Understanding Nutrition Challenges Faced by Older Americans in Rural Areas: The Role of the Food Environment and Neighborhood Characteristics

Year: 2008

Research Center: Southern Rural Development Center, Mississippi State University

Investigator: Sharkey, Joseph R., Scott Horel, Cassandra Johnson, and Rodolfo M. Nayga, Jr.

Institution: Texas Healthy Aging Research Network, Center for Community Health Development, Program for Research in Nutrition and Health Disparities

Project Contact:
Joseph R. Sharkey
Texas Healthy Aging Research Network (TxHAN)
School of Rural Public Health
Texas A&M Health Science Center, MS 1266
College Station, TX 77843-1266
Phone: 979-458-4268


The economic burden posed by nutrition-related chronic health conditions, such as obesity, cardiovascular disease, cancer, and diabetes, is tremendous. Good nutrition (that is, healthy eating) is now recognized as one modifiable determinant of preventing and managing chronic diseases. However, as life expectancy increases, the burden of chronic health conditions, functional decline, and diminished independence place an unprecedented strain on individuals, families, caregivers, communities, the health care system, and service providers.

Older adults in rural areas disproportionately grapple with problems that affect functional decline and loss of independence: high levels of chronic conditions, low levels of available health support, limited personal and community resources, geographic isolation, and poor nutritional health, among others. Healthy dietary patterns—eating fruits, vegetables, low-fat dairy products, and diets low in total and saturated fat, cholesterol, and sodium—are part of a lifestyle that promotes good health and reduces incidence of chronic disease. Personal, structural, and neighborhood characteristics influence differential access to health care, serving either as barriers or enhancements to lifestyle behaviors, such as physical activity or healthy eating.

Residents of rural and poor areas face the greatest structural and neighborhood disadvantages, with older adults in these regions being particularly challenged to make or maintain lifestyle changes that are critical for preventing or managing disease. Access to grocery stores and availability of healthy foods undoubtedly influence dietary choices. Without access to a food store, such as a supermarket, individuals have difficulty obtaining the food needed for a healthy diet, especially for a vulnerable population like older adults. Accessibility to an available source of affordable healthy foods affects food assistance and nutrition needs, especially in rural areas.

Thus, the goals of this study were to (1) identify and assess the availability of fruits and vegetables through direct observation in a large rural area of six counties in Texas, (2) examine the characteristics of perceived access to foodstores by 645 seniors who participated in the Brazos Valley Health Assessment (BVHA), and (3) evaluate the associations among neighborhood characteristics, perceived and objective measures of food access, and nutrition-related outcomes of the BVHA seniors.

The 6-county study area included 101 census block groups, a rural land area of approximately 4,500 square miles, and a population of more than 119,650 people. Three databases were linked: Brazos Valley Food Environment Project (BVFEP), BVHA, and the 2000 U.S. Census. BVFEP data included the onsite identification and geocoding of all supermarkets or supercenters, grocery stores, convenience stores, dollar stores, mass merchandisers, and pharmacies, as well as completion of an observational survey of the availability and variety of fresh and processed (canned, frozen, and juice) fruits and vegetables in 185 foodstores. The BVHA, which was conducted by a professional survey company for the Brazos Valley Health Partnership and the Center for Community Health Development, included a randomly recruited sample of 695 adults who were 60 years of age or older. Nutrition-related survey questions included the following areas: obesity (self-reported height and weight), food security, food behaviors, perceptions of community food resources, perceptions of the store at which they purchase most groceries, and access to affordable, healthful food. Additional BVHA data included sample sociodemographic characteristics and neighborhood activity. Census block group level socioeconomic characteristics were extracted from the U.S. Census Summary File 3.

Availability and variety for fresh and processed fruits and vegetables were calculated for each food store from the BVFEP data. Network distance (along road network) was calculated from the residence of each BVHA senior participant to the nearest supermarket, nearest food store with a good variety of fresh fruits or vegetables, and to the nearest food store with a good variety of fresh and processed fruits or vegetables. Unadjusted and adjusted models were estimated for the relationship of perceived and objective measures with nutrition-related outcomes. Maps were created to show the spatial distribution of foodstores and BVHA participants.

This study examined the fruit and vegetable availability and variety data from 185 supermarkets/supercenters, grocery stores, convenience stores, dollar stores, mass merchandisers, and pharmacies. In the 27 neighborhoods with the largest concentration of senior residents, the average distance to the nearest supermarket was 14.0 miles, with a range of 0.25-33.6 miles; the nearest senior meal site was 8.9 miles (median = 9.6 miles), with a range of 0.6-20.6 miles. In a multiple variable regression model, an increase in neighborhood percentage of seniors was associated with greater distance to the nearest supermarket/supercenter (p <0.01), and an increase in population density and socioeconomic deprivation were associated with shorter distance to the nearest supermarket/supercenter (p <0.001).

Good selection of fruits or vegetables could be found in all types of foodstores, with the exception of convenience stores. In the 33 neighborhoods that were at least 10 miles from the nearest food store for fresh fruit, seniors were 21.4 percent of the population. BVHA data revealed that 35 percent of the 645 seniors reported a household income below 200 percent of the Federal poverty level. Sixty percent of the BVHA seniors had few grocery stores or supermarkets in their communities, 32.7 percent of seniors had little variety in foods, and food prices were high for more than 80 percent of seniors. Many seniors had problems with variety, freshness, or price of fruits and vegetables in the stores where most of their groceries were purchased. More than 36 percent of the sample resided at least 10 miles from the nearest senior congregate meal site, and almost 45 percent were at least 10 miles from the nearest supermarket. About a fourth of the sample was within 1 mile of a good selection of fresh fruits or vegetables. The share increased to at least a third of BVHA seniors within 1 mile of a good selection of fresh or processed fruits or vegetables. At the other extreme, at least a fourth were at least 10 miles from fresh fruits or vegetables.

This study is the first step in understanding the spatial challenges to nutrition health faced by seniors in a large rural area that also lacks public transportation. This study goes beyond prior studies by simultaneously examining neighborhood and individual access to foodstores, senior congregate meal sites, and availability and variety of fresh and processed fruits and vegetables. Indeed, initiating or maintaining healthful eating habits is difficult without access to healthful foods.

Direct inquiries about this study to the Project Contact listed above.