Relative and absolute availability of healthier food and beverage alternatives across communities in the United States

Am J Public Health. 2014 Nov;104(11):2170-2178.
Authors: Zenk SN, Powell LM, Rimkus L, Isgor Z, Barker DC, Ohri-Vachaspati P, Chaloupka F.

Objectives: We examined associations between the relative and absolute availability of healthier food and beverage alternatives at food stores and community racial/ethnic, socioeconomic, and urban-rural characteristics. Methods: We analyzed pooled, annual cross-sectional data collected in 2010 to 2012 from 8462 food stores in 468 communities spanning 46 US states. Relative availability was the ratio of 7 healthier products (e.g., whole-wheat bread) to less healthy counterparts (e.g., white bread); we based absolute availability on the 7 healthier products. Results: The mean healthier food and beverage ratio was 0.71, indicating that stores averaged 29% fewer healthier than less healthy products. Lower relative availability of healthier alternatives was associated with low-income, black, and Hispanic communities. Small stores had the largest differences: relative availability of healthier alternatives was 0.61 and 0.60, respectively, for very low-income black and very low-income Hispanic communities, and 0.74 for very high-income white communities. We found fewer associations between absolute availability of healthier products and community characteristics. Conclusions: Policies to improve the relative availability of healthier alternatives may be needed to improve population health and reduce disparities.

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