Benjamin W. Chrisinger

A Mixed-Method Assessment of a New Supermarket in a Food Desert: Contributions to Everyday Life and Health

Initiatives to build supermarkets in low-income areas with relatively poor access to large food retailers (“food deserts”) have been implemented at all levels of government, although evaluative studies have not found these projects to improve diet or weight status for shoppers. Though known to be influential, existing evaluations have neglected in-store social dynamics and shopper behaviors. Surveys and walking interviews were used with shoppers (n = 32) at a supermarket developed through the Pennsylvania Fresh Food Financing Initiative in Philadelphia, PA. Key informant interviews with stakeholders in the supermarket’s development and operations provided additional context to these shopper experiences. Data were collected in July and September 2014 and qualitatively analyzed in NVivo 10.0. Participants described how the retailer helped them adapt or cope with difficult shopping routines and how it presented a reliable high-quality option (in terms of cleanliness, orderliness, and social atmosphere) in contrast to other neighborhood retailers. Health concerns were also identified, especially among those managing chronic disease for themselves or a family member. These issues underscored multiple points of challenge required to adjust shopping and eating behavior. In-store supports that reflect these challenges are warranted to more fully address food deserts and reduce health disparities.

Ethical imperatives against item restriction in the Supplemental Nutrition Assistance Program

The Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) is the federal governments largest form of food assistance, and a frequent focus of political and scholarly debate. Previous discourse in the public health community and recent proposals in state legislatures have suggested limiting the use of SNAP benefits on unhealthy food items, such as sugar-sweetened beverages (SSBs). This paper identifies two possible underlying motivations for item restriction, health and morals, and analyzes the level of empirical support for claims about the current state of the program, as well as expectations about how item restriction would change participant outcomes. It also assesses how item restriction would reduce individual agency of low-income individuals, and identifies mechanisms by which this may adversely affect program participants. Finally, this paper offers alternative policies to promote healthier purchasing and eating among SNAP participants that can be pursued without reducing individual agency. Health advocates and officials must more fully weigh the attendant risks of implementing SNAP item restrictions, including the reduction of individual agency of a vulnerable population.

Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk

AIM Approximately 424,000 out-of-hospital cardiac arrests (OHCA) occur in the US annually. As automated external defibrillators (AED) are an important part of the community response to OHCA, we investigated how well the spatial demand (likelihood of OHCA) was met by the spatial supply (AEDs) in a dense urban environment. METHODS Using geographic information system (GIS) software, we applied kernel density and optimized hot spot procedures with two differently-sized radii to model OHCA incidence rates from existing studies, providing an estimate of OHCA likelihood at a given location. We compared these density maps to existing AED coverage in the study area. Descriptive statistics summarized coverage by land use. RESULTS With a 420-ft buffer, we found that 56.0% (79.9%, 840-ft buffer) of the land area in the city center was covered by existing AEDs at, though 70.1 (91.5)% of the OHCA risk was covered using kernel density and 79.8% (98.1) was covered using hot spot analysis. CONCLUSIONS The difference in coverage by area and risk seems to indicate efficient placement of existing AEDs. Our findings also highlight the possible benefits to expanding the influence of AEDs by lowering search times, and identify opportunities to improve AED coverage in the study area. This article offers one method by which local officials can use spatial data to prioritize attention for AED placement and coverage.

Reconsidering the Supplemental Nutrition Assistance Program as Community Development

The Supplemental Nutrition Assistance Program (SNAP) protects households from severe food insecurity or extreme poverty, buffers against certain adverse health effects, and exhibits a multiplier effect on the nations economy. Nonetheless, SNAP remains contentious and benefit reductions are currently being debated. One new direction is to reconceptualize people-based SNAP allocations within place-based community development. Programs such as the federal Healthy Food Financing Initiative encourage retailer development in underserved neighborhoods, creating healthy options and opportunities to reinvest SNAP dollars locally. By exploring relationships between these programs, researchers and practitioners can better understand how to enhance their impact on individuals and neighborhoods.

Family food purchases of high- and low-calorie foods in full-service supermarkets and other food retailers by Black women in an urban US setting

Public health interventions to increase supermarket access assume that shopping in supermarkets is associated with healthier food purchases compared to other store types. To test this assumption, we compared purchasing patterns by store-type for certain higher-calorie, less healthy foods (HCF) and lower-calorie, healthier foods (LCF) in a sample of 35 black women household shoppers in Philadelphia, PA. Data analyzed were from 450 food shopping receipts collected by these shoppers over four-week periods in 2012. We compared the likelihood of purchasing the HCF (sugar-sweetened beverages, sweet/salty snacks, and grain-based snacks) and LCF (low-fat dairy, fruits, and vegetables) at full-service supermarkets and six other types of food retailers, using generalized estimating equations. Thirty-seven percent of participants had household incomes at or below the poverty line, and 54% had a BMI >30. Participants shopped primarily at full-service supermarkets (55%) or discount/limited assortment supermarkets (22%), making an average of 11 shopping trips over a 4-week period and spending mean (SD) of

