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Nutrition labels on pre-packaged foods: a systematic review
Objective To review research on consumer use and understanding of nutrition labels, as well as the impact of labelling on dietary habits. Design A systematic review was conducted by searching electronic databases. Relevant articles were screened by two reviewers and included if they met inclusion criteria, including eight methodological criteria. A total of 120 articles were included in the review, including cross-sectional surveys (n 96), experimental designs (n 17), ‘natural experiments’ (n 7) and longitudinal population-based surveys (n 2). Setting Articles covered seven jurisdictions: USA (n 88), Europe (n 12), Canada (n 9), Australia and New Zealand (n 4), Norway (n 2), Thailand (n 1) and Trinidad (n 1). Subjects Participants were from a wide range of age groups, socio-economic strata and geographical regions. Results Nutrition labels on pre-packaged foods are among the most prominent sources of nutrition information. Nutrition labels are perceived as a highly credible source of information and many consumers use nutrition labels to guide their selection of food products. Evidence also shows a consistent link between the use of nutrition labels and healthier diets. However, the use of labels varies considerably across subgroups, with lower use among children, adolescents and older adults who are obese. Research also highlights challenges in terms of consumer understanding and appropriate use of labelling information. Conclusions Nutrition labels on pre-packaged foods are a cost-effective population-level intervention with unparalleled reach. However, to capitalize on their potential, governments will need to explore new formats and different types of information content to ensure that nutrition information is accessible and understandable.
Journal Article
Pattern of the past : studies in honour of David Clarke
David Clarke's work concentrated on the establishment of explicit theory and logic in archaeological method. The contributors to this volume demonstrate how vital was his inspiration and reflect its diversity.
Book
Anything You Can Do, I Can Do Better: Can Aptamers Replace Antibodies in Clinical Diagnostic Applications?
The mainstay of clinical diagnostics is the use of specialised ligands that can recognise specific biomarkers relating to pathological changes. While protein antibodies have been utilised in these assays for the last 40 years, they have proven to be unreliable due to a number of reasons. The search for the ‘perfect’ targeting ligand or molecular probe has been slow, though the description of chemical antibodies, also known as aptamers, nearly 30 years ago suggested a replacement reagent. However, uptake has been slow to progress into the clinical environment. In this review, we discuss the issues associated with antibodies and describe some of the applications of aptamers that have relevancy to the clinical diagnostic environment.
Journal Article
Associations between online food outlet access and online food delivery service use amongst adults in the UK: a cross-sectional analysis of linked data
Background
Online food delivery services facilitate ‘online’ access to food outlets that typically sell energy-dense nutrient-poor food. Greater online food outlet access might be related to the use of this purchasing format and living with excess bodyweight, however, this is not known. We aimed to investigate the association between aspects of online food outlet access and online food delivery service use, and differences according to customer sociodemographic characteristics, as well as the association between the number of food outlets accessible online and bodyweight.
Methods
In 2019, we used an automated data collection method to collect data on all food outlets in the UK registered with the leading online food delivery service
Just Eat
(
n
= 33,204). We linked this with contemporaneous data on food purchasing, bodyweight, and sociodemographic information collected through the International Food Policy Study (analytic sample
n
= 3067). We used adjusted binomial logistic, linear, and multinomial logistic regression models to examine associations.
Results
Adults in the UK had online access to a median of 85 food outlets (IQR: 34–181) and 85 unique types of cuisine (IQR: 64–108), and 15.1% reported online food delivery service use in the previous week. Those with the greatest number of accessible food outlets (quarter four, 182–879) had 71% greater odds of online food delivery service use (OR: 1.71; 95% CI: 1.09, 2.68) compared to those with the least (quarter one, 0–34). This pattern was evident amongst adults with a university degree (OR: 2.11; 95% CI: 1.15, 3.85), adults aged between 18 and 29 years (OR: 3.27, 95% CI: 1.59, 6.72), those living with children (OR: 1.94; 95% CI: 1.01; 3.75), and females at each level of increased exposure. We found no association between the number of unique types of cuisine accessible online and online food delivery service use, or between the number of food outlets accessible online and bodyweight.
Conclusions
The number of food outlets accessible online is positively associated with online food delivery service use. Adults with the highest education, younger adults, those living with children, and females, were particularly susceptible to the greatest online food outlet access. Further research is required to investigate the possible health implications of online food delivery service use.
Journal Article
Association between time-weighted activity space-based exposures to fast food outlets and fast food consumption among young adults in urban Canada
Background
Despite increased attention on retail food environments and fast food consumption, results from previous studies have been inconsistent. Variation in measurement of exposure to retail food environments and the context of the built environment are possible reasons for inconsistencies. The purpose of the current study is to examine the association between exposure to fast food environment and fast food consumption among young adults, and to explore possible associations between built environment and fast food consumption.
