Shopper marketing nutrition interventions.

PHB-10359; No of Pages 10 Physiology & Behavior xxx (2014) xxx–xxx

Contents lists available at ScienceDirect

Physiology & Behavior journal homepage: www.elsevier.com/locate/phb

Shopper marketing nutrition interventions Collin R. Payne a,⁎, Mihai Niculescu a, David R. Just b, Michael P. Kelly c a b c

New Mexico State University, United States Cornell University, United States Paso del Norte Health Foundation, United States

H I G H L I G H T S • • • • •

We introduce the concept of Shopper Marketing Nutrition Interventions. We provide a conceptual framework for targeting unplanned purchases to increase shopper nutrition. Shopper Marketing Nutrition Interventions can increase healthier purchases ceteris paribus. Shopper Marketing Nutrition Interventions can increase retail profit without increasing shopper budgets. We describe measurement tools to implement Shopper Marketing Nutrition Interventions.

a r t i c l e

i n f o

Article history: Received 1 December 2013 Received in revised form 24 February 2014 Accepted 29 March 2014 Available online xxxx Keywords: Shopper marketing Behavioral economics Grocery store Nutrition interventions Fruit and vegetable purchases Social norms

a b s t r a c t Grocery stores represent a context in which a majority of people's food purchases occur. Considering the nutrition quality of the population's food intake has dramatically decreased, understanding how to improve food choice in the grocery store is paramount to healthier living. In this work, we detail the type of financial resources from which shoppers could draw (i.e., personal income and benefits from government food assistance programs to low income populations) and explain how these financial resources are allocated in the grocery store (i.e., planned, unplanned, error). Subsequently, we identify a conceptual framework for shopper marketing nutrition interventions that targets unplanned fruit and vegetable purchases (i.e., slack, or willingness to spend minus list items). Targeting slack for fresh fruit and vegetable purchases allows retailers to benefit economically (i.e., fruit and vegetables are higher margin) and allows shoppers to improve their nutrition without increasing their budgets (i.e., budget neutrality). We also provide preliminary evidence of what in-store marketing of fresh fruits and vegetables could entail by modifying grocery carts and grocery floors to provide information of what is common, normal, or appropriate fruit and vegetable purchases. In each example, fresh fruit and vegetable purchases increased and evidence suggested shopper budget neutrality. To provide context for these results, we detail measurement tools that can be used to measure shopper behaviors, purchases, and consumption patterns. Finally, we address theoretical, practical, and policy implications of shopper marketing nutrition interventions. © 2014 Elsevier Inc. All rights reserved.

1. Introduction Grocery retailers find themselves in a precarious public health position. Prevalence of adult overweight and obesity has increased and remains well above (e.g., 69.2%) national targets [10]. Many have blamed the food industry. With over half of all food purchases occurring in grocery stores [78], grocery retailers are facing mounting public pressure to address the issue. In response (and to their credit), grocery retailers have hired corporate nutritionists to educate shoppers [26,69], deployed nutritional profiling on their products (e.g., Guiding Stars and NuVal) [19,39,76], changed their product offerings to include healthier ⁎ Corresponding author at: New Mexico State University, Box 30001, Dept. 5280, Las Cruces, NM 88003-8001, United States. Tel.: +1 575 646 6693. E-mail address: [email protected] (C.R. Payne).

foods, reduced produce prices, and committed to building stores in food deserts [1,21,53,71]. Yet, despite these multifaceted efforts there is little evidence to suggest population improvement in one of the key indicators identified by the United States' Institute of Medicine for evaluating obesity and overweight prevention efforts—the purchase and consumption of fruits and vegetables, which also has health benefits beyond those of weight control [9,25,34]. One reason why fruit and vegetable purchase and consumption may remain relatively low is because current grocery store nutrition interventions do not consider powerful applications of in-store marketing [37,58]. In this work, we explore the possibility of using in-store marketing to target fruit and vegetable purchases that may not only benefit economic concerns of retailers, but also economic and nutritional concerns of shoppers. Previous research documents the probability of unplanned purchases in grocery stores as very high (e.g., 42% to 93%) [35,74,75].

http://dx.doi.org/10.1016/j.physbeh.2014.03.029 0031-9384/© 2014 Elsevier Inc. All rights reserved.

Please cite this article as: Payne CR, et al, Shopper marketing nutrition interventions, Physiol Behav (2014), http://dx.doi.org/10.1016/ j.physbeh.2014.03.029

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C.R. Payne et al. / Physiology & Behavior xxx (2014) xxx–xxx

