Sociodemographic differences in nutrition labels effect on Chilean and Mexican youth.

Objective: To examine sociodemographic differences in the awareness, understanding, use and effect of nutrition labels among Mexican and Chilean youth. Methods: Online surveys among youth (10-17 years) were obtained in 2019 (n=2631). Participants reported their awareness, understanding, and use of their country-specific nutrition facts tables (NFT) and front-of-pack labels (FOPL) (Chile: warning labels [WLs]; Mexico: guideline daily amounts [GDA]). Additionally, participants reported their perceived healthfulness of a sweetened fruit drink after viewing one of six versions of it with different FOPL (no-label control, Health Star Rating, WLs, GDAs, Traffic Light, or Nutri-Score) during an experimental task. Results: Higher self-reported nutrition knowledge was associated with higher NFT and FOPL awareness, understanding, and use, except for WL use. WLs were the most effective FOPL in decreasing the perceived healthfulness of the sweetened fruit drink compared to a no-label condition and other FOP labels. In Chile, the effect of GDA differed by income adequacy, while in Mexico Nutri-Score differed by age. Conclusions: Results suggest that nutrition label awareness, use, understanding, and impact differ across demographics, favoring higher income and nutrition knowledge. Despite this, WLs are likely to have a positive impact on nutrition-related knowledge and behaviors among Mexican and Chilean youth, independently of their socio-demographic groups.

#junkfluenced: the marketing of unhealthy food and beverages by social media influencers popular with Canadian children on YouTube, Instagram and TikTok.

BACKGROUND: Marketing of unhealthy foods to children on digital media significantly impacts their dietary preferences and contributes to diet-related noncommunicable diseases. Canadian children spend a significant amount of time on digital devices and are frequently exposed to unhealthy food marketing on social media, including by influencers with celebrity status who endorse products. This study aimed to examine the frequency, healthfulness, and power of unhealthy food marketing in posts by influencers popular with Canadian children on YouTube, Instagram and TikTok. METHODS: The top 9 influencers popular amongst Canadian children aged 10-12 years were identified from the 2021 International Food Policy Study Youth Survey. A total of 2,232 Instagram, YouTube and TikTok posts made by these influencers between June 1st 2021 and May 31st 2022 were examined for instances of food marketing. Food products/brands were identified and frequencies were calculated for the number of posts promoting food products/brands, posts promoting products/brands classified as less healthy according to Health Canada's Nutrient Profile Model (2018) and marketing techniques utilized. RESULTS: YouTube had the highest average rate of food marketing instances per post, at a rate of 1 food marketing instance every 0.7 posts, while TikTok and Instagram had instances every 10.2 posts and 19.3 posts, respectively. Overall, fast food restaurants was the most promoted food category (21%), followed by regular soft drinks (13%), snacks (11%), candy and chocolate (11%) and water (8%). The most frequently used marketing techniques were appeals to fun/cool (37%), the use of songs or music (28%) and the product being consumed (25%). In terms of healthfulness, 83% of the products/brands (87% of brands and 82% of products) promoted were classified as less healthy. CONCLUSIONS: Social media influencers play a substantial role in promoting unhealthy food products to children, primarily fast food items. Given the significant impact of such marketing on children, there is a need for ongoing government-led monitoring, and it is crucial to include social media and influencer marketing in marketing restrictions targeting children in Canada to safeguard this vulnerable demographic.

Can a health warning label diminish the persuasive effects of health-oriented nutrition advertising on ready-to-drink alcohol product packaging? A randomized experiment.

BACKGROUND AND AIMS: A health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health-oriented nutrition advertising on ready-to-drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age. DESIGN: A between-subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready-to-drink (RTD) vodka-based soda container. SETTING AND PARTICIPANTS: Alcohol consumers (n = 5063; 52% women) in Canada aged 18-64 recruited through a national online panel. MEASUREMENTS: Participants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product. FINDINGS: Compared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (ß = -0.72, 95% confidence interval [CI] = -1.37,-0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age. CONCLUSIONS: Health warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims.

Qualitative analysis of UK women's attitudes to calorie-based alcohol marketing and alcohol calorie labelling.

