Healthy Retail Program

Transcription

1 Healthy Retail Program Supporting Corner Stores for Improving Access to Healthy Food and Reducing Youth Access to Alcohol & Tobacco Pilot Program Progress Report Alameda County Public Health Department

2 TABLE OF CONTENTS Table of Contents... Introduction... 1 Pilot/Demonstration Project... 1 Implementation... 1 Results... 2 Discussion: Successes, Challenges, Lessons Learned and Recommendations... 4 Expansion Projects... 5 Researching local policy options... 7 Developing a countywide Healthy Retail Coalition... 7 Healthy Retail s Future... 7 Acronym Glossary Report Prepared by the Alameda County Public Health Department Community Health Services and CAPE Units in Collaboration with Hope Collaborative and Mandela Marketplace June 2017 Cover photo is from the One Stop Store Mural.

3 Acknowledgements The Healthy Retail Program is a pilot project made possible by the support of Alameda County Board of Supervisors and funded by Measure A grant. This report was produced by the Alameda County Public Health Department (ACPHD) Community Assessment, Planning, Education, and Evaluation (CAPE) Epidemiology Unit. Public Health s Community Health Services Division thanks the retail stores that participated: General Grocery, One-Stop Market, Sky Market, Sunbeam Market, Three Amigos Market, and Wah Fay Market. Data was collected and reported by: ACPHD s Community Health Services (CHS) Division, Hope Collaborative, Mandela Marketplace, Hill and Company Communications, Eat Drink Politics, Eden Youth and Family Center, and REACH Ashland Youth Center Data analysis: Liz Maker, DrPH, CAPE Chuck McKetney, MPH, PhD, Director, Health and Business Data Analytics, Alameda County Health Care Services Agency and Former CAPE Director Editorial support and comments: Guenet Sebsibe, MPH, CHS; Paul Cummings, Tobacco Program Director, Quamrun Eldridge, CHS Division Director Report was published in June 2017 and is available on-line at Suggested Citation: Alameda County Public Health Department. Healthy Retail Program Progress Report , Oakland, California, June 2017.

4 INTRODUCTION The Vision for this project is to develop a model for achieving and sustaining Healthy Retail venues in neighborhoods most burdened by chronic diseases. The three main components of the Healthy Retail program are: Pilot demonstration projects in East/West Oakland; Research of possible local policy options to institutionalize healthy choices in the retail environment; and Develop a vision and identify resources for a countywide Healthy Retail Coalition. The goal of the Healthy Retail demonstration projects is to identify best practices for transforming corner stores into healthy retail establishments that have both increased healthy food and beverage options and reduced unhealthy product options, particularly increased fresh fruits and vegetables and decreased alcohol and tobacco products that appeal to youth. Alameda County Public Health Department s Community Health Services Division (CHS) pursued a program evaluation to identify successes, challenges and lessons learned from the Healthy Retail program, which would inform creation of a sustainable model that could be expanded and replicated. The evaluation methods included pre and post-intervention customer surveys; periodic documentation of store changes; interviews and focus groups with staff, contractors and consultants. While the evaluation design is strengthened by using mixed methods, it has several limitations. The ability to apply survey results to all customers of a store is limited by the small number of respondents. This issue was mitigated by speaking to customers at similar days and times, and making sure the samples were similar in number of years lived in the neighborhood and race/ethnicity. Interviews and focus groups can provide rich information, but they represent subjective opinions of respondents. Speaking to a variety of people, and conducting a thorough analysis of all responses reduced bias. This report will focus on progress made during the first two years of the Pilot Healthy Retail Program, as well as an expansion project involving two additional Community-Based Organizations. More recent efforts on local policy options and in developing a countywide Healthy Retail Coalition, are described in later sections of this report. PILOT/DEMONSTRATION PROJECT IMPLEMENTATION Healthy Retail Stores HOPE Collaborative (HOPE) Three Amigos Market* (San Antonio) Sunbeam (West Oakland) One-Stop (East Oakland) Mandela Marketplace (MMP) General Grocery* (West Oakland) Wah Fay (San Antonio) Sky Market (San Antonio) *= first year stores In FY , ACPHD contracted with two community-based organizations (CBOs), HOPE Collaborative (HOPE) and Mandela Marketplace (MMP) to develop and implement demonstration projects in the neighborhoods of East and West Oakland. During the first year of the program, each of the Healthy Retail Program Contractors (HRPC) worked with one retail store. After CHS decided to extend the pilot one more year (to June 2016), each contractor added two additional stores. As described in a December report to the Board of Supervisors, Healthy Retail was supported by a Learning Community consisting of: CHS staff representing policy, nutrition and tobacco control, contractors and consultants. The Learning Community supported the program by developing a joint vision for healthy retail, a marketing plan, and common evaluation measures. Based on recommendations from the Learning Community, CHS developed the following objectives for HRPCs to achieve by the end of fiscal year 2015: Choose 2-6 stores to implement healthy retailer changes; Engage at least 30 consumers per store in before and after public opinion surveys; Alameda County Public Health Department Healthy Retail Progress Report

