Tara McCoy

Snacking in Children: The Role of Urban Corner Stores

OBJECTIVE: Childhood obesity is higher among ethnic minorities. One reason may be the limited access to affordable, healthy options. The disparate prevalence of urban corner stores in low-income and high-minority communities has been well documented. There are no data, however, on what children purchase in these environments before and after school. The purpose of this study was to document the nature of childrens purchases in corner stores proximal to their schools. METHODS: This was an observational study from January to June 2008. Participants were children in grades 4 through 6 from 10 urban K-8 schools with ≥50% of students eligible for free or reduced-price meals. A total of 833 intercept surveys of childrens purchases were conducted outside 24 corner stores before and after school. The main outcomes were type and energy content of items purchased. RESULTS: The most frequently purchased items were energy-dense, low-nutritive foods and beverages, such as chips, candy, and sugar-sweetened beverages. Students spent

Physical Activity Patterns of Inner-City Elementary Schoolchildren

1.07 ± 0.93 on 2.1 ± 1.3 items (1.6 ± 1.1 food items and 0.5 ± 0.6 beverage items) per purchase. The total number of calories purchased per trip was 1497.7 ± 1219.3 kJ (356.6 ± 290.3 kcal). More calories came from foods than from beverages. CONCLUSIONS: Purchases made in corner stores contribute significantly to energy intake among urban school children. Obesity prevention efforts, as well as broader efforts to enhance dietary quality among children in urban settings, should include corner store environments proximal to schools.

Stocking characteristics and perceived increases in sales among small food store managers/owners associated with the introduction of new food products approved by the Special Supplemental Nutrition Program for Women, Infants, and Children.

PURPOSE This study aimed to objectively measure the physical activity (PA) characteristics of a racially and ethnically diverse sample of inner-city elementary schoolchildren and to examine the influence of sex, race/ethnicity, grade level, and weight status on PA. METHODS A total of 470 students in grades 4-6 from six inner-city schools in Philadelphia wore an ActiGraph GT3X+ accelerometer (Actigraph, Pensacola, FL) for up to 7 d. The resultant data were uploaded to a customized Visual Basic EXCEL macro to determine the time spent in sedentary (SED), light-intensity PA (LPA), and moderate- to vigorous-intensity PA (MVPA). RESULTS On average, students accumulated 48 min of MVPA daily. Expressed as a percentage of monitoring time, students were sedentary for 63% of the time, in LPA 31% of the time, and in MVPA 6% of the time. Across all race/ethnicity and grade level groups, boys exhibited significantly higher levels of MVPA than girls did; fifth-grade boys exhibited significantly lower MVPA levels than fourth- and sixth-grade boys did, and sixth-grade girls exhibited significantly lower MVPA levels than fourth- and fifth-grade girls did. Hispanic children exhibited lower levels of MVPA than children from other racial/ethnic groups did, and overweight and obese children exhibited significantly lower MVPA levels than children in the healthy weight range did. Across the entire sample, only 24.3% met the current public health guidelines for PA. Physical inactivity was significantly greater among females, Hispanics, and overweight and obese students. CONCLUSIONS Fewer than one in four inner-city schoolchildren accumulated the recommended 60 min of MVPA daily. These findings highlight the need for effective and sustainable programs to promote PA in inner-city youth.

Middle School Student and Parent Perceptions of Government-Sponsored Free School Breakfast and Consumption: A Qualitative Inquiry in an Urban Setting

OBJECTIVE The present study assessed the impact of the 2009 food packages mandated by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on perceived sales, product selection and stocking habits of small, WIC-authorized food stores. DESIGN A cross-sectional study involving in-depth interviews with store managers/owners. SETTING Small, WIC-authorized food stores in eight major cities in the USA. SUBJECTS Fifty-two store managers/owners who had at least 1 year of experience in the store prior to study participation. RESULTS The WIC-approved food products (fresh, canned and frozen fruits; fresh, canned and frozen vegetables; wholegrain/whole-wheat bread; white corn/whole-wheat tortillas; brown rice; lower-fat milk (<2 %)) were acquired in multiple ways, although acquisition generally occurred 1-2 times/week. Factors such as customer requests (87 %), refrigerator/freezer availability (65 %) and profitability (71 %) were rated as very important when making stocking decisions. Most managers/owners perceived increases in sales of new WIC-approved foods including those considered most profitable (wholegrain/whole-wheat bread (89 %), lower-fat milk (89 %), white corn/whole wheat tortillas (54 %)), but perceived no changes in sales of processed fruits and vegetables. Supply mechanisms and frequency of supply acquisition were only moderately associated with perceived sales increases. CONCLUSIONS Regardless of type or frequency of supply acquisition, perceived increases in sales provided some evidence for the potential sustainability of these WIC policy efforts and translation of this policy-based strategy to other health promotion efforts aimed at improving healthy food access in underserved communities.

