Effects of marketing claims on toddler food products on parents' product preferences, perceptions and purchasing intentions: an online experiment.

BACKGROUND: The retail market for toddler-specific packaged foods is growing. Many of these products are ultra-processed and high in nutrients of concern for health, yet marketed in ways that may make them appear wholesome. This study aims to assess parents' responses to claims on unhealthy, ultra-processed toddler food products and test whether removing such claims promotes more accurate product perceptions and healthier product preferences. METHODS: Parents of toddlers aged 12 to < 36 months (N = 838) were recruited for an online experiment testing four on-pack claim conditions: control (no claim); 'contains "good" ingredient'; 'free from "bad" ingredient'; and unregulated 'child-related' claim. Participants were randomly assigned to one condition, then viewed images of toddler food products that varied in nutrition content and the claims displayed. Participants completed tasks assessing product preferences (unhealthy product displaying claim vs. a healthier option with no claim, across four food categories (banana bars, strawberry snacks, blueberry yogurt snacks and veggie snacks)), purchase intentions and product perceptions. Poisson regression (count variable) and linear regression (continuous outcomes) analyses were employed to test for mean differences by marketing claim conditions. RESULTS: For the overall sample, brief exposure to 'free from "bad" ingredient' claims increased participant's intentions to purchase unhealthy food products for their toddlers, but there was no clear evidence that 'contains "good" ingredient' claims and 'child-related' claims significantly impacted parent's preferences, purchase intentions and perceptions of toddler foods. However, certain claims influenced particular parent subgroups. Notably, parents with three or more children chose more unhealthy products when these products displayed 'contains "good" ingredient' or 'free from "bad" ingredient' claims; the latter claims also promoted stronger purchase intentions and enhanced product perceptions among this subgroup. CONCLUSIONS: Findings indicate that 'free from "bad" ingredient' claims on unhealthy toddler foods are of most concern, as they boost the appeal of these products to parents. 'Contains "good" ingredient' claims and 'child-related' claims showed limited effects in this study. Considering available evidence, we recommend claims should not be permitted on child-oriented foods, as they may promote inaccurate product perceptions and unhealthy product choices by parents, that can detract from their children's diets and health.

Evaluation of the population-level impacts of the LiveLighter® obesity prevention campaign from 2012 to 2019 based on serial cross-sectional surveys.

BACKGROUND: Halting and reversing the upward trend in obesity requires sustained implementation of comprehensive, evidence-based strategies at the population-level. The LiveLighter® program targets adults using a range of public education strategies, including mass media campaigns, to support healthy lifestyle changes to attain or maintain a healthy weight and reduce the risk of chronic disease. LiveLighter® has been implemented in Western Australia (WA) since 2012 and, to our knowledge, includes the longest running adult-targeted mass media campaign for healthy weight and lifestyle promotion and education globally. This evaluation assessed the impact of LiveLighter® on WA adults' knowledge, intentions and behaviours as they relate to healthy eating and body weight from 2012 to 2019. METHODS: LiveLighter® mass media campaigns, which are TV-led and aired statewide, depict genuine, graphic imagery of visceral fat around internal organs to raise awareness about the link between excess body weight and chronic diseases; demonstrate how unhealthy food and drink consumption can contribute to unhealthy weight gain; and recommend healthy alternatives. Cross-sectional telephone surveys were conducted at baseline and following each campaign phase with an independent, randomly selected sample of WA adults aged 25 to 49 years (n = 501 to n = 1504 per survey) to assess their knowledge of the link between excess body weight and chronic diseases, and their intentions and behaviours related to healthy eating and weight. Multivariable logistic regression models were undertaken to assess differences in responses between baseline and each post-campaign survey. RESULTS: Compared to baseline, there were significant increases in the proportion of respondents reporting knowledge of excess body weight as a risk factor for certain cancers and type 2 diabetes, intentions to eat more fruit and vegetables and drink less sugar sweetened beverages (SSBs) in the next seven days, and the proportion of respondents who reported meeting guidelines for daily vegetable intake. Reported consumption of SSBs significantly decreased. CONCLUSIONS: LiveLighter® is associated with improvements in knowledge of the health risks associated with excess body mass, increased vegetable intake and reduced SSB consumption in WA adults. These findings support the use of sustained, well-designed healthy lifestyle promotion and education programs as part of a comprehensive obesity prevention strategy.

