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A SYSTEMATIC REVIEW OF MOBILE MARKET INTERVENTIONS TO ADDRESS URBAN FOOD DESERTS IN THE UNITED STATES
by
Kellee Bornemann
BA, University of Pittsburgh, 2010
Submitted to the Graduate Faculty of
Department of Behavioral and Community Health Sciences
Graduate School of Public Health in partial fulfillment
of the requirements for the degree of
Master of Public Health
University of Pittsburgh
2015
UNIVERSITY OF PITTSBURGH
GRADUATE SCHOOL OF PUBLIC HEALTH
This essay is submitted
by
Kellee Bornemann
on
December 11, 2015
and approved by
Essay Advisor:Martha Ann Terry, PhD ______________________________________Assistant ProfessorBehavioral and Community Health SciencesGraduate School of Public HealthUniversity of Pittsburgh
Essay Reader:Larissa Myaskovsky, PhD ______________________________________Associate ProfessorDepartment of MedicineSchool of MedicineUniversity of Pittsburgh
Copyright © by Kellee Bornemann
2015
ABSTRACT
Food deserts are geographic areas that have poor access to nutritious foods. Previous research
has shown that people living in food deserts are at greater risk for poor nutrition and diet-related
diseases such as obesity, diabetes, and cardiovascular disease. A new type of intervention to
address food deserts is the mobile market intervention, a type of intervention involving travelling
food dispensaries that sell fresh, healthy groceries in food-insecure communities. Although
mobile market interventions are becoming increasingly popular as a means of alleviating food
deserts in urban areas, the literature associated with this type of intervention had yet to be
systematically reviewed. A systematic review was conducted to identify all peer-reviewed,
published literature associated with mobile-based food distribution interventions conducted in
US urban areas. A total of 10 articles met the inclusion criteria and were retrieved and reviewed.
The interventions reviewed included both for-profit interventions that were free-market mobile
produce businesses operated by private vendors, and not-for-profit interventions that were either
community, grant, or research funded. The review suggests that the most successful mobile
market interventions are those that provide affordable quality produce, focus on convenience and
location, and cultivate community trust and community involvement. Overall, the mobile market
interventions reviewed tended to positively affect fruit and vegetable access and consumption
Martha Ann Terry, PhD
A SYSTEMATIC REVIEW OF MOBILE MARKET INTERVENTIONS TO ADDRESS URBAN FOOD DESERTS IN THE UNITED STATES
Kellee Bornemann, MPH
University of Pittsburgh, 2015
among low-income, low access communities. Mobile markets represent a low cost, self-
sustaining, effective method of bringing healthy food to those that need it most. These results
have public health significance because they can help guide future researchers, policy makers
and public health officials in creating effective interventions to address food deserts.
TABLE OF CONTENTS
1.0 INTRODUCTION.........................................................................................................1
2.0 BACKGROUND...........................................................................................................3
2.1 HISTORY OF FOOD DESERTS.......................................................................3
2.1.1 Political History of Food Deserts in the US....................................................3
2.1.2 Definition of a Food Desert..............................................................................5
2.1.3 Methods of Identifying Food Deserts..............................................................5
2.1.4 Public Health Impacts......................................................................................7
2.2 PREVIOUS PUBLIC HEALTH INTERVENTIONS IN FOOD DESERTS. 8
2.2.1 Mobile Market Interventions........................................................................11
3.0 METHODS..................................................................................................................13
4.0 RESULTS....................................................................................................................16
4.1 FOR-PROFIT INTERVENTIONS...................................................................19
4.1.1 Naturally Occurring Mobile Markets..........................................................20
4.1.2 Mobile Markets as a Response to Policy Changes.......................................21
4.2 NOT-FOR-PROFIT INTERVENTIONS.........................................................23
4.2.1 Community and/or Grant Funded Interventions........................................24
4.2.2 Research Funded Intervention......................................................................25
5.0 DISCUSSION..............................................................................................................26
5.1 CHARACTERISTICS OF SUCCESSFUL INTERVENTIONS...................26
5.2 POLICY RECOMMENDATIONS...................................................................32
6.0 CONCLUSION...........................................................................................................35
BIBLIOGRAPHY........................................................................................................................39
LIST OF TABLES
Table 1. Search Terms and Results................................................................................................14
Table 2. Summary of Selected Articles.........................................................................................17
1.0 INTRODUCTION
Chronic diseases are a growing health and economic concern in the United States (US)1. In 2012
nearly half of all adults suffered from a chronic disease, and in 2010 chronic diseases accounted
for 86% of healthcare spending in the US1. A well-known risk factor for chronic disease is
obesity, shown to be associated with higher rates of diabetes, heart disease, stroke and cancer2.
Obesity contributes to $147 billion in medical costs annually and affects nearly one-third of all
American adults1. Additionally, economic and racial disparities in obesity and obesity-related
illness are well established3. There are many risk behaviors that contribute to this public health
problem. One very common and preventable risk behavior is poor nutrition1.
A healthy diet, such as a one high in fruits and vegetables, can help prevent obesity and
chronic diseases such as diabetes, heart disease and cancer4. Unfortunately, many people do not
consume the recommended portions of fruits and vegetables per day5. Low fruit and vegetable
consumption and poor quality diet are especially common among those living in poverty.
Traditional efforts to improve poor nutrition have focused on personal behaviors and
responsibility. However, research suggests that food choices are strongly a matter of automatic
behavior influenced by the food environment6,7, rather than a matter of personal choice.
Inequalities in the food environment, and therefore in food access, especially in low income
communities, may contribute to inequalities in a healthy diet, diet-related illness, and overall
health8. Although researchers have studied disparities in the food environment since the 1960s9,
environmental or community level interventions to address these disparities have only recently
begun to gain support. Interventions that focus on improving food environments may help to
relieve disparities related to obesity and chronic disease prevalence.
Many different types of interventions have been conducted to improve the food
environment in low-income communities. This essay examines one type of intervention called
the mobile market intervention. The purpose of this essay is to provide a systematic review of the
available literature associated with mobile market interventions and how they may help to
improve poor food environments, referred to as “food deserts,” in low-income communities. It is
important to understand the effectiveness and potential benefit of various interventions in order
to guide communities who want to apply them.
Thus, to provide a complete and detailed review of mobile market interventions, this
essay first provides a background on the essay topic, including a description of the political
history of food deserts in the US, how food deserts are defined and identified, the public health
impacts, a review of previous types of interventions, and a general definition of a mobile market
intervention. Next, this essay describes the methods and results of a systematic literature review
conducted to better understand the characteristics and public health impacts of mobile markets.
