| Popis: |
Diet disparities by socioeconomic status are increasing in the US, yet it is unknown whether the quality of packaged food purchases (PFPs), a substantial portion of the diet, follow the same pattern. In addition, little is known about how dietary quality differs by geographic region of the US. The objective of this study was to characterize socioeconomic and geographic differences in the quality of PFPs and determine whether state policies were associated with PFPs. We used a nationally-representative dataset of household PFPs and measured quality through a series of nutrient and food group outcomes. First, we characterized trends in disparities by income, education, and race/ethnicity for each PFP outcome from 2008-2018. Secondly, we used spatial cluster analysis to examine regional high (or low) clusters of each nutrient or food group outcome and used multilevel generalized linear models to confirm geographic variation after controlling for household demographic composition across the country. Lastly, we tested whether state-level policies were associated with the quality of PFPs, which we hypothesized would be more salient for low-income and low-education households. We found disparities in the quality of PFPs by income and race/ethnicity, with the greatest disparities observed by education. These disparities were largely persistent from 2008 to 2018. In addition, we found geographic variation in the quality of PFPs that reflected the geographic distribution of the prevalence of diet-related disease. We also found significant variation in the magnitude of disparities within U.S. states after controlling for other household characteristics. However, despite these differences between states, we found very few associations between these outcomes and state-level food and social welfare policies in models that controlled for state fixed effects. We found this to be true even when we limited our sample to low-income or low-education households. In conclusion, future policy efforts at the local, state, and national level should intentionally aim to narrow disparities in the quality of packaged foods households purchase. Although the state policies we examined explained little of the quality of PFPs, our identification of 1) persistent disparities over time for specific food groups 2) regional clusters of relatively higher quality PFPs and 3) states with both no disparities and higher quality PFPs, all provide multiple opportunities to investigate other systemic drivers of the quality of PFPs. |
