Medical Student Vanderbilt University School of Medicine Nashville, Tennessee, United States
Background: Differential access to healthy foods among low-income and minority populations has a crucial role in numerous health disparities, including higher rates of childhood obesity and resulting comorbidities. Research exploring the associations between food access and health outcomes has primarily relied on public datasets that cannot adequately account for grocery-store level factors. Objective: Our goal was to conduct in-person assessments of grocery stores in Nashville’s low-income, Latino communities to better characterize the food-built environment. Design/Methods: We performed audits on 31 Nashville grocery stores selected based on closest proximity to the addresses of 102 Latino families enrolled in a randomized trial for obesity prevention. The Nutrition Environment Measures Survey (NEMS) was used to collect availability, price, and quality data for healthier and unhealthier items in 11 categories that compose a typical American diet. Availability scoring entails presence and number of alternatives of healthier options (possible distribution 0 to 30), price scoring entails price comparison for healthier versus unhealthier options (possible distribution –9 to 18), and quality scoring for produce entails calculating the percent graded acceptable (possible distribution 0 to 6). The NEMS total score sums these domains, with a distribution from –9 to 54. For each score, a higher value represents a healthier domain. Results: NEMS scoring of the 31 grocery stores produced an average total score of 33.9 (SD 7.8), with a range from 14 to 43. The average availability score was 23.5, (SD 6.8), and the average price score was 4.4 (SD 3.5). All stores scored 6 for the quality domain. Based on observed patterns, the highest total NEMS scores were distributed throughout all assessed regions. Descriptively, smaller ethnic grocery stores had lower total scores, driven by lower availability. Price appeared to vary across store sizes and locations with no obvious pattern.
Conclusion(s): Despite the relatively close proximity of grocery stores with high NEMS scores for most of the participants in this sample, variability in the price scores suggests that policies encouraging stores to lower the price of healthier food options could increase the accessibility of a healthy food environment, especially for low-income families.
