Psychosocial Influences on Fruit and Vegetable Intake Following a NYC Supermarket Discount
Maria Bernales-Korins, Ian Yi Han Ang, Shamima Khan, Allan Geliebter, Maria Bernales-Korins, Ian Yi Han Ang, Shamima Khan, Allan Geliebter
Abstract
Objective: To assess the effect of a 50% discount on fruits and vegetables (F&V) on the purchase and intake of F&V and on psychosocial determinants of F&V intake: self-efficacy (SE), stages of change (SOC), and perceived barriers (PB).
Methods: This randomized controlled trial was conducted in local supermarkets over 16 weeks, including a 4-week baseline, 8-week discount intervention, and 4-week follow-up. Shoppers with overweight or obesity (BMI > 25) were randomized to receive a discount or no discount via their reward scan card after the baseline. Twenty-four-hour recalls and psychosocial measures were obtained for each study period.
Results: Purchases (P < 0.0005) and intakes (P = 0.019) of F&V increased significantly during the intervention, while only F&V intake was sustained at follow-up. The discount intervention increased SE (P < 0.01) and SOC (P < 0.05) and did not decrease PB (P = 0.057) during the intervention. SOC mediated the discount intervention effect on F&V intake (P < 0.05) during the intervention, explaining 43% of variance.
Conclusions: A supermarket discount intervention led to increases in purchases and intakes of F&V and increases in the psychosocial factors SE and SOC and did not decrease PB. The discount intervention prompted participants to move from the preparation to action stage of SOC, which acted as a mediator for increased F&V intake.
Trial registration: ClinicalTrials.gov NCT01509664.
Conflict of interest statement
The authors declared no conflict of interest.
© 2017 The Obesity Society.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5731775/bin/nihms870712f1.jpg)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5731775/bin/nihms870712f2.jpg)
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5731775/bin/nihms870712f3.jpg)
Figure 4
Fruit and vegetable intake during…
Figure 4
Fruit and vegetable intake during baseline, intervention, and follow-up periods. Fruit and vegetable…
Figure 5
Basic multiple mediator model of…
Figure 5
Basic multiple mediator model of psychosocial outcome measures at end of intervention on…
Figure 6
Final model showing significant mediation…
Figure 6
Final model showing significant mediation effect of stage of change (SOC) at end…
- Supermarket discounts of low-energy density foods: effects on purchasing, food intake, and body weight.Geliebter A, Ang IYH, Bernales-Korins M, Hernandez D, Ochner CN, Ungredda T, Miller R, Kolbe L. Geliebter A, et al. Obesity (Silver Spring). 2013 Dec;21(12):E542-8. doi: 10.1002/oby.20484. Epub 2013 Jul 5. Obesity (Silver Spring). 2013. PMID: 23596089 Clinical Trial.
- Discounts on fruit and vegetables combined with a space management intervention increased sales in supermarkets.Toft U, Winkler LL, Mikkelsen BE, Bloch P, Glümer C. Toft U, et al. Eur J Clin Nutr. 2017 Apr;71(4):476-480. doi: 10.1038/ejcn.2016.272. Epub 2017 Feb 1. Eur J Clin Nutr. 2017. PMID: 28145417
- Price discounts significantly enhance fruit and vegetable purchases when combined with nutrition education: a randomized controlled supermarket trial.Waterlander WE, de Boer MR, Schuit AJ, Seidell JC, Steenhuis IH. Waterlander WE, et al. Am J Clin Nutr. 2013 Apr;97(4):886-95. doi: 10.3945/ajcn.112.041632. Epub 2013 Feb 27. Am J Clin Nutr. 2013. PMID: 23446898 Clinical Trial.
- Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial.Ball K, McNaughton SA, Le HN, Gold L, Ni Mhurchu C, Abbott G, Pollard C, Crawford D. Ball K, et al. Am J Clin Nutr. 2015 May;101(5):1055-64. doi: 10.3945/ajcn.114.096735. Epub 2015 Apr 15. Am J Clin Nutr. 2015. PMID: 25877492 Clinical Trial.
- Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults.Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Mastellos N, et al. Cochrane Database Syst Rev. 2014 Feb 5;(2):CD008066. doi: 10.1002/14651858.CD008066.pub3. Cochrane Database Syst Rev. 2014. PMID: 24500864 Review.
- The impact of the consumer and neighbourhood food environment on dietary intake and obesity-related outcomes: A systematic review of causal impact studies.Atanasova P, Kusuma D, Pineda E, Frost G, Sassi F, Miraldo M. Atanasova P, et al. Soc Sci Med. 2022 Apr;299:114879. doi: 10.1016/j.socscimed.2022.114879. Epub 2022 Mar 10. Soc Sci Med. 2022. PMID: 35290815 Free PMC article.
- Perspectives on Fruit and Vegetable Consumption and Government Dietary Guidelines: Content Analysis of Comments on News Websites.Hornsby B, Ensaff H. Hornsby B, et al. J Med Internet Res. 2021 Aug 19;23(8):e19917. doi: 10.2196/19917. J Med Internet Res. 2021. PMID: 34420913 Free PMC article.
- Improving Consumption and Purchases of Healthier Foods in Retail Environments: A Systematic Review.Karpyn A, McCallops K, Wolgast H, Glanz K. Karpyn A, et al. Int J Environ Res Public Health. 2020 Oct 16;17(20):7524. doi: 10.3390/ijerph17207524. Int J Environ Res Public Health. 2020. PMID: 33081130 Free PMC article.
