Exploring the effectiveness of policy options for simultaneous displaying multiple added sugar labels in Australian adults

INTERVENTION: Interventional We will examine (i) the relative effect of different combinations of added sugar labels on food and beverage purchasing (using the two most effective labels from a previous trial [Trial 1ACTRN12620000858998]); and (ii) effects by level of participant sugar consumption, gender, age, education, and income. This new evidence will guide and inform the development of effective labelling policies to reduce added sugar consumption for Australians and New Zealanders. Trial: A third‐party recruitment company will be used to recruit participants for the online study. The recruitment company have security measures in place to securely store participants’ identifiable data. No identifiable information will be received by the researchers from the recruitment company. Research data (i.e. answers to the survey) will not be available to or stored by the recruitment company. Eligible participants will be randomised to complete one of four online survey conditions that will take approximately 10‐15 minutes to complete. Participants will be screened in order to classify them as high or low sugar purchasers. Participants will be asked to select all relevant products they purchase at least once a month for themselves or their household from a range of generic product subcategories in each of the product categories of interest (yoghurt and custards, breakfast cereal and non‐alcoholic packaged drinks). For example, in the yoghurt categories this will include: plain Greek or natural yoghurt, flavoured Greek or natural yoghurt, custard etc. These generic subcategories will be classified as “high” and “low” sugar products. If the participants select one or more high sugar products in each category they will be considered a high sugar purchaser. Participan CONDITION: Diet and Nutrition ‐ Obesity Promotion of healthy diet choices;Obesity; ; Promotion of healthy diet choices ; Obesity Public Health ‐ Health promotion/education Public Health ‐ Other public health PRIMARY OUTCOME: The proportion of high sugar products purchased will be assessed using study specific hypothetical food purchasing task questions. “High” sugar products will be classified using the UK Nutrient Profiling Model (foods >6.25g added sugar/100g and beverages >3.13g/100ml). Purchases of high sugar products will be compared between labelling conditions for each food category.[Immediately after being exposed to the study intervention] SECONDARY OUTCOME: The mean added sugar content of purchases (g/100g) will be assessed using study‐specific hypothetical food purchasing task questions. ; To calculate added sugar of products we will use the following decision tree: i) if the ingredients list includes added/free sugars only then the total sugars will be considered added sugars; ii) if the ingredients list includes a mixture of added sugars and intrinsic sugars then we will allocate added sugar as a percentage of total sugar content, based on the percentage added sugar content of a similar generic product in AUSNUT database. We will use AUSNUT “free sugars” content to calculate this. For water‐based beverages we will assume that all sugars are added sugars. For fruit juices, we will select branded drinks that provide the percentage of juice the product so we can calculate added sugar content. ; Purchases will be compared between labelling conditions for each food category. INCLUSION CRITERIA: ‐Australian residents ‐18 years or older ‐Access to a computer and internet connection to complete the survey ‐Regular (at least once a month or more) purchasers of breakfast cereal, yoghurt and non‐ alcoholic pre‐packaged drinks for themselves or their household ‐Completes at least one supermarket shop per month for their household ‐Lives with at least one child <18 years ; [Immediately after being exposed to the study intervention] The mean Health Star Rating (from 0.5 to 5) of purchases, will be assessed using study‐specific hypothetical food purchasing task questions. Health Star Rating will be derived using modifications to the publicly available calculator of the HSR algorithm. To calculate the modified Health Star Rating including added sugar, we will use the UK Nutrient Profiling Model scale for 10% added sugar intake. Purchases will be compared between labelling conditions for each food category.[Immediately after being exposed to the study intervention] The proportion of Five Food Group (healthy) and discretionary (unhealthy) foods purchased will be assessed using study‐specific hypothetical food purchasing task according to Australian Dietary Guidelines. Purchases will be compared between labelling conditions for each food category.[Immediately after being exposed to the study intervention] We will also apply the following recruitment quota: ‐At least 50% of participants will be considered high sugar purchases. To categorise participants into high sugar purchasers and low sugar purchasers they will be asked to indicate whether they purchase at least once a month for themselves or their household high sugar yoghurt, breakfast cereal and non‐alcoholic packaged drinks (e.g. flavoured yoghurts, kids cereals). If the participants select one or more high sugar products in each category, they will be considered a high sugar consumer