Change the Future: WV Fresh Fruit and Vegetable Initiative

State: WV Type: Promising Practice Year: 2014

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Across rural West Virginia there are many areas that are known as 'food deserts', vast geographic areas that low socioeconomic individuals lack access to fresh fruits and vegetables. Because of this, individuals have processed and other unhealthy food options, of which they rely on for nutrition, from convenience stores within reach of their homes. With this said, a supportive environment to maintain a healthy lifestyle does not exist, which leads to obesity and chronic disease. The goal of Change the Future WV's Fresh Fruit and Vegetable Initiative is to

1) assist convenience stores in carrying fresh fruits and vegetables to improve the access and affordability to the impoverished people living in the food deserts and

2) encourage grocery stores to host healthy checkout aisles that promote healthy options such as fresh fruit, 100% fruit juice, nuts, water and physical activity merchandise.

 

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Kanawha-Charleston Health Department
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Change the Future: WV Fresh Fruit and Vegetable Initiative
Kanawha-Charleston Health Department is located in Charleston, WV in Kanawha County, which is centrally located in the state. Across rural West Virginia there are many areas that are known as 'food deserts', vast geographic areas that low socioeconomic individuals lack access to fresh fruits and vegetables. Because of this, individuals have processed and other unhealthy food options, of which they rely on for nutrition, from convenience stores within reach of their homes. With this said, a supportive environment to maintain a healthy lifestyle does not exist, which leads to obesity and chronic disease. The goal of Change the Future WV's Fresh Fruit and Vegetable Initiative is to 1) assist convenience stores in carrying fresh fruits and vegetables to improve the access and affordability to the impoverished people living in the food deserts and 2) encourage grocery stores to host healthy checkout aisles that promote healthy options such as fresh fruit, 100% fruit juice, nuts, water and physical activity merchandise. With improved options, individuals will begin to recognize and make healthy food and beverage choices. The Community Transformation Program, a CDC-funded initiative, is hosted by Kanawha-Charleston Health Department in Region 3, which covers most of southern West Virginia: Kanawha, Raleigh, Fayette, Monroe, Summers, Greenbrier, Mercer, Wyoming and McDowell Counties. Known statewide as Change the Future WV, the objective of the Community Transformation Program initiative is to provide healthy options in rural and low socioeconomic communities. The first approach utilized is to provide the support for convenience stores in rural and low socioeconomic areas to carry fresh fruits and vegetables. The second approach is to provide support to grocery stores to operate healthy checkout aisles that will market to children and impulse buyers. Change the Future WV does this by providing signage and displays to convenience stores and grocery stores willing to participate in the initiative. Additionally the develops contacts with fruit and vegetable distributors willing to divide produce to smaller portions and still sell those portions to convenience stores at wholesale prices. In turn, the store signs a contract stating that they will carry fresh fruit and vegetables at reasonable prices or host a healthy checkout aisle for two years. The initial steps included prevention coordinators mapping and locating convenience stores and grocery stores across the region and visiting the locally owned stores with information on the benefits of the program. Chain convenience stores were contacted at a state level to promote the program. If stores did not sign on after the primary visit, follow-ups were made to those possibly interested. Those stores that signed on with the program contracts for two years receive the promotional materials and any paid or earned media that Change the Future WV can provide. In 2013, 21 convenience stores and 15 healthy checkout aisles have been implemented in a nine county region. The goal set for Region 3 in 2013 was 10 convenience stores and 5 healthy checkouts to be signed on, which was more than doubled. Community buy-in was of utmost importance in this practice. Store owners and managers had to recognize the importance of the health of the communities they serve and in turn understand their role in changing the status quo of their friends and neighbors.  Prevention Coordinators also visit the stores bimonthly to check compliance with the contract and provide assistance when necessary. Additionally, Change the Future WV and Kanawha-Charleston Health Department operate in these counties offering wellness classes; handing out pamphlets and information on healthy eating, active living, tobacco cessation and chronic disease management; and supporting local initiatives and organizations such as Farmer's Markets, Family Resource Networks and Health Fairs. With an increase of access to fresh fruits and vegetables within rural communities and food deserts, Change the Future WV and Kanawha-Charleston Health Department foresee a gradual shift in healthier choices being made by consumers because a healthy option is now available. In turn, environmental supports of healthier options lead to a better understanding of the importance of healthy eating and physical activity.
