A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017–2020
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 na...
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2021-03-01
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Series: | International Journal of Behavioral Nutrition and Physical Activity |
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Online Access: | https://doi.org/10.1186/s12966-021-01109-8 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stephanie B. Jilcott Pitts Qiang Wu Kimberly P. Truesdale Ann P. Rafferty Lindsey Haynes-Maslow Kathryn A. Boys Jared T. McGuirt Sheila Fleischhacker Nevin Johnson Archana P. Kaur Ronny A. Bell Alice S. Ammerman Melissa N. Laska |
spellingShingle |
Stephanie B. Jilcott Pitts Qiang Wu Kimberly P. Truesdale Ann P. Rafferty Lindsey Haynes-Maslow Kathryn A. Boys Jared T. McGuirt Sheila Fleischhacker Nevin Johnson Archana P. Kaur Ronny A. Bell Alice S. Ammerman Melissa N. Laska A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017–2020 International Journal of Behavioral Nutrition and Physical Activity Healthy corner stores Food environment Health policy Food desert Rural Fruits and vegetables |
author_facet |
Stephanie B. Jilcott Pitts Qiang Wu Kimberly P. Truesdale Ann P. Rafferty Lindsey Haynes-Maslow Kathryn A. Boys Jared T. McGuirt Sheila Fleischhacker Nevin Johnson Archana P. Kaur Ronny A. Bell Alice S. Ammerman Melissa N. Laska |
author_sort |
Stephanie B. Jilcott Pitts |
title |
A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017–2020 |
title_short |
A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017–2020 |
title_full |
A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017–2020 |
title_fullStr |
A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017–2020 |
title_full_unstemmed |
A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017–2020 |
title_sort |
four-year observational study to examine the dietary impact of the north carolina healthy food small retailer program, 2017–2020 |
publisher |
BMC |
series |
International Journal of Behavioral Nutrition and Physical Activity |
issn |
1479-5868 |
publishDate |
2021-03-01 |
description |
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. |
topic |
Healthy corner stores Food environment Health policy Food desert Rural Fruits and vegetables |
url |
https://doi.org/10.1186/s12966-021-01109-8 |
work_keys_str_mv |
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doaj-0b6a181f57b947bf8fe3b12cd01a45a52021-03-28T11:25:06ZengBMCInternational Journal of Behavioral Nutrition and Physical Activity1479-58682021-03-0118111210.1186/s12966-021-01109-8A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017–2020Stephanie B. Jilcott Pitts0Qiang Wu1Kimberly P. Truesdale2Ann P. Rafferty3Lindsey Haynes-Maslow4Kathryn A. Boys5Jared T. McGuirt6Sheila Fleischhacker7Nevin Johnson8Archana P. Kaur9Ronny A. Bell10Alice S. Ammerman11Melissa N. Laska12Department of Public Health, Brody School of Medicine, East Carolina UniversityDepartment of Biostatistics, East Carolina UniversityDepartment of Nutrition, University of North Carolina at Chapel HillDepartment of Public Health, Brody School of Medicine, East Carolina UniversityDepartment of Agricultural & Human Sciences, North Carolina State UniversityDepartment of Agricultural & Resource Economics, North Carolina State UniversityDepartment of Nutrition, University of North Carolina at GreensboroGeorgetown University Law CenterDepartment of Public Health, Brody School of Medicine, East Carolina UniversityDepartment of Public Health, Brody School of Medicine, East Carolina UniversityDepartment of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of MedicineDepartment of Nutrition, University of North Carolina at Chapel HillHealthy Weight Research Center, University of Minnesota School of Public HealthAbstract 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.https://doi.org/10.1186/s12966-021-01109-8Healthy corner storesFood environmentHealth policyFood desertRuralFruits and vegetables |