Background. Minority communities are at a higher risk for chronic diseases related to obesity because they lack access to stores that have affordable, fresh, nutritious foods that are necessary for a healthy diet. Photovoice can serve as a tool to engage youth in positive health behaviors and behavior change. Healthy food access has been analyzed based on nutrition, yet there is a lack of literature as to what factors enable and prevent access to healthy foods.

Methodology. The purpose of this study was to determine if a photovoice intervention would create a difference in perception of food access, empowerment and self-efficacy between three study groups. The aim of the photovoice intervention was to improve the ability of youth to evaluate healthy food access in the built environment and increase individual self-empowerment and self-efficacy levels.

This study, with a theoretical framework in critical consciousness, used a pretest posttest randomized study design. A total of 653 youth, ages 11 to 18 years old, were recruited from a charter school in South Los Angeles, California. Volunteers were recruited and placed into the control group or randomly assigned into the intervention or placebo group. The intervention group took part in a photovoice intervention (n=134). Youth used cameras to identify and photographically capture their community’s strengths and weaknesses which promoted discussions of change in the community. The placebo group took part in taking pictures of their environment but did not receive any photovoice training and did not take part in discussions of change (n=126). The remaining youth had no exposure to photovoice and only took part in a pre and posttest 10 weeks apart (control group, n=394).

Results. Significant statistical changes were found between and across the three groups. Overall, the intervention group experienced the most change within group pre and post test results. The intervention group experienced an increase in the number of barriers to food access, an increase in advocacy, decrease in self-efficacy, an increase in the negative perceptions of food access and a decrease in the positive perceptions of food access in their community. The intervention group experienced what may be a more realistic and evaluatory analysis due to the photovoice training, skill building and peer-to-peer discussions. Youth identified more barriers in accessing healthy foods because they went out into their communities and were encouraged to take photos and think further about the condition of their built environment. Lack of availability of healthy foods, high costs of foods, lack of access to full service grocery stores, advertisements/social norms and overall lack of resources were repetitive and high-ranked themes amongst this group of youth.

After analysis between perceptions of the quantity of fast food restaurants, grocery stores, liquor stores and corner markets and GIS map data, it appears that a significant discrepancy exists between the two. No statistically significant differences were found between pre and posttest for all three groups and across the study groups. However, there was a statistically significant discrepancy between the perceptions of volume of these food venues and GIS data. Students underestimated the number of food establishments in nearly every category and in every zip-code. Furthermore, definition perceptions of grocery stores differ between youth and GIS map classifications.

Conclusion. Results indicate that youth perceive the volume of unhealthy food venues to be far less than what is reported in GIS databases. Furthermore, GIS databases do not define “supermarkets” in accordance with how residents perceive them; hence the gap in perception and reality in the number of supermarkets in the area. This supports the results of the qualitative analysis where youth reported the lack of options and availability of healthy foods in their community. Based on the pre-posttest analysis, the photovoice intervention group was able to better evaluate and analyze the community’s food access issues and qualitatively offer solutions. They were able to identify more barriers in healthy food access, were engaged and talking to others about the issues at hand, and felt less in control of their eating habits based on the availabilities of their built environment. With a difference of the photovoice intervention, the outcome resulted in a change in perceptions of food access between the pre and posttest and between the intervention and control groups.

Results can serve as evidence directly from the community as the positives and negatives they find when trying to encounter healthy foods in their community. In order to better connect with youth, public health professionals must explore evolving interventions, such as the photovoice method, to better engage the young population.

Future research needs to examine the influence of other variables on food access habits such as the role of safety, homelessness and lack of youth economic power and social norm.


School of Public Health

First Advisor

Naomi Modeste

Second Advisor

Helen Hopp Marshak

Third Advisor

Daniel Handysides

Fourth Advisor

Samuel Soret

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Health Food -- supply and distribution; Health Food -- nutritive value; Fast Foods -- supply and distribution; Attitude to Health -- Adolescent; Socioeconomic Factors; Health Education -- methods; Health Promotion -- methods; Preceptorship; Nutrition Surveys.



Page Count

xi; 230

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives