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Inquiry Article

Consumers' opinions on alert labels on food packages: A qualitative report in Brazil

• Priscila de Morais Sato,
• Laís Amaral Mais,
• Neha Khandpur,
• Mariana Dimitrov Ulian,
• Ana Paula Bortoletto Martins,
• Mariana Tarricone Garcia,
• Carla Galvão Spinillo,
• Carlos Felipe Urquizar Rojas,
• Patrícia Constante Jaime,
• Fernanda Baeza Scagliusi

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• Published: June 26, 2019
• https://doi.org/x.1371/periodical.pone.0218813

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Abstract

This report aimed to assess consumers' uses of and opinions on the electric current Brazilian food characterization and their reaction to the introduction of a front end-of-package warning label. We conducted 12 focus groups amid a diverse sample of adult consumers, to broadly assess: (ane) uses of and perceptions virtually the current food label, and (2) opinions about implementing a front-of-package warning label to guide food purchases. Information was analyzed with a triangulation of researchers using an exploratory content analysis, which allowed codes to emerge from the data. The frequency of codes across focus groups was compared by gender and socioeconomic status to explore differences past these sociodemographic factors. Codes were divided into half-dozen primary themes: (1) "Reasons for using food labels"; (2) "Barriers to using food labels"; (iii) "Requirements for a new label"; (four) "Perceived influence on consumption behaviors"; (five) "Perceived influence on kid behaviors"; and (6) "Perceptions of the food manufacturers using of warning labels". Participants used food labels to check food content and ingredient data merely the format of these labels and the technicality of the content displayed frequently made the information inaccessible, peculiarly for those with low socioeconomic status. Well-nigh participants were supportive of the display of front-of-package warning labels on products and considered them useful to inform purchases. Women believed that they and their children would reduce the consumption of foods with front-of-package alert labels, while men reported more polarity in their intentions. For men and their children, front-of-package warning labels would upshot in either stopping nutrient intake entirely or continued consumption without changes to the amount. The study results highlight the potential of front-of-package alert labels to support healthier behaviors in both consumers and their children.

Citation: de Morais Sato P, Mais LA, Khandpur N, Ulian Medico, Bortoletto Martins AP, Garcia MT, et al. (2019) Consumers' opinions on warning labels on nutrient packages: A qualitative study in Brazil. PLoS One xiv(6): e0218813. https://doi.org/10.1371/journal.pone.0218813

Editor: Zhifeng Gao, University of Florida, UNITED STATES

Received: Jan ii, 2019; Accepted: June ten, 2019; Published: June 26, 2019

Copyright: © 2019 de Morais Sato et al. This is an open up admission article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted employ, distribution, and reproduction in any medium, provided the original author and source are credited.

Information Availability: De-identified excerpts are available inside the paper and its Supporting Information files. Full transcripts cannot be made publicly available due to ethical concerns imposed by the participants' consent and by Brazilian Ideals Committees. Researchers interested in the transcripts may contact Alicia Gomes of the Nupens Group (Center for Epidemiological Research in Nutrition and Health), from the University of São Paulo, at alicia.tsg@gmail.com.

Funding: The data collection for this report was financed past Bloomberg Philanthropies (BRAZIL-IO-05). PdMS was supported by FAPESP fellowship 2017/05651-0, NK was supported by FAPESP fellowship 2016/13669-iv and FBS was supported past CNPq (grant 311357/2015-6). The funders had no office in study blueprint, data drove and analysis, decision to publish, or training of the manuscript.

Competing interests: The authors accept declared that no competing interests exist.

Introduction

The increment in the consumption of ultra-processed food products (UPP) plays a fundamental role in the procedure of nutrition transition, defined as a shift in dietary intake and energy expenditure that coincides with epidemiological, demographic and economic changes [1]. UPP typically comprise high amounts of sodium, free sugars, total and saturated fats, and trans-fatty acids [ii]. Decreasing their consumption is important for safeguarding public health in Brazil, as diets high in these products have been associated with lower diet quality [3,four], and with obesity among adults and children [5].

In this context, providing nutrition information at points of purchase through food labels is likely to be a cost-effective strategy for supporting changes to a healthier dietary pattern that may protect against time to come non-infectious disease [6]. This strategy is supported by international health agencies that recognize appropriate labelling of foods and drinks as a necessary environmental alter for decreasing the consumption of UPP [7].

The National Wellness Surveillance Agency in Brazil (Agência Nacional de Vigilância Sanitária–Anvisa) is responsible for the regulation of food labelling, which has been mandatory since 2002. In 2003, information on calories, carbohydrates, proteins, full and saturated fats, cholesterol, fiber, calcium, iron and sodium, as well as the percentage of the daily value of each nutrient per portion was made mandatory on packaged food in Brazil. If the manufacturer includes any merits on the food package (called Complementary Nutritional Information; Informação Nutricional Complementar–INC), it is obligatory to declare the nutrition data of the related nutrient as well. Trans fats labelling became mandatory in 2006, when Brazil adopted the Southern Common Market (Mercado Comum do Sul—Mercosul) norms [8]. All nutrient information is ordinarily presented in a nutrition facts panel at the back of the parcel and has to exist: (ane) structured in a tabular array or presented as a text, (2) presented in culinary measurements, (3) in the state's official linguistic communication, (4) legible [ix].

Some quantitative studies in Brazil with adults have indicated a low utilise of the electric current food labels past the consumers. Cassemiro et al. reported that but 23.0% of the 200 adults studied read the nutritional data on nutrient labels before buying a production [10]. The report conducted by Machado et al. showed that, although many people might study reading the food characterization, most of them only consult the expiration engagement. In their study (n = 300), of the 81% that reported reading food labels, 91.3% consulted the expiration date while only two% looked for nutrition data [11]. A mixed methods report by Marins et al. with 400 consumers in Niterói, Brazil, provided further insight into the low utilize of food labels—near one quaternary said they did non trust nutrient labels and most of them could not understand the information [12].

In the electric current scenario of nutritional and epidemiological transition in Brazil, with increasing rates of obesity, particularly among female person and lower income groups [13], information technology is essential to provide articulate and attainable nutrition data on food labels. To target disquisitional products such equally UPP, additional measures such as the forepart-of-package labels (FOPL) have been proposed. These are considered particularly advantageous because of their elementary message and symbol, which complements the current nutrition information displayed by the listing of ingredients, the nutrition facts panel and the INC. Moreover, FOPLs have the potential to capture consumer attention, better consumer agreement of the nutritional content of the products and encourage the use of the nutrition information [14] to make quick decisions near the healthfulness of a nutrient product [15].

Ane of the proposed options for FOPL in Brazil is the warning label (WL) [16]. This model is a relatively recent format of a food-specific FOPL and is displayed exclusively to point that key nutrients exceed recommendation levels. Interest in WLs has been growing internationally, with the model already being implemented in Chile [17] and in procedure of implementation in Canada [xviii], Peru [19], Israel [twenty] and Uruguay [21]. WLs aim to effectively alert the population about the presence of high amounts of disquisitional nutrients, which can negatively impact their health [22].

There is some quantitative evidence to support the effectiveness of WLs over other options of FOPLs that brandish more complex information, such as the traffic-light label (TLL), which presents high and low levels of nutrients and their equivalent contribution to an adult'southward daily needs. The WL had a higher bear on on the food choices of 442 Chilean children, promoting the selection of healthier foods, than the TLL [23]. In Brazil, an online controlled experiment with a representative population sample (n = three,353) showed that WLs were more effective at improving participants' (a) understanding of excessive content of disquisitional nutrients and (b) their ability to identify the healthier production than TLLs [24]. However, in order to ameliorate empathize needs and implications of implementing WLs, information technology is of import to complement the insights from existing quantitative work with a more in-depth assessment of the consumers' perceptions and initial reactions to WLs.

Our study proposes to address these gaps inside a various sample of Brazilian adult consumers. Specifically, we aim to: (1) understand their use of nutrition labels, (two) investigate the challenges faced in using these labels, (3) assess their opinions of WLs, and (4) empathize how the WL might address some of the barriers of the electric current diet labels.

Materials and methods

Study blueprint

We conducted a qualitative study using focus groups (FGs). Through participants' interaction with each other, FGs can provide rich data, eliciting social norms, feelings, attitudes and perceptions near a specific topic [25]. Materials and methods of study will be reported below, following the Standards for Reporting Qualitative Research (SRQR) [26] and the Consolidated Criteria for Reporting Qualitative Enquiry (COREQ) [27].

The current food label in Brazil was represented by the list of ingredients and the nutrition facts panel, and the WL model was represented by a black triangle with the warning "loftier in (proper name of the critical nutrient)" [28]. This model has been proposed by the Brazilian Found for Consumer's Defense (Idec) and developed in partnership with researchers from the Department of Design at the Federal University of Paraná, Brazil. Researchers involved in this study were nutritionists and designers, working in either public Universities in Brazil or a non-governmental establishment.

Setting

FGs were held in enquiry facilities in 4 different capitals: Recife, Goiânia, São Paulo and Porto Alegre, which stand for four of the five regions of the state: Northeast, Midwest, Southeast and South. The geographic distribution of the groups aimed to capture a diverseness of stance that may be influenced by regional differences in cultures, habits, contexts, and behavior in food and nutrition.

Sampling

Participants were invited to participate by a Brazilian research house, thus no researcher involved in the design and analysis of this study has had any interaction with the participants. Ten to twelve people were invited to each FG, with an attendance of eight in each, totaling 96 participants. Groups were stratified past gender and socioeconomic status (SES) (high and depression), with three FGs of each: high SES females, high SES males, low SES females and low SES males.

SES was assessed through the "Brazilian Criteria", a classifying system based on the households' possession of goods proposed past the "Inquiry Companies Brazilian Association". The questionnaire covers: (1) the number of bathrooms, domestic employers, automobiles, personal computers, dishwashers, refrigerators, freezers, washing machines, DVD players, microwave ovens, motorcycles, and wearing apparel driers in the household; (2) the householder education; and (iii) admission to public utility services (piped water and paved street). Each response has a value from 0 to fourteen, depending on the item and the number of items. The sum of all responses classifies the household from A (high social class) to East (low social course) [29]. The methodology for the development of the criteria and values for each component are described elsewhere [30].

Inclusion criteria were: (a) being between 20 and 50 years of age, (b) being responsible for grocery shopping in the household, (c) shopping for groceries for the household at to the lowest degree in one case a month, (d) residing in the same city for at least three years, (e) not working or having worked for market research firms, nutrient industries or in the health sector (nor having a family unit member who has), and (f) not having participated in another research discussion in the concluding 24 months. As reimbursement, all participants were awarded "points" that could be exchanged for a selection of giveaways. This report was approved by the Ethics Commission of the University of São Paulo (protocol n. 2.236.264) and all FGs were conducted afterward participants had given written informed consent.

Procedures

The interview guide had two sections. The first section aimed to investigate participants' opinions about the current characterization and identify barriers to its use. This focused on answering our ii offset aims (empathize use of nutrition labels and challenges in using them), which was important to evaluate if the WL would be able to assistance overcoming the current barriers to labeling apply (our 4th aim). Thus, the department included questions about information participants looked for in food labels, opinions almost the clearness of food labels, barriers in reading food labels, reasons not to read the food characterization, amidst others.

In the second section, we focused on consumers' opinions about WLs, with a focus on how they could affect consumer'due south food characterization use. Participants saw an paradigm of a WL and of mock-ups of dissimilar products with WLs and were asked for their opinions on implementing WLs and their expected reactions to it when shopping for food. These questions aimed to answer aims iii and four: to appraise opinions of WLs and evaluate if information technology could address some of the barriers of the current nutrition labels. A final question was used to wrap up the groups and let for whatsoever opinions that did not emerge in the earlier discussion to be expressed. The section included questions about interpretation of the WL, reactions to seeing the WL, and the relevance of the WL.

The guide was pre-tested with a grouping of high SES women living in São Paulo (north = viii). After that, and because of the relevant and rich discussion that emerged about the impacts of the WL not only to the participants, only also to the children, nosotros revised the FG guide; including one question nearly the predicted impact of WLs on children's eating behaviors. The revised interview guide was used for the 12 FGs conducted from July 13^th 2017 to July 18^th 2017– three in each study location. The average duration of the FG was 2h45m, ranging from 2h39m to 3h15m. All FGs were conducted in Portuguese by a trained moderator, audio and video recorded and transcribed verbatim. Transcripts were read by PdMS and every bit no relevant new information was identified in the last two FGs, data saturation was considered reached.

Data analysis

A content analysis followed Bernard, Wutich and Ryan's recommendations, using an inductive approach to let a posteriori codes to sally from the data [31]. Thus, although codes answered the main questions in our research, new, unanticipated themes were allowed to emerge from the FG discussions. To improve the robustness of the analysis, we used a triangulation of researchers to ensure multiple views on the procedure of code development and awarding. First, PdMS extensively read all transcripts, making notes and highlighting salient aspects of the text. Exploratory coding was conducted where similar information was grouped into codes using a cutting and sorting arroyo. The list of codes and their meanings were discussed with FBS. After consensus was reached, PdMS adult a codebook equanimous of detailed descriptions, inclusion and exclusion criteria, typical and singular examples, and an instance named "close simply no", illustrating the codes' limits.

LAM and MDU applied the codebook separately to all transcriptions using MAXQDA, version 17.0 [32]. PdMS compared both coding sheets and calculated the inter-rater reliability (IRR), the caste of agreement betwixt coders using Cohen's kappa coefficients, equally suggested by Bernard, Wutich and Ryan [31]. The kappa is standardized and therefore can exist interpreted similarly across several studies, with values to a higher place 0.viii considered almost perfect agreement [33]. Analyses were performed using GraphPad QuickCalcs (GraphPad Software, U.s.a.) (Table 1). Three codes were excluded because they: (1) showed moderate or weak IRR, as adamant past kappa <0.7, (2) did not make relevant contributions to answering the inquiry questions, and (3) were used less than 10 times by the coders. Finally, to explore differences by sociodemographic factors and to aid in the generation of future hypothesis, the frequency of codes across FGs was compared according to gender and SES of the participants. Codes are presented in the results section in assuming letters and described using direct quotes (translated from Portuguese to English), paraphrases, and summary quantitative indicators.

Results

A full of 96 participants (equally distributed beyond gender and SES) composed our FGs (Tabular array two).

Codes were classified into six themes. 3 concerning the first section of questions: 2 budgeted the current Brazilian food label–"Reasons for using food labels, "Barriers to using food labels"), 1 about demands on how to amend it–"Requirements for a new label". And three related to the second department of questions: two codes presented the consumers' expected reactions to the WL–"Perceived influence on consumption behaviors", "Perceived influence on child behaviors"–, and one code presented an unexpected discussion on the FGs about how WLs would bear on consumers' opinions about the food manufacturers–"Perceptions of the food manufacturers using of WLs" (Table 1). A final subsection entitled "Comparison of frequency of codes according to gender and SES" compares codes among groups according to gender and SES.

Reasons for using food labels

Participants' reported using nutrient labels were mainly to search for the products' nutritional characteristics through their information on nutrients, ingredients and composition. Expiration date was besides cited. Looking for such data was important to compare products and decide which 1 to buy.

Information on nutrients was the most assessed among our participants. Sodium was the almost searched nutrient on food labels, followed by sugar. The reason for consulting labels for this information was having a health status that raises awareness for the need to limit the consumption of those nutrients. "In my case, I always await for the sodium data because I have a blood pressure problem" (male, low SES). Another reason was having a family unit member with health weather. "I have diabetic family members, my grandmother is diabetic" (male person, depression SES).

Fat was also mentioned past many participants; when the type of fat was specified, participants mentioned eating less of the products with trans fatty. Other less mentioned nutrients were calories, gluten and lactose, specially when the participant or a family unit member was lactose intolerant. "I look if the production has lactose, stuff similar that, because my son is allergic" (female, depression SES). Calorie data was consulted if participants were on weight-loss diets.

Looking for data on the products' ingredients was besides frequently reported. Most participants looked for data well-nigh preservatives or food coloring, in particular when the food was targeted at children. "Information technology [ingredients] is the first thing that I expect for, because my son cannot eat anything with colorings. Information technology's the starting time thing that I look, if it [the nutrient] has colorings" (female, low SES).

Interest in data nearly overall nutrient composition was cited less oft. Information technology was used to talk nigh the products generically, without specifying the search for a specific component. "I expect at the diet facts console and the production's composition, considering I saw on the TV, I don't know if that's truthful, just I saw that the first ingredients are in the highest amounts in the nutrient" (female, loftier SES). This code overlapped with the codes nutrients and ingredients, equally participants referred to the product'due south composition when searching for nutrients' amounts and allergenic ingredients.

As a particularity of this code, participants reported looking for limerick information to ascertain if a product that they were used to buying was modified, especially if they noticed changes in the food packaging. "If I already know the production, I take a wait at the package to run across if in that location is anything different. If any change catches my eye, I take a ameliorate look and see if anything in the composition has changed" (female, depression SES).

Apart from the products' nutritional characteristics, expiration date was extensively cited, being the second information well-nigh looked for, only backside nutrients. Sometimes both codes, expiration date and nutrients, appearing together and reinforcing that these two information were the most of import to our participants. "I wait the expiration appointment and that sodium stuff, if I take my glasses on" (female person, high SES).

Some participants consulted information on labels to compare products at the time of purchase, specially in terms of nutrients and price: "I take the option of a product "A" and a product "B". I know some products, only I try to compare them, considering 1 tin be like to another, merely with a more bonny toll" (male, low SES). "Light" or "whole grain" products were also compared with their regular versions to evaluate the toll-benefit of buying those products.

Barriers to using nutrient labels

Not reading nutrient labels was frequently cited in the groups. The main reason was the familiarity with the product. The distinction fabricated between the use of food labels amid known and unknown products was evident. Some participants even said that if the recipe of a product that they use changed, they would probably not realize it, since they never pay attending to the label. In the case of known products, reading the food labels was only cited when the packaging changed. "When the package changes, we keep looking for the product that we were used to ownership. And so we see that information technology has a new package and evaluate if it is the same thing as before" (female person, depression SES).

While the products not unremarkably consumed needed to be evaluated through their label information, the known products provided a means of comparison, which was associated with the products' brand. In addition, reading the same information on the frequently used products was considered repetitive, which too helps understanding why the expiration date was so cited by our participants. "If you always buy an orangish juice, you merely check its expiration date, you won't read everything all the time, you but catch what you lot always purchase, information technology is hard to change" (male person, high SES).

Barriers to using food labels cited by our participants illustrate the need for time and skills to access this information, as they were hard to read (being too small and hidden ) and to empathise (the data was non clear and usually presented in technical terms ).

The nigh cited bulwark was the letters in labels being too pocket-size, making it difficult to read it, especially in comparison to other data. "It's written in very small letters all the [diet] data, and in the front end information technology says "tasty" in huge messages. It makes you pay attention to the "tasty" office, not to the rest of the information" (female, high SES).

Using technical terms was the 2nd most cited barrier amongst participants. "The sodium… the sugar… sometimes they brand it besides confusing. They say sucrose, saccharine… we don't fifty-fifty know what that means!" (female, high SES). Some participants felt that the lack of accessibility to understanding food labels served to do good the food industry or to run across legal requirements, simply not to inform the full general population. "Sometimes they make it difficult for the consumer to understand because we are uninformed in some subjects. They arrive difficult to understand so people won't exist inhibited to buy [the products]" (male, depression SES).

Some other frequent complaint was that the information was not clear, which could exist related to its format or to the amount of information presented. "Sometimes the letters are in a dark color, the background is nighttime, the letters are too minor, non even with a magnifying drinking glass you tin sympathize. It is really bad to read" (female person, high SES).

Finally, having the information hidden was related to inconsistencies in placement.

Requirements from a new label

Suggestions for a new food label highlighted visibility and ease of understanding of information. The most frequent demands were almost understanding the labels through popular language and clearer information. Co-ordinate to our participants, the use of popular linguistic communication would be more suitable for the general population, for themselves and for their family members: "Our mothers have a hard fourth dimension reading [the labels], many of them don't know these terms and cannot give meaning to them, for case, that sodium is salt. That is very worrying" (female, high SES).

Clearer data was suggested by and large without specification of what should exist clearer. In those cases in which the participants specified what was unclear, they complained virtually the different terms used in the labels and the lack of organization in presenting them: "I said "clearer information" because it says "v% carbohydrate", and I worry well-nigh my family eating too much carbohydrate, merely in the other production it says "energy", how much of energy is sugar? […] then, information technology should be clearer, organized…" (female, high SES).

Other suggestions concerned the labels' readability, through larger letters or more visibility. Accompanied by the utilise of popular linguistic communication and clearer information, larger messages would help identifying information and comparison products at time of purchase. Some participants besides demanded more visibility for the data: "Information technology could be something more than highlighted, that catches your attending, that you expect direct to it" (female person, loftier SES).

Perceived influence on consumption behaviors

When food with the WL was shown to the participants, their reactions ranged from proceed eating to cease eating it. Standing consumption, but reducing the amount eaten was the almost cited intention: "I would non stop eating it, just I would certainly reduce it. When I like a product, I am faithful to it" (female, low SES). The intention of reducing the amount instead of stopping the consumption was related to how much people liked the production. The reduction was sometimes mentioned as a gradual process. Less often, people reported that they would consume less of other foods high in the same food: "Since I am already used to using this product, I would keep ownership information technology, but I would use with moderation other foods with the same ingredient. If information technology was sugar, since there is sugar in so many things, I would reduce something else" (female person, depression SES).

Participants as well said that they would choose another product. The participants' rationale to substitute products highlights the support that the WL may provide for product comparisons: "If i production has it [WL] and some other doesn't, I would purchase the ane without information technology" (female, high SES).

Participants said that they would finish eating the nutrient if "it was something not important" (male person, high SES) to them. This code showed a relation with fourth dimension, equally stop eating a product could either just be an initial reaction to the WL or a longer term strategy. "The day that I think that it will damage me, I will stop eating. If my blood [saccharide] levels are loftier, I will cease it" (female, loftier SES).

The conclusion to keep eating was mainly related to either liking the product or beingness used to it: "I beloved condensed milk. I don't intendance if it comes written in its package "if you eat this you will dice", I will continue eating it" (male, low SES).

The WL did not seem to reduce participants' autonomy to choose products, only, on the reverse, helped them to make more than witting choices: "I think it is up to each one to make up one's mind [what to eat], I think that everything in backlog is bad for you. I don't run into a problem in drinking a can of soda or one of these beverages; you only can't do it in backlog" (female, low SES). The private's autonomy in choosing what to eat was highlighted in the code whoever wants to eat information technology, eats information technology, which supported by the idea that "the conclusion [to eat the product or not] is yours to make" (female, high SES).

Perceived influence on kid behaviors

Opinions about children's eating in the presence of the WL focused on either children would go along eating to children would stop eating. Amongst the parents believing that their children would keep eating food products with WLs, the main reason was the lack of interest. Less frequently, participants cited that their children would keep eating such products considering of their practicality: "It is the famous emergency kit, if the food was all gone in the tiffin and yous don't accept more for dinner, you make an instant noodle" (male, low SES).

There was some difference in opinion betwixt fathers and mothers in the grouping. While for the fathers, children would stop eating such foods equally a consequence of an adult's action: "I would not buy this for my son anymore" (male, high SES); mothers expected that the initiative to stop eating would come from the kid. "When my daughter gets to the snack shelves and sees those warnings, I am certain she won't want to buy them. At her school she does this. The other mean solar day we were going to buy a snack and there was a whole grain option that I didn't know, she wanted that one" (female person, high SES).

For the children to brand healthier and more conscious food choices, they had to learn what to swallow. In this sense, participants affirmed that the WL could help their children's nutrition education, since it is attainable to children. The attainable warning could also potentially promote children's curiosity to learn more nigh nutrients or healthy eating in general. This would help improving their autonomy: "From the moment that you explicate to your child that this product is not practiced for you lot, he/she volition commencement to practice [not choosing information technology]" (male person, loftier SES).

Perceptions of the food manufacturers using WL

Participants too reflected on the image of the food manufacturers that used the WL. The WL contributed to a positive perception of food manufactures, giving more than brownie to the company. "I would showtime looking at that visitor with better eyes, considering they are not only worried most selling, they are too worried with the amount of saccharide" (male, depression SES). The credibility was reinforced because of the Ministry of Health'due south stamp. Yet, when participants predicted reaction of food manufactures, they believed that the companies would resist adopting the WL. "I think that the person that produces will not want to utilize this [WL], because he will stop selling. Usually, that is how the producers' minds work" (female, low SES).

Comparison of frequency of codes co-ordinate to gender and SES

When nosotros compared the number of times that each code was mentioned in male and female FGs, we observed a similar use of the current labels betwixt men and women (Fig i). Women, however, were more vocal about the barriers to using the food labels, as well making suggestions for improvements, especially nearly the concern of presenting data in larger messages. When asked nigh their reactions to the WL, women seemed more inclined to reducing the corporeality of food eaten, while men tended to study more dichotomous intentions, of either stopping or continuing to eat. Differences in responses were also observed in men'south and women's expectations of the influence of WLs on their children'due south eating, with some men saying that their children would keep eating the nutrient and women hoping that the WL would assistance them educate their children.

All participants looked for data about nutrients and composition in the current label, but more than people with high SES mentioned using the information to compare products (Fig two). The main barrier to the participants in the low SES was the technical terms used in the labels. Participants with high SES more frequently mentioned the requirements in a new food label and reacted to the WL by saying that they would reduce the amount of the food. Participants with low SES said more ofttimes that they would choose another product or keep eating the food with a WL than the ones with high SES. Differences were also observed concerning their children'south eating, as parents with high SES saw the WL as an educational tool.

Discussion

Our results reiterate the need for accurate nutrition information on nutrient labels and the potential of WLs to present information technology. Participants of the FGs were interested in assessing information that would help them make healthier food choices, in detail about the foods' nutrients and ingredients. However, the language and format in which the current available information–i.e. listing of ingredients and nutrition facts panel–is presented constitutes important barriers to its understanding and utilise (Fig iii).

These observations may help understand the difficulties that Brazilian consumers have in agreement food labels, as observed in the report conducted by Cavada et al. with 241 adults [34]. The authors described that although 48.1% of the participants read the labels of the nutrient products; only 29.four% understood the data. Our observations also approve quantitative studies performed in the U.s. of America which described that many consumers have difficulty understanding diet facts panels and lists of ingredients, with the need for high health literacy to apply them, in particular when they needed to perform calculations [35,36].

In our report, WLs were reviewed positively, by helping consumers place loftier amounts of critical nutrients and ingredients, and compare products without needing any special skills, such as performing calculations or knowing technical terms. These benefits of the FOPL are also supported by other studies [37]. The comparing among products was too observed in the study comparing FOPLs to list of ingredients and nutrition facts panels, which showed that WLs had better results improving consumers' ability to identify the healthier nutrient [24]. The placement, simplicity and standardization of the data seemed to be of import advantages of this model to promote consumers' autonomy. Thus, participants could adopt diverse strategies in accordance with their priorities, such as comparison and substituting food products, decreasing consumption or reducing the consumption of other food products high in the same nutrient (Fig 3).

Our results approve quantitative literature that found similar trends where some consumers reported stopping purchasing the product, shifting to healthier products, or standing to purchase the product [24,36]. In the quantitative study performed by Khandpur et al. in Brazil, the authors described an increment from 2.9% to 13% in the participants saying that would not buy de production. In the experimental study conducted by Ares et al. in Uruguay, production substitution was the main response to WLs. Stopping purchase of the product was the response only when all food options in the category presented WLs. Among our participants, intentions of stopping to purchase and substituting were similar. However, participants likewise mentioned standing to buy the same products, simply in lower amounts, presenting another reaction to WLs and corroborating their potential to encourage healthier eating practices [38].

The different responses to the WL also depended on the type of product displaying it. Since the foods' healthiness was of import to the participants; the intention to consume information technology or not was highly related with personal taste and familiarity with that nutrient. Understanding the interaction between gustation and intention to eat is peculiarly relevant for UPP, every bit the high palatability and marketing associated to such foods make them extremely highly-seasoned to consumers, in taste and besides in symbolic meaning. In this scenario, WLs can help diminish the backlog consumption of UPP, through negatively influencing consumers' appetite bulldoze and intention to eat UPP, equally observed in the controlled experimental study conducted by David et al. [36].

This written report adds to the existing literature on food choices [39,40,41] by incorporating the part of the familiarity with the product in label reading, equally participants reported not reading labels of foods they were accustomed to consuming, even though some of them recognized that the foods' ingredients could change–which technically could mean not consuming the known product anymore–without them realizing it. In this context, consumers are more likely to notice the WL since it is displayed on the front panel and will be considered equally "changes in packaging".

