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Background The effectiveness of Front-of-Pack nutrition Labels (FoPLs) may be influenced by national context. In light of the ongoing efforts to harmonize FoPLs across Europe, this study aimed to compare the effectiveness of five FoPLs (Health Star Rating system, Multiple Traffic Lights, Nutri-Score, Reference Intakes, Warning symbols) on consumer understanding and food choice in 12 European countries. Methods In 2018–2019, for three food categories, approximately 1000 participants per country were asked to select which food they would prefer to purchase between three products with distinct nutritional quality profiles, and then to rank the products by nutritional quality. Participants ( N  = 12,391 in total) completed these tasks first with no FoPL and then, after randomization to one of the five FoPLs, with a FoPL on the food packages. Associations between FoPLs and change in (i) nutritional quality of food choices and (ii) ability to correctly rank the products by nutritional quality were assessed with logistic regression models adjusted for sociodemographic and lifestyle characteristics of participants, conducted overall and by country. Findings Compared with the Reference Intakes, the Nutri-Score (OR = 3.23[2.75–3.81]; p  < 0.0001), followed by the Multiple Traffic Lights (OR = 1.68[1.42–1.98]; p  < 0.0001), was the most effective FoPL in helping consumers identify the foods’ nutritional quality, overall and in each of the 12 countries. Differences between FoPLs regarding food choice modifications were smaller, but the effect of the Nutri-Score seemed slightly higher in eliciting healthier food choices overall compared with the Reference Intakes, followed by the Warning symbols, the Multiple Traffic Lights and the Health Star Rating system. Interpretation In the context of FoPL harmonization in Europe, these findings from an online experiment provide insights into the Nutri-Score’s effectiveness on European consumers.

The incidence of overweight and obesity has generated significant concerns among European consumers and institutions. As part of a set of measures undertaken, the European Union (EU) called for one harmonized mandatory front-of-pack nutritional label (FOPL) to improve consumer food nutritional knowledge and encourage healthier and more informed food choices. Different types of FOPLs, ranging from nutrient-specific labels—such as the NutrInform Battery—to summary labels—such as the Nutri-Score—have been developed and introduced in different markets, reporting different degrees of effectiveness in terms of understanding. The aim of this study is to provide actionable insights by analyzing a specific part of the complex consumers’ decision-making process in food when aided by FOPLs. Adopting a between-subject experiment on a sample of 4560 respondents in 20 EU member countries, the study compares the consumer subjective understanding and liking of two labels currently under examination by the EU bodies, the NutrInform Battery and the Nutri-Score. At an aggregated level, the results show that NutrInform Battery is more effective than Nutri-Score in improving consumer subjective understanding and leads to a higher liking towards the label. A detailed by-country analysis highlights either a superiority or a parity of NutrInform Battery for subjective understanding and liking. Theoretically, this study, through a large panel of respondents, adds the fundamental perspective on subjective understanding, complementing the findings of extant research on objective understanding, and further clarifies the role of liking as a complementary element in the food decision-making process toward heathier and more informed food choices. This might be of significant relevance in providing additional evidence that can be used by policymakers in their attempt toward the selection of a uniform FOPL at EU level.

