DETERMINING THE NEED AND FEASIBILITY OF A HEALTHY CORNER STORE
INTERVENTION IN GAINESVILLE, FL
By
VANESSA BERTHOUMIEUX
A THESIS PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE
UNIVERSITY OF FLORIDA
2017
© 2017 Vanessa Berthoumieux
To my parents
4
ACKNOWLEDGMENTS
I thank my parents, my friends, my thesis advisor, and my thesis committee for all of
their help and support throughout this process.
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TABLE OF CONTENTS
page
ACKNOWLEDGMENTS ...............................................................................................................4
LIST OF TABLES ...........................................................................................................................7
LIST OF FIGURES .........................................................................................................................9
ABSTRACT ...................................................................................................................................10
CHAPTER
1 LITERATURE REVIEW AND RESEARCH RATIONALE ................................................12
Food Deserts ...........................................................................................................................12 Food Deserts and Risk for Disease .........................................................................................13
Food Deserts and Corner Stores .............................................................................................15 Customer Preference for Shopping at Corner Stores ..............................................................19 Supplemental Nutrition Assistance Program ..........................................................................19
2 METHODS .............................................................................................................................25
IRB Approval ..........................................................................................................................25
Corner Store Selection ............................................................................................................25
Food Environment Evaluation ................................................................................................26
Customer Perception Evaluation ............................................................................................27 Data Analysis ..........................................................................................................................28
3 RESULTS ...............................................................................................................................31
Aim 1: Food Environment Evaluation ....................................................................................31 Aim 2: Customer Intercept Surveys .......................................................................................33
Aim 3: Corner Store Manager Interviews ..............................................................................45
4 DISCUSSION .........................................................................................................................47
APPENDIX
A IRB APPROVAL....................................................................................................................59
B GIS MAPS ..............................................................................................................................60
C WINDSHIELD SURVEY SAMPLE .....................................................................................61
D CORNER STORE MANAGER INTERVIEW GUIDE1 .......................................................64
E CX3 THREE PART SURVEY ...............................................................................................67
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F HEALTHY CORNER STORES BASELINE CUSTOMER INTERCEPT SURVEY ..........68
G WIC STORE MINIMUM STOCKING REQUIREMENTS ..................................................84
LIST OF REFERENCES ...............................................................................................................87
BIOGRAPHICAL SKETCH .........................................................................................................90
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LIST OF TABLES
Table page
1-1 Federal SNAP income eligibility requirements. ................................................................20
1-2 SNAP final rule requirements. ...........................................................................................21
3-1 CX3 Corner store evaluation results of the healthfulness of the food environment for
both corner stores. ..............................................................................................................31
3-2 Store intercept survey customer demographics. ................................................................33
3-3 Store intercept survey food assistance questions. ..............................................................34
3-4 Customer intercept survey frequency of shopping at corner store questions. ...................35
3-5 Customer intercept survey produce/other healthy foods participants want to see sold
at their corner stores. ..........................................................................................................36
3-6 Impact of different variables on the customer’s decision to purchase fresh fruits and
vegetables. ..........................................................................................................................38
3-7 Univariate analysis of the impact of items on customer’s decision to purchase fresh
fruits and vegetables. .........................................................................................................39
3-8 How strongly customers agree or disagree that they would buy healthier food at their
corner store based on different variables. ..........................................................................40
3-9 Chi-square test for significance between levels of agreement by customers with
statements about buying healthier food at the corner stores. .............................................41
3-10 Daily servings of fruit consumed by customers of corner stores. ......................................42
3-11 Pearson correlation test for daily fruit consumption and purchasing of healthy foods
based on price ....................................................................................................................42
3-12 Daily servings of vegetables consumed by customers of corner stores. ............................43
3-13 Pearson correlation test for daily vegetable consumption and purchasing of healthy
foods based on price...........................................................................................................43
3-14 Mean impact of price on decision to purchase fresh fruits and vegetables in SNAP
and non-SNAP recipients. ..................................................................................................44
3-15 Independent samples t-test for SNAP/non-SNAP recipients and decision to purchase
healthier food. ....................................................................................................................44
4-1 SNAP final rule requirements. ...........................................................................................50
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C-1 Sample of windshield survey data. ....................................................................................61
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LIST OF FIGURES
Figure page
4-1 Factors that impact the food purchasing of SNAP customers. ..........................................54
B-1 GIS map of food deserts and SNAP eligible populations. .................................................60
B-2 GIS map of two corner stores selected within food deserts with high SNAP eligible
populations. ........................................................................................................................60
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Abstract of Thesis Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Master of Science
DETERMINING THE NEED AND FEASIBILITY OF A HEALTHY CORNER STORE
INTERVENTION IN GAINESVILLE, FL
By
Vanessa Berthoumieux
May 2017
Chair: Karla Pagan Shelnutt
Major: Food Science and Human Nutrition
The purpose of this study was to determine whether a need exists for a healthy corner
store intervention in Gainesville, Florida, and whether it is a feasible way to make healthy foods
available to those living in food deserts. Geographic Information System (GIS) mapping and
windshield survey data were used to identify two corner stores located in two food deserts in
Gainesville, Florida. Store managers were approached and consented to participate in the study.
As part of study inclusion, store managers (N=2) were interviewed, and the store food
environment was evaluated using the Communities of Excellence in Nutrition, Physical Activity,
and Obesity Prevention Survey (CX3). In addition, customers (N=30 at each store; total=60) who
purchased food at each store and met the inclusion criteria were surveyed using a survey adapted
from a customer intercept survey developed by the Regional Nutrition Education and Obesity
Prevention Centers of Excellence - South for use by SNAP-Ed. Data were analyzed using a
mixed methods approach, specifically using content analyses and descriptive statistics for each
specific aim. The healthfulness of the corner stores and the purchasing decisions of SNAP
recipients were analyzed using univariate or bivariate analyses as well as Pearson’s Correlation
test or independent samples t-test. Manager interviews were transcribed and focused coding was
used to assess the food environment and customers from the perspective of the store managers.
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According to CX3 data both corner stores had an unhealthy food environment in and surrounding
the stores. Customers indicated that the top four items that have the most impact on their
decision to purchase fresh fruits and vegetables in descending order were: price, appearance,
healthfulness, and convenience. Customers agreed that they would buy healthier food products at
their respective corner store if the prices were lower and the store had a wider variety of healthy
food products. There were no differences between SNAP and non-SNAP recipients in their
decision to purchase fresh fruits and vegetables based on price. Finally, both of the store
managers stressed the importance of forming relationships with their customers, that they like to
cater to their customers’ needs, and that their monthly SNAP sales range from $2600 to $3000.
However, store managers reported differences in what food items bought with SNAP dollars sell
the most. They also reported various barriers to selling fresh produce. In conclusion, a healthy
corner store intervention is needed and feasible in the two corner stores evaluated for this study.
This would be aided by continuing and strengthening relationships and trust between researchers,
store managers, and customers, as well as fostering ties to the communities these stores reside in.
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CHAPTER 1
LITERATURE REVIEW AND RESEARCH RATIONALE
Food Deserts
According to the Centers for Disease Control and Prevention (CDC), 36.5% of adults are
obese (CDC, 2016). Obesity-related diseases such as type 2 diabetes, heart disease, and stroke
are not only some of the leading causes of death but also cost the United States billions of dollars
in health care costs every year (CDC, 2016). Certain racial/ethnic groups are disparately affected
by obesity, and one contributing factor is limited access to nutritious foods (Trust, 2014).
Residents of low-income, minority, and rural neighborhoods are most affected by poor access to
supermarkets and healthy foods (Larson et al., 2009). These groups of people live in what is
coined a “food desert”. The United States Department of Agriculture (USDA) defines a food
desert as a community that is both low-income and low-access, meaning that it has the following:
1) a poverty rate of at least 20%, or an average annual family income at or below 80 percent of
the area’s average family income and 2) at least 500 people and/or at least 33% of the census
tract's population live more than one mile in urban areas, or more than 10 miles in rural areas
from either a large grocery store or supermarket (USDA, 2013). The Census Bureau defines
urban in the following two ways: Urbanized Areas (UAs) of 50,000 or more people or urban
Clusters (UCs) of at least 2,500 and less than 50,000 people (Branch, 2016). The Census Bureau
defines rural as encompassing all population, housing, and territory not included within an urban
area (Branch, 2016).
According to the USDA, 29.7 million people lived in areas that were low-income and
more than one mile from a grocery store, in 2012 (USDA, 2012). The USDA also reported that
out of those living in food deserts, 2.1 million households, or 1.8%, did not have access to a
vehicle (USDA, 2012). In addition, the USDA has also reported an increase in the number of
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census tracts from 2010 to 2015 that qualify as being food deserts; done by overlapping the low
income (LI) and low access (LA) census tracts (Rhone et al., 2017). Another important finding is
an increase in the amount of low access tracts without access to a car from 2010 to 2015 (Rhone
et al., 2017). This poor access to grocery stores has been associated with poor eating habits that
can potentially lead to an increase in obesity and other chronic diseases (USDA, 2013). On the
other hand, neighborhood residents who have better access to supermarkets and limited access to
convenience stores tend to have healthier diets and lower levels of obesity (Larson et al., 2009).
Food Deserts and Risk for Disease
In Florida, individuals in both urban and rural areas are more likely to die prematurely
from type 2 diabetes, diet-related cancers, stroke, and liver disease if they live more than a half-
mile from the nearest fully stocked grocery store and do not have access to a car compared to
individuals living closer to grocery stores who have more access to a car (Gallagher, 2014).
Walker et al. (2010) published a review on food deserts to determine the implications of poor
food access in the United States. Studies on food deserts and food access published between
January 2008 and January 2010 were analyzed (Walker et al., 2010). According to this review,
the main tools used to analyze food access in these studies were the following: business
lists/directories and census data, focus groups, food store assessments, food use inventory, GIS
technology and census data, interviews, inventory for measuring perceptions of food access,
questionnaires, and surveys. The authors reported that foods found in food deserts were less
healthy than those found in other areas, which makes it more difficult for residents of food
deserts to have access to foods recommended for a healthy diet (Walker et al., 2010). According
to this review, certain variables such as median household income and the presence of a
supermarket were inversely associated with obesity risk (Walker et al., 2010). In addition, the
rates of child overweight were positively associated with the percentage of children in the school
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district residing in a food desert (Walker et al., 2010). Although beneficial information was
gained from this review, it was only concerned with objective information, such as distance from
large supermarkets, and price of foods in these supermarkets versus corner stores. This leaves out
many other factors that could have an influence on health complications not associated solely
with poor food access, such as nutrition knowledge, desirability to be healthy, and influence
from unhealthy marketing.
