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Across the U.S., there are notable disparities in the healthfulness of foods and beverages found in retail settings. Small food stores tend to lack a wide array of healthy, staple foods.TRANSCRIPT
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Minimum Stocking Levels and Marketing Strategies of Healthful Foods for Small Retail Food Stores
Healthy Eating Research:Building Evidence to Prevent Childhood Obesity
We will be tweeting during the webinar, please tag @HEResearch in your tweets
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PresentersMelissa LaskaAssociate Professor, Epidemiology & Community HealthUniversity of Minnesota School of Public Health
Jennifer PelletierPhD Candidate and Research AssistantUniversity of Minnesota School of Public Health
Tracy FoxPresident Food, Nutrition & Policy Consultants, LLC
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Across the U.S., there are notable disparities in the healthfulness of foods and beverages found in retail settings.
Small food stores tend to lack a wide array of healthy, staple foods.
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Introduction
Limited access to stores that carry healthful food may contribute – at least in part – to disparities in diet and health.
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Addressing the Problem
Strategies for addressing limited access to stores that stock and sell healthy, staple foods and beverages include: • Attracting new grocery stores or supermarkets
to an underserved community. • Improving the healthfulness of products sold
by existing food retailers in a given community.
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Small Food Stores
Small stores face challenges in stocking and selling healthy food.• “Healthy corner store” programming has
shown some success in addressing challenges.
• Policy action has been used to support healthy corner store work and to institute healthy stocking standards for retailers.
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Key Challenge
Lack of consistency in standards across these programs and policies.
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Aims of this report
Identify basic and preferred minimum stocking levels for healthful foods and beverages in small retail food stores. Identify marketing strategies small stores should use to enhance sales of healthy foods and beverages.
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Expert Panel LeadershipPanel Conveners:Mary Story, PhD, RDDirector, Healthy Eating ResearchProfessor, Global Health and Community and Family MedicineAssociate Director of Education and TrainingDuke Global Health Institute Megan Lott, MPH, RDNSenior Associate of Policy and Research, Healthy Eating ResearchDuke Global Health Institute
Panel Chair:Melissa N. Laska, PhD, RDAssociate Professor, Epidemiology & Community HealthCo-Director, Obesity Prevention CenterSenior Program Advisor, Healthy Eating ResearchUniversity of Minnesota School of Public Health
Panel Support: Jennifer E. Pelletier, MPHPhD Candidate and Research AssistantUniversity of Minnesota School of Public Health
Lesley Schmidt Sindberg, MPHSenior Research Coordinator, Healthy Eating ResearchUniversity of Minnesota School of Public Health
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Expert Panel MembersGuadalupe X. Ayala, PhD, MPHSan Diego State University
Brian Elbel, PhD, MPHNew York University School of Medicine andWagner Graduate School of Public Service
Christine Fry, MPPChangeLab Solutions
Joel Gittelsohn, PhDJohns Hopkins Bloomberg School of Public Health
Steve Gortmaker, PhDHarvard T.H. Chan School of Public Health
Allison Karpyn, PhDUniversity of Delaware
Fred A. Katz, MBA, MSDEJohns Hopkins University Carey Business School
Paul NojaimNojaim Brothers Supermarket
Collin R. Payne, PhDNew Mexico State University
Stephanie Jilcott Pitts, PhDEast Carolina University
Julie Ralston Aoki, JDPublic Health Law Center
Tracy Fox, MPH, RDFood, Nutrition & Policy Consultants, LLC
Bill McKinneyThe Food Trust
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Scope
Small retail food stores• Have retail floor space dedicated to foods/ beverages• Have no more than 3 cash registers that may be
used for food/beverage transactions• Includes: dollar stores, retail pharmacies, stores
accepting WIC or SNAP• Excludes: home goods stores, electronics stores,
office supply stores
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Methodology
