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Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Prepared for the Commonwealth Department of Health Submitted by the National Heart Foundation of Australia, April 2016 Reporting period: June 2014 to June 2015 (Year 1) For enquiries about this report, please contact: Front-of-Pack Labelling Secretariat Department of Health GPO Box 9848, Canberra, ACT, 2601 Phone: 1800 099 658 Email: [email protected] © 2016 National Heart Foundation of Australia, ABN 98 008 419 761 Suggested citation: National Heart Foundation of Australia. Report on the monitoring of the implementation of the Health Star Rating system – Year 1. Commissioned by the Commonwealth Department of Health. Melbourne, Australia: National Heart Foundation of Australia, 2016. Disclaimer: This material has been developed by the Heart Foundation for general information. The statements and recommendations it contains are, unless labelled as ‘expert opinion’, based on independent review of the available evidence. While care has been taken in preparing the content of this material, the Heart Foundation and its employees cannot accept any liability, including for any loss or damage, resulting from the reliance on the content, or for its accuracy, currency and completeness. The information is obtained and developed from a variety of sources including, but not limited to, collaborations with third parties and information provided by third parties under licence. It is not an endorsement of any organisation, product or service. This material may be found in third parties’ programs or materials (including, but not limited to, show bags or advertising kits). This does not imply an endorsement or recommendation by the National Heart Foundation of Australia for such third parties’ organisations, products or services, including their materials or information. Any use of National Heart Foundation of Australia materials or information by another person or organisation is at the user’s own risk. The entire contents of this material are subject to copyright protection. Enquiries concerning permissions should be directed to copyright@ heartfoundation.org.au COR-212 Contents Figures and tables Acknowledgements Abbreviations and acronyms Year 1 of the Health Star Rating System at a glance Executive summary ii vi vii ix xi Background and objectives Agreement to develop the HSR system What is the HSR system? Objective of the HSR system Implementation of the HSR system Monitoring and evaluation of the HSR system: Areas of Enquiry Project objective xiii xiii xiii xiii xiii xiii xiv Program Logic Framework xiv General methodology Food composition data and products displaying the HSR system graphic: FoodTrackTM Customising FoodTrackTM for this project xvi xvi xvi Chapter 1. Area of enquiry 1 Label implementation and consistency with the Health Star Rating system Style Guide 1.1 Chapter summary 1.2 Methodology 1.3 Results 1 3 4 6 Chapter 2. Area of enquiry 2 Consumer awareness and ability to use the HSR system correctly 2.1 Chapter summary 2.2 Methodology 2.3 Results 21 25 26 28 Chapter 3. Area of enquiry 3 Nutrient status of products carrying a HSR system graphic 3.1 Chapter summary 3.2 Methodology 3.3 Results 53 55 56 56 References Appendix 1. Wave 1 uptake report Appendix 2. Compliance checklist Appendix 3. Foods that contribute to FVNL values, and examples for determining FVNL content from incomplete datasets Appendix 4. Consumer survey questionnaire for AoE 2 62 63 66 72 73 National Heart Foundation of Australia i Figures and tables Figures Figure I. Program Logic Framework for the monitoring and evaluation of implementation of the HSR system .......... xv Figure 1.1. Number of products (n) displaying the HSR system graphic, by HSR Category, by HSR Option, at Year 1 (June 2014 to June 2015) .................................................................................................... 7 Figure 1.2. Number of products (n) displaying the HSR system graphic, by manufacturers and retailers, by HSR Option, at Year 1 (June 2014 to June 2015) .............................................................................. 9 Figure 1.3. Number of products (n) displaying the HSR system graphic, by HSR Category, by major manufacturers and retailers, at Year 1 (June 2014 to June 2015) ............................................................... 11 Figure 1.4. Comparison of the uptake of the HSR system to the uptake of the DIG, over time ................................. 13 Figure 1.5. Proportion of products (%) displaying the HSR system graphic, by HSR Option, at Year 1 (June 2014 to June 2015) ............................................................................................................................ 13 Figure 1.6. Number of products (n) displaying the HSR system graphic, by manufacturers and retailers, by HSR Option, at Year 1 (June 2014 to June 2015) .................................................................................................. 14 Figure 1.7. Number of products (n) displaying the HSR system graphic, by HSR Category, by HSR Option, at Year 1 (June 2014 to June 2015) ............................................................................................................................ 15 Figure 1.8. Number of products (n) displaying Option 1, by HSR Category, by HSR Option, at Year 1 (June 2014 to June 2015) ............................................................................................................................ 16 Figure 1.9. Proportion of products (%) displaying HSR Option 1, by optional nutrient, at Year 1 (June 2014 to June 2015) ............................................................................................................................ 17 Figure 1.10. Number of products (n) displaying the optional nutrient icon, by HSR Category, by optional nutrient, at Year 1 (June 2014 to June 2015) ........................................................................................... 17 Figure 1.11. Proportion of products (%) displaying the optional nutrient icon, by manufacturers and retailers, at Year 1 (June 2014 to June 2015) ...................................................................................................... 17 Figure A1. When buying food at the supermarket, what is the main thing that influences your choice between two similar products? (Sample: 2,036) ............................................................................................. 29 Figure A2. Which supermarkets have you visited in the past month? (Sample: 2,036) ............................................. 29 Figure A3. When choosing a new food during grocery shopping, how often do you compare how healthy products are? (Sample: 2,036) ............................................................................................................... 29 Figure A4. On average, when at the supermarket, do you look at the nutrition information panel on…? (Sample: 2,036) ...................................................................................................................................... 31 Figure B1. Apart from brand names, thinking about different logos that help customers choose the food they buy in the supermarket, which ones are you aware of? (Sample: 2,036)............................................. 31 Figure B2. Which of the following are you aware of on food packaging? (Sample: 2,036) ........................................ 33 Figure B3. Prompted awareness of the HSR system over time (Sample: 2,036) ...................................................... 33 Figure C1. When the HSR system graphic is on the packaging of food, what do you think it means? (Sample: 1,084) .......................................................................................................................................................... 34 Figure C2. In your opinion, how is the number of stars on a product determined? (Sample: 1,084) ......................... 36 Figure C3. How would you use the HSR system? (Sample: 1,084) ........................................................................... 37 Figure C4. If a food product has one star, what do you think this means? (Sample: 1,084) ...................................... 37 ii Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Figure C5. If a food product has five stars, what do you think this means? (Sample: 1,084) ................................... 37 Figure C6. Why do you prefer that option? (Sample: 1,084) ...................................................................................... 40 Figure D1. Why didn’t the HSR system influence your choice? (Sample: 180)......................................................... 42 Figure D2. Please select which foods and/or beverages you purchased in the supermarket which had the HSR system graphic on them? (Sample: 507) .................................................................................... 44 Figure D3. Please select which foods and/or beverages you believe it is important to have the HSR system graphic on them? (Sample: 1,084) ....................................................................................................... 45 Figure E1. Where had you seen or heard about the HSR system? (Sample: 217)................................................... 46 Figure E2. Which organisation or company did the advertising or promotion(s)? (Sample: 217) .............................. 47 Figure E3. What product or products were being advertised or promoted? (Sample: 217) ...................................... 47 Figure F1. Overall, what level of confidence do you have in the HSR system? (Sample: 1,084) .............................. 49 Figure G1. Which of the following changes have you made in the past six months to your diet? (Sample: 794) ...... 51 Figure G2. For which of the following reasons did you make changes to your diet? (Sample: 794).......................... 51 Figure 3.1. Number of products (n) displaying each HSR on pack, at Year 1 (June 2014 to June 2015) .................. 56 Figure 3.2. Mean HSR displayed on pack, by HSR Category Class, at Year 1 (June 2014 to June 2015) ................ 57 Figure 3.3. Number of products (n) displaying each HSR on pack, by HSR Category Class, at Year 1 (June 2014 to June 2015) ............................................................................................................................ 57 Figure 3.4. Mean energy content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) ............................................................................................................................ 59 Figure 3.5. Mean saturated fat content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) ............................................................................................................................ 59 Figure 3.6. Mean sugars content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) ............................................................................................................................ 60 Figure 3.7. Mean sodium content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) ............................................................................................................................ 60 Figure 3.8. Mean protein content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) ............................................................................................................................ 61 Figure 3.9. Mean fibre content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) ............................................................................................................................ 61 Tables Table I. Key features of data coverage and data collection using the FoodTrackTM platform ..................................... xvi Table 1.1. HSR Calibration Category and associated HSR Category Class ................................................................ 5 Table 1.2. HSR Categories that had 2% or less of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) .............................................................................................................................. 6 Table 1.3. Proportion of products (%) for each manufacturer and retailer displaying the HSR system graphic at Year 1 (June 2014 to June 2015) ............................................................................................ 8 Table 1.4. Manufacturers and retailers with more than 10 products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) .......................................................................................... 10 Table 1.5. Manufacturers and retailers in the four HSR breakfast cereal categories, displaying the HSR system graphic, and their respective volume market shares (% tonnes) within the breakfast cereal category, according to Retail World8,9,*, at Year 1 (June 2014 to June 2015)……………………………………………………………….………12 National Heart Foundation of Australia iii Table 1.6. Technical errors identified when assessing consistency in implementation of the HSR system graphic with the Style Guide, at Year 1 (June 2014 to June 2015) ........................................................ 18 Table 2.1. Sample characteristics of the population surveyed for Wave 1.................................................................. 27 Table A1. On average, how often do you visit a supermarket to do your grocery shopping? (Sample: 2,036) ......... 28 Table A2. On average, how much do you spend in one visit to the supermarket? (Sample: 2,036) .......................... 28 Table B1. Age group ................................................................................................................................................... 30 Table B2. Gender ........................................................................................................................................................ 30 Table B3. Household income ...................................................................................................................................... 30 Table B4. BMI.............................................................................................................................................................. 30 Table B5. Indigenous status ........................................................................................................................................ 30 Table B6. Language .................................................................................................................................................... 32 Table B7. Residential location..................................................................................................................................... 32 Table B8. Children at home ........................................................................................................................................ 32 Table B9. Age group ................................................................................................................................................... 32 Table B10. Gender ...................................................................................................................................................... 32 Table B11. Household income .................................................................................................................................... 32 Table B12. BMI............................................................................................................................................................ 32 Table B13. Indigenous status ...................................................................................................................................... 34 Table B14. Language .................................................................................................................................................. 34 Table B15. Residential location ................................................................................................................................... 34 Table B16. Children at home ...................................................................................................................................... 34 Table C1. Age group ................................................................................................................................................... 35 Table C2. Gender ........................................................................................................................................................ 35 Table C3. Household income ...................................................................................................................................... 35 Table C4. BMI ............................................................................................................................................................. 35 Table C5. Language .................................................................................................................................................... 35 Table C6. Residential location .................................................................................................................................... 35 Table C7. Children at home ........................................................................................................................................ 35 Table C8. How strongly do you agree or disagree that the HSR system? (Sample: 1,084) ....................................... 36 Table C9. How strongly do you agree or disagree that a product with more stars means…? (Sample: 1,084) ........ 38 Table C10. The HSR system graphic can be displayed in five different ways. Please select the style you believe is the easiest to understand? (Sample: 1,084) ............................................................................................... 38 Table C11. The HSR system graphic can be displayed in five different ways. Please select the style you believe is the easiest to recognise? (Sample: 1,084) .......................................................................................... 39 Table C12. The HSR system graphic can be displayed in five different ways. Please select the style you believe provides sufficient information? (Sample: 1,084) .................................................................................... 39 Table C13. Overall, please select the style you prefer the most? (Sample: 1,084) .................................................... 40 Table D1. In the past three months have you purchased a product that had the HSR system graphic? (Sample: 1,084) 41 Table D2. Age group ................................................................................................................................... 41 Table D3. BMI ............................................................................................................................................................. 41 iv Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Table D4. Household income ...................................................................................................................................... 41 Table D5. Gender ........................................................................................................................................................ 41 Table D6. Language.................................................................................................................................................... 41 Table D7. Children at home ........................................................................................................................................ 41 Table D8. Residential location .................................................................................................................................... 41 Table D9. Did the HSR system graphic on the product influence your choice? (Sample: 489) ................................. 41 Table D10. How did it influence your choice? (Sample: 273) ..................................................................................... 42 Table D11. Have you continued or will continue to buy the product? (Sample: 273) ................................................. 42 Table D12. Have you continued or will continue to buy the product? (Sample: 1,084) .............................................. 43 Table D13. Please select which you think is a healthier option in each pair? (Sample: 1,084) ................................. 43 Table D14. Please select which you think is a healthier option in each pair? (Sample: 1,084) ................................. 43 Table D15. Please select which you think is a healthier option in each pair? (Sample: 1,084) ................................. 43 Table D16. Please select which you think is a healthier option in each pair? (Sample: 1,084) ................................. 43 Table D17. Please select which you think is a healthier option in each pair? (Sample: 1,084) ................................. 43 Table E1. In the last three months, do you remember seeing, hearing or reading any advertising or promotions about the HSR system? (Sample: 1,084) ............................................................................................ 46 Table E2. After seeing or hearing this advertising or promotion(s) for products with a HSR system graphic, did it influence you to buy a product or products you normally wouldn’t buy? (Sample: 217) ................................... 47 Table F1. How strongly do you agree or disagree that the HSR system…? (Sample: 1,084) ................................... 48 Table F2. How strongly do you agree or disagree that the HSR system…? (Sample: 1,084) ................................... 48 Table F3. How strongly do you agree or disagree that the HSR system…? (Sample: 1,084) ................................... 48 Table F4. Age group.................................................................................................................................................... 49 Table F5. BMI .............................................................................................................................................................. 49 Table F6. Household Income ...................................................................................................................................... 49 Table F7. Children at home ........................................................................................................................................ 49 Table F8. Language .................................................................................................................................................... 49 Table F9. Gender ........................................................................................................................................................ 49 Table F10. Residential location ................................................................................................................................... 49 Table G1. In general, thinking about all the food you buy, how concerned are you about how healthy the food is for you? (Sample: 2,036) .......................................................................................................................... 50 Table G2. Thinking about your diet, would you say that what you usually eat is? (Sample: 2,036) ........................... 50 Table G3. Over the past six months, have you made any changes to your diet? (Sample: 2,036) ............................ 50 Table G4. In general, would you say your overall health is? (Sample: 2,036) ........................................................... 52 Table G5. In a typical week, on how many days would you do moderate or vigorous physical activity for at least 30 minutes? (Sample: 2,036) .................................................................................................................... 52 Table G6. How many serves of fruit (including fresh, dried, frozen and tinned fruit) do you usually eat each day? (Sample: 2,036) ......................................................................................................................................................... 52 Table G7. How many serves of vegetables (including fresh, frozen and tinned vegetables) do you usually eat each day? (Sample: 2,036) ...................................................................................................................... 52 Table 3.1. Number of products (n) in each HSR Category Class, by HSR vs non-HSR products, for each nutrient, at Year 1 (June 2014 to June 2015) ................................................................................................ 