Features in Grocery Stores that Motivate Shoppers to Buy Healthier Foods, ConsumerStyles 2014

Food availability and advertising within food outlets around primary healthcare services in Brazil

The consumer food environment is changing: an extensive variety of foods are now available in most markets, offering palatability, convenience and novelty. However, little is known about the availability and advertising of food items within food outlets, especially among developing countries. The present study examined these dimensions in 281 food outlets located around eighteen primary healthcare services in Belo Horizonte, Brazil, in 2013. These establishments were classified as large-chain supermarkets; specialised fruits and vegetable (F&V) markets; and local grocery stores, convenience stores or bakeries. Availability of F&V, availability of ultra-processed foods (UPF) and food advertising were compared across the food outlet categories by applying the χ² test. Almost 60 % of the food outlets were specialised F&V markets, 21⋅4 % were large-chain supermarkets and 19⋅2 % were local grocery stores, convenience stores or bakeries. Almost 80 % contained at least eight types of fruits and vegetables, and 60 % contained UPF. Food advertisement was absent in 59⋅8 % of the food outlets, 19⋅6 % were advertising only F&V and 17⋅4 % were advertising only UPF. Higher F&V availability was noted inside specialised F&V markets and large-chain supermarkets than local grocery stores, convenience stores or bakeries. Advertising of F&V was more common within specialised F&V markets. However, large-chain supermarkets and local grocery stores, convenience stores or bakeries contained more frequent UPF food advertising isolated: 38⋅3 and 35⋅2 %, respectively. Therefore, the availability and advertising of food items within food outlets around primary healthcare services are different according to the type of food outlet.

Healthy choice architecture in the supermarket: Does it work?

Improving dietary quality of supermarket purchases could help reduce obesity and chronic diseases worldwide. In the past decade, there has been increasing academic interest in using behavioral economics strategies, primarily choice architecture, to "nudge" shoppers to make healthier purchases in supermarkets. In a recent study, Young et al. collaborated with a supermarket retailer to test the impact of prominent shelf placement on the sales of healthier breakfast cereals. This well-designed, 12-week product placement intervention did not increase sales of the healthier products. Does this mean healthy supermarket choice architecture does not work? Shelf placement interventions may not be able to overcome customers' strong preferences for their habitual choices and brands, and in-store displays and promotions may further reduce the effect of these interventions. Healthy choice architecture is more likely to be effective if default choices are compatible with shoppers' personal preferences or long-term goals, such as saving money or keeping their children healthy. Combining product placement interventions with other nudges that are salient, such as price incentives or simplified health labels, are more effective. Healthy choice architecture interventions hold promise for improving population dietary behaviors and health, but academic and public health collaboration with food retailers is needed to develop effective strategies that take into account shoppers' preferences, socioeconomic barriers, and health-related knowledge.

Factors Influencing Purchase Intention for Low-Sodium and Low-Sugar Products

As sodium and sugar intake in South Korea exceed recommended levels, the government and food industry have been attempting to reduce the amount of sodium and sugar in the food products. In line with these efforts, this study sought to examine how the purchase intention for low-sodium/low-sugar products vary based on consumers’ previous choices of low-sodium/low-sugar products and other consumer-related factors. For this study, two online survey-based experiments were conducted: one using soy sauce to represent a sodium-based product and the other using yogurt to represent a sugar-based product. The significant variables that influenced the purchase intention for both were the consumers’ previous low-sodium/low-sugar product choices and their propensity for food neophobia. Consumers who had previously selected regular products showed a lower intention to purchase low-sodium soy sauce or low-sugar yogurt. In addition, those who had a strong tendency toward food neophobia also had a significantly lower purchase intention for these products. Moreover, the lower the consumer′s unhealthy = tasty intuition (UTI), the higher the purchase intention for the low-sodium soy sauce, but UTI did not act as a significant variable for the low-sugar yogurt. These results demonstrate that government interventions for low-sodium products and low-sugar products should be differentiated.

