title: Relative and absolute availability of healthier food and beverage alternatives across communities in the United States.
abstract: OBJECTIVE
  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.
authors.affiliation: Shannon N. Zenk is with the College of Nursing, Lisa M. Powell is with the School of Public Health, Leah Rimkus and Zeynep Isgor are with the Institute for Health Research and Policy, and Frank Chaloupka is with the Department of Economics, University of Illinois at Chicago. Dianne C. Barker is with Barker Bi-Coastal Health Consultants Inc, Calabasas, CA. Punam Ohri-Vachaspati is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Zenk
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Powell
authors.forename: Leah
authors.initials: L
authors.lastname: Rimkus
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Isgor
authors.forename: Dianne C
authors.initials: DC
authors.lastname: Barker
authors.forename: Punam
authors.initials: P
authors.lastname: Ohri-Vachaspati
authors.forename: Frank
authors.initials: F
authors.lastname: Chaloupka
mesh_terms: D001628:Beverages / Q000706:statistics & numerical data / Q000600:supply & distribution; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005502:Food / Q000706:statistics & numerical data; D005523:Food Supply / Q000592:standards / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D009765:Obesity / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology