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Objective Conduct a pilot study to determine if improving the visibility and quality of fresh produce (choice architecture) in corner stores would increase fruit/vegetable purchases by families participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Design Six stores were randomly assigned to choice architecture intervention or control. Store-level WIC sales data were provided by the state. Primary outcomes were WIC fruit/vegetable voucher and non-fruit/vegetable voucher sales, comparing trends from baseline (December 2012–October 2013) to the five month intervention period (December 2013–April 2014). Secondary outcomes were differences in customer self-reported fruit/vegetable purchases between baseline and the end of intervention. Setting Chelsea, Massachusetts, a low-income urban community. Subjects 575 adult customers completing store exit interviews. Results During baseline, WIC fruit/vegetable and non-fruit/vegetable sales decreased in both the intervention and control stores by $16/month. During the intervention period, WIC fruit/vegetable sales increased in intervention stores by $40/month but decreased in control stores by $23/month (difference in trends $63/month, 95% CI, $4–121/month; p=0.036); WIC non-fruit/vegetable sales were not different (p=0.45). Comparing baseline to intervention period exit interview responses by customers participating in WIC (N=134), intervention store customers reported increased fruit/vegetable purchases compared to control store customers (18% vs. −2%), but this did not achieve statistical significance (p=0.11). Conclusions Placement of fruit/vegetables near the front of corner stores increased purchase of produce by customers using WIC. New policies that incentivize stores to stock and prominently display good quality produce could promote healthier food choices of low-income families.

The literature consistently shows associations of adverse cardiovascular and pulmonary outcomes with residential proximity to highways and major roadways. Air monitoring shows that traffic-related pollutants (TRAP) are elevated within 200–400 m of these roads. Community-level tactics for reducing exposure include the following: 1) HEPA filtration; 2) Appropriate air-intake locations; 3) Sound proofing, insulation and other features; 4) Land-use buffers; 5) Vegetation or wall barriers; 6) Street-side trees, hedges and vegetation; 7) Decking over highways; 8) Urban design including placement of buildings; 9) Garden and park locations; and 10) Active travel locations, including bicycling and walking paths. A multidisciplinary design charrette was held to test the feasibility of incorporating these tactics into near-highway housing and school developments that were in the planning stages. The resulting designs successfully utilized many of the protective tactics and also led to engagement with the designers and developers of the sites. There is a need to increase awareness of TRAP in terms of building design and urban planning.

Background: In a world of finite research funding, efforts to prioritize future research topics are increasingly necessary. Objective: The aim of this study was to identify and prioritize the direction of future research in the broad area of low-calorie sweetener (LCS) intake and potentially related health outcomes by using a novel method that incorporates evidence mapping in the Agency for Healthcare Research and Quality's Future Research Needs (FRN) process. Methods: A diverse expert stakeholder panel was convened and engaged to identify research gaps and prioritize future research needs. An independent research team hosted a number of interactive webinars and elicited feedback through surveys and individual interviews with the stakeholder panel, which included policymakers, lay audience members, health providers, a research funder, individuals with food industry experience, and researchers of several different specialties. Results: The stakeholder panel generated and ranked a list of 18 FRN questions across 5 broad research areas. Overall, stakeholder panel members unanimously agreed that the research questions that will have the largest public health impact are those that address outcomes related to body weight, appetite, and dietary intake. Although the LCSs included in this FRN project have all been Generally Recognized as Safe by the FDA or approved as food additives, the recurrent concerns and confusions with regard to the “safety” of LCSs by consumers underscore the importance of communicating the science to the general public. Conclusion: Our project provides evidence that engaging a diverse expert stakeholder panel is an effective method of translating gaps in nutrition research into prioritized areas of future research.

Background: In 2009, the Special Supplemental Nutrition program for Women, Infants, and Children (WIC) increased access to healthy foods by providing cash-value vouchers for fruit/vegetables, but improving access alone is not sufficient to reduce disparities in food choices and obesity among low-income families. We hypothesized that making fresh produce more visible and of better quality in corner stores would increase their WIC fruit/vegetable sales. Methods: We conducted a randomized, controlled trial of 6 WIC-certified corner stores in a low-income, Latino community. Three stores were assigned to “choice architecture” intervention that increased visibility and quality of fresh fruit/vegetables. Primary outcome was WIC fruit/vegetable voucher (FVV) sales, comparing changes in sales trends from baseline (Dec. 2012-Oct. 2013) to follow-up (Dec. 2013-Apr. 2014) for intervention vs. control stores. Secondary outcomes, from customer exit surveys at all 6 stores (N=575), were changes between baseline and follow-up in self-reported fresh fruit/vegetable purchases by customers on WIC or Supplemental Nutrition Assistance Program (SNAP). Results: WIC FVV sales decreased in both intervention and control stores during baseline but increased in the 3 intervention stores after implementing choice architecture (Figure). In exit surveys, 23% of all corner store customers reported using WIC, and 37% used SNAP. Compared to baseline, intervention store customers on SNAP increased purchase of fruit/vegetables at follow-up more than SNAP customers at control stores (6% vs. -15%, p=0.007). For WIC customers, there was a similar but not statistically significant difference between intervention and control (18% vs. -2%, p=0.11). Conclusion: A simple choice architecture intervention increased purchases of fruit/vegetables by corner store customers using WIC. Policies that incentivize WIC-certified stores to stock and prominently display good quality fresh produce could improve healthy choices of low-income families.