Mienah Z. Sharif

Proyecto MercadoFRESCO: A Multi-level, Community-Engaged Corner Store Intervention in East Los Angeles and Boyle Heights

Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents’ access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.

Substantial improvements not seen in health behaviors following corner store conversions in two Latino food swamps.

BackgroundThe effectiveness of food retail interventions is largely undetermined, yet substantial investments have been made to improve access to healthy foods in food deserts and swamps via grocery and corner store interventions. This study evaluated the effects of corner store conversions in East Los Angeles and Boyle Heights, California on perceived accessibility of healthy foods, perceptions of corner stores, store patronage, food purchasing, and eating behaviors.MethodsHousehold data (n = 1686) were collected at baseline and 12- to 24-months post-intervention among residents surrounding eight stores, three of which implemented a multi-faceted intervention and five of which were comparisons. Bivariate analyses and logistic and linear regressions were employed to assess differences in time, treatment, and the interaction between time and treatment to determine the effectiveness of this intervention.ResultsImprovements were found in perceived healthy food accessibility and perceptions of corner stores. No changes were found, however, in store patronage, purchasing, or consumption of fruits and vegetables.ConclusionsResults suggest limited effectiveness of food retail interventions on improving health behaviors. Future research should focus on other strategies to reduce community-level obesity.

An Implementation Evaluation of the Community Engagement and Planning Intervention in the CPIC Depression Care Improvement Trial

The goal of this paper is to document and evaluate the process of implementing an evidence-based depression intervention in community settings through the use of community-academic partnered approaches. We discuss how and to what extent the goals of community engagement and collaborative planning were achieved in the intervention arm of the Community Partners in Care study that aimed to adapt evidence-based depression care toolkits for diverse agencies in Hollywood and South Los Angeles. We find that partnered research strategies have a potential to effectively engage community members around depression and involve them in intervention planning activities. Our results suggest that successful collaboration among diverse agencies requires that they understand what is expected of them, are comfortable with the role they choose to perform, and have organizational support to contribute to the project. To facilitate the development of collaborative relationships, time and effort should be devoted to explaining how collaboration among diverse agencies may take place.

Evaluation of a Statewide Public Health Nursing Training in Utah

Public health nurses continue to struggle to provide culturally relevant services that focus on the multiple needs of an ethnically diverse population while at the same time providing services to the population at large. This article describes the formative research, implementation, and results of a statewide effort to broaden UtahAEs public health nurses perception about their role and responsibility in addressing and serving the emerging needs of underserved and atrisk populations in Utah. A total of 51% of Utah state and local health department public health nurses participated in the training. There was a statistically significant increase in the mean level of perceived understanding of topic material from pretest to posttest, and 80% of participants reported applying what they learned in the training to their practice. Our experience demonstrates that even with limited resources, it is possible to deliver high quality training to a large proportion of public health nurses practicing in urban, rural, and frontier populations; observe significant results in their comprehension of training material and, most importantly; see application of what they learned in the training to their health care practice.

Deconstructing family meals: Do family structure, gender and employment status influence the odds of having a family meal?

OBJECTIVES We assessed the odds of having a family dinner by parental gender, family structure and parental employment. METHODS This study used data from the American Time Use Survey (ATUS) (2006-2008). Multivariate analyses assessed the odds of two outcomes among parents: 1) eating at all with children and 2) having a family dinner. RESULTS Single men had lower odds of eating at all with children and eating a family dinner in comparison to partnered/married males. Partnered/married women had increased odds of eating at all with children and eating a family dinner compared to their partnered/married male counterparts. While single women had increased odds of eating at all with children compared to partnered/married males, no difference was detected in the odds of having a family dinner. Among dual-headed households, women had lower odds of eating a family dinner when both parents were employed compared a dual-headed household with employed male/non-employed female. There were no differences among men regardless of their employment status or that of their partner/spouse. CONCLUSIONS Family structure, parental gender and employment status all influence the odds of having a family dinner. Future research on family meals should consider all of these factors to better understand trends and disparities across household compositions.

Social cohesion and the smoking behaviors of adults living with children

INTRODUCTION The smoking behavior of adults can negatively impact children through exposure to environmental tobacco smoke and by modeling this unhealthy behavior. Little research has examined the role of the social environment in smoking behaviors of adults living with children. The present study specifically analyzed the relationship between social cohesion and smoking behaviors of adults living with children. METHODS Data from the 2009 California Health Interview Survey, a random-digit dial cross-sectional survey of California Adults, were used. Adults living with children reported their levels of social cohesion and smoking behaviors (N=13,978). Logistic regression models were used to predict odds of being a current smoker or living in a household in which smoking was allowed, from social cohesion. RESULTS Overall, 13% of the sample was current smokers and 3.74% lived in households in which smoking was allowed. Logistic regression models showed that each one-unit increase in social cohesion is associated with reduced odds of being a current smoker (AOR=0.92; 95% CI=0.85-0.99) and reduced odds of living in a household in which smoking is allowed (AOR=0.84; 95% CI=0.75-0.93), after controlling for sociodemographic characteristics. CONCLUSIONS Among adults living with children, higher social cohesion is associated with a lower likelihood of both being and smoker and living in a home where smoking is allowed. Thus, future research is needed to better understand mechanisms that explain the relationship between social cohesion and smoking-related behavior in order to prevent smoking-related health consequences and smoking initiation among children and adults.

