Using Video Gaming to Evaluate Front of Pack Labeling With Children

Background It has been estimated that only two percent of children eat a diet that is
consistent with the Food Guide pyramid, consuming diets that are too high in fat, saturated
fat and sodium, and too low in fiber. Furthering concerns associated with these statistics is
the fact that childhood is a determinant phase in the establishment of eating habits, and
that developing healthy eating practices as a child has long-term health benefits.

That said, children are an attractive segment for food marketers. Children are not only
represent a primary market with growing access to discretionary income, children also have
significant power to influence decisions and are a promising future market. As such, kids
represent an attractive target for marketers, and research suggests vulnerability to the
messages which target them.

It has been suggested that directing messages to children "increases children's preferences
for the foods advertised and increases their requests to parents for those foods."
Recognizing this, packaging plays an important role in the marketing mix. The US Federal
Trade Commission (FTC) has estimated that 12% of all youth marketing expenditures are spent
on packaging and in-store in store display materials. This is because of packaging's ability
to influence purchase within retail spaces, at the point where purchasing decisions are made;
something researchers have referred to as the "nag factor."

Clearly, the idea of presenting information directed at children using packaging for the
purpose of motivating sales is utilized; however, the idea of presenting regulated
information (e.g. nutritional information) in a format that might be readily understood by
this vulnerable audience has not been widely explored. A major goal of nutritional labeling
on food packages is to help consumers make appropriate choices. However, the current approach
to nutritional labeling is targeted at adults, rather than children.

Although children as young as age four are capable of classifying familiar foods (e.g. ice
cream vs. broccoli) as healthy or unhealthy, the investigators are the first to examine
whether children can use visual cues from Front of Pack (FOP) labels to compare and evaluate
food products from the same category (cereal). FOP labels appear on the front of packages and
provide truncated information about nutrients that tend to be associated with disease (e.g.
fats, trans fats, sugar and sodium).

Two semi-directive overlays, namely, color (2 levels present/absent) and facial icon (present
and absent) were crossed, for a total of four FOP treatments. The study investigated color
because it represents the traffic light system, which is a standard FOP design in the United
Kingdom (UK), and its use is a topic of significant debate globally. Investigators also
tested the efficacy of schematic facial expressions representing relatively high, medium, and
low values for nutrients (i.e. frowning for high; straight face for moderate and a smile for
those low). Overwhelming evidence indicates that face stimuli are given extremely high
attentional priority and that the processing of facial expressions of emotion requires very
few cognitive resources. These findings suggest that a face stimulus might be a particularly
effective stimulus for drawing attention to the FOP nutritional panel and conveying relative
qualitative information about the nutritional value of a product. As such, study
investigators postulated that FOP utilizing faces would be particularly well-suited for use
with children. Faces are known for garnering increased attention in infants and children as
young as age 4 can reliably identify facial expressions of emotion. In fact, developmental
research often exploits children's ease of comprehending iconic faces to measure children's
judgments of stimuli or situations.

Materials and Methods Investigators leverage these fundamental insights in work presented
here, such insights can be used in ways that positively enhance attention to and
understanding of nutrition information in a vulnerable audience, children aged 6 to 10.

Children were seated at a computer and given a brief overview of the game. The program began
with an instruction scene in which a purple monster character (Munchy) said

"Hi my name is Munchy. I like to eat, but only healthy foods. Will you please feed me? In the
game, you will see two cereal boxes. One is healthier than the other. To feed me please press
the button on the side with the healthy cereal. If you select the healthy one I will eat it
and you will get points. If you select the unhealthy one I will refuse to eat and you will
not get any points. I am really hungry so please choose the healthy one as fast as you can.
Do you have any questions?"

For each trial, both cereals had the same FOP treatment. However, one package contained
"healthy levels" of key nutrients (e.g. for colored FOP three or more nutrients at "green
levels") while the other contained "unhealthy levels" (three or more nutrients at "red
levels"). Nutrients were categorized into high, moderate and low levels based on Traffic
Light Label Guidelines released by the Food Standards Agency. The appearance of the brand and
the position of the package (right or left side of screen) were randomized; additionally, a
second randomization was done with the healthfulness level of the nutrition information such
that the positioning (right side of screen or left) was randomized. As a result, for one
subject brand X might appear as healthy, while for another it might be presented with
unhealthy information. Each participant completed 80 trials, with each of the four FOP
designs appearing in 20 trials per participant by the conclusion of the game. The time it
took for the participant to make a correct choice was recorded along with a binary response
of correct choice (yes or no).

Two blocks of participants were recruited. In the first block, no reference was made to the
FOP labeling. For the second block of participants, at the beginning of the experiment, in
addition to being shown the basic premise of the game and told that Munchy preferred to eat
healthy options, the researcher pointed to one of the FOPs and told children "this
information might be helpful when you decide what's healthy."

Inclusion Criteria:

- 6-10 years of age

- Legally sighted

- have parent or legal guardian present (written consent of parent)

- have transportation to the test site

- be willing to share contact information for reminders be willing to have deidentified
data stored provide written or verbal assent (depending on the age of the child)

Exclusion Criteria:

- legally blind

- no assent