A Qualitative Study of Perceived Barriers to Fruit and Vegetable Consumption Among Low-Income Populations, North Carolina, 2011 (original) (raw)
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Journal of Hunger & Environmental Nutrition, 2012
Low fruit and vegetable (F&V) consumption is associated with higher rates of obesity and chronic disease among low-income individuals. Understanding attitudes towards F&V consumption and addressing policy and environmental changes could help improve diet and reduce disease risk. A survey of North Carolinians receiving government assistance was used to describe benefits, barriers, and facilitators of eating F&V and shopping at farmers' markets in this population. A total of 341 eligible individuals from 14 counties completed the survey. The most commonly cited barriers to eating F&V were cost (26.4%) and not having time to prepare F&V (7.3%). Facilitators included access to affordable locally grown F&V (13.5%) and knowledge to quickly and easily prepare F&V (13.2%). Among people who did not use farmers' markets, common barriers to shopping there were not being able to use food assistance program benefits (35.3%) and not knowing of a farmers' market in their area (28.8%); common facilitators included transportation (24.8%) and having more information about farmers' market hours (22.9%). In addition to breaking down structural/environmental barriers to farmers' market usage, there is a need to disseminate promotional information about farmers' markets, including hours, location, and accepted forms of payment.
Translational behavioral medicine, 2020
Perception-based and objective food access measures are often examined as factors influencing individuals' shopping decisions and dietary habits, but the relative influence of these two factors on behaviors needs further examination. This study sought to (a) determine if perception-based and objective measures of fruit and vegetable (F&V) access were related and (b) examine perception-based and objective access measures as predictors of F&V consumption. Participants were recruited as part of a larger intervention study from 12 sites across three urban North Carolina counties. Perception-based food access measured included self-reported perceptions of convenience, variety, and quality of F&V within a neighborhood. Food outlet density was used as the objective measure. This was derived by summing the total number of geocoded convenience stores, grocery stores, supermarkets, and supercenters located within 1 road network mile of participants' home address. Associations between ...
Preventing Chronic Disease, 2016
Introduction Food security status may moderate how people perceive barriers to fruit and vegetable consumption. This study aimed to 1) describe the association between fruit and vegetable consumption and microbarriers and mezzobarriers to consumption, and 2) test whether these associations differ by food security status. Methods We surveyed adults (n = 531) living in 2 economically deprived communities in Oakland, California, in 2013 and 2014. Multivariate linear regression assessed associations between microbarriers (taste, cost, busyness) and mezzobarriers (produce selection, quality, and purchase ease) and fruit and vegetable consumption, derived from a 26-item dietary screener. Interactions were tested by food security status. Results Respondents consumed a mean 2.4 (standard deviation, 1.5) servings of fruits and vegetables daily; 39% of the sample was food insecure. Being too busy to prepare healthy foods was associated with reduced fruit and vegetable consumption (β busyness = −0.40; 95% confidence interval [CI], −0.52 to −0.28) among all respondents. Food security moderated the relationship between fruit and vegetable consumption and taste, cost, and perceived ease of purchase of healthy foods. Among the food secure, disliking healthy food taste (β taste = −0.38; 95% CI, −0.60 to −0.15) and cost (β cost = −0.29; 95% CI, −0.44 to −0.15) concerns were associated with lower consumptions of fruits and vegetables. Mezzobarriers were not significantly associated with consumption in either group. Conclusion Perceived time constraints influenced fruit and vegetable consumption. Taste and cost influenced fruit and vegetable consumption among the food secure and may need to be considered when interpreting analyses that describe dietary intake and designing diet-related interventions.
