Corner Store Intervention Research Articles

Using diffusion of innovations theory to examine a discontinued heathy corner store pilot program

ABSTRACT Limited research has been published on healthy corner store (HCS) interventions that have failed to be correctly implemented or sustained. We drew on Diffusion of Innovations theory to examine public health unit (PHU) staff members’ and corner store (CS) retailers’ experiences with a HCS program in Ottawa, Canada, that was implemented and then discontinued. Qualitative data analysis of interviews revealed intertwined challenges that we describe in two themes: 1) PHU staff members’ and CS retailers’ differing views and experiences with the HCS program and its implementation; and 2) challenges with the HCS program that were intertwined with the setting.

Novel Sales Tracking Method to Evaluate a Healthy Corner Store Intervention.

This article describes a Supplemental Nutrition Assistance Program-Education-funded (SNAP-Ed) healthy corner store intervention and novel evaluation method for tracking sales of promoted foods in two corner stores in North Carolina. The healthy corner store intervention was designed to encourage the purchase of healthy foods among SNAP participants. Stickers were placed on eligible foods to highlight healthy options as well as assist with tracking the sales of those products. Store staff removed the sticker and placed it on a tracking sheet that recorded the date, number of healthy foods purchased, whether the purchased item(s) contained a fruit or vegetable, and the type of payment. Storeowners were interested in participating and remained engaged throughout the program; however, there were challenges with fidelity to the intervention and its evaluation using the sticker method to track sales. Additional research on methods for evaluating healthy retail interventions that are simple, low cost, and feasible for retailers that do not have electronic sales data is needed.

Demographic differences in healthy food purchases in a corner store intervention

ABSTRACTThe aims of the current study were to examine the availability and customer purchases of five types of healthy foods promoted through a corner store intervention and to examine the association between healthy food purchases and age, gender, race/ethnicity, and receipt and use of WIC or SNAP benefits. Intercept surveys were conducted with 532 corner store customers. Most customers thought it was easy to find healthy food within the corner stores, but only 48% purchased at least one type of healthy food. Females, individuals who used WIC/SNAP benefits for their purchase, and Hispanics/Latinos had the highest probability of purchasing at least one type of healthy food. Implications for tailoring corner store interventions to different populations are discussed.

Exploring sales data during a healthy corner store intervention in Toronto: the Food Retail Environments Shaping Health (FRESH) project.

Population health interventions in the retail food environment, such as corner store interventions, aim to influence the kind of cues consumers receive so that they are more often directed toward healthier options. Research that addresses financial aspects of retail interventions, particularly using outcome measures such as store sales that are central to retail decision making, is limited. This study explored store sales over time and across product categories during a healthy corner store intervention in a lowincome neighbourhood in Toronto, Ontario. Sales data (from August 2014 to April 2015) were aggregated by product category and by day. We used Microsoft Excel pivot tables to summarize and visually present sales data. We conducted t-tests to examine differences in product category sales by "peak" versus "nonpeak" sales days. Overall store sales peaked on the days at the end of each month, aligned with the issuing of social assistance payments. Revenue spikes on peak sales days were driven predominantly by transit pass sales. On peak sales days, mean sales of nonnutritious snacks and cigarettes were marginally higher than on other days of the month. Finally, creative strategies to increase sales of fresh vegetables and fruits seemed to substantially increase revenue from these product categories. Store sales data is an important store-level metric of food environment intervention success. Furthermore, data-driven decision making by retailers can be important for tailoring interventions. Future interventions and research should consider partnerships and additional success metrics for retail food environment interventions in diverse Canadian contexts.

Examining the Need for a Healthy Corner Store Intervention

Examining the Need for a Healthy Corner Store Intervention

Community Residents’ Beliefs About Neighborhood Corner Stores in 2 Latino Communities: Implications for Interventions to Improve the Food Environment

ABSTRACTWe assessed community residents’ perceptions of corner stores to better understand what facilitates and deters patronage at these food outlets. Data came from 978 household interviews in 2 Latino communities undergoing corner store interventions. Chi-square tests, an independent sample t test, and a multivariate logistic regression were conducted to assess the relationship between residents’ perceptions about corner stores and their reported patronage at these food outlets. Residents reported that corner stores do not sell a variety of fruits and vegetables and are not places where one can get information about healthy eating. Convenience, cleanliness, positive customer service, availability of culturally appropriate items, and availability of quality fresh fruit increased the odds of store patronage. Simply providing healthy foods will not incentivize patrons to purchase them. Corner store interventions can be more effective if they address the characteristics that community residents prioritize.

A corner store intervention to improve access to fruits and vegetables in two Latino communities.

