MHRA WIC Vendor Management Agency1 WIC Vendor Management Agency Low - Fat Milk Initiative August 16, 2007 Medical and Health Research Association of NYC,

MHRA WIC Vendor Management Agency

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WIC Vendor Management Agency

Low - Fat Milk Initiative

August 16, 2007

Medical and Health Research Association of NYC, Inc. (MHRA)


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General Background

According to a 2004 Center for Disease Control study, the New York State Medicaid program spends $3.5 billion per year on obesity related problems.

In low income areas, such as the South Bronx, 27% of the residents are obese compared with 16% citywide.

In these areas, many residents rely on bodegas and other small stores as the primary place to buy food.

Access to healthy food choices, in these stores, is limited and is believed to be a contributing factor to this problem.

According to City Harvest, “Bodega owners are hesitant to stock produce and other healthy but perishable items because of low product margin and questionable demand”.


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Low/Non Fat Milk Availability

In April 2006, the New York State WIC milk report indicated that various WIC local agencies in the Metro Region were issuing high percentages of low fat/non fat milk checks.

WIC clients have reported a lack of availability of low fat/non fat milk in small groceries in low-income neighborhoods.

Many low fat/non fat milk checks are in fact being redeemed for whole milk.


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Program Goals

The goal of this initiative is to ensure that WIC vendors: Understand the importance of low-fat/non-

fat milk to the health of the community. Consistently maintain low fat/non fat milk on

their shelves Redeem low-fat/non-fat milk checks

appropriately.


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Project Design

The Milk Initiative was implemented in four phases:

BaselineIntervention Two month post-intervention Four months post-intervention

No TrainingAdditional Training provided


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Baseline Phase

Health Promoters visited over 1000 stores. A Price Stock Survey was used to record low fat/non

fat milk stock levels, thus establishing a baseline measurement.

Upon completion of this activity, a list of stores that did not carry low fat/non fat milk was compiled and these vendors will be targeted for intervention.

Health Promoters also recorded the container size available as well as the quantity stocked.

WIC milk checks are usually written for gallons and half gallons. Stores carrying only quarts and small amounts will need to be targeted.


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How Were Stores Targeted

Over 656 stores were targeted for intervention.

A tiered approach was used to select the stores to receive intervention:No Low/Non fat milkZero GallonsOne GallonTwo Gallons


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Intervention Phase

A store-based intervention was implemented that provided vendors with the knowledge, support and incentives to consistently maintain adequate stocks of low fat/non fat milk on their shelves.

Vendors received posters promoting low fat/non fat milk, a laminated point of purchase (POP) pricing sign to be placed on the milk case as well as decals and tee shirts.

Health Promoters provided vendors with a highly focused Power Point about the importance of low-fat/non-fat milk to the health of the community.


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First Follow Up Intervention

656 stores were targeted for 1st Follow up.

Complete Price Stock Survey (milk section ONLY!)

Provide and/or put up materials if needed (posters, etc)


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Second Follow-Up

Complete Price Stock Survey (milk section ONLY!)

Go over PowerPoint presentation (ask if vendor understands the presentation and if they have any questions)

Open and provide materials (Dairy Council incentives and Milk facts.)

Put up posters, milk signs and other materials from the tool kit (give extras to vendor)

Provide business card to vendor


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Results

After each phase of the project, staff collected and reviewed milk related data.

A total of 1122 WIC Vendors were visited at baseline (February - April 2007).

Of these, 139 (12.3%) were either WIC inactive, supermarkets, non-existent locations, and/or out of business.


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Baseline

Of the 983 active stores visited at baseline.

Of the WIC Vendors monitored:

242 (24.6%) were found to have no low fat milk.

187 (19%) were found to have no low fat milk in gallon containers.

59 (6%) were found to have one gallon of low fat milk.

76 (7.7%) were found to have two gallons of low fat milk on their shelves.

88 (36.3%) were found to have three gallons of low fat milk


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Intervention

MHRA selected 656 stores for first follow up based on intervention visits.

Staff visited 628 stores.

On June 20th staff completed intervention. Bronx- 238 stores Brooklyn- 188 stores Manhattan- 88 stores Queens- 142 stores


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First Follow Up

All 628 stores visited at intervention were scheduled for first follow up.

Staff visited 618 stores.

On July 27th staff completed First Follow Up. Bronx- 228 stores Brooklyn- 177 stores Manhattan-83 stores Queens- 130 stores


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Second Follow Up: No Training

Second Follow up began July, 20, 2007.

There are 385 stores that did not require training. Brooklyn: 79Manhattan: 61Queens: 84Bronx: 161There are 135 remaining stores to visit. This phase will be completed by September 12th.


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Second Follow Up: Training

Second Follow with training began August 8th.

There are 214 stores that require training.

Of these 199 are still active.Brooklyn: 93Manhattan: 18Queens: 41Bronx: 52There are 149 remaining stores to visit. This phase will be completed by September 12th.


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Notes from the Field Vendors were cooperative (and excited that they began to see more

checks for Low-Fat milk). Vendors appreciated the posters and other materials. Stores continue to claim confusion and promise to change—most claim

to think that 2% is Low-Fat milk. Some vendors actually thought 2% was the healthier choice.

The vendors were cooperative and understood they needed to carry the milk. A few were surprised that whole milk had so much saturated fat and said they are going to switch to 1%.

The component that continued to have the most impact was the bacon comparison.

Health Promoters are seeing more low-fat milk being stocked. However, it is still not being stocked in gallon containers.

Some vendors are claiming that the 1% milk does not sell. Vendors are experiencing resistance from some WIC participants that

are refusing to take the 1% milk. Vendors are beginning to see the new checks that are being adjusted to

reflect the increase in milk prices. Needless to say, the vendors are feeling less stressed about losing money.


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Next Steps

Complete Second Follow UpProvide NYSDOH with data

InterventionFirst Follow UpSecond Follow Up

Produce reports for NYSDOHPrepare for FFY08 Project

Documents

MHRA WIC Vendor Management Agency1 WIC Vendor Management Agency Low - Fat Milk Initiative August 16, 2007 Medical and Health Research Association of NYC,