Nutrition Environment Measures Survey Research Articles

Understanding Restaurant Healthfulness in Food Deserts

ObjectiveTo determine differences in restaurant environments between neighborhood and restaurant type to understand better a food desert's eating environments. MethodsThe Nutrition Environment Measures Survey for restaurants was used to assess restaurant healthfulness. Kruskal-Wallis compared healthy index scores, and Pearson chi-square compared individual items. ResultsHealthy index scores were consistently low across neighborhoods (total mean = 4.6 out of 23). Fast-food restaurants (mean = 5.7) were more healthful than sit-down restaurants (mean = 3.1). Individual comparisons showed more healthy eating facilitators (eg, nutrition information at point-of-purchase, P = 0.004) in food deserts and more available healthful items (eg, whole grain bread, P < 0.001) in the neighborhoods with high incomes. Conclusions and ImplicationsFindings indicate equities in restaurant environments across all neighborhoods but inequities across restaurant types, thus conclude the importance of restaurant type in understanding restaurant healthfulness. Policymakers can use these findings to develop healthy eating strategies in varying neighborhoods.

Examining the consumer restaurant environment and dietary intake in children.

Within the away-from-home food environment there is a need to account for individual exposure (e.g., frequency of visitation) to that environment. The present study examined the consumer environment in both proximal and visited restaurants and their association with childrens’ diet quality and anthropometrics. A cross-sectional analysis used baseline data from the Neighborhood Impact on Kids (NIK) study (2007–2009). Participants were 6–12-year-olds living in King County, WA and San Diego County, CA. This analysis (conducted 2019–2020) examined relationships between nearby restaurant count, Nutrition Environment Measures Survey in Restaurants (NEMS-R) within the child’s block group, and weighted NEMS-R scores based on the restaurant where the child ate most frequently in relation to child energy intake, Healthy Eating Index (HEI-2010) total score and anthropometrics. Children’s HEI-2010 scores were associated with NEMS-R scores within block groups, with children in the lowest NEMS-R tertile having significantly higher HEI scores than participants in the middle tertile. Weighted NEMS-R scores were significantly associated with waist circumference, with children in the highest NEMS-R tertile having a lower waist circumference than children in the lowest tertile. Nearby restaurant count was not associated with children’s diet quality or anthropometrics. Our findings suggest the relationship between nutrition environment and child diet and anthropometrics varied depending on how nutrition environment was defined. However, findings may be limited by the low frequency of eating out reported in this sample. Food environment measures that account for individual-level behavior are needed to better understand the influence of food environments on diet and anthropometrics

Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED).

The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED tool to observe and rate food outlets in 21 census tracts and 43 food stores across the city of Madrid, Spain. We evaluated inter-rater and intra-rater reliabilities, construct validity, and the tool’s ability to discriminate between store types and between stores by area-level Socio-Economic Status (SES). Overall, the mean NEMS-S-MED score was 20.7 (SD = 9.8), which ranged from 7 to 43. Most food items displayed substantial or almost perfect inter-rater and intra-rater agreements; the percentage agreement across availability items was almost perfect and kappa statistics were also very high (median κ = 1.00 for inter-rater; κ = 0.92 for intra-rater). Furthermore, the NEMS-S-MED tool was able to discriminate between store types and census tracts of different SES. The adapted NEMS-S-MED instrument is a reliable and valid audit tool to assess the consumer food environment in Mediterranean urban contexts. Well-constructed measurement tools, such as the NEMS-S-MED, may facilitate the development of effective policy interventions to increase healthy food access and affordability.

