Objective To evaluate a 12-session home and community-based health promotion/obesity prevention program (Challenge!) on changes in BMI, body composition, physical activity (PA), and diet. Methods 235 African-American adolescents (11–16 yrs, 38% overweight/obese) were recruited from low-income urban communities. Baseline measures included weight, height, body composition (dual-energy x-ray absorptiometry (DEXA) and bioelectrical impedance), physical activity (PA) (accelerometry), and diet (food frequency). PA was measured by time in play-equivalent physical activity (PEPA≥1800 activity counts/min). Participants were randomized into a home- and community-based health promotion/obesity prevention controlled trial, anchored in social cognitive theory and involving motivational interviewing techniques, and delivered by college-enrolled, African-American mentors. Control adolescents did not receive the intervention or a mentor. Post-intervention (10 mos) and delayed follow-up (24 mos) evaluations were conducted. Longitudinal analyses using random mixed effects models and generalized estimating equations (GEE) examined direct and moderated effects of time, gender, and baseline BMI category on changes at both follow-ups. Results Retention was 76% (178/235) over 2 years; overweight/obese status declined 5.3% among intervention adolescents and increased 11.3% among control adolescents (χ2=5.8, p=0.02, GEE). Among males, but not females, fat free mass was significantly higher among intervention members at both follow-up evaluations. PA effects were moderated by baseline BMI category; among adolescents ≥ 85th percentile, control adolescents averaged 25.5 min less daily activity than intervention adolescents (p=0.018) at the 10-mo, but not the 24-mo follow-up. Intervention adolescents declined significantly more in snack and dessert consumption than control adolescents (p=0.045). Conclusion A 12-session, home-and community-based intervention, based on social cognitive theory and delivered by college-enrolled mentors, had sustained effects over 24 months in preventing an increase in BMI category, in enhancing fat free mass among males, and in reducing snack and dessert intake. The intervention prevented PA declines among the heaviest adolescents, but effects were not sustained.

ObjectiveWhile corner store-based nutrition interventions have emerged as a potential strategy to increase healthy food availability in low-income communities, few evaluation studies exist. We present the results of a trial in Baltimore City to increase the availability and sales of healthier food options in local stores.DesignQuasi-experimental study.SettingCorner stores owned by Korean-Americans and supermarkets located in East and West Baltimore.SubjectsSeven corner stores and two supermarkets in East Baltimore received a 10-month intervention and six corner stores and two supermarkets in West Baltimore served as comparison.ResultsDuring and post-intervention, stocking of healthy foods and weekly reported sales of some promoted foods increased significantly in intervention stores compared with comparison stores. Also, intervention storeowners showed significantly higher self-efficacy for stocking some healthy foods in comparison to West Baltimore storeowners.ConclusionsFindings of the study demonstrated that increases in the stocking and promotion of healthy foods can result in increased sales. Working in small corner stores may be a feasible means of improving the availability of healthy foods and their sales in a low-income urban community.

Obesity and other diet-related chronic diseases are more prevalent in low-income urban areas, which commonly have limited access to healthy foods. The authors implemented an intervention trial in nine food stores, including two supermarkets and seven corner stores, in a low-income, predominantly African American area of Baltimore City, with a comparison group of eight stores in another low-income area of the city. The intervention (Baltimore Healthy Stores; BHS) included an environmental component to increase stocks of more nutritious foods and provided point-of-purchase promotions including signage for healthy choices and interactive nutrition education sessions. Using pre- and postassessments, the authors evaluated the impact of the program on 84 respondents sampled from the intervention and comparison areas. Exposure to intervention materials was modest in the intervention area, and overall healthy food purchasing scores, food knowledge, and self-efficacy did not show significant improvements associated with intervention status. However, based on adjusted multivariate regression results, the BHS program had a positive impact on healthfulness of food preparation methods and showed a trend toward improved intentions to make healthy food choices. Respondents in the intervention areas were significantly more likely to report purchasing promoted foods because of the presence of a BHS shelf label. This is the first food store intervention trial in low-income urban communities to show positive impacts at the consumer level.

