**Background:** Individuals with excessive body weight face elevated risks of cardiovascular disease, type 2 diabetes, metabolic syndrome, certain cancers, and discrimination. Diets high in fruits and vegetables are protective against obesity, while unhealthful diets with sugar-sweetened beverages (SSBs) and added sugars are positively associated with obesity. African American families purchase more high-sugar foods and SSBs than white households, and African Americans suffer from higher obesity rates. The 'neighborhood context'—including limited availability of fresh fruits and vegetables—has been proposed as a key factor explaining these disparities. The Healthy People 2030 framework recognizes neighborhood and built environment as important social determinants of health. This study investigated racial/ethnic inequities in dietary behaviors, diet quality, and obesity rates among white, Latina, African American, and Asian American, Native Hawaiian, or Pacific Islander (AANHPI) mothers from CalFresh Healthy Living-eligible (SNAP-Ed) households in California.
**Methods:** Data came from telephone interviews conducted in 2018 and 2019 with female adult caregivers of children 5–17 years from CalFresh Healthy Living-eligible households across California. Households were randomly selected from the California Department of Health Services Medi-Cal Eligibility Data System (MEDS) database from all 58 California counties. Trained interviewers conducted 24-hour dietary recall interviews using the National Cancer Institute's web-based Automated Self-administered 24-Hour (ASA24) Dietary Assessment Tool. Five ASA24-derived dietary outcomes were examined: cups of fruits and vegetables, ounces of SSBs, teaspoons of added sugars, kilocalories, and Healthy Eating Index (HEI)-2015 scores (range 0–100). Weight and height were self-reported; BMI was calculated and obesity defined as BMI ≥30. Perceived food access was assessed by agreement (5-point scale) with statements about ease of buying fresh fruits and vegetables and healthy foods in one's neighborhood. General linear models (ANOVA) with Fisher's least significant difference tests compared mean dietary outcomes across groups. Linear regression examined BMI; logistic regression examined obesity and limited perceived access. All models adjusted for age and education. The analytic sample included 9,200 mothers after excluding 66 with other race/ethnicity and 314 with missing racial/ethnic data; dietary analyses excluded 354 reporting implausible daily kilocalorie intake (≤400 or ≥4,400).
**Key Results:** The sample was 66.3% Latina, 17.3% white, 12.6% African American, and 3.8% AANHPI; mean age 38.3 years; 29.2% had less than high school education. Significant differences across groups were observed for all dietary outcomes (p<0.001 for all F statistics). African American mothers consumed the fewest cups of fruits and vegetables (2.68 cups; 95% CI: 2.54–2.82) compared to whites (2.87), Latinas (3.13), and AANHPIs (3.25). African Americans consumed the most SSBs (9.1 ounces; 95% CI: 8.4–9.9) and added sugars (13.7 teaspoons; 95% CI: 13.4–14.8), and had the highest daily kilocalorie intake (1,896; 95% CI: 1,852–1,940). HEI-2015 scores were lowest for African Americans (53.8; 95% CI: 53.0–54.7) and whites (54.1; 95% CI: 53.4–54.8), compared to Latinas (58.6; 95% CI: 58.2–59.0) and AANHPIs (56.6; 95% CI: 55.1–58.0). The overall unadjusted obesity rate was 45.7%. African American mothers had the highest obesity rate (54.7%), followed by Latinas (46.9%), whites (39.9%), and AANHPIs (23.5%). Adjusted odds of obesity for African Americans compared to whites was 1.82 (95% CI: 1.56–2.12); for Latinas, 1.25 (95% CI: 1.11–1.41); for AANHPIs, 0.46 (95% CI: 0.36–0.61). African American mothers were significantly more likely to report limited perceived access to fresh fruits and vegetables (aOR=1.87; 95% CI: 1.48–2.35) and healthy foods in general (aOR=2.10; 95% CI: 1.60–2.76). Regardless of race/ethnicity, mothers reporting limited perceived availability of fruits and vegetables (aOR=1.28; 95% CI: 1.11–1.47) or healthy foods (aOR=1.40; 95% CI: 1.18–1.66) were more likely to be obese.
**Clinical Implications:** This study demonstrates that among low-income California mothers, African American women bear a disproportionate burden of poor dietary quality, high obesity rates, and limited perceived access to healthful foods. The findings support the hypothesis that the group with the poorest diet and highest obesity also reports the most restricted food access. However, the authors caution that simply increasing availability of healthful food outlets is insufficient, citing studies where new grocery stores in low-income neighborhoods did not improve dietary intake or BMI. The authors argue that systemic racism—encompassing structural control by whites, disproportionate resource distribution, and social psychological advantages—underlies socioeconomic disparities that drive these health inequities. Broader interventions addressing socioeconomic barriers (e.g., living wages) and systemic racism are needed beyond traditional public health nutrition approaches. Study strengths include population-based sampling and validated 24-hour dietary recall. Limitations include self-reported behaviors and anthropometrics, potential recall bias, absence of data on other environmental factors (e.g., fast food availability), and inability to use geographic location data due to data use agreements.