Leveraging Citizen Science for Healthier Food Environments: A Pilot Study to Evaluate Corner Stores in Camden, New Jersey

350 (

Evaluating Healthy Corner Stores: A Survey of Assessment Tools Used in the San Francisco Bay Area, 2016

222). Of full-service supermarket receipts, 64% included at least one HCF item and 58% at least one LCF. Most trips including HCF (58%) and LCF (60%) expenditures were to full-service or discount/limited assortment supermarkets rather than smaller stores. Spending a greater percent of total dollars in full-service supermarkets was associated with spending more on HCF (p = 0.03) but not LCF items (p = 0.26). These findings in black women suggest a need for more attention to supermarket interventions that change retailing practices and/or consumer shopping behaviors related to foods in the HCF categories examined.

Discrete Choice Model of Food Store Trips Using National Household Food Acquisition and Purchase Survey (FoodAPS)

Over the last 6 years, a coordinated “healthy corner store” network has helped an increasing number of local storeowners stock healthy, affordable foods in Camden, New Jersey, a city with high rates of poverty and unemployment, and where most residents have little or no access to large food retailers. The initiative’s funders and stakeholders wanted to directly engage Camden residents in evaluating this effort to increase healthy food access. In a departure from traditional survey- or focus group-based evaluations, we used an evidence-based community-engaged citizen science research model (called Our Voice) that has been deployed in a variety of neighborhood settings to assess how different features of the built environment both affect community health and wellbeing, and empower participants to create change. Employing the Our Voice model, participants documented neighborhood features in and around Camden corner stores through geo-located photos and audio narratives. Eight adult participants who lived and/or worked in a predefined neighborhood of Camden were recruited by convenience sample and visited two corner stores participating in the healthy corner store initiative (one highly-engaged in the initiative and the other less-engaged), as well as an optional third corner store of their choosing. Facilitators then helped participants use their collected data (in total, 134 images and 96 audio recordings) to identify and prioritize issues as a group, and brainstorm and advocate for potential solutions. Three priority themes were selected by participants from the full theme list (n = 9) based on perceived importance and feasibility: healthy product selection and display, store environment, and store outdoor appearance and cleanliness. Participants devised and presented a set of action steps to community leaders, and stakeholders have begun to incorporate these ideas into plans for the future of the healthy corner store network. Key elements of healthy corner stores were identified as positive, and other priorities, such as improvements to safety, exterior facades, and physical accessibility, may find common ground with other community development initiatives in Camden. Ultimately, this pilot study demonstrated the potential of citizen science to provide a systematic and data-driven process for public health stakeholders to authentically engage community residents in program evaluation.

Tradition of healthy food access in low-income neighborhoods: Price and variety of curbside produce vending compared to conventional retailers.

Stakeholders from healthy corner store programs in the San Francisco Bay Area convened in November 2015 to discuss the future of programmatic and collaborative efforts. This study’s objective, to gather and synthesize the types of evaluation tools used in the 9-county region, was identified as one of several priorities. Tools were collected via an online survey in July 2016, and data were extracted for comparison, including data on the number and types of food items, nutritional standards, and store characteristics. Twenty-five evaluation tools were collected, and differences were found in nutritional standards, terminology, and use of validated measures. Discrepancies between evaluation tools should be reconciled to make robust regional comparisons.

Diet Quality Over the Monthly Supplemental Nutrition Assistance Program Cycle

Where households across income levels shop for food is of central concern within a growing body of research focused on where people live relative to where they shop, what they purchase and eat, and how those choices influence the risk of obesity and chronic disease. We analyzed data from the National Household Food Acquisition and Purchase Survey (FoodAPS) using a conditional logit model to determine where participants shop for food to be prepared and eaten at home and how individual and household characteristics of food shoppers interact with store characteristics and distance from home in determining store choice. Store size, whether or not it was a full-service supermarket, and the driving distance from home to the store constituted the three significant main effects on store choice. Overall, participants were more likely to choose larger stores, conventional supermarkets rather than super-centers and other types of stores, and stores closer to home. Interaction effects show that participants receiving Supplemental Nutrition Assistance Program (SNAP) were even more likely to choose larger stores. Hispanic participants were more likely than non-Hispanics to choose full-service supermarkets while White participants were more likely to travel further than non-Whites. This study demonstrates the value of explicitly spatial discrete choice models and provides evidence of national trends consistent with previous smaller, local studies.