Healthy Corner Store Initiative

State: NC Type: Promising Practice Year: 2014

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Goal: To increase the number of Davidson County residents who are at a healthy weight.

Objective: To increase the percentage of adults who consume 5 or more servings of fruits and vegetables from 18.4% to 29% (N.C. Healthy People 2020 objective)

Objective: to increase the number of vendors providing healthy food choices from 0 to 3 (this is the objective established in our 2012 ACHIEVE community action plan).

The Obesity Work Group developed a work plan that included increasing the number of community venues allowing for greater access to healthy food options. One of the strategies identified was working with corner stores/convenience stores to offer healthier food options. 

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Davidson County Health Department
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Healthy Corner Store Initiative
Davidson County is a small county in North Carolina (NC) located just to the west of central North Carolina, in the Piedmont region of the state. According to the 2010 NC Behavioral Risk Factor Surveillance System, 67% of Davidson County adults are either overweight or obese. Fewer than one out of five (18%) adults in Davidson County currently eats the recommended 5 servings of fruits and vegetables per day. Davidson County is considered a rural community. Residents tend to have lower education levels, lower per capita incomes, and higher rates of unemployment. There are limited opportunities for healthy eating in the county. There are only three farmers’ markets in the county and 12 grocery stores. Six of the grocery stores are located within city limits and six are spread out in rural communities. The southern part of the county is very rural and residents need to travel approximately 20 miles to either Lexington or Thomasville, or even outside the county to access resources. There is no public transportation system in the county, which limits access to resources. Davidson County has a disparity in access to healthy environments, such as environments that offer access to healthy food options. Less than half of the zip codes in the county have a healthy food outlet. Goal: To increase the number of Davidson County residents who are at a healthy weight. Objective: To increase the percentage of adults who consume 5 or more servings of fruits and vegetables from 18.4% to 29% (N.C. Healthy People 2020 objective) Objective: to increase the number of vendors providing healthy food choices from 0 to 3 (this is the objective established in our 2012 ACHIEVE community action plan). The Obesity Work Group developed a work plan that included increasing the number of community venues allowing for greater access to healthy food options. One of the strategies identified was working with corner stores/convenience stores to offer healthier food options. In the spring of 2012, the health department made contact with a newly opened convenience store (The Patriot Market) in the southern part of the county, a rural area with limited resources. In the summer of 2012, Patriot Market began offering local produce. The owner traveled to various produce wholesalers to purchase the produce and sold it to customers who came through his store. He built a set of shelves for display and, through a grant obtained by the health department, a produce cooler was purchased to lengthen the shelf life of some of the produce. Through collaborating with the Obesity Work Group, the owner has successfully applied to accept EBT. The owner has more than doubled his profits in the sale of produce, and according to the owner, sold more produce than cigarettes during the summer months. Since partnering with the Patriot Market, the health department has expanded the corner store initiative to include the Exxon Market, Hill’s Farm and Garden, and the Southmont Grocery. Randy’s #1 and Randy’s #2 have expressed an interest in joining the initiative in the spring of 2014. It is too early to determine if the goal of increasing the number of Davidson County residents who are at a healthy weight is successfully met. There are a lot of factors that impact this goal. It is also too early to determine if the objective of increasing the percentage of adults who consume 5 or more servings of fruits and vegetables from 18.4% to 29% is successfully met. This statistic will be assessed during the next Behavioral Risk Factor Surveillance System is completed in 2014. The objective of increasing the number of vendors providing healthy food choices from 0 to 3 was over-achieved. There are currently 4 corner stores participating, with 2 more pending next spring. A more telling measure of success is the amount of produce sold and the profit made by the convenience store. In 2012, the owner spent $75,000 on produce and had over $150,000 in sales. According to the store owner, “I sold more produce than cigarettes this summer” and “I don’t know why other stores don’t do this; it makes money”.The Corner Store Initiative impacts the community by enhancing access to healthier food options. This results in residents eating healthier foods and reducing their risk for chronic health conditions, especially in rural areas of the county and those with areas without a source of fresh produce.
