A Trial of Behavioral Economic Interventions Among Food Pantry Clients

A Randomized Trial of Web-based Behavioral Economic Interventions to Promote Healthy Food Choices Among Food Pantry Clients

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).

Study Overview

• Status: Completed
• Conditions: Food Preferences
• Intervention / Treatment: Behavioral: Behavioral economic intervention of online purchasing at a food pantry

Detailed Description

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
• Enrollment (Actual): 286
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • University of Pennsylvania

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Group; Participants in this arm will view the typical web-based ordering system platform (usual care group).
Experimental: Behavioral Economic Intervention Group; Participants in this arm will be exposed to the web-based ordering system with multiple behavioral economic interventions applied, including healthy food shopping cart defaults, healthy placement choice architecture, traffic light nutrition labels, social norms messaging, and healthy swaps.	Behavioral: Behavioral economic intervention of online purchasing at a food pantry; This intervention includes multiple behavioral economic interventions, healthy food shopping cart defaults, healthy placement choice architecture, traffic light nutrition labels, social norms messaging, and healthy swaps.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	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.	Collected from the online system at baseline and then each month for the remaining 3 months of participation.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Body Mass Index (BMI)	Change from baseline in BMI (weight in kg / height in meters^2)	Assessed at baseline and 3 months.
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.	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.	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.	Assessed at baseline and 3 months.
Biomarker Change in Fruit and Vegetable Intake	Change from baseline in carotenoid levels (scores range 0-800) as measured by the VeggieMeter®. The VeggieMeter® is a spectroscopy-based skin carotenoid measurement device, created by Longevity Link Corporation in 2015. It uses pressure-mediated reflection spectroscopy (RS) to detect and quantify skin carotenoids as a proxy for fruit and vegetable intake in humans. Validation studies show VeggieMeter scores to be highly correlated with blood serum measures of carotenoids (R=.81). Higher units represent a higher concentration of carotenoids in the skin.	Assessed at baseline and 3 months.
Change in Systolic Blood Pressure	Change from baseline in systolic blood pressure (indicator of heart health)	Assessed at baseline and 3 months.
Change in Diastolic Blood Pressure	Change from baseline in diastolic blood pressure (indicator of heart health)	Assessed at baseline and 3 months.

Collaborators and Investigators

• Sponsor: Abramson Cancer Center at Penn Medicine
• Collaborators: National Cancer Institute (NCI); Massachusetts General Hospital; University of Connecticut
• Investigators: Principal Investigator: Christina A Roberto, PhD, University of Pennsylvania

Study record dates

Study Major Dates

• Study Start (Actual): July 5, 2019
• Primary Completion (Actual): December 21, 2022
• Study Completion (Actual): December 21, 2022

Study Registration Dates

• First Submitted: July 5, 2019
• First Submitted That Met QC Criteria: July 5, 2019
• First Posted (Actual): July 8, 2019

Study Record Updates

• Last Update Posted (Estimated): February 29, 2024
• Last Update Submitted That Met QC Criteria: February 4, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Biomarkers; Economics, Behavioral; Food Labeling; Diet Records; Food Assistance
• Other Study ID Numbers: UPCC 06022; R01CA229502 (U.S. NIH Grant/Contract); 829702 (Other Identifier: IRB)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No