Point-of-purchase messages framed in terms of cost, convenience, taste, and energy improve healthful snack selection in a college foodservice setting LORI A, BUSCHER; KATHLEEN A. MARTIN, PhD; SHANNON CROCKER, MSc, RD Objective To examine the effects of a point-of-purchase (POP) intervention emphasizing various properties of ‘healthful food items on college students’ snack purchases. Design In Study 1, vegetable baskets (containing cut pieces of vegetables), fruit baskets (containing cut pieces of fruit), pretzels, and yogurt were promoted in separate POP interventions. Food sales were monitored over 2-week baseline, 4-week intervention, and 2-week follow-up periods. In Study 2, yogurt was promoted across a 2-week baseline, 2-week intervention, and 2-week follow-up periods and an tercept survey was conducted, Sublects’setting Approximately 2,280 university students were potentially exposed to the intervention, and 72 students responded to the intercept survey. Intervention POP messages were placed on an 11 x 17-in poster located at the cafeteria entrance, and two 4% 2.5-in, signs placed next to the targeted food item. Messages emphasized the Budget-friendly, Energizing, Sensory/taste, ‘Time efficient/convenient (BEST) stimulus properties of food, Main outcome measures Daily sales of the targeted food items. Statistical analyses performed Analyses of variance with ‘Tukey post hoc tests were used to compare food sales during the baseline, intervention, and follow-up periods. Results In Study 1, yogurt and pretzel sales increased during the intervention and post-intervention periods (P<.05). Interventions had no effect on frult basket and vegetable basket sales (P>.05), but whole fruit sales Increased during the fruit basket intervention and follow-up (P<.05). In Study 2, yogurt sales were significantly greater during the intervention and follow-up periods than at, baseline (P<.01). Applications/conclusions Using the BEST properties in POP interventions may be beneficial in promoting the consumption of healthful foods among university students, particularly when the targeted foods are priced comparably to less healthful foods, .'Am Diet Assoe. 2001;101:909-913. have diets that are high in fat and that lack fruits, vegetables, and variety (1-6). Point-of-purchase (POP) interventionshave often been used in studies to promote healthful eating among college students, but have produced mixed results (6-10). For example, in | study, a POP interven- tion was unsuccessfulin reducing fat consumption (7), whereas, another intervention increased sales of cholesterol and en: ergy-reduced entrees (10). One factor that may explain the Limited success of college interventions using POP advertising is the use of nutrition labeling as a core aspect ofthe interven- tions, Nutrition labeling cannot compete aesthetically with the 2graphics-intensive, eye catching comercial food promotions inand around the cafeteria (11). Moreover, the typical location of POP materials—directly in front of targeted foods—limits exposure of the information to those persons who approach, the targeted itern, To have maximum effect, POP messages must be attention-grabbing and visible to all persons entering the foodservice facility. Another problem is that even when students read nutrition labels, they often fail to use that information (12) because it can be difficult o understand and, apply. When choosing foods, nutrition information may not even be particularly important to students relative to other aspects (13), including taste (6-9), cost (9,12), convenience (9) and energy value, Indeed, these 4 aspects have been Identified important factors in the selection of foods (6,12,14- 18), ‘Yet, to the best of our knowledge, no POP intervention has used these 4 aspects of food choice consideration to promote healthful eating. According to theory-based guidelines for developing health-promoting messages (19), messages are ‘most effective when they are framed in terms of the benefits of engaging in a healthful behavior. POP messages that empha- size the benefits of a healthful food choice (eg, tasty, conve- nient, inexpensive) should be effective in promoting healthful eating because they provide the consumer with clear and Cc ollege students tend to snack frequently, skip meals, and L. A. Buscher is a graduate student in the Department of Public Health Sciences, University of Toronto. KA Martin is a professor in the Department of Kinesiology, MeMaster University, Hamilton, Ontario, Canada. Crocker is with Eat This nutrition consulting, Burlington, Ontario, Canada. ‘Address correspondence to: Kathleen A. Martin, PhD, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada L8S 4K1 Journal of THE AMERICAN DIETETIC ASSOCIATION / 909)Table 1 Overview of the B-week point of purchase intervention targeting col lege students n a residence dining hal Week Food Message" 12 Basaine Nene a Vegetabie basket _Revilaize youself by snacking ona resh (cut poces of ‘backer of crisp red pepper, cy vegetables) Tomatoes, and crunahy carol. Easy ‘Seaton the run! 4 Prezoe ood asl fk? Tvow a twat into your ie ‘by snagging a bag of pete, 5 Yoout Neou a sweat last onorgy boost? Get Tongeasing energy and tone of Naver by grabbing a yogurt 6 Fruitbasket (out Bost yousauthFresh pineappe, ieces of rut) oranges, grapes, and melon! Pk up a frat Basket ee fet and budget lena 78 Folomup None ‘yaessages fooused on BEST simaus propeice cl food (BudgetHlendi, Em fexgzrg, Sensory safacton. Ter), specific benefits of choosing the healthful food. Our study examined the effects of benefit-framed POP messages on the consumption of healthful snack foods. The benefits reflected the 4 food choice factors described here, which we refer to as, the Budget-Friendly, Energizing, Sensory satisfuctiowtaste, ‘Time/eonvenience (BEST) food properties. sTuoy1 Whereas entrées or whole meals have been the tangets of previous POP interventions (4), our study focused on snack foods (13). Because students tend to snack frequently and have an array of snack food choices in cafeterias, snacks were considered an important target for intervention to improve overall diet quality (20) Four foods were targeted: fruits and vegetables, which tend to be underconsumed by students (2); pretzels, a lower fat alternative to potato chips; and yogurt, ‘which was targeted because ofits calcium and protein content but was promoted asa sweet snack with the hope that custom. ers would choose it over chocolate or candy. ‘The primary hypothesis was that sales fora food item would be greater during the week in which the food was promoted with a POP intervention than during a baseline period. A secondary hypothesis was thet by promoting pretzelsasasalty snack choice, we would decrease Consumption of potato chips and that by promoting yogurt as a sweet snack, we would decrease consumption of chocolate and candy. Methods. Participants were approximately 2,280 Canadian university undergraduate students who were on full meal plans. Approval to conduct this study was granted by the research ethics review board of the university. The study took place in the university's largest cafeteria and included a 13-day baseline, 28-day intervention, and a 13-day follow-up period. Four foods ‘were promoted in Separate L-week interventions: vegetable baskets (approximately 2 servings of cut pieces of carrots, cucumbers, broccoli, cherry tomatoes, and sweet peppers), pretzels (2'sizes), yogurt, and fruit baskets (about 2 servings 910/ August 2001 Volume 101 Number 8 of strawberries, pineapple, metons, oranges, and grapefruit) Sales of these items along with those for whole fruit, packaged. salads, chocolate, candy, and potato chips were monitored to determine if te promotions had any effect on their consump. tion. One POP message was written for each of the 4 targeted foods. Messages inclucled at least 1 BEST food choice stimulus property (Table 1), 1 active cartoon person, and 1 or more cartoon renditions of the targeted food, all in vibrant colors. ‘The message was placed on an 11x1-in poster located at the cafeteria entrance, and two 4.0x2.5-in cards were placed di- rectly in front of the targeted foods. Food availability was monitored 1 to 2 times daily by the investigators. During the baseline, intervention, and follow-up periods, sales ofall moni. tored items, except pretzels and chips, were recorded from cash register data. For logistical reasons, pretzel sales were determined via hand-counts at the start and end of each day. The number of daily sales transactions was also recorded. A transaction was defined as each time a person visited the cash register. Statistical Analysis, The unit of analysis was the percentage of total daily transac- tions that included the monitored item. A series of L-way analyses of variance (ANOVAs) compared sales of food items across the study periods (see Table 1) and when significant, were followed-up with Tukey's ESD posthoc tests Allanalyses were conducted using SPSS for Windows (version 10, 1999, Chicago, I. Results On average, there were 4,0042795 sales transactions per day. ANOVA indicated no differences in the number of sales trans- actions across the 6 weeks. Ashypothesized, sales