[Designing effective front-of-package warning labels for prepackaged food in China:based on Delphi method]

OBJECTIVE

To design front-of-package warning labels for prepackaged food adapted to the Chinese context.

METHODS

Delphi method was used to evaluate the first graft of indicatorsof the front-of-package warning labels. The front-of-package warning labels suitable for China's national conditions was selected according to the direct scoring method.

RESULTS

4 sets of front-of-package warning labels for prepackaged food were selected after two rounds of Delphi expert method.

CONCLUSION

The final draft of the front-of-package warning labels for prepackaged food is in line with expectations.

[Evaluation of the front-of-package warning labels of prepackaged food in China based on focus group discussion]

OBJECTIVE

To understand the public's perceptions and preferences on the designed front-of-package warning labels of prepackaged food, and to evaluate and identify the effective warning label.

METHODS

A total of 116 participants were recruited from six provinces(autonomous regions/municipalities) in China. Focus group discussions were conducted with four types of warning labels on prepackaged food. And the score of attitude on different warning labels were compared.

RESULTS

There was no difference in the total score of the four warning labels. Total score of black shield label was higher in citizen participants and college education level participants than in their respective counterparts(P<0.05). Parents or primary caregiver of children under 16 years old gave higher scores to each labels than their respective counterparts(P<0.05). The black shield label was most likely to attract the attention of the respondents, most likely to influence the decision on eating and drinking, and most likely to have an unhealthy warning effect. The yellow hexagonal label was least likely to attract the attention of the respondents, least likely to affect the decision to eat and drink food, and least likely to have an unhealthy warning effect.

CONCLUSION

Black shield warning label is the most effective.

Consumers' Perceptions of the Design of Front-of-Package Warning Labels-A Qualitative Study in China

The warning label is identified as a simple front-of-package labeling format that assists consumers in making healthier food choices at the point of purchase. The color and/or shape of the design elements of the packaging labels can influence the understanding and purchase intention outcomes. This study aimed to explore the perceptions of consumers regarding differently designed warning labels (WLs) to identify a possibly suitable warning label design in the Chinese context. Using a qualitative approach, we collected data through 12 focus group discussions consisting of 116 participants residing in 6 provinces. Participants were selected by purposive sampling. Data were coded following inductive thematic analysis and summarized into three themes: (1) perceived preference for the appearance of the WLs, (2) perceived benefits of the WLs, and (3) suggestions for promoting the WLs. Participants preferred the black shield label showing a high content of the nutrients of concern (e.g., sodium, added sugar, and saturated fat) in both Chinese and English. Consumers generally agreed that the WLs were easy to understand and offered a simple method for choosing healthier foods. They anticipated that WLs could encourage the food industry to reformulate their products. Our study results will support the design and facilitate the use of WLs in China.

Categorization and labeling systems concerning driving-impairing medicines: A scoping review

OBJECTIVE

Classification systems concerning driving-impairing medicines can help healthcare providers identify medicinal drugs with no or the least impairing effects and inform patients of the potential risks of certain medicines to safe driving. This study aimed to comprehensively assess the characteristics of classifications and labeling systems regarding driving-impairing medicines.

METHODS

Google Scholar and several databases, including PubMed, Scopus, Web of Science, EMBASE, safetylit.org, and TRID were searched to identify the relevant published material. The retrieved material was assessed for eligibility. Data extraction was done to compare the categorization/labeling systems concerning driving-impairing medicines in terms of characteristics such as the number of categories, description of each category, and description of pictograms.

RESULTS

After screening 5,852 records, 20 studies were selected for inclusion in the review. This review identified 22 categorization/labeling systems regarding medicines and driving. Classification systems had different characteristics, but most of them were designed based on the graded categorization system described by Wolschrijn. Initially, categorization systems had seven levels, but later the medicine impacts were summarized into 3 or 4 levels.

