Section D

Baltimore Healthy Stores

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  To increase availability and access to healthy foods for residents of Baltimore City

  To promote these foods at the point of purchase

  To work in collaboration with community agencies, the city of Baltimore, and local food sources

Baltimore Healthy Stores Goals

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Healthy Foods Availability in Baltimore City*

Type of food stores

Healthy food availability index, mean (range 0–27)

Skim milk (%)

Fruit (%)

1–25 ≥26

Vegetables (%)

1–25 ≥26

Whole wheat bread

(%)

Supermarkets (16) 19.0 100 25 69

13 81

100

Grocery/corner stores (107)

4.4 25 43 3

57 3

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“Behind-the- glass” stores (20)

2.0 0 0 0

0 0

0

Convenience stores (33)

3.8 36 33 0

21 0

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*Franco data, n = 176

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A Corner Store

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Store Interior

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Baltimore Healthy Stores, Round 1

  East Baltimore: intervention area

  West Baltimore: comparison area

  Store sample -  Two supermarkets per area -  Six to seven small stores per

area

  Consumer sample

-  Eighty-seven respondents per area

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Energy Fat Sugar

Food item Energy (%) Food item Fat

(%) Food item Sugar (%)

Sodas 9.5 Chicken 12.1 Sodas 34.1

Chicken 8.2 Hot dogs, sausages 8.1 Sugary drinks (iced tea, punch) 15.2

Breads 6.0 Chips 6.3 Juices 9.0

Cake, donut and other pastry 4.2 Meat dishes 5.2 Sugar and syrup 8.3

Sandwiches and burgers 4.0 Margarine and butter 5.2 Cake, pastry and donut 4.2

Sugary drinks 3.8 Cake, donut and other pastry 5.1 Candies 4.1

Chips 3.7 Mayo, salad dressing, dips 4.9 Ice cream 3.2

Pasta dishes 3.3 Sandwiches and burgers 4.5 Cookies 2.5

Meat dishes 3.1 Cheese 4.3 Fruits 2.1

Candies 2.9 Eggs 4.0 Cereals 1.6

Total 48.7 Total 59.8 Total 84.3

Top Sources of Energy, Fat, and Sugar (Baltimore City)

  Top ten sources of energy, fat, and sugar of inner city adult respondents in Baltimore (Sharma et al.)

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Phase 0: Teasers/Recruitment

Phase 1: Healthy Eating for your Kids

Phase 2: Cooking at Home

Phase 3: Healthy Snacks

Phase 4: Carryout Foods

Phase 5: Low-Calorie Drinks

Baltimore Healthy Stores Phases

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Intervention Activities

  Stop, Shop, Save Phase 2: Healthy Breakfast

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Phase 0: Documents for Store Owners

  Cultural guidelines for Korean store owners

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Educational display

Flyer

Coupon

Phase 1: Low-Calorie Beverages

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Phase 2: Healthy Breakfast

Educational display

Flyer

13

Phase 3: Cooking at Home

Posters

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Phase 4: Healthy Carryout

Educational display Flyer

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Posters

Phase 5: Healthy Snacks

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BHS Evaluation Plan

Instrument Pre- Mid- Post- Follow- up

Process evaluation

 Store process evaluation

 Store owner process evaluation

 Cooking demo, taste test evaluation

 Cooking demo, taste test customer evaluation

 Weekly interventionist progress report

x

x

x

x

x

Store impact and feasibility

  Store impact questionnaire

  Bi-weekly food sales (corner)

  In-depth interviews

x

x x

x

x

x

x

x

Customer impact and feasibility

  Customer impact questionnaire

  Food frequency questionnaire

  Customer feasibility interviews

x

x

x

x

x

x

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Average stocking feasibility scores (Score range 0–10)

Average sales feasibility score (Score range 0–10)

Intervention Comparison Significance Intervention Comparison Significance

Baseline 5.9 ± 2.0 6.8 ± 1.6 NS 4.4 ± 1.8 5 ± 1.5 NS

Post-phase 8.3 ± 1.0 6 ± 1.8 0.004 7.1 ± 2.0 5.8 ± 1.8 0.05

Post- intervention

7 ± 2.0 5.5 ± 1.5 0.009 6.4 ± 1.8 4.7 ± 1.5 0.003

Store Results

  Average stocking/sales feasibility scores at baseline, post-phase, and post-intervention

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Consumer Results

  After adjustment for baseline value, age, sex, and SES -  Significant impact on food preparation methods and frequency

of purchase of promoted foods -  Trend of impact on food intentions

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Eight Total Programs

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Healthy Stores Studies Summary

Program

Intervention components Impact observed

Basic store

activities

Other store

activities Media Other venues

Consumer psychosocial

factors

Consumer behavior

Store

Marshall Islands Healthy Stores

X X Knowledge Healthy food purchasing

N/A

Apache Healthy Stores 1,2

X X X

(Commodity, vendors rd 2)

Knowledge Healthy food

purchasing and consumption

Increased stocking and

sales

Zhiiwaapenewin Akino’maagewin

X X X

(Schools, HSS)

Knowledge (assoc. w/exposure)

Healthy food purchasing

N/A

Baltimore Healthy Stores 1,2

X X X (CAC, churches)

Intentions

Healthy cooking

methods, purchasing

labeled foods

Increased stocking and

sales

Healthy Foods Hawaii

X X X (Producers, distributors)

? ? ?

Healthy Foods North (Arctic)

X X X (Worksites, HSS)

? ? ?

Navajo Healthy Stores

X X X ? ? ?

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Future Directions

  Baltimore Healthy Stores -  Baltimore Healthy Eating Zones (youth) -  Baltimore Healthy Church Zones (adult churchgoers)

  Zhiiwaapenewin Akino’maagewin -  Proposed expanded trial under review by USDA/NRI

  Navajo Healthy Stores -  Producer formative research -  Farms to Table program

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Acknowledgments

  Collaborators -  Jean Anliker, U Mass -  Benjamin Caballero, JHSPH -  Sally Davis, UNM -  Elsie DeRoose, GNWT -  Kevin Frick, JHSPH -  Rachel Novotny, U Hawaii -  Cindy Roache, GN -  Sangita Sharma, PhD -  Allan Steckler, UNC

  Community partners -  Bashas supermarkets -  Red Mesa Stores -  Diabetes Prevention Programs -  Kids on the Hill -  Government of Nunavut, NWT -  Tribal Governments -  Special Diabetes Programs

  Students and staff -  Chrisa Arcan -  Mirielle Begay

  Former and ongoing students/staff -  Xia Cao -  Sarah Curran -  Justine Dang -  Nadine Eads -  Becky Ethelbah -  Jill Faucette -  Attia Goheer -  Lara Ho -  Sharla Jennings -  David Lessens -  Jessica Noel -  Ogban Omoronia -  Stephanie Oppenheimer -  Marla Pardilla -  Wendy Pavlovich -  Irit Rasooly -  Hannah Reddick -  Amanda Rosecrans -  Hee-Jung Song -  Melanie Thurber -  Muge Qi -  Amy Vastine

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Funders

  Center for a Livable Future

  USDA/Food Assistance Nutrition Research Program

  USDA/National Research Institute

  Robert Wood Johnson Foundation Healthy Eating Research program

  American Diabetes Association

  Stulman Foundation

  Isador and Gladys Foundation

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