Packaged Food Purchases Research Articles

Trends (2014-2018) in the healthiness of packaged food purchases of Australian consumers before and after the introduction of voluntary Health Star Rating nutrition labels.

To evaluate the trends in the healthiness of packaged food purchases of Australian consumers before and after the introduction of the Health Star Rating (HSR) nutrition labels. Panel data analysis and difference-in-differences analysis. The Australian Government endorsed HSR nutrition labels for voluntary implementation on packaged foods in June 2014. We analyse the packaged food purchases of households across all major supermarkets before (January 2014 to June 2014) and after (June 2014-Dec 2018) the introduction of HSR. 6284 members of a panel of households across Australia reporting their grocery purchases to a market research company (Nielsen Homescan panel). The healthiness of household food purchases exhibited a U-shaped trend - decreasing from 2014 to 2017, and then increasing from 2018, corresponding to the time when a higher proportion of products were HSR-labelled. Households that purchased a higher proportion of HSR-labelled products had healthier household purchases overall. Further, the healthiness of households' category-specific food purchases was positively associated with the proportion of HSR-labelled products in categories where HSR was adopted, relative to control categories where HSR was not adopted. In Australia, once a substantial number of packaged food products adopted the voluntary HSR summary indicator, we observed an increasing trend in the healthiness of household food purchases. Widespread adoption of a nutrition summary indicator, such as HSR, on packaged food is likely to be beneficial for population health.

Whole Grain and Refined Grains: An Examination of US Household Grocery Store Purchases

BackgroundThe health benefits related to intake of whole grain foods are well established. Consumption of whole grains in the US population is low, and whole grain content can vary greatly depending upon the specific products that are purchased. ObjectivesTo examine the proportion of products purchased by US households containing whole grain and refined grain ingredients using time-specific food composition data, and examine whether purchases differ between income, race or ethnicity, and household make-up. MethodsNationally representative Nielsen Homescan 2018 data were used. Each barcoded product captured in Nielsen Homescan 2018 was linked with ingredient information using commercial nutrition databases in a time-relevant manner. Packaged food products containing whole grain ingredients, refined grain ingredients, neither, or both were identified. The percentage of packaged food products containing whole grain and refined grain ingredients purchased by US households was determined overall, by demographic subgroup, and by food category. ResultsThe proportion of packaged food purchases containing refined grain ingredients was significantly higher than whole grain ingredients (30.9% compared with 7.9%; P < 0.0001). Lower income households and households with children purchased a significantly higher proportion of products containing refined grain ingredients, with no nutritionally meaningful racial or ethnic differences observed. Concerningly, across all demographic subgroups >90% of bread purchases contained refined grain ingredients, and the 5 categories with the largest proportion of whole grain ingredients contributed to <20% of overall US household packaged food purchases. ConclusionsUS households are purchasing a significantly higher proportion of packaged food products containing refined grain ingredients than whole grain ingredients. Future policy changes are needed to provide incentives and information (e.g., front-of-pack labels) to aid in encouraging manufacturers to increase whole grain product offerings while decreasing refined grain offerings, and to encourage consumers to substitute away from refined grain products toward whole grain products.

Associations Among Select State Policies and the Nutritional Quality of Household Packaged Food Purchases in the United States from 2008 Through 2017

BackgroundPolicy interventions are important public health tools because they can reach large numbers of people. State context has been associated with health outcomes, yet few studies have examined the extent to which state-level policies are associated with dietary quality. ObjectivesThe objective of this study was to evaluate whether state policies are associated with the nutritional quality of household packaged food purchases. DesignThis observational study used data from Nielsen Homescan, an open-cohort household panel where participants track purchases, and a combination of state-level food and social safety net policy variables from 2008 through 2017. Participants and settingThis study included 615,634 household-year observations in the United States from 2008 through 2017. Household-year observations were excluded in the case that a household did not make a minimum number of purchases and in the case that they had incorrect geographic information. The final analytic sample was 611,719 household-years. Main outcome measuresStudy outcomes included a set of nutrition-related measures of public health interest, including nutrients of concern (eg, sugar, saturated fat, and sodium) and calories from specific food groups (eg, fruits, nonstarchy vegetables, processed meats, mixed dishes, sugar-sweetened beverages, and desserts and snacks). Statistical analysisThis study used multilevel generalized linear models with state fixed effects on three samples: all households, only households with low income, and only households with low educational attainment. ResultsFew significant associations were found between healthy food retail policies and the nutritional quality of purchases, and mixed associations were found between social safety net policies and lower or higher quality packaged food purchases. ConclusionsLittle evidence was found that state policy context in 2008 through 2017 was associated with the quality of packaged food purchases. However, variation in state policies is increasing over time, warranting future research into the relationship between these policies, the quality of packaged food purchases, and the rest of the diet.

