All Publications

  • Diet Quality Over the Monthly Supplemental Nutrition Assistance Program Cycle. American journal of preventive medicine Whiteman, E. D., Chrisinger, B. W., Hillier, A. 2018


    INTRODUCTION: Supplemental Nutrition Assistance Program (SNAP) benefits, which are distributed monthly, help low-income families put food on their tables. Both food spending and caloric intake among recipients decrease over the month following benefit receipt. This pattern, termed the "SNAP-cycle," has serious implications for health and food security of low-income households. To understand better the SNAP-cycle, this study explored (1) differences in diet quality between SNAP and non-SNAP households and (2) the association between the SNAP-cycle and diet quality.METHODS: Multivariate linear regression with SNAP households in the U.S. Department of Agriculture's Food Acquisition and Purchase Survey to evaluate changes in diet quality as time from SNAP distribution increased. Diet quality of food purchases was measured by Healthy Eating Index-2010 total and component scores. Data were collected 2012-2013 and analyzed 2016-2017.RESULTS: Overall dietary quality was low throughout the SNAP-cycle (n=1,377, mean Healthy Eating Index 46.14 of 100). SNAP households had significantly lower Healthy Eating Index scores compared with eligible and ineligible nonparticipants (p<0.05). After controlling for covariates, households in the final 10 days of the benefit cycle had Healthy Eating Index-2010 total scores 2.95 points lower than all other SNAP households (p=0.02). Significant declines in Healthy Eating Index fruit and vegetable scores contributed to worsening diet quality over the SNAP-cycle.CONCLUSIONS: This study provides evidence of low dietary quality throughout the SNAP-cycle with significantly lower Healthy Eating Index scores in the final 10 days of the benefit month. This suggests less healthy purchasing occurs when resources are diminished, but overall that current SNAP levels are insufficient to consistently purchase foods according to dietary guidelines.

    View details for DOI 10.1016/j.amepre.2018.04.027

    View details for PubMedID 29935945

  • Leveraging Citizen Science for Healthier Food Environments: A Pilot Study to Evaluate Corner Stores in Camden, New Jersey Frontiers in Public Health Chrisinger, B. W., Ramos, A., Shaykis, F., Martinez, T., Banchoff, A. W., Winter, S. J., King, A. C. 2018: 89


    Over the last 6 years, a coordinated "healthy corner store" network has helped an increasing number of local storeowners stock healthy, affordable foods in Camden, New Jersey, a city with high rates of poverty and unemployment, and where most residents have little or no access to large food retailers. The initiative's funders and stakeholders wanted to directly engage Camden residents in evaluating this effort to increase healthy food access. In a departure from traditional survey- or focus group-based evaluations, we used an evidence-based community-engaged citizen science research model (called Our Voice) that has been deployed in a variety of neighborhood settings to assess how different features of the built environment both affect community health and wellbeing, and empower participants to create change. Employing the Our Voice model, participants documented neighborhood features in and around Camden corner stores through geo-located photos and audio narratives. Eight adult participants who lived and/or worked in a predefined neighborhood of Camden were recruited by convenience sample and visited two corner stores participating in the healthy corner store initiative (one highly-engaged in the initiative and the other less-engaged), as well as an optional third corner store of their choosing. Facilitators then helped participants use their collected data (in total, 134 images and 96 audio recordings) to identify and prioritize issues as a group, and brainstorm and advocate for potential solutions. Three priority themes were selected by participants from the full theme list (n = 9) based on perceived importance and feasibility: healthy product selection and display, store environment, and store outdoor appearance and cleanliness. Participants devised and presented a set of action steps to community leaders, and stakeholders have begun to incorporate these ideas into plans for the future of the healthy corner store network. Key elements of healthy corner stores were identified as positive, and other priorities, such as improvements to safety, exterior facades, and physical accessibility, may find common ground with other community development initiatives in Camden. Ultimately, this pilot study demonstrated the potential of citizen science to provide a systematic and data-driven process for public health stakeholders to authentically engage community residents in program evaluation.

    View details for DOI 10.3389/fpubh.2018.00089

    View details for PubMedCentralID PMC5879453

  • Where do U.S. households purchase healthy foods? An analysis of food-at-home purchases across different types of retailers in a nationally representative dataset Preventive Medicine Chrisinger, B. W., Kallan, M. J., Whiteman, E. D., Hillier, A. 2018
  • Stress experiences in neighborhood and social environments (SENSE): a pilot study to integrate the quantified self with citizen science to improve the built environment and health. International journal of health geographics Chrisinger, B. W., King, A. C. 2018; 17 (1): 17


    Identifying elements of one's environment-observable and unobservable-that contribute to chronic stress including the perception of comfort and discomfort associated with different settings, presents many methodological and analytical challenges. However, it also presents an opportunity to engage the public in collecting and analyzing their own geospatial and biometric data to increase community member understanding of their local environments and activate potential environmental improvements. In this first-generation project, we developed a methodology to integrate geospatial technology with biometric sensing within a previously developed, evidence-based "citizen science" protocol, called "Our Voice." Participants used a smartphone/tablet-based application, called the Discovery Tool (DT), to collect photos and audio narratives about elements of the built environment that contributed to or detracted from their well-being. A wrist-worn sensor (Empatica E4) was used to collect time-stamped data, including 3-axis accelerometry, skin temperature, blood volume pressure, heart rate, heartbeat inter-beat interval, and electrodermal activity (EDA). Open-source R packages were employed to automatically organize, clean, geocode, and visualize the biometric data.In total, 14 adults (8 women, 6 men) were successfully recruited to participate in the investigation. Participants recorded 174 images and 124 audio files with the DT. Among captured images with a participant-determined positive or negative rating (n = 131), over half were positive (58.8%, n = 77). Within-participant positive/negative rating ratios were similar, with most participants rating 53.0% of their images as positive (SD 21.4%). Significant spatial clusters of positive and negative photos were identified using the Getis-Ord Gi* local statistic, and significant associations between participant EDA and distance to DT photos, and street and land use characteristics were also observed with linear mixed models. Interactive data maps allowed participants to (1) reflect on data collected during the neighborhood walk, (2) see how EDA levels changed over the course of the walk in relation to objective neighborhood features (using basemap and DT app photos), and (3) compare their data to other participants along the same route.Participants identified a variety of social and environmental features that contributed to or detracted from their well-being. This initial investigation sets the stage for further research combining qualitative and quantitative data capture and interpretation to identify objective and perceived elements of the built environment influence our embodied experience in different settings. It provides a systematic process for simultaneously collecting multiple kinds of data, and lays a foundation for future statistical and spatial analyses in addition to more in-depth interpretation of how these responses vary within and between individuals.

    View details for DOI 10.1186/s12942-018-0140-1

    View details for PubMedID 29871687

  • Family food purchases of high- and low-calorie foods in full-service supermarkets and other food retailers by Black women in an urban US setting Preventive Medicine Reports Chrisinger, B. W., DiSantis, K. I., Hillier, A. E., Kumanyika, S. K. 2018
  • Ethical imperatives against item restriction in the Supplemental Nutrition Assistance Program. Preventive medicine Chrisinger, B. W. 2017; 100: 56-60


    The Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) is the federal government's largest form of food assistance, and a frequent focus of political and scholarly debate. Previous discourse in the public health community and recent proposals in state legislatures have suggested limiting the use of SNAP benefits on unhealthy food items, such as sugar-sweetened beverages (SSBs). This paper identifies two possible underlying motivations for item restriction, health and morals, and analyzes the level of empirical support for claims about the current state of the program, as well as expectations about how item restriction would change participant outcomes. It also assesses how item restriction would reduce individual agency of low-income individuals, and identifies mechanisms by which this may adversely affect program participants. Finally, this paper offers alternative policies to promote healthier purchasing and eating among SNAP participants that can be pursued without reducing individual agency. Health advocates and officials must more fully weigh the attendant risks of implementing SNAP item restrictions, including the reduction of individual agency of a vulnerable population.

    View details for DOI 10.1016/j.ypmed.2017.04.009

    View details for PubMedID 28392253

  • Evaluating Healthy Corner Stores: A Survey of Assessment Tools Used in the San Francisco Bay Area, 2016. Preventing chronic disease Chrisinger, B. 2017; 14: E43-?


    Stakeholders from healthy corner store programs in the San Francisco Bay Area convened in November 2015 to discuss the future of programmatic and collaborative efforts. This study's objective, to gather and synthesize the types of evaluation tools used in the 9-county region, was identified as one of several priorities. Tools were collected via an online survey in July 2016, and data were extracted for comparison, including data on the number and types of food items, nutritional standards, and store characteristics. Twenty-five evaluation tools were collected, and differences were found in nutritional standards, terminology, and use of validated measures. Discrepancies between evaluation tools should be reconciled to make robust regional comparisons.

    View details for DOI 10.5888/pcd14.170002

    View details for PubMedID 28570208

  • Interdisciplinary Food-Related Academic Programs: A 2015 Snapshot of the United States Landscape Journal of Agriculture, Food Systems, and Community Development Hartle, J. C., Cole, S., Trepman, P., Chrisinger, B. W., Gardner, C. D. 2017; 7 (4)
  • Letter Regarding “Improving the Nutritional Impact of the Supplemental Nutrition Assistance Program” American Journal of Preventive Medicine Chrisinger, B. 2017; 53 (3): e119
  • Discrete choice model of food store trips using National Household Food Acquisition and Purchase Survey (FoodAPS) International Journal of Environmental Research and Public Health Hillier, A., Smith, T. E., Whiteman, E. D., Chrisinger, B. W. 2017; 14 (1133)


    Where households across income levels shop for food is of central concern within a growing body of research focused on where people live relative to where they shop, what they purchase and eat, and how those choices influence the risk of obesity and chronic disease. We analyzed data from the National Household Food Acquisition and Purchase Survey (FoodAPS) using a conditional logit model to determine where participants shop for food to be prepared and eaten at home and how individual and household characteristics of food shoppers interact with store characteristics and distance from home in determining store choice. Store size, whether or not it was a full-service supermarket, and the driving distance from home to the store constituted the three significant main effects on store choice. Overall, participants were more likely to choose larger stores, conventional supermarkets rather than super-centers and other types of stores, and stores closer to home. Interaction effects show that participants receiving Supplemental Nutrition Assistance Program (SNAP) were even more likely to choose larger stores. Hispanic participants were more likely than non-Hispanics to choose full-service supermarkets while White participants were more likely to travel further than non-Whites. This study demonstrates the value of explicitly spatial discrete choice models and provides evidence of national trends consistent with previous smaller, local studies.

    View details for DOI 10.3390/ijerph14101133

    View details for PubMedCentralID PMC5664634

  • Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk. Resuscitation Chrisinger, B. W., Grossestreuer, A. V., Laguna, M. C., Griffis, H. M., Branas, C. C., Wiebe, D. J., Merchant, R. M. 2016; 109: 9-15


    Approximately 424,000 out-of-hospital cardiac arrests (OHCA) occur in the US annually. As automated external defibrillators (AED) are an important part of the community response to OHCA, we investigated how well the spatial demand (likelihood of OHCA) was met by the spatial supply (AEDs) in a dense urban environment.Using geographic information system (GIS) software, we applied kernel density and optimized hot spot procedures with two differently-sized radii to model OHCA incidence rates from existing studies, providing an estimate of OHCA likelihood at a given location. We compared these density maps to existing AED coverage in the study area. Descriptive statistics summarized coverage by land use.With a 420-ft buffer, we found that 56.0% (79.9%, 840-ft buffer) of the land area in the city center was covered by existing AEDs at, though 70.1 (91.5)% of the OHCA risk was covered using kernel density and 79.8% (98.1) was covered using hot spot analysis.The difference in coverage by area and risk seems to indicate efficient placement of existing AEDs. Our findings also highlight the possible benefits to expanding the influence of AEDs by lowering search times, and identify opportunities to improve AED coverage in the study area. This article offers one method by which local officials can use spatial data to prioritize attention for AED placement and coverage.

    View details for DOI 10.1016/j.resuscitation.2016.09.021

    View details for PubMedID 27702581

  • A Mixed-Method Assessment of a New Supermarket in a Food Desert: Contributions to Everyday Life and Health JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE Chrisinger, B. 2016; 93 (3): 425-437


    Initiatives to build supermarkets in low-income areas with relatively poor access to large food retailers ("food deserts") have been implemented at all levels of government, although evaluative studies have not found these projects to improve diet or weight status for shoppers. Though known to be influential, existing evaluations have neglected in-store social dynamics and shopper behaviors. Surveys and walking interviews were used with shoppers (n = 32) at a supermarket developed through the Pennsylvania Fresh Food Financing Initiative in Philadelphia, PA. Key informant interviews with stakeholders in the supermarket's development and operations provided additional context to these shopper experiences. Data were collected in July and September 2014 and qualitatively analyzed in NVivo 10.0. Participants described how the retailer helped them adapt or cope with difficult shopping routines and how it presented a reliable high-quality option (in terms of cleanliness, orderliness, and social atmosphere) in contrast to other neighborhood retailers. Health concerns were also identified, especially among those managing chronic disease for themselves or a family member. These issues underscored multiple points of challenge required to adjust shopping and eating behavior. In-store supports that reflect these challenges are warranted to more fully address food deserts and reduce health disparities.

    View details for DOI 10.1007/s11524-016-0055-8

    View details for Web of Science ID 000377466300003

    View details for PubMedID 27197735

  • The Reality of Urban Food Deserts and What Low-Income Food Shoppers Need Social Policy and Social Justice Hillier, A., Chrisinger, B. edited by Jackson, Jr., J. L. University of Pennsylvania Press. 2016: 74–86
  • Urban Agriculture and Health: What is Known, What is Possible? Cities of Farmers: Urban Agricultural Practices and Processes Chrisinger, B. W., Golden, S. University of Iowa Press. 2016: 230–244
  • Reconsidering the Supplemental Nutrition Assistance Program as Community Development JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR Chrisinger, B. W. 2015; 47 (3): 273-277


    The Supplemental Nutrition Assistance Program (SNAP) protects households from severe food insecurity or extreme poverty, buffers against certain adverse health effects, and exhibits a multiplier effect on the nation's economy. Nonetheless, SNAP remains contentious and benefit reductions are currently being debated. One new direction is to reconceptualize people-based SNAP allocations within place-based community development. Programs such as the federal Healthy Food Financing Initiative encourage retailer development in underserved neighborhoods, creating healthy options and opportunities to reinvest SNAP dollars locally. By exploring relationships between these programs, researchers and practitioners can better understand how to enhance their impact on individuals and neighborhoods.

    View details for DOI 10.1016/j.jneb.2014.10.005

    View details for Web of Science ID 000355955600013

    View details for PubMedID 25467214

  • Changing food stamp distribution to attract new grocers Chrisinger, B. The Baltimore Sun. Baltimore, MD. 2015


    With one in four Baltimoreans living in a food desert, city officials have a long road ahead to deliver on promises of healthy, affordable and accessible food options. One of the city's approaches follows a tried-and-true roadmap that involves offering incentives, like tax breaks for locating in underserved areas, to retailers and developers — also known as "fresh food financing." Created over the last decade, these types of incentives work; in Philadelphia, the number of people living in food deserts was cut by 56 percent this way, for example.There is a simpler, less costly solution under consideration, however: changing when food stamps are distributed. Link:

  • Should We Still Be Talking About Food Deserts? Chrisinger, B. American Planning Association Food Systems Planning Interest Group. 2015


    By now, you’ve probably heard about food deserts. Maybe as part of the First Lady’s Let’s Move! Campaign to end childhood obesity. Maybe your state has established a task force to investigate food accessibility. Perhaps you’ve even mapped a food desert in your own town or city, using tools like the USDA’s Food Environment Atlas. Though the term “food desert” can mean a variety of things, generally speaking, it refers to places with limited proximity to supermarkets and low rates of vehicle ownership, thus making a simple shopping trip more difficult than in better-served areas. In many cities, the term also describes distinct racial and income disparities in terms supermarket access. Link:

  • Tradition of healthy food access in low-income neighborhoods: Price and variety of curbside produce vending compared to conventional retailers. Journal of agriculture, food systems, and community development Brinkley, C., Chrisinger, B., Hillier, A. 2013; 4 (1): 155-169


    This paper describes the longstanding, naturally emergent model of curbside vending of whole fruit and vegetable produce across several low-income, low-health Philadelphia neighborhoods. We conducted open-ended interviews with managers of 11 curbside produce vendors and compared prices and varieties of fruits and vegetables with the 11 closest conventional outlets. We find that produce trucks offer significantly lower prices on common fruit and vegetable items and they carry a variety of items comparable to that carried by limited-assortment grocery stores. We conclude with recommendations regarding zoning, licensing, and Supplemental Nutrition Assistance Program (SNAP) authorization that could stabilize and expand this model of healthy food access.

    View details for PubMedID 25541595

  • Tradition of healthy food access in low-income neighborhoods: Price and variety of curbside produce vending compared to conventional retailers Journal of Agriculture, Food Systems, and Community Development Brinkley, C., Chrisinger, B., Hillier, A. 2013; 4 (1): 155-169
  • Food Stamps and Place: New Cuts Could Dry Up Food Desert Improvements Chrisinger, B. Planetizen. 2013


    On November 1, Congress allowed a provision of the American Recovery and Reinvestment Act to sunset, immediately reducing the monthly food stamp (or SNAP) benefit by $36 for an average household of four. We’ve heard stories of SNAP participants’ strategies for coping with less: diverting already-scarce money from other expenditures (if possible), turning to friends, family, or charitable organizations, or simply eating less to bridge the gap. We’ve also heard about the probable effects on businesses: store owners who accept SNAP are likely to see decreased sales. Amid attention to the households and businesses affected by the SNAP cut, we have yet to discuss the effect on place. By stripping low-income neighborhoods of buying power - specifically food dollars - the federal government stands to thwart its own efforts to address the nation’s food desert problem. Link: