1Instituto Nacional De Salud Pública, Cuernavaca, Morelos, México, 2University of North Carolina at Chapel Hill, Chapel Hill, U.S.
Background: Mexico implemented in October 2020 a frontof- pack warning labelling (FOPWL). A legend informing about the presence of non-caloric sweeteners (NCS) is also included. Objective: We aimed to identify changes in healthfulness perception and preferences of parents and children when FOPWL were displayed. Methods: This study used data from a national web-based cohort of Mexican children 5-10y and one of their parents. Three waves of data were collected between November 2020 and November 2022 with a self-administered questionnaire for parents and an interviewer-administered questionnaire for children. For each wave, parents were asked which product they would choose for their children, and to rate their healthfulness on a scale of four options (very healthy to not healthy at all). Similarly, children’s questionnaire asked them their preference and which one they considered to be healthier. For this analysis, we looked at the changes for the juice and nectar category using dyads of children and parents who completed the three waves (n=769). Differences in proportions were compared using a chi-squared test. Results: In the first wave without FOPWL, both parents and children prefered 100% juice over nectar, and considered 100% juice to be healthier than nectar. A third option of light nectar (with NCS) was presented to parents, without difference in the healthfulness perception compared to regular nectar. When the FOPWL of excess sugar and the NCS legend were displayed, parents’ preference decreased for regular (-12.6pp) and NCS nectar (-20.9pp). Healthfulness perception increased for 100% juice and decreased for both nectars (p<0.05), especially for NCS nectar, with 58% of parents considering it not healthy at all. Children’s healthfulness perception decreased for nectar with FOPWL (-7.4pp), however, it increased to baseline levels when the child-directed character was removed (8.3pp). Yet, their preference for nectar decreased with FOPWL (-8.1pp) and when the character was removed (-8.3pp). Conclusions: Even though healthfulness perception did not change for children with FOPWL, their preference for the non-healthy option decreased. For parents, the biggest change was seen for nectar with NCS, with decrease preference and healthfulness perception.
Kew-words: front-of-pack warning labels, Mexico, healthfulness perception.