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- Title
Effects of 4 Interpretive Front-of-Package Labeling Systems on Hypothetical Beverage and Snack Selections: A Randomized Clinical Trial.
- Authors
Grummon, Anna H.; Gibson, Laura A.; Musicus, Aviva A.; Stephens-Shields, Alisa J.; Hua, Sophia V.; Roberto, Christina A.
- Abstract
This randomized clinical trial tests the effects of 4 interpretative front-of-package food labeling systems on the healthfulness of beverage and snack selections overall and by education level. Key Points: Question: What are the effects of 4 interpretative front-of-package food labeling systems on beverage and snack selections, and do effects differ by education level? Findings: In this randomized clinical trial of 7945 adults, participants exposed to green ("choose often"), single traffic light, physical activity calorie equivalent, or nutrient warning labels selected 28 to 39 fewer calories from beverages and 13 to 18 fewer calories from snacks than participants exposed to calorie labels, which were statistically significant reductions that were similar across the 4 interpretative labels. Effects did not differ by participants' education level. Meaning: Interpretative food labeling systems can encourage selection of healthier products among people with varying education levels. Importance: Policymakers and researchers have proposed a variety of interpretative front-of-package food labeling systems, but it remains unclear which is most effective at encouraging people to choose healthier foods and beverages, including among people with less education. Objective: To test the effects of 4 interpretative front-of-package food labeling systems on the healthfulness of beverage and snack selections, overall and by education level. Design, Setting, and Participants: This randomized clinical trial of a national sample of US adults 18 years and older was conducted online from November 16 to December 3, 2022. Intervention: Participants were randomized to view products with 1 of 5 food labeling systems, including control (calorie labels only) or 1 of 4 interpretative labeling systems: green ("choose often") labels added to healthy foods; single traffic light labels added to healthy, moderately healthy, and unhealthy foods; physical activity calorie equivalent labels added to all products; and nutrient warning labels added to products high in calories, sugar, saturated fat, or sodium. All conditions had calorie labels on all products. Main Outcomes and Measures: Participants selected 1 of 16 beverages and 1 of 16 snacks that they wanted to hypothetically purchase. The primary outcomes were calories selected from beverages and from snacks. Secondary outcomes included label reactions and perceptions. Results: A total of 7945 participants completed the experiment and were included in analyses (4078 [51%] female, 3779 [48%] male, and 88 [1%] nonbinary or another gender; mean [SD] age, 47.5 [17.9 years]). Compared with the control arm, exposure to the green (average differential effect [ADE], −34.2; 95% CI, −42.2 to −26.1), traffic light (ADE, −31.5; 95% CI, −39.5 to −23.4), physical activity (ADE, −39.0; 95% CI, −47.0 to −31.1), or nutrient warning labels (ADE, −28.2; 95% CI, −36.2 to −20.2) led participants to select fewer calories from beverages (all P <.001). Similarly, compared with the control label, exposure to the green (ADE, −12.7; 95% CI, −17.3 to −8.2), traffic light (ADE, −13.7; 95% CI, −18.2 to −9.1), physical activity (ADE, −18.5; 95% CI, −23.1 to −13.9), or nutrient warning labels (ADE, −14.2; 95% CI, −18.8 to −9.6) led participants to select fewer calories from snacks (all P <.001). These effects did not differ by education level. The green labels were rated as less stigmatizing than the other interpretative systems but otherwise generally received the least favorable label reactions and perceptions (eg, elicited less attention, were perceived as less trustworthy), while the nutrient warnings and physical activity labels received the most favorable ratings. Conclusions and Relevance: In this randomized clinical trial of front-of-package food labeling systems, all 4 interpretative labeling systems reduced calories selected from beverages and from snacks compared with calorie labels, with no differences by education level. Trial Registration: ClinicalTrials.gov Identifier: NCT05432271
- Subjects
UNITED States; SNACK foods; FOOD labeling; MEDICINE information services; BEVERAGES; FOOD consumption; FOOD packaging; CONSUMER attitudes; HEALTH information services; FOOD preferences; MARKETING; RANDOMIZED controlled trials; DESCRIPTIVE statistics; HEALTH behavior; RESEARCH funding; NATURAL foods; POLICY sciences; DATA analysis software
- Publication
JAMA Network Open, 2023, Vol 6, Issue 9, pe2333515
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.33515