Brief description of LHD – location, size, population served Davidson County is a small county in North Carolina (NC) located just to the west of central North Carolina, in the Piedmont region of the state. There are 18 townships and municipalities in the county. The county land area is 552 square miles with 205 miles of paved roads. The county has a growing population that increased 10.6% from 2000 to 2010. The county’s population is estimated to be 162,878; 82.1% are white, 9.3% are African-American, 6.3% are Hispanic, 13.7% of the population is elderly, 6% are under school age, and 26% are age 19 and under. The median age is 40.3, as compared to the state of North Carolina at 37.4. Almost 15% of the population in Davidson County is over the age of 65. Poverty affects approximately 17.3% of the population. Davidson County is recognized as a Medically Underserved Area. A shortage of primary care, mental health and dental providers combined with an aging workforce nearing retirement limits the availability of services to residents. Davidson County is considered a rural community in North Carolina. Residents tend to have lower educational levels, lower per capita incomes, and higher rates of unemployment. In addition, people living in rural areas have statistically significantly higher death rates from heart disease, stroke, cancer, and diabetes. Access to physicians is more limited in rural communities, as addressed previously in this section.The proportion of Davidson County adults who are overweight or obese rose from 61% in 2006 to 67% in 2010 (NC Behavioral Risk Factor Surveillance System (BRFSS). According to the 2009 NC Nutrition and Physical Activity Surveillance System, 30% of children ages 2-18 are either overweight or obese. Fewer than 1 out of 5 adults (18.4%) in Davidson County currently eats the recommended 5 servings of fruit and vegetables per day (BRFSS 2010). There are limited opportunities for healthy eating and physical activity in Davidson County. There are only three Farmers’ Markets in the county: one in Lexington, one in Thomasville, and one in Denton. Only the Farmers’ Market in Lexington accepts EBT, WIC, and senior citizen vouchers. The southern part of the county is very rural and residents need to travel approximately 20 miles to either Lexington, Thomasville, or even further outside the county to access resources. There is no public transportation system in the county, which limits access to resources. Davidson County has disparities in access to healthy environments, such as an environment that offers access to healthy food options. Typically, grocery stores have been shown to have a larger quantity of fresh, healthy food at a more affordable price than convenience stores or other neighborhood grocers. A healthy food outlet is defined as a grocery store with more than four employees or a farmers’ market/produce stand. Based on this definition, less than half of the zip codes in Davidson County have a healthy food outlet. There are only 12 grocery stores in Davidson County. According to the USDA web site, the Healthy Food Financing Initiative (HFFI) Working Group considers a food desert as a low-income census tract where a substantial number or share of residents has low access to a supermarket or large grocery store. Low access to a healthy food retail outlet is defined as more than 1 mile from a supermarket or large grocery store in urban areas and as more than 10 miles from a supermarket or large grocery store in rural areas. Once the distance to the nearest supermarket or large grocery store is calculated for each grid cell, the estimated number of people or housing units more than one mile from a supermarket or large grocery store in urban tracts (or 10 miles for rural census tracts) is aggregated to the census tract level. (A census tract is considered rural if the centroid of that tract is located in an area with a population of less than 2,500, and all other tracts are considered  urban tracts.). If the aggregate number of people in the census tract with low access is at least 500 or the percentage of people in the census tract with low access is at least 33 percent, then the census tract is considered a food desert. There are 5 census tracts in Davidson County that are considered food deserts by the USDA. Davidson County has an estimated population of 162,878. 18,808 reside within Lexington City limits and 26,800 reside within Thomasville City limits – thereby leaving 117,270 residents residing in rural communities. One census tract within the City of Lexington and all four census tracts within the City of Thomasville are considered food deserts. There are three farmers’ markets and 12 grocery stores located within the county.Only those residents living within a few miles of a grocery store or farmers’ market would be unaffected by the problem of accessing healthy food options. All others would be affected due to the lack of a source of healthy food options and limited public transportation available. Prior to 2010, the health department had not established a community network of partners. Each agency tended to operate in its own silo – exhausting resources, accomplishing minimal results. There was also duplication of services as the agencies did not communicate and did not know