title: 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).
  
  
  METHODS
  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.
  
  
  METHODS
  Chelsea, MA, USA, a low-income urban community.
  
  
  METHODS
  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.
authors.affiliation: 1General Medicine Division,Department of Medicine,Massachusetts General Hospital,50 Staniford Street,9th Floor,Boston,MA 02114,USA.
authors.forename: Anne N
authors.initials: AN
authors.lastname: Thorndike
authors.affiliation: 1General Medicine Division,Department of Medicine,Massachusetts General Hospital,50 Staniford Street,9th Floor,Boston,MA 02114,USA.
authors.forename: Oliver-John M
authors.initials: OM
authors.lastname: Bright
authors.affiliation: 3Center for Community Health Improvement,Massachusetts General Hospital,Boston,MA,USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Dimond
authors.affiliation: 3Center for Community Health Improvement,Massachusetts General Hospital,Boston,MA,USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Fishman
authors.affiliation: 2Harvard Medical School,Boston,MA,USA.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D003258:Consumer Behavior; D005191:Family Characteristics; D005260:Female; D063105:Food Assistance; D005518:Food Preferences; D005523:Food Supply; D005638:Fruit; D006293:Health Promotion; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010865:Pilot Projects; D012959:Socioeconomic Factors; D014675:Vegetables; D055815:Young Adult
keywords: Choice architecture; Corner stores; Fruits and vegetables; WIC