Below are research abstracts of consumer research studies conducted or supported by the Center for Food Safety and Applied Nutrition.
The Health and Diet Survey is a national consumer survey conducted by the Food and Drug Administration (FDA). The national single-stage random-digit-dialing telephone survey has been commissioned by CFSAN since early 1980’s. Respondents are randomly selected non-institutionalized adults in the 50 states and the District of Columbia. The latest iteration was conducted in 2008. The purpose of the survey is to track and gather information on consumer awareness, attitudes and practices related to health and diet issues. In particular, the survey focuses on foods and dietary supplements, two categories of the consumer products regulated by the FDA. On diet and health, the survey asks about (1) awareness of the relationship between diet and diseases (cancer, heart disease, high blood pressure), (2) knowledge of fats and cholesterol, (3) knowledge of dietary deficiencies, (4) dietary management practices, and (5) use and impact of food labels. On dietary supplements, the survey asks about (1) prevalence of use, (2) information sources and uses, (3) perceptions of dietary supplements and their labels, (4) substitution of dietary supplements for prescription or over-the-counter drugs, (5) adverse experiences with dietary supplements, and (6) children's and teenagers' use of dietary supplements. The available demographic information includes gender, age, education, race/ethnicity, household size, pregnancy/lactation status, health status, region, and household income. [Contact: Amy Lando]
Nutrient Content Claims: How They Impact Perceived Healthfulness of Fortified Snack Foods and the Moderating Effects of Nutrition Facts Labels. 2017. Irina A. Iles, Xiaoli Nan and Linda Verrill. Health Communication.
Nutrient content claims (NCCs) may inflate perceived healthfulness of nutritionally poor foods. The aim of this study is to experimentally test the effects of NCCs on consumers’ perceptions of fortified snack foods in terms of the presence of both healthful and less healthful nutrients, as well as their intentions to consume such products. It also explores the potential moderating effects of reading Nutrition Facts Labels (NFL) on the influence of NCCs. Data for this study were collected through a web-based experiment (N = 5,076). Results indicated that the presence of an NCC on a fortified snack food product increased perceived healthfulness of that product, perceptions of the presence of healthful nutrients, and intentions to consume the product. The presence of NCCs also decreased perceptions of the presence of certain less healthful nutrients. Reading the NFL had mixed effects on the impact of NCCs. [Contact: Linda Verrill]
Vitamin-Fortified Snack Food May Lead Consumers to Make Poor Dietary Decisions. 2016. Linda Verrill, Dallas Wood, Sheryl Cates, Amy Lando, and Yaunting Zhang. Journal of the Academy of Nutrition and Dietetics.
BACKGROUND: The US Food and Drug Administration’s fortification policy discourages the fortification of certain foods, including sugars and snack foods such as cookies, candies, cakes, chips, and carbonated beverages, yet manufacturers sometimes add vitamins and minerals to snack foods.
OBJECTIVE: To assess whether vitamin-fortified snack foods affect consumers’ information-seeking, purchase decisions, and product-related health perceptions.
DESIGN: For this experimental study, participants were randomly assigned to study conditions to compare products that varied in product type, nutrition profile, and fortification and nutrient claim status. Data were collected via an online consumer panel.
PARTICIPANTS/SETTING: US adults aged 18 years and older were randomly selected from Research Now’s e-panel online household panel. Data were collected during fall 2014 (N=5,076).
INTERVENTION: Participants were randomly assigned to one of 24 conditions: two products (vegetable chip/potato chip), two nutrition profiles (healthier/less healthy), two fortification scenarios (not fortified/fortified), and three nutrient claim conditions (two no claim/one with claim). The design was not balanced; claims were not shown on products that were not vitamin fortified.
MAIN OUTCOME MEASURES: Outcome measures were information-seeking (viewed the Nutrition Facts label), purchase decisions, perception of product healthfulness, and correct selection of product with the healthier nutrient profile.
STATISTICAL ANALYSIS PERFORMED: Logistic regression was used to test all models. Analyses was adjusted for general label use, consumes product, health status, age, sex, level of education, presence of children in the household, and race/ethnicity.
RESULTS: When the snack food carried a nutrient claim for vitamin fortification, participants were 1) less likely to look for nutrition information on the Nutrition Facts label, 2) more likely to select the product for purchase, 3) more likely to perceive the product as healthier, and 4) less likely to correctly choose the healthier product. CONCLUSIONS: Snack foods that have been vitamin-fortified may cause consumers to make poor dietary decisions.
[Contact: Linda Verrill]
This study examines predictors of American consumers’ preferences for fortified foods, focusing on sociodemographic as well as psychological correlates. Analysis of a probability-based survey (N = 6,728) revealed that females and the more educated tended to have greater preferences for fortified foods. Whites held the least favorable views on fortified foods when compared to Blacks and Hispanics. In terms of psychological predictors, people who were more health-conscious were more likely to prefer fortified foods. Perceived usefulness of nutrition labels and confusion about healthy food choices were both associated with stronger preferences for fortified foods. Both relationships appeared to be moderated by health consciousness. Communication and policy implications of these findings are discussed. [Contact: Linda Verrill]
BACKGROUND: Epidemiologic evidence indicates that food allergies are increasing in the population. Information on a change in self-reported food allergy (srFA) in adults over time is lacking.
OBJECTIVE: To report the prevalence of srFA and compare differences at three time points over a decade.
METHODS: We analyzed srFA and reported physician-diagnosed food allergy in 4000 U.S. adults who participated in the 2010 U.S. Food and Drug Administration Food Safety Survey. Information on causative food(s), reaction severity characteristics, and various diagnostic factors was also analyzed. We compared 2010 Food Safety Survey data with 2006 and 2001 data, and highlighted relevant differences.
RESULTS: SrFA prevalence increased significantly, to 13% in 2010 and 14.9% in 2006 compared with 9.1% in 2001 (p<0.001). Physician diagnosed food allergy was 6.5% in 2010, which was not significantly different compared with 7.6% in 2006 and 5.3% in 2001. SrFA increased in both men and women, non-Hispanic white and black adults, 50–59 year olds, and in adults with a high school or lower education. In 2010, milk, shellfish, and fruits were the most commonly reported food allergens, similar to 2001. Also, in 2010, 15% of reactions reportedly required a hospital visit and 8.4% were treated with epinephrine. Minor differences in reaction severity characteristics were noted among the surveys.
