ArticleBMJ open2025
Key sociodemographic factors and food packaging attributes associated with poor diet quality among rural Americans: a cross-sectional survey study.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Association Between Various Metrics of the Rural Food Environment and Diabetes and Obesity.Preventing chronic disease · 2026Article
- How Is U.S. Food-Insecurity Related to Dietary Quality? A Scoping Review to Inform Nutrition Security Across the Lifespan.Nutrients · 2026Article
- Disentangling the Multifactorial Influences on Diabetes Risk Among Rural Communities: Food Environment, Diet Quality, and Dietary Chemical Exposures.Diabetes/metabolism research and reviews · 2026Observational
- Nutritional strategies against dementia in rural populations.Frontiers in nutrition · 2025Review
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Authors and funding
10 authors.
Funding
Abstract
objectivesRural residents face unique challenges that contribute to poor diet quality and health. The objective of this study was to assess diet quality using the Alternative Healthy Eating Index (aHEI) among residents of a rural New York county with poor health outcomes, and identify geographic and individual-level factors associated with lower diet quality.
designWe performed a cross-sectional study using survey data and multivariable linear regression analyses, supplemented by geographic distribution assessment of aHEI scores.
settingSullivan County, New York, a rural county with poor health outcomes.
participantsHouseholds in Sullivan County who responded to a dietary and sociodemographic health survey in 2021-2022. OUTCOME MEASURES: The primary outcome was the aHEI score and its dietary subscores. Secondary measures included sociodemographic characteristics, receipt of income assistance, financial hardship, food and housing insecurity, primary food store type, distance to food store and frequency of canned or plastic-wrapped food consumption.
resultsThe overall survey response rate was 42.5%. The mean aHEI score was 56.5 (SD: 11.9), normally distributed across respondents. Lower aHEI scores were associated with not completing high school (10.0 points lower vs college graduates, p<0.01), reporting a disability (3.5 points lower, p<0.01), experiencing food insecurity (3.0 points lower, p<0.01) and frequent consumption of canned foods (6.2 points lower compared with those who never consumed canned foods, p<0.01). Geographic analysis revealed clustering of predictors but no substantial geographic clustering of aHEI scores.
conclusionsPoor diet quality in rural areas is associated with education level, disability, food insecurity and canned food consumption. These findings highlight potentially modifiable risk factors and support the need for targeted interventions to improve diet quality and reduce health disparities in rural populations.
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