2014 New AES Research Projects – 723

COL00723 – Don’t Drink the Kool-Aid: Using front-of-package labeling and consumer education to reduce children’s consumption of sugary drinks and unhealthy foods

Sponsoring Institution: National Institute of Food and Agriculture

Project Director:

Rachel Graham
Assistant Professor
(970) 491-5718
lucas-thompson.rachel@colostate.edu
Department of Human Development and Family Studies

Non-Technical Summary

One of the primary contributors to the recent spike in childhood obesity is unhealthful food choices, leading to excess consumption. Nutrition labels are intended to help consumers make healthful food choices, but recent research from our team and others suggests that nutrition information on food packages is neither seen nor well-understood by most consumers, particularly those at highest risk for obesity, thereby preventing individuals from making more healthful choices and reducing consumption. Therefore, to reduce these trends in childhood obesity, there is a critical need to develop strategies to help consumers – particularly parents and children – use nutrition labels effectively to make healthful food choices. Without these strategies, consumers will continue to use labels poorly or not at all and struggle to make healthful food choices, thereby failing to curtail increases in childhood obesity. Our objective in this application is to evaluate the feasibility and effectiveness of a brief educational program to improve parents’ and children’s knowledge about how to use nutrition labels effectively, and to determine characteristics of parents and dyads that promote effective use of this education. Parent and child dyads will be randomly assigned to receive brief education about nutrition labels, or to not receive such education; they will then work together to choose foods to take home from a laboratory set up to resemble a grocery aisle. Most dyads will see food packaging with front-of-package nutrition labels; others will not. Eye-tracking glasses will be used to monitor parent and child attention during the shopping task, and also to later code for parent-child interaction behaviors. These methods will allow us to determine how front-of-package labels affect product choice, as well as whether a brief education program increases the healthfulness of foods and beverages selected by parents and children.

Goals / Objectives

Specific Aim #1: Evaluate the effects of front-of-package (FOP) labels on consumer food selections. We hypothesize that compared to those who view products with no labels, participants who view foods and beverages with star-based FOP labels will a) be better able to evaluate the healthfulness of foods and beverages, and b) choose more healthful products.

Specific Aim #2: Assess the impact of a brief educational program on consumer use of FOP labels and on consumer food and beverage selections. We hypothesize that participants who receive this education will be more likely to attend to the labels when later shopping for foods and beverages; as a result, we hypothesize that they will a) choose more healthful products, and b) be better able to evaluate the healthfulness of foods and beverages.

Specific Aim #3: Determine whether this educational program is most effective in influencing food choices for parent-child dyads in which parents display both warmth and structuring. We hypothesize that dyads with these characteristics will choose healthier foods and beverages and be better able to evaluate the healthfulness of food items, particularly if they have received education about effectively using nutrition labels to make healthful choices.

At the completion of this project, it is our expectation that we will have found evidence for a cost-effective and time-efficient educational program that helps parents and children make more-healthful food choices; once effectiveness has been established, we will disseminate this program to the local community. As a result, the completion of this project is expected to have a significant positive impact on the health and well-being of Colorado families.

Methods

Target Population, Sample, and Setting: Lower-income and racial/ethnic minority families will be targeted due to obesityrisk17,18. Colorado State University’s role as a land grant institution provides researchers opportunities to access diverse populations through its statewide extension programs and offices in 60 of Colorado’s 64 counties. The mission of CSU Extension is to encourage the application of knowledge in response to local and national issues; we will utilize the relationships established through CSU Extension in our recruiting efforts. In addition, we are collaborating with a local organization that works with lower-income and racial/ethnic minority families, the Coalition for Activity and Nutrition to Defeat Obesity (CanDo). They will help us to target these families at greatest risk for obesity. Eligible families will have a child aged 5-10. Participant pairs (n =195) will come to CSU to participate in two back-to-back studies.

Research Strategy: Parent/child dyads will participate in two brief studies, described separately to reduce the influence of demand characteristics on participant behavior. Study 1 will be billed as a Marketing study seeking feedback on a variety of TV advertisements unfamiliar to participants (an FOP-label educational program will be created by the study team; also used will be other unfamiliar ads [e.g., product ads taken from other English-speaking countries]). Participants will be randomly assigned to one of three conditions (see Table 1).