Background Warning Labels (WL) highlight excessive amounts of critical nutrients in order to discourage consumption of unhealthful packaged food products. This study aimed to evaluate among Mexican school children, the objective understanding of traditional and numeric WL (aimed at small products) considered by the Mexican regulation, and whether cartoon characters influenced the understanding of WL. We also tested some communication strategies to facilitate the correct use of the WL. Methods We carried out a randomized experiment in July 2019 in public elementary schools from Morelos, Mexico. Participants aged 6–13 years, were randomly assigned to one of four groups: 1) Nutrient Facts Panel (NF) ( n  = 120), 2) Nutrient Facts Panel with cartoon characters (NF + C) ( n  = 83), considered the control groups, 3) Warning Labels (WL) ( n  = 109), and 4) Warning Labels with cartoon characters (WL + C) ( n  = 96). After allocation, children assigned to both WL groups (WL or WL + C), were randomly required to watch two posters simultaneously or a video explaining how to correctly interpret WLs. Logistic regression models adjusted by sex, age and cluster (school) were fitted. Results The percentage of children correctly choosing the healthiest or the unhealthiest option was higher for WL groups (56.8, 95%CI; 40.8–72.8) compared to NF groups (24.3, 95%CI; 20.4–28.3, p  < 0.05). The understanding of traditional WL was higher (28.7, 95%CI: 22.8–35.4) than the numeric WL (19, 95%CI: 14.2–25.0, p  < 0.05). But, correct answers for identifying healthy and unhealthy products were higher for numeric WL than for NF groups. Cartoon characters reduced the percentage of correct answers for choosing unhealthiest products (WL + C: 48.9, 95%CI: 25.6–72.4 vs WL: 58.7, 95%CI: 36.4–81.1, p  < 0.05). The video was 2.23 times more helpful than the posters to the correct interpretation of the WL ( p  < 0.05). Conclusions In scholar Mexican children, traditional and numeric WL were useful to identify healthier and unhealthier packaged products in comparison to NF, suggesting that both WL formats may effectively communicate the excessive content of nutrients of concern among children. Cartoon characters may reduce the objective understanding of the WL, underscoring the need to regulate advertising directed to children along with the implementation of front-of-pack labeling.

Background: This study investigates the efficacy of Front-of-Pack Nutrition Labels (FOPNLs) as a cost-effective tool for improving dietary choices among Greek consumers. The purpose of the study was to investigate Greek customers’ preferences and comprehension of commonly used European FOPNL schemes. Methods: The Hellenic Food Authority and the Agricultural University of Athens performed a representative online survey in March 2022, titled “The Role of Nutritional Labelling in Public Perception and Food Procurement.” Consumers responded to a questionnaire separated into two parts. Part one included (i) personal, sociodemographic information, and (ii) subjective opinions on the FOPNL schemes, and part two comprised (iii) an objective understanding of NutriScore and NutrInform Battery, using 15 different foods. Participants were randomly allocated to these groups, and general mixed models were used for analysis. Results: A total of 1389 adults completed the first part of the survey, and 74.8% completed the second part. The Multiple Traffic Lights scheme was the preferred FOPNL, chosen by 48.4% of respondents, compared to 19.7% for NutrInform Battery and 12.3% for NutriScore. However, the mean objective assessment score was highest for NutriScore (5.8 ± 2.3) compared to NutrInform Battery (5.4 ± 1.9). Conclusion: The results highlight the necessity for comprehensive nutrition education programs by showing a considerable gap between subjective preferences and an objective understanding of nutrition labels.

In the ongoing debate about front-of-package (FOP) nutrition labels, little data exist regarding nutritionally at-risk populations, although they are critical targets of prevention programs. This study aimed to compare the impact of FOP labels on the ability to rank products according to their nutritional quality among French adults potentially at risk of poor dietary quality (N = 14,230). Four labels were evaluated: Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), 5-Color Nutrition Label (5-CNL), Green Tick (Tick), along with a reference without label. Mixed models were used to assess how individual characteristics and FOP labels were associated with the ability to rank products. Older participants and those with a lower educational level, income, nutritional knowledge, and likelihood of reading nutrition facts were less skilled at ranking food products according to nutritional quality. Compared with individual characteristics, nutrition labels had an increased impact on food product ranking ability. Overall, 5-CNL corresponded to the highest rate of correct responses, followed by MTL, GDA, and Tick (p < 0.0001). The strongest impact of 5-CNL was observed among individuals with no nutritional knowledge (odds ratio (OR): 20.24; 95% confidence interval (CI): 13.19–31.06). Therefore, 5-CNL appeared to be effective at informing consumers, including those who are nutritionally at-risk, about the nutritional quality of food products.

