# Diversity Supplement for: Impact of a Healthy Checkout Policy on Healthfulness of Grocery Environments and Sales

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA AT DAVIS · 2024 · $59,777

## Abstract

PROJECT SUMMARY/ABSTRACT OF PARENT GRANT
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:** 11003880
- **Project number:** 3R01DK135099-02S1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA AT DAVIS
- **Principal Investigator:** Jennifer Falbe
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $59,777
- **Award type:** 3
- **Project period:** 2023-02-01 → 2027-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11003880

## Citation

> US National Institutes of Health, RePORTER application 11003880, Diversity Supplement for: Impact of a Healthy Checkout Policy on Healthfulness of Grocery Environments and Sales (3R01DK135099-02S1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/11003880. Licensed CC0.

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