of yogurt, F(5,48) =6.89, P<.001, and pretzels, F(6,48) ~ 7.84, P<.001, increased over the study periods (see Table 2). Relative to baseline, yogurt and pretzel sales increased during their respective intervention weeks, (P<.05), and remained higher than baseline during both the fruit basket intervention and follow-up periods (P<.05). Con trary to hypothesis, there were no differences in the sales of fruit baskets, F(5,48) = 0.75, P>.05, or vegetable baskets, F (5,48) =0.20, P>.05, acrossthe study periods, butthere were differences in whole fruit sales, F(5,48) = 2.85, P-.001. Rela- tive to baseline, whole fruit sales were greater during the fruit basket intervention (Ps.05) and follow-up periods (P=.001), Sales of packaged salads also increased, F(5,48) =2.84, P<.05, but only during the yogurt promotion’ (P<.05). Also as pre~ dicted, the ratio of pretzel to chip sales changed, F(6,48) = 6.22, P<.001, Pretzels accounted for a significantly greater proportion of total chip and pretzel sales during the pretzel intervention (12.8%) than during baseline (4.5%, P<.001). Contrary tohypothesis sales of chocolate and candyincreased, FG,48) = 7.30, P<.001, and were higher than baseline during the follow-up (P.001). Interestingly, the follow-up ended just days before the start of exams, Discussion ‘The results suggest that students’ selection of healthful snacks can be improved through benefit-framed, POP messages that ST stimulus properties of food. Pretzel and y es increased significantly during the weeks in which, these foods were promoted and remained higher than baseline even after the POP messages were removed. Sales of whole‘RESEARCH Table 2 Sales of targeted foods! Intervention Basotine Vegetable Pretzel Youur Frat basket Followup beaker Intervention Intervention Intervention intervention ‘ean andard Govaon Food items Vogetabe basket 0572020 ooaso.13 ogi=0.17 Salads 12030, 1480.30" iais0ai Fr basher 2542057 2162048 2312056 ‘hoe frat 212053 2eeeors 293=0.90 4020.11" dasenis s02015 298=050 3.162029 3.287065, 23832033 S5ee06 Banos CChocelate and candy 7e02143 0321.00 7a02074 asad oa pacar oh "Contained various combinations ofeut cats, cucumbers, oreccol, che tomatoes, and sweet peppers ‘Contained varous combinations of cut srawoornos, pneapple, melons, oranges, and graoetat “Denotes signicanty derert rom baseine (P05) “Denotes signitearty aiferon: tom baseline (P<). fruit also increased significantly during the week in which a fruitbasket was promoted, and chip sales were reduced during the pretzel intervention, Why did the POP interventions affect sales of pretzels and yogurt, but not fruit and vegetable baskets? Price may have deen a limiting factor, Whereas pretzels and yogurt were priced ($0.79 and $1.19 respectively) similar to snack foods suchas chipsand candy (<$1), fruitand vegetable baskets cost substantially more ($2.25 and $1.99 respectively). Interest- ingly, whole fruit sales increased during the fruit basket inter- vention period, perhaps because it was priced at only $0.68. Unfortunately, during the vegetable basket intervention, there ‘was no smaller, cheaper portion ol vegetablesavailable. Ifaless, expensive option had been available (eg, packets of carrot or celery sticks) its sales might have increased. Other factors that could explain the ineffectiveness of the vegetable intervention are the contentof the both the message and the vegetable baskets. The message may have been too Tong (it was the longest message of the 4), and overly focused onfood texture rather than taste. Second, customers may have doubted the freshiness of the vegetable baskets, disliked par- ticular vegetables included in the basket, or felt that the portion was too large, and thus chose vegetables from the salad bar. Because salad bar transactions included sales of veg- lables as well as nonvegetable products (og, pasta salads, chickpeas, croutons), it was impossible to monitor salad bar vegetable sales vis a vis cash register transactions. Collection of disappearance data was also impossible—considering how frequently salad bar ingredients were refilled, it would have been too laborious for cafeteria staff to monitor consumption of vegetable items. Yet given that salad bar sales have been shown to inerease when a POP intervention is included as part, of a multicomponent promotion (1), it is possible that our intervention increased vegetable sales at the salad bar. Sales of pretzels and yogurt remained higher than baseline for several weeks after their respective POP interventions. Apparently, a I-week promotion can have significant long- term effects