Impact of front-of-pack labels on the perceived healthfulness of a sweetened fruit drink: a randomized experiment in 5 countries
Abstract Objective: Front-of-pack (FOP) nutrition labeling is a globally-recommended strategy to encourage healthier food choices. We evaluated the effect of FOP labels on the perceived healthfulness of a sweetened fruit drink in an international sample of adult consumers. Design: Six-arm randomized controlled experiment to examine the impact of FOP labels (No label control, Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTLs), the Health Star Ratings (HSR), Health Warning Labels (HWLs), and ‘High-in’ Warning Labels (HIWLs)) on the perceived healthfulness of the drink. Linear regression models by country examined healthfulness perceptions on FOP nutrition labels, testing for interactions by demographic characteristics. Setting: Online survey in 2018 among participants from Australia, Canada, Mexico, United Kingdom (UK), and United States (US). Participants: Adults (18 years, n=22,140) Results: Compared to control, HIWLs had the greatest impact in lowering perceived healthfulness (Betas from -0.62 to -1.71) across all countries. The HIWL and the HSR had a similar effect in Australia. Other labels were effective in decreasing the perceived healthfulness of the drink within some countries only, but to a lower extent. The GDAs did not reduce perceived healthfulness in most countries. In the UK, the effect of HIWL differed by age group, with greater impact among older participants (>40y). There were no other variations across key demographic characteristics. Conclusions: HIWLs, which communicates clear, non-quantitative messages about high levels of nutrient of concern, demonstrated the greatest efficacy to decrease the perceived healthfulness of a sweetened fruit drink across countries. This effect was similar across demographic characteristics.