Use of baby food products during the complementary feeding period: What factors drive parents' choice of products?

It is recommended that infants are introduced to complementary foods from 6 months old, moving from a solely milk diet to eating a family diet by 12 months old. Although home cooking of family foods is recommended, a rapidly growing market producing baby food products (BFP) such as jars, pouches and snacks has developed. These are often accompanied by marketing claims around nutritional, health and developmental impacts despite research highlighting high sugar content. Although numerous studies have explored drivers of infant formula choice and use, little research has examined the drivers of BFP use. This study used an online survey for United Kingdom parents of infants aged 4-12 months to explore use of BFP alongside perceptions and drivers to purchase products. Overall, 271 parents participated (173 used BFP and 98 did not), with a descriptive analysis of closed items and a thematic analysis for open ended text conducted. The top motivators for using BFP were convenience, time saving, and baby's perceived enjoyment of products. The most purchased puree was fruit based and the most purchased baby snacks were vegetable puffs/sticks, with snack purchases being more common than purees in this sample. Aspects such as perceived healthiness drove choice, with snack foods being seen to enhance self-feeding skills, appetite regulation and motor development. Those who did not use BFP did not trust them and preferred to feed their baby home cooked foods. The findings are important for professionals working with parents, to support them through the transition to solid foods, particularly around raising awareness of marketing techniques and how to check content of foods to make a more informed choice.

Front-of-Package Protein Labels on Cereal Create Health Halos.

Front-of-package protein labels are frequently added to breakfast cereals, aimed at increasing purchases by consumers who believe they would benefit from eating more protein. However, the overall nutritional compositions of such products are often not significantly better than similar products without protein labels, and may contain more sugar, sodium, and calories to improve taste. We conducted an online survey with 1022 US adults to examine consumer perceptions of two cereals (Special K Original and Special K Protein). Participants perceived Special K Protein as healthier and more nutritious, though less tasty, than Special K Original. Special K Protein was perceived as providing greater health benefits, such as being more likely to help them build muscle, stay healthy, and live longer. Many participants perceived no differences in the amounts of certain nutrients between the cereals, such as sugar (54.5%), sodium (59.2%), and calories (49.1%). Yet, when serving sizes are equalized to one cup, Special K Protein has more sugar, sodium, and calories than Special K Original. Though most participants reported viewing the Facts Up Front label, only 21.3% correctly chose Special K Original as having the larger serving size. This pattern of results suggests the presence of a health halo surrounding the protein-labeled product.

Influence of nutrition claims on different models of front-of-package nutritional labeling in supposedly healthy foods: Impact on the understanding of nutritional information, healthfulness perception, and purchase intention of Brazilian consumers.

Nutrition claims are positive information about foods, which are widely used as a marketing strategy on labels. On the contrary, front-of-package nutritional labeling (FoPNL) aims to make it easier for consumers to understand the nutritional composition of foods and favor healthy food choices. However, the concomitant presence of nutrition claims and FoPNL may hinder the understanding, judgment, and choices of consumers at the moment of purchase. Therefore, the objective of this study was to evaluate the influence of nutrition claims on the efficacy of FoPNL models in the understanding of nutritional information, healthfulness perception, and purchase intention of Brazilian consumers. It was an experimental cross-sectional study carried out using an online questionnaire, with a total of 720 participants randomly divided into four FoPNL conditions: control, octagon, triangle, and magnifying glass. Each participant looked at 12 food packages, which were produced following the factorial design: (i) food category (cereal bar, whole grain cookies, and snacks); (ii) product type (containing one critical nutrient × containing two critical nutrients); and (iii) nutrition claims (present × absent). The comprehension of nutritional information was evaluated through the identification of excessive nutrients, and the healthfulness perception and purchase intention were evaluated using a seven-point scale. The results indicated that the presence of FoPNL increased the understanding of the information and reduced healthfulness perception and purchase intention. The presence of nutrition claims influenced the three outcomes, decreasing the probability of understanding information about food composition by 32% (OR 0.68, 95% confidence interval 0.58-0.78, p < 0.01) and significantly increasing (p < 0.05) average health scores (1.95-2.02) and purchase intention (2.00-2.05). Nonetheless, the interaction "FoPNL × claims" was not significant, which indicated that claims act independently. All FoPNL models were more effective than the control. For the least healthful type of product (two nutrients in excess), the octagon and triangle models were superior to the magnifying glass, regarding the outcome of healthfulness perception. The results prove the efficacy of FoPNL in consumer understanding and judgment. Despite the positive effects of FoPNL, it did not cancel the positivity bias generated by the claims.

