Front of Pack Nutritional Labeling of Processed Foods Among Mexican Consumers

Food Labeling Clinical Trial

Official title:

Front of Pack Nutritional Labeling of Processed Foods Among Mexican Consumers

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04308408
• Other study ID #: 7-68S4-17
• Status: Completed
• Phase: N/A
• Start date: May 1, 2018
• Est. completion date: June 30, 2018

Study information

• Verified date: March 2020
• Source: Instituto Nacional de Salud Publica, Mexico
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The effect of three front of pack (FOP) labeling schemes (Mexican Guideline Daily Amounts (GDA), Ecuador's Multiple Traffic Light (MTL) and Chilean Warning Labels (WL) in red) on purchasing intentions was evaluated using a randomized experiment of an online shopping simulation. The study employed an online grocery store developed for this purpose to simulate a shopping situation.

Description:

Nutrition labels may modify purchasing behavior. Different labels may influence consumer purchasing behaviors in different ways.

In general, for nutrition labels to have any effect on purchasing decisions, consumers must first be exposed to them and perceive the displayed information on the labels. Then, the effect will be mediated by consumer understanding. Based on this understanding, consumers may use the label to make inferences about the nutritional quality or healthiness of the product, which, together with other information (e.g. trust or liking of the label or taste of the product) may affect the evaluation of the product and eventually the purchase decision of the product.

GDA provide numeric information on the content of key nutrients in the food product without interpreting the information.

MTL and WL are nutrient-specific labels providing an interpretation of the nutritional content of specific nutrients in the product. The MTL uses traffic light colors to indicate the high (red) or low (green) content of key nutrients, whereas the WL are only included in a product when the content of each key ingredient is above specific criteria.

Trained undergraduate student research assistants from eight universities across the country recruited the study participants. Research assistants were trained on how to approach and recruit participants and obtain informed consent. They were instructed to recruit 20 or more participants each. Recruitment took place in public spaces previously selected by convenience by the research team, based on their use by low- and middle-income groups in Mexico (i.e., public schools, public squares, public health centers, as well as supermarket chains and shopping centers located in low-income neighborhoods). Potential participants were approached by research assistants, who explained study objectives and invited them to be part of the study. Then, individuals were screened for eligibility using a 3-item screener. To access this screener, research assistants used a tablet or laptop with internet-access, to access a unique web address where our web-based tool was hosted. Research assistants were automatically informed by the web-based tool about the eligibility of the participant. Informed consent was obtained from all eligible participants using an automated computer-based form. Then, the tablet or laptop was handed to participants, who completed a self-administered online demographic and health survey, and then accessed the online shopping site to simulate a shopping situation. Participants completed the shopping task on the same day at the public place where they were recruited.

After allocation, participants viewed a video explaining how to correctly interpret the assigned label. Each participant was asked to shop freely, to better mimic real-world grocery shopping conditions. Research assistants instructed participants as follows: "take into account the assigned label and choose your preferred products". Participants were assigned an initial budget to do their shopping, although they did not pay actual money for their groceries. This budget corresponded to their weekly expenditure in groceries reported in the demographic survey, from 500-5000 Mexican pesos ($28-280 USD), in multiples of 500. No specific instructions were given related to the number or total cost of food products purchased.

FOP nutrition labels were affixed on the food items of the virtual supermarket. The store displayed the name, price and the front of the pack image of 60 food products from 5 food groups (ready-made foods, dairy products, non-dairy beverages, salty snacks, and breakfast cereals). Products were shown on traditional shopping shelves. Participants could zoom in to look more closely at the products and their prices, and could click on the product to access a new pop-up window. This new window displayed product information (i.e., name and brand), a larger image of the front of the product packaging, and an area where they could select the amount or number of products they wanted to put in their shopping cart. The pop-up window was the only way in which participants could select the food products to "purchase". Participants could also zoom in further on this pop-up to look more closely at the package and the nutritional label.

After completing their shopping, participants revised their shopping cart and "purchased" their products. A brief feedback on the nutritional quality of the products in their shopping cart was provided as a retribution for their time.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 2105
• Est. completion date: June 30, 2018
• Est. primary completion date: June 30, 2018
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Consuming at least one of the five food groups included in the shopping site (salty snacks, beverages, dairy products, breakfast cereals and ready-made foods)

• Shopping for groceries at least twice per week

Exclusion Criteria:

• Working in the food and beverage industry

• Having any of their direct family members working in the food and beverage industry

Related Conditions & MeSH terms

• Food Labeling

Intervention

Behavioral:
• Guideline Daily Amounts
All food items displayed the corresponding GDA label in the lower left corner of the front of the package.
• Multiple Traffic Light
All food items displayed the corresponding MTL label in the lower left corner of the front of the package.
• Warning Labels
Food products were labeled with "High in" labels In the lower left corner of the front of the package. In total, 37 of the 60 food products in the shopping site did not display a WL.
• Video
Participants viewed a short (less than 1 min) video explaining how to interpret the label.

Locations

Country	Name	City	State
Mexico	Universidad Autónoma Metropolitana	Ciudad de Mexico	Ciudad De México
Mexico	Univesidad Autónoma de Morelos	Cuernavaca	Morelos
Mexico	Hospital de Alta Especialidad del Bajío	León	Guanajuato
Mexico	Universidad Iberoamericana	Mexico City
Mexico	Universidad Nacional Autónoma de México	Mexico City
Mexico	Universidad Autónoma de Nuevo León	Monterrey	Nuevo León
Mexico	Universidad de Monterrey	Monterrey	Nuevo León
Mexico	Universidad Autónoma de San Luis Potosí	San Luis Potosí

Sponsors (1)

Lead Sponsor	Collaborator
Instituto Nacional de Salud Publica, Mexico

Country where clinical trial is conducted

Mexico, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Mean nutritional quality of the shopping cart	The Nutrient Profiling Scoring Criterion model was used as the main measure to evaluate the nutritional quality of the shopping cart.	On the date of randomization
Primary	Mean nutritional quality of the shopping cart (negative nutrients)	The Nutrient Profiling Scoring Criterion baseline score, considering only negative nutrients, was used to explore a nutritional quality measure consistent with the key nutrients evaluated.	On the date of randomization
Secondary	Mean protein content	The mean protein content per 100g or 100 mL of the purchased items was calculated by dividing the total protein content in the shopping cart by the number of products purchased	On the date of randomization, after completion of the online shopping simulation
Secondary	Mean fiber content	The mean fiber content per 100g or 100 mL of the purchased items was calculated by dividing the total fiber content in the shopping cart by the number of products purchased	On the date of randomization, after completion of the online shopping simulation
Secondary	Mean sodium content	The mean sodium content per 100g or 100 mL of the purchased items was calculated by dividing the total sodium content in the shopping cart by the number of products purchased	On the date of randomization, after completion of the online shopping simulation
Secondary	Mean sugar content	The mean sugar content per 100g or 100 mL of the purchased items was calculated by dividing the total sugar content in the shopping cart by the number of products purchased	On the date of randomization, after completion of the online shopping simulation
Secondary	Mean saturated fat content	The mean saturated fat content per 100g or 100 mL of the purchased items was calculated by dividing the total saturated fat content in the shopping cart by the number of products purchased.	On the date of randomization, after completion of the online shopping simulation
Secondary	Mean energy content	The mean energy content per 100g or 100 mL of the purchased items was calculated by dividing the total energy content in the shopping cart by the number of products purchased	On the date of randomization, after completion of the online shopping simulation
Secondary	Mean fat content	The mean fat content per 100g or 100 mL of the purchased items was calculated by dividing the total fat content in the shopping cart by the number of products purchased	On the date of randomization, after completion of the online shopping simulation
Secondary	Time to first product selection (minutes)	Calculated as the time required to "buy" a product after entering the online grocery store.	On the date of randomization, during the online shopping simulation
Secondary	Time spent looking at a product before deciding to buy it (seconds)	Estimated as the time between observing the food product on the pop-up window and clicking on the "add to shopping cart" button	On the date of randomization, during the online shopping simulation
Secondary	Time spent looking at a product before deciding not to buy it (seconds)	Estimated as the time between observing the food product on the pop-up window and going back to the shopping shelf	On the date of randomization, during the online shopping simulation
Secondary	Total time spent shopping (minutes)	Calculated as the time spent shopping, between entering and exiting the online grocery store.	On the date of randomization, after completion of the online shopping simulation