A Trial of Behavioral Economic Interventions Among Food Pantry Clients

Abramson Cancer Center at Penn Medicine286 enrolled

Overview

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).

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

286

Conditions

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

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.

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.

Secondary Outcomes

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.

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.

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.