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Pettigrew S, Sträuli B, Yusoff A, O'Brien P, Bowden J, Jongenelis M, Brownbill A, Chikritzhs T, Petticrew M, Matheson A, Taylor F, Jones A. "There's just a lot of numbers and I just want to have a drink": The challenge of communicating the energy content of alcohol products. Appetite 2024:107700. [PMID: 39366521 DOI: 10.1016/j.appet.2024.107700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 09/13/2024] [Accepted: 10/01/2024] [Indexed: 10/06/2024]
Abstract
Various governments are considering the implementation of energy labelling on alcohol products as one element of obesity prevention policies. However, little is known about the most effective ways to communicate energy information to consumers. The aim of the present study was to explore consumers' reactions to different energy information provision formats to assist the development of effective energy labels. Nine focus groups (n=83 participants) were conducted with Australian adults who reported drinking alcohol at least twice per month. Participants were exposed to an energy-only information label and labels displaying full nutrition information panels. A thematic analysis approach was used to identify key issues. While few participants were overtly enthusiastic about the mandatory display of energy values on alcohol products, there was general support for the provision of this information to assist those drinkers who could benefit from it. Substantial confusion was apparent as participants attempted to distil meaning from the provided information, particularly where it was expressed in terms of serving sizes and standard drinks. Full nutrition panels were especially problematic in terms of creating a health halo due to the nil or low values for multiple nutrients listed. This was especially notable for information relating to sugar content. Overall, there appears to be inadequate public understanding of the concept of dietary energy in alcoholic beverages and the various terms used to quantify its presence, which is likely to limit the utility of mandatory energy information provision requirements unless they are accompanied by effective community education.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, L18, Tower 3, International Towers, Barangaroo, Sydney, 2000, Australia.
| | - Bella Sträuli
- The George Institute for Global Health, University of New South Wales, L18, Tower 3, International Towers, Barangaroo, Sydney, 2000, Australia.
| | - Asad Yusoff
- The George Institute for Global Health, University of New South Wales, L18, Tower 3, International Towers, Barangaroo, Sydney, 2000, Australia.
| | - Paula O'Brien
- Melbourne Law School, University of Melbourne, Melbourne, Australia.
| | - Jacqueline Bowden
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia.
| | - Michelle Jongenelis
- Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, Australia.
| | | | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Perth, Western Australia.
| | | | - Angela Matheson
- Centre for Alcohol & Other Drugs, NSW Ministry of Health, Sydney, Australia.
| | - Fraser Taylor
- The George Institute for Global Health, University of New South Wales, L18, Tower 3, International Towers, Barangaroo, Sydney, 2000, Australia.
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, L18, Tower 3, International Towers, Barangaroo, Sydney, 2000, Australia.
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Joshi R. Prevalence of menu label use and its association with calorie intake among US adults. Appetite 2024; 200:107577. [PMID: 38909695 DOI: 10.1016/j.appet.2024.107577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 06/12/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024]
Abstract
The 2018 Federal Menu Labeling regulations require restaurants and similar retail food establishments that are part of a chain with 20 or more locations to provide calorie and other nutrition information for standard menu items. In this study, we describe the sociodemographic correlates of prevalence of menu label use at Food-Away-From-Home (FAFH) establishments and estimate the association between menu label use and calorie intake. We use nationally representative data spanning the years 2007-2018 and multivariable logit regression and ordinary least squares regression models. For FAFH establishments, we find that female respondents have about 26% (95% CI = [1.14, 1.39]) higher odds of using menu labels. Respondents with high school degree have 51 percent higher odds (95% CI = [1.24, 1.85]), respondents with some college education have 107 percent higher odds (95% CI = [1.74, 2.47]) of seeing menu labels. Higher income is associated with 12% (95% CI = [1.08, 1.15]) greater odds of seeing menu labels. Hispanic respondents have 29% (95% CI = [0.62, 0.81]) lower odds of seeing and 79% (95% CI = [1.41, 2.29]) higher odds of using menu labels. Black respondents have 54% (95% CI = [1.35,1.75] higher odds of seeing menu labels at sit-down restaurants. Menu label users at fast-food restaurants reported consuming 202 kcal (95% CI = [-252,-153]) fewer total calories than nonusers and menu label users at sit-down restaurants reported using 181 kcal (95% CI = [-256,-106]) fewer total calories than nonusers. Our findings highlight the sociodemographic disparities in menu label use and provide baseline estimates for future studies evaluating the federal menu labeling regulation.
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Affiliation(s)
- Riju Joshi
- Department of Economics, Portland State University, College of Urban and Public Affairs, 450-K Urban Center Building, 506 SW Mill Street, Portland, OR, 97201-5412, USA.
