Comparing five front-of-pack nutrition labels' influence on consumers' perceptions and purchase intentions.

In 2011, a National Academy of Medicine report recommended that packaged food in the U.S. display a uniform front-of-package nutrition label, using a system such as a 0-3 star ranking. Few studies have directly compared this to other labels to determine which best informs consumers and encourages healthier purchases. In 2013, we randomized adult participants (N=1247) in an Internet-based survey to one of six conditions: no label control; single traffic light; multiple traffic light; Facts Up Front; NuVal; or 0-3 star ranking. We compared groups on purchase intentions and accuracy of participants' interpretation of food labels. There were no differences in the nutritional quality of hypothetical shopping baskets across conditions (p=0.845). All labels improved consumers' abilities to judge the nutritional quality of foods relative to no label, but the best designs varied by outcomes. NuVal and multiple traffic light labels led to the greatest accuracy identifying the healthier of two products (p<0.001), while the multiple traffic light also led to the most accurate estimates of saturated fat, sugar, and sodium (p<0.001). The single traffic light outperformed other labels when participants compared nutrient levels between similar products (p<0.03). Single/multiple traffic light and Facts Up Front labels led to the most accurate calories per serving estimations (p<0.001). Although front-of-package labels helped participants more accurately assess products' nutrition information relative to no label, no conditions shifted adults' purchase intentions. Results did not point to a clearly superior label design, but they suggest that a 3-star label might not be best for educating consumers.

Product reformulation and nutritional improvements after new competitive food standards in schools.

OBJECTIVE: In 2012, Massachusetts enacted school competitive food and beverage standards similar to national Smart Snacks. These standards aim to improve the nutritional quality of competitive snacks. It was previously demonstrated that a majority of foods and beverages were compliant with the standards, but it was unknown whether food manufacturers reformulated products in response to the standards. The present study assessed whether products were reformulated after standards were implemented; the availability of reformulated products outside schools; and whether compliance with the standards improved the nutrient composition of competitive snacks. DESIGN: An observational cohort study documenting all competitive snacks sold before (2012) and after (2013 and 2014) the standards were implemented. SETTING: The sample included thirty-six school districts with both a middle and high school. RESULTS: After 2012, energy, saturated fat, Na and sugar decreased and fibre increased among all competitive foods. By 2013, 8 % of foods were reformulated, as were an additional 9 % by 2014. Nearly 15 % of reformulated foods were look-alike products that could not be purchased at supermarkets. Energy and Na in beverages decreased after 2012, in part facilitated by smaller package sizes. CONCLUSIONS: Massachusetts' law was effective in improving the nutritional content of snacks and product reformulation helped schools adhere to the law. This suggests fully implementing Smart Snacks standards may similarly improve the foods available in schools nationally. However, only some healthier reformulated foods were available outside schools.

Parents' Perceptions of the Challenges to Helping Their Children Maintain or Achieve a Healthy Weight.

Introduction: Parents play a critical role in their children's weight. This paper examines parents' perceptions about the challenges to helping their kids maintain or achieve a healthy weight. Methods: We analyzed data in 2017 from a U.S. telephone poll conducted during October-November 2012 among parents or caregivers of children aged 2-17 years using a nationally representative sample of households. It included 667 White, 123 Black, and 167 Hispanic parents. Multiple logistic regressions were used to examine parent perceptions about the individual- and environmental-level challenges to helping their children maintain or achieve a healthy weight. Results: Overall, 45% of children have parents who reported challenges helping the child eat to maintain or achieve a healthy weight, and 35% have parents who reported challenges for exercise. According to parents, most children consumed snacks between 3 pm and bedtime during the school week (83%), and 63% of those children had an unhealthy snack. Parents did not express much concern about unhealthy snacks; 80% of children had parents who said that they did not mind since their child generally ate healthy food. Children with Hispanic and Black parents were more likely than those with White parents to have parents reporting environment challenges, such as unhealthy foods in schools. Conclusions: Helping children maintain a healthy weight through diet is a problem for many parents, regardless of their race or ethnicity. Differences by race/ethnicity in parent perceptions of food environment challenges to helping their child maintain or achieve a healthy weight suggest possible areas for future interventions.

Differences in the Neighborhood Retail Food Environment and Obesity Among US Children and Adolescents by SNAP Participation.

