Dataset Information

The Impact of the Australasian 'Health Star Rating', Front-of-Pack Nutritional Label, on Consumer Choice: A Longitudinal Study.

ABSTRACT: Front-of-pack (FoP) nutrition labels are a widely deployed tool in public good marketing. This article reports on a field experimental test of the impact of one of these systems, the Australasian Health Star Rating system (HSR), on consumer choice in the breakfast cereals category in New Zealand. This study forms part of a time-series replication stream of research on this topic. The research applied a 2 × 2 factorial design with multiple replications to retail food consumers exiting from supermarkets in New Zealand. The first part of the time series, undertaken shortly after the HSR's initiation in 2014, indicated that the HSR was ineffective. Between 2014 and 2016, commercial brands in the category within New Zealand massively promoted the HSR as a basis for consumer choice. The research presented in this article forms part of the second part of the series, undertaken in 2016, using an identical experimental methodology to the 2014 study. The results indicate that the HSR may be beginning to influence consumer choice as it was predicted to, but the impact of the system is still small, and statistically sub-significant, relative to other consumer decision inputs presented on the package.

SUBMITTER: Hamlin R

PROVIDER: S-EPMC6073628 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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The Impact of the Australasian 'Health Star Rating', Front-of-Pack Nutritional Label, on Consumer Choice: A Longitudinal Study.

Hamlin Robert R McNeill Lisa L

Nutrients 20180716 7

Front-of-pack (FoP) nutrition labels are a widely deployed tool in public good marketing. This article reports on a field experimental test of the impact of one of these systems, the Australasian Health Star Rating system (HSR), on consumer choice in the breakfast cereals category in New Zealand. This study forms part of a time-series replication stream of research on this topic. The research applied a 2 × 2 factorial design with multiple replications to retail food consumers exiting from superm ...[more]

PMID: 30012941

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Project description:The Health Star Rating (HSR) is an interpretive front-of-pack labelling system that rates the overall nutritional profile of packaged foods. The algorithm underpinning the HSR includes total sugar content as one of the components. This has been criticised because intrinsic sugars naturally present in dairy, fruits, and vegetables are treated the same as sugars added during food processing. We assessed whether the HSR could better discriminate between core and discretionary foods by including added sugar in the underlying algorithm.Nutrition information was extracted for 34,135 packaged foods available in The George Institute's Australian FoodSwitch database. Added sugar levels were imputed from food composition databases. Products were classified as 'core' or 'discretionary' based on the Australian Dietary Guidelines. The ability of each of the nutrients included in the HSR algorithm, as well as added sugar, to discriminate between core and discretionary foods was estimated using the area under the curve (AUC).15,965 core and 18,350 discretionary foods were included. Of these, 8230 (52%) core foods and 15,947 (87%) discretionary foods contained added sugar. Median (Q1, Q3) HSRs were 4.0 (3.0, 4.5) for core foods and 2.0 (1.0, 3.0) for discretionary foods. Median added sugar contents (g/100 g) were 3.3 (1.5, 5.5) for core foods and 14.6 (1.8, 37.2) for discretionary foods. Of all the nutrients used in the current HSR algorithm, total sugar had the greatest individual capacity to discriminate between core and discretionary foods; AUC 0.692 (0.686; 0.697). Added sugar alone achieved an AUC of 0.777 (0.772; 0.782). A model with all nutrients in the current HSR algorithm had an AUC of 0.817 (0.812; 0.821), which increased to 0.871 (0.867; 0.874) with inclusion of added sugar.The HSR nutrients discriminate well between core and discretionary packaged foods. However, discrimination was improved when added sugar was also included. These data argue for inclusion of added sugar in an updated HSR algorithm and declaration of added sugar as part of mandatory nutrient declarations.

Project description:BackgroundFront-of-pack nutrition labelling (FoPL) of packaged foods can promote healthier diets. Australia and New Zealand (NZ) adopted the voluntary Health Star Rating (HSR) scheme in 2014. We studied the impact of voluntary adoption of HSR on food reformulation relative to unlabelled foods and examined differential impacts for more-versus-less healthy foods.Methods and findingsAnnual nutrition information panel data were collected for nonseasonal packaged foods sold in major supermarkets in Auckland from 2013 to 2019 and in Sydney from 2014 to 2018. The analysis sample covered 58,905 unique products over 14 major food groups. We used a difference-in-differences design to estimate reformulation associated with HSR adoption. Healthier products adopted HSR more than unhealthy products: >35% of products that achieved 4 or more stars displayed the label compared to <15% of products that achieved 2 stars or less. Products that adopted HSR were 6.5% and 10.7% more likely to increase their rating by ≥0.5 stars in Australia and NZ, respectively. Labelled products showed a -4.0% [95% confidence interval (CI): -6.4% to -1.7%, p = 0.001] relative decline in sodium content in NZ, and there was a -1.4% [95% CI: -2.7% to -0.0%, p = 0.045] sodium change in Australia. HSR adoption was associated with a -2.3% [-3.7% to -0.9%, p = 0.001] change in sugar content in NZ and a statistically insignificant -1.1% [-2.3% to 0.1%, p = 0.061] difference in Australia. Initially unhealthy products showed larger reformulation effects when adopting HSR than healthier products. No evidence of a change in protein or saturated fat content was observed. A limitation of our study is that results are not sales weighted. Thus, it is not able to assess changes in overall nutrient consumption that occur because of HSR-caused reformulation. Also, participation into labelling and reformulation is jointly determined by producers in this observational study, impacting its generalisability to settings with mandatory labelling.ConclusionsIn this study, we observed that reformulation changes following voluntary HSR labelling are small, but greater for initially unhealthy products. Initially unhealthy foods were, however, less likely to adopt HSR. Our results, therefore, suggest that mandatory labelling has the greatest potential for improving the healthiness of packaged foods.

Project description:Front-of-pack (FOP) nutrition labelling has received growing attention from public health authorities, as a tool to promote healthier diets in the population. Recently, the French Health law introduced the principle of implementing a FOP nutrition labelling system. A scientific proposal has put forward the 5-Colour Nutrition Label (5-CNL), a five-category colour-coded summary system supported by research suggesting that it is well perceived and understood in the population. Our objective was to investigate the impact of the 5-CNL on the nutritional quality of purchases in experimental supermarkets.Participants (n?=?901) were recruited using quota sampling between September and December 2015 and evenly distributed in three experimental conditions: 1) control situation; 2) Application of the 5-CNL on all food products in three specific sections: breakfast cereals, sweet biscuits and appetizers; 3) introduction of the 5-CNL accompanied by consumer information on use and understanding of the label. Main outcome was the nutritional quality of the shopping cart in the three sections combined, measured using the United Kingdom Food Standards Agency nutrient profiling system (FSA score).Significantly higher mean nutritional quality of the purchased items per section were observed for the sweet biscuits category in the intervention combining the label?+?communication (overall FSA score 21.01 vs. 20.23, P?=?0.02). No significant effects were observed for the general mean over the three sections combined or other food categories. The results observed on purchase may be related to the high level of recall, self-reported and objective understanding of the label that were observed in the intervention groups as they are pre-requisites for use of a label in purchasing situations.These results suggest that the 5-CNL FOP nutrition label may have a limited impact on purchases, leading to healthier food choices in some food categories such as sweet biscuits.The trial was registered on Clinicaltrials.gov under the number NCT02546505 .

Project description:BackgroundMost food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior.ObjectiveThe Front-of-pack food Labels: Impact on Consumer Choice (FLICC) study is a pilot randomized controlled trial of a digital behavior change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial.MethodsThe intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals for behavior change, and model and practice the recommended healthy shopping behavior using traffic light labels. The control consisted of Web-based information on traffic light labeling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the 6 months before recruitment, during the 6-week intervention period, and during a 12-week washout period were transferred to the research team by the participating supermarket. Healthiness of ready meals and pizzas was measured using a predeveloped scale based solely on the traffic light colors on the foods. Questionnaires were completed at recruitment, end of the intervention, and end of washout to estimate the effect of the intervention on variables that mediate behavior change (eg, belief and intention formation).ResultsWe recruited 496 participants from an initial email to 50,000 people. Only 3 people withdrew from the study, and purchase data were received for all other participants. A total of 208 participants completed all 3 questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P=.32) or at washout (P=.59).ConclusionsAlthough the FLICC study did not find evidence of an impact of the intervention on food purchasing behavior, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research.Trial registrationISRCTN Registry ISRCTN19316955; http://www.isrctn.com/ISRCTN19316955 (Archived by WebCite at http://www.webcitation.org/76IVZ9WjK).International registered report identifier (irrid)RR2-10.1186/s40814-015-0015-1.

Project description:Front-of-pack labeling is a cost-effective strategy to decrease population consumption of sodium, sugar, saturated fat, total fat, and trans-fatty acids, considered critical nutrients for chronic disease. Our main objective was to explore the subjective understanding of labels that are currently used internationally among low- and middle-income Mexican consumers. We performed two phases of 10 focus groups with adolescents (13-15 y), young adults (21-23 y), mothers of children 3-12 y, fathers of children 3-12 y and older adults (55-70 y). Seven FOPL were evaluated: Guideline Daily Amounts, Multiple Traffic Light, Chilean Warning labels, Warning labels in Red, 5-Color Nutrition Label, Health Star Rating, and Healthy Choice label. Data was analyzed with a triangulation of researchers using a content analysis, based on three codes: 1) awareness and use of the Guideline Daily Amounts, 2) acceptability, and 3) subjective understanding of labels. Most participants were aware of the Guideline Daily Amounts, however they rarely used it because interpreting the information displayed on the label was too complicated. Health Star Rating, Warning labels, Multiple Traffic Light and the Healthy Choice logo labels were the most understandable, however the acceptability of the The Healthy Choice logo decreased as it did not provide information on specific ingredients. The Warning labels was the only label able to warn about critical nutrients that could represent a health risk. The Warning labels in red was more accepted compared to Warning labels in black. Results show that directive and semi-directive labels, such as Warning labels, Health Star Rating or Multiple Traffic Light, may be better at helping population of low- and middle income make healthier food choices, than non-directive FOPL such as the Guideline Daily Amounts implemented in México. The study results highlight the potential of Warning labels to support decreases in the consumption of critical ingredients in low- and middle-income Mexican consumers.

Project description:BACKGROUND:Front-of-pack (FOP) nutrition labeling is a cost-effective strategy to help consumers make informed and healthier food choices. We aimed to investigate the effect of the FOP labels used in the Latin American region on consumers' shopping intentions when prompted to make their choices with specific nutrients-to-limit in mind among low- and middle-income Mexican adults (>?18 y). METHODS:In this experimental study of an online simulated shopping situation participants (n?=?2194) were randomly assigned to one of three labeling conditions: Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), or red Warning Labels (WL). Participants were required to view a video explaining how to correctly interpret the assigned label. Primary outcomes were the overall nutritional quality (estimated using the Nutrient Profiling Scoring Criterion [NPSC] and NPSC baseline score) and mean energy and nutrient content of purchases. Secondary outcomes included shopping time variables. We also evaluated the impact of the labels across food categories (ready-made foods, dairy beverages, non-dairy beverages, salty snacks, and breakfast cereals) and sociodemographic subgroups. RESULTS:The MTL and the WL led to a better overall nutritional quality of the shopping cart compared to the GDA (p?<?0.05). According to the NPSC score, the WL led to a better nutritional quality across breakfast cereals and salty snacks compared to the GDA (p?<?0.05); a similar effect was observed for the MTL among non-dairy beverages (p?<?0.05). The MTL and the WL required shorter shopping times compared to GDA (p?<?0.05). Across all labeling conditions, the nutritional quality of the shopping cart tended to be lower among those with low income, education and nutrition knowledge levels. CONCLUSION:WL and MTL may foster healthier food choices in a faster way among low- and middle-income groups in Mexico. To produce an equitable impact among consumers of all socioeconomic strata, efforts beyond simply the inclusion of a communication campaign on how to use and interpret FOP labels will be required. TRIAL REGISTRATION:clinicaltrials.gov. NCT04308408 Retrospectively registered March 16, 2020.

Project description:BACKGROUND:Front-of-package labelling is a cost-effective strategy to help consumers make healthier choices and informed food purchases. The effect of labels is mediated by consumer understanding and acceptability of the label. We compared the acceptability and understanding of labels used in Latin-America among low- and middle-income Mexican adults. METHODS:Participants (n =?2105) were randomly assigned to one of three labels: Mexican Guideline Daily Allowances (GDA), Ecuador's Multiple Traffic Lights (MTL), or Chile's Warning Labels (WL) in red. Label acceptability was evaluated through items regarding likeability, attractiveness and perceived cognitive workload. Objective understanding was evaluated by asking participants to select the product with the lowest nutritional quality among three products. We measured the time participants took to choose the product. Differences in label acceptability, understanding and time required to choose a product across labels were tested. RESULTS:Compared to the GDA, a higher proportion of participants liked the MTL and WL, considered them attractive, and with a lower perceived cognitive workload (p <?0.05). Participants had 4.00 (2.86-5.59) times the odds of correctly identifying the product with the lowest nutritional quality when using the MTL label and 4.52 (3.24-6.29) times the odds when using the WL, in comparison to the GDA. Time required to choose the product was lower for the MTL (Median: 11.25?s; IQR?=?8.00-16.09) and the WL (Median?= 11.94?s, IQR?=?8.56-16.52) compared to the GDA (Median: 15.31?s; IQR?=?10.81-20.21; p <?0.05). No differences were observed between the MTL and the WL. CONCLUSIONS:GDA had the lowest acceptability and understanding among the labels tested. The MTL and the WL were more accepted and understood, and allowed low- and middle-income consumers to make nutrition-quality related decisions more quickly. WL or MTL may foster healthier food choices in the most vulnerable groups in Mexico compared to the current labelling format.

Dataset Information

The Impact of the Australasian 'Health Star Rating', Front-of-Pack Nutritional Label, on Consumer Choice: A Longitudinal Study.

Publications

The Impact of the Australasian 'Health Star Rating', Front-of-Pack Nutritional Label, on Consumer Choice: A Longitudinal Study.

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