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Quevedo KL, Jáuregui A, Nieto C, Contreras-Manzano A, White CM, Vanderlee L, Barquera S, Corvalán C, Hammond D. Sociodemographic differences in nutrition labels effect on Chilean and Mexican youth. Rev Panam Salud Publica 2024; 48:e33. [PMID: 38576841 PMCID: PMC10993807 DOI: 10.26633/rpsp.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 04/06/2024] Open
Abstract
Objective To examine sociodemographic differences in the awareness, understanding, use and effect of nutrition labels among Mexican and Chilean youth. Methods Online surveys among youth (10-17 years) were obtained in 2019 (n=2631). Participants reported their awareness, understanding, and use of their country-specific nutrition facts tables (NFT) and front-of-pack labels (FOPL) (Chile: warning labels [WLs]; Mexico: guideline daily amounts [GDA]). Additionally, participants reported their perceived healthfulness of a sweetened fruit drink after viewing one of six versions of it with different FOPL (no-label control, Health Star Rating, WLs, GDAs, Traffic Light, or Nutri-Score) during an experimental task. Results Higher self-reported nutrition knowledge was associated with higher NFT and FOPL awareness, understanding, and use, except for WL use. WLs were the most effective FOPL in decreasing the perceived healthfulness of the sweetened fruit drink compared to a no-label condition and other FOP labels. In Chile, the effect of GDA differed by income adequacy, while in Mexico Nutri-Score differed by age. Conclusions Results suggest that nutrition label awareness, use, understanding, and impact differ across demographics, favoring higher income and nutrition knowledge. Despite this, WLs are likely to have a positive impact on nutrition-related knowledge and behaviors among Mexican and Chilean youth, independently of their socio-demographic groups.
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Affiliation(s)
- Kathia Larissa Quevedo
- Instituto Nacional de Salud PúblicaCuernavacaMexicoInstituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Alejandra Jáuregui
- Instituto Nacional de Salud PúblicaCuernavacaMexicoInstituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Claudia Nieto
- Instituto Nacional de Salud PúblicaCuernavacaMexicoInstituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Alejandra Contreras-Manzano
- Consejo Nacional de HumanidadesCiencias y TecnologíasMexico CityMexicoConsejo Nacional de Humanidades, Ciencias y Tecnologías, Mexico City, Mexico
| | - Christine M. White
- University of WaterlooWaterlooCanadaUniversity of Waterloo, Waterloo, Canada.
| | - Lana Vanderlee
- Université LavalQuebecCanadaUniversité Laval, Quebec, Canada
| | - Simón Barquera
- Instituto Nacional de Salud PúblicaCuernavacaMexicoInstituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Camila Corvalán
- Universidad de ChileSantiagoChileUniversidad de Chile, Santiago, Chile
| | - David Hammond
- University of WaterlooWaterlooCanadaUniversity of Waterloo, Waterloo, Canada.
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Thrasher JF, Villalobos-Daniel VE, Fang D, Nieto C, White CM, Armendariz G, Jáuregui A, Hammond D, Davis RE. Assessing transnational spillover effects of Mexico's front-of-package nutritional labeling system among Mexican Americans in the US. Prev Med 2024; 179:107855. [PMID: 38215993 PMCID: PMC10929004 DOI: 10.1016/j.ypmed.2024.107855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE In 2020, Mexico implemented innovative front-of-package nutrition warning labels (FoPWLs) for packaged foods to increase the salience and understanding of nutrition information. This study evaluated Mexican Americans' self-reported exposure to Mexican FoPWLs and self-reported effects of FoPWLs on purchasing behavior. METHODS The 2021 International Food Policy Study surveyed online panels of adult Mexican Americans in the US (n = 3361) to self-report on buying food at Mexican-oriented stores, noticing Mexican FoPWLs, and being influenced by FoPWLs to purchase less of eight different unhealthy foods (each assessed separately). After recoding the frequency of buying foods in Mexican stores and noticing FoPWLs (i.e., "often" or "very often" vs. less often), logistic models regressed these outcomes on sociodemographics, adjusting for post-stratification weights. RESULTS Most participants (88.0%) purchased foods in Mexican stores. Of these, 64.1% reported noticing FoPWLs, among whom many reported that FoPWLs influenced them to buy fewer unhealthy foods (range = 32% [snacks like chips] - 44% [colas]). Participants were more likely to buy foods in Mexican stores and notice FoPWLs if they were younger, had ≥two children at home vs no children (AOR = 1.40, 95%CI = 1.15-1.71; AOR = 1.37, 95%CI = 1.03-1.80, respectively), and more frequently used Spanish (AOR = 1.91, 95%CI = 1.77-2.07; AOR = 1.87, 95%CI = 1.69-2.07). Also, high vs. low education (AOR = 1.51, 95%CI = 1.17-1.94) and higher income adequacy (AOR = 1.37, 95%CI = 1.25-1.51) were positively associated with noticing FoPWLs. Being female and more frequent Spanish use were consistently associated with reporting purchase of fewer unhealthy foods because of FoPWLs. CONCLUSIONS Many Mexican Americans report both exposure to Mexican FOPWLs and reducing purchases of unhealthy foods because of them.
