Household Food Purchase Research Articles

Food purchase diversity is associated with market food diversity and diets of children and their mothers but not fathers in rural Tanzania: Results from the EFFECTS baseline survey.

Rural households in East Africa rely on local markets, but the influence of market food diversity and household food purchase diversity on diets has not been well-characterized. We quantify the associations among market food diversity, household food purchase diversity and dietary diversity of mothers, fathers and children in rural Tanzania. This study uses baseline data from a randomized controlled trial, Engaging Fathers for Effective Child Nutrition and Development in Tanzania. We used the 10 food groups for women's dietary diversity to assess the seasonal availability of nutritious foods in 79 markets. Using data from 957 rural households in two districts in Mara, Tanzania, we measured household food purchase diversity over the previous month and dietary diversity among children (6-23 months), mothers and fathers. Overall, 63% of markets sold all 10 food groups throughout the year, indicating high-market food diversity and minimal seasonality. However, only 33% of women and 35% of children met dietary diversity recommendations. Households that reported higher purchasing power (0.14, p < 0.001), lived within 30 min of a market (0.36, p = 0.001) and had access to a highly diverse market (0.37, p = 0.01) purchased a higher diversity of foods. In turn, food purchase diversity was positively associated with the dietary diversity of mothers (p < 0.001) and children 9-23 months (p < 0.001) but not fathers (p = 0.56). Interventions must account for food availability and access in local markets, and promoting diverse food purchases may be an effective strategy to improve women's and children's diets in rural areas.

Associations between exposure to advertising of foods high in fats, salt and sugar and purchase of energy and nutrients: a cross-sectional study.

To assess associations between self-reported advertising exposure to foods high in fats, salt and sugar and household purchases of energy, nutrients and specific product categories. A cross-sectional design was used. Advertising exposure data were gathered using a questionnaire administered to the main shopper of each household, and purchase data from supermarkets and other stores for these households were accessed for a 4-week period during February 2019. Households in London and the North of England. Representative households (N 1289) from the Kantar Fast Moving Consumer Goods Panel. Main shoppers were predominantly female (71 %), with a mean age of 54 years (±13). Linear regression models identified that exposure to foods high in fats, salt and sugar advertising through traditional mediums (including broadcast and print), but not digital, transport, recreational or functional mediums, was associated with greater purchases of energy (9779 kcal; 95 % CI 3515, 16 043), protein (416 g; 95 % CI 161, 671), carbohydrate (1164 g; 95 % CI 368, 1886) and sugar (514 g; 95 % CI 187, 841). Generalised linear models showed that individuals who reported exposure to sugary drink advertising were more likely to purchase sugary drinks (1·16; 95 % CI 2·94, 4·99) but did not purchase more energy or nutrients from sugary drinks. There was no evidence of associations between exposure to advertising for sugary cereals or sweet snacks and purchases from these categories. There was a strong influence of traditional advertising and sugar-sweetened beverage advertising on household food and drink purchases, thus supporting the need for advertising restrictions across traditional formats and for sugary drinks specifically.

Reduced red and processed meat consumption is associated with lower diet costs in US households: a national analysis of protein substitutions.

To examine the association between red and processed meat consumption and total food expenditures in US households and explore whether households could reduce food costs by substituting these meats with other protein sources such as poultry, seafood, eggs and plant proteins. Cross-sectional study using data from the National Household Food Acquisition and Purchase Survey (FoodAPS). Using adult male equivalents (AME) for standardisation, we categorised red and processed meat purchases into quintiles. We used generalised linear models to explore the association between red or processed meat consumption and food expenditures and the cost effect of substituting meat with other proteins. United States. Data from 4739 households with valid acquisition information from FoodAPS, a stratified multistage probability sample of US households. Higher red and processed meat consumption were both significantly associated with higher total weekly food expenditures, particularly among households with low income. Substituting red or processed meat with poultry, eggs or plant proteins did not significantly affect overall food expenditures, whereas replacing meat with seafood, especially varieties high in n-3 fatty acids, led to increased costs. Reducing red and processed meat consumption could offer savings for households, particularly those with low income. Although substitutions with seafood high in n-3 could increase expenses, alternative protein sources like poultry and plant proteins may serve as cost-neutral replacements. Public health strategies should emphasise dietary shifts' economic, health and environmental benefits and aim to make nutritious yet affordable protein sources more accessible.

