Abstract
The nutrition environment, including food store type, may influence dietary choices, which in turn can affect risk of obesity and related chronic diseases such as CHD, diabetes and cancer. The objective of the present study was to elucidate the extent to which healthy foods are available and affordable in various rural food outlets. A subset of the nutrition environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S). The NEMS-S instrument assessed the availability and price of healthy foods (e.g. low-fat/non-fat milk, lean meats and reduced-fat dinner entrées) compared with less healthy counterparts (e.g. whole milk, non-lean meats and regular dinner entrées). The NEMS-S also assessed the quality of fresh fruits and vegetables. Availability, prices and quality of healthy foods were compared between grocery stores (n 24) and convenience stores (n 67) in nine rural counties in Alabama. Mean availability subscale score (possible range 0 to 30; higher score indicates a greater number of healthier foods were available) for grocery stores was 22·6 (sd 8·1), compared with 6·6 (sd 5·2) in convenience stores (P < 0·0001); and mean price subscale score (possible range -9 to 18; higher score indicates that healthier options were less expensive than the less healthy options) for grocery stores was 2·4 (sd 2·7), compared with 0·7 (sd 1·2) in convenience stores (P = 0·0080). Mean total NEMS-S score (possible range -9 to 54) in grocery stores was 29·8 (sd 10·9) compared with 7·3 (sd 7·1) in convenience stores (P < 0·0001). Both grocery and convenience stores could be strategic points of intervention to improve the nutrition environment in the counties that were surveyed.
Highlights
While generally it is agreed that the problem of obesity has risen to epidemic proportions, the specific factors that are implicated in the development of obesity are still under investigation[1]
A total of twenty-four grocery stores and sixty-seven convenience stores were surveyed in the nine rural Alabama counties
African American residents comprised a mean of 60·6 (SD 15·0) % of the population in the included counties, with a range of 40·2 to 81·5 %
Summary
While generally it is agreed that the problem of obesity has risen to epidemic proportions, the specific factors that are implicated in the development of obesity are still under investigation[1]. In attempting to pinpoint specific contributors to obesity and related chronic diseases (CHD, diabetes and cancer), individual responsibility cannot be ignored; yet the nutrition environment to which one is exposed may, to a large degree, influence the dietary choices that a person makes, which in turn can affect the risk of obesity and related chronic diseases[3]. The prevalence of obesity is higher in lower-income and African American communities than in the general population[4,5]. African American residents increased fruit and vegetable intake by 32 % when there was availability of healthy food options in the local supermarket[9]. Little is known about the nutrition environments in rural communities that may predispose residents to higher obesity risk than their urban counterparts.
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