Abstract
Worldwide, interest in research on methods to define access to healthy food at the local level has grown, given its central connection to carrying out a healthy lifestyle. Within this research domain, papers have examined the spatial element of food access, or individual perceptions about the food environment. To date, however, no studies have provided a method for linking a validated, objective measure of the food environment with qualitative data on how people access healthy food in their community. In this study, we present a methodology for linking scores from a modified Nutrition Environment Measures Survey in Stores (conducted at every store in our study site of Flint, Michigan) with perceptions of the acceptability of food stores and shopping locations drawn from seven focus groups (n = 53). Spatial analysis revealed distinct patterns in visiting and avoidance of certain store types. Chain stores tended to be rated more highly, while stores in neighborhoods with more African-American or poor residents were rated less favorably and avoided more frequently. Notably, many people avoided shopping in their own neighborhoods; participants traveled an average of 3.38 miles to shop for groceries, and 60% bypassed their nearest grocery store when shopping. The utility of our work is threefold. First, we provide a methodology for linking perceived and objective definitions of food access among a small sample that could be replicated in cities across the globe. Second, we show links between perceptions of food access and objectively measured food store scores to uncover inequalities in access in our sample to illustrate potential connections. Third, we advocate for the use of such data in informing the development of a platforms that aim to make the process of accessing healthy food easier via non-food retail based interventions. Future work can replicate our methods to both uncover patterns in distinct food environments and aid in advocacy around how to best intervene in the food environment in various locales.
Highlights
Food access and the study of so-called ‘food deserts’—or low-income areas where people have limited access to healthy food—have emerged as major inquiries within public health: while just 7 studies on food deserts were conducted prior to 1990, 12 were conducted in the 1990s, and 29 more were conducted in the 2000s [4]
Our immediate objective is to combine perceptions about food shopping and self-reported shopping behavior with a food store survey to provide a method for exploring how people use their food environments. This offers an improvement on existing methods because we found no studies linking objective food environment data with food store perceptions
Disinvestment over many years created an environment where traditional food retail options were greatly diminished in quality: only one chain grocery store exists in a city of nearly 100,000 people, and a handful of independent grocers lag behind the quality, variety, and price of the chains that dominate the suburban fringe
Summary
Food access and the study of so-called ‘food deserts’—or low-income areas where people have limited access to healthy food—have emerged as major inquiries within public health: while just 7 studies on food deserts were conducted prior to 1990, 12 were conducted in the 1990s, and 29 more were conducted in the 2000s [4]. Sadler et al Int J Health Geogr (2019) 18:31 former Food Desert Atlas, for example, previously designated food deserts based solely on the absence of a large grocery store or supermarket (combined with socioeconomic deprivation) [68]. Researchers have criticized such approaches, because they provide little or no insight into how people’s perceptions of their food environment align (or fail to align) with these simplistic measures [59]. Two primary gaps in food access research of interest in this paper include: (1) many objective food environment measures do not take into account the variability of healthy food availability from store to store; and (2) methods for linking spatially referenced perceptions of the food environment to these audits are not yet in common use
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