Healthy In-Store Marketing Study

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.