Methods
We employed an observational, cross-sectional study design. Cross-sectional surveys were conducted in 2016 and 2017. In a sample of 591 young adults aged 16–30 years in five Canadian cities, we constructed and computed individual-level time-weighted number and ratio of fast food outlets in activity spaces derived from GPS trajectory data. Negative binomial regression models estimated the associations between exposure measures and frequency of fast food consumption (number of times consuming fast food meals in a seven-day period), controlling for built environment characterization and individual-level characteristics.
Results
Significant positive associations were found between time-weighted
number
of fast food outlets and count of fast food meals consumed per week in models using a radius of 500 m (IRR = 1.078, 95% CI: 0.999, 1.163), 1 km (IRR = 1.135, 95% CI: 1.024, 1.259), or 1.5 km (IRR = 1.138, 95% CI: 1.004, 1.289) around GPS tracks, when generating activity spaces. However, time-weighted
ratio
of fast food outlets was only significantly associated with count of fast food meals consumed when a radius of 500 m is used (IRR = 1.478, 95% CI: 1.032, 2.123). The time-weighted Active Living Environment Index with Transit measure was significantly negatively related to count of fast food meals consumed across all models.
Conclusions
Our study demonstrated associations of time-weighted activity space-based exposure to fast food outlets and fast food consumption frequency in a sample of young adults in urban Canada, and provides evidence of the association between context of built environment and fast food consumption, furthering discussion on the utility of individual-level, activity space-based data and methods in food environment research. These results imply that both food retail composition and activity spaces in urban areas are important factors to consider when studying diets.
Journal Article
Awareness and interest in IQOS heated tobacco products among youth in Canada, England and the USA
IntroductionHeated tobacco products (HTPs), such as IQOS, have been introduced in a growing number of international markets. However, little is known about perceptions of HTP products among youth.MethodsData are from wave 1 of the International Tobacco Control Youth Tobacco and E-cigarette Survey (2017), a web-based cohort survey of people aged 16–19 years from Canada, England and the USA. Respondents (n=12 064) were shown an image of IQOS and asked about their awareness, interest in trying and susceptibility to trying the product. Youth awareness, interest in trying and susceptibility to trying IQOS were analysed using descriptive statistics, and logistic regression models were used to examine correlates of these outcomes.ResultsOverall, 7.0% of youth reported awareness of IQOS (England=5.6%, Canada=6.4% and USA=9.1%) and 38.6% expressed interest in trying the product (England=41.8%, Canada=33.0% and USA=40.9%). Within each country, all key outcomes varied by smoking status: greater proportions of youth who were currently smoking or had a history of smoking reported being aware of, interested in trying and susceptible to trying IQOS. Interest and susceptibility to trying IQOS were associated with male sex, current tobacco use and current e-cigarette use. Across all countries, susceptibility to trying IQOS (25.1%) was higher than for tobacco cigarettes (19.3%), but lower than for e-cigarettes (29.1%).ConclusionsAwareness of HTPs, such as IQOS, is emerging among youth in Canada, England and the USA. Interest in trying these products is very high among smokers, but also present among non-smokers.
Journal Article
Adverse outcomes of cannabis use in Canada, before and after legalisation of non-medical cannabis: cross-sectional analysis of the International Cannabis Policy Study
ObjectivesTo date, there is little evidence on the extent to which cannabis legalisation affects the prevalence of adverse events from cannabis at the population level. The current study examined trends in the prevalence of adverse events among people who consumed cannabis before and after Canada’s legalisation of recreational cannabis.DesignData come from the first four survey waves of the International Cannabis Policy Study, which were conducted online annually immediately prior to non-medical cannabis legalisation in Canada in October 2018, and in the three following years (2019–2021).ParticipantsThe current analysis included 18 285 Canadian respondents aged 16–65 who reported cannabis use in the past 12 months.Outcome measuresPrimary outcomes included types of adverse events experienced from cannabis use, medical help-seeking and the types of products used. Weighted logistic regression models examined differences in help-seeking, emergency room usage and the experience of cannabinoid hyperemesis syndrome across survey years.ResultsApproximately one-third of people who consume cannabis reported experiencing at least one adverse event within the past 12 months, including 5% of consumers who sought medical help for an adverse event, most commonly for panic attacks, feeling faint/dizzy/passing out, heart/blood pressure problems and nausea/vomiting. The prevalence of seeking help and the types of adverse events were similar before (2018) and after legalisation (2019–2021); however, the proportion of consumers seeking help from emergency rooms increased postlegalisation (F=2.77, p=0.041). Adverse events were associated with various product types, with dried flower and oral oils accounting for the largest proportion of events. Help-seeking associated with cannabis edibles significantly decreased after legalisation (p=0.001).ConclusionsSubstantial proportions of people who consume cannabis report adverse events, suggesting widespread difficulty in ‘dosing’. Few changes were observed in the prevalence of adverse events reported by consumers since legalisation; however, the location of medical help-seeking and associated products used have changed postlegalisation.
