Snacking in Children: The Role of Urban Corner Stores
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Snacking in Children: The Role of Urban Corner
Stores
WHAT’S KNOWN ON THIS SUBJECT: Childhood obesity is higher AUTHORS: Kelley E. Borradaile, PhD,a Sandy Sherman,
among ethnic minorities. The disparate prevalence of urban EdD,b Stephanie S. Vander Veur, MPH,a Tara McCoy, MEd,a
corner stores in low-income and high-minority communities could Brianna Sandoval, MSSP,b Joan Nachmani, MS, CNS, SNS,c
affect the quantity and quality of energy intake among youth at highest Allison Karpyn, PhD,b and Gary D. Foster, PhDa
aTemple University, Center for Obesity Research and Education,
risk for obesity.
Philadelphia, Pennsylvania; bThe Food Trust, Philadelphia,
Pennsylvania; and cSchool District of Philadelphia, Philadelphia,
WHAT THIS STUDY ADDS: Purchases made in corner stores Pennsylvania
contribute significantly to energy intake among urban school
KEY WORDS
children. Children shop at corner stores frequently and purchase snacking, urban, dietary quality, obesity, purchases
energy-dense, low-nutritive foods and beverages that average more
www.pediatrics.org/cgi/doi/10.1542/peds.2009-0964
than 1497.7 kJ (356.6 kcal) per purchase.
doi:10.1542/peds.2009-0964
Accepted for publication Jun 5, 2009
Address correspondence to Kelley E. Borradaile, PhD, Center for
Obesity Research and Education, Temple University, 3223 N
abstract Broad St, Suite 175, Philadelphia, PA 19140. E-mail:
borradak@temple.edu
OBJECTIVE: Childhood obesity is higher among ethnic minorities. One PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
reason may be the limited access to affordable, healthy options. The Copyright © 2009 by the American Academy of Pediatrics
disparate prevalence of urban corner stores in low-income and high- FINANCIAL DISCLOSURE: Dr. Foster serves on the scientific
minority communities has been well documented. There are no data, advisory board for Con Agra Foods and has served as a
however, on what children purchase in these environments before and consultant to General Mills. He has also received funding for
research grants on the role of almonds (Almond Board of
after school. The purpose of this study was to document the nature of California) and diet beverages (Coca Cola Company) on adult
children’s purchases in corner stores proximal to their schools. obesity.
METHODS: This was an observational study from January to June 2008.
Participants were children in grades 4 through 6 from 10 urban K-8
schools with ⱖ50% of students eligible for free or reduced-price
meals. A total of 833 intercept surveys of children’s purchases were
conducted outside 24 corner stores before and after school. The main
outcomes were type and energy content of items purchased.
RESULTS: The most frequently purchased items were energy-dense,
low-nutritive foods and beverages, such as chips, candy, and sugar-
sweetened beverages. Students spent $1.07 ⫾ 0.93 on 2.1 ⫾ 1.3 items
(1.6 ⫾ 1.1 food items and 0.5 ⫾ 0.6 beverage items) per purchase. The
total number of calories purchased per trip was 1497.7 ⫾ 1219.3 kJ
(356.6 ⫾ 290.3 kcal). More calories came from foods than from
beverages.
CONCLUSIONS: Purchases made in corner stores contribute signifi-
cantly to energy intake among urban school children. Obesity preven-
tion efforts, as well as broader efforts to enhance dietary quality
among children in urban settings, should include corner store environ-
ments proximal to schools. Pediatrics 2009;124:1292–1297
1292 BORRADAILE et al
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Nearly one third (31.9%) of children The purpose of this study was to quan- were eligible for free or reduced-price
are overweight or obese (ⱖthe 85th tify the contribution of corner store meals and children in grades 4
percentile of BMI for age) and 16.3% purchases to energy intake among through 6 because of the previously
are obese (ⱖthe 95th percentile).1 fourth- to sixth-grade children. Given documented high risk for obesity
These rates are even higher among the disproportionately high rates of (14.9% incidence rate of overweight
children of ethnic minorities who live obesity among children in lower socio- over a 2-year period).2 The study was
in low socioeconomic environments, economic status groups,11 the study approved by Temple University’s insti-
approximating 50% who are at least was conducted in corner stores proxi- tutional review board.
overweight and 25% who are obese.2,3 mal to schools that had at least 50% of
A potential explanation for the higher children eligible for federally subsi- Outcomes
prevalence may be the limited access dized, free or reduced-price meals.
