“If you build it, they will come” isn’t a cure-all for the problem of healthy options in urban food deserts. Study after study has found that even when fruits and vegetables are easier to come by, residents aren’t necessarily more likely to buy them.
Take Philadelphia and Detroit, where healthy eating campaigns raised awareness, but didn’t spur behavioral change. In 2014, summarizing the disappointing findings from the study in Philadelphia, the Los Angeles Times’ Melissa Hardy posited that future interventions might do well to adopt a more holistic approach and deepen their engagement with the community. She wrote:
Community groups and supermarkets may need to teach shopping and cooking skills to consumers who might not know how to choose a ripe tomato and may never have learned to cook at home. The retailers that open those stores may need to develop pricing and credit policies that make sense in the neighborhoods they serve. And the store shelves themselves may need to help educate new customers about what a healthy diet looks like.
If plunking down a new store doesn’t seem to do the trick, it does seem logical to wonder if a multi-pronged approach that considers a community’s habits and needs would do more to promote long-term, large-scale change. That’s the perspective researchers adopted when designing a study about the impact of corner-store makeovers on shoppers’ perceptions and behaviors, recently published in the journal BMC Public Health.
Researchers surveyed approximately 1,000 residents in majority-Latino neighborhoods in East Los Angeles, where 30 percent of adults and nearly 33 percent of children are obese, according to a 2011 report prepared by the county’s public health department. Subjects were asked about the perceived accessibility of healthy food, perceptions of corner stores, and their browsing, buying, and eating habits.
To determine what changes would be most effective, the researchers solicited community feedback and participation from the outset. And they tried to fold in those sorts of educational components Hardy mentioned in her article. They met with local residents and leaders and recruited high-school students to brainstorm ideas to raise awareness about healthy eating, papered bus shelters with nutrition-focused marketing, and produced a cookbook with nourishing recipes.
Applying feedback from residents, the researchers gave three stores major overhauls, including updated signage and paint, refrigerated cases, security upgrades, and promotions focused on healthy eating. Rejiggered interior layouts put the healthy choices in plain view. Five stores were left untouched as the control group.
Before-and-after pictures of one of the markets in the study. (©2014 Public Matters)
Engagement did not stop there. The store owners participated in trainings about procurement and marketing. They learned about developing relationships with wholesalers and local famers’ markets, estimating perishable inventory, and meeting customer demands. Then, they were free to choose produce that they thought would be most popular in their communities. Overall, most of the intervention stores added about a dozen fresh options to their shelves.
Two years after the intervention, the researchers repeated the surveys. By some metrics, the interventions were meaningful: respondents who shopped at the stores in the intervention group perceived those stores to be cleaner and safer than before. They also noted an increase in “culturally appropriate Latino ingredients.”
But shoppers didn’t report a change in their buying patterns or eating habits. They weren’t loading up on more produce. “Perceptions change, but consumption patterns don’t,” says Alex Ortega, the study’s lead author and a professor at Drexel University’s Dornsife School of Public Health.
All of this work represents, the researchers write, a kind of “best-case scenario” that still fell flat. Before imposing changes, the researchers and store owners listened to the community’s self-described needs; they invested in trainings for store owners and informational materials for consumers. Even so, the cooperative model wasn’t sufficient to drive long-term change.
Coupled with previous studies that yielded similar findings, these results underscore the need for even more comprehensive interventions that go beyond corner stores. “If the obesity epidemic was caused by really big changes in production, marketing, and selling of unhealthy foods that took place over a long period of time, it probably is not realistic to expect a quick fix,” Ortega said in a statement. Future work might attend to the overarching—and deeply tangled—problems of poverty, education, and policy. Still, Ortega tells CityLab, researchers should be careful not to lose sight of a community’s needs as they fix their gaze on the bigger picture. “Any time you do any kind of built environment intervention, you have to understand wants, needs, and demands,” he says. “It’s an essential intervention component.” It’s just not enough.