Hee-Jung Song

A corner store intervention in a low-income urban community is associated with increased availability and sales of some healthy foods

OBJECTIVE While corner store-based nutrition interventions have emerged as a potential strategy to increase healthy food availability in low-income communities, few evaluation studies exist. We present the results of a trial in Baltimore City to increase the availability and sales of healthier food options in local stores. DESIGN Quasi-experimental study. SETTING Corner stores owned by Korean-Americans and supermarkets located in East and West Baltimore. SUBJECTS Seven corner stores and two supermarkets in East Baltimore received a 10-month intervention and six corner stores and two supermarkets in West Baltimore served as comparison. RESULTS During and post-intervention, stocking of healthy foods and weekly reported sales of some promoted foods increased significantly in intervention stores compared with comparison stores. Also, intervention storeowners showed significantly higher self-efficacy for stocking some healthy foods in comparison to West Baltimore storeowners. CONCLUSIONS Findings of the study demonstrated that increases in the stocking and promotion of healthy foods can result in increased sales. Working in small corner stores may be a feasible means of improving the availability of healthy foods and their sales in a low-income urban community.

An Urban Food Store Intervention Positively Affects Food-Related Psychosocial Variables and Food Behaviors

Obesity and other diet-related chronic diseases are more prevalent in low-income urban areas, which commonly have limited access to healthy foods. The authors implemented an intervention trial in nine food stores, including two supermarkets and seven corner stores, in a low-income, predominantly African American area of Baltimore City, with a comparison group of eight stores in another low-income area of the city. The intervention (Baltimore Healthy Stores; BHS) included an environmental component to increase stocks of more nutritious foods and provided point-of-purchase promotions including signage for healthy choices and interactive nutrition education sessions. Using pre- and postassessments, the authors evaluated the impact of the program on 84 respondents sampled from the intervention and comparison areas. Exposure to intervention materials was modest in the intervention area, and overall healthy food purchasing scores, food knowledge, and self-efficacy did not show significant improvements associated with intervention status. However, based on adjusted multivariate regression results, the BHS program had a positive impact on healthfulness of food preparation methods and showed a trend toward improved intentions to make healthy food choices. Respondents in the intervention areas were significantly more likely to report purchasing promoted foods because of the presence of a BHS shelf label. This is the first food store intervention trial in low-income urban communities to show positive impacts at the consumer level.

Access to food source and food source use are associated with healthy and unhealthy food-purchasing behaviours among low-income African-American adults in Baltimore City

OBJECTIVE Although previous research has shown limited availability of healthy food in low-income urban neighbourhoods, the association between food source use and food-purchasing patterns has not yet been examined. We explored food-purchasing patterns in the context of food source use and food source access factors in low-income areas of Baltimore City. DESIGN Cross-sectional survey. SETTING Predominantly low-income neighbourhoods in East and West Baltimore City. SUBJECTS A total of 175 low-income African-American adult residents. RESULTS Supermarkets and corner stores were the most frequently used food sources. Walking was the main form of transportation used by 57 % of all respondents, 97 % of corner-store shoppers and 49 % of supermarket shoppers. Multiple linear regression models adjusting for demographic factors, type of food source used and transportation type found that corner-store use was associated with obtaining more unhealthy food (P = 0·005), whereas driving to the food source was associated with obtaining more healthy food (P = 0·012). CONCLUSIONS The large number of corner stores compared with supermarkets in low-income neighbourhoods makes them an easily accessible and frequently used food source for many people. Interventions to increase the availability and promotion of healthy food in highly accessed corner stores in low-income neighbourhoods are needed. Increased access to transportation may also lead to the use of food sources beyond the corner store, and to increased healthy food purchasing.

