My thesis aimed to find an association between older adults' fruit & vegetable consumption and their farmers' market shopping by studying seniors in Lexington, KY and Taipei City, Taiwan.

1. AN ASSOCIATION BETWEEN
OLDER ADULTS’ FRUIT &
VEGETABLE INTAKE AND
FARMERS’ MARKET SHOPPING
Presenter: GilliamTsao (SHU-FENGTSAO)
Date: November 1st , 2016
Advisor: Dr. Bastin
Committee members: Dr. Brewer, Dr. Stephenson
Thesis Defense

2. Agend
a
■ Literature review
■ Study Introduction
■ Methodology
■ Result
■ Discussion
■ Conclusion
Adapted from Lexington Farmers Market, 2016

3. LITERATURE REVIEW

4. What is a farmers’ market?
■ A place where local farmers gather on a recurring basis to sell
fresh fruits, vegetables, and other farm products directly to
consumers (Farmers Market Coalition, 2016).
Adapted from Lexington Farmers’ Markets (2014), and CityTalk (2012).

5. Numbers of farmers’ markets in the US increased over
300% in past two decades.
■ 1,755 in 1994 →
8,476 in 2015 (USDA,
2015).
■ Reflect increasing
demand for:
– local food products
– Better freshness &
quality
– support for the local
economy
(Martinez et al, 2015)

6. Farmers’ Markets and Fruit &Vegetable Intake
■ Inverse association between low intake of fruits and vegetables and
high risks for chronic diseases and obesity (Boeing et al., 2012).
■ Lacking affordable sources of fresh produce may contribute to poor
nutrition, especially in low-income populations.
■ CDC and the USDA recommend increasing access to farmers’
markets (Cole et al, 2013).
– Cost effective

7. Farmers’ markets and SNAP

8. Other common programs intervened at
farmers’ markets
WIC SFMNP
Adapted from theGreensboro FarmersCurb Market,Community Partnership on Aging, andWashington State Department of Health, 2016.

9. Local/statewide nutrition assistance programs
Other states
■ North Carolina: the Community
Transformation Grant Project (GTC-
Project)
■ NewYork City:The Health Buck initiative
■ Utah: “Double-Up Food Bucks”
……and so on.
Lexington, Kentucky
■ SNAP in a “Double Dollars” way

10. Public health & nutrition
professionals consider
farmers’ markets an
ideal platform to reach
many people and
encourage them to
consume fruits &
vegetables.
Adapted from Urban Gardens, 2016.

11. Perceived barriers to buying at farmers’ markets
45%
38.8%
36.9%
21.9%
Adapted from Wade K. et al (2015).

12. Taiwan

13. Farmers’
Markets in
Taipei City

14. STUDY INTRODUCTION

15. Recommendations for consumption of
fruits & vegetables
USA Taiwan
Latest Guideline The 2015-2020 Dietary
Guidelines for Americans
2012 Daily Dietary
Guidelines
Fruits “Fill half of your plate with
fruits & vegetables.”
3-5 servings
Vegetables 2-4 servings
Adapted from USDA, and Nutrition Foundation
ofTaiwan.

16. Background in Kentucky
■ Fruit & vegetable consumption remains low in KY (CDC, 2013).
– 45.9% and 25.2% reported consuming fruits & vegetables, respectively, less
than once a day.
– Median intakes of fruits and vegetables in Kentucky were 1.0 and 1.7 times
per day, respectively.
■ Findings from Perkins’s thesis (2013) and Jilcott Pitts et al (2014):
– Consumption of fruits & vegetables was positively associated with use of
farmers’ markets among Kentucky customers.
– Some barriers hindered shoppers’ utilization of farmers’ markets.
• “Out of way” and “market days and hours”

17. Background of farmers’ markets inTaiwan
■ Not a strategy to facilitate consumption of fruits & vegetables.
– Marketing channels for small farmers, especially organic farmers,
benefiting from directly selling their products to customers (Lin and Wang,
2014).
■ Difficulties developing farmers’ markets (Huang, 2014).
■ Seniors aged 65+ had 3.2 to 3.5 servings of vegetables and 1.5
servings of fruit daily in the 2005-2008 NAHSIT (Wu et al, 2011).

