Formative Evaluation to Increase Availability of Healthy Snacks and Beverages in Stores Near Schools in Two Rural Oregon Counties, 2013.

INTRODUCTION: Children living in rural areas are at greater risk for obesity than their urban counterparts. Differences in healthy food access may contribute to this disparity. Most healthy food access initiatives target stores in urban areas. We conducted a formative evaluation to increase availability of healthy snacks and beverages in food stores near schools in rural Oregon. METHODS: We assessed availability of healthy snacks and beverages in food stores (n = 15) using the SNACZ (Students Now Advocating to Create Healthy Snacking Zones) checklist and conducted in-depth interviews with food store owners (n = 6). Frequency distributions were computed for SNACZ checklist items, and interview data were analyzed by using applied thematic analysis. RESULTS: Overall, availability of healthy snacks and beverages in study communities was low. Four interrelated themes regarding store owner perspectives on stocking healthy snacks and beverages emerged from the interviews: customer demand, space constraints, vendor influence, and perishability. CONCLUSION: In addition to working with food store owners, efforts to increase availability of healthy snacks and beverages in rural areas should engage young people, food buyers (eg, schools), and vendors as stakeholders for identifying strategies to increase demand for and availability of these items. Further research will be needed to determine which strategies or combinations of strategies are feasible to implement in the study communities.

Inter-rater reliability of a food store checklist to assess availability of healthier alternatives to the energy-dense snacks and beverages commonly consumed by children.

BACKGROUND: Food stores have gained attention as potential intervention targets for improving children's eating habits. There is a need for valid and reliable instruments to evaluate changes in food store snack and beverage availability secondary to intervention. The aim of this study was to develop a valid, reliable, and resource-efficient instrument to evaluate the healthfulness of food store environments faced by children. METHODS: The SNACZ food store checklist was developed to assess availability of healthier alternatives to the energy-dense snacks and beverages commonly consumed by children. After pretesting, two trained observers independently assessed the availability of 48 snack and beverage items in 50 food stores located near elementary and middle schools in Portland, Oregon, over a 2-week period in summer 2012. Inter-rater reliability was calculated using the kappa statistic. RESULTS: Overall, the instrument had mostly high inter-rater reliability. Seventy-three percent of items assessed had almost perfect or substantial reliability. Two items had moderate reliability (0.41-0.60), and no items had a reliability score less than 0.41. Eleven items occurred too infrequently to generate a kappa score. CONCLUSION: The SNACZ food store checklist is a first-step toward developing a valid and reliable tool to evaluate the healthfulness of food store environments faced by children. The tool can be used to compare availability of healthier snack and beverage alternatives across communities and measure change secondary to intervention. As a wider variety of healthier snack and beverage alternatives become available in food stores, the checklist should be updated.