5 Work with stores to make at least three changes from the options below: o Increase availability of healthy foods; o Reduce shelf-space allotted for tobacco products, malt liquor and alcopops; o Reduce advertising for unhealthy products in the store; o Increase visibility for healthier choices to consumers. To identify their three stores, contractors visited and spoke with owners of more than 100 stores. They conducted a pre-screening process which included review of available data on food deserts and crime, and then visited the stores to assess safety, community feel and store product mix, store owner interest and past experience with Healthy Retail. ACPHD and contractors developed several tools to assist with assessment, including a customer survey of their opinions about the store, shopping habits and food preferences. They completed either a written survey or one-on-one interview with each store owner. Contractors provided technical assistance to begin store improvements, including: Initial changes in store appearance and safety Rearrangement of inventories to promote healthy products and de-emphasize unhealthy ones Reduced alcohol and tobacco advertising Community engagement Implementation of marketing and promotional activities In-store trainings in safe food handling and taking inventories of store products. RESULTS New Signage at General Grocery As of June 30, 2016, Healthy Retail had completed Assessment and Planning with all six stores. Three stores were in the process of making basic improvements (Sky Market, Sunbeam and Wah Fay). General Grocery, One-Stop and Three Amigos made additional changes, including: Clearance of store clutter by an estimated 50-75%; Added equipment or shelving to increase capacity to sell healthier foods; Increased visibility of healthy food products, particularly at entry and check-out; Availability of at least 5 new types of produce; Reduction in unhealthy items to 25-50% of visible inventory; Reduction in alcohol and tobacco ads inside and outside of the store by 25-50%; Active engagement of store owner to make and maintain health-promoting changes. Fresh Fruits and Vegetables Now on Sale Alameda County Public Health Department Healthy Retail Progress Report

6 Accomplishments specific to each contractor include: MMP maintained a consignment produce delivery service to maintain more than 15 varieties of produce in their stores; HOPE worked with Three Amigos to design a deli, shepherd the plans through the Environmental Health approval process, and begin construction. One Stop Store BEFORE HOPE Workday One Stop Store AFTER HOPE Workday To determine changes in customer views of Healthy Retail stores, contractors surveyed customers at the beginning of their engagement with the store ( Pre ) and after the stores began making substantial improvements ( Post ). Both Pre and Mid- Program surveys had been completed at Three Amigos (managed by HOPE) and General Grocery (managed by MMP) by June 30, The following section describes highlights of survey findings for Three Amigos (managed by HOPE) and General Grocery (managed by MMP). Respondents in Pre and Post surveys were fairly similar in years spent in the neighborhood for all three stores, increasing the likelihood that responses are comparable between the pre and Post survey. MMP asked about ethnicity in the Pre and Post survey at General Grocery, finding that the survey samples had comparable numbers of African-American, White and Latino respondents. As shown in Figure 1, surveys found an increase between the percentage of customers who agreed this store serves the community well before (Pre) and after implementation of the (Post) Healthy Retail Program. Alameda County Public Health Department Healthy Retail Progress Report

7 Figure 2 shows increases in satisfaction for General Grocery Customers before (Pre) and after implementation in the areas of store prices, quality of vegetables, variety of products and quality of fruit. Both HOPE and Mandela have garnered media coverage for their work. Two examples are: Oakland: Corner Store Get a Healthy Outlook, published October 2014 in the East Bay Times. 1 The Healthful Corner Store Movement, published January 2016 in the East Bay Express. 2 DISCUSSION: SUCCESSES, CHALLENGES, LESSONS LEARNED AND RECOMMENDATIONS The Healthy Retail program conducted interviews, focus groups and site visits with contractors, staff and consultants ( respondents ) to learn more about successes, challenges and lessons learned. Along with concrete changes in Healthy Retail Stores, respondents identified the following successes: Relationship-building with store owners, which built store owner investment and participation; Marketing or branding stores, so customers associated them with healthy products; Conveying health messages to customers through demonstrations and marketing materials; Using Alameda County resources to garner additional funding to support store changes. Respondents noted some important challenges including: Economic pressures on store owners, who needed to replace lost profit from unhealthy products; Strong marketing of unhealthy products by distributors of alcohol and tobacco products; Negative views of retail stores from residents and law enforcement; High costs of making big improvements in stores are a challenge for Alameda County, which has finite and time-limited resources as well as constraints on how public funds are used; Alameda County Public Health Department Healthy Retail Progress Report

