Baltimore Food Environment Programs

• The Baltimore Food Environment suite of programs grew out of PI Dr. Joel Gittelsohn's work in the Marshall Islands and on Native American Apache reservations. 
• First launched in the early 2000s, the program targets the Baltimore Healthy Food Priority areas: regions of Baltimore that both lack healthy foods and have an abundance of unhealthy food options. 
• Since the first program -- "Baltimore Healthy Food Stores" -- the different food environment interventions have grown more complex, targeting multiple levels of the food environment.
• Initially concentrated on consumers and providers, interventions now include suppliers and policy makers. These program evolutions have been triggered by on-going reflections on how to improve the reach and impact of programs targeting the food environment.

Based on the long-term investments represented by the Baltimore Food Environment interventions, the team has drawn the following key, cross-cutting conclusions from their work: 

1. It is key to invest in formative research; for example, in the Baltimore Healthy Food Stores Program extensive formative research explored family, school and neighborhood influences on eating habits and health concepts and helped better target the interventions and behavior change messages (LINK).
2. Long-term engagement with communities can support sustainability, build trust and rapport, and allows interventions to iterate and build on one another; participatory community workshops are one approach that facilitates this type of long-term engagement (LINK).
3. Environmental interventions face particular challenges related to exposure -- individuals need to interact with program messages and materials with enough frequency to instigate behavior change; this requires a special attention to monitoring, comparisons with standards, and ability to make course corrections as needed.  Exposure monitoring was an area of focus for the B'more Healthy Communities for Kids Program (LINK). 
4. It is necessary to work at multiple levels of the food system: consumers, retailers, suppliers, and policy makers.  This evolution is visible in the design of the team's programs, and working across all levels is key to the ongoing Baltimore Urban Food Development App Program (LINK). 
5. Food environment interventions need to pay particular attention to engagement at the policy level; techniques for measuring policy engagement include process evaluations, as demonstrated in the B'more Healthy Communities for Kids Program (LINK).