Dollar General plans to open 1,000 stores in 2020; some worry they contribute to poor nutrition in rural areas

Dollar General Corp., one of the fastest-growing retailers in the country, has announced it will open 1,000 new stores in 2020, just as it did last year. That's on top of the more than 16,000 stores it already has (dozens of which are in Kentucky). "Dollar General's growth is nearly unrivaled in the industry at a time in which many brick-and-mortar retailers are closing stores or folding," Nathaniel Meyersohn reports for CNN."Walmart, which swept into new towns for decades with massive superstores, has essentially stopped opening new ones. By contrast, Dollar General is entering new cities and towns with small stores and opening up in areas where it has already gained hold."

One reason dollar stores are so popular: despite the low unemployment rate, "wages for a vast number of Americans have grown only modestly," Meyersohn reports. "Americans living paycheck-to-paycheck have been a boon to Dollar General, and wages for a vast number of them have grown only modestly. The chains have also reached higher-income shoppers seeking discounts." And Dollar General appeals to convenience, offering many of the same goods as Walmart with a shorter drive.

The chain's growing presence has hurt some small-town retailers. Small, full-service groceries in some towns have been put out of business by Dollar General Markets, which sell fresh produce and meat, though usually not with as wide a selection as the grocery they dislodged.

Most Dollar Generals sell only prepackaged food, which worries nutritionists concerned about rural health. Barry Popkin, a nutrition professor at the University of North Carolina at Chapel Hill, has been a long-time critic of dollar stores. "At a time when poor diets are linked to nearly 900 deaths a day in this country, Popkin says to look at what Dollar Stores sell: rows and rows of sugary drinks, candies, and processed foods high in salt and fat," Allison Aubrey of NPR reports for CBS News. Dollar Generals are frequently located in "food deserts," where residents have little access to fresh food and are often obliged to buy the pre-packaged food Popkin warns against.

For example: in Dekalb County, Georgia, which includes part of Atlanta, there are 68 dollar stores (a mix of Dollar General, Family Dollar, and Dollar Tree, the latter two with the same owner). County Commissioner Lorraine Cochran-Johnson told Aubrey that a quarter of the county's residents live in food deserts, and that dollar stores target such areas. "When you look at the trends and you look at the pattern of growth of the dollar store as well as the areas that have the highest levels of obesity, hypertension, high blood pressure, there is a direct correlation," Cochran-Johnson said.

Food-desert concerns have led some cities and towns to pass laws limiting dollar-store expansion. "Advocates of tighter controls on dollar stores claim the big chains intentionally cluster multiple stores in low-income areas, a strategy that strategy discourages supermarkets from opening and threatens existing mom-and-pop grocers, critics say," Meyersohn reports. "Opponents also express concerns that most dollar stores don't offer fresh produce."

Dollar General spokesperson Crystal Ghassemi objected to the perception that dollar stores contribute to poor eating habits, and told Aubrey that even their regular stores have plain vegetables and chicken in the frozen-foods section. Only about 3 percent of Dollar General outlets sell fresh produce.

Introduction to adult food can be a big turning point in a child's nutritional health; program in 22 counties helps poor get local food

By Melissa Patrick
Kentucky Health News

Taste preferences are established early, and that's why those early bites of ice cream matter.
A program that helps low-income families who use food-assistance programs to get locally produced food gets additional funding.
A group in Louisville is working on opening a community-owned grocery store.

These were just some of the topics discussed during the July 12 "Food in Kentucky" webinar, sponsored by the Foundation for a Healthy Kentucky.

Ana Chang, founder of Concept Hatchery, a California consultancy, opened the webinar with findings from her company's research with the 1,000 Days project, which looks at the nutritional health of mothers and their children during the 1,000 days from pregnancy to a child's second birthday.

Chang said her research involved 19 mothers from Kentucky, California and Mississippi, with varying levels of income levels. The study looked at what the children ate and how the mothers decided what to feed them, through food journals and in-person evaluations during meal and snacks.

All of the children started out on equal footing because they were all fed either formula or breast milk, Chang said, but the nutritional value of their food changed quickly when they started eating adult food.

"The first taste of food that babies get are really often what the family eats; they are not specialized for babies. And so the taste preferences are established really early. Even as young as four months or younger, babies might be given a finger that's been dipped in soup that the family is having, or a lick of ice cream," she said. "So how well that family ate, that's how well that baby is going to eat as it starts growing up."

Chang noted that one of the Kentucky families in the study was part of a diabetes-prevention program that provided fresh produce to the whole family, even though only one family member had been diagnosed with the disease. "That is the kind of intervention that we need to start thinking about," she said, "because once food is brought into a family kitchen, it becomes available for everybody."

Chang noted some nutrition challenges for the low-income families in the study, including: lack of access to fresh fruits and vegetables, transportation barriers, lack of a safe place to store foods, and a lack of a cooking space. She said almost every family in the study struggled with food bounty and scarcity issues which were tied to the arrival of their paychecks and food stamps.

Martin Richards, executive director of the Community Farm Alliance, said his 32-year-old group focuses on agriculture and family farming policy because policy can affect the most people, but also supports non-legislative initiatives that reinforces the bills they are trying to pass.

Click on the image to view a larger version.

One of those projects is Kentucky Double Dollars, a program that allows low-income families who use food-assistance programs to double their purchasing power at participating farmers' markets and retail stores in 22 Kentucky counties.

The program allows those on food stamps (now called the Supplemental Nutrition Assistance Program) or the Women, Infants and Children program to double the value of their SNAP or WIC dollars to buy Kentucky-grown produce, meats, eggs and dairy products. The double dollars program is also available to seniors who are part of the Senior Farmers Market Nutrition Program for Kentucky-grown produce only.

"We saw the huge amount of money that comes into Kentucky from federal food nutrition programs and we saw this as a way to get that money to support local and regional food systems," Richards said, adding that the program recently received an additional $1.4 million from federal, state and private-sector funding to help sustain it. (The program was formerly called "Double Dollars," but recently changed its name to Kentucky Double Dollars after it merged with the Bluegrass Farm to Table and the "Bluegrass Double Dollar" programs in Lexington.)

This season, 27 Kentucky farmers’ markets, 12 Fresh Stop Markets in Lexington and Louisville, and Good Foods Co-op in Lexington and Lexington Market East End, are participating in Kentucky Double Dollars.

Other CFA initiatives include a program that gives children vouchers to use at participating farmers' markets; a program that allows health-care providers to prescribe fruits and vegetables as part of a treatment plan; a program that provides food to children in the summer; a walking program that links farmers' market vouchers to community exercise goals; a school-based program that encourages students to drink water; and healthy cooking classes.

The CFA also offers technical and financial support through a 50-50 cost-sharing arrangement to communities that want to create a farmers' market. "When a farmers' market has somebody dedicated to help making that market run, even if it is just part time and seasonal, it makes a huge difference to that market," Richards said.

In another part of the webinar, Cassia Herron of the Louisville Food Co-op said her group is working to open a community-owned grocery store in one or more of the neighborhoods in Louisville's urban core. She said this group is working to hire a project manager who will lead and launch a capital campaign for this project, which they hope will come to fruition within the next two years.

Teacher learns food literacy is more than teaching about healthy food; it's also about geographic and socioeconomic challenges

Cooking Club, part of Fern Creek's Food
Literacy class (Photo by Joe Franzen)

A "food literacy" class that began as a way to teach high-school students to eat healthier has turned into a social-justice exploration through the shared language of food preparation and eating, Joe Franzen writes in a "Classroom Connection" piece for The Courier-Journal.

Franzen, a food and sustainability educator at Fern Creek High School in Jefferson County, said he showed up to his first food-literacy class at FCHS with plans to teach about "healthy" foods, new and improved cooking techniques and how to grow a garden.

"My students balked," he wrote, saying they pushed back on his curriculum with real-world issues that screamed of the geographic and socioeconomic realities that often segregate people into those who can afford to eat "healthy" and have access to fresh, healthy foods and those who can't and don't.

"They complained of not having the tools to cook at home or the ability to purchase ingredients on a budget.They explained how apartments don’t have yards to dig up.They talked about how junk food tastes good," he wrote.

So Franzen said he shifted the focus of the class, realizing that it would have to deal with the "dynamic realities" of his students.

Franzen noted that one of the first changes he implemented was to ask his students: "What is your food reality? What is your definition of 'good' food? What are the recipes that your family values? What are the boundaries that you face in eating well?"

Which, he said, led to "student-written food narratives, lessons in food discourse and debate, class cookbooks, 30-student potlucks, and conversations about what people deserve, what is just and right -- all while using our city as a classroom, textbook, and laboratory to explore and critically engage."

