Nutrition equity and food environments in rural communities: assessment of small discount stores
1
Global Health Studies & Sociology, University of Miami, Coral Gables, United States
2
School of Health Sciences and Human Services, California State University, San Marcos, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Rural areas in the southern United States experience a disproportionate burden of diet-related disorders, driven by limited access to nutritious and affordable foods. Dollar stores have rapidly grown in these regions, often replacing traditional grocers and shaping residents’ nutritional behavior. However, their food environment and their readiness to serve as vendors for the Women, Infants, and Children (WIC) nutrition program remain under-examined. This study addressed this gap using a newly developed Nutrition Environment Measures Survey for Dollar Stores (NEMS-DS). This tool captures dimensions that previous assessments may overlook, mainly since dollar stores rely heavily on ultra-processed foods.
METHODS:
A quantitative, cross-sectional study was conducted in 13-dollar stores across six rural counties in the Lowcountry, South Carolina. All stores were located in rural, high-deprivation areas identified through the area deprivation index. Food environments of sampled stores were assessed to capture (1) Healthy Food Availability (HFA); (2) WIC Readiness; (3) Marketing of healthy versus unhealthy items. Descriptive statistics, F-tests, and χ²-tests were employed to compare Lowcountry stores and 202-dollar stores from a parallel multi-state study.
RESULTS:
The Lowcountry’s stores demonstrated limited HFA scores (mean 23/62) and low WIC readiness (mean 51/190). Stores devoted only 12% of the total shelf space to healthy items compared to unhealthy snacks. None of the stores marketed healthy foods at checkout, while 100% promoted sugar-sweetened beverages and ultra-processed snacks—no significant differences with other sites. Although fresh produce availability was slightly higher than in stores from other states, frozen and shelf-stable produce options were significantly lower.
CONCLUSIONS:
Dollar stores in the Lowcountry mirrored national patterns of reinforcing unhealthy food environments in rural high-poverty settings. Findings provide a policy-actionable framework for expanding WIC vendor eligibility to dollar stores, regulating marketing to improve nutritional behavior, promoting equitable access to nutritious foods, and preventing chronic disease in rural communities.
Rural areas in the southern United States experience a disproportionate burden of diet-related disorders, driven by limited access to nutritious and affordable foods. Dollar stores have rapidly grown in these regions, often replacing traditional grocers and shaping residents’ nutritional behavior. However, their food environment and their readiness to serve as vendors for the Women, Infants, and Children (WIC) nutrition program remain under-examined. This study addressed this gap using a newly developed Nutrition Environment Measures Survey for Dollar Stores (NEMS-DS). This tool captures dimensions that previous assessments may overlook, mainly since dollar stores rely heavily on ultra-processed foods.
METHODS:
A quantitative, cross-sectional study was conducted in 13-dollar stores across six rural counties in the Lowcountry, South Carolina. All stores were located in rural, high-deprivation areas identified through the area deprivation index. Food environments of sampled stores were assessed to capture (1) Healthy Food Availability (HFA); (2) WIC Readiness; (3) Marketing of healthy versus unhealthy items. Descriptive statistics, F-tests, and χ²-tests were employed to compare Lowcountry stores and 202-dollar stores from a parallel multi-state study.
RESULTS:
The Lowcountry’s stores demonstrated limited HFA scores (mean 23/62) and low WIC readiness (mean 51/190). Stores devoted only 12% of the total shelf space to healthy items compared to unhealthy snacks. None of the stores marketed healthy foods at checkout, while 100% promoted sugar-sweetened beverages and ultra-processed snacks—no significant differences with other sites. Although fresh produce availability was slightly higher than in stores from other states, frozen and shelf-stable produce options were significantly lower.
CONCLUSIONS:
Dollar stores in the Lowcountry mirrored national patterns of reinforcing unhealthy food environments in rural high-poverty settings. Findings provide a policy-actionable framework for expanding WIC vendor eligibility to dollar stores, regulating marketing to improve nutritional behavior, promoting equitable access to nutritious foods, and preventing chronic disease in rural communities.
| eISSN: | 2654-1459 |
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