Consumer Education Campaign Research Articles

Prospects of Food Taxes for Planetary Health: A Systematic Review of Modeling Studies.

The aim of this study was to analyze the modeling methodologies of fiscal policies on food with health or environmental outcomes. Evidence suggests that fiscal policies on food can contribute to addressing the growing burden of noncommunicable diseases and climate change. These policies should be modeled in advance to see the implications for the environment and health. A systematic review was conducted of studies that modeled fiscal policies on the food groups targeted by the EAT-Lancet Commission and examined their health or environmental outcomes. The Scopus and PubMed databases were searched on November 30, 2021. The records were double-screened and data on modeling methods were extracted from the included studies. A total of 55 studies were included in the review. The most frequently modeled interventions were fruit and vegetable subsidies (n = 19) and carbon taxes on food (n = 17). One study also included a consumer education campaign to enhance the effect of fiscal policy. The outcomes are highly sensitive to consumption change and price elasticities. None of the studies modeled the health effects of environmental outcomes. A model that covered all the relevant aspects of the issue was not found. Some parts were missing from all the included models. It is advisable to model the stability of the amount of diet consumed, either by keeping the amount of food in the diet stable or by taking a more conservative approach and keeping the consumed calories stable. It is preferable to keep the included diseases and environmental boundaries broad to have more valid outcome estimates on this complex issue. A more comprehensive understanding of fiscal policies would allow us to better anticipate the impact of our actions and inactions and thus could lead to more sophisticated measures taken by policymakers. PROSPERO registration no. 2022 CRD42022291945/.

Spillover effects of an information intervention on food handling behavior and the stimulus of survey in rural China

A substantial proportion of foodborne illnesses arise at home as a result of poor food handling practices. Consumer information intervention has usually been conducted to prevent such illness; however, few studies have examined the spillover effect of these interventions. This study aimed to identify whether an information intervention focused on one target food handling behavior has spillover effects on other aspects of food handling behaviors (nontargeting behaviors) through a randomized controlled trial (RCT) conducted in rural China. The results estimated by the difference-in-difference model reveal that information intervention has a significant impact on both target and nontarget food handling behaviors. The existence of positive spillover effects is mainly due to the release of limited attention resources from information interventions and the motivation of consumers to maintain other aspects of behaviors as regulated as the target behaviors. In addition, the results also show that being surveyed spurs a stimulus to subsequent behavior. The survey effect is taken into account when calculating the spillover effects in this paper, so a more accurate estimate is obtained. These findings can motivate governments to conduct more consumer education campaigns, especially in emerging countries, and can also contribute to experimental design, data collection methods and cost‒benefit analyses of interventions, thereby helping researchers avoid biased parameter estimation.

Barriers: Location, Functionality, and Method of Access in Childhood Pool/Spa Submersion Incidents, United States, 2000-2017

Drowning is a leading cause of fatality among children in the United States, and residential pools/spas currently account for as much as 80% of these submersion incidents. This study reviewed narrative case reports obtained from the United States Consumer Product Safety Commission (CPSC) to understand barrier location, type, and functionality as methods of pool/spa access for childhood submersion incidents. Retroactive analysis of 1,523 fatal and non-fatal submersion incidents among children aged 13 years old and younger was conducted using the CPSC in depth investigation dataset from 2000-2017. Narrative descriptions were coded according to the attributes of barrier location, functionality, and method of access; to our knowledge, these characteristics of barriers have not been previously investigated to this depth. Outcomes indicate that consumer education campaigns should target households with swimming pools/spas and reiterate key findings that (1) submersion incidents occur even when barriers are present and (2) the importance of multiple layers of protection against unauthorized pool/spa access. Additionally, improved documentation of barriers is imperative to better understand and prevent drowning among children.

