1
|
Pineda E, Li J, Li D, Brown T, Bhatia T, Walker IF, Olney J, Sassi F. Lessons on food security from the COVID-19 pandemic in Bermuda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002837. [PMID: 38346066 PMCID: PMC10861061 DOI: 10.1371/journal.pgph.0002837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024]
Abstract
Compared with other OECD countries, Bermuda ranks third globally in terms of income inequality globally. During the COVID-19 pandemic, anecdotal evidence suggested, significant fluctuations in the food demand and supply. We aimed to examine the impact of the COVID-19 pandemic on food insecurity, with a focus on the availability and affordability of various foods in Bermuda. We utilized a cross-sectional study design to investigate potential drivers of food insecurity within the local population. To gauge the level of household food insecurity we relied on the Bermuda Omnibus survey (N = 400) undertaken by Total Research Associates Ltd via telephone. To assess changes in food availability and affordability we conducted semi-structured interviews with key stakeholders who played pivotal roles in shaping food accessibility availability and affordability of food in Bermuda. These interviews were systematically analysed using the framework method. We performed analyses of food retail and import data to evaluate fluctuations in food prices and their impact on food availability and affordability. We found statistically significant associations between changes in food consumption, household income, and government aid. Food aid beneficiaries ate fewer fruits and vegetables by 50% [95% CI:17%-83%] and less fresh meat and fish by 39% [95 CI:3%-75%] compared with residents who did not receive any aid during the COVID-19 period from March 2020 to March 2021. Although we did not identify statistically significant food price increases feeding programmes played a pivotal role in preventing food insecurity during the pandemic in Bermuda. However, a lack of monitoring regarding the nutritional quality within the programmes, allowed a wide availability of foods high in sugar, salts, and fats, disproportionately affected low-income populations. In conclusion, food availability in Bermuda remained largely unaffected during the pandemic. Nevertheless, the surge in demand for feeding programs underscores underlying food security challenges in Bermuda and warrants further attention.
Collapse
Affiliation(s)
- Elisa Pineda
- Department of Economics & Public Policy, Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, United Kingdom
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Junhui Li
- Department of Economics & Public Policy, Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, United Kingdom
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Danying Li
- Department of Economics & Public Policy, Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, United Kingdom
| | - Todd Brown
- Department of Economics & Public Policy, Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, United Kingdom
| | - Tazeem Bhatia
- Office for Health Improvement and Disparities, Department of Health and Social Care, United Kingdom Government, London, United Kingdom
| | - Ian F. Walker
- Office for Health Improvement and Disparities, Department of Health and Social Care, United Kingdom Government, London, United Kingdom
| | - Jack Olney
- Department of Economics & Public Policy, Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, United Kingdom
| | - Franco Sassi
- Department of Economics & Public Policy, Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Grummon AH, Petimar J, Moran AJ, Anderson E, Lurie P, John S, Rimm EB, Thorndike AN. Effects of in-store marketing on food and beverage purchases: a longitudinal study of households with children. Public Health Nutr 2023; 27:e4. [PMID: 38037704 PMCID: PMC10830370 DOI: 10.1017/s1368980023002641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/24/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Most food retailers display foods in prominent locations as a marketing strategy (i.e. 'placement promotions'). We examined the extent to which households with children change their food and beverage purchases in response to these promotions. DESIGN We analysed a novel dataset of all products promoted in two supermarkets from 2016 to 2017, including promotion dates and locations (e.g. aisle endcaps and front registers). We linked promotions to all purchases from the supermarkets from 2016 to 2017 by a cohort of households with children. We calculated the number of weekly promotions in each of thirteen food and beverage groups (e.g. bread; candy) and used fixed effects regressions to estimate associations between number of weekly promotions and households' weekly food purchases, overall and by Supplemental Nutrition Assistance Program (SNAP) participation. SETTING Two large supermarkets in Maine, USA. PARTICIPANTS Eight hundred and twenty-one households with children. RESULTS Most promotions (74 %) were for less healthy foods. The most promoted food groups were sweet and salty snacks (mean = 131·0 promotions/week), baked goods (mean = 68·2) and sugar-sweetened beverages (mean = 41·6). Households generally did not change their food group purchases during weeks when they were exposed to more promotions for those groups, except that a 1-sd increase in endcap candy promotions (about 1 promotion/week) was associated with $0·19/week (about 14·5 %) increase in candy purchases among SNAP nonparticipants (adjusted P < 0·001). CONCLUSIONS In-store placement promotions for food groups were generally not associated with purchases of promoted food groups, perhaps because exposure to unhealthy food marketing was consistently high. Substantial changes to in-store food marketing may be needed to promote healthier purchases.
Collapse
Affiliation(s)
- Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA94304, USA
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, USA
| | - Alyssa J Moran
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma Anderson
- Department of Population Health Management, Cambridge Health Alliance, Cambridge, USA
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, USA
| | - Sara John
- Center for Science in the Public Interest, Washington, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| |
Collapse
|
3
|
Petimar J, Moran AJ, Grummon AH, Anderson E, Lurie P, John S, Rimm EB, Thorndike AN. In-Store Marketing and Supermarket Purchases: Associations Overall and by Transaction SNAP Status. Am J Prev Med 2023; 65:587-595. [PMID: 36878416 PMCID: PMC10475490 DOI: 10.1016/j.amepre.2023.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION In-store placement promotions are used widely in supermarkets, but their effects on customer purchases remain largely unknown. This study examined associations of supermarket placement promotions with customer purchases overall and by Supplemental Nutrition Assistance Program (SNAP) benefit use. METHODS Data on in-store promotions (e.g., endcaps, checkout displays) and transactions (n=274,118,338) were obtained from a New England supermarket chain with 179 stores from 2016 to 2017. Product-level analyses examined multivariable-adjusted changes in products' sales when they were promoted (versus not) across all transactions and stratified by whether the transaction was paid for with SNAP benefits. Food group-level analyses examined the extent to which a 20% increase from the mean number of weekly promotions for a food group (e.g., increasing the number of candy promotions from 17.0 to 20.4) was associated with total food group sales. Analyses were conducted in 2022. RESULTS Across stores, the mean (SD) number of promotions per week was highest for sweet/salty snacks (126.3 [22.6]), baked goods (67.5 [18.4]), and sugar-sweetened beverages (48.6 [13.8]) and lowest for beans (5.0 [2.6]) and fruits (6.6 [3.3]). Product sales were between 16% (low-calorie drinks) and 136% (candy) higher when promoted versus not promoted. In 14 of 15 food groups, associations were stronger among transactions made with SNAP benefits than among those not made with SNAP benefits. The number of in-store promotions was generally not associated with total food group sales. CONCLUSIONS In-store promotions, which were mostly for unhealthy foods, were associated with large product sales increases, particularly among SNAP purchasers. Policies limiting unhealthy in-store promotions and incentivizing healthy promotions should be explored.