- A Systematic Review of the Effect of Retail Food Environment Interventions on Diet and Health with a Focus on the Enabling Role of Public Policies.Mah CL, Luongo G, Hasdell R, Taylor NGA, Lo BK. Mah CL, et al. Curr Nutr Rep. 2019 Dec;8(4):411-428. doi: 10.1007/s13668-019-00295-z. Curr Nutr Rep. 2019. PMID: 31797233 Free PMC article.
- Randomized Controlled Trial
- Adult
- Body Mass Index
- Commerce / economics*
- Cross-Sectional Studies
- Diet, Healthy / economics*
- Diet, Healthy / psychology
- Female
- Follow-Up Studies
- Fruit / economics*
- Health Behavior
- Humans
- Male
- Mental Recall
- Middle Aged
- Obesity / psychology
- Overweight / psychology
- Socioeconomic Factors
- Vegetables / economics*
- Young Adult
- ClinicalTrials.gov/NCT01509664
- Full Text Sources
- Other Literature Sources
- Medical
NCBI Literature Resources
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
![Figure 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5731775/bin/nihms870712f4.jpg)
![Figure 5](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5731775/bin/nihms870712f5.jpg)
Figure 6
Final model showing significant mediation…
Figure 6
Final model showing significant mediation effect of stage of change (SOC) at end…
- Supermarket discounts of low-energy density foods: effects on purchasing, food intake, and body weight.Geliebter A, Ang IYH, Bernales-Korins M, Hernandez D, Ochner CN, Ungredda T, Miller R, Kolbe L. Geliebter A, et al. Obesity (Silver Spring). 2013 Dec;21(12):E542-8. doi: 10.1002/oby.20484. Epub 2013 Jul 5. Obesity (Silver Spring). 2013. PMID: 23596089 Clinical Trial.
- Discounts on fruit and vegetables combined with a space management intervention increased sales in supermarkets.Toft U, Winkler LL, Mikkelsen BE, Bloch P, Glümer C. Toft U, et al. Eur J Clin Nutr. 2017 Apr;71(4):476-480. doi: 10.1038/ejcn.2016.272. Epub 2017 Feb 1. Eur J Clin Nutr. 2017. PMID: 28145417
- Price discounts significantly enhance fruit and vegetable purchases when combined with nutrition education: a randomized controlled supermarket trial.Waterlander WE, de Boer MR, Schuit AJ, Seidell JC, Steenhuis IH. Waterlander WE, et al. Am J Clin Nutr. 2013 Apr;97(4):886-95. doi: 10.3945/ajcn.112.041632. Epub 2013 Feb 27. Am J Clin Nutr. 2013. PMID: 23446898 Clinical Trial.
- Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial.Ball K, McNaughton SA, Le HN, Gold L, Ni Mhurchu C, Abbott G, Pollard C, Crawford D. Ball K, et al. Am J Clin Nutr. 2015 May;101(5):1055-64. doi: 10.3945/ajcn.114.096735. Epub 2015 Apr 15. Am J Clin Nutr. 2015. PMID: 25877492 Clinical Trial.
- Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults.Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Mastellos N, et al. Cochrane Database Syst Rev. 2014 Feb 5;(2):CD008066. doi: 10.1002/14651858.CD008066.pub3. Cochrane Database Syst Rev. 2014. PMID: 24500864 Review.
- The impact of the consumer and neighbourhood food environment on dietary intake and obesity-related outcomes: A systematic review of causal impact studies.Atanasova P, Kusuma D, Pineda E, Frost G, Sassi F, Miraldo M. Atanasova P, et al. Soc Sci Med. 2022 Apr;299:114879. doi: 10.1016/j.socscimed.2022.114879. Epub 2022 Mar 10. Soc Sci Med. 2022. PMID: 35290815 Free PMC article.
- Perspectives on Fruit and Vegetable Consumption and Government Dietary Guidelines: Content Analysis of Comments on News Websites.Hornsby B, Ensaff H. Hornsby B, et al. J Med Internet Res. 2021 Aug 19;23(8):e19917. doi: 10.2196/19917. J Med Internet Res. 2021. PMID: 34420913 Free PMC article.
- Improving Consumption and Purchases of Healthier Foods in Retail Environments: A Systematic Review.Karpyn A, McCallops K, Wolgast H, Glanz K. Karpyn A, et al. Int J Environ Res Public Health. 2020 Oct 16;17(20):7524. doi: 10.3390/ijerph17207524. Int J Environ Res Public Health. 2020. PMID: 33081130 Free PMC article.
- A Systematic Review of the Effect of Retail Food Environment Interventions on Diet and Health with a Focus on the Enabling Role of Public Policies.Mah CL, Luongo G, Hasdell R, Taylor NGA, Lo BK. Mah CL, et al. Curr Nutr Rep. 2019 Dec;8(4):411-428. doi: 10.1007/s13668-019-00295-z. Curr Nutr Rep. 2019. PMID: 31797233 Free PMC article.
- Randomized Controlled Trial
- Adult
- Body Mass Index
- Commerce / economics*
- Cross-Sectional Studies
- Diet, Healthy / economics*
- Diet, Healthy / psychology
- Female
- Follow-Up Studies
- Fruit / economics*
- Health Behavior
- Humans
- Male
- Mental Recall
- Middle Aged
- Obesity / psychology
- Overweight / psychology
- Socioeconomic Factors
- Vegetables / economics*
- Young Adult
- ClinicalTrials.gov/NCT01509664
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 6](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5731775/bin/nihms870712f6.jpg)
Source: PubMed