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The International Journal of Health, Wellness, and Society
Volume 11, Issue 2, 2021, https://healthandsociety.com
© Common Ground Research Networks, Douglas Sirutis, Maxwell Droznin,
All Rights Reserved. Permissions: cgscholar.com/cg_support
ISSN: 2156-8960 (Print), ISSN: 2156-9053 (Online)
https://doi.org/10.18848/2156-8960/CGP/v11i02/41-58 (Article)
Assessing Fresh Produce Accessibility of a
Low-Income Community in DeLand, Florida
Douglas Sirutis,1 University of Miami Miller School of Medicine, USA
Maxwell Droznin, University of Central Florida College of Medicine, USA
Abstract: Spring Hill is a small community in central Florida that is demographically dense in Black and Hispanic
residents, marked by a poverty rate three-times that of the county average, and characterized by a lack of access to
healthy foods. A 2016 Spring Hill community needs assessment indicated that residents are concerned about access to
fresh produce, as well as high rates of hypertension, type II diabetes, and cardiovascular disease in their community.
The literature has established that low food security is correlated with an increased risk of several chronic diseases,
including those mentioned. The Supplemental Nutrition Assistance Program (SNAP) has implemented a Fresh Access
Bucks initiative at a nearby, weekly farmers’ market, where SNAP beneficiaries can purchase double the value of their
SNAP benefits when spending on fresh fruits and vegetables. This program has been marketed to the Spring Hill
community in response to their concerns. This cross-sectional study used a questionnaire distributed at the Spring Hill
Resource Center to evaluate: 1) the effectiveness of the Fresh Access Bucks program incentivization, 2) the farmers’
market as a source of fresh produce for Spring Hill, and 3) obstacles preventing residents from accessing the farmers’
market. Results indicate that the farmers’ market can be a viable source of healthy food for Spring Hill residents and
SNAP beneficiaries alike, while also revealing strategies to improve awareness and access to the Fresh Access Bucks
program. Considerations for future improvements include shuttle transportation to the farmers’ market and the
possibility of a mobile food market.
Keywords: Food Security, Food Desert, Farmers’ Market, Fresh Access Bucks Program
Introduction
aily consumption of fresh fruits and vegetables is promoted by health institutions
worldwide. The United States Department of Agriculture Dietary Guidelines for
Americans 2015–2020 recommends filling half of each meal’s plate with fruits and
vegetables (DeSalvo, Olson, and Casavale 2016). The literature documenting the association
between diet and improved health is expanding. Sufficient intake of fresh produce is associated
with decreased risk of cardiovascular disease (Huang et al. 2011). There is evidence indicating
that eating enough servings of fresh produce correlates with a lower risk of developing type II
diabetes (Muraki et al. 2013). Likewise, consuming fresh produce can combat the growing rates
of obesity and micronutrient deficiencies in the United States (Via 2012). Fruits and vegetables
are low-calorie options that are generally rich in under-consumed nutrients and can replace the
higher-calorie foods that contribute to weight gain (DeSalvo, Olson, and Casavale 2016).
Food Security and Food Deserts
With the growing body of evidence supporting the link between diet and health, it is paramount
to evaluate micro- and macro-social elements that promote or inhibit access to fruits and
vegetables. Low food security, previously labeled as food insecurity, is a state where
individuals report insufficient quality, variety, or desirability of their diet (USDA Economic
Research Service n.d.). Areas where people experience low food security have been termed
“food deserts.” They are areas without ready access to fresh produce and healthy foods due to a
lack of grocery stores within a mile radius. Food deserts are generally characterized by low-
1Corresponding Author: Douglas Sirutis, 2890 Green Mountain Road, University of Miami Miller School of Medicine,
Miami, FL, 32720, USA. email: dsirutis@miami.med.edu
D
THE INTERNATIONAL JOURNAL OF HEALTH, WELLNESS, AND SOCIETY
income neighborhoods, disproportionately African American and Hispanic residents, and poor
public transit systems (Walker, Keane, and Burke 2010; Dutko, Ver Ploeg, and Farrigan 2012;
Smoyer-Tomic et al. 2008; Gundlach, Resch, and Omri 2013). The literature surrounding food
security and food deserts aims to uncover methods of providing healthy, affordable food to
these communities (Gundlach, Resch, and Omri 2013).
