Nutrition Environment Measures Survey In Stores Research Articles

Association between the community food environment and dietary patterns in residents of areas of different socio-economic levels of a southern capital city in Brazil.

This study aimed to verify the association between the community food environment and dietary patterns in a population of different socio-economic levels. This cross-sectional study was conducted with a sample of 400 adults and elderly aged between 20 and 70 years residing in the central area of Porto Alegre, Rio Grande do Sul. Four dietary patterns were explored: healthy, traditional Brazilian, refined carbohydrates and sugars, and fast food. The community food environment included the identification of all food stores by areas where individuals lived and auditing based on the Nutrition Environment Measures Survey in Stores (NEMS-S) score. Poisson regression was used to estimate the prevalence ratios (PR) and their respective 95 % CI. After the adjustment for individual sociodemographic characteristics, residents of the area with the best community food environment (highest NEMS-S score) had 12 % and 18 % lower probabilities of high consumption (upper tertile) of the traditional (PR = 0·88; 95 % CI (0·78, 0·98)) and refined carbohydrate and sugar (PR = 0·82; 95 % CI (0·73, 0·92)) dietary patterns, respectively, compared with those living in the area with the worst community food environment (lowest NEMS-S score). Healthy and fast-food dietary patterns showed no association with the community food environment. In conclusion, the community food environment is a factor associated with the consumption of certain dietary patterns, independent of individual sociodemographic characteristics. Thus, aspects of the community food environment become important in food and nutrition actions and policies aimed at health promotion.

Adaptation and Validation of the Nutrition Environment Measures Survey in Stores (NEMS-S) in Costa Rica

ABSTRACT This study adapted and validated the NEMS-S in Costa Rica. Twenty-nine food stores were assessed, three times, by two raters. Inter-rater precision and intra-rater stability were quantified. Construct validity was determined with the known-groups method. Relative precision ranged from 0.54 to 0.77 and was 0.87 for total score. Relative stability ranged from 0.58 to 0.96 and was 0.94 for total score. For construct validity, the hypothesized relationship that supermarkets would have the highest scores was supported. The instrument has moderate to excellent precision and stability, has construct validity, and can be useful to develop policies that encourage healthy environments in food stores.

Validity of a Market Basket Assessment Tool for Use in Supplemental Nutrition Assistance Program Education Healthy Retail Initiatives

ObjectiveTo assess the validity of the Market Basket Analysis Tool (MBAT) for food environment quality within various retail environments compared to the Nutrition Environment Measures Survey in Stores (NEMS-S). MethodsIn-store assessments using the MBAT and the NEMS-S on the same day in a given store were conducted in grocery stores, corner stores, pharmacies, and dollar stores in a metropolis, and urban and rural counties across 4 states: Louisiana, Mississippi, North Carolina, and Virginia. Descriptive statistics, correlations, and ANOVAs were used to assess store location, store type differences, and MBAT and NEMS-S scores. ResultsMarket Basket Analysis Tool and NEMS-S data were collected from 114 stores. Market Basket Analysis Tool and NEMS-S total and all individual component scores were significantly correlated (r = 0.84, P ≤ 0.0001; r range, 0.51–0.88; P ≤ 0.0001). Conclusions and ImplicationsThe MBAT offers a methodology to measure the food retail environment focusing on the availability of healthful food items with a reduced training time and streamlined data collection compared with the NEMS-S. Future work can assess the completion time of the MBAT compared with the NEMS-S and the ability of the MBAT to detect changes in food environment quality post healthy food retail interventions.

Development of a Nutrition Environment Assessment Tool for Latino Ethnic Stores

The objectives were to: (1) adapt the Nutrition Environment Measures Survey for Stores (NEMS-S) to better culturally fit small Latino grocery stores (tiendas) in Iowa; (2) assess the newly adapted Latino NEMS-S for inter-rater and test-retest reliability; and (3) compare Latino and original NEMS-S summary scores. This pilot instrument, containing culturally appropriate foods from the original NEMS-S and 2015 US Dietary Guidelines for Americans, underwent two rounds of formative evaluation. The new instrument and scoring protocol were applied to a random sample of 42 of 81 possible tiendas in Iowa. Cohen’s kappa was used to assess inter-rater and test-retest reliability for availability and quality of indicator food items (total scores and food category sub scores). There were no differences in summary scores for inter-rater or test-retest reliability using paired t-tests. Inter-rater agreement was high (range 0.82–1.00; p < 0.001). Tiendas averaged 42.0 ± 7.5 of 57 possible points on the Latino NEMS-S, but only 12.0 ± 4.6 of 54 points on the original NEMS-S (p < 0.001). The Latino NEMS-S is a reliable tool for assessing the food environment within Iowa tiendas. Culturally specific instruments can describe diverse food environments more accurately and guide public health nutrition interventions within communities.

