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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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2
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Jeanes YM, Kallos S, Muhammad H, Reeves S. Who gets an annual review for coeliac disease? Patients with lower health literacy and lower dietary adherence consider them important. J Hum Nutr Diet 2024; 37:1022-1031. [PMID: 38713740 DOI: 10.1111/jhn.13314] [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: 12/14/2023] [Accepted: 04/20/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND A lifelong gluten-free (GF) diet to manage coeliac disease is recognised to be challenging. This paper comprises two studies: study one aimed to report the opinions of adults with coeliac disease on review provision and explore factors influencing dietary adherence. Study two aimed to report dietetic provision for adults with coeliac disease. METHODS A cross-sectional online survey was completed by 722 adults with coeliac disease, including validated dietary adherence, health literacy and quality-of-life questionnaires. An online and paper survey designed to capture the provision of dietetic services to adults with coeliac disease was completed by 88 dietetic departments within the United Kingdom. RESULTS Only 26% of adults with coeliac disease were offered annual reviews. In contrast, 85% considered reviews important, with 62% preferring dietetic provision. Those who considered reviews important had lower health literacy, greater dietary burden, poorer GF dietary adherence and lower GF food knowledge (all p < 0.05) compared with those who did not consider reviews important. GF dietary adherence was associated with health literacy, self-regulatory behaviours, dietary burden and GF food knowledge; 53% agreed with the 'cost of GF food restricts what I eat'; they had poorer GF dietary adherence compared with those who disagreed (p < 0.001). More than 72% of dietetic coeliac review provision provided content on improving access to GF foods and eating out of the home. CONCLUSIONS A subpopulation of adults with coeliac disease have a greater need for support and guidance, which supports the viewpoint that limited resources should be targeted towards patients with the most need for support to enable successful disease management.
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Affiliation(s)
- Yvonne M Jeanes
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Sharon Kallos
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Humayun Muhammad
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Sue Reeves
- School of Life and Health Sciences, University of Roehampton, London, UK
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3
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Chilón-Troncos RF, García-Salirrosas EE, Escobar-Farfán M, Millones-Liza DY, Villar-Guevara M. Predicting willingness to consume healthy brand foods using the theory of planned behavior: the role of nutritional literacy. Front Nutr 2024; 11:1353569. [PMID: 38638294 PMCID: PMC11025538 DOI: 10.3389/fnut.2024.1353569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The willingness to consume healthy foods has highlighted the growing importance of health, even more so when it comes to food choice, and predicting the willingness to consume foods of a healthy brand represents an action that leads to the practice of conscious eating habits, but what is behind this willingness? To answer this question and based on previous studies such as the theory of planned behavior and nutritional literacy, this study aimed to build a predictive model through an empirical study to examine the influence of nutritional literacy (NL) on attitude (ATT), subjective norm (SN) and perceived behavioral control (PBC), as well as to determine the influence of the three variables of the theory of planned behavior (TPB) on the willingness to consume healthy brand foods (WCHBF) in the Peruvian market. Methods The research focused on the population that stated that they were consumers of the Unión brand (a brand whose value proposition is the sale of healthy foods), obtaining 482 consumers. The study was conducted under a quantitative, non-experimental, cross-sectional design approach. Results The results support the existence of a positive and significant effect of NL on ATT, SN, and PBC, finding the exact behavior of SN and PBC in WCHBF; however, in the proposed model, it is observed that ATT has no impact on WCHBF. Conclusion Applying strategies that lead to a change in consumer behavior towards healthy brands is a matter of time and will. In this context, the findings indicate that nutritional literacy plays an essential role in the willingness to consume healthy foods, which sheds more light on the design of educational interventions and awareness campaigns that independently inform about nutritional benefits and empower consumers, allowing them to make informed and healthy choices.
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Affiliation(s)
| | | | - Manuel Escobar-Farfán
- Departamento de Administración, Facultad de Administración y Economía, Universidad de Santiago de Chile, Santiago, Chile
| | - Dany Yudet Millones-Liza
- Unidad de Ciencias Empresariales, Escuela de Posgrado, Universidad Peruana Unión, Lima, Peru
- Escuela Profesional de Administración, Facultad de Ciencias Empresariales, Universidad Peruana Unión, Lima, Peru
| | - Miluska Villar-Guevara
- Escuela Profesional de Administración, Facultad de Ciencias Empresariales, Universidad Peruana Unión, Juliaca, Peru
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Chen J, Fan Y, Zhang M, Wu S, Li H. The neural model of front-of-package label processing. Nutr Rev 2024; 82:374-388. [PMID: 37604108 DOI: 10.1093/nutrit/nuad060] [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] [Indexed: 08/23/2023] Open
Abstract
Front-of-package (FOP) labels have been adopted in many countries to battle the obesity pandemic and its serious health consequences by providing clearer and easier-to-understand nutrition and health information. The effectiveness of FOP labels has been generally confirmed, with some contextual and individual factors modifying their effectiveness. Existing theories (eg, the dual-process theory) and shifting priorities for self-control, provide some explanations for the FOP label effect. However, the cognitive and neural mechanisms underlying the processing of FOP labels remain unknown. Here, a new model, namely, the neural model of FOP label processing, has been proposed to fill this gap by providing an integrated account of FOP label processing while simultaneously considering multiple important situational and individual factors in the same framework. This neural model is built on the core eating network (ie, the ventral reward pathway and the dorsal control pathway) for food cue processing and actual food consumption. The new model explains how FOP labels may facilitate attention, influence the core eating network, and thus alter food choices. It also demonstrates how motivation may modify FOP label processing in 2 ways: affecting attention (the indirect way) and changing the process of evaluating the food (the direct way). It further explains how some contextual and individual factors (eg, ego depletion, time pressure, and health knowledge) influence the process. Thus, the neural model integrates evidence from behavioral, eye-tracking, and neuroimaging studies into a single, integrated account, deepening understanding of the cognitive and neural mechanisms of FOP label processing. This model might facilitate consensus on the most successful FOP label. Moreover, it could provide insights for consumers, food industries, and policy makers and encourage healthy eating behaviors.
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Affiliation(s)
- Jing Chen
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Yixuan Fan
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Manlu Zhang
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Shuhuan Wu
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Huiyan Li
- School of Psychology, Beijing Sport University, Beijing 100084, China
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Sousa IC, Mucinhato RMD, Prates CB, Zanin LM, da Cunha DT, Capriles VD, de Rosso VV, Stedefeldt E. Do Brazilian consumers intend to use food labels to make healthy food choices? An assessment before the front-of-package labelling policy. Food Res Int 2023; 172:113107. [PMID: 37689875 DOI: 10.1016/j.foodres.2023.113107] [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: 04/04/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 09/11/2023]
Abstract
Front-of-package labelling is a measure that can facilitate consumption of healthier foods. This study examined the predictors of consumers' intentions to use food labelling to make healthy food choices and prevent non-communicable diseases before the implementation of the front-of-package labelling policy in Brazil. An extended theory of planned behaviour incorporating knowledge and food literacy served as the theoretical foundation. First, experts (n = 6) and the target population (n = 30) validated the questionnaire, and the validation data were analysed using content validity coefficients (CVC). An online questionnaire was administered to 783 participants, and data were collected between May and October 2022. Partial least squares structural equation modelling (PLS-SEM) was used to test the prediction hypothesis. The questionnaire showed adequate content validity, with all indicators of CVC ≥ 0.75. In the PLS-SEM attitudes (p < 0.001), subjective norms (p < 0.001), knowledge (p < 0.001), and food literacy (p < 0.001) positively predicted the intention to use food labels to make healthy food choices, confirming the main hypothesis. Also, Food literacy and knowledge predicted all constructs of the theory of planned behaviour (p < 0.001). The results highlight the importance of providing nutritional knowledge and food literacy, developing nutritional skills and abilities to encourage consumers to make healthy food choices, and to strengthen other policies such as front-of-package labelling.
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Affiliation(s)
- Isabel Costa Sousa
- Food Labeling Observatory, Nutrition and Food Service Research Center (CPPNAC), Federal University of São Paulo (UNIFESP), Santos, SP, Brazil.
| | - Raísa Moreira Dardaque Mucinhato
- Postgraduate Program in Nutrition - Federal University of São Paulo - UNIFESP, 862, Botucatu St, Vila Clementino, São Paulo, SP 04024-002, Brazil.
| | - Carolina Bottini Prates
- Postgraduate Program in Nutrition - Federal University of São Paulo - UNIFESP, 862, Botucatu St, Vila Clementino, São Paulo, SP 04024-002, Brazil.
| | - Laís Mariano Zanin
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo - USP, 3900 Bandeirantes Av., Monte Alegre, Ribeirão Preto, SP 14049-900, Brazil.
| | - Diogo Thimoteo da Cunha
- Multidisciplinary Laboratory of Food and Health, School of Applied Sciences - State University of Campinas - UNICAMP - SP, 1300, Pedro Zaccaria St., Limeira, SP 13484-350, Brazil.
| | - Vanessa Dias Capriles
- Food Labeling Observatory, Nutrition and Food Service Research Center (CPPNAC), Federal University of São Paulo (UNIFESP), Santos, SP, Brazil; Federal University of São Paulo (UNIFESP), Institute of Health and Society (Campus Baixada Santista), Department of Biosciences, Silva Jardim st, 136, 11015-020, Santos, SP, Brazil.
| | - Veridiana Vera de Rosso
- Food Labeling Observatory, Nutrition and Food Service Research Center (CPPNAC), Federal University of São Paulo (UNIFESP), Santos, SP, Brazil.
| | - Elke Stedefeldt
- Food Labeling Observatory, Nutrition and Food Service Research Center (CPPNAC), Federal University of São Paulo (UNIFESP), Santos, SP, Brazil; Department of Preventive Medicine - Federal University of São Paulo - UNIFESP, 740, Botucatu St, fourth floor, Vila Clementino, São Paulo, SP 04024-002, Brazil.
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6
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Heerman WJ, Sneed NM, Sommer EC, Truesdale KP, Matheson D, Noerper TE, Samuels LR, Barkin SL. Ultra-processed food consumption and BMI-Z among children at risk for obesity from low-income households. Pediatr Obes 2023; 18:e13037. [PMID: 37070567 PMCID: PMC10434975 DOI: 10.1111/ijpo.13037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/13/2023] [Accepted: 04/03/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To evaluate the association between baseline ultra-processed food consumption in early childhood and child BMI Z-score over 36 months. METHODS We conducted a prospective cohort analysis as a secondary data analysis of the Growing Right Onto Wellness randomised trial. Dietary intake was measured via 24-h diet recalls. The primary outcome was child BMI-Z, measured at baseline and at 3-, 9-, 12-, 24- and 36-month timepoints. Child BMI-Z was modelled using a longitudinal mixed-effects model, adjusting for covariates and stratifying by age. RESULTS Among 595 children, median (Q1-Q3) baseline age was 4.3 (3.6-5.0) years, 52.3% of the children were female, 65.4% had normal weight, 33.8% were overweight, 0.8% were obese and 91.3% of parents identified as Hispanic. Model-based estimates suggest that, compared with low ultra-processed consumption (300 kcals/day), high ultra-processed intake (1300 kcals/day) was associated with a 1.2 higher BMI-Z at 36 months for 3-year-olds (95% CI = 0.5, 1.9; p < 0.001) and a 0.6 higher BMI-Z for 4-year-olds (95% CI = 0.2, 1.0; p = 0.007). The difference was not statistically significant for 5-year-olds or overall. CONCLUSIONS In 3- and 4-year-old children, but not in 5-year-old children, high ultra-processed food intake at baseline was significantly associated with higher BMI-Z at 36-month follow-up, adjusting for total daily kcals. This suggests that it might not be only the total number of calories in a child's daily intake that influences child weight status, but also the number of calories from ultra-processed foods.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nadia M Sneed
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | - Evan C Sommer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly P Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Lauren R Samuels
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shari L Barkin
- Virginia Commonwealth University, Richmond, Virginia, USA
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Forray AI, Coman MA, Cherecheș RM, Borzan CM. Exploring the Impact of Sociodemographic Characteristics and Health Literacy on Adherence to Dietary Recommendations and Food Literacy. Nutrients 2023; 15:2853. [PMID: 37447180 DOI: 10.3390/nu15132853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
This study investigates food literacy-related abilities and adherence to dietary recommendations in relation to sociodemographic characteristics and health-related features (health literacy, self-rated health and morbidity) in the North-Western region of Romania. This is a secondary analysis of cross-sectional data collected in 2019 from a representative and randomised sample of 1572 individuals. A questionnaire was employed to record participants' sociodemographic characteristics, food-related and health-related features. Most participants were non-adherent to dietary recommendations for fruit and vegetables (83.5%), fish and seafood (61.3%), and water intake (67.9%). However, most participants reported an adequate ability to understand the connection between nutrition and health (89.1%), to distinguish between healthy and less healthy options (84.4%), and to acquire nutrition information (75.6%). Non-adherence to dietary recommendations and low food literacy abilities were more prevalent in disadvantaged groups (older age, rural settings, retirement or social welfare, low educational attainment, formerly married). Health literacy was negatively associated with not adhering to dietary recommendations and poor self-rated food literacy abilities. The study suggests that low socioeconomic status negatively impacts food literacy and adherence to dietary recommendations among Romanian adults. Identifying target populations to improve food-related abilities and health literacy can aid public health services in improving health outcomes.
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Affiliation(s)
- Alina Ioana Forray
- Discipline of Public Health and Management, Department of Community Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Mădălina Adina Coman
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, 400132 Cluj-Napoca, Romania
| | - Răzvan Mircea Cherecheș
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, 400132 Cluj-Napoca, Romania
| | - Cristina Maria Borzan
- Discipline of Public Health and Management, Department of Community Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
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Herman WH, Schillinger D. Rethinking diabetes in the United States. Front Endocrinol (Lausanne) 2023; 14:1185719. [PMID: 37396183 PMCID: PMC10310945 DOI: 10.3389/fendo.2023.1185719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Despite the availability of effective medical treatments, the diabetes epidemic has accelerated in the United States, efforts to translate treatments into routine clinical practice have stalled, and health inequities have persisted. The National Clinical Care Commission (NCCC) was established by the Congress to make recommendations to better leverage federal policies and programs to more effectively prevent and control diabetes and its complications. The NCCC developed a guiding framework that incorporated elements of the Socioecological and Chronic Care Models. It gathered information from both health-related and non-health-related federal agencies, held 12 public meetings, solicited public comments, met with interested parties and key informants, and performed comprehensive literature reviews. The final report of the NCCC was transmitted to the Congress in January 2022. It called for a rethinking of the problem of diabetes in the United States, including the recognition that the lack of progress is due to a failure to confront diabetes as both a complex societal problem as well as a biomedical problem. To prevent and control diabetes, public policies and programs must be aligned to address both social and environmental determinants of health and health care delivery as they impact diabetes. In this article, we discuss the findings and recommendations of the NCCC as they relate to the social and environmental factors that influence the risk of type 2 diabetes and argue that the prevention and control of type 2 diabetes in the U.S. must begin with concrete population-level interventions to address social and environmental determinants of health.
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Affiliation(s)
- William H. Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Dean Schillinger
- San Francisco General Hospital, University of California San Francisco School of Medicine, San Francisco, CA, United States
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Musicus AA, Gibson LA, Bellamy SL, Orr JA, Hammond D, Glanz K, Volpp KG, Schwartz MB, Bleakley A, Strasser AA, Roberto CA. Effects of Sugary Beverage Text and Pictorial Warnings: A Randomized Trial. Am J Prev Med 2023; 64:716-727. [PMID: 36764835 PMCID: PMC10121881 DOI: 10.1016/j.amepre.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Multiple U.S. localities have introduced legislation requiring sugar-sweetened beverage (SSB) warnings. This study effects of different warning designs on beverage selections and perceptions. STUDY DESIGN The study was an RCT. SETTING/PARTICIPANTS An online virtual convenience store and survey were used with a nationally representative sample of primary caregivers of 6-11-year-olds (n=961). Data were collected in January 2020 and analyzed in May-July 2020. INTERVENTION Participants were randomized to view SSBs with 1 of 4 front-of-package label designs: (1) no-warning control, (2) health-related text warning, (3) sugar pictorial warning (image of beverage sugar content in cubes/teaspoons/packets with health-related warning text), or (4) health pictorial warning (image of possible health consequences of overconsuming SSBs with health-related warning text). MAIN OUTCOME MEASURES Outcomes included participants' beverage choice for their child and perceptions of beverages, their assigned labels, and warning policies. RESULTS Proportionally fewer participants chose a SSB in the sugar pictorial warning condition (-13.4 percentage points; 95% CI= -21.6 to -0.1 percentage points; p=0.007) and in the health pictorial warning condition (-14.7 percentage points; 95% CI= -22.8 to -0.1 percentage points; p=0.004) compared to the control. Sugar pictorial warnings led to more accurate added-sugar content estimates than all conditions and greater label trust and support for sugar-sweetened beverage warning policies than health pictorial warnings. CONCLUSIONS SSB warning policies may be most effective if they mandate images of beverages' added sugar content accompanied by warning text. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT03648138.
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Affiliation(s)
- Aviva A Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Laura A Gibson
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scarlett L Bellamy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer A Orr
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Karen Glanz
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin G Volpp
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marlene B Schwartz
- Rudd Center for Food Policy and Health, University of Connecticut, Storrs, Connecticut
| | - Amy Bleakley
- Department of Communication, College of Arts and Sciences, University of Delaware, Newark, Delaware
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Du M, Griecci CF, Cudhea F, Eom H, Wong JB, Wilde P, Kim DD, Michaud DS, Wang YC, Mozaffarian D, Zhang FF. What is the cost-effectiveness of menu calorie labelling on reducing obesity-associated cancer burdens? An economic evaluation of a federal policy intervention among 235 million adults in the USA. BMJ Open 2023; 13:e063614. [PMID: 37072239 DOI: 10.1136/bmjopen-2022-063614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE To assess the impact of menu calorie labelling on reducing obesity-associated cancer burdens in the USA. DESIGN Cost-effectiveness analysis using a Markov cohort state-transition model. SETTING Policy intervention. PARTICIPANTS A modelled population of 235 million adults aged ≥20 years in 2015-2016. INTERVENTIONS The impact of menu calorie labelling on reducing 13 obesity-associated cancers among US adults over a lifetime was evaluated for: (1) effects on consumer behaviours; and (2) additional effects on industry reformulation. The model integrated nationally representative demographics, calorie intake from restaurants, cancer statistics and estimates on associations of policy with calorie intake, dietary change with body mass index (BMI) change, BMI with cancer rates, and policy and healthcare costs from published literature. MAIN OUTCOME MEASURES Averted new cancer cases and cancer deaths and net costs (in 2015 US$) among the total population and demographic subgroups were determined. Incremental cost-effectiveness ratios from societal and healthcare perspectives were assessed and compared with the threshold of US$150 000 per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analyses incorporated uncertainty in input parameters and generated 95% uncertainty intervals (UIs). RESULTS Considering consumer behaviour alone, this policy was associated with 28 000 (95% UI 16 300 to 39 100) new cancer cases and 16 700 (9610 to 23 600) cancer deaths averted, 111 000 (64 800 to 158 000) QALYs gained, and US$1480 (884 to 2080) million saved in cancer-related medical costs among US adults. The policy was associated with net cost savings of US$1460 (864 to 2060) million and US$1350 (486 to 2260) million from healthcare and societal perspectives, respectively. Additional industry reformulation would substantially increase policy impact. Greater health gains and cost savings were predicted among young adults, Hispanic and non-Hispanic Black individuals. CONCLUSIONS Study findings suggest that menu calorie labelling is associated with lower obesity-related cancer burdens and reduced healthcare costs. Policymakers may prioritise nutrition policies for cancer prevention in the USA.
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Affiliation(s)
- Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Christina F Griecci
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Heesun Eom
- New York Academy of Medicine, New York, New York, USA
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts, USA
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, School of Medicine, Tuft University, Boston, Massachusetts, USA
| | - Y Claire Wang
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Herman WH, Schillinger D, Bolen S, Boltri JM, Bullock A, Chong W, Conlin PR, Cook JW, Dokun A, Fukagawa N, Gonzalvo J, Greenlee MC, Hawkins M, Idzik S, Leake E, Linder B, Lopata AM, Schumacher P, Shell D, Strogatz D, Towne J, Tracer H, Wu S. The National Clinical Care Commission Report to Congress: Recommendations to Better Leverage Federal Policies and Programs to Prevent and Control Diabetes. Diabetes Care 2023; 46:255-261. [PMID: 36701592 PMCID: PMC9887614 DOI: 10.2337/dc22-1587] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/01/2022] [Indexed: 01/27/2023]
Abstract
The National Clinical Care Commission (NCCC) was established by Congress to make recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. The NCCC developed a guiding framework that incorporated elements of the Socioecological and Chronic Care Models. It surveyed federal agencies and conducted follow-up meetings with representatives from 10 health-related and 11 non-health-related federal agencies. It held 12 public meetings, solicited public comments, met with numerous interested parties and key informants, and performed comprehensive literature reviews. The final report, transmitted to Congress in January 2022, contained 39 specific recommendations, including 3 foundational recommendations that addressed the necessity of an all-of-government approach to diabetes, health equity, and access to health care. At the general population level, the NCCC recommended that the federal government adopt a health-in-all-policies approach so that the activities of non-health-related federal agencies that address agriculture, food, housing, transportation, commerce, and the environment be coordinated with those of health-related federal agencies to affirmatively address the social and environmental conditions that contribute to diabetes and its complications. For individuals at risk for type 2 diabetes, including those with prediabetes, the NCCC recommended that federal policies and programs be strengthened to increase awareness of prediabetes and the availability of, referral to, and insurance coverage for intensive lifestyle interventions for diabetes prevention and that data be assembled to seek approval of metformin for diabetes prevention. For people with diabetes and its complications, the NCCC recommended that barriers to proven effective treatments for diabetes and its complications be removed, the size and competence of the workforce to treat diabetes and its complications be increased, and new payment models be implemented to support access to lifesaving medications and proven effective treatments for diabetes and its complications. The NCCC also outlined an ambitious research agenda. The NCCC strongly encourages the public to support these recommendations and Congress to take swift action.