Overcoming Premature Smartphone Obsolescence amongst Young Adults

Rapid smartphone replacement contributes significantly to electronic waste issues. This paper investigates determinants of premature smartphone obsolescence amongst young adults and proposes psychology-based solutions to reduce associated sustainability impacts. Activity Theory maps replacement journeys to focus interventions on problem recognition. Grounded in contemporary Installation Theory, obsolescence drivers are analysed across physical affordances, embodied competencies and social regulations. Smartphone replacement journeys are mapped through Activity Theory to focus on problem recognition as an intervention point. Expert interviews and a user survey supplement literature in investigating obsolescence factors. Solutions are then structured along Installation Theory dimensions for a systemic approach targeting underlying barriers. Solutions address the three layers of behavioural determination. Smartphone modularity addresses physical issues, like repairability and upgrade. Consumer education campaigns improve competencies and perceptions, hereby fostering longer use. A “Slow Smartphone Movement” is proposed, leveraging social strategies, including pledges and online communities, to redefine cultural obsolescence narratives and address the positional aspects of having the latest generation smartphone. Together these multilayered interventions provide actionable pathways to prolonging lifespan by fundamentally reshaping psychological ownership patterns underlying premature smartphone disposal. Rather than isolated initiatives, these synergistic solutions provide specific, evidence-based pathways to fundamentally transforming entrenched obsolescence mindsets and behaviours amongst younger demographics. The paper concludes by outlining study limitations and stating that future research must empirically evaluate the proposed solutions.The current paper investigates the determinants and consequences of premature smartphone obsolescence amongst young adults and proposes psychology-based solutions to reduce its detrimental environmental and societal impact. Activity Theory was used to define the research scope, ultimately focusing on the first stage in the buyer behaviour model, reflecting a prototypical customer journey along five consecutive decision stages. Problem recognition, essentially the perceived difference between the current and desired state of being, was subsequently analysed through the three interrelated layers of Installation Theory, physical affordances, embodied competencies, and social regulations. Eventually, potential solutions, grounded in academic literature, expert interviews, and a consumer survey, were organised along the three dimensions of installation theory, creating a holistic and effective strategy for tackling smartphone obsolescence. Smartphone modularity represents a promising starting point to address the problems associated with physical affordances, such as broken parts, worn batteries, and planned obsolescence more generally.Additionally, extensive consumer education coupled with awareness campaigns highlighting the alternatives to purchasing new products and awareness campaigns highlighting the alternatives to purchasing new products could tackle issues associated with embodied competencies. Lastly, social regulations manifested partly in the universal need for belonging and social inclusion, represent the last driver of smartphone obsolescence. Virtual communities and reward schemes could further foster lasting normative change, eventually helping redefine the detrimental consumerism culture.

Prevalence of Skin Lightening Product Usage among the Young Generation in Lahore after Puberty: A Comprehensive Study

Background & Objective: The desire for fairer skin has become a global phenomenon, with colonial remnants in South Asia being identified as contributory factors to the perception of white skin as supreme. Skin lightening products (SLPs) are commonly used to reduce melanin concentration in the skin and achieve a lighter complexion. While SLPs can be medicated for treating hyperpigmented disorders and other skin conditions, their predominant use is for brightening the skin tone. Aim: To investigate the prevalence of SLP usage among males and females in the young generation in Lahore, Pakistan, and assess their knowledge and perception of the associated risks. Additionally, the study will examine the ingredients commonly found in SLPs and their potential adverse effects. Methodology: The instrument employed for the study was self-administered Questionnaire designed by the researcher. The data collected were analyzed as descriptive and bivariate using percentages, mean and median. Result: The study found that a significant percentage of young males and females in Lahore, Pakistan, use skin-lightening products, with social media and advertisements influencing their knowledge about these products. While participants were aware of potential harm from skin-lightening creams, many could not identify the active ingredients. Study highlighted the need for more inclusive beauty standards and consumer education campaigns. The study's results contribute valuable insights into the multifaceted landscape of skin tone perceptions, skin whitening product usage, and the associated complexities. Conclusion: The findings underscore the importance of considering cultural, psychological, and health-related aspects.

