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To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups.
Cross-sectional data from the International Food Policy Study (IFPS) online survey.
IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019.
Adults aged 18–99; n 19 393.
Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy.
Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.
This study aimed to identify correlates of nutrition label awareness and use, particularly subgroup differences among consumers. Two label types were assessed: (1) nutrition facts tables (NFt) in Australia, Canada, Mexico, UK, and USA and (2) front-of-package (FOP) labels, including mandatory Guideline Daily Amounts (Mexico), voluntary Health Star Ratings (Australia) and voluntary Traffic Lights (UK).
Respondents were recruited using Nielsen Consumer Insights Global Panel (n 21 586) and completed online surveys in November–December 2018. Linear regression and generalised linear mixed models examined differences in label use and awareness between countries and label type based on sociodemographic, knowledge-related and dietary characteristics.
Australia, Canada, Mexico, UK and USA.
Adults (≥18 years).
Respondents from the USA, Canada and Australia reported significantly higher NFt use and awareness than those in Mexico and the UK. Mexican respondents reported the highest level of FOP label awareness, whereas UK respondents reported the highest FOP label use. NFt use was higher among females, ‘minority’ ethnic groups, those with higher nutrition knowledge and respondents with ‘adequate literacy’ compared with those with ‘high likelihood of limited literacy’. FOP label use was higher among those with a ‘high likelihood of limited literacy’ compared with ‘adequate literacy’ across countries.
Lower use of mandatory Guideline Daily Amount labels compared with voluntary FOP labelling systems provides support for Mexico’s decision to switch to mandatory ‘high-in’ warning symbols. The patterns of consumer label use and awareness across sociodemographic and knowledge-related characteristics suggest that simple FOP labels may encourage broader use across countries.
Front-of-pack (FOP) nutrition labelling is a globally recommended strategy to encourage healthier food choices. We evaluated the effect of FOP labels on the perceived healthfulness of a sweetened fruit drink in an international sample of adult consumers.
Six-arm randomised controlled experiment to examine the impact of FOP labels (no label control, Guideline Daily Amounts (GDA), Multiple Traffic Lights, the Health Star Ratings (HSR), Health Warning Labels, and ‘High-in’ Warning Labels (HIWL)) on the perceived healthfulness of the drink. Linear regression models by country examined healthfulness perceptions on FOP nutrition labels, testing for interactions by demographic characteristics.
Online survey in 2018 among participants from Australia, Canada, Mexico, United Kingdom (UK) and United States.
Adults (≥18 years, n 22 140).
Compared with control, HIWL had the greatest impact in lowering perceived healthfulness (β from −0·62 to −1·71) across all countries. The HIWL and the HSR had a similar effect in Australia. Other labels were effective in decreasing the perceived healthfulness of the drink within some countries only, but to a lower extent. The GDA did not reduce perceived healthfulness in most countries. In the UK, the effect of HIWL differed by age group, with greater impact among older participants (> 40 years). There were no other variations across key demographic characteristics.
HIWL, which communicates clear, non-quantitative messages about high levels of nutrients of concern, demonstrated the greatest efficacy to decrease the perceived healthfulness of a sweetened fruit drink across countries. This effect was similar across demographic characteristics.
To examine awareness and recall of healthy eating public education campaigns in five countries.
Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Open-ended descriptions were coded to indicate recall of specific campaigns. Logistic models regressed awareness of healthy eating campaigns on participant country, age, sex, ethnicity, education, income adequacy and BMI. Analyses were also stratified by country.
Participants were Nielsen panelists aged ≥18 years in Australia, Canada, Mexico, UK and the USA (n 22 463).
Odds of campaign awareness were higher in Mexico (50·9 %) than UK (18·2 %), Australia (17·9 %), the USA (13·0 %) and Canada (10·2 %) (P < 0·001). Awareness was also higher in UK and Australia v. Canada and the USA, and the USA v. Canada (P < 0·001). Overall, awareness was higher among males v. females and respondents with medium or high v. low education (P < 0·001 for all). Similar results were found in stratified models, although no sex difference was observed in Australia or UK (P > 0·05), and age was associated with campaign awareness in UK (P < 0·001). Common keywords in all countries included sugar/sugary drinks, fruits and vegetables, and physical activity. The top five campaigns recalled were Chécate, mídete, muévete (Mexico), PrevenIMSS (Mexico), Change4Life (UK), LiveLighter® (Australia), and Actívate, Vive Mejor (Mexico).
In Mexico, UK and Australia, comprehensive campaigns to promote healthy lifestyles appear to have achieved broad, population-level reach.
To assess associations between household food security status and indicators of food skills, health literacy and home meal preparation, among young Canadian adults.
