This assignment is an in-depth, literature-grounded analysis of a significant U.S.health policy issue. The final paper is to be approximately 8–10 ten pages in length (excluding the list of references cited at the end); apply and cite at least ten high-quality references, and address the following ten elements: 1) Overview and Significance of the Health Policy Issue 2) History of the Health Policy Issue (Including Legislative Processes and Partisan Politics) 3) Current Challenges Associated with the Health Policy Issue 4) Stakeholder Analysis 5) Policy Options and Analysis of Trade-Offs 6) Policy Recommendations 7) Recommended Roles for Federal Government, State Government, and Markets 8) Implications of the Policy Recommendations a) Analysis of Population Health Implications b) Analysis of Economic Implications c) Analysis of Political Implications d) Analysis of Implications for Health Care Organizations e) Application of Two Saint Leo University Core Values 9) Conclusion 10) References Cited The Final Term Paper must also follow APA format including: · Double-spaced · 1-inch margins left, right, top, and bottom · 12-point font Example U.S. health policy issue topics Care fraud and abuse Anti-kickback Prohibitions HIPPA False Claim ACT Antitrust Compliance Programs Tobacco free policies Disability legislation Right to die Right to refuse life treatment Child abuse and neglect Global pricing on drugs Abortions Child abuse and neglect Global pricing on drugs Abortions Running head: FOOD ACCESS AND HEALTH OUTCOMES IN AMERICAN 1 FOOD ACCESS AND HEALTH OUTCOMES IN AMERICAN 4 Food Access and Health Outcomes in American Huang School of Public Health LM Ho June 31, 2016 Abstract In the U.S., food access and food security is a challenge. The lack of convenient access to affordable and healthy food is a considered a national challenge. Socio-economic status of the country’s population affects the consumption and access of health food. Low-income areas usually lack access to adequate food and high-income areas have a challenge of access to health food. Therefore, for the two areas with different socio-economic population statuses, they all have challenges to food access. Lack of healthy foods often lead to poor diet and higher levels of risk to obesity. Due to the persistent food access and food insecurity challenges, the aim of this study is to discuss the link between food access and food consumption among the American population. The paper will also focus on the exploring the variation between food access and food consumption among the American population. A two-stage sampling cross-sectional survey will be used to sample participants from 48 states of the U.S. A self-administered questionnaire will be used as quantitative data collection instrument. The target population will be sampled adult U.S. citizens who have families to feed. Grown-ups with families are likely to demonstrate their understanding of ...

1. This assignment is an in-depth, literature-grounded analysis of a
significant U.S.health policy issue. The final paper is to be
approximately 8–10 ten pages in length (excluding the list of
references cited at the end); apply and cite at least ten high-
quality references, and address the following ten elements:
1) Overview and Significance of the Health Policy Issue
2) History of the Health Policy Issue (Including Legislative
Processes and
Partisan Politics)
3) Current Challenges Associated with the Health Policy Issue
4) Stakeholder Analysis
5) Policy Options and Analysis of Trade-Offs
6) Policy Recommendations
7) Recommended Roles for Federal Government, State
Government, and Markets
8) Implications of the Policy Recommendations
a) Analysis of Population Health Implications
b) Analysis of Economic Implications
c) Analysis of Political Implications
d) Analysis of Implications for Health Care Organizations
e) Application of Two Saint Leo University Core Values
9) Conclusion
10) References Cited
The Final Term Paper must also follow APA format including:
· Double-spaced
· 1-inch margins left, right, top, and bottom
· 12-point font
Example U.S. health policy issue topics
Care fraud and abuse Anti-kickback Prohibitions
HIPPA False Claim ACT
Antitrust Compliance Programs Tobacco free policies
Disability legislation Right to die

2. Right to refuse life treatment Child abuse and neglect
Global pricing on drugs Abortions
Child abuse and neglect Global pricing on drugs
Abortions
Running head: FOOD ACCESS AND HEALTH OUTCOMES IN
AMERICAN 1
FOOD ACCESS AND HEALTH OUTCOMES IN AMERICAN
4
Food Access and Health Outcomes in American
Huang
School of Public Health
LM Ho
June 31, 2016
Abstract
In the U.S., food access and food security is a challenge. The
lack of convenient access to affordable and healthy food is a
considered a national challenge. Socio-economic status of the
country’s population affects the consumption and access of
health food. Low-income areas usually lack access to adequate
food and high-income areas have a challenge of access to health
food. Therefore, for the two areas with different socio-economic
population statuses, they all have challenges to food access.
Lack of healthy foods often lead to poor diet and higher levels

