factor. The following discussion focuses on other barriers to access to healthy foods.

Urban or rural locale In a survey of the availability of fruits and vegetables in urban and rural areas of upstate New York, Hosler and colleagues (2008) identified one urban minority neighborhood among those surveyed that, in this respect, was the most disadvantaged site within an urban locale, as measured by the population density of stores selling these products. This community was found to be lacking not in the number of food stores but in an accessible high-impact super produce store. By contrast, such stores were available in a higher-income urban mixed neighborhood in the same locale, illustrating that disparity in access to fresh produce was associated with a single disadvantaged area within a larger locale.

A recent example of associations between access to healthy food and consumption is a cross-sectional community survey, conducted in 2002-2003, which was used as a data source for analyzing associations between neighborhood availability and consumption of dark green and orange vegetables in an ethnically diverse low- to moderate-income population in Detroit (Izumi et al., 2011). Data derived from the survey included the frequency of consumption of these vegetables and their availability in all food stores in the communities studied. The mean intake of dark green and orange vegetables among all participants was found to be 0.61 servings per day. The lowest intake was among participants living in neighborhoods where no store carried five or more varieties of such vegetables; residents in those neighborhoods consumed 0.17 fewer servings per day than those in neighborhoods where at least two stores provided more variety. The results of this study suggest a direct relationship between the availability of vegetables and consumption patterns within a locale.

Fisher and Strogatz (1999) conducted a telephone survey to (1) determine whether there is an association between the availability and consumption of low-fat milk, and (2) assess whether the availability of low-fat milk is associated with household income and racial composition. The study was carried out in three different geographic settings in New York: large metropolitan, midsize urban, and rural. Household interviews were conducted in each setting to determine the type of milk consumed. In each store surveyed within a corresponding zip code, containers of whole, 2 percent, 1 percent, and skim milk were counted for each container size (quart, half gallon, and gallon). The percentage of low-fat milk in the store and the average percentage across all stores in a zip code were then determined. A direct correlation was found among the percentage of low-fat milk in stores, consumption of low-fat milk in the household, and income level by zip code. In particular, low-fat milk tended to be less common in the stores located in rural or low-income areas and areas in which the majority



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