A nudge in a healthy direction. The effect of nutrition labels on food purchasing behaviors in university dining facilities

Factors affecting public acceptance of healthy lifestyle nudges

In two online vignette studies, we investigated the effects of healthy lifestyle nudging and pricing interventions in two different contexts: a supermarket (Study 1) and a train station (Study 2). In Study 1 (N = 318) participants were randomly assigned to evaluate one of eight interventions described in a vignette and designed to either encourage healthier food choices or discourage unhealthy food choices in a supermarket setting. Two interventions comprised a small financial incentive to either encourage a healthy food choice or discourage an unhealthy food choice, but the other six interventions were nudges conceived to specifically impact agency, self-constitution or freedom of choice (three different aspects of autonomy). Relative to these nudges, the financial incentive interventions were not found to be less acceptable or more patronising. Overall, the encouragement of healthy food choices was rated as more acceptable and less patronising. The same pattern of results was found in Study 2 (N = 314). We conclude that interventions threatening specific aspects of one's autonomy do not necessarily affect its acceptance. However, the behavioural focus does affect intervention acceptance, that is, interventions focused on encouraging healthy choices are considered more acceptable than interventions that discourage the unhealthy option.

The rewards US university students associate with campus dining halls and food choices

Objective: To understand the rewards university students associate with two key decisions shaping food choices. Participants: Thirty-eight university students. Methods: In this exploratory research, we conducted focus groups to identify the rewards students associated with choosing to eat at the campus dining hall and their specific food choices within that venue. We also obtained feedback on reward nomenclatures identified via a content analysis of health and business literature. Results: Students primarily chose the dining hall due to its convenience, foods offered, and the social aspects of the venue. Rewards associated with food choice included freshness, customization, variety, local foods, healthy foods, convenience, and portion size. Nomenclatures were relevant and meaningful. Conclusions: These students associate food choice decisions with rewards. Universities should consider whether dining halls and menu items link healthy foods to the rewards prioritized by students. Reward nomenclatures may be useful for researchers investigating the drivers of food choice.

The impact of nutritional labeling on adult snack choices: A controlled field experiment in a non-commercial professional setting

Each year, 2.8 million people die because of comorbidities associated with being overweight. Snacking substantially contributes to people's calorie intake. One way to nudge consumers towards healthier alternatives is the implementation of nutritional labeling. This study reports on a controlled field experiment that evaluates the effect of two nutritional labels on free snack choices (n = 739). Participants at a conference could choose between nuts, cookies, and candy bars as a snack, presented at the bar at six different locations across 2 bar counters. The labels were set up in front of each snack in three conditions: no labeling (control), a calorie label, or a traffic light label (i.e., the Nutri-Score). The location of the snacks on the counter (Either side of the counter; Center, Right, Left) and the time-of-day (Morning (=reference) vs Afternoon) were statistically controlled for. The results show that calorie labels could not successfully nudge consumers toward healthier snack choices (nuts instead of candy bars or cookies). In contrast, the Nutri-Score label significantly increased the probability of choosing nuts over candy bars. The Nutri-Score also increased the chance of choosing nuts over cookies, but the difference was not significant. No prior studies to our knowledge have directly compared calorie labels to the Nutri-Score. This study suggests that the Nutri-Score label can be a more successful intervention than calorie labels to nudge consumers towards healthier choices in situations were free snacks are offered, like many modern workplaces. Changing snacking behavior is challenging and naturalistic field experiments like this one are needed to translate the theory from previous laboratory studies to real-life settings.

Health Literacy and Its Associations with Understanding and Perception of Front-of-Package Nutrition Labels among Higher Education Students

(1) Background: Nutrition labels on the front of food packages have increasingly become the focus of research. However, too few studies have placed special emphasis on nutritionally at-risk subpopulations, such as young adults or those with low literacy/numeracy skills. The present study aimed to assess both the perception and objective understanding of three front-of-package labeling (FOPL) formats currently in use on the Belgian market, i.e., the Nutri-Score, Reference Intakes, and Multiple Traffic Lights, among students of varying health literacy (HL) levels. (2) Methods: A web-based survey was carried out among 2295 students of tertiary education in the province of Liège, Belgium. The questionnaire included questions related to general characteristics, objective understanding, and perception in response to the assigned FOPL format and level of HL. (3) Results: With respect to objective understanding, the Nutri-Score outperformed all other labels across all HL levels, and it was similarly understood in students of varying HL levels. Several students’ characteristics appeared to be associated with each cluster of perception, with the Nutri-Score cluster having the highest percentages of disadvantaged students, i.e., those with inadequate HL, from non-university institutions, with low self-estimated nutrition knowledge, and with low self-estimated diet quality. (4) Conclusion: Overall, the findings supported the Nutri-Score as particularly effective in guiding students in their food choices. Of particular importance is the fact that the summarized and graded color-coded nutritional label would be a useful strategy for those disadvantaged by limited HL.

Central Persons in Sustainable (Food) Consumption

What people eat has become a highly political issue, closely intertwined with public health, environmental concerns, and climate change. Individuals' consumption decisions tend to be greatly influenced by the people that surround them, and this seems to be especially true when it comes to food. In recent years, alongside close contacts, such as family and friends, a myriad of social influencers have appeared on the screens, sharing opinions on what (not) to eat. Presenting results from a youth survey conducted in Sweden in 2019 (N = 443), this paper shows that social media have become the primary source of information about food and eating for youths, followed by schools and families. However, primary sources of influence continue to be parents and the family at large. Furthermore, the study shows that it is possible to identify 'central persons', i.e., relatively clear-cut groups of people whose food choices-measured as tendency to eat climate friendly-is mirrored by the youths, both in their everyday food preferences and in their broader political awareness as expressed through political consumerism. A conclusion from this is that certain people can be particularly successful at inspiring larger numbers of other people to engage with healthier and environmentally friendlier (food) consumption in a society.

A pilot study of a school lunchroom intervention in a predominately Latinx sample

OBJECTIVE

The purpose of the study was to assess the feasibility of an environmental school lunchroom intervention ('Smarter Lunchrooms') and test initial efficacy within a predominately Latinx population.

DESIGN

We collected baseline and intervention lunchroom food consumption and waste data in a pre-post, single group design. Meal consumption data was analyzed using Nutrition Data System for Research software to obtain estimates of nutritional content.

MAIN OUTCOME MEASURES

Feasibility.

SECONDARY MEASURES

Plate Waste, Nutrient Intake.

RESULTS

Participants were 88 1st-4th graders (51% female; 77% Latinx). Our recruitment rate was 45%, we were able to implement 8 Smarter Lunchroom strategies, and we were able to collect 82 baseline plate photos (93%) and 80 intervention photos (90%) of school lunches. On average, students threw away more than half of their meals on both days. Fruit consumption and fiber per 1000 kcal were significantly poorer at intervention compared to baseline.

