Prevalence and determinants of adult consumer use and comprehension of food labels in sub-Saharan Africa: a systematic review and meta-analysis

CONTEXT

Food labelling is a global strategy recommended to reduce noncommunicable diseases. Few reviews, however, have focused on food label use in sub-Saharan Africa (SSA).

OBJECTIVE

To determine the prevalence of food label use and describe determinants of food label use and purchasing decisions of adult consumers in SSA.

DATA SOURCE

PubMed (Medline), Web of Science, Cochrane Central, and Google Scholar databases.

DATA EXTRACTION

Search criteria included adults (aged ≥18 years), conducted in SSA, focusing on food label use or understanding and their determinants or determinants of food-purchasing decisions, and articles published in English.

STUDY QUALITY AND DATA ANALYSIS

Risk-of-bias assessment of included studies was done using the Joann Briggs Institute checklist for prevalence studies. Publication bias was assessed using funnel plots and Egger's test. Analysis included narrative synthesis and moderator and meta-analyses of food label use.

RESULTS

A total of 124 articles were found, of which 21 were included in the review. Of participants in the selected studies, 58% were female. About 80% reported food label use (either used sometimes or always) (70%-88%) (I2 = 97%; n = 6223), and regular use was estimated at 36% (28%-45%) (I2 = 97%; n = 5147). Food label use was influenced by level of income, education, employment status, and household size. Food-purchasing decisions were influenced by attributes such as expiry dates, price, and taste. Major recommendations reported were tailored education campaigns and reducing barriers to food label use.

CONCLUSION

Most (80%) of adults in SSA reported using food labels; however, only about one-third used them consistently. Demographic and situation factors determined patterns in food label use, whereas product attributes influenced food purchasing decisions. Complexity of these determinants requires adopting tailored, multisectoral, theory-driven programs to improve food label use.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework (https://osf.io/kc562).

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

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.

U.S. consumer support for genetically modified foods: Time trends and assessments of four GM attributes

There is a large literature about consumer acceptance of GM foods dating back almost three decades, but there are fewer studies that investigate how support for specific GM attributes contribute to general support for novel plant technologies. In addition, there is little information on how support has changed over time. Using survey data from 2018 to 2023 in a U.S. State (Vermont) (n = 3101), we analyze changes in support for a variety of GM attributes over time. There are three major findings. First, there is movement toward neutrality in support for various GM attributes, but opposition continues. Second, there is variability in support for different GM attributes. People are most supportive (least opposed) to GM attributes that improve flora (plant health or drought tolerance), and most opposed (least supportive) of attributes that impact fauna (specifically fish). Third, multivariate regression reveals that assessments of individual GM attributes contribute to levels of overall support of the use of GM technologies in agricultural production.

Promotion of ultra-processed foods in Brazil: combined use of claims and promotional features on packaging

OBJECTIVE

To assess the availability of different promotional strategies applied for UPF sales in Brazilian food retailers.

METHODS

Information available on food packaging was gathered from all packaged products sold in the five largest food retail chains in Brazil in 2017. UPF were identified using the NOVA food classification system. From this sample, data related to promotional characteristics, nutrition claims and health claims were collected and coded using the INFORMAS methodology. Additional claims referring to the Brazilian Dietary Guidelines were also collected.

RESULTS

This study evaluated the packaging of 2,238 UPF, of which 59.8% presented at least one promotional strategy. Almost one third denoted a simultaneous use of different promotional strategies in the same packaging. Nutrition claims were the most commonly found promotional strategy, followed by health claims and the use of characters. The food subgroups comprising the highest prevalence of promotional strategies on their labels were: noncaloric sweeteners (100.0%), breakfast cereals and granola bars (96.2%), juices, nectars and fruit-flavoured drinks (92.9%), other unsweetened beverages (92.9%), and other sweetened beverages (92.6%).

CONCLUSIONS

Considering the poor nutritional quality of UPF, the widespread presence of promotional features on their packaging highlights the need for marketing restrictions on this kind of product.

'Feta is obviously very dangerous stuff looking at all those reds': Can nutrition labelling help people living with type 2 diabetes to self-manage their condition?

BACKGROUND

The consumption of a healthy balanced diet is the cornerstone of treatment for people living with type 2 diabetes (PLWT2DM). The United Kingdom recommends a standardised voluntary front-of-pack food labelling system which uses the green-amber-red colour coding to indicate the presence of nutrients in a food item. Research with PLWT2DM suggests that they may find it challenging to interpret the information on food labels. This paper draws from a larger study exploring nutrition information practices for PLWT2DM. The aim of this paper is to explore the experiences of using nutrition information found on food labels among PLWT2DM and their partners/carers.