CONCLUSIONS: Analysis of survey results indicates that the prevalence of srFA increased among U.S. adults from 2001 to 2010 and that adults are increasingly self-reporting FAs without obtaining medical diagnosis. Improved education about food allergies is needed for this risk group.
[Contact: Linda Verrill]
Fish consumption during pregnancy is one important area of dietary advice. There are potential benefits for pregnant women and their babies from a diet that contains sufficient amounts of fish. However, methylmercury, which is in most fish in at least trace amounts, can have adverse effects on the cognitive development of fetuses and can have neurological effects on children and adults in high amounts. The Federal government first issued national consumption advice in order to minimize the risk to the developing fetus from methylmercury in fish in the 1990s. This advice was updated in 2001 and again in 2004. Most recently, the US Dietary Guidelines for Americans, 2010 recommends a consumption target for pregnant and nursing women of 8 to 12 oz/wk of a variety of fish lower in methyl-mercury—to take advantage of the potential benefits that fish could provide to children’s development— while avoiding the 4 fish species highest in methylmercury that are named in joint 2004 Food and Drug Administration/Environmental Protection Agency advice (tilefish, shark, swordfish, and king mackerel). The challenge for policy makers, public health officials, and clinicians is to determine how best to communicate with pregnant women about both the benefits and risks associated with fish consumption. [Contact: Amy Lando]
Consumer Research Needs from the Food and Drug Administration on Front-of-Package Nutritional Labeling. 2014. J. Craig Andrews, Jordan Lin, Alan S. Levy, and Serena Lo. Journal of Marketing and Public Policy 33(1):10-16.
Americans have increasingly busy lifestyles and desire quick and nutritious food choices. To provide consumers with at-a-glance nutrition information, many food manufacturers have introduced front-of-package (FOP) nutritional labeling systems. The purpose of this review is to reach out to the marketing and public policy discipline by identifying research needs on FOP systems not only to aid decision making for federal agencies, but also to help advance research on this important topic. We describe the many FOP systems, the FDA's regulatory background and approach to FOP systems, recent experimental research and gaps in knowledge, and research needs on FOP nutrition labeling. [Contact: Chung-Tung Lin]
Simulating the Potential Effects of a Shelf-Tag Nutrition Information Program and Pricing on Diet Quality Associated with Ready-to-Eat Cereals. 2014. Biing-Hwan Lin, Joanne Guthrie, Ilya Rahkovsky, Chung-Tung J. Lin, and Jonq-Ying Lee. International Food and Agribusiness Management Review 17(Special Issue A):7-24.
Previous research has shown that the Guiding Stars ProgramTM (GSP), a shelf -tag nutrition information system used in some supermarkets in the United States (US), increases consumer demand for ready-to-eat (RTE) breakfast cereals that the program considers more nutritious. Further, consumer demand for cereals is found to respond to price. Here we simulate potential changes in RTE cereal consumption predicted by estimated demand if a GSP or a 10% price manipulation were in effect nationwide in the US, and measure the impact on intakes of whole grains, added sugars, sodium, and calories. We find small effects for the GSP and somewhat larger ones for a 10% price intervention. [Contact: Chung-Tung Lin]
Food label usage and reported difficulty with following a gluten-free diet among individuals in the USA with coeliac disease and those with noncoeliac gluten sensitivity. 2013. Linda Verrill, Yuanting Zhang, and Rhonda Kane. Journal of Human Nutrition and Dietetics 26:479-487.
Individuals with coeliac disease (CD) and those with noncoeliac gluten sensitivity (GS) have reported difficulty following a gluten-free diet (GFD); however, few studies have explored the link between the food label, gluten-free (GF) claims and the difficulty associated with following a GFD. The present study surveyed adults with CD (n = 1,583) and adults with GS (n = 797) about their reported difficulty following a GFD, including assessing the role of food labels and GF claims, as well as other factors known to contribute to this difficulty. A two-sample t-test and chi squared tests for equality of means or proportions were used for the descriptive data and ordinal logistic regression (OLR) was used to model associations. On average, individuals with GS reported slightly more difficulty following the GFD than did participants with CD. According to the OLR results, reading the food label often was significantly associated with less reported difficulty following a GFD, whereas consuming packaged processed foods and looking for GF claims more often were significantly associated with more reported difficulty for both respondent groups. Individuals with GS may rely more heavily on the GF claim for information about a product’s gluten content. Individuals with CD, on the other hand, may be more experienced food label readers and may rely more on the ingredient list for finding GF foods. More studies are needed aiming to understand the role of the food label in facilitating consumers’ ability to follow a GFD. [Contact: Linda Verrill]
Single-Larger-Portion-Size and Dual-Column Nutrition Labeling May Help Consumers Make More Healthful Choices. 2013. Amy Lando and Serena Lo. Journal of the Academy of Nutrition and Dietetics 113(2):241-250.
BACKGROUND: The Food and Drug Administration is considering changes to the Nutrition Facts label to help consumers make more healthful choices.
OBJECTIVE: To examine the effects of modifications to the Nutrition Facts label on foods that can be listed as having 1 or 2 servings per container, but are reasonably consumed at a single eating occasion.
DESIGN: Participants were randomly assigned to study conditions that varied on label format, product, and nutrition profile. Data were collected via an online consumer panel.
PARTICIPANTS/SETTING: Adults aged 18 years and older were recruited from Synovate's online household panel. Data were collected during August 2011. A total of 32,897 invitations were sent for a final sample of 9,493 interviews.
INTERVENTION: Participants were randomly assigned to one of 10 label formats classified into three groups: listing 2 servings per container with a single column, listing 2 servings per container with a dual column, and listing a single serving per container. Within these groups there were versions that enlarged the font size for "calories," removed "calories from fat," and changed the wording for serving size declaration.
