title: A possible dose-response association between distance to farmers' markets and roadside produce stands, frequency of shopping, fruit and vegetable consumption, and body mass index among customers in the Southern United States.
abstract: The association between farmers' market characteristics and consumer shopping habits remains unclear. Our objective was to examine associations among distance to farmers' markets, amenities within farmers' markets, frequency of farmers' market shopping, fruit and vegetable consumption, and body mass index (BMI). We hypothesized that the relationship between frequency of farmers' market shopping and BMI would be mediated by fruit and vegetable consumption.
  
  
  
  In 15 farmers' markets in northeastern North Carolina, July-September 2015, we conducted a cross-sectional survey among 263 farmers' market customers (199 provided complete address data) and conducted farmers' market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent variables included farmers' market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for age, race, sex, and education, were used to examine associations between distance to farmers' markets, amenities within farmers' markets, frequency of farmers' market shopping, fruit and vegetable consumption, and BMI.
  
  
  
  Those who reported shopping at farmers' markets a few times per year or less reported consuming 4.4 (standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers' market amenities, and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of the relationship between frequency of shopping and BMI by fruit and vegetable consumption.
  
  
  
  More work should be done to understand factors within farmers' markets that encourage fruit and vegetable purchases.
authors.affiliation: Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC, 27834, USA. jilcotts@ecu.edu.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Jilcott Pitts
authors.affiliation: Healthy Foods Coordinator Partnerships to Improve Community Health, Albemarle Regional Health Services, Elizabeth City, NC, USA.
authors.forename: Jedediah
authors.initials: J
authors.lastname: Hinkley
authors.affiliation: Department of Biostatistics, East Carolina University, 2435D Health Sciences Building, Greenville, NC, 27834, USA.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
authors.forename: Jared T
authors.initials: JT
authors.lastname: McGuirt
authors.affiliation: Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC, 27834, USA.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Lyonnais
authors.affiliation: Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC, 27834, USA.
authors.forename: Ann P
authors.initials: AP
authors.lastname: Rafferty
authors.affiliation: Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC, 27834, USA.
authors.forename: Olivia R
authors.initials: OR
authors.lastname: Whitt
authors.affiliation: Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC, 27834, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Winterbauer
authors.affiliation: Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC, 27834, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Phillips
mesh_terms: D000383:Agriculture / Q000191:economics* / Q000706:statistics & numerical data; D015992:Body Mass Index; D003132:Commerce / Q000379:methods / Q000706:statistics & numerical data; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004032:Diet / Q000379:methods / Q000706:statistics & numerical data; D000067565:Farmers; D005260:Female; D005523:Food Supply / Q000379:methods / Q000706:statistics & numerical data*; D005638:Fruit; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D014675:Vegetables
keywords: Community nutrition; Consumer behavior; Farmers’ market; Fruit; Obesity; Vegetable