Skip to main content Accessibility help

Neighbourhood and consumer food environment is associated with dietary intake among Supplemental Nutrition Assistance Program (SNAP) participants in Fayette County, Kentucky

  • Alison Gustafson (a1), Sarah Lewis (a1), Sarah Perkins (a1), Corey Wilson (a1), Elizabeth Buckner (a2) and Ann Vail (a3)...



The aim of the study was to determine the association between dietary outcomes and the neighbourhood food environment (street network distance from home to stores) and consumer food environment (Nutrition Environment Measurement Survey-Stores (NEMS-S) audit).


The neighbourhood food environment was captured by creating 0·5-mile and 1-mile network distance (street distance) around each participant's home and the nearest food venue (convenience store, grocery store, supermarket, farmers' market and produce stand). The consumer food environment was captured by conducting NEMS-S in all grocery stores/supermarkets within 0·5 and 1 mile of participants’ homes.


Fayette County, KY, USA.


Supplemental Nutrition Assessment Program (SNAP) participants, n 147.


SNAP participants who lived within 0·5 mile of at least one farmers’ market/produce stand had higher odds of consuming one serving or more of vegetables (OR = 6·92; 95 % CI 4·09, 11·69), five servings or more of grains (OR = 1·76; 95 % CI 1·01, 3·05) and one serving or more of milk (OR = 3·79; 95 % CI 2·14, 6·71) on a daily basis. SNAP participants who lived within 0·5 mile of stores receiving a high score on the NEMS-S audit reported higher odds of consuming at least one serving of vegetables daily (OR = 3·07; 95 % CI 1·78, 5·31).


Taken together, both the neighbourhood food environment and the consumer food environment are associated with a healthy dietary intake among SNAP participants.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Neighbourhood and consumer food environment is associated with dietary intake among Supplemental Nutrition Assistance Program (SNAP) participants in Fayette County, Kentucky
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Neighbourhood and consumer food environment is associated with dietary intake among Supplemental Nutrition Assistance Program (SNAP) participants in Fayette County, Kentucky
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Neighbourhood and consumer food environment is associated with dietary intake among Supplemental Nutrition Assistance Program (SNAP) participants in Fayette County, Kentucky
      Available formats


