Evaluating Community Measures of Healthy Food Access

Several community level measures of healthy food access exist, but evaluation efforts have been limited leaving uncertainty about how to prioritize communities for intervention. This study aimed to assess several existing measures to inform statewide public health planning efforts in New Jersey, USA. We assessed agreement between community measures of healthy food access and then evaluated the predictive validity of each measure by describing its association with complete fruit and vegetable cash-value voucher redemption (proportion redeemed ≥70, ≥80, ≥90%) among 30,078 low-income households participating in the New Jersey Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during 2013-2014. The United States Department of Agriculture's (USDA) food desert measure agreed with the Centers for Disease Control and Prevention's (CDC) no healthier food retailers (NHFR) measure for 76.5% of New Jersey census tracts, but the Kappa statistic was only 0.10. For urban households, the NHFR measure was negatively associated with complete redemption after adjusting for demographic factors and Supplemental Nutrition Assistance Program participation (≥70% odds ratio (OR) 0.68, 95% confidence interval (CI) 0.61-0.75; ≥80% OR 0.67, 95% CI 0.62-0.73; ≥90% OR 0.72, 95% CI 0.66-0.77). For rural households, a negative association was observed for the USDA's low-income/low-vehicle access measure (≥70% OR 0.48, 95% CI 0.26-0.90). The CDC's NHFR measure is more appropriate for prioritizing urban areas while the USDA's low-income/low-vehicle access measure may be better for rural areas.