Comparing the Effects of Four Front-of-Package Nutrition Labels on Consumer Purchases of Five Common Beverages and Snack Foods: Results from a Randomized Trial.

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Date: Jan. 2022
Publisher: Elsevier Science Publishers
Document Type: Report
Length: 506 words

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Keywords Nutrition labels; Front-of-package labels; Nutrition policy; Food policy; Experimental marketplace Abstract Background Front-of-package (FOP) nutrition labeling systems differ in how they rate food and beverage products. There is a need to examine the implications of these differences, including their focus on nutrients of public health concern. Objective Our aim was to examine the impacts of 4 common FOP labels on consumers' purchases of products that received conflicting ratings across FOP systems. Design In an experimental marketplace, participants were randomized to complete a series of purchases under 1 of 5 FOP conditions: no label, "high in" nutrient labels, multiple traffic light, Health Star Rating, or a 5-color nutrition grade. Participants/setting A final sample of 3,584 Canadians (13 years and older) were recruited from shopping centers in March to May 2018. Main outcome measures Probability of purchasing was assessed for 5 product categories (100% fruit juice, plain milk, chocolate milk, cheese snacks, and diet beverages), which received conflicting ratings across the FOP conditions. Statistical analyses Separate generalized linear mixed models estimated the influence of FOP condition on 5 binary outcomes (1 = purchased, 0 = not purchased) corresponding to the product categories. Results Few differences were observed among the full sample. Among participants who noticed the labels (n = 1,993), those in the Health Star Rating condition were 4.5 percentage points (95% CI --7.0 to --1.9) more likely to purchase 100% fruit juice (compared to multiple traffic light) and 3.3 (95% CI 0.4 to 6.2) and 3.0 percentage points (95% CI 0.1 to 6.1) more likely to purchase cheese snacks (compared to no label and "high in"). "High in" labels produced fewer purchases of chocolate milk than no label. Conclusions Despite some similarities, existing FOP systems differ in the extent to which they promote or dissuade purchases of common product categories. Although the Health Star Rating might encourage purchases of products with certain positive nutritional attributes, "high in" and multiple traffic light systems might more effectively discourage purchases of products contributing nutrients of public health concern. Author Affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada * Address correspondence to: David Hammond, PhD, School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada. Article History: Received 22 October 2020; Accepted 26 July 2021 (footnote) Supplementary materials:, , , and are available at www.jandonline.org(http://www.jandonline.org) (footnote) STATEMENT OF POTENTIAL CONFLICT OF INTEREST David Hammond has provided paid expert testimony on behalf of public health authorities in response to legal challenges from the food and beverage industry. No potential conflict of interest was reported by the remaining authors. (footnote) FUNDING/SUPPORT This study was supported by a Canadian Institutes of Health (CIHR) Research Operating Grant in Sugar and Health (SAH-152808). Additional funding for this project has been provided by a Public Health Agency of Canada (PHAC)--CIHR Chair in Applied Public Health, which supports Professor Hammond, staff, and students at the University of Waterloo. Byline: Rachel B. Acton, PhD, Sharon I. Kirkpatrick, PhD, David Hammond, PhD [david.hammond@uwaterloo.ca] (*)

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Gale Document Number: GALE|A686979915