The Impact of Toddler Milk Claims on Beliefs and Misperceptions: A Randomized Experiment with Parents of Young Children.

BACKGROUND: Toddler milk (ie, a nutrient-fortified milk-based drink marketed for children aged 12 to 36 months) has been marketed increasingly in the United States with structure/function claims on product packaging that are potentially misleading. OBJECTIVE: This study examined how structure/function claims impact parents' beliefs and perceptions about a toddler milk product. DESIGN: This was a 3-arm between-subjects randomized experiment. PARTICIPANTS: A diverse sample of 2,190 US parents of children aged 1 to 5 years were chosen to take an online survey. INTERVENTION: Participants were randomly assigned to view a toddler milk package with either an unrelated claim ("new and improved," ie, control condition), a "brain development" claim (ie, "brain" claim), or an "immunity-related" claim (ie, "immunity" claim). MAIN OUTCOME MEASURES: Outcomes included perceptions, intentions, and beliefs about the toddler milk product. STATISTICAL ANALYSES PERFORMED: Linear regression for continuous outcomes and logistic regression for dichotomous outcomes. RESULTS: Parents who were exposed to the "brain" claim or the "immunity" claim were more likely to incorrectly believe that the toddler milk was as healthy or healthier than cow's milk compared with those who saw the control claim (89% for brain claim, 87% for immunity claim, and 79% for control; P < .001 for both comparisons). Parents exposed to either the brain or immunity claim had higher intentions to give the toddler milk to their child, higher perceived product healthfulness, and stronger beliefs that pediatricians would recommend the product compared with parents exposed to the control (all, P < .001). CONCLUSIONS: These findings suggest that structure/function claims on toddler milk packaging may mislead parents and increase the appeal of toddler milk. Our findings support calls for public health policies to regulate marketing on toddler milk packaging.

Health halo or genuine product development: Are better-for-you alcohol products actually healthier?

ISSUE ADDRESSED: Alcoholic products marketed as better-for-you is an emerging trend in Australia that has received limited research attention to date. This study aimed to examine the nutrient profiles of alcoholic products marketed as better-for-you that are available in the Australian market. METHODS: We extracted the details of alcoholic product announcements published on the Drinks Trade website in 2019 and 2020 containing at least one keyword used to promote better-for-you products. The alcohol, energy, carbohydrate and sugar content of each product was recorded and assessed against existing classifications for alcohol strength and sugar and carbohydrate content. RESULTS: We identified 144 products promoted as better-for-you. The majority of products (85%, n = 122) were classified as full-strength, and the median alcohol content across each alcohol product category was classified as full-strength. Most of the energy content came from alcohol, with 62% of products deriving at least 75% of their energy content from alcohol. CONCLUSIONS: Alcoholic products marketed as better-for-you appear to rely on an illusion of healthfulness, without addressing the ingredient of most concern to health, the alcohol content. SO WHAT?: Controls on alcohol marketing should be expanded to limit the use of health and nutrient claims. Mandatory labelling of alcoholic products with nutrition information would support consumers to be better informed about the contents of alcoholic products.

Impact of warning labels on reducing health halo effects of nutrient content claims on breakfast cereal packages: A mixed-measures experiment.

Chile recently implemented a food labeling law that requires packaged foods with sugar, saturated fats, sodium, and/or calorie content that exceeds government-defined thresholds to carry a front-of-package warning for each excessive nutrient. This law does not prohibit the use of nutrient content (NC) marketing claims on packages, as long as the claims do not directly contradict the warnings. Yet, having NC claims alongside nutrient warnings might send mixed messages confusing consumers about the overall healthiness of a product. The present study tests the co-occurrence of warning labels and NC claims in breakfast cereal packages on product perceptions and behavioral intentions of Chilean adults in a 3 (warnings: none, high calorie, high calorie/high sugar) × 3 (NC claims: none, fiber/wholegrain, low fat/cholesterol-free) mixed-measures experiment. Fiber-related claims had a main effect leading to more positive ratings of the product, compared to having no NC claims or fat-related claims. These positive ratings extended beyond perceptions of the fiber content to perceptions of overall healthiness, naturalness, quality, vitamin content, and intentions to purchase and recommend the product-a health halo effect. No significant interaction between warnings and NC claims was found. However, warnings had a main effect on perceptions irrespective of the presence of NC claims, with one warning significantly reducing ratings, dampening any halo effects, and two warnings further dampening any effects. These findings indicate that warning labels can mitigate, but not eliminate the influences of NC claims on consumer perceptions of product healthiness.

Effect of health-promoting messages in television food commercials on adolescents' attitudes and consumption: A randomized intervention study.