MAIN OUTCOME MEASURES: The single product task measured product healthfulness, the amount of calories and various nutrients per serving and per container, and label perceptions. The product comparison task measured ability to identify the healthier product and the product with fewer calories per container and per serving.
STATISTICAL ANALYSES PERFORMED: Analysis of covariance models with Tukey-Kramer tests were used. Covariates included general label use, age, sex, level of education, and race/ethnicity.
RESULTS: Single-serving and dual-column formats performed better and scored higher on most outcome measures.
CONCLUSIONS: For products that contain 2 servings but are customarily consumed at a single eating occasion, using a single-serving or dual-column labeling approach may help consumers make healthier food choices.
[Contact: Amy Lando]
Effects of the Guiding Stars Program on Purchases of Ready-To-Eat Cereals With Different Nutritional Attributes. 2013. Ilya Rahkovsky, Biing-Hwan Lin, Chung-Tung J. Lin, and Jonq-Ying Lee. Food Policy 43:100-107.
Over the past decade, the food industry has increased its use of front-of-package and shelf-tag nutrition labeling designed to present key nutritional aspects and characteristics of food products. One such system is the Guiding Stars Program™ (GSP), which uses an algorithm to score the nutritional values of food products from one to three stars, where more stars mean more nutritious. We studied how the introduction of the GSP in one supermarket chain affected the demand for ready-to-eat cereals. We estimated the demand for cereals and measured the effect using a treatment–control approach. We found that the GSP significantly increased the demand for cereals that GSP considers more nutritious at the expense of cereals that GSP considers less nutritious. [Contact: Chung-Tung Lin]
Associations Between Self-Reported Weight Management Methods With Diet Quality as Measured by the Health Eating Index-2005. 2013. Chung-Tung J. Lin, Zhifeng Gao, and Jonq-Ying Lee. Preventive Medicine 57(3):238-243.
OBJECTIVE: We examine the relationship between weight management practices and diet quality.
METHOD: Regressions were used to analyze the associations between self-reported weight management methods and diet quality, as measured by the Healthy Eating Index-2005 (HEI-2005), of 1,933 respondents who tried to lose or not gain weight in the 2003-2004 National Health and Nutrition Examination Survey (NHANES). The regressions controlled for sociodemographics, lifestyle behaviors, and other health-related behaviors and perceptions.
RESULTS: Including both switching to foods with lower calories and exercise in weight management was associated with better diet quality, i.e., a higher total HEI-2005 score and higher scores in eight of the twelve HEI-2005 components than including neither method. The eight components included six components on fruit, vegetables and grains, milk, and calories from solid fat, alcohol beverages, and added sugars. Similar but smaller associations were also found among those who reported including either switching to foods with lower calories or exercise.
CONCLUSIONS: Based on self-reported data, the findings suggest that including switching to lower calorie foods and exercise in weight management, as recommended by the Dietary Guidelines for Americans (DGA), is associated with diet quality that is more consistent with the key diet-related advice of the DGA.
[Contact: Chung-Tung Lin]
Sex-Based Differences in Food Consumption: Foodborne Disease Active Surveillance Network (FoodNet) Population Survey, 2006-2007. 2012. Beletshachew Shiferaw, Linda Verrill, Hillary Booth, Shelley Zansky, Dawn Norton, Stacy Crim, Olga Henao. Clinical Infectious Diseases 54:S453-S457.
This analysis used data from the most recent Foodborne Diseases Active Surveillance Network (FoodNet) Population Survey (May 2006 through April 2007) to examine differences in the consumption of various types of foods between men and women. Participants were surveyed by telephone and asked whether or not they had consumed certain foods in the past 7 days, including the following ‘‘high-risk’’ foods commonly associated with foodborne illness: pink hamburger, raw oysters, unpasteurized milk, cheese made from unpasteurized milk, runny eggs, and alfalfa sprouts. Data were weighted to adjust for survey design and to reflect the age and sex distribution of the population under FoodNet surveillance. A total of 14 878 persons $18 years were interviewed, of whom 5688 (38%) were men. A higher proportion of men reported eating meat and certain types of poultry than women, whereas a higher proportion of women ate fruits and vegetables. A higher proportion of men than women reported consuming runny eggs (12% versus 8%), pink hamburger (7% versus 4%), and raw oysters (2% versus 0.4%). A higher proportion of women than men ate alfalfa sprouts (3% versus 2%). No differences by sex were observed for consumption of unpasteurized milk or cheese. Data from the FoodNet Population Surveys can be useful in efforts to design targeted interventions regarding consumption of high-risk foods. Moreover, understanding the background rates of food consumption, stratified by sex, may help investigators identify the kinds of foods likely to be associated with outbreaks in which a preponderance of cases occur among members of one sex. [Contact: Linda Verrill]
OBJECTIVE: Impact of mandatory trans fat labelling on US snack food introductions is examined.
DESIGN: Using label information, lipid ingredients and fat profiles are compared pre- and post-labelling.
SETTING: Key products in the US snack food industry contribute significant amounts of artificial trans fat. Industry efforts to reformulate products to lower trans fat may alter the overall fat profile, in particular saturates.
SUBJECTS: Composition data for more than 5000 chip and cookie products introduced for sale between 2001 (pre-labelling) and 2009 (post-labelling) were analyzed.
RESULTS: One-way ANOVA was used to test for significant changes in saturated fat content per serving and the ratio of saturated to total fat. The shares of chip and cookie introductions containing partially hydrogenated vegetable oil declined by 45 and 42 percentage points, respectively. In cookies, there was an increase of 0·49 (98 % CI 0·01, 0·98) g in the average saturated fat content per 30 g serving and an increase of 9 (98 % CI 3, 15) % in the average ratio of saturated to total fat. No statistically significant changes in fat content were observed in chips.
CONCLUSIONS: This research suggests that, holding other factors constant, the policy has resulted in a decreased use of partially hydrogenated vegetable oil in chip products without a corresponding increase in saturated fat content, but led to significantly higher levels of saturated fat and ratio of saturated fat to total fat in cookie products.
