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Boys KA, Haynes-Maslow L, McGuirt JT, Ammerman AS, Van Fleet EE, Johnson NS, Kelley CJ, Donadio VE, Fleischhacker SE, Truesdale KP, Bell RA, Jilcott Pitts SB. Perceived barriers and facilitators to participating in the North Carolina Healthy Food Small Retailer Program: a mixed-methods examination considering investment effectiveness. Public Health Nutr 2021; 24:6555-6565. [PMID: 34509178 PMCID: PMC11148602 DOI: 10.1017/s1368980021003955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The North Carolina Legislature appropriated funds in 2016-2019 for the Healthy Food Small Retailer Program (HFSRP), providing small retailers located in food deserts with equipment to stock nutrient-dense foods and beverages. The study aimed to: (1) examine factors facilitating and constraining implementation of, and participation in, the HFSRP from the perspective of storeowners and (2) measure and evaluate the impact and effectiveness of investment in the HFSRP. DESIGN The current analysis uses both qualitative and quantitative assessments of storeowner perceptions and store outcomes, as well as two innovative measures of policy investment effectiveness. Qualitative semi-structured interviews and descriptive quantitative approaches, including monthly financial reports and activity forms, and end-of-programme evaluations were collected from participating HFSRP storeowners. SETTING Eight corner stores in North Carolina that participated in the two cohorts (2016-2018; 2017-2019) of the HFSRP. PARTICIPANTS Owners of corner stores participating in the HFSRP. RESULTS All storeowners reported that the HFSRP benefitted their stores. In addition, the HFSRP had a positive impact on sales across each category of healthy food products. Storeowners reported that benefits would be enhanced with adjustments to programme administration and support. Specific suggestions included additional information regarding which healthy foods and beverages to stock; inventory management; handling of perishable produce; product display; modified reporting requirements and a more efficient process of delivering and maintaining equipment. CONCLUSIONS All storeowners reported several benefits of the HFSRP and would recommend that other storeowners participate. The barriers and challenges they reported inform potential approaches to ensuring success and sustainability of the HFSRP and similar initiatives underway in other jurisdictions.
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Affiliation(s)
- Kathryn A Boys
- Department of Agricultural & Resource Economics, North Carolina State University, 4306 Nelson Hall, Campus Box 8109, Raleigh, NC27695-8109, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural & Human Sciences, North Carolina State University, Raleigh, NC, USA
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin E Van Fleet
- Department of Agricultural & Resource Economics, North Carolina State University, 4306 Nelson Hall, Campus Box 8109, Raleigh, NC27695-8109, USA
| | - Nevin S Johnson
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Casey J Kelley
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Victoria E Donadio
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | | | - Kimberly P Truesdale
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Jilcott Pitts SB, Wu Q, Truesdale KP, Rafferty AP, Haynes-Maslow L, Boys KA, McGuirt JT, Fleischhacker S, Johnson N, Kaur AP, Bell RA, Ammerman AS, Laska MN. A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017-2020. Int J Behav Nutr Phys Act 2021; 18:44. [PMID: 33761952 PMCID: PMC7990380 DOI: 10.1186/s12966-021-01109-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The North Carolina (NC) Healthy Food Small Retailer Program (HFSRP) was passed into law with a $250,000 appropriation (2016-2018) providing up to $25,000 in funding to small food stores for equipment to stock healthier foods and beverages. This paper describes an observational natural experiment documenting the impact of the HFSRP on store food environments, customers' purchases and diets. METHODS Using store observations and intercept surveys from cross-sectional, convenience customer samples (1261 customers in 22 stores, 2017-2020; 499 customers in 7 HFSRP stores, and 762 customers in 15 Comparison stores), we examined differences between HFSRP and comparison stores regarding: (1) change in store-level availability, quality, and price of healthy foods/beverages; (2) change in healthfulness of observed food and beverage purchases ("bag checks"); and, (3) change in self-reported and objectively-measured (Veggie Meter®-assessed skin carotenoids) customer dietary behaviors. Differences (HFSRP vs. comparison stores) in store-level Healthy Food Supply (HFS) and Healthy Eating Index-2010 scores were assessed using repeated measure ANOVA. Intervention effects on diet were assessed using difference-in-difference models including propensity scores. RESULTS There were improvements in store-level supply of healthier foods/beverages within 1 year of program implementation (0 vs. 1-12 month HFS scores; p = 0.055) among HFSRP stores only. Comparing 2019 to 2017 (baseline), HFSRP stores' HFS increased, but decreased in comparison stores (p = 0.031). Findings indicated a borderline significant effect of the intervention on self-reported fruit and vegetable intake (servings/day), though in the opposite direction expected, such that fruit and vegetable intake increased more among comparison store than HFSRP store customers (p = 0.05). There was no significant change in Veggie Meter®-assessed fruit and vegetable intake by customers shopping at the intervention versus comparison stores. CONCLUSIONS Despite improvement in healthy food availability, there was a lack of apparent impact on dietary behaviors related to the HFSRP, which could be due to intervention dose or inadequate statistical power due to the serial cross-sectional study design. It may also be that individuals buy most of their food at larger stores; thus, small store interventions may have limited impact on overall eating patterns. Future healthy retail policies should consider how to increase intervention dose to include more product marketing, consumer messaging, and technical assistance for store owners.
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Affiliation(s)
- Stephanie B. Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC 27834 USA
| | - Kimberly P. Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Healthy Weight Research Center, University of Minnesota School of Public Health, Minneapolis, MN 55454 USA
| | - Ann P. Rafferty
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural & Human Sciences, North Carolina State University, Raleigh, 27695 USA
| | - Kathryn A. Boys
- Department of Agricultural & Resource Economics, North Carolina State University, Raleigh, 27695 USA
| | - Jared T. McGuirt
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, 27412 NC USA
| | | | - Nevin Johnson
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Archana P. Kaur
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Ronny A. Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, 27157 USA
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157 USA
| | - Alice S. Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Melissa N. Laska
- Healthy Weight Research Center, University of Minnesota School of Public Health, Minneapolis, MN 55454 USA
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