Income, Healthy Food Availability, and Consumption Mediate Rural-Urban Health Disparities.

Background: Examine the role of income, perceived healthy foods availability, and consumption as mediators of rural-urban health disparities.

Method: Pre-registered simple mediation models with post hoc multi-mediator models were tested using national- and state-level survey data. Oregon data was collected in an online Qualtrics survey between October 8 and November 9, 2021 using CloudResearch; Health Information National Trends Survey (HINTS) 5, a nationally representative dataset, was collected over 4 cycles from 2017 to 2020. Oregon residents (n = 771; rural = 313, urban = 458) self-reported online: income, perceived fruits and vegetable (FV) availability, FV consumption, and BMI measures (height, weight). HINTS respondents (rural n = 1235; urban n = 13,912) self-reported the same variables of interest without FV availability, and with an additional self-rated health variable detailed below.  RESULTS: The effect of rurality on BMI (b = 0.012, SE = 0.005, p = 0.01) and self-rated health (b = 0.003, SE = 0.001, p = 0.008) when combining datasets was mediated by a series of income, perceived FV availability, and FV consumption.

Conclusion: To address rural-urban health disparities, individual (cognition, behavior), social (household income), and community (healthy food availability) factors should be targeted together.