[Contact: Chung-Tung Lin]
Dietary advice emphasizes that some dietary fats increase the risk of heart disease, whereas other dietary fats decrease risk if they are substituted for more risk-increasing fats. Thus, it is important that consumers understand the differences between dietary fats. Existing evidence in the United States suggests troublesome consumer misunderstanding. As part of its continuing effort to promote public health, the US Food and Drug Administration measured consumer awareness and understanding of dietary fats in its Health and Diet Survey- 2004 Supplement. After cognitive interviews and pretests of the questionnaire, telephone interviews of randomly selected noninstitutionalized adults aged 18 years and older in the United States were conducted between October 12, 2004, and January 21, 2005. Using cross-sectional data collected from 1,798 respondents who completed the survey, this study estimated the prevalence of awareness and understanding of six dietary fats among US adults and identified the characteristics of adults with different levels of awareness and understanding. Descriptive analyses were used, along with logistic regression models, developed to accommodate the survey design and responses. There was a wide disparity among US consumers in their awareness and understanding. Saturated fat was most recognized and understood, whereas awareness of other fats was much lower. Most importantly, having heard of a fat did not necessarily mean understanding its relationship to heart disease. Only half of those who had heard of trans fat and n-3 fatty acids understood that the fats raise and lower the risk of heart disease, respectively. Only a minority of those who had heard of partially hydrogenated oil and polyunsaturated fat knew the fats raise and lower the risk of heart disease, respectively. Many admitted being uncertain about how a fat relates to the risk of heart disease. College or more-educated adults had better awareness and understanding. Nonwhite adults were less knowledgeable. Findings on the awareness and understanding and how they are related to individual characteristics can inform deliberations about educational messages, nutrition programs, and food labeling about dietary fats to promote public health. [Contact: Chung-Tung Lin]
Effect of Low-carbohydrate Claims on Consumer Perceptions about Food Products' Healthfulness and Helpfulness for Weight Management. 2010. Judith Labiner-Wolfe, Chung-Tung Jordan Lin, and Linda Verrill. Journal of Nutrition Education and Behavior 42(5):315-320.
OBJECTIVE: Evaluate effect of low-carbohydrate claims on consumer perceptions about food products' healthfulness and helpfulness for weight management.
DESIGN: Experiment in which participants were randomly assigned 1 of 12 front-of-package claim conditions on bread or a frozen dinner. Seven of the 12 conditions also included Nutrition Facts (NF) information.
PARTICIPANTS: 4,320 members of a national on-line consumer panel.
INTERVENTION: Exposure to images of a food package.
MAIN OUTCOME MEASURES: Ratings on Likert scales about perceived healthfulness, helpfulness for weight management, and caloric content.
ANALYSIS: Mean ratings by outcome measure, condition, and product were calculated. Ratings were also used as the dependent measure in analysis of variance models.
RESULTS: Participants who saw front-of-package-only conditions rated products bearing low-carbohydrate claims as more helpful for weight management and lower in calories than the same products without a claim. Those who saw the bread with low-carbohydrate claims also rated it as more healthful than those who saw no claim. When the NF label was available and products had the same nutrition profile, participants rated products with low-carbohydrate claims the same as those with no claim.
CONCLUSIONS AND IMPLICATIONS: Consumers who do not use the NF panel may interpret low-carbohydrate claims to have meaning beyond the scope of the claim itself.
[Contact: Chung-Tung Lin]
Are Food Allergen Advisory Statements Really Warnings? Variation in Consumer Preferences and Consumption Decisions. 2009. Linda A. Verrill and Conrad J. Choiniere. Journal of Food Products Marketing 15:139-151.
The authors surveyed consumers for preferences on allergen advisory statements on food labels (N = 1,243). They also conducted an experiment to assess how consumers use advisory statements (N = 4,049) to make food consumption decisions. Results show that food allergic individuals, including caregivers to food allergic individuals, and a control group of nonallergic people preferred “Allergen Information: May Contain . . .” over three other statements tested. The experiment revealed measurable differences among the statements in how they are used to make food consumption decisions. Statements rated as more believable and more helpful also received higher ratings on a “likelihood of eating/ serving” measure. [Contact: Linda Verrill]
Helping Consumers Make More Healthful Food Choices: Consumer Views on Modifying Food Labels and Providing Point-of-purchase Nutrition Information at Quick-service Restaurants. 2007. Amy M. Lando and Judith Labiner-Wolfe. Journal of Nutrition Education & Behavior 39(3):157-163.
OBJECTIVES: To understand consumer (1) interest in nutrition information on food labels and quick-service restaurant menu boards and (2) reactions to modifying this information to help highlight calories and more healthful choices.
DESIGN: Eight consumer focus groups, using a guide and stimuli.
SETTING: Focus group discussions in 4 US cities.
PARTICIPANTS: A total of 68 consumers, with 7 to 10 per focus group.
ANALYSIS: Authors prepared detailed summaries of discussions based on observation. Video recordings and transcripts were used to cross-check summaries. Data were systematically reviewed, synthesized, and analyzed.
PHENOMENON OF INTEREST: Consumer views on alternative presentations of nutrition information on packaged food items and quick-service restaurant menu boards.
RESULTS: Participants (1) were interested in having nutrition information available, but would not use it at every eating occasion; (2) thought that food products typically consumed at 1 eating occasion should be labeled as a single serving; and (3) indicated that an icon on labels and menu boards that signaled more healthful options could be helpful.
CONCLUSIONS AND IMPLICATIONS: Findings provide a basis for the development of more systematic studies to better understand whether alternative presentations of nutrition information would help consumers.
