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A Study of the Importance of Education and Cost Incentives on Individual Food Choices at the Harvard School of Public Health Cafeteria

Department of Epidemiology, Harvard School of Public Health (K.B.M., W.C.W.)
Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Harvard Medical School (K.B.M.)
Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School (K.B.M., B.A.R., W.C.W.)
Dean's Office, Harvard School of Public Health (B.R.B., P.R.)
Department of Biostatistics, Harvard School of Public Health (B.A.R.)
Department of Nutrition, Harvard School of Public Health (W.C.W.), Boston, Massachusetts

Address correspondence to: Dr. Karin B. Michels, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115. E-mail: kmichels{at}rics.bwh.harvard.edu

Objectives: To investigate the importance of cost and awareness of health- or disease-promoting properties of foods and meals for choices by customers of a cafeteria.

Design: A non-randomized intervention study.

Setting: A medium size cafeteria in the Harvard School of Public Health.

Participants: Customers of the cafeteria mainly consisting of public health students, faculty, and school staff and workers from the medical campus.

Intervention: The purchase of healthy foods and dishes was subsidized and their prices reduced by 20%. This promotion was accompanied by the distribution of educational material.

Main Outcome Measures: Change in consumption of healthy and less healthy foods.

Analysis: The geometric mean was used to calculate the change in consumption.

Results: During the intervention, we observed a 6% increase in the consumption of healthy foods (95% confidence interval [CI]; 5% to 8%), and a 2% decline in the consumption of less-healthy foods (95% CI; –1% to –4%). After the prices returned to their original levels, the consumption of healthy foods increased further to 17% (95% CI; 13% to 20%) and a 2% decline in the consumption of less-healthy foods (95% CI; % 1 to –5%) persisted.

Conclusions: Subsidizing healthful meals and educating consumers about the importance of a healthy diet can result in a modest increase in the selection of healthy foods and meals that can be maintained beyond the periods of subsidy and promotion.

Key words: food choices, cost, point-of-purchase

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