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Guo Z, Ning Y, Mustafa M. Impact of Five Types of Front-of-Package Nutrition Labels on Consumer Behavior among Young Adults: A Systematic Review. Nutrients 2024; 16:2819. [PMID: 39275139 PMCID: PMC11397554 DOI: 10.3390/nu16172819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/16/2024] Open
Abstract
The World Health Organization (WHO) recommends that governments promote and implement front-of-package (FoP) nutrition labels to prevent noncommunicable diseases. Recently, additional research has focused on various views on FoP label creation. However, few review studies have examined how different FoP labels affect young consumer behavior. Therefore, this study thoroughly analyzed the evidence on how FoP labels in five categories affect young consumer purchasing intention and behavior. We searched for keywords in the Web of Science, Scopus, and EBSCO databases and screened study samples according to inclusion and exclusion criteria. Fourteen studies that matched the criteria were included in this review. We discovered that numerous studies support the efficacy of the "graded indicators" category labels, with the "color-coded" and "positive logos" categories trailing closely behind. The effectiveness of the "warning" FoP label category is mixed on consumers' healthy purchasing behavior and intention. The numerical FoP labels were most commonly used to indicate ineffectiveness. Future studies should investigate the effects of FoP labels on various subpopulations and conduct thorough evaluations of the design elements of FoP labels. Also, they should offer evidence-based recommendations, supported by both quantitative and qualitative data, for regions that have not yet implemented FoP labeling systems.
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Affiliation(s)
| | | | - Muhizam Mustafa
- School of the Arts, University Sains Malaysia, Penang 11800, Malaysia; (Z.G.); (Y.N.)
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Montoye AHK, Molesky MJ, Vondrasek JD, Becker TB. Evidence-based food serving size labelling: Survey and laboratory analyses of consumer cooking spray usage. NUTR BULL 2024. [PMID: 39120004 DOI: 10.1111/nbu.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 07/02/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024]
Abstract
Nutrition label serving sizes are determined primarily based on typical consumption when such data are available. However, such data are not available for certain foods such as spray cooking oil (cooking spray). Our study assessed cooking spray use by the United States (US) adults compared to the 0.25-s serving size used on US-sold cooking spray labels. Adults (n = 1041, aged 33 ± 16.7 years) completed a 13-question survey on cooking spray use and perceptions. In the survey, participants reported using cooking spray for 1.9 ± 0.9 s per use, and 42.3%-43.1% of participants reported being more likely to purchase products if they were labelled calorie- or fat-free. Next, 30 adults (aged 29.7 ± 11.0 years) completed a laboratory-based study which assessed cooking spray durations for seven cookware items. Spray times ranged from 1.0 ± 0.5 (smallest pan) to 2.5 ± 1.3 s (largest baking sheet), with 100% of sprays (210/210) exceeding the 0.25-s US serving size. Our results suggest that cooking spray serving size should be increased to 1 s to better reflect actual consumption, and this would have the added benefit of aligning better with cooking spray serving sizes in other developed countries (0.5-1.0 s). A 1-s serving size would also preclude cooking spray advertised as calorie- or fat-free, allowing consumers to make more informed choices on the dietary implications of using cooking spray.
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Affiliation(s)
| | - Monroe J Molesky
- Alma College, Alma, Michigan, USA
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Joseph D Vondrasek
- Alma College, Alma, Michigan, USA
- Univerisyt of Mississippi Medical Center, Florida State University, Tallahassee, Florida, USA
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Hyink J, McFadden BR, Ellison B. Potential consumer response to the healthy symbol proposed by the U.S. food and Drug Administration. Heliyon 2024; 10:e30863. [PMID: 38778947 PMCID: PMC11109763 DOI: 10.1016/j.heliyon.2024.e30863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
The U.S. Food and Drug Administration (FDA) has proposed updates to the definition of "healthy," including distinctions between types of sugar and fats and limits on added sugar, saturated fat, and sodium. To communicate the updated standards, the FDA is developing a Healthy symbol to display on food packages, which could reduce knowledge gaps by assisting U.S. consumers in meeting recommended nutritional guidelines. This study aimed to explore the potential for the label to increase consumers' ability to correctly identify a food product that met the FDA's criteria for a healthy symbol. To complete the study objective, 1018 adults were recruited to represent the U.S. population regarding gender, age, income, and geographic region, and a randomized group experiment was used to determine the potential communication value of an FDA Healthy symbol. Respondents were randomized to a group shown either a healthy yogurt with the FDA symbol, a healthy yogurt without the symbol, or an unhealthy yogurt. Respondents were then asked whether they considered the yogurt shown to be healthy, a question examining the desired criteria for the Healthy symbol, willingness to accept various costs to implement the symbol, and questions to measure objective dietary knowledge. Adding the symbol to yogurt that already met the healthy criteria only yielded about a 4 percentage point increase in the proportion of respondents identifying it as healthy. However, 53 % of participants still identified a yogurt too high in added sugars as healthy. For the desired label criteria, 64 % of respondents selected limits on added sugars, 57 % selected limits on sodium, and 54 % selected limits on saturated fats, which all align with the proposed updates to the definition of healthy. Over half of the participants supported the implementation of the label, even at a cost of $40 annually, and 86 % supported implementation at no cost.
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Affiliation(s)
- Jillian Hyink
- Department of Agricultural Economics & Agribusiness, University of Arkansas, Fayetteville, AR, USA
| | - Brandon R. McFadden
- Department of Agricultural Economics & Agribusiness, University of Arkansas, Fayetteville, AR, USA
| | - Brenna Ellison
- Department of Agricultural Economics, Purdue University, West Lafayette, IN, USA
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Javier CA, Capanzana MV, Gohilde SS. Socio-demographic Determinants of Filipino Consumers Reading Food Product Labels and Nutrition Facts: Findings from the 2018-2019 ENNS. ACTA MEDICA PHILIPPINA 2024; 58:92-100. [PMID: 38812762 PMCID: PMC11132288 DOI: 10.47895/amp.vi0.7207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Objectives While food product labelling is deemed important in providing consumer information, little is known about the characteristics of those reading and not reading. This study aimed to determine the socio-demographic characteristics of Filipino adult consumers reading and not reading food product labels and nutrition facts to provide insights on their understanding and usage of food labels that may help in designing better label formats of packaged foods and related health education campaigns. Methods Cross-sectional design using secondary data from the Expanded National Nutrition Survey (ENNS) 2018-2019 was employed. A survey form on Reading Food Product Labels and Nutrition Facts in the ENNS 2018-2019 were collected through face-to-face interviews. Descriptive statistics, test of proportions, and logistic regression were done using Stata version 16. Results Always reading product labels were reported only by 19.6% of adult consumers, 18 years old and above, while 45.9% reported not reading food product labels. Among those who read food product labels, only 16.7% reported reading nutrition facts. Higher proportions of adults reading nutrition facts were found among those who attained a higher educational level, were less than 40 years old, living in urban residences, and belonging to higher wealth status. 'Not interested' was the top reason of adults who reported not reading nutrition facts. Conclusion Reading product labels and nutrition facts is not common among Filipino adults. Being not interested was the top reason for not reading food product labels. Older persons, adults with low educational attainment, and belonging to poor households were more likely to not read food product labels and not influenced by nutrition facts which imply the need for a food label format that would cater to those who cannot or have difficulty reading food labels and nutrition facts. An intensified campaign on the importance of reading food product labels is also needed.
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Affiliation(s)
- Charina A Javier
- Department of Science and Technology - Food and Nutrition Research Institute
| | - Mario V Capanzana
- Department of Science and Technology - Food and Nutrition Research Institute
| | - Sarah S Gohilde
- Department of Science and Technology - Food and Nutrition Research Institute
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Kelly M, McCann JR, Chapple CI, Woods J, Russell CG. Visual communication design: a neglected factor in nutrition promotion via packaged food labels. Front Public Health 2024; 12:1296704. [PMID: 38420036 PMCID: PMC10899386 DOI: 10.3389/fpubh.2024.1296704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Packaging design is a communication device and a critical component in branding strategy, and has relevance for food policy. Presently, packaging-related nutrition policy initiatives focus on the role of regulated claims, nutrition information panels and front-of-pack nutrition labels to help guide consumer food choices and address high prevalences of discretionary and ultra-processed food consumption in many countries. However, these nutrition labelling systems are not optimized as public health policy tools as many consumers do not use them to inform their food choices. Visual communication design theory posits that a designer orders the elements and principles of design into hierarchies that prioritize certain elements over others, and that some of these elements are more dominant and given more emphasis than others. The overall design of the package thereby directs consumer attention to some aspects of pack design (e.g., characters, contents of the package) and away from others (e.g., nutrition details). Dual processing frameworks propose that food decisions are made with the interplay between automatic and rational thinking processes. Packaging designs affect whether consumers rely predominantly on automatic or rational thinking to select a food. This narrative review outlines the role of food packaging design and how it impacts the clear communication of nutrition aspects of food products and how the use of nutrition information by consumers to make decisions may depend upon design structures in packaging. This article attests that nutrition scientists and policy makers should incorporate visual communication design into research on the food packaging as a public health promotion tool. A stronger focus on the communication of regulated front-of-pack nutrition information can be made with a re-evaluation of the hierarchy of elements in the front-of-pack design enabling consumers to make healthier decisions.
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Affiliation(s)
- Meghan Kelly
- School of Communication and Creative Arts, Faculty of Arts and Education, Deakin University, Geelong, VIC, Australia
| | - Jennifer R. McCann
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Celeste I. Chapple
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Julie Woods
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Catherine G. Russell
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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Abboud M, Nacouzi C, Chahine Z, Atallah A, Hleyhel M. Dietary Knowledge and Eating Habits among Patients with Type 2 Diabetes in Lebanon. Glob Health Epidemiol Genom 2024; 2024:3623555. [PMID: 38356468 PMCID: PMC10864039 DOI: 10.1155/2024/3623555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
Little is known about the dietary knowledge (DK) and eating habits (EHs) of patients with type 2 diabetes (T2D) in Lebanon. Therefore, the aim of this study was to assess the DK and EH of the population with T2D and determine their associated factors. A cross-sectional survey enrolling 351 patients with T2D was carried out, using the snowball sampling technique. The survey used the UK Diabetes and Diet Questionnaire and the Dietary Knowledge questionnaire to assess participants' EH including the frequency of consumption of certain foods and their knowledge of food groups and food choices. While a higher DK index indicated better knowledge, a higher EH index indicated less healthy EH. Independent sample T-test and Mann-Whitney test were used for dichotomous variables, and ANOVA and Kruskal-Wallis tests were used for polytomous variables. Correlation analysis tested the association between two continuous variables. Two multiple linear regression models were used to identify factors associated with DK and EH. Overall, 67% of participants had good or adequate DK, and around 25% and 75% of them had healthy and less healthy EH, respectively. Better knowledge was significantly related to occupation, BMI, presence of comorbidities, and HbA1c testing during the last 3 months. Higher family income, physical activity, family history of diabetes, receiving help in medication administration from family or friends, and higher DK level were factors associated with healthier EH. Nutrition education and awareness campaigns aimed at patients and their families are needed to empower patients with adequate DK and skills to facilitate the adoption of healthy EH.
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Affiliation(s)
- Myriam Abboud
- Department of Health, College of Natural and Health Sciences, Zayed University, Dubai 144534, UAE
| | - Cyrille Nacouzi
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon
| | - Zeina Chahine
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon
| | - Angelica Atallah
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon
| | - Mira Hleyhel
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon
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Chattaraman V, Lee YM, Robinson EM, Book AJ, Al-Amin F. The Effects of Social Distance and Front-of-Package Claims on Healthy Food Selection: Moderating Role of Perceived Importance of Eating Healthily. Nutrients 2023; 15:3427. [PMID: 37571366 PMCID: PMC10420879 DOI: 10.3390/nu15153427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Applying construal level theory, this study examined how social distance (thinking of self/children), front-of-package (FOP) claim type (nutrient/health/control), and perceived importance of eating healthily (low/high) impact consumer responses (attitudes/purchase intent) to healthier food products through an online experiment with 171 U.S. parents from low-to-mid socio-economic households. Participants were randomly assigned to view controlled images of healthier foods with packaging that bore different claim types for real and fictitious brands. Results revealed that when choosing for themselves, consumer attitudes were more positive when the healthier food package carried a nutrient (vs. health) claim, however, control claims received the most positive evaluations. When choosing for children, attitudes were more positive when the package carried a health (vs. nutrient/control) claim. Attitudes toward healthier foods were higher for consumers with high (vs. low) perceived importance of eating healthily when the package bore a nutrient claim, however, their attitudes did not significantly differ when the package bore a health/control claim. Purchase intent for healthier foods was higher for consumers with high (vs. low) perceived importance of healthy eating when shopping for self; whereas, when shopping for children, purchase intent did not significantly differ between consumers who varied in perceived importance of eating healthily.
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Affiliation(s)
- Veena Chattaraman
- Department of Consumer and Design Sciences, Auburn University, Auburn, AL 36849, USA; (A.J.B.); (F.A.-A.)
| | - Yee Ming Lee
- Horst Schulze School of Hospitality, Auburn University, Auburn, AL 36849, USA;
| | - Ebony Marchelle Robinson
- Department of Human Development and Consumer Sciences, University of Houston, Houston, TX 77204, USA;
| | - Adam J. Book
- Department of Consumer and Design Sciences, Auburn University, Auburn, AL 36849, USA; (A.J.B.); (F.A.-A.)
| | - Fnu Al-Amin
- Department of Consumer and Design Sciences, Auburn University, Auburn, AL 36849, USA; (A.J.B.); (F.A.-A.)
