title: Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of consumers and paediatricians in Laos.
abstract: OBJECTIVE
  To investigate the use of Bear Brand coffee creamer as a food for infants and the impact on consumers of the logo of a cartoon baby bear held by its mother in the breastfeeding position.
  
  
  METHODS
  Interviews with paediatricians throughout the country and a national survey of potential consumers regarding their perceptions and use of the Bear Brand coffee creamer.
  
  
  METHODS
  84 randomised villages in south, central, and northern Laos.
  
  
  METHODS
  26 Lao paediatricians and 1098 adults in households in a cluster sampling.
  
  
  RESULTS
  Of the 26 paediatricians, 24 said that parents "often" or "sometimes" fed this product to infants as a substitute for breast milk. In the capital city, paediatricians said that mothers used the product when they returned to work. In the countryside, they reported that poor families used it when the mother was ill or died. Of 1098 adults surveyed, 96% believed that the can contains milk; 46% believed the Bear Brand logo indicates that the product is formulated for feeding to infants or to replace breast milk; 80% had not read the written warning on the can; and over 18% reported giving the product to their infant at a mean age of 4.7 months (95% confidence interval 4.1 to 5.3).
  
  
  CONCLUSIONS
  The Bear Brand coffee creamer is used as a breast milk substitute in Laos. The cartoon logo influences people's perception of the product that belies the written warning "This product is not to be used as a breast milk substitute." Use of this logo on coffee creamer is misleading to the local population and places the health of infants at risk.
authors.affiliation: Institut de la Francophonie pour la Médecine Tropicale, BP 9519, Vientiane, Lao Popular Democratic Republic. hubert.barennes@auf.org
authors.forename: Hubert
authors.initials: H
authors.lastname: Barennes
authors.forename: Todisoa
authors.initials: T
authors.lastname: Andriatahina
authors.forename: Vattanaphone
authors.initials: V
authors.lastname: Latthaphasavang
authors.forename: Margot
authors.initials: M
authors.lastname: Anderson
authors.forename: Leila M
authors.initials: LM
authors.lastname: Srour
mesh_terms: D000328:Adult; D000329:Advertising; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000706:statistics & numerical data*; D007812:Laos; D008297:Male; D041941:Milk Substitutes / Q000008:administration & dosage / Q000706:statistics & numerical data*; D010372:Pediatrics; D010465:Perception; D019064:Product Packaging; D018570:Risk Assessment
references.citation: Med Trop (Mars). 1997;57(4):380-8
references.pmid: 9612782
references.citation: Ann Trop Paediatr. 2003 Sep;23(3):181-6
references.pmid: 14567833
references.citation: Bull World Health Organ. 2006 Feb;84(2):132-8
references.pmid: 16501731
references.citation: Public Health Nutr. 2006 Sep;9(6):673-85
references.pmid: 16925871
references.citation: Pediatrics. 1981 Sep;68(3):432-4
references.pmid: 7279477
references.citation: Asia Pac J Clin Nutr. 2007;16(3):537-45
references.pmid: 17704036
references.citation: Eur J Clin Nutr. 2005 Jul;59(7):887-90
references.pmid: 15915154
references.citation: BMJ. 2003 Jan 18;326(7381):113-4
references.pmid: 12531818
references.citation: BMJ. 2004 May 22;328(7450):1218
references.pmid: 15155483
references.citation: N Engl J Med. 2006 Jun 15;354(24):2527-9
references.pmid: 16775233
references.citation: J Trop Pediatr. 1996 Feb;42(1):5-11
references.pmid: 8820613
references.citation: Eur J Clin Nutr. 2009 Mar;63(3):323-31
references.pmid: 18000519
references.citation: P R Health Sci J. 2008 Mar;27(1):49-54
references.pmid: 18450233
references.citation: Pediatr Int. 2007 Apr;49(2):260-5
references.pmid: 17445054
references.citation: J Pediatr Gastroenterol Nutr. 2005 Nov;41(5):584-99
references.pmid: 16254515
references.citation: BMJ. 1998 Apr 11;316(7138):1117-22
references.pmid: 9552947
references.citation: Southeast Asian J Trop Med Public Health. 2004;35 Suppl 2:50-2
references.pmid: 15906634
references.citation: BMJ. 2003 Jan 18;326(7381):127
references.pmid: 12531842
references.citation: N Engl J Med. 2005 Apr 14;352(15):1514-6
references.pmid: 15829531
references.citation: Int Breastfeed J. 2006 Aug 22;1:12
references.pmid: 16925828