Labeling Policy Research Articles

Reformulation of Top-Selling Processed and Ultra-Processed Foods and Beverages in the Peruvian Food Supply after Front-of-Package Warning Label Policy.

Front-of-package warning label (FOPWL) policies incentivize the food industry to reduce the content of regulated nutrients in products. We explored changes in the content of nutrients of concern (sugar, saturated fat, trans fat, and sodium) and the percentage of products in the Peruvian food supply that would carry a FOPWL before and after Peru’s implementation of FOPWLs. Longitudinal data on the top-selling foods and beverages (n = 94) were collected at three time points: three months before the implementation of the policy, four months after, and two years after. Using the nutritional information declared on products’ labels, we compared quantities of nutrients of concern and the percentage of foods that would carry a FOPWL at each time point. Between the first and the third data collection, a decrease in the median sugar content of beverages was observed (from 9.0 to 5.9 g/100 mL, p = 0.005), accompanied by an increase in the use of nonnutritive sweeteners. This change drove the reduction of the percentage of beverages that would carry a FOPWL (from 59 to 31%, p = 0.011). Among foods, decreases were observed in saturated fat (from 6.7 to 5.9 g/100 g, p = 0.002). The percentage of foods that would carry a FOPWL according to their nutritional profile declined from before to after implementation of the policy (from 82 to 62%, p < 0.001). The study shows that the industry reformulated products in Peru after implementation of its FOPWL policy.

Sugar-sweetened beverage purchases in urban Peru before the implementation of taxation and warning label policies: a baseline study

BackgroundSugar-sweetened beverage consumption is associated with obesity and chronic disease. In 2018, Peru increased the tax on high-sugar beverages (≥6 g of sugar per 100 mL) from 17 to 25%, yet little is known about pre-existing beverage trends or demographic characteristics associated with purchases in the country. The aim of this study was to explore beverage purchasing trends from 2016 to 2017 and examine variation in purchase volume by sociodemographic characteristics among urban households in Peru.MethodsThis study used monthly household purchase data from a panel of 5145 households from January 2016–December 2017 from Kantar WorldPanel Peru. Beverage purchases were categorized by type and tax status under the 2018 regulation (untaxed, lower-sugar taxed, high-sugar taxed). To assess beverage purchasing trends, per-capita volume purchases were regressed on a linear time trend, with month dummies for seasonality and clustered standard errors. Mean volume purchases by beverage tax status (total liters purchased per month), overall and by key demographic characteristics (education, socioeconomic status, and geographic region), were calculated. Mean volume by beverage type was assessed to identify the largest contributors to total beverage volume.ResultsThe trends analysis showed a decline in total beverage volume of − 52 mL/capita/month (95% CI: − 72, − 32) during the 24-month study period. Over 99% of households purchased untaxed beverages in a month, while > 92% purchased high-sugar taxed beverages. Less than half of all households purchased low-sugar taxed beverages in a month and purchase volume was low (0.3 L/capita/month). Untaxed beverage purchases averaged 9.4 L/capita/month, while households purchased 2.8 L/capita/month of high-sugar taxed beverages in 2017. Across tax categories, volume purchases were largest in the high education and high socioeconomic (SES) groups, with substantial variation by geographic region. The highest volume taxed beverage was soda (2.3 L/capita/month), while the highest volume untaxed beverages were milk and bottled water (1.9 and 1.7 L/capita/month, respectively).ConclusionsNearly all households purchased high-sugar taxed beverages, although volume purchases of taxed and untaxed beverages declined slightly from 2016 to 2017. Households with high SES and high education purchased the highest volume of taxed beverages, highlighting the need to consider possible differential impacts of the tax policy change by sub-population groups.

Moving in the right direction: tobacco packaging and labeling in the Americas.

