The State of Healthy RetailCity Harvest • August 2017

Kristin SukysProgram Planning Fellow

Friedman School of Nutrition Science & Policy Tufts University

Table of Contents

Historic Assumptions

Research Snapshots

Innovative Strategies

Key Findings

References

Historic Assumptions

Historic Assumptions Research Shows

1. Altering environment alters diet

Physical access to healthy food may not be the only factor impacting consumption of healthy food. [5, 7, 11, 13, 14, 15]

• “Programs may improve residents’ perceptions of food accessibility, [but] they might be less effective in changing diet and reducing obesity,” (Cummings, 2013).

• “[A]s evidence increasingly suggests that focusing solely on the increasing availability of fresh produce may not result in overall healthier diets,” (Glanz, 2016)

2. Physical access is the primary barrier to

healthy eating

Price is the primary barrier to healthy eating. [1, 2, 3, 4, 5, 6, 7, 8 , 9, 10, 12, 34, 38]

• “The primary barrier to obtaining desired foods [low-income areas of Oakland and Chicago] was lack of income, not proximity or lack of knowledge,” (Alkon, 2013)

• “Cost is the primary barrier to healthy eating,” (Share Our Strength, 2012)

• "Lower prices for vegetables, fruits and dairy products have been found to predict lower gains in BMI among children as well as intake of these products." (Glanz, 2016)

• "Increased access to healthier items alone is insufficient and greater marketing, counter-marketing, educational, and pricing-related efforts are needed to promote changes that affect the energy and nutrient content of corner store purchases" (Steves & Gittlesohn, 2014)

Historic Assumptions Research Shows

3. Low-income people shop in their neighborhoods

Low-income individuals travel to supermarkets they prefer (based on price, quality and quantity), often bypassing supermarkets and grocers in neighborhoods. [4, 7, 9, 14, 15]

• “Disadvantaged consumers living on the lower east side of Detroit, Michigan bypass their neighborhood food environments,” (LeDoux, 2013) [n=202]

• "Low-income NYC households make about 11 trips to 5 stores to find good deals each month". (Strategy Brief, 2016)

4. Nutrition education leads to behavior change

Food knowledge is less influential than economic constraints on food consumption behaviors among low-income households. [1,3,6]

• “Price incentives contribute significantly to the effectiveness of intervention strategies, especially when combined with other components such as nutrition knowledge,” (Adam, 2016) [Meta-analysis of 42 studies]

• "Nutrition ranks last in surveys of the drivers of food choices, after taste, cost, and convenience". (Chandon, 2012)(n=1104)

• "What people want in the short term is tasty, inexpensive, varied, convenient, and healthy foods – roughly in that order of benefit importance." (Chandon, 2012) (n=1104)

5. Consumer engagement boosts healthy habits

Interventions that combine price, information and easy access to and availability of healthy foods with interactive and engaging nutrition information, if carefully designed can help customers of food stores to buy and consume more healthy food. [1, 23, 24, 27]

• "It seems that engaging consumers, in addition to the posters and shelf labels, is more helpful than mere labels or nutrition information. Examples of successful consumer engagement include cooking demonstrations/taste tests, and interactive education." (Adam A, Jensen J., 2016)

Historic Assumptions Research Shows

6. The retail environment impacts purchasing

In-store environment increases likelihood of healthy food purchasing. [1, 3 , 22, 21, 23]

• “Shoppers report that choices are often influenced by end-of-aisle and merchandising displays, and other in-store promotions,” (Glanz, 2012) [Meta-analysis of 125 peer-reviewed articles]

• “In the current study, customers had about 3 times greater odds of purchasing produce at stores that offered at least 14 varieties.” (Caspi, 2017)

7. Increasing healthy food stocking is sufficient to

encourage people to make healthy choices

It is equally important to focus efforts on decreasing less healthy foods within a space. [1, 20, 21, 22, 24, 25]

• “These observations suggest that health interventions need to alter the presence of less-healthy foods in stores, rather than attempting only to increase access to healthier options,” (Glanz, 2012) [Meta-analysis of 125 peer-reviewed articles]

• “to date, there is limited evidence that increasing access to healthy food products in stores increases healthful eating,” (Glanz, 2012) [Meta-analysis of 125 peer-reviewed articles]

• “primary emphasis on increasing healthy foods may not be sufficient to alter the energy or nutrient content of purchases,” (Lawman, 2015).

