Impact of front-of-pack nutrition labels on consumer purchasing intentions: a randomized experiment in low- and middle-income Mexican adults

Alejandra Jáuregui, Jorge Vargas-Meza, Claudia Nieto, Alejandra Contreras-Manzano, Nelson Zacarías Alejandro, Lizbeth Tolentino-Mayo, Marissa G Hall, Simón Barquera, Alejandra Jáuregui, Jorge Vargas-Meza, Claudia Nieto, Alejandra Contreras-Manzano, Nelson Zacarías Alejandro, Lizbeth Tolentino-Mayo, Marissa G Hall, Simón Barquera

Abstract

Background: Front-of-pack (FOP) nutrition labeling is a cost-effective strategy to help consumers make informed and healthier food choices. We aimed to investigate the effect of the FOP labels used in the Latin American region on consumers' shopping intentions when prompted to make their choices with specific nutrients-to-limit in mind among low- and middle-income Mexican adults (> 18 y).

Methods: In this experimental study of an online simulated shopping situation participants (n = 2194) were randomly assigned to one of three labeling conditions: Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), or red Warning Labels (WL). Participants were required to view a video explaining how to correctly interpret the assigned label. Primary outcomes were the overall nutritional quality (estimated using the Nutrient Profiling Scoring Criterion [NPSC] and NPSC baseline score) and mean energy and nutrient content of purchases. Secondary outcomes included shopping time variables. We also evaluated the impact of the labels across food categories (ready-made foods, dairy beverages, non-dairy beverages, salty snacks, and breakfast cereals) and sociodemographic subgroups.

Results: The MTL and the WL led to a better overall nutritional quality of the shopping cart compared to the GDA (p < 0.05). According to the NPSC score, the WL led to a better nutritional quality across breakfast cereals and salty snacks compared to the GDA (p < 0.05); a similar effect was observed for the MTL among non-dairy beverages (p < 0.05). The MTL and the WL required shorter shopping times compared to GDA (p < 0.05). Across all labeling conditions, the nutritional quality of the shopping cart tended to be lower among those with low income, education and nutrition knowledge levels.

Conclusion: WL and MTL may foster healthier food choices in a faster way among low- and middle-income groups in Mexico. To produce an equitable impact among consumers of all socioeconomic strata, efforts beyond simply the inclusion of a communication campaign on how to use and interpret FOP labels will be required.

Trial registration: clinicaltrials.gov. NCT04308408 Retrospectively registered March 16, 2020.

Keywords: Latin-America; Nutritional labeling; Shopping time.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The online shopping site. a Food categories. b Products on shopping shelves; c Pop-up window displaying product information; d Zoom into the package and the nutritional label. Source: Figure prepared by authors using the website purposively created by the research team for this experiment
Fig. 2
Fig. 2
Front-of-pack labeling systems tested. 1) Guideline Daily Allowances, 2) Multiple Traffic Lights used in Ecuador, 3) Red Warning Labels similar to Chile’s labeling system