Collapse
Affiliation(s)
- Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Alyssa J Moran
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Anna H Grummon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emma Anderson
- Department of Population Health Management, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, District of Columbia
| | - Sara John
- Center for Science in the Public Interest, Washington, District of Columbia
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Petimar J, Grummon AH, Simon D, Block JP. Nutritional Composition and Purchasing Patterns of Supermarket Prepared Foods Over Time. Am J Prev Med 2023; 64:213-220. [PMID: 36280402 PMCID: PMC9976399 DOI: 10.1016/j.amepre.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/10/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Prepared (ready-to-eat) foods are sold in >90% of U.S. supermarkets, but little is known about their nutritional quality. This study examined trends in purchases of supermarket prepared foods and compared their nutritional profile with that of supermarket packaged foods and restaurant foods. METHODS Nutrition data were obtained on prepared foods sold from 2015 to 2019 in 2 supermarket chains (∼1,200 stores). One chain (193 stores) provided transaction-level sales data from 2015 to 2017. Analyses (conducted in 2021-2022) examined trends in the number of different prepared foods offered by the chains and trends in purchases of calories, total sugar, saturated fat, and sodium from prepared foods. Calorie and nutrient densities (i.e., per 100 g of food) and prevalence of being high in calories or nutrients (on the basis of Chilean standards) were analyzed among supermarket prepared foods, supermarket packaged foods, and restaurant foods consumed in the National Health and Nutrition Examination Surveys 2015-2018. RESULTS The number of different prepared foods offered at supermarket chains increased from 1,930 in 2015 to 4,113 in 2019. Calories per transaction purchased from supermarket prepared foods increased by 1.0 calories/month (95% CI=0.8, 1.1), a ∼3% annual increase, with similar trends for other nutrients. At supermarkets, >90% of prepared bakery and deli items and 61% of prepared entrees/sides were high in calories or another nutrient of concern, similar to supermarket packaged foods and restaurant foods. CONCLUSIONS Supply of and demand for supermarket prepared foods have grown substantially over time. These trends are concerning given these foods' overall poor nutritional quality.
Collapse
Affiliation(s)
- Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Anna H Grummon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Denise Simon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jason P Block
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW In 2020, obesity prevalence among US children reached 19.7%, impacting about 14.7 million children and adolescents. Food insecurity among children is also a public health concern but has largely decreased or remained stable over the past decade, reaching 6.2% of US households with children in 2021. Given food insecurity and obesity's interconnected nature and their negative consequences on children's health, it is of interest to assess the Supplemental Nutrition Assistance Program's (SNAP's) impact on childhood food security, dietary quality, disease risk, and health outcomes. RECENT FINDINGS Evidence suggests that SNAP participants, including children, struggle to meet key dietary guidelines and perform poorly on key health indicators when compared with income-eligible and higher income nonparticipants. Children participating in SNAP were more likely to have elevated disease risk and consume more sugar-sweetened beverages (SSBs), more high-fat dairy, and more processed meats than income-eligible nonparticipants. However, research suggests that federal food assistance programs with more stringent nutrition standards - the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the National School Lunch Program (NSLP) and School Breakfast Program (SBP) - improve dietary quality, increase birth weight and gestation periods, and reduce childhood obesity, infant mortality and healthcare costs. SUMMARY After reviewing the evidence on SNAP's impacts on food insecurity, dietary quality, and health as well as research on the health impacts of other more successful federal food assistance programs, we provide three policy recommendations to strengthen SNAP's effectiveness as a health intervention for children and families.
Collapse
|
6
|
Maciel FA, Duarte D. The Impact of Cash Transfer Participation on Unhealthy Consumption in Brazil. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
7
|
Petimar J, Grummon AH, Zhang F, Gortmaker SL, Moran AJ, Polacsek M, Rimm EB, Roberto CA, Rao A, Cleveland LP, Simon D, Franckle RL, Till S, Greene J, Block JP. Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain. JAMA Intern Med 2022; 182:965-973. [PMID: 35913728 PMCID: PMC9344388 DOI: 10.1001/jamainternmed.2022.3065] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Calorie labels for prepared (ie, ready-to-eat) foods are required in large chain food establishments in the US. Large evaluations in restaurants suggest small declines in purchases of prepared foods after labeling, but to the authors' knowledge, no studies have examined how this policy influences supermarket purchases. OBJECTIVE To estimate changes in calories purchased from prepared foods and potential packaged substitutes compared with control foods after calorie labeling of prepared foods in supermarkets. DESIGN, SETTING, AND PARTICIPANTS This controlled interrupted time series compared sales 2 years before labeling implementation (April 2015-April 2017) with sales 7 months after labeling implementation (May 2017-December 2017). Data from 173 supermarkets from a supermarket chain with locations in Maine, Massachusetts, New Hampshire, New York, and Vermont were analyzed from March 2020 to May 2022. INTERVENTION Implementation of calorie labeling of prepared foods in April 2017. MAIN OUTCOMES AND MEASURES Purchased items were classified as prepared foods, potential packaged substitutes for prepared foods, or all other (ie, control) foods. The primary outcome was mean weekly calories per transaction purchased from prepared foods, and the secondary outcome was mean weekly calories per transaction purchased from similar packaged items (for substitution analyses). Analyses of prepared and packaged foods were stratified by food category (bakery, entrées and sides, or deli meats and cheeses). RESULTS Among the included 173 supermarkets, calorie labeling was associated with a mean 5.1% decrease (95% CI, -5.8% to -4.4%) in calories per transaction purchased from prepared bakery items and an 11.0% decrease (95% CI, -11.9% to -10.1%) from prepared deli items, adjusted for changes in control foods; no changes were observed for prepared entrées and sides (change = 0.3%; 95% CI, -2.5% to 3.0%). Labeling was also associated with decreased calories per transaction purchased from packaged bakery items (change = -3.9%; 95% CI, -4.3% to -3.6%), packaged entrées and sides (change = -1.2%; 95% CI, -1.4% to -0.9%), and packaged deli items (change = -2.1%; 95% CI, -2.4% to -1.7%). CONCLUSIONS AND RELEVANCE In this longitudinal study of supermarkets, calorie labeling of prepared foods was associated with small to moderate decreases in calories purchased from prepared bakery and deli items without evidence of substitution to similar packaged foods.