Fruit and vegetable access in four low-income food deserts communities in Minnesota
Agriculture and Human Values, 2006
Access to fruits and vegetables by low-income residents living in selected urban and rural Minnesotan communities was investigated. Communities were selected based on higher than state average poverty rates, limited access to grocery stores, and urban influence codes (USDA ERS codes). Four communities, two urban and two rural, were selected. Data were gathered from focus group discussions (n = 41), responses to a consumer survey (n = 396 in urban neighborhoods and n = 400 in rural communities), and an inventory of foodstuffs available at stores located in all the communities and at large grocery stores in neighborhoods adjacent to the urban communities. In the two urban neighborhoods, a significant number of foods (26% and 52%) were significantly more expensive than the Thrifty Food Plan's (TFP) market basket price (MBP). Additionally, a significant number of foods in the two rural communities were more expensive (11% and 26%). In focus groups, participants identified major barriers to shopping in their community to be cost, quality of food, and food choice limitations. Results of the food inventory show that foods within the communities were costly, of fair or poor quality, and limited in number and type available, supporting complaints verbalized by focus group participants. Through focus groups and surveys, participants expressed concern that healthy food choices were not affordable within their communities and believed that people in their community suffered from food insecurity. The absence of quality, affordable food for low-income residents in these four Minnesota communities prevents or diminishes their ability to choose foods that help maintain a healthy lifestyle.
Public Health Nutrition, 2003
Objective: To determine low-income consumers' attitudes and behaviour towards fruit and vegetables, in particular issues of access to, affordability of and motivation to eat fruit and vegetables. Design and setting: Questionnaire survey mailed to homes owned by a large UK housing association. Participants: Participants were 680 low-income men and women, aged 17-100 years. Results: Age, employment, gender, smoking and marital status all affected attitudes towards access, affordability and motivation to eat fruit and vegetables. Few (7%) participants experienced difficulty in visiting a supermarket at least once a week, despite nearly half having no access to a car for shopping. Fruit and vegetables were affordable to this low-income group in the amounts they habitually bought; purchasing additional fruits and vegetables was seen as prohibitively expensive. Less than 5% felt they had a problem with eating healthily and yet only 18% claimed to eat the recommended 5 or more portions of fruit and vegetables every day. Conclusions: Supported by research, current UK Government policy is driven by the belief that low-income groups have difficulties in access to and affordability of fruit and vegetables. Findings from this particular group suggest that, of the three potential barriers, access and affordability were only a small part of the 'problem' surrounding low fruit and vegetable consumption. Thus, other possible determinants of greater consequence need to be identified. We suggest focusing attention on motivation to eat fruit and vegetables, since no dietary improvement can be achieved if people do not recognise there is a problem.
Public Health Nutrition, 2012
Objective: Perceptions that fruit and vegetables are expensive have been found to be associated with lower consumption of fruit and vegetables among disadvantaged women; however, the determinants of these perceptions are relatively unknown. The purpose of the current paper is to examine whether perceived availability and quality of fruit and vegetables, and social support for healthy eating, are associated with perceptions of fruit and vegetable affordability among women residing in disadvantaged neighbourhoods. Design: Cross-sectional self-report survey. Setting: The study was conducted in Melbourne, Australia. Subjects: An Australian sample of 4131 women, aged 18-45 years, residing in neighbourhoods ranked in the lowest Victorian tertile of relative disadvantage by the Australian Bureau of Statistics, an index that considers aspects of disadvantage such as residents' income, education, motor vehicle access and employment. Results: Results showed that irrespective of education, income and other key covariates, women who perceived poor availability and quality of fruit and vegetables in their local neighbourhood were more likely to perceive fruit and vegetables as expensive. Conclusions: Our results suggest that perceptions of fruit and vegetable affordability are not driven exclusively by lack of financial or knowledge-related resources, but also by women's psychological response and interpretation of their local nutrition environment.
