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Background: Dutch adolescents predominantly purchase unhealthy snacks in supermarkets, which negatively influence their health. The aim of this study was to investigate the short- and longer-term effects of a nutrition peer-education intervention in supermarkets on food purchases and determinants of food purchase behaviour among adolescents of different education levels. Methods: We performed a quasi-experimental study in three supermarkets (two intervention and one comparison school) in Amsterdam, the Netherlands. The intervention schools received a 45-min peer-education workshop in the supermarket near their school, and the comparison school received no intervention. The workshops also included a 2-week 'healthy snacking challenge' and were led by two young supermarket employees. Measurements were performed 2 weeks before the intervention (T0) 2 weeks after (T1) and 3 months (T2) after the intervention. Cash receipts were used to examine food purchases (n = 458) and questionnaires to examine determinants of food purchase behaviour (n = 463). Results: The nutrition peer-education intervention did not improve food purchases but did improve several determinants of food purchase behaviour. Adolescents from the intervention schools reported improved nutritional knowledge (β = 0.38, 95% CI: 0.04–0.72) at T1, more favourable attitudes (β = 0.21, 95% CI: 0.00–0.42) and stronger social support (β = 0.27, 95% CI: 0.02–0.53) for healthy food purchases at T2 compared to those from the comparison schools. Adolescents with a low level of education reported more short- and longer-term improvements of determinants of food purchase behaviour compared to those with a higher level of education. Conclusions: While nutrition peer education in supermarkets did not improve adolescents' food purchases in the supermarket, determinants of food purchase behaviour did improve. The intervention was especially effective among adolescents with a low level of education. Nevertheless, to promote healthy food purchases of adolescents in supermarkets, more efforts are needed. [ABSTRACT FROM AUTHOR]

Background: Bangladesh suffered a severe COVID-19 wave from June to August 2021, which forced the government to impose emergency nationwide lockdown measures for three months with discontinuities. The sudden lockdown strongly affected the dietary preferences, financial circumstances, and social interactions of citizens. Methods: In this comprehensive study, we collected sociodemographic information as well as data on food purchase and consumption behaviors from 1,350 adults in Bangladesh during the weeks of enforced confinement. The association between the sociodemographic factors (viz., gender, age, education status, income, occupation, and household size) and food purchase and consumption behaviors were determined by conducting bivariate and multivariate logistic regression models reporting as odds ratios. Results: The descriptive result reveals that 49.63% of the participants experienced wage reductions, with many people enduring reductions of up to 75%; 12.22% lost their jobs. Besides, a decline in the frequency of shopping was observed by 35.04%; and 24.52% avoided outdoor shopping during the pandemic period. Additionally, 28.74% of participants purchased less overall, while 19.48% purchased significantly fewer items per trip compared to the pre-pandemic period. The multivariate analysis shows a prominent increase in online grocery shopping (OR: 4.03, 95% CI: 2.38–6.83, p < 0.001) and meal delivery services (OR = 5.19, 95% CI = 3.21–7.17, p < 0.001) among higher educated individuals compared to the individuals having no institutional education. The personnel having formal jobs purchased 2.34 times more from online grocery sites (95% CI = 0.34–4.08, p = 0.003) compared to the unemployed one. In contrast, a notable increase in panic buying and stockpiling was observed, driven by scarcity and escalating prices of essential food items. The frequency of meals with families, active engagement in meal preparation, and the exploration of novel recipes also increased notably. Conclusions: The consumption of takeaway food and inter-meal snacks increased significantly with the education level of individuals. These findings highlighted that a prolonged pandemic could magnify economic vulnerability in Bangladesh. [ABSTRACT FROM AUTHOR]

Background: Rapid urbanisation without concomitant infrastructure development has led to the creation of urban slums throughout sub-Saharan Africa. People living in urban slums are particularly vulnerable to food insecurity due to the lack of physical and economic accessibility to food. Hence, it is important to explore how vulnerable groups living in slums interact with the food environment. This study assessed the relationships between food insecurity, including restrictive coping strategies, food purchasing patterns and perceptions about the food environment among dwellers of selected urban slums in Ibadan, Nigeria. Methods: This community-based cross-sectional study was conducted with people responsible for food procurement from 590 randomly selected households in two urban slums in Ibadan. Food insecurity and restrictive coping strategies were assessed using the Household Food Insecurity Access Scale and the Coping Strategy Index, respectively. We examined purchasing patterns of participants by assessing the procurement of household foodstuffs in different categories, as well as by vendor type. Participants' perceptions of the food environment were derived through a five-item composite score measuring food availability, affordability and quality. Chi-square tests and logistic regression models analysed associations between food insecurity, purchasing patterns and perceptions of the food environment. Results: The prevalence of food insecurity in the sample was 88%, with 40.2% of the households experiencing severe food insecurity. Nearly a third (32.5%) of the households used restrictive coping strategies such as limiting the size of food portions at mealtimes, while 28.8% reduced the frequency of their daily meals. Participants purchased food multiple times a week, primarily from formal and informal food markets rather than from wholesalers and supermarkets. Only a few households grew food or had livestock (3.2%). Food insecure households had a lower perceived access to the food environment, with an approximate 10% increase in access score per one-unit decrease in food insecurity (AOR = 0.90, 95% CI: 0.84, 0.96). The most procured foods among all households were fish (72.5%), bread (60.3%), rice (56.3%), yam and cassava flours (50.2%). Food-secure households procured fruit, dairy and vegetable proteins more frequently. Conclusion: Food insecurity remains a serious public health challenge in the urban slums of Ibadan. Perceptions of greater access to the food environment was associated with increasing food security. Interventions should focus on creating more robust social and financial protections, with efforts to improve livelihoods to ensure food security among urban slum-dwellers. [ABSTRACT FROM AUTHOR]