Collapse
Affiliation(s)
- Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anna H Grummon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alyssa J Moran
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, Portland, Maine
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Anjali Rao
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Lauren P Cleveland
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Denise Simon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Sue Till
- Hannaford Supermarkets, Scarborough, Maine
| | - Julie Greene
- Guiding Stars Licensing Company LLC, Ahold Delhaize USA, Scarborough, Maine
| | - Jason P Block
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on the available data regarding the associations of Ultra-processed food (UPF) consumption with food intake and possible underlying mechanisms relating UPF consumption to weight gain and co-morbidities. RECENT FINDINGS In primarily observational studies, UPF consumption is consistently associated with an increased risk for weight gain among adults and children and increased risk for adiposity-related co-morbidities in adults. In a single mechanistic study, consumption of UPFs led to increased energy intake and weight gain relative to whole foods. UPFs tend to be more energy-dense than nutrient-dense, and UPF consumption is associated with increased adiposity and co-morbidity risk. These data suggest that recommendations to limit UPF consumption may be beneficial to health - though further mechanistic studies are needed.
Collapse
Affiliation(s)
- Anthony Crimarco
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Matthew J Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christopher D Gardner
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA.
| |
Collapse
|
9
|
Franckle RL, Boulos RJ, Thorndike AN, Moran AJ, Khandpur N, Blue D, Greene J, Block JP, Rimm EB, Polacsek M. Implementation of a 2-for-1 Price Incentive for Fruits and Vegetables in a Grocery Retail Setting. Health Promot Pract 2022:15248399221086880. [PMID: 35414293 DOI: 10.1177/15248399221086880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE There is growing interest in expanding healthy eating interventions in the retail setting. The purpose of this study was to evaluate the implementation of a successful 2-for-1 price incentive for fruits and vegetables (F&V), including frozen and canned, that took place in partnership with a large chain grocery retailer in Maine. Intervention Approach. A randomized controlled trial (RCT) pilot study was conducted in 2015-2016, followed by a larger RCT in 2016-2017, to assess whether a supermarket double-dollar F&V incentive increased purchases of these items. EVALUATION METHODS A convergent, parallel mixed-methods design was used to examine barriers and facilitators to implementing the interventions, using six implementation outcomes: acceptability, adoption, appropriateness, feasibility, implementation fidelity, and perceived cost. RESULTS The intervention was deemed highly acceptable, appropriate, and feasible by shoppers, retailers, and researchers. The F&V discount had a high rate of initial adoption. There was a moderate degree of fidelity, which improved over time based on lessons learned from the pilot and applied to the subsequent RCT. Specific costs associated with implementation from the research perspective are reported. Implications for Practice, Policy, and Research. Partnerships between academic researchers and retailers can be an effective model for improving healthful purchases among shoppers. These findings are relevant for investigators, public health advocates, and retailers interested in implementing similar grocery retail-based interventions.
Collapse
Affiliation(s)
| | - R J Boulos
- Maine Public Health Association, Augusta, ME, USA
| | - A N Thorndike
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - A J Moran
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Khandpur
- University of Sao Paulo, Sao Paulo, Brazil
| | - D Blue
- Hannaford Supermarkets, Scarborough, ME, USA
| | - J Greene
- Guiding Stars Licensing Company LLC, Ahold Delhaize, USA
| | - J P Block
- Harvard Medical School, Boston, MA, USA
- Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - E B Rimm
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - M Polacsek
- University of New England, Portland, ME, USA
| |
Collapse
|
10
|
Grummon AH, Roberto CA, Lawman HG, Bleich SN, Yan J, Mitra N, Hua SV, Lowery CM, Peterhans A, Gibson LA. Purchases of Nontaxed Foods, Beverages, and Alcohol in a Longitudinal Cohort After Implementation of the Philadelphia Beverage Tax. J Nutr 2022; 152:880-888. [PMID: 34910200 DOI: 10.1093/jn/nxab421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence suggests that sweetened beverage taxes reduce taxed beverage purchases, but few studies have used individual-level data to assess whether these taxes affect purchases of nontaxed foods, beverages, and alcohol. Additionally, research has not examined whether sweetened beverage taxes influence restaurant purchases. OBJECTIVES We assessed changes in individuals' purchases of taxed beverage types; low-calorie/low-added-sugar nontaxed beverages; high-calorie/high-added-sugar nontaxed beverages, foods, and alcohol; and beverages from restaurants following implementation of the 1.5 cent-per-ounce Philadelphia sweetened beverage tax. METHODS A longitudinal cohort of adult sugar-sweetened beverage consumers in Philadelphia (n = 306; 67% female; mean age: 43.9 years) and Baltimore (n = 297; comparison city without a beverage tax; 58% female; mean age: 41.7 years) submitted all food and beverage receipts during 2-week periods at baseline and at 3, 6, and 12 months posttax. Difference-in-differences analyses compared changes in purchases from pre- to posttax in Philadelphia to changes in Baltimore. RESULTS Purchases of taxed juice drinks [ratio of incidence rate ratios (RIRR) = 0.62; 95% CI, 0.42-0.91], but not other taxed beverage types, decreased in Philadelphia compared to Baltimore following the tax. Analyses did not find changes in purchases of low-calorie/low-added-sugar nontaxed beverages, such as water or milk. Additionally, analyses did not find increases in purchases of most high-calorie/high-added-sugar nontaxed products, including alcohol, juice, candy, sweet snacks, salty snacks, and desserts. Purchases of beverage concentrates increased in Philadelphia (RIRR = 2.22; 95% CI, 1.39-3.54). CONCLUSIONS In this difference-in-differences analysis, the Philadelphia beverage tax was associated with reduced purchases of taxed juice drinks. Purchases of beverage concentrates increased after the tax, but no increases were observed for other high-calorie/high-added-sugar nontaxed foods, beverages, or alcohol.
