Methods: A subsample of 79 individuals living in two adjacent zipcodes in an urban Appalachian community was selected from 700 research participants living in different areas of a large Midwest city for analysis. Twenty-five people administered the survey at 15 community sites. Others took an identical online version. Recruitment occurred through word of mouth, posters, agency and business partnerships, email, social media, and on-site. Surveys included the six-item USDA food security module, questions related to food access, food shopping behaviors, and the neighborhood environment. Quantitative data was analyzed for descriptive information. Food availability and price data was collected on 86 items at two discount grocery stores, one partial market, and one grocery store where our subsample purchased food and compared to the USDA Thrifty Food Plan as a measure of affordability.
Results: Our sample included over 45% who were considered food insecure. Over 1/3 had incomes below $15,000. Almost 18% received disability and 15% received Social Security or retirement. In this neighborhood, no grocery stores exist, and ¼ of the sample never used a car to obtain food. One-half walked, while 20% rode a bike, and 7.6% used public transportation. The average travel time was 36 minutes. Transportation or distance limited the ability to purchase the food they desired (25%). Decisions to purchase food regularly at the prolific fast food establishments were common (72%) as were making purchases at corner stores (44%) and partial markets (e.g., dollar store) (54%). Food store audits revealed that the store located in the neighborhood was missing 51% of the food items, including having no fresh produce. Comparisons to the Thrifty Food Plan revealed that three of the four stores were priced above the TFP. No considerations for quality are included in these measures, though respondents stated nutritional value was extremely important (83%) as was having pesticide-free produce (38%).
Conclusions and Implications: These results will be used in a city-county food action plan. Results reveal that not all neighborhoods have equitable access to food. Low-income individuals with poor transportation in areas where food availability is limited often make decisions based on convenience and price, not desirability. While nutrition was important to people, not having access to fresh produce limited the ability to provide enough food for a healthy lifestyle. Delving more into the price differences compared to the TFP can help inform national policy-level discussions about SNAP allotments, as can understanding the impact farmers’ market incentive programs have on the food environment. Results have informed community-based grants, including the development of a non-profit grocery store.