Full-service Grocery Stores Research Articles

Early impact of a new food store intervention on health-related outcomes

This study investigated the early impact of a community-based food intervention, the Good Food Junction (GFJ), a full-service grocery store (September 2012 – January 2016) in a former food desert in Saskatoon, Canada. The hypothesis tested was that frequent shopping at the GFJ improved food security and selected health-related outcomes among shoppers, and the impact was moderated by socioeconomic factors. Longitudinal data were collected from 156 GFJ shoppers, on three occasions: 12-, 18-, and 24-months post-opening. Participants were grouped into three categories based on the frequency of shopping at the GFJ: low, moderate, and high. A generalized estimating equations approach was used for model building; moderating effects were tested. Participants were predominantly female, Indigenous, low-income, and had high school or some post-secondary education. The GFJ use was associated with household food security (OR for high and moderate frequency shoppers reporting less than a high school education were 1.81 and 1.06, respectively), and mental health (OR for high and moderate frequency shoppers reporting high income were 2.82 and 0.87, respectively) exhibiting a dose-response relationship, and indicated that these outcomes were significantly moderated by participants’ socioeconomic factors. Shopping at the GFJ had a positive effect on food security and mental health, but to varying levels for those with low incomes, with less than high school or high school or better levels of education.

Food access in Kalamazoo, Michigan: A spatial analysis

Healthy and affordable food is a universal human need. In the U.S., food access is often limited in low-income areas as opposed to medium- and high-income areas. To address disparities in the availability of healthy foods, the dispersion of food access points needs to be quantified and docu­mented. Nutritional quality and consistency of availability vary across different types of food access points, including permanent grocery stores, farmers markets, community gardens, food pan­tries, and convenience stores. Accessibility is also determined by the means of transportation avail­able or required to get to food access points (public transit, driving, or walking). In this geographic information systems (GIS)-based analysis, we iden­tify differences in accessibility to distinct types of food access points—reliable, seasonal, and lower quality—between low-income and higher-income tracts in the City of Kalamazoo, Michigan. We found that all full-service grocery stores are acces­sible via bus routes in the City of Kalamazoo; however, 11% of people reside in low-income areas with low access to these grocery stores—beyond the 0.25-mile walkable distance to bus routes. We then asked whether the addition of community gardens, food pantries, and farmers markets, on the “plus” side, or convenience and dollar stores, on the “minus” side, changes the food access landscape in this community. We found that the “positive” access points served areas that already had access to grocers, while “negative” access points filled the access gap in lower income areas. More than twice as many low-income residents had walkable access to convenience stores—which provide lower-quality and highly processed food—with 81% of them being located within low-income tracts. Geographical analysis of low food access and low-quality food access is important to identify structural patterns, but it needs to be paired with interview-based community assessments to ascertain how residents actually procure their food.

Changes in Policy Supports for Healthy Food Retailers, Farmers Markets, and Breastfeeding Among US Municipalities, 2014-2021: National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (CBS-HEAL).

Policies and practices at the local level can help reduce chronic disease risk by providing environments that facilitate healthy decision-making about diet. We used data from the 2014 and 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living to examine prevalence among US municipalities of policies to support access to healthier food in supermarkets, convenience stores, and farmers markets, as well as policies to support breastfeeding among government employees. Chi-square tests were conducted to compare prevalence estimates from 2021 to 2014 overall and according to municipal characteristics. In 2021, 29% of municipalities had at least 1 policy to encourage full-service grocery stores to open stores, which was not significantly different from 31% in 2014. Prevalence of having at least 1 policy to help corner stores sell healthier foods declined significantly from 13% in 2014 to 9% in 2021. Prevalence of policies providing all local government employees who were breastfeeding breaktime and space to pump breast milk increased significantly from 25% in 2014 to 52% in 2021. The percentage of municipalities that provided 8 or more weeks of paid maternity leave for employees increased significantly from 16% in 2014 to 19% in 2021. Prevalence of supports for supermarkets, convenience stores, and farmers markets generally did not increase among US municipalities from 2014 to 2021, while some supports for breastfeeding among municipal employees increased during this time. Opportunities exist to improve municipal-level policies that support healthy eating and breastfeeding among community residents and employees.

Community Solutions to Increase the Healthfulness of Grocery Stores: Perspectives of Immigrant Parents.

