***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Objective Small food store interventions show promise to increase healthy food access in under-re source d areas . However , none have tested the impact of price discounts on healthy food supply and dem and . We tested the impact of store-directed price discounts and communications strategies , separately and combined , on the stocking , sales and prices of healthier foods and on storeowner psychosocial factors . Design Factorial design r and omized controlled trial . Setting Twenty-four corner stores in low-income neighbourhoods of Baltimore City , MD , USA . Subjects Stores were r and omized to pricing intervention , communications intervention , combined pricing and communications intervention , or control . Stores that received the pricing intervention were given a 10–30 % price discount by wholesalers on selected healthier food items during the 6-month trial . Communications stores received visual and interactive material s to promote healthy items , including signage , taste tests and refrigerators . Results All interventions showed significantly increased stock of promoted foods υ . control . There was a significant treatment effect for daily unit sales of healthy snacks ( β = 6·4 , 95 % CI 0·9 , 11·9 ) and prices of healthy staple foods ( β = −0·49 , 95 % CI −0·90 , −0·03 ) for the combined group υ . control , but not for other intervention groups . There were no significant intervention effects on storeowner psychosocial factors . Conclusions All interventions led to increased stock of healthier foods . The combined intervention was effective in increasing sales of healthier snacks , even though discounts on snacks were not passed to the consumer . Experimental research in small stores is needed to underst and the mechanisms by which store-directed price promotions can increase healthy food supply and dem and BACKGROUND In 2016 , the US Department of Agriculture ( USDA ) 's Supplemental Nutrition Assistance Program ( SNAP ) Retailer Rule proposed several changes for SNAP-authorized retailers , including : requiring retailers to have at least 85 % of their food sales come from items that are not cooked or heated on site before or after purchase ; requiring stores to stock seven varieties of qualifying foods from four staple food groups ; requiring stores to carry perishable foods in three of the four staple groups ; requiring stores to carry six units of qualifying foods at all times ( depth of stock ) ; disqualifying multiple ingredient foods and accessory foods from counting toward depth of stock requirements . OBJECTIVES To better underst and arguments used to support or oppose the USDA 's proposed rule that all SNAP-authorized retailers carry more nutritious foods . DESIGN We conducted a qualitative content analysis of a r and om sample of public comments posted to the US Federal Register ( a publicly available data base ) in response to the USDA 's proposed rule . PARTICIPANTS / SETTING A r and om sample of 20 % of all public comments su bmi tted by individuals and organizations to the US Federal Register were analyzed ( n=303 ) for this study . RESULTS Three main themes were discussed : 1 ) arguments used in opposition to the rule ; 2 ) arguments used in support of the rule ; and 3 ) facilitators to assist stores in implementing the rule . Some of the subthemes included focusing on definitions used in the rule , reduced food access caused by stores leaving the SNAP program , lack of space and equipment for healthy foods , and the potential for increasing healthy food access . CONCLUSIONS Nutrition and dietetics practitioners may be tasked with working with stores to implement healthy changes . Nutrition and dietetics practitioners must underst and the role that the USDA has in food policy . In addition , underst and ing how federal food policy influences the environments in which dietetics professionals ' clients are making food choices is important PURPOSE To estimate the impacts of a new supermarket in a low-income desert , on residents ' economic status and health . METHODS We surveyed a r and omly selected cohort in two low-income Pittsburgh neighborhoods before and about 1 year following the opening of a supermarket .  We used difference-in-difference approach to test changes across the two neighborhoods in residents ' food security , United States Department of Agriculture Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women Infant and Children participation , employment , income , and self-reported health/chronic disease diagnoses . RESULTS We observed declines in food insecurity ( -11.8 % , P < .01 ) , Supplemental Nutrition Assistance Program participation ( -12.2 % , P < .01 ) , and fewer new diagnoses of high cholesterol ( -9.6 % , P = .01 ) and arthritis ( -7.4 % , P = .02 ) in the neighborhood with the new supermarket relative to residents of the comparison neighborhood . We also found suggestive evidence that residents ' incomes increased more ( $ 1550 , P = .09 ) and prevalence of diabetes increased less in