Mandatory standardized nutritional information on alcoholic drinks such as energy, or calorie labelling, is a population-level public health measure aimed at addressing obesity and alcohol consumption. In the UK, such measures are not a statutory requirement, but some alcohol brands do include references to calories on their products and in their marketing materials, as a marketing strategy to encourage sales and consumption. This article presents findings of semi-structured individual (N = 43) and group (N = 9) interviews with 78 women living in the UK that aimed to gain insight into their attitudes towards calorie-based alcohol brand marketing, and alcohol calorie labelling (ACL) as a health policy. Three themes are presented that outline how women rejected calorie marketing and labelling; the potential positive and unintended impact on alcohol consumption and dietary/eating practices; and how views on calorie labelling were intertwined with women's attitudes towards marketing that draws on calorie messaging. A feminist anti-diet discourse, as well as a discourse of pleasure through alcohol consumption, was at play in women's accounts, which may limit the intended aims of ACLs. It is concluded that ACLs should be considered within the wider commercial context of alcohol marketing that draws on calories to promote sales and consumption, consideration of the gendered factors that may lead some to reject ACLs as a health policy, and the potential for unintended consequences.

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021.

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Sociodemographic differences in nutrition labels effect on Chilean and Mexican youth / Diferencias sociodemográficas en el efecto de las etiquetas nutricionales en las adolescentes de Chile y México / Diferenças sociodemográficas no efeito da rotulagem nutricional em adolescentes chilenos e mexicanos

[ABSTRACT]. Objective. To examine sociodemographic differences in the awareness, understanding, use and effect of nutrition labels among Mexican and Chilean youth. Methods. Online surveys among youth (10-17 years) were obtained in 2019 (n=2631). Participants reported their awareness, understanding, and use of their country-specific nutrition facts tables (NFT) and front-of-pack labels (FOPL) (Chile: warning labels [WLs]; Mexico: guideline daily amounts [GDA]). Additionally, participants reported their perceived healthfulness of a sweetened fruit drink after viewing one of six versions of it with different FOPL (no-label control, Health Star Rating, WLs, GDAs, Traffic Light, or Nutri-Score) during an exper- imental task. Results. Higher self-reported nutrition knowledge was associated with higher NFT and FOPL awareness, understanding, and use, except for WL use. WLs were the most effective FOPL in decreasing the perceived healthfulness of the sweetened fruit drink compared to a no-label condition and other FOP labels. In Chile, the effect of GDA differed by income adequacy, while in Mexico Nutri-Score differed by age. Conclusions. Results suggest that nutrition label awareness, use, understanding, and impact differ across demographics, favoring higher income and nutrition knowledge. Despite this, WLs are likely to have a positive impact on nutrition-related knowledge and behaviors among Mexican and Chilean youth, independently of their socio-demographic groups.

[RESUMEN]. Objetivo. Examinar las diferencias sociodemográficas por lo que respecta al conocimiento, la comprensión, el uso y el efecto de las etiquetas nutricionales en adolescentes de México y Chile. Métodos. En el 2019 se efectuó una encuesta en línea en adolescentes (10 a 17 años) (n=2631). Los participantes indicaron su conocimiento, comprensión y uso de los cuadros de información nutricional y los etiquetados frontales específicos de los empaques de su país (en el caso de Chile, las etiquetas de advertencia, y en el de México, las guías diarias de alimentación (GDA). Asimismo, se llevó a cabo un experimento en el que los participantes indicaron su percepción de lo saludable que era una bebida de fruta azucarada después de ver una de sus seis versiones con diferentes etiquetas frontales en los envases (control sin etiqueta, calificación de producto saludable mediante estrellas Health Star, etiquetas de advertencia, GDA, colores del semáforo, o sistema Nutri-Score). Resultados. El autorreporte de un mayor conocimiento sobre nutrición por parte de los participantes se aso- ció a un mayor conocimiento, comprensión y uso de los cuadros de información nutricional y los sistemas de etiquetado frontal, excepto en el caso del uso de las etiquetas de advertencia. Las etiquetas de advertencia fueron el sistema de etiquetado frontal más eficaz para reducir la percepción saludable del producto con respecto a la bebida de fruta azucarada, en comparación con la ausencia de etiqueta y el resto de los eti- quetados frontales. En Chile, el efecto de las GDA variaba en función de la adecuación del ingreso, mientras que en México el efecto del Nutri-Score difería según la edad. Conclusiones. Los resultados sugieren que el conocimiento, el uso, la comprensión y el efecto de las etique- tas nutricionales difieren entre los distintos grupos demográficos, de tal manera que son más favorables en las personas con mayores ingresos y conocimientos de nutrición. A pesar de esto, es probable que las etiquetas de advertencia tengan un impacto positivo sobre los conocimientos y los comportamientos relacionados con la nutrición en los adolescentes de México y Chile, con independencia de los grupos sociodemográficos de los que forman parte.