Cross-sectional data were analysed using logistic regression and general linear models to assess associations between food security status and food skills, health literacy and the proportion of meals prepared at home, by gender.
Participants recruited from five Canadian cities (Vancouver (BC), Edmonton (AB), Toronto (ON), Montreal (QB) and Halifax (NS)) completed an online survey.
1389 men and 1340 women aged 16–30 years.
Self-reported food skills were not associated with food security status (P > 0·05) among men or women. Compared to those with high health literacy (based on interpretation of a nutrition label), higher odds of food insecurity were observed among men (adjusted OR (AOR): 2·58, 95 % CI 1·74, 3·82 and 1·56, 95 % CI 1·07, 2·28) and women (AOR: 2·34, 95 % CI 1·48, 3·70 and 1·92, 95 % CI 1·34, 2·74) with lower health literacy. Women in food-insecure households reported preparing a lower proportion of breakfasts (β = −0·051, 95 % CI −0·085, −0·017), lunches (β = −0·062, 95 % CI −0·098, −0·026) and total meals at home (β = −0·041, 95 % CI −0·065, −0·016). Men and women identifying as Black or Indigenous, reporting financial difficulty and with lower levels of education had heightened odds of experiencing food insecurity.
Findings are consistent with other studies underscoring the financial precarity, rather than lack of food skills, associated with food insecurity. This precarity may reduce opportunities to apply health literacy and undertake meal preparation.
To examine the impact of front-of-package (FOP) labels on perceived healthfulness, purchasing intentions and understanding of common FOP systems.
A parallel, open-label design randomised participants to different FOP labelling conditions: ‘high in’ warning labels (WL), multiple traffic light labelling (TLL), health star ratings (HSR) (all displayed per serving) or control with no interpretive FOP labelling. Participants completed a brief educational session via a smartphone application and two experimental tasks. In Task 1, participants viewed healthy or unhealthy versions of four products and rated healthiness and purchasing intention on a seven-point Likert-type scale. In Task 2, participants ranked three sets of five products from healthiest to least healthy.
Online commercial panel.
Canadian residents ≥ 18 years who were involved in household grocery shopping, owned a smartphone and met minimum screen requirements.
Data from 1997 participants (n 500/condition) were analysed. Task 1: across most product categories, the TLL and HSR increased perceived healthiness of healthier products. All FOP systems decreased perceived healthiness of less healthy products. Similar, albeit dampened, effects were seen regarding purchasing intentions. Task 2: participants performed best in the HSR, followed by the TLL, WL and control conditions. Lower health literacy was associated with higher perceived healthiness and purchasing intentions and poorer ranking task performance across all conditions.
All FOP labelling systems, after a brief educational session, improved task performance across a wide spectrum of foods. This effect differed depending on the nutritional quality of the products and the information communicated on labels.
Canada's food supply is abundant in energy-dense products containing excess amounts of sodium, saturated fat and free sugars, increasing Canadians' risk of developing obesity and non-communicable diseases. Food companies shape the food supply through their control over the formulation of their products; however, no studies have examined the healthfulness of products offered by different companies in Canada. This study aimed to assess and compare the nutritional quality of the product portfolios of major packaged food and beverage companies in Canada. Twenty-two top food companies were selected for study, representing a combined 50% and 73% of Canadian packaged food and beverage sales in 2018, respectively. This included 18 multinational companies, 2 Canadian manufacturers and 2 retailers with private-label brands. Nutritional information for products was sourced from the University of Toronto Food Label Information Program 2017 database. The nutritional quality of all products offered by the sampled companies that were included in the database (n = 8,211) were evaluated using the Health Star Rating (HSR) system, with HSRs ranging from 0.5 (less healthy) to 5 (healthier). Descriptive analyses and analysis of variance with post-hoc tests examined the HSRs of each company's products overall and by food category (n = 24). Mean HSRs of companies’ overall product portfolios ranged from 1.8 to 3.7 (μx̅ = 2.7, σx̅ = 0.5) and differed significantly between companies (p < 0.001). Mean HSRs differed between companies for all food categories except eggs (p = 0.5), seafood (p = 0.2), legumes (p = 0.1), nuts and seeds (p = 0.4), and vegetables (p = 0.08). Variation in mean HSRs of products offered by different companies was greatest for beverages (range = 1.3–5.0, μx̅ = 2.0, σx̅ = 1.0), fats/oils (range = 0.7–4.4, μx̅ = 3.6, σx̅ = 1.6), fruit/fruit juices (range = 0.8–4.0, μx̅ = 2.6, σx̅ = 0.9), and sauces/dips/gravies/condiments (range = 0.5–3.4, μx̅ = 2.3, σx̅ = 1.0). These findings demonstrate that the nutritional quality of products offered by leading food manufacturers in Canada varies significantly overall and by food category, with many of these products considered less healthy according to the HSR system. Differences between companies may reflect the nature of their products; for example, products offered by dairy companies were healthier than those of confectionary and soft drink manufacturers, on average. Variation in nutritional quality within food categories illustrates the need and potential for many companies to improve the healthfulness of their products. By identifying companies that offer less healthy products compared with others in Canada, this study may prompt reformulation.
