Skip to main content
OpenTrials
Completed

NCT Number: NCT05549388

Effect of Front-of-Pack Labels in Ethiopia

Ethiopia is experiencing the type of rapid food system transformation that leads to a double burden of malnutrition and increased non-communicable diseases. Front-of-pack labels on packaged foods are an emerging public health strategy with the potential to address non-communicable diseases by discouraging the purchase and consumption of products with high levels of nutrients of public health concern. The aim of this study is to evaluate and compare the effectiveness of front-of-pack labeling systems to reduce the intent to purchase unhealthy foods among adults in Ethiopia. The study will recruit approximately 1200 adults using a street-intercept methodology. Participants will be randomized to 1 of 4 arms to complete a survey in which the presence and type of front-of-pack label differs across survey arms and asked to rate participants' intent to purchase unhealthy packaged foods.

Completed

Looking for future studies?

Notify Me

Key information

Conditions

Cardiovascular Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Street-Intercept Survey

Addis Ababa, Oromiya, Ethiopia

About this study

In 2017, cardiovascular disease was the leading age-standardized cause of death in Ethiopia. The national prevalence of hypertension in Ethiopia in 2015 is estimated to be 16% (Gebreyes et al. 2018). Urban diets are rapidly changing, but not becoming healthier (Wolle et al. 2020). Diet quality remains poor: only 2.4% of the national population meets the WHO recommendation of five servings of fruit and vegetables per day. The mean estimated salt intake of 8.3 g/day exceeds the WHO maximum recommended intake (Challa et al. 2017). Processed foods are penetrating the market at a rapid pace (Melesse et al. 2019; Stuckler et al. 2012). Increasing income has increased demand for convenience foods (Minten et al. 2018). Ethiopia is experiencing the type of rapid food system transformation that leads to a double burden of malnutrition and increased non-communicable diseases (Popkin 2017).

Front-of-pack labels on packaged foods are an emerging public health strategy with the potential to address non-communicable diseases by discouraging the purchase and consumption of products with high levels of nutrients of public health concern (Croker et al. 2020). However, front-of-pack labels have not been tested in the Ethiopian context. Additionally, there are multiple types of front-of-pack labeling systems in use around the world, such as Multiple Traffic Light/Guideline Daily Amounts, the Nutri-Score system, and nutrient-specific warning labels.

Therefore, the study aims to to evaluate and compare the effectiveness of front-of-pack labeling systems to reduce the intent to purchase unhealthy foods among adults in Ethiopia. The study will recruit approximately 1200 adults using a street-intercept methodology. Participants will be randomized to 1 of 4 arms to complete a survey in which the presence and type of front-of-pack label differs across survey arms and asked to rate participants' intent to purchase unhealthy packaged foods.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age ≥18 years
  • Purchase foods outside of the household

Exclusion criteria

  • Age <18 years
  • Do not purchase foods outside of the household
  • Unable to complete the survey protocol

Treatment and study plan

Front-of-pack labeling

Other

The intervention being tested is the effect of front-of-package labeling on consumers' intent to purchase foods which are high in one or more nutrients of public health concern. Participants randomized to the control group will view images of packaged foods and beverages and answer a series of questions about those products. In the intervention arms, participants will view images of the same packaged foods and beverages, but with different front-of-package labels displayed that provide nutrition information about the product. Participants in each arm will be asked the same series of questions about the products shown.

Primary outcomes

  1. Intent to purchase based on single product tasks

    Time frame: The outcome will be assessed during survey administration at a single time point (baseline).

    Participants will be shown images of four single products, two of which are high in sodium and two of which are high in sugar. For each product, participants will rate their intent to purchase the product on a likert scale. The investigators will calculate the mean of the responses to questions about the four products.

Secondary outcomes

  1. Purchase choice based on product comparison tasks

    Time frame: The outcome will be assessed during survey administration at a single time point (baseline).

    The investigators will evaluate responses to three product comparison tasks, each of which will present two packaged food items in the same food category and ask respondents which product they would choose to purchase. Specifically, the investigators will examine the proportion in each arm who report they would avoid purchasing the "less healthy" product.

  2. Label understanding and acceptability

    Time frame: The outcome will be assessed during survey administration at a single time point (baseline).

    In the warning label, multiple traffic light, and Nutriscore arms, participants will be shown images of the respective labels. They will be asked a series of questions regarding their understanding of the label and its acceptability in Ethiopia and provide responses using a likert scale.

Other outcomes

  1. Intent to purchase foods high in sodium

    Time frame: The outcome will be assessed during survey administration at a single time point (baseline).

    In exploratory analyses, the investigators will compare purchase intentions based on the single product tasks, examined separately for high sodium and high sugar products. For each product high in sodium, participants will rate their intent to purchase the product on a likert scale. The investigators will calculate the mean of the responses to questions about the two products high in sodium.

  2. Intent to purchase foods high in sugar

    Time frame: The outcome will be assessed during survey administration at a single time point (baseline).

    In exploratory analyses, the investigators will compare purchase intentions based on the single product tasks, examined separately for high sodium and high sugar products. For each product high in sugar, participants will rate their intent to purchase the product on a likert scale. The investigators will calculate the mean of the responses to questions about the two products high in sugar.

Sponsors and collaborators

Lead sponsor

Johns Hopkins Bloomberg School of Public Health

Other

Collaborators

  • Addis Continental Institute of Public Health
  • Resolve to Save Lives

Registry information

Official study title

Effect of Front-of-Package Labels on the Intent to Purchase Packaged Foods in Ethiopia

Important dates

Study start
2022
Primary completion
2023
Study completion
2023
First posted
Sep 22, 2022
Registry last updated
Jan 19, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.