Thornton L. Exploring the influence of local food environments on food behaviours: a systematic review of qualitative literature. Public Health Nutr. 2017;20(13):2393-2405. doi:10.1017/S1368980017001069
23. Dhakal CK, Khadka S. Heterogeneities in Consumer Diet Quality and Health Outcomes of Consumers by Store Choice and Income. Nutrients. 2021;13(4):1046. doi:10.3390/nu13041046
24. Jilcott Pitts SB, Wu Q, McGuirt JT, Crawford TW, Keyserling TC, Ammerman AS. 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. Public Health Nutr. 2013;16(11):1944-1952. doi:10.1017/S1368980013001389
25. Vaughan CA, Collins R, Ghosh-Dastidar M, Beckman R, Dubowitz T. Does where you shop or who you are predict what you eat?: The role of stores and individual characteristics in dietary intake. Prev Med. 2017;100:10-16. doi:10.1016/j.ypmed.2017.03.015
26. Spees CK, Clark JE, Hooker NH, Watowicz RP, Taylor CA. Dietary Intake Contributions of Food and Beverages by Source and Food Security Status in US Adults. J Nutr Educ Behav. 2017;49(8):667-673.e1. doi:10.1016/j.jneb.2017.01.009
27. Porter CM. What gardens grow: Outcomes from home and community gardens supported by community-based food justice organizations. J Agric Food Syst Community Dev. 2018;8(Suppl 1):187-205. doi:10.5304/jafscd.2018.08A.002
28. Kegler MC, Prakash R, Hermstad A, Williamson D, Anderson K, Haardörfer R. Home gardening and associations with fruit and vegetable intake and BMI. Public Health Nutr. 2020;23(18):3417-3422. doi:10.1017/S1368980020001329
29. Hume C, Grieger JA, Kalamkarian A, D’Onise K, Smithers LG. Community gardens and their effects on diet, health, psychosocial and community outcomes: a systematic review. BMC Public Health. 2022;22(1):1247. doi:10.1186/s12889-022-13591-1
30. Drisdelle C, Kestens Y, Hamelin AM, Mercille G. Disparities in Access to Healthy Diets: How Food Security and Food Shopping Behaviors Relate to Fruit and Vegetable Intake. J Acad Nutr Diet. 2020;120(11):1847-1858. doi:10.1016/j.jand.2020.03.020
31. Liu Y, Zhang Y, Remley DT, Eicher-Miller HA. Frequency of Food Pantry Use Is Associated with Diet Quality among Indiana Food Pantry Clients. J Acad Nutr Diet. 2019;119(10):1703-1712. doi:10.1016/j.jand.2019.02.015
32. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Statistical Supplement to Household Food Security in the United States in 2020. US Dept of Agriculture, Economic Research Service. Published Sept 2021. https://www.ers.usda.gov/webdocs/publications/102072/ap-091.pdf?v=4878
33. Coleman-Jensen A. Household Food Security in the United States in 2020. US Dept of Agriculture, Economic Research Service. Published Sept 2021. https://www.ers.usda.gov/webdocs/publications/102076/err-298.pdf
34. Simmet A, Depa J, Tinnemann P, Stroebele-Benschop N. The Dietary Quality of Food Pantry Users: A Systematic Review of Existing Literature. J Acad Nutr Diet. 2017;117(4):563-576. doi:10.1016/j.jand.2016.08.014
35. Kaiser ML, Carr JK, Fontanella S. A tale of two food environments: Differences in food availability and food shopping behaviors between food insecure and food secure households. J Hunger Environ Nutr. 2019;14(3):297-317. doi:10.1080/19320248.2017.1407723
36. Lyonnais MJ, Rafferty AP, Jilcott Pitts S, Blanchard RJ, Kaur AP. Examining Shopping Patterns, Use of Food-Related Resources, and Proposed Solutions to Improve Healthy Food Access Among Food Insecure and Food Secure Eastern North Carolina Residents. Int J Environ Res Public Health. 2020;17(10):3361. doi:10.3390/ijerph17103361
37. Hanson KL, Connor LM. Food insecurity and dietary quality in US adults and children: a systematic review. Am J Clin Nutr. 2014;100(2):684-692. doi:10.3945/ajcn.114.084525
38. Kowaleski-Jones L, Wen M, Fan JX. Unpacking the paradox: Testing for mechanisms in the food insecurity and BMI association. J Hunger Environ Nutr. 2019;14(5):683-697. doi:10.1080/19320248.2018.1464997