Collapse
Affiliation(s)
- Anna H Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hannah G Lawman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jiali Yan
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sophia V Hua
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Caitlin M Lowery
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Ana Peterhans
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura A Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
11
|
Grummon AH, Petimar J, Zhang F, Rao A, Gortmaker SL, Rimm EB, Bleich SN, Moran AJ, Franckle RL, Polacsek M, Simon D, Greene JC, Till S, Block JP. Calorie Labeling and Product Reformulation: A Longitudinal Analysis of Supermarket-Prepared Foods. Am J Prev Med 2021; 61:377-385. [PMID: 34103209 PMCID: PMC8384707 DOI: 10.1016/j.amepre.2021.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The 2010 Affordable Care Act required chain retail food establishments, including supermarkets, to post calorie information for prepared (i.e., ready to eat) foods. Implementation of calorie labeling could spur companies to reduce the calorie content of prepared foods, but few studies have explored this. This study evaluates the changes in the calorie content of prepared foods at 2 large U.S. supermarket chains after they implemented calorie labels in April 2017. METHODS The chains (≈1,200 stores) provided data on the calorie content and labeling status of all items sold between July 2015 and January 2019. In 2021, analyses used a difference-in-differences approach to examine the changes in the calorie content of prepared bakery, entree, and deli items introduced before calorie labeling to those introduced after the labeling compared with changes in similar foods not subject to the new labeling requirement. Primary analyses examined continuously available items; exploratory analyses examined items newly introduced to the marketplace. RESULTS Relative to changes in comparison foods not subject to the labeling requirement, continuously available prepared bakery items decreased by 7.7 calories per item after calorie labels were implemented (95% CI= -12.9, -2.5, p=0.004, ≈0.5% reduction). In exploratory analyses, prepared bakery items introduced after calorie labeling contained 440 fewer calories per item than those introduced before calorie labeling (95% CI= -773.9, -106.1, p=0.01, ≈27% reduction), driven by reductions in product size. No changes were observed in the calorie content of continuously available or newly introduced prepared entrees or deli items. CONCLUSIONS Implementing calorie labels could encourage product reformulation among some types of prepared supermarket foods. These supply-side changes could lead to reductions in caloric intake.
Collapse
Affiliation(s)
- Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Anjali Rao
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alyssa J Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rebecca L Franckle
- Program for Global Public Health and the Common Good, The Schiller Institute for Integrated Science and Society, Boston College, Boston, Massachusetts
| | - Michele Polacsek
- Center for Excellence in Public Health, University of New England, Portland, Maine
| | - Denise Simon
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Julie C Greene
- Guiding Stars Licensing Company LLC, Ahold Delhaize USA, Scarborough, Maine
| | - Sue Till
- Hannaford Supermarkets, Scarborough, Maine
| | - Jason P Block
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| |
Collapse
|
12
|
Zatz LY, Moran AJ, Franckle RL, Block JP, Hou T, Blue D, Greene JC, Gortmaker S, Bleich SN, Polacsek M, Thorndike AN, Rimm EB. Comparing Online and In-Store Grocery Purchases. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:471-479. [PMID: 34116742 DOI: 10.1016/j.jneb.2021.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the grocery shopping patterns of people who shopped both online and in-store and evaluate whether shoppers purchased fewer unhealthy, impulse-sensitive items online. DESIGN Secondary analysis of 44 weeks of grocery transaction data collected for fruit and vegetable incentive trials in 2 Maine supermarkets. PARTICIPANTS A total of 137 primary household shoppers who shopped at least once in-store and online (curbside pickup) for 5,573 total transactions MAIN OUTCOME MEASURES AND ANALYSIS: Paired t tests and descriptive analyses compared online and in-store transactions with respect to frequency, total spending, number of items purchased, and spending on 10 food groups and 34 subgroups. Mixed-effects regression models estimated differences in online vs in-store spending on 5 unhealthy, impulse-sensitive subgroups. RESULTS When shopping online, participants spent 44% more per transaction ($113.58 vs $78.88, P < 0.001) and purchased more items (38.3 vs 26.6 items/transaction, P < 0.001). Compared with in-store, shopping online was associated with reduced spending per transaction on candy (-$0.65, P < 0.001), cold or frozen desserts (-$0.52, P < 0.001), and grain-based desserts (-$1.29, P < 0.001). CONCLUSIONS AND IMPLICATIONS Online shopping was associated with lower spending on certain unhealthy, impulse-sensitive foods. Grocery-based healthy eating initiatives might leverage online ordering platforms to increase their reach and effectiveness.
Collapse
Affiliation(s)
- Laura Y Zatz
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Alyssa J Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca L Franckle
- Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, MA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA
| | - Tao Hou
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Dan Blue
- Hannaford Marketing, Hannaford Supermarkets, Scarborough, ME
| | | | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Michele Polacsek
- Westbrook College of Health Professions, University of New England, Portland, ME
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
13
|
Bleich SN, Moran AJ, Vercammen KA, Frelier JM, Dunn CG, Zhong A, Fleischhacker SE. Strengthening the Public Health Impacts of the Supplemental Nutrition Assistance Program Through Policy. Annu Rev Public Health 2021; 41:453-480. [PMID: 32237988 DOI: 10.1146/annurev-publhealth-040119-094143] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The US Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) is the cornerstone of the US nutrition safety net. Each month, SNAP provides assistance to 40 million low-income Americans-nearly half of them children. A number of changes could strengthen the public health impacts of SNAP. This review first presents a framework describing the mechanisms through which SNAP policy can influence public health, particularly by affecting the food security, the diet quality, and, subsequently, the health of SNAP participants. We then discusspolicy opportunities with the greatest potential to strengthen the public health impacts of SNAP, organized into three areas: (a) food production and distribution, (b) benefit allocation, and (c) eligibility and enrollment. For each section, we describe current policy and limitations of the status quo, suggest evidence-based opportunities for policy change to improve public health, and identify important areas for future research.
Collapse
Affiliation(s)
- Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA; , ,
| | - Alyssa J Moran
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA;
| | - Kelsey A Vercammen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Johannah M Frelier
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA; , ,
| | - Caroline G Dunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA; , ,
| | - Anthony Zhong
- Harvard College, Harvard University, Cambridge, Massachusetts 02138, USA;
| | | |
Collapse
|
14
|
Booshehri LG, Dugan J. Impact of the supplemental nutritional assistance program on diet-related disease morbidity among older adults. Health Serv Res 2021; 56:854-863. [PMID: 33491211 PMCID: PMC8522576 DOI: 10.1111/1475-6773.13609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives To examine the health effects of the Supplemental Nutritional Assistance Program (SNAP) and the differential impact of SNAP across race/ethnicity among older adults. Data Source/Study Setting 2008‐2013 Medical Expenditure Panel Survey, a nationally representative population‐based complex sample survey. Study Design A difference‐in‐regression‐discontinuity (DRD) design is used to assess the impacts of SNAP on diet‐related disease morbidity. The primary outcomes were the prevalence rate of hypertension, coronary heart disease, stroke, diabetes, and cancer. We also conducted supplemental analysis to examine potential co‐occurring trends in medical utilization. Data Collection/Extraction Methods Data are publicly available. Principal Findings In the full sample, SNAP eligibility was associated with a significant decline in diabetes (−3.71 percentage points [pp]; P < .05). Non‐Hispanic (NH) White respondents reported trends similar to the full sample; however, NH Black respondents reported large declines in hypertension (−13.95 pp; P < .01) and Hispanic respondents reported declines in the prevalence of angina (−6.94 pp; P < .05) and stroke (−4.48 pp; P < .05). Conclusions Supplemental Nutritional Assistance Program eligibility was associated with the reduced prevalence of diet‐related disease among older adults. These observed declines in the prevalence of diet‐related disease do not appear to be attributable to increased medical visits or spending on medical services and prescriptions.