Corner Store Purchases
to healthy foods.
METHODS All data were collected during January
Corner stores, a part of the urban to June 2008. During school, partici-
landscape, occupy relatively small Study Design
pants were told that they may be asked
square footage (ⱕ200 sq ft) and con- Schools questions about their corner store
centrate on high-profit, low-nutritive purchases (intercept survey) by re-
Eligibility criteria for schools were 1)
items (eg, packaged foods including search staff in identifiable clothing
kindergarten through eighth grade, 2)
candy, chips, pretzels, ice creams, bev- (shirts and jackets with the study’s
ⱖ50% of students eligible for free or
erages).4–6 Corner stores can be found logo) outside corner stores. Data on
reduced-price meals, and 3) proximity
within or on the corners of urban res- corner store purchases were col-
(ⱕ4 urban blocks) to ⱖ2 corner
idential blocks and may be located lected immediately outside the 24 cor-
stores. Using a random-number gen-
within a few hundred feet of a school. ner stores as children left the store
erator, schools were randomly se-
In Philadelphia, there are multiple before school in the morning and after
lected from among the 15 eligible in
stores within a 4-block radius of a dismissal in the afternoon. Staff asked
Philadelphia, Pennsylvania. A total of
given school. These stores also serve children what they purchased and re-
12 schools were approached; 2 de-
as a convenience store for families in quested to look into their bags to
clined, and 10 were enrolled. The av-
communities where there are no su- record each item’s name, product
erage free or reduced-price meal el-
permarkets. The higher prevalence of type, and weight or size. Research staff
igibility rate across the 10 schools
corner stores in low-income and high- was 82.1 ⫾ 7.4%. also asked students a series of ques-
minority communities has been well tions, including how much money they
documented.6,7 This disparity could af- Stores just spent and how frequently (per day
fect both the quantity and quality of en- Corner stores proximal to the 10 and per week) they shop at corner
ergy intake among youth at highest schools were identified by students stores. Each intercept lasted ⬃1.5
risk for obesity. through surveys administered during minutes. Study staff assessed corner
Snacking has increased across all class. In addition, school staff (eg, ad- store shopping behavior an average of
age groups,8,9 and the contribution of ministrators, crossing guards) and 18.2 ⫾ 5.4 times per school community
snacking to daily calories increased by store owners identified stores as be- during a 5-month period for a total of
30% between 1977 and 1996.10 Accord- ing frequented regularly by school 182 observations (⬃7.6 visits per
ing to recent estimates, snacking ac- children before or after school. Each store). Approximately half of the ob-
counts for ⬃25% of total energy intake school had between 2 and 4 stores servations were conducted before
in children.10 Purchases from corner within its 4-block radius for a total of school, and half were conducted after
stores among urban youth before and 24 stores. school. Each observation consisted of
after school may contribute signifi- 1 to 2 research staff and was ⬃30 to 45
cantly to snacking and overall energy Participants minutes in duration.