Communication channels for air quality alerts in the United States

Short-term exposure to air pollution can result in acute health effects, particularly for individuals with respiratory and cardiovascular disease. Air quality alert programs that notify the public about high air pollution days are critical for susceptible populations. We assessed how U.S. adults receive air quality alerts and whether it varies by demographic or health characteristics. We analyzed data from the summer 2014 wave of ConsumerStyles, a nationally representative survey of U.S. adults (n = 4269). We calculated the weighted proportion of individuals who received air quality alerts from seven communication channels, combining all individuals and stratifying by demographics. To assess whether the reach of communication channels varied by respiratory and cardiovascular disease status, we computed weighted prevalence ratios adjusted for sex, age, race, and education. Forty-eight percent of U.S. adults had heard about air quality alerts. Within every demographic category, television was the most common communication channel (76% among individuals aware of air quality alerts). Other common communication modes were radio (30%), newspaper (24%), and internet (20%). Less common communication modes were friend or family member, mobile phone or device app, and electronic highway sign. The reach of communication channels varied by demographic factors, such as age, but not by respiratory or cardiovascular disease status. Television is the most common communication channel for receiving air quality alerts. Expanding use of other communication channels might increase awareness of air quality alerts. These results can help decision-makers target communication channels that reach susceptible populations and will achieve the greatest impact.

A systematic review of factors that influence food store owner and manager decision making and ability or willingness to use choice architecture and marketing mix strategies to encourage healthy consumer purchases in the United States, 2005-2017

Background

Altering food store environments is a promising approach to encourage healthy product purchases by consumers to improve their diet quality and health. Food store owners and managers are intermediaries to ensure that environmental changes are enacted. Despite their role as gatekeepers to implement and sustain healthy food environment changes, no systematic review has been published that examines food store owner and manager (retailer) data. Thus a review of retailer information available within the expansive United States (US) food environment literature was the purpose of this research.

Methods

The PRISMA protocol was used. A search strategy, including published articles from years 1980–2017, was applied to six databases to locate relevant articles that addressed the perspective of food store retailers in the US. Data were extracted, organized, and agreed upon between two authors based on pre-designed constructs: (1) a social-ecological model to capture factors that influence retailer decision making; and (2) a marketing-mix and choice-architecture framework to examine perspectives of applied (or the prospective application of) strategies at the store-level. Study quality was assessed using quality criteria checklists for qualitative and quantitative research.

Results

Thirty-one articles met inclusion criteria and most studies (n = 22) were qualitative and conducted in urban food stores (n = 23). Multiple social-ecological factors influenced retailer decision making and ability or willingness to use marketing-mix and choice-architecture strategies to improve consumers’ healthy choices to support dietary quality. These factors included: conflicting training outcomes to enhance retailers’ knowledge and skills (individual, n = 9); the importance of trust (interpersonal, n = 8); views about marketing-mix and choice-architecture strategies in the food environment (n = 25); consumer demand or demographics (community, n = 19); supplier and food store management variables (systems or sectors, n = 18); local and federal policy (n = 8); and support for community health (norms/values, n = 8).

Conclusions

Research partnerships can support favorable business and public health outcomes to align with retailers’ business models and available resources. A participatory and translational approach to food environment research will likely maximize public health impact. Urban and rural food store retailers are important actors for future research to inform the feasibility of store retailers to apply MMCA strategies that are profitable and promote health.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0767-8) contains supplementary material, which is available to authorized users.

Being Motivated by Nutrition Is Associated With Healthy Home Food Environment of Supplemental Nutrition Assistance Program (SNAP) Recipients

OBJECTIVE

To examine the relationship between food shopping motivating factors and the home food environment (HFE).

METHODS

Participants in the Supplemental Nutrition Assistance Program (n = 123) who were taking part in the Utah State Double-Up Food Bucks evaluation program were interviewed about their HFE, factors motivating shopping, and food security status. Composite HFE scores were derived from the Perceived Nutrition Environment Measure Survey questionnaire and food security score from the 6-item US Household Food Security Survey questionnaire. Analysis included multiple linear regression.

RESULTS

Mean age was 46 ± 16.1 years. Regression models showed significant associations of being motivated by nutrition, education, and food security with HFE (β = 4.70, P = .03; β = 1.44, P = .06; and β = 1.44, P = .06, respectively).

CONCLUSION AND IMPLICATIONS

In-store interventions to improve perceived nutrition importance among shoppers may be a useful tool to improve home food supplies. Further research is recommended examining the association between food shopping motivators and the HFE in a larger population.