The Influencing Mechanism of Household Food Purchasing Behavior and Household Reserve Efficiency under Non-Normal Conditions

Family reserves are an important part of national reserves, and how to do a good job in family reserves is a common concern of the government and society. Under the non-normal conditions of major accidents and disasters, wars, plagues, social unrest, etc., urban food supply mainly depends on external supply guarantee, and urban residents’ risk perception is more sensitive. Based on the Theory of Planned Behavior and Norm Activation Model, this study constructs an analytical framework for the risk perception, perceived behavior control, and family reserve efficacy of urban residents under non-normal conditions from the perspectives of rationality and sensibility, self-interest, and altruism. The perceived behavior control of household food reserves in non-normal conditions is affected by risk perception, subjective norms, and personal norms. On this basis, countermeasures and suggestions are put forward: Urban residents should strengthen their sense of risk and responsibility for storing food at home, reserve food appropriately, and develop a good habit of family saving. On the other hand, it is necessary to pay attention to personal norms, reduce the negative impact of subjective norms on residents, and avoid excessive food storage and food waste.

Trends in the contribution of greenhouse gas emissions from food and beverage purchases in Mexico: 1989–2020

BackgroundAssessing the trends in dietary GHGE considering the social patterning is critical for understanding the role that food systems have played and will play in global emissions in countries of the global south. Our aim is to describe dietary greenhouse gas emissions (GHGE) trends (overall and by food group) using data from household food purchase surveys from 1989 to 2020 in Mexico, overall and by education levels and urbanicity.MethodsWe used cross-sectional data from 16 rounds of Mexico’s National Income and Expenditure Survey, a nationally representative survey. The sample size ranged from 11,051 in 1989 to 88,398 in 2020. We estimated the mean total GHGE per adult-equivalent per day (kg CO2-eq/ad-eq/d) for every survey year. Then, we estimated the relative GHGE contribution by food group for each household. These same analyses were conducted stratifying by education and urbanicity.ResultsThe mean total GHGE increased from 3.70 (95%CI: 3.57, 3.82) to 4.90 (95% CI 4.62, 5.18) kg CO2-eq/ad-eq/d between 1989 and 2014 and stayed stable between 4.63 (95% CI: 4.53, 4.72) and 4.89 (95% CI: 4.81, 4.96) kg CO2-eq/ad-eq/d from 2016 onwards. In 1989, beef (19.89%, 95% CI: 19.18, 20.59), dairy (16.87%, 95% CI: 16.30, 17.42)), corn (9.61%, 95% CI: 9.00, 10.22), legumes (7.03%, 95% CI: 6.59, 7.46), and beverages (6.99%, 95% CI: 6.66, 7.32) had the highest relative contribution to food GHGE; by 2020, beef was the top contributor (17.68%, 95%CI: 17.46, 17.89) followed by fast food (14.17%, 95% CI: 13.90, 14.43), dairy (11.21%, 95%CI: 11.06, 11.36), beverages (10.09%, 95%CI: 9.94, 10.23), and chicken (10.04%, 95%CI: 9.90, 10.17). Households with higher education levels and those in more urbanized areas contributed more to dietary GHGE across the full period. However, households with lower education levels and those in rural areas had the highest increase in these emissions from 1989 to 2020.ConclusionsOur results provide insights into the food groups in which the 2023 Mexican Dietary Guidelines may require to focus on improving human and planetary health.

How does eligibility for GusNIP produce prescriptions relate to fruit and vegetable purchases and what factors shape the relationship? A protocol for a secondary analysis of nationally representative data in the USA

IntroductionUS Department of Agriculture (USDA) Gus Schumacher Nutrition Incentive Programme (GusNIP) produce prescription programme (PPR) ‘prescriptions’ provide eligible participants with low income, risk for diet-related chronic disease and food insecurity...

