title: Food Costs Are Higher in Counties With Poor Health Rankings.
abstract: BACKGROUND
  Poor dietary habits are associated with higher rates of cardiovascular disease. However, the cost of foods associated with lower risk of cardiovascular disease can be a significant barrier to healthy eating.
  
  
  OBJECTIVE
  The aim of this study is to determine whether food prices per serving differed across Kentucky counties based on health ranking and overall nutritional quality.
  
  
  METHODS
  Fifteen counties were randomly selected based on County Health Ranking. Overall Nutritional Quality Index and cost of 75 foods were assessed in all 15 counties in the same week. A generalized estimating equations model and post hoc analyses were used to assess differences in food cost by nutritional quality and health ranking.
  
  
  RESULTS
  Food prices were significantly less in the most healthy counties compared with the least healthy (Z = 3.8; P < .001; $0.08 per serving). Prices were also significantly higher in least healthy counties (tertile 3) compared with moderately healthy counties (tertile 2) (Z = 2.3; P = .024; $0.05 per serving).
  
  
  CONCLUSIONS
  Disproportionately higher food costs are associated with poor health outcomes in Kentucky counties. Community-based interventions can potentially improve access to affordable healthy foods. Current supplemental nutritional policies do not address disparate food costs. Health professionals should advocate for policy changes that are reflective of these food cost disparities.
authors.affiliation: Frances Hardin-Fanning, PhD, RN Assistant Professor, College of Nursing, University of Kentucky, Lexington. Amanda T. Wiggins, PhD Lecturer, College of Nursing, University of Kentucky, Lexington.
authors.forename: Frances
authors.initials: F
authors.lastname: Hardin-Fanning
authors.forename: Amanda T
authors.initials: AT
authors.lastname: Wiggins
mesh_terms: D003365:Costs and Cost Analysis; D005247:Feeding Behavior; D005502:Food / Q000191:economics*; D006304:Health Status; D006801:Humans; D007629:Kentucky; D009753:Nutritive Value; D012959:Socioeconomic Factors