Research Snapshots

How Significant is the Local Food Environment?

CVD Prevention Through Policy: A Review of Mass Media, Menu Labeling, Taxation/Subsidies, Built Environment, School Procurement, Worksite Wellness, and Marketing Standards to Improve Diet (Afshin, 2015)

• Reviewed >150 cross-sectional studies

• Identified evidence to support benefits of:• focused mass media campaigns (especially for fruits,

vegetables, salt)• food pricing strategies (both subsidies and taxation, with

stronger effects at lower income levels)• school procurement policies (for increasing healthful or

reducing unhealthful choices)• worksite wellness programs (especially when comprehensive

and multicomponent)

• Evidence was inconclusive for:• food and menu labeling (for consumer or industry behavior)• changes in local built environment (availability/accessibility of

supermarkets, fast food outlets).

• Local Food Environment• “Findings have been inconsistent, with no clear associations

between availability or accessibility of supermarkets or other food outlets and measures of adiposity or diet quality.”

• “current evidence for effects of local built environment on diet or diet-related risk factors remains surprisingly limited”

Physical Proximity May Not Be Enough

The Devastating Consequences of Unequal Food Access (Haynes-Maslow, 2016)

• Analyzed USDA 2012 Environmental Atlas Data • Higher-income counties are affected more by the increase of healthy and unhealthy food

more than lower-income counties

• Lack of economic access can override physical access to healthy food

• "Many studies of access to healthy food have focused on the physical environment, including distance to and/or density of food retailers in the area. However, living closer to a food retailer that sells healthy food may be necessary but not sufficient to improve health outcomes in lower-income communities and communities of color."

• “While income is an important factor, the historical and continuing structural racism embedded in the food system prevents people of color, not just lower-income people, from producing, selling, and buying healthy food.”

• Recommendations1. Bring more healthy food to the places where people of color and lower-income people

live and gather- “all of the above” approach

• Incentives that encourage healthy eating, policies and programs that create and expand food hubs and other distribution mechanisms (including innovative initiatives such as mobile food markets that address transportation challenges), and nutrition assistance programs

2. Prioritize culturally appropriate nutrition education for children, food service personnel, and parents

3. Create comprehensive national food and farm policy that incorporates all of the above and more

Shopping Habits of the Urban Poor

Foodways of the Urban Poor (Alkon, 2013)

• 5 independently conducted studies from Oakland and Chicago that investigate how low-income people eat, where and how they shop, and what motivates their food choices

• Study highlighted three trends in population:1. Significant knowledge about healthy food and

understood eating as a cultural act2. Proximity to a supermarket was deemed helpful, but

most of those we studied left their "food desert" neighborhoods to shop at supermarkets because they prioritized price over convenience

3. placed high value on quality of food rather than simply the quantity of they could obtain

• Data reveals that cost, not lack of knowledge of physical distance, is the primary barrier to healthy food access.

"We argue that even these supply-side approaches don’t take

into account the foodways-cultural, social, and economic

food practices, habits and desires- of those who reside in so-

called food deserts."

Individuals Are Traveling to Preferred Stores

In DetroitGoing Outside The Neighborhood: The Shopping Patterns and Adaptations of Disadvantaged Consumers Living in the Lower Eastside Neighborhoods of Detroit (LeDoux, 2013)

• Analysis of 202 low-income households

• "Disadvantaged consumers living on the lower east side of Detroit, Michigan bypass their neighborhood food environments, which are disproportionately composted of convenience and party stores, to shop at independent, discount and regional supermarkets located in other parts of the city and in the suburbs. These trends hold despite various economic and physical constraints to their mobility."

• “low-income households shop predominantly at the independent supermarkets and choose the discount supermarkets over farmer markets, green grocers, and meat and fish markets”

• “solely focusing on the composition of the neighborhood food environment often leads to solutions that fail to address the regional processes and structural conditions that are marginalizing neighborhood residents and uprooting the social fabric of their neighborhoods and communities.”

In New York City

What Are People Purchasing in Bodegas?

