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Using a Naturalistic Store Laboratory for Clinical Trials of Point-of-Sale Nutrition Policies and Interventions: A Feasibility and Validation Study.

ABSTRACT: Point-of-sale policies such as warnings and taxes are promising tools for improving the nutritional quality of food purchases. Research studies conducted in naturalistic store laboratories could improve the quality of evidence about point-of-sale interventions by allowing for realistic exposure in a controlled setting. This study aimed to assess whether purchasing behavior in a naturalistic store laboratory setting was similar to real-life purchasing behavior and to evaluate participants' perceptions of store realism and the acceptability of research study protocols in this setting. In a longitudinal observational study in 2019, Latinx parents in North Carolina (n = 61) attended five weekly visits at the UNC Mini Mart, a naturalistic store laboratory that resembled a small convenience store. At each visit, participants purchased a week's supply of beverages. Purchases of beverages in the Mini Mart were compared to participants' purchases from receipts submitted the week prior to the study. Analyses compared the percentage of participants buying sugary drinks and non-sugary drinks in the Mini Mart vs. in real stores using Chi-Square tests with Fisher's p. The percentage of parents who purchased sugary drinks in the Mini Mart (93%) was not significantly different from the percentage who purchased sugary drinks during the week before the study (74%, p = 0.28). The percentage purchasing non-sugary drinks was similar in the two settings (85% in the Mini Mart vs. 85% from receipts, p = 0.33). Nearly all participants reported that their Mini Mart purchases were similar to real-life purchases (96%); the Mini Mart felt like a real store (94%); they could find all the beverages they were looking for (92%); and they could imagine doing their real-life beverage shopping in the Mini Mart (92%). Moreover, retention was high, with 97% of participants attending the final study visit. These results indicate that naturalistic store laboratories are a promising method for increasing the ecological validity of trials to evaluate point-of-sale interventions.

SUBMITTER: Hall MG

PROVIDER: S-EPMC8394834 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPoint-of-sale is a potentially important opportunity to promote healthy eating through nutrition education and environment modification. The aim of this review was to describe and review the evidence of effectiveness of various types of interventions that have been used at point-of-sale to encourage purchase and/or eating of healthier food and to improve health outcomes, and the extent to which effectiveness was related to intensity, duration and intervention setting.MethodsRecords from searches in databases were screened and assessed against inclusion criteria. Included studies had risk of bias assessed. Intervention effectiveness was assessed for two outcomes: i) purchase and/or intake of healthier food options and/or nutrient intake; and ii) mediating factors that might effect the primary outcome.ResultsThe search identified 5635 references. Thirty-two papers met the inclusion criteria. Twelve studies had low risk of bias and were classified as strong, nine were moderate and 11 were weak. Six intervention types and a range of different outcome measures were described in these papers: i) nutrition education and promotion alone through supermarkets/stores; ii) nutrition education plus enhanced availability of healthy food; iii) monetary incentive alone; iv) nutrition education plus monetary incentives; v) nutrition intervention through vending machines; and vi) nutrition intervention through shopping online. The evidence of this review indicates that monetary incentives offered to customers for a short-term look promising in increasing purchase of healthier food options when the intervention is applied by itself in stores or supermarkets. There was a lack of good quality studies addressing all other types of relevant point-of-sale interventions examining change in purchase and/or intake of healthier food options. There were few studies that examined mediating factors that might mediate the effect on the primary outcomes of relevant interventions.ConclusionsA range of intervention types have been used at point-of-sale to encourage healthy purchasing and/or intake of healthier food options and to improve health outcomes. There is a need for more well designed studies on the effectiveness of a range of point-of-sale interventions to encourage healthier eating and improve health outcomes, and of the mediating factors that might impact these interventions.