The health halo effect of 'low sugar' and related claims on alcoholic drinks: an online experiment with young women.

AIMS: To investigate whether 'low sugar' and related claims influence consumers' perceptions of the healthiness or other attributes of alcoholic drinks, promote greater consumption or impact diet and activity behaviour intentions. METHOD: N = 501 Australian women aged 18-35 viewed and rated six images of alcoholic drinks in a randomized online experiment with a 2 (claim: low sugar claim, no claim control) × 2 (drink type: cider, ready-to-drink spirits) between-subjects design. RESULTS: Participants who viewed drinks with low sugar claims rated them as healthier, less harmful to health, lower in sugar and kilojoules, and more suitable for weight management and a healthy diet than participants who viewed identical drinks with no claim (P < 0.001-P = 0.002). Drinks with low sugar claims were also perceived as being lower in alcohol (P < 0.001) despite being of equivalent alcohol content. There were no significant differences in anticipated social approval associated with consumption or in hypothetical intended consumption of the drinks, but participants who viewed drinks with low sugar claims were less likely to indicate they would compensate for consumption of the drink by modifying food intake or physical activity (P = 0.01). CONCLUSIONS: Low sugar and related claims on alcoholic drinks can generate a health halo: consumers generalise from a specific favourable attribute (low sugar) to misperceive other favourable health- and nutrition-related attributes, including lower alcohol content. Findings support calls to reconsider the permissibility of low sugar claims on alcoholic drinks as they may mislead consumers.

Can counter-advertising exposing alcohol sponsorship and harms influence sport spectators' support for alcohol policies? An experimental study.

BACKGROUND: Exposure to alcohol advertising and sponsorship through elite sport is associated with harmful use of alcohol. Owing to strong financial and cultural ties between alcohol and sport in Australia, policy action to restrict alcohol sport sponsorship is unlikely to occur without strong public support for change. This study tested whether exposure to counter-advertising exposing industry marketing of harmful products-a technique shown to be effective in tobacco control-promotes higher support for policy change and less favourable beliefs about the alcohol industry among sport spectators. METHODS: A sample of 1,075 Australian adults aged 18-49 years who planned to watch an National Rugby League (NRL) State of Origin series game, featuring prominent alcohol sponsorship, was recruited through an online panel and randomly assigned to one of three conditions: control (neutral advertisement); counter-advertisement exposing alcohol harms; counter-advertisement exposing alcohol sponsorship and harms. Participants completed a pre-test questionnaire and viewed their assigned counter-advertisement multiple times in the 5-7 days before the NRL game. Within four days of watching the game, participants completed post-test measures. RESULTS: Compared to both the control advertisement and the counter-advertisement exposing alcohol harms, participants who viewed the counter-advertisement exposing alcohol sponsorship and harms were significantly more likely to indicate support for each of four policies aimed at restricting sports-related alcohol marketing, including the complete removal of alcohol sponsorship from sport (51% vs. 32% and 37%). They were also significantly less likely to agree with statements such as "alcohol companies should be allowed to sponsor sport since their products are legal" (39% vs. 63% and 60%) and significantly less likely to report liking alcohol companies in general (38% vs. 59% and 54%). There were no significant differences in policy support or industry beliefs between participants who saw the counter-advertisement exposing alcohol harms and those who saw the control advertisement. CONCLUSION: Counter-advertising employing messages that expose and critique the intent and impact of pervasive alcohol sponsorship in sport has potential to bolster public support for policies targeting alcohol sport sponsorship, diminish beliefs supportive of alcohol industry marketing strategies and enhance negative views of alcohol companies and their marketing practices.