3. of risk to obesity. Due to the persistent food access and food
insecurity challenges, the aim of this study is to discuss the link
between food access and food consumption among the American
population. The paper will also focus on the exploring the
variation between food access and food consumption among the
American population. A two-stage sampling cross-sectional
survey will be used to sample participants from 48 states of the
U.S. A self-administered questionnaire will be used as
quantitative data collection instrument. The target population
will be sampled adult U.S. citizens who have families to feed.
Grown-ups with families are likely to demonstrate their
understanding of access to health foods because they have
families to feed. Descriptive statistics and Analysis of Variance
will be used to analyze data using the SPSS software version
22. Food access in the U.S. remains a challenge even in the
modern society. Food security is also a challenge and this
challenge is a risk factor to the health outcome of the consumer.
Table of Contents
Abstract 2
CHAPTER 1 5
Introduction 5
CHAPTER TWO 8
Systematic reviews 8
Food accessibility versus dietary intakes 8
Food accessibility and prevalence of obesity 9
Role of food pricing in food accessibility 1110
Formulation of products 11
Role of different policies in ensuring accessibility of food
1211
The role of Geographic distribution, food access and food
security 13
Research question 14
Hypothesis 14

4. CHAPTER THREE 15
METHODOLOGY 15
Study location 15
Research design 15
Target population 1615
Variables 16
Sampling Procedure 16
Sample size determination 16
Inclusion criteria 1716
Exclusion criteria 1716
Research instrumentation for data collection procedure 17
Methods of Data Collection 17
Quality control 1817
Pre-test 18
Validity 18
Reliability 18
Methods of Data analysis 1918
Ethical consideration 19
Limitations of the study methodology 19
CHAPTER FOUR 20
WORK SCHEDULE 20
Expected results and Implications of results 2120
TENTATIVE THESIS CHAPTER OUTLINE 22
Reference 23

5. CHAPTER 1Introduction
Most of Americans live in places characterized as low income
areas with limited access to supermarkets and grocery stores.
Individuals in such areas find themselves seeking food from fast
food restaurants that offer limited varieties of food. Inability to
access healthy foods is the leading cause for poor dietary
decisions. This is because limited access to healthy food
contributes to difficulties in adhering to nutritious diet for the
low income families (Inagami, et al., 2006). However, for
communities with better accessibility to supermarkets with
limited access to stores, they have better and healthier diets and
lower chances of diseases such as obesity. Consumer
accessibility to supermarkets, grocery stores and appropriate
markets allows consumers to choose from a variety of fruits and
vegetables. Research has demonstrated that diets rich in fruits
and vegetables offer several health benefits to the consumers
which imply lower levels of obesity and increased weight loss.
It is studied that Americans living in low income areas
consumes fewer fruits and vegetables than what is recommended
by dietary guidance. It is also suggested that availability of a
number of retail stores corresponds to healthier eating, (Galvez
et al., (2007). There are a number of factors that contribute to a
person’s body weight and risks associated with diet related
diseases such as diabetes and other chronic diseases. It is
hypothesized that lack of access to fully equipped groceries
with easier accessibility of fast foods contributes to poor diets
accelerating the rate of chronic diseases that are termed as food
related diseases.
In US, the issue of public health has over years been an
increasing concern due to increases in health care costs and
economic constraints. Most of diet related diseases are
constantly increasing in both rural and poorer urban centers.
Relationship between poverty and poor health outcomes are
increasing which poses complexity in understanding the issue
despite solutions being suggested (Michimi and Michael, 2010).
Most work that has been studied focuses on food access by

6. poorer urban dwellers without concentration on rural poverty to
unhealthy diets. This forms the basis as to why there is
difficulties in identifying the key reasons as to why the rural
citizens are not able to access healthier diets despite the fact
that they are at a position of consuming healthier diets due to
availability of land where they can grow their fruits and
vegetables, and in case they are to buy from those growing them
they can access at a cheaper price other than those from urban
centers.
Observations on the changes that occur in the food environment,
utilization patterns and diet-related diseases are the basic
reasons behind more researches being conducted in determining
possible association of the issues (Morland, 2015). The field of
food access is the common source of information that elaborates
the effects of food access on consumption and health outcomes
that has different perception by different researchers. It is
identified that food access is piled into food availability,
accessibility, affordability, acceptance and accommodation
which are aspects of importance to an individual and health
outcomes. The problem of one being unable to access healthy
food in US was initially dealt with by the food conservation and
energy act of 2008. Later, the act delegated most of its duties
such as the assessment ofthe extent of limited access, the
identification of characteristics and causes of the problem
together with effects associated with the problem to US
department of agriculture (USDA), which is the body that
handles all food problems within US. A number of methods
have been used in identifying the extent of limited availability
and nutritious food which are individual and area based
measures of food accessibility (Pearson, 2005). Attention has
concentrated on studying the relationship between food access
and increase on chronic diseases so as to understand the factors
behind food accessibility and individual behavior in
establishment of appropriate health and outcomes. This work
will give a synthesis of skills and core competencies in the
public health at the verge of accessing food accessibility and