intake. Although several have called Participants for this study were any
for obesity prevention efforts to be fo- students who were from these 10 Nutrition Information
cused on corner stores,4–6 we are not schools in grades 4 through 6 and Nutrition information was obtained
aware of any data on children’s food making purchases at corner stores be- for all items (prepackaged and pre-
and beverage purchases in these envi- fore or after school. We focused on pared) purchased by children at the
ronments before and after school. schools with ⱖ50% of students who corner stores. In the case of pack-
PEDIATRICS Volume 124, Number 5, November 2009 1293
Downloaded from www.aappublications.org/news by guest on March 14, 2021aged items, nutrition information TABLE 1 School Characteristics TABLE 2 Purchase Characteristics
was obtained by purchasing an iden- Characteristic Mean ⫾ SD Characteristic Mean ⫾ SD
tical item in the corner store and School size (No. of students) 515.0 ⫾ 111.7 Total amount spent, $ 1.07 ⫾ 0.93
Race/ethnicity (%) Total No. of items 2.1 ⫾ 1.3
looking at the nutrition label. When Black 54.0 ⫾ 37.8 Food items 1.6 ⫾ 1.1
items were no longer available for White 11.6 ⫾ 25.5 Beverage items 0.5 ⫾ 0.6
purchase or no nutrition label was Asian 10.8 ⫾ 20.9 Calories, kJ (kcal) 1497.7 ⫾ 1219.3kJ
Hispanic/Latino 22.9 ⫾ 29.0 (356.6 ⫾ 290.3 kcal)
present, staff contacted the manu- Other 0.7 ⫾ 0.9 Calories from fat, % 29.2 ⫾ 22.8
facturer or distributor directly for Free or reduced-price meal 82.1 ⫾ 7.4 Fat, g 13.5 ⫾ 15.5
nutrition information (via Web site or eligibility Saturated fat, g 3.8 ⫾ 5.4
Source: School District of Philadelphia (2006 –2007). N ⫽ Calories from protein, % 5.2 ⫾ 5.6
telephone). When information was Protein, g 6.1 ⫾ 10.9
10 K-8 schools.
not available directly from the man- Calories from 65.6 ⫾ 30.0
ufacturer, data were obtained from carbohydrates, %
Carbohydrates, g 54.6 ⫾ 45.1
onlinefooddatabasessuchasCalorie- RESULTS Sugars, g 31.8 ⫾ 35.8
King.12 After exhausting these meth- Dietary fiber, g 1.2 ⫾ 1.6
School Characteristics
ods, there were still a small number Sodium, mg 535.8 ⫾ 777.2
of items (n ⫽ 22 [6.2%]) that were no School characteristics are shown in N ⫽ 833 purchases.
longer available for purchase, the Table 1. More than 80% (82.1 ⫾ 7.4) of
students in these 10 schools were eli-
manufacturer could not be con- Food Items
gible for free/reduced-price meals.
tacted, and they were not listed in
Most students in the schools were Food items accounted for 81.3% of
databases such as CalorieKing. For
black (54.0%) or Hispanic/Latino all items purchased. Chips were the
this small number of items, nutrition
(22.9%). most frequently purchased item (33.5%
data were obtained on comparable
of all items purchased). The most popu-
items (similar in size, weight, and ingre- Store Characteristics lar chips purchased were 1-oz cheese
dients). These items were typically from On average, stores were 172.9 ⫾ 70.4 flavored corn or potato chips at 588.0 to
local vendors (eg, Day’s Soda) and had a square feet and contained 2.1 ⫾ 0.5 714.0 kJ/oz (140 to 170 kcal/oz; eg, Chee-
very small distribution. aisles. Each store had only 1 cash reg- tos, Doritos). Candy (21.3%) was the sec-
In the case of prepared items (eg, ister with 2.4 ⫾ 1.0 employees working ond most frequently purchased category
sandwiches), staff purchased the iden- at a given time. These stores sell pre- of items. The most popular candies were
tical sandwiches as individual compo- dominately packaged food. Typically, items such as Peanut Chews and Sour
nents (eg, bread, deli meat, condi- the only fresh foods that are sold are Patch Kids. Prepared items were among
ments) with the help of store staff to be prepared sandwiches. the least frequently purchased items
sure that the typical amounts and (6.9%) and included pizza, sandwiches,
Corner Store Purchases
types of items were included. The com- egg rolls, and chicken wings.