[Contact: Amy Lando]
Consumer psychology suggests that fat intake and search for fat information on food labels may be mutually dependent. This study extends previous research by using a simultaneous-equation model to measure the relationship between fat intake and label use. Using the 1994-6 USDA CSII and DHKS data, our results suggest individuals who consume a higher percentage of calories from fat are less likely to report searching for fat information on food labels. We also identified the roles played by several psychological variables on information search and fat intake. These findings have important implications on nutrition education and effectiveness of food labels. [Contact: Chung-Tung Lin]
Nutrition labels on food packages are designed to promote and protect public health by providing nutrition information so that consumers can make informed dietary choices. High levels of total fat, saturated fat and cholesterol in diets are linked to increased blood cholesterol levels and a greater risk of heart disease. Therefore, an understanding of consumer use of total fat, saturated fat, and cholesterol information on food labels has important implications for public health and nutrition education. This study explores the association between dietary intakes of these three nutrients and psychological or demographic factors and the search for total fat, saturated fat, and cholesterol information on food labels. Psychology literature suggests a negative association between intakes of these nutrients and probability of search for their information on food labels. Health behavior theories also suggest perceived benefits and costs of using labels and perceived capability of using labels are associated with the search behavior. We estimate the relationship between label information search and its predictors using logistic regressions. Our samples came from the 1994-1996 Continuing Survey of Food Intakes by Individuals and Diet and Health Knowledge Survey conducted by the United States Department of Agriculture. Results suggest that search for total fat, saturated fat, and cholesterol information on food labels is less likely among individuals who consume more of the three nutrients, respectively. The search is also related to perceived benefits and costs of using the label, perceived capability of using the label, knowledge of nutrition and fats, perceived efficacy of diets in reducing the risk of illnesses, perceived importance of nutrition in food shopping, perceived importance of a healthy diet, and awareness of linkage between excessive consumption of the nutrients and health problems. These findings suggest encouraging search of food label information among consumers with unhealthy dietary habits would need innovative approaches. Yet, nutrition education can be instrumental in encouraging this search by stimulating motivation and providing technical help. [Contact: Chung-Tung Lin]
Cost/benefit analysis justifies regulations altering the amount of health-related information presented to consumers. The current method of benefit analysis, the cost of avoided illness, is limited; it assumes the benefits of health-related information are adequately represented by changes in illnesses. The manuscript develops a benefit estimation method to measure the welfare impacts of providing nutrient information. Nutrient labeling significantly affects purchase behavior but may not lead to increased consumption of healthy foods. Nutrient labeling may increase welfare without any change in health risk. Thus, the cost of avoided illness approach can underestimate the social benefits of providing nutrient information. [Contact: Sherry Liu]
Food Sources of Added Sweeteners in the Diets of Americans. 2000. Joanne F. Guthrie, and Joan F. Morton. Journal of the American Dietetic Association 100(1):43-51.
OBJECTIVE: To identify food sources of added sweeteners in the US diet.
DESIGN: A descriptive study using data from the US Department of Agriculture (USDA) 1994-1996 Continuing Survey of Food Intakes by Individuals. Each subject provided one 24-hour dietary recall. Intake of added sweeteners was calculated using the USDA Food Guide Pyramid servings database.
SUBJECTS/SETTING: A national sample of noninstitutionalized persons aged 2 years and older (N = 15,010).
STATISTICAL ANALYSES: Mean intakes of added sweeteners from all food sources and from specific food categories; percentage contribution of added sweeteners to total energy intake; and percentage contribution of each food category to total intake of added sweeteners. All analyses were conducted for the total sample and for 12 age-gender groups.
RESULTS: During 1994 to 1996, Americans aged 2 years and older consumed the equivalent of 82 g carbohydrate per day from added sweeteners, which accounted for 16% of total energy intake. In absolute terms, adolescent males consumed the most; as a percentage of energy, male and female adolescents had the highest intakes (averaging 20% of total energy from added sweeteners). The largest source of added sweeteners was regular soft drinks, which accounted for one third of intake. Other sources were table sugars, syrups, and sweets; sweetened grains; regular fruitades/drinks; and milk products.
APPLICATIONS/CONCLUSIONS: Intakes of added sweeteners exceed levels compatible with meeting current dietary recommendations. Knowing food sources of added sweeteners for the overall population and for specific age-gender groups can help dietitians provide appropriate nutrition education.
[Contact: Sherry Liu]
The Effects of Education and Information Source on Consumer Awareness of Diet-Disease Relationships. 1999. Mario F. Teisl, Alan S. Levy, and Brenda M. Derby. Journal of Public Policy and Marketing 18(2):197-207.
Information about diet--disease relationships provided by the news media is associated with increases in consumer awareness of these relationships. However, consumer awareness levels have declined during time periods when nutrient information increasingly was provided in food advertising. People with higher (lower) education levels were more (less) aware of diet--disease relationships. In general, the authors do not find strong evidence that media- or firm-provided information decreases the difference in awareness between more and less educated persons. [Contact: Sherry Liu]
The Impact of Health Claims on Consumer Search and Product Evaluation Outcomes: Results from FDA Experimental Data. 1999. Brian E. Roe, Alan S. Levy, and Brenda M. Derby. Journal of Public Policy and Marketing 18(1):89-105.
The authors report results of a mall-intercept study regarding the effects of health claims on consumer information search and processing behavior. Results suggest that the presence of health and nutrient-content claims on food packages induces respondents to truncate information search to the front panel of packages. Respondents who either truncate information search or view claims provide more positive summary judgments of products and give greater weight to the information mentioned in claims than to the information available in the Nutrition Facts panel. The presence of a claim also is associated with a halo effect (rating the product higher on other health attributes not mentioned in the claim) and, for one of the three products tested, a magic-bullet effect (attributing inappropriate health benefits to the product). The authors discuss the policy implications of these results for Food and Drug Administration health claim regulations. [Contact: Sherry Liu]
Consumers' ability to perform common nutritional label use task components, which revealed the effect of prior knowledge, were analyzed for relationships with demographic characteristics, label reading, and health status. Data were from a mall intercept experimental study. Most consumers (78%) accurately compared two products, 58% accurately evaluated nutrient level claims, 45% comprehensively balanced nutrients over a daily diet, and 20% accurately calculated the contribution of a single food to a daily diet, a task that required complex math. The subjects who performed significantly poorer were over 55 years of age, nonwhite, and less educated than those who performed best. Not reading food labels and having a diet-related health condition were also related to poorer performance. Task component analysis showed that all types of subjects shared the same response tendencies when making nutrition judgments. The findings suggest that dietary guidance for consumers will be more effective if it does not require quantitative tasks but relies instead on tasks that are easier for consumers. [Contact: Sherry Liu]
During the last two decades, product labeling has become an increasingly used policy tool, particularly with respect to the provision of health and environmental information. Theory holds that the flow of information among market participants plays a critical role in the efficient operation of markets. This paper explores the role of product labeling policy in ameliorating two potential market deficiencies: asymmetric information and costly search behavior. Practical considerations for the design and implementation of labeling policy and of labeling research are explored. [Contact: Sherry Liu]
Changes in Consumers' Knowledge of Food Guide Recommendations, 1990-91 Versus 1994-95. 1998. Joanne F. Guthrie, and Brenda M. Derby. Family Economics and Nutrition Review 11(4):42-48.