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Affiliation(s)
- James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, USA; Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Victor Eduardo Villalobos-Daniel
- Non Communicable Diseases and Mental Health, Pan American Health Organization, Washington DC, USA.; Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.
| | - Dai Fang
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, USA
| | - Claudia Nieto
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Gabriela Armendariz
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, USA
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Canada
| | - Rachel E Davis
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, USA
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Pfledderer CD, Ranjit N, Pérez A, Malkani RI, Ferreira De Moraes AC, Hunt ET, Smith CL, Hoelscher DM. Using the Nutrition Facts Label to Make Food Choices Is Associated with Healthier Eating among 8th and 11th-Grade Students: An Analysis of Statewide Representative Data from the 2019-2020 Texas School Physical Activity and Nutrition Survey. Nutrients 2024; 16:311. [PMID: 38276549 PMCID: PMC10819117 DOI: 10.3390/nu16020311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Nutrition labels are a tool to inform and encourage the public to make healthier food choices, but little information is available about use in multi-ethnic adolescent populations in the U.S. The purpose of this study was to examine associations between the level of nutrition label usage and healthy/unhealthy eating behaviors among a statewide representative sample of 8th and 11th-grade students in Texas. METHODS We analyzed cross-sectional associations between the Nutrition Facts label use and eating behaviors from a statewide sample of 8th and 11th-grade students in Texas, (n = 4730, weighted n = 710,731, mean age = 14.7 ± 1.6 years; 49% female, 51% Hispanic), who completed the 2019-2020 Texas School Physical Activity and Nutrition (TX SPAN) survey. Students self-reported their level of nutrition label usage to make food choices (5-point Likert scale from "Never" to "Always") and previous day consumption of 26 food items (13 healthy, 13 unhealthy). The 26 food items were used to calculate a Healthy Eating Index (HEI) score (0-100), a Healthy Foods Index (HFI) score (0-100), and an Unhealthy Foods Index (UFI) score (0-100). Weighted linear regression models were employed to examine the associations between self-reported use of nutrition labels to make food choices and HEI, HFI, and UFI scores. Marginal predicted means of HEI, HFI, and UFI scores were calculated post hoc from linear regression models. The odds of consuming specific individual food items for nutrition label usage were also calculated from weighted logistic regression models. All linear and logistic regression models were adjusted for grade, sex, Body Mass Index (BMI), race/ethnicity, economic disadvantage, and percentage of English language learners by school. RESULTS A total of 11.0% of students reported always/almost always using nutrition labels to make food choices, 27.9% reported sometimes using them, while 61.0% indicated they never/almost never used nutrition labels to make food choices. The average HEI score among students in the sample was 47.7 ± 5.9. Nutrition Facts label usage was significantly and positively associated with HEI (b = 5.79, 95%CI: 4.45, 7.12) and HFI (b = 7.28, 95%CI:4.48, 10.07), and significantly and negatively associated with UFI (b = -4.30, 95%CI: -6.25, -2.34). A dose-response relationship was observed between nutrition label usage and HEI, HFI, and UFI scores, such that the strength of these associations increased with each one-point increase in nutrition label usage. Students who reported using nutrition labels always/almost always to make food choices had significantly higher odds of consuming healthy foods including baked meat, nuts, brown bread, vegetables, whole fruit, and yogurt (ORrange = 1.31-3.07), and significantly lower odds of consuming unhealthy foods including chips, cake, candy, and soda (ORrange = 0.48-0.68) compared to students who reported never/almost never using the Nutrition Facts label. CONCLUSIONS Using the Nutrition Facts labels to make food choices is beneficially associated with healthy and unhealthy eating among 8th and 11th-grade students, although the proportion of students using nutrition labels to make their food choices was low. Public health efforts should be made to improve nutrition literacy and encourage nutrition label use among secondary students in the United States.
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Affiliation(s)
- Christopher D. Pfledderer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (N.R.); (E.T.H.); (D.M.H.)
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (N.R.); (E.T.H.); (D.M.H.)
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA
| | - Raja I. Malkani
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Augusto César Ferreira De Moraes
- Department of Epidemiology, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA;
| | - Ethan T. Hunt
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (N.R.); (E.T.H.); (D.M.H.)
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Carolyn L. Smith
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Deanna M. Hoelscher
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (N.R.); (E.T.H.); (D.M.H.)