To assess the adoption of tobacco packaging and labeling policies based on the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC)'s Article 11 guidelines, in the WHO Region of the Americas (AMRO). We reviewed tobacco control laws in AMRO from the Campaign for Tobacco-Free Kids' Tobacco Control Laws database. We analyzed four sub-policy areas for smoked and smokeless tobacco products: 1) health warning labels (HWLs), 2) constituents and emissions (C&Es), 3) misleading tobacco packaging and labeling, and 4) standardized "plain" packaging. Of 35 countries in AMRO, 31 have tobacco packaging and labeling laws. Twenty-six countries require pictorial HWLs, 24 require warnings printed on at least 50% of the front and back of the packs, and 24 rotate a single or multiple (from 2 to 16) warnings within a specified period (from 5 up to 24 months). Only 21 countries require descriptive messages on toxic C&Es information. Twenty-seven countries ban brand descriptors with references to implied harm reduction (e.g., "light"), 24 ban figures, colors, and other signs, but only 13 prohibit emission yields printed on the packs. Only Canada and Uruguay have adopted standardized tobacco packaging while Uruguay also requires a single presentation (one brand variant) per brand family. Many countries in AMRO have made good progress in adopting multiple, rotating, large pictorial HWLs and banning misleading brand descriptors. However, there needs to be greater attention on other tobacco packaging and labeling provisions with a focus on implementing standardized tobacco packaging.

Consumer Social and Psychological Factors Influencing the Use of Genetically Modified Foods—A Review

Due to rapid globalization in the world, the understanding of cultural differences, such as beliefs, values, ways of thinking, and perceptions about new technologies in food processing have also increased. Since the 1990s, when genetically modified (GM) foods were introduced into the food supply, they have provoked many debates. In this review, it was identified and discussed how social and psychological factors influence public attitudes to GM foods and the perceptions of consumers in using GM foods. According to this review, GM foods are deemed unnatural and artificial, thus affecting the overall acceptance of their application. Due to the concerns about their effects on the environment and human health, people expect an assessment of the known or possible dangers, as well as the preventative management of the risks. Providing adequate information about GM foods via a compulsory labeling policy may serve as an appropriate way to increase public awareness and acceptance of GM foods.

Improving nutrition through carbon reduction policies: an online randomized experiment

Abstract Background There has been increasing policy interest in changing dietary patterns to reduce diet-related diseases and improve population health. Meanwhile, the food choices people make every day have a determining impact on the climate change, with food systems responsible for a third of global greenhouse gas emissions. Current policies focused on dietary health are designed, implemented and evaluated in relative isolation, and there is a critical open question concerning the extent of possible synergy with an additional focus on carbon removal. Methods We analysed the changes in UK households’ food purchases from an online, randomized control experiment (n = 3933) designed to contrast respondents’ current food purchase behaviour with that under a range of potential tax and labelling policies targeting improvement in dietary health, alone or combined with those designed to reduce carbon emissions. We assessed changes in the healthiness of food baskets between interventions through indicators of: i) purchase of calories; ii) % of calories purchased from 23 food groups; and iii) relative changes in nutrient composition of food purchased. Results Food labelling and fiscal measures for both health and decarbonisation have a positive impact on dietary health, by reducing the calorie content of food purchases (p &amp;lt; 0.001). Adding carbon reduction considerations into health policies achieves nutritional improvement by further reducing fat and increasing fibre, resulting in a reduction of up to 193 kcal/person/day (95%CI: 172-214). Conclusions With an additional focus on planetary health, the combined (health + carbon) tax and food labelling policies could achieve a reduction in calorie content at a magnitude close to the Public Health England's estimate of average excess calories consumed by adults (195kcal). Key messages • Policies focused on achieving both nutrition and carbon reduction goals could achieve greater improvements in food choices and produce win-win scenarios. • There is a need for greater dialogue and policy development between public health and environmental researchers, practitioners and policy makers.

Mortality prediction of the nutrient profile of the Chilean front-of-pack warning labels: Results from the Seguimiento Universidad de Navarra prospective cohort study.

Front-of-Pack (FoP) nutrition labelling has been established as a policy, empowering consumers to choose healthy food options for preventing diet-related non-communicable diseases. This study aimed to evaluate the association between the nutrient profile underlying the Chilean warning label score and all-cause mortality and to conduct a calibration with the Nutri-Score in a large cohort of Spanish university graduates. This prospective cohort study analysed 20,666 participants (8,068 men and 12,598 women) with a mean (standard deviation) age of 38 years (±12.4) from the SUN cohort. Dietary food intake was assessed by a validated semi-quantitative food-frequency questionnaire at baseline and after 10 years of follow-up. The warning label score was calculated by considering the threshold of nutrients (sugar, saturated fat, and sodium) and energy density per 100 g/ml of product, as established by Chilean Legislation. Participants were classified according to quartiles of consumption of daily label score: Q1 (≤5.0), Q2 (>5.0-7.1), Q3 (>7.1-9.8), and Q4 (>9.8). Time-dependent, multivariable-adjusted Cox models were applied. To compare the performance of the warning label score and Nutri-Score to predict mortality, we used the Akaike information criterion (AIC) and Bayesian information criterion (BIC) methods. During a median of 12.2 years of follow-up, 467 deaths were identified. A higher score in the warning label values (lower nutritional quality) was associated with an increased risk of all-cause mortality [HR (95% CI) Q4 vs. Q1: 1.51 (1.07-2.13); p-trend = 0.010] and cancer mortality [HR (95% CI) Q4 vs. Q1: 1.91 (1.18-3.10); p-trend = 0.006]. However, no statistically significant association was found for cardiovascular mortality. Furthermore, the warning label score and Nutri-Score exhibited comparable AIC and BIC values, showing similar power of prediction for mortality. A diet with a higher warning label score (>9.8 per day) was a good predictor of all cases and cancer mortality in a large Spanish cohort of university graduates. Also, the warning label score was capable to predict mortality as well as the Nutri-Score. Our findings support the validity of the warning label score as a FoP nutrition labelling policy since it can highlight less healthy food products.

Examining the Effectiveness of the 2012 Canadian Graphic Warning Label Policy Change by Sex, Income, and Education.

We examined the differential impact of the 2012 Canadian GWL policy changes on key indicators of warning label impact and quit intentions using national cohorts of Canadian and U.S. adults who smoke. We used data from all waves of the International Tobacco Control surveys (2002-2020) in Canada and the United States. Our key measures were quit intentions and an index of warning label effectiveness (salience, cognitive and behavioral reactions). We estimated overall policy impact by comparing Canada (treatment group) with the United States (control group) using controlled interrupted time series (CITS) regression models, with interactions to examine whether policy impact varied by sex, education, and income. The CITS model showed a statistically significant increase in the warning label effectiveness in Canada post-policy, compared to the United States (β = 0.84, 95% CI 0.35,1.33). Similarly, the odds of quit intentions were relatively higher among adults who smoked in Canada compared to the United States (OR = 1.89, 95% CI 1.51,2.36) post-policy. The three-way interaction model showed that these associations were greater among adults from low socioeconomic status (SES) groups than in high SES groups. The 2012 change in the Canadian GWL policy was associated with stronger cognitive and behavioral responses to GWLs and higher odds of quit intentions among adults who smoked in Canada when compared to the United States, specifically among individuals from low SES groups, suggesting a positive equity impact. Our findings affirm the need for countries to implement or enhance GWLs, in line with the WHO Framework Convention on Tobacco Control (FCTC). The evidence on the potential health equity benefit of GWL policies is mixed. To further understand the influence of GWL policies on tobacco use disparities, more systematic research using pre/post-policy designs with control groups is needed. Using a CITS model, we aimed to strengthen the available evidence on the causal influence of this tobacco control approach. Our findings show that the 2012 GWL policy change had a greater impact on adults who smoked from low SES groups than it did on adults who smoked from high SES groups, indicating a potentially positive equity impact and confirming the need for countries to implement or maximize the size of GWLs, as recommended by the WHO FCTC.

