title: Availability of healthier options in traditional and nontraditional rural fast-food outlets.
abstract: BACKGROUND
  Food prepared away from home has become increasingly popular to U.S. families, and may contribute to obesity. Sales have been dominated by fast food outlets, where meals are purchased for dining away from home or in the home. Although national chain affiliated fast-food outlets are considered the main source for fast food, fast foods are increasingly available in convenience stores and supermarkets/grocery stores. In rural areas, these nontraditional fast-food outlets may provide most of the opportunities for procurement of fast foods.
  
  
  METHODS
  Using all traditional and nontraditional fast-food outlets identified in six counties in rural Texas, the type and number of regular and healthier menu options were surveyed using on-site observation in all food venues that were primarily fast food, supermarket/grocery store, and convenience store and compared with 2005 Dietary Guidelines.
  
  
  RESULTS
  Traditional fast-food outlets represented 84 (41%) of the 205 opportunities for procurement of fast food; 109 (53.2%) were convenience stores and 12 (5.8%) supermarkets/grocery stores. Although a similar variety of regular breakfast and lunch/dinner entrées were available in traditional fast-food outlets and convenience stores, the variety of healthier breakfast and lunch/dinner entrées was significantly greater in fast food outlets. Compared with convenience stores, supermarkets/grocery stores provided a greater variety of regular and healthier entrées and lunch/dinner side dishes.
  
  
  CONCLUSIONS
  Convenience stores and supermarkets/grocery stores more than double the potential access to fast foods in this rural area than traditional fast-food outlets alone; however, traditional fast food outlets offer greater opportunity for healthier fast food options than convenience stores. A complete picture of fast food environment and the availability of healthier fast food options are essential to understand environmental influences on diet and health outcomes, and identify potential targets for intervention.
authors.affiliation: Texas Healthy Aging Research Network, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA. jenniferscreel@gmail.com
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Creel
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Sharkey
authors.forename: Alex
authors.initials: A
authors.lastname: McIntosh
authors.forename: Jenna
authors.initials: J
authors.lastname: Anding
authors.forename: J Charles
authors.initials: JC
authors.lastname: Huber
mesh_terms: D003132:Commerce / Q000145:classification* / Q000592:standards / Q000706:statistics & numerical data; D004435:Eating; D005504:Food Analysis / Q000379:methods / Q000706:statistics & numerical data*; D019649:Food Industry; D017408:Guidelines as Topic; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008612:Menu Planning / Q000592:standards*; D018673:Nutrition Policy; D009753:Nutritive Value; D012111:Residence Characteristics; D012147:Restaurants / Q000145:classification* / Q000592:standards / Q000706:statistics & numerical data; D012423:Rural Health; D012931:Social Environment; D013781:Texas