Abstract
Few studies have compared the effects of different front-of-package label (FOPL) systems in the ‘real world’. This study assessed adults’ awareness, use and understanding of nutrition facts labels (NFLs) and nationally implemented FOPLs such as Health Star Ratings (HSR), Traffic lights, and Guideline Daily Amounts (GDAs) in five countries, including before and after implementation of Mexico’s warning FOPLs in 2020. Data were from the International Food Policy Study, an annual repeat cross-sectional study conducted in 2018-2020 among adults (N=64,032) in Australia, Canada, Mexico, the UK and the US. Self-reported awareness, use, and understanding of NFLs (in all five countries) and FOPLs (in Australia, Mexico, and UK) were assessed over time, between countries, and between NFLs and FOPLs. Most respondents in all countries reported seeing their country’s NFLs (awareness) ‘often’ or ‘all the time’ across all three years, with one third to half of respondents using NFLs ‘often’ or ‘all the time’ (Australia: 43-45%; Canada: 47-50%; Mexico: 36-39%; UK: 32-34%; US: 47-49%), and approximately one half to two thirds finding NFLs ‘easy’ or ‘very easy to understand’ (56-57%; 67-69%; 51-54%; 48-51%; 70-71%). In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were highest among all countries with a FOPL (p<0.001), whereas awareness and use were lowest for Australia's HSR (p<0.001). In countries with FOPLs, self-reported understanding was higher for FOPLs than NFLs, except for the GDA FOPL in Mexico. Only modest changes were observed over time. Warning FOPLs were associated with greater levels of self-reported awareness, use and understanding among adults compared to NFLs and GDA-based FOPLS. FOPLs implemented on a voluntary basis, such as Australia's HSR, may be less likely to be seen and used.
Generated Summary
This study employed a cross-sectional design within the International Food Policy Study (IFPS) to assess the awareness, use, and understanding of nutrition facts labels (NFLs) and front-of-package labels (FOPLs) among adults in Australia, Canada, Mexico, the UK, and the US. Data were collected annually from 2018 to 2020. The research examined the impact of Mexico’s 2020 implementation of warning FOPLs, comparing it with pre-existing GDA labels and also comparing awareness, use, and understanding of NFLs versus FOPLs in the different countries. The study used a natural experimental design, which allowed for the observation of changes in self-reported awareness, use, and understanding over time. The research measured self-reported awareness, use, and understanding of NFLs in all five countries, and FOPLs in Australia, Mexico, and the UK. The study’s methodology included a survey design, where participants were asked questions about their use, awareness, and understanding of nutrition labels. The data collection was conducted via web-based surveys with adults aged 18-100, recruited through the Nielsen Consumer Insights Global Panel and their partners’ panels. Statistical analyses were performed using the SURVEYLOGISTIC procedure for each primary outcome. Comparisons between NFL and FOPL awareness, use, and understanding were conducted by the GENMOD procedure.
Key Findings & Statistics
- Across all three years, the UK reported the lowest levels of NFL awareness (all comparisons p < .001).
- Canada showed the highest awareness.
- In Canada and the US, awareness of NFLs decreased from 2018 to 2019 and 2018 to 2020 (Canada: AOR = 0.86, 0.75-0.99, p = .042; US: AOR = 0.84, 0.74-0.97, p = .014; Canada: AOR = 0.87, 0.75-1.00, p = .048; US: AOR = 0.81, 0.70-0.92, p = .002).
- In Australia and the UK, awareness of NFLs increased from 2018 to 2019 (Australia: AOR = 1.15, 1.02-1.30, p = .022; UK: AOR = 1.20, 1.08-1.33, p < .001) and 2018 to 2020 (Australia: AOR = 1.12, 1.00-1.26, p = .045; UK: AOR = 1.14, 1.03-1.25, p = .010).
- In Mexico, awareness of NFLs increased between 2018 and 2020 (AOR = 1.24, 1.09-1.40, p < .001).
- Awareness of the HSR FOPL in Australia increased from 2018 to 2019 (AOR = 1.25, 1.13-1.38, p < .001) and 2018 to 2020 (AOR = 1.27, 1.15-1.40, p < .001).
- Awareness of the Traffic Light FOPL in the UK increased between 2018 and 2020 (AOR = 1.17, 1.06-1.29, p = .002).
- Awareness of Mexico’s GDA FOPL increased from 2018 to 2020 (AOR = 1.44, 1.27-1.63, p < .001) and from 2019 to 2020 (AOR = 1.30, 1.15-1.47, p < .001), and was higher for the new Warning FOPL in 2020 than the GDA FOPL in 2018 (AOR = 1.98, 1.73-2.25, p < .001) and 2019 (AOR = 1.79, 1.57-2.03, p < .001).
- In 2020, respondents in Australia were less likely to report seeing the HSR FOPL compared to NFLs (AOR = 0.27, 0.25-0.29, p < .001).
- In contrast, UK respondents were more likely to see the Traffic Light FOPL than NFLs (AOR = 1.18, 1.10-1.27, p < .001).
- In Mexico, respondents were more likely to report seeing the new Warning FOPL compared to both the NFL (AOR = 1.23, 1.09-1.38, p < .001) and the GDA FOPL (AOR = 1.36, 1.22-1.52, p < .001).