Background: On 6 April 2022, legislation came into effect in England requiring calorie labels to be applied to food items on menus of larger food businesses. This study aimed to assess the impact of calorie labelling on (a) food purchased and (b) energy content of menu options in worksite cafeterias. Methods: Product-level sales data and energy content of available items was obtained from 142 worksite cafeterias from January 2022-October 2022. Interrupted-time-series (ITS) analysis with level and slope change evaluated daily energy (kcal) purchased per item, and ITS with level change assessed mean energy per option available on menus before and after calorie labelling. Each analysis was conducted 6 weeks and 6 months from implementation. A post-hoc ITS examined weekly energy purchased per item over a longer period (March 2021-October 2022; 135 sites). Results: There was no evidence calorie labelling changed the energy content of foods purchased (6-week: + 0.60 cal/product, 95%CI:-2.54, + 3.75; 6-month: + 1.59 cal/product, 95%CI:-0.96, + 4.16). Post-hoc analyses suggested calorie labels were associated with a reduction in mean energy of items purchased over time (-0.65 kcal/week, 95%CI:-0.81,-0.49), but a significant increase (+ 3 kcal, 95%CI: + 0.43, + 5.60) at the point of implementation. There was a reduction in the mean energy content of menu options at each seasonal menu change (April 2022:-1.79 kcal, 95%CI:-3.42,-0.15; July 2022:-4.18 kcal, 95% CI:-7.65,-0.73). Conclusion: This large observational study in worksite cafeterias found no evidence to indicate the introduction of calorie labelling led to any immediate reduction in energy purchased by customers. There was some evidence of increasing impact over time, possibly associated with changes in menu offerings, but this effect was small and cannot be directly attributed to calorie labelling. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated 'audit and feedback' with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia. Methods: Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023. Discussion: We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly. Trial registration: ACTRN12622000596707, Protocol version 1. [ABSTRACT FROM AUTHOR]

Background: Supermarket interventions are promising to promote healthier dietary patterns, but not all individuals may be equally susceptible. We explored whether the effectiveness of nudging and pricing strategies on diet quality differs by psychological and grocery shopping characteristics. Methods: We used data of the 12-month Supreme Nudge parallel cluster-randomised controlled supermarket trial, testing nudging and pricing strategies to promote healthier diets. Participants were Dutch speaking adults aged 30–80 years and regular shoppers of participating supermarkets (n = 12) in socially disadvantaged neighbourhoods. Data on psychological characteristics (food-related behaviours; price sensitivity; food decision styles; social cognitive factors; self-control) and grocery shopping characteristics (time spent in the supermarket; moment of the day; average supermarket visits; shopping at other retailers; supermarket proximity) were self-reported at baseline. These characteristics were tested for their moderating effects of the intervention on diet quality (scored 0–150) in linear mixed models. Results: We included 162 participants from intervention supermarkets and 199 from control supermarkets (73% female, 58 (± 10.8) years old, 42% highly educated). The interventions had no overall effect on diet quality. Only five out of 23 potential moderators were statistically significant. Yet, stratified analyses of these significant moderators showed no significant effects on diet quality for one of the subgroups and statistically non-significant negative effects for the other. Negative effects were suggested for individuals with lower baseline levels of meal planning (β − 2.6, 95% CI − 5.9; 0.8), healthy shopping convenience (β − 3.0, 95% CI − 7.2; 1.3), and healthy food attractiveness (β − 3.5, 95% CI − 8.3; 1.3), and with higher levels of price consciousness (β − 2.6, 95% CI − 6.2; 1.0) and weekly supermarket visits (β − 2.4, 95% CI − 6.8; 1.9). Conclusions: Adults with varying psychological and grocery shopping characteristics largely seem equally (un)susceptible to nudging and pricing strategies. It might be that certain characteristics lead to adverse effects, but this is not plausible, and the observed negative effects were small and statistically non-significant and may be explained by chance findings. Verification of these findings is needed in real-world trials based on larger sample sizes and with the use of more comprehensive interventions. Trial registration: Dutch Trial Register ID NL7064, 30th of May, 2018, https://onderzoekmetmensen.nl/en/trial/20990 [ABSTRACT FROM AUTHOR]

Background: Assessing the trends in dietary GHGE considering the social patterning is critical for understanding the role that food systems have played and will play in global emissions in countries of the global south. Our aim is to describe dietary greenhouse gas emissions (GHGE) trends (overall and by food group) using data from household food purchase surveys from 1989 to 2020 in Mexico, overall and by education levels and urbanicity. Methods: We used cross-sectional data from 16 rounds of Mexico's National Income and Expenditure Survey, a nationally representative survey. The sample size ranged from 11,051 in 1989 to 88,398 in 2020. We estimated the mean total GHGE per adult-equivalent per day (kg CO2-eq/ad-eq/d) for every survey year. Then, we estimated the relative GHGE contribution by food group for each household. These same analyses were conducted stratifying by education and urbanicity. Results: The mean total GHGE increased from 3.70 (95%CI: 3.57, 3.82) to 4.90 (95% CI 4.62, 5.18) kg CO2-eq/ad-eq/d between 1989 and 2014 and stayed stable between 4.63 (95% CI: 4.53, 4.72) and 4.89 (95% CI: 4.81, 4.96) kg CO2-eq/ad-eq/d from 2016 onwards. In 1989, beef (19.89%, 95% CI: 19.18, 20.59), dairy (16.87%, 95% CI: 16.30, 17.42)), corn (9.61%, 95% CI: 9.00, 10.22), legumes (7.03%, 95% CI: 6.59, 7.46), and beverages (6.99%, 95% CI: 6.66, 7.32) had the highest relative contribution to food GHGE; by 2020, beef was the top contributor (17.68%, 95%CI: 17.46, 17.89) followed by fast food (14.17%, 95% CI: 13.90, 14.43), dairy (11.21%, 95%CI: 11.06, 11.36), beverages (10.09%, 95%CI: 9.94, 10.23), and chicken (10.04%, 95%CI: 9.90, 10.17). Households with higher education levels and those in more urbanized areas contributed more to dietary GHGE across the full period. However, households with lower education levels and those in rural areas had the highest increase in these emissions from 1989 to 2020. Conclusions: Our results provide insights into the food groups in which the 2023 Mexican Dietary Guidelines may require to focus on improving human and planetary health. [ABSTRACT FROM AUTHOR]

Objectives / purpose: After school programs represents a setting for promoting healthy dietary habits. The aim of this study was to evaluate how effective the after school program staff perceived nutrition training aiming to improve quality of food purchased and meal practices. We further aimed to assess the changes in purchase of primarily fish and fish products, whole grains and fruit and vegetables, by collecting receipts from food purchase before and after the intervention. Results: This is a mixed methods study. Group interviews with after school staff were carried out and the data was analyzed deductively according to the RE-AIM framework. Receipts from food purchase were collected. Findings from the qualitative interviews indicated that the intervention had been a positive experience for the staff and suggested a new way of working with promoting healthy foods in after school program units. Although there were some challenges reported, the staff made necessary adjustments to make the changes possible to sustain over time. Findings from the receipts support the changes reported by the staff. These showed increased purchase of vegetables, fish, and whole grain in all four after school program units. After school programs in similar settings may expand on these findings to improve the students' dietary habits. [ABSTRACT FROM AUTHOR]