[RESUMO]. Objetivo. Analisar diferenças sociodemográficas em termos de conhecimento, compreensão, uso e efeito da rotulagem nutricional entre adolescentes mexicanos e chilenos. Métodos. Foram realizadas pesquisas on-line entre adolescentes de 10 a 17 anos ao longo de 2019 (n=2631). Os participantes relataram que conheciam, compreendiam e usavam as tabelas de informação nutricional e a rotulagem frontal de embalagens específicas de seus respectivos países (Chile: rotulagem de advertência; México: valores diários de referência). Além disso, os participantes relataram sua percepção sobre a saud- abilidade de um suco de fruta adoçado depois de ver uma de seis versões diferentes de rotulagem frontal (controle sem rótulo, Health Star Rating, rótulos de advertência, valores diários de referência, semáforo nutri- cional ou Nutri-Score) durante uma tarefa experimental. Resultados. Um maior conhecimento autodeclarado sobre nutrição foi associado a maior conhecimento, compreensão e uso de tabelas de informação nutricional e rotulagem frontal, com exceção do uso de rótu- los de advertência. Os rótulos de advertência foram o tipo de rotulagem frontal mais efetivo para reduzir a percepção de saudabilidade do suco de fruta adoçado em comparação com o controle sem rótulo e outros tipos de rotulagem frontal. No Chile, o efeito dos valores diários de referência variou de acordo com a renda, enquanto no México o Nutri-Score variou de acordo com a idade. Conclusões. Os resultados sugerem que o conhecimento, a compreensão, o uso e o impacto da rotulagem nutricional variam de acordo com fatores demográficos, favorecendo uma renda mais alta e conhecimento sobre nutrição. Apesar disso, é provável que os rótulos de advertência tenham um impacto positivo sobre o conhecimento e os comportamentos relativos à nutrição entre adolescentes mexicanos e chilenos, indepen- dentemente do grupo sociodemográfico a que pertencem.

The relationship between parent's self-reported exposure to food marketing and child and parental purchasing and consumption outcomes in five countries: findings from the International Food Policy Study.

Food and beverage marketing influences children's food preferences and dietary intake. Children's diets are also heavily influenced by their family environment. The aim of this study was to assess the relationship between parent's self-reported exposure to unhealthy food marketing and a range of outcomes related to children's desire for and intake of unhealthy foods and beverages. The study also sought to examine whether these outcomes varied across different countries. The analysed data are from the International Food Policy Study and were collected in 2018 using an online survey. The sample included 5764 parents of children under 18, living in Australia, Canada, Mexico, the United Kingdom, or the United States. Binary logistic regressions assessed the link between the number of parental exposure locations and children's requests for and parental purchases of unhealthy foods. Generalized ordinal regression gauged the relationship between the number of exposure locations and children's consumption of such items. Interaction terms tested if these associations varied by country. Parental exposure to unhealthy food marketing was positively associated with parents reporting child purchase requests and purchase outcomes; and differed by country. Increased parental exposure to unhealthy food marketing was associated with slightly lower odds of children's weekly consumption of unhealthy foods, and this association varied by country. In conclusion, parental report of a greater range of food marketing exposure was associated with a range of outcomes that would increase children's exposure to unhealthy food products or their marketing. Governments should consider developing more comprehensive restrictions on the marketing of unhealthy foods.