Investments have been made to alter the food environment of neighbourhoods that have a disproportionate number of unhealthy food venues. Corner store conversions are one strategy to increase access to fruits and vegetables (F&V). Although the literature shows modest success, the effectiveness of these interventions remains equivocal. The present paper reports on the evaluation of Proyecto MercadoFRESCO, a corner store conversion intervention in two Latino communities. A repeated cross-sectional design was employed. Data were stratified by intervention arm and bivariate tests assessed changes over time. Logistic and multiple regression models with intervention arm, time and the interaction of intervention and time were conducted. Supplementary analyses account for clustering of patrons within stores and staggering of store conversions. Three stores were converted and five stores served as comparisons in East Los Angeles and Boyle Heights, California, USA. Store patrons were interviewed before (n550) and after (n407) the intervention. Relative to patrons of comparison stores, patrons of intervention stores demonstrated more favourable perceptions of corner stores and increased purchasing of F&V during that store visit. Changes were not detected in store patronage, percentage of weekly dollars spent on food for F&V or daily consumption of F&V. Consistent with some extant food environment literature, findings demonstrate limited effects. Investments should be made in multilevel, comprehensive interventions that target a variety retail food outlets rather than focusing on corner stores exclusively. Complementary policies limiting the availability, affordability and marketing of energy-dense, nutrient-poor foods should also be pursued.

An introduction to the healthy corner store intervention model in Canada.

The majority of Canadians' food acquisition occurs in retail stores. Retail science has become increasingly sophisticated in demonstrating how consumer environments influence population-level diet quality and health status. The retail food environment literature is new but growing rapidly in Canada, and there is a relative paucity of evidence from intervention research implemented in Canada. The healthy corner store model is a comprehensive complex population health intervention in small retail stores, intended to transform an existing business model to a health-promoting one through intersectoral collaboration. Healthy corner store interventions typically involve conversions of existing stores with the participation of health, community, and business sector partners, addressing business fundamentals, merchandising, and consumer demand. This article introduces pioneering experiences with the healthy corner store intervention in Canada. First, we offer a brief overview of the state of evidence within and outside Canada. Second, we discuss three urban and one rural healthy corner store initiatives, led through partnerships among community food security organizations, public health units, academics, and business partners, in Manitoba, Ontario, and Newfoundland and Labrador. Third, we synthesize the promising practices from these local examples, including aspects of both intervention science (e.g., refinements in measuring the food environment) and community-based practice (e.g., dealing with unhealthy food items and economic impact for the retailer). This article will synthesize practical experiences with healthy corner stores in Canada. It offers a baseline assessment of promising aspects of this intervention for health and health equity, and identifies opportunities to strengthen both science and practice in this area of retail food environment work.

Fresh Fruit and Vegetable Profitability: Insights From a Corner Store Intervention in New Orleans, Louisiana

ABSTRACTFood store environments can influence consumers’ choices, but little is known about the financial feasibility of carrying healthier products. This case study evaluated the profits of a small store and the effect of infrastructure changes on produce availability and customer response. Invoice and inventory data were collected and customer intercept surveys (n = 323) measured exposure to promotions and awareness of a new cooler. Produce accounted for a greater percentage of store profits than energy-dense snacks, although the main sources of profit were tobacco, beer, and soft-drinks. The number of produce items on display 1 year after the intervention increased by 16%, whereas energy-dense snacks decreased. Customers exposed to at least one promotion were more likely (χ2 = 12.4, p < 0.001) to notice the cooler than those who were not. These results could encourage store owners to stock and promote healthier items.

Perspectives of Urban Corner Store Owners and Managers on Community Health Problems and Solutions.

IntroductionUrban corner store interventions have been implemented to improve access to and promote purchase of healthy foods. However, the perspectives of store owners and managers, who deliver and shape these interventions in collaboration with nonprofit, government, and academic partners, have been largely overlooked. We sought to explore the views of store owners and managers on the role of their stores in the community and their beliefs about health problems and solutions in the community.MethodsDuring 2013 and 2014, we conducted semistructured, in-depth interviews in Philadelphia, Pennsylvania, and Camden, New Jersey, with 23 corner store owners/managers who participated in the Healthy Corner Store Initiative spearheaded by The Food Trust, a nonprofit organization focused on food access in low-income communities. We oversampled high-performing store owners.ResultsStore owners/managers reported that their stores served multiple roles, including providing a convenient source of goods, acting as a community hub, supporting community members, working with neighborhood schools, and improving health. Owners/managers described many challenging aspects of running a small store, including obtaining high-quality produce at a good price and in small quantities. Store owners/managers believed that obesity, diabetes, high cholesterol, and poor diet are major problems in their communities. Some owners/managers engaged with customers to discuss healthy behaviors.ConclusionOur findings suggest that store owners and managers are crucial partners for healthy eating interventions. Corner store owners/managers interact with community members daily, are aware of community health issues, and are community providers of access to food. Corner store initiatives can be used to implement innovative programs to further develop the untapped potential of store owners/managers.

