Food Swamps and Transportation Access: Intersecting Structural Determinants of Food Shopping and Access in Marginalized Urban Communities.

The study examined the relationship between food swamps and self-reported food shopping frequency and perceived food access, while considering transportation mode and travel time. This Community-Based Participatory Research study surveyed residents from six neighborhoods in Hartford. Individual-level food swamp exposure (the ratio of unhealthy to healthy food stores within a 0.5-mile radius of participants' homes) was measured both objectively (using GIS-based methods) and subjectively (through self-reporting). Poisson regression models assessed the associations between food swamps and outcomes (shopping frequency by store types and perceived access to food), with transportation mode and travel time as moderators. Of 304 participants, 51% lived in subjective (n = 153) and 71% in objective (n = 198) food swamps. Food swamp exposure was associated with greater shopping frequency at unhealthy outlets (β = 0.12, p < 0.001), less access to healthier food (β = -0.13, p < 0.001), and increased access to unhealthy food (β = 0.08, p < 0.001). Transportation significantly moderates these relationships; bus riders reported the highest rates of unhealthy food purchasing (β = 0.17, p < 0.001). Longer travel times increased both healthy and unhealthy food access (β = 0.01, p < 0.001 for each). Food swamps interact with public transportation to contribute to food shopping and access, underscoring the need for integrated food and transportation policies to address structural barriers and promote health equity in underserved urban communities.