Food purchasing practices in various retail settings and dietary intake: A cross-sectional survey of Australian adolescents.

BACKGROUND/AIMS: Discretionary, energy-dense, nutrient-poor food and drinks are heavily marketed and readily available in retail settings frequented by adolescents. This study examines associations between food purchasing practices in various retail settings and dietary intake among Australian adolescents. METHODS: Participants were students in years 8 to 11 (ages 12-17 years) who completed the 2009-10 (n = 13 790), 2012-13 (n = 10 309) or 2018 (n = 9102) National Secondary Students' Diet and Activity (NaSSDA) cross-sectional survey. Multistage stratified random sampling was used. An online survey completed at school assessed self-reported frequency of food purchasing practices in various retail settings and consumption of discretionary food, sugary drinks, fruit and vegetables. Generalised linear regression models examined associations between food purchasing practices and dietary behaviour. RESULTS: Relative to students who brought lunch from home, those who purchased lunch from school or nearby outlets reported higher intake of discretionary food and sugary drinks and lower fruit intake. Buying lunch from school was also associated with lower vegetable intake. Buying food or drinks on the school commute, outside school grounds during school hours, from supermarket checkouts, and using mobile phone apps were each associated with higher discretionary food and sugary drink intake (all P < .01). CONCLUSIONS: Purchasing food or drink in various retail settings is associated with higher intake of discretionary food and drink among Australian adolescents, and some purchasing practices appeared to displace fruit and vegetable intake. SO WHAT?: These findings highlight a need to improve the accessibility and promotion of healthier food and drink options in schools and other retail settings.

LiveLighter® 'Junk Food' mass media campaign increases behavioural strategies to reduce consumption.

The LiveLighter® 2016 'Junk Food' campaign ran for 5 weeks in Western Australia (WA) and urged adults to reduce their junk food consumption to avoid weight gain and associated chronic disease. A cohort design assessed campaign impact on knowledge, beliefs and behaviour. Pre-campaign (n = 1501) and post-campaign (n = 737) telephone surveys of WA adults aged 25-49 were undertaken. A post-campaign-only sample (n = 501) controlled for pre-test effects. The campaign reached 57% of respondents and increased knowledge of the link between overweight and non-alcoholic fatty liver disease (78% cf. 87%; P < 0.01). Following campaign activity, respondents were more likely to avoid purchasing food from settings depicted in the advertisements (fast food outlets: 63% cf. 77%; service stations: 82% cf. 93%; vending machines: 87% cf. 96%; all P < 0.001), particularly among pre-campaign consumers of fast food and salty snacks (≤2 times/week). Weight-loss self-efficacy increased among adults with higher body weight and campaign exposure (89% cf. 97%; P < 0.01), and there was no increased endorsement of overweight stereotypes among the full sample. Support for fiscal disincentives and nutritional disclosure policies increased among healthy weight adults. LiveLighter® positively influenced knowledge, beliefs and behaviours, along with attitudes towards policies to encourage healthy eating, supporting LiveLighter® as an advocacy campaign.

Obesity prevention and related public health advertising versus competing commercial advertising expenditure in Australia.

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016-18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.

Differences in healthiness perceptions of food and dietary patterns among the general public and nutrition experts: A cross-sectional online survey.

ISSUES ADDRESSED: Diet quality plays a vital role in the prevention of prevalent non-communicable diseases; however, misperceptions of healthiness of common foods and beverages may be undermining Australians' attempts to maintain a healthy diet. The current study aimed to assess the extent and nature of differences in public and expert opinion in the foods, beverages and dietary patterns that are considered healthy. METHODS: A cross-sectional online survey of 1,097 Victorian adults aged 18-64 and 134 professional dietitians and nutritionists assessed healthiness perceptions of foods, beverages and dietary patterns, self-reported dietary patterns, and factors considered when making healthy choices. Differences in perceptions and dietary patterns between samples and by sex, socio-economic area and level of education were assessed using multivariable logistic regression. RESULTS: There were large discrepancies in which items the public and expert samples considered healthy. Females and those in high socio-economic areas tended to report healthiness perceptions that aligned with the expert sample to a greater degree than their counterparts. Personal judgement of products was important to both samples when making decisions about healthy choices. CONCLUSIONS: The public and expert samples differed greatly in healthiness perceptions with significant variation by demographics. SO WHAT?: Well-funded, sustained public health campaigns are needed to provide the public with evidence-based health and nutrition information and combat persuasive, misleading messaging from popular media and marketing.