Another study by Bonnie Ghosh-Dastidar and colleagues (2016) explored the relationship
between distance to stores, food prices, and obesity in urban food deserts. The study, titled the
Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health (PHRESH) Study,
spanned a total of five years and analyzed two low-income food deserts in Pittsburgh,
Pennsylvania, that were populated by mostly African Americans. One of these food deserts
acquired a new supermarket during the study timeframe (Ghosh-Dastidar et al., 2016). Data were
collected through surveys by the primary food shopper as well as audits of stores most popular
amongst residents for food purchases whether they were located in a food desert or not (Ghosh-
Dastidar et al., 2016). The audits assessed prices of junk foods and healthy foods as well as
healthy or unhealthy marketing and the kinds of foods visible from the front store window. After
adjusting for sociodemographic characteristics, there was a significant positive association
between obesity and distance, with the likelihood of being obese increasing by 5% with every
extra mile traveled to shop (Ghosh-Dastidar et al., 2016). This study looked at both high-price
stores, which in this study were full-service supermarkets and a specialty grocery store, as well
as low-price stores, which were two discount grocery stores, two supercenters, two meat/seafood
markets, and one wholesale club (Ghosh-Dastidar et al., 2016). These stores were the locations
identified by the study participants to be the main store where they do the majority of their
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grocery shopping. Fruits and vegetable availability was similar in both high-price and low-price
stores (Ghosh-Dastidar et al., 2016). However, in the high price stores, it was fruits and/or
vegetables that were visible from the main entrance, as opposed to low-price stores that had junk
foods visible from the main entrance (Ghosh-Dastidar et al., 2016). In addition, there were more
displays promoting healthy foods in the high-price stores compared to the low-price stores,
which advertised more junk food (Ghosh-Dastidar et al., 2016). These are all factors that can
influence purchasing decisions and therefore have an effect on health. It is important to keep all
of these factors in mind when assessing corner stores.
Food Deserts and Corner Stores
A corner store is defined as a store that primarily sells food and is less than 2000 square
feet, has less than four aisles, and only has one cash register (Lawman et al., 2015). These corner
stores also mainly serve inexpensive, unhealthy foods such as candy, sweet beverages, and high-
fat, fried snacks (Lawman et al., 2015). Corner stores are usually located in low-income areas
where residents have limited access to supermarkets and contribute significantly to energy intake
among low-income, minority populations (Lawman et al., 2015). Therefore, since corner stores
may be the only option in certain neighborhoods, corner store food purchases could be
specifically detrimental for low-income, minority populations who already have increased rates
of obesity and increased risk for chronic disease compared to individuals who are higher-income
and non-minority (Lawman et al., 2015).
DeWeese et al. (2016) compared the healthfulness of the food environment of corner
stores that either accepted SNAP benefits or Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC) benefits and/or had undergone a healthy corner store
intervention to control stores. They focused specifically on corner stores in four different cities in
New Jersey and evaluated the availability of healthy foods using parts of the Nutrition
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Environment Measures Survey for Corner Stores (NEMS-CS) created by Cavanaugh and
collaborators in 2013, as well as a new short-form corner store audit tool (SCAT) (DeWeese et
al., 2016). They found that WIC and non-SNAP corner stores both had higher scores using the
NEMS-CS and SCAT instruments, revealing greater healthfulness compared to non-WIC and
SNAP stores (DeWeese et al., 2016). A proposed reasoning by the authors for this phenomenon
is that although a SNAP participating store must have at least three varieties of items in each of
four staple food groups, there are no specific regulations against having unhealthy items such as
prepared mixtures with multiple ingredients (e.g., frozen pizza and ready-made cold sandwiches)
or accessory food items (e.g., chips and crackers) (DeWeese et al., 2016).
Therefore, SNAP stores can sell these items and may stock them more abundantly than
healthier items. In addition, these items tend to be more popular than the healthy items, and if
they are what SNAP recipients are purchasing most frequently, they will be made more readily
available in the store (Lawman et al., 2015). On the other hand, WIC foods only include: infant
formula; infant and adult cereal; baby food fruits, vegetables and meats; whole wheat bread,
brown rice, soft corn and whole wheat tortillas; juice; eggs; milk; cheese; peanut butter; dried
beans or peas; fruits and vegetables; soy beverage and tofu; and canned fish (DeWeese et al.,
2016). These are the only foods that WIC recipients can purchase, so the store is less likely to
stock snack and junk foods as they cannot be purchased with WIC dollars. This, in addition to
the minimum requirements needed to be a WIC vendor (Appendix F), led stores who were WIC
vendors to have healthier options than their non-WIC and SNAP counterparts (DeWeese et al.,
2016). In addition, higher SCAT scores were found in stores that had undergone a healthy
intervention, irrespective to whether the stores were also WIC vendors (DeWeese et al., 2016). In
terms of consumer purchasing patterns, it was found that for each additional type of fruit stocked
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in corner stores, there was a 12% increased chance for customers to purchase fruits (DeWeese et
al., 2016). Similarly, for each additional type of vegetable stocked in corner stores, there was a
15% increased chance for customers to purchase vegetables in corner stores with produce
available (DeWeese et al., 2016).
Lastly, SNAP customers were 1.7 times more likely to make a fruit purchase compared to
non-SNAP customers (DeWeese et al., 2016). The authors, however, stress that increasing the
amount of healthy foods in corner stores is not enough. If a healthy corner store intervention
were to ever occur in Alachua County, Florida, perhaps coupling it with nutrition education
would be most beneficial to increase purchasing and ultimately consumption of healthier foods.
In addition, based on these studies, helping stores to accept WIC benefits would be beneficial for
increasing its healthfulness as its guidelines are stricter in terms of foods allowed for purchase by
its recipients. However, beginning on January 17, 2018, a new “final rule” will be implemented
by SNAP in which stores who currently accept SNAP benefits must increase the number of
staple food varieties per category, and the number of stocking units per variety from the
following four categories: vegetables or fruits; dairy products; meat, poultry, or fish; and bread
or cereals (USDA, 2017). This new rule would require store managers to increase the variety of
healthy foods available, helping them make their store environment healthier. This rule,
however, still does not limit accessory food items like snacks and desserts, which would still be
available for purchase. In terms of selecting corner stores to assess for a healthy corner store
intervention, the following was deemed most important in Proyecto Mercado FRESCO, or The
Fresh Market Project, a community driven corner store intervention brought on by academic,
community, and business partners: “(1) location in a residential area, (2) distance from a
comprehensive grocery store/supermarket, (3) retail square footage of more than 500 square feet
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with ample room for produce refrigeration units and display cases, (4) sufficient customer flow,
(5) patronage among neighborhood residents, (6) quality customer service, (7) clear need for
physical transformation of the store, (8) low availability or absence of high quality fruits and
vegetables in the store, (9) day-to-day store owner operation, (10) store owner buy-in, (11)
regular hours of operation, and (12) absence of criminal activity in the immediate area” (Ortega
et al., 2015). These are all valid criteria when choosing corner stores as they combine aspects
showing the needs of the store, aspects of the physical characteristics of the store that would
make an intervention feasible, as well as aspects from day to day operations that ensure that the
stores chosen would have the most successful outcomes form an intervention. These criteria were
considered in this present research in Alachua County, Florida, when choosing stores to assess.
Ortega et al. (2015) stress the importance of establishing trust with store owners as they
had a number of stores that changed their minds and decided not to be involved because they
feared the research team’s motives for the intervention. The research in Alachua County, Florida,
emphasized building initial rapport with the storeowner that can hopefully lead to a trusting
relationship. Lastly, this study also identified the following three aspects to facilitate the
conversion of a corner store into a healthy one: 1) including community participation throughout
every phase, 2) working closely with a partner who understands the corner stores business, and
3) incorporating a social marketing campaign with nutrition/health education and messaging
(Ortega et al., 2015). Although the current research in Alachua County, Florida, will not include
an intervention component, strong community involvement as mentioned in Ortega and
colleagues’ study will be key in creating trusting relationships with both storeowners and
customers.
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Customer Preference for Shopping at Corner Stores
Walker et al. (2016) published a review on food deserts and included one study that
compared customer attitudes and behaviors before and after the opening of a large grocery store
in a food desert. However, only about half of the participants switched to shopping at the new
store once it opened even though it had a greater variety of foods and was also on average closer
to most residents (Walker et al., 2016). One factor that discouraged food desert residents from
shopping at the new grocery store as opposed to their usual corner store was that the larger
variety of foods, including prepared foods, led to customers experiencing temptation to buy more
than they could afford on larger quantities of foods or on items out of their price range (Walker
et al., 2016). In addition, customers who did not upgrade to shopping at the new stores reported a
feeling of familiarity with the corner store where they usually shopped, as well as finding
cheaper prices at their corner store (Walker et al., 2016). These same customers also reported a
sense of loyalty to owners of their neighborhood corner stores, and therefore did not make the
switch to the grocery store (Walker et al., 2016). These data show that attitudes of customers
play as big a role as convenience and variety.
Supplemental Nutrition Assistance Program
The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance
program for millions of eligible, low-income individuals and their families (SNAP, 2016). In
2012, SNAP provided about $80 billion in aid to a total of 47 million recipients (Gregory et al.,
2015). SNAP has two main goals: to decrease the likelihood of families facing food insecurity,
as well as aiding those who are low-income in consuming healthy, wholesome meals (Gregory et
al., 2015). In order to be eligible to receive SNAP benefits, a household must not make more
than the amounts listed in the first column in Table 1-1. However, a household with an elderly or
person who is receiving any disability payments only has to meet the net income amounts listed
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in the second column. These are the latest eligibility requirements, effective until September 30,
2017: (SNAP, 2016):
Table 1-1. Federal SNAP income eligibility requirements.
Household Size Gross monthly income
(130 percent of poverty)
Net monthly income
(100 percent of poverty)
1 $1,287 $ 990
2 1,736 1,335
3 2,184 1,680
4 2,633 2,025
5 3,081 2,370
6 3,530 2,715
7 3,980 3,061
8 4,430 3,408
Each additional member +451 +347
Stores who want to accept SNAP must also meet one of the following eligibility
requirements: 1) “Offer for sale, on a continuous basis, at least three varieties of qualifying foods
in each of the following four staple food groups, with perishable foods in at least two of the
categories:
• meat, poultry or fish
• bread or cereal
• vegetables or fruits
• dairy products
OR
2) More than one-half (50%) of the total dollar amount of all retail sales (food, nonfood,
gas and services) sold in the store must be from the sale of eligible staple foods” (USDA, 2016).
However, the USDA has now made a “final rule” whose requirements must be met starting May
17, 2017 by new stores applying to be SNAP stores, or by January 17, 2018 by stores that are
currently authorized to accept SNAP benefits (USDA, 2017). The requirements state that 84
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staple food items must be sold, according to these new requirements, broken down in Table 1-2
provided by the USDA (2017):
Table 1-2. SNAP final rule requirements.
Staple Food Category Number of Varieties Number of Units/Variety Total Items/Category
Vegetables or fruits 7 3 21
Dairy products 7 3 21
Meat, poultry, or fish 7 3 21
Bread or cereals 7 3 21
In 2011, the USDA published a report of benefit redemption patterns of SNAP recipients
using data from Electronic Benefit Transfer (EBT) transactions, authorized retailer information
from the Store Tracking and Redemption Subsystem (STARS), and household characteristics
from the SNAP Quality Control (QC) system (USDA, 2011). This study made the following
conclusions: 1) SNAP benefits are primarily redeemed at supermarkets and supercenters as
opposed to convenience stores; 2) 64% of all SNAP transactions, adding up to 84% of total
SNAP dollars, were made at larger retailers including supermarkets and supercenters, while only
15% of all SNAP transactions, adding up to 4% of SNAP dollars, were made at convenience
stores; 3) when looking at the U.S. as a whole, more than 96% of participants spend at least a
portion of their SNAP benefits in supermarkets; 4) SNAP purchase totals are higher at
supermarkets than at small stores, with the average supermarket transaction totaling about $42,
while only totaling $8 at convenience stores; and 5) SNAP recipients do not use all of their
benefits in one food shopping trip but instead make about 9 transactions per month, on average
(USDA, 2011). It is possible that the lack of desirable options at corner stores discourages
recipients from using their SNAP benefits at these locations. Despite the low amount of SNAP
purchases made at corner stores, residents who may not receive SNAP benefits may also be
purchasing food at corner stores. Corner stores should still be considered for interventions that
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improve the healthfulness of the food environment as some families may utilize them as their
main location for grocery shopping.
Chrisinger (2015) analyzed different aspects of SNAP, including innovations to
encourage healthier eating, and found that some places have used SNAP to encourage the
purchasing of healthy foods by offering bonuses for spending SNAP benefits on fruits or
vegetables. The USDA's Healthy Incentives Pilot looked at an intervention group receiving
incentives for purchasing fruits and vegetables versus a control group and found that fruit and
vegetable consumption and perceptions among the intervention population improved compared
to a control group (Chrisinger, 2015). In general, it seems that the USDA prefers trying to
increase healthy eating with incentives instead of making SNAP-eligible item restrictions based
on nutritional content (Chrisinger, 2015).
One specific study tested this SNAP incentive strategy in western Massachusetts (Grindal
et al., 2016). This study was conducted by randomly assigning SNAP households in Hampden
County, Massachusetts, to either an intervention group that earned a 30% price incentive for the
purchase of fruits and vegetables with SNAP or a control group with no incentive (Grindal et al.,
2016). This study also took into consideration the distance of households to grocery stores to see
if this would have an impact on the use of the incentives. The authors reported that the same
amount of SNAP incentives were spent on vegetables and fruits regardless of the distance
traveled by the customers, even though customers that lived one mile or less from a large grocery
store accepting these incentives spent about $2.13 or 19% more per month on eligible fruits and
vegetables than customers who lived more than one mile away (Grindal et al., 2016). A similar
program for use in farmers’ markets exists in Florida called the Fresh Access Bucks (FAB)
program, which allows SNAP customers to purchase double their food dollars for fresh, locally-
23
grown fruits and vegetables (Florida Organic Growers, 2016). From 2008 to 2014, SNAP
purchases at farmers’ markets, farm stands, and local farmers increased almost six times (SNAP,
2015). SNAP credits this increase in part to programs like FAB that motivate participants to
increase their fruit and vegetable purchasing (SNAP, 2015). Incentives therefore seem to be an
effective strategy to encourage fruit and vegetable purchase and consumption amongst SNAP
recipients and may be a good strategy to use if a healthy corner store initiative is implemented in
Alachua County, Florida.
The purpose of the current study was to determine whether a need exists for a healthy
corner store intervention in Alachua County, Florida, and whether it is a feasible way to make
healthy foods available to those living in food deserts. It also aimed to lead to a better
understanding of the purchasing habits and attitudes among SNAP-eligible populations living in
food deserts to inform the development of a healthy corner store intervention. The aims of the
current study and their designated hypotheses were the following:
Aim 1: To determine the healthfulness of the food environment of two corner stores in
food deserts in Gainesville, Florida based on food and beverage availability and marketing.
• Hypothesis 1: The selected corner stores will not have overall healthy food environments;
they will both have a healthfulness score under the satisfactory 75 out of a possible 100.
Aim 2: To determine the factors that influence fruit and vegetable purchasing decisions
of SNAP-eligible consumers.
• Hypothesis 2a: SNAP-eligible customers will report that price, convenience, appearance,
and taste influence their fruit and vegetable purchasing decisions more than healthfulness,
organically grown, grown in the U.S., and locally grown.
• Hypothesis 2b: SNAP-eligible customers are more likely to agree than disagree that they
will buy healthier food products if the prices were lower and if the store had a wider
variety of healthy food products.
24
• Hypothesis 2c: Customers who consume the most servings of fruits daily will be more
likely to agree that they would buy healthier food products at their respective store if
prices were lower.
• Hypothesis 2d: Customers who consume the most servings of vegetables daily will be
more likely to agree that they would buy healthier food products at their respective store
if prices were lower.
• Hypothesis 2e: Participants not currently receiving SNAP benefits will state that price has
a large impact on their decision to purchase fresh fruit and vegetables relative to
participants currently receiving SNAP benefits.
Aim 3: To assess the food environment within and surrounding each of the two corner
stores from the perspective of the store managers.
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CHAPTER 2
METHODS
IRB Approval
Prior to beginning any data collection, IRB approval for this research was obtained from
the University of Florida Institutional Review Board (Appendix A) and consent was obtained
from each participant.
Corner Store Selection
In order to determine which two stores to assess, a Geographic Information System (GIS)
mapping expert generated maps identifying all of the food deserts in Alachua County, Florida,
that are also considered low income and populated the maps with the highest density of SNAP
recipients (Appendix B). All of the corner stores that exist in these specific areas were identified
and windshield surveys of the areas surrounding each corner store were completed. These
windshield surveys were completed using criteria created by the research team, which was then
entered into an excel spreadsheet (Appendix C). Completing windshield surveys ensures that the
store still exists and is open to the public as well as whether it indeed lies within the food desert
boundary. Secondly, the windshield survey allows for first hand observations of the
neighborhoods surrounding the corner store in terms of environmental, physical, and social
characteristics. The surveys were conducted with three people in a vehicle; one person driving,
one person giving directions, and the last person writing down the observations. These
observations, along with the GIS map, identified the two stores that served the most SNAP
recipients and had the highest need.
Visits were made to each store to get in contact with their managers and determine
whether they would like to participate in this research project. In the event that a store owner
refused participation, notes from the windshield surveys and the GIS map were reevaluated to
26
choose other stores. Once two willing store managers were identified, they provided written
consent to be interviewed and recorded. The store manager interview was semi-structured with
open ended questions about their clientele, their purchasing patterns, items that tend to sell the
most or least, their vendors, etc. (Appendix D). The interviews took place at a convenient
location and time for the managers and were transcribed and analyzed using focused coding.
Food Environment Evaluation
The CX3 (Communities of Excellence in Nutrition, Physical Activity and Obesity
Prevention) three-part survey was used to assess the food environment. This tool includes the
following three components: 1) Food Availability and Marketing, 2) Fruit and Vegetable
Comparison Price Data, and 3) Store Environment Safety and Walkability Survey (Appendix D).
To ensure accurate data collection, the research team observed two webinars on The Food
Availability and Marketing tool. Data were collected at each corner store by scheduling a time
with the owner to come to the store and answer all of the questions on this survey. This CX3 tool
focuses on the healthfulness of the marketing inside and outside of the store, in addition to the
types of food and beverages sold, their placement, and their healthfulness. The Fruit and
Vegetable Comparison Price Data were collected by visiting three large supermarket chains,
specifically a Publix, a Winn-Dixie, and a Walmart and filling out the survey. This CX3 tool
focuses on current prices of produce at large chain supermarkets to be used as a comparison tool
for the price of the produce, if any, sold at the corner stores. Once those are collected, a day was
chosen to go back to the corner store to conduct the Store Environment Safety and Walkability
Survey on a two block area around the store. This tool focuses on the physical environment,
safety, and ease of access to get to and from the corner store from surrounding neighborhoods.
Once all parts of the CX3 were collected, the data were entered into an already formatted excel
spreadsheet created by the California Department of Public Health and then analyzed.
27
Customer Perception Evaluation
The last part of data collection consisted of interviewing 30 customers from each store
(N=60) using the Customer Intercept Survey (see Appendix E), which was developed by the
research team by adapting the RNECE customer intercept survey found on the SNAP-Ed
connection website. These interviews were conducted by one interviewer and an undergraduate
volunteer on a daily basis at each store until all the data were collected. Informed consent was
obtained by each potential participant before answering a series of inclusion criteria questions
(Appendix F). In order to qualify for the study, the customer had to meet the following inclusion
criteria:
1. must be at least 18 years old
2. must have purchased some type of food at the store the day the survey was being
conducted
3. must be the primary person responsible for buying food for their family
4. must have shopped at the store previously to the day the survey was being conducted
5. must live close to the store
6. based on the number of people living in their house, their gross monthly income must fall
at or below 130% of the poverty line, indicating SNAP eligibility.
If the customer did not meet all of the inclusion criteria, they could not complete the survey and
receive the $25 incentive. It was explained to the customer that this survey was about their
purchasing and consumption habits, focused primarily at this store, and that they had to qualify
to take the survey by answering a series of question to first see if they met these qualifications. It
was also explained to them at the beginning that if they did not qualify, they would not be able to
complete the survey and would therefore not receive the monetary incentive. If the participant
answered yes to all the inclusion questions, they would be invited to complete the rest of the
survey. The signed consent form was kept and an unsigned copy was provided to the participant.
28
The following was the schedule for interviewing customers, which was generated based on
interviewer availability as well as wanting a variety of times to be able to be exposed to as many
customers as possible: Monday: 10am to 1pm, Tuesday: 3pm to 6pm, Wednesday: 11am to 2pm,
Thursday: 9am to 12pm, and Friday: 10am to 1pm. This schedule was more or less followed at
each store until 30 customers were interviewed. The interviewers approached customers who had
purchased a food or drink item and asked them if they had time to participate in a survey. The
volunteer provided each participant who had successfully completed the survey an envelope
filled with $25 and documented each transaction with a receipt book. The data gathered from
these Customer Intercept Surveys was entered into SPSS by either dummy coding data with two
or more variables (i.e., 0-No, 1-Yes) or typing in textual data from open-ended questions, and
then analyzed. The data were summarized and the information will be shared with the store
managers at a later date. This will allow them to be aware of the areas in their stores that they
could potentially improve as well as help them get a better understanding of their SNAP
clientele.
Data Analysis
The data were analyzed using mixed methods, specifically content analyses and
descriptive statistics, including univariate, bivariate, mean comparisons, and significance of
correlations. The data analysis was broken down by specific aim. Aim 1, which was to determine
the healthfulness of the food environment of two corner stores in food deserts in Gainesville, FL,
based on food and beverage availability and marketing was analyzed using an already generated
CX3 excel spreadsheet with built in formulas. These formulas generate a series of total points
based on different parts of the surveys. This spreadsheet can be found on the California
Department of Public Health’s website
29
(https://www.cdph.ca.gov/programs/cpns/Pages/CX3_Main_Navgation.aspx) along with
instructions on how to enter the data from the CX3 surveys. Based on the total points generated,
healthfulness of the store was scored. A total score of up to 100 points can be achieved by adding
up the points from the following categories: access (WIC/SNAP), fruit and vegetable prices,
availability/quality of fruits and vegetables, other healthy foods, nutrition information, exterior
marketing, interior marketing, and walkability/safety. A total score of 75 is considered
satisfactory to earn the title of being a healthy store.
Aim 2, which was to determine the factors that influence fruit and vegetable purchasing
decisions of SNAP-eligible consumers, used the data from the Customer Intercept Surveys.
Descriptive statistics were used to analyze the data from this aim. Specifically, each hypothesis
was analyzed using the following methods:
1. Hypothesis 2a: SNAP-eligible customers will report that price, convenience, appearance, and
taste influence their fruit and vegetable purchasing decisions more than healthfulness,
organically grown, grown in the U.S., and locally grown. This hypothesis was analyzed using
univariate analyses, which includes means, modes, max, min, sum, and frequencies.
Univariate analyses include only a single variable and do not deal with causes and
relationships, with the goal of describing data.
2. Hypothesis 2b: SNAP-eligible customers are more likely to agree than disagree that they will
buy healthier food products if the prices were lower and if the store had a wider variety of
healthy food products. This hypothesis will be analyzed using univariate analyses, which
includes means, modes, max, min, sum, and frequencies. Univariate analyses include only a
single variable and does not deal with causes and relationships, with a goal of describing
data.
