Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
PLoS Med. 2022 Mar 24;19(3):e1003952. doi: 10.1371/journal.pmed.1003952. eCollection 2022 Mar.
Governments are increasingly looking for policies to change supermarket environments to support healthier food purchasing. We evaluated 6 interventions within major United Kingdom grocery stores, including availability, positioning, promotions, and signage strategies to encourage selection of healthier products.
Nonrandomised controlled study designs were used, except for one intervention that was rolled out nationwide using a pre/post within-store design. Store-level weekly sales (units, weight (g), and value (£)) of products targeted in the interventions were used in primary analyses using multivariable hierarchical models and interrupted time series (ITS) analyses. Stocking low fat chips next to regular chips was associated with decreases in sales of regular chips (units) in intervention versus control stores (-23% versus -4%; P = 0.001) with a significant level change in ITS models (P = 0.001). Increasing availability of lower energy packs of biscuits was associated with increased sales but reduced sales of regular biscuits in intervention versus control stores (lower energy biscuits +18% versus -2%; P = 0.245; regular biscuits -4% versus +7%; P = 0.386), although not significantly, though there was a significant level change in ITS models (P = 0.004 for regular biscuits). There was no evidence that a positioning intervention, placing higher fibre breakfast cereals at eye level was associated with increased sales of healthier cereal or reduced sales of regular cereal. A price promotion on seasonal fruits and vegetables showed no evidence of any greater increases in sales of items on promotion in intervention versus control stores (+10% versus +8%; P = 0.101) but a significant level change in ITS models (P < 0.001). A nationwide promotion using Disney characters was associated with increased sales of nonsugar baked beans (+54%) and selected fruits (+305%), with a significant level change in ITS models (P < 0.001 for both). Shelf labels to highlight lower sugar beverages showed no evidence of changes in purchasing of lower or higher sugar drinks. These were all retailer-led interventions that present limitations regarding the lack of randomisation, residual confounding from unmeasured variables, absolute differences in trends and sales between intervention versus control stores, and no independent measures of intervention fidelity.
Increasing availability and promotions of healthier alternatives in grocery stores may be promising interventions to encourage purchasing of healthier products instead of less healthy ones. There was no evidence that altering positioning within an aisle or adding shelf edge labelling is associated with changes in purchasing behaviours.
政府越来越多地寻求政策来改变超市环境，以支持更健康的食品购买。我们评估了英国主要杂货店的 6 项干预措施，包括可用性、定位、促销和标志策略，以鼓励选择更健康的产品。
使用了非随机对照研究设计，除了一项使用店内前后设计在全国范围内推出的干预措施外。使用多变量层次模型和中断时间序列（ITS）分析对干预措施中针对的产品的商店级每周销售额（单位、重量（g）和价值（£））进行了主要分析。在干预措施中，将低脂肪薯条与普通薯条放在一起会导致普通薯条的销售额下降（单位）（干预商店 -23%，对照商店-4%；P = 0.001），ITS 模型的水平变化具有统计学意义（P = 0.001）。增加低能量包装饼干的供应与干预商店中销售的普通饼干增加有关，但销售减少（低能量饼干+18%，对照商店-2%；P = 0.245；普通饼干-4%，对照商店+7%；P = 0.386），尽管不显著，但 ITS 模型的水平变化具有统计学意义（普通饼干 P = 0.004）。没有证据表明，将高纤维早餐麦片定位在眼睛水平的干预措施与更健康的麦片销售增加或普通麦片销售减少有关。季节性水果和蔬菜的价格促销活动表明，干预商店与对照商店相比，促销商品的销售额没有任何更大的增加（增加 10%，对照商店增加 8%；P = 0.101），但 ITS 模型的水平变化具有统计学意义（P < 0.001）。使用迪士尼角色进行的全国性促销活动与非糖烤豆（+54%）和精选水果（+305%）的销售增加有关，ITS 模型的水平变化具有统计学意义（两者均为 P < 0.001）。突出低糖饮料的货架标签没有证据表明购买低糖或高糖饮料的行为发生了变化。这些都是零售商主导的干预措施，由于缺乏随机分组、未测量变量的残余混杂、干预与对照商店之间趋势和销售额的绝对差异以及对干预可信度的独立衡量，存在一定的局限性。
增加杂货店中更健康替代品的供应和促销可能是鼓励购买更健康产品而不是不太健康产品的有希望的干预措施。没有证据表明改变过道内的位置或添加货架边缘标签与购买行为的变化有关。
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