Further evidence from the LiveLighter® campaign: A controlled cohort study in Victoria and South Australia.

ISSUE ADDRESSED: The LiveLighter® healthy weight and lifestyle social marketing campaign, developed in Western Australia, employs graphic advertising to communicate negative health effects of overweight and motivate behaviour change. This study extends prior evidence of the effectiveness of the LiveLighter® campaign by evaluating its implementation in a new jurisdiction. METHODS: A controlled cohort design was employed in intervention (Vic) and comparison states (SA), with and without campaign exposure. Population surveys conducted at baseline (BL) (n = 1000 each state), had 75% retention at follow-up (FU) (Vic: n = 715; SA: n = 787). RESULTS: Total campaign awareness was moderate (61.5%). Exposed respondents indicated the campaign was "believable" (91.0%), made a strong argument for reducing weight (87.3%), made them "stop and think" (70.1%), motivated action to reach/stay a healthy weight (59.1%) and was "relevant" (55.6%). The proportion of respondents indicating "toxic fat build up" was a health consequence of overweight increased significantly from BL to FU in Vic and to a lesser extent in SA (Vic:55.7% vs 75.9%; SA:58.1% vs 62.6%, interaction P < .001). The proportion indicating cancer is a health consequence of overweight increased significantly from BL to FU in Vic, but not in SA (Vic:77.1% vs 83.4%; SA:77.8% vs 78.1%, interaction P < .05). CONCLUSIONS: This study extends the evidence base for the LiveLighter® campaign. Sustained campaign activity with clear behavioural recommendations is required to translate improved knowledge into behaviour change. SO WHAT: Evidence-based mass media campaigns can positively impact health behaviours to address the unsustainable increasing burdens of unhealthy weight, dietary risk and inadequate physical activity. A National Obesity Campaign is needed and LiveLighter® is a ready-made, relevant Australian resource.

Can point-of-sale nutrition information encourage reduced preference for sugary drinks among adolescents?

OBJECTIVE: To test whether point-of-sale (POS) information about the nutrition content of sugar-sweetened beverages (SSB) promotes healthier drink choices among teenagers, and explore whether POS intervention effects vary based on prior exposure to a sugary drink public health campaign (13 Cancers). DESIGN: Between-subjects online experiment with three POS signage conditions: no signage (control); sugar content (SC) and Health Star Rating (HSR). Participants viewed their assigned POS sign alone, then alongside a drinks product display and chose which drink they would buy. Perceptions of various drink products and campaign recall were assessed. SETTING: Australia. PARTICIPANTS: Adolescents aged 13-17 years (n 925) recruited via an online panel. RESULTS: POS signs did not promote a significant reduction in preference for SSB (cf. control condition). Cognitive and emotional responses to POS signs were strongest for the SC sign, which was rated higher than the HSR sign on various perceived effectiveness measures. Participants who saw the SC sign rated SSB as less healthy (cf. control condition) and were more likely to accurately estimate the number of teaspoons of sugar in soft drink (cf. HSR sign and control conditions). There was no significant interaction between prior exposure to the 13 Cancers campaign and POS signage condition regarding preferences for and perceptions of SSB. CONCLUSIONS: SSB POS interventions may not have the desired effect on adolescents' drink preferences. Testing SSB POS signs in real-world retail settings is needed to determine whether positive educational impacts extend to promoting healthier drink purchases and reduced SSB consumption among teenagers.

General and specific graphic health warning labels reduce willingness to consume sugar-sweetened beverages.