CONCLUSIONS

Our findings highlight challenges in collecting consumption data in a real-world setting. We describe directions for future research taking into consideration our "lessons learned" from this formative work.

Toward a Healthy and Environmentally Sustainable Campus Food Environment: A Scoping Review of Postsecondary Food Interventions

Interventions are urgently needed to transform the food system and shift population eating patterns toward those consistent with human health and environmental sustainability. Postsecondary campuses offer a naturalistic setting to trial interventions to improve the health of students and provide insight into interventions that could be scaled up in other settings. However, the current state of the evidence on interventions to support healthy and environmentally sustainable eating within postsecondary settings is not well understood. A scoping review of food- and nutrition-related interventions implemented and evaluated on postsecondary campuses was conducted to determine the extent to which they integrate considerations related to human health and/or environmental sustainability, as well as to synthesize the nature and effectiveness of interventions and to identify knowledge gaps in the literature. MEDLINE (via PubMed), CINAHL, Scopus, and ERIC were searched to identify articles describing naturalistic campus food interventions published in English from January 2015 to December 2019. Data were extracted from 38 peer-reviewed articles, representing 37 unique interventions, and synthesized according to policy domains within the World Cancer Research Foundation's NOURISHING framework. Most interventions were focused on supporting human health, whereas considerations related to environmental sustainability were minimal. Interventions to support human health primarily sought to increase nutrition knowledge or to make complementary shifts in food environments, such as through nutrition labeling at point of purchase. Interventions to support environmental sustainability often focused on reducing food waste and few emphasized consumption patterns with lower environmental impacts. The implementation of integrated approaches considering the complexity and interconnectivity of human and planetary health is needed. Such approaches must go beyond the individual to alter the structural determinants that shape our food system and eating patterns.

The effectiveness of nudging interventions to promote healthy eating choices: A systematic review and an intervention among Italian university students

Nudges are changes in choice architecture (i.e., the environment in which people make decisions) aiming to steer a person's decision to a particular choice, without restricting alternative options or changing financial incentives. These strategies have been extensively used to promote healthy eating, above all among youths, whose behaviors can still be easily shaped compared to older people's. The current paper describes two studies aiming to investigate the effectiveness of nudging interventions in promoting healthy eating among university students. The first study consisted of a systematic review mapping all the published studies which describe the effectiveness of this kind of intervention worldwide. Twelve eligible records were selected after a search of three different databases. Information about the publication of the record, the adopted research methods and the described intervention was retrieved from each selected record. Based on this review's results, a new nudging intervention was developed to promote healthy food choice among Italian university students. The intervention aimed to modify students' choice for each of the Italian meal courses: first course (pasta, rice or soup), second course (meat, fish, cheese or cured meat), side dish, bread, and fruit. An Italian university cafeteria was observed in two phases: a pre-intervention phase (baseline) and a post-intervention phase (nudging strategies were implemented in the cafeteria's architecture). The applied nudging intervention was effective in promoting healthy choices in relation to the second course, the side dish, and the bread, but it did not significantly affect choices related to the first course or the fruit. Implications of these results and suggestions for future interventions are discussed.

[Towards healthy pathways: Effect of nutrition labels on eating behaviours in a university canteen]

Objetivo

Evaluar la efectividad de incluir información nutricional y de propiedades de los alimentos en un comedor universitario de Salamanca (España), para promover las conductas alimentarias saludables.

Diseño

Estudio experimental y correlacional transversal.

Emplazamiento

Comedor universitario de Salamanca (España).

Participantes

En el experimento se recogió información de la elección de 1.122 menús por parte de estudiantes universitarios. El cuestionario fue respondido por 48 estudiantes universitarios que participaron en el experimento.

Medidores principales

Metodología mixta (experimento de campo y cuestionario en línea). La variable independiente fue la inclusión o no de información nutricional de los menús. Con el cuestionario se evaluó la actitud de los estudiantes sobre este tipo de herramientas.

Resultados

El experimento muestra una mejora en la dieta de los estudiantes universitarios con la inclusión de elementos informativos que apelan a la elección más saludable, aumentando su consumo de fruta, verduras, legumbres, pescado y carne blanca.

Los encuestados mostraron un alto grado de receptividad de estas herramientas para la promoción de la salud. A pesar de esto, su autopercepción de mejoría de la dieta era más optimista que lo cuantificado en el experimento. Los estudiantes universitarios muestran un grado de aprobación muy alto frente a otras herramientas de promoción de alimentación saludable, especialmente aquellas de carácter educativo e informativo. Se comprobó que una preocupación mayor por la dieta estaba asociada con un mayor apoyo de estas herramientas.

Conclusión

Existe una mejora en la alimentación de los estudiantes universitarios y una actitud positiva frente a herramientas de promoción de la salud, especialmente por parte de quienes tienen una autopercepción más saludable. Es necesario emplear nuevas herramientas basadas en las ciencias conductuales en la promoción de la salud, por parte de la industria privada y las entidades públicas.

Nudges, Norms, or Just Contagion? A Theory on Influences on the Practice of (Non-)Sustainable Behavior

‘Nudging’ symbolizes the widespread idea that if people are only provided with the ‘right’ options and contextual arrangements, they will start consuming sustainably. Opposite to this individual-centered, top-down approach stand observations highlighting the ‘contagiousness’ of thoughts, emotions, and behaviors of reference groups or persons present in a decision-context. Tying in these two lines, this paper argues that nudging may sound promising and easily applicable, yet the social dynamics occurring around it can easily distort or nullify its effects. This argument stems from empirical evidence gained in an exploratory observation study conducted in a Swedish cafeteria (N = 1073), which included a ‘nudging’ treatment. In the study, people in groups almost unanimously all chose the same options. After rearranging the choice architecture to make a potentially sustainable choice easier, people stuck to this mimicking behavior—while turning to choose more the non-intended option than before. A critical reflection of extant literature leads to the conclusion that the tendency to mimic each other (unconsciously) is so strong that attempts to nudge people towards certain choices appear overwhelmed. Actions become ‘contagious’; so, if only some people stick to their (consumption) habits, it may be hard to induce more sustainable behaviors through softly changing choice architectures.

College campuses' influence on student weight and related behaviours: A review of observational and intervention research

Research indicates that most college students are not meeting dietary and physical activity guidelines, and the average student gains an estimated 1.6-3.0 kg during 4 years of study. College administrations are well-positioned to influence student weight-related health behaviours by ensuring that campus environments/policies promote health. However, to date, campus health interventions have largely addressed individual and interpersonal factors rather than environmental/policy-level changes. Using an ecological perspective, this narrative review synthesizes the literature on campus environmental/policy-level factors (e.g., food availability, physical activity requirements) associated with student diet, physical activity and weight, as well as campus interventions to address these factors. Web of Science and PubMed databases were searched between December 2018 and November 2019. Results indicate that campus food environments may contribute to overconsumption and weight gain, and the number of campuses requiring students to participate in physical activity courses is in decline. Eight examples of environmental/policy-level campus interventions are presented: nutrition labels in dining halls, campus-wide healthy choice marketing campaigns, restricted payment methods for à la cart dining, trayless dining, health-themed residence halls, peer health education programmes, active classroom spaces and physical activity course requirements. Implications for research and health promotion programmes/policies in the field of college health are discussed.

Uruguayan Citizens' Perception of Messages to Promote Healthy Eating Through the Use of Nutritional Warnings

OBJECTIVE

To explore the specific type of messages people consider most appropriate for a mass communication campaign aimed to promote healthy eating in the context of the implementation of nutritional warnings.

DESIGN

Online study including multiple-choice and open-ended questions.

SETTING

Uruguay, 1 of the Latin American countries with the highest prevalence of overweight and obesity.

PARTICIPANTS

A total of 859 participants were recruited using social media. They were diverse in terms of gender, age, educational level, socioeconomic status, and self-reported body mass index.

PHENOMENON OF INTEREST

Participants were presented with 3 series of messages and were asked to select the 1 they perceived as the most appropriate and to provide a brief explanation for their selection.

ANALYSIS

Descriptive statistics for the multiple-choice questions and inductive coding for the responses to the open-ended questions.

RESULTS

Participants tended to prefer messages that conveyed a cue to action for achieving changes to their perceived ability to make healthful food choices. Although messages related to the promotion of informed food choices were the most frequently preferred, messages related to negative health consequences and health benefits were also selected repetitively.

CONCLUSIONS AND IMPLICATIONS

Communication campaigns aimed at promoting healthy eating through the use of nutritional warnings could include different contents to target specific segments with different motivations.

The effects of nudges on purchases, food choice, and energy intake or content of purchases in real-life food purchasing environments: a systematic review and evidence synthesis

Background

Adults with a low socioeconomic position (SEP) are more likely to engage in unhealthy diets as compared to adults with high SEP. However, individual-level educational interventions aiming to improve food choices have shown limited effectiveness in adults with low SEP. Environmental-level interventions such as nudging strategies however, may be more likely to benefit low SEP groups. We aimed to review the evidence for the effectiveness of nudges as classified according to interventions in proximal physical micro-environments typology (TIPPME) to promote healthy purchases, food choice, or affecting energy intake or content of purchases, within real-life food purchasing environments. Second, we aimed to investigate the potentially moderating role of SEP.

Methods

We systematically searched PubMed, EMBASE, and PsycINFO until 31 January 2018. Studies were considered eligible for inclusion when they i) complied with TIPPME intervention definitions; ii) studied actual purchases, food choice, or energy intake or content of purchases, iii) and were situated in real-life food purchasing environments. Risk of bias was assessed using a quality assessment tool and evidence was synthesized using harvest plots.

Results

From the 9210 references identified, 75 studies were included. Studies were generally of weak to moderate quality. The most frequently studied nudges were information (56%), mixed (24%), and position nudges (13%). Harvest plots showed modest tendencies towards beneficial effects on outcomes for information and position nudges. Less evidence was available for other TIPPME nudging interventions for which the harvest plots did not show compelling patterns. Only six studies evaluated the effects of nudges across levels of SEP (e.g., educational level, food security status, job type). Although there were some indications that nudges were more effective in low SEP groups, the limited amount of evidence and different proxies of SEP used warrant caution in the interpretation of findings.

Conclusions

Information and position nudges may contribute to improving population dietary behaviours. Evidence investigating the moderating role of SEP was limited, although some studies reported greater effects in low SEP subgroups. We conclude that more high-quality studies obtaining detailed data on participant’s SEP are needed.

Registration

This systematic review is registered in the PROSPERO database (CRD42018086983).

Impact of Nutritional Information on Consumers' Willingness to Pay for Meat Products in Traditional Wet Markets of Taiwan

The application of nutritional labels provides information regarding the health and nutritional value of products and allows consumers to engage in healthier dietary habits. However, not all types of retail markets provide full nutrition information for meat products. Since there is no nutritional information for fresh meat products in traditional wet markets, this study aimed to investigate consumer purchasing intention and willingness to pay (WTP) for this nutritional information in Taiwanese traditional wet markets. A total of 1420 valid respondents were examined using the random utility theory to explain consumer purchasing intention and WTP for nutritional information. Results showed that most (over 60%) consumers in traditional wet markets have positive purchasing intent for meat products with the nutrition information provided. Furthermore, the nutrition information in traditional wet markets significantly boosts consumers’ purchasing intention and WTP when consumers have a personal health awareness on meat, have proficient experience in buying meat, and continuously receive information from health-related media. Specifically, consumers’ shopping background and their level of health consciousness would be the key factors that would alter their WTP, if provided nutritional claims.

Sensory Nudges: The Influences of Environmental Contexts on Consumers' Sensory Perception, Emotional Responses, and Behaviors toward Foods and Beverages

Food products with highly acceptable flavors are not always successful in the marketplace. Sales of identical food products sold in two different stores often differ. Patrons’ choices of specific menu items vary depending on menu designs at restaurants. Such examples suggest that consumer behavior related to eating, preparing, or purchasing foods and beverages is typically complex, dynamic, and sensitive. There is a growing body of evidence that environmental cues surrounding foods and beverages can modulate consumer perception and behavior in the context of eating and drinking. In light of increasing interest in environmental cues, this Special Issue was designed to introduce recent research that highlights how sensory cues derived from environmental cues can modulate consumer perceptions, emotional responses, and behavior related to foods and beverages. The eleven articles addressed in this Special Issue provide informative and insightful findings that may be applied to a wide range of food-related sites, including grocery stores, retail markets, restaurants, dining facilities, and public dining areas. The findings from these articles also suggest that product developers, sensory professionals, retailers, marketers, and business owners should consider not only sensory aspects of food products, but also sensory cues derived from surrounding contexts to better understand consumer perception, acceptability, and behavior toward their food products.

