Most studies examining the association of the food environment and health outcomes have focused on urban settings. However, rural adults and children have high rates of obesity, which may be related to their food environments. This study examines the food environment in 7 rural counties in Maryland. A cross-sectional study was conducted at 244 retail food stores from 2012 to 2013. Data on store-level characteristics were collected and a healthy food availability index (HFAI) ranging from 0 to 31 points was calculated for each store. Convenience stores (18.9%) and other nontraditional stores (16.8%) were the most common store types, and box stores were the least (4.9%). Supermarkets had the highest mean HFAI (24.8), whereas gas stations (8.7) had the lowest; convenience stores were also low (11.1). In rural Maryland, the most common food source types have low healthy food availability, and nontraditional food sources are an important part of the food environment.
Keywords: Food environment; food access; obesity; rural health.