Shopping for healthy and wholesome food can be a challenge.

Sugary cereals and candy gleam in colorful packaging. Prominent displays of cakes and tasty treats abound. Initial intentions to stick to a list of nutritious items can quickly evaporate, especially when shopping on an empty stomach.

However, a simple approach might help shoppers — particularly Latinas responsible for buying groceries for their family — learn how to handle those distractions. A new study published in American Journal of Public Health shows that Latinas exposed to mindfulness-inspired practices tend to choose and buy more healthy items and are more likely to use a preplanned shopping list.

“Most nutrition interventions are not highly impactful because they are lengthy, people drop out, they are expensive and they don’t reach most people who would benefit,” said Hortensia Amaro, Dean’s Professor of Social Work and Preventive Medicine at the USC Suzanne Dworak-Peck School of Social Work and the university’s associate vice provost for community research initiatives.

“We wanted to develop a different approach — one that would be brief, fun, accessible, low cost and that would produce favorable outcomes,” she said. “Through focus group discussions with Latina mothers, we realized that distractions and stress during grocery shopping were challenging for them to overcome.”

The result: a short and engaging video, titled Ser Consciente, showing actors playing a Latina mother and her young son as they prepare their grocery list, have a quick healthy snack before going to the grocery store, check for special deals on healthy food and confront various obstacles while shopping.

In particular, the video shows several scenarios in which the mother becomes stressed or overwhelmed with advertisements and strategically placed unhealthy foods.

“She is at her wits end with her son’s repeated requests for sugary cereals and drinks, and her own distraction by a delicious-looking cake with high sugar content,” Amaro said. “These are situations experienced by many mothers when shopping for family groceries.”

Center of attention

Then the video shows how the mother uses simple mindfulness practices like the stoplight technique, which emphasizes purposefully paying attention with intention before making a decision under stress: Stop, take several slow breaths, notice what is distracting or stressful and then decide how to proceed.

“She focuses her attention on her list and her intention to bring home healthy foods for her family,” Amaro said. “These steps allow her to be purposeful about her food choices and she gets back on track. These scenarios teach the viewers how to cope with similar situations.”

To test the effectiveness of the approach, Amaro and her colleagues recruited Latina mothers from USC-sponsored Head Start programs and local churches surrounding the University Park and Health Sciences campuses. Participants first filled out surveys to assess their nutrition knowledge and grocery shopping behaviors, such as eating and making a grocery list before shopping. Participants then watched two short videos.

The first video focused on enhancing nutrition knowledge and how to select healthy foods based on federal guidelines. The second video, Ser Consciente (which roughly translates as “being aware or mindful”), focused on how to manage distractions and stress while grocery shopping using selected mindfulness-informed strategies.

Both videos were developed to be culturally relevant to Latinas and provided in English or Spanish depending on participants’ preferred language. The research team then compared their knowledge of healthy foods and grocery shopping behaviors before they watched the videos and two months later.

State of mind

Results indicate the participants were more likely to fill their carts with wholesome foods and stick to their shopping plan after watching both videos. They also outperformed a comparison group that only watched the nutrition education video.

“One of the unique aspects of this study is we didn’t just rely on women’s self-report of food purchased,” Amaro said. “We asked women to bring in grocery store receipts from purchases they had made in the previous month before they viewed the video and then two months after. Then we coded receipt items based on dietary guidelines and definitions of foods that qualify as healthy and unhealthy for each of the major food groups.”

Those receipts confirmed that women who watched the mindfulness video bought a greater percentage of healthy foods, suggesting that the awareness and stress management techniques outlined in the video had paid off.

“Nutrition knowledge alone was not sufficient to change grocery shopping behaviors,” Amaro said. “Both groups increased in knowledge, but gaining practical skills on how to manage stress and distractions during shopping enabled women to more effectively act on their intention to bring home healthy foods.”

Encouraging healthier diets is critical given national and local rates of obesity and related issues like diabetes, she said, particularly in the Latino community. Approximately 77 percent of Latinas are considered overweight or obese, and 22 percent of young Latino children are obese.

Next in line

Amaro plans to build on the research team’s promising findings by seeking funding for a larger multisite trial. She is planning a longer-term exploration of the effectiveness of Ser Consciente, including randomly assigning different neighborhoods to either the video or control condition to explore whether the mindfulness video changes broader community norms and grocery shopping habits, which could lead to small but significant population-level improvement in consumption of healthy foods among Latinos.

“If shown to be efficacious in a larger study, taking it to scale will cost next to nothing,” she said, noting that the videos can be broadly disseminated via platforms like YouTube and shown to parents in health clinics, federal supplemental nutrition programs, Head Start programs, schools and churches. “Once we verify that it’s helpful in a larger clinical trial, we want to develop a dissemination plan and provide it at no cost.”

In addition to the peer-reviewed journal article, Amaro also discussed the study findings in a podcast in Spanish with Alfredo Morabia, editor-in-chief of American Journal of Public Health and professor of clinical epidemiology at Columbia University.

Amaro’s coauthors are Dharma Cortés from Cambridge Health Alliance, Samantha Garcia from UC Irvine, Lei Duan from the USC Suzanne Dworak-Peck School of Social Work and David Black from the Department of Preventive Medicine at the Keck School of Medicine of USC. The study and the development of Ser Consciente were funded by the USC Community Benefits and Sponsorship Program at the Keck Medical Center of USC.