Public support for food policies in Mexican adults: Findings from the International Food Policy Study, 2017-2021.

Deaths attributable to unhealthful eating underscore the need to improve dietary patterns through upstream, policy-led solutions. The approval and successful implementation of food policies is partly determined by their public acceptance. Little is known about public support for food policies in Mexico. We aimed to investigate the level of public support for 30 food policies, grouped into 5 domains, and their associated characteristics among Mexican adults. Data are from the 2017-2021 International Food Policy Study (IFPS), a cross-sectional web-based survey of adults. Differences in public support across years were estimated using linear regression models. The association between demographic characteristics and policy support was analyzed using multivariate logistic regression models. The highest mean support was for the subsidies and benefits domain, followed by the labelling and reformulation domain. The level of support varied across years and policy domains. Support was higher in 2019 compared to 2017 and 2018, and subsequently lower in 2020 and 2021 compared to previous years. Older age was associated with greater support across all domains (OR ranged from 0.002 to 0.004, p < 0.01). Female participants and those selfidentifying as indigenous showed greater support for certain policy domains, whereas higher income adequacy was associated with lower support for other policy domains. In Mexico, support for food policies varies across subpopulations. Our findings may serve as a guide to the development and promotion of food policies in Mexico, as well as to improve their feasibility and success.

A multi-country comparison of jurisdictions with and without mandatory nutrition labelling policies in restaurants: analysis of behaviours associated with menu labelling in the 2019 International Food Policy Study.

OBJECTIVE: To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups. DESIGN: Cross-sectional data from the International Food Policy Study (IFPS) online survey. SETTING: IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019. PARTICIPANTS: Adults aged 18-99; n 19 393. RESULTS: Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy. CONCLUSIONS: Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.

Protecting traditional cultural food practices: Trends in diet quality and intake of ultra-processed foods by Indigenous status and race/ethnicity among a nationally representative sample of adults in Canada.

Background: The traditional cultural food practices of Indigenous people and adults from racial/ethnic minority groups may be eroded in the current food system where nutrient-poor and ultra-processed foods (UPF) are the most affordable and normative options, and where experiences of racism may promote unhealthy dietary patterns. We quantified absolute and relative gaps in diet quality and UPF intake of a nationally representative sample of adults in Canada by Indigenous status and race/ethnicity, and trends between 2004 and 2015. Methods: Adults (≥18 years) in the Canadian Community Health Survey-Nutrition self-reported Indigenous status and race/ethnicity and completed a 24-h dietary recall in 2004 (n = 20,880) or 2015 (n = 13,970) to calculate Healthy Eating Index-2015 (HEI-2015) scores from 0 to 100 and proportion of energy from UPF. Absolute and relative dietary gaps were quantified for Indigenous people and six racial/ethnic minority groups relative to White adults and trends between 2004 and 2015. Results: Adults from all six racial/ethnic minority groups had higher mean HEI-2015 scores (58.7-61.9) than White (56.3) and Indigenous adults (51.9), and lower mean UPF intake (31.0%-41.0%) than White (45.9%) and Indigenous adults (51.9%) in 2015. As a result, absolute gaps in diet quality were positive and gaps in UPF intake were negative among racial/ethnic minority groups-indicating more favourable intakes-while the reverse was found among Indigenous adults. Relative dietary gaps were small. Absolute and relative dietary gaps remained largely stable. Conclusions: Adults from six racial/ethnic minority groups had higher diet quality and lower UPF intake, whereas Indigenous adults had poorer diet quality and higher UPF intake compared to White adults between 2004 and 2015. Absolute and relative dietary gaps remained largely stable. Findings suggest racial/ethnic minority groups may have retained some healthful aspects of their traditional cultural food practices while highlighting persistent dietary inequities that affect Canada's Indigenous people.

The impact of fast food marketing on brand preferences and fast food intake of youth aged 10-17 across six countries.