3. Hypotheses 2c: Customers who consume the most servings of fruits daily will be more likely
to agree that they would buy healthier food products if prices were lower. This hypothesis
was analyzed using bivariate analysis as it utilizes two questions: question 18 and question
21 and then question 18 and question 22. Bivariate analysis includes two variables and deals
with causes or relationships with the goal of explaining a phenomenon. This hypothesis was
analyzed by using Pearson’s Correlation Coefficient Test.
4. Hypothesis 2d: Customers who consume the most servings of vegetables daily will be more
likely to agree that they would buy healthier food products if prices were lower. This
hypothesis will be analyzed using bivariate analysis as it utilizes two questions: question 18
and question 21 and then question 18 and question 22. Bivariate analysis includes two
30
variables and deals with causes or relationships with the goal of explaining a phenomenon.
This hypothesis was analyzed by using Pearson’s Correlation Coefficient Test.
5. Hypothesis 2e: Participants not currently receiving SNAP benefits will state that price has a
large impact on their decision to purchase fresh fruits and vegetables relative to participants
currently receiving SNAP benefits. This hypothesis was analyzed using bivariate analysis as
it assesses both question 17 and question 23 of the customer intercept survey. An
independent samples t-test was performed to determine if there was a statistically significant
difference between the means of the data from the participants not currently receiving SNAP
benefits and those that are.
Aim 3, which was to assess the food environment within and surrounding each of the
three corner stores from the perspective of the store managers, was analyzed using focused
coding. After transcribing the two store manager interviews, each interview was coded by
breaking the information down by themes of interest to the study, which were color coded.
Matching color coded information found in both interviews was then further broken down to
look for similar themes and trends.
31
CHAPTER 3
RESULTS
Aim 1: Food Environment Evaluation
Aim 1 of this study was to determine the healthfulness of the food environment at two
corner stores in Gainesville, FL. The healthfulness score was based on the CX3 evaluation from
the California Department of Public Health. Scores for both corner stores are listed in Table 3-1.
Table 3-1. CX3 Corner store evaluation results of the healthfulness of the food environment for
both corner stores.
Criteria Corner Store #1 Corner Store #2
Store accepts WIC and
SNAP (max score=10, meets
standards ≥ 5)
5 5
Store prices for fresh
fruits and vegetables are
<10% of county average (max
score=10, meets standards ≥
7)
0 0
Store sells wide range
and good quality fruit (max
score=20, meets standards ≥
18)
0 0
Store sells wide range
and good quality vegetables
(max score=20, meets
standards ≥ 18)
0 0
Store sells wide range
of other healthy foods: Q33
(max score of 10, meets
standards ≥ 8)
4 1
Nutrition information
score (max score of 4, meets
standards ≥ 3)
0 0
Store has limited
exterior marketing (max score
of 8, meets standards ≥ 4)
1 1
Store has limited
interior marketing (max score
of 8, meets standards ≥ 5)
3 0
32
Table 3-1. Continued.
Criteria Corner Store #1 Corner Store #2
Store located in safe
areas (max score of 10, meets
standards ≥ 7)
5 5
Subtotal: 18 11
The healthfulness of the corner stores was determined based on a score out of 100 with a
score of 75 considered a healthy corner store. This score was calculated by summing the
following categories from the CX3 Food Availability and Marketing Survey, the Store
Environment Safety and Walkability Survey, and the Reasonable Price Collection Survey: store
accepts WIC and SNAP (max score=10, meets standards ≥ 5), store prices for fresh fruits and
vegetables are <10% of county average (max score=10, meets standards ≥ 7), store sells wide
range and good quality fruit (max score=20, meets standards ≥ 18), store sells wide range and
good quality vegetables (max score=20, meets standards ≥ 18), store sells wide range of other
healthy foods (max score of 10, meets standards ≥ 8), nutrition information score (max score of
4, meets standards ≥ 3), store has limited exterior marketing (max score of 8, meets standards ≥
4), store has limited interior marketing (max score of 8, meets standards ≥ 5), store located in
safe areas (max score of 10, meets standards ≥ 7). Corner store #1 earned a score of 18 out of
100 and corner store #2 earned a score of 11 out of 100. Both scores were well below the 75
needed to be considered healthy. The only criteria that the stores met as satisfactory was “store
accepts WIC and SNAP (max score=10, meets standards ≥ 5)” in which a score of 5 was
obtained by both. Both stores scored an unsatisfactory rating in all other categories with both
stores scoring 0 in four categories (store prices for fresh fruits and vegetables; store sells wide
range and good quality fruit; store sells wide range and good quality vegetables; nutrition
information score) and store #2 scoring 0 on “store has limited interior marketing”.
33
Aim 2: Customer Intercept Surveys
Aim 2 involved intercept survey data from customers who purchased food from both
stores. Table 3-2 describes the customer demographics.
Table 3-2. Store intercept survey customer demographics.
Variable Frequency or
Mean
Percentage or Max/Min
Age 39 Max: 61/Min:18
Gender (n=60)
Woman 26 43.3%
Man 34 56.7%
Parent
Yes 51 85%
No 9 15%
Children live with you
Yes 33 64.7%
No 18 35.3%
Currently employed
Yes 21 35%
No 39 65%
Highest level of education
Some high school 10 16.7%
High school diploma/GED 37 61.7%
Some college 11 18.3%
Associate’s degree/ Technical degree 2 3.3%
Bachelor’s degree 0 0.0%
Master’s degree 0 0.0%
Doctoral degree 0 0.0%
Hispanic/Latino
Yes 2 3.3%
No 58 96.7%
Race you most identify with
American Indian or Alaska Native 1 1.7%
Asian 0 0.0%
Black or African American 54 90%
Native Hawaiian or other Pacific Islander 0 0%
White 3 5%
Multi-racial 2 3.3%
Customer demographics included age, gender, status as a parent, questions about
children, employment, education, and race/ethnicity. Overall, there was a total of 60 participants
34
that successfully completed the customer intercept surveys, 30 at each of two corner stores. As
seen in Table 3-2, the participants from both corner stores ranged in age from 18 years old to 61
years old, with the mean age being 39 years old. There was a total of 34 men and 26 women.
Two participants identified as Hispanic or Latino. In terms of race, 90% or 54 out of 60
participants identified themselves as Black/African American, 3 as White, 2 as Multi-racial, and
1 as American Indian/Alaska Native. With regards to employment, 39 out of 60 (65%)
participants were not currently employed. Education levels varied across participants, with 10
having some high school, 37 having a high school diploma or GED, 11 having some college, and
2 having an Associate’s or Technical degree. Eighty-five percent, or 51 participants, reported
being parents. Out of those 51 participants that are parents, 33 of them or almost 65%, have
children living with them.
Table 3-3 describes the food assistance characteristics of the participants. Although all
the participants from this study qualified for SNAP based on inclusion criteria, only 32
participants, or 53.3% were currently receiving SNAP benefits and received them in the last
twelve months (Table 3-3).
Table 3-3. Store intercept survey food assistance questions.
Variable Frequency Percentage
Currently receiving SNAP benefits
Yes 32 53.3%
No 28 46.7%
Received SNAP benefits in the last 12 months
Yes 32 53.3%
No 28 46.7%
35
Table 3-3. Continued.
Of the 32 who received the SNAP benefits, 19 were women and 13 were men. One of
participants did not currently receive SNAP, but had received it in the last twelve months. In
addition, one currently receives SNAP but had not been receiving it in the last twelve months.
Corner store #1 had 18 out of 30 eligible participants currently receiving SNAP benefits versus
14 out of 30 eligible participants at corner store #2. Of the 18 SNAP recipients at corner store #1,
13 were women and 5 were men. Of the 14 SNAP recipients at corner store #2, 6 were women
and 8 were men. In addition, 32 participants also reported having ever used SNAP at their
respective corner stores, while 28 had not. Finally, 6 participants reported receiving WIC, while
54 did not.
In order to get a better picture of shopping habits of customers, additional questions were
added regarding frequency of shopping at the corner store (Table 3-4).
Table 3-4: Customer intercept survey frequency of shopping at corner store questions.
Variable Frequency Percentage
Daily 37 61.7%
Several times a week 22 36.7%
Once a week 1 1.7%
Every other week 0 0.0%
Once a month 0 0.0%
Less than once a month 0 0.0%
This is the first time (exclusion criteria) 0 0.0%
Variable Frequency Percentage Ever used SNAP benefits at this store
Yes 32 53.3%
No 28 46.7%
Currently receive WIC
Yes 6 10%
No 54 90%
36
Customers reported shopping at their respective corner stores no less than once a week.
Sixty-two percent or 37 customers reported shopping at their corner store daily, 36.7% or 22
customers reported several times a week, and only 1 person once a week.
In order to determine the types of healthy options customers wanted to see at their corner
stores, customers were given a list of foods for them to indicate which ones they wanted to see
sold at their corner stores (Table 3-5).
Table 3-5: Customer intercept survey produce/other healthy foods participants want to see sold at
their corner stores.
Fruit/Vegetable/Other Healthy
Item
Frequency Percentage of
Customers Wanting
each Item
Bananas 29 48.3%
Apples 26 43.3%
Oranges 16 26.7%
Strawberries 16 26.7%
Pineapple 11 18.3%
Grapes 10 16.7%
Tomatoes 7 11.7%
Broccoli 5 8.3%
Mangoes 5 8.3%
Greens 5 8.3%
Watermelon 5 8.3%
Lettuce 5 8.3%
Onions 5 8.3%
Peaches 4 6.7%
Cucumbers 3 5.0%
Cabbage 3 5.0%
Pears 3 5.0%
Any fruits 3 5.0%
Beans 2 3.3%
Cauliflower 2 3.3%
Squash 2 3.3%
Peas 2 3.3%
Spinach 2 3.3%
Apricots 1 1.7%
Cherries 1 1.7%
37
Table 3-5. Continued.
Fruit/Vegetable/Other Healthy
Item
Frequency Percentage of
Customers Wanting
each Item
Celery 1 1.7%
Salad 1 1.7%
Potatoes 1 1.7%
Tangerines 1 1.7%
Cantaloupe 1 1.7%
Juice 1 1.7%
Canned fruit 1 1.7%
Plums 1 1.7%
Kiwis 1 1.7%
Any vegetables 1 1.7%
Any produce 1 1.7%
The most popular items customers wanted to see at their corner stores were fruit. The
fruit most desired to least desired were bananas, apples, oranges, and strawberries in that order.
There was a wide variety of other items reported by participants. The most popular vegetables
customers wanted to see at their corner stores were tomatoes, broccoli, greens, lettuce, and
onion.
Aim 2, which was to determine the factors that influence fruit and vegetable purchasing
decisions of SNAP-eligible consumers, was broken down into five different hypotheses, each
analyzed differently. Hypothesis 2a of aim 2 tested whether SNAP-eligible customers report that
price, convenience, appearance, and taste influence their fruit and vegetable purchasing decisions
more than healthfulness, organically grown, grown in the U.S., and locally grown. Table 3-6 lists
the rankings from 1 to 5 of the impact of the variables on the customer’s decision to purchase
fresh fruits and vegetables.
38
Table 3-6. Impact of different variables on the customer’s decision to purchase fresh fruits and
vegetables. A) Appearance. B) Taste. C) Price. D) Healthfulness. E) Convenience.
