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Rummo PE, Seet C, Reimold AE, Duffy EW, Prestemon CE, Hall MG, Bragg MA, Taillie LS. Online retail nudges to help parents with lower-income choose healthy beverages for their children: A randomized clinical trial. Pediatr Obes 2024; 19:e13150. [PMID: 38993007 DOI: 10.1111/ijpo.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/21/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024]
Abstract
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.
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Affiliation(s)
- Pasquale E Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Carla Seet
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Alexandria E Reimold
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily W Duffy
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carmen E Prestemon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marie A Bragg
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Trude ACB, Bunzl NB, Rehman ZN, Elbel B, Lau S, Talal LA, Weitzman BC. "I Don't Want an App to Do the Work for Me": A Qualitative Study on the Perception of Online Grocery Shopping From Small Food Retailers. J Acad Nutr Diet 2024; 124:804-822. [PMID: 38103594 DOI: 10.1016/j.jand.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Small food retailers often stock energy-dense convenience foods, and they are ubiquitous in low-income urban settings. With the rise in e-commerce, little is known about the acceptability of online grocery shopping from small food retailers. OBJECTIVE To explore perceptions of the role of small food retailers (bodegas) in food access and the acceptability of online grocery shopping from bodegas among customers and owners in a diverse New York City urban neighborhood with low incomes. DESIGN In-depth interviews were conducted with bodega owners and adult customers between May and July 2022. PARTICIPANTS/SETTING Bodega owners who either had (n = 4) or had not (n = 2) implemented a locally designed online grocery system. Customers (n = 25) were recruited through purposive sampling and were eligible if they purchased at bodegas (>once per month), had low income (household income ≤130% of the federal poverty level or Supplemental Nutrition Assistance Program [SNAP] participants), and owned smartphones. ANALYSES PERFORMED All interviews were transcribed and analyzed in MAXQDA (Verbi Software, Berlin, Germany), using grounded theory. RESULTS To owners and customers, bodegas were seen as good neighbors providing culturally appropriate foods and an informal financial safety net. Their perceptions concerning food cost and availability of healthy foods in bodegas diverged. Although most perceived online grocery from bodegas as a positive community resource, they also believed it was not suited to their own community because of the bodega's proximity to customers' homes and the low digital literacy of some community members. Customers reported social norms of pride in not using online grocery shopping. Owners and customers believed the service would more likely be used if government benefits such as SNAP allowed payment for online orders. Both suggested improved outreach to increase program awareness and uptake. CONCLUSIONS Online grocery shopping from small food retailers may be acceptable in urban communities with low income and was perceived as a community resource. However, important barriers need to be addressed, such as social norms related to pride in not using online grocery services, digital literacy, program awareness, and allowing SNAP payment for online orders from bodegas.
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Ferrante MJ, McGovern L, Epstein LH, Hollis-Hansen K, Leone LA, Anzman-Frasca S. Optimal Defaults in Online Grocery Shopping: A Secondary Analysis to Explore Impacts in Multiresident Households and Families. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:332-341. [PMID: 38416095 DOI: 10.1016/j.jneb.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To examine whether household type (eg, families with children) moderated the effects of an optimal defaults grocery intervention and examine intervention effects on grocery purchases to be consumed by the participant vs others in the household. METHODS Participants (n = 65) diagnosed with or at risk for type 2 diabetes were recruited and randomized into an optimal default online grocery intervention or an online or in-person control group. Grocery receipt data were coded into Dietary Approaches to Stop Hypertension nutritional quality scores, and energy, carbohydrate, and sugar content were calculated. Repeated measures analysis of variance examined household types (eg, single vs multi-resident) as moderators of intervention effects. Parallel models explored foods purchased for the participant and foods purchased for other household members separately. RESULTS Household type was not a significant moderator of intervention effects on nutritional quality or other nutrients of interest (P > 0.10). The default intervention significantly increased the nutritional quality of groceries purchased across household types and for other household members besides the participant (P < 0.05). CONCLUSIONS AND IMPLICATIONS Optimal defaults may improve grocery purchases across different household types and extend to others in the household, supporting use across household types.
