Effectiveness of front-of-pack nutrition symbols: a pilot study with consumers.
Front-of-pack nutrition rating systems and symbols (FOPS) have been proposed as a public health strategy for combatting diet-related chronic diseases (1-6). Nutrition rating systems and symbols have proliferated within the past decade in Canada and other nations (1,5-9), and consumers value having simplified nutrition information on food labels (5,10-13). Outside Canada, research is conflicting on the effectiveness of different FOPS in guiding healthier choices (12,14-20) and shows variations from one country to the next (14,15). Research is warranted to test the effectiveness of various FOPS with Canadian consumers.
Our aim was to pilot test a survey on FOPS with a regional consumer panel before its use with a Canada-wide panel, and to provide preliminary data on the effectiveness of different FOPS formats with respect to helpfulness, how well consumers liked them, influence, credibility, and consumers' ability to understand them.
This pilot study was conducted with the Guelph Food Panel, a cohort representative of Guelph, Ontario (one of the most representative Canadian cities for market research); the panel has been described elsewhere (21). First established in 2008, as of June 2011, it consisted of 1591 panellists aged 20 to 69. These panellists periodically complete online surveys. Ethics approval for this study was obtained from the University of Guelph Research Ethics Board.
Participants were randomly exposed to one of four FOPS (Figure 1) on mock food packages in an online survey. Participants were further randomized to view the FOPS with or without a Nutrition Facts table, so that we could gauge differences in effectiveness when FOPS are used with the mandatory table (typically found on the back of the pack) or when only front-of-pack information is viewed (simulating what consumers see on store shelves without turning over the package). Participants rated FOPS on a five-point Likert-type scale for helpfulness, how much they liked the symbol, influence, credibility, and how well they understood the symbol. Feedback questions related to the survey itself were also included. Before administration, the survey was face validated by nutrition labelling professionals.
[FIGURE 1 OMITTED]
SAS software (version 9.2, SAS Institute Inc., Cary, NC, 2008) was used for data analysis. Analysis of variance was performed for the four FOPS to permit us to evaluate mean differences in the characteristics of liking, credibility, understanding, helpfulness, and influence.
The response rate was 21.2% (337 of 1591 panellists); 66% of respondents were female. Respondents' reported ages were as follows: 20 to 29 (13%), 30 to 39 (20%), 40 to 49 (28%), 50 to 59 (27%), and 60 to 69 (12%). Fifty-seven percent of respondents provided feedback on the survey. Most respondents considered the survey length and language appropriate (100% and 80.1%, respectively). Suggested improvements to the survey were noted.
Seventy-eight percent of respondents used FOPS at least sometimes, while 6.7% used them only the first time they purchased a product. Many (65.1%) believed FOPS should be on all food packages, while 15.4% stated that FOPS should be used only on healthier products. Most participants (81.5%) preferred the use of a single, regulated symbol by all manufacturers instead of multiple unregulated FOPS. Fifty-three percent of respondents thought the government should be the body responsible for overseeing FOPS, while 27.4% and 15.1% thought FOPS should be overseen by a nonprofit group or by manufacturers, respectively.
The results from the analysis of variance of participants' ratings of FOPS characteristics are shown in Table 1. For the characteristics of helpfulness, liking, influence, and credibility, the Percent Daily Value treatments (with and without the Nutrition Facts table) had the highest mean scores and were consistently rated higher than at least one other FOPS treatment. Conversely, in terms of ease of understanding, the Percent Daily Value treatment had the lowest score, with or without a Nutrition Facts table, and was rated significantly lower than both the Health Check and manufacturer-style Smart Pick treatments. The Smart Pick treatment was rated lowest for all characteristics except ease of understanding. Despite the Percent Daily Value's higher ratings on individual FOPS characteristics, when asked directly which of the four FOPS they preferred, 53.1% of respondents preferred the traffic light over the Percent Daily Value (40.0%), Health Check (6.7%), and Smart Pick (0.3%) FOPS.
Defining healthy foods
Front-of-pack nutrition rating systems and the consequent need to define healthy foods have been the focus of international attention in recent years (1,8,9,22,23). The proliferation of FOPS has led to concerns about their reliability as sources of information to guide the selection of healthier foods (1,6). Consequently, in Canada, a Health Canada Healthy Foods Working Group has been examining approaches to define healthy foods (8,9). Similarly, in the United States (US), the Institute of Medicine (IOM) recently completed a systematic review of FOPS, to examine the appropriate courses of action for the Canadian and US governments, within the broader food labelling context (1,22).
Although the optimal front-of-pack rating system for encouraging consumers' healthy food choices has not been identified, the IOM has recommended the use of a single, standardized symbol over multiple FOPS to help consumers identify healthier foods (22). This recommendation is consistent with the opinions of our respondents, who preferred a single, government- or nonprofit-regulated symbol for use on all food products.
Information versus threshold systems
The IOM has further concluded that threshold-based FOPS, which set maximum levels for nutrients as the basis for determining which products qualify for FOPS, should be used over algorithms, which use a formula considering multiple nutrients to arrive at a final score for a product (1). The FOPS examined in this pilot study were threshold systems (traffic light, Health Check, and Smart Pick) and a system that repeats information from the Nutrition Facts table (Percent Daily Value).
The results from this study indicate that consumers prefer information systems over threshold systems on the front of food packs. Although they found the Percent Daily Value symbol difficult to understand, respondents liked the detailed nutrition information it provided and found it helpful, influential in terms of purchases, and credible. The traffic light also enjoyed a certain degree of acceptability. In contrast, although it was easier to understand, respondents rated the Health Check and Smart Pick FOPS, which provided minimal information, low in helpfulness, liking, influence, and credibility. Our findings are consistent with results from other studies that have shown consumers' preferences for FOPS do not always reflect the ability to understand them (15,16). Worth noting is the fact that our study was conducted online, and therefore our results may differ from those obtained under more realistic shopping conditions, where consumers must balance information needs with time, cost, and other pressures (22).
Respondents' use of FOPS (77.7% at least sometimes) was substantially higher than reported by Canadian label readers in another consumer study (23%) (24). This may be due to greater interest in food and nutrition within the Guelph Food Panel, as evidenced by their repeated participation in panel surveys.
This survey was a pilot test, and so results should be interpreted with caution, especially as the sample size was small. Furthermore, participation in repeated food-related surveys may have made this panel's nutrition knowledge and awareness higher than that of the general population. Results therefore may not be generalizable.
RELEVANCE TO PRACTICE
Identifying FOPS that help Canadians identify healthier grocery products is vital to the evolution of nutrition labelling policy. Information concerning Canadian consumers' liking for, understanding of, and trust in various FOPS, which will be collected in a subsequent national survey, can be used by dietitians to advocate for informed policies related to the use of FOPS in Canada.
We thank Dr. Spencer Henson and the members of the Advanced Food and Materials Network Food, Diet, and Health Group for their assistance with the survey. The Guelph Food Panel is funded by Dairy Farmers of Canada. Stipend support for Teri Emrich was funded by the Advanced Food and Materials Network. Additional funding was provided to Mary L'Abbe by the Earle W. McHenry Research Chair Award.
(1.) Committee on the Examination of Front-of-Package Nutrition Rating Systems and Symbols, Institute of Medicine. Examination of front-of-package nutrition rating systems and symbols: phase I report; 2011 [cited 2012 Mar 1]. Available from: http://www.iom.edu/Reports/2010/Examination-ofFront-of-Package-Nutrition-Rating-Systems-and- Symbols-Phase-1-Report. aspx
(2.) Carlson LA. Front-of-the-pack and on-shelf labeling: tools for spotting nutritious choices at the supermarket shelf. Nutr Today. 2010;45(1):15-21.
