Date of Award


Level of Access Assigned by Author

Campus-Only Thesis

Degree Name

Master of Science (MS)


Food Science and Human Nutrition


Dorothy Klimis-Zacas

Second Committee Member

Rodney J. Bushway

Third Committee Member

Teresa Hubley


Research regarding the barriers to healthful food access has principally focused on urban environments. The issues surrounding food access in the rural environment are less well known. Studies indicate that low-income consumers face greater barriers to the access of healthful food. This study aims to evaluate the availability, cost, and quality barriers to healthful food access faced by low-income families living in rural Maine. The objectives of this study were threefold: (1) to adapt the Nutrition Environment Measures Survey (NEMS) for use in Maine food stores, (2) to test the reliability of the Maine Rural Food Access Survey (MRFAS) and modify the survey based on pilot test findings, and (3) to determine availability, cost, and quality of healthful food items in all stores accepting Supplemental Nutrition Assistance Program (SNAP) in Somerset County, Maine. MRFAS was developed from NEMS, a valid and reliable, commonly used food environment survey developed at Emory University (Glanz, 2008). The NEMS was adapted to reflect those foods recommended in the 2005 Dietary Guidelines for Americans and the USDA's SNAP key education messages. MRFAS was modified to include local produce and was further adapted to the rural environment to include canned and frozen fruits and vegetables. The survey tool was piloted in 6 stores: 2 convenience stores, 2 grocery stores, and 2 superstores, to evaluate inter-rater and test-retest reliability and content validity. Pilot test data were used to revise MRFAS, which was renamed ME-NEMS for the main phase of the study. ME-NEMS was then used to evaluate availability, quality, and price in all stores accepting SNAP in Somerset County, Maine. The main phase of the survey was conducted in 50 stores: 8 supermarkets, 8 grocery stores, and 34 convenience stores. Descriptive statistics were used to evaluate store demographic information and availability, quality, and price data. Logistic regression was used to evaluate availability and quality data by store type and store urban or rural location. Independent sample t-tests and Tukey's post hoc analysis were used to evaluate food prices by store type and location. Values were considered significant at p ≤ 0.05. Results indicate that availability of healthful food items was greatest in supermarkets, then grocery stores, and lowest in convenience stores. Survey items were most available in rural stores compared to urban stores. Quality did not differ significantly among store types or by store location; however, most unacceptable ratings came from stores in rural towns, and from convenience stores. In general, supermarkets had the lowest priced items, followed by grocery and convenience stores. Though some significant differences were observed, neither urban nor rural stores exhibited a defined trend toward higher or lower prices. The findings of this research indicate that store type has a greater impact on healthful food access than store location, as determined by food availability, quality, and price. Grocery stores and convenience stores carried the fewest healthful foods options, poorest quality items, and highest prices according to ME-NEMS. Residents living in rural areas appear to have greater access to healthful food items compared to urban residents, however, the distance required to travel to these stores may create a greater burden. If rural consumers have limited access to stores, store owners may be more inclined to carry a wider variety of foods. Overall, consumers in Somerset County likely face the greatest barriers to healthful food access if they live furthest from a supermarket, or if their primary food store is a grocery or convenience store.