Small Convenient Stores and the Local Food Environment: An Analysis of Resident Shopping Behavior Using Multilevel Modeling (Ruff, 2016)

• 171 NYC bodegas, 2118 shoppers sampled- focused on individual purchases

• Findings• <1% of urban residents reported conducting their primary food shopping at

convenience stores• 71% of participants shop at bodegas 5+ times a week• 13% of purchases were impulse buys• 35% reported using all or most of their monthly food and nonalcoholic beverage

allotment at bodegas

Types of Food Items Purchased• 18% sugar sweetened beverages (SSBs)• 16% snacks• 7% produce• 22% other food

• Insights: People are mostly going to bodegas to purchase non-food items, sugar sweetened beverages, snacks and foods other than produce.

"Impulse buys are more likely

to be a function of the food

environment within the store.

Such as, modifying unplanned

behavior may be easier to

attain than modifying planned

behavior."

How effective are incentives?Supermarket Discounts of low-energy density foods: Effects on purchasing, food intake and body weight (Geliebter, 2013)

• N=47: 4-week baseline, 8-week trial period, 4-week baseline • 50% discount of low-ED fruits and vegetables, led to more than

threefold purchasing by the discount group• 50% increase in fruit and vegetable intake by the discount group• Purchasing remained significantly above the baseline period, reflecting

a partially sustained effect of the intervention.

2015 FINI Grant Results

• “redemption rates in grocery stores ranged from 60% to 78%, but customer feedback was uniformly positive.”

• “63% of participants said that they were eating more fruits and vegetables as a result of the incentives and 52% reported eating less junk food because of the program.”

• Lessons Learned• “Produce incentives increase SNAP shoppers’ purchases of healthy

fruits and vegetables in all kinds of retail environments.”• “Financial incentives are more effective when coupled with

experiential education.”

Effects of price discounts and tailored nutrition

education on supermarket purchases: a randomized

controlled trial (Ni, 2010)

N=1,104 shoppers: 12-wk baseline, 24 wk intervention, 24 wk

follow up -- assigned 1 of 4 interventions

Interventions: price discounts (12.5%) on healthier foods,

tailored nutrition education, discounts plus education, or

control (no intervention).

12.5% temporary price discount on healthier foods increased

purchase volume by 11% among low-income consumers who

received the coupons.

The effect of discounts on healthier food purchases was

sustained at 12 months post- randomization

Education had no effect on food purchases

The significant and sustained effect of discounts on food

purchases suggests that pricing strategies hold promise as a

means to improve population diets.

Our findings suggest that structural interventions are more

powerful determinants of dietary behavior than those that

rely on individual responsibility.

Effectiveness of Price Intervention Combined with Interactive NE and Access to Healthy Foods

What is the Effectiveness of Obesity Related Interventions at Retail Grocery Stores and Supermarkets? (Adam, 2016)

• Review of 42 studies on interventions that intended to increase consumption of healthy food in physical retail settings

• Three main strategies:1. Information (education)2. Access & Affordability3. Monetary Incentives

• Results• Price incentives contribute significantly to the effectiveness of

intervention strategies• Food store health interventions generally work, especially if they

combine multiple components• More focus should be given to both healthy and unhealthy foods and

substitution behavior• Engaging consumers, in addition to the posters and shelf labels, is more

helpful than mere labels or nutrition information• Cooking demonstrations, taste tests, and interactive education

“Interventions which combine

price, information and easy

access to and availability of

healthy foods with interactive

engaging nutrition

information, if carefully

designed, can help customers

of food stores to buy and

consume more healthy foods.”

Change Buying Habits by Changing Store Design

“What people want in the short term is tasty, inexpensive, varied, convenient, and

healthy foods- roughly in that order of benefit importance."

Healthy Profits: An Interdisciplinary Retail Framework that Increases the Sales of Healthy Foods (Wansink, 2017)

• CAN: Convenient, attractive & normal

• Three different ways retailers can influence shoppers:• Signage, structure &

service

• Behavior change does not happen through education and convincing, but by coaching shoppers to improve imperfect willpower

How Are People Eating?It’s Dinnertime: A Report on Low-Income Families’ Efforts to Plan, Shop for and Cook Healthy Meals (Share Our Strength, 2012)

• 1500 low-income individuals interviewed

• 8/10 families make dinner at home at least 5 times a week

• Cook dinner from scratch 4 times a week, use prepared foods for dinner from packaged foods 2 nights a week and eats fast food 1 night a week

• Cost is the primary barrier to healthy eating

• 1 in 4 families report skipping healthy purchases often or always due to price

• General understanding of benefits of fresh produce, but lack of understanding of comparable healthy benefits of frozen and canned produce

• 20-30% agree that price, time and conflicting schedules are common obstacles for cooking healthy meals

How Are People Eating?

