The impact of a household-level food retail environment health quality measure on diet quality

Differences in access to healthy and affordable food retailers may contribute to disparities in diet-related health. Although this relationship has been studied extensively, due to the wide-reaching significance of the impacts of poor diet-related health, most research focuses on the effect for the average household. However, focusing on the effect for the average household may mask heterogeneity in how individuals are exposed to their local food retail environment. Using household-level data from the National Household Food Acquisition and Purchase Survey, we contribute to the food retail environment literature by utilizing a continuous, household-specific measure of exposure to the healthfulness of the food retail environment to examine how this exposure may influence household diet quality. Using Instrumental Variable methods, we find that improving household exposure to a healthier food retail environment is positively related to household diet quality and that responsiveness to improved exposure is heterogeneous across food groups and household demographics. Specifically, the responsiveness is largest for households residing in low and moderate quality food environments and lower-income households, independent of SNAP participation. As a result, targeted programs that improve household-specific exposure to healthier food retail environments, as part of a broader suite of policies and programs, may be an effective lever for policymakers to improve diet-related health outcomes.