Store Environment Assessment (SEA) Tool: Design and validation of a food environment audit protocol

Abstract Background Unhealthy food environments are key factors in diet-related disease risk. Many audit methods have been designed for the retail food environment, but weaknesses of existing methods include: validity in study methods and design, and heterogeneity in adaptation and analysis methods. This paper describes the development and validation of a novel protocol for designing store audit instruments - the Store Environment Assessment (SEA) Tool. Methods This research involved four steps: 1. a scoping review of consumer food environment audit tools; 2. classify key variables from the literature; 3. use the variables to design a protocol for development of audit instruments tailored to local contexts and research questions; and 4. validate the protocol by designing and validating a sample audit tool based on Canada's Food Guide (2019). Results Variables from the literature included: Product (availability, variety, size, reference), Price, Promotion, Placement-accompanied by: definition, type of variable, range of values, scale of measurement, and measurement outcome. The protocol has seven steps: identify dietary guideline criteria; conduct content analysis; define setting; align research questions with scale and scope; variable selection; audit tool design; and validation strategy. The protocol was used to design a store audit instrument for Canadian jurisdictions, based on Canada's Food Guide, and validated against the gold standard, Nutrition Environment Measures Survey (NEMS). Discussion The SEA protocol can strengthen researchers and practitioners' capacity to use structured guidelines to develop geographically and socio-demographically relevant Store Environment Assessments, and avoid heterogeneity arising from ad hoc adaptations of tools such as NEMS. Our methodological approach can support greater consistency, feasibility, and rigour of food environment audits for diverse public health research and practice objectives. Key messages Researchers and practitioners will be able to utilize the SEA tool protocol, using jurisdictional food and nutrition criteria, to better assess 4Ps related to food, in retail food environments. The variables and measurement outcomes included in the SEA tool protocol will support public health practitioners in developing relevant interventions to support healthy consumer food purchasing.

P1 Assessing Food Offerings Among Emerging Food Outlets in Northern Arkansas

<h3>Background</h3> Limited study of the availability of food in nontraditional food stores (Pharmacy and convenience stores) has left a gap in the understanding of the food environment in Arkansas. Recent corporate action among nontraditional food stores suggests that consumers are looking to these stores as sources of healthier food. <h3>Objective</h3> The question that guided this work asked, "Are there differences in food offerings among non-traditional food outlets, such as CVS and Walgreens, and how do those offerings compare to the offerings of convenience stores, in Arkansas?" Understanding differences among these food store types may be useful for subsequent efforts to improve equitable access to healthy food across Arkansas. <h3>Study Design, Setting, Participants</h3> This study used an observational design to assess offerings in non-traditional food outlets. The Nutrition Environment Measures Survey (NEMS) assessment tool was used to document and score the availability of food products in 54 stores in the northern half of Arkansas, including 27 pharmacy stores and 27 convenience stores within a 2.5 mile radius. <h3>Measurable Outcome/Analysis</h3> The NEMS tool gathered availability data across 13 measures, including: fruit, vegetables, dairy products, meat products, frozen dinners, baked goods, bread, beverages, chips and snacks, and cereal. <h3>Results</h3> Pharmacy stores had a higher mean availability score (x̅ = 19.0) than convenience stores (x̅ = 7.2). A paired sample t test indicated that the difference in mean availability score between the store types was not likely due to chance [t(26) = 16.01, <i>P</i> < .001]. <h3>Conclusions</h3> These findings suggest that pharmacy stores offer a healthier supply of foods as compared to convenience stores. Nontraditional food stores may be important intervention sites as consumers look to these stores for an increasing proportion of their food purchases. Further study may help to uncover differences in rural and urban food supply in Arkansas, and may have positive consequences for better understanding best practices for increasing access to food across the state.