Substantial improvements not seen in health behaviors following corner store conversions in two Latino food swamps.

BackgroundThe effectiveness of food retail interventions is largely undetermined, yet substantial investments have been made to improve access to healthy foods in food deserts and swamps via grocery and corner store interventions. This study evaluated the effects of corner store conversions in East Los Angeles and Boyle Heights, California on perceived accessibility of healthy foods, perceptions of corner stores, store patronage, food purchasing, and eating behaviors.MethodsHousehold data (n = 1686) were collected at baseline and 12- to 24-months post-intervention among residents surrounding eight stores, three of which implemented a multi-faceted intervention and five of which were comparisons. Bivariate analyses and logistic and linear regressions were employed to assess differences in time, treatment, and the interaction between time and treatment to determine the effectiveness of this intervention.ResultsImprovements were found in perceived healthy food accessibility and perceptions of corner stores. No changes were found, however, in store patronage, purchasing, or consumption of fruits and vegetables.ConclusionsResults suggest limited effectiveness of food retail interventions on improving health behaviors. Future research should focus on other strategies to reduce community-level obesity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3074-1) contains supplementary material, which is available to authorized users.

Abstract 03: Choice Architecture Increases WIC Fruit and Vegetable Purchases in a Latino Community: Randomized, Controlled Corner Store Intervention

Background: In 2009, the Special Supplemental Nutrition program for Women, Infants, and Children (WIC) increased access to healthy foods by providing cash-value vouchers for fruit/vegetables, but improving access alone is not sufficient to reduce disparities in food choices and obesity among low-income families. We hypothesized that making fresh produce more visible and of better quality in corner stores would increase their WIC fruit/vegetable sales. Methods: We conducted a randomized, controlled trial of 6 WIC-certified corner stores in a low-income, Latino community. Three stores were assigned to “choice architecture” intervention that increased visibility and quality of fresh fruit/vegetables. Primary outcome was WIC fruit/vegetable voucher (FVV) sales, comparing changes in sales trends from baseline (Dec. 2012-Oct. 2013) to follow-up (Dec. 2013-Apr. 2014) for intervention vs. control stores. Secondary outcomes, from customer exit surveys at all 6 stores (N=575), were changes between baseline and follow-up in self-reported fresh fruit/vegetable purchases by customers on WIC or Supplemental Nutrition Assistance Program (SNAP). Results: WIC FVV sales decreased in both intervention and control stores during baseline but increased in the 3 intervention stores after implementing choice architecture (Figure). In exit surveys, 23% of all corner store customers reported using WIC, and 37% used SNAP. Compared to baseline, intervention store customers on SNAP increased purchase of fruit/vegetables at follow-up more than SNAP customers at control stores (6% vs. -15%, p=0.007). For WIC customers, there was a similar but not statistically significant difference between intervention and control (18% vs. -2%, p=0.11). Conclusion: A simple choice architecture intervention increased purchases of fruit/vegetables by corner store customers using WIC. Policies that incentivize WIC-certified stores to stock and prominently display good quality fresh produce could improve healthy choices of low-income families.

Access to and Use of Health Care Services Among Latinos in East Los Angeles and Boyle Heights.

This study examined differences in access, utilization, and barriers to health care by nativity, language spoken at home, and insurance status in East Los Angeles and Boyle Heights, California. Data from household interviews of neighborhood residents conducted as part of a corner store intervention project were used. Binary and multinomial logistic regression models were fitted. Results showed that uninsured and foreign-born individuals were differentially affected by lack of access to and utilization of health care. While the Affordable Care Act may ameliorate some disparities, the impact will be limited because of the exclusion of key groups, like the undocumented, from benefits.

Mobilizing Young People in Community Efforts to Improve the Food Environment: Corner Store Conversions in East Los Angeles.

