A Randomized Trial and Impact Evaluation of Singapore's New Food Labels Aimed to Address the War on Diabetes
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 110
- Locations
- 1
- Primary Endpoint
- Sugar Levels
Study Overview
Brief Summary
This study aims to systematically evaluate the effect of Singapore's new front-of-pack non-alcoholic beverage labels, called Nutri-Grade, on the consumption of processed beverages. Using a fully functional grocery webstore, the investigators wish to assess the causal effect of the new labels on food and beverage purchase, sugar intake, and overall diet quality and examine how this effect varies by shoppers' income and education level.
The investigators' hypotheses about the effects of these new food labels, measured by the grams of sugar per serving (primary) of finalized shopping baskets, are as follows:
- Hypotheses 1: The new sugar-sweetened beverage (SSB) labels will shift consumers toward healthier products. Sugar-sweetened beverages are any liquids that have been sweetened with one or more of the different forms of added sugars.
- Hypotheses 2: The new SSB labels will reduce overall sugar and calories purchased and increase overall diet quality.
- Hypotheses 3: Effects will be greater for those with low income/low education as they are least familiar with the nutrition facts panel and thus most likely to benefit from the new information.
Detailed Description
- Experimental Design and Procedures
The aim of this study is to use a 2 x 2 within-subject crossover design with an online grocery store, to systematically evaluate the effect of the new SSB front-of-pack labels, Nutri-Grade, on diet quality and examine how this effect varies by shoppers' income and education level. To this end, the investigators will be using two different versions of an online experimental grocery store called NUSMart, designed for research purposes. The two versions are described below. 2. Overview of Experimental Design
The investigators will recruit Singapore residents aged 21 years or older. Prospective participants will be asked to complete an online screener to determine their eligibility to participate in the study. Those who do not consent or are deemed ineligible will be notified of their ineligibility with an on-screen message.
If interested and eligible, the applicant will then be asked to complete a registration form containing name, mobile number, and email address. Contact information for the Duke-NUS study team will be provided to allow questions to be asked at any point in the consent process and throughout the study. Upon completion of the registration form, NUSMart will create the participant account and a unique ID number (CID) for use throughout the study. Participants will receive an automated email with their unique login details.
Participants will be directed to read the Participant Information Sheet and provide consent. The investigators will provide information on study protocols and participation details without disclosing the intervention arms explicitly, to maintain the integrity of participant responses and hence to ensure validity of results. It will be deleterious to the study to reveal the labels or the differences between study arms before participants complete both shops as this will likely confound participant responses. The consent form will state that in each of the shops there is a 50% chance that the participant will have to make actual purchases i.e. buy the groceries in the cart they checked out. In reality, it will be randomly decided earlier whether shopping trip 1 or 2 is the real shop. This will be achieved via a collaboration with a local online grocery provider, FairPrice.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Crossover
- Primary Purpose
- Health Services Research
- Masking
- Triple (Participant, Investigator, Outcomes Assessor)
Eligibility Criteria
- Ages
- 21 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Singapore resident
- •Age 21 and above
- •Must be the primary weekly grocery shopper in their household
- •Must have an account with our appointed online grocery service provider or is willing to create one.
Exclusion Criteria
- •Non-Singapore resident
- •Non-primary grocery shopper in their household
- •Less than 21 years old
- •Doesn't have an account with our appointed online grocery service provider and is unwilling to create one.
Arms & Interventions
Arm 1 (Control Arm)
A default NUSMart that mirrors a conventional web-grocery store in Singapore where some healthier products are displayed with Singapore's Healthier Choice Symbol (HCS) logos (Control).
Arm 2 (Nutri-Grade Arm)
Similar to Arm 1 except that beverages will be displayed with a color-coded and graded Nutri-Grade label.
Intervention: Nutri-Grade labels (Behavioral)
Outcomes
Primary Outcomes
Sugar Levels
Time Frame: After completion of data collection, an average of about 5 months
Grams of sugar per serving
Secondary Outcomes
- Calorie Intake(After completion of data collection, an average of about 5 months)
- Purchased Beverage Quality(After completion of data collection, an average of about 5 months)
- Overall Diet Quality(After completion of data collection, an average of about 5 months)
Investigators
Soye Shin
Research Fellow
Duke-NUS Graduate Medical School