Availability and Pricing of Infant Snack Foods in Low-Income Communities Across Rhode Island

Abstract Objectives Marketing for infant snack foods has increased in the past 20 years, yet little is known about the availability and pricing of these foods. This study assessed the availability and pricing of infant snack foods in grocery stores in low-income communities across Rhode Island. Methods A random sample of grocery stores (N = 20) was selected from low-income census tracts. Twelve items were developed for this study to assess the availability and pricing of infant foods (e.g., infant formula, purees) and infant snack foods (e.g., puffs, melts). The Nutrition Environment Measures Survey in Stores (NEMS-S) was used to assess the nutrition environment including the availability, pricing, and quality of healthful foods compared to less healthful foods. Total NEMS-S scores range from -9 to 54 with higher scores indicating more healthful foods. Data were collected by trained research assistants during a 2-week period to limit confounding due to restocking and seasonality. This analysis included descriptive statistics to summarize the infant snack foods and the total nutrition environment. Results All 20 grocery stores in this sample sold infant foods and 18 stores sold infant snack foods. Availability of infant snack foods varied by store with puffs having the highest availability (n = 18) followed by melts (n = 15), teething cookies (n = 10), and baby yogurt (n = 7). Baby yogurt had the highest average price per serving ($0.72) followed by melts ($0.62), teething cookies ($0.50), and puffs ($0.49). Mean total NEMS-S score for all grocery stores was 27.5 (SD = 4.7). Conclusions Infant snack foods are available in grocery stores in low-income communities. Recent increases in marketing and availability of infant snack foods make it important to explore factors that influence caregivers to offer these snacks. Future studies should explore these factors and develop evidence-based recommendations for developmentally appropriate, healthful snacking during infancy. Funding Sources This work was supported by the USDA National Institute of Food and Agriculture, [Hatch/Tovar/1,001,894].

Food for Thought: The Perceived Food Environment and its Association with Food Insecurity in a Low-Income District of Lima, Peru

Abstract Objectives To examine the association between food insecurity – the inability to acquire adequate nutritious foods due to economic constraints – and perceptions of food accessibility, quality, and variety in one's neighborhood in a low socioeconomic district of Lima, Peru. Methods A household survey was conducted among randomly selected households with at least one child &amp;lt;18 years of age in Villa El Salvador (Lima, Peru; N = 329). The language-validated questionnaire included questions from the Perceived Nutrition Environment Measures Survey (NEMS), which were adapted to the local setting and translated into Spanish. These NEMS questions assessed perceived accessibility, quality, and variety of foods in the neighborhood of residence on a Likert scale (e.g., 1 = completely agree to 5 = completely disagree) and were later dichotomized for analysis. The questionnaire also included the Household Food Insecurity Access Scale (HFAIS), to measure food insecurity. Multivariable logistic regression was used to assess the association between the perceived neighborhood food environment and food insecurity, adjusting for sociodemographic variables. Results About 77% of the households reported having food insecurity. Adjusting for age, gender, and education of the homemaker, food insecurity was associated with perceptions of decreased accessibility to fresh fruits and vegetables (OR = 5.05; 95% CI = 2.03–12.60) and low-fat products (OR = 2.07; 95% CI = 1.18, 3.65); low quality of fresh fruits and vegetables (OR = 3.28; 95% CI = 1.84, 5.86) and low-fat products (OR = 2.13; 95% CI = 1.22, 3.73); and a low variety of fresh fruits and vegetables (OR = 2.62; 95% CI = 1.43, 4.79) in the neighborhood. Conclusions Food insecure families living in a low-income district in Lima, Peru share negative perceptions of access, quality, and variety of food in their surrounding neighborhood. Efforts to improve the availability of affordable healthy foods in low-income neighborhoods in Lima may help ameliorate food insecurity. Funding Sources This work was supported by the National Institute on Minority Health and Health Disparities’ Minority Health and Health Disparities International Training Grant, the Fulbright U.S. Student Program, and the Carol Lavin Bernick Faculty Grant Program (Tulane University).

Measurement of Nutrition Environments in Grocery Stores, Convenience Stores, and Restaurants in the Lower Mississippi Delta.