This study assessed the awareness of people in the United States about the specific food group recommendations of the Food Guide Pyramid between 1990-1991 and 1994-1995. [Contact: Sherry Liu]
Changes in Children's Total Fat Intakes and Their Food Group Sources of Fat, 1989-91 Versus 1994-95: Implications for Diet Quality. 1998. Joan F. Morton and Joanne F. Guthrie. Family Economics and Nutrition Review 11(3):44-57.
The 1995 Dietary Guidelines for Americans recommends that children 2 through 5 years old should gradually adopt a diet that contains no more than 30 percent of calories from fat and continue this diet throughout life. This study compares total fat intakes of children 2 to 17 years old in 1989-91 to intakes in 1994-95 to determine if improvement took place. The U.S. Department of Agriculture's 1989-91 and 1994-95 Continuing Survey of Food Intakes by Individuals was used. Overall nutrient intake and food group consumption patterns were also compared. Although grams of fat consumed increased over the periods, percentage of calories from fat declined due to increased caloric intake, particularly from carbohydrates. Children consumed less dairy products overall but more low-fat milks. Grain consumption rose, but the grain products consumed were not any lower in fat over the years studied. Beverage consumption, particularly soft drinks, rose, especially for adolescent males and contributed importantly to an increase in carbohydrate consumption. When assessing progress in meeting fat recommendations, professionals need to consider overall diet quality. [Contact: Sherry Liu]
The authors propose a conceptual model of the use of nutrition labels and on-package claims. Knowledge, perceived diet effectiveness, health status, and skepticism toward claims are all hypothesized to be significant in explaining the use of package claims and nutrition labels. Results from a preliminary investigation of the relationships among these constructs show that a person’s perception of how effective diet is in the fight against disease is related positively to the use of nutrition panel information and package claims. In addition, diet-disease knowledge is related positively to the use of package nutrition information in the forms of both package claims and panel information. Finally, being at risk for a diet-related disease is related positively to knowledge about the dietary links to the disease. The authors discuss policy implications of these findings. [Contact: Sherry Liu]
Nutrient labeling is found to significantly affect consumer purchase behavior; some evidence that consumers may act as if they hold nutrient (or health risk) budgets is found. Providing nutrient information may allow consumers to more easily switch consumption away from 'unhealthy' products in those food categories where differences in other quality characteristics (e.g., taste) are relatively small between the more and less 'healthy' products, toward 'unhealthy' products in categories where differences may be relatively large (i.e., a 'substitution effect'). If this substitution effect is large, nutrient labeling may not change the overall consumption of 'unhealthy' nutrients and thus may not lead to significant changes in health risk. [Contact: Sherry Liu]
The authors evaluate seven nutrition label formats to determine consumer comprehension and acceptance of displayed information. They test comprehension of five tasks: comparing two products, judging healthfulness, verifying claims, estimating servings needed to meet the daily requirements for a nutrient, and balancing nutrients in a daily diet. Performance scores were higher on some tasks--particularly dietary management ones--for formats that displayed nutrient amounts in percentages than for those that displayed nutrient amounts in metric units, even when interpretational aids were included on the metric formats. The two most preferred formats were metric formats with an interpretational aid. The findings have an important impact on decisions about the final nutrition label format required by the Food and Drug Administration. [Contact: Sherry Liu]
Using data from a national survey of weight loss practices, this study examined those dieters who were of normal weight. Forty-seven percent of White women, 25% of Black women, and 16% of men currently trying to lose weight had a body mass index under 25. Women's primary motive was health improvement. Among normal-weight female dieters, 12% of Whites and 27% of Blacks were using risky strategies. Dieters were less likely than nondieters to smoke and reported better nutritional practices; however, they were not more likely to exercise, and their maximum weight fluctuation was 50% greater. Additional research on the consequences of dieting among normal-weight individuals is of high priority. [Contact: Sherry Liu]
This study attempted to determine whether dieters differ from nondieters in how and where they obtain nutrition and health information and whether choice of weight-loss practices is related to use of different information sources. A national telephone survey of a probability sample of 1649 adults provided detailed information on the weight-loss practices of 1431 dieters and comparable background information on 218 nondieters. Dieters were more active readers of nutrition information than were nondieters. However, their choices about type of regimen and about specific products and services were more heavily dependent on word of mouth, commercial sources, and physicians than on written information. Dieters relying on written materials were more likely to engage in healthy weight-loss regimens and less likely to engage in questionable weight-loss practices than were those relying on other sources. The pattern of information-seeking behavior observed for dieters, which indicated greater motivation to seek out written information but reliance on oral sources to inform them of specific weight-loss practices, suggests that if authoritative written information about specific weight-loss practices was available, it would be used and would likely be effective. [Contact: Sherry Liu]
Consumer knowledge of dietary fats and cholesterol was analyzed for trends over time and for relationships with demographic characteristics and health and dieting behaviors. The data were obtained from three approximately biennial Health and Diet Surveys conducted by the Food and Drug Administration and the National Heart, Lung and Blood Institute between 1983 and 1988. Statistical methods included regression analysis and factor analysis. The results indicate that consumer knowledge about dietary fats and cholesterol is poor. Respondents with greater knowledge in 1988 were those who were more educated, middle-aged, or white, and those who were on a cholesterol-lowering diet. The regression analysis of 1988 scores indicated that education was the most important predictor of knowledge scores. Being on a self-prescribed cholesterol-lowering diet was related to higher knowledge, but being on a physician-recommended diet was related to higher knowledge scores only for younger respondents. None of the health behaviors, except engaging in regular exercise, was associated with higher knowledge levels. [Contact: Sherry Liu]
