Access to Fruits and Vegetables for Low-Income Populations: A Mixed Methods Study to Healthy Eating Public Deposited

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  • March 20, 2019
  • Maslow, Lindsey Haynes
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • Consuming fresh fruits and vegetables (F&V) can help reduce the risk of chronic diseases. Lower-income individuals do not consume the recommended servings F&V. Access to and consumption of F&Vs is a multi-dimensional issue that includes various levels of influence. The purpose of this dissertation is to examine these various levels of influences and explore strategies to increase F&V consumption. Aim 1 assessed low-income individuals' perceptions about how F&V access programs, including mobile markets, electronic benefits (EBT) cards at farmers' markets, and community gardens, could improve F&V consumption. Participants felt that mobile markets addressed barriers such as availability of fresh F&V, convenience, and quality and variety. Participants had mixed opinions about how helpful EBT was in overcoming cost barriers. Participants had uncertainty about community gardens, mostly surrounding feasibility and implementation. Aim 2 compared the predictive power of geographic information systems (GIS) and self-reported perceived access data for estimating the association between F&V access and consumption. Results showed GIS-based measures had more predictive power than perceived access measures for estimating the association between access and consumption. Perceived access measures (quality, variety, and convenience) were not associated with higher consumption. Aim 3 analyzed stakeholder arguments in access to healthy food state-level legislation legislative hearing data and newspaper articles. Bills that expanded access, rather than restricted access, were most likely to pass. For enacted legislation, non-profit organizations were the largest proponents. Among stakeholder arguments used to support expanding legislation, fairness and economic security were the most frequently cited. Sugar-sweetened beverage (SSB) tax bills accounted for nearly all failed restricting legislation and were opposed by businesses. While proponents focused mainly on factual arguments, opponents focused heavily on value-laden arguments such as economic security, fear of big government, and personal responsibility. Businesses used valued-laden arguments more often than non-profits. Data from these aims suggest that changing the food environment, while also addressing how low-income individuals' perceive that environment is the first step towards increasing F&V consumption. Policy efforts should focus on improving geographic proximity to healthier food outlets and investing in nutrition education to change low-income individuals' food preferences and increase demand for fresh F&Vs.
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  • In Copyright
  • Silberman, Pam
  • Doctor of Philosophy
Graduation year
  • 2014

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