Mobilizing Young People in Community Efforts to Improve the Food Environment: Corner Store Conversions in East Los Angeles

From the Schools and Programs of Public Health MOBILIZING YOUNG PEOPLE IN COMMUNITY EFFORTS TO IMPROVE THE FOOD ENVIRONMENT: CORNER STORE CONVERSIONS IN EAST LOS ANGELES Mienah Z. Sharif, MPH Jeremiah R. Garza, MA, MPH Brent A. Langellier, MA, PhD Alice A. Kuo, MD, PhD Deborah C. Glik, ScD Michael L. Prelip, DPA Alexander N. Ortega, PhD Latino young people are significantly more likely to be obese than their non-Latino white peers. 1–3 Higher obesity rates place Latino young people—one of the largest, fastest-growing ethnic groups in the United States—at a heightened risk for developing a range of chronic diseases, including obesity, cardiovascu- lar disease (CVD), and type 2 diabetes. 4–8 Moreover, Latinos are far from meeting the recommended daily intake of fruit and vegetables, 9–12 which is a critical public health concern considering that maintaining a healthful diet, including fruit and vegetables, is a key strategy for preventing chronic disease. 13–21 The food environment influences dietary behavior. However, social and economic factors lead to stark variations in the composition and quality of food among communities that help explain disparities in dietary practices and health outcomes. 22–28 Specifically, low-income communities of color have less access to fresh, affordable fruit and vegetables than more afflu- ent communities. 25,26,29–31 Furthermore, low-income, racial/ethnic minority families often find it easier to purchase energy-dense foods (characterized as high in fat, calories, and sugar) than healthier options, such as fresh fruit and vegetables. 25,29,32–34 One such example is East Los Angeles (East LA), an urban, predominantly Mexican-American community that has limited access to affordable, healthful food, but an abundance of fast-food restaurants and other sources of unhealthful food. 35,36 The food environment is one factor that helps explain why East LA residents experience higher rates of heart disease, diabetes, hypertension, and stroke than residents of more affluent LA neighborhoods. 37 Converting corner stores to improve access to affordable, healthful foods is one potential strategy to improve the food environment. 28,34,38–44 There is no one definition, or approach, for conducting corner store conversions. However, common strategies include improving the store’s facade and installing refrigera- tion units to store the newly available fresh produce. 44 The University of California, Los Angeles (UCLA) Center for Population Health and Health Disparities (CPHHD) implemented a community-engaged corner store conversion project called Proyecto Mercado- FRESCO (Fresh Market Project) in East LA and the neighboring community of Boyle Heights. This inter- vention converted four locally owned corner stores with the goal of increasing access to healthful food and reducing CVD risk. The CPHHD approach emphasized collaboration among community residents and orga- nizations, public health agencies, local public schools, and store owners. 44–47 The process included moving less healthful food items (i.e., chips, soda, and candy) to the back of the store, installing a fresh produce section at the front, improving the interior and exterior store facade, replacing alcohol and tobacco advertisements with healthful food messages, and providing business skills training to store owners. A major supplement to the conversion was a youth- driven campaign of community nutrition education and social marketing to promote the converted stores and increase the purchase of fruit and vegetables. 45–47 An elective course was implemented at two public high schools, one in East LA and one in Boyle Heights, to build the capacity of local students to lead the com- munity social marketing campaign. Students received classroom and field training in nutrition, food justice, media production, and social marketing. The campaign consisted of the following activities: performances at schools, community centers, and parks; short videos on buses; the design and dissemination of posters at bus shelters and marketing materials in neighborhoods surrounding converted stores; and cooking demonstra- tions at the stores (Photos 1 and 2). In addition to lead- ing the social marketing campaign, young people were actively involved in the stores’ physical transformation. The importance of youth perspectives in imple- menting policy advocacy, social marketing, and health projects has been well established in tobacco and substance use prevention. 48–54 While some reports document the engagement of low-income, minority young people in advocating for improvements in their access to healthful food, few reports focus on corner store interventions, and none use qualitative Public Health Reports / July–August 2015 / Volume 130

