Environment influences food access and resulting shopping and dietary behaviors among homeless Minnesotans living in food deserts

Fruit and vegetable (F&V) intake is inversely associated with obesity, which is disproportionately high in urban food deserts and low-income populations, including Supplemental Nutrition Assistance Program (SNAP) participants. This cross sectional study sought to examine factors associated with food desert SNAP recipients’ F&V purchases and weight status in multi-person households. Socio-demographic characteristics, access to healthy foods and stores, affordability, purchasing practices, use of food assistance and weight status were analyzed. A convenience sample of seventy-one SNAP recipients were recruited from a Detroit, MI food desert. Participants were 45–54 years of age (33.8%), average BMI = 30.33. Multiple linear regression determined if socio-demographic and household factors were associated with fruit and vegetable purchases and BMI. Results showed that those who were more likely to limit F&V purchases were not getting enough food to eat (p = 0.009), and males who indicated limited finances (p = 0.043). BMI was negatively associated with participants not getting enough food to eat within the household (p = .04). SNAP recipients, living in food deserts can benefit from public health interventions, policies and education that can influence F&V purchases and likely consumption.

In today's society there is evidence of a culture of the 'empowered consumer' -- an image of the consumer as a citizen rather than a subordinate. In fact, human rights language is increasingly coming to the fore in the consumption debate. The consumer has been allocated rights by the United Nations whereby all human beings are born free and equal and have civil, political, economic and social rights (McGregor 44). However, as citizens we also have responsibilities of an environmental and social concern. Food retailing and equality of shopping provision is one such concern. Food is a basic right. According to the Universal Declaration of Human Rights everyone has a fundamental right to be free from hunger and have access to safe and nutritious food. Social exclusion refers to those in the population who are unable to participate in economic, political, social and cultural life. Social exclusion is different from, but related to, poverty since it further marginalises the most disadvantaged -- for example, those who cannot access a large supermarket. In keeping with the rights/responsibilities language, the consumer has a basic right to food and the retailer has the social responsibility to supply the needs of the consumer. It is in this respect that food is an ethical issue and has social justice implications. Inability to consume, or have access to, sufficient food of nutritional quality is a global concern. In North America the issue is one of 'food insecurity' or 'food poverty' due to inadequate finance to purchase sufficient food. In the United Kingdom the same problem arises within the context of access to food stores. This is identified as a 'food (shopping) desert', where due to restricted access social exclusion can arise. The term 'food deserts' was first used by the Low Income Project Team of the Nutrition Task Force in 1996 and was succinctly defined by Tessa Jowell (Government Health Minister) in 1997 when she stated that a food desert was an area "where people do not have easy access to healthy, fresh foods particularly if they are poor and have limited mobility". The term 'food desert' is an emotive one referring to a unique tool of social polarisation and exclusion (Lang 5). The issues compounding the problem include low income, locational policy of supermarkets with the acquisition of edge-of-town / out-of-town sites, consumer mobility, car ownership levels and food availability. This research study focuses on Northern Ireland -- a region of the UK on the periphery of Europe. The Province of Northern Ireland (Ulster) is a sparsely populated (122 people per km²), predominantly rural area with the highest unemployment and poverty statistics in the United Kingdom. Similarly, Northern Ireland has a proportionately high degree of non-car ownership (35%) which further complicates the equation since shopping is increasingly becoming a car-borne activity necessitating transportation to edge-of-town superstores. Those not able to avail themselves of large edge-of-town superstores are being socially excluded, since inner-city areas are becoming denuded of food stores. Those that do exist usually have a limited range of food items, usually non-perishable, or are specialist shops stocking high priced items. It is the aim of the study to identify the characteristics, extent and location of food deserts in both rural and urban areas of Northern Ireland. It is a particularly apt time to do so since Northern Ireland is experiencing a 'retail revolution' with the arrival of the major UK grocery multiples and subsequent situational policies to locate off-centre. Similarly, there are plans to curtail out-of-town developments which has been viewed by some smaller retailers as "too little, too late". With the above in mind, it is a timely study for Northern Ireland. Multiple research tools of both a qualitative and a quantitative nature have been employed including consumer focus groups, shopping diaries, comparative shopping exercises, consumer questionnaires and retail interviews. This will enable sufficient validation of results. The focus groups provide qualitative depth (Colquhoun 39) and serve to highlight the