Raw fish consumption in Portugal: Commonly consumed fish species and associated risk factors for anisakiosis

Foodborne parasitic zoonoses from fish and shellfish products are of significant health concern. Anisakiosis is an important fish-borne zoonosis caused by nematodes of the genus Anisakis. Humans are infected through consumption of raw or undercooked fish or cephalopods containing Anisakis spp. Third stage larvae. Infection can result in both gastrointestinal and allergic symptoms. Globalization has resulted in a growth in demand for raw or undercooked food, and this may increase the population at risk of anisakiosis. Our study's main aim was to investigate the risk of anisakiosis from the five fish species most frequently consumed raw or undercooked in Portugal, as identified by a previous study. In addition, a study was carried out to identify the fish species most commonly used in raw fish dishes in Asian restaurants serving Japanese food in the Porto district. The results of this study were incorporated into the risk investigation. The 5 fish species most commonly eaten raw were salmon, tuna, cod, hake and sardines. This was similar to our findings in the restaurant survey, which identified salmon and tuna as the most popular fish served in raw dishes. It also identified nigiri, sashimi and temaki as the most popular raw fish dishes. After examination of the production practices and parasite prevalence for each of the five fish species, we concluded that the main risk groups for anisakiosis were consumers who prepare raw or lightly processed fish dishes at home, if they are unaware of methods to prevent anisakiosis. Some cooked fish dishes may also present a risk, lightly grilled wild salmon or sardines have the potential to contain viable Anisakis larvae. We identified a need for further studies, to establish the level of consumption of wild salmon and wild tuna, and a large-scale study to examine the level of sensitization to Anisakis within the Portuguese population. Our findings highlight the need for more consumer education campaigns regarding the risks associated with raw fish consumption, and prevention methods for anisakiosis. In addition, our study emphasises the need for a more standardized approach to inspection measures within the fish supply chain, to prevent products contaminated with parasites reaching the market.

True to type? EU-style date marking and the valuation of perishable food

Date marking is intended to help consumers make informed food safety and quality choices when confronted with perishable food products. We provide causal in-store evidence on how EU-style date marking (best before and use by) influences consumers’ valuation of perishable food around the expiry date. In a preparatory survey (n=100), we first identify perishable food items amenable to experimental manipulation. A modified multiple price list (MPL) experiment (n=200) then tests shoppers’ valuation of perishable food with expiry dates in the future and the past. We vary date mark type (use-by versus best-before) and information status (with and without education) while preventing free disposal censoring. We find that expiry dates affect consumer valuation. Variation in date mark type has little practical relevance. Educating consumers about the meaning of date mark types reduces willingness to pay for potentially unsafe food, but does not increase it for more durable items. An attentiveness experiment (n=160) finds that inattention and consumers’ native understanding of current date marks can explain the evidence from the modified MPL experiment. Jointly, these results help explaining existing observational evidence and assessing the prospects of consumer education campaigns.

An Empirical Study on Demand and Consumers Perception of Organic Food Products

The term "organic" comes from the Greek word "Organics." Organic foods are created using natural methods. In ancient times, farmers relied on conventional agriculture and natural manure methods. Later on, to boost output, the green revolution was born. Pesticides and insecticides were introduced during the green revolution. However, the usage of insecticides and pesticides has increased over time, resulting in damaged crops and posing several health risks. Then conventional farming was reintroduced under the banner of "organic." Customers are more and more worried about their health than ever before and environmental sustainability nowadays. Consumers of modern times are prepared to pay a premium for organic food since it is unprocessed, healthy, and fresh. There are two categories of buyers: organic and conventional. The barriers to demand organic food for non-organic buyers include increased prices, a lack of information, and unavailability. Governments and marketers must take the lead in promoting organic farming. A consumer education campaign should be created to educate consumers about the advantages of organic food. Farmers must also be recognized for their organic agricultural practices. For example, Mr. Reddy of Hyderabad was just awarded the Padma Shri. He patented his invention for vitamin D-enhanced cereal grains that are more nutritious. He employed a variety of nutrient-enhancing compositions, including carrot extract, maize flour, and sweet potato extract, which, when applied during irrigation, increase the vitamin D content of plants. Positive attitudes towards organic food may increase demand for organic food.

