Coping strategies of food insecure households with children and adolescents in Uruguay, a high-income Latin American country: A qualitative study through the lens of Bourdieu's theories of capitals and practice.

Food insecurity has been associated with negative short, medium, and long-term health consequences, which are more detrimental for children and adolescents. These effects may depend on the coping strategies developed to deal with food shortages. The present research aimed at exploring coping strategies in food insecure households with children and adolescents in Uruguay, incorporating sociological theoretical insights from Bourdieu. A qualitative approach based on individual semi-structured interviews was used. A total of 40 interviews were conducted with adults who had parental responsibilities of children and adolescents and who received different types of food assistance, between July and December 2022, in four cities. Results showed that adults tend to develop a wide range of coping strategies aimed at: reducing food expenditure, increasing the availability of money for purchasing food, increasing food availability and/or rationing the food available in the household. Some of the strategies were implemented regardless of the severity of food insecurity, whereas others were characteristic of the moderate and severe levels of the construct. Evidence to support the mediation effect of coping strategies on health outcomes was found. Discourses suggested that lower accumulation of economic and cultural capital may be aligned with the adoption of less socially accepted mechanisms to access to food. Expressions of a specific habitus aimed at securing food were identified among participants with more deprivations. Taken together, the findings suggest that coping strategies may not be a universal or invariant sequence according to the severity of food insecurity and stress the importance of considering households' resources and local context for the development of strategies to improve access to food.

Parent Experiences With Warning Labels After Policy Implementation in Uruguay.

OBJECTIVE: To explore the perception and experiences of parents of children and adolescents during the first year of the mandatory implementation of nutritional warning labels in Uruguay. DESIGN: Qualitative research based on semistructured interviews. SETTING: Montevideo, Uruguay. PARTICIPANTS: Twenty-eight parents of children and adolescents. PHENOMENON OF INTEREST: Perception of and experiences with warning labels, a front-of-pack nutrition labeling scheme that has become increasingly popular in Latin America. ANALYSIS: Content analysis of the transcripts based on a deductive-inductive approach. RESULTS: Interview transcripts evidenced high awareness, acceptance, and understanding of warning labels among parents of children and adolescents. Most participants reported considering warnings for decision making and changing their purchase decisions because of their implementation, particularly when choosing foods for their children. They reported their children were aware of and understood warnings but did not tend to take them into account when choosing foods. CONCLUSIONS AND IMPLICATIONS: Results from the present work contribute to the growing body of literature showing the effectiveness of warning labels. Lack of interest or perceived benefits and structural barriers emerged as key motives for not using the warnings when making purchasing decisions, suggesting the need to develop additional strategies to increase policy effectiveness.

Use of nutritional warning labels at the point of purchase: An exploratory study using self-reported measures and eye-tracking.

Nutritional warning labels are gaining relevance in the region of the Americas as a policy tool to reduce information asymmetry and encourage healthier food choices. However, empirical evidence about consumer experiences with warning labels after implementation is still scarce. In this context, the aim of the present work was to explore the use of nutritional warning labels after policy implementation in Uruguay, using a combination of eye-tracking and self-reported data. The study was conducted in three supermarkets, in two regional capitals, 19 months after the entry into force of the policy. A total of 224 participants were intercepted while entering the facilities of the supermarket and asked to wear a mobile eye-tracker while making their food purchases. Then, they were asked a series of questions about their awareness and use of warning labels. Although participants reported high awareness and understanding of the labels, active search and use at the point of purchase was low. Only 6% of the consumers declared having actively searched for the warning labels and 7% fixated their gaze on the labels. The majority of the participants (72%) who declared having seen the warnings on a product, purchased it anyway. However, 56% declared having changed their food choice decisions as a consequence of the implementation of the policy. Participants' accounts about reasons for (not) taking into account the warning labels provide relevant insights for the development of strategies to encourage citizens to increase policy effectiveness and encourage healthier food choices.

Qualitative exploration of the reasons for not using nutritional warnings after policy implementation in Uruguay.

Nutritional warnings have gained popularity, particularly in the region of the Americas, to facilitate the identification of products with excessive content of nutrients associated with non-communicable diseases and encourage healthier food choices. Although warnings have been shown to be effective, an in-depth understanding of the reasons why some consumers do not use them is still lacking. The aim of the present work was to explore self-reported use of nutritional warnings and to identify the reasons for not considering nutritional warnings for making food purchase decisions after policy implementation in Uruguay. A non-probabilistic sample of 858 Uruguayan participants was recruited using an advertisement on Facebook and Instagram. Through an online survey, self-reported use of nutritional warnings was asked using a closed-open ended questions. Participants who reported not considering warnings to make their purchase decisions were asked to explain the reasons why using an open-ended question. Responses were analysed using deductive coding, based on the Behavioural Drivers Model. Thirty seven percent of the participants stated that the warnings had not influenced their purchase decisions. Motives for not being influenced by the warnings were related to lack of interest, attitudes, lack of perceived self-efficacy, cognitive biases and limited rationality when making purchase decisions. In addition, structural barriers, such as availability, cost and trust in the food industry also emerged from participants' responses. Strategies to encourage the use of warnings should include communication campaigns and policies to address structural barriers related to the perceived availability and affordability of healthy foods.

Health-related cues on the packages of processed and ultra-processed products: prevalence and policy implications.

The information included on food packages has a crucial role in influencing consumer product associations and purchase decisions. In particular, visual and textual cues on processed and ultra-processed products can convey health-related associations that influence consumer healthiness perception and purchase decisions. In this context, the present work aimed to explore the use of health-related cues on the packages of processed and ultra-processed products sold in Uruguay to provide insights for policy making. A total of 3813 products from thirty-four different food categories found in four of the most important supermarket chains in Uruguay were surveyed. The textual and visual information included on the packages as well as the nutritional composition of the products were analysed. Results showed that 67 % of the products included at least one health-related cue. Pictures of culinary ingredients, natural and minimally processed foods were the most frequent health-related cue, followed by references to naturalness and claims related to critical nutrients. The prevalence of health-related cues largely differed across product categories, ranging from 100 to 17 %. The relationship between the presence of health-related cues on the packages and the excessive content of nutrients associated with non-communicable diseases was assessed using a gradient boosting model, which showed limited predictive ability. This suggests that the inclusion of health-related cues on food packages was not strongly related to the nutritional composition of products and therefore cannot be regarded as a healthiness indicator. These results stress the need to develop stricter labelling regulations to protect consumers from misleading information.

Food donation as a strategy to reduce food waste in an emerging Latin American country: a case study in Uruguay.

Abstract: Food donation has expanded globally and has become a common form of food assistance in emerging countries. However, research on food donation experiences in these settings is still scarce. Purpose: In this context, the objectives of the present work were as follows: (i) to explore the views of Uruguayan stakeholders on food donation as a strategy to reduce food waste, (ii) to identify barriers and enablers for food donation in Uruguay, and (iii) to explore the organizational characteristics of Uruguayan food banks. Methods: A qualitative approach based on two data collection strategies was used: documentary content analysis of official governmental documents and in-depth semi-structured interviews with key stakeholders related to food waste and food donations in Uruguay. Results: Food donation emerged as a central strategy for food waste reduction in the view of Uruguayan stakeholders, mainly because it was perceived as an efficient strategy to reduce food insecurity. The complexity of food donation was acknowledged by Uruguayan stakeholders and who identified several barriers for its implementation related to economic considerations, the characteristics of the donated products, legal and commercial considerations, and organizational characteristics of food banks. Conclusion: Although most barriers were aligned with results from previous studies conducted in developed countries, some specificities to the Uruguayan context were also identified. Clear and detailed legal frameworks to ensure that the donated products reach the target population along with nutritional requirements for the foods to be donated were deemed necessary.

A Qualitative Exploration of Parents' Food Choices During Early Childhood.

