Food Preferences
Conditions
Keywords
Food Assistance, Economics, Behavioral, Food Labeling, Diet Records, Biomarkers
Brief summary
Obesity, unhealthy dietary habits, and food insecurity are major public health concerns, especially affecting individuals living in poverty. Food pantries, which provide free food to those in need, are increasingly interested in promoting healthy choices, but few rigorous studies have tested healthy eating interventions in food pantry settings. The overall objective of this proposal is to conduct a randomized-controlled trial among 500 regular food pantry clients to compare the influence of a behavioral economic intervention to promote healthier food choices delivered via a web-based ordering platform to usual care (control group).
Detailed description
The primary objective of this proposal is to evaluate the influence of a web-based behavioral economic intervention compared to a control group on the following outcomes among food pantry clients: 1) Nutritional quality of food chosen at the pantry using food transaction data; 2) Fruit and vegetable intake measured by biomarkers and food frequency questionnaires; 3) Objectively measured biomarkers of health. The web-based behavioral economic intervention will include the following modifications to the online shopping platform: 1) Healthy food shopping cart defaults, 2) healthy placement choice architecture, 3) traffic light nutrition labels, 4) social norms messaging, and 5) healthy swaps. Food transaction data will be collected from the online system at baseline and then continuously for the remaining 3 months of the study (participants typically shop monthly). Surveys and objective biomarkers will be collected at baseline and three-months.
Interventions
BEHAVIORALBehavioral economic intervention of online purchasing at a food pantry
This intervention includes multiple behavioral economic interventions, healthy food shopping cart defaults, healthy placement choice architecture, traffic light nutrition labels, social norms messaging, and healthy swaps.
Sponsors
Massachusetts General Hospital
University of Connecticut
National Cancer Institute (NCI)
Abramson Cancer Center at Penn Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Investigator)
Masking description
The research team will create the randomization list and a research assistant will assign the participant to the correct online platform condition, but the investigators and data analysts will remain blind to group assignment. This study will contain two parallel groups. Although participants will not initially be aware of the other study condition, they will not be blinded to study condition because those in the intervention condition will be viewing the altered ordering platform as they shop.
Intervention model description
The researchers will recruit 500 regular food pantry clients to participate in a randomized-controlled trial that involves visiting the food pantry and selecting food using the web-based ordering system, having physical measurements collected by study staff, completing food frequency questionnaires, completing a health survey, and getting a blood draw to measure fruit and vegetable intake and health outcomes from biomarkers. Participants will be randomized to 1 of 2 conditions: 1) control group (usual care); or 2) behavioral economic intervention group.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* ≥18 years old * primary grocery shopper for the family * a regular in-person client at the food pantry (i.e., shops at pantry ≥ 1 per month) * able to use the web-based touchscreen ordering system * able to use a blood pressure cuff and scale provided to them for taking blood pressure and weight * able to come outside their home for 5 minutes for the Veggie Meter measurement
Exclusion criteria
* \<18 years old * not the primary grocery shopper for the family * not a regular client at the food pantry (i.e., shops at pantry \< 1 per month) * not able to use the web-based touchscreen ordering system * not able to use a blood pressure cuff and scale provided to them for taking blood pressure and weight * not able to come outside their home for 5 minutes for the Veggie Meter measurement
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Monthly Change in Number of Units of Healthier Foods | Collected from the online system at baseline and then each month for the remaining 3 months of participation. | Average monthly change from baseline across 3 months of participation, in number of units of healthier foods (labeled with a green traffic light) purchased per shopping trip using the food pantry's definition of a unit. |
| Mean Monthly Change in Number of Units of Less Healthy Foods | Collected from the online system at baseline and then each month for the remaining 3 months of participation. | Average monthly change from baseline across 3 months of participation, in number of units of less healthy foods (labeled with a red or yellow traffic light) purchased per shopping trip using the food pantry's definition of a unit. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Monthly Change in Calories From Less Healthy Foods Per Shopping Trip | Collected from the online system at baseline and then each month for the remaining 3 months of participation. | Average monthly change from baseline across 3 months of participation, in number of calories from less healthy foods per shopping trip. |
| Self-reported Change in Fruit and Vegetable Intake | Assessed at baseline and 3 months. | Change from baseline in fruit and vegetable intake as measured by the National Cancer Institute (NCI)'s fruit and vegetable module of the Dietary Screener Questionnaire in the National Health and Nutrition Examination Survey (NHANES). Scores estimate average daily cup equivalents of total fruit and vegetable servings. |
| Change in Diastolic Blood Pressure | Assessed at baseline and 3 months. | Change from baseline in diastolic blood pressure (indicator of heart health) |
| Change in Body Mass Index (BMI) | Assessed at baseline and 3 months. | Change from baseline in BMI (weight in kg / height in meters\^2) |
| Change in Systolic Blood Pressure | Assessed at baseline and 3 months. | Change from baseline in systolic blood pressure (indicator of heart health) |
| Biomarker Change in Fruit and Vegetable Intake | Assessed at baseline and 3 months. | Change from baseline in carotenoid levels (scores range 0-800) as measured by the VeggieMeter®. The VeggieMeter® is a spectroscopy-based skin carotenoid measurement device, created by Longevity Link Corporation in 2015. It uses pressure-mediated reflection spectroscopy (RS) to detect and quantify skin carotenoids as a proxy for fruit and vegetable intake in humans. Validation studies show VeggieMeter scores to be highly correlated with blood serum measures of carotenoids (R=.81). Higher units represent a higher concentration of carotenoids in the skin. |
| Mean Monthly Change in Calories From Healthier Foods Per Shopping Trip | Collected from the online system at baseline and then each month for the remaining 3 months of participation. | Average monthly change from baseline across 3 months of participation, in number of calories from healthier foods per shopping trip. |
Countries
United States
Participant flow
Recruitment details
Participants were clients at a food pantry and were recruited either in-person at the pantry or by phone (after March 2020 due to the Covid-19 pandemic). Recruitment ran from July 2019 to September 2022. 70% of participants were recruited before the pandemic.
