(OR35-07-24) Impact of the World’s First Healthy Checkout Policy on Store Food Environments

Objectives: In 2021, Berkeley, CA became the world’s first jurisdiction to implement a healthy checkout ordinance (HCO), which sets nutritional standards for foods and beverages placed at store checkouts. The objective of this study was to compare pre- to 1-year post-policy changes in Berkeley relative to comparison cities in the percent of store checkout products that were HCO compliant and fell into healthy and unhealthy food categories.

Methods: In a natural experiment, we conducted a difference-in-differences study of product facings at store checkouts, collecting data from Berkeley and 3 comparison cities 1-month pre-implementation and 1 year later. We collected data on a near census of product facings (N=76,817) at up to 3 randomly selected checkouts from 23 Berkeley stores and 75 comparison stores. The exposure was the HCO, which permits only the following at checkout: non-food/beverage products, unsweetened beverages, and foods with ≤5 g added sugar and ≤200 mg sodium per serving in the categories of sugar-free gum and mints, fruit, vegetables, nuts, seeds, legumes, yogurt or cheese, and whole grains. The primary outcomes included a product facing’s (1) HCO compliance and (2) category, determined using a photo-based tool with high reliability.

Results: From pre- to post-policy implementation, the percent of checkout facings that were HCO compliant increased from 52% to 83% in Berkeley, a 65% increase relative to comparison cities (RR=1.65; 95%CI: 1.43-1.90). The percent of food-and-beverage checkout facings that were HCO compliant (i.e., healthy) increased in Berkeley from 29% to 61%, a 126% increase relative to comparison cities (RR=2.26; 95%CI: 1.81-2.83). Stores replaced unhealthy products—particularly candy and SSBs—with non-food/beverage products, unsweetened beverages, and healthy foods like fruits, vegetables, nuts, and seeds.

Conclusions: A healthy checkout policy was associated with substantial improvements in the healthfulness of checkout food environments 1-year post-implementation.

Funding Sources: This research was supported by a grant from Bloomberg Philanthropies’ Food Policy Program (https://www.bloomberg.org) and NIDDK Award Number R01DK######. The content is solely the responsibility of the authors and does not necessarily represent the official views of Bloomberg Philanthropies or the NIH.