Contribution of Food from Market Purchases and Home Production to Child Nutrient Intake: Evidence from the EFFECTS Study Baseline Data

BackgroundChild undernutrition is prevalent in Tanzania, and households rely primarily on local markets and home production as food sources. However, little is known about the contribution of food market purchases to nutrient intakes among children consuming complementary foods. ObjectivesTo quantify the relationships between diversity of foods purchased and produced by households and adequate child nutrient intake in Mara, Tanzania. MethodsCross-sectional baseline dietary and household food source data from the Engaging Fathers for Effective Child Nutrition and Development in Tanzania study were collected from mothers of 586 children aged 9–23 mo clustered in 80 villages in Mara, Tanzania. We conducted mixed effects linear regressions to quantify the association between the diversity of foods consumed at home, from market purchases and home production, and nutrient intake adequacy (based on 24-h food recalls). ResultsChildren had inadequate diets, with fewer than half of children consuming adequate amounts of vitamin A, vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B9 (folate), calcium, iron, and zinc. Breastfeeding was associated with higher overall mean adequacy (b = 0.15–0.19 across models, P < 0.001). Diversity of foods purchased was positively associated with the intake of vitamin B12 and calcium (both P < 0.001); this effect was attenuated among breastfed children. Among nonbreastfed children, production diversity was positively associated with vitamin A intake (b=0.04; P < .05) but not with intake of other nutrients. ConclusionsBoth household food purchase and food production diversities were positively associated with children’s nutrient intake in rural Mara, Tanzania. Nutrition programming should consider the role of food markets in addition to home food production to improve child diets.This trial was registered at clinicaltrials.gov as NCT03759821, https://clinicaltrials.gov/study/NCT03759821.

Changing food preferences and choices – A framework for analyzing households food purchases over time

Scientific interest in food consumption has grown significantly in recent decades due to its profound implications for individuals’ and societies’ health and wellbeing and implications for domestic and global systems sustainability. Food purchases can be directly and indirectly related to household and consumer characteristics. While food purchase habits may be dynamic and influenced by changing circumstances over the years, most related research presents a snapshot of the studied issues within a single year or period or focus on a specific social group or food commodity. This paper introduces and illustrates a framework for analyzing household food purchasing clusters over a period of time. It uses data from over 120,000 households in Israel to analyze household food purchases over two decades. The analysis segments the population into clusters and accounts for their food purchases through an extensive bottom-up approach. It identifies several major clusters, including small and large families and young and elderly households, each representing a unique range of food purchase patterns and a different share of the overall society. It analyses different levels of consumption, from broad categories to specific products, and examines the relationships between food purchases and household characteristics. Examining specific food categories and commodities illustrates a complex trend over the research period, including rising demand for beef, poultry, and soft drinks, steady patterns of consumption of frozen and canned vegetables and oils, and a clear decline in demand for dairy, grain, and sugar products.

Abstract P483: Food Purchase Priorities and Healthy Food Purchase Supports and Barriers for U.S. General and Low-Income Consumers: A Quantitative Survey

Introduction: Identifying priorities and attributes that influence food purchase decisions will inform interventions and strategies to promote healthy eating. Aim: This study aimed to identify food purchase priorities and healthy food purchase supports and barriers for the general population and those with limited household income. Methods: Participants were recruited by a market research company in May 2023 and were required to be ≥ 18 years old, not work in healthcare/medical/nutrition or advertising/public relations/marketing/market research and be the primary/shared food decision maker for the household. Recruitment quotas ensured age, income, gender and geographic region approximated 2022 US census data (n=1,182) (Census-representative group, CRG). A sample with limited income and participation in federal food or healthcare programs (low-income group, LIG) was also recruited (n=506). The survey was administered online in May and June 2023. Differences between LIG and CRG were assessed using z-tests (p &lt; 0.05). Results: Taste was most commonly rated by CRG as very or extremely important in household food purchasing (87%). Availability, price, ingredients and nutritional value were also important to at least two-thirds of CRG. Taste was similarly important to LIG (85%), but they were more likely to rate price and less likely to rate availability, nutritional value and ingredients as important. When prompted to choose the most important factor, price and taste were the most common responses, chosen by similar proportions of CRG, while price was the most important factor for LIG, followed by taste. CRG versus LIG were more likely to prioritize personal taste over cost, health and nutrition information on labels, buying local and selecting according to nutrition, brand and origin/sourcing information. CRG were less likely than LIG to prefer a lower cost and usually select according to price. LIG were more likely than CRG to state that nothing supports them in selecting healthier foods and less likely to have found support from good-tasting recipes, advance meal or grocery list preparation, cooking equipment access, following influencers, recommendations from organizations or consulting a dietitian/nutritionist. Conversely, LIG were more likely to identify price and availability as barriers to selecting healthier foods, and less likely to see long preparation time, small servings sizes or nothing as barriers. Conclusions: Cost is a strong barrier to healthy eating, especially with limited income, along with taste, while nutrition is not a leading influence on food choice. Strategies to enable healthy eating among low-income households must prioritize taste and cost.

