The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area
Abstract
:1. Introduction
- (1)
- To evaluate the impact of the BHCK multilevel intervention on sales of promoted foods at the wholesaler level.
- (2)
- To evaluate the impact of BHCK on stocking and sales of promoted foods in corner stores and carryouts.
- (3)
- To assess the impact of BHCK on adult caregiver and child healthy food purchasing.
2. Materials and Methods
2.1. Setting and Study Design
2.2. Measurements
2.2.1. Wholesaler
2.2.2. Corner Stores & Carryouts Stocking and Sales
2.2.3. Child-Caregiver Dyads
2.2.4. Data Collection and Management
2.3. Statistical Analysis
2.3.1. Wholesaler
2.3.2. Corner Stores and Carryouts
2.3.3. Child-Caregiver Dyads
3. Results
3.1. Impact on Sales of Promoted Foods at the Wholesaler Level
3.2. Impact on Stocking and Sales of Promoted Foods in Corner Stores and Carryouts
3.3. Association between Exposure to BHCK Corner Store and Carryout Intervention and Change in Purchasing of Promoted Foods and Beverages among Adult Caregivers
3.4. Association between Exposure to BHCK Corner Store and Carryout Intervention and Change in Purchasing Promoted Foods and Beverages among Children
4. Discussion
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Wave | Child-Caregiver Dyad Data Collection | Wave 1 Implementation (14 Zones) | Child-Caregiver Dyad Data Collection (Wave 1 Post and Wave 2 Baseline) | Wave 2 Implementation (14 Zones) | Child-Caregiver Dyad Data Collection | |||||
---|---|---|---|---|---|---|---|---|---|---|
Phase | Phase 1 Beverages | Phase 2 Snacks | Phase 3 Cooking | Phase 1 Snacks | Phase 2 Cooking | Phase 3 Beverages | Phase 4 Review | |||
Promoted Products’ Example | 1. Water 2. Sugar free tea mixes 3. Low-sugar fruit drinks | 1. Low-fat yogurt 2. Low-fat popcorn 3. Fresh fruits 4. Fresh vegetables | 1. Low-sugar cereal 2. 100% whole wheat bread 3. Fresh/frozen vegetables | 1. Low-fat yogurt 2. Low-fat popcorn 3. Fresh fruits 4. Fresh vegetables | 1. Low-sugar cereal 2. 100% whole wheat bread 3. Fresh/frozen vegetables | 1. Water 2. Sugar free tea mixes 3. Low-sugar fruit drinks | 1. Low-fat yogurt 2. Fresh/frozen vegetables 3. Small fresh vegetables bags | |||
Start date | June 2013 | July 2014 | September 2014 | November 2014 | April 2015 | December 2015 | March 2016 | May 2016 | June 2016 | August 2016 |
End date | June 2014 | August 2014 | October 2014 | February 2015 | November 2015 | February 2016 | April 2016 | June 2016 | July 2016 | January 2017 |
Baseline Sociodemographic | Intervention | Comparison | ||
---|---|---|---|---|
n | Mean (SD) or % | n | Mean (SD) or % | |
Child’s Characteristics | ||||
Age 1 | 199 | 11.7 (1.4) | 186 | 11.9 (1.6) |
Sex (female) 2 | 109 | 54% | 90 | 60% |
Caregiver’s Characteristics | ||||
Age 1 | 197 | 39.4 (1.2) | 188 | 40.5 (9.8) |
Sex (female) 2 | 187 | 94.4% | 170 | 90.4% |
Race (African American) 2 | 185 | 93.4% | 174 | 93.0% |
Household’s Characteristics | ||||
Household Size 1 | 198 | 4.5 (1.5) | 188 | 4.5 (1.6) |
SNAP 2 | 133 | 70.7% | 141 | 71.2% |
WIC 2 | 46 | 23.2% | 44 | 23.4% |
Average Change in Corner Store HFAI by Treatment Group | |||
---|---|---|---|
Change in HFAI | Comparison (n = 24) | Intervention (n = 26) | p-Value 1 |
Mean (±SD) | Mean (±SD) | ||
Total score | 1.67 (5.35) | 5.65 (4.95) | 0.01 |
Beverage subscore 2 | 0.17 (1.09) | 0.92 (1.16) | 0.02 |
Snack subscore 3 | 0 (1.10) | 1.19 (1.81) | 0.01 |
Cooking subscore 4 | 1.5 (4.35) | 3.54 (3.87) | 0.08 |
Average Change in Corner Store HFAI by Wave and Treatment Groups | |||
Total Score | |||
Wave 1 | 5.56 (4.28) | 7.86 (4.00) | 0.20 |
Wave 2 | −0.67 (4.59) | 3.08 (4.83) | 0.05 |
Beverage subscore 2 | |||
Wave 1 | 0.56 (1.13) | 0.86 (1.03) | 0.52 |
Wave 2 | −0.07 (1.03) | 1.0 (1.35) | 0.03 |
Snack subscore 3 | |||
Wave 1 | 0.77 (0.97) | 1.64 (1.45) | 0.13 |
Wave 2 | −0.47 (0.92) | 0.67 (2.10) | 0.07 |
