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Background There are few objective data on how nutrition labels are used in real-world shopping situations, or how they affect dietary choices and patterns. Design The Starlight study was a four-week randomised, controlled trial of the effects of three different types of nutrition labels on consumer food purchases: Traffic Light Labels, Health Star Rating labels, or Nutrition Information Panels (control). Smartphone technology allowed participants to scan barcodes of packaged foods and receive randomly allocated labels on their phone screen, and to record their food purchases. The study app therefore provided objectively recorded data on label viewing behaviour and food purchases over a four-week period. A post-hoc analysis of trial data was undertaken to assess frequency of label use, label use by food group, and association between label use and the healthiness of packaged food products purchased. Results Over the four-week intervention, study participants (n = 1255) viewed nutrition labels for and/or purchased 66,915 barcoded packaged products. Labels were viewed for 23% of all purchased products, with decreasing frequency over time. Shoppers were most likely to view labels for convenience foods, cereals, snack foods, bread and bakery products, and oils. They were least likely to view labels for sugar and honey products, eggs, fish, fruit and vegetables, and meat. Products for which participants viewed the label and subsequently purchased the product during the same shopping episode were significantly healthier than products where labels were viewed but the product was not subsequently purchased: mean difference in nutrient profile score −0.90 (95% CI -1.54 to −0.26). Conclusions In a secondary analysis of a nutrition labelling intervention trial, there was a significant association between label use and the healthiness of products purchased. Nutrition label use may therefore lead to healthier food purchases.

Price is a key determinant of food choice, particularly for low-income households who may be more sensitive to price-lowering strategies such as price promotions and generic/retailer-owned brands. Price-lowering strategies may therefore represent important policy targets to improve population nutrition and reduce inequities. This study aimed to describe household purchasing patterns of price promoted and generic branded foods and beverages in New Zealand (2016-2017). One year of grocery purchase data from a national consumer research panel in New Zealand (n = 1778 households) were analysed. Purchases were classified by processing level and food type. Linear mixed models were fitted to estimate the mean proportion of annual household purchases (unique items and volumes (kg/L)) that were price promoted or generic branded (overall and by food category), and to assess whether purchasing patterns were modified by income level. On average, price promoted products constituted 50% (95%CIs; 49,51) of all unique annual household grocery items purchased. Fifty-nine percent (95%CIs; 58,60) of processed, 55% (95%CIs; 54,56) of ultra-processed, 45% (95%CIs; 44,46) of unprocessed and 45% (95%CIs; 44,46) of ingredient purchases were price promoted. By volume, the proportion of purchases that were price promoted was highest for meat (65%[95%CIs; 64,66]), sugar-sweetened beverages (64%[95%CIs; 62,65]), dairy foods (64%[95%CIs; 63,66]), confectionary (64%[95%CIs; 63,66]), snack foods (63%[95%CIs; 61,64]), oils (61%[95%CIs; 60,62]) and non-sugar-sweetened beverages (60%[95%CIs; 58,62]), and lowest for dairy beverages (30%[95%CIs; 28,31]), sugar/honey (33%[95%CIs; 32,35]) and sauces/spreads (39%[95%CIs; 37,40]). On average, generic brands constituted 10% (95%CIs; 9,10) of all household purchases. Overall, a significantly greater proportion of purchases made by low and middle-income households were price promoted and generic branded compared to high-income households (p 0.001 for both), a pattern generally observed across food categories. This study supports recent calls to address unhealthy food and beverage price promotions in comprehensive policy strategies aiming to improve population diets and weight.

Breakfast cereals substantially contribute to daily energy and nutrient intakes among children. In New Zealand, new regulations are being implemented to restrict nutrition and health claims to products that meet certain 'healthy' criteria. This study investigated the difference in nutritional quality, labelling and promotion between 'healthy' and 'less healthy' breakfast cereals, and between breakfast cereals intended for children compared with other breakfast cereals on the New Zealand market. The cross-sectional data collection involved taking pictures of the nutrition information panel (NIP) and front-of pack (FoP) for all breakfast cereals (n = 247) at two major supermarkets in Auckland in 2013. A nutrient profiling tool was used to classify products into 'healthy'/'less healthy'. In total 26% of cereals did not meet the 'healthy' criteria. 'Less healthy' cereals were significantly higher in energy density, sugar and sodium content and lower in protein and fibre content compared with 'healthy' cereals. Significantly more nutrition claims (75%) and health claims (89%) featured on 'healthy' compared with 'less healthy' cereals. On the 'less healthy' cereals, nutrition claims (65%) were more predominant than health claims (17%). Of the 52 products displaying promotional characters, 48% were for 'cereals for kids', and of those, 72% featured on 'less healthy' cereals. In conclusion, most breakfast cereals met the 'healthy' criteria; however, 'cereals for kids' were 'less healthy' and displayed more promotional characters than other cereal categories. Policy recommendations include: food composition targets set or endorsed by government, strengthening and enforcing current regulations on health and nutrition claims, considering the application of nutrient profiling for nutrition claims in addition to health claims, introducing an interpretative FoP labelling system and restricting the use of promotional characters on 'less healthy' breakfast cereals.

The aim of this study was to assess the availability of healthier options and nutrition information at major New Zealand fast food chains. A cross-sectional survey was undertaken at 24 fast food stores (two from each of 12 major chains) using on-site visits, telephone calls, and website searches. Of available products, only 234/1126 (21%) were healthier options. Healthier options were generally cheaper and lower in energy, total fat, saturated fat, sugar, and sodium per serve than their regular counterparts. Regular options were commonly high in sugar or sodium per serve (mean sugar content of beverages=56 g (11 teaspoons) and sodium content of burgers and pasta=1095 mg and 1172 mg, respectively). Nutrition information was available at 11/12 (92%) restaurant chains (range=0% at Tank Juice to 99% at Domino's Pizza). However