Background: Geographic access to food may affect dietary choices and health outcomes, but the strength and direction of associations may depend on the operationalization of exposure measures. We aimed to systematically review the literature on up-to-date evidence on the association between food environment exposures based on Global Positioning System (GPS) and diet-related and cardiometabolic health outcomes. Methods: The databases PubMed, Embase.com, APA PsycInfo (via Ebsco), Cinahl (via Ebsco), the Web of Science Core Collection, Scopus, and the International Bibliography of the Social Sciences (via ProQuest) were searched from inception to October 31, 2022. We included studies that measured the activity space through GPS tracking data to identify exposure to food outlets and assessed associations with either diet-related or cardiometabolic health outcomes. Quality assessment was evaluated using the criteria from a modified version of the Newcastle–Ottawa Scale (NOS) for cross-sectional studies. We additionally used four items from a quality assessment tool to specifically assess the quality of GPS measurements. Results: Of 2949 studies retrieved, 14 studies fulfilled our inclusion criteria. They were heterogeneous and represent inconsistent evidence. Yet, three studies found associations between food outlets and food purchases, for example, more exposure to junk food outlets was associated with higher odds of junk food purchases. Two studies found associations between greater exposure to fast food outlets and higher fast food consumption and out of three studies that investigated food environment in relation to metabolic outcomes, two studies found that higher exposure to an unhealthy food environment was associated with higher odds of being overweight. Conclusions: The current and limited evidence base does not provide strong evidence for consistent associations of GPS-based exposures of the food environment with diet-related and cardiometabolic health outcomes. [ABSTRACT FROM AUTHOR]

Background: Using rewards may be an effective method to positively influence children's eating behaviour but evidence to date is limited, particularly in older children. The cashless canteen systems in schools provides a unique opportunity to implement a food-based reward scheme but intervention development work and feasibility testing is needed. The overall aim of the E4T feasibility study was to examine the feasibility and acceptability of implementing a rewards scheme based on the food purchasing behaviour of pupils in cashless canteens in secondary schools. Methods: A non-randomised, controlled, parallel-group cluster feasibility study conducted in four secondary schools (two intervention and two control) serving areas of the highest social deprivation in Northern Ireland. During the 4-month trial, pupils earned points for foods purchased at the school canteen, with better nutritional choices having a higher value. Pupils could exchange the points they earned for rewards (e.g. stationery, vouchers, sports equipment) via the E4T website. Qualitative and quantitative data was collected from year 9 and 10 pupils (boys and girls aged 12–14 years), teachers and canteen staff to address the feasibility questions. Results: Two intervention (one urban, one rural) and one control (urban) school completed the study. Seventy-one percent of 12–14-year-old pupils consented to take part; 1% of parents opted their child out of the study. Questionnaire completion rates were high (6 and 11% of questionnaires were partially completed at baseline and follow-up respectively). Collecting data on food consumed in the canteen was challenging logistically. Focus groups with pupils indicated that the overall concept of E4T was well received and there was a high degree of satisfaction with the rewards available. Pupils and teachers made several suggestions for improvements. Conclusions: E4T was successfully implemented as a result of collaboration between schools, school canteens and cashless canteen providers working with a multidisciplinary research team. It was acceptable to pupils, teachers and canteen staff. The findings suggest a few areas for refining implementation and evaluation processes that would need to be considered in the design of a larger trial, particularly resources required to streamline implementation and ways to optimise pupil engagement. Trial registration: Under review with https://www.clinicaltrials.gov (retrospective registration—reg number and weblink to be added). [ABSTRACT FROM AUTHOR]

Background: Active partner involvement during pregnancy is an effective strategy to enhance both maternal and newborn health outcomes. The presence of a supportive partner equips women with a heightened sense of empowerment to deal with the challenges of pregnancy, including maintaining a healthy diet during pregnancy, which is important for the health of both the mother and child. However, little information exists regarding the partner's role in encouraging a pregnant woman's healthy dietary choices. This study aimed to explore the perspectives of pregnant women and their partners concerning the partner's role in promoting a healthy dietary intake during pregnancy. Methods: Sixteen semi-structured couple interviews were conducted in the Netherlands, involving expecting couples. Based on Berkman's social networks and support theory, we categorized various forms of support as emotional, instrumental, appraisal, and informational. The interviews were accurately recorded, transcribed verbatim, and analysed using an inductive approach. Results: In general, pregnant women reported being positive regarding the support they received from their partners. Partners primarily offered instrumental support to pregnant women, such as cooking, grocery shopping, and helping them avoid unsafe foods. Partners provided informational support, mainly about foods considered unsafe during pregnancy. Emotional support was relatively less common. The primary motives for giving support were pregnancy-related symptoms, the importance of the health of the mother and baby, and solidarity with the pregnant woman. Support from the partner was more willingly accepted by pregnant women if the support was perceived as being helpful, showing involvement, and positive. Conversely, partner support was not accepted if it was perceived as judgmental or unwanted. Conclusions: The majority of pregnant women were satisfied with the support received from their partners, although there are opportunities for a partner to provide more support to improve the dietary intake of pregnant women. To optimise this support, partners are advised to tailor their support to the needs and expectations of pregnant women. Personalizing dietary support can be achieved by couples communicating their dietary wishes and expectations regarding support. [ABSTRACT FROM AUTHOR]

Background: Organic farming is a relatively new concept in developing countries compared to developed countries. Understanding the factors affecting consumers' willingness to pay for organic foods is critical to increasing the production of these products. This study aimed to develop and validate a Persian version of the questionnaire for assessing determinants of organic food purchase intention among adults in Tehran, the capital of Iran. Methods: The study was conducted in a two-phased standardized methodology in 2019. During Phase 1, a draft questionnaire was developed based on a comprehensive literature review. In phase 2, validation of the instrument was performed. Participants included a multidisciplinary expert panel comprising 14 members to evaluate content validity, a sample of lay people to assess face validity (n = 20), internal consistency (n = 300), and test-retest reliability (n = 62). The internal consistency and test-retest reliability were measured using the intraclass correlation coefficient (ICC) and Cronbach's alpha. Results: Forty-nine of 57 items had a CVR above 0.51 and were retained in the questionnaire. Three items were added to the questionnaire. The average CVI for the questionnaire was 0.97. Cronbach's α and ICC of the entire questionnaire were 0.86 and 0.93, respectively. Each phase of development progressively improved the questionnaire, resulting in a final 52-item questionnaire divided into 9 dimensions, including knowledge, attitude, subjective norms, health consciousness, environmental concerns, perceived convenience of purchase, perceived cost, sensory characteristics, and purchase intention. Conclusions: The developed questionnaire appears to be a valid and reliable instrument for examining determinants of consumer intentions to purchase organic food. [ABSTRACT FROM AUTHOR]