Farm to school programming spillovers and households' fruits and vegetables purchases

AbstractThe number of US school food authority's (SFA) implementing Farm to School Programming (FTSP) is growing. Little is known about potential spillover effects of school children's exposure to FTSP on household food purchases. We measure the relationship between school age children's exposure to FTSP and household‐level Food‐At‐Home fruits and vegetables (FV) expenditures and expenditure shares. Combining Farm to School Census data on SFAs' FTSP participation with household‐level scanner data, we estimate positive relationships between FV expenditures and different measures of children's exposure to FTSPs, especially for metro households. However, the magnitude of these relationships is likely too small to be meaningful.

Restaurant outlet density and the healthfulness of food purchases: evidence from FoodAPS.

The average American household's diet and food purchasing patterns are out of sync with federal recommendations. Researchers have connected this with the large and growing rates of obesity, diabetes, and other diet-related ailments in the U.S. Restaurant food has been discussed a potential contributor to unhealthful diets, as it is often calorically dense. We investigate the association between household access to restaurants and diet quality using USDA FoodAPS data and NPD ReCount data. We define radii around households to measure restaurant outlet counts and apply a regression analysis incorporating household characteristics. We find that neither restaurant counts nor openings share many statistically or economically significant associations with average dietary quality. Household characteristics and demographics are far more powerful in explaining variation in diet quality. Our findings align with the large and growing body of empirical research that suggests that personal preferences and other household characteristics are more important than the food environment in explaining food choices and diet quality. Given the extant research on the importance of access to large supermarkets, our results suggest that access to food retailers is more important in explaining diet quality than access to restaurants.

Sodium intake according to NOVA food classification in Brazil: trends from 2002 to 2018.

Excessive sodium intake is a major global public health issue and the identification of dietary sources and temporal trends in its consumption are a key to effective sodium reduction policies. This study aims to update estimates of sodium intake and its dietary sources in Brazil according to the NOVA food classification system. Records of 7-day food purchases of households from the Brazilian Household Budgets Survey of 2002-2003, 2008-2009, and 2017-2018 were converted into nutrients using food composition tables and the mean availability was estimated per 2,000kcal/day. Mean daily sodium available for consumption in Brazilian households has increased from 3.9 to 4.7g per 2,000kcal, from 2002-2003 to 2017-2018, over twice the recommended levels of sodium intake. From 2002-2003 to 2017-2018, the processed culinary ingredients, including table salt, represented the largest dietary source of sodium, although their participation in dietary sodium was reduced by 17% (66.6% to 55%), while the percentage of dietary sodium from processed foods increased by 20.3% and from ultra-processed foods increased by 47.6% (11.3% to 13.6% and 17% to 25.1%, respectively). In conclusion, the total household sodium availability remains high and has increased over time in Brazil, yet the participation of different dietary sources of sodium have gradually changed.

Trends (2014-2018) in the healthiness of packaged food purchases of Australian consumers before and after the introduction of voluntary Health Star Rating nutrition labels.

To evaluate the trends in the healthiness of packaged food purchases of Australian consumers before and after the introduction of the Health Star Rating (HSR) nutrition labels. Panel data analysis and difference-in-differences analysis. The Australian Government endorsed HSR nutrition labels for voluntary implementation on packaged foods in June 2014. We analyse the packaged food purchases of households across all major supermarkets before (January 2014 to June 2014) and after (June 2014-Dec 2018) the introduction of HSR. 6284 members of a panel of households across Australia reporting their grocery purchases to a market research company (Nielsen Homescan panel). The healthiness of household food purchases exhibited a U-shaped trend - decreasing from 2014 to 2017, and then increasing from 2018, corresponding to the time when a higher proportion of products were HSR-labelled. Households that purchased a higher proportion of HSR-labelled products had healthier household purchases overall. Further, the healthiness of households' category-specific food purchases was positively associated with the proportion of HSR-labelled products in categories where HSR was adopted, relative to control categories where HSR was not adopted. In Australia, once a substantial number of packaged food products adopted the voluntary HSR summary indicator, we observed an increasing trend in the healthiness of household food purchases. Widespread adoption of a nutrition summary indicator, such as HSR, on packaged food is likely to be beneficial for population health.

