A possible dose\u2013response association between distance to farmers\u2019 markets and roadside produce stands, frequency of shopping, fruit and vegetable consumption, and body mass index among customers in the Southern United States

Stephanie B. Jilcott Pitts,Qiang Wu,Jedediah Hinkley,Olivia R. Whitt,Lisa Phillips,Nancy Winterbauer,Mary Jane Lyonnais,Jared T. McGuirt,Ann P. Rafferty

doi:10.1186/s12889-016-3943-7

Abstract

BackgroundThe association between farmers’ market characteristics and consumer shopping habits remains unclear. Our objective was to examine associations among distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and body mass index (BMI). We hypothesized that the relationship between frequency of farmers’ market shopping and BMI would be mediated by fruit and vegetable consumption.MethodsIn 15 farmers’ markets in northeastern North Carolina, July–September 2015, we conducted a cross-sectional survey among 263 farmers’ market customers (199 provided complete address data) and conducted farmers’ market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent variables included farmers’ market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for age, race, sex, and education, were used to examine associations between distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and BMI.ResultsThose who reported shopping at farmers’ markets a few times per year or less reported consuming 4.4 (standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers’ market amenities, and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of the relationship between frequency of shopping and BMI by fruit and vegetable consumption.ConclusionsMore work should be done to understand factors within farmers’ markets that encourage fruit and vegetable purchases.

Highlights

The association between farmers’ market characteristics and consumer shopping habits remains unclear
We hypothesized that the relationship between frequency of farmers’ market shopping and body mass index (BMI) would be mediated by fruit and vegetable consumption
We examined associations between farmers’ market characteristics, frequency of farmers’ market shopping, and fruit and vegetable consumption among 263 customers in 15 farmers’ markets and roadside produce stands in northeastern North Carolina

Summary

Introduction

The association between farmers’ market characteristics and consumer shopping habits remains unclear. In the United States, there is greater obesity among rural versus urban populations [1, 2] Factors in both the community and consumer food environments are associated with dietary behaviors and subsequent obesity [3]. Adding new farmers’ markets is one strategy to increase access to healthy foods in rural areas, improving both the community and consumer food environments [4]. There are associations between the consumer and community food environment and purchase and consumption of healthier foods: Individuals who live closer to chain supermarkets and farmers’ markets (community food environment) have healthier diets and lower body mass index (BMI) [5,6,7]. Focusing on the community and consumer food environments aligns with the 5 dimensions of food access proposed by Caspi and colleagues, [16] based off of Penchansky and Thomas’s model of health care access, [17] including availability (i.e., adequacy of healthy foods), accessibility (travel time and distance to food retail outlets), affordability (food prices), accommodation (attitudes about the food environment), acceptability (how well local food sources adapt to residents’ needs) [16]

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