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Affiliation(s)
- Mackenzie J Ferrante
- Department of Nutritional Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Lily McGovern
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY; Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY
| | - Kelseanna Hollis-Hansen
- Peter O'Donnell Jr, School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lucia A Leone
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY; Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY.
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Calloway EE, Steeves EA, Nitto AM, Hill JL. A Mixed-Methods Study of Perceived Implementation Challenges for WIC Online Ordering and Transactions. J Acad Nutr Diet 2023; 123:1449-1460. [PMID: 37149033 DOI: 10.1016/j.jand.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/29/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Federal food assistance programs are working towards online grocery shopping. Online ordering in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is emerging following successful implementation in Supplemental Nutrition Assistance Program (SNAP). OBJECTIVE To identify anticipated challenges, potential solutions, and expected costs of WIC online ordering. DESIGN Cross-sectional, mixed-methods, web-based, survey research. SUBJECTS AND SETTING Data were collected from December 2020 to January 2021. Purposeful and snowball sampling included WIC stakeholders involved in developing processes and systems required for WIC online ordering. Respondents represented diverse geographic areas, levels of intraorganizational authority, and WIC benefit card types. STATISTICAL ANALYSES PERFORMED The research team used a rapid analysis and lean coding approach to identify emergent themes from open-ended survey responses. Descriptive statistics were used to describe the distribution of responses across themes and stakeholder types. RESULTS Respondents (n = 145) described 812 anticipated challenges within 20 themes grouped into five topic areas: rules and regulations; shopping experience; security, confidentiality, fraud, and WIC State agency processes; training, assistance, and education; and equitable access and buy-in. Addressing anticipated regulatory issues were among the few concrete potential solutions described. The two most frequent costs reported were increased staff time and start-up and ongoing technology costs. CONCLUSIONS This study identified several, critical anticipated challenges and considerations that will help prepare WIC state agencies for opportunities to expand online ordering to WIC participants.
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Affiliation(s)
| | - Elizabeth Anderson Steeves
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska; Department of Nutrition, University of Tennessee, Knoxville, Tennessee
| | | | - Jennie L Hill
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska; Population Health Sciences, University of Utah, Salt Lake City, Utah
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Keeton VF, Yu SM, Al-Lami N, Ramilo K, Chavez L, Angila E. Barriers and Facilitators to Implementation of a Child Care Center-Based Produce Delivery Program. Prog Community Health Partnersh 2023; 17:645-652. [PMID: 38286779 PMCID: PMC10832254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Regular consumption of produce is a challenge for families with young children in low food access areas. OBJECTIVE A community partnership formed to evaluate feasibility of and interest in a child care center-based program for produce delivery from an online grocery vendor. METHODS Surveys were collected from caregivers across three child care centers, including produce program participants. Descriptive statistics summarize household characteristics and participants' experience with the program. RESULTS Challenges related to online payment and difficulty planning delivery times led to implementation of a modified intervention. Survey results revealed factors related to food access and storage that may impact interest and feasibility of online grocery in some communities. CONCLUSIONS Online grocery vendors may increase accessibility to fresh produce for families, but barriers to their use still exist. Trusted community partners such as child care centers may offer some of the resources needed for success.
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Trude ACB, Ali SH, Lowery CM, Vedovato GM, Lloyd-Montgomery JM, Hager ER, Black MM. A click too far from fresh foods: A mixed methods comparison of online and in-store grocery behaviors among low-income households. Appetite 2022; 175:106038. [PMID: 35421540 DOI: 10.1016/j.appet.2022.106038] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/09/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
Abstract
A recent policy in the U.S. authorized monthly benefits from a nutrition assistance program - Supplemental Nutrition Assistance Program (SNAP) - to be used online to increase grocery access and promote healthy eating. This study examined online grocery attitudes and purchasing behaviors among low-income SNAP-eligible households with young children with and without online grocery experience. An explanatory sequential mixed methods design was used, including a survey informed by the theory of planned behavior (TPB) and focus groups conducted between November-March 2021. In the quantitative phase, 310 Maryland residents completed an online survey assessing TPB constructs (attitudes, social norms, perceived control), and food purchase frequency online and in-store. Subsequently, 42 participated in the qualitative phase. Differences in TPB constructs and food purchases were compared between families with and without online grocery experience. Online food selection and fees were a common obstacle to online grocery purchasing. Families who had purchased groceries online (57%) had more positive attitudes and perceived fewer barriers to online shopping than those who had not. Self-reported frequency of buying fresh produce (OR = 0.34, p < 0.001), meat and seafood (OR = 0.29, p < 0.001), and sweets (OR = 0.54, p = 0.005) were lower online than in-store. Families discussed mistrust of online hired shoppers and fewer impulse purchases online as reasons for less frequent purchases of produce and sweets, respectively. Successful scale-up of the U.S. policy must address barriers to healthier purchasing behaviors to effectively promote equitable food access, such as decreasing delivery fees and improving the online food selection.
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Affiliation(s)
- Angela C B Trude
- University of Maryland School of Medicine, Baltimore, 737 W. Lombard St., Baltimore, MD, 21201, USA; New York University, Steinhardt School of Culture, Education, and Human Development, Department of Nutrition and Food Studies, 411 Lafayette St, 5th Floor, New York, NY, 10003, USA.
| | - Shahmir H Ali
- New York University, School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Caitlin M Lowery
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Gabriela M Vedovato
- Federal University of Sao Paulo, Institute of Health and Society, 136 Silva Jardim, Santos, SP, 11015-020, Brazil.
| | - Joy M Lloyd-Montgomery
- University of Maryland School of Medicine, Baltimore, 737 W. Lombard St., Baltimore, MD, 21201, USA; American Psychiatric Association Foundation, 800 Maine Avenue, S.W., Suite 900, Washington, DC, 20024, USA.
| | - Erin R Hager
- University of Maryland School of Medicine, Baltimore, 737 W. Lombard St., Baltimore, MD, 21201, USA; Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
| | - Maureen M Black
- University of Maryland School of Medicine, Baltimore, 737 W. Lombard St., Baltimore, MD, 21201, USA; RTI International, Research Triangle Park, NC, 27709, USA.
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Foster IS, Liu SY, Hoffs CT, LeBoa C, Chen AS, Rummo PE. Disparities in SNAP online grocery delivery and implementation: Lessons learned from California during the 2020-21 COVID pandemic. Health Place 2022; 76:102811. [PMID: 35605572 PMCID: PMC9122786 DOI: 10.1016/j.healthplace.2022.102811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
During the COVID-19 pandemic in 2020, the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) was rapidly expanded across the US. This program, enabling direct-to-home grocery delivery, could be a transformative step towards improving fresh-food access. However, lack of information on which areas are serviced by SNAP OPP hinders the identification of potential demographic and regional disparities in access. Lessons from the initial implementation period are critical for understanding continuing inequities and informing the implementation of future programs. In California, SNAP OPP expanded food access for 85.9% of the state's SNAP households in 2020–21. Coverage was significantly greater in urban areas, covering 87.2% of CalFresh households in urban limited food access areas as compared with 29.9% of CalFresh households in rural limited food access areas. County-level COVID-19 rates did not have a meaningful association with SNAP OPP coverage.
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Affiliation(s)
- Isabelle S Foster
- Freeman Spogli Institute for International Studies: FSI, Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA.
| | - Samantha Y Liu
- Department of Civil and Environmental Engineering, Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA.
| | - Charlie T Hoffs
- Department of Chemical Engineering, Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA.
| | - Christopher LeBoa
- Department of Infectious Disease and Geographic Medicine, Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA.
| | - Andrew S Chen
- Department of Computer Science, Stanford University, Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA.
| | - Pasquale E Rummo
- Department of Population Health, NYU Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA.
