Skip to main content Accessibility help

Promoting access to fresh fruits and vegetables through a local market intervention at a subway station

  • Sarah Chaput (a1) (a2), Geneviève Mercille (a3), Louis Drouin (a4) and Yan Kestens (a1) (a2)



Alternative food sources (AFS) such as local markets in disadvantaged areas are promising strategies for preventing chronic disease and reducing health inequalities. The present study assessed how sociodemographic characteristics, physical access and fruit and vegetable (F&V) consumption are associated with market use in a newly opened F&V market next to a subway station in a disadvantaged neighbourhood.


Two cross-sectional surveys were conducted among adults: (i) on-site, among shoppers who had just bought F&V and (ii) a telephone-based population survey among residents living within 1 km distance from the market.


One neighbourhood in Montreal (Canada) with previously limited F&V offerings.


Respectively, 218 shoppers and 335 residents completed the on-site and telephone-based population surveys.


Among shoppers, 23 % were low-income, 56 % did not consume enough F&V and 54 % did not have access to a car. Among all participants living 1 km from the market (n 472), market usage was associated (OR; 95 % CI) with adequate F&V consumption (1·86; 1·10, 3·16), living closer to the market (for distance: 0·86; 0·76, 0·97), having the market on the commute route (2·77; 1·61, 4·75) and not having access to a car (2·96; 1·67, 5·26).


When implemented in strategic locations such as transport hubs, AFS like F&V markets offer a promising strategy to improve F&V access among populations that may be constrained in their food acquisition practices, including low-income populations and those relying on public transportation.


Corresponding author


Hide All
1. Boeing, H, Bechthold, A, Bub, A et al. (2012) Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr 51, 637663.
2. Lock, K, Pomerleau, J, Causer, L et al. (2005) The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet. Bull World Health Organ 83, 100108.
3. McGrail, KM, Van Doorslaer, E, Ross, NA et al. (2009) Income-related health inequalities in Canada and the United States: a decomposition analysis. Am J Public Health 99, 1856–1563.
4. Ezzati, M, Friedman, AB, Kulkarni, SC et al. (2008) The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. PLoS Med 5, e66.
5. Mackenbach, JP, Stirbu, I, Roskam, A-JR et al. (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358, 24682481.
6. Darmon, N & Drewnowski, A (2008) Does social class predict diet quality? Am J Clin Nutr 87, 11071117.
7. Kamphuis, CB, Giskes, K, de Bruijn, G-J et al. (2006) Environmental determinants of fruit and vegetable consumption among adults: a systematic review. Br J Nutr 96, 620635.
8. Cannuscio, CC, Tappe, K, Hillier, A et al. (2013) Urban food environments and residents’ shopping behaviors. Am J Prev Med 45, 606614.
9. Zachary, DA, Palmer, AM, Beckham, SW et al. (2013) A framework for understanding grocery purchasing in a low-income urban environment. Qual Health Res 23, 665678.
10. Beagan, BL, Power, EM & Chapman, GE (2015) ‘Eating isn’t just swallowing food’: food practices in the context of social class trajectory. Can Food Stud 2, 7598.
11. Clifton, KJ (2004) Mobility strategies and food shopping for low-income families: a case study. J Plann Educ Res 23, 402413.
12. Fish, CA, Brown, JR & Quandt, SA (2015) African American and Latino low income families’ food shopping behaviors: promoting fruit and vegetable consumption and use of alternative healthy food options. J Immigr Minor Health 17, 498505.
13. Tach, L & Amorim, M (2015) Constrained, convenient, and symbolic consumption: neighborhood food environments and economic coping strategies among the urban poor. J Urban Health 92, 815834.
14. Zenk, SN, Odoms-Young, AM, Dallas, C et al. (2011) ‘You have to hunt for the fruits, the vegetables’: environmental barriers and adaptive strategies to acquire food in a low-income African American neighborhood. Health Educ Behav 38, 282292.
15. Rose, DJ (2011) Captive audience? Strategies for acquiring food in two Detroit neighborhoods. Qual Health Res 21, 642651.
16. Webber, CB, Sobal, J & Dollahite, JS (2010) Shopping for fruits and vegetables. Food and retail qualities of importance to low-income households at the grocery store. Appetite 54, 297303.
17. Cannuscio, CC, Hillier, A, Karpyn, A et al. (2014) The social dynamics of healthy food shopping and store choice in an urban environment. Soc Sci Med 122, 1320.
18. Mah, C, Minaker, L & Cook, B (2014) Policy options for healthier food environments in city-regions: a discussion paper. (accessed November 2016).
19. Dubowitz, T, Ghosh-Dastidar, M, Cohen, DA et al. (2015) Changes in diet after introduction of a full service supermarket in a food desert. Health Aff (Millwood) 34, 18581868.
20. Cummins, S, Flint, E & Matthews, SA (2014) New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity. Health Aff (Millwood) 33, 283291.
21. Wrigley, N, Warm, D & Margetts, B (2003) Deprivation, diet, and food-retail access: findings from the Leeds ‘food deserts’ study. Environ Plan A 35, 151188.
22. Sadler, RC, Gilliland, JA & Arku, G (2013) A food retail-based intervention on food security and consumption. Int J Environ Res Public Health 10, 33253346.
23. Cummins, S, Petticrew, M, Higgins, C et al. (2005) Large scale food retailing as an intervention for diet and health: quasi-experimental evaluation of a natural experiment. J Epidemiol Community Health 59, 10351040.
24. Wang, MC, MacLeod, KE, Steadman, C et al. (2007) Is the opening of a neighborhood full-service grocery store followed by a change in the food behavior of residents? J Hunger Environ Nutr 2, 318.
25. Rudkin, S (2015) Supermarket interventions and diet in areas of limited retail access: policy suggestions from the Seacroft Intervention Study. (accessed July 2018).
26. Rahmanian, E, Gasevic, D, Vukmirovich, I et al. (2014) The association between the built environment and dietary intake – a systematic review. Asia Pac J Clin Nutr 23, 183196.
27. Gittelsohn, J, Rowan M & Gadhoke P (2012) Interventions in small food stores to change the food environment, improve diet, and reduce risk of chronic disease. Prev Chronic Dis 9, E59.
28. Dannefer, R, Williams, DA, Baronberg, S et al. (2012) Healthy bodegas: increasing and promoting healthy foods at corner stores in New York City. Am J Public Health 102, e27e31.
29. Paek, H-J, Oh, HJ, Jung, Y et al. (2014) Assessment of a healthy corner store program (FIT Store) in low-income, urban, and ethnically diverse neighborhoods in Michigan. Fam Community Health 37, 8699.
30. Wegener, J & Hanning, RM (2010) Concepts and measures of ‘alternative’ retail food outlets: considerations for facilitating access to healthy, local food. J Hunger Environ Nutr 5, 158173.
31. Young, C, Karpyn, A, Uy, N et al. (2011) Farmers’ markets in low income communities: impact of community environment, food programs and public policy. Community Dev 42, 208220.