Energy labelling of alcoholic drinks: An important or inconsequential obesity policy?

Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behavior are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behavior, suggest alcohol energy labelling may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity.

A randomised experimental study comparing perceptions of two energy drink health warning labels.

Consumption of energy drinks is a public health concern, particularly in adolescents and young adults. This study explored energy drink consumers' reactions to an energy drink-specific warning label (risk of cardiac effects) and a more general sugary drink warning label (risk of obesity). An online experimental study randomly allocated Australian energy drink consumers aged 18-39 years (N=435) to view one of two label conditions (cardiac effects or obesity). Participants were assessed on: intention to reduce energy drink consumption, perceived health threat, perceived label effectiveness and policy support for energy drink warning labels. Mean intentions to reduce consumption scores were similar across the two label conditions (Mobesity =2.5, Mcardiac =2.6) overall; and were higher for the cardiac label (compared to obesity label) for some subgroups: females (Mobesity =2.3, Mcardiac =2.8; p=.037), older (25-39 years; Mobesity =2.4, Mcardiac =2.8; p=.016); and higher education level (Mobesity =1.9, Mcardiac =2.7; p=.004). While perceived health threat measures were higher for obesity than cardiac effects, perceived label effectiveness measures of 'believable' and 'relevant to me' were higher for the cardiac label than the obesity label (believable: 71.0% vs 56.1%; relevant: 42.5% vs 29.4%). Participants who viewed the cardiac label were more likely to support policy than those shown the obesity label (OR=1.6, 95%CI [1.1, 2.3], p=.02). Health effect warnings labels were perceived by energy drink consumers to be impactful and are supported. Labels with energy drink-specific health effects may offer additional benefit. SO WHAT?: Policy makers can feel confident that warning labels on energy drinks will confer public health benefit.

Monitoring the Nutrient Composition of Food Prepared Out-of-Home in the United Kingdom: Database Development and Case Study.

BackgroundHand transcribing nutrient composition data from websites requires extensive human resources and is prone to error. As a result, there are limited nutrient composition data on food prepared out of the home in the United Kingdom. Such data are crucial for understanding and monitoring the out-of-home food environment, which aids policy making. Automated data collection from publicly available sources offers a potential low-resource solution to address this gap.ObjectiveIn this paper, we describe the first UK longitudinal nutritional database of food prepared out of the home, MenuTracker. As large chains will be required to display calorie information on their UK menus from April 2022, we also aimed to identify which chains reported their nutritional information online in November 2021. In a case study to demonstrate the utility of MenuTracker, we estimated the proportions of menu items exceeding recommended energy and nutrient intake (eg, >600 kcal per meal).MethodsWe have collated nutrient composition data of menu items sold by large chain restaurants quarterly since March 2021. Large chains were defined as those with 250 employees or more (those covered by the new calorie labeling policy) or belonging to the top 100 restaurants based on sales volume. We developed scripts in Python to automate the data collection process from business websites. Various techniques were used to harvest web data and extract data from nutritional tables in PDF format.ResultsAutomated Python programs reduced approximately 85% of manual work, totaling 500 hours saved for each wave of data collection. As of January 2022, MenuTracker has 76,405 records from 88 large out-of-home food chains at 4 different time points (ie, March, June, September, and December) in 2021. In constructing the database, we found that one-quarter (24.5%, 256/1043) of large chains, which are likely to be subject to the United Kingdom’s calorie menu labeling regulations, provided their nutritional information online in November 2021. Across these chains, 24.7% (16,391/66,295) of menu items exceeded the UK government’s recommendation of a maximum of 600 kcal for a single meal. Comparable figures were 46.4% (29,411/63,416) for saturated fat, 34.7% (21,964/63,388) for total fat, 17.6% (11,260/64,051) for carbohydrates, 17.8% (11,434/64,059) for sugar, and 35.2% (22,588/64,086) for salt. Furthermore, 0.7% to 7.1% of the menu items exceeded the maximum daily recommended intake for these nutrients.ConclusionsMenuTracker is a valuable resource that harnesses the power of data science techniques to use publicly available data online. Researchers, policy makers, and consumers can use MenuTracker to understand and assess foods available from out-of-home food outlets. The methods used in development are available online and can be used to establish similar databases elsewhere.