Background: Nudging is increasingly used to promote healthy food choices in supermarkets. Ordering groceries online is gaining in popularity and nudging seems efficacious there as well, but is never comprehensively tested in real-life. We evaluated the real-life effectiveness of nudging in an online supermarket on healthy food purchases.Methods: We conducted a multi-arm, parallel-group, individually randomized controlled trial in an online supermarket. During 1 month, all customers were randomized to (1) control condition, (2) information nudges, (3) position nudges, and (4) information and position nudges combined. Allocation was concealed and customers were not blinded, but unaware of the intervention. Mean differences between the control condition and the intervention arms in the total percentage of healthy purchases were assessed with a linear mixed model. We tested for effect modification by area-level deprivation.Results: Based on sales data from 11,775 shoppers, no overall significant effects were detected. Yet, effects were modified by area-level deprivation (pArm 2 < 0.001). Among shoppers from deprived areas, those allocated to information nudges purchased a 2.4% (95%CI 0.8, 4.0) higher percentage of healthy products compared to controls. No significant differences were observed for position (- 1.3%; 95%CI - 2.8, 0.3) and combined nudges (- 0.1%; 95%CI - 1.7, 1.5). Shoppers from non-deprived areas exposed to information nudges (- 1.6%; 95%CI - 3.2, - 0.1) and the combined nudges (- 2.1%; 95%CI - 3.6, - 0.6), but not position nudges (- 0.9%; 95%CI - 2.4, 0.7), purchased a lower percentage of healthy products.Conclusion: Information nudges in an online supermarket can increase healthy product purchases, but only for those living in deprived areas. The adverse effects found on purchasing behaviors for those from non-deprived areas call for further research. Further research should also focus on real-life effects of online healthy food nudging as part of a broader nutrition intervention strategy, and on the equitability of the online nudging intervention within populations.Trial Registration: Retrospectively registered in the ISRCTN registry at May 21, 2021 ( ISRCTN10491616 ). [ABSTRACT FROM AUTHOR]

A central feature of the transformation of urban food systems in cities of the Global South is the growing presence of supermarkets and their supply chains, often termed supermarketization or a supermarket revolution. A key issue in the African context is whether supermarkets are a threat to other sources of food including informal sector vendors. Most research on the supermarket revolution and competition with other food retailers focuses on large urban conurbations with little attention paid to the role of supermarkets in smaller urban centres. This paper aims to rectify this situation through a case study of the role of supermarkets in three small urban centres in northern Namibia. The paper uses data from a representative household food security survey in 2018 which collected detailed information on household food consumption and food purchasing patterns. We show that supermarkets have established a dominant role in the local food system and are patronized by almost all households. However, the informal food sector displays considerable resilience and is patronized on a regular basis by low-income households. Future research on the impact of the secondary supermarket revolution should examine the experience and strategies of informal food vendors and whether the relationship with supermarkets is truly symbiotic or not. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the impact of two nudge interventions on customers' produce purchases at a rural Canadian grocery store. A pre- and post-intervention observational study design was used. Sales data were gathered before and after the staggered implementation of two nudge-based interventions to encourage produce purchases: grocery cart dividers to encourage shoppers to fill one-third of their cart with produce and grocery cart plaques with information about how many fruits and vegetables were typically purchased in the store. The proportion of total sales accounted for by produce was compared between baseline and implementation of the first intervention (Phase 1), between implementation of the first intervention and the addition of the second intervention (Phase 2), and between baseline and post-implementation of both interventions together. There was a 5% relative increase (0.5% absolute increase) in produce spending between baseline and post-implementation of both interventions (10.3% to 10.8%, p < 0.001, 95% CI 0.2%, 0.7%). Intervention phase-specific produce spending showed no significant change in the percentage of produce spending from baseline to Phase 1 of the intervention, and an 8% relative increase (0.8% absolute increase) in the percentage of produce spending from Phase 1 to Phase 2 of the intervention (10.3% to 11.1%, p < 0.001, 95% CI 0.5, 1.1%). Simple, low-cost nudge interventions were effective at increasing the proportion of total grocery spend on produce. This study also demonstrated that partnerships with local businesses can promote healthier food choices in rural communities in Canada. [ABSTRACT FROM AUTHOR]

Background: Food prepared out-of-home is typically energy-dense and nutrient-poor. This food can be purchased from multiple types of retailer, including restaurants and takeaway food outlets. Using online food delivery services to purchase food prepared out-of-home is increasing in popularity. This may lead to more frequent unhealthy food consumption, which is positively associated with poor diet and living with obesity. Understanding possible reasons for using online food delivery services might contribute to the development of future public health interventions, if deemed necessary. This knowledge would be best obtained by engaging with individuals who use online food delivery services as part of established routines. Therefore, we aimed to investigate customer experiences of using online food delivery services to understand their reasons for using them, including any advantages and drawbacks.Methods and Results: In 2020, we conducted telephone interviews with 22 adults living in the UK who had used online food delivery services on at least a monthly basis over the previous year. Through codebook thematic analysis, we generated five themes: 'The importance of takeaway food', 'Less effort for more convenience', 'Saving money and reallocating time', 'Online food delivery service normalisation' and 'Maintained home food practices'. Two concepts were overarching throughout: 'Place. Time. Situation.' and 'Perceived advantages outweigh recognised drawbacks'. After considering each of the accessible food purchasing options within the context of their location and the time of day, participants typically selected online food delivery services. Participants reported that they did not use online food delivery services to purchase healthy food. Participants considered online food delivery service use to be a normal practice that involves little effort due to optimised purchasing processes. As a result, these services were seen to offer convenient access to food aligned with sociocultural expectations. Participants reported that this convenience was often an advantage but could be a drawback. Although participants were price-sensitive, they were willing to pay delivery fees for the opportunity to complete tasks whilst waiting for delivery. Furthermore, participants valued price-promotions and concluded that receiving them justified their online food delivery service use. Despite takeaway food consumption, participants considered home cooking to be irreplaceable.Conclusions: Future public health interventions might seek to increase the healthiness of food available online whilst maintaining sociocultural values. Extending restrictions adopted in other food environments to online food delivery services could also be explored. [ABSTRACT FROM AUTHOR]

