Bringing Healthy Retail to Urban “Food Swamps”: a Case Study of CBPR-Informed Policy and Neighborhood Change in San Francisco

Abstract

In urban “food swamps” like San Francisco’s Tenderloin, the absence of full-service grocery stores and plethora of corner stores saturated with tobacco, alcohol, and processed food contribute to high rates of chronic disease. We explore the genesis of the Tenderloin Healthy Corner Store Coalition, its relationship with health department and academic partners, and its contributions to the passage and implementation of a healthy retail ordinance through community-based participatory research (CBPR), capacity building, and advocacy. The healthy retail ordinance incentivizes small stores to increase space for healthy foods and decrease tobacco and alcohol availability. Through Yin’s multi-method case study analysis, we examined the partnership’s processes and contributions to the ordinance within the framework of Kingdon’s three-stage policymaking model. We also assessed preliminary outcomes of the ordinance, including a 35% increase in produce sales and moderate declines in tobacco sales in the first four stores participating in the Tenderloin, as well as a “ripple effect,” through which non-participating stores also improved their retail environments. Despite challenges, CBPR partnerships led by a strong community coalition concerned with bedrock issues like food justice and neighborhood inequities in tobacco exposure may represent an important avenue for health equity-focused research and its translation into practice.

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Acknowledgements

The authors gratefully acknowledge our partners at the Tenderloin Healthy Corner Store Coalition and, particularly, the Food Justice Leaders, without whom this work would not have been possible. We thank, as well, the Tenderloin Neighborhood Development Corporation, the San Francisco Department of Public Health, the SF Office of Economic and Workforce Development, and Sutti & Associates. Particular thanks are due to Gladis Chavez, Susana Hennessey-Lavery, Norval Hickman, Phillip Gardiner, Sandra Witt, Judi Larsen, and Anthony Iton for their belief in and support of this work.

Funding Information

This research was supported by the University of California Tobacco-Related Disease Research Program (TRDRP) grant #23AT-0008 and a gift from The California Endowment. JF’s work was supported in part by the American Heart Association grant #14POST20140055 and the National Institute Of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number #K01DK113068. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Jennifer Falbe.

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Minkler, M., Estrada, J., Thayer, R. et al. Bringing Healthy Retail to Urban “Food Swamps”: a Case Study of CBPR-Informed Policy and Neighborhood Change in San Francisco. J Urban Health 95, 850–858 (2018). https://doi.org/10.1007/s11524-018-0234-x

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Keywords

  • Tobacco
  • Community-based participatory research
  • Health inequities
  • Healthy retail
  • Corner stores
  • Small stores
  • Municipal health policy
  • Nutrition
  • Food swamp
  • Food environment