Quantifying the Food and Physical Activity Environments in Rural, High Obesity Communities.

The built environment contributes to an individual’s health, and rural geographies face unique challenges for healthy eating and active living. The purpose of this descriptive study was to assess the nutrition and physical activity environments in rural communities with high obesity prevalence. One community within each of six high obesity prevalence counties in a rural Midwest state completed the Nutrition Environment Measures Survey for Stores (NEMS-S) and the Rural Active Living Assessment (RALA). Data were collected by trained community members and study staff. All communities had at least one grocery store and five had at least one convenience store. Grocery stores had higher mean total NEMS-S scores than convenience stores (26.6 vs. 6.0, p < 0.001), and higher scores for availability (18.7 vs. 5.3, p < 0.001) and quality (5.4 vs. 0, p < 0.001) of healthful foods (higher scores are preferable). The mean RALA town-wide assessment score across communities was 56.5 + 15.6 out of a possible 100 points. The mean RALA program and policy assessment score was 40.8 + 20.4 out of a possible 100 points. While grocery stores and schools are important for enhancing food and physical environments in rural areas, many opportunities exist for improvements to impact behaviors and address obesity.

What is the availability, affordability, and quality of foods and beverages aligned with dietary guidance in Louisiana Supplemental Nutrition Assistance Program (SNAP) authorized stores?

Healthy food retail strategies are delivered by Cooperative Extension Services in Louisiana to improve public health among communities with lower income. To guide Cooperative Extension Services Programming, the aim of this study was to assess healthy food access among SNAP-authorized stores. This included comparing the availability, affordability, and quality of healthy foods sold in these stores by geography, ownership, and store type. Seventy-five Louisiana SNAP-authorized stores were selected for measurement. Between October 2019 and March 2020 (prior to the COVID-19 national emergency declaration), trained researchers used the Nutrition Environment Measures Survey in Stores (NEMS-S) to assess the availability, affordability, and quality of healthy versus less healthy foods and beverages in 42 SNAP-authorized stores, including: grocery (n = 12, 29%), convenience (n = 17, 41%), drug (n = 1, 2%), dollar (n = 11, 26%), and butcher/meat (n = 1, 2%). Multivariate analysis of variance (a priori, p < 0.05) determined if differences in total NEMS-S scores or subscores existed by geography (urban versus rural), ownership (corporate/chain versus independent), or store type. No urban/rural differences were identified. Corporate/chain SNAP-authorized stores scored higher on average than independent SNAP-authorized stores for the total NEMS-S score (17.2 versus 8.1; p = 0.009) and availability subscore (13.1 versus 6.1; p = 0.02). SNAP-authorized grocery stores scored higher than all other store types (total NEMS-S score 27.6), followed by SNAP-authorized dollar stores (total NEMS-S score 10.7), and SNAP-authorized convenience stores (total NEMS-S score 5) (p < 0.001). Louisiana Cooperative Extension Services should explore ways to scale healthy food retail strategies statewide with a specific emphasis on independent and smaller SNAP-authorized retailers.

Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED).

The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED tool to observe and rate food outlets in 21 census tracts and 43 food stores across the city of Madrid, Spain. We evaluated inter-rater and intra-rater reliabilities, construct validity, and the tool’s ability to discriminate between store types and between stores by area-level Socio-Economic Status (SES). Overall, the mean NEMS-S-MED score was 20.7 (SD = 9.8), which ranged from 7 to 43. Most food items displayed substantial or almost perfect inter-rater and intra-rater agreements; the percentage agreement across availability items was almost perfect and kappa statistics were also very high (median κ = 1.00 for inter-rater; κ = 0.92 for intra-rater). Furthermore, the NEMS-S-MED tool was able to discriminate between store types and census tracts of different SES. The adapted NEMS-S-MED instrument is a reliable and valid audit tool to assess the consumer food environment in Mediterranean urban contexts. Well-constructed measurement tools, such as the NEMS-S-MED, may facilitate the development of effective policy interventions to increase healthy food access and affordability.