BACKGROUND: Consumption of fast food, which is associated with poor diet, weight gain and the development of noncommunicable diseases, is high amongst youth. Fast food marketing, a modifiable determinant of excess weight and obesity, affects youth's food-related behaviours. This study aimed to examine the relationship between exposure to fast food marketing and the fast food brand preferences and intake amongst youth aged 10-17 across six countries. METHODS: Data from 9,695 youth respondents living in Australia, Canada, Chile, Mexico, the United Kingdom (UK) and the United States (US) were analyzed from the 2019 International Food Policy Study (IFPS) Youth Survey. Survey measures assessed exposure to fast food marketing and brand-specific marketing, and preference for these brands and fast food intake. Regression models adjusted for age, sex, income adequacy and ethnicity were used to examine the associations. RESULTS: Exposure to fast food marketing was positively associated with brand preferences and intake consistently across most countries. Overall, preference for McDonald's (OR:1.97; 95% CI:1.52, 2.56), KFC (OR:1.61; 95% CI:1.24, 2.09) and Subway (OR:1.73; 95% CI:1.34, 2.24) were highest when exposed to general fast food marketing ≥ 2x/week compared to never. Preference for McDonald's (OR:2.32; 95% CI:1.92, 2.79), KFC (OR:2.28; 95% CI:1.95, 2.68) and Subway (OR:2.75; 95% CI:2.32, 3.27) were also higher when exposed to marketing for each brand compared to not. Fast food intake was highest in Chile (IRR:1.90; 95% CI:1.45, 2.48), the UK (IRR:1.40; 95% CI:1.20, 1.63), Canada (IRR:1.32; 95% CI:1.19, 1.48), Mexico (IRR:1.26; 95% CI:1.05, 1.53) and the US (IRR:1.21; 95% CI:1.05, 1.41) when exposed to general fast food marketing ≥ 2x/week compared to never and was higher across most countries when exposed to brand-specific marketing compared to not. Respondents classified as ethnic minorities were more likely to report consuming fast food than ethnic majorities, and females were less likely to report consuming fast food than males. CONCLUSIONS: Exposure to fast food marketing is consistently and positively associated with brand preferences and fast food intake in all six countries. Our results highlight the need for strict government regulation to reduce exposure of unhealthy food marketing to youth in all six countries.

Availability of calorie information on online food delivery service platforms among major chain restaurants in Canadian provinces with different calorie labelling policies.

OBJECTIVE: This study aimed to characterize the availability of calorie labelling on major online food delivery (OFD) platforms for the largest restaurant brands in Canada to examine differences in provinces with and those without mandatory calorie labelling regulations. METHODS: Data were collected for the 13 largest restaurant brands with locations in Ontario (with mandatory menu labelling) and Alberta and Quebec (with no mandatory menu labelling) from the web applications of the three largest OFD platforms in Canada. Data were sampled from three selected restaurant locations within each province (n = 117 locations across all provinces) on each platform. Univariate logistic regression models were used to test differences in the presence and amount of calorie labelling and other nutritional information across provinces and platforms. RESULTS: The analytical sample included 48,857 food and beverage items (n = 16,011 in Alberta, n = 16,683 in Ontario, and n = 16,163 in Quebec). Items were more likely to have menu labelling in Ontario (68.7%) than in Alberta (44.4%, OR = 2.75, 95% CI 2.63-2.88) or Quebec (39.1%, OR = 3.42, 95% CI 3.27-3.58). In Ontario, 53.8% of restaurant brands had calorie labelling for > 90% of items, compared to 23.0% in Quebec and 15.4% in Alberta. The presence of calorie labelling also differed across platforms. CONCLUSION: Nutrition information from OFD services differed across provinces with and those without mandatory calorie labelling. Chain restaurants on OFD service platforms were more likely to provide calorie information in Ontario, where calorie labelling is mandatory, compared to elsewhere where no such policy exists. In all provinces, calorie labelling was inconsistently implemented across OFD service platforms.

