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The Healthy Stores projects aim to improve health and prevent
obesity and disease in low-income communities through culturally
appropriate store-based interventions that increase the supply
of healthy foods and promote their purchase.
Beginning with the Marshall Islands Healthy
Stores program in 2000, Dr. Joel Gittelsohn of the Johns
Hopkins Center for Human Nutrition initiated a series
of store-based interventions to address the need for systemic
environmental change in low income areas where healthy options
are irregularly available, if at all.
The Apache Healthy Stores intervention
began in July 2003 on the White Mountain and San Carlos Apache
reservations in Arizona. Formative research for a larger intervention
program in Baltimore, MD was completed in the Spring of 2003
and the research team is preparing for a pilot trial for the
Baltimore Healthy Stores intervention
that will take place in the Spring of 2004.
Future Healthy Stores programs are being planned in three
Native Canadian communities
and in Hawaii and other Pacific Island
nations.
By now, you've no doubt heard about the global obesity epidemic.
Obesity is the most common nutrition-related disorder in Western
countries, and its prevalence is increasing in both children
and adults across all segments of the population and in developing
countries around the world.
But, did you know*:
- 70 percent of the U.S. population is overweight.
- About 25 percent of that group are obese.
- Approximately 30 percent of children (ages 6 to 11) are
overweight and 15 percent are obese.
- Obesity costs the U.S. more than $93 billion a year due
to chronic disease complications, absenteeism, and loss
of productivity.
- African American, Hispanic, Native American, and Pacific
Islanders have higher rates of obesity than white Americans.
- Poor women are 50% more likely to be obese than those
with higher socioeconomic status.
*(Source: The
Surgeon General's Call to Action to Prevent and Decrease Overweight
and Obesity, 2001; American
Obesity Association; Prevalence
and Trends in Obesity Among US Adults, 1999-2000 Katherine
M. Flegal; Margaret D. Carroll; Cynthia L. Ogden; Clifford
L. Johnson
JAMA. 2002;288:1723-1727)
Many obesity prevention interventions in the past have focused
on changing individual behavior, but not adequately addressed
the need for systemic environmental change. In many low income
regions of the United States, including inner city areas and
rural regions, healthy options are often hard to find. The
dramatic increase in obesity over the past two decades is
related to an environment laden with inexpensive, high-fat
convenience foods and super-sized portions, as well as a marked
decrease in physical activity.
The Healthy Stores projects are intervention plans, developed
from substantial formative research, that seek to reduce obesity
and disease risk in specific populations. They utilize conceptual
frameworks and approaches from:
- educational psychology,
- medical anthropology,
- and health communications.
These constructs guide specific intervention phases and strategies.
FORMATIVE RESEARCH
Ethnographic approaches drawn from anthropology are used in
each setting to:
- identify core cultural concepts,
- identify appropriate cultural metaphors for health communications,
- frame messages in appropriate ways,
- and to understand the social and cultural context of key
behaviors relating to food and health.
INTERVENTION
Tested frameworks from educational psychology (specifically
Social
Cognitive Theory) address factors at both the individual
and environmental levels to support behavioral change relating
to diet.
Key components of Social Cognitive Theory (SCT) are:
- incorporation of the broader environment,
- behavioral capability,
- self-efficacy,
- observational learning,
- goal setting,
- role modeling,
- reinforcement,
- and reciprocal determinism.
Health communication and social marketing approaches enable
investigators to develop effective messages targeted to specific
audiences. These approaches have helped make mass media an
effective componement of the healthy stores interventions.
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