Finally, a discussion and conclusion is provided to explore the characteristics of successful
mobile market interventions, and future policy and research recommendations.
2.0 BACKGROUND
A first step in a systematic review of mobile market interventions to improve food deserts is to
understand the history of food deserts and food desert interventions. The following chapter first
describes the history of food deserts in the US including government influences, how food
deserts are defined and measured, and what the identified public health impacts have been. Next
it describes previous interventions to address food deserts in the US and evaluates their strengths
and weaknesses. Finally, it introduces and defines the mobile market the intervention.
2.1 HISTORY OF FOOD DESERTS
2.1.1 Political History of Food Deserts in the US
In the United States, the 2001 Surgeon General’s Report first established improving the food
environment as a national priority as a way of preventing and treating overweight and obesity10,
11. The report recommended a multidimensional public health approach to solving overweight
and obesity wherein both individual behavior and community, institutional, and policy
influences are examined and improved10. The guidelines suggested that personal behavior change
can occur only under a public strategy that acknowledges economic and environmental
influences and supports affordable healthy food choices10. Suggestions for action included
researching how and where environmental modifications could support healthier eating and
improving availability and affordability of healthy foods in communities that lacked them,
especially in urban areas10, 11. As a result, many researchers began creating maps to identify
which geographic areas were most in need of intervention11.
As a response to the Surgeon General’s Report, Congress passed the Food, Conservation
and Energy Act of 2008, more popularly known as the 2008 Farm Bill. The bill allowed the
United States Department of Agriculture (USDA) to collaborate with other government entities
including the Economic Research Service, Food and Nutrition Service, Cooperative State
Research, Education and Extension Service, Institute of Medicine, and National Research
Council in order to address issues related to the food environment9. The goals included
addressing how and where disparities in food access existed, identifying the impacts, and
proposing solutions9. In response to the bill, the USDA began studying and classifying
geographic areas based on the area’s access to affordable healthy foods.
By 2009 the Centers for Disease Control and Prevention (CDC) also began working to
better understand and classify the geographic food environment for the purposes of conducting
surveillance, informing policy and developing interventions. By 2011, the White House Task
Force on Childhood Obesity, with assistance from the USDA, US Department of Treasury, and
US Department of Health and Human Services (HHS) brought $400 million in state and federal
funding to the Healthy Food Financing Initiative, an effort to increase access to healthy foods in
poor food environments. These poor food environments were becoming more commonly referred
to by researchers, government and the media as “food deserts.”
2.1.2 Definition of a Food Desert
The term “food desert” was first referenced by researchers in Scotland in the 1990s8, 9, 11 to
describe variations in the presence of food geographically, and has since had many different
definitions worldwide. Some sources define food deserts simply as areas or communities that are
lacking food, while others include concepts of affordability, nutritional quality, and racial
disparities8, 9, 12. The official US government definition of a “food desert” comes from the USDA
and the 2008 Farm Bill9, 11, 13. According to the USDA Agricultural Marketing Service website14,
the official definition is: “an area in the US with limited access to affordable and nutritious food,
particularly such an area composed of predominantly lower income neighborhoods and
communities” (p.1). Most experts would agree that food deserts are usually located in
impoverished and/or urban communities where supermarkets, chain stores, and mid-sized or
large stores carrying nutritious foods are less prevalent8, 14. At this time, there is no standard way
of identifying food deserts15. Throughout the literature, different organizations or researchers use
different definitions, methods and data sources in their approaches9, 13, 16, 17.
2.1.3 Methods of Identifying Food Deserts
Most approaches to identifying food deserts begin by measuring access to “supermarkets” in
some way. In most of the literature, access to a supermarket tends to represent access to healthy
food because it is agreed that supermarkets are the nation’s primary source of various types of
affordable, quality produce16, 17. A standard definition of a supermarket is a store that sells each
major food group and produces at least $2 million in annual sales17; however, many
organizations and researchers use varying definitions. Many different approaches are used to
measure access to supermarkets. These include measuring distance to the closest store,
identifying the presence of a store that is within walking distance, and measuring the balance of
different food retailers9, 12, 13, 16. For example, the USDA considers a geographic area a food desert
if it is beyond a certain distance to a supermarket, 14, 16, 17 and specifies urban food deserts as
being areas >1 mile from a supermarket and rural food deserts as being areas >10 miles from a
supermarket14, 16, 17. Alternatively, some researchers prefer to measure “balance” of foods, rather
than distance to foods, by looking to see whether certain geographic areas have an even
distribution of stores with healthy offerings (such as supermarkets or grocery stores), versus
stores with unhealthy foods (such as convenient convenience stores and fast food
establishments)9, 12.
Researchers and organizations also use different units to identify food deserts. Many use
geographic boundaries as a starting point. The USDA primarily uses census tracts as the main
unit of analysis because data to describe these boundaries are easily available14. The USDA has
also used different methods such as a 1x1 kilometer grid16. Other more local efforts might begin
with zip codes or neighborhood boundaries within a city or community16. Thus, studies may
show very different results13 depending on the methods used to identify a food desert.
The differences in how researchers identify “food deserts” contribute to discrepancies in
describing their impact. For example, the USDA and the CDC each uses different methods for
identifying food deserts13. The CDC method identifies approximately 30% of census tracts as
food deserts, while the USDA method identifies only 12%13. Researchers Liese et al. attempted
to standardize and re-compare the two methods to create a more consistent description. However,
even after standardizing, the researchers found the CDC method to identify 29% prevalence
while the USDA method identified only 22.5%, with only 71% consistency between the two
methods13. Likewise, when Jiao et al. tested multiple methods of measuring physical and
economic access to supermarkets, they found that food deserts were identified differently
depending on the method used, and that the access for low income individuals may be even
lower than is described in much of the literature16. Taking the USDA definition of foods desert as
the national standard, approximately 23.5 million Americans live in food deserts14.
2.1.4 Public Health Impacts
Although researchers may disagree on exactly how to identify food deserts and their prevalence,
the public health impact has been well demonstrated. Due to poor access to healthy food sources,
individuals in food deserts rely heavily on processed foods, known to be associated with diet
related illnesses14. Mapping has shown that people living in food deserts are at greater risk for
poor nutrition and diet-related diseases such as obesity, diabetes, and cardiovascular disease9, 17,
18. Additionally, food insecurity, which is common in food deserts, has been shown to be
associated with hypertension, hyperlipidemia, uncontrolled diabetes, and cardiovascular disease
among National Health and Nutrition Examination Survey (NHANES) participants19. Increased
access to convenience stores, common sources of food in food deserts, is also associated with
increased risk of obesity8. Conversely, living in a non-food desert is associated with better health
overall8, 20, 21. Research has shown that individuals with greater access to supermarkets tend to
have increased fruit and vegetable consumption and higher diet quality, and be generally less
overweight or obese8, 20, 21. For example, Dubowitz et al. showed that women who reported
having supermarkets close to their homes also reported having lower BMIs20. Morland et al.
showed that people living in census tracts with more supermarkets tended to be 24% less obese
and 9% less overweight21.