58 National Heart Foundation of Australia v Acknowledgements Project team Project staff Project Manager – Ms Xenia Cleanthous, Manager Nutrition Data & Analysis, Health Outcomes Division, National Heart Foundation of Australia Ms Theresa Pham and Ms Emily Scott, Nutrition Field Officers, Health Outcomes Division, National Heart Foundation of Australia Ms Melanie Chisholm, National Manager, Health Outcomes Division, National Heart Foundation of Australia Casual Nutrition Data Collection team for FoodTrackTM Ms Rachael Reynolds, Nutrition Data Officer, Health Outcomes Division, National Heart Foundation of Australia Professor Manny Noakes, Research Program Director, Food and Nutrition, CSIRO Dr Jill Freyne, Principle Research Scientist, Health and Biosecurity, CSIRO Associate Professor Sarah McNaughton, Discipline Leader Nutrition & Dietetics, Deakin University Mr Bill Stavreski, National Director Data & Evaluation, Health Outcomes Division, National Heart Foundation of Australia Ms Cliona Fitzpatrick, Research and Evaluation Consultant, Health Outcomes Division, National Heart Foundation of Australia Mr Simon Gibson, Software Engineer, Health and Biosecurity, CSIRO Ms Karen Harrap, Senior Engineer, Health and Biosecurity, CSIRO Funding The National Heart Foundation of Australia was awarded the funding for the Tender number Health/74/1415; monitoring and evaluation of the implementation of the Health Star Rating system, in May 2015. vi Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Abbreviations and acronyms AFGC Australian Food and Grocery Council AoE Area of Enquiry AoEs Areas of Enquiry App Smartphone application BMI Body Mass Index Checklist The Compliance Checklist developed by the Heart Foundation for assessment against the Style Guide conc. FVNL Concentrated fruit, vegetable, nut, legume CSIRO Commonwealth Scientific and Industrial Research Organisation Ct Compared to Department The Department of Health FoP Front-of-pack FoPL Front-of-pack labelling Forum Australia and New Zealand Ministerial Forum on Food Regulation Framework Program Logic Framework FSANZ Food Standards Australia and New Zealand FVNL Fruit, vegetable, nut, legume as defined in the Food Standards Australia and New Zealand Food Standards Code Heart Foundation The National Heart Foundation of Australia HSR Health Star Rating – a star rating scale of ½ to 5 stars (with ½ star increments) HSR system Health Star Rating system – a star rating scale of ½ to 5 stars (with ½ star increments, underpinned by the Health Star Rating Calculator) and the display of information icons for energy and specific nutrients HSR system graphic Health Star Rating system graphic – a display of the Health Star Rating +/- information icons for energy, saturated fat, sugars and sodium, and can include one optional positive nutrient (such as calcium or fibre). HSRAC Health Star Rating Advisory Committee HSRC Health Star Rating Calculator NIP Nutrition information panel Style Guide Health Star Rating Style Guide Year 1 The first year of implementation of the Health Star Rating system (June 2014 to June 2015) Year 2 The second year of implementation of the Health Star Rating system (June 2015 to June 2016) National Heart Foundation of Australia vii Health Star Rating system graphics Option 1 HSR + energy icon + 3 prescribed nutrient icons + optional nutrient Option 3 HSR + energy icon viii Option 2 HSR + energy icon + 3 prescribed nutrient icons Option 4 HSR only Option 5 Energy icon only Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Year 1 of the Health Star Rating system at a glance Key achievements Uptake of the Health Star Rating (HSR) system is tracking well, with presence on 1,526 products at Month 15 of implementation - nearly 3.5 times that of the Daily Intake Guide, for the corresponding time-point. The majority of manufacturers and retailers (92% of products) are implementing the HSR system graphic consistent with the HSR Style Guide. The majority of manufacturers and retailers (at least 95%) are displaying the correct HSR on pack. There have been significant increases in awareness, both unprompted and prompted, in a short time frame (comparing April 2015 to September 2015). Based on those aware of the HSR system, 45% of consumers reported purchasing a product with the HSR system graphic on it – more than a five-fold increase in a six-month period. It is also having an influence on purchasing habits: more than one in two reported that the HSR played a factor in which product they purchased. National Heart Foundation of Australia For the future Although uptake of the HSR system is tracking well, the number of products on which it has been implemented to date represents a low proportion of the food supply. To optimise the impact of the HSR system, it is important to maintain continued uptake by the manufacturers and retailers. Trust and relevance are the two key drivers that influence use and understanding of the HSR system. Although there has been a significant jump in the past six months, one in two consumers aware of the HSR system still don’t see it as personally relevant or trust the system. Both are critical factors to ensure usage rates continue to rise and influence purchasing decisions. ix x Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Executive summary This interim report details the results from the first year of monitoring and evaluation of the Health Star Rating (HSR) system (June 2014 to June 2015) under the three specified Areas of Enquiry (AoEs). AoE 1: Label implementation and consistency with the HSR system Style Guide AoE 1 was assessed under three sub-sections: uptake of the HSR system by manufacturers and retailers, consistency in implementation of the HSR system graphic against the HSR Style Guide (the Style Guide), and a comparison of the HSR system value displayed on pack to that determined by the Health Star Rating Calculator (HSRC). At Year 1 (June 2014 to June 2015), the HSR system graphic was displayed on 363 products out of an eligible 12,176 products from the FoodTrack TM database (3% of total product suite), and on at least one product in 37/81 (46%) HSR Categories. Only 22 manufacturers and retailers, from the 665 recorded in FoodTrackTM, displayed the HSR system graphic (3%). Private Label – Coles displayed the HSR system graphic on the greatest number of products (132/363, 36%) in a variety of categories. The ‘Ready-to-eat breakfast cereals’ HSR Category had the highest number of products displaying the HSR system graphic (n = 59), followed by ‘Mueslis’ (n = 37), however it was displayed on the greatest proportion of products in the ‘Hot cereals – flavoured’ HSR Category (46%). In September 2015, 1,526 products were identified in-store (Coles and Woolworths) as displaying the HSR system graphic (Month 15 since implementation of the HSR system). At Month 15, uptake of the Daily Intake Guide (DIG) was 448 products compared to 1,526 products at the equivalent time point for the HSR system (nearly 3.5 times higher). Option 1 (refer to key at end of this section) of the HSR system graphic was displayed on the greatest number of products (121/363, 33%), 93 of which were from the four breakfast cereals categories (‘Readyto-eat breakfast cereals’, ‘Mueslis’, ‘Hot cereals – flavoured’, ‘Hot cereals – plain’). Within products displaying Option 1, 50% displayed fibre as the optional nutrient. Of the 121 products displaying Option 1, 101 were by Private Label – Coles and Nestle Australia. The majority (92%) of products displaying the HSR system graphic were consistent with the Style Guide. Of the 28 products identified as having a technical error, 13 products displayed a serving size as part of the HSR system graphic that was not part of the industry-agreed standard serving size range outlined in the Style Guide. For 95% of products (314/331, excludes those displaying the energy icon only) the HSR displayed on pack matched the output from the HSRC. Of the 17 products for which the HSR did not match, 16 were out by +/- 0.5 star and one by 1.0 star, however 11 of these products did not have sufficient data on pack to be able to fully calculate the HSR. AoE 2: Consumer awareness and ability to use the HSR system correctly AoE 2 was assessed under four sub-sections: awareness of the HSR system, consumer knowledge and understanding of the HSR system, correct use the HSR system and the level of trust consumers have in the HSR system. This assessment was conducted via an online survey with a sample of 2,036 Australian adults. Of those surveyed, unprompted awareness of the HSR system has increased from 3% in April 2015 to 11% in September 2015. Likewise, prompted awareness of the HSR system has increased significantly from 33% in April 2015 to 53% in September 2015. Close to 90% of respondents understand that a product with one star means that it is less healthy compared to a product with more stars, and likewise, that a product with five stars represents the healthiest choice. Of those aware of the HSR system, almost two in three respondents were aware that the HSR system is a rating scale of the healthiness of a food product or a comparison between two products in the same category. More than two in five reported that they have purchased a product with the HSR system graphic in the past three months, which is significantly higher compared to April 2015 (8%). Of those who had reported purchasing a product with the HSR system graphic, more than one in two reported that the rating scale had influenced their purchasing decision; 37% reported that the rating scale influenced them to purchase a product that they normally wouldn’t purchase because it had more stars. The proportion of respondents who reported they trust the HSR system has increased from 38% in April 2015 to 51% in September 2015. More than 70% of respondents also reported that the HSR system is easy to use and easy to understand. Option 1 of the HSR system graphic was the most preferred Option and was reported to be the easiest to understand, the easiest to recognise and the Option that was perceived to provide sufficient information. National Heart Foundation of Australia xi AoE 3: Nutrient status of products carrying a HSR system graphic The most commonly displayed HSR on pack was 4.0, which was on 30% of products, and was also the mean HSR. The ‘2 – Food’ Category Class had the majority of products displaying the HSR system graphic (86%). For each nutrient that underpins the HSRC (energy, saturated fat, sugars, sodium, protein and fibre), the mean nutrient content per 100 g/100 mL was similar between HSR products and non-HSR products across all HSR Category Classes. Option 1 HSR + energy icon + 3 prescribed nutrient icons + optional nutrient Option 3 HSR + energy icon Option 2 HSR + energy icon + 3 prescribed nutrient icons Option 4 HSR only Option 5 Energy icon only xii Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Background and objectives Agreement to develop the HSR system In December 2011, the Australia and New Zealand Ministerial Forum on Food Regulation (the Forum) agreed to support Recommendation 50 of Labelling Logic: Review of Food Labelling Law and Policy1 namely that an interpretive Front-of-Pack Labelling (FoPL) scheme should be developed. At its 14 June 2013 meeting, the Forum agreed to develop and implement a FoPL scheme – the Health Star Rating (HSR) system – that, except for agreed exemptions, applies to all packaged, manufactured or processed foods presented ready for sale to the customer in the retail sector. What is the HSR system? The HSR system comprises a star rating scale of onehalf star to five stars (with half star increments) and the display of information icons for energy and specific nutrients. The HSR system is a joint initiative of Australian, state and territory, and New Zealand governments, and was developed in partnership with industry, public health and consumer groups. Objective of the HSR system The objective of the HSR system is to provide convenient, relevant and readily understood nutrition information and/ or guidance on food packs to assist consumers to make informed food purchases and healthier eating choices.3 Implementation of the HSR system The HSR Advisory Committee (HSRAC) is responsible for overseeing the monitoring and evaluation of the HSR system and for providing advice to the FoPL Steering Committee, and in turn to the Forum on related matters. The Department of Health (the Department) provides independent secretariat support to the HSRAC. The star rating component of the HSR system is underpinned by the HSR Calculator (HSRC), which was developed by the former FoPL Technical Design Working Group in consultation with Food Standards Australia New Zealand (FSANZ). The HSRC comprises a modified version of the Nutrient Profiling Scoring Criterion that was developed by FSANZ for the purpose of Standard 1.2.7 – Nutrition, Health and Related Claims.2 The Forum endorsed the HSRC on 13 December 2013. Foods with more stars are considered a healthier choice than similar products with less stars. At its meeting on 27 June 2014, the Forum agreed that the HSR system should be voluntarily implemented over five years (27 June 2014 to 26 June 2019) with a review of the progress of implementation after two years. Implementation of the HSR system officially began on 27 June 2014. Along with the HSR, the HSR system graphic displays information icons for energy, saturated fat, sugars and sodium, and can include one optional positive nutrient (such as calcium or fibre). The HSRC, however, takes into account a greater number of food components than those displayed. These other components include fruit, vegetable, nut and legume (FVNL) content and, in some instances, calcium, fibre and protein. The latter considerations recognise the role of cereals, lean meat, dairy products, fish, fruit, vegetables, nuts and legumes as important components of a healthy diet. Taking these components into account, points are allocated based on the nutritional composition of 100 g or 100 mL, based on the units used in the nutrition information panel (NIP) of a food product. Energy, saturated fat, sugars and sodium were chosen for presentation because they contribute to overweight and obesity, and diet-related chronic disease (e.g. cardiovascular disease and Type 2 diabetes), as well as being nutrients of interest to consumers (as indicated by market research). At its 15 July 2014 meeting, the HSRAC agreed that the Areas of Enquiry (AoEs) for the purposes of monitoring and evaluating the HSR system would be: Monitoring and evaluation of the HSR system: Areas of Enquiry 1. Label implementation and consistency with the HSR system Style Guide (AoE 1) 2. Consumer awareness and ability to use the HSR system correctly (AoE 2) 3. Nutrient status of products carrying a HSR system graphic (AoE 3). In March 2015, the Department put out a request for tender for the provision of services to monitor and evaluate the implementation of the HSR system. The National Heart Foundation of Australia (the Heart Foundation) submitted a request for tender and was awarded this in May 2015 (Tender number Health/74/1415). National Heart Foundation of Australia xiii Project objective The objective of this project is to objectively monitor and evaluate the implementation, awareness and use, and changes in the food supply, of the HSR system over a two-year period (27 June 2014 to 26 June 2016). This objective will be addressed under the three AoEs described above. In addition, the Heart Foundation was required to conduct more regular monitoring of the uptake of the HSR system over three time points within the two-year period. The results from this additional monitoring work are included in this report. Program Logic Framework To assess the implementation and impact of the HSR system, a Program Logic Framework (Framework) was developed under the required deliverables: Outline key outcomes desired from the monitoring and evaluation of the HSR system and relevant indicators of achievement. Address the three AoEs and detail all activities to be carried out and data to be obtained to successfully report against each AoE. Identify data sources and methods to be used for the purpose of the ongoing collection of all data and information necessary for successful monitoring for the HSR system implementation period (27 June 2014 to 26 June 2019). For completeness, the Framework includes the outcomes up to 26 June 2016 (i.e. the two-year period) and also the impact thereafter for the two-to-five-year period (up to 26 June 2019). Note that the work for this project is for the first two years of the implementation period only (June 2014 to June 2016), and this document only reports on Year 1 (the first year of implementation of the HSR system, June 2014 to June 2015). The Framework was implemented to specifically address the monitoring, evaluation and reporting for the implementation of the HSR system against the three AoEs. The Framework developed by the Project Team and agreed to by the HSRAC at the 2 October 2015 teleconference is outlined in Figure I. The general principle of a Framework is to provide a visual representation, usually linear, of a sequence of steps that need to occur for a project to meet its desired outcomes. The general flow of a Framework is inputs, activities and output, outcomes and impact.4 xiv Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Figure I. Program Logic Framework for the monitoring and evaluation of implementation of the HSR system National Heart Foundation of Australia xv General methodology Table I. Key features of data coverage and data collection using the FoodTrackTM platform Food composition data and products displaying the HSR system graphic: FoodTrackTM To meet the requirements of assessment against AoE 1 and AoE 3 it was necessary to have access to retrospective and current food composition data for products displaying the HSR system graphic, as well as data for those that do not, for comparison. TM TM We used FoodTrack to address this. FoodTrack is a food composition database that contains nutrient and other information (e.g. manufacturer, brand, ingredients and FoPL) on food products sold in major Australian supermarkets (Coles and Woolworths). It is a joint initiative between the Heart Foundation and the Commonwealth Scientific Industrial Research Organisation (CSIRO) and was first implemented in February 2014. Data is collected using the FoodTrackTM platform on a rolling annual collection schedule, i.e. every category is collected every year. The collection process involves trained field officers with a background in nutrition and/ or dietetics. The field officers use a custom-designed application (app) for an iPad mini to collect the data and selected images. Once the data is collected, it is uploaded into a remote database. Data can then be accessed through a web portal and extracted and audited in-house by Heart Foundation staff. Auditing of the whole product suite is conducted continuously throughout the year. The first year of data collection was completed in early 2015, with nutrient and product data collected for more than 13,000 products. The second year of data collection is due for completion in early 2016, and annually thereafter. FoodTrackTM houses data for more than 80 fresh and packaged food and beverage categories, across more than 90% of the Australian retail market. Data for products displaying the HSR system graphic has been recorded using FoodTrackTM since its inception in 2014. This includes the presence (or absence) of a HSR system graphic on pack, and any required accompanying information such as the ingredients list, the nutritional information panel and the product descriptor information. Table I outlines a summary of the key features of the FoodTrackTM platform. xvi Feature Information Number of categories collected > 80 food and beverage categories, including some fresh foods Category coverage > 90% national market coverage within each category Product coverage > 13,000 products annually Stores visited Collection frequency Collection schedule Key exclusions from dataset Nationally representative sample across major Coles and Woolworths in metropolitan Victoria All data updated annually, new products also recorded Rolling collection throughout the year, seasonality factored in to schedule, where possible Baby formula, supplements (vitamins and minerals), alcohol Customising FoodTrackTM for this project To meet the project requirements, FoodTrackTM was customised to include additional variables for reporting. A Glossary was developed in consultation with the Department to map products in FoodTrackTM to a categorisation system specifically for this project, including key inclusions and exclusions within each category. All products that fell within the required time frame for reporting were allocated according to the Glossary definitions, and mapped to the four variables described below. 1. HSR Primary Category – This is a primary categorisation system that is matched closely to the primary categories used in the Australian Health Survey.5 Each HSR Primary Category encompasses multiple HSR Categories. For example the Non- alcoholic beverages HSR Primary Category contains the following HSR Categories: ‘Fruit and vegetable juices’, ‘Breakfast drinks’, ‘Milk modifiers and flavourings’, ‘Sugar (or artificially) – sweetened beverages’ and ‘Tea and coffee’. 2. HSR Category – This is the main categorisation system used specifically for this project and is based primarily on the definitions outlined in the Glossary. Report on the monitoring of the implementation of the Health Star Rating system – Year 1 3. HSR Category Class – This is the categorisation system of products displaying the HSR system graphic as outlined in the HSR Guide for Industry to the Health Star Rating Calculator,6 whereby every product displaying the HSR system graphic is categorised into one of the following six Category Classes: - 1 – Beverages - 1D – Dairy beverages - 2 – Food - 2D – Dairy food - 3 – Oils and spreads - 3D – Cheese and processed cheese. Each Category Class aligns with a different algorithm that underpins the HSRC – a tool that manufacturers and retailers can use to determine the HSR of their product(s). 4. HSR Year – This is the time frame that relates specifically to the year of implementation of the HSR system: - Year 1 – the first year of implementation of the HSR system (June 2014 to June 2015) - Year 2 – the second year of implementation of the HSR system (June 2015 to June 2016). All technical changes to the FoodTrack TM platform were performed by senior software engineers at CSIRO in consultation with the Project Manager. National Heart Foundation of Australia xvii xviii Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 1 Area of Enquiry 1 Label implementation and consistency with the Health Star Rating system Style Guide National Heart Foundation of Australia 1 National Heart Foundation of Australia 1 National Heart Foundation of Australia 19 xix Chapter 1 – Area of Enquiry 1 1.1 Chapter summary 3 1.1.1 1.1.2 1.1.3 1.1.4 3 3 3 3 Uptake of the HSR system Comparison of uptake of the HSR system to the Daily Intake Guide (DIG) Consistency in implementation of the HSR system graphic with the HSR Style Guide Assessment of the HSR displayed on pack using the HSRC 1.2 Methodology 4 1.2.1 Uptake of the HSR system by manufacturers and retailers 1.2.2 Consistency in implementation of the HSR system graphic with the HSR system Style Guide 1.2.3 Assessment of HSR displayed on pack against that determined by the HSRC Table 1.1. HSR Calibration Category and associated HSR Category Class 1.2.4 Data analysis 4 5 5 5 6 1.3 3 Results 6 1.3.1 Uptake of the HSR system at Year 1 (June 2014 to June 2015) 6 Table 1.2. HSR Categories that had 2% or less of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) 6 Figure 1.1. Number of products (n) displaying the HSR system graphic, by HSR Category, by HSR Option, at Year 1 (June 2014 to June 2015) 7 Table 1.3. Proportion of products (%) for each manufacturer and retailer displaying the HSR system graphic at Year 1 (June 2014 to June 2015) 8 Figure 1.2. Number of products (n) displaying the HSR system graphic, by manufacturers and r etailers, by HSR Option, at Year 1 (June 2014 to June 2015) 9 Table 1.4. Manufacturers and retailers with more than 10 products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) 10 Figure 1.3. Number of products (n) displaying the HSR system graphic, by HSR Category, by major manufacturers and retailers, at Year 1 (June 2014 to June 2015) 11 Table 1.5. Manufacturers and retailers in the four HSR breakfast cereal categories, displaying the HSR system graphic, and their respective volume market shares (% tonnes) within the breakfast cereal category, according to Retail World8,9,*, at Year 1 (June 2014 to June 2015) 1.3.2 Results from Wave 1 of additional uptake monitoring (September 2015) Figure 1.4. Comparison of the uptake of the HSR system to the uptake of the DIG, over time 1.3.3 Consistency in implementation of the HSR system graphic with the HSR Style Guide 12 12 13 13 Figure 1.5. Proportion of products (%) displaying the HSR system graphic, by HSR Option, at Year 1 (June 2014 to June 2015) 13 Figure 1.6. Number of products (n) displaying the HSR system graphic, by manufacturers and retailers, by HSR Option, at Year 1 (June 2014 to June 2015) 14 Figure 1.7. Number of products (n) displaying the HSR system graphic, by HSR Category, by HSR Option, at Year 1 (June 2014 to June 2015) 15 Figure 1.8. Number of products (n) displaying Option 1, by HSR Category, by HSR Option, at Year 1 (June 2014 to June 2015) 16 Figure 1.9. Proportion of products (%) displaying HSR Option 1, by optional nutrient, at Year 1 (June 2014 to June 2015) 17 Figure 1.10. Number of products (n) displaying the optional nutrient icon, by HSR Category, by optional nutrient, at Year 1 (June 2014 to June 2015) 17 Figure 1.11. Proportion of products (%) displaying the optional nutrient icon, by manufacturers and retailers, at Year 1 (June 2014 to June 2015) 17 Table 1.6. Technical errors identified when assessing consistency in implementation of the HSR system graphic with the Style Guide, at Year 1 (June 2014 to June 2015) 1.3.4 Assessment of HSR displayed on pack against that determined by the HSRC at Year 1 (June 2014 to 1.3.5 June 2015) 2 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 18 19 Chapter 1 – Area of Enquiry 1 1.1 Chapter summary All sections below relate to Year 1 (June 2014 to June 2015) unless otherwise specified. 1.1.3 Consistency in implementation of the HSR system graphic with the HSR Style Guide Option 1 was displayed on the greatest number of products (121/363, 33%). Option 5 was displayed on the least number of products (9%). Ninety-one per cent of products displaying the HSR system graphic used Options 1 to 4 (refer to key at end of this section). Twenty products displayed a HSR system graphic that was a combination of Option 3 and Option 5 of the HSR system graphic. Option 5 (energy icon only) of the HSR system graphic was exclusively displayed on products in both the ‘Confectionary’ and ‘Relishes, chutneys and pastes’ categories. Fourteen out of 20 manufacturers and retailers displayed a single option of the HSR system graphic, with Option 4 being the most popular (9/14). In 18/37 HSR Categories, exclusive use of one Option was observed. ‘Ready-to-eat breakfast cereals’ had the highest number of products displaying the HSR system graphic (n = 59), followed by ‘Mueslis’ (n = 37). Option 1 was implemented on the greatest number of products in the four breakfast cereal categories (n = 93). The HSR system graphic was displayed on the greatest proportion of products in the ‘Hot cereals – flavoured’ HSR Category (46%). Within products displaying Option 1, 50% displayed fibre as the optional nutrient. Use of Option 1 was dominated by Private Label Coles and Nestle Australia, which, combined, displayed this Option on 101 of the 121 products (83%) displaying Option 1. Only 28 of the 363 products displaying the HSR system graphic (8%) were identified as having a technical error. The most common technical error was that 13 products displayed a serving size as part of the HSR system graphic that was not an approved industry- agreed standard serving size as outlined in the Style Guide. 