Association between Retail Food Environment Composition and Poor Mental Health in the United States: A Cross-Sectional Analysis Restricted; Files Only

Abstract

Background: Poor mental health is a major public health concern in the United States. The

neighborhood environment is an important social determinant of health, and the retail food

environment may influence mental health through its effects on food access and health

behaviors. However, little research has examined the association between retail food

environment composition and mental health.

Methods: This cross-sectional ecological study examined the association between retail food

environment composition and poor mental health across 2,881 United States counties. Retail

food environment composition was defined as the ratio of dollar stores to grocery stores.

Counties were categorized into quintiles based on this ratio, with separate categories for counties

with no dollar stores and counties with no grocery stores. The outcome was the average number

of poor mental health days in the past 30 days. Multivariable linear regression was used to

estimate associations, adjusting for demographic and socioeconomic covariates. Rural–Urban

county classification was evaluated as a potential effect modifier.

Results: Higher dollar store-to-grocery store ratios were associated with more poor mental

health days, particularly in the two highest exposure quintiles (p < 0.05). Stratified analyses

showed generally similar patterns across rural–urban county classifications, with the strongest

associations observed in urban adjacent counties. Rural–urban classification was also

independently associated with the poor mental health days, with urban adjacent (p < 0.05) and

urban non-adjacent (p < 0.05) counties reporting fewer poor mental health days than metro

counties.

Discussion: These findings suggest that retail food environment composition is associated with

county-level mental health. The results support considering food retail environments in public

health research and community-level strategies aimed at improving mental health.

Table of Contents

Table of Contents

Introduction ………………………………………………………………………………1

Methods …………………………………………………………………………………. 5

Results …………………………………………………………………………………... 9

Discussion ……………………………………………………………………………… 19

References ……………………………………………………………………………… 25

Appendix ……………………………………………………………………………….. 29

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Mental Health Social Determinants of Health Retail Food Environment
Committee Chair / Thesis Advisor	Christine Ekenga, Emory University

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