Nutrients, 2019
Community-supported agriculture (CSA) participation has been associated with high fruit and vegetable (FV) consumption, which may be due to better access to FV for CSA purchasers, or to positive knowledge, attitudes, and beliefs (KAB) regarding healthy eating among CSA applicants. The objective of this study was to examine KAB and consumption, in association with application to a cost-offset CSA (CO-CSA) program, and with CO-CSA purchase among applicants. We conducted a cross-sectional survey of CO-CSA applicants and a comparison sample in August 2017. All respondents were English-reading adults with a child 2–12 years old and household income of ≤185% of the federal poverty level. Among CO-CSA applicants, some were CO-CSA purchasers (n = 46) and some were not (n = 18). An online comparison sample met equivalent eligibility criteria, but had not participated in CSA for three years (n = 105). We compared CO-CSA applicants to the comparison sample, and compared purchasers and non-purc...
Health Promotion International, 2008
A diet high in fruits and vegetables (F&V) has been associated with a decreased risk of certain cancers, reduced morbidity and mortality from heart disease, and enhanced weight management. Yet to date, most of the US population does not consume the recommended amount of F&V despite numerous interventions and government guidelines to promote consumption. Research has found various impediments to F&V consumption, such as high costs, an obesogenic environment and low socio-economic status. However, studies have not sufficiently focused on barriers and enablers to F&V intake among adult multi-ethnic populations. The present qualitative study examines 147 focus group participants' perceptions of impediments and enablers to F&V consumption. Twelve focus groups were conducted among African American, Hispanic and Caucasian men and women in North Carolina and Connecticut. Focus groups were audiotaped, transcribed verbatim and entered into QSR NVivo Software. Text data were systematically analyzed by investigators to identify recurrent themes both within and across groups and states. Focus group results indicate that most participants were aware of the health benefits associated with a diet rich in F&V. Yet many admitted not adhering to the Health and Human Service's recommendations. Individual impediments consisted of the high costs of F&V and a perceived lack of time. Early home food environment was perceived as affecting F&V consumption later in life. Other barriers reported were ethnic-specific. The African American participants reported limited access to fresh produce. This finding is consistent with numerous studies and must be addressed through health promotion intervention. Both the church and primary care clinics were described by African Americans as appropriate settings for health behavior interventions; these findings should be considered. Hispanic participants, mostly immigrants, cited inhibiting factors encountered in their adopted US environment. There is a need to improve the availability and access to fresh F&V commonly available in the home countries of Hispanic immigrants.
Nutrients
The aims of this study were to determine if fresh fruit and vegetable consumption and purchasing behaviors were associated with geographic food access and/or food insecurity status, and to explore the role of sociodemographic characteristics among participants of a lower-income, racially/ethnically diverse cohort. This study used a cross-sectional design and baseline survey data from the FRESH-Austin study (N = 393). Associations between fresh produce consumption/purchasing and food insecurity status and geographic access to food were assessed utilizing univariate, bivariate, and multivariate linear regression methods and potential interactions were examined. The sample 40% reported being food insecure and the majority identified as Hispanic. Geographic food access was directly associated with fresh produce consumption (β = 0.46, p = 0.02); however, the directionality of the relationship between food insecurity and fresh produce consumption varied due to a significant interaction wi...
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International Journal of Behavioral Nutrition and Physical Activity
Background: Poorer diets and subsequent higher rates of chronic disease among lower-income individuals may be partially attributed to reduced access to fresh fruits and vegetables (F&V) and other healthy foods. Mobile markets are an increasingly popular method for providing access to F&V in underserved communities, but evaluation efforts are limited. The purpose of this study was to determine the impact of Veggie Van (VV), a mobile produce market, on F&V intake in lower-income communities using a group randomized controlled trial. Methods: VV is a mobile produce market that sells reduced-cost locally grown produce and offers nutrition and cooking education. We recruited 12 sites in lower-income communities in North Carolina (USA) to host VV, randomizing them to receive VV immediately (intervention) or after the 6-month study period (delayed intervention control). Participants at each site completed baseline and follow-up surveys including F&V intake, perceived access to fresh F&V and self-efficacy for purchasing, preparing and eating F&V. We used multiple linear regression to calculate adjusted differences in outcomes while controlling for baseline values, education and clustering within site. Results: Among 142 participants who completed the follow-up, baseline F&V intake was 3.48 cups/day for control and 3.33 for intervention. At follow-up, adjusted change in F&V consumption was 0.95 cups/day greater for intervention participants (p = 0.005), but was attenuated to 0.51 cups per day (p = 0.11) after removing extreme values. VV customers increased their F&V consumption by 0.41 cups/day (n = 30) compared to a 0.25 cups/day decrease for 111 non-customers (p = 0.04). Intervention participants did not show significant improvements in perceived access to fresh F&V, but increased their self-efficacy for working more F&V into snacks (p = 0.02), making up a vegetable dish with what they had on hand (p = 0.03), and cooking vegetables in a way that is appealing to their family (p = 0.048). Conclusions: Mobile markets may help improve F&V intake in lower-income communities.