Geographic patterns and socioeconomic differences in the nutritional quality of household packaged food purchases in the United States

It is unclear whether dietary quality varies by geography in the US. Assess patterns in packaged food purchases (PFPs). We characterized variation in PFP quality from 2008 to 2018 by 1) examining geographic clustering and 2) using regression analysis to control for household characteristics. Lower quality purchases clustered in the Southeast and Appalachia, whereas higher quality purchases clustered in the West and Northeast. Spatial patterns were similar for low socioeconomic households but not high socioeconomic households. Geographic differences in quality remained after controlling for demographic composition. This analysis should inform research into systemic drivers of PFP quality.

Socio-economic and racial/ethnic disparities in the nutritional quality of packaged food purchases in the USA, 2008-2018.

To determine whether disparities exist in the nutritional quality of packaged foods and beverage purchases by household income, education and race/ethnicity and if they changed over time. We used Nielsen Homescan, a nationally representative household panel, from 2008 to 2018 (n = 672 821 household-year observations). Multivariate, multilevel regressions were used to model the association between sociodemographic groups and a set of nutritional outcomes of public health interest, including nutrients of concern (sugar, saturated fat and Na) and calories from specific food groups (fruits, non-starchy vegetables, processed meats, sugar-sweetened beverages and junk foods). Household panel survey. Approximately 60 000 households each year from the USA. Disparities were found by income and education for most outcomes and widened for purchases of fruits, vegetables and the percentage of calories from sugar between 2008 and 2018. The magnitude of disparities was largest by education. Disparities between Black and White households include the consumption of processed meats and the percentage of calories from sugar, while no disparities were found between White and Hispanic households. Disparities have been largely persistent, as any significant changes over time have been substantively small. Policies to improve the healthfulness of packaged foods must be expanded beyond SSB taxes, and future research should focus on what mediates the relationship between education and diet so as not to exacerbate disparities.

Urban vs. Rural Socioeconomic Differences in the Nutritional Quality of Household Packaged Food Purchases by Store Type.

The U.S. food system is rapidly changing, including the growth of mass merchandisers and dollar stores, which may impact the quality of packaged food purchases (PFPs). Furthermore, diet-related disparities exist by socioeconomic status (SES) and rural residence. We use data from the 2010–2018 Nielsen Homescan Panel to describe the nutritional profiles of PFPs by store type and to assess whether these vary by household urbanicity and SES. Store types include grocery stores, mass merchandisers, club stores, online shopping, dollar stores, and convenience/drug stores. Food and beverage groups contributing the most calories at each store type are estimated using survey-weighted means, while the associations of urbanicity and SES with nutritional quality are estimated using multivariate regression. We find that households that are customers at particular store types purchase the same quality of food regardless of urbanicity or SES. However, we find differences in the quality of foods between store types and that the quantity of calories purchased at each store type varies according to household urbanicity and SES. Rural shoppers tend to shop more at mass merchandisers and dollar stores with less healthful PFPs. We discuss implications for the types of store interventions most relevant for improving the quality of PFPs.