7. health outcomes in America.
CHAPTER TWOSystematic reviews
[1. You will a short para describing the structure of systematic
reviews.
2. More importantly, you should highlight what has been known
and what has not been known, so that you can formulate your
research questions]Food accessibility versus dietary intakes
Most researches examine the effects of food access on outcomes
[what kinds of outcomes?] such as food retailing behavior and
consumption in regard to specific fruits and vegetables, whole
grains and milk products. There are those studies that have
focused on outcomes on the basis of BMI, heart diseases and
obesity. The reasons for different outcomes are to specifically
identify the outcome that accounts for rates of food
inaccessibility. Majority of studies explains the relationship
between food accessibility [consistent use of Access vs
Accessibility] and dietary intake from large stores in showing
that there people who are likely to source their foods from such
stores consumes healthier diets (Larson et al., 2009).
Relationship between availability of fast food from restaurants
and the intake of such food is studied to informing citizens that

8. even if the consumers access the food at cheaper prices, the
content of the food is poor in terms of nutrition. There is less
information on how changes in food accessibility affect diet
changes. For instance, from a study by Cummins et al. (2005), it
was demonstrated that shopping behavior is influenced by
establishment of new stores. Probably because the more stores
are there in a location, the more dwellers are able to consume a
variety of the foods and source the food stuff from various
stores. Additionally, the owners are likely to source a variety of
fresh fruits and vegetables more often as a strategy of offering
quality products to the customers, which will be result into
appropriate health among the consumers.
Some localities have also implemented programs that are geared
to improvement on what is offered by the residential stores.
This is a cost effective strategy instead of building new stores
that would somehow be expensive for rural dwellers. The idea is
to cause [an in?] improvement by [offering healthier options
with less healthier options what do you mean?]. This also
improves sales within a store as consumers are able to access a
variety of foods. For instance a study by Galvez et al. (2009) in
which consumption of fruits and vegetables was evaluated to
determine the number of customers who preferred [purchasing
their products when packaged ?meaning?] or to consume it at
the store showed that most consumers preferred packaged
product due to convenience in consuming it at work place or at
home. The study was testing whether [improvement on a
product ?meaning?] has repercussion on consumer’s preference.
This implies that [small store interventions are a promising
strategy to having consumers take the product. ?meaning?]Food
accessibility and prevalence of obesity
A Study by Larson et al., (2009) has explained the
relationship between accessibility of food from a store or
restaurant with cause ofand obesity by measuring the BMI of a
person. The study explains that individuals who have an
appropriate access to supermarkets for their foods experience
less risks of obesity, unlike and those who have better access to

9. convenience stores who experience increased risks of obesity.
In a study by Chung and Myers (1999), there is a relationship
between accessibility of fast food from supermarkets and
restaurants, andto BMI offrom Indiana citizens. The study
shows that proximity of fast foods from supermarkets has a
small [positive implication ??meaning??] on BMI which is a
contrast to many studies that shows negative implications on
BMI on food sourced from grocery stores. The occurrence of
obesity based on BMI calculations is also dependent on
neighborhood environment that one lives at. This is because
according to a study done by Chauet al. (2013), the
neighborhood that had a wider access to fresh commodities had
a lower susceptibility to obesity than those neighborhoods that
lacks stores for fresh nutritious commodities.
It is hypothesized that food rich in fiber content, fruits and
vegetables and whole grains increases satiety, making
consumers to consume less. This is an indicator that those
consumers who much of the time access foods that are rich in
fats [do you mean that these consumers tend to consume more?]
are likely to be obesity victims. This is because stronger
evidence exists in suggesting that consumption of sweetened
beverages [do you mean that fat food is sweet, as you use “This
is because” ?] is associated with increases in BMI and obesity.
However, there is less evidence to proving that consumption of
healthy foods such as fruits and vegetables leads to lower BMI,
meaning that one has a reduced risk of obesity [?are you sure
that there is “less evidence” on this point?.
The assessment of nearest food environment to an individual
The geographical regions on the basis of socioeconomic,
demographic and local food surroundings are the determinants
of a person’s behavior into choosing which food are to be
consumed (Cummins and Sally, 2005). The nearest store to an
individual determines the buying pattern since most of the
consumers are concerned with convenience into accessing the
food. For instance, a nearest store may be offering fast foods
that are poor in nutrition quality but there are consumers who

