Predictors of Healthy Food Store Shopping Among Rural Residents

Background and Purpose: Healthy food store availability is by no means equitable, that is supermarkets and supercenters are not located nearby for certain populations. Specifically, residents of rural areas have disadvantaged food environments, where they often must travel far distances to access healthy food stores. The disparities in healthy food store availability are detrimental to resident health and create economic burdens on low income households. Residents are faced with the choice of either using more of their economic resources to access a healthy food store farther from home or must make do with what is available near home. There is limited literature examining the determinants of healthy food store shopping among rural households. Thus, the purpose of this exploratory study was to examine which household and geographic factors predicted healthy food store shopping among rural residents.

Methods: This study used secondary data from the USDA’s National Household Food Acquisition and Purchase Survey (FoodAPS) which asked about household food acquisitions and household demographics. A subsample of rural households (N= 1,311) were included in this study.

Measures: Healthy store type assessed the primary food store for each household, as either healthy (supermarket or supercenter) or less healthy (all other store types). Distance to the food store was the road network distance in miles from the respondent’s home to their primary food store. Car to store was assessed by asking the respondent to identify their mode of transportation to their primary food store which was dichotomized as car to store and all other modes. Additional variables of interest included household poverty, enrollment in SNAP, age, gender, race, education, marital status, food environment, and census tract characteristics.

Analysis: First univariate and bivariate analysis were conducted to examine the relationships between variables. I then conducted two multilevel logistic regressions in Stata 14.

Results: Most households shopping at healthy food stores (90.4%) and used a car to store (87%). On average, rural households traveled 9.8 miles to their primary food store and had an average of 3.2 food stores within 5.0 miles of their home. Multivariate results show that the greater distance (miles) a rural resident traveled to their primary food store was associated with an increased odds of shopping at a healthy food store (OR = 1.03, p < .05). Households who used a car as the mode of transportation to the food store were also more likely to shop at a healthy food store (OR = 2.29, p < .05).Neither the economic resources or food environment were significant predictors of shopping at a healthy food store.

Conclusions and Implications: I found that using a car as a household’s mode of transportation and traveling farther distances predicted shopping at healthy food stores. This points to the importance of access to cars among rural residence to aid them in accessing healthy food stores. Social workers in rural areas can be cognizant of the effects car have on client access to food stores and help them connect to programs or services seeking to fill this gap.