(3.) Lupton JR, Balentine DA, Black RM, Hildwine R, Ivens BJ, Kennedy ET, et al. The Smart Choices front-of-package nutrition labeling program: rationale and development of the nutrition criteria. Am J Clin Nutr. 2010;91(4):1078S89S.
(4.) Silverglade B, Ringel Heller I. Food labelling chaos--the case for reform. Washington: Centre for Science in the Public Interest; 2010.
(5.) Stockley L. Review of "front of pack" nutrition schemes; 2007 [cited 2012 Mar 1]. Available from: http://www.sge-ssn.ch/fileadmin/pdf/500-fuer_experten/ 70-labelling/Stockley_EHN_Review_2007.pdf
(6.) The Standing Committee on Health. Healthy Weights for Healthy Kids; 2007 [cited 2012 Mar 1]. Available from http://www.parl.gc.ca/HousePublications/ Publication.aspx?DocId=2795145&Language=E&Mode=1&Parl=39&Ses=1
(7.) Health Canada. Managing health claims for foods in Canada: towards a modernized framework; 2007 [cited 2012 Mar 1]. Available from: http://www. hc-sc.gc.ca/fn-an/consult/_man-gest_health_claims-allegations_sante/ index-eng.php
(8.) Hawkes C. Defining "healthy" and "unhealthy" foods: an international review; 2009 [cited 2012 Mar 1]. Available from: http://www.hc-sc.gc.ca/fn-an/ nutrition/pol/exsum-som-defin-international-eng.php
(9.) Reza Z. Defining "healthy" foods: environmental scan of the situation in Canada; 2009 [cited 2012 Mar 1]. Available from: http://www.hc-sc.gc.ca/fnan/nutrition/pol/exsum-som-healthy-sains- environ-eng.php
(10.) van Kleef E, van Trijp H, Paeps F, Fernandez-Celemin L. Consumer preferences for front-of-pack calories labelling. Public Health Nutr. 2007; 11(2):203-13.
(11.) Vyth EL, Steenhuis IH, Mallant SF, Mol ZL, Brug J, Temminghoff M, et al. A front-of-pack nutrition logo: a quantitative and qualitative process evaluation in The Netherlands. J Health Commun. 2009;14(7):631-45.
(12.) Kelly B, Hughes C, Chapman K, Louie JC, Dixon H, Crawford J, et al. Consumer testing of the acceptability and effectiveness of front-of-pack food labelling systems for the Australian grocery market. Health Promot Int. 2009;24(2):120-9.
(13.) Grunert KG, Wills JM. A review of European research on consumer response to nutrition information on food labels. J Public Health. 2007;15(5):385-99.
(14.) Moser A, Hoefkens C, Van Camp J, Verbeke W. Simplified nutrient labelling: consumers' perceptions in Germany and Belgium. J Consum Prot Food Safety. 2010;5(2):169-80.
(15.) Feunekes GIJ, Gortemaker IA, Willems AA, Lion R, van den Kommer M. Front-of-pack nutrition labelling: testing effectiveness of different nutrition labelling formats front-of-pack in four European countries. Appetite. 2008;50(1):57-70.
(16.) Malam S, Clegg S, Kirwan S, McGinigal S. Comprehension and use of UK nutrition signpost labelling schemes. London, UK: Food Standards Agency; 2009.
(17.) Scott V, Worsley AF. Ticks, claims, tables and food groups: a comparison for nutrition labelling. Health Promot Int. 1994;9(1):27-37.
(18.) Grunert KG, Wills JM, Fernandez-Celemin L. Nutrition knowledge, and use and understanding of nutrition information on food labels among consumers in the UK. Appetite. 2010;55(2):177-89.
(19.) Borgmeier I, Westenhoefer J. Impact of different food label formats on healthiness evaluation and food choice of consumers: a randomized-controlled study. BMC Public Health. 2009;9:184.
(20.) Andrews JC, Burton S, Kees J. Is simpler always better? Consumer evaluations of front-of-package nutrition symbols. J Public Policy Mark. 2011;30(2):175 90.
