Food Deserts: Methodology
1. Cummins, Steven 2002. A Systematic Study of an Urban Foodscape: The Price
and Availability of Food in Greater Glasgow. Urban Studies Oct2002, Vol. 39
Issue 11, p2115-2130.
o Location:
 Greater Glasgow Health Board (GGHB) area in the West of
Scotland
 Neighborhoods: very poor to very affluent
o Deprivation and Geographical Scale
 Carstairs-Morris Deprivation Category (DEPCAT): to measure
area-based socioeconomic advantage and disadvantage
 4 variables:
o percentage overcrowding
o percentage male unemployment
o percentage low social class
o percentage no car
o Definition of Shops in the Survey Sample
 Shop types:
 Multiples
 Independents
o Sample, Data and Methods
 Conducted a survey of 325 food retail outlets
 The sample was drawn in two stages
 First stage: all national ‘multiple-owned’ retail formats
were identified
 Second stage: a random sample of 1 in 8 ‘independent’
food retail outlets was drawn from lists of shops in the
Public Registers of Food Premises, lists of all premises
that fall under the Food Safety and Hygiene guidelines
 Data were collected by in-person visits to each store
o Food Price and Availability Measures
 Collected data on 57 standard food items covering all the major
food groups derived from the London Family Budget Unit’s
‘modest but adequate’ diet devised by Nelson et al. (p.6)
 For each item, and in each shop, they collected information on
cheapest price, branded price, general food availability
o Analysis
 Analyzed cheapest price, brand price and availability on three
groups of retail outlets:
 All shops
 Multiples
 Independents
 Statistical tests




ANOVAs: to test differences in mean cheapest prices
and mean brand prices between shop types
Chi-Squares: to test for differences in food availability
between shop types
T-tests: to analyze food price differences between more
or less affluent places for mean cheapest price and
mean brand price
General linear modeling and logistic regression: to
investigate how much of the variation in food price and
availability can be attributed to three independent
variables (shop type, deprivation and shop location)
2. Chung, Chanjin 1999. Do the Poor Pay More for Food? An Analysis of Grocery
Store Availability and Food Price Disparities. Journal of Consumer Affairs
Winter99, Vol. 33 Issue 2, p276.
o Population
 Stores listed in the American Business Directory as grocery or
convenience stores in Hennepin and Ramsey counties
 526 stores are listed, including grocery and convenience stores
but excluding gas stations
o Store Availability
 From the selected 526 stores, the distribution of large chain
grocery stores and all other stores across the two counties by
poverty rates in zip code areas were examined
 Comparison: the distribution of stores with more than $10
million in annual revenues vs. stores with less than $10 million
in annual revenues by poverty rates in zip code areas
o Price Disparity
 Prices of individual purchase items in chain stores were
compared with those from convenience or small grocery stores,
and also prices from inner-city stores with those from other
locations
o Survey
 Price of food items were surveyed from grocery stores located
in Hennepin and Ramsey counties
 Survey was completed in person at the stores
 Food item surveys were based on the USDA weekly Thrifty
Food Plan for a family of four
 49 food items were selected for the survey (p. 282)
o Pilot survey
 The most popular brand and package size for each product was
chosen in the survey
 It was conducted at five stores before implementing the fullscale survey
o Market-basket prices

They were constructed and compared across different types of
stores and neighborhoods
o Study Questions
 Why do inner-city poor residents pay more for food?
 Do inner-city residents have the same level of access to
large chain stores as suburban residents? What are the
prevalent types and sizes of grocery stores across innercity and suburban locations? Is access to grocery stores
affected by a neighborhood’s poverty rate?
 How do prices compare between large chain stores and
all other forms of grocery stores, including small and
midsized stores and convenience stores? How do prices
within different types and sizes of stores compare
across inner-city and suburban communities?
 Do poor, inner-city residents pay more for a weekly
family food basket that meets the USDA food plan?
Which is the dominant factor of market basket price
disparities: fewer chains in poor communities or pricing
disparities among stores located in poor communities?
o Analyze
 Following USDA guidelines, the weekly home food cost for
these four family members was computed
 Totaling the prices for all market-basket commodities for each
store gives the cost of purchasing the Thrifty Food Plan
 Using surveyed food prices to examine the differences in
market-basket prices between
 Chains and non chains
 Suburbs and inner cities
 Nonpoor and poor neighborhoods
 Equations: (p. 284)
 P=P (X, A)
 A=A (X)
o P and A represent market-basket price and
percentage of availability
o A = number of surveyed market-basket items
available in the store divided by the total
number of survey market-basket items
o Vector X includes Chain (1 if chain store, 0
otherwise), Poor (1 if located in poor
neighborhood, ) otherwise), and percentage of
chain stores in the neighborhood
3. Nicole Darmon 2004. Energy-dense diets are associated with lower diet costs: a
community study of French adults. Public Health Nutrition Jan2004, Vol. 7 Issue
1, p21-27.
o Population
 837 French Adults, aged 18-76 years
o Method
 Survey design and dietary assessment
 The Val-de Marne dietary survey used a two-stage
cluster design sampling procedure
 Trained dietitians interviewed members of each
household at home
 Dietary intakes were estimated using a dietary history
interview, based on daily intakes representative of a
habitual diet over 6 months
 Habitual food consumption at breakfast, lunch and
dinner, and during snacks, was assessed in terms of
frequencies (per week) and quantities consumed
 Dietary intake data were then used to calculate daily
amounts of 73 distinct foods and food groups, as well
as water and five types of alcoholic beverage
 Energy density
 Analyses were based on 57 of the 73 food items in the
Val-de-Marne database (p. 22)
 The amounts consumed (gm/day) were used to
calculate daily energy intakes
 The edible portion of each food was taken into account
in calculating diet weight
 Dietary energy density was obtained by dividing energy
intake by the estimated edible weight of all foods and
caloric beverages consumed (excluding alcohol)
 Estimated diet costs
 For each of the 57 food items, the most frequently
consumed items in that particular category were
selected as the representative foods
o Statistical analyses
 Regression model: to examine the relationship between dietary
energy density and daily energy intake
 The complex relationships between energy intake, diet weight
and diet cost were tested using multivariate regression analysis
with diet cost as the dependent variable and energy intake and
diet weight as independent variables
4. Smoyer-Tomic, Karen E. 2006 Food Deserts in the Prairies? Supermarket
Accessibility and Neighborhood Need in Edmonton, Canada. Professional
Geographer Aug2006, Vol. 58 Issue 3, p307-326.
o Population Data

