This commentary highlights the release of findings now available in the report International Food Policy Study Youth Surveys: Summary of Findings 2019–2021.

The survey data described in this commentary consist of repeated cross-sectional surveys conducted annually beginning in 2019.

Online surveys were conducted in 2019 to 2021 among respondents living in Australia, Canada, Chile, Mexico, the United Kingdom and the USA.

Survey respondents were youth aged 10–17 years in 2019 (n 12 031), 2020 (n 11 108) and 2021 (n 10 459).

The report described in this commentary summarises findings on food and nutrition behaviours, attitudes and knowledge among youth, including their diet sources and patterns, school nutrition environments, food security, diet intentions, weight perceptions and weight loss behaviours, sugary drink perceptions, awareness of public education and mass media campaigns, perceptions of food labels and exposure to food and beverage marketing.

Results from the IFPS Youth surveys provide important insights into key policies of global interest, including front-of-package nutrition labelling, levies on sugary beverages and restrictions on marketing unhealthy food and beverages to children. As policymakers continue to seek effective strategies to improve adolescent health outcomes, ongoing cross-country monitoring of food and nutrition-related indicators, such as the data from the International Food Policy Study, will be critical in assessing dietary trends and evaluating upcoming policies.

Estimate the impact of 20 % flat-rate and tiered sugary drink tax structures on the consumption of sugary drinks, sugar-sweetened beverages and 100 % juice by age, sex and socio-economic position.

We modelled the impact of price changes – for each tax structure – on the demand for sugary drinks by applying own- and cross-price elasticities to self-report sugary drink consumption measured using single-day 24-h dietary recalls from the cross-sectional, nationally representative 2015 Canadian Community Health Survey-Nutrition. For both 20 % flat-rate and tiered sugary drink tax scenarios, we used linear regression to estimate differences in mean energy intake and proportion of energy intake from sugary drinks by age, sex, education, food security and income.

Canada.

19 742 respondents aged 2 and over.

In the 20 % flat-rate scenario, we estimated mean energy intake and proportion of daily energy intake from sugary drinks on a given day would be reduced by 29 kcal/d (95 % UI: 18, 41) and 1·3 % (95 % UI: 0·8, 1·8), respectively. Similarly, in the tiered tax scenario, additional small, but meaningful reductions were estimated in mean energy intake (40 kcal/d, 95 % UI: 24, 55) and proportion of daily energy intake (1·8 %, 95 % UI: 1·1, 2·5). Both tax structures reduced, but did not eliminate, inequities in mean energy intake from sugary drinks despite larger consumption reductions in children/adolescents, males and individuals with lower education, food security and income.

Sugary drink taxation, including the additional benefit of taxing 100 % juice, could reduce overall and inequities in mean energy intake from sugary drinks in Canada.

Front-of-package warning labels introduced in Mexico in 2020 included disclaimers that caution against allowing children to consume products with non-sugary sweeteners and caffeine. We examined the awareness and use of the disclaimers among Mexican adults and youth 1 month after the regulation was implemented. We also investigated their impact on the perceived healthfulness of industrialised beverages designed for children.

Data on the awareness and use of the disclaimers were analysed. Two between-subjects experiments examined the effect of a sweetener disclaimer (Experiment 1, youth and adults) or a caffeine disclaimer (Experiment 2, only adults) on the perceived healthfulness of industrialised beverages. Interactions between experimental conditions and demographic characteristics were tested.

Online survey in 2020.

Mexican adults (≥18 years, n 2108) and youth (10–17 years, n 1790).

Most participants (>80 %) had seen the disclaimers at least rarely, and over 60 % used them sometimes or frequently. The sweetener disclaimer led to a lower perceived healthfulness of a fruit drink (adults: 2·74 ± 1·44; youth: 2·04 ± 0·96) compared with the no-disclaimer condition (adults: 3·17 ± 1·54; youth: 2·32 ± 0·96) (t’s: >4·0, P values: <0·001). This effect was larger among older adults and male youth. The caffeine disclaimer did not affect adult’s perceived healthfulness of a caffeinated drink (t = 0·861, P value = 0·3894).

There were high awareness and use of the sweeteners and caffeine disclaimers shortly after the warning labels were implemented. The sweetener disclaimer appears to be helping consumers modify their perceptions regarding industrialised beverages for children. Findings may help decision-makers improve the regulation and better target communication strategies.

To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups.

Cross-sectional data from the International Food Policy Study (IFPS) online survey.

IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019.

Adults aged 18–99; n 19 393.

Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy.

Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.

