Fruit and vegetable intake among rural populations in the United States, by sociodemographic characteristics, behavioral risk factor surveillance system 2019, 2021

Abstract

Background: Rural populations in the US experience a higher prevalence of chronic diseases compared with urban populations. Consumption of healthy foods in rural areas can be limited by factors such as reduced access and availability. Limited intake of fruits and vegetables is a common risk factor for chronic disease, but differences in intake by sociodemographic characteristics among rural populations are inadequately characterized. Aim: We described the prevalence of consuming fruits and vegetables at least once per day by sociodemographic subgroups among US adults in rural counties. Methods: We conducted a pooled, cross-sectional study of 218,905 US adults aged ≥18 years in rural counties (non-metropolitan and non-core counties defined by the National Center for Health Statistics) using 2019 and 2021 Behavioral Risk Factor Surveillance System data. Sociodemographic factors included age, sex, race or ethnicity, education, employment, income, healthcare access, US Census division, and state. The two primary outcomes were self-reported consumption of fruits and of vegetables at least once per day. Weighted prevalence estimates were calculated using predictive margins derived from adjusted logistic regression models. Results: The prevalence of consuming fruits at least once per day was 57.6% (95% confidence interval (CI): [57.1-58.0]) and for vegetables was 80.0% (95% CI: [79.6-80.4]). For both fruits and vegetables, prevalence was generally higher among rural adults who were older; female; reported higher education, higher income, greater healthcare access; or resided in states in New England. Conclusion: Fruit and vegetable consumption is inadequate across the population with some groups more likely to have lower consumption, such as younger adults, men, and adults of lower socioeconomic status. Interventions that address both population-level contextual factors and individual-level barriers for those most at risk for lower consumption may increase fruit and vegetable consumption.

Keywords: Rural health; food access; fruits; sociodemographic factors; vegetables.

Figure 1.. Percent of Adults in US Rural Areas Reporting at Least Once Per Day Consumption of Fruits, by State, BRFSS 2019 and 2021

Areas in grey are those with no rural counties (Connecticut, Delaware, District of Columbia, New Jersey, Rhode Island). Estimates for Florida are based on survey data from 2019 as no data were available for the 2021 survey. Estimates are derived from Model 2, which adjusted for age, sex, race or ethnicity, and education.

Figure 2.. Percent of Adults in US Rural Areas Reporting at Least Once Per Day Consumption of Vegetables, by State, BRFSS 2019 and 2021

Areas in grey are those with no rural counties (Connecticut, Delaware, District of Columbia, New Jersey, Rhode Island). Estimates for Florida are based on survey data from 2019 as no data were available for the 2021 survey. Estimates are derived from Model 2, which adjusted for age, sex, race or ethnicity, and education.