Evaluating nutrition labeling policy changes in the US and Mexico.

PROJECT SUMMARY The United States (US) and Mexico have the highest prevalence of obesity in the world. In the US, Latinxs, who comprise the largest ethnic minority group, have disproportionately high rates of poor diet quality, obesity, and diet-related health outcomes. Food labeling is a low-cost, wide-reaching intervention for communicating

nutrition information to consumers so they can make more informed, healthier food choices. Between 2020 and 2021, the US is changing the Nutrition Facts Label (NFL) on pre-packaged foods, which will increase the visibility of calorie amounts and serving sizes while introducing information on added sugar. NFLs have been

criticized, however, for their complexity and location on the back of packaging. Front-of-package (FOP) nutrition labels provide more visible and simplified information on the nutritional value of foods, enabling consumers to easily compare options at the point of product selection. Between 2020 and 2021, Mexico will

implement mandatory FOP warnings in the form of prominent “stop signs” on packaged foods that are high in calories, sodium, sugar, saturated fat, or trans fats, as well as products with added caffeine or non-caloric sweeteners. To evaluate the relative effectiveness of these new US and Mexican policies, the current proposal

leverages data from the International Food Policy Study (IFPS), which has annually surveyed approximately 4000 US and 4000 Mexican adults since 2018. Funding for Mexico ends in 2020, though funding is secured for the US through 2024. Mexicans and US Latinxs with lower educational attainment – key groups with

disproportionately high obesity rates and for whom the FOP warnings may be most effective – have been under-represented in IFPS surveys. The proposed study will continue annual surveys of Mexican consumers through 2024 (n=4000/year) while providing an oversample of US Mexican Americans (MAs; n=2000/year)

who comprise approximately two-thirds of all US Latinxs. We will recruit additional samples of Mexicans (n=1500/year) and MAs (n=1500/year) with lower education. This pre/post study will compare within- and between-countries over time to address two aims. Aim 1 will evaluate the impact of the mandatory FOP

warnings in Mexico relative to NFL changes in the US. We hypothesize that increases in awareness/use of nutrition labels, nutrition knowledge, and healthy dietary behaviors will be greater in Mexico than in the US, including US MAs. Aim 2 will evaluate disparities in the effects of these nutrition labeling policies. We

hypothesize that awareness and use of FOP warnings, nutrition knowledge, and healthy dietary behaviors will increase more from pre- to post-policy among disadvantaged groups in Mexico than in the US due to the greater prominence and simplicity of the Mexican FOP warnings. Finally, we expect that post-implementation

trends in labeling effects among disadvantaged groups will favor the Mexican over US policy. The results from this study will inform policy development in the US and globally, as well as communication theories that guide product labeling to promote healthy behaviors.