Who in the US has the poorest diet scores?
Among 155,331 CPS-3 adults, poor ACS diet quality was independently higher in Black (+16%) and rural (+61%) participants and in food deserts (+17%), while Hispanic (−16%) and Asian/NHPI (−33%) groups had lower risk.
Source
Association of Socioeconomic and Geographic Factors With Diet Quality in US Adults
Study at a glance
- Design
- Cross-sectional — Cancer Prevention Study-3 adults; ACS 2020 diet score poorest quartile vs race/ethnicity, education, income, rurality, and USDA food-desert status
- N
- N=155331 · 155,331 adults (123,115 women, 79.3%); mean age 52 years; enrolled 2006–2013, FFQ 2015–2017
- Population
- US adults in CPS-3 from 35 states, D.C., and Puerto Rico with a validated food-frequency questionnaire
- Outcome
- Poor diet quality (lowest quartile of ACS 2020 recommendation concordance) and component foods
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Who in the US has the poorest diet scores?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
N=155,331 adults; 123,115 women (79.3%).
Among 155 331 adults, 123 115 were women (79.3%)
Rural residence: 61% higher risk of poor diet quality.
rural residence was associated with a 61% (95% CI, 48%-75%) higher risk of poor diet quality
What they did
Linked CPS-3 demographics and geocoded rurality/food-desert status to a 2015–2017 FFQ scored against 2020 ACS cancer-prevention diet recommendations (vegetables, fruit, whole grains, red/processed meat, ultraprocessed foods, sugary drinks).
What they found
All key exposures associated with poor diet. Black vs White +16% risk; Hispanic −16%; Asian/NHPI −33%. Rural +61%; food desert +17%. Income and education effects differed by race/ethnicity (interaction p=0.01 and <0.001).
The limits
What it doesn't show
Cross-sectional FFQ cannot prove that moving out of a food desert improves diet; CPS-3 is volunteer-heavy and 88.9% White, so absolute US disparities are underestimated.
Key terms
- CPS-3
- American Cancer Society Cancer Prevention Study-3 cohort.
- ACS diet score
- Concordance with 2020 American Cancer Society cancer-prevention diet advice.
- Food desert
- USDA Food Access Research Atlas low-access area used as a geographic exposure.
- RUCA
- Rural-Urban Commuting Area codes classifying urbanization.
- FFQ
- Validated food-frequency questionnaire (2015–2017).
- Poor diet quality
- Lowest quartile of the sex-specific ACS concordance score.
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Study design was:
Common questions
How large was the sample?
155,331 adults, 79.3% women.
Rural vs urban poor-diet risk?
+61% (48–75%) for rural residence.
Food-desert association?
+17% (12–22%) poor diet quality.
Black vs White?
+16% (8–25%) risk of poor diet quality.
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