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Food Costs Are Higher in Counties With Poor Health Rankings

Hardin-Fanning, Frances PhD, RN; Wiggins, Amanda T. PhD

Journal of Cardiovascular Nursing: March/April 2017 - Volume 32 - Issue 2 - p 93–98
doi: 10.1097/JCN.0000000000000329
ARTICLES: Prevention and Early Response

Background: Poor dietary habits are associated with higher rates of cardiovascular disease. However, the cost of foods associated with lower risk of cardiovascular disease can be a significant barrier to healthy eating.

Objective: The aim of this study is to determine whether food prices per serving differed across Kentucky counties based on health ranking and overall nutritional quality.

Methods: Fifteen counties were randomly selected based on County Health Ranking. Overall Nutritional Quality Index and cost of 75 foods were assessed in all 15 counties in the same week. A generalized estimating equations model and post hoc analyses were used to assess differences in food cost by nutritional quality and health ranking.

Results: Food prices were significantly less in the most healthy counties compared with the least healthy (Z = 3.8; P < .001; $0.08 per serving). Prices were also significantly higher in least healthy counties (tertile 3) compared with moderately healthy counties (tertile 2) (Z = 2.3; P = .024; $0.05 per serving).

Conclusions: Disproportionately higher food costs are associated with poor health outcomes in Kentucky counties. Community-based interventions can potentially improve access to affordable healthy foods. Current supplemental nutritional policies do not address disparate food costs. Health professionals should advocate for policy changes that are reflective of these food cost disparities.

Frances Hardin-Fanning, PhD, RN Assistant Professor, College of Nursing, University of Kentucky, Lexington.

Amanda T. Wiggins, PhD Lecturer, College of Nursing, University of Kentucky, Lexington.

This study was funded by the University of Kentucky Research Faculty Support Funds and the National Institutes of Nursing Research grant 5K23NR014883-02.

No human subjects or animals were involved in this study. Ethics approval was not required for this cost comparison.

The authors have no funding or conflicts of interest to disclose.

Correspondence Frances Hardin-Fanning, PhD, RN, College of Nursing, University of Kentucky, 751 Rose Street HSLC 439, Lexington, KY 40536 (

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