Community differences in availability of prepared, ready-to-eat foods in U.S. food stores

Introduction. Eating out of the home is on the rise and associated with increased energy intake and poor dietary outcomes. Most research has focused on the role of fast-food restaurants, although the availability of prepared, ready-to-eat foods within food stores is increasing. This cross-sectional study compared the availability of healthier and less healthy prepared, ready-to-eat foods at stores across U.S. communities.

Methods. Data are from 5,660 stores located in 317 communities spanning 42 states. Each year trained observers visited a representative sample of supermarkets, grocery stores, convenience stores, and “limited service” stores (i.e., convenience, dollar, pharmacy) in each community. Availability of select healthier (i.e., vegetable-based salads) and less healthy (i.e., pizza, hot dog/hamburger, taco/burrito/taquito) prepared foods was assessed and each dichotomized for analysis. Community characteristics were derived from American Community Survey data. Binary logistic regression estimated relationships, adjusting for store type, region, and other covariates.

Results. Overall, 26.4% of stores carried at least one unhealthy prepared food option as compared to 15.0% that carried salads. Stores in rural communities were 30% more likely to carry unhealthy prepared foods (O.R.=1.30; 95%C.I.=0.99,1.69) but 27% less likely to carry salads (O.R.=0.73; 95%C.I.=0.54,0.99) as compared to suburban stores. Stores in low-income communities were 45% less likely to carry salads than those in high-income communities (O.R.=0.55; 95%C.I.=0.40,0.76). This income difference was most pronounced in convenience stores.

Discussion. Rural and low-income communities face more barriers to selecting healthy prepared foods in food stores. Interventions are needed to increase the healthfulness of stores’ packaged and prepared foods.