title: Understanding the rural food environment--perspectives of low-income parents.
abstract: BACKGROUND
  Childhood obesity rates appear to be more pronounced among youth in rural areas of the USA. The availability of retail food outlets in rural communities that sell quality, affordable, nutritious foods may be an important factor for encouraging rural families to select a healthy diet and potentially reduce obesity rates. Researchers use the term 'food desert' to describe communities where access to healthy and affordable food is limited. Understanding the ways in which the food environment and food deserts impact childhood obesity may be a key component to designing interventions that increase the availability of healthy and affordable foods, thus improving the health of rural communities.
  
  
  METHODS
  The food environment was investigated in 6 rural low-income Maine communities to assess how food environments affect eating behaviors and obesity rates of rural children enrolled in Medicaid/State Children's Health Insurance Program in Maine ('MaineCare'). Focus groups were conducted with low-income parents of children enrolled in MaineCare to ask them about their food shopping habits, barriers faced when trying to obtain food, where they get their food, and what they perceive as healthy food.
  
  
  RESULTS
  Cost, travel distance, and food quality were all factors that emerged as influential in rural low-income family's efforts to get food. Parents described patterns of thoughtful and creative shopping habits that involve coupons and sales. Grocery shopping is often supplemented with food that is harvested, hunted, and bartered. The use of large freezers for storing bulk items was reported as necessary for survival in 'tough' times. Families often travel up to 128.8 km (80 miles) to purchase good quality, affordable food, recognizing that in rural communities travelling these distances is a reality of rural life. Parents appeared to know what qualities describe 'healthy food'.
  
  
  CONCLUSIONS
  Rural families may have greater flexibility and opportunity to be methodical in their food shopping than urban families since many have access to cars and large freezers. This creates a buffer around these rural communities that might otherwise be considered food deserts. Although the meaning of food desert may be different in rural areas than in urban, it does not negate the fact that low-income rural families are struggling. The combination of challenges that rural low-income families face call for more rigorous study to identify promising interventions for increasing food access and quality in these communities. Participants have developed creative skills for getting food on the table and they know what healthy food is. Despite having acquired this knowledge and these skills, rural families are struggling. With these struggles in mind, policy-makers should consider the shopping patterns reported in this study when thinking about how to help rural residents better access affordable, healthy and quality foods. Customary approaches to remedying the problem of food deserts in urban areas, such as building more grocery stores, may not be necessary in rural areas. More creative approaches for food-access policy changes, subsidies and incentives are needed to match the complex and multi-faceted strategies that low-income residents utilize to feed their families.
authors.affiliation: Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Maine, USA. ayousefian@usm.maine.edu
authors.forename: Anush
authors.initials: A
authors.lastname: Yousefian
authors.forename: Al
authors.initials: A
authors.lastname: Leighton
authors.forename: Kimberly
authors.initials: K
authors.lastname: Fox
authors.forename: David
authors.initials: D
authors.lastname: Hartley
mesh_terms: D004032:Diet; D005247:Feeding Behavior; D005260:Female; D017144:Focus Groups; D005523:Food Supply; D006801:Humans; D008281:Maine; D008297:Male; D008484:Medicaid; D009765:Obesity / Q000517:prevention & control; D011203:Poverty; D012424:Rural Population; D014481:United States