Revista Brasileira de Fruticultura, 2015
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International Journal of Environmental Research and Public Health
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Renewable Agriculture and Food Systems
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International Journal of Behavioral Nutrition and Physical Activity, 2019
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International Journal of Environmental Research and Public Health, 2019
Fresh fruits and vegetables are a cornerstone of a balanced diet; their consumption has health, environmental, ethical, and economic implications. This pilot study aimed to: (i) measure fruit and vegetable consumption; (ii) understand consumer perceptions of the perceived importance of regionally grown fresh fruit and vegetables (RGFFV); and (iii) identify the barriers and enablers of access and consumption of RGFFV. The study took place in Tasmania (TAS) and South Western Australia (SWA). A 54-item survey included questions relating to purchasing and consumption patterns; barriers and enablers related to access and consumption of RGFFV; and sociodemographic information. Survey data were analyzed using Chi-square test and binary logistic regression. A total of n = 120 TAS and n = 123 SWA adult respondents participated. SWA respondents had higher intakes of fruit (p < 0.001) and vegetables (p < 0.001). Almost all respondents (97%) rated purchasing of RGFFV as important. Top ena...
International Journal of Environmental Research and Public Health, 2020
The retail food environment (RFE) has important implications for dietary intake and health, and dramatic changes in RFEs have been observed over the past few decades and years. Prior conceptual models of the RFE and its relationships with health and behavior have played an important role in guiding research; yet, the convergence of RFE changes and scientific advances in the field suggest the time is ripe to revisit this conceptualization. In this paper, we propose the Retail Food Environment and Customer Interaction Model to convey the evolving variety of factors and relationships that convene to influence food choice at the point of purchase. The model details specific components of the RFE, including business approaches, actors, sources, and the customer retail experience; describes individual, interpersonal, and household characteristics that affect customer purchasing; highlights the macro-level contexts (e.g., communities and nations) in which the RFE and customers behave; and ...
PLOS ONE, 2021
The association between family environment and child’s eating behaviors is well established but a multidimensional approach to study this relation is lacking. This study aimed to assess the proprieties of a questionnaire created to evaluate parental practices, preferences, skills and attitudes regarding fruit and vegetables (F&V), sugar and salt. Participants (n = 714) were families of pre-school children (aged 2–6 years old) of the Nutriscience Project–a web-based gamification program–who answered a questionnaire assessing socio-demographic characteristics, nutrition knowledge, and a scale evaluating parental practices, preferences, skills and attitudes, at the baseline of the project. Exploratory factorial analysis was applied to the scale: 21 items and 5 factors were extracted (52.4% of explained variance) with a Kaiser-Meyer-Olkin (KMO) value of 0.770: 1. Modelling/active promotion of F&V consumption (α = 0.73), 2. Skills for choosing/preparing healthy food (α = 0.75), 3. Food p...
Public Health Nutrition, 2020
Objective:Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors.Design:In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits.Setting:An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits.Participants:This study describes current market customers at twelve market sites serving low-income seniors.Results:Market customers were most...