Grocery store environments are recognized as one of the most crucial community settings for developing and maintaining healthy nutritional behaviors in children. This is especially true for disadvantaged ethnic minority families, such as immigrants, who reside in the Detroit Metropolitan area and have historically experienced inequities that result in poor health outcomes. Rates of obesity and type II diabetes have affected Detroit 38% more than the rest of the state and nationwide. In 2019, almost 54% of children aged 0-17 in Metro Detroit lived in poverty, and 21.6% experienced food insecurity, compared with the state level of 14.2%. Moreover, nearly 50% of ethnic minority children in Metro Detroit consume sports drinks, and 70% consume soda or pop in an average week. The primary purpose of this study was to explore immigrant parents' perspectives on (1) how in-store Sugar-Sweetened Beverage (SSB) marketing impacts the purchasing behaviors of parents and the eating behaviors of toddlers, and the secondary objective was to (2) determine strategies to reduce SSB purchases and consumption within grocery environments from the viewpoints of immigrant parents. A qualitative multiple-case study design was used to achieve the aims of this study. Semi-structured individual interviews were completed with 18 immigrant parents of children aged 2 to 5 years old who were consumers in 30 independently owned full-service grocery stores within the immigrant enclaves of Detroit, Dearborn, Hamtramck, and Warren, Michigan. Three key thematic categories emerged from the parents' narratives. These themes were: (1) non-supportive grocery store environments; (2) acculturation to the American food environment; and (3) strategies to support reduced SSB consumption among young immigrant children. The findings of this study revealed widespread SSB marketing targeting toddlers within the participating independently owned grocery stores. Even if families with young children practiced healthy nutritional behaviors, the prices, placements, and promotion of SSBs were challenges to establishing and sustaining these healthy eating habits. The parents believed that planning and implementing retail-based strategies in collaboration with families and considering families' actual demands would assist in managing children's eating patterns and reducing early childhood obesity.

Food Insecurity Is Common in the Orthopedic Trauma Population: A Multicenter Cross-Sectional Study

ObjectivesMalnutrition increases the risk for adverse outcomes after musculoskeletal trauma. Food insecurity is an increasingly recognized risk factor for malnutrition. The purpose of this investigation is to evaluate the prevalence and risk factors for food insecurity in a diverse population treated for operative fracture fixation. MethodsA two-center study (Midwest and Pacific Northwest) enrolled participants of any age within 6 months of operative fixation of pelvis or extremity fractures. Food insecurity was assessed using the USDA Household Food Insecurity questionnaire. A score ≥3 indicated food insecurity, 1 or 2 indicated marginal food security, and 0 indicated high food security. Subgroup analysis was performed for participants with available demographic, income, and food access data. Differences between food insecure and food secure participants in continuous and categorical variables were evaluated using the Wilcoxon sum rank test and Fisher’s exact test, respectively. Spearman’s correlation was used to describe associations between food security scores and participant characteristics. Logistic regression was used to relate patient demographics and odds of food insecurity. ResultsOf the 476 participants enrolled, 53 (11%) were food insecure, 48 (10%) had marginal food security, and 375 (79%) were food secure. Those with food insecurity were more commonly female (p < 0.0001). Participants with a household income ≤$15,000 were 5.7 times more likely to be food insecure (95% CI 1.8–18.1). Widowed/single/divorced participants were 10.2 times more likely to experience food insecurity than married/partnered participants (95% CI 2.3–45.6). Median time to the nearest full-service grocery store was significantly longer for food insecure (t = 10 minutes) than for food secure participants (t = 7 minutes, p = 0.0202). Time to store demonstrated a weak correlation with food security score (r = 0.23, p = 0.0041). Age (r = –0.08, p = 0.327) and hours working (r = –0.10, p = 0.429) demonstrated no correlation with food security score. ConclusionsFood insecurity is common in the musculoskeletal trauma population. Those with lower household incomes and living alone are more likely to experience food insecurity. Food insecurity is a potentially modifiable risk factor for malnutrition-related complications after operative fracture fixation. Funding SourcesNone.