on snack food choices, But by promoting a differ- ent food each week, we may Nave detracted from the potential impact of POP interventions. The goal of a college foodservice POP intervention should not be to simply increase consurap: tion ofa particular food for a week or even a few weeks, but to help young people establish healthful eating habits that. will last a lifetime, Ifa particular behavior (eg, consuming more fruits and vegetables) is to become a health habit, one must, have repeated, continuous experiences with that behavior (21,22). Instead of promoting a different. food each week, it may be best to promote 1 type of food for several weeks, to provide aclequate time to develop a habit of incorporating that food into one’s diet. This possibility was examined in Study 2. STUDY 2 ‘The primary purpose of Study 2 was to investigate the impact, ofa2-week POP intervention that targeted asingle snack food, yogurt, in order to examine the intervention’s effects without bias from other preceding or antecedent POP promotions. It was hypothesized that yogurt sales would increase signifi- cantly from baseline to intervention, and from intervention to follow-up. Asecondary purpose was to determine the extent to which customers saw, read, and were influenced by the POP messages. An intercept survey of foodservice customers was conducted to examine these issues. Design and Procedure ‘Study 2 took place 7 weeks after the completion of Study and ‘was similar in design and procedure to Study 1. However, the baseline and follow-up periods were 14 days each, and the intervention period was 15 days. Eight days (spring break) separated the end of the intervention period from the begin- ning of the follow-up. An intercept survey was performed over 3 days during the follow-up. Respondents were recruited during the dinner hour (between 5 and 7») in the seating section of the cafeteria by 1 of the investigators. The survey was administered using an interview format. Results ‘There was no difference in the mean number of daily transac- tions over the course of the study. On average, there were 3,016 + 776 transactions per day Yogurt sales were significantly different across the study periods, F(2,40) = 8.78, P<.01, and were greater during the intervention (mean = 4.84% 40.67 of all transactions) and Journal of THE AMERICAN DIETETIC ASSOCIATION / 911follow-up (mean 4.03% + 0.74), P<.01. Contrary to hypothesis, there was no difference in sales between the invervention and follow-up (P>.05). 10% + 0.70) than at baseline (mean Intercept Survey Seventy-two students living in the residence hall completed the survey (63% women). Only 114 of respondents could Ireely recall any of the Study 1 or 2 POP messages, but 85% could recall other commercial food promotions. With a verbal prompt, 40% of respondents recalled seeing the yogurt POP messages, 86% of whom recalled seeing the poster situated at the front door of the foodservice facility. Only 7% recalled seeing the labels placed in frontof the yogurt, and the remain- der recalled seeing both the poster and the small labels, When visually prompted, the majority (68%) recalled seeing the yogurt POP messages, and more men (89%) than women, (795) said that they actually read the signs. However, more women (8754) than men (25%) admitted thatthe signs enticed them to buy yogurt. The intercept survey queried aspects of the sign that might have enticed customersto purchase yogurt. Most respondents did not endorse any of these reasons, but said that the sign simply reminded them that they had not, eaten yogurt for a while. Discussion As predicted, a 2-week POP intervention significantly in- creased yogurt consumption relative to baseline. These in- creases were maintained 2 weeks after the messages were removed. Analysis of the intercept survey data suggests that the POP messages served as a reminder, rather thant a pressure, to consume or maintain consumption of healthful foods (21). Most respondents recalled seeing only the posterat the cafete- ria entrance, and not the cards placed directly in front of the yogurt, Thus, the location of promotional material may be an important factor in the success of a POP intervention. Most POP interventions have only placed labels directly in front of targeted food items, Our results suggest this is an ineffective strategy GENERAL DISCUSSION Although studies have produced mixed findings regarding the benefits of POP interventions in college foodservice facilities (6-10), our studies show that POP messages can increase healthful snack consumption. However, we suspect that the success