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Machín L, Alcaire F, Antúnez L, Giménez A, Curutchet MR, Ares G. Use of nutritional warning labels at the point of purchase: An exploratory study using self-reported measures and eye-tracking. Appetite 2023:106634. [PMID: 37356578 DOI: 10.1016/j.appet.2023.106634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
Nutritional warning labels are gaining relevance in the region of the Americas as a policy tool to reduce information asymmetry and encourage healthier food choices. However, empirical evidence about consumer experiences with warning labels after implementation is still scarce. In this context, the aim of the present work was to explore the use of nutritional warning labels after policy implementation in Uruguay, using a combination of eye-tracking and self-reported data. The study was conducted in three supermarkets, in two regional capitals, 19 months after the entry into force of the policy. A total of 224 participants were intercepted while entering the facilities of the supermarket and asked to wear a mobile eye-tracker while making their food purchases. Then, they were asked a series of questions about their awareness and use of warning labels. Although participants reported high awareness and understanding of the labels, active search and use at the point of purchase was low. Only 6% of the consumers declared having actively searched for the warning labels and 7% fixated their gaze on the labels. The majority of the participants (72%) who declared having seen the warnings on a product, purchased it anyway. However, 56% declared having changed their food choice decisions as a consequence of the implementation of the policy. Participants' accounts about reasons for (not) taking into account the warning labels provide relevant insights for the development of strategies to encourage citizens to increase policy effectiveness and encourage healthier food choices.
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Affiliation(s)
- Leandro Machín
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Uruguay
| | - Florencia Alcaire
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay
| | - Lucía Antúnez
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay
| | - Ana Giménez
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay
| | | | - Gastón Ares
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Uruguay; Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay.
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Sobaih AEE, Algezawy M, Elshaer IA. Adopting an Extended Theory of Planned Behaviour to Examine Buying Intention and Behaviour of Nutrition-Labelled Menu for Healthy Food Choices in Quick Service Restaurants: Does the Culture of Consumers Really Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4498. [PMID: 36901507 PMCID: PMC10002157 DOI: 10.3390/ijerph20054498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
This research aims to examine an extended model of the Theory of Planned Behaviour (TPB) to understand the determinants of consumers' intentions to buy and recommend nutrition-labelled menu (NLM) items for making healthy food choices. The research examines the influence of attitude towards behaviour (ATT), subjective norms (SNs), perceived behavioural control (PBC) and health consciousness on consumers' intentions to buy and recommend NLM. The research also examines the role of culture in shaping buying and recommendation intentions of NLM by undertaking a comparative study of the extended model among consumers in two different countries that have enough variation based on Hofstede's cultural dimensions, i.e., the Kingdom of Saudi Arabia (KSA) and the United Kingdom (UK). The results of questionnaire surveys analysed with SmartPLS version 4 showed that ATT, SNs and health consciousness significantly predict intentions to buy NLM items among KSA consumers in quick service restaurants (QSRs). However, PBC did not have a significant influence on KSA consumers' intentions to buy NLM items. On the other hand, ATT, PBC and health consciousness significantly predict intentions to buy NLM items among UK consumers in QSRs. Nonetheless, SNs did not have a significant influence on UK consumers' intentions to buy NLM items. The intention to buy NLM significantly predicts the intentions to recommend NLM among consumers in both countries (KSA and UK). The results of a multi-group analysis showed significant differences between the KSA and the UK regarding the influence of both SNs and PBC on consumers' intentions to buy NLMs as well as on their indirect influence on intentions to recommend NLM items. The results value the role of culture in shaping consumers' intentions to buy and to recommend NLM items for healthy food choices, which has numerous implications for international QSRs, policy makers, and academics.