39. Brown AGM, Esposito LE, Fisher RA, Nicastro HL, Tabor DC, Walker JR. Food insecurity and obesity: research gaps, opportunities, and challenges. Transl Behav Med. 2019;9(5):980-987. doi:10.1093/tbm/ibz117
40. Gupta NR, Freedman DA. Food security moderates relationship between perceived food environment and diet quality among adults in communities with low access to healthy food retail. Public Health Nutr. 2021;24(10):2975-2986. doi:10.1017/S1368980020001317
41. Oladele CR, Colón-Ramos U, Galusha D, et al. Perceptions of the local food environment and fruit and vegetable intake in the Eastern Caribbean Health Outcomes research Network (ECHORN) Cohort study. Prev Med Rep. 2022;26:101694. doi:10.1016/j.pmedr.2022.101694
42. Chrisinger BW, Kallan MJ, Whiteman ED, Hillier A. Where do U.S. households purchase healthy foods? An analysis of food-at-home purchases across different types of retailers in a nationally representative dataset. Prev Med. 2018;112:15-22. doi:10.1016/j.ypmed.2018.03.015
43. Pinard CA, Byker Shanks C, Harden SM, Yaroch AL. An integrative literature review of small food store research across urban and rural communities in the U.S. Prev Med Rep. 2016;3:324-332. doi:10.1016/j.pmedr.2016.03.008
44. Shikany JM, Carson TL, Hardy CM, et al. Assessment of the nutrition environment in rural counties in the Deep South. J Nutr Sci. 2018;7:e27. doi:10.1017/jns.2018.18
45. Byker Shanks C, Ahmed S, Smith T, et al. Availability, Price, and Quality of Fruits and Vegetables in 12 Rural Montana Counties, 2014. Prev Chronic Dis. 2015;12:150158. doi:10.5888/pcd12.150158
46. Campbell EA, Shapiro MJ, Welsh C, Bleich SN, Cobb LK, Gittelsohn J. Healthy Food Availability Among Food Sources in Rural Maryland Counties. J Hunger Environ Nutr. 2017;12(3):328-341. doi:10.1080/19320248.2017.1315328
47. Mader E, Busse H. Hungry in the Heartland: Using Community Food Systems as a Strategy to Reduce Rural Food Deserts. J Hunger Environ Nutr. 2011;6(1):45-53. doi:10.1080/19320248.2011.549377
48. Dean WR, Sharkey JR. Food insecurity, social capital and perceived personal disparity in a predominantly rural region of Texas: An individual-level analysis. Soc Sci Med. 2011;72(9):1454-1462. doi:10.1016/j.socscimed.2011.03.015
49. Yaroch AL, Tooze J, Thompson FE, et al. Evaluation of Three Short Dietary Instruments to Assess Fruit and Vegetable Intake: The National Cancer Institute’s Food Attitudes and Behaviors Survey. J Acad Nutr Diet. 2012;112(10):1570-1577. doi:10.1016/j.jand.2012.06.002
50. Britten P, Marcoe K, Yamini S, Davis C. Development of Food Intake Patterns for the MyPyramid Food Guidance System. J Nutr Educ Behav. 2006;38(6):S78-S92. doi:10.1016/j.jneb.2006.08.007
51. CDC. Assessing Your Weight. Centers for Disease Control and Prevention. Published June 3, 2022. Accessed August 10, 2022. https://www.cdc.gov/healthyweight/assessing/index.html
52. Alber JM, Green SH, Glanz K. Perceived and Observed Food Environments, Eating Behaviors, and BMI. Am J Prev Med. 2018;54(3):423-429. doi:10.1016/j.amepre.2017.10.024
53. Karpyn A, Tappe K, Hillier A, Cannuscio C, Koprak J, Glanz K. Where Urban Residents Shop for Produce. J Agric Food Syst Community Dev. Published online September 5, 2014:1-13. doi:10.5304/jafscd.2014.044.009
54. Gundersen C, Engelhard EE, Crumbaugh AS, Seligman HK. Brief assessment of food insecurity accurately identifies high-risk US adults. Public Health Nutr. 2017;20(8):1367-1371. doi:10.1017/S1368980017000180
55. Hager ER, Quigg AM, Black MM, et al. Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. PEDIATRICS. 2010;126(1):e26-e32. doi:10.1542/peds.2009-3146
56. US Department of Health and Human Services. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta CDC. Published online 2005.