1.1.1 Uptake of the HSR system The HSR system graphic was displayed on 363 products out of an eligible 12,176 products from the FoodTrackTM database (3% of the total product suite), and on at least one product in 37/81 (46%) HSR Categories. The four breakfast cereal categories (‘Ready-to-eat breakfast cereals’, ‘Mueslis’, ‘Hot cereals – plain’, ‘Hot cereals – flavoured’) were the only HSR Categories to have representation of the HSR system on more than 25% of their products. Within the four breakfast cereal categories, Nestle Australia had the highest number of products displaying the HSR system graphic (n = 56, 79% of their breakfast cereals product suite in FoodTrackTM). Twenty-two manufacturers and retailers (3%), from the 665 recorded in FoodTrackTM, displayed the HSR system graphic. Out of all retailers and manufacturers, Private Label – Coles displayed the HSR system graphic on the greatest number of products (132/363, 36%) in a variety of categories. 1.1.2 Comparison of uptake of the HSR system to the Daily Intake Guide (DIG) In September 2015, 1,526 products were identified in-store (Coles and Woolworths) as displaying the HSR system graphic (Month 15 since implementation of the HSR system). At Month 15, uptake of the DIG was 448 products compared to 1,526 products at the equivalent time point for the HSR system (nearly 3.5 times higher). 1.1.4 Assessment of the HSR displayed on pack using the HSRC For 95% of products (314/331, excludes those displaying the energy icon only), the HSR displayed on pack matched the output from the HSRC. Of the 17 products for which the HSR did not match: - 16 were out by +/- 0.5 star and one by 1.0 stars - 11 did not have sufficient data on pack to be able to fully calculate the HSR and six products had all required data available but still did not match. National Heart Foundation of Australia 3 Chapter 1 – Area of Enquiry 1 Option 1 HSR + energy icon + 3 prescribed nutrient icons + optional nutrient Option 3 HSR + energy icon Option 2 HSR + energy icon + 3 prescribed nutrient icons Option 4 HSR only 1.2 Methodology Outputs for AoE 1 were specifically divided into three key components, as per the Framework: 1. Uptake of the HSR system by manufacturers and retailers Option 5 Energy icon only 1.2.1 Uptake of the HSR system by manufacturers and retailers To conduct this assessment, CSIRO software engineers developed automated reporting scripts in FoodTrackTM that provided reports relating to uptake of the HSR system. The scripts included the following parameters: 2. Assessment of the implementation of the HSR system graphic against the HSR system Style Guide (the Style Guide) Whole Year 1 (June 2014 to June 2015) product suite in FoodTrackTM 3. Assessment of the HSR displayed on pack against that determined by the HSRC. HSR Primary Category, HSR Category, HSR Category Class There are five different ways (‘Options’) in which the HSR system graphic can be displayed on pack. These are outlined in the Style Guide, along with their respective images:7 Those displaying Option 5 of the HSR system graphic Option 1 – HSR + energy icon + 3 prescribed Manufacturers and retailers. nutrient icons (saturated fat, sugars, and sodium) + 1 optional nutrient icon Option 2 – HSR + energy icon + 3 prescribed nutrient icons Option 3 – HSR + energy icon Option 4 – HSR only Option 5 – Energy icon only. An example of each Option of the HSR system graphic is outlined in the ‘Chapter summary’ above. 4 Those displaying Options 1 to 4 of the HSR system graphic For categories that had a large market presence of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015), indication of market share for major manufacturers and retailers was provided, where available, to allow for a more specific assessment of the impact on the food supply. The 2014 and 2015 Retail World Annual Reports8,9 were used to source such content and categories mapped as closely as possible to their respective HSR Category(ies). Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 1 – Area of Enquiry 1 Comparison of the uptake of the HSR system to the uptake of the DIG Following development of the Framework, the Heart Foundation was required to conduct more regular monitoring of the HSR system uptake over three waves. The Heart Foundation conducted the first wave in September 2015, and subsequent waves will be conducted in January and May of 2016. This work mainly aimed to capture the number of products displaying the HSR system graphic at a given time point (refer to Appendix 1 for the Wave 1 Report). The results from Wave 1 of this work were used to compare uptake of the HSR system to that of the DIG* over time. Data on the uptake of the DIG was sourced from the Daily Intake Guide Audit Report May 2013 and personal communication with the Australian Food and Grocery Council (AFGC).10 1.2.2 Consistency in implementation of the HSR system graphic with the HSR system Style Guide For this assessment, Version 3.3 of the Style Guide,7 released on 25 March 2015 was used. Additional supplementary materials that are referenced in the Style Guide were also used, including the Food Standards Code.11 To assess the products at Year 1 (June 2014 to June 2015) that displayed the HSR system graphic against the guidelines outlined in the Style Guide, a Compliance Checklist (Checklist) was developed by the Heart Foundation. The Checklist consolidated content from the Style Guide into a systematic series of Yes/No questions, where possible, to make the assessment as objective as possible (refer to Appendix 2 for the Checklist). The Checklist was divided into five sections, one for each of the five different options for which the HSR system graphic can be displayed on pack, as there were some assessment criteria specific to each Option. This analysis was conducted on an individual product basis using the front-of-pack (FoP) and nutrition information panel (NIP) images extracted from FoodTrackTM. Assessment of products displaying the HSR system graphic against the Style Guide was conducted against the following parameters: Those displaying each Option of the HSR system graphic Manufacturers and retailers HSR Category Variation to the Style Guide Within those displaying Option 1 of the HSR system graphic, optional nutrient by: - HSR Category - type of optional nutrient - manufacturers and retailers. 1.2.3 Assessment of HSR displayed on pack against that determined by the HSRC For this assessment, Version 3.3 of the HSRC (20 January 2015) was used in the available Microsoft Excel format.12 The HSRC has three sections that must be populated to determine the HSR: 1. The categorisation system underpinning the algorithms 2. The NIP data for the relevant nutrients 3. The percentage of fruit, vegetable, nut, legume (% FVNL) and percentage of concentrated (conc) FVNL values (% conc FVNL). For Part 1, products were categorised according to the six HSR Category Classes, and further to the HSR Calibration Category provided in the HSRC.6,12 Table 1.1 summarises the mapping process. Table 1.1. HSR Calibration Category and associated HSR Category Class HSR Calibration Category HSR Category Class Beverages, non-dairy 1 – Beverages Core dairy – beverages 1D – Dairy beverages Core cereals 2 – Food Fruit 2 – Food Non-core foods 2 – Food Protein 2 – Food Vegetables 2 – Food Core dairy – yoghurt, soft cheese 2D - Dairy Food Fats, oils 3 – Oils and spreads Core dairy – cheese 3D – Cheese and processed cheese For Part 2, the relevant nutrient data from product NIPs was extracted from FoodTrackTM and transferred into the Excel version. These nutrients include energy, saturated fat, sugars, sodium, protein and fibre. All of these nutrients, except fibre, are mandatory on the NIP. To determine the fibre content, the NIP data was used, where available. Where fibre was not available on the NIP, it was treated as missing data. The HSRC requires the NIP values to be entered per 100 g/100 mL, and should apply to the form of the food ‘as consumed’, in most cases.6 As this data must be numerical for the HSRC to identify it, the following rules were created: Any NIP data with ‘<’ values was treated as a whole number, e.g. ‘<1’ treated as 1. Any data that was missing (N/A) was treated as missing data, not zero. *The DIG is an FoPL system introduced in 2006 to provide consumers with at-a-glance nutritional information on food products.10 National Heart Foundation of Australia 5 Chapter 1 – Area of Enquiry 1 For Part 3, the % FVNL and % conc FVNL values were determined from the ingredients images, where available. For some products where the data required to determine the % FVNL and % conc FVNL contents was incomplete, this was noted, and assumptions made, where deemed suitable (refer to Appendix 3 for a definition of foods that contribute to FVNL values and for examples on managing incomplete datasets). For each product at Year 1 (June 2014 to June 2015) displaying the HSR system graphic, the HSR determined by using the HSRC was compared to the HSR displayed on pack and, where differences were observed, these differences were grouped into themes, where possible. As the aim of this activity was to determine if the HSR displayed on pack matched that determined by the HSRC, products displaying Option 5 (the energy icon only) were excluded from this analysis. 1.2.4 Data analysis 1.3 Results 1.3.1 Uptake of the HSR system at Year 1 (June 2014 to June 2015) At Year 1, the HSR system graphic was displayed on 363 products out of an eligible 12,176 products from the FoodTrackTM database. This represented 3% of the total product suite. Of these 363 products, the majority (91%) displayed Options 1 to 4 and the remaining smaller percentage displayed Option 5. Forty-six per cent (37/81) of eligible HSR Categories in FoodTrack TM had at least one product that displayed the HSR system graphic as illustrated in Figure 1.1. Seventeen HSR Categories had 2% or less of products that displayed the HSR system graphic at Year 1. These categories are listed in Table 1.2, and are excluded from Figure 1.1. Unless specified, all analyses for AoE 1 were conducted in Microsoft Excel 2013. Automated reporting scripts were developed for use in FoodTrackTM, a cloud-based SQL database. Table 1.2. HSR Categories that had 2% or less of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) Breakfast spreads Number of products (n) displaying HSR system graphic 3 Number of products (n) without HSR system graphic 180 Proportion of products (%) displaying HSR system graphic 2 Cooking sauces 7 279 2 Dairy milks – plain 2 107 2 Grains – processed 1 55 2 Pasta and noodles – plain 5 249 2 Seafood – canned 4 248 2 Spreads – nut and seeds 1 59 2 Cereal-based bars 1 120 1 Cheese – hard and processed 2 350 1 Cream and cream alternatives 1 69 1 Smallgoods 3 207 1 4 443 1 2 177 1 Vegetables – plain 3 384 1 Cheese – soft 1 218 0 Meat – plain 1 203 0 Ready meals 1 275 0 HSR Category Name Sugar (or artificially) – sweetened beverages Vegetable oils 6 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 1 – Area of Enquiry 1 Figure 1.1. Number of products (n) displaying the HSR system graphic, by HSR Category, by HSR Option, at Year 1 (June 2014 to June 2015) The four breakfast cereal categories (‘Ready-to-eat breakfast cereals’, ‘Mueslis’, ‘Hot cereals – plain’, ‘Hot cereals – flavoured’) were the only HSR Categories to have representation of the HSR system graphic on more than 25% of their products, each (Figure 1.1). ‘Ready-to-eat breakfast cereals’ also had the highest number of products displaying the HSR system graphic at Year 1 (n = 59), and this was followed by ‘Mueslis’ (n = 37). Combined, these two categories had around one-quarter of all products displaying the HSR system graphic at Year 1 (96/363). In the ‘Fruit and vegetable juices’ and ‘Soups’ categories, although having over 20 products each that displayed the HSR system graphic, this represented less than 10% coverage within each of these categories. The HSR system graphic was displayed on 19 products in the ‘Hot cereals – flavoured’ category, which represented the greatest proportion of products within any category (46%). A similar trend was observed for ‘Hot cereals – plain’, for which the HSR system graphic was displayed on only eight products, but this represented 30% of the whole category. Most categories displayed only Options 1 to 4 of the HSR system graphic, however Option 5 was exclusively displayed in both the ‘Confectionary’ and the ‘Relishes, chutneys and pastes’ HSR Categories. In both of these categories this number of products represented a small proportion of the whole category (4% and 3%, respectively). National Heart Foundation of Australia 7 Chapter 1 – Area of Enquiry 1 Table 1.3. Proportion of products (%) for each manufacturer and retailer displaying the HSR system graphic at Year 1 (June 2014 to June 2015) Manufacturers and retailers Number of products (n) displaying the HSR system graphic Total manufacturer and retailer product count (n) Proportion of retailer and manufacturer products (%) displaying the HSR system graphic The Wrigley Company 13 13 100 Spreyton Fresh Tasmania 1 1 100 Betta Foods Australia 8 8 100 Emma & Tom Foods 7 8 88 Monster Health Food Co 4 5 80 Food For Health 5 9 56 Popina Foods 3 7 43 Rinoldi Pasta 5 16 31 Freedom Nutritional Products 11 36 31 Chris Dips 4 16 25 Nestle Australia 59 296 20 Vitality Brands Worldwide 3 16 19 Sanitarium Health Foods Company 17 94 18 Mayvers Health Time 1 6 17 Private Label – Coles 132 1531 8 Lion – Dairy & Drinks 20 302 7 HJ Heinz Company Australia 11 276 4 Frucor Beverages 1 23 4 SPC Ardmona Operations 4 119 3 Private Label – Woolworths 51 1811 3 Simplot Australia 2 354 1 Greens General Foods 1 72 1 Twenty-two manufacturers and retailers, from the 665 recorded in FoodTrackTM, displayed the HSR system graphic on their products at Year 1 (3% of product suite). Table 1.3 outlines, for each manufacturer and retailer, the proportion of their products in FoodTrackTM that displayed the HSR system graphic at Year 1. Figure 1.2 displays the number of products in each HSR Category that displayed the HSR system graphic, by manufacturers and retailers, at Year 1. At Year 1 (June 2014 to June 2015), Private Label – Coles alone contributed to 36% of total products displaying the HSR system graphic (132/363), however the HSR system graphic was displayed on only 8% of their total product suite. This was followed by Nestle Australia (n=52), which displayed the HSR system graphic on 17% of their products at Year 1, and then Private Label – Woolworths (n = 51, only 3% of their products). Although the following manufacturers displayed the HSR system graphic on only one of their 8 products at Year 1, this represented between 1% and 100% of their product suite, depending on the manufacturer: Frucor Beverages (n = 1, 4%), Green’s General Foods (n = 1, 1%), Spreyton Fresh Tasmania (n = 1, 100%), and Mayver’s Health Time (n = 1, 17%). Monster Health Food Co and Emma & Tom Foods both had seven or less products displaying the HSR system graphic, but this represented 80% or more of their total product count, each. Eighteen of 22 manufacturers and retailers used Options 1 to 4 of the HSR system graphic on their products. Private Label – Coles was the only retailer (and manufacturer) to use all five options of the HSR system graphic on their products. Three manufacturers exclusively used Option 5 of the HSR system graphic: Frucor Beverages, Betta Foods Australia and The Wrigley Company. The latter two’s HSR products represented 100% coverage for these manufacturers. Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 1 – Area of Enquiry 1 Figure 1.2. Number of products (n) displaying the HSR system graphic, by manufacturers and retailers, by HSR Option, at Year 1 (June 2014 to June 2015) Note: Lion – Dairy & Drinks and Frucor Beverages products have been classified according to the dominant HSR option displayed on pack, despite slight variance (refer to the Style Guide assessment work). National Heart Foundation of Australia 9 Chapter 1 – Area of Enquiry 1 Table 1.4. Manufacturers and retailers with more than 10 products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) Manufacturers and retailers Number of products (n) products displaying HSR system graphic Number of HSR Categories (n) Number and proportion (n,%) of HSR Categories with products displaying HSR system graphic The Wrigley Company 13 1 1 (100) Private Label – Coles 132 72 27 (38) Sanitarium Health Foods Company 17 8 3 (38) Freedom Nutritional Products 11 12 3 (25) Nestle Australia 59 21 5 (24) Private Label – Woolworths 51 76 10 (13) Lion – Dairy & Drinks 20 11 1 (9) HJ Heinz Company Australia 11 22 1 (5) There were eight manufacturers and retailers that had greater than 10 products displaying the HSR system graphic at Year 1. These are summarised in Table 1.4. Of the eight manufacturers and retailers listed in Table 1.4, two had presence in a single category: Lion – Dairy & Drinks (‘Fruit and vegetable juices’) and HJ Heinz Company Australia (‘Soups’). The Wrigley Company (‘Confectionary’) also displayed the HSR system graphic on one category, however this was their only HSR Category in FoodTrackTM, i.e. they displayed the HSR system graphic on 100% of the categories on which they were present at Year 1 (June 2014 to June 2015). Both Private Label – Coles and Sanitarium Health Foods Company had products displaying the HSR system graphic at Year 1 in 38% of their categories. Nestle Australia, Sanitarium Health Foods Company and Freedom Nutritional Products all had the greatest presence in the ‘Ready-to-eat breakfast cereal’ HSR Category (n = 28, 14 and 9, respectively). No presence of Private Label – Woolworths was observed in the ‘Ready-to-eat breakfast cereal’ HSR Category. The four breakfast cereal categories (‘Ready-to-eat breakfast cereals’, ‘Mueslis’, ‘Hot cereals – plain’, ‘Hot cereals – flavoured’) contributed to one-third (123/363) of all products displaying the HSR system graphic at Year 1 (June 2014 to June 2015). Presence of the top five manufacturers and retailers was observed across these four categories (Figures 1.1, 1.3). The spread of HSR Categories in which the top five manufacturers and retailers (i.e. those from Table 1.4 that were present in more than one HSR Category) displayed the HSR system graphic at Year 1 is displayed in Figure 1.3. Private Label – Coles displayed the HSR system graphic across the greatest variety of HSR Categories at Year 1 (n = 27), which represented 38% of their HSR Category count (Table 1.4). They had greatest coverage in the ‘Mueslis’ and ‘Dips’ HSR Categories (n = 19 and 13, respectively). Private Label – Woolworths had coverage across seven of these same HSR Categories, and exclusive coverage in the ‘Butter’ category. The greatest number of Private Label – Woolworths products displaying the HSR system was observed in ‘Meat – processed’ and ‘Vegetarian – processed’ (n = 15, both). 10 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 1 – Area of Enquiry 1 Figure 1.3. Number of products (n) displaying the HSR system graphic, by HSR Category, by major manufacturers and retailers, at Year 1 (June 2014 to June 2015) Table 1.5 summarises the number and proportion of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015), for the four manufacturers and retailers that, combined, made up more than 89% volume market share (tonnes) of the breakfast cereals category†.8,9 Sanitarium Health Foods Company held the greatest volume market share in both 2014 and 2015 in the breakfast cereals category (34.9% and 38.1%, respectively), and the HSR system graphic was displayed on 67% of their breakfast cereal product suite in FoodTrackTM. Kellogg (Australia), although holding the second highest volume market share in both years (refer to Table 1.5), did not have any products displaying the HSR system graphic at Year 1. This would be expected given that products in the four breakfast cereal categories were collected in April–May 2015 using FoodTrackTM, which was prior to the implementation of the HSR system graphic by Kellogg (Australia) on their products. Nestle Australia, with the third highest volume market share in this category, had the greatest proportion of products in their breakfast cereal product suite displaying the HSR system graphic (79%). Conversely, Private Label combined (Coles and Woolworths) displayed the HSR system graphic on only 36% of their breakfast cereal product suite. Data for Private Label – Coles and Private Label – Woolworths is presented combined in Table 1.5, as their market share could not be separated when using the available Retail World data. Some manufacturers, such as Freedom Nutritional Products, Monster Health Food Co, Popina Foods and Food For Health, appeared to have a low number of products displaying the HSR system graphic but this represented 61–100% of their breakfast cereals product suite (sales data was not available in the same format, for these smaller manufacturers). †The category as defined in Retail World is called Breakfast Cereals, which also includes breakfast drinks. The market share figures reported could not be adjusted to account for breakfast drinks. No breakfast drinks products displayed the HSR system at Year 1. Sales data from a smaller sub-category Retail World, Health Foods – Cereals, has been excluded as it was not available to report in the same format as that of the Breakfast Cereals category. National Heart Foundation of Australia 11 Chapter 1 – Area of Enquiry 1 Table 1.5. Manufacturers and retailers in the four HSR breakfast cereal categories, displaying the HSR system graphic, and their respective volume market shares (% tonnes) within the breakfast cereal category, according to Retail World8,9,* at Year 1 (June 2014 to June 2015) Food For Health 4 0 Proportion of products (%) in the HSR breakfast cereals categories displaying the HSR system graphic 100 Monster Health Food Co 4 1 56 Manufacturers and retailers Number of products (n) without the HSR system in the breakfast cereals categories Number of products (n) displaying the HSR system in the breakfast cereals categories Volume market share (% tonnes) within the breakfast cereal category Year: 2014 Year: 2015 N/A N/A 80 N/A N/A 15 79 17.1 17.5 3 1 75 N/A N/A Sanitarium Health Foods Company 14 7 67 34.9 38.1 Freedom Nutritional Products 11 7 61 N/A N/A Private Label (combined) 30 53 36 13.6 12.7 1 16 6 N/A N/A 0 63 0 24.4 23.6 N/A N/A N/A 10.1 8.1 Nestle Australia Popina Foods † Greens General Foods Kellogg (Australia) ‡ Others§ *The category as defined in Retail World is called Breakfast Cereals, which also includes breakfast drinks. The market share figures reported could not be adjusted to account for breakfast drinks. No breakfast drinks products displayed the HSR system at Year 1. Sales data from a smaller sub-category Retail World, Health Foods – Cereals, has been excluded as it was not available to report in the same format as that of the Breakfast Cereals category. †Private Label – Coles represented 25 of the 30 Private Label products displaying the HSR system graphic (68% of their breakfast cereals product suite), Private Label – Woolworths displayed the HSR system on 5 of their 46 products in the breakfast cereals categories (11%). ‡Kellogg Australia did not have any products displaying the HSR system graphic at Year 1. This would be expected given that products in the four breakfast cereal categories were collected in April-May 2015 using FoodTrackTM, which was prior to the implementation of the HSR system graphic by Kellogg Australia on their products. §Number of products cannot be identified as individual manufacturers not available in Retail World for Others. 1.3.2 Results from Wave 1 of additional uptake monitoring (September 2015) In September 2015, the Heart Foundation conducted an in-store audit in metropolitan Victorian Coles and Woolworths stores to identify the number of products at a given time point that displayed the HSR system graphic (refer to Appendix 1 for the Report). A total of 1,513 products were recorded for this given time point. In addition, there were 13 multipack products that displayed more than one HSR system graphic on pack to reflect the different flavour variants. This brought the total number of products to 1,526. Comparison to uptake of the DIG When comparing uptake of the HSR system to that of the DIG over time, there was a greater number of products displaying the HSR system graphic at the corresponding time point (Month 15, refer to Figure 1.4). At Month 15, uptake of the DIG was 448 products compared to 1,526 products for the HSR system – this represented nearly a 3.5 times greater presence of HSR vs the DIG for the corresponding time point. 12 The following should be noted for Figure 1.4: Data for uptake of the DIG was available as a whole number encompassing ALDI, IGA, Coles and Woolworths whereas data for uptake of the HSR system relates to Coles and Woolworths only. It is therefore likely this represents an underestimation. As the two time points of implementation and uptake of the DIG and the HSR system differed (i.e. the dates and years), uptake has been reported in months post implementation, as a standard measure, where zero (0) on the x-axis represents the point of implementation for both the HSR system and the DIG, and each time point thereafter represents months 1, 2 and 3 etc. post-implementation. Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 1 – Area of Enquiry 1 Figure 1.4. Comparison of the uptake of the HSR system to the uptake of the DIG, over time 1.3.3 Consistency in implementation of the HSR system graphic with the HSR Style Guide Figure 1.5. Proportion of products (%) displaying the HSR system graphic, by HSR Option, at Year 1 (June 2014 to June 2015) During assessment of consistency with the Style Guide, it was identified that 21 products displayed an HSR system graphic that was a combined version of one or more of the five Options. For the purposes of reporting against consistency with the Style Guide, these have been reported in this section as ‘Combined’. The most popular Option of the HSR system graphic displayed on pack at Year 1 (June 2014 to June 2015) was Option 1 (33%). A similar proportion displayed Option 2 (13%) and Option 3 (14%), and 25% displayed Option 4. Nine per cent displayed Option 5, and the remaining 21 products displayed a combined version of the HSR system graphic (Figure 1.5). National Heart Foundation of Australia 13 Chapter 1 – Area of Enquiry 1 The 21 products that were identified as displaying a combined version of the HSR system graphic were displayed by Lion – Dairy & Drinks (n = 20) and Frucor Beverages (n = 1). All 21 products were part of the ‘Fruit and vegetable juices’ HSR Category. The combined version of the HSR system graphic displayed on the 20 Lion – Dairy & Drinks products was a combination of Option 3 and Option 5, and the combined version displayed on the Frucor Beverages product was a combination of Option 5 and an optional nutrient icon. For simplicity, these products have been excluded from Figure 1.6. As shown in Figure 1.6, most manufacturers and retailers (14/20) selected to display only a single Option on their products at Year 1 (June 2014 to June 2015). Option 4 was the most popular when a single Option was used (9/14). Four manufacturers used two Options on their products and there were no obvious trends for combining Options, e.g. Nestle Australia used Options 1 and 3, Sanitarium Health Foods Company used Options 1 and 4. Private Label – Woolworths was the only retailer (and manufacturer) to use three Options (2, 3 and 4), and Private Label – Coles was the only retailer (and manufacturer) to display all Options of the HSR system graphic. Figure 1.6. Number of products (n) displaying the HSR system graphic, by manufacturers and retailers, by HSR Option, at Year 1 (June 2014 to June 2015) 14 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 1 – Area of Enquiry 1 In Figure 1.7, in 18/37 HSR Categories, exclusive use of one Option of the HSR system graphic was observed. This was greatest for Option 4 in which six categories used Option 4 only, followed by Option 1 which was used exclusively in four categories. Options 3 and 5 were used exclusively in three categories each, and Option 2 in two categories. Eight categories used two of the Options, ten categories used three Options. Only one category (‘Meat – processed’) used four Options, and no category at Year 1 (June 2014 to June 2015) used all five options of the HSR system graphic. Option 1 was observed in the greatest number in the four breakfast cereal categories (‘Ready-to-eat breakfast cereals’ n =47, ‘Mueslis’ n = 25, ‘Hot cereals – plain’ n = 6, ‘Hot cereals – flavoured’ n= 15). Conversely, Option 5 was observed in the greatest number in ‘Confectionary’ and ‘Relishes, chutneys and pastes’ categories (n = 21 and 7, respectively), and was used exclusively in both of these categories also. Figure 1.7. Number of products (n) displaying the HSR system graphic, by HSR Category, by HSR Option, at Year 1 (June 2014 to June 2015) National Heart Foundation of Australia 15 Chapter 1 – Area of Enquiry 1 Specifically looking at Option 1, there were a total of 121 products that displayed this Option of the HSR system graphic, across 15 HSR Categories (Figure 1.7.). Within these 15 categories, the four breakfast cereal categories (‘Ready-to-eat breakfast cereals’, ‘Mueslis’, ‘Hot cereals flavoured’, ‘Hot cereals – plain’) alone made up 77% of the products (93/121). The remaining 11 categories all had less than five products each displaying Option 1. Figure 1.8 outlines the number of products in each HSR Category that displayed Option 1. Figure 1.9 shows that among products displaying Option 1 of the HSR system graphic, 50% of them displayed fibre as the optional nutrient. This was followed by protein (17%) and iron (10%) while magnesium and Vitamin A were displayed by one product each. Figure 1.10 shows that use of fibre as the optional nutrient was most prominent in three of the four breakfast cereal HSR Categories (‘Ready-to-each breakfast cereals’, ‘Mueslis’, ‘Hot cereals – flavoured’), and was also used exclusively in the ‘Grains – plain’ category. Use of Calcium was observed mainly in the dairy or dairy alternative categories (‘Milk substitutes – plain and flavoured’, ‘Cheese – hard and processed’, ‘Dairy milks – plain’). Use of folate, iron, magnesium and Vitamin E were exclusive to the ‘Ready-to-eat breakfast cereals’ category. Figure 1.11 shows that use of Option 1 at Year 1 (June 2014 to June 2015) was dominated by Private Label – Coles and Nestle Australia, which each contributed to more than 40% of products (within Option 1) using the optional nutrient icon (n = 49 and 52, respectively). Consistency in implementation of the HSR system graphic with the Style Guide on products at Year 1 (June 2014 to June 2015) was also assessed. Overall, minimal variation to the Style Guide was observed; only 28 of 362 (8%) of products displaying the HSR system graphic were identified as having a technical error‡ (Table 1.6). The most common technical error was that 13 products displayed a serving size as part of the HSR system graphic that was not part of the industry-agreed standard serving size range as outlined in the Style Guide,7 at the time of this assessment. Eight of these were from one manufacturer in the same category, and the serving size used was that displayed on the NIP, as determined by the manufacturer. Figure 1.8. Number of products (n) displaying Option 1, by HSR Category, by HSR Option, at Year 1 (June 2014 to June 2015) ‡This component of the assessment excludes one product displaying Option 5 as the images were incomplete in FoodTrack (i.e.: n = 362). 16 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 1 – Area of Enquiry 1 Figure 1.9. Proportion of products (%) displaying HSR Option 1, by optional nutrient, at Year 1 (June 2014 to June 2015) Figure 1.11. Proportion of products (%) displaying the optional nutrient icon, by manufacturers and retailers, at Year 1 (June 2014 to June 2015) Figure 1.10. Number of products (n) displaying the optional nutrient icon, by HSR Category, by optional nutrient, at Year 1 (June 2014 to June 2015) National Heart Foundation of Australia 17 Chapter 1 – Area of Enquiry 1 Table 1.6. Technical errors identified when assessing consistency in implementation of the HSR system graphic with the Style Guide, at Year 1 (June 2014 to June 2015) Section of the Style Guide Number of products* Energy and nutrient icons, including %DI %DI implemented differently to recommended guidelines 3 nutrient(s) values displayed with decimal place different to guidelines 3 value displayed on nutrient icon different to that in the NIP 2 nutrient order varies to recommended guidelines 1 nutrients displayed in different units to recommended guidelines 1 nutrient displayed as ‘<1g’ with a ‘low’ claim – cannot confirm this meets requirements of ‘low’ claim for that nutrient (<0.75 g) 1 Nominated reference measure does not use industry agreed standard serving size (fruit and vegetable juices (9), cheese – aged and processed (1), meat – plain (1), pasta and noodles – plain (1), mueslis (1)) There were also other observations during assessment against the Style Guide: Thirty-five products from the same retailer, across various categories, displayed a design variation compared to the recommended HSR system graphic. Twenty products from the same manufacturer, in the ‘Fruit and vegetable juices’ category, displayed a combination of Option 3 and Option 5 of the HSR system graphic. One product in the ‘Fruit and vegetable juices’ category displayed a combination of Option 5 of the HSR graphic and an optional nutrient icon. Three products by the same manufacturer within the ‘Mueslis’ category displayed an older version of the HSR system graphic, which was implemented at the time in line with an earlier version of the HSR Style Guide (not shown here). There were 18 multipack products identified at Year 1 (June 2014 to June 2015): 13 - For six of them, the HSR system graphic and the NIP reflected an average of all flavours in the packaging values based on food ‘per 100 g’ as sold (i.e. uncooked) which matches NIP, intended to be eaten ‘as prepared’ (single manufacturer, pasta & noodles – plain) 4 - For the remaining 12, the HSR system graphic reflected a single flavour in pack (i.e. the multipack contained only one flavour variant). uses reference measure of ‘per 60g serve’ – varies to recommended reference measure for products presented as multipacks 2 uses reference measure of ‘per 180 g serve’ – varies to recommended reference measure for products presented in single serve packages 1 Two products were identified for which the manufacturer placed a sticker over one nutrient value in the HSR system graphic, with the correct information. *Total count adds up to 31. This is because one product had four technical errors and was therefore reflected four times in Table 1.6. The majority of products (27/28) had one technical error. 18 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 1 – Area of Enquiry 1 1.3.4 Assessment of HSR displayed on pack against that determined by the HSRC at Year 1 (June 2014 to June 2015) The available data for the 331 products displaying a HSR system graphic, from FoodTrackTM, was entered into the HSRC and the output was compared to the HSR displayed on pack. Note this excludes products displaying Option 5 of the HSR system graphic (the energy icon only). For 95% (314/331) of products assessed, the HSR displayed on pack matched the output from the HSRC. The remaining 17 products were from six HSR Categories: ‘Dips’ (n = 8), ‘Nut and seed bars’ (n = 4), ‘Mueslis’ (n = 2), and n= 1 for ‘Vegetarian – processed’, ‘Ready-to-eat breakfast cereals’ and ‘Cereal-based bars’. Of these 17 products, 10 displayed a HSR on pack which was 0.5 stars higher than that calculated by the HSRC, one product displayed 1.0 stars more on pack, and six products displayed 0.5 stars less on-pack than those calculated by the HSRC. Eleven of these 17 products did not have sufficient data on pack to be able to completely determine the HSR (fibre unavailable on the NIP and/or not possible to fully quantify the FVNL values (% FVNL and % conc FVNL) from the ingredients list. For the remaining six products, the HSR did not match despite all required data available on pack and able to be quantified. There were also instances observed where either the fibre content was missing or the quantity of key ingredients was unavailable on pack, yet modelling based on similar product profiles showed these were likely to be in too small amounts to affect the overall star rating. National Heart Foundation of Australia 19 Chapter 1 – Area of Enquiry 1 20 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 Area of Enquiry 2 Consumer awareness and ability to use the HSR system correctly National Heart Foundation of Australia 21 National Heart Foundation of Australia 21 2 Chapter 2 – Area of Enquiry 2 2.1 Chapter summary 2.1.1 Awareness of the HSR system 2.1.2 Understanding what the HSR system represents 2.1.3 Use of the HSR system 2.1.4 Perceptions and attitudes towards the HSR system 25 25 25 25 25 2.2 Methodology 26 2.2.1 Survey design and sample 2.2.2 Online panel partner 2.2.3 Survey questionnaire 2.2.4 ample characteristics Table 2.1. Sample characteristics of the population surveyed for Wave 1 2.2.5 Data analysis 2.3 3 Results 2.3.1 Section A: General supermarket shopping Table A1. On average, how often do you visit a supermarket to do your grocery shopping? (Sample: 2,036) Table A2. On average, how much do you spend in one visit to the supermarket? (Sample: 2,036) 26 26 26 27 27 27 28 28 28 28 Figure A1. When buying food at the supermarket, what is the main thing that influences your choice between two similar products? (Sample: 2,036) Figure A2. Which supermarkets have you visited in the past month? (Sample: 2,036) 29 29 Figure A3. When choosing a new food during grocery shopping, how often do you compare how healthy products are? (Sample: 2,036) 2.3.2 Section B: Awareness of food logos Table B1. Age group Table B2. Gender Table B3. Household income Table B4. BMI Table B5. Indigenous status 29 30 30 30 30 30 30 Figure A4. On average, when at the supermarket, do you look at the nutrition information panel on…? (Sample: 2,036) 31 Figure B1. Apart from brand names, thinking about different logos that help customers choose the food they buy in the supermarket, which ones are you aware of? (Sample: 2,036) 31 Table B6. Language 32 Table B7. Residential location 32 Table B8. Children at home 32 Table B9. Age group 32 Table B10. Gender 32 Table B11. Household income 32 Table B12. BMI 32 Figure B2. Which of the following are you aware of on food packaging? (Sample: 2,036) 33 Figure B3. Prompted awareness of the HSR system over time (Sample: 2,036) 33 Table B13. Indigenous status 34 Table B14. Language 34 Table B15. Residential location 34 Table B16. Children at home 34 2.3.3 Section C: Knowledge and understanding of the Health Star Rating system 34 Figure C1. When the HSR system graphic is on the packaging of food, what do you think it means? (Sample: 1,084)34 Table C1. Age group 35 22 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Table C2. Gender Table C3. Household income Table C4. BMI Table C5. Language Table C6. Residential location Table C7. Children at home Figure C2. In your opinion, how is the number of stars on a product determined? (Sample: 1,084) Table C8. How strongly do you agree or disagree that the HSR system? (Sample: 1,084) Figure C3. How would you use the HSR system? (Sample: 1,084) Figure C4. If a food product has one star, what do you think this means? (Sample: 1,084) Figure C5. If a food product has five stars, what do you think this means? (Sample: 1,084) Table C9. How strongly do you agree or disagree that a product with more stars means…? (Sample: 1,084) 35 35 35 35 35 35 36 36 37 37 37 38 Table C10. The HSR system graphic can be displayed in five different ways. Please select the style you believe is the easiest to understand? (Sample: 1,084) 38 Table C11. The HSR system graphic can be displayed in five different ways. Please select the style you believe is the easiest to recognise? (Sample: 1,084) 39 Table C12. The HSR system graphic can be displayed in five different ways. Please select the style you believe provides sufficient information? (Sample: 1,084) Table C13. Overall, please select the style you prefer the most? (Sample: 1,084) Figure C6. Why do you prefer that option? (Sample: 1,084) 2.3.4 Section D. Purchasing behaviour Table D1. In the past three months have you purchased a product that had the HSR system graphic? (Sample: 1,084) Table D2. Age group Table D3. BMI Table D4. Household income Table D5. Gender Table D6. Language Table D7. Children at home Table D8. Residential location Table D9. Did the HSR system graphic on the product influence your choice? (Sample: 489) Table D10. How did it influence your choice? (Sample: 273) Figure D1. Why didn’t the HSR system influence your choice? (Sample: 180) Table D11. Have you continued or will continue to buy the product? (Sample: 273) Table D12. Have you continued or will continue to buy the product? (Sample: 1,084) Table D13. Please select which you think is a healthier option in each pair? (Sample: 1,084) Table D14. Please select which you think is a healthier option in each pair? (Sample: 1,084) Table D15. Please select which you think is a healthier option in each pair? (Sample: 1,084) Table D16. Please select which you think is a healthier option in each pair? (Sample: 1,084) Table D17. Please select which you think is a healthier option in each pair? (Sample: 1,084) 39 40 40 41 41 41 41 41 41 41 41 41 41 42 42 42 43 43 43 43 43 43 Figure D2. Please select which foods and/or beverages you purchased in the supermarket which had the HSR system graphic on them? (Sample: 507) 44 Figure D3. Please select which foods and/or beverages you believe it is important to have the HSR system graphic on them? (Sample: 1,084) 2.3.5 Section E. Advertising awareness 45 46 Table E1. In the last three months, do you remember seeing, hearing or reading any advertising or promotions about the HSR system? (Sample: 1,084) Figure E1. Where had you seen or heard about the HSR system? (Sample: 217) Figure E2. Which organisation or company did the advertising or promotion(s)? (Sample: 217) 46 46 47 National Heart Foundation of Australia 23 Chapter 2 – Area of Enquiry 2 Figure E3. What product or products were being advertised or promoted? (Sample: 217) 47 Table E2. After seeing or hearing this advertising or promotion(s) for products with a HSR system graphic, did it influence you to buy a product or products you normally wouldn’t buy? (Sample: 217) 47 2.3.6 Section F: Attitudes and perceptions about the HSR system Table F1. How strongly do you agree or disagree that the HSR system…? (Sample: 1,084) Table F2. How strongly do you agree or disagree that the HSR system…? (Sample: 1,084) Table F3. How strongly do you agree or disagree that the HSR system…? (Sample: 1,084) Table F4. Age group Table F5. BMI Table F6. Household Income Table F7. Children at home Table F8. Language Table F9. Gender Table F10. Residential location Figure F1. Overall, what level of confidence do you have in the HSR system? (Sample: 1,084) 2.3.7 Section G: Health attitudes and behaviours 48 48 48 48 49 49 49 49 49 49 49 49 50 Table G1. In general, thinking about all the food you buy, how concerned are you about how healthy the food is for you? (Sample: 2,036) 50 Table G2. Thinking about your diet, would you say that what you usually eat is? (Sample: 2,036) Table G3. Over the past six months, have you made any changes to your diet? (Sample: 2,036) Figure G1. Which of the following changes have you made in the past six months to your diet? (Sample: 794) Figure G2. For which of the following reasons did you make changes to your diet? (Sample: 794) Table G4. In general, would you say your overall health is? (Sample: 2,036) 50 50 51 51 52 Table G5. In a typical week, on how many days would you do moderate or vigorous physical activity for at least 30 minutes? (Sample: 2,036) 52 Table G6. How many serves of fruit (including fresh, dried, frozen and tinned fruit) do you usually eat each day? (Sample: 2,036) 52 Table G7. How many serves of vegetables (including fresh, frozen and tinned vegetables) do you usually eat each day? (Sample: 2,036) 52 24 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 2.1.3 Use of the HSR system 2.1 Chapter summary 2.1.1 Awareness of the HSR system Unprompted awareness of the HSR system has increased from 3% in April 2015 to 11% in September 2015. Unprompted awareness was higher among females, persons aged under 35, those with an annual household income of more than $50,000 or with a body mass index (BMI) in the healthy weight range. Likewise, prompted awareness of the HSR system has also increased significantly from 33% in April 2015 to 53% in September 2015. Prompted awareness was higher among persons aged under 35, those with an annual household income of more than $50,000 or with a BMI in the healthy weight range. 2.1.2 Understanding what the HSR system represents Close to two in three were aware that the HSR system is a rating scale of the healthiness of a food product or a comparison between two products in the same category. Females, persons aged 35 and over or those with an annual household income of more than $50,000 were more likely to know what the HSR system represents than their counterparts. Close to 90% of respondents understand that a product with one star means that it is less healthy compared to a product with more stars, and likewise, that a product with five stars represents the healthiest choice. Option 1 HSR + energy icon + 3 prescribed nutrient icons + optional nutrient Option 3 HSR + energy icon Of those aware of the HSR system, more than two in five reported that they have purchased a product with the HSR system graphic in the past three months. The latest result is significantly higher compared to April 2015, where only 8% reported that they had purchased a product with the HSR system graphic on it. Males, persons aged under 55, those with a BMI in the healthy weight/overweight range or an annual household income of more than $50,000 were more likely to report that they had purchased a product in the past three months with the HSR system graphic. More than one in two who had purchased a product with the HSR system reported that the rating scale had influenced their purchasing decision. In fact, 37% reported that the rating scale influenced them to purchase a product with more stars that they normally wouldn’t purchase. 2.1.4 Perceptions and attitudes towards the HSR system Compared to April 2015, the proportion of people who reported they trust the HSR system has increased from 38% to more than 51% in September 2015. Similarly, more than 70% reported that the HSR system is easy to use and easy to understand, both significantly up compared to the April 2015 result. Notably, more than one in two see the HSR system as either relevant to their family or relevant to them personally. Option 1 (refer to key below) of the HSR system graphic was the most preferred Option; it was reported to be the easiest to understand, the easiest to recognise and the Option perceived to provide sufficient information. Option 2 HSR + energy icon + 3 prescribed nutrient icons Option 4 HSR only Option 5 Energy icon only National Heart Foundation of Australia 25 Chapter 2 – Area of Enquiry 2 2.2 Methodology Outcomes for AoE 2 were specifically divided into four key areas, as per the Framework: 1. Awareness (unprompted and prompted) of the HSR system 2. Consumer knowledge and understanding of the HSR system, including what the HSR system graphic represents and what it means on product packaging 3. Whether consumers are utilising the HSR system accurately and effectively 4. The level of trust, reliability and credibility consumers have in the HSR system. These four key areas were measured at the total population level and by agreed select population groups, age, household income, BMI, gender and language spoken at home. 2.2.1 Survey design and sample In September 2015, the Heart Foundation conducted an online survey with a sample of 2,036 Australians. This was ‘Wave 1’ of the survey, and will be repeated at two more time points in 2016 (Wave 2 in February 2016 and Wave 3 in July 2016). The survey questionnaire is provided in Appendix 4. To be eligible to participate in the survey, participants were required to be the main or shared grocery buyer in their household and be 18 years of age or over. 2.2.3 Survey questionnaire The initial two consumer surveys of the HSR system, conducted in September 2014 and April 2015 were undertaken by the market research group, Pollinate. These surveys evaluated the roll-out of the HSR system and its impact on consumers.12,13 For the current survey, changes were made to the original questionnaire used in the first two surveys conducted by Pollinate. The overall length and the breadth of the questionnaire used in the current survey was expanded, with changes including: broadening the questions on unprompted logos/labels increasing the number of other food logos/labels included for testing of prompted awareness increasing the number of factors influencing purchasing decision new questions relating to what consumers believe the HSR system represents, how it is calculated and what the rating means on a product new questions for those who have used the HSR system, with particular focus on actual and intended behaviours a new question on the level of importance consumers place on the HSR across food products broadening the number of questions on trust, reliability and credibility of the HSR system The sample of consumers was based on a cross-section a question on whether the HSR system is meeting the needs of consumers. of Australian adults, and was stratified to include sufficient sample sizes by: These changes to the questionnaire have limited the direct comparability of the current survey with the two age group (under 35 years of age, 35 to 54 years of previous surveys conducted by Pollinate, however, age and those aged 55 and over) where directly comparable, time series data and/or household income per annum (less than $50,000, analysis has been included in the reporting. between $50,000 to $99,000 and $100,000 or greater) The questionnaire used in this survey consisted of gender (male/female) seven main sections: BMI (underweight/normal weight, overweight or obese) Demographics language spoken at home (English spoken only at - Gender, age, household income, household home or language other than English spoken at home) structure, educational attainment, activity location (respondent resides in metropolitan area or in status, Indigenous status and language spoken regional/rural area). at home. 2.2.2 Online panel partner The survey was conducted in September 2015, in conjunction with the market research company Research Now®, and the sample was obtained through their online research panel. Research Now operates in 38 countries and has more than 6 million panellists internationally. They are one of the leading online sampling and data collection organisations in Australia and worldwide. 26 Awareness of food logos - Unprompted and prompted awareness of the HSR system graphic and other food logos. Purchasing behaviours - Main influencing factor when purchasing products at the supermarket, frequency of visits to supermarket and average spend, supermarkets visited. Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Understanding of the HSR system - What the HSR system graphic on a product means, how the number of stars is determined, comparison of a product with one and five stars. Use of the HSR system - Whether a particular food with the HSR system graphic has been purchased and whether the HSR system graphic influenced the purchasing decision. Perceptions towards the HSR system - Whether the HSR system is credible, trusted, easy to use, easy to understand and overall confidence in the HSR system. General health and food attitudes and behaviours - Concern about healthiness of food and diet, change in dieting behaviour, daily intake of fruit and vegetables and physical activity levels. 2.2.5 Data analysis For AoE 2, data was analysed using the statistical software package, SPSS (version 23), with independent samples t-tests used to determine whether the means of two groups were statistically different from each other (significance level set at p<0.05). Where relevant, the survey population was grouped by gender, age, BMI, annual household income, place of residence, Indigenous status and language spoken at home, for analysis. The survey conducted for AoE 2 was based on a sample of Australian adults, i.e. not a census population, as such some level of error was inherent in the results. This margin of error was quantified statistically such that, with 95% confidence, a given range contains the true result at a population level; the error margin was 2.2%, i.e. with 95% confidence, a result, plus or minus the error margin (i.e. 50% ± 2.2%), contains the true result at the population level. 2.2.4 Sample characteristics Table 2.1 outlines the sample characteristics of the population surveyed for Wave 1. Table 2.1. Sample characteristics of the population surveyed for Wave 1 Characteristic Respondents (%) Gender Male 51 Female 49 Age group Under 35 30 35 to 54 32 55 or over 38 Location Metropolitan 72 Regional/rural 28 Annual household income Below $50,000 36 Between $50,000 to $99,999 37 $100,0000 or higher 27 Speak language other than English Yes 18 No 81 Household structure Children in the household 32 No children in the household 68 Indigenous status Indigenous 2 Non-Indigenous 98 National Heart Foundation of Australia 27 Chapter 2 – Area of Enquiry 2 Average spend per visit to the supermarket 2.3 Results 2.3.1 Section A: General supermarket shopping Main influence when choosing between two products When purchasing food at the supermarket and choosing between two similar products, price was by far the most common factor that influenced purchasing decisions (Figure A1). This was followed by quality of the product and personal or family preference. One in seven respondents reported that the nutritional value or the healthiness of a product primarily influences their purchasing decisions. However, females were more likely than males to focus on the healthiness of a product or its nutritional value (18% ct 12%, p=0.01). Although respondents with an annual household income of less than $50,000 were more likely to focus on price, those with an annual income of more than $100,000 were more likely to be influenced by product quality. Frequency of visits to the supermarket The majority of respondents reported that they visit a supermarket at least once a week to do their grocery shopping. Of those who grocery shop at least once a week, more than one in two reported they shop several times a week or every day. Respondents with an annual household income of more than $50,000 were significantly more likely to visit the supermarket at least several times a week compared to those with an annual income of less than $50,000 (52% ct 45%, p=0.01). Table A1. On average, how often do you visit a supermarket to do your grocery shopping? (Sample: 2,036) Everyday Respondents (%) Sep-15 3 Several times a week 47 Once a week 42 Once a fortnight 7 Once a month 1 The average expenditure per visit to the supermarket varied greatly. For those who reported visiting a supermarket ‘at least once a week’, almost two-thirds (63%) stated that they spend less than $100 per visit. More than two in five (46%) stated they spend between $100 and $199 and a further 13% stated they spend $200 or more. Respondents with an annual household income of more than $100,000 were significantly more likely to spend at least $100 per visit to the supermarket compared to those with an annual household income of less than $50,000 (44% ct 29%, p<0.001). Table A2. On average, how much do you spend in one visit to the supermarket? (Sample: 2,036) Respondents (%) Sep-15 Under $20 3 $20 to $49 27 $50 to $99 31 $100 to $149 22 $150 to $199 8 $200 or more 5 It varies 4 Comparing the healthiness of products Close to three in five respondents stated that they ‘always’ or ‘most of the time’ compare the healthiness of products when grocery shopping, while an additional 30% reported that they sometimes compare the healthiness of products (Figure A3). More than 60% of females reported that they ‘always’ or ‘most of the time’ compare how healthy products are, significantly higher than males, at 50% (p<0.01). Those with a university education were more likely to ‘always’ or ‘most of the time’ compare the healthiness of food products compared to those with a lower level of education (63% ct 49%, p<0.01). Supermarkets visited in the past month Woolworths and Coles were the supermarkets most visited by respondents; close to all respondents (96%) reported that they had visited a Woolworth and/or Coles supermarket in the past month (Figure A2). 28 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Figure A1. When buying food at the supermarket, what is the main thing that influences your choice between two similar products? (Sample: 2,036) Figure A2. Which supermarkets have you visited in the past month? (Sample: 2,036) Figure A3. When choosing a new food during grocery shopping, how often do you compare how healthy products are? (Sample: 2,036) National Heart Foundation of Australia 29 Chapter 2 – Area of Enquiry 2 Use of the nutrition information panel More than two in five respondents reported that they look at the NIP on ‘all’ or ‘most’ food products, when at the supermarket (Figure A4). Significantly, more females than males stated that they look at the nutrition information panel on ‘all’ or ‘most’ food products, when at the supermarket (44% ct 39%; p<0.02). Respondents in the 35 to 54 year age group were much more likely to report they look at the nutrition information panel on ‘all’ or ‘most’ food products (74%), compared to their younger (18 to 34, 49%) or older counterparts (55 years +, 39%). Those with a university education were more likely to look at the nutrition information panel on ‘all’ or ‘most’ food products compared to those without a university education (48% ct 34%, p<0.01). 2.3.2 Section B: Awareness of food logos Unprompted awareness of food logos Respondents were asked about their awareness of different logos that help customers choose the food they buy in the supermarket (Figure B1). Apart from the ‘Heart Foundation Tick’ logo, which was mentioned by 40% of respondents, awareness of such front-of-pack logos/logos was relatively low. ‘Australian Made’ was mentioned by 15% of respondents, followed by the ‘Health Star Rating’ system graphic at 11%. Almost two in five respondents were ‘Unsure’ what front- of-pack logos/logos exist to help consumers choose the food they buy at the supermarket. Unprompted awareness of the HSR system has more than tripled since April 2015, when only 3% nominated the HSR system graphic as a logo. Unprompted awareness of the HSR system* Age group Unprompted awareness of the HSR system was significantly higher among respondents under the age of 35, as they are nearly twice as likely to mention the HSR system compared to those aged 55 and over. Table B1. Age group Age group Respondents (%) Under 35 15.9 Between 35 to 54 10.5 55 or over 8.7 Gender Unprompted awareness of the HSR system was more widespread among females than males. Table B2. Gender Gender Respondents (%) Females 14.7 Males 8.4 Household income Respondents with a household income of at least $50,000 per annum were significantly more likely to be aware of the HSR system, compared to respondents with an annual income of less than $50,000. Unprompted awareness was relatively consistent for any income level above $50,000. Table B3. Household income Gross household income Respondents (%) <$50,000 6.6 $50,000 to $99,999 14.1 $100,000 or more 13.4 BMI Unprompted awareness of the HSR system was negatively correlated with BMI; respondents within the normal or underweight range were significantly more likely to be aware of the HSR system than those who are obese. Table B4. BMI BMI Respondents (%) <25.0 13.7 25.0 to 29.9 10.4 30.0 8.1 Indigenous status† Respondents of Aboriginal and Torres Strait Islander background were significantly less likely to have nominated the HSR system graphic as a food logo than non-Indigenous Australians. Table B5. Indigenous status Indigenous status Respondents (%) Indigenous 4.4 Non-Indigenous 11.7 * Tables B1 to B8: Apart from brand names, thinking about different logos that help customers choose the food they buy in the supermarket, which ones are you aware of? Sample: Age Group – Under 35 (n=610), 35 to 54 (n=655), 55 and over (n=771). Gender – Females (n=989), Males (n=1,047). Gross Household Income – <$50,000 (n=636), $50,000 to $99,999 (n=652), $100,000 or more (n=471). Body Mass Index – Less than 25.0 (n=731), 25.0 to 29.9 (n=588), ≥ 30.0 (n=395). Indigenous status – Indigenous (n=45), Non-Indigenous (n=1,942). Language – English only (n=1,651), Language other than English (n=358). Location Metro (n=1,467), Regional / Rural (n=568). Children at Home – With Children (n=661), No Children (n=1,335). †Caution in using this result, due to small sample size. 30 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Figure A4. On average, when at the supermarket, do you look at the nutrition information panel on…? (Sample: 2,036) Figure B1. Apart from brand names, thinking about different logos that help customers choose the food they buy in the supermarket, which ones are you aware of? (Sample: 2,036) National Heart Foundation of Australia 31 Chapter 2 – Area of Enquiry 2 Language spoken at home The level of unprompted awareness of the HSR system was not influenced by whether a person speaks only English at home or a language other than English. Age group Respondents under the age of 35 were significantly more likely to be aware of the HSR system than those aged 35 or over (p<0.001). Table B9. Age group Table B6. Language Language Respondents (%) Age group Respondents (%) English only 11.4 Under 35 63.8 Other than English 10.6 Between 35 to 54 50.5 55 or over 47.2 Location – metropolitan vs regional/rural Respondents living in metropolitan areas were significantly more likely to nominate the HSR system graphic as a food logo than those living in regional or rural areas of Australia. Table B7. Residential location Location Respondents (%) Metro 12.5 Regional/rural 8.8 Household structure – children Respondents who have children living at home were slightly more likely to have nominated the HSR system graphic as a food logo than those without children. Table B8. Children at home Gender Although not statistically significant, females were slightly more likely than males to be aware of the HSR system. Table B10. Gender Gender Respondents (%) Females 55.3 Males 51.3 Household income Similar to unprompted awareness, respondents with a household income of less than $50,000 were the least likely to be aware of the HSR system. Awareness of the system was highest among respondents with an annual income of $50,000 to $99,999. Table B11. Household income Children at home Respondents (%) With children 13.0 No children 10.7 Prompted awareness of logos on packaging Compared to prompted awareness of other logos on food packaging, the HSR system graphic was the eleventh most recognised logo from the selected list (Figure B2). Prompted awareness of the HSR system‡ In just a 12-month period, prompted awareness of the HSR system has increased four-fold. More than one in two respondents surveyed in September 2015 were aware of the HSR system (Figure B3). Gross household income Respondents (%) <$50,000 48.7 $50,000 to $99,999 58.7 $100,000 or more 53.5 BMI Awareness of the HSR system was highest among respondents who have a BMI <25. There was a marginal difference in awareness among respondents who are overweight or obese (BMI >25). Table B12. BMI BMI Respondents (%) <25.0 57.2 25.0 to 29.9 51.0 30.0 49.4 ‡Tables B9 to B16: Which of the following are you aware of on food packaging? Sample: Age Group – Under 35 (n=610), 35 to 54 (n=655), 55 and over (n=771). Gender – Females (n=989), Males (n=1,047). Gross Household Income – <$50,000 (n=636), $50,000 to $99,999 (n=652), $100,000 or more (n=471). Body Mass Index – Less than 25.0 (n=731), 25.0 to 29.9 (n=588), ≥ 30.0 (n=395). Indigenous status – Indigenous (n=45), Non-Indigenous (n=1,942). Language – English only (n=1,651), Language other than English (n=358). Location – Metro (n=1,467), Regional/rural (n=568). Children at Home – With Children (n=661), No Children (n=1,335). 32 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Figure B2. Which of the following are you aware of on food packaging? (Sample: 2,036) Figure B3. Prompted awareness of the HSR system over time (Sample: 2,036) National Heart Foundation of Australia 33 Chapter 2 – Area of Enquiry 2 Household structure – children Respondents who have children living at home were more likely to be aware of the HSR system than those without children. Indigenous status§ Respondents of Aboriginal and Torres Strait Islander background were more likely to be aware of the HSR system graphic as a food logo than non-Indigenous Australians. Table B16. Children at home Table B13. Indigenous status Children at home Respondents (%) Indigenous status Respondents (%) With children 57.8 Indigenous 62.2 No children 51.3 Non-Indigenous 53.0 2.3.3 Section C: Knowledge and understanding of the Health Star Rating system Language spoken at home Respondents who speak a language other than English at home were slightly more likely to be aware of the HSR system. Table B14. Language Language Respondents (%) English only 52.8 Other than English 55.0 Location – metropolitan vs regional/rural Respondents living in metropolitan areas were slightly more likely to be aware of the HSR system than those living in regional or rural areas of Australia. Understanding of what the HSR system means For respondents who were aware of the HSR system (n = 1,084), around two in three were aware that the HSR system is a rating scale of the healthiness of a food product or a comparison between two products in the same category (Figure C1). However, one in 10 respondents who were aware of the HSR system were unsure about what the HSR system graphic represents on the packaging of a food product. Table B15. Residential location Location Respondents (%) Metro 54.4 Regional/rural 50.4 Figure C1. When the HSR system graphic is on the packaging of food, what do you think it means? (Sample: 1,084) § Caution in using this result, due to small sample size (Indigenous). 34 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Knowledge of what the HSR system represents± Age group While as a proportion of respondents under the age of 35 were most likely to be aware of the HSR system compared to those aged 35 and over, they were however less likely to know that the HSR system is a comparative rating scale of the healthiness of food. Table C1. Age group Age group Respondents (%) Under 35 61.2 Between 35 to 54 68.3 55 or over 67.3 Gender Not only were females more likely than males to be aware of the HSR system, females were also more likely than males to know what the HSR system represents. Table C2. Gender Gender Respondents (%) Female 68.9% Males 61.8% Household income Respondents with an annual household income of less than $50,000 were the least likely to be aware of the HSR system, and if they were aware of the HSR system, they were least likely to know what the rating system represents. Table C3. Household income Income Respondents (%) <$50,000 61.9 $50,000 to $99,999 66.1 $100,000 or more 67.5 BMI Despite respondents with a BMI of at least 25 being less likely to be aware of the HSR system, they were more likely to know what it represents on food packaging compared to those with a BMI of <25. Language spoken at home Respondents who speak English only at home were significantly more likely to know that the HSR system is a comparative rating scale of the healthiness of food. Table C5. Language Language Respondents (%) English only 66.6 Other than English 59.9 Location – metropolitan vs regional/rural A respondent’s place of residence has little influence on whether they know what the HSR system represents on a food product. Table C6. Residential location Location Respondents (%) Metro 65.2 Regional/rural 66.1 Household structure – children There was minimal difference in the level of knowledge of the HSR system between respondents who have children living at home and those without any children in the household. Table C7. Children at home Children at home Respondents (%) With children 66.0 No children 65.0 Understanding about how the number of stars on a product is determined Respondents were asked their opinion about how the number of stars on a product is determined (Figure C2). Almost one-third of respondents believed the number of stars is determined through nutritional analysis. However, one in three were unsure about how the number of stars on a product is determined. Table C4. BMI BMI Respondents (%) <25.0 64.8 25.0 to 29.9 69.0 30.0 67.2 Tables C1 to C7: When the HSR system is on the packaging of food, what do you think it means? Sample: Age Group – Under 35 (n=389), 35 to 54 (n=331), 55 and over (n=364). Gender – Females (n=547), Males (n=537). Gross Household Income – <$50,000 (n=310), $50,000 to $99,999 (n=383), $100,000 or more (n=252). Body Mass Index – Less than 25.0 (n=418), 25.0 to 29.9 (n=300), ≥ 30.0 (n=195). Language – English only (n=872), Language other than English (n=197). Location – Metro (n=798), Regional/rural (n=286). Children at Home – With Children (n=382), No Children (n=685). ± National Heart Foundation of Australia 35 Chapter 2 – Area of Enquiry 2 Figure C2. In your opinion, how is the number of stars on a product determined? (Sample: 1,084) Statements about the HSR system The majority of respondents believed the HSR system makes it easier to identify the healthier option within a category (74%) and to compare products that are in the same category in the supermarket (73%). Both results are on par with the earlier results from April 2015. Seven in 10 respondents agreed the HSR system helps them think about the healthiness of food, and approximately three in five stated the system helps them make decisions about which foods to buy (61%) and makes them want to buy healthier products (58%). Just over one-quarter of respondents (28%) believed the HSR system graphic is just another logo that makes shopping more confusing, while a further 30% sit on the fence, neither agreeing nor disagreeing with this statement. Using the HSR system reported that they would use the HSR system to either compare the healthiness of products, to select the product that is healthier or use it as a quick reference guide. However, more than one-third of respondents were either unsure how they would use the HSR system or reported that they wouldn’t use it at all. Understanding what one star or five stars means Respondents were asked about their understanding of what one star on a product means (Figure C4). More than three-quarters reported they believe that one star represents an unhealthy product or a product of little nutritious value. One in 10 reported they believe one star signifies a product that is less healthy than products with more stars. Respondents were also asked what they believe five stars on a product means (Figure C5). The majority (88%) stated it represents a product that is the ‘the healthiest choice’ and one that is ‘good for your health’. Respondents were asked how they would use the HSR system (Figure C3). More than 60% of respondents Table C8. How strongly do you agree or disagree that the HSR system? (Sample: 1,084) Strongly agree/agree (%) Apr-15 73 Strongly agree/agree (%) Sep-15 74 Makes it easier for me to compare products that are in the same category in the supermarket 74 73 Helps me think about the healthiness of food 73 71 Makes it easier for me to identify the healthier option across all categories n/a 68 Helps me make decisions about which foods to buy 67 61 Makes it easier for me to compare products that are in the different categories in the supermarket 51 58 Makes me want to buy healthier products 62 57 It’s just another thing on a pack that makes shopping more confusing 24 28 Makes it easier for me to identify the healthier option within a category 36 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Figure C3. How would you use the HSR system? (Sample: 1,084) Figure C4. If a food product has one star, what do you think this means? (Sample: 1,084) Figure C5. If a food product has five stars, what do you think this means? (Sample: 1,084) National Heart Foundation of Australia 37 Chapter 2 – Area of Enquiry 2 Statements about HSR system – a product with more stars… Respondents were asked a series of statements about products with the HSR system graphic (Table C9). Table C10. The HSR system graphic can be displayed in five different ways. Please select the style you believe is the easiest to understand? (Sample: 1,084) In comparison with products that have less stars, more than three-quarters of respondents agreed a product with more stars is a healthier option. Almost one-third of respondents (30%) were uncertain (neither agreed nor disagreed or were unsure) whether a product with more stars is healthy. Similarly, there was some ambiguity around whether a product with more stars was more expensive than a product with less stars. More than half of the respondents disagreed with the statement that you can consume a product with more stars ‘as much as you like’ compared to a product with less stars, with more than one-quarter ‘uncertain’. Similarly, almost half disagreed that a product with more stars does not taste as good as a product with less stars. Again, a proportion of respondents were ambiguous to whether they agreed or disagreed with this statement. The HSR system graphic was displayed in the five different options available. Respondents were asked which they believe is easiest to understand (Table C10), to recognise (Table C11) and which provides sufficient information (Table C12). Easiest to understand More than half of respondents choose the most detailed HSR system graphic (Option 1) with additional nutrient information as the ‘easiest to understand’, followed by the next most detailed HSR system graphic (Option 2, 21%) and the single circle HSR system graphic (Option 4, 20%). Table C9. How strongly do you agree or disagree that a product with more stars means…? (Sample: 1,084) Strongly agree/ Agree (%) Neither (%) Strongly disagree/ Disagree (%) Unsure (%) It is a healthier option compared to a similar food product with less stars 78 16 5 1 It is a healthier option compared to a food product with less stars 76 16 6 2 It is healthy 63 28 8 2 It is more expensive than a product with less stars 26 39 30 5 You can eat it as much as you like compared to a product with less stars 17 26 55 2 It does not taste as good as a product with less stars 14 33 49 4 38 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Easiest to recognise Provides sufficient information Similar to ease of understanding, the HSR system graphic with the most detailed nutrient information (Option 1) was also selected by respondents as the easiest to recognise. Almost one-third believed the single circle HSR system graphic (Option 4) was the easiest to recognise. Along with being the easiest to understand and recognise, the HSR system graphic with the most detailed nutrient information (Option 1) was the favourite, most commonly identified as providing sufficient information, at 62%. Table C11. The HSR system graphic can be displayed in five different ways. Please select the style you believe is the easiest to recognise? (Sample: 1,084) Table C12. The HSR system graphic can be displayed in five different ways. Please select the style you believe provides sufficient information? (Sample: 1,084) Provides sufficient information Easiest to recognise HSR graphic Respondents (%) HSR graphic Respondents (%) 45% 62% 32% 21% 16% 11% 7% 5% 1% 1% National Heart Foundation of Australia 39 Chapter 2 – Area of Enquiry 2 Preferred option Not surprisingly, the HSR system graphic voted easiest to understand, easiest to recognise and provides the most sufficient information (Option 1), was chosen as the preferred choice by a significant proportion of respondents (57%). Table C13. Overall, please select the style you prefer the most? (Sample: 1,084) Preferred choice HSR graphic The other HSR system graphic that also provides additional information was selected by one in five as their most preferred option (Option 2). Respondents (%) 57% Reasons for preference Providing detailed information and ease of understanding were the two most common reasons for preference (Figure C6). More than two in three respondents who selected the two HSR system graphics that include nutrient information (Option 1, Option 2) reported that their selection was based on the HSR system graphic providing detailed information. Nine in 10 respondents who selected the HSR system graphic with just the single circle graphic (Option 4) reported that it was their preferred choice as it was easy to understand or simple. 