Supplemental Nutrition Assistance Program (SNAP)-Authorized Grocery, Convenience, Dollar, and Restaurant or Delivery Service Settings Are Associated With Increased Obesity Prevalence in Virginia

Purpose: United States Department of Agriculture Supplemental Nutrition Assistance Program (SNAP) participants use SNAP-authorized stores for dietary purchases. Relationships between obesity prevalence and access to grocery and varied nontraditional (eg, dollar, drug, and convenience) SNAP settings are underexplored. This research aimed to determine the association of a full range of SNAP-authorized stores with obesity prevalence in Virginia. Design: The SNAP Retailer Locator was used to cross-sectionally identify authorized stores, and county health ranking information was applied based on store location. Setting: Virginia, United States. Sample: The SNAP-authorized stores, classified among store categories: grocery or supermarket; drug; mass merchandiser; supercenter; convenience; dollar; club; other; nonfood store; farmers markets; and independent grocery stores. Measures: County-level obesity prevalence with income and rurality as potential confounders. Analysis: Multiple linear regression was used to determine associations between county-level adult obesity prevalence and available SNAP-authorized store formats ( P \u3c .05 a priori). Results: Store format was a predictor of obesity prevalence in Virginia in simple and adjusted models ( R 2 = 0.035, P \u3c .0001 and R 2 = 0.434, P \u3c .0001, respectively). Grocery store or supermarket access was associated with obesity. The SNAP-authorized convenience, dollar, and nonfood stores were associated with a 0.3, 0.5, and 1.3 increase in county obesity prevalence, respectively ( P \u3c .05). Conclusions: Research, practice, and health policy approaches to improve grocery, convenience, dollar, and restaurant or delivery service settings may favorably influence community obesity prevalence in Virginia