title: B'More Healthy: Retail Rewards--design of a multi-level communications and pricing intervention to improve the food environment in Baltimore City.
abstract: BACKGROUND
  Low-income black residents of Baltimore City have disproportionately higher rates of obesity and chronic disease than other Maryland residents. Increasing the availability and affordability of healthy food are key strategies to improve the food environment and can lead to healthier diets. This paper describes B'More Healthy: Retail Rewards (BHRR), an intervention that tests the effectiveness of performance-based pricing discounts and health communications, separately and combined, on healthy food purchasing and consumption among low-income small store customers.
  
  
  METHODS
  BHRR is 2x2 factorial design randomized controlled trial. Fifteen regular customers recruited from each of 24 participating corner stores in Baltimore City were enrolled. Food stores were randomized to 1) pricing intervention, 2) communications intervention, 3) combined intervention, or 4) control. Pricing stores were given a 10-30% price discount on selected healthier food items, such as fresh fruits, frozen vegetables, and baked chips, at the point of purchase from two food wholesale stores during the 6-month trial. Storeowners agreed to pass on the discount to the consumer to increase demand for healthy food. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests, and refrigerators. Primary outcome measures include consumer food purchasing and associated psychosocial variables. Secondary outcome measures include consumer food consumption, store sales, and associated storeowner psychosocial factors. Process evaluation was monitored throughout the trial at wholesaler, small store, and consumer levels.
  
  
  CONCLUSIONS
  This is the first study to test the impact of performance-based pricing and communications incentives in small food stores, an innovative strategy to encourage local wholesalers and storeowners to share responsibility in creating a healthier food supply by stocking, promoting, and reducing costs of healthier foods in their stores. Local food wholesalers were involved in a top-down, participatory approach to develop and implement an effective and sustainable program. This study will provide evidence on the effectiveness of price incentives and health communications, separately and combined, among a low-income urban U.S.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02279849 (2/18/2014).
authors.affiliation: Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. nbudd1@jhu.edu.
authors.forename: Nadine
authors.initials: N
authors.lastname: Budd
authors.affiliation: Army Institute of Public Health, Health Promotion & Wellness Portfolio, USAPHC, ATTN: MCHB-IP-H, 5158 Blackhawk Road, Aberdeen Proving Ground, Aberdeen, MD, 21010, USA. xalison90@gmail.com.
authors.forename: Alison
authors.initials: A
authors.lastname: Cuccia
authors.affiliation: The Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA. jayne.k.jeffries@gmail.com.
authors.forename: Jayne K
authors.initials: JK
authors.lastname: Jeffries
authors.affiliation: Joseph Stokes, Jr. Research Institute, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. prasaddivya@gmail.com.
authors.forename: Divya
authors.initials: D
authors.lastname: Prasad
authors.affiliation: Carey Business School, Johns Hopkins University, 100 International Drive, Baltimore, MD, 21202, USA. kfrick@jhu.edu.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.affiliation: Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA. powelll@uic.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: Powell
authors.affiliation: Carey Business School, Johns Hopkins University, 100 International Drive, Baltimore, MD, 21202, USA. fkatz3@jhu.edu.
authors.forename: Fred A
authors.initials: FA
authors.lastname: Katz
authors.affiliation: Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. jgittel1@jhu.edu.
authors.forename: Joel
authors.initials: J
authors.lastname: Gittelsohn
mesh_terms: D001741:Black or African American; D015142:Baltimore; D003132:Commerce / Q000191:economics*; D003142:Communication; D004777:Environment; D005260:Female; D005523:Food Supply / Q000191:economics*; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D009765:Obesity / Q000208:ethnology; D011203:Poverty; D012107:Research Design; D012201:Reward; D014481:United States