title: A randomized trial testing the efficacy of modifications to the nutrition facts table on comprehension and use of nutrition information by adolescents and young adults in Canada.
abstract: BACKGROUND
  Given the proposed changes to nutrition labelling in Canada and the dearth of research examining comprehension and use of nutrition facts tables (NFts) by adolescents and young adults, our objective was to experimentally test the efficacy of modifications to NFts on young Canadians' ability to interpret, compare and mathematically manipulate nutrition information in NFts on prepackaged food.
  
  
  METHODS
  An online survey was conducted among 2010 Canadians aged 16 to 24 years drawn from a consumer sample. Participants were randomized to view two NFts according to one of six experimental conditions, using a between-groups 2 x 3 factorial design: serving size (current NFt vs. standardized serving-sizes across similar products) x percent daily value (% DV) (current NFt vs. "low/med/high" descriptors vs. colour coding). The survey included seven performance tasks requiring participants to interpret, compare and mathematically manipulate nutrition information on NFts. Separate modified Poisson regression models were conducted for each of the three outcomes.
  
  
  RESULTS
  The ability to compare two similar products was significantly enhanced in NFt conditions that included standardized serving-sizes (p ≤ .001 for all). Adding descriptors or colour coding of % DV next to calories and nutrients on NFts significantly improved participants' ability to correctly interpret % DV information (p ≤ .001 for all). Providing both standardized serving-sizes and descriptors of % DV had a modest effect on participants' ability to mathematically manipulate nutrition information to calculate the nutrient content of multiple servings of a product (relative ratio = 1.19; 95% confidence limit: 1.04-1.37).
  
  
  CONCLUSIONS
  Standardizing serving-sizes and adding interpretive % DV information on NFts improved young Canadians' comprehension and use of nutrition information. Some caution should be exercised in generalizing these findings to all Canadian youth due to the sampling issues associated with the study population. Further research is needed to replicate this study in a more heterogeneous sample in Canada and across a range of food products and categories.
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Hobin
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Sacco
authors.affiliation: University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Vanderlee
authors.affiliation: University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: C M
authors.initials: CM
authors.lastname: White
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Zuo
authors.affiliation: Victoria University, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Sheeshka
authors.affiliation: The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: G
authors.initials: G
authors.lastname: McVey
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Fodor O'Brien
authors.affiliation: University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Hammond
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002170:Canada; D016009:Chi-Square Distribution; D032882:Comprehension; D005260:Female; D005515:Food Labeling / Q000592:standards*; D015438:Health Behavior; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D018673:Nutrition Policy / Q000331:legislation & jurisprudence*; D009751:Nutritional Requirements; D011634:Public Health; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: adolescents; food labelling; nutrition policy; young adults