RéSUMé: OBJECTIF: Cette étude vise à caractériser la disponibilité de l'affichage des calories sur les principales plateformes de service de livraison de repas en ligne (SLRL) pour les plus grandes chaines de restaurants au Canada pour évaluer les différences entre les provinces dotées d'une réglementation sur l'étiquetage obligatoire des calories et celles où une telle politique est inexistante. MéTHODOLOGIE: Les données ont été recueillies pour les 13 plus grandes chaines de restaurants ayant des établissements en Ontario (avec étiquetage des menus obligatoire) et en Alberta et au Québec (étiquetage des menus non obligatoire) sur les applications web des trois principales plateformes de SLRL au Canada. Les données ont été échantillonnées à partir de trois succursales pour chaque chaine de restaurants dans chacune des provinces (n = 117 restaurants dans toutes les provinces) sur chaque plateforme. Des modèles de régression logistique univariés ont été utilisés pour tester les différences dans la présence et la prévalence de l'affichage des calories et d'autres informations nutritionnelles entre les provinces et les plateformes. RéSULTATS: L'échantillon analysé comprenait 48 857 produits alimentaires et boissons (n = 16 011 en Alberta, n = 16 683 en Ontario et n = 16 163 au Québec). Les calories étaient plus susceptibles d'être affichées sur les produits en Ontario (68,7 %) comparativement à l'Alberta (44,4 %, RC = 2,75, IC 95% 2,63­2,88) ou au Québec (39,1 %, RC = 3,42, IC 95% 3,27­3,58). En Ontario, 53,8 % des restaurants affichaient les calories pour > 90 % des produits, contre 23,0 % au Québec et 15,4 % en Alberta. La présence de l'affichage des calories différait également d'une plateforme à l'autre. CONCLUSION: L'information nutritionnelle sur les plateformes de SLRL différait entre les provinces disposant d'une réglementation sur l'affichage des calories et celles sans une telle réglementation. Les chaines de restaurants sur les plateformes de SLRL avaient davantage tendance à afficher les calories en Ontario, où ce type d'affichage est obligatoire, qu'ailleurs, où une telle politique est inexistante. D'une province à l'autre, l'affichage des calories n'a pas été mis en œuvre de manière uniforme sur les différentes plateformes de SLRL.

Awareness, use and understanding of nutrition labels among children and youth from six countries: findings from the 2019 - 2020 International Food Policy Study.

BACKGROUND: Nutrition facts tables (NFTs) on pre-packaged foods are widely used but poorly understood by consumers. Several countries have implemented front-of-package labels (FOPLs) that provide simpler, easier to use nutrition information. In October 2020, Mexico revised its FOPL regulations to replace industry-based Guideline Daily Amount (GDA) FOPLs with 'Warning' FOPLs, which display stop signs on foods high in nutrients of concern, such as sugar and sodium. This study examined self-reported awareness, use, and understanding of NFTs and FOPLs among young people in six countries with different FOPLs, with an additional focus on changes before and after implementation of Mexico's FOPL warning policy. METHODS: A 'natural experiment' was conducted using 'pre-post' national surveys in Mexico and five separate comparison countries: countries with no FOPL policy (Canada and the US), countries with voluntary FOPL policies (Traffic Lights in the UK and Health Star Ratings in Australia), and one country (Chile) with mandatory FOPL 'warnings' (like Mexico). Population-based surveys were conducted with 10 to 17-year-olds in 2019 (n = 10,823) and in 2020 (n = 11,713). Logistic regressions examined within- and between-countries changes in self-reported awareness, use, and understanding of NFTs and FOPLs. RESULTS: Across countries, half to three quarters of respondents reported seeing NFTs 'often' or 'all the time', approximately one quarter reported using NFTs when deciding what to eat or buy, and one third reported NFTs were 'easy to understand', with few changes between 2019 and 2020. In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were higher than for NFTs in all countries, and compared with GDA FOPLs in Mexico (p < .001). Mandated Warning FOPLs in Mexico and Chile had substantially higher levels of awareness, use, and understanding than the voluntary Traffic Lights in the UK and Health Star Ratings in Australia (p < .001 for all). CONCLUSIONS: Mandated easy-to-understand FOPLs are associated with substantially greater levels of self-reported awareness, use and understanding at the population-level compared to NFT and GDA-based labeling systems.

Patterns and correlates of nutrition knowledge across five countries in the 2018 international food policy study.

