Fruits and Vegetables in South Phoenix

1. Fruits and Vegetables in South Phoenix Kai-Ning Khor, MPH June 12, 2008

2. Overview • Learning Objectives • Background • Survey Methods • Data Analysis Methods • Results • Conclusion • Discussion • Challenges in survey methods • Challenges in data analysis methods • Future

3. Learning Objectives • Participants will be able to: • Describe the project Arizona’s Healthy Weight Action Learning Collaborative completed. • Recognize the lessons Arizona’s team learned regarding the NEMS. • Identify ways the fruit and vegetable availability will be affected with the new WIC food package

4. Background • Nutrition Environment Measures Survey (NEMS) • Observational measures of community nutrition environments in stores • Measures focus on availability of healthful choices, prices and quality • Goal: To determine whether the availability and quality of healthy foods in South Phoenix affects the BMIs of WIC participants in that area

5. Background: South Phoenix • Area≈ 80 square miles • From 40th Street to 35th Avenue, and from Buckeye to Baseline • Population has: • Limited resources, low socioeconomic status • Low levels of educational attainment • Health disparities • High levels of the feto-infant mortality Source: Pregnancy Risk Assessment Monitoring System (PRAMS) survey and Perinatal Periods of Risks (PPOR) analyses, 2004

6. Purpose of survey was to assess whether healthy options of various foods were available, their quality, and their costs Foods included: Milk Fruit Vegetables Ground beef Hot dogs Frozen dinners Survey Methods • Baked goods • Beverages • Bread • Baked chips • Cereal • Tortillas

7. Survey Methods, continued… • Two students/volunteers surveyed each store 1-2 times separately • 5 groups, 2 surveyors/group • Permission obtained from managers • Survey period: August-November 2007 • 76 stores surveyed, 238 surveys total • 66 convenient stores, 10 grocery stores • 17 WIC stores, 59 non-WIC stores

8. Data Analysis Methods • Two independent sample T tests • Levene’s Tests for Equality of Variances • Geographic Information Systems (ArcGIS v 9.2)

9. Results: Pre-Pregnancy BMI of WIC women in South Phoenix • The range for average BMI by store was 25.7 to 26.5.   • Fairly homogeneous population

11. Results: Grocery vs. Convenience Stores • On average, grocery stores offered a wider variety of fruits than convenient stores

12. Results: Grocery vs. Convenience Stores • On average, grocery stores offered a wider variety of vegetables than convenient stores

13. Results: Grocery vs. Convenience Stores • On average, grocery stores offered better quality fruits and vegetables than convenient stores

14. Results: WIC vs. Non-WIC Stores • On average, WIC stores offered a wider variety of fruits than non-WIC stores

15. Results: WIC vs. Non-WIC Stores • On average, WIC stores offered a wider variety of vegetables than non-WIC stores

16. Results: WIC vs. Non-WIC Stores • On average, WIC stores offered better quality fruits and vegetables than non-WIC stores

17. Conclusions • BMIs of WIC participants in surveyed South Phoenix area fairly homogeneous • Fruit and vegetable availability and quality differed throughout surveyed area • Availability and quality of fruits and vegetables in South Phoenix did not affect the BMIs of WIC participants in that area • Possible confounding factors: consumption, foods actually purchased, transportation, other sources of fruits and vegetables in area (farms)

18. Conclusions, continued… • New WIC food package would help to increase the varieties of fruits and vegetables available, their quality, and their affordability to WIC participants

19. Challenges in survey methods • Information different between grocery and convenience stores • Possibly use different surveys for each • Consistent training for surveyors

20. Challenges in analysis methods • Analyzing qualitative data • Performing inter-rater reliability and test-retest reliability tests for validity • Not feasible because of: • Inconsistencies in data collection • Number of surveys per store varied • Inconsistencies in data entry

21. Future • More training by Emory University • Overlay population density map to assess where stores are and where residents live • Enhance and expand survey • Survey area with similar demographic population to make comparisons • Include more grocery stores and convenience stores • Include restaurants in area

22. Future, continued… • Survey residents for consumption and purchase behaviors before and after new WIC food package is implemented • Evaluate whether the new WIC food package would help to increase sales • Assess whether sales differ between WIC and non-WIC stores

23. Questions/Comments? Kai-Ning Khor, MPH Chronic Disease Epidemiologist E-mail: khork@azdhs.gov Phone: (602) 542-2850 Fax: (602) 542-0512