10. prefer it other than walking to a longer distance in search of
nutritious products. in a region where there are many stores for
accessing food, consumers are likely to have better and
improved nutrition due to varieties unlike in rural areas where
there may be few limiting alternatives. The economic capacities
of individuals also influence the likelihood of individual to
access nutritious products. Health conscious individuals with
higher levels of income are able to access nutritious product
which is a strategy to stay healthier live and refraining from
diet-based diseases. On the other hand, for consumers who have
less income, they are likely to look for convenience by
consuming fast foods with no nutritional components which lead
to obesity and other diet related complications. Role of food
pricing in food accessibility
Prices of food have an impact on consumer choices (Jetter
and Cassady, 2006). As food prices declines, the energy dense
food becomes a convenient food for consumption. The
technological advancement has contributed to food being cheap
due to available means that can be employed into availing food
to consumers. Research indicates that as the rice of fruits and
vegetables increases at the expense of less healthier foods, most
of the consumers are still passionate in consuming fruits and
vegetables. Some studies indicate that energy-dense foods such
as refined grains and fats are still the lowest kinds of foods that
are consumed by most consumers, probably due to increased
health concerns that consumers have in fighting diet-based
diseases. Research also indicates that healthier foods are
purchased out of reduced prices which to some extent is
difficult to maintain due to increased costs of raw materials and
payment of taxes by the processing companies. Formulation of
products
The accessibility of food stuff at the supermarkets and
grocery stores requires equitable product formulation that is
geared at offering the consumers healthier products, (Jetter and
Cassady, 2006). Processers much of the times have to meet the
demands of the consumers in ensuring compliance to acts that

11. require human food to be safe. When doing this, consumers are
sensitized on strategies that will lead them to consuming
healthier products. It is at this point when some of the
consumers will not inquire of the various products at the shelf
by only preferring a certain product from a particular company
without preferring it. This limits the accessibility of healthier
products from certain companies lowering the efforts of certain
companies which may lead to deterioration of products out of
minimizing the cost incurred during productions. Role of
different policies in ensuring accessibility of food
In America, agricultural policies have tried to ensuring
stability of crop prices, availability, affordability and consistent
food supply. The state calls for researchers to hold studies that
can mitigate unhealthy conditions brought by the above issues.
Subsidized prices are offered by the state in encouraging
citizens to consume healthier food options as an initiative of
limiting poor nutrition. A study on effects of price incentives in
regard to healthy food intake shows that 10% subsidy of fruits
and vegetables increased vegetable and fruits intake from 1.26-
1.33 cups per day (Galvez et al. 2007). The increase is an
indicator that most individuals are closer to what is
recommended.
Based on the above reviews, it is important to develop new
strategies that would make American have an easy access to
nutritious and healthy foods so as to reduce the rate of diet
based diseases. First, there is need to increase the availability of
fruits and vegetables in most of food supply chains. For
instance, food supply chains should be encouraged to have a
variety of raw fresh fruits instead of processed fruit juices
which have preservatives and chemicals that are likely to
accelerate prevalence of diseases. Food supply chains are to
follow the guidelines of the dietary bodies so as to support
consumption of fruits and vegetables. The processing industries
need to be educated on ways of being creative and utilizing the
available resources in developing healthier foods for citizens.
For instance, food should be produced without adding calories,

12. fats, soils and sugars but should be nutritious. All restaurants
need to expand their capability in being actively involved at
production of healthier foods with attention being placed on the
quality of food and not on quantity. Improved policies and
practices may be adopted in ensuring ready accessibility of
nutritious food to citizens through programs that are
demonstrative in encouraging consumers to stay healthier. For
instance, the feeding programs for school going children needs
to be monitored and revised so as to engage healthier food so as
to eliminate calorific and energized foods. This can only be
effective by imposing and laying down rules that school feeding
programs needs to adhere to. In addition to assisting
communities that are under their own authority into eating
whatever they want, communities can be assisted by helping
them eat healthier foods. Knowledge on potential steps that can
be used to promote healthier eating can be given the citizens.
Information can be made available to citizens via
communication networks which are tools that recently been
considered as advertisement tools that reaches a wide scope of
individuals. In regard to this, all stakeholders need to work as a
single unit in assessing the progress of shifting from unhealthier
food to increased intake of healthier foods. The role of
Geographic distribution, food access and food security
Researchers have often indicated that the geographic access to
adequate food is one of the most important dimensions of food
insecurity. Geographic distribution affects the cost of food
among the socio-economic status classes of which the low-
income consumers have limited variety of food to choose from.
Researchers have tried to develop new techniques for
characterizing the food environment as an effort to develop
specific food security income. The central concepts of domestic
food security have constantly been searching for a long term
food security answer with no vain, (Rose, 2010). Every time in
history comes with its own challenges of food security. The
common variables that are used in food security studies include
food availability, food access, food utilization and dietary

13. health outcome.
Rose, (2010), indicates that the process of food insecurity must
be defined. Active food policies must demonstrate their
relationship with geographic food distribution as well as
relationship with future food access and food security
challenges. In broad terms, adequate food security has been
defined in terms of consuming adequate nutritious food. The
process of ensuring adequate and healthy food availability in
the U.S. is continuous. However, even with enough resources
and adequate policies, the challenges of food security remain
persistent because of natural and inevitable environmental
changes. Given that America is high developed, but there is
food access and food security challenges, researchers should
invest on innovating new food security strategies, (Rose, 2010).
Often healthy food items do not exist because of lack of
alternative, but because the modern populations are relying
more on fast foods as compared to natural foods.
Research questions [These research questions should be based
on what has been known and not known from the literature
review. My feeling is that Q3 is difficult to test, eg how to test
for no classification, but you can test for no association]
1. What is the link between food access and health outcome of
American population.
2. What is the variation [?meaning? do you mean
“relationship”?] between food access and food consumption
among American population?
3. What is the classification of healthy and unhealthy foods?
Hypothesis
1. There is no link between food access and health outcome of
American population.
2. There is no variation between food access and food
consumption among American population?
3. There is no classification of healthy and unhealthy foods.
IT SEEMS THAT YOU ARE WRITING A PROPOSAL.