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
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Jiang K, Zhang L, Xie C, Li Z, Shi Z, Sharma M, Zhao Y. Understanding the Knowledge, Attitudes, and Practices of Healthy Eating among Adolescents in Chongqing, China: An Empirical Study Utilizing Structural Equation Modeling. Nutrients 2024; 16:167. [PMID: 38201997 PMCID: PMC10780587 DOI: 10.3390/nu16010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Healthy eating is crucial for optimal growth, development, and the prevention of chronic diseases in adolescents. Our study aimed to develop a comprehensive structural equation model (SEM) to analyze the relationships between knowledge, attitudes, practices (KAP), and healthy eating among adolescents in Chongqing. An online questionnaire was administered to middle school students in 39 districts and counties of Chongqing, China from 2 December to 15 December 2021 to collect sociodemographic and KAP information. SEM models were constructed to examine the relationships between educational environment and healthy eating knowledge, attitudes, and practices. The Monte Carlo test was employed to assess the significance of the mediating effect of relevant variables. The study included 139,832 adolescents aged 14.8 ± 0.7 years, with a 14% rate of overweight and obesity. Health and nutrition knowledge averaged a score of 3.60 ± 1.50 (correct rate: 60%). Participants had positive attitudes (average score: 13.61 ± 2.29) and engaged in healthy eating practices (average score: 12.06 ± 3.08). The results of the SEM revealed a significant influence of the educational environment on adolescents' knowledge (β = 0.235, p < 0.001) and attitude towards healthy eating (β = 0.143, p < 0.001). Knowledge exhibited positive effects on both attitude (β = 0.225, p < 0.001) and practice (β = 0.054, p < 0.001), while attitude exhibited positive effects on practice behavior (β = 0.565, p < 0.001). The indirect effect of knowledge on practices through attitude was more substantial than the direct effect (ratio 2.361). Our study highlights the mediating role of attitude between healthy eating knowledge and practices. A significant association exists between a favorable educational environment and improved knowledge and positive attitudes toward healthy eating among adolescents. In the future, nutrition and health education should prioritize exploring effective ways to translate knowledge into practices.
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Affiliation(s)
- Ke Jiang
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Laixi Zhang
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Changxiao Xie
- Department of Nutrition and Food Hygiene, West China School of Public Health, Sichuan University, Chengdu 610041, China;
| | - Zhourong Li
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA
| | - Yong Zhao
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Child Nutrition and Heath, Children’s Hospital of Chongqing Medical University, Chongqing 401147, China
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Contreras-Manzano A, White CM, Nieto C, Quevedo KL, Vargas-Meza J, Hammond D, Thrasher JF, Barquera S, Jáuregui A. Self-reported decreases in the purchases of selected unhealthy foods resulting from the implementation of warning labels in Mexican youth and adult population. medRxiv 2023:2023.11.22.23298843. [PMID: 38045333 PMCID: PMC10690347 DOI: 10.1101/2023.11.22.23298843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Front-of-package nutritional warning labels (WLs) are designed to facilitate identification and selection of healthier food choices. We assessed self-reported changes in purchasing different types of unhealthy foods due to WLs in Mexico and the association between the self-reported reductions in purchases of sugary beverages and intake of water and sugar-sweetened beverages. Methods Data came from 14-17 year old youth (n=1,696) and adults ≥18 (n=7,775) who participated in the Mexican arm of the 2020-2021 International Food Policy Study, an annual repeat cross-sectional online survey. Participants self-reported whether the WLs had influenced them to purchase less of each of ten unhealthy food categories due to WLs. Among adults, a 23-item Beverage Frequency Questionnaire was used derive past 7-day intake of water and sugary beverages analyzed to determine the relationship between self-reported reductions in purchasing sugary drinks due to the WLs. Multilevel mixed-effects logistic regression models were fitted to estimate the percentage of participants who self-reported reducing purchases within each food group, and overall. Sociodemographic characteristics associated with this reduction were investigated as well. Results Overall, 44.8% of adults and 38.7% of youth reported buying less of unhealthy food categories due to the implementation of WL, with the largest proportion reporting decreased purchases of cola, regular and diet soda. A greater impact of WLs on the reported purchase of unhealthy foods was observed among the following socio-demographic characteristics: females, individuals who self-identified as indigenous, those who were overweight, individuals with lower educational levels, those with higher nutrition knowledge, households with children, and those with a significant role in household food purchases. In addition, adults who reported higher water intake and lower consumption of sugary beverages were more likely to report reduced purchases of sugary drinks due to the WLs. Adults who reported greater water intake and lower sugary beverages intake were significantly more likely to report buying fewer sugary drinks due to the WLs. Conclusion Our findings suggest that implementation of WLs has reduced purchases of unhealthy foods in Mexico. These results underscore the positive impact of the labeling policy particularly in subpopulations with lower levels of education and among indigenous adults.
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