Background: Policy regulations of ethically controversial genetic technologies should, on the one hand, be based on ethical principles. On the other hand, they should be socially acceptable to ensure implementation. In addition, they should align with ethical theory. Yet to date we lack a reliable and valid scale to measure the relevant ethical judgements in laypeople. We target this lacuna.Methods: We developed a scale based on ethical principles to elicit lay judgments: the Genetic Technologies Questionnaire (GTQ). In two pilot studies and a pre-registered main study, we validated the scale in a representative sample of the US population.Results: The final version of the scale contains 20 items but remains highly reliable even when reduced to five. It also predicts behaviour; for example, ethical judgments as measured by the GTQ predicted hypothetical donations and grocery shopping. In addition, the GTQ may be of interest to policymakers and ethicists because it reveals coherent and ethically justified judgments in laypeople. For instance, the GTQ indicates that ethical judgments are sensitive to possible benefits and harms (in line with utilitarian ethics), but also to ethical principles such as the value of consent-autonomy.Conclusions: The GTQ can be recommended for research in both experimental psychology and applied ethics, as well as a tool for ethically and empirically informed policymaking. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of health-related food taxes on substitution and complementary purchases within food groups, including from unhealthier to healthier alternatives and between brands.Methods: We used data from a virtual supermarket experiment with data from 4,259 shopping events linked to varying price sets. Substitution or complementary effects within six frequently purchased food categories were analyzed. Products' own- and cross-price elasticities were analyzed using Almost Ideal Demand System models.Results: Overall, 37.5% of cross-price elasticities were significant (p < 0.05) and included values greater than 0.10. Supplementary and complementary effects were particularly found in the dairy, meats and snacks categories. For example, a 1% increase in the price of high saturated fat dairy was associated with a 0.18% (SE 0.06%) increase in purchases of low saturated fat dairy. For name- and home-brand products, significant substitution effects were found in 50% (n = 3) of cases, but only in one case this was above the 0.10 threshold.Conclusions/policy Implications: Given the relatively low own-price elasticities and the limited substitution and complementary effects, relatively high taxes are needed to substantively increase healthy food purchases at the population level.Trial Registration: This study included secondary analyses; the original trial was registered in the Australian New Zealand Clinical Trials Registry ACTRN12616000122459 . [ABSTRACT FROM AUTHOR]

Background: Obesity remains one of the most challenging public health issues of our modern time. Despite the face validity of claims for influence, studies on the causes of obesity have reported the influence of the food environment to be inconsistent. This inconsistency has been attributed to the variability of measures used by researchers to represent the food environments—Researcher-Defined Food Environments (RDFE) like circular, street-network buffers, and others. This study (i.) determined an individual's Activity Space (AS) (ii.) explored the accuracy of the RDFE in representing the AS, (iii.) investigated the accuracy of the RDFE in representing actual exposure, and (iv.) explored whether exposure to food outlet reflects the use of food outlets. Methods: Data were collected between June and December 2018. A total of 65 participants collected Global Positioning System (GPS) data, kept receipt of all their food purchases, completed a questionnaire about their personal information and had their weight and height measured. A buffer was created around the GPS points and merged to form an AS (GPS-based AS). Results: Statistical and geospatial analyses found that the AS size of participants working away from home was positively related to the Euclidean distance from home to workplace; the orientation (shape) of AS was also influenced by the direction of workplace from home and individual characteristics were not predictive of the size of AS. Consistent with some previous studies, all types and sizes of RDFE variably misrepresented individual exposure in the food environments. Importantly, the accuracy of the RDFE was significantly improved by including both the home and workplace domains. The study also found no correlation between exposure and use of food outlets. Conclusions: Home and workplace are key activity nodes in modelling AS or food environments and the relationship between exposure and use is more complex than is currently suggested in both empirical and policy literature. [ABSTRACT FROM AUTHOR]

Background: Among Bangladeshi men, international labor migration has increased ten-fold since 1990 and rural to urban labor migration rates have steadily increased. Labor migration of husbands has increased household wealth and redefined women's roles, which have both positively and negatively impacted the health of wives "left behind". We examined the direct and indirect effects of husband labor migration on chronic disease indicators and outcomes among wives of labor migrants.Methods: We collected survey, anthropometric, and biomarker data from a random sample of women in Matlab, Bangladesh, in 2018. We assessed associations between husband's migration and indicators of adiposity and chronic disease. We used structural equation modeling to assess the direct effect of labor migration on chronic disease, undernutrition, and adiposity, and the mediating roles of income, food security, and proportion of food purchased from the bazaar. Qualitative interviews and participant observation were used to help provide context for the associations we found in our quantitative results.Findings: Among study participants, 9.0% were underweight, 50.9% were iron deficient, 48.3% were anemic, 39.6% were obese, 27.3% had a waist circumference over 35 in., 33.1% had a high whole-body fat percentage, 32.8% were diabetic, and 32.9% had hypertension. Slightly more women in the sample (55.3%) had a husband who never migrated than had a husband who had ever migrated (44.9%). Of those whose husband had ever migrated, 25.8% had a husband who was a current international migrant. Wives of migrants were less likely to be underweight, and more likely to have indicators of excess adiposity, than wives of non-migrants. Protection against undernutrition was attributable primarily to increased food security among wives of migrants, while increased adiposity was attributable primarily to purchasing a higher proportion of food from the bazaar; however, there was a separate path through income, which qualitative findings suggest may be related to reduced physical activity.Conclusions: Labor migration, and particularly international labor migration, intensifies the nutrition transition in Bangladesh through increasing wealth, changing how foods are purchased, and reducing physical activity, which both decreases risk for undernutrition and increases risk for excess adiposity. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that lifestyle changes, such as diet and exercise, can lead to weight loss, resulting in dramatic improvements in overall health and chronic disease risk. However, while many traditional dieting, food tracking and weight loss coaching programs result in short-term weight loss, there is less evidence of their effectiveness on sustaining weight loss over time.Methods: We conducted a retrospective analysis of 1,740 adults with obesity who used Foodsmart, a digital personalized dietary assessment, meal planning and food purchasing platform. Participants reported age, gender, at least three measures of weight, and their diet using a food frequency questionnaire. We defined sustained weight loss as participants who lost 5 % of initial weight between their first and second reported weights and lost weight or maintained weight between second and third reported weights. A healthy eating score, Nutriscore, was calculated to assess overall diet quality. We used multivariate logistic regression models to examine the association between user characteristics and odds of sustained weight loss.Results: Over a median of 25 months, the mean (standard deviation) change in weight among participants was - 6.2 (19.8) pounds. In total, 39.3 % (684/1,740) of participants lost at least 5 % of their initial weight, and 22.4 % percent (389/1,740) of participants sustained weight loss. In the fully-adjusted logistic regression model, we found that obesity class 2 (odds ratio, OR: 1.69, 95 % confidence interval, CI: 1.27-2.24, P < 0.001), obesity class 3 (OR: 2.23, 95 % CI: 1.68-2.97, P < 0.001), baseline diet quality (OR: 1.06, 95 % CI: 1.02-1.09, P < 0.001), and greater change in diet quality (OR: 1.10, 95 % CI: 1.07-1.14, P < 0.001) were significantly associated with sustained weight loss.Conclusions: This study characterized and demonstrated the utility of Foodsmart, a digital platform that gives personalized nutrition recommendations and meal planning tools, in sustained weight reduction among users with obesity. [ABSTRACT FROM AUTHOR]