Kanawha-Charleston Health Department is centrally located in Charleston, West Virginia. Our Health Department serves just under 200,000 individuals living in Kanawha County. The southern region of the Community Transformation Program operates out of the Kanawha-Charleston Health Department. The target population of the Fresh Fruit and Vegetable Initiative includes rural populations with low socioeconomic status across a nine-county region. As determined by County Health Rankings by the Robert Wood Johnson Foundation, Kanawha County ranks 37th of 55 counties in West Virginia in overall health and well-being based on a number of health behaviors and socioeconomic factors. Some of these rankings include being in the 32nd percentile in adult obesity and 8th percentile in limited access to healthy foods, as compared nationally. In addition, the other eight counties served by Change the Future WV Region 3 Fresh Fruit and Vegetable Initiative operating out of Kanawha-Charleston Health Department include Greenbrier County(ranks 29th percentile in adult obesity and 4th percentile in limited access to healthy foods), Raleigh County(ranks 34th percentile in adult obesity and 13th percentile in limited access to healthy foods), Fayette County(ranks 34th percentile in adult obesity and 7th percentile in limited access to healthy foods), Monroe County(ranks 29th percentile in adult obesity and 2nd percentile in limited access to healthy foods), Summers County (ranks 34th percentile in adult obesity and 7th percentile in limited access to healthy foods), Mercer County (ranks 34th percentile in adult obesity and 10th percentile in limited access to healthy foods), Wyoming County (ranks 36th percentile in adult obesity and 1st percentile in limited access to healthy foods) and McDowell County (ranks 33rd percentile in adult obesity and 2nd percentile in limited access to healthy foods). Based on these statistics, our nine-county region is among the worst in the nation for access to fresh, healthy foods and adult obesity. In our nine-county region we have implemented and supported 21 convenience stores and 15 healthy checkout aisles participating in the Fresh Fruit and Vegetable Initiative. Number of increase participating venues by county includes: Kanawha County: convenience- 7 healthy checkout- 4 Greenbrier County: convenience- 3 healthy checkout- 0 Fayette County: convenience- 4 health checkout- 1, McDowell County: convenience- 3 healthy checkout- 2, Raleigh County: convenience- 2 healthy checkout- 0, Summers County: convenience- 0 healthy checkout- 1, Wyoming County- convenience- 2 healthy checkout- 1, Monroe: convenience- 0 healthy checkout- 0 and Mercer County: convenience- 0 healthy checkout- 5. The Fresh Fruit and Vegetable initiative has impacted 78% of county area while the Healthy Checkout Initiative impacted 67% of our county area. The difference between this new innovative approach and other in the past is that other initiatives attempt to directly impact and change the people without taking into account the environment in which they live and work. By analyzing the environment for barriers to healthy lifestyles, the initiative is directed at changing the environment to be suitable and supportive for healthy lifestyles instead of ignoring this very important factor and on directing attention on the individuals. With the proper changes in place, individuals know begin to recognize the change, but start to be aware that a healthy option exists. With time, individuals should begin utilizing the healthy options available which draws attention to their personal health. This is a new approach of public health in rural areas and food deserts where there is a low socioeconomic status and low education. According to the Centers for Disease Control and Prevention, Healthy eating is associated with lower risk for chronic diseases such as Type 2 diabetes, hypertension, heart disease and certain cancers; overweight and obesity and micro-nutrient deficiencies. Additionally, the Centers for Disease Control and Prevention states fewer than 25% of Americans eat fruits and vegetables 5 or more times per day. Change the Future WV's Fresh Fruit and Vegetable Initiative and Health Checkout Aisle initiative follows 5 of the top 10 recommended evidence-based community strategies and measurements to prevent obesity in the united states: Increase availability of healthier food and beverage choices in public services venues improve availability of healthier food and beverage choices in public service venues Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in under-served areas. Institute smaller portion size options in public service venues 5) Discourage consumption of sugar-sweetened beverages.
