Review of the Evidence:Health Promotion Strategies for Retail Food Shopping Venues

NEOP Research and Evaluation UnitNutrition Policy InstituteUniversity of California

Kelly BlondinDania Orta-Alemán

Gail Woodward-Lopez

May 31st, 2017

Shopping Patterns and Potential Reach

Healthy Retail

•On average SNAP recipients travel 3.8 miles to their primary grocery store

–Closest SNAP-authorized store is 2.0 miles away

Low-income individuals travel to shop at full service markets

Ver Ploeg M, et al., 2015. Where do Americans usually shop for food and how do they travel to get there? Initial findings from the national household food acquisition and purchase survey.

Where do SNAP Participants Shop?

Supermarkets, 42.6%

Supercenters, 41.5%

Grocery stores, 4.7%

Convenience stores, 5.0%

Specialty stores, 1.1%

Farmers' Markets, 0.5%

Castner L, Henke J. Benefit Redemption Patterns in the Supplemental Nutrition Assistance Program: Mathematica Policy Research; 2011

Conclusions: Shopping Patterns

• Income more predictive than access

•SNAP households shop at low-cost venues and will travel to do so

•But still challenged to purchase a healthful product mix–Low-income households may stretch limited dollars by purchasing lower cost, less healthy foods

•A small proportion of households have extremely limited access to healthy full service outlets

What works?

Healthy Retail

MethodsSystematic literature review

• Interventions implemented via retail food stores that sell unprepared food. •Pre/post measures with control group

•Outcome measures: food purchases, dietary intake, and/or adiposity

•Upper-Middle or High-Income countries

Databases: PubMed and agency repositories•88 primary papers•Published between 1982 to present, most from later 1990s on

Access interventions

• Opening new supermarkets in undeserved areas

• Free produce delivery

Store-based interventions

•Printed promotional materials

•In-store nutrition education•Store conversions

•Product placement, improved stocking, training to store owners, taste-tests

Price interventions

• Vouchers/Coupons• Vouchers+Nut Education• Rebates• Discounts• Taxes

1. Access interventions

•Opening new stores: No promise

•Delivering free produce: shows promise but more evidence is needed

n Intervention:n “Rolling Store" food delivery and nutrition education for

African American womenn Study Design:

n RCTn Baton Rouge, LA

n Impact: n Significantly increased consumption of fruit, fruit juice and

vegetables (servings/day) n Mean decrease in weight of 0.4kg (SD 3.0kg), and reduced BMI

at 6 months.

Case in Point: Food Delivery

(Source: Kennedy et al., 2009)

2. Store-Based interventions

•Nutrition education and promotion via print materials or audio-visual mediums: not consistently effective

•Multicomponent store interventions: Not consistently effective

(Source: Payne et al., 2015)

Case in Point: Grocery Cart Placards

• Intervention: § Placards on shopping carts with a message about the number of

produce items normally purchased§ Focus on social norms

• Study Design: § Quasi-experiment § 1 intervention and 1 control supermarket in El Paso, TX

• Impact§ Increased produce spending after 2 weeks (p=0.04)

n Intervention: n Increased stocking of healthy foodsn Shelf labels and signage for

promoted healthier foodsn Taste testsn Store staff training. n Community outreach events

n Study Design: n Quasi-experiment, 4 months

n 2 supermarketsn Baltimore, MD

n Impact: n Increased sales of promoted healthier foods (low-fat, low-sodium, healthier

sugar level, 100% juice) in the intervention store.

Case in Point: Eat Right-Live Well

(Source: Surkan et al., 2016)

3. Price interventions

•Monetary incentives, including vouchers, coupons, rebates and price reductions: Consistently effective

•Taxes: Promising approach

Case in Point:SNAP Healthy Incentive Pilot§Intervention:

• Incentive of 30 cents for every $1 of fruits and vegetables purchased

•Up to $60/month, added to EBT card

§Study Design:•RCT, 23 months •SNAP-authorized retailers in western

MA

§Impact:•26% increase in consumption of FVs•About ¼ cup or ½ serving/day

(Source: Bartlett et al., 2014 (USDA Report))

Conclusions

•Promising evidence: Price interventions (vouchers/coupons, rebates, price reductions, monetary incentives)

• Inconsistent evidence: Store-based interventions (in-store print materials, audio-visual education, multicomponent)

• Insufficient evidence: Access interventions (new supermarkets, free produce delivery)

•No evidence: farmers’ markets, food hubs, food coops, food banks, healthy checkouts, in-store availability of healthy and/or unhealthy products, among others.