18. Gaps
■ Although evidence has shown a positive association between
increased FV consumption and regular shopping frequency at
farmers’ markets,
– Limited studies specifically target older adults aged 55+
• Consumption of fruits & vegetables?
• Their perception regarding their health and diet?
• Any association between the FV intake and farmers’ markets?
– No known studies in Taiwan investigated farmers’ markets from a
nutritional or health standpoint.

19. Research Objectives
1. Determine the general characteristics of farmers’ markets shoppers and
their perceptions regarding the markets in both locations.
2. Compare the amount of fruit and vegetable consumption and shopping
behaviors between older and younger shoppers.
3. Identify common barriers that affect Kentucky residents shopping at
farmers’ markets in Lexington, Kentucky.
4. Compare similarities and differences in three farmers’ markets in
Lexington, Kentucky and three farmers’ markets inTaipei City,Taiwan.

20. METHODOLOG
Y

21. Study design
■ A descriptive, cross-sectional study.
■ Time: June to August, 2015.
■ Questionnaire: A “customer intercept survey” was adapted from
Perkins’s thesis (2014).
– English version for Lexington, KY
– Chinese version forTaipei City,Taiwan

22. Survey locations
Lexington, KY
■ 241West Main Street (downtown)
on Saturday
■ 348 Southland Street on Sunday
■ 400 West Maxwell Street on
Tuesday &Thursday
Taipei City,TW
■ 248 Farmers’ Market on Friday
& Saturday
■ Water Garden Organic Farmers'
Market on Saturday
■ Taipei Expo Farmers’ Market on
Saturday & Sunday

23. Study population
■ Inclusion criteria:
• Local residents who were at least 18 years of age in both places.
• Males & females shopping at farmers’ markets & willing to take survey
• Able to read & write English in Lexington, KY
• Able to read & write Chinese inTaiwan City,TW
■ Exclusion criteria:
• Children and adolescents
• Unable to read & write English or Chinese

24. Statistical analysis
■ For descriptive analyses:
– Percentage, mean ± standard deviation (SD)
■ For the comparison of fruit & vegetable consumption between
older and younger adults:
– t-test

25. RESULTS
Lexington, KY

26. Demographics
70 73
68
29 26
32
1 2 0
% % %
Overall Age < 55 yrs Age ≧ 55 yrs
Gender
Female Male Transgender
6 6 8
86 85 88
8 9
4
Overall Age < 55 yrs Age ≧ 55 yrs
Race/Ethnicity
African American White Others

27. 1 1 0
8
6
11
20
18
23
35
38
31
36 37 36
Overall Age < 55 yrs Age ≧ 55 yrs
Education Level
< high school High school graduate Some college College graduate postgraduate

28. Shopping behaviors
11
35
28
13 13
7
36
24
15
1817
33 33
10
7
> once a week Once a week 2~3 times a month Once a month <1 time a month
Frequency of FM shopping
Overall % Age < 55 yrs % Age ≧ 55 yrs %

29. 38
56
0.95
5
0.05
27
65
0.5
7
0.5
51
44
1
4
0
Shopping alone Shopping with
family and/or friend
Shopping with pet Shopping with pet
and family and/or
friend
Others
Shopping companies
Overall % Age < 55 yrs % Age ≧ 55 yrs %

30. 41
50
9
35
54
11
48
46
6
More expensive About the same Less expensive
Perceived Price
Overall % Age < 55 yrs % Age ≧ 55 yrs %

31. Older vsYounger Adults
Lexington, Kentucky Age
< 55 yrs ≧ 55 yrs χ2 p
Overall health Good Very good 10.345 .035
Overall diet Good Very good 23.748 <.0001
Shopping companies
Shopping with friends
or family
Shopping alone 18.908 .0008
Food price perception About the same More expensive 6.637 .0362
Shopping frequency Once a week
Once a week or
2-3 times a month
20.105 .0005

32. Consumption of Fruits &Vegetables
Lexington, Kentucky Age
< 55 yrs ≧ 55 yrs t df
Fruit servings consumed/day
2.40
(0.09)
2.43
(0.10)
0.21 306
Vegetable servings consumed/day
2.85
(0.08)
2.79
(0.10)
-0.48 306
Dollars spent at farmers’ markets***
22.48
(0.79)
19.54
(0.91)
-2.45* 294

33. Unexpected Outcomes from Lexington
■ Majority of respondents did not experience any barrier related to
visiting farmers’ markets.
• Perhaps due to more available and accessible farmers’ markets in
summer.
■ Percentage of the SNAP participants that redeemed their benefits
at farmers’ markets: only 2%.

