The Influence of Health Claims on Consumers’ Willingness to Buy

The Influence of Health Claims on Consumers’

Willingness to Buy

The Influence of Health Claims on Consumers’

Willingness to Buy

MSc Marketing Management Thesis

University of Groningen

Faculty of Economics and Business

Abstract

Obesity is a global problem. Although global awareness about healthy lifestyles has increased, obesity numbers are still not decreasing. The World Health Organization (WHO) has recommended that governments and food manufacturers take action to limit consumers' intake of sugars, sodium and saturated fat. This has currently been done by implementing labels to indicate that some products are a healthier choice compared to similar food products. As soft drinks are major contributors to the global obesity problem due to their high levels of sugar, the effectiveness of product front-of-package health claims was researched for sugary beverages. This thesis studies the willingness of consumers to buy soft drinks both with and without health claims that state that the products do not contain sugar. In addition, this thesis studies the influences of brand trust and product familiarity on the relationship between health claim and willingness to buy. Based on the experiment conducted among Dutch consumers, it could be concluded that health claims do not have a direct influence on the willingness to buy soft drinks. Product familiarity and brand trust increases the willingness to buy a product. The analyses showed that health claims are most effective when the product is perceived to be healthy in the first place.

Keywords: front-of-package, health claims, brand trust, product familiarity, willingness to

Management Summary

The media has been promoting healthy food consumption habits through several channels. The interest in healthy lifestyles in on the rise. Despite this, obesity rates are still increasing. To this end, health claims have been introduced by food manufacturers and marketers in order to be able to distinguish healthy from unhealthy products. Previous research and the World Health Organization have found that sugary beverages are a major contributor to global obesity rates. Due to the overconsumption of soft drinks containing high levels of sugar, the WHO has recommended a decrease in the consumption of soft drinks or, alternatively, that soft drink ingredients should be adapted to decrease their sugar content (Donnelly, Zatz, Svirsky & John, 2018). With the increasing trend of healthier lifestyles, brands and food manufacturers are trying to position themselves as healthy food options. Front-of-package labels and back-of-package labels have therefore been used to promote the food product as a “healthier” product choice. As no health claim has been implemented in the beverage market, this thesis focuses on the effectiveness of health claims on soft drinks and their influence on willingness to buy. Product familiarity and brand trust play a significant role in consumers’ purchase decisions. Consumers are more likely to choose products that they are familiar with over products that they are not familiar with. The same holds true for brand trust. Positive previous experiences with a product or brand will increase customers’ trust, which increases repurchase intentions. Several hypotheses have been made in order to study the above-mentioned effects on willingness to buy. The hypotheses have been tested by means of an online experiment that was distributed online among citizens in the Netherlands. The online experiment measured the respondent’s responses towards soft drinks that either included a health claim and was perceived to be a familiar brand (condition 1), did not include a health claim and was perceived to be a product from a familiar brand (condition 2), included a health claim and was not perceived to be a product from a familiar brand (condition 3), or did not include a health claim and was also not perceived to be a product from a familiar brand (condition 4). Measurements were based on verified scales for each of the variables as studied in this thesis.

discussed in the literature. Hypothesis 2a and 3a could be confirmed. However the interaction effect of both variables on the relationship between health claims and willingness to buy could not be proven. Also, no significant effect of health claims on willingness to buy could be found. In general, soft drinks are not seen as a healthy beverages as they have proven to be contributors to the global obesity problem. A possible reasoning could be that the health claim on the soft drinks did not correspond with the expectations of the presented soft drinks. This is needed for a consumer to respond favorably to a product.

Further analyses were conducted to measure the effects of perceived healthiness on the willingness to buy and the effects of health claims on the perceived healthiness of a soft drink. From this, it can be concluded that perceived healthiness has a positive influence on the willingness to buy a product. Product familiarity strengthens the positive interaction effect. Product familiarity also has a positive influence on the relation between health claims and perceived healthiness. It is therefore suggested that, in line with the theory, when a familiar product contains a health claim, which corresponds with the expectations of the consumer, it increases the perceived healthiness of a product and consequently willingness to buy.

Table of Contents

1. Introduction ... 8 2. Literature Review ... 12 2.1 Health Claim ... 13 2.2 Brand Trust ... 16 2.3 Product Familiarity ... 19 3. Conceptual Framework ... 22 4. Methodology ... 23 4.1 Data Collection ... 23 4.2 Experimental Variables ... 25 4.2.1 Health Claims ... 25 4.3 Manipulation Variables ... 25 4.3.1 Brand Trust ... 25 4.3.2 Product Familiarity ... 25 4.4 Control Variables ... 26 4.4.1 Health Consciousness ... 26 4.4.2 Perceived Healthiness ... 26 5. Results ... 27 5.1 Sample Characteristics ... 27 5.2 Reliability Analyses ... 27 5.3 Hypotheses Testing ... 30

5.3.1 Multiple Linear Regression ... 32

List of Figures and Tables

Figure Title Page

Figure 3.1 Conceptual Framework 22

Figure 5.3.1 Willingness to Buy for Brand Trust 31 Figure 5.3.2 Willingness to Buy for Product Familiarity 31 Figure 5.3.3 Effect Brand Trust - Willingness to Buy 34 Figure 5.3.4 Effect Product Familiarity - Willingness to Buy 34

Table Title Page

Table 4.1.1 Questionnaire Conditions 24 Table 5.2.1 Multicollinearity Analysis 29

Table 5.2.2 Pearson Correlation 29

1. Introduction

Health is currently a topic of discussion and is not limited to consumers. Retailers and food manufacturers are updating and improving their strategies to provide consumers with relatively healthier versions of certain food products or to inform consumers about certain ingredients or health choices that they tempted to make. Through different touchpoints the media attempts to influence consumers in their food choices. Having a healthy lifestyle has been promoted through many different channels, and younger people are especially attracted to this change of lifestyle (Ahadzadeh, Sharif, Ong & Kong, 2015). This can, for example, be noticed in the availability of online resources providing healthy recipes, sports programs and inspirational information. More people are beginning to be aware of their personal health in terms of exercise and nutritional intake. Through different touchpoints, media try to influence consumers in their food choice. Brands and retailers have been inspired to make these changes due to the increasing health issues that are caused by the over-consumption of fat, sugar and salt. One of the biggest health effects caused by overconsumption is obesity. The WHO, an institution that follows and coordinates health regulations on a global level, has stated that obesity has nearly tripled worldwide since 1975, and that in 2016 13% of the world’s population is suffering from obesity (NCD Risk Factor Collaboration, 2017). Obesity increases the risk of several health diseases such as diabetes or heart diseases. The WHO has found that obesity not only occurs in well-developed countries with relatively high incomes, but also in developing countries in which people consume unhealthy foods in too great quantities. Even though many people are aware of the obesity problem throughout the world, the WHO expects that if post-2000 trends regarding food consumption continue, child and adolescent obesity will exceed the current obesity and overweight numbers by 2022 (NCD Risk Factor Collaboration, 2017). Nevertheless, despite the fact that retailers and food manufacturers are trying to supply the market with healthier food options, the obesity problem does not seem likely to decrease in the near future.

demands while contributing to the increase of healthy lifestyles of consumers (Wansink & Chandon, 2006).

The WHO has recommended that food manufacturers reduce the levels of sugars, sodium and fat in their product compositions, as these ingredients are the main factors that cause obesity when being overconsumed (Feunekes, Gortemaker, Willems, Lion & van den Kommer, 2008). To make healthier food and beverage choices, consumers must be able to distinguish “healthy” products from “unhealthy” products. This can be done through labels on packages, either front-of-package or back-front-of-package, that inform consumers that the product is a healthy choice. In addition, next to labelling, nutritional knowledge can help consumers increase the consciousness of their food and beverage consumption. Several studies have researched the efficacy of actions taken to decrease the consumption of these ingredients or to educate consumers to make healthier food choices in order to decrease the current obesity numbers around the world. Most of this research has focused on the back-of-package nutritional labels, but Feunekes et al. (2008) state that the majority of the consumers find back-of-package nutrition labels confusing, especially when it comes to numerical information and the terminology used. Therefore, consumers find it difficult to determine whether food choices are healthy or not. Front-of-package labels are also criticized and sometimes found to be too complex (Feunekes et al., 2008). Labels often contain too many words that consumers find difficult to interpret or are overlooked to when making a food decision. Research has shown that traffic light food labels is the best presently available for the use of front-of-package labels (Temple & Fraser, 2014). Colored circles indicate whether the product consists of high (red, medium (orange) or low (green) levels of fat, sodium or sugar (Temple & Fraser, 2014). When people become more conscious and educated about healthy food options, chances that healthy choices will be made, increase.

drinks and ice tea amongst youth and high-income households (O’leary et al., 2012). Today, the rise of sales of “unhealthy” drinks has become a highly-visible and controversial public health issue as it has been viewed as a contributor to obesity and related health problems (Vartanian, Schwartz, & Brownell, 2007). The issue of soft drinks is not new. The American Medical Association already announced in 1942 that individuals should be careful with the amount of sugar they consumed via soft drinks (Vartanian et al., 2007). At that time, the United States consumption of soft drinks was 90 servings per person per year; by 2000, this has increased to 2.000 servings per person per year (Vartanian et al., 2007). Sugar intake has increased since the development of soft drinks a century ago, as it was the principal sweetener in these beverages until after World War II (Bray, (2010). Consumption of beverages sweetened with sugar is still rising around the world (Bray, 2010). It has increased from 11.8% of the total caloric intake in 1965 to over 20% of the total caloric intake of consumers living in the United States (Bray,2010). Reports also suggest that the increasing intake of soft drinks is associated with an increased risk in getting diabetes (Bray, 2010).

it remains unknown whether a different effect exists between health claims of familiar and unfamiliar products. In addition, trust does also play a role in product choice. A consumer is more likely to purchase a product from a brand that he or she trusts than from a brand that he or she does not know. As discussed earlier in this introduction, trust does also affect health claims (Feunekes et al., 2008). When consumers are critical or distrust health claims, their willingness to buy might decrease. Brand trust may also play a role in this. When consumers are loyal to a certain brand and trust its products, a health claim might incentivize their willingness to buy even more when seeking a healthier food option. Again, it has not been studied yet whether health claims have a different effects on willingness to buy when a brand is either trusted or distrusted. Therefore, this study analyzes extent to which brand trust and product familiarity has an effect on the relationship between health claims and the willingness to buy.

Following the introduction of factors influence consumer’s product choice, the efforts to decrease obesity by offering healthier products and the indicators of healthy food choices, the following research question has been developed to fill the knowledge gap about the relation between the above-mentioned factors:

“To what extent do health claims influence consumers’ willingness to buy soft drinks and how is this relationship influenced by product familiarity and brand trust?”

2. Literature Review

As described in the introduction, a substantial number of studies have analyzed the relation between nutritional intake and weight gain and obesity. The consumption of sugary drinks such as soft drinks, is a leading contributor to the increase of obesity (Donnelly et al., 2018). Although there has been an increase in the trend of following healthy lifestyles, obesity rates are still not decreasing (Ahadzadeh et al., 2015; NCD Risk Factor Collaboration, 2017; Wansink & Chandon, 2006). As healthier lifestyles have increased, consumers seek easy access to a wide variety of tasty, convenient, cheap and safe-to-eat food products. The food industry has responded to this demand by promoting these types of food extensively (Chandon & Wansink, 2012). These trends have made consumers more conscious about their product choices, but this has not led specifically to a lower or healthier nutritional intake. With pressure from the WHO, food manufacturers have implemented labels on their products, which inform consumers that the products contain less sugar and/or fat. As interest in living healthier lifestyles has increased, health claims may, therefore, increase willingness to buy. A study by Choi & Reid (2018) has demonstrated that health claims regarding restaurants that are initially perceived to be healthy, are believed more than restaurants that are perceived to be unhealthy (e.g. fast food chains). This effect might be the same for food brands. However, Guthrie, Mancino & Jordan Lin (2015), found that provided nutritional information is often considered to be difficult to comprehend, but the way it was presented influenced the purchase intention of the consumer. Furthermore, when health labels on sugary sweetened soft drinks were easy to understand, it reduced the consumption and willingness to buy of these soft drinks (Bleich, Wolfson, Vine & Wang, 2014). Participants were more likely to choose water over soft drinks if an easily-understood health claim was provided (Bleich et al., 2014).

claims, brand trust and product familiarity will be provided in order to develop a comprehendible framework for this thesis.

2.1 Health Claim

By focusing on the improvement in nutritional knowledge among consumers, marketers have voluntarily implemented labels as shopping aids to influence consumers’ willingness to buy (Caswell, Ning, Liu & Mojduszka, 2003; Jew, Vanstone, Antoine & Jones, 2008). In this way, food manufacturers attempt to distinguish their products from the competition by informing consumers with nutrient-content claims that imply that the product is a healthier choice. However, it has been found that the aim of these voluntary claims is to increase willingness to buy and intent to purchase rather than to actually providing the consumer with nutrient information (Caswell et al., 2003). Current European regulations state that claims can only be implemented if the claim is relevant in terms of nutritional information (Guthrie, Mancino & Jordan Lin, 2015; Lalor, Kennedy, Flynn & Wall, 2009).

need to be in accordance with national regulations (Lalor et al., 2009). These regulations were established to avoid biased claims that may mislead consumer’s perception of the perceived healthiness of a given product, which in turn may increase the critique towards front-of-package labels.

Ares and Gámbaro (2007) state, that health claims are partly explained by the perceived healthiness of certain food products. Therefore, when food products are perceived to be healthy in the first place, health claims seem to have more effect and attract consumers’ attention and interest even more. An earlier study has found, that food consumers do not rely solely on health-related information regarding their food choices from specialists, but also on advertisements or labels that provide nutritional information (Choi, Paek & King, 2012). Thus, health claims on food packages would increase consumers’ awareness that certain products are healthier than the others. Previous research suggested that consumers became cautious about their food choice when a label indicated it was lower in fat than another product choice (Garretson and Burton, 2000). They become more conscious about the level of fat that a food product consists of and can recall whether it is a healthy food choice or not. The study of Kozup, Creyer and Burton (2003) showed that health claims on packages have a higher purchase intention when the health claim is favorable than when the health claim on the food package is unfavorable. Moreover, when an inferior or more unhealthy choice is positioned close to the healthier food option, consumers tend to have more positive attitudes towards the product then when there is no inferior option (Kozup et al., 2003). The social adaptation theory explains that when a certain claim matches with consumers’ and preferences of a certain brand or product, consumers are more likely to respond favorable to that brand or product (Choi et al., 2012). Hence, when consumers are shown a bottle of Coca-Cola Light with a nutritional stating it is “sugar free”, consumers are more likely to respond favorably, because the claim matches with the expectations of a light soft drink.

another study, not all healthy claims can be related to every food product, only to those products that are perceived to be a healthier food choice (Ares & Gámbaro, 2007). For example, it would not make sense to use health claims on hamburger packages or deep-fried snacks as these foods are perceived to be unhealthy in general. Moreover, consumers that are buying unhealthy food might not be looking for healthier choices and as stated earlier, may not pay attention to health claims on packages in general. Consequently, the social adaption theory matches with the findings of Ares & Gámbaro (2007), because the claim on the package should be in line with the perceived healthiness of the product. The same study has also showed that the perceived healthiness also depends on characteristics of the consumers and not on a certain product or health claim per se (Ares & Gámbaro, 2007). Based on these findings, it is therefore suggested that health claims alone do not influence the willingness to buy alone. Factors such as type of product, perceived healthiness and demographics also influence the product choice. Thus, effects on willingness to buy will be weaker when a health claim is present on a healthier soft drink than for a fresh pressed-fruit juice. Nevertheless, Andrews, Burton & Netemeyer (1998, 2000) have found that the perceived healthiness of a food product is already influenced by the simplest nutrient-content claim, without providing the consumer with detailed information (Choi et al., 2012). This is in line with the findings from van Herpen & van Trijp (2012), who have stated that nutrition labelling and front-of-package labelling is considered as an important tool to help consumers make healthier food choices. They have found that for nutrition information to have a possible impact on decision making, a health claim needs to be initially appealing, attention should be paid and processed, and it should be used as a decision making indicator (Van Herpen & van Trijp, 2012). From these findings, it can be suggested that health and nutrient-claims on food product packages, have a significant effect on the consumers’ attitudes towards the product. However, the type of attitude might differ per product type and consumer characteristics.

level of sugar in the soft drink or when calories are expressed in the number of sports exercises to compare energy intake. Even though the introduction of health claims on sugary drinks has been proposed multiple times, research about the effectiveness of such a health claim is lacking. Consumers’ perception about certain products and shopping habits do also play a role. So too does the type of food that the consumer is seeking for and its ingredients (Roodenburg, Popkin, & Seidel, 2011). Thus, by choosing a healthier food option, customers should keep in mind the presence of different ingredients for different food types. For example, sugar is for example a relevant ingredient for soft drinks, cereal and ready-to-go snacks.

Substitutes have been found to replace the “unhealthy” ingredients in food and beverages in order to propose healthier options. In line with the increased interest in healthier lifestyles, these substitute ingredients create value for an increasing number of consumers as they seek healthier options. Products that include these ingredients often carry a health claim stating that they consist of healthier ingredients. This may consequently attract more consumers. This might also be the case for soft drinks, as it is known that these beverages often consist of high levels of sugar. In line with this assumption, it has been proven that providing consumers with healthier choices in a product group (e.g., soft drinks) decreases the consumption of nutrients that have negative health consequences (Roodenburg et al., 2011; Choi & Reid, 2018). Therefore, it is assumed that such health claims on foods and beverages that are perceived healthier increases consumers' willingness to buy.

Hypothesis 1: Consumers’ willingness to buy healthier types of soft drinks increases when a health claim is present.

2.2 Brand Trust

Brand trust has been defined as the willingness of the average consumer to rely on the ability of the brand to perform its stated function (Chaudhuri & Holbrook, 2001). Research has shown that trust is mostly relevant in situations of uncertainty, and that it reduces uncertainty in situations in which consumers might feel vulnerable (i.e., they know they can rely on a brand that they trust) (Chaudhuri & Holbrook, 2001). The brand should not make use of the consumer’s vulnerability when consuming the brand. This means that the brand should always act according to the promises that it makes about its products and services. Trust between the consumer and the brand implies that the brand guarantees some specific characteristics that go beyond the considerations and expectations of a simple product (Delgado-Ballester & Manuera-Alemán, 2001). Consequently, manufacturers should develop the brand’s products and execute its marketing plan according to the behaviors and qualities performed previously (Delgado-Ballester & Manuera-Alemán, 2001). Trust is important in relational exchanges, and commitment is also reserved for such relationship (Chaudhuri & Holbrook 2001).

Brand trust may be greater when the utilitarian value in the product category is high in terms of tangible product attributes such as quality and convenience (Chaudhuri & Holbrook, 2001). Utilitarian value is defined as the utility of a certain product (i.e., the product is used and purchased for practical usage). Hence, when the utilitarian value of a product is perceived to be high, consumers tend to choose this product over another product from which the utility is perceived to be lower. According to the authors’ study, brand trust is a significant indicator for purchase loyalty and attitudinal loyalty (Chaudhuri & Holbrook, 2001). Thus, based on the discussed literature, the following is proposed:

Hypothesis 2a: Brand trust has a positive influence on consumers’ willingness to buy healthier soft drinks.

Hypothesis 2b: Health claims have a stronger positive influence on willingness to buy when consumers brand trust is high.

2.3 Product Familiarity

Familiarity is one of the most important drivers of preference in food products. It reduces product uncertainty and is more likely to match between expectations and product characteristics (Borgogno, Favotto, Corazzin, Cardello & Piasentier, 2015). When consumers are highly familiar with a certain product or product category, they will perceive it as more favorable and are able to recall this product more easily (Zhou & Nakamoto, 2007). Hence, in the decision-making process, familiar products will come to the consideration set sooner, which in turn increases the willingness to buy. Habitual behaviors in purchase decisions are often made with little or no conscious effort. Consumers choose products without thinking as it is a habit to buy these specific products (Borgogno et al., 2015). This facilitates the decision-making process in general.

Familiarity is strongly related to consumers’ previous experiences with a product (Giacalone & Jaeger, 2016). Generally, consumers use their past behavior and previous experiences as heuristics to make future decisions. This means that if a consumer has always purchased a certain pasta brand and has had positive experiences with this brand, they will choose this brand again with little cognitive effort. In addition, if consumers are confronted with unfamiliar food, they tend to limit their information search and do not process the given information properly (Fischer & Frewer, 2009). Consumers automatically turn to the products they are familiar with as it is easier for them to choose from a range of familiar products than from a range of unfamiliar products.

same holds true for changes to existing drinks. This will be noticed more with brands that are well-known or familiar to the customer. Individuals tend to be risk averse when making decisions with unfamiliar products and when risk may be present (Fischer & Frewer, 2009). When a consumer perceives a situation to be more beneficial than risky, any potential risks are simultaneously perceived to be lower. This is also true the other way around (Fischer & Frewer, 2009). Hence, when an unfamiliar product indicates potential benefits for the consumer after purchasing, the risks seem to be lower than when a product is showing some potential risks. Consequently, when a consumer seeks a healthy and sugar-free product, a label indicating that a product does not contain sugar increases its benefits and reduces possible risks for the consumer in the decision-making process. Even though the product might contain a large amount of saturated fat, the “no sugar” claim will increase purchase intentions (Fischer & Frewer, 2009). However, this might only be the case for unfamiliar products as consumers may not be aware of other ingredients that may increase risks.

Product familiarity plays a critical role in consumer’s preferences of products which are complemented with new developments and features (Zhou & Nakamoto, 2007). Consumers who are familiar with a product or product category are more likely to take note of new developments or features and will pay more attention to them. For example, consumers will notice changes in Coca-Cola sooner than for a soft drink brand that is lesser-known within the soft drink and beverage market. On the other hand, when consumers have less experience with a product or product category, new developments and features may be noticed less and may gain less attention (Zhou & Nakamoto, 2007). The effect of product familiarity has a positive effect on willingness to buy, while unfamiliarity has a negative effect (Giacalone & Jaeger, 2016). Therefore, the willingness to buy familiar brands and product is perceived to be higher than with unfamiliar brands or products. Based on the above-mentioned research and findings regarding the effect of product familiarity on the willingness to buy, the following hypothesis was composed:

Hypothesis 3a: Product familiarity has a positive influence and increases consumers’ willingness to buy.

product offers in opposition to other products. In terms of food and beverages, this could include elements such as taste, ingredients and serving size. In line with the increased global awareness for healthier food products, low fat, sugar free or low calorie can be features that consumers become attached to. When these features are shown in the form of a health claim, consumers may become more aware of them. This may consequently influence their willingness to buy. The same holds true for the introduction of new products. When new products consist of features that a consumer is attached to and this is communicated through the use of health claims, it increases the consumer's interest and may also increase willingness to buy (Fischer & Frewer, 2009). This has been also studied by Zhou & Nakamoto (2007), who have stated that consumers may focus on just a couple of product characteristics when shopping. As mentioned earlier, more attention is paid to a change in a familiar product than in an unfamiliar product. However, the introduction of a health claim on a familiar product may receive more attention than on an unfamiliar product. Consequently, the increase of attention will increase product familiarity. In all, research based on the effects of health claims and product familiarity has led to the following hypothesis:

3. Conceptual Framework

The research determines the effects of previously-described variables, health claim, brand trust, and product familiarity, on consumers' willingness to buy according to the above-mentioned theory and corresponding hypotheses. All variables have come together in this studies’ conceptual framework as follows in figure 3.1 Conceptual Framework. In addition, the control variable "health consciousness" has been added in order to measure the extent to which a respondent is conscious about healthy food choices when participating in the research.

4. Methodology

4.1 Data Collection

To conduct research for the above-mentioned conceptual framework, respondents living in the Netherlands were led through a virtual supermarket environment developed in Qualtrics, an online program to conduct online questionnaires. A short, explanatory introduction instructed respondents to purchase different types of soft drinks in the virtual supermarket. The research then asked them to complete their grocery shopping trip in Qualtrics.

In the Netherlands, there are a wide variety of products that currently include health claims. Thus, it can be assumed that respondents were familiar with claims on front-off-package labels. It was therefore expected that the respondents had already experienced the decision process involving the choice of products with different types of health claims. It was important to the research that respondents were familiar with grocery shopping, so children were excluded. This was because parents tend to be the grocery shopping decision makers in households. In this study, consumers' willingness to buy soft drinks was measured according to a scale to measure purchase intention as applied by Sweeney, Soutar & Johnson, (1999). Soft drinks are perceived to be an important contributor to global obesity as these beverages often contain high levels of sugar (Donnelly et al., 2018). Due to increased soft drink consumption, governments attempt to interfere by implementing labels that will make consumers aware of their sugar intake (Donnelly et al., 2018). Due to the impact of sugary beverages, this research studied health claims on cola bottles, fruit juices and ice tea packages.

The study was of a descriptive research design, which, according to Malhotra (2010), is a research design that describes something. In this case, the effect of health claims on willingness to buy has been described according to quantitative research in the form of an experiment. The literature review, as described earlier in this thesis, provided the prior knowledge to conduct the questionnaire and collect the secondary data. The descriptive research was characterized by the prior formulation of the hypotheses, which are also discussed in the literature review of this thesis (Malhotra, 2010).

unfamiliar soft drinks. The familiar soft drinks that were selected for this experiment are Coca-Cola Light, Taksi, Wicky and Lipton Ice Tea. The unfamiliar products that were selected for this experiment are Vita Cola Light, Viva, Ceres and Bio Ice Tea. Product familiarity was measured according to the willingness to buy based on the familiar and the unfamiliar product; and brand trust was measured according to the scale as applied by Sweeney et al., (1999). In total, the research was divided into the following four conditions, which have been visualized in Table 4.1.1 Questionnaire Conditions:

1. Health claims were present on familiar soft drinks 2. Health claims were present on unfamiliar soft drinks 3. No health claims were present on familiar soft drinks 4. No health claims were present on unfamiliar soft drinks Table 4.1.1. Questionnaire Conditions

Condition

Health Claim

Product

Familiarity Brand Trust

1 Present Brand A Scale

2 Not present Brand A Scale

3 Present Brand B Scale

4 Not present Brand B Scale

4.2 Experimental Variables 4.2.1 Health Claims

Health claims were clearly visible on the products that were shown to the respondents. In line with the previously-explained literature and the relation of sugar to soft drinks, a health claim stating that the soft drink had a reduced level of sugar was implemented. The effects on willingness to buy as determined by the presence of a health claim were identified by consumers' choice on the willingness to buy scale. To avoid biases in terms of the perceived healthiness of different types of soft drinks, the research mainly focused on one type of soft drink: cola. Cola is produced by one or two well-known brands in the Netherlands that the majority of the respondents were expected to be familiar with. The other cola is perceived to be an unfamiliar product and brand as it is not sold within the Dutch market. To elaborate on the influence of health claims on willingness to buy, fruit juices and ice tea were also measured. The chosen fruit juice and ice tea brands were considered to be familiar when they are available and well-known in Dutch supermarkets, and unfamiliar when they are unavailable in Dutch supermarkets.

4.3 Manipulation Variables 4.3.1 Brand Trust

Brand trust was measured according to the brand trust scale, which has been used in Delgado-Ballester and Manuera-Alemán’s study (2001). The brand trust scale is a frequently-used scale that measures trust. It is a multi-item scale that describes the dimension in terms of specific behaviors (Delgado-Ballester & Manuera-Alemán, 2001). The scale consists of six items that represent characteristics of the brand related to its reliability and intentions towards the respondents (Delgado-Ballester & Manuera-Alemán, 2001). Each item is rated according to a four-point Likert scale ranging from “definitely will not” to “definitely will”. To decrease the number of items that had to be answered by respondents in the experiment, brand trust was only measured for cola.

