Front-of-Package Protein Labels on Cereal Create Health Halos.

Front-of-package protein labels are frequently added to breakfast cereals, aimed at increasing purchases by consumers who believe they would benefit from eating more protein. However, the overall nutritional compositions of such products are often not significantly better than similar products without protein labels, and may contain more sugar, sodium, and calories to improve taste. We conducted an online survey with 1022 US adults to examine consumer perceptions of two cereals (Special K Original and Special K Protein). Participants perceived Special K Protein as healthier and more nutritious, though less tasty, than Special K Original. Special K Protein was perceived as providing greater health benefits, such as being more likely to help them build muscle, stay healthy, and live longer. Many participants perceived no differences in the amounts of certain nutrients between the cereals, such as sugar (54.5%), sodium (59.2%), and calories (49.1%). Yet, when serving sizes are equalized to one cup, Special K Protein has more sugar, sodium, and calories than Special K Original. Though most participants reported viewing the Facts Up Front label, only 21.3% correctly chose Special K Original as having the larger serving size. This pattern of results suggests the presence of a health halo surrounding the protein-labeled product.

Cell-based, cell-cultured, cell-cultivated, cultured, or cultivated. What is the best name for meat, poultry, and seafood made directly from the cells of animals?

To be sold in the United States, meat, poultry, and seafood products made from cultured cells must be labeled with a "common or usual name" to help consumers understand what they are purchasing. The terms "Cultured," "Cultivated," "Cell-Cultured," "Cell-Cultivated," "Cell-Based" and a control (without a common or usual name) were tested using an online experiment. Two regulatory criteria were assessed: that the term distinguishes the novel products from conventional products, and appropriately signals allergenicity. Three consumer acceptance criteria were assessed: that the term is seen as appropriate, does not disparage the novel or conventional products, nor elicit perceptions that the products are unsafe, unhealthy, or not nutritious. Each term was shown on packages of frozen Beef Filets, Beef Burgers, Chicken Breasts, Chicken Burgers, Atlantic Salmon Fillets, and Salmon Burgers. A representative sample of 4385 Americans (18 + ) were randomly assigned to view a single product with a single term or the control. Consumers' ability to distinguish tested terms from conventional products differed by product category. "Cultured" and "Cultivated" failed to adequately differentiate the novel products from "Wild-Caught and Farm-Raised" salmon products. "Cultivated" failed to differentiate the novel Beef Filet product from "Grass-Fed" Beef Filets. "Cell-Cultured," "Cell-Cultivated," and "Cell-Based" each signaled that the products were different from conventional products across the proteins, and signaled allergenicity, meeting the two key regulatory criteria. They were not significantly different on most consumer perception measures. However, "Cell-Cultured" may have slightly better consumer acceptance across the novel beef, chicken, and salmon products, recommending its universal adoption.

Sharing on Facebook and Face-to-Face What Others Do or Approve: Word-of-Mouth Driven by Social Norms.

Information sharing on social media [i.e., electronic word-of-mouth, (eWOM) and face-to-face word-of-mouth (fWOM)] plays an important role in message dissemination. This study investigates the effectiveness of group norms in motivating eWOM and fWOM. Drawing upon the psychological distance and construal level literature, this study tests the impact of group norms, the interaction effect of norms type (descriptive vs. injunctive norms), and the group distance on eWOMand fWOM. Based on one field study and three laboratory experiments, this study finds that normative cues in messages are impactful in driving WOM and the impact becomes especially stronger when the psychological distance of the social group is congruent with that of norms type tied to the group. Specifically, an interaction effect emerges, such as distant (close) group injunctive (descriptive) norms, are more impactful in driving WOM than close (distant) group injunctive (descriptive) norms. Contrary to the conventional wisdom that a close group has greater impacts than distant groups in terms of social influence, this study shows that messages with distant groups are more (or at least equally) likely to be shared than with a close group when tied with injunctive norms. The findings suggest that group norms are perceived to be more relevant when there is a match between the psychological distance of the social group and the norms type tied to the group.

Personal Interventions for Reducing Exposure and Risk for Outdoor Air Pollution: An Official American Thoracic Society Workshop Report.