of our intervention was largely due to the placement, graphies, and message content of our promotional materials Specifically, a large, professionally designed poster was situ: ated at the entrance to the cafeteria, and our POP messages used the BEST stimulus properties of food choice to emphasize Ue multiple benefits of healthful snacks. Given tie success of our intervention and the potential for POP interventions to be conducted relatively inexpensively and with little labor, we recommend their use in cafeteria systems, Itis encouraging that yogurt sales were just as high at Study 2 baseline as at Study 1 follow-up. This finding suggests that the effects of the Study 1 yogurt intervention did not fade over ‘44-day period, and that a simple POP message can stimulate long-term eating behavior change. Perhaps if students can be convinced to purchase and consume a particular food just once—and they enjoy it—they may be more likely to choose ‘that food again and incorporate it into their diet on a habitual 912 / August 201 Volume 101 Number 8 basis. Thus a first step toward changing dietary habits may be to prompt people to make that first healthful snack choice. POPinterventionsmay be 1 way to motivate people to take that first step. APPLICATIONS/ CONCLUSIONS With respect to implementing POP interventions in university cafeterias, we offer several recommendations, 1 First, because the BEST properties are easy to understand, even persons who have no nutrition knowledge may be able to translate messages into specific eating behaviors when the intervention i frarmed with these characteristics (23). The BEST properties should be highlighted in brief POP messages. 1 Second, creative marketing techniques allow healthful food promotions to be noticed by a large number of consumers Posters should be in immediate proximity to the entry to the foodservice facility (not in front of the food product) and should include colorful, graphic representations of the pro- moted food = Third, given that students snack frequently, POP interven- dons that focus on snack foods may improve stuclents’ overall diet quality. 2 Wealso recommend that dietitians work closely with cafete- ria management to ensure commitment to long-term interven tion success. Adequate stock rust be ordered for promotions, and signs must remain in properlocations. Ifa graphic designer is contracted, a small, financial budget may be negotiated. Increased sales figures for promoted foods could be cited.as ant incentive for the Foodservice staff. = Finally, we encourage additional research to identify which of the BEST properties are most beneficial for promoting consumption of different types of foods. Such information can only enhance the potential success of future POP interven- tions. References 1. Chapman G, Malton ©, Hammond G. College and univeraty students Dieaklast consumotion palo behaviors, belle, motvaions and per. sonal and enwronmantaliniuences. Can Diet Prac Res, 1098;58-178-162 2 Naeidos L, VelnotP, chard, McKee E, Galvan T, A carchovascular oath nods asseesrsint of uwersty students living i resience, Cand Public Haan 1008 80 171-175. 23.{ley D. James G, Locdan-Belvar C, Furey S, Catsbeek F. Benjamin J iKarncanT Asaossing tne heath behaviors of Texas college students J Am Col Health T00Ke4'167- 172 4 Haberman 5, Lutte D. Weighing in college students’ cet and exorcise bahavors J Am Coll Heath 1998;46:189-109 B:LowryR, GaluskaD, Futond. loons, Kano, Cline Physicalactvy, food choice, and weight management goals andpractices among US college Students Amd Prev Med. 2000-18. 10-27. 6, Bowman, MeProud MS, UsiewieeR, Gendreau M, Meher 8, Evaluation ff the etlectveness of poin-at-choice nuttin information on consumer Dereepton of food qualty and value ina univers food sorice. J Call Un Food Serv [serial orline} 1895. Available at_ tip. ects. template asp?pagesresources. Accessed Sopt 15,1993 7. Dauie-Chervin O, Roger 7, Clark Influencing food selection wih point Gichelow natiton information. J Nutr Edue 1988 17-18-22. 8, Soyer E, Hanson C, Ebva Ly Fal C, Warce W. The ellects of nutton ‘eduction onthe decision-making eile and fend selection in @ universityresidence hal J Coll Univ Food Sar [eral enline), 1996. Avaliable a: Mp} ‘hewn nactusorghemplate asp?page=resources. Accessed Sept 5, 1998 ‘8. 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Horacek 7, BettsN, Students cluster ito groups accordingto the factors inuencing tne detary intake, Am Diet Assc0. 1998981484. 