Healthy checkout policies set nutritional standards for store checkouts and have been implemented in three US jurisdictions. We compared four message frames, each describing a different rationale for the policy, on adults’ support for a healthy checkout policy.

Participants were randomised to one of four message frames: (1) expanding healthy choices; (2) reducing parental stress by removing unhealthy items from child eye level; (3) improving community and child health; or (4) addressing predatory marketing. We used Poisson regression with robust standard errors to examine policy support by message frame and explore variation in support by socio-demographic characteristics.

Online randomised experiment.

A convenience sample of US adults (analytic N 3978) recruited online via quota-matching to approximate national socio-demographic characteristics.

Overall, most participants (65 %) supported a healthy checkout policy. Support was moderately higher (68 %) when the policy was framed as reducing parental stress than addressing predatory marketing (64 %) or expanding healthy choices (61 %; all p < 0·05). Policy support was also higher when framed as improving community and child health (67 %) than expanding healthy choices (61 %; p < 0·01). In adjusted models, overall policy support was higher among adults with Hispanic ethnicity (68 %); incomes >$35 000 (range 66–70 %); a prediabetes or type 2 diabetes diagnosis (67 %); at least some college education (67 %) and residence in the Northeast US (70 %; all p < 0·05).

Support for a healthy checkout policy was high, especially when framed around benefits to child health. Adults with certain socio-demographic and clinical characteristics may especially support healthy checkout policies.

Produce sold as plastic-wrapped packs of two to four individual items (i.e., produce micro-packs) that are low cost and placed at checkout may appeal to shoppers with budget constraints and provide a second chance to purchase items available elsewhere in the store. This study examined the impact of an intervention that placed produce micro-packs at checkout and promoted them in grocery stores across New Mexico, USA.

This quasi-experimental study placed produce micro-packs at checkout end-caps in thirteen stores (group 1), with eight stores serving as controls (group 2) from 1 July 2019 through 31 January 2020 (first phase). The intervention was extended to group 2 stores from 1 February 2020 through 30 June 2020 (second phase). Cashiers were directed to upsell the micro-packs to Special Supplemental Nutrition Program for Women, Infants, and Children recipients who had unspent cash value benefits for produce purchases.

Twenty-one grocery stores across New Mexico.

Twenty-one produce items sold as micro-packs in stores from July 2019 through June 2020.

A random effects model showed that the daily sales of micro-packs increased by 47 % during each intervention period. Group 2 stores had lower sales than group 1 stores during the first phase of the intervention. Once extended to group 2 stores, sales of micro-packs in those stores increased and sales in group 1 stores continued at the higher level.

Placing produce micro-packs at checkout may increase produce sales and support health promotion efforts by public and private stakeholders.