Sources reviewed• 2015 Dietary Guidelines for Americans• Peer-reviewed research• National recommendations and guidelines• Existing retailer requirements in local, state, and
federal policies and programs• e.g. WIC retailer requirements, Healthy Corner
Store Certification Programs
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Overview
1. Minimum Stocking Levels of Healthful Foods/Beverages (Table 1)• Fruits and Vegetables• Dairy and Fortified Soy Beverages• Whole Grain-Rich Staple Products• Meat/Protein• Beverages
Qualifying Standards (Table 2)
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Overview
Two Levels of Minimum Stocking• Basic• Preferred
2. Marketing Strategies for Food Retailers• Apply to basic & preferred• May also apply to larger stores
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Fruits and VegetablesBasic
Varieties • ≥4 FRUITS• ≥2 Fresh
• ≥6 VEGETABLES• ≥4 Fresh• ≥1 Dark green or
red/orange
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Fruits and VegetablesBasic
Varieties • ≥4 FRUITS• ≥2 Fresh
• ≥6 VEGETABLES• ≥4 Fresh• ≥1 Dark green or
red/orange
Single kind of product,
regardless of form, processing, or package size
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Fruits and VegetablesBasic
Varieties • ≥4 FRUITS• ≥2 Fresh
• ≥6 VEGETABLES• ≥4 Fresh• ≥1 Dark green or
red/orangePounds* ≥30
*No more than 50% from a single variety
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Fruits and VegetablesBasic Preferred
Varieties • ≥4 FRUITS• ≥2 Fresh
• ≥6 VEGETABLES• ≥4 Fresh• ≥1 Dark green or
red/orange
• ≥6 FRUITS• ≥3 Fresh
• ≥8 VEGETABLES• ≥4 Fresh• ≥2 Dark green or
red/orangePounds* ≥30
*No more than 50% from a single variety
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Fruits and VegetablesBasic Preferred
Varieties • ≥4 FRUITS• ≥2 Fresh
• ≥6 VEGETABLES• ≥4 Fresh• ≥1 Dark green or
red/orange
• ≥6 FRUITS• ≥3 Fresh
• ≥8 VEGETABLES• ≥4 Fresh• ≥2 Dark green or
red/orangePounds* ≥30 ≥45
*No more than 50% from a single variety
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)Fresh, frozen, or cannedNon-expired, non-spoiledCanned/frozen fruit packed in water, 100% juice, extra light or light syrupCanned/frozen vegetables with no added ingredients and no more than 240 mg sodiumExcludes fruit or vegetable juice, garlic, herbs, condiments, ginger root, lemons, and limes
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Dairy and Fortified Soy BeveragesBasic
Milk/Fortified Soy Beverage
• ≥5 gallons• ≥1 variety
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)Milk: skim (0% fat), low-fat (1%), in half gallon package or largerFortified soy beverage: original or plain, fortified with calcium and vitamins A and D, in half gallon package or largerYogurt with no more than 23 g total sugar/6 oz serving. No frozen yogurt or yogurt with mix-in ingredients.Cheese that is low-fat, part-skim, or fat free. Excludes processed cheese products and cheese packaged with other foods
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Dairy and Fortified Soy BeveragesBasic
Milk/Fortified Soy Beverage
• ≥5 gallons• ≥1 variety
Yogurt • ≥32 ounces• ≥ 1 variety
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)Milk: skim (0% fat), low-fat (1%), in half gallon package or largerFortified soy beverage: original or plain, fortified with calcium and vitamins A and D, in half gallon package or largerYogurt with no more than 23 g total sugar/6 oz serving. No frozen yogurt or yogurt with mix-in ingredients.Cheese that is low-fat, part-skim, or fat free. Excludes processed cheese products and cheese packaged with other foods
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Dairy and Fortified Soy BeveragesBasic
Milk/Fortified Soy Beverage
• ≥5 gallons• ≥1 variety
Yogurt • ≥32 ounces• ≥ 1 variety
Cheese* • ≥2 pounds• ≥1 variety
*Only if cheese is stockedStandards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)Milk: skim (0% fat), low-fat (1%), in half gallon package or largerFortified soy beverage: original or plain, fortified with calcium and vitamins A and D, in half gallon package or largerYogurt with no more than 23 g total sugar/6 oz serving. No frozen yogurt or yogurt with mix-in ingredients.Cheese that is low-fat, part-skim, or fat free. Excludes processed cheese products and cheese packaged with other foods
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Dairy and Fortified Soy BeveragesBasic Preferred
Milk/Fortified Soy Beverage
• ≥5 gallons• ≥1 variety
• ≥10 gallons• ≥ 2 varieties
Yogurt • ≥32 ounces• ≥ 1 variety
• ≥64 ounces• ≥ 2 varieties
Cheese* • ≥2 pounds• ≥1 variety