To estimate the prevalence and sociodemographic characteristics of youth and young adults in major Canadian cities with self-reported vegetarian dietary practices and examine efforts to alter their diets.
Data were collected in autumn 2016 via web-based surveys. Respondents reported vegetarian dietary practices (vegan, vegetarian or pescatarian) and efforts in the preceding year to consume more or less of several nutrients, food groups and/or foods with particular attributes. Logistic regression models examined sociodemographic correlates of each vegetarian dietary practice and differences in other eating practices by diet type.
Participants were recruited from five major Canadian cities.
Youth and young adults, aged 16–30 years (n 2566).
Overall, 13·6 % of respondents reported vegetarian dietary practices: 6·6 % vegetarian, 4·5 % pescatarian and 2·5 % vegan. Sex, race/ethnicity, self-reported frequency of using the Nutrition Facts table and health literacy were significantly correlated with self-reported vegetarian dietary practice (P < 0·01 for all). Efforts to consume more fruits and vegetables (66·8 %) and protein (54·8 %), and less sugar (61·3 %) and processed foods (54·7 %), were prevalent overall. Respondents with vegetarian dietary practices were more likely to report efforts to consume fewer carbohydrates and animal products, and more organic, locally produced, ethically sourced/sustainably sourced/fair trade and non-GM foods (P < 0·01 for all), compared with those without these reported dietary practices.
Nearly 14 % of the sampled youth and young adults in major Canadian cities reported vegetarian dietary practices and may be especially likely to value and engage in behaviours related to health-conscious diets and sustainable food production.
To test modifications to nutrition label serving size information on understanding of energy (calorie) content among youth and young adults.
Participants completed two online experiments. First, participants were randomly assigned to view a beverage nutrition label with a reference amount of per serving (250 ml), per container (473 ml) or a dual-column format with both reference amounts. Participants were then randomized to view a cracker nutrition label which specified a single serving in small font, a single serving in large font, or the number of servings per bag with single serving information below. In both experiments, participants estimated energy content. Logistic regression analysis modelled correct energy estimation. Finally, participants reported their preference for serving size display format.
Canadian youth and young adults (n 2008; aged 16–24 years).
In experiment 1, participants randomized to view the nutrition label with per container or dual column were more likely to correctly identify energy content than those using per serving information (P<0·01). For experiment 2, the serving size display format had no association with correct energy estimation. The majority of participants (61·9 %) preferred the serving size format that included servings per package.
Labelling foods with nutrition information using a serving size reference amount for the entire container increased understanding of energy content. Consumers prefer nutrition labels that include more prominently featured serving size information. Additional modifications that further improve consumers’ accuracy should be examined. These results have direct implications for nutrition labelling policy.
Food prepared and consumed away from home accounts for a significant proportion of dietary intake among Canadians. Currently, Canadians receive little or no nutrition information when eating in restaurant and fast-food outlets. The present study examined the impact of nutrition information on menus in hospital cafeterias on noticing and perceived influence of nutrition information and on food consumption.
Exit surveys (n 1003) were conducted in two hospital cafeterias. The ‘intervention’ site featured energy (calorie), sodium and fat content on digital menu boards, as well as a health logo for ‘healthier’ items. The intervention site had also revised its menu items to improve the nutrient profiles. The ‘control’ site provided limited nutrition information at the point of sale.
Cafeteria patrons recruited using the intercept technique.
Significantly more respondents at the intervention site reported noticing nutrition information (OR = 7·6, P < 0·001) and using nutrition information to select their food items (OR = 3·3, P < 0·001) compared with patrons at the control site, after adjusting for sociodemographic factors. Patrons at the intervention site consumed significantly less energy (−21 %, P < 0·001), sodium (−23 %, P < 0·001), saturated fat (−33 %, P < 0·001) and total fat (−37 %, P < 0·001) than patrons at the control site.
A nutritional programme, including nutrition information on menus and improved nutrition profile of food offerings, was associated with substantial reductions in energy, sodium and fat consumption. The results are consistent with a positive impact of menu labelling.
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