Raw fish consumption in Portugal: A survey on trends in consumption and consumer characteristics

Portugal has one of the highest levels of fish consumption globally. Raw or lightly processed fish is not part of the traditional diet but the rise in popularity of such dishes worldwide means that consumption of this type of food is likely to increase in Portugal. Anisakiosis is a food-borne zoonotic disease associated with consumption of raw or undercooked fish. An increase in reported incidence of the disease has occurred in recent decades. Our survey aimed to gather data on raw fish consumption in Portugal, looking at the sociodemographic and health characteristics of the individuals who consume raw fish (n = 421), as well as the volume of raw fish consumed, species of fish consumed raw and types of raw fish dishes consumed. The volume of raw fish consumed by our survey population was 6.3 kg per person annually. It accounted for approximately 10% of all fish consumed. Salmon or trout, tuna and cod were the species of fish most frequently consumed raw and the most popular raw fish dishes were sushi or sashimi and fish spiced with vinegar and lemon or marinated. Although the number of respondents with seafood allergies only accounted for 2.6% of the study population, they were responsible for almost 7% of the total volume of raw fish consumed. Based on the volume and species of raw fish consumed, anisakiosis does pose a risk to the Portuguese population, but it would appear to be quite small. Data on Anisakis spp. prevalence are limited for some of the species of fish consumed raw and further studies on these are warranted to better characterise the disease risk in the population studied. In addition, improved risk communication and consumer education campaigns should be implemented to minimize the risk to the Portuguese population from anisakiosis.

Marketing of sugar-sweetened children's drinks and parents' misperceptions about benefits for young children.

Despite expert recommendations, US parents often serve sugar‐sweetened children's drinks, including sweetened fruit‐flavoured drinks and toddler milks, to young children. This qualitative research explored parents' understanding of common marketing tactics used to promote these drinks and whether they mislead parents to believe the drinks are healthy and/or necessary for children. We conducted nine focus groups in Washington, DC and Hartford, CT with parents of children (9–36 months) of diverse race/ethnicity and socioeconomic status (N = 50). Semistructured discussions elicited parents' responses to four concepts designed to correct common misperceptions about toddler milks and sweetened fruit‐flavoured drinks (fruit drinks and flavoured waters) by providing information about drink ingredients and potentially misleading marketing tactics. Participants expressed widespread misperceptions about sweetened fruit‐flavoured drinks and toddler milks, including perceived healthfulness and benefits for children and confusion between sweetened and unsweetened drink categories (sweetened fruit‐flavoured drinks vs. juice, toddler milk vs. infant formula). They confirmed that common marketing strategies contributed to misperceptions, including front‐of‐package claims and marketing messages that imply benefits for children and/or hide problematic ingredients; cross‐branding and product extensions from trusted brands; side‐by‐side shelf placement at retailers; lower price than healthier products; and targeted marketing to children and parents. Some parents expressed anger about deceptive marketing and supported increased regulation and consumer education campaigns. Findings support the need for policies to address potentially misleading marketing of sweetened fruit‐flavoured drinks and toddler milks and revealed opportunities to reduce parents' provision of these drinks through countermarketing campaigns communicated via trusted sources.

What Food waste solutions do people support?