MP26-14 ASSOCIATIONS OF FOOD ACCESS AND NEIGHBORHOOD WALKABILITY WITH URINARY RISK FACTORS FOR KIDNEY STONE DISEASE

You have accessJournal of UrologyCME1 May 2022MP26-14 ASSOCIATIONS OF FOOD ACCESS AND NEIGHBORHOOD WALKABILITY WITH URINARY RISK FACTORS FOR KIDNEY STONE DISEASE Joseph Crivelli, David Redden, Naim Maalouf, Kyle Wood, Dean Assimos, and Gabriela Oates Joseph CrivelliJoseph Crivelli More articles by this author , David ReddenDavid Redden More articles by this author , Naim MaaloufNaim Maalouf More articles by this author , Kyle WoodKyle Wood More articles by this author , Dean AssimosDean Assimos More articles by this author , and Gabriela OatesGabriela Oates More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002569.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Differences in nutrition and lifestyle can explain some differences in 24-hour urine measurements among kidney stone formers. Socioeconomic aspects of these factors underlying stone formation require further investigation. We evaluated associations of neighborhood indices of food access and walkability with 24-hour urine measurements among patients with kidney stone disease (KSD). METHODS: We performed a retrospective analysis of adult patients with KSD evaluated with 24-hour urine collection (2001-2020). Based on the Food Access Research Atlas, low-income neighborhoods >0.5 miles (urban areas) or >10 miles (rural areas) from a full-service grocery store met the definition of low food access. Using the National Walkability Index (NWI), we identified neighborhoods with low walkability (NWI ≤5.75). We then assessed associations of these measures of food access and walkability with groupings of 24-hour urine abnormalities (stone risk factors and dietary factors, as defined by a commercial vendor; see Table) through multivariable logistic regression, as well as individual 24-hour urine measurements through analysis of covariance (ANCOVA) with adjustment for multiple testing. RESULTS: Among 1,119 patients with KSD and at least one adequate 24-hour urine collection based on urinary creatinine, 173 (15.5%) were from neighborhoods with low food access and 516 (46.1%) were from neighborhoods with low walkability. Using multivariable logistic regression (Table), patients from neighborhoods with low food access had higher odds of multiple (>1) stone risk factors (odds ratio: 1.78, 95% confidence interval: 1.03 to 3.09), but not multiple dietary factors. Patients from neighborhoods with low walkability did not have increased odds of multiple stone risk factors or dietary factors. Using ANCOVA, neighborhoods with low food access and or low walkability were not associated with significant differences in individual 24-hour urine measurements. CONCLUSIONS: Among patients with KSD, residence in a neighborhood with low food access was associated with multiple stone risk factors on 24-hour urine testing, though there were no significant differences in individual urinary measurements. The contribution of other sociodemographic factors to 24-hour urine abnormalities should be evaluated. Source of Funding: NIH 5P20DK119788 (DA) and 5K08DK115833 (KW) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e445 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Crivelli More articles by this author David Redden More articles by this author Naim Maalouf More articles by this author Kyle Wood More articles by this author Dean Assimos More articles by this author Gabriela Oates More articles by this author Expand All Advertisement PDF DownloadLoading ...

Increasing Healthy Food Access for Low-Income Communities: Protocol of the Healthy Community Stores Case Study Project.

Improving healthy food access in low-income communities continues to be a public health challenge. One strategy for improving healthy food access has been to introduce community food stores, with the mission of increasing healthy food access; however, no study has explored the experiences of different initiatives and models in opening and sustaining healthy food stores. This study used a case study approach to understand the experiences of healthy food stores in low-income communities. The purpose of this paper is to describe the methodology used and protocol followed. A case study approach was used to describe seven healthy food stores across urban settings in the U.S. Each site individually coded their cases, and meetings were held to discuss emerging and cross-cutting themes. A cross-case analysis approach was used to produce a series of papers detailing the results of each theme. Most case studies were on for-profit, full-service grocery stores, with store sizes ranging from 900 to 65,000 square feet. Healthy Food Availability scores across sites ranged from 11.6 (low) to 26.5 (high). The papers resulting from this study will detail the key findings of the case studies and will focus on the challenges, strategies, and experiences of retail food stores attempting to improve healthy food access for disadvantaged communities. The work presented in this special issue will help to advance research in the area of community food stores, and the recommendations can be used by aspiring, new, and current community food store owners.