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Affiliation(s)
| | - Dean Schillinger
- University of California San Francisco and San Francisco General Hospital, San Francisco, CA
| | - Shari Bolen
- Case Western Reserve at The MetroHealth System, Cleveland, OH
| | - John M. Boltri
- Northeast Ohio Medical University College of Medicine, Rootstown, OH
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | | | - Paul R. Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Ayotunde Dokun
- Carver School of Medicine, University of Iowa, Iowa City, IA
| | - Naomi Fukagawa
- Beltsville Human Nutrition Research Center, U.S. Department of Agriculture Agricultural Research Service, Beltsville, MD
| | | | | | | | - Shannon Idzik
- School of Nursing, University of Maryland Baltimore, Baltimore, MD
| | - Ellen Leake
- International Board of Directors, Juvenile Diabetes Research Foundation, Jackson, MS
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Aaron M. Lopata
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Pat Schumacher
- Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, GA
| | | | | | - Jana Towne
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Howard Tracer
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD
| | - Samuel Wu
- Office of Minority Health, Department of Health and Human Service, Rockville, MD
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12
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Schillinger D, Bullock A, Powell C, Fukagawa NK, Greenlee MC, Towne J, Gonzalvo JD, Lopata AM, Cook JW, Herman WH. The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs for Population-Level Diabetes Prevention and Control: Recommendations From the National Clinical Care Commission. Diabetes Care 2023; 46:e24-e38. [PMID: 36701595 PMCID: PMC9887620 DOI: 10.2337/dc22-0619] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
The etiology of type 2 diabetes is rooted in a myriad of factors and exposures at individual, community, and societal levels, many of which also affect the control of type 1 and type 2 diabetes. Not only do such factors impact risk and treatment at the time of diagnosis but they also can accumulate biologically from preconception, in utero, and across the life course. These factors include inadequate nutritional quality, poor access to physical activity resources, chronic stress (e.g., adverse childhood experiences, racism, and poverty), and exposures to environmental toxins. The National Clinical Care Commission (NCCC) concluded that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be treated as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions that facilitate the prevention and treatment of diabetes. This article reviews the rationale, scientific evidence base, and content of the NCCC's population-wide recommendations that address food systems; consumption of water over sugar-sweetened beverages; food and beverage labeling; marketing and advertising; workplace, ambient, and built environments; and research. Recommendations relate to specific federal policies, programs, agencies, and departments, including the U.S. Department of Agriculture, the Food and Drug Administration, the Federal Trade Commission, the Department of Housing and Urban Development, the Environmental Protection Agency, and others. These population-level recommendations are transformative. By recommending health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, costs, and inequities. Substantial political resolve will be needed to translate recommendations into policy. Engagement by diverse members of the diabetes stakeholder community will be critical to such efforts.
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Affiliation(s)
- Dean Schillinger
- Division of General Internal Medicine, Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco School of Medicine, San Francisco, CA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Clydette Powell
- Division of Neurology, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi K. Fukagawa
- Beltsville Human Nutrition Research Center, U.S. Department of Agriculture Agricultural Research Service, Beltsville, MD
| | | | - Jana Towne
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Jasmine D. Gonzalvo
- Center for Health Equity and Innovation, Purdue University/Eskenazi Health, Indianapolis, IN
| | - Aaron M. Lopata
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | | | - William H. Herman
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
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13
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Bhawra J, Kirkpatrick SI, Hall MG, Vanderlee L, Thrasher JF, Jáuregui de la Mota A, Hammond D. A five-country study of front- and back-of-package nutrition label awareness and use: patterns and correlates from the 2018 International Food Policy Study. Public Health Nutr 2023; 26:275-286. [PMID: 36284083 PMCID: PMC11077451 DOI: 10.1017/s1368980022002257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to identify correlates of nutrition label awareness and use, particularly subgroup differences among consumers. Two label types were assessed: (1) nutrition facts tables (NFt) in Australia, Canada, Mexico, UK, and USA and (2) front-of-package (FOP) labels, including mandatory Guideline Daily Amounts (Mexico), voluntary Health Star Ratings (Australia) and voluntary Traffic Lights (UK). DESIGN Respondents were recruited using Nielsen Consumer Insights Global Panel (n 21 586) and completed online surveys in November-December 2018. Linear regression and generalised linear mixed models examined differences in label use and awareness between countries and label type based on sociodemographic, knowledge-related and dietary characteristics. SETTING Australia, Canada, Mexico, UK and USA. PARTICIPANTS Adults (≥18 years). RESULTS Respondents from the USA, Canada and Australia reported significantly higher NFt use and awareness than those in Mexico and the UK. Mexican respondents reported the highest level of FOP label awareness, whereas UK respondents reported the highest FOP label use. NFt use was higher among females, 'minority' ethnic groups, those with higher nutrition knowledge and respondents with 'adequate literacy' compared with those with 'high likelihood of limited literacy'. FOP label use was higher among those with a 'high likelihood of limited literacy' compared with 'adequate literacy' across countries. CONCLUSIONS Lower use of mandatory Guideline Daily Amount labels compared with voluntary FOP labelling systems provides support for Mexico's decision to switch to mandatory 'high-in' warning symbols. The patterns of consumer label use and awareness across sociodemographic and knowledge-related characteristics suggest that simple FOP labels may encourage broader use across countries.
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Affiliation(s)
- Jasmin Bhawra
- School of Occupational and Public Health, Faculty of Community
Services, Toronto Metropolitan University, Toronto,
ON, Canada
| | - Sharon I Kirkpatrick
- School of Public Health Sciences, Faculty of Health,
University of Waterloo, Waterloo,
ONN2L 3G1, Canada
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public
Health, and Lineberger Comprehensive Cancer Center, University of North
Carolina, Chapel Hill, NC,
USA
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, Santé et Société (Centre
NUTRISS) and Institut Sur la Nutrition et les Aliments Fonctionnels (INAF),
Université Laval, Québec,
Canada
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold
School of Public Health, University of South Carolina,
Columbia, SC, USA
| | | | - David Hammond
- School of Public Health Sciences, Faculty of Health,
University of Waterloo, Waterloo,
ONN2L 3G1, Canada
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14
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Chin C, Wicks M, Feyasa M, Koen N. Food and nutrition labelling as a nutrition education tool: understanding, perspectives and practices of South African dietitians. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2135186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- C Chin
- Division of Human Nutrition, Stellenbosch University, Stellenbosch, South Africa
| | - M Wicks
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - M Feyasa
- Division of Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, South Africa
| | - N Koen
- Division of Human Nutrition, Stellenbosch University, Stellenbosch, South Africa
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15
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Wei H, Jiang K, Liu B, Hu Z, Zhao Y, Xu H, Sharma M, Pu C. Understanding and Use of Nutrition Labels of Prepackaged Food by University Students: A Cross-Sectional Study in Chongqing, China. Nutrients 2022; 14:4189. [PMID: 36235839 PMCID: PMC9573194 DOI: 10.3390/nu14194189] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECT The correct use of nutrition labels for prepackaged food helps university students develop healthy eating habits and prevent the occurrence of chronic non-communicable diseases. This study evaluates the understanding and use of nutrition labels of prepackaged food by university students in four different fields of study in Chongqing, China. METHODS This cross-sectional study used an online survey platform conducted in July 2022 in colleges and universities in Chongqing, China. The convenience sampling method was used to select students in four different fields of study, including medicine, humanities, science and technology, and arts and sports. Ten questions were used to assess participants' understanding of nutrition labels. A score of six or above (60%) indicates that the respondent has a basic understanding of the nutritional labels of prepackaged food. Descriptive statistics and generalized linear models (GLMs) were used to assess participants' understanding and use of nutrition labels for prepackaged foods and their influencing factors. RESULTS A total of 1262 valid questionnaires was collected. The average age of the participants was 21.8 years (SD: 2.43), 50.1% were male, 80.8% were ethnic Han, and 50.9% were from rural areas. Only 21.3% of the university students in Chongqing had a good understanding of the nutrition labels of prepackaged food, where medical students were the highest (39.9%) and science and engineering students were the lowest (15.6%). Gender, ethnicity, grade, major, and whether received courses related to nutrition were influential factors in the understanding and use of nutrition labels of prepackaged food. Medical students also had more positive attitudes toward nutritional labels of prepackaged food. CONCLUSIONS Understanding and use of nutrition labels for prepackaged food by university students in Chongqing are unsatisfactory. Student's major was a significant influencing factor in nutrition label comprehension, with medical students having the greatest understanding. Based on these results, we suggest that nutrition and health courses should be popularized among non-medical students to narrow the differences between different fields of study. For university students in all fields of study, education and publicity of nutrition labels of prepackaged food are needed, not only in the classroom but also in daily life.
