Food access and cost in American Indian communities in Washington State.

Limited access to foods that make up a nutritious diet at minimal cost may influence eating behaviors and, ultimately, obesity. This study examined the number and type of food stores (convenience, grocery, supermarket) on federal reservations in Washington State, and the availability and cost of foods in the US Department of Agriculture Community Food Security Assessment Toolkit market basket, to describe the food environment of American Indians. Stores were identified by telephone survey of tribal headquarters, a commercial database, and on-site visitation. Foods were assessed using a standardized instrument containing 68 items in seven major food groups during April and May 2009. Store type and availability and cost of foods were recorded on a checklist. Fifty stores were identified on 22 American Indian reservations, including 25 convenience, 16 grocery, and 9 supermarkets. Across all stores, about 38% of checklist items were available, with supermarkets having the most and convenience stores the fewest. Foods from the dairy and sugars/sweets groups were the most prevalent, while fresh fruits/vegetables were the least. Cost of the most commonly available items was lowest in supermarkets. Seventeen reservations did not have a supermarket on their reservation, and the nearest off-reservation supermarket was about 10 miles from the tribe's headquarters, which was used as the standard for distance calculations. These results demonstrate that American Indians living on federal reservations in Washington State may have limited access to foods that make up a nutritious diet at minimal cost.