(21.) Cranfield J, Henson S, Masakure O. The global food price crisis: the perspective of Canadian consumers. Guelph, ON: University of Guelph, Department of Food, Agricultural and Resource Economics; 2008 Jul. Report No.: 1.
(22.) Committee on Examination of Front-of-Package Nutrition Ratings Systems and Symbols (phase II), Institute of Medicine. Front-of-package nutrition rating systems and symbols: promoting healthier choices; 2011 [cited 2012 Mar1].Availablefrom: http://www.iom.edu/Reports/2011/Front-of-PackageNutrition-Rating-Systems-and-Symbols-Promoting- Healthier-Choices. aspx
(23.) Roodenburg AJC, Popkin BM, Seidell JC. Development of international criteria for a front of package food labelling system: the International Choices Programme. Eur J Clin Nutr. 2011;65:1190-200.
(24.) Canadian Council of Food and Nutrition. Tracking nutrition trends VII; 2008 [cited 2012 Mar 1]. Available from: http://www.ccfn.ca/pdfs/tnt_vii_ report_%202008.pdf
TERI E. EMRICH, MPH, RD, Department of Nutritional Sciences, University of Toronto, Toronto, ON; JULIO E. MENDOZA, PhD, Department of Food, Agricultural and Resource Economics, university of Guelph, Guelph, ON; MARY R. L'ABBE, PhD, Department of Nutritional Sciences, university of Toronto, Toronto, ON
Table 1 Analysis of variance data on respondent ratings of characteristics of front-of-pack symbols (FOPS), by type and presence or absence of a Nutrition Facts table (NFT) (1) FOPS without NFT FOPS with NFT Characteristics and FOPS n Mean n Mean Helpfulness (2) Percent Daily Value 32 3.67 (a) 31 4.13 (a) Traffic light 35 3 33 (abc) 32 3.25 (b) Health Check 42 2.93 (b) 33 2.59 (bc) Smart Pick 32 2.16 (c) 35 2.40 (c) Liking (3) Percent Daily Value 32 3.73 (a) 30 4.12 (a) Traffic light 35 3.47 (a) 32 3.33 (b) Health Check 41 3.22 (a) 30 2.87 (bc) Smart Pick 31 2.55 (b) 34 2.49 (c) Influence (4) Percent Daily Value 32 3.55 (a) 29 3.76 (a) Traffic light 35 3.33 (a) 32 3.05 (a) Health Check 42 2.69 (b) 32 2.45 (b) Smart Pick 32 2.23 (b) 35 2.21 (b) Credibility (5) Percent Daily Value 32 3.47 (a) 29 3.69 (a) Traffic light 34 3.09 (a) 32 3.05 (b) Health Check 42 3.18 (a) 32 2.92 (b) Smart Pick 31 1.98 (b) 35 2.14 (c) Understanding (6) Percent Daily Value 32 1.53 (a) 31 1.69 (a) Traffic light 35 1.96 (ab) 32 1.86 (a) Health Check 42 2.25 (bc) 33 2.24 (a) Smart Pick 29 3.02 (c) 35 2.30 (a) (1) Means in the same column that do not share superscripts (a, b, or c) differ significantly at p<0.05. (2) Question: "How helpful is this symbol in helping you choose a healthier food?" Scoring: 1 = not very helpful, 5 = extremely helpful (3) Question: "How much do you like the symbol on this food?" Scoring: 1 = do not like at all, 5 = like a lot (4) Question: "Would this symbol influence your decision to buy this food?" Scoring: 1 = not at all, 5 = extremely (5) Question: "How credible is this symbol to you?" Scoring: 1 = not at all credible, 5 = extremely credible (6) Question: "How difficult is it for you to understand this symbol?" Scoring: 1 = very difficult, 5 = very easy
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|Author:||Emrich, Teri E.; Mendoza, Julio E.; Labbe, Mary R.|
|Publication:||Canadian Journal of Dietetic Practice and Research|
|Date:||Dec 22, 2012|
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