Do effects of price discounts and nutrition education on food purchases vary by ethnicity, income and education? Results from a randomised, controlled trial
- Tony Blakely1,
- Cliona Ni Mhurchu2,
- Yannan Jiang2,
- Leonie Matoe3,
- Mafi Funaki-Tahifote4,
- Helen C Eyles2,
- Rachel H Foster1,
- Sarah McKenzie1,
- Anthony Rodgers5
- 1Department of Public Health, University of Otago, Wellington, New Zealand
- 2Clinical Trials Research Unit, The University of Auckland, Auckland, New Zealand
- 3Te Hotu Manawa Māori, Auckland, New Zealand
- 4Pacific Heartbeat, The National Heart Foundation of New Zealand, New Zealand
- 5George Institute of International Health, Sydney, Australia
- Correspondence to Tony Blakely, University of Otago, PO Box 7343, Wellington, New Zealand;
- Accepted 27 December 2010
- Published Online First 4 February 2011
Background Reducing health inequalities requires interventions that work as well, if not better, among disadvantaged populations. The aim of this study was to determine if the effects of price discounts and tailored nutrition education on supermarket food purchases (percentage energy from saturated fat and healthy foods purchased) vary by ethnicity, household income and education.
Method A 2×2 factorial trial of 1104 New Zealand shoppers randomised to receive a 12.5% discount on healthier foods and/or tailored nutrition education (or no intervention) for 6 months.
Results There was no overall association of price discounts or nutrition education with percentage energy from saturated fat, or nutrition education with healthy food purchasing. There was an association of price discounts with healthy food purchasing (0.79 kg/week increase; 95% CI 0.43 to 1.16) that varied by ethnicity (p=0.04): European/other 1.02 kg/week (n=755; 95% CI 0.60 to 1.43); Pacific 1.20 kg/week (n=101; 95% CI 0.06 to 2.34); Māori −0.15 kg/week (n=248; 95% CI −1.10 to 0.80). This association of price discounts with healthy food purchasing did not vary by household income or education.
Conclusions While a statistically significant variation by ethnicity in the effect of price discounts on food purchasing was found, the authors caution against a causal interpretation due to likely biases (eg, attrition) that differentially affected Māori and Pacific people. The study highlights the challenges in generating valid evidence by social groups for public health interventions. The null findings for tailored nutritional education across all social groups suggest that structural interventions (such as price) may be more effective.
- diet RB
- ethnic CG
- ethnic groups
- health education
- household income
- inequalities SI
- price discounts
- randomised trials
- social class
- educational qualification
Funding Health Research Council of New Zealand. The Supermarket Healthy Options Project was supported by the Health Research Council of New Zealand (06/379). CNM holds the Heart Foundation Senior Fellowship (grant 1380). HE is supported by a Heart Foundation of New Zealand postgraduate scholarship (grant 1285). TB, SMc and KS receive salary support from the Health Inequalities Research Programme, funded by the Health Research Council of New Zealand (08/048).
Competing interests None.
Ethics approval This study was conducted with the approval of the Wellington Regional Ethics Committee. The study protocol was also approved by the University of Auckland Human Ethics Committee (reference 2006/462), and all participants provided written informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.