Among noncommunicable disease, cardiovascular-related diseases are the leading cause of death
worldwide and contribute to almost one-third of deaths in Brazil. Cardiovascular disease has
become the leading cause of death in Brazil since 1960 due in part to poor eating habits,
obesity, and insufficient physical activity. Consumption of high levels of sodium, added
sugar, and saturated fat is a major driver of the development of cardiovascular disease. In
this context, nutrition policies and interventions, such as the use of warning labels, are an
important tool for reducing risk of diet-related diseases. The Brazilian Ministry of Health
has recently announced efforts to combat the country's growing burden of diet-related
noncommunicable diseases, and Brazil's National Health Surveillance Agency (ANVISA) has
approved a more transparent and accessible system for communicating nutrition information for
foods and beverages. The proposal will require labeling with a magnifying glass symbol on the
front of products' packages to inform consumers about excess nutrients (i.e., sodium, sugar,
saturated fat). Similar interventions have been implemented across Latin America, including
Chile, Peru, and Mexico. A recent study in Chile demonstrated a reduction in purchases of
food and drink items displaying warning labels.
This study seeks to test the effectiveness of different nutrient profiles to determine which
products should carry the new labels in Brazil (i.e., the Pan-American Health Organization's
profile or Brazil's National Health Surveillance Agency's proposed profile). Additionally, it
seeks to assess whether the inclusion of information about products' ultra-processed nature
further impacts consumers' product perceptions. The study will provide critical information
for the Brazilian Ministry of Health on the effectiveness of the new label proposal and on
strategies to inform Brazilians of product healthfulness.
Participants will be initially redirected from Cint (an online panel company). Following
online consent and completion of a screening survey, participants will be redirected to an
experimental online grocery store (Saruê), given a shopping list, and asked to shop for the
items on the list as if in a real store. Upon redirection from Cint, participants will be
randomly assigned into three arms: 1) control (no FOPLs); 2) FOPLs applied to products based
on Brazil's National Health Surveillance Agency (ANVISA)'s nutrient profile model; or 3)
front-of-package labels applied to products based on the Pan-American Health Organization
(PAHO)'s nutrient profile model. After participants select products and check out, they will
answer a survey about their perceptions about the labels and products carrying them. These
questions will include self-reported responses to the content (e.g., elaboration, beliefs).
After data collection, data on participants' selected products in the online grocery store
will be analyzed to determine which nutrient profile was the most effective in decreasing
participants' consumption of key nutrients.
Setting: The trial will take place in Saruê, an experimental online grocery store created for
researchers to examine how front-of-package labels influence consumer purchases in a
controlled but realistic environment. The online store reflects real-world prices and is
modeled after Pão de Açúcar, a Brazilian online grocery store .
Recruitment: Participants will be recruited through Cint, a survey research firm. The
eligibility criteria are residing in Brazil, being 18 years or older, and being responsible
for at least half of the grocery shopping for one's household. Participants are ineligible if
they were involved in any pre-testing related to the survey. Experiments conducted using
online convenience samples, such as those recruited by Cint, largely replicate findings from
studies conducted via probability-based samples. Cint will screen for eligibility and recruit
participants from their pool of 8 million participants in Brazil. Approximately 3,000
participants will be recruited. As compensation, participants will receive incentives or
points that can be redeemed for gift cards or goods per Cint's protocols.
Informed Consent: Participants will sign an informed consent form that follows a structure
that is customary in Brazil.
Randomization: After the participant has signed the consent form, they will be randomly
assigned to one of the three study arms. Randomization order will be determined a priori.
Participants will have an equal chance of being randomized to each trial arm.