That's My Cue to Eat: A Systematic Review of the Persuasiveness of Front-of-Pack Cues on Food Packages for Children vs. Adults

Packaging is increasingly recognized as an essential component of any marketing strategy. Visual and informational front-of-pack cues constitute salient elements of the environment that may influence what and how much someone eats. Considering their overwhelming presence on packaging of non-core foods, front-of-pack cues may contribute to the growing rates of overweight and obesity in children and adults. We conducted a systematic review to summarize the evidence concerning the impact of front-of-pack cues on choices and eating behaviors. Four electronic databases were searched for experimental studies (2009-present). This resulted in the inclusion of 57 studies (in 43 articles). We identified studies on children (3-12 years) and adults (≥ 18 years), but no studies on adolescents (12-18 years). The results suggest that children and adults are susceptible to packaging cues, with most evidence supporting the impact of visual cues. More specifically, children more often choose products with a licensed endorser and eat more from packages portraying the product with an exaggerated portion size. Adults' eating behaviors are influenced by a range of other visual cues, mainly, package size and shape, and less so by informational cues such as labels.

Choosing or rejecting a food item, does framing matter? And what has sugar to do with it!

The color code of "Traffic Light Labels" (TLL) on food items indicates the amount (e.g., green = low) of fat, saturates, sugar and salt it contains. Consider two ways to select among food items (e.g., two cereal bars) based on their TLLs. You might choose between the two items or you might reject one of the two. Furthermore, differences between choose and reject might be driven more strongly by one factor (e.g., sugar) than by others. In Study 1 our participants made choose or reject decisions between food items with an all-orange TLL (all moderate) and a 2 red/2 green TLL (2 negative/2 positive). Both items had equal energy/caloric content. We found that, independent of the condition (Choose/Reject), participants went home more often with the 2 red/2 green item if sugar was green. This effect was stronger in the Choose than in the Reject condition. In Study 2, we additionally manipulated the energy content (low, high) of the items. In the case where both food items had a low energy content, similar results as in Study 1 were observed. If either or both items had high energy content, the choose/reject interaction with sugar disappeared. Only differences in energy content played a role in the reject condition. Overall, our results can be better explained by an "accentuation hypothesis" than by a "compatibility hypothesis". These findings could be used by choice architects to fight the current obesity crisis.

How Can We Motivate People to Use Nutritional Warnings in Decision Making? Citizen Co-Created Insights for the Development of Communication Campaigns

Nutritional warnings are intended to enable citizens to make informed choice by clearly identifying food products with excessive content of nutrients associated with noncommunicable diseases. The efficacy of this public policy is expected to improve if accompanied by communication campaigns that raise awareness of the existence of nutritional warnings, as well as encourage citizens to take them into account in decision making. Because ordinary citizens have been shown to generate significantly more creative and valuable ideas than advanced users and professional developers, the aim of the present work was to obtain qualitative, citizen co-created insights for the design of a communication campaign. An online study was conducted with 518 Uruguayan citizens, recruited using a Facebook advertisement. Participants were asked to answer a series of open-ended questions about how they would encourage other people to use the warnings for making their food choices, as well as the key contents of a communication campaign. Responses were analyzed using content analysis. Results showed that, according to the participants’ accounts, an effective public awareness campaign aimed at promoting the use of nutritional warnings in decision making should include three main concepts: (a) position warnings as a cue to action for improving eating habits by enabling informed choices; (b) emphasize the benefits of using the warnings for avoiding consumption of unhealthy food and, consequently, achieving a healthier diet and an improvement in health status and quality of life; and (c) increase the perceived susceptibility and severity of the negative consequences of consumption of foods with excessive content of sugar, fat, and sodium. A communication campaign based on these key concepts could contribute to increasing the efficacy of nutritional warnings.

Types of Interventions Targeting Dietary, Physical Activity, and Weight-Related Outcomes among University Students: A Systematic Review of Systematic Reviews

A plethora of studies aiming to improve dietary, physical activity (PA), and weight-related (WR) outcomes among university students have been implemented and summarized in a series of systematic reviews, with unclear conclusions regarding their effectiveness. This overview aims to identify systematic reviews and meta-analyses of studies aiming to improve health outcomes in university students, to assess their methodological quality, to identify the different types of interventions used and outcomes assessed, and to estimate their overall effect. Four electronic databases were searched until 19 March, 2018 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The identified reviews were described and their methodological quality was rated. The studies of reviews were investigated to identify the different types of interventions used and outcomes assessed. Effectiveness was assessed by measuring the overall number of improved outcomes out of the total number of outcomes reported. As a result, 8 reviews were identified targeting food sales (n = 2), dietary (n = 3), PA (n = 1), WR (n = 1), or all outcomes (n = 1). The methodological quality of the reviews was moderate (n = 5) to low (n = 3). In all, the reviews included 122 studies, of which 36 used an environmental, 51 a face-to-face, 30 an e-intervention, and 5 a combined approach. Environmental interventions improved a moderate number of food sales (32 of 61) and dietary intake (22 of 47) outcomes. Face-to-face interventions improved a high number of dietary cognitive outcomes (15 of 18), a moderate number of dietary intake (28 of 65) and WR (11 of 18) outcomes, and a low number of PA behavioral (22 of 69) and cognitive (2 of 14) outcomes. E-interventions improved a high number of dietary cognitive variables (11 of 16) but had a low effect (≤33%) on the other types of outcomes. In conclusion, face-to-face and e-interventions improved cognitive variables toward diet or PA but were less effective in changing actual behaviors. Environmental interventions favorably changed food sales. Face-to-face and e-interventions moderately affected WR outcomes. Future research should focus on long-term studies.

Does message framing matter for promoting the use of nutritional warnings in decision making?

Objective:

To evaluate the impact of message framing on attitudes towards messages aimed at promoting the use of nutritional warnings, behavioural intention and actual behaviour, evaluated through visual attention to nutritional warnings and the choice of a snack product during a real choice task.

Design:

Following a between-subjects design, participants were exposed to loss-framed nutrition messages, gain-framed nutrition messages or non-nutrition-related messages (control group). After evaluating the messages, participants were asked to select a snack product as a compensation for their participation. The experiment was conducted using an eye tracker.

Setting:

Montevideo (Uruguay).

Participants:

Convenience sample of 201 people (18–51 years old, 58 % female).

Results:

The average percentage of participants who fixated their gaze on the nutritional warnings during the choice task was slightly but significantly higher for participants who attended to nutrition messages (regardless of their framing) compared with the control group. Participants who attended to loss-framed messages fixated their gaze on the warnings for the longest period of time. In addition, the healthfulness of the snack choices was higher for participants exposed to nutrition-related messages compared with the control group.

Conclusions:

Results from the present work suggest that nutrition messages aimed at increasing awareness of nutritional warnings may increase consumers’ visual attention and encourage more heathful choices. The framing of the messages only had a minor effect on their efficacy.

Relative Impact of Nutritional Warnings and Other Label Features on Cereal Bar Healthfulness Evaluations

OBJECTIVE

To investigate the relative influence of nutritional warnings and 2 marketing strategies commonly used in food labels, nutrient claims, and fruit images on consumers' healthfulness judgments.

DESIGN

Labels of cereal bars were designed according to a full factorial design with 3 2-level variables: images of fruit (with vs without), nutrient claims about the fiber content (with vs without), and nutritional warnings about excessive content of sugar and saturated fat (with vs without).

SETTING

Experiment conducted in Montevideo, Uruguay.

PARTICIPANTS

One hundred Uruguayan people, 75% female, aged 18-56 years.

MAIN OUTCOME MEASURES

Healthfulness perception and eye-tracking variables.

ANALYSIS

The researchers used ANOVA to evaluate the influence of the experimental design's variables on perceived healthfulness and eye-tracking measures.

RESULTS

Nutritional warnings caught participants' attention and reduced the amount of visual attention needed to evaluate healthfulness. Participants mainly relied on nutritional warnings to make healthfulness judgments.

CONCLUSIONS AND IMPLICATIONS

Findings of the current work confirm the potential of nutritional warnings to influence consumers' healthfulness perception, overriding the effect of other label cues used by the food industry to convey the concept of healthfulness.

Nudging to get our food choices on a sustainable track

Food production is one of the major contributors to environmental damage. Adaptations in our food choices are needed to preserve resources for the needs of future generations. More sustainable consumption patterns have been encouraged by economic incentives, laws, education and communication campaigns. Nonetheless, consumers still find difficulties in trying to change their current food habits. This review takes a behavioural approach in encouraging sustainable food choices among consumers. From a nudging perspective, many behavioural changes can be encouraged in a non-obtrusive way by adapting the complex food environment in which consumers are operating. These interventions do not restrict consumers' choices but rather adapt the choice architecture wherein food decisions are made. Drawing on the literature from diverse theoretical perspectives, we provide an overview of the application of nudging for more sustainable food choices and highlight where more research is needed. More specifically, we discuss research that used nudging to engender cognitive impact (i.e. the use of labels or visibility enhancements), affective responses (i.e. sensorial and social influence cues) and behavioural effects (i.e. adjustments in convenience and product size). We conclude that this review only shows the tip of the iceberg of the research on nudging and sustainable consumption that is likely forthcoming in the next few years, following the successes of nudging applications in other domains. Nonetheless, each individual nudging intervention requires careful examination. Personal predispositions towards the environment should be considered when designing interventions, demonstrating the complementarity of nudging with education on sustainable consumption.

Front-of-Pack Labeling and the Nutritional Quality of Students' Food Purchases: A 3-Arm Randomized Controlled Trial

Objectives. To assess the effects of the Nutri-Score label (relative to the Reference Intakes label or no label) on the nutritional quality of students' food purchases. Methods. A 3-arm randomized controlled trial was conducted in France in 2017; 2907 participants were randomized into 1 of the 3 study arms (Nutri-Score, Reference Intakes, no label) and invited to purchase groceries from an experimental Web-based supermarket. The main outcome was the overall nutritional quality of purchases, measured according to a modified version of the Food Standards Agency Nutrient Profiling System (FSAm-NPS/HCSP) score. Results. The mean (±SD) FSAm-NPS/HCSP score was lower in the Nutri-Score group (2.02 ±3.56) than in the Reference Intakes group (2.69 ±3.44), reflecting higher nutritional quality; however, there was no significant difference between the Nutri-Score and no-label (2.45 ±3.28) groups or between the Reference Intakes and no-label groups. Shopping cart content was lower in calories and saturated fatty acids and higher in fruits and vegetables in the Nutri-Score arm than in the other arms. Conclusions. The Nutri-Score label appeared to improve the nutritional composition of students' food purchases relative to the Reference Intakes label or no label.

Advertising models in the act of eating: How the depiction of different eating phases affects consumption desire and behavior

In print advertising, the use of static pictures depicting models eating food is common practice. However, less is known about how the depiction of models in different phases of consumption (holding food, moving food to mouth, taking a bite, chewing on food) affects consumers. Theories have proposed that not only do individuals mimic actions, but they also adopt the goals and the motivational patterns underlying these actions by observing others. Building on this view, we hypothesized that consumers' desire to eat a food product and their actual consumption of a food product would be greater when the model in the picture was close to engaging in consumption and that desire and actual consumption would be reduced when the model was shown in the process of finishing consumption. In two studies, we found that the participants experienced an increased desire to eat the depicted food (Study 1) and ate more of the advertised food (Study 2) when the model was shown to engage in eating food compared with when the model was shown during completion of a consumption episode. In addition, the results of Study 1 suggest that even subtle differences such as holding food compared with putting food into the mouth might affect consumers' desire to eat. Overall, our results suggest that advertisements may affect consumers' motivation to engage in food intake differently depending on which consumption state they show with the depiction of a model close to engagement in food consumption being most likely to trigger a desire for consumption and an actual engagement in food intake.

The Effect of Randomly Providing Nutri-Score Information on Actual Purchases in Colombia

Recently, front-of-package (FOP) food labeling systems have captured the attention of researchers and policy makers. Several Latin American governments are currently considering employing different FOP labeling systems. However, there is much need for more research-based evidence in these countries. In this paper, we study whether food-purchasing decisions and the nutritional qualities of those purchases are influenced by randomly informing some customers and not others about an FOP label known as Nutri-Score. We also separate the information effect from the effect of being aware of the system. We combined a randomized field intervention in a university cafeteria in Bogotá, Colombia with data from an after-purchase survey and receipts. We found that randomly providing information on Nutri-Score increased total expenditure by $0.18. Additional spending on healthier items was 21% or $0.26 higher, with no change for less healthy items. Expenditure estimates were higher among customers who were aware of the system’s existence. Customers in the study were also 10% more likely to buy a healthier item than control customers were, and the concentration of protein in their purchases was greater. Information on the Nutri-Score system increased the store’s sales. This potential financial incentive may facilitate the implementation of Nutri-Score.

It Is Time to Make Policy for Healthier Food Environments in Australian Universities

The obesogenic food environment is likely driving excessive weight gain in young adults. Our study aimed to investigate the nutritional quality of current food and drink offerings in an Australian university. This cross-sectional study included baseline environmental audits of 30 food outlets and 62 vending machines across campus. A recent food and drink benchmark for health facilities by state government was used to classify the food and beverage offerings. It recommended food outlets and vending machines to offer at least 75% 'Everyday' (healthy) and less than 25% 'Occasional' (less healthy) foods and drinks. Sugary drinks and options with large portion sizes and unhealthy ingredients should be removed from sale. Only two beverage vending machines and none of the food outlets met the full recommendations. The overall proportions of Everyday and Occasional foods in food outlets were 35% and 22%, respectively with 43% falling into the category that should not be sold. Sugary drinks occupied a third of beverage varieties in outlets and 38% of beverage slots in vending machines. The current university food environment was poorly compliant with the existing benchmark. Specific food policy in the university setting may be needed to make healthier choices more accessible to young adults.