References

    1. Branca F, Lartey A, Oenema S, Aguayo V, Stordalen GA, Richardson R, et al. Transforming the food system to fight non-communicable diseases. BMJ. 2019;364:1296.
    1. Cecchini M, Warin L. Impact of food labelling systems on food choices and eating behaviours: a systematic review and meta-analysis of randomized studies. Obes Rev. 2016;17:201–210. doi: 10.1111/obr.12364.
    1. Kanter R, Vanderlee L, Vandevijvere S. Front-of-package nutrition labelling policy: global progress and future directions. Public Health Nutr. 2018:1–10.
    1. Joint FAO/WHO Food Standards Programme . Proc Forty-Third Sess (Comments From IACFO), Ottawa, ON, Canada, 9–13 May 2016 Propos new work concern a glob stand front pack interpret Nutr label. Rome: Codex Alimentarius; 2016.
    1. Grunert KG, Wills JM. A review of European research on consumer response to nutrition information on food labels. J Public Health (Bangkok) 2007;15:385–399. doi: 10.1007/s10389-007-0101-9.
    1. Aguilar A. Inicia hoy MOVISA campaña vs obesidad, “checa y elige” 84 mdp, etiquetado foco e IP a largo plazo. Milenio [Internet]. Ciudad de México; 2017 [cited 2019 May 9]; Available from: . Accessed 24 Mar 2020.
    1. Sánchez K, Bladeras N, Munguía A, Barquera S. El etiquetado de alimentos y bebidas: la experiencia en México. México: Instituto Nacional de Salud Pública; 2018.
    1. Tolentino-Mayo L, Rincón-Gallardo Patiño S, Bahena-Espina L, Ríos V, Barquera S. Knowledge and use of nutrient labelling of industrialized foods and beverages in Mexico. Salud Publica Mex. 2018;60:328–337. doi: 10.21149/8825.
    1. Stern D, Tolentino L, Barquera S. Revisión del etiquetado frontal: análisis de las Guías Diarias de Alimentación (GDA) y su comprensión por estudiantes de nutrición en México. Inst Nac Salud Publica. 2011.
    1. De la Cruz-Góngora V, Torres P, Contreras-Manzano A. Jáuregui de la Mota a, Mundo-Rosas V, Villalpando S, et al. understanding and acceptability by Hispanic consumers of four front-of-pack food labels. Int J Behav Nutr Phys Act. 2017;14:28. doi: 10.1186/s12966-017-0482-2.
    1. Nieto C, Jauregui A, Contreras-Manzano AG, Arillo-Santillán E, Barquera S, White C, et al. Understanding of food labeling systems among White, Latinos, and Mexican population: Data from the International Food Policy Study 2017. Int J Behav Nutr Phys Act. 2019;16:87. doi: 10.1186/s12966-019-0842-1.
    1. Vargas-Meza J, Jáuregui A, Contreras-Manzano A, Nieto C, Barquera S. Acceptability and understanding of front-of-pack nutritional labels: an experimental study in Mexican consumers. BMC Public Health. 2019;19:1751. doi: 10.1186/s12889-019-8108-z.
    1. Correa T, Fierro C, Reyes C, Dillman Carpentier FR, Smith Taillie L, Corvalan C, et al. Responses to the Chilean law of food labeling and advertising: Exploring knowledge, perceptions and behaviors of mothers of young children. Int J Behav Nutr Phys Act. 2019;16:21. doi: 10.1186/s12966-019-0781-x.
    1. Freire WB, Waters WF, Rivas-Mariño G, Nguyen T, Rivas P. A qualitative study of consumer perceptions and use of traffic light food labelling in Ecuador. Public Health Nutr. 2017;20:805–813. doi: 10.1017/S1368980016002457.
    1. de Morais SP, Mais LA, Khandpur N, Ulian MD, Bortoletto Martins AP, Garcia MT, et al. Consumers’ opinions on warning labels on food packages: a qualitative study in Brazil. PLoS One. 2019;14:e0218813. doi: 10.1371/journal.pone.0222604.
    1. Reyes M, Garmendia ML, Olivares S, Aqueveque C, Zacarías I, Corvalán C. Development of the Chilean front-of-package food warning label. BMC Public Health. 2019;19:906. doi: 10.1186/s12889-019-7118-1.