Poor air quality affects the health and wellbeing of large populations around the globe. Although source controls are the most effective approaches for improving air quality and reducing health risks, individuals can also take actions to reduce their personal exposure by staying indoors, reducing physical activity, altering modes of transportation, filtering indoor air, and using respirators and other types of face masks. A synthesis of available evidence on the efficacy, effectiveness, and potential adverse effects or unintended consequences of personal interventions for air pollution is needed by clinicians to assist patients and the public in making informed decisions about use of these interventions. To address this need, the American Thoracic Society convened a workshop in May of 2018 to bring together a multidisciplinary group of international experts to review the current state of knowledge about personal interventions for air pollution and important considerations when helping patients and the general public to make decisions about how best to protect themselves. From these discussions, recommendations were made regarding when, where, how, and for whom to consider personal interventions. In addition to the efficacy and safety of the various interventions, the committee considered evidence regarding the identification of patients at greatest risk, the reliability of air quality indices, the communication challenges, and the ethical and equity considerations that arise when discussing personal interventions to reduce exposure and risk from outdoor air pollution.

A comparison of cell-based and cell-cultured as appropriate common or usual names to label products made from the cells of fish.

Using an online experiment with a nationally representative sample of 1200 adult American consumers, two "common or usual names," "Cell-Based Seafood" and "Cell-Cultured Seafood," were assessed using five criteria. Displayed on packages of frozen Atlantic Salmon, both "Cell-Based" (60.1%) and "Cell-Cultured" (58.9%) enabled participants to differentiate the novel products from "Farm-Raised" and "Wild-Caught" fish and 74% also recognized that those allergic to fish should not consume the product. Thus, both names met key regulatory criteria. Both names were seen as appropriate terms for describing the process for creating the product, meeting the criteria for transparency. There were no significant differences in the perceived safety, naturalness, taste, or nutritiousness of the products bearing the two names. However, participants' overall impressions associated with "Cell-Based" were rated as more positive than those associated with "Cell-Cultured" (P < 0.001, η2  = 0.010), as were their initial thoughts, images, and feelings (P < 0.001, η2  = 0.008). The participants were also slightly more interested in tasting (P < 0.05, η2  = 0.004) and in purchasing (P < 0.01, η2  = 0.006) "Cell-Based" than "Cell-Cultured" seafood. After learning the meaning of the terms, participants' overall impressions of "Cell-Based" remained higher than "Cell-Cultured" (P < 0.05, η2  = 0.003) and they remained slightly more interested in tasting (P < 0.05, η2  = 0.004) and in purchasing (P < 0.05, η2  = 0.005) "Cell-Based" than "Cell-Cultured" seafood. Therefore, "Cell-Based Seafood" should be adopted as the best common or usual name for seafood made from the cells of fish. PRACTICAL APPLICATION: Widespread adoption and consistent use of a single "common or usual name" for "Cell-Based" seafood, meat, poultry, and other products by the food industry, regulators, journalists, marketers, environmental, consumer, and animal rights advocates, and other key stakeholders would help shape public perceptions and understanding of this rapidly advancing technology and its products. This study confirms that "Cell-Based Seafood" is the best performing term to label seafood products made from the cells of fish. It meets relevant FDA regulatory requirements and slightly outperforms "Cell-Cultured Seafood" with regard to positive consumer perceptions, interest in tasting, and likelihood of purchasing these novel products.

Eating green for health or social benefits? Interactions of attitudes with self-identity on the consumption of vegetarian meals among U.S. and Chinese college students.

Encouraging greater consumption of vegetarian foods could be a strategy to improve plant-based food intake among non-vegetarians. Prior research on vegetarianism has focused mostly on people's motivations to be a vegetarian. However, the factors that motivate non-vegetarians to consume vegetarian meals remain largely unknown. The current research tested associations between attitudes, self-identity, and vegetarian meal consumption among 746 U.S. college students and 484 Chinese college students. Two types of attitudes were assessed: attitudes towards vegetarian food (ATF), which represents the personal benefits (including healthiness, tastiness, and enjoyableness) and attitudes towards people who are vegetarians (ATP), which represents the social benefits (perceived as being environmentally friendly, nice, and good-looking). Results showed that U.S. college students were more likely to be either vegetarians or non-vegetarians, while more Chinese college students tended to report being semi-vegetarians. In both samples, ATF and ATP were positively associated with self-identity and vegetarian meal consumption. Moderation analyses suggested that associations between attitudes and consumption were significant only among people who do not hold a definite self-identity as a vegetarian. In addition, ATP was significantly associated with vegetarian meal consumption among U.S. non- and semi-vegetarians alike, but among Chinese non-vegetarians only. These findings suggest that self-identity and cross-cultural differences are important to consider in promoting consumption of vegetarian meals through improving the public's attitudes towards vegetarian food and vegetarians.