And all of this led to "talking about socioeconomic status, income inequality, privilege, race, religion, gender, and ethnicity," he wrote. "All I started out wanting to do was teach a couple of recipes, encourage less soda consumption, and show how to put a plant in a hole."

Franzen said he was "glad that students sent back the first version of 'food literacy' and that the new curriculum now formally "looks like Food Lit., a food-themed pre-AP English course, Cooking Club, Food Sociology, Global Issues, and Environmental Club."

"Through this process, I realized what good teaching should be: responding to the needs and curiosities of the students to help them critically engage and question the world in a way that allows them to improve themselves and the community around them," he wrote.

In conclusion, Franzen challenged all of us to find common ground around the table, to build a relationship over sharing a meal, and "to engage the world around us in a meaningful, sustaining, and compassionate way," and to come back for seconds.

He wrote: Food literacy "isn’t just about eating “healthy” or learning to cook, it is about building community and building resiliency within ourselves and together during such divisive times."

Study finds nutritious food costs more in poor, rural areas, suggests that SNAP (food stamp) policies be changed

A study has found that nutritious foods are more expensive in impoverished rural counties than in urban counties, a phenomenon that doesn't help public health officials who teach healthy eating as a proven, effective strategy to prevent chronic diseases to rural Kentuckians.

"The results of this study find that individuals living in rural areas, particularly food desserts, may be at increased risk of negative health effects as a result of more limited access to higher quality foods compared to those living in urban areas," says the report of the University of Kentucky study, "Food Cost Disparities in Rural Communities," published in Health Promotion Practice.

Researchers analyzed the per-serving cost of 92 foods four times over a 10-month period in the primary grocery stores in four Kentucky counties, two rural and two urban. One rural county was considered a food desert, meaning that fresh produce isn't relatively available. The commonly purchased foods in the study were assigned to one of four categories based on their nutritional value.

Not surprisingly, the cheapest foods were those with the least nutritional value, such as canned fruit in heavy syrup, cereals with high-fructose corn syrup, and processed meats.

Foods that are a bit more nutritional, but mainly processed convenience foods, were more expensive in rural counties than urban counties.

Foods that were considered nutritious, but not the most nutritious, such as white rice, oats, whole-grain bran cereals and frozen fish, cost the most in the rural county with the highest poverty rate.

The cost of the most nutritional items varied by county, with the "most striking finding" being that "the rural food desert had significantly higher per-serving costs among the most nutritious food items, compared to the other three counties," 6 to 8 cents higher per item, the report said.

Within each county, the study did not find much difference in food cost among the foods in each of the four nutrition categories.

However, it did find that highly processed convenience foods in urban counties were more expensive than more nutritional foods, and suggested that those living in urban areas could afford more plant-based foods and fewer processed foods as an "effective strategy to improve overall dietary quality without increasing food budgets."

The study draws attention to the SNAP or food-stamp program, which makes no allowances for food cost differences between regions or counties, and suggests that its model be changed to be more like the Women, Infants and Children program, which uses a portion-based system: Participants buy a set number of ounces or servings of dairy products, whole grains, and fresh produce each month, irrespective of price. This approach "has the potential to adequately meet all participants' nutritional needs, irrespective of differences in food prices," wrote the researchers, Frances Hardin-Fanning and Mary Kay Rayens of the UK College of Nursing.

Rural children are more likely to be obese, but rural communities have several strategies to fight the problem

Children living in rural areas are about 25 percent more likely to be overweight or obese than children in urban areas, studies show. Rural communities have come up with several strategies to battle childhood obesity, Sarah Lifsey and Karah Mantinan report for the Altarum Institute, a nonprofit health-systems research and consulting organization.

 Many people are surprised to hear that childhood obesity is a rural phenomenon because they assume that rural kids have more access to the outdoors and physical activity. However, studies have found that there is little open public space in rural areas, often because of a lack of a strong government to provide and maintain such public spaces, Lifsey and Mantinan write. They also cite research showing that fear of crime in public spaces is a reason rural families don't use public activity areas, even though crime is least likely to occur in rural areas.

 Rural children are also at increased risk of poverty compared to children in cities or suburbs, and face lower access to health care, lower levels of physical activity, lower-quality food, and limited options for transportation.

