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ObjectiveTo provide a richer understanding of food access and purchasing practices among US urban food desert residents and their association with diet and BMI.DesignData on food purchasing practices, dietary intake, height and weight from the primary food shopper in randomly selected households (n 1372) were collected. Audits of all neighbourhood food stores (n 24) and the most-frequented stores outside the neighbourhood (n 16) were conducted. Aspects of food access and purchasing practices and relationships among them were examined and tests of their associations with dietary quality and BMI were conducted.SettingTwo low-income, predominantly African-American neighbourhoods with limited access to healthy food in Pittsburgh, PA, USA.SubjectsHousehold food shoppers.ResultsOnly one neighbourhood outlet sold fresh produce; nearly all respondents did major food shopping outside the …