Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores

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Background: Purchases at small/non-traditional food stores tend to have poor nutritional quality, and have been associated with poor health outcomes, including increased obesity risk The purpose of this study was to examine whether customers who shop at small/non-traditional food stores with more health promoting features make healthier purchases. Methods: In a cross-sectional design, data collectors assessed store features in a sample of 99 small and non-traditional food stores not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Minneapolis/St. Paul, MN in 2014. Customer intercept interviews (n = 594) collected purchase data from a bag check and demographics from a survey. Store measures included fruit/vegetable and whole grain availability, an overall Healthy Food Supply Score (HFSS), healthy food advertisements and in-store placement, and shelf space of key items. Customer nutritional measures were analyzed using Nutrient Databases System for Research (NDSR), and included the purchase of ≥1 serving of fruits/vegetables; ≥1 serving of whole grains; and overall Healthy Eating Index-2010 (HEI-2010) score for foods/beverages purchased. Associations between store and customer measures were estimated in multilevel linear and logistic regression models, controlling for customer characteristics and store type. Results: Few customers purchased fruits and vegetables (8%) or whole grains (8%). In fully adjusted models, purchase HEI-2010 scores were associated with fruit/vegetable shelf space (p = 0.002) and the ratio of shelf space devoted to healthy vs. less healthy items (p = 0.0002). Offering ≥14 varieties of fruit/vegetables was associated with produce purchases (OR 3.9, 95% CI 1.2-12.3), as was having produce visible from the store entrance (OR 2.3 95% CI 1.0 to 5.8), but whole grain availability measures were not associated with whole grain purchases. Conclusions: Strategies addressing both customer demand and the availability of healthy food may be necessary to improve customer purchases. Trial registration: NCT02774330. Registered May 4, 2016 (retrospectively registered).

Original languageEnglish (US)
Article number76
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Issue number1
StatePublished - Jun 5 2017

Bibliographical note

Funding Information:
This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (ML grant number R01DK104348) and the Global Obesity Prevention Center (GOPC) at Johns Hopkins, which is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of the Director, National Institutes of Health (ML, grant number U54HD070725). Support for the lead author was provided by the National Cancer Institute, Cancer Related Health Disparities Education and Career Development Program (CC, grant number R25CA163184). NIH grant UL1TR000114 from the National Center for Advancing Translational Sciences (NCATS) supported data management. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding agencies had no role in the design, analysis or writing of this manuscript.

Publisher Copyright:
© 2017 The Author(s).


  • Community nutrition
  • Corner stores
  • Customer purchases
  • Healthy Eating Index


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