In January 2024, Perris, California implemented a mandatory healthy checkout policy, becoming the third jurisdiction globally to mandate nutrition standards for checkout items, following Berkeley, California, and a similar initiative in England. These healthy checkout policies aim to replace unhealthy foods displayed at checkout lanes with healthier options, potentially improving consumer dietary choices by making nutritious foods more accessible. However, the real impact of such policies on the retail food environment and consumer behavior remains largely underexplored.
This study utilized a natural experimental design to assess the effectiveness of the healthy checkout ordinance (HCO) in Perris. Data collection occurred at two points: June 2023 (baseline) and June 2024 (six months after policy implementation). It involved 13 stores within Perris that were subject to the HCO and 51 matched stores in three comparison cities without the policy.
A total of 65,271 product facings (i.e., products visible to consumers at checkout) were analyzed to evaluate compliance with the HCO standards within various checkout zones. The study focused on products within 6 feet of the register, those beyond 6 feet, and the entire checkout area. Findings revealed that compliance rates within 6 feet of the register rose significantly from 50% to 67%, representing a 37% relative increase compared to stores in comparison cities.
While some improvement was noted, compliance beyond 6 feet within the checkout aisle was less pronounced, with an increase of only 31%. Furthermore, compliance specifically for food and beverage products within 6 feet also showed marked improvement, elevating from 36% to 55%, with compliant beverage placements experiencing a remarkable 141% increase.
Despite these positive trends, the study found no significant reduction in the presence of noncompliant items such as candy, sugar-sweetened beverages, and salty snacks within the same zone. This suggests that while the HCO improved the visibility of healthier options, it did not effectively decrease the prevalence of less healthy products.
The study acknowledged limitations, particularly the assumption that checkout displays in Perris would follow parallel trends with those in comparison cities without the policy, which could introduce bias in the apparent efficacy of the ordinance.
The implementation of mandatory healthy checkout policies has demonstrated a capacity to enhance the checkout food environment, particularly in terms of increasing the availability of healthful foods and beverages within immediate reach of shoppers. However, the overall effectiveness of such policies can vary based on their design and scope. In Perris, while certain improvements were noted nearby checkout registers, no significant changes occurred throughout the entire checkout area. It is suggested that policymakers consider broader definitions that include all checkout products alongside rigorous nutrition standards to maximize the impact of such health-oriented initiatives.
In both the United States and globally, checkout aisles have traditionally been stocked with unhealthy food options like candy and sugary drinks, largely due to marketing agreements from manufacturers. This strategic placement can lead to unintended impulse purchases, particularly in environments marked by socioeconomic disparities where access to healthy foods is already limited. Given the influential role of retail food environments on consumer choices, initiatives that regulate product placement at checkout lanes have been proposed as effective public health strategies. The Perris healthy checkout ordinance signifies a progressive step in addressing these concerns and improving community health outcomes. By analyzing its real-world effects, this study contributes valuable insights into the effectiveness of public health policies aimed at enhancing dietary quality through strategic environmental changes.