Although the foodservices market recognizes several trends in foodservice, such as healthier menu options and blurring the channels by marketing products outside a company's primary product area[6
], little is known about the availability of healthier fast-food options beyond a few traditional national chain brandsin urban areas [4
]. This is the first study, to our knowledge, that describes the availability of healthier options for breakfast and lunch/dinner entrées and lunch/dinner side dishes in traditional and nontraditional fast-food opportunitiesin a large rural area. Three key findings warrant further examination: 1) in this study sample, more opportunities exist for the procurement of fast-food entrées and side dishes from convenience stores and supermarket/groceries than from the traditional fast-food outlet where the primary business is fast food; 2)supermarket/grocery stores had a greater variety of entrées and side dishes than traditional fast-food outlets or convenience stores; and 3) convenience stores offered significantly less variety of healthier breakfast and lunch/dinner entrées and lunch/dinner side dishes than did traditional fast food outlets.
Based on utilization of ground-truth methods (e.g., driving all major roads and conducting on-site surveys) to identify opportunities for procuring fast food [33
], almost 60% of the fast food opportunities in the six rural counties were provided by nontraditional fast food outlets where the primary business was as convenience stores or supermarkets/grocery stores. This is important, given that the preponderance of research on access to fast food focused on traditional fast food outlets, especially the national chains [44
]. As important as away-from-home foods are to dietary intake, restricting the measurement of fast foods to traditional fast food locations may overlook a substantial portion of the fast food available within a given food environment. The decision to purchase food away from home or prepare food at home is weighed by the consumer based on cost in time and money, which commodity is of greater value, and which method of food acquisition allows retention of the commodities[6
]. For the individual who makes food choices based on travel time and money, fast food typically offers a quick meal at an inexpensive price. Travel time as a commodity may be of even greater value in rural environments where the travel distance between all destinations (including grocery stores for the purchase of raw goods) may be great.
A number of factors might explain the larger number of nontraditional fast food outlets in the survey area, compared with traditional fast-food outlets. Convenience stores, which have built their business on fast service and longer hours of operation, understand the consumer's need for convenient shopping, especially one-stop shopping[51
]. With increased costs and competition from other retail channels, the addition of fast food helps convenience store operators attract and hold customers on a daily basis, thereby increasing revenues[43
]. Concomitantly, rural residents face added transportation costs; have better spatial access to convenience stores [33
]; and thus may demand more services in one location. Additionally, supermarkets and grocery stores face the encroachment of other retail channels, such as dollar stores, mass merchandisers, and drugstores[52
]. As a result, supermarkets and groceries seek to expand their offerings and provide the consumer with convenient, appealing foods and a reason to shop more frequently.
Interestingly, supermarket/grocery stores were consistently offered a greater variety of regular fast-food breakfast entrées, lunch/dinner entrées, or lunch/dinner side dishes than either fast food outlets or convenience stores. However, when controlling for other primary businesses and national chain affiliation, convenience stores more likely to offer a greater variety of regular lunch/dinner entrées and lower variety of healthier breakfast entrées, lunch/dinner entrées or side dishes than traditional fast-food outlets. To residents in these six rural counties, convenience stores provide best access (nearest location) to food items[33
]. The results of this study extend those findings to suggest best access to less variety of healthier fast-food entrées. Furthermore, in addition to traditional fast-food outlets, convenience stores should be targeted for expansion of healthier food offerings. While the findings of this study offer insight into the availability of healthier food options at all stores selling fast food within rural areas, further investigation would likely identify potential strategies for increasing healthier options within these stores.
There are several limitations that require mention. First, we were unable to assess exact nutritional information. Due to a lack of nutritional information on menus, it is difficult to assess whether a menu item identified as "low fat" or "light" would actually be considered a healthier option according to recommendations of the Dietary Guidelines[37
]. Second, the availability of healthier food items may have been underestimated where a menu did not identify a healthier option as being healthier (e.g., turkey breast or deli chicken breast). Third, we are unable to report test-retest or inter-rater reliability results. Fourth, data did not capture time of day for the assessment and the potentialunderestimation of breakfast offerings when data were collected later in the day and breakfast menus, signs, or food items were not visible. We expect this to be a factor more in a convenience store or supermarket/grocery store than in a fast food outlet. Future qualitative work will include interviews with owners/managers and observations of the stores during business hours to identify barriers and facilitators for making additional healthier options available within all types of fast-food opportunities and communicating this to the public. Finally, full-service restaurants are now increasing their marketing of take-out foods[53
]. Future work will include an assessment of healthier options in take-out foods from full-service restaurants.