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Title: Enhanced and updated American Heart Association heart-check front-of-package symbol: efforts to help consumers identify healthier food choices

Author
item JOHNSON, RACHEL - University Of Vermont
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item KRIS-ETHERTON, PENNY - Pennsylvania State University
item CARSON, JOANN - University Of Texas
item PAPPAS, ANTIGONI - American Heart Association
item RUPP, LINDA - American Heart Association
item VAFIADIS, DOROTHEA - American Heart Association

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/4/2015
Publication Date: 4/1/2015
Citation: Johnson, R.K., Lichtenstein, A.H., Kris-Etherton, P.M., Carson, J.S., Pappas, A., Rupp, L., Vafiadis, D.K. 2015. Enhanced and updated American Heart Association heart-check front-of-package symbol: efforts to help consumers identify healthier food choices. Journal of the Academy of Nutrition and Dietetics. 115(6):876-884.

Interpretive Summary: A variety of nutrition symbols and rating systems are in use on the front of food packages. They are intended to help consumers make healthier food choices. One system, the American Heart Association Heart (AHA) Heart-Check Program, has evolved over time to incorporate current science-based recommendations for diet and cardiovascular health. Updates on sodium, sugars, fiber, calories, and fatty acids were implemented. These modifications were shown to be associated with improved diet quality and reduced cardiovascular disease risk factors. In January 2013, the AHA commissioned an online virtual shopping study to determine the impact of the AHA Heart-Check mark on product selection behavior and perceptions. 2,887 participants were asked to act as if they were shopping in a virtual store by selecting products from various grocery store shelf scenarios. The scenarios included 1) one brand in a category with the AHA Heart-Check symbol, 2) two brands in a category with the AHA Heart-Check symbol, and 3) one brand with the AHA Heart-Check symbol supported by shelf signage. After shopping, the participants were asked a series of diagnostic questions about their experience and product brands. The key finding was that the AHA Heart-Check mark reinforced that the product was heart-healthy. When the AHA Heart-Check mark was supported with advertising, there was a significant increase in the selection of products, especially among African-American and Hispanic participants, compared to no advertising. There was no drop in perceptions of products carrying the AHA Heart-Check mark, even for the attribute "great tasting." These data suggest the AHA Heart-Check mark is perceived as useful by consumers to identify foods consistent with a heart-healthy dietary pattern.

Technical Abstract: A variety of nutrition symbols and rating systems are in use on the front of food packages. They are intended to help consumers make healthier food choices. One system, the American Heart Association Heart (AHA) Heart-Check Program, has evolved over time to incorporate current science-based recommendations for diet and cardiovascular health. Updates on sodium, sugars, fiber, calories and fatty acids were implemented. The modifications resulted in the 1) addition of more food sources of monounsaturated and polyunsaturated fats, 2) establishment of food category-specific sodium limits, 3) modification of food category-specific requirements for dietary fiber, total sugars and calories and, 4) elimination of foods that list partially-hydrogenated oils in the ingredient list. To accomplish this new certification categories were added to include 1) products with higher levels of monounsaturated and polyunsaturated fats, 2) nuts with sodium levels at 140 mg/serving or less and, 3) fish containing >500 mg of omega-3 fatty acids per 3 ounce serving. These modifications were shown to be associated with improved diet quality and reduced cardiovascular disease risk factors. In January 2013, the AHA commissioned an online virtual shopping study to determine the impact of the AHA Heart-Check mark on product selection behavior and perceptions. Participants (n=2,887) were asked to act as if they were shopping in a virtual store by selecting products from various grocery store shelf scenarios. The scenarios included 1) one brand in a category with the AHA Heart-Check symbol, 2) two brands in a category with the AHA Heart-Check symbol and, 3) one brand with the AHA Heart-Check symbol supported by shelf signage. After shopping, the participants were asked a series of diagnostic questions about their experience and product brands. The key finding was that the AHA Heart-Check mark reinforced that the product was heart-healthy. When the AHA Heart-Check mark was supported with advertising, there was a significant increase in the selection of products, especially among African-American and Hispanic participants, compared to no advertising. There was no drop in perceptions of products carrying the AHA Heart-Check mark, even for the attribute "great tasting." These data suggest the AHA Heart-Check mark is perceived as useful by consumers to identify foods consistent with a heart-healthy dietary pattern.