Research Original Research| Volume 115, ISSUE 12, P1975-1985, December 2015

Download started.


Disparities in the Availability and Price of Low-Fat and Higher-Fat Milk in US Food Stores by Community Characteristics



      National surveillance data identify disparities in low-fat milk consumption by race/ethnicity and income. Some localized studies have shown disparities in access to low-fat milk by community characteristics.


      Our aim was to assess the availability and price of low-fat and higher-fat milk in food stores throughout the United States and examine associations with community characteristics.


      We conducted a cross-sectional study involving observational data collection in 2010, 2011, and 2012.


      The study included 8,959 food stores in 468 communities where nationally representative samples of students attending traditional public middle and high schools resided.

      Main outcome measures

      We studied the availability and price of whole, 2%, 1%, and skim milk.

      Statistical analyses performed

      Multivariate logistic regression and ordinary least squares regression analyses were performed. Models included store type, race/ethnicity, median household income, urbanicity, US Census division, and year of data collection.


      Less than half of all stores carried 1% and skim milk, and more than three-quarters of stores carried whole and 2% milk. Regression results indicated that the odds of carrying any type of milk were 31% to 67% lower in stores in majority black and 26% to 45% lower in other/mixed race compared with majority white communities. The odds of carrying specifically low-fat milk were 50% to 58% lower in majority Hispanic compared with majority white communities, and 32% to 44% lower in low-income compared with high-income communities. Some significant differences in milk prices by community characteristics were observed in grocery and limited-service stores. On average, low-fat milk options were more expensive in grocery stores in majority black and rural and suburban communities compared with such stores in majority white and urban communities.


      This is the first nationwide study to examine the availability and price of low-fat and higher-fat milk in food stores and show disparities in access by community characteristics. Policies and programs can play a role in increasing accessibility of low-fat milk in stores in nonwhite and low-income communities.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • US Department of Agriculture and US Department of Health and Human Services
        Dietary Guidelines for Americans, 2010.
        7th ed. US Government Printing Office, Washington, DCDecember 2010
        • Kit B.K.
        • Carroll M.D.
        • Ogden C.L.
        Low-fat milk consumption among children and adolescents in the United States, 2007-2008.
        NCHS Data Brief. 2011 Sep; : 1-8
        • Dodd A.H.
        • Briefel R.
        • Cabili C.
        • Wilson A.
        • Crepinsek M.K.
        Disparities in consumption of sugar-sweetened and other beverage by race/ethnicity and obesity status among US schoolchildren.
        J Nutr Educ Behav. 2013; 45: 240-249
        • Beydoun M.A.
        • Gary T.L.
        • Caballero B.H.
        • Lawrence R.S.
        • Cheskin L.J.
        • Wang Y.
        Ethnic differences in dairy and related nutrient consumption among US adults and their association with obesity, central obesity, and the metabolic syndrome.
        Am J Clin Nutr. 2008; 87: 1914-1925
        • Cheadle A.
        • Psaty B.M.
        • Curry S.
        • et al.
        Community-level comparisons between the grocery store environment and individual dietary practices.
        Prev Med. 1991; 20: 250-261
        • Fisher B.D.
        • Strogatz D.S.
        Community measures of low-fat milk consumption: Comparing store shelves with households.
        Am J Public Health. 1999; 89: 235-237
        • Sturm R.
        • Datar A.
        Regional price differences and food consumption frequency among elementary school children.
        Public Health. 2011; 125: 136-141
        • Andreyeva T.
        • Long M.W.
        • Brownell K.D.
        The impact of food prices on consumption: A systematic review of research on the price elasticity of demand for food.
        Am J Public Health. 2010; 100: 216-222
      1. California Department of Public Health. Healthy Stores for a Healthy Community. Tobacco Alcohol Nutrition data file. Accessed March 12, 2014.