From the Schools and Programs of Public Health MOBILIZING YOUNG PEOPLE IN COMMUNITY EFFORTS TO IMPROVE THE FOOD ENVIRONMENT: CORNER STORE CONVERSIONS IN EAST LOS ANGELES Mienah Z. Sharif, MPH Jeremiah R. Garza, MA, MPH Brent A. Langellier, MA, PhD Alice A. Kuo, MD, PhD Deborah C. Glik, ScD Michael L. Prelip, DPA Alexander N. Ortega, PhD Latino young people are significantly more likely to be obese than their non-Latino white peers. 1–3 Higher obesity rates place Latino young people—one of the largest, fastest-growing ethnic groups in the United States—at a heightened risk for developing a range of chronic diseases, including obesity, cardiovascu- lar disease (CVD), and type 2 diabetes. 4–8 Moreover, Latinos are far from meeting the recommended daily intake of fruit and vegetables, 9–12 which is a critical public health concern considering that maintaining a healthful diet, including fruit and vegetables, is a key strategy for preventing chronic disease. 13–21 The food environment influences dietary behavior. However, social and economic factors lead to stark variations in the composition and quality of food among communities that help explain disparities in dietary practices and health outcomes. 22–28 Specifically, low-income communities of color have less access to fresh, affordable fruit and vegetables than more afflu- ent communities. 25,26,29–31 Furthermore, low-income, racial/ethnic minority families often find it easier to purchase energy-dense foods (characterized as high in fat, calories, and sugar) than healthier options, such as fresh fruit and vegetables. 25,29,32–34 One such example is East Los Angeles (East LA), an urban, predominantly Mexican-American community that has limited access to affordable, healthful food, but an abundance of fast-food restaurants and other sources of unhealthful food. 35,36 The food environment is one factor that helps explain why East LA residents experience higher rates of heart disease, diabetes, hypertension, and stroke than residents of more affluent LA neighborhoods. 37 Converting corner stores to improve access to affordable, healthful foods is one potential strategy to improve the food environment. 28,34,38–44 There is no one definition, or approach, for conducting corner store conversions. However, common strategies include improving the store’s facade and installing refrigera- tion units to store the newly available fresh produce. 44 The University of California, Los Angeles (UCLA) Center for Population Health and Health Disparities (CPHHD) implemented a community-engaged corner store conversion project called Proyecto Mercado- FRESCO (Fresh Market Project) in East LA and the neighboring community of Boyle Heights. This inter- vention converted four locally owned corner stores with the goal of increasing access to healthful food and reducing CVD risk. The CPHHD approach emphasized collaboration among community residents and orga- nizations, public health agencies, local public schools, and store owners. 44–47 The process included moving less healthful food items (i.e., chips, soda, and candy) to the back of the store, installing a fresh produce section at the front, improving the interior and exterior store facade, replacing alcohol and tobacco advertisements with healthful food messages, and providing business skills training to store owners. A major supplement to the conversion was a youth- driven campaign of community nutrition education and social marketing to promote the converted stores and increase the purchase of fruit and vegetables. 45–47 An elective course was implemented at two public high schools, one in East LA and one in Boyle Heights, to build the capacity of local students to lead the com- munity social marketing campaign. Students received classroom and field training in nutrition, food justice, media production, and social marketing. The campaign consisted of the following activities: performances at schools, community centers, and parks; short videos on buses; the design and dissemination of posters at bus shelters and marketing materials in neighborhoods surrounding converted stores; and cooking demonstra- tions at the stores (Photos 1 and 2). In addition to lead- ing the social marketing campaign, young people were actively involved in the stores’ physical transformation. The importance of youth perspectives in imple- menting policy advocacy, social marketing, and health projects has been well established in tobacco and substance use prevention. 48–54 While some reports document the engagement of low-income, minority young people in advocating for improvements in their access to healthful food, few reports focus on corner store interventions, and none use qualitative Public Health Reports / July–August 2015 / Volume 130

Process Evaluation to Monitor and Guide a Multi‐Level, Multi‐Component Obesity Prevention Program for Low‐Income, African American Youth

Multilevel, multicomponent (MLMC) interventions are needed to address the complex, multifactorial obesity epidemic. Such interventions work in several settings simultaneously, including schools, food stores, restaurants and households. However, limited work has been done to use MLMC program implementation data to guide program delivery. In July 2014, implementation of B'More Healthy Communities for Kids MLMC trial began. It's goal is to reduce obesity among low income African American youth (10‐14 years) by partnering with policymakers, wholesalers, small food stores, carryouts, recreation centers, and families through environmental change, education, structural incentives, and social media. Detailed process evaluation is conducted by regularly assessing 88 implementation standards for reach, dose delivered and fidelity. Every two months, the latest process data is reviewed to improve the program. For example, during the first review, reach to children during corner store intervention delivery periods did not meet the standard of 10 interactions/session (mean: 6.7, range: 0‐20). The # of new items stocked per food store was low. In a second review, reach to children during store interactive sessions increased (mean: 8.7). Additionally, recreation center session reach decreased from 15.7 to 7.6 interactions/session. These findings led to rescheduling intervention delivery times to when more youth were present, and increasing the duration of sessions. Detailed process evaluations using defined standards are essential for continuous improvement of MLMC intervention trials.

