Consuming a nutritious diet is a pillar of good health. Yet, many studies have documented that access to retail food outlets that offer affordable, nutritious foods is lacking in some communities [1
]. In a literature review examining access to food outlets in developed countries, White concludes that the United States “is a more unequal society, where issues such as food retail access are genuinely worse for the poor and, in particular, African Americans”. Nationally, 11.5 million people now live in low-income areas that are more than one mile from a grocery store. Such areas with limited access and limited resources necessary to access healthy foods are termed “food deserts” [4
]. Living in a food desert may make it harder to consume a healthy diet. While findings on the associations between food access and health are mixed, studies have reported that lacking access to affordable, nutritious food is linked to negative health behaviors and outcomes, including decreased consumption of fruits and vegetables [5
] and high obesity rates [7
]. The affordability of healthy foods has also been linked to negative health behaviors and outcomes [10
Equitable access to affordable, healthy food options is thus important for improving and maintaining one’s diet and overall health. However, the most effective way to accomplish this is not inherently clear. While it may be beneficial to build grocery stores within these communities, it is not always possible for multiple reasons. Before locating in an area, grocers typically conduct a cost/benefit analysis that may suggest that economic and market factors do not support such a siting unless coupled with favorable policy or tax interventions. Bitler & Haider provide the following example: suppose the population residing in a food desert largely consists of low income families who, though they may desire nutritious food, are unable to afford it [12
]. In this example, the for-profit business model would suggest that the benefits of locating a store in these areas would be profitable only if food assistance benefits, such as the Supplemental Nutrition Assistance Program (SNAP), are expanded, and/or tax incentives or government subsidizing of higher operating costs are available.
Additional efforts have been made to increase healthy food access, including the use of farmer’s or mobile markets [13
], and in-store marketing of healthy items [14
]. Because it is the role of public health to ensure that all people have the opportunity to access healthy, fresh food, exploring options that may already exist within the community to provide such access could prove to be beneficial.
One phenomenon that may be useful is the practice of channel blurring. Channel blurring occurs when retailers from one channel sell products typically associated with other channels [15
]. For example, drug stores now sell various food products, toys and household goods, big box stores sell a large variety of products, including groceries, and some discount or dollar stores sell fresh produce [15
]. A growing number of these discount stores offer fresh produce and other healthy food options that would traditionally be found only in grocery stores. These non-traditional stores may serve to bridge the gap in providing access to healthy and affordable foods to communities who may otherwise lack access.
To determine if dollar discount stores are filling this gap, the current study used the Nutrition Environment Measures Survey in Stores (NEMS-S) [16
] to compare availability, quality, price differences in the ‘healthier’ versus ‘regular’ food choices, NEMS-S summary score, and price per each food item found at grocery stores to those found at dollar discount stores in the Las Vegas Metropolitan area.
The most interesting findings of this study are that the quality of produce items did not differ between the grocery and dollar discount stores, and that most items were less expensive at the dollar discount stores. These findings are important for public health, as our study indicates that channel blurring at the dollar discount stores results in access to healthy, quality produce and affordable food options. Because cost, quality, and accessibility are established barriers to healthy eating [11
], dollar discount stores can serve as community assets that increases access to quality, affordable food. Additionally, the dollar discount stores in our sample all accepted Supplemental Nutrition Assistance Program (SNAP) funds, further increasing the ability of those most needing to manage and stretch their food budgets. Public health researchers and practitioners should view these retailers as a community asset and work to collaborate on health promotion and outreach efforts.
Overall, grocery stores did have significantly higher availability and NEMS-S summary scores. This is to be expected because our definition for grocery stores limited our sample to chain stores, or those that were comparable in size, which are larger stores that have more shelf space than the dollar discount stores. This definition was purposeful, as larger stores are able to offer products at lower prices due to their buying power [26
], and we were seeking a comparable sample of grocery stores. Thus, our sample of grocery stores was exclusive to larger stores that offered a great variety of foods. In addition to being, on average, smaller store fronts, dollar discount stores are known for selling non-food products, such as party supplies and trinkets, which would compete for space that might otherwise be filled with food products. While the NEMS-S summary scores were higher in grocery stores, they appear to be a less useful indicator of a store’s ability to provide healthy foods at an affordable price; the sub-scales and added variable of sale price per each food item seem to be more informative.
