1. MHRA WIC Vendor Management Agency1 WIC Vendor Management Agency Low - Fat Milk Initiative August 16, 2007 Medical and Health Research Association of NYC, Inc. (MHRA)

2. MHRA WIC Vendor Management Agency2 General Background According to a 2004 Center for Disease Control study, the New York State Medicaid program spends $3.5 billion per year on obesity related problems. In low income areas, such as the South Bronx, 27% of the residents are obese compared with 16% citywide. In these areas, many residents rely on bodegas and other small stores as the primary place to buy food. Access to healthy food choices, in these stores, is limited and is believed to be a contributing factor to this problem. According to City Harvest, “Bodega owners are hesitant to stock produce and other healthy but perishable items because of low product margin and questionable demand”.

3. MHRA WIC Vendor Management Agency3 Low/Non Fat Milk Availability In April 2006, the New York State WIC milk report indicated that various WIC local agencies in the Metro Region were issuing high percentages of low fat/non fat milk checks. WIC clients have reported a lack of availability of low fat/non fat milk in small groceries in low-income neighborhoods. Many low fat/non fat milk checks are in fact being redeemed for whole milk.

4. MHRA WIC Vendor Management Agency4 Program Goals The goal of this initiative is to ensure that WIC vendors: Understand the importance of low-fat/non- fat milk to the health of the community. Consistently maintain low fat/non fat milk on their shelves Redeem low-fat/non-fat milk checks appropriately.

5. MHRA WIC Vendor Management Agency5 Project Design The Milk Initiative was implemented in four phases: Baseline Intervention Two month post-intervention Four months post-intervention No Training Additional Training provided

6. MHRA WIC Vendor Management Agency6 Baseline Phase Health Promoters visited over 1000 stores. A Price Stock Survey was used to record low fat/non fat milk stock levels, thus establishing a baseline measurement. Upon completion of this activity, a list of stores that did not carry low fat/non fat milk was compiled and these vendors will be targeted for intervention. Health Promoters also recorded the container size available as well as the quantity stocked. WIC milk checks are usually written for gallons and half gallons. Stores carrying only quarts and small amounts will need to be targeted.

7. MHRA WIC Vendor Management Agency7 How Were Stores Targeted Over 656 stores were targeted for intervention. A tiered approach was used to select the stores to receive intervention: No Low/Non fat milk Zero Gallons One Gallon Two Gallons

8. MHRA WIC Vendor Management Agency8 Intervention Phase A store-based intervention was implemented that provided vendors with the knowledge, support and incentives to consistently maintain adequate stocks of low fat/non fat milk on their shelves. Vendors received posters promoting low fat/non fat milk, a laminated point of purchase (POP) pricing sign to be placed on the milk case as well as decals and tee shirts. Health Promoters provided vendors with a highly focused Power Point about the importance of low-fat/non-fat milk to the health of the community.

9. MHRA WIC Vendor Management Agency9 First Follow Up Intervention 656 stores were targeted for 1st Follow up. Complete Price Stock Survey (milk section ONLY!) Provide and/or put up materials if needed (posters, etc)

10. MHRA WIC Vendor Management Agency10 Second Follow-Up Complete Price Stock Survey (milk section ONLY!) Go over PowerPoint presentation (ask if vendor understands the presentation and if they have any questions) Open and provide materials (Dairy Council incentives and Milk facts.) Put up posters, milk signs and other materials from the tool kit (give extras to vendor) Provide business card to vendor

11. MHRA WIC Vendor Management Agency11 Results After each phase of the project, staff collected and reviewed milk related data. A total of 1122 WIC Vendors were visited at baseline (February - April 2007). Of these, 139 (12.3%) were either WIC inactive, supermarkets, non-existent locations, and/or out of business.

12. MHRA WIC Vendor Management Agency12 Baseline Of the 983 active stores visited at baseline. Of the WIC Vendors monitored: 242 (24.6%) were found to have no low fat milk. 187 (19%) were found to have no low fat milk in gallon containers. 59 (6%) were found to have one gallon of low fat milk. 76 (7.7%) were found to have two gallons of low fat milk on their shelves. 88 (36.3%) were found to have three gallons of low fat milk

13. MHRA WIC Vendor Management Agency13 Intervention MHRA selected 656 stores for first follow up based on intervention visits. Staff visited 628 stores. On June 20 th staff completed intervention. Bronx- 238 stores Brooklyn- 188 stores Manhattan- 88 stores Queens- 142 stores

14. MHRA WIC Vendor Management Agency14 First Follow Up All 628 stores visited at intervention were scheduled for first follow up. Staff visited 618 stores. On July 27 th staff completed First Follow Up. Bronx- 228 stores Brooklyn- 177 stores Manhattan-83 stores Queens- 130 stores

15. MHRA WIC Vendor Management Agency15 Second Follow Up: No Training Second Follow up began July, 20, 2007. There are 385 stores that did not require training. Brooklyn: 79 Manhattan: 61 Queens: 84 Bronx: 161 There are 135 remaining stores to visit. This phase will be completed by September 12 th.

16. MHRA WIC Vendor Management Agency16 Second Follow Up: Training Second Follow with training began August 8th. There are 214 stores that require training. Of these 199 are still active. Brooklyn: 93 Manhattan: 18 Queens: 41 Bronx: 52 There are 149 remaining stores to visit. This phase will be completed by September 12 th.

17. MHRA WIC Vendor Management Agency17 Notes from the Field Vendors were cooperative (and excited that they began to see more checks for Low-Fat milk). Vendors appreciated the posters and other materials. Stores continue to claim confusion and promise to change—most claim to think that 2% is Low-Fat milk. Some vendors actually thought 2% was the healthier choice. The vendors were cooperative and understood they needed to carry the milk. A few were surprised that whole milk had so much saturated fat and said they are going to switch to 1%. The component that continued to have the most impact was the bacon comparison. Health Promoters are seeing more low-fat milk being stocked. However, it is still not being stocked in gallon containers. Some vendors are claiming that the 1% milk does not sell. Vendors are experiencing resistance from some WIC participants that are refusing to take the 1% milk. Vendors are beginning to see the new checks that are being adjusted to reflect the increase in milk prices. Needless to say, the vendors are feeling less stressed about losing money.

18. MHRA WIC Vendor Management Agency18 Next Steps Complete Second Follow Up Provide NYSDOH with data Intervention First Follow Up Second Follow Up Produce reports for NYSDOH Prepare for FFY08 Project