Navigation
Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption
The increasing prevalence of non-communicable diseases, linked to overindulgence in food, alcohol, and tobacco, necessitates effective public health interventions. This review focuses on strategies to modify physical environments, such as retail spaces, workplaces, and schools, to influence consumer choices regarding these products. Specifically, it examines how changes in the availability and proximity of food items can affect selection and consumption.
The primary goals of the research were twofold: first, to evaluate the effects of changes in the availability or closeness of food, alcohol, and tobacco products on consumer behavior; and second, to identify how study design, intervention specifics, and participant characteristics might influence these outcomes.
A comprehensive search across multiple databases, including CENTRAL, MEDLINE, and Embase, was conducted up to July 23, 2018. The criteria for inclusion were randomized controlled trials employing either parallel or cross-over designs that compared different levels of product availability or proximity, alongside measures of selection or consumption.
The review incorporated 24 studies, with a predominant focus on food products—none evaluated alcohol or tobacco. The majority (20) of these studies raised concerns regarding potential biases. Most were conducted in laboratory settings (14) with adult participants (17), primarily from high-income nations, especially the USA (14).
Among the studies, six explored interventions related to availability, with two modifying the absolute number of options and four adjusting the ratio of healthier to less healthy choices. Meta-analysis revealed that reducing the number of options significantly lowered selection rates, with a standardized mean difference (SMD) of -1.13 (95% confidence interval [CI] -1.90 to -0.37, indicating low certainty). In terms of consumption, another meta-analysis showed a moderate reduction with an SMD of -0.55 (95% CI -1.27 to 0.18, also with low certainty).
Further, 18 studies investigated the impact of proximity interventions. Fourteen focused on the distance of snack foods from participants, while others varied the order of meal components. A single analysis indicated that greater distance led to decreased selection of food, with an SMD of -0.65 (95% CI -1.29 to -0.01, characterized by very low certainty). Regarding consumption, a meta-analysis of 15 comparisons reported a moderate reduction, with an SMD of -0.60 (95% CI -0.84 to -0.36; low certainty). Meta-regression results indicated that this effect intensified with greater distance, limited product availability, lower participants’ deprivation status, and higher study-bias risk.
In conclusion, this analysis suggests that interventions aimed at modifying the availability and positioning of food options can lead to meaningful behavioral changes, supporting the need for policy initiatives in food environments. However, the low level of assurance in the evidence calls for further investigations in real-world contexts, encompassing a broader range of products, including alcohol and tobacco, over extended periods. [NPID: Availability, proximity, food distance, consumption]
Year: 2019