Residents living in food deserts may face obstacles in buying healthy food, may have to travel
farther to purchase healthy food, or may instead rely on closer stores that offer fewer healthy
options (Ver Ploeg et al. 2015). In 2010, nearly 10% of the US population lived in impoverished
areas over one mile from the nearest supermarket (Rahkovsky and Snyder 2015). Access to
transportation was found to be of particular importance, with zero-vehicle older adult residents
living in food deserts being 12% more likely to report poor food access than older adult residents
who owned a vehicle (Fitzpatrick, Greenhalgh-Stanley, and Ver Ploeg 2016).
Studies examining the relationship between low and very low food security and health have
found associations with poor health outcomes. Low food security correlates with increased risk
of several chronic diseases: coronary artery disease, hypertension, chronic obstructive
pulmonary disease (COPD), stroke, cancer, hepatitis, diabetes, asthma, arthritis, and kidney
disease (Gregory and Coleman-Jensen 2017). It is with this backdrop of community welfare,
food security, and health outcomes that this study addresses the Spring Hill Community of
southwestern DeLand, Florida.
Spring Hill
Spring Hill is a community located in the southwest of DeLand, Florida. Spring Hill is made up
of 698 acres—260 under the jurisdiction of the City of DeLand, with the remaining majority
under Volusia County governance (Johnson et al. 2016). As shown in Figure 2, the Spring Hill
area limits are bound by Beresford Avenue to the north, Spring Garden Avenue (SR-15A) to the
south and west, and Woodland Boulevard to the east (Volusia County 2016). According to the
2010 United States Census data, Spring Hill, designated by the census as DeLand Southwest,
has a population of 1,095. The demographics of the residents are 62.4% African American,
14.8% non-Hispanic White, 20.5% Hispanic, and 2.3% Other, with a median age of 33.3 (U.S.
Census Bureau 2010a).
Figure 1: Nested Map of Spring Hill in Relation to Its Location in the City, County, and State
Source: Johnson et al. 2016
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SIRUTIS AND DROZNIN: FRESH PRODUCE ACCESSIBILITY IN A LOW-INCOME COMMUNITY
Figure 2: Spring Hill Redevelopment Agency Area
Source: Volusia County 2016
Spring Hill is a heavily populated, impoverished area, with 1,343 people per square mile and
a median household income of $30,250 (U.S. Census Bureau 2010b). The area has a 37.6%
poverty rate—more than three times higher than the Volusia County average (City of DeLand
2020). As a federally designated food desert, Spring Hill residents must travel more than a mile
outside of their community in order to purchase fresh fruits and vegetables (USDA Economic
Research Service 2020). Figure 3 illustrates that businesses and grocery stores in Spring Hill are
located on the perimeter of the community, while the center of the community lacks both. Spring
Hill residents only have a single convenience store within a mile’s reach that sells overpriced,
nutritionally deficient goods and, notably, no fresh fruits or vegetables. (Johnson et al. 2016).
Further complicating the food access issue, a 2018 Walkability Assessment of Spring Hill found
that there are neither bike lanes, public transportation options, or interconnected sidewalks
available to be utilized by the vast majority of residents, severely limiting mobility of those who
do not have reliable motor vehicle transportation (Droznin et al. 2018). By nearly every measure,
Spring Hill residents face obstacles to accessing a healthy diet.
Figure 3: Asset Map of Spring Hill Community
Source: Johnson et al. 2016
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THE INTERNATIONAL JOURNAL OF HEALTH, WELLNESS, AND SOCIETY
The Spring Hill residents have reported concern about healthy food access themselves. A
Spring Hill public health and community needs assessment conducted by Dr. Asal Johnson of
Stetson University in 2016 found that 90.5% of Spring Hill respondents were concerned about
their access to fresh produce. The study also reported that 69% of Spring Hill residents were
concerned about their access to transportation. Lastly, the study indicated that three of the top
four health concerns of the Spring Hill community (hypertension, type II diabetes, and heart
disease) were chronic conditions associated with poor nutritional intake (Johnson et al. 2016).
The Artisan Alley Farmers Market
Farmers’ markets are an increasingly common response to food deserts across the United States.
Multiple studies have demonstrated the potential for farmers’ markets to increase fruit and
vegetable consumption in various contexts that apply to the Spring Hill community. For
example, there is evidence that farmers’ markets may increase fruit and vegetable consumption
in people who are low-income, have chronic diseases with diet-related risk factors, or live in
food deserts (Freedman et al. 2016; AbuSabha, Namjoshi, and Klein 2011; Evans et al. 2012;
Freedman et al. 2013; Gans et al. 2018, Gary-Webb et al. 2018; Larsen and Gilliland 2009).