Convenience Store Contribution to Adults’ Dietary Intake - What We Eat In America, NHANES, 2013–2016

Abstract Objectives Convenience stores account for a small but growing percentage of household packaged food purchases. This research describes the contribution of convenience stores to U.S. adult food and beverage consumption and energy intake. Methods The study included nationally representative data from 9861 adults, 20+ years old (excluding pregnant/lactating women), participating in What We Eat in America, National Health and Nutrition Examination Survey 2013–2016. Dietary intake data, obtained from an in-person 24-hour recall, were collected using an interviewer-administered 5-step USDA Automated Multiple-Pass Method. For each food/beverage reported, participants were asked name of eating occasion, self-selected from a fixed list, and source where the item was obtained. Meal occasions included breakfast, lunch (includes brunch), and dinner (includes supper). Snack occasions included snack, drink, and extended consumption. Eating occasions of only plain water were excluded from analysis. Convenience store source included convenience-type store (e.g., 7–11, Circle K), dollar store, drug store, gas station, gift shop, and liquor/beer store. Differences were considered significant at P &amp;lt; 0.01. Results Overall, 26% of adults consumed a food or beverage obtained from a convenience store on any given day. Males, older adults (&amp;lt;60 years), and low income individuals (family income &amp;lt;131% of poverty level) were more likely to consume a food or beverage from a convenience store. Comparisons among race/ethnicity groups illustrated a greater percentage of non-Hispanic blacks (36%) and a lower percentage of non-Hispanic Asians (13%) consumed an item from a convenience store. Among consumers of food/beverages from convenience stores, 20% of daily energy intake came from convenience store items, with the majority of energy from these items consumed during snack occasions. Conclusions One in four adults obtained at least one food or beverage from a convenience store on any given day, with convenience store consumers having a different demographic profile than non-consumers. This highlights the importance of convenience stores to U.S. dietary intake and need for further research on socio-demographic differences. Funding Sources United States Department of Agriculture, Agricultural Research Service.

Nutritional Profile of Purchases by Store Type: Disparities by Income and Food Program Participation

Policymakers have focused on the food retail environment for improving the dietary quality for Supplemental Nutrition Assistance Program (SNAP) participants. Yet little is known about where SNAP households make food and beverage purchases or how purchases may vary by store type, SNAP participation, and income level. The objective of this study was to examine the association between SNAP-income status (participant, income-eligible non-participant, higher-income non-participant) and healthfulness of household purchases across store types. Data included household packaged food purchases (N=76,458 unique households) from 2010 to 2014, analyzed in 2017 with multivariable adjusted models to examine the nutritional profile of purchases by store type (grocery, convenience, big box, and other stores) for SNAP participating households, income-eligible non-participants, and higher-income non-participants. Outcomes included volume and nutrients (kilocalories, total sugar, saturated fat, and sodium) and calories from food groups. All households purchased the greatest volume of foods and beverages from grocery stores, followed by big-box and other stores, with relatively little purchased from convenience stores. The largest differences between SNAP participants and non-participants were observed at grocery stores and big-box stores, where SNAP households purchased more calories from starchy vegetables, processed meat, desserts, sweeteners and toppings, total junk food, sugar-sweetened beverages, and milk, than income-eligible and higher-income SNAP non-participants. SNAP purchases also had considerably higher sodium density. Across store types, the nutritional profile of income-eligible non-participants' purchases was similar to higher-income households' purchases. More research is needed to identify strategies to improve the nutritional profile of purchases among SNAP households.

The Club Store Effect: Impact of Shopping in Warehouse Club Stores on Consumers' Packaged Food Purchases

This article studies the impact of shopping at the warehouse club format on households' purchases of packaged food for the home. In addition to low prices, this format has several unique characteristics that can influence packaged food purchases. The empirical analysis uses a combination of households' longitudinal grocery purchase information, rich survey data, and detailed item-level nutrition information. After accounting for selection on observables and unobservables, the authors find a substantial increase in the total quantity (servings per capita) of packaged food purchases attributable to shopping at this format. Because there is no effect on the nutritional quality of purchases, this translates into a substantial increase in calories, sugar, and saturated fat per capita. The increase comes primarily from storable and impulse foods, and it is drawn equally from foods that have positive and negative health halos. The results have important implications for how marketers can create win–win opportunities for themselves and for consumers.

