The Healthy Stores projects aim to improve health and prevent obesity and disease in low-income communities through culturally appropriate store-based interventions that increase the supply of healthy foods and promote their purchase.
Beginning with the Marshall Islands Healthy Stores program in 2000, Dr. Joel Gittelsohn of the Johns Hopkins Center for Human Nutrition initiated a series of store-based interventions to address the need for systemic environmental change in low income areas where healthy options are irregularly available, if at all.
The Apache Healthy Stores intervention began in July 2003 on the White Mountain and San Carlos Apache reservations in Arizona. Formative research for a larger intervention program in Baltimore, MD was completed in the Spring of 2003 and the research team is preparing for a pilot trial for the Baltimore Healthy Stores intervention that will take place in the Spring of 2004.
Future Healthy Stores programs are being planned in three Native Canadian communities and in Hawaii and other Pacific Island nations.
Obesity & Chronic Disease Prevalence
By now, you’ve no doubt heard about the global obesity epidemic. Obesity is the most common nutrition-related disorder in Western countries, and its prevalence is increasing in both children and adults across all segments of the population and in developing countries around the world.
But, did you know*:
70 percent of the U.S. population is overweight.
About 25 percent of that group are obese.
Approximately 30 percent of children (ages 6 to 11) are overweight and 15 percent are obese.
Obesity costs the U.S. more than $93 billion a year due to chronic disease complications, absenteeism, and loss of productivity.
African American, Hispanic, Native American, and Pacific Islanders have higher rates of obesity than white Americans.
Poor women are 50% more likely to be obese than those with higher socioeconomic status.
*(Source: The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity, 2001; American Obesity Association; Prevalence and Trends in Obesity Among US Adults, 1999-2000 Katherine M. Flegal; Margaret D. Carroll; Cynthia L. Ogden; Clifford L. Johnson
The HEALTHY STORES strategy
Many obesity prevention interventions in the past have focused on changing individual behavior, but not adequately addressed the need for systemic environmental change. In many low income regions of the United States, including inner city areas and rural regions, healthy options are often hard to find. The dramatic increase in obesity over the past two decades is related to an environment laden with inexpensive, high-fat convenience foods and super-sized portions, as well as a marked decrease in physical activity.
The Healthy Stores projects are intervention plans, developed from substantial formative research, that seek to reduce obesity and disease risk in specific populations. They utilize conceptual frameworks and approaches from:
and health communications.
These constructs guide specific intervention phases and strategies.
Ethnographic approaches drawn from anthropology are used in each setting to:
identify core cultural concepts,
identify appropriate cultural metaphors for health communications,
frame messages in appropriate ways,
and to understand the social and cultural context of key behaviors relating to food and health.
Tested frameworks from educational psychology (specifically Social Cognitive Theory) address factors at both the individual and environmental levels to support behavioral change relating to diet.
Key components of Social Cognitive Theory (SCT) are:
- incorporation of the broader environment
- behavioral capability
- observational learning
- goal setting
- role modeling
- and reciprocal determinism.
Health communication and social marketing approaches enable investigators to develop effective messages targeted to specific audiences. These approaches have helped make mass media an effective component of the healthy stores interventions.
Gittelsohn J and Sharma S. “Physical, Consumer and Social Aspects of Measuring the Food Environment among Diverse Low-Income Populations,” (2009) American Journal of Preventive Medicine, 36(4S): S161-S165. http://www.ncbi.nlm.nih.gov/pubmed/19285208
Gittelsohn J, Rowan M, Gadhoke P. (2012) “Intervening in small food stores to change the food environment, improve diet and reduce risk from chronic disease,” Prev Chronic Dis. Feb;9:E59. Epub 2012 Feb 16. http://www.ncbi.nlm.nih.gov/pubmed/22338599
Gittelsohn J and Rowan M (2011) “Preventing diabetes and obesity in American Indian communities: The potential of environmental interventions,” American Journal of Clinical Nutrition, Mar 16. [Epub ahead of print]. http://www.ncbi.nlm.nih.gov/pubmed/21411614