Meredith Ledlie-Johnson Elena Serrano Virginia SNAP-Ed ASNNA 2018 Shop Smart, Eat Smart Using Evidence-Based Strategies to Inform a Consumer-Oriented Healthy Food Retail Initiative Meredith Ledlie-Johnson Elena Serrano Virginia SNAP-Ed ASNNA 2018

Introduction Business goals and public health nutrition goals to enhance consumer purchases of Dietary Guidelines for Americans (DGAs), 2015- 2020 may not align.1 Finding common ground is necessary for sustainable behavioral economic interventions.2 This essentially includes altering the way foods are presented and marketed to the consumer without restricting purchasing choices.3 There are practical concerns from the retailer perspective that may influence the success of food store interventions, including: available space and structures the convenience, demand, profitability, and shelf-life of unhealthy food products

Interviews with store managers Market basket assessment tool Focus groups with SNAP participants Market basket assessment tool (MBAT) Inform food images within Shop Smart, Eat Smart logo Inform In-Store Resources Identification of Stores for Partnership Identification of Strategies to Use within Stores and to Guide Conversations with Development of a Curriculum to Support “Asking” Behavior of Consumers in Direct Education

Phase 1: Inform Food Images within Shop Smart, Eat Smart logo

Market Basket Assessment Tool Developing the MBAT Market Basket Assessment Tool Adapted from Nutritional Environment Measures Survey (NEMS) 4-page survey tool Assesses availability and affordability of nutritious food items promoted by SNAP-Ed Grains, fruits, meat, dairy and eggs, beans, seeds, nuts, and nut butters Cheapest healthy item available (price/oz.) Misyak, S., Hedrick, V., Pudney, E., Serrano, E., & Farris, A. (2018). Reliability of a Market Basket Assessment Tool (MBAT) for use in SNAP-Ed Healthy Retail Initiatives. Accepted for Publication in the Journal of Nutrition Education and Behavior.

Market Basket Assessment Tool Developing the MBAT Market Basket Assessment Tool Based on assessments in 37 stores, the following food items were found to be the most popular nutritious options in SNAP- eligible stores: Canned Veggies – 37 Canned Meat – 37 Hot Cereal – 35 Milk – 34 Eggs – 32 Nut butter – 36

Phase 2: Design and Selection of In-Store Promotions and Marketing, including Recipes

Interviews with Food Store Managers (n=29) Low-income and low- access rural areas of central Virginia Measures – Survey with cost analysis Free list exercise Card sort based on marketing mix/nudge strategy (Kraak & co-workers) Market Basket Assessment Tool (MBAT) Kraak VI, T Englund, S Misyak, EL Serrano. A novel marketing mix and choice architecture framework to nudge restaurant customers toward healthy food environments to reduce obesity in the United States. Obesity Review 2017.

Results High Agreement Results - ~70% or at least 20 retailers Increase healthy snack product stocking. Increase self space of healthy foods and beverages. Provide MyPlate shopping lists for consumers to promote healthy foods and beverages. Use an appealing display to highlight healthy foods and beverages. Use shelf labels (messages or nutrition info) in support of healthy foods and beverages. Use product labels (messages or nutrition info) in support of healthy foods and beverages. Use a standardized shelf or product labeling system to indicate if a food is healthy, unhealthy, or neutral. Attach recipes and nutrition info to convenience food products to support healthy foods and beverages. Add healthy foods and beverages to check-out lanes. Use store aisle endcaps to display healthy foods and beverages. Place healthy foods and beverages at eye level locations. Move healthy foods and beverages to the front of the store or to high consumer traffic areas. Move healthy foods and beverages closer to the easy reach of children. Using categories Profile, Promotion, Prompting, Priming, and Proximity to promote purchases of DGAs—supported foods and beverages

Retailer-Facing Menu Strategies

Retailer-Facing Menu Strategies

Shelf-labels to highlight healthy foods & beverages

Retailer 1-Pager

Youth Scavenger Hunts

Nutrition Education for Staff

Food Demonstrations Food Demo Guidebook coming in early 2018

Store Tours

Targeted Social Media to Promote Partner Stores to SNAP-Consumers From other FNP programs, we know SNAP consumers use social media to learn about healthier food options in their communities Promoting stores vs. map of stores to target areas Propel app talks

Phase 3: Development of a Curriculum to Support “Asking” Behavior of Consumers

Focus Groups with SNAP-Ed Participants Held 4 focus groups with SNAP-Ed participants in rural and urban parts of Virginia to help consider opportunities within Virginia SNAP-Ed to support consumer demand Questions designed to explore if participants felt: comfortable asking for specific foods to be sold learning how to ask retailers to sell healthier foods was valuable Found broad support for this approach and these types of lessons Felt “empowering”

“Voice Your Choice” Lessons for Consumers

Phase 4: Identification of Stores for Partnership

Using data to choose retail partners Step-by-step guide to assist SNAP-Ed Agents in identifying retail partners in their communities. Decision based on: Gathering ata from the census, CDC BRFSS & USDA ERS food environment atlas among others Partner stores must be in an area with 50% or more pop at 185% FPL or have $50K or more monthly SNAP sales Assessing potential community stakeholders for partnership Conducting MBAT in potential retail sites to ensure minimum score Approaching retailer with potential strategies and partnership proposal

Thank you! Meredith Ledlie-Johnson, meredil@vt.edu Elena Serrano, serrano@vt.edu Acknowledgements: Sarah Misyak, sbudowle@vt.edu, PSE Evaluation Specialist Liza Dobson, liza7@vt.edu, Healthy Food Retail Initiative Coordinator Kara Lubischer, Stock Healthy, Shop Healthy

Signs, posters, & pictures to promote healthy foods & beverages

Use cues to guide consumers to healthy foods & beverages HEALTHY FOOD THIS WAY HEALTHY FOOD THIS WAY

Use store aisle endcaps to display healthy foods & beverages

Develop appealing displays to highlight healthy foods & beverages

Move healthy foods & beverages to check-out lanes/areas

Place healthy foods & beverages at eye level locations