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| Name | Class |
|---|---|
| National University of Singapore | OTHER |
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This study aims to use the Multiphase Optimization Strategy (MOST) to build and optimize a multi-component intervention that improves diet quality. The investigators will evaluate the effects of evidence-based public health interventions on consumers' diet quality via a web-based grocery store "NUSMart" and then identify a multi-component intervention that includes only those interventions meaningfully affecting diet quality.
The important role that diet plays in health and disease is well established. Excessive intake of energy, saturated fat and sodium increase the risk of heart disease, diabetes and certain cancers. As a result, interventions aimed at encouraging healthier food consumption have been pursued by many countries. These can be broadly grouped into the following categories: price manipulations, food labeling, and behavioral nudges.
No study has previously assessed the potentially interactive effects of a multi-component intervention that incorporates the strongest features of each intervention component while discarding those that do not meaningfully contribute to healthier consumption. That is the goal of this effort.
To this end, the investigators chose a full-factorial design because this experimental design allows us to estimate not only the independent (main) effects of the interventions but also their interaction effects. The full-factorial design includes all possible combinations of the interventions' status. Because the investigators have four interventions, each of which has two levels (intervention On or Off), there are 16 (i.e. 2^4) experimental conditions/arms in total. The four interventions for this study are outlined below:
- Explicit Tax: To impose an explicit tax on food and beverage items that are eligible for red stop-sign (explained in b.) as less healthy foods.
Foods and Beverages: The investigators will impose a 20% tax on sales price of the food items.
Participants will be randomly assigned to one of the 16 arms and instructed to perform a one-time hypothetical grocery shopping on NUSMart.
The investigators will collect participants' demographic and health characteristics as well as hunger at the time of the survey and their self-control in the baseline survey. The collected data will be used to precisely estimate the causal effect of the interventions and address their underlying mechanism to change consumers' food choices.
Our hypotheses about the effects of the interventions on diet quality, measured by the weighted average Nutri-Score (primary) of finalized shopping baskets, are as follows:
We will also run models both with and without including covariates that include demographic variables (e.g., age, minority status, income, BMI, sex, and household size) and measurements of self-control, hunger, and health-status. To test the moderating effects of hunger, self-control, health-status, and education level, we will include interaction terms between the intervention arms and these variables.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1 | Experimental | Tax (ON) Food Labels (ON) Ordering (ON) Substitution (ON) |
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| 2 | Experimental | Tax (ON) Food Labels (ON) Ordering (ON) Substitution (OFF) |
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| 3 | Experimental | Tax (ON) Food Labels (ON) Ordering (OFF) Substitution (ON) |
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| 4 | Experimental | Tax (ON) Food Labels (ON) Ordering (OFF) Substitution (OFF) |
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| 5 | Experimental | Tax (ON) Food Labels (OFF) Ordering (ON) Substitution (ON) |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Explicit Tax | Behavioral | To impose an explicit tax on food and beverage items that are eligible for red stop-sign food logos (explained in Intervention 2) as less healthy foods. Explicit tax shows pre-tax prices and a label indicating that the price includes a corresponding tax on the less healthy products. Food and Beverages: we will impose a 20% tax on sales price of the food items |
| Measure | Description | Time Frame |
|---|---|---|
| Diet Quality | Diet quality measured by the weighted average of all purchased products' Nutri-Score for the shopping trip. Nutri-Score is an individual dietary index based on the British Food Standard Agency Nutrient Profiling System. | At the end of data collection, up to 8 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of products | The proportion of products eligible for the green circle label and the red stop-sign label respectively, of the purchased products. | At the end of data collection, up to 8 weeks |
| Average nutrients per serving |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Duke-NUS Medical School | Singapore | 169857 | Singapore |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35195704 | Derived | Shin S, Chakraborty B, Yan X, van Dam RM, Finkelstein EA. Evaluation of Combinations of Nudging, Pricing, and Labeling Strategies to Improve Diet Quality: A Virtual Grocery Store Experiment Employing a Multiphase Optimization Strategy. Ann Behav Med. 2022 Aug 30;56(9):933-945. doi: 10.1093/abm/kaab115. |
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| ID | Term |
|---|---|
| D005515 | Food Labeling |
| ID | Term |
|---|---|
| D018857 | Food Packaging |
| D005524 | Food Technology |
| D019649 | Food Industry |
| D007221 | Industry |
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| 6 | Experimental | Tax (ON) Food Labels (OFF) Ordering (ON) Substitution (OFF) |
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| 7 | Experimental | Tax (ON) Food Labels (OFF) Ordering (OFF) Substitution (ON) |
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| 8 | Experimental | Tax (ON) Food Labels (OFF) Ordering (OFF) Substitution (OFF) |
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| 9 | Experimental | Tax (OFF) Food Labels (ON) Ordering (ON) Substitution (ON) |
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| 10 | Experimental | Tax (OFF) Food Labels (ON) Ordering (ON) Substitution (OFF) |
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| 11 | Experimental | Tax (OFF) Food Labels (ON) Ordering (OFF) Substitution (ON) |
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| 12 | Experimental | Tax (OFF) Food Labels (ON) Ordering (OFF) Substitution (OFF) |
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| 13 | Experimental | Tax (OFF) Food Labels (OFF) Ordering (ON) Substitution (ON) |
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| 14 | Experimental | Tax (OFF) Food Labels (OFF) Ordering (ON) Substitution (OFF) |
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| 15 | Experimental | Tax (OFF) Food Labels (OFF) Ordering (OFF) Substitution (ON) |
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| 16 | No Intervention | Tax (OFF) Food Labels (OFF) Ordering (OFF) Substitution (OFF) |
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| Food Labels (with the summary of healthiness of shopping baskets & targets) | Behavioral | To provide the green circle 'healthy choice' food label to items with Nutri-Score "A" and "B", the amber circle 'in between healthy and unhealthy choice' food label to items with Nutri-Score "C", and the red stop-sign 'less healthy choice' food label to items with Nutri-Score "D" and "E". In the presence of food labels,
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| Ordering | Behavioral | To order food items by Nutri-Score (high to low). |
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| Within-Group Substitution | Behavioral | To provide substitutes within corresponding food categories that are better than the items that subjects chose in terms of Nutri-Score based on the similarities of price, primary ingredients, flavor, and other characteristics. |
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Average calories, sodium, sugar, fat, and saturated fat per serving, which will be calculated based on all purchased products' total nutritional value.
| At the end of data collection, up to 8 weeks |
| D013676 |
| Technology, Industry, and Agriculture |
| D019064 | Product Packaging |