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Using Choice Architecture to Create Healthy Food Interventions in Food Pantries
Journal of Nutrition Education and Behavior Volume 48, Number 7S, 2016
P67 Assessing Low-Income Clients’ Views About Retail and Food Pantry Environments Catalina Aragon, MS, [email protected], Washington State University, 2606 West Pioneer, Puyallup, WA 98371; A. Bush-Kaufman, MPH, RD; J. Armstrong Shultz, PhD; K. Barale, MS, RD, FADA Objective: To identify low-income clients’ perceptions about their local grocery retail and food pantry environments that potentially influence access to fruits and vegetables (FV). Design, Setting, Participants, and Intervention: A cross-sectional self-administered survey was conducted with low-income adult clients from EFNEP and SNAP-Ed class series (n¼200). Survey design followed the Model of Community Nutrition Environments. Selected items aligned with current environmental scan assessments for retail and food pantry outlets. Questionnaire construction followed the Tailored Design Method. Outcomes Measure and Analysis: Perceived availability, access, and affordability of FV in the retail environment were assessed including factors potentially influencing greater purchase of FV. Attitudes toward environmental features of the client’s primary retail and food pantry outlets were included. Results: The survey sample included clients from six Washington counties and diverse ethnic/racial groups; 55% participated in SNAP and 50% were food pantry clients. Location-related factors that clients indicated were ‘very important’ to their decision to shop at their major retail store included: proximity to where they live (58%), feeling safe shopping at the store (51%), and ability of getting a ride to that store (34%). Factors that clients reported as ‘very likely’ encouraging them to buy more F/V included: in-store sales (69%), attractive displays (37%), free samples (37%) and recipes (27%). Survey respondents valued a variety of factors related to food pantries such as: shopping style, information on other assistance programs, healthier options, and recipes. Conclusions and Implications: Findings provide guidance to retail and food pantry partners for environmental supports that promote healthier choices in ways meaningful to clients. Funding: Supplemental Nutrition Assistance Program Education
P68 Behavioral Nutrition Interventions in Food Pantries: Lessons and Strategies Brian Wansink, PhD, [email protected], Cornell University, Food and Brand Lab, Warren Hall 112, Ithaca, NY 14850; H. Bhana, MHSc, Columbia University; J. W. Cadenhead, BS; M. Qureshi, BS Objective: Emerging evidence shows behavioral interventions in food pantries can be promising to improve healthy food selection; however, conducting research in these settings can be challenging. This article provides recommendations of specific actions and methodological considerations that behavioral practitioners and researchers can take to build stronger collaborative and self-sustaining interventions for food pantries.
Poster Abstracts S35
Target Audience: Researchers and practitioners developing behavioral interventions in food pantries. Theory, Prior Research, Rationale: Interventions employing behavioral science strategies (adjusting convenience, attractiveness, and social norms of target foods) in school lunchrooms, cafeterias, and grocery stores are able to change eating patterns in scalable and affordable ways. Food pantries would benefit from utilizing these strategies, as they serve at-risk populations and operate within financial constraints. Description: A series of studies conducted in urban food pantries illustrates common barriers to successful intervention execution and evaluation include: site-specific disruptions; difficulty maintaining fidelity; difficulty ensuring intervention strength; challenges to measuring and collecting data. Evaluation: Solutions derived from these studies and other literature include: generating key informants and internal advocates of the intervention at all staffing levels; developing logic models and transition plans; considering multi-modal evaluation assessments; conducting needs assessments of the target versus service population; considering competing operation strategies and health service programs provided by the pantry; considering dosage to the intervention with respect to number of exposures and duration of exposure; and providing images/photos to guide staff in the intervention setup. Conclusions and Implications: Easy changes to methodologies and procedures in food pantries can make research efforts more productive and viable in these complex settings. Funding: None
