Dietary supplements are generally exempt from strict governmental regulations, leaving consumers to rely on various information sources to judge the safety and efficacy of these products. Given the differences in the US and Chinese marketplaces concerning government regulation and business responsibility, this study addresses the roles of different information sources for US and Chinese consumers. Findings reveal that while consumers in both countries rank family/friends and health professionals high (and marketer sources low), US consumers are more apt to trust online sources. While neither American nor Chinese consumers trust regulators to ensure supplement safety, Chinese consumers have lower trust than Americans.
Introduction
Dietary supplements (also referred to as natural health products, complementary medicines, or food supplements) broadly include vitamins, minerals, herbs or other botanicals, amino acids, and other substances. Consumers often view them as a viable and low-cost approach to health enhancement, illness management, and personal improvement (Nichter & Thompson 2006). Despite the popularity and growing use of supplements, these products are generally neither regulated as conventional foods nor as drugs. As a result, regulations vary significantly across global markets. In the United States, for example, the Food and Drug Administration (FDA) regulates supplements as a separate category whereby “firms are responsible for evaluating the safety and labeling of their products before marketing to ensure that they meet all the requirements of the Dietary Supplement Health Education Act (DSHEA) and FDA regulations” (US Food and Drug Administration 2019). On the other hand, regulations are more stringent in China. The regulation of dietary supplements in China is governed by the Chinese Food and Drug Administration (CFDA), which requires supplements to be registered and approved by the CFDA before they can be offered for sale. Manufacturers must submit detailed information about the composition of the product, the manufacturing process, and any safety and efficacy studies conducted. Any health claims made about the product must be supported by scientific evidence.
Regardless of government oversight, the burden generally falls on consumers to obtain accurate and comprehensive information regarding the efficacy and safety of dietary supplements. Customers have access to an array of information sources, and it is crucial to understand which sources consumers rely upon in their use of nutritional supplement products. Given the differences in economic and political systems and corresponding differences in the US and China marketplaces concerning consumer attitudes toward government regulation and business responsibility, it is reasonable to question how American and Chinese consumers differ in their trust in product-related information sources.
This study aims to understand various information sources’ role for US and Chinese consumers in the risky but unevenly regulated nutritional supplement product category. It also examines consumer perceptions of supplement efficacy and safety. Finally, we examine which entities US and Chinese consumers believe should ultimately be responsible for ensuring dietary supplements’ effective and safe use.
Literature Review
Market Size & Characteristics − USA
In American society, dietary supplements are now considered a viable and low-cost approach to health enhancement, illness management, and personal improvement (Nichter & Thompson 2006). Americans report using nutritional supplements to maintain or improve overall health and the health of specific
organs, prevent disease, increase energy, improve mental health, achieve weight loss, and resolve miscellaneous health issues such as menopause and hot flashes (Bailey et al. 2013). Even though many dietary supplements are of dubious value and may be dangerous, they are mostly unregulated in the
United States. In fact, the onus is placed on the Food and Drug Administration to prove a product is harmful rather than requiring manufacturers to demonstrate their products are safe and effective. (Wilson et al. 2006). American consumer dietary supplement expenditures are proliferating from US$32 billion in 2016 to a projected about $57 billion in 2024 (Mikulic 2019). According to the US Government Accountability Office (2013), approximately 150 million people in the United States use nutritional supplements, with 79 percent reporting daily use and 10 percent taking five or more different products per day. An estimated 77 percent of Americans use one or more of the tens of thousands of dietary supplements in place of prescription drugs, and 30 million use them instead of over-the-counter medications (Council for Responsible Nutrition 2019).
Research has explored the relationship between demographic factors (e.g. education, gender, and age) and beliefs about and intent to use supplements (Chandra et al. 2005, Gordon & Schaffer 2005). For example, a study of supplement use by US college athletes (Fralick & Trocchio 2019) revealed gender differences both in motivations (males: to gain strength; females; energy) and in the information sources they used (males: parents/guardians; females: coaches). Another stream of research compares the relative impact of dietary supplements versus prescription drugs on consumers’ perceptions of a healthy lifestyle. Compared to nutritional supplements, medications reduce perceptions of health, diminish the importance of healthy lifestyle practices, and lead to lower motivation to engage in health-protective behaviors (Bolton et al. 2008). Subsequently, Royne et al. (2014) examined the impact of health consciousness on
consumer attitudes and perceptions of supplement benefits and risks compared to prescription drug counterparts.
Market Size & Characteristics − China
China’s dietary supplement market is growing at an estimated CAGR of about 13−14 percent. It is on track to overtake the United States as the largest supplement market, projected to reach US$40 billion by 2023 and US$69 billion by 2027. Several market factors fuel this growth, including the rise of China’s consumer class, increasing health consciousness, an aging population, growth in e-commerce, and concerns regarding food security (China Business Review 2016). Chinese consumers’ more popular supplements include collagen, grape seed extract, whey protein powder, and fish oil. It is common for Chinese consumers to take multiple supplements per day to promote overall well-being. Chinese consumers primarily opt for foreign supplement brands, mainly from the US and Australia, as these are more reliable than domestic brands. In turn, foreign brands have responded to the demand to include specific ingredients, branding, and packaging to better suit the Chinese market.
Supplement use in China spans age groups, with the heaviest usage among those 18−29. Consumers under 40 represent 62 percent of total buyers of food supplements (GMA 2020). While gyms and fitness centers are becoming popular in major cities like Shanghai and Beijing, these facilities are less common in
smaller towns and rural areas. Vitamins and other dietary supplements provide an accessible alternative to participate in the wellness movement.
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The use and trust of information sources related to the efficacy and safety of dietary supplements among US vs Chinese consumers
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Forman, AM & Sriram V 2025. The use and trust of information sources related to the efficacy and safety of dietary supplements among US vs Chinese consumers: an exploratory study. Journal of the Academy of Business and Emerging Markets, 5(1), 29−40.
https://doi.org/10.5281/zenodo.14737487
