Age-Specific Differences in Online Grocery Shopping Behaviors and Attitudes among Adults with Low Income in the United States in 2021

Grocery Shopping and Eating Behaviors Differ Between Persons With and Without a Spinal Cord Injury

Background

Spinal cord injury (SCI) heightens the susceptibility to neurogenic obesity, which is driven by alterations in energy metabolism and suboptimal dietary habits after injury. Those with SCI may adjust their grocery shopping and eating behaviors, notably influencing overall health outcomes.

Objectives

To assess differences in grocery shopping and eating behaviors between persons with and without (controls) SCI.

Methods

In an online, cross-sectional study, adults with (n = 207) and without (n = 52) SCI completed a one-time survey that assessed grocery shopping behavior (shopping frequency and who completed the shopping) and eating behaviors, including the frequency of consuming alcoholic beverages, fast food, and preferences for fried food. Regression analyses were employed for group comparisons, controlling for relevant measures.

Results

Compared to the controls, a smaller proportion of persons with SCI grocery shopped independently in person (P = .002), and a greater proportion relied on others to fulfill grocery needs (P = .008). Individuals with SCI demonstrated a reduced monthly frequency of overall (P = .019) and independent in-person grocery shopping than controls (P = .014). In contrast, the monthly frequency of grocery shopping through delivery and from their caregivers was similar (P > .05). Fried food and fast-food intake were comparable (P > .05), whereas alcoholic beverage consumption was lower in individuals with SCI than controls (P = .006).

Conclusion

People with SCI reported obtaining groceries less often than controls, and a greater proportion relied on others, rather than themselves, to fulfill grocery needs. These findings highlight the influence of SCI on biobehavioral activities affecting neurogenic obesity, suggesting potential targets for interventions to enhance health outcomes post-SCI.

Changes in grocery shopping behaviour among low-income households during the COVID-19 pandemic

OBJECTIVE

The Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) authorised the use of SNAP benefits online in Maryland in May 2020. We assessed shopping behaviour and intentions associated with uptake and intended future use of online grocery shopping during and after COVID-19 among SNAP-eligible households.

DESIGN

In this mixed-methods study, participants completed a survey on online grocery shopping, and a purposefully sampled subset participated in focus groups or in-depth interviews between November 2020 and March 2021.

SETTING

Predominantly urban households in Maryland.

PARTICIPANTS

Primary shoppers of SNAP-eligible households with young children (n 310).

RESULTS

Most participants reported first shopping for groceries online after the OPP was implemented (57 %). Families who purchased groceries in-store less frequently were less likely to report ever buying groceries online (rate ratio (RR): 0·66, 95 % CI 0·46, 0·93) compared with weekly grocery shoppers. Shoppers who intended to purchase more groceries online in the next 6 months were more likely to have online shopping experience, although this differed by timing of online grocery service adoption. Participants reported more negative attitudes towards in-store grocery shopping during the pandemic than prior to its onset and cited COVID-19 as a motivator for ordering groceries online in focus groups. Most participants who had shopped online planned to continue after the pandemic (79 %).

CONCLUSIONS

Most participants who shopped online started during the COVID-19 pandemic and considered the pandemic a key motivator. Findings suggest that low-income households will continue to shop online, affirming the need for policies that promote equitable access to healthy food online.

Exploring contexts for using digital food retail services in Canada: a qualitative study

This study aimed to understand contexts for buying food online with food delivery apps, meal kits, and online grocers in Canada. A total of 34 participants (24% identified as men) between the ages of 16 and 60 were interviewed over the phone. The participants were recruited through personal and professional networks, electronic word of mouth, and paid social media ads. The interviews were transcribed verbatim and thematic analysis was used to generate major themes: convenience, food literacy, and cost-effectiveness. Convenience was multifaceted, including protecting time, minimizing food preparation effort, and facilitating food access (without a vehicle, during illness and isolation, during bad weather, with mobility challenges, or while consuming drugs or alcohol). It was found that regardless of age, gender, or lifestyle, the contexts for using digital food retail services were similar. These services made food acquisition and preparation easier; however, the benefits may be at the detriment to food literacy. The added value that digital food retail services provided made up for any additional costs. This study highlighted the need for public health practitioners to consider different facets of convenience and the added value that digital food retail services offer when making healthy food shopping and preparation recommendations. Additionally, further investigation into the impacts of digital food retail on food literacy is warranted. Results from this study will be integrated into a larger survey exploring the relationship between online food purchasing behaviors and diet quality among Canadians.