o
o
o
o
Analyzed Edomonton’s 212 primarily urban and residential
neighborhoods
 Used postal code populations
Variables for Assessing Need
 Compared supermarket accessibility between two different
inner-city clusters with the remainder of the city
 Examined neighborhoods with high concentrations of
vulnerable subgroups (low-income, the elderly, and those
lacking a vehicle)
 Data were collected at the neighborhood unit
 Examined accessibility to supermarket for neighborhoods
within the city’s top quartile for two or more of these variables
Supermarket Data
 Identified 60 stores in Edmonton with a full range of grocery
items
Measuring Neighborhood-Level Supermarket Accessibility
 Calculated spatial accessibility to supermarkets using the
minimum distance and coverage methods with ESRI’s
ArcView 3.2 GIS (2000)
 The coverage method counts the number of stores within a 1km radius of each neighborhood
 Calculated accessibility for a particular neighborhood using the
population-weighted average distance of all the postal codes
within the neighborhood’s boundaries using equation 1 (p.310)
Assessing the Distribution of Supermarkets
 Descriptive maps were used to
 Illustrate the distribution of supermarkets
 Identify neighborhoods with large concentrations of the
three high-need groups
 Identify neighborhoods with high need but low
accessibility to supermarkets
 Used nonparametric correlation and difference-of-means
testing
 to access the relationship between neighborhood need
and supermarket accessibility for the city as a whole
 to compare neighborhood characteristics between those
with high and low access to supermarkets
 to compare accessibility between both inner-city areas
and the remaining Edomonton neighborhoods
5. Shaw, Hillary J. 2006 Food Deserts: Towards the Development of a
Classification. Geografiska Annaler Series B: Human Geography 2006, Vol. 88
Issue 2, p231-247.
o Interviews and research setting

234 semi-structured interviews were carried out during 2001
and 2002 in Norfolk
 56 individual shoppers, 58 shop workers/managers, 120
agency representatives
 Shoppers were selected by door-to-door calling
 Shops were selected by purposive sampling
 Agencies were selected purposively to represent ethnic
communities, poverty and pensioner support groups
 All interview information was recorded on tape and also in
shorthand note form
 Each respondent was asked a short series of open questions (811 questions)
 Respondents representing consumers were asked
 What problems they or their group members had in
accessing grocery shops?
 How they felt these problems could best be tackled and
by whom?
 Their opinions of the local grocery retailing situation.
 Any changes they were aware of in recent years?
 Respondents representing the supply side (commercial property
agents or wholesalers) were asked
 What problems they perceived in the supply of
groceries?
 How such problems might be alleviated?
 How they felt the supply situation had changed in
recent times?
 Representatives of ‘third party’ bodies such as the police or
transport companies were asked
 How retailing affairs affected their organization?
 What changes they would like to see in the retailing
sector and why?
o Mapping the level of grocery retail provision
 Urban areas were divided into 250x250 meter squares, derived
from Ordnance Survey gridlines
 Squares were ranked as to whether they:
 Contained a shop selling ten or more kinds of fresh fruit
and vegetable
 Contained a grocery store but no shop selling ten or
more kinds of fresh fruit and vegetable
 Contained a residential area but no grocery shop
 Were non-residential
6. Baker, Schootman, Barnidge, Kelly 2006. The Role of Race and Poverty in
Access to Foods That Enable Individuals to Adhere to Dietary Guidelines.
Preventing Chronic Disease, Vol. 3 Issue 3, p1-11.
o Study area
 The city of St Louis, Mo, and the eastern part of St Louis
County, Missouri, the area between the Missouri River on the
east and Interstate 270 on the west
o Development of audit tools
 Supermarket audit tool
 Structured to determine the extent to which the
selection of foods available in each supermarket
enabled individuals to meet USDA recommendations
 The fruit and vegetable section of the audit tool was
created as a checklist that included each item identified
by the USDA’s Continuing Survey of Food Intakes by
Individuals (CSFII) as currently being consumed by
adults living in urban Midwestern cities
 The USDA’s Agriculture Handbook 8 was used to
develop the audit tool for assessing the availability of
lean, low-fat, and fat-free meat, poultry, and dairy
products
 Fast food restaurant audit tool
 The tool assessed the extent to which the menu options
at each fast food restaurant provided the opportunity for
individuals to meet the recommended dietary intake
based on the availability and preparation of the foods
 Audit tools were designed for each restaurant chain so
that all items included on the corporate menu that
would enable customers to meet one of the
recommended eating pattern was placed on a checklist
 Conducting audits
 Audits were conducted in person at all stores that were
identified by the 2000 business census as either
supermarkets or major-chain grocery stores
 Each store was audited by two research staff: one
observer and one recorder
 Using the 78-item fruits and vegetable checklist, the
auditor recorded whether each store carried that fruit or
vegetable and whether it was available fresh, frozen, or
canned
 A two-stage process was used to assess the selection of
options that met dietary intake recommendations at
local fast food restaurants
 The data were reviewed after 130 fast food restaurants
had been audited
o Statistical analysis
 Availability of healthy choices
 A composite score was created for each supermarket by
combining the observed number of different fruits and