ponents’ brand and weight were re- A total of 833 intercept surveys were
collected from January to June 2008. Beverages Items
corded by staff and similar methods
(described already) were used to ob- The total number of calories per pur- Beverages accounted for 18.7% of all
chase was 1497.7 ⫾ 1219.3 kJ (356.6 ⫾ purchases. Figure 2 displays the
tain nutrition information for the pre-
290.3 kcal). On average, students spent breakdown of beverage purchases by
pared item, by using Nutritionist Pro
$1.07 ⫾ 0.93 on 2.1 ⫾ 1.3 items (1.6 ⫾ type, which include soda, diet soda, ar-
software.13
1.1 food items and 0.5 ⫾ 0.6 beverage tificially flavored fruit drinks, 100%
items) per purchase. Purchase char- fruit juice, water (water and nonsweet-
Statistical Analysis
acteristics are shown in Table 2. The ened sparkling), ice tea/lemonade,
Descriptive statistics (means and SDs percentage of calories from fat was and other (eg, energy drink, chocolate
for continuous variables and percent- 29.2 ⫾ 22.8%, from protein was 5.2 ⫾ flavored drink). Artificially flavored
ages for categorical variables) were 5.6%, and from carbohydrates was “fruit” drinks were the most popular
analyzed and reported for each vari- 65.6 ⫾ 30.0%. Figure 1 displays the fre- beverages purchased, accounting for
able of interest. Differences in items quency of purchases broken down by almost half of all beverage purchases
purchased by time of day (before item category (beverage, candy, gum, (45.7%). The most popular item (bever-
school and after school) were ana- chips, frozen treats, pastries, and pre- age or food) purchased was a sugar-
lyzed by using 2 tests. pared items). sweetened, artificially flavored fruit
1294 BORRADAILE et al
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Gum, 7.9% followed by candy (23.9%), beverages
Beverages, 18.7% (18.5%), gum (10.4%), prepared items
Prepared foods, 6.9%
(8.4%), pastries (4.2%), and frozen
treats (1.7%). More candy and gum
Pastries, 5.3% were purchased in the morning be-
fore school than in the afternoon
(P ⬍ .0001).
Ice cream, 6.4%
Afternoon Shopping Behavior
Candy, 21.3% A little less than half (45.9%) of all in-
tercepts were collected in the after-
noon. During this time, children spent
$0.94 ⫾ 0.86 and purchased 1.8 ⫾ 1.0
items (1.4 ⫾ 1.0 food items and 0.4 ⫾
Chips, 33.5% 0.5 beverage items). In the afternoon,
FIGURE 1 children purchased 1331.8 ⫾ 1062.6 kJ
Total items purchased by type of item. Data were obtained from all intercept surveys (N ⫽ 833) (317.1 ⫾ 253.0 kcal), 27.0 ⫾ 23.3%
conducted before and after school. Categories included chips (eg, corn and tortilla chips), beverages of which came from fat. The most pop-
(eg, sugar-sweetened artificially flavored fruit drink, soda), candy (eg, candy bars, gum), frozen items
(eg, water ice/Italian ice, popsicles), prepared items (eg, sandwiches, egg rolls, chicken wings), and ular category of item was chips
pastries (eg, cupcakes). (34.4%), followed by beverages
(19.1%), candy (17.1%), frozen treats
(14.0%), pastries (7.3%), gum (3.8%),
drink called a “Hug,” or “Barrel,” which During this time, children spent and prepared items (4.3%). More fro-
comes in either 8 or 16 oz at 147 kJ/8 fl $1.19 ⫾ 0.97 and purchased 2.3 ⫾ 1.4 zen treats were purchased in the after-
oz (35 kcal/8 fl oz). Sugar-sweetened items (1.8 ⫾ 1.2 food items and 0.5 ⫾ noon than in the morning (P ⬍ .0001).
beverages accounted for ⬎88% of all 0.6 beverage items). In the morning, There were no differences between
beverages purchased. children purchased 1638.4 ⫾ 1322.6 kJ morning and afternoon purchases on
Morning Shopping Behavior (390.1 ⫾ 314.9 kcal), 30.6 ⫾ 22.3% of any variable except for candy, gum,
Approximately half (54.1%) of all inter- which came from fat. The most popular and frozen treats. More candy was
cepts were collected in the morning. category of item was chips (32.9%), purchased in the morning, and more
frozen treats were purchased in the
afternoon (P ⬍ .0001).