OBJECTIVE: To explore parents' accounts of the goals they seek when choosing foods for their young children through the lens of goal-systems theory. DESIGN: In-depth interviews with parents of children aged from 6 months to 5 years. SETTING: Montevideo, Uruguay. PARTICIPANTS: Forty-two parents (aged 19-44 years, 90% female). PHENOMENON OF INTEREST: Parents' personal experiences, feelings, and opinions related to how they choose foods for their children. ANALYSIS: Content analysis based on deductive-inductive coding. RESULTS: Parents' accounts confirmed they intended to pursue different goals when choosing foods for their children. Health-related goals mainly motivated the selection of healthy foods, but they also drove the selection of some ultra-processed products because of misconceptions about their healthiness. Pleasure and enjoyment motivated the selection of ultra-processed products, whereas stress avoidance was associated with selecting convenient foods. The selection of unhealthy foods raised conflicts between goals, which were solved using goal shielding, changes in risk perception and/or compensatory health beliefs. CONCLUSIONS AND IMPLICATIONS: Results point to the need for communication campaigns and community-based interventions to introduce changes in how ultra-processed products are conceptualized and increase the associations between healthy foods and children's pleasure and enjoyment to promote healthier eating patterns during infancy and early childhood.

Consumer perspectives on the inclusion of nutritional warnings in retail food establishments

ABSTRACT The present work aimed to assess Uruguayan consumers support of the inclusion of nutritional warnings on four types of retail food establishments and to obtain consumer insights on how the warnings could be implemented in such establishments. For this purpose, an online survey was conducted with a non-probabilistic sample of 547 participants recruited via an advertisement on social media. Participants were requested to indicate their degree of agreement with the implementation of nutritional warnings in bakeries, delicatessens, fast-food restaurants and while ordering food online, and to provide ideas on how to include this information for each establishment. Results suggested that the inclusion of nutritional warnings in retail food establishments was positively perceived by participants. Participants highlighted that warnings should be highly visible to customers while making purchase decisions, so they become a relevant cue for making food choices. In particular, the retail display case and menu boards were identified as key locations for warnings in bakeries, delicatessen, and fast food restaurants, respectively. These results contribute valuable insights on how to implement the extension of nutritional warnings to unpackaged foods or foods made and packaged at the point of purchase.

RESUMEN El presente trabajo tuvo como objetivo evaluar la percepción de los consumidores uruguayos en relación a la implementación de advertencias nutricionales en cuatro puntos de venta de comida y generar ideas sobre cómo podría implementarse esta medida. Se realizó un estudio online con una muestra no probabilística de 547 participantes, reclutados utilizando publicidad en redes sociales. Los participantes indicaron su grado de acuerdo con la implementación de advertencias nutricionales en panaderías, rotiserías, lugares de venta de comida rápida y sitios de pedidos online, y proporcionaron ideas sobre cómo incluir esta inforamción en cada punto de venta. Los resultados sugieren que la población tiene una perecpeción positiva sobre la inclusión de advertencias nutricionales en puntos de venta de comida. Los participantes destacaron la importancia de incluir esta información en un lugar visible al momento de elegir los productos, de forma que pueda ser tenida en cuenta al tomar las decisiones. En particular, las vitrinas y la cartelería/pizarras fueron identificados como lugares estatégicos para la inclusión de advertencias nutricionales en panaderías/rotiserías y puntos de venta de comida rápida, respectivamente. Los resultados proporcionan valiosa información para extender la inclusión de advertencias nutricionales a puntos de venta de comida.

Age, time orientation and risk perception are major determinants of discretionary salt usage.

The present work explored the relationship between discretionary salt usage and personal characteristics, using boosted regression trees (BRT). Specifically, the focus was on how socio-demographic characteristics and personality traits linked to risk perception and time orientation impact on discretionary salt consumption patterns. For this purpose, an online cross-sectional survey with a convenience sample of 498 Uruguayan participants was carried out. Participants completed the consideration of future consequences (CFC) scale adapted for eating behaviour, a short survey about discretionary salt consumption patterns and indicated their degree of agreement with statements measuring perceived risk of sodium consumption. Finally, socio-demographic data were collected. BRT were applied to build predictive models that related discretionary salt usage to socio-demographic characteristics, the two factors of the CFC-Food scale (consideration of the future and consideration of the immediate consequences of eating behaviour), and the two factors of the perceived risk of sodium consumption scale (severity of perceived risks and risk compensation). Age, time orientation and perceived risk were the most relevant explanatory variables for discretionary salt usage. Older people had a lower likelihood of adding salt to food, either at home or when eating out. In addition, individuals who tend to be present rather than future oriented, as well as those with low perception of risk severity and susceptibility were more likely to add salt to foods. Results from the present work suggest that communication campaigns to reduce discretionary salt intake should mainly focus on stressing the short-term health benefits of reducing sodium intake and raising perceived susceptibility.