vegetables available and lean, low-fat, and fat-free
meat, poultry, and dairy options
Using the composite score, z scores were calculated for
each supermarket based on the mean availability and
standard deviation of all items
Tertiles were created to indicate high, medium, or low
availability of fruits and vegetables and low-fat options
7. Hendrickson, Smith, Eikenberry 2006. Fruit and vegetable access in four lowincome food deserts communities in Minnesota. Agriculture and Human Values,
Vol. 23, p371-383.
o Population
 Urban and rural Minnesotans living in four communities with
limited grocery store access and with household incomes below
the state average
 Urban areas with 10 or fewer stores and no stores with more
than 20 employees were considered food deserts
 The number of stores in each neighborhood was determined by
creating a map using the store addresses entered into a
geographic information system software package displaying
the streets of Minneapolis, the neighborhood boundaries, and
the store locations
o Development of the food survey tool for grocery stores
 A survey was developed and used in all four communities
 The survey was prepared with a focus on determining whether
the residents of the selected areas were able to afford foods
needed to meet the daily nutritional recommendations set forth
by the government without substantially hampering household
finances
 All foods included in the survey were separated into the
following major categories:
 Fresh fruit
 Fresh vegetables
 Canned and frozen fruit and vegetables
 Fresh breads, cereals and other grain products
 Dry breads, cereals, and other grain products
 Fresh meat and meat alternatives
 Canned and frozen meat and meat alternatives
 Fats and oils
 Sugars and sweets
 Food items were selected based on their inclusion in the Thrifty
Food Plan (TFP)
 The most economical price for each food found in the store
was recorded on the survey

The average price per pound of selected foods was compared
against the TFP market basket prices per pound
 Each food was judged based on the unit of measure available,
quality, and price
 Brand names were recorded and served to signal whether or not
the food was available
o Consumer focus groups
 15 focus group (n=90) were conducted in the identified
communities according to standard procedures
 Nutrition professionals, community leaders and community
residents were included from the study communities
 Focus group questions were semi-structured, open=ended
questions with prompts
 Topics included
o Access to commercial food sources and food
assistance programs
o Healthy eating
o Food choice behavior
o Types and extent of community
o Food problems
o Community engagement in solving food
problems
 At the beginning of each focus group, participants were asked
to fill out a survey designed to capture information regarding
the quality and price range of foods found in the stores located
in their communities
 The stores within each community were listed on a form,
followed by five choices for quality of food (poor, fair, good,
very good, great), and price range of food ($$$$$)
 Participants were asked how they got to the store (drive, walk,
taxi, public van, bus, and delivery service)
o Development of consumer survey
 Themes from the focus group analysis were used to develop a
self-administered food choice and access survey
 The survey was pre-tested in all four communities for
readability; internal consistency was examined using Cronbach
alpha coefficients
 Data were collected using a 5-point Likert Scale with responses
described as “strongly agree,” “agree,” “unsure,” “disagree,”
and “strongly disagree.”
 12 questions on food availability and accessibility issues
 The answers to the questions were used in establishing the
participant’s knowledge of what constitutes a healthy meal and
ability to purchase healthy foods
 The responses of urban residents were compared to those of
rural residents to determine whether those of similar income