Influence of nutritional warnings and other label features on consumers' choice: Results from an eye-tracking study

Nutritional warnings highlighting products with high content of nutrients associated with non-communicable diseases have emerged as a potentially efficient alternative to discourage consumption of unhealthful products. However, the relative influence of this front-of-pack nutrition information scheme compared to other label features is still under researched. In this context, the aim of the present work was to study the influence of nutritional warnings and other information commonly displayed on food labels to convey health associations on consumers' choice and visual attention. A choice-conjoint study using labels of cookies and crackers was implemented considering the following three variables: front-of-pack nutrition information (nutritional warnings vs. facts up front panel), nutrient claim (present vs. absent) and type of product (conveying health vs. hedonic associations). A total of 124 people completed the task using the monitor of an eye-tracker. Participants were asked to select the label they would prefer to buy if they were in a supermarket. Nutritional warnings were efficient in attracting consumers' attention and required less time and fewer fixations to process than the facts up front panel. In addition, their inclusion on the labels significantly discouraged consumers' choice of labels. However, type of product was the most important variable influencing the choice of both cookies and crackers. Results from the present work confirm the potential of nutritional warnings as directive front-of-pack nutrition labelling scheme and stress that they cannot be expected to cause radical changes in consumers' eating habits due to their competition with other product features. Instead, they are expected to encourage consumers to select the most healthful option within a product category.

Towards a Food-Based Intervention to Increase Protein Intakes in Older Adults: Challenges to and Facilitators of Egg Consumption

Abstract: Background: Dietary protein intake is important for health. Eggs, as a protein-rich food with characteristics that appeal to older adults, may provide opportunities for increasing protein intake. Interventions that focus on the challenges or facilitators that affect a large proportion of the population will be of increased impact on a population-wide scale. This work aimed to investigate the relative importance of a number of challenges to and facilitators of egg consumption in a UK population-wide sample of older adults.

METHODS

A cross-sectional postal questionnaire, measuring habitual egg intake, reasons for eating/not eating eggs and a range of demographic and lifestyle characteristics, was administered by post to 1082 older adults.

RESULTS

230 questionnaires suitable for analysis were returned (110 females, ages 55⁻80+ years). Habitual egg intake ranged from 1⁻89 eggs/month, mean (standard deviation) = 18 (13) eggs/month. Reasons for eating/not eating eggs were reduced using Principal Components Analysis to 23 challenges and facilitators of egg consumption. Regression analyses revealed habitual egg intake to be associated with 10 challenges and facilitators (smallest β = 0.14, p = 0.04), and with protein consumption, age and Body Mass Index (smallest β = 0.14, p = 0.03).

DISCUSSION

Many possibilities for future intervention based on existing challenges or facilitators were found. Our results suggest that strategies to increase egg consumption in older adults should focus on: improving liking, tastiness and adding variety; promoting eggs as an everyday type of food; reducing stereotypes about who does and who does not consume eggs; and promoting eggs for people who have noticed the effects of ageing on their food intake. Strategies that highlight value-for-money may be counterproductive. Future work evaluating the value of these strategies for improving protein intake in this age group would be of value.

Promoting a Healthy Diet in Young Adults: The Role of Nutrition Labelling

The use of the nutrition facts label has been associated with healthy eating behaviors for adults. However, the relationship between nutrition facts label use and overall diet quality is not well known in young adults, a vulnerable group that acquire lifelong eating behaviors during this period of life. This study aimed to assess if the use of information on the nutrition facts label is associated with a higher diet quality in young adults. In this cross-sectional study, 958 university students aged 18–34 years were recruited. Nutrition facts label use was recorded. Dietary intake was assessed using 24-h dietary recall. Healthy Eating Index-2005 (HEI-2005) scores were calculated. HEI-2005 score was significantly associated with using nutrition facts label (p < 0.001). The mean total HEI-2005 score was 60.7 ± 10.11, 62.4 ± 11.43 and 67.1 ± 12.23 respectively for never, sometimes and everytime users of nutrition facts label (p < 0.001). Sub-group scores of HEI-2005 for total fruits, whole fruits, total vegetables, whole grains, milk, oils, saturated fat, and calories from solid fat, alcohol and added sugar (SoFAAS) were significantly higher in regular nutrition facts label users (p < 0.05, for each). This study showed that young adults who regularly use the nutrition facts label have a higher diet quality.

Point-of-Purchase Labels and Reward Cards Improve Sales of Healthy Foods in University Dining Halls

Purpose: To compare sales of Food Resources and Education for Student Health (FRESH) Approved versus non-FRESH Approved menu cycle items pre- and postimplementation of the FRESH program.

Methods: Sales data from 2011–2015 of FRESH Approved versus non-FRESH Approved menu items were analyzed. Fruit and milk items sold, net sales, and the cost of free fruit and milk redeemed through the FRESH Reward Card (FRC) program, were also analyzed.

Results: FRESH Approved items sold more often than non-FRESH Approved items in the latter 2 years (P = 0.01). Prices of FRESH Approved menu items were significantly lower than non-FRESH Approved items for all years (e.g., $1.52 ± $0.94 vs $2.21 ± $1.02 per serving in 2014–2015; P < 0.001). Across all FRESH implementation years, FRESH Approved menu items were found more often on the 6-week menu (P < 0.05). The number of fruit items sold increased from a baseline of 143 052 to 170 954, and net sales increased from $135 450 to $154 248 after 3 years of the FRC implementation.

Conclusions: FRESH Approved items were less expensive, available more often, and had higher sales. The FRC increased net fruit sales despite the cost of free fruit. Highlighting and reducing the cost of healthy foods are promising practices to improve campus food environments.

A citizen perspective on nutritional warnings as front-of-pack labels: insights for the design of accompanying policy measures

Objective

Nutritional warnings have recently been suggested as a simplified front-of-pack nutrition labelling scheme to facilitate citizens’ ability to identify unhealthful products and discourage their consumption. However, citizens’ perspective on this policy is still under-researched. The objective of the present work was to study how citizens perceive nutritional warnings and to evaluate public support of this policy, with the goal of deriving recommendations for the design of policy measures accompanying the introduction of nutritional warnings.

Design

An online survey with 1416 Uruguayan citizens, aged 18–75 years, 61 % female, was conducted. Participants had to answer a series of questions (open-ended and multiple-choice) related to their perception of warnings as a front-of-package nutrition labelling scheme.

