1. Effect of price, variety, and caloric cost on food purchases in corner stores in NYC Mindy Chang, MPH, DVM City Harvest Evaluation Dept. November 2014

2. Disclosure I have no relationships to declare 2

3. Introduction Obesity –34.9% (78.6 million) U.S. adults are obese 1 –Disproportionately affect groups with the highest poverty rates 2 –In NYC, 22% are obese 3 Rates of obesity increases as poverty increases 4 –15.7% with highest income are obese –26.8% with lowest income are obese Food environment of low-income neighborhoods –Predominantly corner stores 5 Charge higher prices for healthier food 6 Limited availability of fruits and vegetables 7 Primarily offer inexpensive snack foods 8 –Candy, fried snacks –Sugar sweetened beverage –Packaged bakery product –Presence of corner stores associated with increased risk of obesity 9 3

4. Introduction City Harvest Healthy Corner Store program –Work with corner stores to encourage Expansion of produce sales Expansion of healthy choices in stores Question: What factors will affect customer purchases 4

5. Methods Inventory of corner stores (n=29) –List varieties of produce, potato chips and candy –List prices of produce, potato chips and candy –List sizes of potato chips and candy Customer surveys (n=437) –What do you purchase most often from corner stores –How far is supermarket, corner store and fast food restaurant from where you live –Did you notice food advertisements Pictures of ads present in 2 block radius around corner store 5

6. Methods Data collection –June 2013 to September 2014 Inventory of corner stores (n=29) –Bedford-Stuyvesant (n=11) –South Bronx (n=9) –Long Island City/Astoria (n=4) –Stapleton (n=2) –Washington Heights/Inwood (n=3) Customer surveys (n=437) –Gender Female45% –Race/ethnicity Black41% Hispanic36% –Average age41.3 years old –Average education level: High school graduate/GED 6

7. What are customers buying-food (n=437) 7

8. Factors that may affect corner store purchases Distance to stores –Supermarket –Corner stores –Fast food restaurants Quality of produce available in corner stores Number of varieties available of produce and snack foods at corner stores Cost of produce and snack foods at corner stores Advertising

9. Factors that may affect purchases: Distance to stores Distance to supermarkets, corner stores and fast food restaurants categorized as –Close (less than 3 blocks) –Medium (3 to 6 blocks) –Far (more than 6 blocks) Store typeRange of blocks to store Average number of blocks to store (+/- stdev) Supermarket0-203.17 (+/-3.18) Corner store0-81.36 (+/-0.98) Fast food restaurant0-253.36 (+/-3.35)

10. Factors that may affect purchases: Distance to stores

11. Factors that may affect purchases: Distance to store

12. Factors that may affect purchases: Quality of produce Quality of produce categorized as –Poor (1) –Fair (2) –Good (3) Average fresh fruit quality 2.4 (+/- 0.49) Average fresh vegetable quality 2.2 (+/- 0.49)

13. Factors that may affect purchases: Quality of produce % Customers who purchase fruits % Customers who purchase vegetables

14. Factors that may affect purchases: Variety Variety of produce, chips and candy available categorized as (based on tertile) –Low variety –Medium variety –High variety Food typeRange of varietyAverage variety (+/- stdev) Fruit0-167.18 (+/-3.92) Vegetable0-209.28 (+/-4.89) Potato chips0-4614.14 (+/-11.64) Candy0-16538.48 (+/-33.57)

15. Factors that may affect purchases: Variety * * *p <0.05

16. Factors that may affect purchases: Cost (per ounce) Candy and potato chips are significantly more expensive –Contradictory to what customers are purchasing Cost per ounce of produce, chips and candy available categorized as (based on tertile) –Low cost –Medium cost –High cost *p<0.05 significantly different compared to chips or candy Food typeRange of cost per ounce Average cost per ounce (+/- stdev) Fruit$0.05-$0.34$0.12* (+/-0.04) Vegetable$0.04-$0.33$0.12* (+/-0.05) Potato chips$0.17-$1.00$0.41 (+/-0.12) Candy$0.01-$1.25$0.47 (+/-0.26)