Nutrition, Physical Activity, and Obesity
The overall goal of the Fresh Fruit and Vegetable Initiative and the Healthy Checkout Initiative implemented by the Community Transformation Program and Kanawha-Charleston Health Department is to increase access to healthy food options to decrease obesity and chronic disease. Objectives include: 1) increasing total number of convenience stores carrying fresh fruits and vegetables by 10 stores by December, 2013; 2) Increase grocery stores that have a healthy checkout aisle by 5 stores by December, 2013; 3)Increase signage in both grocery and convenience stores to promote making the healthy choice the easy choice by 20 stores by December, 2013. Change the Future WV, a statewide, CDC-funded initiative, is hosted by Kanawha-Charleston Health Department in Region 3, which covers most of southern West Virginia: Kanawha, Raleigh, Fayette, Monroe, Summers, Greenbrier, Mercer, Wyoming and McDowell Counties. The objective of the initiative is to provide healthy options in rural and low socioeconomic communities. The first approach utilized is to provide the support for convenience stores in rural and low socioeconomic areas to carry fresh fruits and vegetables. The second approach is to provide support to grocery stores to operate healthy checkout aisles that will market to children and impulse buyers. Change the Future WV does this by providing signage and displays to convenience stores and grocery stores willing to participate in the initiative. Additionally Change the Future WV develops contacts with fruit and vegetable distributors willing to divide produce to smaller portions and still sell those portions to convenience stores at wholesale prices. In turn, the store signs a contract stating that they will carry fresh fruit and vegetables at reasonable prices or host a healthy checkout aisle for two years. The initial steps included prevention coordinators mapping and locating convenience stores and grocery stores across the region and visiting the locally owned stores with information on the benefits of the program. Chain convenience stores were contacted at a state level to promote the program. If stores did not sign on after the primary visit, follow-ups were made to those possibly interested. Those stores that signed on with the program contracts for two years receive the promotional materials and any paid or earned media that Change the Future WV can provide. In 2013, 21 convenience stores and 15 healthy checkout aisles have been implemented in a nine county region. The goal set for Region 3 in 2013 was 10 convenience stores and 5 healthy checkouts to be signed on, which was more than doubled. Community buy-in was of utmost importance in this practice. Store owners and managers had to recognize the importance of the health of the communities they serve and in turn understand their role in changing the status quo of their friends and neighbors. Prevention Coordinators also visit the stores bimonthly to check compliance with the contract and provide assistance when necessary. The only criteria necessary for those to be selected to receive the practice are any grocery store or convenience store located in the state of West Virginia in the following counties: Kanawha, Raleigh, Fayette, Monroe, Greenbrier, Summers, Mercer, McDowell and Wyoming. It was up to the store owner or manager to accept or decline our support to implement the program within their store. Other stakeholders include support from the Centers for Disease Control and Prevention, Kanawha Coalition for Community Health Improvement, local store owners and managers, regional managers of chain markets, the West Virginia DHHR, The Bureau of Healthy Families, local coalitions such as the FACES coalition in McDowell County and local food banks. Kanawha Coalition for Community Health Improvement works closely with Kanawha-Charleston Health Department to conduct a Community Health Assessment. Every three years since its formation in 1994, the Kanawha Coalition for Community Health Improvement has conducted a comprehensive, county-wide health needs assessment to identify top health issues in Kanawha County. The Kanawha Coalition’s comprehensive community health assessment is comprised of four components: 1) Telephone survey among randomly selected Kanawha County households (From January, 2011 through May, 2011 randomized telephone household surveys were conducted and completed by 259 households). 