21% 16% 5% 1% Figure C6. Why do you prefer that option? (Sample: 1,084) 40 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 2.3.4 Section D. Purchasing behaviours¶ Of those aware of the HSR system, more than two in five reported that in the past three months they had purchased a product with the HSR system graphic. Even though there were no significant differences by age, educational attainment and annual household income range, males were significantly more likely than females to have purchased a product displaying the HSR system graphic (49% ct 41%; p=0.008). Those who spoke a language other than English at home were more likely to have purchased a product displaying the HSR system graphic than those who spoke English only at home (56% ct 42%; p=0.000). Even though not significant, those with a BMI in the normal weight range (<25) were more likely to have purchased a product that had the HSR system than those with a BMI in the overweight or obese range (≥25). Table D1. In the past three months have you purchased a product that had the HSR system graphic? (Sample: 1,084) Yes Respondents (%) Apr-15 8 Respondents (%) Sep-15 45 No 41 10 Unsure 51 45 Table D2. Age group Age group Respondents (%) Under 35 46.5 Between 35 to 54 48.9 55 or over 40.1 Table D3. BMI BMI Respondents (%) <25.0 48.6 25.0 to 29.9 45.3 30.0 38.5 Table D4. Household income Gross household income Respondents (%) <$50,000 40.6 $50,000 to $99,999 48.0 $100,000 or more 46.8 Table D5. Gender Gender Respondents (%) Females 41.4 Males 48.8 Table D6. Language Language Respondents (%) English only 42.3 Other than English 55.8 Table D7. Children at home Children at home Respondents (%) With children 48.7 No children 42.7 Table D8. Residential location Location Respondents (%) Metro 45.9 Regional/rural 43.0 HSR system influenced choice More than half of respondents reported having the HSR system graphic on a product influenced their purchasing choice. Those with a BMI in the healthy range were significantly more likely to state that the HSR system on a product influenced their purchasing choice than those with a BMI in the overweight and obese range (61% ct 51%; p=0.04). Similar to purchasing a product with the HSR system graphic, those who were born overseas were more likely to state having the HSR system graphic on the product influenced their purchasing choice (53% ct 63%; p=0.04). Similarly, those who spoke a language other than English at home were more likely to state the HSR system influenced their purchasing choice than those who spoke English only at home (77% ct 50%; p<0.001). Table D9. Did the HSR system graphic on the product influence your choice? (Sample: 489) Respondents (%) Sep-15 Yes 56 No 37 Unsure 7 Tables D2 to D8: In the past three months have you purchased a product that had the HSR system? Sample: Age Group – Under 35 (n=389), 35 to 54 (n=331), 55 and over (n=364). Gender – Females (n=547), Males (n=537). Gross Household Income – <$50,000 (n=310), $50,000 to $99,999 (n=383), $100,000 or more (n=252). Body Mass Index – Less than 25.0 (n=418), 25.0 to 29.9 (n=300), ≥ 30.0 (n=195). Language – English only (n=872), Language other than English (n=197). Location – Metro (n=798), Regional/rural (n=286). Children at Home – With Children (n=382), No Children (n=685). ¶ National Heart Foundation of Australia 41 Chapter 2 – Area of Enquiry 2 How the HSR system influenced choice Continue to buy the product More than two in five respondents who reported the HSR system influenced their purchasing choice stated it confirmed they should buy their usual products. More than one-third of respondents chose a product with more stars that they don’t often buy. Nine in 10 respondents who reported choosing a product (that they don’t often buy or have never tried before) because it had more stars, stated they have continued or will continue to buy the products in the future. Table D10. How did it influence your choice? (Sample: 273) Table D11. Have you continued or will continue to buy the product? (Sample: 273) Respondents (%) Sep-15 Yes Respondents (%) Sep-15 90 No 2 Unsure 8 It confirmed I should buy my usual product 45 I chose a product with more stars that I don’t often buy 37 I chose a product with more stars that I’ve never tried before 11 I chose not to buy my usual product because it had fewer stars than other options Likelihood of the HSR system influencing choices in the future 7 Almost three-quarters of those who purchased a product with the HSR system graphic reported the rating system will likely influence the choices they make in the future when buying food. Reasons why the HSR system didn’t influence choice For those who stated the HSR system did not influence their purchasing choice, more than half stated it was because they choose their preferred choice. Other reasons were they were confident in choosing healthy food, issues surrounding the HSR system and there are more important factors when shopping (Figure D1). Males were more likely than females to state the HSR system will influence the choices they make in the future when buying food (74% ct 68%, p=0.03). Those who spoke a language other than English at home were more likely to state the HSR system will influence the choices they make in the future when buying food, compared to those who only speak English at home (83% ct 69%; p=0.001). Figure D1. Why didn’t the HSR system influence your choice? (Sample: 180) 42 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Table D12. Have you continued or will continue to buy the product? (Sample: 1,084) Very likely Respondents (%) Sep-15 19 Likely 53 Unlikely 14 Very unlikely 7 Unsure 7 HSR system graphic comparison – which is the healthier option? For the first two scenarios, nine in 10 respondents were able to choose the healthier option. In scenario three, when the information icons were added, respondents were slightly less likely to choose the healthier option. Table D15. Please select which you think is a healthier option in each pair? (Sample: 1,084) Scenario 3 These are the same Respondents (%) Apr-15 Respondents (%) Sep-15 3 5 Scenario 4 These are the same 90 *Results for September These are the same 2015 add to 101% 7 due to rounding. 91 5 Respondents (%) Apr-15 Respondents (%) Sep-15 4 3 89 93 Scenario 5 7 4 These are the same These are the same 11 10 81 83 8 7 Respondents (%) Apr-15 Respondents (%) Sep-15 6 9 6 12 87 78 Table D17. Please select which you think is a healthier option in each pair? (Sample: 1,084) Table D14. Please select which you think is a healthier option in each pair? (Sample: 1,084) Scenario 2 Respondents (%) Sep-15 Table D16. Please select which you think is a healthier option in each pair? (Sample: 1,084) Table D13. Please select which you think is a healthier option in each pair? (Sample: 1,084)* Scenario 1 Respondents (%) Apr-15 Respondents (%) Apr-15 Respondents (%) Sep-15 67 56 8 13 25 31 National Heart Foundation of Australia 43 Chapter 2 – Area of Enquiry 2 Foods and/or beverages purchased in the supermarket displaying the HSR system graphic The most popular food and/or beverages purchased in the supermarket displaying the HSR system graphic was breakfast cereals, with almost three in five respondents reported that they purchased breakfast cereals with the HSR system graphic. This was followed by ‘yoghurt and dairy desserts’ (34%), ‘cereal bars, nut/seed bars/ fruit bars’ (33%) and ‘margarines and spreads (including butter)’ (33%). Figure D2. Please select which foods and/or beverages you purchased in the supermarket which had the HSR system graphic on them? (Sample: 507) 44 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Foods and/or beverages on which it is important to display the HSR system graphic Breakfast cereals were most commonly identified as important food products to display the HSR system graphic, at 73%. This was followed by ‘cereal bars, nut/seed bars/fruit bars’ (67%) and ‘ready meals/meal kits’ (64%) and ‘yoghurt and dairy desserts’ (63%). Figure D3. Please select which foods and/or beverages you believe it is important to have the HSR system graphic on them? (Sample: 1,084) National Heart Foundation of Australia 45 Chapter 2 – Area of Enquiry 2 2.3.5 Section E. Advertising awareness Source of HSR system advertising Awareness of HSR system advertising When asked where they had seen, heard or read the advertising, half of respondents reported they saw a ‘TV advertisement’ about the HSR system. This was followed by ‘on food packaging’ and ‘in a supermarket catalogue’. Respondents were asked if they had seen, heard or read any advertising or promotions about the HSR system in the last three months. Only one in five respondents reported that they were aware of any advertising or promotions related to the HSR system. Respondents under the age of 55 were significantly more likely to be aware of HSR system advertising or promotions than those aged 55 and over (24% ct 12%, p<0.0001). Those with a university education were more likely to be aware of the advertising or promotions than respondents without a university education (23% ct 17%; p=0.014). Those who spoke a language other than English at home were more likely to be aware of HSR system advertising or promotional activity compared to those who only speak English at home (33% ct 17%; p<0.0001). Organisation that conducted the advertising More than half of respondents reported that they were ‘unsure’ who was responsible for the advertising or promotion in relation to the HSR system that they had seen or heard (Figure E2). Other responses include ‘product/brand specified’, ‘supermarket chain’ and the ‘Government’. Product advertised or promoted Almost two in five respondents reported that they were ‘unsure’ what product or products were being advertised (Figure E3). Breakfast cereals were most commonly mentioned by respondents, at 26%. Table E1. In the last three months, do you remember seeing, hearing or reading any advertising or promotions about the HSR system? (Sample: 1,084) Yes Respondents (%) Sep-15 20 No 59 Unsure 21 Figure E1. Where had you seen or heard about the HSR system? (Sample: 217) 46 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Influence advertising had on purchasing a product with the HSR system graphic Almost half of respondents stated that they purchased a product with the HSR system graphic that they wouldn’t normally buy, as a result of seeing, hearing or reading the advertisement. Table E2. After seeing or hearing this advertising or promotion(s) for products with a HSR system graphic, did it influence you to buy a product or products you normally wouldn’t buy? (Sample: 217) Yes Respondents (%) Sep-15 48 No 45 Unsure 7 Figure E2. Which organisation or company did the advertising or promotion(s)? (Sample: 217) Figure E3. What product or products were being advertised or promoted? (Sample: 217) National Heart Foundation of Australia 47 Chapter 2 – Area of Enquiry 2 2.3.6 Section F: Attitudes and perceptions about the HSR system Statements about the HSR system – perceptions and attitudes Respondents were provided with a series of statements about the HSR system. The majority of respondents (almost three-quarters) agreed that the HSR system is ‘easy to use’ and ‘easy to understand’. Even though around three in five respondents agreed that the HSR system ‘makes choosing food easier’ and is personally relevant to them and their family, some level of ambiguity exists with just over onequarter neither agreeing nor disagreeing with the statements. Similarly, approximately one in three respondents were uncertain whether the HSR system is credible, reliable, trustworthy, open and transparent. Table F1. How strongly do you agree or disagree that the HSR system…? (Sample: 1,084) Strongly agree/ Agree (%) Sep-14 Strongly agree/ Agree (%) Apr-15 Strongly agree/ Agree (%) Sep-15 34 38 51 Is easy to understand 67 59 72 Is easy to use n/a 58 72 Is a system I trust Table F2. How strongly do you agree or disagree that the HSR system…? (Sample: 1,084) Strongly agree/ Agree (%) Neither (%) Strongly disagree/ Disagree (%) Unsure (%) Is relevant to my family 60 27 12 1 Is personally relevant to me 58 28 13 1 Table F3. How strongly do you agree or disagree that the HSR system…? (Sample: 1,084) Strongly agree/Agree (%) Neither (%) Strongly disagree/ Disagree (%) Unsure (%) Makes choosing food easier 62 27 10 1 Is a credible system 57 29 11 3 Is a reliable system 54 32 10 3 Is open and transparent 50 35 12 3 Is hard to see on the package 26 35 36 2 Is confusing 19 27 53 1 Has a poor reputation 17 34 42 6 48 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Trust in the HSR system** Table F8. Language Respondents aged 55 or over were significantly less likely than those under the age of 55 to trust the HSR system. Similarly, respondents with a household income of less than $50,000 per annum, those with a BMI of 30 or higher or those who speak English only at home were also significantly less likely to trust the HSR system. Table F4. Age group Age group Respondents (%) Under 35 46.5 Between 35 to 54 48.9 55 or over 40.1 Respondents (%) <25.0 48.6 25.0 to 29.9 45.3 30.0 38.5 English only 42.3 Other than English 55.8 Table F9. Gender Gender Respondents (%) Females 41.4 Males 48.8 Location Respondents (%) Metro 45.9 Regional/rural 43.0 Level of confidence in the HSR system Three in five respondents who were aware of the HSR system reported they have a ‘high’ or ‘somewhat high’ level of confidence in the rating system (Figure F1). There was no real difference by gender and age categories, BMI range, educational attainment or household income status. Table F6. Household Income Gross household income Respondents (%) Table F10. Residential location Table F5. BMI BMI Language Respondents (%) <$50,000 40.6 $50,000 to $99,999 48.0 $100,000 or more 46.8 Those who speak a language other than English at home were significantly more likely to have a high or somewhat high level of confidence in the HSR system than those who speak English only at home (72% ct 57%; p=0.001). Table F7. Children at home Children at home Respondents (%) With children 48.7 No children 42.7 Figure F1. Overall, what level of confidence do you have in the HSR system? (Sample: 1,084) ** Tables F4 to F10: How strongly do you agree or disagree that the HSR system is a system that I trust? Sample: Age Group - Under 35 (n=389), 35 to 54 (n=331), 55 and over (n=364). Gender – Females (n=547), Males (n=537). Gross Household Income - <$50,000 (n=310), $50,000 to $99,999 (n=383), $100,000 or more (n=252). Body Mass Index – Less than 25.0 (n=418), 25.0 to 29.9 (n=300), ≥ 30.0 (n=195). Language – English only (n=872), Language other than English (n=197). Location – Metro (n=798), Regional / Rural (n=286). Children at Home – With Children (n=382), No Children (n=685). National Heart Foundation of Australia 49 Chapter 2 – Area of Enquiry 2 2.3.7 Section G: Health attitudes and behaviours Concern about the healthiness of food purchased Almost two in five respondents reported they were ‘extremely’ or ‘very’ concerned about the healthiness of the food they buy. Older respondents (55 years and over) were significantly more likely than their younger counterparts to report they were ‘extremely’ or ‘very’ concerned (44% ct 31%; p=<0.0001). Females were markedly more likely than males to be concerned about the healthiness of food they buy (43% ct 33%; p=0.005). Those with a university education were significantly more likely to be concerned with the healthiness of the food they purchase compared to those without a university education (42% ct 34%; p=0.0002). There was no significant difference between BMI range, annual household income, language spoken at home and whether born in Australia or overseas. Respondents aware of the HSR system were significantly more likely to be ‘extremely’ or ‘very’ concerned about their health, but there was very little difference between respondents who purchased products with the HSR system graphic or not, and whether they are ‘extremely’ or ‘very’ concerned about their health. Table G1. In general, thinking about all the food you buy, how concerned are you about how healthy the food is for you? (Sample: 2,036) Extremely concerned Respondents (%) Sep-15 13 Very concerned 26 Moderately concerned 37 A little concerned 20 Not at all concerned 4 Unsure 1 Those with a university education were significantly more likely than those without one to perceive their diet as ‘healthy’ or ‘very healthy’ (68% ct 61%; p=0.001). Respondents aware of the HSR system and those who reported purchasing products with the HSR system graphic were significantly more likely to report that their diet is either ‘healthy’ or ‘very healthy’. Table G2. Thinking about your diet, would you say that what you usually eat is? (Sample: 2,036) Very healthy Respondents (%) Sep-15 8 Healthy 56 Neither healthy nor unhealthy 30 Unhealthy 4 Very unhealthy 1 Unsure 1 Changes to diet over the last six months Just below two in five respondents made changes to their diet over the last six months. Females were significantly more likely to report having made changes to their diet over the last six months compared to males (44% ct 35%; p<0.0001). Older respondents (aged 55 years and over) were significantly more likely to report having made changes to their diet over the last six months than their younger counterparts (48% ct 32%; p<0.0001). No significant differences existed between socioeconomic status, language spoken at home and BMI range. Respondents aware of the HSR system and those who had purchased products with the HSR system graphic were significantly more likely to report that they had made changes to their diet in the past six months (49% ct 32%, p<.001). Table G3. Over the past six months, have you made any changes to your diet? (Sample: 2,036) Respondents (%) Sep-15 Perceived healthiness of diet Almost two-thirds of respondents perceived their diet to be ‘healthy’ or ‘very healthy’. Almost one-third of respondents (31%) were uncertain or unsure whether their diet is ‘healthy’ or ‘unhealthy’. Older respondents (55 years and over) were more likely to perceive their diet as ‘healthy’ or ‘very healthy’ compared to younger respondents (18 to 34 years) (74% ct 57%; p<0.0001). Respondents with a BMI in the normal weight range were significantly more likely than those with a BMI in the overweight or obese range to perceive their diet as ‘healthy’ or ‘very healthy’ (74% ct 60%; p<0.0001). 50 Yes 39 No 58 Unsure 4 Type of changes made to diet When asked what changes they made to their diet, the three most common changes include changing the types of food they eat (67%), changing the amount of food they eat (57%) and excluding/cutting out types of food from their diet (43%). Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 2 – Area of Enquiry 2 Figure G1. Which of the following changes have you made in the past six months to your diet? (Sample: 794) Figure G2. For which of the following reasons did you make changes to your diet? (Sample: 794) Reasons for making changes to diet Almost two-thirds of respondents stated they made changes to their diet ‘to improve their physical health’. Three in five respondents stated they made changes to their diet ‘to lose weight’ and almost half of respondents changed their diet ‘to feel better’. those with a BMI in the overweight or obese range to perceive their overall health as ‘excellent’ or ‘very good’ (48% ct 29%; p<0.001). More than two in five respondents (44%) with an annual household income of $100,000 or more perceived their overall health as ‘excellent’ or ‘very good’, compared to 30% of those with a lower Perceived overall health More than one-third of respondents perceived their overall household income (p<0.001). Similarly, more than two in five respondents with a university education health to be ‘excellent’ or ‘very good’, with a further 42% perceiving their overall health as ‘good’. In contrast, close perceived their overall health as ‘excellent’ or ‘very good’, compared to 30% of those with a lower to one-quarter perceived their health to be ‘fair’ or ‘poor’. education level (p<0.001). Respondents aware of the There were no notable differences within age and gender HSR system and those who had purchased products categories and perceived health. Those with a BMI in the displaying the HSR system graphic were significantly normal weight range were significantly more likely than more likely to perceive their overall health to be ‘excellent’ or ‘very good’ (46% ct 32%, p<.001). National Heart Foundation of Australia 51 Chapter 2 – Area of Enquiry 2 Table G4. In general, would you say your overall health is? (Sample: 2,036) Respondents (%) Sep-15 Excellent 6 Very good 30 Good 42 Fair 18 Poor 4 Physical activity levels Sufficient physical activity for Australians 18 years and older was measured against the guidelines recommending 150 minutes from five or more sessions per week.15 Just below one-quarter of respondents reported undertaking at least 150 minutes of moderate to vigorous physical activity per week. Those with a BMI in the normal weight range were most likely to meet the recommended guidelines for moderate to vigorous activity, considerably higher than those with a BMI in the obese range (28% ct 18%; p=0.002). Table G5. In a typical week, on how many days would you do moderate or vigorous physical activity for at least 30 minutes? (Sample: 2,036) Daily intake of fruit and vegetables Intake of fruit and vegetables for Australians ages 18 years and older was measured against the guidelines recommending at least two serves of fruit and five serves of vegetables daily.16 Just over half of respondents reported regularly consuming two or more serves of fruit daily. Females were significantly more likely to report consuming the recommended servings of fruit per day than males (54% ct 48%; p=0.05). Those with a university education were more likely than those without to report they consume two or more serves of fruit daily (57% ct 46%; p<0.0001). More than half (56%) of respondents with a BMI in the normal weight range reported consuming the recommended servings of fruit daily, compared to 41% of those with a BMI in the obese range (p<0.0001). Table G6. How many serves of fruit (including fresh, dried, frozen and tinned fruit) do you usually eat each day? (Sample: 2,036) 1–2 serves Respondents (%) Sep-15 46 3–4 serves 39 5 serves or more 9 Don’t eat vegetables 2 Meet guideline 9 None Respondents (%) Sep-15 16 One day 13 Two days 16 Three days 18 Four days 10 Five days 11 Six days 5 Seven days 8 Unsure 2 1 serves Respondents (%) Sep-15 38 Meet guideline 24 2 serves 37 3 serves or more 15 Don’t eat fruit 7 Unsure 4 Meet guideline 51 52 Only one in 11 respondents reported that they regularly consume five or more serves of vegetables daily. Table G7. How many serves of vegetables (including fresh, frozen and tinned vegetables) do you usually eat each day? (Sample: 2,036) Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 3 Area of Enquiry 3 Nutrient status of products carrying a HSR system graphic National Heart Foundation of Australia 53 National Heart Foundation of Australia 53 Chapter 3 – Area of Enquiry 3 3.1 Chapter summary 55 3.1.1 Nutrient status of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) 3.2 Methodology 55 56 3.2.1 Data analysis 3.3 Results 56 56 3.3.1 Nutrient status of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) Figure 3.1. Number of products (n) displaying each HSR on pack, at Year 1 (June 2014 to June 2015) Figure 3.2. Mean HSR displayed on pack, by HSR Category Class, at Year 1 (June 2014 to June 2015) 56 56 57 Figure 3.3. Number of products (n) displaying each HSR on pack, by HSR Category Class, at Year 1 (June 2014 to June 2015) 57 Table 3.1. Number of products (n) in each HSR Category Class, by HSR vs non-HSR products, for each nutrient, at Year 1 (June 2014 to June 2015) 58 Figure 3.4. Mean energy content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) 59 Figure 3.5. Mean saturated fat content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) 59 Figure 3.6. Mean sugars content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) 60 Figure 3.7. Mean sodium content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) 60 Figure 3.8. Mean protein content of HSR vs non-HSR products, by HSR Category Class at Year 1 ( June 2014 to June 2015) 61 Figure 3.9. Mean fibre content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) 61 54 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 3 – Area of Enquiry 3 3.1 Chapter summary 3.1.1 Nutrient status of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) The most commonly displayed HSR on pack was 4.0, which was on 30% of products displaying the HSR system graphic. The lowest star ratings (0.5, 1.0) were displayed on the least number of products (n = 2, both). For products that displayed the HSR system graphic, the mean HSR was 4.0. The mean HSR was greatest for the ‘1 – Beverages’ Category Class (4.5) and lowest for the ‘3 – Oils and spreads’ Category Class (2.0). The ‘2 – Food’ Category Class had the majority of products displaying the HSR system graphic (86%). For each nutrient that underpins the HSRC (energy, saturated fat, sugars, sodium, protein and fibre)1, the mean nutrient content per 100 g/100 mL was similar between HSR products and non-HSR products across all HSR Category Classes. Option 1 HSR + energy icon + 3 prescribed nutrient icons + optional nutrient Option 3 HSR + energy icon Option 2 HSR + energy icon + 3 prescribed nutrient icons Option 4 HSR only Option 5 Energy icon only National Heart Foundation of Australia 55 Chapter 3 – Area of Enquiry 3 3.2 Methodology To conduct part of this assessment, CSIRO software engineers developed automated reporting scripts in FoodTrackTM that provided reports relating to the nutrient status of products displaying the HSR system. The following parameters were used: As there is no comparator, i.e. these were Year 1 measurements (June 2014 to June 2015), no assessment against changes to the formulation of products displaying the HSR system graphic over time was possible. It is anticipated that this additional work will be able to be conducted for Year 2 reporting. It should be noted that due to the small sample sizes of Descriptive statistics including category and group counts products displaying the HSR system graphic, when Distribution of HSR by HSR Category Class and overall broken down by HSR Category Class, no statistical analysis comparing the groups was able to be Mean HSR by HSR Category Class and overall performed. These results are therefore primarily Mean nutrient values, by HSR Category Class, and by descriptive. It is anticipated when the volume of products displaying the HSR system graphic increases (for Year the following three groups: 1), statistical comparisons will be able to be conducted - products displaying the HSR system graphic (‘HSR for some variables. products’) - products not displaying the HSR system graphic (‘non-HSR products’) - whole HSR Category Class* (‘whole category’). For the automated reporting, a series of rules was created in FoodTrackTM: all product NIP data was for the product ‘as consumed’ for categories that have NIP data as ‘dry/undiluted’ only, these were calculated separately; ‘Hot cereals – flavoured’, ‘Hot cereals – plain’, ‘Pasta & Noodles – plain’ All NIP data to be reported 100 g/100 mL 3.2.1 Data analysis Unless specified, all analyses for AoE 3 were conducted in Microsoft Excel 2013. Automated reporting scripts were developed for use in FoodTrack TM, a cloud-based SQL database. 