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 (Rated)
- 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 (Christoph 2018, Roy 2015a, Hobin 2017, Nikolova 2015, Freedman 2010*, Reed 2011*, Sonnenberg 2013*), especially when implemented with other food environment improvements (Seymour 2004*, AHA-Mozaffarian 2012, Shin 2015). 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).
Point-of-purchase signage can influence children’s food selections (CDC MMWR-School health guidelines 2011, Siegel 2015) and has been shown to positively affect food choices among university students (Christoph 2018, Deliens 2016, Roy 2015a, Cioffi 2015, Freedman 2010*, Reed 2011*). 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). A study in rural South Dakota which combined culturally tailored signage with an existing grocery store healthy food labeling system suggests such interventions can increase purchases of healthy foods in the short term, especially fruit and vegetables (Gustafson 2018).
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 (Sonnenberg 2013*). Point-of-purchase prompts on vending machines can modestly increase the sale of healthier items; product labels and promotional posters may be more effective than labels alone (Grech 2015*). 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).
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 areas with lower incomes (Foster 2014). As part of a multi-component worksite intervention, point-of-decision prompts may lower saturated fat and dietary cholesterol intake (Brehm 2011*). A Baltimore-based study suggests multi-component nutrition interventions including point-of-purchase prompts in corner stores can modestly improve weight outcomes among youth who are overweight (Shin 2015).
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*). Multiple traffic light food labels appear to help individuals identify the healthier of two products and accurately estimate saturated fat, sugar and sodium content more than other label types; single traffic light labels may be the most helpful for comparing nutrient levels between products (Gorski Findling 2018). Shelf labels that use a simple nutrition scoring system promote healthier food purchases, especially in healthier product categories (Nikolova 2015, Hobin 2017, Melo 2019, Finkelstein 2018). Other studies suggest nutrition scoring system labels may be associated with individuals reducing their purchases of less healthy foods (Cawley 2015*).
Impact on Disparities
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).
Citations - Evidence
* Journal subscription may be required for access.
Christoph 2018 - Christoph MJ, An R. Effect of nutrition labels on dietary quality among college students: A systematic review and meta-analysis. Nutrition Reviews. 2018;76(3):187-203.
Roy 2015a - Roy R, Kelly B, Rangan A, Allman-Farinelli M. Food environment interventions to improve the dietary behavior of young adults in tertiary education settings: A systematic literature review. Journal of the Academy of Nutrition and Dietetics. 2015;115(10):1647-1681.
Hobin 2017 - Hobin E, Bollinger B, Sacco J, et al. Consumers’ response to an on-shelf nutrition labelling system in supermarkets: Evidence to inform policy and practice. The Milbank Quarterly. 2017;95(3):494-534.
Nikolova 2015 - Nikolova HD, Inman JJ. Healthy choice: The effect of simplified point-of-sale nutritional information on consumer food choice behavior. Journal of Marketing Research. 2015;52:817-835.
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.
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.
Sonnenberg 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.
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.
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.
Shin 2015 - Shin A, Surkan PJ, Coutinho AJ, et al. Impact of Baltimore Healthy Eating Zones: An environmental intervention to improve diet among African American youth. Health Education and Behavior. 2015;42:97S-105S.
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.
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.
Siegel 2015 - Siegel RM, Anneken A, Duffy C, et al. Emoticon use increases plain milk and vegetable purchase in a school cafeteria without adversely affecting total milk purchase. Clinical Therapeutics. 2015;37(9):1938-1943.
Deliens 2016 - Deliens T, Van Crombruggen R, Verbruggen S, et al. Dietary interventions among university students: A systematic review. Appetite. 2016;105:14-26.
Cioffi 2015 - Cioffi CE, Levitsky DA, Pacanowski CR, Bertz F. A nudge in a healthy direction. The effect of nutrition labels on food purchasing behaviors in university dining facilities. Appetite. 2015;92:7-14.
Gustafson 2018 - Gustafson CR, Kent R, Prate MR. Retail-based healthy food point-of-decision prompts (PDPs) increase healthy food choices in a rural, low-income, minority community. PLoS ONE. 2018;13(12).
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.
Grech 2015* - Grech A, Allman-Farinelli M. A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices. Obesity Reviews. 2015;16(12):1030-1041.
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.
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.
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.
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.
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.
Gorski Findling 2018 - Gorski Findling MT, Werth PM, Musicus AA, et al. Comparing five front-of-pack nutrition labels’ influence on consumers’ perceptions and purchase intentions. Preventive Medicine. 2018;106:114-121.
Melo 2019 - Melo G, Zhen C, Colson G. Does point-of-sale nutrition information improve the nutritional quality of food choices? Economics and Human Biology. 2019;35:133-143.
Finkelstein 2018 - Finkelstein EA, Li W, Melo G, Strombotne K, Zhen C. Identifying the effect of shelf nutrition labels on consumer purchases: Results of a natural experiment and consumer survey. American Journal of Clinical Nutrition. 2018;107:647-651.
Cawley 2015* - Cawley J. An economy of scales: A selective review of obesity's economic causes, consequences, and solutions. Journal of Health Economics. 2015;43:244-268.
Citations - Implementation Examples
* Journal subscription may be required for access.
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.
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.
NYU-Nutrition - New York University (NYU). Live well NYU: Nutrition recommendations.
CDC-Obesity in Colorado - Centers for Disease Control and Prevention (CDC). Colorado's response to obesity: State nutrition, physical activity, and obesity profile.
AND-Toner - Toner C. Point-of-purchase food labeling systems. Academy of Nutrition and Dietetics (AND).
US FDA-POP labeling - US Food and Drug Administration (US FDA). Background information on point of purchase (POP) labeling.
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