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

Lindsey Haynes-Maslow¹  Kathryn A. Boys²  Qiang Wu³  Alice S. Ammerman⁴  Kimberly P. Truesdale⁵  Jared T. McGuirt⁶  Ann P. Rafferty⁷  Nevin Johnson⁷  Archana P. Kaur⁷  Stephanie B. Jilcott Pitts⁷  Ronny A. Bell⁸  Sheila Fleischhacker⁹  Melissa N. Laska^1,10 

[1] Department of Agricultural & Human Sciences, North Carolina State University, 27695, Raleigh, USA;Department of Agricultural & Resource Economics, North Carolina State University, 27695, Raleigh, USA;Department of Biostatistics, East Carolina University, 27834, Greenville, NC, USA;Department of Nutrition, University of North Carolina at Chapel Hill, 27599, Chapel Hill, NC, USA;Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 27599, Chapel Hill, NC, USA;Department of Nutrition, University of North Carolina at Chapel Hill, 27599, Chapel Hill, NC, USA;Healthy Weight Research Center, University of Minnesota School of Public Health, 55454, Minneapolis, MN, USA;Department of Nutrition, University of North Carolina at Greensboro, 27412, Greensboro, NC, USA;Department of Public Health, Brody School of Medicine, East Carolina University, 27834, Greenville, NC, USA;Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, 27157, Winston-Salem, USA;Wake Forest Baptist Comprehensive Cancer Center, 27157, Winston-Salem, NC, USA;Georgetown University Law Center, 20001, Washington, DC, USA;Healthy Weight Research Center, University of Minnesota School of Public Health, 55454, Minneapolis, MN, USA;

关键词: Healthy corner stores;    Food environment;    Health policy;    Food desert;    Rural;    Fruits and vegetables;   

DOI  :  10.1186/s12966-021-01109-8

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsUsing 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.ResultsThere 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.ConclusionsDespite 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.

【 授权许可】

CC BY