Exploring the effects of added sugar labels on food purchasing behaviour in Australian parents: An online randomised controlled trial.

Evidence of the effects of front-of-pack added sugar labelling remains limited, especially for foods other than sugary drinks. More information is needed about which labels are likely to be most effective in reducing intended purchases of products with higher added sugar content in realistic contexts to inform policymakers' decisions. To determine the impact of added sugar labels on intended purchases of high sugar breakfast cereals, yoghurt, and non-alcoholic beverages. Australian parents who were regular purchasers of relevant product categories completed an online parallel randomised controlled trial from 31 August 2020 to 13 February 2021. Participants selected their intended purchase from 10 products in each of packaged beverages, breakfast cereal, and yoghurt categories after randomisation to one of seven added sugar labelling conditions in current use or under consideration by the Australian Government. Logistic regressions assessed differences between intervention and control conditions in the odds of intended purchases of a high sugar product. 2825 eligible participants were randomised with 2582 valid surveys analysed (Control n = 367; 'Nutrition Information Panel (NIP) with Added Sugar' n = 364; 'Teaspoons of Sugar' n = 369; 'Warning' n = 371; 'Health Star Rating (HSR) using Total Sugar' n = 368; 'HSR with Added Sugar' n = 371; 'Sugar in the Ingredients List' n = 372). No consistent effects were found on intended purchases of high sugar products overall or within product categories for any of the tested labels compared to controls (overall, 'NIP with Added Sugar': OR 1.00 [95%CI 0.83,1.20]; 'Teaspoons of Sugar': 0.94[0.80,1.11]; 'Warning': 1.10[0.93,1.30]; 'HSR with Total Sugar': 1.01[0.85,1.21]; 'HSR with Added Sugar': 1.09[0.92,1.30]; 'Sugar in the Ingredients List': 1.01[0.85,1.21]). Findings reinforce the importance of ensuring nutrition labelling policies are introduced as part of a suite of interventions to influence both consumer and manufacturer behaviour. Australian New Zealand Clinical Trials Registry, ACTRN12620000858998. Registered 28 August 2020, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000858998.

Rapid review of the front‐of‐pack labelling schemes in Thailand

AbstractThailand has used front‐of‐pack labelling (FoPL) policies to support its public health objectives of improving consumer nutrition to reduce the risk of noncommunicable disease. A rapid literature review explored the current types of FoPL systems in Thailand and how they are understood by consumers. Twelve studies were included, most of which examined the mandatory Guideline Daily Amount (GDA) label. Evidence showed gaps in consumer comprehension of the GDA—consistent with international literature demonstrating the GDA is not as effective at improving identification and choice of healthier foods as interpretive labels. Thai consumers reported somewhat better comprehension when colors or text were added to the GDA. Thai stakeholders should consider supplementing or replacing the GDA with one of the newer FoPL systems shown to be more effective in other countries. More rigorous research is necessary to ensure potential FoPL schemes have intended effects among Thai consumers to inform policy action.

