As the Crow Flies: An Underrepresentation of Food Deserts in the Rural Appalachian Mountains

99 Pages·2015·0.88 MB·English

by  Kasie Richards

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
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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
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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
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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.

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DEDICATION
To Cory: for his logic and levity.
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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.
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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 
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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 
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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 ................................................................................................ 63 
Food Access .......................................................................................................... 64 
Comprehensive Models ........................................................................................ 68 
Health Outcomes ................................................................................................... 71 
Obesity ...................................................................................................... 71 
Diabetes..................................................................................................... 74 
5. DISCUSSION ................................................................................................................... 77 
Summary ............................................................................................................... 77 
Reproducibility ..................................................................................................... 78 
Food Access .......................................................................................................... 78 
Food Outlets .............................................................................................. 78 
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Drive Time ................................................................................................ 80 
Defining Rural ...................................................................................................... 82 
Income Status ........................................................................................................ 83 
Study Limitations .................................................................................................. 83 
Future Studies ....................................................................................................... 85 
Contribution to Public Health ............................................................................... 86 
REFERENCES ............................................................................................................................. 87 
APPENDIX: IRB Exemption ....................................................................................................... 97 
VITA ............................................................................................................................................. 98 

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