Analysis of food supplements and sports foods consumption patterns among a sample of gym-goers in Portugal

BACKGROUND

Gym-goers usually seek methods to improve performance, muscle gain, and overall health. One of the main strategies is including food supplements (FS) into their routine as aids to enhance their athletic capabilities and satisfy their nutritional needs. Thus, this study aimed to investigate and characterize the main FS and Sports Foods (SF) currently consumed, as well as the main reasons for their use and the source of advice in a group of gym-goers in the Lisbon Metropolitan Area (Portugal).

METHODS

A cross-sectional study was conducted, including 303 gym-goers from Lisbon, Portugal, who were 133 women and 170 males (30.8 ± 12.9 years old). Face-to-face interviews were used by qualified researchers to gather data.

RESULTS

Most of the interviewed athletes (71.95 %) took FS/SF, being men the main consumers. On average, 1.59 supplements were consumed per athlete. Logistic regression models indicated significant associations between age, gender, and motivations for gym attendance. While men and younger groups attended mainly for hypertrophy, women and older groups were focused on well-being. Protein (59.17 %) was the most used FS/SF, followed by creatine (41.28 %) and multivitamins (27.06 %). Men and younger individuals preferred protein and creatine, while older individuals focused more on specific vitamins and minerals. Women seemed to prefer L-carnitine and protein yogurts. Main sources of information included the internet, friends, and dietitians with notable gender and age-based preferences. Online stores were the main place of purchase. Monthly expenditures on FS/SF were not significantly affected by age or gender, but motivations for use had an influence.

CONCLUSION

Most of the athletes interviewed took FS/SF, being men the major consumers. Protein was the principal FS/SF used, with online stores being the main place of purchase and the internet the primary source of information. Age and gender were key factors in adopted training, in the FS/SF chosen, and in the source of information selected. It is crucial that health professionals take primary responsibility for providing this guidance.

Feasibility and acceptability of a personalized, pre-filled online grocery cart to improve benefit redemption and diet quality of grocery purchases among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Most participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) do not fully redeem their benefits due to barriers like transportation, confusing product eligibility, and unclear labeling. Online food shopping enables choice architecture to promote benefit redemption and maximize diet quality. We conducted a mixed-methods pilot randomized-controlled trial to assess the feasibility and acceptability of a pre-filled online grocery shopping cart to improve WIC benefit redemption and diet quality of grocery purchases. Rhode Island WIC participants (n = 24, mean age 29.4 ± 1.1 years, 75% Hispanic, 54% had never grocery shopped online) completed a baseline questionnaire and a simulated shopping episode (SSE), buying WIC and non-WIC items. After a week, we randomized participants into the intervention (personalized, modifiable carts pre-filled with 100% of the 2022 proposed WIC packages) or control (selected their items individually) groups before the second SSE. Both groups had WIC labels. We assessed feasibility using process data and percent agreement to feasibility questions, and acceptability via percent agreement to acceptability questions and post-intervention qualitative interviews. We conducted exploratory analyses to examine differences within and between groups at each timepoint for percent WIC benefit redemption and diet quality of grocery purchases, evaluated using the Grocery Purchase Quality Index-2016 (GPQI-2016) scores. Quantitative study measures suggest that the intervention was feasible and that the personalized, modifiable pre-filled cart was acceptable. These findings were supported during qualitative interviews, where participants highlighted time-savings, flexibility, and WIC labels as facilitators of WIC online shopping. Exploratory results showed significant increases in mean percent redemption of most WIC food categories and non-significant moderate increases in most GPQI-2016 scores. These measures are vital for the future adaptation of a full-scale efficacy trial in real-life settings.

Technology-based instrumental activities of daily living in persons with Alzheimer's disease and related disorders

INTRODUCTION

Instrumental activities of daily living (iADLs) increasingly involve technology (e.g., making payments online, texting). The current study examined the applicability and diagnostic accuracy of technology-based iADLs in those evaluated for Alzheimer's disease and related dementias (ADRD).

METHODS

A total of 264 care partners of persons undergoing comprehensive interdisciplinary evaluations completed the Functional Activities Questionnaire and 11 technology-based iADL items.

RESULTS

Technology-based iADLs applied to more than 80% of patients. Average dependence on technology-based items was overall less than for traditional iADLs. The addition of technology-based items to traditional iADL items slightly improved the ability to identify individuals with dementia. When considered separately, technology-based iADL items demonstrated comparable ability to distinguish between diagnostic stages.