 Many of Kentucky's children are poor, overweight and sedentary. One in four children in Kentucky lives in poverty according to the American Public Health Association and 37.1 percent of children in Kentucky between the ages of 10 to 17 are considered overweight or obese, according to the Foundation for a Healthy Kentucky. Seventeen percent of Kentucky children reported not getting any physical activity in the seven days prior to a survey given by the federal Center for Disease Control and Prevention and 28.8 percent of children on the same survey watched television three or more hours per day on an average school day. 

Poorer food and lower levels of activity are often the result of the distance it takes to get to a physical-activity venue or a grocery store in rural areas, the authors write. The round-trip time it takes to get there and the cost of gas for these trips adds a time-and-cost burden to families that often creates a lack of commitment to transport children back and forth to after school activities or to travel to groceries with better food options, Lifsey and Mantinan write.

 Many rural families who lack access to fresh and healthy foods live in "food deserts," Generally defined as those with no grocery with fresh produce within 10 miles. Studies have found poverty and childhood obesity are more likely in rural food deserts.

 Rural communities are using several school-based strategies to fight obesity, Lifsey and Mantinan report. They include making sure school-bus schedules and family transportation schedules coordinate to encourage after-school activities; ensuring that schools provide gym class and recess; allowing recreational areas of school grounds to be available to the community after hours; providing alternative transportation options to students who need rides home in order to participate in after school activities; improving school meals to include more whole grains, fruits and vegetables; and improving the choices available in soda and vending machines.

 Engaging programs and groups that are already in existence, such as 4-H Youth Development and telemedicine programs that focus on childhood obesity intervention, are great places to start when initiating childhood obesity programs, the authors write. Having local farmers teach gardening skills can also improve access to healthy food.

 Noting that African-American children are the most likely to be obese, Lifsey and Mantinan say communities must keep minority populations in mind. They also suggest working with employers to start employee wellness programs that encourage parents to model healthy behaviors for their children.

 Also, It's important for rural communities to observe, measure and decide how each of them want to attack this issue to increase the probability of success, they say.

 Tools are available to help with this planning such as the Rural Active Living Assessment Tools, developed by the Robert Wood Johnson Foundation. Other resources include the Rural Assistance Center, funded by the U.S. Department of Health and Human Services Rural Initiative, which features a Rural Obesity Prevention Toolkit developed by the Nutrition Obesity Research Center's Walsh Center for Rural Analysis, as well as a resource guide for rural areas developed by the University of North Carolina's Active Living by Design.

Convenience, not expense, is making us avoid eating fruits, vegetables and other non-processed foods

A lack of convenience, not a high price, is the major obstacle to getting people to eat more fruit and vegetables, a study published in the journal Public Health Nutrition has found. The study analyzed the fruit and vegetable consumption in six low-income, mostly minority neighborhoods in Chicago.

"Participants who agreed that they had 'convenient access to quality' produce were more than twice as likely to eat the FDA-recommended amounts of fruits and vegetables," Sarah Kliff reports for The Washington Post. "Those who reported high cost as a barrier to the consumption of produce ended up eating just as much as those who didn't." (Post photo above by Barbara Damrosch)

The study seems to support New York Times columnist Mark Bittman's assertion that Americans are skipping nutritious food because it takes much more work to prepare, not because it's too expensive. "It's cooking that's the real challenge," he writes in a September 2011 column. "The core problem is that cooking is defined as work, and fast food is both a pleasure and a crutch." (Times photo by Daniel Borris)

Contributing to the problem, Bittman argues, is the addictive qualities of fast food and processed food: physically addictive, as a study by the Scripps Research Institute shows, and mentally addictive. Bittman cites David A. Kessler, former commissioner of the Food and Drug Administration and author of The End of Overeating, who said manufacturers created food that was "energy-dense, highly stimulating and went down easy. They put it on every street corner and made it mobile, and they made it socially acceptable to eat anytime and anyplace. They created a food carnival, and that's where we live. And if you're used to self-stimulation every 15 minutes, well, you can't run into the kitchen to satisfy that urge."

The answer is in changing mindsets, Bittman writes, and getting "people to see cooking as a joy rather than a burden, or at least as part of a normal life." That takes education and changing the environment, which, he points out, has been done with tobacco. Cultural change can happen by celebrating whole foods, he writes. Political action would mean limiting "the marketing of junk; forcing its makers to pay the true costs of production; recognizing that advertising for fast food is not the exercise of free speech but behavior manipulation of addictive substances; and making certain that real food is affordable and available to everyone. The political challenge is the more difficult one, but it cannot be ignored." (Read more)