<h3>Background</h3> USDA allows SNAP participants in select states to purchase groceries online. As grocery sales migrate online, marketing may also migrate, influencing shoppers' purchases. <h3>Objective</h3> To identify marketing strategies that online retailers employ, and assess the healthfulness of groceries they promote. <h3>Study Design, Setting, Partiicpants</h3> We assessed the promotional, pricing, placement, and delivery practices of 6 retailers in the Washington, DC area between February and April 2019. Promotions: On retailers' home and 5 search results pages, we recorded promotions for food and beverages. One month later, we recorded emails with food and beverage promotions. After ordering, we also noted targeted promotions on the homepage linked to previous purchases or address. For each, we saved a screenshot, noting whether the product was produce, a sugar-sweetened beverage, or a salty/sweet snack. Price: We collected base and price promotion data for unhealthy and healthy market baskets using USDA's Foods Typically Purchased by SNAP Households. Placement: From the same USDA resource, we developed a list of staple items with healthy and less-healthy versions. We recorded top search results for these items, saving a screenshot to later analyze the placement of healthy items. Delivery: We adapted the SNAP-Ed Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention (CX3) Toolkit to assess quality of produce delivered. <h3>Measurable Outcome/Analysis</h3> Promotions: We assessed nutritional quality of homepage, search page, email, and targeted promotions using the National Alliance for Nutrition and Activity Vending Standards. Price: We calculated the percentage discount for healthy products and compared to the discount for unhealthy products. Placement: We assessed the nutritional quality of products featured prominently in search results. Delivery: We used the CX3 Toolkit to assess produce firmness, freshness, and color. <h3>Results</h3> A majority of homepage, search page, email, and targeted promotions were unhealthy. Price data is inconclusive. A majority of items featured prominently in search results for staple foods were unhealthy. Produce quality was typically good. <h3>Conclusions</h3> Retailers should promote, competitively price, and prominently place healthy items online.
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