Women, Infants, and the Food Environment: Influences on Food Security and Obesity

Year: 2004

Research Center: Southern Rural Development Center, Mississippi State University

Investigator: Laraia, Barbara, and Peggy Bentley

Institution: University of North Carolina, Chapel Hill

Project Contact:
Barbara Laraia
Department of Nutrition
School of Public Health
University of North Carolina
Chapel Hill, NC 27599
Phone: 919-966-5969


Over the past decade there has been a new interest in neighborhood-level effects on health. The role that the local food environment—in particular, the presence of large supermarkets—plays in providing high diet quality foods to neighborhood residents is being studied. Although the proportion of meals eaten away from home has increased, families on average continue to purchase most of their food from supermarkets and grocery stores. Those families who spend more of their food dollars on at-home foods have higher diet quality than those families who spend more money on away-from-home foods. Supermarkets provide the greatest food variety at lower cost compared to restaurants. The presence of grocery stores in a neighborhood varies by neighborhood racial composition, with fewer supermarkets located in African- American neighborhoods, and by whether the neighborhood is in a rural area.

As part of an ongoing cohort study to investigate risk factors for postpartum weight retention, this study investigated the food and physical activity environments in a three-county area in central North Carolina.

The study had two objectives:

  1. To identify environmental influences on shopping behaviors, dietary intake, meal patterns, and physical activity among postpartum women, infant caregivers and infants
  2. To identify policies and social factors that influence food resource and recreation location, and to investigate the relationship between food environment and dietary intake.
Various factors make it difficult to assess the hypothesis that supermarkets have an independent influence on diet quality. First, endogeneity, or omitted variable bias, may not take into account the personal choice that influences both residence and the distance to supermarket that might influence diet quality. Second, although an independent relationship has been found between presence of a supermarket and diet, the impact of distance from a supermarket on diet is not fully understood.

Women were recruited within 1 year postpartum, primarily through clinics supporting the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). A total of 34 women participated in focus groups and individual interviews. These sessions were organized by race and Body Mass Index (BMI) status. Each focus-group interview lasted about 90 minutes and each individual interview lasted 30-45 minutes. In addition, nine interviews were conducted with community leaders including nutritionists at three WIC clinics, a manager of a convenience store, town planners, representatives from State and national nonprofit organizations that promote smart growth and active living, and State public health officials. All interviews were audiotaped, transcribed verbatim, coded, and imported into software for data management and analysis.

The open coding process produced 47 themes categorized into eight headings: neighborhood social and physical characteristics, food environment, supermarket environment, physical activity environment, individual resources, individual considerations, individual physical activity issues, and perceived societal and programmatic influences.

Preliminary findings of postpartum women’s perception of their food environment, especially as it applies to a supermarket survey, suggest that food purchase decisions are affected by more than cost, quality and food variety. The general atmosphere of supermarkets, specifically cleanliness and customer service, also influences where women shop. Study participants articulated a strong preference for two of seven commonly mentioned supermarket chains in three central North Carolina counties. Women conveyed a vague sense of “fitting” with their preferred supermarkets. Stores perceived as having higher quality food also were seen as more expensive. The women were not as comfortable shopping in the more expensive stores because they either didn’t feel welcome or familiar with item locations, which increased their shopping time.

Although most women shopped at large chain supermarkets, they spoke of the quality of the supermarkets differing by neighborhood wealth. Findings also suggested that individual self-esteem may confound the association of neighborhood food resources on diet and weight. Other psychosocial factors, such as anxiety and discrimination, might be important characteristics to measure, especially among low-income households. Such variables have not been included in models of the neighborhood food environment and diet.