METHODS

This study used a qualitative and mixed methods design, using a solicited 4-week unstructured diary followed by a qualitative interview with each participant. The theoretical framework drew on practice theory. Data were analysed using thematic analysis.

RESULTS

Nineteen PLWT2DM and one partner took part. Data consisted of 19 diaries and interviews. Almost all participants used food labels to help manage their condition; however, the colour-coding link with traffic lights appeared to overemphasise the need to avoid foods with red labels. Participants' beliefs about sugar influenced their food choices which in turn could impact on their nutritional intake. Highly developed mathematical skills were needed to interpret information about portion sizes.

CONCLUSIONS

Healthcare professionals and patient support groups should focus more on educating PLWT2DM about how to interpret food labels so that they are able to apply these to their own food choices. Future research and development of subsequent versions of the food labelling system should include PLWT2DM to ensure that labels are both clear and relevant to them.

Knowledge, Attitudes, and Practices of Consumers on Food Allergy and Food Allergen Labeling: A Case of Lebanon

The epidemiology of food allergies is increasing worldwide. International labeling standards were developed to enhance consumers' awareness of allergen-free foods. The main objective of the present study is to assess the characteristics of allergen labeling and consumers' knowledge, attitudes, and purchasing habits of food products with allergens in Lebanon. We evaluated the allergen labeling of 1000 food products form Lebanese supermarkets. A random sample of 541 consumers was recruited through an online survey (November 2020-February 2021). Descriptives and regression analysis were conducted. Results showed that wheat represents the largest group of food allergens on food labels, followed by milk and soybean. Furthermore, 42.9% of supermarket food products had a precautionary allergen labeling with "may contain traces of allergens". The majority of food products complied with local regulations for locally manufactured and imported products. One-quarter of survey respondents had a food allergy or were caregivers of food-allergic individuals. Regression analyses showed that "previous experience of a severe reaction" was negatively associated with food allergy-related knowledge and attitude scores respectively (β = -1.394, 95% CI: (-1.827, -1.034) and β = -1.432, 95% CI: (-2.798, -0.067)). The findings of this study provide practical insights on food allergy labeling issues for stakeholders and policymakers in the food supply chain.

The ability of five different front-of-pack labels to assist Australian consumers to identify healthy versus unhealthy foods

OBJECTIVE

The aim of this study was to assess the relative ability of different interpretive front-of-pack food labels to alert consumers to both healthier and unhealthier options to inform their food choices.

METHODS

One thousand Australians completed an online experiment where they rated the nutritional quality of sets of fictional products pre- and post-randomisation to one of five front-of-pack labels: Health Star Rating, Multiple Traffic Lights, Nutri-Score, Reference Intakes and Warning Label. Two sample z-tests were used to assess the ability of each label to facilitate the correct identification of the least and most healthy product options.

RESULTS

The Nutri-Score was superior in assisting respondents to identify both the healthiest and unhealthiest options. The Health Star Rating ranked second for both outcomes, followed by the Multiple Traffic Lights.

CONCLUSIONS

Results reinforce the role of interpretive front-of-pack labels in assisting consumers to understand the nutritional quality of food products and suggest spectrum labels may provide superior utility in assisting consumers to identify both the most and least nutritious products from among available product options.

IMPLICATIONS FOR PUBLIC HEALTH

The strongest performance of a highly interpretive front-of-pack label (Nutri-Score) featuring colour in a summary indicator suggests potential strategies for enhancing the performance of the Health Star Rating.

Effectiveness of Displaying Traffic Light Food Labels on the Front of Food Packages in Japanese University Students: A Randomized Controlled Trial

Nutrition labeling on the front of food packages has been implemented worldwide to help improve public health awareness. In this randomized double-blind controlled trial, we used a Google Forms questionnaire to evaluate the effectiveness of nutrition labeling on food packages in university students. The questionnaire, ultimately completed by 247 students, included 15 dietary images from which they were asked to choose what they wanted to eat for breakfast, lunch, and dinner the following day. For the interventional (traffic light food [TLF]) group only, TLF labels were displayed on dietary images. This group had a significantly higher proportion of people conscious of healthy eating during all meals than the control group, and the effect of TLF labeling on choosing meals was the highest for lunch. In addition to the indicated nutritional components, the TLF group had a significantly higher proportion of people who were conscious of the ones of protein and dietary fiber that were not indicated on the label. The use of TLF labels resulted in an increase in the proportion of people choosing a healthy diet as well as being conscious of their nutritional components. Therefore, the use of TLF labels may help promote healthy dietary choices in Japan.