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Affiliation(s)
- Abu Elnasr E. Sobaih
- Management Department, College of Business Administration, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Faculty of Tourism and Hotel Management, Helwan University, Cairo 12612, Egypt
| | - Mohamed Algezawy
- Management Department, College of Business Administration, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Ibrahim A. Elshaer
- Management Department, College of Business Administration, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Faculty of Tourism and Hotel Management, Suez Canal University, Ismailia 41522, Egypt
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12
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Liao Y, Yang J. Status of nutrition labeling knowledge, attitude, and practice (KAP) of residents in the community and structural equation modeling analysis. Front Nutr 2023; 10:1097562. [PMID: 37139447 PMCID: PMC10149812 DOI: 10.3389/fnut.2023.1097562] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Unhealthy foods were a major contributor to the occurrence of chronic non-communicable diseases. The promotion of nutrition labeling in the community can effectively help residents to choose healthy foods, which plays an important role in the prevention of chronic diseases. However, the public awareness of this measure is not clear. Our study used a structural equation model based on the KAP theory to analyze the interaction mechanisms among knowledge, attitude, and practice and aimed to evaluate the relationships among nutrition knowledge, attitude, and practice of residents, which can provide the basis of policy formulation for nutrition education and behavior intervention. Methods We carried out a cross-sectional study from May 2022 to July 2022 in the "Community Health Service Center", and each "Community Service Station" in Yinchuan use a self-designed questionnaire and convenience sampling to evaluate resident nutrition labeling KAP status. This study adopted the structural equation modeling approach to analyze a survey of Chinese individuals through the cognitive processing model, interrelated nutrition knowledge, nutrition label knowledge, attitude, and practice. Results According to the principle of sample size estimation, a total of 636 individuals were investigated, with the ratio of male to female being 1:1.2. The average score of community residents' nutrition knowledge was 7.48 ± 3.24, and the passing rate was 19.4%. Most residents had a positive attitude toward nutrition labeling, but the awareness rate was only 32.7% and the utilization rate was 38.5%. Univariate analysis showed that women had higher knowledge scores than men (p < 0.05), and young people had higher scores than older adults (p < 0.05), and the difference was significant. Based on the KAP structural equation model (SEM), residents' nutrition knowledge will directly affect their attitude toward nutrition labeling. Attitude played a greater role as an indirect effect between knowledge and behavior, while trust limits residents' practice of nutrition labeling and then affects their practice. It could be explained that nutrition knowledge was the prerequisite for label reading behavior, and attitude was the intermediary effect. Conclusion The nutrition knowledge and nutrition labeling knowledge of respondents hardly directly support the practice of nutrition labeling, but it can influence the use behavior by forming a positive attitude. The KAP model is suitable for explaining residents' use of nutrition labeling in the region. Future research should focus on better understanding the motivations of residents to use nutrition labeling and the opportunity to use nutrition labeling in real-life shopping settings.
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Affiliation(s)
- Yinxia Liao
- School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jianjun Yang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, Ningxia, China
- *Correspondence: Jianjun Yang
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Landais E, Miotto-Plessis M, Bene C, Maitre d’Hotel E, Truong MT, Somé JW, Verger EO. Consumption of food away from home in low- and middle-income countries: a systematic scoping review. Nutr Rev 2022; 81:727-754. [PMCID: PMC10170323 DOI: 10.1093/nutrit/nuac085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Context Consumption of food away from home represents an increasing share of people’s food consumption worldwide, although the percentage of food intake that is consumed away from home varies among countries and among individuals. Previous systematic reviews have reported that, overall, consumption away from home negatively affects an individual’s diet and nutritional status. However, these reviews have mainly focused on high-income countries, leaving a gap in knowledge and data for people in low- and middle-income countries (LMICs). Objective The present review aimed to describe trends in the consumption of food away from home in an apparently healthy population in low- and middle-income countries (LMICs) and to investigate any associations between this behavior and diet quality, nutritional status, and health outcomes. Data Sources A structured search strategy was developed for retrieving (from MEDLINE [via PubMed], Web of Science, and Scopus) peer-reviewed articles published in English from March 2011 until May 2021. Data Extraction Forty studies were included, and from them information was obtained based on data from 12 different countries. A qualitative and descriptive approach was used to review the evidence. Data Analysis It was found that there was large heterogeneity in the definition of food consumed away from home and the methods used to measure it, making comparisons and syntheses difficult. Consumption of food away from home in LMICs was relatively common and was positively driven by factors such as being a male, being young, having a high socio-economic status, being educated, and living in urban areas. As in high-income countries, consumption of food away from home in LMICs had unfavorable effects on an individual’s diet quality, nutritional status, and health. Conclusion There is a need to develop harmonized surveillance systems for better monitoring of the phenomenon of food consumption away from home in LMICs, including a need for a standardized definition for food consumed away from home, to enable the design of effective regulatory policies.
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Affiliation(s)
- Edwige Landais
- are with the MoISA, University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Mathilda Miotto-Plessis
- are with the MoISA, University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Chris Bene
- is with the International Center for Tropical Agriculture, Cali, Colombia
- is with the Wageningen Economic Research Group, Wageningen University, The Netherlands
| | - Elodie Maitre d’Hotel
- are with the MoISA, University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
- is with the CIRAD, UMR MOISA, Montpellier, France
| | - Mai Tuyet Truong
- is with the Nutrition-Network Department, National Institute of Nutrition, Hanoi, Vietnam
| | - Jérome W Somé
- is with the Département Biomédical et Santé Publique, Centre National de la Recherche Scientifique et Technologique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Eric O Verger
- are with the MoISA, University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
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Perception of Portuguese Consumers Regarding Food Labeling. Nutrients 2022; 14:nu14142944. [PMID: 35889901 PMCID: PMC9323138 DOI: 10.3390/nu14142944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Food labels are the first information tool used by consumers in the purchase and consumption of food products. Food labeling is a tool that can influence the consumers’ perception of quality and, in turn, their food choice. This study characterizes and demonstrates the importance of labeling and the degree of consumers’ perception and literacy about food labels through the application of an online questionnaire. The results obtained, in a sample of n = 467, showed that Portuguese consumers have the habit of reading the label and recognizing its importance but do not understand all the information contained in the label. They have an easier time understanding the front-of-pack labeling systems, especially those presented through symbols/colors. Thus, it demonstrates the need for greater education and literacy in the areas of food and nutrition so that through the reading and interpretation of labels, consumers can make informed food choices.