The distributional impact of SNAP on dietary quality

AbstractThe Supplemental Nutrition Assistance Program (SNAP) is the nation's largest domestic food and nutrition assistance program for low‐income Americans. Recent studies that examined the effect of SNAP on dietary quality focus on the average effects. Using the USDA's 2012 National Household Food Acquisition and Purchase Survey (FoodAPS) and an unconditional quantile estimator, we examine the distributional impacts of SNAP on dietary quality as measured by Healthy Eating Index‐2010 (HEI‐2010). To identify the differential impacts of SNAP across the distribution of dietary quality, we exploit exogenous variation in state's maximum weekly unemployment insurance benefits and state outreach spending per capita as instrumental variables. We find that SNAP has no significant impact on households’ dietary quality on average. However, for households with initially low‐to‐intermediate dietary quality, SNAP participation reduces their HEI scores by over 17% or more than 7 points out of a total score of 100. The negative impacts of SNAP on these HEI quantiles are mainly driven by an increased acquisition of empty calories.

Associations between retail food environment and organic food purchases in French households

Abstract Background The aim of our study was to assess the associations between organic food purchases of French households and their exposure to food outlets that sell organic foods, including organic food stores (selling only organic products) and standard food outlets, independently from households’ characteristics. Methods This cross-sectional study included 462 households from a quota sampling survey conducted in France. Share of expenditures for organic foods over a one-month period was assessed using food supply diaries and grocery receipts. The objective retail food environment (RFE) was assessed around the home and in activity space (AS) (i.e. areas around places of main activity and commuting journeys) using geographic information systems. Associations between RFE indicators and organic food purchases were assessed using multinomial logistic regression models, adjusted for households’ characteristics. Results Households exposed to organic food outlets around their home (OR presence vs. absence [95% CI]=2.27 [1.33; 3.89]) had higher expenses in organic foods. Households exposed to organic food outlets in their AS were also more likely to have medium (OR ≥ 3 organic food outlets vs. absence [95% CI]=2.52 [1.34;4.76]) or high organic food purchases (OR [95% CI]=1.90 [1.04;3.47]). The models that included different types of organic food stores confirmed the first ones: households who were exposed to organic specialized food stores (greengrocers, bakeries and butcher's stores) around home and in their AS were more likely to have medium or high organic food purchases. In addition, the distance to the nearest organic grocery food store was inversely associated with high expenses in organic foods (OR [95% CI]=0.57 [0.41; 0.80]). Conclusions These results suggest exposure to organic food outlets and their use are related, providing knowledge for cities’ commercial planning with the aim of promoting spatial access to organic food for their inhabitants. Key messages • Exposure to organic food outlets and their use are related. • Food environment may influence consumers’ grocery shopping behaviors.

Healthier Food Purchase and Its Determinants in an Urban Resettlement Colony of Delhi

ABSTRACT Dietary risk, one of the major risk factors for the increasing burden of non-communicable diseases, is influenced by household food choices and purchases. A community-based cross-sectional study was conducted in 250 randomly selected households of an urban resettlement colony in Delhi to estimate the proportion of households purchasing different healthier food options during the last purchasing occasion and to identify its key determinants. Purchase of healthier options in staple items like wheat flour with fiber (100%), plant-based oils (97.9%), unpolished pulses (96.2%), and toned milk (94.5%) was high. Affordability and health considerations in food purchases were identified as key determinants.

Food Purchase Prioritization During the COVID-19 Pandemic in Latin America

ABSTRACT The paper determines the prioritization of household food purchases during the COVID-19 pandemic confinement in Latin America. This is a multicenter, cross-sectional study. An online questionnaire including sociodemographic, socioeconomic, and food purchasing prioritization information was sent through digital platforms. A total of 6,357 individuals participated; 83.6% were women, 56.3% belonged to the middle socioeconomic level. Low socioeconomic level was correlated with high prioritization of rice/pasta, potatoes, cookies, sugar/bread, flours, and sweets. The higher the socioeconomic level, the higher the purchasing of alcohol, nuts, vegetables, and meats. Purchase prioritization is related to the socioeconomic level of the participants.

