Association for Public Policy Analysis & Management

Research Objective: Roughly one in three American adults has high blood pressure, and research has indicated that lowering sodium consumption can lower blood pressure. U.S. state and local policymakers have used a variety of strategies to help adults find lower sodium options. This study maps the landscape of laws and regulations (“policies”) that expressly target sodium in all fifty states and the twenty most populous counties and cities in the U.S. (including Washington, D.C.), and evaluates the evidence for six policy interventions.

Study Design: Based on a preliminary literature review and discussion with subject matter experts, researchers chose to analyze U.S. interventions targeted either toward adults or toward the general population that expressly mention “sodium” or “salt” and fall into one or more of the following categories: (1) vending machines, (2) institutional meal services, (3) menu labeling, (4) consumer incentives, (5) grocer incentives, and (6) worksites. Legal researchers used Westlaw, American Legal Publishing, Municode, local government websites, and Google, to identify, code, and map policies. Health researchers conducted a literature search for relevant interventions in these six topical areas in Medline, Embase, and Cinahl. They used the Quality and Impact of Component Evidence Assessment (QuIC) tool to assess the strength of each intervention’s evidence base based on study quality and outcomes, and then assigned an evidence rating to each intervention: “best”, “promising quality”, “promising impact”, or “emerging”.

Principal Findings: Researchers preliminarily identified 38 relevant sodium reduction (21 state and 17 urban local) and 10 state preemption policies. Policies expressly incentivizing grocers to carry lower sodium products were least common, while policies impacting government worksites, vending machines, labeling, and meal services were most common. Local urban sodium reduction policies were largely concentrated in the West. Meal service, workplace, labeling, and grocer interventions were supported by “best” evidence, vending initiatives were supported by “promising impact”, and consumer incentives were supported by “emerging” evidence.

Conclusions: Sodium reduction policies related to institutional meal services, workplaces, and menu labeling are more common and geographically widespread, and each are supported by “best” or “promising” evidence. Grocer-focused sodium reduction policies are less common and also reflect “best” evidentiary support. “Emerging” evidence supports sodium reduction interventions related to consumer incentives, and further research in these areas is welcome.