Using Video Gaming to Evaluate Front of Pack Labeling With Children
Condition: Child Obesity
MeSH terms: Pediatric Obesity
Study type: Interventional

Summary: 
      Regulated nutrition information is complex, using decimal places and percentages. Front of
      pack (FOP) labels provide simplified nutrition information on the front of packages. It has
      been suggested that the traditional approach to nutrition labeling is difficult for children
      to use; this is unfortunate as childhood is a critical time for developing long-lasting
      eating habits and children influence purchase decisions.

      Materials and Methods Children aged 6-10 played a video game in which participants fed
      "Munchy Monster" the healthier of two cereal products presented on a computer screen. Across
      trials the FOP format varied in a 2 (color/no color) x 2 (facial emotion icon/no facial icon)
      factorial design. Within a trial both cereals presented the same FOP format, with one cereal
      healthier than the other.

      Results Data suggest that color coding and/or facial icon significantly benefits selection
      accuracy and speed, particularly for the youngest children. Minimal training (awareness of
      the FOPs existence and that it might contain nutrition information) further improved accuracy
      and speed of responses.

      Conclusions FOPs that leverage visual indicators assist even young children in assessing the
      nutritional value of a product.
    

Detailed description: 
      Background It has been estimated that only two percent of children eat a diet that is
      consistent with the Food Guide pyramid, consuming diets that are too high in fat, saturated
      fat and sodium, and too low in fiber. Furthering concerns associated with these statistics is
      the fact that childhood is a determinant phase in the establishment of eating habits, and
      that developing healthy eating practices as a child has long-term health benefits.

      That said, children are an attractive segment for food marketers. Children are not only
      represent a primary market with growing access to discretionary income, children also have
      significant power to influence decisions and are a promising future market. As such, kids
      represent an attractive target for marketers, and research suggests vulnerability to the
      messages which target them.

      It has been suggested that directing messages to children "increases children's preferences
      for the foods advertised and increases their requests to parents for those foods."
      Recognizing this, packaging plays an important role in the marketing mix. The US Federal
      Trade Commission (FTC) has estimated that 12% of all youth marketing expenditures are spent
      on packaging and in-store in store display materials. This is because of packaging's ability
      to influence purchase within retail spaces, at the point where purchasing decisions are made;
      something researchers have referred to as the "nag factor."

      Clearly, the idea of presenting information directed at children using packaging for the
      purpose of motivating sales is utilized; however, the idea of presenting regulated
      information (e.g. nutritional information) in a format that might be readily understood by
      this vulnerable audience has not been widely explored. A major goal of nutritional labeling
      on food packages is to help consumers make appropriate choices. However, the current approach
      to nutritional labeling is targeted at adults, rather than children.

      Although children as young as age four are capable of classifying familiar foods (e.g. ice
      cream vs. broccoli) as healthy or unhealthy, the investigators are the first to examine
      whether children can use visual cues from Front of Pack (FOP) labels to compare and evaluate
      food products from the same category (cereal). FOP labels appear on the front of packages and
      provide truncated information about nutrients that tend to be associated with disease (e.g.
      fats, trans fats, sugar and sodium).

      Two semi-directive overlays, namely, color (2 levels present/absent) and facial icon (present
      and absent) were crossed, for a total of four FOP treatments. The study investigated color
      because it represents the traffic light system, which is a standard FOP design in the United
      Kingdom (UK), and its use is a topic of significant debate globally. Investigators also
      tested the efficacy of schematic facial expressions representing relatively high, medium, and
      low values for nutrients (i.e. frowning for high; straight face for moderate and a smile for
      those low). Overwhelming evidence indicates that face stimuli are given extremely high
      attentional priority and that the processing of facial expressions of emotion requires very
      few cognitive resources. These findings suggest that a face stimulus might be a particularly
      effective stimulus for drawing attention to the FOP nutritional panel and conveying relative
      qualitative information about the nutritional value of a product. As such, study
      investigators postulated that FOP utilizing faces would be particularly well-suited for use
      with children. Faces are known for garnering increased attention in infants and children as
      young as age 4 can reliably identify facial expressions of emotion. In fact, developmental
      research often exploits children's ease of comprehending iconic faces to measure children's
      judgments of stimuli or situations.

      Materials and Methods Investigators leverage these fundamental insights in work presented
      here, such insights can be used in ways that positively enhance attention to and
      understanding of nutrition information in a vulnerable audience, children aged 6 to 10.

      Children were seated at a computer and given a brief overview of the game. The program began
      with an instruction scene in which a purple monster character (Munchy) said

      "Hi my name is Munchy. I like to eat, but only healthy foods. Will you please feed me? In the
      game, you will see two cereal boxes. One is healthier than the other. To feed me please press
      the button on the side with the healthy cereal. If you select the healthy one I will eat it
      and you will get points. If you select the unhealthy one I will refuse to eat and you will
      not get any points. I am really hungry so please choose the healthy one as fast as you can.
      Do you have any questions?"

      For each trial, both cereals had the same FOP treatment. However, one package contained
      "healthy levels" of key nutrients (e.g. for colored FOP three or more nutrients at "green
      levels") while the other contained "unhealthy levels" (three or more nutrients at "red
      levels"). Nutrients were categorized into high, moderate and low levels based on Traffic
      Light Label Guidelines released by the Food Standards Agency. The appearance of the brand and
      the position of the package (right or left side of screen) were randomized; additionally, a
      second randomization was done with the healthfulness level of the nutrition information such
      that the positioning (right side of screen or left) was randomized. As a result, for one
      subject brand X might appear as healthy, while for another it might be presented with
      unhealthy information. Each participant completed 80 trials, with each of the four FOP
      designs appearing in 20 trials per participant by the conclusion of the game. The time it
      took for the participant to make a correct choice was recorded along with a binary response
      of correct choice (yes or no).

      Two blocks of participants were recruited. In the first block, no reference was made to the
      FOP labeling. For the second block of participants, at the beginning of the experiment, in
      addition to being shown the basic premise of the game and told that Munchy preferred to eat
      healthy options, the researcher pointed to one of the FOPs and told children "this
      information might be helpful when you decide what's healthy."
    

Intervention name(s): Four FOP label designs
Intervention type(s): Other
Intervention description(s): Color (present and absent) were crossed with facial icon (present and absent) for a total of four FOP label treatments. For each trial, both packages had the same FOP treatment, but one appeared at a "healthy level" while the second "unhealthy." Subjects were asked to choose the healthier option as quickly as possible. Accuracy and speed to correct selection both served as dependent variables.
Other intervention name(s): color plus facial icon; no color plus facial icon; color plus no facial icon; no color plus no facial icon
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Two blocks of participants were recruited. One block received no information regarding the FOP; for the second block, researchers pointed to an FOP and suggested that the information might be helpful in deciding which product was healthier.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: labeling; Front of pack; nutrition; nutrition facts panel