1. Nutrition Labelling: Understanding and Use of Nutrition Facts Tables among Young People in Canada Erin Hobin Public Health Ontario May 28, 2014 Erin.Hobin@oahpp.ca

2. PublicHealthOntario.ca Background Dietary patterns are associated with nutrition-related chronic diseases such as obesity, diabetes, cardiovascular disease, and cancer Poor dietary patterns among adolescents and young adults in Canada

3. PublicHealthOntario.ca Adolescents and Young Adults

4. PublicHealthOntario.ca a

5. HC Report – Serving Size

6. PublicHealthOntario.ca Not a single published study in Canada has examined the understanding and use of NFts among young people Previous Research

7. PublicHealthOntario.ca Primary Research Objective To investigate if and how young people in Canada comprehend and use serving size and %DV information on the current and modified NFts when choosing and comparing foods.

8. PublicHealthOntario.ca STUDY 1 used qualitative methods to explore the process by which young people engage with, understand, and use serving size and %DV information on the current and modified NFts. STUDY 2 consists of a quantitative survey with 2,000 participants between the ages of 16-24 years from across Canada.

9. PublicHealthOntario.ca Stimulus Conditions Current Serving SizesStandard Serving Sizes % Daily Value (%DV) only Condition #1 - controlCondition #2 % Daily Value (%DV) + HIGH / LOW Descriptors** Condition #3Condition #4 % Daily Value (%DV) + HIGH / LOW Descriptors** + Colour Condition #5Condition #6 **HIGH = ≥ 15% DV per serving; LOW = ≤ 5% DV per serving

10. PublicHealthOntario.ca CONDITION #5 Product AProduct B Nutrition Facts / Valeur Nutritive Per: 19 crackers (20g) /par 19 craquelins (20g) Amount Teneur % Daily Value % valeur quotidienne Calories / Calories 100 Fat / Lipides 3.5g 5% Saturated/ saturates 1g 5% + Trans / trans 0g Cholesterol/ Cholesterol 5mg Sodium/Sodium 200mg 13% Carbohydrate/ Glucides 22g 4% Fibre 1.7g 4% Sugars 1.7g Protein 5g Vit A/Vit A 2% Vit C/Vit C 0% Calcium/Calcium 6% Iron/Fer 6% % DV = LOW/BAS MED/MOY HIGH/HAUT Nutrition Facts / Valeur Nutritive Per: 7 crackers (30g) /par 7 craquelins (30g) Amount Teneur % Daily Value % valeur quotidienne Calories / Calories 145 Fat / Lipides 2.6g 4% Saturated/ saturates 0.8g 4% + Trans / trans 0g Cholesterol/ Cholesterol 4mg Sodium/Sodium 60mg 4% Carbohydrate/ Glucides 19g 6% Fibre 1g 0% Sugars 5g Protein 2g Vit A/Vit A 0% Vit C/Vit C 0% Calcium/Calcium 0% Iron/Fer 6% % DV = LOW/BAS MED/MOY HIGH/HAUT

11. PublicHealthOntario.ca STUDY 1 Design Overview: Verbal Protocol + semi-structured interviews within randomized stimulus conditions and asked to “think aloud” while participating in 2 Behavioural Tasks 26 participants 50% 16 – 18 years / 19 – 24 years 50% Male / Female June – August 2013

12. PublicHealthOntario.ca Task #1 – Hypothetical purchase situation Price and taste are most important factors when choosing foods. “Get more, get a better bang for my buck.” The nutrition information on the NFt considered when choosing foods varies between participants. “I mean I don’t personally know too much about like the pros and cons of different vitamins, and different stuff.” Simple at-a-glance symbols and colours can support interpretation of nutrition information. “There is a term next to calories that I noticed immediately when scanning the box. I have never seen both those terms before.”

13. PublicHealthOntario.ca Task #2: Functional Survey with NFts “More than the other product.”

14. PublicHealthOntario.ca Task #2: Functional Survey with NFts Do not know what the daily recommended amount is for different nutrients and were unable to use %DV information. “I don’t know what the daily value is.” Using the same metrics (e.g., %DV) for positive nutrients (e.g., calcium) and negative nutrients (e.g., saturated fat) may cause confusion for participants. “You should always get 100% DV.” Participants randomized to the NFt conditions with standard serving sizes performed significantly better on survey tasks requiring comparisons across products. “More than the other product.” No sense of whether high amounts of saturated fat are a good or bad thing; however, participants randomized to the NFt conditions with simple descriptors or colour coded %DV information performed significantly better on survey task requiring interpretation of %DV information. “High” indicates high amount.”

15. PublicHealthOntario.ca Key take-away message Standard serving sizes across similar products can support food choices and more prescriptive information leaves less for interpretation and places information into context.

16. PublicHealthOntario.ca Relevance Aligned with several food-related recommendations made in the Healthy Kids Report section 2.5. Results can provide evidence to support more effective regulatory changes to Nutrition Facts tables. Translate findings to communicating nutrition information on front-of- package and menu labelling initiatives. Guide school curricula.

17. PublicHealthOntario.ca Next Steps Conduct Study 2 – online survey with 2,000 participants across Canada Expose participants to same 6 experimental conditions testing current NFT compared to standardized serving sizes and simple descriptors and colours to interpret %DV information Specific applications of NFt such as more prominent display of calories, including “added sugars” information

18. PublicHealthOntario.ca RESEARCH TEAM Food and Nutrition Experimental Design and Survey Methods Qualitative Methods and Think Aloud Dr. David Hammond Associate Professor, U Waterloo Dr. Erin Hobin Scientist, Public Health Ontario Dr. Judy Sheeshka RD, Professor, Victoria University Ms. Mary Fodor O’Brien RD, Public Health Ontario Dr. Gail McVey Scientist, Hospital for Sick Kids Young People TIMELINE: September 2012 through to July 2014

19. PublicHealthOntario.ca ACKNOWLEDEMENTS Funding for this study was provided through a Research in Action grant from: Dr. Grace Shen-Tu, practicum student at PHO Christine White, Program Manager, Propel Centre for Population Health Impact

20. PublicHealthOntario.ca E: Erin.Hobin@oahpp.ca T: 647-260-7198 Thank you for listening

21. PublicHealthOntario.ca Do not know what the daily recommended amount is for different nutrients and were unable to use %DV information. Task #2: Functional Survey with NFts “I don’t know what the daily value is.”

22. PublicHealthOntario.ca Task #2: Functional Survey with NFts Using the same metrics (e.g., %DV) for positive nutrients (e.g., calcium) and negative nutrients (e.g., saturated fat) may cause confusion for participants. “You should always get 100% DV.”

23. PublicHealthOntario.ca Task #2: Functional Survey with NFts Participants randomized to the NFt conditions with simple descriptors or colour coded %DV information performed significantly better on survey task requiring interpretation of %DV information. “High” indicates high amount.”