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					Baltimore Healthy Stores
• 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.
Guiding Principles and Goals
• To work with local merchants to offer more healthy

• To increase sales and consumption of healthy foods

• To teach healthy food preparation methods

• To form partnerships with local food stores and

• To form partnerships with community organizations
       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
   – 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)
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
     Food Sources Used In the Last Six Months %*
    Location                                                       %
    Supermarket                                                    94
    Fast Food                                                      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

* Respondents were permitted to check all food sources they used
          Reported Reasons for Using a Food Source*
     Reason                 Reason for only    Reason for two     Reason for all        Number of           % of all
                               one food         food sources        three food       times response       responses
                             source (no. of        (no. of        sources (no. of      was provided
                             respondents)       respondents)       respondents

     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                 1                  1                  1                   8                 2
     Accessible by public         1                  0                  1                   4                 1

     Accept WIC or                0                  0                  1                   3                 1
     food stamps
     Credit available             2                  0                  0                   2                 1

* 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.
         Type of Milk Gotten, %*
                 (Respondents = 50)

   20%                                              14%
            Whole        2 percent     1 percent   Skim

*Respondents may select more than one type
  “Low fat milk is better for your
     health than whole milk”
70%     64%



30%                           24%

      Agree    Undecided   Disagree
“Low-fat milk contains the same nutrients as
   whole milk except for the fat content”
   40%                            38%

   20%                 18%
         Agree     Undecided   Disagree
   What would help the community?
Option                                     % of respondents who             % of total
                                             chose this option             responses*

Improve food prices                                  54                        21
Establish standards of                               38                        14
cleanliness in stores
Bring stores closer to homes                         36                        13
Increase food selection in stores                    30                        12
Start farmers‟ markets in the                        26                        10
Provide public transportation to                     24                            9
Teach healthier cooking methods                      18                            8
Establish a community garden                         10                            4
Expand WIC acceptance to                             10                            4
corner stores

*Respondents were permitted to select three options for a total of 138 responses
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
       Foods Mentioned One or More Times, %

Food Item       % of Total   Food Item             % of Total
White bread       51%        Cookies                 15%
Soda (cola)       51%        Hot dog                 14%
Potato chips      39%        Chicken wings           14%
Cheese            37%        Soda (non-cola)         14%
Sugar             30%        Whole milk              11%
Coffee            27%        Bacon                   11%
Eggs              24%        Hamburger                8%
Mayonnaise        21%        Cake                     8%
French fries      20%        Rice                     8%
Candy             15%        Cereal (high-sugar)      7%
Vegetable/Fruit and Other „Healthy‟ Foods
   Consumed One or More Times, %

Food Item                   % of Total
Fresh fruit                   30%
Canned vegetables             14%
Fruit juice                   13%
Fresh/frozen vegetables       11%
Cereal (low-sugar)            11%
Fish                          11%
2% Milk                       11%
Green salad                   10%
Canned fruit                   3%
Yogurt                         1%
   Qualitative Research with Local Stores
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.”
   Qualitative Research with Local Stores
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
   Qualitative Research with Local Stores
Relationships with customers in the community:
• Problem with customers
   – Stealing, cursing, “drug people,” crime, teenagers particularly
• 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.”
         Food Source Survey
• Census tracts randomly selected:
  –   East Baltimore (803.01)
  –   West Baltimore (1503)
  –   Park Heights (1513)
  –   Federal Hills (2403)
  –   Cherry Hill (2502.07)
       Differences between tracts in
            healthy food options
Census Area             Low-fat    3+ Fresh        Average
Tract                   Milk       Fruit/Vegetable Milk Price
                        Sources    Sources
803.01   East              0             0            $3.36
1503     West              0             0            $3.19
1513     Park            1 (10%)      1 (10%)         $3.02
2403     Federal Hill    2 (8%)        1 (4%)         $2.96

2502.07 Cherry Hill      1 (9%)        1(9%)          $2.67
   Qualitative Research with Community
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”

• 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
• 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.‟”
   Qualitative Research with Community
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.”
   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

• 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
    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)
 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
             Future Work
• Need to continue to establish strong
  community partnerships
• Develop and refine intervention strategies
  in collaboration with project partners
• Implement intervention to determine
Community Organizations/Baltimore
   Healthy Stores Collaboration
• Community Organizations
  – Support Baltimore Healthy Stores through awareness
    of goals and strategies
  – Review and provide feedback on intervention
  – Serve as venue for community outreach

• Baltimore Healthy Stores
  – Implement and evaluate program
  – Report findings to merchants
  – Make public intervention materials

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