Development and implementation of Baltimore Healthy Eating Zones: a youth-targeted intervention to improve the urban food environment

Abstract

Poor accessibility to affordable healthy foods is associated with higher rates of obesity and diet-related chronic diseases. We present our process evaluation of a youth-targeted environmental intervention (Baltimore Healthy Eating Zones) that aimed to increase the availability of healthy foods and promote these foods through signage, taste tests and other interactive activities in low-income Baltimore City. Trained peer educators reinforced program messages. Dose, fidelity and reach-as measured by food stocking, posting of print materials, distribution of giveaways and number of interactions with community members-were collected in six recreation centers and 21 nearby corner stores and carryouts. Participating stores stocked promoted foods and promotional print materials with moderate fidelity. Interactive sessions were implemented with high reach and dose among both adults and youth aged 10-14 years, with more than 4000 interactions. Recreation centers appear to be a promising location to interact with low-income youth and reinforce exposure to messages.

Development and Implementation: B’More Healthy Communities for Kid’s Store and Wholesaler Intervention

“…BHCK implementation took place in two distinct waves, which allowed for improvements to be made prior to Wave 2 implementation. The program had a 56% increase in community members interactions throughout the duration of the program than previous corner store trials in Baltimore (Gittelsohn et al, 2013). BHCK also maintained a higher percent of label placement than Baltimore Healthy Eating Zones, a previous Baltimore corner store trial, (73.9% vs. 36% correct label placement, respectively; Gittelsohn et al, 2013).…”

“…The intervention mirrored previous store trials, but included new innovative components, such as store owner training with an incentive structure to improve knowledge and self-efficacy (Budd et al, 2015; Gittelsohn et al, 2010; Gittelsohn et al, 2013). The tiered incentive structure rewarded owners with structural incentives to address stocking barriers (e.g., produce bins, small refrigerator/freezers, and banana holders) for completing training videos and stocking promoted items.…”

“…Trained data collectors conducted monthly structured observations at both the corner store and wholesale level to assess (1) maintenance of communication materials (e.g., BHCK shelf labels, posters), (2) healthy food availability, and (3) state of the store environment (Budd et al, 2015; Gittelsohn et al, 2010; Gittelsohn et al, 2013; Shin et al, 2015). At the wholesale level, the environmental assessment monitored price changes (e.g., discounts) on promoted items.…”

“…Other strategies include involvement of stakeholders, community forums, cooking demonstrations, and taste tests (Bodor, Ulmer, Dunaway, Farley, & Rose, 2010; Budd et al, 2015; Gittelsohn et al, 2013; Gittelsohn et al, 2012). Previous corner store trials in Baltimore have improved store owner stocking of healthy foods and significantly decreased the weight of female adolescent participants through the utilization of point of purchase labeling, taste testing, and supplemental nutrition education in recreation centers (Gittelsohn et al, 2010; Gittelsohn et al, 2013). The B’More Healthy Communities for Kids (BHCK) trial intervened at multiple levels of the food environment in collaboration with city officials, local wholesalers, corner stores, carryouts, and recreation centers (Gittelsohn et al, 2014).…”

Welke factoren bepalen de implementatie van een lokale integrale aanpak van overgewicht bij kinderen?

“…De gevonden implementatiegraad (52 %) is relatief hoog. Hoewel meer onderzoeken naar de implementatie van een integrale aanpak een dergelijke implementatiegraad rapporteren [18,19], is een compleetheid van meer dan 50 % ongebruikelijk hoog te noemen [20]. Daarnaast werd een positief verband gevonden tussen de mate van ervaring met implementatie en de compleetheid van implementatie.…”