***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 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 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 Purpose . Nutrition education and labeling may help consumers to eat less fat . The purpose of this study is to assess the effect of nutrition education with and without shelf labeling on reduced fat intake in Dutch supermarkets . Methods . The design consisted of a r and omized , pretest-posttest , experimental control group design . In total , 2203 clients of 13 supermarkets were included in the sample .  Total fat intake of clients and behavioral determinants of eating less fat were measured by a question naire . A mixed-effect regression model was used for the analysis . Results . No significant effects were found for the educational intervention , alone or with the labeling , on total fat intake and the psychosocial determinants of eating less fat . Conclusion . Nutrition education and labeling of low-fat food products in supermarkets did not prove to be effective strategies . The fact that the supermarket is a highly competitive environment may have accounted for this lack of effect OBJECTIVE The objective of the present study was to test the effectiveness of financial incentives and traffic-light labels to reduce purchases of sugar-sweetened beverages in a community supermarket . DESIGN In this r and omized controlled trial , after a 2-month baseline period ( February-March 2014 ) , in-store traffic-light labels were posted to indicate healthy ( green ) , less healthy ( yellow ) or unhealthy ( red ) beverages . During the subsequent five months ( April-August 2014 ) , participants in the intervention arm were eligible to earn a $ US 25 in-store gift card each month they refrained from purchasing red-labelled beverages . SETTING Urban supermarket in Chelsea , MA , USA , a low-income Latino community . SUBJECTS Participants were customers of this supermarket who had at least one child living at home . A total of 148 customers ( n 77 in the intervention group and n 71 in the control group ) were included in the final analyses . RESULTS Outcomes were monthly in-store purchases tracked using a store loyalty card and self-reported consumption of red-labelled beverages . Compared with control participants , the proportion of intervention participants who purchased any red-labelled beverages decreased by 9 % more per month ( P=0·002 ) . More intervention than control participants reduced their consumption of red-labelled beverages ( -23 % v. -2 % for consuming ≥1 red beverage/week , P=0·01 ) . CONCLUSIONS Overall , financial incentives paired with in-store traffic-light labels modestly reduced purchase and consumption of sugar-sweetened beverages by customers of a community supermarket Objective : To carry out a pilot study to determine whether a supermarket double‐dollar fruit and vegetable ( F&V ) incentive increases F&V purchases among low‐income families . Design : R and omized controlled design . Purchases were tracked using a loyalty card that provided participants with a 5 % discount on all purchases during a 3‐month baseline period followed by the 4‐month intervention . Setting : A supermarket in a low‐income rural Maine community . Participants : A total of 401 low‐income and Supplemental Nutrition Assistance Program ( SNAP ) supermarket customers . Intervention : Same‐day coupon at checkout for half‐off eligible fresh , frozen , or canned F&V over 4 months . Main Outcome Measure : Weekly spending in dollars on eligible F&V. Analysis : A linear model with r and om intercepts accounted for repeated transactions by individuals to estimate change in F&V spending per week from baseline to intervention . Secondary analyses examined changes among SNAP‐eligible participants . Results : Coupons were redeemed among 53 % of eligible baskets . Total weekly F&V spending increased in the intervention arm compared with control ( $ 1.83 ; 95 % confidence interval [ CI ] , $ 0.29 to $ 3.88 ) . The largest increase was for fresh F&V ( $ 1.97 ; 95 % CI , $ 0.49 to $ 3.44 ) . Secondary analyses revealed greater increases in F&V spending among SNAP‐eligible participants who redeemed coupons ( $ 5.14 ; 95 % CI , $ 1.93 to $ 8.34 ) than among non – SNAP eligible participants who redeemed coupons ( $ 3.88 ; 95 % CI , $ 1.67 to $ 6.08 ) . Conclusions and Implication s : A double‐dollar pricing incentive increased F&V spending in a low‐income community despite the moderate uptake of the coupon redemption . Customers who were eligible for SNAP saw the greatest F&V spending increases . Financial incentives for F&V are an effective strategy for food assistance programs to increase healthy purchases and improve dietary intake in low‐income families There is a paucity of evidence regarding the impact of sugar sweetened beverage ( SSB ) price increases on beverage consumption , using individual-level data , for the population overall and for different socioeconomic groups . This study aim ed to predict the impact of altered beverage prices and educational messages on consumer purchasing behavior . 2020 adults representative of the Australian population by age , gender and income completed a discrete choice experiment online in 2016 . Each subject completed 20 choice scenarios in a hypothetical convenience store setting where subjects chose between seven SSB and non-SSB beverage options or a no beverage option . Beverage prices and volumes varied between scenarios . Half of participants ( n = 1012 ) were r and omly  exposed to an educational poster discouraging SSB consumption prior to completing choice scenarios . We used discrete choice models to predict purchases under several policy proposals , overall and for income and SSB consumption frequency sub-groups . Compared to baseline prices , a 10 % SSB price increase was predicted to reduce SSB purchases by 15.0 % [ 95%CI -15.2 , -14.7 ] , and increase purchases of non-SSBs by + 11.0 % [ 95%CI 10.8 , 11.2 ] and no beverage by + 15.5 % [ 95%CI 15.1 , 15.9 ] . Effects were greater with a 20 % SSB price increase . Across all policy scenarios , the highest income quintile had a similar absolute and slightly greater relative decrease in SSB purchases compared to the lowest quintile . Educational poster exposure  reduced SSB choice for all groups , with a greater reduction in the lower compared to higher income group , and additively increased response to price changes . Our results support the use of population -wide SSB pricing and educational interventions to reduce dem and across all income groups Background The Good Food Junction Grocery Store  was opened in a former food desert in the inner city of Saskatoon , Canada . Objective The purpose of this research was to examine , using grocery store sales data , healthy and less healthful food purchasing over a one-year period beginning eight months after opening by shoppers ' neighborhood of residence . Design A multilevel cross sectional design was used . The sample consisted of members of the Good Food Junction with a valid address in Saskatoon , Saskatchewan . All purchases made by members who reported their postal code of residence from May 15 , 2013 to April 30 , 2014 were analyzed . The outcome variable was the total amount spent on foods in 11 food groups . Linear r and om intercept models with three levels were fit to the data . Results Shoppers who were residents of former food desert neighborhoods spent $ 0.7 ( 95 % CI : 0.2 to 1.2 ) more on vegetables , and $ 1.2 ( 95 % CI : − 1.8 to − 0.6 ) less on meat , and $ 1.1 ( 95 % CI : − 2.0 to − 0.3 ) less on prepared foods than shoppers who did not reside in those neighborhoods . Conclusions When given geographical access to healthy food , people living in disadvantaged former food desert neighborhoods will take advantage of that access 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 The prevalence of obesity is significantly higher among American Indians ( AIs ) and is associated with increased rates of diabetes , hypertension , and cardiovascular disease . We implemented a 14-mo intervention trial ( Navajo Healthy Stores )  on the Navajo Nation that sought to increase availability of healthier foods in local food stores and to promote these foods at the point of purchase and through community media . We divided the Navajo Nation into 10 store regions , half of which were r and omized to intervention and half to 
    Output:
    
The retail food environment intervention literature continues to grow and has become more robust overall , with clearer evidence of the effect of interventions on diet-related outcomes , including consumer purchasing , dietary intakes , and health .