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Ganderats-Fuentes M, Morgan S. Front-of-Package Nutrition Labeling and Its Impact on Food Industry Practices: A Systematic Review of the Evidence. Nutrients 2023; 15:nu15112630. [PMID: 37299593 DOI: 10.3390/nu15112630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
The obesity epidemic has become a major public health concern globally, and the food supply is a significant driver of this trend. Front-of-package (FOP) labels have been implemented in many countries to encourage healthier food choices. This systematic review aimed to examine the effect of FOP label implementation on food manufacturers' practices. A comprehensive search of multiple databases was conducted following PRISMA guidelines, identifying 39 relevant articles from 1990 to 2021. The studies indicated that FOP labels conveying intuitive information influenced product reformulation, whereas those with numerical information without specific guidance had no impact on reducing unhealthy nutrients. The most common outcomes were sodium, sugar, and calorie reduction. Mandatory policies reported higher and more consistent effects on product reformulation compared to voluntary approaches. Voluntary FOP labeling resulted in low uptake and tended to be applied to healthier products. Food manufacturers responded to FOP labeling heterogeneously, depending on the label design and type of enforcement. FOP label implementation can reduce nutrients of concern but food manufacturers behave strategically by labeling healthier choices. This review provides recommendations for maximizing the benefits of using FOP labels to prevent obesity, and findings can inform future public health research and policymaking.
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Affiliation(s)
| | - Sherry Morgan
- Holman Biotech Commons, University of Pennsylvania, Philadelphia, PA 19104, USA
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"No Child or Adult Would Ever Probably Choose to Have 16 Teaspoons of Sugar": A Preliminary Study of Parents' Responses to Sugary Drink Warning Label Options. Nutrients 2022; 14:nu14194173. [PMID: 36235825 PMCID: PMC9571345 DOI: 10.3390/nu14194173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Front-of-pack (FoP) warning labels are a viable policy option with the potential to inform consumer choice and assist in reducing sugar-sweetened beverage (SSB) consumption as part of a multi-faceted approach. This study explored parents' perceptions and understanding of a range of SSB warning labels. Focus groups (n = 12) with 82 parents of school-aged children were conducted, stratified according to education level, sex and location. Health effects, exercise equivalents, sugar content (teaspoons in text and pictograms, "high in") and energy content labels were shown. Through thematic analysis we identified three themes. Theme 1 related to perceptions of effectiveness of labels, underpinned by four subthemes: perceptions of labels as credible, informative and useful, personally relevant and having the potential to change be haviour. Theme 2 related to participants finding opportunities for self-exemption (e.g., physically active) and message rejection (e.g., misinterpretation). Theme 3 encompassed the potential negative consequences of some labels (e.g., body image concerns). The text teaspoons label was perceived most favourably across all themes, with minimal negative issues raised. These results provide in-depth insight into potential responses to labelling as a policy intervention, providing important guidance for the development of labels to ensure optimal message content and framing for future testing and subsequent implementation.
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Dono J, Ettridge KA, Wakefield M, Pettigrew S, Coveney J, Roder D, Durkin S, Wittert G, Martin J, Miller CL. Intentions to reduce sugar-sweetened beverage consumption: the importance of perceived susceptibility to health risks. Public Health Nutr 2021; 24:5663-5672. [PMID: 33472724 PMCID: PMC10195437 DOI: 10.1017/s1368980021000239] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/16/2020] [Accepted: 01/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are numerous health effects associated with excess sugar-sweetened beverage (SSB) consumption. Interventions aimed at reducing population-level consumption require understanding of the relevant barriers and facilitators. This study aimed to identify the variables with the strongest relationship with intentions to reduce SSB consumption from a suite of variables derived from the literature. DESIGN Random-digit dialling of landline and mobile phones was used to survey adults using computer-assisted telephone interviews. The outcome variable was 'likelihood of reducing SSB consumption in next 6 months', and the predictor variables were demographics, SSB attitudes and behaviour, health risk perceptions and social/environmental exposure. SETTING Australia. PARTICIPANTS A subsample of 1630 regular SSB consumers from a nationally representative sample of 3430 Australian adults (38 % female, 51 % aged 18-45 years, 56 % overweight or obese). RESULTS Respondents indicated that they were 'not at all' (30·1 %), 'somewhat' (43·9 %) and 'very likely' (25·3 %) to reduce SSB consumption. Multivariate nominal logistic regressions showed that perceiving future health to be 'very much' at risk was the strongest predictor of intention to reduce SSB consumption (OR = 8·1, 95 % CI 1·8, 37·0, P < 0·01). Other significant predictors (P < 0·01) included self-perceptions about too much consumption, habitual consumption, difficulty reducing consumption and likelihood of benefitting from reduced consumption. CONCLUSIONS Health risk perceptions had the strongest relationship with intentions to reduce consumption. Age and consumption perceptions were also predictors in the multivariate models, whereas social/environmental exposure variables were not. Interventions may seek to incorporate strategies to denormalise consumption practices and increase knowledge about perceived susceptibility to health risks.
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Affiliation(s)
- Joanne Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA5000, Australia
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Kerry A Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA5000, Australia
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Simone Pettigrew
- Food Policy, The George Institute for Global Health, Sydney, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - Sarah Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men’s Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
- Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jane Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Australia
| | - Caroline L Miller
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA5000, Australia
- School of Public Health, The University of Adelaide, Adelaide, Australia
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Miller C, Ettridge K, Pettigrew S, Wittert G, Wakefield M, Coveney J, Roder D, Martin J, Brownbill A, Dono J. Warning labels and interpretive nutrition labels: Impact on substitution between sugar and artificially sweetened beverages, juice and water in a real-world selection task. Appetite 2021; 169:105818. [PMID: 34838869 DOI: 10.1016/j.appet.2021.105818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
Effective strategies to reduce free sugar intake are needed. This study examined exposure to a warning label, independently and in conjunction with a Health Star Rating (HSR) label, on the selection of commercially available cold beverages with real decision-making stakes. Participants (N = 511, 47.9% female, mean = 21.7 (SD = 6.1) years) accessed an online convenience store app via an on-campus laptop to select one of 10 beverages (5 sugar-sweetened beverages [SSBs], 1100% fruit juice, 2 artificially sweetened beverages [ASBs] and 2 waters). The task was repeated with the addition of a warning label on high-sugar drinks in Round 2, and the addition of an HSR label on all drinks in Round 3. Participants were informed that they would receive a complementary drink (valued at <$5AUD) based on their selections following the completion of a brief questionnaire. Baseline results indicated that SSBs and waters were the most and least popular choices, respectively. For both males and females, there was a significant decrease in SSB selection (p < 0.001) and significant increase in ASB and water selection (p < 0.001) following the addition of warning labels to high-sugar drinks. The decreased selection of SSBs and increased selection of waters was maintained in Round 3 when HSR labels were added to all drinks. 100% fruit juice selection decreased with the addition of a warning label for females only (p < 0.01), but increased following the addition of a 4-star HSR label, for both males (p < 0.05) and females (p < 0.001). Warning labels reduced young adults' selection of SSBs and promoted substitution to water. The HSR reinforced this effect for the least healthy drinks. Increased water selection may be further enhanced by ensuring that warning label thresholds and HSR algorithms align to present consistent messaging.
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Affiliation(s)
- Caroline Miller
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Kerry Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Simone Pettigrew
- Food Policy, The George Institute for Global Health, Sydney, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia; Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute Adelaide, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - Jane Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Australia
| | - Aimee Brownbill
- Foundation for Alcohol Research and Education, Canberra, Australia
| | - Joanne Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
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Health Star Ratings and Beverage Purchase Intentions: A Study of Australian and New Zealand Hospitality Consumers. Foods 2021; 10:foods10112764. [PMID: 34829045 PMCID: PMC8617703 DOI: 10.3390/foods10112764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
This study examines the effects of a health star rating system on the attitudes of consumers and their purchase intentions towards beverage products sold in hospitality venues. Previous studies linking health ratings to the food and beverages of consumers mainly focus on fast-moving consumer goods and retail purchasing. However, purchasing patterns in hospitality and foodservice environments are distinct as consumers may be less concerned about health and more interested in the dining experience. Thus, this research focuses on: (1) whether the presence of health star ratings on beverage products influences the willingness of consumers to purchase in the context of the hospitality industry, and (2) identifying the demographic and psychographic factors influencing these behavioural intentions. Using Ordinary Least Squares regression to analyse data from an e-survey of 1021 consumers in Australia and New Zealand, the study found that health star ratings do have an impact on the willingness of consumers to purchase healthy beverages. Specifically, psychographic segmentation around ‘health goals’ is far more pertinent to understanding purchase behaviour in a hospitality setting than age, gender, income, or country. The findings present new insights into the importance of health star labelling on beverages and the purchase intentions of consumers.
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Judd JA, Griffiths K, Bainbridge R, Ireland S, Fredericks B. Equity, gender and health: A cross road for health promotion. Health Promot J Austr 2020; 31:336-339. [PMID: 32996234 DOI: 10.1002/hpja.422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jenni A Judd
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia
| | - Kalinda Griffiths
- Faculty of Medicine, University of NSW, Menzies School of Health Research, Kensington, NSW, Australia
| | - Roxanne Bainbridge
- Research Division, Central Queensland University, Cairns, QLD, Australia
| | - Sarah Ireland
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, NT, Australia
| | - Bronwyn Fredericks
- Indigenous Engagement, University of Queensland, Brisbane, QLD, Australia
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Rissel C, Elbayeh L, Xu H, Wen LM. Recall of and confidence in using the Health Star Rating system among pregnant women in New South Wales, Australia: Cross-sectional survey. Health Promot J Austr 2020; 31:354-356. [PMID: 32402093 DOI: 10.1002/hpja.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/20/2019] [Accepted: 07/14/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chris Rissel
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Linda Elbayeh
- Health Promotion Service, Sydney Local Health District, Sydney, NSW, Australia
| | - Huilan Xu
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Health Promotion Service, Sydney Local Health District, Sydney, NSW, Australia
| | - Li Ming Wen
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Health Promotion Service, Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Fudan University, Shanghai, China
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Consumption of Sugar-Sweetened Beverages, Juice, Artificially-Sweetened Soda and Bottled Water: An Australian Population Study. Nutrients 2020; 12:nu12030817. [PMID: 32204487 PMCID: PMC7146120 DOI: 10.3390/nu12030817] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/06/2020] [Accepted: 03/12/2020] [Indexed: 01/27/2023] Open
Abstract
Reducing consumption of free sugars, such as those found in high concentrations in manufactured products such as sugar-sweetened beverages (SSBs) and 100% fruit juices, is a global public health priority. This study aimed to measure prevalence of widely available pre-packaged non-alcoholic water-based beverages (carbonated sodas, sports drinks, energy drinks, artificially-sweetened sodas, fruit juices (any type), and bottled water) and to comprehensively examine behavioral, environmental, current health, and demographic correlates of consumption. A cross-sectional, nationally-representative population survey of 3430 Australian adults (18+ years) was conducted using computer-assisted telephone (mobile and landline) interviewing. Past week prevalence of pre-packaged drinks containing free sugar was 47.3%; daily prevalence was 13.6%. Of all the pre-packaged drinks assessed, consumption of fruit juices (any type) was the most prevalent (38.8%), followed by bottled water (37.4%), soda (28.9%), artificially-sweetened soda (18.1%), sports drinks (8.1%), and energy drinks (4.2%). Higher soda consumption was associated with males, younger age, socio-economic disadvantage, frequent takeaway food consumption, availability of soda in the home, obesity, and a diagnosis of heart disease or depression. A diagnosis of Type 2 Diabetes was associated with increased likelihood of consuming artificially-sweetened sodas and decreased likelihood of consuming sugar-sweetened soda. SSB consumption is prevalent in Australia, especially among young adults and males, foreshadowing continued population weight gain and high burdens of chronic disease. To reduce consumption, Australia must take a comprehensive approach, incorporating policy reform, effective community education, and active promotion of water.
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Badland H. Thinking differently: Reducing obesity and health inequities through action on the social determinants of health. Health Promot J Austr 2019; 30:7-8. [PMID: 30648336 DOI: 10.1002/hpja.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Hannah Badland
- Principal Research Fellow in the Centre for Urban Research, RMIT University, Melbourne, Australia.,2018 Australian Health Promotion Association Thinker in Residence
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Jones A, Thow AM, Ni Mhurchu C, Sacks G, Neal B. The performance and potential of the Australasian Health Star Rating system: a four‐year review using the RE‐AIM framework. Aust N Z J Public Health 2019; 43:355-365. [DOI: 10.1111/1753-6405.12908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Alexandra Jones
- George Institute for Global HealthUNSW Sydney New South Wales
- Charles Perkins CentreThe University of Sydney New South Wales
| | - Anne Marie Thow
- Menzies Centre for Health PolicyThe University of Sydney New South Wales
| | - Cliona Ni Mhurchu
- George Institute for Global HealthUNSW Sydney New South Wales
- National Institute for Health InnovationUniversity of Auckland New Zealand
| | - Gary Sacks
- School of Health and Social DevelopmentDeakin University Melbourne Victoria
| | - Bruce Neal
- George Institute for Global HealthUNSW Sydney New South Wales
- Department of Epidemiology and Biostatistics, School of Public HealthFaculty of Medicine, Imperial College London London United Kingdom
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