In the U.S., the estimated food waste at the household level is 32% of purchased food, translating to $240 billion in economic losses. The U.S. Department of Agriculture and Environmental Protection Agency set the first-ever national food waste reduction goal of a 50-percent reduction by 2030. Under this policy environment, this study assesses public support for nine food waste solutions: changes in food packaging, changes in portion sizes, standardization of date labeling terms, selling imperfect produce in retail stores, making donations easier, using uneaten food to feed animals, implementing composting in communities, consumer education campaigns on food waste, and taxing food waste. An online survey was sent to a nationally representative sample of U.S. respondents that asked about support for and perception of the effectiveness of each food waste solution. This study finds that making donations easier and the standardization of date labels were the most supported food waste solutions. Different food waste solutions appealed to different demographics of people based on their personal food waste experiences. Results are similar for the perception of the effectiveness of each food waste solution. Nevertheless, the percentage of respondents that considered each food waste solution to be effective was almost always less than the share of respondents who supported the solution. Thus, it is important to be cautious about this divergence when assessing public opinion on potential solutions, which may be enacted as policies designed to mitigate food waste.

Survey of New Zealand Poultry Consumers' Handling of Raw Poultry and Food Safety Awareness To Provide Insight into Risk Factors for Campylobacteriosis

New Zealand (NZ) has a high rate of reported campylobacteriosis cases. Cross-contamination in home kitchens during poultry handling is considered the main factor in campylobacteriosis transmission. The main aim of this study was to measure NZ consumers' food safety awareness and self-reported food safety practices associated with handling raw poultry. This study will contribute to the existing knowledge to explain the reasons behind the increase of campylobacteriosis incidents. Findings can help inform future consumer education campaigns to help reduce the incidence of campylobacteriosis in NZ. A cross-sectional survey composed of 31 multiple-choice questions was designed, piloted, and used to collect information about the last time consumers purchased and prepared raw poultry at home. A street-intercept survey in public places, such as supermarkets in the Canterbury region, was used to recruit respondents for this study. A descriptive and inferential data analysis was performed, including a one-way analysis of variance test used to compare the mean scored responses of the respondents among different sociodemographics. Overall, 301 valid responses were obtained. Scores representing reported safe food practices ranged between 2 and 19 (maximum 21), with a mean score of 9.83 (standard deviation of 3.50 with a standard error of 0.20). There was some variation in correctly answered questions by respondents for food hygiene (25%), cross-contamination prevention (55%), temperature control and storage practices (49%), and food safety (52%). Approximately 30% of the respondents reported symptoms of a foodborne disease experienced once to four times during the past 12 months. The study identified low adherence to current recommended food safety practices, including safe food storage and temperature control. The findings can be used to inform a communication campaign regarding food safety needs to be designed urgently in NZ to reduce the rate of campylobacteriosis.

Survival of Salmonella on raw poultry exposed to 10% lemon juice and vinegar washes

The widespread practice of washing raw poultry has been the target of multiple consumer education campaigns in recent years. In addition to rinsing with plain water, a subset of consumers report using acidic solutions (diluted lemon/lime juice or vinegar) to wash raw poultry. While studies have demonstrated the ineffectiveness of acidic marinades to eliminate pathogens from raw meat, the effect of acidic washes on raw poultry has not previously been examined. The research reported here determined the fate of Salmonella enterica 19214 inoculated onto raw poultry and subsequently exposed to acidic washes. Chicken breasts were inoculated with approximately 5 × 108 CFU of Salmonella enterica 19214 (resistant to tetracycline, streptomycin and chloramphenicol). Inoculated breasts were then washed for 10 s, 30 s, 2 min or 5 min in control (tap water) or acidic (10% vinegar or 10% lemon juice) solutions to simulate consumer washing. Following washing, S. enterica 19214 levels were determined both in the wash water and on the chicken using media containing antibiotics. Washing with 10% vinegar (pH 3.1) resulted in the recovery of 7.23–7.46 log CFU/ml S. enterica from the chicken and 6.63 to 6.73 log CFU/ml S. enterica from the vinegar wash solution. Washing with 10% lemon juice (pH 2.6) resulted in the recovery of 7.26–7.42 log CFU/ml from the chicken and 6.28 to 7.06 log CFU/ml from the lemon juice wash. Results indicate that acidic washes result in live Salmonella both in the wash as well as remaining on the chicken. Washing raw poultry in a diluted lemon juice or vinegar solution is an inefficient method for removing pathogens and results in pathogens both in the wash water and on the chicken, increasing the risk for cross contamination and potential foodborne illness.