3.3 Results 3.3.1 Nutrient status of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) The number of products displaying each HSR on pack is outlined in Figure 3.1. The most commonly displayed NIP data with ‘<’ values was treated as a whole HSR on pack was 4.0, which was on 30% of products. number, eg. ‘<1’ treated as 1 Similar levels of presence were seen for HSRs 3.5, 4.5 any data that was missing (N/A) was treated as missing and 5.0. The lowest star ratings, 0.5 and 1.0, were data, not zero. displayed on the least number of products (n = 2, both). Figure 3.1. Number of products (n) displaying each HSR on pack, at Year 1 (June 2014 to June 2015) *It was not possible to conduct this work by HSR Category as the sample sizes were too small. 56 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 3 – Area of Enquiry 3 For products that displayed the HSR system graphic at Year 1, the mean HSR was 4.0.† Figure 3.2 shows the mean HSR by HSR Category Class. There were no products at Year 1 displaying the HSR system graphic that belonged to the ‘2D – Dairy food’ Category Class. The mean HSR was greatest for ‘1 – Beverages’ (4.5), and lowest for ‘3 – Oils and spreads’ (2.0)‡. The number of products displaying each HSR on pack across the five HSR Category Classes is outlined in Figure 3.3. The majority of products were observed in the ‘2 – Food’ Category Class across all HSRs except 0.5 and 1.0. This is reflective of the fact that 86% of products displaying the HSR system at Year 1 fell into the ‘2 – Food’ Category Class. The large majority (27/32) of products in the ‘1 – Beverages’ Category Class displayed 5.0 stars. Figure 3.2. Mean HSR displayed on pack, by HSR Category Class, at Year 1 (June 2014 to June 2015) Figure 3.3. Number of products (n) displaying each HSR on pack, by HSR Category Class, at Year 1 (June 2014 to June 2015) † Excludes products displaying Option 5, energy icon only, as this cannot be quantified as a single HSR. ‡ Category Class product counts are as follows: n=3, 2, 285, 9 and 32 for Class 3, 3D, 2, 1D and 1, respectively. National Heart Foundation of Australia 57 Chapter 3 – Area of Enquiry 3 graphic at Year 1 (‘non-HSR products’) varied across nutrients, this is reflective of missing data on-pack. The count varied for fibre for both products displaying the HSR system graphic (‘HSR products’) and those not displaying the HSR system graphic (‘non-HSR products’) as it is not mandatory to list fibre on the NIP, and therefore the counts are lower for fibre than all other nutrients listed (Table 3.1). Those products in the ‘1D – Dairy beverages’ Category Class all displayed 3.0 stars or more, where as those in the ‘3 – Oils and spreads’ and ‘3D – Cheese and processed cheese’ all displayed 3.0 stars or less. Note the small sample size, however, in these latter two HSR Category Classes (n = 5 in total)‡. This next section compares the nutrient status of products displaying the HSR system graphic at Year 1 (June 2014 to June 2015) to that of products without the HSR system graphic, within each of the five HSR Category Classes (there were no products at Year 1 displaying the HSR system graphic that belonged to the ‘2D – Dairy food’ Category Class). Specifically, comparisons were made of the nutrients that are incorporated into the HSRC, i.e. energy, saturated fat, sugars, sodium, protein, and fibre.§ All per 100 g or 100 mL as consumed. The next section compares the mean values of the nutrients listed in Table 3.1 between HSR products and non-HSR products, by HSR Category Class. There was no marked difference in the mean energy content (per 100 g/100 mL) between each of HSR products and non-HSR products, within each HSR Category Class (Figure 3.4). The greatest variance was observed in ‘3 – Oils and spreads’ for which the HSR products had a higher mean energy content than the non- HSR products. However this result should be interpreted with caution as there were only three products at Year 1 displaying the HSR system in this HSR Category Class. A similar observance was seen with ‘3D – Cheese and processed cheese’, which also had a small sample size (n = 2) for products displaying the HSR system graphic at Year 1 (Figure 3.4). Statistical comparisons were not conducted due to the small sample size within most of these groups. In addition, analysis did not specifically look at these same comparisons by HSR Category due to the even smaller sample sizes of products displaying the HSR system graphic at Year 1. It is anticipated more detailed analysis will be able to be conducted for Year 2 reporting, which will have a larger number of products displaying the HSR system graphic, and will have Year 1 data as a comparator for assessment of reformulation over time. Figure 3.5 shows similar trends for the mean saturated fat content for both ‘3 – Oils and spreads’ and ‘3D – Cheese and processed cheese’, which although may appear more marked than the differences observed within these categories for the mean energy content, again the small sample sizes at Year 1 should be noted (n = 3 and n = 2, respectively). For this next section, the sample size of some groups was small and should be interpreted with caution. The product counts are summarised in Table 3.1. Where product counts for those not displaying the HSR system Table 3.1. Number of products (n) in each HSR Category Class, by HSR vs non-HSR products, for each nutrient, at Year 1 (June 2014 to June 2015) Number of products (n) in each Category Class Grouping HSR products Non-HSR products 1 – Beverages 1D – Dairy beverages 2 – Food Energy, saturated fat, sugars, protein, sodium 32 9 257 3 2 Fibre 27 9 219 N/A N/A Energy 816 282 8,324 292 418 Saturated fat 816 281 8,307 292 417 Sugars 816 282 8,314 289 415 Protein 816 282 8,323 290 418 Sodium 816 282 8,319 269 416 Fibre 319 107 2,573 10 19 Nutrient(s) per 100 g/100 mL 3 – Oils and spreads § Fruit, vegetable, nut, legume (FVNL) content has been excluded from the analyses in this section. Excludes those displaying Option 5, energy icon. Also excludes 28 products in ‘2 – Food’, for which NIP data was only available ‘dry/undiluted’. All other data is reported per 100 g/100 ml ‘as consumed’. 58 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 3D – Cheese and processed cheese Chapter 3 – Area of Enquiry 3 Figure 3.4. Mean energy content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) Figure 3.5. Mean saturated fat content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) National Heart Foundation of Australia 59 Chapter 3 – Area of Enquiry 3 The mean sugars content for ‘1D – Dairy Beverages’ and ‘2 – Food’, as shown in Figure 3.6, was visibly less for HSR products vs non-HSR products. Conversely, this was the opposite for ‘1 – Beverages’. The sugars content of ‘3 – Oils and spreads’ and ‘3D – Cheese and processed cheese’ was minimal across both groups (HSR products and non-HSR products), which would be expected given the nutritional profile of these types of foods. The mean sodium content of HSR products in ‘2 – Food’ and ‘3D – Cheese and processed cheese’ was lower than that of the products without. Conversely, the opposite was observed in ‘3 – Oils and spreads’, noting the small product count, n = 2 (Figure 3.7). The mean protein content of products in ‘2 – Food‘ and ‘3D – Cheese and processed cheese’ was slightly greater for HSR products compared to nonHSR products compared to those without (Figure 3.8). The opposite was observed with ‘1D – Dairy beverages’. Figure 3.6. Mean sugars content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) Figure 3.7. Mean sodium content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) 60 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Chapter 3 – Area of Enquiry 3 The mean fibre content, as shown in Figure 3.9, was greatest in ‘2 – Food’, and there was minimal difference between HSR and non-HSR products, within this HSR Category Class. Conversely, the mean fibre content for both HSR and non-HSR products was much lower for ‘1 – Beverages’, ‘1D – Dairy beverages’, ‘3 – Oils and spreads’ and ‘3D – Cheese and processed cheese’. This would be expected, however, due to the nutritional profile of the foods and beverages in these HSR Category Classes¶. Figure 3.8. Mean protein content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) Figure 3.9. Mean fibre content of HSR vs non-HSR products, by HSR Category Class at Year 1 (June 2014 to June 2015) ¶ Note mean fibre values for Category Classes 3 and 3D, for HSR products, are N/A as fibre not available on the NIPs. National Heart Foundation of Australia 61 References 1. Commonwealth of Australia. Labelling Logic; Review of Food Labelling Law and Policy. Canberra: Commonwealth of Australia; 2011. Available at: www.foodlabellingreview.gov.au/internet/foodlabelling/publishing.nsf/Content/labelling-logic. Accessed 17 March 2016. 2. Food Standards Australia and New Zealand (FSANZ). Australia and New Zealand Food Standards Code 1.2.7; Nutrition, Health and Related Claims. Canberra: FSANZ; 2015. Available at: http://www.foodstandards.gov.au/industry/labelling/Pages/Further- work-related-to-Standard-1.2.7-.aspx. Accessed 17 March 2016. 3. Department of Health. Health Star Rating system. Available at: http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/style-guide. Accessed 17 March 2016. 4. Program Logic 2015. Available at: http://evaluationtoolbox.net.au/. Accessed 17 March 2016. 5. Australian Bureau of Statistics (ABS). Australian Health Survey: First Results, 2011-1’, cat. no. 4364.0.55.001. Canberra: ABS; 2014. Available at: www.abs.gov.au/ausstats/[email protected]/Lookup/4364.0.55.001main+features12011-12. Accessed 17 March 2016. 6. Department of Health. Guide for industry to the Health Star Rating Calculator; Version 3. Canberra: Commonwealth of Australia; 2015. 7. Department of Health. Health Star Rating System Style Guide: Version 3.3. Canberra: Commonwealth of Australia; 2014. 8. Retail Media. Retail World Annual Report December 2014. Sydney: Retail Media; 2015. 9. Retail Media. Retail World Annual Report December 2015. Sydney: Retail Media; 2016. 10. Australian Food and Grocery Council (AFGC). DIG Audit Report May 2013. 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Available at: http://www.healthstarrating.gov.au/internet/healthstarrating/ publishing.nsf/Content/DFBB60481884B091CA257F1C000B631B/$File/HSR-Consumer-Use-and-UnderstandingBenchmark- report.pdf. Accessed 17 March 2016. 15. Commonwealth of Australia. Australia’s Physical Activity & Sedentary Behaviour Guidelines for Adults (18–64 years). Canberra: Commonwealth of Australia; 2014. Available at: www.health.gov.au/internet/main/publishing.nsf/content/healthpubhlth-strateg- phys-act-guidelines. Accessed 17 March 2016. 16. National Health and Medical Research Council (NHMRC). Australian Dietary Guidelines 2013. Canberra: NHMRC; 2013. Available at: www.nhmrc.gov.au/guidelines-publications/n55. Accessed 17 March 2016. 62 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Appendix 1. Wave 1 Uptake Report Report for Wave 1 of additional uptake monitoring of the Health Star Rating (HSR) System, in Australian supermarkets in September 2015 Submission to: Department of Health (the Department) Submitted by: National Heart Foundation of Australia (the Heart Foundation) Thursday 22 October 2015 Contact: Project Manager – Xenia Cleanthous Manager, Nutrition Data & Analysis, Health Outcomes Tel: (03) 9321 1516 Email: [email protected] Background The Department have requested more regular monitoring of uptake of the Health Star Rating (HSR) system across products stocked in the two major retailers (Coles and Woolworths). In response to this, the Heart Foundation submitted a proposal in July 2015 to conduct an additional three waves of data collection to monitor the uptake of the HSR system in-store. The time frames for these three waves are: Wave 1 – September 2015 Wave 2 – January 2016 Wave 3 – May 2016. This report provides the results for the Wave 1 of this collection. Methodology The Heart Foundation is using the joint Heart Foundation and CSIRO FoodTrackTM database to conduct the monitoring and evaluation of the implementation of the HSR system for a two-year period (retrospective June 2014 to June 2016). The data collection method, to populate this database, is an annual rolling process whereby the 80+ categories are collected progressively throughout the year, across major Australian retailers – Coles and Woolworths. The Heart Foundation currently has a team of trained data collection field officers (qualifications in nutrition and/or dietetics) who populate the FoodTrack TM database on an ongoing basis, by collecting data instore using smartphone technology. This collection methodology does not capture the roll-out of the HSR system at a given point in time. The Health Star Rating Advisory Committee (HSRAC) and the Department of Health (the Department) regularly receive requests for an update on the number of products carrying the HSR system at a given time point, and currently have no methodology in place to capture this on a regular basis. To address the request for the additional uptake monitoring, one of our trained data collection officers was recruited specifically for this piece of work. The activities conducted were as follows: 1. Heart Foundation staff developed a template for collection of the required data in-store, and an additional standard operating procedure (SOP) to ensure standardised collection methodology. 2. The data collection officer was trained for this work using the developed SOP. Training was conducted by Heart Foundation staff and the officer was provided with instructions regarding the data they were required to collect. 3. Data was collected according to the SOP during two consecutive weeks in September. 4. The written record of data collected was transcribed into an existing Excel template. 5. Data collected was audited by Heart Foundation staff, and supplemented with products in the FoodTrackTM database that display the HSR system, that were not captured in-store. What was collected (as per original proposal) Barcode, manufacturer, brand, item description (including pack size). Presence of a HSR system graphic. National Heart Foundation of Australia 63 What was not collected (as per original proposal) No additional product information, i.e.: images, star-type, use of ‘snail’ or not, NIP data, ingredients, positon on packaging, etc. Manufacturer, brand Count of products with a HSR system graphic Freedom Nutritional Products 18 Freedom Foods Go Natural (Manufacturer) Go Natural Scope of products The data collection officer visited one major Coles and one major Woolworths in metropolitan Victoria during the month of September. Green’s General Foods Lowan Hampden Trading Freelicious All Private Label and Branded products were reviewed, for all FoodTrackTM categories. HJ Heinz Company Australia Multipacks and variety packs were included. Kellogg (Aust) Products with multiple pack sizes were included, with one record per pack size. Results Table A1.1 outlines the number of products found in-store, by manufacturer, by brand. Table A1.1. Products with HSF graphic found in-store by manufacturer and brand Al & Dan’s (Manufacturer) Al & Dan’s Arnott’s Biscuits Arnott’s Australian Wholefoods Clever Cooks Count of products with a HSR system graphic 2 2 5 5 3 3 1 1 1 1 18 18 44 Be Natural 1 Kellogg’s 42 Vogel’s 1 Kez’s Kitchen A total of 1,513 products were recorded for the given time point. In addition, there were 13 multipack products which displayed more than one HSR system graphic on pack to reflect the different flavour variants. Manufacturer, brand Heinz 18 Kez’s Lion – Dairy & Drinks 1 1 40 Berri 5 Just Juice 8 The Daily Juice Company 17 Vitasoy 2 YoGo 1 Yoplait 7 Lucozade Ribena Suntory Ribena Mayver’s Health Time Health Time Monster Health Food Co 3 Monster Muesli 3 Nestle Australia 1 1 5 5 5 5 156 8 Allens 23 8 Maggi 18 2 Milo 8 2 Nestle 35 15 Uncle Toby’s 71 Carman’s 15 Wonka 1 Chris’ Dips 4 Norco Foods 3 4 Mighty Cool 3 7 Parilla Fresh 3 Emma & Tom’s 7 Good 4U 3 Fonterra Australia 6 Betta Foods Australia Capricorn Campbell Australia V8 Carman’s Kitchen Chris’ Emma & Tom Foods Nestle 6 Food For Health (Manufacturer) 11 Food For Health 64 11 Picot Productions Pic’s Popina Foods 2 2 18 Arnold’s Farm 11 Goodness Superfoods 7 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Manufacturer, brand Count of products with a HSR system graphic Manufacturer, brand Count of products with a HSR system graphic Primo Moraitis Fresh 2 The Juice Lab (Manufacturer) 5 Mrs Crocket’s Private Label – Coles 2 557 The Juice Lab 5 The Wrigley Company 19 508 Skittles 6 Coles Graze 1 Starburst 13 Coles Grill 16 Coles Made Easy 13 Coles Simply Gluten Free 4 Coles Smart Buy 15 Coles Private Label – Woolworths 368 Homebrand 31 Macro 52 Macro Organic 28 Woolworths 66 Woolworths Created With Jamie 30 Woolworths Free From Dairy 3 Woolworths Free From Gluten 2 Woolworths Gold 9 Woolworths Select 147 PureBred Bakery 2 Pure Bred 2 Rinoldi Pasta 8 Vetta 8 Sanitarium Health Foods Company 85 Naturally Nood 9 Sanitarium 58 So Good 13 Vegie Delights 5 Simplot Australia 20 John West 5 Lean Cuisine 14 Quorn 3 Ardmona Spreyton Fresh Tasmania 3 Unilever Australasia Continental 10 Vitality Brands Worldwide Well Naturally 3 3 YOLO (Manufacturer) Total count 10 6 6 1,513 The 13 multipack products that displayed more than one HSR system graphic on pack include: eight x Nestle Australia products (Brand; Nestle – Ski D’lite) that were multipacks with more than one HSR system graphic on them (one for each flavour variant) five x Private Label – Woolworths products (Brand; Woolworths Select) that were multipacks with more than one HSR system graphic on them (one for each flavour variant). 1 Sunbeam Foods 4 Sunpork Tucker’s 3 6 1 Sunpork Fresh Foods 3 Tucker’s Natural YOLO 3 6 Spreyton Fresh Sunbeam Evia 42 Birds Eye SPC Ardmona Operations The Yoghurt Co 4 5 5 The Happy Snack Company (Manufacturer) 2 The Happy Snack Company 2 National Heart Foundation of Australia 65 Appendix 2. Compliance checklist # Question Answer Next step 1 Does the product carry a HSR system graphic? 2 Is the product one that can display a HSR 1 = Go to Q2 2 = End of questions Go to Q3 3 system graphic? Is the product one that is intended to display 1 = Yes 2 = No 1 = Yes 2 = No 1 = Yes 2 = No 1 = HSR + energy icon + 3 prescribed nutrients + 1 optional nutrient 2 = HSR + energy icon + 3 prescribed nutrients 3 = HSR + energy icon 4 = HSR 5 = Energy icon 1 = Go to Q5 2 = Go to Q6 3 = Go to Q7 4 = Go to Q8 5 = Go to Q9 4 a HSR system graphic? Which version of the HSR system graphic does the product display? Go to Q4 HSR + energy icon + 3 prescribed nutrients + 1 optional nutrient 5A Which HSR system graphic configuration has been used? 1 = Horizontal 2 = Vertical Go to Q5B 5B Is the HSR system graphic on the front of pack? 1 = Yes 2 = No Go to Q5C Is the HSR element of the graphic larger than the nutrient information elements? Is the HSR system graphic presented with contrasting background and text? Is the HSR system graphic a rating of ½ star to 5 stars in ½ star increments? 1 = Yes 2 = No Go to Q5D Does the HSR system graphic value match the numerical rating value? Are the words ‘Health Star Rating’ displayed prominently below the HSR element of the graphic? Has sufficient space been provided to accommodate energy and nutrient names and values in a clear and legible way? 1 = Yes 2 = No Go to Q5G 1 = Yes 2 = No Go to Q5H 1 = Yes 2 = No Go to Q5I 1 = Yes 2 = No Go to Q5J 1 = Yes 2 = No Go to Q5K 5C 5D 5E 5F 5G 5H 5I 5J 5K 5L 5M 5N 66 Have the correct prescribed nutrients been used? Are all nutrient icons displayed in conjunction with the energy icon and does the order of the prescribed nutrient icons reflect their order in the NIP? Does the optional nutrient icon provide nutrition information only? Do the energy and nutrient values reflect those stated in the NIP? Have the energy and nutrient values been recorded in the correct units? Have the energy and nutrient values been recorded to the correct decimal places? 1 = Yes 2 = No 1 = Yes 2 = No 1 = Yes 2 = No 1 = Yes 2 = No 1 = Yes 2 = No 1 = Yes 2 = No Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Go to Q5E Go to Q5F Go to Q5L Go to Q5M Go to Q5N Go to Q5O HSR + energy icon + 3 prescribed nutrients + 1 optional nutrient 5O Does the energy icon display %DI? 1 = Yes 2 = No 1 = Go to Q5P 2 = Go to Q5Q 5P If %DI is used, is the HSR system graphic displayed ‘per serve’ or ‘per pack’ and according to guidelines? 1 = Yes 2 = No 3 = N/A Go to Q5Q Does the product contain the dietary intake guide on pack? Please note where on pack. If the dietary intake guide has been used on pack, has it been displayed in a manner not to mislead the consumer that the two systems are linked? 1 = Yes 2 = No 1 = Go to Q5R 2 = Go to Q5S 1 = Yes 2 = No 3 = N/A Go to Q5S 1 = Yes 2 = No 1 = Go to Q5T 2 = Go to Q5U 5Q 5R 5S Do the nutrients use the terms ‘high’ or ‘low’? 5T If the nutrients use the terms ‘high’ or ‘low’, have they been 1 = Yes 2 = No used correctly? 3 = N/A Go to Q5U 5U Is the nominated reference measure appropriate? 1 = Yes 2 = No Go to Q5V 5V Is the nominated reference measure placed to the right hand side of the HSR system graphic (for horizontal graphics) or at the bottom of the HSR system graphic (for vertical graphics)? 1 = Yes 2 = No Go to Q5W 5W Is the serve size specified in the NIP? 1 = Yes 2 = No Go to Q5X 5X Is the nominated reference measure legible? 1 = Yes 2 = No Go to Q5Y 5Y Is the product a multipack? 5Z If the product is a multipack, how is the HSR system graphic displayed? 5AA What optional nutrient has been used? 1 = Yes 2 = No 1 = One HSR system graphic reflecting a single variant multipack 2 = One HSR system graphic that is an average of all flavour variants 3 = One HSR system graphic of one of the flavour variants 4 = Multiple HSR system graphics for all flavour variants 5 = Other (please specify) 6F == fibre N/A 1 = Go to Q5Z 2 = End of questions End of questions P = protein C = calcium I = iron M = magnesium O = omega 3 VE = vitamin E VC - vitamin C Fo = folate VA = vitamin A National Heart Foundation of Australia 67 HSR + energy icon + 3 prescribed nutrients 6A Which HSR system graphic configuration has been used? 6B Is the HSR system graphic on the front of pack? 6C 6D 6E 6F 6G 6H 6I 6J 6K 6L 6M Is the HSR element of the graphic larger than the nutrient information elements? Is the HSR system graphic presented with contrasting background and text? Is the HSR system graphic a rating of ½ star to 5 stars in ½ star increments? Does the HSR system graphic value match the numerical rating value? Are the words ‘Health Star Rating’ displayed prominently below the HSR element of the graphic? Has sufficient space been provided to accommodate energy and nutrient names and values in a clear and legible way? Have the correct prescribed nutrients been used? Are all nutrient icons displayed in conjunction with the energy icon and does the order of the prescribed nutrient icons reflect their order in the NIP? Do the energy and nutrient values reflect those stated in the NIP? Have the energy and nutrient values been recorded in the correct units? Have the energy and nutrient values been recorded to the correct decimal places? 1 = Horizontal 2 = Vertical 1 = Yes 2 = No 1 = Yes 2 = No Go to Q6B Go to Q6C Go to Q6D 1 = Yes 2 = No Go to Q6E 1 = Yes 2 = No Go to Q6F 1 = Yes 2 = No Go to Q6G 1 = Yes 2 = No Go to Q6H 1 = Yes 2 = No Go to Q6I 1 = Yes 2 = No Go to Q6J 1 = Yes 2 = No Go to Q6K 1 = Yes 2 = No Go to Q6L 1 = Yes 2 = No Go to Q6M 1 = Yes 2 = No Go to Q6N 6N Does the energy icon display %DI? 1 = Yes 2 = No 1 = Go to Q6O 2 = Go to Q6P 6O If %DI is used, is the HSR graphic displayed ‘per serve’ or ‘per pack’ and according to guidelines? 1 = Yes 2 = No 3 = N/A Go to Q6P 1 = Yes 2 = No 1 = Go to Q6Q 2 = Go to Q6R 6P 6Q 6R 6S 6T Does the product contain the dietary intake guide on pack? Please note where on pack. If the dietary intake guide has been used on pack, has it been displayed in a manner not to mislead the consumer that the two systems are linked? Do the nutrients use the terms ‘high’ or ‘low’? 1 = Yes If the nutrients use the terms ‘high’ or ‘low’, have they been 2 = No used correctly? 3 = N/A 1 = Yes Is the nominated reference measure appropriate? 2 = No 3 = N/A 6U Is the nominated reference measure placed to the right hand side of the HSR system graphic (for horizontal graphics) or at the bottom of the HSR system graphic (for vertical graphics)? 6V 6W 68 1 = Yes 2 = No 3 = N/A 1 = Yes 2 = No Go to Q6R 1 = Go to Q6S 2 = Go to Q6T Go to Q6T Go to Q6U 1 = Yes 2 = No Go to Q6V Is the serve size specified in the NIP? 1 = Yes 2 = No Go to Q6W Is the nominated reference measure legible? 1 = Yes 2 = No Go to Q6X Report on the monitoring of the implementation of the Health Star Rating system – Year 1 HSR + energy icon + 3 prescribed nutrients 6X 6Y Is the product a multipack? If the product is a multipack, how is the HSR system graphic displayed? 