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Affiliation(s)
- Hao Wei
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Collaborative Innovation Center for Early Warning of Health-Related Major Social Risks, Chongqing Medical University Sub Center, Chongqing 400016, China
| | - Ke Jiang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Boya Liu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Collaborative Innovation Center for Early Warning of Health-Related Major Social Risks, Chongqing Medical University Sub Center, Chongqing 400016, China
| | - Zhichuan Hu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Yong Zhao
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Child Nutrition and Health, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Hong Xu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Collaborative Innovation Center for Early Warning of Health-Related Major Social Risks, Chongqing Medical University Sub Center, Chongqing 400016, China
| | - Manoj Sharma
- Department of Social and Behavioral Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Chuan Pu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Collaborative Innovation Center for Early Warning of Health-Related Major Social Risks, Chongqing Medical University Sub Center, Chongqing 400016, China
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16
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Maganja D, Trieu K, Reading M, Huang L, Hart AC, Taylor F, Stamatellis S, Arnott C, Feng X, Schutte AE, Di Tanna GL, Ni Mhurchu C, Cameron AJ, Huffman MD, Neal B, Wu JH. Protocol for a novel sodium and blood pressure reduction intervention targeting online grocery shoppers with hypertension - the SaltSwitch Online Grocery Shopping randomized trial. Am Heart J 2022; 252:70-83. [PMID: 35777455 DOI: 10.1016/j.ahj.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND High dietary sodium intake is a leading cause of hypertension. A major source of dietary sodium is salt added to processed food products available in retail food environments. The fast-growing online grocery shopping setting provides new opportunities for salt reduction interventions that support consumers in choosing healthier options. METHODS The SaltSwitch Online Grocery Shopping randomized controlled trial is investigating the feasibility, acceptability, and effectiveness of a novel intervention for lowering salt consumption and blood pressure amongst people with hypertension who shop for groceries online. The intervention is based on a bespoke web browser extension that interfaces with a major retailer's online store to highlight and interpret product sodium content and suggest similar but lower-sodium alternatives. The primary outcome of interest is change in mean systolic blood pressure between individuals randomized (1:1) to the intervention and control (usual online shopping) arms at 12 weeks. Secondary outcomes are diastolic blood pressure, spot urinary sodium and sodium:potassium ratio, sodium purchases, and dietary intake. Intervention implementation and lessons for future uptake will be assessed using a mixed methods process evaluation. Participants with hypertension who shop online for groceries and exhibit high sodium purchasing behavior are being recruited across Australia. A target sample size of 1,966 provides 80% power (2-sided alpha = 0.05) to detect a 2 mm Hg difference in systolic blood pressure between groups, assuming a 15 mm Hg standard deviation, after allowing for a 10% dropout rate. DISCUSSION This trial will provide evidence on an innovative intervention to potentially reduce salt intake and blood pressure in people with hypertension. The intervention caters to individual preferences by encouraging sustainable switches to similar but lower-salt products. If effective, the intervention will be readily scalable at low cost by interfacing with existing online retail environments.
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Affiliation(s)
- Damian Maganja
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Reading
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ashleigh Chanel Hart
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Fraser Taylor
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Steve Stamatellis
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Xiaoqi Feng
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Aletta E Schutte
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Adrian J Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Cardiovascular Division and Global Health Center, Washington University, St. Louis, MO
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology and Biostatistics, Imperial College London, South Kensington, London, United Kingdom
| | - Jason Hy Wu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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17
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Hoge A, Labeye M, Donneau AF, Nekoee HZ, Husson E, Guillaume M. Health Literacy and Its Associations with Understanding and Perception of Front-of-Package Nutrition Labels among Higher Education Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8751. [PMID: 35886603 PMCID: PMC9319699 DOI: 10.3390/ijerph19148751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: Nutrition labels on the front of food packages have increasingly become the focus of research. However, too few studies have placed special emphasis on nutritionally at-risk subpopulations, such as young adults or those with low literacy/numeracy skills. The present study aimed to assess both the perception and objective understanding of three front-of-package labeling (FOPL) formats currently in use on the Belgian market, i.e., the Nutri-Score, Reference Intakes, and Multiple Traffic Lights, among students of varying health literacy (HL) levels. (2) Methods: A web-based survey was carried out among 2295 students of tertiary education in the province of Liège, Belgium. The questionnaire included questions related to general characteristics, objective understanding, and perception in response to the assigned FOPL format and level of HL. (3) Results: With respect to objective understanding, the Nutri-Score outperformed all other labels across all HL levels, and it was similarly understood in students of varying HL levels. Several students' characteristics appeared to be associated with each cluster of perception, with the Nutri-Score cluster having the highest percentages of disadvantaged students, i.e., those with inadequate HL, from non-university institutions, with low self-estimated nutrition knowledge, and with low self-estimated diet quality. (4) Conclusion: Overall, the findings supported the Nutri-Score as particularly effective in guiding students in their food choices. Of particular importance is the fact that the summarized and graded color-coded nutritional label would be a useful strategy for those disadvantaged by limited HL.
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Affiliation(s)
- Axelle Hoge
- Department of Public Health, University of Liège, 4000 Liege, Belgium; (M.L.); (A.-F.D.); (H.Z.N.); (E.H.); (M.G.)
| | - Mathilde Labeye
- Department of Public Health, University of Liège, 4000 Liege, Belgium; (M.L.); (A.-F.D.); (H.Z.N.); (E.H.); (M.G.)
| | - Anne-Françoise Donneau
- Department of Public Health, University of Liège, 4000 Liege, Belgium; (M.L.); (A.-F.D.); (H.Z.N.); (E.H.); (M.G.)
- Biostatistics and Research Method Center, University of Liège, University Hospital of Liège, 4000 Liege, Belgium
| | - Halehsadat Zahraei Nekoee
- Department of Public Health, University of Liège, 4000 Liege, Belgium; (M.L.); (A.-F.D.); (H.Z.N.); (E.H.); (M.G.)
- Biostatistics and Research Method Center, University of Liège, University Hospital of Liège, 4000 Liege, Belgium
| | - Eddy Husson
- Department of Public Health, University of Liège, 4000 Liege, Belgium; (M.L.); (A.-F.D.); (H.Z.N.); (E.H.); (M.G.)
- Biostatistics and Research Method Center, University of Liège, University Hospital of Liège, 4000 Liege, Belgium
| | - Michèle Guillaume
- Department of Public Health, University of Liège, 4000 Liege, Belgium; (M.L.); (A.-F.D.); (H.Z.N.); (E.H.); (M.G.)
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18
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Bhawra J, Kirkpatrick SI, Hall MG, Vanderlee L, Thrasher JF, Hammond D. Correlates of Self-Reported and Functional Understanding of Nutrition Labels across 5 Countries in the 2018 International Food Policy Study. J Nutr 2022; 152:13S-24S. [PMID: 35274701 PMCID: PMC9188861 DOI: 10.1093/jn/nxac018] [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: 10/06/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nutrition 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. OBJECTIVES This 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. METHODS Adults (≥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. RESULTS Self-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). CONCLUSIONS Nutrition 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.
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Affiliation(s)
- Jasmin Bhawra
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Sharon I Kirkpatrick
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, México
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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19
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Beasant B, Lee G, Vaughan V, Lotfaliany M, Hosking S. Health literacy and cardiovascular disease prevention: a systematic scoping review protocol. BMJ Open 2022; 12:e054977. [PMID: 35676010 PMCID: PMC9185497 DOI: 10.1136/bmjopen-2021-054977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Health literacy is 'The skills and resources of a person to access, understand and use information to make decisions, and take action on their own health and healthcare'. Literature investigating cardiovascular disease (CVD) prevention and health literacy often exist in silos, only exploring one element of prevention. This protocol aims to establish a scoping method of articles investigating health literacy and CVD preventive practices or knowledge in lay populations. METHODS AND ANALYSIS A scoping review was deemed the most appropriate study design. The topic was conceptualised, with preliminary searching informing subsequent development of search strings. A search of the following databases will be conducted on 31 January 2022: MEDLINE, Global Health, PubMed, Embase, PsycINFO and CINAHL. Studies included will be published in English, of appropriate design, measuring health literacy and some aspect of primary CVD prevention in lay-populations. These criteria will be tested against 25 'pilot' articles from the results, undergoing necessary review before screening commences. A secondary author will screen 10% of abstracts, with a third subject-matter expert reviewing conflicts. ETHICS AND DISSEMINATION This review will be disseminated through peer-reviewed scholarly networks, most likely including journal publication and conference presentation. ARTICLE SUMMARY CVD is the leading cause of death around the world. This paper proposes an exploration of health literacy's relationship with CVD prevention as a whole, contrasting with the more segmented reviews currently published.
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Affiliation(s)
- Bonnie Beasant
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Georgie Lee
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Vanessa Vaughan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Mojtaba Lotfaliany
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Sarah Hosking
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
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20
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Kostecka M. The Effect of the "Colorful Eating Is Healthy Eating" Long-Term Nutrition Education Program for 3- to 6-Year-Olds on Eating Habits in the Family and Parental Nutrition Knowledge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041981. [PMID: 35206167 PMCID: PMC8872545 DOI: 10.3390/ijerph19041981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 12/04/2022]
Abstract
Background: Effective strategies for improving eating habits and dietary intake in preschoolers are essential for reducing the risk of chronic non-infectious diseases in later life. The aim of this study was to evaluate the effect of long-term nutrition education for 3- to 6-year-olds on parental nutrition knowledge. Methods: The study was conducted as part of the “Colorful Eating is Healthy Eating” nutrition education program that has been implemented in kindergartens in Lublin since 2016. A total of 11 kindergartens were involved in this stage of the program, and 733 parents consented to participate in the project. The study was divided into three stages. In the first stage all parents completed a questionnaire containing 54 items. In the next stage, 211 children from four randomly selected kindergartens participated in the “Colorful Eating Is Healthy Eating” educational program that lasted 7 months. In the third stage of the study, the parents of children who had completed the 7-month educational program and the parents of control group children once again completed the questionnaire. Results: A positive outcome of the educational program was that it contributed to a decrease in the consumption of sweetened hot beverages (p = 0.005) and an increase in water intake (p = 0.001). The nutrition education program was also successful in reducing the consumption of sweets. Children’s education improved the parents’ knowledge about dietary sources of fiber and the recommended fiber intake, and it contributed to the awareness that breakfast is the most important meal of the day. The program did not enhance the parents’ knowledge about snacking between meals or the role of sweetened beverages in dental caries, overweight and obesity. Conclusions: Long-term multi-stage nutrition education for children aged 3 to 6 years can be helpful in shaping families’ eating habits and improving parental nutrition knowledge. However, the program was less effective in eliminating the respondents’ preference for sweet-tasting foods.