issues of shopping inequality from the point of view of different consumer groups which could be identified as potentially vulnerable in the food poverty stakes; the elderly, the disabled, the unemployed or low income families, lone-parent families and females in general; to whom falls the responsibility for provisioning the household, organising the kitchen and doing the household's cooking (Murcott 11). Basically, food is gendered -- women are mainly in charge (Vaines 13). The respondents in this study demonstrate exactly that point since 77% of the sample were female and reported that they were responsible for household shopping. This point is particularly prevalent with regard to access to cars. In fact over 50% of women in 1991-1993 either lived in households without a car or were non-drivers in a household with a car. Similarly, although there is a rising proportion of women who work they still do most of the shopping and spend twice as much time as men provisioning the household (Piachaud & Webb 18). Ultimately, anything that affects the purchaser also affects the purchasing experience -- in this case physical access to the foodstore. Comparative shopping exercises illustrate the availability and price indices of food and reiterate the price differences between the smaller independents, the local corner shops and the supermarkets. Initial research using the British Ministry of Agriculture, Fisheries and Food's "Low Cost, Healthy Diet" (Leather 75) provides evidence of a cost differential of £1.41, or a 26% cost penalty by shopping at a corner store rather than a superstore. Availability among corner shops similarly compared unfavourably with the supermarkets, with the smallest stores offering minimal fresh fruit and vegetables and regularly offering no 'economy' branded equivalent to an established manufacturer's brand. This supports previous research which found that in areas where small shops do exist they offer only a limited overpriced range of processed foods (Elliott 5), and it is generally accepted that those who can shop at supermarkets can generally benefit from lower prices and more choice (Piachaud & Webb 32). The benefits of supermarkets are not therefore available to all. Shopping diaries further illustrate this point with the dichotomy existing where the lower-income consumer shops more frequently and locally than does her higher-income counterpart and it is these same consumers who patronise the smaller, often more expensive corner shop. Many consumers like the convenience of large supermarkets where they have access to a vast range of items and do not mind paying premium prices on some items for this convenience. Supermarkets do not offer low prices on all items, but do stock economy lines as well as premium priced items. The consumer questionnaire provides some quantitative analysis and statistical weight to the data and was analysed using the χ-square test on SPSS for Windows Version 8. With the χ-square test the important detail is the significance level (reported as a p-value). A p-value of less than 0.05 indicates that the two groups are significantly different at a confidence level of 95% -- in other words, it can be concluded that the author is 95% certain that the result is statistically significant and free from error. Four areas of the Province were sampled -- two rural and two urban. The sample was 77% female and the median age group fell between 45 to 54 years. The social class status was skewed towards the lower socio-economic classes and only 12% fell into social classes A or B. The mean household income was £151 to £200 per week. The survey was interviewer-assisted and pointed to some interesting correlations between levels of satisfaction with store location and distance travelled, product choice and the decision to continue shopping in the town centre. Thirty percent of the sample stated that they shop at off-centre complexes and 70% of the sampled households shop in the town centre or closer to home. This sample also provides evidence that shopping is largely a car-borne activity with 58% of the sample using the family car. Journey distance is significantly influenced by degree of satisfaction with locality: p<0.01 and is supported with the evidence that 64% of the respondents stated that they shop less than fifteen minutes from home. Similar relationships exist between reported satisfaction with locality and differing degrees of satisfaction for product choice: p<0.01. A significant bias similarly exists between those who continue to shop in the town centre after the advent of the UK multiples into Northern Ireland in 1996 and those who do not: p<0.05 with a bias towards those continuing to shop in the town centre reporting high satisfaction levels. Ultimately, perceived adequacy of shopping provision influences satisfaction with store locality: p<0.05. Although the majority of respondents' weekly shopping is conducted at a multiple there is still an identified need for the local corner shops and independents since approximately 29% of respondents buy essentials like bread, milk and other basic grocery provision there. In fact, 98% of those surveyed reported that every town centre should have a food store, and 82% noticed a reduction in the number of food stores locally in recent years. In a concluding open question in the survey attitudes towards off-centre supermarkets were gauged. Responses ranged from positive in nature ("better parking facilities") to indifferent ("I never bother with them") to negative ("they [out-of-town supermarkets] only suit people with cars" and "they h

BackgroundA lack of healthy food stores is associated with obesity and a high proportion of Black residents.ObjectivesTo examine the distribution and concentration of 721 food stores in a large urban county in the Southeastern U.S. We also examine how the presence and concentration of stores and types of stores are related to race/ethnicity, income, and premature heart disease and diabetes mortality.Design and MethodsCross sectional analysis using census block groups, or neighborhoods. Zero‐inflated negative binomial and ordinal least square regression examined the relationship between the availability of certain types of food stores, the ratio between non‐full service stores that accept Supplemental Nutrition Assistance Program (SNAP) benefits in relation to full service stores that accept SNAP benefits (SNAP store ratio), and demographic and health characteristics.ResultsNearly two‐thirds of neighborhoods did not include a full service food store; 60 of which were defined as food deserts. Neighborhoods with higher proportions of Hispanics or Asians were associated with having more food stores. Each additional full service food store was associated with a decrease in 23 per 100,000 premature heart disease deaths. An increase in the ratio SNAP store ratio was associated with an increase in 18 per 100,000 premature deaths to heart disease.ConclusionsNeighborhood access to nutritious food is important, especially for low‐income communities. Since many residents of low‐income neighborhoods are SNAP participants, the types of foods offered at SNAP approved stores may affect their health.This study was funded by the Mecklenburg County, NC Health Department

Conceptualisations of 'food deserts' (areas lacking healthful food/drink) and 'food swamps' (areas overwhelm by less-healthful fare) may be both inaccurate and incomplete. Our objective was to more accurately and completely characterise food/drink availability in urban areas. Cross-sectional assessment of select healthful and less-healthful food/drink offerings from storefront businesses (stores, restaurants) and non-storefront businesses (street vendors). Two areas of New York City: the Bronx (higher-poverty, mostly minority) and the Upper East Side (UES; wealthier, predominantly white). All businesses on 63 street segments in the Bronx (n 662) and on 46 street segments in the UES (n 330). Greater percentages of businesses offered any, any healthful, and only less-healthful food/drink in the Bronx (42·0 %, 37·5 %, 4·4 %, respectively) than in the UES (30 %, 27·9 %, 2·1 %, respectively). Differences were driven mostly by businesses (e.g. newsstands, gyms, laundromats) not primarily focused on selling food/drink - 'other storefront businesses' (OSBs). OSBs accounted for 36·0 % of all food/drink-offering businesses in the Bronx (more numerous than restaurants or so-called 'food stores') and 18·2 % in the UES (more numerous than 'food stores'). Differences also related to street vendors in both the Bronx and the UES. If street vendors and OSBs were not captured, the missed percentages of street segments offering food/drink would be 14·5 % in the Bronx and 21·9 % in the UES. Of businesses offering food/drink in communities, OSBs and street vendors can represent substantial percentages. Focusing on only 'food stores' and restaurants may miss or mischaracterise 'food deserts', 'food swamps', and food/drink-source disparities between communities.

OBJECTIVES. High rates of overweight and obesity among low-income children have led some to question whether participation in US domestic food assistance programs contributes to this health problem. We use multiple years of data to examine trends in children's body weight and participation in the Food Stamp Program (FSP) or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Specifically, we assess whether a consistent relationship between program participation and body weight exists over time. METHODS. Data from multiple waves of the National Health and Nutrition Examination Surveys (NHANES) are used to examine the relationship between children's body weight and food assistance programs between 1976 and 2002. Linear regression models are used to estimate BMI and logit models are used to predict the probabilities of at-risk of overweight and overweight. Food assistance program participants (either FSP or WIC participants depending on age) are compared with income eligible non-participants and higher income children. RESULTS. Results show no systematic relationship over time between FSP participation and weight status for school-aged children (age 5-17). For children aged 2-4, no differences in weight status between WIC participants and eligible non-participants were found. However, recent data show some differences between WIC participants and higher income children. CONCLUSIONS. Our analysis does not find evidence of a consistent relationship between childhood obesity and participation in the FSP or WIC programs.