Feature Availability Comparison in Free and Paid Versions of Popular Smartphone Weight Management Applications.

OBJECTIVE: Characterize capabilities of nutrition applications (apps) for weight management and associations between features, ratings, and app installations. DESIGN: Calorie tracking apps with weight management as a primary outcome were selected from the Apple App Store and Google Play Store using keywords "diet" and "weight loss." METHODS: Reviewers assessed free and upgraded versions of nutrition apps (n = 15) for features within 4 categories: (1) dietary intake, (2) anthropometrics, (3) physical activity, and (4) behavior change strategies. OUTCOME MEASURES: Presence of specific app features, app ratings, and app installations. ANALYSIS: Descriptive statistics of free and paid app versions. Spearman rank-order correlations were used to determine associations between feature inclusion, app ratings, and installations. RESULTS: The apps had the greatest number of features in the dietary intake category. Additional dietary intake features were those most likely obtained through a subscription purchase. Behavior change content was absent from most apps. The macronutrient adjustment feature was strongly associated with average app ratings (rs = 0.74; P < 0.002) and with subscription costs (rs = 0.60; P < 0.019). CONCLUSIONS AND IMPLICATIONS: This study found most nutrition apps possess an abundance of features dedicated to dietary intake, anthropometric, and physical activity tracking while also being notably devoid of behavior change content features.

Impact of Abstract Versus Concrete Conceptualization of Genetic Modification (GM) Technology on Public Perceptions.

Based on the scholarship of abstract/concrete cognition, mental schema, and the integrated model of behavior change, this study found that using concrete over abstract language increased support for specific genetically modified (GM) applications and GM in general, and improved intentions to purchase products containing genetically modified organisms (GMOs). An online survey with an embedded 3 × 2 experiment was conducted using a national sample of U.S. adults (N = 1,470). Participants were randomly assigned to conditions that varied in abstract/concrete conceptualization of GMOs and were prompted to assess GM risk and benefit perceptions with respect to human health and the environment. Regardless of whether they assessed risks or benefits, participants who assessed GMOs through concrete terms compared to abstract terms showed an increase in positive emotions, which in turn increased their support for specific GM applications and GM in general, and their intentions to buy products with GMOs.

An empirical assessment of common or usual names to label cell-based seafood products.

An important consideration in the commercialization of cell-based meat, poultry, and seafood is what common or usual name to use on package labels to meet U.S. Food and Drug Administration (FDA) regulations. However, naming these products has been the subject of considerable debate. This study used a 3 × 10 between-subjects online experiment involving a quota sample of 3,186 U.S. adult panel participants to test common or usual names using images of realistic packages of three types of seafood that a consumer might encounter in a supermarket. The terms tested were, "cell-based seafood," "cell-cultured seafood," "cultivated seafood," and "cultured seafood" and the phrases, "produced using cellular aquaculture," "cultivated from the cells of ____," and "grown directly from the cells of ____," where the blanks are filled by the name of the seafood product. Five criteria were used for evaluation, including each term's ability to: enable consumers to distinguish cell-based seafood from wild and farmed fish, to signal potential allergenicity, be seen by consumers as an appropriate term to identify the product, not disparage either cell-based or conventional products, and not evoke thoughts, images, or emotions that are inconsistent with the idea that the products are safe, healthy, and nutritious. The results showed that "cell-based seafood" outperforms the other names tested. It enables consumers to recognize that the products are neither wild caught nor farm raised, signals potential allergenicity, is seen as an appropriate name for describing the technology/process, and it performs well with respect to measures of consumer acceptance, particularly in comparison to conventional products. PRACTICAL APPLICATION: Creating consensus around a single common or usual name for cell-based meat, poultry, and seafood products is clearly important both for regulatory reasons and for shaping public perceptions and understanding of the products that are labeled with it. Our findings suggest that "cell-based" is the best common or usual name for seafood products that both meets FDA regulatory requirements and performs well with respect to potential consumer acceptance. Consistent use of this term by industry, advocates, and regulators would help orient consumers to what is likely to be a transformational food technology.