Life-Space Constriction in Aging Adults

Community-dwelling aging adults desire to maintain independence and prevent or delay a sequela of declining function and ultimate frailty. Early indicators of potential declines in function and frailty, such as life-space constriction (LSC), are important to identifying early. The purpose of this study was to examine factors associated with LSC and the influence of these factors and LSC on function and frailty. A cross-sectional study using a convenience sample of community dwelling persons 55 and older living in the South was conducted. Results indicated most participants (N = 72) were female (69%; n = 50) and half were White (53.5%; n = 38). LSC explained 34% variance in function (F = 3.805 (8, 59); p = .001) when environmental supports (social network), challenges (driving time it took the participant to get to the nearest full-service grocery store) and individual factors were controlled for. There was a significant difference between Black and White participants with environmental challenges (p = .001) and function (p = .001). Individual factors included challenges (age-related physiological changes, disease burden, and mental health limitations) and buoy (assistive devices), these explained 22% variance in self-reported frailty (F= 3.099 (6, 65); p = .01). Number of assistive devices was the only significant predictor of self-reported frailty.

Measuring the Impact of a Full Service Grocery Store in a Food Desert

Food deserts, areas in which it is difficult to obtain affordable, nutritious food, are especially problematic in low-income neighbourhoods. One model for addressing food hardship and unemployment issues within low-income food deserts is a cooperative grocery store. Through the cooperative model, the grocery store can serve as a cornerstone to address socio-economic marginalisation of low-income neighbourhoods and improve the health and well-being of its residents. It is important for communities and policymakers to be able to assess the effectiveness of these types of endeavours beyond traditional economic factors such as profitability. This article uses a systems engineering approach to develop a framework for measuring the holistic impact of a cooperative grocery store on community health and well-being. This framework encompasses values that characterise the relationship between food retail, economic viability and social equality. We develop a dashboard to display the key metrics for measuring the economic, social and environmental indicators that reflect a grocery store’s social impact. We demonstrate the usefulness of the framework through a case study of a full-service cooperative grocery store that is planned within the city of Dayton, OH.

SPATIAL DIFFERENCES IN FRESH VEGETABLE SPENDING: A CASE STUDY IN GUILFORD COUNTY, NORTH CAROLINA

Abstract. This paper investigates the spatial differences in fresh vegetable spending in Guilford County, North Carolina. We create a geo-coded spatial-temporal database for both human factors and natural factors to understand why food deserts have become a serious issue in a county with many farming activities. We find that residents living in food deserts do not buy enough fresh vegetables compared with their counterparts, even when they are shopping at full-service grocery stores. Social-economic factors are most sensitive and are important determinants of fresh food demand. Using an agent-based toy model, we find that fresh vegetable demand in each census tract in Guilford County varies to a large extent. The results suggest that the formation of food deserts may root from the demand side.

P110 Understanding the Impact of the Opening of a Supermarket on a College Campus on College Students: A Qualitative Study

Many college campus areas are food deserts, with limited access to healthy foods. In the Fall of 2018, the University of North Carolina Greensboro (UNCG) opened a mix-used development area that includes a full-service grocery store. Little research has focused on the impact of supermarket openings as part of a mixed-used environment. Our team conducted an evaluation of this natural experiment, which included a qualitative study, aiming to understand the impact of this environmental change. Understand the impact of the opening of a supermarket on food shopping experiences and dietary behaviors of college students using focus groups. Six focus groups were conducted with students by a moderator, using open-ended questions and probes. Participants were recruited from the quasi-experimental intervention arm of this study and were at least 18 years old, English-speaking, and a UNCG student living in Spartan Village. Focus groups were audio-recorded, transcribed verbatim, and thematically analyzed. Overall experiences with, and facilitators and barriers to food shopping and healthy eating at the new supermarket. Overall, students suggested that the mixed-use residence positively influenced dietary intake. Convenience, small store footprint, ability to use university FLEX card, visible produce, and friendly service were perceived as facilitators of healthy eating and shopping. Prices, food acceptability, small-item sizes, limited variety, insufficient stocking, and lack of cooking equipment/tools were identified barriers. Prices decreased staple food purchases, but also deterred snack food item purchases. Nutrition and food preparation education, along with access to cooking equipment were identified as potential supports. Development of mixed-used college residential areas, that includes a full-service grocery store, may present an opportunity to increase access to healthier foods. Consideration of student needs plays a key role in the use of facilities as promoters of dietary intake.