17. Factors that may affect purchases: Cost (per ounce) *p <0.05

18. Factors that may affect purchases: Cost (per calorie) Potato chips and candy is significantly cheaper per calorie Cost per calorie of produce, chips and candy available categorized as (based on tertile) –Low cost –Medium cost –High cost $0.0043 +/- 0.0024 per calorie *p<0.05 significantly different compared to chips or candy Food typeRange of cost per calorie Average cost per calorie (+/- stdev) Fruit0.33¢-7.14¢1.76¢ (+/-1.233) Vegetable0.19¢-3.62¢1.11¢* (+/-0.53) Potato chips0.11¢-0.65¢0.27¢ (+/-0.08) Candy0.09¢-1.15¢0.43¢ (+/-0.24)

19. Factors that may affect purchases- Cost (per calorie) *p <0.1 *

20. Factors that may affect purchases: Advertising Number of advertisements of produce and fast foods chips in neighborhood categorized as (based on tertile) –Low number of ads –Medium number of ads –High number of ads Ads for type of food Range of number of ads seen Average number of ads seen Fruits and vegetables 0-92.71 Fast foods0-145.36

21. Factors that may affect purchases: Advertising *

22. Conclusions Factors that showed significant association with customer reported purchases from corner stores –Number of varieties available –Cost of produce (per calorie) Factors that did not show any significant association –Distance to store –Quality –Advertising Program should focus on availability –Increasing variety of fruits and vegetables sold Work with suppliers, retailers and policy makers to affect prices –May be difficult to achieve

23. Limitations Self-report Sample size –437 customers –29 corner stores Assessment of quality of produce –Subjective process Number of varieties available of produce –Seasonality not accounted for Cost of produce at corner stores –Approximation of produce based on average size and calorie content of produce Advertising –Only print ads present in neighborhood –May not have captured all ads –TV commercial ads not accounted for

24. Works cited 1.Centers for Disease and Prevention. Overweight and Obesity: Adult Obesity Facts. Accessed Nov 11, 2014. www.cdc.gov/obesity/data/adult.htmlwww.cdc.gov/obesity/data/adult.html 2.Arfken CL, Houston CA. Obesity in inner-city African Americans. Ethn Healthy. 1996 Dec; 1(4): 317-26. 3.New York City Department of Health and Mental Hygiene. Obesity. Access Nov 11, 2014. www.nyc.gov/html/doh/html/living/obesity.shtmlwww.nyc.gov/html/doh/html/living/obesity.shtml 4.New York City Department of Health and Mental Hygiene. Community Health Survey (2012): public use dataset accessed on Nov 11, 2014. http://www.nyc.gov/html/doh/html/data/chs-data.shtml http://www.nyc.gov/html/doh/html/data/chs-data.shtml 5.Cannuscio CC, Tappe K, Hillier A, Buttenheim A, Karpyn A, Glanz K. Urban food environments and residents shopping behaviors. Am J Prev Med. 2013; 45(5):606- 614. 6.Krukowski RA, West DS, Harvey-Berino J, Elaine Prewitt T. Neighborhood impact on healthy food availability and pricing in food stores. J Community Health. 2010; 35: 315-20. 7.Leone AF, Rigby S, Betterley C, et al. Store type and demographic influence on the availability and price of healthful foods, Leon County, Floriday, 2008. Prev. Chronic Dis.. 2011; 8, A140. 8.Lucan SC, Karpyn A, Sherman S. Storing empty calories and chronic disease risk: Snack-food products, nutritive content and manufacturers in Philadelphia corner stores. J Urban Health. 2010; 287: 394-409. 9.Bodor JN, Rice JC, Farley TA, Swalm CM, Rose D. The association between obesity and urban food environments. J Urban Health. 2010; 87(5):771-81.

25. Special Thanks To Veronica Uzoebo Sally Cooper Sheilah Crowley Jennifer McLean Raul Barrios Touro Interns Aditi Puri Sarah MacLeod CUNY Corp Interns