Federal Nutrition Program Revisions Impact Low-income Households’ Food Purchases

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) required major revisions to food packages in 2009; effects on nationwide low-income household purchases remain unexamined. This study examines associations between WIC revisions and nutritional profiles of packaged food purchases from 2008 to 2014 among 4,537 low-income households with preschoolers in the U.S. (WIC participating versus nonparticipating) utilizing Nielsen Homescan Consumer Panel data. Overall nutrients purchased (e.g., calories, sugar, fat), amounts of select food groups with nutritional attributes that are encouraged (e.g., whole grains, fruits and vegetables) or discouraged (e.g., sugar-sweetened beverages, candy) consistent with dietary guidance, composition of purchases by degree of processing (less, moderate, or high), and convenience (requires preparation, ready to heat, or ready to eat) were measured. Data analysis was performed in 2016. Longitudinal random-effects model adjusted outcomes controlling for household composition, education, race/ethnicity of the head of the household, county quarterly unemployment rates, and seasonality are presented. Among WIC households, significant decreases in purchases of calories (-11%), sodium (-12%), total fat (-10%), and sugar (-15%) occurred, alongside decreases in purchases of refined grains, grain-based desserts, higher-fat milks, and sugar-sweetened beverages, and increases in purchases of fruits/vegetables with no added sugar/fats/salt. Income-eligible nonparticipating households had similar, but less pronounced, reductions. Changes were gradual and increased over time. WIC food package revisions appear associated with improved nutritional profiles of food purchases among WIC participating households compared with low-income nonparticipating households. These package revisions may encourage WIC families to make healthier choices among their overall packaged food purchases.

Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases-A Randomised Controlled Trial.

Background: Front-of-pack nutrition labelling may support healthier packaged food purchases. Australia has adopted a novel Health Star Rating (HSR) system, but the legitimacy of this choice is unknown. Objective: To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions. Design: Individuals were assigned at random to access one of four different formats of nutrition labelling—HSR, multiple traffic light labels (MTL), daily intake guides (DIG), recommendations/warnings (WARN)—or control (the nutrition information panel, NIP). Participants accessed nutrition information by using a smartphone application to scan the bar-codes of packaged foods, while shopping. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks. Results: The 1578 participants, mean age 38 years, 84% female recorded purchases of 148,727 evaluable food items. The mean healthiness of the purchases in the HSR group was non-inferior to MTL, DIG, or WARN (all p < 0.001 at 2% non-inferiority margin). When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all p > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; p = 0.04). HSR was perceived by participants as more useful than DIG, and easier to understand than MTL or DIG (all p < 0.05). Participants also reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all p < 0.03). Conclusions: These real-world data align with experimental findings and provide support for the policy choice of HSR. Recommendation/warning labels warrant further exploration, as they may be a stronger driver of healthy food purchases.

Does the country of origin of a halal logo matter? The case of packaged food purchases

PurposeThis paper aims to model consumers’ decision to use halal logo on packaged food products. The model primarily tests the importance of country of origin (COO) of a halal logo as an indicator for assessing credibility of a halal logo, and its relevance in consumers’ decision to use the logo in packaged food purchase.Design/methodology/approachA data set from a survey of 559 respondents from two countries was used to test eight hypotheses that were developed based on a modified theory of planned behaviour framework, using partial least squares procedures.FindingsHalal certification logo was found to have COO effect on consumers’ evaluation during purchase decision of food items. Consumer uses information on the COO of a halal logo to assess the logo’s credibility in delivering the halal food standard. The construct, along with the constructs of religiosity and its interaction terms, subjective norms and attitude, explains consumers’ intention to consider the halal logo during packaged food purchase.Research limitations/implicationsGeneralization of the findings is limited to the packaged food industry and to the consumer groups surveyed in the two countries.Practical implicationsThere is a need for marketers to recognize Muslim consumers’ sensitivity towards the origin of a halal logo in choosing the right logo for their products. Logo certifiers may want to consider adopting marketing strategies to market their certification as a credible marker of a halal food standard.Originality/valueThe effect of COO of halal logo and its influence on consumers’ decision to use the logo in purchase decision are new to the literature.