Increasing Access to WIC through Discount Variety Stores: Findings from Qualitative Research

BackgroundMany low-income neighborhoods do not include a full-service grocery store. In these communities, discount variety stores (DVS) can be convenient points of food access. However, no identified DVS are authorized to accept Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC) benefits. ObjectiveOne national DVS retailer implemented WIC in 10 stores located in low-income communities in North Carolina over a 10-month pilot period to assess WIC feasibility. MethodsTo better understand the facilitators and barriers to WIC implementation from the perspective of DVS staff, we analyzed 36 in-depth interviews with employees of this DVS chain at corporate, manager, and store clerk levels. ResultsMost participants provided positive feedback about implementing and offering WIC. Many store employees had personal experience participating in WIC, which increased their understanding of the WIC shopping experience. Store staff’s prior WIC participation and customers’ proximity to DVS locations were facilitators to implementation. Primary barriers included limited choice of store products for customers, complicated or unclear labeling of WIC products, and difficulty training employees to process WIC vouchers. ConclusionsThese findings suggest that whereas most employees viewed WIC positively, barriers related to product selection and training must be addressed. Notably, North Carolina’s recent change to an electronic system to process WIC transactions requires minimal manual employee training and should address several barriers to implementation. However, the computer system upgrades necessary to accept electronic WIC transactions may be a barrier for DVS to continued WIC acceptance. Future research is needed to evaluate implementation of electronic WIC transactions in DVS.

Abstract P283: Where You Shop and Neighborhood Access to Fruit and Vegetables are Associated With Self-rated and Cardiometabolic Health

Introduction: The food environment, including food retail venues, has been shown to be associated with diet, and many disadvantaged neighborhoods lack access to high quality and affordable healthy foods. Research has sought to understand whether and how the food retail environment influences diet, and it is possible that shopping at different types of stores (e.g. full-service vs discount grocery store) influences diet and self-reported health outcomes. There is limited understanding of whether factors of the food environment and primary shopping location impact cardiometabolic health (blood pressure, HbA1c, cholesterol) and self-rated health. Methods: We report on 459 individuals who participated in a blood draw in 2018 as part of the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health, a longitudinal natural-experiment study among African American adults from two socioeconomically similar neighborhoods. Participants reported their perceived access to fruit and vegetables within their neighborhood and where they did their primary food shopping. Outcomes include measured height, weight, blood pressure, cholesterol (HDL, Total), HbA1c, and participant’s self-rated health. We employed logistic regression to examine associations between 1) perceived fruit and vegetable availability, quality, and price and 2) primary food shopping store type and reason for shopping there, with cardiometabolic and self-rated health outcomes. Covariates were neighborhood, years lived in neighborhood, age, race, income, education, and marital status. Results: Participants were on average, 60.7 years old (SD=13.9); 81.7% (375 of 459) female; 80.4% (369 of 459) overweight/obese. After covariate adjustment, both more perceived accessibility of purchasing (OR: 0.47, 95% CI: 0.28, 0.79) and pricing of fruits and vegetables (OR: 0.59, 95% CI: 0.36, 0.96) within one’s neighborhood were associated with lower odds of high blood pressure. More accessible purchasing (OR: 0.59, 95% CI: 0.39, 0.90), pricing (OR: 0.62, 95% CI: 0.41, 0.94), and higher quality of fruits and vegetables (OR: 0.64, 95% CI: 0.42, 0.97) within one’s neighborhood were associated with lower odds of poor self-rated health. Doing one’s primary food shopping at a discount grocery store compared to a full-service grocery store was associated with lower odds of being overweight (OR: 0.51, 95% CI: 0.26, 0.99). Choosing a primary food store based on price rather than quality of food was associated with increased odds of high cholesterol (OR: 2.02, 95% CI: 1.19, 3.45). Conclusion: These results suggest that higher perceptions of access to fruits and vegetables in one’s neighborhood and choice of primary food shopping store are important correlates of cardiometabolic health. Further research should look towards understanding how direct food choices made at stores impact cardiometabolic outcomes within this population.

A pilot study of an online produce market combined with a fruit and vegetable prescription program for rural families.

