erin hobin public health ontario may 29, 2014. in canada, deaths due to chronic disease account for...

Erin HobinPublic Health Ontario

May 29, 2014

www.oahpp.ca

• In Canada, deaths due to chronic disease account for                     approximately 75% of all deaths each year (Public Health Agency of Canada, 2009)

• The most recent Global Burden of Disease Study (2010) ranks unhealthy diet as the leading risk factor for chronic disease and premature death in Canada (Institute for Health Metrics and Evaluation, 2012) 

Chronic Disease and Chronic Disease and UnUnhealthy Eatinghealthy Eating

www.oahpp.ca

Promoting Healthy Promoting Healthy Food ChoicesFood Choices

• Supermarkets are a critically important environment for influencing food choices  (Government of Canada, 2013)

• Approximately 70 – 80% of food purchases are made at the supermarket (Carlson et al., 2002; Ransley et al., 2004)

www.oahpp.ca

Nutrition Labels in CanadaNutrition Labels in Canada

• Nutrition labels are the main source of nutrition information for Canadians (Goodman et al., 2008)

• 71% of Canadians report reading the Nutrition Facts table on a regular basis to compare and select foods when making purchase decisions (Health Canada, 2011)

www.oahpp.ca

BarriersBarriers to using NFts to using NFts

• the complexity of the information, 

• the time and effort required to process the information, and 

• the positioning of the information on the back or side of food packages.

Information on Nutrition Facts tables can be difficult to interpret and apply because of:

(Health Canada, 2011; Campos et al., 2011; Sinclair et al., 2013) 

www.oahpp.ca

Standardized, Simple, Interpretive Ordinal

www.oahpp.ca

Supported by a Promotional Campaign

www.oahpp.ca

www.oahpp.ca

Overall Research ObjectiveOverall Research Objective

To investigate the impact of an on-shelf nutrition labelling system on the nutritional

quality of consumer food purchases in supermarkets in Canada.

• Pre-post quasi-experimental design with a control group• 3 data sources:• Supermarket transaction data• Cardholder data• Exit surveys with supermarket customers

www.oahpp.ca 10

Loblaws supermarkets

August 2012

Intervention Implementation in Loblaws Supermarkets in Ontario

www.oahpp.ca

Wave 1: Loblaws and Zehrs Supermarket Sites in Ontario

11

Loblaws supermarkets

August 2012

February 2013

Wave 1n=882

www.oahpp.ca 12

Loblaws supermarkets

August 2012

February 2013

Wave 1n=882

March 2013

Zehrssupermarkets

Intervention Implementation in Zehrs Supermarkets in Ontario

www.oahpp.ca

Wave 2: Loblaws and Zehrs Supermarket Sites in Ontario

13

Loblaws supermarkets

August 2012 March 2013

Zehrs supermarkets

February 2013 February 2014

Wave 1n=882

Wave 2n=792

www.oahpp.ca

Study Design

14

Wave 1 Wave 2

Loblaws Supermarkets

Zehrs Supermarkets X

Preliminary results from Loblaws supermarkets indicate differences between Wave 1 and  Wave 2 after 1-year implementation.Preliminary results from Zehrs supermarkets indicate differences between Wave 1 and Wave 2, before and after the intervention was implemented.

www.oahpp.ca

• Regression models to examine the change in Zehrs supermarkets (intervention) compared to Loblaws supermarkets (active control) from Wave 1 to Wave 2 controlling for covariates. 

• Four key outcomes:1. Unprompted Awareness2. Understanding3. Trust4. Self-reported Use

15

www.oahpp.ca

Sample Description

Wave 1 Participants (n=882)

•72% female 

•Mean Age = 51.5 years

•24% with high school or less

•85% White

•78% primary shopper

•67% main supermarket

•56% doing a large shop

Wave 2 Participants (n=792)

•69% female 

•Mean Age = 50.2 years

•22% with high school or less

•83% White

•76% primary shopper

•65% main supermarket

•57% doing a large shop

16

www.oahpp.ca

Unprompted Awareness of Stars on Shelf Tag

17

Zehrs SupermarketsLoblaws Supermarkets (n=882) (n=792)

(X2 = 0.45, p=0.50) (X2 = 17.55, p<.0001)

www.oahpp.ca

Understand the Stars indicate Nutritional Quality

18Loblaws Supermarkets

• Overall, 9% of participants in Loblaws Supermarkets in Wave 1 and Wave 2 understood the stars symbol indicate nutritional quality of food (X2=0.78, p=0.38)

(n=84)

Among those who noticed the stars symbol

www.oahpp.ca

Understand the Stars indicate Nutritional Quality

19Zehrs Supermarkets

• Overall, 0% and 4.6% of participants understood the stars symbol indicate the nutritional quality of food in Wave 1 and Wave 2 (X2=35.50, p<.0001)

(n=41)

Among those who noticed the stars symbol

www.oahpp.ca

Self-Reported Use of Stars

20

Loblaws Supermarkets

• Overall, 2% and 1.5% of participants in Loblaws Supermarkets reported using the stars symbol when choosing foods in the supermarket in Wave 1 and Wave 2 (X2=1.23, p=0.27)

(n=78)

Among those who noticed and understood the stars symbol

www.oahpp.ca

(n=36)

Self-Reported Use of Stars

21

Zehrs Supermarkets

• Overall, 0% and 3% of participants reported using the stars symbol when choosing foods in Zehrs Supermarkets in Wave 1 and Wave 2 (X2=8.57, p=0.01)

Among those who noticed and understood the stars symbol

www.oahpp.ca

Trust in Guiding Stars symbol for providing food and nutrition information

22

Mean (SD) T-test p-value

Loblaws Supermarkets

Wave 1 2.81 (1.3) -1.5 p=0.18

Wave 2 2.95 (1.2)

Zehrs Supermarkets

Wave 1 2.76 (1.2) 0.13 p=0.86

Wave 2 2.71 (1.2)

www.oahpp.ca

Support for displaying symbols on shelf tags to indicate the nutritional quality of foods

23

((n=882) (n=792)Loblaws Supermarkets Zehrs SupermarketsX2=2.54, p=0.11 X2=9.06, p=0.003

www.oahpp.ca

Summary

•Overall, relatively low levels of consumer awareness, understanding, and self-reported use of Guiding Stars labelling system

•No differences in levels of awareness, understanding, and self-reported use of Guiding Stars labelling system in Loblaws Supermarkets 1-year after implementation

•Small but statistically significant differences in consumer awareness, understanding, and self-reported use of the Guiding Stars labelling system in Zehrs Supermarkets 

www.oahpp.ca

Summary •Moderate levels of trust in the Guiding Stars labelling system 

•High levels of support for on-shelf nutrition labelling systems

www.oahpp.ca

Next Steps •Analyze the supermarket and cardholder

transaction data to examine the actual impact of the Guiding Stars labelling system on the nutritional quality of food purchases over time

•Conduct Wave 3 Exit Surveys in Ontario and comparison provinces to examine changes in consumer awareness, understanding, trust, and self-reported use of the Guiding Stars labelling system over time

www.oahpp.ca

Acknowledgements• Dr. David Hammond, University of Waterloo

• Lana Vanderlee, University of Waterloo

• Dr. Laura Rosella, Public Health Ontario

• Dr. Heather Manson, Public Health Ontario

• Dr. Mary L’Abbe, University of Toronto

• Dr. Bryan Bollinger, New York University

• Alexis Williams, RD, Loblaw Corp. Ltd.

Funding for this study was provided by Propel Centre for Population Health Impact as well as a CIHR Operating Research Grant

www.oahpp.ca

Thank You for Listening!Thank You for Listening!

E: Erin.Hobin@oahpp.caT: 647-260-7198