Older Adults FV Intake & FM shopping
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AN ASSOCIATION BETWEEN OLDER ADULTS’ FRUIT & VEGETABLE INTAKE AND
FARMERS’ MARKET SHOPPINGPresenter: Gilliam Tsao (SHU-FENG TSAO)
Date: November 1st , 2016Advisor: Dr. Bastin
Committee members: Dr. Brewer, Dr. Stephenson
Thesis Defense
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Agenda■Literature review■Study
Introduction■Methodology■Result■Discussion■Conclusion
Adapted from Lexington Farmers Market, 2016
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LITERATURE REVIEW
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What is a farmers’ market?■A place where local farmers gather on a recurring basis to sell fresh fruits, vegetables, and other farm products directly to consumers (Farmers Market Coalition, 2016).
Adapted from Lexington Farmers’ Markets (2014), and CityTalk (2012).
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Numbers of farmers’ markets in the US increased over 300% in past two decades.■1,755 in 1994 →
8,476 in 2015 (USDA, 2015).
■Reflect increasing demand for:– local food
products– Better freshness
& quality– support for the
local economy(Martinez et al, 2015)
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Farmers’ Markets and Fruit & Vegetable Intake
■Inverse association between low intake of fruits and vegetables and high risks for chronic diseases and obesity (Boeing et al., 2012).
■Lacking affordable sources of fresh produce may contribute to poor nutrition, especially in low-income populations.
■CDC and the USDA recommend increasing access to farmers’ markets (Cole et al, 2013).– Cost effective
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Farmers’ markets and SNAP
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Other common programs intervened at farmers’ markets
WIC SFMNP
Adapted from the Greensboro Farmers Curb Market, Community Partnership on Aging, and Washington State Department of Health, 2016.
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Local/statewide nutrition assistance programs
Other states■ North Carolina: the Community
Transformation Grant Project (GTC-Project)
■ New York City: The Health Buck initiative
■ Utah: “Double-Up Food Bucks”……and so on.
Lexington, Kentucky■ SNAP in a “Double Dollars” way
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Public health & nutrition
professionals consider farmers’ markets an ideal platform to reach many people and
encourage them to consume fruits &
vegetables.Adapted from Urban Gardens, 2016.
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Perceived barriers to buying at farmers’ markets
45%
38.8%
36.9%
21.9%
Adapted from Wade K. et al (2015).
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Taiwan
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Farmers’ Markets in Taipei City
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STUDY INTRODUCTION
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Recommendations for consumption of fruits & vegetables USA Taiwan
Latest Guideline
The 2015-2020 Dietary Guidelines for Americans
2012 Daily Dietary Guidelines
Fruits “Fill half of your plate with fruits & vegetables.”
3-5 servingsVegetables 2-4 servings
Adapted from USDA, and Nutrition Foundation of Taiwan.
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Background in Kentucky■Fruit & vegetable consumption remains low in KY (CDC, 2013).– 45.9% and 25.2% reported consuming fruits & vegetables,
respectively, less than once a day.– Median intakes of fruits and vegetables in Kentucky were
1.0 and 1.7 times per day, respectively.■ Findings from Perkins’s thesis (2013) and Jilcott Pitts et al
(2014):– Consumption of fruits & vegetables was positively
associated with use of farmers’ markets among Kentucky customers.
– Some barriers hindered shoppers’ utilization of farmers’ markets.• “Out of way” and “market days and hours”
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Background of farmers’ markets in Taiwan
■Not a strategy to facilitate consumption of fruits & vegetables.– Marketing channels for small farmers, especially organic
farmers, benefiting from directly selling their products to customers (Lin and Wang, 2014).
■Difficulties developing farmers’ markets (Huang, 2014).■Seniors aged 65+ had 3.2 to 3.5 servings of
vegetables and 1.5 servings of fruit daily in the 2005-2008 NAHSIT (Wu et al, 2011).
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Gaps■Although evidence has shown a positive association
between increased FV consumption and regular shopping frequency at farmers’ markets,– Limited studies specifically target older adults aged
55+• Consumption of fruits & vegetables?• Their perception regarding their health and diet?• Any association between the FV intake and farmers’ markets?