8 Lack of participation from some key players, particularly from the business/retail sector, the City of Oakland and Alameda County s Environmental Health department. Respondents reflected on Lessons Learned during the pilot phase of the Healthy Retail program: Asking store owners for layout changes for tobacco and alcohol was easier after building a relationship; Once tobacco and alcohol ads were reduced, customers seemed to change their perceptions of stores; Oakland s neighborhood demographics are changing, which has increased demand for produce and prepared food, as well as the prices customers are willing to pay. Offering a variety of store interventions contributed to the success of the Healthy Retail model. The Healthy Retail pilot was developing strategies and business structures that could be used to expand the model to additional stores. Mural pictures at the One Stop store Based on Lessons Learned, respondents made several recommendations to improve the Healthy Retail program. Hire Healthy Retail coordinator who could provide strategic and innovative leadership, more direction to contractors and better coordination with CBOs, agencies and government boards. (CHS hired a new part-time Healthy Retail Program Coordinator in May 2016); Bring additional players to the Healthy Retail Collaborative, including Alameda County s Environmental Health department, the City of Oakland and the business/retail sector (In-progress); Develop a resource guide to assist CBOs and retailers to work with local government on Healthy Retail projects(currently not feasible with current funding resources); Consider a Healthy Retail Certification program for stores that offered healthier food choices and reduced alcohol and tobacco sales (Certification strategizing is currently in-progress). EXPANSION PROJECTS ACPHD decided to assess the retail environment in other neighborhoods, releasing an RFP in winter 2015 to recruit CBO s in targeted low-income communities in Central, East and South County. Alameda County selected Eden Youth and Family Center and REACH Ashland Youth Center. Both agencies identified youth in their communities who were trained to learn about healthy retail, conduct the surveys and present the results. Alameda County Public Health Department Healthy Retail Progress Report

9 Quotes from FLASH Focus Groups I feel like the owners should care just as much as we do. Alcohol and tobacco is a big problem around this area. Too many tobacco and liquor stores around this area, I hope they will cut or close some of them -Parents from Ashland Apartment Focus Group At the Reach Ashland Youth Center, The FLASH (Fit Ladies Always Staying Healthy) Youth Group (8 young women) assessed the unincorporated area of Ashland regarding availability of food, beverages and tobacco products by conducting neighborhood and store observations, focus groups, and surveys. Through the store assessment, FLASH observed many products and advertisements for sugary drinks, fast food and alcohol, and relatively few healthy options. Through focus groups and a survey with Ashland residents, FLASH learned more about attitudes toward healthy eating, where people shopped, and both barriers and incentives to healthy eating. Having the store within walking distance FLASH came to the following conclusions about their research, which they presented to the Ashland Health Collaborative in June: The community has very low options and opportunities for healthy living. Lack of awareness and education for healthy living Lack of support given by community organizations and major industries who are profiting from this community There is an excessive amount of advertisement and sale of sugary drinks, fast food, alcohol and tobacco; however, the community residents are ready for change. Twenty-seven youth from Eden Youth and Family Center s Youth Advisory Council (Eden YAC) project participated in the Healthy Retail assessment, conducting on-site store surveys and focus groups with residents. They observed that most stores had advertising for sugary drinks, tobacco and alcohol, many were surrounded by litter and some were located near schools and parks. Along with store observations, Eden conducted three focus groups with residents to identify residents opinions about the benefits and challenges of healthy eating. Based on the results of the observational surveys and focus groups, the Youth Advisory Council developed the following Call to Action: Create safer & cleaner spaces; Ban alcohol from cashier counter; More fruits and vegetables with more variety in local markets; Require all substances to be placed in back of store or behind counter; Eliminate alcohol, tobacco & E-cig ads and promotions; Ban flavored or small packages of tobacco products. Graphic of the Eden YAC Focus Group discussion of What makes it hard to eat healthy? Larger words indicate more time spent discussing an issue during the focus group. Both REACH and Eden identified a strong need for healthy retail efforts in communities outside of Oakland. Both also found community support in both South Hayward and Ashland for supporting healthy retail efforts. Alameda County Public Health Department Healthy Retail Progress Report

10 RESEARCHING LOCAL POLICY OPTIONS During the pilot phase, some research of local policies & regulations for small stores was done. Through local networking, the Healthy Retail Program Contractors (HRPC) were actively involved in trying to understand the various ways to influence and possibly institutionalize healthy choices in the retail environment. Communications and collaborations with, local Green Business outfits and City of Oakland City Planning Division proved to be most helpful and offered the program solid tips of how to further develop the program moving forward. Also, currently, the Healthy Retail Program, with the assistance of ACPHD leadership, is trying to establish a working relationship with Alameda County Environmental Health division. These efforts will position our Healthy Retail Program to create synergies across county agencies working at various levels in retail establishments across the county. DEVELOPING A COUNTYWIDE HEALTHY RETAIL COALITION During the pilot phase, this objective was implemented informally through gatherings of the contractors, health department staff and invited guests. Due to the amount of time it took to work with the various stores in the program, this objective was not directly addressed. However, more recently, the Healthy Retail Program Coordinator and contractors have joined various other local coalitions addressing corner stores : Oakland Food Policy Council, Bay Area Healthy Corner Store Coalition (BAHCSC), University of California Cooperative Extension-Bay Area Urban Agriculture group etc. Since these groups are already formed and active with more robust local memberships, it seems to be more efficient to join them rather than to start yet another Coalition. The BAHCSC, a group facilitated by Change Lab Solutions (Oakland), is comprised of members from the larger Bay Area programs including Sonoma and Santa Clara counties has been most beneficial in resource sharing and support. By being active participants in such groups, the county is now more networked and engaged with several local grassroots efforts as well. HEALTHY RETAIL S FUTURE The Alameda County s Healthy Retail Program has gained wisdom and is moving forward with renewed energy. The two CBOs, each with slightly different perspectives, have been instrumental in moving the pilot project forward. Mandela Market Place works towards community engagement, education, business cultivation, and financing. Hope Collaborative uses the racial & equity lens towards economic & food sovereignty and capacity building. Together, both CBOs spent considerable amount of time to identify the stores, gain the trust of store owners and community members to change perceptions & behaviors about healthy stores and start the actual work of the Healthy Retail Program. It must be stated that when the program started, it began from zero. After gathering lessons learned from the demonstration project, several valuable program tools have been developed. One of these tools is called the Levels of Store Engagement. CHS s Healthy Retail Program Coordinator, Contractors and the Learning Community (CHS staff and invited guests with relevant resources/ knowledge) wove insights from the first 3 years of the pilot into a Five-Level model designed to: create a structure to gage a store s current situation and develop a path for progress; provide concrete and consistent guidelines for contractors; determine the appropriate level of time and resources to devote to each store. See Table 1 for a description of each level, suggested duration and related activities. Alameda County Public Health Department Healthy Retail Progress Report

11 Level Of Engagement Table 1: Store and Contractor Activities at each Engagement Level Activities at this Level Duration Contractor Will: Store Will: (months 1 Store Selection & Relationship Building 2 Scoping & Data Collection 3 Facilitating Basic Improvements 4 Major Improvements 3-6 Visit stores and Complete Neighborhood and Store Preintervention Environmental Assessment Forms 3-6 Conduct Customer Survey (pre-test), general store assessment and product mapping Develop Scope of Work (SOW) Intervention Plan with each store 12 Provide support, technical assistance (TA) and access to trainings Install health-promoting marketing, including food demos Conduct ongoing monitoring 24 Provide TA on community engagement and stocking healthy products Help plan for larger store improvements Conduct ongoing monitoring and adjust SOW as needed. Support contractor in store assessment and information gathering Sign Healthy Retail Memorandum of Understanding (MOU) with contractor Begin improving store, including cleaning and taking out clutter. Continue cleaning and clearing clutter Increase visibility and stock of healthy foods and produce Reduce alcohol and tobacco ads Make larger, visible improvements to store Add equipment or shelving to increase capacity to sell healthier foods 5 Moving towards Sustainability 12 Conduct ongoing TA and support to maintain improvements and community engagement Support Store rebranding to reflect healthy focus Complete Customer Post-Surveys and Neighborhood and Store Preintervention Environmental Assessment Forms Moving towards independence and sustainability as a healthy store Consistently stocking produce and other healthy items. Using a Point of Sale (POS) system to track sales of healthy items Eligible for Alameda County Certificate of Recognition as a Healthy Retail Store Total: months (4.5 to 5 years) In creating this model, CHS worked closely with contractors to envision the highest level of their Healthy Retail Model, which has not yet been reached by the six demonstration stores. The suggested duration at each Level provides a benchmark for when to introduce new aspects of the program with store owners, and what constitutes adequate progress. Table 2 provides the amount of healthy and unhealthy products and practices expected at each Level of Engagement. At Level 5: Sustainability, stores would be well on their way to maintaining healthy changes with significantly less engagement with CHS or contractors. At the end of the 12 months, these stores would graduate out of the county program and earn a Healthy Retail Certificate (currently working on the details). This will allow the Healthy Retail Program to shift support and resources to recruiting new stores in underserved communities. Alameda County Public Health Department Healthy Retail Progress Report

