RESEARCH Current Research Food Store Types, Availability, and Cost of Foods in a Rural Environment ANGELA D. LIESE, PhD; KRISTINA E. WEIS, MPH; DELORES PLUTO, PhD; EMILY SMITH, MSPH; ANDREW LAWSON, PhD ABSTRACT Objective To characterize the built nutritional environ- ment in terms of types and number of food stores, avail- ability, 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 out- numbered by convenience stores offering lower availabil- ity of more healthful foods. Our findings underscore the challenges of shopping for healthful and inexpensive foods in rural areas. J Am Diet Assoc. 2007;107:1916-1923. T he newly revised Dietary Guidelines for Americans encourage healthful eating patterns and making “wiser food choices.” For instance, a daily intake of 4 1 /2 cups of fruits and vegetables is recommended, and at least half of the grain intake should come from whole- grain foods (1). While dietary behavior has traditionally been considered a function of individual choice, the eco- logic perspective questions to what extent the nutritional environment may facilitate or present barriers to health- promoting individual behaviors (2). The importance of the neighborhood environment for health behaviors and health status is increasingly being recognized (3-6). Disadvantaged neighborhoods, charac- terized by overcrowding, lower social class, high percent male unemployment, or households without cars, have been shown to be associated with a variety of poor health behaviors (7). While extensive research efforts are under- way assessing how physical activity levels are impacted by physical environment (8), comparatively little atten- tion has been paid to the nutritional environment and its influence on dietary behaviors and health outcomes. The absence of supermarkets and the availability of fast-food restaurants in a neighborhood has been related to a reduced likelihood of consuming sufficient amounts of fruits and vegetables (9,10). As the distance to a super- market increases, a lower quality of dietary intake was observed in lower-income pregnant women (11). In addi- tion, the availability and display of health-promoting foods seems to impact food intake (12). While the vast majority of research in this area has been conducted in urban or suburban settings, very little is known about the nutritional environment in rural areas. In the United States, 20% of the population are rural residents (13). Rural areas are not only in- herently sparsely populated and characterized by large distances, but also by high levels of poverty, low housing values, and low educational attainment of the resident population. These characteristics can be associated with lower geographic purchasing power, which can affect business decisions about the location and types of food stores and service places. The purpose of this study was to characterize the types and numbers of food stores and the availability and cost of certain food items in a rural South Carolina county. A. D. Liese is an associate professor, K. E. Weis is a doctoral candidate, E. Smith is a recent masters gradu- ate, and A. Lawson is a professor, Department of Epide- miology and Biostatistics; D. Pluto is associate director, Prevention Research Center and research assistant pro- fessor, Department of Health Promotion, Education, and Behavior; all at the Arnold School of Public Health, University of South Carolina, Columbia. Address correspondence to: Angela D. Liese, PhD, De- partment of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 800 Sumter St, Columbia, SC 29208. E-mail: liese@ sc.edu Copyright © 2007 by the American Dietetic Association. 0002-8223/07/10711-0007$32.00/0 doi: 10.1016/j.jada.2007.08.012 1916 Journal of the AMERICAN DIETETIC ASSOCIATION © 2007 by the American Dietetic Association