Given that our grocery store definition limited us to larger stores for their lower prices, our finding that nearly all items were still less expensive or not significantly different at the dollar discount store is important. This definition precluded the inclusion of any smaller neighborhood markets that, while they are likely to be an asset to a community’s food environment, have higher prices [26
]. Including the smaller neighborhood markets would have driven the mean prices of food up, further highlighting the dollar discount stores as an affordable option.
Grocery stores were more likely to price the healthy food alternatives at lower prices. While this finding was not surprising given that the dollar discount store priced most food items uniformly at dollar discount, a lower sticker price on the healthy food at point of sale may have an effect on food choices, as previous research has shown that reducing the price of the desired healthy choice does influence sales [28
]. For example, French found that “price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively” [29
]. However, our findings indicated that the overall price of nearly all items at the dollar discount store were lower or did not differ from the grocery store, so it is difficult to speculate if consumer behaviors would result in the purchase of the non-healthy or healthy alternative given equal pricing at point of sale. Overall research findings support price modification as a tool to influence targeted food purchases [28
]. From a public health perspective, lower price points for healthy alternatives are likely to impact those who are often more vulnerable to chronic disease and chronic disease indicators, such as low income individuals and those with less education, as they are forced to be more price conscious than those with more expendable income [30
]. In addition to price modification, instore marketing of inexpensive foods with high nutritional value have also been shown to influence purchasing behaviors in some food categories [14
]. Instore marketing may be viewed by retailers as an easier, sustainable alternative to price modification.
It should be noted that the dollar discount stores did not always carry the same brand name products that are found in grocery stores. While the products themselves are likely to be equivalent nutritionally [32
], marketing research confirms that pricing and branding influence perceptions of both quality and intention to buy. Studies have shown that consumers recognize brand names and perceive them to be of higher quality [34
], even when they are not [32
]. Brand loyalty may also influence purchases and perceptions of products at the dollar discount versus grocery stores, as those who are loyal to a specific brand may be unwilling to deviate from their normal buying habits [34
Consumers also use price as an indicator of quality, thus, the lower price at the dollar discount store may result in perceptions of lower quality [35
]. Market factors such as these may result in dollar discount store consumers either purchasing fewer products or feeling as though they are receiving an inferior product. Overcoming these market factors is likely to prove difficult, as changing brand recognition and reputation requires large investments in advertising [40
]. Public health interventions in communities with low access to chain grocery stores may work to overcome this misperception by informing the community that the quality of produce did not differ at either location and that significantly lower prices at dollar discount stores can result in overall cost savings. This is particularly valuable information for vulnerable populations such as recipients of SNAP and those with limited incomes and/or food budgets.
The current study also has implications for public health practice. In addition to considering dollar discount stores and other non-traditional food outlets when assessing community food environments, public health researchers and practitioners should consider collaboration and partnership opportunities. For example, outreach programs such as the “Double Up Food Bucks” program that matches the value of SNAP funds when those funds are spent on fresh produce, might consider the dollar discount stores and other discount markets when looking for partners. Public health workers may also consider working with such stores to offer point-of-choice nutrition information, or manipulate the price differences between the non-healthy and healthy alternative foods to influence purchases of the desired healthy choices.
While dollar discount stores, pricing all items at a fixed $1 price, may be more common in the US, findings are still pertinent to other countries. For example, non-fixed price discount stores, as well as full service grocery stores that sell non-brand name food items are likely to offer equally healthy foods at a lower price. Hence, compared with branded products, non-branded alternatives are nutritionally equivalent options for a better price, and should therefore be preferred options to improve dietary quality when the budget for food is low.
This study assessed the food environment of a sample of grocery stores and dollar discount stores in the Las Vegas metropolitan area, and is not without limitations. While most of the stores we assessed are regional or national chains, our findings may not be generalizable to other locations. Although research supports a relationship between food price, quality, and availability, because we only assessed the food environment, we cannot be certain how this influences the relationship with health behaviors and outcomes. Our study was carried out in the summer, a season when fresh fruits and vegetables are more plentiful due to the growing seasons. It is unknown how the price, quality, and availability of produce and other food items would be affected in non-summer months.