the neighborhood with the supermarket than in the comparison neighborhood ( -3.6 % , P = .10 ) . CONCLUSIONS Locating a new supermarket in a low-income neighborhood may improve residents '  economic well-being and health . Policymakers should consider broad impacts of neighborhood investment that could translate into improved health for residents of underserved neighborhoods Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Research suggests that the food environment influences individual eating practice s. To date , little is known about effective interventions to improve the food environment of restaurants and food stores and promote healthy eating in rural communities . We tested “ Waupaca Eating Smart ” ( WES ) , a pilot intervention to improve the food environment and promote healthy eating in restaurants and supermarkets of a rural community . WES focused on labeling , promoting , and increasing the availability of healthy foods . Methods We conducted a r and omized community trial , with two Midwestern U.S. communities r and omly assigned to serve as intervention or control site . We collected process and outcome data using baseline and posttest owner and customer surveys and direct observation methods . The RE- AIM framework was used to guide the evaluation and organize the results . Results Seven of nine restaurants and two of three food stores invited to participate in WES adopted the intervention . On a 0 - 4 scale , the average level of satisfaction with WES was 3.14 ( SD=0.69 ) for restaurant managers and 3 ( SD=0.0 ) for store managers . On average , 6.3 ( SD=1.1 ) out of 10 possible intervention activities were implemented in restaurants and 9.0 ( SD=0.0 ) out of 12 possible activities were implemented in food stores . One month after the end of the pilot implementation period , 5.4 ( SD=1.6 ) and 7.5 ( SD=0.7 ) activities were still in place at restaurants and food stores , respectively . The intervention reached 60 % of customers in participating food outlets . Restaurant food environment scores improved from 13.4 to 24.1 ( p < 0.01 ) in the intervention community and did not change significantly in the control community . Food environment scores decreased slightly in both communities . No or minimal changes in customer behaviors were observed after a 10-month implementation period . Conclusion The intervention achieved high levels of reach , adoption , implementation , and maintenance , suggesting the feasibility and acceptability of restaurant- and food store-based interventions in rural communities . Pilot outcome data indicated very modest levels of effectiveness , but additional research adequately powered to test the impact of this intervention on food environment scores and customer behaviors needs to be conducted in order to identify its potential to promote healthy eating in rural community setting We examined nine features in grocery stores shoppers reported motivated them to purchase more healthful foods in the past month . Features were compiled from common supermarket practice s for each of the 4 Ps of marketing : pricing , placement , promotion , and product . We examined percentages of the features overall and by shopping frequency using Chi square tests from a 2014 cross sectional web-based health attitudes and behaviors survey , ConsumerStyles . The survey was fielded from June to July in 2014 . Participants were part of a market research consumer panel that were r and omly recruited by probability-based sampling using address-based sampling methods to achieve a sample representative of the U.S. population . Data from 4242 adults ages 18 and older were analyzed . About 44 % of respondents indicated at least one feature motivated them to purchase more healthful foods . Top choices included in-store coupons or specials ( 20.1 % ) , availability of convenient , ready-to-eat more healthful foods ( 18.8 % ) , product labels or advertising on packages ( 15.2 % ) , and labels or signs on shelves that highlighted more healthful options ( 14.6 % ) . Frequent shoppers reported being motivated to purchase more healthful foods by in-store tastings/recipe demonstrations and coupons/specials more often than infrequent shoppers . Enhancing the visibility and appeal of more healthful food items in grocery stores may help improve dietary choices in some population s but additional research is needed to identify the most effective strategies for interventions INTRODUCTION Most evidence -based interventions to improve fruit and vegetable ( FV ) consumption target individual behaviors and family systems ; however , these changes are difficult to sustain without environmental support . This paper describes an innovative social and structural food store-based intervention to increase availability and accessibility of FVs in tiendas ( small- to medium-sized Latino food stores ) and purchasing and consumption of FVs among tienda customers . METHODS Using a cluster r and omized controlled trial with 16 tiendas pair-matched and r and omized to an intervention or wait-list control condition , this study will evaluate a 2-month intervention directed at tiendas , managers , and employees followed by a 4-month customer-directed food marketing campaign . The intervention involves social ( e.g. , employee trainings ) and structural ( e.g. , infrastructure ) environmental changes . Three hundred sixty-nine customers ( approximately 23 per tienda ) serve on an evaluation cohort and complete assessment s ( interviews and measurements of weight ) at 3 time points : baseline , 6-months post-baseline , and 12-months post-baseline . The primary study outcome is customer-reported daily consumption of FVs . Manager interviews and monthly tienda audits and collection of sales data will provide evidence of tienda-level intervention effects , our secondary outcomes . Process evaluation methods assess dose delivered , dose received , and fidelity . RESULTS Recruitment of tiendas , managers , employees , and customers is complete . Demographic data shows that 30 % of the customers are males , thus providing a unique opportunity to examine the effects of a tienda-based intervention on Latino men . CONCLUSIONS Determining whether a tienda-based intervention can improve customers ' FV purchasing and consumption will provide key evidence for how to create healthier consumer food environments Background Low-income black residents of Baltimore City have disproportionately higher rates of obesity and chronic disease than other Maryl and residents . Increasing the availability and affordability of healthy food are key strategies to improve the food environment and can lead to healthier diets . This paper describes B’More Healthy : Retail Rewards ( BHRR ) , an intervention that tests the effectiveness of performance-based pricing discounts and health communications , separately and combined , on healthy food purchasing and consumption among low-income small store customers . Methods / design BHRR is 2x2 factorial design r and omized controlled trial . Fifteen regular customers recruited from each of 24 participating corner stores in Baltimore City were enrolled . Food stores were r and omized to 1 ) pricing intervention , 2 ) communications intervention , 3 ) combined intervention , or 4 ) control . Pricing stores were given a 10 - 30 % price discount on selected healthier food items , such as fresh fruits , frozen vegetables , and baked chips , at the point of purchase from two food wholesale stores during the 6-month trial . Storeowners agreed to pass on the discount to the consumer to increase dem and for healthy food . Communications stores received visual and interactive material s to promote healthy items , including signage , taste tests , and refrigerators . Primary outcome measures include consumer food purchasing and associated psychosocial variables . Secondary outcome measures include consumer food consumption , store sales , and associated storeowner psychosocial factors . Process evaluation was monitored throughout the trial at wholesaler , small store , and consumer levels . Discussion This is the first study to test the impact of performance-based pricing and communications incentives in small food stores , an innovative strategy to encourage local wholesalers and storeowners to share responsibility in creating a healthier food supply by stocking , promoting , and reducing costs of healthier foods in their stores . Local food wholesalers were involved in a top-down , participatory approach to develop and implement an effective and sustainable program . This study will provide evidence on the effectiveness of price incentives and health communications , separately and combined , among a low-income urban U.S. population .Trial registration Clinical Trials.gov : NCT02279849 ( 2/18/2014 ) This article describes a comprehensive process evaluation of an efficacious store-based intervention that increased store customers ’ fruit and vegetable consumption . The process evaluation plan was design ed at study inception and implemented at baseline , during the intervention , and at immediate postintervention . Four Latino food stores were r and omly assigned either to an intervention or to a control condition . Data were collected from store managers , employees , and 139 Latino customers . Research ers used manager , employee , and customer interviews ; weekly observations of the store environment ; and implementation logs to assess reach , dose delivered , dose received , and fidelity . Results indicated that it is possible to reach customers in a store-based intervention . Indicators of dose delivered demonstrated that the intervention was implemented as planned , and in the case of employee training , it exceeded the plan . Dose received data indicated that customers moderately engaged with the intervention activities . Together these suggest that the intervention 
    Output:
    
Multiple social-ecological factors influenced retailer decision making and ability or willingness to use marketing-mix and choice-architecture strategies to improve consumers ’ healthy choices to support dietary quality .