• ≥4 pounds• ≥2 varieties
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)Milk: skim (0% fat), low-fat (1%), in half gallon package or largerFortified soy beverage: original or plain, fortified with calcium and vitamins A and D, in half gallon package or largerYogurt with no more than 23 g total sugar/6 oz serving. No frozen yogurt or yogurt with mix-in ingredients.Cheese that is low-fat, part-skim, or fat free. Excludes processed cheese products and cheese packaged with other foods
*Only if cheese is stocked
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Whole Grain-Rich Staple ProductsBasic
Whole Grain-Rich Staple Products*
• ≥5 pounds• ≥2 varieties
*Excluding cereal
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)Varieties of staple products include but are not limited to whole grain bread, brown rice, whole wheat or whole corn tortillas, quinoa, and barley.Whole grain is the first ingredientExcludes whole grain-rich snacks and sweetsWhole grain-rich cereal must have no more than 21.2 g total sugar per 100 g, or no more than 6 g per 1 dry ounce and be in packages of at least 11 ounces
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Whole Grain-Rich Staple ProductsBasic
Whole Grain-Rich Staple Products*
• ≥5 pounds• ≥2 varieties
Whole Grain-Rich Cereal
• ≥4 containers• ≥3 varieties
*Excluding cereal
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)Varieties of staple products include but are not limited to whole grain bread, brown rice, whole wheat or whole corn tortillas, quinoa, and barley.Whole grain is the first ingredientExcludes whole grain-rich snacks and sweetsWhole grain-rich cereal must have no more than 21.2 g total sugar per 100 g, or no more than 6 g per 1 dry ounce and be in packages of at least 11 ounces
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Whole Grain-Rich Staple ProductsBasic Preferred
Whole Grain-Rich Staple Products*
• ≥5 pounds• ≥2 varieties
• ≥10 pounds• ≥ 2 varieties
Whole Grain-Rich Cereal
• ≥4 containers• ≥3 varieties
• ≥12 containers• ≥ 4 varieties
*Excluding cereal
Standards: (SEE TABLE 2 OF REPORT FOR MORE DETAIL)Varieties of staple products include but are not limited to whole grain bread, brown rice, whole wheat or whole corn tortillas, quinoa, and barley.Whole grain is the first ingredientExcludes whole grain-rich snacks and sweetsWhole grain-rich cereal must have no more than 21.2 g total sugar per 100 g, or no more than 6 g per 1 dry ounce and be in packages of at least 11 ounces
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Meat/ProteinBasic
VarietiesMeat productsPoultryFishEggsDried or canned beans Dried split peasBlack-eyed peasLentilsSoybean products (including tofu)NutsNut butter
• ≥4 total varieties
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):Cuts of meat or deli meat that are labeled by USDA as lean or extra lean. Qualifying products must be plain and packages with no oils, sauces, or other food products. All products in this category must be low sodium (no more than 360 mg per serving). Nuts must have no added sugar and nut butter must be packaged with no other food products.
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Meat/ProteinBasic
VarietiesMeat productsPoultryFishEggsDried or canned beans Dried split peasBlack-eyed peasLentilsSoybean products (including tofu)NutsNut butter
• ≥4 total varieties• ≥1 lean or
extra lean red meat*
*Only if red meat is stocked
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):Cuts of meat or deli meat that are labeled by USDA as lean or extra lean. Qualifying products must be plain and packages with no oils, sauces, or other food products. All products in this category must be low sodium (no more than 360 mg per serving). Nuts must have no added sugar and nut butter must be packaged with no other food products.
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Meat/ProteinBasic Preferred
VarietiesMeat productsPoultryFishEggsDried or canned beans Dried split peasBlack-eyed peasLentilsSoybean products (including tofu)NutsNut butter
• ≥4 total varieties• ≥1 lean or
extra lean red meat*
• ≥8 total varieties• ≥1 lean or extra
lean red meat*
*Only if red meat is stocked
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):Cuts of meat or deli meat that are labeled by USDA as lean or extra lean. Qualifying products must be plain and packages with no oils, sauces, or other food products. All products in this category must be low sodium (no more than 360 mg per serving). Nuts must have no added sugar and nut butter must be packaged with no other food products.