"I don't throw away food, unless I see that it's not fit for consumption": An in-depth exploration of household food waste in Uruguay.

Significant reductions in household food waste have been regarded as a key step towards achieving global sustainable development. Household food waste is a complex phenomenon determined by consumer behavior along the steps of the "food journey" that goes from purchasing to final disposal. Although avoiding food waste is socially desirable and raises positive attitudes, consumers do not frequently engage in avoidance behaviors. The objectives of the present work were: i) to explore the views of Uruguayan citizens on household food waste, and ii) to identify drivers of food waste among Uruguayan households. A total of 20 in-depth interviews based on a semi-structured guide were conducted by telephone. Participants were asked to recall and describe the last time they discarded food, as well as to describe the most common food waste situations in their household, the most commonly used strategies to avoid food waste and how they could reduce it. The transcripts were analyzed using content analysis based on a deductive-inductive approach. Interviews revealed that most of the participants perceived food waste in their homes as null or low, whereas food waste in the country was regarded as high. When participants described food waste incidents, they perceived it as 'unavoidable', suggesting that they tended to find a rational explanation outside of their will to justify their behavior. Participants' discourses enabled the identification of drivers related to behavioral factors, personal factors, product factors, and contextual factors. Results stress that most promising entry points for communication campaigns and intervention programs to reduce household food waste should focus on behavioral factors, planning throughout all the household stages of the food journey and the provision of knowledge and skills on food storage, handling, and preparation.

Is COVID-19 a threat or an opportunity for healthy eating? An exploration of the factors that moderate the impact of the pandemic on eating habits in Uruguay.

In May 2020, Uruguay was one of the few Latin American countries that had managed to control the outbreak of COVID-19 without mandatory curfews or quarantines. However, several social distancing measures created a major disruption in different aspects of the daily life of Uruguayan citizens. In this context, the objectives of the present work were i) to identify changes in eating habits perceived by Uruguayan citizens as a consequence of the COVID-19 pandemic, and ii) to explore factors associated with different perceived changes on eating habits. A cross-sectional online study was conducted with 891 participants, recruited using an advertisement on Facebook and Instagram. Fifty-one percent of the participants indicated that their eating habits had changed since the detection of the first cases of COVID-19 in Uruguay. Large heterogeneity in the categorization of the changes existed: 45% of the participants regarded the changes as positive, 32% as negative and 23% as neither positive nor negative. A multinomial logistic regression analysis was used to study the influence of explanatory variables in the likelihood of belonging to groups who reported different changes in eating habits (no changes, positive, negative, or neither positive nor negative changes). Household income and reliance on instrumental and emotional support increased the likelihood of reporting positive changes in eating habits, whereas negative changes were associated with a reduction in household income due to COVID-19 and the coping strategies self-distraction and self-blaming. Insights for policy making to reinforce positive effects and minimize threats to healthy eating are discussed.

How do consumer characteristics influence responses to nutritional warnings?

ABSTRACT The aim of the present work was to explore the influence of consumer characteristics on purchase decisions when facing products with nutritional warnings a few days after their implementation in Uruguay. A non-probabilistic sample of 917 participants was obtained using an advertisement on social media. Participants were asked if they had seen the warning signs when making their food purchases and if they had seen the warnings on any product they intended to buy. Participants who answered affirmately (n= 616) were asked about their purchase decision by answering the question "What have you done with the product?" using the following response options: 'I purchased it anyway', 'I purchased a similar product with fewer excess signs', 'I purchased a similar product without excess signs', 'I didn't purchase the product or any similar one'. Univariate and multivariate multinomial logistic regression models were used to explore the influence of individual variables on participants' likelihood of having taken different decisions when facing a product with warnings. Results showed that participants older than 55 years were more likely to react to the warnings by purchasing a similar product with fewer warnings or by not purchasing any product. Likelihood of modifying purchase decisions due to the inclusion of the warnings was associated with a frequent consumption of natural and minimally processed foods and a low consumption frequency of ultra-processed products. These results provide insights to target efforts to promote the use of nutritional warnings in decision making.

