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(First of two parts) 
				WILKES-BARRE &mdash; According to a recent study by The Institute for Public Policy & Economic Development at Wilkes University, food insecurity, or sub-optimal diet, results in sub-optimal nutritional status, which then directly and indirectly influences overall health and well-being through various clinical or biochemical mechanisms.
				&ldquo;The Institute convenes, facilitates and provides research support for a volunteer group of health and health care professionals representing different sectors within the broad category,&rdquo; said Teri Ooms, The Institute&rsquo;s Executive Director. &ldquo;Each year, the task force identifies an area of research. This paper focuses on food access. A strong connection between nutrition and health outcomes is well-documented.&rdquo;
				Ooms said one published case study serves as an example &mdash; it illustrates the relationship between nutrition and overall health. The study examines the case of a seven-year-old girl. Her family received monthly cash assistance, which proved to be inadequate.
				&ldquo;Despite the aid, the family still experienced episodic food shortages on a monthly basis while waiting for the next payment to arrive,&rdquo; Ooms said. &ldquo;Poor food choices and/or physiological factors manifested during those shortages and were subsequently linked to increased body fat.&rdquo;
				Ooms said the data demonstrate that malnutrition &mdash; be it from food scarcity or a dearth of nutritious foods &mdash; is linked to both acute health impacts and, at least in the case of childhood malnutrition, increased risk of obesity and chronic disease later in life.
				According to Ooms, &ldquo;nutritional status&rdquo; is a phrase that encompasses far more than the ability to consume food in sufficient quantity. Excessive consumption of unhealthy foods &mdash; those that are calorically dense and have high glycemic load &mdash; is also detrimental to health.
				For example, Ooms said a systematic review of the link between fast food and obesity found a positive correlation between fast food consumption and body mass index (BMI), despite other intervening factors.
				Ooms said obesity, in turn, is an established risk factor for all causes of death, hypertension, high cholesterol, diabetes, heart disease, stroke, and other poor physical and mental health outcomes.
				Ooms said this research seeks to understand better how several related concepts impact overall community health in Northeastern Pennsylvania. Those concepts are food access, food deserts and food literacy.
				For the purposes of this research, Ooms said food access is defined as the availability of food in a particular environment, with a focus on the differences in availability of whole and healthy foods versus fast food and other less healthful options. The analysis here uses the USDA definition of food deserts, which includes two census-tract level criteria: low food access (more than one mile from a grocery store for urban areas, and more than 10 miles in rural areas) and low income.
				&ldquo;Food literacy can be understood to include critical and functional knowledge of food and food systems and their relationship with health,&rdquo; Ooms said. &ldquo;Previously offered definitions of food literacy generally encompass themes of skills and behaviors, food and health choices, culture, knowledge, emotions and food systems. Another factor that affects food choices and overall health outcomes is poverty.&rdquo;
				Ooms added that income is a key social determinant of health, and lack of resources to pay for food can lead to persistent hunger. Because poverty includes economic issues beyond the scope of food literacy and the food system as a whole, Ooms said food challenges stemming from insufficient income are not the primary focus of this research.
				Regional Data
				Health risk factors & outcomes
				As Ooms noted above, nutrition and obesity are closely tied to general health outcomes. They are factors that increase a person&rsquo;s risk for several chronic diseases.
				The age-adjusted death rates of several obesity-linked diseases are higher in Lackawanna and Luzerne counties compared with the Commonwealth of Pennsylvania as a whole. Ooms said of particular note is the rate of death from diabetes, a chronic health condition often linked to diet, which is significantly higher in both counties compared with the statewide rate. Rates are expressed as the number of expected deaths per 100,000 population after accounting for differences in age distributions between the geographic regions.
				In the three-county region used for reporting results from the Centers for Disease Control and Prevention&rsquo;s Behavioral Health Risk Factors Surveillance System (BRFSS), the region&rsquo;s population is at least as likely as all other Pennsylvanians to have experienced a heart attack, heart disease, or stroke; have been told they have diabetes; or to be in fair or poor general health. The obesity rate is also near that of the statewide rate. The most recent data tell us that fewer than one in four residents of the region consumes at least five servings of fruits and/or vegetables daily. The data are the same for the Commonwealth as a whole.
				Furthermore, the study shows that Lackawanna and Luzerne counties most recently ranked 54th and 60th out of 67 counties in Pennsylvania on measures of Health Outcomes (including length and quality of life), according to the Robert Wood Johnson Foundation&rsquo;s County Health Rankings and Roadmaps program.
				In the parallel ranking of Health Factors, which includes factors such as smoking, obesity, physical inactivity, clinical care, physical environment and socioeconomic factors, the two counties ranked 40th and 56th respectively of Pennsylvania&rsquo;s 67 counties.