After viewing each ad, participants will be asked to report how the ad impacted their attitudes and intentions through standardized questionnaires used in advertising research (e.g., The Perceived Sensation Value Scale34 and The Perceived Message Cognition Value Scale35). The use of these measures is not only common in testing advertising stimuli for their effectiveness, thus adding realism to this study, but can also be used to assess how well our target population comprehends and engages with the information provided in the educational program. Parents and children will view the ads separately on computers equipped with eye-tracking cameras (used to monitor visual attention, allowing us to determine which portions of the ads are most visually salient). The questions asked of parents and children after viewing the ads will address similar constructs, but will be modified for children, using fewer questions and understandable, age-appropriate vocabulary.

Study 2 will involve parent/child interaction tasks and build on our previous work. Study 2 will occur in a second lab, set up to resemble a grocery aisle filled with common foods and beverages. FOP labels will be added to all packages (for conditions 1and 2). Dyads will be given a budget of $20 and instructed to work together to select products to take home. Participants will wear eye-tracking glasses to allow us to determine if those in the educational condition look more frequently at the FOP labels; the recorded interactions will also be coded for parenting style and discussions around the FOP labels. The products selected will be recorded and evaluated in terms of healthfulness. Participants will then complete a post-test assessment of knowledge and purchasing intention. Next, parents and children will together complete a second interaction task where they will be provided with 10 foods and beverages and asked to work together to identify the 3 most healthful products. They will then pour their estimate of a single serving of each of the 3 chosen products into an appropriate container. This additional task will be included so that after measuring food and beverage choices in a naturalistic setting (when steps have been taken to reduce demand characteristics related to health), we can examine how effectively families can use health information when they are explicitly asked to do so.

An important gap in our previous work on parent-child behavior while grocery shopping is that parents/dyads were not informed that product healthfulness was of interest; therefore, it is impossible to determine if dyads chose unhealthful foods because they were unable to determine which foods were healthful, or if they did not value choosing healthful foods. Adding a task in which participants are explicitly asked to identify healthy options will clarify whether lack of knowledge or lack of interest is driving unhealthful choices. Disentangling these influences will help us to make policy recommendations that can most effectively increase healthy eating. Post-task questionnaire: To delay directing their attention to the health/nutrition focus of the study, parents will respond to health-related questions after completing the interaction tasks. The post-task questionnaire will assess parent/child overall health, parent perception of the importance of health and healthy eating, motivation to choose healthy products, and awareness of federal nutrition information programs and use of food labels (questions taken from the National Health and Nutrition Examination Survey36). Parents will complete a brief battery of measures that will be used to assess potential control/confounding variables, including: demographics, home environment and family resources37,38, family well-being39,purchasing behavior/intention for a selected list of foods and how much his/her child likes these foods, parenting style ingeneral40 and in relation to eating41; and dietary behaviors for the previous 30 days using the Five Factor Screener from the2005 NHIS Cancer Control Supplement42,43. In addition, parent and child height and weight will be assessed viastadiometer/calibrated scale.

Finally, before debriefing dyads about the aims of the research and the link between the two studies, the study team will talk with the participants about the relative healthfulness of the various products included in the rating task, and also provide feedback about portion sizes. Dyads will receive the foods and beverages they selected from the grocery aisle, a $20 gift card, and $10 for study-related travel compensation.

Table 1. Condition descriptions

Condition N Education present
(Study 1)		 FOP labels present
(Study 2)
1: Education and Label 65 Yes Yes
2: Label Only 65 No Yes
3: Control (Neither) 65 No No

Target Audience

For the duration of our project, the target audience will be parent-child dyads in Northern Colorado and the surrounding areas. At the completion of the project, an additional target audience will be local and national stakeholders, advocates, and policy-makers.

Products

At the completion of this project, we expect that we will have conducted a study with parent-child dyads from the community to test our 3 specific aims; we will have created and experimentally tested a short, public service announcement explaining how to use nutrition labels to identify and select healthier foods, and we expect that we will have found evidence that it is cost-effective and time-efficient.

Expected Outcomes

  • Increase in knowledge about the effects of front-of-package labels on consumer food selections
  • Increase in knowledge about the impact of a brief educational program on consumer use of FOP labels and on consumer food selection
  • Increase in knowledge about whether this educational program is most effective for parent-child dyads in which parents are both warm and structuring
  • If we have found evidence that this educational program is effective, it will be disseminated into the local community, which we expect will lead to an increase in the healthy food choices made by parents and children

Keywords: Nutrition labeling, Front-of-package labeling, Healthfulness of food selection, Eye-tracking