CONCLUSIONS

Although different categorization/labeling systems regarding driving-impairing medicines are available, the most effective systems in changing driver's behavior are the simple and understandable ones. Besides, health care providers should consider patient's socio-demographic features when informing them about driving under the influence.

The Influence of E-cigarette Warning Labels on Youths' Use Intentions - A Mediation Analysis of Role of Perceived Harm

Background: Electronic cigarettes (e-cigarettes) were introduced to the United States marketplace in 2007 and had dominated all other tobacco products used by youth by 2014. In May 2016, the Food and Drug Administration extended the final rule to include e-cigarettes in implementing text-based health warnings on cigarette packs and advertising, as required by the 2009 Tobacco Control Act. This study tested the hypothesis that youth's perceived harm of using e-cigarettes mediates the impact of seeing warning labels on their use intentions. Methods: We used a cross-sectional quantitative research design to analyze the 2019 National Youth Tobacco Survey data from 12,563 students in middle schools (grades 6 - 8) and high schools (grades 9 - 12) in the U.S. We conducted the 4-step Baron and Kenny Mediation Analysis using IBM SPSS® Hayes' PROCESS macro analysis. Results: Our study revealed a mediational process's presence, confirming the mediational role of youth's perceived harm of e-cigarettes on the relationship between seeing a warning label and their use intentions. Conclusion: This study provided insights into the relationship between seeing warning labels and the intention to use e-cigarettes among youth. Through the Tobacco Control Act, influential warning labels potentially increase youth's perception of harm in e-cigarettes, lowering their intention to use.

Introducing the Front-Of-Pack Acceptance Model: the role of usefulness and ease of use in European consumers' acceptance of Front-Of-Pack Labels

In recent years, increasing attention to the utilisation of Front-Of-Pack Labels (FOPLs) as a tool to prompt individuals towards healthier food choices has been observed both in regulatory bodies and academic research. However, few theoretical models have been used to understand their role in consumer decision-making, as well as the antecedents that induce individuals to accept the information provided by the label, and to benchmark FOPL performance in different markets.Through a sequence of two studies conducted in Italy, France and the UK on 2812 primary grocery shoppers, we developed a new theoretical framework, the Front-Of-Pack Acceptance Model, applicable both in contexts in which FOPL are present, and in which they should be introduced. Our findings suggest a structural link between the usefulness and ease of use of the labels and the way consumers form their attitudes and intentions towards buying healthier products.

Using social media comments to reduce alcohol purchase intentions: An online experiment

INTRODUCTION

Alcohol advertising is prevalent on social media. The current study sought to identify effective message types to pair with social media alcohol ads to minimise purchase intentions associated with exposure.

METHODS

A 6 (within) × 5 (between) randomised controlled experiment was conducted with n = 723 US participants. Participants viewed six unique social media alcohol ads and were randomised to view one of four message types (i.e. pro-drinking comments, anti-drinking comments, industry responsibility messages and health warning labels) associated with the ads or the control (i.e. no messages). Purchase intentions were measured after each ad exposure. Significant main and interactive effects were determined by two-level, random intercept hierarchical linear models.

RESULTS

Purchase intentions were significantly lower among participants who viewed anti-drinking comments relative to the control (P = 0.022) and warning labels (P = 0.016). Purchase intentions were significantly greater among participants who viewed pro-drinking comments and had a family history of alcohol use (P = 0.032) and among those who viewed warning labels and were previously exposed to alcohol depictions through family and friends' social media posts (P = 0.033).

DISCUSSION AND CONCLUSIONS

Anti-drinking messages, written by social media users, may be effective at reducing alcohol purchase intentions when posted as social media comments. Current industry responsibility messages had no effect, and caution may be needed if warning labels are applied to ads in this medium.

Signs of Warning: Do Health Warning Messages on Sweets Affect the Neural Prefrontal Cortex Activity?