– No known studies in Taiwan investigated farmers’ markets from a nutritional or health standpoint.
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Research Objectives1.Determine the general characteristics of farmers’ markets shoppers and their perceptions regarding the markets in both locations.
2.Compare the amount of fruit and vegetable consumption and shopping behaviors between older and younger shoppers.
3. Identify common barriers that affect Kentucky residents shopping at farmers’ markets in Lexington, Kentucky.
4.Compare similarities and differences in three farmers’ markets in Lexington, Kentucky and three farmers’ markets in Taipei City, Taiwan.
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METHODOLOGY
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Study design
■A descriptive, cross-sectional study.■Time: June to August, 2015.■Questionnaire: A “customer intercept survey” was
adapted from Perkins’s thesis (2014).– English version for Lexington, KY– Chinese version for Taipei City, Taiwan
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Survey locations
Lexington, KY■241 West Main Street
(downtown) on Saturday■348 Southland Street on
Sunday■400 West Maxwell Street on
Tuesday & Thursday
Taipei City, TW■248 Farmers’ Market on
Friday & Saturday■Water Garden Organic
Farmers' Market on Saturday■Taipei Expo Farmers’ Market
on Saturday & Sunday
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Study population
■Inclusion criteria:• Local residents who were at least 18 years of age in both
places.• Males & females shopping at farmers’ markets & willing to
take survey• Able to read & write English in Lexington, KY• Able to read & write Chinese in Taiwan City, TW
■Exclusion criteria:• Children and adolescents• Unable to read & write English or Chinese
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Statistical analysis
■For descriptive analyses:– Percentage, mean ± standard deviation (SD)
■For the comparison of fruit & vegetable consumption between older and younger adults:– t-test
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RESULTSLexington,
KY
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Demographics
% % %Overall Age < 55 yrs Age 55 yrs≧
70 7368
29 2632
1 2 0
Gender
Female Male Transgender
Overall Age < 55 yrs
Age 55 ≧yrs
% % %
6 6 8
86 85 88
8 9 4
Race/Ethnicity
African American White Others
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Overall Age < 55 yrs Age 55 yrs≧ % % %
1 1 0
86
11
2018
23
3538
31
36 37 36
Education Level
< high school High school graduate Some collegeCollege graduate postgraduate
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Shopping behaviors
> once a week Once a week 2~3 times a month Once a month <1 time a month
11
35
28
13 13
7
36
24
151817
33 33
107
Frequency of FM shopping
Overall % Age < 55 yrs % Age 55 yrs %≧
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Shopping alone Shopping with family and/or
friend
Shopping with pet Shopping with pet and family and/or
friend
Others
38
56
0.955
0.05
27
65
0.5
7
0.5
51
44
14
0
Shopping companies
Overall % Age < 55 yrs % Age 55 yrs %≧
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More expensive About the same Less expensive
41
50
9
35
54
11
4846
6
Perceived Price
Overall % Age < 55 yrs % Age 55 yrs %≧
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Older vs Younger Adults
Lexington, Kentucky Age
< 55 yrs ≧ 55 yrs χ2 p
Overall health Good Very good 10.345 .035
Overall diet Good Very good 23.748 <.0001
Shopping companiesShopping with friends
or familyShopping alone 18.908 .0008
Food price perception About the same More expensive 6.637 .0362
Shopping frequency Once a weekOnce a week or
2-3 times a month20.105 .0005
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Consumption of Fruits & Vegetables
Lexington, Kentucky Age
< 55 yrs ≧ 55 yrs t df
Fruit servings consumed/day2.40
(0.09)
2.43
(0.10)0.21 306
Vegetable servings consumed/day2.85
(0.08)
2.79
(0.10)-0.48 306
Dollars spent at farmers’ markets***22.48
(0.79)
19.54
(0.91)-2.45* 294
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Unexpected Outcomes from Lexington
■Majority of respondents did not experience any barrier related to visiting farmers’ markets.• Perhaps due to more available and accessible farmers’
markets in summer.■Percentage of the SNAP participants that redeemed
their benefits at farmers’ markets: only 2%.