57. Gravlee CC, Boston PQ, Mitchell MM, Schultz AF, Betterley C. Food store owners’ and managers’ perspectives on the food environment: an exploratory mixed-methods study. BMC Public Health. 2014;14(1):1031. doi:10.1186/1471-2458-14-1031
58. Befort CA, Nazir N, Perri MG. Prevalence of Obesity Among Adults From Rural and Urban Areas of the United States: Findings From NHANES (2005-2008). J Rural Health. 2012;28(4):392-397. doi:https://doi.org/10.1111/j.1748-0361.2012.00411.x
59. Kegler MC, Prakash R, Hermstad A, Anderson K, Haardörfer R, Raskind IG. Food Acquisition Practices, Body Mass Index, and Dietary Outcomes by Level of Rurality. J Rural Health. Published online November 17, 2020:jrh.12536. doi:10.1111/jrh.12536
60. Pickens CM. Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas — Behavioral Risk Factor Surveillance System, United States, 2015. MMWR Surveill Summ. 2018;67. doi:10.15585/mmwr.ss6709a1
61. Barnidge EK, Hipp PR, Estlund A, Duggan K, Barnhart KJ, Brownson RC. Association between community garden participation and fruit and vegetable consumption in rural Missouri. Int J Behav Nutr Phys Act. 2013;10(1):128. doi:10.1186/1479-5868-10-128
62. Alaimo K, Packnett E, Miles RA, Kruger DJ. Fruit and Vegetable Intake among Urban Community Gardeners. J Nutr Educ Behav. 2008;40(2):94-101. doi:10.1016/j.jneb.2006.12.003
63. AbuSabha R, Namjoshi D, Klein A. Increasing Access and Affordability of Produce Improves Perceived Consumption of Vegetables in Low-Income Seniors. J Am Diet Assoc. 2011;111(10):1549-1555. doi:10.1016/j.jada.2011.07.003
64. Evans AE, Jennings R, Smiley AW, et al. Introduction of farm stands in low-income communities increases fruit and vegetable among community residents. Health Place. 2012;18(5):1137-1143. doi:10.1016/j.healthplace.2012.04.007
65. Gorham G, Dulin-Keita A, Risica PM, et al. Effectiveness of Fresh to You, a Discount Fresh Fruit and Vegetable Market in Low-Income Neighborhoods, on Children’s Fruit and Vegetable Consumption, Rhode Island, 2010–2011. Prev Chronic Dis. 2015;12:140583. doi:10.5888/pcd12.140583
66. Castro DC, Samuels M, Harman AE. Growing Healthy Kids. Am J Prev Med. 2013;44(3):S193-S199. doi:10.1016/j.amepre.2012.11.024
67. Blitstein JL, Snider J, Evans WD. Perceptions of the food shopping environment are associated with greater consumption of fruits and vegetables. Public Health Nutr. 2012;15(6):1124-1129. doi:10.1017/S1368980012000523
68. Caldwell EM, Miller Kobayashi M, DuBow W, Wytinck S. Perceived access to fruits and vegetables associated with increased consumption. Public Health Nutr. 2009;12(10):1743-1750. doi:10.1017/S1368980008004308
69. Gase LN, Glenn B, Kuo T. Self-Efficacy as a Mediator of the Relationship Between the Perceived Food Environment and Healthy Eating in a Low Income Population in Los Angeles County. J Immigr Minor Health. 2016;18(2):345-352. doi:10.1007/s10903-015-0186-0
70. Inglis V, Ball K, Crawford D. Socioeconomic variations in women’s diets: what is the role of perceptions of the local food environment? J Epidemiol Community Health. 2008;62(3):191-197. doi:10.1136/jech.2006.059253
71. Sharkey JR, Johnson CM, Dean WR. Research article Food Access and Perceptions of the Community and Household Food Environment as Correlates of Fruit and Vegetable Intake among Rural Seniors. BMC Geriatrics. 2010;10(32):1-12. doi:10.1186/1471-2318-10-32
72. Auchincloss AH, Mujahid MS, Shen M, Michos ED, Whitt-Glover MC, Diez Roux AV. Neighborhood health-promoting resources and obesity risk (the multi-ethnic study of atherosclerosis). Obesity. 2013;21(3):621-628. doi:10.1002/oby.20255
73. Liese A, Ma X, Hutto B, Sharpe P, Bell B, Wilcox S. Food Shopping and Acquisition Behaviors in Relation to BMI among Residents of Low-Income Communities in South Carolina. Int J Environ Res Public Health. 2017;14(9):1075. doi:10.3390/ijerph14091075
74. Woodruff RC, Haardörfer R, Raskind IG, Hermstad A, Kegler MC. Comparing food desert residents with non-food desert residents on grocery shopping behaviours, diet and BMI: results from a propensity score analysis. Public Health Nutr. 2020;23(5):806-811. doi:10.1017/S136898001900363X
75. Kegler MC, Swan DW, Alcantara I, Feldman L, Glanz K. The Influence of Rural Home and Neighborhood Environments on Healthy Eating, Physical Activity, and Weight. Prev Sci. 2014;15(1):1-11. doi:10.1007/s11121-012-0349-3
76. Ma X, Liese AD, Hibbert J, Bell BA, Wilcox S, Sharpe PA. The Association between Food Security and Store-Specific and Overall Food Shopping Behaviors. J Acad Nutr Diet. 2017;117(12):1931-1940. doi:10.1016/j.jand.2017.02.007