Behavioral economics to implement a traffic light nutrition ranking system in a network of food pantries

大约十分之一的美国家庭经历着食物不安全，这与心脏代谢有关 疾病风险。联邦食品援助项目往往不足，因此慈善食品系统， 主要由向伙伴机构(如食品储藏室)分发食品的食品库组成，是一种常规食品 每年为5300万人提供来源。储藏室提供的和顾客消费的食物的质量通常会 不符合美国饮食指南。促进更健康食物选择的食品储藏室干预措施可以改善客户的 健康，但由于实施障碍，尚未得到广泛采用。该项目的总体目标是 使用多层次行为经济学(BE)干预来实施基于证据的战略，以改善 由食品储藏室提供并由顾客选择和消费的食物的饮食质量。红绿灯营养 排名是一种基于证据的BE策略，用于在多种环境下增加健康食品的选择。喂食 美国，美国最大的私人饥饿救济组织，在2021年发布了关于食品银行的建议 在他们的订餐平台上进行红绿灯营养排名。支持食品储藏室的健康(交换) 是一个指导在订购平台和食品货架上使用的红绿灯标签以及食物的程序 食品储藏室布局，告知顾客，鼓励选择健康食品。然而，广泛实施的 由于时间限制和相互竞争的优先事项等障碍，SWAP具有挑战性。建议的项目是 与大波士顿食品银行(GBFB)合作测试BE策略(选择架构、框架、 实施循证干预(交通灯营养)的社会规范和激励 在慈善食品系统的两个层面：食品银行和食品储藏室。我们将进行一项 混合类型II的有效性--实施研究，以实用、稳健、实施和 可持续发展模型(PRISM)用于检查REACH有效性采用实施维护(RE- Aim)域。AIM 1是一项对600个GBFB伙伴机构进行的随机对照试验，以确定是否使用BE GBFB订购平台上的策略将增加机构对平台红绿灯营养的利用 超过12个月的健康食品标签(REACH)及其订单(有效性和维护)。目标2是一个 30个GBFB食品储藏室的等待名单对照随机试验，以确定BE干预是否会增加食品储藏室 实施SWAP(实施、采用)，改善客户的食物选择和膳食摄入量， 使用Prime膳食筛选器和素食仪皮肤类胡萝卜素测量超过24个月 (有效性、维护性)。目标3将评估BE战略的预算影响和成本效益 (执行、有效性)从食品银行和食品储藏室的角度来看。这项研究的结果将 向为美国提供食物的其他国家和地方饥饿救济组织通报实施情况并 传播基于证据的营养建议，以改善儿童的饮食和健康 易患心脏代谢性疾病风险最高的边缘化家庭。

Approximately one in 10 US households experience food insecurity, which is associated with cardiometabolic disease risk. Federal food assistance programs are often insufficient, and therefore the charitable food system, largely comprised of food banks that distribute food to partner agencies (e.g., pantries), is a regular food source for 53 million people a year. The quality of food offered in pantries and consumed by clients often does not align with US dietary guidelines. Pantry interventions to promote healthier food choices can improve clients’ health but have not been widely adopted due to implementation barriers. The project’s overall objective is to use multi-level behavioral economics (BE) interventions to implement evidence-based strategies to improve the dietary quality of food offered by pantries and selected and consumed by clients. Traffic light nutrition ranking is an evidence-based BE strategy for increasing healthy food choices in multiple settings. Feeding America, the largest U.S. private hunger relief organization, released recommendations in 2021 for food banks to implement traffic light nutrition ranking on their ordering platforms. Supporting Wellness at Pantries (SWAP) is a program to guide both traffic light labeling for use on ordering platforms and pantry shelves, as well as food pantry layout to inform clients and encourage healthy food choice. Nevertheless, widespread implementation of SWAP is challenging due to barriers such as time constraints and competing priorities. The proposed project is a collaboration with the Greater Boston Food Bank (GBFB) to test BE strategies (choice architecture, framing, social norms, and incentives) for implementation of an evidence-based intervention (traffic light nutrition ranking, SWAP) at two levels of the charitable food system: a food bank and food pantries. We will conduct a Hybrid Type II effectiveness-implementation study, guided by the Practical, Robust, Implementation, and Sustainability Model (PRISM) to examine Reach Effectiveness Adoption Implementation Maintenance (RE- AIM) domains. Aim 1 is a randomized controlled trial of 600 GBFB partner agencies to determine if using BE strategies on the GBFB ordering platform will increase agencies’ utilization of the platform’s traffic light nutrition labels (Reach) and their orders of healthy food over 12 months (Effectiveness and Maintenance). Aim 2 is a waitlist-control randomized trial of 30 GBFB pantries to determine if BE interventions will increase pantries’ implementation of SWAP (Implementation, Adoption) and improve clients’ food selection and dietary intake, assessed with the PRIME diet screener and Veggie Meter skin carotenoid measure over 24 months (Effectiveness, Maintenance). Aim 3 will evaluate the budget impact and cost-effectiveness of BE strategies (Implementation, Effectiveness) from the food bank’s and pantries’ perspectives. Results of this research will inform Feeding America and other national and local hunger relief organizations about the implementation and dissemination of evidence-based nutrition recommendations that can improve the diet and health of marginalized families at highest risk for cardiometabolic diseases.