Implementation of food labelling policy in small, medium and micro food businesses in West Nusa Tenggara

Background and purpose: The government has adopted policies regarding food labelling to ensure food quality and safety, but the implementation has not yet optimal. This study identifies resources, knowledge, and facilities that affect food labelling implementation in small, medium, and micro food-businesses (SMMF-B) in West Nusa Tenggara, Indonesia. Methods: We conducted a mixed method study. The qualitative data was collected through in-depth interviews with informants from the West Nusa Tenggara Provincial Office of National Agency of Drug and Food Control and the Mataram City. Health Office, and a focused-group discussion involving SMMF-B owners. The quantitative data was collected with a survey to 30 respondents using questionnaire and observation of the label of 36 SMMF-B products to determine the presence of product’s label, composition, net-weight, producer’s name and address, production code, expiry date and distribution license. Results: We found SMMF-B owners’ knowledge on food labelling was low, however, they expressed supports to the implementation of food label controlling. Of the 36 food labels, the two highest number of violations were the absence of production code (88.9%) and net weight (86.1%). Meanwhile, of the 30 surveyed respondents, the majority (96.6%) stated the importance of labels on SMMF-B products and almost two third (63.4%) read food labels before purchasing the product. Conclusion: This study reveals that SMMF-B in West Nusa Tenggara has not implemented food labelling policies optimally. The lack of implementation was influenced by the government’s lack of funds and minimal information and monitoring efforts. Therefore, government should increase budget allocation for food label controlling, number and capacity of food label controllers and strengthen the enforcement.

Health-Oriented Marketing on Alcoholic Drinks: An Online Audit and Comparison of Nutrition Content of Australian Products.

Marketing, label design, and product innovation strategies are being used by the alcohol industry to position some products as "healthier choices." The aim of this study was to systematically document the content and prevalence of health-oriented marketing on alcohol products on the Australian market and to compare the online availability of nutrition information and the alcohol and nutrient content between products with and without such features. Health-oriented marketing features on all beer, cider, and ready-to-drink (RTD) premixed drinks, and selected wines on the website of the largest liquor retailer in Australia were audited using a systematic coding protocol. Nutrition information was sought from manufacturer/brand websites. A total of 54% of beers, ciders, and RTDs featured health-oriented marketing, the most common forms being natural imagery or descriptors, or references to fruit ingredients. Twenty-one percent of audited wines featured health-oriented marketing. The prevalence of specific features varied by product category. Online availability of nutrition information for alcohol products was poor (12% of beer, cider, and RTDs). Products with health-oriented marketing were lower in energy and alcohol content than those without but were still classed as full-strength alcohol on average. Health-oriented marketing is prevalent on alcohol products sold in Australia. In the absence of universal and standardized health warning and energy content information on labels, permitted health-oriented marketing has the potential to mislead consumers about product healthiness or to detract from the perceived harm associated with alcohol consumption. Research to test this proposition is now needed to guide labeling policy reform.

Consumers' Response to Sugar Label Formats in Packaged Foods: A Multi-Methods Study in Brazil.

Providing information about the sugar content of packaged foods on product labels is an important strategy to lower consumers' sugar intake. This study assessed the effect of exposure to different sugar labels on consumers' understanding of the sugar content of foods and their food choices. In the first phase, five focus groups were conducted with a convenience sample of Brazilian adults to explore their perceptions about food labelling in general and sugar labelling in particular. Based on the qualitative results, four sugar label formats were developed and subsequently tested in a five-arm study on 1,277 adults via a randomised controlled online survey. The formats were: (i) no sugar information—control, (ii) total and added sugar content displayed in the Nutrition Information Panel (NIP), (iii) a front-of-package (FoP) octagonal warning for “high-in-sugar” products, (iv) a FoP magnifying glass warning for “high-in-sugar” products, and (v) a “high-in-sugar” warning text embedded on the NIP. Participants from the focus groups reported being confused about the meaning of “sugar” and “added sugar” on food labels and indicated that more interpretive labels, such as the FoP warnings, would help them choose products with low sugar content. In the experiment, all intervention sugar label formats improved participants' understanding of the sugar content of the tested food products, with the FoP warnings (iii and iv) showing the best results. While non-significant differences among label conditions were observed for food choices, the FoP octagonal warning prompted participants to choose high-in-sugar products less often. Given current public policy agendas aiming to reduce added sugar intake, there is a need to strengthen food labelling policies and nutrition disclosure policies that target the display of added sugar and build consumer awareness in using these tools to avoid high-in-sugar products.