These unplanned purchases have been shown to be highly influenced by in-store marketing [31,33]. In-store marketing is arguably the largest component of manufacturer and retailers' toolbox of what is now called shopper marketing—or engaging consumers in “shopper mode” throughout the entire path to purchase (i.e., at home, on-the-go, inthe-store) through easy to use rules-of-thumb to help consumers know what and how much to purchase [24]. So efficacious is shopper marketing that it represents the fastest growing sector of manufacturer and retail marketing programs resulting in their business' increased economic sustainability [54,72]. Despite success of shopper marketing providing for retailers' economic sustainability, to our knowledge, research on shopper marketing has not addressed nutritional needs of the shopper. Consequently, we introduce a framework for understanding how grocery store nutrition interventions can become a consistent component of shopper marketing that can benefit not only economic sustainability of retailers, but also shoppers' nutritional needs. Specifically, we focus on in-store promotion of fruits and vegetables based on social messages of what are common, normal, and appropriate amounts and types to purchase. Interestingly, fruits and vegetables—one of the highest margin (i.e., 33.2%) [51], and highly perishable product categories [38]—represent 10% of all grocery store sales and 16% of overall store profits [20,40,50]. Shopper marketing innovation in this product category could spur increased profit margins for grocery stores and increased shopper purchase and consumption of fruits and vegetables— with the intent of keeping constant shoppers' budgets. The remaining work is as follows. First, we provide a conceptual framework for examining grocery store nutrition interventions as a potential tool of shopper marketing. We then provide specific examples of shopper marketing innovations (e.g., the grocery cart and grocery floor) that suggest evidence of retail economic sustainability and meet shopper economic and nutritional needs. Finally, we attempt to advance a field research domain regarding nutrition interventions as a potential tool for shopper marketing by leveraging existing measurement tools to understand shopper behavior, shopper purchase, and shopper consumption.

The right hand side of the equation details expense categories to which available resources are allocated—i.e., planned and unplanned purchases [74]. We also include an error component that accounts for human (e.g., computational errors) and systematic (e.g., government program inefficiencies; measurement errors) limitations. We assume that individuals with budget constraints will generally try to balance resources and expenses during shopping—that is, shop within a budget [27,57,75]. We briefly review the input–output equation and emphasize unplanned purchasing, which is a target of any shopper marketing nutrition intervention. 2.1. Customer financial resources On the left side of the input–output equation in Fig. 1, there are three financial resources that generally fall on a continuum of constraints. The least constrained source is personal income. That is, personal income can be used to purchase any item in the grocery store. More constrained resources come from governmental food assistance programs such as SNAP and WIC. For example, SNAP benefits can be used to purchase anything in the grocery store except hot foods, foods that can be eaten in the store, or non-food items. Shoppers (46.6 million participants funded at $78.4 billion in 2012) qualify for SNAP based on resource and income requirements [79]. The most constrained financial resource comes from WIC, which can only be used to purchase foods from specific categories (e.g., fruits and vegetables, cereal, juice, milk, eggs, cheese, whole-grain bread and other whole-grain foods, legumes, fish). Shoppers (8.9 million women and children participants funded at $6.6 billion in 2011) qualify for WIC based on economic and nutritional need [22, 80]. Understanding financial resources derived from government food assistance programs, such as SNAP and WIC, is important because of the specific shopper population affected. That is, low income shoppers and their children, who represent some of the highest rates of obesity, overweight, and health disparities and lowest rates of fruit and vegetable consumption [55], are likely to not only purchase with personal income, but also from government food assistance programs. 2.2. Grocery store expenses

2. Background Consider the input–output equation presented in Fig. 1. The left hand side of the equation captures the resources shoppers have available for a generic grocery shopping trip—these resources include personal income and benefits from government food assistance programs to lower income populations. For purposes of exposition, we consider benefits derived from the United States' Women Infants and Children program (WIC) and Supplemental Nutrition Assistance Program (SNAP) though similar programs exist in the UK, Brazil, Jamaica, Sri Lanka, Honduras, and Mexico.

The right side of the equation in Fig. 1 proposes that financial resources during shopping can be allocated to different expense categories: planned and unplanned. Planned purchases—mainly characterized by shopping lists (mental, paper, or electronic)—rely on cognitive effort that precedes the shopping trip. Hence, in-store food selection resulting from planned purchasing is deliberative, multi-stage (i.e., preactional and actional), systematic, and committed [7,15]. Because of these planned purchasing characteristics, attempting to change in-store shopping behaviors is very difficult [77]. Interestingly, many nutrition interventions assume that all purchases are planned. Consequently, these interventions attempt to appeal to shoppers' deliberative thought by

Grocery Store Expenditures

Financial Resources

Personal Income

+

WIC benefits

+

SNAP benefits

=

Planned purchases

+

Unplanned purchases

+

Error

IN-STORE SLACK

Fig. 1. Input–output equation.