2) Interviews with and surveys among Kanawha County key informants 3) Data analysis (survey results and existing health statistics) 4) Community Health Issues Forum (The Health Issues Forum took place Tuesday, October 11, 2011 and approximately 125 community members and leaders prioritized the top issues on which the Kanawha Coalition for Community Health Improvement would focus its efforts over the next three years. Twelve priorities areas were identified as follows: Obesity/Nutrition, Lack of Physical Activity/Exercise, Drug Abuse, High School Dropout, Diabetes, Tobacco, Heart Disease, Illiteracy, Dental Health, Poverty/Unemployment, Access to Healthcare/Lack of Insurance and Air Pollution. The top three priorities; Obesity/Nutrition, Lack of Physical Activity/Exercise, Drug Abuse (including prescription drug abuse), were selected for community focus for the next three years. Two of these are primary initiatives in the Community Transformation Program. These stakeholders helped market the Fresh Fruit and Vegetable Initiative in their communities, provided in kind support when necessary and served as a link into the communities for Kanawha-Charleston Health Department. Kanawha-Charleston Health Department reaches out to potential stakeholders and finds common goals and objectives that are shared. With these shared interests, collaboration is done to utilize resources effectively and efficiently to meet objectives and improve the overall health and well-being of the shared communities. The Fresh Fruit and Vegetable Initiative is made possible by funding through the Community Transformation Grant from the Centers for Disease Control and Prevention. The estimated 2013 budget for the Fresh Fruit and Vegetable Initiative and the Healthy Checkout Initiative is as follows: $180.00 per produce display, $10.00 per signage display, $5.00 per decal display for 36 stores totals $7020.00; $38,000 for employee services and $2,820.00 in transportation costs totals 47,840 for one year implementation of the Fresh Fruit and Vegetable Initiative and the Healthy Checkout Initiative under the Community Transformation Program's Kanawha-Charleston Health Department's nine-county region.
Data for implementation of the Fresh Fruit and Vegetable Initiative and the Health Checkout Initiative are being collected over a five-year period by the West Virginia University Research and Evaluation team. Initially a process evaluation is taking place to determine effectiveness and efficiency of the implementation of the Fresh Fruit and Vegetable Initiative and the Healthy Checkout Initiative. The overall goal of the Fresh Fruit and Vegetable Initiative and the Healthy Checkout Initiative implemented by the Community Transformation Program and Kanawha-Charleston Health Department is to increase access to healthy food options to decrease obesity and chronic disease. Objectives include:   Increasing total number of convenience stores carrying fresh fruits and vegetables by 10 stores by December, 2013; Increase grocery stores that have a healthy checkout aisle by 5 stores by December, 2013; Increase signage in both grocery and convenience stores to promote making the healthy choice the easy choice by 20 stores by December, 2013.   Primary data being collected includes number of stores in a county by county region, number of stores contracted with the Fresh Fruit and Vegetable Initiative and the Healthy Checkout Initiative and number of stores complying with contractual agreements for the 2-year length. Additionally secondary data will be taken the determine increase of produce sales in rural and low socioeconomic areas.
A few lessons were learned during implementation of the Fresh Fruit and Vegetable Initiative and the Healthy Checkout Initiative. First, the aisles in a grocery store are sometimes contracted out to product companies; therefore, they cannot release an aisle to be dedicated to healthy choices. The best way to cross this barrier is to inquire when the contract ends and make it a point to attempt to implement the Healthy Checkout Aisle at the time before another contract is in place. Second, some of the distributors for the Fresh Fruit and Vegetable Initiative were delivering bad produce, costing the stores a significant loss.This practice is the first of its kind to be implemented through the Community Transformation Grant. Prior to this, focus was on changing behaviors of individuals in the community rather than investigating the environment for possible positive changes that will support healthy behaviors. A cost benefit analysis has not been completed. Sustainability is based on the norms of the environment changing. The Community Transformation Grant operated through September, 2016. Once fresh fruits and vegetables are established in rural and low socioeconomic communities for five years there will be a demand for produce products. Because of this demand grocery and convenience stores will carry produce and utilize prominent product placement to encourage healthy lifestyles. Coupled with other initiatives that encourage healthy lifestyles by change the future and other organizations, Region 3 and West Virginia as a whole will develop healthier environments statewide and improve the health status of our residents.
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