Pack Labelling Research Articles

The effect of front-of-package labels or point-of-sale signage on consumer knowledge, attitudes and behavior regarding sugar-sweetened beverages: a systematic review.

Globally, the use of labels or signage targeting SSBs remains in its infancy and there is limited evidence available regarding its ability to decrease purchase and consumption of SSBs. This systematic review aimed to synthesize the evidence on the effect of sugar- or health-related sugar-sweetened beverage (SSB) warning labels or signage on knowledge, attitudes, and beliefs, and SSB purchase and consumption. Nine databases - Ovid Medline, Emerald Insight, Scopus, Informit, Business Source Complete, CINAHL, Global Health, PsychINFO, and SocIndex - were searched along withgrey literature from inception to December 2019. The PRISMA guidelines were applied for reporting this systematic review. Studies examining the impact of front of pack (FOP) labels and/or point of sale (POS) signage highlighting added sugar content or its health risks were included. Two authors independently extracted data on items, including study details, study design, population characteristics, intervention label details (type, duration, and settings), and outcomes measures. The Effective Public Health Practice Project tool was used to assess the study quality. Findings were synthesized narratively. Twenty-one studies published between 1992 and 2019 were included. Of these, 16 studies examined the impact of FOP labels and 5 studies examined the impact of POS signage. Both FOP labels and POS signage were associated with improved health knowledge, attitudes, and beliefs regarding SSBs and reduced SSB purchases. Warning labels with diet-related health consequences were found to be particularly effective. Overall quality of studies was assessed as mixed. Health- or sugar-related FOP labels and POS signage for SSBs are promising public health measures and may improve consumers' health behaviors toward reduced SSB purchase and consumption.

Junk food advocacy. Countering the industry

Abstract Background The junk food and alcohol industries have taken a page from the tobacco industry play book in an attempt to resist regulation through delay, self-regulation and effective lobbying. The junk food industry internationally is constantly seeking to increase sales at a time when the obesity crisis continues to grow. The industry thrives through widespread marketing with a particular focus on children. Methods An assessment of the number of lobbyists engaged to influence members of Parliament in Australia is being conducted to understand attempts to influence policy. This follows a scan of the lobbyists' register by Daube et al in 2018 that found the junk food industry had 33 direct and 13 indirect lobbyists. A re-examination of the register in 2020 is expected to reveal an increase in these numbers as international junk food companies become more concerned about regulation by government in areas such as front of pack labelling and marketing. There will also be an examination of the State and Territory registers in an attempt to understand the extent of influence in all governments across Australia. Discussion This examination is focused on the Australian Parliament/s. However, the message will be similar world-wide. Many companies have been challenged about their approaches to marketing and the sales of junk food. However, despite some attempt at corporate responsibility (Ronald McDonald House), they continue to sell their products to the detriment of community health. Presentation The presentation will focus on the importance and methods of countering the efforts of industry to increase availability of junk food by opposing regulation. It will also provide a series of steps that public health advocates can take in order to persuade governments of the importance of protecting community health through appropriate regulation of the marketing and sales of junk food. Key messages Junk food industry employs multiple lobbyists to resist regulatory reform. There are tools available for public health advocates to counter this influence.

Cigarette Packs With URLs Leading to Tobacco Company Websites: Content Analysis.

BackgroundTobacco companies include on the packaging of their products URLs directing consumers to websites that contain protobacco messages. Online media tend to be underregulated and provide the industry with an opportunity to present users with protobacco communication.ObjectiveThe objective of our study was to document the content of websites that were advertised on tobacco packs in 14 low- and middle-income countries.MethodsWe purchased tobacco packs from 14 low- and middle-income countries in 2013 and examined them for the presence of URLs. We visited unique URLs on multiple occasions between October 1, 2016 and August 9, 2017. We developed a coding checklist and used it to conduct a content analysis of active corporate websites to identify types of protobacco communication. The coding checklist included the presence of regulatory controls and warnings, engagement strategies, marketing appeals (eg, description of product popularity, luxury/quality, taste), corporate social responsibility programs, and image management. We coded brand websites separately and also described social media and other website types.ResultsWe identified 89 unique URLs, of which 54 were active during the search period. We assessed 26 corporate websites, 21 brand websites, 2 nontobacco websites, and 5 social media pages. We excluded 2 corporate websites and 14 brand websites due to limited accessible content or incomplete content. Corporate social responsibility was discussed on all corporate websites, and marketing appeals were also common. Corporate websites were also more likely to include more nonspecific (12/24, 50%) than specific (7/24, 29%) health warnings. Promotions (6/7, 86%) and sociability appeals (3/7, 43%) were common on brand websites. The small number of social media webpages in our sample used gendered marketing.ConclusionsURLs appearing on tobacco packs direct consumers to websites where users are exposed to marketing that highlights the “positive” contributions of tobacco companies on corporate websites, and extensive promotions and marketing appeals on brand websites and social media pages. It is essential that marketing regulations become more comprehensive and ban all protobacco communication, a policy that is in line with articles 5.3 and 13 of the World Health Organization Framework Convention on Tobacco Control. For countries that already ban internet tobacco advertising, enforcement efforts should be strengthened. Tobacco companies’ use of URLs on packs may also be compelling for plain packaging advocacy, where all branding is removed from the pack and large graphic health warning labels are the only communication on the tobacco packaging. Future research should consider including tobacco websites in marketing surveillance.

