Relative and absolute availability of healthier food and beverage alternatives across communities in the United States

Am J Public Health. 2014 Nov;104(11):2170-8. doi: 10.2105/AJPH.2014.302113. Epub 2014 Sep 11.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Beverages / statistics & numerical data
  • Beverages / supply & distribution
  • Continental Population Groups / statistics & numerical data
  • Cross-Sectional Studies
  • Ethnic Groups / statistics & numerical data
  • Food / statistics & numerical data
  • Food Supply / standards
  • Food Supply / statistics & numerical data*
  • Health Status Disparities
  • Humans
  • Obesity / epidemiology
  • Residence Characteristics / statistics & numerical data
  • Socioeconomic Factors
  • United States / epidemiology