Disentangling racial/ethnic and income disparities of food retail Environments: Impacts on adult obesity prevalence

This research aims to assess county food retail environment (FRE) with multifaceted measurements and disentangle how racial/ethnic and income disparities contribute to geographic variations in obesity rates via FRE. County obesity rates, racial/ethnic and income factors, as well as the data of food stores, restaurants, and stores in the Supplemental Nutrition Assistance Program (SNAP) were obtained from the U.S. Department of Agriculture. FRE was assessed with availability (density), healthfulness (ratio of healthy to unhealthy stores), and accessibility (proximity to healthy stores measured by population-weighted distance). Obesity rates and FRE indicators were compared with t-test among 3,107 counties stratified by racial/ethnic vs. income factors. We used Varying Coefficient Models to quantify the influences of racial/ethnic and income factors on the FRE and obesity association. Our analysis indicates narrowing disparities in availability but persisting inequalities of healthfulness and accessibility between low- and high-income counties with low and high percentages of racial/ ethnic minority populations. Furthermore, racial/ethnic and income factors play essential roles in shaping the obesity and FRE relationship. Among three indicators, healthfulness exhibits relatively consistent relationships with obesity rates as the income or the racial/ethnic factor changes.