B'more Healthy Corner Stores for Moms and Kids: Identifying Optimal Behavioral Economic Strategies to Increase WIC Redemptions in Small Urban Corner Stores

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) redemption rates have been declining in many low-income urban settings, potentially related to aspects of the food environment. B’more Healthy Corner Stores for Moms and Kids was a feasibility trial in Baltimore City that aimed to test multiple behavioral economic (BE) strategies in 10 corner stores (intervention = eight stores, comparison = two stores), to evaluate their influence on the stocking and redemptions of WIC foods. Tested strategies included in-person storeowner training, point of purchase promotion, product placement, and grouping of products in a display. All four strategies were feasible and implemented with high reach, dose delivered, and fidelity. Additionally, text messaging was found to be an acceptable form of intervention reinforcement for storeowners. Analyses to assess change in stocking of WIC foods, total sales of WIC foods, and sales of WIC foods to WIC clients, revealed consistent positive changes after implementation of the store owner training strategy, while changes after the implementation of other strategies were mixed. Furthermore, WIC food sales to WIC clients significantly increased after the simultaneous implementation of two strategies, compared to one (p > 0.05). Results suggest that store owner training was the most influential strategy and that the implementation of more BE strategies does not necessarily lead to proportional increases in stocking and sales. Selected BE strategies appear to be an effective way of increasing stocking and sales of WIC foods in small urban food stores.

Air Quality Awareness Among U.S. Adults With Respiratory and Heart Disease

INTRODUCTION

Poor air quality affects respiratory and cardiovascular health. Information about health risks associated with outdoor air quality is communicated to the public using air quality alerts. This study was conducted to assess associations of existing respiratory and heart disease with three aspects of air quality awareness: awareness of air quality alerts, discussing with a health professional strategies to reduce air pollution exposure, and avoiding busy roads to reduce air pollution exposure when walking, biking, or exercising outdoors.

METHODS

During 2014-2016, a total of 12,599 U.S. adults participated in summer waves of the ConsumerStyles surveys and self-reported asthma, emphysema/chronic obstructive pulmonary disease, heart disease, and each aspect of air quality awareness. In 2017, associations between each health condition and air quality awareness were estimated using log binomial and multinomial regression.

RESULTS

Overall, 49% of respondents were aware of air quality alerts, 3% discussed with a health professional strategies to reduce air pollution exposure, and 27% always/usually avoided busy roads to reduce air pollution exposure. Asthma was associated with increased prevalence of awareness of air quality alerts (prevalence ratio=1.11, 95% CI=1.04, 1.20), discussing with a health professional (prevalence ratio=4.88, 95% CI=3.74, 6.37), and always/usually avoiding busy roads to reduce air pollution exposure (prevalence ratio=1.13, 95% CI=1.01, 1.27). Heart disease was not associated with air quality awareness.

CONCLUSIONS

Existing respiratory disease, but not heart disease, was associated with increased air quality awareness. These findings reveal important opportunities to raise awareness of air quality alerts and behavior changes aimed at reducing air pollution exposure among adults at risk of exacerbating respiratory and heart diseases.

Traffic-light labels and financial incentives to reduce sugar-sweetened beverage purchases by low-income Latino families: a randomized controlled trial

OBJECTIVE

The objective of the present study was to test the effectiveness of financial incentives and traffic-light labels to reduce purchases of sugar-sweetened beverages in a community supermarket.

DESIGN

In this randomized controlled trial, after a 2-month baseline period (February-March 2014), in-store traffic-light labels were posted to indicate healthy (green), less healthy (yellow) or unhealthy (red) beverages. During the subsequent five months (April-August 2014), participants in the intervention arm were eligible to earn a $US 25 in-store gift card each month they refrained from purchasing red-labelled beverages.

SETTING

Urban supermarket in Chelsea, MA, USA, a low-income Latino community.

SUBJECTS

Participants were customers of this supermarket who had at least one child living at home. A total of 148 customers (n 77 in the intervention group and n 71 in the control group) were included in the final analyses.

RESULTS

Outcomes were monthly in-store purchases tracked using a store loyalty card and self-reported consumption of red-labelled beverages. Compared with control participants, the proportion of intervention participants who purchased any red-labelled beverages decreased by 9 % more per month (P=0·002). More intervention than control participants reduced their consumption of red-labelled beverages (-23 % v. -2 % for consuming ≥1 red beverage/week, P=0·01).

CONCLUSIONS

Overall, financial incentives paired with in-store traffic-light labels modestly reduced purchase and consumption of sugar-sweetened beverages by customers of a community supermarket.

Understanding motivations for dietary supplementation during pregnancy: A focus group study

OBJECTIVE

to increase understanding of psychosocial factors (behavioural, normative and control beliefs) motivating vitamin and mineral supplement use during pregnancy.

DESIGN

ten focus group discussions and two in-depth interviews were conducted using a script comprising questions based on study objectives. All discussions were recorded, transcribed verbatim and analysed using a framework approach.

SETTING

South Australia, Australia.

SUBJECTS

40 women aged 21-45 years who were either pregnant or<12 months postpartum. Groups were stratified by education level (secondary education only vs. post-secondary) and gravidity (first vs. subsequent pregnancy).