providing nutrition education, nutrition profiling, or nutrition information assuming individuals will internalize healthier behaviors and act accordingly. Unfortunately, these types of nutrition interventions have been met with limited success [37,58,71]. In contrast to planned purchases, unplanned purchases frequently result from in-store marketing of forgotten needs and unplanned wants [74]. As such, in-store food selection resulting from unplanned purchasing is made quickly, is affect and/or stimulus driven, and based on rules-of-thumb (e.g., perceptions of what is common, normal, or appropriate to buy) [3,48,67]. Research documents the proportion of unplanned purchases in grocery stores as quite high (i.e., ~ 50%) [75]. Unplanned purchasing of fresh fruits and vegetables is an overlooked opportunity for in-store marketing and a focus of this work. Finally, the input–output equation in Fig. 1 also accounts for potential errors when shoppers attempt to balance the equation resulting in under or overspending. These errors can stem from a combination of human and systematic factors. For example, one significant reason why a significant portion of WIC fruit and vegetable benefits go unused (e.g., 22% in Texas [8]; 21% nationally [18]) may be because it is difficult to interact with a benefit system that requires more deliberative thought (e.g., precise weight-to-price summative calculations) than what would be expected from a given shopping trip, leaving a significant amount of benefits underutilized both nutritionally and economically [see 22]. Additionally, errors may exist due to calendar events— such as benefit payment date—that can result in predictable purchasing patterns for grocery stores, but overspending in financial resource categories. For example, 90% of SNAP benefits are redeemed within the first two weeks of issuance—with 19 states/territories issuing benefits in the first week of every month [84]. Overall, the input–output equation in Fig. 1 suggests that nutrition interventions can target three areas when it comes to increasing fresh fruit and vegetable purchases: planned purchases, unplanned purchases, and the error component. However, in retail environments, only unplanned purchasing is a viable candidate for in-store marketing of fresh fruits and vegetables (as planned and error purchases are difficult to change). To this end, we introduce a conceptual framework for understanding how to approach shopper marketing nutrition interventions. 3. Shopper marketing nutrition interventions: a conceptual framework While shopper marketing has yet to be precisely defined, four general assumptions have emerged. First, shopper marketing assumes that a significant portion (i.e., up to 50%) of people's mental budget while shopping is apportioned to unplanned purchasing [75]. Second, shopper marketing assumes that people can be guided to apportion this slack to purchases influenced by point-of-purchase marketing [21]. Third, because retail firm economic impact is most easily seen “in-store,” most of shopper marketing focuses its efforts in this context [24]. Fourth, shopper marketing leverages academic (and corporate) laboratories to refine point-of-purchase retail strategies by using the latest in data acquisition [29–31]. We believe that these same marketing laboratory approaches to acquiring verifying data should be expanded to include nutrition interventions to more closely align with not only economic sustainability of retailers, but also economic and nutrition needs of the shopper. Consider Fig. 2. We take the aforementioned shopper marketing assumptions and apply them to a conceptual framework for sustainable grocery store nutrition interventions. Our intent is not to provide a comprehensive accounting of our research in grocery stores, but rather make a case for why this conceptual framework, if followed, can move forward a novel field research domain that has the potential to impact powerfully the population's health. Specifically, we first address unplanned purchasing in the grocery store in the form of discretionary money in mental budgets (i.e., slack). We then address fruits and vegetables as a product category within the grocery store with the greatest potential not only to achieve economic sustainability of the grocery

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store, but also to meet economic and nutritional needs of the shopper. We then provide an example of a regimen of shopper marketing nutrition interventions that deploy social messages in grocery carts and floors that could move shoppers toward the purchase and consumption of fruits and vegetables. Finally, we review current measurement tools that can provide the best chance for reliable and valid evidence for actionable and sustainable shopper marketing nutrition interventions. 3.1. In-store slack The U.S. grocery store is massive (an average of 46,000 ft2 ≈ American football field without the end zones) and crowded with products (an average of 38,718 items ≈ 1 item/ft2) [20]. To help circumnavigate efficiently shoppers use mental, physical (e.g., paper), or electronic lists (e.g., smartphone) [7,77]. Lists, however, do not exactly match shopping budgets. A list, for example, may guide purchases for specific items or general item categories, but in aggregate represent much less than what a shopper is willing to spend for a particular shopping trip [74]. This gap (or slack) between how much a shopper is willing to spend during a shopping trip minus resource allocation to list items (and/or list categories) suggests that shoppers leave open the opportunity for unplanned in-store choices of forgotten needs and unplanned wants [33]. This slack represents a significant portion of shopping budgets (~ 50%) and therefore has become a focus of in-store shopper marketing. To our knowledge, no shopper marketing program has attempted to balance the economic sustainability of the retailer with the economic and nutritional needs of the shopper. This could be because the degree of difficulty; that is, any shopper marketing nutrition intervention should achieve three goals: (i) improve shopper nutrition, (ii) keep constant (or decrease) shoppers' total budgets, and (iii) keep constant (or increase) grocery store profitability. Fortunately, an opportunity to achieve all goals is represented in the attempt to capture slack within the product category of fresh fruits and vegetables. 3.2. Shopper marketing nutrition intervention goals The primary goals of improving shopper nutrition, keeping constant (or decrease) shoppers' total budgets, and keeping constant (or increase) grocery store profitability are essential to convincing grocery stores to implement any shopper marketing nutrition intervention. That is, evidence of meeting shoppers' nutritional and economic needs is not enough. Economic evidence is needed to convince grocery stores that these types of in-store marketing programs can help not only their shoppers' waistline, but also their bottom line. Accordingly, instore marketing (and subsequent capture of in-store slack) of fresh fruits and vegetables provides a platform on which each goal can be accomplished [58,59]. 3.2.1. Improving shopper nutrition Fruit and vegetable purchase and consumption is associated with a host of positive health outcomes including decreased risk for certain types of cancer, coronary heart disease, stroke, oxidative stress and inflammation, and obesity and overweight prevention [9,28,32,43]. Yet, despite the positive outcomes on health, there is little to suggest that fruit and vegetable purchase and consumption has improved over time. Current estimates (i.e., 2009) from the Behavioral Risk Factor Surveillance System suggest that only 23.5% of adults consume fruits and vegetables at least five or more times a day representing an actual decrease from when this behavior was first measured in 1996. Considering that a majority of food purchases occur in the grocery store environment, there is an opportunity (or obligation) to provide shoppers with shopper marketing that effectively communicates forgotten needs and unplanned wants that would be attractive for slack allocation. Fortunately, for grocery store economic sustainability, the product category of fresh fruits and vegetables represents an attractive target.


