We employ multilevel models with neighborhood and state effects (fixed effects and random effects) to analyze the associations between household characteristics, neighborhood characteristics, regional attributes and dietary quality. We use data from the USDA National Household Food Acquisition and Purchase Survey. Our dependent variable is a Healthy Eating Index that incorporates dollars spent and amount of food in several categories. Key explanatory variables at the household level include variables household financial condition, housing burden, home ownership, car access, household size. We include a variable for the number of large food stores in the neighborhood, a neighborhood deprivation index, and a regional food price index, along with neighborhood and state random effects. Our model shows that at the household level, financial condition and home ownership are significantly and positively related to dietary quality, while U.S. citizenship status and living in a rural area were negatively associated with dietary quality. The number of large food stores in the neighborhood is significantly and positively associated with dietary quality. Neighborhood deprivation is not significantly associated with dietary quality, nor is the regional food price index. However, the neighborhood and state random effects variables were both significant, and the neighborhood variable explains close to half of the variation in household dietary quality. Our results highlight the complexity of understanding factors at different spatial scales that influence dietary quality. Food environments are important in shaping household food decisions, as are household finances. Future research should work on untangling additional neighborhood-level factors that matter for dietary quality.
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