Effect of Front-of-Pack Labels in Ethiopia

NCT05549388 | Completed

• 1 other identifier: IRB00016498
• Study Type: interventional
• Target: 1,200
• Locations: 1 country
• Sites: 1

Brief Summary

Ethiopia is experiencing the type of rapid food system transformation that leads to a double burden of malnutrition and increased non-communicable diseases. Front-of-pack labels on packaged foods are an emerging public health strategy with the potential to address non-communicable diseases by discouraging the purchase and consumption of products with high levels of nutrients of public health concern. The aim of this study is to evaluate and compare the effectiveness of front-of-pack labeling systems to reduce the intent to purchase unhealthy foods among adults in Ethiopia. The study will recruit approximately 1200 adults using a street-intercept methodology. Participants will be randomized to 1 of 4 arms to complete a survey in which the presence and type of front-of-pack label differs across survey arms and asked to rate participants' intent to purchase unhealthy packaged foods.

Conditions

Cardiovascular Diseases

Keywords

Nutrition; Packaged food

Outcome Measures

Primary Outcomes (1)

• Intent to purchase based on single product tasks

  Participants will be shown images of four single products, two of which are high in sodium and two of which are high in sugar. For each product, participants will rate their intent to purchase the product on a likert scale. The investigators will calculate the mean of the responses to questions about the four products.

  The outcome will be assessed during survey administration at a single time point (baseline).

Secondary Outcomes (2)

• Purchase choice based on product comparison tasks

  The outcome will be assessed during survey administration at a single time point (baseline).

• Label understanding and acceptability

  The outcome will be assessed during survey administration at a single time point (baseline).

Other Outcomes (2)

• Intent to purchase foods high in sodium

  The outcome will be assessed during survey administration at a single time point (baseline).

• Intent to purchase foods high in sugar

  The outcome will be assessed during survey administration at a single time point (baseline).

Study Arms (4)

No label

NO INTERVENTION

In this arm, participants will view images of packaged food or beverage products without a front-of-pack label and respond to questions about the products.

Multiple Traffic Light (MTL)

EXPERIMENTAL

In this arm, participants will view images of packaged food or beverage products which have multiple traffic light labels displayed on the front-of-pack and respond to questions about the products.

Other: Front-of-pack labeling

Nutri-Score

EXPERIMENTAL

In this arm, participants will view images of packaged food or beverage products which have a Nutriscore front-of-pack label and respond to questions about the products.

Other: Front-of-pack labeling

Warning Label

EXPERIMENTAL

In this arm, participants will view packaged food or beverage products which have front-of-pack warning labels if the product is high in one or more nutrients of concern and respond to questions about the products.

Other: Front-of-pack labeling

Interventions

Front-of-pack labeling OTHER

The intervention being tested is the effect of front-of-package labeling on consumers' intent to purchase foods which are high in one or more nutrients of public health concern. Participants randomized to the control group will view images of packaged foods and beverages and answer a series of questions about those products. In the intervention arms, participants will view images of the same packaged foods and beverages, but with different front-of-package labels displayed that provide nutrition information about the product. Participants in each arm will be asked the same series of questions about the products shown.

Multiple Traffic Light (MTL); Nutri-Score; Warning Label

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥18 years
• Purchase foods outside of the household

You may not qualify if:

• Age \<18 years
• Do not purchase foods outside of the household
• Unable to complete the survey protocol

Sponsors & Collaborators

• Johns Hopkins Bloomberg School of Public Health: lead
• Addis Continental Institute of Public Health: collaborator
• Resolve to Save Lives: collaborator

Study Sites (1)

Street-Intercept Survey

Addis Ababa, Oromiya, Ethiopia

Location

Related Publications (5)

• Croker H, Packer J, Russell SJ, Stansfield C, Viner RM. Front of pack nutritional labelling schemes: a systematic review and meta-analysis of recent evidence relating to objectively measured consumption and purchasing. J Hum Nutr Diet. 2020 Aug;33(4):518-537. doi: 10.1111/jhn.12758. Epub 2020 May 4.

  PMID: 32364292 BACKGROUND

• Popkin BM. Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutr Rev. 2017 Feb 1;75(2):73-82. doi: 10.1093/nutrit/nuw064. No abstract available.

  PMID: 28395033 BACKGROUND

• Gebreyes YF, Goshu DY, Geletew TK, Argefa TG, Zemedu TG, Lemu KA, Waka FC, Mengesha AB, Degefu FS, Deghebo AD, Wubie HT, Negeri MG, Tesema TT, Tessema YG, Regassa MG, Eba GG, Beyene MG, Yesu KM, Zeleke GT, Mengistu YT, Belayneh AB. Prevalence of high bloodpressure, hyperglycemia, dyslipidemia, metabolic syndrome and their determinants in Ethiopia: Evidences from the National NCDs STEPS Survey, 2015. PLoS One. 2018 May 9;13(5):e0194819. doi: 10.1371/journal.pone.0194819. eCollection 2018.

  PMID: 29742131 BACKGROUND

• Challa F, Tadesse Y, Mudie K, et al. Urinary Sodium Excretion and Determinants among Adults in Ethiopia: Findings from National STEPS Survey. Ethiopian Journal of Health Development. 2017; 31(1):370-77.

  BACKGROUND

• Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med. 2012;9(6):e1001235. doi: 10.1371/journal.pmed.1001235. Epub 2012 Jun 26.

  PMID: 22745605 BACKGROUND

Related Links

• Melesse et al. 2019. Understanding urban consumers' food choice behavior in Ethiopia: Promoting demand for healthy foods.

MeSH Terms

Conditions

Cardiovascular Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The statistical analyst will be masked to the study arms during the analysis phase.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 2, 2022
• First Posted: September 22, 2022
• Study Start: December 28, 2022
• Primary Completion: January 6, 2023
• Study Completion: January 6, 2023
• Last Updated: January 19, 2023

Record last verified: 2022-09

Data Sharing

• IPD Sharing: Will not share

Locations

ET (1)