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IN-STORE SLACK Willingness to Spend Minus List Items

FRESH FRUITS & VEGETABLES Goals: - Improve nutrition - Keep constant (or decrease) shoppers’ budget - Keep constant (or increase) store profitability

Strategies GROCERY CART - Half cart - Cart placards

GROCERY FLOOR - Arrows/ Stickers

MEASUREMENT TOOLS - Shopper behavior - Shopper purchase - Shopper consumption

ACTIONABLE & SUSTAINABLE OUTCOME

Fig. 2. Conceptual framework for grocery store shopper marketing nutrition interventions.

While packaged food companies have become very good at providing in-store rules of thumb regarding their products' nutritional and non-nutritional benefits, rules-of-thumb for purchasing fruits and vegetables are almost non-existent. The few grocery selection rules of thumb, such as the 1–3 star and 1–100 point food rating systems, provide an excellent foundation for consumers' ability to choose foods within the same food category (e.g., Oreo Cookies = one star vs. Nilla Wafers = two stars; apples = 95 pts. vs. bananas = 98 pts.) [19,39]. Currently, however, there are no rules-of-thumb helping consumers choose between food categories (e.g., cookies vs. fruit) and categories in particular amounts, despite plenty of consumer research suggesting that consumers process differently alternatives from within- versus between-product categories, with the latter one being more inferential in nature [36,62]. Because of this, in-store marketing may simply assist

food-related decisions within categories (e.g., potato chips vs. tortilla chips) that people already historically patronize instead of considering other more nutritive food categories—such as fresh fruits and vegetables—in greater amounts. In fact, preliminary evidence from nutrition profiling systems (e.g., Guiding Stars) suggests no change in fruit and vegetable purchases in grocery stores in which these systems were implemented [47,58,76]. 3.2.2. Keep constant (or increase) grocery store profitability In the grocery store, fruits and vegetables are generally sold in three forms—fresh, frozen, and canned. While there is debate regarding the relative nutritional value of all three, it is clear that in terms of variety, taste, and average quality, the average fresh fruit and vegetable is preferred to the average frozen or canned fruit and vegetable [46]. This is



fortunate considering that fresh fruits and vegetables, perhaps because of perishability, represent one of the highest margin product categories in the grocery store [38,46]. As well, fresh fruits and vegetables represent only 10% of all grocery sales [50]. These two points (i.e., high margin, relatively low sales) establish nicely the platform on which any shopper marketing nutrition intervention can maintain (or increase) the economic sustainability of grocery stores targeting slack allocation to fresh fruits and vegetables. In the first case (i.e., high margin), even if shoppers' purchasing of lower margin (and potentially less nutritive) products decreases somewhat as a result of shopper marketing targeting slack allocation to fresh fruits and vegetables, it is likely that the grocery store can maintain or even slightly increase profitability—i.e., depending on the aggregate margin difference between other product categories and fresh fruits and vegetables. In the second case (i.e., relatively low sales), the product category of fresh fruit and vegetable sales represents a growth opportunity for grocery stores. That is, if the product category of fresh fruits and vegetables was already a significant portion of total grocery store revenue, there may not be much of a financial incentive to attempt to boost sales in this category.

3.2.3. Keep constant (or decrease) shoppers' total budgets For shopper marketing nutrition interventions to be sustainable for shoppers, budgets must not be expanded. This is possible because shopper marketing targets slack, which is an already fixed, predetermined resource, yet flexible in how it is allocated [75]. Consider the shopper purchasing with less restrictive resources such as personal income or SNAP. A successful shopper marketing nutrition intervention may possibly move slack previously allocated to less nutritive, lower margin foods (i.e., processed packaged foods) to more nutritive, higher margin foods (i.e., fruits and vegetables)—effectively not only inducing food category substitution, but also leaving exponentially less slack for less nutritive purchases, because fruit and vegetable purchases are higher margin. For a shopper purchasing with restrictive government food assistance benefits, such as the WIC fruit and vegetable voucher, a successful nutrition intervention as shopper marketing may possibly move slack—previously unused (i.e., unused portion of the fruit and vegetable voucher)—to increase fresh fruit and vegetable purchases. Even if shopper marketing nutrition interventions increased government food assistance redemption rates because of food category substitution or food category increases (i.e., simply purchasing more fruits and vegetables), these increases do not have personal financial consequences to the shopper—i.e., shoppers cannot use the benefit for anything other than food. Improving shopper nutrition, keeping constant (or increasing) grocery store profitability, and keeping constant (or decreasing) shoppers' total budgets are reasonable goals for any product category, such as fresh fruits and vegetables, targeted for a sustainable shopper marketing nutrition intervention. Unfortunately, fresh fruits and vegetables are rarely targeted for nutrition interventions (or shopper marketing) [21,58]. When fresh fruits and vegetables are targeted, informational (e.g., kiosk systems), promotional (e.g., Guiding Stars, Nuval), and economic (e.g., discounts) strategies have been ineffectual, are not sustainable, or have unintended consequences [11,58,71]. Decreasing fruit and vegetable prices, for example, may unintentionally increase demand for sodium and saturated fat because greater resources are now available to purchase less healthy foods [41]. Furthermore, government mandating of nutrition facts panels on the back (or side) of less healthy products may have led unintentionally to manufacturers repositioning their products as healthier front-of-package (e.g., “smart choice”). This is because nutrition facts panels exposed less healthy products' nutritional inadequacies making it necessary to aggressively market their relative health benefits where most people notice (i.e., front-of-package) resulting in increased demand for these products and simultaneously decreasing the amount of slack available for fruit and vegetable purchases [58].