- Mexico respondents were less likely to report seeing the GDA FOPL compared to NFLs (AOR = 0.90, 0.82-0.99, p = .026).
- NFL use decreased from 2018 to 2020 in Canada (AOR = 0.88, 0.80-0.98, p = .015) and between 2019 and 2020 in Australia (AOR = 0.91, 0.82-1.00, p = .046).
- NFL use increased between 2018 and 2019 in the UK (AOR = 1.11, 1.00-1.24, p = .045) and Mexico (AOR = 1.12, 1.01-1.25, p = .39).
- Across the three years, respondents in Australia were less likely to report using their country’s FOPL than respondents in the UK for the Traffic Light FOPL and those in Mexico for the GDA FOPL (p < .001 for all comparisons).
- FOPL use was higher for the Traffic Light FOPL in the UK than the GDA FOPL in Mexico (AOR = 1.08, 1.01–1.16, p = .020).
- In Australia, FOPL use increased between 2018 and 2019 (AOR = 1.15, 1.02-1.29, p = .020) and between 2018 and 2020 (AOR = 1.19, 1.06-1.33, p = .003).
- Use of Mexico’s GDA FOPL increased between 2018 and 2020 (AOR = 1.13, 1.01-1.27, p = .027), and use was higher for Mexico’s new Warning FOPL in 2020 than for the GDA FOPL in 2018 (1.38, 1.24-1.54, p < .001) and 2019 (1.29, 1.16–1.44, p < .001).
- In 2020, respondents in Australia were less likely to use the HSR FOPL compared to NFLs (AOR = 0.47, 0.43-0.51, p < .001), while UK respondents were more likely to use the Traffic Light FOPL than NFLs (AOR = 1.14, 1.07-1.22, p < .001).
- In Mexico, respondents were more likely to use the new Warning FOPL compared to NFLs (AOR = 1.21, 1.12-1.31, p < .001) and the GDA FOPL (AOR = 1.22, 1.12-1.32, p < .001), with no difference between the NFL and GDA FOPL.
- In the UK, NFL understanding increased between 2018 and 2020 (AOR = 1.12, 1.02-1.23, p = .013).
- In Mexico, NFL understanding increased between 2018 and 2020 (AOR = 1.15, 1.04-1.28, p = .008) and between 2019 and 2020 (AOR = 1.13, 1.02-1.26, p = .023).
- In Australia and the UK, respondents reported greater understanding of the HSR and Traffic Light FOPLs, respectively, compared to NFLs (Australia: AOR = 1.26, 1.17-1.36, p < .001; UK: AOR = 1.61, 1.50-1.72, p < .001).
- In Mexico, respondents reported greater understanding of the new Warning FOPL compared to NFLs (AOR = 3.37, 3.05-3.72, p < .001) and the GDA FOPL (AOR = 3.61, 3.27-3.98, p < .001).
- Mexico respondents reported lower understanding of the GDA FOPL than for NFLs (AOR = 0.93, 0.87-1.00, p = .045).
Other Important Findings
- In Mexico, the Warning FOPL was reported to be seen more, used more, and easier to understand than the previous GDA FOPL, Australia’s HSRs, and the UK’s traffic light labels.
- Awareness of NFLs was relatively high across all countries, with the UK showing the lowest use and understanding.
- In Mexico, the increase in awareness and use of the Warning FOPL was greater than changes in Australia and the UK.
- The study found that self-reported awareness, use, and understanding were higher for Mexico’s newly implemented Warning FOPL than for the previous GDA FOPL.
- Within the study, the FOPLs were reported to be more easily understood than the traditional back-of-package NFLs, except for the GDA FOPLs in Mexico.
Limitations Noted in the Document
- The study’s findings might be overestimated for Mexico due to the sample’s higher education levels compared to national benchmarks.
- The research relies on self-reported data, which does not measure the downstream impacts of FOPLs on improving healthy eating.
- The study does not evaluate all major FOPL systems.
- The study did not display updated images of Mexico’s NFLs corresponding to the 2020 nutrition labeling regulation changes.
- The final wave of data collection in this study was conducted in the midst of the global COVID-19 pandemic.
Conclusion
The study shows that the Warning FOPL in Mexico was associated with higher levels of self-reported awareness, use, and understanding among adults compared to NFLs and GDA-based FOPLs. The implementation of warning labels in Mexico demonstrated a marked improvement in awareness, use, and comprehension compared to the prior GDA system. This contrasts with the HSR in Australia and the traffic light labels in the UK. These findings suggest that simpler, interpretive FOPLs, specifically those using warning symbols, are effective and easily understood, offering a notable advantage over traditional NFLs and non-interpretive systems. The lower uptake of the voluntary HSR in Australia emphasizes the need for mandatory FOPL regulations. The research underscores the importance of prioritizing the evaluation of the effects of various FOPL systems and promoting the adoption of those that are simple and easily understood. Further research should explore how individuals use FOPLs in purchasing decisions to support their health, and also assess the impacts of FOPL policies on purchasing patterns and dietary intake. The authors state, “Reported understanding was found to be higher for all of the FOPLs compared to NFLs, aside from Mexico’s GDA labels.”