Corresponding author

*Corresponding author: Email


Hide All
1.Mokdad, AH, Ford, ES, Bowman, BAet al. (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289, 7679.
2.Middaugh, AL, Fisk, PS, Brunt, Aet al. (2012) Few associations between income and fruit and vegetable consumption. J Nutr Educ Behav 44, 196203.
3.Kaufman, P, MacDonald, J, Lutz, Set al. (1997) Do the Poor Pay More for Food? Item Selection and Price Differences Affect Low-Income Household Food Costs. Washington, DC: Food and Rural Economics Division, Economic Research Service, US Department of Agriculture.
4.Debono, NL, Ross, NA & Berrang-Ford, L (2012) Does the Food Stamp Program cause obesity? A realist review and a call for place-based research. Health Place 18, 747756.
5.US Department of Agriculture (2011) Program Data. Supplemental Nutrition Assistance Program. Annual State Level Data. (accessed January 2013).
6.Dinour, LM, Bergen, D & Yeh, MC (2007) The food insecurity–obesity paradox: a review of the literature and the role food stamps may play. J Am Diet Assoc 107, 19521961.
7.Dietz, WH, Franks, AL & Marks, JS (1998) The obesity problem. N Engl J Med 338, 1157.
8.Fox, MK, Hamilton, WL & Lin, B-H (2004) Effects of Food Assistance and Nutrition Programs on Health. Executive Summary of the Literature Review. Washington, DC: US Department of Agriculture, Economic Research Service.
9.Townsend, MS, Peerson, J, Love, Bet al. (2001) Food insecurity is positively related to overweight in women. J Nutr 131, 17381745.
10.Leung, CW & Villamor, E (2011) Is participation in food and income assistance programmes associated with obesity in California adults? Results from a state-wide survey. Public Health Nutr 14, 645652.
11.Jilcott, SB, Liu, H, Dubose, KDet al. (2011) Food stamp participation is associated with fewer meals away from home, yet higher body mass index and waist circumference in a nationally representative sample. J Nutr Educ Behav 43, 110115.
12.Webb, AL, Schiff, A, Currivan, Det al. (2008) Food Stamp Program participation but not food insecurity is associated with higher adult BMI in Massachusetts residents living in low-income neighbourhoods. Public Health Nutr 11, 12481255.
13.Ver Ploeg, M, Mancino, L, Lin, BHet al. (2007) The vanishing weight gap: trends in obesity among adult food stamp participants (US) (1976–2002). Econ Hum Biol 5, 2036.
14.Rose, D & Richards, R (2004) Food store access and household fruit and vegetable use among participants in the US Food Stamp Program. Public Health Nutr 7, 10811088.
15.Ford, PB & Dzewaltowski, DA (2011) Neighborhood deprivation, supermarket availability, and BMI in low-income women: a multilevel analysis. J Community Health 36, 785796.
16.Han, E, Powell, LM & Isgor, Z (2012) Supplemental nutrition assistance program and body weight outcomes: the role of economic contextual factors. Soc Sci Med 74, 18741881.
17.Jilcott, SB, Moore, JB, Wall-Bassett, EDet al. (2011) Association between travel times and food procurement practices among female supplemental nutrition assistance program participants in eastern North Carolina. J Nutr Educ Behav 43, 385389.
18.Morland, K & Filomena, S (2007) Disparities in the availability of fruits and vegetables between racially segregated urban neighbourhoods. Public Health Nutr 10, 14811489.
19.Bodor, JN, Rice, JC, Farley, TAet al. (2010) The association between obesity and urban food environments. J Urban Health 87, 771781.
20.Schulz, AJ, Zenk, SN, Israel, BAet al. (2008) Do neighborhood economic characteristics, racial composition, and residential stability predict perceptions of stress associated with the physical and social environment? Findings from a multilevel analysis in Detroit. J Urban Health 85, 642661.
21.Izumi, BT, Zenk, SN, Schulz, AJet al. (2011) Associations between neighborhood availability and individual consumption of dark-green and orange vegetables among ethnically diverse adults in Detroit. J Am Diet Assoc 111, 274279.
22.Zenk, SN, Lachance, LL, Schulz, AJet al. (2009) Neighborhood retail food environment and fruit and vegetable intake in a multiethnic urban population. Am J Health Promot 23, 255264.
23.Gustafson, A, Hankins, S & Jilcott, S (2012) Measures of the consumer food store environment: a systematic review of the evidence 2000–2011. J Community Health 37, 897911.
24.McKinnon, RA, Reedy, J, Morrissette, MAet al. (2009) Measures of the food environment: a compilation of the literature, 1990–2007. Am J Prev Med 36, 4 Suppl., S124S133.
25.Caspi, CE, Sorensen, G, Subramanian, SVet al. (2012) The local food environment and diet: a systematic review. Health Place 18, 11721187.
26.Thornton, LE, Crawford, DA & Ball, K (2010) Neighbourhood-socioeconomic variation in women's diet: the role of nutrition environments. Eur J Clin Nutr 64, 14231432.
27.Lucan, SC, Barg, FK & Long, JA (2010) Promoters and barriers to fruit, vegetable, and fast-food consumption among urban, low-income African Americans – a qualitative approach. Am J Public Health 100, 631635.
28.Pearce, J, Blakely, T, Witten, Ket al. (2007) Neighborhood deprivation and access to fast-food retailing: a national study. Am J Prev Med 32, 375382.
29.Fleischhacker, SE, Evenson, KR, Rodriguez, DAet al. (2011) A systematic review of fast food access studies. Obes Rev 12, e460e471.
30.Boone-Heinonen, J, Gordon-Larsen, P, Kiefe, CIet al. (2011) Fast food restaurants and food stores: longitudinal associations with diet in young to middle-aged adults: the CARDIA Study. Arch Intern Med 171, 11621170.