The DeLand Artisan Alley Farmers and Makers Market is a farmers’ market in downtown
DeLand held every Friday from 6 to 9 p.m. It is located 1.8 miles from the center of the Spring
Hill community, and several vendors at the market sell locally grown, fresh produce. The
market is a potential source of healthy, fresh produce, and could be a resource in alleviating the
diet-related concerns and health issues of the Spring Hill community.
In response to efforts to improve food access at farmers’ markets, multiple studies have
found that SNAP implementation significantly improved access to nutritious foods in low-
income, historically marginalized neighborhoods (Wetherill and Gray 2015; Jones and Bhatia
2011; Young et al. 2013; Lindsay et al. 2013; Freedman et al. 2016). As no such program yet
existed in Volusia County, the Stetson Center for Community Engagement partnered with the
Artisan Alley Farmers Market in 2017 and secured funding through the national Food Insecurity
Nutrition Incentive program to operate an EBT card reader and run the Fresh Access Bucks
program—a program where Supplemental Nutrition Assistance Program (SNAP) beneficiaries
can double their SNAP benefits when purchasing locally grown fresh fruits and vegetables at
farmers’ markets in Florida. The transactions can be carried out using Florida Electronic
Benefits Transfer (EBT) cards.
The DeLand Artisan Alley Farmers Market and accompanied SNAP/EBT program is
positioned as a potential resource to improve Spring Hill’s food access and diet-related
behaviors. However, little is known about Spring Hill residents’ use of the market and
SNAP/EBT program. This study will assess the utilization of the DeLand Artisan Alley Farmers
Market as a source of fresh produce for Spring Hill residents. It will explore potential obstacles
preventing Spring Hill residents from accessing the farmers’ market, and survey for
improvements that may facilitate increased market attendance. Additionally, this study will
address the utilization of the SNAP/EBT program at the market, and the perception of the
market’s produce prices. Lastly, this study will make suggestions for increasing Spring Hill
residents’ access to locally grown, fresh produce, hopefully providing a pathway toward
choosing healthier diets.
Methods
Participants
Participants in this study were volunteers obtained via convenience sampling. As with many
historically marginalized communities in the American South, decades of Jim Crow laws and
44
SIRUTIS AND DROZNIN: FRESH PRODUCE ACCESSIBILITY IN A LOW-INCOME COMMUNITY
their lasting legacies have eroded trust in organizations outside of the community, sentiments
expressed in the 2016 needs assessment (Geronimus and Thompson 2004; Johnson et al. 2016).
As such, surveys were placed at the check-in desk of the Spring Hill Resource Center, the
community asset most Spring Hill residents were most proud of (Johnson et al. 2016). In
partnership with staff there, all clients that worked with the resource center during the week
were asked if they wanted to take the survey. There were forty-eight participants in total, of
which 79% (n = 38) lived in Spring Hill, 17% (n = 8) lived outside of Spring Hill, and 4% (n =
2) were unsure if they resided within Spring Hill’s boundaries. The participants were comprised
of 63% females (n = 30) and 37% males (n = 18), with 40% (n = 19) ranging between ages 18
and 35, 35% (n = 17) between ages 36 and 50, 21% (n = 10) older than 50, and 4% (n = 2) not
indicating an age range. The majority of participants were African Americans (83%, n = 40),
while 6% (n = 3) were Hispanic and 6% (n = 3) White. One participant only partially filled out
a survey and was not included in the data.
Materials
This was a cross-sectional study utilizing a questionnaire written specifically for this study. The
questionnaire was designed to categorize participants as Spring Hill residents or non-Spring Hill
residents as well as SNAP recipients or non-SNAP recipients, and measure their awareness of
the DeLand Artisan Alley Farmers Market, attitudes toward the market, and potential variables
affecting market attendance. The questionnaire first identified whether participants lived in the
study area or not, asking “Do you live in Spring Hill?” In the case that participants may not
have been familiar with the boundaries of Spring Hill, the second question featured a map of the
Greater Spring Hill area, asking “Do you live in the following boundaries?” The questionnaire
also identified whether participants were SNAP recipients or non-SNAP recipients with a