Changing the Food Environment for Obesity Prevention: Key Gaps and Future Directions (Steeves& Gittlesohn, 2014)

• “National data indicates that Americans spend half of their food budget on prepared foods. To created maximum impact, food environment interventions should target food sources that are most heavily used by consumers.”

• Appropriate Interventions• Prepared Foods• Sourcing• P.O.S. Systems• Policy

• Supported by industry data that show value-added fruit and vegetable sales increasing (United Fresh, 2016)

Consider Expanding Focus Beyond Supermarkets

Creating Healthy Food Access in a Changing Food Retail Sector (Cohen, 2016)

Improving access to healthy affordable food will require:• reviewing housing and real estate development policies• zoning rules• minimum wage• tax policy• public food benefits• state and national agricultural and nutrition policies.• A systems perspective that acknowledges the complexity of the

determinants of food retail environments and the necessity of interdisciplinary contributions is essential for effective solutions.

Alternative markets• Like the City of Baltimore’s Baltimarket Virtual Supermarket

program or increasing box delivery programs like GrowNYC’s Fresh Food Box program

“These new challenges for

supermarkets in NYC and

nationally suggest that policy

prescriptions developed in

an earlier era, focusing

exclusively on traditional

supermarkets, may no longer

be relevant.”

Innovative Strategies

Social Media and Text Messaging• Spotlight: B’More Healthy: Communities for Kids

Wholesale Intervention• Spotlight: Minneapolis’ Shop Healthy Program

Brand Development• Spotlight: San Jose, California

Spotlight: Social Media & Text MessagesB’More Healthy Communities for Kids Project

Interview: Angela Trude (Senior Analyst) &Lisa Poirier (Data Manager and Research Assistant)

Overview: 5 year community Intervention dispatched in 2 phases within 1.5 radius surrounding recreation centers in Baltimore. Each phase had 7 intervention communities and 7 control communities. Each trial partnered with 3-5 small food retailers and prepared food stores

Outcomes: 1. Small Retail Food Availability2. Household healthy Food Purchasing

3. Dietary intake of urban youth

Multilevel: Policy, wholesaler, corner store, carry out, household, individual

Phase 1: Participants would register for text message healthy product promotions and ideas. Texts went to adults, caregivers and kids. A social media campaign was used for product and store promotion, healthy ideas, nutrition education and community engagement

Challenge: Often, kids did not have phones and adults would sometimes not pay phone bill.

Success: The social media campaign gained a strong following and residents were particularly excited with the highlighted store owners (gave a personal touch). Using a social media promotion tool, BHCK could target zip codes and age ranges

Phase 2: Discontinued text messages and instead began sending information via mail. One week mail would be sent to caregiver, and the following week, mail would be sent to children. Continued use of social media throughout phase 2.

Social Media campaigns have been so successful that

they have chosen to continue them post-intervention.

Spotlight: Wholesale InterventionShop Healthy (Minneapolis)

Methods Tested:

1. Emergency Food Shelf Network • store owners could purchase produce at low wholesale cost in small quantities from food bank

2. University of St. Thomas campus experiment garden• professor led, student-run biology experiments testing organic soil growing methods offered surplus

produce to corner stores

3. Farmers Market • market offered discounts to owners on produce remaining after peak hours. Wholesale vender attended

and divided cases to sell smaller quantities to owners.

4. Local, Mobile Vendor • Vender operated from van, making regular informal rounds offering produce at very low prices

Outcomes: The most successful model was the local, mobile vender- stemming from his relationship and comfort with owners, flexibility with delivery and case sizes, and shared cultural background. Additionally, the university garden was extremely successful and morphed into a local produce business called Brightside Produce

Spotlight: Develop a BrandThe Health Trust (San Jose, CA)

• Hired marketing firm and created a brand: Good-To-Go

• Marketing firm found in their research that consumers know what is healthy, but they still make consumer and dietary choices based on taste, price and convenience

• Do not use health in their marketing, but promotes food as fun, fast and fresh-emphasizing snacks

• For promotion, they used social media, outdoor media, print advertisement, coupons and promotions, brand recognition and web map/mobile app