classes shared similar barriers to healthy eating and to examine
how the urban influence affected food choice
Survey questions (p. 375)
 Crime in my community makes it harder for me to get
food.
 Fresh fruits and vegetables are available in my
community.
 Canned fruits are available in my community.
 Transportation problems make eating healthy hard for
me.
 Cost makes healthy eating hard for me.
 I would eat more fruits and vegetables if they didn’t go
bad so often.
 People in my community never go hungry.
 There are enough food stores in my community.
 The cost of healthy eating is higher in my community
than other places.
 The food available to me in my community is safe to
eat.
 The healthy food choices in my community are
affordable.
 I do most of my food shopping within my community.
 I would eat healthier food if the community stores
offered more healthy options.
8. Guy, David 2004. Measuring physical access to ‘healthy foods’ in areas of social
deprivation: a case study in Cardiff. International Journal of Consumer Studies,
Vol. 28 Issue 3, p222-234.
o To investigate the availability of a sample of food items to residents to
the British cities, particularly those who find it difficult to travel to
superstores
o Focused on items which are considered essential components of a
healthy diet, using a checklist of 50 such items developed by Dowler
et al. in Sandwell, West Midlands (p. 230)
o Examined to what extent the small stores within the areas could
compete for price with larger multiple-owned stores in neighboring
areas
9. Morland, Wing, Roux, Poole 2002. Neighborhood Characteristics Associated with
the Location of Food Stores and Food Service Places. Am J Prev Med, Vol. 22
Issue 1, p23-29.
o Populations
 Neighborhoods in the following areas: Jackson City,
Mississippi; Forsyth County, North Carolina; Washington
County, Maryland; and selected suburbs of Minneapolis,
Minnesota.
o Measurement of the Local Food Environment
 Business and addresses of places where people can buy food
were collected from the local departments of environmental
health and state departments of agriculture
o Neighborhood Wealth and Racial Segregation
 The median value for homes in each census tract was used as a
measure of neighborhood wealth
 Used home values to measure neighborhood wealth, which is a
measurement of individual wealth
 Site-specific quintiles of wealth were averaged to create a
measure of relative wealth
o Statistical Analysis
 Poisson regressions were used to evaluate the relationship
between the number of stores (dependent variable) and
neighborhood wealth and racial composition (independent
variables)
 A linear term for population density (person/km2) was
included in separate models that focus on the effects of
neighborhood wealth and racial segregation
 Indicator variables for each Atherosclerosis Risk in
Communities location were used to adjust for geographic
difference
 All statistics were calculated using SAS GENMOD procedure
10. Alwitt, Donley 1997. Retail Stores in Poor Urban Neighborhoods. The Journal of
Consumer Affairs, Vol.31, No. 1 1997 pp.139-164.
o Population
 The poorest members of urban areas live in Chicago
neighborhoods with multiple problems (low income, low levels
of education, low participation in the labor force, and high
unemployment)
o Methods
 The distribution of all retail establishments, grocery stores,
apparel stores, drinking establishments, liquor stores, and drug
stores is analyzed with data derived from the Census of Retail
Trade
 The numbers of banks, discount stores, and restaurants in each
Chicago zip code area were derived from the Prophone 1995
CD-ROM telephone database
 Looked at the incidence of stores of different sizes in poor and
nonpoor zip code areas

Using data from the Census of Retail Trade for selected types
of stores, the number of employees was used as a surrogate to
identify stores of different sizes
11. Stephen J. Scanlan 2001. Food Availability and Access in Lesser-Industrialized
Societies: A Test and Interpretation of Neo-Malthusian and Technoecological
Theories. Sociological Forum, Vol. 16, No. 2 2001-06 pp. 231-262.
o Population
 Less-industrialized countries with a population of 1 million or
more in 1970
o The Dependent Variable: Food Security
 Examined the food availability and food access components of
food security
 Examined the level of per capita food availability with
countries as the unit of analysis
 Determinant of food security
 Dietary energy supply
 Food access
 Population growth
 Fertility
 Age dependency
 Agricultural density
 Population pressure
 Rural-urban disparity index
 Overurbanization
 Infrastructural development
 Fertilizer consumption
 Land use intensity
 Food import ratio
 Level of development
 Economic growth
12. Keller, Heather H. Food Security in Older Adults Community Service Provider
Perceptions of Their Roles. Canadian Journal on Aging / La Revue canadienne du
vieillissement.
o Population
 Focus groups were chosen as the mean of gathering data on
service providers’ opinions about and experiences of food
insecurity among their older adult clients
 The City of Hamilton was chosen for the study
 Low-income seniors are vulnerable, and their numbers
are increasing within the community

Community agencies servicing low-income seniors
were contacted. They were asked to seek participants
for the project among their staff and volunteers
 Focus-group dates were set in consultation with
providers
 During a 4-week period, four 1-hour long focus groups
were held over lunch at various locations around the
city
 Participants were representatives of seniors’ centers,
food banks, meal programs, and immigrant groups
o Focus-Group Procedure and Analysis
 The researchers used a previously tested semi-structured
interview guide that a focused on topics pertaining to food
insecurity (Brown & Raphael, 2002; Hayward & Rootman,
2001)
 Key questions included:
 How can services and programs support older adults atrisk for food insecurity?
 What additional services and programs are needed to
promote food security?
 What changes in policy are needed to promote food
security in older adults?
 What limits service providers’ ability to promote food
security in their older clients?
 Data analysis
 Each research team member systematically reviewed all
transcripts and inductively generated a list of codes
describing themes
 The team recognized that the health promotion
principles identified in the 1986 Ottawa Charter for
Health Promotion could be a template for organizing
themes specific to potential roles that participants might
take on to promote food security
o Advocate, enable, mediate, build healthy public
policy, create supportive environments,
strengthen community action, develop personal
skills, and reorient health services
13. Wrigley, Neil 2003. Deprivation, diet, and food-retail access: findings from the
Leeds 'food deserts' study. Environment & Planning A Jan2003, Vol. 35 Issue 1,
p151.
o The survey and its methodology
 Interviewer placed and collected
 Seven-day food-consumption diary


