Association Between the Retail Food Environment, Neighborhood Deprivation, and County-Level Dietary Outcomes Among Supplemental Nutrition Assistance Program–Education (SNAP-Ed) Recipients in Kentucky, 2010–2011

The term obesity paradox was coined to describe potential associations between Supplemental Nutrition Assistance Program (SNAP) participation, food insecurity, and obesity. The study aimed to examine associations between (1) the retail food environment and macronutrients and (2) neighborhood deprivation and macronutrients. During 2010–2011, 57 Kentucky counties participated in the Supplemental Nutrition Assistance Program for Education (SNAP-Ed; n = 1585 total individuals aggregated at the county level) through the University of Kentucky Cooperative Extension. Dietary data were used to create county-level aggregate mean intake on calories, fat, protein, and carbohydrates. The retail food environment was determined by collecting food venue data from InfoUSA 2011, local health departments, and the Kentucky Department of Agriculture. There was a higher mean aggregate consumption of calories (206.23; 95% confidence interval [CI]: 173.93, 418.25) and fat grams (6.50; 95% CI: 3.04, 10.81) among SNAP-Ed participants in counties with 3 or more gas stations with food marts compared to SNAP-Ed participants in counties with less than 3 gas stations with food marts. County-level availability of certain food venues was associated with county-level aggregate dietary intake among SNAP-Ed participants.