RESUMEN El objetivo del presente trabajo fue explorar la influencia de caraterísticas de los consumidores en sus decisiones de compra al enfrentar productos con advertencias nutricionales, unos días después de su implementación en Uruguay. Se obtuvo una muestra no probabilística de 917 participantes utilizando redes sociales. Se les preguntó a los participantes si habían visto las advertencias en un producto que tenían la intención de comprar. A los participantes que respondieron afirmativamente (n= 616) se les pidió qué indicarn qué habían hecho con el producto, utilizando las siguientes opciones de respuesta: 'Lo compré igual', 'Compré un producto similar con menos símbolos de exceso', 'Compré un producto similar sín símbolos de exceso' y 'No compré el producto ni tampoco otro similar. Los datos se analizaron utilizaron modelos de regresión multinomial univariados y multivariados. Los participantes mayores de 55 años presentaron una mayor probabilidad de reaccionar a las advertencias no comprando el producto. La probabilidad de modificar la decisión de compra debido a las advertencias estuvo asociada con una mayor frecuencia de consumo de alimentos naturales y mínimamente procesados y una menor frecuencia de consumo de productos ultra-procesados. Los resultados del presente trabajo sugieren que los esfuerzos para promover el uso de las advertencias en la toma de decisiones deben estar focalizados en los ciudadanos con el mayor consumo de productos ultra-procesados.

Health gains through loss frames: Testing the effectiveness of message framing on citizens' use of nutritional warnings.

The aim of the present work was twofold: (i) to evaluate the effect of nutritional warnings and health-related packaging cues (nutrient claim and images of natural foods) on consumers' food choices, and (ii) to evaluate the influence of two types of messages (gain-framed and loss-framed) aimed at encouraging the use of such warnings and packaging cues on food choices. A total of 510 participants were recruited using an advertisement on Facebook and Instagram targeted at Uruguayan adult users. Participants were randomly allocated to one of three experimental groups: control (n = 167), loss-framed messages (n = 177) and gain-framed messages (n = 166). Then, they completed a choice-conjoint task involving packages of crackers differing in three variables: nutritional warnings (present vs. absent), nutrient claim (present vs. absent) and images of seeds and wheat (present vs. absent). Warnings were the most relevant package element driving choices, even when participants were not exposed to any type of message. Exposure to loss-framed messages led to changes in the relative importance attached to the package characteristics, whereas gain-framed messages did not. Graphic pieces conveying messages encouraging the use of nutritional warnings by stressing the negative consequences of excessive consumption of sugar, fat, and sodium increased the relative importance attached to nutritional warnings and decreased the relative importance attached to health-related cues (nutrient claims and images of seeds and wheat). These results suggest that public awareness campaigns aimed at encouraging citizens to use nutritional warnings should emphasize the negative health consequences of excessive intake of sugar, fat, and sodium.

Communication Campaigns to Support the Use of Nutritional Warnings: Different Messages for Different People?

Communication campaigns are expected to contribute to increase the efficacy of nutritional warnings. In this context, the aims of the present work were (a) to evaluate how citizens perceive different types of messages for a communication campaign and (b) to determine if personal characteristics such as gender, age, and educational level, as well socioeconomic and nutritional status, moderate how citizens perceive such campaign messages. A series of graphic pieces were designed for each of the following three types of messages: promotion of informed food choices; raising awareness of the negative health consequences of excessive consumption of sugar, fat, and sodium; and promotion of healthy food choices. An online study was conducted with 774 participants, who were randomly assigned to one of the three types of messages. The participants' self-reported perception of the graphic pieces was evaluated using 7-point Likert-type scales. After completing the evaluation task, the participants proceeded to a series of choices. This was implemented to evaluate whether exposure to different types of messages affected hypothetical food choices. Results revealed that messages related to the promotion of healthy eating were perceived as the most adequate as part of a communication campaign and had the potential to encourage more healthful hypothetical choices in the experimental task. However, gender, age, and nutritional status moderated the influence of the type of message on the participants' perception, meaning that different groups perceived different types of messages as the most adequate. The results from the present work stress the need to include different types of messages in a communication campaign to target individuals with different motivations and characteristics.

