Using a cluster randomized controlled design, this study will evaluate effects of in-store healthy food marketing strategies on sales and purchase of specific healthier items in six product categories (milk, frozen entrees, beverage checkout coolers, salty snacks, bread and cheese); and examine the effects of changes in in-store food marketing environments on sales of healthier foods. If these strategies are found to be effective, they could be used widely to encourage healthy retail sales, complement food access initiatives, and reduce health disparities in obesity and other diseases. Supermarkets will be the unit of randomization, intervention, and analysis.

As the prevalence of obesity has increased, public health experts have increasingly focused on the environments that shape overeating and unhealthy food choices. Retail grocery stores are pivotally positioned to influence choices and favorably affect energy balance. Greater availability of healthier foods, if translated to health-promoting purchases, can positively affect diet quality among those at greatest risk for obesity- low-income, ethnic minorities.

The aims of the proposed study are:

1. To evaluate, in a cluster randomized controlled trial design, effects of in-store healthy food marketing strategies on sales and purchase of healthier items in six product categories (milk, frozen entrees, beverage checkout coolers, bread, salty snacks and cheese); and
2. To evaluate the association of changes in supermarket food marketing environments with changes in sales of specific healthier food items in the same six product categories; and
3. To examine the relationships between neighborhood characteristics and changes in sales and purchases of healthier items in the six product categories.

Investigators hypothesize that sales of targeted products will be significantly higher, and that more health-focused food marketing environments will be associated with higher sales of healthy food items.

The study will be conducted in 32 supermarkets in urban, low-income, high-minority neighbor-hoods in the mid-Atlantic and Northeast regions. Intervention strategies will include prime placement, increased visibility of healthier products, call-out signs, and taste-testing for milk. Control stores will be assessment-only. Supermarket chains will help implement the strategies and provide data on sales of targeted products. Interventions will be conducted for 2 years, with an emphasis on scalability and long-term sustainability. The primary outcome measures of purchasing will be weekly sales per store for each product. Individual purchasing will be assessed in a cohort of shoppers by interviews and shopping receipts. The Grocery Marketing Environment Assessment (GMEA) tool will be used to assess marketing environments.

The research team completed a randomized pilot study of a 6-month intervention in eight supermarkets, which demonstrated the impact of the interventions on three food categories. The proposed study will provide an expanded and extended, larger-scale, rigorous test of novel and widely applicable strategies to encourage healthy retail sales, complement increased-access initiatives, and reduce health disparities in obesity and related diseases.

Inclusion Criteria:

• 18 years of age or older
• Do most of your food shopping at the store where they are recruited
• Speak English
• Be the main household shopper

Exclusion Criteria:

• No exclusion criteria defined

  • Eligible stores will be at least 35,000 square feet in size, and be located in urban or suburban communities with at least 50% of households below the state median income.