BACKGROUND: Nutrition knowledge is an important determinant of diet-related behaviour; however, the use of disparate assessment tools creates challenges for comparing nutrition knowledge levels and correlates across studies, geographic contexts, and populations. Using the Food Processing Knowledge (FoodProK) score - a measure of nutrition knowledge based on consumers' ability to understand and apply the concept of food processing in a functional task - nutrition knowledge levels and associated correlates were assessed in five countries. METHODS: Adults, aged ≥18 years, were recruited through the Nielsen Consumer Insights Global Panel in Australia (n = 3997), Canada (n = 4170), Mexico (n = 4044), the United Kingdom (UK) (n = 5363), and the United States (US) (n = 4527). Respondents completed web-based surveys in November-December 2018. Functional nutrition knowledge was measured using the FoodProK score. Linear regression models examined associations between FoodProK score and sociodemographic, dietary behaviours, and knowledge-related characteristics. RESULTS: FoodProK scores (maximum, 8 points) were highest in Canada (mean: 5.1) and Australia (5.0), followed by the UK (4.8), Mexico (4.7), and the US (4.6). Health literacy and self-rated nutrition knowledge were positively associated with FoodProK scores (p < .001). FoodProK scores were higher among those who reported vegetarian/other dietary practices (p < .001); made efforts to consume less sodium, trans fats, or sugars (p < .001); ≥60 years (p = 0.002), female (p < .001), and 'majority' ethnic group respondents in their respective countries (p < .001). CONCLUSIONS: This study found differences in consumers' ability to distinguish levels of food processing for common foods, with somewhat lower levels of nutrition knowledge in countries with the highest intake of highly processed foods. Nutrition knowledge differences based on consumer characteristics highlight the need for accessible policy interventions that support uptake of healthy eating efforts across populations to avoid exacerbating nutrition-related disparities. Tools such as the FoodProK can be used to evaluate the impact of policies targeting nutrition knowledge across contexts.

Nutrition cues on ready-to-drink alcoholic beverage containers sold in grocery stores in Québec City, Canada.

Nutrition cues on ready-to-drink alcoholic beverages (RTDs) may create an illusion of healthfulness; however, nutrition information on alcohol in Canada is seldom regulated. This research aimed to systematically record the use of nutrition cues on a subsample of RTDs sold in grocery stores. In July 2021, all available RTDs were purchased from three major grocery store banners in Québec City, Canada. Data regarding container size, purchase format, alcohol-by-volume (ABV), presence of nutrition cues (nutrient claims, other food-related claims and nutrition facts tables [NFTs]) and container surface occupied by nutrition cues were recorded. RTDs were classified as hard seltzers or pre-mixed cocktails and their ABV as "light-strength" (3.5%-4.0% ABV) and "regular-strength" (>4.0%-7.0% ABV). In total (n = 193), 23% were hard seltzers and 17% light-strength. Most RTDs (68%) had ≥1 type of nutrition cue, most often natural flavour claims (45%), an NFT (38%), and calorie claims (29%). Light-strength beverages were more likely than regular-strength to carry any nutrient claim (97% vs. 19%, p < 0.0001), an NFT (97% vs. 26%, p < 0.0001) and other food-related claims (e.g., natural flavour) (88% vs. 52%, p = 0.0002). In adjusted regression analyses, hard seltzers were more likely than pre-mixed cocktails to carry any nutrient claim (AOR = 19.1, 95% CI:7.5,48.7), any other food-related claim (AOR = 7.5, 95% CI:2.9,19.4), and an NFT (AOR = 45.5, 95% CI:12.6,163.9). The mean container surface occupied by nutrition cues was higher for hard seltzers compared to pre-mixed cocktails (13% vs 3%, p < 0.0001). The high proportion of RTDs carrying nutrition cues supports the need to further regulate labelling and marketing of RTDs.

Examining differences in children and adolescents' exposure to food and beverage marketing in Canada by sociodemographic characteristics: Findings from the International Food Policy Study Youth Survey, 2020.