Journal of Clinical Medicine, 2019
Fruits and vegetables (FV) are very important for the prevention of noncommunicable diseases (NCDs), but it has been demonstrated that FV consumption is below that recommended. Several companies have worked to offer FV concentrates, but it remains unclear whether they represent a potentially effective means of reducing the burden of NCDs. The present study provides a systematic review aimed at assessing the effect of FV concentrate supplementation on select parameters that are known to be risk factors for NCDs. The systematic review was done according to the PRISMA guidelines. Relevant studies were identified through the online databases PubMed, Scopus, Web of Science, and Embase. The physiological parameters of interest were total cholesterol, low-density lipoprotein, plasmatic homocysteine, systolic blood pressure, and body mass index. Data extraction was performed in duplicate. The results of the systematic review provided input for a Markov chain simulation model aimed at estima...
Nutrients, 2020
Knowing which barriers to buying and preparing/cooking vegetables at home are linked with the home availability of vegetables and how food-security status impacts this relationship will facilitate the tailoring of future public health interventions. Baseline data were used from an elementary-school-based intervention. Data on household food-security status, availability of vegetables at home, and barriers to buying and preparing/cooking vegetables were collected from 1942 parents. Differences between food-secure and food-insecure households were examined for barriers to buying and preparing/cooking vegetables. Mixed-effects linear regression was used to estimate the associations between barriers to buying and preparing/cooking vegetables and food-security status on the home availability of vegetables. Food insecurity was reported in 27% of households. Food-insecure households were significantly more likely to report barriers to buying and preparing/cooking vegetables. The barriers t...
ACM Transactions on Computer-Human Interaction, 2018
Advances in Information and Communication Technologies (ICTs) offer new opportunities for addressing transportation needs; however, past research suggests that opportunities are not equally shared by millions of low-income Americans. We draw from four empirical studies and two case studies to contribute descriptions of the 11 everyday transportation models currently used by residents of low-income and underserved communities to enhance their access to health-enhancing resources. These models fell into personal, private, public, and interpersonal categories. We contribute insights regarding the following barriers and facilitators associated with these models: (1) affordability; (2) individual capabilities; (3) interpersonal trust, care and/or reciprocity; (4) trust in technology; (5) service availability/eligibility; (6) spatial and temporal matches; (7) match between transportation mode and physical needs; (8) service reliability and quality; and (9) infrastructure access. To addres...
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Ethnicity & disease, 2006
To compare the availability, selection, quality, and price of fresh fruit and vegetables at food stores in four Detroit-area communities: 1) predominately African-American, low socioeconomic position (SEP); 2) racially heterogeneous, low SEP; 3) predominately African-American, middle SEP; and 4) racially heterogeneous, middle SEP. Cross-sectional observational survey, conducted fall 2002. Detroit, Michigan Overall, 304 food stores located in the four communities were evaluated: chain grocery, large independent grocery, "mom-and-pop" grocery, specialty (meat, fruit and vegetable markets), convenience without gasoline, and liquor stores. Availability was indicated by whether a store carried fresh fruit or vegetables, selection was based on a count of 80 fruit and vegetables, quality was evaluated according to USDA guidelines for a subset of 20 fruit and vegetables, and price was assessed for 20 fruit and vegetables by using the lowest-cost method. Mean quality of fresh produ...
2011
Objective: There is little evidence of how fruit and vegetable (FV) household food availability changes over a one-month period among low-income households. The objective of this study was to analyze how FV variety and sustainability changes over a 4-week period. Design: Inventories were conducted in low-income family households (n=49) once a week over a 4-week period. Trained researchers gathered the weights of all FV, including legumes, within the home. Previously determined mean container weights were subtracted to obtain the estimated weight of the FV. All weights were then converted to edible cups of FV, taking into account the weight that is removed when stems, peels, skins, and canning liquid are removed. Analysis: Variety was measured by analyzing the number of kinds of FV within the USDA subgroups (100% fruit juice, citrus fruits, other fruits, dark green vegetables, orange vegetables, dry beans and peas, starchy vegetables, and other vegetables) found in the home. In addit...