Other, 3.1%
Water, 10.9% Frequency of Shopping
Soda, 26.5% More than half (53.3%) of the partici-
pants reported shopping at corner
Iced tea/lemonade, stores every day, and another 21.9%
12.1% reported shopping 2 to 4 times per
week. Approximately 42% of partici-
100% Fruit juice, pants reported that they usually shop
Diet soda, 0.7%
1.0% at a corner store 2 times per day, and
53.9% reported shopping once a day.
The most frequent shoppers, those
who shop 2 times per day, 5 days/wk,
represented 28.8% of the sample.
Artificially flavored fruit drink, 45.7%
DISCUSSION
FIGURE 2 There are several principal findings
Total beverage items purchased by type of beverage. Data were obtained from all intercept surveys from this study. First, urban children
that contained a beverage item (N ⫽ 363) conducted before and after school. Categories included
soda, diet soda, ice tea/lemonade, artificially flavored fruit drink, water, 100% fruit juice, and other who were in grades 4 through 6 and
(eg, energy drink, smoothies, chocolate flavored drinks). shopped at corner stores before or
PEDIATRICS Volume 124, Number 5, November 2009 1295
Downloaded from www.aappublications.org/news by guest on March 14, 2021after school purchased, on average, kcal]) for regular (630 kJ [150 kcal]) chased and obtained its relevant nutri-
1495.2 kJ (356 kcal) per purchase. For potato chips. Sugar-sweetened bever- tion information. There are also sev-
the most frequent shoppers, those ages accounted for ⬃16% of kilocalo- eral limitations. First, the shopping
who shopped both before and after ries per purchase, which is consistent behavior of children may have been
school, 5 times per week, this would with previous estimates of 10% to 15% subject to demand characteristics of
amount to 2990.4 kJ/day (712 kcal/ of intake.18 An intervention that re- identifiable staff positioned outside
day), or 14 952 kJ/wk (3560 kcal/wk). placed sugar-sweetened beverages corner stores. In addition, children
Even the less frequent shoppers with water has the potential to de- may shop at multiple corner stores for
(13.3% of the sample), those who crease caloric purchases by ⬃252 kJ different items (eg, 1 store for candy, 1
shopped once per day 3 days/wk, pur- (⬃60 cal) per purchase. For a frequent store for chips). These effects, how-
chased 1495.2 kJ/day (356 kcal/day) shopper, this amounts to ⬃504 kJ/day ever, would likely result in an underes-
and ⬎4200 kJ/wk (⬎1000 kcal/wk) (⬃120 kcal/day), or ⬃2520 kJ/wk timation of energy intake rather than
from corner stores. (⬃600 kcal/wk). an overestimation. Second, it was
The most frequently purchased items These small changes could yield a sig- necessary for staff to be physically
are energy-dense, low-nutritive items nificant impact on the quantity and present at stores to collect data. The
(eg, sugar-sweetened and artificially quality of children’s intake. For exam- large number of stores (N ⫽ 24) pre-
flavored drinks, nacho cheese flavored ple, previous research suggested that cluded staff presence at every store
chips, candy). Previous research dem- decreasing energy intake by 462 to 693 twice a day. Third, our sample was re-
onstrated the deleterious effects (both kJ/day (110 –165 kcal/day) may coun- stricted to fourth- to sixth-graders and
immediate and long-term) of poor- terbalance among children the energy data were collected during the school
quality nutrition on health (eg, obesity, gap that is responsible for body weight year, so the data should not be gener-
dental caries),14 as well as on behavior increases from 1988 to 1994 and from alized to other age groups or times of
and cognition in children.15,16 Of addi- 1999 to 2002.19 These alternative foods, year. This age group, however, is at
tional concern is the prevalence of however, may be more expensive or high risk for obesity with a previously
energy-dense and low-nutritive pur- unavailable in stores. Future research documented 14.9% incidence rate of
chases just before children begin the is necessary to understand how fac-
overweight during a 2-year period.2 Fi-
tors such as price and availability
school day. nally, it is unclear whether corner store
influence child and adolescent pur-
A third major finding is that a little purchases were made in place of or in
chases. Future interventions may
more than $1.00 purchases 1495.2 kJ addition to free- or reduced-price
consider targeting children directly
(356 kcal). This is not surprising given meals. Future research should address
through nutrition education in the
that energy-dense foods are generally whether corner store purchases affect
schools, social marketing, and incen-
inexpensive.17 A dollar has a high rate school meal participation.