Qualified Health Claim Language affects Purchase Intentions for Green Tea Products in the United States.

Qualified health claims (QHC) describe diet-disease relationships and summarize the quality and strength of evidence for a claim. Companies assert that QHCs increase sales and take legal action to ensure claims reflect their interests. Yet, there is no empirical evidence that QHCs influence consumers. Using green tea as a case study, this study investigated the effects of QHCs on purchase intentions among adults 55 years and older living in the US. An online survey using a between-subjects design examined QHCs about the relationship between green tea and the reduced risk of breast and/or prostate cancer or yukichi fruit juice and the reduced risk of gastrocoridalis, a fictitious relationship. QHCs written by a green tea company generated greater perceptions of evidence for the relationship, greater confidence in green tea and cancer, and increased purchase intentions for green tea than other QHCs. Factors that mitigated the claim's effects on purchase intentions are: Race/ethnicity; age; importance of health claims; supplement use; health; worry about health/becoming sick with cancer; worry that led to dietary change; green tea consumption; and familiarity with the green tea-cancer. Consumers who made health-related dietary change in the past year and consider health claims important indicated greater purchase intentions than others.

Anthrax Exposure, Belief in Exposure, and Postanthrax Symptoms Among Survivors of a Bioterrorist Attack on Capitol Hill.

BACKGROUND: Following chemical, biological, radiological, and nuclear disasters, medically unexplained symptoms have been observed among unexposed persons. OBJECTIVES: This study examined belief in exposure in relation to postdisaster symptoms in a volunteer sample of 137 congressional workers after the 2001 anthrax attacks on Capitol Hill. METHODS: Postdisaster symptoms, belief in exposure, and actual exposure status were obtained through structured diagnostic interviews and self-reported presence in offices officially designated as exposed through environmental sampling. Multivariate models were tested for associations of number of postdisaster symptoms with exposure and belief in exposure, controlling for sex and use of antibiotics. RESULTS: The sample was divided into 3 main subgroups: exposed, 41%; unexposed but believed they were exposed, 17%; and unexposed and did not believe that they were exposed, 42%. Nearly two-thirds (64%) of the volunteers reported experiencing symptoms after the anthrax attacks. Belief in anthrax exposure was significantly associated with the number of ear/nose/throat, musculoskeletal, and all physical symptoms. No significant associations were found between anthrax exposure and the number of postdisaster symptoms. CONCLUSIONS: Given the high incidence of these symptoms, these data suggest that even in the absence of physical injury or illness, there may be surges in health care utilization. (Disaster Med Public Health Preparedness. 2019;13:555-560).

Engaging in Effective Science Communication: A Response to Blancke et al. on Deproblematizing GMOs.

As science communication scholars, we encourage interdisciplinary efforts such as those by Blancke, Grunewald, and De Jaeger to engage with the public on GMOs and genetic engineering broadly. We extend the advice given by these scholars with tips based on what we know from the science of science communication.

Communicating scientific evidence in qualified health claims.

Qualified health claims (QHCs) are found on food and dietary supplement labels and aim to communicate the quality and strength of scientific evidence for a diet-disease relationship. Since the evidence varies for diet-disease relationships, the language to describe the evidence also varies. However, research indicates that consumers misinterpret QHCs as a whole product evaluation. The FDA is reviewing the evidence ranking system for QHCs and the current study aims to inform future consumer research. A content analysis examined the language used to convey scientific evidence in 53 QHCs and organized them into an intrinsic scale of evidence. Results revealed 36 formats to present the evidence in 53 QHCs. Seventy-seven percent (n = 41) demonstrate a reading level above 9th grade. Most claims describe the quality of evidence (n = 51, 96%) ("very weak") and/or reference its consistency (n = 41, 77%), while a quarter (n = 13) also quantify the evidence ("two studies"). Twenty-five claims (47%) present the evidence before stating the diet-disease relationship. There is an absence of a systematic description of evidence among QHCs that may contribute to the misleading, albeit unintentional, nature of these claims. Policymakers might consider reforming QHC regulations so that a hierarchy of evidence for diet-disease relationships is clearly communicated to consumers.

