This study documented the availability and price of more healthful foods to better understand the consumer nutrition environment of Leon County, Florida. Our findings suggest that store type is associated with the availability and price of more healthful foods. Neighborhood income level was related to the availability but not the price of some healthful foods.
Greater availability of foods in supermarkets compared with other food stores has been shown (10
). As expected, among surveyed stores, supermarkets had the greatest availability of all more healthful foods, followed by grocery stores and convenience stores.
Several studies have found price differences between store types for various foods (11
). Few studies have analyzed the price of more healthful foods, but previous studies have consistently found that supermarkets offer more healthful foods at a lower price compared with other food stores (10
). We found significant differences in price by store type for low-fat half-gallon size milk and 6 of 20 fresh fruits and vegetables. These items were significantly less expensive in supermarkets than in grocery stores and convenience stores. Some of the nonsignificant differences in the price of produce may be due to the time of year that the study was conducted, the absence of produce items in grocery and convenience stores, and the use of the USDA nutrient database to roughly estimate price of produce.
Previous consumer nutrition environment studies (16
) have focused on examining whether the poor and minority neighborhoods have less access to affordable foods and have found inconsistent results. We found no significant differences in the availability and price of more healthful foods by neighborhood racial composition, but neighborhood wealth was associated with significant differences in the availability of 10 of the 20 fruits and vegetable items surveyed, shelf space devoted to low-fat milk, and the availability of varieties of whole-wheat bread. Although it appears that stores in predominantly black and low-income neighborhoods in Leon County provide similar availability and prices of more healthful foods compared with stores in predominantly white and high-income neighborhoods, poor and minority neighborhoods have fewer supermarkets. Supermarkets are distributed fairly equally between high- and low-income level neighborhoods in Leon County, but the distribution of supermarkets by neighborhood racial composition is disproportionate (27
). This finding is similar to those of other studies, and this disproportionate distribution may influence the purchasing and consumption of more healthful foods among these populations (24
This study is unique because it was designed and conducted by health department administrators with the intent to make policy changes and interventions in their community. Administrators adopted the best available method by using the validated NEMS-S. Although the study was conducted in a single county at 1 point in time by using a convenience sample of a small number of stores, research has suggested that 1 observation of an area's consumer nutrition environment is sufficient to provide accurate data (29
). An additional strength of this study is its focus on the availability and price of more healthful foods that are essential to promoting health and preventing disease and that are the focus of federal dietary guidelines.
This study has many limitations. As with any consumer nutrition environment study, the findings of this study cannot be easily generalized or compared with those of previous studies for the following reasons. First, this study used census tracts to define neighborhoods. Although research has found that residents' definition of a neighborhood is comparable to a census tract, most neighborhoods include parts of at least 2 census tracts (30
). Making associations between neighborhoods and their accompanying nutrition environment relies on the assumptions of understanding where people shop for food and the various contexts in which a person's food-related behaviors occur. Second, this study used census tract-level demographic characteristics to determine neighborhood wealth and racial composition. Similar to Morland and Filomena (16
), we defined predominantly black as more than 80% of the population. Other studies have defined predominantly black as more than 75% (31
) or used more than 50% nonwhite or Hispanic populations or both to define a minority population (26
). Third, a range of store type definitions have been used in previous studies. Depending on which source is used, the results of a study may vary. Other potential limitations of the study include the use of the USDA nutrient database to estimate produce prices, inaccurate or unclear data collection resulting from human error, and the convenience sampling that was used to select stores to be audited.
This study suggests that access to supermarkets and more healthful foods varies by neighborhood, which may negatively influence people's eating behavior. By employing the best available tools and method, nutrition environment studies can be used to provide convincing evidence to policy makers, administrators, and consumers that will encourage improvements in neighborhoods that lack adequate access to affordable, healthful food. Examples of such improvements include advocating for large retail stores, farmer's markets, and community gardens in disadvantaged neighborhoods.