Spatial and Psychosocial Influences on Food Access in Rural Appalachia

描述（由申请人提供）：肥胖是美国的一个主要公共卫生问题。阿巴拉契亚农村居民，特别是那些生活在经济落后县的居民，受到肥胖和相关医疗条件的不成比例的影响。包括个人、家庭、朋友、社区和政策在内的多个不利因素之间的复杂相互作用，促成了可能导致肥胖的不健康饮食行为。社区食物环境是指在一个社区内获取和接触食物的途径。获得健康或不健康食品的可能性取决于提供不同食品选择的食品店的空间供应情况。实现的获取，或个人对现有食物的利用，最终取决于个人、社会和经济因素。然而，很少有研究从农村居民的角度考察影响他们获得食物的地点及其食物选择的机会和障碍。这项横断面混合方法研究对弗吉尼亚州阿巴拉契亚县农村地区约20名低收入妇女进行了研究，将定性访谈、参与者观察、地理信息系统（GIS）测绘和店内食物评估结合起来，以检查影响食物获取的空间和社会心理因素。研究的问题是：阿巴拉契亚低收入农村居民的食物获取和食物选择受到哪些影响？本研究的具体目的是：1)描述社区零售食品环境（潜在的食品获取途径），包括门店距离、食品供应、定价和营销；2)描述食物获取行为（实现的食物获取）；3)探索社会心理、经济、文化和环境对实现食物获取的影响。公共卫生护士注重人口层面的干预措施，以解决健康问题。这项研究通过增进对与弱势群体慢性疾病预防有关的复杂社会和行为模式的理解，以及通过应用地理信息系统技术加强社区健康评估，支持国家减灾研究所的战略目标。这项研究的结果将为未来的食物选择分析研究提供信息，并将促进合作，跨专业干预，以改善营养和减少肥胖。

DESCRIPTION (provided by applicant): Obesity is a major public health problem in the United States (U.S.). Rural Appalachian residents, especially those living in economically disadvantaged counties, are disproportionately affected by obesity and associated medical conditions. Complex interactions among multiple levels of disadvantage, including individual, family, friends, community, and policy, contribute to unhealthy dietary behaviors that can lead to obesity. Community food environment refers to access and exposure to foods in a community. Potential access to healthy or unhealthy foods depends on spatial availability of food outlets offering different food choices. Realized access, or individual utilization of available foods, ultimately depends on personal, social, and economic factors. However, few studies have examined, from the point of view of rural residents, the opportunities and barriers that influence where they access food and their food choices. This cross-sectional mixed methods study of approximately 20 lower-income women in a rural Appalachian county in Virginia will integrate qualitative interviews, participant observation, geographic information systems (GIS) mapping, and in- store food assessments to examine spatial and psychosocial factors that affect access to food. The research question is: What are some influences on food access and food choices in low-income rural Appalachian residents? The specific aims of this study are to: 1) Describe the community retail food environment (potential food access), including store proximity, food availability, pricing, and marketing; 2) Describe food access behaviors (realized food access); and 3) Explore psychosocial, economic, cultural, and environmental influences on realized food access. Public health nurses focus on population-level interventions to address health problems. This study supports NINR strategic objectives by improving understanding of complex social and behavioral patterns that relate to prevention of chronic disease in a disadvantaged population, and by applying GIS technology to enhance a community health assessment. The results of this study will inform future analytic studies of food choice and will promote collaborative, inter-professional interventions to improve nutrition and reduce obesity.