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Point-of-purchase prompts for healthy foods

Health Factors: Diet & Exercise
Decision Makers: Educators Employers & Businesses Nonprofit Leaders Public Health Professionals & Advocates
Evidence Rating: Some Evidence
Population Reach: 100% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Point-of-purchase or point-of-decision prompts are motivational messages such as signs, posters, front of package labels or shelf labels placed near fruits, vegetables and other items to encourage individuals to purchase these healthier food options. Point-of-purchase prompts can provide specific nutrition information, use symbols to rate or indicate healthy items, or promote selection of specific types of healthy foods. Point-of-purchase prompts for healthy food choices can be implemented in cafeterias, vending machines, grocery stores, or retail locations in worksites, hospitals, schools, or other community venues. Point-of-purchase prompts are often implemented as part of a multi-component approach to improving food environments (US FDA-POP labeling).

Expected Beneficial Outcomes

Increased fruit & vegetable consumption
Improved dietary choices

Evidence of Effectiveness

There is some evidence that point-of-purchase prompts increase the purchase and consumption of fruits and vegetables and other healthy foods (Freedman 2010Buscher 2001Reed 2011Story 2008, Sonnenburg 2013), especially when implemented with other food environment improvements (Seymour 2004, AHA-Mozaffarian 2012). Used in conjunction with advertising and promotion of healthy foods, point-of-purchase prompts have been shown to increase healthy food selection (Escaron 2013). However, additional evidence is needed to confirm effects (Escaron 2013, AHA-Mozaffarian 2012).

Fruit and vegetable consumption and fat intake can be positively affected through environmental strategies such as point-of-decision prompts; effects are less consistent in grocery stores than in settings such as worksites and universities where fewer food choices are available (Story 2008, Seymour 2004). In a Boston-based study, point-of-purchase traffic light food labels in hospital cafeterias led to healthier choices (Sonnenburg 2013). Point-of-purchase signage can also influence children’s food selections (CDC MMWR-School health guidelines 2011) and has been shown to positively affect food choices among university students (Buscher 2001Freedman 2010Reed 2011). As part of a multi-component worksite intervention, point-of-decision prompts may lower saturated fat and dietary cholesterol intake (Brehm 2011).

In grocery stores, point-of-purchase prompts that use symbolic colors, pictures, and text coding to indicate the overall rating of a product’s nutrition content can influence consumer selection of healthy food items (Hersey 2013, Swartz 2013, Newman 2014). As part of a multi-component intervention that includes signage, placement, and product availability strategies, point-of-decision prompts can increase healthy food sales in supermarkets in low income areas (Foster 2014). In some circumstances, front of package labels and other point-of-purchase prompts can encourage food producers to reformulate their products to be healthier (AHA-Mozaffarian 2012).

Culturally relevant food products and culturally sensitive materials and messaging can increase the effectiveness of point-of-purchase prompts, especially in communities with limited access to healthy foods (Escaron 2013).

Implementation

United States

Over 30 communities across the country implemented point-of-purchase prompts through CDC Communities Putting Prevention to Work grants (Bunnell 2012). Point-of-decision prompts are being implemented as part of obesity prevention interventions in school, hospital, and worksite cafeterias. For example, Kaiser Permanente has a Cafeteria Menu Labeling Program at hospitals in California, Hawaii, and Oregon (USDA-Obesity prevention toolkit 2014). Such prompts are also part of the nutrition recommendations for cafeterias at New York University (NYU-Nutrition).

Campaigns for healthy eating and obesity prevention support the use of point-of-decision prompts in retail locations across the country, as in California (USDA-Obesity prevention toolkit 2014). Colorado’s Smart Meal Seal program is an example of an effort that partners with restaurants to provide point-of-decision prompts indicating healthier options (CDC-Obesity in Colorado).

There are several point-of-decision food labelling systems in use across the country. Examples include Guiding Stars, AHA Heart Check, Whole Grains Stamp, Aggregate Nutrient Density Index (ANDI), Nutrition Keys, Healthy Ideas, NuVal, Nutrition IQ, Simple Nutrition (AND-Toner), and Smart Choices Program (US FDA-POP labeling). 

Wisconsin

The Wisconsin Department of Health Services Nutrition, Physical Activity & Obesity Program promotes point-of-decision prompts as a strategy to improve foods and beverages in food retail outlets (UW DPHS-Checkout healthy 2013).

Implementation Resources

Food Trust-Supermarket toolkit - The Food Trust. Supermarket strategies to encourage healthy eating: Toolkit. Accessed on March 4, 2016
HI SDH-CHN toolkit - Hawaii State Department of Health (HI SDH). Choose healthy now! (CHN) toolkit. Accessed on March 4, 2016

Citations - Description

US FDA-POP labeling - US Food and Drug Administration (US FDA). Background information on point of purchase (POP) labeling. Accessed on February 27, 2017

Citations - Evidence

AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514–63. Accessed on May 15, 2017
Brehm 2011* - Brehm BJ, Gates DM, Singler M, Succop PA, D’Alessio DA. Environmental changes to control obesity: A randomized controlled trial in manufacturing companies. American Journal of Health Promotion. 2011;25(5):334–40. Accessed on November 30, 2015
Buscher 2001* - Buscher L, Martin K, Crocker S. Point-of-purchase messages framed in terms of cost, convenience, taste, and energy improve healthful snack selection in a college foodservice setting. Journal of the American Dietetic Association. 2001;101(8):909-13. Accessed on November 30, 2015
CDC MMWR-School health guidelines 2011 - National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Adolescent and School Health (DASH). School health guidelines to promote healthy eating and physical activity. Morbidity and Mortality Weekly Report (MMWR). 2011:60(RR-05):1-71. Accessed on December 7, 2015
Escaron 2013 - Escaron AL, Meinen AM, Nitzke SA, Martinez-Donate AP. Supermarket and grocery store-based interventions to promote healthful food choices and eating practices: A systematic review. Preventing Chronic Disease. 2013;10:E50. Accessed on March 4, 2016
Foster 2014 - Foster GD, Karpyn A, Wojtanowski AC, et al. Placement and promotion strategies to increase sales of healthier products in supermarkets in low-income, ethnically diverse neighborhoods: A randomized controlled trial. The American Journal of Clinical Nutrition.  2014;99(6):1359-1368. Accessed on March 4, 2016
Freedman 2010* - Freedman MR, Connors R. Point-of-purchase nutrition information influences food-purchasing behaviors of college students: A pilot study. Journal of the American Dietetic Association. 2010;110(8):1222-6. Accessed on February 4, 2016
Hersey 2013* - Hersey JC, Wohlgenant KC, Arsenault JE, Kosa KM, Muth MK. Effects of front-of-package and shelf nutrition labeling systems on consumers. Nutrition Reviews. 2013;1-14. Accessed on March 4, 2016
Newman 2014* - Newman CL, Howlett E, Burton S. Shopper response to front-of-package nutrition labeling programs: Potential consumer and retail store benefits. Journal of Retailing. 2014;90(1):13-26. Accessed on March 4, 2016
Reed 2011* - Reed JA, Powers A, Greenwood M, Smith W, Underwood R. Using “point of decision” messages to intervene on college students’ eating behaviors. American Journal of Health Promotion. 2011;25(5):298-300. Accessed on May 24, 2016
Seymour 2004* - Seymour JD, Yaroch AL, Serdula M, Blanck HM, Khan LK. Impact of nutrition environmental interventions on point-of-purchase behavior in adults: A review. Preventive Medicine. 2004;39(2):108-136. Accessed on March 4, 2016
Sonnenburg 2013* - Sonnenberg L, Gelsomin E, Levy DE, et al. A traffic light food labeling intervention increases consumer awareness of health and healthy choices at the point-of-purchase. Preventive Medicine. 2013;57(4):253-257. Accessed on March 4, 2016
Story 2008* - Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health. 2008;29:253-72. Accessed on November 9, 2015
Swartz 2013 - Swartz JJ, Dowray S, Braxton D, Mihas P, Viera AJ. Simplifying healthful choices: A qualitative study of a physical activity based nutrition label format. Nutrition Journal. 2013;12:72. Accessed on March 4, 2016

Citations - Implementation

AND-Toner - Toner C. Point-of-purchase food labeling systems. Academy of Nutrition and Dietetics (AND). Accessed on March 4, 2016
Bunnell 2012* - Bunnell R, O’Neil D, Soler R, et al. Fifty communities putting prevention to work: Accelerating chronic disease prevention through policy, systems and environmental change. Journal of Community Health. 2012;37(5):1081–90. Accessed on December 1, 2015
CDC-Obesity in Colorado - Centers for Disease Control and Prevention (CDC). Colorado's response to obesity: State nutrition, physical activity, and obesity profile. Accessed on December 12, 2015
NYU-Nutrition - New York University (NYU). Live well NYU: Nutrition recommendations. Accessed on March 4, 2016
US FDA-POP labeling - US Food and Drug Administration (US FDA). Background information on point of purchase (POP) labeling. Accessed on February 27, 2017
USDA-Obesity prevention toolkit 2014 - US Department of Agriculture (USDA), Center TRT, National Collaborative on Childhood Obesity Research (NCCOR). SNAP-ED strategies & interventions: An obesity prevention toolkit for states. 2014. Accessed on March 16, 2017
UW DPHS-Checkout healthy 2013 - University of Wisconsin-Madison Department of Population Health Sciences (UW DPHS). Checkout health: A Wisconsin resource for healthier foods & beverages in food stores. 2013. Accessed on March 4, 2016

Page Last Updated

August 6, 2015

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