				These results demonstrate that the region, as compared to Pennsylvania, has significant health challenges both generally and with respect to indicators linked to food and nutrition.
				County-level food choices
				For individuals, a variety of factors shape food choices. These factors include taste preferences (including individual preferences as well as cultural preferences among different ethnic groups), economic considerations, and convenience. Another important factor influencing food choices is the geographic distribution of food outlets. The availability and type of food outlets in a community will influence the food choices made by those who live there. This manifests in a number of ways.
				For example, in prior research, increased density of fast food outlets has been found to correlate with unhealthier lifestyles and poorer health outcomes.
				One study undertaken in Pennsylvania found living in a food desert, an area with limited access to retail food outlets, was positively correlated with childhood obesity.
				Fresh food outlets include supermarkets and other kinds of grocery stores (excluding convenience stores); specialty food stores like butcher shops, bakeries, fruit and vegetable markets; and other specialized food stores. Convenience food outlets include convenience stores and limited-service restaurants (which include fast food and other counter-service restaurants). Though both categories represent an imperfect classification of outlets serving healthier versus less healthy options, this framework serves as a proxy for analyzing the relative concentrations of healthy food outlets versus outlets where fresh, whole or healthy food options may be more limited.
				Lackawanna and Luzerne counties both have a higher concentration of convenience food options (9.2 and 9.5 outlets per 10,000 residents, respectively) compared with eight adjacent counties, the Commonwealth as a whole and the nation. However, the counties also have an equal or higher concentration of fresh food outlets as well. This may be explained by the two counties&rsquo; greater degree of urbanization compared with neighboring counties.
				Neighborhood scale data: Food deserts
				Food deserts are one widely discussed aspect of food access. Food deserts are geographic regions where there is limited access to fresh foods, such as fresh fruit, vegetables, and other healthful whole foods. Food deserts are largely characterized by a lack of grocery stores, farmers&rsquo; markets, and other healthy food outlets, and are frequently found in impoverished communities.
				The United States Department of Agriculture&rsquo;s Economic Research Service compiles granular data on food access and socioeconomic characteristics. The map below shows regional data from 2017 on food access by census tract. Census tracts in red meet the US Department of Agriculture&rsquo;s baseline criteria for being categorized as food deserts. The two criteria are:
				&#8226; Low income. Low income tracts refer to those in which the poverty rate is greater than 20 percent, or the median family income is less than or equal to 80 percent of the statewide or metropolitan area median.
				&#8226; Low access to food within one mile for urban areas or 10 miles for rural areas. A tract is determined to be low access if either 500 or more residents or 33 percent or more of the population live more than 1 mile from a supermarket in urban areas or more than 10 miles from a supermarket in rural areas.
				Notably, a food desert or low-access designation does not necessarily indicate that a tract has no supermarkets or fresh food outlets. The designation only means a significant portion of residents live more than one mile from any supermarket (within or outside that tract) for urban residents or more than 10 miles for rural residents. Supermarkets include large grocery stores and super-centers that accept SNAP. One limitation of these data is that the database of supermarkets used dates to 2010. Since that time, various store openings and closures have occurred in the region.
				Census tracts considered to be food deserts, shown in red below, are found in both Lackawanna and Luzerne counties, as well as most neighboring counties. Throughout the broader region, food deserts exist in urban, suburban, and rural communities.
				These types of communities cover a broader portion of the region, including significant portions of Lackawanna and Luzerne counties. Though these areas are less impoverished, they still represent communities where distance could represent a barrier to fresh food, especially for households in these tracts without access to a car.
				Finally, this more inclusive definition extends low-access designations to large portions of the urbanized core of Lackawanna and Luzerne counties, including the majority of tracts in the cities of Scranton and Wilkes-Barre.
				Like Lackawanna County, Luzerne County has several food deserts as well. They include two tracts in the northern part of Wilkes-Barre, the southeastern parts of Nanticoke, the western parts of Hanover Township, and the borough of Edwardsville.
				These areas include many towns within the Wyoming Valley, including Larksville, Wyoming, Exeter, Dupont, and Avoca, as well as Harvey&rsquo;s Lake, parts of Mountain Top, and several communities along the I-80 corridor.
				Finally, the yellow tracts show communities that meet a more inclusive threshold for limited food access with one-half mile thresholds for urban areas (including low-income and non-low income tracts). Using this more inclusive threshold adds Freeland, parts of Hazleton, Dallas, Pittston, West Pittston, and numerous tracts in and around Nanticoke and Wilkes-Barre.

Study shows strong connection between nutrition and health outcomes