Do nutritional warnings encourage healthier choices on food ordering websites? An exploratory experimental study in Uruguay.

OBJECTIVE: To evaluate if the inclusion of nutritional warnings in food ordering websites can discourage consumers from purchasing foods with excessive content of nutrients associated with non-communicable diseases (NCD). DESIGN: Participants were randomly assigned to one of the two experimental conditions: control (n 225) or nutritional warnings (n 222). Nutritional warnings corresponded to separate black octagonal signs containing the word 'Excess' followed by the corresponding nutrient: total fat, saturated fat, sugars and sodium. Participants were asked to purchase a lunch for themselves using a simulated food ordering website. SETTING: Online study in Uruguay. PARTICIPANTS: Convenience sample of 447 Uruguayan participants, recruited using social media. RESULTS: In the control condition, 76 % of the participants selected a dish or a beverage with excessive content of at least one nutrient in the simulated food ordering website. When nutritional warnings were included, this percentage significantly decreased to 62 % (P = 0·002). In addition, nutritional warnings caused a significant reduction in the percentage of participants who selected dishes with excessive content of total fat: 50 % v. 62 % (P = 0·012). CONCLUSIONS: Results from the present work provide preliminary evidence that the inclusion of nutritional warnings in food ordering websites could discourage consumers from selecting dishes and beverages with excessive content of nutrients associated with NCD.

Immediate effects of the implementation of nutritional warnings in Uruguay: awareness, self-reported use and increased understanding.

OBJECTIVE: To assess the effects of nutritional warnings during the first month after the date of full compliance by the food industry in Uruguay in terms of citizen awareness, self-reported use and ability to understand nutritional information. DESIGN: The present work encompassed two online studies, conducted before (Study 1) and during the first month after the date of full compliance by the food industry (Study 2). An after-only design was used to assess awareness of the policy, exposure to nutritional warnings on food packages and self-reported use of warnings for making purchase decisions in Study 2. An after-only with control group experimental design was used to assess the effect of nutritional warnings on understanding of nutrition information in Studies 1 and 2. SETTING: Uruguay, one of the Latin American countries, that has recently implemented nutritional warnings. PARTICIPANTS: A non-probabilistic sample of 1772 participants was recruited using Facebook advertisements targeted at Uruguayan adult users. RESULTS: High awareness and self-reported use of nutritional warnings during the first month after the date of full compliance in Uruguay were observed. In addition, the before and after comparison showed that the implementation of warnings increased citizens' ability to use nutritional information to compare products and to identify products with excessive content of sugar, fat, saturated fat and sodium. CONCLUSIONS: The current study confirms results from experimental studies and provides additional evidence to support the implementation of nutritional warnings as one of the public policies that can contribute to tackle obesity and non-communicable diseases.

The heuristics that guide healthiness perception of ultra-processed foods: a qualitative exploration.

OBJECTIVE: To explore the conceptualisation of healthy food by citizens and how they judge the healthiness of ultra-processed foods. DESIGN: Four focus groups were conducted using a semi-structured discussion guide. Focus group discussions were held about the concept of healthy food, what characterise a healthy product and healthiness perception of ultra-processed products. Transcripts of the focus groups were analysed following an inductive coding approach. SETTING: Uruguay, one of the Latin American countries with the highest prevalence of overweight and obesity. PARTICIPANTS: Fifty-two adult Uruguayan participants, diverse in terms of gender, age, educational level and socio-economic status. RESULTS: In agreement with previous studies on lay perceptions of healthy eating, the conceptualisation of healthy food was mainly focused on food characteristics. Although participants regarded lack of processing as a cue for healthiness, they did not categorise all ultra-processed products as unhealthy. Albeit some product categories were automatically regarded as unhealthy, participants considered that other categories could include healthy and unhealthy products. In such cases, they explicitly referred to several simplified cognitive strategies to judge whether an ultra-processed product is healthy or not. Results showed that participants tended to rely on simple cues, such as label design, nutrient claims, brand, price and country of origin as indicators of product healthiness. CONCLUSIONS: Healthiness perception of ultra-processed products seems to be largely influenced by heuristics, which stresses the need to implement policies that make the potential negative effects of ultra-processed products salient.