DISCUSSION

Technology use is common in older adults with ADRD for a range of daily activities. Accounting for technology use increases the content validity of existing iADL measures for the modern context and yields comparable diagnostic accuracy.

Highlights

Technology use is often integral to daily activity performance for individuals with Alzheimer's disease and related dementias (ADRD).Daily technologies, such as smartphones, were used frequently by those with ADRD.Many individuals were less dependent on technology activities than traditional activities.Adding technology questions slightly increased diagnostic accuracy for detecting dementia.

"The Dollar Store Got It Going On": Understanding Food Shopping Patterns and Policy Preferences among Dollar Store Shoppers with Low Incomes

Background

The growing dollar store sector has raised concerns about nutrition and associated health outcomes, especially for low-income communities who disproportionately rely on dollar stores. Perspectives of dollar store shoppers are largely absent.

Objective

This study aimed to understand why low-income shoppers choose to purchase food from dollar stores and what store changes, policies, and programs would make it easier for them to purchase healthier items.

Methods

In May-June 2023, we conducted interviews with 19 dollar store shoppers in an urban county in North Carolina. We used thematic analysis and the framework method to identify emergent patterns and themes across responses.

Results

Individuals relied on dollar stores because of the affordable prices and convenient locations. In order of frequency, most participants purchased candy and snacks from dollar stores, followed by meat, fruits, and vegetables. Participants wanted more fruits, vegetables, and higher quality proteins at dollar stores and supported policies that increase access to healthier options via increased purchasing power, increased access to a mobile farmers' market, marketing that identifies nutritionally healthy products, and improved access to other store types. Responses to removing unhealthy items from checkout areas were mixed.

Conclusions

Dollar stores are affordable and convenient food retailers for people with low incomes. However, dollar stores are not meeting demand for fruits, vegetables, and proteins, items necessary for food and nutrition security. To improve food access and community health, decision makers should incorporate community perspectives into efforts aimed at improving dollar store food options.

Barriers and Facilitators to Online Grocery Shopping Among Supplemental Nutrition Assistance Program (SNAP) Participants: A Mixed Method Study

This mixed methods study explored online grocery shopping perceptions by surveying individuals who do and do not receive SNAP benefits (n = 129) and by conducting interviews with SNAP recipients (n = 26) who have grocery shopped online. T-tests assessed survey findings, codebook thematic analysis was used to identify qualitative themes, and results were interpreted collectively. Survey results found no differences in perceptions of online grocery shopping between SNAP and non-SNAP recipients (p-values = 0.2-1.0) and that 97% of SNAP recipients felt comfortable using SNAP online. Five qualitative themes were identified and provided context to the survey results. The study findings can inform policy actions within SNAP.

Online retail nudges to help parents with lower-income choose healthy beverages for their children: A randomized clinical trial

BACKGROUND

Nudges offer a promising tool to reduce sugary drink intake among children who are most at risk for diet-related disease.

OBJECTIVE

To examine the impact of online store nudges on purchases of sugary drinks for children in lower-income households.

METHODS

Caregivers with lower-income were recruited to an online shopping experiment and instructed to spend $10-$30 on three beverages for their child aged 1-5 years. Participants were randomized to navigate an online supermarket in its standard version (n = 1106) or a version with nudges (n = 1135), including a product placement nudge (i.e. placing healthy beverages in prominent positions) and a swap nudge (i.e. offering a swap of water, plain milk and/or 100% fruit juice upon selection of sugary drinks).

RESULTS

On average, participants purchased 1887 (SD = 2113) and 620 (SD = 1528) calories from sugary drinks per basket in the control and experimental conditions, respectively. Model-based results indicate that those in the experimental condition purchased 1267 (95% CI: 1419, 1114) fewer calories from sugary drinks, and fewer grams of total sugar (β = -253.5 g (95% CI: -286.3, -220.6)) and added sugar (β = -287.8 g (95% CI: -323.1, -252.5)) purchased from sugary drinks.

CONCLUSION

Nudges may be an effective, acceptable, scalable strategy for leading caregivers in lower-income households to purchase fewer sugary drinks for their children.

Perspectives and Attitudes of Newer New Jersey High School Teachers towards Cleaning, Sanitizing, and Disinfecting Consumer Products Used in School Classrooms

During the COVID-19 pandemic, there was an increased reported use of chemical cleaning, sanitizing, and disinfecting products (CSDPs), which created public concerns about negative health consequences for both children and adults in public schools. A subset of newer teachers shared experiences regarding safety and health (S&H) while working in school-based settings through a series of online surveys. Surveys were provided to teachers who completed work-based learning supervisory trainings provided by the New Jersey Safe Schools Program between October 2021 and June 2023. The participants answered questions focusing on CSDPs purchased for school use, their attitudes towards CSDPs, their use of personal protective equipment, and symptoms employees may have had due to CSDPs. A total of 205 teacher participants successfully completed the surveys. Over 25% of the teachers did not know where their CSDPs originated from, as they were provided by the school. Most participants "sometimes", "not often", or "never" read labels for CSDP ingredients or looked them up on healthy product apps. The participants (60%) tended to wear gloves while cleaning/disinfecting but did not wear masks. A third of the participants experienced respiratory health problems after working at school. Overall, the data suggest that more education on S&H regarding CSDPs needs to be provided to New Jersey teachers.

Effect of Financial Incentives and Default Options on Food Choices of Adults With Low Income in Online Retail Settings: A Randomized Clinical Trial

Importance

Despite recent growth in online redemption of Supplemental Nutrition Assistance Program (SNAP) benefits, no previous work has tested the impact of economic and behavioral economic strategies on food purchasing behaviors in an online grocery retail setting among adults with low income.

Objective

To examine the extent to which financial incentives and default shopping cart options influence fruit and vegetable purchases.

Design, Setting, and Participants

This randomized clinical trial used an experimental online grocery store for adults who currently or have ever received SNAP benefits. From October 7 to December 2, 2021, participants were instructed to shop for a week's worth of groceries for their household, with a budget tailored to household size; no payment was taken.

Interventions

Random assignment to 1 of 4 conditions: no intervention, 50% discount on eligible fruits and vegetables, prefilled shopping carts with tailored fruit and vegetable items (ie, default options), or a combination of the discount and default options.

Main Outcomes and Measures

The primary outcome was the percentage of nondiscounted dollars spent on eligible fruit and vegetables per basket.

Results

Of 2744 participants, mean (SD) age was 46.7 (16.0) years, and 1447 (52.7%) identified as women. A total of 1842 participants (67.1%) reported currently receiving SNAP benefits and 1492 (54.4%) reported shopping online for groceries in the previous 12 months. Participants spent a mean (SD) 20.5% (23.5%) of total dollars on eligible fruits and vegetables. Compared with no intervention, those in the discount condition spent 4.7% (98.3% CI, 1.7%-7.7%) of more total dollars on eligible fruits and vegetables; those in the default condition, 7.8% (98.3% CI, 4.8%-10.7%) more; and those in the combination condition, 13.0% (98.3% CI, 10.0%-16.0%) more (P < .001 for all). There was no difference between the discount and the default conditions (P = .06), but the effect in the combination condition was significantly larger than both discount and default conditions (P < .001). Default shopping cart items were purchased by 679 participants (93.4%) in the default condition and 655 (95.5%) in the combination condition, whereas 297 (45.8%) in the control and 361 (52.9%) in the discount conditions purchased those items (P < .001). No variation was observed by age, sex, or race and ethnicity, and results were similar when those who reported never shopping online for groceries were excluded.

Conclusions and Relevance

In this randomized clinical trial, financial incentives for fruits and vegetables and default options, especially in combination, led to meaningful increases in online fruit and vegetable purchases among adults with low income.

Trial Registration

ClinicalTrials.gov Identifier: NCT04766034.

Can Ordering Groceries Online Support Diet Quality in Adults Who Live in Low Food Access and Low-Income Environments?

During the COVID-19 pandemic, U.S. food assistance programs allowed the use of program benefits to order groceries online. We examined relationships between the food environment, food assistance, online grocery ordering, and diet quality among adults from one low-income, low food access community in Northeastern Connecticut during the pandemic. Via online survey, adults (n = 276) reported their perceived home and store food environments, food assistance participation, whether they ordered groceries online, and consumption frequency and liking of foods/beverages to calculate diet quality indices. Those who ordered groceries online (44.6%) were more likely to participate in food assistance programs and report greater diet quality. Perceived healthiness of store and home food environments was variable, with the ease of obtaining and selecting unhealthy foods in the neighborhood significantly greater than healthy foods. Healthier perceived home food environments were associated with significantly higher diet qualities, especially among individuals who participated in multiple food assistance programs. Ordering groceries online interacted with multiple measures of the food environment to influence diet quality. Generally, the poorest diet quality was observed among individuals who perceived their store and home food environments as least healthy and who did not order groceries online. Thus, ordering groceries online may support higher diet quality among adults who can use their food assistance for purchasing groceries online and who live in low-income, low-access food environments.