Abstract
Background
About 40 million Americans do not have easy access to affordable nutritious foods.
Healthier foods are less likely to be available to those living in rural and/or lower-income
communities.
Objective
The objective of this study was to analyze the association between nutritional quality
of household food purchases and county-level food retail environment; county-level
demographic, health, and socioeconomic indicators; and household composition, demographic
characteristics, and socioeconomic characteristics.
Design
This study is a secondary analysis of the 2015 Information Resources Inc Consumer
Network panel; Purchase-to-Plate Crosswalk, which links US Department of Agriculture
nutrition databases to Information Resources Inc scanner data; County Health Rankings;
and the Food Environment Atlas data.
Participants and settings
A total of 63,285 households, representative of the contiguous US population, consistently
provided food purchase scanner data from retail stores throughout 2015.
Main outcome measures
Nutritional quality of retail food purchases was assessed using the Healthy Eating
Index 2015 (HEI-2015).
Statistical analysis
Multivariate linear regression analysis was used to simultaneously test the relationship
between the main outcome and household-level demographic and socioeconomic characteristics
as well as the county-level demographic, health, socioeconomic, and retail food environment.
Results
Household heads who had higher education and households with higher incomes purchased
food of better nutritional quality (ie, higher HEI-2015 scores). Also, the association
between retail food purchase HEI-2015 scores and the food environment was weak. Higher
density of convenience stores was associated with lower retail food purchase nutritional
quality for higher-income households and households living in urban counties, whereas
low-income households in counties with higher specialty (including ethnic) store density
purchased higher nutritional quality food. Both in the full sample and when stratified
by household income or county rural vs urban status, no association was found between
grocery store, supercenters, fast-food outlets, and full-service restaurant densities
and retail food purchase HEI-2015 scores. HEI-2015 scores were negatively correlated
with the county average number of mental health days for higher income and urban households.
Conclusions
The study findings suggest that availability of healthier food alone may not improve
healthfulness of retail food purchases. Future studies examining the influence of
demand-side factors/interventions, such as habits, cultural preferences, nutrition
education, and cost/affordability, on household purchasing patterns could provide
complementary evidence to inform effective intervention strategies.
Keywords
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Biography
A. Ghazaryan is Steven M. Teutsch Prevention Effectiveness Fellow and a health economics researcher.
Biography
K. Roy is a senior economic advisor, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA.
Biography
A. Carlson is an economist, and A. Rhone is an agricultural economist, Food Economics Division, Economic Research Service, US Department of Agriculture, Washington, DC.
Article info
Publication history
Published online: October 27, 2022
Accepted:
October 25,
2022
Received:
April 1,
2022
Publication stage
In Press Corrected ProofFootnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors
FUNDING/SUPPORT This research was supported in part by the US Department of Agriculture (USDA). The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, USDA, or other US Government determination or policy. The analysis, findings, and conclusions expressed in this report should not be attributed to Information Resources Inc.
AUTHOR CONTRIBUTIONS Conceptualization: K. Roy and A. Carlson; methodology: A. Ghazaryan, A. Carlson, and K. Roy; software: A. Ghazaryan and A. Carlson; validation: A. Carlson; formal analysis: A. Ghazaryan and A. Carlson; resources: A. Carlson and A. Rhone; data curation: A. Ghazaryan, A. Carlson, and A. Rhone; writing—original draft preparation, A. Ghazaryan; writing—review and editing, K. Roy, A. Carlson, A. Rhone, and A. Ghazaryan; visualization: A. Ghazaryan, K. Roy, and A. Carlson; supervision, K. Roy and A. Carlson; project administration, K. Roy and A. Carlson. All authors reviewed and commented on subsequent drafts of the manuscript.
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© 2022 by the Academy of Nutrition and Dietetics.
