OBJECTIVES : Meals prepared away from the home have been associated with worse diet quality and higher food expenditures. We examined these relationships accounting for county-level cost per meal, as the price of food affects consumer behavior and has not been previously studied.

METHODS : Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) of participants living in urban areas, 2015 Map the Meal Gap county-level food price, and 2017 U.S. Department of Agriculture (USDA) Food Atlas were compiled for analysis. We used multilevel, random effects ordered logistic and linear regression modeling to study associations between the frequency of consumption of meals prepared away from the home, diet quality and food expenditures, controlling for the county-level cost per meal, county-level density of food establishments, and county- and individual-level sociodemographic characteristics.

RESULTS : 38.7% of our study sample consumed meals prepared away from the home frequently (5-21 meals/week), 24.6% sometimes (2-4 meals/week), and 26.7% never/rarely (0-1 meals/week). Greater frequency of consuming meals prepared away from the home was associated with worse diet measures (frequent consumers ate 174.8 more calories per day and 343.0 more grams of sodium per day relative to never/rarely consumers, both p<0.05) and higher total food expenditures (frequent consumers spent $168.55 more per month relative to the never/rarely consumers) when controlling for cost per meal and other county-level factors. The highest tertile of county-level cost per meal was associated with a 3% decrease in food expenditures allocated to meals prepared away from the home, relative to counties with the lowest tertile cost per meal (β=-0.03; p<0.05).

CONCLUSIONS : Higher cost per meal reduced the amount of spending on meals prepared away from the home. An excise tax to increase the price of unhealthy meals prepared away from the home may decrease the consumption of meals prepared away from the home.