ASU Food Policy and Environment Research Group

The epidemic of overweight and obesity and its multiple causes have captured the attention of researchers, program administrators, politicians, and the public alike. Recently, many stakeholder groups have started investigating the role that food and nutrition assistance programs play in the etiology of the problem and in identifying possible solutions. As a result, policy changes have been recommended and implemented for programs such as the National School Lunch Program (NSLP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to improve the nutritional quality of foods they offer to their participants. The Supplemental Nutrition Assistance Program (SNAP) is also attracting attention as a potential vehicle to reduce the burden of obesity among its users. Because of the tough economic and political climate in which all federal programs currently operate, the need for making nutrition assistance programs more efficient and effective in addressing health and nutrition related problems affecting the country has never been greater.

This document proposes a set of strategies to improve the effectiveness and efficiency of SNAP. These strategies are based on a review of research literature, recommendations from expert groups, and the experiences of other communities and states. We include information that pertains to potential stakeholder arguments for and against each strategy, as well as the political feasibility, financial impact, and logistical requirements for implementation. We drew candidate strategies from the range of options that have been tested through research and from policies that have been implemented around the country. The order of strategies in this document is based on overall strength of supportive research, as well as political and implementation feasibility. The four proposed strategies are improving access to healthy foods to provide better choices, incentivizing the purchase of healthy foods, restricting access to unhealthy foods, and maximizing education to more effectively reach a larger population of SNAP participants.

Programs such as the Healthy Corner Store Initiative have been widely adopted in recent years to increase the availability of healthy foods in small retail food stores. Valid and reliable measures are necessary to evaluate the effectiveness of these programs. The validated instruments currently available for assessments require in-person evaluations, with surveys taking up to 30 minutes per store to complete. This instrument was developed by researchers at Arizona State University to simplify the process of evaluating the effectiveness of healthy store interventions, and to enable community partners and practitioners to conduct their own evaluations of food access. The SCAT was validated against an adapted version of the Nutrition Environment Measures Survey for Corner Stores, and tested for feasibility of use over the telephone. The SCAT was found to discriminate between corner stores in the top 20% of healthfulness scores from those in the lower 80% with 89% accuracy.

In 2015 a panel of experts was convened by Healthy Eating Research, a program of the Robert Wood Johnson Foundation, to establish a set of minimum guidelines small retail food stores could reach to be classified as meeting basic or preferred stocking levels. Work is currently in progress to assess how the SCAT scores correlate with basic and preferred levels. 

Purpose: To develop a valid and feasible short-form corner store audit tool (SCAT) that could be used in-store or over the phone to capture the healthfulness of corner stores.

Design: Nonexperimental.

Setting: Four New Jersey cities.

Subjects: Random selection of 229 and 96 corner stores in rounds 1 and 2, respectively.

Measures: An adapted version of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to conduct in-store audits. The 7-item SCAT was developed and used for round 2 phone audits.

Analysis: Exploratory factor analysis and item response theory were used to develop the SCAT.

Results: The SCAT was highly correlated with the adapted NEMS-CS ( r = .79). Short-form corner store audit tool scores placed stores in the same healthfulness categories as did the adapted NEMS-CS in 88% of the cases. Phone response matches indicated that store owners did not distinguish between 2% and low-fat milk and tended to round up the fruit and vegetable count to 5 if they had fewer varieties.

Conclusion: The SCAT discriminates between higher versus lower healthfulness scores of corner stores and is feasible for use as a phone audit tool.

Objective

In response to recent national efforts to increase the availability of healthy food in small stores, we sought to understand the extent to which small food stores could implement the newly published Healthy Small Store Minimum Stocking Recommendations and reflect on the new US Department of Agriculture Food and Nutrition Service's final rule for stocking of staple foods for Supplemental Nutrition Assistance Program–approved retailers.

Design

We collected qualitative and quantitative data from 57 small stores in four states (Arizona, Delaware, Minnesota, and North Carolina) that accepted Supplemental Nutrition Assistance Program but not Special Supplemental Nutrition Assistance Program for Women, Infants, and Children benefits. Data from semistructured, in-depth interviews with managers/owners were transcribed, coded, and analyzed. We collected quantitative store inventory data onsite and later performed descriptive analyses.

Results

Store interviews revealed a reluctant willingness to stock healthy food and meet new recommendations. No stores met recommended fruit and vegetable stocking, although 79% carried at least one qualifying fruit and 74% carried at least one qualifying vegetable. Few stores met requirements for other food categories (ie, whole grains and low-fat dairy) with the exception of lean proteins, where stores carrying nuts or nut butter were more likely to meet the protein recommendation. Water and 100% juice were widely available and 68% met basic healthy beverage criteria.

Conclusions

In contrast to the inventory observed, most owners believed store stock met basic recommendations. Further, findings indicate that small stores are capable of stocking healthy products; however, technical and infrastructure support, as well as incentives, would facilitate shifts from staple to healthier staple foods. Retailers may need support to understand healthier product criteria and to drive consumer demand for new products.

In response to lack of access to healthy foods, many low-income communities are instituting local healthy corner store programs. Some stores also participate in the United States Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP). This study used two assessment tools to compare the healthfulness of offerings at stores participating in local healthy store programs (upgraded stores), WIC, and/or SNAP to that of similar non-participating stores.

Based on store audits conducted in 315 New Jersey corner stores in 2014, we calculated healthy food availability scores using subsections of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS-Availability) and a short-form corner store audit tool (SCAT). We used multivariable regression to examine associations between program participation and scores on both instruments.

Adjusting for store and block group characteristics, stores participating in a local healthy store program had significantly higher SCAT scores than did non-participating stores (upgraded: M = 3.18, 95% CI 2.65–3.71; non-upgraded: M = 2.52, 95% CI 2.32–2.73); scores on the NEMS-CS-Availability did not differ (upgraded: M = 12.8, 95% CI 11.6–14.1; non-upgraded: M = 12.5, 95% CI 12.0–13.0). WIC-participating stores had significantly higher scores compared to non-participating stores on both tools. Stores participating in SNAP only (and not in WIC) scored significantly lower on both instruments compared to non-SNAP stores.

WIC-participating and non-SNAP corner stores had higher healthfulness scores on both assessment tools. Upgraded stores had higher healthfulness scores compared to non-upgraded stores on the SCAT.