Measuring food and physical activity environment of populations at high risk for obesity, poor diet, and inactivityMeasuring Potential Access to Food Stores and Food-Service Places in Rural Areas in the U.S.
Introduction
The consumption of nutritious foods is essential to achieve and maintain good health, and to prevent and manage nutrition-related health conditions, such as obesity, type 2 diabetes, and cardiovascular disease.1 It is generally accepted that personal, structural, and neighborhood characteristics serve as barriers or enhancements to healthful eating.2, 3, 4, 5 In particular, recognition is growing that in order for individuals to make health-promoting food choices, low-calorie, nutrient-dense food resources need to be accessible (located near neighborhoods, especially low-income or rural areas, or with transportation available); available (including a variety of low-fat and nutrient-dense options in local stores); and affordable (reasonably priced).6, 7, 8 The purpose of this article is to expand our understanding of potential spatial access to food stores and food-service places within the overall food environment in the U.S. to include rural areas. In so doing, context of the rural food environment and spatial access will be explained, followed by challenges to measurement in rural areas. Recommendations will be presented and conclusions drawn.
Section snippets
Context of the Rural Food Environment
The rural food environment includes a wider variety of food stores and food-service places than commonly reported in studies of urban or metropolitan areas.9, 10, 11 Using modified versions of the North America Industry Classification System (NAICS) definitions for the primary business,12 rural food stores may be classified as conventional or traditional food stores, such as supercenters (e.g., Super Wal-Mart or Super Kmart), supermarkets, grocery stores, and specialty food stores (e.g., meat
Spatial Access
Spatial access from the home to the food environment (i.e., food stores and food-service places) remains a major focus of research that examines the contribution of the built environment to healthy eating.5 There are several dimensions of accessibility to food resources, each with its own measure: proximity (distance to the nearest food store or food-service place)9, 23, 24, 25; variety (number of food stores or food-service places within a specified distance, such as ½-mile, 1-mile, or
Challenges
Key challenges to the accurate measurement of the food environment in rural areas include:
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defining the rural food environment, recognizing that market factors (e.g., type of store and offering of food items) may be changing;
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developing methods to identify all food stores and food-service places;
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describing characteristics that may differentiate similar types of food stores and food-service places; and
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determining locations of food stores and food-service places.
Collecting Access Data
Determining potential spatial access to the food environment relies on two main activities: (1) identifying store types and locations of retail establishments that make food available for purchase,5 and (2) geospatially measuring or geocoding store locations. The built-environment literature has articulated two main approaches to carrying out these activities: intermediate and direct methods.50 Intermediate methods include the use of historical databases that provide secondary data from public
Recommendations
Carrying out the following recommendations would greatly enhance measurement of the food environment in rural areas:
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Ground-truthed methodology, which includes on-site observation and collection of GPS data, should become the standard for rural areas.
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The measurement of the food environment must recognize the emergence of new and changing store formats.
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Multiple measures of the food environment over time should be encouraged, especially in studies that are measuring other variables at multiple
Conclusion
Rural populations live with the confluence of greater burden of nutrition-related disease, economic restrictions, and greater spatial inequality for access to healthful food.40, 46 Increased attention must be directed toward the availability of affordable, nutritious food in rural areas. The measurement of food access will be critical for community-based approaches to meet dietary needs. Researchers must be willing to take the steps necessary for rigorous measurement of a dynamic, food
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