Impact of different food label formats on healthiness evaluation and food choice of consumers: a randomized-controlled study

Background  

Front of pack food labels or signpost labels are currently widely discussed as means to help consumers to make informed food choices. It is hoped that more informed food choices will result in an overall healthier diet. There is only limited evidence, as to which format of a food label is best understood by consumers, helps them best to differentiate between more or less healthy food and whether these changes in perceived healthiness result in changes of food choice.     

Public understanding of food risks in four European countries: a qualitative study

BACKGROUND: In the wake of the 'bovine spongiform encephalopathy (BSE) crisis' there was renewed interest in how those responsible for public health could take account of public views, both to 'democratize' policy making and to increase the likelihood of information about health risks resonating with public concerns. This study explored how members of the public in four European countries (Finland, Germany, Italy and the UK) understood food risks in general, and risks arising from BSE in particular. The aims were to identify the sources of knowledge used and trusted by the public and to explore how public views could be accessed for public health information policy. METHODS: Thirty-six focus group interviews were held using a common protocol across the four countries, including people from four life-cycle stages. RESULTS: The study demonstrated the utility of using focus groups as a relatively efficient method for accessing public views, and the feasibility of cross-national qualitative research on public views. We found that public views of food risks are neither irrational nor na?ve, but that they do need to be interpreted in the context of everyday food purchasing decisions, in which particular food risks are unlikely to have the same salience as they do for experts. CONCLUSIONS: Focus groups are a feasible method for accessing public knowledge on public health risks to inform information strategies.     

General practitioners' referral thresholds and choices of referral destination: an experimental study

General practitioners (GPs) exert a major impact on NHS resource use, both as providers of primary care and as referrers to secondary care. Referral rates are subject to wide variations, leading to the conjecture that certain GPs may have different ‘referral thresholds’ from those of others. In this paper, the authors describe an experiment designed both to test the referral threshold hypothesis and to illuminate the GP'apos;s decision process with respect to choice over referral destination. Nottinghamshire GPs were provided with hypothetical case histories and a list of possible referral destinations, specifying a range of consultants, their specialist interests, plus the expected waiting times and costs for both out-patient investigation and in-patient treatment. For each case, respondents were requested to indicate whether or not they would refer the patient, and to whom. Respondents were also asked to indicate the extent to which their choices of consultants generally were governed by the specialist interest, the waiting time and the cost information. The responses of the sample support the referral threshold conjecture, with specialist interests and waiting time appearing to be far more important than cost in influencing choice of referral destination. The possibilities of influencing GPs' referral behaviour are discussed, in the light of recent initiatives with respect to prescribing. Copyright © 1998 John Wiley & Sons, Ltd.     

The effect of food label cues on perceptions of quality and purchase intentions among high-involvement consumers with varying levels of nutrition knowledge

ObjectiveTo determine whether differences in nutrition knowledge affected how women (a high-involvement group) interpreted intrinsic cues (ingredient list) and extrinsic cues (“all natural” label) on food labels.MethodsA 2 (intrinsic cue) × 2 (extrinsic cue) × 2 (nutrition knowledge expert vs novice) within-subject factorial design was used. Participants were 106 female college students (61 experts, 45 novices). Dependent variables were perception of product quality and purchase intention.ResultsAs predicted by the elaboration likelihood model, experts used central route processing to scrutinize intrinsic cues and make judgments about food products. Novices used peripheral route processing to make simple inferences about the extrinsic cues in labels.Conclusions and ImplicationsConsumers' levels of nutrition knowledge influenced their ability to process food labels. The United States Food and Drug Administration should regulate the “all natural” food label, because this claim is likely to mislead most consumers.     

Effects of calorie labeling and value size pricing on fast food meal choices: Results from an experimental trial

Background  

Although point-of-purchase calorie labeling at restaurants has been proposed as a strategy for improving consumer food choices, a limited number of studies have evaluated this approach. Likewise, little research has been conducted to evaluate the influence of value size pricing on restaurant meal choices.     

The impact of interpretive and reductive front-of-pack labels on food choice and willingness to pay

Background

This study examined how front-of-pack labels and product healthfulness affect choice and willingness to pay across a range of foods. It was hypothesized that: (i) product choice and (ii) willingness to pay would be more aligned with product healthfulness when healthfulness was expressed through the Health Star Rating, followed by the Multiple Traffic Light, then the Daily Intake Guide, and (iii) the Nutrition Facts Panel would be viewed infrequently.

Methods

Adults and children aged 10+ years (n?=?2069) completed an online discrete choice task involving mock food packages. A 4 food type (cookies, corn flakes, pizza, yoghurt) × 2 front-of-pack label presence (present, absent) × 3 front-of-pack label type (Daily Intake Guide, Multiple Traffic Light, Health Star Rating) × 3 price (cheap, moderate, expensive) × 3 healthfulness (less healthy, moderately healthy, healthier) design was used. A 30 s time limit was imposed for each choice.

Results

Of the three front-of-pack labels tested, the Health Star Rating produced the largest differences in choices, with 40% (95% CIs: 38%-42%) of respondents selecting the healthier variant, 33% selecting the moderately healthy variant (95% CIs: 31%-35%), and 23% (95% CIs: 21%-24%) selecting the less healthy variant of the four products included in the study. The Multiple Traffic Light led to significant differences in choices between healthier (35%, 95% CIs: 33%-37%) and less healthy products (29%, 95% CIs: 27%-31%), but not moderately healthy products (32%, 95% CIs: 30%-34%). No significant differences in choices were observed by product healthfulness when the Daily Intake Guide was present. Only the Health Star Rating resulted in a significantly greater willingness to pay for healthier versus less healthy products. The Nutrition Facts Panel was viewed for only 7% of all mock packages.

Conclusions

Front-of-pack labels that are more interpretive, such as the Health Star Rating, can be more effective at directing consumers towards healthier choices than reductive front-of-pack labels such as the Daily Intake Guide. The study results provide policy makers with clear guidance on the types of front-of-pack labels that are most likely to achieve positive health outcomes at a population level.

     

Experimental studies of food choices and palatability responses in European subjects exposed to the Umami taste

In the Western world, consumers have only recently learned to discriminate the Umami taste, although they have enjoyed its contribution to the palatability of traditional dishes for centuries. The flavor enhancing properties of MSG have been scientifically investigated in European subjects. By adding MSG to such foods as soups, their content in sodium can be decreased without altering palatability, thus favoring a net decrease in sodium intake. Consumers presented with a novel food often have to get accustomed to the new taste before they acquire a preference for the food. A study showed that when such novel foods are added with some appropriate amount of MSG, consumers acquire a preference for them more rapidly. In elderly persons, the addition of MSG to nutritionally valuable foods (soups, vegetables, starches) did induce an increase of intake of MSG-added foods. Total meal size, however, was not affected, since the increased intake of MSG-containing foods was followed by a decreased consumption of foods served later in the meal, such as desserts. The same observations were repeated in hospitalized diabetic patients. Again, the patients ingested more healthy MSG-containing foods and less of other foods, with the same total meal energy intake. These two studies suggested that MSG could be used to stimulate appropriate food choices in certain populations.     

Obesity prevention and personal responsibility: the case of front-of-pack food labelling in Australia

Background  

In Australia, the food industry and public health groups are locked in serious struggle for regulatory influence over the terms of front-of-pack food labelling. Clear, unambiguous labelling of the nutritional content of pre-packaged foods and of standardized food items sold in chain restaurants is consistent with the prevailing philosophy of 'personal responsibility'. An interpretive, front-of-pack labelling scheme has the capacity to encourage healthier patterns of eating, and to be a catalyst for improvements in the nutritional quality of food products through re-formulation. On the other hand, the strength of opposition of the Australian Food and Grocery Council to 'Traffic Light Labelling', and its efforts to promote a non-interpretive, voluntary scheme, invite the interpretation that the food industry is resistant to any reforms that could destabilise current (unhealthy) purchasing patterns and the revenues they represent.     

Exploring the main and moderating effects of individual-level characteristics on consumer responses to sugar taxes and front-of-pack nutrition labels in an experimental marketplace

InterventionThis study examined whether the impacts of sugar taxes and front-of-pack (FOP) nutrition labels differ across socio-demographic subgroups.Research questionWhat are the main and moderating effects of individual-level characteristics on the nutrient content of participants’ purchases in response to varying taxation levels and FOP labels?MethodsData from an experimental marketplace were analyzed. A sample of 3584 Canadians aged 13 years and older received $5 to purchase an item from a selection of 20 beverages and 20 snack foods. Participants were shown products with one of five FOP labels and completed eight within-subject purchasing tasks with different tax conditions. Linear mixed models were used to estimate the main and moderating effects of 11 individual-level variables on the sugars, sodium, saturated fats, and calorie content of participants’ purchases.ResultsParticipants who were younger, male, and more frequent consumers of sugary drinks purchased products containing more sugars, sodium, saturated fats, and calories. Sex and age moderated the relationship between tax condition and sugars or calories purchased: female participants were more responsive than males to a tax that included fruit juice, and younger participants were more responsive to all sugar tax conditions than older participants. Reported thirst and education level also moderated the relationship between tax condition and calories purchased. No individual-level characteristics moderated the effects of FOP labels.ConclusionA small proportion (7 of 176) of the moderating effects tested in this study were significant. Sugar taxes and FOP labelling policies may therefore produce similar effects across key socio-demographic groups.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00475-x.     

Use and understanding of nutrition information on food labels in six European countries

Aim

The goal of the study was to investigate the use of nutrition information on food labels and understanding of guideline daily amount (GDA) front-of-pack nutrition labels in six European countries.

Subjects and methods

In-store observations and in-store interviews were conducted in major retailers in the UK (n?=?2019), Sweden (n?=?1858), France (n?=?2337), Germany (n?=?1963), Poland (n?=?1800) and Hungary (n?=?1804), supplemented by questionnaires filled out at home and returned (overall response rate 50.3%). Use of labels was measured by combining in-store observations and in-store interviews on concrete purchases in six product categories. Understanding of GDA front-of-pack nutrition labels was measured by a variety of tasks dealing with conceptual understanding, substantial understanding and health inferences. Demographics, nutrition knowledge and interest in healthy eating were measured as potential determinants.

Results

Across six product categories, 16.8% of shoppers were found to have looked for nutrition information on the label, with the nutrition grid (table or list), GDA labels and the ingredients list as the main sources consulted and calories, fat and sugar the information most often looked for. Understanding of GDA labels was high in the UK, Sweden and Germany, and more limited in the other countries. Regression analysis showed that, in addition to country-specific differences, use and understanding are also affected by differences in interest in healthy eating and in nutrition knowledge and by social grade.

Conclusion

Understanding of nutrition information seems to be more widespread than use, suggesting that lack of use is a question of not only understanding, but also motivation. Considerable national differences exist in both understanding and use, some of which may be attributed to different histories of the role of nutrition in the public debate.     

Influencing healthful food choices in school and home environments: results from the TEENS study

BACKGROUND: The purpose of this research is to examine the effects of an intervention designed to increase the availability of fruits, vegetables and lower fat foods in homes and schools. This research is part of the TEENS study, a school-based intervention study. METHODS: Sixteen schools in Minnesota were recruited to be in the study, and approximately 3600 middle school students in the eight intervention schools were exposed to a multi-component intervention. The TEENS intervention included classroom-based curricula, family newsletters, and changes in the school food environment including increasing more healthful options on a la carte and on the school lunch line. In addition to student-level outcomes, changes in availability of fruits, vegetables, and lower fat snacks in home and school environments were evaluated. The TEENS study was conducted from 1997 to 2000. RESULTS: Parents of students in intervention schools reported making healthier choices when grocery shopping as compared to parents of students in control schools (P = 0.01). No intervention effects were evident from a home food inventory. Compared to control schools, intervention schools offered (P = 0.04) and sold (P = 0.07) a higher proportion of healthier foods on a la carte, but no effects were seen for fruit and vegetables sales as part of the regular meal pattern lunch. CONCLUSION: Our results show mixed results for positively influencing adolescents' school and home environments.     

The joint effect of tangible and non-tangible rewards on healthy food choices in children

This study investigated how a combination of tangible and non-tangible rewards can alter health-related decisions made by children. Children chose between an unhealthy food option (a bowl of potato crisps) and a healthy food option (a bowl of grapes) on two occasions. In the first round, we manipulated the expected tangible reward and praise. The tangible reward was manipulated by means of a game that the child received upon choosing the healthy product, and the praise was manipulated by means of the teacher's applause and smiles if the child selected the healthy option. The second trial occurred three days after the first trial using the same food item options. Neither tangible rewards nor praise influenced the children's choices by themselves, but combining the two substantially increased the children's likelihood of selecting the healthy food choice. The data were consistent with a reattribution process akin to social labelling. Although initially externally motivated to select the healthy option, the children who received praise appeared to interpret their choice as internally motivated and therefore continued to select the healthy option even in the absence of reward.     

Differential effect of Pistacia vera extracts on experimental atherosclerosis in the rabbit animal model: an experimental study

Background

The association between modulation of detailed lipoprotein profiles and cholesterol ester transfer (CET) activity by peroxisome proliferator-activated receptor (PPAR)-a agonists in patients with coronary artery disease remains unclear. We assessed lipid profiles, plasma CET activity, and in-stent intimal hyperplasia after fenofibrate treatment in patients who underwent elective coronary stenting.

Methods

Forty-three consecutive patients who underwent elective coronary stenting were randomized to the fenofibrate group (300 mg/day for 25 weeks, n = 22) or the control group (n = 21). At baseline and follow up, CET activity and lipoprotein profiles were measured, and quantitative coronary angiography was performed.

Results

In the fenofibrate group, the levels of large very low-density lipoprotein cholesterol, and small low-density lipoprotein (LDL) cholesterol decreased and those of small high-density lipoprotein (HDL) cholesterol increased. Besides, CET activity decreased independent of the effect of fenofibrate on total and LDL cholesterol. The reduction of CET activity significantly correlated with the increase in LDL particle size (r = 0.47, P = 0.03) and the decrease of triglycerides in large HDL subclasses (r = 0.48, P = 0.03). Although there were no significant differences in restenosis parameters between the two groups, low CET activity significantly correlated with the inhibition of neointimal hyperplasia (r = 0.56, P = 0.01).

Conclusions

Fenofibrate inhibited CET activity and thereby improved atherogenic lipoprotein profiles, and reduced intimal hyperplasia after coronary stenting.