The TastyKake truck comes three times a week to the corner store on North Mount Street, rumbling past drug dealers and piles of trash to fill the racks with cupcakes and cream-filled chocolate bars. The Utz man comes twice to deliver little bags of chips, each one containing about 20 percent of the recommended daily intake of fat.
But if the owner of Blooming Sun Market, Grace Lyo, wants to sell fruits or vegetables, "I have to go to Sam's Club and get them myself."
As public health researchers grapple with the alarmingly high rates of diabetes, obesity and heart disease in poor urban neighborhoods, they are turning their attention to corner stores. Places like Lyo's market in West Baltimore, which does a brisk business in soda, whole milk, chips and cigarettes, supply much of the food for their community's residents.
A Johns Hopkins University project to get better food into the stores -- and, ultimately, improve the health of urban residents -- is expanding this fall from 17 stores to 35, scattered across the city. Store owners who agree to stock the healthful foods receive promotional materials, shelf labels and posters. Hopkins researchers offer samples to customers and do cooking demonstrations to introduce new foods. They sometimes provide stores with bananas and whole wheat bread on a trial basis.
But the healthful foods don't always sell.
"I'm not a big fan of whole-wheat bread. I like white bread," said Nytearia Bradshaw, 16, who was standing outside the New Sandtown Market on North Calhoun Street after buying white bread, potato chips and soda for the children she was baby-sitting. "We teenagers, we live it up. We like to eat junk food."
African-Americans make up the bulk of the poor in the city, and nearly a third of black adults are obese, studies have found, an epidemic that leads to substantially higher rates of diabetes and heart disease compared with other races. Researchers say the "food environment" in black neighborhoods -- the corner stores, carryout stores and fast-food restaurants -- is a contributing factor. Supermarkets are scarce and hard to reach.
"If you have a lot of healthy foods available close by, either in corner stores or supermarkets, then people's diets are better and the rates of chronic disease are lower," said Joel Gittelsohn, director of the Hopkins Healthy Stores Project. "We see our role as priming the pump a little bit, to say to these stores: If you agree to stock this food, we will promote it. You provide the supply, and we'll work to provide the demand."
His researchers are tracking sales and interviewing customers to measure whether diets change. But the real measure of the program's success, the rates of chronic diseases, won't be clear for years.
There are about 800 corner stores in Baltimore. Many lack any kind of refrigeration, except for cases to cool bottles of soda, so selling produce is almost impossible. Instead, the stores offer racks of processed food, heavily marketed by the manufacturers and sold cheaply to a captive audience.
"As a city and as a country, we don't promote healthy foods," said Anne Palmer, program director at the Johns Hopkins Center for a Livable Future, which funded the first phase of the Healthy Stores Project. "Changing people's tastes in food is one of the most difficult things to do. It's so wrapped up in what you've grown up with. People don't eat for health, necessarily. They eat because that's what satisfies them. It tastes good."
At Melvin's Market on West Baltimore Street, owner Melvin A. Brown has stocked more whole-wheat bread since he joined the Hopkins project last fall. With some promotion, sales of the bread have gone up from 10 loaves a week to 20 or 25. But he sells about 400 loaves of white bread each week.
He's offering more turkey products in place of pork and beef, and he carries 10 low-sugar cereals, as well as skim, 1 percent and 2 percent fat milk. He said senior citizens with restricted diets buy the foods, but kids are a harder sell.
"They're eating the junk food," he said, wearing a red apron and blue ball cap behind the counter of the store he's owned for 35 years. "Especially when they're spending their money, they want that sweet stuff -- chips, ice cream, cakes."
The expansion of the Healthy Stores Project, funded by the Robert Wood Johnson Foundation, will focus on stores near schools and recreation centers to target children 10 to 14. The project has identified the foods that provide the most fat, sugar and calories in children's diets, and will be promoting alternatives. That means flavored water instead of the sweetened Kool-Aid-type drinks, trail mix and granola bars instead of cakes, fruits instead of candy.
Not all store owners agree to participate. With limited space, and operating on a thin profit margin, some owners worry that the healthful foods won't sell or will perish quickly. They are reluctant to take the risk.
"You have this curious circle where people don't buy the [healthful] foods because they're not available, and the stores don't stock them because they think no one wants them," said Gittelsohn. His job is to break that circle.
One key is to provide healthful foods that are the same price as the unhealthful ones. That's a challenge. Whole-wheat bread is more expensive than white. Baked chips and Sun Chips don't come in the same 25-cent bags as Utz's high-fat Cheddar and Sour Cream Chips. And 100 percent fruit juice costs several times more than the small 35-cent plastic bottles of Hugs, the sweetened drinks that kids slurp down.
Next year, the Healthy Stores Project will grow again, to include stores around 15 black churches in the city. Money for that phase will come from the American Diabetes Association, which will run workshops at the churches on diabetes prevention while Gittelsohn and his team work to get better foods into the nearby stores.
Public health experts believe that if nutritious food is available, and promoted, people will buy it. But in too many places, it's just not available. Dr. Manuel Franco, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, assessed the food offerings at 226 stores in Baltimore City and County. He found that predominantly black and low-income neighborhoods have significantly less healthful food available than white and more affluent areas.
Franco found that in 21 stores -- all in black neighborhoods -- the food is kept behind bulletproof glass and sold through a revolving window, making it impossible for customers to assess the quality of the food or read nutrition labels.
"We're living in cities right now where healthy foods are not available," Franco said, referring to inner-city neighborhoods, not the affluent areas where Whole Foods and farmers' markets offer a healthful eater's nirvana. For people without cars, getting to those places, and getting their groceries home, is an ordeal.
"People want to eat better, but the problem is we don't have access," said Joyce Smith, executive director of the community group Operation ReachOut SouthWest. She said in her own survey of corner stores, she found "skids and skids of ramen noodles," which are high in sodium, and processed food. And if there is fruit, it's behind glass barriers. "How can people touch it?" she wondered.
Outside the Blooming Sun Market on Mount Street, Davon Burges was sitting on some steps last week having an Icee pop and Sunny Delight he got from the store. Burges, 17, said he wished the store would carry apples and strawberries, not just bananas. But he blames his fellow customers, not the store owner. "Everything in that store is what people want to buy," he said.
Grace Lyo has made some changes to her store since joining the Hopkins program. She placed a basket of bananas on her counter and found space on her shelves for low-sugar cereals like corn flakes, low-fat milk, cooking spray and mayonnaise substitutes such as Miracle Whip.
"When I see my customers, no one is helping them eat nutritious foods," she said. "They're my neighbors, and I want them to be healthy."
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