Food Security and Weight Status in Children: Interactions With Food Assistance Programs

Residents of neighborhoods with limited access to grocery stores may face barriers to obtaining adequate food for a healthy diet. Low‐income elderly may be uniquely affected by these so‐called “food deserts” due to limited transportation options, strong attachments to local neighborhoods, fixed incomes, and physical limitations for food shopping. Using 2006 and 2010 Health and Retirement Study data linked to census tract‐level measures of food deserts, this study measures whether living in a food desert affects food and material hardship, participation in food assistance programs, and the food spending of elderly adults. In both cross‐sectional and fixed effects regressions of elderly residents of urban counties, we find little evidence that living in a food desert affects these outcomes. We find, however, that individuals residing in a food desert without a vehicle are 12 percentage points more likely to report food insufficiency. Those SNAP recipients living in food deserts are 11 percentage points more likely to receive subsidized meals, while nonparticipants in food deserts and SNAP recipients outside of food deserts are less likely to receive subsidized meals. Our findings suggest that seniors without vehicles and SNAP recipients in food deserts may be the most vulnerable to limited food store access.

Accessibility Landscapes of Supplemental Nutrition Assistance Program−Authorized Stores

The Supplemental Nutrition Assistance Program and Child Weight Status: A Review

BackgroundFood insecurity is a critical problem in the United States and throughout the world. There is little published data that provides insights regarding the extent and severity of food insecurity among the hard-to-reach Mexican-origin families who reside in the growing colonias along the Texas border with Mexico. Considering that culture, economics, and elements of the environment may increase the risk for food insecurity and adverse health outcomes, the purpose of this study was to examine the relation between household and community characteristics and food insecurity.MethodsThe study used data from the 2009 Colonia Household and Community Food Resource Assessment (C-HCFRA). The data included 610 face-to-face interviews conducted in Spanish by promotoras (indigenous community health workers) in forty-four randomly-identified colonias near the towns of Progreso and La Feria in Hidalgo and Cameron counties along the Texas border with Mexico. C-HCFRA included demographic characteristics, health characteristics, food access and mobility, food cost, federal and community food and nutrition assistance programs, perceived quality of the food environment, food security, eating behaviors, and alternative food sources.Results78% of participants experienced food insecurity at the level of household, adult, or child. The most severe - child food insecurity was reported by 49% of all households and 61.8% of households with children. Increasing levels of food insecurity was associated with being born in Mexico, increasing household composition, decreasing household income, and employment. Participation in federal food assistance programs was associated with reduced severity of food insecurity. Greater distance to their food store and perceived quality of the community food environment increased the odds for food insecurity.ConclusionsThe Mexican-origin population is rapidly expanding; record numbers of individuals and families are experiencing food insecurity; and for those living in rural or underserved areas such as the colonias, the worst forms of food insecurity are an ongoing reality. The rates of households with adult and child food insecurity in this border area are alarming and among the highest reported. Clearly, systematic and sustained action on federal, state, and community levels is needed to reduce household, adult, and child food insecurity that integrates cultural tailoring of interventions and programs to address food and management skills, multi-sector partnerships and networks, expansion of food and nutrition assistance programs, and enhanced research efforts.

Usual nutrient intakes and diet quality among United States older adults participating in the Supplemental Nutrition Assistance Program compared with income-eligible nonparticipants

We measure how Supplemental Nutrition Assistance Program (SNAP) participants respond to policies designed to improve access to retail food store formats that stock healthy foods, specifically grocery stores. Supply‐side policies seek to increase the supply of grocery stores by subsidizing store openings. Demand‐side policies seek to increase the demand for food from grocery stores by, for example, increasing benefits. Unique SNAP administrative data allow us to estimate and compare impacts of grocery store openings and a SNAP benefit increase at a fine geographic scale. We find both policies increase shopping at grocery stores relative to other store formats but observe substantive impacts for grocery store openings only among households in very close proximity to the opening. Furthermore, we find that the impacts are mediated by car ownership and food desert status. In particular, households without cars in food deserts exhibit the largest impact. Grocery store openings decrease SNAP spending shares primarily at ethnic stores, whereas benefit increases decrease SNAP spending shares at convenience stores. Neither policy decreases total SNAP spending at convenience stores. The spillover effects on shopping at other store formats therefore make the potential effect on access to healthy food ambiguous.