initiatives other agencies were addressing. The Davidson County Health Department really began its capacity to address chronic diseases when we were the recipient of a 2010 National Association of County and City Health Officials (NACCHO) Public Health Leadership for Healthy Communities grant. This opportunity provided technical assistance by NACCHO to assist our community in addressing childhood obesity through policy, systems, and environmental changes. With the assistance provided by NACCHO, our community successfully implemented a physical activity policy with an afterschool program, implemented a healthy foods policy with an African-American church, and implemented a Healthy Vending Machine Policy with county government (at least 50% of vending options must be healthy). But just as important, the monthly conference calls and webinars exposed our community to national experts and resources to help us become more knowledgeable in the areas of policy development and systems changes. In 2011, the health department successfully received the Action Communities for Health, Innovation, and EnVironmental changE (ACHIEVE) Communities grant through NACCHO. ACHIEVE communities receive support to strengthen a coalition of community partners and develop a community action plan that addresses comprehensive chronic disease prevention through policy, systems, and environmental (PSE) change strategies. In Davidson County, this coalition of community partners is the Davidson County Healthy Communities Coalition (DCHCC) and includes representation from both hospitals, all three school systems, three Recreation Departments, two YMCA’s, Senior Services, Smart Start/Partnership for Children, Davidson County Community College, County Planning, County Government, health department, Cooperative Extension, Cardinal Innovations (mental health entity), medical providers, and Davidson Medical Ministries Clinic (charitable clinic and newly awarded FQHC). DCHCC established breastfeeding policies, Healthy Foods Policy at high school concession stand, and the Corner Store Initiative with four convenience stores. The Corner Store Initiative is an effective practice. Residents have access to fresh produce. When a customer enters the store to purchase a snack, options have previously been something processed with high fat, high sodium, high calories and low nutrients. Now, they can select a low fat, low sodium,  low calorie, high nutrient food option at a relatively cheap price. The Patriot Market actually prices produce cheaper than the nearest grocery store.The Corner Store Initiative is an innovative practice. The concept of communities working with local convenience stores is a new concept for public health. Public health has established a reputation working with traditional health related partners. It is only within the past five years or so that health departments have begun to establish relationships with non-health entities that were concerned about the health of their community. Public health provides knowledge of successful practices, skill at developing community coalitions, relationships with local media. Convenience stores are established in their communities, know the residents in their vicinity, and have a concern for their community.This initiative is new to the field of public health. This initiative is evidence-based: July 24, 2009 MMWR – Recommended Community Strategies and Measurements to Prevent Obesity in the United States Robert Wood Johnson Action Strategies Toolkit
Food Safety|Nutrition, Physical Activity, and Obesity
Goal: To increase the number of Davidson County residents who are at a healthy weight. Objective: To increase the percentage of adults who consume 5 or more servings of fruits and vegetables from 18.4% to 29% (N.C. Healthy People 2020 objective) Objective: to increase the number of vendors providing healthy food choices from 0 to 3 (this is the objective established in our 2012 ACHIEVE community action plan).In 2011, the health department successfully received the Action Communities for Health, Innovation, and EnVironmental changE (ACHIEVE) Communities grant through NACCHO. Over a two-year period, ACHIEVE communities receive support to strengthen a coalition of community partners and develop a community action plan that addresses comprehensive chronic disease prevention through policy, systems, and environmental (PSE) change strategies. In Davidson County, the coalition is the Davidson County Healthy Communities Coalition (DCHCC). It includes representation from both hospitals, all three school systems, Recreation Departments, YMCA’s, Senior Services, Davidson County Community College, County Planning, County Government, health department, Cooperative Extension, medical providers, and Davidson Medical Ministries Clinic (newly awarded FQHC). The mission of DCHCC is to provide leadership for environmental and policy changes for a healthier Davidson County. The vision is that residents of all ages will pursue healthy lifestyles through reducing tobacco use, increasing physical activity, and improving nutrition. DCHCC established a Nutrition Work Group that focused on increasing access to healthy food options. One of the strategies in the work plan was the Corner Store Initiative. Work group members brainstormed potential convenience stores to target – criteria being they were not located near a grocery store and members thought the owner would be receptive to participating in the initiative. In the spring of 2012, work group members began approaching convenience store owners. The first store that was approached was not receptive at all. To quote the owner, “Who would buy produce from a gas station?” The second owner was at The Patriot Market. He was very receptive and took the idea and ran with it. He purchased produce from a wholesale distributor located in the adjoining county, marked the price up between 35-50%, purchased signage to display at the side of the road, and applied to accept EBT vouchers. The health department contacted the local media for coverage. He has received newspaper and television coverage and has had visitors from the North Carolina Department of Health and Human Services, NACCHO, and the Food Trust out of Philadelphia. In 2013, the owner built a greenhouse and is now offering flowers and plants for sale. He built a substantial garden beside his store and grew produce to sell through his store. Part of his garden is a community garden. He invited youth from several local churches to come plant their own garden at his site. He provided the seeds/plants to these youth. Since establishing the relationship with The Patriot Market, the health department has added The Exxon Market, Southmont Grocery, and Hill’s Farm and Garden. Randy’s #1 and Randy’s #2 have expressed an interest in joining next spring. The only start up costs would be associated with the purchase of the produce, shelving to place it on, and signage to promote the produce. The health department had received a grant to initially purchase a produce cooler for The Patriot Market, but he has since returned it. He has restructured the layout for his produce and didn’t need it any longer. The health department developed a news release at the start of the initiative and sent it out to the local newspapers and television stations. The media coverage that has been received has been news stories provided at no charge.
Goal: To increase the number of Davidson County residents who are at a healthy weight. Objective: To increase the percentage of adults who consume 5 or more servings of fruits and vegetables from 18.4% to 29% (N.C. Healthy People 2020 objective) Objective: to increase the number of vendors providing healthy food choices from 0 to 3 (this is the objective established in our 2012 ACHIEVE community action plan).It is too early to determine if the goal of increasing the number of Davidson County residents who are at a healthy weight is successfully met. There are a lot of factors that impact this goal. It is also too early to determine if the objective of increasing the percentage of adults who consume 5 or more servings of fruits and vegetables from 18.4% to 29% is successfully met. This statistic will be assessed during the next Behavioral Risk Factor Surveillance System is completed in 2014. The objective of increasing the number of vendors providing healthy food choices from 0 to 3 was over-achieved. There are currently 4 corner stores participating, with 2 more pending next spring. A more telling measure of success is the amount of produce sold and the profit made by the convenience store. In 2012, the owner spent $75,000 on produce and had over $150,000 in sales. According to the store owner, “I sold more produce than cigarettes this summer” and “I don’t know why other stores don’t do this; it makes money”.
There were lessons learned in relation to the Corner Store Initiative. Originally, it was believed that the convenience store owners needed to be “incentivized” to participate. The health department had the funds to pay for produce coolers as an incentive. The owner of The Patriot Market took the cooler at the onset, but said he didn’t have to have it and actually returned it about a year later. The Exxon Market was also offered a produce cooler and he still has it. Southmont Grocery and Hill’s Farm and Garden are both participating without any incentives being provided. Also, work group members learned to be patient. Although this sounds like a simple initiative, and it is, it still took more start up time then we had hoped. One of the convenience stores took more coaxing and handling than the other three. There were also lessons learned through partner collaboration. More can accomplish goals than less. Once we shared resources and energy into the project, work group members were able to accomplish more in one year than the health department had been able to accomplish in the past five years. More policies and environmental strategies have been implemented that benefit all the residents in the county.The Corner Store Initiative is sustainable as long as the owners are interested in continuing the initiative. Selling produce makes money for the business, which is an incentive to continue it. Once the initiative begins, the only additional expense is the purchasing of new produce to sell. This knowledge will encourage new stores to participate. The Corner Store Initiative increases access to fresh produce for the community. This will encourage the health department and community partners to keep promoting and encouraging participation in the initiative.
 
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