Community-Based Efforts Aim to Improve the Food Environment within a Highly Obese Rural Appalachian County

Abstract

Rural communities in Appalachia are displaying increased obesity prevalence, yet traditional interventions have not provided a broad enough impact to improve dietary consumption patterns. Therefore, expanding efforts that address the food environment and incorporate behavioral nudges through community-developed marketing strategies may be a viable mechanism to improve food and beverage choices within this unique population. This study installed shelf-wobblers across n = 5 gas stations in one rural Appalachian county in Kentucky. Smart Snacks were identified from store inventory lists utilizing the CDC Food Service Guideline for Federal Facilities calculator and were categorized into high-protein snacks, low-fat carbohydrate snacks, meal replacement snacks, and no-calorie beverages. NEMS-CS audits were conducted, and monthly sales data was collected at baseline and for six months thereafter for each store location. A difference-in-difference model was used, adjusting for total sales or total mean sales for each Smart Snack model to assess the percentage change within and between stores. Overall, percent change in mean sales and total sales across all stores resulted in a percentage increase of sales of Smart Snack items following wobbler installment. This study provides unique insight into how a community-driven approach to marketing can influence the sale of healthier food and beverage items.

Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019–2022

“…An important finding was a significant reduction in the amount of SSBs consumed among the cohort during the study period. We have previously reported on the key role that gas stations play in purchasing habits in this community and how non-soda SSBs are a significant source of added sugar in the diet of adults in this community (55,56). As a result, marketing strategies were deployed within gas stations to promote healthier beverage choices and nutritious snacks within this study.…”

“…As a result, marketing strategies were deployed within gas stations to promote healthier beverage choices and nutritious snacks within this study. Although substantial changes in beverage purchases were not observed cross-sectionally (55), the cohort study allowed us to capture differences in consumption patterns over time. Although SSB consumption in the sample decreased, there were no significant changes in water consumption.…”

“…Considering the challenges and barriers rural communities face to promote and sustain health improvement, initiatives and interventions must consider community-driven and communitybased approaches to improve health outcomes through nutrition and physical activity (19)(20)(21). This provides a localized mechanism that accounts for the culture and existing resources within a community that can be leveraged to mitigate public health challenges.…”

Enduring Effects of the COVID-19 Pandemic on Food Access, Nutrition, and Well-Being in Rural Appalachia

“…When transportation is limited, shopping at Dollar Stores may be the only viable solution for residents. Resources highlighting nutritious food options available at these venues could be instrumental in helping individuals and families stretch their food dollars while simultaneously supporting more balanced diets to support health, such as what has been done in other nontraditional food outlets in rural communities already [38]. Ensuring these resources and initiatives are community-specific is critical, and although our study highlights the perspectives of individuals in one specific Appalachian community, these findings may be insightful for other rural highly impoverished or isolated communities, as the widespread impacts of the pandemic are still being understood.…”

Sugar-sweetened beverage consumption among adults in rural Appalachia

“…Driven by this study’s findings, several PSE approaches for reducing SSB consumption have been implemented or considered for implementation in Martin County since survey administration. Community-developed in-store marketing tools were designed and installed in five convenience stores featuring low and no-calorie beverages, with significant increases in total sales of no-calorie beverages at all locations over a six-month period ( Gillespie et al, 2021 ). Changes in beverage purchasing patterns over time in different age groups may be explored to further understand consumer purchasing behavior and food retailer preference in this rural community.…”