Project description:BackgroundDiet is an important determinant of health, and food purchasing is a key antecedent to consumption.ObjectiveWe set out to evaluate the effectiveness of grocery store interventions to change food purchasing, and to examine whether effectiveness varied based on intervention components, setting, or socioeconomic status.DesignWe conducted a systematic review of randomized controlled trials (search performed June 2017). Studies must have: aimed to change food purchasing; been implemented in grocery stores (real or simulated); reported purchasing; and had a minimal control or compared interventions fulfilling our criteria. Searching, screening, bias assessment, and data extraction followed Cochrane methods. We grouped studies by intervention type (economic, environmental, swaps, and/or education), synthesized results narratively, and conducted an exploratory qualitative comparative analysis.ResultsWe included 35 studies representing 89 interventions, >20,000 participants, and >800 stores. Risk of bias was mixed. Economic interventions showed the most promise, with 8 of the 9 studies in real stores and all 6 in simulated environments detecting an effect on purchasing. Swap interventions appeared promising in the 2 studies based in real stores. Store environment interventions showed mixed effects. Education-only interventions appeared effective in simulated environments but not in real stores. Available data suggested that effects of economic interventions did not differ by socioeconomic status, whereas for other interventions impact was variable. In our qualitative comparative analysis, economic interventions (regardless of setting) and environmental and swap interventions in real stores were associated with statistically significant changes in purchasing in the desired direction for ?1 of the foods targeted by the intervention, whereas education-only interventions in real stores were not.ConclusionsFindings suggest that interventions implemented in grocery stores-particularly ones that manipulate price, suggest swaps, and perhaps manipulate item availability-have an impact on purchasing and could play a role in public health strategies to improve health. Review protocol registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42017068809.

Project description:IntroductionFor cigars sold individually without packaging, including many premium cigars, the US Food and Drug Administration (FDA) proposed that retailers display six warning statements on a sign at the point-of-sale (POS).Aims and methodsTo examine the potential effectiveness of cigar warning signs, we conducted a between-subjects online experiment. Participants were 809 U.S. adults who reported using cigars (78% ever large cigar use, 49% past 30-day large cigar use) recruited from a probability-based panel. Participants viewed an image of a cigar store countertop with randomization to one of four conditions: (1) no warning sign, (2) a sign with six FDA proposed text-only warnings, (3) a sign with six novel text-only warnings, or (4) a sign with six novel text + image warnings. We used analysis of variance (ANOVA) models and post hoc Tukey tests to examine the results.ResultsThe FDA-proposed text-only warning sign was perceived as less effective in discouraging participants from smoking cigars (M: 3.26, SD: 1.39; scale range: 1-5, where five indicates higher discouragement) compared with the novel text-only warning sign (M = 3.38, SD = 1.40) and the novel text + image warning sign (M = 3.65, SD = 1.34). The novel text + image warning sign increased discouragement from smoking cigars versus the FDA-proposed text-only warning sign (p = .02) and decreased the perceived satisfaction of smoking cigars versus no warning sign (p = .04). In a sensitivity analysis, the novel text + image warning sign decreased the perceived satisfaction of smoking cigars (p = .01), decreased cigar purchase intentions (p = .03), decreased the urge to smoke (p = .03), and increased discouragement from smoking cigars (p = .006) compared with all other study conditions.ConclusionsResults provide new evidence that policymakers, such as the FDA, could use when proposing POS warning signs for cigars.ImplicationsThe US FDA proposed that retailers display a warning sign at the POS for cigars sold individually without packaging. We conducted an online experiment concerning the potential effectiveness of this regulatory policy with people who use cigars recruited from a probability-based panel. Results provide the first evidence that the FDA-proposed text-only warning sign was perceived as less effective than other types of warning signs and that adding images could potentially increase the effectiveness of warning signs. These findings are particularly relevant for premium cigars, which are often sold individually in brick-and-mortar retail settings.

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Using a Naturalistic Store Laboratory for Clinical Trials of Point-of-Sale Nutrition Policies and Interventions: A Feasibility and Validation Study.

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