Supermarket Science: Multipronged Approaches to Increasing Fresh, Frozen and Canned Fruit and Vegetable Purchases

Through research, education and extension, this project will promote fruit and vegetable (F&V) purchases and consumption by families in under-resourced communities, thus reducing health disparities, improving human nutrition, and preventing unhealthy weight gain among children. Specifically, this project aims to evaluate the success of promoting F&V purchases among low- income and SNAP-eligible families and children living in a rural Maine community. The project will use a multipronged approach in the supermarket setting, including implementation methods from the highly effective, double value coupon incentive program used at farmers' markets, as well as the Cooking Matters at the Store educational program to incentivize the purchase and consumption of fresh produce, and healthful frozen and canned F&V (without syrup or salt), nutrient-rich and affordable year- round alternatives to fresh produce.

Education and extension efforts based on the study findings will contribute to meeting United States Department of Agriculture (USDA) Childhood Obesity Prevention Challenge Area Goals of generating new knowledge; developing, assessing and expanding effective interventions; and increasing the number of skilled and informed professionals and consumers to address the complex problem of childhood obesity. The project team will partner with a large national retail grocery chain (Hannaford Brothers), Cooking Matters, University of Maine (UMaine) Cooperative Extension, eXtension Communities of Practice, Maine SNAP-Education (SNAP-Ed), and The Food Trust to accomplish its objectives.

Methods:

Research Strategy: The study will enroll 600 shoppers (and assume 70% retention, with an initial N of 600: n=210 per study arm) entering the store in months 6-7. If a customer has interest in participating and meets enrollment criteria (having a child between ages 2 and 18 years of age living in the household, and use of the Hannaford store as the primary grocery shopping venue), then the customer will be asked to enroll. At enrollment, research assistants will obtain informed consent, instruct participants about how to join "MyHannaford" in order to receive a unique study ID for tracking of all purchases, and give participants a MyHannaford "study loyalty" card and Guiding Stars information. A short survey will be administered to collect information about demographics (age, gender, family size, ethnicity), shopping habits (e.g. percent of total grocery shopping done at this Hannaford and person doing most of the shopping in the household), best method to communicate incentive changes once randomization has occurred, and F&V promotion reminders (e.g. text, email, mail), SNAP eligibility, and SNAP participation. Through the loyalty card and study ID, all participants will receive a 5% discount on all purchases at the participating Hannaford store during months 6-16 of the project.

Semi-quantitative Food Frequency Questionnaire (FFQ): The FFQ consists of approximately 130 food items and is regularly updated to account for changes in the availability of foods. At baseline and post intervention, participants will be emailed a link to the FFQ administered online through Qualtrics, which will take approximately 20 minutes to complete. Participant who complete the survey will be emailed an e-gift card. Participants will be asked to identify one index child in the household closest to the age range of 6-10 yrs (where children may be most receptive and influenced by parents eating patterns). Participants will be provided an excerpted section of the FFQ with only F&V listed for the respondent to complete, representing the child's average at-home consumption.