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:
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.
- To identify environmental influences on shopping behaviors,
dietary intake, meal patterns, and physical activity among postpartum
women, infant caregivers and infants
- To identify policies and social factors that influence food resource
and recreation location, and to investigate the relationship between
food environment and dietary intake.
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.