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RESULTSTaipei City,
TW
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Demographics
% % %Overall Age < 55 yrs Age 55 yrs≧
80 7987.5
20 2112.5
Gender
Female Male
Elementar
y sch
ool
Junior high
school g
raduate
Senior h
igh sc
hool grad
uate
College
grad
uate
postgrad
uate
1 110
64
24
0 08
68
24
2.5 5.5
2939
24
Education Level
Overall % Age < 55 yrs % Age 55 yrs %≧
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Shopping Behaviors
Drive a ca
r
Share a ride
Bus
Subway
Bus + Subway
WalkingBiking
Ride a motorcy
cleOther
19
68
31
9
14
24
7
198 8
33
1012
24 4
22
12 1210
29
52
53
Transportation
Overall % Age < 55 yrs % Age 55 yrs %≧
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> once a week Once a week 2~3 times a month
Once a month <once a month
4
14
2422
37
2
13
22 22
40
10
20
38
20
13
Frequency of FM shopping
Overall % Age < 55 yrs % Age 55 yrs %≧
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Shopping alone Shopping with family and/or
friend
Shopping with pet Shopping with pet and family and/or
friend
Others
35
58
2 3 2
32
61
2 3 2
63
32
2 0 2
Shopping Companies
Overall % Age < 55 yrs % Age 55 yrs %≧
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More expensive About the same Less expensive
75
23
2
77
21
2
63
32
5
Perceived Price
Overall % Age < 55 yrs % Age 55 yrs %≧
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Older vs Younger Adults
Taipei City, Taiwan Age
< 55 yrs ≧ 55 yrs χ2 p
Overall health Good & Very good Very good 14.504 .0058
Overall diet Good Very good 22.504 .0002
Shopping companiesShopping with friends
or familyShopping alone 16.904 .0020
Food price perception More expensive More expensive 4.007 .1349
Shopping frequency < once a month 2-3 times a month 18.197 .0011
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Consumption of Fruits & Vegetables
Taipei City, Taiwan Age
< 55 yrs ≧ 55 yrs t df
Fruit servings consumed/day2.23
(0.06)
2.59
(0.15)2.23* 335
Vegetable servings consumed/day2.48
(0.06)
2.73
(0.15)1.60 335
Dollars spent at farmers’ markets***15.40
(0.62)
22.25
(1.71)3.77** 303
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Similarities
Both studied regions Age
< 55 yrs ≧ 55 yrs
Overall health Good Very good
Overall diet Good Very good
Shopping companiesShopping with friends
or familyShopping alone
Food price perception More expensive
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Differences Location Lexington, KY Taipei City, TW
Age < 55 yrs ≧ 55 yrs < 55 yrs ≧ 55 yrs
Food price perception About the same More expensive More expensive
Shopping frequency Once a week < once a month
Fruit servings
consumed/day2.31 to 2.49* 2.33 to 2.53 2.17 to 2.29* 2.44 to 2.74
Vegetable servings
consumed/day2.77 to 2.93* 2.69 to 2.89 2.42 to 2.54* 2.58 to 2.88
Dollars spent at farmers’
markets21.69 to 23.27* 18.63 to 20.45⸸ 14.78 to 16.02* 20.54 to 23.96⸸
* p<0.05 in age < 55 years ⸸ p<0.05 in age ≥ 55
years
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Limitations
■Cross-sectional design■A convenient sampling method■Association, not causation■Non-response bias■Limited number of older
participants■Limited generalization
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Implications
■Inadequate consumption of fruits & vegetables, regardless of age, health consideration, and country.
■Low SNAP redemption■Farmers’ markets in Taiwan are probably not suitable
for encouraging fruit and vegetable consumption
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Recommendations for Future Studies
■what causes a gap between the attendance of farmers’ markets and the consumption of fruits and vegetables?
■Why the redemption of SNAP benefits remains extremely low at farmers’ markets in Lexington, Kentucky?
■Include more farmers’ markets across various regions and more participants aged 55 and over.
■in Taiwan, what motivates older adults spending more money than their younger peers at farmers’ markets?
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Q & A
Thank you for your listening
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References■ Wade K. et al (2015). Would Consumers Purchase a Wider Variety of Produce and Products at West Virginia Farmers' Markets if They Were Available? Journal of Extension, 53(3), 3RIB6. Available at https://joe.org/joe/2015june/rb6.php
■ Bluegrass Farm to Table (2015). Available at http://www.bgfarmtotable.org/double-dollars/■ Boeing, H., Bechthold, A., Bub, A., Ellinger, S., Haller, D., Kroke, A. … Watzel, B. (2012). Critical review: vegetables
and fruits in the prevention of chronic diseases. Eur J Nutr, 51, 637-663. doi:10.1007/s00394-012-0380-y.■ Bowling, A.B., Moretti, M., Ringelheim, K., Tran, A., & Davison, K. (2016). Health Foods, Healthy Families: combining
incentives and exposure interventions at urban farmers’ markets to improve nutrition among recipients of US federal food assistance. Health Promot Persepct, 6(1), 10-16. doi:10.1517/hpp.2016.02
■ Byker, C.J., Misyak, S., Shanks, J., & Serrano, E.L. (2013). Do farmers’ markets improve diet of participants using federal nutrition assistance programs? A literature review. Journal of Extension, 51(6), 6FEA5
■ Cole, K., McNees, M., Kinney, K., Fisher, K., & Krieger, J.W. (2013). Increasing access to farmers’ markets for beneficiaries of nutrition assistance: evaluation of the farmers’ market access project. Prev Chronic Dis, 10, 130121. doi:10.5888/pcd10.130121
■ Colby, S.L. & Ortman, J.M. (2015). Projections of the size and composition of the U.S. population: 2014 to 2060. Population Reports, pp.25-1143, United States Census Bureau. Available at https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf
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■ Freedman, D.A., Vaudrin, N., Scheider, C., Trapl, E., Ohri-Vachaaspati, P., Taggart, M. … Flocke, S. (2016). Systematic review of factors influencing farmers’ market use overall and among low-income populations. J Acad Nutr Diet, 16, S2212-2672. doi: 10.1016/j.jand.2016.02.010
■ Hsu, P.T., Liao, P.H., Chu, W., Yang, S.Y., & Chen, I.J. (2014). Exploration and forecasting of behaviours and factors relating to fruit and vegetable intake among seniors in the community. Public Health Nutrition, 18(6), 1052-1059. doi:10.1015/S1368980014001232
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■ Huang, W.J. (2014). Current conditions and challenges of the development of Taiwan’s farmers’ market. Journal of Taichung District Agricultural Research and Extension Station, 122, 287-289.
■ Kamp, B.J., Wellman, N.S., & Russell, C. (2010). Position of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education: food and nutrition programs for community-residing older adults. Journal of Nutrition Education and Behavior, 42(2), 72-82. doi:10.1016/j.jned.2009.12.001
■ Kunkel, M.E., Luccia, B., & Moore, A. (2003). Evaluation of the South Carolina Seniors Farmers’ Market Nutrition Education Program. J Am Diet Assoc, 103, 880-883. doi:10.1053/j.ada.2003.50164
■ Lee, J.S., Fisher, J.G., & Johnson, M.A. (2010). Food insecurity, food and nutrition programs, and aging: experiences from Georgia. Journal of Nutrition for the Elderly, 29(2), 116-149. doi:10.1080/01639366.2010.480895.
■ Lin, F.R. & Wang, S.Y. (2014). Service value network for organic agricultural produce: an actor network theory perspective. IEEE, 1296-1305. doi:10.1109/HICSS.2014.167
■ Middleton, C. & Smith S. (2011). Purchasing habits of senior farmers’ market shoppers: utilizing the theory of planned behavior. Journal of Nutrition in Gerontology and Geriatrics, 30, 248-260. doi:10.1080/21551197.2011.591269
■ Jilcott Pitts, S.B., Acheson, M.L.M, Ward, R.K., Wu, Q., McGuirt, J.T., Bullock, S.L. … Ammerman, A.S. (2015). Disparities in healthy food zoning, farmers’ market availability, and fruit and vegetable consumption among North Carolina residents. Archives of Public Health, 73:35. doi:10.1186/s13690-015-0085-9
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