    1. Khandpur N, de Morais SP, Mais LA, Bortoletto Martins AP, Spinillo CG, Garcia MT, et al. Are front-of-package warning labels more effective at communicating nutrition information than traffic-light labels? A randomized controlled experiment in a Brazilian sample. Nutrients. 2018;10:1–15. doi: 10.3390/nu10060688.
    1. Cabrera M, Machín L, Arrúa A, Antúnez L, Curutchet MR, Giménez A, et al. Nutrition warnings as front-of-pack labels: influence of design features on healthfulness perception and attentional capture. Public Health Nutr. 2017;20:3360–3371. doi: 10.1017/S136898001700249X.
    1. Arrúa A, MacHín L, Curutchet MR, Martínez J, Antúnez L, Alcaire F, et al. Warnings as a directive front-of-pack nutrition labelling scheme: comparison with the guideline daily amount and traffic-light systems. Public Health Nutr. 2017;20:2308–2317. doi: 10.1017/S1368980017000866.
    1. Sandoval LA, Carpio CE, Sanchez-Plata M. The effect of ‘traffic-light’ nutritional labelling in carbonated soft drink purchases in Ecuador. PLoS One. 2019;14:e0222866. doi: 10.1371/journal.pone.0222866.
    1. Machín L, Arrúa A, Giménez A, Curutchet MR, Martínez J, Ares G. Can nutritional information modify purchase of ultra-processed products? Results from a simulated online shopping experiment. Public Health Nutr. 2018;21:49–57. doi: 10.1017/S1368980017001185.
    1. Machín L, Aschemann-Witzel J, Curutchet MR, Giménez A, Ares G. Does front-of-pack nutrition information improve consumer ability to make healthful choices? Performance of warnings and the traffic light system in a simulated shopping experiment. Appetite. 2018;121:55–62. doi: 10.1016/j.appet.2017.10.037.
    1. Díaz A, Veliz P, Rivas G, Mafla C, Martínez L, Vaca C. Etiquetado de alimentos en Ecuador: implementación, resultados y acciones pendientes Investigación original. Rev Panam Salud Publica. 2017;41:1–7. doi: 10.26633/RPSP.2017.54.
    1. Mørk T, Grunert KG, Fenger M, Juhl HJ, Tsalis G. An analysis of the effects of a campaign supporting use of a health symbol on food sales and shopping behaviour of consumers. BMC Public Health. 2017;17:239. doi: 10.1186/s12889-017-4149-3.
    1. Grunert KG, Fernández-Celemín L, Wills JM, Bonsmann SSG, Nureeva L. Use and understanding of nutrition information on food labels in six European countries. J Public Health (Bangkok) 2010;18:261–277. doi: 10.1007/s10389-009-0307-0.
    1. van Herpen E. Trijp HCM va. Front-of-pack nutrition labels. Their effect on attention and choices when consumers have varying goals and time constraints. Appetite. 2011;57:148–160. doi: 10.1016/j.appet.2011.04.011.
    1. Egnell M, Talati Z, Hercberg S, Pettigrew S, Julia C. Objective understanding of front-of-package nutrition labels: an international comparative experimental study across 12 countries. Nutrients. 2018;10:1542. doi: 10.3390/nu10101542.
    1. Cowburn G, Stockley L. Consumer understanding and use of nutrition labelling: a systematic review. Public Health Nutr. 2005;8:21–28. doi: 10.1079/PHN2004666.
    1. Vargas-Meza J, Jáuregui A, Pacheco-Miranda S, Contreras-Manzano A, Barquera S. Front-of-pack nutritional labels: Understanding by low- and middle-income Mexican consumers. PLoS One. 2019;14:e0225268. doi: 10.1371/journal.pone.0225268.
    1. Grummon AH, Hall MG, Taillie LS, Brewer NT. How should sugar-sweetened beverage health warnings be designed? A randomized experiment. Prev Med (Baltim) 2019;121:158–166. doi: 10.1016/j.ypmed.2019.02.010.
    1. Baig SA, Noar SM, Gottfredson NC, Boynton MH, Ribisl KM, Brewer NT. UNC perceived message effectiveness: validation of a brief scale. Ann Behav Med. 2018;53:732–742. doi: 10.1093/abm/kay080.