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Affiliation(s)
- Malgorzata Kostecka
- Faculty of Food Science and Biotechnology, University of Life Sciences in Lublin, Akademicka 15, 20950 Lublin, Poland
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21
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Bawadi H, Al-Jayyousi GF, Shabana H, Boutefnouchet S, Eljazzar S, Ismail S. Innovative Nutrition Education: A Color-Coded Tool for Individuals with Low Literacy Level. Healthcare (Basel) 2022; 10:healthcare10020272. [PMID: 35206887 PMCID: PMC8871548 DOI: 10.3390/healthcare10020272] [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: 10/15/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: The food exchange system was developed to serve as an educational tool in helping individuals plan their own meals. This study aimed to develop a friendly-user food exchange list for individuals with a low literacy level; (2) Methods: A two-group, pre-test/post-test research study aimed to develop a friendly-user food exchange list for individuals with a low literacy level. Thirty female workers of low literacy were recruited. Participants were divided into two groups. Group one was taught how to use the standard exchange system, while group two was taught how to use the modified exchange system. Each participant was assigned a task of prepare a meal with a specified caloric content and macronutrient distribution. The task was assigned before and after the exchange list education session. Groups’ differences were tested using the chi-square test, and the analysis of variance (ANOVA); (3) Results: A higher percentage of participants in group two were able to plan daily diets that achieved the recommendations of fruits (p = 0.02), protein (p = 0.03), dairy (p < 0.001), carbohydrates (p < 0.001), and calories (p < 0.001). Moreover, diet plans prepared by group two had a higher healthy eating index (p < 0.001) when compared to diet plans prepared by group one. The modified exchange lists are a friendly-user tool that can be implemented for individuals with low literacy, since it relies on visual techniques.
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Affiliation(s)
- Hiba Bawadi
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (H.S.); (S.B.); (S.E.); (S.I.)
- Correspondence:
| | - Ghadir Fakhri Al-Jayyousi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Hala Shabana
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (H.S.); (S.B.); (S.E.); (S.I.)
| | - Sana Boutefnouchet
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (H.S.); (S.B.); (S.E.); (S.I.)
| | - Sereen Eljazzar
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (H.S.); (S.B.); (S.E.); (S.I.)
| | - Shrooq Ismail
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (H.S.); (S.B.); (S.E.); (S.I.)
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22
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Kotecki JE, Greene MA, Jones MM. Utilizing Health Literacy Measures to Assess the Content of a Food Quality Screener for Understandability and Actionability. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1973929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Jamshidi-Naeini Y, Moyo G, Napier C, Oldewage-Theron W. Food and beverages undermining elderly health: three food-based dietary guidelines to avoid or delay chronic diseases of lifestyle among the elderly in South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1947039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Gugulethu Moyo
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Carin Napier
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
- Centre for Longitudinal Research, The University of Auckland, Auckland, New Zealand
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
- Department of Sustainable Food Systems and Development, Free State University, Bloemfontein, South Africa
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24
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Rivera Rivero B, Makarova A, Sidig D, Niazi S, Abddelgader R, Mirza S, Joud H, Urfi M, Ahmed A, Jureyda O, Khan F, Swanson J, Siddique M, Weare-Regales N, Mirza AS. Nutritional Literacy Among Uninsured Patients With Diabetes Mellitus: A Free Clinic Study. Cureus 2021; 13:e16355. [PMID: 34414041 PMCID: PMC8364779 DOI: 10.7759/cureus.16355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Evaluate nutrition literacy in uninsured subjects with diabetes mellitus (DM) who presented to free diabetes management classes. Design This single-site, cross-sectional observational study recruited thirty subjects from a free clinic for uninsured patients to attend diabetes mellitus, self-management classes. Before starting the classes, DM care-related data were collected, and subjects were administered the Nutrition Literacy Assessment Instrument (NLit). The assessment covers six subscales in nutrition and categorizes results into three possible categories: the likelihood of poor nutrition literacy (NLit Score ≤ 44), the possibility of poor nutrition literacy (NLit Score- 45-57), and the likelihood of good nutrition literacy (NLit score ≥ 58). Results Median glycated haemoglobin (HbA1c) was 7.45% for study participants. The mean NLit score was 38.1 (SD ± 9.4), correlating with a likelihood of poor nutrition literacy. All participants had either likelihood or the possibility of poor nutrition literacy based on the NLit Assessment. There were no participants who scored in the range of likelihood of good nutrition literacy. Subjects who scored in the range of likelihood of poor nutrition literacy had a significantly higher mean HbA1c (8.6 %) than those who scored in the possibility of poor nutrition literacy (6.9 %, p=0.005). Conclusions Poor nutrition literacy is associated with worse glycemic control among uninsured subjects with diabetes mellitus.
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Affiliation(s)
| | - Alena Makarova
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Dina Sidig
- General Medicine, Red Crescent Clinic, Tampa , USA
| | - Saniya Niazi
- General Medicine, Red Crescent Clinic, Tampa, USA
| | | | - Sabbir Mirza
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Hadi Joud
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Mustafa Urfi
- Miscellaneous, University of South Florida College of Arts and Sciences, Tampa, USA
| | - Abdillahi Ahmed
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Omar Jureyda
- Miscellaneous, University of South Florida College of Arts and Sciences, Tampa, USA
| | - Firaas Khan
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Justin Swanson
- Miscellaneous, University of South Florida College of Public Health, Tampa, USA
| | - Maqsood Siddique
- Cardiology, James A. Hailey Veterans Affairs Medical Center, Tampa, USA
| | - Natalia Weare-Regales
- Endocrinology, Diabetes and Metabolism, James A. Hailey Veterans Affairs Medical Center, Tampa, USA
| | - Abu-Sayeef Mirza
- Internal Medicine, University of South Florida Morsani College of Medicine, Florida, USA
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25
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Holleman BC, van Os-Medendorp H, van den Bergh H, van Dijk LM, Linders YFM, Blom WM, Verhoeckx KCM, Michelsen-Huisman A, Houben GF, Knulst AC, Lentz LR. Poor understanding of allergen labelling by allergic and non-allergic consumers. Clin Exp Allergy 2021; 51:1374-1382. [PMID: 34288165 PMCID: PMC8519062 DOI: 10.1111/cea.13975] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
Background Understanding consumers’ interpretation of allergy information is crucial for effective food safety policies. We evaluated consumer understanding of allergy information on foods in controlled, experimental studies. Method Using 18 packaged foods, we evaluated consumer understanding of information about allergens in two experiments: First, a comparison of foods with no stated allergen versus allergen as a stated ingredient versus a precautionary allergen label (PAL); second, a comparison of three common variants of PAL. In each experiment, consumers with and without self‐reported food allergy were asked to estimate the risk of allergic reaction and to rate the comprehensibility of the allergen information. In the second experiment, consumers were also asked which form of PAL they preferred. Results Risk of reaction was assessed as high and low for foods with the allergen stated as ingredient, or without any mention of allergen. However, risk assessment for PAL varied and was judged as higher by non‐allergic than allergic participants (82% vs. 58%, p < .001). Understanding of risk associated with PAL also varied by health literacy (p < .001). Both allergic and non‐allergic consumers judged all forms of allergy information to be unclear, especially products with no allergy information for non‐allergic consumers. Products with a ‘Produced in a Factory’ PAL were perceived as less risky than ‘May contain’ or ‘Traces of’ PALs (p < .001), less than 40% of participants judged PAL information to be comprehensible, and participants preferred ‘May contain’ over the other PALs. Conclusion Both allergic and non‐allergic consumers find allergen information difficult to interpret on packaged foods and misunderstand PAL, incorrectly distinguishing different risk levels for different PAL wording. Clearer allergy information guidelines are called for, and the use of only one PAL wording is recommended.
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Affiliation(s)
- Bregje C Holleman
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Harmieke van Os-Medendorp
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,The Netherlands Organization for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Huub van den Bergh
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Liselotte M van Dijk
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - Yvette F M Linders
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - W Marty Blom
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Saxion University of Applied Science, School of Health, Deventer, The Netherlands
| | - Kitty C M Verhoeckx
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anouska Michelsen-Huisman
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert F Houben
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Saxion University of Applied Science, School of Health, Deventer, The Netherlands
| | - André C Knulst
- Department of Dermatology/ Allergology and Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leo R Lentz
- Utrecht Institute for Linguistics OTS, Utrecht University, Utrecht, The Netherlands
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26
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Food Insecurity and Food Label Comprehension among Libyan Migrants in Australia. Nutrients 2021; 13:nu13072433. [PMID: 34371942 PMCID: PMC8308906 DOI: 10.3390/nu13072433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
Food security among migrants and refugees remains an international public health issue. However, research among ethnic minorities in Australia is relatively low. This study explored the factors that influence the understanding of food labelling and food insecurity among Libyan migrants in Australia. An online survey was completed by 271 Libyan migrant families. Data collection included the 18-item US Household Food Security Survey Module (for food security) and a question from the Food Standards Australia New Zealand Consumer Label Survey (for food labelling comprehension). Multivariable logistic regression modelling was utilised to identify the predictors of food label comprehension and food security. Food insecurity prevalence was 72.7% (n = 196) while 35.8% of families (n = 97) reported limited food label understanding. Household size, food store location, and food affordability were found to be significantly related to food insecurity. However, gender, private health insurance, household annual income, education, and food store type and location were found to be significantly related to food labelling comprehension. Despite the population’s high educational status and food labelling comprehension level, food insecurity remained an issue among the Libyan migrants. Policy makers should consider the incorporation of food label comprehension within a broader food security approach for migrants.
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27
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Choi H, Northup T, Reid LN. How Health Consciousness and Health Literacy Influence Evaluative Responses to Nutrient-Content Claimed Messaging for an Unhealthy Food. JOURNAL OF HEALTH COMMUNICATION 2021; 26:350-359. [PMID: 34240681 DOI: 10.1080/10810730.2021.1946217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Guided by the theoretical frameworks of the "health halo effect" and consumer expertise, this research was undertaken to determine how two individual factors, health consciousness and health literacy, differentially influence evaluations of nutrient-content claimed messaging for an unhealthy food (i.e., chocolate) and whether such evaluations are moderated by the reading of the food's Nutrition Facts Label displaying different serving sizes. The research found that health consciousness positively influenced evaluative responses to unhealthy food messaging, and that the positive influence persisted following the reading of a Nutrition Facts label listing a large quantity of unhealthy ingredients per serving size. In contrast, health literacy negatively influenced perceived healthiness and purchase intention when the nutrition label communicated a higher serving size, indicating that subjective and objective expertise work differently. The results advance understanding of the information processing of nutrient-claimed unhealthy foods, and suggest implications for food marketing communication and public health policy.