The effects of food deserts on diet quality may particularly impact childhood
development17, 22-24. Poor nutrition in children has been shown to be associated with impaired
cognitive development, poor social skills, and higher rates of childhood obesity17. Food
insecurity has also been shown to lead to emotional problems in youth22. On the other hand,
children with better diets experience better cognitive functioning, higher IQs, and higher test
scores17. Research on the effects of food deserts on child health and development show similar
findings17, 23, 24. Schafft et al.’s study in the state of Pennsylvania showed that the percentage of
overweight children in a particular school district was related to the percent of children living in
food deserts in that district24. Similarly, Sturm et al. showed that affordability of fruits and
vegetables was related to body mass index (BMI) in children23. Frndak showed that living in a
food desert and having low income predicted poor academic achievement in 4th graders17.
2.2 PREVIOUS PUBLIC HEALTH INTERVENTIONS IN FOOD DESERTS
The potential health impacts of food deserts demand a need for public health intervention. A
review of the recent literature shows that there have been many different types of interventions
and studies aimed at increasing access to healthy, affordable foods in food deserts. Some
interventions have worked with large retailers and chain stores to encourage and incentivize
them to open new stores in underserved areas9, 25. Similarly, some interventions have worked to
assist and incent smaller, existing stores to increase their supply of fresh fruits and vegetables9.
Other interventions have aimed to encourage the expansion of farmer’s markets, develop
community gardens, and implement zoning laws against fast food establishments9, 25. However,
there have been mixed results as to the effectiveness of any of these types of interventions on
diet and community health.
Dubowitz and colleagues conducted a natural experiment in two low-income,
predominantly African American food-desert neighborhoods in Pittsburgh, Pennsylvania26. The
study followed a cohort of individuals living in two food-desert neighborhoods, one of which
gained access to a new, full-service grocery store26. The authors showed that although a new
supermarket opened, 76% of the residents living in the neighborhood already travelled to and
shopped at a preferred supermarket prior to the intervention, and continued to shop at their
preferred store after the intervention, rather than at the new store26. This was troublesome
because the preferred stores were often far from the neighborhood (anywhere from 2.7-7.9 miles
away), which could mean increased travel costs, decreased food budget, and less frequent store
trips. Their results imply that simply opening new, nearby supermarkets does not guarantee that
residents will shop at those markets, and developing strategies to encourage residents to shop at
new stores may be necessary.
Similarly, Cummins and colleagues conducted surveys of two Philadelphia food desert
neighborhoods before and after the opening of a new supermarket in one of the neighborhoods27.
This was a natural experiment as the new supermarket was a result of existing efforts by the
Pennsylvania Fresh Food Financing Initiative27. The researchers found that the intervention
improved residents’ perceptions of grocer choice, quality, fruit and vegetable choice, fruit and
vegetable quality, and perceived costs27. However, the intervention did not affect the residents’
BMIs or actual fruit and vegetable intake, and many residents did not use the new store. These
results suggest that additional efforts are necessary27 to encourage individuals to change their
current shopping habits.
Langellier et al. conducted a systematic literature review of “corner store conversion”
interventions. This type of intervention involves working with local corner stores or convenience
stores to improve their selections of healthy foods such as fresh fruits, vegetables and whole
grain items25. The research team reviewed ten studies of corner store conversion interventions in
food deserts and found mixed results. Although some studies showed increases in healthy
purchases and positive psychosocial factors such as self-efficacy, knowledge, attitude, and
intention, others did not find these changes25.
Jilcott-Pitts et al. studied the effects of farmers’ markets in rural areas with high obesity
rates and low access to fresh fruits and vegetables28. Their study surveyed residents of two
geographic areas regarding their food shopping habits, perceived barriers to shopping at farmers’
markets, fruit and vegetable consumption, and BMI28. They found the use of farmers’ markets to
be positively associated with fruit and vegetable consumption, but not with BMI28. They also
found perceived barriers to the use of farmers’ markets to include the days and hours of
operation, location, and weather28. Their study suggests that interventions similar to farmer’s
markets may be successful at improving fruit and vegetable intake if perceived barriers to access
can be addressed.
A few studies have looked at community gardens as a means of addressing food deserts.
Barnidge et al. conducted surveys with community garden participants in rural Mississippi to
explore if garden participation increased fruit and vegetable consumption29. Individuals who
reported participating in community gardens consumed on average two more fruit and three
more vegetables per day than individuals who did not participate29. However, they also found
that only 5% of the population participated in these gardens29. Focus groups conducted by
Haynes-Maslow et al. suggest that while community members agree that community gardens
may increase fruit and vegetable consumption, they worried about the feasibility and
implementation of these types of interventions. Perceived barriers included concerns about
safety, time commitments vs. reward, and costs for lower income individuals30. These concerns
may limit some communities from benefiting from this type of intervention.
Other research has studied low-income or food-desert community members’ perceptions
and opinions of barriers and solutions for addressing food access. In these studies, community
members identified barriers such as mistrust of store owners, history of retailers offering poor
quality produce, unfamiliarity with healthy foods, fear of crime, transportation or perceived
distance, cost, convenience, availability and variety15, 30, 31. Community members from one study
identified as facilitators having good customer service, employing trustworthy vendors, building
relationships with community members, and offering tips for storing and cooking their
products30.
2.2.1 Mobile Market Interventions
A new type of intervention, which may address some of the community input and research
findings described above, and the focus of this research paper, is the mobile market intervention.
Mobile markets are food dispensaries that travel from place to place to sell or distribute fresh,
healthy foods such as fruits and vegetables in food-insecure communities32. These interventions
usually involve large trucks, buses, trailers, vans or carts equipped with special features such as
refrigeration, cash registers, food safety features, and storage33. The mobile markets typically
operate during regular times and in pre-specified locations, and sometimes work with other
community organizations and local food providers. In theory, mobile markets allow food
retailers to cover larger geographic areas than traditional supermarkets and are less expensive as
they need fewer resources and lower start-up costs33. Successful mobile markets have the
potential to address barriers and facilitators to food access by relieving travel costs, offering
convenient and affordable products, providing trustworthy service, and ultimately supplying high
quality produce that may not otherwise be available. Mobile market interventions, when
implemented properly, may help to address the public health issue of food deserts in the US.