A Community-Based, Culturally Tailored Behavioral Intervention for Korean Americans With Type 2 Diabetes

Purpose The purpose of this study is to test the efficacy of a culturally tailored comprehensive type 2 diabetes management intervention for Korean American immigrants (KAIs) with type 2 diabetes. Methods A randomized controlled pilot trial with 2 parallel arms (intervention vs control) with a delayed intervention design was used. A total of 79 KAIs, recruited from the Baltimore-Washington area, completed baseline, 18-week, and 30-week follow-ups (intervention, n = 40; control, n = 39). All participants had uncontrolled type 2 diabetes (hemoglobin A1C ≥7.5%) at baseline. The authors’ comprehensive, self-help intervention program for type 2 diabetes management (SHIP-DM) consisted of a 6-week structured psychobehavioral education, home glucose monitoring with teletransmission, and bilingual nurse telephone counseling for 24 weeks. The primary outcome of the study was A1C level, and secondary outcomes included an array of psychobehavioral variables. Results Using analysis of covariance, the findings support that the proposed intervention was effective in significantly lowering A1C and fasting glucose and also in improving psychosocial outcomes in the sample. Specifically, the amount of reduction in A1C among intervention group participants was 1.19% at 18 weeks and 1.31% at 30 weeks, with 10% and 15.5% of the participants achieving the suggested goal of A1C <7% at 18 and 30 weeks of follow-up, respectively. Conclusions The results highlight the clinical efficacy of the SHIP-DM intervention composed of a 6-week education program, self-monitoring, and follow-up counseling, in terms of maintaining the improved intervention effects obtained and in terms of glucose control.

Unmet needs for social support and effects on diabetes self-care activities in Korean Americans with type 2 diabetes

Objective The purpose of this study was (1) to characterize the primary sources of social support and the extent of unmet needs for support (defined as the gap between social support needs and the receipt of social support) in a sample of Korean Americans (KAs) with type 2 diabetes and (2) to examine the effect of unmet needs for support on their self-care activities. Methods Baseline data obtained from a community-based intervention trial were used for this study of 83 middle-aged KAs with type 2 diabetes. Study design and data analysis were guided by social cognitive theory. The key variables were dictated the order of the variables in multivariate regression analysis. Results Our findings indicated that for diabetic KAs, the primary source of social support differed according to gender. Unmet needs for support were significantly associated with self-care activities, but the amount of support needs and of social support received were not. Multivariate analysis also confirmed that unmet needs for social support are a significant strong predictor of inadequate type 2 diabetes self-care activities, after controlling for other covariates. The hierarchical regression model explained about 30% of total variance in self-care activities. Conclusions The findings highlight the importance of considering unmet needs for social support when addressing self-care activities in type 2 diabetes patients. Future interventions should focus on filling gaps in social support and tailoring approaches according to key determinants, such as gender or education level, to improve self-care activities in the context of type 2 diabetes care.

Korean American storeowners' perceived barriers and motivators for implementing a corner store-based program.

Based on substantial formative research, the authors developed and implemented a year-long corner store-based program in East Baltimore focusing on Korean American (KA) stores. To understand acceptability of the intervention by storeowners, the authors examined the motivating factors for program participation, barriers to program implementation, perceived effectiveness of intervention materials, and perceptions about the program. Data collection methods included in-depth interviews with seven corner store owners, field notes by interventionists, and a follow-up survey. Stores varied considerably in terms of owners’ perceptions about the program, supportive atmosphere, and acceptability of intervention strategies. The storeowners who showed strong or moderate support for the program were more likely to sustain the stocking of promoted foods such as cooking spray and baked or low-fat chips after the program was completed as compared to less supportive stores. The level of support and active participation of storeowners can greatly influence the success of corner store-based nutrition interventions.

