Attitude and Behavior Factors Associated with Front-of-Package Label Use with Label Users Making Accurate Product Nutrition Assessments

Factors associated with food label use: focus on healthy aspects of orthorexia and orthorexia nervosa

PURPOSE

This study aimed to investigate the potential relationships between the use of different section of food label, and healthy and pathological aspects of orthorexia among adults.

METHODS

This cross-sectional study was conducted using an online survey (n = 1326). Inclusion criteria were being 19-64 years and graduated from at least primary school. Pregnant and lactating women were excluded. Data were collected using questionnaire including socio-demographic variables, lifestyle factors, body weight and height, frequency of reading different sections of food label ("always", "when buying a food for the first time", "when comparing similar packaged foods", "rarely", "never"), food label literacy, and Teruel Orthorexia Scale. Participants were categorized as nutrition facts panel-users, ingredients list-users or claim-users if they read at least one item from the relevant parts.

RESULTS

The proportions of nutrition facts, ingredients list, and claims sections users were 72.3%, 76.3%, and 79.9%, respectively. Both healthy and pathological aspects of orthorexia were associated with reading food labels. The healthy orthorexia had the strongest association with using the ingredients list (OR 1.76, 95% CI 1.41-2.20), whereas the orthorexia nervosa showed the highest association with using nutrition facts panel (OR 1.48, 95% CI 1.20-1.81). While women, physically active participants and those with higher food label literacy were more likely to use all sections of food labels; older age, having children, and chronic disease increased the likelihood of using claims and ingredients list (p < 0.05). Besides, following a diet was associated with higher use of nutrition facts and ingredients list (p < 0.05).

CONCLUSIONS

The study demonstrates that food label users have higher orthorexia tendencies compared to non-users. Of the food label sections, healthy orthorexia showed the strongest association with use of the list of ingredients, while pathological orthorexia showed the strongest association with use of the nutrition facts panel.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

The Ability of Nutrition Warning Labels to Improve Understanding and Choice Outcomes Among Consumers Demonstrating Preferences for Unhealthy Foods

BACKGROUND

Given growing interest in warning labels as a form of front-of-pack nutrition label, it is important to better understand the mechanisms via which these labels may exert their effects, especially among those making suboptimal food choices.

OBJECTIVE

The study aim was to assess the extent to which consumers with the weakest outcomes for objective understanding and choice in no-label conditions were able to improve their understanding and choices after exposure to warning labels on food product options.

DESIGN

Post-hoc analyses of the cross-sectional FOP-ICE (Front-of-Pack International Comparative Experimental) study data generated from an online survey that included simulated food choice and nutritional quality ranking scenarios.

PARTICIPANTS/SETTING

Participants included 3,680 adults from the following 18 countries: Argentina, Australia, Belgium, Bulgaria, Canada, Denmark, France, Germany, Italy, Mexico, Netherlands, Poland, Portugal, Singapore, Spain, Switzerland, United Kingdom, and United States.

INTERVENTION

Survey respondents selected their preferred product options and ranked foods according to their healthiness before and after exposure to mock breakfast cereal, cake, and pizza products displaying warning labels.

MAIN OUTCOME MEASURES

Objective understanding and food choice were measured.

STATISTICAL ANALYSES PERFORMED

Within each product category, analyses were conducted on respondents who initially incorrectly identified the healthiest option and/or selected the unhealthiest option as their preferred choice. Significant differences between proportions selecting each understanding and choice response option were assessed using 2-sample z tests for proportions.

RESULTS

Salience of the warning labels was low; 46% reported noticing the labels while completing the survey. Just over one-third of those aware of the presence of warning labels were able to identify the least healthy option in the post-exposure condition. Approximately one-half reselected the least healthy option post exposure and just over one-fourth switched to the healthiest option.

CONCLUSIONS

The results indicated that warning labels can assist some consumers to improve their food quality assessments and choices. However, design improvements could enhance the salience and interpretability of this label format.

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

Introduction

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

Methods

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

Results

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

Discussion

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

Understanding of front of package nutrition labels: Guideline daily amount and warning labels in Mexicans with non-communicable diseases

One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile’s labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants’ number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA.