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We take an alternative approach to existing in-store attempts to increase fruit and vegetable purchases wherein we consider social aspects of grocery shopping [2,58]. This is done by leveraging messages that provide information on what others think are common, normal or appropriate types and amounts of foods to purchase. This approach more closely matches how shoppers make decisions in the grocery store relying more on easy to use rules-of-thumb (i.e., if everyone else is doing it, it must be good for me!) than deliberative thought (e.g., understanding implications of nutritional information) when making slack purchases [12,56, 65,66,68,83]. We detail how these messages can be delivered and offer specific examples that show promise in encouraging slack allocation to fresh fruits and vegetables. 3.3. Shopper marketing nutrition intervention strategies We assume that any social message (i.e., describing what is common, normal, or appropriate) used to capture slack in grocery stores for fruits and vegetables must be salient, easy to interpret and easy to compare against shoppers' current behavior [58]. These three characteristics of social messages are most easily met when deployed in shopping carts and grocery store floors. That is, for social messages to be easily interpreted and compared against shoppers' own behavior, they must first be salient. This saliency can come from social messages that are exposed to shoppers wherever they decide to travel in the store (i.e., shopping cart) or are most likely to travel—for example, the perimeter of the store (i.e., grocery store floor) [42]. In both cases, we provide specific examples of how social messages can re-direct shopper slack toward fruit and vegetable purchases. 3.3.1. Grocery cart Interestingly, social messages were a significant component in initial grocery cart acceptance. One of the originators of the shopping cart (i.e., Sylvan Goldman) had difficulty in shopper acceptance—men balked at needing support in the grocery store and women did not appreciate pushing a device that reminded them of childcare. It was only when models of both sexes and of varied ages were sent to pose as shoppers using the carts that the device became popular [23]. To a certain extent, the content of a grocery cart is a temporary extension of the self [4]. That is, shopper product choice can signal their identity to themselves and similar others who may live in the same socioeconomic neighborhoods and share similar ethnic and religious identities [5,6,16,66]. This identity signaling is possible because what shoppers decide to put in their cart cannot only be seen by others during their shopping trip, but also when each item must be placed (sometimes embarrassingly) on the checkout counter. Given people generally have a motivation to behave correctly—either in accordance with what is perceived to be common, normal, or appropriate [12,64,70]—identity signaling may be predisposed to social messages placed in the grocery cart that would allow them to appear compliant with social norms. Specifically, social messages that are easy to interpret and easy to compare against shoppers' behavior can be placed in the grocery cart making continually salient suggestions of common, normal, or appropriate purchases of food types and amounts [58]. We provide two brief field study examples of shopper marketing nutrition interventions that leverage social messages in grocery carts. • (Half-Cart). In response to limitations of current grocery selection rules-of-thumb, we focused on a novel grocery selection rule-ofthumb that emphasized social appropriateness of only two categories of food—nutritive items that included fresh fruits and vegetables and “everything else.” To do this, we affixed a wide yellow line across the width of the grocery cart basket on both its bottom and sides (i.e., outside and inside the cart) and placed a sign on the end of the cart facing the grocery shopper. The top half of the sign read: “In the Front of Your Cart…Please Put Only Healthy Foods Such as…Fruits, Vegetables, Dairy, Meat.” The bottom half of the sign read “In the


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Back of Your Cart…Please Put Everything Else Such as…Chips, Detergent, Soft Drinks, Breakfast Cereal.” Shoppers were randomly assigned a half-cart or regular cart under the guise of participating in a grocery store taste test. After shopping, participants were approached by a researcher who asked to scan their receipt and had them complete a short questionnaire. Preliminary evidence of the efficacy of the halfcart is promising. Compared to regular carts, half-carts doubled produce purchases [52,82]. (Future investigations of the half-cart). We are currently working on refining the implementation of the half-cart as well as understanding better its economic sustainability for grocery stores and consumers. By refining the implementation of the half-cart as well as understanding better its economic sustainability for grocery stores and consumers, greater confidence in our initial results is possible. In future studies, for example, we will simply transform all grocery carts into half-carts during treatment days, so that we remove any potential bias that interaction with a researcher may have on treatment outcome. Furthermore, transformation of all carts into half-carts during treatment days will allow us to understand—from grocery store sales reports—if the half-cart is economically sustainable for grocery stores and consumers. Finally, we plan to test different placements of the line demarking suggested purchases (e.g., what space is optimal for fresh fruit and vegetable purchase) as well as social messaging that implies appropriate purchases (e.g., only fresh fruits and vegetables versus “everything else”). • (Cart placards). Advertising on grocery carts is not novel. Procter & Gamble and Coke, for example, have long used advertising in grocery carts to affect sales of their respective products. However, advertising on shopping carts is still not common and still considered an “alternative” form of marketing. What is novel, however, is using advertising based on social norms in grocery carts for shopper marketing nutrition interventions. We gained access to a grocery store who allowed us to test social messaging on their grocery carts as part of a larger 14-week shopper marketing nutrition intervention study. We were able to collect information on over 396,000 individual grocery store transactions wherein we were able to assess average total grocery store purchases and average total produce purchases (aggregated by day per transaction) when social messages were deployed in grocery carts versus when they were not [60]. To develop social messages in the grocery cart, the grocery store information technology representative provided us with a list of the most popular fruits and vegetables purchased at the particular store as well as the average frequency at which fruits and vegetables were purchased for any given day. This information allowed us to create social messages (in English and Spanish) of what was common or normal to purchase in the particular store. Specifically, the message stated “in this store, most people choose at least five produce items.” We further listed the fruits and vegetables that were most popular in that particular store (i.e., bananas, limes, avocados, corn, oranges, tomatoes, jalapenos and long green peppers, onions, and peaches). This information was placed on a placard that was attached to the inside (and outside) front of the cart so that not only the shopper could see the information, but also the information would be visible to other shoppers. We also included a smiley icon on the placard with a “thumbs up” with the number five. This was to reinforce the idea that it was normal and common to purchase at least five items (as a “low reference number”), so that those who already purchased above the low reference number would not feel pressure to decrease purchasing as per research on boomerang effects in social messages [70]. The goal was to increase produce purchases of those who may have historically purchased less than five produce items during a particular trip and reinforce those who may have historically purchased more than five items during a given trip. Produce purchases increased by 10% (compared to baseline) by the second week of placard deployment while the control store (located

