Barriers to healthy food access: Associations with household income and cooking behavior.

To examine how barriers to healthy food access and household income are associated with cooking and eating behaviors we fielded a nationally representative survey among 1112 adults in the United States in 2015. The survey included measures of barriers to accessing healthy food, household income, and frequency of cooking and eating meals, cooking practices, and other eating behaviors. We used multivariable poisson regression to examine the association of household income and barriers to healthy food access with cooking and eating behavior outcomes. We find that low income was associated with higher barriers to accessing healthy food (barriers) and that both income and barriers were associated with differences in cooking frequency/practices, and consumption behaviors. In interaction models, cooking and eating behaviors did not vary based on barriers for the lowest income level (<$25,000). In the middle income level ($25,000-$59,000), barriers were associated with cooking breakfast (3.35 vs. 2.64 times/week, p = 0.03) and lunch (3.32 vs. 2.56 times/week, p = 0.02) more frequently compared to those who never/rarely encountered barriers. At the highest income level (≥$60,000), barriers were associated with less frequently eating breakfast (4.29 vs. 5.11 times/week, p < 0.001) and lunch (4.77 vs. 5.56, times/week, p < 0.001) compared to those who never/rarely encountered barriers. Barriers to healthy food access are related to both household income and cooking and eating behaviors important for diet quality and healthy eating. Targeted interventions to address time available to shop, and the price, selection and quality of healthy foods, are necessary.