The impact of front-of-pack marketing attributes versus nutrition and health information on parents' food choices
Introduction
The eating behaviors, dietary intakes and weight status of children in many developed countries are far from optimal. In the United States, 17% of children aged six to eleven years are obese and over one third are overweight or obese (Ogden, Carroll, Kit, & Flegal, 2014), whilst in the UK, 30% of five to ten year olds are overweight or obese (Health and Social Care Information Centre, 2015). In Australia, the setting for the present study, 23% of children aged four to 18 years are overweight or obese (Hardy et al., 2017). In addition, a national survey found that 98% of Australian children aged five to 14 years did not eat the recommended daily serves of fruit and vegetables (Australian Institute of Health and Welfare, 2016), whilst other research discovered two thirds of children exceed recommended sugar intakes, and four fifths exceed recommended saturated fat intakes (CSIRO, 2008). This presents a significant public health challenge as many aspects of eating behaviors, as well as weight status, are formed in childhood and are subsequently difficult to change (Savage et al., 2007, Scaglioni et al., 2008, Wheaton et al., 2015). This puts individuals at greater risk for developing non-communicable diseases such as diabetes, cardiovascular disease and some forms of cancer in later life (Ebbeling, Pawlak, & Ludwig, 2002), which are presently the biggest causes of disease and disability in many developed countries including Australia (Australian Institute of Health and Welfare, 2016).
The development of poor eating behaviors in childhood is a complex problem that is the result of the interacting effects of multiple personal and societal factors, however the role of parents is well established (e.g., Birch and Davison, 2001, Golan and Crow, 2004, Lindsay et al., 2006, Savage et al., 2007). Parents shape children's food environments, thus affecting not only the foods that are available for consumption, but also the development of eating behaviors, attitudes towards eating and food preferences (Benton, 2004, Birch and Davison, 2001, Johnson, 2016, Peters et al., 2012, Shloim et al., 2015, Steinsbekk et al., 2016, Syrad et al., 2016).
Although parents are generally motivated to feed their children well, they often struggle to do so (Alderson and Ogden, 1999, Maubach et al., 2009, Russell et al., 2015). The reasons for this are multifaceted, but contributions are made by: 1) individual-level parent factors, such as lower education, ethnicity, socio-economic position, gender and eating pathology (Lloyd et al., 2014, McPhie et al., 2014, Shloim et al., 2015); 2) individual-level child factors, such as pestering (Pettigrew, Jongenelis, Chapman, & Miller, 2015), temperament (Bergmeier, Skouteris, Horwood, Hooley, & Richardson, 2014), and food fussiness (Dovey, Staples, Gibson, & Halford, 2008); and 3) societal factors, such as the availability of healthy and unhealthy foods (Swinburn et al., 2011), and the effects of marketing and advertising (Hastings et al., 2006, Mehta et al., 2012, Roberto et al., 2010).
Marketing and advertising is particularly influential on both parents' and children's selection and consumption of non-core foods (Cairns et al., 2013, Vilaro et al., 2017). Although television advertising is still the predominant medium for promoting foods to children (Hastings et al., 2006, Kelly et al., 2007, Kelly et al., 2015, Roberts et al., 2014), food packaging is also significant as it affects consumers, both parents and children, at the point of purchase (Hawkes, 2010, Young, 2004). Subsequently, Front of Pack (FoP) features have the potential to affect a large proportion of consumers' food choices and, therefore, health at the population level.
Many FoP attributes, such as imagery (e.g., of the product ingredients or sports people), colors, typography and unregulated written claims (e.g., taste claims), form important parts of a product's marketing and communications with consumers about its healthiness, tastiness or suitability for children (Dixon et al., 2014, Mehta et al., 2012). In fact, with few exceptions (e.g., nutrient facts panel, health claims or ingredient list, which are at least partly regulated by governments) marketers control the majority of information contained on food packages. As such, marketers use multiple techniques to influence both parents and children (Elliott, 2008, Mehta et al., 2012), such as bright colors, childish script and cartoon characters, with a particular emphasis on making a visual impact for products oriented towards children (Young, 2004).
The wide range of marketing, nutrition and ingredient information on food packages can make it confusing for consumers to make informed decisions. Packages may contain marketing images signaling health (e.g. athletes, fruits), but may also report nutrient profiles inconsistent with a healthy diet (e.g. high levels of sugar or sodium) on their nutrition information panels (Elliott, 2012). Furthermore, some FoP features (e.g. use of claims) are used extensively, regardless of the product's actual nutrient profile, highlighting that similar techniques are used to promote both healthy and unhealthy products (Elliott, 2008, Mehta et al., 2012). In fact, some unhealthy children's products are more likely to contain marketing images and text implying health than healthier products (Elliott, 2008), thus making it difficult for consumers to make accurate assessments of a product's healthfulness (Abrams et al., 2015, Elliott, 2008, Mehta et al., 2012).
In an effort to help consumers make more informed decisions about the health content of packaged foods, many governments have introduced summary FoP nutrition labels to supplement more detailed nutrition information panels and ingredient information contained on sides or backs of packs. Systems range from those that are simple (e.g., ticks; stars) to those that are more complex (e.g., Guideline Daily Amount scores). Feunekes, Gortemaker, Willems, Lion, & van den Kommer's (2008) study of European consumers comparing several of these systems, found that all are effective in helping consumers make healthier choices, with little differences in perceived friendliness across systems. The authors did, however, find consumers made faster decisions with simpler FoP formats, thereby suggesting their suitability to be effective in shopping environments requiring quick decision-making. Various elements of the health ratings system can receive differing levels of attention. In studying cereal choices by Dutch and Turkish university students, van Herpen and van Trijp (2011) found that traffic light labels and logos receive greater attention and guide healthier choices relative to nutrition tables.
In Australia, the Government introduced the Health Star Rating (HSR) system in 2014, and several companies have adopted this voluntary system (see, www.healthstarrating.gov.au). This system combines both evaluative (i.e. numerical information on key nutrients) and reductive (i.e. a summary assessment of the food's health value) elements (Hamlin, McNeill, & Moore, 2015) in the form of a visual star rating (from ½ to five stars) and summary nutrient facts panel. This panel information contains the amount of four ‘risk’ nutrients (energy, sugar, saturated fat and sodium) and one positive nutrient (e.g., dietary fiber or protein per 100 g) (Department of Health, 2015). A recent study of Australian consumers found the HSR labeling to be most preferred over two other FoP labeling systems (Daily Intake Guide; Multiple Traffic Lights) largely because of its simplicity and ease of use (Pettigrew et al., 2017). However, whether parents actually rely more on the HSR system than on other FoP elements is unclear.
Although research effort has been directed at understanding how parents use and respond to nutrition and health information on food packages (Harris et al., 2011, Watson et al., 2014b, van Herpen and van Trijp, 2011), little is known about how this information affects parents' decisions when considered relative to other marketing FoP features. This is important given that developing an understanding of and strategies for addressing the effects of the obesogenic environment on parents and children (Swinburn, Egger, & Raza, 1999), and specifically the purchase and consumption of packaged foods as part of this is needed. To effectively promote healthier packaged foods to parents and their children it is necessary to understand not only how parents use FoP nutrition information like the HSR system, but also how these systems affect parents when taken in the context of other, possibly conflicting, FoP marketing attributes.
In understanding how parents use FoP attributes it is likely that not all parents will be affected in the same way. This is partly because parental feeding practices and decisions are affected by the characteristics of their child and their beliefs about them (Jansen et al., 2014). Children's food fussiness or pickiness is one characteristic that has wide ranging effects on parent-child feeding interactions (Cardona Cano et al., 2015, Dovey et al., 2008). Food fussiness is characterized by an unwillingness to eat both familiar and unfamiliar foods, and, therefore, a poorer dietary intake (Carruth et al., 2004, Dovey et al., 2008, Taylor et al., 2015, Wardle et al., 2001). Parents of fussy children have higher motivations to select foods that their child is already familiar with and likes, and, therefore, can be less focused on health or nutrition (Perry et al., 2015, Russell and Worsley, 2013) and so offer their children a limited range of foods (Carruth et al., 2004, Galloway et al., 2005, Koivisto and Sjödén, 1996, Russell et al., 2015).
A child's weight status also affects parental feeding practices (Jansen et al., 2014), but parental concerns about their child's weight status and perceived vulnerability to obesity appear to mediate relationships between a child's actual weight and how they are fed (Webber, Hill, Cooke, Carnell, & Wardle, 2010). Parents with higher concerns about their child's weight use more restriction of non-core foods and have greater use of highly directive strategies in an attempt to control the child's weight status (Costanzo and Woody, 1985, Faith et al., 2004). Whether these effects extend to parents' use of FoP attributes is unknown.
Given the dearth of information comparing effects of FoP attributes on parents' food choices, the aim of this study was to understand the trade-offs that parents make when faced with products displaying a range of front-of-pack features while evaluating and selecting a suitable breakfast cereal for their child's consumption, and how this related to the child's characteristics. Specifically, the research objectives were to: (1) discover the relative importance of six FoP attributes (HSR stars and panel, written claims, product visuals, additional visuals and price) when parents choose to purchase a cereal for their child to consume; and (2) discover how product choice relates to the child's fussiness and the parents' level of concern about their child's weight. This study contributes to the literature by examining the influence of multiple packaging features on parents' choices from a holistic perspective to consider the relative impact of various packaging elements, including those controlled by the health and food regulators and those added by marketers.
Section snippets
Motivation and background to discrete choice experiment methodology
As stated, the current research aims to determine the relative importance of six FoP attributes when parents choose to purchase a cereal for their child to consume. Specifically, this requires an understanding of how parents make trade-offs when making food choices for their children. To do so, we use an indirect measurement approach that replicates marketplace decisions (Maubach et al., 2009), namely a discrete choice experiment (DCE). In the present context, the DCE asks parents to make
Overview
The study examined parent's food choices among cereals using a DCE. Parents were presented boxes of hypothetical cereal boxes in which FoP information varied. The parents then had to select the cereal they were most likely to buy. Parents also provided information about themselves, including socio-demographic information, concerns that they may have about their child's weight, and the fussiness of their child with respect to eating behaviors.
Participants
To be included in the study, parents had to be over
Sample
A total of 810 respondents commenced the survey with 172 respondents not meeting the screening criteria. Of the qualified 638 respondents, 520 parents completed the survey in full (completion rate 81.5%). The median response time was 15 min. Approximately half of the sample was male (53%) with a median age of 37 years. The majority of respondents had two children (52%). The majority of parents were married or living with a long-term partner (84%). The sample was made up of 68% of respondents
Discussion
This study manipulated nutrition and marketing information commonly featured on children's breakfast cereal packs to understand how parents trade off this information when making food product choices on behalf of their children. Results indicated that the most influential FoP feature was the product visual followed by the nutrition and health information; written claims and other visuals contributed the least. Furthermore, the impact of these elements varied according to whether the child was
Conclusion
This study analyzed the trade-offs that parents make when faced with products displaying a range of front-of-pack features while evaluating and selecting a suitable cereal for their child's consumption. Findings indicated that when considering the relative importance of a range of packaging features on parents' food choices for their children, attributes that do not draw attention of food regulators and policy makers, but are instead the realm of marketers and advertisers were highly
Ethics approval
This study received approval from the UTS Human Ethics Research (UTS HREC ETH16-0493). Inquiries on this ethics approval can be provided upon request via +61 2 9514 9772.
Acknowledgement and financial disclosure
The researchers acknowledge the assistance of Rupert Crossley along with colleagues and reviewers that have provided feedback and assistance, particularly Dr Natalina Zlatevska. The research was supported by the Australian Research Council (DE130101463) and a UTS Research Re-establishment grant (RES15/970).
