title: 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.
abstract: BACKGROUND
  Fiscal strategies are increasingly considered upstream nutrition promotion measures. However, few trials have investigated the effectiveness or cost effectiveness of pricing manipulations on diet in real-world settings.
  
  
  OBJECTIVE
  We assessed the effects on fruit, vegetable, and beverage purchasing and consumption of a 20% price-reduction intervention, a tailored skills-based behavior-change intervention, and a combined intervention compared with a control condition.
  
  
  METHODS
  The Supermarket Healthy Eating for Life trial was a randomized controlled trial conducted over 3 mo [baseline (time 1) to postintervention (time 2) with a 6-mo follow-up (time 3)]. Female primary household shoppers in Melbourne, Australia, were randomly assigned to a 1) skill-building (n = 160), 2) price-reduction (n = 161), 3) combined skill-building and price-reduction (n = 160), or 4) control (n = 161) group. Supermarket transaction data and surveys were used to measure the following study outcomes: fruit, vegetable, and beverage purchases and self-reported fruit and vegetable consumption at each time point.
  
  
  RESULTS
  At 3 mo (time 2), price reduction-alone participants purchased more total vegetables and frozen vegetables than did controls. Price reduction-alone and price reduction-plus-skill-building participants purchased more fruit than did controls. Relative to controls, in the price-reduction group, total vegetable consumption increased by 233 g/wk (3.1 servings or 15% more than at baseline), and fruit purchases increased by 364 g/wk (2.4 servings; 35% more than at baseline). Increases were not maintained 6 mo postintervention (time 3). Price reduction-alone participants showed a tendency for a slight increase in fruit consumption at time 2 (P = 0.09) that was maintained at time 3 (P = 0.014). No intervention improved purchases of bottled water or low-calorie beverages.
  
  
  CONCLUSIONS
  A 20% price reduction in fruit and vegetables resulted in increased purchasing per household of 35% for fruit and 15% for vegetables over the price-reduction period. These findings show that price modifications can directly increase produce purchases. The Supermarket Healthy Eating for Life trial was registered at Current Controlled Trials Registration as ISRCTN39432901.
authors: From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP).
authors: Kylie
authors: K
authors: Ball
authors: From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP).
authors: Sarah A
authors: SA
authors: McNaughton
authors: From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP).
authors: Ha N D
authors: HN
authors: Le
authors: From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP).
authors: Lisa
authors: L
authors: Gold
authors: From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP).
authors: Cliona
authors: C
authors: Ni Mhurchu
authors: From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP).
authors: Gavin
authors: G
authors: Abbott
authors: From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP).
authors: Christina
authors: C
authors: Pollard
authors: From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP).
authors: David
authors: D
authors: Crawford
mesh_terms: D000328:Adult; D001315:Australia; D001628:Beverages / Q000191:economics; D003132:Commerce / Q000191:economics; D004032:Diet / Q000191:economics*; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D058870:Food, Organic / Q000191:economics*; D005638:Fruit / Q000191:economics; D015438:Health Behavior; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D012959:Socioeconomic Factors; D014675:Vegetables / Q000191:economics
keywords: behavior change; fruit and vegetables; price discounts; randomized controlled trial; skills