tivizing purchases of healthier items.
of return in an urban corner store. For Interventions may also consider tar-
example, $0.25 can buy 8 oz of an arti- CONCLUSIONS
geting store inventories by providing
ficially flavored fruit drink, a single- store owners with incentives or subsi- This is the first study to document the
serving bag of chips, an assortment of dies to provide more affordable, purchases that children in grades 4
candy/gum, or a popsicle. healthy options. through 6 made in corner stores prox-
The popularity of inexpensive, energy- This study has several strengths. It is imal to their schools. We observed that
dense, low-nutritive foods and bever- the first study to document the pur- children shop at corner stores fre-
ages presents several opportunities chases that children make in corner quently and purchase energy-dense,
for future intervention targets. Chips, stores proximal to their schools. As low-nutritive foods and beverages that
for example, represent ⬃34% of all such, it quantifies an environmental average 1497.7 ⫾ 1219.3 kJ (356.6 ⫾
items purchased. Switching from reg- and behavioral risk factor for obesity 290.3 kcal) per purchase. Obesity pre-
ular (588 kJ [140 kcal]) to a baked (504 among children. A second strength is vention efforts in urban settings, as
kJ [120 kcal]) version of 1 of the most the collection of objective purchase well as efforts to enhance dietary qual-
frequently purchased nacho tortilla data at the point of sale. Given the sig- ity among urban youth, should take
chips would reduce calories by 14.3%. nificant limitations in collecting self- into account the corner store environ-
This reduction is even larger (26.7%) report intake data among children,20 ment and its significant effect on en-
when substituting baked (462 kJ [110 we directly observed each item pur- ergy intake.
1296 BORRADAILE et al
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ACKNOWLEDGMENTS We acknowledge the contribution of the ant Deinhardt, Taya Malone, Tina Nguyen,
This work was supported by Robert Wood following individuals for the collection, and Alexis Wotjanowski. We thank the
Johnson, Healthy Eating Research grants entry, and management of all data: Ravi children and their parents, schools, and
NCT00593749 (GDF) and 65050 (KEB). Chawla, Teressa Chen, Cornell Davis, Bry- stores for participation.
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PEDIATRICS Volume 124, Number 5, November 2009 1297
Downloaded from www.aappublications.org/news by guest on March 14, 2021Snacking in Children: The Role of Urban Corner Stores
Kelley E. Borradaile, Sandy Sherman, Stephanie S. Vander Veur, Tara McCoy,
Brianna Sandoval, Joan Nachmani, Allison Karpyn and Gary D. Foster
Pediatrics originally published online October 12, 2009;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/early/2009/10/12/peds.2
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Downloaded from www.aappublications.org/news by guest on March 14, 2021Snacking in Children: The Role of Urban Corner Stores
Kelley E. Borradaile, Sandy Sherman, Stephanie S. Vander Veur, Tara McCoy,
Brianna Sandoval, Joan Nachmani, Allison Karpyn and Gary D. Foster
Pediatrics originally published online October 12, 2009;
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/early/2009/10/12/peds.2009-0964.citation
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