IntroductionThe Lower Mississippi Delta is characterized by several factors associated with poor diet quality. Our objective was to measure local nutrition environments of pregnant women and their infants who participated in a nutrition and physical activity intervention to assess environmental exposures potentially influencing their dietary habits.MethodsWe measured the nutrition environments of 5 towns in which participants resided by using the Nutrition Environment Measures Survey for grocery stores, convenience stores, full-service restaurants, and fast food restaurants. We used general linear models to test for differences in ratio scores, calculated by dividing each food outlet score by the maximum score possible, among food outlet classes and subclasses.ResultsMean total ratio scores (expressed as percentages) for the Nutrition Environment Measures Survey among 4 classes of food outlets were significantly different from one another except for convenience stores and full-service restaurants. On average, grocery stores (n = 11) had 54% of maximum points possible, followed by full-service restaurants (21%; n = 50), convenience stores (16%; n = 86), and fast food restaurants (8%; n = 119). We found no significant differences in mean total ratio scores among convenience store subclasses. For fast food restaurant subclasses, stand-alone restaurants (n = 81) had 19% of maximum points possible, significantly higher than grocery store delicatessens (6%; n = 8), corner stores that sold fast food (3%; n = 5), and gas stations that sold fast food (4%; n = 25).ConclusionThese 5 Lower Mississippi Delta towns scored low on nutrition environment measures associated with healthful eating. Behavioral interventions designed to bring about positive changes in dietary habits of rural residents are needed; however, effects may be minimal if environmental factors supportive of healthful eating are not available.

A method for assessing links between objectively measured food store scores and store & neighborhood favorability

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.

The Healthfulness of Eateries at the University of Waterloo: A Comparison across 2 Time Points.

Purpose: The aim of this study was to assess the healthfulness of a sample of campus eateries at 2 time points, 2 years apart. Methods: Five eateries at the University of Waterloo were audited using the Nutrition Environment Measures Survey adapted for university campuses (NEMS-UC) in 2015 and late 2017-early 2018. Based on the availability of healthy options and facilitators of and barriers to healthy eating, possible NEMS-UC scores ranged from -5 to 23 points. Results: Scores were low, ranging from 7 to 14 (mean = 10.8, SD = 2.59) points in 2015 and 7 to 13 (mean = 9.6, SD = 2.19) points in 2017-2018. For all eateries except 1 residence cafeteria, scores at time 2 were the same or lower than scores at time 1. All venues carried whole fruit and vegetable options and lower-fat milks, and most offered whole-wheat options. However, healthier items were often located in low-traffic areas, priced higher than less healthy options, and sometimes limited to prepackaged items. Misleading health messaging was also evident. Conclusions: Increased availability, accessibility, and visibility of healthy offerings is needed to enhance campus food environments and support healthy eating patterns, while barriers such as contradictory messaging should be minimized.

Store patterns of availability and price of food and beverage products across a rural region of Newfoundland and Labrador.

Rural populations bear a disproportionate burden of diet-related risk, and one important explanation is retail food access disparities. Much existing literature has focused on subjective measures of the rural retail food environment, as well as urban-rural differences. The purpose of this paper is to examine how objectively measured food availability and prices vary within a rural region, and to explore how store features predict rural food availability and prices. We conducted an observational audit of a census of rural food stores (n = 78) using a modified Nutrition Environment Measures Survey instrument. The study was conducted on the Avalon Peninsula in Newfoundland and Labrador. Observed prices in-store were matched to nutrient composition data and converted to three units of measure for all analyses: unit price ($/kg), serving price ($/serving), and energy price ($/kcal). We examined average availability and prices across the region, and how store features were associated with prices. Healthy food options were generally less available across the stores than regular items. However, with few exceptions, there were no clear or consistent patterns of difference in availability or pricing between stores of different types. No single product category stood out in terms of a clear price pattern. Store characteristics (including store type, size, ownership, or rurality) did not predict food prices. Food availability and prices varied in this rural region, but with limited differences between stores of different types. More research is needed on measuring rural environmental determinants of diet in Canada.

Food and Beverage Options at Highway Rest Areas in North Carolina: A Mixed-Methods Audit and Geospatial Approach.