Eating contexts determine the efficacy of nutrient warning labels to promote healthy food choices

Introduction

Unhealthy food choices increase the risk of obesity and its co-morbidities. Nutrition labels are a public health policy that aims to drive individuals toward healthier food choices. Chile has been an example of this policy, where mandatory nutrient warning labels (NWL) identify processed foods high in calories and critical nutrients. Eating contexts influence individual food choices, but whether eating contexts also influence how NWL alter the decision process and selection during food choice is unknown.

Methods

In an online mouse-tracking study, participants prompted to health, typical, or unrestricted eating contexts were instructed to choose between pairs of foods in the presence or absence of NWL. Conflict during choices was analyzed using mouse paths and reaction times.

Results

NWL increased conflict during unhealthy food choices and reduced conflict during healthy choices in all contexts. However, the probability that NWL reversed an unhealthy choice was 80% in a healthy, 37% in a typical, and 19% in an unrestricted context. A drift-diffusion model analysis showed the effects of NWL on choice were associated with an increased bias toward healthier foods in the healthy and typical but not in the unrestricted context.

Discussion

These data suggest that the efficacy of NWL to drive healthy food choices increases in a healthy eating context, whereas NWL are less effective in typical or unrestricted eating contexts.

Knowledge on added sugar content in food labels among adult out-patient clinic visitors at a tertiary care teaching hospital, Riyadh, KSA

Consumption of added sugars is reported as an etiological factor for high prevalence of diet-related diseases. Food labels of food products indicate the presence of added sugars. Knowing the different terms used to describe added sugars helps people to avoid food products rich in added sugars. Therefore, it is of interest to assess consumer knowledge about the added sugar terms on food labels. A study was conducted among 215 visitors of a tertiary care hospital outpatient clinic during July-September 2020. The data for this prospective cross-sectional study was collected by using online Google form. Adult visitors of both genders were selected using a non-probability convenient sampling technique. Demography and knowledge of the added sugars were collected. SPSS version 22 was used for data analysis. Mean (± SD), median, and Inter quartile Range (IQR), and Pearson Chi-square test were used. A "p" value of < 0.05 was considered statistically significant. The majority (96.7%) of the study participants was Saudi nationals with a median (IQR) age of 28 (23, 38). Most (68.37%) of the respondents were undergraduates. Physical inactivity (37.21%) and incidence of obesity (25.58%), and lifestyle diseases (15.40%) were reported. The chi-square test indicated a significant relationship between gender and knowledge of added sugars (χ2 = 69.85; p<0.05). Females (69.41%) have more knowledge about added sugars than males. These findings support the notion that there is a lack of knowledge about added sugar terms on the nutrition labels, which might contribute to the prevalence of obesity and other non-communicable chronic illnesses.

Dietary Glycaemic Index Labelling: A Global Perspective

The glycaemic index (GI) is a food metric that ranks the acute impact of available (digestible) carbohydrates on blood glucose. At present, few countries regulate the inclusion of GI on food labels even though the information may assist consumers to manage blood glucose levels. Australia and New Zealand regulate GI claims as nutrition content claims and also recognize the GI Foundation’s certified Low GI trademark as an endorsement. The GI Foundation of South Africa endorses foods with low, medium and high GI symbols. In Asia, Singapore’s Healthier Choice Symbol has specific provisions for low GI claims. Low GI claims are also permitted on food labels in India. In China, there are no national regulations specific to GI; however, voluntary claims are permitted. In the USA, GI claims are not specifically regulated but are permitted, as they are deemed to fall under general food-labelling provisions. In Canada and the European Union, GI claims are not legal under current food law. Inconsistences in food regulation around the world undermine consumer and health professional confidence and call for harmonization. Global provisions for GI claims/endorsements in food standard codes would be in the best interests of people with diabetes and those at risk.

A Standardized Guide to Developing an Online Grocery Store for Testing Nutrition-Related Policies and Interventions in an Online Setting

Simulated online grocery store platforms are innovative tools for studying nutrition-related policies and point-of-selection/point-of-purchase interventions in online retail settings, yet there is no clear guidance on how to develop these platforms for experimental research. Thus, we created a standardized guide for the development of an online grocery store, including a detailed description of (1) methods for acquiring and cleaning online grocery store data, and (2) how to design a two-dimensional online grocery store experimental platform. We provide guidance on how to address product categorization, product order/sorting and product details, including how to identify outliers and conflicting nutritional information and methods for standardizing prices. We also provide details regarding our process of “tagging” food items that can be leveraged by future studies examining policies and point-of-selection/point-of-purchase interventions targeting red and processed meat and fruits and vegetables. We experienced several challenges, including obtaining accurate and up-to-date product information and images, and accounting for the presence of store-brand products. Regardless, the methodology described herein will enable researchers to examine the effects of a wide array of nutrition-related policies and interventions on food purchasing behaviors in online retail settings, and can be used as a template for reporting procedures in future research.