Pre-assignment details
Due to the Covid-19 pandemic, we lost 47 participants who were consented (before March 2020), but had not yet completed their baseline appointment. 3 others were accidentally enrolled, but did not meet our enrollment criteria and were excluded before baseline. Finally 1 was excluded because they were not randomized to a condition.
Participants by arm
| Arm | Count |
|---|---|
| Control Group Participants in this arm will view the typical web-based ordering system platform (usual care group). | 109 |
| Behavioral Economic Intervention Group Participants in this arm will be exposed to the web-based ordering system with multiple behavioral economic interventions applied, including healthy food shopping cart defaults, healthy placement choice architecture, traffic light nutrition labels, social norms messaging, and healthy swaps.
Behavioral economic intervention of online purchasing at a food pantry: This intervention includes multiple behavioral economic interventions, healthy food shopping cart defaults, healthy placement choice architecture, traffic light nutrition labels, social norms messaging, and healthy swaps. | 124 |
| Total | 233 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Withdrawal by Subject | 2 | 0 |
Baseline characteristics
| Characteristic | Total | Behavioral Economic Intervention Group | Control Group |
|---|---|---|---|
| Age, Continuous | 66 years STANDARD_DEVIATION 14 | 66 years STANDARD_DEVIATION 15 | 66 years STANDARD_DEVIATION 12 |
| Children at home 1 or more children at home | 36 Participants | 17 Participants | 19 Participants |
| Children at home No children at home | 192 Participants | 105 Participants | 87 Participants |
| Children at home Unknown | 5 Participants | 2 Participants | 3 Participants |
| Education College or above | 102 Participants | 53 Participants | 49 Participants |
| Education High school degree or equivalent | 59 Participants | 29 Participants | 30 Participants |
| Education Less than high school | 11 Participants | 6 Participants | 5 Participants |
| Education Some college or associates | 57 Participants | 33 Participants | 24 Participants |
| Education Unknown | 4 Participants | 3 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 6 Participants | 3 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 226 Participants | 121 Participants | 105 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants |
| Language English | 105 Participants | 55 Participants | 50 Participants |
| Language Other language | 6 Participants | 3 Participants | 3 Participants |
| Language Russian | 122 Participants | 66 Participants | 56 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 13 Participants | 7 Participants | 6 Participants |
| Race (NIH/OMB) Black or African American | 13 Participants | 5 Participants | 8 Participants |
| Race (NIH/OMB) More than one race | 5 Participants | 2 Participants | 3 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants | 0 Participants | 4 Participants |
| Race (NIH/OMB) White | 197 Participants | 109 Participants | 88 Participants |
| Sex: Female, Male Female | 156 Participants | 91 Participants | 65 Participants |
| Sex: Female, Male Male | 77 Participants | 33 Participants | 44 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 109 | 0 / 124 |
| other Total, other adverse events | 0 / 109 | 0 / 124 |
| serious Total, serious adverse events | 0 / 109 | 0 / 124 |
Outcome results
Primary
Mean Monthly Change in Number of Units of Healthier Foods
Average monthly change from baseline across 3 months of participation, in number of units of healthier foods (labeled with a green traffic light) purchased per shopping trip using the food pantry's definition of a unit.
Time frame: Collected from the online system at baseline and then each month for the remaining 3 months of participation.
Population: Some participants were missing order data -- especially near March 2020 at the start of the Covid-19 pandemic.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control Group | Mean Monthly Change in Number of Units of Healthier Foods | -1.32 units of healthy food | Standard Deviation 7.77 |
| Behavioral Economic Intervention Group | Mean Monthly Change in Number of Units of Healthier Foods | 0.53 units of healthy food | Standard Deviation 5.54 |
Primary
Mean Monthly Change in Number of Units of Less Healthy Foods
Average monthly change from baseline across 3 months of participation, in number of units of less healthy foods (labeled with a red or yellow traffic light) purchased per shopping trip using the food pantry's definition of a unit.
Time frame: Collected from the online system at baseline and then each month for the remaining 3 months of participation.