IntroductionEach year, millions of people purchase food at highway rest areas. Rest areas are potential sites for health promotion because they are operated by the public sector; they are frequently visited by professional truck drivers, who have a disproportionate burden of chronic disease; and they are easily accessible. To our knowledge, no research has systematically examined the healthfulness of food offerings at rest areas. The objective of this study was to determine the accessibility and healthfulness of food and beverages offered at highway rest areas in North Carolina using a mixed-methods audit and geospatial approach.MethodsWe conducted a cross-sectional audit of all rest areas offering foods and beverages in North Carolina (N = 30) in summer 2018. We used the Nutrition Environment Measures Survey–Vending (NEMS–V) to record the 1) type, price, and size of all foods and beverages and 2) healthfulness of items offered (based on NEMS–V categorization). Two researchers independently double coded NEMS–V data. We used geospatial analysis to examine proximity of rest areas to food stores. We analyzed data by using univariate and bivariate analysis.ResultsThe mean number of vending machines per site was 8.0 (range, 2–12, standard deviation, 2.8). The healthfulness of offerings varied across sites. Most food items (88.1%; 2,922 of 3,315) and beverage items (63.7%; 1,567 of 2,459) were classified as least healthful. Cold beverage machines had a greater percentage of healthful items (38.2%; 778 of 2,036) than snack machines (11.4%; 374 of 3,270) (P < .001), mainly because of water and diet soda in beverage machines.ConclusionPolicy changes are needed to increase the number and presentation of healthful food options at highway rest areas. Policy changes could provide travelers with more healthful options conveniently located along their travel route.

P106 Availability and Affordability of Yogurt in SNAP-Authorized Convenience Stores in Mississippi

Background Many Mississippians are Supplemental Nutrition Assistance Program (SNAP) eligible, face high rates of food insecurity, and often live in food deserts. Compared to national data, Mississippians were more likely to be obese and reported eating fewer fruits and vegetables. Increasing healthy food availability and affordability in SNAP-authorized convenience stores (CS) may improve Mississippians’ health and eating behaviors. Objective The study objective was to examine the availability and affordability of yogurt in SNAP-authorized CS across Mississippi. Study Design, Settings, Participants This cross-sectional study was conducted from January to February 2017. Stores were identified from the United States Department of Agriculture SNAP-authorized store list (n = 3585). Approximately the same proportion of stores from each county in Mississippi was surveyed to achieve a representative sample (n = 405). Stores were categorized by number of cash registers into: CS (n = 212), grocery stores (n = 154), and supermarkets (n = 39). Trained Mississippi State University Extension Service employees (Nutrition Educators and Extension Agents) and research team members collected data using a modified Nutrition Environment Measures Survey – Corner Store (NEMS-CS). Measurable Outcome/Analysis The outcome measure is the availability and affordability of yogurt in SNAP-authorized stores in Mississippi. Availability was measured by the percent of SNAP-authorized stores reported as carrying yogurt. Affordability was measured by the average price of an individually sold, single-serving size (≤ 6oz) container of yogurt in a CS. Results Approximately 16% (n = 36) of CS, 57% (n = 91) of grocery stores, and 89% (n = 36) of supermarkets carry any form of yogurt. The average price of an individually sold, single-serving size (≤ 6oz) container of yogurt in a convenience store is $0.97. Conclusion While yogurt is a relatively affordable snack, it is not readily available in SNAP-authorized CS in Mississippi. Policy efforts should be made to promote health by increasing the availability of yogurt and other healthy foods. These findings will be used to inform future studies and pilot interventions to increase food availability for Mississippi's SNAP participants.

