We found that the presence of a large grocery store within 0.5 mile was positively related to fruit and vegetable consumption, and that individual race/ethnicity moderated relationships between neighborhood store availability and fruit and vegetable intake. Neighborhood store availability accounted for the between-neighborhood variation in fruit and vegetable intake.
Our findings suggest that availability of large non-chain grocery stores, particularly at a small spatial scale, may facilitate the purchase and consumption of fruit and vegetable by residents. We found no relationship between supermarket proximity and fruit and vegetable consumption. Prior research, using a wide variety of designs and store definitions, is inconsistent regarding relationships between fruit and vegetable consumption and supermarket proximity.5, 8–10, 12
Given the sensitivity to distance suggested by our finding that large grocery store availability within 0.5 mile but not one mile influences fruit and vegetable intake, supermarkets may have been located too far away to facilitate fruit and vegetable intake in our sample, with the nearest supermarket, on average, over 3 miles from respondents’ residential census blocks. Studies examining the distribution of different store types across neighborhoods and the effects of store availability on dietary intake have generally classified grocery stores as chain (“supermarkets”) or non-chain,5, 11, 26, 27
with few distinguishing between large and small non-chain grocery stores.7, 28
As a result, little is known about the potential contributions of large versus small non-chain grocery stores to fruit and vegetable intake or other dietary behaviors. Our findings suggest that this is an important direction for future research. If research evidence amasses showing that large non-chain grocers are nutritional resources, cultivating these store types in underserved urban neighborhoods, not just chain supermarkets, may be an effective community change strategy.
Because large food stores (e.g., supermarkets) generally have greater varieties, lower prices, and possibly higher quality foods for sale than smaller food stores (e.g., convenience stores),29–31
store type is often used as a proxy for the food supply. Yet, we found no direct associations between the observed or perceived neighborhood fruit and vegetable supply (availability, variety, quality, price) and consumption. One potential explanation is that stocks of canned, frozen, or dried fruits and vegetables, which we did not measure, at large grocery stores may promote higher fruit and vegetable consumption. It is also possible (as suggested below under Limitations) that there was insufficient variation in the neighborhood fruit and vegetable supply to detect effects or that our observed and perceived measures do not capture aspects of the neighborhood fresh fruit and vegetable supply that are influential. Indeed, in the limited number of studies that have directly tested relationships between fruit and vegetable intake and aspects of the fruit and vegetable supply in either the residential neighborhood or stores where people shop, results are inconsistent. Studies are needed to develop reliable and valid measures of the neighborhood fruit and vegetable supply, which are grounded in residents’ understandings and experiences, for use in both observational and experimental research on the food environment.
Presence of a large grocery store was associated with a greater increase in average daily fruit and vegetable servings among Latinos compared with African-Americans. Presence of a convenience store was negatively related to fruit and vegetable intake while more stores selling fresh produce was positively related to consumption among Latinos, but not African-Americans. Relationships between the food environment and intake did not differ between African-Americans and Whites. Extant studies of primarily African-American and White samples have been inconsistent regarding whether individual race/ethnicity moderates relationships between store availability or proximity and dietary intake.5, 32
More specifically, a North Carolina study found no difference in relationships between store proximity and dietary quality by race in a predominately African-American and White sample of pregnant women,32
whereas another study with a primarily Southern population showed stronger associations between store availability and fruit and vegetable consumption among African-Americans than Whites.5
Our study differs from these studies in its inclusion of a substantial number of Latinos and focus on a midwestern U.S. urban population.
