Obesity is a major public health problem in the United States (U.S.). Rural Appalachian residents, especially those living in economically disadvantaged counties, are disproportionately affected by obesity and associated medical conditions. Complex interactions among multiple levels of disadvantage, including individual, family, friends, community, and policy, contribute to unhealthy dietary behaviors that can lead to obesity. Community food environment refers to access and exposure to foods in a community. Potential access to healthy or unhealthy foods depends on spatial availability of food outlets offering different food choices. Realized access, or individual utilization of available foods, ultimately depends on personal, social, and economic factors. However, few studies have examined, from the point of view of rural residents, the opportunities and barriers that influence where they access food and their food choices. This cross-sectional mixed methods study of approximately 20 lower-income women in a rural Appalachian county in Virginia will integrate qualitative interviews, participant observation, geographic information systems (GIS) mapping, and in- store food assessments to examine spatial and psychosocial factors that affect access to food. The research question is: What are some influences on food access and food choices in low-income rural Appalachian residents? The specific aims of this study are to: 1) Describe the community retail food environment (potential food access), including store proximity, food availability, pricing, and marketing;2) Describe food access behaviors (realized food access);and 3) Explore psychosocial, economic, cultural, and environmental influences on realized food access. Public health nurses focus on population-level interventions to address health problems. This study supports NINR strategic objectives by improving understanding of complex social and behavioral patterns that relate to prevention of chronic disease in a disadvantaged population, and by applying GIS technology to enhance a community health assessment. The results of this study will inform future analytic studies of food choice and will promote collaborative, inter-professional interventions to improve nutrition and reduce obesity.

Public Health Relevance

Obesity is one of the most important modifiable causes of disease, disability, and death in the U.S., with disproportionately high rates in rural, Appalachian, and low-income populations. There is increasing evidence that food choices that contribute to obesity are based on complex interactions between individuals, the foods they can access, and the messages about food they receive. In order to design effective obesity interventions for communities, it is important to understand residents'experiences with food access.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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University of Virginia
Schools of Nursing
United States
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