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Food environments are potential targets for interventions to reduce obesity prevalence, particularly in island settings that are typically dependent on food imports. This observational study aimed to characterise the availability, quality and price of foods and beverages in a nationally representative sample of grocery stores in Malta using the Nutrition Environment Measures Survey for Stores (NEMS-S) instrument, and to examine the association between area-level density of different types of food stores and the likelihood of children living in these areas being overweight or obese. Fieldwork was carried out between March and May 2014. There was a strong positive correlation between store size and NEMS-S score (p = <0.001), suggesting that smaller grocery stores generally offered a smaller range of products and fewer healthy food/beverage options than larger supermarkets. Across all stores, median prices of certain ‘healthier’ versions of foods were more expensive than their less healthy alternatives. A significant association between risk of childhood overweight, and density of confectionery stores in children’s locality of residence, was found (OR 1.19; 95% CI: 1.04, 1.37). These baseline findings highlight opportunities to improve the food environment in Malta to support more healthful eating, and may be of particular interest to public health practitioners in island settings.

The Flint Food Store Survey: combining spatial analysis with a modified Nutrition Environment Measures Survey in Stores (NEMS-S) to measure the community and consumer nutrition environments - ADDENDUM.

The Flint Food Store Survey: combining spatial analysis with a modified Nutrition Environment Measures Survey in Stores (NEMS-S) to measure the community and consumer nutrition environments – ADDENDUM - Volume 22 Issue 11

Appraisal of short and long versions of the Nutrition Environment Measures Survey (NEMS-S and NEMS-R) in Australia.

Research has begun to take a more ecological view of eating behaviour, examining multiple levels of influence: personal, social and environmental. The food environment is a major influence on eating behaviour, attracting the attention of researchers who have measured it in a number of ways. The present paper examines the short-form version, in comparison to the long-form version, of the Nutrition Environment Measures Survey (NEMS) - an observational food outlet audit tool. Both the short-form and long-form were examined to qualitatively appraise the dimensions of the food environment assessed by each measure. Data from 135 food outlets in Australia were then used to compare results obtained using the short-form with the results from the long-form method, to consider the utility of the short-form measure. The retail food environment in Australia.ParticipantsOne hundred and thirty-five food outlets in Australia. Results indicate that the short-form predominantly assessed availability of healthful foods (one aspect of the food environment). Several critical dimensions of the food environment known to influence eating behaviour were not assessed. For this data set, the short-form produced scores inconsistent with the longer version of the measure, delivering inflated estimates for stores and deflated estimates for restaurants. Scores between the long-form and short-form versions were not comparable in this Australian study. Further development of food environment measures is recommended and must balance instrument brevity with the need to accurately capture important aspects of the food environment known to influence eating behaviour.

Availability of affordable healthy food in Hillsborough County, Florida

Prior research has indicated that low‐income neighborhoods in urban regions throughout the United States have limited access to healthy food, which partly explains the prevalence of diet‐related diseases. Our study provides new evidence on the relationship between access, prices of healthy food, and key demographic factors in Hillsborough County, Florida. The research team completed 65 surveys of grocery and convenience stores regarding availability and prices of 11 food items included in the Nutrition Environment Measures Survey in Stores (NEMS‐S). Results from the regression analysis indicate that affordable healthy food is more likely to be found in grocery stores than in convenience stores. There is no significant evidence, however, that low‐income neighborhoods have less access to healthy food than the not‐low‐income ones. We also observe significant price differences among types of stores but not in grocery‐to‐convenience store ratios among income groups, suggesting that low‐income families are not exposed to higher food prices.

A Nutrition Environment Measure to Assess Tribal Convenience Stores: The THRIVE Study.