An experimental design was used to compare performance and preference for five nutrition label formats. Four performance measures--accuracy and false-positives in identifying nutrient differences, time required, and correctness in judging which product was more nutritious-- were derived from a product-comparison task. A sample of 1,460 food shoppers over 18 years old was recruited by a shopping mall-intercept method. Results of the study demonstrated that preferences and performance do not necessarily agree. The Control format, which had no nutrition profile information, performed the best but was liked the least. The Adjectival format, which provided nutrition profile information in the form of descriptive adjectives, was the most preferred. Results also showed that listing Daily Reference Values or nutrition profile aids increased preference but either did not affect performance or decreased it, depending on the specific aid and performance measure. Formats that some subjects liked for having adequate information others disliked for being hard to use. Formats that some subjects liked for being easy to use others disliked for having inadequate information. Age, education, and race were related to all of the performance measures except judgment of relative nutrition. Only gender was related to preference. Results of the study are useful as guidance for the development of consumer education materials. [Contact: Sherry Liu]
Four consumer focus group sessions, with a total of 40 participants, were conducted to gather information on the utility and appropriateness of selected components of nutrition label formats.. The formats reviewed were bar graphs, pie charts, numeric listings, and adjectival descriptors such as high and low. Participants were asked to compare food labels using various format types and to discuss the utility and interpretability of the formats. The outcomes suggested that these consumers did not find pie charts useful. They considered bar graphs confusing or unnecessary when numeric values were provided. Participants expressed concern that adjectival descriptors could be misleading. The numeric listing format they considered the most useful consisted of two columns of numbers: one listing the amounts of food components present in a serving of the food, and a second listing either the percentage of the label reference value (e.g., the US Recommended Daily Allowance) or the quantity established as the label reference value. Participants repeatedly stressed their interest in a simple label. The results form one component of the Food and Drug Administration's efforts to evaluate nutrition label formats and will be used in conjunction with ongoing experimental and quantitative research studies. [Contact: Sherry Liu]
Trends in Prevalence and Magnitude of Vitamin and Mineral Supplement Usage and Correlation with Health Status. 1992. Mary M. Bender, Alan S. Levy, Raymond E. Schucker, and E.A. Yetley. Journal of the American Dietetic Association 92(9):1096-1101.]
The 1980 Food and Drug Administration Vitamin and Mineral Supplement Use Survey and the 1986 National Health Interview Survey used similar questions and procedures to estimate and identify trends in the prevalence and magnitude of supplement usage in the United States. A comparison of the two surveys reveals that prevalence of supplement use among adults decreased slightly, from 42% in 1980 to 38% in 1986. The magnitude of supplement use has also decreased; users reported taking a mean of 2.15 supplements in 1980 compared with a mean of 1.77 in 1986. The prevalence of supplement users identified as light users increased from 42% in 1980 to 57% in 1986. Supplement usage was more likely and more intense among individuals who had one or more health problems and among individuals who perceived their health as very good or excellent. The findings indicate that supplement usage remains a widespread behavior linked to popular conceptions of good health and well-being but one that is susceptible to change. [Contact: Sherry Liu]
Comparisons of five Food and Drug Administration Health and Diet Surveys conducted in the 1980s provide estimates of the numbers of consumers who report that they pay attention to ingredient lists and nutrition labels and identify trends based on replicated measures. Recent estimates indicate that more than four out of five U.S. consumers report that they pay attention to one or both types of label information, with just under three-fourths reporting use of each individual information source. There was no net increase in consumer use of the food label ingredient list from 1982 to 1986, but use of the nutrition label increased significantly. Consumers who use both types of labels are more likely to be young (25–34), white, female, better educated, and to follow a self-initiated or doctor-prescribed low-sodium or low-cholesterol diet. Educators now face a challenge—to address remaining knowledge gaps, particularly among population groups who are less likely to use labels, and to develop practical strategies to help all consumers make more effective use of food label information in dietary management. [Contact: Sherry Liu]
A nutrition information program, consisting of brand-specific nutrition shelf-tags and a supplementary explanatory booklet, was tested for two years in Baltimore stores of the Giant Food chain, replicating a previous successful trial of the program in Washington, DC. Over the two-year evaluation period, market shares of shelf-tagged products increased 12% on average in Baltimore stores in 8 of 16 product categories that had been included in the original program trial. The largest market share increases occurred for products with the most flagged nutrients. Products with fewer flagged nutrients actually lost market share, suggesting that shopper purchases tended to be influenced by the number of featured nutrients as well as by the nature of the nutrients themselves. Responses to a shopper survey as well as the sales data converged to indicate that shopper concerns about nutrition and health status of family members are more highly correlated with program use than are education, income, and age. [Contact: Sherry Liu]
Weight Loss Attempts in Adults: Goals, Duration, and Rate of Weight Loss. 1992. David F. Williamson, M.K. Serdula, R.F. Anda, Alan S. Levy, and T. Byers. American Journal of Public Health 82(9):1251-1257.]
OBJECTIVES: Although attempted weight loss is common, little is known about the goals and durations of weight loss attempts and the rates of achieved weight loss in the general population.
METHODS. Data were collected by telephone in 1989 from adults aged 18 years and older in 39 states and the District of Columbia. Analyses were carried out separately for the 6758 men and 14,915 women who reported currently trying to lose weight.
RESULTS. Approximately 25% of the men respondents and 40% of the women respondents reported that they were currently trying to lose weight. Among men, a higher percentage of Hispanics (31%) than of Whites (25%) or Blacks (23%) reported trying to lose weight. Among women, however, there were no ethnic differences in prevalence. The average man wanted to lose 30 pounds and to weigh 178 pounds; the average woman wanted to lose 31 pounds and to weigh 133 pounds. Black women wanted to lose an average of 8 pounds more than did White women, but Black women's goal weight was 10 pounds heavier. The average rate of achieved weight loss was 1.4 pounds per week for men and 1.1 pounds per week for women; these averages, however, may reflect only the experience of those most successful at losing weight.