Correlates of Self-Reported and Functional Understanding of Nutrition Labels across 5 Countries in the 2018 International Food Policy Study

BackgroundNutrition labels on prepackaged foods are an important source of nutrition information; however, differences in comprehension of varying label formats can limit their use and effectiveness. ObjectivesThis study examined levels and correlates of consumers’ self-reported understanding of Nutrition Facts tables (NFts) and front-of-package (FOP) labels, as well as functional NFt understanding. MethodsAdults (≥18 y) in Australia (n = 3901), Canada (n = 4107), Mexico (n = 4012), the United Kingdom (n = 5121), and the United States (n = 4445) completed online surveys in November/December 2018. Descriptive statistics summarized sample profiles by country. Linear regression models examined the association between label understanding (self-reported NFt and FOP, functional NFt) and consumer dietary behaviors, functional nutrition knowledge, and sociodemographic characteristics. NFt understanding was measured in all countries, with FOP labeling assessed only in Mexico, Australia, and the United Kingdom. ResultsSelf-reported and functional NFt understanding was significantly higher in the United States and Canada (P < 0.0001). In adjusted analyses, functional NFt understanding was significantly higher among women compared to men (P < 0.0001); respondents from the “majority” ethnic group in their respective countries compared with minority ethnic groups (P < 0.0001); those with higher education levels (P < 0.0001) and functional nutrition knowledge compared with their lower education and nutrition knowledge counterparts (P < 0.0001), respectively; and those making efforts to consume less sodium, sugar, or fat compared with those not reporting dietary efforts (P < 0.0001). Self-reported FOP label understanding was significantly higher for interpretive labeling systems in Australia (health star ratings) and the United Kingdom (traffic lights) compared with Mexico's Guideline Daily Amounts (GDAs) (P < 0.0001). ConclusionsNutrition labels requiring greater numeracy skills (i.e., NFts, GDAs) were more difficult for consumers to understand than interpretive FOP labels (i.e., traffic lights). Differences in NFt and FOP label understanding by income adequacy and education suggest potential disparities in labeling policy effects among vulnerable subgroups.

Computational Technologies for Pakistani Consumers’ Understanding of the Country-of-Origin Label for Fruit and Vegetable Products in Social Networks

Whether or not consumers consider information about origin in their routine food purchase decisions is a contentious issue. Usage of social networks has redefined lifestyle and culture, and firms are finding it difficult to understand their customers. This study aims to investigate the effect of social networks (digital marketing) on Pakistani consumers’ understanding of the CoO (country-of-origin) label for F&amp;V (fruit and vegetable) products and its relative importance in daily purchase decisions of fruit and vegetable products. In a random survey of 797 consumers in two Pakistani cities, we found that the relationship between the CoO information and the daily F&amp;V product choices of Pakistani consumers was less important than other factors. Consumers are mistaken about the CoO label, with only one-third of respondents correctly understanding the difference between labels of “made in...” and “product of....” Therefore, mandatory CoO label policies may increase costs and reinforce consumers’ misinterpretation of the meaning of these labels; obtaining a “user-friendly” CoO label serves only those consumers who properly understand the information. This study contributes to understanding of the extent to which consumers are competent in their knowledge and understanding of these informational labels.

Stakeholder Network Analysis for Front-of-Pack Labeling in China.