GMO Food Labels Do Not Affect College Student Food Selection, Despite Negative Attitudes towards GMOs

US Public Law 114–216 dictates that food producers in the United States of America will be required to label foods containing genetically modified organisms (GMOs) starting in 2022; however, there is little empirical evidence demonstrating how U.S. consumers would use food labels that indicate the presence or absence of GMOs. The aim of this two-phase study was to determine how attitudes towards GMOs relate to food choices and how labels indicating the presence or absence of GMOs differentially impact choices among college students—the age group which values transparent food labeling more than any other. Participants (n = 434) made yes/no choices for each of 64 foods. In both phases of the study, participants were randomly assigned to seeing GMO Free labels, contains GMOs labels, or no GMO labels. Across the two phases, 85% of participants reported believing that GMOs were at least somewhat dangerous to health (42% believed GMOs to be dangerous), yet in both studies, although eye-tracking data verified that participants attended to the GMO labels, these labels did not significantly affect food choices. Although college consumers may believe GMOs to be dangerous, their food choices do not reflect this belief.

The Effect of Front-of-Pack Nutritional Labels and Back-of-Pack Tables on Dietary Quality

A healthy diet is important to prevent lifestyle diseases. Food labels have been proposed as a policy tool to improve the healthiness of food choices, as they provide information about nutritional content and health attributes which may otherwise have been unknown to the consumer. This study investigates the effect of food labels with different formats on dietary quality by using home-scan panel data and difference-in-difference methods to compare the change in dietary quality over time for households that start to use food labels with households that do not use labels. I find that the use of front-of-pack (FOP) nutritional labels increases overall dietary quality, which is driven by reduced intake of added sugar and increased intake of fiber. The use of back-of-pack (BOP) nutritional tables does not influence dietary quality. There is no additional benefit to overall dietary quality by using both labels. However, the results indicate that there could be a benefit of using both labels on certain nutrients. The results imply that additional policies are needed to supplement food labels in order to improve dietary quality.

Assessing consumers' understanding of the term "Natural" on food labeling

The objective of this study was to gain a better understanding of how consumers' interpret the term "natural" by assessing food choice based on labels describing attributes of a product associated with the term "natural"; to assess food intake of chosen food, and; to determine factors that influence food choice and intake. A randomized, single-visit pilot study was conducted where participants (n = 105) were presented with seven identical bowls of granola each bearing a different descriptive label. Participants were asked to choose and eat the granola (ad libitum) that coincided with what was closest to their view of "natural." Food choice, intake amount, demographics, self-health perception, label use, dietary restraint, and mindfulness were measured. "Organic" (31%), "Made with real grains" (17%), and "No preservatives" (15%) were the top three chosen labels. These choices related to concerns about environment and processing, personal health, and additives and preservatives, respectively (P = 0.049). Income level and age were significantly associated with choice (P = 0.003). Defining the term "natural" for use on food labels will require follow-up researchacrosseconomically diverse populations and age groups to understand expectations of food products bearing the term "natural."

Stars versus warnings: Comparison of the Australasian Health Star Rating nutrition labelling system with Chilean Warning Labels

OBJECTIVE

The Health Star Rating (HSR) is a voluntary front-of-pack nutrition labelling system that rates products from ½ to 5 stars (five being healthiest). The Chilean Warning Label system displays warnings on foods high in sugar, saturated fat, sodium, or energy. We aimed to evaluate alignment between the systems.

METHODS

New Zealand packaged products (n=13,868) were classified according to the two systems. Alignment was assessed by cross-checking the number of products meeting the criteria for warnings against star ratings. Products with no warnings but an HSR <2, or with >1 warning but an HSR of ≥3.5 were considered outliers.

RESULTS

Two-thirds of products met the criteria for at least one warning. There was a significant positive relationship between the number of warnings and mean HSR: 0 warnings = HSR 3.77±.0166 (p<0.001), 1 warning = HSR 2.70±.0206 (p<0.001) and >1 warning = HSR 2.00±.0160 (p<0.001). The systems were non-aligned for 1,117 products (8%).

CONCLUSION

HSR and the Chilean Warning Label systems are broadly aligned. Non-alignment is due to the Chilean system restricting warnings to foods containing added ingredients and HSR awarding points for positive components. Implications for public health: These results could be helpful in informing improvements to the HSR system.

