Changes in Neighborhood Foodscapes From 2003 to 2023 by Area Rurality in the United States.

Abstract

<b>Objectives.</b> To evaluate the change in the US foodscape from 2003 to 2023 overall and by area rurality, considering various modes of transportation. <b>Methods.</b> We conducted this study using longitudinal data on all licensed food retailers, geocoded to census-tract level, and examined changes in the foodscape by estimating the percentages of tracts defined as food deserts (no grocery stores) and food swamps (mostly restaurants or fast-food locations). <b>Results.</b> We found a considerable increase in the percentage of food swamps and no substantial progress in reducing food deserts. For example, using distance-based foodscape measure (one half of a mile from tract borders), between 2003 and 2023, the percentage of tracts categorized as food swamps increased from 80.2% to 88.5%, while the percentage of food deserts decreased minimally from 6.1% to 5.5%. Across all years, the percentage of food deserts was substantially higher in rural areas, and when people used public transit as a mode of transportation. <b>Conclusions.</b> The findings underscore the need for improving accessibility to healthy foods across the United States, particularly in rural areas. <b>Public Health Implications.</b> Expanding public-private partnerships to establish healthy food retailers in food deserts may improve the foodscape quality. (<i>Am J Public Health</i>. 2026;116(7):1004-1014. https://doi.org/10.2105/AJPH.2026.308495).