4.3.2 Product Familiarity

(1979) was used to further assess familiarity of the product. For this thesis, only the items to familiarity were used as these were most relevant for this study. The scale consists of three items reflecting familiarity that had to be rated according to a seven-point-Likert scale ranging from "strongly disagree" to "strongly agree."

4.4 Control Variables 4.4.1 Health Consciousness

To control for health consciousness among the respondents, it was measured according to the Health Consciousness Scale by Gould (1988). The Health Consciousness Scale reflects the overall awareness of self-consciousness, involvement and self-monitoring of the respondent’s health (Bearden, Netemeyer & Haws, 2011). The Health Consciousness Scale is composed with nine items that are measured on a five-point Likert scale. This control variable was measured among all participating respondents to measure their level of health interest. Respondents that did not meet the requirements set by Gould (1988) were excluded from this study as their responses might bias the study outcomes.

4.4.2 Perceived Healthiness

5. Results

5.1 Sample Characteristics

A total of 178 participants completed the survey. However, 50 participants stopped halfway through the survey. This could be due to a possible language barrier because the survey was distributed in English, which is not the native language for most of the Dutch inhabitants, or respondents had no interest in filling out their opinions regarding grocery shopping and decision making. At the end of the survey, one question functioned as a manipulation check for the health claim. Four participants were not able to identify the correct beverage that had been shown to them earlier. This means that these four respondents were excluded from the analysis in order to increase its validation. Hence, the final sample of the study included 124 respondents.

In total, 124 respondents completed the survey, of which 96 were female and 28 were male. Ages ranged from 16 to 88. The mean age was 32.85 (SD=14.44). The majority of the respondents were young adults with ages between 22 to 26 years old. Respondents were either employed full time or were students. Due to the gender difference and the narrow representation of age, this sample is not a significant reflection of the market. However, the sample is large enough to run analyses and provide an overview of the effects as drawn in the conceptual framework of this study. Participants were divided over four conditions which included either familiar soft drinks with a health claim; familiar soft drinks without a health claim; unfamiliar soft drinks with a health claim; or unfamiliar soft drinks without a health claim. Sixty-two respondents were randomly assigned to the condition in which familiar soft drinks were displayed with a health claim; 63 respondents were randomly assigned to the condition in which unfamiliar soft drinks were displayed with a health claim; 62 respondents were randomly assigned to the condition in which unfamiliar soft drinks were displayed without a health claim; and 61 respondents were assigned to the condition in which unfamiliar soft drinks were displayed without a health claim.

5.2 Reliability Analyses

Chronbach’s Alpha of 𝛼 = .960 was found. There was no indication that deleting an item would increase the reliability of the scale. The same was done for brand trust. This factor returned a Chronbach’s Alpha of 𝛼 = .805. Similarly, deleting an item would not increase the reliability of this scale. Lastly, a reliability analysis was conducted for the health consciousness scale. This also resulted in one factor with a Chronbach’s Alpha of 𝛼 = .914. Again, deleting an item would not increase the reliability of the scale. The high Chronbach’s Alpha scores in the reliability analyses, indicated that the combined items for all three variables could be used for further analyses in this study. As willingness to buy, brand trust and health consciousness will be measured based on established scales, the high Cronbach’s Alpha scores were expected. For interpretation purposes, the items of the three scales were combined into unweighted means for each variable, as the sample sizes for each condition are fairly equal and no information would be lost.

Table 5.2.1 Multicollinearity Analysis

Variable VIF Score

Dummy Health Claim 1.003

Dummy Product Familiarity 1.119

Brand Trust Mean-Centered 1.118 Health Claim * Product Familiarity 1.119

Health Claim * Brand Trust 1.118

Dependent variable: WTB Cola mean

Table 5.2.1 Multicollinearity Analysis shows the Variation Inflation Factors which indicate the level of multicollinearity among the variables. A score above four indicates a moderate multicollinearity, and a score above ten indicates a strong multicollinearity. All of the VIF scores are between one and four. Thus, it can be concluded that multicollinearity is not an issue in this study.

Table 5.2.2 Pearson Correlation

Dummy Health Claim Brand Trust Mean-Centered Dummy Product Familiarity Willingness to Buy Mean

Dummy Health Claim 1 -.006 .032 -.008

Brand Trust Mean-Centered -.006 1 .320** .437**

Dummy Product Familiarity .032 .320** 1 .400**

Factor Willingness to Buy -.008 .437** .400** 1

** Correlation is significant at the 0.05 level (2-tailed).

in line with the literature and proposed hypotheses. Further analyses will provide more insights about these effects, and whether these expected relations can be confirmed.

The data was checked for normality before linear regression was conducted. When the data is normally distributed, more accurate conclusions can be drawn from the results of the analyses. The normal distribution was checked by means of a histogram based on the dependent variable (willingness to buy). The histogram, shown in Appendix II, displays a bell-shaped form. This means that the data is normally distributed.

5.3 Hypotheses Testing

Figure 5.3.1 Willingness to Buy for Brand Trust

Figure 5.3.2 Willingness to Buy for Product Familiarity

1.6695 3.9563 2.2361000 3.6014 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

Low Brand Trust High Brand Trust Low Brand Trust High Brand Trust Health claim No health claim

WI L L IN G N E SS T O B U Y BRAND TRUST

Willingness to Buy for Brand Trust

4.03 2.45 4.09 2.50 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5

Familiar Unfamiliar Familiar Unfamiliar Health Claim No Health Claim

WI L L IN G N E SS T O B U Y PRODUCT FAMILIARITY

Two figures were established to display the individual effect of both moderators separately. Based on the figures as displayed above, brand trust and product familiarity seem to have a positive effect on willingness to buy. Health claims seem to increase the positive effects of brand trust and familiarity. In the next sections these relationships will be tested according to the proposed model.

5.3.1 Multiple Linear Regression

In order to test the proposed framework (Figure 3.1 Conceptual Framework) that has been discussed so far, a multiple linear regression was conducted with the PROCESS Macro by Andrew F. Hayes. Model 2 was used to conduct the multiple linear regression, including both moderators. As the correlation matrix in table 5.2.2 indicated that there is a weak correlation between brand trust and product familiarity, chances of correlation should still be taken into consideration.

All regressions were also conducted with mean-centered variables. However, the analyses did not provide different results than the analyses without mean-centering. In order to significantly distinguish the main effects from the simple slopes, the mean-centered results were used for this analysis.

effect on the willingness to buy Β = .558 (p = .0010). This means that when a consumer is more familiar with a product, the willingness to buy increases with .558 Hypothesis 3a could therefore be confirmed as it stated that product familiarity would have a positive effect on the willingness to buy. Furthermore, the interaction effect of product familiarity on the relationship between health claims and willingness to buy was not significant (p = > .05). There is therefore no evidence that product familiarity has an effect on the relationship as proposed in this thesis. Hypothesis 3b could not be confirmed. Output of the multiple linear regression can be found in Appendix III Multiple Regression Conceptual Model.