P69 Using Choice Architecture to Create Healthy Food Interventions in Food Pantries Brian Wansink, PhD, [email protected], Cornell University, Food and Brand Lab, Warren Hall 112, Ithaca, NY 14850; H. Bhana, MHSc, Columbia University; M. Qureshi, BS; J. W. Cadenhead, BS Objective: Food pantries offer a wide array of healthy foods which are often bypassed in favor of less healthy items. This study examined whether altering the location of a target healthy food could increase selection of it over competitive and less healthy foods. Design, Setting, Participants, and Intervention: The study used a quasi-experimental design with an intervention and matched control client-choice pantry (pantries where clients are able to ‘‘shop’’ in a fashion similar to a grocery store). Pantry clients were mostly female, 2083 years of age, and Hispanic/Latino (63%) and AfricanAmerican/Black (28%). In this study, the location of a healthy whole grain cereal was altered to two conditions: either located along with all other (less healthy) cereals or ahead of (and separate from) alternative cereals. Outcome Measures and Analysis: Inventory records of the target cereal and all competing cereals were tracked and pre-post self-report surveys conducted with intervention Continued on page S36
S36 Poster Abstracts
Journal of Nutrition Education and Behavior Volume 48, Number 7S, 2016
P69 (continued) (n¼313) and control (n¼293) pantry clients from January to June 2015. Results: When the target cereal was placed separate and ahead of competitive cereals, self-reported selection rose from 8.4% to 32% (X2 ¼ 27.53; p< .0001) in intervention compared to control clients. Conclusions and Implications: This preliminary field study underscores two important findings: small, easy, no-cost changes can improve food selections in a pantry setting; and contrary to prior work, healthier food should be seen first and placed separately from less healthy competing foods in order to encourage selection. Leveraging principles of choice architecture and behavioral economics has implications for healthier food selection in pantry settings for the most at risk populations. Funding: None
P70 Food Packaging Pictures Have More Calories Than They Recommend – Oversized and Overeaten John Brand, PhD, [email protected], Cornell University, Food and Brand Lab, Warren Hall 112, Ithaca, NY 14850; B. Wansink, PhD Objective: Do supplementary extras appearing on packaging – such as frosting on cake –lead consumers to overconsume? Theory, Prior Research, Rationale: Food packaging pictures supplementary extras not listed on nutritional labeling. If consumers believe that these extras are part of a regular serving size, then they could encourage them to overconsume. Such findings could impact consumer welfare, company-packaging policies, and federal-labeling policies. Design, Setting, Participants, and Intervention: Study 1 examines the number of additional calories that supplementary frosting adds to the recommended calories per serving size for 21 cake mix brands. In studies 2 and 3, we give either undergraduates (Study 2), or food service professionals (Study 3) a typical cake mix package (that includes a picture of cake with frosting), or a typical cake mix package with the added message that single serving size calories do not include frosting. We then ask consumers to serve themselves a single portion of cake to consume. Outcome Measures and Analysis: The number of additional calories that supplementary frosting adds to the recommended calories per serving size (Study 1). Number of calories selected per serving size (Studies 2 and 3). Results: Compared to recommended serving size calories, supplementary frosting exaggerates calories per serving by an average of 134% (p < .001). Undergraduates and food service professionals serve 22% and 26% fewer calories of cake when shown packaging that clearly states that single serving size calories do not include frosting (both p’s < .001). Conclusions and Implications: Supplementary extras unconsciously influence the most nutritionally savvy consumers. To be less misleading, packaging should clearly state what is not included in calorie counts. Funding: None
P71 Prime-Time Weight Discrimination: A Body Weight Analysis of Prime-Time Television Characters From 1950-2015 John Brand, PhD, [email protected], Cornell University, Food and Brand Lab, Warren Hall 112, Ithaca, NY 14853; B. Wansink, PhD Objective: To compare the BMIs of TV characters and the general American public over the past 65 years. Theory, Prior Research, Rationale: Compared to thin characters, obese characters are underrepresented and routinely cast in stereotypical roles. This type of media weight discrimination is argued to contribute to the social acceptability of weight stigmatization in real life. Given this suggestion, tracking this underrepresentation longitudinally could help elucidate how media weight discrimination contributes to real life weight stigmatization. Design, Setting, Participants, and Intervention: The BMIs of lead actors appearing in top-ten primetime television shows from 1950 to 2015 (defined by Nielsen ratings) were coded using the Stunkard Figure Rating Scale. The average BMI of Americans over the same time period was obtained through the CDC’s National Health and Nutrition Examination Surveys. Outcome Measures and Analysis: Linear trend analyses were used to track and compare the BMI changes in both TV characters and the American public over time. Results: Whereas the average BMI of the American public has linearly increased every decade, the BMI of TV characters has linearly decreased over the same time period (p ¼ .001). The average BMI of female TV characters decreased by 16.95% (p < .001) and the average BMI of male characters decreased by 8.91% (p < .01). Conversely, the average BMI of the american female increased by 25.8% and the average BMI of the american male increased by 18.7%. Conclusions and Implications: The decreasing BMI of TV characters, combined with the increasing BMI of the American public, underscores the increasingly unrealistic ideals portrayed in the media and may contribute to weight stigmatization. Funding: None
P72 Healthy Child Care Georgia: Improving Teacher Self-Efficacy to Implement Wellness Policies and Increase Wellness Education Caree Cotwright, PhD, RD, LDN, [email protected], University of Georgia, Athens, GA 30602; D. Bales, PhD; J. S. Lee, PhD, RD Objective: To pilot the use of a combined policy and direct education intervention, Eat Healthy, Be Active (EHBA), to improve teachers’ self-efficacy to implement wellness policies and increase classroom nutrition and physical activity (PA) education. Target Audience: Child care providers in Clarke County, GA and children (ages 3-5) in their care. Theory, Prior Research, Rationale: According to Social Cognitive Theory, increasing self-efficacy is an essential component of promoting behavior change. This Continued on page S37
P67 Assessing Low-Income Clients’ Views About Retail and Food Pantry Environments Catalina Aragon, MS, [email protected], Washington State University, 2606 West Pioneer, Puyallup, WA 98371; A. Bush-Kaufman, MPH, RD; J. Armstrong Shultz, PhD; K. Barale, MS, RD, FADA Objective: To identify low-income clients’ perceptions about their local grocery retail and food pantry environments that potentially influence access to fruits and vegetables (FV). Design, Setting, Participants, and Intervention: A cross-sectional self-administered survey was conducted with low-income adult clients from EFNEP and SNAP-Ed class series (n¼200). Survey design followed the Model of Community Nutrition Environments. Selected items aligned with current environmental scan assessments for retail and food pantry outlets. Questionnaire construction followed the Tailored Design Method. Outcomes Measure and Analysis: Perceived availability, access, and affordability of FV in the retail environment were assessed including factors potentially influencing greater purchase of FV. Attitudes toward environmental features of the client’s primary retail and food pantry outlets were included. Results: The survey sample included clients from six Washington counties and diverse ethnic/racial groups; 55% participated in SNAP and 50% were food pantry clients. Location-related factors that clients indicated were ‘very important’ to their decision to shop at their major retail store included: proximity to where they live (58%), feeling safe shopping at the store (51%), and ability of getting a ride to that store (34%). Factors that clients reported as ‘very likely’ encouraging them to buy more F/V included: in-store sales (69%), attractive displays (37%), free samples (37%) and recipes (27%). Survey respondents valued a variety of factors related to food pantries such as: shopping style, information on other assistance programs, healthier options, and recipes. Conclusions and Implications: Findings provide guidance to retail and food pantry partners for environmental supports that promote healthier choices in ways meaningful to clients. Funding: Supplemental Nutrition Assistance Program Education
P68 Behavioral Nutrition Interventions in Food Pantries: Lessons and Strategies Brian Wansink, PhD, [email protected], Cornell University, Food and Brand Lab, Warren Hall 112, Ithaca, NY 14850; H. Bhana, MHSc, Columbia University; J. W. Cadenhead, BS; M. Qureshi, BS Objective: Emerging evidence shows behavioral interventions in food pantries can be promising to improve healthy food selection; however, conducting research in these settings can be challenging. This article provides recommendations of specific actions and methodological considerations that behavioral practitioners and researchers can take to build stronger collaborative and self-sustaining interventions for food pantries.
Poster Abstracts S35
Target Audience: Researchers and practitioners developing behavioral interventions in food pantries. Theory, Prior Research, Rationale: Interventions employing behavioral science strategies (adjusting convenience, attractiveness, and social norms of target foods) in school lunchrooms, cafeterias, and grocery stores are able to change eating patterns in scalable and affordable ways. Food pantries would benefit from utilizing these strategies, as they serve at-risk populations and operate within financial constraints. Description: A series of studies conducted in urban food pantries illustrates common barriers to successful intervention execution and evaluation include: site-specific disruptions; difficulty maintaining fidelity; difficulty ensuring intervention strength; challenges to measuring and collecting data. Evaluation: Solutions derived from these studies and other literature include: generating key informants and internal advocates of the intervention at all staffing levels; developing logic models and transition plans; considering multi-modal evaluation assessments; conducting needs assessments of the target versus service population; considering competing operation strategies and health service programs provided by the pantry; considering dosage to the intervention with respect to number of exposures and duration of exposure; and providing images/photos to guide staff in the intervention setup. Conclusions and Implications: Easy changes to methodologies and procedures in food pantries can make research efforts more productive and viable in these complex settings. Funding: None
P69 Using Choice Architecture to Create Healthy Food Interventions in Food Pantries Brian Wansink, PhD, [email protected], Cornell University, Food and Brand Lab, Warren Hall 112, Ithaca, NY 14850; H. Bhana, MHSc, Columbia University; M. Qureshi, BS; J. W. Cadenhead, BS Objective: Food pantries offer a wide array of healthy foods which are often bypassed in favor of less healthy items. This study examined whether altering the location of a target healthy food could increase selection of it over competitive and less healthy foods. Design, Setting, Participants, and Intervention: The study used a quasi-experimental design with an intervention and matched control client-choice pantry (pantries where clients are able to ‘‘shop’’ in a fashion similar to a grocery store). Pantry clients were mostly female, 2083 years of age, and Hispanic/Latino (63%) and AfricanAmerican/Black (28%). In this study, the location of a healthy whole grain cereal was altered to two conditions: either located along with all other (less healthy) cereals or ahead of (and separate from) alternative cereals. Outcome Measures and Analysis: Inventory records of the target cereal and all competing cereals were tracked and pre-post self-report surveys conducted with intervention Continued on page S36
S36 Poster Abstracts
Journal of Nutrition Education and Behavior Volume 48, Number 7S, 2016
P69 (continued) (n¼313) and control (n¼293) pantry clients from January to June 2015. Results: When the target cereal was placed separate and ahead of competitive cereals, self-reported selection rose from 8.4% to 32% (X2 ¼ 27.53; p< .0001) in intervention compared to control clients. Conclusions and Implications: This preliminary field study underscores two important findings: small, easy, no-cost changes can improve food selections in a pantry setting; and contrary to prior work, healthier food should be seen first and placed separately from less healthy competing foods in order to encourage selection. Leveraging principles of choice architecture and behavioral economics has implications for healthier food selection in pantry settings for the most at risk populations. Funding: None
P70 Food Packaging Pictures Have More Calories Than They Recommend – Oversized and Overeaten John Brand, PhD, [email protected], Cornell University, Food and Brand Lab, Warren Hall 112, Ithaca, NY 14850; B. Wansink, PhD Objective: Do supplementary extras appearing on packaging – such as frosting on cake –lead consumers to overconsume? Theory, Prior Research, Rationale: Food packaging pictures supplementary extras not listed on nutritional labeling. If consumers believe that these extras are part of a regular serving size, then they could encourage them to overconsume. Such findings could impact consumer welfare, company-packaging policies, and federal-labeling policies. Design, Setting, Participants, and Intervention: Study 1 examines the number of additional calories that supplementary frosting adds to the recommended calories per serving size for 21 cake mix brands. In studies 2 and 3, we give either undergraduates (Study 2), or food service professionals (Study 3) a typical cake mix package (that includes a picture of cake with frosting), or a typical cake mix package with the added message that single serving size calories do not include frosting. We then ask consumers to serve themselves a single portion of cake to consume. Outcome Measures and Analysis: The number of additional calories that supplementary frosting adds to the recommended calories per serving size (Study 1). Number of calories selected per serving size (Studies 2 and 3). Results: Compared to recommended serving size calories, supplementary frosting exaggerates calories per serving by an average of 134% (p < .001). Undergraduates and food service professionals serve 22% and 26% fewer calories of cake when shown packaging that clearly states that single serving size calories do not include frosting (both p’s < .001). Conclusions and Implications: Supplementary extras unconsciously influence the most nutritionally savvy consumers. To be less misleading, packaging should clearly state what is not included in calorie counts. Funding: None
P71 Prime-Time Weight Discrimination: A Body Weight Analysis of Prime-Time Television Characters From 1950-2015 John Brand, PhD, [email protected], Cornell University, Food and Brand Lab, Warren Hall 112, Ithaca, NY 14853; B. Wansink, PhD Objective: To compare the BMIs of TV characters and the general American public over the past 65 years. Theory, Prior Research, Rationale: Compared to thin characters, obese characters are underrepresented and routinely cast in stereotypical roles. This type of media weight discrimination is argued to contribute to the social acceptability of weight stigmatization in real life. Given this suggestion, tracking this underrepresentation longitudinally could help elucidate how media weight discrimination contributes to real life weight stigmatization. Design, Setting, Participants, and Intervention: The BMIs of lead actors appearing in top-ten primetime television shows from 1950 to 2015 (defined by Nielsen ratings) were coded using the Stunkard Figure Rating Scale. The average BMI of Americans over the same time period was obtained through the CDC’s National Health and Nutrition Examination Surveys. Outcome Measures and Analysis: Linear trend analyses were used to track and compare the BMI changes in both TV characters and the American public over time. Results: Whereas the average BMI of the American public has linearly increased every decade, the BMI of TV characters has linearly decreased over the same time period (p ¼ .001). The average BMI of female TV characters decreased by 16.95% (p < .001) and the average BMI of male characters decreased by 8.91% (p < .01). Conversely, the average BMI of the american female increased by 25.8% and the average BMI of the american male increased by 18.7%. Conclusions and Implications: The decreasing BMI of TV characters, combined with the increasing BMI of the American public, underscores the increasingly unrealistic ideals portrayed in the media and may contribute to weight stigmatization. Funding: None
P72 Healthy Child Care Georgia: Improving Teacher Self-Efficacy to Implement Wellness Policies and Increase Wellness Education Caree Cotwright, PhD, RD, LDN, [email protected], University of Georgia, Athens, GA 30602; D. Bales, PhD; J. S. Lee, PhD, RD Objective: To pilot the use of a combined policy and direct education intervention, Eat Healthy, Be Active (EHBA), to improve teachers’ self-efficacy to implement wellness policies and increase classroom nutrition and physical activity (PA) education. Target Audience: Child care providers in Clarke County, GA and children (ages 3-5) in their care. Theory, Prior Research, Rationale: According to Social Cognitive Theory, increasing self-efficacy is an essential component of promoting behavior change. This Continued on page S37