Availability and Pricing of Infant Snack Foods in Low-Income Communities Across Rhode Island

Abstract Objectives Marketing for infant snack foods has increased in the past 20 years, yet little is known about the availability and pricing of these foods. This study assessed the availability and pricing of infant snack foods in grocery stores in low-income communities across Rhode Island. Methods A random sample of grocery stores (N = 20) was selected from low-income census tracts. Twelve items were developed for this study to assess the availability and pricing of infant foods (e.g., infant formula, purees) and infant snack foods (e.g., puffs, melts). The Nutrition Environment Measures Survey in Stores (NEMS-S) was used to assess the nutrition environment including the availability, pricing, and quality of healthful foods compared to less healthful foods. Total NEMS-S scores range from -9 to 54 with higher scores indicating more healthful foods. Data were collected by trained research assistants during a 2-week period to limit confounding due to restocking and seasonality. This analysis included descriptive statistics to summarize the infant snack foods and the total nutrition environment. Results All 20 grocery stores in this sample sold infant foods and 18 stores sold infant snack foods. Availability of infant snack foods varied by store with puffs having the highest availability (n = 18) followed by melts (n = 15), teething cookies (n = 10), and baby yogurt (n = 7). Baby yogurt had the highest average price per serving ($0.72) followed by melts ($0.62), teething cookies ($0.50), and puffs ($0.49). Mean total NEMS-S score for all grocery stores was 27.5 (SD = 4.7). Conclusions Infant snack foods are available in grocery stores in low-income communities. Recent increases in marketing and availability of infant snack foods make it important to explore factors that influence caregivers to offer these snacks. Future studies should explore these factors and develop evidence-based recommendations for developmentally appropriate, healthful snacking during infancy. Funding Sources This work was supported by the USDA National Institute of Food and Agriculture, [Hatch/Tovar/1,001,894].

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Food environments are potential targets for interventions to reduce obesity prevalence, particularly in island settings that are typically dependent on food imports. This observational study aimed to characterise the availability, quality and price of foods and beverages in a nationally representative sample of grocery stores in Malta using the Nutrition Environment Measures Survey for Stores (NEMS-S) instrument, and to examine the association between area-level density of different types of food stores and the likelihood of children living in these areas being overweight or obese. Fieldwork was carried out between March and May 2014. There was a strong positive correlation between store size and NEMS-S score (p = <0.001), suggesting that smaller grocery stores generally offered a smaller range of products and fewer healthy food/beverage options than larger supermarkets. Across all stores, median prices of certain ‘healthier’ versions of foods were more expensive than their less healthy alternatives. A significant association between risk of childhood overweight, and density of confectionery stores in children’s locality of residence, was found (OR 1.19; 95% CI: 1.04, 1.37). These baseline findings highlight opportunities to improve the food environment in Malta to support more healthful eating, and may be of particular interest to public health practitioners in island settings.

The Flint Food Store Survey: combining spatial analysis with a modified Nutrition Environment Measures Survey in Stores (NEMS-S) to measure the community and consumer nutrition environments - ADDENDUM.

The Flint Food Store Survey: combining spatial analysis with a modified Nutrition Environment Measures Survey in Stores (NEMS-S) to measure the community and consumer nutrition environments – ADDENDUM - Volume 22 Issue 11

Availability of affordable healthy food in Hillsborough County, Florida

Prior research has indicated that low‐income neighborhoods in urban regions throughout the United States have limited access to healthy food, which partly explains the prevalence of diet‐related diseases. Our study provides new evidence on the relationship between access, prices of healthy food, and key demographic factors in Hillsborough County, Florida. The research team completed 65 surveys of grocery and convenience stores regarding availability and prices of 11 food items included in the Nutrition Environment Measures Survey in Stores (NEMS‐S). Results from the regression analysis indicate that affordable healthy food is more likely to be found in grocery stores than in convenience stores. There is no significant evidence, however, that low‐income neighborhoods have less access to healthy food than the not‐low‐income ones. We also observe significant price differences among types of stores but not in grocery‐to‐convenience store ratios among income groups, suggesting that low‐income families are not exposed to higher food prices.