Collapse
Affiliation(s)
- Layla G Booshehri
- Department of Health Services, School of Public Health, Hans Rosling Center for Population Health, University of Washington, Seattle, Washington, USA
| | - Jerome Dugan
- Department of Health Services, School of Public Health, Hans Rosling Center for Population Health, University of Washington, Seattle, Washington, USA
| |
Collapse
|
15
|
Decreasing Trends in Heavy Sugar-Sweetened Beverage Consumption in the United States, 2003 to 2016. J Acad Nutr Diet 2020; 120:1974-1985.e5. [DOI: 10.1016/j.jand.2020.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/18/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022]
|
16
|
Understanding the Intersection of Race/Ethnicity, Socioeconomic Status, and Geographic Location: A Scoping Review of U.S. Consumer Food Purchasing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207677. [PMID: 33096828 PMCID: PMC7593902 DOI: 10.3390/ijerph17207677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/11/2023]
Abstract
Disparities in diet quality persist in the U.S. Examining consumer food purchasing can provide unique insight into the nutritional inequities documented by race/ethnicity, socioeconomic status (SES), and geographic location (i.e., urban vs. rural). There remains limited understanding of how these three factors intersect to influence consumer food purchasing. This study aimed to summarize peer-reviewed scientific studies that provided an intersectional perspective on U.S. consumer food purchasing. Thirty-four studies were examined that presented objectively measured data on purchasing outcomes of interest (e.g., fruits, vegetables, salty snacks, sugar-sweetened beverages, Healthy Eating Index, etc.). All studies were of acceptable or high quality. Only six studies (17.6%) assessed consumer food purchases at the intersection of race/ethnicity, SES, or geographic location. Other studies evaluated racial/ethnic or SES differences in food purchasing or described the food and/or beverage purchases of a targeted population (example: low-income non-Hispanic Black households). No study assessed geographic differences in food or beverage purchases or examined purchases at the intersection of all three factors. Overall, this scoping review highlights the scarcity of literature on the role of intersectionality in consumer food and beverage purchasing and provides recommendations for future studies to grow this important area of research.
Collapse
|
17
|
Fruit and Vegetable Purchasing Patterns and Supplemental Nutrition Assistance Program Participation: Findings From a Nationally Representative Survey. J Acad Nutr Diet 2020; 120:1633-1642. [PMID: 32736954 DOI: 10.1016/j.jand.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous studies suggest that Supplemental Nutrition Assistance Program (SNAP) participants purchase less produce than nonparticipants. Whether this is due to buying smaller amounts or to being less likely to buy any produce is unclear. Purchase patterns may also differ over the monthly distribution cycle. OBJECTIVE To examine differences in the likelihood and amounts of fruits and vegetables purchased between SNAP household compared with nonparticipant households and to determine differences in produce purchases among SNAP households at different time points in the monthly distribution cycle. DESIGN Cross-sectional. PARTICIPANTS/SETTING Data from 4708 households in the National Household Food Acquisition and Purchase Survey (April 2012 to January 2013). Participants recorded all foods acquired over 7 days. MAIN OUTCOME MEASURES Fruits and vegetables acquired over a 7-day period. STATISTICAL ANALYSES PERFORMED Weighted logistic and linear regression models adjusting for household and primary respondent characteristics were used to compare odds of purchasing fruits and vegetables and amounts purchased across 3 categories: SNAP participants, SNAP-eligible nonparticipants, and ineligible nonparticipants. SNAP participants were further subdivided according to weeks since last receiving benefits. RESULTS In adjusted analyses, SNAP participants and nonparticipants were similarly likely to purchase fruits and vegetables. However, SNAP households within a week of receiving benefits were more likely than SNAP households later in the benefit cycle to buy fruit overall, especially frozen or canned fruit, and vegetables overall, including fresh, frozen or canned, starchy, and nonstarchy vegetables (fruit odds ratio [OR] 1.68, 95% confidence interval [CI] 1.12, 2.53; vegetable OR 1.63, 95% CI 1.04, 2.55 vs households in middle of cycle). In contrast, those in the last week of the benefit cycle were less likely to purchase fruit, especially fresh fruit, and vegetables, especially fresh and nonstarchy vegetables (fruit OR 0.58, 95% CI 0.35, 0.94; vegetable OR 0.58, 95% CI 0.42, 0.79 vs. households in middle of cycle), and when they bought vegetables, they bought significantly less. CONCLUSION Considering all SNAP households together at different points in their distribution cycle masks substantial declines in purchasing fruits and vegetables over the monthly cycle.
Collapse
|
18
|
Supplemental Nutrition Assistance Program participation and current restricted food expenditures: implications for policy. Public Health Nutr 2020; 23:3448-3455. [PMID: 32524927 DOI: 10.1017/s1368980020000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE National concerns over food insecurity and obesity have prompted legislation seeking to further restrict Supplemental Nutrition Assistance Program (SNAP) purchases. The objective of this study is to provide insight on the potential impact of proposed purchase restrictions by comparing SNAP participant and income-eligible non-participants' expenditures on current SNAP-restricted foods, that is, hot foods, prepared foods, alcohol, vitamins and meal supplements. DESIGN Cross-sectional study. Bivariate analysis and multivariable regression analysis with an instrumental variables approach were employed to compare the probability of purchasing and expenditures on current SNAP-restricted foods among SNAP participants and income-eligible non-participants. SETTING National Household Food Acquisition and Purchase Survey, 2012-2013. PARTICIPANTS 2513 households, of which 1316 were SNAP participants and 1197 were income-eligible non-participants. RESULTS Both the share of households purchasing and household expenditures on current SNAP-restricted foods were similar among SNAP participants and income-eligible non-participants. CONCLUSIONS Results provide further empirical evidence that proposed SNAP purchase restrictions on sugar-sweetened beverages, snack foods and luxury foods are unlikely to have a meaningful effect on SNAP household food purchases.
