摘要：Objectives. We examined associations between the relative and absolute availability of healthier food and beverage alternatives at food stores and community racial/ethnic, socioeconomic, and urban–rural characteristics. Methods. We analyzed pooled, annual cross-sectional data collected in 2010 to 2012 from 8462 food stores in 468 communities spanning 46 US states. Relative availability was the ratio of 7 healthier products (e.g., whole-wheat bread) to less healthy counterparts (e.g., white bread); we based absolute availability on the 7 healthier products. Results. The mean healthier food and beverage ratio was 0.71, indicating that stores averaged 29% fewer healthier than less healthy products. Lower relative availability of healthier alternatives was associated with low-income, Black, and Hispanic communities. Small stores had the largest differences: relative availability of healthier alternatives was 0.61 and 0.60, respectively, for very low-income Black and very low-income Hispanic communities, and 0.74 for very high-income White communities. We found fewer associations between absolute availability of healthier products and community characteristics. Conclusions. Policies to improve the relative availability of healthier alternatives may be needed to improve population health and reduce disparities. Poor diet is common in the United States, particularly among disadvantaged groups, and is a risk factor for obesity and numerous chronic diseases. 1,2 The retail food environment may present barriers to healthy eating in Black, low-income, rural, and central-city communities in the United States. Considerable research demonstrates that healthier foods and beverages, such as low-fat dairy and whole-grain products, are less available in Black, low-income, rural, and central-city communities than in White, higher-income, and urban and suburban communities. 3–6 Other studies show no systematic differences in healthier food availability across communities. 7,8 Some contend that it is not just absolute availability of foods and beverages but rather the relative availability of less healthy products compared with healthier alternatives that may influence food choices. 9–12 Although studies generally have not compared relative availability across communities, relative availability of healthier to less healthy foods was related to lower risk of overweight and obesity in 1 study. 9 Differences in store composition across communities may partially explain observed community differences in absolute and relative availability of healthier food and beverage products. Inequities in the spatial accessibility of supermarkets and other retail food stores, such as convenience stores, are well documented, with low-income, Black, rural, and central-city communities having less access to supermarkets, for example. 13–16 Supermarkets have greater availability of healthier products than do convenience stores and many small grocery stores. 10,17,18 Yet research shows that differences in healthier food and beverage availability across communities persist among stores of the same type or after accounting for differences in the types of stores present. 19 In one of the first nationwide studies of directly observed food availability in the United States, we examined associations between the relative and absolute availability of healthier food and beverage alternatives and community characteristics (racial/ethnic composition, socioeconomic characteristics, and urbanicity). Our study was novel not only because of its focus on relative availability of healthier alternatives, but also because it examined communities nationwide, compared the food environment across a continuum of community characteristics (e.g., urban–rural, predominant race/ethnicity, high–low income), and had ample statistical power to detect differences because of the large number of stores.