Nutrients, 2020
Knowing which barriers to buying and preparing/cooking vegetables at home are linked with the home availability of vegetables and how food-security status impacts this relationship will facilitate the tailoring of future public health interventions. Baseline data were used from an elementary-school-based intervention. Data on household food-security status, availability of vegetables at home, and barriers to buying and preparing/cooking vegetables were collected from 1942 parents. Differences between food-secure and food-insecure households were examined for barriers to buying and preparing/cooking vegetables. Mixed-effects linear regression was used to estimate the associations between barriers to buying and preparing/cooking vegetables and food-security status on the home availability of vegetables. Food insecurity was reported in 27% of households. Food-insecure households were significantly more likely to report barriers to buying and preparing/cooking vegetables. The barriers t...
American Journal of Public Health, 2010
To identify promoters of and barriers to fruit, vegetable, and fast-food consumption, we interviewed low-income African Americans in Philadelphia. Salient promoters and barriers were distinct from each other and differed by food type: taste was a promoter and cost a barrier to all foods; convenience, cravings, and preferences promoted consumption of fast foods; health concerns promoted consumption of fruits and vegetables and avoidance of fast foods. Promoters and barriers differed by gender and age. Strategies for dietary change should consider food type, gender, and age. (Am J Public Health.
Journal of nutrition education and behavior, 2018
Describe fruit and vegetable (FV) preferences and other factors that may influence participation in community-supported agriculture (CSA). In-depth, semi-structured interviews. Eight rural/micropolitan communities in 4 US states. There were 41 caregivers and 20 children (8-12years of age) from low-income, English-speaking households. Knowledge, attitudes, and behaviors regarding FVs; perceived barriers to CSA participation. Transcribed verbatim and iteratively coded. Caregivers and children believed FVs were important to health, yet FVs were not featured in dinners or snacks and consumption was challenged by limited preferences and neophobia. Few caregivers and children knew about the seasonality of FV. Most caregivers were unfamiliar with CSA and had concerns about CSA cost, accessibility, produce quality, and selection. These qualitative data support improvements in: 1) CSA distribution practices to offer flexible payment and pick-up options, more fruits, and self-selection of FV;...
Appetite, 2010
Shopping for and purchasing fruits and vegetables is an integral part of managing produce consumption and of maintaining dietary quality (Hersey et al., 2001). However, 2004 United States Department of Agriculture (USDA) calculations (Blisard, Steward, & Jolliffe 2004) suggest that almost 20% of all low-income households (<130% poverty level) buy no fruits and vegetables in a given week compared to about 9% of high-income households. How low-income shoppers decide what, if any, fruits and vegetables to purchase and prepare appears to depend on a variety of factors. Food cost, consumers' income and resources, level of education, and nutrition knowledge are associated with fewer purchases (
Benefits and barriers to fruit and vegetable intake: relationship between attitudes and consumption
Journal of Nutrition Education, 1995
Consumption of fruits and vegetables is suggested to be beneficial in cancer prevention. However, surveys indicate that a large percentage of the population does not consume the recommended intake of fruits and vegetables. A mail survey was conducted in 1990 to examine attitudes toward nutrition and reported fruit and vegetable intake among randomly sampled Washington state residents (n = 1069; age range = 20-88 years). Individuals in low-income and low-education categories and males had significantly higher scores measuring barriers to fruit and vegetable intake compared to the highest income and education groups or females. All respondents had high nutrition concern despite income or education level. Nutrition behavior scores were significantly higher for individuals with high income. Results of the multiple regression analysis indicated that 16% of the variance in fruit and vegetable intake was accounted for by attitude variables. Barriers to fruit and vegetable intake were the largest component of variability in actual fruit and vegetable consumption. Results suggest a relationship between attitudes about barriers to fruit and vegetable intake and nutrition behaviors. Additionally, males and individuals with limited education and lower income may benefit from education directed toward reducing barriers to fruit and vegetable intake.
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