Perceptions of Animal Welfare With a Special Focus on Turkeys

Meat consumption and public concern for farm animal welfare are increasing, despite limited public understanding of agriculture and animal welfare. Turkey is important in U.S. holiday meal traditions and turkey meat is a frequently consumed processed product (i.e., lunchmeat). However, little is known about public perceptions and knowledge of commercial turkeys. An online survey was administered to 1,695 respondents in November 2018 to examine U.S. (1) demographic factors affecting meat consumption, selection of labeled meat products, and concern for animal welfare, (2) public knowledge of turkeys, and (3) concerns regarding the welfare of turkeys and other species. A total of 95% of respondents consumed meat and 10% hunted for some of the meat they consumed. Meat consumption frequency depended on region of residence, income level, gender, age, and whether respondents hunted. Of the meat consumers, 86% purchased turkey products. More meat consumers looked for the USDA organic label (39%) and the Non Genetically Modified Organism (GMO) project label (38%) than animal-welfare food labels (14%) when buying meat products. More pet owners (39%) than non-pet owners (25%) looked for animal welfare food labels. Being a pet owner increased the probability of being concerned about farm animal welfare. Concern for the commercial turkey was similar to concern for other farm animal species; self-reported knowledge of turkey production was low (mean score 2.64; scale of 1 to 7, 7 = highest). Turkey welfare concerns (mean score; rank from 1 to 5; 5 = least concerning) included poor nutrition (2.471) and illness (2.508), followed by housing (2.732), hot or cold weather (3.308) and transportation (3.981). Turkey welfare attributes that respondents cared the most about (mean score; scale of 1–5, 5 = cared the least) included space to move around (2.366), followed by veterinary health and wellness (2.680), ability to perform natural behavior (2.812), no feather loss or visible injuries (3.304), and decreased aggression (3.837). Demographic factors are important determinants of meat consumption and animal welfare concern. Public knowledge of turkey production is limited, despite a large percentage of the population purchasing turkey products.

Trans Fat Labeling Information on Brazilian Packaged Foods

Although the adverse effects of trans fat consumption are well documented, industrially-produced trans fats are still used in a variety of food products. Our objective was to investigate the presence of trans fat information on the nutrition facts panel, in the list of ingredients, and the use of trans fat claims in packaged food and beverages marketed in Brazil. This was a cross-sectional study that used data from packaged food and beverages available in the five supermarket chains with the largest market share in Brazil. Of the 11,434 products that were analyzed, 81.3% did not present a source of trans fats in the list of ingredients. The percentages of products with specific (hydrogenated fats or oils) and unspecific trans fat terms (margarine, vegetable fat, and vegetable cream) in the list of ingredients were 4.1% and 14.6%, respectively. Bakery products, cookies and crackers, candies and desserts, snacks, and convenience foods had the highest percentages of trans fat claims. We also found claims in products with ingredients that are sources of trans fats. In conclusion, trans fat ingredients were found in almost one-fifth of the Brazilian packaged foods. The current Brazilian legislation is not sufficient to inform consumers about the content of trans fats in packaged foods. Along with measures to restrict the use of industrially-produced trans fats, improvements in nutritional labeling are also needed.

Consumers' Views on the Importance of Specific Front-of-Pack Nutrition Information: A Latent Profile Analysis

Nutrition labelling can influence consumers’ assessments of food healthiness and their food choices. However, there is a lack of consensus about the optimal type and amount of nutrition information to provide on food packages. This study analysed consumers’ preferences for front-of-pack information relating to energy and various nutrients (sugar, saturated fat, sodium, fibre, carbohydrate, and protein). The aim was to identify discrete preference segments within the Australian market where the current Health Star Rating front-of-pack labelling system can be displayed with different levels of nutrition information. Adults (n = 1558) completed a survey assessing socio-demographics, self-reported nutrition knowledge, diet healthiness, special dietary requirements, and perceived importance of the provision of energy and nutrient information on the front of food packs. Latent profile analysis identified five consumer segments within the sample that ranged from groups exhibiting high levels of interest in various forms of nutrition information to one with very low interest and one with divergent scores according to whether nutrients were perceived as positive or negative for health. The results indicate that different forms of front-of-pack labelling featuring varying degrees of information about energy and specific nutrients are likely to be of interest and use to different market segments.

Guidelines-Driven Educational Intervention Promotes Healthy Lifestyle Among Adolescents and Adults: A Serbian National Longitudinal Study

Background and objectives: The effectiveness of short-term focused educational programs to change health behaviors across large populations seems to be poorly described so far. The main aim of the present study was to evaluate an age-specific 45-min educational program, designed in accordance with the current U.S. Department of Health and Human Services and U.S. Department of Agriculture dietary guidelines and physical activity (PA) guidelines, among adolescents and adults. Materials and Methods: We evaluated the health-promoting lifestyle habits by the Health-Promoting Lifestyle Profile (HPLP-II) at baseline and following 6–8 weeks post-education in a nationally representative sample of Serbian adolescents and adults (n = 3822). Results: The percentage of adolescents eating 3–5 servings of vegetables per day increased at follow-up (20.1% versus 23.1%, p = 0.001), with significantly more adolescents regularly reading food labels (from 12.2% at baseline to 14.2% at follow-up; p = 0.02). Taken together, mean HPLP-II scores in adolescents significantly improved for both diet (0.05 points; p < 0.0001) and PA (0.09 points; p < 0.0001), and for PA in adults (0.08 points; p < 0.0001). Hierarchical multiple regression analysis revealed that our model as a whole (including time of testing as a predictor variable, and age and gender as control variables) explained 3.0% of the variance in mean HPLP-II scores for diet (p = 0.942) and 3.0% for PA (p = 0.285) in adolescents, and 1.1% of the variance in HPLP-II scores for diet (p = 0.781) and 1.9% for PA (p = 0.075) in adults, respectively. Conclusions: It appears that a brief focused education can positively tackle unhealthy lifestyles in promoting good health in general population. Different modes of interactive communication used here appeared to strengthen participants’ capacities for lifestyle changes.

Effect of Educational Interventions on Understanding and Use of Nutrition Labels: A Systematic Review

The potential for nutrition labels to impact on population health is dependent on consumer ability to understand and use this information. Consumer understanding of this information varies across sociodemographic groups and with different label design formats. Labeling legislation requires consumer education on how to use nutrition labels, and recent mandatory changes to the Nutrition Facts Panel (NFP) are underway to improve comprehensibility. This review aimed to evaluate if educational programs can improve understanding and use of nutrition labels. Database searches were performed to identify interventions which delivered education on nutrition labels with outcomes measuring aspects of comprehension or use. A total of 17 studies were selected for review, including nine randomized and eight cohort studies. The majority of studies were conducted in the United States Study participants included school aged children, older adults, and those with diabetes within a range of intervention types involving taught sessions or web-based education. Whilst outcome measures were heterogenous, all studies reported a statistically significant improvement in one or more outcomes of participant understanding or use of nutrition labels. Aspects such as general nutrition knowledge, health literacy, and program delivery format warrant attention in future research. Education which optimizes comprehension and use of nutrition labels may have the potential to improve the impact of this information on dietary health.

Are They Buying It? United States Consumers' Changing Attitudes toward More Humanely Raised Meat, Eggs, and Dairy

Simple Summary

The lack of a consistent approval process for animal welfare claims in the US has allowed for misleading labeling of meat, eggs, and dairy. Products that do have meaningful welfare certifications tend to be more expensive. We administered a survey to determine consumers’ attitudes towards welfare certifications and the willingness to pay for foods from animals raised under more humane conditions. Most respondents (78%) thought it was important to know that animal-welfare assessments are conducted by an independent third party or the federal government (and not only the industry producer). The majority of respondents would be willing to pay extra for foods with a trustworthy welfare certification both in supermarkets and in restaurants. Our findings underscore the importance of eliminating fraudulent or misleading claims that can erode consumer trust and suggest that retailers can best serve consumers who are interested in higher welfare products by stocking products with certifications that convey meaningful information on the animal welfare standards from the source farms.

Abstract

This survey research sampled 1000 US (United States) consumers of meat, eggs, and dairy on their attitudes towards the welfare of farm animals and the willingness to pay for products with trustworthy welfare certifications. Most respondents (70%) reported paying attention to labels that indicate how the animals were raised and 78% believed there should be an objective third party to ensure farm animal welfare. The weighted average of the marginal willingness to pay for products raised under a trustworthy welfare certification was $0.79 for eggs (a 32% premium) and $0.96 for 1 lb. of chicken breast (a 48% premium). In addition, 57% of respondents reported they would be likely to choose a restaurant because it serves welfare-certified animal products and are also willing to pay ≥$5.00 extra per entrée. These findings suggest that many US consumers, particularly millennials, would be willing to seek out higher welfare products if they trust the label claims.