Several potential explanations may account for the stronger effect of the food environment on Latinos compared with African-Americans. First, because 60% of our Latino sample was first-generation immigrants (born outside the U.S.) and immigrants’ dietary quality is generally than that of those who have been in the U.S. for two or more generations or who are more acculturated,33, 34
exposure to less expensive, energy-dense foods in neighborhood convenience stores may have a stronger negative effect on their fruit and vegetable consumption, whereas large grocers and more stores selling fresh produce may facilitate food choices from their home countries including higher fruit and vegetable intake. Indeed, having inadequate physical access to high-quality fruits and vegetables that were commonly available in their home countries or that their parents served or prepared has been found to be a barrier to fruit and vegetable consumption among some Latinos.35
It is possible that the large grocery stores located near our Latino respondents offer these more familiar and sought-after fruits and vegetables. Second, drawing on research suggesting that first-generation urban Mexican immigrants conduct their lives mostly in their residential neighborhood,36
Latinos in our sample may be more reliant upon and thus their food choices potentially influenced by neighborhood stores than African-Americans who may have larger activity spaces and greater exposure to food sources outside the neighborhood. Third and related, given the pervasive and persistent deficiencies in the retail food environment (e.g., few supermarkets, poor quality produce) of neighborhoods where they live,13, 16, 18, 26–28, 37
African-Americans may have developed strategies (e.g., ride-sharing) for purchasing foods outside their neighborhoods. Fourth, inadequate family economic resources and unsupportive retail food environments during childhood and thus insufficient opportunities to develop a preference or “taste” for fruits and vegetables may result in African-Americans being less sensitive to the neighborhood food environment compared to Latinos.38–40
If supported by other studies, research to better understand the nature of the stronger relationships between the neighborhood food environment and fruit and vegetable consumption among urban Latinos might inform approaches to create supportive food environments for Latinos and other racial/ethnic subpopulations.
A major strength of this study is inclusion of multiple aspects of the neighborhood retail food environment, including availability of or proximity to a range of store types as well as perceived and observed measures of the fruit and vegetable supply (availability, variety, quality, price). However, the study has limitations. First, the study is cross-sectional. Therefore, we cannot determine whether the neighborhood food environment affected residents’ fruit and vegetable consumption or their fruit and vegetable intake and thus demand shaped the neighborhood food environment. Second, neighborhoods were not sampled to achieve maximum variation in the retail food environment; therefore, there may be insufficient variation to detect environmental effects. Third, this study did not include gas station convenience stores or food service places (e.g., restaurants), and therefore may underestimate the role of the neighborhood food environment in fruit and vegetable intake. Fourth, because store listings in business databases were incomplete, we relied primarily on data collected during in-person observations of stores to classify stores by type. Though our approach increased the comprehensiveness and accuracy of store locations, we were not able to classify stores by type using Standard Industry Classification (SIC) or North American Industrial Classification System (NAICS) codes, as has been done in some prior work. Fifth, our observed and perceived measures of the neighborhood fruit and vegetable supply only included “fresh” options, not frozen, canned, or dried. Sixth, we assessed neighborhood fruit and vegetable supply based on a single observation in a single season, the validity of which for characterizing the fruit and vegetable supply within season or across the year is unknown. Seventh, the relatively small average number of survey respondents per census block may have resulted in underestimated standard errors and thus greater risk of a Type I error (rejecting a null hypothesis when it is true).
In conclusion, rigorous research is needed to guide the development of effective evidence-based interventions and policies to create environments supportive of healthful dietary intakes, including fruits and vegetables.41
Adding to a growing body of evidence that disparities in the retail food environment may play a role in shaping dietary intakes in the U.S.,42, 43
we found that the neighborhood food environment may influence fruit and vegetable intake of Latinos to a greater extent than African-Americans and Whites, perhaps due to differences in historical and contemporary circumstances. Our results suggest that increasing the availability of large non-chain grocery stores and fresh produce at stores may be effective strategies to promote fruit and vegetable intake in urban racial/ethnic subpopulations, particularly Latinos. Because fruits and vegetables must compete with cheaper energy dense foods for consumers’ food dollars, taxation policies to alter the price structure of foods by subsidizing the costs of fruits and vegetables and raising prices of energy-dense foods has also been proposed, particularly for low-income consumers.3
However, further research is needed to examine whether effects of the neighborhood food environment on fruit and vegetable intake and other dietary behaviors depend on individual characteristics and resources. This research, particularly if it actively engages communities according to community-based participatory research principles, may be informative for identifying and instigating necessary changes at multiple levels to improve not only neighborhood food environments, but also individual material, attitudinal, or motivational resources.44–46