Community-based efforts aim to improve the food environment within a highly obese rural appalachian county

Rachel Gillespie, Emily Dewitt, Heather Norman-Burgdolf, Alison Gustafson, Brynnan Dunnaway

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Rural communities in Appalachia are displaying increased obesity prevalence, yet traditional interventions have not provided a broad enough impact to improve dietary consumption patterns. Therefore, expanding efforts that address the food environment and incorporate behavioral nudges through community-developed marketing strategies may be a viable mechanism to improve food and beverage choices within this unique population. This study installed shelf-wobblers across n = 5 gas stations in one rural Appalachian county in Kentucky. Smart Snacks were identified from store inventory lists utilizing the CDC Food Service Guideline for Federal Facilities calculator and were categorized into high-protein snacks, low-fat carbohydrate snacks, meal replacement snacks, and no-calorie beverages. NEMS-CS audits were conducted, and monthly sales data was collected at baseline and for six months thereafter for each store location. A difference-in-difference model was used, adjusting for total sales or total mean sales for each Smart Snack model to assess the percentage change within and between stores. Overall, percent change in mean sales and total sales across all stores resulted in a percentage increase of sales of Smart Snack items following wobbler installment. This study provides unique insight into how a community-driven approach to marketing can influence the sale of healthier food and beverage items.

Original languageEnglish
Article number2200
Issue number7
StatePublished - Jul 2021

Bibliographical note

Funding Information:
Funding: This research was funded by Centers for Disease Control and Prevention (CDC) Division of Nutrition, Physical Activity, and Obesity (DNPAO), Cooperative Agreement number 1NU58DP0065690100.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • Behavioral nudge
  • Food environment
  • Marketing
  • Obesity
  • Rural

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


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