European Journal of Nutrition & Food Safety

Background: Nutrition information on food labels is considered to be a tool that helps reduce obesity risk by nudging people away from poor dietary habits towards healthy food choices European Commission, [1]. To work it needs to be available when food is purchased, it has to be clear, easily understood and consumers need to use it. This study explores determinants of label use, lifestyle and dietary habits of 16-17 year old adolescents, and evaluates whether food labelling could be an effective vehicle for promoting healthy food choice in this underrepresented age group.
Method: Cross-sectional survey using a validated questionnaire Mackison et al., [2] adapted for use with 16-17 year old adolescents (n=179) from a comprehensive high school in Cheshire, UK. A census approach with option to opt out was used and all pupils present on the day (n=132; male: 65, female: 65, unspecified: 2) completed the questionnaire. Data was analysed using SPSS v20.0. Between group differences of demographic and lifestyle factors were determined for interest in healthy eating (independent-samples t-test and one-way independent analysis of variance), and label understanding (Kruskal Wallis and Mann-Whitney U tests). Categorical data was explored using chi-squared test for independence. A significance level of p<0.5 was used. The project was risk assessed and ethical approval granted by the Department of Clinical Sciences Ethics Committee at the University of Chester. 
Results: Food labels were considered important by 87% of participants but less than one third (32%) self-reported frequent use of labels when buying food. Nearly three quarters (71%) answered more than half of the label understanding questions correctly; just over half (59%) had a high interest in healthy eating. Label understanding scores were lower for those with: lower GCSE grades in maths (p<0.001) and English (p=0.03); lower frequency of family meals (p=0.04) and higher frequency of fast food consumption (p=0.03) and snacking (p=0.005). Lower interest in healthy eating was associated with male gender (p=0.004), less physical activity (p=0.04), and more frequent snacking (p<0.001) and fast food consumption (p<0.001).
Discussion: A unique aspect of the study was the use of a census type approach that allowed the views of males, females, and those with various levels of interest to be equally represented. Many existing studies focussed specifically on label users or used a random sampling approach to recruitment that results in non-response bias. Those at increased risk of obesity due to dietary and lifestyle choices were found to be less likely to benefit from food labels as they have less interest in healthy eating (a marker for actual in store label use), and lower label understanding and self-reported usage. The association between low GCSE grades and low label understanding highlights a barrier to effective use. The low levels of interest and usage amongst males raises a question about whether the introduction of energy labelling in catering outlets could actually increase energy consumption in this group.
Conclusion: Food labelling may enable those desiring to eat healthily to exercise that choice but has limited influence on the dietary choices of those at increased risk of obesity in this age group.