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

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA AT DAVIS · 2023 · $709,625

## Abstract

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.

## Key facts

- **NIH application ID:** 10587200
- **Project number:** 1R01DK135099-01A1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA AT DAVIS
- **Principal Investigator:** Jennifer Falbe
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $709,625
- **Award type:** 1
- **Project period:** 2023-02-01 → 2027-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10587200

## Citation

> US National Institutes of Health, RePORTER application 10587200, Impact of a Healthy Checkout Policy on Healthfulness of Grocery Environments and Sales (1R01DK135099-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10587200. Licensed CC0.

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