BACKGROUND: Many countries, including Canada, are considering regulations to restrict food and beverage marketing to children. However, little evidence is available outside of the US on how marketing exposure differs across sociodemographic subgroups. OBJECTIVE: To investigate potential associations between child and adolescent sociodemographic characteristics and exposure to food and beverage marketing in Canada. METHODS: Participants (n = 3780) aged 10-17 self-reported exposure to food and beverage marketing across food categories, locations and marketing techniques. Logistic regression models tested relationships between sociodemographics (age, sex, ethnicity and income adequacy) and marketing exposure. RESULTS: Among other differences identified, 13-17 years old were more likely than 10-12 years old to report seeing unhealthy food marketing online. Girls were more likely than boys to see such marketing online and in retail settings, while boys were more likely to see it in video games. Minority ethnicities (including Indigenous youth) and respondents with lower income adequacy generally reported more exposure than White and higher income respondents, respectively. CONCLUSIONS: This study highlights important differences in marketing exposure among youth of different sociodemographic groups in Canada, including greater exposure to marketing among those most disadvantaged and emphasizes the essential need to consider food marketing across equity groups when developing restrictions on marketing to kids.

Public Support for Nutrition-Related Actions by Food Companies in Australia: A Cross-Sectional Analysis of Findings from the 2020 International Food Policy Study.

Unhealthy food environments contribute to unhealthy population diets. In Australia, the government currently relies on voluntary food company actions (e.g., related to front-of-pack labelling, restricting promotion of unhealthy foods, and product formulation) as part of their efforts to improve population diets, despite evidence that such voluntary approaches are less effective than mandatory policies. This study aimed to understand public perceptions of potential food industry nutrition-related actions in Australia. An online survey was completed by 4289 Australians in 2020 as part of the International Food Policy Study. The level of public support was assessed for six different nutrition-related actions related to food labelling, food promotion, and product formulation. High levels of support were observed for all six company actions, with the highest support observed for displaying the Health Star Rating on all products (80.4%) and restricting children's exposure to online promotion of unhealthy food (76.8%). Findings suggest the Australian public is strongly supportive of food companies taking action to improve nutrition and the healthiness of food environments. However, given the limitations of the voluntary action from food companies, mandatory policy action by the Australian government is likely to be needed to ensure company practices align with public expectations.

The structure of the Canadian packaged food and non-alcoholic beverage manufacturing and grocery retailing sectors through a public health lens.

BACKGROUND: Corporate power has been recognized as an important influence on food environments and population health more broadly. Understanding the structure of national food and beverage markets can provide important insight into the power held by leading corporations. This study aimed to descriptively analyze the structure of the Canadian food and beverage manufacturing and grocery retailing sectors as of 2020/21. METHODS: Packaged food manufacturers, non-alcoholic beverage manufacturers and grocery retailers with ≥ 1% market share in 2020/21 in Canada as per Euromonitor International were identified and characterized. Proportion of market share held by public vs private, multinational vs national, and foreign multinational companies was assessed for the 3 sectors. The concentration of 14 packaged food, 8 non-alcoholic beverage and 5 grocery retailing markets was assessed using the Herfindahl-Hirschman Index (HHI) and the four firm concentration ratio (CR4) (HHI > 1800 and CR4 > 60 suggest high market concentration). Company ownership structure was also assessed, including common ownership of public companies by three of the largest global asset managers using data from Refinitiv Eikon, a financial market database. RESULTS: The Canadian non-alcoholic beverage manufacturing sector, and, to a lesser extent, the packaged food manufacturing sector were dominated by foreign multinational companies, in contrast with the grocery retailing sector which was dominated by national companies. Market concentration varied across sectors and markets but was substantially greater within the retailing (median CR4 = 84; median HHI = 2405) and non-alcoholic beverage sectors (median CR4 = 72; median HHI = 1995) compared to the packaged food sector (median CR4 = 51; median HHI = 932). There was considerable evidence of common ownership across sectors. Overall, the Vanguard Group Inc owned at least 1% of shares in 95% of publicly listed companies, Blackrock Institutional Trust Company 71%, and State Street Global Advisors (US) 43%. CONCLUSIONS: The Canadian packaged food and non-alcoholic beverage manufacturing and grocery retailing sectors include several consolidated markets, with a high degree of common ownership by major investors. Findings suggest that a small number of large corporations, particularly in the retailing sector, have extensive power to influence Canadian food environments; their policies and practices warrant substantial attention as part of efforts to improve population diets in Canada.