Speaker
Pasquale Rummo, PhD, MPH
Associate Professor
NYU Grossman School of Medicine
Keywords
Randomized clinical trial; Food insecurity; Nutrition; Online retailer; Equity
Key Points
- Supplemental Nutrition Assistance Program (SNAP) provides nutrition assistance benefits to supplement food budgets with the goal of mitigating food insecurity. SNAP does not focus on mitigating nutrition insecurity, which is where nutrition incentive programs come into play. Nutrition incentive programs match SNAP dollars for people to use on fresh produce at supermarkets, which increases sales and consumption of produce in brick-and-mortar settings. However, the results of nutrition incentive programs had not been evaluated previously in an online setting.
- Behavioral nudges may increase healthy food purchasing by “nudging” consumers to purchase healthier options by providing discounts or lower-cost options. Default options have been shown to increase healthy food orders in restaurants, but no studies had not been previously conducted to represent the effects of online shopping carts pre-filled with tailored fruit and vegetable items.
- SNAP Online Purchasing Pilot rapidly expanded during the pandemic with the goal of creating equitable access to online grocery shopping, leading to the growth of online grocery shopping sales among those with low incomes.
- The goals of this project were to characterize online food shopping behaviors in an online survey and conduct a randomized clinical trial of behavioral economic strategies on fruit and vegetable purchases in an online grocery store.
- The sample included 2,744 adults at least 18 years of age who currently or had previously received SNAP benefits. Participants were randomized into four different groups: 1) Control – participants received no discount, and shopping cart was not prefilled; 2) Discount – participants who received a 50% discount on eligible fruits and vegetables; 3) Default – participants who had shopping carts were prefilled with tailored fruit and vegetables; 4) Combination (Discount and Default) – participants who received a prefilled shopping cart plus a 50% discount on eligible fruits and vegetables.
- Participants were asked to shop for a typical week’s worth of groceries for their household on a budget adjusted for household size. The team created an online grocery store that simulates a real online retailer to conduct this experiment.
- The team analyzed non-discounted dollars spent on eligible fruits and vegetables per food basket and out-of-pocket dollars spent on fruits and vegetables, as well as non-discounted dollars spent on fresh, frozen, and canned fruits and vegetables as well as the macronutrients from these fruits and vegetables.
- The results showed that about 20% of the cart total was spent on fruits and vegetables across all cases. Over 90% of people in the default and combination groups purchased at least one of the default fruits and/or vegetables in their cart. About half of those in the control and discount groups purchased at least one of the fruits and vegetables offered to the default group on their own accord. About two thirds of the participants stated that they would support the default strategy with or without the discounts offered to them. Compared with the control group, participants in the discount, default, and combination groups spent greater percentages of non-discounted dollars on fruits and vegetables.
- These findings suggest that the expansion of nutrition incentives to online settings is a potentially promising strategy to promote equitable access to food. Providing default options is also an effective strategy in motivating individuals to purchase fruits and vegetables. Additionally, combining discounts and default options creates a synergistic effect of increasing the amount of fresh produce people purchase. This may also be a more equitable strategy than defaults alone, as it may increase purchasing power for individuals with food insecurity.
Discussion Themes
– Compared to some of the other work that you and your colleague shave done, would you describe this as easier to do since you’re taking advantage of online approaches, or was it harder? In terms of balance, it was easier. I think there’s probably a lot of people here who know how difficult it is to recruit people in person. It was also easier because we used a survey research firm, although I will say we are progressively considering and have started recruiting people through alternate methods. The part that’s more difficult is operationalizing all of this, as none of our team has expertise in computer science, for example, which has been really challenging. One thing we want to do in the future is pair with people who can help us do things that are more sophisticated, rather than just asking a question in a survey that says, “Here’s five options. Which do you purchase the most?”
– Did you have any intention to evaluate if the behavior would continue without the incentives? I want to acknowledge that there’s definitely questions about the sustainability of types of behavior changes like the default options or even the economic incentives. My thoughts differ for each strategy. I would love for the financial incentive for fruits and vegetables for participants to remain a permanent strategy. I’m a little less interested in the sustainability of those effects. I’d be more interested in this with respect to the default strategy. But, to answer your question more directly, we didn’t look at the sustainability of these behaviors, as this trial was cross-sectional. I’m proposing and writing a grant now to run a longitudinal study focused on at different strategies to address this issue over time.
– Could you comment on the magnitude of the changes in purchasing and whether you think those are of sufficient size to have an impact on clinical outcomes? I’m also wondering if we know people who receive these discounts and save the money on the healthy food are substituting it and using that money to purchase unhealthy food? To me, the goal of these incentives is to make healthy eating more affordable, so I think it accomplishes that goal. With respect to whether this would change clinical outcomes, I’m skeptical, especially given the size of the effect that we saw. I think we would need several different strategies all in combination to effect clinical outcomes. As far as the savings go, I looked at substitution spending in a prior study, and at least for other grocery orders, people didn’t substitute to some of the unhealthy categories. I’m proposing to evaluate another incentive program with that in mind in order to more closely track those purchase. For this study, people are ultimately buying more fruits and vegetables regardless of what they choose to spend their savings on.
Tags
#pctGR, @Collaboratory1