In this study, the perceived condom of consuming a food production was highly related to trusting food brands, corroborating other researches that support the influence of branding on food choices [42,43]. In this sense, our results on the participants' positive perceptions of the food manufacturers using of WLs adds to Spink et al.'s discussion on the value of WLs and information labels for brand marketers to heighten consumer'due south confidence [44]. Thus, WLs would permit consumers to change their perceptions of non just the foods simply of those who brand them, the manufacturers.

Our human relationship with food is dynamic and in constant construction. Therefore, we tin can await reactions to WLs to modify over fourth dimension, as described by some participants. This ascertainment tin be compared with the study performed by Swayampakala et al. in Canada with smokers exposed to wellness WLs [45]. The authors described a subtract of attention to the WL in cigarettes overtime, but an increase of cognitive and foregoing responses. Conspicuously, food WLs will accept the maximum effect on consumers' behavior when newly introduced, since it will mean new packaging and new information, fifty-fifty on familiar products, as highlighted by our participants. However, information technology is important to sympathize how these furnishings translate over fourth dimension–in other words: "Are changed behaviors maintained in consumers?" or "Practise consumers revert to older behaviors and continue to buy unhealthy products?" Thus, our results shed light to the importance of evaluating the effects of the WL post implementation.

It is of import to too monitor the WL impacts on distinct groups, as unlike gender and SES showed differences in uses of the current nutrient characterization and in reactions to the WL. Our results approve Crockett et al.'s argument that nutritional labelling may accept different furnishings on singled-out SES groups and contribute to understanding how nutrient labelling may play a role in health inequalities [46]. In our report, the lower interest in diet information amidst the participants with depression SES could reverberate how inaccessible the current data is for this grouping, equally illustrated by the complaint of the technical terms used in labels.

Differences were too observed between men and women, corroborating other studies that reported gender differences in nutrient labeling apply [47]. Svederberg's observed through a qualitative report that Swedish women searched for more than information on food labels than men. Our results complement the author's word on gender roles and food label use. In her inquiry, Svederberg observed that women'southward concern almost the family's health reflected in their searching for more information on food labels [47]. Among our participants, the mothers' usual responsibility for the children eating [48] reflected on their involvement of how the WL could help them teach their children to choose healthier food options. The capability of the WLs for children is reinforced past the study conducted by Arrúa et al. that compared the influence of WLs and TLLs on 442 Uruguayan children's snack choices. The authors described that both FOPs had a significant influence on children's food choice, with WLs presenting higher bear on than TLLs [49].

Our report has some limitations. Outset, nosotros showed merely the WL to the participants during the FGs, without any other kind of FOPL, which prevented comparisons. Still, since quantitative studies have already focused in this comparison, we aimed to focus on the participants' opinions on the WL that is currently being discussed in Brazil. Second, only urban, literate participants, living in central capitals of Brazil, were assessed. Thus, further studies are needed to understand the touch of WLs on rural and illiterate groups. Finally, no FG was performed in the North region of Brazil due to logistical limitations. Although the representation of all regions would exist desired, we believe that capturing perceptions on four of the five Brazilian regions was enough to inform the aims of the present study. Furthermore, we did non notice important differences between regions corroborating that our FGs were plenty to assess the main ideas of Brazilian consumers almost food labels.

Conclusion

This study shows a complex web of factors influencing consumers' food label use and the expected benefits of WLs to promote healthier food choices. Although many consumers were interested in agreement data about foods' diet limerick and ingredients, the linguistic communication and format used in current Brazilian food labels often make such information inaccessible. WLs show potential to support consumers in addressing those barriers and their suggestions for a new characterization. Thus, WLs seem suitable in improving consumers' autonomy in making healthier food choices and aiding with health promotion, especially amidst children.

Supporting data

Acknowledgments

The data drove for this written report was financed by Bloomberg Philanthropies (BRAZIL-IO-05). The funding trunk had no function to play in the design of the written report, data collection, analysis, and interpretation or in writing the manuscript. Sato was supported by FAPESP fellowship 2017/05651-0, while Khandpur was supported by FAPESP fellowship 2016/13669-4 and Scagliusi by CNPq (grant number 311357/2015-half dozen).

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