Impact of front-of-pack labels on the perceived healthfulness of a sweetened fruit drink: a randomised experiment in five countries.

Alejandra Jáuregui,Marissa G Hall,Claudia Nieto,David Hammond,Alejandra Contreras-Manzano,James F Thrasher,Gary Sacks,Lana Vanderlee,Christine M White,Simón Barquera

doi:10.1017/s1368980021004535

Abstract

Front-of-pack (FOP) nutrition labelling is a globally recommended strategy to encourage healthier food choices. We evaluated the effect of FOP labels on the perceived healthfulness of a sweetened fruit drink in an international sample of adult consumers. Six-arm randomised controlled experiment to examine the impact of FOP labels (no label control, Guideline Daily Amounts (GDA), Multiple Traffic Lights, the Health Star Ratings (HSR), Health Warning Labels, and 'High-in' Warning Labels (HIWL)) on the perceived healthfulness of the drink. Linear regression models by country examined healthfulness perceptions on FOP nutrition labels, testing for interactions by demographic characteristics. Online survey in 2018 among participants from Australia, Canada, Mexico, United Kingdom (UK) and United States. Adults (≥18 years, n 22 140). Compared with control, HIWL had the greatest impact in lowering perceived healthfulness (β from -0·62 to -1·71) across all countries. The HIWL and the HSR had a similar effect in Australia. Other labels were effective in decreasing the perceived healthfulness of the drink within some countries only, but to a lower extent. The GDA did not reduce perceived healthfulness in most countries. In the UK, the effect of HIWL differed by age group, with greater impact among older participants (> 40 years). There were no other variations across key demographic characteristics. HIWL, which communicates clear, non-quantitative messages about high levels of nutrients of concern, demonstrated the greatest efficacy to decrease the perceived healthfulness of a sweetened fruit drink across countries. This effect was similar across demographic characteristics.

Highlights

Stratified models showed that High-in’ Warning Labels (HIWL) were the most effective label in reducing the perceived healthfulness of the fruit drink compared with the control group in all countries, as
Results indicate that warning labels are the most promising FOP labelling option to change consumer healthfulness perceptions
Given that HIWL have been effectively implemented in several countries to date, and are compatible with international trade agreements, the current study adds to the evidence demonstrating that implementing HIWL on the front of packages is a strong policy option

Summary

Methods

Study design and recruitment A six-arm, unblinded online randomised experiment was conducted as part of the broader 2018 International Food Policy Study (IFPS), a cross-sectional survey of adults aged ≥18 years (n 22 824) from Australia, Canada, Mexico, the UK and the US, who completed an online survey in 2018. 2·9 % of participants (n 684) were excluded due to missing data in the outcome (n 634) or a technical glitch in the survey platform making participants view all experimental conditions on the screen (n 50), leaving 22 140 participants for analyses (Australia = 3964; Canada = 4311; Mexico = 4057; UK = 5290; US = 4518). Small differences between included and excluded participants were observed (P < 0·01) (online supplementary material, Supplemental Table 2). Missing data in the outcome across label conditions ranged from 1·8 to 3·7 % (P < 0·001) (online supplementary material, Supplemental Table 3)

Results

Discussion

Conclusion