B’More healthy: retail rewards - design of a multi-level communications and pricing intervention to improve the food environment in Baltimore City

Abstract

BackgroundLow-income black residents of Baltimore City have disproportionately higher rates of obesity and chronic disease than other Maryland residents. Increasing the availability and affordability of healthy food are key strategies to improve the food environment and can lead to healthier diets. This paper describes B’More Healthy: Retail Rewards (BHRR), an intervention that tests the effectiveness of performance-based pricing discounts and health communications, separately and combined, on healthy food purchasing and consumption among low-income small store customers.Methods/designBHRR is 2x2 factorial design randomized controlled trial. Fifteen regular customers recruited from each of 24 participating corner stores in Baltimore City were enrolled. Food stores were randomized to 1) pricing intervention, 2) communications intervention, 3) combined intervention, or 4) control. Pricing stores were given a 10-30% price discount on selected healthier food items, such as fresh fruits, frozen vegetables, and baked chips, at the point of purchase from two food wholesale stores during the 6-month trial. Storeowners agreed to pass on the discount to the consumer to increase demand for healthy food. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests, and refrigerators. Primary outcome measures include consumer food purchasing and associated psychosocial variables. Secondary outcome measures include consumer food consumption, store sales, and associated storeowner psychosocial factors. Process evaluation was monitored throughout the trial at wholesaler, small store, and consumer levels.DiscussionThis is the first study to test the impact of performance-based pricing and communications incentives in small food stores, an innovative strategy to encourage local wholesalers and storeowners to share responsibility in creating a healthier food supply by stocking, promoting, and reducing costs of healthier foods in their stores. Local food wholesalers were involved in a top-down, participatory approach to develop and implement an effective and sustainable program. This study will provide evidence on the effectiveness of price incentives and health communications, separately and combined, among a low-income urban U.S. population.Trial registrationClinicalTrials.gov: NCT02279849 (2/18/2014).

Local food: benefits and failings due to modern agriculture

“…The author assumes that this is due to the possibility of encouraging better and healthier food choices. Thus, increasing the availability and affordability of healthy foods are key strategies to improving diet and health (Budd et al, 2015). With respect to obesity, Hamilton et al (2014) believe that urban agriculture, with local food production, shows particularly significant potential for stifling the obesity epidemic.…”

Development and Implementation: B’More Healthy Communities for Kid’s Store and Wholesaler Intervention

“…Store circulars have been considered as an environmental factor that can shape health-related behaviors and have been described as an effective tool to promote healthful foods (Ethan, Basch, Rajan, Samuel, & Hammond, 2014). The wholesale-level evaluation included seven standards, developed based on previous experience working with wholesalers in Baltimore, related to reach, dose, and fidelity (Table 2; Budd et al, 2015). …”

Exploring sales data during a healthy corner store intervention in Toronto: the Food Retail Environments Shaping Health (FRESH) project

“…directly collected checkout scanner data, commercially available data sets and grocery receipts) have been used to monitor the effectiveness of interventions in a variety of types of retail food stores, [9][10][11][12] including a number of recent small-store studies. [13][14][15][16][17] Together, these studies suggest that sales data can actually be used in the design of retail food interventions. For example, Foster and colleagues 9 found that low-cost strategies focussed on improving product availability and placement enhanced sales of some foods and beverage categories (milk, water, frozen meals) but not others (regular soda, diet soda, cereal).…”