Introduction: Healthy checkout policies that set nutritional standards for store checkout areas were recently implemented in two U.S. cities and have been recommended for consideration by federal policymakers. We examined which of four message frames garnered the highest public support for this policy type.

Methods: A sample of U.S. adults (n=3,978) matching national distributions of key sociodemographic characteristics participated in an online experiment. Participants were randomized to one of four messages describing a hypothetical healthy checkout policy framed as: (1) expanding healthy choices, (2) making shopping less stressful for parents by removing junk food from children’s eye-level, (3) improving community and child health, or (4) addressing predatory marketing. The primary outcome was support for a healthy checkout policy. Data were analyzed using a generalized linear model with a Poisson distribution and robust standard errors. We then explored how support for a healthy checkout policy varied by sociodemographic variables.

Results: Most participants (65%) supported a healthy checkout policy. Support was highest when framed around “making shopping less stressful for parents” (68%), followed by “improving community and child health” (67%), “addressing predatory marketing” (64%), and “expanding healthy choices” (61%). Support for a healthy checkout policy was significantly higher when framed as “making shopping less stressful for parents by removing junk food from children’s eye-level” than “addressing predatory marketing” and “expanding healthy choices” (p-values<0.05). Support for a healthy checkout policy was also significantly higher when framed as “improving community and child health” than “expanding healthy choices” (p<0.01). There was no significant effect modification by sociodemographic variables; however, Hispanic adults and adults in the Northeast were significantly more likely to support a healthy checkout policy (p-values<0.05), regardless of frame.

Conclusion: Support for a healthy checkout policy was high, especially in response to message framing around making shopping less stressful for parents or improving community and child health . Hispanic communities and those in the Northeast may especially support healthy checkout policies.