Some 20 percent of Americans live in rural areas but the "nutritional environment" of these areas remains under-explored, Liese's team said.
The researchers identified 77 stores in the county in 2004, of which only 16 percent were supermarkets and 10 percent were grocery stores. The remaining 74 percent were convenience stores.
There were seven stores per 100 square miles and eight stores per 10,000 county residents.
Healthy foods were more available at supermarkets and grocery stores. Low-fat/nonfat milk, apples, high-fiber bread, eggs and smoked turkey were available in 75 percent to 100 percent of supermarkets and grocery stores versus 4 percent to 29 percent of convenience stores. Just 28 percent of all stores sold any of the fruits or vegetables included in the survey -- apples, cucumbers, oranges and tomatoes. Convenience stores tended to charge more for items than did supermarkets.
"The relative availability of healthy versus unhealthy items is way out of whack, so people have much more availability of unhealthy foods," said Tom Farley, co-author of Prescription for a Healthy Nation and a professor of community health sciences at Tulane University School of Public Health and Tropical Medicine in New Orleans. "This suggests that the primary environmental reason why people have unhealthy diets is simple availability."
"There are certain things in public policy that we have the ability to influence and those we don't," Farley continued. "What goes on inside people's heads is tough to influence but we can influence what happens in stores with subsidies, financial incentives, guidelines and public pressure."
Check out the latest federal dietary guidelines at the U.S. Department o
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