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15
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Projecting the Influence of Sugar-Sweetened Beverage Warning Labels and Restaurant Menu Labeling Regulations on Energy Intake, Weight Status, and Health Care Expenditures in US Adults: A Microsimulation. J Acad Nutr Diet 2021; 122:334-344. [PMID: 34689957 DOI: 10.1016/j.jand.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 04/01/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accurate, readily accessible, and easy-to-understand nutrition labeling is a promising policy strategy to address poor diet quality and prevent obesity. OBJECTIVE This study projected the influence of nationwide implementation of sugar-sweetened beverage (SSB) warning labels and restaurant menu labeling regulations. DESIGN A stochastic microsimulation model was built to estimate the influences of SSB warning labels and menu labeling regulations on daily energy intake, body weight, body mass index, and health care expenditures among US adults. PARTICIPANTS/SETTING The model used individual-level data from the National Health and Nutrition Examination Survey, Medical Expenditure Panel Survey, and other validated sources. STATISTICAL ANALYSES PERFORMED The model was simulated using the bootstrapped samples, and the means and associated 95% CIs of the policy effects were estimated. RESULTS SSB warning labels and restaurant menu labeling regulations were estimated to reduce daily energy intake by 19.13 kcal (95% CI 18.83 to 19.43 kcal) and 33.09 kcal (95% CI 32.39 to 33.80 kcal), body weight by 0.92 kg (95% CI 0.90 to 0.93 kg) and 1.57 kg (95% CI 1.54 to 1.60 kg), body mass index by 0.32 (95% CI 0.31 to 0.33) and 0.55 (95% CI =0.54 to 0.56), and per-capita health care expenditures by $26.97 (95% CI $26.56 to $27.38) and $45.47 (95% CI $44.54 to $46.40) over 10 years, respectively. The reduced per-capita health care expenditures translated into an annual total medical cost saving of $0.69 billion for SSB warning labels and $1.16 billion for menu labeling regulations. No discernable policy effect on all-cause mortality was identified. The policy effects could be heterogeneous across population subgroups, with larger effects in men, non-Hispanic Black adults, and younger adults. CONCLUSIONS SSB warning labels and menu labeling regulations could be effective policy leverage to prevent weight gains and reduce medical expenses attributable to adiposity.
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Dimova ED, Mitchell D. Rapid literature review on the impact of health messaging and product information on alcohol labelling. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1932754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Elena D. Dimova
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Danielle Mitchell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Conde-Caballero D, Rivero-Jimenez B, Mariano-Juarez L. Memories of hunger, continuities, and food choices: An ethnography of the elderly in extremadura (Spain). Appetite 2021; 164:105267. [PMID: 33933550 DOI: 10.1016/j.appet.2021.105267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/15/2021] [Accepted: 04/11/2021] [Indexed: 11/18/2022]
Abstract
Food choices are a complex subject of study. This study reviews existing literature on the topic, while also offering new perspectives. It introduces empirical materials that suggest the existence of continuities between childhood memories of food insecurity and current nutritional choices and practices among older adults. This is a qualitative study, based on grounded theory, which explores memories of hunger in the aftermath of the Spanish Civil War through ethnographic fieldwork conducted in 12 rural localities in Extremadura (Spain) - analysing current food practices and ideologies among surviving post-war children and tracing continuities between the past and the present. It provides results in the field of food continuities and shows how experiences and memories of hunger have an impact on food choices many decades later Data analysis and interpretation revealed three main categories: food memories of the so-called "years of hunger"; present-day food practices; and continuities between past and present. The inductive-deductive analysis revealed enduring memories that shaped present-day attitudes towards food - i.e. maximisation of ingredients and "zero-waste" practices; conspicuous consumption at particular times of the year; the central role of bread; and even certain food taboos. More than seventy years later, memories of deprivation and hunger are still pervasive and permeate present-day dietary practices and choices.
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Affiliation(s)
- David Conde-Caballero
- Department of Nursing, Faculty of Nursing and Occupational Therapy, Avenida de La Universidad S/n, 10003, Cáceres, Spain.
| | - Borja Rivero-Jimenez
- Department of Computer Systems and Telematics Engineering, Polytechnic School, Avenida de La Universidad S/n, 10003, Cáceres, Spain.
| | - Lorenzo Mariano-Juarez
- Department of Nursing, Faculty of Nursing and Occupational Therapy, Avenida de La Universidad S/n, 10003, Cáceres, Spain.