The same multiple linear regression with product familiarity as a moderator was also done for fruit juices and ice tea. Brand trust was not measured for these products, this was only done for the cola products. The analysis did not show significant results and therefore no effect on willingness to buy could be found (p = > .05). Output for the multiple regression of willingness to buy fruit juice, can be found in Appendix VII – Multiple Regression Willingness to Buy Fruit Juice. The same test was done for ice tea and also for this test no significant result could be found (p = > .05). Output for the multiple regression of willingness to buy ice tea, can be found in Appendix VIII – Multiple Regression Willingness to Buy Ice Tea. As both models for fruit juice and ice tea failed to provide significant results, no conclusions could be drawn from these analyses.

Brand trust and product familiarity could only be measured for the cola products. As in both analyses health claim does not prove to have an effect on the willingness to buy soft drinks, hypothesis 1 could still not be confirmed.

Figure 5.3.3 Effect Brand Trust – Willingness to Buy

Figure 5.3.4 Effect Product Familiarity – Willingness to Buy

Health consciousness was studied according to the health consciousness scale by Gould (1988). This scale consisted of eight items that measured the health consciousness of the respondents. The reliability of the factor on the scale showed a Chronbach’s Alpha of 𝛼 = .914. The

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

Low Brand Trust Medium Brand Trust High Brand Trust

Wi lli ng ne ss to B uy Brand Trust

Effect Brand Trust

Health Claim No health Claim

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

Unfamiliar Product Familiar Product

Wi lli ng ne ss to B uy Product Familiarity

Effect Product Familiarity

cases, this variable did not show a significant effect on the model (p = >.05). No conclusion could therefore be drawn regarding the effect of health consciousness on the willingness to buy.

Table 5.3.1 Overview of Hypotheses

Hypothesis Confirmed

Hypothesis 1: Consumers’ willingness to buy healthier types of

soft drinks, increases when a health claim is present.

×

Hypothesis 2a: Brand trust has a positive influence on

consumers’ willingness to buy healthier soft drinks.

✓

Hypothesis 2b: Health claims have a stronger positive influence

on willingness to buy when consumers’ brand trust is high.

×

Hypothesis 3a: Product familiarity has a positive influence and

increases consumers’ willingness to buy.

✓

Hypothesis 3b: The effect of health claims on willingness to buy

will be increased by consumers’ product familiarity.

×

5.4 Additional results

of product familiarity on the relation between perceived healthiness and willingness to buy. This effect is the strongest when there is high brand trust (Β = .615, p = 0000), weaker for medium (Β = .571, p = .0000) and weakest for low brand trust (Β = .527, p = .0021). Brand trust also showed a significant positive effect on willingness to buy Β = .889 (p = .0035), however the effect of brand trust on the relationship between perceived healthiness and willingness to buy did not show a significant interaction (p = > .05). Output of this multiple regression, can be found in Appendix IV – Multiple Regression – Perceived Healthiness-Willingness to Buy.

Secondly, a multiple regression has been conducted to identify the effects of health claims on the perceived healthiness of the cola products.. The multiple regression (PROCESS model 2 by Andrew Hayes) showed a significant effect R2 _{= .159, F(5, 118) = 4.451, p = .0009. Product} familiarity did not show a significant direct effect on the perceived healthiness (p = > .05). Health claim did not show a significant direct effect on the perceived healthiness either (p = > .05). However, the interaction of product familiarity on the effect of health claim on perceived healthiness did show significant results of Β = .302 (p = .0368), which indicates a positive effect. Thus, product familiarity has a positive interaction on the effect of health claims on perceived healthiness. The simple slopes for this interaction did not show a significant effect (p = > .05) and could therefore not be interpreted. Brand trust has a significant positive effect on perceived healthiness Β = 1.031 (p = .0001). Thus, when brand trust increases, perceived healthiness increases with 1.031. The interaction of brand trust on the effect of health claims on perceived healthiness is not significant (p = > .05). Output of this multiple regression can be found in Appendix V – Multiple Regression Health Claim-Perceived Healthiness.

Output for the mediation of perceived healthiness, can be found in Appendix VI – Mediation Perceived Healthiness.

6. Discussion

Literature demonstrates that there is an increased awareness of both healthy lifestyles and food consumption. However, global obesity rates are still on the rise. The WHO is conducting efforts to decrease this number by applying certain rules and regulations on food manufacturers by introducing front-of-package or back-of-package labels indicating the “healthiness” of food products. Food manufacturers are also responding to the increased interest in healthy lifestyles by using less sugars and saturated fat in their products to meet consumers’ standards. Nevertheless, consumers have become critical toward these labels as they are often found to be misleading (Choi et al., 2012; Ares & Gámbaro, 2007). The research in this thesis provides some insights into the effectiveness of applying health claims to products and to what extent they affect a product's perceptions as a healthier choice compared to a similar products. Furthermore, this research assesses whether the effectiveness of the health claim differs depending on brand trust and product familiarity.

no effect on the willingness to buy could be found. On the other hand, Garretson and Burton (2000) also found that nutrient claims (i.e. sugar free), do not influence consumers’ attitudes towards the products or purchase intentions. Only when substantiated facts were present, consumers tend to rely more on these facts, than on front-of-package health claims (Garretson & Burton, 2000). Furthermore, consumers who are looking for healthy products pay more attention to health claims than consumers who do not specifically look for such products (Sierra, Taute & Turri, 2015). This may have influenced the effect as well. In this study, the health claim was fictional and had not been tested on the soft drinks beforehand, which could have affected the reliability of the claim and therefore the effect on willingness to buy the soft drinks. In all, multiple factors could have played a role in the lacking effect of health claims on willingness to pay. Therefore, future research in this field is recommended.

nutrient-health claims (Sierra et al., 2015). Results showed, that when a product is familiar to the consumer or when the consumer trusts the brand, perceived healthiness of the product increases. Product familiarity has shown to strengthen this effect. Thus, when consumers are familiar with a product that is perceived to be healthy, it has a positive interaction effect on the willingness to buy. Furthermore, based on the mediation (Appendix VI Mediation Perceived Healthiness) and the multiple regression (Appendix IV Multiple Regression Perceived Healthiness – Willingness to Buy) perceived healthiness showed a positive direct effect on willingness to buy. Thus, when a consumer perceives a product to be healthy, willingness to buy increases.

pay attention to the aspects they are familiar with. Thus, if consumers seek for a cola light and they see one in the supermarket they are familiar with, they will choose this product because they are familiar with the product. Attention might not be paid to the health claim that is visible on the soft drink’s label because the consumer has not assigned importance to this aspect of the product. Also, not everyone pays attention to health claims on food products. Consumers who seek for healthier products, notice health claims more than consumers who are not (Sierra et al., 2015). It is therefore assumed that health claims have more effect for consumers who seek for healthier products.

