County-level food-related implicit associations, socioeconomic factors, food environment, and health outcomes.

BACKGROUND: Obesity and diabetes are partly driven by obesogenic environments, which promote poor diet. Among individuals, health-favoring implicit associations (i.e., automatically activated beliefs) toward food are associated with healthier eating behaviors. Aggregated implicit associations may reflect features within local environments. However, it remains unclear whether such associations reflect systemically obesogenic environments. OBJECTIVE: We examined county aggregates of American adults' implicit and explicit associations toward healthy (vs. unhealthy) food and their role in the relationship between food and socioeconomic environments and health outcomes across the United States. METHOD: We aggregated individual implicit associations toward palatability (n = 10,838; 76% female) and acceptability (n = 11,944; 82% female) of healthy (vs. unhealthy) food from Project Implicit Health within counties in the United States (palatable food: 1,316 counties; acceptable food: 1,339 counties). Additionally, we captured county-level environmental factors (fast-food restaurant density, median household income) and health outcomes (obesity, diabetes). RESULTS: Stronger health-disfavoring implicit palatability associations were linked with lower median income (β = .05, 95% confidence interval [.01, .10]), higher fast-food restaurant density (β = -.09, [-.16, -.02]), higher obesity prevalence (β = -.07, [-.13, -.02]), and higher diabetes prevalence (β = -.05, [-.10, -.01]). These implicit associations mediated the relationship between environmental factors (median income and fast-food restaurant density) and health outcomes (obesity and diabetes prevalence). No relationships were observed with acceptability beliefs. CONCLUSIONS: Implicit food-related hedonic associations may be one pathway for how socioeconomic and food environments are linked with health. This approach could inform interventions to reduce geographic health disparities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).