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Affiliation(s)
- Hojoon Choi
- Jack J. Valenti School of Communication, College of Liberal Arts and Social Sciences, University of Houston, Houston, Texas, USA
| | - Temple Northup
- School of Journalism & Media Studies, College of Professional Studies and Fine Arts, San Diego State University, San Diego, California, USA
| | - Leonard N Reid
- Professor Emeritus of Advertising, Department of Advertising & Public Relations, University of Georgia, Athens, Georgia, USA
- Robertson School of Media and Culture, Virginia Commonwealth University, Richmond, Virginia, USA
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28
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Vergeer L, Franco-Arellano B, Tjong GB, Bernstein JT, L’Abbé MR. The Level of Processing, Nutritional Composition and Prices of Canadian Packaged Foods and Beverages with and without Gluten-Free Claims. Nutrients 2021; 13:nu13041183. [PMID: 33918418 PMCID: PMC8066194 DOI: 10.3390/nu13041183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022] Open
Abstract
Little is known about the healthfulness and cost of gluten-free (GF) foods, relative to non-GF alternatives, in Canada. This study compared the extent of processing, nutritional composition and prices of Canadian products with and without GF claims. Data were sourced from the University of Toronto Food Label Information Program (FLIP) 2013 (n = 15,285) and 2017 (n = 17,337) databases. Logistic regression models examined the association of NOVA processing category with GF claims. Calorie/nutrient contents per 100 g (or mL) were compared between GF and non-GF products. Generalized linear models compared adjusted mean prices per 100 g (or mL) of products with and without GF claims. The prevalence of GF claims increased from 7.1% in 2013 to 15.0% in 2017. GF claims appeared on 17.0% of ultra-processed foods, which were more likely to bear GF claims products than less-processed categories. Median calories and sodium were significantly higher in GF products; no significant differences were observed for saturated fat or sugars. Compared to non-GF products, adjusted mean prices of GF products were higher for 10 food categories, lower for six categories and not significantly different for six categories. Overall, GF claims are becoming increasingly prevalent in Canada; however, they are often less healthful and more expensive than non-GF alternatives, disadvantaging consumers following GF diets.
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Affiliation(s)
- Laura Vergeer
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (L.V.); (B.F.-A.); (G.B.T.); (J.T.B.)
| | - Beatriz Franco-Arellano
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (L.V.); (B.F.-A.); (G.B.T.); (J.T.B.)
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Gabriel B. Tjong
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (L.V.); (B.F.-A.); (G.B.T.); (J.T.B.)
| | - Jodi T. Bernstein
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (L.V.); (B.F.-A.); (G.B.T.); (J.T.B.)
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (L.V.); (B.F.-A.); (G.B.T.); (J.T.B.)
- Correspondence: ; Tel.: +1-416-946-7545
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29
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Consumers' Implicit and Explicit Recall, Understanding and Perceptions of Products with Nutrition-Related Messages: An Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218213. [PMID: 33172128 PMCID: PMC7664426 DOI: 10.3390/ijerph17218213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022]
Abstract
This study aimed to assess consumers' implicit and explicit recall, understanding and perceptions of products with a nutrition claim and a symbol depicting 'health,' and to determine whether these perceptions differed among Nutrition Facts table (NFt) users vs. nonusers. In an online survey, participants (n = 1997) were randomized to one of eight conditions in a 2 × 2 × 2 factorial design, consisting of a label with a claim (present/absent) a heart-shaped symbol depicting 'health' (present/absent) for a healthier or less healthy soup. Participants were shown a label for 10 s and asked whether they recalled seeing a claim. If participants answered yes, they were then asked to describe their response using open-ended questions. Participants also rated the product's perceived nutritional quality and purchase intentions using seven-point Likert scales. In the claim condition, most participants (75%) were able to recall the presence of a claim, while 12% incorrectly mentioned the presence of a claim when there was none. Claims likely attracted consumers' attention and increased perceived nutritional quality, although with limited influence among NFt users (23%). The symbol depicting 'health' did not enhance perceived nutritional quality or purchase intentions. Although most participants (77%) made their decisions implicitly using the front of labels, those who used the NFt had a better understanding of the nutritional quality of products.
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30
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Naorungroj S. Sugary Snack Consumption and Tooth Retention among Middle-aged Thai Adults. J Int Soc Prev Community Dent 2020; 10:394-401. [PMID: 33042879 PMCID: PMC7523934 DOI: 10.4103/jispcd.jispcd_249_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/09/2020] [Accepted: 05/29/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives: This study investigated whether the habit of consuming sugary snacks was independently associated with the loss of permanent teeth. Materials and Methods: Eight hundred ninety-seven adults aged 35–65 from four communities in the lower regions of Southern Thailand completed a structured questionnaire interview and dental examinations. The independent variable was frequency of sweet snack consumption between meals in the previous week and coded as: never (0 days), occasionally (1–4 days), or frequently (≥5 days). The outcome was the number of permanent teeth (1–19 vs. ≥20 teeth). Multivariate logistic regression was used to examine the adjusted associations between sugary snack consumption and the number of retained teeth. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results: Approximately 23% of participants retained fewer than 20 permanent teeth. Approximately 30% of participants reported sugary snack intake most days. Fewer teeth were positively associated with high-frequency sugary snack consumption, older age, Muslim, ≤ 6 years of education, universal healthcare, infrequent tooth brushing, smoking, and alcohol consumption, but not sugar-sweetened beverages. After adjusting for sociodemographic characteristics and other potential confounders, the odds of having fewer teeth were higher among participants who frequently consumed sugary snacks (OR = 2.03, 95% CI = 1.21–3.39), but was not significantly different from those who occasionally consumed sugary snacks (OR = 0.93; 95% CI = 0.58–1.50) compared to nonsugary snack consumers. Conclusion: In this study, habitual sugary snack intake was associated with fewer teeth among middle-aged Thai adults. To improve oral health and prevent further tooth loss, efforts to reduce sugary snack consumption would be needed.
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Affiliation(s)
- Supawadee Naorungroj
- Department of Conservative Dentistry, Prince of Songkla University, Hat Yai, Thailand.,Common Oral Diseases and Oral Epidemiology Research Center, Prince of Songkla University, Hat Yai, Thailand.,Prosthodontics and Occlusion Rehabilitation Research Unit, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Thailand
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31
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Lorini C, Lastrucci V, Paolini D, Bonaccorsi G. Measuring health literacy combining performance-based and self-assessed measures: the roles of age, educational level and financial resources in predicting health literacy skills. A cross-sectional study conducted in Florence (Italy). BMJ Open 2020; 10:e035987. [PMID: 33020080 PMCID: PMC7537461 DOI: 10.1136/bmjopen-2019-035987] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The objective was to compare the results of performance-based and self-assessed measures of health literacy (HL) and to evaluate the contribution of their joint use in assessing some HL antecedents. DESIGN This was a cross-sectional study. SETTING The study was conducted on the general population in Florence (Italy). PARTICIPANTS This study is part of a larger one, where participants were randomly selected from the registries of 11 general practitioners working in the municipality of Florence. Inclusion criteria were the following: 18-69 years of age and Italian speaking. Exclusion criteria included cognitive impairment, severe psychiatric disease or end-stage disease. In this paper, 212 adults were included. OUTCOME MEASURES HL was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the Newest Vital Sign (NVS). The HL levels obtained by means of the two measurement tools were combined into a new variable that described three different levels of HL skills: low HL skills, partial HL skills and high HL skills. Multivariate ordinal logistic regression analysis was performed to assess the predictive roles of age class, educational level and financial resources with respect to HL skills. RESULTS Twenty-two per cent of the sample had high HL skills, 28.3% had low HL skills and 49.5% had partial HL skills. Educational level, age class and financial resources were significantly associated with HL skills, with OR values being higher than those obtained using the NVS or the HLS-EU-Q16 individually. CONCLUSION The combination of the results obtained using the NVS and the HLS-EU-Q16 improves the understanding of HL. The new variable generated by this combination could be considered as a different way to assess HL and its multidimensional contents.
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Affiliation(s)
- Chiara Lorini
- Department of Health Sciences, University of Florence, Firenze, FI, Italy
| | - Vieri Lastrucci
- Department of Health Sciences, University of Florence, Firenze, FI, Italy
| | - Diana Paolini
- Department of Health Sciences, University of Florence, Firenze, FI, Italy
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Abstract
Objectives: To collect and summarise all current data from observational studies, generating evidence of the association between health literacy (HL) and the dietary intake of sugar, salt and fat, to analyse intervention studies on the promotion of an appropriate dietary intake of the above-mentioned nutrients and to ascertain whether HL moderates the efficacy of such intervention. Design: A systematic literature search of analytical observational studies on the association between HL and dietary intake of sugar, salt and fat was performed in Medline and Scopus databases. Intervention studies on the promotion of healthy nutrition that concerned the intake of sugar, salt and fat were also assessed. Results: Of the eight observational studies included in this review, five investigated dietary intake of sugar, one focused on salt, one assessed sugar and salt and one analysed the fat intake. The results of the five studies assessing sugar were mixed: three found an association between low levels of HL and a high sugar intake, one found this association only for boys and two found no evidence of any association. The two studies assessing salt and the one assessing fat found no evidence of any association with HL. One intervention study on the sugar intake concluded that HL was not a significant moderator of the intervention’s effectiveness. Conclusion: No evidence of any association between HL and salt and fat intake emerged, while for sugar, the results are mixed. More work is needed to better understand the moderating effects of HL on the outcomes of health promotion interventions.
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Lobstein T, Neveux M, Landon J. Costs, equity and acceptability of three policies to prevent obesity: A narrative review to support policy development. Obes Sci Pract 2020; 6:562-583. [PMID: 33082998 PMCID: PMC7556431 DOI: 10.1002/osp4.423] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022] Open
Abstract
Obesity prevention policies are a priority for many governments and intergovernmental agencies. Policy makers not only use systematic reviews of effectiveness but also consider contextual issues including cost and cost‐effectiveness, equity, rights, acceptability and feasibility. To support their work, the present narrative review examines three contextual issues (costs, equity and acceptability) in relation to three policies for obesity prevention: sweetened beverage taxes, front‐of‐pack nutrition labelling and restrictions on advertising to children. Literature searches led to over 1100 documents, of which 125 informed the present review. Beverage taxes were found likely to be highly cost‐effective, moderately favourable for health equity, supported by the public (depending on the use of revenues) and by health professionals and civil society groups and opposed by commercial interests. Depending on the design, front‐of‐pack nutritional labelling is likely to be highly cost‐effective, moderately favourable for health equity, supported by the public, health professionals and civil society groups, and opposed by commercial interests. Restrictions on child‐directed advertising are likely to be highly cost‐effective in the longer term, moderately favourable for health equity, supported by the public, health professionals and civil society groups and opposed by commercial interests (unless voluntary). The evidence base needs strengthening, but the authors find that all three policies merit consideration by governmental authorities, and should be implemented to reduce obesity risk.