The Flint Food Store Survey: combining spatial analysis with a modified Nutrition Environment Measures Survey in Stores (NEMS-S) to measure the community and consumer nutrition environments.

The goal of the present study was to use a methodology that accurately and reliably describes the availability, price and quality of healthy foods at both the store and community levels using the Nutrition Environment Measures Survey in Stores (NEMS-S), to propose a spatial methodology for integrating these store and community data into measures for defining objective food access. Two hundred and sixty-five retail food stores in and within 2 miles (3·2 km) of Flint, Michigan, USA, were mapped using ArcGIS mapping software. A survey based on the validated NEMS-S was conducted at each retail food store. Scores were assigned to each store based on a modified version of the NEMS-S scoring system and linked to the mapped locations of stores. Neighbourhood characteristics (race and socio-economic distress) were appended to each store. Finally, spatial and kernel density analyses were run on the mapped store scores to obtain healthy food density metrics. Regression analyses revealed that neighbourhoods with higher socio-economic distress had significantly lower dairy sub-scores compared with their lower-distress counterparts (β coefficient=-1·3; P=0·04). Additionally, supermarkets were present only in neighbourhoods with <60 % African-American population and low socio-economic distress. Two areas in Flint had an overall NEMS-S score of 0. By identifying areas with poor access to healthy foods via a validated metric, this research can be used help local government and organizations target interventions to high-need areas. Furthermore, the methodology used for the survey and the mapping exercise can be replicated in other cities to provide comparable results.

Assessment of the nutrition environment in rural counties in the Deep South.

The nutrition environment, including food store type, may influence dietary choices, which in turn can affect risk of obesity and related chronic diseases such as CHD, diabetes and cancer. The objective of the present study was to elucidate the extent to which healthy foods are available and affordable in various rural food outlets. A subset of the nutrition environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S). The NEMS-S instrument assessed the availability and price of healthy foods (e.g. low-fat/non-fat milk, lean meats and reduced-fat dinner entrées) compared with less healthy counterparts (e.g. whole milk, non-lean meats and regular dinner entrées). The NEMS-S also assessed the quality of fresh fruits and vegetables. Availability, prices and quality of healthy foods were compared between grocery stores (n 24) and convenience stores (n 67) in nine rural counties in Alabama. Mean availability subscale score (possible range 0 to 30; higher score indicates a greater number of healthier foods were available) for grocery stores was 22·6 (sd 8·1), compared with 6·6 (sd 5·2) in convenience stores (P < 0·0001); and mean price subscale score (possible range -9 to 18; higher score indicates that healthier options were less expensive than the less healthy options) for grocery stores was 2·4 (sd 2·7), compared with 0·7 (sd 1·2) in convenience stores (P = 0·0080). Mean total NEMS-S score (possible range -9 to 54) in grocery stores was 29·8 (sd 10·9) compared with 7·3 (sd 7·1) in convenience stores (P < 0·0001). Both grocery and convenience stores could be strategic points of intervention to improve the nutrition environment in the counties that were surveyed.

Food environments in Malta: Associations with store size and area-level deprivation

Food environments are potential targets for interventions to reduce obesity prevalence, particularly in island settings that are typically dependent on food imports. This observational study aimed to characterise the availability, quality and price of foods and beverages in a nationally representative sample of grocery stores in Malta using the Nutrition Environment Measures Survey for Stores (NEMS-S) instrument, and to examine the association between area-level density of different types of food stores and the likelihood of children living in these areas being overweight or obese. Fieldwork was carried out between March and May 2014. There was a strong positive correlation between store size and NEMS-S score (p=<0.001), suggesting that smaller grocery stores generally offered a smaller range of products and fewer healthy food/beverage options than larger supermarkets. Across all stores, median prices of certain ‘healthier’ versions of foods were more expensive than their less healthy alternatives. A significant association between risk of childhood overweight, and density of confectionery stores in children’s locality of residence, was found (OR 1.19; 95% CI: 1.04, 1.37). These baseline findings highlight opportunities to improve the food environment in Malta to support more healthful eating, and may be of particular interest to public health practitioners in island settings.

