Baltimore Healthy Stores Project

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Baltimore Healthy Stores Project
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Mission

• To develop programs to improve the availability
  of healthy food options to all residents of
  Baltimore City.
• To promote these foods at the point of purchase,
  and work in collaboration with community
  agencies, the city of Baltimore, and local food
  sources.

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Guiding Principles and Goals

• To work with local merchants to offer more
  healthy choices
• To increase sales and consumption of healthy
  foods
• To teach healthy food preparation methods
• To form partnerships with local food stores and
  markets
• To form partnerships with community organizations

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Formative PhaseFebruary 2002-September 2003

• Objectives
• To inform design of appropriate food-store
  centered health education interventions
• To identify needs and options for improved supply
  of healthy foods
• To plan an effective and sustainable program in
  Baltimore City
• Methods
• Food source surveys (12 census tracts)
• Consumer surveys (n 50)
• In-depth interviews with store managers (n 17)
• In-depth interviews with community leaders (n
  26)
• 24-hour diet recall surveys (n75)

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Consumer Survey of Food Shopping and Preparation
Patterns (n50)

• 76 African American
• 54 female
• 22 reported receiving government food assistance
  (Food Stamps, WIC, Commodity Foods, Free/Reduced
  Price School Lunch)
• 16 were food insecure without hunger (USDA food
  security scale)
• 8 were food insecure with hunger

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Food Sources Used In the Last Six Months
Location

Respondents were permitted to check all food
sources they used
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Reported Reasons for Using a Food Source
Respondents were asked to provide three reasons
for each of their top three choices, yielding a
total of 369 responses. There were a total of 46
other responses. If only one response was given
for a food source, that reason was counted three
times. All responses were considered for the
calculation of the last two columns.
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Type of Milk Gotten, (Respondents 50)
Respondents may select more than one type
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Low fat milk is better for your health than
whole milk
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Low-fat milk contains the same nutrients as
whole milk except for the fat content
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What would help the community?
Respondents were permitted to select three
options for a total of 138 responses
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24-hour Dietary Recall Surveys, n71

• 96 African-American
• 85 Female
• 51 reported receiving government food
  assistance (Food Stamps and/or WIC)
• 23 18-30 years age group
• 56 31-50 years age group
• 21 51 years age group

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Foods Mentioned One or More Times,
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Vegetable/Fruit and Other Healthy Foods
Consumed One or More Times,
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Qualitative Research with Local Stores Owners

• How do store owners/managers decide what foods to
  stock and how to promote them?
• Order and stock on demand
• corner store dont have much saying to serve,
  for example, particular low sodium, low fat food.
  See, we serve food already existing, already
  produced, we sell what consumer like and consumer
  like it.
• we dont buy what consumers never buy, only buy
  popular product otherwise sits there, gets bad,
  we dont want product to sit there, if not sell,
  try to avoid stock doesnt move.
• Environment of the store generates demand
• People looking, people buying same stuff.
  Sometimes they ask for stuff. This store blocked
  by glass keeping customers in the front
  anteroom, they cant come in. So people buy
  same stuff.

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Qualitative Research with Local Stores Owners

• What do customers buy?
• Storeowners reported most sold items are
• soda, chips, candies
• Elderly reported to buy groceries and juices
• Korean-American Grocers Association (KAGRO)
  reported most sold items are
• bread, milk, eggs, soft drink, cigarettes
• Direct observations at stores
• Most common purchases chips, Pepsi, donuts

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Qualitative Research with Local Stores Owners

• Relationships with customers in the community
• Problem with customers
• Stealing, cursing, drug people, crime,
  teenagers particularly problematic
• Relationships with good customers
• Carrying food to the elderly and sick
• Purchasing special goods for certain clients
• Letting them into the store to browse items
• Concern for the good customers, kids and elderly
• Reciprocal relationships
• Customers watch the store at night
• Watch out for their cars during the day
• Proud of providing services to the community
• Customers ask for things and I buy it for them.
  They ask, I go to Mars and find it and put it
  here on the shelf. They see it and they are
  happy.

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Food Source Survey

• Census tracts randomly selected
• East Baltimore (803.01)
• West Baltimore (1503)
• Park Heights (1513)
• Federal Hills (2403)
• Cherry Hill (2502.07)

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Differences between tracts in healthy food options
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Qualitative Research with Community Leaders

• Community leaders identified the following
  problems with local food stores include
• Store Conditions
• Quality - Just open the door to the supermarket
  and you can smell it. If they sell fish, it
  smells like fish. Fish, chicken blood, I dont
  know if everyone can smell it, but can. If you go
  to Giant, you dont get that
• Access
• Prices - I know budget affects food of choice
  because when people think in terms of going to
  the grocery store and they want to get.they want
  to stretch dollars as much as they can. So, often
  times, they buy the cheaper things.
• Transportation - No, not any major supermarkets
  around, but also a lot of people in the community
  dont have transportation, major transportation
  like cars to get to the other supermarkets
  that are in other areas.
• Safety - When I suggest to people that they
  walk, then theyll say, The streets are
  dangerous, you cant walk on the streets.

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Qualitative Research with Community Leaders

• Community leaders identified the following
  barriers to solving the nutritional situation in
  East Baltimore
• Community in Crisis - The community has changed
  over the years. I would definitely like to say
  not for the better because there are a lot of
  vacant homes in the community which brings a lot
  of crime. There is a lot of drug activity in the
  community and it doesnt make for a pretty place
  to want to live.
• Change in Community Membership - I think
  unfortunately when this change started coming
  about, I think some of the people in this
  community leftthey moved out to the county and
  because they werent getting the help that they
  might have needed from the government or from
  other partners in the community until it got to
  this status and so they left to save their
  children.

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Qualitative Research with Community Leaders,
continued

• Community leaders identified the following
  barriers to solving the nutritional situation in
  East Baltimore
• Change in Societal Values - You got other
  parents, they are really thoughtful parents, but
  they are working or theyre working two jobs, or
  their working and going to school, but they got
  the busy schedules. Theres very few people that
  quote spend very little quality time doing
  things for their family.
• Lack of Community Cohesion - I think that if the
  people that work here and live here and brought
  their relationship closer together then a lot of
  those things health hazards rats, trash,
  crime, discrimination would disappear.

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Possible Interventions Promoting Healthy Food
Choice

• Character Motif
• Logo
• Flyers
• Cooking Demonstrations (In-store)
• Taste Tests
• Specialized Food Displays (In-store)
• Prepackaged healthy meals (In-store)
• Recipe Cards (In-store)
• Shopping Lists (In-store)
• Posters (Mass media)

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Community Collaborative Partners

• Center for a Livable Future
• BCHD Child and Adult Care Food Program
• HABC, Division of Family Support Services Human
  Services Offices (Districts 2,4,5)
• The Mens Center
• Middle East Community Development Corporation
• Historic East Baltimore Community Action
  Coalition
• Baltimores Safe and Sound Campaign
• St. Francis Academy
• Super A Farms
• Baltimore Public Markets Corporation
• Stop, Shop, and Save Food Markets

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Future Work

• Need to continue to establish strong community
  partnerships
• Develop and refine intervention strategies in
  collaboration with project partners
• Implement intervention to determine feasibility

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Community Organizations/Baltimore Healthy Stores
Collaboration

• Community Organizations
• Support Baltimore Healthy Stores through
  awareness of goals and strategies
• Review and provide feedback on intervention
  materials
• Serve as venue for community outreach
• Baltimore Healthy Stores
• Implement and evaluate program
• Report findings to merchants
• Make public intervention materials