Graduation Date

Summer 8-15-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Health Promotion and Disease Prevention Research

First Advisor

Chad Abresch

Second Advisor

Abadi Azar

Third Advisor

Donna Winham

Fourth Advisor

Lisa Franzen-Castle

MeSH Headings

Diet Food and Nutrition [G07.203], Ethnic and Racial Minorities [N01.224.708.437], Neighborhood Characteristics [N01.224.791.775], Health Inequities [N01.224.425.394], Social Determinants of Health [N01.224.425.762], Public Health [N06.850], Academic Dissertation [V02.050], Midwestern United States [Z01.107.567.875.510], Health Disparate Minority and Vulnerable Populations [M01.270]

Abstract

Background: Food insecurity is a public health issue in the United States, with disproportionately higher rates among Latino/Hispanic households. Rural communities face unique geographical, socioeconomic, and systemic barriers that often exacerbate food access disparities. Despite the growing Latino population in rural areas, particularly in Midwestern states like Nebraska, there remains a critical gap in comprehensive research that integrates both objective and subjective understandings of their food environments. Understanding these multifaceted influences is crucial for developing effective, culturally sensitive interventions.

Problem Statement: This dissertation aims to answer the central question: How does food access and food insecurity manifest amongst Latinos in rural Nebraska? This research addresses the need for a holistic understanding of the complex interplay between environmental characteristics, socioeconomic factors, and policy impacts on food security within this vulnerable population.

Methods: This dissertation comprises three interconnected studies. Chapter 3 develops a novel Food Insecurity Vulnerability Index (FIVI) using Principal Component Analysis of 2020 US Census data to spatially identify and quantify food insecurity vulnerability across Nebraska's census tracts. Chapter 4 assesses the objective food environment in 28 rural stores across nine towns using the culturally adapted Latino Nutrition Environment Measures Survey in Stores (Latino NEMS-S), examining food availability, store features, and acceptance of federal benefits. Chapter 5 employs a qualitative phenomenological approach, utilizing participatory mapping and semi-structured interviews with 18 self-identifying Latinas in rural Nebraska, to explore their lived experiences and perceptions of food access in their towns.

Results: Chapter 3 revealed that higher FIVI scores were concentrated in tribal areas and urban census tracts with significant Hispanic/Latino and Black/African American populations, indicating greater vulnerability to experiencing food insecurity. Chapter 4 demonstrated that large chain and local grocery stores significantly outperformed ethnic stores in terms of overall healthy and culturally relevant food availability. However, ethnic stores offered a unique selection of cultural food items. A significant finding was that a store's acceptance of SNAP benefits was a strong predictor of a higher Latino NEMS-S score. Chapter 5's findings showed that 68.3% of participants were food insecure, highlighting key barriers such as limited access to health-specific foods, inadequate public transportation, high rural cost of living, the detrimental "benefits cliff" effect of assistance programs, and challenges related to immigration documentation status.

Conclusions: Food insecurity among rural Latinos in Nebraska is an issue driven by the complex relationships between environmental characteristics, socioeconomic factors, and systemic policies. The findings highlight the need for interventions that extend beyond simply increasing the number of food retailers in rural areas. Interdisciplinary efforts must focus on comprehensive economic development, equitable city planning, advocating for culturally relevant, healthy, and affordable food options, and reforming assistance program eligibility and education to dismantle systemic barriers and promote health equity for all.

Comments

2025 Copyright, the authors

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