Sugar-sweetened beverage (SSB) consumption is associated with obesity and other severe negative health consequences. The present study examined the effectiveness of two types of health warning labels (HWLs) in modulating dietary choices for SSBs: specific HWLs, presenting health consequences associated with consuming SSBs, and general HWLs, presenting health consequences of an unhealthy diet and obesity. While electroencephalography (EEG) was recorded, 63 participants completed a computer-based task in which they were first randomly allocated to view either SBB-specific, general, or non-warning control HWLs. They then viewed images of a range of SSB products, varying on perceived healthiness and tastiness, and rated their willingness to consume (WTC) each one. Linear mixed-effect model analyses revealed that general and specific HWLs both decreased WTC SSBs perceived as tasty, compared to the control condition. For general HWLs, this effect was reduced for SSBs perceived to be healthy, suggesting that specific HWLs may be more effective at reducing SSB consumption. The EEG data showed that SSBs considered unhealthy elicited greater N1 amplitudes, and tasty SSBs elicited greater late positive potential (LPP) amplitudes, possibly reflecting attentional allocation and craving responses, respectively. However, no strong differences between HWL types were found. Taken together, the results suggest that graphic HWLs, both general and specific, have the potential to reduce SSB consumption, but they do not strongly modulate craving-related neural responses to SSBs.

Sun-protective clothing and shade use in public outdoor leisure settings from 1992 to 2019: Results from cross-sectional observational surveys in Melbourne, Australia.

Skin cancer presents a significant public health burden in Australia. The present study aimed to supplement population-based estimates of sun protection behaviour by examining setting-specific trends in directly observed sun protection in public outdoor leisure settings. Repeated cross-sectional observational surveys of adolescents and adults were conducted on summer weekends between 11 am and 3 pm from 1992 to 2002, 2006 to 2012, and 2018 to 2019 (N = 44,979) at pools/beaches and parks/gardens within 25 km of the centre of Melbourne, Victoria. The primary outcome was a binary index representing individuals having above or below the median level of body surface covered by hat, shirt, and leg garments in each setting type. The prevalence of above-median body coverage increased between 1992 and 2002 in both settings. At pools/beaches, a slight decline in above-median body coverage between 2006 and 2019 in males and females (adjusted odds ratio, AOR = 0.96 [0.94, 0.97]; 0.94 [0.93, 0.95]) appeared to be driven by a decline in leg coverage, while arm coverage, hat, sunglasses, and shade use remained stable. At parks/gardens, a decline in above-median body coverage between 2006 and 2019 (AOR = 0.90 [0.89, 0.91]; 0.94 [0.93, 0.95]) was accompanied by small declines across other protective behaviours that varied between males and females. Patterns in protective behaviours observed in outdoor leisure settings may reflect the changing composition of individuals choosing to remain outdoors during peak UV times and highlight the importance of continued promotion and monitoring of the use of multiple measures to protect against UV damage in Australia.

Parents' reactions to unhealthy food v. pro-health sponsorship options for children's sport: an experimental study.

OBJECTIVE: To explore parents' responses to sponsorship of children's sport by unhealthy food brands and two alternative pro-health sponsorship options. DESIGN: Between-subjects online experiment with four sponsorship conditions: (i) non-food branding (control); (ii) unhealthy food branding; (iii) healthier food branding; (iv) public health nutrition campaign branding. Participants were shown a short video and a promotional flyer for a fictional junior sports programme, with sponsor content representing their assigned brand. Afterwards, participants were asked a series of questions assessing their brand awareness, brand attitudes and preference for food sponsor branded products. SETTING: Australia. PARTICIPANTS: Australian parents (n 1331) of children aged 6-9 years. RESULTS: Compared with the control condition, unhealthy food sponsorship promoted increased awareness, branded product preferences and favourable attitudes towards unhealthy food sponsor brands. Healthier food sponsorship promoted similar effects for healthier food sponsor brands, except there was no significant increase in positive attitudes towards these brands. Sponsorship by public health nutrition campaigns promoted more negative attitudes towards unhealthy food sponsor brands and increased preference for healthier food sponsor branded products. Overall, healthier food sponsors and public health campaign sponsors were perceived to have better programme-sponsor fit and to be more appropriate sponsors of children's sport than unhealthy food sponsors. CONCLUSIONS: Restrictions on unhealthy food sponsorship of children's sport are needed to prevent unhealthy food brands from exploiting junior sport sponsorship to enhance their appeal. Sponsorship of children's sport by healthier food brands or public health nutrition campaigns could help promote healthier food choices among parents.

Secondary school canteens in Australia: analysis of canteen menus from a repeated cross-sectional national survey.

OBJECTIVE: The current study aimed to assess the nutritional quality of Australian secondary school canteen menus. DESIGN: Stratified national samples of schools provided canteen menus in 2012-2013 and 2018, which were systematically assessed against a 'traffic light' classification system according to the National Healthy School Canteen Guidelines. Items were classified as green (healthiest and recommended to dominate canteen menus), amber (select carefully) or red (low nutritional quality, should not appear on canteen menus), and pricing and promotional strategies were recorded. SETTING: Australia. PARTICIPANTS: Canteen menus from 244 secondary schools (2012-2013 n 148, 2018 n 96). RESULTS: A total of 21 501 menu items were classified. Forty-nine percent of canteen menus contained at least 50 % green items; however, nearly all (98·5 %) offered at least one red item and therefore did not comply with national recommendations. Snacks and drinks had the least healthy profile of all product sectors, and a large proportion of schools supplied products typically of poor nutritional quality (meat pies and savoury pastries 91·8 %, sugary drinks 89·5 %, sweet baked goods 71·5 %, ice creams 64·1 % and potato chips 44·0 %). Red items were significantly cheaper than green items on average, and many schools promoted the purchase of red items on canteen menus (52·8 %). There were few differences between survey waves. CONCLUSIONS: There is considerable room for improvement in the nutritional quality of canteen menus in Australian secondary schools, including in the availability, pricing and promotion of healthier options. Additional resources and services to support implementation of national guidelines would be beneficial.

Can counter-advertising diminish persuasive effects of conventional and pseudo-healthy unhealthy food product advertising on parents?: an experimental study.

BACKGROUND: To help address rising rates of obesity in children, evidence is needed concerning impacts of common forms of marketing for unhealthy child-oriented food products and the efficacy of educational interventions in counteracting any detrimental impacts of such marketing. This study aims to explore parents' responses to advertising for unhealthy children's food products that employ different types of persuasive appeals and test whether a counter-advertising intervention exposing industry motives and marketing strategies can bolster parents' resistance to influence by unhealthy product advertising. METHODS: N = 1613 Australian parents were randomly assigned to view online either a: (A) non-food ad (control); (B) conventional confectionery ad (highlighting sensory benefits of the product); (C) pseudo-healthy confectionery ad (promoting sensory benefits and health attributes of the product); (D) conventional confectionery ad + counter-ad (employing inoculation-style messaging and narrative communication elements); (E) pseudo-healthy confectionery ad + counter-ad. Parents then viewed various snacks, including those promoted in the food ads and counter-ad. Parents nominated their preferred product, then rated the products. RESULTS: Exposure to the conventional confectionery ad increased parents' preference for the advertised product, enhanced perceptions of the product's healthiness and reduced sugar content and boosted brand attitude. Exposure to the pseudo-healthy confectionery ad increased parents' preference for the advertised product, and enhanced perceptions of healthiness, fibre content and lower sugar content. The counter-ad diminished, but did not eliminate, product ad effects on parents' purchasing preference, product perceptions and brand attitudes. The counter-ad also prompted parents to perceive processed foods as less healthy, higher in sugar and lower in fibre and may have increased support for advertising regulation. CONCLUSIONS: Exposure to unhealthy product advertising promoted favourable perceptions of products and increased preferences for advertised products among parents. Counter-advertising interventions may bolster parents' resistance to persuasion by unhealthy product advertising and empower parents to more accurately evaluate advertised food products.

Can point-of-sale nutrition information and health warnings encourage reduced preference for sugary drinks?: An experimental study.

Point-of-sale (POS) interventions that prompt consumers to more critically evaluate sugary drinks could encourage reduced consumption of these drinks and reinforce public health campaign messages. This study tested whether: (i) POS nutrition information and health warnings about sugary drinks promote healthier drink choices and (ii) impacts of prominent POS signs on drink choices vary based on participants' self-reported prior exposure to a sugary drink public health campaign. In an online experiment, 3034 Australian adults aged 18-59 years who were past-week sugary drink consumers were randomly assigned to one of five POS signage conditions (no signage (control); sugar content of specific beverages; Health Star Rating of specific beverages; generic text health warning about sugary drinks; generic graphic health warning about sugary drinks) and shown their randomly assigned POS sign alone, then alongside a drinks product display and asked to select which drink they would choose to buy. The proportion selecting a sugary drink was significantly lower among participants who viewed either the sugar content (29%), Health Star Rating (33%) or graphic health warning (34%) signs compared to those who saw no sign (43%). These effects held for participants who did not recall previously seeing the campaign; however, for participants with self-reported prior exposure to the campaign, POS signs did not promote significant reductions in sugary drink choices. POS signage has the potential to shift consumers away from choosing sugary drinks and could complement mass media campaigns by reaching people who may not otherwise be exposed to sugary drink public health messages.

Effects of health star labelling on the healthiness of adults' fast food meal selections: An experimental study.

The addition of Health Star Rating (HSR) labelling to menus at fast food outlets is feasible, however how this would impact consumer menu selection remains unclear. The aim of this study was to test whether the addition of HSR labelling to kilojoule (kJ) labelling on menus at fast food outlets would prompt consumers to select healthier meals. Using a between-subjects experimental design, 1007 adults aged 18-49 were allocated to one of four menu labelling conditions: (i) no labelling; (ii) kilojoule labelling; (iii) HSR labelling; and (iv) kilojoule + HSR labelling. Respondents were presented with their assigned menu online and instructed to select an evening meal as they would at a fast food restaurant. The main analyses tested differences by menu labelling condition in the total mean kilojoule content and Nutrient Profiling Score (NPS) of respondents' evening meal selections using one-way ANOVA. The mean kilojoule content of meals did not differ significantly by menu labelling condition. However, respondents in the kilojoule + HSR labelling condition selected healthier meals (lower mean NPS) than those who viewed menu boards with kilojoule labelling only (M = 2.88 cf. M = 3.78, p = 0.046). In addition, in a post hoc per-protocol analysis of respondents who reported using menu labelling to assist their meal selection, respondents shown kilojoule + HSR menu labelling selected meals with a significantly lower kilojoule content compared to those shown HSR labelling only (4751 kJ cf. 5745 kJ, p = 0.038). Findings provide evidence that adding HSRs to kilojoule labelling on menu boards at fast food outlets has the potential to assist adults to make healthier evening meal selections.

Association of the LiveLighter mass media campaign with consumption of sugar-sweetened beverages: Cohort study.

ISSUE ADDRESSED: Evaluation of the behavioural impact of Western Australia's LiveLighter healthy weight and lifestyle campaign focussed on decreasing consumption of sugar-sweetened beverages (SSBs) using graphic imagery, as well as monitoring unintended consequences. METHODS: A cohort design with pre-campaign telephone survey of Western Australian adults aged 25-49 (Time 1 May/Jun 2013: N = 1504) undertaken and repeated following the campaign (Time 2 Aug/Sep 2013: N = 822). RESULTS: Post-campaign awareness was 67% with respondents in low socio-economic areas most likely to report viewing the campaign frequently. There was evidence of reduced SSB intake from baseline to follow-up among frequent (4+/week) SSB consumers (22% cf. 16%; P = 0.003) and some evidence among overweight (BMI 25+) weekly SSB consumers (56% cf. 48%; P = 0.013). There was also some evidence consumption of sweet food decreased (3+/week: 53% cf. 48%; P = 0.035) while fruit, vegetable and fast food consumption remained stable. Knowledge of potential health consequences of SSBs increased (70% cf. 82%; P < 0.001) with no change in knowledge of potential health consequences of overweight generally (86% cf. 89%). Importantly, there was no increase in endorsement of overweight stereotypes. CONCLUSIONS: The LiveLighter "Sugary Drinks" campaign positively impacted adults' knowledge and behaviour with regard to SSB consumption in a pattern specific to the campaign messaging and without adverse impact on weight-related stereotypes. SO WHAT?: Findings support the use of mass media for healthy lifestyle change. They suggest the public are receptive to undertaking the campaign's simple concrete lifestyle recommendation and provide an indication of the campaign dose required to achieve positive behaviour change.

Community junior sport sponsorship: an online experiment assessing children's responses to unhealthy food v. pro-health sponsorship options.

OBJECTIVE: To explore children's responses to sponsorship of community junior sport by unhealthy food brands and investigate the utility of alternative, pro-health sponsorship options. DESIGN: Between-subjects experiment, with four sponsorship conditions: A, non-food branding (control); B, unhealthy food branding; C, healthier food branding; D, obesity prevention campaign branding. SETTING: Online experiment conducted in schools. Participants were shown a junior sports pack for their favourite sport that contained merchandise with branding representing their assigned sponsorship condition. Participants viewed and rated the sports pack, completed a distractor task, then completed questions assessing brand awareness, brand attitudes and preference for food sponsors' products. SUBJECTS: Students in grades 1 to 3 (aged 5-10 years; n 1124) from schools in metropolitan Melbourne, Australia. RESULTS: Compared with the control condition, there were no significant effects of unhealthy food branding on awareness of, attitudes towards or preference for these brands. Exposure to healthier food branding prompted a significant increase in the proportion of children aware of these brands, but did not impact attitudes towards or preference for these brands. Exposure to either healthier food branding or obesity prevention campaign branding prompted a significant reduction in the proportion of children showing a preference for unhealthy food sponsor products. CONCLUSIONS: The sponsorship of children's sport by healthier food brands may promote awareness of these brands and healthier sponsorship branding may reduce preferences for some unhealthy food products. Establishing and implementing healthy sponsor criteria in sports clubs could forge healthier sponsorship arrangements and help phase out unhealthy food and beverage sponsors.

Can front-of-pack labels influence portion size judgements for unhealthy foods?

OBJECTIVE: By clearly conveying the healthiness of a food, front-of-pack (FOP) labels have the potential to influence the portion size considered appropriate for consumption. The present study examined the how the Daily Intake Guide (DIG), Multiple Traffic Lights (MTL) and Health Star Rating (HSR) FOP labels affect judgements of appropriate portion sizes of unhealthy foods compared with when no FOP label is present. DESIGN: Respondents viewed mock packages of unhealthy variations of pizzas, cookies, yoghurts and cornflakes featuring the DIG, MTL, HSR or no FOP label, and indicated the portion size they believed should be eaten of each food on a single occasion. SETTING: The survey was completed on the respondent's personal computer. SUBJECTS: A total of 1505 Australian adults provided 4166 ratings across 192 mock packages relating to four product categories: pizza, yoghurt, cornflakes and cookies. RESULTS: Compared with no FOP label, the HSR resulted in a small but significant reduction in the portion size selected as appropriate for consumption of pizzas and cornflakes (P<0·05). The MTL resulted in smaller portions of cornflakes being selected compared with no FOP label (P<0·05). CONCLUSIONS: Respondents perceived smaller portion sizes as appropriate for some, but not all, of the foods tested when FOP labels with more interpretative formats (HSR, MTL) appeared on-pack compared with no FOP label. No effect was found for the less interpretive FOP label (the DIG). Interpretive FOP labels may have the potential to influence portion size judgements, albeit at modest levels.