The Source of Protein or Its Value? Consumer Perception Regarding the Importance of Meat(-like) Product Attributes

Food product attributes may significantly influence the general perception of the product itself, as well as the willingness for its consumption. Assessment of the product is based on customers’ beliefs and individual preferences. Because meat-like products are presented as meat substitutes providing sufficient protein values, the present study aimed to determine the effect of protein source and labelling pointing at high protein content on the evaluation of the product. The experimental online study was conducted with a group of 552 respondents. Four versions of product packaging were designed and tested. These packages differed in the presence or absence of the Nutrition Claim and the presence of the text indicating the vegetable or meat origin of the product. Data collected in the experiment were analyzed using a 2 × 2 ANOVA. The study revealed that the source of protein (plant vs. animal) appears to shape consumers’ perception of the product as more eco-friendly (F (1.518) = 38.681, p < 0.001, η2 = 0.069), natural (F (1.518) = 15.518, p < 0.001, η2 = 0.029), and healthy (F (1.518) = 25.761, p < 0.001, η2 = 0.047). Moreover, labelling including a “high-protein” Nutrition Claim increases the willingness to consume the product (F (1.518) = 4.531, p = 0.034, η2 = 0.009), and provides the impression of it being more eco-friendly (F (1.518) = 6.658, p = 0.01, η2 = 0.012) and of a higher quality (F (1.518) = 7.227, p = 0.007, η2 = 0.014). The obtained results may have theoretical significance by improving the understanding of factors determining the perception of food products and the use of meat substitutes.

The Effectiveness of Pamphlet toward Consumption Behavior Changing of Iodized Salt among Housewives: A Quasi-experimental Study

BACKGROUND: Prenatal and postnatal growth is affected by iodized salt. Poor management of iodized salt when cooking food or vegetables can reduce iodine levels in salt. AIM: This study aimed to determine the effectiveness of pamphlets to increase behavior toward consumption of iodized salt among housewives. METHODS: Study design quasi-experiment with the control group. The intervention group attached to media pamphlet on a kitchen wall or cooking area (The brochure contains how to process iodized salt properly), while the control group was given a leaflet (The leaflet contains how to manage iodized salt properly). The total number of samples was 76 (each group had 38 samples). Before implementing the attached pamphlet media in the kitchen wall, each group measured iodized salt management behavior (pre-test). After four months of intervention, the iodized salt management behavior was measured again. After collecting the data, it was analyzed using logistic regression. RESULTS: The results of the study showed that there was a difference in the proportion in the group that intervened with pamphlets compared to leaflets in the management of iodized salt, it’s illustrated from the exponent value (β) or Odds Ratio (OR) 3.37 CI: (0.63-17.92) after being controlled by other variables. CONCLUSION: The attached pamphlets in the kitchen area effectively increase consuming iodized salt among housewives, so the media should be placed where the behavior will appear to change the desired behavior.  

The Effects of Dairy Product Label Information on Cognition of Consumers: The Case of the China Choices

Food safety issues were a growing concern in most countries; affecting the people's health, social stability, economic development, and dairy product safety had always been an important topic of concern for consumers. This study is aimed at investigating the concerns of consumers about dairy product label information and its influencing factors. These survey data were reported for 4408 respondents with a total response rate of 96.35%. Findings revealed that consumers' concern on dairy product label information was relatively high on the whole, and there were significant differences in the level of consumers' concern on dairy product label information (P < 0.05). Regression results indicated that education significantly influenced consumers' concern about dairy product label information than age and Engel's coefficient (P < 0.05). Findings from this study will provide references for the government to disseminate dairy product knowledge to the public effectively.

How Is Functional Food Advertising Understood? An Approximation in University Students

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.

A Model Depicting the Retail Food Environment and Customer Interactions: Components, Outcomes, and Future Directions

The retail food environment (RFE) has important implications for dietary intake and health, and dramatic changes in RFEs have been observed over the past few decades and years. Prior conceptual models of the RFE and its relationships with health and behavior have played an important role in guiding research; yet, the convergence of RFE changes and scientific advances in the field suggest the time is ripe to revisit this conceptualization. In this paper, we propose the Retail Food Environment and Customer Interaction Model to convey the evolving variety of factors and relationships that convene to influence food choice at the point of purchase. The model details specific components of the RFE, including business approaches, actors, sources, and the customer retail experience; describes individual, interpersonal, and household characteristics that affect customer purchasing; highlights the macro-level contexts (e.g., communities and nations) in which the RFE and customers behave; and addresses the wide-ranging outcomes produced by RFEs and customers, including: population health, food security, food justice, environmental sustainability, and business sustainability. We believe the proposed conceptualization helps to (1) provide broad implications for future research and (2) further highlight the need for transdisciplinary collaborations to ultimately improve a range of critical population outcomes.

Peer Networks and Intention to Consume Unhealthy Food: The Association Through Cognitive Mediators in Peruvian Adolescents

This cross-sectional study examined the mediating role of three reasoned action approach (RAA) constructs—attitudes, perceived social pressure, and perceived behavioral control—on the relationship between peer networks and intention to consume unhealthy food. The authors examined self-reported data of a sample of 277 adolescents from public and private schools in Lima, Peru. Results revealed a total mediating effect of the reasoned action constructs; yet attitudes and perceived behavioral control, but not perceived social pressure (injunctive and descriptive norms), mediated the relationship between peer network and intention to consume unhealthy food. Explanations for these results are discussed in light of social cognitive theory and Ajzen and Fishbein’s postulates about specific attitudes. Finally, we discuss how school nurses can take advantage of RAA variables to influence food environments, use peer networks for reducing unhealthy food consumption, and organize workshops to inform parents about the mechanisms that promote junk food intake.

