***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE This study tested the efficacy of a multicomponent supermarket point-of-purchase intervention featuring in-person nutrition education on the nutrient composition of food purchases . DESIGN The design was a r and omized trial comparing the intervention with usual care ( no treatment ) . SETTING AND PARTICIPANTS A supermarket in a socioeconomically diverse region of Phoenix , AZ . One hundred fifty-three adult shoppers were recruited onsite . INTERVENTION The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket point-of-purchase healthful shopping program that included posted shelf signs identifying healthful foods , sample shopping lists , tips , and signage . MAIN OUTCOME MEASURES Outcomes included purchases of total , saturated , and trans fat ( grams/1,000 kcal ) , and fruits , vegetables , and dark-green/yellow vegetables ( servings/1,000 kcal ) derived through nutritional analysis of participant shopping baskets . ANALYSIS Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income . RESULTS The intervention result ed in greater purchasing of fruit and dark-green/yellow vegetables . No other group differences were observed . CONCLUSIONS AND IMPLICATION S Long-term evaluations of supermarket interventions should be conducted to improve the evidence base and to determine the potential for influence on food choices associated with decreased chronic disease incidence This study examined the direct and mediated impact of a self-administered , computer-based intervention on nutrition behavior , self-efficacy , and outcome expectations among supermarket food shoppers . The intervention , housed in kiosks in supermarkets and based on social cognitive theory , used tailored information and self-regulation strategies delivered in 15 brief weekly segments . The study sample ( N = 277 ) , stratified and r and omly assigned to treatment or control , was 96 % female , was 92 % White , had a median annual income of about $ 35,000 , and had a mean education of 14.78 ±2.11 years . About 12 % of the sample reported incomes of $ 20,000 or less , and about 20 % reported 12 years or fewer of education . Analysis of covariance immediately after intervention and at a 4- to 6-month follow-up found that treatment led to improved levels of fat , fiber , and fruits and vegetables . Treatment also led to higher levels of nutrition-related self-efficacy , physical outcome expectations , and social outcome expectations . Logistic regression analysis determined that the treatment group was more likely than the control group to attain goals for fat , fiber , and fruits and vegetables at posttest and to attain goals for fat at follow-up . Latent variable structural equation analysis revealed self-efficacy and physical outcome expectations mediated treatment effects on nutrition . In addition , physical outcome expectations mediated the effect of self-efficacy on nutrition outcomes . Implication s for future computer-based health promotion interventions are discussed OBJECTIVES This study examined the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines . METHODS  Low-fat snacks were added to 55 vending machines in a convenience sample of 12 secondary schools and 12 worksites . Four pricing levels ( equal price , 10 % reduction , 25 % reduction , 50 % reduction ) and 3 promotional conditions ( none , low-fat label , low-fat label plus promotional sign ) were crossed in a Latin square design . Sales of low-fat vending snacks were measured continuously for the 12-month intervention . RESULTS Price reductions of 10 % , 25 % , and 50 % on low-fat snacks were associated with significant increases in low-fat snack sales ; percentages of low-fat snack sales increased by 9 % , 39 % , and 93 % , respectively . Promotional signage was independently but weakly associated with increases in low-fat snack sales . Average profits per machine were not affected by the vending interventions . CONCLUSIONS Reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent population BACKGROUND Many question whether mass media , in the absence of other programming , can produce significant and sustained behavior change . METHODS The 1 % Or Less campaign  in Wheeling , West Virginia ( population 35,000 ) , used paid advertising and public relations to encourage members of one community to switch from whole or 2 % milk ( high-fat milk ) to 1 % or fat-free milk ( low-fat milk ) . The study used a quasi-experimental research design with one intervention city and one comparison city . The effectiveness of the campaign was evaluated by collecting milk sales data from supermarkets and conducting pre- and post-intervention telephone surveys in intervention and comparison cities . RESULTS In the intervention city , low-fat milk sales increased from 29 % of overall milk sales before the campaign to 46 % of sales in the month following the campaign . The increase was maintained at the 6-month follow up . According to the telephone surveys , 34.1 % of high-fat-milk drinkers reported switching to low-fat milk in the intervention community compared with 3.6 % in the comparison community ( z = 13.1 , P < 0.0001 ) . CONCLUSIONS A media-only approach was sufficient to encourage a significant proportion of the people in one community to alter the dietary habit targeted by the intervention Objectives : The supermarket industry now services many customers through online food shopping over the Internet . The Internet shopping process offers a novel opportunity for the modification of dietary patterns . The aim of this study was to evaluate the effects on consumers ' purchases of saturated fat of a fully automated computerised system that provided real-time advice tailored to the consumers ' specific purchases recommending foods lower in saturated fat . Design : This study was a blinded , r and omised controlled trial . Setting : The study was conducted in Sydney , New South Wales , Australia . Participants : The participants were consumers using a commercial online Internet shopping site between February and June 2004 . Interventions : Individuals assigned to intervention received fully automated advice that recommended specific switches from selected products higher in saturated fat to alternate similar products lower in saturated fat . Participants assigned to control received general non-specific advice about how to eat a diet lower in saturated fat . Outcome Measures : The outcome measure was the difference in saturated fat ( grams per 100 g of food ) in shopping baskets between the intervention and control groups . Results : There were 497 r and omised participants , mean age 40 y , each shopping for an average of about three people . The amount of saturated fat in the foods purchased by the intervention group was 0.66 % lower ( 95 % confidence interval 0.48–0.84 , p < 0.001 ) than in the control group . The effects of the intervention were sustained over consecutive shopping episodes , and there was no difference in the average cost of the food bought by each group . Conclusions : Fully automated , purchase-specific dietary advice offered to customers during Internet shopping can bring about changes in food purchasing habits that are likely to have significant public health implication s. Because implementation is simple to initiate and maintain , this strategy would likely be highly cost-effective BACKGROUND Reducing fruit and vegetable ( F&V ) prices is a frequently considered policy to improve dietary habits in the context of health promotion . However , evidence on the effectiveness of this intervention is limited . OBJECTIVE The objective was to examine the effects of a 50 % price discount on F&Vs or nutrition education or a combination of both on supermarket purchases . DESIGN A 6-mo r and omized controlled trial within Dutch supermarkets was conducted . Regular supermarket shoppers were r and omly assigned to 1 of 4 conditions : 50 % price discounts on F&Vs , nutrition education , 50 % price discounts plus nutrition education , or no intervention .  A total of 199 participants provided baseline data ; 151 ( 76 % ) were included in the final analysis .  F&V purchases were measured by using supermarket register receipts at baseline , at 1 mo after the start of the intervention , at 3 mo , at 6 mo ( end of the intervention period ) , and 3 mo after the intervention ended ( 9 mo ) . RESULTS Adjusted multilevel models showed significantly higher F&V purchases ( per household/2 wk ) as a result of the price discount ( + 3.9 kg ; 95 % CI : 1.5 , 6.3 kg ) and the discount plus education intervention ( + 5.6 kg ; 95 % CI : 3.2 , 7.9 kg ) at 6 mo compared with control . Moreover , the percentage of participants who consumed recommended amounts of F&Vs ( ≥400 g/d ) increased from 42.5 % at baseline to 61.3 % at 6 mo in both discount groups ( P = 0.03 ) . Education alone had no significant effect . CONCLUSIONS Discounting F&Vs is a promising intervention strategy because it result ed in substantially higher F&V purchases , and no adverse effects were observed . Therefore , pricing strategies form an important focus for future interventions or policy . However , the long-term effects and the ultimate health outcomes require further investigation . This trial was registered at the IS RCT N Trial Register as number IS RCT N56596945 and at the Dutch Trial Register ( http://www.trialregister.nl/trialreg/index.asp ) as number NL22568.029.08 BACKGROUND Vending machines account for food sales and revenue in schools . We examined 3 strategies for promoting the sale of lower-calorie food products from vending machines in high schools in the Netherl and s. METHODS A school-based r and omized controlled trial was conducted in 13 experimental schools and 15 control schools . Three strategies were tested within each experimental school : increasing the availability of lower-calorie products in vending machines , labeling products , and reducing the price of lower-calorie products . The