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Headrick G, Khandpur N, Perez C, Taillie LS, Bleich SN, Rimm EB, Moran A. Content Analysis of Online Grocery Retail Policies and Practices Affecting Healthy Food Access. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:219-229. [PMID: 34920967 DOI: 10.1016/j.jneb.2021.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe policies and practices of online grocery retailers that may affect healthy food access, including retailers participating in the US Department of Agriculture's Supplemental Nutrition Assistance Program Online Purchasing Pilot. DESIGN Cross-sectional, quantitative content analysis of 21 online grocery retail websites from November 2019 to January 2020. MAIN OUTCOME MEASURES Data collected using a coding instrument capturing the presence of policies and practices related to (1) online purchasing and delivery access; (2) availability of features that allow price comparisons and provide nutrition information; and (3) data privacy. ANALYSIS Descriptive statistics for features, practices, and policies across online grocery retail websites. RESULTS Most retailers (95%) added fees to online orders. Among pilot retailers, 38% added ≥ 3 fees, and 50% required a minimum order > $15. Few retailers (29%) displayed Nutrition Facts Labels on all products, including 50% of pilot retailers. All retailers collected personal information from shoppers and automatically shared data with affiliated companies. CONCLUSIONS AND IMPLICATIONS High fees, limited access to nutrition information on retailer sites, and lack of data privacy are prevalent in online grocery retail settings, including among Online Purchasing Pilot retailers. Online retail practices may perpetuate disparities in healthy food access by discouraging use through fees and making nutritious food choices difficult.
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Affiliation(s)
- Gabby Headrick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Neha Khandpur
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutrition, University of Sao Paulo, Sao Paulo, Brazil
| | - Crystal Perez
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lindsey Smith Taillie
- Department of Nutrition, UNC Gillings School of Global Public Health, Caroline Population Center, University of North Carolina, Chapel Hill, NC
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alyssa Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Abstract
Context Online grocery services are an emerging component of the food system with the potential to address disparities in access to healthy food. Objective We assessed the barriers and facilitators of equitable access to healthy foods in the online grocery environment, and the psychosocial, purchasing, and dietary behaviors related to its use among low-income, diverse populations. Data Sources Four electronic databases were searched to identify relevant literature; 16 studies were identified. Results Barriers to equitable access to healthy food included cost and limited availability of online grocery services in food deserts and rural areas. The expansion of online grocery services and the ability to use nutrition assistance benefits online were equity-promoting factors. Perceived low control over food selection was a psychosocial factor that discouraged online grocery use, whereas convenience and lower perceived stress were facilitators. Findings were mixed regarding healthfulness of foods purchased online. Although few studies assessed diet, healthy food consumption was associated with online grocery use. Conclusion Researchers should assess the impact of online grocery shopping on low-income families’ food purchases and diet. Systematic Review Registration PROSPERO registration no. CRD: 42021240277
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Affiliation(s)
- Angela C B Trude
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- A.C.B. Trude, 411 Lafayette St, New York, NY 10003, USA. E-mail:
| | - Caitlin M Lowery
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shahmir H Ali
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York, USA
| | - Gabriela M Vedovato
- Institute of Health and Society, Federal University of Sao Paulo, Santos, Sao Paulo, Brazil
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Fernandez MA, Raine KD. Digital Food Retail: Public Health Opportunities. Nutrients 2021; 13:nu13113789. [PMID: 34836044 PMCID: PMC8624168 DOI: 10.3390/nu13113789] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 02/03/2023] Open
Abstract
For over two decades, digital food retail services have been emerging alongside advances in mobile technology and improved access to wi-fi. Digitalization has driven changes within the food environment, complicating an already complex system that influences food-related behaviors and eating practices. Digital food retail services support an infrastructure that enhances commercial food systems by extending access to and availability of highly processed foods, further escalating poor dietary intakes. However, digital food retail services are heterogeneous–food delivery apps, online groceries, and meal kits–and can be feasibly adapted to nutrition interventions and personalized to individual needs. Although sparse, new evidence indicates great potential for digital food retail services to address food insecurity in urban areas and to support healthy eating by making it easier to select, plan, and prepare meals. Digital food retail services are a product of the digital transformation that reflect consumers’ constant need for convenience, which must be addressed in future research and interventions. This paper will discuss public health opportunities that are emerging from the global uptake of digital food retail services, with a focus on online groceries, food delivery apps, and meal kits.
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Harnack L, Redden J, French S, Sherwood NE, Rivera G, Valluri S, Tahir M. Designing online grocery stores to support healthy eating for weight loss. Public Health Nutr 2021; 25:1-11. [PMID: 33634775 PMCID: PMC8387504 DOI: 10.1017/s1368980021000896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The current study aimed to identify features to include in online grocery stores to support healthful food purchasing by those striving to lose weight. DESIGN A Value Proposition Design approach was used to gain shopper insights, devise potential online grocery store features and obtain feedback on these features. SETTING Telephone interviews were conducted to gain insight into shoppers' needs and perceptions. Results were used by the research team to identify potential online grocery shopping features that may support healthful purchase decisions, and interviews were conducted with a different sample of shoppers to gather feedback on features. PARTICIPANTS Insight (n 25) and feedback (n 25) interviews were conducted with convenience samples of adults trying to lose weight. RESULTS Participants were primarily female, white, college educated and with obesity or overweight. Online grocery features devised by the research team based on findings from the insight interviews included (1) shopping cart nutrition rating tool; (2) healthy meal planning tool; (3) interactive healthy eating inspiration aisle and (4) healthy shopping preference settings option. Findings from the feedback interviews indicated that the healthy meal planning tool, healthy shopping preference settings option and shopping cart nutrition rating tool features were positively rated by most participants. CONCLUSIONS There are multiple features grocers should consider including in their online stores to attract and support customers striving to eat healthy for weight loss.
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Affiliation(s)
- Lisa Harnack
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd St., Suite 300, Minneapolis, MN 55454, USA
| | - Joseph Redden
- Carlson School of Management, University of Minnesota, Minneapolis, MN, USA
| | - Simone French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd St., Suite 300, Minneapolis, MN 55454, USA
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd St., Suite 300, Minneapolis, MN 55454, USA
| | - Gabrielle Rivera
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd St., Suite 300, Minneapolis, MN 55454, USA
| | - Sruthi Valluri
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd St., Suite 300, Minneapolis, MN 55454, USA
| | - Muna Tahir
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd St., Suite 300, Minneapolis, MN 55454, USA
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Locher I, Waselewski M, Sonneville K, Resnicow K, Chang T. Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study. JMIR Form Res 2020; 4:e21602. [PMID: 33361055 PMCID: PMC7790606 DOI: 10.2196/21602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/31/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. OBJECTIVE Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. METHODS The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US $35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants' perspectives on grocery delivery, participants' perspectives on dietary impact of the program, and foods consumed by participants. RESULTS A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5% (259/263) successful deliveries and 89.4% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. CONCLUSIONS A grocery delivery-based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy.
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Affiliation(s)
- Ione Locher
- University of Michigan, Ann Arbor, MI, United States
| | | | | | - Ken Resnicow
- University of Michigan, Ann Arbor, MI, United States
| | - Tammy Chang
- University of Michigan, Ann Arbor, MI, United States
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Jilcott Pitts SB, Ng SW, Blitstein JL, Gustafson A, Kelley CJ, Pandya S, Weismiller H. Perceived Advantages and Disadvantages of Online Grocery Shopping among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participants in Eastern North Carolina. Curr Dev Nutr 2020; 4:nzaa076. [PMID: 32399508 PMCID: PMC7204786 DOI: 10.1093/cdn/nzaa076] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022] Open
Abstract
This study's purpose was to qualitatively examine perceived advantages and disadvantages of online grocery shopping among participants (n = 7) in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Initial in-depth, qualitative interviews were conducted, after which participants completed an episode of online grocery shopping, picked up the online order at the store, and completed an in-store shopping episode and a follow-up in-depth interview. Interviews were audio-recorded, transcribed verbatim, and analyzed deductively. Participants stated that in-store impulse purchases occurred at the check-out and cookie aisles and included chips and candy, but sometimes healthier foods such as fruit. Advantages of online grocery shopping included ease, convenience, and saving time. Disadvantages included inadequate substitutions, the online shopping fee, lack of control over selection of perishable goods, and inability to find good deals online versus in the store. Further research is needed to determine how to encourage healthy grocery purchases online.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA
| | - Jonathan L Blitstein
- RTI International, Social Policy, Health, and Economic Research Unit, Research Triangle Park, NC, USA
| | | | - Casey J Kelley
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Shivani Pandya
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Hillary Weismiller
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Knowledge, Behaviors, and Social Factors That Influence Pregnancy Weight Gain among Youth Ages 16-24 Years. J Pediatr Adolesc Gynecol 2020; 33:64-71. [PMID: 31606389 PMCID: PMC6981007 DOI: 10.1016/j.jpag.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/27/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE A large proportion (50%-75%) of youth (younger than 21 years old) who become pregnant gain more weight during pregnancy than is recommended by the National Academy of Medicine. Excess weight gain during pregnancy is a strong risk factor for long-term obesity among mothers and their infants. There is a significant gap in our understanding of youth's knowledge and behavior related to weight gain during pregnancy. To develop effective interventions for pregnant youth, it is necessary to understand their distinct needs and preferences. Using a youth-centered qualitative approach, the purpose of this study was to explore the knowledge, behaviors, and social factors that influence weight gain during pregnancy for youth. DESIGN Participants completed weekly text message surveys and semistructured interviews to explore their perspectives of weight gain during pregnancy. Data were analyzed using qualitative thematic analysis on the basis of grounded theory. SETTING AND PARTICIPANTS Pregnant youth ages 16-24 years old recruited from 2 urban, low-income, primary care clinics in Southeast Michigan. INTERVENTIONS, MAIN OUTCOME MEASURES, AND RESULTS Among our sample (N = 54) 4 themes emerged. First, many youths were knowledgeable about healthy behaviors in pregnancy. However, the second theme showed that many youths reported barriers to engaging in these healthy behaviors, including stress, poor motivation, and issues of convenience. Third, they showed inadequate knowledge about exercise in pregnancy, and fourth, many endorsed food cravings that significantly influenced diet choices. CONCLUSION Many pregnant youths have appropriate knowledge about healthy behaviors during pregnancy, but face many youth-specific barriers to achieving these behaviors. Interventions should address logistical challenges (eg, food access, cost, transportation) to healthy behaviors in pregnancy to make healthy diet and exercise more convenient for pregnant youth.
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Lagisetty P, Flamm L, Rak S, Landgraf J, Heisler M, Forman J. A multi-stakeholder evaluation of the Baltimore City virtual supermarket program. BMC Public Health 2017; 17:837. [PMID: 29061141 PMCID: PMC5653995 DOI: 10.1186/s12889-017-4864-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/16/2017] [Indexed: 11/24/2022] Open
Abstract
Background Increasing access to healthy foods and beverages in disadvantaged communities is a public health priority due to alarmingly high rates of obesity. The Virtual Supermarket Program (VSP) is a Baltimore City Health Department program that uses online grocery ordering to deliver food to low-income neighborhoods. This study evaluates stakeholder preferences and barriers of program implementation. Methods This study assessed the feasibility, sustainability and efficacy of the VSP by surveying 93 customers and interviewing 14 programmatic stakeholders who had recently used the VSP or been involved with program design and implementation. Results We identified the following themes: The VSP addressed transportation barriers and food availability. The VSP impacted customers and the city by including improving food purchasing behavior, creating a food justice “brand for the city”, and fostering a sense of community. Customers appreciated using Supplemental Nutrition Assistance Program (SNAP) benefits to pay for groceries, but policy changes are needed allow online processing of SNAP benefits. Conclusions This evaluation summarizes lessons learned and serves as a guide to other public health leaders interested in developing similar programs. Provisions in the U.S. Department of Agriculture (USDA) Farm Bill 2014 allow for select grocers to pilot online transactions with SNAP benefits. If these pilots are efficacious, the VSP model could be easily disseminated.
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Affiliation(s)
- Pooja Lagisetty
- Division of General Internal Medicine at University of Michigan, Ann Arbor, MI, USA. .,VA Ann Arbor Center for Clinical Management Research, North Campus Research Center, University of Michigan, 2800 Plymouth Road, Bldg 16 Rm 345E, Ann Arbor, MI, 48109, USA. .,Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Laura Flamm
- Baltimore City Health Department, Baltimore, USA
| | - Summer Rak
- Baltimore City Health Department, Baltimore, USA
| | | | - Michele Heisler
- Division of General Internal Medicine at University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Center for Clinical Management Research, North Campus Research Center, University of Michigan, 2800 Plymouth Road, Bldg 16 Rm 345E, Ann Arbor, MI, 48109, USA.,Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Jane Forman
- Division of General Internal Medicine at University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Center for Clinical Management Research, North Campus Research Center, University of Michigan, 2800 Plymouth Road, Bldg 16 Rm 345E, Ann Arbor, MI, 48109, USA
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Appelhans BM, French SA, Pagoto SL, Sherwood NE. Managing temptation in obesity treatment: A neurobehavioral model of intervention strategies. Appetite 2015; 96:268-279. [PMID: 26431681 DOI: 10.1016/j.appet.2015.09.035] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/26/2015] [Accepted: 09/28/2015] [Indexed: 12/31/2022]
Abstract
Weight loss outcomes in lifestyle interventions for obesity are primarily a function of sustained adherence to a reduced-energy diet, and most lapses in diet adherence are precipitated by temptation from palatable food. The high nonresponse and relapse rates of lifestyle interventions suggest that current temptation management approaches may be insufficient for most participants. In this conceptual review, we discuss three neurobehavioral processes (attentional bias, temporal discounting, and the cold-hot empathy gap) that emerge during temptation and contribute to lapses in diet adherence. Characterizing the neurobehavioral profile of temptation highlights an important distinction between temptation resistance strategies aimed at overcoming temptation while it is experienced, and temptation prevention strategies that seek to avoid or minimize exposure to tempting stimuli. Many temptation resistance and temptation prevention strategies heavily rely on executive functions mediated by prefrontal systems that are prone to disruption by common occurrences such as stress, insufficient sleep, and even exposure to tempting stimuli. In contrast, commitment strategies are a set of devices that enable individuals to manage temptation by constraining their future choices, without placing heavy demands on executive functions. These concepts are synthesized in a conceptual model that categorizes temptation management approaches based on their intended effects on reward processing and degree of reliance on executive functions. We conclude by discussing the implications of our model for strengthening temptation management approaches in future lifestyle interventions, tailoring these approaches based on key individual difference variables, and suggesting high-priority topics for future research.
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Affiliation(s)
- Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren St, Suite 470, Chicago, IL 60612, USA; Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd Suite 400, Chicago, IL 60612, USA.
| | - Simone A French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454, USA.
| | - Sherry L Pagoto
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, 8170 33rd Ave S, Mail Stop 23301A, Bloomington, MN 55425, USA.
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Posner SF. Outstanding student research: Li et al on investigating the placement of green carts to improve access to healthful foods in food deserts. Prev Chronic Dis 2014; 11:E157. [PMID: 25211505 PMCID: PMC4164036 DOI: 10.5888/pcd11.140338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Samuel F Posner
- Preventing Chronic Disease: Public Health Research, Practice, and Policy, 4770 Buford Hwy, MS F-80, Atlanta GA 303041. E-mail:
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