32. Sadler, RC, Gilliland, JA & Arku, G (2016) Theoretical issues in the ‘food desert’ debate and ways forward. GeoJournal 81, 443455.
33. Higgins, V, Dibden, J & Cocklin, C (2008) Building alternative agri-food networks: certification, embeddedness and agri-environmental governance. J Rural Stud 24, 1527.
34. Sitaker, M, Kolodinsky, J, Pitts, SJ et al. (2014) Do entrepreneurial food systems innovations impact rural economies and health? Evidence and gaps. Am J Entrepreneurship 7, 316.
35. Blitstein, JL, Snider, J & Evans, WD (2012) Perceptions of the food shopping environment are associated with greater consumption of fruits and vegetables. Public Health Nutr 15, 11241129.
36. Pitts, SBJ, Wu, Q, McGuirt, JT et al. (2013) Associations between access to farmers’ markets and supermarkets, shopping patterns, fruit and vegetable consumption and health indicators among women of reproductive age in eastern North Carolina, USA. Public Health Nutr 16, 19441952.
37. Pitts, SBJ, Wu, Q, Demarest, CL et al. (2015) Farmers’ market shopping and dietary behaviours among supplemental nutrition assistance program participants. Public Health Nutr 18, 24072414.
38. Pitts, SBJ, Gustafson, A, Wu, Q et al. (2014) Farmers’ market use is associated with fruit and vegetable consumption in diverse southern rural communities. Nutr J 13, 1.
39. Gustafson, A, Christian, JW, Lewis, S et al. (2013) Food venue choice, consumer food environment, but not food venue availability within daily travel patterns are associated with dietary intake among adults, Lexington Kentucky 2011. Nutr J 12, 1.
40. Zepeda, L, Reznickova, A & Lohr, L (2014) Overcoming challenges to effectiveness of mobile markets in US food deserts. Appetite 79, 5867.
41. McCormack, LA, Laska, MN, Larson, NI et al. (2010) Review of the nutritional implications of farmers’ markets and community gardens: a call for evaluation and research efforts. J Am Diet Assoc 110, 399408.
42. Freedman, DA, Flocke, S, Shon, E-J et al. (2017) Farmers’ market use patterns among Supplemental Nutrition Assistance Program recipients with high access to farmers’ markets. J Nutr Education Behav 49, 397404.e1.
43. Jennings, A, Cassidy, A, Winters, T et al. (2012) Positive effect of a targeted intervention to improve access and availability of fruit and vegetables in an area of deprivation. Health Place 18, 10741078.
44. Lotoski, LC, Engler-Stringer, R & Muhajarine, N (2015) Cross-sectional analysis of a community-based cooperative grocery store intervention in Saskatoon, Canada. Can J Public Health 106, 147153.
45. Woodruff, RC, Coleman, A-M, Hermstad, AK et al. (2016) Increasing community access to fresh fruits and vegetables: a case study of the Farm Fresh Market pilot program in Cobb County, Georgia, 2014. Prev Chronic Dis 13, E36.
46. Evans, AE, Jennings, R, Smiley, AW et al. (2012) Introduction of farm stands in low-income communities increases fruit and vegetable among community residents. Health Place 18, 11371143.
47. Ruelas, V, Iverson, E, Kiekel, P et al. (2012) The role of farmers’ markets in two low income, urban communities. J Community Health 37, 554562.
48. Gorham, G, Dulin-Keita, A, Risica, PM et al. (2015) Effectiveness of Fresh to You, a discount fresh fruit and vegetable market in low-income neighborhoods, on children’s fruit and vegetable consumption, Rhode Island, 2010–2011. Prev Chronic Dis 12, E176.
49. AbuSabha, R, Namjoshi, D & Klein, A (2011) Increasing access and affordability of produce improves perceived consumption of vegetables in low-income seniors. J Am Diet Assoc 111, 15491555.
50. Black, C, Moon, G & Baird, J (2014) Dietary inequalities: what is the evidence for the effect of the neighbourhood food environment? Health Place 27, 229242.
51. Santé Canada (2013) Mesure de l’environnement alimentaire au Canada. (accessed November 2016).
52. Freedman, DA, Vaudrin, N, Schneider, C et al. (2016) Systematic review of factors influencing farmers’ market use overall and among low-income populations. J Acad Nutr Diet 116, 11361155.
53. Sadler, RC (2016) Strengthening the core, improving access: bringing healthy food downtown via a farmers’ market move. Appl Geogr 67, 119128.
54. Statistique Canada (2017) Montréal, V [Subdivision de recensement], Québec et Montréal, TÉ [Division de recensement], Québec (tableau) Ottawa. (accessed April 2017).
55. Tarasuk, V, Mitchell, A & Dachner, N (2016) Household food insecurity in Canada, 2014. (accessed November 2016).
56. Springmann, V, Frigault, L & Drouin, C (2014) La santé des Montréalais: les maladies chroniques et leurs déterminants selon l’enquête TOPO 2012. (accessed August 2016).
57. Apparicio, P, Cloutier, M-S & Shearmur, R (2007) The case of Montreal’s missing food deserts: evaluation of accessibility to food supermarkets. Int J Health Geogr 6, 4.
58. Daniel, M, Kestens, Y & Paquet, C (2009) Demographic and urban form correlates of healthful and unhealthful food availability in Montréal, Canada. Can J Public Health 100, 189193.
59. Bertrand, L, Thérien, F & Cloutier, M-S (2008) Measuring and mapping disparities in access to fresh fruits and vegetables in Montreal. Can J Public Health 99, 611.
60. Bertrand, L, Thérien, F, Goudreau, S et al. (2013) Étude sur l’accès aux aliments santé à Montréal: six ans après la première étude, mêmes disparités?. (accessed August 2016).