Deal or no deal? The prevalence and nutritional quality of price promotions among U.S. food and beverage purchases

ObjectiveThis study examines trends in the prevalence of price promotions among packaged food and beverage purchases, differences in prevalence by household race/ethnicity or income, and the association between price promotions and the nutritional profile of purchases. DesignThis cross-sectional study utilizes a dataset of 90 million purchases from 38,744 (2008) to 45,042 (2012) US households in 2008–2012. Chi-square tests were used to examine whether the proportion of purchases with price promotions changed over time or differed by household race/ethnicity or income. T-tests were used to compare purchased products’ nutritional profiles. ResultsPrevalence of price promotions among packaged food and beverage purchases increased by 8% and 6%, respectively, from 2008 to 2012, with both reaching 34% by 2012. Higher-income households had greater proportions of purchases with price promotions than lower-income households. Asian households had the highest proportion of purchases with any price promotion, followed by non-Hispanic whites. While total price-promoted packaged food purchases had higher mean energy, total sugar, and saturated fat densities than purchases with no price promotions, absolute differences were small. ConclusionsPrevalence of price promotions among US household purchases increased from 2008 to 2012 and was greater for higher-income households. No clear associations emerged between presence of price promotions and nutritional quality of purchases.

A salt-reduction smartphone app supports lower-salt food purchases for people with cardiovascular disease: Findings from the SaltSwitch randomised controlled trial.

Background SaltSwitch is an innovative smartphone application (app) that enables shoppers to scan the barcode of a packaged food and receive an immediate, interpretive, traffic light nutrition label on the screen, along with suggestions for lower salt alternatives. Our aim was to determine the effectiveness of SaltSwitch to support people with cardiovascular disease to make lower salt food choices. Design Six-week, two-arm, parallel, randomised controlled trial in Auckland, New Zealand (2 weeks baseline and 4 weeks intervention). Methods Sixty-six adults with diagnosed cardiovascular disease (mean (SD) age 64 (7) years) were randomly assigned in a 1:1 ratio to either the SaltSwitch smartphone app or control (usual care). The primary outcome was the salt content of household packaged food purchases during the 4-week intervention (g/MJ). Secondary outcomes were the saturated fat content (g/MJ), energy content (kJ/kg) and expenditure (NZ$) of household food purchases; systolic blood pressure (mmHg), urinary sodium (mg) and use and acceptability of the SaltSwitch app. Results Thirty-three participants with cardiovascular disease were allocated to the SaltSwitch intervention, and 33 to the control group. A significant reduction in mean household purchases of salt was observed (mean difference (95% confidence interval), -0.30 (-0.58 to -0.03) g/MJ), equating to a reduction of ∼0.7 g of salt per person per day during the 4-week intervention phase. There were no significant between-group differences in any secondary outcomes (all P > 0.05). Conclusions The SaltSwitch smartphone app is effective in supporting people with cardiovascular disease to make lower salt food purchases. A larger trial with longer follow-up is warranted to determine the effects on blood pressure. Trial registration Australian New Zealand Clinical Trials Registry https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365784&isReview=true ACTRN12614000206628.

Sodium Reduction in US Households’ Packaged Food and Beverage Purchases, 2000 to 2014

