Skip to main content Accessibility help

Impact of explained v. unexplained front-of-package nutrition labels on parent and child food choices: a randomized trial

  • Dan J Graham (a1) (a2), Rachel G Lucas-Thompson (a3), Megan P Mueller (a2) (a4), Melanie Jaeb (a2) and Lisa Harnack (a2)...



The present study investigated whether parent/child pairs would select more healthful foods when: (i) products were labelled with front-of-package (FOP) nutrition labels relative to packages without labels; (ii) products were labelled with colour-coded Multiple Traffic Light (MTL) FOP labels relative to monochromatic Facts up Front (FuF) FOP labels; and (iii) FOP labels were explained via in-aisle signage v. unexplained.


Participants were randomly assigned to one of five conditions: (i) FuF labels with in-aisle signs explaining the labels; (ii) FuF labels, no signage; (iii) MTL labels with in-aisle signage; (iv) MTL labels, no signage; (v) control group, no labels/signage. Saturated fat, sodium, sugar and energy (calorie) content were compared across conditions.


The study took place in a laboratory grocery aisle.


Parent/child pairs (n 153) completed the study.


Results did not support the hypothesis that MTL labels would lead to more healthful choices than FuF labels. The presence of FOP labels did little to improve the healthfulness of selected foods, with few exceptions (participants with v. without access to FOP labels selected lower-calorie cereals, participants with access to both FOP labels and in-aisle explanatory signage selected products with less saturated fat v. participants without explanatory signage).


Neither MTL nor FuF FOP labels led to food choices with significantly lower saturated fat, sodium or sugar. In-aisle signs explaining the FOP labels were somewhat helpful to consumers in making more healthful dietary decisions. New FOP labelling programmes could benefit from campaigns to increase consumer awareness and understanding of the labels.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Impact of explained v. unexplained front-of-package nutrition labels on parent and child food choices: a randomized trial
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Impact of explained v. unexplained front-of-package nutrition labels on parent and child food choices: a randomized trial
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Impact of explained v. unexplained front-of-package nutrition labels on parent and child food choices: a randomized trial
      Available formats


Corresponding author

* Corresponding author: Email


Hide All
1. Dietary Guidelines Advisory Committee (2010) Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. Beltsville, MD: US Department of Agriculture, Agricultural Research Service.
2. World Health Organization (2015) Healthy Diet, Fact Sheet No. 394. (accessed September 2016).
3. Olshansky, SJ, Passaro, DJ, Hershow, RC et al. (2005) A potential decline in life expectancy in the United States in the 21st century. New Eng J Med 352, 11381145.
4. Centers for Disease Control and Prevention (2013) Overweight and Obesity., (accessed August 2016).
5. Wang, Y, Beydoun, MA, Liang, L et al. (2008) Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity (Silver Spring) 16, 23232330.
6. US Government, 101st Congress (1990) Nutrition Labeling Education Act of 1990. Public Law 101-535. (accessed September 2016).
7. US Food and Drug Administration (2014) Proposed Changes to the Nutrition Facts Label. (accessed February 2016).
8. European Food Information Council (2015) Global Update on Nutrition Labelling: Executive Summary. (accessed September 2016).
9. Graham, DJ & Jeffery, RW (2011) Location, location, location: eye-tracking evidence that consumers preferentially view prominently positioned nutrition information. J Am Diet Assoc 111, 17041711.
10. Graham, DJ, Heidrick, C & Hodgin, K (2015) Nutrition label viewing during a food-selection task: front-of-package labels vs nutrition facts labels. J Acad Nutr Diet 115, 16361646.
11. Campos, S, Doxey, J & Hammond, D (2011) Nutrition labels on pre-packaged foods: a systematic review. Public Health Nutr 14, 14961506.
12. Rothman, RL, Housam, R, Weiss, H et al. (2006) Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med 31, 391398.
13. Sinclair, S, Hammond, D & Goodman, S (2013) Sociodemographic differences in the comprehension of nutritional labels on food products. J Nutr Educ Behav 45, 767772.
14. Cowburn, G & Stockley, L (2005) Consumer understanding and use of nutrition labelling: a systematic review. Public Health Nutr 8, 2128.
15. US Food and Drug Administration (2009) Background Information on Point of Purchase Labeling. (accessed August 2016).
16. LetsMove (2013) Eat Healthy: Nutrition information. (accessed August 2016).
17. Hersey, JC, Wohlgenant, KC, Arsenault, JE et al. (2013) Effects of front-of-package and shelf nutrition labeling systems on consumers. Nutr Rev 71, 114.
18. Burton, S & Kees, J (2012) Flies in the ointment? Addressing potential impediments to population-based health benefits of restaurant menu labeling initiatives. J Public Policy Mark 31, 232239.
19. Andrews, JC, Lin, C-TJ, Levy, AS et al. (2014) Consumer research needs from the food and drug administration on front-of-package nutritional labeling. J Public Policy Mark 33, 1016.
20. Grocery Manufacturers of America & Food Marketing Institute (2011) Food and beverage industry launches Nutrition Keys front-of-pack nutrition labeling initiative to inform consumers and combat obesity. (accessed August 2016).
21. UK Department of Health (2013) Guide to creating a front of pack (FoP) nutrition label for pre-packed products sold through retail outlets. (accessed August 2016).
22. Hawley, KL, Roberto, CA, Bragg, MA et al. (2013) The science on front-of-package food labels. Public Health Nutr 16, 430439.
23. Balcombe, K, Fraser, I & Di Falco, S (2010) Traffic lights and food choice: a choice experiment examining the relationship between nutritional food labels and price. Food Policy 35, 211220.
24. Borgmeier, I & Westenhoefer, J (2009) Impact of different food label formats on healthiness evaluation and food choice of consumers: a randomized-controlled study. BMC Public Health 9, 184.
25. Kelly, B, Hughes, C, Chapman, K et al. (2009) Consumer testing of the acceptability and effectiveness of front-of-pack food labelling systems for the Australian grocery market. Health Promot Int 24, 120129.
26. Roberto, CA, Bragg, MA, Schwartz, MB et al. (2012) Facts up front versus traffic light food labels: a randomized controlled trial. Am J Prev Med 43, 134141.
27. Roberto, CA, Larsen, PD, Agnew, H et al. (2010) Evaluating the impact of menu labeling on food choices and intake. Am J Public Health 100, 312318.
28. Malam, S, Clegg, S, Kirwan, S et al. (2009) Comprehension and Use of UK Nutrition Signpost Labelling Schemes. London: Food Standards Agency.
29. Robert Wood Johnson Foundation Healthy Eating Research Program (2011) Using New Eye-Tracking Technologies to Assess the Effects of Varied Nutrition Labels on the Selection and Purchase of Healthful Foods. (accessed August 2016).
30. Faul, F, Erdfelder, E, Lang, A-G et al. (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39, 175191.
31. Graham, DJ & Jeffery, RW (2012) Predictors of nutrition label viewing during food purchase decision making: an eye tracking investigation. Public Health Nutr 15, 189196.
32. Keller, SB, Landry, M, Olson, J et al. (1997) The effects of nutrition package claims, nutrition facts panels, and motivation to process nutrition information on consumer product evaluations. J Public Policy Mark 16, 256269.
33. Grunert, KG, Wills, JM & Fernández-Celemín, L (2010) Nutrition knowledge, and use and understanding of nutrition information on food labels among consumers in the UK. Appetite 55, 177189.
34. Sonnenberg, L, Gelsomin, E & Levy, DE (2013) A traffic light food labeling intervention increases consumer awareness of health and healthy choices at the point-of-purchase. Prev Med 57, 253257.
35. Bialkova, S & van Trijp, HC (2011) An efficient methodology for assessing attention to and effect of nutrition information displayed front-of-pack. Food Qual Prefer 22, 592601.
36. Graham, DJ & Laska, MN (2012) Nutrition label use partially mediates the relationship between attitude toward healthy eating and overall dietary quality among college students. J Acad Nutr Diet 112, 414418.
37. Halford, JC, Boyland, EJ, Hughes, GM et al. (2008) Beyond-brand effect of television food advertisements on food choice in children: the effects of weight status. Public Health Nutr 11, 897904.
38. Mela, DJ (2001) Determinants of food choice: relationships with obesity and weight control. Obes Res 9, Suppl. 4, 249S255S.
39. O’Dougherty, M, Story, M & Stang, J (2006) Observations of parent–child co-shoppers in supermarkets: children’s involvement in food selections, parental yielding, and refusal strategies. J Nutr Educ Behav 38, 183188.
40. Dhar, R & Simonson, I (2003) The effect of forced choice on choice. J Mark Res 40, 146160.
41. Dhar, R & Simonson, I (1999) Making complementary choices in consumption episodes: highlighting versus balancing. J Mark Res 36, 2944.
42. Roberto, CA, Bragg, MA, Seamans, MJ et al. (2012) Evaluation of consumer understanding of different front-of-package nutrition labels, 2010–2011. Prev Chronic Dis 9, 120015.
43. Feunekes, GI, Gortemaker, IA, Willems, AA et al. (2008) Front-of-pack nutrition labelling: testing effectiveness of different nutrition labelling formats front-of-pack in four European countries. Appetite 50, 5770.
44. Newman, CL, Howlett, E & Burton, S (2014) Shopper response to front-of-package nutrition labeling programs: potential consumer and retail store benefits. J Retail 90, 1326.
45. Andrews, JC, Burton, S & Kees, J (2011) Is simpler always better? Consumer evaluations of front-of-package nutrition symbols. J Public Policy Mark 30, 175190.
46. NuVal (2016) Where to find NuVal®. (accessed August 2016).
47. Rose, G (1992) The Strategy of Preventive Medicine. Oxford: University Press.
48. Rose, G (2001) Sick individuals and sick populations. Int J Epidemiology 30, 427432.
49. Wolfson, JA, Graham, DJ & Bleich, SN (2016) Attention to physical activity-equivalent calorie information on Nutrition Facts Labels: an eye tracking investigation. J Nutr Educ Behav (In the Press).



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed