Where do U.S. households purchase healthy foods? An analysis of food-at-home purchases across different types of retailers in a nationally representative dataset.
ABSTRACT: Food shopping decisions are pathways between food environment, diet and health outcomes, including chronic diseases such as diabetes and obesity. The choices of where to shop and what to buy are interrelated, though a better understanding of this dynamic is needed. The U.S. Department of Agriculture's nationally representative Food Acquisitions and Purchase Survey food-at-home dataset was joined with other databases of retailer characteristics and Healthy Eating Index-2010 (HEI) of purchases. We used linear regression models with general estimating equations to assess relationships between trip, store, and shopper characteristics with trip HEI scores. We examined HEI component scores for conventional supermarkets and discount/limited assortment retailers with descriptive statistics. Overall, 4962 shoppers made 11,472 shopping trips over one-week periods, 2012-2013. Trips to conventional supermarkets were the most common (53.6%), followed by supercenters (18.6%). Compared to conventional supermarkets, purchases at natural/gourmet stores had significantly higher HEI scores (??=?6.48, 95% CI?=?[4.45, 8.51], while those from "other" retailers (including corner and convenience stores) were significantly lower (-3.89, [-5.87, -1.92]). Older participants (versus younger) and women (versus men) made significantly healthier purchases (1.19, [0.29, 2.10]). Shoppers with less than some college education made significantly less-healthy purchases, versus shoppers with more education, as did households participating in SNAP, versus those with incomes above 185% of the Federal Poverty Level. Individual, trip, and store characteristics influenced the healthfulness of foods purchased. Interventions to encourage healthy purchasing should reflect these dynamics in terms of how, where, and for whom they are implemented.
Project description:BACKGROUND:Many lower-income and racially diverse communities in the U.S. have limited access to healthy foods, with few supermarkets and many small convenience stores, which tend to stock limited quantities and varieties of healthy foods. To address food access, in 2015 the Minneapolis Staple Foods Ordinance became the first policy requiring food stores to stock minimum quantities and varieties of 10 categories of healthy foods/beverages, including fruits, vegetables, whole grains and other staples, through licensing. This study examined whether: (a) stores complied, (b) overall healthfulness of store environments improved, (c) healthy customer purchases increased, and (d) healthfulness of home food environments improved among frequent small store shoppers. METHODS:Data for this natural (or quasi) experiment were collected at four times: pre-policy (2014), implementation only (no enforcement, 2015), enforcement initiation (2016) and continued monitoring (2017). In-person store assessments were conducted to evaluate food availability, price, quality, marketing and placement in randomly sampled food retailers in Minneapolis (n?=?84) and compared to those in a nearby control city, St. Paul, Minnesota (n?=?71). Stores were excluded that were: supermarkets, authorized through WIC (Special Supplemental Nutrition Program for Women, Infants, and Children), and specialty stores (e.g., spice shops). Customer intercept interviews were conducted with 3,039 customers exiting stores. Home visits, including administration of home food inventories, were conducted with a sub-sample of frequent shoppers (n?=?88). RESULTS:Overall, findings indicated significant improvements in healthy food offerings by retailers over time in both Minneapolis and St. Paul, with no significant differences in change between the two cities. Compliance was low; in 2017 only 10% of Minneapolis retailers in the sample were fully compliant, and 51% of participating Minneapolis retailers met at least 8 of the 10 required standards. Few changes were observed in the healthfulness of customer purchases or the healthfulness of home food environments among frequent shoppers, and changes were not different between cities. CONCLUSIONS:This study is the first evaluation a local staple foods ordinance in the U.S. and reflects the challenges and time required for implementing such policies. TRIAL REGISTRATION:NCT02774330 .
Project description:Where people shop for food is often linked to the healthiness of food purchases. In Mexico, no research has examined the connection between where people shop, what they buy, and their socioeconomic status (SES). Mexico's sugary beverage and junk food taxes have made households decrease purchases of taxed products. However, whether households have changed where they shop is unknown. To address this gap, we use a repeated cross-sectional analysis of household packaged food and beverage purchases from the Nielsen Mexico Consumer Panel Survey from 2012 to 2015 (n > 5500 households). We examine changes in the volume of the purchase of taxed and untaxed products from different store-types (i.e., convenience stores, supermarkets, traditional retailers, wholesalers, home water-delivery, and others) by SES using multivariate linear regression models. Results show that high-SES households purchased more foods and beverages at all store-types except for low-SES who purchased the most foods and taxed beverages at traditional retailers. Purchases of taxed foods and beverages from traditional retailers significantly decreased for low-SES and middle-SES households and from supermarkets for middle-SES and high-SES households. Purchases of untaxed beverages from wholesalers significantly increased for middle-SES households and from convenience stores for high-SES households. Our findings suggest that consumers choose different stores to purchase beverages than to purchase foods and that taxes may have differentially affected each store-type.
Project description:Under the assumption that differential food access might underlie nutritional disparities, programs and policies have focused on the need to build supermarkets in underserved areas, in an effort to improve dietary quality. However, there is limited evidence about which types of stores are used by households of different income levels and differing races/ethnicities. We used cross-sectional cluster analysis to derive shopping patterns from US households' volume food purchases by store from 2000 to 2012. Multinomial logistic regression identified household socioeconomic characteristics that were associated with shopping patterns in 2012. We found three food shopping patterns or clusters: households that primarily shopped at grocery stores, households that primarily shopped at mass merchandisers, and a combination cluster in which households split their purchases among multiple store types. In 2012 we found no income or race/ethnicity differences for the cluster of households that primarily shopped at grocery stores. However, low-income non-Hispanic blacks (versus non-Hispanic whites) had a significantly lower probability of belonging to the mass merchandise cluster. These varied shopping patterns must be considered in future policy initiatives. Furthermore, it is important to continue studying the complex rationales for people's food shopping patterns.
Project description:BACKGROUND:Lower household income has been consistently associated with poorer diet quality. Household food purchases may be an important intervention target to improve diet quality among low income populations. Associations between household income and the diet quality of household food purchases were examined. METHODS:Food purchase receipt data were collected for 14?days from 202 urban households participating in a study about food shopping. Purchase data were analyzed using NDS-R software and scored using the Healthy Eating Index 2010 (HEI 2010). HEI total and subscores, and proportion of grocery dollars spent on food categories (e.g. fruits, vegetables, sugar sweetened beverages) were examined by household income-to-poverty ratio. RESULTS:Compared to lower income households, after adjusting for education, marital status and race, higher income households had significantly higher HEI total scores (mean [sd]?=?68.2 [13.3] versus 51.6 [13.9], respectively, adjusted p?=?0.05), higher total vegetable scores (mean [sd]?=?3.6 [1.4] versus 2.3 [1.6], respectively, adjusted p?<?.01), higher dairy scores (mean [sd]?=?5.6 [3.0] versus 5.0 [3.3], p?=?.05) and lower proportion of grocery dollars spent on frozen desserts (1% [.02] versus 3% [.07], respectively, p?=?.02). CONCLUSIONS:Lower income households purchase less healthful foods compared with higher income households. Food purchasing patterns may mediate income differences in dietary intake quality. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT02073643.
Project description:The relative affordability of energy-dense versus nutrient-rich foods may promote socioeconomic disparities in dietary quality and obesity. Although supermarkets are the largest food source in the American diet, the associations between SES and the cost and nutrient content of freely chosen food purchases have not been described.To investigate relationships of SES with the energy cost ($/1000 kcal) and nutrient content of freely chosen supermarket purchases.Supermarket shoppers (n=69) were recruited at a Phoenix AZ supermarket in 2009. The energy cost and nutrient content of participants' purchases were calculated from photographs of food packaging and nutrition labels using dietary analysis software. Data were analyzed in 2010-2011.Two SES indicators, education and household income as a percentage of the federal poverty guideline (FPG), were associated with the energy cost of purchased foods. Adjusting for covariates, the amount spent on 1000 kcal of food was $0.26 greater for every multiple of the FPG, and those with a baccalaureate or postbaccalaureate degree spent an additional $1.05 for every 1000 kcal of food compared to those with no college education. Lower energy cost was associated with higher total fat and less protein, dietary fiber, and vegetables per 1000 kcal purchased.Low-SES supermarket shoppers purchase calories in inexpensive forms that are higher in fat and less nutrient-rich.
Project description:BACKGROUND:The majority of food in the United Kingdom is purchased in supermarkets, and therefore, supermarket interventions provide an opportunity to improve diets. Randomized controlled trials are costly, time-consuming, and difficult to conduct in real stores. Alternative approaches of assessing the impact of supermarket interventions on food purchases are needed, especially with respect to assessing differential impacts on population subgroups. OBJECTIVE:The aim of this study was to assess the feasibility of using the United Kingdom Virtual Supermarket (UKVS), a three-dimensional (3D) computer simulation of a supermarket, to measure food purchasing behavior across income groups. METHODS:Participants (primary household shoppers in the United Kingdom with computer access) were asked to conduct two shopping tasks using the UKVS and complete questionnaires on demographics, food purchasing habits, and feedback on the UKVS software. Data on recruitment method and rate, completion of study procedure, purchases, and feedback on usability were collected to inform future trial protocols. RESULTS:A total of 98 participants were recruited, and 46 (47%) fully completed the study procedure. Low-income participants were less likely to complete the study (P=.02). Most participants found the UKVS easy to use (38/46, 83%) and reported that UKVS purchases resembled their usual purchases (41/46, 89%). CONCLUSIONS:The UKVS is likely to be a useful tool to examine the effects of nutrition interventions using randomized controlled designs. Feedback was positive from participants who completed the study and did not differ by income group. However, retention was low and needs to be addressed in future studies. This study provides purchasing data to establish sample size requirements for full trials using the UKVS.
Project description:Grocery shopping shapes the home food environment, which can contribute to the development of obesity. Episodic future thinking (EFT) helps adults make healthier decisions by initiating prospective thinking, which guides one to forego smaller immediate rewards in favor of larger delayed rewards. EFT could help parents improve grocery purchases thereby improving the home food environment and family eating behaviors. The effect of EFT on food shopping was evaluated in two studies with mothers who were overweight/obese and primary household shoppers. In Study 1, 24 mothers were randomized to goal-directed process EFT versus a money saving control. In Study 2, 33 mothers were randomized to goal-directed process EFT, general EFT, or an episodic recent thinking (ERT) control. Following cue generation, participants completed a task where they purchased one week of groceries from an online store. Food purchases were analyzed for calories purchased per family member. In Study 1 the goal-directed process EFT group purchased fewer calories per person (F(1, 23)?=?25.16, p?<?.001; ?p2?=?0.522). In Study 2 the goal-directed process EFT purchased fewer calories (F(1, 30)?=?5.98, p?=?.02; ?p2?=?0.166) than the ERT control as did the EFT general group (F(1, 30)?=?4.61, p?=?.04; ?p2?=?0.133). The two EFT groups did not differ from each other (F(1, 30)?=?0.16, p?=?.69; ?p2?=?0.005). EFT may be an effective intervention for reducing the energy intake of foods purchased while grocery shopping.
Project description:OBJECTIVE:Delay discounting is a neurocognitive trait that has been linked to poor nutritional health and obesity, but its role in specific dietary choices is unclear. This study tested whether individual differences in delay discounting are related to the healthfulness of household food purchases and reliance on nonstore food sources such as restaurants. METHOD:The food purchases of 202 primary household food shoppers were objectively documented for 14 days through a food receipt collection and analysis protocol. The nutrient content of household food purchases was derived for each participant, and the overall diet quality (Healthy Eating Index-2015) and energy density (kcal/g) of foods and beverages were calculated. The proportion of energy from nonstore food sources was also derived. Delay discounting was assessed with a choice task featuring hypothetical monetary rewards. RESULTS:Data were available for 12,624 foods and beverages purchased across 2,340 shopping episodes. Approximately 13% of energy was purchased from restaurants and other nonstore food sources. Steeper discounting rates were associated with lower overall Healthy Eating Index-2015 scores and a higher energy density (kcal/g) of purchased foods. Associations were attenuated but remained statistically significant when accounting for body mass index and sociodemographic variables. Discounting rates were unrelated to reliance on nonstore food sources or the energy density of purchased beverages. CONCLUSIONS:Delay discounting is related to the healthfulness of food purchases among primary household shoppers. As food purchasing is a key antecedent of dietary intake, delay discounting may be a viable target in dietary and weight management interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Project description:Food purchasing is considered a key mediator between the food environment and eating behavior, and food purchasing patterns are increasingly measured in epidemiologic and intervention studies. However, the extent to which food purchases actually reflect individuals' dietary intake has not been rigorously tested. This study examined cross-sectional agreement between estimates of diet quality and nutrient densities derived from objectively documented household food purchases and those derived from interviewer-administered 24-h diet recalls. A secondary aim was to identify moderator variables associated with attenuated agreement between purchases and dietary intake.Primary household food shoppers (N?=?196) collected and annotated receipts for all household food and beverage purchases (16,356 total) over 14 days. Research staff visited participants' homes four times to photograph the packaging and nutrition labels of each purchased item. Three or four multiple-pass 24-h diet recalls were performed within the same 14-d period. Nutrient densities and Healthy Eating Index-2010 (HEI-2010) scores were calculated from both food purchase and diet recall data.HEI-2010 scores derived from food purchases (median?=?60.9, interquartile range 49.1-71.7) showed moderate agreement (?c?=?.57, p?<?.0001) and minimal bias (-2.0) with HEI-2010 scores from 24-h recalls (median?=?60.1, interquartile range 50.8-73.9). The degree of observed bias was unrelated to the number of food/beverage purchases reported or participant characteristics such as social desirability, household income, household size, and body mass. Concordance for individual nutrient densities from food purchases and 24-h diet recalls varied widely from ?c?=?.10 to .61, with the strongest associations observed for fiber (?c?=?.61), whole fruit (?c?=?.48), and vegetables (?c?=?.39).Objectively documented household food purchases yield an unbiased and reasonably accurate estimate of overall diet quality as measured through 24-h diet recalls, but are generally less useful for characterizing dietary intake of specific nutrients. Thus, some degree of caution is warranted when interpreting food purchase data as a reflection of diet in epidemiological and clinical research. Future work should examine agreement between food purchases and nutritional biomarkers.ClinicalTrials.gov, NCT02073643 . Retrospectively registered.
Project description:Along with the development of the Internet and technology, food retailers have increasingly adopted online channels that enable consumers to buy food products online. This research aims to investigate the factors that influence consumer attitude and intention towards online food purchasing. A research framework was developed by combining the technology acceptance model with website trust, which is an important facilitator of online shopping. Using an online survey, data were obtained from 319 online food shoppers in an Asian emerging economy, i.e., Vietnam. Results from structural equation modeling show that perceived usefulness, perceived ease of use, and website trust are important drivers of attitude towards online food purchasing. Among these drivers, perceived ease of use has the greatest impact on attitude. Additionally, attitude and website trust exert a direct and positive effect on intention towards online food purchasing. Taken together, these findings have important managerial implications for key stakeholders, such as online food retailers, associations, and policy makers. One key implication is that online food sellers must endeavor to make their websites simple to use, easy to navigate, reliable, and secure. Several potential caveats for future research studies are also presented in this paper.