Despite being surrounded by farms, rural families are often at risk for diet-related diseases because of food disparities. Barriers such as distance and transportation to a full service grocery store, lack of cooking knowledge and skills, and the cost of fresh produce, force families to shop at convenience stores that carry predominantly unhealthy, processed foods. We combined a Fruit and Vegetable Prescription Program (F&VRx) with family cooking/nutrition classes and a pilot online produce shopping to promote lifestyle dietary changes in rural families. In 2 rural upstate New York communities school health staff referred low income families with one or more children at risk for chronic disease related to obesity for this pilot program. Each family was given a weekly online produce credit for 5months, September/October 2017 through January/February 2018. Two monthly nutrition/cooking lessons were provided for the entire family. Evaluation was done using pre and post program surveys and Photovoice. Families took photos in response to the question "How has the F&VRx program affected my family?". Redemption of online produce credit was 94% and class attendance was 80%. Fruit and vegetable consumption rose for children. Confidence, culinary skills, and food literacy increased slightly. Three months after program completion, 60% of the families continued weekly online produce shopping without the F&VRx. Healthy behaviors for shopping, preparing, and consuming fruits and vegetables can be increased using a F&VRx, online produce ordering, and family cooking classes.

The Role of Social Issues on Food Procurement among Corner Store Owners and Shoppers

ABSTRACTObjective: We assessed corner store shopper and owner perceptions, barriers, and enablers related to food procurement in a sample of neighborhood corner stores where over 50% of families are SNAP eligible. Design: We conducted semi-structured interviews to identify inventory stocking, shopping and marketing approaches, and perspectives on healthy eating. Participants: Five corner store owners and 20 corner store shoppers. Results: Corner store owners: 1) did not feel as though they belonged to the community where their corner store was located; 2) had difficulty in becoming authorized WIC retailers because of the perceived complexity of the process, and 3) stated tobacco products and hot food items are their best-selling items; fruits and vegetables were perceived as unmarketable. Corner store shoppers preferred shopping at local corner stores because: 1) lack of transportation made corner stores easier to access than full-service grocery stores; 2) hot foods are readily available and inexpensive; 3) some home kitchens lacked an oven or stovetop for meal preparation; 4) they need to shop daily for children or other family members. Conclusions: Social issues such as housing quality, corner store owner sense of community, and acculturation should be addressed when considering food environment in limited resource communities.

Changing the Food Environment: What is Feasible in Small Food Stores

Small retail food stores are on the decline in Minnesota, and 1.6 million Minnesotans have little access to a full-service grocery store (Rauch & Mattessich, 2016). Additionally, grocery stores closing in rural communi­ties can be economically and socially detrimental to communities. Small food stores, such as convenience and corner stores, are becoming an increasingly important source of healthy food and an important partner with local food distributors in rural communities. The importance of small food stores is especially pronounced in under-resourced communities, as increasing their stock of healthy, appealing, and affordable foods, especially fruits and vegetables, could make these stores a more attractive destination for shoppers and decrease travel­ing time to other food stores. The Minnesota Department of Health (MDH) is responding to the need in rural Minnesota to develop flexible guidelines that advance place-based food systems. MDH collaborated with 10 local public health (LPH) agencies from across the state and partnered with small food stores to modify the availability, placement, and promotion of healthy food and beverage products. MDH and LPH agencies co-developed the intervention and evaluation and gathered input from storeowners to create innova­tive intervention strategies. Strategies were rooted in policies, systems, and environmental (PSE) change approaches and focused on stocking and selling healthy products. The approaches for sourcing healthy prod­ucts varied, but some strategies included working with local food distributors to stock healthy products, which can not only increase healthy food availability, but also help to stimulate the local economy. In this presentation, we shared how MDH collaborated with partners to develop innovative interventions, strategies, and materials. We highlighted challenges and opportunities in evaluating an evolving, community-based inter­vention where implementation strategies are tailored to unique store needs. We discussed the feasibility of this model and lessons learned about how to successfully make PSE change in stores across Minnesota to create a more robust place-based food system.

Bringing Healthy Retail to Urban "Food Swamps": a Case Study of CBPR-Informed Policy and Neighborhood Change in San Francisco.

In urban "food swamps" like San Francisco's Tenderloin, the absence of full-service grocery stores and plethora of corner stores saturated with tobacco, alcohol, and processed food contribute to high rates of chronic disease. We explore the genesis of the Tenderloin Healthy Corner Store Coalition, its relationship with health department and academic partners, and its contributions to the passage and implementation of a healthy retail ordinance through community-based participatory research (CBPR), capacity building, and advocacy. The healthy retail ordinance incentivizes small stores to increase space for healthy foods and decrease tobacco and alcohol availability. Through Yin's multi-method case study analysis, we examined the partnership's processes and contributions to the ordinance within the framework of Kingdon's three-stage policymaking model. We also assessed preliminary outcomes of the ordinance, including a 35% increase in produce sales and moderate declines in tobacco sales in the first four stores participating in the Tenderloin, as well as a "ripple effect," through which non-participating stores also improved their retail environments. Despite challenges, CBPR partnerships led by a strong community coalition concerned with bedrock issues like food justice and neighborhood inequities in tobacco exposure may represent an important avenue for health equity-focused research and its translation into practice.

Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States.

This paper investigates the effect of food environments, characterized as food swamps, on adult obesity rates. Food swamps have been described as areas with a high-density of establishments selling high-calorie fast food and junk food, relative to healthier food options. This study examines multiple ways of categorizing food environments as food swamps and food deserts, including alternate versions of the Retail Food Environment Index. We merged food outlet, sociodemographic and obesity data from the United States Department of Agriculture (USDA) Food Environment Atlas, the American Community Survey, and a commercial street reference dataset. We employed an instrumental variables (IV) strategy to correct for the endogeneity of food environments (i.e., that individuals self-select into neighborhoods and may consider food availability in their decision). Our results suggest that the presence of a food swamp is a stronger predictor of obesity rates than the absence of full-service grocery stores. We found, even after controlling for food desert effects, food swamps have a positive, statistically significant effect on adult obesity rates. All three food swamp measures indicated the same positive association, but reflected different magnitudes of the food swamp effect on rates of adult obesity (p values ranged from 0.00 to 0.16). Our adjustment for reverse causality, using an IV approach, revealed a stronger effect of food swamps than would have been obtained by naïve ordinary least squares (OLS) estimates. The food swamp effect was stronger in counties with greater income inequality (p < 0.05) and where residents are less mobile (p < 0.01). Based on these findings, local government policies such as zoning laws simultaneously restricting access to unhealthy food outlets and incentivizing healthy food retailers to locate in underserved neighborhoods warrant consideration as strategies to increase health equity.

Food deserts in Winnipeg, Canada: a novel method for measuring a complex and contested construct.

"Food deserts" have emerged over the past 20 years as spaces of concern for communities, public health authorities and researchers because of their potential negative impact on dietary quality and subsequent health outcomes. Food deserts are residential geographic spaces, typically in urban settings, where low-income residents have limited or no access to retail food establishments with sufficient variety at affordable cost. Research on food deserts presents methodological challenges including retail food store identification and classification, identification of low-income populations, and transportation and proximity metrics. Furthermore, the complex methods often used in food desert research can be difficult to reproduce and communicate to key stakeholders. To address these challenges, this study sought to demonstrate the feasibility of implementing a simple and reproducible method of identifying food deserts using data easily available in the Canadian context. This study was conducted in Winnipeg, Canada in 2014. Food retail establishments were identified from Yellow Pages and verified by public health dietitians. We calculated two scenarios of food deserts based on location of the lowest-income quintile population: (a) living ≥ 500 m from a national chain grocery store, or (b) living ≥ 500 m from a national chain grocery store or a full-service grocery store. The number of low-income residents living in a food desert ranged from 64 574 to 104 335, depending on the scenario used. This study shows that food deserts affect a significant proportion of the Winnipeg population, and while concentrated in the urban core, exist in suburban neighbourhoods also. The methods utilized represent an accessible and transparent, reproducible process for identifying food deserts. These methods can be used for costeffective, periodic surveillance and meaningful engagement with communities, retailers and policy makers.

The Urban Food Hubs Solution: Building Capacity in Urban Communities

Access to affordable fresh food is an ongoing challenge for underserved urban neighborhoods across the United States. Several are designated food deserts with no access to a full-service grocery store within a one-mile radius. The Urban Food Hubs of the College of Agriculture, Urban Sustainability, and Environmental Sciences (CAUSES) of the University of the District of Columbia (UDC) exemplify the University’s commitment to building capacity in the food desert neighborhoods of Washington D.C. The four components of the Urban Food Hubs are food production, food preparation, food distribution, and waste and water recovery (http://www.udc.edu/category/causes). They are designed to not only provide access to fresh food, but also to create jobs, improve public health, mitigate water management problems, and create urban resiliency. The contributions in economic, social/cultural, and physical/environmental impacts, and the five pillars of economic development that track the broader impacts of urban capacity building are described here. The Urban Food Hubs demonstrate the investment metropolitan universities could make to ensure the long-term economic, social, and environmental health of each community. The model is scalable and replicable in other metropolitan areas including those that experience high pressure on land-use and those experiencing decline.