Front of pack nutritional labelling schemes: a systematic review and meta-analysis of recent evidence relating to objectively measured consumption and purchasing.

Front of pack labelling (FOPL) provides visible nutritional information and appears to influence knowledge and reformulation. However, a recent Cochrane review found limited and inconsistent evidence for behaviour change. The present review aimed to examine studies published subsequent the Cochrane review, focusing on prepackaged foods, examining the impact of FOPL on purchasing and consumption. Controlled experimental/intervention and interrupted time series (ITS) studies were included, with no age/geography restrictions. Exposures were FOPL with objectively measured consumption/purchasing outcomes. Thirteen databases were searched (January 2017 to April 2019) and forward citation searching was undertaken on the included studies. Purchasing data from experimental studies were meta-analysed. Two series of meta-analyses were undertaken; combined FOPL versus no-FOPL and specific FOPL scheme versus no-FOPL. Outcomes were sugar (g 100g-1 ), calories (kcal 100g-1 ), saturated fat (g 100g-1 ) and sodium (mg 100g-1 ). We identified 14 studies, reporting consumption (experimental; n=3) and purchasing (n=8, experimental; n=3, ITS). Meta-analysis of experimental studies showed sugar and sodium content of purchases was lower for combined FOPL versus no-FOPL (-0.40g sugar 100g-1 , P<0.01; -24.482mg sodium 100g-1 , P=0.012), with a trend for lower energy and saturated fat (-2.03 kcal 100g-1 , P=0.08; -0.154g saturated fat 100g-1 , P=0.091). For specific FOPL, products purchased by 'high in' FOPL groups had lower sugar (-0.67g sugar 100g-1 , P≤0.01), calories (-4.43 kcal 100g-1 , P<0.05), sodium (-33.78mg 100g-1 , P=0.01) versus no-FOPL; Multiple Traffic Light had lower sodium (-34.94mg 100g-1 , P<0.01) versus no-FOPL. Findings regarding consumption were limited and inconsistent. FOPL resulted in healthier purchasing in ITS studies. This review provides evidence from experimental and 'real-life' studies indicating that FOPL encourages healthier food purchasing. PROSPERO CRD42019135743.

Public Health, Ministry of Health and Economic Actors: the case of food and information of public

Abstract The experience of France in the implementation of a frontof- pack label, the Nutri-Score, clearly illustrates the constant tug-ofwar between public health experts and the industry and provides a framework for an efficient strategy that could be replicated at the EU level. Dietary risk factors is in the top three leading causes of morbidity and mortality in Western Europe. Such high burden of diseases urges the implementation of strong and efficient public health strategies in order to curb the impact of poor diets. The public health community has long promoted strategies impacting both individual dietary behavior and the food environment, in a consistent global framework. However, the latter strategies imply to act upon the food and beverage manufacturers, to provide consumers with better information on the nutritional quality of the foods they produce and to ensure a shift in the nutritional composition of the food offer towards healthier foods. Among the various public health nutrition strategies that are considered efficient in both modifying consumer behavior and enticing reformulations by the food industry, front-of-pack food labeling has been identified as a key policy component in a global program.

Haematological quality and age of donor blood issued for paediatric transfusion to four hospitals in sub-Saharan Africa.

Background and ObjectivesPaediatric blood transfusion for severe anaemia in hospitals in sub‐Saharan Africa remains common. Yet, reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes.Materials and MethodsWe undertook three audits examining the distribution of pack types, haematological quality and storage duration of donor blood used in a paediatric clinical trial of blood at four hospitals in Africa (Uganda and Malawi).ResultsThe overall distribution of whole blood, packed cells (plasma‐reduced by centrifugation) and red cell concentrates (RCC) (plasma‐reduced by gravity‐dependent sedimentation) used in a randomised trial was 40·7% (N = 1215), 22·4% (N = 669) and 36·8% (N = 1099), respectively. The first audit found similar median haematocrits of 57·0% (50·0,74·0), 64·0% (52·0,72·5; P = 0·238 vs. whole blood) and 56·0% (48·0,67·0; P = 0·462) in whole blood, RCC and packed cells, respectively, which resulted from unclear pack labelling by blood transfusion services (BTS). Re‐training of the BTS, hospital blood banks and clinical teams led to, in subsequent audits, significant differences in median haematocrit and haemoglobins across the three pack types and values within expected ranges. Median storage duration time was 12 days (IQR: 6, 19) with 18·2% (537/2964) over 21 days in storage. Initially, 9 (2·8%) packs were issued past the recommended duration of storage, dropping to 0·3% (N = 7) in the third audit post‐training.ConclusionThe study highlights the importance of close interactions and education between BTS and clinical services and the importance of haemovigilance to ensure safe transfusion practice.

Editorial and News

Editorial and News

Evaluation of the nutrient content of yogurts: a comprehensive survey of yogurt products in the major UK supermarkets

ObjectivesTo comprehensively survey the sugar and nutrient contents of yogurt products available in UK supermarkets, in particular those marketed to children.DesignA cross-sectional survey of yogurt products available in the UK’s...

Awareness, understanding and use of sodium information labelled on pre-packaged food in Beijing:a cross-sectional study

BackgroundNutrition labelling has been mandatory for pre-packaged foods since 2013 in China, and sodium is one of the nutrients required for display on the nutritional information panel (NIP). This study aimed to estimate the awareness, understanding of, and use of sodium labelling information among the population in China.MethodsA cross-sectional survey was carried out in urban Beijing in 2016 on pre-packaged foods. The researchers randomly selected 380 residents from four convenient but disconnected communities and 370 shoppers from four supermarkets owned by different companies and conducted face-to-face interviews. Questions on nutritional knowledge, health attitude, understanding and use of nutritional labels as well as other related factors were assessed.ResultsAll of the 380 community residents and 308 of the 370 supermarket shoppers successfully completed the survey. Of those 688 respondents, 91.3% understood that excessive salt intake was harmful, 19.5% were aware that sodium content is listed on the NIP, 5.5% understood the meaning of NRV% (Percentage of Nutrient Reference Values), 47.7% did not know the relationship between sodium and salt, and 12.6% reported they frequently read the label when shopping. Factors for why people were more likely to choose a product because of its low level of salt shown on the label include income level and their level of awareness of the link between salt and diet.ConclusionsAlthough the participants had a good understanding of the harmful effects of salt, the awareness, understanding and use of sodium labels was very low in Beijing, and even worse nationwide. Efforts should be taken to educate the public to understand and use the NIP better and design clearer ways of displaying such information, such as front-of pack (FoP) labelling or health-related smartphone applications to improve health and help people make better food choices.

Nutrient profiling for front of pack labelling: how to align logical consumer choice with improvement of products?

The primary goal of front of pack (FOP) labelling is to help consumers make healthier choices through communication. A secondary goal is to encourage producers to improve the nutritional composition of their products. Evidence has shown that (FOP) labelling can help consumers to make healthier food choices and has been an incentive for producers to improve product composition. As FOP labelling is seen as an important tool to improve food environments for public health purposes, the WHO supports initiatives of governments to implement an FOP labelling system. Based on the experiences of a wide range of countries over many years, possible success factors for such an FOP system have been defined, six of which are discussed in the present paper and used to evaluate the Dutch Choices Programme that was started in 2006. In the course of time a large number of producers joined the programme and the logo was recognised by more than 90 % of the consumers, but by 2016 the Dutch consumer organisation argued on the basis of their own research that a quarter of the consumers did not understand the colour coding of the logo and as a result the Dutch government decided to no longer support this logo and to introduce a nutrition app. The challenge that remains is to find a system that consumers understand well and that still encourages manufacturers of food to improve product composition. New technology-based data collecting initiatives might provide the right tools to develop such a system.

The Impact of Using Combined Front of Pack Labelling on the Food Stakeholders

The Impact of Using Combined Front of Pack Labelling on the Food Stakeholders

Rice starch and fructo-oligosaccharides as substitutes for phosphate and dextrose in whole muscle cooked hams: Sensory analysis and consumer preferences

Sensory characteristics and visual acceptability of cooked hams with rice starch (RS) and fructo-oligosaccharides (FOS) as substitutes for, respectively, sodium tripolyphosphate (STPP) and dextrose (Dex), were evaluated. Replacement of STPP with RS is associated with hams being less juicy, salty and springy, but more adhesive and could negatively affect appearance; but replacement of Dex by FOS had minimal sensory influence. The relative importance of product appearance, pack labels and price information cues in simulated purchasing decisions was also investigated. Consumer purchase choices were more influenced by product appearance than by pack labels referring to additives or price. Including labelling information regarding reduction or exclusion of phosphates may be more important than labels regarding a reduction in salt. For the Irish consumers studied here, the use of phosphates in cooked hams sounds artificial, unhealthy and unknown, whereas dietary fibre was perceived as healthy, natural and improving of the eating quality.

Front of pack labels enhance attention to nutrition information in novel and commercial brands

Objectives(1) To assess whether Front-of-Pack (FOP) nutrition labels garner attention more readily than more complete, mandated nutrition information (the Nutrition Facts Panel (NFP), required in the US), and (2) To determine whether label design characteristics, specifically, color coding and/or coding with facial icons, increase attention to the FOP label. MethodsIn two experiments, we tracked the allocation of attention while participants (n=125) viewed novel and commercial packages with varied FOP designs using a change detection methodology. ResultsWe found empirical evidence that FOP labels are attended more often, and earlier, than the currently mandated NFP, and that this benefit is due both to its placement on the front of the package and to the design characteristics of the FOP. Specifically, the use of color in FOPs increased attention to the label, but there was no evidence that coding information via facial icons impacted attention. ConclusionsOur work supports a growing body of evidence supporting the use of FOP labels to attract attention to nutritional information. Findings may be relevant to inform policy decisions on labeling standards.

Salt Reduction Initiatives around the World - A Systematic Review of Progress towards the Global Target.

ObjectiveTo quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025.MethodsA systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework.ResultsA total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt.ConclusionThe large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake.

Salt reduction in Australia: from advocacy to action.

As part of its endorsement of the World Health Organization's Global Action Plan to prevent non-communicable diseases, the Federal Government of Australia has committed to a 30% reduction in average population salt intake by 2025. Currently, mean daily salt intake levels are 8-9 g, varying by sex, region and population group. A number of salt reduction initiatives have been established over the last decade, but key elements for a co-ordinated population-level strategy are still missing. The objective of this review is to provide a comprehensive overview of existing population-level salt reduction activities in Australia and identify opportunities for further action. A review of the published literature and stakeholder activities was undertaken to identify and document current activities. The activities were then assessed against a pre-defined framework for salt reduction strategies. A range of initiatives were identified from the review. The Australian Division of World Action on Salt and Health (AWASH) was established in 2005 and in 2007 launched its Drop the Salt! Campaign. This united non-governmental organisations (NGOs), health and medical and food industry organisations in a co-ordinated advocacy effort to encourage government to develop a national strategy to reduce salt. Subsequently, in 2010 the Federal Government launched its Food and Health Dialogue (FHD) with a remit to improve the health of the food supply in Australia through voluntary partnerships with food industry, government and non-government public health organisations. The focus of the FHD to date has been on voluntary reformulation of foods, primarily through salt reduction targets. More recently, in December 2014, the government's Health Star Rating system was launched. This front of pack labelling scheme uses stars to highlight the nutritional profile of packaged foods. Both government initiatives have clear targets or criteria for industry to meet, however, both are voluntary and the extent of industry uptake is not yet clear. There is also no parallel public awareness campaign to try and influence consumer behaviour relating to salt and no agreed mechanism for monitoring national changes in salt intake. The Victorian Health Promotion Foundation (VicHealth) has recently instigated a State-level partnership to advance action and will launch its strategy in 2015. In conclusion, salt reduction activities are currently being implemented through a variety of different programs but additional efforts and more robust national monitoring mechanisms are required to ensure that Australia is on track to achieve the proposed 30% reduction in salt intake within the next decade.

Nutrition labelling, marketing techniques, nutrition claims and health claims on chip and biscuit packages from sixteen countries.

Food packages were objectively assessed to explore differences in nutrition labelling, selected promotional marketing techniques and health and nutrition claims between countries, in comparison to national regulations. Cross-sectional. Chip and sweet biscuit packages were collected from sixteen countries at different levels of economic development in the EPOCH (Environmental Profile of a Community's Health) study between 2008 and 2010. Seven hundred and thirty-seven food packages were systematically evaluated for nutrition labelling, selected promotional marketing techniques relevant to nutrition and health, and health and nutrition claims. We compared pack labelling in countries with labelling regulations, with voluntary regulations and no regulations. Overall 86 % of the packages had nutrition labels, 30 % had health or nutrition claims and 87 % displayed selected marketing techniques. On average, each package displayed two marketing techniques and one health or nutrition claim. In countries with mandatory nutrition labelling a greater proportion of packages displayed nutrition labels, had more of the seven required nutrients present, more total nutrients listed and higher readability compared with those with voluntary or no regulations. Countries with no health or nutrition claim regulations had fewer claims per package compared with countries with regulations. Nutrition label regulations were associated with increased prevalence and quality of nutrition labels. Health and nutrition claim regulations were unexpectedly associated with increased use of claims, suggesting that current regulations may not have the desired effect of protecting consumers. Of concern, lack of regulation was associated with increased promotional marketing techniques directed at children and misleadingly promoting broad concepts of health.

Testing warning messages on smokers’ cigarette packages: a standardised protocol

PurposeLab experiments on cigarette warnings typically use a brief one-time exposure that is not paired with the cigarette packs smokers use every day, leaving open the question of how repeated...

Greening the curriculum to foster environmental literacy in human nutrition students

s / Journal of Nutrition & Intermediary Metabolism 1 (2014) 1e55 38 Conclusions: Estimated HSR for the reality television products varied widely. There were no 5 stars products. The most popular product had the minimum possible rating and is not a healthy choice. Front of Pack Labelling with HSR is designed to promote healthier choices. Funding source(s).N/A GREENING THE CURRICULUM TO FOSTER ENVIRONMENTAL LITERACY IN HUMAN NUTRITION STUDENTS S.A. Skeaff . Department of Human Nutrition, University of Otago, Dunedin,

Beyond nutrition and agriculture policy: collaborating for a food policy.

Global interest in food policy is emerging in parallel with mounting challenges to the food supply and the rising prevalence of diet-related chronic health conditions. Some of the foundational elements of food policies are agricultural practices, finite resources, as well as economic burdens associated with a growing and ageing population. At the intersection of these interests is the need for policy synchronisation and a better understanding of the dynamics within local, regional and national government decision-making that ultimately affect the wellness of the populous and the safety, quality, affordability and quantity of the food supply. Policies, synchronised or not, need to be implemented and, for the food industry, this has seen a myriad of approaches with respect to condensing complex nutritional information and health claims. These include front and/or back of pack labelling, traffic light systems, etc. but in general there is little uniformity at the more regional and global scales. This translation of the nutritional and health-beneficial messages accompanying specific products to the consumer will undoubtedly be an area of intense activity, and hopefully interaction with policy makers, as the food industry continues to become a more global industry.

Cigarette pack labelling practices in Nigeria-Implications for policy recommendations

Cigarette packaging has been reported to be a major means of promoting initiation and maintenance of cigarette use. This may impact on smoking habits in low and middle income countries where tobacco related burden is high. This is a cross-sectional study of cigarette pack labelling practices in a local government area in southwestern Nigeria. A data collection instrument was used to obtain information from all cigarette packs identified. Twenty different brands with varying pack colours, designs and labels were found. The average cost of a pack was $1.25. All the packs provided information on tar levels and had a single, non-specific textual warning message “Federal ministry of health warns that smokers are liable to die young” located in the front panel. None provided health warnings in any of the local languages. The findings suggest that the prevalence of promotional labeling may be quite high. Future studies may be required to determine the impact of restrictive labeling practices on incidence on tobacco use.