What Is Nutritious Snack Food? A Comparison of Expert and Layperson Assessments

The term “nutritious” is being increasingly used by product manufacturers but the term is not currently regulated as a nutrition claim. It is unclear how lay consumers and experts define and interpret the term or how they evaluate the “nutritiousness” of various foods. To address this evidence gap, a mixed methods design was applied and both nutrition experts (n = 206) and lay participants (n = 269) provided definitions of the term “nutritious” and evaluated the “nutritiousness” of 20 different snack foods in a cross-sectional survey. Definitions were analysed using Leximancer and snack evaluations were compared both between groups and with nutrient profile scores (UK Ofcom and Australian Health Star Rating). Expert and lay definitions differed considerably, with experts using terms such as nutrient-density, macro- and micronutrients, kilojoules/Calories, while lay consumers used descriptions such as fuel, fresh, natural, body needs, and functioning. Snack evaluations were highly correlated between groups (R_s > 0.89, p < 0.001) and between nutrient profile scores (R_s > 0.75, p < 0.001). However, mean perceptions significantly differed for 18 out of 20 foods with the largest difference for yoghurts (p < 0.05). There are discrepancies between expert and lay perceptions of snack foods and the definition of the term “nutritious”. The results highlight the need for an agreed definition and the potential regulation of the term “nutritious” in food marketing.

Color-Coded Front-of-Pack Nutrition Labels-An Option for US Packaged Foods?

The implementation of a standardized front-of-pack-labelling (FoPL) scheme would likely be a useful tool for many consumers trying to improve the healthfulness of their diets. Our objective was to examine what the traffic light labelling scheme would look like if implemented in the US. Data were extracted from Label Insight’s Open Access branded food database in 2017. Nutrient levels and the proportion of products classified as “Red” (High), “Amber” (Medium) or “Green” (Low) in total fat, saturated fat, total sugar and sodium for food and beverage items were examined. The proportion of products in each category that had each possible combination of traffic light colors, and met the aggregate score for “healthy” was examined. Out of 175,198 products, >50% of all US packaged foods received a “Red” rating for total sugar and sodium. “Confectionery” had the highest mean total sugar (51.9 g/100 g) and “Meat and meat alternatives” the highest mean sodium (781 mg/100 g). The most common traffic light label combination was “Red” for total fat, saturated fat and sodium and “Green” for sugar. Only 30.1% of products were considered “healthy”. A wide variety (n = 80) of traffic light color combinations were observed. A color coded traffic light scheme appears to be an option for implementation across the US packaged food supply to support consumers in making healthier food choices.

The informational turn in food politics: The US FDA's nutrition label as information infrastructure

This article traces the history of the US FDA regulation of nutrition labeling, identifying an 'informational turn' in the evolving politics of food, diet and health in America. Before nutrition labeling was introduced, regulators actively sought to segregate food markets from drug markets by largely prohibiting health information on food labels, believing such information would 'confuse' the ordinary food consumer. Nutrition labeling's emergence, first in the 1970s as consumer empowerment and then later in the 1990s as a solution to information overload, reflected the belief that it was better to manage markets indirectly through consumer information than directly through command-and-control regulatory architecture. By studying product labels as 'information infrastructure', rather than a 'knowledge fix', the article shows how labels are situated at the center of a legally constructed terrain of inter-textual references, both educational and promotional, that reflects a mix of market pragmatism and evolving legal thought about mass versus niche markets. A change to the label reaches out across a wide informational environment representing food and has direct material consequences for how food is produced, distributed, and consumed. One legacy of this informational turn has been an increasing focus by policymakers, industry, and arguably consumers on the politics of information in place of the politics of the food itself.

Effects of social sustainability signaling on neural valuation signals and taste-experience of food products

Value-based decision making occurs when individuals choose between different alternatives and place a value on each alternative and its attributes. Marketing actions frequently manipulate product attributes, by adding, e.g., health claims on the packaging. A previous imaging study found that an emblem for organic products increased willingness to pay (WTP) and activity in the ventral striatum (VS). The current study investigated neural and behavioral processes underlying the influence of Fair Trade (FT) labeling on food valuation and choice. Sustainability is an important product attribute for many consumers, with FT signals being one way to highlight ethically sustainable production. Forty participants valuated products in combination with an FT emblem or no emblem and stated their WTP in a bidding task while in an MRI scanner. After that, participants tasted-objectively identical-chocolates, presented either as "FT" or as "conventionally produced". In the fMRI task, WTP was significantly higher for FT products. FT labeling increased activity in regions important for reward-processing and salience, that is, in the VS, anterior and posterior cingulate, as well as superior frontal gyrus. Subjective value, that is, WTP was correlated with activity in the ventromedial prefrontal cortex (vmPFC). We find that the anterior cingulate, VS and superior frontal gyrus exhibit task-related increases in functional connectivity to the vmPFC when an FT product was evaluated. Effective connectivity analyses revealed a highly probable directed modulation of the vmPFC by those three regions, suggesting a network which alters valuation processes. We also found a significant taste-placebo effect, with higher experienced taste pleasantness and intensity for FT labeled chocolates. Our results reveal a possible neural mechanism underlying valuation processes of certified food products. The results are important in light of understanding current marketing trends as well as designing future interventions that aim at positively influencing food choice.