Collapse
|
19
|
Kris-Etherton PM, Petersen KS, Velarde G, Barnard ND, Miller M, Ros E, O'Keefe JH, Williams K, Horn LV, Na M, Shay C, Douglass P, Katz DL, Freeman AM. Barriers, Opportunities, and Challenges in Addressing Disparities in Diet-Related Cardiovascular Disease in the United States. J Am Heart Assoc 2020; 9:e014433. [PMID: 32200727 PMCID: PMC7428614 DOI: 10.1161/jaha.119.014433] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In the United States, cardiovascular disease (CVD) is the leading cause of death and disability. Suboptimal diet quality is responsible for a greater percentage of CVD-related morbidity and mortality than any other modifiable risk factor. Further troubling are the stark racial/ethnic and socioeconomic disparities in diet quality. This represents a major public health concern that urgently requires a coordinated effort to better characterize the barriers to healthy dietary practices in population groups disproportionally affected by CVD and poor diet quality to inform multifaceted approaches at the government (policy), community environment, sociocultural, and individual levels. This paper reviews the barriers, opportunities, and challenges involved in shifting population behaviors, especially in underserved populations, toward healthy dietary practices. It is imperative that public health policies address the social determinants of nutrition more intensively than previously in order to significantly decrease CVD on a population-wide basis.
Collapse
Affiliation(s)
- Penny M Kris-Etherton
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Kristina S Petersen
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Gladys Velarde
- Division of Cardiology Department of Medicine University of Florida Jacksonville FL
| | - Neal D Barnard
- Adjunct Faculty George Washington University School of Medicine Physicians Committee for Responsible Medicine Washington DC
| | - Michael Miller
- Department of Medicine University of Maryland School of Medicine Baltimore MD
| | - Emilio Ros
- Lipid Clinic Endocrinology and Nutrition Service Institut d'Investigacions Biomediques August Pi Sunyer Hospital Clinic University of Barcelona, and Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición Instituto de Salud Carlos III Madrid Spain
| | - James H O'Keefe
- Saint Luke's Mid America Heart Institute School of Medicine University of Missouri-Kansas City MO
| | | | - Linda Van Horn
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Muzi Na
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Christina Shay
- Center for Health Metrics and Evaluation American Heart Association American Heart Association Dallas TX
| | - Paul Douglass
- Wellstar Medical Group, Metro Atlanta Cardiovascular Medicine Atlanta GA
| | - David L Katz
- Yale-Griffin Prevention Research Center Derby CT
| | - Andrew M Freeman
- Division of Cardiology Department of Medicine National Jewish Health Denver CO
| |
Collapse
|
20
|
Franckle RL, Thorndike AN, Moran AJ, Hou T, Blue D, Greene JC, Bleich SN, Block JP, Polacsek M, Rimm EB. Supermarket Purchases Over the Supplemental Nutrition Assistance Program Benefit Month: A Comparison Between Participants and Nonparticipants. Am J Prev Med 2019; 57:800-807. [PMID: 31753261 PMCID: PMC6876700 DOI: 10.1016/j.amepre.2019.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The Supplemental Nutrition Assistance Program provides financial assistance for food and beverage purchases to approximately 1 in 7 Americans, with benefits distributed once monthly. Most Supplemental Nutrition Assistance Program benefits are spent early in the month, leading to decreased caloric intake later in the month. The effects of this early benefit depletion on the types of foods and beverages purchased over the course of the month is unclear. METHODS Using individually tracked sales data from 950 participants enrolled in 2 supermarket-based RCTs in Maine (October 2015-April 2016 and October 2016-June 2017), purchases of selected food categories by Supplemental Nutrition Assistance Program participants (n=248) versus nonparticipants (n=702) in the first 2 weeks compared with the last 2 weeks of the Supplemental Nutrition Assistance Program benefit month were examined. Analyses were completed in 2019. RESULTS For Supplemental Nutrition Assistance Program participants, adjusted mean food spending decreased 37% from the first 2 weeks to the last 2 weeks of the Supplemental Nutrition Assistance Program benefit month (p<0.0001) compared with a 3% decrease (p=0.02) for nonparticipants. The decline in spending by Supplemental Nutrition Assistance Program participants occurred in all examined categories: vegetables (-25%), fruits (-27%), sugar-sweetened beverages (-30%), red meat (-37%), convenience foods (-40%), and poultry (-48%). Difference-in-difference estimators comparing Supplemental Nutrition Assistance Program participants with nonparticipants were statistically significant (p<0.05) for all examined categories. CONCLUSIONS In the second half of the Supplemental Nutrition Assistance Program benefit month, individuals reduced purchases of all examined categories. More research is needed to understand the impact of these fluctuations in spending patterns on the dietary quality of Supplemental Nutrition Assistance Program participants.
Collapse
Affiliation(s)
- Rebecca L Franckle
- Department of Biology, Boston College, Chestnut Hill, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alyssa J Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tao Hou
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dan Blue
- Hannaford Marketing, Hannaford Supermarkets, Scarborough, Maine
| | | | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Michele Polacsek
- Westbrook College of Health Professions, University of New England, Portland, Maine
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
21
|
Moran AJ, Khandpur N, Polacsek M, Rimm EB. What factors influence ultra-processed food purchases and consumption in households with children? A comparison between participants and non-participants in the Supplemental Nutrition Assistance Program (SNAP). Appetite 2019; 134:1-8. [DOI: 10.1016/j.appet.2018.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 11/02/2018] [Accepted: 12/10/2018] [Indexed: 01/14/2023]
|
22
|
Brewster PJ, Durward CM, Hurdle JF, Stoddard GJ, Guenther PM. The Grocery Purchase Quality Index-2016 Performs Similarly to the Healthy Eating Index-2015 in a National Survey of Household Food Purchases. J Acad Nutr Diet 2018; 119:45-56. [PMID: 30413342 DOI: 10.1016/j.jand.2018.08.165] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Household food purchases are potential indicators of the quality of the home food environment, and grocery purchase behavior is a main focus of US Department of Agriculture (USDA) nutrition education programs; therefore, objective measures of grocery purchases are needed. OBJECTIVE The objective of the study was to evaluate the Grocery Purchase Quality Index-2016 (GPQI-2016) as a tool for assessing grocery food purchase quality by using the Healthy Eating Index-2015 (HEI-2015) as the reference standard. DESIGN In 2012, the USDA Economic Research Service conducted the National Household Food Acquisition and Purchase Survey. Members of participating households recorded all foods acquired for a week. Foods purchased at stores were mapped to the 29 food categories used in USDA Food Plans, expenditure shares were estimated, and GPQI-2016 scores were calculated. USDA food codes, provided in the survey database, were used to calculate the HEI-2015. PARTICIPANTS/SETTING All households in the 48 coterminous states were eligible for the survey. The analytic sample size was 4,276 households. MAIN OUTCOME MEASURES GPQI-2016 and HEI-2015 scores were compared. STATISTICAL ANALYSES PERFORMED Correlation of scores was assessed using Spearman's correlation coefficient. Linear regression models with fixed effects were used to determine differences among various subgroups of households. RESULTS The correlation coefficient for the total GPQI-2016 score and the total HEI-2015 score was 0.70. For the component scores, the strongest correlations were for Total and Whole Fruit (0.89 to 0.90); the weakest were for Dairy (0.67), Refined Grains (0.66), and Sweets and Sodas/Added Sugars (0.65) (all, P<0.01). Both the GPQI-2016 and HEI-2015 were significantly different among subgroups in expected directions. CONCLUSIONS Overall, the GPQI-2016, estimated from a national survey of households, performed similarly to the HEI-2015. The tool has potential for evaluating nutrition education programs and retail-oriented interventions when the nutrient content and gram weights of foods purchased are not available.