Population: Some participants were missing order data -- especially near March 2020 at the start of the Covid-19 pandemic.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control Group | Mean Monthly Change in Number of Units of Less Healthy Foods | 0.20 units of less healthy food | Standard Deviation 3.67 |
| Behavioral Economic Intervention Group | Mean Monthly Change in Number of Units of Less Healthy Foods | -0.04 units of less healthy food | Standard Deviation 2.68 |
Secondary
Biomarker Change in Fruit and Vegetable Intake
Change from baseline in carotenoid levels (scores range 0-800) as measured by the VeggieMeter®. The VeggieMeter® is a spectroscopy-based skin carotenoid measurement device, created by Longevity Link Corporation in 2015. It uses pressure-mediated reflection spectroscopy (RS) to detect and quantify skin carotenoids as a proxy for fruit and vegetable intake in humans. Validation studies show VeggieMeter scores to be highly correlated with blood serum measures of carotenoids (R=.81). Higher units represent a higher concentration of carotenoids in the skin.
Time frame: Assessed at baseline and 3 months.
Population: Many participants were unable to complete the 2nd in-person data collection due to Covid-19
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control Group | Biomarker Change in Fruit and Vegetable Intake | 11 skin carotenoid score | Standard Deviation 113 |
| Behavioral Economic Intervention Group | Biomarker Change in Fruit and Vegetable Intake | 4 skin carotenoid score | Standard Deviation 113 |
Secondary
Change in Body Mass Index (BMI)
Change from baseline in BMI (weight in kg / height in meters\^2)
Time frame: Assessed at baseline and 3 months.
Population: Several participants were not able to do the follow-up in-person measures due to the Covid-19 pandemic
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control Group | Change in Body Mass Index (BMI) | -0.11 kilograms per square meter | Standard Deviation 1.48 |
| Behavioral Economic Intervention Group | Change in Body Mass Index (BMI) | -0.12 kilograms per square meter | Standard Deviation 1.48 |
Secondary
Change in Diastolic Blood Pressure
Change from baseline in diastolic blood pressure (indicator of heart health)
Time frame: Assessed at baseline and 3 months.
Population: Several participants were not able to make it to their follow-up in-person appointment due to the Covid-19 pandemic.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control Group | Change in Diastolic Blood Pressure | 2.5 mmHg | Standard Deviation 11 |
| Behavioral Economic Intervention Group | Change in Diastolic Blood Pressure | -0.3 mmHg | Standard Deviation 9 |
Secondary
Change in Systolic Blood Pressure
Change from baseline in systolic blood pressure (indicator of heart health)
Time frame: Assessed at baseline and 3 months.
Population: Several participants were not able to complete the follow-up in-person appointments due to the Covid-19 pandemic.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control Group | Change in Systolic Blood Pressure | 5.3 mmHg | Standard Deviation 16.3 |
| Behavioral Economic Intervention Group | Change in Systolic Blood Pressure | 0.1 mmHg | Standard Deviation 16.5 |
Secondary
Mean Monthly Change in Calories From Healthier Foods Per Shopping Trip
Average monthly change from baseline across 3 months of participation, in number of calories from healthier foods per shopping trip.
Time frame: Collected from the online system at baseline and then each month for the remaining 3 months of participation.
Population: Some participants were missing order data -- especially near March 2020 at the start of the Covid-19 pandemic.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control Group | Mean Monthly Change in Calories From Healthier Foods Per Shopping Trip | -124 calories from healthy food | Standard Deviation 694 |
| Behavioral Economic Intervention Group | Mean Monthly Change in Calories From Healthier Foods Per Shopping Trip | 31 calories from healthy food | Standard Deviation 581 |
Secondary
Mean Monthly Change in Calories From Less Healthy Foods Per Shopping Trip
Average monthly change from baseline across 3 months of participation, in number of calories from less healthy foods per shopping trip.
Time frame: Collected from the online system at baseline and then each month for the remaining 3 months of participation.
Population: Some participants were missing order data -- especially near March 2020 at the start of the Covid-19 pandemic.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control Group | Mean Monthly Change in Calories From Less Healthy Foods Per Shopping Trip | 29 calories from less healthy food | Standard Deviation 545 |
| Behavioral Economic Intervention Group | Mean Monthly Change in Calories From Less Healthy Foods Per Shopping Trip | 14 calories from less healthy food | Standard Deviation 472 |
Secondary
Self-reported Change in Fruit and Vegetable Intake
Change from baseline in fruit and vegetable intake as measured by the National Cancer Institute (NCI)'s fruit and vegetable module of the Dietary Screener Questionnaire in the National Health and Nutrition Examination Survey (NHANES). Scores estimate average daily cup equivalents of total fruit and vegetable servings.
Time frame: Assessed at baseline and 3 months.
Population: Some participants were missing survey data -- especially near March 2020 at the start of the Covid-19 pandemic.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control Group | Self-reported Change in Fruit and Vegetable Intake | -0.01 cup equivalents/day | Standard Deviation 1.25 |
| Behavioral Economic Intervention Group | Self-reported Change in Fruit and Vegetable Intake | 0.08 cup equivalents/day | Standard Deviation 1.32 |