14. Of THE 4 COMPETENCIES, WHICH 2 ARE YOU AIMING
AT?
CHAPTER THREEMETHODOLOGY
This chapter deals with the research design and methodology
employed in the study. It also outlines the location of the study,
target population, sample size and sample selection, sampling
technique, data collection and analysis methods.Study location
This study will be conducted in 48 States of the United States.
The rationale for choosing the 48 States is that food security
instruments cater for all Americans and not just a section of the
American. Even though America tends to be divided into two
parts: the Northerners and Southerners, with different socio-
economic population statuses, food security resources and
recommendations are distributed equally. The Northerners are
considered being a population of a higher socio-economic class
as compared to the Southerners and the researcher believes that
food access and food security might be different in these two
classes. Research design
The study design for this research is a cross sectional survey
that involve a onetime interaction with the target population of
the study. The study will be quantitative in nature, which will
utilize a structured questionnaire as the main data collection
instrument. The purpose of the choice of a cross-sectional
survey is that there will be a large target population for this
study. Also, the information needed for this research will
evaluate the current food access situation in the country. Target
population
This study will be carried out in 50 states of the U.S. and will

15. target a sample population from high, middle and low socio-
economic income. The study participants will comprise of
adults who are informed about food security, food access and
who have knowledge of healthy foods in the U.S. Sample units
for this study are likely to be family homes in the select study
locations. The sample size will be determined using a
standardized formula for determining the sample size of cross
sectional surveys. The target participants in the sampled units
have equal chances of participating in the study. However, the
sampling frame utilized for this study will determine the limit
number of study participants who will provide data for survey.
Variables
The independent variables for this study will be availability of
health foods, socio-economic status, food security resources,
and food consumption status. The dependent variable will be
indicators for food access among the U.S. population. Sampling
Procedure
Two-stage sampling procedure will be used to identify and
register the study population in the study location. The two-
stage cluster sample will be obtaining by selecting cluster
samples in the first stage and the selecting samples of elements
from a sampled cluster. Simple random sample is used in the
second stage. The two-stage sampling is quicker and more
reliable and is therefore used to sampling in this study. Sample
size determination
The sample size for the study population will be calculated
using the Fisher's et al., (1999) formula. The margin of error to
be allowed in the estimate is 5% which means a 95% confidence
level, (Mugenda, 2008).
n= sample size for the study
p= percentage estimate picking a choice (50%) expressed in
decimal (0.5)
z=statistical constant representing a 95% confidence interval
which is 1.96
d= sampling error representing 5% expressed in decimal.

16. Inclusion criteria
Inclusion criteria for participating in this study will be adults
who have families. Adults with families are likely to understand
the required health foods for their families and are likely to
give information on their status of food assess. Exclusion
criteria
Exclusion criteria for participating in this study will be those
adults who do not have their own families and those who are
likely to not understand the purpose of health maintaining
healthy foods. Research instrumentation for data collection
procedure
The study survey instruments that will be used to collect data
for food access and health outcome based on the identified
variables will be a structured questionnaire. This questionnaire
will be self administered. The questionnaire is a quantitative
data collection tool significant with social science surveys
where researchers use descriptive statistics and concepts of
hypothesis testing with the data collected using these
instruments.
The range of expected values in the data collected using the
questionnaire depends on the variables used. Since demographic
variables are general and the value trends are known in the
home science sector, they will provide a rough map of the
expected qualitative variables that will be used to estimate the
expected values in the present. Since the variables for the
present study test seeks to identify various food access and
health outcome for the American population among participants,
a higher number of the healthy participants are likely to report
that there are significant food access resources. This means that
the general distribution graph will be skewed towards healthy
participants who will be expected to give concrete data.
Methods of Data Collection
A structured self-administered questionnaire will be used to
collect data for this study. Through stratified random sampling,
the researcher through their assistants will identify the
presumed eligible participants will be approached for face to

17. interview before allowing them to fill in the self-administered
questionnaire. At a select sample unit, researchers will approach
identified study participants, introduce themselves and explain
the basic study intentions. The study participants will be asked
to provide their consent and will sign the consent form. The
research assistants will guide the study participants on how to
fill the questionnaire and request them to consider providing as
much data as possible within their capacity. Section one of the
questionnaire will be used to collect data on demographic
information of the study participants. Section two and three will
involve the variables for this study. Quality control
Quality control will be a continuous process throughout the
study to maximize validity and reliability of the findings of the
study.
Pre-test
Pre-testing for this questionnaire will be done in select non-
study states. One state in the Northern and one state in the
Southern parts of the U.S. The states that will be used for pre-
test will be excluded from the main study. Pre-test activity is
done to ensure clarity and for gaining preliminary insight into
the questionnaire construct. Sample size for pre-testing will be
30% respondent of the target sample population for the study.
Validity
According to Mugenda (2008), validity is the degree to which
an instrument measures what it purports to measure. The
validity of the study will be ascertained by ensuring that the
data collection instruments reflect the objectives of the study.
The research will concentrate on content validity by performing
a pre-test so as to adjust the research tool to meet the required
standards. The questionnaire will be presented to the University
for Validation by the supervisors and research panelists before
data collection. Reliability
This is a measure of the degree to which a research instrument
would yield the same results after repeated trials, (Mugenda,
2008). The reliability of the questionnaire will be established
through a test and re-test technique whereby the instrument will

18. be administered twice to the same group of subjects during the
pilot study. There will be a time lapse between the first test and
the second test. Cronbach's alpha coefficient will be used to test
reliability of data collected. An alpha (α) score of 0.70 or
higher will be considered satisfactory and ascertains reliability.
Methods of Data analysis
Descriptive and Analysis of Variance (ANOVA) statistics will
be used for analyzing results for this study. Data of the scores
from the measurable variables in the questionnaire will be
coded into SPSS Version 12. The data will be tabulated and
analyzed to generate graphs and charts that will be used to make
inference on hypotheses presented. Ethical consideration
Permission to conduct research will be sought from the relevant
authorities. Respondents will give their consent to participate.
The respondents will be informed that their participation is
voluntary and will also be informed of their rights to accept or
withdraw or refuse to participate in the study. The researcher
will give full information about what the research entails and
ensure participants are competent to give consent. Full consent
and explanation will be contained in the questionnaire. The
questionnaires will be administered with duly obtaining the
consent of the participant. Participants’ privacy will be highly
maintained by ensuring that they will not be exposed to public
when filling questionnaires. The researcher will ensure the
anonymity of respondents by concealing their identity and keep
research data confidential for research purposes only. All
concerns causing any sort of discomfort to respondents will be
resolved immediately and mitigation strategies put in
place.Limitations of the study methodology
Based on the cross-sectional nature of the study, foreseen
limitations include limited target respondent. The investigator
only assumes positive response for completing the
comprehensive questionnaire with no influence to have the
questionnaire completed in full. Missing responses are common
in long and comprehensive questionnaires that affect the general
data analysis. Furthermore, this is a field study. Field studies

19. are associated with unpredictable challenges that will often
compromise on scope of time to finish collecting data. Extended
time will not only constrain the research study schedule but is
also associated with increased miscellaneous cost.
CHAPTER FOURWORK SCHEDULE
ACTIVITY
April 2016
May
June
July
Aug
Sept
Oct
Nov
2016
Identification of research topic
Formulation of research objectives

20. Literature review
Concept note
Proposal writing
Defense of proposal

21. Data collection
Data Analysis
Report writing and refining
Submission of report to the department

22. Expected results and Implications of results
In this study, the expected results include determining food
access for the American population within the 48 study states of
the U.S. The study will also determine the classification of food
in the U.S. and the link between food access and health outcome
of American population. The study will also determine the food
access and food consumption among and the classification of
healthy and unhealthy foods. The implications of the study will
be inform and recommend to stakeholders on how they will
change the food access and food insecurity challenges among
the study population. The study will identify stakeholders and
inform them on the strategies that are appropriate in changing
the organization’s needs.
TENTATIVE THESIS CHAPTER OUTLINE
Abstract
The abstract contain information aiming at summarizing the
project study. This section briefly presents an overview of all
the sections of the research.
CHAPTER 1

23. This section contains the introduction to the topic as well as to
the study. Americans are considered having limited food
choices hence the phenomenon of food insecurity. This study
will aim at documenting the link between food insecurity and
health among the U.S. populations.
CHAPTER TWO
Systematic reviews
This section aims at evaluating literature and past researches
about the topic. Recent literatures are evaluated to try and
identify gaps existing about food access, food insecurity and
health outcome among the American citizens.
CHAPTER THREE
METHODOLOGY
This chapter deals with the research design and methodology
employed in the study. It also outlines the location of the study,
target population, sample size and sample selection, sampling
technique, data collection and analysis methods.
CHAPTER FOUR
WORK SCHEDULE
The project schedule information will be contained in this
section. The project will run from April through November
2016. This section will also contain the expected results and
implications of the study. Reference
Chau, C., Jamie, Z. and Jennie, H. (2013). Availability of
healthy food: Does block group
race and income matter? Journal of Hunger and Environmental
Nutrition.8:22-38.
Chung, C., and Myers, J. (1999). Do the poor pay more for
food? An analysis of grocery
store availability and food price disparities.Journalof Consumer
Affairs 33:276-296.
Cummins, S and Sally, M. (2005). Food environments and
obesity neighborhood or
nation?International Journal of Epidemiology. 35:100-104.
Galvez, M., Morland, K., Raines, C. (2007). Race and food

24. store availability in an inner
city neighborhood. PublicHealth Nutrition 11: 624-631.
Inagami, S., Cohen, D., Finch K. B., and Asch, S. (2006). You
are where you shop:
Grocery store locations, weight, and Neighborhoods.American
Journalof Preventive Medicine.31(1): 10-17.
Jetter, K., and Cassady, D. (2006). The Availability and cost of
healthier food
alternatives. AmericanJournal of Preventive Medicine 30:38-44.
Larson, N., Mary, S and Melissa, N. (2009). Neighborhood
environments disparities in
access to healthy foods in the US. American Journal of
Preventative Medicine36(1):74-81.
Morland, K. (2015).Local food environment food access in
America.Boca Raton.
Michimi, A. and Michael W. (2010). Associations of
supermarket accessibility with
obesity and fruit and vegetable consumption in the
conterminous United States. International Journal of Health
Geographic’s.9(1):49-63.
Mugenda, A. G. (2008). Social science research conception.
Nairobi: Applied Research and Training Services.
Pearson, T., Jean, R., Michael C. and Margo B. (2005). Do food
deserts' influence fruit
and vegetable consumption? A cross sectional
study.Appetite.45:195-197.
Rose, D. (2010). Access to Healthy Food: A Key Focus for
Research on Domestic Food Insecurity. The Journal of
Nutrition.140(6):1167-1169.
4
Public Health Capstone report will demonstrate the acquisition
and synthesis of skills and core competencies

25. Topic: Food Access and Health Outcomes in American
Healthy option is hard to find in many millions of low-income
Americans who live in the community of "food desert". The
communities, that lack convenient access to affordable and
healthy food, rather than a supermarket or grocery store, usually
have a lot of fast food restaurants and convenience stores. In
addition, the store stock fewer and lower quality healthy foods
in low-income communities. Fresh food costs can be high in
supermarket. Low-income areas usually lack of public
transportation, long distance separate home, and supermarket in
many rural communities. It is hard for residents of these areas,
even those fully informed and motivated to follow the necessary
and recommended steps, to maintain a healthy weight for
themselves and their children. Too often, economic incentives
strongly favor unhealthy eating, and accessibility, safety
concerns, and convenience can also promote unhealthy
outcomes. 1
Lack of healthy foods can lead to poor diet and higher levels of
obesity, and other diet related diseases. Moreover, it is difficult
to obtain affordable food that lead to high levels of food
insecurity, increasing the number of low- and moderate-income
families without access to enough food to sustain a healthy,
active life.
This paper will discuss food access and health outcomes in diet-
related disease. The purpose of this paper is to demonstrate the
relationship between individual’s overall diet, body weight, and
the risk of developing diet-related disease. Personal factors can
explain some but not all differences in the rate of people’s
experience of these problems. Pay attention to food access
could be better to understand factors in addition to personal
behavior that can lead to differences in diet and health
outcomes.
Interest in the relationship between food access and health diet
also has its roots in a large number of literature showing those

26. differences in many health outcomes across racial, ethnic, and
socioeconomic status. This is based on the assumption that the
differences in food access across racial, ethnic, social and
economic status could lead to the health disparities.
In order to examine this relationship, I will use Systematic
review, scholarly literature, both primary and secondary
sources. Within these documents, I will focus on the behavior
and communication strategies. By doing so, I will demonstrate
the rationales, purposes, and methods behind the use of food
access and its relationship to diet and effects on health
outcomes. Medline will be searched for keywords including diet
and health outcome from 2005 to 2015. I will examine how food
access can influence the outcome of the diet and the diet related
disease, and then review the relationships among access to food,
diet, obesity, and diet-related problem. This study will allow me
to explore the strategies within food access, and how these
strategies influence diet and health.
TWO Competencies to be addressed
1. To assemble, critically review, synthesise and interpret
published literature (including grey literature) on a public
health topic.
i.e., systematic review or literature review that clearly
describes and assesses the problem, its magnitude, causes and
determinants, and discusses prevention and intervention
strategies
2. To use epidemiological or other approaches to describe the
health status or health care needs of a defined population and
identify environmental or personal risk factors which threaten
or enhance health.
i.e., primary or secondary data analysis; policy analysis; an
original report built on the Practicum experience (independent
of the Practicum report).