The association between self-rated eating habits and dietary behavior in two Latino neighborhoods: Findings from Proyecto MercadoFRESCO

Objective Latinos are the largest racial and ethnic minority group in the United States and bear a disproportionate burden of obesity related chronic disease. Despite national efforts to improve dietary habits and prevent obesity among Latinos, obesity rates remain high. The objective of this study is to explore the relationship between self-rated dietary quality and dietary behavior among Latinos and how this may vary by socio-demographics to help inform future public health efforts aiming to improve eating habits and obesity rates. Design Cross-sectional study using a series of chi-square tests, the non-parametric Wilcoxon–Mann–Whitney test and logistic regression to explore self-rated eating habits. Setting Two urban, low-income, predominantly Latino neighborhoods in Los Angeles County. Subjects 1000 adults who self-identified as their households primary food purchaser and preparer were interviewed from 2012 to 2013. Households were randomly selected based on their proximity to corner stores participating in a project to improve the food environment. Results Most respondents (59%) report “good” eating habits. Significant associations between “good” eating habits and overall health, fruit and vegetable consumption were observed (p < 0.001). Despite these promising findings, we also find high levels of regular soda and energy-dense food consumption. Conclusion This study revealed a general understanding that healthy dietary habits are associated with fruit and vegetable consumption among Latinos in two urban neighborhoods. However, there is a need for more targeted health promotion and nutrition education efforts on the risks associated with soda and energy-dense food consumption to help improve dietary habits and obesity levels in low-income Latino communities.

A corner store intervention to improve access to fruits and vegetables in two Latino communities

OBJECTIVE Investments have been made to alter the food environment of neighbourhoods that have a disproportionate number of unhealthy food venues. Corner store conversions are one strategy to increase access to fruits and vegetables (F&V). Although the literature shows modest success, the effectiveness of these interventions remains equivocal. The present paper reports on the evaluation of Proyecto MercadoFRESCO, a corner store conversion intervention in two Latino communities. DESIGN A repeated cross-sectional design was employed. Data were stratified by intervention arm and bivariate tests assessed changes over time. Logistic and multiple regression models with intervention arm, time and the interaction of intervention and time were conducted. Supplementary analyses account for clustering of patrons within stores and staggering of store conversions. SETTING Three stores were converted and five stores served as comparisons in East Los Angeles and Boyle Heights, California, USA. SUBJECTS Store patrons were interviewed before (n550) and after (n407) the intervention. RESULTS Relative to patrons of comparison stores, patrons of intervention stores demonstrated more favourable perceptions of corner stores and increased purchasing of F&V during that store visit. Changes were not detected in store patronage, percentage of weekly dollars spent on food for F&V or daily consumption of F&V. CONCLUSIONS Consistent with some extant food environment literature, findings demonstrate limited effects. Investments should be made in multilevel, comprehensive interventions that target a variety retail food outlets rather than focusing on corner stores exclusively. Complementary policies limiting the availability, affordability and marketing of energy-dense, nutrient-poor foods should also be pursued.

Misplaced Trust: Racial Differences in Use of Tobacco Products and Trust in Sources of Tobacco Health Information

Introduction Recently, the rates of utilization of alternative tobacco products have increased. Providing health information about tobacco products from trustworthy sources may help decrease the popularity of these products. Using a nationally representative study of adults, we fill the current gap in research on racial and ethnic disparities in utilization of alternative tobacco products as well as in trust of sources of health information about tobacco products. Aims and Methods Data came from the Health Information National Trends Survey (N = 3738), which was collected in 2015. Logistic regression models were used to calculate odds of use of seven different tobacco product (eg, hookah, e-cigarettes, etc.), trust in seven different sources of e-cigarette health information (eg, family or friends, health care providers, etc.), and trust in six different sources of tobacco health information, adjusting for control variables. Results There were disparities in utilization of alternative tobacco products and in trust, in tobacco companies across racial and ethnic groups. Blacks and Asians were far more likely than whites to trust tobacco (adjusted odds ratios = 8.67 and 4.34) and e-cigarette companies (adjusted odds ratios = 6.97 and 3.13) with information about the health effects of e-cigarettes than whites. Conclusions The popularity of alternative tobacco products appears to be high and may offset recent observed decreases in cigarette use. Blacks and Asians appear to trust tobacco companies as sources of information when compared to whites. Implications Higher levels of trust in tobacco companies among Asians and blacks may translate to greater susceptibility to utilize tobacco products among these groups, thereby increasing disparities. There is a need for social marketing and education efforts focused on increasing awareness of adverse health effects of using alternative tobacco products as well as on the untrustworthiness of tobacco and e-cigarette companies, especially among racial and ethnic minorities.