- Grocery store availability. As the population density in urban and rural communities has decreased, large grocery stores have moved out. Often, only smaller stores are available to the community. These small corner grocery or convenience stores offer less variety of fresh foods and healthy items (Morland, 2002).
- Quality of healthy foods. Urban and rural grocery stores operate at a lower volume and higher cost than large supermarkets. As a result, there is a reduced availability of fresh fruits, vegetables, meats and dairy products. In addition, the prices for the fresher foods are often higher (Zenk, 2005).
- Access to nutrition education. Many nutrition concerns in rural America stem from the lack of proper education and available dietitians. In addition, schools may lack resources for adequate nutrition interventions (Tai-Seale, 2003).
- Socioeconomic status. The socioeconomic status of individuals living in urban and rural communities might explain differences in healthy food intake (Drewnowski, 2004).The per capita income in rural areas is lower than in urban and suburban areas. Also, individuals living in these areas are more likely to live under the poverty level. For minorities, the disparity in income is even greater (NRHA, 2005).
- Higher fat intake. Studies show that rural residents have a higher fat and calorie intake than others (Tai-Seale, 2003).
- Sedentary lifestyles. Rural youth may spend more time watching television than their urban peers. This leads to an increase in snacking, increased desire for highly advertised foods, and less time participating in calorie-expending activities (Tai-Seale, 2003).
Strategies to address these considerations
- Improve availability of affordable, healthy food choices. Work with local community- and faith-based organizations, businesses, and governmental leaders to increase the healthy options available at existing markets and restaurants (Zenk, 2005). Some communities have offered grants, loans, and tax benefits to stimulate the development of neighborhood groceries, farmers’ markets, community gardens, and farm-to-cafeteria programs (IOM, 2005). A larger supermarket will carry more fresh items at lower prices (Zenk, 2005).
- Improve access to healthy food choices. Creating a network that includes community groups, local government, nonprofit organizations, local farmers and food processors can help expand accessibility (IOM, 2005). It may be useful to work with city officials, urban planners, transportation departments, and faith-based organizations to develop city- or county-wide strategies related to land use planning and transportation so as to provide equal access to healthy food choices (Yancey, 2004).
- Improve access to nutrition information. It may be useful to work with registered dietitians, school and worksite personnel, and community-based organizations and community members to ensure that the messages, content, format and placement of educational materials are appropriate for the population of interest. It may also be useful to work with healthcare providers in rural and urban settings to enhance their ability to convey appropriate nutritional counseling (Tai-Seale, 2003).
- Use established settings. Strategies should maximize participation in the nutrition education intervention by having meetings or events at convenient locations and times (Bank-Wallace, 2002). It may be useful to schedule intervention activities with other church or community social events.
- Convenient dissemination of nutrition information. Correspondence or web-based courses may prove useful in overcoming barriers to meeting places and times in rural areas (Tai-Seale, 2003).
- Increase usage of supplemental food and nutrition information programs. Helping individuals get to the right place at the right time, and with necessary information, to enroll or participate in food and nutrition assistance programs can increase usage of food assistance programs (Strasser, 1991). Case management has also been suggested as a mechanism to help individuals overcome barriers and increase use of food assistance programs (Heslin, 2003).
- School/Worksite Environment. Many successful interventions have focused on making more healthy choices available in schools and worksites as well as incorporating nutrition education and time for physical activity (Tai-Seale, 2003).
- Involve the priority populations. It is important that individuals who are from the community of interest take an active role in planning, implementing and evaluating interventions (Bank-Wallace, 2002).
- Engage community stakeholders. Leadership and active participation by community members, especially health care providers and community and religious leaders, can strengthen the credibility of and respect for the intervention (Bank-Wallace, 2002).
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