BackgroundFront-of-pack (FoP) labeling on packaged foods is recommended by the World Health Organization (WHO) to reduce diet-related non-communicable diseases, but it has not yet been implemented in China. The introduction of FoP labeling is driven by multiple institutions and stakeholders. This study aimed to identify key institutional actors involved in FoP labeling and describe links between actors to support future FoP labeling policies and programmes in China.MethodsThe Net-Map method was adopted. We conducted Net-map activities with eight participants using face-to-face interviews between November 2020 and May 2021. Participants were asked to identify actors involved in the development and implementation of FoP labeling in China, describe networks among actors according to pre-defined link types (command, dissemination, funding, and technical assistance), and estimate influence of each actor within the FoP labeling landscape. Social network analysis measures of cohesion and centrality were used to describe each network. Gephi software was used for social network analysis and network visualization.ResultsForty-one unique actors were identified across seven actor categories including government agencies (n = 14), technical support agencies (n = 7), professional associations (n = 10), food industry groups (n = 2), media groups (n = 4), international organizations (n = 3), and a consumer group (n = 1). Weighted influence scores among actors ranged from 0.13 to 3.13. The Department of Food Safety Standards, Risk Surveillance and Assessment of the National Health Commission (DFSSRSA of NHC) was the actor with the highest weighted influence score, followed by the Bureau of Disease Prevention and Control of National Health Commission, Chinese Nutrition Society, and the National Institute for Nutrition and Health of Chinese Center for Disease Control and Prevention. DFSSRSA of NHC played a central role in both command and technical assistance networks. State-owned media had the greatest betweenness and outdegree centrality in the dissemination network. The Chinese Nutrition Society was in the central position and provided funding to diverse actors in the funding network.ConclusionsA variety of multisectoral actors have an interest in the introduction of FoP labeling policies and programmes. Effectively engaging key actors identified in this study can generate a multisectoral commitment to advance FoP labeling policies and programmes in China.

Use of Food and Nutrition Labels Among Urban Mongolian Supermarket Shoppers: Implications for Food Labeling Policy and Practice

Use of Food and Nutrition Labels Among Urban Mongolian Supermarket Shoppers: Implications for Food Labeling Policy and Practice

The Differential Impact of the 2000 Canadian Graphic Warning Label Policy on Smoking Prevalence by Sex and Education: A Difference-in-Difference-in-Difference Model.

Using a quasiexperimental design, we compared the impact of the 2000 Canadian introduction of graphic warning labels (GWLs) on differences in smoking prevalence by sex and education, to the United States, where no GWLs were introduced. We pooled 1999-2004 data from the Canadian Tobacco Use Monitoring Survey and the U.S. Behavioral Risk Factor Surveillance System. We used a difference-in-difference (DD) model to assess the impact of Canadian policy introduction on smoking prevalence, and a difference-in-difference-in-difference (DDD) model to examine differences in the policy impact by sex and education, comparing Canada (the treatment group) with the United States (the control group). From 1999 to 2004, smoking prevalence decreased from 23.7% to 18.6% in Canada, and from 21.7% to 20.0% in the United States. Results from the DD regression models showed that Canadian respondents reported lower odds of being a current smoker compared to the U.S. respondents following the 2000 introduction of GWLs (OR = 0.84, 95% CI = 0.74-0.94). The DDD model showed that the impact of the Canadian GWLs versus the United States did not differ by sex or education. The 2000 Canadian GWL policy reduced smoking prevalence overall, with similar reductions for males and females and across education levels. The impact of the Canadian GWLs in reducing smoking prevalence did not reduce differences by sex or education. Although beneficial for all smokers, GWLs may not serve to decrease existing disparities, especially those by socioeconomic status. Existing evidence shows that GWL implementation is associated with reductions in smoking prevalence. But there is limited evidence from past evaluation studies on whether the impact of GWLs on smoking prevalence differs by sociodemographic subgroup. Our findings confirm existing studies that the 2000 implementation of GWLs in Canada was significantly associated with an overall reduction in smoking prevalence in Canada compared to the United States. However, our study improves existing evidence by showing that the impact of the Canadian GWLs on smoking prevalence did not differ by sex or education, and thus did not reduce existing smoking disparities by educational levels.