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The purpose of this study was to evaluate a multifaceted, collaborative approach to supermarket environmental change that included in-store couponing and educational marketing to increase low-fat milk purchasing across a 48-store supermarket chain serving predominately Hispanic customers. Point-of-sale (POS) and process data collected during the 16-week program implementation included in-store radio advertising, in-store signage, and POS coupons. POS data were analyzed by the coupon marketing partner, and a chi-square test was conducted to test for significant differences between groups. POS data indicated that 44,050 low-fat milk coupons were issued to traditional full-fat milk purchasing customers with a redemption rate of 5.3%. Of these, 42% became repeat low-fat milk purchasers (i.e., after initial purchase with coupon, customer re-purchased low-fat milk). Results from the chi-square test revealed significant differences in rates of purchase between those who received a coupon (5.87%) and those who did not (4.00%), (χ2 = 8.61, p = .0033). Findings indicate that collaborative public health efforts between retail and marketing partners to engage supermarket customers in a multifaceted yet targeted intervention are feasible and can shift purchasing behaviors towards a healthy alternative. This study has implications for informing future environmental change supermarket strategies.

Introduction: Despite UN recommendations to monitor food insecurity using the Food Insecurity Experience Scale (FIES), to date there are no published reports of its validity for The Bahamas, nor have prevalence rates of moderate or severe food insecurity been reported for the remote island nation. At the same time, food security is a deep concern, with increasing incidence of natural disasters and health concerns related to diet-related disease and dietary quality plaguing the nation and its food system. This article aims to examine the validity of the FIES for use in The Bahamas, the prevalence of moderate and severe food insecurity, and the sociodemographic factors that contribute to increased food insecurity. Methods: The FIES survey was administered by randomized and weighted landline telephone survey in Nassau in The Bahamas to 1000 participants in June and July 2017. The Rasch modelling procedure was applied to examine tool validity and prevalence of food insecurity. Equating procedures calibrated this study's results to the global FIES reference scale and computed internationally comparable prevalence rates of both moderate and severe food insecurity. A regression analysis assessed the relationship between household variables and food security. Results: The FIES met benchmarks for fit statistics for all eight items and the overall Rasch reliability is 0.7. As of 2017, Bahamians' prevalence of moderate and severe food insecurity was 21%, and the prevalence of severe food insecurity was 10%. Statistically significant variables that contribute to food insecurity included education, age, gender, and presence of diabetes, high blood pressure, or heart disease. Results also indicated that Bahamians experience food insecurity differently than populations across the globe, likely due in large part to the workings of an isolated food system heavily dependent on foreign imports. Responses showed that by the time a Bahamian worries they will not have enough food to eat, they have already restricted their meals to a few kinds of foods and begun to limit their intake of vegetables and fruits. Conclusion: This study, which is among the first to comprehensively measure food security in The Bahamas, provides a baseline for further research and evaluation of practices aimed at mitigating food insecurity in small island developing states. Further, this study provides a benchmark for future research, which may seek to understand the impacts of Hurricane Dorian and COVID-19, disasters further isolating the remote island nation. Post-disaster food security data are needed to further understand the extent to which food security is impacted by natural disasters and identify which sectors and stakeholders are most vital in restructuring the agricultural sector and improving food availability following catastrophic events.

The consumption of sugar-sweetened beverages (SSBs) has been linked to obesity, diabetes, and other negative health outcomes among children. In response, many government entities have enacted healthy default beverage policies that require restaurants offering bundled kids’ meals—food and drink items combined and sold as a single unit—to include only healthier drinks. Despite growing interest in these policies, little is known about their potential reach, restaurant management perceptions, and possible implementation challenges. This study evaluated restaurant managers’ knowledge and support of a policy in Delaware that had passed, but not yet gone into effect. We conducted structured in-person interviews with managers (n = 50) from full-service and quick-service chain and non-chain restaurants (QSRs) using a stratified random sample. Managers were interviewed about the number of bundled meals sold, beverage sales with those meals, and awareness and perceptions of the policy. On average, QSRs sold significantly more bundled kids’ meals per week (281) compared to full-service restaurants (111), and managers from chain restaurants reported selling significantly more bundled kids’ meals per week (233) compared to non-chain restaurants (91). Managers reported 72.5% of those meals were sold with a healthier beverage (water, milk, or 100% juice), consistent with the forthcoming policy, while 28% were sold with SSBs. Furthermore, although only three managers (6%) reported knowing about the policy, the majority supported it when it was explained. Our findings indicate general support for the intent of the policy, but suggest the need for tailored implementation approaches and additional education for restaurant manager’s and staff.

