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Most snacks displayed at supermarket checkouts do not contribute to a healthy diet. We investigated the effects of introducing healthier snack alternatives at checkouts in supermarkets on purchasing behavior. In Study 1, we investigated the effect of completely substituting less healthy with healthier snacks (one supermarket). In Study 2, we investigated the effect of placing and discounting healthier snacks while the less healthy snacks remain in place (two supermarkets). In both studies, the number of purchased snacks (per 1000 customers) was used as the outcome variable. Results for Study 1 showed that the absolute number of purchased checkout snacks was 2.4 times lower (95% confidence interval (CI): 1.9–2.7) when healthier snacks instead of less healthy snacks were placed at the supermarket checkouts. Results for Study 2 showed that when additional healthier snacks were placed near the checkouts, the absolute number of healthier purchased snacks increased by a factor of 2.1 (95% CI: 1.3–3.3). When additional healthier snacks were placed near the checkouts and discounted, the absolute number of healthier purchased snacks increased by a factor of 2.7 (95% CI: 2.0–3.6), although this was not statistically significant higher than placement only (ratio: 1.1, 95% CI: 0.7–1.9). Purchases of less healthy snacks did not decline, and even slightly increased, during the intervention period (ratio: 1.3, 95% CI: 1.1–1.5). If supermarkets want to promote healthier snack purchases, additional healthier products can be positioned near the checkouts. However, this does not discourages the purchase of less healthy snacks. Therefore, to discourage unhealthy snack purchases at supermarket checkouts, a total substitution of less healthy snacks with healthier alternatives is most effective

Background Since 2010, the Zwolle Healthy City approach, an integrated community-based approach, has been implemented in the Dutch municipality of Zwolle. This approach is proven successful in reducing health inequalities. However, the key elements of this approach are not clear. The current study aimed to identify key elements of this successful local community-based approach, according to the perspectives of various stakeholders. Methods Semi-structured interviews were carried out with 29 professionals who were involved in the approach in the period 2010–2018 and have occupations at the strategic (n = 4), tactical (n = 17) and operational level (n = 8). Data was analyzed using the thematic analysis approach. Results We identified nine perceived key elements that contributed to the success of the approach aimed at reducing socioeconomic health inequalities. The respondents indicated the following key elements: (1) collaboration between a variety of local organizations that want to have impact on the health of citizens; (2) support for the approach on the strategic, tactical and operational level of involved organizations; (3) proper communication and coordination, both for the network and within the organizations; (4) embeddedness in organizations’ policies and processes and (5) collaboration with private organizations is of added value, although there is no “one size fits all”. Other key elements are (6) collaboration with citizens, (7) profiling the approach like a brand and (8) moving along with and taking advantage of opportunities. Finally, (9) continuous monitoring and evaluating goals and processes, and learning from the results, is important. Conclusion Nine key elements were identified that, according to various stakeholders, contributed to the success of the Zwolle Healthy City approach. These insights are important to further strengthen the Zwolle Healthy City approach but may also help and inspire other local i

OBJECTIVE: To investigate fruit and vegetable (F&V) intakes of university students and associated demographic and lifestyle characteristics, and students' perceptions of F&V availability and F&V intervention strategies in the university environment.DESIGN: Cross-sectional questionnaire data were collected; F&V intakes were measured using a food frequency tool. Multivariable linear regression analyses were used to analyse the associations between demographic and lifestyle characteristics and F&V intakes.SETTING: Universities in the Netherlands.SUBJECTS: University students (n 717).RESULTS: The majority of students did not adhere to Dutch F&V guidelines (71 % and 93 %, respectively). Fruit intake was lower among students who were male, living independently, enrolled in a technical study, not adhering to physical activity guidelines, and heavy to excessive alcohol drinkers. Vegetable intake was lower among students who were non-Dutch, living with their parents, not adhering to physical activity guidelines, and moderate and heavy to excessive alcohol drinkers. Most students perceived that their university environment offers sufficient healthy foods (60 %) and F&V (65 %), but also indicated that their F&V intakes would increase with interventions concerning affordable F&V in the university canteen (64 %) or university supermarket (60 %). Students were less disposed to indicate that weekly local farmers' markets, vegetable parcels or a vegetable garden would increase their F&V intakes.CONCLUSIONS: Dutch university students do not consume enough F&V. Future efforts that aim to promote students' F&V intakes should consider the differences between subgroups based on demographic and lifestyle characteristics and that affordable F&V in the university environment might be an effective strategy.