of the population was nonwhite. The authors note, however, that only 51 percent of survey respondents reported usually purchasing milk within their residential zip code.

Cheadle and colleagues (1991) conducted a similar study using a survey of healthful food choices in different grocery store environments to assess the relationship between individual dietary choices and the grocery store environment. They carried out a telephone survey in 12 different communities, including the corresponding larger zip code area, to obtain self-reported dietary intake data on low-fat and high-fiber foods, as well as the availability of health information in the community stores. They found a significant correlation between the availability of healthful foods in the community and zip code area stores and the self-reported healthfulness of participants’ diets. In a review of cross-sectional studies on associations between food environment and consumption, Rose and colleagues (2010) identified a number of studies that combined in-store measures with mapping of store location and found significant direct associations between neighborhood food environment and measures of consumption.

These studies are important because they suggest a link between purchasing power and access to food. A general conclusion that can be drawn from this work is that although associated with income, access to food outlets and healthy foods needs to be considered in the context of how certain factors within the food environment affect the cost of healthier food options. Overall, the evidence suggests that limited access to healthy food may influence food shopping and spending behavior by reducing choices.

Farm-to-consumer venues Farm-to-consumer venues show promise in improving dietary intake among all people in the United States, including low-income groups (Blanck et al., 2011). However there are few such venues, especially in low-income communities (FNS, 2011). In addition, many farmers’ markets do not accept SNAP. Although USDA figures indicate that the number of farmers’ markets accepting SNAP has increased by 16 percent since 2010, more needs to be done to increase the number of these venues authorized as retailers by the program (FNS, 2011). The lack of awareness of farm-to-consumer venues, the lack of farmers’ markets and farm stands close to home, the lack of transportation to these venues, inconvenient hours, and affordability concerns are additional barriers to use of farm-to-consumer venues among those receiving federal food assistance (Briggs et al., 2010).

Disparities in Access and Geographic Proximity to Food Outlets

According to a 2009 USDA report, 23.5 million people lack access to a supermarket within a mile of their home (Ver Ploeg et al., 2009). Limited



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