F) Organically grown. G) U.S. grown. H) Locally grown. No Impact 2 Medium
Impact
4 Strong
Impact
A Frequency 1 1 10 2 46
Percentage 1.70% 1.70% 16.70% 3.30% 76.70%
B Frequency 0 1 5 4 50
Percentage 0.00% 1.70% 8.30% 6.70% 83.30%
C Frequency 5 3 19 1 32
Percentage 8.30% 5.00% 31.70% 1.70% 53.30%
D Frequency 3 0 13 5 39
Percentage 5.00% 0.00% 21.70% 8.30% 65.00%
E Frequency 5 3 13 3 36
Percentage 8.30% 5.00% 21.70% 5.00% 60.00%
F Frequency 25 3 16 1 15
Percentage 41.70% 5.00% 26.70% 1.70% 25.00%
G Frequency 17 2 8 1 32
Percentage 28.30% 3.30% 13.30% 1.70% 53.30%
H Frequency 17 3 8 1 31
Percentage 28.30% 5.00% 13.30% 1.70% 51.70%
Univariate analyses were run to determine which variable had the strongest impact on the
customer’s decision to purchase fresh fruits and vegetables (Table 3-7).
39
Table 3-7. Univariate analysis of the impact of items on customer’s decision to purchase fresh
fruits and vegetables.
N Minimum Maximum Mean Std. Deviation
Appearance 60 1.00 5.00 4.5167 .94764
Taste 60 2.00 5.00 4.7167 .69115
Price 60 1.00 5.00 3.8667 1.34626
Healthfulness 60 1.00 5.00 4.2833 1.12131
Convenience 60 1.00 5.00 4.0333 1.33996
Organically grown 60 1.00 5.00 2.6333 1.62571
U.S. grown 60 1.00 5.00 3.4833 1.77068
Locally grown 60 1.00 5.00 3.4333 1.76948
The results of the univariate analysis, summarized in Table 3-7, indicate that the following had
the most impact (in descending order) on customers’ decision to purchase fresh fruits and
vegetables:
1. 1. Taste
2. 2. Appearance
3. 3. Healthfulness
4. 4. Convenience
5. 5. Price
6. 6. U.S. grown
7. 7. Locally grown
8. 8. Organically grown
Hypothesis 2a of aim 2 tested whether SNAP-eligible customers are more likely to agree
than disagree that they will buy healthier food products if the prices were lower and if the store
had a wider variety of healthy food products. Table 3-8, including subparts A through H, lists
how strongly customers agree or disagree with statements about buying healthier food at the
corner stores. The results were calculated by adding up the frequencies for “strongly agree” and
“agree” and comparing them to the sum of the frequencies of “strongly disagree” and disagree”.
A one sample Chi-Square test was also conducted to look for statistical differences between the
40
different levels of agreement, as seen in table 3-9. Table 3-8 describes how strongly customers
agree or disagree with statements about buying healthier food at their corner store.
Table 3-8 How strongly customers agree or disagree that they would buy healthier food at their
corner store based on different variables. A) Lower prices. B) Better food quality. C)
Better customer service. D)Food that met food safety guidelines. E) Safer store
location. F) Cleaner Store. G) Longer store hours. H) Wider variety of healthy food
products. Strongly
disagree
Disagree Neither agree/
Nor disagree
Agree Strongly
agree
A Frequency 1 3 8 18 30
Percentage 1.70% 5.00% 13.30% 30.00% 50.00%
B Frequency 0 4 6 22 28
Percentage 0.00% 6.70% 10.00% 36.70% 46.70%
C Frequency 6 17 12 14 11
Percentage 10.00% 28.30% 20.00% 23.30% 18.30%
D Frequency 0 5 2 22 31
Percentage 0.00% 8.30% 3.30% 36.70% 51.70%
E Frequency 8 17 10 13 12
Percentage 13.30% 28.30% 16.70% 21.70% 20.00%
F Frequency 7 16 9 12 16
Percentage 11.70% 26.70% 15.00% 20.00% 26.70%
G Frequency 3 13 8 18 18
Percentage 5.00% 21.70% 13.30% 30.00% 30.00%
H Frequency 1 3 3 15 38
Percentage 1.70% 5.00% 5.00% 25.00% 63.30%
41
Table 3-9: Chi-square test for significance between levels of agreement by customers with
statements about buying healthier food at the corner stores.
Lower
Prices
Better
Food
Quality
Better
Customer
Service
Food
Meeting
Food
Safety
Guidelines
Safer
Store
Location
Cleaner
Store
Longer
Store
Hours
Wider
Variety
of
Healthy
Food
Products
Chi-
Square
48.167 28.000 5.500 38.267 3.833 5.500 14.167 80.667
df 4 3 4 3 4 4 4 4
P-
value
0.000 0.000 0.240 0.000 0.429 0.240 0.007 0.000
As seen in Table 3-7, eighty percent of customers agreed that they would buy healthier
food products at their respective corner stores if the prices were lower and only 6.7% of
customers disagreed. In addition, as seen in table 3-7 subpart G, 88.3% of customers agreed that
they would buy healthier food products at their respective corner stores if they had a wider
variety of healthy food products compared to only 6.7% of customers who disagreed.
As seen in Table 3-9, there was statistical significance between different levels of
agreement in the following categories: lower prices, better food quality, food meeting food safety
guidelines, longer store hours, and wider variety of healthy food products. However, there was
no statistical significance between different levels of agreement in the following categories:
better customer service, safer store location, and cleaner store.
Hypothesis 2c of aim 2 tested whether customers who consumed the most servings of
fruits daily are more likely to agree that they would buy healthier food products if prices were
lower. Table 3-10 lists how many servings of fruits participants consume on a typical day, with
the majority, or 53.4% of them indicating that they consume 3 or more servings of fruits a day.
42
Table 3-10. Daily servings of fruit consumed by customers of corner stores.
A Pearson Correlation Test was run to determine whether there was an association
between the servings of fruit customers consumed and whether customers agreed to buy healthier
food if prices were lower. Table 3-11 lists the results of the Pearson Correlation. There was no
significance between the two variables (R = -.144; P = 0.3).
Table 3-11: Pearson correlation test for daily fruit consumption and purchasing of healthy foods
based on price
Hypothesis 2d of aim 2 tested whether customers who consume the most servings of
vegetables daily will be more likely to agree that they would buy healthier food products if prices
were lower. Table 3-12 lists how many servings of vegetables customers consume on a typical
day, with 55% of customers indicating they consume 3 or more servings of vegetables a day.
Servings of Fruit Frequency Percentage
1 12 20.0%
2 16 26.7%
3 22 36.7%
4 3 5.0%
More than 4 7 11.7%
Buy Healthier
Food if Prices
Were Lower
Daily fruit
servings
Buy Healthier Food if Prices
Were Lower
Pearson Correlation 1 -.144
Sig. (2-tailed) .273
N 60 60
Daily fruit servings Pearson Correlation -.144 1
Sig. (2-tailed) .273
N 60 60
43
Table 3-12. Daily servings of vegetables consumed by customers of corner stores.
Servings of vegetables Frequency Percentage
None 1 1.7%
1 9 15.0%
2 17 28.3%
3 26 43.3%
4 4 6.7%
More than 4 3 5.0%
A Pearson Correlation Test was run to determine whether there was an association
between the servings of vegetables customers consumed and whether customers agreed to buy
healthier food if prices were lower. Table 3-13 lists the results of the Pearson Correlation. There
was no significance between the two variables (R = 0.34; P = 0.8).
Table 3-13. Pearson correlation test for daily vegetable consumption and purchasing of healthy
foods based on price.
Hypothesis 2e of aim 2 tested whether customers not currently receiving SNAP benefits
will state that price has a large impact on their decision to purchase fresh fruits and vegetables
relative to participants currently receiving SNAP benefits. This hypothesis was tested using
question 17 of the customer intercept survey stating “What impact do each of the following items
have on your decision to purchase fresh fruits and vegetables?”, focusing on price. The answer
choices ranged from 1 to 5, 1 being “no impact”, 3 being “medium impact”, and 5 being “large
Buy Healthier
Food if Prices
Were Lower
Daily Vegetable
Servings
Buy Healthier Food if Prices
Were Lower
Pearson Correlation 1 .034
Sig. (2-tailed) .795
N 60 60
Daily Vegetable Servings Pearson Correlation .034 1
Sig. (2-tailed) .795
N 60 60
44
impact”. Values of 2 and 4 had no labels but were included in the range of answers. As seen in
Table 3-14, the mean impact of price on decision to purchase fresh fruits and vegetables was
almost the same between the two populations, with non-SNAP recipients having a mean of 3.82
and SNAP recipients having a mean of 3.90. Both means indicate that the average impact across
both populations was between a medium impact, which had a value of 3, and a large impact,
which had a value of 5.
Table 3-14. Mean impact of price on decision to purchase fresh fruits and vegetables in SNAP
and non-SNAP recipients.
To determine whether the mean impact of price on decision to purchase fresh fruits and
vegetables differed between SNAP and non-SNAP recipients, an independent samples t-test was
performed. As seen in Table 3-15, the significance value of .791 and the 2-tailed significance of
.810 indicates that there is no significant difference between SNAP and non-SNAP recipients in
their decision to purchase fresh fruits and vegetables.
Table 3-15. Independent samples t-test for SNAP/non-SNAP recipients and decision to purchase
healthier food.
Levine's test for
Equality of
Variances
t-test for Equality of
Means
95%
Confidence
Interval of the
Difference
F Sig. t df
Sig.
(2-
tailed)
Mean
Difference
Std. Error
Difference Lower Upper
Equal
variances
assumed
0.07 0.79 -0.24 58.00 0.81 -0.08 0.35 -0.79 0.62
Equal
variances
not
assumed
-0.24 57.363 0.81 -0.08 0.35 -0.79 0.62
SNAP N Mean Std. Deviation Std. Error Mean
Price No 28 3.8214 1.33482 0.25226 Yes 32 3.9063 1.37628 0.24329
45
Aim 3: Corner Store Manager Interviews
Aim 3 was to assess the food environment within and surrounding each of the two corner
stores from the perspective of the store managers. This aim was completed by conducting
interviews using the same questions with the managers of the two stores that were recorded and
later transcribed and analyzed by focused coding (Appendix F). There were both similarities and
differences in the perspectives of the store managers on their respective stores.
Familiarity with customers:
Manager #1 of corner store #1: 65% to 70% are regular customers. 35% to 40% of my regular
customers live in this area.
Manager #2 from corner store #2: I would say 75% of the people I know, are return customers.
Relationships with customers:
Manager #1 of corner store #1: I have good relations with a lot of people in this neighborhood.
I’m here almost 13 years, so it’s my second home. You maintain relations so
people (…) instead of dropping by somewhere else, they will come down here to
have a friendly conversation.
Manager #2 of corner store #2: It’s a friendly relationship, there’s a trust between me and the
customers.
If manager has ever sold produce:
Manager #1 of corner store #1: No, not really. (…) There was a company that used to sell fruit,
like bananas and apples (…) and they stopped coming on this side. When I came
(…) there was a guy who was coming, but at the time it was a franchise. So they
were serving all the franchises, and the moment I bought it out, they stopped
coming.
Manager #2 of corner store #2: I used to carry apples and bananas at one time, but it’s like
sometimes it takes time for people to know that I carry this. And I end up
throwing it because it goes bad. I didn’t have enough patience I guess.
If SNAP clientele would want to buy healthier foods like produce:
Manager #1 of corner store #1: Early birds who are going to work, those people ask do you carry
bananas and apples. I don’t know if the food stamp people ask or not.
