In-store Features and Healthy Food Availability Among Small Corner and Convenience Stores Serving Urban and Rural...

Adequate access to healthy food is crucial for preventing and managing diet-related chronic diseases, especially for vulnerable populations. In neighborhoods lacking supermarkets, lower-income residents tend to source food in small independently-owned stores. To understand how retail food environments are associated with healthy food availability, we examined associations between in-store features and Healthy Food Availability Index (HFAI) scores in Baltimore and Charles County, Maryland stores. Cross-sectional data were collected from 2022 to 2024 across 18 stores. Observational Store Environmental Checklists assessed in-store features, food assistance program authorization, and targeted point-of-purchase promotions. An adapted HFAI scale was used to score each store from 0 to 27 with a higher score indicating greater healthy food availability. Linear regression models analyzed associations between in-store features and HFAI scores using R software. Across all urban and rural stores, the average HFAI score was low (M = 9.16, SD = 4.38). Unsurprisingly, rural stores were more likely to have a larger retail space (2.60 more aisles, on average) than urban stores. Urban vs. rural location and other store characteristics were not found to be significantly associated with HFAI scores. However, the presence of point-of-purchase promotions was associated with a 6.74-point higher HFAI score (CI: 2.40-11.08) after adjusting for number of aisles, food assistance program authorization, and location. Our sample of small Maryland stores generally had low healthy food availability regardless of urban or rural location. This suggests a need for further research to scale-up and evaluate retail food environment interventions that reach both urban and rural settings, nationwide.