experimental schools introduced the strategies in 3 consecutive phases , with phase 3 incorporating all 3 strategies . The control schools remained the same . The sales volumes from the vending machines were registered . Products were grouped into ( 1 ) extra foods containing empty calories , for example , c and ies and potato chips , ( 2 ) nutrient-rich basic foods , and ( 3 ) beverages . They were also divided into favorable , moderately unfavorable , and unfavorable products . RESULTS Total sales volumes for experimental and control schools did not differ significantly for the extra and beverage products . Proportionally , the higher availability of lower-calorie extra products in the experimental schools led to higher sales of moderately unfavorable extra products than in the control schools , and to higher sales of favorable extra products in experimental schools where students have to stay during breaks . Together , availability , labeling , and price reduction raised the proportional sales of favorable beverages . CONCLUSION Results indicate that when the availability of lower-calorie foods is increased and is also combined with labeling and reduced prices , students make healthier choices without buying more or fewer products from school vending machines . Changes to school vending machines help to create a healthy school environment BACKGROUND The greater presence of supermarkets in low-income , high-minority neighborhoods has the potential to positively affect diet quality among those at greatest risk of obesity . In-store marketing strategies that draw attention to healthier products may be effective , sustainable , and scalable for improving diet quality and health . Few controlled studies of in-store marketing strategies to promote sales of healthier items in low-income , high-minority neighborhoods have been conducted . OBJECTIVE The objective of this study was to evaluate the effects of in-store marketing strategies to promote the purchase of specific healthier items in 5 product categories : milk , ready-to-eat cereal , frozen meals , in-aisle beverages , and checkout cooler beverages . DESIGN The design was a cluster-r and omized controlled trial conducted from 2011 to 2012 . Eight urban supermarkets in low-income , high-minority neighborhoods were the unit of r and omization , intervention , and analysis . Stores were matched on the percentage of sales from government food-assistance programs and store size and r and omly assigned to an intervention or control group . The 4 intervention stores received a 6-mo , in-store marketing intervention that promoted the sales of healthier products through placement , signage , and product availability strategies . The 4 control stores received no intervention and were assessment -only controls . The main outcome measure was weekly sales of the targeted products , which was assessed on the basis of the stores ' sales data . RESULTS Intervention stores showed significantly greater sales of skim and 1 % milk , water ( in aisle and at checkout ) , and 2 of 3 types of frozen meals compared with control store sales during the same time period . No differences were found between the stores in sales of cereal , whole or 2 % milk , beverages , or diet beverages . CONCLUSIONS These data indicate that straightforward placement strategies can significantly enhance the sales of healthier items in several food and beverage categories . Such strategies show promise for significant public health effects in communities with the greatest risk of obesity Although much evidence links dietary patterns with coronary heart disease , effective and economical methods for inducing dietary change in non clinical population s are needed to influence public health . This study was design ed as a preliminary investigation of the feasibility of conducting effective nutrition education campaigns in supermarket setting s. Eight supermarkets from a supermarket chain in the Twin Cities area participated . Four were assigned to an experimental condition in which educational material s consisting of posters , recipes , and brochures were placed in the dairy section during a 6-month period .  Four other stores were assigned to a control condition and received no educational material s. Shoppers in experimental and control stores completed a nutrition survey pre- and post-intervention . In addition , sales data for 2 
    Output:
    
The evidence of this review indicates that monetary incentives offered to customers for a short-term look promising in increasing purchase of healthier food options when the intervention is applied by itself in stores or supermarkets .
There was a lack of good quality studies addressing all other types of relevant point-of-sale interventions examining change in purchase and /or intake of healthier food options .
Conclusions A range of intervention types have been used at point-of-sale to encourage healthy purchasing and /or intake of healthier food options and to improve health outcomes .