Choice architecture to promote fruit and vegetable purchases by families participating in the Special Supplemental Program for Women, Infants, and Children (WIC): randomized corner store pilot study

Abstract

Objective: To conduct a pilot study to determine if improving the visibility and quality of fresh produce (choice architecture) in corner stores would increase fruit/vegetable purchases by families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Design: Six stores were randomly assigned to choice architecture intervention or control. Store-level WIC sales data were provided by the state. Primary outcomes were WIC fruit/vegetable voucher and non-fruit/vegetable voucher sales, comparing trends from baseline (December 2012-October 2013) with the five-month intervention period (December 2013-April 2014). Secondary outcomes were differences in customer self-reported fruit/vegetable purchases between baseline and end of the intervention.

Setting: Chelsea, MA, USA, a low-income urban community.

Subjects: Adult customers (n 575) completing store exit interviews.

Results: During baseline, WIC fruit/vegetable and non-fruit/vegetable sales decreased in both intervention and control stores by $US 16/month. During the intervention period, WIC fruit/vegetable sales increased in intervention stores by $US 40/month but decreased in control stores by $US 23/month (difference in trends: $US 63/month; 95 % CI 4, 121 $US/month; P=0·036); WIC non-fruit/vegetable sales were not different (P=0·45). Comparing baseline and intervention-period exit interview responses by customers participating in WIC (n 134), intervention store customers reported increased fruit/vegetable purchases compared with control store customers (18 v. -2 %), but this did not achieve statistical significance (P=0·11).

Conclusions: Placement of fruits/vegetables near the front of corner stores increased purchase of produce by customers using WIC. New policies that incentivize stores to stock and prominently display good-quality produce could promote healthier food choices of low-income families.

Keywords: Choice architecture; Corner stores; Fruits and vegetables; WIC.

Fig. 1

Trends in (a) WIC fruit and vegetable voucher (FVV) and (b) WIC non-fruit and vegetable voucher (non-FVV) sales at intervention (———) and control (– – – – –) stores in Chelsea, MA, USA, December 2012–April 2014. *Statistical significance at P<0·05 for comparison of trend changes for intervention v. control stores using generalized least-squares models with store random effects (WIC, Special Supplemental Nutrition Program for Women, Infants, and Children)