Although mobile market interventions are becoming increasingly more popular as a means of
alleviating food deserts in urban areas, the research on them is scarce, and the literature
associated with this type of intervention has yet to be systematically reviewed. A systematic
review of the literature associated with mobile market interventions is needed to help identify
components of successful interventions that can be used to guide future programs.
The purpose of this essay is to provide a systematic review of the available literature
associated with mobile market interventions to address food deserts. This paper addresses three
research questions related to mobile markets. First, what types of mobile market interventions
have been developed to address the issue of food deserts in urban areas in the United States?
Second, have mobile market interventions been successful in providing nutritious foods to urban
food deserts? Third, what are the components or characteristics of successful mobile market
interventions?
3.0 METHODS
A focused literature search was conducted to identify all peer-reviewed, published literature
associated with mobile-based food distribution interventions conducted in US urban areas. In
order to be included in the review, articles had to (1) describe mobile-based interventions aimed
at improving the food environment, (2) report on projects conducted in the US, (3) be published
in English, and (4) describe programs conducted in an urban area. Any article that included an
outcome evaluation related to the presence of a portable or traveling dispensary (such as a truck,
van, or cart) was included. Any type of intervention that attempted to supply healthy foods such
as fruits and vegetables in any form, including prepared foods, was included in the search. Only
articles published after 1995 were included in the search because that was the year when the term
“food desert” was first introduced into the lexicon.
A search log (see Table 1) was created to document the date, search engine, terms, and
number of articles produced for each search conducted. To identify references, a search was
conducted in the PubMed database. The search took place between September 17 and September
23, 2015. Among the search terms were mobile market/s, food desert/s, mobile, intervention,
mobile food vendors, mobile food interventions, fruit and vegetable, produce, food truck, fruit
and vegetable carts, produce carts, food carts and grocery carts (see Table 1)for additional details
on search terms). To identify additional references a hand search was conducted of the reference
lists of the identified relevant articles.
Table 1. Search Terms and Results
Date Search Engine Search Terms Number of Articles
Produced
Number of Articles Kept
for Review9/17/15 PubMed “mobile
markets”6 3
9/17/15 PubMed “food deserts” AND mobile
3 1
9/17/15 PubMed “mobile food vendors”
11 4
9/17/15 PubMed Mobile food interventions
56 0
9/17/15 PubMed “fruit and vegetable” AND mobile
30 6
9/17/15 PubMed “mobile” AND “produce” AND “intervention”
33 3
9/17/15 PubMed Food truck intervention
19 0
9/20/15 PubMed “mobile market” AND “food desert”
1 1
9/20/15 PubMed “mobile market” AND “food deserts”
2 1
9/20/15 PubMed Mobile market intervention
5 0
9/20/15 PubMed Fruit and vegetable carts
8 3
9/20/15 PubMed Produce carts 8 09/20/15 PubMed Food carts 42 09/20/15 PubMed Grocery carts 14 09/23/15 Reviewed
reference pages of relevant articles
N/A 6 0
The abstracts of all returned articles were reviewed for relevance and duplicates, and a
final sample of ten articles was obtained and reviewed. The sample of articles was organized and
analyzed to address the research questions specified above. The initial search of the PubMed
database returned 244 articles. A hand search of the reference pages of identified articles
returned six additional articles. The total articles returned were 250. Titles and abstracts of all
250 articles were reviewed for the inclusion criteria and all articles that met the inclusion criteria
were retrieved.
4.0 RESULTS
After reviewing the titles and abstracts of all 250 returned articles, 17 articles were retrieved. Of
those not retrieved, most did not describe relevant topics or outcomes related to mobile based
food interventions. Of the 17 articles were retrieved, a total of 10 articles were included. Of the
articles not included, one was not a study, five had irrelevant outcomes or comparisons, and one
was not conducted in the United States. Table 2 lists all of the relevant details regarding the final
set of articles included in the review. All of the articles were from sources published between
2011 and 2015. All of the described interventions took place in U.S. cities. One of the
interventions which took place in multiple cities included four sites, two in Chicago and DC, and
two in rural Stephenson WA and Madison WI. Although this intervention included a rural
component, it was determined to be relevant to this review and was included. Nine of the 10
articles took advantage of natural experiments, wherein they evaluated interventions that were
being conducted independently of the researchers (for example by a private organization,
government program or independent vendor). Only one of the 10 sources reported on a short
term research funded intervention.
The mobile market interventions identified can be organized into two main categories:
‘for profit’ (free market) mobile market interventions and ‘not for profit’ mobile market
interventions. Seven of the articles described ‘for profit’ or free market interventions and three
described ‘not for profit’ interventions that were grant, community or research funded. The
following sections describe each category of mobile market and their accomplishments and
limitations.
Table 2. Summary of Selected Articles
For-Profit InterventionsAuthors Title Journal Year of
PublicationLocation of Intervention
For-Profit?
Margaret Leggat, Bonnie Kerker, Cathy Nonas, and Elliot Marcus
Pushing Produce: The New York City Green Carts Initiative
Journal of Urban Health
2012 New York City, New York
Yes
Sean C. Lucan, Andrew Maroko, Renee Shanker, and William B. Jordan
Green Carts (Mobile Produce Vendors) in the Bronx- Optimally Positioned to Meet Neighborhood Fruit-and-Vegetable Needs?
Journal of Urban Health
2011 Bronx New York City, New York
Yes
Kathleen Y. Li, Ellen K. Cromley, Ashley M Fox, Carol R. Horowitz
Evaluation of the Placement of Mobile Fruit and Vegetable Vendors to Alleviate Food Deserts in New York City
Preventing Chronic Disease: Public Healthy Research Practice, and Policy
2014 New York City, New York
Yes
Katherine Wright, Lauren Anderson
Comparing Apples to Oranges: Comparative Case Study of 2 Produce Carts in Chicago
Preventing Chronic Disease: Public Healthy Research Practice, and Policy
2014 Chicago, Illinois
Yes
Sean C. Lucan, Andrew R. Maroko, Joel Bumol, MonicaVarona, Luis Torrens, Clyde Schechter
Mobile Food Vendors in Urban Neighborhoods- Implications for Diet-Related Health by Weather and Season
Health Place 2014 Bronx New York City, New York
Yes
Christine Brinkley,
Tradition of Healthy Food
Journal of Agricultural
2013 Philadelphia, Pennsylvania
Yes
Table 2 Continued
Not-For-Profit InterventionsAuthors Title Journal Year of
PublicationLocation of Intervention
For-Profit?
June M. Tester, Irene H. Yen, Barbara Laraia
Using Mobile Fruit Vendors to Increase Access to Fresh Fruit and Vegetables for Schoolchildren
Preventing Chronic Disease: Public Healthy Research Practice, and Policy
2012 Oakland, California
No
Rayane Abusabha, Dipti Namjoshi, Amy Klein
Increasing Access and Affordability of Produce Improves Perceived Consumption of Vegetables in Low-Income Seniors
Journal of the American Dietetic Association
2011 Troy, New York; Albany, New York
No
Lydia Zepeda, Anna Reznickova, Luanne Lohr
Overcoming Challenges to Effectiveness of Mobile Markets in US Food Deserts
Appetite 2014 Chicago, Illinois; Washington DC; Stephenson Washington; Madison Wisconsin
No
4.1 FOR-PROFIT INTERVENTIONS
Seven of the identified articles described ‘for-profit’ interventions. These were free-market
mobile produce businesses operated by private vendors and primarily profit-driven. Of the seven
‘for-profit’ interventions reviewed, five described mobile markets that were a response to recent
policy changes encouraging mobile produce vending, and two described mobile markets that
were naturally occurring, or not occurring as a result of policy or outside intervention.
Table 2 Continued
4.1.1 Naturally Occurring Mobile Markets
This review found mixed results regarding naturally occurring, for-profit mobile markets. In one
study, Brinkley, Chrisinger, and Hillier describe naturally occurring curbside produce vendors in
low-income neighborhoods in Philadelphia, Pennsylvania34. The authors surveyed 11 curbside
vendors to evaluate their fruit and vegetable offerings and their impact on low-income, poor
health areas34. They found that the vendors tended to locate nearby other supermarkets (0.4 miles
on average) or commercial districts rather than in food deserts34. While most of the vendors
operated out of the back of box trucks with mobile capability, 10 of the 11 vendors chose to
remain mainly stationary, selling from one primary location34. Only one vendor was mainly
mobile34.
Six of the 11 vendors accepted Supplemental Nutrition Assistance Program (SNAP)
benefits, making their produce more affordable for low income individuals34. On average,
vendors offered 35 varieties of produce.34 The curbside vendors tended to offer less variety than
large supermarkets, but variety similar to smaller or medium grocery stores34. The prices at the
curbside vendors on almost all items tended to be lower when compared to supermarket prices.
Quality of produce was not reported. Vendors who had large customer bases and were long
standing reported relying primarily on word-of-mouth and personal relationships with
community members34. They often provided customers with informal lines of credit, or donated
some of their products to community functions34. They also catered to their community’s cultural
preferences, often supplying unique products customers could not get elsewhere34.
Vendors reported locating near existing supermarkets so that their customers who were
already shopping at the large supermarkets did not have to go out of their way to shop at the
curbside market34. Overall, successful vendors tended to rely on affordable prices and
community relationships34. The authors reported barriers to this type of business model including
difficulties obtaining permits, and logistical and facility challenges. Policy changes that
addressed these barriers could help encourage this type of intervention. However, one limitation
to using this natural model as a public health intervention is that market factors encourage
vendors to locate near existing supermarkets. For this reason, for-profit vendors are likely to
locate in areas that already have high quality food access, rather than in food deserts34.
Lucan et al. also studied naturally occurring mobile food vendors in the Bronx, New
York. The authors compared the characteristics and influences of mobile vendors (street
vendors) who offered less healthy foods to vendors who offered healthy foods35. Less-healthy
food vendors included those that offered packaged, prepared, or processed foods, whereas
healthy-food vendors included those that offered whole, fresh produce35. They found that when
not regulated by policy, healthy-food vendors were outnumbered 3:1 by unhealthy-food
vendors35. The unhealthy-food vendors tended to locate in poorer neighborhoods compared to the
healthy-food vendors, and the presence of unhealthy-food vendors was related to poor diet and
poor health35. While mobile vending can bring resources to food deserts at lower costs than
permanent stores, these findings suggest that naturally occurring healthy-food vendors do not
open in food deserts where they are most needed35. Rather, vendors of unhealthy food tend to
open in these areas, further disadvantaging underserved populations and impacting health35.
4.1.2 Mobile Markets as a Response to Policy Changes
In some underserved urban areas where fruit and vegetable consumption is low, public health
departments have implemented policy changes to encourage mobile produce vending36-40. One of
these public health efforts is New York City’s (NYC) “Green Carts.” The Green Carts program
was created in 2008 by the NYC Department of Health and Mental Hygiene (DOHMH)36-39.
Under the program, the DOHMH agreed to grant up to 1,000 permits for free-market, for-profit
mobile street vendors or “green carts” to sell whole fresh fruits and vegetables in NYC’s most
underserved areas where these items were not previously available36-39. The green carts are
permitted to travel freely within designated geographic areas (pre-defined by the DOHMH as the
areas having the lowest fruit and vegetable access and consumption and the highest obesity rates)
and are intended as a low-cost way to improve fruit and vegetable consumption and overall
health in those areas, with only minor resources needed36-39. Four of the five articles in this
category examined the New York City Green Carts program.
Based on this review, mobile market programs as a response to policy changes have
experienced some successes and some limitations. According to Leggat et al. and NYC’s
DOHMH evaluations of the program, from 2008-2009 the sale of fresh fruits and vegetables
increased in areas that were granted Green Cart permits compared to areas that were not36. When
the fruit and vegetable sales directly associated with Green Carts were removed from analysis,
results still showed an increase in fruit and vegetable sales in the Green Carts areas, suggesting
that Green Carts encouraged the sale of fresh fruits and vegetables by other types of vendors as
well36. Similarly, Breck and colleagues showed that allowing the use of SNAP benefits at Green
Carts increases fruit and vegetable spending by $3.8639 (and presumably consumption), and that
SNAP customers reported spending more at Green Carts than at other types of food retailers39,
which may encourage other retailers to lower their prices on produce.
However, some researchers found limitations in the Green Cart program’s ability to
address the issue of food deserts. Lucan et al. and Li et al. both showed that Green Carts, while
operating in the specified “underserved” boundaries, tended to cluster near high-traffic,
commercial locations37, 38. Popular locations included medical centers, academic institutions,
transportation areas such as subway stops, retail centers with other grocery vendors, and
recreational centers37, 38. Li et al. showed that only 7% of the carts studied were located in food
deserts, while the rest were located in areas where food stores already existed38. Based on these
location patterns, the most disadvantaged areas and individuals are likely to remain
disadvantaged.
Somewhat different results were found in a study of a similar program by the Chicago
Department of Public Health (CDPH). In 2012 the CDPH legalized mobile produce vending
throughout the city of Chicago as long as 50% of vendors operated in designated underserved
areas40. Wright and Anderson showed that these vendors also tended to cluster in more central,
high commercial areas (sometimes illegally locating outside the specified zones)40. However,
mapping by the researchers showed that centrally located carts actually reached more
underserved individuals than did carts that were located inside underserved neighborhoods. This
may have been due to the number of people who live in underserved neighborhoods but who
pass through more central areas on their way to work, appointments, school, or other places40.
These results suggest that convenience of a location may be more important than the distance of
the locations from an individual’s home.
4.2 NOT-FOR-PROFIT INTERVENTIONS
Three of the identified articles described ‘not for profit’ interventions. These interventions were
either community, grant, or research funded and operated primarily for the public health purpose
of providing fresh food to underserved individuals. Of the three ‘not for profit’ interventions, two
were community or grant funded and one was research funded.
4.2.1 Community and/or Grant Funded Interventions
These interventions were shown to have multiple positive influences on the communities they
served. The first was the “Veggie Mobile,” a mobile market intervention operated by Capital
District Community Gardens in Troy, NY41. The Veggie Mobile launched in 2007 and is
operated via grant funding and community donations41. The market travels by box truck to low-
income neighborhoods selling wholesale produce 48% cheaper than local supermarket prices41. It
sells 50-75 varieties of fruits and vegetables and has 22 weekly stops including senior centers
and public housing projects41. Abusabha, Namjoshi, and Klein studied the effects of the Veggie
Mobile in the low-income seniors that it serves41. First, they showed that the market decreased
trips to the supermarket for seniors, potentially relieving mobility and transportation challenges,
and reducing the costs and burden of travel41 for many. They also showed that those who used
the Veggie Mobile spent $29 less on average at the supermarket than those who did not41.
Finally, they showed that among seniors who used the Veggie Mobile, the percent of participants
meeting the daily fruit and vegetable consumption recommendations increased from 33% to
51%, with average fruit and vegetable consumption increasing by approximately 0.37 servings
per day41. Of shoppers surveyed, 86% reported the Veggie Mobile as having lower prices and
better quality than the supermarket, and 73% reported more variety41.
Zepeda, Reznickova and Lohr also studied community and/or grant funded mobile
market interventions by conducting focus groups of mobile market shoppers and non-shoppers at
four mobile markets across the country sponsored by various non-profit organizations33. Like
Abusabha et al, this study showed that among mobile market shoppers, vegetable consumption
increased33. The researchers found that mobile market shoppers ate an average of 3.5 servings of
fruits and vegetables per day, whereas non shoppers ate 2.0 servings per day33. However,
limitations included the mobile market’s inability to affect those who do not shop there. Focus
groups with non-shoppers revealed the main barriers to mobile market shopping to be knowledge
and perceptions of the market, lack of familiarity, perceived affordability, convenience, value
and service, and trust33.
4.2.2 Research Funded Intervention
Only one of the 10 articles reviewed described a purely research funded project. The intervention
by Tester, Yen and Laraia looked at the implementation and effectiveness of mobile fruit and
vegetable vendors in school zones in Oakland, California. The intervention market was given
permission to operate for 14 days, before and after school, selling pre-cut bags of fruits and
vegetables to school children for $1.50 each. In the 14 days the researchers sold 248 bags. Also,
for each of the 14 days that the market was open, sales from the intervention market increased by
one bag per day, while sales from competing non-healthy vendors (such as ice cream or cotton
candy vendors) decreased by 1.5 bags per day, suggesting that the longer the intervention market
was open, the more students purchased fruits and vegetables and the less they purchased the non-
healthy items. The researchers showed that, when available, children chose fruits and vegetables
to replace their typical non-healthy purchases, and suggested that mobile markets might solve
some issues of healthy snack options in low-income schools.
5.0 DISCUSSION
These results show that only a limited number of mobile market interventions have actually been
evaluated for their effectiveness in providing nutritious food to urban food deserts. Some of the
interventions reviewed were naturally occurring free market businesses, some were non-profit or
research efforts, and some were responses to policy changes. Overall, these interventions tended
to positively affect fruit and vegetable access and consumption among low-income, low access
communities. Across interventions, some aspects or features of programs seemed to be more
successful than others. In general, the most successful interventions tended to be those that
provided affordable quality produce, focused on convenience and location, and cultivated
community trust and community involvement.
5.1 CHARACTERISTICS OF SUCCESSFUL INTERVENTIONS
Affordability of produce tended to be a major contributor to a mobile market’s success in a
community33, 41. Many individuals have reported thinking of fruits and vegetables as luxury
items, and shy away from these purchases if they perceive them to be prohibitively expensive or
of low quality33. Individuals tend to buy more fruits and vegetables when these items are more
affordable, and tend to try a new business (such as the mobile market) if it has lower costs than
their usual supermarket. One feature that allowed some mobile markets to provide more
affordable products (compared to other mobile markets) was accepting SNAP benefits. Markets
that accepted SNAP benefits tended to be more successful and do more business, especially with
low income individuals, than markets that did not34, 36. Additionally, individuals who used SNAP
at mobile markets tended to spend more money on produce than individuals who did not, and
tended to report purchasing produce from mobile markets more frequently39. This may be
because individuals who use SNAP have previously experienced more barriers to purchasing
healthy foods. When mobile markets address these barriers SNAP users may be more likely to
frequent and purchase produce from them. Moreover, when a market accepts SNAP, SNAP users
have a larger spending budget when shopping at that market, making it more likely that they
might spend some of their budget on produce even if they perceive these items to be more
expensive. Thus, accepting SNAP may help contribute to the overall goals of the market.
Other qualities that allowed mobile markets to provide lower cost produce included
operating simple, non-complicated programs, focusing on staple items, and having low start-up
costs and small staff. All of these qualities contribute to overall lower operating costs of the
mobile market, which could decrease the price of the market’s produce. By providing more
affordable produce than traditional grocery stores, successful mobile markets can not only supply
affordable products to their customers, but can also reduce the amount that their customers spend
at other grocery stores36, 41, 42. This type of market competition may encourage other grocery
stores to lower their own produce prices in order to increase sales, ultimately reducing the cost
and increasing the accessibility of fresh produce throughout the entire community. In this way,
affordable produce from mobile markets encourages fruit and vegetable consumption in the
community overall, even for community members who do not shop at the mobile market.
This phenomenon was demonstrated by Leggat et al. They found that fruit and vegetable
sales increased overall in areas where NYC green carts were located because when fruit and
vegetable sales directly associated with green carts were removed from analysis the increase
remained36. To elaborate of the potential process that may be occurring, low costs and
convenience associated with produce from mobile markets may pull customers away from other
retailers, who then must promote their fruit and vegetable purchases through strategies such as
sales, sampling, or advertising. These sale strategies may then further drives down the costs of
produce, contributing to overall increased sales by all parties as individuals are more likely to
purchase lower cost produce. Ultimately, this process may encourage overall increased
consumption among the affected community. Even in situations where mobile market prices are
not competitive enough to affect other businesses, the presence of mobile markets in general
might contribute to an overall culture of healthy shopping, cooking and eating in the community.
Convenience and location of the mobile market were other features that seemed to predict
a market’s success. Individuals who shopped at mobile markets reported convenience as a
primary motivator33, 41. Individuals also reported wanting to know when and where a market
would be open, and wanted the market to be open during convenient hours and in popular
community locations33. Considering these results, it may be important for mobile markets to base
their operation hours and locations on the needs of the communities they serve. However, what
constitutes a convenient time or location may vary depending on the community and on the
individual residents. For example, residents who are elderly, who work evenings or who have
children in school may prefer more daytime hours, whereas residents who work daytime hours
may prefer more evening and weekend hours. Likewise, parents may prefer schools or childcare
centers as convenient market locations, whereas elderly residents may prefer churches or
community centers, and disabled residents or those without transportation may prefer locations
close to home. In these cases, it may be challenging for a mobile market to be convenient to all
community members.
While for-profit mobile market hours and locations are primarily dictated by sales, labor
costs, and permitting, not-for-profit mobile markets may have a unique ability to operate at hours
and locations that best serve their target population. One strategy may be for mobile market
operators to speak with or survey community members before opening a new market to learn
what times and locations best serve the community. Markets that offer convenient hours and
locations may be able to attract more customers and sell more produce than markets that do not,
contributing to sustainability of the market and overall increased fruit and vegetable consumption
in the locations they serve.
An issue that seemed to arise among for-profit mobile markets, such as Green Carts, was
economic influences that drove vendors to locate in more profitable areas rather than more
underserved areas. In these instances, some of the articles reviewed37, 38 suggested that these
types of mobile market models did not achieve their ultimate goal of increasing access to healthy
foods in food deserts. However, even in these circumstances, the mobile market may still have
some effect on underserved individuals. One article40 suggested that centrally located carts
actually reached more underserved individuals than did those inside underserved neighborhoods,
possibly due to the convenience of these carts. The food environment is complex, and although
most definitions of food deserts consider the presence of healthy food near an individual’s home,
individuals buy food in places beyond their neighborhood as well. For-profit vendors that operate
in more commercial locations may still be able to reach underserved individuals by increasing
the supply of fresh foods where individuals work, travel, or frequent. Ultimately, mobile markets
must determine which locations best serve their specific target population while also reaching
enough customers to sustain the market.
Essentially, a major appeal of mobile markets is that they can go places individuals are
already going, making them convenient suppliers. In some studies, vendors purposely located
near other grocery stores because they knew their customers were already going there and did
not want them to have to go out of their way34. In this way, locating near more commercial areas
may actually represent a strategy of customer or community consideration, where vendors tailor
their locations to the customers’ or community needs. This approach represents perhaps one of
the most important aspects of a successful mobile market intervention: community consideration,
trust and involvement.
In nearly every intervention reviewed, community trust and involvement contributed to
mobile market success. When one study conducted focus groups with mobile market shoppers
and non-shoppers, the researchers found that non-shoppers did not use mobile markets because
they perceived them to be exclusive, uninviting, and unfamiliar33. Non-shoppers identified lack
of trust, familiarity, comfort, and awareness as barriers to use of the market33. Markets that
advertise in central community locations or cultivate community involvement and engage
community members may be more successful at overcoming these barriers. For example, one
successful mobile market hired local high school students from the community it served33.
Another program primarily hired community members who had experienced barriers to
employment40. When examining the Green Carts program, researchers found that support of
community organizations and having vendors who spoke the language of the communities they
served predicted carts’ success36. Much of the research showed that when people chose to shop at
mobile markets, they did so for the social and community building aspect of it. Some for-profit
mobile markets reported that the success of their business was due to their community
relationships and word-of-mouth advertising by their customers. These markets tended to cater to
their community’s tastes and cultural preferences, as well as maintaining customer relationships
through strategies such as offering informal lines of credit or providing special products34, 36.
Community engagement might be important to successful mobile markets for a number
of reasons. First, it is important because it can affect perceptions of the other influencing factors
(i.e., affordability and convenience). If community members feel engaged with the market, and
trust the managers and/or mission of a local mobile market, that might affect how they perceive
the quality and cost of the food supplied. Trusting that market vendors have their best interests in
mind, community members may be less likely to fear being taken advantage of by poor quality
or over-priced food. For non-profit mobile markets, if community members understand the non-
profit’s goal is to help the community, they may be more accepting of the mobile market’s
limited variety of products, fixed costs or operating hours.
Community engagement may also be important to the success of the mobile market
because it contributes to sustainability. When mobile markets build relationships with the
community and with customers, the market may be able to better meet the community’s and
customers’ needs and the customers may be more likely to come back to the market, or to choose
the market over their usual grocery store, contributing to sustainability. In a circular way, the
sustainability of the mobile market model may then help to cultivate additional community trust.
For example, many past attempts at addressing food deserts have involved opening new
traditional brick and mortar food stores. However, the problem with this approach is that these
stores are often resource intensive and expensive to maintain. The closing of large brick and
mortar stores in low-income communities where this model is not economically viable can create
mistrust among community members and be harmful to the overall public health mission.
Because of the sustainability of mobile markets, they may be a more reliable way of creating and
maintaining community trust and buy-in.
5.2 POLICY RECOMMENDATIONS
Communities and governments can do many things to promote sustainability and effectiveness of
mobile markets as a means of relieving food deserts. One recommendation is for governments to
create policies that are supportive and encouraging of the mobile market model. For example,
one would be making it easier for mobile markets to accept SNAP benefits. Currently, in order
for a business to accept SNAP the business must first apply for, pay for, and install an Electronic
Benefit Transfer (EBT) system. Obtaining an EBT system can be potentially burdensome and
costly for non-profit programs or small retailers. In order to encourage the acceptance of SNAP
at mobile markets, governments might consider policies that waive or supplement the costs of
this process for mobile market vendors. Another example would be policies that make it easier
for mobile markets to obtain and afford a permit to operate. Policies that help simplify the
permitting process or waive permitting fees may help relieve some of the burden involved in
starting a mobile market.