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Affiliation(s)
- Tim Lobstein
- Policy Department World Obesity Federation London UK.,The Boden Institute, Charles Perkins Centre The University of Sydney Sydney New South Wales Australia
| | - Margot Neveux
- Policy Department World Obesity Federation London UK
| | - Jane Landon
- Policy Department UKPH Consultancy London UK
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Chen YC, Huang YL, Chien YW, Chen MC. The Effect of an Online Sugar Fact Intervention: Change of Mothers with Young Children. Nutrients 2020; 12:E1859. [PMID: 32580451 PMCID: PMC7353269 DOI: 10.3390/nu12061859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
Research indicates that high sugar intake in early childhood may increase risks of tooth decay, obesity and chronic disease later in life. In this sugar fact study, we explored whether an online intervention which focused on comprehensive and useful information about nutrition labels impacted mother's choice of low sugar food. The intervention was developed on the basis of the theory of planned behavior. In total, 122 mothers were recruited. Mothers were divided into an online-only group and a plus group. Knowledge of sugar and nutrition labels, behavioral attitudes, perceived behavioral control, behavioral intentions and behavior towards purchasing low-sugar products with nutrition labels were collected. After the intervention, both groups exhibited significantly enhanced sugar and nutrition label knowledge, perceived behavioral control, behavioral intentions and behavior. Compared to the online-only group, knowledge, perceived behavioral control and behavior of the plus group significantly improved. After the intervention, about 40% of the plus group and 80% of the online-only group still did not know the World Health Organization (WHO) sugar recommendations. Understanding sugar recommendations and using nutrition labels are crucial to help people control calorie and sugar intake. Further research with a larger sample is warranted to evaluate the effects of the intervention on long-term changes in shopping behavior. More efficient and convenient nutrition education is required to increase public awareness of sugar recommendations and help people control calorie and sugar intake.
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Affiliation(s)
- Yi-Chun Chen
- School of Nutrition and Health Sciences, Taipei Medical University, Xinyi District, Taipei City 110, Taiwan; (Y.-W.C.); (M.C.C.)
- Research Center of Health Equity, College of Public Health, Taipei Medical University, Xinyi District, Taipei City 110, Taiwan;
| | - Ya-Li Huang
- Research Center of Health Equity, College of Public Health, Taipei Medical University, Xinyi District, Taipei City 110, Taiwan;
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Xinyi District, Taipei City 110, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Xinyi District, Taipei City 110, Taiwan
| | - Yi-Wen Chien
- School of Nutrition and Health Sciences, Taipei Medical University, Xinyi District, Taipei City 110, Taiwan; (Y.-W.C.); (M.C.C.)
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Xinyi District, Taipei City 110, Taiwan
| | - Mei Chun Chen
- School of Nutrition and Health Sciences, Taipei Medical University, Xinyi District, Taipei City 110, Taiwan; (Y.-W.C.); (M.C.C.)
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Mansfield E, Wahba R, De Grandpré E. Integrating a Health Literacy Lens into Nutrition Labelling Policy in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114130. [PMID: 32531887 PMCID: PMC7312128 DOI: 10.3390/ijerph17114130] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022]
Abstract
An increasingly important concern in public health practice is health literacy. Simply stated, it refers to the interactions between individuals and health related information to make informed decisions concerning their health. Research shows that consumers face many health literacy challenges in accessing, understanding and evaluating nutrition labelling information when making food choices. The systematic integration of health literacy considerations into social science and consumer behaviour research can help address these challenges and better meet the needs of the increasingly diverse Canadian population. This application of a health literacy lens should be considered for all future food and nutrition labelling research, to maximize the positive impact of subsequent health policies and regulations on health outcomes and health status of Canadians.
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Franco-Arellano B, Vanderlee L, Ahmed M, Oh A, L'Abbé M. Influence of front-of-pack labelling and regulated nutrition claims on consumers’ perceptions of product healthfulness and purchase intentions: A randomized controlled trial. Appetite 2020; 149:104629. [DOI: 10.1016/j.appet.2020.104629] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 01/17/2023]
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Grutzmacher S, Munger A, Messina L, Downes K. Screening for Health Literacy among SNAP-eligible Adults Using the Newest Vital Sign: Implications for Nutrition Facts Label Policy and Education. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2019.1590277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Stephanie Grutzmacher
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Ashley Munger
- Department of Child and Family Studies, California State University, Los Angeles, CA, USA
| | - Lauren Messina
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Katheryne Downes
- Florida Orthopaedic Institute and Foundation for Orthopaedic Research and Education, Tampa, FL, USA
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Blair M, Kellow NJ, Dordevic AL, Evans S, Caissutti J, McCaffrey TA. Health Benefits of Whey or Colostrum Supplementation in Adults ≥35 Years; a Systematic Review. Nutrients 2020; 12:E299. [PMID: 31979025 PMCID: PMC7070284 DOI: 10.3390/nu12020299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 01/20/2023] Open
Abstract
Food-health claims are an important method of translating nutrition research to consumers. Whey and colostrum are thought to exert health benefits to adults, but it is unclear what measurable, objective health benefits they impart. This review aimed to identify the objective health benefits of bovine whey or colostrum-based beverages to healthy adults aged ≥35 years to substantiate a food-health claim. Seven databases were systematically searched. Eligible articles were RCTs that involved healthy adults aged ≥35 years, consuming whey or colostrum in beverage form and measuring objective health markers. Quality assessment and data extraction was conducted in duplicate. The searches identified 9943 papers and 16 were included in this review; 13 studies, reported across 15 papers, related to whey, one study to colostrum. The outcomes identified were body composition, bone mineral density, biochemical markers, such as blood glucose and lipids, and muscle strength and synthesis. Heterogeneous outcomes, high risk of bias and inconsistent findings resulted in inconclusive evidence to substantiate a food-health claim. Clearer reporting and consensus on a minimum set of objective measures would allow for more robust recommendations regarding food-health claims. Protecting consumers from misleading health claims will require collaboration between regulators, researchers, and the food industry.
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Affiliation(s)
| | | | | | | | | | - Tracy A. McCaffrey
- Department of Nutrition, Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Road, Melbourne, VIC 3168, Australia; (M.B.); (N.J.K.); (A.L.D.); (S.E.); (J.C.)
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WFPHA: World federation of public health associations : Balanced influence is needed for front-of-pack labelling to protect the health of the public. J Public Health Policy 2019; 41:102-106. [PMID: 31548587 DOI: 10.1057/s41271-019-00188-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Santos-Antonio G, Bravo-Rebatta F, Velarde-Delgado P, Aramburu A. [Effects of front-of-package nutritional labeling of food and beverages: synopsis of systematic reviewsEfeitos da rotulagem nutricional frontal de alimentos e bebidas: sumário de estudos de revisão sistemática]. Rev Panam Salud Publica 2019; 43:e62. [PMID: 31456819 PMCID: PMC6692502 DOI: 10.26633/rpsp.2019.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/15/2019] [Indexed: 12/16/2022] Open
Abstract
Objetivos. Sintetizar la información disponible sobre el efecto del etiquetado nutricional frontal en la elección, compra y consumo de alimentos y bebidas, y el estado nutricional de los consumidores, e identificar los factores que influyen en su efectividad. Métodos. Se realizó una sinopsis de revisiones sistemáticas (RS) conforme a las recomendaciones PRISMA. La búsqueda bibliográfica se realizó en Medline (Pubmed), The Cochrane Library, LILACS, EBSCOhost y Scopus, limitada a estudios publicados en español o inglés sin restricción por fecha de publicación. La calidad metodológica se evaluó utilizando la herramienta AMSTAR 2. Resultados. Se incluyeron siete RS. El etiquetado frontal facilitó la elección de alimentos saludables y tuvo un efecto variable sobre las dimensiones de consumo y compra. Ninguna RS evaluó el efecto sobre el estado nutricional. El costo y sabor, los hábitos alimentarios, el nivel educativo y los sistemas dominantes de procesamiento de información en el consumidor influyeron en su efectividad. La mayoría de RS mostraron limitaciones metodológicas y un nivel de confianza críticamente bajo. Conclusiones. El etiquetado frontal tuvo efecto positivo en la elección de alimentos saludables, con resultados variables en las dimensiones de compra y consumo. Se necesitan estudios locales con una adecuada calidad metodológica para identificar el formato de etiquetado más efectivo en cada país. Su implementación como política de salud pública debe acompañarse de estrategias para mejorar el acceso a alimentos saludables, promover la actividad física y brindar educación nutricional a los consumidores.
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Affiliation(s)
- Gabriela Santos-Antonio
- Centro Nacional de Alimentación y Nutrición Centro Nacional de Alimentación y Nutrición Instituto Nacional de Salud Lima Perú Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Lima, Perú
| | - Fernando Bravo-Rebatta
- Centro Nacional de Alimentación y Nutrición Centro Nacional de Alimentación y Nutrición Instituto Nacional de Salud Lima Perú Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Lima, Perú
| | - Patricia Velarde-Delgado
- Centro Nacional de Alimentación y Nutrición Centro Nacional de Alimentación y Nutrición Instituto Nacional de Salud Lima Perú Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Lima, Perú
| | - Adolfo Aramburu
- Centro Nacional de Alimentación y Nutrición Centro Nacional de Alimentación y Nutrición Instituto Nacional de Salud Lima Perú Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Lima, Perú
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Backes JM, Melton BL, Ruisinger JF, Burkhardt CD, Moriarty PM. Comparing patients’ prescribed, self-reported, and actual intake of supplemental eicosapentaenoic acid + docosahexaenoic acid. J Clin Lipidol 2019; 13:170-175. [DOI: 10.1016/j.jacl.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 09/06/2018] [Accepted: 11/06/2018] [Indexed: 11/15/2022]
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Garza C, Stover PJ, Ohlhorst SD, Field MS, Steinbrook R, Rowe S, Woteki C, Campbell E. Best practices in nutrition science to earn and keep the public's trust. Am J Clin Nutr 2019; 109:225-243. [PMID: 30657846 PMCID: PMC6900562 DOI: 10.1093/ajcn/nqy337] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022] Open
Abstract
Public trust in nutrition science is the foundation on which nutrition and health progress is based, including sound public health. An ASN-commissioned, independent Advisory Committee comprehensively reviewed the literature and available public surveys about the public's trust in nutrition science and the factors that influence it and conducted stakeholder outreach regarding publicly available information. The Committee selected 7 overlapping domains projected to significantly influence public trust: 1) conflict of interest and objectivity; 2) public benefit; 3) standards of scientific rigor and reproducibility; 4) transparency; 5) equity; 6) information dissemination (education, communication, and marketing); and 7) accountability. The literature review comprehensively explored current practices and threats to public trust in nutrition science, including gaps that erode trust. Unfortunately, there is a paucity of peer-reviewed material specifically focused on nutrition science. Available material was examined, and its analysis informed the development of priority best practices. The Committee proposed best practices to support public trust, appropriate to ASN and other food and nutrition organizations motivated by the conviction that public trust remains key to the realization of the benefits of past, present, and future scientific advances. The adoption of the best practices by food and nutrition organizations, such as ASN, other stakeholder organizations, researchers, food and nutrition professionals, companies, government officials, and individuals working in the food and nutrition space would strengthen and help ensure earning and keeping the public's continued trust in nutrition science.
