Underlying Logic: The Baltimore Healthy Stores (BHS) intervention uses constructs of the Social Ecological Models and Social Cognitive Theory, including: knowledge; reciprocal determinism; and self-efficacy and behavioral intentions to select, prepare and consume healthier foods.
Strategies Used1: The BHS intervention includes strategies related to healthy eating:
- Changing access and availability to favor healthy foods and beverages, in particular the stocking of healthier foods in corner stores.
- Point-of-purchase and point-of-decision labeling to favor healthy foods and beverages, such as labeling on the store shelves and posters promoting healthier food items.
The BHS intervention was evaluated as a quasi-experimental study with a comparison group.
The intervention group consisted of 9 stores (7 corner and 2 supermarkets) in East Baltimore, while the comparison group was comprised of 8 stores (6 corner and 2 supermarkets) in West Baltimore. East and West Baltimore are two of the poorest areas in Baltimore City.
Data were collected at multiple levels: 1) at the store level, data were collected related to environmental and practice changes (e.g., food stocking, placement, and preparation); 2) at the store owner level, data were collected related to psycho-social impact of the intervention (e.g., knowledge of nutrition, self-efficacy to change stocking and food preparation, and intentions to change stocking and food preparation); and 3) at the consumer level, data were collected related to behavior change (e.g., increased purchasing and consumption of healthier foods) and psycho-social impact of the intervention (e.g., knowledge of nutrition, self-efficacy to change diet, and intentions to change diet).
At the consumer-level, 175 people were recruited at baseline from study supermarkets and corner stores and community action centers that serve East and West Baltimore. Despite multiple attempts to re-contact participants, only 84 (48% of original baseline sample) were re-interviewed at post intervention. The consumer-level outcome data are based on the 84 post-intervention respondents (intervention group n=45 and comparison group n=39).
Store-level: More corner stores in the intervention group showed increased stocking of some of the promoted healthy foods (low-sugar cereals, baked/low-fat chips, low-salt crackers, and cooking spray) from baseline to immediately post intervention (p=0.009). Six months after the intervention, the stocking of baked/low-fat chips, low-salt crackers, cooking spray, and whole wheat breads was sustained in the intervention group. No other data was collected at the six-month follow-up period.
In the intervention group, weekly sales* of low-sugar cereals, cooking spray, baked/low-fat chips, low-salt crackers, whole wheat bread, and 100% fruit juices increased from baseline to post-intervention. However, sales of cooking spray was the only statistically significant outcome for a particular food (p=0.05). Weekly sales of other promoted foods, such as diet soda/diet drinks and water, decreased in the same time period, although the results were not significant.
*Weekly sales data were determined from store owners’ recall.
Store owner-level: Overall, no significant changes in overall outcome expectations, self-efficacy and knowledge scores were observed comparing the intervention and comparison group store owners. However, significant changes were observed for some specific foods: outcome expectations for sales of low-salt crackers decreased for comparison store owners (p=0.04); outcome expectations for the effectiveness of taste tests tended to increase for intervention store owners (p=0.06); self-efficacy scores for stocking certain healthy foods such as low-sugar cereals increased for intervention store owners, while it decreased for comparison store owners (p=0.01).
Consumer-level: Healthy food preparation behavior, measured by pre-and post-intervention questionnaires, significantly improved in the intervention consumers as compared to comparison group (p