Journal Article
Taxes and front-of-package labels improve the healthiness of beverage and snack purchases: a randomized experimental marketplace
Background
Sugar taxes and front-of-package (FOP) nutrition labelling systems are strategies to address diet-related non-communicable diseases. However, there is relatively little experimental data on how these strategies influence consumer behavior and how they may interact. This study examined the relative impact of different sugar taxes and FOP labelling systems on beverage and snack food purchases.
Methods
A total of 3584 Canadians 13 years and older participated in an experimental marketplace study using a 5 (FOP label condition) × 8 (tax condition) between-within group experiment. Participants received $5 and were presented with images of 20 beverages and 20 snack foods available for purchase. Participants were randomized to one of five FOP label conditions (
no label
;
‘high in’ warning
;
multiple traffic light
;
health star rating
;
nutrition grade
) and completed eight within-subject purchasing tasks with different taxation conditions (beverages:
no tax
,
20% tax on sugar-sweetened beverages (SSBs)
,
20% tax on sugary drinks
,
tiered tax on SSBs
,
tiered tax on sugary drinks
; snack foods:
no tax
,
20% tax on high-sugar foods
,
tiered tax on high-sugar foods
). Upon conclusion, one of eight selections was randomly chosen for purchase, and participants received the product and any change.
Results
Compared to those who saw no FOP label, participants who viewed the ‘high in’ symbol purchased less sugar (− 2.5 g), saturated fat (− 0.09 g), and calories (− 12.6 kcal) in the beverage purchasing tasks, and less sodium (− 13.5 mg) and calories (− 8.9 kcal) in the food tasks. All taxes resulted in substantial reductions in mean sugars (− 1.4 to − 4.7 g) and calories (− 5.3 to − 19.8 kcal) purchased, and in some cases, reductions in sodium (− 2.5 to − 6.6 mg) and saturated fat (− 0.03 to − 0.08 g). Taxes that included 100% fruit juice (‘sugary drink’ taxes) produced greater reductions in sugars and calories than those that did not.
Conclusions
This study expands the evidence indicating the effectiveness of sugar taxation and FOP labelling strategies in promoting healthy food and beverage choices. The results emphasize the importance of applying taxes to 100% fruit juice to maximize policy impact, and suggest that nutrient-specific FOP ‘high in’ labels may be more effective than other common labelling systems at reducing consumption of targeted nutrients.
Journal Article
Cross-sectional analysis of cannabis use at work in the USA: differences by occupational risk level and state-level cannabis laws
ObjectiveTo examine the prevalence of workplace cannabis use, including by state-level cannabis laws, occupational risk and medical cannabis use.MethodsData are cross-sectional from wave 6 (2023) of the International Cannabis Policy Study (ICPS) and include 26 458 respondents aged 16–65 years from the USA. Separate regression models were run analysing workplace cannabis use across: (1) state-level cannabis laws and occupational risk, (2) reasons for cannabis use and (3) medical cannabis authorisation. All models were adjusted for sociodemographic characteristics.ResultsOverall, 7.4% of workers and 21.5% of past 12-month cannabis consumers reported using cannabis at or within 2 hours of starting work in the last 30 days. Workplace cannabis consumption was highest among workers in states with ‘recreational’ cannabis laws (8.5%) compared with states with medical (6.3%; adjusted OR (AOR)=1.45, p=0.006) or illegal laws (6.2%; AOR=1.06, p=0.005). Workers in high-risk jobs were more likely to use cannabis at work (11.4%) than those in lower risk jobs (5.8%; AOR=1.58, p<0.001). Workplace cannabis use was also greater among cannabis consumers who use cannabis for medical versus recreational (29.4% vs 15.6%; AOR=2.35, p<0.001) or mixed reasons (24.2%; AOR=1.78, p=0.007); the same was true for consumers who reported having medical cannabis authorisation (39.0%) versus those without authorisation (17.4%; AOR=2.66, p<0.001).ConclusionsReported cannabis use at work was most prevalent in states with recreational legalisation, particularly among individuals with medical cannabis authorisation and those who work higher risk jobs. Longitudinal research should examine the individual and occupational-level factors associated with workplace cannabis use.
Journal Article