You Can’t Find Healthy Food in the Bush: Poor Accessibility, Availability and Adequacy of Food in Rural Australia
Abstract
1. Introduction
2. Methods
2.1. Design
2.2. Context
2.3. Selection of Retail Food Outlets
2.4. Selection of Food Environment Measurement Tools
2.5. Nutrition Environment Measures Survey for Stores (NEMS-S)
2.6. Nutrition Environment Measures Survey for Restaurants (NEMS-R)
2.7. Data Collection
2.8. Data Analysis
3. Results
3.1. Food Stores
3.2. Food Service Outlets
4. Discussion
4.1. Food Stores
4.2. Food Service Outlets
4.3. NEMS Tools for a Rural Australian Context
4.4. Strengths
4.5. Limitations
5. Conclusions
6. Recommendations
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Core Food Group (AGHE ref) | Total N = 11 | Super-Markets N = 5 | General Stores N = 6 |
---|---|---|---|
Availability of healthier breakfast cereal > 2 varieties | 9 | 5 | 4 |
n (%) cost healthy cereal < unhealthy | 5 | 3 | 2 |
Whole grain bread availability | 10 | 5 | 5 |
>2 varieties whole wheat bread | 8 | 5 | 3 |
Price same for both | 7 | 4 | 3 |
Price higher for whole wheat | 3 | 1 | 2 |
DAIRY OR ALTERNATIVES | |||
Low-fat/skim milk available | 11 | 5 | 6 |
Price Higher for low-fat/skim milk | 11 | 5 | 6 |
Low-fat cheese available | 3 | 3 | 0 |
Price Same for both | 2 | 2 | 0 |
Price Higher for low-fat | 1 | 1 | |
Low fat Yoghurt availability | 3 | 3 | 0 |
Price Lower for lowest-fat | 1 | 1 | 0 |
Price Same for both | 1 | 1 | 0 |
Price Higher for low-fat | 1 | 1 | |
FRESH FRUIT AVAILABILITY—NUMBER OF VARIETIES | |||
<5 varieties | 1 | 1 | |
5–9 varieties | 3 | 3 | |
10 varieties | 7 | 5 | 2 |
FRESH VEGETABLES AVAILABILITY—NUMBER OF VARIETIES | |||
5–9 varieties | 2 | 0 | 2 |
10 varieties | 9 | 5 | 4 |
MEAT OR MEAT ALTERNATIVES | |||
Low-fat mince availability (beef or turkey) | 2 | 2 | 0 |
Higher price for lean meat | 1 | 1 | |
Chicken availability—skinless breast | 5 | 4 | 1 |
Price Higher for skinless | 3 | 3 | |
Legumes available (could also be classified as vegetables) | 10 | 5 | 5 |
Eggs available | 10 | 5 | 5 |
DISCRETIONARY FOODS | |||
Healthier snack alternatives to chips (e.g., Grain Waves) (Baked alternative to fried potato crisps) | 4 | 4 | 0 |
Chips- Price- (Fried potato crisps) | |||
Price Lower for Grain Waves than Smiths Chips | 0 | 0 | 0 |
Price Higher for Grain Waves than Smiths Chips | 4 | 4 | |
Healthier dry biscuits available (e.g., water crackers) | 11 | 5 | 6 |
Price Lower for water crackers than BBQ shapes (Savoury crackers) | 10 | 5 | 5 |
Diet soft drinks available | 10 | 5 | 5 |
Same price for both | 10 | 5 | 5 |
100% Juice Availability- | 9 | 5 | 4 |
Lower for 100% juice (2 L) | 1 | 1 | |
Same for both | 1 | 1 | |
Higher for 100% juice (2 L) | 4 | 2 | 2 |
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Food Stores | Food Service |
---|---|
Supermarket—sells food products and other items, large scale, may open for extended hours on most days of the week. (Register numbers: 1 to 5) | Restaurants Sit-down—order and pay at table, table service, food eaten at outlet e.g.,: traditional restaurants |
General—sells food products and other items, small scale, typically in a small town. General stores generally have reduced hours and usually are not open on weekends. | Fast-casual—order and pay at counter, may have table service, food eaten at outlet or taken away e.g.,: hotels (pubs) and cafés |
Convenience stores (North American)—extended hours, stocking a limited range of household goods and groceries. | Fast-food—order, pay and served food at counter, quick service, food usually eaten away from outlet e.g.,: take-aways and bakeries |
