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Background The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program in the United States. Participants receive electronic benefits that are redeemable at a variety of food stores. Previous research notes that low-income neighborhoods often lack supermarkets with high-quality, affordable food.

Objective The first aim of this study was to explore the number and spatial distribution of SNAP stores by type and to assess how SNAP benefit redemption is linked to store type in North Carolina in 2015. The second aim was to compare the demographics of populations living in areas with a high concentration of SNAP participants vs areas with a lower concentration of SNAP participants. The third aim was to test for disparities in the availability of and access to SNAP-authorized stores in areas with high vs low concentration of SNAP participants stratified by rural/urban status.

Design US Department of Agriculture and US Census data were used to explore the spatial distribution of SNAP stores at the census block group level utilizing a Geographic Information System.

Participants The 9,556 North Carolina SNAP stores in 2015 categorized into full-variety and limited-variety stores.

Outcome measures Proximity to limited-variety SNAP food stores and full-variety SNAP food stores within access range (1 mile in urban areas and 10 miles in rural areas).

Statistical analyses Wilcoxon rank sum and X-2 tests are used to compare the distance to and concentration of SNAP stores by rurality and SNAP participant concentration at census block group scale.

Results Among the SNAP stores in North Carolina, 83% are limited-variety stores and 17% are full-variety stores. There are disparities in the demographics of individuals living in census block groups with a high proportion of SNAP participants compared to census block groups with a lower proportion of SNAP participants. More households in higher SNAP participant census block groups were non-white, did not have a car, and had children compared to census block groups with lower SNAP participation. Residents in high SNAP participant census block groups typically had access to 0 full-variety stores and 4 limited-variety stores in urban areas and 3 full-variety stores and 17 limited variety stores in rural areas.

Conclusions SNAP participant access to a variety of stores should be considered when approving food stores for SNAP authorization. More research is essential to disentangle the relationship between access to SNAP store type and SNAP food choice and to estimate geographical disparities.