A Trial of Traffic Light Labeling With Behavioral Nudges and a Healthy Recipe Database to Increase Selection of Healthier Foods in Client-choice Food Pantries

Healthy Pantry Program Intervention Evaluation (HAPPIE)

This study is a pilot evaluation of the Healthy Pantry Program, a new behavioral economics-based training that allows pantry staff to learn how to implement nudges integrating traffic-light nutrition labeling and a healthy recipe database in the pantry environment. The hypothesis is that participation the Healthy Pantry Program will lead to increases in pantry purchases of healthy foods.

Study Overview

• Status: Terminated
• Conditions: Food Selection
• Intervention / Treatment: Behavioral: Healthy Pantry Program; Other: Waitlist Control

Detailed Description

Food insecurity affects more than one in 10 Americans and is associated with poor nutrition and adverse health outcomes, including diabetes, hypertension, and mental health issues. Many food-insecure individuals use food pantries, which provide charitable food, to supplement household food needs. The emergence of client-choice food pantries, where individuals can select the foods they take home, provides a novel opportunity to intervene on the diets of food pantry clients.

This study evaluates the Healthy Pantry Program (HPP) in a sample of 10 food pantries in the greater Boston area. Pantries will be matched on baseline characteristics and randomized 1:1 into participation in HPP (intervention) or wait list (control). Outcomes data will be collected at the pantry and client level. The aims of the study are as follows:

Aim 1: To evaluate whether HPP is associated with increased healthy food purchases from the food bank by intervention food pantries compared to control food pantries.

Aim 2: To evaluate whether HPP is associated with increases in the availability of healthy food in intervention food pantries compared to control food pantries.

Aim 3: To evaluate whether HPP is associated with an increase in healthy food selection and dietary intake by clients of intervention food pantries compared to clients of control food pantries, using a cross-sectional sample of 400 food pantry clients at baseline and 400 food pantry clients at 6-month follow up.

• Study Type: Interventional
• Enrollment (Actual): 3
• 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

Pantry Inclusion Criteria:

• maximum client-choice (clients can choose all items that they take from pantry)
• operate at least once weekly
• affiliated with the Greater Boston Food Bank

Pantry Exclusion Criteria:

• not affiliated with the Greater Boston Food Bank
• operating less than once weekly
• not a maximum client-choice food pantry
• >1 hr drive from Boston
• <50 clients on average per open day

Client Inclusion Criteria (for cross-sectional surveys at baseline and 6-month follow up):

• ≥18 years old
• pantry client
• speaks English or Spanish

Client Exclusion Criteria:

• <18 years old
• does not speak English or Spanish

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: Intervention Food Pantries; Food pantries will complete online training to help them rank foods by nutritional value and promote those foods to pantry clients; the effect on pantries and their clients will be measured.	Behavioral: Healthy Pantry Program; Food pantries will receive the Healthy Pantry Program online training, which will be completed by at least one pantry staff member and teaches pantry staff a novel traffic-light nutrition labeling system, a multilingual healthy recipe database, and how to use those and other behavioral economic strategies to implement simple interventions in the food pantry to promote client selection of healthier options. Onsite support by a registered dietitian is included.
Active Comparator: Control Food Pantries; Food pantries will continue to operate as usual during the study period; the effect on pantries and their clients will be measured.	Other: Waitlist Control; Normal food pantry use for duration of the 9-month study period. Control pantries will have access to the Healthy Pantry Program after study is completed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Monthly change in proportion of green-labeled foods purchased by food pantries from the food bank	Monthly change from baseline values of healthier foods purchased by pantries from the food bank in the proportion of green-labeled foods.	Collected from the electronic ordering system at baseline and prospectively each month for 9 months
Monthly change in the Healthy Purchasing Score of foods purchased by food pantries from the food bank	Monthly change from baseline values of healthier foods purchased by pantries from the food bank in a weighted Healthy Purchasing Score that includes all foods (range: 0-1, higher scores represent healthier selection)	Collected from the electronic ordering system at baseline and prospectively each month for 9 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in food availability at food pantries	Change from baseline in food availability score using the Healthy Food Pantry Assessment Tool (range: 0-45, higher scores represent greater food availability)	Assessed at baseline and 6 months
Change in healthier food selection by pantry clients	Change from baseline in pantry basket inventories of pantry clients measured by the proportion of green-labeled foods for each basket	Assessed at baseline and 6 months
Change in healthier food selection by pantry clients	Change from baseline in pantry basket inventories of pantry clients measured by Healthy Purchasing Score for each basket (range: 0-1, higher scores represent healthier selection)	Assessed at baseline and 6 months
Change in self-reported fruit and vegetable intake of pantry clients	Change from baseline fruit and vegetable intake in cup equivalents measured by the Dietary Screener from the California Health Information Survey 2005	Assessed at baseline and 6 months

Collaborators and Investigators

• Sponsor: Massachusetts General Hospital
• Collaborators: Greater Boston Food Bank

Study record dates

Study Major Dates

• Study Start (Actual): March 5, 2020
• Primary Completion (Actual): March 12, 2020
• Study Completion (Actual): March 12, 2020

Study Registration Dates

• First Submitted: January 22, 2020
• First Submitted That Met QC Criteria: January 24, 2020
• First Posted (Actual): January 28, 2020

Study Record Updates

• Last Update Posted (Actual): June 18, 2021
• Last Update Submitted That Met QC Criteria: June 15, 2021
• Last Verified: June 1, 2021

More Information

Terms related to this study

• Keywords: food insecurity
• Other Study ID Numbers: 2019P003211

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