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Trial registered on ANZCTR
Registration number
ACTRN12617000129381
Ethics application status
Approved
Date submitted
17/01/2017
Date registered
24/01/2017
Date last updated
24/01/2017
Type of registration
Retrospectively registered
Titles & IDs
Public title
Food product health warnings promote healthy dietary decision making.
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Scientific title
Health warnings promote healthier dietary decision making in healthy participants: effects of message framing and graphic versus text-based warnings.
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Secondary ID [1]
290949
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Obesity
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Dietary decision making
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Condition category
Condition code
Public Health
301392
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0
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Health promotion/education
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Diet and Nutrition
301450
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0
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Obesity
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The intervention entails presentation with obesity-prevention health warnings designed to be used in health promotion campaigns at point-of-sale or on food product packaging. Ten health warning messages (derived from the NHMRC Dietary Guidelines for Australians, 2013) were used to create 40 health warnings across four health warning design groups (text-based or text-and-graphic health warnings presented with positive or negative message framing), by altering the message framing and image content of the warnings. An example of a negatively framed health warning message is “Being overweight increases your risk of heart disease.” The positively framed variant of this message reads, “Maintaining a healthy weight reduces your risk of heart disease.” Similarly, the negative graphic variant of this message features an image of an unhealthy heart affected by heart disease, while the positive graphic variant features a stylised ‘healthy’ heart arranged out of fruit and vegetable products. The intervention is delivered at the midpoint (see below) of a single testing session conducted at The University of Melbourne's decision neuroscience laboratory.
All participants complete an unprimed/baseline test phase in which they make dietary choices prior to exposure to health warnings. Following this phase, all participants are instructed to attend to and read 10 health warning messages/images (each participants is presented with 10 health warnings of a single health warning format, e.g. participants in the positively framed, text warning group see only positively framed, text-based warnings; text based health warnings were 500 x 300 pixels; graphic health warnings were 500 x 500 pixels) presented centrally on a computer monitor for 8 seconds each (with a 2 - 6 second break between each presentation). During the intervention presentation phase of the experiment, participants are instructed to press the space bar if the border around the health warning stimulus changes colour (which occurs on a random 3 trials out of the total 10), to ensure that participants attend to the health warning messages. Following delivery of the intervention, participants complete a primed/test phase of the same dietary choice task. Participants are allowed to take a self-paced break between the baseline phase, the intervention delivery, and then the test phase. The baseline and test phases are approximately 40 minutes long, while the intervention presentation phase lasts approximately 8 minutes.
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Intervention code [1]
296897
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Prevention
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Intervention code [2]
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Lifestyle
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Intervention code [3]
296899
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Behaviour
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Comparator / control treatment
This study features a within participant control (in the form of a pre-intervention baseline period) and a between groups control (in the form of a control group who are presented with a message free image that is visually analogous to the health warning stimuli used in the test conditions.
Control health warning images were created by replacing the words in the health warning message with non-words of equivalent length from the ARC non-word database. The images used in the graphic variants of the health warning images were masked by randomly sorting the pixels of the image horizontally and then applying a high frequency noise filter. At the completion of the experiment, participants are given an open ended questionnaire to ensure that participants in the control group did not guess the purpose of the study.
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Control group
Active
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Outcomes
Primary outcome [1]
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Dietary self-control measure assessing participants’ frequency of choosing healthy but not tasty items and rejecting unhealthy yet tasty items in a dietary decision task.
This measure was adapted from the dietary self-control measure used by Harris, Hare & Rangel (2013), but was altered to work for our task by allowing participants to respond on a continuous, rather than binary, scale (i.e. participants can indicate whether they want to eat a particular food item, and also indicate how much they do or do not want to eat this item).
Reference.
Harris A., Hare T., Rangel A. (2013). Temporally dissociable mechanisms of self-control: Early attentional filtering versus late value modulation. The Journal of Neuroscience, 33, 18917–18931.
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Assessment method [1]
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Timepoint [1]
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Following exposure to food product health warnings.
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Secondary outcome [1]
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None
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Assessment method [1]
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Timepoint [1]
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None
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Eligibility
Key inclusion criteria
- Men and women aged 18-70 years.
- Right-handed.
- Familiar with common Australian supermarket snack food brands.
- Fluent in spoken and written English.
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Minimum age
18
Years
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Maximum age
70
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Subjects will be excluded if they:
- Are currently restricting their diet.
- Have any medical, ethical, religious or other belief or condition (e.g. coeliac disease, diabetes or following a vegan diet) limiting the consumption of common snack food brands.
- Have a past or current eating disorder diagnosis.
- Have any food allergies.
- Are pregnant.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Participants are unaware of the purpose of the study. At commencement of the experimental task, MATLAB’s random number generation functions are used to allocate participants a condition code from 1-5, which determines the type of health warnings that that participant will see. This method of group allocation is concealed by its nature.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Random trial sequence generation using MATLAB's random number generation functions.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
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Intervention assignment
Other
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Other design features
The study featured a crossed factorial experimental design, in which participants completed an pre-intervention experimental stage, and were then randomly allocated into test groups (text-based, positively framed health warnings; text-based, negatively framed health warnings; text-and-graphic, positively framed health warnings; text-and-graphic, negatively framed health warnings; control group). Each participant then completed a second, post-intervention stage. An interaction effect between the between groups and repeated measures factors was taken as evidence that health warnings influence dietary decision making.
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Linear mixed effects modelling using backwards selection. Participants and food items specified as random effects. Satterthwaite degrees of freedom approximation is used to calculate p-values.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
1/02/2016
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Date of last participant enrolment
Anticipated
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Actual
31/05/2016
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Date of last data collection
Anticipated
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Actual
16/06/2016
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Sample size
Target
96
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Accrual to date
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Final
96
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Recruitment in Australia
Recruitment state(s)
VIC
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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The Cancer Council Victoria
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Address [1]
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615 St Kilda Road, Melbourne VIC 3004
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Daniel Rosenblatt
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Address
The University of Melbourne
Melbourne School of Psychological Sciences
Redmond Barry Building, Building 115
Tin Alley, Parkville VIC 3010
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Country
Australia
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Secondary sponsor category [1]
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Individual
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Name [1]
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Melanie Wakefield
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Address [1]
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Cancer Council Victoria,
Centre for Behavioural Research in Cancer,
615 St Kilda Road,
Melbourne VIC 3004
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Country [1]
294217
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Australia
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Secondary sponsor category [2]
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Individual
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Name [2]
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Stefan Bode
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Address [2]
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The University of Melbourne
Melbourne School of Psychological Sciences
Redmond Barry Building, Building 115
Tin Alley, Parkville VIC 3010
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Country [2]
294218
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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University of Melbourne Human Research Ethics Committee
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Ethics committee address [1]
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The University of Melbourne, Parkville VIC 3010
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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18/12/2014
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Approval date [1]
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26/01/2015
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Ethics approval number [1]
296706
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1443258
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Summary
Brief summary
Following successful use in tobacco control, health warnings on food products and at point-of-sale have been proposed as a potential obesity prevention measure. This study aims to investigate the efficacy of food product health warnings for promoting healthy dietary decision making. Additionally, the study aims to investigate the degree to which two key health warning design factors (text-based health warnings versus text-and-graphic health warnings; health warnings featuring positively versus negatively framed messages) influence health warning efficacy. Ninety-six participants will be recruited to complete a mixed design dietary self-control experiment conducted as a single session. The experiment features four stages; the rating stage, the unprimed decision stage, the priming stage, and the primed decision stage. In the first stage, participants will be shown a selection of 100 common Australian snack foods (including chocolate, chips, cookies, fruit, nuts and vegetables) and asked to provide subjective health and taste ratings for each food item. In the unprimed (baseline) decision stage, participants will be shown half of the food items they rated in the first stage and asked to indicate which of these items they would like to eat at the end of the experiment. Prior to the priming stage, participants will be randomly allocated to one of five health warning format conditions; text-based, negative framing (n = 16); graphic, negative framing (n = 16); text, positive framing (n = 16); graphic, positive framing (n = 16); control group (n = 32). During the priming stage, participants will be exposed to health warnings of their allocated format only. In the primed decision stage participants will be shown the remaining half of the snack food items and again asked to indicate which foods they would like to consume at the end of the experiment. A measure of dietary self-control will be calculated based on the proportion of healthy but not tasty items chosen for consumption and the number of unhealthy yet tasty items rejected. Participants will be granted one of their chosen items to eat and will be asked to complete demographic and dietary behaviour questionnaires at the end of the experiment.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Mr Daniel Rosenblatt
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Address
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Melbourne School of Psychological Sciences
Redmond Barry Building,
The University of Melbourne,
Parkville VIC 3010
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Country
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Australia
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Phone
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+61383444446
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Daniel Rosenblatt
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Address
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Melbourne School of Psychological Sciences
Redmond Barry Building,
The University of Melbourne,
Parkville VIC 3010
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Country
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Australia
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Phone
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+61383444446
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Daniel Rosenblatt
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Address
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Melbourne School of Psychological Sciences
Redmond Barry Building,
The University of Melbourne,
Parkville VIC 3010
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Country
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Australia
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Phone
71828
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+61383444446
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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