Supplemented by a wide-ranging interviewer-administered
household questionnaire exploring issues of:
 Household composition
 Welfare benefits and income
 Education and work status
 Disabilities and long-term health problems
 Smoking habits
 Attitudes to healthy eating
 Food-store choice
 Mode of travel to stores
 Car ownership or access
 Perceived constraints on choice of foods bough
The National Food Survey (NFS), the diary and questionnaire
were to be completed by the person primarily responsible for
the domestic food arrangements of the household
14. Clarke, Graham 2002. Deriving Indicators of Access to Food Retail Provision in
British Cities: Studies of Cardiff, Leeds and Bradford. Urban Studies Oct2002,
Vol. 39 Issue 11, p2041-2060.
o Modeling Methodology
 Spatial interaction models are formulated to quantify the
interaction that occurs between origins and destinations
(p.2042)
 the origins are residence zones (both postal sectors and
enumeration districts)
 the destinations are food retailers
 a proxy measure of net square feet of retail space is used,
supplemented by retail fascia
 average revenue per square foot for retailers is used to
determine retail quality
 Distance between origins and destinations is calculated as
straight-line distance modified by travel time where obvious
physical barriers to movement occur
o Performance Indicators
 Three types of indicator have been calculated an compared
 Simple provision indicators
o Retail grocery square feet per household
 Accessibility indicators
o Local mapping approach: to mapping
accessibility to food provision
o Hansen accessibility: to reflect the opportunities
for grocery retailing that are available at all
different localities and is related to the distance
and scale of provision of grocery retail services
 Model-based indicators

Measure the effectiveness of delivery of grocery
retailing to residential locations
o Aggregate level of provision
o The level of provision per household
o Examining Change
 Key question
 What can planners do to alleviate some of the problems
identified
15. Morton, Lois Wright 2005. Solving the Problems of Iowa Food Deserts: Food
Insecurity and Civic Structure. Rural Sociology Mar2005, Vol. 70 Issue 1, p94112.
o Population
 The number of grocery stores in each of Iowa’s 99 counties
was identified
o Study design
 To assess the food environment of rural places with limited
grocery stores
 Conducted focus groups with Iowa State University Extension
support
 Data from these focus groups were used to construct the mail
survey
 Addresses for each of the two study counties were purchased
and a random sample was drawn from each county
 Survey were mailed to the sample
 Data from the two counties are combined for analyses
 Food insecure/food secure is used as the dependent variable
 Four independent variables represent personal connections and
civic structure
 Age, income and education are used as control variables
 USDA Core Food Insecurity Variables (p. 103)
16. Rose, Donald 2006. Household Food Insecurity and Overweight Status in Young
School Children: Results From the Early Childhood Longitudinal Study.
Pediatrics Feb2006, Vol. 117 Issue 2, p464-473.
o Population
 Data for the analysis come from the ECLS-K, which is being
conducted by the Department of Education to provide
information on children’s status at entry into kindergarten and
on their progression through school on a number of educational
outcomes
o Overweight Status
 All measurement in the ECLS-K were conducted by field
teams that consisted of a supervisor and 3 assessors

For each child, height was measured twice by using a Shorr
measuring board, and weight was measured twice by using a
digital scale
 Values were averaged from the 2 measurements and used to
calculate BMI
 BMI-for-age percentiles were assigned to each child
o Food-Insecurity Status
 All 18 questions from the USDA Household Food Security
Scale were included in the ECLS-K wave 2 household
questionnaire
 On the basis of their answers to these questions, household
were classified into:
 Food secure
 Food insecure without hunger
 Food insecure with hunger
o Statistical Analysis
 Conducted bivariate analyses to test for association between
household food-security status and demographic
socioeconomic, and behavioral variables using the x2 statistic
and a significance level with a P value of <0.05.
 x2 statistics were used to test for differences in overweight
prevalence rates between children from food-insecure and
food-secure households
 Simple t tests were used to determine the differences in BMI
 Multivariate logistic regression was used to assess the
relationship between overweight and food-insecurity status
while controlling for potential demographic, socioeconomic,
and behavioral confounders
17. Peterman, Jerusha N. 2006. Individual Weight Change Is Associated with
Household Food Security Status. Journal of Nutrition May2006, Vol. 136 Issue 5,
p1395-1400.
o Sample and sampling frame
 Examined data from the 1999-2000 and 2001-2002, and
compared outcomes for women and men >18 years old by
household food security status
o Survey measures
 Household food security status was based on the NHANES
household food security category designation
 Food security questions referred to circumstances over the 12
months preceding the survey
 Current measured height and weight were obtained in
NHANES mobile examination centers
 Self-reported current and past weight were obtained from the
Weight History Questionnaire