Collapse
|
23
|
Leschewski AM, Weatherspoon DD. The Supplemental Nutrition Assistance Program: Current and Proposed Restricted Food Expenditures. Am J Prev Med 2018; 55:e70-e77. [PMID: 30033027 DOI: 10.1016/j.amepre.2018.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/22/2018] [Accepted: 04/23/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Between 2000 and 2017, a total of 23 states proposed legislation to further restrict Supplemental Nutrition Assistance Program (SNAP) purchases. In the absence of a pilot program, the potential effect of such restrictions is unclear. The objective of this study is to provide insight on the proposed restrictions' effectiveness by characterizing SNAP households' expenditures on current and proposed restricted foods, and comparing them with their cash expenditures. Restrictions on sugar-sweetened beverages, snack foods, and foods ineligible under the Special Supplemental Program for Women, Infants and Children (WIC) are considered. METHODS The National Household Food Acquisition and Purchase Survey (collected 2012-2013) provided weekly food expenditures for 1,234 SNAP households. Descriptive statistics and t-tests (completed in 2017) were used to characterize and compare households' cash and restricted food expenditures. RESULTS On average, SNAP households' allocated 7%, 6%, 17%, and 66% of their food expenditures to currently restricted foods, sugar-sweetened beverages, snack foods, and WIC-ineligible foods. Given a sugar-sweetened beverage or snack food restriction, the average SNAP household can cover their restricted expenditures with cash. However, the average household's expenditures on current restricted and WIC-ineligible foods exceed their cash expenditures by a mean of $40.84 (SE=$2.44). Note that results characterize the impact of proposed SNAP restrictions on the average SNAP household. Individually, it is likely that some SNAP households would be affected by a sugar-sweetened beverage or snack food restriction. CONCLUSIONS Legislation restricting specific foods will likely be less effective at altering SNAP households' food expenditures than legislation seeking to restrict all WIC-ineligible foods.
Collapse
Affiliation(s)
- Andrea M Leschewski
- Department of Economics, South Dakota State University, Brookings, South Dakota.
| | - Dave D Weatherspoon
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, Michigan
| |
Collapse
|
24
|
Taillie LS, Grummon AH, Miles DR. Nutritional Profile of Purchases by Store Type: Disparities by Income and Food Program Participation. Am J Prev Med 2018; 55:167-177. [PMID: 29910116 PMCID: PMC6054884 DOI: 10.1016/j.amepre.2018.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/16/2018] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Policymakers have focused on the food retail environment for improving the dietary quality for Supplemental Nutrition Assistance Program (SNAP) participants. Yet little is known about where SNAP households make food and beverage purchases or how purchases may vary by store type, SNAP participation, and income level. The objective of this study was to examine the association between SNAP-income status (participant, income-eligible non-participant, higher-income non-participant) and healthfulness of household purchases across store types. METHODS Data included household packaged food purchases (N=76,458 unique households) from 2010 to 2014, analyzed in 2017 with multivariable adjusted models to examine the nutritional profile of purchases by store type (grocery, convenience, big box, and other stores) for SNAP participating households, income-eligible non-participants, and higher-income non-participants. Outcomes included volume and nutrients (kilocalories, total sugar, saturated fat, and sodium) and calories from food groups. RESULTS All households purchased the greatest volume of foods and beverages from grocery stores, followed by big-box and other stores, with relatively little purchased from convenience stores. The largest differences between SNAP participants and non-participants were observed at grocery stores and big-box stores, where SNAP households purchased more calories from starchy vegetables, processed meat, desserts, sweeteners and toppings, total junk food, sugar-sweetened beverages, and milk, than income-eligible and higher-income SNAP non-participants. SNAP purchases also had considerably higher sodium density. Across store types, the nutritional profile of income-eligible non-participants' purchases was similar to higher-income households' purchases. CONCLUSIONS More research is needed to identify strategies to improve the nutritional profile of purchases among SNAP households.
Collapse
Affiliation(s)
- Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Anna H Grummon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Donna R Miles
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
25
|
Moran AJ, Musicus A, Gorski Findling MT, Brissette IF, Lowenfels AA, Subramanian SV, Roberto CA. Increases in Sugary Drink Marketing During Supplemental Nutrition Assistance Program Benefit Issuance in New York. Am J Prev Med 2018; 55:55-62. [PMID: 29776786 PMCID: PMC6128139 DOI: 10.1016/j.amepre.2018.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/16/2018] [Accepted: 03/12/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The Supplemental Nutrition Assistance Program (SNAP) is the largest federal food assistance program, providing $67 billion in benefits to 44 million Americans. Some states distribute SNAP benefits over one or a few days each month, which may create an incentive for retailers to heavily promote top-selling products, like sugar-sweetened beverages, when benefits are disbursed. METHODS A beverage environment scan assessing presence of displays, advertisements, and price promotions for sugar-sweetened, low-calorie, and unsweetened beverages was administered in a census of SNAP-authorized beverage retailers (n=630) in three cities in New York from September to November 2011. Multilevel regression models controlling for store type; county; and percentage SNAP enrollment, poverty, and non-Hispanic white population in the store's census tract were used to estimate the odds of in-store beverage marketing during the SNAP benefit issuance period compared to other days of the month. Data were analyzed in 2016. RESULTS There were higher odds of in-store sugar-sweetened beverage marketing during SNAP benefit issuance days (first to ninth days of the month) compared with other days of the month, particularly for sugar-sweetened beverage advertisements (OR=1.66, 95% CI=1.01, 2.72) and displays (OR=1.88, 95% CI=1.16, 3.03). In census tracts with high SNAP enrollment (>28%), the odds of a retailer having sugar-sweetened beverage displays were 4.35 times higher (95% CI=1.93, 9.98) during issuance compared with non-issuance days. There were no differences in marketing for low-calorie or unsweetened beverages. CONCLUSIONS Increases in sugar-sweetened beverage marketing during issuance may exacerbate disparities in diet quality of households participating in SNAP. Policy changes, like extending SNAP benefit issuance, may mitigate these effects.