on the same street, but 8 miles away) did not significantly increase or decrease produce sales (compared to baseline) during the same time period. Equally important, total sales did not significantly increase or decrease for treatment or control stores compared to their respective baselines during the same time period. This suggests that we were able to keep constant shoppers' total budgets and keep constant (or increase) grocery store profitability. (Future investigations of the cart placards). We are currently working on deploying tailored social messages (i.e., stores' popular produce items and frequency of purchase) on placards in grocery carts in additional stores to replicate results. Furthermore, we are increasing the length of time that placards will be deployed to understand the long-term effect on produce purchases. Specifically, we will be able to understand produce sale trajectory—e.g., rise, fall, plateau. Crucial to this understanding will be the ability to obtain more fine-grained data regarding the movement of specific produce and grocery items to determine product category substitution. 3.3.2. Grocery floor The perimeter (i.e., racetrack) of the grocery store results in the majority of traffic, but not necessarily purchases [42]. This is possibly because the perimeter of the store is used mainly as a thoroughfare that allows customers to quickly enter and exit particular aisles [42]. Considering the amount of traffic incurred by the perimeter of the grocery store, it is curious that no research has examined the efficacy of using floor advertising to promote fruits and vegetables. Specifically, floor social messages directing an appropriate route (e.g., to the produce department) as well as reasons why this route was appropriate (e.g., for health) could provide shoppers a salient rule of thumb that could be easy to interpret and easy to compare against their current shopping trip behavior. • (Floor arrows). We created ten six-foot long by three-foot wide green arrows that could be adhered to the grocery floor perimeter. These arrows suggested both an appropriate direction to take—i.e., to the produce section—and why the direction was appropriate. Specifically, five arrows were placed along the length of the far perimeter (i.e., in the back of the store) and five arrows were placed along the length of the near perimeter (i.e., between the check-out aisles and interior aisles). Individual arrows stated (in English and Spanish) to “follow the green arrow for your health”, “follow the green arrow for a healthy heart,” or “follow the green arrow for a healthy weight.” As part of the same 14-week shopper marketing nutrition intervention study mentioned previously (i.e., alternating interventions with two week wash-out periods), we were able to assess average total grocery store purchases and average total produce purchases (aggregated by day) when social messages were deployed on grocery store floors versus when they were not. Produce purchases increased by 9% (compared to baseline) by the second week of floor arrow deployment while the control store (located on the same street, but 8 miles away) did not significantly increase or decrease produce sales (compared to baseline) during the same time period. During floor arrow deployment—as with social messages deployed on grocery carts—total sales for treatment or control stores did not significantly increase or decrease compared to their respective baselines during the same time period. This suggests again that we were able to keep constant shoppers' total budgets and keep constant (or increase) grocery store profitability [60]. (Future investigations of the floor arrows). Similar to our work with social messages deployed on grocery carts, we are currently working on deploying tailored social messages on floors in additional grocery stores (i.e., particular routes to their produce section) to understand if similar results can be obtained. As well, we are increasing the length of time that floor arrows will be deployed to understand long-term effect on produce purchases—including understanding potential product category substitution (i.e., trading less nutritive lower margin



