Our study is the first to detail the frequency of nutrition facts label use among adolescents using a population-based survey, and the first to evaluate association between nutrition facts label use and overweight and obesity. A low percentage of US adolescents regularly use the information on the nutrition facts label, with more than 50% rarely or never using the nutrition information. Similarly, a low percentage were familiar with the Dietary Guidelines for Americans, but almost half were aware of the 5-A-Day program and almost all had heard of the Food Guide Pyramid.
Our results contrast with previous studies that have found a higher percentage of US adolescents reading the nutrition facts label [18
]. However, none of these studies was population-based, and the adolescents/young adults were older than those surveyed in our study. Our results are also much lower than previous population-based surveys with adults. The 1995, 1997 and 2010 Shopping for Health surveys found between 54% and 68% of US adult consumers regularly use nutrition labels when shopping for food items [21
This is the first study to suggest significant racial/ethnic differences in awareness of nutrition programs and use of the information on the nutrition labels. Specifically, Mexican-American adolescents had the lowest awareness of nutrition programs, and African-American adolescents were the least likely to check fat information on the nutrition facts label. This differs sharply from other studies with adults that have found 78% of African-Americans read nutrition labels when purchasing food items [24
]. Our results may have diverged from previous studies with older African-American due to concomitant health issues such as diabetes mellitus or hypertension that necessitate more frequent label reading, in contrast with the younger population of African-American adolescents surveyed in NHANES who likely do not have a high prevalence of these health issues. Other studies have found that adults with chronic disease have a higher frequency of use of nutrition facts labels [25
Recently, Wright and Wang [26
] analyzed awareness of federal dietary programs in adults older than 15
years of age using the same NHANES 2005–6 survey data. They found that that awareness of the Dietary Guidelines for Americans was lowest among older adolescents 16–19
years and higher in older age groups, while the awareness of the Food Guide Pyramid was highest among adolescents compared with older age groups [26
]. Knowledge of the 5-A-Day Program was lower among adolescents compared with adults
years but comparable with adults ≥60
years of age. Similar to our results of low awareness among Mexican-Americans of federal dietary programs, Wright and Wang found the lowest awareness of federal dietary guidance among Mexican-Americans in all age groups [26
As significant racial and ethnic differences persist in the incidence of childhood obesity [25
], intervention programs should attempt to address these disparities. Non-governmental organizations and governmental task forces are pushing the Obama administration and the Food and Drug Administration (FDA) to adopt more consumer friendly nutrition facts labels in part to address the obesity epidemic [11
]. As the US government debates how to best address the obesity epidemic and how to provide accessible nutrition information to Americans, it is imperative to recognize the current low use by US adolescents and especially the lowest use among non-Hispanic African-American and Mexican-American adolescents.
Of concern, we also found that a low percentage of US adolescents were aware of the USDA’s Dietary Guidelines for Americans, and less than half were aware of the 5-A-Day for Better Health Programs. One of the recommendations from the 2010’s White House Task Force on Obesity was to disseminate important nutrition information from the 2010 Dietary Guidelines through simple, easy actionable messages [11
]. However, educators and public health workers should be aware of the low reach of the current guidelines among adolescents. This may be particularly important as we found that awareness of the 5-A-Day for Better Health Program was associated with reduced risk for obesity. As a diet high in fruits and vegetables has been associated with reduced risk for obesity [27
], we suggest expanding this CDC program to all children and adolescents and potentially incorporating aspects into the expanded nutrition education programs promoted by the Let’s Move campaign for school-based nutrition education [11
]. Previous studies have also found that providing nutrition educational information on fruits and vegetables and computer based communications can increase fruit and vegetable intakes in adolescents and young adults, suggesting that a more targeted intervention using the 5-A-Day program could have a positive impact [28
Of note, none of the 17 nutrition-awareness and label reading variables evaluated in relationship to overweight and obesity were significant in multivariate analysis. It is possible that this lack of association may be related to the overall low prevalence of label reading behavior among adolescents, in general, for many of the behaviors surveyed. Further studies need to evaluate why there was no association between awareness of nutrition programs and overweight and obesity in adolescents. It is possible that while many of the adolescents were aware of the programs, they were not knowledgeable of the components of the programs or the guidance recommendations.
There were specific limitations in conducting this study that should be considered in interpreting the results. As questions on awareness of nutrition programs and frequency of use of nutrition information were included only in the 2005–6 NHANES and not other cycles of the survey, the sample size for this study was relatively small. It would have been preferable to use two or more cycles of the NHANES survey. Additionally, as we conducted many statistical tests to assess for possible association between awareness of nutritional programs and use of nutrition facts panel information, some of our positive results could have been the result of chance given the number of hypotheses that were tested. Further studies need to validate our findings with other adolescent groups.
Also, while the NHANES set of surveys does collect information on dietary intake including information on detailed macro and micronutrient intake, we did not evaluate awareness of federal nutrition program or use of nutrition information in relation to adolescent dietary intake. As the primary goal of this study was to quantify awareness of nutrition programs and use of nutrition facts panel in adolescents as well as assess risk in relation to obesity and overweight, the relationship between these factors and dietary intake was outside the purview of this study.