This study aimed to identify correlates of nutrition label awareness and use, particularly subgroup differences among consumers. Two label types were assessed: (1) nutrition facts tables (NFt) in Australia, Canada, Mexico, UK, and USA and (2) front-of-package (FOP) labels, including mandatory Guideline Daily Amounts (Mexico), voluntary Health Star Ratings (Australia) and voluntary Traffic Lights (UK).

Respondents were recruited using Nielsen Consumer Insights Global Panel (n 21 586) and completed online surveys in November–December 2018. Linear regression and generalised linear mixed models examined differences in label use and awareness between countries and label type based on sociodemographic, knowledge-related and dietary characteristics.

Australia, Canada, Mexico, UK and USA.

Adults (≥18 years).

Respondents from the USA, Canada and Australia reported significantly higher NFt use and awareness than those in Mexico and the UK. Mexican respondents reported the highest level of FOP label awareness, whereas UK respondents reported the highest FOP label use. NFt use was higher among females, ‘minority’ ethnic groups, those with higher nutrition knowledge and respondents with ‘adequate literacy’ compared with those with ‘high likelihood of limited literacy’. FOP label use was higher among those with a ‘high likelihood of limited literacy’ compared with ‘adequate literacy’ across countries.

Lower use of mandatory Guideline Daily Amount labels compared with voluntary FOP labelling systems provides support for Mexico’s decision to switch to mandatory ‘high-in’ warning symbols. The patterns of consumer label use and awareness across sociodemographic and knowledge-related characteristics suggest that simple FOP labels may encourage broader use across countries.

Front-of-pack (FOP) nutrition labelling is a globally recommended strategy to encourage healthier food choices. We evaluated the effect of FOP labels on the perceived healthfulness of a sweetened fruit drink in an international sample of adult consumers.

Six-arm randomised controlled experiment to examine the impact of FOP labels (no label control, Guideline Daily Amounts (GDA), Multiple Traffic Lights, the Health Star Ratings (HSR), Health Warning Labels, and ‘High-in’ Warning Labels (HIWL)) on the perceived healthfulness of the drink. Linear regression models by country examined healthfulness perceptions on FOP nutrition labels, testing for interactions by demographic characteristics.

Online survey in 2018 among participants from Australia, Canada, Mexico, United Kingdom (UK) and United States.

Adults (≥18 years, n 22 140).

Compared with control, HIWL had the greatest impact in lowering perceived healthfulness (β from −0·62 to −1·71) across all countries. The HIWL and the HSR had a similar effect in Australia. Other labels were effective in decreasing the perceived healthfulness of the drink within some countries only, but to a lower extent. The GDA did not reduce perceived healthfulness in most countries. In the UK, the effect of HIWL differed by age group, with greater impact among older participants (> 40 years). There were no other variations across key demographic characteristics.

HIWL, which communicates clear, non-quantitative messages about high levels of nutrients of concern, demonstrated the greatest efficacy to decrease the perceived healthfulness of a sweetened fruit drink across countries. This effect was similar across demographic characteristics.

To examine awareness and recall of healthy eating public education campaigns in five countries.

Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Open-ended descriptions were coded to indicate recall of specific campaigns. Logistic models regressed awareness of healthy eating campaigns on participant country, age, sex, ethnicity, education, income adequacy and BMI. Analyses were also stratified by country.

Online surveys.

Participants were Nielsen panelists aged ≥18 years in Australia, Canada, Mexico, UK and the USA (n 22 463).

Odds of campaign awareness were higher in Mexico (50·9 %) than UK (18·2 %), Australia (17·9 %), the USA (13·0 %) and Canada (10·2 %) (P < 0·001). Awareness was also higher in UK and Australia v. Canada and the USA, and the USA v. Canada (P < 0·001). Overall, awareness was higher among males v. females and respondents with medium or high v. low education (P < 0·001 for all). Similar results were found in stratified models, although no sex difference was observed in Australia or UK (P > 0·05), and age was associated with campaign awareness in UK (P < 0·001). Common keywords in all countries included sugar/sugary drinks, fruits and vegetables, and physical activity. The top five campaigns recalled were Chécate, mídete, muévete (Mexico), PrevenIMSS (Mexico), Change4Life (UK), LiveLighter® (Australia), and Actívate, Vive Mejor (Mexico).

In Mexico, UK and Australia, comprehensive campaigns to promote healthy lifestyles appear to have achieved broad, population-level reach.

In February 2020, San Francisco proposed mandatory health warnings for sugar-sweetened beverage (SSB) advertisements. Industry legal challenges stated that the warning would detract from advertisers’ ability to convey their intended message and mislead consumers into believing that SSB cause weight gain regardless of consumption amount, lifestyle or intake of other energy-dense foods.

Online between-group experiments tested the impact of SSB warnings on advertising outcomes and consumer perceptions. Respondents were randomised to view six SSB print advertisements with or without a health warning (‘Warning’ and ‘No Warning’ condition, respectively). Linear and binary logistic regression models tested differences between groups, including ad recall, brand perceptions and beliefs about SSB health effects.

Panelists from the US Nielsen Global Panel.

Sixteen to 65-year-old respondents (n 1064).

Overall, 69·2 % of participants in the ‘Warning’ condition recalled seeing warnings on SSB ads. Compared with the ‘No Warning’ condition, participants in the ‘Warning’ condition who reported noticing the warnings were equally likely to recall the brands featured in the SSB ads and to recall specific attributes of the final ad they viewed. Similarly, no differences were observed between groups in perceptions of SSB, such as perceived taste, or in the prevalence of false beliefs regarding the health effects of SSB and intake of other sugary foods on weight gain.

Overall, there was no evidence that SSB health warnings detracted from attention to promotional elements in advertisements or that the warnings misled consumers into false beliefs about SSB as the exclusive cause of weight gain.

To assess associations between household food security status and indicators of food skills, health literacy and home meal preparation, among young Canadian adults.

Cross-sectional data were analysed using logistic regression and general linear models to assess associations between food security status and food skills, health literacy and the proportion of meals prepared at home, by gender.

Participants recruited from five Canadian cities (Vancouver (BC), Edmonton (AB), Toronto (ON), Montreal (QB) and Halifax (NS)) completed an online survey.

1389 men and 1340 women aged 16–30 years.

Self-reported food skills were not associated with food security status (P > 0·05) among men or women. Compared to those with high health literacy (based on interpretation of a nutrition label), higher odds of food insecurity were observed among men (adjusted OR (AOR): 2·58, 95 % CI 1·74, 3·82 and 1·56, 95 % CI 1·07, 2·28) and women (AOR: 2·34, 95 % CI 1·48, 3·70 and 1·92, 95 % CI 1·34, 2·74) with lower health literacy. Women in food-insecure households reported preparing a lower proportion of breakfasts (β = −0·051, 95 % CI −0·085, −0·017), lunches (β = −0·062, 95 % CI −0·098, −0·026) and total meals at home (β = −0·041, 95 % CI −0·065, −0·016). Men and women identifying as Black or Indigenous, reporting financial difficulty and with lower levels of education had heightened odds of experiencing food insecurity.

Findings are consistent with other studies underscoring the financial precarity, rather than lack of food skills, associated with food insecurity. This precarity may reduce opportunities to apply health literacy and undertake meal preparation.

To estimate food insecurity (FI) prevalence among UK adults and investigate associations with socio-demographic characteristics, diet and health.

Weighted cross-sectional survey data. FI was measured using the USDA Adult Food Security Survey Module. Data were analysed using adjusted logistic regression models.

United Kingdom.

2551 participants (aged 18–64 years); sub-sample (n 1949) used to investigate association between FI and overweight.

FI prevalence was 24·3 %. Higher odds of FI were observed among participants who reported that making ends meet was difficult v. easy (OR 19·76, 95 % CI 13·78, 28·34), were full-time students v. non-students (OR 3·23, 95 % CI 2·01, 5·18), had low v. high education (OR 2·30, 95 % CI 1·66, 3·17), were male v. female (OR 1·36, 95 % CI 1·01, 1·83) and reported their ethnicity as mixed (OR 2·32, 95 % CI 1·02, 5·27) and white other (OR 2·04, 95 % CI 1·04, 3·99) v. white British. Odds of FI were higher in participants living with children v. alone, especially in single-parent households (OR 2·10, 95 % CI 1·19, 3·70). Odds of FI decreased per year of increase in age (OR 0·95, 95 % CI 0·94, 0·96) and were lower in participants not looking for work v. full-time employed (OR 0·60, 95 % CI 0·42, 0·87). Food insecure v. food secure adults had lower odds of consuming fruits (OR 0·59, 95 % CI 0·47, 0·74) and vegetables (OR 0·68, 95 % CI 0·54, 0·86) above the median frequency, and higher odds for fruit juice (OR 1·39, 95 % CI 1·10, 1·75). Food insecure v. food secure adults had higher odds of reporting unhealthy diets (OR 1·65, 95 % CI 1·31, 2·10), poor general health, (OR 1·90, 95 % CI 1·50, 2·41), poor mental health (OR 2·10, 95 % CI 1·64, 2·69), high stress (OR 3·15, 95 % CI 2·42, 4·11) and overweight (OR 1·32, 95 % CI 1·00, 1·75).

FI prevalence was high and varied by socio-demographic characteristics. FI was associated with poorer diet and health.

Test the efficacy and perceived effectiveness of nutrition labels on children’s menus from a full-service chain restaurant in an online study.

