food environment interventions to promote healthy choices in a low-income, latino community anne...
TRANSCRIPT
![Page 1: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/1.jpg)
Food environment interventions to promote healthy choices in a low-income,
Latino community
Anne Thorndike, MD, MPHGeneral Medicine Division and Cardiovascular Prevention Center,
Massachusetts General Hospital, Boston, MA
Hispanic-American Institute, Healthy Foods Symposium
March 9, 2015
1
![Page 2: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/2.jpg)
Overview
2
1. Obesity, diabetes, and the food environment
2. Food environment interventions in Chelsea, MA
3. Summary/Next steps
![Page 3: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/3.jpg)
3
![Page 4: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/4.jpg)
4
![Page 5: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/5.jpg)
5
![Page 6: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/6.jpg)
6
![Page 7: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/7.jpg)
7
Obesity Rates in Hispanic Youth and Adults 2011-2012
Ogden, et al. JAMA, 2014.
% o
verw
eigh
t or o
bese
![Page 8: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/8.jpg)
Diabetes in Hispanic/Latinos
8
• Rates of diabetes 7.1% non-Hispanic whites12.6% non-Hispanic blacks11.8% Hispanic/Latinos
• 7.6% Cuban Americans and Central/South Americans• 13.3% Mexican Americans• 13.8% Puerto Ricans
• Latinos are 1.5 times more likely to die from diabetes than non-Hispanic whites
• In 2014, one in five Latinos in America reported diabetes is the biggest health problem facing their families
![Page 9: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/9.jpg)
A framework for thinking about the obesity problem
9
INDIVIDUALS
ENVIRONMENTSVECTORS
Non-modifiable factors: genes, ageModifiable factors: behaviors and attitudes
Computers, cars,sedentary job; “toxic” food environment
Physical, economic,sociocultural, policy
Educational, behavioral,and medical intervention
Food environment;technology
Policy and social change
Adapted from Swinburn et al, Obesity Reviews, 2002.
![Page 10: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/10.jpg)
Targeting sugar-sweetened beverages and fruits and vegetables to prevent obesity
10
• Sugar-sweetened beverages (SSBs)– major contributor to excessive calories in children’s
diets; US children drink more than one SSB per day– reducing SSB consumption can help reduce obesity
• Fruits and vegetables (F/V)– increased F/V intake associated with lower rates of
obesity and chronic disease
• Low-income individuals consume more SSBs and fewer F/V than those with higher incomes
![Page 11: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/11.jpg)
Food Environment Interventions
11
1. Healthy Chelsea Corner Store Connection
2. Compare Market, Choose Well/Elige Bien!
![Page 12: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/12.jpg)
Chelsea, Massachusetts
12
• Two square miles; 35,000 residents
• 62% Latino; 44% Spanish as primary language
• Median income= $30,000; 25% of families live at or below poverty
• 2010: 50% school-aged children were overweight or obese
• 2011 survey: 46 of 49 stores that sold food had limited availability of healthy foods
– 25% no produce; 50% fewer than 4 varieties
![Page 13: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/13.jpg)
Chelsea Corner Store Connection
13
• Collaboration between MGH researchers, MGH Center for Community Health Improvement (CCHI), and six corner stores in Chelsea.
• Objective: Increase availability and visibility of produce in corner stores and test whether customers purchased more fruits and vegetables after the intervention.
• Enrolled 6 stores; 3 intervention and 3 control
• Outcomes: 1. WIC fruit and vegetable voucher redemption at stores 2. Store customer exit surveys
![Page 14: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/14.jpg)
Chelsea Corner Store Connection
14
Key aspects• All stores paid $500 every 3 months (total of $1500)
to participate in the research
• Intervention: new produce baskets, shelving, refrigerator (one); signage; targeted education about produce storage, display, and shelf life
• Friendly negotiations with owners
• Evaluation of outcomes
![Page 15: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/15.jpg)
15
Intervention Store A: Before
![Page 16: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/16.jpg)
16
Intervention Store A: After
![Page 17: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/17.jpg)
Intervention Store B: Before
17
![Page 18: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/18.jpg)
Intervention Store B: After
18
![Page 19: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/19.jpg)
Chelsea Corner Store Connection: preliminary survey results
19
Control store customers
(N=280)
Intervention store customers
(N=294) P value
Male 43% 47% NS
Hispanic/Latino 93% 84% .001
Main reason for visiting store: Groceries Snack Beverage Lottery ticket/cigarettes Other
64%13%17%7%
10%
36%21%20%21%18%
<.001.02NS
<.001<.001
Lives within 3 blocks of store 88% 79% .07
WIC participant 29% 24% NS
SNAP participant 38% 36% NS
![Page 20: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/20.jpg)
Chelsea Corner Store Connection: preliminary survey results
20
Pre-intervention
Post-intervention Change
P-value
P-value interaction
Purchased fresh fruit
Control stores 21% 23% 2% NS NS
Intervention stores 13% 13% 0 NS
Purchased fresh vegetables
Control stores 26% 15% -10% .03 NS
Intervention stores 8% 7% -1% NS
Planned to buy F/V at corner store
Control stores 38% 32% -6% NS NS
Intervention stores 20% 21% 1% NS
![Page 21: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/21.jpg)
• Collaboration between MGH and Harvard School of Public Health researchers, MGH CCHI, and Alberto Calvo, owner of Compare
• Objective:– To conduct a randomized controlled trial testing the
effectiveness of in-store traffic-light labels, beverage education, and financial incentives to reduce the purchase of sugar-sweetened beverages by low-income, Latino families who were regular customers of Compare Supermarket.
21
Compare Supermarket: Choose Well/Elige Bien!
![Page 22: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/22.jpg)
• Randomized, controlled trial
• 216 customers enrolled; half randomly assigned to get financial incentives
• Inclusion criteria: regular customer of Compare supermarket; speak English or Spanish
• “Loyalty card” identifies customer’s purchases at check-out; 5% off every purchase
22
Study Design and Data Collection
Anne ThorndikeAnne Thorndike
![Page 23: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/23.jpg)
• Collected baseline purchasing data for 2 months
• Labeled beverages with “traffic lights”
• Half of study participants received monthly letters with targeted beverage education and financial incentive ($25 Compare gift card) for not purchasing “red” beverages
• Collected sales data for 5 months after labels in place
23
Study Design and Data Collection
![Page 24: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/24.jpg)
24
In-store signage
![Page 25: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/25.jpg)
25
Traffic-light shelf labels
![Page 26: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/26.jpg)
26
Demographics of study participants
Intervention group(N=77)
Control group(N=71)
Subjects who never used card
(N=36)
Age category 18-39 40 and over
66%34%
66%34%
74%26%
Female 100% 97% 100%
Hispanic/Latino 99% 99% 100%
Children in household, mean (SD) 2.0 (1.0) 2.1 (1.1) 2.1 (0.9)
Use SNAP for groceries 66% 49%* 54%
Frequency of shopping at Compare Once a month Once a week Twice a week or more
1%26%73%
3%34%63%
9%23%63%
Proportion groceries from Compare More than half or all About half
42%58%
38%62%
29%71%
* P=0.04 compared to intervention group
![Page 27: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/27.jpg)
27
Self-reported daily beverage consumption
Intervention group(N=77)
Control group(N=71)
Water 94% 97%
Hot coffee or tea 77% 77%
Seltzer water 5% 7%
Diet soda 3% 6%
100% fruit juice 55% 54%
Juice drinks 40% 32%
Soda 29% 23%
Powder mixes 29% 17%
Sports drinks 14% 21%
![Page 28: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/28.jpg)
28
Proportion of intervention subjects who purchased any red beverages decreased 9% more per month than control
(N=148)
%
who
pur
chas
ed r
ed b
ever
ages
Baseline Intervention
P=0.002
Traffic-light labels posted
![Page 29: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/29.jpg)
29
Trend over time in proportion of subjects who purchased any red beverages
%
who
pur
chas
ed r
ed b
ever
ages
Baseline Intervention
P=0.002
Traffic-light labels posted
![Page 30: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/30.jpg)
30
Proportion of intervention subjects on SNAP who purchased any red beverages decreased 8% more per
month than control (N=86)
%
who
pur
chas
ed r
ed b
ever
ages
Baseline Intervention
P=0.07
Traffic-light labels posted
![Page 31: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/31.jpg)
31
Trend over time in proportion of subjects on SNAP who purchased “red” beverages
%
who
pur
chas
ed r
ed b
ever
ages
Baseline Intervention
P=0.07
Traffic-light labels posted
![Page 32: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/32.jpg)
Choose Well/Elige Bien!Conclusions
32
• In-store traffic-light labels, beverage education, and financial incentives reduced SSB purchases among low-income Latino families.
• Strategies that combine point-of-purchase labeling, education, and incentives have potential to improve both motivation and skills for making healthier choices among low-income populations.
• Future research is needed to test scalability and long-term effectiveness.
![Page 33: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/33.jpg)
Summary
33
• Obesity is higher among Hispanic/Latino youth and adults and contributes to higher rates of chronic disease and death.
• The strong evidence base for reducing SSB’s and increasing F/V to reduce obesity provides an opportunity for targeted efforts that could have a large impact in low-income neighborhoods.
• Relatively small changes in neighborhood corner stores and grocery stores have potential for promoting healthier choices.
![Page 34: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/34.jpg)
Next steps
34
• Project to connect the MGH Chelsea pediatric practice with Compare Supermarket and to evaluate change in consumption and purchases of SSB’s and F/V.
• Hypothesize “linking” health care and food retail to provide consistent, evidence-based nutrition information reinforced in the community food environment will lead to healthier choices.
• New rules allow non-profit hospitals to use community benefits for “nutrition and other social determinants of health,” and could potentially fund these types of partnerships in the future.
![Page 35: Food environment interventions to promote healthy choices in a low-income, Latino community Anne Thorndike, MD, MPH General Medicine Division and Cardiovascular](https://reader035.vdocuments.net/reader035/viewer/2022062322/56649e395503460f94b2a760/html5/thumbnails/35.jpg)
Acknowledgements
Collaborators• MGH Center for Community
Health Improvement– Melissa Dimond
– Ron Fishman
• MGH Health Policy – Douglas Levy
• Harvard School of Public Health– Eric Rimm
– Lorena Macias-Navarro
– Becky Franckle
• Compare Supermarket– Alberto Calvo
Funding• Nutrition Obesity Research
Center at Harvard
• Harvard Catalyst
• MGH Center for Community Health Improvement
35