Purpose 

During COVID-19 lockdowns, mobility restrictions and closure of non-essential public places (restaurants, canteens, open-air markets etc.) affected peoples’ food environment (FE) and thus their food purchasing practices (FPP). This study aimed to explore changes in FPP of French households during lockdown and their associations with individual and environmental factors.

Methods

In April of 2020 households from the Mont’Panier cross-sectional study (N=306), a quota sampling survey conducted in the south of France, were asked to complete an online questionnaire about their FPP during lockdown and other related factors, including their perceived FE (distance to closest food store, perception of increased food prices etc.). The objective FE (presence, number, density and proximity of multiple food outlet types) was assessed around participants' home using a geographical information system. Multiple correspondence analysis based on changes in frequency of use and quantity of food purchased by food outlet type, followed by a hierarchical cluster analysis resulted in the identification of clusters. Logistic regression models were performed to assess associations between identified clusters and households' sociodemographic characteristics, perceived and objective FE.

Results

Five clusters were identified: cluster “Supermarket” (38% of the total sample), made up of households who reduced frequency of trips, but increased quantity bought in supermarkets during lockdown, associated with lower incomes and the perception of increased food prices; cluster “E-supermarket” (12%), in which households increased online food shopping with pick up at supermarket, associated with higher incomes; cluster “Diversified” (22%), made up of households who reduced frequency of trips to diverse food outlet types, associated with the perception of increased food prices; cluster “Organic Food Store” (20%), in which households did not change frequency of trips, nor quantity purchased in organic food stores, associated with being older (35-50 vs <35 years); and finally, cluster “Producer” (8%), including households who regularly purchased food from producers, but mostly reduced these purchases during lockdown, associated with the presence of an organic food store within a 1-km walking distance around home.

Conclusion

This study highlighted diverse changes in FPP of French households during lockdown and overall more significant associations with perceived than with objective FE indicators.

Purpose: Marketing strategies for sugar- and artificially-sweetened beverages are pervasive features across convenience and other small food stores. Yet, few studies have been able to examine the ways different strategies (e.g., advertisements, product placement) and customers’ cumulative exposure to them associate with planned and unplanned sweetened beverage purchases. The purpose of this study was to examine whether customers with a greater exposure to sweetened beverage marketing strategies are more likely to make sweetened beverage purchases and whether this varied by customer demographics (e.g., age).

Methods: We used objective (observed) purchase and store assessment data from a sample of 1604 food and beverage customers at 144 randomly-sampled stores in Minneapolis-St. Paul, MN, USA. Store assessments of sweetened beverage marketing included advertisements, in-store product placement, and shelf space. Sweetened beverage purchasing included any ready-to-drink sugar- and/or artificially-sweetened beverage of at least 4 fluid ounces. Associations between sweetened beverage marketing strategies and customer purchasing were estimated using mixed regression models, which controlled for customer demographics and accounted for customers nested within stores.

Results: Fifty-six percent of customers purchased a sweetened beverage and 14% also specified that it was an unplanned purchase. We found that customers were more likely to purchase a sweetened beverage when there were exterior store advertisements of unhealthy products (p<.0001) and when sweetened beverage advertisements were hanging from the ceiling (p<.0001). We also identified that customers with moderate and high cumulative exposure to any sweetened beverage retail marketing were significantly more likely to purchase sweetened beverages (51.2% and 54.9%, respectively) than those with lower exposure (34%) and that this effect was particularly prominent among men. There were no significant associations identified between the retail marketing strategies and making an unplanned sweetened beverage purchase.

Conclusions: Findings demonstrate that multiple strategies are needed to address sweetened beverage marketing and purchasing within convenience and other small food stores. Both priming and cumulative marketing approaches were associated with higher purchasing, and men were disproportionately influenced by these marketing tactics. Feasible and sustainable approaches are required from policymakers and other public health professionals to shift store environments away from cues that promote unhealthy beverage selections.

Purpose:

Consumption of sugar-sweetened beverages (SSBs), especially beverages other than soda, remains high among US children, perhaps because parents may view certain SSB categories as healthier options. Evidence from tobacco control indicates that pictorial warnings reduce smoking, but few studies have assessed the impact of pictorial warnings on SSBs. This study examined the effects of pictorial warnings on parents’ purchases and perceptions of different SSB categories.

Methods:

Parents of children ages 2-12 (n=326, 25% Black, 20% Hispanic) participated in a shopping task in a naturalistic store laboratory in North Carolina. Participants were randomly assigned to an intervention arm (SSBs displayed pictorial warnings about type II diabetes and heart damage), or a control arm (SSBs displayed control labels). Parents then purchased a beverage for their child and completed a survey about their perceptions of different SSB categories.

Findings:

Among participants in the pictorial warnings arm, 28% bought a sugar-sweetened beverage for their child, compared to 45% in the control arm (p<.001). Pictorial warnings led to the largest reductions in likelihood of purchasing fruit drinks (-10.6 percentage points), flavored milk (-3.7 percentage points), soda (-3.1 percentage points) and sports drinks (-1.3 percentage points). Pictorial warnings increased perceived added sugar content of SSBs compared to the control label, an effect that was largest for sweet teas (d=.22, p<.05), followed by smaller and non-significant differences for sports drinks (d=0.18, p>.05) and fruit drinks (d=0.16, p>.05). Pictorial warnings also led to lower perceived product healthfulness compared to the control label, an effect that was largest for flavored water (d=-0.34, p<.05), flavored milk (d=-0.28, p<.05), and sports drinks (d=-0.25, p<.05). Similarly, pictorial warnings led to the largest reductions in purchase intentions for sports drinks (d=-0.30, p<.05), flavored water (d=-0.24, p<.05) and sweet teas (d=-0.22, p<.05).

Conclusions:

In our study, warnings had the largest effect on reducing purchases of fruit drinks, followed by flavored milk and soda. In terms of perceptions, the largest effects of warnings were generally observed on sports drinks, sweet teas, and flavored water. Future warning label studies should stratify analyses by SSB category to determine if findings are replicated in different contexts.