In the global attempt to combat rising obesity rates, the introduction of health warning messages on food products is discussed as one possible approach. However, the perception of graphical health warning messages in the food context and the possible impact that they may have, in particular at the neuronal level, have hardly been studied. Therefore, the aim of this explorative study was to examine consumers’ reactions (measured as neuronal activity and subjective reporting) of two different types of graphical health warning messages on sweets compared to sweets without warning messages. One type used the red road traffic stop sign as graphical information (“Stop”), while the other one used shocking pictures (“Shock”), an approach similar to the images on cigarette packages. The neural response of 78 participants was examined with the neuroimaging technique functional near-infrared spectroscopy (fNIRS). Different hemodynamic responses in the orbitofrontal cortex (OFC), the frontopolar cortex (FOC), and the dorsolateral prefrontal cortex (dlPFC) were observed, regions which are associated with reward evaluation, social behavior consequences, and self-control. Further, the health warning messages were actively and emotionally remembered by the participants. These findings point to an interesting health information strategy, which should be explored and discussed further.

Warning Labels Reduce Sugar-Sweetened Beverage Intake among College Students

BACKGROUND

Health-related warning labels may reduce the intake of sugar-sweetened beverages (SSBs), but the effectiveness of such labels in real-world settings is not well established.

OBJECTIVES

We investigated the influence of warning labels on SSB intake among college students at a large public Midwestern university.

METHODS

We conducted a quasi-experimental intervention study among 840 undergraduate students recruited from 3 dining halls on 1 university campus. One dining hall was selected as the intervention (I) site, whereas the other dining halls served as control (C) sites. In January 2019, warning labels were posted on SSB dispensers at the I site. All students reported their beverage intake using a modified beverage frequency questionnaire 2 mo before and 2 mo after the warning label implementation. Generalized linear models examined the influence of the warning labels on SSB consumption at the I site compared with the C sites, adjusting for students' sociodemographic characteristics.

RESULTS

In the sample, 68% were aged 17-18 y old at baseline, and 51% identified as female. From baseline to follow-up, there was a 19% decrease in SSB intake at the I site, compared with a 5% decrease at the C sites (P = 0.049 comparing I with C). This difference was driven by significant decreases in the intakes of fruit-flavored drinks, sweetened teas, and flavored milk at the I site compared with the C sites. Although not an SSB, 100% fruit juce consumption decreased 21% at the I site, compared with a 1% increase at the C sites (P = 0.01 comparing I with C). No significant differences were observed in the intakes of soda, energy drinks, sweetened coffees, and nonsugary drinks at the I site compared with the C sites.

CONCLUSIONS

Warning labels were effective in reducing SSB intake among college students, particularly for fruit-flavored drinks, sweetened teas, and flavored milk.This trial was registered at clinicaltrials.gov as NCT04435145.

Changes in Nutrient Declaration after the Food Labeling and Advertising Law in Chile: A Longitudinal Approach

Chile has implemented several strategies to decrease the burden of obesity and chronic diseases. The Food Labeling and Advertising Law (Law 20.606) requires a front-of-package "high in" warning label when energy and nutrients of concern (ENC) (total sugar, saturated fats, sodium) exceed established limits. This study aims to evaluate the impact of Law 20.606 on the ENC declaration of packaged foods in Chile, before and after the law implementation. We analyzed food nutritional labeling declarations from 70% of the most consumed packaged foods in Chile. Data collection was conducted in 2013 and 2019 in Santiago. Pictures from all sides of the package were taken from 476 products, classified into 16 food groups. All food groups had changes in the ENC declaration during the study period. Total sugar content showed the highest reduction (-15.0%; p = 0.001). Dairy, confitures and similar and sugary beverages had the greatest reduction in energy and total sugar content (p < 0.01). Energy, total sugar and sodium front of package "high in" simulation was significantly reduced in dairy, sugary beverages, flour-based foods, confitures and similar, fish and seafoods, fats and oils, spices, condiments and sauces and sugars (p < 0.05). We observed that companies reformulated products to adapt to the new regulation.

Consumers' Perceptions of Five Front-of-Package Nutrition Labels: An Experimental Study Across 12 Countries

Consumers’ perceptions of five front-of-pack nutrition label formats (health star rating (HSR), multiple traffic lights (MTL), Nutri-Score, reference intakes (RI) and warning label) were assessed across 12 countries (Argentina, Australia, Bulgaria, Canada, Denmark, France, Germany, Mexico, Singapore, Spain, the UK and the USA). Perceptions assessed included liking, trust, comprehensibility, salience and desire for the label to be mandatory. A sample of 12,015 respondents completed an online survey in which they rated one of the five (randomly allocated) front-of-pack labels (FoPLs) along the perception dimensions described above. Respondents viewing the MTL provided the most favourable ratings. Perceptions of the other FoPLs were mixed or neutral. No meaningful or consistent patterns were observed in the interactions between country and FoPL type, indicating that culture was not a strong predictor of general perceptions. The overall ranking of the FoPLs differed somewhat from previous research assessing their objective performance in terms of enhancing understanding of product healthiness, in which the Nutri-Score was the clear front-runner. Respondents showed a strong preference for mandatory labelling, regardless of label condition, which is consistent with past research showing that the application of labels across all products leads to healthier choices.

Alcohol counter-advertising and the media. A review of recent research

Counter-advertising commonly is used to balance the effects that alcohol advertising may have on alcohol consumption and alcohol-related problems. Such measures can take the form of print or broadcast advertisements (e.g., public service announcements [PSAs]) as well as product warning labels. The effectiveness of both types of counter-advertising is reviewed using the Elaboration Likelihood Model as a theoretical framework. For print and broadcast counter-advertisements, such factors as their emotional appeal and the credibility of the source, as well as audience factors, can influence their effectiveness. Further, brewer-sponsored counter-advertisements are evaluated and received differently than are the more conventional PSA counter-advertisements. For warning labels, both the content and design of the label influence their effectiveness, as do audience factors. The effectiveness of those labels is evaluated in terms of the extent to which they impact cognitive and affective processes as well as drinking behavior.

Fetal alcohol syndrome prevention research

Alcohol consumption during pregnancy can have numerous adverse health consequences for the developing fetus, including fetal alcohol syndrome (FAS) and alcohol-related effects, and therefore is a significant public health problem. A variety of programs have been developed to prevent drinking during pregnancy and the resulting health problems. Some of these efforts, such as public service announcements and beverage warning labels, are universal and strive to increase the public's knowledge about FAS. Selective prevention approaches target women of reproductive age who drink alcohol. Such approaches may involve screening all pregnant women for alcohol consumption and counseling those women who do drink. Indicated prevention approaches target high-risk women (e.g., women who have previously abused alcohol or have had a child with FAS or other alcohol-related effects) and typically offer repeated counseling over several years. Both selective and indicated prevention efforts can reduce maternal alcohol consumption and improve the outcome of the offspring.

Alcohol-related birth defects--the past, present, and future

In 1994 Alcohol Health & Research World (now titled Alcohol Research & Health) last devoted a full issue to the topic of fetal alcohol syndrome (FAS) and other alcohol-related birth defects (ARBD). This introductory article provides readers with information on how the field has advanced since then. In addition to tracing the development of the terminology used in the field, it describes the difficulties involved in determining the true prevalence of FAS and ARBD; the mechanisms that may play a role in alcohol-derived fetal injuries; approaches to preventing drinking during pregnancy; and strategies for assisting people who have been born with FAS and ARBD.

Alcohol Research and Social Policy: An Overview

Science can facilitate the task of choosing among complex social policies, although it rarely serves as the only basis for policy development. Science's role in policy formation can be decisive when public support already exists, as with the passage of the Federal Uniform Drinking Age Act. Science can assess a policy after it has been implemented, as in the scientific evaluation of the health warning labels on alcoholic beverage containers. In addition, science can investigate the short- and long-term benefits and risks of areas where the development of policies is likely. An example is the current scientific examination of the tradeoffs involved in moderate alcohol consumption.