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Baltimore Healthy Stores (BHS)

Potential for Public Health Impact

Reach: This program has the potential to reach a large number of low-income individuals as it aims to increase the availability of healthy foods in existing small stores within low-income, urban areas, which generally have limited access to healthy foods.  However, the reach of the different components of the intervention varied. Taste tests/interactive sessions had good reach, while the reach of print materials and coupons/incentive cards was inconsistent.

Effectiveness: There is evidence for small environmental and behavioral changes resulting from this intervention.  Data available at the time of the review suggest that, compared to the comparison stores, the intervention stores were more likely to stock healthier foods.  However, some corner stores stocked certain healthy foods prior to the intervention.  The intervention stores did have increased sales of promoted healthy foods, but, with the exception of cooking sprays, those increases were statistically non-significant.  Participants based in the intervention area of Baltimore also reported improved healthy food preparation.

Adoption: The Healthy Stores intervention approach has been implemented in other locations, including the Republic of the Marshall Islands, Apache Reservations in Arizona, Ontario First Nation Reserves, and Hawaii with significant impacts observed related to food purchasing, consumption, and preparation behavior.  The Apache Healthy Store (AHS) program included in-store point-of-purchase signage (shelf labels, posters, displays), working with stores to stock a broader range of healthy foods, interactive sessions (taste tests, cooking demonstrations), and mass media communication (radio and local newspapers) to reinforce key themes using culturally appropriate messages. Respondents living in the intervention areas were significantly more likely to increase their consumption of vegetables, lowfat milk, and high-fiber cereals, and less likely to increase their frequency of consumption of sweets and fast food than those living in comparison areas.The Ontario First Nations trial, Zhiwaapenewin Akinomaagewin (ZA), worked with schools, food stores, and health and social services agencies and included stocking and labeling of healthier foods, curricula for grades 3 and 4, cooking demonstrations, mass media, and community events. ZA participants showed higher healthy food intentions and significantly increased frequency of choosing healthy foods. 

Implementation: Good partnerships with corner store owners are needed to support implementation of this intervention. In the Baltimore test of the intervention, implementation of different components was inconsistent. Taste tests/interactive sessions conducted by the research staff were implemented well, while implementation of coupons and incentive cards was challenging as store owners expressed concern over customer misuse.  Implementation of print materials varied according to availability of wall space, and who was responsible for posting signage (e.g., research staff or store owners). 

Maintenance: Limited data assessing long-term maintenance of the intervention was available.   Six months after the intervention, the stocking of certain healthy foods, such as baked/low-fat chips, low-salt crackers, cooking spray and whole wheat breads, was sustained by the intervention store owners.