A nutrition environment measures survey for dollar stores (nems-ds) in rural south carolina: assessing nutrition equity and WIC readiness.

backgroundRural areas in the southern United States experience a disproportionate burden of diet-related disorders, driven by limited access to nutritious and affordable foods. Dollar stores have rapidly grown in these regions, including South Carolina's Lowcountry, where they often replace traditional grocery stores and shape residents' nutritional behaviors. However, their food environment and readiness to serve as vendors for the Women, Infants, and Children (WIC) nutrition program remain under-examined. This study addressed this gap using a newly developed Nutrition Environment Measures Survey for Dollar Stores (NEMS-DS), which captures dimensions overlooked by previous assessment tools, particularly given dollar stores' reliance on shelf-stable and ultra-processed foods.

methodsA quantitative, cross-sectional study was conducted in 13 dollar stores across six rural counties in the Lowcountry. All Lowcountry stores were located in rural areas, and the majority (46%) were in high-deprivation areas identified through the Area Deprivation Index. Food environments of sampled stores were assessed across three domains: (1) healthy food availability; (2) WIC readiness; and (3) marketing of healthy versus unhealthy items (e.g., shelf-space allocation). Descriptive statistics, F-tests, and chi-square tests were employed to compare Lowcountry stores with 202 dollar stores from a parallel multiple state assessment.

resultsLowcountry stores demonstrated limited healthy food availability scores (mean 23 out of a possible 62) and low WIC readiness (mean 51 out of a possible 190). Stores allocated only 12% of the total shelf space to healthy items. None marketed healthy foods at checkout, whereas 100% promoted sugar-sweetened beverages and ultra-processed snacks, patterns consistent with stores in comparison research sites. Although fresh produce availability was slightly higher in the Lowcountry than in the comparison sample, frozen and shelf-stable produce availability was significantly lower.

conclusionDollar stores in the Lowcountry mirrored national patterns characterized by heavy reliance on ultra-processed foods in rural high-poverty settings. Findings inform policy discussions regarding WIC vendor eligibility, retail product placement practices, and marketing regulation to improve nutritional behaviors, promote equitable access to nutritious foods, and prevent diet-related chronic disease in rural communities.