Food store types, availability, and cost of foods in a rural environment.

OBJECTIVE To characterize the built nutritional environment in terms of types and number of food stores, availability, and cost of selected food items in a rural area. DESIGN A cross-sectional survey of food stores conducted in 2004. SUBJECTS/SETTING We selected a rural county (population 91,582; 1,106 square miles). Food stores identified from a database were mapped and presence, location, and store type verified by ground-truthing. Stores were surveyed for availability and cost of selected foods. MAIN OUTCOME MEASURES Price and availability of a limited number of staple foods representing the main food groups. STATISTICAL ANALYSES PERFORMED Availability comparisons used least square means models and price comparisons used t tests. RESULTS Of 77 stores identified, 16% were supermarkets, 10% grocery stores, and 74% convenience stores. There were seven stores per 100 square miles and eight stores per 10,000 residents. Availability of more healthful foods was substantially higher at supermarkets and grocery stores. For instance, low-fat/nonfat milk, apples, high-fiber bread, eggs, and smoked turkey were available in 75% to 100% of supermarkets and groceries and at 4% to 29% of convenience stores. Foods that were available at both supermarkets and convenience stores tended to be substantially more expensive at convenience stores. The healthful version of a food was typically more expensive than the less healthful version. CONCLUSIONS In this rural environment, stores offering more healthful and lower-cost food selections were outnumbered by convenience stores offering lower availability of more healthful foods. Our findings underscore the challenges of shopping for healthful and inexpensive foods in rural areas.