Measuring food justice, winning friends, and influencing people.

Kristin Harding, Development Coordinator JB Rinaldi, Research Associate Fanny Rodriguez, Research Associate

MAKING YOUR WORK COUNT What does it mean to measure the food environment? Who measures the food environment? What tools can you use to measure the food environment? Case Studies Our personal experience: Social Determinants of Health Challenges Food measurement, funders, and policy

It s where food is located and how it s related to you in geographical and cultural space. -What sources of food are available? -Who has access to this food? -What messages link people to this food?

Clive Derwicky 2215 NE 22 nd Ave Portland, OR 9721

Whole Foods

Whole Foods Fred Meyer

It s Tricky.

Researchers Governments Community Members

Document current conditions Understand drivers of effects Assess change

Often grant-funded Executed by academics or students Goal is publication or a contribution to existing knowledge Subject to strict expectations for measurement and analysis

Cheadle, et al 1991. Availability of healthful products in grocery stores = % of shelf devoted to a certain set of healthy foods -low-fat milk -Whole wheat bread -Lean meats Found a correlation between the availability of healthy foods in stores and the healthfulness of individual diets

Morland et al, 2002 Measured the number of supermarkets, grocery stores, and restaurants in census tracts Found that Black Americans fruit and vegetable intake increased by 32% for each additional supermarket in their tract; White Americans fruit and vegetable intake increased by 11% with the presence of 1 or more supermarket.

Understand the needs of a community Measure the impact of an initiative or an innovation Inform policy decisions

Often funded regionally Framed by the specific needs of particular communities May involve expert analysts or scientists Often subject to public review

An important part of modern public health practice involves advocating for healthy neighborhood design.

Ranked neighborhoods based on: Grocery store density Population within.5 miles of a grocery store Access to grocery stores via transport Fast food per capita Retail Food Environment Index Proximity of fast food to schools

Some findings: Northeast and Southeast Portland rank high on all of the food access measures Though Gresham, Wood Village, and East Portland rank high on access to grocery stores, residents of these areas likely have difficulty getting to grocery stores using public transportation.

Call attention to existing conditions Create a case for change Hold public and private agencies accountable

May have limited resources May have limited expertise May choose measures based on the outcome desired Audience: other citizens, policymakers

A community-based research project to measure how much food is grown in NYC s community gardens and school gardens Calculate the area, weight and monetary value of food grown in community gardens

2011 report: 132 different crop varieties recorded Estimated total yields for participating gardens = 17,000 lbs Estimated total dollar value = $52,700 www.farmingconcrete.org

Healthy food production in community gardens is especially relevant today, when the number of New York City residents who rely on emergency food and lack access to affordable fresh produce in grocery stores is increasing. No one knows just how much food NYC community gardeners are growing. That is what this project seeks to measure

Market basket Checklists Inventories Shelf space Analysis of Promotional Materials Surveys

Used to measure affordability Used to quantify differences in price among stores or regions Measurement team calculates the price of a given set of foods at a given location

Used to measure the availability of certain foods Standardized list of items; you mark if they are available or not Most often used to measure availability of healthy or unhealthy foods

Adapted from Giskes et. Al (2007).

Classify stores as healthy or unhealthy Map # of healthy and unhealthy stores within 1 mile Compare outcomes for residents within 1 mile of a healthy store against residents further away

Records all items available Items in Vending Machine M + Ms Doritos Trail Mix Granola Bar Snickers Red Licorice Corn Nuts

Using a tape measure, calculate the amount of shelf space reserved for certain foods Used to measure availability in the context of visibility The amount of shelf space has been linked to sales Some indication of priority is considered (i.e. there is a sense that consumers might be pressured one way or another)

An effort to measure the influence of instore marketing on consumer purchases Can include posters or signs, educational materials, or displays Some tools consider the proximity of a material or an item to checkout

Miller, Bodor and Rose (2012) measured the number of separate displays of fruits, vegetables, and energy-dense snack foods (chips, candies, and sodas) and their proximity to cash registers in stores in New Orleans

Supermarkets had an average of 20 displays of energy-dense snacks within 1 meter of their cash registers, yet none of them had even a single display of fruits or vegetables near their cash registers.

Some surveys assess food intake Some surveys assess perceptions of the food environment Surveys are self-report instruments; use special caution

How easy is it to find affordable healthy foods in your neighborhood? a. Very easy b. Somewhat easy c. Somewhat difficult d. Very difficult On average, how many pieces of fruit do you eat per day? a. 1 b. 2 c. More than 2

Seek the assistance of someone who s done it before Use questions that have been used before Limit open-ended responses

Business listings + address Market basket Checklists Inventories Shelf space Analysis of Promotional Materials Surveys Sales Trends

Teens Eating for Energy and Nutrition at School INVENTORY: Recorded what was offered at school lunch for 5 days straight INVENTORY: Recorded all the foods and beverages that were sold in a la cart lines for a 5 day period Put foods into categories: Foods to Promote Foods to Limit

TEENS intervention: education and stakeholder involvement Took inventory before and after the TEENS intervention

RESULTS: The proportion of healthier foods available in intervention schools more than doubled and offerings of less healthful choices declined.

