Interpretive Nutrition Labels, Parent-Child Interactions, and Food Choices in Indonesia

The aim of this project is to investigate if interpretive nutrition labels may potentially food consumption of parents and children and that, in turn, may potentially inform current nutrition policies in Indonesia. First, we apply a “traffic lights” food labelling approach in the Indonesian context to examine its potential effect on the nutritional content of the grocery basket for family consumption. Second, we build on previous research studying the effect of “emoji” labels on children’s snack choices by extending the analysis from the lab experiment to a close-to-the-real-life food environment. Third, we assess the spillover effects of “traffic lights” labelling on parental ability and willingness to “correct” children’s choices. Fourth, we explore the nutrition knowledge and motivations behind children’s and parents’ decisions and choices related to food consumption.

We conduct a series of lab-in-the-field experiments with parents and children in public primary schools in Bogor, Indonesia.

In an online supermarket experiment with parents, we will test a nudge (interpretative nutritional “traffic lights” labels: Green “Healthier choice”, yellow “OK choice”, red “Less healthy choice”) against a control group that “purchases” their groceries from the same list of foods and drinks but without “traffic lights” labels attached to the products. The participants are requested to purchase food items for typical weekly family consumption. The participants select among a range of around a hundred popular food and drink items typically found at a local supermarket using a fixed (virtual) monetary budget. The participants are given 15 minutes to make their choices. We incentivize the participants to make a “honest” choice by giving them a chance of receiving their purchased basket at home the next day. The lottery (1 out of 15 or slightly more/less depends on the number of participants showed up for the session) takes place right after the participants completed the shopping task and a short post-experimental survey. We will compare the proportions of healthy/unhealthy foods and drinks purchased by these two groups. In post-experimental parental survey, we ask adult participants about their experiences in the experiment and record their perceptions of nutrition labels as a policy instrument.

Using a snack table (similar to a food vendor’s stall offering a variety of snacks and drinks on school grounds) with many snacks on it, we ask children to individually pick a snack or a drink of their choice. For a random half of children, we attach the “traffic lights” labels to the snacks and drinks. The other half chooses a snack/drink in its original packaging. At the end of the experiment the children complete a short post-experimental survey (quiz), and their anthropometrics are measured. In post-experimental quiz we ask children about their perception of the labels as well as their motivation of choosing the snack/drink. We will compare the proportions of healthy/unhealthy snacks/drinks in these two groups.

After the parents and children completed their experimental tasks, the parents are asked to “approve” (or not) the choice of snack/drink of their children. Parents are not informed whether their children have been exposed to the “traffic lights” labels. We record whether a parent approves/disapproves the snack choice of her child and whether a child accepts/rejects it. We offer some fruit to all children whose parents do not “approve” their choice (extra, not a swap). We will compare across four conditions: Parent control – Child control, Parent “traffic lights” – Child control, Parent “traffic lights” – Child “traffic lights”, and Parent control – Child “traffic lights”.

We make the following hypotheses:
H1: Parents exposed to the interpretative nutritional “traffic lights” labels purchase more healthier (in terms of number, value and proportion) foods and drinks for family consumption.
H2: Children exposed to the interpretative nutritional “traffic lights” labels choose more healthier snacks and drinks for individual consumption.
H3: The rates of parental approval and child acceptance of the chosen snack is the highest in the Parent “traffic lights” – Child “traffic lights” condition.

2024-08-13

2024-09-30

1. Number, value and proportion of healthy classified products purchased by parents in treatment (“traffic lights” labels) and control groups.
2. Number, value and proportion of healthy classified snacks chosen by children in treatment (“traffic lights labels) and control groups.
3. Parental approval of children snack choices across four parent-child experimental conditions (binary variable where 1=approval).
4. Acceptance of parental (dis)approval by children (binary variable where 1=acceptance) across four parent-child experimental conditions.

1. Parental and children’s attitudes towards the “traffic lights” labels (attention, understanding, perception) among parents and children exposed to the “traffic lights” labels.
2. Children’s motivations of choosing the snack (perceived tastiness and healthiness of various snacks).

The study uses a randomized control design at the individual level based on the parents of 7-10 years old children from public primary schools. Subjects of our study are the parents and their children that agreed to participate in the laboratory experiment. The schools are sampled at random from the list of public primary schools in the area.

The parents are invited to a room where they are briefed about the procedure, task, the lottery with a chance to win a weekly supply of food for family consumption, and informed about a post-experimental survey. Participants are told that they are given 15 minutes and a fixed (virtual) budget to buy food and drink items in an online supermarket using their mobile phones. The online experimental supermarket offers a range of fresh fruits and vegetables, processed and non-processed foods, and healthy and sugary drinks. Following the completion of the experimental task, the participants fill out a post-experimental survey questionnaire. At the end of the session, the parents are invited to another room to pick up their children.

