National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia.
Food Economics Division, Economic Research Service, US Department of Agriculture, Washington, DC.
J Acad Nutr Diet. 2023 May;123(5):796-808. doi: 10.1016/j.jand.2022.10.015. Epub 2022 Oct 28.
About 40 million Americans do not have easy access to affordable nutritious foods. Healthier foods are less likely to be available to those living in rural and/or lower-income communities.
The objective of this study was to analyze the association between nutritional quality of household food purchases and county-level food retail environment; county-level demographic, health, and socioeconomic indicators; and household composition, demographic characteristics, and socioeconomic characteristics.
This study is a secondary analysis of the 2015 Information Resources Inc Consumer Network panel; Purchase-to-Plate Crosswalk, which links US Department of Agriculture nutrition databases to Information Resources Inc scanner data; County Health Rankings; and the Food Environment Atlas data.
A total of 63,285 households, representative of the contiguous US population, consistently provided food purchase scanner data from retail stores throughout 2015.
Nutritional quality of retail food purchases was assessed using the Healthy Eating Index 2015 (HEI-2015).
Multivariate linear regression analysis was used to simultaneously test the relationship between the main outcome and household-level demographic and socioeconomic characteristics as well as the county-level demographic, health, socioeconomic, and retail food environment.
Household heads who had higher education and households with higher incomes purchased food of better nutritional quality (ie, higher HEI-2015 scores). Also, the association between retail food purchase HEI-2015 scores and the food environment was weak. Higher density of convenience stores was associated with lower retail food purchase nutritional quality for higher-income households and households living in urban counties, whereas low-income households in counties with higher specialty (including ethnic) store density purchased higher nutritional quality food. Both in the full sample and when stratified by household income or county rural vs urban status, no association was found between grocery store, supercenters, fast-food outlets, and full-service restaurant densities and retail food purchase HEI-2015 scores. HEI-2015 scores were negatively correlated with the county average number of mental health days for higher income and urban households.
The study findings suggest that availability of healthier food alone may not improve healthfulness of retail food purchases. Future studies examining the influence of demand-side factors/interventions, such as habits, cultural preferences, nutrition education, and cost/affordability, on household purchasing patterns could provide complementary evidence to inform effective intervention strategies.
约有 4000 万美国人难以获得负担得起的营养食品。生活在农村和/或低收入社区的人获得更健康食品的机会更少。
本研究的目的是分析家庭食品购买的营养质量与县一级食品零售环境、县一级人口、健康和社会经济指标以及家庭构成、人口特征和社会经济特征之间的关系。
本研究是对 2015 年信息资源公司消费者网络小组；购买到盘子的交叉路口的二次分析，该交叉路口将美国农业部营养数据库与信息资源公司的扫描仪数据联系起来；县卫生排名；以及食品环境地图集数据。
共有 63285 户家庭，代表美国大陆的人口，从 2015 年开始一直从零售店提供食品购买扫描仪数据。
使用 2015 年健康饮食指数（HEI-2015）评估零售食品购买的营养质量。
使用多元线性回归分析同时测试主要结果与家庭层面人口和社会经济特征以及县一级人口、健康、社会经济和零售食品环境之间的关系。
受教育程度较高的家庭户主和收入较高的家庭购买的食品营养质量更好（即 HEI-2015 得分较高）。此外，零售食品购买 HEI-2015 得分与食品环境之间的关联较弱。便利店密度较高与高收入家庭和居住在城市县的家庭的零售食品购买营养质量较低有关，而低收入家庭在少数民族（包括少数民族）商店密度较高的县购买的食品营养质量较高。在全样本以及按家庭收入或县农村与城市状况进行分层时，杂货店、超级中心、快餐店和全方位服务餐厅的密度与零售食品购买 HEI-2015 得分之间均无关联。HEI-2015 得分与高收入和城市家庭的县平均心理健康天数呈负相关。
研究结果表明，仅提供更健康的食品可能无法改善零售食品购买的健康度。未来研究考察需求方因素/干预措施（如习惯、文化偏好、营养教育和成本/负担能力）对家庭购买模式的影响，可以提供补充证据，为有效的干预策略提供信息。