items for more nutritive higher margin items). Finally, we are conceptualizing a traffic system—to be adhered to the grocery floor—that could provide easy to use rules-of-thumb regarding appropriate shopping paths for nutritive purchases. 3.4. Shopper marketing nutrition intervention measurement tools The ability to understand if shopper marketing nutrition interventions reach the stated goals of increasing shopper nutrition, keeping constant (or increasing) grocery store profitability, and keeping constant (or decreasing) shoppers' total budgets, relies on the assumption that data acquired is reliable and valid. To this end, three general categories of data acquisition are possible—shopper behavior, shopper purchase, and shopper consumption. Each category is addressed regarding their means and methods. 3.4.1. Shopper behavior Data regarding shopper behavior helps identify reasons why (or why not) a particular shopper marketing nutrition intervention was (wasn't) successful. Knowing the reasons for success or failure allows for successful replication or adjustments respectively [9,44,71]. For example, it may be that the reason why a particular shopper marketing nutrition intervention wasn't successful may be not because of the intervention itself, but instead where it was placed in the store. Furthermore, it could be that the shopper marketing nutrition intervention was successful not because of design, but rather because it changed an unexpected variable (e.g., time in store) [45,61], which led to success. In both cases, existing tools are available that can help disentangle reasons for success and failure. Radio frequency identification tags (RFID) have been used now for quite some time [29,30,73]. Most frequently, RFID are placed on carts to track cart movement in the grocery store. A signal is emitted every few seconds from the tag that is captured by antennae located in different parts of the store. The signal is then processed via a software program that plots individually or in aggregate movement from all tagged carts. Comparisons can then be made regarding movement in the store regarding days, times, and shopper marketing conditions. Security camera overlay (e.g., Prism Skylabs) is a recent addition to understanding shopper data for shopper marketing nutrition interventions [72]. Existing security cameras in the store can be used to deploy software that tracks and aggregates all shopper movement (i.e., paths vs. RFID grocery paths) in various dimensions—e.g., whether shoppers pick up products in a particular area, how long shoppers spend at different places in the store, how many shoppers take different paths, and how large crowd sizes are in particular places in the store. All of this data is uploaded—in real time—into a cloud computing format, which then can be accessed anytime, anywhere via internet [63]. Much like RFID, this would be an invaluable tool to understand comparisons between movement in the store regarding days, times, and shopper marketing conditions—but in a much more detailed way. Finally, mobile, wireless eye-tracking glasses can be used in the grocery store to understand better the salience of shopper marketing nutrition interventions [14,30]. For example, in the aforementioned grocery cart and grocery floor studies, the ability to gather data regarding shopper gaze for social messages deployed would be invaluable in knowing what components were salient and which components were ignored. While saliency does not equal purchase, evidence of salient features of social messages could be improved (or non-salient features removed). 3.4.2. Shopper purchase A variety of methods are available to assess fresh fruit and vegetable purchases including receipt sampling, sales reports, and integrated customer databases. For all methods it is important to collect purchase information during periods of baseline and shopper marketing nutrition intervention in a target store as well as for the same time period in a control store. The control grocery store should be as similar as possible

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to the target in terms of location (i.e., near the first), type of shopper (i.e., demographic and socioeconomic), as well as store configuration. Collection of purchase data in target and control stores can increase validity of any shopper marketing nutrition intervention. This is because not only can you compare fruit and vegetable purchasing patterns within the store (fruit and vegetable purchases baseline vs. shopper marketing) but also between stores (i.e., change in fruit and vegetable purchases due to shopper marketing vs. change in fruit and vegetable purchases during same time periods in control store). Receipt sampling refers to the practice of randomly selecting shoppers' receipts in a nutrition intervention as shopper marketing study [11]. This method is used when it is impossible to have access to sales reports or integrated customer databases. The major issue with receipt sampling is that it is extremely difficult to sample enough receipts across all days and time periods to truly be representative of the sheer magnitude of transactions. For example, the aforementioned 14-week shopper marketing nutrition intervention studies included over 396,000 individual person transactions across two stores. To accurately sample receipts within individual days (and hours within the day) would have been very difficult—if not impossible. Grocery store sales reports provide an attractive, alternative option to receipt sampling when collecting fresh fruit and vegetable purchase data. Usually aggregated by day and store department (e.g., produce, bakery), sales reports are useful if customer count data are included per day. Specifically, unless produce department sales per day can be corrected for a daily customer count, any comparisons made between baseline (or control) time periods and shopper marketing nutrition intervention time periods may be spurious. In addition, sales reports— unlike receipts or integrated customer databases—do not allow researchers to understand (because data are aggregated by grocery department) if shoppers are switching from specific products to specific produce as a function of shopper marketing nutrition interventions. Finally, integrated customer databases are the holy grail of evaluating fresh fruit and vegetable shopper purchases. Integrated customer databases include customer transaction data that is tied to both individual purchases overtime and to customer demographic information (e.g., loyalty card). The ability to assess changes in grocery purchases at the product level allows a more fine-grained analysis to facilitate an accurate understanding of economic sustainability of any nutrition intervention as shopper marketing as well as which fruits and vegetables are being favored (if any) over other products historically purchased. Furthermore, the connection of customer transaction data to individual purchases allows analysis that could reveal exactly for whom particular shopper marketing nutrition interventions would benefit. 3.4.3. Shopper consumption A key marker of success regarding shopper marketing nutrition interventions would be providing evidence of sustainable increases in fresh fruit and vegetable purchases. This, however, is only a first step; evidence of consumption is needed. While it may be assumed that increased fresh fruit and vegetable purchases also result in increased fruit and vegetable consumption, proportionally, this may not be the case. It may, for example, take a disproportionate increase (on average) in fresh fruit and vegetable purchases before a detectable difference is noticed in consumption. This could occur if shoppers maintain (e.g., because of habit or lack of preparation knowledge) the same intake patterns as before shopper marketing leaving spoiled any extra fresh fruit and vegetables purchased. Consequently, a non-invasive tool, which could be deployed in-store (and by corporate nutritionists), is needed to understand better if shopper marketing nutrition interventions actually increase not only purchases of fresh fruits and vegetables, but also their consumption. One promising way to assess fresh fruit and vegetable intake patterns in-store is via resonance Raman spectroscopy (RRS). RRS can measure bloodstream carotenoid levels, which is a biomarker of fresh fruit and vegetable consumption. Bloodstream carotenoids are the


