Store and restaurant advertising and health of public housing residents

Evaluation of Store Environment Changes of an In-Store Intervention to Promote Fruits and Vegetables in Latino/Hispanic-Focused Food Stores

Implementing interventions that manipulate food store environments are one potential strategy for improving dietary behaviors. The present study evaluated intervention effects, from the El Valor de Nuestra Salud (The Value of Our Health) study, on in-store environmental changes within Latino/Hispanic-focused food stores (tiendas). Sixteen tiendas were randomly assigned to either: a six-month structural and social food store intervention or a wait-list control condition. Store-level environmental measures of product availability, placement, and promotion were assessed monthly from baseline through six-months post-baseline using store audits. Linear mixed effects models tested for condition-by-time interactions in store-level environmental measures. Results demonstrated that the intervention was successful at increasing the total number of fruit and vegetable (FV) promotions (p < 0.001) and the number of FV promotions outside the produce department (p < 0.001) among tiendas in the intervention versus control condition. No changes in product availability or placement were observed. Results suggests changing the marketing mix element of promotions within small stores is measurable and feasible in an in-store intervention. Difficulties in capturing changes in product availability and placement may be due to intervention implementation methods chosen by tiendas. It is important to build upon the lessons learned from these types of interventions to disseminate evidence-based in-store interventions.

Cross-Country Comparison of School Neighborhood Food Environments in Houston, Texas and Guadalajara, Mexico

Studies in the U.S. and Mexico have observed the clustering of food resources around schools, which may promote the use of these resources. Our study characterized and compared school neighborhood food environments in Guadalajara, Jalisco, and Houston, Texas, and examined socioeconomic disparities in food resource availability across school neighborhoods. We used the Goods and Services Inventory to document the frequency and type of resources within each school neighborhood. School neighborhoods in Guadalajara had significantly more food resources than those in Houston. We found that convenience stores and table service restaurants were the most prevalent food resources in school neighborhoods in both cities. Guadalajara school neighborhoods had a higher prevalence of supermarkets and grocery stores than Houston. Low-income school neighborhoods in Guadalajara with poorly educated residents had significantly more food carts than high-income neighborhoods with more educated residents. In Houston, we found significantly more fast food restaurants and convenience stores in school neighborhoods with more educated residents than school neighborhoods with less educated residents. The influence of food resources within school neighborhoods on the dietary habits of schoolchildren should be further explored in both the U.S. and Mexico. The characterization of school neighborhood food environments can inform policymakers, city planners, and school officials who seek to implement policies to create healthier food environments.

Examination of the Relationship between In-Store Environmental Factors and Fruit and Vegetable Purchasing among Hispanics

Retail food environments have received attention for their influence on dietary behaviors and for their nutrition intervention potential. To improve diet-related behaviors, such as fruit and vegetable (FV) purchasing, it is important to examine its relationship with in-store environmental characteristics. This study used baseline data from the “El Valor de Nuestra Salud” study to examine how in-store environmental characteristics, such as product availability, placement and promotion, were associated with FV purchasing among Hispanic customers in San Diego County. Mixed linear regression models indicated that greater availability of fresh FVs was associated with a $0.36 increase in FV purchasing (p = 0.01). Placement variables, specifically each additional square foot of display space dedicated to FVs (p = 0.01) and each additional fresh FV display (p = 0.01), were associated with a $0.02 increase and $0.29 decrease, respectively, in FV purchasing. Introducing FV promotions in the final model was not related to FV purchasing. Exploratory analyses indicated that men reported spending $3.69 fewer dollars on FVs compared to women, controlling for covariates (p = 0.02). These results can help inform interventions targeting in-store environmental characteristics to encourage FV purchasing among Hispanics.

Small Convenience Stores and the Local Food Environment: An Analysis of Resident Shopping Behavior Using Multilevel Modeling

PURPOSE

Local food environments can influence the diet and health of individuals through food availability, proximity to retail stores, pricing, and promotion. This study focused on how small convenience stores, known in New York City as bodegas, influence resident shopping behavior and the food environment.

