19 - “It’s Cheaper to Buy Cheap Food:” Qualitative Study of the Impact of Produce Affordability on the Household Budget

Publication Number: 4018.19

Laura Plencner, Children's Mercy Kansas City, Prairie Village, KS, United States; Evelyn S. Donis De Miranda, Children's Mercy, Las Vegas, NV, United States; Karynn Glover, Children's Mercy Research Institute, Kansas City, MO, United States; Molly Krager, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Andrea D. Bradley-Ewing, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Jeffrey D. Colvin, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

Background: Though childhood fruit and vegetable ("produce") consumption is critical for the prevention of obesity and other chronic diseases, few children consume the daily recommended amount. Households with limited income must balance spending money on food with other household essentials.

Objective: We aim to explore barriers to produce intake.

Design/Methods: This qualitative study included adult parents of patients in an academic pediatric primary care center clinic enrolling into a produce prescription (PRX) program, who spoke English or Spanish, screened positive for food insecurity, and resided in a zip code with a produce prescription redemption location. All participants enrolled in the PRX program were offered an interview opportunity before the program started. A semi-structured interview guide, based on the social-ecological model and a previously described framework for healthy eating, was used to explore barriers to produce consumption. Interviews were transcribed verbatim; Spanish transcripts were translated into English. Each transcript was coded in Dedoose using deductive and inductive methods by 2 team members; coding discrepancies were resolved by consensus and were thematically analyzed.

Results: The majority of the 26 participants were female (96%), Black/African American (50.0%), and spoke English (69.2%) (Table 1). Three themes were identified (Table 2). First, participants reported that food affordability affects shopping behaviors and produce consumption. Second, tradeoffs are common and affect spending on food, including produce. Parents prioritize paying for rent and utilities over food. They prioritize food over other household needs such as cleaning products and personal care items and purchase specific low-cost foods based on budget. Third, some families receive assistance from relatives, community programs such as food pantries, or government programs (i.e., SNAP, WIC). However, those supports are often inadequate and may not include fruits and vegetables to avoid budget stress related to food. Affordability traps families in a cycle where even food becomes a struggle.

Conclusion(s): Parents experience barriers to buying produce, especially in the overall family budget context, resulting in tradeoffs between healthy food and other household necessities. This affects their consumption of produce and leads to budget-related stress. Access to affordable produce or financial supports for household essentials could increase produce consumption in low-income families. Additional evaluation of interventions aimed at improving access to fresh produce is needed.

Table 1: Participant Demographics
~ No response for 4 participants; ^ No response for 5 participants;
*No response for 1 participant


Table 2