Background: Modifying a household's food environment by targeting a single retailer type, like supermarkets, has a limited impact on dietary outcomes. This may be because the food environment has a limited impact on shopping behaviors, or because households are not as reliant on supermarkets as we assume. However, our understanding of how households shop for food, especially when considering the use of both food at home (FAH) retailers, such as supermarkets, and away from home retailers (FAFH), such as restaurants, is limited. Thus, understanding how households shop for food is a necessary first step when developing programs to modify food purchasing behavior.Methods: K-means cluster analysis was used to identify weekly food shopping trip patterns based on the percentage of trips to FAH and FAFH retailers in the 2013 Food Acquisition and Purchase Survey (FoodAPS) dataset (n = 4665 households). Multinomial logistic regression was used to examine the relationship between shopping trip patterns, household and food environment characteristics.Results: Three patterns emerged: primarily supermarket, primarily supercenter, or mix (i.e. no dominant retailer type, but high FAFH use). Households with incomes below 185% of the federal poverty line were evenly divided between patterns that rely primarily on FAH retailers, and the mix pattern. While nearly 70% of households with incomes above 185% of the federal poverty line are in the mix cluster. Supermarket and superstore availability significantly influenced the likelihood of belonging to those clusters respectively, while having a child, higher income, and attitudes towards healthy meal preparation time or taste significantly influenced the likelihood of belonging to the mix cluster.Conclusion: Although lower-income households are more likely to rely primarily on FAH retailers, household's, regardless of income, that primarily utilize FAH retailers show a strong preference for either superstores or supermarkets suggesting a need for interventions to reach both retailer types. However, altering the food environment alone may not be sufficient to discourage use of FAFH retailers as households relying on FAFH retailers are significantly influenced by meal preparation time and healthy food taste. [ABSTRACT FROM AUTHOR]

Background: In the elderly, nutritional status and quality of life (QOL) could potentially affect food purchasing behaviors. We examined the association between combinations of nutritional status and QOL and food purchasing motives among the elderly.Methods: A total of 143 community-dwelling elderly were recruited in Seoul, South Korea. Nutritional status and QOL were assessed and participants were divided into four groups according to those combinations. Binary logistic regression analysis was used to examine the odds of food purchasing motives according to combinations of nutritional status and QOL.Results: As a result of comparing the scores (mean ± SD) of the overall important factors for food purchasing, health related factors such as Nutrition quality and Preventive of treatment effect were the highest score (4.4 ± 0.8), followed by Price (4.1 ± 0.9), Ease of purchase (3.8 ± 0.9), Ease of chewing (3.7 ± 0.9), and Taste (3.6 ± 0.9). Participants with a low nutritional status and low QOL had more eating-related problems (77.8%) including chewing difficulty (48.9%) and constipation (17.8%) than those with a high nutritional status and high QOL (P < 0.05). Participants who were in high nutritional status and low QOL were more likely to be motivated by Ease of chewing (OR: 6.72; 95% CI: 1.44-31.37; P < 0.05), while those who were in low nutritional status and high QOL were less motivated by Taste (OR: 0.28; 95% CI: 0.08-0.94; P < 0.05) compared to those who were in high nutritional status and high QOL.Conclusions: There were differences in food purchasing motives such as Ease of chewing or Taste according to combinations of nutritional status and QOL. These data are important in demonstrating differing motives for food choice across nutritional status and QOL, and also provide indications of which care service and food development may be needed in promoting health for the elderly in South Korea. [ABSTRACT FROM AUTHOR]

Background: Empirically derived food purchase patterns provide information about which combinations of foods were purchased from households. The objective of this study was to identify what kinds of patterns exist, which level of diet quality they represent and which factors are associated with the patterns.Methods: The study made use of representative German consumption data in which approximately 12 million food purchases from 13,125 households are recorded. In accordance with healthy diet criteria the food purchases were assigned to 18 food groups of the German Food Pyramid. Based on these groups a factor analysis with a principal component technique was applied to identify food patterns. For these patterns nutrient and energy densities were examined. Using regression analysis, associations between pattern scores and socio-economic as well as attitude variables, reflecting personal statements about healthy eating, were analyzed.Results: In total, three food purchase patterns could be identified: a natural, a processed and a traditional one. The first one was characterized by a higher purchasing of natural foods, the second by an increased purchasing of processed foods and the third by a meat-oriented diet. In each pattern there were specific diet quality criteria that could be improved whereas others were in line with actual dietary guidelines. In addition to socio-demographic factors, attitudes were significantly associated with the purchase patterns.Conclusions: The findings of this study are interesting from a public health perspective, as it can be assumed that measures focusing on specific aspects of diet quality are more promising than general ones. However, it is a major challenge to identify the population groups with their specific needs of improvement. As the patterns were associated with both socio-economic and attitude variables these grouping criteria could be used to define target groups. [ABSTRACT FROM AUTHOR]

Background: Studies exploring associations between food environments and food purchasing behaviours have been limited by the absence of data on where food purchases occur. Determining where food purchases occur relative to home and how these locations differ by individual, neighbourhood and trip characteristics is an important step to better understanding the association between food environments and food behaviours. Methods: Conducted in Melbourne, Australia, this study recruited participants within sixteen neighbourhoods that were selected based on their socioeconomic characteristics and proximity to supermarkets. The survey material contained a short questionnaire on individual and household characteristics and a food purchasing diary. Participants were asked to record details related to all food purchases made over a 2-week period including food store address. Fifty-six participants recorded a total of 952 food purchases of which 893 were considered valid for analysis. Households and food purchase locations were geocoded and the network distance between these calculated. Linear mixed models were used to determine associations between individual, neighbourhood, and trip characteristics and distance to each food purchase location from home. Additional analysis was conducted limiting the outcome to: (a) purchase made when home was the prior origin (n. 484); and (b) purchases made within supermarkets (n. 317). Results: Food purchases occurred a median distance of 3.6 km (IQR 1.8, 7.2) from participants' homes. This distance was similar when home was reported as the origin (median 3.4 km; IQR 1.6, 6.4) whilst it was shorter for purchases made within supermarkets (median 2.8 km; IQR 1.6, 5.6). For all purchases, the reported food purchase location was further from home amongst the youngest age group (compared to the oldest age group), when workplace was the origin of the food purchase trip (compared to home), and on weekends (compared to weekdays). Differences were also observed by neighbourhood characteristics. Conclusions: This study has demonstrated that many food purchases occur outside what is traditionally considered the residential neighbourhood food environment. To better understand the role of food environments on food purchasing behaviours, further work is needed to develop more appropriate food environment exposure measures. [ABSTRACT FROM AUTHOR]