Manager #2 of corner store #2: The healthy foods is (are) a little bit expensive, with this clientele
they don’t want to spend that kind of money.
46
Amount of SNAP customers:
Manager #1 of corner store #1: Between 300 and 350 transactions a month or around 10-12
transactions a day are made with EBT cards.
Manager #2 of corner store #2: 25% of my (his) customers probably use EBT.
Amount of sales that come from SNAP dollars:
Manager #1 of corner store #1: Between $2600 to $3000 total a month, consistent every month
tracked by a separate SNAP transaction machine.
Manager #2 of corner store #2: Right now I can’t tell how much EBT. When I used to have the
machine, I knew it was about $3000 a month. About a year ago, SNAP stopped
giving us the machine without fees, and I did not want to pay the fees, so I
stopped keeping one. I still accept EBT, but there is just no way of tracking SNAP
sales separately by machine.
What sells the most with SNAP money:
Manager #1 of corner store #1: Most of the time we sell like a food, a milk, a bread, sometimes
people buy candy too, but we would like if they buy more groceries instead of
buying those things (candy, gum).
Manager #2 of corner store #2: Snack stuff, sodas, bacon that we sell over there, cold sandwiches
that we have, the big bags of chips, small bags of chips sell the most on SNAP
dollars.
Keeping up with the needs of customers:
Manager #1 of corner store #1: If you (customer) come in and say, “Okay, do you carry this
thing?”, I will say; I don’t, but it will be there in 48 hours. Whatever people need,
we try to keep it.
Manager #2 of corner store #2: Sometimes, customers will ask you can you get this for us and
we do it that way.
47
CHAPTER 4
DISCUSSION
The objective of this study was to determine the need and feasibility of a healthy corner
store intervention in two corner stores in Gainesville, FL. This study provided important data
describing the food environments of two corner stores in two low-income neighborhoods
residing in two different food deserts in Gainesville, FL, available to many SNAP-eligible
customers. In addition, data on the preferences and shopping habits of SNAP-eligible customers
were obtained.
Socioeconomic status is a strong predictor of health outcomes with low-income families
disproportionately affected by poor health (Lawman et al., 2015). Many low-income families
live in food deserts with poor access to the healthy foods necessary for chronic disease
prevention (Lawman et al., 2015). Interventions that focus on increasing access to healthier foods
at corner stores have been shown to increase the selection and consumption of healthy foods
such as fruits and vegetables, as seen in two corner store interventions analyzed in a review by
Joel Gittelsohn and Katherine Lee (Gittelsohn and Lee, 2013). Both the Baltimore Healthy
Corner Stores and Navajo Healthy Corner Stores interventions led to an increase in inventory
and sales of healthy foods, healthier customer cooking methods, an increase in purchasing of
healthier foods, and healthier food intentions (Gittelsohn and Lee, 2013). The Navajo Healthy
Corner Stores intervention also led to reduced BMI in customers (Gittelsohn and Lee, 2013).
Based on the success of these interventions, it is important to expand this effort into other
communities in need and document impact before and after the intervention. Therefore, the first
aim of this study was to determine the healthfulness of the food environment of the two corner
stores.
48
The first hypothesis, which stated that the selected corner stores will not have overall
healthy food environments, was proved to be true. As seen in table 2, both stores’ scores were
well below the 75 needed to be considered healthy with corner store #1 having an overall score
of 18 and corner store #2 having an overall score of 11, showing a definite need for a healthy
corner store intervention. This score was derived from the following categories CX3 Food
Availability and Marketing Survey, the Store Environment Safety and Walkability Survey, and
the Reasonable Price Collection Survey: store accepts WIC and SNAP (max score=10, meets
standards ≥ 5), store prices for fresh fruits and vegetables are <10% of county average (max
score=10, meets standards ≥ 7), store sells wide range and good quality fruit (max score=20,
meets standards ≥ 18), store sells wide range and good quality vegetables (max score=20, meets
standards ≥ 18), store sells wide range of other healthy foods (max score of 10, meets standards
≥ 8), nutrition information score (max score of 4, meets standards ≥ 3), store has limited exterior
marketing (max score of 8, meets standards ≥ 4), store has limited interior marketing (max score
of 8, meets standards ≥ 5), store located in safe areas (max score of 10, meets standards ≥ 7).
These two corner stores, consistent with some previous research on these types of stores,
mostly carry and advertise unhealthy food, beverage, and other items such as alcohol and
tobacco (Lawman et al., 2015). Simply swapping out some unhealthy food items for healthy ones
could help the stores increase their scores, by increasing their score of 0 they currently have in
the following categories: store sells wide range and good quality fruit and store sells wide range
and good quality vegetables, as well as increase their respective scores of 4 and 1 in the
following category: store sells wide range of other healthy foods. In addition, limiting unhealthy
advertisements and increasing healthy ones could help them improve their scores in the
49
following categories that looks for limited unhealthy advertisements: store has limited exterior
marketing and store has limited interior marketing.
Moreover, accepting WIC could also help them increase their current scores of 5 out of
10 in the following category: store accepts WIC and SNAP. This was the highest score seen in
any category across both stores as they each received 5 points for accepting SNAP. It could
perhaps also help them in the fresh fruit, fresh vegetable, and other healthy foods categories as
WIC foods only include: infant formula; infant and adult cereal; baby food fruits, vegetables and
meats; whole wheat bread, brown rice, soft corn and whole wheat tortillas; juice; eggs; milk;
cheese; peanut butter; dried beans or peas; fruits and vegetables; soy beverage and tofu; and
canned fish (DeWeese et al., 2016). These are the only foods that WIC recipients can purchase,
so the store is less likely to stock snack and junk foods as they cannot be purchased with WIC
dollars. This, in addition to the minimum requirements needed to be a WIC vendor (Appendix
F), as well as a SNAP vendor, could perhaps help stores achieve a higher healthfulness score, as
evidenced in DeWeese et al.’s study that found WIC stores to be healthier than SNAP stores
(DeWeese et al., 2016).
In addition, in order to accept SNAP benefits, a store must carry certain items for sale.
According to a new “final rule” by SNAP, retailers who want to continue to accept SNAP
benefits are required to have at least 84 staple food items for sale habitually (USDA, 2017). This
84 staples item rule falls under criterion A (USDA, 2016). Stores can still be SNAP retailers by
meeting Criterion B, or having 50% of the all retail sales coming from staple foods (USDA,
2017). Requirements must be met starting May 17, 2017 by new stores applying to be SNAP
stores, or by January 17, 2018 by stores that are currently authorized to accept SNAP benefits
50
(USDA, 2016). The 84 staple food items are broken down into Table 4-1 provided by the USDA
(2016):
Table 4-1. SNAP final rule requirements.
Staple Food Category Number of Varieties Number of Units/Variety Total Items/Category
Vegetables or fruits 7 3 21
Dairy products 7 3 21
Meat, poultry, or fish 7 3 21
Bread or cereals 7 3 21
After surveying what was in the store, it was evident that both of these stores did not
meet these requirements. However, this could be because of what is known as the need for access
provision of the final rule that states that if a store operates in an isolated or underserved
community and cannot meet either Criterion A nor B, then FNS is granted permission to consider
other factors when making a SNAP authorization determination (USDA, 2017). This allows
accommodations of small businesses and protects against what could be a loss of food access in
an area like a food desert (USDA, 2017). As part of a healthy corner store intervention,
researchers can help store managers meet this requirement to continue accepting SNAP benefits.
Based on the success that other studies have had increasing the selection and
consumption of fresh fruits and vegetables and other health foods by providing more access to
these foods, store managers could increase the procurement of those products that are most
desired by their customers. According to Table 7 customers preferred fruits over vegetables,
making it seem as though most customers like fruits more than vegetables even though the mean
daily servings of fruits and vegetables were very similar; 2.5 mean servings of vegetables and 2.6
51
mean servings of fruits. In addition to providing the desired foods, Gittelson and Lee discuss
including behavioral economic strategies to nudge consumers toward healthier foods without
taking away their freedom of choice (Gittelsohn and Lee, 2013). They analyzed the Navajo
Healthy Stores Intervention that coupled their already high availability of healthy foods with
healthy cooking classes and some nutrition lessons, which led to increased purchasing of
healthier foods by customers. Including a nutrition education component with cooking
demonstrations featuring fruits and vegetables would be a good component of a future healthy
corner store intervention (Gittelsohn and Lee, 2013).
In order to better understand the customers that frequent the corner stores, customer
intercept surveys were conducted at each corner store. The majority of customers surveyed were
mostly men, were parents, identified with being Black/African American, were not currently
employed, and had a high school diploma or completed a GED as their highest level of
education. The mean age was 39 years. These demographics are important when thinking about a
future healthy corner store intervention. The changes made must be culturally, educationally, and
age appropriate to cater to customers.
According to Table 5, only 53.3% of customers were currently receiving SNAP benefits.
This number is lower than the national average, which according to the latest data available, is
75% of SNAP-eligible recipients that utilize SNAP (New America & SNAP to Health, 2010).
This is an important factor because it shows the amount of people in two different low-income
food deserts not participating in a food assistance program for which they may be eligible for and
that could benefit them in many ways. Indeed, it would have been interesting to ask a question
about reasons and/or barriers to receiving SNAP benefits to get an understanding as to why these
52
people are not utilizing SNAP. This is something that could possibly be added to the RNECE
customer intercept survey as it is a tool that was developed for this type of work in SNAP-Ed.
Hypothesis 2a, which stated that SNAP-eligible customers will report that price,
convenience, appearance, and taste influence their fruit and vegetable purchasing decisions more
than healthfulness, organically grown, grown in the U.S., and locally grown, was not fully
supported. The top factors that impact fruit and vegetable purchasing decisions are taste,
appearance, healthfulness, and convenience over U.S. grown, price, locally grown, and
organically grown. A USDA analysis on 2007-2010 National Health and Nutrition Examination
Survey Data (NHANES) found that SNAP recipients, as well as their non-SNAP counterparts
(including SNAP eligible, and participants with higher income), all reported that taste is the
factor that most influences their food purchases (Mancino & Guthrie, 2014). This NHANES
report also found that in descending order after taste, these were the factors that most influenced
SNAP recipient purchases: how well the food keeps, nutrition, price, and convenience; similar to
the findings of this present study (Mancino & Guthrie, 2014). It was surprising that price did not
have as high of an impact as expected, and this is all information that would be taken into
consideration should an intervention take place at these two corner stores. Another study found
that other factors that influence fruit and vegetable consumption among SNAP recipients was
realized access, or access besides just distance from nearest store, and access or ownership of
car, especially in food insecure participants (Strome et. al, 2016). It is important to know what
influences these participants’ decision when buying fresh fruits and vegetables to be better able
to cater to their specific needs.
Hypothesis 2b, which stated that SNAP-eligible customers are more likely to agree than
disagree that they will buy healthier food products if the prices were lower and if the store had a
53
wider variety of healthy food products was supported. While customers were more likely to
agree than disagree that they would buy healthier food products if the prices were lower, price
was not more important than other factors such as U.S. grown, locally grown, and organically
grown. So while it is a factor they consider important, other factors are more important to these
customers. The customer intercept survey did not include questions asking the customers to
compare prices of the corner store to larger chain stores and supermarkets. It is possible that the
customers believe that prices of at the corner stores they frequent are more expensive than other
chain stores and supermarkets. One of the CX3 surveys, the Food Availability & Marketing –
Reasonable Price Collection Survey, required fresh fruit and vegetable price data from grocery
stores near the corner stores to compare with prices of the produce sold in the corner stores.