In rural American Indian (AI) communities, where supermarkets are rare, tribally owned and operated convenience stores are an important food source. Food environment measures for these settings are needed to understand and address the significant diet-related disparities among AIs. Through a tribal-university partnership that included tribal health and commerce representatives from two Native Nations in rural southeastern Oklahoma, we developed the Nutrition Environment Measures Survey for Tribal Convenience Stores (NEMS-TCS) to inform the development and evaluation of a healthy food retail intervention. The NEMS-TCS assessed four scored domains of the rural convenience store food environment-food availability, pricing, quality, and placement-and included 11 food categories that emphasized ready-to-eat food items. Trained raters administered the NEMS-TCS using a sample of 18 rural convenience stores (primarily ranging between 2,400 and 3,600 square feet). We assessed interrater reliability with kappa statistics for dichotomized variables and intraclass correlation coefficients (ICC) for continuous variables. NEMS-TCS demonstrated high inter-rater reliability for all food categories (>85% agreement), subscores (ICC = 0.73-1.00), and the total score (ICC = 0.99). The NEMS-TCS responds to recent calls for reliable measures for rural food environments and may be valuable for studying food environments of large convenience stores in other Native Nations as well as other rural settings.

P5 - Healthy Corners: What Variables Predict Sustainability?

Background (Background, Rationale, Prior Research, and/or Theory): Lack of access to healthful foods is a contributing factor to higher rates of chronic conditions. To address this determinant of health and increase access to fresh fruits and vegetables, corner stores have been targeted to transition from a traditional to a healthy corner store, particularly in food deserts. The question of whether these stores will sustain this initiative, after current subsidies end, remains unclear. Objective: The goal of the healthy corners' evaluation is to understand what variables predict continuity (sustainability) in providing healthy items should the financial and technical assistance supports for the program be reduced or eliminated. Study Design, Setting, Participants, Intervention: District of Columbia (DC) has been actively engaged in supporting 71 healthy corner stores to increase the sale of fresh fruits and vegetables. Using nine variables such as sales data, Nutrition Environment Measures Survey—Corner Store, and owner surveys, we created a Healthy Corner Store Scorecard to predict sustainability of the market. Outcome Measures and Analysis: Forty two stores had complete datasets that were used in the analysis. Using the Healthy Corner Scorecard, a higher score may predict long-term sustainability. Results: Years in the healthy corners program, store owner involvement, and variety and pounds of fruit and vegetables sold appear to predict the sustainability of a healthy corner store. Stores that have been in the healthy corner store program for an average of 58 months, earned the highest scores on the scorecard. Conclusions and Implications: Transitioning traditional corner stores to healthy corner stores takes long-term support, funding, and time. DC has made an investment to improve food access to its most vulnerable residents. It appears from the store-level data that DC is making great progress in having corner stores offer healthful food items. Additional research is needed to fully answer the sustainability question. Funding: Department of Health, Washington, DC.

Food availability and food access in rural agricultural communities: use of mixed methods

BackgroundHispanics bear some of the highest burden of the obesity epidemic and the disparities gap is bigger among Hispanics in rural communities. This mixed methods study examined the objective and subjective assessment of food availability and food access in four rural, agricultural, and predominantly Hispanic communities.MethodsIn this convergent parallel mixed methods study, we used the Nutrition Environment Measures Survey (NEMS) of Food Stores and Restaurants to objectively assess 57 food stores and 69 restaurants in four rural agricultural communities in Washington State. To complement the objective assessment findings, we conducted semi-structured interviews with 32 community residents. The data were collected from 2013 to 2014. Frequencies and means were calculated for quantitative data and content analysis conducted for interview data.ResultsParticipants (n = 32) had a mean age of 35.6 (SD 6.2) years, were mostly women, uninsured, low income, and had less than a high school education. Grocery and convenience stores had low NEMS composite scores indicating low overall availability of food items, low quality, and high food prices. Composite scores for sit-down restaurants, fast casual restaurants, and fast-food restaurants were similarly low in all four towns indicating limited availability of healthier options. Semi-structured interviews revealed participants perceived high availability and accessibility of quality fresh produce. Most participants reported eating out regularly several times a week, frequenting restaurant chains that serve buffets or fast foods, and allowing children to make decisions regarding their own food choices.ConclusionsCommunity members’ perception of food availability and food access may be different from the objective assessment of food environment. This information can be used to inform community-wide interventions to address food environment in these rural communities.