Cutler Institute for Health and Social Policy

Population Health and Health Policy

How Does The Rural Food Environment Affect Rural Childhood Obesity?

Abstract: 

This article by Muskie School researchers assesses the impact of the rural food environment on the eating behaviors and BMI of rural low-income children, using a statewide (Maine, 2009) household survey of parents of children on Medicaid, oversampled in six rural communities, resulting in n=272 for six target communities. The food environment was measured using modified Nutrition Environment Measures Survey in Stores (NEMS-S) for 46 retail food outlets. Multi-variate analysis assessed factors affecting home food environment, child's eating behavior and BMI. <br></br><b>Results:</b> Home food behaviors (how often: family eats together, child eats breakfast, vegetables served) and parent food consumption were significantly associated with children's healthy eating behaviors. The only significant predictor of childhood obesity was parent eating behavior. We observed several alternative strategies such as hunting, gathering and buying from local farmers. Parents who drove over 20 miles to shop were found to shop at stores with higher NEMS scores as compared to parents who drove shorter distances.<br></br><b>Conclusion:</b> Defining and identifying "food deserts" is not a promising approach to measuring the rural food environment due to long distance trips, careful price shopping, and local, alternative strategies. Strategies to place healthier food in the home should be combined with interventions directed at parents' and families' eating behaviors.

Publication Type: 
Journal Article
Publish Date: 
December 31, 2011

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Dr. Ziller to speak on Rural Implementation and Impact of Medicaid Expansions

The impact of the ACA Medicaid expansion on health care coverage and access in rural areas is largely unknown and will depend on the different state policy contexts in which the expansions are implemented and on existing system capacity. Understanding how many rural residents are likely to become newly eligible for Medicaid under the ACA, as well as their characteristics and health status, will provide important information to aid policymakers in structuring outreach and enrollment strategies and ensuring that the healthcare infrastructure and delivery systems in rural areas can address the needs of these individuals.

On March 18th, Dr. Ziller, Deputy Director of the Maine Rural Health Research Center at the University of Southern Maine, will present via a SHARE webinar, nationally representative information identifying rural-urban differences among low-income non-elderly adults (18 to 65) in the following areas:

  • Medicaid eligibility, pre-ACA
  • Medicaid participation, pre-ACA
  • New Medicaid eligibility in 2014

Dr. Ziller will also analyze the characteristics associated with any rural-urban differences in the above areas. Characteristics to be considered include age, gender, employment, education, income, Census region, health status, current relationship to primary care provider, primary care supply, and FQHC availability.

This webinar is based on Dr. Ziller's research under a State Health Access Reform Evaluation (SHARE) grant to inform federal and state implementation of the ACA Medicaid expansion by estimating the size and characteristics of the rural population likely to be newly eligible.
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