1467, 19.Flatvran A, Salovey P Shaping perceptions tomerivate heathy behavior {he ree ! message framing, Psyeho! Bul 1997-121 3-19, 20. Nouhouser & Patterson R, Krstal A, Rock C, NeumarkSztainar O, ‘Thoxnquist Mf, Cheskin Do consumars of savory sracke have poor qual lots? J Am Bet Assoc: 2000; 100576579, 2 Macon J. Social cogntiva modes of halt and exercise behavior an invoductionandevew ofconceptualesues J Ano! Spor Psychol 10005116. 0, 22, Kita A, Glanz K, Tiley B, Li S. Meclating factors in dietary change: Werstanding the impact of a workste ution Intervention. Healm Educ Behav. 2000,215112.125, 23, BrinbergD, Axelson ML Pee S. Changing food knowedge fod choice, land dietary floer consumprion by using falored messages. Appetite 2000:38 95-43, ‘The authors thank Thomas J. Bonney (manager, Commons Marketplace, McMaster University, Hamilton, Ontario, Canada) and Gordon Cooledge (evecutive chef, McMaster University Hospitality Services, Hamilton, Ontario, Canada) for their hard work and commitment to this project, College and university students present a challenge for nutritionists ver on the go, students skip meals, snack frequently, and. gravitate toward foods that are high in fat and lovrin fruits, vegetables, and variety. They snack more and their meal times are more fluid. Sandy Procter, MS, RD, a coordinator of expanded food and. nutrition programs at Kansas State University, has seen this firsthand, On positive note, says Procter, collegestudents are eating smaller meals more frequently. “College students em- brace grazing through the day. Timing isn’t as important— their schedule is more variable. They have no set times to eat— they eat when they are hungry, and they have 24-hour access to food these days.” ‘Students’ eating patterns are closely linked to their mobile, fast-paced lifestyle, says Jill Irvin, MA, RD, assistant director of housing food services at The Ohio State University. She finds that college students have grown up in families that don't often eal dinner together, with activities and jobs, they've grown up as “on-the-run” eaters. Asaresult, portability isa key feature in food choices. “They want food they can toss in a backpack. A lot of them are not buying for that moment...they may be eating that food hours later,” said Procter, While college students are aware of good nutrition and are a healthy population, for the most part they see weight gain as, the only consequence of unhealthy eating habits. Procter says they fee! “untouchable.” “If you are invincible, [eating wel] is not a priority.” Another challenge is increased eating options. Students don't have to eat on campus, and they can select a food service plan with fewer meals or none at all. Convenience stores, vending machines, and even fast-food restaurants have moved onto campuses. “Eating out is eating in,” says Procter. Mary Molt, PAD, RD, assistant director of housing and dining services at Kansas State University, concurs. In order to en- courage healthy food choices, she says foods must be easily available and look good. Brand is important, too, as students equate brand with quality and are willing to pay for it Tn response to students’ demands, college and university food services now serve healthier foods. Molt says prompting by students has spurred dining officials to offer smaller por- tions, meatless meals, an expanded salad bar, and lower fat items. Yet anyone marketing to students had better beware— they've grown up with video games, MTV, and the Internet and. are media savvy. “Students are very aware of the marketing images that bombard them. Advertising pieces need to be professionally done, high on graphicsand able to compete with other marketing campaigns,” says Irvin, “Ads targeted to stu- dents must be short on words.” They respond to quick, flashy ‘messages, The table tents Irvin designs have bare-bones mes- sages, bullet points, and snazzy images. ‘While advertising can change short-term behavior, it takes, ‘more than that to change long-term eating habits. Education is key to sustaininglife-long eating choices. Given students’ fragmented schedules and lack of time, the challenge js to create nutritional messages that reach them. In addition to table tents, Irvin has found a medium perfectly targeted to this group: a Web site sponsored by OSU dining services on which students can find daily menus, nutritional information, food choices coded for top allergens, and comparative informa- tion on fast-food options. Students can respond with their input as well. Hits are high, and it’s proving to be an excellent collaboration. This article was written by Ann Belaskt, a freelance writer in Chicago, Ml, Journal of THE AMERICAN DIETETIC ASSOCIATION / 913