Characteristics of food‐wasting consumers in the Czech Republic

AbstractThis paper investigates food waste at the consumer stage of the food chain. The authors conducted a questionnaire survey with 259 respondents to identify the key characteristics of food‐wasting consumers and to suggest strategies to improve food‐wasting behaviour. The results of the survey confirmed that the rate at which food is wasted depends on the age, economic status and education of the person managing food in a household, on the household's income per person and on total household income. Younger people, students, economically active people and people from higher‐income households (both per household and per person) waste more, while pensioners waste much less than other groups. However, the sex of the food manager is not associated with food waste. These demographic characteristics should be considered when designing consumer education campaigns focussed on changing consumer motivation and behaviour. This paper also recommends other solutions tailored for specific demographic groups: Younger people and students may be influenced by the actions of opinion leaders within social networks, and technical devices enabling better food management could help them reduce waste. Supporting work‐life balance, broadening the network of food delivery services and implementing corporate initiatives that support food waste prevention could help economically active people reduce their food waste. Additionally, offers of ready‐to‐eat food should be expanded for people with higher incomes.

Message framing and individual traits in adopting innovative, sustainable products (ISPs): Evidence from biofuel adoption

This research examines the positive role of consumer education in diffusing innovative, sustainable products (ISPs). To enhance the effectiveness of a consumer education campaign, this study explores the type of message framing that can best facilitate product adoption among three different approaches: positive, negative, and hybrid framing. This study also investigates consumer traits and retailer attributes that facilitate or deter product adoption. The empirical application using biofuels shows that a negatively framed educational message highlighting the negative impact of gasoline (versus biofuels) is most effective in leveraging the social desirability of product adoption against its economic disadvantages. Consumer traits positively associated with the adoption of biobutanol are environmental consciousness, prosocial behavior, and openness to new experiences, whereas vertical individualism discourages such adoption. Furthermore, retailer choice attributes of location and payment convenience facilitate adoption, while retailer choice attributes based on price and servicescape cleanliness discourage such adoption.

Dietary Salt Intake and Discretionary Salt Use in Two General Population Samples in Australia: 2011 and 2014.

The limited Australian measures to reduce population sodium intake through national initiatives targeting sodium in the food supply have not been evaluated. The aim was, thus, to assess if there has been a change in salt intake and discretionary salt use between 2011 and 2014 in the state of Victoria, Australia. Adults drawn from a population sample provided 24 h urine collections and reported discretionary salt use in 2011 and 2014. The final sample included 307 subjects who participated in both surveys, 291 who participated in 2011 only, and 135 subjects who participated in 2014 only. Analysis included adjustment for age, gender, metropolitan area, weekend collection and participation in both surveys, where appropriate. In 2011, 598 participants: 53% female, age 57.1(12.0)(SD) years and in 2014, 442 participants: 53% female, age 61.2(10.7) years provided valid urine collections, with no difference in the mean urinary salt excretion between 2011: 7.9 (7.6, 8.2) (95% CI) g/salt/day and 2014: 7.8 (7.5, 8.1) g/salt/day (p = 0.589), and no difference in discretionary salt use: 35% (2011) and 36% (2014) reported adding salt sometimes or often/always at the table (p = 0.76). Those that sometimes or often/always added salt at the table and when cooking had 0.7 (0.7, 0.8) g/salt/day (p = 0.0016) higher salt excretion. There is no indication over this 3-year period that national salt reduction initiatives targeting the food supply have resulted in a population reduction in salt intake. More concerted efforts are required to reduce the salt content of manufactured foods, together with a consumer education campaign targeting the use of discretionary salt.

Who Uses Facts Up Front? A Baseline Examination of Who is Using Standardized Front‐of‐Package Nutrition Disclosures

The Facts Up Front front‐of‐package (FOP) nutrition system is currently displayed on packaged foods in the United States. This initiative is being implemented by more than 50 manufacturers, retailers, and wholesalers in the United States on their branded and private‐label packaged food products. The in‐store presence of Facts Up Front is supported by a recently launched consumer education campaign. This study employs a sample of 1,400 female primary household shoppers with children, with oversamples of Hispanic and African American ethnic subgroups, to examine initial awareness and evaluations of Facts Up Front. Results show that Hispanics are more aware of and engaged with Facts Up Front than Caucasians. African Americans report higher levels of engagement and understanding of Facts Up Front vs. Caucasians. Importantly, Hispanic and African American mothers also report using this FOP system to make decisions. Based on these findings, important implications are offered for consumer welfare and public policy.

A Regulatory Approach to Demand Reduction in the Illegal Wildlife Market

Demand reduction has now been recognised as crucial to prevention of wildlife crime, but ideas for effectively decreasing demand are still in short supply. Two demand reduction strategies currently predominate, consumer education campaigns and legal prohibitions on consumption. But further strategies need to be found urgently, as Earth is losing wildlife at frightening rates. This paper argues for greater regulatory pluralism and a more systematic approach to addressing demand. The complex and multi-layered concept of demand is unpacked and current demand reduction activities by states and non-state actors are discussed. The paper identifies third parties (non-state non-offending actors) in prime positions to intervene to reduce demand and sets out diverse ways in which their capacities could be harnessed as part of a whole-of-society demand reduction response.

The challenge of curbing counterfeit prescription drug growth: Preventing the perfect storm

The recent case of fake Avastin® brought the problem of counterfeit pharmaceuticals to the forefront of illicit trade. Drug counterfeiters are opportunistic criminals motivated by the windfall profits that are realized from selling fake pharmaceuticals with limited legal penalties. This article describes the interrelated trends that may trigger a catastrophic situation of counterfeit drugs infiltrating the global pharmaceutical supply chain—a ‘perfect storm.’ We discuss the failure of policymakers to note the early warning signs and the ease of penetrating the pharmaceutical supply chain—both physically and virtually—by an array of illicit traders, ranging from small cottage operations to full-scale manufacturing facilities; the recent U.S. legislation enacted to curb growth in counterfeit pharmaceuticals; and the proliferation of national, multilateral, and industry-led agencies to protect the prescription drug supply chain. Finally, we conclude with an analysis of anti-counterfeiting tactics (e.g., consumer education campaigns, authentication technology) developed by various stakeholders.

Poor Knowledge and Practices Related to Iodine Nutrition during Pregnancy and Lactation in Australian Women: Pre- and Post-Iodine Fortification

A before-after review was undertaken to assess whether knowledge and practices related to iodine nutrition, supplementation and fortification has improved in Australian women since the introduction of mandatory iodine fortification in 2009. Surveys of pregnant (n = 139) and non-pregnant (n = 75) women in 2007–2008 are compared with surveys of pregnant (n = 147) and lactating women (n = 60) one to two years post-fortification in a regional area of New South Wales, Australia. A self-administered questionnaire was completed and dietary intake of iodine was assessed using a validated food frequency questionnaire. A generally poor knowledge about the role and sources of iodine in the diet remained after fortification. Post-fortification, iodine-containing supplements were being taken by 60% (up from 20% pre-fortification) and 45% of pregnant and lactating women, respectively. Dairy foods were the highest contributors to dietary iodine intake (57%–62%). A low intake of fish and seafood resulted in this food group contributing only 3%–8% of total intake. A low level of public awareness regarding the role of iodine in health supports the need for public health strategies in addition to fortification, such as an accompanying consumer education campaign, increased uptake of supplementation, and on-going monitoring.