    1. Harris HL, Graff SK. Protecting children from harmful food marketing: options for local government to make a difference. Prev Chronic Dis. 2011;8:A92.
    1. Araya S, Elberg A, Noton C, Schwartz D. Identifying Food Labeling Effects on Consumer Behavior. SSRN Electron J. 2018; Available from:. 10.2139/ssrn.3195500.
    1. Food Standard Australia New Zealand . Nutrient Profiling Scoring Calculator for Standard 1.2.7. 2016.
    1. Contreras-Manzano A, Alejandra J, Velasco-bernal A, Vargas-Meza J, Rivera JA, Tolentino-Mayo L, et al. Comparative analysis of the classification of food different nutrient profiling systems. Nutrients. 2018;10.
    1. NORMA . Oficial Mexicana NOM-051-SCFI/SSA1-2010, Especificaciones generales de etiquetado para alimentos y bebidas no alcohólicas preenvasados-Información comercial y sanitaria. 2010. pp. 1–31.
    1. Corvalán C, Reyes M, Garmendia ML, Uauy R. Structural responses to the obesity and non‐communicable diseases epidemic: Update on the Chilean law of food labelling and advertising. Obes Rev. 2019;20(3):367–37.
    1. Ducrot P, Julia C, Méjean C, Kesse-guyot E, Touvier M, Fezeu LK, et al. Impact of different front-of-pack nutrition labels on consumer purchasing intentions. Am J Prev Med Elsevier. 2016;50:627–636. doi: 10.1016/j.amepre.2015.10.020.
    1. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46. doi: 10.1177/001316446002000104.
    1. Encuesta Nacional de Ingresos y Gastos de los Hogares 2016 Nueva serie [Internet]. Inst. Nac. Estad. y Geogr. 2016 [cited 2019 May 11]. Available from: .
    1. Ikonen I, Sotgiu F, Aydinli A, Verlegh PWJ. Consumer effects of front-of-package nutrition labeling: an interdisciplinary meta-analysis. J Acad Mark Sci. 2019:1–24.
    1. Egnell M, Crosetto P, D’Almeida T, Kesse-Guyot E, Touvier M, Ruffieux B, et al. Modelling the impact of different front-of-package nutrition labels on mortality from non-communicable chronic disease. Int J Behav Nutr Phys Act. 2019;16:56. doi: 10.1186/s12966-019-0817-2.
    1. Aschemann-Witzel J, Grunert KG, van Trijp H, Bialkova S, Raats MM, Hodgkins C, et al. Effects of nutrition label format and product assortment on the healthfulness of food choice. Appetite. 2013;71:63–74. doi: 10.1016/j.appet.2013.07.004.
    1. Visschers VH, Hess R, Siegrist M. Health motivation and product design determine consumers visual attention to nutrition information on food products. Public Health Nutr. 2010;13:1099–1106. doi: 10.1017/S1368980009993235.
    1. Ares G, Machín L, Vidal L, Aschemann-Witzel J, Otterbring T, Curutchet MR, et al. How can we motivate people to use nutritional warnings in decision making? Citizen co-created insights for the development of communication campaigns. Heal Educ Behav. 2019;47(2):321–31.
    1. Roberto CA, Bragg MA, Schwartz MB, Seamans MJ, Musicus A, Novak N, et al. Facts up front versus traffic light food labels: a randomized controlled trial. Am J Prev Med. 2012;43:134–141. doi: 10.1016/j.amepre.2012.04.022.
    1. Helfer P, Shultz TR. The effects of nutrition labeling on consumer food choice: a psychological experiment and computational model. Ann N Y Acad Sci. 2014;1331:174–185. doi: 10.1111/nyas.12461.
    1. Khandpur N, Swinburn B, Monteiro CA. Nutrient-based warning labels may help in the pursuit of healthy diets. Obesity. 2018;26:1670–1671. doi: 10.1002/oby.22318.
    1. Milosavljevic M. Consumers can make decisions in as little as a third of a second. Judgement Decis Mak. 2011;6:520–530.
    1. Pieters R, Warlop L. Visual attention during brand choice: the impact of time pressure and task motivation. Int J Res Mark. 1999;16:1–16. doi: 10.1016/S0167-8116(98)00022-6.

Source: PubMed

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