Background: Diet is important for chronic disease management, with limited research understanding dietary choices among those with multi-morbidity, the state of having 2 or more chronic conditions. The objective of this study was to identify associations between packaged food and drink purchases and diet-related cardiometabolic multi-morbidity (DRCMM).Methods: Cross-sectional associations between packaged food and drink purchases and household DRCMM were investigated using a national sample of U.S. households participating in a research marketing study. DRCMM households were defined as household head(s) self-reporting 2 or more diet-related chronic conditions. Separate multivariable logistic regression models were used to model the associations between household DRCMM status and total servings of, and total calories and nutrients from, packaged food and drinks purchased per month, as well as the nutrient density (protein, carbohydrates, and fat per serving) of packaged food and drinks purchased per month, adjusted for household size.Results: Among eligible households, 3795 (16.8%) had DRCMM. On average, households with DRCMM versus without purchased 14.8 more servings per capita, per month, from packaged foods and drinks (p < 0.001). DRCMM households were 1.01 times more likely to purchase fat and carbohydrates in lieu of protein across all packaged food and drinks (p = 0.002, p = 0.000, respectively). DRCMM households averaged fewer grams per serving of protein, carbohydrates, and fat per month across all food and drink purchases (all p < 0.001). When carbonated soft drinks and juices were excluded, the same associations for grams of protein and carbohydrates per serving per month were seen (both p < 0.001) but the association for grams of fat per serving per month attenuated.Conclusions: DRCMM households purchased greater quantities of packaged food and drinks per capita than non-DRCMM households, which contributed to more fat, carbohydrates, and sodium in the home. However, food and drinks in DRCMM homes on average were lower in nutrient-density. Future studies are needed to understand the motivations for packaged food and drink choices among households with DRCMM to inform interventions targeting the home food environment. [ABSTRACT FROM AUTHOR]

Background: Swaps are often used to encourage healthier food choices, but there is little evidence of their effectiveness. The current study assessed the impact of offering swaps on groceries purchased within a bespoke online supermarket; specifically the objective was to measure the impact on energy density (ED) of food purchases following the offer of lower ED alternatives (a) at point of selection or at checkout, and (b) with or without explicit consent to receive swap prompts. Method: Participants were asked to complete a 12-item shopping task within an online shopping platform, developed for studying food purchasing. 1610 adults were randomly assigned to a no swap control condition or to one of four interventions: consented swaps at selection; consented swaps at checkout; imposed swaps at selection; or imposed swaps at checkout. Each swap presented two lower ED options from the same category as the participant's chosen food. Swap acceptance rate and purchased food ED were the primary outcomes. Results: Of the mean 12.36 (SD 1.26) foods purchased, intervention participants were offered a mean of 4.1 (SD 1.68) swaps, with the potential to reduce the ED of purchased food (effect (95 % CI): -83 kJ/100 g (-110 - -56), p = <0.0001). A median of one swap (IQR 0 to 2) was accepted, not significantly reducing the purchased food ED (effect (95 % CI): -24 kJ/100 g (4 - -52), p = 0.094). More swaps were accepted when offered at selection than at checkout (OR (95 % CI) = 1.224 (1.11 - 1.35), p< 0.0001), but no differences were seen with consent. Purchased food ED was unaffected by point of swap or consent, but reduced with number of swaps accepted (effect per swap (95 % CI) = -24 kJ/100g (-35 --14), p< 0.0001). Conclusion: Within category swaps did not reduce the ED of food purchases reflecting the observation that the use of swaps within an on-line shopping platform offered small potential gains in ED and a minority was accepted. [ABSTRACT FROM AUTHOR]

Background: The present study examined income-related household food purchases among a sample of 90 households from the community. Methods: Annotated food purchase receipts were collected for a four-week period by the primary household shopper. Receipt food source and foods items were classified into specific categories, and food quantities in ounces were recorded by research staff. For home sources, a limited number of food/beverage categories were recorded. For eating out sources, all food/beverage items were recorded. Median monthly per person dollars spent and per person ounces purchased were computed. Food sources and food categories were examined by household income tertile. Subjects and Setting: A community-based sample of 90 households. Results: Higher income households spent significantly more dollars per person per month from both home and eating out sources compared with lower income households ($163 versus $100, p < .001). Compared with lower income households, higher income households spent significantly more home source dollars on both fruits/ vegetables (21.5 versus 10.2, p < .001) and sweets/snacks (17.3 versus 8.3, p < .001), but did not differ on home dollars spent on sugar sweetened beverages (2.0 versus 1.7, p < .46). The proportion of home beverages that were sugar sweetened beverages was significantly higher among lower income households (45% versus 26%, p < .01). Within eating out sources, lower income households spent a significantly greater percent of dollars per person at carry out places (54% versus 37%, p < .01). No income differences were observed for dollars spent at discount grocery stores, small grocery stores or convenience stores. Conclusions: Higher income households spent more money on both healthy and less healthy foods from a wide range of sources. Lower income households spent a larger proportion of their eating out dollars at carry out places, and a larger proportion of their home beverage purchases were sugar sweetened beverages. [ABSTRACT FROM AUTHOR]

