All ETDs from UAB

Advisory Committee Chair

Olivia Affuso

Advisory Committee Members

Ermanno Affuso

Monica Baskin

Emily Levitan

Bisakha Sen

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Disparities in the neighborhood retail food environment have been hypothesized to be associated with poor diet quality and adverse health outcomes such as obesity. Studies have found that lower income communities often have reduced access to affordable healthy foods. In 2009, the Centers for Disease Control and Prevention proposed direct farm-to-consumer (FTC) retail outlets (i.e. farmers markets, farm/roadside stands, community gardens and community supported agriculture programs) as a potential strategy to alleviate retail food environment disparities in communities with limited resources. Information on the behavioral and health implications of FTC outlet usage by lower income individuals is limited. This research project aimed to examine FTC retail outlet usage among women who participate in the WIC program in Birmingham, AL. A cross-sectional study design was used to address the following specific aims: Specific Aim 1: Assess associations between residential proximity to FTC retail outlets and usage among WIC recipients. Specific Aim 2: Identify the perceived barriers and facilitators of FTC retail outlet use among WIC recipients. Specific Aim 3: Examine associations between FTC outlet usage, fruit and vegetable consumption and obesity status among WIC recipients. Between October 2014 and January 2015, study participants were recruited from the WIC program office at The Jefferson County Department of Health Central Health Center in Birmingham, AL. Eligible women were Alabama residents, ≥ 19 years old and had received WIC program vouchers in the prior 3 months. After enrollment, participants provided study staff a current residential address and completed the Block Fruit-Vegetable-Fiber Screener and The Survey of Farm-to-Consumer Outlet Use and Produce Shopping Behaviors in Birmingham, AL. Data were entered into a secure Microsoft Access database and analyzed with ArcGIS version 10.2 and SAS version 9.3. Approval for this study was obtained from the Institutional Review Board at UAB and the Alabama Department of Health. Results from this project will provide researchers, policy makers and key stakeholders further insight to the potential FTC retail outlets possess to be a viable strategy to address outcomes associated with healthy food access disparities.

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