A National Study of the Association Between Food Environments and County-Level Health Outcomes

Authors


  • The authors gratefully acknowledge the contributions of Christiaan Abildso, Joel Halverson, and Melissa Olfert to this study. Support for this report was provided by the Office of Rural Health Policy, Health Resources and Services Administration, PHS Grant No. 1 U1CRH10664-01-00. The authors gratefully acknowledge the assistance of Michael Hendryx, PhD, in the preparation of this manuscript. For further information, contact: Melissa Ahern, MBA, PhD, Department of Pharmacotherapy, College of Pharmacy, Washington State University, PO Box 1495, Spokane, WA 99210; e-mail: ahernm@wsu.edu.

Abstract

Purpose: This national, county-level study examines the relationship between food availability and access, and health outcomes (mortality, diabetes, and obesity rates) in both metro and non-metro areas.

Methods: This is a secondary, cross-sectional analysis using Food Environment Atlas and CDC data. Linear regression models estimate relationships between food availability and access variables (direct-to-consumer farm sales, per capita grocery stores, full-service restaurants, fast food restaurants, and convenience stores) with health outcomes. Controls include smoking, race/ethnicity, gender, age, education, poverty, primary care availability, recreational facility availability, and mobility/distance-from-grocery-store.

Findings:Non-metro findings: Lower adjusted mortality rates were associated with more per capita full-service restaurants and grocery stores, and greater per capita direct farm sales. Lower adjusted diabetes rates were associated with a lower per capita supply of fast food restaurants and convenience stores, and more per capita full-service restaurants and grocery stores. Lower adjusted obesity rates were associated with more per capita full-service restaurants and grocery stores. Unexpectedly, obesity rates were positively associated with per capita grocery stores and negatively associated with fast food restaurants. Metro findings: More per capita full-service restaurants, grocery stores, and direct farm sales are associated with positive health outcomes; fast food restaurants and convenience stores are associated with negative health outcomes.

Conclusions: The food access/availability environment is an important determinant of health outcomes in metro and non-metro areas. Future research should focus on more refined specifications that capture variability across non-metro settings.

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