8


“gold standard” for assessing human fruit and vegetable consumption [17,85]. RRS has been found to be a highly reliable and valid in clinical applications to detect skin carotenoid levels. Given that RRS is noninvasive (i.e., no blood is drawn), problems with self-report dietary intake, and quick assessment (i.e., b1 min per palm scan) and carotenoid detection after consumption (i.e., b1 week), portable laser based RRS instruments are ideal tools to measure success of shopper marketing nutrition interventions [49]. 4. Discussion Grocery stores represent a context in which a majority of food purchases occur. Considering that the nutrition quality of the population's food intake has dramatically decreased [81], understanding how to improve food choice in the grocery store is paramount to healthier living [21,25,71]. In this work, we first provided an input–output equation (i.e., Fig. 1) that detailed the type of financial resources from which shoppers could draw (i.e., personal income, WIC, SNAP) and explained how these financial resources were allocated in the grocery store (i.e., planned, unplanned, error). Subsequently, we identified a conceptual framework for shopper marketing nutrition interventions (i.e., Fig. 2) that targeted unplanned fruit and vegetable purchases (i.e., slack). Targeting slack for fresh fruit and vegetable purchases allows retailers to benefit economically (i.e., fruit and vegetables are higher margin) and allows shoppers to improve their nutrition without increasing their budgets (i.e., budget neutrality). We then provided preliminary evidence of what in-store marketing of fresh fruits and vegetables could entail by modifying grocery carts and grocery floors to provide information of what is common, normal, or appropriate fruit and vegetable purchases. In each example, fresh fruit and vegetable purchases increased and evidence was obtained that suggested shopper budget neutrality. Finally, we detailed measurement tools that can be used to measure shopper behaviors, purchases, and consumption related to in-store marketing of fresh fruits and vegetables. Considering the conceptual framework provided in Fig. 2, theoretical, practical, and policy implications are possible. Theoretical implications include the examination of shopper financial resources and the assumptions of the social aspects of grocery shopping. For instance, the use of in-store slack derived from government food assistance benefit programs (e.g., WIC and SNAP) needs further research. Knowing how and why in-store marketing can affect fruit and vegetable purchases derived from government benefit slack purchases is crucial to improving nutrition for those who are most vulnerable. In addition, more evidence is needed regarding the extent to which shoppers are affected by social aspects of shopping. For example, test grocery carts that make it more or less difficult for others to see what is placed therein may possibly result in more (or less) indulgent product purchases. Such evidence would further establish the importance of social aspects in influencing fresh fruit and vegetable purchases. While it was not our intent to provide a comprehensive accounting of this field research, but rather give an example of what in-store marketing of fruits and vegetables could entail, future research should attempt to detail both theoretical implications (i.e., government benefit slack purchasing and social aspects of shopping). Practical implications include shopper acceptability of in-store marketing of fresh fruits and vegetables. If shoppers are willing to expose a significant amount of their financial resources (i.e., slack) to in-store marketing of fresh fruits and vegetables, then our conceptual framework is promising. However, it is not known at what level too much in-store marketing of fresh fruit and vegetables would start having a detrimental effect—as research suggests a saturation point at which shoppers begin to react, resulting in decreased purchases [13]. Thus, for shopper marketing nutrition interventions to be truly effective, it is essential that they are not only salient, easy to interpret, and easy to compare against shoppers' current behavior, but also not too overbearing. One way to maximize the likelihood of success in this regard is to

pilot-test proposed shopper marketing health interventions in both laboratory settings (e.g., virtual grocery store) and in field settings. The former (i.e., laboratory) would be to ensure internal validity and initial reactions of potential shoppers and the latter (i.e., field) would be to ensure external validity and assess initial purchasing patterns before long-term final deployment [58]. Finally, policy implications include understanding how retailers can respond to potential manufacturer repositioning in response to successful in-store marketing of fresh fruits and vegetables. For example, assuming in-store marketing can affect fresh fruit and vegetable purchases as we suggest, manufacturers (not retailers) of less healthy packaged foods may see sales decrease. Consequently, manufacturers of less healthy foods may engage in countermeasures and provide retailers monetary incentives to increase promotion of their products in-store. Considering the sheer magnitude of financial resources and marketing expertise at the disposal of large food manufacturers, these countermeasures could have the effect of further degrading the nutritional quality of shopper purchases. This is why it is important that—once efficacy of in-store marketing of fresh fruit and vegetables is established— retailers commit to programs that highlight their corporate responsibility while still maintaining beneficial relationships with manufacturers. For example, if it is found that the kind of in-store marketing proposed in this article is efficacious across contexts and time, retailers could commit to using grocery carts and floors only for the promotion of fresh fruits and vegetables. This commitment would—in effect—suggest that the retailer is willing to claim a permanent and significant portion of “shopper mind” for the benefit of shopper health. From this perspective, we suggest that shopper marketing nutrition interventions represent an opportunity to collaborate with retailers to improve not only their bottom line, but also the nutritional quality of their shoppers' purchases.

Acknowledgments We would like to thank Paso del Norte Health Foundation (GR0003992) for their financial support of this research, as well as Pay and Save, Inc. for the opportunity to implement our nutrition interventions in their stores and shared access to sales data. This manuscript is based on work presented during the 2013 Annual Meeting of the Society for the Study of Ingestive Behavior, July 30–August 3, 2013. The SSIB meeting was made possible in part by generous unrestricted donations from Ajinomoto North America, Inc, The Coca-Cola Company, GlaxoSmithKline Consumer Health Care, PepsiCo, Inc, Research Diets, Inc, Advanced Targeting Systems, Elsevier, Lafayette-Campden Neuroscience, Sable Systems International, Senomyx, and TSE.

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