• Had to install more marketing materials than expected to compete with unhealthy advertising

Innovative Strategies • Food Hubs

• “Food hubs can improve access to healthy foods in low-income or underserved areas by making it easier for farmers to offer their products in these areas by assuming costs associated with infrastructure and logistics. Food hubs may also provide additional value-added services like fresh-cut operations for fruits and vegetables, or may serve as a business incubator for small-scale food producers “

• Common Market (Philadelphia), Intervale Food Hub (Burlington), Corbin Hill Project (NYC), Farm Fresh Rhode Island

• Incubator Kitchens• Provide: Centralized processing facilities; Culinary, foodservice, food retail, and other food sector job training; Business

incubators; Commercial kitchens• CommonWealth Kitchen (Dorchester, MA), DC Central Kitchen, La Cocina (San Francisco), Hot Bread Kitchen (NYC)

• Nutrition Incentives• FINI Grants• At Farmers Markets: Health Bucks (NYC), DoubleUp Bucks (Michigan & Piloting in California), Bonus Bucks (Rhode Island)• At Retail Stores: Field & Fork Network (NY) Hartford, CN & Vermont FINI grant

• F&V Prescriptions• 10 States Participating: CA, CT, MA, ME, MN, NY, RI, TX, D.C., Navajo Nation• Capital Roots (NY), Eisen Pediatric & Family Medical Center with Target Corporation (L.A.), Blue Cross & Blue Shield

(Minneapolis), NYC Health & Hospitals Corporation (NYC)

• Co-Ops• Mandela Foods (Oakland), Mariposa Food Co-Op (Philadelphia), Hendersonville Co-Op (Hendersonville),

• Start a Fund• Spotlight: Farm Fresh Rhode Island’s Fresh for all Fund• Supports: 40% SNAP buying power, market nutrition education and vouchers (Kids), nutrition education and voucher

(Seniors), F&V Prescriptions

Keep an Eye On: • Minneapolis is focusing on how to increase demand of healthy food in low income

neighborhoods, connecting customers to stores and affordability success models (Market Bucks incentive for stores)

• B’More Healthy: Communities for Kids’ data analysis on the entire intervention, but specifically incentives, use of social media and community health outcomes

• Snap Online pilot project

• All FINI Grantees• NYC Department of Health’s FINI grant for pilot nutrition incentives program in grocery stores

• Wholesome Wave’s Nutrition Incentive Program Grantees

• Washington State Department of Health & Safeway partnership for healthy food incentives called Complete Eats

• NYS Greenmarket Regional Food Hub

• The NYC Health and Hospitals Corporation (HHC) refining the FVRx model to be scaled at hospitals city-wide, then replicated through the country

Key Findings

1. Price is the primary barrier [1, 2, 3, 4, 5, 6, 7, 8 , 9, 10, 12, 34]

2. Physical access is not the only barrier to healthy diets [5, 7, 11, 13, 14, 15]

3. People travel to their preferred stores [4, 7, 9, 14, 15]

4. Modifying unplanned behavior may be easier to attain than modifying planned behavior [17, 18]

5. Marketing strategies need to incorporate counter-marketing and may be most effective when avoiding “healthy” as a promotional tool [1, 17, 19, 20, 21, 22]

Key Findings

6. Produce variety is positively associated with produce purchases [21]

7. In-store environment increases likelihood of healthy food purchasing [1, 3 , 22, 21, 23]

8. Food knowledge is less influential than economic constraints on food consumption behaviors among low-income households [6]

9. Decreasing less healthy foods within a space is equally important as increasing healthy foods [1, 20, 21, 22, 24, 25]

10. Prepared food sources are appropriate intervention targets [7, 27, 28, 29, 30, 32, 33, 12]

Key Findings

11. Incorporating wholesalers and distributors into interventions is important to getting affordable, feasible small scale distribution [14, 18, 25, 26, 31, (K. Klingler, personal

communication, June 23, 2017), (L. Poirier and A. Trude, personal communication, July 6, 2017]

12. Multi-level partnerships are the key to a successful intervention [2, 8, 11, 23, 27]

13. Low-income families continue to cook at home [10]

14. Interventions that combine multiple strategies with interactive and engaging nutrition information are the most effective. [1, 23, 24, 27]

References

1. Adam A, Jensen J. What is the Effectiveness of Obesity Related Interventions at Retail Grocery Stores and Supermarkets? - A Systematic Review. BMC Public Health. 2016;16(1247).

2. Alkon A, Block D, Moore K, Gills C, DiNuccio N, Chavez N. Foodways of the Urban Poor. Geoforum. 2013;48: 126-135.

3. Chandon P, Wansink B. Does Food Marketing Need to Make Us Fat? A Review and Solutions. Nutrition Reviews. 2012.

4. Ghosh-Dastidar M, Hunter G, Collins R, Zenk S, Cummings S, Beckman R, Nugroho A, Sloan J, Wagner L, Dubowitz T. Does Opening a Supermarket in a Food Desert Change the Food Environment? Health & Place. 2017;46:249-256.

5. Haynes-Maslow L. Policy Brief: The Devastating Consequences of Unequal Food Access. Union of Concerned Scientists. 2016.

6. Kato Y, McKinney L. Bringing food desert residents to an alternative food market. Agric Hum Values. 2015;32:215-227

7. LeDoux T, Vojnovic I. Going Outside the Neighborhood: The Shopping Patterns and Adaptations of Disadvantaged Consumers Living in the Lower Eastside Neighborhoods of Detroit, Michigan. Health & Place. 2013; 19:1-14.

8. Pearson-Stuttard J, Bandosz P, Rehm C, Penalvo J, Whitsel L, Gaziano T, Conrad Z, Wilde P, Micha R, Lloyd-Williams F, Capewell S, Mozaffarian D, O’Flaherty M. Reducing US Cardiovascular Disease Burden and Disparities Through National and Targeted Dietary Policies: A Modeling Study. PLoS Medicine. 2017.

9. Shannon J. What does SNAP Benefit Usage Tell Us About Food Access in Low-Income Neighborhoods? Social Science & Medicine. 2014;107:88-99.

10. Share Our Strength. Its Dinnertime: A Report on Low-Income Families’ Efforts to Plan, Shop for and Cook Healthy Meals. Share Our Strength’s Cooking Matters. 2012:1-54.

11. Cummings S, Flint E, Matthews S. New Neighborhood Grocery Store Increased Awareness of Food Access but Did Not Alter Dietary Habits or Obesity. Health Affairs. 2014; 33(4).

12. Black C, Moon G, Baird J. Dietary Inequalities: What is the evidence for the effect of the neighborhood food environment? Health & Place. 2014;27:229-242.

13. Dubowitz T, Ghosh-Dastidar M, Cohen D, Beckman R, Steiner E, Hunter G, Flórez K, Huang C, Vaughan C, Sloan J, Zenk S, Cummins S, Collins R. Diet and Perceptions Change with Supermarket Introduction in a Food Desert, but not because of supermarket use. Health Affairs. 2015;34(11):1858-68.

14. Walker R, Block J, Kawachi I. Do Residents of Food Deserts Express Different Food Buying Preferences Compared to Residents of Food Oases? A Mixed-Methods Analysis. International Journal of Behavioral Nutrition and Physical Activity. 2012;9(41).

15. Afshin, A, Penalvo J, Gobbo L, Kashaf M, Micha R, Morrish K, Person-Stuttard J, Rehm C, Shangguan S, Smith J, Mozaffarian D. CVD Prevention through Policy: A Review of Mass Media, Menu Labeling, Taxation/Subsidies, Built Environment, School Procurement, Worksite Wellness, and Marketing Standards to Improve Diet. Curr Cardiol Rep. 2015;17(98).

16. Cannuscio C, Tappe K, Hillier A, Buttenheim A, Kapryn A, Glanz K. Urban Food Environments and Residents’ Shopping Behaviors. American Journal of Preventative Medicine. 2013;45(5):606-614.

17. Ruff R, Akhund A, Adjoian T. Small Convenient Stores and the Local Food Environment: An Analysis of Resident Shopping Behavior Using Multilevel Modeling. American Journal of Health Promotion. 2016;30(3):172-180.

18. Mayer V, Young C, Cannuscio C, Karpyn A, Kounaves S, Strupp E, McDonough K, Shea J. Perspectives of Urban Corner Store Owners and Managers on Community Health Problems and Solutions. Preventing Chronic Disease Public Health Research, Practice, and Policy. 2016;13(144).

19. Bleich S, Herring B, Flagg D, Gary-Webb T. Reduction in Purchases of Sugar-Sweetened Beverages Among Low-Income Black Adolescents after Exposure to Caloric Information. American Journal of Public Health. 2012;102(2)

20. Lawman H, Vander Veur, Mallya G, McCoy T, Wojtanowski A, Colby L, Sanders T, Lent M, Sandoval B, Sherman S, Wylie-Rosett J, Foster G. Changes in Quantity, Spending and Nutritional Characteristics of Adult, Adolescent and Child Corner Store Purchases after an Environmental Intervention. Preventative Medicine; 2015;74:81-85.

21. Caspi C, Lenk K, Pelletier J, Barnes T, Harnack L, Erickson D, Laska M. Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores. International Journal of Behavior Nutrition and Physical Activity. 2017;14(76).

22. Wansink B. Healthy Profits: An Interdisciplinary Retail Framework that Increases the Sales of Healthy Foods. Journal of Retailing. 2017;93:65-78.

23. Escaron A, Meinen A, Nitzke S, Martinez-Donate A. Supermarket and Grocery Store-Based Interventions to Promote Healthful Food Choices and Eating Practices: A Systematic Review. Preventing Chronic Disease. 2013;10.

24. Glanz, Karen, Lauren Johnson, Amy Yaroch, Matthew Phillips, Guadalupe Ayala, Erica Davis. Measure of Retail Food Store Environments and Sales Review and Implicationsfor Healthy Eating Initiatives. Journal of Nutrition Education and Behavior. 2016; 48(4).

25. Policy Link and The Food Trust. Building a Healthy Corner Store Network [Video Webinar]. 2015. Accessed: https://www.youtube.com/watch?v=kJg9AIAZMMM&feature=youtu.be

26. Steeves E, Martins P, Gittlesohn J. Changing the Food Environment for Obesity Prevention: Key Gaps and Future Directions. Springer Science+Business Media New York. 2014;3:451-458.

27. Gittlesohn J, Steeves E, Mui Y, Kharmats A, Hopkins L, Dennis D. B’More Healthy Communities for Kids: Design of a Multi-Level Intervention for Obesity Prevention for Low-Income African American Children. BMC Public Health. 2014;14(942).

28. Block J, Scribner R, Desalvo K. Fast Food, Race/Ethnicity, and Income: A geographic Analysis. American Journal of Preventative Medicine, 2004;27(3):211-217.

29. Boone-Heinonen J, Gordon-Larsen P, Kiefe C, Shikany J, Lewis C, Popkin B. Fast Food Restaurants and Food Stores. American Medical Association. 2011; 171(13).

30. Neckerman K, Lovasi L, Yousefzadeh P, Sheedan D, Milinkovic K, Baecker A, Bader M, Weiss C, Lovasi G, Rundle A. Comparing Nutrition Environments in Bodegas and Fast-Food Restaurants. Journal of the Academy of Nutrition Dietetics. 2014;114(4):595-602.

31. Lourison H, Hadwin A. Providing Fresh Produce in Small Food Stores. ChangeLabSolutions- The National Policy & Legal Analysis Network to Prevent Childhood Obesity (NPLAN). 2014.

32. Produce for Better Health Foundation. State of the Plate, 2015 Study on America’s Consumption of Fruits and Vegetables. Produce for Better Health Foundation. 2015.

References

References

33. Ghosh-Dastidar B, Cohen D, Hunter G, Zenk S, Huang C, Beckman R, Dubowitz T. Distance to Store, Food Prices and Obesity in Urban Food Deserts. American Journal of Preventative Medicine. 2014; 47(5) 587-595.

34. Afshin A, Peñalvo J, Del Gobbo L, Silva J, Michaelson M, O’Flahtery M, Capewell S, Spiegelman D, Danael G, Mozaffarian D. The Prospective impact of food pricing on improving dietary consumption: A Systematic Review and Meta-Analysis. PLoS ONE. 2017;12(3).

35. Healy E, Zavaleta-Martin M. Good- To-Go: San Jose Healthy Corner Store Program Case Study. The Health Trust . 2015.36. Futrell-Dunaway L, Carton T, Ma P, Mundorf A, Keel K, Theall K. Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children’s Diets.