Both interaction effects of brand trust and product familiarity did not prove to have an effect on the relation between health claims and willingness to buy. This can be due to the fact that cola is known to be a relatively unhealthy product. Also, Coca Cola is globally a well-known brand for sugary soft drinks. As mentioned earlier, consumers who seek healthier products, pay more attention to health claims (Sierra et al., 2015). When consumers notice the health claims on cola products, it will not meet their expectations regarding the product. Furthermore, health claims tend to decrease quality of the products (van Doorn & Verhoef, 2011). As quality is a predictor for purchasing intentions, it may have a negative effect on willingness to buy. Soft drinks have proven to be associated with obesity and diabetes (Donnelly et al., 2018; Mayo Clinic, 2010). Thus, cola is perceived as an unhealthy product. Implementing a health claim on an unhealthy product might have less effect on the willingness to buy as it does not match with the expectations of the product. Claims on a drink or food packages should be in line with the perceived healthiness of the product in order to have a positive influence on consumers purchasing behaviors (Ares & Gámbaro, 2007).

sugar than regular colas. The health claim stated that the product did not contain sugar, which might have matched with consumers’ expectations about the Coca-Cola Light. This way, providing a claim on a familiar product stating a beneficial nutrition fact, increases the perceived healthiness of a product. Brand trust did also show a positive effect on perceived healthiness in the same analysis. This is a surprising effect as Coca-Cola is generally perceived as an unhealthy brand due to the image that soft drinks have (Mayo Clinic, 2010). However, respondents in the study may have linked Cola light to the “healthier” version of the soft drink. Thus in combination with a higher level of trust in the brand, this may have a positive influence on the perceived healthiness of a product.

Based on the analyses and the discussion of the outcomes, the research question as follows can be answered:

“To what extent do health claims influence consumers’ willingness to buy soft drinks and how is this relationship influenced by product familiarity and brand trust?”

healthy food products, that have been in the market for a longer time, in order to increase consumers' willingness to buy.

As not all the assumptions, that were based on the literature could be confirmed, it is expected that several confounds have influenced willingness to buy as a dependent variable. First, a potential confound in this study can be quality. Van Doorn and Verhoef (2011) stated that health claims can decrease the quality of a product and consequently influence the willingness to pay. When consumers are familiar with a product expectations have been formed during previous experiences. However, when these expectations are not met due to the implementation of a health claim consumers’ perceived quality of the product might decrease, which consequently influences willingness to buy. Secondly, as stated earlier, taste perception may also have played a role in defining the willingness to buy amongst respondents. According to Glanz, Basil, Maibach, Goldberg and Snyder (1998), are consumers mainly purchasing products that are expected to meet taste perceptions of the product. When respondents that participated in the study did not expect to like the taste of the displayed soft drinks beforehand, based on the pictures showed to them, willingness to buy would be low. Thus, quality and taste perceptions may be factors that have been influencing the willingness to buy in this study.

6.1 Implications

Due to rising obesity rates, retailers and food manufacturers are finding new ways to provide consumers with healthier food options and to inform them about ingredients that their products consists of. People are becoming more and more aware of the importance of healthier lifestyles and start to be aware of personal health and nutritional intake. In order to distinguish “healthy” products from “unhealthy” products health claims have been implemented often to provide consumers with nutrient information about the product. However, the efficacy of health claims are criticized due to the often complicated terms and information overload.

of consumers that are seeking for healthier products. This has also been explained by Ares and Gámbaro (2007) as the effect of a health claim for one part explained by the perceived healthiness of a product and to what extent the consumer is looking for a healthier product. This will first of all further increase the perceived healthiness of a product, and consequently strengthen the positive effect on willingness to buy. As consumers tend to be risk averse when making purchasing decisions (Fischer & Frewer, 2009) and tend to rely on heuristics to make product choices, it is important that the content of the health claim matches with the characteristics of the product, which the consumer is familiar with. Hence, another indicator may be product familiarity. As critics are influencing the reliability of health claims, it is recommended not to use health claims to differentiate a product, with the intention to increase willingness to buy. This will not increase perceived healthiness of a product, and makes consumers more critical towards the health claim and the product. As the perceived healthiness and product familiarity are found to be important indicators, health claims are recommended to be used on products that are familiar and trusted for being a healthier product choice. 6.2 Future Research

influenced by previous purchase decisions that had been done in other food and product categories. It is also recommended that this study will be duplicated using organic soft drinks or soft drinks that are known to be healthier. As stated by Ares and Gámbaro (2007), the image of the product, in this case the perceived healthiness, plays a role in the recognition of the health claim and the willingness to buy. These types of soft drinks may have this healthy image, which may lead to a more effective implementation of the health claim. Fourth, willingness to buy was measured electronically via questions, and only one product was exposed at a time. In this sense, the respondent was not exposed to any other stimuli or incentives that are normally present in a grocery store. Therefore, a field study is recommended to analyze the willingness to buy of consumers when other soft drinks and marketing stimuli are present. Lastly, the label that was used as a health claim in this study had not been tested before nor used on any other products. This unfamiliarity may have had an effect on the willingness to buy as respondents had not seen it before or fully understood its meaning in relation to the product.

References

Ahadzadeh, A. S., Sharif, S. P., Ong, F. S., & Khong, K. W. 2015. Integrating health belief model and technology acceptance model: an investigation of health-related internet use. Journal of medical Internet research, 17(2).

Andrews, J.C., Burton, S., & Netemeyer, R.G. 2000. Are some comparative nutrition claims misleading? The role of nutrition knowledge, ad claim type and disclosure conditions.

Journal of Advertising, 29: 29–42.

Andrews, J.C., Burton, S., & Netemeyer, R.G. 2013. Are Some Comparative Nutrition Claims Misleading? The Role of Nutrition Knowledge, Ad Claim Type and Disclosure Conditions. Journal of Advertising, 29(3): 29 – 42.

Andrews, J.C., Netemeyer, R.G., & Burton, S. 1998. Consumer generalization of nutrient- content claims in advertising. Journal of Marketing, 62: 62–75.

Ares, G., & Gámbaro, A. 2007. Influence of gender, age and motives underlying food choice on the perceived healthiness and the willingness to try functional foods. Appetite, 49(1): 148 – 158.

Aschemann-Witzel, J., & Hamm, U. 2010. Do consumers prefer foods with nutrition and health claims? Results of a purchase simulation. Journal of Marketing Communications, 16(1-2): 47 – 58.

Bearden, W.O., Netemeyer, R.G., & Haws, K.L. 2011. Handbook of Marketing Scales. Multi-Item Measures for Marketing and Consumer Behavior Research. Thousand Oaks: Sage Publications Inc.

Belen del Rio, A., Vázquez, R., & Iglesias, V. 2001. The effects of brand associations on consumer response. Journal of Consumer Marketing, 18(5): 410 – 425.

Bleich, S.N., Wolfson, J.A., Vine, S., & Wang, Y.C. 2014. Diet-Beverage

Consumption and Caloric Intake Among US Adults, Overall and by Body Weight. American

Journal of Public Health, 104(3): 72 – 78.

Borgogno, M., Favotto, S., Corazzin, M., Cardello, A.V., & Piasentier, E. 2015. The role of product familiarity and consumer involvement on liking and perceptions of fresh meat. Food Quality and Preference, 44: 139 – 147.

Bray, G.A. 2010. Soft drink consumption and obesity: it is all about fructose. Current

Opinion in Lipidology, 21(1): 51 – 57.

