Effects of interpretive nutrition labels on consumer food purchases: the Starlight randomized controlled trial ,

Abstract

Background: Nutrition labeling is a prominent policy to promote healthy eating. Objective: We aimed to evaluate the effects of 2 interpretive nutrition labels compared with a noninterpretive label on consumer food purchases. Design: In this parallel-group randomized controlled trial, we enrolled household shoppers across New Zealand who owned smartphones and were aged $18 y. Eligible participants were randomly assigned (1:1:1) to receive either traffic light labels (TLLs), Health Star Rating labels (HSRs), or a control [nutrition information panel (NIP)]. Smartphone technology allowed participants to scan barcodes of packaged foods and to receive allocated labels on their smartphone screens. The primary outcome was the mean healthiness of all packaged food purchases over the 4-wk intervention period, which was measured by using the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC). Results: Between October 2014 and November 2015, 1357 eligible shoppers were randomly assigned to TLL (n = 459), HSR (n = 443), or NIP (n = 455) labels. Overall difference in the mean transformed NPSC score for the TLL group compared with the NIP group was 20.20 (95% CI: 20.94, 0.54; P = 0.60). The corresponding difference for HSR compared with NIP was 20.60 (95% CI: 21.35, 0.15; P = 0.12). In an exploratory per-protocol analysis of participants who used the labeling intervention more often than average (n = 423, 31%), those who were assigned to TLL and HSR had significantly better NPSC scores [TLL compared with NIP: 21.33 (95% CI: 22.63, 20.04; P = 0.04); HSR compared with NIP: 21.70 (95% CI: 22.97, 20.43; P = 0.01)]. Shoppers who were randomly assigned to HSR and TLL also found the labels significantly more useful and easy to understand than the NIP (all P values ,0.001). Conclusions: At the relatively low level of use observed in this trial, interpretive nutrition labels had no significant effect on food purchases. However, shoppers who used interpretive labels found them to be significantly more useful and easy to understand, and compared with frequent NIP users, frequent TLL and HSR users had significantly healthier food purchases. This trial was registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id= 366446&isReview=true) as ACTRN12614000644662.Am J Clin Nutr 2017;105:695-704.

The performance and potential of the Australasian Health Star Rating system: a four‐year review using the RE‐AIM framework

“…Understanding and use: Most research identified the HSR graphic as easy to understand and use. The HSR star logo was found to be more likely to be understood and to influence product selection than the Nutrition Information Panel (NIP), 35,36 health and nutrient content claims, 37–40 and alternative FoPL designs including the Multiple Traffic Light (MTL) 35,36,38,41 and industry‐preferred Daily Intake Guide 35,36,38,41–44 . Several studies confirmed these results in children 40–42,44 .…”

“…In the disparate New Zealand studies noted above, HSR was shown to be ineffective in influencing unprompted consumer choice between two breakfast cereals 46,47 and consumers made similar purchases using HSR and MTL 45 . Randomised controlled trials examining the impact of FoPL in the real world identified no effect of HSR on the healthiness of food purchases, 35,36 despite participants' stated preference for the HSR label format.…”

Color-Coded Front-of-Pack Nutrition Labels—An Option for US Packaged Foods?

“…Most recently, studies have appeared which utilise smartphone technology to understand whether consumer use of FOP labelling schemes translates to healthier food choices. For example, the Starlight trial undertaken in New Zealand compared the mean healthfulness of all packaged food purchases over a four week intervention period and found that traffic light label users had significantly healthier food purchases than users of the standard back-of-pack information [26]. A similar study is currently underway in Australia comparing the healthfulness of food purchases using five different forms of labelling via a consumer’s smartphone [27].…”

A randomized controlled trial examining consumers’ perceptions and opinions on using different versions of a FoodFlip© smartphone application for delivery of nutrition information

“…Although many different formats of INRS have been identified worldwide; traffic light labels, health star rating or star rating (adapted from Australia/NZ health star rating) and 'high in' warning labels (Fig. 1) were selected for the current study, given that: 1) traffic light, star rating and 'high in' warning labels reflect different FOP symbols currently in use around the world [51,52]; 2) regulations requiring 'high in' warning labels were recently proposed by Health Canada as part of Canada's Healthy Eating Strategy [20]; 3) supportive evidence for all three systems suggests potential acceptance or usage by consumers [19,52] and; 4) all three systems could be formatted to be congruent with Canadian food standards and regulations. The app displaying the Canadian NFt was provided as a control.…”