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BeveragesBasic
Plain water • ≥384 ounces (24 bottles of size 16 oz)
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):Low-calorie beverages have no more than 40 calories per 8 ounce servingVegetable juice with no more than 140 mg sodium per servingsFamily size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
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BeveragesBasic
Plain water • ≥384 ounces (24 bottles of size 16 oz)
Fountain beverages*
*Only if fountain beverages are sold
• Plain water available• ≥1 low-calorie beverage• ≥1 container size 12
ounces or smaller
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):Low-calorie beverages have no more than 40 calories per 8 ounce servingVegetable juice with no more than 140 mg sodium per servingsFamily size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
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BeveragesBasic
Plain water • ≥384 ounces (24 bottles of size 16 oz)
Fountain beverages*
*Only if fountain beverages are sold
• Plain water available• ≥1 low-calorie beverage• ≥1 container size 12
ounces or smaller
100% Fruit or Vegetable Juice*
*Only if juice or juice-flavored beverages are stocked
• ≥6 family-sized containers OR
• ≥24 individual-sized bottles (8 ounces)
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):Low-calorie beverages have no more than 40 calories per 8 ounce servingVegetable juice with no more than 140 mg sodium per servingsFamily size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
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BeveragesBasic Preferred
Plain water • ≥384 ounces (24 bottles of size 16 oz)
• ≥384 ounces (24 bottles of size 16 oz)
Fountain beverages*
*Only if fountain beverages are sold
• Plain water available• ≥1 low-calorie beverage• ≥1 container size 12
ounces or smaller
• Plain water available• ≥2 low-calorie beverages• ≥2 container sizes 12
ounces or smaller• No container sizes larger
than 16 ounces100% Fruit or Vegetable Juice*
*Only if juice or juice-flavored beverages are stocked
• ≥6 family-sized containers OR
• ≥24 individual-sized bottles (8 ounces)
• ≥12 family-sized containers OR
• ≥48 individual-sized bottles (8 ounces)
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):Low-calorie beverages have no more than 40 calories per 8 ounce servingVegetable juice with no more than 140 mg sodium per servingsFamily size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
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BeveragesBasic Preferred
Plain water • ≥384 ounces (24 bottles of size 16 oz)
• ≥384 ounces (24 bottles of size 16 oz)
Fountain beverages*
*Only if fountain beverages are sold
• Plain water available• ≥1 low-calorie beverage• ≥1 container size 12
ounces or smaller
• Plain water available• ≥2 low-calorie beverages• ≥2 container sizes 12
ounces or smaller• No container sizes larger
than 16 ounces100% Fruit or Vegetable Juice*
*Only if juice or juice-flavored beverages are stocked
• ≥6 family-sized containers OR
• ≥24 individual-sized bottles (8 ounces)
• ≥12 family-sized containers OR
• ≥48 individual-sized bottles (8 ounces)
Access to dispensed, potable water
• Must be provided free of charge
Standards (SEE TABLE 2 OF REPORT FOR MORE DETAIL):Low-calorie beverages have no more than 40 calories per 8 ounce servingVegetable juice with no more than 140 mg sodium per servingsFamily size containers are 59 ounces or larger, or 11.5-12 ounces frozen or non-frozen concentrate
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Marketing Strategies
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Marketing StrategiesCategory Description
Placement Physical location of products in store
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Marketing StrategiesCategory Description
Placement Physical location of products in store
Price Relative and absolute prices of products
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Marketing StrategiesCategory Description
Placement Physical location of products in store
Price Relative and absolute prices of products
Promotion Deals, advertisements, signage
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Marketing Strategies: PlacementCategory StrategiesPlacement Place healthier foods/beverages in multiple prominent
locations throughout the store• Eye level• End caps• Grab & go displays near entrance/checkout
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Marketing Strategies: PlacementCategory StrategiesPlacement Place healthier foods/beverages in multiple prominent
locations throughout the store• Eye level• End caps• Grab & go displays near entrance/checkout
Stock only healthier foods/beverages/non-food items in some or all checkout areas-OR-Increase the proportion of healthier foods/beverages/non-food items in all checkout areas
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Marketing Strategies: PlacementCategory StrategiesPlacement Place healthier foods/beverages in multiple prominent
locations throughout the store• Eye level• End caps• Grab & go displays near entrance/checkout
Stock only healthier foods/beverages/non-food items in some or all checkout areas-OR-Increase the proportion of healthier foods/beverages/non-food items in all checkout areasCross-merchandize healthier foods/beverages by placing complementary products near each other