All Food Stores (n = 11) | Supermarkets (n = 5) | General Stores (n = 6) | p | |||||
---|---|---|---|---|---|---|---|---|
Max | Mean | SD | Mean | SD | Mean | SD | ||
Availability | 30 | 16.3 | 5.7 | 21.4 | 3.0 | 12.0 | 3.0 | p < 0.05 |
Price | 18 | 1.1 | 1.0 | 1.2 | 1.1 | 1.0 | 1.1 | NS * |
Quality | 6 | 4.6 | 2.1 | 5.4 | 1.3 | 4.0 | 2.5 | NS * |
Total Score | 54 | 21.0 | 4.6 | 24.8 | 2.6 | 17.8 | 3.2 | p < 0.05 |
Food Stores (n = 11) | North (n = 3) | Central (n = 5) | South (n = 3) | ||||
---|---|---|---|---|---|---|---|
Max | Mean | SD | Mean | SD | Mean | SD | |
Availability | 30 | 14.0 | 5.2 | 19.0 | 8.7 | 17.3 | 2.5 |
Price | 18 | 1.2 | 1.1 | 1.3 | 1.2 | 0.7 | 1.2 |
Quality | 6 | 4.8 | 1.6 | 6.0 | 0.0 | 3.0 | 3.0 |
Total Score | 54 | 20.0 | 4.4 | 24.0 | 4.6 | 19.7 | 5.1 |
Food Service | Number of Outlets | NEMS-R SCORE | % of Max NEMS-R SCORE (−5 to 23) | |
---|---|---|---|---|
N | Mean | SD | % | |
Fast Casual: Hotels/pubs/restaurant | 13 | 1.8 | 1.6 | 7.8 |
Fast Casual: Café | 7 | 7.0 | 5.6 | 30.0 |
Fast Food: Take-aways | 5 | 2.0 | 2.9 | 8.7 |
Fast Food: Bakeries | 2 | 4.0 | 0.7 | 17.4 |
Total | 27 | 3.0 | 4.0 | 13.0 |
Comparison | 1 | 10.0 | 0.0 | 43.0 |
Score Range | NORTH | CENTRAL | SOUTH | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Number of outlets | 27 | 9 | 13 | 5 | ||||||
MEAN | SD | % * | MEAN | SD | % | MEAN | SD | % | ||
NEMS-R score | −8–32 | 2.0 | 1.0 | 6% | 4.0 | 5.0 | 12% | 3.0 | 3.0 | 9% |
Type of Outlet | Total | Hotels/Pubs/Restaurant * | Cafes | Fast Food | Bakeries | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Outlets (n (%)) | 27 (100) | 13 (48.1) | 7 (25.9) | 5 (18.5) | 2 (7.4) | ||||||
NEMS-R items | Possible Score (A score closer to the maximum possible score indicates a healthier food environment.) | M | SD | M | SD | M | SD | M | SD | M | SD |
Availability of healthy choices | 0–15 | 2.8 | 2.5 | 1.4 | 1.4 | 5.3 | 3.1 | 2.6 | 1.5 | 3.5 | 0.7 |
Facilitators of healthy eating | 0–8 | 0.4 | 1.4 | 0.2 | 0.4 | 1.1 | 2.6 | −1.0 | 1.4 | 0.0 | 0.0 |
Barriers to healthy eating | −5–0 | −0.3 | 0.8 | 0.0 | 0.0 | −0.3 | 0.8 | −1.0 | 1.4 | 0.0 | 0.0 |
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Whelan, J.; Millar, L.; Bell, C.; Russell, C.; Grainger, F.; Allender, S.; Love, P. You Can’t Find Healthy Food in the Bush: Poor Accessibility, Availability and Adequacy of Food in Rural Australia. Int. J. Environ. Res. Public Health 2018, 15, 2316. https://doi.org/10.3390/ijerph15102316
Whelan J, Millar L, Bell C, Russell C, Grainger F, Allender S, Love P. You Can’t Find Healthy Food in the Bush: Poor Accessibility, Availability and Adequacy of Food in Rural Australia. International Journal of Environmental Research and Public Health. 2018; 15(10):2316. https://doi.org/10.3390/ijerph15102316
Chicago/Turabian StyleWhelan, Jill, Lynne Millar, Colin Bell, Cherie Russell, Felicity Grainger, Steven Allender, and Penelope Love. 2018. "You Can’t Find Healthy Food in the Bush: Poor Accessibility, Availability and Adequacy of Food in Rural Australia" International Journal of Environmental Research and Public Health 15, no. 10: 2316. https://doi.org/10.3390/ijerph15102316
APA StyleWhelan, J., Millar, L., Bell, C., Russell, C., Grainger, F., Allender, S., & Love, P. (2018). You Can’t Find Healthy Food in the Bush: Poor Accessibility, Availability and Adequacy of Food in Rural Australia. International Journal of Environmental Research and Public Health, 15(10), 2316. https://doi.org/10.3390/ijerph15102316