INTRODUCTION: The HAVISA plan is a Spanish government's policy for the promotion of healthy lifestyles via health messages in television food advertisements. This study evaluated the positive or negative impact (health halo effect) of health messages on food choices and predisposition towards healthy habits of Spanish adolescents. METHODS: Randomized controlled study in 11-14 years old adolescents. The intervention group watched television advertisements for unhealthy foods with HAVISA health messages, while the control group watched the same advertisements without them. A self-administered questionnaire measured participants' attitudes towards the products advertised, to diet and physical activity, and recognition of messages. Afterwards they chose between fruit and unhealthy snacks. The differences between the two groups were then compared. RESULTS: A total of 27.2% of the control group versus 29.6% of the intervention group chose fruit (p = 0.54). Both groups displayed high desire for (7.24 vs. 7.40, p = 0.29) and intention to consume (6.67 vs. 6.73, p = 0.63) the unhealthy products advertised. There were no differences in perceived healthiness of these foods (4.11 vs. 4.19, p = 0.74), or perceived importance of a healthy diet (3.17 vs. 3.12, p = 0.55) or physical activity (4.53 vs. 4.51, p = 0.73). Desire for vegetables (2.49 vs. 2.66, p = 0.08) and fruit (3.15 vs. 3.30, p = 0.09) were higher in the intervention group, but the differences were not significant. Only 47.6% of participants noticed the presence of health messages; of these, 31% correctly recalled their content. CONCLUSION: HAVISA health messages changed neither the attitudes nor immediate eating behaviors of adolescents. There was no immediate healthy-lifestyle promoter or adverse health halo effect, probably due to the messages' low prominence. Further research should evaluate the long-term effect of repeated exposure to health messages.

Which brand should be more nervous about nutritional information disclosure: McDonald's or Subway?

This study examines the health halo and horn effects in the context of two fast food brands commonly associated with healthy and unhealthy food (i.e., Subway and McDonald's). Health halo is consumers' tendency to overestimate the healthiness of certain food categories or items based on a single claim, whereas health horn is the tendency to underestimate it. Specifically, we investigated the moderating effects of nutritional information disclosure and dietary restraint on consumers' behavioral intentions. Two items from the McDonald's and Subway menus each served as stimuli. They represented health halo confirmation (Roast Chicken sandwich) or disconfirmation (Italian Spicy sandwich) and health horn confirmation (Big Mac burger) or disconfirmation (McSpicy Cajun Burger). This study employed a 2 (nutritional information: present vs. absent) × 4 (menu item type: a health halo or horn associated with Subway or McDonald's menu items with favorable and unfavorable nutritional profiles) and 2 (dietary restraint: restrained eaters vs. unrestrained eaters) × 4 (menu item type: a health halo or horn associated with Subway or McDonald's menu items with favorable and unfavorable nutritional profiles) mixed factorial design. Participants were randomly assigned to one of two experimental conditions (nutritional information: present vs. absent) and presented with all four menu items. There was a decrease in behavioral intentions toward all menu items except the one representing health horn disconfirmation. In particular, behavioral intentions were most substantially weakened for the item that entailed a health halo disconfirmation (Italian Spicy sandwich). The findings not only delineate the different practices companies adopt but also underscore the importance of nutritional information disclosure in helping consumers make healthier food choices.

The Effect of an Evaluative Label on Consumer Perception of Cheeses in Hungary.

Traditional strategies (such as education, economic incentives or prohibitions) targeted at altering dietary habits only influence health-conscious consumers. Less health-conscious consumers are less capable of self-regulatory behavior, therefore they are more likely to be influenced through perception. The present study aimed to examine how external cues such as labeling affect the consumer's perception of foods. The paper includes a case study based on an experiment. In the experiment the same cheese was tested with four different types of labeling (labeled "conventional", "low salt", "low fat" and "low salt and low fat"). It was found that the health halo effect worked in the case of cheese testing. In spite of all the samples being identical, the healthy samples were associated with considerably less sensory pleasure. The use of labels by the producers resulted in exactly the opposite effect to that intended. The experiment confirmed the efficiency of the application of this type of behavior-oriented nudge.

Halo It's Meat! the Effect of the Vegetarian Label on Calorie Perception and Food Choices.

In the last few years, vegetarian products have become a widespread dietary option in food industry to the point that large retail chains such as McDonald's has offered a vegetarian burger to their customers (e.g., the Grand Veggie). In the present research, two studies investigated the influence of a vegetarian label on calorie perception, frequency consumption and food choices. In the first study (N = 211) participants were randomly assigned to an experimental design 2 (burger type: Grand Veggie vs Big Mac). In the second study (N = 915), participants were either exposed to a similar burger labeled vegetarian or a meat-based. Both studies show that vegetarian products are perceived as being less caloric than their non-vegetarian equivalents. However, participants do not report more intention to eat more vegetarian products and do not lead to differences in menu composition.

Are the Claims to Blame? A Qualitative Study to Understand the Effects of Nutrition and Health Claims on Perceptions and Consumption of Food.

Nutrition and Health Claims (NHCs) have been found to influence perceptions of food and consumption behaviour. While previous quantitative research has identified factors that may explain these effects, the current study aimed to address the dearth of in-depth exploration as to the underlying reasons why and how claims may impact upon perceptions and behaviour and the relationships between key factors. Seventy-eight participants took part in 10 focus groups. Discussions were transcribed verbatim and Nvivo 11 was used for thematic analysis. Six themes were developed from the data: 1. Target populations for NHCs; 2. Influence of NHCs on purchasing behaviour; 3. Characteristics/perceptions of products displaying NHCs; 4. Believability of NHCs; 5. Superior yet superficial knowledge; 6. Consumption of products displaying NHCs. Knowledge was a key factor influencing how much individuals believe claims (Believability of NHCs) and their perceptions (Characteristics/perceptions of products displaying NHCs). These perceptions and the characteristics of products displaying claims also impacted believability, as well as purchasing behaviour and consumption. Future research should be cognisant of the role of knowledge and characteristics or perceptions of products in the relationship between NHCs and consumer behaviour, and modelling of these relationships would allow their relative strength to be identified.

The calories underestimation of "organic" food: Exploring the impact of implicit evaluations.

Specific attributes of a food product can cause it to be spontaneously but wrongly perceived as healthier than it really is (i.e., the health halo effect). Notably, there is preliminary evidence that individuals evaluate organic food as less caloric than regular, non-organic food. However, explanations regarding the cognitive mechanisms underlying the health halo effect remain scarce. Drawing from the implicit cognition literature, we hypothesize that this effect could be due to (a) the reactivation in memory of implicit positive evaluations and/or (b) the reactivation of a semantic association between the concepts "organic" and "non-caloric". We first conducted a 2 (Product label: organic versus non-organic) × continuous (Valence-IAT score) × continuous (Calorie-IAT score) study (N = 151) to test these hypotheses, and conducted a conceptual replication in a second study (N = 269). We computed Bayesian analyses alongside frequentist analyses in order to test for potential null hypotheses, as well as frequencies and Bayesian meta-regression including both datasets. Both methods provided consistent results. First, Bayesian analyses yielded extremely strong evidence in favor of the hypothesis that the organic label leads to an underestimation of caloric value. Second, they provided strong evidence that this effect is not moderated by implicit evaluations. Hence, we replicated the organic halo effect but showed that, surprisingly, it does not arise from implicit associations. We discuss these findings and propose directions for future research regarding the mechanisms underlying calories (under)estimation.

Influence of organic labels on consumer's flavor perception and emotional profiling: Comparison between a central location test and home-use-test.

Organic food products are often perceived as healthier by consumers, but the question remains if organic labels might influence consumer's perception of specific sensory attributes and emotional associations and to which extent this effect goes beyond the lab context. Therefore, the objective of this study was to examine the potential effects of organic labels on the overall liking and emotional and sensory profiling, comparing measurements obtained from a CLT and HUT test. In this study, 76 consumers participated at a central location test (CLT) and 75 during a home-use-test (HUT) to examine the effect of organic labeling on pairs of three food products (i.e. yogurt, potato chips and juice). While the same food product was used, one sample of the pair was labelled as conventional and the other as organic. Results showed that providing an organic label leads to a higher overall liking, willingness to pay and lower kcal estimation of a food product regardless of the evaluation context. Also, the perception of sensory attributes was altered by providing the organic labeling, but mainly for the juice and yogurt sample. Moreover, organic labeling evoked more positive emotions and less negative emotions of the food products. While previous research indicated that organic labeling might affect consumer's perception of food products, this study shows that this effect is consistent regardless of the evaluation context (HUT and CLT). Although some context effects occurred on the emotional profiling of the food products, more research is warranted given the different eating conditions when conducting HUT. Furthermore, policy makers should be aware of the health halo effect as consumers tend to significantly lower the kcal estimations when an organic label is provided.

Industry use of 'better-for-you' features on labels of sugar-containing beverages.

OBJECTIVE: To examine the ways in which sugar-containing beverages are being portrayed as 'better-for-you' (BFY) via features on product labels. DESIGN: Cross-sectional audit of beverage labels. SETTING: Adelaide, Australia. Data on beverage labels were collected from seventeen grocery stores during September to November 2016. SUBJECTS: The content of 945 sugar-containing beverages labels were analysed for explicit and implicit features positioning them as healthy or BFY. RESULTS: The mean sugar content of beverages was high at 8·3 g/100 ml and most sugar-containing beverages (87·7 %) displayed features that position them as BFY. This was most commonly achieved by indicating the beverages are natural (76·8 %), or contain reduced or natural energy/sugar content (48·4 %), or through suggesting that they contribute to meeting bodily needs for nutrition (28·9 %) or health (15·1 %). Features positioning beverages as BFY were more common among certain categories of beverages, namely coconut waters, iced teas, sports drinks and juices. CONCLUSIONS: A large proportion of sugar-containing beverages use features on labels that position them as healthy or BFY despite containing high amounts of sugar.

The Impact of Nutrition and Health Claims on Consumer Perceptions and Portion Size Selection: Results from a Nationally Representative Survey.

Nutrition and health claims on foods can help consumers make healthier food choices. However, claims may have a 'halo' effect, influencing consumer perceptions of foods and increasing consumption. Evidence for these effects are typically demonstrated in experiments with small samples, limiting generalisability. The current study aimed to overcome this limitation through the use of a nationally representative survey. In a cross-sectional survey of 1039 adults across the island of Ireland, respondents were presented with three different claims (nutrition claim = "Low in fat"; health claim = "With plant sterols. Proven to lower cholesterol"; satiety claim = "Fuller for longer") on four different foods (cereal, soup, lasagne, and yoghurt). Participants answered questions on perceived healthiness, tastiness, and fillingness of the products with different claims and also selected a portion size they would consume. Claims influenced fillingness perceptions of some of the foods. However, there was little influence of claims on tastiness or healthiness perceptions or the portion size selected. Psychological factors such as consumers' familiarity with foods carrying claims and belief in the claims were the most consistent predictors of perceptions and portion size selection. Future research should identify additional consumer factors that may moderate the relationships between claims, perceptions, and consumption.

Do Health Claims and Front-of-Pack Labels Lead to a Positivity Bias in Unhealthy Foods?

Health claims and front-of-pack labels (FoPLs) may lead consumers to hold more positive attitudes and show a greater willingness to buy food products, regardless of their actual healthiness. A potential negative consequence of this positivity bias is the increased consumption of unhealthy foods. This study investigated whether a positivity bias would occur in unhealthy variations of four products (cookies, corn flakes, pizzas and yoghurts) that featured different health claim conditions (no claim, nutrient claim, general level health claim, and higher level health claim) and FoPL conditions (no FoPL, the Daily Intake Guide (DIG), Multiple Traffic Lights (MTL), and the Health Star Rating (HSR)). Positivity bias was assessed via measures of perceived healthiness, global evaluations (incorporating taste, quality, convenience, etc.) and willingness to buy. On the whole, health claims did not produce a positivity bias, while FoPLs did, with the DIG being the most likely to elicit this bias. The HSR most frequently led to lower ratings of unhealthy foods than the DIG and MTL, suggesting that this FoPL has the lowest risk of creating an inaccurate positivity bias in unhealthy foods.

Simply adding the word "fruit" makes sugar healthier: The misleading effect of symbolic information on the perceived healthiness of food.

People may use simple heuristics to assess the healthiness of food products. For instance, the information that a product contains "fruit sugar" (in German, "fruit sugar" is the colloquial term for fructose) could be interpreted as a cue that the product is relatively healthy, since the term "fruit" symbolizes healthiness. This can have a misleading effect on the perceived healthiness of a product. In Experiment 1, participants (N = 164) were asked to evaluate the healthiness of one of two breakfast cereals based on the information provided in a nutrition table. For one group, the label "fruit sugar" was used; for the other, the label "sugar" was used. Results suggest that the phrase "fruit sugar" listed as an ingredient of the breakfast cereal resulted in a more positive perception of the healthiness of the cereal compared with the ingredient labeled "sugar." In Experiment 2 (N = 202), the results of Experiment 1 were replicated with a within-subjects design in which participants evaluated the two products simultaneously. Experiment 3 (N = 251) ruled out the alternative explanation that the effect could be due to differing inferences about the product's ingredients based on the label used, that is, that the product labeled with "fruit sugar" contains fruit. Finally, in Experiment 4 (N = 162), the results show that the healthiness associated with the labeling of the ingredient "sugar" ("fruit sugar" vs. "sugar") mediates the observed effect. Results of the four experiments indicate that symbolic information is an important factor that can influence people's health perceptions of food. These findings have implications for marketing and public health.