Despite demographic variation, we observed virtually no effects on fruit and vegetable prices of the percentage of the population that was African American or of education or poverty level across the 44 stores we surveyed in the Birmingham MSA. Our findings suggest that relationships between fruit and vegetable pricing and neighborhood demographics are limited in the Birmingham area.
The characteristics of this study may influence the findings in a number of ways. Factors such as grocery store density and transportation patterns are unique to a given area and could affect fruit and vegetable prices. With the dominance of large chain grocery stores in the Birmingham MSA, not only are prices suppressed and retailer competition increased, but the ability of a smaller grocer to maintain a viable business may be limited because of pressure to lower prices. As a result of their proximity to each other, large stores provide the consumer with multiple shopping options. Other factors to consider include the transportation patterns of adults in the Birmingham area. According to the 2000 census, 94% of households in the area have at least 1 car, and 40% of households have 2 cars. Driving allows consumers to travel farther from home, increasing the available food outlet options.
One key point of this study is that the regional setting of the food environment seems to affect food availability, variety, and pricing. Across different types of population centers (for example, rural compared with urban), previous studies have shown differences in the types and density of food outlets available. One study in the Lower Mississippi Delta region found a low density of large grocery stores and supermarkets (8
). Of 36 counties studied, there was only 1 store per 1.6 square miles. In the urban Birmingham area, there is 1 store per 14.3 square miles. Given the low accessibility of larger stores in rural areas, smaller food outlets play a larger role in the food supply. These smaller stores typically charge 3% to 10% more for food (8
). Even when people in rural areas access larger stores, their travel costs may be substantially higher than those of people who live in urban areas.
Regional differences are also apparent when assessing the food environment, even in population centers designated as urban. For example, 1 study reported a total of 324 food stores in East Harlem and the Upper East Side of New York City (12
). Despite the high concentration of stores in this densely populated area, 249 of the stores (77%) had only 1 cash register, indicating a smaller food store with less variety. However, in our local assessment, almost all of the stores had more than 4 cash registers, and there were no major differences in the variety of items available within the stores.
In our limited regional setting, the lack of variation in food price has at least 2 implications. First, this evidence does not support the notion that obesity is related to high prices of fruit and vegetables. Despite the high availability and lack of price variation for fruits and vegetables, the prevalence of obesity was approximately twice as high in African American parents of children from the Hi5+ study as in non-African Americans (16
). The second implication of this study is that it may highlight an opportunity to increase fruit and vegetable intake by increasing knowledge about the availability of healthy alternatives that are reasonably priced. To take advantage of a food environment that offers a variety of fruits and vegetables, additional effort will need to be directed toward helping people make healthy choices in an economical fashion.
This study has several limitations. Although we did not see differences across neighborhoods in prices of fruits and vegetables in the surveyed stores, additional factors may increase food costs for those who have lower income, are African American, or have less education. One study showed that impoverished neighborhoods that were predominately African American were approximately 1.1 miles farther from the nearest grocery store than were white neighborhoods (11
). Travel distance was not assessed in our study and may be a moderating factor that increases the cost of food. Differences in food quality may also affect cost in a way that is not reflected in retail price. If the quality of an item is better at 1 store than at another, even if the price is the same, the perceived value of the higher-quality item will be higher. Quality, a highly subjective measure, was not assessed in this study and may vary by the demographic variables of interest. Store-level factors and potential spatial inequalities should be considered as well. We presumed that the density of stores, services offered, and size of the stores are relatively constant across the sites because they had to meet the criteria for a retail food store. Unaccounted differences may contribute to variations in price of or access to fruits and vegetables. Spatial inequalities in metropolitan areas such as Birmingham can also lead to variations that may not be captured in our study design. Relevant types of spatial inequalities include the tendency for large chain grocery stores to locate in more affluent areas, along with more availability of green spaces and full-service restaurants that may actively support a healthy lifestyle and healthful food choices.
In conclusion, our findings suggest that in the Birmingham MSA, where there is a high density of grocery stores that sell fruits and vegetables, neighborhood demographics are not associated with variations in fruit and vegetable prices. Despite the high availability of fruits and vegetables and the lack of price variations for them, intake remains lower than recommended. Interventions in the Birmingham MSA aimed at educating people about the availability and economical choices of fruits and vegetables could be effective at reducing obesity. For example, point-of-purchase programs that incorporate education on food labeling as well as shelving-level promotion of fruits and vegetables have shown promise in increasing consumption of fruits and vegetables, particularly among minority populations (19
). Additionally, educating consumers on the value of fruits and vegetables could be done through in-store cooking demonstrations and signs that show a product comparison of various healthy alternatives at multiple price points. To more fully understand the dynamics of decision-making processes involved with buying and eating fruits and vegetables, research is needed to address perceived obstacles, including availability, preparation time, and product uses, in conjunction with the price of fruits and vegetables.