Food labels use is associated with higher adherence to Mediterranean diet: results from the Moli-sani study

Mediterranean diet (MD) has been associated with lower risk of ischemic cerebro- and cardio-vascular disease, neurological degenerative disease, and breast and colonrectal cancers. Nevertheless, adherence to this pattern has decreased. Food labels are a potentially valid means to encourage towards healthier dietary behavior. This study, conducted on a subsample of 883 subjects enrolled in the Moli-sani Project, evaluated whether food labels reading (LR) is associated with MD adherence. Participants completed a questionnaire on nutrition knowledge, information, and attitudes, with a specific question on food labels reading. Biometric measurements, socio-economic status, education, physical activity, and smoking habits were collected. The European Prospective Investigation into Cancer and Nutrition (EPIC) food frequency questionnaire was used to collect dietary habits, and subsequently evaluated by both the Mediterranean diet score (MDS) and Italian Mediterranean index (IMI), a priori dietary patterns. Food consumption patterns were generated by Principal Components Analysis (PCA), an a posteriori approach. Multivariable odds ratios were calculated to quantify the association of LR categories with dietary habits. LR was significantly associated with greater adherence to both MDS (p = 0.0004) and IMI (p = 0.0019) in a multivariable model. LR participants had 74% (MDS) or 68% (IMI) higher probability to be in the highest level of adherence to Mediterranean diet-like patterns. Moreover, they showed greater adherence to Mediterranean-like food consumption patterns (0.1 vs. -0.2, p < 0.0001) and lower adherence to two Western-like patterns (0.01 vs. 0.2, p = 0.009 and 0.1 vs. 0.2, p = 0.02). These findings support an association between food label use and consuming a Mediterranean-type diet.

Knowledge and practices of using food label information among adolescents attending schools in Kolkata, India

OBJECTIVE

To assess knowledge and use of label information among adolescents.

METHODS

A cross-sectional study was conducted among adolescents (N = 316) from 6 schools selected randomly using cluster sampling. A pre-coded questionnaire was used to assess frequently consumed packaged foods, whether label information was read, knowledge of symbols, and usefulness of nutrition information display. The data were analyzed using descriptive statistics and chi-square tests.

RESULTS

Although 88% of adolescents read food labels, many read only date of manufacture (79%), expiration (74%) or best used before dates (65%). Fewer adolescents read ingredients (50%) and nutrition information (20%). Their knowledge about quality symbols was low. Many of them (over 60%) recognized the symbols but had no knowledge of what they indicated. About 66% believed that nutrition information on labels was too complex to understand.

CONCLUSIONS AND IMPLICATIONS

There is a need to provide education on different aspects of label information to promote label use. The effectiveness of alternative methods of nutrition information display should also be investigated.

Sociodemographic differences in the comprehension of nutritional labels on food products

OBJECTIVE

To examine comprehension of nutrition labels across sociodemographic groups using a measure of health literacy.

METHODS

Cross-sectional survey of a community sample of adults including an adapted version of the Newest Vital Sign for Canadian Nutrition Facts table on prepackaged grocery products, including numerical conversion questions for calorie content and percent daily value.

RESULTS

Approximately two thirds of participants were able to correctly identify calorie content and percent daily value from the nutrition label. Participants with higher education and higher income, those aged ≤ 64 years, and those who look at nutritional facts or calories were significantly more likely to estimate the correct calorie content. Participants were significantly more likely to correctly identify percent daily value if they reported higher education, higher income, and white ethnicity.

CONCLUSIONS AND IMPLICATIONS

Approximately one third of participants could not comprehend basic information on Canadian nutrition labels. Lower socioeconomic status was associated with poorer performance.

Swedish consumers' cognitive approaches to nutrition claims and health claims

Introduction and Aim

Studies show frequent use of nutrition claims and health claims in consumers' choice of food products. The aim of the present study was to investigate how consumers' thoughts about these claims and food products are affected by various types of food-related experiences.

Material and Methods

The data collection comprised 30 individual interviews among Swedish consumers aged 25 to 64 years.

Results

The results indicated that participants who expressed special concern for their own and their families' health were eager to find out the meaning of concepts and statements made. A lack of understanding and lack of credibility of concepts and expressions often caused suspicion of the product. However, in some cases this was counterbalanced by confidence in manufacturers, retailers, and/or the Swedish food legislation.

Discussion and Conclusion

To achieve effective written communication of food products' health-conducive properties on food labels, there is a need to consider the importance many consumers attach to understanding the meaning of concepts and expressions used and the importance of credibility in certain expressions. Consumers' varying cognitive approaches are suggested as a basis for pre-tests of nutrition claims and health claims.