Abstract
BACKGROUND: Food security is a severe problem in the United States. Few studies have examined its relationship with food shopping behaviors. OBJECTIVE: This study aimed to examine the association between food security and store-specific and overall food shopping among residents of low-income neighborhoods. DESIGN: We conducted a cross-sectional study. PARTICIPANTS/SETTING: Five hundred twenty-seven households were recruited from two counties in South Carolina from November 2013 to May 2014, and 474 households were included in the final analysis. MAIN OUTCOMES MEASURES: Food security was assessed using the 18-item US-Household Food Security Module questionnaire, and classified into three categories: high or marginal food security (FS), low food security (LFS), and very low food security (VLFS). Store-specific shopping behaviors including frequency, store type, and transportation were queried via in-person interview for the three most-frequented grocery stores. Distance from participants' homes to their reported stores was calculated using Geographic Information Systems. STATISTICAL ANALYSES: Multivariate linear regression for analyses of distance and frequency and multinomial/ordinary logistic regression for analyses of store type and transportation were used. RESULTS: Compared to FS participants, a significantly higher proportion of VLFS participants reported a convenience/dollar store as their most-frequented store (odds ratio [OR] 2.31, 95% CI 1.08 to 4.95) or a lack of transportation (OR 2.04, 95% CI 1.25 to 3.33). They also shopped less frequently (b=-.31, P=0.03) at their third most-frequented store and traveled fewer total miles for shopping (b=-4.71, P=0.04). In analyses considering all stores jointly, LFS participants had lower odds of shopping at both supermarkets and convenience/dollar stores (OR 0.44, 95% CI 0.21 to 0.91) compared to food-secure residents. CONCLUSIONS: The current findings suggest that households with VLFS tend to shop more frequently in stores that have less-healthful options, such as convenience/dollar stores. These findings lend support to ongoing community and policy interventions aimed at improving food access among food-insecure populations.