Initiatives to reduce sodium in packaged foods have been launched in the United States, yet corresponding changes in the amount of sodium that US households obtain from packaged foods have not been evaluated, to our knowledge. To assess 15-year changes in the amount of sodium that US households acquire from packaged food purchases, the sodium content of purchases, and the proportion of households that have purchases with optimal sodium density. Longitudinal study of US households in the 2000 to 2014 Nielsen Homescan Consumer Panel, a population-based sample of households that used barcode scanners to record all packaged foods purchased throughout the year. Time-varying brand- and product-specific nutrition information was used for 1 490 141 products. Sociodemographic-adjusted changes in mean sodium per capita (mg/d) and sodium content (mg/100 g), overall and for top food group sources of sodium, and the proportion of households that have total purchases with sodium density of 1.1 mg/kcal or less. In a nationwide sample of 172 042 US households (754 608 year-level observations), the amount of sodium that households acquired from packaged food and beverage purchases decreased significantly between 2000 and 2014 by 396 mg/d (95% CI, -407 to -385 mg/d) per capita. The sodium content of households' packaged food purchases decreased significantly during this 15-year period by 49 mg/100 g (95% CI, -50 to -48 mg/100 g), a 12.0% decline; decreases began in 2005 and continued through 2014. Moreover, the sodium content of households' purchases decreased significantly for all top food sources of sodium between 2000 and 2014, including declines of more than 100 mg/100 g for condiments, sauces, and dips (-114 mg/100 g; 95% CI, -117 to -111 mg/100 g) and salty snacks (-142 mg/100 g; 95% CI, -144 to -141 mg/100 g). However, in all years, less than 2% of US households had packaged food and beverage purchases with sodium density of 1.1 mg/kcal or less. In this nationwide study, significant reductions in sodium from packaged food purchases were achieved in the past 15 years. Nonetheless, most US households had food and beverage purchases with excessive sodium density. Findings suggest that more concerted sodium reduction efforts are needed in the United States.

Effects of interpretive nutrition labels on consumer food purchases: the Starlight randomized controlled trial ,

Background: Nutrition labeling is a prominent policy to promote healthy eating.Objective: We aimed to evaluate the effects of 2 interpretive nutrition labels compared with a noninterpretive label on consumer food purchases.Design: In this parallel-group randomized controlled trial, we enrolled household shoppers across New Zealand who owned smartphones and were aged ≥18 y. Eligible participants were randomly 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 Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC).Results: Between October 2014 and November 2015, 1357 eligible shoppers were randomly 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: −2.97, −0.43; P = 0.01)]. Shoppers who were randomly assigned to HSR and TLL also found the labels significantly more useful and easy to understand than the NIP (all P values <0.001).Conclusions: At the relatively low level of use observed in this trial, interpretive nutrition labels had no significant effect on food purchases. However, shoppers who used interpretive labels found them to be significantly more useful and easy to understand, and compared with frequent NIP users, frequent TLL and HSR users had significantly healthier food purchases. This trial was registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366446&isReview=true) as ACTRN12614000644662.

First-Year Evaluation of Mexico’s Tax on Nonessential Energy-Dense Foods: An Observational Study

BackgroundIn an effort to prevent continued increases in obesity and diabetes, in January 2014, the Mexican government implemented an 8% tax on nonessential foods with energy density ≥275 kcal/100 g and a peso-per-liter tax on sugar-sweetened beverages (SSBs). Limited rigorous evaluations of food taxes exist worldwide. The objective of this study was to examine changes in volume of taxed and untaxed packaged food purchases in response to these taxes in the entire sample and stratified by socioeconomic status (SES).Methods and FindingsThis study uses data on household packaged food purchases representative of the Mexican urban population from The Nielsen Company’s Mexico Consumer Panel Services (CPS). We included 6,248 households that participated in the Nielsen CPS in at least 2 mo during 2012–2014; average household follow-up was 32.7 mo. We analyzed the volume of purchases of taxed and untaxed foods from January 2012 to December 2014, using a longitudinal, fixed-effects model that adjusted for preexisting trends to test whether the observed post-tax trend was significantly different from the one expected based on the pre-tax trend. We controlled for household characteristics and contextual factors like minimum salary and unemployment rate. The mean volume of purchases of taxed foods in 2014 changed by -25 g (95% confidence interval = -46, -11) per capita per month, or a 5.1% change beyond what would have been expected based on pre-tax (2012–2013) trends, with no corresponding change in purchases of untaxed foods. Low SES households purchased on average 10.2% less taxed foods than expected (-44 [–72, –16] g per capita per month); medium SES households purchased 5.8% less taxed foods than expected (-28 [–46, –11] g per capita per month), whereas high SES households’ purchases did not change. The main limitations of our findings are the inability to infer causality because the taxes were implemented at the national level (lack of control group), our sample is only representative of urban areas, we only have 2 y of data prior to the tax, and, as with any consumer panel survey, we did not capture all foods purchased by the household.ConclusionsHousehold purchases of nonessential energy-dense foods declined in the first year after the implementation of Mexico’s SSB and nonessential foods taxes. Future studies should evaluate the impact of the taxes on overall energy intake, dietary quality, and food purchase patterns (see S1 in Spanish).

