Healthier Options in Traditional and Nontraditional Rural Fast-food Stores?
Background: Food prepared away from home has become increasingly popular to U.S. families, and may contribute to obesity. Sales have been dominated by fast food outlets, where meals are purchased for dining away from home or in the home. Although national chain affiliated fast-food outlets are considered the main source for fast food, fast foods are increasingly available in convenience stores and supermarkets/grocery stores. In rural areas, these nontraditional fast-food outlets may provide most of the opportunities for procurement of fast foods.
Methods: Using all traditional and nontraditio nal fast-food outlets identified in six counties in rural Texas, the type and number of regular and healthiermenu options were surveyed using on-site observation in all food venues that were primarily fast food, supermarket/grocery store, and convenience store and compared with 2005 Dietary Guidelines.
Results: Traditional fast-food outlets represented 84 (41%) of the 205 opportunities for procurement of fast food; 109 (53.2%) were convenience stores and 12 (5.8%) supermarkets/grocery stores. Although a s imilar variety of regular breakfast and lunch/dinner entrées were available in traditional fast-food outlets and convenience stores, the variety of healthier breakfast and lunch/dinner entrées was significantly greater in fast food outlets. Compared with convenience stores, supermarkets/grocery stores provided a greater variety of regular and healthier entrées and lunch/dinner side dishes.
Conclusion: Convenience stores and supermarkets/grocery stores more than double the potential access to fast foods in this rural area than traditional fast-food outlets alone; however, traditional fast food outlets offer greater opportunity for healthier fast food options than convenience stores. A complete picture of fast food environment and the availability of healthier fast food options are essential to understand environmental influences on diet and health outcomes, and identify potential targets for intervention.

Between 1977 and 1996, a dramatic shift in food sources in the U.S. was observed that reflected a significant increase in calories consumed from away-from-home versus home-prepared food. Trends indicate that more Americans eat out, and today, almost 50% of the U.S. food dollar is spent at full-service and fast food restaurants. Meals purchased away from home are playing an increasingly important role in the amount and type of foods consumed. Household economics, opportunity costs, time constraints, and convenience appear to be major factors that influence greater reliance on food prepared outside the home .

Fast-food places have surpassed full-service restaurants as the largest source of away-from-home foods, which may explain why many researchers believe that consumption of fast-food items is a contributor to obesity. Current investigations point to the increased availability of energy-dense foods as a major contributor to energy imbalance and obesity. Fast food is considered to be low-cost (and almost resistant to inflation), energy-dense, low in several important nutrients, and high in calories, fat, and cholesterol. Increased consumption of fast food is associated with lower intake of fruits and vegetables, increased body weight, increased intake of carbonated beverages, and lower consumption of milk and
grains.

Some full-service and fast-food restaurants have recently added healthier options to menus as well as menu identification of healthier options; however, there have been few studies to examine such offeringsin fast food restaurants. Although identifying healthier options and providing nutrition information on the menu appears to be an emerging trend within the food industry, a great deal of variability exists between food outlets and available nutrition information.

While these studies provide nascent insight into the availability of healthier fast-food options in traditional, "big chain" fast-food restaurants in urban areas, little is known about availability in rural areas in the United States. Rural areas in the United States are increasing in population, especially in minority population. At the same time, there is a greater prevalence of obesity among adults and children, and limited access to supermarkets, which provide larger selections of healthy foods. Further, there is little understanding of the extent to which convenience stores, supermarkets, and mass merchandisers have added fast foods to their primary business as they seek new sales opportunities and increase the access of fast foods to consumers. This "channel blurring" has created nontraditional fast-food outlets, where fast food items are sold by retail stores in which the primary business is not fast food.

This study expands our understanding of the fast-food environment by: 1) identifying all opportunities for the procurement of fast-food entrées and side dishes in a six-county rural region of Texas using ground-truth methods; and 2) determining the extent to which a variety of regular and healthier fast-food options was associated with the type of primary business – traditional fast food outlet, convenience store, and supermarket/grocery.