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Ergun-Longmire B, Clemente E, Vining-Maravolo P, Roberts C, Buth K, Greydanus DE. Diabetes education in pediatrics: How to survive diabetes. Dis Mon 2021; 67:101153. [PMID: 33541707 DOI: 10.1016/j.disamonth.2021.101153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diabetes mellitus is the most common abnormal carbohydrate metabolism disorder affecting millions of people worldwide. It is characterized by hyperglycemia as a result of ß-cell destruction or dysfunction by both genetic and environmental factors. Over time chronic hyperglycemia leads to microvascular (i.e., retinopathy, nephropathy and neuropathy) and macrovascular (i.e., ischemic heart disease, peripheral vascular disease, and cerebrovascular disease) complications of diabetes. Diabetes complication trials showed the importance of achieving near-normal glycemic control to prevent and/or reduce diabetes-related morbidity and mortality. There is a staggering rate of increased incidence of diabetes in youth, raising concerns for future generations' health, quality of life and its enormous economic burden. Despite advancements in the technology, diabetes management remains cumbersome. Training individuals with diabetes to gain life-long survival skills requires a comprehensive and ongoing diabetes education by a multidisciplinary team. Diabetes education and training start at the time of diagnosis of diabetes and should be continuous throughout the course of disease. The goal is to empower the individuals and families to gain diabetes self-management skills. Diabetes education must be individualized depending on the individual's age, education, family dynamics, and support. In this article, we review the history of diabetes, etiopathogenesis and clinical presentation of both type 1 and type 2 diabetes in children as well as adolescents. We then focus on diabetes management with education methods and materials.
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Affiliation(s)
- Berrin Ergun-Longmire
- Associate Professor, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Ethel Clemente
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Patricia Vining-Maravolo
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Cheryl Roberts
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Koby Buth
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Donald E Greydanus
- Professor, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI United States
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Association Between Restaurant Menu Item Descriptions and Their Nutrient Content. Am J Prev Med 2021; 60:232-240. [PMID: 33482981 DOI: 10.1016/j.amepre.2020.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Item descriptions on restaurant menus often include claims about health and other attributes, and these are much less regulated than the language on packaged food labels. This study tests whether menu items with claims have different nutritional content from items without claims. METHODS Investigators compiled a data set of menu items, their claims, and their nutrition content using MenuStat. Data included 84,788 item-year observations at up to 96 of the top-selling restaurant chains from 2012 to 2018. Items were identified with general health, health-related ingredients, nutrient content, product sourcing, and vegan or vegetarian claims through a matching algorithm. Mixed-effects models were used to examine the effect of claims on calories, nutrients to limit (e.g., saturated fat and sodium), and other nutrients by dish types (sides, main dishes, desserts). RESULTS Most dishes with claims were lower in calories; however, items with claims were not consistently lower in other nutrients to limit (sodium, saturated fat, sugar, or trans fat). Vegan or vegetarian desserts had 128 mg (95% CI=20.9, 235.1) more sodium than desserts without this claim. Main and side dishes with claims had equivalent or higher sugar content than items without claims. Many items with claims were lower in saturated fat, especially main dishes with a nutrient content claim (-2.8 percentage points, 95% CI= -3.4, -2.2). CONCLUSIONS Items with claims were high in nutrients to limit. Additional efforts to increase transparency around excessive ingredients, such as the sodium warning labels, could be implemented by the restaurant industry.
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González-Díaz C, Vilaplana-Aparicio MJ, Iglesias-García M. How Is Functional Food Advertising Understood? An Approximation in University Students. Nutrients 2020; 12:E3312. [PMID: 33137940 PMCID: PMC7692513 DOI: 10.3390/nu12113312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
In functional food advertising, messages are not always easily understandable for the target audience. Current European legislation, enforced through Regulation 1924/2006, specifies that such messages should be clear and precise so as not to mislead the consumer. The objective of this study was to observe consumers' understanding of messages in functional food advertisements. The methodology used was a self-administered survey filled out by 191 students enrolled in a Degree in Advertising and Public Relations at the University of Alicante (Spain). The results suggest that a large number of students do not know what functional food is and obtain information about these products mainly from labelling/packaging. The major means of communication through which they learn about health benefits via advertising is the internet, followed by television. Most respondents indicated that they understood related advertisements and found it helpful to be given additional information on health benefits. Worthy of note, the greater their level of understanding of the messages, the higher their level of distrust of advertising messages, which they considered to be deceptive or misleading.
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Affiliation(s)
- Cristina González-Díaz
- Department of Communication and Social Psychology, University of Alicante, 03080 San Vicente del Raspeig (Alicante), Spain; (M.J.V.-A.); (M.I.-G.)
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