Background/aims: EAT-Lancet Commission's Planetary Health Diet proposed a diet that integrates nutrition and sustainability considerations, however its affordability is unknown in many country-specific contexts, including Australia. The aim of this study is to develop a healthy and sustainable food basket modelled on the Planetary Health Diet to determine the affordability of the Planetary Health Diet basket across various socio-economic groups, and compare this affordability with a food basket modelled on the typical current diet, in an Australian setting.Methods: An Australian-specific Planetary Health Diet basket was developed for a reference household (2 adults and 2 children) modelled on the Planetary Health Diet reference diet, and compared to a previously-developed Typical Australian Diet basket. The cost of each food basket was determined by online supermarket shopping surveys in low, medium and high socio-economic areas in each Australian state. Basket affordability was determined for the reference household by comparing the basket cost to disposable income in each socio-economic group in each state. Mann-Whitney U tests then determined if there were significant differences between the median costs and the median affordability of both baskets.Results: The Planetary Health Diet basket was shown to be less expensive and more affordable than the Typical Australian Diet basket nationally, in all metropolitan areas, in all socio-economic groups across Australia (median cost: Planetary Health Diet = AUD$188.21, Typical Australian Diet = AUD$224.36; median affordability: Planetary Health Diet = 13%, Typical Australian Diet = 16%; p = < 0.05).Conclusions: This study showed the Planetary Health Diet to be more affordable than the Typical Australian Diet for metropolitan-dwelling Australians.Implications: These results can help to inform public health and food policy aimed at achieving a healthy and sustainable future for all Australians, including reductions in overweight/obesity rates and increased food security. [ABSTRACT FROM AUTHOR]

Background: Adults with a low socioeconomic position (SEP) are more likely to engage in unhealthy diets as compared to adults with high SEP. However, individual-level educational interventions aiming to improve food choices have shown limited effectiveness in adults with low SEP. Environmental-level interventions such as nudging strategies however, may be more likely to benefit low SEP groups. We aimed to review the evidence for the effectiveness of nudges as classified according to interventions in proximal physical micro-environments typology (TIPPME) to promote healthy purchases, food choice, or affecting energy intake or content of purchases, within real-life food purchasing environments. Second, we aimed to investigate the potentially moderating role of SEP.Methods: We systematically searched PubMed, EMBASE, and PsycINFO until 31 January 2018. Studies were considered eligible for inclusion when they i) complied with TIPPME intervention definitions; ii) studied actual purchases, food choice, or energy intake or content of purchases, iii) and were situated in real-life food purchasing environments. Risk of bias was assessed using a quality assessment tool and evidence was synthesized using harvest plots.Results: From the 9210 references identified, 75 studies were included. Studies were generally of weak to moderate quality. The most frequently studied nudges were information (56%), mixed (24%), and position nudges (13%). Harvest plots showed modest tendencies towards beneficial effects on outcomes for information and position nudges. Less evidence was available for other TIPPME nudging interventions for which the harvest plots did not show compelling patterns. Only six studies evaluated the effects of nudges across levels of SEP (e.g., educational level, food security status, job type). Although there were some indications that nudges were more effective in low SEP groups, the limited amount of evidence and different proxies of SEP used warrant caution in the interpretation of findings.Conclusions: Information and position nudges may contribute to improving population dietary behaviours. Evidence investigating the moderating role of SEP was limited, although some studies reported greater effects in low SEP subgroups. We conclude that more high-quality studies obtaining detailed data on participant's SEP are needed.Registration: This systematic review is registered in the PROSPERO database ( CRD42018086983 ). [ABSTRACT FROM AUTHOR]

Background: The HealthyFood (HF) program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members.Methods: Members receiving the lowest (10%) cash back level were randomized to one of six arms: Arm 1 (Usual Care): 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items.Results: Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean (standard deviation) difference in percent healthy spending was between Arm 1 (24.8% [11%]) and Arm 2 (26.8% [13%]), and the largest mean difference in percent unhealthy spending was also between Arm 1 (24.4% [20%]) and Arm 2 (21.7% [17%]), but no differences were statistically significant after correction for multiple comparisons.Conclusions: None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors.Trial Registration: NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. [ABSTRACT FROM AUTHOR]

Background: Lower household income has been consistently associated with poorer diet quality. Household food purchases may be an important intervention target to improve diet quality among low income populations. Associations between household income and the diet quality of household food purchases were examined.Methods: Food purchase receipt data were collected for 14 days from 202 urban households participating in a study about food shopping. Purchase data were analyzed using NDS-R software and scored using the Healthy Eating Index 2010 (HEI 2010). HEI total and subscores, and proportion of grocery dollars spent on food categories (e.g. fruits, vegetables, sugar sweetened beverages) were examined by household income-to-poverty ratio.Results: Compared to lower income households, after adjusting for education, marital status and race, higher income households had significantly higher HEI total scores (mean [sd] = 68.2 [13.3] versus 51.6 [13.9], respectively, adjusted p = 0.05), higher total vegetable scores (mean [sd] = 3.6 [1.4] versus 2.3 [1.6], respectively, adjusted p < .01), higher dairy scores (mean [sd] = 5.6 [3.0] versus 5.0 [3.3], p = .05) and lower proportion of grocery dollars spent on frozen desserts (1% [.02] versus 3% [.07], respectively, p = .02).Conclusions: Lower income households purchase less healthful foods compared with higher income households. Food purchasing patterns may mediate income differences in dietary intake quality.Trial Registration: ClinicalTrials.gov identifier: NCT02073643. [ABSTRACT FROM AUTHOR]

Background: In developed countries, adolescent and young adult diets have been found to be nutritionally poor. The aim of this study was to examine whether a choice architecture intervention, re-arrangement of produce within a grocery store to increase the accessibility of fruit and vegetables, affected purchasing behaviour on a university campus.Methods: A database of daily sales data from January 2012 to July 2017 was obtained from a campus grocery store. Two changes to the layout were made during this time period. In January 2015, fruit and vegetables were moved from the back of the store, furthest from the entrance, to the aisle closest to the entrance and an entrance-facing display increasing their accessibility. In April 2016, the entrance-facing display of fruit and vegetables was replaced with a chiller cabinet so that fruit and vegetables remained more accessible than during the baseline period, but less accessible than in the period immediately previously. A retrospective interrupted time series analysis using dynamic regression was used to model the data and to examine the effect of the store re-arrangements on purchasing. All analyses were carried out both for sales-by-quantity and for sales-by-money.Results: The first shop re-arrangement which made fruit and vegetables more prominent, increased the percentage of total sales that were fruit and vegetables, when analysed by either items purchased or money spent. The second rearrangement also had a positive effect on the percentage of total sales that were fruit and vegetables compared to baseline, however this was not significant at the 5% level. Over the five year period, the percentage of sales that were fruit and vegetables declined both in terms of items purchased, and money spent.Conclusions: Increasing accessibility of fruit and vegetables in a grocery store is a feasible way to improve the diet of students in tertiary education. There is evidence of declining fruit and vegetable consumption among the studied population, which should be further investigated. [ABSTRACT FROM AUTHOR]