Results

Participants showed a positive attitude towards nutritional warnings, which were regarded as easy to understand and to identify on food packages. The majority of respondents emphasized that they would take nutritional warnings into account when making their food choices, stating that they would allow them to make informed choices and, consequently, to increase the quality of their diet and their health status. Health motivation appeared as a crucial driver for taking nutritional warnings into consideration.

Conclusions

A high level of public support for nutritional warnings was observed. Responses can be used to derive a range of recommendations for a policy mix that should synergistically support the introduction of nutritional warnings and encourage citizens to take them into account when making their food purchases.

5-a-day fruit and vegetable food product labels: reduced fruit and vegetable consumption following an exaggerated compared to a modest label

BACKGROUND

Food product labels based on the WHO 5-a-day fruit and vegetable (FV) message are becoming increasingly common, but these labels may impact negatively on complementary or subsequent FV consumption. This study aimed to investigate the impact of a '3 of your 5-a-day' versus a '1 of your 5-a-day' smoothie product label on subsequent FV consumption.

METHODS

Using an acute experimental design, 194 participants (90 males, 104 females) were randomised to consume a smoothie labelled as either '3 of your 5-a-day' (N = 97) or '1 of your 5-a-day' (N = 97) in full, following a usual breakfast. Subsequent FV consumption was measured for the rest of the day using 24-h recall. Usual FV consumption was also assessed via 24-h recall for the day before the study.

RESULTS

Regression analyses revealed a significantly lower subsequent FV consumption following smoothies displaying the '3 of your 5-a-day' label compared to the '1 of your 5-a-day' label (Beta = - 0.15, p = 0.04). Secondary analyses revealed these effects to be driven mainly by changes to consumption in usual high FV consumers, in females and in vegetable as opposed to fruit consumption.

CONCLUSIONS

These findings demonstrate a role for label information in food intake, and the potential negative impacts of an exaggerated food product label on healthy food consumption and healthy dietary profiles.

Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption

BACKGROUND

Nutritional labelling is advocated as a means to promote healthier food purchasing and consumption, including lower energy intake. Internationally, many different nutritional labelling schemes have been introduced. There is no consensus on whether such labelling is effective in promoting healthier behaviour.

OBJECTIVES

To assess the impact of nutritional labelling for food and non-alcoholic drinks on purchasing and consumption of healthier items. Our secondary objective was to explore possible effect moderators of nutritional labelling on purchasing and consumption.

SEARCH METHODS

We searched 13 electronic databases including CENTRAL, MEDLINE and Embase to 26 April 2017. We also handsearched references and citations and sought unpublished studies through websites and trials registries.

SELECTION CRITERIA

Eligible studies: were randomised or quasi-randomised controlled trials (RCTs/Q-RCTs), controlled before-and-after studies, or interrupted time series (ITS) studies; compared a labelled product (with information on nutrients or energy) with the same product without a nutritional label; assessed objectively measured purchasing or consumption of foods or non-alcoholic drinks in real-world or laboratory settings.

DATA COLLECTION AND ANALYSIS

Two authors independently selected studies for inclusion and extracted study data. We applied the Cochrane 'Risk of bias' tool and GRADE to assess the quality of evidence. We pooled studies that evaluated similar interventions and outcomes using a random-effects meta-analysis, and we synthesised data from other studies in a narrative summary.

MAIN RESULTS

We included 28 studies, comprising 17 RCTs, 5 Q-RCTs and 6 ITS studies. Most (21/28) took place in the USA, and 19 took place in university settings, 14 of which mainly involved university students or staff. Most (20/28) studies assessed the impact of labelling on menus or menu boards, or nutritional labelling placed on, or adjacent to, a range of foods or drinks from which participants could choose. Eight studies provided participants with only one labelled food or drink option (in which labelling was present on a container or packaging, adjacent to the food or on a display board) and measured the amount consumed. The most frequently assessed labelling type was energy (i.e. calorie) information (12/28).Eleven studies assessed the impact of nutritional labelling on purchasing food or drink options in real-world settings, including purchases from vending machines (one cluster-RCT), grocery stores (one ITS), or restaurants, cafeterias or coffee shops (three RCTs, one Q-RCT and five ITS). Findings on vending machines and grocery stores were not interpretable, and were rated as very low quality. A meta-analysis of the three RCTs, all of which assessed energy labelling on menus in restaurants, demonstrated a statistically significant reduction of 47 kcal in energy purchased (MD -46.72 kcal, 95% CI -78.35, -15.10, N = 1877). Assuming an average meal of 600 kcal, energy labelling on menus would reduce energy purchased per meal by 7.8% (95% CI 2.5% to 13.1%). The quality of the evidence for these three studies was rated as low, so our confidence in the effect estimate is limited and may change with further studies. Of the remaining six studies, only two (both ITS studies involving energy labels on menus or menus boards in a coffee shop or cafeteria) were at low risk of bias, and their results support the meta-analysis. The results of the other four studies which were conducted in a restaurant, cafeterias (2 studies) or a coffee shop, were not clearly reported and were at high risk of bias.Seventeen studies assessed the impact of nutritional labels on consumption in artificial settings or scenarios (henceforth referred to as laboratory studies or settings). Of these, eight (all RCTs) assessed the effect of labels on menus or placed on a range of food options. A meta-analysis of these studies did not conclusively demonstrate a reduction in energy consumed during a meal (MD -50 kcal, 95% CI -104.41, 3.88, N = 1705). We rated the quality of the evidence as low, so our confidence in the effect estimate is limited and may change with further studies.Six laboratory studies (four RCTs and two Q-RCTs) assessed the impact of labelling a single food or drink option (such as chocolate, pasta or soft drinks) on energy consumed during a snack or meal. A meta-analysis of these studies did not demonstrate a statistically significant difference in energy (kcal) consumed (SMD 0.05, 95% CI -0.17 to 0.27, N = 732). However, the confidence intervals were wide, suggesting uncertainty in the true effect size. We rated the quality of the evidence as low, so our confidence in the effect estimate is limited and may change with further studies.There was no evidence that nutritional labelling had the unintended harm of increasing energy purchased or consumed. Indirect evidence came from five laboratory studies that involved mislabelling single nutrient content (i.e. placing low energy or low fat labels on high-energy foods) during a snack or meal. A meta-analysis of these studies did not demonstrate a statistically significant increase in energy (kcal) consumed (SMD 0.19, 95% CI -0.14to 0.51, N = 718). The effect was small and the confidence intervals wide, suggesting uncertainty in the true effect size. We rated the quality of the evidence from these studies as very low, providing very little confidence in the effect estimate.