Background The front of pack nutrition label Nutri-Score, intended to help consumers orient their choices towards foods that are more favorable to health, was developed in France and applied in several European countries. Consideration is underway for its use in Morocco. This study aims to assess Moroccan consumers’ perception and objective understanding of Nutri-Score and 4 other nutritional information labels (Health Star Rating, Health warning, Reference Intakes and Multiple Trafic Light) and their impact on purchase intentions. Methods 814 participants were asked to choose among 3 food classes (yoghurts, biscuits and cold cuts), which ones they would prefer to buy among three products with different nutritional profiles and then to rank them according to their nutritional quality. Participants first performed these tasks without a visible nutritional label, and then, after being randomized to one of five labels tested, with the nutritional label visible on front of packs. Next, the full set of tested labels was presented to the participants who were asked a series of questions regarding their preferences, the attractiveness of the labels, their perceptions, intention to use and the trustworthiness placed in the labels. Results Compared to the Reference Intake, the Nutri-Score (OR = 2.48 [1.53–4.05], p  < 0.0001), was associated with the highest improvement in the ability to correctly classify foods based on their nutritional quality. The percentage of participants who improved their food choice was higher than those who worsened it for all the labels. For yogurts and cookies, the most significant improvements were observed for the Nutri-Score and the Reference Intakes: Concerning the perception of labels, the Nutri-Score is the label that received the highest number of positive responses, whether concerning the ease of being spotted (82.2%), of being understood (74%), and to provide rapid information (68.8%). The Nutri-Score was ranked as the preferred label by 64.9% of the participants. Conclusion The Nutri-Score appears to be the most effective nutritional information system to inform consumers about the nutritional quality of foods in Morocco, where it could constitute a useful tool to help consumers in their food choices in situations of purchase.

This study aimed to assess the objective understanding of five front-of-pack label formats, namely the Reference Intake, Multiple Traffic Light label, Nutri-Score, health endorsement logo and warning label, among consumers in Nelson Mandela Bay, South Africa. This was a cross-sectional, exploratory study. Interviewer-administered surveys were conducted at 12 randomly selected food retail outlets in an urban setting. A total of 359 adult participants were included in this study. Objective understanding was measured by asking participants to rank food products according to their nutritional quality, using the displayed front-of-pack label. The type of front-of-pack label significantly influenced ranking ability (p < 0.00001). All the evaluative front-of-pack labels significantly improved the participants' ability to identify healthier food products compared with the no-label control. The reductive Reference Intake, however, showed no significant impact on consumer understanding. Evaluative front-of-pack labels significantly improved the participants' ability to identify healthier food products, when compared with the Reference Intake and no-label control. Future research should test the objective understanding of culturally diverse groups in South Africa, particularly among rural populations.

Grinder and Bandler (1976) asserted that if therapists communicate with clients using verbal predicates that match the modality of the clients' primary representational system (PRS), it will be easier for the clients to understand the therapist and to believe that they are understood. In this study we investigated the relationship between predicate matching and understanding. Participants (N=99) listened to a recorded narrative under either a “matched” or “mismatched” experimental condition. Participants' objective understanding (factual recall) and subjective understanding (feelings of having understood) were assessed. The results weakly supported a claim of enhanced accuracy of understanding on one measure of objective understanding, and they suggested greater understanding and recall for visual PRS participants.

This chapter contains sections titled: The basics Developing a good set of objectives Working with objectives in environmental management processes Case studies Key messages Suggested reading References and notes

This essay theorizes New York University A/P/A Studies’ efforts to develop a participatory process of critical knowledge-building with undergraduate students. In my larger project, I seek to work toward a practical approach to cultivate the embodied knowledges of people to name and critique their omnipresent realities. Building on the work of feminist standpoint and intersectional theories, I seek to forge a productive link between post-positivist realism and dialogic theory. By so doing, I believe mutually beneficial, democratic collaborations can build the knowledges by, for, and of marginalized communities and peoples.1