Collapse
Affiliation(s)
- Alyssa J Moran
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Aviva Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mary T Gorski Findling
- Interfaculty Initiative in Health Policy, Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts
| | | | | | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
26
|
Chrisinger BW, Kallan MJ, Whiteman ED, Hillier A. Where do U.S. households purchase healthy foods? An analysis of food-at-home purchases across different types of retailers in a nationally representative dataset. Prev Med 2018; 112:15-22. [PMID: 29555187 PMCID: PMC5970989 DOI: 10.1016/j.ypmed.2018.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/16/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Abstract
Food shopping decisions are pathways between food environment, diet and health outcomes, including chronic diseases such as diabetes and obesity. The choices of where to shop and what to buy are interrelated, though a better understanding of this dynamic is needed. The U.S. Department of Agriculture's nationally representative Food Acquisitions and Purchase Survey food-at-home dataset was joined with other databases of retailer characteristics and Healthy Eating Index-2010 (HEI) of purchases. We used linear regression models with general estimating equations to assess relationships between trip, store, and shopper characteristics with trip HEI scores. We examined HEI component scores for conventional supermarkets and discount/limited assortment retailers with descriptive statistics. Overall, 4962 shoppers made 11,472 shopping trips over one-week periods, 2012-2013. Trips to conventional supermarkets were the most common (53.6%), followed by supercenters (18.6%). Compared to conventional supermarkets, purchases at natural/gourmet stores had significantly higher HEI scores (β = 6.48, 95% CI = [4.45, 8.51], while those from "other" retailers (including corner and convenience stores) were significantly lower (-3.89, [-5.87, -1.92]). Older participants (versus younger) and women (versus men) made significantly healthier purchases (1.19, [0.29, 2.10]). Shoppers with less than some college education made significantly less-healthy purchases, versus shoppers with more education, as did households participating in SNAP, versus those with incomes above 185% of the Federal Poverty Level. Individual, trip, and store characteristics influenced the healthfulness of foods purchased. Interventions to encourage healthy purchasing should reflect these dynamics in terms of how, where, and for whom they are implemented.
Collapse
Affiliation(s)
| | - Michael J Kallan
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, USA
| | - Eliza D Whiteman
- Department of City & Regional Planning, School of Design, University of Pennsylvania, USA
| | - Amy Hillier
- Department of City & Regional Planning, School of Design, University of Pennsylvania, USA; School of Social Policy and Practice, University of Pennsylvania, USA
| |
Collapse
|
27
|
Gorski Findling MT, Wolfson JA, Rimm EB, Bleich SN. Differences in the Neighborhood Retail Food Environment and Obesity Among US Children and Adolescents by SNAP Participation. Obesity (Silver Spring) 2018; 26:1063-1071. [PMID: 29797558 PMCID: PMC5975976 DOI: 10.1002/oby.22184] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The goal of this study was to understand the association between children's neighborhood food access and overweight/obesity in a national sample of US households, and whether this association differs by Supplemental Nutrition Assistance Program (SNAP) participation or household purchases. METHODS Data were obtained from the National Household Food Acquisition and Purchase Survey (2012-2013; n = 3,748 children aged 2 to 18 years). Logistic regression was used to examine associations between neighborhood retail food access (≤1 mile from home), food purchases (including sugary beverages), and overweight/obesity, stratified by SNAP status (1,720 participants, 453 eligible nonparticipants, 1,575 SNAP ineligible). Store types included supermarkets/grocery, combination grocery/other (independent drug, dollar, and general stores), convenience, fast food, and non-fast food restaurants. RESULTS Odds of childhood overweight/obesity (OR [95% CI]) were higher with greater access to combination grocery/other stores overall (1.10 [1.03-1.17]) and for children in SNAP (1.14 [1.05-1.24]). Eligible non-SNAP children had higher odds of overweight/obesity with greater access to convenience stores (1.11 [1.04-1.18]). The average child lived in a household with 6.3% of total spending at food outlets on sugary beverages (SNAP: 8.3%, eligible non-SNAP: 7.7%, SNAP ineligible: 5.5%). CONCLUSIONS Greater neighborhood access to combination grocery/other stores is associated with higher obesity prevalence for children overall and those in SNAP.
Collapse
Affiliation(s)
| | - Julia A. Wolfson
- Departments of Health Management and Policy and Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Eric B. Rimm
- Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts and Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
28
|
Polacsek M, Moran A, Thorndike AN, Boulos R, Franckle RL, Greene JC, Blue DJ, Block JP, Rimm EB. A Supermarket Double-Dollar Incentive Program Increases Purchases of Fresh Fruits and Vegetables Among Low-Income Families With Children: The Healthy Double Study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:217-228.e1. [PMID: 29126661 PMCID: PMC6247420 DOI: 10.1016/j.jneb.2017.09.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To carry out a pilot study to determine whether a supermarket double-dollar fruit and vegetable (F&V) incentive increases F&V purchases among low-income families. DESIGN Randomized controlled design. Purchases were tracked using a loyalty card that provided participants with a 5% discount on all purchases during a 3-month baseline period followed by the 4-month intervention. SETTING A supermarket in a low-income rural Maine community. PARTICIPANTS A total of 401 low-income and Supplemental Nutrition Assistance Program (SNAP) supermarket customers. INTERVENTION Same-day coupon at checkout for half-off eligible fresh, frozen, or canned F&V over 4 months. MAIN OUTCOME MEASURE Weekly spending in dollars on eligible F&V. ANALYSIS A linear model with random intercepts accounted for repeated transactions by individuals to estimate change in F&V spending per week from baseline to intervention. Secondary analyses examined changes among SNAP-eligible participants. RESULTS Coupons were redeemed among 53% of eligible baskets. Total weekly F&V spending increased in the intervention arm compared with control ($1.83; 95% confidence interval [CI], $0.29 to $3.88). The largest increase was for fresh F&V ($1.97; 95% CI, $0.49 to $3.44). Secondary analyses revealed greater increases in F&V spending among SNAP-eligible participants who redeemed coupons ($5.14; 95% CI, $1.93 to $8.34) than among non-SNAP eligible participants who redeemed coupons ($3.88; 95% CI, $1.67 to $6.08). CONCLUSIONS AND IMPLICATIONS A double-dollar pricing incentive increased F&V spending in a low-income community despite the moderate uptake of the coupon redemption. Customers who were eligible for SNAP saw the greatest F&V spending increases. Financial incentives for F&V are an effective strategy for food assistance programs to increase healthy purchases and improve dietary intake in low-income families.
Collapse
Affiliation(s)
- Michele Polacsek
- Westbrook College of Health Professions, University of New England, Portland, ME.
| | - Alyssa Moran
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Rebecca Boulos
- Muskie School of Public Service, University of Southern Maine, Portland, ME
| | - Rebecca L Franckle
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | | | - Jason P Block
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Eric B Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| |
Collapse
|