34. RESULTS
Taipei City,TW

35. Demographics
80 79
87.5
20 21
12.5
% % %
Overall Age < 55 yrs Age ≧ 55 yrs
Gender
Female Male
1 1
10
64
24
0 0
8
68
24
2.5 5.5
29
39
24
Elementary
school
Junior high
school
graduate
Senior high
school
graduate
College
graduate
postgraduate
Education Level
Overall % Age < 55 yrs % Age ≧ 55 yrs %

36. Shopping Behaviors
19
6
8
31
9
14
2 4
7
19
8 8
33
10
12
2 4 4
22
12 12
10
29
5 2 5 3
Transportation
Overall % Age < 55 yrs % Age ≧ 55 yrs %

37. 4
14
24
22
37
2
13
22 22
40
10
20
38
20
13
> once a week Once a week 2~3 times a
month
Once a month <once a month
Frequency of FM shopping
Overall % Age < 55 yrs % Age ≧ 55 yrs %

38. 35
58
2 3 2
32
61
2 3 2
63
32
2
0
2
Shopping alone Shopping with
family and/or
friend
Shopping with pet Shopping with pet
and family and/or
friend
Others
Shopping Companies
Overall % Age < 55 yrs % Age ≧ 55 yrs %

39. 75
23
2
77
21
2
63
32
5
More expensive About the same Less expensive
Perceived Price
Overall % Age < 55 yrs % Age ≧ 55 yrs %

40. Older vsYounger Adults
Taipei City, Taiwan Age
< 55 yrs ≧ 55 yrs χ2 p
Overall health Good & Very good Very good 14.504 .0058
Overall diet Good Very good 22.504 .0002
Shopping companies
Shopping with friends
or family
Shopping alone 16.904 .0020
Food price perception More expensive More expensive 4.007 .1349
Shopping frequency < once a month 2-3 times a month 18.197 .0011

41. Consumption of Fruits &Vegetables
Taipei City, Taiwan Age
< 55 yrs ≧ 55 yrs t df
Fruit servings consumed/day
2.23
(0.06)
2.59
(0.15)
2.23* 335
Vegetable servings consumed/day
2.48
(0.06)
2.73
(0.15)
1.60 335
Dollars spent at farmers’ markets***
15.40
(0.62)
22.25
(1.71)
3.77** 303

42. Similarities
Both studied regions Age
< 55 yrs ≧ 55 yrs
Overall health Good Very good
Overall diet Good Very good
Shopping companies
Shopping with friends
or family
Shopping alone
Food price perception More expensive

43. Differences
Location Lexington, KY Taipei City, TW
Age < 55 yrs ≧ 55 yrs < 55 yrs ≧ 55 yrs
Food price perception About the same More expensive More expensive
Shopping frequency Once a week < once a month
Fruit servings
consumed/day
2.31 to 2.49* 2.33 to 2.53 2.17 to 2.29* 2.44 to 2.74
Vegetable servings
consumed/day
2.77 to 2.93* 2.69 to 2.89 2.42 to 2.54* 2.58 to 2.88
Dollars spent at farmers’
markets
21.69 to 23.27*
18.63 to
20.45
14.78 to 16.02* 20.54 to 23.96
* p<0.05 in age < 55 years
p<0.05 in age ≥ 55 years

44. Limitations
■ Cross-sectional design
■ A convenient sampling method
■ Association, not causation
■ Non-response bias
■ Limited number of older participants
■ Limited generalization

45. Implications
■ Inadequate consumption of fruits & vegetables, regardless of
age, health consideration, and country.
■ Low SNAP redemption
■ Farmers’ markets inTaiwan are probably not suitable for
encouraging fruit and vegetable consumption

46. Recommendations for Future Studies
■ what causes a gap between the attendance of farmers’ markets
and the consumption of fruits and vegetables?
■ Why the redemption of SNAP benefits remains extremely low at
farmers’ markets in Lexington, Kentucky?
■ Include more farmers’ markets across various regions and more
participants aged 55 and over.
■ inTaiwan, what motivates older adults spending more money
than their younger peers at farmers’ markets?

47. Q & A
Thank you for your listening

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