A Meta-Analysis of Interventions to Promote Mammography Among Ethnic Minority Women

Background:Although many studies have been focused on interventions designed to promote mammography screening among ethnic minority women, few summaries of the effectiveness of the interventions are available. Objective:The aim of this study was to determine the effectiveness of the interventions for improving mammography screening among asymptomatic ethnic minority women. Methods:A meta-analysis was performed on intervention studies designed to promote mammography use in samples of ethnic minority women. Random-effects estimates were calculated for interventions by measuring differences in intervention and control group screening rates postintervention. Results:The overall mean weighted effect size for the 23 studies was 0.078 (Z = 4.414, p < .001), indicating that the interventions were effective in improving mammography use among ethnic minority women. For mammography intervention types, access-enhancing strategies had the biggest mean weighted effect size of 0.155 (Z = 4.488, p < .001), followed by 0.099 (Z = 6.552, p < .001) for individually directed approaches such as individual counseling or education. Tailored, theory-based interventions resulted in a bigger effect size compared with nontailored interventions (effect sizes = 0.101 vs. 0.076, respectively; p < .05 for all models). Of cultural strategies, ethnically matched intervention deliveries and offering culturally matched intervention materials had effect sizes of 0.067 (Z = 2.516, p = .012) and 0.051 (Z = 2.365, p = .018), respectively. Discussion:Uniform improvement in mammography screening is a goal to address breast cancer disparities in ethnic minority communities in this country. The results of this meta-analysis suggest a need for increased use of a theory-based, tailored approach with enhancement of access.

Assessment of dietary intake in an inner-city African American population and development of a quantitative food frequency questionnaire to highlight foods and nutrients for a nutritional invention

Primary objective To characterize the diets of low-income inner-city African Americans to develop a population-specific quantitative food frequency questionnaire (QFFQ) that will be used to highlight foods and nutrients for a nutritional intervention program aimed at reducing the risk of chronic disease and to evaluate the program. Methods and procedures A cross-sectional survey conducted in inner-city Baltimore, Maryland, USA. Twenty-four-hour dietary recalls were collected in 91 low-income African Americans aged between 18 and 74 years. Main outcomes and results The average daily energy intake was approximately 2,165 kcal for women and 2,509 kcal for men. The percentages of energy from fat were approximately 34% and 33% for women and men, respectively. Sodas were the main contributor to energy and sugar intake. A 113-item QFFQ was developed. Conclusions The results highlighted specific foods and nutrients that would be targeted in the nutritional intervention. The QFFQ developed is culturally appropriate and specific for low-income African Americans in inner-city Baltimore.

Correlates of self-care behaviors for managing hypertension among Korean Americans: A questionnaire survey

BACKGROUND While self-care behaviors have been documented as one of the main determinant of hypertension control, studies investigating correlates of self-care behaviors have been rare regarding hypertension among minority population. OBJECTIVES The purpose of this study was to examine factors associated with self-care behaviors for hypertension using a community sample of Korean Americans. DESIGN A descriptive cross-sectional design. SETTINGS Community setting in the Baltimore-Washington metropolitan area. PARTICIPANTS The sample included 445 middle-aged (40-64 years of age) Korean Americans with hypertension (systolic BP > or = 140 and/or diastolic BP > or = 90 mmHg; or taking antihypertensive medication). METHODS Guided by Social Cognitive Theory, a variety of personal (age, gender, marital status, employment status, years in U.S., duration of hypertension, hypertension knowledge, hypertension belief, and hypertension control self-efficacy) and environmental (social support) factors were examined in relation to hypertension self-care behaviors, including medication-taking, exercise, diet, and weight control. RESULTS The model explained 18.0% of the total variance in self-care scores. Hierarchical multiple regression revealed that personal factors contributed significantly to the explanatory model, whereas social support did not add much. Examination of individual regression coefficients showed that Korean Americans who were older, who had longer duration of hypertension, and who had higher hypertension control self-efficacy were more likely to have higher self-care scores. CONCLUSIONS Hypertension control self-efficacy emerged as the most significant contributing factor to hypertension self-care. Future intervention programs should focus on improving hypertension control self-efficacy as a modifiable personal factor.

Interventions that increase use of Pap tests among ethnic minority women: a meta-analysis.

Objective: Although a variety of intervention methods have been used to promote Pap test screening among ethnic minority women in the US, the effectiveness of such interventions is unclear. We performed a meta‐analysis to examine the overall effectiveness of these interventions in increasing Pap test use by ethnic minority women in the US.