(PTFS11-01-26) Caregivers’ Perception and Utilization of Front-of-Package Labeling and Its Effect on Added Sugar Intake Among Mexican Children: Results From ENSANUT 2018

Objectives: From 2016 to 2020, the Guideline Daily Amounts (GDA) front-of-package labeling (FOPL) policy was implemented in Mexico. This study evaluated the associations between caregivers’ perceptions, literacy, and utilization of GDA and Mexican children’s intake of added sugar (AS).

Methods: Cross-sectional data of child-caregiver dyads were analyzed. The dyads included children aged 2-11 years and their caregivers aged ≥20 years who participated in the 2018 National Health and Nutrition Survey of Mexico (ENSANUT). AS intake outcomes were estimated as % of total energy intake (TEI) calculated from 7-day recall semi-quantitative food frequency questionnaire data. Guided by the Health Belief Model, two-group structural equation modeling assessed associations of caregivers’ perceived benefits, barriers, and nutrition literacy with their GDA utilization (all latent) as well as the effect of GDA utilization on child AS intake, with mediated moderation by caregiver AS intake (≥ 10%TEI vs. < 10%TEI).

Results: A total of 5,040 child-caregiver dyads were included in the analyses. Over 80% of children consumed ≥10% TEI from AS, with higher intake associated with younger child age, lower fiber intake of children, and lower caregiver educational attainment. Caregivers’ perceived benefits of using GDA for healthy food choices showed large positive association to GDA utilization (standardized estimation ± standard error of coefficient β _{< 10%TEI} = 0.49 ± 0.03, p< 0.001; β_≥10%TEI = 0.47 ± 0.02, p< 0.001) while nutrition literacy showed moderate positive association (β _{< 10%TEI} = 0.34 ± 0.04, p< 0.001; β_≥10%TEI=0.27 ± 0.03, p< 0.001), irrespective of caregiver AS intake. Of the sociodemographic factors, higher caregivers’ education level was moderately associated with greater GDA utilization, regardless of their AS intake (β _{< 10%TEI} = 0.18 ± 0.03, p< 0.001; β_≥10%TEI = 0.16 ± 0.02, p< 0.001). No significant association was observed between GDA utilization and child AS intake, regardless of caregiver AS intake.

Conclusions: While caregivers’ health beliefs were significant predictors of their GDA utilization, utilizing GDA was not significantly associated with AS intake among Mexican children in the 2018 ENSANUT.

Funding Sources: This work was supported by the National Institutes of Health.