Food Accessibility Trends and Health in America’s Counties

supermarkets is inversely related to obesity, while close proximity to fast food restaurants and convenience stores correlates positively with obesity rates. Most analyses of these relationships have been cross-sectional. The purpose of this study was to analyze relationships between number/type/density of different food outlets and the health outcomes of the populations of United States rural (county \u3e 70% rural) counties over a 4-year time period. A Freedom of Information Act (FOIA) request was completed to acquire data on types of food outlets (i.e., supermarkets, grocery stores, convenience stores, specialty food outlets, fast food restaurants and farmers markets) located in each United States county from 2010-2013. Relationships between county health ranking variables (i.e., premature death, poor health days and obesity rates) and changes in the number and type of food outlets from 2010-2013 were analyzed. Fast food and combination stores (convenience + grocery) have the highest mean number of outlets per 10,000. As the number of fast food outlets (per 10K) increased, the percent of the population in poor/fair health increased (r=.16; p\u3c.001). There was no statistically significant association between fast food outlets and obesity rates (p=.09). In contrast, as the number of grocery stores increased, the percent of the population in poor/fair health decreased (r=-0.12; p\u3c.001). An increase in number of grocery stores was also associated with a slight decrease in obesity (-0.08; p=.007). Over the past four years, an increase in the number of fast food and combination store outlets is positively correlated with an increase in fair/poor health and obesity. An increase in the number of grocery stores over the past four years is associated with a decrease in fair/poor health. As fast food restaurants continue to increase in low socioeconomic areas, health outcomes in these areas may continue to decline. In contrast, as the number of grocery stores increases health outcomes may improve. Additional research is needed to determine any correlation between the socioeconomic status of different counties and concentration of food outlets as well as research to determine all the barriers to access to beneficial food outlets versus fast food outlets