Modeling retrospective attribution of responsibility to hazard-managing institutions: an example involving a food contamination incident.

Perceptions of institutions that manage hazards are important because they can affect how the public responds to hazard events. Antecedents of trust judgments have received far more attention than antecedents of attributions of responsibility for hazard events. We build upon a model of retrospective attribution of responsibility to individuals to examine these relationships regarding five classes of institutions that bear responsibility for food safety: producers (e.g., farmers), processors (e.g., packaging firms), watchdogs (e.g., government agencies), sellers (e.g., supermarkets), and preparers (e.g., restaurants). A nationally representative sample of 1,200 American adults completed an Internet-based survey in which a hypothetical scenario involving contamination of diverse foods with Salmonella served as the stimulus event. Perceived competence and good intentions of the institution moderately decreased attributions of responsibility. A stronger factor was whether an institution was deemed (potentially) aware of the contamination and free to act to prevent or mitigate it. Responsibility was rated higher the more aware and free the institution. This initial model for attributions of responsibility to impersonal institutions (as opposed to individual responsibility) merits further development.

Gender and food, a study of attitudes in the USA towards organic, local, U.S. grown, and GM-free foods.

Food choice is influenced by consumer attitudes towards food attributes. This U.S.-based study (n = 601) simultaneously compares attitudes towards selected food attributes of organic, locally grown, U.S. grown, and GM-free food in relation to other food attributes. Exploratory factor analysis identifies underlying constructs that determine, together and separately, female and male food choice decisions. Gendered analysis of the value of food in life and food behaviours (cooking and shopping) support the investigation of the highlighted food attributes. Respondents generally assigned greater importance to the U.S. grown, followed by GM-free, locally grown, and organically produced food attributes in deciding what to eat. Analysis of the female and male subsamples yielded similar factor results. All four main attributes were captured in a single factor, associated with respondents in both the female and male subsamples who are older, have lower incomes, and who are religiously observant. Additionally, among females, this factor was associated with higher education; and among males, living in households with children and/or with partners. Additional studies should further explore the interaction of food attributes now becoming increasingly important and prevalent in current food products.

Nutrient analysis of varying socioeconomic status home food environments in New Jersey.

Home food inventories of Oaxacan Mexican-American and African-American families of low-socioeconomic status living in an urban area in New Jersey with at least one child under the age of 12 were conducted using Universal Product Code scanning. The African-American and Oaxacan household food supplies were compared with a sample of White households, also with at least one child under the age of 12, not of low-socioeconomic status. Nutrient Adequacy Ratios for total fat, saturated fat, cholesterol, sodium, total carbohydrate, sugar, dietary fiber, protein, vitamin A, vitamin C, calcium, and iron were used to quantify the adequacy of household food supplies per 2000 cal. The food supplies of the White households had significantly more calcium, vitamin A, and sugar and less total fat than the other two samples. The home food supplies of African-American households contained significantly less vitamin C than White and Oaxacan households. Compared to both other samples, Oaxacan household food supplies were lower in protein, sodium, and iron. Per 2000 cal, African-American households had the lowest supply of nutrients recommended to be maximized (i.e., vitamin A, vitamin C, calcium, iron, protein, and dietary fiber) and highest supply of nutrients to be minimized (i.e., total fat, cholesterol, sodium, and sugar). Overall household food quality scores were lowest for the African-American sample with no differences between Oaxacan and White household food supply quality scores.

A computerized, self-administered questionnaire to evaluate posttraumatic stress among firefighters after the World Trade Center collapse.