We invite children to participate in a quiz and bring them one-by-one to a separate room making a stop on the way to pick up a snack. In that room the children are waiting for their parents, fill a quiz, and their height and weight are measured. The parents are invited to pick up their children and every parent is asked to tell the child whether he or she is allowed to consume the snack.

The study uses a randomized control design at the individual level based on the parents of 7-10 years old children from 20 public primary schools. Subjects of our study are the parents and their children (a parent is allowed to bring only one child) that agreed to participate in the laboratory experiment. The experimental lab is organized at public primary schools (Monday-Friday, after school hours). The schools are sampled at random from the list of public primary schools in Central Bogor (n=34).

We invite parents together with their children to participate in the study by sending them a message in the class chat one week in advance. The message provides general information about the study, informs about a lottery for the participants (incentive to participate) and contains a link to a registration form.

At the arrival to the experimental facilities (Room 1), the parents are asked to sign the informed consent for themselves and their children. Only subjects with signed informed consent will be participating in the experiments. We check if all parents have a mobile (smart) phone with them. Every dyad parent-child gets an ID sticker - one sticker with 6 sub-stickers of which (1) is used for the consent form, (2) is given to the parent to stick on the smartphone to enter the online supermarket (online supermarket ID), (3) is put on a form next to the record of child's choice, (4) is put on the quiz questionnaire, (5) is put on a form with records of parent-child interaction, and (6) is used for the form with records children’s anthropometrics. Also, every child randomly picks a token with his or her line number. We follow the order of line numbers throughout the entire study (from Room 1 to Room 4).

The parents are invited to Room 2 where they are briefed about the procedure and task, reminded about the lottery and next day delivery and informed about a post-experimental survey. Participants are explained that in the lottery one (out of +/-15) randomly chosen participant from their session will have her “purchased” groceries delivered home next day. Participants are told that they are given 15 minutes to buy food and drink items in an online supermarket using their mobile phones. All of them are given a fixed (virtual) budget of 800.000 IDR (approximately 47 Euro). The food and drink items and their prices in our virtual supermarket are matching the items and prices at a local convenience store/supermarket. The online experimental supermarket offers approximately 100 items of fresh fruits and vegetables, processed and non-processed foods, and healthy and sugary drinks. The layout of our virtual supermarket (sections, number of items of foods and drinks) is consistent across treatment and control arms. We randomize the order of items within product category to avoid occurrence of ordering effects. Additionally, we inform the participants that they do not need to spend the entire allocated budget, and that they will not be paid back a difference. An experimenter shows how to navigate in the online supermarket, repeats the experimental procedure and the amounts of allocated time and budget. Following the completion of the experimental task, the participants fill out a survey questionnaire. When all parents finished the shopping task and survey, the experimenter conducts a lottery. At the end of the session, the parents are invited to the area of Room 4 to pick up their children.

We ask children to stay at the Welcome area and wait to be invited to participate in a quiz. Children are invited one-by-one to Room 4 making a stop at Room 3. In Room 3, each child is asked to pick one snack- or a drink from the table and is asked to go to Room 4 and not to eat it until the parent allows it. We remind the child not to eat the snack until his or her parent approves the consumption.

In Room 4, the children wait for the parents, fill a quiz, and their height and weight are measured. The children are reminded not to eat their snacks. The parents are invited to pick up their children by entering Room 4 one-by-one. We ask every parent to tell the child whether he or she is allowed to consume the snack. We record parental approval/disapproval of children snack choices as well as children’s acceptance/rejection of parental (dis)approval. We offer some fruit to all children whose parents do not “approve” their choice (extra, not a swap).

Randomization of parents and children is done by a computer

Individual

No

20 schools (we plan to add more schools if participation in the randomly selected 20 schools is lower than expected)

800 parents and 800 children

800 dyads parent-child

The minimum required sample size of 800 observations (parent-child dyads) is calculated assuming 80 percent power and a 5 percent level of significance. We expect the minimum detectable treatment effect of 9.7 percentage points. The value share of processed/prepared foods accounts for 36 percent of per capita monthly food expenditures in urban Indonesia (National Statistics Bureau of Indonesia). If the share of unhealthy foods (labeled “red” in treatment “Traffic lights”) in the experimental shopping basket of adults at a baseline will be 40 (rounded) percent, we are powered to detect a positive treatment effect (“traffic lights”) decreasing the share to 30 percent within our setting given that we look at repeat exposure to labels in the online supermarket.