A cross-sectional study of US rural adults’ consumption of fruits and vegetables: do they consume at least five servings daily?

BMC Public Health

Martin S Lipsky²  Linda F Chang²  M Nawal Lutfiyya¹ 

[1] Essentia Institute of Rural Health, Division of Research, 502 East 2nd Street, Duluth, MN, 55805, USA;Department of Community and Family Medicine, University of Illinois-Chicago College of Medicine at Rockford, 1601 Parkview Avenue, Rockford, IL, 61107, USA

关键词: BRFSS;    Adult nutrition;    Fruit and vegetable consumption;    Rural health;   

Others  :  1163695
DOI  :  10.1186/1471-2458-12-280

 received in 2011-09-19, accepted in 2012-04-10,  发布年份 2012

【 摘 要 】

Background

Rural residents are increasingly identified as being at greater risk for health disparities. These inequities may be related to health behaviors such as adequate fruits and vegetable consumption. There is little national-level population-based research about the prevalence of fruit and vegetable consumption by US rural population adults. The objective of this study was to examine the prevalence differences between US rural and non-rural adults in consuming at least five daily servings of combined fruits and vegetables.

Methods

Cross-sectional analysis of weighted 2009 Behavioral Risk Factor Surveillance Survey (BRFSS) data using bivariate and multivariate techniques. 52,259,789 US adults were identified as consuming at least five daily servings of fruits and vegetables of which 8,983,840 were identified as living in rural locales.

Results

Bivariate analysis revealed that in comparison to non-rural US adults, rural adults were less likely to consume five or more daily servings of fruits and vegetables (OR = 1.161, 95% CI 1.160-1.162). Logistic regression analysis revealed that US rural adults consuming at least five daily servings of fruits and vegetables were more likely to be female, non-Caucasian, married or living with a partner, living in a household without children, living in a household whose annual income was 

>

 $35,000, and getting at least moderate physical activity. They were also more likely to have a BMI of <30, have a personal physician, have had a routine medical exam in the past 12 months, self-defined their health as good to excellent and to have deferred medical care because of cost. When comparing the prevalence differences between rural and non-rural US adults within a state, 37 States had a lower prevalence of rural adults consuming at least five daily servings of fruits and vegetables and 11 States a higher prevalence of the same.

Conclusions

This enhanced understanding of fruit and vegetable consumption should prove useful to those seeking to lessen the disparity or inequity between rural and non-rural adults. Additionally, those responsible for health-related planning could benefit from the knowledge of how their state ranks in comparison to others vis-à-vis the consumption of fruits and vegetables by rural adults---a population increasingly being identified as one at risk for health disparities.

