Measuring the Nutrition Environment in Rural Arizona

By Elizabeth Kizer

Groceries We often hear that “healthy diet and exercise” are the solutions to reducing the increasing rates of obesity in the United States and many other countries around the world.  But many things can make healthy eating and active lifestyles difficult choices, including the community environment in which we live.  This is especially true in rural areas. 

According to the United States Department of Agriculture (USDA) Food Access Research Atlas, in Arizona, 36% of rural census tracts do not have a grocery store within 10 miles and 15% do not have a grocery store within 20 miles.  Without access to nutritious foods, rural and underserved residents must often turn to convenient and unhealthy alternatives.  The challenge for public health professionals is to identify ways to enhance or alter the environment to make healthy eating and active lifestyles easy choices.

Each year the Arizona Area Health Education Center (AHEC) program in the University of Arizona Health Sciences Center provides small grants to graduate students for projects that promote community and academic/educational partnerships to enhance the health of residents in rural and underserved communities.  This year, I was awarded an AHEC grant to collect data about the community and consumer nutrition environments in the rural town of Florence, AZ. 

A community’s nutrition environment is described as the sum of all of its food outlets – such as grocery stores, convenience stores, full-service and fast-food restaurants, farmer’s markets, etc.  A consumer’s nutrition environment is described as what he or she encounters when buying food – particularly regarding the availability, cost, and quality of healthy food choices1.

One way to measure the nutrition environment of a community is to survey its food outlets.  The Nutrition Environment Measurement Survey (NEMS), measures the availability, price, and quality of nutritious foods in stores and restaurants.  The NEMS is easily accessible to rural communities.  A free, online training is available through the University of Pennsylvania here.   Once the online training is completed, they provide access to all materials.  For this project, I completed the online training (approximately 20 hours) and am currently training six local volunteers as NEMS raters.  By the end of June, the raters will collect a total of thirty-five surveys from licensed stores and restaurants in Florence. 

The information collected using the NEMS survey will be analyzed along with other measures of the local nutrition environment, including  a different survey of members of a local coalition to improve the nutrition environment, notes from community meetings, a community survey, and a review of government data and other information regarding nutrition, physical activity, and health in and around Florence. 

At the end of the summer, after all of the information is collected and analyzed, I will work with a local community action board (which will consist of a subset of members from the local coalition) to develop an action agenda for local policy and/or environmental change.  The action agenda will guide the efforts of both the local coalition and me as I engage in my planned dissertation project – a community-based participatory research project to improve the nutrition environment in Florence. More blogs will follow to report on progress and findings.

1Glanz K, Sallis JF, Saelens BE, Frank LD. 2005. Healthy nutrition environments: concepts and measures. Am. J. Health Promot. 19:330–33

About the Author

Elizabeth Kizer is a doctoral student studying public health policy and management at the University of Arizona Mel and Enid Zuckerman College of Public Health. Her current research interest is how rural communities can improve their nutrition environments and make healthy foods more available. Her focus is on identifying policy or environmental changes that can affect the availability of healthy foods. Ms. Kizer utilizes community-based participatory research frameworks in order to engage community members facing disparities in terms of access to healthy foods. If you have any questions about this project, please contact Elizabeth Kizer at

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