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately strained households experiencing poverty, particularly Black and Latino households. Food insecurity, which entails having limited or uncertain access to a sufficient quantity of nutritious food, is a key pandemic-related consequence. We examined how people enrolled in the Supplemental Nutrition Assistance Program (SNAP) have been affected by the pandemic, particularly Black participants and participants residing in food deserts. Using survey data from a longitudinal cohort study of predominantly Black low-income adults aged ≥18 residing in urban food deserts in Pittsburgh, Pennsylvania, we examined changes in food insecurity and SNAP participation before COVID-19 (2018) and early in the COVID-19 pandemic (March-May 2020). We modeled changes in food insecurity from 2018 to 2020 via covariate-adjusted logistic regression. Food insecurity increased significantly among participants enrolled in SNAP and surveyed in both 2018 and 2020 (from 25.9% in 2018 to 46.9% in 2020; P < .001). Compared with cohort participants not enrolled in SNAP at both points, cohort participants enrolled in SNAP in 2018 and 2020 had the highest rates of using a food bank in 2020 (44.4%) and being newly food insecure in 2020 (28.9%) (ie, they were food insecure in 2020 but not in 2018). Food insecurity during the COVID-19 pandemic increased among low-income Black households enrolled in SNAP and residing in a food desert. Public health recovery efforts might focus on modifying SNAP to improve the food security of people experiencing poverty.

M any Americans received food assistance from the Federal Government in fiscal 1990, including food stamps, vouchers, food packages, or cash. The Food Stamp Program is the largest of the Federal food assistance programs in terms of both the number of people served and the amount of money spent. Monthly participation rates in the Food Stamp Program were almost 20 million, up over 1 million from fiscal 1989. Through U.S. food assistance programs, over 28 million school children received free or reduced-cost school breakfasts and lunches, and almost 962 million meals were served in the Child Care Food Program. To provide this food, the U.S. Government spent over $24.2 billion in fiscal 1990 (table 1). This represents a 70-percent increase over the $14.2 billion spent in 1980 and over a 10-percent rise since 1989. Overall growth of food assistance programs during the past decade was sporadic, but with a continual upward trend. Three factors account for most of the increase in program expenditures since 1980. First, inflation caused the cost-of-living adjustments to rise each year. Second, increased unemployment associated with recessions in 1982-83 and 1990 created additional demand for food assistance, particularly food stamps. Third, the large accumulation of Government surplus commodities, particularly dairy products, fostered a major increase in food donations, particularly The Emergency Food Assistance Program (TEFAP). USDA food assistance programs are designed to improve the nutritional wellbeing of low-income persons and other target groups, such as children and the elderly. Food assistance programs, which are administered by USDA's Food and Nutrition Service, were initiated during the Great Depression of the 1930's. The programs were to help feed the poor and unemployed and to stabilize farm prices by distributing growing stocks of surplus agricultural commodities. Since then, assistance programs have expanded and new programs have been implemented. The National School Lunch Program and the Food Stamp Program are notable examples.

The present study aimed to understand the relationship between need and help-seeking behaviour in older adults by examining the patterns of food insecurity and participation in food assistance programmes (FAP), i.e. the Food Stamp Program and home-delivered meals. Data from two longitudinal studies were used. The studies were designed to obtain nationally representative information on health, insurance coverage, financial status, family support systems, labour market status and retirement planning, every two years: the Health and Retirement Study (HRS, 1996-2002) and Asset and Health Dynamics Among the Oldest Old (AHEAD, 1995-2002). USA. There were 7623 participants for HRS and 3378 for AHEAD. The older adults appeared to have persistent patterns between food insecurity and participation in FAP, especially in the Food Stamp Program. More persistently food-insecure older adults had higher participation in FAP (P < 0.001). Food-insecure older adults at one time were more likely to shift from non-participation to participation in FAP the next time than food-secure older adults (P < 0.001). Regardless of previous food insecurity status, previous participants in FAP were more likely to participate subsequently. The relationship between need and help-seeking behaviour in older adults was found to follow a persistent positive pattern, determined by looking at the patterns of food insecurity and participation in FAP. Although food insecurity as a need is a good predictor of participation in FAP, it is not enough to fully predict participation in FAP. Help-seeking behaviour (i.e. previous programme participation) is also important in predicting participation in FAP.