摘要：Objectives. Fruit and vegetable cost is a presumed barrier to intake. We sought to determine whether fruit and vegetable cost and consumers’ race and income would predict availability of fruits and vegetables in homes of schoolchildren in the Birmingham, Ala, area. Methods. Data on availability of 27 fruit and vegetable items were obtained from homes of 1355 children (32% African American) in the Birmingham area. Fruit and vegetable costs were obtained from the US Department of Agriculture. We used discrete choice analysis with the dependent variable represented as presence or absence of the fruit or vegetable item. Explanatory variables included fruit and vegetable price per serving; child’s gender, race, and age; and parent’s body mass index and income. Results. Higher cost was inversely related to fruit and vegetable availability. Higher income, African American race, and female gender were positively related to availability. Cost per serving was stratified into 3 categories—low, medium, and high. Relative to low-cost items, only high-cost items decreased the odds of availability significantly. Conclusions. Fruit and vegetable cost does impact availability and has the greatest impact for high-cost items. Although cost was inversely related to availability, African Americans reported higher fruit and vegetable availability than Whites. Additional studies are needed to determine whether food items of lower nutritive value and comparable cost impact availability. Over the past 40 years, the national prevalence of obesity (body mass index [BMI] ≥ 30 kg/m2) has risen from 13% to 31%, and the prevalence of overweight (25≤ BMI < 30 kg/m2) has grown from 31% to 34%. 1 Potential explanations for the increasing prevalence of obesity include, but are not limited to, increased intake of energy-dense foods and sugar-containing beverages, lower levels of physical activity, declining levels of strenuous activity at work, and the proximity of fast-food restaurants. 2 , 3 The combination of increased access to low-cost convenience foods and decreased disposable income for food may lead to preferential displacement of fruits and vegetables. This is unfortunate, as increased consumption of fruits and vegetables, coupled with a reduced-calorie dietary intake, may reduce obesity 4 , 5 as well as protect against other health conditions such as cancer, diabetes, and hypertension. 6 – 8 Increasing fruit and vegetable consumption may be difficult, because consumer food choice is closely linked with food cost. 9 Retail price increases between 1982 and 1997 were lower for sugar and sweets (52%) and fats and oils (47%) compared with that for fruits and vegetables (93%). 10 As such, food items purchased from retailers in high-income communities are less energy dense than in lower-income communities (i.e., more fruits and vegetables and fewer high-fat foods purchased). 11 This type of evidence is consistent with (but does not prove) the notion that the costs of healthy items, specifically fruits and vegetables, are a limiting factor in consumption and lead to preferential purchasing of lower-cost, more-energy-dense food items with less nutritive value. 12 Research by Zenk et al. has recently focused on the relationship between fruit and vegetable consumption and retail food store location and characteristics. 13 Their analysis found no direct association between per capita income and fruit and vegetable consumption and between fruit and vegetable affordability and consumption for a sample of predominantly African American consumers in the Detroit metropolitan area. However, they used a self-reported ordinal ranking of “food affordability,” which may not be truly representative of actual food cost per serving or relative prices of fruits and vegetables. As more discussion regarding the impact of fruit and vegetable costs has developed, lowering the cost of these items has become an intervention target of interest in combating obesity. Therefore, it may be important for investigators, public health practitioners, and policymakers to understand the true effect of fruit and vegetable pricing on consumption and, ultimately, body weight. Several studies have examined the relationship between weekly household expenditure on certain food groups including fruits and vegetables using economic theories of consumer behavior as applied by the linear expenditure system model. 14 – 16 To date, we are unaware of any studies that demonstrate that lowering the cost per serving of fruits and vegetables leads to increased availability in the home. Defining this relationship and other significant moderating factors would be a first step in making the link between fruit and vegetable costs and obesity. Moreover, understanding how the costs of fruits and vegetables impact special populations that suffer from disproportionate rates of obesity, including low-income and African American populations, would be valuable. In this study, we linked baseline food availability data from participants of the Hi5+ intervention in Birmingham, Ala, 17 , 18 to national price indices to assess the relationship between the costs of the items and the self-reported in-home availability.