What Dimensions of Risk Perception are Associated with Avoidance of Buying Processed Foods with Warning Labels?

Nutritional Warning Labels (NWLs) inform consumers about processed foods that exceed critical nutrient levels activating the risk perception in consumers. However, this information is limited. The objective was to identify the dimensions of risk perception and to study their associations with avoidance of buying processed foods with warning labels. A survey was applied to 807 decision-makers who choose what to eat at home. The four dimensions of risk perception (performance, financial, physical, and psychological) were identified through exploratory factor analysis. Through a multiple regression model, we determined the dimensions of risk perception and sociodemographic variables that affect the intention to avoid buying processed foods with NWLs. The results show that the performance risk, physical risk, and psychological risk positively affect the intention of avoiding processed foods with NWLs. In addition, the female gender considers NWLs to purchase foods. Nevertheless, the high frequency of consumption and belonging to a lower-income socioeconomic group are barriers to the use of NWLs. In conclusion, NWLs help people to choose processed food that does not impact negatively their food expectations, as well as their mental and physical health. However, health authorities must invest in nutrition education. Specifically, in groups who pay less attention to NWLs. Such groups include people with high daily consumption of processed foods, males, and low-income socioeconomic groups.

Nutrient Profiling Systems, Front of Pack Labeling, and Consumer Behavior

PURPOSE OF REVIEW

Guiding consumers toward more healthful food choices may help address the high prevalence of poor dietary quality and diet-related diseases. The use of front-of-package labels (FOPL) on food items is expanding to provide focused nutritional information or representations, often based upon nutrient profiling systems.

RECENT FINDINGS

FOPL provide a source of nutrition and health information that is readily understood by consumers, including those with limited literacy. There is evidence that FOPL can shift consumer behavior toward more nutritious and healthful choices. However, assessments of the effectiveness of FOPL have been restricted in scope and rely largely on simulation models rather than real-world environments. FOPL are a direct source of nutritional guidance at the point-of-purchase and provide an opportunity to convey critical information on ingredients that are associated with health promotion and/or increased risk of non-communicable diseases. However, limited evidence regarding the most effective forms of FOPL to achieve behavior change and challenges from the food industry impedes the establishment of standardized nutrient profiles and algorithms. Future opportunities for FOPL include the potential for integrating nutritional profiles with non-nutrient factors affecting health such as food processing and environmental sustainability.

Personal and Psychological Traits Influencing the Willingness to Pay for Food with Nutritional Claims: A Comparison between Vice and Virtue Food Products

Several studies have demonstrated the usefulness of nutritional claims (NCs) to help consumers make more informed food decisions. However, fewer studies have investigated the effect of personal and psychological consumer characteristics on their food purchase decision. Hence, the main aim of this study is to examine the impact of body image, emotional eating style, anxiety traits, and body mass index on consumer preferences for multiple NCs on the front of the package (FOP) of hedonic (potato chips) and utilitarian (toasted bread) products carrying the same NCs. Therefore, a real choice experiment (RCE) has been used and the willingness-to-pay-space model was estimated to analyse the interaction between personal and psychological characteristics and consumer preferences. The main finding suggests differences in purchase behaviour between potato chips and toasted bread. In particular, consumers are willing to pay more for toasted bread with one NC than potato chips with one NC. Moreover, personal and psychological consumer characteristics influence the purchase behaviour regarding food products with nutritional claims. However, only the anxiety trait appears to explain the differences between the selection of both types of food products. In line with this new evidence, we proposed some behavioural, political, and managerial implications.

Objective Understanding of Front-of-Package Nutrition Labels: An International Comparative Experimental Study across 12 Countries

Front-of-Package labels (FoPLs) are efficient tools for increasing consumers' awareness of foods' nutritional quality and encouraging healthier choices. A label's design is likely to influence its effectiveness; however, few studies have compared the ability of different FoPLs to facilitate a consumer understanding of foods' nutritional quality, especially across sociocultural contexts. This study aimed to assess consumers' ability to understand five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbol] in 12 different countries. In 2018, approximately 1000 participants per country were recruited and asked to rank three sets of label-free products (one set of three pizzas, one set of three cakes, and one set of three breakfast cereals) according to their nutritional quality, via an online survey. Participants were subsequently randomised to one of five FoPL conditions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Changes in a participants' ability to correctly rank products across the two tasks were assessed by FoPL using ordinal logistic regression. In all 12 countries and for all three food categories, the Nutri-Score performed best, followed by the MTL, HSR, Warning symbol, and RIs.