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Marketing Strategies: PriceCategory StrategiesPrice Offer at least 10% price discount in promotions for
fruits and vegetables through coupons, vouchers, rebates, or other methods
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Marketing Strategies: PriceCategory StrategiesPrice Offer at least 10% price discount in promotions for
fruits and vegetables through coupons, vouchers, rebates, or other methods
Offer at least 10% price discount in promotions for healthier versions of products within a product category (e.g., whole grain-rich bread vs. white bread)
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Marketing Strategies: PriceCategory StrategiesPrice Offer at least 10% price discount in promotions for
fruits and vegetables through coupons, vouchers, rebates, or other methods
Offer at least 10% price discount in promotions for healthier versions of products within a product category (e.g., whole grain-rich bread vs. white bread)
Use proportional pricing, as opposed to value pricing, for full-calorie fountain beverages
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Marketing Strategies: PromotionCategory Strategies
Promotion Cross-promote healthier foods/beverages by offering price promotions for complementary products purchased together (e.g., through circulars, digital media, in-store signage)
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Marketing Strategies: PromotionCategory Strategies
Promotion Cross-promote healthier foods/beverages by offering price promotions for complementary products purchased together (e.g., through circulars, digital media, in-store signage)
Use shelf tags, labels, tear off cards, and/or other point-of-purchase signage to promote healthier foods/beverages
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SummaryBasic Level Preferred LevelMinimum Stocking Requirements• Fruits and Vegetables• Dairy and Fortified Soy Beverages• Whole Grain-Rich Staple Products• Meat/Protein• Beverages
Minimum Stocking Requirements• Fruits and Vegetables• Dairy and Fortified Soy Beverages• Whole Grain-Rich Staple Products• Meat/Protein• Beverages
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SummaryBasic Level Preferred LevelMinimum Stocking Requirements• Fruits and Vegetables• Dairy and Fortified Soy Beverages• Whole Grain-Rich Staple Products• Meat/Protein• Beverages
Minimum Stocking Requirements• Fruits and Vegetables• Dairy and Fortified Soy Beverages• Whole Grain-Rich Staple Products• Meat/Protein• Beverages
Marketing Strategies• Placement• Price• Promotion
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Tracy Fox, MPH, RDPresident, Food, Nutrition & Policy Consultants, LLC
Culver, IN
www.foodnutritionpolicy.com
@TracyFoxRD
Policy Implications Feb. 10, 2016
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Policy Opportunities• SNAP: Enhancing Food
Retail Eligibility (proposed rule anticipated)
• National Commission on Hunger Report
• SNAP EBT Pilot and Expansion
• Healthy Food Financing Initiatives
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SNAP: Enhancing Retail Food Store Eligibility
Aug. 2013: FNS issued a Request for Information on ways to “enhance retailer definitions and requirements in a manner that improves access to healthy food choices for SNAP participants”FNS “considers access to a variety of healthy foods at SNAP retailers to be fundamental to the effectiveness of… the program”Proposed rule expected – soon?
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Freedom from Hunger: An Achievable Goal for the US National Commission on Hunger Report
Rec. 5. Use evidence-based product placement strategies that encourage purchase of healthy products with SNAP
benefits, and tie it to SNAP eligibility for stores.Action ItemThe USDA should create new standards for SNAP vendor eligibility to ensure that participating store… comply with improved health and nutrition standards; ie.: USDA should require SNAP retail stores (or those applying to become one) to provide enhanced and immediately visible shelf space for healthy foods and beverages.
https://hungercommission.rti.org
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SNAP Summer EBT Pilot and Expansion
Households receiving free or reduced price school meals got either a $60 increase in SNAP or a $30 increase in SNAP per month over summerBoth resulted in reduced food insecurity (more food security)Sites that had a WIC delivery (specified certain foods) resulted in same improvement in food security at regular SNAP delivery (no limits on purchases)
One concern was redemption: lower redemption with WIC
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Healthy Food Financing Initiatives
Stocking recommendations could be used in setting standards for financing of new retail food stores in underserved communities
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Subscribe to RWJF Weekly Policy Update• Go to:
http://www.rwjf.org/en/manage-your-subscriptions.html
• Select: “Childhood Obesity Weekly Policy Update Newsletter”
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Tracy Fox, MPH, RDPresident, Food, Nutrition & Policy Consultants, LLC
Culver, IN
www.foodnutritionpolicy.com
@TracyFoxRD
Thank You
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QUESTIONS?
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http://healthyeatingresearch.org
Thank You