12 Table 2: Amount of Healthy and Unhealthy Items in Stores at Each Level of Engagement Level of Engagement # of Varieties of Produce # of Healthy Items* % of Non- Healthy Items** % Clutter % Unhealthy Advertising In Store % Unhealthy Advertising on Door % Unhealthy Advertising Outside of Store % 100% 100% 75% 100% % 100% 100% 75% 100% % % % 50-75% % % 25-50% 25-50% 25% 25-50% 5 Above 10 Above % 0-25% 0-25% 0% 0-25% *Healthy Items: whole grain items, low fat milk products, canned and dry goods, nutritious snacks, 100% fruit juice, water etc. **Non-Healthy Items: flavored tobacco, little cigars, malt liquor, sugar-sweetened beverages, alcopops For FY 2016/17, CHS has continued to contract with Mandela and HOPE to each engage with two new stores, while maintaining work with their other 3 stores (each). This will bring the FY Healthy Retail Program stores total to ten. For FY 2017/18, CHS aims strengthen the Healthy Retail Program by continuing to find appropriate linkages with other efforts within and outside of the health department to leverage resources and promote wider efforts in a greater number of stores and neighborhoods. The Healthy Retail Coordinator is also reaching out to additional partners within the county, such as Environmental Health Services and City of Oakland Planning Division as well as Green Business Organizations. As a way to institutionalize Healthy Retail Program practices throughout the county, CHS is also continuing to explore a certification program for stores who sell and market a variety of healthy foods, and fewer unhealthy foods, alcohol or tobacco products. The aims of the certification program is to acknowledge the dedication and efforts of the store owners that have accomplished the goals of our Healthy Retail Program and to help them access various incentives (currently being researched) that can be awarded to stores to help them maintain their healthy store environment. Another aim of the certification program is to create a path to scale-up and increase the number of stores participating in the Alameda County Healthy Retail Program. Long-term vision for the Healthy Retail Program includes creating training sessions for store owners around topics related to healthy foods, maintaining produce, greening their business, nutrition tips when purchasing their inventory from distributors and business development. Another vision would be to explore ways to engage community members especially youth, living close to the program stores. This will empower residents to support and maintain a healthy food retail outlet in their own neighborhood. Table 3: Level of Engagement with 10 Current Healthy Retail Program Stores Managed by HOPE Managed by Mandela Store Name Area/BOS district Current Current Store Name Area/BOS district Level Level Three Amigos Market East Oakland/ 3 4 General Grocery West Oakland// 5 4 One Stop East Oakland/ 3 3 Sky Market East Oakland/ 3 3 Sunbeam Market West Oakland/5 3 Wah Fay West Oakland/ 3 3 Fairfax Liquors East Oakland/ Amigo s Market East Oakland/ 4 1 Isler s Liquors East Oakland/ 5 1 Rowaid Market East Oakland/ 4 1 Alameda County Public Health Department Healthy Retail Progress Report

13 ACRONYM GLOSSARY ACPHD Alcopop CBO CHS E-Cig Eden FLASH HOPE HRPC MMP MMP POS REACH SOW TA Alameda County Public Health Department Flavored malt liquor beverage Community-Based Organization Community Health Services Electronic Cigarette Eden Youth Center in Hayward Fit Ladies Always Staying Healthy (REACH) Health for Oakland s people and environment Healthy Retail Program Contractors Mandela Marketplace Mandela Marketplace Point of Sale REACH Ashland Youth Center Scope of Work Technical Assistance Alameda County Public Health Department Healthy Retail Progress Report