Demographic information for gender, race/ethnicity, highest
education level, and income were obtained from the
Demographic Questionnaire
 Current health status was obtained from the Current Health
Status Questionnaire
o Cross-sectional comparisons
 Conducted bivariate cross-sectional comparisons by household
food security status and gender for measured BMI, percentage
overweight, percentage obese, and percentage underweight,
using CDC standards to define weight categories
o Changes in weight over time
 Compared change in self-reported weight over the past year by
household food security status and gender
 Checked the accuracy of self-reported weight
o Statistical analysis
 Using SAS procedures surveymeans, surveyreg, and
surveylogistic (Statistical Analysis system, Release 9.2 for
Windows, SAS Institute)
 All analyses were weighted using the NHANES mobile
examination center sampling weights
18. M. Weigel 2007. The Household Food Insecurity and Health Outcomes of U.S.Mexico Border Migrant and Seasonal Farmworkers. Journal of Immigrant &
Minority Health Jul2007, Vol. 9 Issue 3, p157-169.
o Population
 An estimated 12,000 MSFW and their households live and
work on the U.S. side of the border in the Paso del Norte, a
region located inside the Chihuahua Desert
o Household Sampling and Recruitment
 Migrant and seasonal farmworker households were recruited
from the two adjacent border counties of El Paso County,
Texas, and Dona Ana County, New Mexico
 A site-based convenience sampling strategy was used to
identify prospective study households.
 Prospective households were recruited from several different
organizations and agencies serving farmworkers and their
families in the region
o Data Collection
 A four-person bilingual, bicultural study team conducted the
household food security and health interviews and performed
the anthropometric, clinical, and laboratory examinations
 One adult respondent from each household took part in the
interviews

All of the subjects requested to be interviewed in Spanish.
Household food security status was evaluated with the 18-item
U.S. Food Security Survey (U.S. FSS)
 The U.S. FSS measures food insecurity and hunger caused by a
household’s inability to afford enough food and not that caused
by being too busy to eat or fasting for reasons such as weight
loss, religious purposes, health fasting, or illness
 The responses of the adult respondent from each household
were used to classify household food security status during the
previous 12 months into three major categories: food secure,
food insecure without hunger, and food insecure with hunger
 A modified (shortened) version of the main California
Agricultural Worker Health Survey (CAWHS) and its female
and male health supplements were used to collect data from
each household adult respondent.
 The first set of questions focused on the characteristics of adult
respondents and their respective households.
 household size, composition, age, birthplace, education,
current employment, ethnicity/race, place of permanent
residence, migration patterns, level of Spanish/English
proficiency, living conditions, and use of food
assistance, social services, and health care
 The second set of questions collected information on physical
conditions that affected household members during the
previous 12-month period
 The third set of questions asked whether any household
members had ever been medically diagnosed with diabetes,
hypertension, heart attack, stroke/embolism, cardiovascular and
cerebrovascular disease, cancer, asthma, allergies, tuberculosis,
hepatitis, arthritis, skin conditions, learning disabilities, or
neurological disorders
 The anthropometric evaluations performed on each household
adult respondent included body weight, height, and waist
circumference.
 A portable stadiometer was used to measure standing height
 The weight and height measurements were used to calculate
body mass index (BMI) defined as weight (kg)/height (m2)
 Waist circumference was used to identify adults with central
body adiposity
 Evaluations of infants aged ≤24 months were made using
established anthropometric measurement
 Blood pressure data were collected from adult subjects using a
calibrated manual mercury syphganometer obtained from the
right arm of seated subjects
o Data Analysis






The data were entered into an SPSS database (SPSS, Chicago,
IL; version 13.5)
Descriptive data are presented as means ± SD, frequency
counts, and percentages. Students’ t-test or Fisher’s exact test,
as appropriate were used in the initial bivariate analyses to
examine differences between means
Predictors of household food security status identified as
significant in the initial cross-tabulation analyses were
subsequently analyzed with multiple logistic regression.
Adjusted odds ratios and their 95% confidence intervals were
calculated from the multiple logistic regression analyses, taking
the influence of covariates into account
To facilitate calculation of odds ratios, household food security
status was dichotomized as: food secure versus food insecure
(with or without hunger) or hunger (food insecure with hunger)
versus no hunger (i.e., food secure or food insecure without
hunger)
Anthropometric, clinical, laboratory, and other categorical
health outcomes identified as having a statistically significant
association (P < 0.05) with food security status in the bivariate
analyses were subsequently analyzed with multiple logistic
regression, controlling for covariates
19. Rose-Jacobs, Ruth 2008. Household Food Insecurity: Associations With At-Risk
Infant and Toddler Development. Pediatrics Jan2008, Vol. 121 Issue 1, p65-72.
o Setting and Instruments
 The Children’s Sentinet Nutritional Assessment Program
conducted household-level surveys and medical chart audits at
5 central-city medical centers
 The sample was recruited from primary care clinics and
hospital emergency departments
 The Children’s Sentinel Nutritional Assessment Program
survey instrument includes questions regarding demographic
information
 Caregiver employment
 The child’s lifetime history of hospitalizations since
discharge from the newborn nursery
 Household food security questions
 A maternal depression screen
 The Parents’ Evaluations of Developmental Status
(PEDS)
 Household food security status was derived from the 18-item
US Food Security Scale
 Developmental risk was measured with the PEDS