Corner Stores: The Perspective of Urban Youth

ObjectiveWe examined the perspectives of low-income, urban youth about the corner store experience to inform the development of corner store interventions. DesignFocus groups were conducted to understand youth perceptions regarding their early shopping experiences, the process of store selection, reasons for shopping in a corner store, parental guidance about corner stores, and what their ideal, or “dream corner store” would look like. Thematic analysis was employed to identify themes using ATLAS.ti (version 6.1, 2010, ATLAS.ti GmbH) and Excel (version 2010, Microsoft Corp). SettingFocus groups were conducted in nine kindergarten-through-grade 8 (K-8) public schools in low-income neighborhoods with 40 fourth- to sixth-graders with a mean age of 10.9±0.8 years. ResultsYouth report going to corner stores with family members at an early age. By second and third grades, a growing number of youth reported shopping unaccompanied by an older sibling or adult. Youth reported that the products sold in stores were the key reason they choose a specific store. A small number of youth said their parents offered guidance on their corner store purchases. When youth were asked what their dream corner store would look like, they mentioned wanting a combination of healthy and less-healthy foods. ConclusionThese data suggest that, among low-income, urban youth, corner store shopping starts at a very young age and that product, price, and location are key factors that affect corner store selection. The data also suggest that few parents offer guidance about corner store purchases, and youth are receptive to having healthier items in corner stores. Corner store intervention efforts should target young children and their parents/caregivers and aim to increase the availability of affordable, healthier products.

Examination of the Strategy, Instruments, and Measurements Used to Evaluate a Healthy Corner Store Intervention

As more interest is paid by researchers and community groups to food insecure communities and the associated health impacts for residents, interventions have been conducted to improve healthy food accessibility. Not much literature can be found, however, evaluating the healthy corner store programs implemented to improve the food environment and change consumer behavior. This case study attempts to fill that gap with an examination and discussion of the strategies developed by a community collaborative to evaluate a healthy corner store project for a coupled individual and environmentally based intervention. We address limitations of the evaluation approach and recommendations for improving community-based assessment.

A randomized controlled study of a healthy corner store initiative on the purchases of urban, low-income youth.

ObjectiveAlthough many initiatives exist to improve the availability of healthy foods in corner stores, few randomized trials have assessed their effects. This study evaluated, in a randomized, controlled trial, the effects of a first-generation healthy corner store intervention on students’ food and beverage purchases over a two-year period.Design and MethodsParticipants (n=767) were 4th-6th grade students. Ten schools and their nearby corner stores (n=24) were randomly assigned to the healthy corner store intervention or an assessment-only control. Intercept surveys directly assessed the nutritional characteristics of students’ corner store purchases at baseline, 1 and 2 years. Students’ weight and heights were measured at baseline, 1 and 2 years.ResultsThere were no differences in energy content per intercept purchased from control or intervention schools at year 1 (p=0.12) or 2 (p=0.58). There were no differences between control and intervention students in BMI-z score (year 1, p=0.83; year 2, p=0. 98) or obesity prevalence (year 1, p=0.96; year 2, p=0.58).ConclusionsA healthy corner store initiative did not result in significant changes in the energy content of corner store purchases or in continuous or categorical measures of obesity. These data will help to inform future interventions.

Proyecto MercadoFRESCO: a multi-level, community-engaged corner store intervention in East Los Angeles and Boyle Heights.

Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents' access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.

Changes in food and beverage environments after an urban corner store intervention

ObjectiveIn response to the obesity epidemic, interventions to improve the food environment in corner stores have gained attention. This study evaluated the availability, quality, and price of foods in Philadelphia corner stores before and after a healthy corner store intervention with two levels of intervention intensity (“basic” and “conversion”). MethodsObservational measures of the food environment were completed in 2011 and again in 2012 in corner stores participating in the intervention, using the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS). Main analyses included the 211 stores evaluated at both time-points. A time-by-treatment interaction analysis was used to evaluate the changes in NEMS-CS scores by intervention level over time. ResultsAvailability of fresh fruit increased significantly in conversion stores over time. Specifically, there were significant increases in the availability of apples, oranges, grapes, and broccoli in conversion stores over time. Conversion stores showed a trend toward a significantly larger increase in the availability score compared to basic stores over time. ConclusionInterventions aimed at increasing healthy food availability are associated with improvements in the availability of low-fat milk, fruits, and some vegetables, especially when infrastructure changes, such as refrigeration and shelving enhancements, are offered.