Small retailer perspectives of the 2009 women, infants and children program food package changes

Universal free access to school breakfast is available in large urban schools, but participation rates are less than half of what they are at lunch. The purpose of this qualitative study was to understand the discrepancy between access and participation in school breakfast in a low-income, urban school district. Youth (n=23) and parents (n=22) were recruited from three middle schools where ≥ 50% of students were eligible for free or reduced-price meals. Parent focus groups (n=2) and student focus groups (n=4) were conducted in the fall/winter of 2009/2010. Content analysis was conducted to code transcripts and a constant comparative technique was used to identify emergent themes. Findings were validated using triangulation methods. The following themes emerged from the student and parent perceptions: sociocultural beliefs, physical availability, economic accessibility, social stigma, and consumption practices. There was agreement between students and parents across most themes, except consumption practices. Students were commonly purchasing food and beverages on the way to school, which was in conflict with parent rules. Parents desired access to copies of the school menus to be more involved in breakfast decisions with their child and students desired input into menu planning and taste testing to overcome school meal quality concerns. Future research aiming to improve participation in the breakfast program should examine the impact of student involvement in school menu planning and environmental modifications to reduce the social stigma associated with the program.

Elevated circulating tissue factor procoagulant activity, factor VII, and plasminogen activator inhibitor-1 in childhood obesity: evidence of a procoagulant state.

OBJECTIVE To understand vendor perspectives regarding changes made in 2009 to the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) food package. METHODS Fifty-two in-depth, qualitative interviews with owners or managers of small stores in 8 urban areas across 7 states conducted 6-12 months after the changes. RESULTS Store owners experienced implementation challenges, but felt the changes increased the number of customers, sales, and profits. CONCLUSION This research provides vendor perspectives on the 2009 WIC policy changes and may enhance policy implementation directed at increasing healthy food availability, particularly in urban communities.

Corner store purchases made by adults, adolescents and children: items, nutritional characteristics and amount spent

Childhood obesity is rapidly increasing in prevalence. We compared circulating membrane‐bound tissue factor (FIII, F3) procoagulant activity (TF‐PCA) and plasma markers of coagulation, fibrinolysis and endothelial dysfunction in 21 obese (10·1 ± 1·5 years, mean ± standard deviation) and 22 healthy weight children (9·9 ± 1·6 years), classified by Body Mass Index (BMI). TF‐PCA and factor VII coagulant activity (FVII:C), plasminogen activator inhibitor (PAI‐1, SERPINE1) and soluble vascular cell adhesion molecule 1 (sVCAM1) were higher in obese children. BMI correlated positively with TF‐PCA, FVII:C, and PAI‐1. Childhood obesity is associated with a procoagulant state and endothelial dysfunction. Studies are needed to assess whether weight reduction reverses these abnormalities.

Trends in relative weight over 1 year in low-income urban youth

OBJECTIVE Corner stores, also known as bodegas, are prevalent in low-income urban areas and primarily stock high-energy foods and beverages. Little is known about individual-level purchases in these locations. The purpose of the present study was to assess corner store purchases (items, nutritional characteristics and amount spent) made by children, adolescents and adults in a low-income urban environment. DESIGN Evaluation staff used 9238 intercept surveys to directly examine food and beverage purchases. SETTING Intercepts were collected at 192 corner stores in Philadelphia, PA, USA. SUBJECTS Participants were adult, adolescent and child corner store shoppers. RESULTS Among the 9238 intercept surveys, there were 20 244 items. On average, at each corner store visit, consumers purchased 2.2 (sd 2.1) items (1.3 (sd 2.0) foods and 0.9 (sd 0.9) beverages) that cost

Changes in quantity, spending, and nutritional characteristics of adult, adolescent and child urban corner store purchases after an environmental intervention

US 2.74 (sd

A randomized controlled study of a healthy corner store initiative on the purchases of urban, low‐income youth

US 3.52) and contained 2786.5 (sd 4454.2) kJ (666.0 (sd 1064.6) kcal). Whether the data were examined as a percentage of total items purchased or as a percentage of intercepts, the most common corner store purchases were beverages, chips, prepared food items, pastries and candy. Beverage purchases occurred during 65.9% of intercepts and accounted for 39.2% of all items. Regular soda was the most popular beverage purchase. Corner store purchases averaged 66.2 g of sugar, 921.1 mg of sodium and 2.5 g of fibre per intercept. Compared with children and adolescents, adults spent the most money and purchased the most energy. CONCLUSIONS Urban corner store shoppers spent almost