Research articleThe Availability and Cost of Healthier Food Alternatives
Introduction
Dietary recommendations encourage people to protect themselves against chronic diseases such as diabetes, hypertension, stroke, and some types of cancer by increasing their intake of whole grains, fruits, and vegetables, and by reducing their intake of fat and added sugar.1, 2, 3, 4 Meeting the dietary recommendations does not necessarily require consumers to make major changes in their diet. Minor changes can be effective, such as substituting whole wheat bread for white bread, lean ground beef for regular ground beef, or low-fat milk for whole milk. Few people, however, successfully follow the dietary recommendations, and low-income consumers are even less likely to meet them. For instance, 10% of upper-income adults eat three or more servings of whole grains each day, compared to 5% for low-income adults.5 Higher-income adults come closer to consuming the recommended daily amounts of fruits and vegetables.6
The food environment may have a significant impact on the ability of low-income consumers to eat healthier foods. When asked, low-income consumers frequently cite unavailability and higher prices among the constraints to eating healthier.7 However, no studies have methodically examined whether healthier substitutes are readily available in low-income neighborhoods or at what price. If healthier food items are frequently unavailable, or prices are significantly higher, then nutrition education targeted at low-income consumers may be ineffectual.
Market-basket studies are frequently used to assess the availability and prices of food items. In previous studies, low-income consumers have healthy food items available to them if they have access to a grocery store.8, 9, 10 These studies have for the most part ignored the nutritional characteristics of the food being sold. This has led to a potentially erroneous conclusion that low-income consumers also have sufficient access to the healthier alternatives, and is at odds with their assertions that the healthier alternatives are in fact not readily available.
Price may also be a factor in the choice to eat healthier. Drewnowski et al.11 argue that the low price of energy-dense food encourages low-income Americans to consume an unhealthy diet. Recent research on the food environment has shown that people are sensitive to the relative price of healthier food items. One study suggests that price is a significantly stronger influence on healthy food choices compared to labeling healthy foods.12 In an experiment manipulating prices and labels on foods sold in vending machines, price reductions of 10%, 25%, and 50% on lower-fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions.
The research on market-basket studies has focused on whether prices paid in low-income neighborhoods reflect the same prices used to determine public food assistance benefits.13, 14 These studies are usually based on the U.S. Department of Agriculture’s Thrifty Food Plan (TFP).15 The TFP is a meal plan that demonstrates how a diet that meets the minimum recommendations of the 1995 Dietary Guidelines for Americans16 may be achieved by a family of four on a modest budget or by food stamp recipients. However, the TFP does not have the whole grains or the leanest meats recommended for a healthier diet. No research to date has examined the cost of healthier alternatives to the TFP.
For this research, a market-basket study was completed to compare the availability and cost of a standard market basket to a market basket with healthier substitutes. This analysis was conducted to answer two research questions: (1) What is the availability of healthier foods in low-income compared to higher-income neighborhoods? (2) Does a healthier food basket cost more than the standard food basket?
Section snippets
Methods and Materials
The market-basket study involved surveyors going into grocery stores in the areas of interest and collecting prices for a list of food items from each store. The average cost of the standard TFP market basket and the healthier market basket was calculated from these prices and compared using a standard t-test.
Availability
The items most likely to be missing were whole wheat breads and grain products, and ground beef with ≤10% fat (Table 2). Six stores were missing whole wheat spaghetti; three stores were missing whole wheat English muffins, higher-fiber hamburger buns, ground beef with ≤10% fat, and low-fat cheddar cheese; and two stores did not have whole wheat bagels and frozen fish filets (unbreaded). Except for the frozen fish filets, all items that were never available were recorded for stores located in
Discussion
For people in higher-income neighborhoods, access to the healthier substitutes recommended for a healthy diet is as easy as their access to a supermarket. Almost all supermarkets stock a variety of the recommended substitutes. However, small independent grocery stores, usually found in low-income neighborhoods, often do not have in stock the higher-fiber breads and whole grains, or ground beef with ≤10% fat. The items may never be available, or available only some of the time. Within these
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