Direct and indirect attempts to increase parents' fruit and vegetable purchases have had little, if any, success. Most of the disappointing results are reported in the grocery environment. In this context, embedding messages with social meaning may have a significant impact on current campaigns. We use the focus theory of normative conduct as an alternative theoretical framework and suggest that social norms that are salient, easy to interpret, and easy to compare against individuals' behavior may improve current attempts to increase parents' fruit and vegetable purchases in retail environments.
Key Words: supermarket, social norms, intervention tools, childhood obesity, fruits and vegetables, behavioral economics
Recent estimates suggest that 16.9 percent of children and adolescents age 2-19 in the United States are obese (Centers for Disease Control and Prevention 2010); this represents a 338 percent increase from when estimates were first obtained in the early 1970s. Stakeholders, such as government, food manufacturers, food retailers, and parents, have attempted to curb this increase with little, if any, success. One reason this may be is because indirect routes attempting to influence parents' food purchasing, such as government attempts through manufacturer and retail stakeholders, can result in sometimes unintentional, yet deleterious, effects, resulting in purchasing more of less healthy food (Mathios 2000, FTC 2008a, Wansink and Chandon 2006). Unlike indirect routes, direct routes give parents untainted exposure to attempts to increase healthier purchases. This route is more promising, yet questions of efficacy and feasibility remain. In response, we suggest a direct approach that considers social components of parents' food purchasing. This overlooked behavioral economic component could improve existing health interventions that target parents' food purchasing while incurring minimal expense, having potential for a large impact, and benefiting multiple stakeholders of childhood obesity.
Consider the supermarket. Nearly all major childhood obesity stakeholders inhabit this food environment where roughly 60 percent of all American food expenditures occur (USDA 2010). Despite the breadth of childhood obesity stakeholders and depth of consumer food expenditures, comparatively little health intervention research is done in the supermarket. The lack of health intervention research in supermarkets may be for two reasons: (i) supermarkets may be hesitant to engage in activities that are perceived to decrease profitability through encouraging fewer purchases (Ratner et al. 2008), and (ii) existing health intervention studies that attempt to directly leverage supermarkets as a context for health intervention research show inconsistent, if any, effects.
To address supermarkets' possible hesitancy to engage in activities that are perceived to decrease profitability, we suggest supermarket intervention research that focuses on purchase of fresh fruit and vegetables. This is for four reasons. First, fresh fruit and vegetables represent a product category that is high margin and highly perishable for supermarkets (McLaughlin 2004). Providing tools that would help turn over this product category would be attractive to them. Second, promotion of fresh fruit and vegetables does not actively demote other product categories, decreasing the likelihood that manufacturers and retailers would oppose these promotions. Third, a significant portion of children's fruit and vegetable intake- as well as their weight status (i.e., normal, overweight, or obese)-is associated with their parents' grocery purchasing patterns (Rolls, Ello- Martin, and Tohill 2004, Mushi-Brunt, Haire- Joshu, and Elliott 2007, Busick et al. 2008, Gross, Pollock, and Braun 2010, DeMattia and Denny 2008). Last, fruit and vegetable consumption is associated with not only decreased risk of developing obesity, but also diabetes and particular types of cancer (Hung et al. …