1. Nashville’s CPPW Corner Store Initiative: Methods and Measurement Celia Larson, PhD Director of Evaluation Alisa Haushalter, DNP, RN Project Director Bill Paul, MPH, MD Director of Health Annual Meeting of the American Public Health Association October 31, 2012

2. The Challenges Geographic areas that lack full service grocery stores are known as food deserts.  These areas have been shown to have:  higher rates of obesity,  chronic diseases,  as well as, lower rates of fruit and vegetable availability and consumption.  Primarily populated with low-income and racial and ethnic minority individuals and families.  Three food deserts were identified in the service area.

3. The Strengths  Strong Partnerships in each food desert Leaders of religious institutions Community organizations Community leaders  Food Advocacy (organizations and individuals) 501c3 – Community Food Advocates Mobile Market Metro Farmers Market  Preliminary work prior to grant achieved:  Emerging community awareness of the problem.  Broad identification of population areas in need.  Establishment of a mobile food supplier.

4. CPPW Corner Store Objective: Access to healthy foods and beverages will be improved among low income residents by increasing shelf space by 20% for selling healthy foods and beverages in corner stores located in 3 geographic areas that are defined as food deserts in low-income neighborhoods.

5. Methods  Refinement of Food Desert Definition & Geography  Store Selection for Intervention  Strategy Development & Implementation  Assessment Tools & Process

6. Refinement of Food Desert Definition & Geography  Four food deserts established  Corner/Convenience stores were mapped. Data Sources: Census Data and Metro Planning & Transit Departments Data

7. Store Selection for Intervention Criteria developed to select stores to receive intervention Presence of assets and resources in neighborhoods  5 stores selected Presence of Assets and Resources for each Store Store Sidewalks Schools/ Childcare Facilities Public Housing/ Residential Religious Institutions Businesses Parks/ Community Centers Store A  Store B  Store C   Store D  Store E 

8. Strategy Development and Implementation  Listening sessions held in each neighborhood  Interviews conducted with store proprietors Community Sensitive Strategies

9. Strategy Development and Implementation  Technical Assistance Structural support items such as displays and coolers Procurement of products not currently retailed How to promote and direct consumers to items  Neighborhood Partnerships Faith Community Business Community  Communications Campaign Corner Store Logo NashVitality Campaign Billboards & Print Ads

10. Assessment Tools & Process  Baseline Assessment to Inform Strategies  Proprietor Interviews  Neighborhood Listening Sessions  Pre-Post Measures: Store Audits  Store Audits: Nutrition Environment Measures Survey-Corner Stores (NEMS-CS) Tool  Pre-Post Measures: Customer Intercepts  Store Customer Intercepts: Standardized NEMS protocol and training materials

11. Evaluation Results Qualitative Analysis Results – Proprietor Perceptions Store AStore BStore CStore DStore E Barriers Neighborhood Crime / Shoplifting  Structural support for selling items (coolers/displays)  Strengths Dense residential area   High foot traffic   Families - primary customer   Only store in area/great location   Role of Store Supports community as a sponsor of sports or events  Customers proud of or like having store in neighborhood 

12. Evaluation Results Qualitative Analysis Results – Neighborhood Listening Sessions  Themes identified  Consumer Education (Clergy & Residents)  Poor Quality Produce (Clergy & Residents)  Mistrust of Store Owners (Clergy & Residents)  Mistrust of Government (Clergy & Residents)

13. Evaluation Results: Store Outcomes  Audit results (3 stores) Fruit – Availability & variety increased in all stores Vegetables – Availability & variety increased in all stores Milk – Low fat availability increased in 2 of 3 stores Whole Wheat Bread – Availability & variety increased in all stores

14. Evaluation Results: Store Outcomes Increase in Variety and Space Available

15. Evaluation Results: Consumer Purchases n = 103

16. Lessons Learned to Date  Start Small  Community Engagement  Expertise in Food Retail & Marketing  Utilize National Expertise  Standardized Evaluation  Communication  Coordination of Efforts

17. Disclosures This project was supported in part by a contract through Metro Public Health Department, Nashville, TN with a cooperative agreement (1U58DP002447-01) with the Centers for Disease Control and Prevention. Portions of this project’s work involve the Communities Putting Prevention to Work initiative supported by CDC funding. However the findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.