Checklist of Health Promotion Environments at Worksites CHECKLIST: Includes foods available in the workplace, foods available in the surrounding neighborhood, and the information environment in the workplace. Data collectors personally toured the workplace environment

Used the checklist at 20 workplaces in Australia Results: 4 of 20 worksites had a cafeteria 39% had vending machines for snacks 44% had vending machines for soft drinks 1 of 20 worksites had a sign promoting healthful diet 12% of worksites had a nearby shopping center

Presents an opportunity to track whether workplace initiatives actually result in changes in the worksite food environment

Thrifty Food Plan is a governmental meal plan that sets national standards for low cost, nutritious foods TFP market baskets are created based on federal age and gender recommendations

Hendrickson et al 2006: 2 rural and 2 urban communities Low-income population Limited access to grocery stores Calculated price for TFP market basket at grocery stores

RESULTS: Foods in the urban neighborhoods were significantly more expensive than food in the rural neighborhoods Non-staple foods were more expensive than the TFP price in rural neighborhoods Staple foods were more expensive than the TFP price in urban neighborhoods

Grocery Store Auditing By: J.B. Rinaldi & Fanny Rodriguez

The Social Determinants of Health project seeks to understand the interplay between; Medicaid The built environment Health

Existing and new data sources to draw a conclusion for the Social Determinants of Health: Oregon Health Study (in person interviews and biomarkers) Observational Data (Street audits that measured neighborhood characteristics and grocery store audits) Public datasets (census data such as population density, race/ethnicity, income levels, home ownerships, poverty, crime, employment rates) Geographic Information Systems from Metro (including access to transit, Walk Scores, and present Green Space)

This data will add a new dimension to OHS: the ability to understand how neighborhood characteristics interact with health insurance as drivers of population health and health care utilization.

Food desert: Any area in the industrialized world where healthy, unprocessed food is absent or inaccessible. Food Oasis: Where the closest store is too expensive to shop at, forcing people in that area to go further out to find affordable healthy food.

Portland's low-income neighborhoods are city's food deserts Faith Cathcart/The Oregonian Video

Our database used to select grocery stores.

Adapted from the Nutrition Environment Measurement Study (NEMS) Modified by Dr. Janne Boone-Heinonen of OHSU and Kristin Harding of CORE

A set of rules as detailed as possible that defines how data needs to be collected in a consistent way. An agreed standardized way of performing a task. A process that is repeatable and reproducible. It prevents all/some errors.

Paper Form Plus Price (PFPP)

An example of a filled out Paper Form Plus Price (PFPP)

Steps for filling out the form 1.) Look for FRESH produce 2.) If there is no fresh option available, look for frozen, then canned. 3.) Pricing: always picked the least expensive* 4.) Look for the other foods on the list and find the cheapest options* 5.) Review the form *Our protocol

What did we do with the forms? Turned in the forms for data entry

How long did it take to go all the stores? Roughly 1 month How long did it take per store? Roughly 10 minutes

Where did we go? 44 Cities/Towns: Aloha, Banks, Beaverton, Boring, Canby, Carlton, Clackamas, Clatskanie, Colton, Corbett, Damascus, Dayton, Deer Island, Estacada, Forest Grove, Gaston, Gladstone, Government Camp, Gresham, Happy Valley, Hillsboro, Lafayette, Lake Oswego, McMinnville, Milwaukie, Molalla, Newberg, Oregon City, Portland, Rainier, Rhododendron, Sandy, Scappoose, Sheridan, Sherwood, St. Helens, Troutdale, Tigard, Vernonia, Welches, West Linn, Wilsonville, Wood Village, Yamhill.

Where did we go? We went to a total of 232 stores 160 140 120 100 80 60 40 20 0 Types of Stores # of Stores

We will analyze all the data we collected to determine an affordability score for each store. We will then combine all the SDH data sources and produce an overall score for each neighborhood.

Measuring the Food Environment often requires a lot of resources People to do the audits Mapping software Analytic power

Correlation is not indicative of causal relationships Cross-Sectional Design: Shows relationships at a single point in time Example: Higher-income neighborhoods tend to include more supermarkets than lower-income neighborhoods

Correlation is not indicative of causal relationships Longitudinal Study with Control: Better for suggesting cause/effect Example: Before the intervention, all schools offered soda at lunch. After the intervention, 89% of the control schools still offered soda at lunch, while only 25% of the intervention schools offered soda at lunch.

Endogeneity: People aren t randomly dropped into neighborhoods; they choose them.

Reliability: Are these measurements repeatable?

Validity: Are we measuring what we SAY we are measuring?

Document a need Demonstrate cross-disciplinary collaboration Highlight results of a pilot project Draw attention to a record of success

Shape priorities Create actionable items Enhance a persuasive case Speed up innovation

McKinnon et al (2009) Measures of the Food Environment: A Compilation of the Literature Lytle, Leslie (2009) Measures of the Food Environment: State of the Science Glanz, Karen (2009) Measuring Food Environments: A Historical Perspective (All found in Am J Prev Med 36 (4S))

Kristin Harding, kristin.harding@providence.org Fanny Rodriguez, fanny.rodriguez@providence.org JB Rinaldi, joseph.rinaldi@providence.org