Ang Felicia Jia Ler, Agrawal Sagun, Finkelstein Eric A
Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
BMC Public Health. 2019 Feb 7;19(1):164. doi: 10.1186/s12889-019-6496-8.
Front-of-pack (FOP) nutrition warning labels to identify potentially harmful foods/beverages have recently been considered in Singapore. The objective of this study was to pilot test two promising FOP warning labels intended to reduce purchases of products high in sugar to determine whether a full scale trial testing one or both these labels using actual purchases is warranted.
Five hundred twelve participants ≥21 years old and residing in Singapore completed all study elements online via the NUSMart Online Grocery Store study website. The study was designed as a Randomized Controlled Trial (RCT) where consumers were randomized and asked to hypothetically shop in one of three versions of an online grocery store; 1) no FOP label (control), 2) a graphical high-in-sugar label shaped like a stop sign, or 3) a text-based warning label. The proportion of labelled products purchased (primary outcome) and all secondary measures of diet quality were calculated using participants' orders. Ordinary Least Squares (OLS) regression was used to compare purchasing behavior across the three study arms.
The proportion of high-in-sugar products selected (i.e., those targeted for labelling) was largest in the no label control arm at 20%. The proportion was a non-statistically significant 2 percentage points lower (P = 0.146) for the high-in-sugar stop-sign label arm and 4 percentage points lower (P < 0.05) in the warning label with deterrent text arm. We could not reject the hypothesis of equal effectiveness of the two warning labels (P = 0.231).
Results suggest that the two health warning labels have potential to reduce demand for high-in-sugar products in Singapore. Future studies should test the influence of these labels using actual purchases in efforts to identify whether either labelling strategy should be considered for adoption in the local setting.
The American Economic Association's registry for randomized controlled trials; AEARCTR-0003800 . Registered 18 January 2019.
新加坡最近考虑采用包装正面（FOP）营养警示标签来识别潜在有害的食品/饮料。本研究的目的是对两个有前景的FOP警示标签进行试点测试，旨在减少高糖产品的购买量，以确定是否有必要进行一项使用实际购买情况对其中一个或两个标签进行全面试验测试。
512名年龄≥21岁且居住在新加坡的参与者通过新加坡国立大学在线杂货店研究网站在线完成了所有研究内容。该研究设计为随机对照试验（RCT），消费者被随机分组，并被要求在一个在线杂货店的三个版本之一中进行虚拟购物；1）无FOP标签（对照组），2）一个形状像停车标志的高糖图形标签，或3）一个基于文本的警示标签。使用参与者的订单计算购买的贴标产品比例（主要结果）以及饮食质量的所有次要指标。采用普通最小二乘法（OLS）回归比较三个研究组的购买行为。
在无标签对照组中，选择的高糖产品比例（即那些目标贴标产品）最高，为20%。高糖停车标志标签组的这一比例低2个百分点，差异无统计学意义（P = 0.146），而带有威慑性文字的警示标签组低4个百分点（P < 0.05）。我们不能拒绝两个警示标签效果相同的假设（P = 0.231）。
结果表明，这两个健康警示标签有可能降低新加坡对高糖产品的需求。未来的研究应该使用实际购买情况来测试这些标签的影响，以确定在当地环境中是否应考虑采用任何一种标签策略。
美国经济协会随机对照试验注册库；AEARCTR - 0003800。2019年1月18日注册。
