title: Store-directed price promotions and communications strategies improve healthier food supply and demand: impact results from a randomized controlled, Baltimore City store-intervention trial.
abstract: OBJECTIVE
  Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors.
  
  
  METHODS
  Factorial design randomized controlled trial.
  
  
  METHODS
  Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA.
  
  
  METHODS
  Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10-30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators.
  
  
  RESULTS
  All interventions showed significantly increased stock of promoted foods v.
  
  
  METHODS
  There was a significant treatment effect for daily unit sales of healthy snacks (β=6·4, 95 % CI 0·9, 11·9) and prices of healthy staple foods (β=-0·49, 95 % CI -0·90, -0·03) for the combined group v. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors.
  
  
  CONCLUSIONS
  All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand.
authors.affiliation: 1Division of Nutrition,Physical Activity,and Obesity,Centers for Disease Control and Prevention,4770 Buford Highway,Mailstop F-77,Atlanta,GA 30341,USA.
authors.forename: Nadine
authors.initials: N
authors.lastname: Budd
authors.affiliation: 2The Gillings School of Global Public Health,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA.
authors.forename: Jayne K
authors.initials: JK
authors.lastname: Jeffries
authors.affiliation: 3Department of Health Services & Nutrition Sciences Program,University of Washington,Seattle,WA,USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Jones-Smith
authors.affiliation: 4The Global Obesity Prevention Center,Bloomberg School of Public Health,Johns Hopkins University,Baltimore,MD,USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Kharmats
authors.affiliation: 4The Global Obesity Prevention Center,Bloomberg School of Public Health,Johns Hopkins University,Baltimore,MD,USA.
authors.forename: Ann Yelmokas
authors.initials: AY
authors.lastname: McDermott
authors.affiliation: 4The Global Obesity Prevention Center,Bloomberg School of Public Health,Johns Hopkins University,Baltimore,MD,USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Gittelsohn
mesh_terms: D015142:Baltimore; D003132:Commerce / Q000191:economics; D003142:Communication; D003258:Consumer Behavior / Q000191:economics; D003365:Costs and Cost Analysis / Q000191:economics*; D000072001:Diet, Healthy / Q000191:economics* / Q000523:psychology*; D005260:Female; D063105:Food Assistance / Q000191:economics; D005523:Food Supply / Q000191:economics; D006801:Humans; D008297:Male; D012111:Residence Characteristics; D012959:Socioeconomic Factors
keywords: Food access interventions; Food stores; Obesity; Pricing interventions; Trade promotions