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An Underrepresentation of Food Deserts in the Rural Appalachian Mountains Kasie Richards East Tennessee State University

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An Underrepresentation of Food Deserts in the Rural Appalachian Mountains Kasie Richards East Tennessee State University East Tennessee State University Digital Commons @ East Tennessee State University Electronic Theses and Dissertations Student Works 8-2012 As the Crow Flies: An Underrepresentation of Food Deserts in the Rural Appalachian Mountains Kasie Richards East Tennessee State University Follow this and additional works at: https://dc.etsu.edu/etd Part of the Policy Design, Analysis, and Evaluation Commons Recommended Citation Richards, Kasie, "As the Crow Flies: An Underrepresentation of Food Deserts in the Rural Appalachian Mountains" (2012). Electronic Theses and Dissertations. Paper 1453. https://dc.etsu.edu/etd/1453 This Dissertation - Open Access is brought to you for free and open access by the Student Works at Digital Commons @ East Tennessee State University. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Digital Commons @ East Tennessee State University. For more information, please contact [email protected]. As the Crow Flies: An Underrepresentation of Food Deserts in the Rural Appalachian Mountains ____________________ A dissertation presented to the faculty of the College of Public Health East Tennessee State University In partial fulfillment of the requirements for the degree Doctor of Public Health with a concentration in Community and Behavioral Health ____________________ by Kasie Richards August 2012 ____________________ Dr. Deborah Slawson, Chair Dr. Arsham Alamian Dr. Ke Chen Keywords: Appalachian, “food desert”, “food access”, “food availability”, GIS ABSTRACT As the Crow Flies: An Underrepresentation of Food Deserts in the Rural Appalachian Mountains by Kasie Richards Diet and dietary related health outcomes such as obesity and diabetes are major public health concerns. While personal choice and dietary behaviors are major influences on how an individual eats, the environment influences these choices and behaviors. The nutrition environment is one key influence and its relationship with food choice, behaviors, and socioeconomic influences is complex. Within the structure of the nutrition environment, food access and socioeconomic status compound influencing nutrition behavior and food choice. Food deserts are defined as geographic region of low access to healthy affordable food in low income areas. The USDA developed a system for the analysis of food deserts in the United States. However, the methods the USDA uses do not acknowledge potential geographical barriers present in rural mountainous regions including Appalachia. The purpose of this research is to determine whether the USDA methodology underrepresents food deserts in Appalachia and to develop a modified analysis model for the region. The region was analyzed at the census tract level using methods based on USDA guidelines for low income, rurality, and grocery store identification, then applied in Geographic Information Systems (GIS) to roadway data. Network analysis of drive time from grocery stores to 20 minutes away was performed. Low income, rural census tracts with 33% of their area outside of 2 the 20-minute drive time zone were identified as food deserts. Counties containing tracts were then compared to USDA designated counties, using the dependent variables of obesity and diabetes diagnosis rates and controlled for by county level rurality and economic distress. Of the counties designated as rural, 63 contained food deserts by the modified methods and the USDA model identified 20, there was an overlap in identification of 12 counties. There was no significant difference for 2 methods in health outcomes for the counties. In conclusion, the modified methods do identify a larger food desert region. It is crucial to understand the geographic barriers to regions when addressing nutrition environment concerns. The underrepresentation of food desert areas can leave populations and communities underserved and without much needed resources to improve their access to healthy and affordable foods. 3 DEDICATION To Cory: for his logic and levity. 4 ACKNOWLEDGEMENTS Thank you to: Dr. Deborah Slawson my mentor for patience, support, confidence, and guidance; to my dissertation committee (Dr. Chen and Dr. Alamian) and my academic committee (Dr. Pack and Dr. Bounds) for knowledge, support, and fortitude; Dr. Chris Gregg for mentorship; to the ETSU College of Public Health and my friends and family. 5 CONTENTS Page ABSTRACT .................................................................................................................................... 2 DEDICATION ................................................................................................................................ 4 ACKNOWLEDGEMENTS ............................................................................................................ 5 LIST OF TABLES ........................................................................................................................ 10 LIST OF FIGURES ...................................................................................................................... 11 LIST OF ABBREVIATIONS ....................................................................................................... 12 Chapter 1. INTRODUCTION ............................................................................................................ 13 Food Deserts ......................................................................................................... 13 USDA Food Desert Locator...................................................................... 13 Geographic Information Systems (GIS) ................................................... 14 Food Access .......................................................................................................... 14 The Appalachian Region ....................................................................................... 16 Significance........................................................................................................... 16 Research Purpose .................................................................................................. 17 Specific Aims ........................................................................................................ 17 Specific Aim 1 .......................................................................................... 17 Specific Aim 2 .......................................................................................... 17 6 Specific Aim 3 .......................................................................................... 18 Research Hypotheses ............................................................................................ 18 Hypothesis 1.............................................................................................. 18 Hypothesis 2.............................................................................................. 18 2. 2.LITERATURE REVIEW .............................................................................................. 19 Theoretical Framework ......................................................................................... 19 Neighborhood Deprivation and Food Environment ............................................. 23 Health Outcomes and Food Environment ............................................................. 25 Rural Food Environment ...................................................................................... 28 Fruit and Vegetable Availability and Intake ......................................................... 31 Spatial Analysis .................................................................................................... 34 Conclusion ............................................................................................................ 37 3. METHODS ....................................................................................................................... 39 Data Used .............................................................................................................. 39 Sample Selection ................................................................................................... 40 Why Appalachia? ...................................................................................... 40 Regional Economics ................................................................................. 41 Economic Distress .................................................................................... 42 Rural Urban Commuting Area Codes ....................................................... 44 7 Analysis................................................................................................................. 49 Data and Mapping Methodology .............................................................. 49 Statistical Analysis .................................................................................... 52 Dependent Variables ................................................................................. 52 Independent Variables .............................................................................. 54 4. RESULTS ......................................................................................................................... 56 Descriptive Data.................................................................................................... 56 Rural Designation ................................................................................................. 62 Economic Distress ...............................................................................................
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