A Novel Intervention to Improve Food-Purchasing Behavior in Low-Income School Children

Background: Food-purchasing behaviors of families is often influenced by children. Improving food-purchasing behaviors of children may influence parental food choices. We developed a novel musical intervention called “Hip Hop” HEALS to provide children with basic consumer literacy skills, improve caloric and menu board literacy, in order to motivate healthier food-purchasing behavior. Methods: We enrolled 57 children aged 8-11 years from a low-income neighborhood to participate in two pre- intervention and two post-intervention cost-controlled school-based food sales. Caloric content of each food item ranged from 30 to 270 calories. The purpose of the first sale was to collect baseline data, so no calorie labels appeared on food tags; calorie labels appeared in the second pre-intervention sale to evaluate the effect of caloric labels independent of the intervention. Two post-intervention sales were designed to evaluate the effect of the intervention on food-purchasing behavior. Results: Mean participation rate across food sales was 54%. Mean caloric content per food item purchased in the two pre-intervention sales was 176 calories and 173 calories respectively (p = 0.77), suggesting that calorie labels alone may be insufficient. However, immediately following the HEALS intervention, mean caloric content per food item was 122, a 29% reduction from baseline (p<.001), and mean changes in nutrient density per food item significantly improved (p<.001). These effects were sustained 1 week post-intervention.

Conclusion: Calorie labels, by themselves, may not influence food-purchasing behavior among low-income children. Adding the HEALS intervention significantly improved childrens' food-purchasing behavior. Larger studies are needed to confirm these findings.