31.Block, JP, Christakis, NA, O'Malley, AJet al. (2011) Proximity to food establishments and body mass index in the Framingham Heart Study offspring cohort over 30 years. Am J Epidemiol 174, 11081114.
32.Story, M, Kaphingst, KM, Robinson-O'Brien, Ret al. (2008) Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 29, 253272.
33.Buttenheim, AM, Havassy, J, Fang, Met al. (2012) Increasing supplemental nutrition assistance program/electronic benefits transfer sales at farmers’ markets with vendor-operated wireless point-of-sale terminals. J Acad Nutr Diet 112, 636641.
34.McCormack, LA, Laska, MN, Larson, NIet al. (2010) Review of the nutritional implications of farmers’ markets and community gardens: a call for evaluation and research efforts. J Am Diet Assoc 110, 399408.
35.Glanz, K, Sallis, JF, Saelens, BEet al. (2005) Healthy nutrition environments: concepts and measures. Am J Health Promot 19, 330333, ii.
36.Gustafson, AA, Sharkey, J, Samuel-Hodge, CDet al. (2011) Perceived and objective measures of the food store environment and the association with weight and diet among low-income women in North Carolina. Public Health Nutr 14, 10321038.
37.Franco, M, Diez-Roux, AV, Nettleton, JAet al. (2009) Availability of healthy foods and dietary patterns: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr 89, 897904.
38.Hutchinson, PL, Nicholas Bodor, J, Swalm, CMet al. (2012) Neighbourhood food environments and obesity in southeast Louisiana. Health Place 18, 854860.
39.US Department of Commerce (2010) United States Census Bureau. (accessed January 2012).
40.Thornton, LE, Pearce, JR & Kavanagh, AM (2011) Using Geographic Information Systems (GIS) to assess the role of the built environment in influencing obesity: a glossary. Int J Behav Nutr Phys Act 8, 71.
41.US Department of Agriculture (2012) Building a Healthy America: A Profile of the Supplemental Nutrition Assistance Program. (accessed April 2012).
42.Broda, C, Leibtag, E & Weinsten, D (2009) The role of prices in measuring the poor's living standards. J Econ Perspect 23, 7797.
43.Glanz, K, Sallis, JF, Saelens, BEet al. (2007) Nutrition Environment Measures Survey in stores (NEMS-S): development and evaluation. Am J Prev Med 32, 282289.
44.Andreyeva, T, Blumenthal, DM, Schwartz, MBet al. (2008) Availability and prices of foods across stores and neighborhoods: the case of New Haven, Connecticut. Health Aff (Millwood) 27, 13811388.
45.Piernas, C & Popkin, BM (2011) Food portion patterns and trends among US children and the relationship to total eating occasion size, 1977–2006. J Nutr 141, 11591164.
46.Rose, D, Hutchinson, PL, Bodor, JNet al. (2009) Neighborhood food environments and body mass index: the importance of in-store contents. Am J Prev Med 37, 214219.
47.Creel, JS, Sharkey, JR, McIntosh, Aet al. (2008) Availability of healthier options in traditional and nontraditional rural fast-food outlets. BMC Public Health 8, 395.
48.Babey, SDA, Hastert, T, Harvey, Set al. (2008) Designed for Disease: The Link Between Local Food Environments and Obesity and Diabetes. Los Angeles, CA: California Center for Public Health Advocacy, PolicyLink and UCLA Center for Health Policy Research.
49.Kennedy, ET, Ohls, J, Carlson, Set al. (1995) The Healthy Eating Index: design and applications. J Am Diet Assoc 95, 11031108.
50.Morland, K, Wing, S & Diez Roux, A (2002) The contextual effect of the local food environment on residents’ diets: the atherosclerosis risk in communities study. Am J Public Health 92, 17611767.
51.Sharkey, JR, Johnson, CM, Dean, WRet al. (2011) Association between proximity to and coverage of traditional fast-food restaurants and non-traditional fast-food outlets and fast-food consumption among rural adults. Int J Health Geogr 10, 37.
52.Bertmann, FM, Ohri-Vachaspati, P, Buman, MPet al. (2012) Implementation of wireless terminals at farmers’ markets: impact on SNAP redemption and overall sales. Am J Public Health 102, e53e55.
53.Kropf, ML, Holben, DH, Holcomb, JP al. (2007) Food security status and produce intake and behaviors of Special Supplemental Nutrition Program for Women, Infants, and Children and Farmers’ Market Nutrition Program participants. J Am Diet Assoc 107, 19031908.
54.Evans, AE, Jennings, R, Smiley, AWet al. (2012) Introduction of farm stands in low-income communities increases fruit and vegetable among community residents. Health Place 18, 11371143.
55.Laska, MN, Hearst, MO, Forsyth, Aet al. (2010) Neighbourhood food environments: are they associated with adolescent dietary intake, food purchases and weight status? Public Health Nutr 13, 17571763.
56.Jilcott, SB, Wade, S, McGuirt, JTet al. (2011) The association between the food environment and weight status among eastern North Carolina youth. Public Health Nutr 14, 16101617.
57.Zick, CD, Smith, KR, Fan, JXet al. (2009) Running to the store? The relationship between neighborhood environments and the risk of obesity. Soc Sci Med 69, 14931500.
58.Shier, V, An, R & Sturm, R (2012) Is there a robust relationship between neighbourhood food environment and childhood obesity in the USA? Public Health 126, 723730.
59.Glanz, K, Bader, MD & Iyer, S (2012) Retail grocery store marketing strategies and obesity: an integrative review. Am J Prev Med 42, 503512.
60.Ohri-Vachaspati, P, Leviton, L, Bors, Pet al. (2012) Strategies proposed by healthy kids, healthy communities partnerships to prevent childhood obesity. Prev Chronic Dis 9, E11.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed