Randomized Trial of Financial Incentives to Reduce Sugar-sweetened Beverage Purchases by Low-income, Latino Families

Approximately 15% of the US population is enrolled in the Supplemental Nutrition Assistance Program (SNAP), and 50% are children. Although the goal is to improve nutritional health, preliminary data suggest that enrollment in SNAP is associated with obesity and metabolic risks and that SNAP reimburses $4 billion annually for sugar-sweetened beverages (SSBs). This pilot project tests an innovative strategy to reduce purchase of non-nutritive, SSBs by low-income families with children by combining targeted point-of-purchase education with a randomized trial of financial incentives to discourage purchase of unhealthy beverages. The study will take place at a mid-size grocery store that is located in a low-income, Latino community and where 30% of purchases are made with SNAP. Targeted beverage education will be provided to all study subjects with a traffic-light system to identify healthy and unhealthy beverages at the point-of-purchase. Individual beverage purchases will be tracked by electronically stored cash register sales. Supplementary validation of beverage consumption will be assessed by 24 hour dietary recall. Aim 1 is to conduct a randomized controlled trial to compare purchase and consumption of SSBs by families assigned to a financial incentive to reduce purchase of SSBs with families assigned to control (no incentives). Aim 2 is to compare the purchase of SSBs by families in both arms during the study period when they are exposed to the traffic-light system to a baseline period prior to traffic-light education. Results of this project will provide pilot data for larger scale interventions to promote healthy choices among low-income families.

Study Overview

• Status: Completed
• Conditions: Obesity Prevention
• Intervention / Treatment: Behavioral: Targeted beverage education and financial incentives; Behavioral: Traffic-light labeling of all beverages in store

• Study Type: Interventional
• Enrollment (Actual): 216
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Massachusetts General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• purchase >75% of groceries at targeted supermarket (regular customer)
• at least one child <= 18 years old living at home

Exclusion Criteria:

• not fluent in Spanish or English
• no address or phone for contact

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Targeted beverage education and financial incentives; Study subjects receive monthly letters with beverage education and financial incentives for not purchasing sugar-sweetened beverages	Behavioral: Targeted beverage education and financial incentives; Behavioral: Traffic-light labeling of all beverages in store; All beverages in the supermarket will be labeled as red, yellow, or green
Sham Comparator: Control; Monthly letters with generic nutrition information only	Behavioral: Traffic-light labeling of all beverages in store; All beverages in the supermarket will be labeled as red, yellow, or green

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Purchase of sugar-sweetened beverages	4 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Consumption of sugar-sweetened beverages	4 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Purchase of red-labeled beverages	Pre-post evaluation of purchase of red-labeled beverages before and after the labels are in place	6 months

Collaborators and Investigators

• Sponsor: Massachusetts General Hospital
• Collaborators: Harvard School of Public Health (HSPH)
• Investigators: Principal Investigator: Anne N Thorndike, MD, MPH, Massachusetts General Hospital

Publications and helpful links

General Publications

• Franckle RL, Levy DE, Macias-Navarro L, Rimm EB, Thorndike AN. Traffic-light labels and financial incentives to reduce sugar-sweetened beverage purchases by low-income Latino families: a randomized controlled trial. Public Health Nutr. 2018 Jun;21(8):1426-1434. doi: 10.1017/S1368980018000319. Epub 2018 Mar 1.

Study record dates

Study Major Dates

• Study Start: January 1, 2014
• Primary Completion (Actual): September 1, 2014
• Study Completion (Actual): September 1, 2014

Study Registration Dates

• First Submitted: November 15, 2013
• First Submitted That Met QC Criteria: November 15, 2013
• First Posted (Estimate): November 21, 2013

Study Record Updates

• Last Update Posted (Estimate): October 6, 2015
• Last Update Submitted That Met QC Criteria: October 2, 2015
• Last Verified: October 1, 2015

More Information

Terms related to this study

• Keywords: sugar-sweetened beverages; obesity prevention; traffic-light labels; financial incentives; low-income community
• Additional Relevant MeSH Terms: Overnutrition; Nutrition Disorders; Overweight; Body Weight; Obesity
• Other Study ID Numbers: 2013P001130