. 2017 Nov 10;14(11):1371.

doi: 10.3390/ijerph14111371.

The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area

Joel Gittelsohn^{1

2}, Angela C Trude^{3

4}, Lisa Poirier^{5

6}, Alexandra Ross⁷, Cara Ruggiero⁸, Teresa Schwendler⁹, Elizabeth Anderson Steeves¹⁰

Affiliations

¹ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. jgittel1@jhu.edu.
² Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. jgittel1@jhu.edu.
³ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. atrude1@jhu.edu.
⁴ Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. atrude1@jhu.edu.
⁵ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. lpoirie4@jhmi.edu.
⁶ Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. lpoirie4@jhmi.edu.
⁷ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. aross37@jhu.edu.
⁸ Center for Childhood Obesity Research, Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA. cfr8@psu.edu.
⁹ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. teresarose199@gmail.com.
¹⁰ Department of Nutrition, University of Tennessee, 1215 W. Cumberland Ave., Knoxville, TN 37996, USA. eander24@utk.edu.

PMID: 29125558
PMCID: PMC5708010
DOI: 10.3390/ijerph14111371

The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area

Joel Gittelsohn et al. Int J Environ Res Public Health. 2017.

. 2017 Nov 10;14(11):1371.

doi: 10.3390/ijerph14111371.

Authors

Joel Gittelsohn^{1

2}, Angela C Trude^{3

4}, Lisa Poirier^{5

6}, Alexandra Ross⁷, Cara Ruggiero⁸, Teresa Schwendler⁹, Elizabeth Anderson Steeves¹⁰

Affiliations

¹ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. jgittel1@jhu.edu.
² Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. jgittel1@jhu.edu.
³ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. atrude1@jhu.edu.
⁴ Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. atrude1@jhu.edu.
⁵ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. lpoirie4@jhmi.edu.
⁶ Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. lpoirie4@jhmi.edu.
⁷ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. aross37@jhu.edu.
⁸ Center for Childhood Obesity Research, Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA. cfr8@psu.edu.
⁹ Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. teresarose199@gmail.com.
¹⁰ Department of Nutrition, University of Tennessee, 1215 W. Cumberland Ave., Knoxville, TN 37996, USA. eander24@utk.edu.

PMID: 29125558
PMCID: PMC5708010
DOI: 10.3390/ijerph14111371

Abstract

The multifactorial causes of obesity require multilevel and multicomponent solutions, but such combined strategies have not been tested to improve the community food environment. We evaluated the impact of a multilevel (operating at different levels of the food environment) multicomponent (interventions occurring at the same level) community intervention. The B'more Healthy Communities for Kids (BHCK) intervention worked at the wholesaler (n = 3), corner store (n = 50), carryout (n = 30), recreation center (n = 28), household (n = 365) levels to improve availability, purchasing, and consumption of healthier foods and beverages (low-sugar, low-fat) in low-income food desert predominantly African American zones in the city of Baltimore (MD, USA), ultimately intending to lead to decreased weight gain in children (not reported in this manuscript). For this paper, we focus on more proximal impacts on the food environment, and measure change in stocking, sales and purchase of promoted foods at the different levels of the food system in 14 intervention neighborhoods, as compared to 14 comparison neighborhoods. Sales of promoted products increased in wholesalers. Stocking of these products improved in corner stores, but not in carryouts, and we did not find any change in total sales. Children more exposed to the intervention increased their frequency of purchase of promoted products, although improvement was not seen for adult caregivers. A multilevel food environment intervention in a low-income urban setting improved aspects of the food system, leading to increased healthy food purchasing behavior in children.

Keywords: African American; childhood obesity; food availability; food environment; food purchasing; urban.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Sales of BHCK promoted drinks, promoted snacks, and promoted low-fat cooking ingredients during wave 1 and wave 2 of the BHCK wholesaler intervention.

See this image and copyright information in PMC

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The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area

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The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area

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