DESIGN

Using a cross-sectional design, 171 bodegas and 2118 shoppers were sampled.

SETTING

Small convenience stores in New York City.

SUBJECTS

Any bodega shopper aged 18+ who purchased food or beverage from a participating store.

MEASURES

Data collection consisted of a store assessment, a health and behavior survey given to exiting customers, and a bag check that recorded product information for all customer purchases.

ANALYSIS

Descriptive statistics were generated for bodega store characteristics, shopper demographics, and purchase behavior. Multilevel models were used to assess the influence of product availability, placement, and advertising on consumer purchases of sugar-sweetened beverages (SSBs), water, and fruits and vegetables.

RESULTS

Seventy-one percent of participants reported shopping at bodegas five or more times per week, and 35% reported purchasing all or most of their monthly food allotment at bodegas. Model results indicated that lower amounts of available fresh produce were significantly and independently associated with a higher likelihood of SSB purchases. A second, stratified multilevel model showed that the likelihood of purchasing an SSB increased with decreasing varieties of produce when produce was located at the front of the store. No significant effects were found for water placement and beverage advertising.

CONCLUSIONS

Small convenience stores in New York City are an easily accessible source of foods and beverages. Bodegas may be suitable for interventions designed to improve food choice and diet.

Health care and end-of-life decisions: community engagement with adults in East Harlem

This was a model of community engagement for a Hispanic population in East Harlem, New York City to assess health care decision-making processes, with a focus on end-of-life decisions, among older men and women. The design involved two senior center-based semi-structured focus groups conducted in Spanish and English followed by a series of bilingual skills-building workshops focusing on situational decision-making. All program aspects were conducted between April and June of 2013. The themes for the workshops included: "Getting the most from your pharmacist encounter;" "How to prepare for your primary care visit;" and "I am getting discharged from the hospital: what do I do?" For the two focus groups, 21 community members participated, each of whom self-identified as Hispanic or Latina/o. Ten common themes emerged from a two-stage/two coder, grounded theory-based qualitative analysis and included: Where Community Members Receive Care; General Challenges, Cultural Challenges, and Benefits of Health Care in New York City/East Harlem; Key Facilitators in Health Care Decision Making; Key Facilitators in End-of-Life Decision Making; and Perceptions of Health Care Disparity. Themes and their subcategories, discussed herein, may offer guidance for area health providers and health care delivery entities. This project served as formative, qualitative data collection for a larger scale forthcoming community assessment while offering community benefit related to health decision-making, especially end-of-life decision making, in the context of a rapidly changing urban American health care delivery landscape. Application of this synergistic community benefit and data collection model is recommended for similar and other communities in the U.S. and other countries.

Outdoor advertising, obesity, and soda consumption: a cross-sectional study

Background

Recent research has shown that neighborhood characteristics are associated with obesity prevalence. While food advertising in periodicals and television has been linked to overweight and obesity, it is unknown whether outdoor advertising is related to obesity.

Methods

To test the association between outdoor food advertising and obesity, we analyzed telephone survey data on adults, aged 18–98, collected from 220 census tracts in Los Angeles and Louisiana. We linked self-reported information on BMI and soda consumption with a database of directly observed outdoor advertisements.

Results

The higher the percentage of outdoor advertisements promoting food or non-alcoholic beverages within a census tract, the greater the odds of obesity among its residents, controlling for age, race and educational status. For every 10% increase in food advertising, there was a 1.05 (95% CI 1.003 - 1.093, p<0.03) greater odds of being overweight or obese, controlling for other factors. Given these predictions, compared to an individual living in an area with no food ads, those living in areas in which 30% of ads were for food would have a 2.6% increase in the probability of being obese.

Conclusions

There is a relationship between the percentage of outdoor food advertising and overweight/obesity.