Impact of nutrition environmental interventions on point-of-purchase behavior in adults: a review.
BACKGROUND
Nutrition interventions targeted to individuals are unlikely to significantly shift US dietary patterns as a whole. Environmental and policy interventions are more promising for shifting these patterns. We review interventions that influenced the environment through food availability, access, pricing, or information at the point-of-purchase in worksites, universities, grocery stores, and restaurants.


METHODS
Thirty-eight nutrition environmental intervention studies in adult populations, published between 1970 and June 2003, were reviewed and evaluated on quality of intervention design, methods, and description (e.g., sample size, randomization). No policy interventions that met inclusion criteria were found.


RESULTS
Many interventions were not thoroughly evaluated or lacked important evaluation information. Direct comparison of studies across settings was not possible, but available data suggest that worksite and university interventions have the most potential for success. Interventions in grocery stores appear to be the least effective. The dual concerns of health and taste of foods promoted were rarely considered. Sustainability of environmental change was never addressed.


CONCLUSIONS
Interventions in "limited access" sites (i.e., where few other choices were available) had the greatest effect on food choices. Research is needed using consistent methods, better assessment tools, and longer durations; targeting diverse populations; and examining sustainability. Future interventions should influence access and availability, policies, and macroenvironments.
Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA. jseymour1@cdc.gov
Jennifer D
JD
Seymour
Amy Lazarus
AL
Yaroch
Mary
M
Serdula
Heidi Michels
HM
Blanck
Laura Kettel
LK
Khan
D000328:Adult; D003132:Commerce; D005247:Feeding Behavior; D019649:Food Industry / Q000191:economics; D005522:Food Services / Q000191:economics; D005638:Fruit / Q000191:economics; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D014481:United States; D014675:Vegetables / Q000191:economics