Adaptation and Validation of the Nutrition Environment Measures Survey in Stores (NEMS‐S) in Costa Rica

Overweight and obesity affect 21.4% of children, 20.8% of adolescents and close to 60% of adults in Costa Rica. The nutrition environment, which includes the social, political and environmental factors that influence the access to food, might play an important role in the development of obesity, as evidence suggests that local food stores are associated with unhealthy eating patterns.An array of instruments and measures have been developed and validated to assess food environment. The objective of this study is to adapt and validate the Nutrition Environment Measures Survey for Stores (NEMS‐S) in Costa Rica.The original NEMS‐S was translated to Spanish (and renamed IMANEA), and its food categories were adapted to the Costa Rican context. The instrument was pre‐tested in a selection of food stores different from our study sample, and changes were made in formatting and food categories. The resulting instrument was used to assess 29 food stores on three non‐consecutive days by two evaluators. The food store sample included supermarkets, “minisupers” (e.g. convenience stores), and “pulperías” (e.g. corner store). Specialized food stores such as pastries, farmer's markets, and butchery shops were excluded since they only offer a limited type of food.Food stores were assessed in La Union de Cartago for seven food categories. Inter‐rater and intra‐rater reliability were measured through intra‐class coefficient (ICC). Construct validity was determined using known‐groups method through Student's t‐test. All food categories had an ICC between 0.55 and 0.70, except the vegetables category (ICC=0.83), which suggests moderate to excellent reliability.The IMANEA represents the first adapted and validated instrument designed to measure nutrition environment in food stores in Costa Rica. It could be used as a tool in future obesity research, as well as an instrument to develop interventions that encourage healthy eating through the modification of the nutrition environment in food stores. Furthermore, IMANEA could complement research assessing food security and could be used as a reference in other developing countries of the region.

Urban Latino Families' Food Built Environment and Young Children's Produce Consumption.

This study explored the association between objective and subjective ratings of the food environment and child produce consumption for Latino preschoolers at-risk for obesity. Parental surveys (N = 115) assessed perceptions of food availability, affordability, and acceptability. Comparable factors were objectively rated by a trained observer, using the Nutrition Environment Measures Survey for Stores (NEMS-S), in commonly frequented grocery stores cited by participants. There were no significant correlations between objective and subjective measures of food availability, affordability, and acceptability. Greater household income was associated with higher participant perceptions of food acceptability (r = .33, p = .003) and affordability (r = .22, p = .04). Participant-perceived affordability of food was correlated with more frequent child fruit and vegetable consumption (r = .21, p = .03). These findings support that parental subjective ratings of the food environment affects their child's eating behaviors more than objective ratings.

Availability, Price, and Quality of Fruits and Vegetables in 12 Rural Montana Counties, 2014.

We assessed the consumer food environment in rural areas by using the Nutrition Environment Measures Survey for Stores (NEMS–S) to measure the availability, price, and quality of fruits and vegetables. We randomly selected 20 grocery stores (17 rural, 3 urban) in 12 Montana counties using the 2013 US Department of Agriculture’s rural–urban continuum codes. We found significant differences in NEMS–S scores for quality of fruits and vegetables; of 6 possible points, the mean quality score was 4.5; of rural stores, the least rural stores had the highest mean quality scores (6.0). Intervention strategies should aim to increase fruit and vegetable quality in rural areas.

Comparative Performance of NEMS‐S Surveys in Latino Corner Stores in the Greater Boston Area

BackgroundIn diverse areas, culturally‐sensitive tools may better assess the food environment associated with diet.ObjectiveTo determine the availability of healthy foods in Latino corner stores (bodegas) to elucidate its relationship with culture.Methods: Three bodegas were selected from low‐income urban areas in Somerville, MA by field enumeration. The reference Nutrition Environment Measures Survey for Stores (NEMS‐S) and a Guatemala NEMS‐S version were used to assess healthy food vs. regular food availability in bodegas. Both surveys were conducted in each bodega. Frequency and proportion of items were determined. Chi‐square tests assessed differences in availability by survey method across stores.Results: Bodegas have limited healthy foods as measured by the reference NEMS‐S. A greater availability of healthy foods in bodegas is indicated by the Guatemala NEMS‐S. All stores had 100% of the time, regular: milk, baked goods, soda, juice, chips, bread; diet soda; and 100% juice. Often, stores had skim milk, low‐sugar cereal, and wheat bread; but rarely, frozen dinners and low fat baked goods. Of the three vegetables added to the Guatemala NEMS‐S, at least one was available in two of the three stores; and of the six fruits added at least two were available in each store. No significant differences in availability by store were found.ConclusionsThe Guatemala NEMS‐S indicates a greater availability of healthy foods in bodegas than the reference NEMS‐S. Therefore, culture may impact food availability, as stores may cater towards specific ethnic populations. The existence of culturally‐specific stores needs consideration when creating healthy food policies.Funding: Tufts Undergraduate Research Fund