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Affiliation(s)
- Cutberto Garza
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Patrick J Stover
- College of Agriculture and Life Sciences, Texas A&M University, College Station, TX
| | | | - Martha S Field
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Robert Steinbrook
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Catherine Woteki
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA
| | - Eric Campbell
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Denver, CO
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Law QPS, Yau AHY, Chung JWY. Chinese adults' nutrition label literacy in Hong Kong: Implications for nurses. Nurs Health Sci 2018; 21:171-177. [PMID: 30345724 DOI: 10.1111/nhs.12575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 08/24/2018] [Accepted: 08/30/2018] [Indexed: 12/01/2022]
Abstract
The study aimed to investigate Chinese adults' nutrition label literacy in Hong Kong. It employed a web-based survey with structured questions. A total of 368 Chinese adults aged 18-59 participated in the survey and their nutrition label literacy was measured by the Newest Vital Sign (NVS). About two-thirds (68%) of the participants had limited nutrition literacy skills. Although they were able to identify correctly the calorie and sugar content of food products, 44% and 48% of them had difficulty in determining the consumption of calories and serving food sizes respectively. Another finding from the survey was that those with lower education level and of older age had significantly lower mean nutrition label literacy scores, which indicated that they were at higher risk for food insecurity. The findings showed that the nutrition label literacy level of Hong Kong's general public is quite low. This study can provide insights for nurses and healthcare professionals on how to educate people with lower education level and/or of advanced age to use nutrition labels more effectively and to further nutrition label literacy study and research, particularly in Hong Kong.
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Affiliation(s)
| | - Alice Hoi Ying Yau
- Centre for Applied English Studies and Centre for the Humanities and Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Joanne Wai Yee Chung
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong
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Moore SG, Donnelly JK, Jones S, Cade JE. Effect of Educational Interventions on Understanding and Use of Nutrition Labels: A Systematic Review. Nutrients 2018; 10:E1432. [PMID: 30287766 PMCID: PMC6213388 DOI: 10.3390/nu10101432] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022] Open
Abstract
The potential for nutrition labels to impact on population health is dependent on consumer ability to understand and use this information. Consumer understanding of this information varies across sociodemographic groups and with different label design formats. Labeling legislation requires consumer education on how to use nutrition labels, and recent mandatory changes to the Nutrition Facts Panel (NFP) are underway to improve comprehensibility. This review aimed to evaluate if educational programs can improve understanding and use of nutrition labels. Database searches were performed to identify interventions which delivered education on nutrition labels with outcomes measuring aspects of comprehension or use. A total of 17 studies were selected for review, including nine randomized and eight cohort studies. The majority of studies were conducted in the United States Study participants included school aged children, older adults, and those with diabetes within a range of intervention types involving taught sessions or web-based education. Whilst outcome measures were heterogenous, all studies reported a statistically significant improvement in one or more outcomes of participant understanding or use of nutrition labels. Aspects such as general nutrition knowledge, health literacy, and program delivery format warrant attention in future research. Education which optimizes comprehension and use of nutrition labels may have the potential to improve the impact of this information on dietary health.
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Affiliation(s)
- Sally G Moore
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK.
| | - Judy K Donnelly
- School of Health and Social Sciences, Leeds Trinity University, Leeds LS18 5HD, UK.
| | - Steve Jones
- School of Health and Social Sciences, Leeds Trinity University, Leeds LS18 5HD, UK.
| | - Janet E Cade
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK.
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Menu labels, for better, and worse? Exploring socio-economic and race-ethnic differences in menu label use in a national sample. Appetite 2018; 128:223-232. [PMID: 29894697 DOI: 10.1016/j.appet.2018.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 11/21/2022]
Abstract
Menu calorie labeling aims to empower customers to make healthier food choices, but researchers have questioned whether labels will empower those with greater health literacy, literacy or numeracy more, possibly reinforcing race-ethnic or socioeconomic inequalities in obesity. The goal of this study was to investigate differences in seeing and using restaurant menu calorie labels and whether differences have compounded over time. Using data from three rounds of the National Health and Nutrition Examination Survey covering the period 2007-2014, we investigate race-ethnic and socio-economic differences in menu label usage over time adjusting for sex, age and body weight. While menu label usage increased over time, not all groups increased their use equally. While we find that Blacks and Hispanics use labels more than Whites in sit-down restaurants, more educated individuals, higher income groups and Whites each increased the degree to which they saw and/or used labels in certain settings compared with other groups. This study reinforces concerns that menu-calorie labeling may exacerbate socio-economic and certain race-ethnic obesity differences. As menu labeling policy moves forward to be implemented federally, more attention may need to be diverted to educational campaigns accompanying the implementation and improving the labels so the information is easier to use.
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Mulders MDGH, Corneille O, Klein O. Label reading, numeracy and food & nutrition involvement. Appetite 2018; 128:214-222. [PMID: 29886052 DOI: 10.1016/j.appet.2018.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 05/23/2018] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
The purpose of this study was to investigate objective performance on a nutrition label comprehension task, and the influence of numeracy and food-related involvement on this performance level. A pilot study (n = 45) was run to prepare the scales in French. For the main study (n = 101), participants provided demographic information and answered the nutrition label survey, the short numeracy scale and two different food-related involvement scales (i.e. the food involvement scale and the nutrition involvement scale). Both studies were conducted online, and consent was obtained from all participants. Participants answered correctly only two-thirds of the nutrition label task items. Numeracy and food involvement scores were positively correlated with performance on this task. Finally, food involvement interacted with numeracy. Specifically, people scoring low in numeracy performed generally more poorly on the task, but if they had high food involvement scores, their performance increased. This suggests that high food-related motivation may compensate for poor numeracy skills when dealing with nutrition labels.
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Affiliation(s)
- Maria D G H Mulders
- Center for Social and Cultural Psychology, Université Libre de Bruxelles, Belgium.
| | - O Corneille
- Psychological Sciences Research Institute, Université Catholique de Louvain-la-Neuve, Belgium
| | - O Klein
- Center for Social and Cultural Psychology, Université Libre de Bruxelles, Belgium
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Gibbs HD, Ellerbeck EF, Gajewski B, Zhang C, Sullivan DK. The Nutrition Literacy Assessment Instrument is a Valid and Reliable Measure of Nutrition Literacy in Adults with Chronic Disease. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:247-257.e1. [PMID: 29246567 PMCID: PMC5845801 DOI: 10.1016/j.jneb.2017.10.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/12/2017] [Accepted: 10/19/2017] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To test the reliability and validity of the Nutrition Literacy Assessment Instrument (NLit) in adult primary care and identify the relationship between nutrition literacy and diet quality. DESIGN This instrument validation study included a cross-sectional sample participating in up to 2 visits 1 month apart. SETTING/PARTICIPANTS A total of 429 adults with nutrition-related chronic disease were recruited from clinics and a patient registry affiliated with a Midwestern university medical center. MAIN OUTCOME MEASURES Nutrition literacy was measured by the NLit, which was composed of 6 subscales: nutrition and health, energy sources in food, food label and numeracy, household food measurement, food groups, and consumer skills. Diet quality was measured by Healthy Eating Index-2010 with nutrient data from Diet History Questionnaire II surveys. ANALYSIS The researchers measured factor validity and reliability by using binary confirmatory factor analysis; test-retest reliability was measured by Pearson r and the intraclass correlation coefficient, and relationships between nutrition literacy and diet quality were analyzed by linear regression. RESULTS The NLit demonstrated substantial factor validity and reliability (0.97; confidence interval, 0.96-0.98) and test-retest reliability (0.88; confidence interval, 0.85-0.90). Nutrition literacy was the most significant predictor of diet quality (β = .17; multivariate coefficient = 0.10; P < .001). CONCLUSIONS The NLit is a valid and reliable tool for measuring nutrition literacy in adult primary care patients.
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Affiliation(s)
- Heather D Gibbs
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS.
| | - Edward F Ellerbeck
- Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Byron Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | - Chuanwu Zhang
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS
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Merks P, Świeczkowski D, Balcerzak M, Drelich E, Białoszewska K, Cwalina N, Krysinski J, Jaguszewski M, Pouliot A, Vaillancourt R. The evaluation of pharmaceutical pictograms among elderly patients in community pharmacy settings - a multicenter pilot study. Patient Prefer Adherence 2018; 12:257-266. [PMID: 29497281 PMCID: PMC5818874 DOI: 10.2147/ppa.s150113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The search for new ways to optimize the use of medications by patients has led the pharmaceutical community to promote the idea of introducing pictograms into routine practice. The main intention of pictograms is to ease patient adherence and to reduce potential risks or errors associated with the use of medications. PURPOSE To evaluate a series of pharmaceutical pictograms for patient comprehension. PATIENTS AND METHODS The study was conducted in community pharmacies within a European Union country that belongs to the professional research network. Structured interviews were used to evaluate the pictograms for patient comprehension. This consisted of an assessment of the following: the transparency and translucency of the pictograms, health literacy, and pictogram recall. Participants were also given the opportunity to provide feedback on how to improve the pictograms. The primary endpoint was pictogram comprehension. Secondary outcomes included recall of the pictograms and pictogram translucency. RESULTS The study included 68 patients with whom face-to-face interviews were performed. Low transparency results (≤25%) and extensive patient feedback in initial interviews led to the withdrawal of certain pictograms (n=15) from the evaluation. Among the pictograms included in the final stage of our research, 22 pictograms (62.8%) obtained an acceptable transparency level ≥66%. All pictograms passed the short-term recall test with positive results. CONCLUSION A majority of the designed and modified pictograms reached satisfactory guess-ability scores. Feedback from patients enabled modification of the pictograms and proved that patients have an important voice in the discussion regarding the design of additional pictograms.
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Affiliation(s)
- Piotr Merks
- Department of Pharmaceutical Technology, Collegium Medicum in Bydgoszcz, Nicolaus University in Torun, Bydgoszcz-Torun, Poland
- Piktorex Sp. z.o.o., Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
- Correspondence: Damian Świeczkowski; Miłosz Jaguszewski, First Department of Cardiology, Medical University of Gdansk, Dębinki 7, 80-952 Gdansk, Poland, Tel +48 73 202 2498, Email ;
| | | | | | | | - Natalia Cwalina
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Jerzy Krysinski
- Department of Pharmaceutical Technology, Collegium Medicum in Bydgoszcz, Nicolaus University in Torun, Bydgoszcz-Torun, Poland
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
- Correspondence: Damian Świeczkowski; Miłosz Jaguszewski, First Department of Cardiology, Medical University of Gdansk, Dębinki 7, 80-952 Gdansk, Poland, Tel +48 73 202 2498, Email ;
| | - Annie Pouliot
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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