Baltimore Healthy Stores Project

1. Baltimore Healthy Stores Project

2. 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. Mission

3. 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

4. Formative Phase:February 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 (n=75)

5. Consumer Survey of Food Shopping and Preparation Patterns (n=50) • 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

6. Supermarket 94 FastFood 77 Carry-out 76 Full-service restaurants 72 Corner Stores 70 Wholesaler 54 Farmer’s Market/Public Markets 52 Convenience Store 50 Specialty Stores 44 Vending Machines 34 Bars 20 Church 20 Food Pantry 12 Soup Kitchen 10 Community Center 10 Community Garden 6 Food Sources Used In the Last Six Months %* Location % * Respondents were permitted to check all food sources they used

7. Reason Reason for only one food source (no. of respondents) Reason for two food sources (no. ofrespondents) Reason for all three food sources (no. of respondents Number of times response was provided % of all responses Close to home 12 15 13 103 28 Less expensive 17 13 2 61 17 Better quality 17 3 3 38 10 Greater variety 16 3 1 31 8 Clean 8 3 2 22 6 Close to work 5 3 1 14 4 Good services 8 1 1 14 4 Have certain items 4 1 1 12 3 Know the owner 6 1 1 11 3 Free food or meals 1 1 1 8 2 Accessible by public transportation 1 0 1 4 1 Accept WIC or food stamps 0 0 1 3 1 Credit available 2 0 0 2 1 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.

8. Type of Milk Gotten, %*(Respondents = 50) *Respondents may select more than one type

9. “Low fat milk is better for your health than whole milk”

10. “Low-fat milk contains the same nutrients as whole milk except for the fat content”

11. Option % of respondents who chose this option % of total responses* Improve food prices 54 21 Establish standards of cleanliness in stores 38 14 Bring stores closer to homes 36 13 Increase food selection in stores 30 12 Start farmers’ markets in the community 26 10 Provide public transportation to stores 24 9 Teach healthier cooking methods 18 8 Establish a community garden 10 4 Expand WIC acceptance to corner stores 10 4 What would help the community? *Respondents were permitted to select three options for a total of 138 responses

12. 24-hour Dietary Recall Surveys, n=71 • 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

13. Foods Mentioned One or More Times, %

14. Vegetable/Fruit and Other ‘Healthy’ Foods Consumed One or More Times, %

15. 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 don’t 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 don’t buy what consumers never buy, only buy popular product otherwise sits there, gets bad, we don’t want product to sit there, if not sell, try to avoid stock doesn’t 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 can’t come in. So people buy same stuff.”

16. 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

17. 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.”

18. Food Source Survey • Census tracts randomly selected: • East Baltimore (803.01) • West Baltimore (1503) • Park Heights (1513) • Federal Hills (2403) • Cherry Hill (2502.07)

19. Differences between tracts in healthy food options

20. 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 don’t know if everyone can smell it, but can. If you go to Giant, you don’t 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 don’t 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 they’ll say, ‘The streets are dangerous, you can’t walk on the streets.’”

21. 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 doesn’t 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 left…they moved out to the county and because they weren’t 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.”

22. 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 they’re working two jobs, or their working and going to school, but they got the busy schedules. There’s 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.”

23. 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)

24. 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 Men’s Center • Middle East Community Development Corporation • Historic East Baltimore Community Action Coalition • Baltimore’s Safe and Sound Campaign • St. Francis Academy • Super A Farms • Baltimore Public Markets Corporation • Stop, Shop, and Save Food Markets

25. 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

26. 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