        • Cavanaugh E.
        • Mallya G.
        • Brensinger C.
        • Tierney A.
        • Glanz K.
        Nutrition environments in corner stores in Philadelphia.
        Prev Med. 2013; 56: 149-151
        • Glanz K.
        • Sallis J.F.
        • Saelens B.E.
        • Frank L.D.
        Nutrition Environment Measures Survey in stores (NEMS-S): Development and evaluation.
        Am J Prev Med. 2007; 32: 282-289
        • Liese A.D.
        • Weis K.E.
        • Pluto D.
        • Smith E.
        • Lawson A.
        Food store types, availability, and cost of foods in a rural environment.
        J Am Diet Assoc. 2007; 107: 1916-1923
        • Laska M.N.
        • Borradaile K.E.
        • Tester J.
        • Foster G.D.
        • Gittelsohn J.
        Healthy food availability in small urban food stores: A comparison of four US cities.
        Public Health Nutr. 2009; 13: 1031-1035
        • Ploeg M.V.
        • Breneman V.
        • Farrigan T.
        • et al.
        Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences.
        (Report to Congress) US Department of Agriculture, Economic Research Service, Washington, DCJune 2009
        • Zenk S.N.
        • Grigsby-Toussaint D.S.
        • Curry S.J.
        • Berbaum M.
        • Schneider L.
        Short-term temporal stability in observed retail food characteristics.
        J Nutr Educ Behav. 2010; 42: 26-32
        • Leone A.F.
        • Rigby S.
        • Betterley C.
        • et al.
        Store type and demographic influence on the availability and price of healthful foods, Leon County, Florida, 2008.
        Prev Chronic Dis. 2011; 8: A140
        • Sharkey J.R.
        • Dean W.R.
        • Nalty C.
        Convenience stores and the marketing of foods and beverages through product assortment.
        Am J Prev Med. 2012; 43: S109-S115
        • Smith M.L.
        • Sunil T.S.
        • Salazar C.I.
        • Rafique S.
        • Ory M.G.
        Disparities of food availability and affordability within convenience stores in Bexar County, Texas.
        J Environ Public Health. 2013; 2013: 782756
        • Wechsler H.
        • Basch C.E.
        • Zybert P.
        • Lantigua R.
        • Shea S.
        The availability of low-fat milk in an inner-city Latino community: Implications for nutrition education.
        Am J Public Health. 1995; 85: 1690-1692
        • Hosler A.S.
        • Varadarjulul D.
        • Ronsani A.E.
        • Frederick B.L.
        • Fisher B.D.
        Low-fat milk and high-fiber bread availability in food stores in urban and rural communities.
        J Public Health Manage Pract. 2006; 12: 556-562
        • Horowitz C.R.
        • Colson K.A.
        • Hebert P.L.
        • Lancaster K.
        Barriers to buying healthy foods for people with diabetes: Evidence of environmental disparities.
        Am J Public Health. 2004; 94: 1549-1554
        • Emond J.A.
        • Madanat H.N.
        • Ayala G.X.
        Do Latino and non-Latino grocery stores differ in the availability and affordability of healthy food items in a low-income, metropolitan region?.
        Public Health Nutr. 2012 Feb; 15: 360-369
        • Bachman J.G.
        • Johnston L.D.
        • O'Malley P.M.
        • Schulenberg J.E.
        The Monitoring the Future Project after Thirty-Seven Years: Design and Procedures.
        (Monitoring the Future Occasional Paper No. 76) Institute for Social Research, Ann Arbor, MI2011
      2. Barker D.C. Chaloupka F.J. Chriqui J.F. Bridging the Gap Community Obesity Measures Project: Methodology. BTG Research Paper Series, Paper #1. Bridging the Gap, Chicago, IL2014
        • Rimkus L.
        • Powell L.M.
        • Zenk S.N.
        • et al.
        Development and reliability testing of a food store observation form.
        J Nutr Educ Behav. 2013; 45: 540-548
        • Powell L.M.
        • Han E.
        • Zenk S.N.
        • et al.
        Field validation of secondary commercial data sources on the retail food outlet environment in the US.
        Health Place. 2011; 17: 1122-1131
        • Zenk S.N.
        • Powell L.M.
        • Rimkus L.
        • et al.
        Relative and absolute availability of healthier food and beverage alternatives across communities in the United States.
        Am J Public Health. 2014; 104: 2170-2178
        • Andreyeva T.
        • Middleton A.E.
        • Long M.W.
        • Luedicke J.
        • Schwartz M.B.
        Food retailer practices, attitudes and beliefs about the supply of healthy foods.
        Public Health Nutr. 2011; 14: 1024-1031
        • Havens E.K.
        • Martin K.S.
        • Yan J.
        • Dauser-Forrest D.
        • Ferris A.M.
        Federal nutrition program changes and healthy food availability.
        Am J Prev Med. 2012; 43: 419-422
        • Rose D.
        • O’Malley K.
        • Dunaway L.F.
        • Bodor J.N.
        The influence of the WIC food package changes on the retail food environment in New Orleans.
        J Nutr Educ Behav. 2014; 46: S38-S44
        • Institute of Medicine and National Research Council
        The Public Health Effects of Food Deserts: Workshop Summary.
        The National Academies Press, Washington, DC2009
        • Gittelsohn J.
        • Laska M.N.
        • Andreyeva T.
        • et al.
        Small retailer perspectives of the 2009 Women, Infants, and Children Program food package changes.
        Am J Health Behav. 2012; 36: 655-665
        • Martin K.S.
        • Havens E.
        • Boyle K.E.
        • et al.
        If you stock it, will they buy it? Healthy food availability and customer purchasing behaviour within corner stores in Hartford, CT, USA.
        Public Health Nutr. 2012; 15: 1973-1978
        • Khan L.K.
        • Sobush K.
        • Keener D.
        • et al.
        • Centers for Disease Control and Prevention
        Recommended community strategies and measurements to prevent obesity in the United States.
        MMWR Recomm Rep. 2009 Jul 24; 58: 1-26
        • ChangeLab Solutions
        Incentives for Change: Rewarding Healthy Improvements to Small Food Stores.
        ChangeLab Solutions, Oakland, CA2014
        • Weiss S.
        • Davis E.
        • Wojtanowski A.C.
        • Foster G.D.
        • Glanz G.
        • Karpyn A.
        Consumer taste tests and milk preference in low-income, urban supermarkets.
        Public Health Nutr. 2015; 18: 1419-1422
        • Dennison B.A.
        • Erb T.A.
        • Jenkins P.L.
        Predictors of dietary milk fat intake by preschool children.
        Prev Med. 2001; 33: 536-542


      L. Rimkus is a visiting research specialist in public health and deputy director of the Bridging the Gap Program, Institute for Health Research and Policy, University of Illinois at Chicago.


      Z. Isgor is a postdoctoral research associate, Institute for Health Research and Policy, University of Illinois at Chicago.


      S. N. Zenk is an associate professor of health systems science, College of Nursing, University of Illinois at Chicago.


      L. M. Powell is a professor of health policy and administration at the School of Public Health and associate director, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago.


      F. J. Chaloupka is a distinguished professor of economics and director, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago.


      P. Ohri-Vachaspati is an associate professor of nutrition, School of Nutrition and Health Promotion, Arizona State University, Phoenix.


      D. C. Barker is president, Barker Bi-Coastal Health Consultants, Inc, Calabasas, CA.