Impact of health warning labels on selection and consumption of food and alcohol products: systematic review with meta-analysis

Natasha Clarke; Emily Pechey; Daina Kosīte; Laura M. König; Eleni Mantzari; Anna K.M. Blackwell; Theresa M. Marteau; Gareth J. Hollands

doi:10.1080/17437199.2020.1780147

Impact of health warning labels on selection and consumption of food and alcohol products: systematic review with meta-analysis

Natasha Clarke
, Emily Pechey
, Daina Kosīte
, Laura M. König
, Eleni Mantzari
, Anna K.M. Blackwell
, Theresa M. Marteau
, Gareth J. Hollands

Department of Psychology

University of Cambridge
University of Konstanz
Tobacco and Alcohol Research Group
University of Bristol

Research output: Contribution to journal › Article › peer-review

91 Citations (SciVal)

Abstract

Health warning labels (HWLs) could reduce harmful consumption of food (including non-alcoholic drinks) and alcoholic drinks. A systematic review with meta-analysis using Cochrane methods was conducted to assess the impact on selection (including hypothetical selection) or consumption of food or alcoholic drink products displaying image-and-text (sometimes termed ‘pictorial’) and text-only HWLs. Fourteen randomised controlled trials were included, three for alcohol, eleven for food. For the primary outcomes, eleven studies measured selection and one measured consumption (two measured only other secondary outcomes). Meta-analysis of twelve comparisons from nine studies (n=12,635) found HWLs reduced selection of the targeted product compared with no HWL (RR=0.74 (95%CI 0.68–0.80)), with participants 26% less likely to choose a product displaying a HWL. A planned subgroup analysis suggested a larger (although not statistically significant) effect on selection of image-and-text HWLs (RR=0.65 (95%CI 0.54–0.80)) than text-only HWLs (RR=0.79 (95%CI 0.74–0.85)). These findings suggest significant potential for HWLs to reduce selection of food and alcoholic drinks, but all experimental studies to date were conducted in laboratory or online settings with outcomes assessed immediately after a single exposure. Studies in field and naturalistic laboratory settings are needed to estimate the potential effects of food and alcohol HWLs. Study registration: PROSPERO 2018 (registration number: CRD42018106522).

Original language	English
Pages (from-to)	1-24
Number of pages	24
Journal	Health Psychology Review
Early online date	2 Jul 2020
DOIs	https://doi.org/10.1080/17437199.2020.1780147
Publication status	Published - 31 Dec 2020

Bibliographical note

Funding Information:
This work was funded by a Collaborative Award in Science from Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z: PIs: Theresa Marteau, Paul Fletcher, Gareth Hollands and Marcus Munafò). The views expressed in this publication are those of the author(s) and not necessarily those of Wellcome Trust. We are grateful to Professor Susan Jebb for helpful comments on an earlier draft of this manuscript. NC, TMM and GJH conceived the review. NC, EP, EM, AKMB, TMM and GJH developed the protocol for the review. NC, EP, DK and LK conducted the searches and data extraction. NC and GJH analysed the data. NC drafted the initial draft of the manuscript, TMM and GJH significantly contributed to amending and drafting the final version. All authors read and approved the final version of the manuscript.

Publisher Copyright:
© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Data Availability Statement

The registered data can be found on the Open Science Framework (https://osf.io/kmqut/) which is linked to the PROS-PERO international Prospective Register of Systematic Reviews database (PROSPERO registration number:CRD42018106522). All meta-analysed data can be found in the Supplementary Material and the full meta-analysisoutputs are available in the forest plots in Figures 2–5 and the Supplementary Material (Figures 1 and 2).ORCIDNatasha Clarke http://orcid.org/0000-0003-2375-4510Emily Pechey http://orcid.org/0000-0002-2288-2652Laura M. König http://orcid.org/0000-0003-3655-8842Eleni Mantzari http://orcid.org/0000-0003-3147-5079Anna K.M. Blackwell http://orcid.org/0000-0002-4984-1818Theresa M. Marteau http://orcid.org/0000-0003-3025-1129Gareth J. Hollands http://orcid.org/0000-0002-0492-3924ReferencesActon, R. B., & Hammond, D. (2018). The impact of price and nutrition labelling on sugary drink purchases: Results from anexperimental marketplace study. Appetite, 121, 129–137. https://doi.org/10.1016/j.appet.2017.11.089American Heart Association (AHA). (2016). Warning labels on sugary drinks AHA policy position and issue messaging.https://www.heart.org/-/media/ﬁles/about-us/policy-research/prevention-nutrition/warning-labels-on-sugary-drinks-ucm_482397.pdf?la=en&hash=63E7C377A3F1E5BB1A2CF37A691CCEF034953F1E.Ang, F. J. L., Agrawal, S., & Finkelstein, E. A. (2019). Pilot randomized controlled trial testing the inﬂuence of front-of-packsugar warning labels on food demand. BMC Public Health, 19, 164. https://doi.org/10.1186/s12889-019-6496-8Araya, S., Elberg, A., Noton, C., & Schwartz, D. (2018). Identifying food labeling eﬀects on consumer behavior. SSRN: https://doi.org/10.2139/ssrn.3195500.Becker, M.P., & Balagtas, C. C. (1994). Marginal modeling of binary cross-over data. Biometrics, 49, 997–1009. https://doi.org/10.2307/2532242Billich, N., Blake, M. R., Backholer, K., Cobcroft, M., Li, V., & Peeters, A. (2018). The eﬀect of sugar-sweetened beverage front-of-pack labels on drink selection, health knowledge and awareness: An online randomised controlled trial. Appetite,128, 233–241. https://doi.org/10.1016/j.appet.2018.05.149Bleich, S. N., Economos, C. D., Spiker, M. L., Vercammen, K. A., VanEpps, E. M., Block, J. P., Elbel, B., Story, M., & Roberto, C. A.(2017). A systematic review of calorie labeling and modiﬁed calorie labeling interventions: Impact on consumer andrestaurant behavior. Obesity, 25(12), 2018–2044. https://doi.org/10.1002/oby.21940Bollard, T., Maubach, N., Walker, N., & Ni Mhurchu, C. (2016). Eﬀects of plain packaging, warning labels, and taxes onyoung people’s predicted sugar-sweetened beverage preferences: An experimental study. International Journal ofBehavioral Nutrition and Physical Activity, 13(1), https://doi.org/10.1186/s12966-016-0421-7450 N. CLARKE ET AL.