International Journal of Environmental Research and Public Health. 2017;14(6):66237. Cohen N, Freudenberg N. Creating Healthy Food Access in a Changing Food Retail Sector: Invitation to a Dialogue. CUNY Food Policy Institute. 2016.38. Ni Mhurchu C, Blakely T, Jiang Y, et al. Effects of price discounts and tailored nutrition education on supermarket purchases: a randomized controlled trial. Am J Clin Nutr.

2010;91:736–74739. Geliebter A, Ang I, Bernales-Korins M, Hernandez D, Ochner C, Ungredda T, Miller R, Kolbe. Supermarket Discounts of low-energy density foods: Effects on purchasing,

food intake and body weight. Obesity Society. 2013;21(12):E542-E54840. Glanz K, Bader M, Iyer S. Retail Grocery Store Marketing Strategies and Obesity: An Integrative Review. American Journal of Preventative Medicine. 2012;42(5):503-512.41. Gittlesohn J, Rowan M, Gahdoke P. Interventions in Small Food Stores to Change the Food Environment, Improve Diet, and Reduce Risk of Chronic Disease. CDC-

Preventing Chronic Disease. 2012;9. 42. An R. Effectiveness of Subsidies in Promoting Healthy Food Purchases and Consumption: A Review of Field Experiments. Public Health Nutrition. 2013;16(7):1215-1228. 43. Manhattan Supermarkets: How to Keep Them Alive. Manhattan Borough President’s Office. 2017. Accessed Online: http://manhattanbp.nyc.gov/downloads/pdf/2017-6-

13-Supermarket%20Report%20and%20Age%20Friendly%20Combined.pdf44. Improving Access to Affordable Food in New York City- Strategy Brief. NYC Mayor’s Office of Food Policy. 2017. Accessed Online: http://healthyfoodretailnyc.org/wp-

content/uploads/2017/06/2017-06-22-Affordability-Food-Retail-Strategy.pdf?utm_source=HFRAN+JUNE+2017&utm_campaign=35b677b975-EMAIL_CAMPAIGN_2017_06_23&utm_medium=email&utm_term=0_7edf2eea65-35b677b975-526991729

45. Shop Healthy NYC- Year 1 Evaluation Report. NYC Department of Health and Mental Hygiene. 2014. Accessed Online: http://www1.nyc.gov/assets/doh/downloads/pdf/pan/shop-sealthy-report.pdf

46. NYC Foodscapes by Neighborhood. Hunter College New York City Food Policy Center. 2017. Accessed Online: http://www.nycfoodpolicy.org/nyc-foodscapes-community/?utm_source=HFRAN+JUNE+2017&utm_campaign=35b677b975-EMAIL_CAMPAIGN_2017_06_23&utm_medium=email&utm_term=0_7edf2eea65-35b677b975-526991729

47. Supplying Health in New York City- Lessons from Shop Healthy NYC’s Partnership with Wholesale Suppliers for Healthy Food Retail. ChangeLab Solutions. 2015. Accessed Online: http://www.changelabsolutions.org/sites/default/files/NYC_DistributionCaseStudy_FINAL_20150729.pdf

Fresh Approach Interview: Andy Ollove, Food Access Program Manager

“INCENTIVES ARE THE KEY TO INCREASING INDIVIDUAL CONSUMPTION OF F&V”• Wholesome Wave’s incentive structure was very successful in Hartford, CT. When buyers had at least

one F or V in their cart at the check out, they received $5 towards fruits and vegetables. This program had about 70% redemption rate

“When looking at sourcing, we are going to be pretty powerless at impacting the supply chain. A better way to go would be to look at Food Hub Models (like Rhode Island’s Farm Fresh).”

“Veggie prescriptions are extremely important, impactful and very possible since there is a lot of money available for them right now.”

“Money talks- when owners make money, their investment and interest increases.” (A. Ollove, personal communication, July 7, 2017)

HFRAN Quarterly Meeting

• “Behavioral interventions have not worked as well as we want. Look at practices people already engage in instead. Huge reliance on microwaves change the focus of what type of food is appropriate. Beef up meals on wheels- meal kits and pre-prepped food. Most food retail has been based on poor data. We need a retail database.”

• NYC Food Policy Report: “Everyone shops at grocery stores, but low-income individuals tend to travel further and cannot pay for convenience.”

• Donna (Anna?) Kurato: “Re-invent home delivered meals”