61. Direction de la santé publique de Montréal (2011) Caractéristiques sociodémographiques de la population, 2011. (accessed April 2017).
62. Statistique Canada (2015) Les mesures de faible revenue. (accessed April 2017).
63. Bertrand, L & Goudreau, S (2014) Étude sur l’accès aux aliments sains à Montréal: Regard sur le territoire du CSSS Lucille-Teasdale. (accessed August 2016).
64. Charreire, H, Casey, R, Salze, P et al. (2010) Measuring the food environment using geographical information systems: a methodological review. Public Health Nutr 13, 17731785.
65. Green, S & Glanz, K (2015) Development of the perceived nutrition environment measures survey. Am J Prev Med 49, 5061.
66. Cheng, R, Mercille, G, Hamelin, A et al. (2015) Partnering with local organizations to measure food shopping practices and perceptions of food access of Montrealers. Presented at Food Environments in Canada: Symposium and Workshop, Saskatoon, SK, Canada, 21–23 May 2015.
67. Olsho, L, Baronberg, S, Abel, Y et al. (2012) Health Bucks Evaluation Toolkit. (accessed July 2018).
68. Statistique Canada (2014) Enquête sur la santé des collectivités canadiennes (N°3226). (accessed August 2016).
69. Shatenstein, B & Payette, H (2015) Evaluation of the relative validity of the short diet questionnaire for assessing usual consumption frequencies of selected nutrients and foods. Nutrients 7, 63626374.
70. CIUSSS du Centre-Est-de-l'Île-de-Montréal (2015) Enquête TOPO 2012: Guide méthodologique. (accessed August 2016).
71. Olsho, LE, Payne, GH, Walker, DK et al. (2015) Impacts of a farmers’ market incentive programme on fruit and vegetable access, purchase and consumption. Public Health Nutr 18, 27122721.
72. National Cancer Institute (2016) Identifying Extreme Exposure Values. (accessed April 2017).
73. DiSantis, KI, Hillier, A, Holaday, R et al. (2016) Why do you shop there? A mixed methods study mapping household food shopping patterns onto weekly routines of black women. Int J Behav Nutr Phys Act 13, 11.
74. Hirsch, JA & Hillier, A (2013) Exploring the role of the food environment on food shopping patterns in Philadelphia, PA, USA: a semiquantitative comparison of two matched neighborhood groups. Int J Environ Res Public Health 10, 295313.
75. Kerr, J, Frank, L, Sallis, JF et al. (2012) Predictors of trips to food destinations. Int J Behav Nutr Phys Act 9, 58.
76. R Core Team (2016) R: a language and environment for statistical computing. (accessed August 2017).
77. Buuren Sv & Groothuis-Oudshoorn K (2011) MICE: multivariate imputation by chained equations in R. J Stat Softw 45, 167.
78. Box, GE & Tidwell, PW (1962) Transformation of the independent variables. Technometrics 4, 531550.
79. Tabachnick, B & Fidell, L (2007) Using Multivariate Statistics. Boston, MA: Pearson Education.
80. Valchuis, L, Conner, DS, Berlin, L et al. (2015) Stacking beliefs and participation in alternative food systems. J Hunger Environ Nutr 10, 214229.
81. Yeh, M-C, Ickes, SB, Lowenstein, LM et al. (2008) Understanding barriers and facilitators of fruit and vegetable consumption among a diverse multi-ethnic population in the USA. Health Promot Int 23, 4251.
82. Gustat, J, O’Malley, K, Luckett, BG et al. (2015) Fresh produce consumption and the association between frequency of food shopping, car access, and distance to supermarkets. Prev Med Rep 2, 4752.
83. Haynes-Maslow, L, Auvergne, L, Mark, B et al. (2015) Low-income individuals’ perceptions about fruit and vegetable access programs: a qualitative study. J Nutr Educ Behav 47, 317324.e1.
84. Azagba, S & Sharaf, MF (2011) Disparities in the frequency of fruit and vegetable consumption by socio-demographic and lifestyle characteristics in Canada. Nutr J 10, 118.
85. Link, MW, Battaglia, MP, Frankel, MR et al. (2007) Reaching the US cell phone generation: comparison of cell phone survey results with an ongoing landline telephone survey. Public Opin Q 71, 814839.
86. Blumberg, SJ & Luke, JV (2007) Coverage bias in traditional telephone surveys of low-income and young adults. Public Opin Q 71, 734749.
87. Blanck, HM, Thompson, OM, Nebeling, L et al. (2011) Improving fruit and vegetable consumption: use of farm-to-consumer venues among US adults. Prev Chronic Dis 8, A49.
88. Onianwa, OOW, Gerald, Mojica & Maribel, N (2005) An analysis of the determinants of farmer-to-consumer direct-market shoppers. J Food Distrib Res 36, 130134.
89. Byker, C, Shanks, J, Misyak, S et al. (2012) Characterizing farmers’ market shoppers: a literature review. J Hunger Environ Nutr 7, 3852.
90. Freedman, DA, Choi, SK, Hurley, T et al. (2013) A farmers’ market at a federally qualified health center improves fruit and vegetable intake among low-income diabetics. Prev Med 56, 288292.
91. Clary, C, Matthews, SA & Kestens, Y (2017) Between exposure, access and use: reconsidering foodscape influences on dietary behaviours. Health Place 44, 17.
92. Beckie, MA, Kennedy, EH & Wittman, H (2012) Scaling up alternative food networks: farmers’ markets and the role of clustering in western Canada. Agric Hum Values 29, 333345.


Promoting access to fresh fruits and vegetables through a local market intervention at a subway station

  • Sarah Chaput (a1) (a2), Geneviève Mercille (a3), Louis Drouin (a4) and Yan Kestens (a1) (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed