We may think that we are the captains of our own destiny, making our own decisions and guiding our own ship. But it’s not that simple — and that’s a fact that was understood well by whoever put snacks in the checkout line.

Over eight decades ago, a psychologist named Kurt Lewin declared that behavior is a function of the person in their environment. Lewin pointed out that under right set of circumstances, our behavior will be determined more by our environment than our personality.

For example, we may want to eat healthy in order to live a better life. But if your environment offers us nothing but unhealthy food choices, we are not going to be eating healthy.

The Solano County Public Health Department (SPH) identified checkout lines at neighborhood shops and convenience stores as a key environment where unhealthy food choices were being made. The SPH then partnered with IMPAQ to measure the changes and evaluate the effectiveness of the SPH’s Healthy Checkout Initiative.

Funded through a community health grant from the Centers for Disease Control, SPH proposed to improve community health levels by working through shop owners and other stakeholders to modify the environment of the checkout lines.

SPH personnel believed that could sway people into making healthier food choices through the following strategies:

  • Make unhealthy food less available. Noting that people waiting at checkout lines were bombarded by the sign of unhealthy, sugar- and calorie-laden foods like chocolates, candies, and cookies, SPH tried to minimize the presence of these items in the checkout line. The store owners were also asked to stock more non-food items in the checkout area like batteries, toothpaste, etc.
  • Make healthy food available and inviting. SPH helped store owners stock fresh fruit, vegetables and other healthy foods at checkout line. They provided shelves and wire baskets for the fruits and greens and linked storeowners with local suppliers of these healthier foods. SPH also helped clean the stores façade and checkout area in order to make the healthy food display more appealing.
  • Make information about the healthy food initiative widespread in the community. SPH personnel promoted the checkout line “makeovers” over local and social media to bring in more customers into the seven stores that agreed to test the healthy food initiative.

IMPAQ was brought in to design the evaluation of the healthy food initiative and assess is effectiveness. IMPAQ designed the in-depth interview instrument and protocols to draw out the appropriate information from the storeowners, the stakeholders, and the customers of the stores. Data collection for the three- and six-month follow-ups was also handled by IMPAQ.

IMPAQ researchers used intercept interviews at the three- and six-month follow-ups to determine attitudes to the healthy food initiative and how those changed over time. Reactions to the checkout line “makeovers” were generally very positive among store owners, stakeholders and customers. Over 80% said that the general healthfulness of food products had improved or stayed the same over the previous 3 months. Nearly 70% said they were more likely to buy healthier food. Store owners also said the some of the items introduced during the initiative also increased sales.

Although the initiative was well-received, IMPAQ found that the changes were not sustainable in several locations.

A 7-Eleven owner reported that he had to bring back the candy, cookies, and sweet drinks because of a steep decline in sales and pilferage of the healthy foods. Despite this, the overall healthfulness of the checkout line was still higher than the baseline. The biggest success story of the effort was Grocery Outlet, whose level of healthfulness rose from a low of 20% at the baseline to over 91% by the end of the trial. But this success had to be tempered by the fact that only one of Grocery Outlet’s multiple checkout lines was converted.

IMPAQ also mentioned that scarcity of resources also forced them to limit intercept interview sample size to only 35 at each follow-up. The research firms also mentioned some problems with the instrument design, including the facings survey instrument that did not take into account the size of the items involved. One extreme example was a pack of gum and a barrel-sized water bottle bin that were considered equivalent in the facings survey.

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