Using a between-groups experiment, parents were randomised to view children’s menus displaying one of five children’s nutrition labelling conditions: (i) No Nutrition Information (control); (ii) Calories Only; (iii) Calories + Contextual Statement (CS); (iv) Calories, Sodium + CS; or (v) Calories and Sodium in Traffic Lights + CS. Parents hypothetically ordered up to one entrée, side, beverage and dessert for their child, then rated and ranked all five labelling conditions on the level of perceived effectiveness.

Online survey.

998 parents with a 3–12 year old child.

Parents exposed to menus displaying ‘Calories, Sodium + CS’ selected significantly fewer calories ‘overall’ (entrées + side + dessert + beverage) compared to parents exposed to the control condition (−53·1 calories, P < 0·05). Parents selected ‘entrees’ with significantly fewer calories and lower sodium when exposed to menus with ‘Calories + CS’ (−24·3 calories, P < 0·05); ‘Calories, Sodium + CS’ (−25·4 calories, −56·1 mg sodium, P < 0·05 for both); and ‘Calories and Sodium in Traffic Lights + CS’ (−29·1 calories, −58·6 mg sodium, P < 0·05 for both). Parents exposed to menus with ‘Calories, Sodium + CS’ and ‘Calories and Sodium in Traffic Lights + CS’ were more likely to notice and understand nutrition information compared to other nuntrition labelling conditions. Parents perceived the menu with ‘Calories and Sodium in Traffic Lights + CS’ as most effective (P < 0·05).

Menus disclosing calories, sodium and a contextual statement increased the proportion of parents who noticed and understood nutrition information, and resulted in parents selecting lower calorie and sodium entrées for their children in the hypothetical purchase task.

To estimate the prevalence and sociodemographic characteristics of youth and young adults in major Canadian cities with self-reported vegetarian dietary practices and examine efforts to alter their diets.

Data were collected in autumn 2016 via web-based surveys. Respondents reported vegetarian dietary practices (vegan, vegetarian or pescatarian) and efforts in the preceding year to consume more or less of several nutrients, food groups and/or foods with particular attributes. Logistic regression models examined sociodemographic correlates of each vegetarian dietary practice and differences in other eating practices by diet type.

Participants were recruited from five major Canadian cities.

Youth and young adults, aged 16–30 years (n 2566).

Overall, 13·6 % of respondents reported vegetarian dietary practices: 6·6 % vegetarian, 4·5 % pescatarian and 2·5 % vegan. Sex, race/ethnicity, self-reported frequency of using the Nutrition Facts table and health literacy were significantly correlated with self-reported vegetarian dietary practice (P < 0·01 for all). Efforts to consume more fruits and vegetables (66·8 %) and protein (54·8 %), and less sugar (61·3 %) and processed foods (54·7 %), were prevalent overall. Respondents with vegetarian dietary practices were more likely to report efforts to consume fewer carbohydrates and animal products, and more organic, locally produced, ethically sourced/sustainably sourced/fair trade and non-GM foods (P < 0·01 for all), compared with those without these reported dietary practices.

Nearly 14 % of the sampled youth and young adults in major Canadian cities reported vegetarian dietary practices and may be especially likely to value and engage in behaviours related to health-conscious diets and sustainable food production.

The current study aimed to examine the correspondence between sales data and dietary recall data for sugary drinks in Canada.

Repeat cross-sectional analysis of sales data for sugary drinks sold in Canada from 2004 to 2015 from two sources: GlobalData (GD) and Euromonitor (EM). Sugary drinks included ten beverage categories containing free sugars. Analyses examined sales volumes over time, with adjustment for population growth. National intake estimates were drawn from the 2004 and 2015 Canadian Community Health Survey (CCHS) Nutrition.

Canada.

Not applicable.

In 2015, daily per capita sugary drinks consumption was estimated as 356 ml (GD) and 443 ml (EM) from sales data sources, and as 277 ml from dietary recall data. Both sales data sources and dietary recall data indicated that per capita sugary drinks consumption decreased from 2004 to 2015, although the magnitude of this change differed: −23 % (GD), −17 % (EM) and −32 % (CCHS Nutrition). Market sales data showed similar trends among categories of sugary drinks, with decreases in sales of traditional beverage categories (e.g. carbonated soft drinks) and increases in novel categories (e.g. sugar-sweetened coffee).

All data sources indicate a declining trend in sugary drinks consumption between 2004 and 2015, but with considerable differences in magnitude. Consumption estimates from sales data were substantially higher than estimates from dietary recall data, likely due to under-reporting of beverage intake through dietary recall and the inability of sales data to account for beverages sold but not consumed. Despite the observed decline, sugary drinks sales volumes remain high in Canada.