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Future pricing interventions should be based on solid formative research, and these findings should be reported in the published literature. Process evaluation of any form was rarely conducted in these studies. This is a major limitation of these studies, as it is of any intervention that neglects to collect process data Failure to include process evaluation means that whether the failure of the intervention was because it was inherently flawed or because the intervention was not implemented as intended cannot be understood. Process evaluation data should be collected to assess implementation for all future pricing interventions.

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Several studies emphasized the importance of assessing the substitution effect using savings from discounts to purchase other less healthy foods and the compensation effect purchasing more healthy foods but not reducing total energy intake of pricing interventions on food purchases and dietary intakes 28,63, However, such assessment was not done in any of the studies reviewed and remains a major gap in this literature. Finally, a major gap in the studies reviewed is any type of uniform attention to consumer psychosocial outcomes.

We recommend developing a core set of psychosocial measures for these types of intervention trials and recommend that they be based on theoretical frameworks. This systematic review has several limitations. First, we focused exclusively on peer-reviewed literature. It is possible that additional, unpublished trials have been conducted.

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This information may have been available in gray literature reports, on websites, or in other unexamined documents and thus were not included in this review. However, our use of only peer-reviewed literature helps to ensure a reasonable quality level of the research reported. Third, the use of only peer-reviewed literature may lead to publication bias, because studies with negative or null outcomes are less likely to be published. Fourth, our quality of study criteria did not include a measure of number of community venues for implementation sites.

Nevertheless, we used these criteria to ensure comparability to previous studies Finally, we did not conduct a meta-analysis to evaluate the pooled effectiveness of each pricing intervention strategy. Thus, the statement that one pricing strategy was no more effective than any other is based on the synthesis of the results and should be interpreted with caution.

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Because each pricing intervention strategy assessed different outcomes, it was challenging to compare the effect sizes of the studies and assess treatment effect. We included many studies outside the United States to enhance generalizability. Pricing incentives and disincentive strategies to affect access, purchasing, and consumption of healthy and unhealthy foods and beverages in high-income and medium-income countries provide an evidence-based approach to improve healthy food access at the retail level and consumer purchasing and consumption individual-level behaviors.

Most studies reviewed promoted fresh produce, although few discouraged purchasing and consumption of unhealthy foods. Further research that uses robust study designs and measurements are needed in real community settings to simultaneously test subsidies of healthy foods and beverages and the effects of increased costs of unhealthy foods and beverages. The content is solely the responsibility of the authors and does not necessarily represent the official views of RWJF.

RWJF had no role in study design; collection, analysis, and interpretation of data; writing the article; and the decision to submit the article for publication. We thank Dr Mary Story for her helpful comments. Telephone: Email: jgittel1 jhu.

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Preventing Chronic Disease. Section Navigation. Minus Related Pages. View Page In: pdf icon. Links with this icon indicate that you are leaving the CDC website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link. CDC is not responsible for Section compliance accessibility on other federal or private website. Cancel Continue. Low-income black residents in Baltimore, Maryland, To improve healthy food purchasing in carryout restaurants offering a reduced-price combination meal; to increase total sales of healthy foods and carryout revenue.

RCT, 4 arms: 1 pricing incentive at wholesaler, 2 communications, 3 pricing and communications, 4 control.

Low-income black adult consumers in Baltimore, Maryland, — To assess the impact of separate and combined pricing and communication strategies on food purchasing and on retailer stocking and sales. Quasi-experimental successive and additive interventions: signage, taste-testing, price reduction; qualitative and quantitative observations.

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Pool patrons: children and adults living in Alberta, Canada, in To assess the comparative and additive efficacy of 2 nudges and an economic incentive in supporting healthy food purchases. Group-randomized controlled trial, 2 arms: 1 intervention, 2 control. Employees at 6 worksites in Minneapolis—St Paul, Minnesota, — To positively influence weight gain prevention. Quasi-experimental design: first year, no intervention; second year, intervention.

School-aged children K—12 , various income levels, living in Mississippi, — To improve purchase of healthy beverage choices; maintaining profit in school stores by increasing availability, reducing prices, and labeling. Adult sports club members in New South Wales, Australia, — RCT, 4 arms: 1 skill-building, 2 price reduction, 3 skill-building and price reduction, 4 control.

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To increase purchasing and consumption of FV, reduce purchasing of SSBs, increase purchasing of low-calorie soft drinks and water. RCT, 4 arms: 1 tailored nutrition education, 2 price reduction, 3 combination of tailored nutrition and price reduction, 4 control. To test the effect of price discounts and nutrition education on supermarket food and nutrient purchases. Quasi-experimental, 3 phases: 1 location only, 2 location and signage, 3 location, signage, and price reduction. Young adults, college students in Lima Peru, To improve fruit purchases in a university cafeteria.

Mixed-methods, pre—post repeated measure design; no comparison group. Low-income urban Hispanic families in San Diego, California, — To examine the effect of a doubling incentive on number of farmers market visits, consumer diets, and economic benefits to farmers. Quasi-experimental, 4 arms: 1 coupon, 2 education, 3 coupon and education, 4 control. To increase FV attitudes and intake through a coupon intervention and education combined. Quasi-experimental, 3 arms: 1 WIC site no. Quasi-experimental, time series, no comparison.

Low-income, predominantly black women in rural South Carolina, — To increase access to FV, increase use of food assistance, and improve revenue trends at a farmers market through a pricing intervention. RCT, 3 arms: 1 letter with social norm feedback, 2 letter plus financial incentive, 3 control. Low-income health-deprived adults in France, — To evaluate the impact of nutritional counseling alone, or counseling plus vouchers, on FV consumption and biomarkers. Case-control, nonrandomized trial, 2 arms: 1 rebate, 2 control. Low-income overweight Latino women with type 2 diabetes in New York City, To improve intake and purchasing of FV by a combined education and voucher intervention.


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To examine the effect of additional money supermarket vouchers on food expenditures in food-insecure households with children. Secondary school students in Minneapolis—St Paul, Minnesota, — To increase availability and sales of low-fat food options in high school cafeterias. RCT, 2 arms: 1 rewards intervention, 2 delayed intervention control. Low-income pregnant women in the United Kingdom.

To increase fruit and fruit juice intake by pregnant women by using vouchers or counseling.