Do obese and nonobese consumers respond differently to price changes? Implications of preference heterogeneity for obesity‐oriented food taxes and subsidies

AbstractPreference heterogeneity in food demand has important health and equity implications for targeted and broad‐based taxes and subsidies intended to enhance diet quality and reduce obesity. We study the role of obesity in the purchases of food at home and food away from home using data from the nationally representative National Household Food Acquisition and Purchase Survey. We develop a method for incorporating the complex survey design and retail scanner data into the estimation of a 21‐good Exact Affine Stone Index demand system with endogenous prices and truncated purchases. We find significant preference heterogeneity associated with the obesity status of household members. Counterfactual simulations find that (1) a sweetened beverage tax is effective in increasing the healthfulness of purchases by lower income obese consumers; (2) the nutritional benefits of a fruit and vegetable subsidy are concentrated on nonobese consumers with little improvement in obese consumers' Healthy Eating Index and an increase in their total calories purchased; and (3) a fiscally neutral healthy food subsidy fully funded by an unhealthy food tax benefits nonobese consumers both financially and nutritionally more than it does obese consumers. These findings show that lowering healthy food prices without raising the cost of unhealthy foods is unlikely to reduce obesity. Policymakers in favor of a systems approach of simultaneously taxing unhealthy foods and subsidizing healthy foods should be mindful of the distributional effects of this policy on obese consumers and the lower income population.

Analysis of factors influencing USA households' choice of ethnic restaurants

PurposeThis study empirically identifies household demographic and socioeconomic characteristics as well as restaurant characteristics that affect the probability of households choosing an ethnic restaurant (American, Asian, European, Mexican and other) in the USA.Design/methodology/approachA multinomial logistic regression model is applied using the data derived from the information from the National Household Food Acquisition and Purchase Survey conducted between April 2012 and January 2013.FindingsThe empirical findings suggest that such factors as the unit cost on away-from-home food items (i.e. price), region of residence, primary respondent's ethnicity, race, education level, marital status and employment status as well as such restaurant characteristics as availability of loyalty program and presence of coupons significantly affect the probability of households choosing a particular ethnic restaurant in the USA.Research limitations/implicationsThe original dataset employed in this study does not permit the quantification of information associated with size, location, and number of years in operation for the ethnic restaurants considered. Also, the dataset does not permit the classification of the ethnic restaurants included in the “other” category.Originality/valueTo the best of the authors' knowledge, there has been no empirical micro-level analysis associated with determining factors impacting households' choice of ethnic restaurants using a polytomous logistic regression model allowing for a wide range of ethnic restaurants and covering the entire USA, based on an extensive set of household demographic and socioeconomic factors and restaurants characteristics. As such, the current study plugs this research gap, with the empirical findings furnished by this study being of importance to ethnic restaurant operators (owners) in the operators' effort to develop effective marketing strategies.

Association Between County-Level Food Retail and Socioeconomic Environment and Nutritional Quality of Household Food Purchases, 2015.

About 40 million Americans do not have easy access to affordable nutritious foods. Healthier foods are less likely to be available to those living in rural and/or lower-income communities. The objective of this study was to analyze the association between nutritional quality of household food purchases and county-level food retail environment; county-level demographic, health, and socioeconomic indicators; and household composition, demographic characteristics, and socioeconomic characteristics. This study is a secondary analysis of the 2015 Information Resources Inc Consumer Network panel; Purchase-to-Plate Crosswalk, which links US Department of Agriculture nutrition databases to Information Resources Inc scanner data; County Health Rankings; and the Food Environment Atlas data. A total of 63,285 households, representative of the contiguous US population, consistently provided food purchase scanner data from retail stores throughout2015. Nutritional quality of retail food purchases was assessed using the Healthy Eating Index 2015 (HEI-2015). Multivariate linear regression analysis was used to simultaneously test the relationship between the main outcome and household-level demographic and socioeconomic characteristics as well as the county-level demographic, health, socioeconomic, and retail food environment. Household heads who had higher education and households with higher incomes purchased food of better nutritional quality (ie, higher HEI-2015 scores). Also, the association between retail food purchase HEI-2015 scores and the food environment was weak. Higher density of convenience stores was associated with lower retail food purchase nutritional quality for higher-income households and households living in urban counties, whereas low-income households in counties with higher specialty (including ethnic) store density purchased higher nutritional quality food. Both in the full sample and when stratified by household income or county rural vs urban status, no association was found between grocery store, supercenters, fast-food outlets, and full-service restaurant densities and retail food purchase HEI-2015 scores. HEI-2015 scores were negatively correlated with the county average number of mental health days for higher income and urban households. The study findings suggest that availability of healthier food alone may not improve healthfulness of retail food purchases. Future studies examining the influence of demand-side factors/interventions, such as habits, cultural preferences, nutrition education, and cost/affordability, on household purchasing patterns could provide complementary evidence to inform effective intervention strategies.