The Nutrition Environment Measurement Survey‐Stores in Guatemala: measurement performance between the standard (USA) and a modified version (1019.7)

Background: The nutrition environment measures survey for stores (NEMS‐S) is a way to assess the consumer nutrition environment, which affects individual dietary intake. While NEMS‐S has high validity in the United States, its validity has not been tested in Guatemala. The standard US NEMS‐S was tested, modified and re‐tested in urban Quetzaltenango, Guatemala.Objective: To compare the measurement performance between the standard NEMS‐S (USA) and the modified NEMS‐S (Guatemala), respectively.Methods: Seven trained raters tested the modified NEMS‐S in 3 supermarkets, and returned one week later at the same time. Inter‐rater and test‐retest reliability were assessed using percent agreement and Cohen’s kappa. Measurement validity was based on how well each item was found based on the modified NEMS‐S. The reliability and validity of the modified NEMS‐S were compared to the standard NEMS‐S.Results: Both the inter‐rater and test‐retest reliability were very high (Cohen’s kappa &gt;0.78) and similar to the standard NEMS‐S. The validity of many standard NEMS‐S items improved in the modified NEMS‐S, especially lean meat, milk, hot dogs, and diet soda.Conclusions: The modified NEMS‐S has a better measurement performance as compared to the standard NEMS‐S. Therefore, the modified NEMS‐S is a reliable and valid tool that can be used to measure the nutrient environment in Quetzaltenango, Guatemala.

Abstract 18025: Greater Consumer Nutrition Environment Disparities Are Associated With Lower Levels of Neighborhood Wellness

Introduction: Poor AHA Healthy Diet Scores are a major obstacle to the improvement of cardiovascular (CV) health in the U.S. population. Food accessibility and availability have been widely recognized to influence eating behaviors that lead to obesity and adversely influence CV health status. The purpose of this investigation is to examine associations between the consumer nutrition environment and level of community wellness in a Southwestern metropolitan area of the United States (U.S.). Methods: The Nutrition Environment Measures Survey in Stores (NEMS-S) was used to assess the availability, quality, and price of healthy food options in supermarkets located in Oklahoma County, Oklahoma. NEMS-S is a validated measure that assesses a variety of food products commonly purchased in the U.S., including low-fat milk, fruits, vegetables, lean meats, processed foods, whole grain breads, lower-calorie/-fat food options, and sugar-sweetened beverages. The Oklahoma County Wellness Score was calculated for all regional ZIP codes according to major health and socioeconomic indicators. NEMS-S scores were compared between ZIP codes with highest (n=11) and lowest (n=11) quartiles of Wellness Score. Results: High Wellness score ZIP codes exhibited significantly higher overall NEMS-S scores compared to those with low Wellness Scores (38.0 vs. 30.6, p=0.003). Although NEMS-S food quality and price scores were similar across ZIP code Wellness Scores, food availability score was significantly higher in high Wellness Score ZIP codes compared to ZIP codes with low Wellness Score (27.9 vs. 2.6, p&lt;0.001). ZIP codes with lower NEMS-S scores also had a higher percentage of households lacking access to a personal vehicle (6.1 vs. 16.0, p=0.001), higher proportion of minority population (50.9% vs. 20.7%, p=0.015), and lower median household income ($27,954 vs. $61,370, p&lt;0.0001) compared to high NEMS-S Score ZIP codes. Conclusions: Consumer nutrition environment disparities that limit access to healthy food options are negatively associated with regional indicators of health and socioeconomic status. Promoting healthy food availability in neighborhoods with low health status may be a successful strategy for improving the CV health of the U.S. population.