AUTHORS' CONCLUSIONS

Findings from a small body of low-quality evidence suggest that nutritional labelling comprising energy information on menus may reduce energy purchased in restaurants. The evidence assessing the impact on consumption of energy information on menus or on a range of food options in laboratory settings suggests a similar effect to that observed for purchasing, although the evidence is less definite and also of low quality.Accordingly, and in the absence of observed harms, we tentatively suggest that nutritional labelling on menus in restaurants could be used as part of a wider set of measures to tackle obesity. Additional high-quality research in real-world settings is needed to enable more certain conclusions.Further high-quality research is also needed to address the dearth of evidence from grocery stores and vending machines and to assess potential moderators of the intervention effect, including socioeconomic status.

Effect of default menus on food selection and consumption in a college dining hall simulation study

OBJECTIVE

To test an obesity prevention strategy derived from behavioural economics (optimal defaults plus delay), focused on changing the college dining hall service method.

DESIGN

After a uniform pre-load, participants attended an experimental lunch in groups randomized to one of three conditions: a nutrient-dense, lower-fat/energy lunch as an optimal default (OD); a less-nutrient-dense, higher-fat/energy lunch as a suboptimal default (SD); or a free array (FA) lunch. In the OD condition, students were presented a menu depicting healthier vegetarian and omnivore foods as default, with opt-out alternatives (SD menu) available on request with a 15 min wait. In the SD condition, the same menu format was used with the positioning of food items switched. In the FA condition, all choices were presented in uniform fonts and were available immediately.

SETTING

Private rooms designed to provide a small version of a college dining hall, on two campuses of a Northeastern US university.

SUBJECTS

First-year college students (n 129).

RESULTS

There was a significant main effect for condition on percentage of optimal choices selected, with 94 % of food choices in the OD condition optimal, 47 % in the FA condition optimal and none in the SD condition optimal. Similarly, energy intake for those in the SD condition significantly exceeded that in the FA condition, which exceeded that in the OD condition.

CONCLUSIONS

Presenting menu items as optimal defaults with a delay had a significant impact on choice and consumption, suggesting that further research into its long-term applicability is warranted.

Nudging Healthier Choices in a Hospital Cafeteria: Results From a Field Study

More than two thirds of adults and one third of children are overweight or obese in the United States. These trends have led to initiatives to provide information that supports informed choices. Traffic light labeling has been shown to increase consumer awareness and encourage healthy selections. This article contributes to the literature on healthy choices by comparing the additional contribution of a number of interventions used in combination with traffic light labeling. We conducted a 21-month field study in a workplace cafeteria. We analyzed cash register receipts, focusing on sales of beverages and chips. We found that the traffic light system was effective. The addition of caloric information to traffic light labeling had a positive effect on the purchase of healthy chips. However, other interventions appeared to produce more harm than good, essentially wiping out the benefits from traffic light labeling. These findings suggest that although it is possible to improve on traffic light labeling with selective interventions, caution is in order as some interventions may trigger compensatory behavior that results in the purchase of unhealthy items.

Nutrition labeling reduces valuations of food through multiple health and taste channels

One popularized technique to promote healthy dietary choice involves posting calorie or other nutritional information at the time individuals make a consumption decision. While the evidence on the effectiveness of such interventions is mixed, relatively little work has focused on the underlying mechanisms of how such labels alter behavior. In the research reported here, we asked 87 hungry laboratory subjects to make bids over foods with or without nutrition labels present. We found that the presence of a nutrition label reduced bids by an average of 25 cents. Furthermore, we found this reduction was driven by differences in perceptions and the importance individuals placed on health features of the foods, but also by differences in the importance individuals placed on more visceral taste features. These results help explain the various methods in which nutritional information postings or other policy tools can nudge individuals to consume healthier options.

A Cross-Sectional Study of the Relationship between Nutrition Label Use and Food Selection, Servings, and Consumption in a University Dining Setting

BACKGROUND

Nutrition labels at the point of purchase are recommended to improve food choice, yet food choice does not always translate into food consumption. It is important to understand the relationship between label use, food selection, servings, and consumption. Previous research, which has relied on self-reported intake or inferred label use or intake based on sales data, has not adequately answered this question.

OBJECTIVE

To combine survey and meal photographic data to compare food selection, servings, and consumption between label users and nonusers.

DESIGN

Diners were surveyed in two cross-sectional waves during the fall 2014 semester. Food selections were recorded, and pre- and postmeal photographs were taken of diners' plate. Photographs were coded to identify the selection, servings, and consumption of MyPlate food categories.

PARTICIPANTS/SETTING

Convenience sample of 1,069 diners (39% women, 53% freshman) in two university dining halls. Students had to be older than age 18 years and just beginning their meal to participate.

MAIN OUTCOME MEASURES

Selection, servings, and consumption of MyPlate food categories for label users and nonusers.

STATISTICAL ANALYSES PERFORMED

Differences in food selection were tested via χ² tests, and differences in adjusted least squares means for servings and consumption were tested via t tests.

RESULTS

A greater proportion of nutrition label users selected fruits, vegetables, and beans and fewer selected potatoes compared with nonusers. In addition, fewer label users selected fried foods and foods with added sugars (all P values <0.05). Label users served themselves and consumed more vegetables and fewer potatoes and refined grains compared with nonusers (all P values <0.05).

CONCLUSIONS

Our results suggest label users behave differently compared with nonusers. Based on the meals observed, these differences appear more qualitative in nature (selecting different foods) than quantitative (selecting more or less food).

Correlates of nutrition label use among college students and young adults: a review

OBJECTIVE

Nutrition labels are an essential source for consumers to obtain nutrition-related information on food products and serve as a population-level intervention with unparalleled reach. The present study systematically reviewed existing evidence on the correlates of nutrition label use among college students and young adults.

DESIGN

Keyword and reference searches were conducted in PubMed, EBSCO, PsycInfo, Cochrane Library and Web of Science. Inclusion criteria included: study design (randomized controlled trial, cohort study, pre-post study or cross-sectional study); population (college students and young adults 18-30 years old); main outcome (nutrition label use); article type (peer-reviewed publication); and language (English).

SETTING

College/university.

SUBJECTS

College students and young adults.

RESULTS

Sixteen studies based on data from college surveys in four countries (USA, UK, Canada, South Korea) were identified from keyword and reference search. Reported prevalence of nutrition label use varied substantially across studies; a weighted average calculation showed 36·5 % of college students and young adults reported using labels always or often. Females were more likely to use nutrition labels than males. Nutrition label use was found to be associated with attitudes towards healthy diet, beliefs on the importance of nutrition labels in guiding food selection, self-efficacy, and nutrition knowledge and education.

CONCLUSIONS

The impact of nutrition labelling on food purchase and intake could differ by population subgroups. Nutrition awareness campaigns and education programmes may be important mechanisms for promoting nutrition label use among college students and young adults. Future research is warranted to assess the role of label use on improved dietary decisions.