27. Format
1. Abstract of Thesis Proposal
The abstract is a summary of your thesis proposal. It is usually
not more than 1 or 2 pages containing the problem statement,
the rationale of the study, the hypothesis, the methodology that
you are proposing to use, the expected result and the
significance of your study. This section gives the reader an
overview of your thesis proposal. Don’t try to explain the
technical details or methodology of your study here, as these
should be included in the latter sections. Try to present your
idea in layman language so that even readers who are not in
your field could understand. This section should not contain
references.
III. Basic Elements of a Thesis Propos
2. Table of Contents
You should list all headings and subheadings with page
numbers. Subheadings should be indented.
3. Introduction
This section sets the context for your proposed project and must
capture the reader’s interest. You should explain the
background of your study starting from a broad picture
narrowing in on your research questions, listing the relevant
references, as appropriate. The introduction should be at a level
that makes it easy to understand for readers with a general
background in your field.
4. Systematics Review
The section demonstrates that you are knowledgeable of the
primary texts and secondary research studies done by other
researchers and ensure that you are not “reinventing the wheel”.
It is important to note that this section is not merely a summary
of the relevant literature you have read but instead, you have to
provide a critical review on it and be able to relate the literature
to your proposed research. You should point to areas overlooked
or inadequately addressed by previous studies and discuss how

28. your proposed research could contribute to the knowledge
advancement in the area. This shows your ability to integrate
and synthesize the literature and to develop new ideas and
innovations. Proper referencing in this section is very
important.
The followings are the most common deficiencies of a literature
review and you should try to avoid all of them:
- lack of organization and structure
- lack of focus and coherence
- being repetitive
- failing to cite influential papers or studies
- citing irrelevant and trivial references
- failing to cite the current papers or studies
- failing to critically evaluate cited papers
5. Research Questions and Hypotheses
This section tells reader what you would like to find out in your
research. State your research questions and hypotheses
explicitly in this section. In most cases, the primary research
question should be broad enough to cover your whole proposed
research and the subsidiary research questions and hypotheses
are more specific c and each of them should focus on a certain
aspect of your research. These hypotheses usually form chapters
or sub-sections of your final thesis. You should explain how
these research questions and hypotheses are formulated.
6. Methodology
This section explains “how” you are going to conduct your
research. You should demonstrate that you are fully aware of
the alternative research methods and explain how your proposed
methodology is more advantageous than the others in attaining
your stated objectives.
For quantitative research, you should include:
(i) the research design, e.g. a questionnaire study or a

29. laboratory experiment
(ii) the subjects or data source, e.g. who will participate in the
data collection, the sample size and sampling methodology
(iii) the instruments, e.g. the kind of measuring instruments or
questionnaires and the reason for choosing these instruments
(iv) procedure, e.g. how you are going to carry out your study,
what activities are involved and how long does it take
(v) the methods of analysis, e.g. modeling techniques or
statistical methods
You should also discuss the limitations of the proposed
methodology, the assumption and the range of validity in data
collection.
Where the thesis research involves human subjects, you must
also obtain the approval from the appropriate ethics committee.
A copy of the approval, if available, should be attached to the
proposal.
7
If you have conducted a pilot study, please also provide the
details here and discuss how the methodology will be improved
in view of the previous experience.
For qualitative research, as there are no well-established and
widely accepted general rules or principles, you need to
elaborate more on the data collection process and how you will
analyze the results.
The methodology carries great weight to affect the success of a
piece of research. You can have a very good research topic but a
poor research methodology could easily ruin the outcome! In
order to prepare yourself for your research and to enable the
reviewer to understand your proposed study better, you should
be more detail in your research methodology. For example, how
to collect your data, how many samples to take, what specific
methods will you used in analyzing your data.

30. 7. Work Schedule
In this section, you need to identify the tasks and make realistic
estimates of the time required for each task. This could be
easily done in a table or chart format. Setting important
milestones could definitely help to monitor the research
progress.
8. Expected Results and Implication of Results
Obviously you do not have results at the proposal stage.
However, you need to have some idea about what kind of data
you will be collecting, and what methods will be used in order
to answer your research question or test your hypothesis. You
should also state the contribution expected from your research
efforts.
9. Tentative Thesis Chapter Outline
Present the chapter outline as a draft contents page with brief
annotations of expected content or stages will help you in
thinking through the process and outcome of your research.
Follow the standard sections relevant to your type of research.
Look at past theses in your area and discuss your ideas with
your supervisor.
10. List of References
This list is desirable only if the proposal contains six or more
references. Otherwise, the references can be inserted in the text
within parentheses, i.e.
(Morita, Y [1996], Spring torrents: The catastrophic effects of
corn snow meltdown. European Ski Journal, 5, 141-162). (Note
that brackets, not parentheses, are used within parentheses.)
The style and format of the references depend on the
disciplinary field. The main consideration is consistency;
whatever style is chosen should be followed scrupulously

31. throughout. (Please see IV(1)(v) below.)