Funding

This work was funded by a Collaborative Award in Science from Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z: PIs: Theresa Marteau, Paul Fletcher, Gareth Hollands and Marcus Munafò). The views expressed in this publication are those of the author(s) and not necessarily those of Wellcome Trust. We are grateful to Professor Susan Jebb for helpful comments on an earlier draft of this manuscript. NC, TMM and GJH conceived the review. NC, EP, EM, AKMB, TMM and GJH developed the protocol for the review. NC, EP, DK and LK conducted the searches and data extraction. NC and GJH analysed the data. NC drafted the initial draft of the manuscript, TMM and GJH significantly contributed to amending and drafting the final version. All authors read and approved the final version of the manuscript.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

alcohol
food
Health warning labels
meta-analysis
sugar sweetened beverages
systematic review

ASJC Scopus subject areas

Clinical Psychology
Psychiatry and Mental health

Access to Document

10.1080/17437199.2020.1780147Licence: CC BY

Cite this

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title = "Impact of health warning labels on selection and consumption of food and alcohol products: systematic review with meta-analysis",

abstract = "Health warning labels (HWLs) could reduce harmful consumption of food (including non-alcoholic drinks) and alcoholic drinks. A systematic review with meta-analysis using Cochrane methods was conducted to assess the impact on selection (including hypothetical selection) or consumption of food or alcoholic drink products displaying image-and-text (sometimes termed {\textquoteleft}pictorial{\textquoteright}) and text-only HWLs. Fourteen randomised controlled trials were included, three for alcohol, eleven for food. For the primary outcomes, eleven studies measured selection and one measured consumption (two measured only other secondary outcomes). Meta-analysis of twelve comparisons from nine studies (n=12,635) found HWLs reduced selection of the targeted product compared with no HWL (RR=0.74 (95\%CI 0.68–0.80)), with participants 26\% less likely to choose a product displaying a HWL. A planned subgroup analysis suggested a larger (although not statistically significant) effect on selection of image-and-text HWLs (RR=0.65 (95\%CI 0.54–0.80)) than text-only HWLs (RR=0.79 (95\%CI 0.74–0.85)). These findings suggest significant potential for HWLs to reduce selection of food and alcoholic drinks, but all experimental studies to date were conducted in laboratory or online settings with outcomes assessed immediately after a single exposure. Studies in field and naturalistic laboratory settings are needed to estimate the potential effects of food and alcohol HWLs. Study registration: PROSPERO 2018 (registration number: CRD42018106522).",

keywords = "alcohol, food, Health warning labels, meta-analysis, sugar sweetened beverages, systematic review",

author = "Natasha Clarke and Emily Pechey and Daina Kosīte and K{\"o}nig, \{Laura M.\} and Eleni Mantzari and Blackwell, \{Anna K.M.\} and Marteau, \{Theresa M.\} and Hollands, \{Gareth J.\}",

note = "Funding Information: This work was funded by a Collaborative Award in Science from Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z: PIs: Theresa Marteau, Paul Fletcher, Gareth Hollands and Marcus Munaf{\`o}). The views expressed in this publication are those of the author(s) and not necessarily those of Wellcome Trust. We are grateful to Professor Susan Jebb for helpful comments on an earlier draft of this manuscript. NC, TMM and GJH conceived the review. NC, EP, EM, AKMB, TMM and GJH developed the protocol for the review. NC, EP, DK and LK conducted the searches and data extraction. NC and GJH analysed the data. NC drafted the initial draft of the manuscript, TMM and GJH significantly contributed to amending and drafting the final version. All authors read and approved the final version of the manuscript. Publisher Copyright: {\textcopyright} 2020, {\textcopyright} 2020 The Author(s). Published by Informa UK Limited, trading as Taylor \& Francis Group.",

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AU - Clarke, Natasha

AU - Pechey, Emily

AU - Kosīte, Daina

AU - König, Laura M.

AU - Mantzari, Eleni

AU - Blackwell, Anna K.M.

AU - Marteau, Theresa M.

AU - Hollands, Gareth J.

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KW - sugar sweetened beverages

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JF - Health Psychology Review

ER -

Impact of health warning labels on selection and consumption of food and alcohol products: systematic review with meta-analysis

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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