Research has demonstrated the crucial role fresh fruit and vegetable consumption plays in maintaining good health. However, most Americans do not consume adequate amounts, and low-income Americans consume the lowest quantities of fresh fruits and vegetables. The Farmers’ Market Nutrition Program (FMNP) and Senior Farmers’ Market Nutrition Program (SFMNP) attempts to rectify this situation by providing vouchers to low-income women, children, and elders that can be used only at farmers’ markets for the purchase of locally grown, fresh fruits and vegetables. Unfortunately, FMNP and SFMNP exhibit variable and often low benefit utilization. This variable and often low benefit utilization is unique among all other federal food assistance programs. Given the importance of fresh fruit and vegetable consumption to health and the incomplete understanding of low-income food-related behaviors, this research endeavored to understand the unique benefit utilization patterns exhibited by FMNP. Utilizing the theoretical framework of Pierre Bourdieu, benefit utilization was conceptualized as an inherently social activity occurring within the field of food acquisition. Through the use of extensive interviews with FMNP and SFMNP officials, field observations, and secondary data analysis, data was collected to determine the relevant capitals and features of the field contributing to benefit utilization. Cultural capital was deemed to be particularly important to benefit utilization vis-à-vis the requirement to enter the subfield of the farmers’ market to redeem their vouchers. Compared to SFMNP participants, FMNP participants exhibited lower and often multiple deficits of the types of cultural capital needed to successfully use the vouchers at farmers’ markets. However, the local fields in which the farmers’ markets operated also had a significant impact on benefit utilization. For example, Appalachian counties exhibited higher rates of benefit utilization that were statistically significant compared to non-Appalachian counties. This resulted in several policy recommendations including the distribution of recipes, interagency collaboration, and repeated opportunities to enter the subfield of the farmers’ market to encourage higher benefit utilization in FMNP and SFMNP.

Food deserts are a growing problem in the United States, and occur in areas of low-income where people have limited access to healthy foods. In response, the presence of farmers’ markets has grown exponentially, and improved healthy food access. Additionally, the USDA has strived to connect families to healthy foods through food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Senior Farmers’ Market Nutrition Program (SFMNP). This study investigated the relationship between farmers’ markets, their acceptance of food assistance benefits, and their locations within Tennessee food deserts census tracts. Using the 2017 Farmers’ Market Directory, this study merged market data, including geocoded addresses, with the appropriate census tract data from the 2015 Food Access Research Atlas. Chi-square tests of independence and spatial visualizations were used to assess the relationship of census tracts, farmers markets, and food assistance benefits. Of the 1,497 Tennessee census tracts, 18.0% were food deserts. Of these food deserts, 9.3% had at least one market present. Of these food deserts, 92.0% were urban. Of 130 farmers’ markets in Tennessee, 34.6% accepted any food assistance benefits. Additionally, 56.9% of all markets were in areas of high socioeconomic status (SES). Results indicated that markets were clustered in urban areas, and few were identified as food deserts. Additionally, few markets were in food deserts and accepted any food assistance benefit. Due to these findings, the definition of food deserts should be expanded to include additional food retailers other than supermarkets. Also, additional policies and research is needed to reinforce farmers’ markets and food assistance programs as food access interventions.

Objective: To evaluate changes in shopping behaviors among low-income families over a one-month period of time in Utah County, Utah. Design: Two researchers conducted thirteen 90-minute focus groups. Setting: Two community organizations serving low-income populations and a university campus. Participants: Seventy-two low-income adults who were the primary household food shoppers and who had at least one child less than 18 years in their household. Main Outcome Measures: Shopping behavior changes during one month period of time. Analysis: Focus groups were recorded and transcribed, and then coded independently by two researchers with any differences reconciled. Paired t-tests were used to test differences of food expenditures by food group between the beginning and end-of-the-month shopping behaviors. Results: Shopping habits among low-income families changed throughout the month and were impacted by use of food assistance programs, food prices, and shopping logistics. Participants reported purchasing more varied foods at the beginning of the month versus more starch-based and canned foods at the end-of-the-month. To overcome economic barriers, participants used numerous strategies including weekly or monthly menu planning, price matching, and bulk buying. Conclusions and Implications: Low-income families make strategic decisions based on economic circumstances and other factors, including participation in food assistance programs, or the timing of the month, in order to stretch food expenditures. Our results suggest limited economics throughout the month may hinder families' ability to consume a varied, nutrient-rich diet, which may impact future health status.

