Background The dietary choices of women have a major influences on their children’s diets, and childhood diet quality tracks into adulthood. Supermarkets are a major source of food for families, yet understanding of how the environment within supermarkets influences food choices is sparse. Evaluating environmental strategies to enable families, particularly those from disadvantaged backgrounds, to make healthier food choices is necessary to improve diet, reduce obesity prevalence and improve population health. We assessed the effect of improving the availability and placement of fruit and vegetables in supermarkets, and removing confectionery from checkouts, on the diet quality of women of childbearing age from disadvantaged backgrounds.
Methods This study was the pilot phase of a natural experiment with a prospective matched cluster design. The setting was a discount supermarket chain in England. The intervention had three components: i) new fresh fruit and vegetable section at store entrances, replacing smaller display at the back ii) frozen fruit and vegetables in the first aisle, and iii) removal of confectionery from checkouts. Women customers aged 18 to 45 years, with a store loyalty card, who regularly shopped at three intervention and three matched-control stores in England were recruited. Data on women’s diet quality and demographic characteristics were collected via telephone survey before refurbishment, and three months after. Linear regression models adjusting for baseline diet were used to assess whether diet quality improved in women who shopped in intervention stores.
Results A total of 150 women were recruited (56 from intervention stores and 74 from control stores), and 138 provided complete data at baseline and follow-up three months after refurbishment. Participant characteristics at baseline were similar in intervention and control groups; median age was 36 years (IQR 31–41), 91% were white British and 55% were educated to GCSE level or below. Almost half (41%) reported that the discount supermarket chain was their primary supermarket. Diet quality was higher among intervention than control participants at three months: β=0.25 SD (95% CI 0.01, 0.49), equivalent to four additional portions of green salad per week. This relationship weakened slightly after adjustment for neighbourhood deprivation, age, money spent on groceries, number of children and educational attainment (β=0.23 (95% CI −0.01, 0.47).
Conclusion Creating a healthier store layout within supermarkets may improve the diets of women customers. Future government programmes targeting the food environment could consider working with the food industry to improve product placement.
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