Where people shop is not associated with the nutrient quality of packaged foods for any racial-ethnic group in the United States

In the literature, it has been suggested that there are race-ethnic disparities in what Americans eat. In addition, some studies have shown that residents of African American and low-income neighborhoods have less access to grocery stores and supermarkets, which tend to stock healthier foods. However, it is unclear whether differences in food shopping patterns contribute to the poorer nutrient profile of food purchases made by racial-ethnic minorities. We examined whether the mix of food stores where people shop (i.e., food-shopping patterns) was associated with the nutrient profile of packaged food purchases (PFPs) and the types of foods and beverages purchased, and we determined whether these associations differ across racial-ethnic groups. We used PFPs by US households (Nielsen National Consumer Panel) from 2007 to 2012 and implemented a cluster analysis to categorize households according to their food-shopping patterns. Longitudinal random-effects linear regression models were used to examine the association between food shopping patterns and the nutrient qualities and types of packaged foods and beverages purchased by race-ethnicity in US households. Shopping primarily at grocery chains was not associated with a better nutrient profile of household PFPs or the food and beverages that households purchased than was shopping primarily at mass merchandisers (value-oriented stores that sell merchandise lines in multiple departments) or at a combination of large and small stores. These results were consistent across racial-ethnic groups. Regardless of where households shopped, non-Hispanic African American households purchased foods with higher energy, total sugar, and sodium densities than did non-Hispanic white and Hispanic households. Policy initiatives that focus on increasing physical access to stores or helping stores sell healthier products to encourage healthier purchases may be ineffective because other factors may be more important determinants of food and beverage purchases than where people shop or what is available in the store.

Walmart and Other Food Retail Chains: Trends and Disparities in the Nutritional Profile of Packaged Food Purchases.

Proliferation of food retail chains has created an environment in which a few food retailers account for the majority of U.S. packaged food purchases (PFPs). Despite the major potential for these food retail chains (FRCs) to impact what U.S. consumers buy and eat, little is known about the nutritional profile of PFPs from these retailers, particularly PFPs from Walmart, the largest U.S. grocer. A data set of household PFPs from Nielsen Homescan was linked to data from the Nutrition Facts Panel (N=164,315), analyzed in 2014. Fixed effects models and inverse probability weights accounting for selectivity of shopping at a retailer were used to examine shifts in nutrient densities and key food groups purchased at Walmart and other FRCs from 2000 to 2013, and whether these changes differed for low-income or racial/ethnic-minority households. There were substantial declines in energy (-73 kcal/100 g); total sugar (-8 g/100 g); and sodium density (-33 mg/100 g) of Walmart PFPs, coupled with decreases in percentage volume purchased from sweets (-11%); grain-based desserts (-2%); and savory snacks (-3%) and increases in fruits (+3%) and vegetables (+1%). PFPs from other FRCs had a more favorable nutritional profile than Walmart PFPs in 2000, but demonstrated smaller shifts over time. Disparities in the nutritional profile of Walmart PFPs by race/ethnicity but not by income level shrank over time. The nutritional profile of Walmart purchases has improved over time and in 2013 was similar to PFPs from other FRCs.

Global growth of "big box" stores and the potential impact on human health and nutrition.

Despite a large body of literature on the food environment, little is known about the role of supercenters in human nutrition and health. The objectives of this review are to examine what is currently known about the association between supercenters, nutrition, and obesity, to identify how supercenters may affect disparities in food access and nutritional quality of food purchases, and to document the rapid rise of supercenters as a source of food purchases in the United States. A case study of Wal-Mart, the largest food retailer in the United States, is presented that demonstrates the major and increasing role of supercenters as a source of packaged food purchases in the United States, particularly among low-income households, as well as the role of supercenters in supplying key nutrients. Taken together, this review and case study highlight the dominant role of supercenters in the US diet and the need to better understand how supercenters can be leveraged to improve the nutritional quality of what consumers buy and eat.