Abstract
BackgroundDietary inequalities between population groups are common with older and more affluent individuals tending to have healthier diets. Differential responses to health interventions may exacerbate inequalities. Changing what foods are displayed at supermarket checkouts is one intervention that has the potential to change diets. The aim of this study was to assess whether differences in purchases of common checkout foods from supermarkets with different checkout food policies varied according to age group and social grade.MethodsWe analysed annual household purchase data for 2013–17 from nine leading UK supermarkets, split according to age of the main household shopper and household social grade. Checkout food policies were categorised as clear and consistent, vague or inconsistent, and none. Policies were heterogeneous but all included removal of confectionery and/or chocolate from checkouts. Mixed effects linear regression models were used to assess differences in purchases of common checkout foods (sugary confectionery, chocolate and potato crisps) by checkout food policy and whether these varied by age group or occupational social grade.ResultsRelative to supermarkets with no checkout food policy, 14% (95% CI: 4–22%) fewer purchases of common checkout foods per household per percentage market share were made in supermarkets with a clear and consistent policy. Adjusted mean numbers of purchases were higher in older age groups than the youngest, but there were no differences between the highest and other social grades. There were significant interactions between checkout food policy and both age group and social grade. In supermarkets with clear and consistent policies, 23% (6–36%), 20% (2–34%), and 23% (7–37%) fewer purchases were made in age groups 45–54, 55–64 and 65+ years respectively, compared to all groups combined. In supermarkets with clear and consistent policies, there were 21% (4–35%), 26% (9–39%) and 21% (3–35%) fewer purchases made by households in the highest two and lowest social grades respectively, compared to all groups combined.ConclusionsHouseholds with older main shoppers and those in the most and least affluent social grades may be most responsive to supermarket checkout food policies. As older and more affluent groups tend to have healthier diets overall, it is unlikely that supermarket checkout food policies contribute to greater dietary equity.
Highlights
Dietary inequalities between population groups are common with older and more affluent individuals tending to have healthier diets
The aim of this study was to assess whether differences in purchases of common checkout foods from supermarkets with different checkout food policies vary according to age group or socio-economic position
Overall, older people purchased more common checkout foods than younger people, but there were no differences in purchases between those in most affluent versus other social grades
Summary
Dietary inequalities between population groups are common with older and more affluent individuals tending to have healthier diets. Some population interventions may have differential effects by socio-economic position, exacerbating existing inequalities in health. Interventions characterised as high-agency, which rely on individuals’ using their personal resources to benefit (such as labelling or education), may be less effective in less affluent groups [5, 6]. Lower-agency population interventions that require recipients to use few of their personal resources to benefit (such as nutrient fortification of foods or marketing controls) are thought to be less likely to exacerbate existing inequalities [5,6,7]
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