Caswell, J.A., Ning, Y., Liu, F., & Mojduszka, E.M. 2003. The Impact of New Labeling Regulations on the Use of Voluntary Nutrient-Content and Health Claims by Food Manufacturers. Journal of Public Policy & Marketing, 22(2): 147 – 158.

Chandon, P., & Wansink, B. 2012. Does food marketing need to make us fat? A review and solutions. Nutrition Reviews, 70(10): 571 – 593.

Chandon, P., & Wanskin, B. 2007. The Biasing Health Halos of Fast-Food Restaurant Health Claims: Lower Calorie Estimates and Higher Side-Dish Consumption intentions.

Journal of Consumer Research, 34(3): 301 – 314.

Chaudhuri, A., & Holbrook, M.B. 2001. The Chain of Effects from Brand Trust and Brand Affect to Brand Performance: The Role of Brand Loyalty. Journal of Marketing, 65(2): 81 – 93.

Choi, H., & Reid, N.R. 2018. Promoting Healthy Menu Choices in Fast Food

Restaurant Advertising: Influence of Perceived Brand Healthiness, Brand Commitment, and Health Consciousness. Journal of Health Communication, 23: 387 – 398.

Choi, H., Paek, H.J., & King, K.W. 2012. Are nutrient-content claims always effective? Match-up effects between product type and claim type in food advertising.

International Journal of Advertising, 31(2): 421 - 443.

Cowburn, G., & Stockley, L. 2005. Consumer understanding and use of nutrition labelling: A systematic review. Public Health Nutrition, 8: 21–28.

Delgado-Ballester, E., & Manuera-Alemán, J.L. 2001. Brand trust in the context of consumer loyalty. European Journal of Marketing, 35(11/12): 1238 – 1258.

Denehy, J. 2003. The Health effects of Soft Drinks. The Journal of School Nursing, 19(2): 63 – 64.

Donnelly, G.E., Zatz, L.Y., Svirsky, D., & John, L.K. 2018. The Effect of Graphic Warnings on Sugary-Drink Purchasing. Psychological Science. 29(8): 1321 – 1333.

Feunekes, G.I.J, Gortemaker, I.A., Willems, A.A., Lion, R., & van den Kommer, M. 2008. Front-of-pack nutrition labelling: Testing effectiveness of different nutrition labelling formats front-of-pack in four European countries. Appetite, 50: 57 – 70.

Fischer, A.R.H., & Frewer, L.J. 2009. Consumer familiarity with foods and the perception of risk and benefits. Food Quality and Preference, 20(8): 576 – 585.

Disease-familiarity affects usage versatility of foods and beverages. Journal of Economic Psychology, 55: 120 – 138.

Glanz, K., Basil, M., Maibach, E., Goldberg, J., & Snyder, D. 1998. Why Americans eat what they do: Taste, nutrition, cost, convenience, and weight control concerns as

influences on food consumption. Journal of the American Dietetic Association, 98(10): 1118 – 1126.

Gould, S.J. 1988. Consumer Attitudes Toward Health and Health Care: A Differential Perspective. Journal of Consumer Affairs, 22: 96 – 118.

Grunert, K. G., Wills, J. M., & Fernandez-Celemin, L. 2010. Nutrition knowledge, and use and understanding of nutrition information on food labels among consumers in the UK. Appetite, 55: 177–189.

Guthrie, J., Mancino, L., & Jordan Lin, C.T. 2015. Nudging Consumers toward Better Food Choices: Policy Approaches to Changing Food Consumption behaviors. Psychology &

Marketing, 32(5): 501 – 511.

Jew, S., Vanstone, C.A., Antoine, J.M., & Jones, P.J.H. 2008. Generic and Product-Specific Health Claim Processes for Functional Foods across Global Jurisdictions. The

Journal of Nutrition, 138(6): 1228 – 1236.

Jo, M.S., Nakamoto, K., & Nelson, J.E. 2003. The shielding effects of brand image against lower quality countries-of-origin in global manufacturing. Journal of Business

Research, 56(8): 637 – 646.

Johnson, E.J., & Russo, J.E. 1984. Product Familiarity and Learning New Information. Journal of Consumer Research, 11(1): 542 – 550.

Kozup, J.C., Creyer, E.H., & Burton, S. 2003. Making Healthful Food Choices: The Influence of Health Claims and Nutrition Information on Consumers’ Evaluations of Packaged Food Products and Restaurant Menu Items. Journal of Marketing, 67(2): 19 – 34.

Lalor, F., Kennedy, H., Flynn, M.A.T., & Wall, P.G. 2009. A study of nutrition and health claims – a snapshot of what’s on the Irish market. Public Health Nutrition, 13(5): 704 – 711.

Lähteenmäki, L., Lampila, P., Grunert, K., Boztug, Y., Ueland, Ø., Åström, A., & Martinsdóttir, E. 2010. Impact of health-related claims on the perception of other product attributes. Food Policy, 35(3): 230 - 239.

Malhotra, N.K. 2010. Marketing Research. An Applied Orientation. New Jersey: Pearson Education Inc.

of health claims and nutritional composition on consumers’ yoghurt preferences. Food

Quality and Preference, 43: 26 – 33.

Mitchell, V., & Walsh, G. 2004, Gender differences in German consumer decision-making styles. Journal of Consumer Behaviour, 3: 331-346.

Mukaka, M. M. (2012). A guide to appropriate use of correlation coefficient in medical research. Malawi Medical Journal, 24(3), 69-71.

Mayo Clinic. 2010. Soda consumption linked to obesity, type 2 diabetes, other health concerns. Mayo Clinic News. Retrieved from http://professional.diabetes.

org/News_Display.aspx?CID=82591

NCD Risk Factor Collaboration. 2017. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1976 to 2016: a pooled analysis of 2416

population-based measurement studies in 128.9 million children, adolescents, and adults. The

Lancet, 390(10113): 2627 – 2642.

Nocella, G., & Kennedy, O. 2012. Food health claims – What consumers understand.

Food Policy, 37: 571–580.

O’Cass, A., & Frost, H. 2002. Status brands: examining the effects of non-product-related brand associations on status and conspicuous consumption. Journal of Product &

Brand Management, 11(2): 67 – 88.

O’leary, F., Hattersly, L., King, L., & Allman-Farinelli, M. 2012. Sugary drink consumption behaviors among young adults at university. Nutrition & Dietetics, 69: 119 – 123.

Roodenburg, A.J.C., Popkin, B.M., & Seidell, J.C. 2011. Development of

international criteria for a front of package food labelling system: the International Choices Programme. Journal of Clinical Nutrition, 65: 1190 – 1200.

Schlinger, M. 1979. A Profile of Responses to Commercials. Journal of Advertising

Research, 19: 37–46.

Svederberg, E., & Wendin, K. 2011. Swedish consumers’ cognitive approaches to nutrition claims and health claims. Food & Nutrition Research, 55.

Sweeney, J., Soutar, G., & Johnson, L. 1999. The role of perceived risk in the quality - value relationship: a study in a retail environment. Journal of Retailing, 75(1): 77 - 105.