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. 2019 Sep 4;9(9):CD012573.
doi: 10.1002/14651858.CD012573.pub3.

Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption

Gareth J Hollands  1 , Patrice Carter, Sumayya Anwer, Sarah E King, Susan A Jebb, David Ogilvie, Ian Shemilt, Julian P T Higgins, Theresa M Marteau
Affiliations

Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption

Gareth J Hollands et al. Cochrane Database Syst Rev. .

Abstract

Background: Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers.

Objectives: 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii.

Search methods: We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches.

Selection criteria: We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product.

Data collection and analysis: We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE.

Main results: We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias.

Authors' conclusions: The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.

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Conflict of interest statement

Gareth Hollands declares no financial or other conflicts of interest.

Patrice Carter declares no financial or other conflicts of interest.

Sumayya Anwer declares no financial or other conflicts of interest.

Sarah King declares no financial or other conflicts of interest.

Susan Jebb declares no financial or other conflicts of interest.

David Ogilvie declares no financial or other conflicts of interest.

Ian Shemilt declares no financial or other conflicts of interest.

Julian Higgins declares no financial or other conflicts of interest.

Theresa Marteau declares no financial or other conflicts of interest.

Figures

1
1
Final conceptual model. Changes from the provisional conceptual model (Hollands 2017b), comprising two additions, are shown in red type.
2
2
Study flow diagram.
3
3
Forest plot of the standardised mean difference (SMD) in selection with higher (intervention 1) versus lower (intervention 2) availability of food products (i.e. more versus fewer options).
4
4
Forest plot of the standardised mean difference (SMD) in consumption with higher (intervention 1) versus lower (intervention 2) availability of food products (i.e. more versus fewer options).
5
5
Forest plot of the standardised mean difference (SMD) in consumption with higher (intervention 1) versus lower (intervention 2) proximity of food products (i.e. placed nearer versus farther away).
6
6
Funnel plot for meta‐analysis of consumption with higher versus lower proximity.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Muckelbauer 2009 {published data only}
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Novotny 2011 {published data only}
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Parker 2001 {published data only}
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Patel 2011 {published data only}
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Perez‐Morales 2011 {published data only}
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Perry 2004 {published data only}
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Rausch 2013 {published data only}
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Raynor 2006 {published data only}
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Raynor 2012a {published data only}
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Raynor 2012c {published data only}
    1. Raynor HA, Steeves EA, Hecht J, Fava JL, Wing RR. Limiting variety in non‐nutrient‐dense, energy‐dense foods during a lifestyle intervention: a randomized controlled trial. American Journal of Clinical Nutrition 2012;95:1305‐1314. - PMC - PubMed
Redden 2015 {published data only}
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Romero 2016 {published data only}
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Rozin 2011 {published data only}
    1. Rozin P, Scott S, Dingley M, Urbanek JK, Jiang H, Kaltenbach M. Nudge to nobesity I: Minor changes in accessibility decrease food intake. Judgment and Decision Making 2011;6:323‐332.
Sallis 2003 {published data only}
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    1. Scherr RE, Linnell J, Smith M, Nicholson Y, Spezzano T, Bergman J, et al. The shaping healthy choices program: a multi‐component, school‐based approach to improve children's nutrition and health behaviors while supporting regional agriculture. FASEB Journal 2013;27:623.6.
Scherr 2014 {published data only}
    1. Scherr R, Linnell J, Smith M, Nicholson Y, Spezzano T, Bergman J, et al. The Shaping Healthy Choices Program results in improved nutrition and health‐related outcomes. FASEB Journal 2014;28:273.6.
Schwartz 2009 {published data only}
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Song 2008 {published data only}
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Stea 2009 {published data only}
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Steyn 2015 {published data only}
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Te Velde 2008 {published data only}
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Thorndike 2016 {published data only}
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Thorndike 2017 {published data only}
    1. Thorndike AN, Bright OM, Dimond MA, Fishman R, Levy DE. Choice architecture to promote fruit and vegetable purchases by families participating in the Special Supplemental Program for Women, Infants, and Children (WIC): randomized corner store pilot study. Public Health Nutrition 2017;20(7):1297‐1305. - PMC - PubMed
Toft 2017 {published data only}
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Uglem 2013 {published data only}
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Uglem 2014 {published data only}
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van Kleef 2012 {published data only}
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Wansink 2013b {published data only}
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Wijnhoven 2015 {published data only}
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Wilbur 1981 {published data only}
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Wilcox 2009 {published data only}
    1. Wilcox K, Vallen B, Block L, Fitzsimons GJ. Vicarious goal fulfillment: when the mere presence of a healthy option leads to an ironically indulgent decision. Journal of Consumer Research 2009;36:380‐393.
Wilson 2017 {published data only}
    1. Wilson NLW, Just DR, Swigert J, Wansink B. Food pantry selection solutions: a randomized controlled trial in client‐choice food pantries to nudge clients to targeted foods. Journal of Public Health 2017;39(2):366‐372. - PubMed
Wolfenden 2015 {published data only}
    1. Wolfenden L, Kingsland M, Rowland BC, Dodds P, Gillham K, Sze LY, et al. Improving availability, promotion and purchase of fruit and vegetable and non sugar‐sweetened drink products at community sporting clubs: a randomised trial. International Journal of Behavioral Nutrition and Physical Activity 2015;12:35. - PMC - PubMed
Wordell 2012 {published data only}
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Zeinstra 2010 {published data only}
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References to studies awaiting assessment

Hua 2017 {published data only}
    1. Hua SV, Kimmel L, VanEmmenes M, Taherian R, Remer G, Millman A, et al. Health promotion and healthier products increase vending purchases: a randomized factorial trial. Journal of the Academy of Nutrition and Dietetics 2017;117:1057‐1065. - PubMed
Watanabe 2016 {published data only}
    1. Watanabe A, Fukuda Y. Effect of dish order on food intake in a buffet lunch among Japanese university students. JJHEP 2016;24(1):3‐11.

References to ongoing studies

Knowles 2017 {published data only}
    1. Knowles D, Brown K, Aldrovandi S. Investigating the proximity effect in a competitive food environment: a study protocol. osf.io/fgm4s/ (created 18 September 2017).
Knowles 2018a {published data only}
    1. Knowles D, Brown K, Aldrovandi S. Exploring the role of effort within the proximity effect: a study protocol. osf.io/eqt92/ (created 5 April 2018).
Knowles 2018b {published data only}
    1. Knowles D, Brown K, Aldrovandi S. Exploring the role of visual salience within the proximity effect. osf.io/5gx9y/ (created 21 May 2018).
Knowles 2018c {published data only}
    1. Knowles D, Brown K, Aldrovandi S. Does the proximity effect occur through non‐conscious processes? A study protocol. osf.io/zn256/ (created 26 November 2018).

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