RESULTS

all women, except one, used dietary supplements during pregnancy. Most women took supplements to achieve peace of mind knowing that nutrient requirements were 'definitely' being met. Other common factors motivating supplement use were the beliefs that supplementation: benefits maternal and fetal health; corrects known nutritional deficiencies; and is a more efficient method of obtaining required nutrients relative to food. Advice received from healthcare providers and marketing of supplements also motivated supplementation, while forgetting to take supplements was the most common barrier to use. Cost was only a barrier when considering whether or not to continue supplementation post-birth.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

women believe that supplements are an easier and more reliable source of nutrients than food intake alone, and rely on dietary supplementation as an insurance policy during pregnancy. Further studies are needed in larger and more representative samples to validate these findings and to test the effectiveness of information and intervention strategies targeting appropriate supplement use during pregnancy.

Less healthy breakfast cereals are promoted more frequently in large supermarket chains in Canada

BACKGROUND

The majority of food expenditures are made in supermarkets and this environment influences our purchasing and food intake. Breakfast cereals are frequently marketed as healthy food choices. The objective of this study was to examine the frequency of in-store promotions for cold breakfast cereals in Canadian supermarkets and to determine whether healthier or less healthy breakfast cereals are promoted more frequently.

METHODS

Data was collected once per week over a four-week period from a convenience sample of the five largest Canadian supermarkets in the Ottawa/Gatineau area. Data collection included the number of shelf facings, promotional displays, and the cost of cereals/100 g. The UK Nutrient Profiling Model was used to determine the healthfulness of each breakfast cereal.

RESULTS

29.8% (n = 67) of the 225 unique cereals were classified as healthier and 70.2% (n = 158) were classified as less healthy. Less healthy cereals were displayed at eye level, in the profitable middle shelves, 2.9 times more frequently than healthier cereals. There were 5.3 times more breakfast cereal shelf facings, 4.2 more end cap displays, 1.7 more mid-aisle displays and 3.3 more special pricing signage for less healthy cereals compared to healthier cereals. Less healthy cereals had a significantly higher average total number of shelf facings compared to healthier cereals (t = -4.28 (280.8), p < .001).

CONCLUSIONS

Breakfast cereal manufacturers need to consider reformulation of their breakfast cereals to improve their healthfulness and supermarkets need to increase the marketing of healthy breakfast cereals within their stores.

Marketing Strategies to Encourage Rural Residents of High-Obesity Counties to Buy Fruits and Vegetables in Grocery Stores

Introduction

Obesity rates in Appalachia are among the highest in the United States, and knowledge of upstream approaches to decrease prevalence among this vulnerable population is limited. The primary aim of this study was to examine the association between healthy, diet-based, social marketing interventions in grocery stores and frequency of fruit and vegetable intake.

Methods

A social marketing campaign was conducted among 17 grocery stores (N = 240 participant surveys) over 4 months in 5 rural Kentucky counties. Interventions included providing food samples, recipe cards, and promotional discounts on fruits and vegetables and moving high-calorie foods to side aisles.

Results

Most survey participants reported that recipe cards influenced their desire to purchase ingredients as well as fruits and vegetables in general. Results indicated a significant association between the influence of recipe cards and frequency of fruit and vegetable consumption.

Conclusion

Small-scale interventions in grocery stores influenced purchasing choices among Appalachian residents. Working with various store managers and food venues in rural high-obesity communities is a promising way to encourage purchasing of fruits and vegetables.

Development and Implementation: B'More Healthy Communities for Kid's Store and Wholesaler Intervention

Higher rates of obesity and obesity-related chronic disease are prevalent in communities where there is limited access to affordable, healthy food. The B'More Healthy Communities for Kids (BHCK) trial worked at multiple levels of the food environment including food wholesalers and corner stores to improve the surrounding community's access to healthy food. The objective of this article is to describe the development and implementation of BHCK's corner store and wholesaler interventions through formal process evaluation. Researchers evaluated each level of the intervention to assess reach, dose delivered, and fidelity. Corner store and wholesaler reach, dose delivered, and fidelity were measured by number of interactions, promotional materials distributed, and maintenance of study materials, respectively. Overall, the corner store implementation showed moderate reach, dose delivered, and high fidelity. The wholesaler intervention was implemented with high reach, dose, and fidelity. The program held 355 corner store interactive sessions and had 9,347 community member interactions, 21% of which were with children between the ages of 10 and 14 years. There was a 15% increase in corner store promoted food stocking during Wave 1 and a 17% increase during Wave 2. These findings demonstrate a successfully implemented food retailer intervention in a low-income urban setting.