Healthy Bodegas: Increasing and Promoting Healthy Foods at Corner Stores in New York City

摘要

Objectives. We assessed the effectiveness of an initiative to increase the stock and promotion of healthy foods in 55 corner stores in underserved neighborhoods. Methods. We evaluated the intervention through in-store observations and preintervention and postintervention surveys of all 55 store owners as well as surveys with customers at a subset of stores. Results. We observed an average of 4 changes on a 15-point criteria scale. The most common were placing refrigerated water at eye level, stocking canned fruit with no sugar added, offering a healthy sandwich, and identifying healthier items. Forty-six (84%) store owners completed both surveys. Owners reported increased sales of healthier items, but identified barriers including consumer demand and lack of space and refrigeration. The percentage of customers surveyed who purchased items for which we promoted a healthier option (low-sodium canned goods, low-fat milk, whole-grain bread, healthier snacks and sandwiches) increased from 5% to 16%. Conclusions. Corner stores are important vehicles for access to healthy foods. The approach described here achieved improvements in participating corner stores and in some consumer purchases and may be a useful model for other locales. Access to healthier food is associated with a healthier diet. 1–8 Supermarkets, which tend to offer a larger variety of healthier foods such as fresh produce, 9,10 are especially important. People who do not live near a supermarket are as much as 46% less likely to have a healthy diet than are people with the most supermarkets nearby. 11 The presence of supermarkets has also been associated with a lower prevalence of obesity. 12–14 Low-income and minority communities, which bear a disproportionately high burden of obesity, diabetes, and other diet-related diseases, generally have fewer supermarkets than do other communities. 7,9,10 A national study found that low-income areas had only 75% as many chain supermarkets as did middle-income areas and that Black neighborhoods had roughly half as many chain supermarkets as did White neighborhoods. 7 These areas are instead highly populated with smaller convenience or corner stores. 8,15,16 These corner stores are less likely to carry healthy foods such as fresh fruits or vegetables, 15,17 heavily advertise unhealthy products, and are laden with convenience items that are often high in calories. 2,3,7,17 The presence of corner stores has been associated with increased risk of obesity, 4,18 a finding which is particularly relevant in New York City’s most underserved neighborhoods, where corner stores, often termed bodegas , can make up more than 80% of retail food outlets. 2 Researchers have pointed to the potential for increasing consumption of healthy foods by making environmental changes in retail food outlets, including corner stores. 1,19 In urban settings, these changes may be particularly relevant because corner stores are regularly frequented by neighborhood residents. In New York City, bodegas receive an average of 703 customer visits from 8:00 am to 8:00 pm (556 from adults and 147 from youths; R. Dannefer, MPH, MIA, A. Sperling, MPH, S. Baronberg, MPH, and A. Abrami, MS, RD, unpublished data, 2009). A study in Philadelphia, Pennsylvania, revealed that children frequenting corner stores near their schools bought an average of 357 calories per visit and mostly purchased energy-dense products with little nutritional value such as chips, candy, and sugary drinks. 20 Given the ubiquity of corner stores in underserved communities, many interventions have been developed to increase their healthy offerings, using a variety of strategies to change the store environment. 21–24 For example, an intervention with corner stores and supermarkets in Baltimore, Maryland, provided store owners with monetary incentives, in-store materials, recommendations for stocking and promoting healthy foods, guidelines for interacting with customers, nutrition education, and taste tests. Participating corner stores demonstrated significant increases in stocking healthy foods, and consumer purchases of some healthy foods increased. 21 Other programs have used promotional materials, local advertising and mass media messaging, cooking demonstrations, and taste tests to promote healthy foods. Positive findings from these interventions have included increases in stores’ stock of healthy foods and, in 1 case, increased purchases of some healthy foods. 22–24 These findings are complemented by research indicating that changes in the retail environment can effect changes in sales; for example, strategies such as increasing shelf space, in-store advertising, and locating foods in prime areas have all been demonstrated to increase sales for the promoted items. 22 One of the country’s largest corner store programs to date is the Healthy Bodegas Initiative, coordinated by the New York City Department of Health and Mental Hygiene and funded by the New York City Center for Econ