【 授权许可】

   
2012 Lutfiyya et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion: [http://www.healthypeople.gov/2020] webciteHealthy People 2020. 2012.
• [2]U.S. Department of Agriculture U.S. Department of Health and Human Services: Dietary Guidelines for Americans, 2010. 7th edition. U.S. Government Printing Office, Washington, DC; 2010.
• [3]Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ: Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ 2010, 341:c4229.
• [4]Aatola H, Koivistoinen T, Hutri-Kähönen N, Juonala M, Mikkilä V, Lehtimäki T, Viikari JS, Raitakari OT, Kähönen M: Lifetime fruit and vegetable consumption and arterial pulse wave velocity in adulthood: the cardiovascular risk in young Finns study. Circulation 2010, 122:2521-2528.
• [5]Dauchet L, Amouyel P, Hercberg S, Dallongeville J: Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 2006, 136:2588-2593.
• [6]He FJ, Nowson CA, MacGregor GA: Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 2006, 367:320-326.
• [7]Michimi A, Wimberly MC: Associations of supermarket accessibility with obesity and fruit and vegetable consumption in the conterminous United States. Int J Health Geogr 2010, 9:49.
• [8]Boggs DA, Palmer JR, Wise LA, Spiegelman D, Stampfer MJ, Adams-Campbell LL, Rosenberg L: Fruit and vegetable intake in relation to risk of breast cancer in the black women's health study. Am J Epidemiol 2010, 172:1268-1279.
• [9]Fernández E, Gallus S, La Vecchia C: Nutrition and cancer risk: an overview. J Br Menopause Soc 2006, 12:139-142.
• [10]Lee JE, Männistö S, Spiegelman D, Hunter DJ, Bernstein L, van den Brandt PA, Buring JE, Cho E, English DR, Flood A, Freudenheim JL, Giles GG, Giovannucci E, Håkansson N, Horn-Ross PL, Jacobs EJ, Leitzmann MF, Marshall JR, McCullough ML, Miller AB, Rohan TE, Ross JA, Schatzkin A, Schouten LJ, Virtamo J, Wolk A, Zhang SM, Smith-Warner SA: Intakes of fruit, vegetables, and carotenoids and renal cell cancer risk: a pooled analysis of 13 prospective studies. Cancer Epidemiol Biomarkers Prev 2009, 18:1730-1739.
• [11]Büchner FL, Bueno-de-Mesquita HB, Ros MM, Overvad K, Dahm CC, Hansen L, Tjønneland A, Clavel-Chapelon F, Boutron-Ruault MC, Touillaud M, Kaaks R, Rohrmann S, Boeing H, Nöthlings U, Trichopoulou A, Zylis D, Dilis V, Palli D, Sieri S, Vineis P, Tumino R, Panico S, Peeters PH, van Gils CH, Lund E, Gram IT, Braaten T, Sánchez MJ, Agudo A, Larrañaga N, Ardanaz E, Navarro C, Argüelles MV, Manjer J, Wirfält E, Hallmans G, Rasmuson T, Key TJ, Khaw KT, Wareham N, Slimani N, Vergnaud AC, Xun WW, Kiemeney LA, Riboli E: Variety in fruit and vegetable consumption and the risk of lung cancer in the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 2010, 19:2278-2286.
• [12]Benetou V, Orfanos P, Lagiou P, Trichopoulos D, Boffetta P, Trichopoulou A: Vegetables and fruits in relation to cancer risk: evidence from the Greek EPIC cohort study. Cancer Epidemiol Biomarkers Prev 2008, 17:387-392.
• [13]McCabe-Sellers BJ, Skipper A, American Dietetic Association: Position of the American Dietetic Association: integration of medical nutrition therapy and pharmacotherapy. J Am Diet Assoc 2010, 110:950-956.
• [14]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure National High Blood Pressure Education Program Coordinating Committee: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560-2572.
• [15]Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH, DASH-Sodium Collaborative Research Group: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001, 344:3-10.
• [16]Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) JAMA 2001, 285:2486-2497.
• [17]Hartley D: Rural health disparities, population health, and rural culture. Am J Public Health 2004, 94:1675-1678.
• [18]Lovasi GS, Hutson MA, Guerra M, Neckerman KM: Built environments and obesity in disadvantaged populations. Epidemiol Rev 2009, 31:7-20.
• [19]Lutfiyya MN, McCullough JE, Lipsky MS: A population-based study of health services deficits for U.S. adults with asthma. J Asthma 2011, 48:931-944.
• [20]Braveman P: Health disparities and health equity: concepts and measurement. Annu Rev Public Health 2006, 27:167-194.
• [21]Phelan JC, Link BG, Tehranifar P: Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav 2010, 51:S28-S40.
• [22]Dubowitz T, Heron M, Bird CE, Lurie N, Finch BK, Basurto-Da´vila R, Hale L, Escarce JJ: Neighborhood socioeconomic status and fruit and vegetable intake among whites, blacks, and Mexican Americans in the United States. Am J Clin Nutr 2008, 87:1883-1891.
• [23]Devine CM, Wolfe WS, Frongillo EA, Bisogni CA: Life-course events and experiences: association with fruit and vegetable consumption in 3 ethnic groups. J Am Diet Assoc 1999, 99:309-314.
• [24]Yeh MC, Ickes SB, Lowenstein LM, Shuval K, Ammerman AS, Farris R, Katz DL: Understanding barriers and facilitators of fruit and vegetable consumption among a diverse multi-ethnic population in the USA. Health Promot Int 2008, 23:42-51.
• [25]Baker AH, Wardle J: Sex differences in fruit and vegetable intake in older adults. Appetite 2003, 40:269-275.
• [26]Savoca MR, Arcury TA, Leng X, Bell RA, Chen H, Anderson A, Kohrman T, Quandt SA: The diet quality of rural older adults in the South as measured by healthy eating index-2005 varies by ethnicity. J Am Diet Assoc 2009, 109:2063-2067.