The habitual nature of food purchases at the supermarket: Implications for policy making.

Supermarkets have become the most important provider of food products worldwide. However, empirical evidence about how consumers make their food purchase decisions in this environment is still scarce. The present field study aimed to: i) explore how people make their in-store food purchases, and ii) identify the information they search for when making those purchases. Consumers (n = 144) were intercepted when entering the facilities of three supermarkets in two Uruguayan cities. They were asked to wear a mobile eye-tracker while they made their purchases as they normally do. The great majority of the consumers bought at least one food product or beverage (92%) and, on average, examined products from 2.8 sections. In total, they investigated 37 categories within 13 self-service sections, corresponding to 26 categories of ultra-processed products. For 67% of the products, consumers went straight to the product they seemed to be looking for, grabbed it and put it in their shopping basket or cart, without making any comparison among products. A limited information search was observed. On average, consumers spent 22 s examining products within self-service sections and only 6.9 s were elapsed from the moment they grabbed a product until they put it in the shopping cart. These results provide empirical evidence of the habitual nature of supermarket food purchases in a context characterized by wide availability of ultra-processed products. Taken together, the findings suggest that policies and interventions aimed at reducing purchases of ultra-processed products should disrupt habitual decisions at the point of purchase. In this sense, policies targeted at introducing salient changes on food packages hold potential to disrupt food purchases and encourage consumers to establish new and more healthful food purchase habits.

How Can We Motivate People to Use Nutritional Warnings in Decision Making? Citizen Co-Created Insights for the Development of Communication Campaigns.

Nutritional warnings are intended to enable citizens to make informed choice by clearly identifying food products with excessive content of nutrients associated with noncommunicable diseases. The efficacy of this public policy is expected to improve if accompanied by communication campaigns that raise awareness of the existence of nutritional warnings, as well as encourage citizens to take them into account in decision making. Because ordinary citizens have been shown to generate significantly more creative and valuable ideas than advanced users and professional developers, the aim of the present work was to obtain qualitative, citizen co-created insights for the design of a communication campaign. An online study was conducted with 518 Uruguayan citizens, recruited using a Facebook advertisement. Participants were asked to answer a series of open-ended questions about how they would encourage other people to use the warnings for making their food choices, as well as the key contents of a communication campaign. Responses were analyzed using content analysis. Results showed that, according to the participants' accounts, an effective public awareness campaign aimed at promoting the use of nutritional warnings in decision making should include three main concepts: (a) position warnings as a cue to action for improving eating habits by enabling informed choices; (b) emphasize the benefits of using the warnings for avoiding consumption of unhealthy food and, consequently, achieving a healthier diet and an improvement in health status and quality of life; and (c) increase the perceived susceptibility and severity of the negative consequences of consumption of foods with excessive content of sugar, fat, and sodium. A communication campaign based on these key concepts could contribute to increasing the efficacy of nutritional warnings.

Factors underlying compliance with a healthy snacking initiative in the school environment: accounts of school principals in Montevideo (Uruguay).

OBJECTIVE: To evaluate the implementation of the Uruguayan healthy snacking initiative in primary and secondary schools in the capital, and to explore the factors underlying compliance from the perspective of school principals. DESIGN: A mixed-method approach was used, which included semi-structured interviews with school principals and a survey of the foods and beverages sold and advertised in the schools. SETTING: Primary and secondary schools in Montevideo (the capital city of Uruguay). PARTICIPANTS: School principals. RESULTS: The great majority of the schools did not comply with the initiative. Exhibition of non-recommended products was the main cause for non-compliance, followed by advertising of non-recommended products through promotional activities of food and beverage companies. Although school principals were aware of the healthy snack initiative and showed a positive attitude towards it, the majority lacked knowledge about its specific content. Factors underlying compliance with the healthy snacking initiative were related to its characteristics, characteristics of the schools, and external factors such as family habits and advertising. CONCLUSIONS: Results showed that the rationale underlying the selling of products at schools favours the availability of ultra-processed products and constitutes the main barrier for the promotion of healthy dietary habits among children and adolescents. Strategies aimed at facilitating the identification of unhealthy foods and beverages and provision of incentives to canteen managers to modify their offer are recommended.