"The Dollar Store Got It Going On": Understanding Food Shopping Patterns and Policy Preferences among Dollar Store Shoppers with Low Incomes.

Background: The growing dollar store sector has raised concerns about nutrition and associated health outcomes, especially for low-income communities who disproportionately rely on dollar stores. Perspectives of dollar store shoppers are largely absent. Objective: This study aimed to understand why low-income shoppers choose to purchase food from dollar stores and what store changes, policies, and programs would make it easier for them to purchase healthier items. Methods: In May-June 2023, we conducted interviews with 19 dollar store shoppers in an urban county in North Carolina. We used thematic analysis and the framework method to identify emergent patterns and themes across responses. Results: Individuals relied on dollar stores because of the affordable prices and convenient locations. In order of frequency, most participants purchased candy and snacks from dollar stores, followed by meat, fruits, and vegetables. Participants wanted more fruits, vegetables, and higher quality proteins at dollar stores and supported policies that increase access to healthier options via increased purchasing power, increased access to a mobile farmers' market, marketing that identifies nutritionally healthy products, and improved access to other store types. Responses to removing unhealthy items from checkout areas were mixed. Conclusions: Dollar stores are affordable and convenient food retailers for people with low incomes. However, dollar stores are not meeting demand for fruits, vegetables, and proteins, items necessary for food and nutrition security. To improve food access and community health, decision makers should incorporate community perspectives into efforts aimed at improving dollar store food options.