OBJECTIVE: The goal of this study was to understand the association between children's neighborhood food access and overweight/obesity in a national sample of US households, and whether this association differs by Supplemental Nutrition Assistance Program (SNAP) participation or household purchases. METHODS: Data were obtained from the National Household Food Acquisition and Purchase Survey (2012-2013; n = 3,748 children aged 2 to 18 years). Logistic regression was used to examine associations between neighborhood retail food access (≤1 mile from home), food purchases (including sugary beverages), and overweight/obesity, stratified by SNAP status (1,720 participants, 453 eligible nonparticipants, 1,575 SNAP ineligible). Store types included supermarkets/grocery, combination grocery/other (independent drug, dollar, and general stores), convenience, fast food, and non-fast food restaurants. RESULTS: Odds of childhood overweight/obesity (OR [95% CI]) were higher with greater access to combination grocery/other stores overall (1.10 [1.03-1.17]) and for children in SNAP (1.14 [1.05-1.24]). Eligible non-SNAP children had higher odds of overweight/obesity with greater access to convenience stores (1.11 [1.04-1.18]). The average child lived in a household with 6.3% of total spending at food outlets on sugary beverages (SNAP: 8.3%, eligible non-SNAP: 7.7%, SNAP ineligible: 5.5%). CONCLUSIONS: Greater neighborhood access to combination grocery/other stores is associated with higher obesity prevalence for children overall and those in SNAP.

The Impact of 1 Year of Healthier School Food Policies on Students' Diets During and Outside of the School Day.

BACKGROUND: In 2012, Massachusetts implemented both the updated national school meal standards and comprehensive competitive food/beverage standards that closely align with current national requirements for school snacks. OBJECTIVES: This study examines the impact of these combined standards on school meal and snack food selections, as well as food choices outside of school. In addition, this study examines the impact of these standards on nutrients consumed. DESIGN: The NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) Study was an observational cohort study conducted among students from spring 2012 to spring 2013. PARTICIPANTS/SETTING: One hundred sixty students in 12 middle schools and high schools in Massachusetts completed two 24-hour recalls before (spring 2012) and after implementation (spring 2013) of the updated standards. MAIN OUTCOME MEASURES: Changes in school meals, competitive food, and after-school snack selection, as well as nutrients consumed outside of school were examined. STATISTICAL ANALYSES PERFORMED: Logistic regression and mixed-model analysis of variance were used to examine food selection and consumption. RESULTS: After implementation, 13.6% more students chose a school meal (70.1% vs 56.5%; P=0.02). There were no differences in competitive food purchases but a significant decrease in the number of after-school unhealthy snacks consumed (0.69 [standard error=0.08] vs 1.02 [standard error=0.10]; P=0.009). During the entire day, students consumed, on average, 22 fewer grams of sugar daily after implementation compared with before implementation (86 g vs 108 g; P=0.002). CONCLUSIONS: With the reduction in the number of unhealthy school snacks, significantly more students selected school meals. Students did not compensate for lack of unhealthy snacks in school by increased consumption of unhealthy snacks outside of school. This provides important new evidence that both national school meal and snack policies may improve daily diet quality and should remain strong.

Increases in Sugary Drink Marketing During Supplemental Nutrition Assistance Program Benefit Issuance in New York.

INTRODUCTION: The Supplemental Nutrition Assistance Program (SNAP) is the largest federal food assistance program, providing $67 billion in benefits to 44 million Americans. Some states distribute SNAP benefits over one or a few days each month, which may create an incentive for retailers to heavily promote top-selling products, like sugar-sweetened beverages, when benefits are disbursed. METHODS: A beverage environment scan assessing presence of displays, advertisements, and price promotions for sugar-sweetened, low-calorie, and unsweetened beverages was administered in a census of SNAP-authorized beverage retailers (n=630) in three cities in New York from September to November 2011. Multilevel regression models controlling for store type; county; and percentage SNAP enrollment, poverty, and non-Hispanic white population in the store's census tract were used to estimate the odds of in-store beverage marketing during the SNAP benefit issuance period compared to other days of the month. Data were analyzed in 2016. RESULTS: There were higher odds of in-store sugar-sweetened beverage marketing during SNAP benefit issuance days (first to ninth days of the month) compared with other days of the month, particularly for sugar-sweetened beverage advertisements (OR=1.66, 95% CI=1.01, 2.72) and displays (OR=1.88, 95% CI=1.16, 3.03). In census tracts with high SNAP enrollment (>28%), the odds of a retailer having sugar-sweetened beverage displays were 4.35 times higher (95% CI=1.93, 9.98) during issuance compared with non-issuance days. There were no differences in marketing for low-calorie or unsweetened beverages. CONCLUSIONS: Increases in sugar-sweetened beverage marketing during issuance may exacerbate disparities in diet quality of households participating in SNAP. Policy changes, like extending SNAP benefit issuance, may mitigate these effects.