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abstract: ABSTRACT Fruit and vegetable intake is not uniform across levels of socioeconomic status (SES) and researchers have identified low SES as a risk factor for poor intake of fruits and vegetables. In an effort to eliminate public health disparities and increase fruit and vegetable intake, the Women, Infant, and Children (WIC) program implemented additional food assistance programs, with a specific emphasis on fresh fruits and vegetables. The Farmers' Market Nutrition Program (FMNP) provides pre-existing WIC clients with coupons to purchase fresh, locally grown produce at farmers' markets. In addition, Congress also approved the WIC Cash Value Voucher (CVV) program, which provides WIC participants with vouchers to purchase fresh fruits and vegetables at farmers' markets or grocery stores. The purpose of this thesis was to investigate the relation of FMNP coupon use with accessibility and WIC CVV redemption rates at farmers' markets. Furthermore, this thesis addressed whether WIC shoppers redeemed a higher percentage of their WIC CVV value at farmers' markets or grocery stores. WIC CVV and FMNP issuance and redemption data were analyzed to establish overall redemption rates and total perecent of WIC CVV value redeemed. Accessibility was assessed using the Geographic Information System, which allowed me to calculate the distance that WIC participants would have to travel to redeem their FMNP coupons at FMNP-approved farmers' markets. The results showed that less than 1% of WIC shoppers redeem their WIC CVVs at farmers'markets in Arizona. However, the redemption of WIC CVV was significantly higher during the months when shoppers had the option of using both WIC CVV and FMNP coupons at farmers' markets. Furthermore, the percent of total CVV value redeemed at farmers' markets was 99%, significantly higher than grocery stores (93.5%). Average FMNP coupon redemption rates for 2008-2010 was 43.3%, well below the national average of 59%. However, my spatial analysis revealed that there was no significant association between the distance traveled to farmers' markets and FMNP redemption rates. This indicates that the distance traveled to farmers' markets is not a major barrier to redemption of FMNP coupons in Arizona. / Dissertation/Thesis / M.S. Nutrition 2012

<p>  </p> <p>Food insecurity describes the lack of access to foods and affects 10.2% of general U.S. households and 27% of low-income households in 2021. Food insecurity is a pervasive public health concern in the United States and has been linked to poor dietary intake and diet quality, overweight and obesity (especially among women), and risk of other chronic diseases, such as diabetes, hypertension and dyslipidemia. </p> <p>To better understand food security status and address its associated health and dietary outcomes among low-income populations, a conceptualized model was built and served as research framework for the dissertation, including 1) internal factors and motivations, such as traits related to self-efficacy and sufficiency that may influence diet and health; 2) external factors of temporary support, such as financial benefits from assistance programs that low-income populations are eligible for that may influence diet and health; and 3) external factors of potentially long-term support, such as nutrition education programs targeting low-income groups that may foster internalized knowledge that could sustain impact and improvement of diet and health in the long-term. Each chapter of this dissertation addresses a component of the model.</p> <p>Cross-sectional analysis of a sample of rural veterans using food pantries quantified psychological traits related to self-motivation and efficacy including grit and help seeking, at the individual and internal factors level of the conceptualized model, and their links to food security and resource use, and revealed an inverse association between grit score and risk of food insecurity. The findings provided evidence for future interventions targeting food insecurity improvement to include education and resources that address traits related to self-efficacy, such as grit, among low-income populations to improve health outcomes directly or through improving food security or use of resources. </p> <p>Using nationally representative data, the second study investigated relationships between food assistance through the Supplemental Nutrition Assistance Program (SNAP) participation, a type of societal level external support, and dietary outcomes among low-income older U.S. adults. There were no differences in dietary quality, usual nutrient intake or risk of inadequacy between SNAP participants and eligible nonparticipants. Furthermore, results revealed a high prevalence of not meeting the Estimated Average Requirement from dietary sources for several nutrients (vitamins A, C, D, E, calcium, and magnesium) but the prevalence was lower when nutrients from dietary supplements were included. The results highlight a need for continued effort to improve nutrient and dietary intake among low-income older adults.</p> <p>External factors of potentially long-term support (e.g. nutrition education and food assistance) were evaluated for relationships with body mass index. A longitudinal sample of low-income women interested in participating in nutrition education through SNAP-Education (SNAP-Ed) was examined to determine the relationship between nutrition education (SNAP-Ed) and food assistance program participation through (SNAP, WIC), separately and in combination, with long-term changes in body mass index. No differences in changes of weight status over time were observed by nutrition education, food assistance, or combination participation. The prevalence of obesity was high among this sample, calling for targeted obesity prevention interventions and further support of healthy lifestyle promotion among low-income populations. </p> <p>The findings shown in this dissertation further reveal a high health burden among low-income groups. The studies filled several research gaps described in the conceptualized model. The results may be used to inform future tailored interventions to address food insecurity, dietary and health outcomes at individual and societal levels, incorporating internal motivation and external support to mediate health and dietary risks among low-income population.</p>