***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 Lowering the price of fruit and vegetables is a promising strategy in stimulating the purchase of those foods . However , the true effects of this strategy are not well studied and it is unclear how the money saved is spent . The aim of this study is to examine the effects of a 25 % discount on fruits and vegetables on food purchases in a supermarket environment . Methods A r and omized controlled trial with two research conditions was conducted : a control condition with regular prices  ( n = 52 ) and an experimental condition with a 25 % discount on fruits and vegetables  ( n = 63 ) . The experiment was carried out using a three-dimensional web-based supermarket , which is a software application in the image of a real supermarket . Data were collected in 2010 in the Netherl and s. Participants received a fixed budget and were asked to buy weekly household groceries at the web-based supermarket . Differences in fruit and vegetable purchases , differences in expenditures in other food categories and differences in total calories were analyzed using independent sample s t-tests and multiple linear regression models accounting for potential effect modifiers and confounders . Results The purchased amount of fruit plus vegetables was significantly higher in the experimental condition compared to the control condition ( Δ984 g per household per week , p = .03 ) after appropriate adjustments . This corresponds to a 25 % difference compared to the control group . Both groups had similar expenditures in unhealthier food categories , including desserts , soda , crisps , c and y and chocolate . Furthermore , both groups purchased an equal number of food items and an equal amount of calories , indicating that participants in the discount condition did not spend the money they saved from the discounts on other foods than fruits and vegetables . Conclusion A 25 % discount on fruits and vegetables was effective in stimulating purchases of those products and did neither lead to higher expenditures in unhealthier food categories nor to higher total calories purchased . Future studies in real supermarkets need to confirm these findings Twenty-four-hour urine collection , as a gold st and ard method of measuring salt intake , is costly and re source consuming , which limits its use in monitoring population salt reduction programs . Our study aim ed to determine whether a salt sales survey could serve as an alternative method . This was a sub study of China Rural Health Initiative-Sodium Reduction Study ( CRHI-SRS ) , in which 120 villages were r and omly allocated ( 1:1:2 ) into a price subsidy+health education ( PS+HE ) group , a HE-only group or a control group . Salt substitutes ( SS ) were supplied to shops in the intervention groups ; 24-h urine was collected from 2567 r and omly selected adults at the end of the trial to evaluate the effects of the intervention . Ten villages were r and omly selected from each group ( that is , 30 villages in total ) , and 166 shops from these villages were invited to participate in the monthly salt sales survey . The results showed that during the intervention period , mean monthly sales of SS per shop were 38.0 kg for the PS+HE group , 19.2 kg for the HE only and 2.2 kg for the control group ( P<0.05 ) , which was consistent with the results from the 24-h urine sodium and potassium data . The intervention effects of CRHI-SRS on sodium and potassium intake estimated from SS sales were 101 % and 114 % , respectively , of those observed from the 24-h urine data . Furthermore , the salt sales survey cost only 14 % of the cost of the 24-h urine method and had greater statistical power . The results indicate that a salt sales survey could serve as a simple , sensitive and cost-effective method to evaluate community-based salt reduction programs in which salt is mainly added by the consumers OBJECTIVE Fiscal policies may form a solution in improving dietary intake . This study aim ed to examine the effectiveness of varying taxing and subsiding schemes to stimulate healthier food purchases . METHODS A r and omized controlled trial with three levels of price reduction on healthy foods ( no ; 25 % ; 50%) × three levels of price increase on unhealthy foods ( 5 % ; 10 % ; 25 % ) factorial design was used . 150 participants were r and omized into one of nine conditions and were asked to purchase groceries at a web-based supermarket . Data were collected in the Netherl and s in January-February 2010 and analyzed using analysis of covariance . RESULTS Subjects receiving 50 % discount purchased significantly more healthy foods than subjects receiving no ( mean difference=6.62 items , p<0.01 ) or 25 % discount ( mean difference=4.87 items , p<0.05 ) . Moreover , these subjects purchased more vegetables ( mean difference=821 g;p<0.05 compared to no discount ) . However , participants with the highest discount also purchased significantly more calories . No significant effects of the price increases on unhealthy foods were found . CONCLUSION Price decreases are effective in stimulating healthy food purchases , but the proportion of healthy foods remains unaffected . Price increases up to 25 % on unhealthier products do not significantly affect food purchases . Future studies are important to vali date these results in real supermarkets and across different countries Background Two strategies commonly recommended to improve population diets include food labels and food taxes/subsidies . The aim of this study was to examine the effects of both strategies separately and in combination . Findings An experiment with a 3x3 factorial design was conducted , including : three levels of price reduction ( 10 % ; 25 % ; and 50 % ) x three labels ( ‘ special offer ’ , ‘ healthy choice ’ and ‘ special offer & healthy choice ’ ) on healthy foods defined following the Choices front-of-pack nutrition label . N = 109 participants completed the experiment by conducting a typical weekly shop for their household at a three-dimensional web-based supermarket . Data were analysed using analysis of covariance . Participants receiving a 50 % price discount  purchased significantly more healthy foods for their household in a typical weekly shop than the 10 % discount ( + 8.7 items ; 95%CI = 3.8 - 13.6 ) and the 25 % discount group ( + 7.7 items ; 95%CI = 2.74 – 12.6 ) . However , the proportion of healthy foods was not significantly higher and the discounts lead to an increased amount of energy purchased . No significant effects of the labels were found . Conclusion This study brings some relevant insights into the effects of price discounts on healthier foods coupled with different labels and shows that price effects over shadowed food labels . However , price discounts seem to have ambiguous effects ; they do encourage the purchase of healthy products , but also lead to increased energy purchases . More research is needed to examine how pricing strategies can work in directing consumers towards interchanging unhealthier options for healthier alternatives 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 OBJECTIVES Financial constraint is the underpinning determinant of household food insecurity ; however , there has been little research examining the impact that increasing the ‘ money available ’ to food-insecure households could have on food purchasing . The main objective of the present study was to examine the effect of additional money ( in the form of supermarket vouchers ) on food expenditure in food-insecure households with children . DESIGN A parallel r and omized controlled trial with a 4-week baseline phase followed by a 4-week intervention phase . Households were r and omized to either receive vouchers ( coupons ) for 4 weeks or a control group that did not receive any vouchers . SETTING Dunedin , New Zeal and . SUBJECTS Low-income households with children ≥ 18 years ) reporting food insecurity ( n 214 ) . RESULTS The mean monetary value of the vouchers received by households was $ NZ 17?00 per week . The voucher group spent ≥ NZ 15.20 ( 95 % CI 1.46 , 28.94 ) more per week on food during the intervention phase compared with the control group ( P50.030 ) . There were no differences in expenditure between the voucher and the control group for the food groups ‘ fruit and vegetables ’ ( mean difference : ≥ NZ 0?46 ; 95 % CI 21.97 , 2.89 ; P50.709 ) , ‘ meat and poultry ’ ( mean difference : ≥ NZ 0.29 ; 95 % CI 23.07 , 3.64 ; P50.866 ) and ‘ dairy ’ ( mean difference : ≥ NZ 0.82 ; 95 % CI 20.75 , 2.42 ; P50.302 ) . CONCLUSIONS Providing money via supermarket vouchers to food-insecure result ed in an increase in overall expenditure on food Background : Nutrition labeling is a prominent policy to promote healthy eating . Objective : We aim ed to evaluate the effects of 2 interpretive nutrition labels compared with a noninterpretive label on consumer food purchases . Design : In this parallel-group r and omized controlled trial , we enrolled household shoppers across New Zeal and who owned smartphones and were aged ≥18 y. Eligible participants were r and omly assigned ( 1:1:1 ) to receive either traffic light labels ( TLLs ) , Health Star Rating labels ( HSRs ) , or a control [ nutrition information panel ( NIP ) ] . Smartphone technology allowed participants to scan barcodes of packaged foods and to receive allocated labels on their smartphone screens . The primary outcome was the mean healthiness of all packaged food purchases over the 4-wk intervention period , which was measured by using the Food St and ards Australia New Zeal and Nutrient Profiling Scoring Criterion ( NPSC ) . Results : Between October 2014 and November 2015 , 1357 eligible shoppers were r and omly assigned to TLL ( n = 459 ) , HSR ( n = 443 ) , or NIP ( n = 455 ) labels . Overall difference in the mean transformed NPSC score for the TLL group compared with the NIP group was -0.20 ( 95 % CI : -0.94 , 0.54 ; P = 0.60 ) . The corresponding difference for HSR compared with NIP was -0.60 ( 95 % CI : -1.35 , 0.15 ; P = 0.12 ) . In an exploratory per- protocol analysis of participants who used the labeling intervention more often than average ( n = 423 , 31 % ) , those who were assigned to TLL and HSR had significantly better NPSC scores [ TLL compared with NIP : -1.33 ( 95 % CI : -2.63 , -0.04 ; P = 0.04 ) ; HSR compared with NIP : -1.70 ( 95 % CI : -2. 
    Output:
    
Store environment interventions showed mixed effects .
Education-only interventions appeared effective in simulated environments but not in real stores .
Available data suggested that effects of economic interventions did not differ by socioeconomic status , whereas for other interventions impact was variable .
In our qualitative comparative analysis , economic interventions ( regardless of setting ) and environmental and swap interventions in real stores were associated with statistically significant changes in purchasing in the desired direction for ≥1 of the foods targeted by the intervention , whereas education-only interventions in real stores were not .
Conclusions Findings suggest that interventions implemented in grocery stores-particularly ones that manipulate price , suggest swaps , and perhaps manipulate item availability-have an impact on purchasing and could play a role in public health strategies to improve health .