However, there was no fresh produce at all available at either of the corner stores. This
information, nonetheless, would be helpful to the store managers when deciding on price points
for their fresh produce should they decide to start selling in the future.
Hypothesis 2c, which stated that customers who consume the most servings of fruits daily
will be more likely to agree that they would buy healthier food products if prices were lower,
was not supported. There was no significance between these two variables. It is possible that
with a larger sample size the correlation may have been stronger and significant. Future studies
should include a larger sample of customers to determine whether this is the case, which may
increase the number of customers who report consuming more servings of fruit.
Moreover, hypothesis 2d, which stated that customers who consume the most servings of
vegetables daily will be more likely to agree that they would buy healthier food products if prices
were lower, was also not supported. There was also no significance between these two variables.
As mentioned above, increasing the sample size may result in a significant finding as it may
54
include more customers who report consuming more servings of vegetables. As price was not
considered one of the top factors affecting the purchase of fresh fruits and vegetables, customers
may not mind spending more money on healthy foods.
Hypothesis 2e, which stated that participants not currently receiving SNAP benefits will
state that price has a large impact on their decision to purchase fresh fruit and vegetables relative
to participants currently receiving SNAP benefits, was not supported. There was no difference
between the decision of SNAP and non-SNAP recipients to purchase fruits and vegetables based
on price. This is different from a USDA analysis on 2007-2010 National Health and Nutrition
Examination Survey Data (NHANES) that found that SNAP recipients put more emphasis on
price when buying food, compared to their non-SNAP counterparts, as seen in Figure 4-1. This
figure was obtained from the USDA Economic Research Service analysis of 2007-2010 National
Health and Nutrition Examination (NHANES) data, and used in an online Amber Waves
magazine article written by Mancino & Guthrie. 2014 (Mancino & Guthrie, 2014).
Figure 4-1. Factors that impact the food purchasing of SNAP customers.
55
Recently, the USDA Food and Nutrition Service released a report comparing food
purchases between SNAP households and non-SNAP households, and found only relatively
small differences between the two; their top ten food items usually purchased were the same, just
in a slightly different order (Garasky et. al, 2016). The top three foods purchased by SNAP
households were found to be: 1) meat, poultry, and seafood; 2) sweetened beverages; and 3)
vegetables (Garasky et. al, 2016). The top three foods purchased by non-SNAP households were
found to be: 1) meat, poultry, and seafood; 2) vegetables, and 3) high fat dairy/cheese (Garasky
et. al, 2016).
Aim 3 focused on the food environment and the customer from the perspective of the
store manager. Based on the manager interviews it is evident that customer trust in store
managers is important to the managers and they both reported having good relationships with
their customers. They also reported stocking food in their store based on customer demand, and
that they do not currently sell produce because of either difficulty finding vendors and produce
expiring quickly when it is not selling. A study conducted by the Public Health Law & Policy
(PHLP) in 2008 that involved interviews with store managers with corner store owners in San
Francisco had similar results (PHLP, 2009). The store managers interviewed reported having
favorable relationships with their customers and strong ties to their community, stocking their
stores based on their customers’ demands (PHLP, 2009). Moreover, in this study, one of the
managers also reported that healthy foods are expensive, and therefore their clientele was not
willing to purchase it. The PHLP had a similar finding, reporting that demand for fresh fruits and
vegetables at their stores is limited (PHLP, 2009). The researchers in this study learned that
developing a relationship with the store manager based on trust is absolutely necessary when
conducting healthy corner store work.
56
There were certain limitations to this study. There was a small sample size, with only two
corner stores being evaluated, and only a total of 30 participants at each store. Conducting
windshield surveys and food environment surveys is very time consuming and labor intensive.
Using GIS mapping to identify the correct stores can be expensive. It is not feasible to have a
large sample size of corner stores unless there is a large budget and research team. This type of
formative work that precedes a healthy corner store intervention is critical in order to assess the
current status of the store and document any positive changes and impacts, which is important
for reporting and obtaining more funding for the work. This formative work fits well within
certain existing programs and agencies such as SNAP-Ed implementing agencies and work
performed by the Department of Health and Cooperative Extension Systems.
The customer intercept surveys collected self-reported data. It is well known that surveys
that are often used in behavioral research to collect self-reported data may not always be the
most valid or reliable (Kelley et. al, 2003). Problems associated with self-reported data include
honesty, understanding, inaccurate responses, and response bias. The interviewers oftentimes
found themselves having to using simpler terms to describe a question. Some questions were also
interpreted differently by interviewers, and one question was mistakenly left out when
interviewing because it was combined with another question, and interviewers found themselves
overlooking it because it was not on its proper line. The population group was also not culturally
diverse, but that was by chance because participants were randomly recruited. This study was
also focused only on SNAP-eligible recipients. However, this was done to get a better
understanding of SNAP purchasing habits as well as get a look at how many people who are
eligible for SNAP were actually utilizing its benefits.
57
The research team learned many lessons as a result of this pilot study that will inform
future work. For future studies, it would be beneficial to evaluate the food environment within
and surrounding corner stores, and the purchasing habits of its customers, in non-food deserts as
comparison and interview SNAP eligible and non-eligible recipients to maybe see if there are
any differences. In addition, including cognitive interviews with the target population before
utilizing the customer intercept survey to ensure a proper reading level and understanding would
result in the collection of more reliable data. While inter-rater reliability (IRR) was determined
before using the CX3 to assess the food environment, IRR was not obtained for the customer
intercept survey because it was not anticipated that the researchers would have to interpret the
standard questions for different customers. Providing a more intense training for interviewers
before data collection to ensure consistent interpretation would also help with more reliable data
collection. The questions on the survey should also be better defined. For example, one
eligibility question was “do you live close to this store?’ However, there was no definition about
what close means. In the future, this question should include a limit in miles so that the customer
would know the exact definition of close. It is important to have connections in the target
community to act as a buffer between researcher and the corner store neighborhoods that the
researchers do not usually frequent. Partnering with Cooperative Extension or the local
Department of Health is a great way to plug into these relationships and earn the trust of a
community. Lastly, having a group of researchers doing the field work is important for quality
and safety, especially if women are involved in the data collection. Overall, this study found that
the food environments in and around two corner stores in two low-income areas in two different
food deserts in Alachua County, Florida, with high populations of SNAP-eligible customers were
not healthy. This shows that there is a need in these two stores for a healthy corner store
58
intervention. The data gathered from store manager interviews and customer intercept surveys,
coupled with the relationships formed between the researchers and the store managers, shed light
on attitudes and behaviors of both managers and clientele that would help make a future
intervention, should one take place, feasible. The next step is to obtain funding to implement a
healthy corner store intervention to make positive changes to these stores.
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APPENDIX A
IRB APPROVAL
60
APPENDIX B
GIS MAPS
Figure B-1. GIS map of food deserts and SNAP eligible populations.
Figure B-2. GIS map of two corner stores selected within food deserts with high SNAP eligible
populations.
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APPENDIX C
WINDSHIELD SURVEY SAMPLE
Table C-1. Sample of windshield survey data.
Corner Store 1
Google Earth Name Sunrise Food Mart
Windshield Survey Name Quick Mart
Address 3845 NE 15th Street, Gainesville, FL 32609
Food Desert Status Yes
Open at First Visit Yes
Open for Business Yes
Date of First Visit 2/2/2016
Time of First Visit 9:20 AM
Advertisement Type A lot of large alcohol ads, tobacco ads, beer ads, ice cream ad,
jumbo boiled peanuts
Location of
Advertisements Windows
Gas Station Attached Yes
Name of Gas Station
Attached Citgo
Bars on Windows or Door Not observed
Phone Number 352-336-0260
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Hours of Operation Monday-Friday 7:00 to 10:00, Saturday 8:00 to 10:00, Sunday
8:00 to 9:30
Sidewalks on Nearby
Streets Yes, on both sides of nearby street
Located near
Neighborhood Yes
Observed Schools within
<1 mile Yes
Name of Observed
Schools
One Room Middle School, Marjorie K Rawlings Center for
Fine Arts, Pre-K at Family Services Center
Observed Places of
Worship within <1 mile Yes
Observed Park/Playground
within <1 mile Yes
Name of Observed
Parks/Playgrounds
Observed Community
Garden <1 mile nearby Yes, but looked empty
Observed Social Services
<1 Yes
Name of Observed Social
Services <1 mile
Florida Department of Children and Families, Family Services
Center
Litter around Store Yes
Stray Animals No
Accepts SNAP Yes
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Additional Notes
Quite a few cars pulled up to go in store and another to get gas.
Got us wondering if people are stopping by area to get gas
because it is on busy road or are customers locals. Sign on
store indicated Citgo is locally owned. Not clear that this store
is affiliated with "Sunrise" anymore.
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APPENDIX D
CORNER STORE MANAGER INTERVIEW GUIDE1
Opening of Interview:
1. Tell me a little about how you got involved with this store? (Purpose: initiate rapport etc.)
2. Our aim for this project is to highlight and promote healthy items carried at the store and to
make it easier for shoppers to identify and purchase those products. The larger goal is to
increase healthy food access for community residents, and to identify your store as a place to get
healthy food.
a. Would you like to work with us?
b. Are there things about this project you think could work in favor of reaching that
goal?
c. Have you ever tried to reach this goal?
d. How do you think it could be accomplished?
Overall Project Performance:
1. Do you think this experience could change business for you?
a. Would you be willing to share your current sales with us? How much (estimate) do
you think your sales could grow by increasing your healthy food items?
b. Have you ever carried fresh produce? When? For how long? How much (estimate)?
c. On average, how much of your total sales are from fresh produce? What percent?
d. Do you sell healthy foods? Which ones? How much (estimate)? How long have you
been selling these?
2. Do you track sales of certain items? How?
3. How do you know if an item is selling well?
a. What items sell well?
4. Describe your customer base.
a. Who are they?
b. What do they buy?
5. What do you think about adding a Healthy Aisle in the store?
Measuring Project Tools:
1. Do you accept EBT? What are your EBT sales?
2. What has been your experience with using EBT to accept SNAP/food stamp money?
a. Are there challenges?
b. If so, what are they?
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3. Do you accept WIC? What are your WIC sales?
4. What has been your experience with using WIC?
a. Are there challenges?
b. If so, what are they?
Barriers to participation of store owners/managers:
1. Have you experienced any challenges in selling fresh produce? If so, please tell us more about it.
2. How do you supply the store with fresh produce? Who is your vendor(s)?
3. How do you decide what items to sell?
4. Do neighborhood residents ever comment about the fresh produce for sale here? (What do they
say?)
a. How do you think you could get customers to buy healthier foods?
5. What types of customers buy the fresh produce? (e.g. youth, seniors)
6. How often do people buy produce using SNAP here? (Or WIC if they don’t accept SNAP)
7. Do you think selling healthier foods at the store would increase business?
Storeowner’s willingness to participate and acceptability of the program:
1. Would you recommend other store owners to participate in a program like the one we are
proposing?
2. What would you consider when making the decision to recommend/not recommend it?
3. Would you be interested in working with other members of the community (i.e. residents, youth
groups) on this program? (ex. Painting of store, creation of marketing activities in the store)
4. If you could design this entire project yourself, how would you do it?
5. What would this program have to do to earn a grade of A, B, C, D or F by you?
Demographics:
What is the highest level of education you have obtained?