Policy makers might also consider ways to incentivize for-profit mobile markets to locate
in underserved areas. For programs such as NYC’s Green Carts, the program administers permits
only to vendors who agree to operate in pre-specified underserved areas. Other programs might
consider offering fee waivers or small business loans for mobile market operators who agree to
operate in certain underserved areas or to sell a certain percentage of healthy foods. Programs
could also offer additional support or incentives to low-income or underserved residents who
would like to open mobile markets in their own communities. Such a policy may make it more
likely that the market will serve a needy community and gain community support and buy-in, as
well as contribute to the economic development of the neighborhood.
Mobile markets that are mission-driven (such as those operated by non-profit
organizations) rather than profit-driven may be the best way to provide fresh healthy food to
underserved populations such as the elderly or the disabled. In order to encourage non-profit
organizations to develop these types of programs, cities with large urban food deserts should
make funding available for this cause. Funders might then stipulate operating rules that
encourage the success of the market, such as target populations, time and location requirements,
or price thresholds. Funders might require that the mobile market be staffed by community
residents and meet certain operation standards such as offering a certain percentage of high
quality local or organic produce. These types of requirements can ensure that the program uses
the best practices available to meet its mission and enhance the community it serves.
Policy makers should also take existing research findings into consideration when
developing mobile market policies or programs. For example, focus groups with mobile market
shoppers and low-income community residents have shown that residents are unfamiliar with a
lot of the produce sold at mobile markets and want more information about how to use these
foods. Policy makers might consider partnering with mobile markets to administer educational
materials such as information on serving recommendations, or recipe cards that encourage home
cooking and the use of new ingredients. Prior research has also shown that it takes more than just
opening a new store or mobile market to change people’s existing shopping habits26. New mobile
markets should develop strategies for encouraging community members to try shopping at a new
location. Such strategies may include advertising the mobile market, or offering vouchers or
coupons to new shoppers. New policies and programs should rely on lessons available in the
literature to use and build on existing research and evidence.
6.0 CONCLUSION
The study of food deserts as an environmental determinant of obesity and diet related illness, and
how to intervene in underserved communities has been a national public health priority in the
U.S. since the early 2000s. A great deal of research has been conducted to show the negative
health effects of living in a food desert, and many different types of interventions have been
tested to address them. Previous interventions have included incentivizing supermarkets to open
in underserved areas, increasing fruit and vegetable supplies among existing corner stores and
small grocers, and expanding farmers markets and community gardens. However, many of these
interventions have proved to be costly and have shown limited impact. Though mobile market
interventions are becoming increasingly popular among policy makers and non-profit
organizations as a way to better serve food-poor urban areas, the literature on this topic has not
been systematically reviewed.
When it comes to mobile markets as a public health intervention, market “success” can
be described in many different ways. Success might include demonstrating sustainability,
reaching underserved populations, improving fresh food access, or increasing overall fruit and
vegetable consumption. This review showed that many urban areas have succeeded in
implementing mobile markets in underserved communities. This success comes both from
mission-driven, not-for-profit mobile market programs, and policies that encourage for-profit
mobile markets. In this review, successful markets tended to share three major components: (1)
providing affordable, quality produce by accepting SNAP benefits and focusing on simple
programs, staple items, and low operation costs; (2) operating during times and in locations that
were convenient to their target population; and (3) prioritizing community needs, buy-in and
engagement, and building community trust. Based on the successful components identified,
future policy recommendations include encouraging SNAP acceptance, simplifying fee and
permitting practices, engaging community members, promoting educational campaigns, and
providing financial support to mobile market programs.
Although this review contributes to a better understanding of mobile market interventions
to address food deserts, it does have some limitations. First, this review may not have accessed
all studies conducted on this topic. Only studies that met the search and inclusion criteria and
were published in peer reviewed journals accessible through the PubMed database were
accessed; thus this review may not fully cover the entirety of the literature. Second, though this
review does not contribute anything new to the literature, it synthesizes work that has already
been conducted. Additionally, due to the small amount of articles that met the search parameters,
four out of the ten articles reviewed described the same interventions (Green Carts), limiting the
number of actual interventions reviewed. Finally, this review included only interventions
conducted in US urban areas and published in English. Thus, these results are not generalizable
across countries or in rural areas. Further information is needed to understand how this type of
intervention actually affects behavior and impacts community health. Future interventions and
policies may find the information in this review useful when developing future program and
evaluation plans.
The research and evaluation described in this essay begin to provide an understanding of
how mobile markets affect diet behavior, and how they can best serve communities in need.
However, based on this review, there are two main gaps in the literature that remain. First, future
research should aim to understand the most effective locations for mobile markets to increase
accessibility. This approach may include a study that compares the reach of mobile markets that
locate in highly populated areas versus mobile markets that locate in more underserved areas.
This research should also aim to understand how to incentivize for-profit vendors to serve in the
most effective locations, where they can reach the most at need individuals most cost-effectively.
One way to do this might be to first test different location strategies across different cities or
neighborhoods and compare how many individuals from the target populations are reached.
Then, researchers can compare incentive strategies for encouraging vendors to serve in these
effective locations. If researchers can determine where the most effective locations are and how
to ensure that these locations are used, policy makers, small business owners, and non-profit
organization can maximize the impact of their mobile markets to relieve food deserts.
Second, future research should aim to understand the long-term effects of mobile markets
on individual shopping and eating behaviors, community health, and community engagement.
This research may be done via non-profit organizations conducting and publishing impact
evaluations of their interventions, or by cities or researchers studying communities before and
after implementing policy changes. This research should also further examine the mobile
market’s effects on the overall cost and affordability of fresh fruits and vegetables in a
community. Understanding the effects of mobile markets may help to better guide future public
health efforts to relieve food deserts.
In conclusion, local and national government organizations and public health officials
have a responsibility to ensure and improve the health of all communities. Low-income
communities are plagued by high rates of obesity, diabetes, heart disease, and other diet related
chronic illnesses. Disparities in diet-related health are reflective of disparities in the larger food
environment, wherein low-income communities have poor access to fresh, healthy, affordable
food. If a community needs to be healthy in order to thrive, and needs nutritious food in order to
be healthy, then food desert communities are left deprived of the basic resources needed to
promote wellness and community development. Thus, it must be a priority of public health to
address disparities in food access where they exist. Mobile markets represent a low cost, self-
sustaining, effective method of bringing healthy food to those that need it most. Thus,
government and public health officials that oversee the well-being of individuals living in food
poor environments may find that mobile markets address a number of barriers caused by food
deserts. Ultimately, diet and diet related health relies on the food choices that individuals and
families make on a daily basis. These choices may be based on personal tastes, cultural norms,
economic restraints, time restraints, access, and many other influencing factors. While no
government or public health organization can account for all individual needs and influence all
individual behaviors, they can work to create an environment where people are encouraged to
make healthy food choices, and can do so with ease.
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