Caregivers are asked to report any concerns about the child’s
development in 8 areas
 Expressive and receptive language
 Fine and gross motor
 Behavior
 Social/emotional
 Self-help
 School
 Caregivers are asked 2 open-ended questions about concerns in
the global/cognitive area and other concerns
 At the time of the caregiver interview, child weight and length
were recorded
 Weight-for-age z scores were calculated by using the US CDC
and prevention age- and gender-specific reference values
o Data Analyses
 Multivariate logistic analyses were used to evaluate food
insecurity as a predictor of developmental risk
 Child-related covariates were gender, age at time of interview,
weight-for-age z score, low birth weight, ever breastfed,
history of previous hospitalizations, and type of health
insurance
 Caregiver-related covariates were education, marital status,
employment status, positive depressive symptoms on the
screening instrument, country of birth, and geographic site of
interview
 Evaluated whether the threshold for the effect on
developmental risk occurred at the level of household food
insecurity without hunger
20. González W, Jiménez A, Madrigal G, Muñoz LM, Frongillo EA. 2008.
Development and validation of measure of household food insecurity in urban
Costa Rica confirms proposed generic questionnaire. J Nutr. Mar;138(3):587-92.
o Methods
 A questionnaire to measure food insecurity was developed
based on the first FANTA guide using both qualitative and
quantitative methods
 A sample of 49 mothers with children <15 y of age were
selected from 2 urban middle-low income communities in San
Diego and Concepcion de La Union de Tres Rios, in the
province of Cartago
 The questionnaire consisted of general open-ended questions
that allowed the interviewer to explore or detail issues that
arose during conversation
 A total of 14 close-ended questions were created with 3
possible ordinal answers: Never, sometimes and many times.



Evaluation on 4 basic needs:
 Access to an adequate household
 A healthy life
 Knowledge
 Other resources and services
The PLM and UBNM measure difference aspects of the
condition of poverty, an aggregation of the 2 methods, known
as the Integrated Poverty Classification
Pearson chi-square and ANOVA were used to test for
associations between household food insecurity status and
socioeconomic variables such as education, insurance
coverage, and income
21. Bhargava A, Jolliffe D, Howard LL. 2008. Socio-economic, behavioral and
environmental factors predicted body weights and household food insecurity
scores in the Early Childhood Longitudinal Study-Kindergarten. Br J Nutr.14:1-7.
o Subjects
 19684 children in kindergarten enrolled in 1277 schools and
their parents
o Socio-demographic and economic variables
 Children’s ethnicity, childcare arrangements, time spent
watching television, numbers of siblings and household
members, and physical exercise patterns were investigated
 Parents’ education, occupation, and physical and emotional
health were investigated
 Annual household incomes were assessed
 Measurement of physical exercise
o Anthropometric measures and households’ food insecurity scores
 Children’s heights and weights were measured in all survey
rounds
 A Shorr Board was used to measure height
 Children’s weight was measured using digital scales
 Households’ food insecurity levels in the previous 12 months
were investigated using an 18 item scale
 Food insecurity status was analyzed using the four categories:
food secure, food insecure without hunger, food insecure with
moderate hunger and food insecure with severe hunger
22. Gundersen C, Lohman BJ, Eisenmann JC, Garasky S, Stewart SD. 2008. Childspecific food insecurity and overweight are not associated in a sample of 10- to
15-year-old low-income youth. J Nutr.138(2):371-8.
o Sampling and data collection

A household-based stratified random sample survey with over
2400 low-income children and their mothers in low-income
neighborhoods in Boston, Chicago, and San Antonio
 In selected families with household incomes 200% or less than
the poverty line, interviewers randomly selected 1 focal child
per family and invited the focal child and his or her primary
female caregiver to participate
 In each family, focal children and mothers participated in
separate in-home interviews led by trained field investigators
o Measures
 Height and weight were measured by personnel in the child’s
home
 BMI was used to determine overweight and obesity based on
age- and sex-specific reference values
 3 questions about the child’s food insecurity status taken from
the 18-item CFSM used by the USDA in the calculation of
official food insecurity rates in the US
 “At any time in the past 12 months, did you cut the size
of any of [focal child’s name] meals because there
wasn’t enough money for food?”
 “At any time in the past 12 months, was [focal child’s
name] hungry but you just couldn’t afford more food?”
 “At any time in the past 12 months, did [focal child’s
name] skip a meal because there wasn’t enough money
for food?”
o Statistical analyses
 Descriptive statistics were calculated for the total sample by
normal weight/at-risk of overweight/overweight under the
CDC standards, by normal weight/at-risk of
overweight/overweight under the IOITF standards, and by food
insecure/food secure
 T tests for continuous variables and x2 tests for categorical
variables to test for significance within the various overweight
and food insecurity categories with respect to the variables of
interest
23. “Examining The Impact Of Food Deserts on Public Health in Chicago.” Mari
Gallagher Research & Consulting Group. 2006.
o Methodology and data development
 Analyze patterns by census tractm official City of Chicago
Community Areas, and by Zip Codes
 Objective:
 To compare food access and diet-related health
outcomes holding other influencers such as income,