CONCLUSIONS. Attempted weight loss is a common behavior, regardless of age, gender, or ethnicity, and weight loss goals are substantial; however, obesity remains a major public health problem in the United States.
[Contact: Sherry Liu]
The National Heart, Lung, and Blood Institute, Bethesda, Md, sponsored national telephone surveys of practicing physicians and the adult public in 1983, 1986, and 1990 to assess attitudes and practices regarding high serum cholesterol levels. Each time, approximately 1600 physicians and 4000 adults were interviewed. Trends show continuing change in medical practice and public health behavior relating to serum cholesterol. In 1990, physicians reported treating serum cholesterol at considerably lower levels than in 1986 and 1983. The median range of serum cholesterol at which diet therapy was initiated was 5.17 to 5.66 mmol/L (200 to 219 mg/dL) in 1990, down from 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1986 and 6.72 to 7.21 mmol/L (260 to 279 mg/dL) in 1983. The median ranges for initiating drug therapy were 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1990, 7.76 to 8.25 mmol/L (300 to 319 mg/dL) in 1986, and 8.79 to 9.28 mmol/L (340 to 359 mg/dL) in 1983. The number of adults who reported having had their cholesterol level checked rose from 35% to 46% to 65% in 1983, 1986, and 1990, respectively. Between 1983 and 1990, the number of adults reporting a physician diagnosis of high serum cholesterol increased from 7% to 16%; the number reporting a prescribed cholesterol-lowering diet increased from 3% to 9%. Reports of self-initiated diet efforts reached a high of 19% in 1986 and decreased to 15% in 1990 compared with 1% in earlier years. In 1990, over 90% of physicians reported awareness and use of the recommendations from the Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, and the public reported marked increases in awareness of dietary methods to lower serum cholesterol. These changes suggest educational gains; the data also suggest areas for continued cholesterol educational initiatives. [Contact: Sherry Liu]
The Nutrition Labeling and Education Act of 1990 requires almost all food products to bear nutrition labeling. To obtain consumer input into any revisions in the nutrition labeling format, the Food and Drug Administration has conducted a consumer study of five possible formats. This article describes a consumer study conducted as one component of FDA's information-gathering activities on nutrition labeling formats. The study was a controlled experimental evaluation of five formats. The experimental design used enables researchers to compare format performance characteristics and expressed preferences for the formats in a realistic label-use situation. [Contact: Sherry Liu]
Declared Serving Sizes of Packaged Foods, 1977-86. 1990. J.T. Heimbach, Alan S. Levy, and Raymond E. Schucker. Food Technology 44(6):82-90.
FDA surveys of nutrition-labeled foods indicate that food manufacturers have occasionally reduced the serving size to be able to make low-sodium and similar claims. To answer the question of whether declared serving sizes have been reduced, the study obtained a sample of nutrition-labeled food products from a large collection of packaged processed food products that have been collected by FDA in biennial surveys since 1977. The goal was to identify product classes and individual products for which the declared serving sizes either did not change over time or exhibited significant increases or decreases. [Contact: Sherry Liu]
The Impact of a Nutrition Information Program on Food Purchases. 1985. Alan S. Levy, Odonna Mathews, Marilyn Stephenson, Janet E. Tenney, and Raymond E. Schucker. Journal of Public Policy and Marketing 4(1):1-13.
A quasi-experimental repeated measures design using a matched set of 20 test and comparison supermarkets in the Washington, D.C. and Baltimore, Md., metropolitan areas was used to evaluate a nutrition information program called "Special Diet Alert" (SDA) introduced by Giant Food, Inc. into Washington, D.C. stores in March 1981. The objective of the SDA program was to help supermarket shoppers find products for special diet needs by providing brand-specific (i.e., individual product level) shelf markers that identified products considered low or reduced in sodium, calories, cholesterol, and fat, supplemented by take-away information booklets available from a rack in the store which listed SDA brand names and specific nutrient values. Market shares of these products were tracked over the two-year evaluation period in Washington, D.C. and Baltimore stores. The pattern of differential sales trends across 16 individual food categories was complicated, but sales of shelf-marked products increased on the average 4 to 8 percent more over the two-year evaluation period in Washington, D.C. than in Baltimore, Md. stores. The average magnitude of effect attributable to SDA was modest in comparison with other factors influencing consumer purchases, highlighting the need for powerful evaluation designs to assess the effectiveness of information programs that operate in the context of many other more powerful influences. Further research is needed to determine which aspects of the SDA program were critical to its success, but one obvious difference between SDA and other in-store nutrition information programs that have been reported in the literature was the use of individual brand-specific shelf markers to deliver nutrition information to shoppers rather than prominently displayed sectional posters and detailed educational pamphlets. [Contact: Sherry Liu]
The effect of the saccharin warning label on sales of diet soft drinks was modeled with an autoregressive integrated moving average (ARIMA) process. Retail price trends and attendant publicity were modeled concurrently to separate these effects from those due to the warning. Results indicated that the label produced a small yet statistically significant reduction in sales, with an abrupt onset and, thus far, permanent duration. Reasons for the absence of decay effects, limitations of interpretability, and ideas for improving future evaluations of warning labels are discussed. [Contact: Sherry Liu]
Nutrition Labeling and Public Health: Survey of American Institute of Nutrition Members, Food Industry, and Consumers. 1982. James T. Heimbach and Raymond C. Stokes. American Journal of Clinical Nutrition 36:700-708.
Five hundred thirty-one members of the American Institute of Nutrition, 177 persons from the food industry, and 107 consumers from a Food and Drug Administration mailing list responded to a survey dealing with nutrition labeling of foods. They identified obesity and heart disease as the major diet-related national health problems and chose information about calories, sodium, fat, protein, iron, calcium, and carbohydrates as most useful to the public. [Contact: Sherry Liu]