B‘More Healthy: Communities for Kids


Joel Gittelsohn MS, PhD
Principal Investigator

Cara Shipley RD, LDN
Project Coordinator

Intervention Materials


  • Our overarching goal is to develop and evaluate a community-based obesity prevention program, which operates at multiple levels of an urban food system (policy, wholesaler, corner stores, carryout, household, individual; in Baltimore, MD), and will improve the healthy food supply chain to increase affordability, availability, purchasing and consumption of healthy foods within low-income minority neighborhoods. Our research will include stakeholders/ partners at different levels, e.g., the policy, wholesaler, retailer, adult caregiver, and individual child levels, and then develop, implement, and assess a two year multi-level systems-based child obesity prevention strategy targeting minority and low-income children (predominantly African American (AA)). Thirty low-income, predominantly AA geographic zones will be identified (“healthy eating zones” (HEZ)).  Half of these zones will be randomized to intervention, while the other half will be control.  Within each intervention zone we will work with at least 5 small food stores and prepared food sources to increase access to healthy foods through wholesaler discounts, display point of purchase promotional materials, and provide nutrition and food preparation education targeting youth and caregivers.  We will work with local policymakers to institutionalize and sustain these changes. We will also conduct a pilot study with two local urban farms and neighboring cornerstore markets aimed to introduce local produce as part of the retail food store component of the intervention.

Primary Aims:

  • To develop a community-based obesity prevention program, which operates at multiple levels of the Baltimore city food system (policy, wholesaler, corner stores, carryout, household, individual), and aims to increase affordability, availability, purchase and consumption of healthy foods within low-income minority neighborhoods.
  • To implement the program with high reach, dose and fidelity in 14 high-risk zones in Baltimore City.
  • To evaluate the impact of the program on: a) healthy food pricing and availability, b) low income AA adult food purchasing and preparation, and c) low-income AA youth diet, and associated psychosocial factors.

Project Features: 

The intervention trial utilizes a systems-based approach to test and evaluate multilevel structural interventions.  Our trial will: 1) improve the healthy food supply chain from wholesalers, to small stores/carryouts, to consumers; 2) create cost-effective partnerships between small urban food source owners and wholesalers, 3) develop strategies to increase individual and retailer demand for healthy foods, 4) reveal barriers and enhancing factors to scaling up these interventions city-wide via policy changes, and 5) provide the evidence and data needed to develop and refine multi-level obesity-prevention systems-models, enhance GIS mapping systems of the urban food environment.  The federal government has recently tested programs to further subsidize costs of specific foods within existing programs, such as SNAP. It is crucial to understand how stakeholders can work together to maximize the impact of such discounts, and to determine ways to enhance consumer demand for healthy foods.

    •  Interventions included: (much of this is still being developed as well)
      • Print media (such as posters, handouts, and bulletins)
      • Interactive sessions
      • Taste tests
      • Price point options at wholesaler and retailer levels
      • Educational sessions
      • Giveaways
      • Upgrades to cornerstores
      • Marketing and promotion of targeted foods in stores
      • Policy changes

Phases of Research

Phase Months Focus
1 1-9 Formative ResearchZone SelectionPolicy planningPilot Study
2 3-12 Development of retail/wholesaler collaborativesIntervention Development
3 13-20 RecruitmentBaseline data collection
4 20-36 Intervention ImplementationProcess Evaluation
5 37-44 Post-intervention data collection
6 45-52 6 month follow-up data collection
7 45-60 Analysis and preparation of publicationDissemination

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