education, and race constant to the degree possible
given time and resource constraints.
To calculate the average distance to a food venue, researchers
measured the distance between the geographic centers of each
block and the locations of each food venue in the Chicago
vicinity
The distance from the center of each block to each food venue
was calculated using the latitude and the longitude of each food
venue and of each block center
The minimum distance was calculated for each block
Developed a ratio score: the distance to any grocer divided by
the distance to any fast food venue
Food venue data consists of grocery stores and fast food
restaurants
Fast food venues were collected in one category and include
chain as well as smaller, independent outlets
Years of potential life lost (YPLL) was used to calculate for
cancer, cardiovascular disease, diabetes, and chronic liver
disease and cirrhosis, and for total diet-related diseases
Analyzed food access impact using grocer-to-fast-food distance
ratio scores through a regression analysis
Used regression analysis to compare food ratio scores and their
impact on YPLL and BMI outcomes, holding education,
income, and race constant
24. Apparicio, Cloutier, Shearmur 2007. The case of Montreal’s missing food deserts:
Evaluation of accessibility to food supermarkets. International Journal of Health
Geographics 6(4):1-13.
o Study area
 The study focuses on the Island of Montreal
o Supermarket data
 Addresses and affiliation were confirmed by telephoning the
stores
 167 supermarkets were retained for two reasons
 they represent a type of food retailer where the variety
of products is greater and the pricing more competitive
than in small grocery shops
 in Montreal, supermarkets represent approximately 24
% of food retail outlets but 80% of food sales
o Low income population data and social deprivation index
 Two variables were used at the census tract level
 Low income population
 A social deprivation index
 A social deprivation index was calculated based on five types
of populations that are usually associated with poverty in order
to characterized the distribution of social deprivation across the
Island of Montreal
 The index represents the sum of five variables collected at the
census tract level and standardized on a 0 to 1 scale
 The percentage of people with low incomes relative to
the total population
 The percentage of lone-parent families relative to the
total number of families
 The unemployment rate
 The percentage of individuals over the age of 20 with
no more than Grade 9 education
 The percentage of recent immigrants relative to the total
population
o Measuring accessibility to supermarkets
 The evaluation of accessibility to urban amenities has been
conducted using methodologies replying on defined
accessibility measures calculated within geographic
information systems
 3 different measures of accessibility
 distance to the closest supermarket: to evaluate
immediate proximity
 number of supermarkets within a walkable distance of
less than 1000 meters: to evaluate the diversity
provided by the immediate surroundings
 mean distance to three supermarkets belonging to
different companies: to evaluate access to variety in
terms of both products and prices
o Linking low income population, level of social deprivation and
accessibility to supermarkets
 3 different approaches are used to explore the link between
accessibility and a neighborhoods’ socioeconomic status
 calculation of population-weighted descriptive
accessibility statistics: to compare low income people’s
accessibility to supermarkets relative to the rest of the
population
 calculation of Pearson correlation coefficients to
explore the statistical significant of the link between
social deprivation and supermarket accessibility
 computation of a hierarchical cluster analysis to classify
and characterize census tracts in different groups of
CTs with similar levels of social deprivation and
accessibility
25. Whelan, Amanda 2002. Life in a 'Food Desert'. Urban Studies Oct2002, Vol. 39
Issue 11, p2083-2100.
o The Structure of the Focus Groups in the Seacroft Study
 A series of five focus groups with residents living in or around
the Seacroft/Whinmoor housing estates was conducted
 To examine the factors affecting food shopping and purchasing
patterns, the factors affecting food consumption patterns and
the issue of healthy eating for residents living in and around
what was viewed as a quinteseential ‘food desert’
 Focus group 1 and 2
 Comprised mothers with younger children
 These mothers were attending a ‘mother and toddler’
group and an exercise class respectively
 Aged 18-38 years
 Focus group 3
 Comprised mothers with older school-aged children
 They were selected from a GCSE examination class at
the local community college in Swarcliffe
 Aged between 26-40 years
 Focus group 4 and 5
 Comprised women over 65 years old with and without
mobility problems
 They lived alone
 All the focus groups were tape-recorded and transcribed
verbatim
 The group transcripts were analyzed using a descriptive
comparative approach
 The focus groups were asked
 What factors affected food shopping and purchasing
patterns in the pre-intervention period?
 What factors affected food consumption patterns in the
pre-intervention period?
 Was healthy eating an issue?
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Minority Health Jul2007, Vol. 9 Issue 3, p157-169.
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Infant and Toddler Development. Pediatrics Jan2008, Vol. 121 Issue 1, p65-72.
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Development and validation of measure of household food insecurity in urban
Costa Rica confirms proposed generic questionnaire. J Nutr. Mar;138(3):587-92.
21. Bhargava A, Jolliffe D, Howard LL. 2008. Socio-economic, behavioural and
environmental factors predicted body weights and household food insecurity
scores in the Early Childhood Longitudinal Study-Kindergarten. Br J Nutr.14:1-7.
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15-year-old low-income youth. J Nutr.138(2):371-8.
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Evaluation of accessibility to food supermarkets. International Journal of Health
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