In response to lack of access to healthy foods, many low-income communities are instituting local healthy corner store programs. Some stores also participate in the United States Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP). This study used two assessment tools to compare the healthfulness of offerings at stores participating in local healthy store programs (upgraded stores), WIC, and/or SNAP to that of similar non-participating stores.Based on store audits conducted in 315 New Jersey corner stores in 2014, we calculated healthy food availability scores using subsections of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS-Availability) and a short-form corner store audit tool (SCAT). We used multivariable regression to examine associations between program participation and scores on both instruments.Adjusting for store and block group characteristics, stores participating in a local healthy store program had significantly higher SCAT scores than did non-participating stores (upgraded: M = 3.18, 95% CI 2.65–3.71; non-upgraded: M = 2.52, 95% CI 2.32–2.73); scores on the NEMS-CS-Availability did not differ (upgraded: M = 12.8, 95% CI 11.6–14.1; non-upgraded: M = 12.5, 95% CI 12.0–13.0). WIC-participating stores had significantly higher scores compared to non-participating stores on both tools. Stores participating in SNAP only (and not in WIC) scored significantly lower on both instruments compared to non-SNAP stores.WIC-participating and non-SNAP corner stores had higher healthfulness scores on both assessment tools. Upgraded stores had higher healthfulness scores compared to non-upgraded stores on the SCAT. Keywords: Diet, Food, And nutrition, Nutrition surveys, Food environment, Food assistance

An emerging body of research examines the health and economic impacts of healthy corner store interventions, although implementing valid mechanisms to capture changes in diet remains a challenge. Healthy corner store interventions employ strategies to help corner stores procure, maintain and market healthier foods such as fruits and vegetables, whole grains and low-fat dairy items like skim milk. A recent national convening of partners yielded a series of research and evaluation questions that need answers in order for the field to progress. Participants in the Healthy Corner Stores Symposium identified several challenges to developing a sustainable business model for small-scale healthy food retail. This group of practitioners, funders, lenders, academics, and other leaders ranked what they saw as the most promising opportunities for maximizing the positive impact these businesses have on the community. Unique to this forum, the agenda was born from a program-operation perspective and not from the more common approach where an independent researcher evaluates the efficacy of a program or intervention. As efforts to improve food systems emerge, such an approach to research is critical. The central challenges and a prioritized list of research questions are discussed.

There is limited research documenting the shopping behaviors of urban residents with regard to where they shop for fruits and vegetables. This study sought to: (1) describe characteristics of consumers who shop for produce at supermarkets, alternative fresh food outlets, and farmers' markets; and (2) identify correlates of farmers' market shopping among urban consumers. Participants were recruited from 30 randomly selected residential blocks in West and Southwest Philadelphia, Pennsylvania, to complete a cross-sectional survey. Of 622 residents contacted, 82.6 percent completed a usable survey. Participants were predominantly African American (75.2 percent), single (47 percent), and receiving public assistance (30.1 percent). About half of the respondents reported shopping at farmers' markets (48.2 percent), produce stores (47.9 percent), and/or fruit and vegetable trucks (48.0 percent percent) for produce. Having vouchers for farmers' markets was significantly associated with shopping at those markets, being younger, and not owning a car. Our analysis begins to bridge the gap in understanding how individual-level differences may influence shopping patterns. Findings suggest that financial incentives to shop at farmers' markets can be meaningful contributors to shopping at these venues and may work to support the narrowing of disparities in access to healthy, affordable food.