Cooking subscore 4 | |||
Wave 1 | 4.22 (3.31) | 5.36 (3.65) | 0.46 |
Wave 2 | −0.13 (4.16) | 1.42 (3.03) | 0.29 |
Change in Food Purchasing Behavior by Exposure Quartiles | Combined Exposure Score | Corner Store Score | Carryout Score | |||
---|---|---|---|---|---|---|
IRR (Robust SE) | 95% CI | IRR (Robust SE) | 95% CI | IRR (Robust SE) | 95% CI | |
Healthy Food Purchasing 2 | ||||||
Very LowExposure | Reference | Reference | Reference | |||
Low Exposure | 1.07 (0.21) | 0.73; 1.58 | 0.97 (0.19) | 0.65; 1.45 | 1.07 (0.21) | 0.89; 1.34 |
Medium Exposure | 0.71 (0.16) | 0.45; 1.10 | 0.77 (0.17) | 0.50; 1.20 | 0.74 (0.17) | 0.95; 1.43 |
High Exposure | 0.92 (0.19) | 0.61; 1.37 | 0.99 (0.20) | 0.67; 1.48 | 0.93 (0.19) | 1.00; 1.47 |
Healthy Food Purchasing 2 among Intervention | ||||||
Very Low Exposure | Reference | Reference | Reference | |||
Low Exposure | 0.59 (0.24) | 0.25; 1.33 | 0.54 (0.23) | 0.23; 1.24 | 0.67 (0.27) | 0.30; 1.48 |
Medium Exposure | 0.54 (0.18) | 0.27; 1.07 | 0.51 (0.18) | 0.24; 1.04 | 0.56 (0.20) | 0.27; 1.12 |
High Exposure | 0.67 (0.22) | 0.36; 1.27 | 0.80 (0.25) | 0.43; 1.51 | 0.70 (0.23) | 0.37; 1.33 |
Healthy Food Purchasing 2 among Comparison | ||||||
Very Low Exposure | Reference | Reference | Reference | |||
Low Exposure | 1.33 (0.30) | 0.85; 2.07 | 1.25 (0.29) | 0.85; 1.29 | 1.30 (0.30) | 0.82; 2.05 |
Medium Exposure | 0.87 (0.31) | 0.43; 1.75 | 1.18 (0.32) | 0.56; 1.11 | 0.97 (0.31) | 052; 1.81 |
High Exposure | 1.17 (0.37) | 0.63; 2.17 | 1.07 (0.36) | 0.32; 1.05 | 1.23 (0.38) | 0.66; 2.27 |
Change in Food Purchasing Behavior by Exposure Quartiles | Combined Exposure Score | Corner Store Score | Carryout Score | |||
---|---|---|---|---|---|---|
IRR (Robust SE) | 95% CI | IRR (Robust SE) | 95% CI | IRR (Robust SE) | 95% CI | |
Healthy Food Purchasing 2 | ||||||
Very Low Exposure | Reference | Reference | Reference | |||
Low Exposure | 1.12 (0.12) | 0.92; 1.40 | 1.15 (0.11) | 0.94; 1.41 | 1.10 (0.11) | 0.89; 1.34 |
Medium Exposure | 1.23 (0.12) | 1.01; 1.50 | 1.14 (0.12) | 0.94; 1.41 | 1.17 (0.12) | 0.95; 1.43 |
High Exposure | 1.24 (0.12) | 1.02; 1.52 | 1.22 (0.12) | 1.01; 1.48 | 1.21 (0.12) | 1.00; 1.47 |
Healthy Food Purchasing 2 among Intervention | ||||||
Very Low Exposure | Reference | Reference | Reference | |||
Low Exposure | 2.36 (0.74) | 1.27; 4.38 | 2.15 (0.63) | 1.21; 3.85 | 1.96 (0.57) | 1.10; 3.49 |
Medium Exposure | 2.72 (0.82) | 1.51; 4.93 | 2.38 (0.67) | 1.37; 4.13 | 2.29 (0.64) | 1.32; 3.95 |
High Exposure | 2.81 (0.83) | 1.56; 5.04 | 2.51 (0.70) | 1.45; 4.34 | 2.35 (0.64) | 1.37; 4.03 |
Healthy Food Purchasing 2 among Comparison | ||||||
Very Low Exposure | Reference | Reference | Reference | |||
Low Exposure | 0.96 (0.11) | 0.77; 1.21 | 1.05 (0.11) | 0.85; 1.29 | 1.01 (0.11) | 0.81; 1.25 |
Medium Exposure | 0.92 (0.14) | 0.68; 1.23 | 0.79 (0.14) | 0.56; 1.11 | 0.84 (0.13) | 0.62; 1.15 |
High Exposure | 0.52 (0.17) | 0.27; 1.01 | 0.58 (0.17) | 0.32; 1.05 | 0.57 (0.18) | 0.30; 1.08 |
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Gittelsohn, J.; Trude, A.C.; Poirier, L.; Ross, A.; Ruggiero, C.; Schwendler, T.; Anderson Steeves, E. The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area. Int. J. Environ. Res. Public Health 2017, 14, 1371. https://doi.org/10.3390/ijerph14111371
Gittelsohn J, Trude AC, Poirier L, Ross A, Ruggiero C, Schwendler T, Anderson Steeves E. The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area. International Journal of Environmental Research and Public Health. 2017; 14(11):1371. https://doi.org/10.3390/ijerph14111371
Chicago/Turabian StyleGittelsohn, Joel, Angela C. Trude, Lisa Poirier, Alexandra Ross, Cara Ruggiero, Teresa Schwendler, and Elizabeth Anderson Steeves. 2017. "The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area" International Journal of Environmental Research and Public Health 14, no. 11: 1371. https://doi.org/10.3390/ijerph14111371