1 Some high school 2 High school diploma/GED
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3 Some college 4 Associate’s degree/Technical degree 5 Bachelor’s degree 6 Master’s degree 7 Doctoral degree What is your age? _____________ What is your gender? 1 Woman 2 Man 3 Other ______________ What do you consider to be your racial background? 1 White 2 Black, African-American, Caribbean-American 3 Asian 4 Multi-racial 5 American Indian/Alaska Native 6 Hawaiian Native/Pacific Islander 7 Other: __________________________
Do you identify as Hispanic or Latino? _____________
Adding up all the income you and other people who live with you received in 2015, what would you
say your household income was in 2015 before taxes?
1 Less than $15,000 2 $15,000 to $24,999 3 $25,000 to $34,999 4 $35,000 to $49,999 5 $50,000 to $74,999 6 $75,000 or more 7 Not sure/Prefer not to answer
67
APPENDIX E
CX3 THREE PART SURVEY
https://www.cdph.ca.gov/programs/NEOPB/Pages/CX3_OTG_FAMSurvey.aspx
https://www.cdph.ca.gov/programs/NEOPB/Pages/CX3_OTG_WalkabilitySurvey.aspx
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APPENDIX F
HEALTHY CORNER STORES BASELINE CUSTOMER INTERCEPT SURVEY
Store
Name:__________________________________Address:_______________________________
_________________________
Date:__________________________________________Time:__________________________
__________________________________
Interviewer:____________________________________________________________________
________________________________
Hi, my name is __________. The UF IFAS Extension Family Nutrition Program is interested in
increasing the availability of fruits, vegetables, and other healthy food options at this store. We
would like to learn about the food you currently purchase and other foods you would be
interested in purchasing at this location in the future.
This survey is completely voluntary and if at any time you want to end the interview or want to
skip any questions that you do not feel comfortable answering – please just let me know. If you
have any questions about this study – please feel free to contact Dr. Karla Shelnutt at 352-273-
3535 or Dr. Nicole Owens at 352-273-3551.
Eligibility Questions
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1. Are you at least 18 years of age?
Yes No (End Survey)
2. Did you purchase any food at the store today?
Yes No (End Survey)
3. Are you the primary person responsible for buying food for your family?
Yes No (End Survey)
4. How often do you shop at this store?
Daily Several times a week Once a week Every other week Once a month
Less than once a month This is the first time (End Survey)
5. Do you live close to this store?
Yes No (End Survey)
Directions for question 5: Use household size and 130% to find number to ask.
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6a. How many people are live in your household? ________
6b. Is your gross (before taxes) household monthly income under $________?
Yes No
2015-2016 GROSS MONTHLY INCOME FOR SNAP ELIGIBILITY
Household Size 130%
1 $1,276
2 $1,726
3 $2,177
4 $2,628
5 $3,078
6 $3,529
7 3,980
8 $4,430
Each additional family
member add
+$451
6c. If the respondent falls at or below 130% of the poverty line, calculated by obtaining the
information given in questions 5a and 5b, select yes below and move on to the next question. If
not, end survey.
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Yes No (End Survey)
Store Accessibility Questions
7. How did you get to the store today?
_____________________________________________________________________________
8. How long does it take you to get here (in minutes)?
____________________________________________
9a. Would you walk to this store from your house?
Yes No
9b. If no, why not? -
______________________________________________________________________________
______________________
10. Do you own a car?
Yes No
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Food Purchasing Questions
11. How much money does your family usually spend on groceries each week?
_________________________________
12. How much money do you think your family spent on fruits and vegetables each week?
_____________
13. What items do you usually buy from this store, and please be as specific as possible.
**For instance, what type of fruit? How many baked goods? (e.g., 1 carton of soymilk, 4
bananas, 3 large bags of cool ranch Doritos)
Item Comments:
Fruits
Vegetables
Milk
Cheese
Yogurt
Beverages
Bread
Pasta
Rice
Cereal
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15. What produce or other healthy foods would you purchase, if offered at this location? (Give
examples: lettuce, onions, bananas, strawberries, etc.)
______________________________________________________________________________
______________________________________________
Tortillas
Meat
Eggs
Fish
Dried beans/peas
Soy products
Baked goods
Chips/candy/snacks/ice cream
Hot food items
Beer/wine
Cigarettes
Lottery tickets
Other:
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______________________________________________________________________________
______________________________________________
______________________________________________________________________________
______________________________________________
16. Where do you buy most of your food:
Grocery store or supermarket (e.g., Publix) Large store (e.g., Walmart)
Small market (without gas station) ) Convenience store (with gas station)
Drug store (e.g., CVS) Dollar store Farmers’ market Roadside stand
Garden Food pantry, church, or community center Other – Please specify
-
______________________________________________________________________________
____________________________________
17. “What impact do each of the following items have on your decision to purchase fresh fruit
and vegetables?”
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Item
1
No
Impact
2
3
Medium
Impact
4
5
Large
Impact
Appearance
Taste
Price
Healthfulness
Convenience
Organically grown
U.S. grown
Locally grown
Other:
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How strongly do you agree or disagree with the following statements about buying healthier food
at this store?
Item
1
Strongly
Disagree
2
Disagree
3
Neither
Agree/Nor
disagree
4
Agree
5
Strongly
Agree
I would buy healthier food
products at this store if prices were
lower.
I would buy healthier food
products at this store if the quality
of the food was better.
I would buy healthier food
products at this store if the
customer service at the store was
better.
I would buy healthier food
products at this store if I knew the
food met food safety guidelines.
I would buy healthier food
products at this store if the store’s
location was safer.
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19. Is there anything I haven’t listed that could be done to help you buy healthier food options at
this store?
I would buy healthier food
products at this store if the store
was cleaner.
I would buy healthier food
products at this store if the store
had longer store hours.
I would buy healthier food
products at this store if the store
had a wider variety of healthy food
products.
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20. I am going to read a few more statements regarding this store. For each statement please tell
me if you strongly agree, disagree, neither agree nor disagree, agree or strongly agree?
Item
1
Strongly
Disagree
2
Disagree
3
Neither
Agree/Nor
disagree
4
Agree
5
Strongly
Agree
This looks like the type of store
where I would like to shop for
produce.
Compared to other stores, produce
at this store has a higher price.
The interior of this store gives the
shopper the feeling that it is a
healthy place to shop.
It is easy to find healthy foods
inside this store.
There are enough healthy food
products to choose from in this
store.
The people working at this store
are knowledgeable on healthy
foods sold at the store.
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Food Consumption Questions
21. On a typical day, how many servings of vegetables do you eat? (1 serving = 1 cup cooked
broccoli)
None 1 2 3 4 More than 4
22. On a typical day, how many servings of fruits (not including juice) do you eat? (1 serving = 1
medium apple)
None 1 2 3 4 More than 4
Food Assistance Questions
23. Do you currently receive SNAP benefits:
Yes No
24. Have you received SNAP benefits in the last 12 months?
Yes No
I buy most of my food from this
store.
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25. Have you ever used your SNAP benefits at this store?
Yes No
26. Do you receive WIC benefits:
Yes No
Demographics
27. What is your age? __________________
28. What is your gender?
Woman Man
28a. Are you a parent?
Yes No
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28b. If a parent, what are the ages of your children?
______________________________________________________
28c. Do your children live with you?
Yes No
29a. Do you have pets?
Yes No
29b. If yes, how many pets and what types of pets?
____________________________________________________________________-
______________________________________________
29c. Do you get your pet food at this store? If not, where do you get it?
____________________________________________________________________-
______________________________________________
29d. Would you benefit from food assistance for your pets?
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____________________________________________________________________-
______________________________________________
30. Are you currently employed?
Yes No
31. What is the highest level of education you have obtained?
Some high school High school diploma/GED
Some college Associate’s degree/Technical degree Bachelor’s degree
Master’s degree Doctoral degree
32. Are you Hispanic or Latino?
Yes No
33. Of the following choices, which race do you most identify with?
American Indian or Alaska Native Asian
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Black or African American Native Hawaiian or Other Pacific Islander
White Multi-racial
Visual Data
34. Can we take a picture of the items you purchased today?
Yes
No
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APPENDIX G
WIC STORE MINIMUM STOCKING REQUIREMENTS
IMAGE ON NEXT PAGE
85
EFFECTIVE OCTOBER 17, 2013
MINIMUM STOCKING REQUIREMENTS
Refer to the WIC Authorized Food List Shopping Guide, March 28, 2016, for product specifications and WIC Bulletin Regulation 71100 for regulation detail
FOOD CATEGORY: BOTTLED JUICE AND CONCENTRATE JUICE (8) 64-ounce shelf-stable
AND (10) 11.5 or 12-ounce frozen concentrate
FOOD CATEGORY: INFANT CEREAL (2) 16-ounce
AND (2) 8-ounce containers
FOOD CATEGORY: BREAKFAST CEREAL At least (144) total ounces, of any (4) different types or brands of authorized cereal. Of the total ounces (1) type must be of (12) ounce size box and (1) type must be of (18) ounce box. Two of the types or brands must be listed as whole grain cereals on the WIC Authorized Food List and Shopping Guide.
FOOD CATEGORY: INFANT FORMULA Authorized milk-based powdered formula……………………(20) cans
(10) on the shelf, and (10) on the premises
FOOD CATEGORY: CANNED FISH
Tuna……………………………….(12) 5-ounce cans OR
Sardines…………………………..(4) 15-ounce cans OR
Salmon……………………………(12) 5-ounce cans OR (10) 6-ounce cans
OR (4) 14.75-ounce cans
FOOD CATEGORY: INFANT FRUITS AND VEGETABLES
(56) 4-ounce containers OR
(64) 3.5-ounce containers
FOOD CATEGORY: INFANT MEATS (62) 2.5-ounce containers:
(31) on the shelf, and (31) on the premises
FOOD CATEGORY: CHEESE (4) 1-pound packages
FOOD CATEGORY: PEANUT BUTTER (4) 16 to 18-ounce containers
FOOD CATEGORY: DRY BEANS, PEAS OR LENTILS (6) Pounds of any 1-pound packages or
(6) pounds bulk
FOOD CATEGORY: FRESH BANANAS Fresh only (8) yellow bananas
FOOD CATEGORY: EGGS (4) dozens
FOOD CATEGORY: WHOLE GRAIN
100% whole wheat bread….(2) 1-pound loaves AND
Soft corn tortillas………..(2) 1 pound packages AND
Oatmeal………………….(2) 1 pound packages or 2 pounds in bulk
OR
Brown rice……………(2) 1 pound packages of or 2 pounds in bulk
FOOD CATEGORY: MILK
Whole…………………………………...(6) one gallon AND
2% reduced fat or 1% low fat or nonfat………….(14) one gallon (10) on the shelf
(4) on the premises AND
(2) half-gallon
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FOOD CATEGORY: FRUITS AND VEGETABLES Fresh:.…………………..$32 worth of a combination of 5 varieties of
fruits and 5 varieties of vegetables AND
Frozen:………………….$32 worth of a combination of 3 varieties of fruits and 3 varieties of vegetables
AND Canned:………………...$32 worth of a combination of 3 varieties of
fruits and 3 varieties of vegetables
03/28/2016
Page 1 of 1
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BIOGRAPHICAL SKETCH
Vanessa received a bachelor’s degree in 2014 in Dietetics and Nutrition. In 2015, she
went on to pursue her master’s degree in Food Science and Human Nutrition, with a
concentration in Nutritional sciences. She received this master’s degree in the spring of 2017.
