BackgroundTargeted coupons strongly influence purchasing behavior and may represent an innovative approach for improving dietary behaviors.MethodsThe retail analytics firm, Dunnhumby, provided secondary retail data containing grocery transactions, targeted coupon exposures, and coupon use for 2500 households over 2-years. The USDA Quarterly At-Home Food Purchasing Database was used to categorize individual foods into 52 categories and combined into 12 food groups. Mixed effects linear models estimated the difference-in-difference effects of coupon exposure on category-level purchase rate/wk. pre- and post-campaign; models also tested effect modification by food category.ResultsCategory-level food purchases significantly increased post-campaign. Mean (SD) food purchases/wk. Among exposed households (17.34 (13.08) units/wk) vs. unexposed households (3.75 (4.59) units/wk) were higher (p < 0.001). Difference-in-difference effects of coupon exposure showed a higher increase in purchase rate among exposed vs. unexposed households (5.73 vs. 0.67, p < 0.001). Food category significantly modified the association between coupon exposure and coupon campaign. Category-level purchase rate among exposed vs. unexposed households was relatively higher in less healthful (e.g. convenience foods) vs. more healthful categories (e.g. nuts) with a 1.17 unit/wk. increase in convenience foods purchase (p < 0.001) vs. a 0.03 unit/wk. increase in nuts (p < 0.001). Exploratory analyses suggested that price elasticity of food categories for targeted coupons (1.02–2.81) was higher than previous estimates for untargeted coupons.ConclusionAcross food categories, coupon exposure increased category-level purchase rate, with a relatively larger effect size for less healthful than more healthful categories. Promising results from this preliminary study suggest that experimental research is warranted to determine whether targeting with the explicit purpose of improving dietary quality can more effectively influence diet, and whether it can do so more cost effectively.Electronic supplementary materialThe online version of this article (10.1186/s12966-018-0744-7) contains supplementary material, which is available to authorized users.

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Key Points Question Does a semiautomated, personalized, healthy food incentive intervention improve grocery purchase dietary quality and percentage spending in targeted food groups? Findings In this randomized clinical crossover trial of 209 adult participants, healthy food incentives personalized according to customer data were associated with a small but significant improvement in grocery purchase quality and percentage spending on targeted food groups. Meaning A personalized healthy food incentive intervention increased grocery purchase quality and may be a promising population-based strategy for improving dietary intake.

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Introduction: Incentives can increase healthy food purchases, but less is known about whether they improve dietary quality. The Smart Cart Study evaluated whether healthful food incentives based on customer preferences and purchase history increased grocery purchase quality and the proportion of spending on targeted foods. Hypothesis: Targeted incentives will increase grocery purchase quality as measured by the Grocery Purchase Quality Index- 2016 (GPQI) and percent spending on targeted healthful foods. Methods: Adults (n=224) who shopped at an independent supermarket for ≥50% of their groceries, participated in the store’s loyalty program, and completed study questionnaires were enrolled in summer 2018. All participants received a 5% loyalty card discount. The intervention group received targeted weekly coupons (~$10 value) with brief education to improve purchase quality for 13-weeks. A computerized study algorithm allocated targeted healthy food coupons to participants’ loyalty cards by using purchase history, dietary preferences, and diet quality. The control group received weekly brief education and occasional generic coupons. After a brief washout, the groups crossed over. GPQI-16 scores (range 0-75) were calculated from cumulative food purchasing data by comparing actual to recommended spending within 11 food groups, with higher scores reflecting higher purchase quality; % spending on targeted vs. all foods was also compared. Paired t-tests examined differences between groups. Results: Participants with extreme spending (i.e. top/bottom 1%) were excluded, leaving an analytic sample of 207 mostly white adults (95%), with mean age of 56 and 50% with household incomes ≥100K. The Table shows changes in GPQI-16 scores and % spending in the first 13-week intervention period, followed by the cross-over intervention period. Conclusions: Results from this pilot trial suggest that targeted healthy supermarket incentives are feasible and are promising tools to help improve diet quality and health.