• [27]Eikenberry N, Smith C: Healthful eating: perceptions, motivations, barriers, and promoters in low-income Minnesota communities. J Am Diet Assoc 2004, 104:1158-1161.
• [28]Sisson A: [http://escholarship.org/uc/item/4kc331x6] webciteFruit and vegetable consumption by low-income Americans. Nutrition Noteworthy. Department of Biological Chemistry, UCLA, David Geffen School of Medicine, UC Los Angeles; 2002.
• [29]Montez JK, Eschbach K: Country of birth and language are uniquely associated with intakes of fat, fiber, and fruits and vegetables among Mexican-American women in the United States. J Am Diet Assoc 2008, 108:473-480.
• [30]Hosler AS, Rajulu DT, Fredrick BL, Ronsani AE: Assessing retail fruit and vegetable availability in urban and rural underserved communities. Prev Chronic Dis 2008, 5:A123.
• [31]Sharkey JR, Johnson CM, Dean WR: Food access and perceptions of the community and household food environment as correlates of fruit and vegetable intake among rural seniors. BMC Geriatr 2010, 10:32.
• [32]Kanungsukkasem U, Ng N, Van Minh H, Razzaque A, Ashraf A, Juvekar S, Masud Ahmed S, Huu Bich T: Fruit and vegetable consumption in rural adult population in INDEPTH HDSS sites in Asia. Glob Health Action 2009., 2
• [33]Berke EM: Geographic Information Systems (GIS): recognizing the importance of place in primary care research and practice. J Am Board Fam Med 2010, 23:9-12.
• [34]Cummins S, Curtis S, Diez-Roux AV, Macintyre S: Understanding and representing ‘place’ in health research: a relational approach. Soc Sci Med 2007, 65:1825-1838.
• [35]Lutfiyya MN, Lipsky MS, Wisdom-Behounek J, Inpanbutr-Martinkus M: Is rural residency a risk factor for overweight and obesity for U.S. children? Obesity (Silver Spring) 2007, 15:2348-2356.
• [36]Jackson JE, Doescher MP, Jerant AF, Hart LG: A national study of obesity prevalence and trends by type of rural county. J Rural Health 2005, 21:140-148.
• [37]Schwartz F, Ruhil AV, Denham S, Shubrook J, Simpson C, Boyd SL: High self-reported prevalence of diabetes mellitus, heart disease, and stroke in 11 counties of rural Appalachian Ohio. J Rural Health 2009, 25:226-230.
• [38]Krishna S, Gillespie KN, McBride TM: Diabetes burden and access to preventive care in the rural United States. J Rural Health 2010, 26:3-11.
• [39]Mokdad AH, Stroup DF, Giles WH: Behavioral Risk Factor Surveillance Team. Public health surveillance for behavioral risk factors in a changing environment: recommendations from the Behavioral Risk Factor Surveillance Team. MMWR 2003, 52(RR-9):1-12.
• [40]U.S. Office of Management and Budget: 2010 standards for delineating metropolitan and micropolitan statistical areas; Notice. Fed Regist 2010., 75
• [41]Isserman AM: In the national interest: defining rural and urban correctly in research and public policy. Int Reg Sci Rev 2005, 28:465-499.
• [42]Hart LG, Larson EH, Lishner DM: Rural definitions for health policy and research. Am J Public Health 2005, 95:1149-1155.
• [43]Woods M: Rural geography: blurring boundaries and making connections. Prog Hum Geogr 2009, 33:849-858.
• [44]Hall SA, Kaufman JS, Ricketts TC: Defining urban and rural areas in U.S. epidemiologic studies. J Urban Health 2006, 83:162-175.
• [45]Hall JN, Moore S, Harper SB, Lynch JW: Global variability in fruit and vegetable consumption. Am J Prev Med 2009, 36:402-409.
• [46]United States Department of Agriculture: 2007 Census of Agriculture United States Summary and State Data. Geographic Area Series Part 51 2009., 1
• [47]Terry P, Terry JB, Wolk A: Fruit and vegetable consumption in the prevention of cancer: an update. J Intern Med 2001, 250:280-290.
• [48]Blanck HM, Gillespie C, Kimmons JE, Seymour JD, Serdula MK: Trends in fruit and vegetable consumption among U.S. men and women, 1994–2005. Prev Chronic Dis 2008, 2:A35.
• [49]Liese AD, Weis KE, Pluto D, Smith E, Lawson A: Food store types, availability, and cost of foods in a rural environment. J Am Diet Assoc 2007, 107:1916-1923.
• [50]Glanz K, Sallis JF, Saelens BE, Frank LD: Healthy nutrition environments: concepts and measures. Am J Health Promot 2005, 19:330-333. ii
• [51]Central Intelligence Agency World Factbook[https://www.cia.gov/library/publications/the-world-factbook/geos/us.html] webcite 2011.
• [52]Deshmukh-Taskar P, Nicklas TA, Yang SJ, Berenson GS: Does food group consumption vary by differences in socioeconomic, demographic, and lifestyle factors in young adults? The Bogalusa Heart Study. J Am Diet Assoc 2007, 107:223-234.
• [53]Patterson BH, Harlan LC, Block G, Kahle L: Food choices of whites, blacks, and Hispanics: data from the 1987 National Health Interview Survey. Nutr Cancer 1995, 23:105-119.
• [54]Gans KM, Burkholder GJ, Risica PM, Lasater TM: Baseline fat-related dietary behaviors of white, Hispanic, and black participants in a cholesterol screening and education project in New England. J Am Diet Assoc 2003, 103:699-706.
• [55]Champagne CM, Bogle ML, McGee BB, Yadrick K, Allen HR, Kramer TR, Simpson P, Gossett J, Weber J, Lower Mississippi Delta Nutrition Intervention Research Initiative: Dietary intake in the lower Mississippi delta region: results from the foods of our delta study. J Am Diet Assoc 2004, 104:199-207.
• [56]Larson NI, Story MT, Nelson MC: Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med 2009, 36:74-81.
• [57]Morton LW, Blanchard C: Starved for access: life in rural America’s food deserts. Rural Real 2007, 1:1-10.