Reduced access to affordable healthy foods is linked to higher rates of chronic diseases in lowincome urban settings. The authors conduct a feasibility study of an environmental intervention (Baltimore Healthy Stores) in seven corner stores owned by Korean Americans and two supermarkets in low-income East Baltimore. The goal is to increase the availability of healthy food options and to promote them at the point of purchase. The process evaluation is conducted largely by external evaluators. Participating stores stock promoted foods, and print materials are displayed with moderate to high fidelity. Interactive consumer taste tests are implemented with high reach and dose.

Genetic sensitivity to bitter taste may be associated with preference or rejection of some foods by children. Thirty-four children aged 5-7 y participated in the following assessments: a threshold test for 6-n-propylthiouracil (PROP), a scaling test to determine PROP sensitivity above threshold concentrations, a taste test of 11 foods and beverages with two methods of assessing preference (order of food selection and hedonic rating), and a verbally administered food-preference questionnaire. The 30 children who completed these tests successfully were classified as nontasters or tasters based on their PROP thresholds as well as their suprathreshold PROP functions. Analysis of variance showed significant differences in acceptance of cheese and milk for the two taste groups on one of the three preference tasks, selection of foods in order of preference. Tasters selected cheese later than did nontasters, suggesting that they like it less. Tasters selected milk earlier than did nontasters, suggesting that they like it more.

OBJECTIVES: This National Cancer Institute-funded study sought to increase fruit and vegetable consumption among women served by the WIC program in Maryland. METHODS: Over a 2-year period, a multifaceted intervention program using a randomized crossover design sought to increase fruit and vegetable consumption at 16 WIC program sites in Baltimore City and 6 Maryland counties. Participants were surveyed at baseline, 2 months postintervention, and 1 year later. RESULTS: Two months postintervention, mean daily consumption had increased by 0.56 +/- 0.11 servings in intervention participants and 0.13 +/- 0.07 servings in control participants (P = .002). Intervention participants also showed greater changes in stages of change, knowledge, attitudes, and self-efficacy. Changes in consumption were closely related to number of nutrition sessions attended, baseline stage of change, race, and education. One year later, mean consumption had increased by an additional 0.27 servings in both intervention and control participants. CONCLUSIONS: Dietary changes to prevent cancer can be achieved and sustained in this hard-to-reach, low-income population. However, many obstacles must be overcome to achieve such changes.

Based on substantial formative research, the authors developed and implemented a year-long corner store-based program in East Baltimore focusing on Korean American (KA) stores. To understand acceptability of the intervention by storeowners, the authors examined the motivating factors for program participation, barriers to program implementation, perceived effectiveness of intervention materials, and perceptions about the program. Data collection methods included in-depth interviews with seven corner store owners, field notes by interventionists, and a follow-up survey. Stores varied considerably in terms of owners' perceptions about the program, supportive atmosphere, and acceptability of intervention strategies. The storeowners who showed strong or moderate support for the program were more likely to sustain the stocking of promoted foods such as cooking spray and baked or low-fat chips after the program was completed as compared to less supportive stores. The level of support and active participation of storeowners can greatly influence the success of corner store-based nutrition interventions.

Obesity and other diet-related chronic diseases are widespread in American Indian communities. Inadequate access to healthy food on many reservations has led to a high-fat, high-sugar diet. The purpose of this paper is to report on the results of the process evaluation of a food store-based program to improve diet on two American Indian reservations. Process data were collected from 11 intervention stores to document the implementation of the Apache Healthy Stores (AHS) program. Process evaluation instruments recorded the stocking of promoted foods, presence of in-store communication materials, implementation of and participation in the cooking demonstrations and taste tests, and the transmission of mass-media messages. At the store level, the program was implemented with a high level of dose and reach, and a moderate to high level of fidelity. At the community level, the AHS program was implemented with a moderate degree of fidelity and dose. At the individual level, the cooking demonstrations and taste tests reached a large number of community members with a high dose. Implementing the AHS program on multiple levels (store, community, individual) was challenging, and differed between levels. Overall, improvements were seen from start to finish as program staff monitored, documented and responded to barriers to implementation. Process data will be tied to outcomes and will be useful for the planning of future store-based programs.