OBJECTIVES: We sought to determine the frequency of psychological symptoms and elevated posttraumatic stress disorder (PTSD) risk among New York City firefighters after the World Trade Center (WTC) attack and whether these measures were associated with Counseling Services Unit (CSU) use or mental health-related medical leave over the first 2.5 years after the attack. METHODS: Shortly after the WTC attack, a computerized, binary-response screening questionnaire was administered. Exposure assessment included WTC arrival time and "loss of a co-worker while working at the collapse." We determined elevated PTSD risk using thresholds derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a sensitivity-specificity analysis. RESULTS: Of 8487 participants, 76% reported at least 1 symptom, 1016 (12%) met criteria for elevated PTSD risk, and 2389 (28%) self-referred to the CSU, a 5-fold increase from before the attack. Higher scores were associated with CSU use, functional job impairment, and mental health-related medical leave. Exposure-response gradients were significant for all outcomes. CONCLUSIONS: This screening tool effectively identified elevated PTSD risk, higher CSU use, and functional impairment among firefighters and therefore may be useful in allocating scarce postdisaster mental health resources.

The symmetry rule: a seven-year study of symptoms and explanatory labels among Gulf War veterans.

Noticing medical symptoms can cause one to search for explanatory labels such as "ate bad food" or even "exposed to anthrax," and perhaps these labels may cause new symptom reports. The present study examined whether there is empirical support for this symptom-label "symmetry rule." We interviewed veterans (N= 362) from the Gulf War Registry in 1995 and 2002 about their medical symptoms and about their exposure to war-related hazards and stressors. Health symptom reports were strongly correlated between the two time periods and showed relatively stable mean levels, whereas recall of war-related exposures was notably unstable. Veterans starting with fewer medical symptoms recalled fewer war-related exposures seven years later. Initial recollection of chemical and biological warfare exposure (but not other exposures) longitudinally predicted novel medical symptoms. The findings generally support the symmetry rule hypotheses, although the evidence for the label to symptom link was less strong. The findings account for some variability in symptoms and exposure recall over time, but they do not, on their own, account for the Gulf War veterans' elevated number of unexplained medical symptoms.

Subjective and objective risk as predictors of influenza vaccination during the vaccine shortage of 2004-2005.

BACKGROUND: We aimed to identify the role of objective risk status and subjective risk beliefs in influenza vaccination decisions during the recent rationing of influenza vaccine. METHOD: A random sample of 300 Americans, obtained through random-digit dialing, was interviewed regarding influenza vaccination practices and beliefs in September 2004 and again in March 2005. RESULTS: One-half of individuals at high risk of influenza did not know that they were at high risk and, therefore, were not vaccinated. Respondents at high objective risk were more likely to report having been vaccinated than respondents who were not at high objective risk (36% vs. 6%, respectively; odds ratio, 8.31; 95% confidence interval, 3.65-18.88). However, a more powerful predictor of self-reported vaccination was subjective risk (64% vs. 7%, respectively; odds ratio, 24.02; 95% confidence interval, 12.18-48.09). Subjective risk fully mediated the relationship between objective risk and vaccination. Other predictors of vaccination included physician recommendation, habit, prior vaccination intention, belief that the influenza vaccine is safe and effective, perceived likelihood of getting influenza, and trait neuroticism. CONCLUSION: Health communication efforts must be more effective in persuading adults with chronic illness and individuals in contact with persons at risk that they should be vaccinated against influenza.

Persistence of symptoms in veterans of the First Gulf War: 5-year follow-up.

BACKGROUND: During the 1990-1991 Gulf War, approximately 700,000 U.S. troops were deployed to the Persian Gulf theater of operations. Of that number, approximately 100,000 have presented medical complaints through various registry and examination programs. OBJECTIVES: Widespread symptomatic illness without defining physical features has been reported among veterans of the 1991 Gulf War. We ascertained changes in symptom status between an initial 1995 symptom evaluation and a follow-up in 2000. METHODS: We assessed mailed symptom survey questionnaires for 390 previously surveyed members of the U.S. Department of Veterans Affairs Gulf War Registry for changes over the 5-year interval in terms of number and severity of symptoms. RESULTS: For the cohort as a whole, we found no significant changes in symptom number or severity. Those initially more symptomatic in 1995 showed some improvement over time, but remained much more highly symptomatic than those who had lesser initial symptomatology. CONCLUSIONS: The symptom outbreak following the 1991 Gulf War has not abated over time in registry veterans, suggesting substantial need for better understanding and care for these veterans.