Georgina Russell is Post-Doctoral Research Fellow at the University of Technology, Sydney. She has a background in public health nutrition with a particular focus on understanding food choice behaviors. She is primarily interested in psychological, social and environmental influences on children's health behaviors, especially how parents influence the development of children's eating and weight. She has published in various journal including Appetite, Journal of Nutrition Education, Behavior
References (97)
- et al.
Ignorance is bliss. How parents of preschool children make sense of front-of-package visuals and claims on food
Appetite
(2015) - et al.
Identifying consumer preferences for nutrition information on grocery store shelf labels
Food Policy
(2010) - et al.
Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight
Pediatric Clinics
(2001) - et al.
How do early career teachers value different types of support? A scale-adjusted latent class choice model
Teaching and Teacher Education
(2015) - et al.
Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary
Appetite
(2013) - et al.
Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food
Journal of the American Dietetic Association
(2004) - et al.
Economic valuation of cultural heritage sites: A choice modeling approach
Tourism Management
(2010) - et al.
Food neophobia and ‘picky/fussy’eating in children: A review
Appetite
(2008) - et al.
Childhood obesity: public-health crisis, common sense cure
The Lancet
(2002) - et al.
Front-of-pack nutrition labelling: Testing effectiveness of different nutrition labelling formats front-of-pack in four European countries
Appetite
(2008)
Parental pressure, dietary patterns, and weight status among girls who are “picky eaters”
Journal of the American Dietetic Association
Front-of-pack nutrition labels. Their effect on attention and choices when consumers have varying goals and time constraints
Appetite
Feeding practices and child weight: Is the association bidirectional in preschool children?
The American Journal of Clinical Nutrition
Developmental and environmental influences on young Children's vegetable preferences and consumption
Advances in Nutrition: An International Review Journal
Food and general neophobia in Swedish families: Parent-child comparisons and relationships with serving specific foods
Appetite
Maternal and paternal parenting practices and their influence on children's adiposity, screen-time, diet and physical activity
Appetite
A comparison of importance weights and willingness-to-pay measures derived from choice-based conjoint, constant sum scales and best–worst scaling
Journal of Business Research
Interpretive front-of-pack nutrition labels. Comparing competing recommendations
Appetite
An exploration of parents' food purchasing behaviours
Appetite
The types and aspects of front-of-pack food labelling schemes preferred by adults and children
Appetite
Parental family food choice motives and children's food intake
Food Quality and Preference
Why don't they like that? And can I do anything about it? The nature and correlates of parents' attributions and self-efficacy beliefs about preschool children's food preferences
Appetite
Strategies used by parents to influence their children's food preferences
Appetite
Dissecting obesogenic environments: The development and application of a framework for identifying and prioritizing environmental interventions for obesity
Preventive Medicine
The global obesity pandemic: Shaped by global drivers and local environments
The Lancet
Predictors of food decision making: A systematic interdisciplinary mapping (SIM) review
Appetite
Appetitive traits and food intake patterns in early life
The American Journal of Clinical Nutrition
Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes
Appetite
The development of a child into a consumer
Journal of Applied Developmental Psychology
Weekday and weekend food advertising varies on children's television in the USA but persuasive techniques and unhealthy items still dominate
Public Health
Can front-of-pack labelling schemes guide healthier food choices? Australian shoppers' responses to seven labelling formats
Appetite
What do mothers feed their children and why?
Health Education Research
What will consumers pay for social product features?
Journal of Business Ethics
Grocery unit prices
Responsible children's marketing initiative
Australia's Health 2016
Response styles in marketing research: A cross-national investigation
Journal of Marketing Research
Role of parents in the determination of the food preferences of children and the development of obesity
International Journal of Obesity
Associations between child temperament, maternal feeding practices and child body mass index during the preschool years: A systematic review of the literature
Obesity Reviews
The marketing of gluten-free cereal products. Gluten-Free cereal products and beverages
Trajectories of picky eating during childhood: A general population study
International Journal of Eating Disorders
Food giants sugar-coating the truth (by Katinka Day)
Measuring social desirability effects on self-reported turnout using the item count technique
International Journal of Public Opinion Research
Domain-specific parenting styles and their impact on the child's development of particular deviance: The example of obesity proneness
Journal of Social and Clinical Psychology
Health star rating system: Applying to products
Cited by (33)
Regulated nutrition claims increase perceived healthiness of an ultra-processed, discretionary toddler snack food and ultra-processed toddler milks: A discrete choice experiment
2022, AppetiteCitation Excerpt :The DCE design, by presenting consumers with attributes concurrently and in different combinations, replicates real marketplace decisions by forcing consumers to make choices between factors that may be important to them (e.g., low sugar, made with real fruit, all natural). DCEs have been performed on packaged food products for older children and on products such as cereals (G. C. Russell, Burke, Waller, & Wei, 2017), non-toddler-specific unhealthy snacks (Johnson, Golley, Zarnowiecki, Hendrie, & Huynh, 2020), and sugar sweetened beverages (Mantzari, Vasiljevic, Turney, Pilling, & Marteau, 2018), but none have been performed to determine how on-pack claims influence parental choice of toddler foods or milks. Thus, the aim of this study was to investigate the relative impact of different regulated and unregulated claims on parent perceptions of the healthiness of an ultra-processed, discretionary toddler snack food and an ultra-processed toddler milks in Australia.
The influence of label information on the snacks parents choose for their children: Individual differences in a choice based conjoint test
2021, Food Quality and PreferenceCitation Excerpt :This group of mothers tended to select products with cartoon characters for their children. Although a previous study reported that cartoon characters had a low influence on parents’ choices (Russell et al., 2017), other studies have reported that parents perceive products with cartoon characters as more appealing for children (Abrams et al., 2015). In the present study, the effect of cartoon character was larger for the chocolate milk than for the sponge cake.
Consumers’ reactions to nutrition and ingredient labelling for wine – A cross-country discrete choice experiment
2021, AppetiteCitation Excerpt :In a DCE, the respondents’ attribute importance is derived indirectly by forcing the respondents to make trade-offs between different product concepts that consist of different levels of attributes (Louviere et al., 2000; Louviere & Islam, 2008; Williamson et al., 2016). Although DCEs are limited by hypothetical bias they have been extensively used in food consumer research (Blake et al., 2018; Russell et al., 2017; Scozzafava et al., 2016) and where shown to be highly predictive for real-world decisions across a wide range of choice contexts (Lancsar & Louviere, 2008; Lancsar & Swait, 2014). To assess the effect of information on wine choices, the respondents of the choice experiment were randomly assigned to two different treatment conditions (Blake et al., 2018; Williamson et al., 2016).
Georgina Russell is Post-Doctoral Research Fellow at the University of Technology, Sydney. She has a background in public health nutrition with a particular focus on understanding food choice behaviors. She is primarily interested in psychological, social and environmental influences on children's health behaviors, especially how parents influence the development of children's eating and weight. She has published in various journal including Appetite, Journal of Nutrition Education, Behavior Public Health Nutrition, and Food Quality & Preference.
Paul Burke is an Associate Professor at the University of Technology Sydney (UTS). He has an extensive background in applied and theoretical aspects of choice modelling, experimental design and consumer behavior. His work has been published in International Journal of Research in Marketing, Research Policy, Journal of Product Innovation Management, International Business Review, European Journal of Marketing, Journal of Business Ethics, Journal of Operations Management and Tourism Analysis.
David Waller is Senior Lecturer in Marketing at the University of Technology Sydney (UTS) in the School of Business. His research has predominantly focused on marketing communications, controversial advertising, international advertising; and marketing ethics. He has published in numerous journals including Journal of Advertising, Journal of Advertising Research, European Journal of Marketing, and Journal of Food Products Marketing.
Edward Wei is a Senior Research Associate at UTS from which he received his PhD. He also holds a Masters of Business from QUT and a Bachelor of Economics from University of International Business & Economics (UIBE), China. Edward has worked with various companies, including AC Nielsen, as a quantitative analyst, operations and survey manager. He has published in journals such as Design Science, Agenda, and Energy Policy.