Impact of a Healthy Checkout Policy on Healthfulness of Grocery Environments and Sales

项目总结/摘要 美国第一个健康结账政策于2021年在加州伯克利实施，并将于2022年实施。 2022年，提供了一个了解政策对饮食质量影响的机会。这项政策禁止高糖 和高钠产品从结帐，一个地区的冲动购买而闻名。通过降低 消费含糖饮料，糖果，和咸零食-最常见的项目在结帐-这一政策 可以降低肥胖和2型糖尿病的人群风险。其他地区采用的自愿结账标准 各国成功地减少了不健康食品和饮料的购买， 这表明强制性的健康检查政策可以有意义地改善饮食质量。 然而，由于伯克利的政策是同类政策中的第一个，因此没有研究表明， 健康结账政策改变了商店食品环境和食品和饮料的健康性 购买-人口饮食质量的客观代表。这项研究将评估的长期影响， 美国第一个关于商店食品环境和购买健康的健康结账政策。通过 利用自然实验，这些结果将在伯克利商店和 三个比较城市采用综合控制和差异中的差异方法。第一个目标是评估 该政策对结账时和商店其他地方的商店环境的影响，包括 不健康和健康产品的流行率及其添加糖，热量和钠的含量， 干预商店和随机抽样的81个比较商店。第二个目标是评估政策影响 购买（a）通常在结账处出售的小尺寸零食和饮料，以及（B）各种尺寸的 这些产品（占替代）使用商店和产品级销售数据，从16个干预 和172家比较商店。第三个目标是确定影响政策的执行因素 有效性，如政策支持，成本，覆盖面和利益相关者的反应，使用与城市工作人员的访谈， 政策制定者，零售商和伯克利居民的调查。本评价利用基线和1- 研究小组使用一种新颖的基于照片的工具收集的基线后一年的商店环境数据。的 拟议的研究预计将提供第一个证据的有效性，强制性健康 改善食品环境和商店销售的结账政策以及促进或构成障碍的因素 这可以为其他司法管辖区的政策决定提供信息。

PROJECT SUMMARY/ABSTRACT The nation’s first healthy checkout policy was implemented in Berkeley, CA in 2021 and will be enforced in 2022, presenting an opportunity to understand policy effects on diet quality. This policy prohibits high-sugar and high-sodium products from checkouts, an area known for impulse purchasing. By potentially lowering consumption of sugary beverages, sweets, and salty snacks—the most common items at checkout—this policy could reduce population risk of obesity and types 2 diabetes. Voluntary checkout standards adopted in other countries have successfully decreased purchases of unhealthy foods and beverages and increased purchases of healthy ones, indicating that a mandatory healthy checkout policy could meaningfully improve diet quality. However, because Berkeley’s policy is the first of its kind, there are no studies on the degree to which a healthy checkout policy changes store food environments and the healthfulness of food and beverage purchases—an objective proxy for population diet quality. This research will evaluate the long-term impact of the nation’s first healthy checkout policy on the healthfulness of store food environments and purchases. By leveraging a natural experiment, these outcomes will be compared between Berkeley stores and stores in three comparison cities using synthetic control and difference-in-differences methods. The first aim is to assess the impact of the policy on store environments at checkout and elsewhere in the store, including the prevalence of unhealthy and healthy products and their contents of added sugar, calorie, and sodium in all 26 intervention stores and a random sample of 81 comparison stores. The second aim is to assess policy impact on purchases of (a) small sizes of snack foods and beverages commonly sold at checkout and (b) all sizes of these products (which accounts for substitution) using store- and product- level sales data from 16 intervention and 172 comparison stores. The third aim is to identify implementation factors that influence policy effectiveness, such as policy support, costs, reach, and stakeholder reactions using interviews with city staff, policymakers, and retailers and surveys of Berkeley residents. This evaluation leverages the baseline and 1- year post-baseline store environment data collected by the research team using a novel photo-based tool. The proposed research is expected to provide the first evidence on the effectiveness of a mandatory healthy checkout policy for improving food environments and store sales and the factors that facilitate or pose barriers to implementation, which can inform policy decisions in other jurisdictions.