Section D
Baltimore Healthy Stores
Baltimore Healthy Stores Goals

To increase availability and access to healthy foods for residents of
Baltimore City

To promote these foods at the point of purchase

To work in collaboration with community agencies, the city of
Baltimore, and local food sources
2
Healthy Foods Availability in Baltimore City*
Type of food stores
Healthy food
availability
index, mean
(range 0–27)
Skim milk
(%)
Fruit
(%)
1–25
≥26
Vegetables
(%)
1–25
≥26
Whole wheat
bread
(%)
Supermarkets (16)
19.0
100
25
69
13
81
100
Grocery/corner
stores (107)
4.4
25
43
3
57
3
8
“Behind-theglass” stores (20)
2.0
0
0
0
0
0
0
Convenience stores
(33)
3.8
36
33
0
21
0
24
*Franco data, n = 176
3
A Corner Store
4
Store Interior
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Baltimore Healthy Stores, Round 1

East Baltimore: intervention area

West Baltimore: comparison area

Store sample
-  Two supermarkets per area
-

Six to seven small stores per
area
Consumer sample
-
Eighty-seven respondents per
area
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Top Sources of Energy, Fat, and Sugar (Baltimore City)

Top ten sources of energy, fat, and sugar of inner city adult
respondents in Baltimore (Sharma et al.)
Energy
Food item
Fat
Energy
(%)
Food item
Sugar
Fat
(%)
Food item
Sugar
(%)
Sodas
9.5
Chicken
12.1
Sodas
34.1
Chicken
8.2
Hot dogs, sausages
8.1
Sugary drinks (iced tea, punch)
15.2
Breads
6.0
Chips
6.3
Juices
9.0
Cake, donut and other pastry
4.2
Meat dishes
5.2
Sugar and syrup
8.3
Sandwiches and burgers
4.0
Margarine and butter
5.2
Cake, pastry and donut
4.2
Sugary drinks
3.8
Cake, donut and other pastry
5.1
Candies
4.1
Chips
3.7
Mayo, salad dressing, dips
4.9
Ice cream
3.2
Pasta dishes
3.3
Sandwiches and burgers
4.5
Cookies
2.5
Meat dishes
3.1
Cheese
4.3
Fruits
2.1
Candies
2.9
Eggs
4.0
Cereals
1.6
Total
48.7
Total
59.8
Total
84.3
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Baltimore Healthy Stores Phases
Phase 0: Teasers/Recruitment
Phase 1: Healthy Eating for your Kids
Phase 2: Cooking at Home
Phase 3: Healthy Snacks
Phase 4: Carryout Foods
Phase 5: Low-Calorie Drinks
8
Intervention Activities

Stop, Shop, Save
Phase 2: Healthy Breakfast
9
Phase 0: Documents for Store Owners

Cultural guidelines for Korean store owners
10
Phase 1: Low-Calorie Beverages
Flyer
Educational display
Coupon
11
Phase 2: Healthy Breakfast
Flyer
Educational display
12
Phase 3: Cooking at Home
Posters
13
Phase 4: Healthy Carryout
Educational display
Flyer
14
Phase 5: Healthy Snacks
Posters
15
BHS Evaluation Plan
Instrument
Pre-
Mid-
Post-
Followup
x
x
Process evaluation
  Store process evaluation
  Store owner process evaluation
  Cooking demo, taste test evaluation
  Cooking demo, taste test customer evaluation
  Weekly interventionist progress report
x
x
x
x
x
Store impact and feasibility
  Store impact questionnaire
  Bi-weekly food sales (corner)
  In-depth interviews
x
x
x
x
x
x
Customer impact and feasibility
  Customer impact questionnaire
  Food frequency questionnaire
  Customer feasibility interviews
x
x
x
x
x
x
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Store Results

Average stocking/sales feasibility scores at baseline, post-phase,
and post-intervention
Average stocking feasibility scores
(Score range 0–10)
Average sales feasibility score
(Score range 0–10)
Intervention
Comparison
Significance
Intervention
Comparison
Significance
Baseline
5.9 ± 2.0
6.8 ± 1.6
NS
4.4 ± 1.8
5 ± 1.5
NS
Post-phase
8.3 ± 1.0
6 ± 1.8
0.004
7.1 ± 2.0
5.8 ± 1.8
0.05
Postintervention
7 ± 2.0
5.5 ± 1.5
0.009
6.4 ± 1.8
4.7 ± 1.5
0.003
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Consumer Results

After adjustment for baseline value, age, sex, and SES
-  Significant impact on food preparation methods and frequency
of purchase of promoted foods
-
Trend of impact on food intentions
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Eight Total Programs
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Healthy Stores Studies Summary
Intervention components
Program
Marshall Islands
Healthy Stores
Apache Healthy
Stores 1,2
Zhiiwaapenewin
Akino’maagewin
Basic
store
activities
Other
store
activities
X
Consumer
psychosocial
factors
Consumer
behavior
Store
Knowledge
Healthy food
purchasing
N/A
X
X
(Commodity,
vendors rd 2)
Knowledge
Healthy food
purchasing and
consumption
Increased
stocking and
sales
X
X
(Schools,
HSS)
Knowledge
(assoc. w/
exposure)
Healthy food
purchasing
N/A
X (CAC,
churches)
Intentions
Healthy
cooking
methods,
purchasing
labeled foods
Increased
stocking and
sales
Media
Other venues
X
X
X
Impact observed
Baltimore Healthy
Stores 1,2
X
Healthy Foods
Hawaii
X
X
X (Producers,
distributors)
?
?
?
Healthy Foods North
(Arctic)
X
X
X (Worksites,
HSS)
?
?
?
Navajo Healthy
Stores
X
?
?
?
X
X
X
20
Future Directions

Baltimore Healthy Stores
-  Baltimore Healthy Eating Zones (youth)
-
Baltimore Healthy Church Zones (adult churchgoers)

Zhiiwaapenewin Akino’maagewin
-  Proposed expanded trial under review by USDA/NRI

Navajo Healthy Stores
-  Producer formative research
-  Farms to Table program
21
Acknowledgments

Collaborators
-  Jean Anliker, U Mass
-  Benjamin Caballero, JHSPH
-  Sally Davis, UNM
-  Elsie DeRoose, GNWT
-  Kevin Frick, JHSPH
-  Rachel Novotny, U Hawaii
-  Cindy Roache, GN
-  Sangita Sharma, PhD
-  Allan Steckler, UNC

Community partners
-  Bashas supermarkets
-  Red Mesa Stores
-  Diabetes Prevention Programs
-  Kids on the Hill
-  Government of Nunavut, NWT
-  Tribal Governments
-  Special Diabetes Programs

Students and staff
-  Chrisa Arcan
-  Mirielle Begay

Former and ongoing students/staff
-  Xia Cao
-  Sarah Curran
-  Justine Dang
-  Nadine Eads
-  Becky Ethelbah
-  Jill Faucette
-  Attia Goheer
-  Lara Ho
-  Sharla Jennings
-  David Lessens
-  Jessica Noel
-  Ogban Omoronia
-  Stephanie Oppenheimer
-  Marla Pardilla
-  Wendy Pavlovich
-  Irit Rasooly
-  Hannah Reddick
-  Amanda Rosecrans
-  Hee-Jung Song
-  Melanie Thurber
-  Muge Qi
-  Amy Vastine
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Funders

Center for a Livable Future

USDA/Food Assistance Nutrition Research Program

USDA/National Research Institute

Robert Wood Johnson Foundation Healthy Eating Research program

American Diabetes Association

Stulman Foundation

Isador and Gladys Foundation
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