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Using spatial analysis to examine best placement of electronic benefit transfer services at farmers’ markets in Honolulu County, Hawaii, USA

  • O Vanessa Buchthal (a1), Grace Wolff (a2), Daniela Kittinger (a3), Danielle Schaeffner (a3) and Denise C Nelson-Hurwitz (a1)...



Farmers’ market interventions are a popular strategy for addressing chronic disease disparities in low-income neighbourhoods. With limited resources, strategic targeting of interventions is critical. The present study used spatial analysis to identify where market interventions have the greatest impact on healthy food access within a geographic region.


All farmers’ markets in a mixed urban/rural county were mapped and those that accepted Supplemental Nutrition Assistance Program (SNAP) electronic benefit transfer (EBT) cards identified. Households were grouped into small neighbourhoods and mapped. The area of ‘reasonable access’ around each market (walking distance (0·8 km; 0·5mile) in urban areas, driving distance (15 min) in rural areas) was calculated using spatial analysis. The percentage of county low-income households within a market’s access area, and the percentage of county SNAP-participating households within an EBT-accepting market’s access area, were calculated. The ten neighbourhoods with the most low-income households and with the most SNAP-participating households were then identified, their access areas calculated and mapped, and those lacking access identified. County-level gains resulting from improving market accessibility in these areas were calculated.




Honolulu County, Hawaii, USA.


Only 44 % of SNAP-participating households had EBT-market access. Six of the ten highest SNAP-participant neighbourhoods lacked access. Improving access for these neighbourhoods increased county-level access by 23 %. Market access for low-income households was 74 %. Adding markets to these low-income neighbourhoods without market access increased county-level access by 4 %.


Geographic identification of market access demographics, and strategic targeting of EBT interventions, could improve regional access to healthy foods.


Corresponding author

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1. Larson, NI, Story, MT & Nelson, MC (2009) Neighborhood environments: disparities in access to healthy foods in the US. Am J Prev Med 36, 7481.
2. Dubowitz, T, Zenk, SN, Ghosh-Dastidar, B et al. (2015) Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet and BMI. Public Health Nutr 18, 22202230.
3. Ollberding, NJ, Nigg, CR, Geller, KS et al. (2012) Food outlet accessibility and fruit and vegetable consumption. Am J Health Promot 26, 366370.
4. Burgoine, T, Mackenbach, JD, Lakerveld, J et al. (2017) Interplay of socioeconomic status and supermarket distance is associated with excess obesity risk: a UK cross-sectional study. Int J Environ Res Public Health 14, 1290.
5. Fan, JX, Hanson, HA, Zick, CD et al. (2014) Geographic scale matters in detecting the relationship between neighbourhood food environments and obesity risk: an analysis of driver license records in Salt Lake County, Utah. BMJ Open 4, e005458.
6. Pitt, E, Gallegos, D, Comans, T et al. (2017) Exploring the influence of local food environments on food behaviours: a systematic review of qualitative literature. Public Health Nutr 20, 23932405.
7. Clary, C, Matthews, SA & Kestens, Y (2017) Between exposure, access and use: reconsidering foodscape influences on dietary behaviours. Health Place 44, 17.
8. 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.
9. Caspi, CE, Kawachi, I, Subramanian, SV et al. (2012) The relationship between diet and perceived and objective access to supermarkets among low-income housing residents. Soc Sci Med 75, 12541262.
10. 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.
11. Cole, K, McNees, M, Kinney, K et al. (2013) Increasing access to farmers markets for beneficiaries of nutrition assistance: evaluation of the farmers market access project. Prev Chronic Dis 10, E168.
12. Sadler, RC (2016) Strengthening the core, improving access: bringing healthy food downtown via a farmers’ market move. App Geogr 67, 119128.
13. Jones, P & Bhatia, R (2011) Supporting equitable food systems through food assistance at farmers’ markets. Am J Public Health 101, 781783.
14. 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.
15. Inda, C, Washburn, A, Beckham, S et al. (2011) Home grown: the trials and triumphs of starting up a farmers’ market in Waianae, Hawaii. Community Dev 42, 181192.
16. Colasanti, KJA, Conner, DS & Smalley, SB (2010) Understanding barriers to farmers’ market patronage in Michigan: perspectives from marginalized populations. J Hunger Environ Nutr 5, 316338.
17. 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.
18. Bertmann, FMW, Ohri-Vachaspati, P, Buman, MP et al. (2012) Implementation of wireless terminals at farmers’ markets: impact on SNAP redemption and overall sales. Am J Public Health 102, e53e55.
19. 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 Edu Behav 49, 397404.e1.
20. Hodgins, KJ & Fraser, EDG (2018) ‘We are a business, not a social service agency.’ Barriers to widening access for low-income shoppers in alternative food market spaces. Agric Hum Values 35, 149162.
21. Buttenheim, AM, Havassy, J, Fang, M et al. (2012) Increasing supplemental nutrition assistance program/electronic benefits transfer sales at farmers’ markets with vendor-operated wireless point-of-sale terminals. J Acad Nutr Diet 112, 636641.
22. Guthman, J, Morris, AW & Allen, P (2009) Squaring farm security and food security in two types of alternative food institutions. Rural Sociol 71, 662684.
23. Larimore, S (2018) Cultural boundaries to access in farmers markets accepting Supplemental Nutrition Assistance Program (SNAP). Qual Sociol 41, 6387.
24. US Census Bureau (2012) American Factfinder | Table S0501: Selected Characteristics of the Native and Foreign-Born Populations. 2007–2011 American Community Survey 5-Year Estimates. (accessed March 2018).
25. Hawaii State Department of Business, Economic Development and Tourism (2018) 2016 State of Hawaii Data Book | Farm organization and principal operator characteristics. (accessed June 2018).
26. US Census Bureau (2010) Cartographic Boundary Shapefiles: Block Groups. (accessed October 2017).
27. State of Hawaii, Office of Planning (2012) State of Hawaii GIS Data Download Portal. (accessed October 2017).
28. US Census Bureau (2010) Centers of Population. (accessed October 2017).
29. US Department of Agriculture, Economic Research Service (2007) Data Products | Rural Definitions: Hawaii. (accessed December 2017).
30. 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.
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