1 = Yes 2 = No 1 = Go to Q6Y 2 = End of questions 1 = One HSR system graphic reflecting a single variant multipack 2 = One HSR system graphic that is an average of all flavour variants 3 = One HSR system graphic of one of the flavour variants 4 = Multiple HSR system graphics for all flavour variants 5 = Other (please specify) 6 = N/A End of questions HSR + energy icon 7A Which HSR system graphic configuration has been used? 7B Is the HSR system graphic on the front of pack? 7C 7D 7E 7F 7G 7H Is the HSR element of the graphic larger than the nutrient information elements? Is the HSR system graphic presented with contrasting background and text? Is the HSR system graphic a rating of ½ star to 5 stars in ½ star increments? Does the HSR system graphic value match the numerical rating value? Are the words ‘Health Star Rating’ displayed prominently below the HSR element of the graphic? Has sufficient space been provided to accommodate energy name and value in a clear and legible way? 7I Does the energy value reflect that stated in the NIP? 7J Has the energy value been recorded in the correct unit? 7K 7L Has the energy value been recorded to the correct decimal place? Does the energy icon sit to the right of the HSR element of the system graphic (if horizontal option) or below (if vertical option)? 7M Does the energy icon display %DI? 7N If %DI is used, is the HSR graphic displayed ‘per serve’ or ‘per pack’ and according to guidelines? 7O 7P 7Q Does the product contain the dietary intake guide on pack? Please note where on pack. If the dietary intake guide has been used on pack, has it been displayed in a manner not to mislead the consumer that the two systems are linked? Is the nominated reference measure appropriate? 1 = Horizontal (refer to image) 2 = Vertical (refer to image) 1 = Yes 2 = No 1 = Yes 2 = No 1 = Yes 2 = No Go to Q7B Go to Q7C Go to Q7D Go to Q7E 1 = Yes 2 = No Go to Q7F 1 = Yes 2 = No Go to Q7G 1 = Yes 2 = No Go to Q7H 1 = Yes 2 = No Go to Q7I 1 = Yes 2 = No 1 = Yes 2 = No Go to Q7J Go to Q7K 1 = Yes 2 = No Go to Q7L 1 = Yes 2 = No Go to Q7M 1 = Yes 2 = No 1 = Yes 2 = No 3 = N/A 1 = Go to Q7N 2 = Go to Q7O 1 = Yes 2 = No 1 = Go to Q7P 2 = Go to Q7Q 1 = Yes 2 = No 3 = N/A Go to Q7Q 1 = Yes 2 = No Go to Q7R Go to Q7O National Heart Foundation of Australia 69 HSR + energy icon 7R Is the nominated reference measure placed to the right hand side of the HSR system graphic (for horizontal graphics) or at the bottom of the HSR system graphic (for vertical graphics)? 7S 1 = Yes 2 = No Go to Q7S Is the serve size specified in the NIP? 1 = Yes 2 = No Go to Q7T 7T Is the nominated reference measure legible? 1 = Yes 2 = No Go to Q7U 7U Is the product a multipack? 1 = Yes 2 = No 1 = Go to Q7V 2 = End of questions 7V If the product is a multipack, how is the HSR system graphic displayed? 1 = One HSR system graphic reflecting a single variant multipack 2 = One HSR system graphic that is an average of all flavour variants 3 = One HSR system graphic of one of the flavour variants 4 = Multiple HSR system graphics for all flavour variants 5 = Other (please specify) 6 = N/A End of questions HSR 8A Is the HSR system graphic on the front of pack? 8B Is the HSR system graphic presented with contrasting background and text? 1 = Yes 2 = No 1 = Yes 2 = No 8C Is the HSR system graphic a rating of ½ star to 5 stars in ½ star increments? 1 = Yes 2 = No Go to Q8D Does the HSR system graphic value match the numerical rating value? Are the words ‘Health Star Rating’ displayed prominently below the HSR element of the graphic? Does the product contain the dietary intake guide on pack? Please note where on pack. If the dietary intake guide has been used on pack, has it been displayed in a manner not to mislead the consumer that the two systems are linked? 1 = Yes 2 = No Go to Q8E 1 = Yes 2 = No Go to Q8F 1 = Yes 2 = No 1 = Go to Q8G 2 = Go to Q8H 8D 8E 8F 8G 8H Is the product a multipack? 8I If the product is a multipack, how is the HSR system graphic displayed? 70 1 = Yes 2 = No 3 = N/A 1 = Yes 2 = No 1 = One HSR system graphic reflecting a single variant multipack 2 = One HSR system graphic that is an average of all flavour variants 3 = One HSR system graphic of one of the flavour variants 4 = Multiple HSR system graphics for all flavour variants 5 = Other (please specify) 6 = N/A Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Go to Q8B Go to Q8C Go to Q8H 1 = Go to Q8I 2 = End of questions End of questions Energy icon 9A Is the HSR system graphic on the front of pack? 1 = Yes 2 = No Go to Q9B 9B Is the HSR system graphic presented with contrasting background and text? 1 = Yes 2 = No Go to Q9C 9C Has sufficient space been provided to accommodate energy name and value in a clear and legible way? 1 = Yes 2 = No Go to Q9D 9D Does the energy value reflect that stated in the NIP? 1 = Yes 2 = No Go to Q9E 9E Has the energy value been recorded in the correct unit? 1 = Yes 2 = No Go to Q9F 9F Has the energy value been recorded to the correct decimal place? 1 = Yes 2 = No Go to Q9G 9G Does the energy icon display %DI? 1 = Yes 2 = No 1 = Go to Q9H 2 = Go to Q9I 9H If %DI is used, is the HSR graphic displayed ‘per serve’ or ‘per pack’ and according to guidelines? 1 = Yes 2 = No 3 = N/A Go to Q9I Does the product contain the dietary intake guide on pack? Please note where on pack. If the dietary intake guide has been used on pack, has it been displayed in a manner not to mislead the consumer that the two systems are linked? 1 = Yes 2 = No 1 = Go to Q9J 2 = Go to Q9K 1 = Yes 2 = No 3 = N/A Go to Q9K 1 = Yes 2 = No Go to Q9L 9I 9J 9K Is the nominated reference measure appropriate? 9L Is the nominated reference measure above or below the energy icon? 9M Is the serve size specified in the NIP? 9N Is the nominated reference measure legible? 9O Is the product a multipack? 9P If the product is a multipack, how is the HSR system graphic displayed? 1 = Below 2 = Above 1 = Yes 2 = No 1 = Yes 2 = No 1 = Yes 2 = No Go to Q9M Go to Q9N Go to Q9O 1 = Go to Q9P 2 = End of questions 1 = One HSR system graphic reflecting a single variant multipack 2 = One HSR system graphic that is an average of all flavour variants 3 = One HSR system graphic of one of the flavour variants 4 = Multiple HSR system graphics for all flavour variants 5 = Other (please specify) 6 = N/A End of questions National Heart Foundation of Australia 71 Appendix 3. Foods that contribute to FVNL values, and examples for determining FVNL content from incomplete datasets According to Standard 1.2.7 in the Food Standards Code (2), foods that contribute to the %FVNL and % conc. FVNL values are: fruits, vegetables, nuts and legumes Below is a series of example where the complete %FVNL and % conc FVNL values cannot be fully determined from the ingredients list, and assumptions are required. spices, herbs, fungi, seeds, and algae Example 1 – Tomatoes chopped 400 g fresh, cooked, frozen, canned, pickled or preserved Ingredients: tomatoes 99% (chopped 64%, juice, paste) peeled, diced or cut (or otherwise reduced in size), pureed or dried fruit juice or vegetable juice, including concentrated juices and purees coconut flesh (as a nut) – juiced, dried or desiccated, water in the centre of the coconut. What cannot count towards %FVNL or % conc FVNL Processed coconut products such as coconut milk, coconut cream or coconut oil. A constituent, extract or isolate of a food mentioned above (e.g. peanut oil derived from peanuts, fruit pectin, de-ionised juices). Cereal grains as a class of food in Schedule 4 of Standard 1.4.2 (e.g. barley, buckwheat, maize, millet, oats, popcorn, rice, rye, sorghum, triticale, wheat and wild rice). Oils derived from seeds, nuts, vegetables/herbs. Table A3.1 lists how different products would be classified. Table A3.1. Classification system examples % FVNL % conc FVNL Tomato puree Potato crisps Dried fruit Tomato paste % FVNL / % conc FVNL: paste concentrated, juice/chopped not, but only chopped quantified Conclusion: use nutrition expertise to provide a recommended approach Example 2 – Coconut milk original 1 L Ingredients: coconut milk 21% (water, coconut cream) % FVNL / % conc FVNL: apply technical knowledge of manufacturing of coconut milk to infer that water is plain water, not coconut water Conclusion: % FVNL = 0 Example 3 – Chicken thighs lemon and herb 450 g Ingredients: garlic 1%, parsley 0.8%, lemon zest 0.6%, pepper 0.5%, celery % FVNL / % conc FVNL: the celery component does not have a quantity specified, however is at the end of the ingredient list → assume negligible and disregard Conclusion: % FVNL = 2.9% Example 4 – Mixed frozen vegetables 850 g Ingredients: broccoli, yellow beans, carrot, sugar snap peas, water chestnuts, capsicum % FVNL / % conc FVNL: no percentages have been assigned to any of the ingredients how they are the only ingredients listed → assume 100% vegetables 72 Conclusion: % FVNL = 100% Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Appendix 4. Consumer survey questionnaire for AoE 2 HEALTH STAR RATING TRACKER September 2015 Survey introduction Thank you for agreeing to participate in this important survey. We are conducting research to understand how Australians go about their grocery shopping. Your input will help shape future aspects of grocery shopping in Australia. The survey will take about 15 minutes to complete and is being conducted on behalf of a well-known organisation. Your answers will be de-identified, held in the strictest confidence and the responses of everyone who participates in this survey will be combined for analysis. Under the Privacy Act, all information provided will only be used for research purposes. Thank you again for your time. SCREENING ASK ALL S1. To begin with could you please confirm your age? Under 18 [Terminate] 1 18 to 24 1 25 to 29 2 30 to 34 3 35 to 39 4 40 to 44 5 45 to 49 6 50 to 54 7 55 to 59 8 60 to 65 9 Over 65 10 ASK ALL QS2. Are you the main or shared grocery buyer in your household? [NB: Main grocery buyer is the person in your household who does most of the grocery shopping] Main grocery buyer 1 Shared grocery buyer 2 Not the grocery buyer [Terminate] 3 Unsure [Terminate] 98 National Heart Foundation of Australia 73 ASK ALL QS3. What gender are you? Male 1 Female 2 NSW 1 VIC 2 QLD 3 SA 4 WA 5 NT 6 TAS 7 ACT 8 ASK ALL QS4. Where do you live? ASK ALL QS5. What is your postcode? MODULE A: GENERAL SUPERMARKET SHOPPING ASK ALL QA1. When buying food at the supermarket, what is the main thing that influences your choice between two similar products? (ROTATE ORDER) Price 1 Product quality 2 Product taste 3 Product advertising or promotions 4 Personal or family preference 5 Portion size 6 Nutritional value 7 How healthy I think it is 8 Front of pack labelling 9 Other (please specify) 97 Unsure 98 ASK ALL QA2. On average, how often do you visit a supermarket to do your grocery shopping? Every day 1 Several times a week 2 Once a week 3 Once a fortnight 4 Once a month 5 Less often than monthly 6 Unsure 74 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 98 ASK ALL QA3. Which supermarkets have you visited in the past month? (MULTIPLE RESPONSE: ROTATE ORDER) ASK ALL QA3. On average, how much do you spend in one visit to the supermarket? ALDI 1 BI-LO 2 Coles 3 IGA 4 Woolworths/Safeway 5 Foodworks 6 Costco 7 Other (Please specify) 97 Unsure 98 Under $20 1 $20 to $49 2 $50 to $99 3 $100 to $149 4 $150 to $199 5 $200 or more 6 It varies 7 Unsure 98 Always 1 Most of the time 2 Sometimes 3 Just occasionally 4 Never 5 Not sure 6 All food products 1 Most food products 2 Some food products 3 Few food products 4 ASK ALL QA5. When choosing a new food during grocery shopping, how often do you compare how healthy products are? ASK ALL QA6. On average, when at the supermarket, do you look at the nutrition information panel on …? Never 98 Unsure 98 National Heart Foundation of Australia 75 MODULE B:AWARENESS OF HSR/FOOD LABELS ASK ALL QB1. Apart from brand names, thinking about different logos that help customers choose the food they buy in the supermarket, which ones are you aware of? OPEN VERBATIM (DO NOT LIST: MULTIPLE RESPONSE) Health Star Rating 1 Glycemic Index 2 No added salt/reduced salt 3 Australian made 4 Country of origin 5 Environment safe 6 Heart Foundation Tick 7 Organic 8 Natural 9 Fat reduced/low fat 10 Lite 11 Fat free 12 Cholesterol free 13 Low joule/low calories 14 Energy/kilojoules 15 Unsweetened/no added sugar/sugar free 16 Weight watchers 17 Gluten free 18 Other 97 Unsure 98 ASK ALL QB2. Are you aware of the Health Star Rating system? Yes 1 No 2 Unsure 76 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 98 ASK ALL QB3. Which of the following are you aware of on food packaging? (ROTATE ORDER: MULTIPLE RESPONSE) GI (Glycaemic Index) 1 No added salt / reduced salt 2 Fat reduced/low fat 3 Lite 4 Fat-free 5 Cholesterol free 6 Heart Foundation Tick 7 Low joule/low calories 8 Energy/kilojoules 9 Unsweetened/no added sugar/sugar free 10 Gluten free 11 Weight Watchers 12 % Dietary intake 13 Be treatwise 14 None of the above (Exc) 99 Unsure (Exc) 98 ASK IF QB2 = 1, IF QB2 = 2 OR 3, GO TO QH1 MODULE C: KNOWLEDGE OF HSR QC1. When the Health Star Rating system is on the packaging of Specify food, what do you think it means? 97 QC2. In your opinion, how is the number of stars on a product determined? 97 QC3. Below are a series of statements about the Health Star Rating system. How strongly do you agree or disagree that the Health Star Rating system…? (ROTATE ORDER) Strongly Agree Agree Neither Agree nor disagree Disagree Strongly Disagree Unsure Makes it easier for me to compare products that are in the same category in the supermarket 1 2 3 4 5 97 Makes it easier for me to compare products that are in different categories in the supermarket 1 2 3 4 5 97 Makes it easier for me to identify the healthier option within a category 1 2 3 4 5 97 Makes it easier for me to identify the healthier option across all categories 1 2 3 4 5 97 Helps me think about the healthiness of food 1 2 3 4 5 97 Helps me make decisions about which foods to buy 1 2 3 4 5 97 Makes me want to buy healthier products 1 2 3 4 5 97 It’s just another thing on a pack that makes shopping more confusing 1 2 3 4 5 97 National Heart Foundation of Australia 77 QC4. How would you use the Health Star Rating system? Specify 97 QC5. If a food product has one star, what do you think this means? Specify 97 QC6. If a food product has five stars, what do you think this means? Specify 97 MODULE D: UNDERSTANDING OF HSR QD1. Below are a series of statements about the Health Star Rating system. How strongly do you agree or disagree that a product with more stars means…? Strongly Agree Agree Neither Agree nor disagree Disagree Strongly Disagree Unsure It is a healthier option compared to a similar food product with less stars 1 2 3 4 5 97 It is a healthier option compared to a food product with less stars 1 2 3 4 5 97 You can eat it as much as you like compared to a product with less stars 1 2 3 4 5 97 It is more expensive than a product with less stars 1 2 3 4 5 97 It is healthy 1 2 3 4 5 97 It does not taste as good as a product with less stars 1 2 3 4 5 97 QD2. The Health Star Rating can be displayed in five different ways. Please select the style you believe…? Is easiest to understandIs easiest to recognise. Provides sufficient information QD3. Overall, please select the style you prefer the most? QD4. Why do you prefer that option? 78 Specify Report on the monitoring of the implementation of the Health Star Rating system – Year 1 97 MODULE E: PURCHASING BEHAVIOUR (POTENTIAL & CURRENT) QE1. In the past three months have you purchased a product that had the Health Star Rating system? Yes 1 No 2 Unsure 98 ASK IF QE1= 1, IF QE1 = 2 OR 98, GO TO MODULE F QE2. Did the Health Star Rating system on the product influence your choice? Yes 1 No 2 Unsure 98 ASK IF QE2= 1, IF QE2 = 2, GO TO QE4. IF QE2=98, GO TO QE5 QE3. How did it influence your choice? Yes, it confirmed I should buy my usual product 1 Yes, I chose a product with more stars that I don’t often buy 2 Yes, I chose a product with more stars that I’ve never tried before 3 Yes, I chose not to buy my usual product because it had fewer stars than other options 4 ASK IF QE3 = 2 TO 4 QE2. Have you continued or will continue to buy the product? Yes 1 No 2 Unsure 98 GO TO QE5 QE4. Why didn’t the Health Star Rating system influence your choice? Specify QE5. How likely or unlikely is the Health Star Rating to influence choices you make in the future when buying food? Very likely 1 Likely 2 Unlikely 3 Very unlikely 4 Unsure 97 98 National Heart Foundation of Australia 79 MODULE I: COMPARISON QI. Of the Health Star Ratings below, please select which you think is a healthier option in each pair? A These are the same B These are the same C These are the same D These are the same E These are the same 80 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 MODULE F: HSR & FOOD CATEGORIES ASK IF QE1= 1, IF QH3 = 2 OR 98, GO TO QF2 QF1. Please select which foods and/or beverages you purchased in the supermarket which had the Health Star Rating system on them Provide list: MULTIPLE RESPONSE ROTATE Bread 1 Breakfast cereals (e.g. ready-to-eat, muesli, oats, breakfast drinks) 2 Cereal bars, nut/seed bars, fruit bars 3 Cheese 4 Confectionary (e.g. lollies, chocolates) 5 Cooking sauces (pasta & other) 6 Crisps and similar snacks 7 Fruit and Vegetables (frozen, fresh, canned, or dried) 8 Finishing sauces Legumes (canned, e.g. baked beans) 9 Margarines and spreads (including butter) 10 Meat, poultry, seafood (plain, processed, canned, fresh, frozen) 11 Milks (plain and flavoured) 12 Non-alcoholic beverages (e.g. soft drinks, fruit/vegetable juices ) 13 Nuts and seeds 14 Pasta & noodles, and products 15 Pastries – sweet or savoury (e.g. pies/pasties, fruit pies, tarts) 16 Ready meals, meal kits 17 Recipe bases 18 Rice & rice products 19 Salad dressings and mayonnaise 20 Savoury biscuits, crackers, crispbreads 21 Spreads (e.g. peanut butter, jam) 22 Sweet biscuits, cakes, muffins 23 Table sauces (e.g. tomato sauce) 24 Vegetable oils 25 Yoghurt & dairy desserts (incl. custards, ice cream, frozen yoghurt) 26 None of the above 97 National Heart Foundation of Australia 81 QF2. Please select which foods and/or beverages you believe it is important to have the Health Star Rating system on them? Provide list: MULTIPLE RESPONSE ROTATE 82 Bread 1 Breakfast cereals (e.g. ready-to-eat, muesli, oats, breakfast drinks) 2 Cereal bars, nut/seed bars, fruit bars 3 Cheese 4 Confectionary (e.g. lollies, chocolates) 5 Cooking sauces (pasta & other) 6 Crisps and similar snacks 7 Fruit and Vegetables (frozen, fresh, canned, or dried) 8 Finishing sauces 9 Legumes (canned, e.g. baked beans) 10 Margarines and spreads (including butter) 11 Meat, poultry, seafood (plain, processed, canned, fresh, frozen) 12 Milks (plain and flavoured) 13 Non-alcoholic beverages (e.g. soft drinks, fruit/vegetable juices ) 14 Nuts and seeds 15 Pasta & noodles, and products 16 Pastries – sweet or savoury (e.g. pies/pasties, fruit pies, tarts) 17 Ready meals, meal kits 18 Recipe bases 19 Rice & rice products 20 Salad dressings and mayonnaise 21 Savoury biscuits, crackers, crispbreads 22 Spreads (e.g. peanut butter, jam) 23 Sweet biscuits, cakes, muffins 24 Table sauces (e.g. tomato sauce) 25 Vegetable oils 26 Yoghurt & dairy desserts (incl. custards, ice cream, frozen yoghurt) 27 None of the above 97 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 MODULE G:ADVERTISING/CAMPAIGN ASK ALL QG1. In the last three months, do you remember seeing, hearing or reading any advertising or promotions about the Health Star Rating system? Yes 1 No 2 Unsure 97 ASK IF QG1= 1, IF QG1 = 2 OR 98, GO TO MODULE H QG2. Where had you seen or heard about the Health Star Rating? Provide list: MULTIPLE RESPONSE On food packaging 1 In store promotion 2 On posters/digital posters in shopping centres 3 On a bus shelter/other outdoor areas 4 In a newspaper/magazine 5 In a catalogue (i.e. Coles/Woolworths) 6 In online reviews/blogs 7 In an online ad 8 On the radio 9 News program 10 TV ad 11 Supermarket website 12 Food product website 13 Social media (e.g. Facebook) 13 Word of mouth 13 Other (specify) 14 Unsure 97 QG3. Which organisation or company did the advertising or promotion(s)? Specify 1 Unsure 97 QG4. What product or products were being advertised or promoted? Specify 1 Unsure 97 QG5. After seeing or hearing this advertising or promotion(s) for products Yes with a Health Star Rating, did it influence you to buy a product or No products you normally wouldn’t buy? Unsure 1 2 97 National Heart Foundation of Australia 83 MODULE H: GENERAL ATTITUDES TOWARDS THE HSR QH1. Below are a series of statements about the Health Star Rating system. How strongly do you agree or disagree that the Health Star Rating system…? (ROTATE ORDER) Strongly Agree Agree Neither Agree nor disagree Disagree Strongly Disagree Unsure Is a system I trust 1 2 3 4 5 97 Is easy to understand 1 2 3 4 5 97 Is easy to use 1 2 3 4 5 97 Stands out on the package 1 2 3 4 5 97 Makes choosing food easier 1 2 3 4 5 97 Has a good reputation 1 2 3 4 5 97 Is informative 1 2 3 4 5 97 Is a reliable system 1 2 3 4 5 97 Is a credible system 1 2 3 4 5 97 Is personally relevant to me 1 2 3 4 5 97 Is relevant to my family 1 2 3 4 5 97 Has a good reputation 1 2 3 4 5 97 Is open and transparent 1 2 3 4 5 97 QH2. Overall, what level of confidence do you have in the Health Star Rating system? High 5 Somewhat high 4 Indifferent 3 Somewhat low 2 low 1 Unsure 84 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 97 Very MODULE I: HEALTH ATTITUDES ASK ALL QH1. In general, thinking about all the food you buy, how concerned are you about how healthy the food is for you? Not at all concerned 1 A little concerned 2 Moderately concerned 3 Very concerned 4 Extremely concerned 5 Unsure 98 ASK ALL QH2. Thinking about your diet, would you say that what you usually eat is … Very healthy 1 Healthy 2 Neither healthy nor unhealthy 3 Unhealthy 4 Very unhealthy 5 Unsure QH3. Over the past six months, have you made any changes to your diet? 98 Yes 1 No 2 Unsure 98 ASK IF QH3= 1, IF QH3 = 2 OR 98, GO TO H6 ASK IF QH3 = 1 QH4. Which of the following changes have you made in the past six months to your diet? Please select all that apply Changing the types of foods I eat 1 Changing the amount of food I eat 2 Changing how often I eat 3 Counting calories 4 Excluding/cutting out types of food from my diet 5 Other (please specify) 97 Unsure 98 National Heart Foundation of Australia 85 QH5. For which of the following reasons did you make changes to your diet? Please select all that apply To lose weight 1 To improve my physical health 2 Because of a specific health condition 3 To maintain my weight 4 To feel better 5 To lower my cholesterol 6 Other (please specify) 97 Unsure 98 ASK ALL QH6. In general, would you say your overall health is…? Excellent 1 Very good 2 Good 3 Fair 4 Poor 5 Unsure 98 MODULE J: HEALTHY WEIGHT ASK ALL QJ1. What is your height? Please enter just one measure. Metres (e.g. 1.65 m) (Specify) 1 Centimetres (e.g. 165 cm) (Specify 2 Feet and inches (e.g. 5 ft, 5 in) (Specify) 3 Prefer not to say/Unsure 98 ASK ALL QJ2. What is your weight? Please enter just one measure. Kilograms (e.g. 65 kg) (Specify) 1 Pounds (e.g. 150 Ib) (Specify) 2 Stones and Pounds (e.g. 10 st, 10 Ib) (Specify) 3 Prefer not to say/Unsure 98 ASK ALL QJ3 How many serves of vegetables (including fresh, frozen and tinned vegetables) do you usually eat each day? (A ‘serving’ = ½ cup of cooked vegetables or 1 cup of salad vegetables) 1–2 serves 1 3–4 serves 2 5 serves or more 3 Don’t eat vegetables 4 (Unsure) 86 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 98 ASK ALL QJ4 How many serves of fruit (including fresh, dried, frozen and tinned fruit) do you usually eat each day? (A ‘serving’ = 1 medium piece or 2 small pieces of fruit or 1 cup of diced pieces) 1 serve 1 2 serves 2 3 serves or more 3 Don’t eat fruit 4 (Unsure) 98 MODULE K: RESPONDENT PROFILE ASK ALL QK1 Which of the following best describes your household structure? Single person, living alone 1 Single person, living with parents/family 2 Single person, living with one or more children 3 Couple 4 Couple living with one or more children 5 Share house (group home of unrelated adults) 6 Other 98 Prefer not to say 97 ASK IF QK1 = 3 OR 5 (HAVE CHILDREN LIVING AT HOME) QK2 What age ranges do your children (living at home) fall into? Under 6 years 1 6–12 years 2 13–17 years 3 18 years or over 4 Prefer not to say 97 Year 11 or below 2 Year 11 3 Year 12 4 Vocational qualification (e.g. trade/apprenticeship) 5 Other TAFE or technical certificate 6 Diploma 7 Bachelor Degree (including Honours) 8 Post graduate degree 9 Other (please specify) 98 Prefer not to say 97 ASK ALL QK3. What is the highest level of education that you have completed? National Heart Foundation of Australia 87 ASK ALL QK4 Which of these categories best describes your main activity at the moment? Working full time 1 Working on a part-time or casual basis 2 Doing study or training 3 Looking for work 4 Doing unpaid voluntary work 5 Retired 6 Home duties 7 Something else (please specify) 98 Prefer not to say 97 Below $30,000 1 Between $30,000 to $39,999 2 Between $40,000 to $49,999 3 Between $50,000 to $59,999 4 Between $60,000 to $69,999 5 Between $70,000 to $99,999 6 Between $100,000 to $119,999 7 Between $120,000 to $149,999 7 Between $150,000 to $199,999 7 $200,000 or more 8 Prefer not to say 97 ASK ALL QK5. Which of the following broad ranges best describes your TOTAL GROSS ANNUAL HOUSEHOLD INCOME from all sources? Please include all income including pensions and allowances for all household members? [NB: Gross income is your household income before tax is taken out] ASK ALL QK6. Are you of Aboriginal or Torres Strait Islander origin? Neither 1 Aboriginal 2 Torres Strait Islander 3 Both 4 Prefer not to say 97 ASK ALL QK7. Were you born in Australia or overseas? Australia 1 Overseas 2 Prefer not to say 97 ASK ALL QK8. Do you speak a language other than English at home? 88 Yes 1 No 2 Prefer not to say 97 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 Notes National Heart Foundation of Australia 89 Notes 90 Report on the monitoring of the implementation of the Health Star Rating system – Year 1 For enquiries about this report, please contact: Front-of-Pack Labelling Secretariat Department of Health GPO Box 9848, Canberra, ACT, 2601 Phone: 1800 099 658 Email: [email protected] © 2016 National Heart Foundation of Australia, ABN 98 008 419 761 Suggested citation: National Heart Foundation of Australia. Report on the monitoring of the implementation of the Health Star Rating system – Year 1. Commissioned by the Commonwealth Department of Health. Melbourne, Australia: National Heart Foundation of Australia, 2016. Disclaimer: This material has been developed by the Heart Foundation for general information. 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