Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Deborah Slawson

Committee Members

Arsham Alamian, Ke Chen


Diet and dietary related health outcomes such as obesity and diabetes are major public health concerns. While personal choice and dietary behaviors are major influences on how an individual eats, the environment influences these choices and behaviors. The nutrition environment is one key influence and its relationship with food choice, behaviors, and socioeconomic influences is complex. Within the structure of the nutrition environment, food access and socioeconomic status compound influencing nutrition behavior and food choice.

Food deserts are defined as geographic region of low access to healthy affordable food in low income areas. The USDA developed a system for the analysis of food deserts in the United States. However, the methods the USDA uses do not acknowledge potential geographical barriers present in rural mountainous regions including Appalachia. The purpose of this research is to determine whether the USDA methodology underrepresents food deserts in Appalachia and to develop a modified analysis model for the region.

The region was analyzed at the census tract level using methods based on USDA guidelines for low income, rurality, and grocery store identification, then applied in Geographic Information Systems (GIS) to roadway data. Network analysis of drive time from grocery stores to 20 minutes away was performed. Low income, rural census tracts with 33% of their area outside of the 20-minute drive time zone were identified as food deserts. Counties containing tracts were then compared to USDA designated counties, using the dependent variables of obesity and diabetes diagnosis rates and controlled for by county level rurality and economic distress.

Of the counties designated as rural, 63 contained food deserts by the modified methods and the USDA model identified 20, there was an overlap in identification of 12 counties. There was no significant difference for 2 methods in health outcomes for the counties.

In conclusion, the modified methods do identify a larger food desert region. It is crucial to understand the geographic barriers to regions when addressing nutrition environment concerns. The underrepresentation of food desert areas can leave populations and communities underserved and without much needed resources to improve their access to healthy and affordable foods.

Document Type

Dissertation - unrestricted


Copyright by the authors.